scholarly journals Comparison of Maternal and Perinatal Outcome in Elective and Emergency Cesarean Section in a Tertiary Care Centre

2019 ◽  
Vol 4 (1) ◽  
pp. 616-620
Author(s):  
Anjali Subedi ◽  
Junu Shrestha ◽  
Krishna Murari Adhikari ◽  
Aashika Shrestha ◽  
Sangeeta Gurung
Keyword(s):  
Cesarean Section ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
P Value ◽  
Antenatal Visit ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Elective Group

Introduction: Cesarean delivery is the birth of a fetus via laparotomy and then hysterotomy. There are increased maternal and fetal morbidities and mortalities associated with such delivery, more in emergency cesarean section. Various studies have shown increasing trend of this mode of delivery worldwide leading to an increase in its associated risks and cost to the patients. Objective: The objective of the study was to compare the maternal and perinatal outcome in elective and emergency cesarean section. Methodology: It was a prospective comparative study conducted in the department of obstetrics and gynecology, Manipal Teaching Hospital from March, 2018 to September, 2018. All the patients undergoing cesarean section either elective or emergency were enrolled in the study after their consent. After collecting data from patients, maternal and perinatal outcomes were analyzed by using SPSS software. Results: There were total 1254 deliveries in the study duration, out of which 461(36.76%) were cesarean section (cs). The incidence of emergency cs was 86.5% and elective cs was 13.5%. Majority of women (75.7%) undergoing cs had no any antenatal visit. Around 81% of cases undergoing emergency cs were unbooked whereas only 48.4% of unbooked cases underwent elective cs (P-value 0.000). The most common indication for cs in both elective and emergency category was previous cs. There was no maternal complication in elective cs group but there were 8 cases (2%) in emergency cs (P value-0.293). In emergency cs group, 7 babies had poor Apgar score whereas all babies had good Apgar score in elective group (P-value-0.057). There was increased rate of NICU admission in emergency group than in elective group (3% vs 0%, P value-0.166). Conclusion The study showed that the incidence of cesarean section was high in our centre. The maternal and fetal risks were higher in emergency cs than in elective cs, but these were not statistically significant.

scholarly journals Bupivacaine-Fentanyl vs Ropivacaine-Fentanyl: Evaluation of two Spinal Anesthesia Protocols for Emergency Cesarean Section

2020 ◽  
Vol 10 (6-s) ◽  
pp. 3-7
Author(s):  
Moustapha Diedhiou ◽  
E.B. Ba ◽  
D Barboza ◽  
A. Diouf ◽  
M. Dieng ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Randomized Study ◽  
Bivariate Analysis ◽  
P Value ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
The Mean

Objective: Evaluation of the hemodynamic, respiratory and fetal side effects of two protocols for spinal anesthesia (P1: bupivacaine-fentanyl; P2: ropivacaine-fentanyl). Material and Method: Prospective pseudo-randomized study comparing two spinal anesthesia protocols for emergency cesarean section conducted in the operating room of the regional hospital center of Saint Louis in Senegal. Study duration was 4 months. We studied, age, indication for Caesarean section, medical and surgical history, P1 and P2 protocols, hypotension, bradycardia, Apgar scores at birth and at 5min. Univariate and bivariate analysis was performed on the R software. Result: A total of 115 patients were collected, with a mean age of 27.1 years (E: 15 - 45) and a standard deviation of 7.6. Indications for Caesarean section were maternal and fetal dystocia for 67 patients (58%), fetal distress for 39 parturients (34%), and pre-eclampsia for 5 patients (4%). The P1-Bupi spinal protocol was used in 42 patients (36.5%) and the P2-Ropi spinal protocol was used in 73 patients (63.5%). Anesthetic complications such as low blood pressure, bradycardia and desaturation were found in a total of 30 patients, i.e. in 26% of cases. The mean Apgar score at birth for newborns from the P1-Bupi protocol was 8 (Extremes: 7, 9); the mean Apgar score at birth for newborns from the P2-Ropi protocol was 7.5 (Extremes: 2, 10). There was a significantly negative correlation between the P1-bupi protocol and the appearance of hypotension with p-value: 0.04 and a significantly positive correlation between the P2-ropi protocol and the appearance of hypotension with p-value: 0.04. Discussion/ Conclusion: Ropivacaine certainly has a better cardiovascular and neurological tolerance and a better efficacy in terms of analgesia. However, during caesarean sections, it is important to consider the risk of hypotension and possible fetal complications related to its use. Keywords: Ropivacaine - Bupivacaine - Spinal anesthesia - Caesarean section

Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

2020 ◽  
pp. 000486742095428
Author(s):  
Lei Sun ◽  
Su Wang ◽  
Xi-Qian Li
Keyword(s):  
Postpartum Depression ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Spontaneous Vaginal Delivery ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

Background: Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery. Methods: We searched in three electronic databases: PubMed, EMBASE and Cochrane Library. Results: This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]). Conclusion: The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

scholarly journals Risk Factors for Perinatal Arterial Ischemic Stroke

Cell Medicine ◽  
2018 ◽  
Vol 10 ◽  
pp. 215517901878534 ◽  
Author(s):  
Daniela Munoz ◽  
María José Hidalgo ◽  
Fernanda Balut ◽  
Mónica Troncoso ◽  
Susana Lara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Cesarean Section ◽  
Apgar Score ◽  
Birth Asphyxia ◽  
Arterial Ischemic Stroke ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Associated Risk Factors ◽  
Perinatal Arterial Ischemic Stroke

Introduction: Arterial ischemic stroke in newborns is an important cause of neonatal morbidity and mortality. Its pathophysiology and associated risk factors are not yet clearly understood and defined. Objective: The aim of this retrospective study was to investigate possible risk factors in diagnosed cases of PAIS (perinatal arterial ischemic stroke). Materials and methods: Case–control study. Clinical data of patients with PAIS diagnosis were analyzed. Two healthy controls were selected for each PAIS case, matched for gestational age. Risk factors were explored using univariable and multivariable analysis. Outcome: 40 patients were included in the study, 24 males and 16 females; 52.5% of cases were diagnosed within the first month of birth, and 47.5% were retrospectively diagnosed. The results showed a male predominance (66.7%). The distribution of cerebral ischemic injury was predominantly medial cerebral artery (87.5%) and occurred more commonly in the left cerebral hemisphere (62.5%). Significant risk factors in the univariate analysis (P < 0.05) were primiparity, stillbirth, neonatal sepsis, asphyxia, twin pregnancy, placenta abruption, emergency cesarean section, Apgar score ≤7 after 5 min, breech presentation, and hyperbilirubinemia. In the multivariate analysis, primiparity (OR 11.74; CI 3.28–42.02), emergency cesarean section (OR 13.79; CI 3.51–54.13), birth asphyxia (OR 40.55; CI 3.08–532.94) and Apgar score ≤7 after 5 min (OR 13.75; CI 1.03–364.03) were significantly associated factors with PAIS. Only five (16.6%) patients had an abnormal thrombophilia study. Conclusion: Risk factors of primiparity, emergency cesarean section, birth asphyxia, and Apgar score ≤7 after 5 min were significantly associated with perinatal stroke. More studies with a larger number of patients and with prolonged follow up are required to establish more clearly the associated risk factors involved in this pathology.

scholarly journals Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Tulasa Basnet ◽  
Baburam Dixit Thapa ◽  
Dipti Das ◽  
Ramesh Shrestha ◽  
Sarita Sitaula ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Perinatal Mortality ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Care Hospital ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
Emergency Cesarean

Background. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P = 0.043 ). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

scholarly journals VAGINAL DELIVERY VERSUS CESAREAN SECTION

2010 ◽  
Vol 17 (02) ◽  
pp. 300-303
Author(s):  
BUSHRA SHER ZAMAN ◽  
Ali Zulqarnain ◽  
RASHAD QAMAR ◽  
Anza Saleem ◽  
SUMERA SIDDIQUE
Keyword(s):  
Cesarean Section ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Apgar Score ◽  
Distress Syndrome ◽  
Breech Presentation ◽  
Neonatal Morbidity ◽  
Birth Trauma ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

