scholarly journals Review of Cesarean Section on Maternal Request in a Tertiary Care Institute; Scenario in Developing Country

2015 ◽  
Vol 11 (4) ◽  
pp. 349-354 ◽  
Author(s):  
S Panda ◽  
V Jha ◽  
AS Singh
Keyword(s):  
Developing Countries ◽  
Cesarean Section ◽  
Maternal Mortality ◽  
Developing Country ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Evidence Base ◽  
Study Data ◽  
Maternal Request ◽  
Care Institute

Mother requesting of caesarean reflects a belief among society that elective caesarean safer than vaginal delivery in term of fetus and mother. Although the study data neglecting the facts other skewed part in this issue is consideration of resources, as in developing countries, where maternal mortality is still high due to lack of adequate resources. Mother coming to obstetrician with mother’s request should individualize in every case considering mother’s argument, society and evidence base guideline.Kathmandu Univ Med J 2013; 11(4): 349-354

scholarly journals Prevalence of teenage pregnancy and its obstetric and perinatal outcomes in a rural tertiary care hospital

2020 ◽  
Vol 9 (10) ◽  
pp. 3989
Author(s):  
Venkata Ramya Krishna Madala ◽  
Keshav Gangadharan ◽  
Pradeep Shivaraju ◽  
Devivaraprasad Mateti
Keyword(s):  
Developing Countries ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Teenage Pregnancy ◽  
Tertiary Care ◽  
Developed Countries ◽  
Care Hospital ◽  
Maternal Complications ◽  
Hypertensive Disorders

Background: Teenage pregnancy has been reported as one of the leading causes of death in adolescent girls in both developed and developing countries. In developed countries teenage pregnancies are most common in unmarried girls whereas in developing countries like India where early marriages are more common, teenage pregnancies are seen mostly in married women.Methods: In this retrospective observational study, data between January 2018 and December 2019 was studied; data was evaluated using MS excel for statistical purpose. In the present study, only pregnant women less than 20 years were included.Results: Out of 6,028 pregnant women delivered during this period, 686 i.e. 11.3% age of women were less than 20 years, 609 (88.7%) had delivery at term and the remaining 77 (11.2%) women had preterm delivery. As per this study, incidence of hypertensive disorders were 12.24%, 5.5% were associated with anemia and most of them had vaginal delivery (65.01%) including induced and instrumental; cesarean section was 35.5%. In present study, 24.1% babies were of low birth weight and 3.49% of babies were intrauterine growth restricted (IUGR) babies.Conclusions: This study showed hypertensive disorders were the most common maternal complication and the incidence of vaginal delivery was higher compared to that of cesarean section, incidence of anaemia was less compared with other studies. Proper antenatal care, institutional delivery and postnatal care can reduce fetal and maternal complications in childbearing women in teenage age group. 

scholarly journals The Efficacy of Intravenous Tranexamic Acid in Reduction of Blood Loss in Women at High Risk of Postpartum Hemorrhage

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
K M Diab ◽  
R M Mohamed ◽  
A G Abdelhay
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Maternal Mortality ◽  
Vaginal Delivery ◽  
Control Group ◽  
Study Group ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk for PPH and its sequelae. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Aim of the Work To assess the efficacy and safety intravenous tranexamic acid in reduction of amount of blood loss in high risk women who deliver by cesarean section or vaginal delivery in postpartum period. Patients and Methods This prospective double blind randomized controlled clinical trial study was conducted on 200 patients planned for LSCS or vaginal delivery at Gestational Age ≥ 34 Weeks at Ain Shams University Maternity Hospital. Recruitment of data begun once the protocol was approved by research and ethical committee of the department of obstetrics and gynecology. Results No significant difference between Study and Control groups as regards age (p = 0.508), no significant difference between Study and Control groups as regards Gestational age (p = 0.447),total blood loss (p < 0.001) was significantly lower in study group than control group, Vaginal pads in the 1st 24 hours post-partum was significantly less soaked in study group than control group (p < 0.001). no significant difference between Study and Control groups as regards Preoperative Hemoglobin, Postoperative Hemoglobin was significantly higher in study group than control group (p < 0.001), Reduction in Hemoglobin was significantly less in study group than control group (p < 0.001), no significant difference between Study and Control groups as regards Preoperative Hematocrite, Postoperative Hematocrit was significantly higher in study group than control group (p < 0.001), Reduction in Hematocrite was significantly less in study group than control group (p < 0.001).Need to iron replacement or blood transfusion was significantly less frequent in study group than control group (p = 0.24). Conclusion The use of tranexamic acid prior to cesarean section or vaginal delivery is effective as a prophylaxis against post-partum hemorrhage as shown by the results of this study. It can significantly reduce blood loss during and after cesarean section or vaginal delivery.

scholarly journals Feto-maternal Outcomes in Cesarean Section Compared to Vaginal Delivery in Eclamptic Patients in a Tertiary Level Hospital

2013 ◽  
Vol 3 (2) ◽  
pp. 77-83
Author(s):  
Sheuly Begum ◽  
Ferdousi Islam ◽  
Arifa Akter Jahan
Keyword(s):  
Cesarean Section ◽  
Maternal Mortality ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Birth Asphyxia ◽  
Maternal Outcome ◽  
Maternal Complications ◽  
Medical College ◽  
Group I ◽  
Significant Difference

Background: Over  half-a-million women die each year  from pregnancy-related  causes, and  99 percent of these occur in developing countries. In Bangladesh though maternal mortality  rate (MMR) declined  significantly  around 40% in  the  past  decade,  still  eclampsia  accounts  for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure  is  delivery  regardless  of  gestational  age.  A  rational  therapy  for  general  management  of  hypertension and convulsion has been established in Bangladesh by the Eclampsia Working  Group.  But  controversy  still  exists  regarding  obstetric  management. Objective: To  evaluate  the  feto-maternal  outcome  in  cesarean  section  compared  to  vaginal  delivery  in  eclamptic  patients. Materials  and  Methods: This  prospective  cohort  study  was  conducted  in  the  department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from  January to December 2011. A total 100 eclamptic women with term pregnancy and live foetus  were purposively included in the study (Group I, 50 patients with vaginal delivery and Group  II, 50 with cesarean section). Results: Out  of these 100 patients 56% were aged <20 years,  71%  were  primigravida  and  77%  were  from  low  socioeconomic  status.  Sixteen  percent  patients from vaginal delivery group and 18% from cesarean section group had no antenatal  care. The mean gestational age was about 38 weeks in two groups. No significant difference  was found between the two groups regarding blood pressure, proteinuria, consciousness level  and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group  compared  to  6%  in  cesarean  section  group.  Maternal  complications  such  as  postpartum  hemorrhage,  cerebrovascular  accident,  renal  failure,  obstetric  shock  and  abruptio  placenta  were  higher  among  vaginal  delivery  group  patients  (46%)  than  cesarean  section  patients  (16%).  Maternal  mortality  was 6% in  the  vaginal  delivery  group  and  none  in  the  cesarean  section  group.  Regarding  fetal  outcome,  stillbirth  was  20%  after  vaginal  delivery  and  6%  after cesarean section,  the result was statistically  significant.  Birth asphyxia was less  in  the  cesarean  section  group  (23.4%)  than  in  vaginal  delivery  group  (60%)  and  this  was  statistically  significant. Conclusions:  The  result  of  the  present  study  shows  a  better  feto- maternal outcome in the cesarean section group than in the vaginal delivery group. Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 77-83 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16128

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 Trial of labor after previous cesarean delivery (TOLAC) and association of BMI and previous vaginal delivery with frequency of VBAC

2016 ◽  
Vol 15 (4) ◽  
pp. 546-550 ◽  
Author(s):  
Huma Tasleem ◽  
Haider Ghazanfar
Keyword(s):  
Cesarean Section ◽  
Success Rate ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Health Centre ◽  
Tertiary Care ◽  
Vaginal Birth ◽  
Trial Of Labor ◽  
Emergency Cesarean ◽  
Previous Cesarean