Objective: It is to compare neonatal morbidity in terms of birth trauma, respiratory distress syndrome, APGAR score in Primigravida with breech presentation delivered vaginally and emergency cesarean section. Design: Cross-sectional comparative study. Place and Duration of Study: Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur from 1-5-2007 to 30-4-2008. Patients and Method: The study was carried out on all Primigravida with breech presentation reported through emergency in labour deliveredvaginally and by emergency cesarean section. The variable analyzed were birth trauma, respiratory distress syndrome and APGAR score at 1 and 5 minutes. Students-t test was used for comparison between means and chi square test for comparison between percentages. Significance was taken at P<0.05. Results: It was found that mean APGAR score at 1 and 5 minutes is 7.31 and 9.066 in vaginal and 8.533 and 9.644 incesarean group. Respiratory distress syndrome is more in cesarean (4.4%) than vaginal group (2.2%). Observed neonatal trauma is more in vaginal group (6.7%) than cesarean section (2.2%). Conclusion: Neonatal morbidity appears to be more in vaginal breech delivery than cesarean section for Primigravida with breech presentation at term. 

scholarly journals Umbilical Cord Abnormalities and Maternal and Perinatal Outcome: A Prospective Observational Study

2021 ◽  
Author(s):  
Kalpna Kulshrestha ◽  
Debbarma Sukla ◽  
Kalpana Verma
Keyword(s):  
Observational Study ◽  
Umbilical Cord ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Prospective Observational Study ◽  
Mode Of Delivery ◽  
Insertion Site ◽  
Circulatory System ◽  
P Value ◽  
Maternal Complications

Introduction: The umbilical cord is the vital extension of the fetal circulatory system which regulates blood flow in both directions, thus allowing mother-child communications viz., immunological, oxygenation, fetal nutrition, cardiac function. Umbilical cord abnormalities are associated with the adverse maternal and perinatal outcome.. Aim: To assess prevalence of various umbilical cord abnormalities and its association with maternal complications and perinatal outcome. Materials and Methods: This prospective observational study was conducted at Saraswathi Institute of Medical Sciences Pilkhuwa, Hapur, Uttar Pradesh, India from June 2019 till March 2020. The approval for the study was taken from the Institutional Ethical Committee. Total number of deliveries during this period were 1284. After satisfying exclusion criteria, total 600 deliveries of more than 37 weeks of gestation were included in the study at random. Examination of cord was done during delivery for presence of loops of cord around the neck or body, any knots, true or false. After the delivery, the cord was clamped 5 cm from the fetal end and the total length was measured from the cut end till the placental insertion site, and 5 cm added therein. Umbilical cord was examined for any abnormalities and numbers of coils recorded and Umbilical Coiling Index (UCI) measured. Apgar score and NICU admissions noted. Results: Out of 600 patients, umbilical cord abnormalities were seen in 194 (32.33%) patients, while in 406 (67.67%) no abnormality was detected. The mode of delivery was vaginal in 441 cases (73.5%) while 159 (26.5%) had Lower Segment Cesarian Section (LSCS). Out of 194 cases with umbilical cord abnormality, 89 (45.87%) had LSCS and out of 406 cases with no cord abnormality, only 70 cases (17.24%) had LSCS (p-value<0.0001). Mean UCI was 0.25±0.09. Total 269(44.83%) had maternal complications and 143 cases (53.16%) had umbilical cord abnormalities. While 126 (46.84%) cases with maternal complications did not show any cord abnormality. Apgar score of <7 at one minute was seen in 43 cases (22.16%) and 23 (11.86%) were admitted in Neonatal Intensive Care Unit (NICU) with umbilical cord abnormality. Conclusion: The umbilical cord abnormalities were associated with the adverse maternal and perinatal outcome and increased rate of LSCS (p-value <0.0001). The study shows the importance of knowledge of cord abnormalities. The cord abnormality should be looked for after each delivery, with the aim to reduce perinatal morbidity.

scholarly journals Relation between immediate postpartum APGAR score with umblical cord blood pH and fetal distress

2019 ◽  
Vol 8 (12) ◽  
pp. 4690
Author(s):  
Varuna Pathak ◽  
Deep Shikha Sahu
Keyword(s):  
Cesarean Section ◽  
Cord Blood ◽  
Apgar Score ◽  
Ph Value ◽  
Fetal Distress ◽  
Well Being ◽  
Emergency Cesarean Section ◽  
Medical Disorders ◽  
Blood Ph ◽  
Emergency Cesarean