Objectives: To determine the frequency of successful Vaginal Birth after One Cesarean Section in our tertiary care institution and to determine the causes of its failure.Material and Methods: This study was conducted in department of Obstetrics and Gynecology of Shifa International Hospital and Shifa Foundation Community Health Centre Islamabad Pakistan from Feb 2011 to Dec 2014. This study included 592 patients who presented in labor room emergency reception of Obs/Gynae department at term with previous one scar having fulfilled the laid down inclusion criteria for VBAC during ante-natal care. The patients were admitted in hospital and were allowed to proceed for spontaneous labor under vigilant monitoring on complications of trial of scar. Immediate emergency cesarean sections were performed, where indicated.Results: Out of 592 patients 70.7% were delivered vaginally after previous one cesarean section and 29.3% had emergency cesarean section. Leading indications for repeat cesarean section was fetal distress, failure to progress and scar tenderness. No maternal and fetal complication occurred in our study. The success rate of Trial of labor after one previous cesarean delivery was lower in obese (64.38%) as compared to non-obese women (82.06%) (p<0.001). Women with previous successful vaginal delivery had a success rate of 88.2% compared with 62.25% in women without such a history (OR 4.4; 95% CI 2.7-7.2 p <0.001).Conclusion: Vaginal birth after one lower segment cesarean section should be encouraged with vigilant monitoring provided no obstetric contra-indication to vaginal birth exists.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.546-550

scholarly journals A Study of Relationship Between Maternal Vitamin D Status and Mode of Delivery in a Tertiary Care Military Hospital

2020 ◽  
Author(s):  
Gurpreet Kaur Dhillon ◽  
Suneeta Singh ◽  
Harpreet Singh Dhillon ◽  
Shibu Sasidharan
Keyword(s):  
Vitamin D ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Serum Vitamin ◽  
Maternal Serum ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
The Relationship

Abstract Background: Vitamin D deficiency has been shown to be related to multiple adverse pregnancy related outcomes. An observational study was undertaken to study the relationship between maternal serum vitamin D levels during peripartum period and outcome in the form of mode of delivery.Methods: This study was done in a tertiary care centre on 569 patients to study the relationship between maternal serum vitamin D levels and mode of delivery categorized into vaginal delivery (VD), (including assisted delivery) and Lower Segment Cesarean Section (LSCS). The primary objective of this project was to assess the vitamin D levels in maternal serum and to study its relationship, if any, with mode of delivery. Results: A total of 569 samples of maternal and neonatal serum were analyzed for serum 25(OH)D levels. 464 (81.54%) mothers had Vitamin D sufficient (VDS) levels ≥30ng/ml and 105 (18.45%) had vitamin D deficient (VDD) levels <30ng/ml. Out of total 569 newborns; LSCS and spontaneous Vaginal Delivery were 152 (26.71%) and 417 (73.28%) respectively. The incidence of LSCS was 19.61% in the vitamin D sufficient group as compared to 58.09% in the vitamin D deficient group (p<0.0005). The mean cord blood 25(OH) D levels of the neonates born by vaginal delivery was 14.05ng/ml (SD 3.86, range 8.2-27) whereas those born by LSCS was 12.11 ng/ml (SD 3.18, range 7.9-22), which was significantly lower (p<0.00000042).Conclusion: The rates of Cesarean section deliveries was 2.96 times higher in mothers who had deficient Vitamin D levels. Also the levels of mean cord blood vitamin D was higher in vaginally delivered newborns.

scholarly journals Cesarean Section and Maternal-fetal Mortality Rates in Nigeria: An Ecological Lens into the Last Decade

2020 ◽  
Vol 9 (1) ◽  
pp. 128-135
Author(s):  
Hadiza Galadanci ◽  
Deepa Dongarwar ◽  
Wolfgang K ◽  
Oladapo Shittu ◽  
Murtala Yusuf ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Maternal Mortality ◽  
Vaginal Delivery ◽  
Mortality Rates ◽  
Significant Rise ◽  
Fetal Mortality ◽  
Maternal Deaths ◽  
Spontaneous Vaginal Delivery ◽  
The Sustainable Development ◽  
Global Average

Background or Objectives: Despite the global decline in maternal mortality within the last decade, women continue to die excessively from pregnancy-related complicationsin developing countries. We assessed the trends in maternal mortality, fetal mortality and cesarean section (C-Section) rates within 25 selected Nigerian hospitals over the last decade. Methods: Basic obstetric data on all deliveries were routinely collected by midwives using the maternity record book developed for the project in all the participating hospitals. Trends of C-Section Rates (CSR), Maternal Mortality Rates (MMR), Fetal Mortality Rates (FMR) and Spontaneous Vaginal Delivery rates (SVD) were calculated using joinpoint regression models. Results: The annual average percent change in CSR was 12.2%, which was statistically significant, indicating a rise in CSR over the decade of the study. There was a noticeable fall in MMR from a zenith of about 1,868 per 100,000 at baseline down to 1,315/100,000 by the end of the study period, representing a relative drop in MMR of about 30%. An average annual drop of 3.8% in FMR and 1.5% drop in SVD over time were noted over the course of the study period. Conclusion and Global Health Implications: We observed an overall CSR of 10.4% and a significant rise in CSR over the 9-year period (2008-2016) of about 108% across hospital facilities in Nigeria. Despite the decrease in MMR, it was still high compared to the global average of 546 maternal deaths per 100 000 livebirths. The FMR was also high compared with the global average. The MMR found in this study clearly indicates that Nigeria is far behind in making progress toward achieving the Sustainable Development Goal 3 (SGD 3) which aims to reduce the global MMR to less than 70 per 100 000 live births by 2030. Key words: • Cesarean section • Maternal mortality • Fetal mortality • Spontaneous vaginal delivery • Trends in MMR • Nigeria   Copyright © 2020 Galadanci et al. This is an open-access article distributed under the terms of the Creative Com - mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  

scholarly journals ETHICAL DILEMMA OF CESAREAN SECTION ON MATERNAL REQUEST (CSMR)

2021 ◽  
Vol 71 (2) ◽  
pp. 535-39
Author(s):  
Abeera Choudary ◽  
Asifa Siraj ◽  
Humaira Tariq ◽  
Faiqa Chughtai ◽  
Uzma Urooj
Keyword(s):  
Pain Relief ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Birth Outcome ◽  
Military Hospital ◽  
Cross Sectional ◽  
Maternal Request ◽  
Lower Segment Cesarean Section ◽  
Child Bearing ◽  
Negative Perceptions

Objective: To study the demographic characteristics of pregnant ladies and factors contributing towards rise in cesarean section on maternal request to aid the obstetricians in decision making. Study Design: Cross sectional analytical survey. Place and Duration: Gynecology Department of Pak Emirates Military Hospital, Rawalpindi, from Nov 2019 to Mar 2020. Methodology: One hundred and fifteen women of child bearing age requesting cesarean section were included in the study. Demographic details were noted. A study proforma was filled for determinants of primary and secondary tocophobia and factors that may be improved for vaginal delivery.Results: A total of 115 patients with mean age of 27.99 years were included. Amongst them, 88 (76.5%) were Punjabi with 92 (80%) living in rural area. Primigravida were 11 (9.6%), 83 (72.2%) had previous lower segment cesarean section and 3 (2.6%) had vaginal delivery. For primary tocophobia, 22 ( 24.4%) experienced anxiety. Fear of labor pains was seen in 20 (19.2%) and lack of control in 27 (26%). For secondary tocophobia, 15 (37.5%) were fearful of prolonged labor and 5 (22.5%) of sub optimal birth outcome. In women with previous one cesarean section, 13 (14.8%) correlated negatively with birth experience and 20 (22.7%) found timed cesarean section convenient. For vaginal delivery, pain relief was preferred by 19 (20.2%) and 31 (33%)wanted pain relief and attendant. Conclusion: Better understanding of fears behind maternal request for cesarean section can lead to improved attitudes towards vaginal delivery. The negative perceptions of pregnant ladies should be addressed in antenatal.........

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