Background: The one-minute Apgar score, proven useful for rapid assessment of the neonate, is often poorly correlated with other indicators of intrauterine well-being. Fetal asphyxia is directly associated with neonatal acidosis. Umbilical cord pH is best indicator of fetal hypoxemia and hypoxemia leads to neonatal acidosis. In today scenario, fetal distress is the leading indication of emergency cesarean section.Methods: A observational cross-sectional study conducted of one year between march 2017 to February 2018; of full-term obstetric patients undergoing emergency cesarean section for fetal distress as an indication. All patients included are term gestation with low risk pregnancy excluding medical disorders and other complications of pregnancy. Immediately after delivery umbilical artertial cord blood from placental site collected and sent for pH determination and Apgar score calculated of newborn.Results: Emergency cesarean section was being done for fetal distress diagnosed based on guidelines for Intermittent auscultation; maximum patients had fetal bradycardia (240) followed by fetal tachycardia (12) and irregular rhythm (18). Relation between pH value and the fetal outcome babies who had low pH value. i.e. <7.1; had maximum referrals with poor Apgar score at 1 min (<3) and at 5 min (<3). Out of 270 babies 18 had Apgar score <3 at 1 min, out of which 10 continued to have Apgar score <3 at 5 mins. These babies were referred to department of pediatrics and were not alive beyond day 2-4.Conclusions: The values of mean Apgar score and cord blood pH decreases, which is inversely proportion to duration and severity of intrauterine/intra partum asphyxia. Umbilical arterial cord blood pH correlation was found to be significant with Apgar score in neonates delivered with indication as fetal distress.

scholarly journals Assessment of Patient Satisfaction after Counseling by a Health Care Provider before Emergency Cesarean Section in a Tertiary Care Hospital

2017 ◽  
Vol 9 (1) ◽  
pp. 33-38
Author(s):  
Tehmina P Syed ◽  
Zakia Sheikh ◽  
Farah Hameed
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Cesarean Section ◽  
Health Care Provider ◽  
Care Provider ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

ABSTRACT Introduction Patient satisfaction is one of the most frequently reported outcome measures for quality of health care. In recent years, effective counseling has become a very important tool to involve patient participation in decision-making. The objective of this study was to assess the patient satisfaction by the counseling of a health care provider before emergency cesarean section (C-section) in a tertiary care hospital. Materials and methods A descriptive cross-sectional questionnaire study of 53 women, who had their first babies by C-section or had C-section first time with previous normal deliveries, in Hamdard University hospital in 3 months. Data analysis Questionnaires were distributed among patients on their second postoperative day after emergency C-section. A good total response rate for patient satisfaction survey is in the 40 to 60% range. Statistical Package for the Social Sciences version 20 was used to analyze the data, patient satisfaction was analyzed by using descriptive statistics (%, frequency), and independent sample t-test and analysis of variance were applied to assess the satisfaction level for demographic indicators. Results Out of 53 women, 38 (71.7%) were satisfied with the counseling while 15 (28.3%) were dissatisfied; 35 (66%) were primigravida while 17 (32%) were multigravida. The majority was in the age group of 25 to 30 (41%) years; 21 (39.6%) were undergraduate, out of them 12 (55.2%) were satisfied; 32 (60.3%) were graduate, out of them 26 (82%0) agreed; 46 (86%) participants know their counselor; and 44 (83%) reported good attitude. A safe atmosphere was created by the counselor in 38 (71.7%) cases, and 24 (45%) participants reported that the counselor used medical jargons. Privacy was not maintained in 39.6%, and 18 (33.9%) reported negative feelings like anxiety and depression after their counseling. Conclusion Patient satisfaction is an important quality outcome indicator to measure success of the health care services. Evaluation of patient care is vital to provide opportunity for improvement like strategic framing of health plans. How to cite this article Syed TP, Sheikh Z, Hameed F. Assessment of Patient Satisfaction after Counseling by a Health Care Provider before Emergency Cesarean Section in a Tertiary Care Hospital. J South Asian Feder Obst Gynae 2017;9(1):33-38.

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