A study of respiratory disorders in neonates in emergency caesarean section, elective caesarean section and normal vaginal delivery at term

PICO question In pregnant bitches due to whelp, is elective caesarean section more effective than vaginal delivery to improve puppy survival? Clinical bottom line Category of research question The category of the research question is regarding the incidence of puppy mortalities as a result of vaginal delivery, emergency caesarean section and elective caesarean section. The number and type of study designs reviewed Two retrospective articles were reviewed and critically appraised; one retrospective study with high single canine breed bias and one study on different canine breeds but limited support in directly answering the PICO question. Strength of evidence The studies selected both had strong uses of experimental designs but together provided weak evidence to determine a definitive answer to the PICO question. Outcomes reported The outcomes from both retrospective studies suggests that the mortality rates of newborn puppies can be reduced if pregnant bitches are scheduled ahead for elective caesareans, in comparison to undergoing an emergency caesarean section when complications develop, particularly in breeds with higher risks of dystocia. Therefore, there is some evidence to support that it may be advantageous to consider the breed, age and overall health of the bitch during pregnancy to determine whether elective caesarean sections, for the safe delivery of puppies, should be considered. Conclusion There are currently insufficient studies, literatures and evidence in veterinary medicine for caesarean sections to become a routine procedure in first opinion practices. Future prospective studies should be conducted and include the optimum anaesthetic protocols with the lowest associated risks for the pregnant bitch and puppies. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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Profile of Caesarean Section at Kathmandu Medical College

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v15i2.18165 ◽

2017 ◽

Vol 15 (2) ◽

pp. 110-113

Author(s):

Apurwa Prasad ◽

Garima Bhandari ◽

Rachana Saha

Keyword(s):

Caesarean Section ◽

Demographic Data ◽

Elective Caesarean Section ◽

Emergency Caesarean Section ◽

Medical College ◽

Emergency Caesarean ◽

Clinical Indications ◽

Depth Study ◽

Elective Procedure ◽

Failed Induction

Background: There is a world-wide rise in caesarean section rateduring the last three decades and has been a cause of alarm and needs an in-depth study. The objective of this study was to determine the rate and clinical indications of Caesarean Section.Methods: A hospital based study was carried out from 15th June 2015 to 15th January 2016 in Department of Obstetrics and Gynecology at Kathmandu Medical College, Sinamangal, Nepal. Patients who delivered by caesarean section were included in the study. Basic demographic data and clinical indications were noted.  Results: A total of 1172 deliveries were carried out during the study period. Total number of caesarean section was 537 accounting to 45.81%. Most of the patients were of the age group of 25-29 years (42.8%). Most of the patients were primigravida (n=274; 51%). Emergency caesarean section was 411 (76.5%) and elective caesarean section was 126 (23.4%). Multigravida (71%) underwent more elective procedure than primigravida (25. 39%).The most frequent indication was fetal distress19.55% (n=105), failed induction 19.73%(n=106), and previous caesarean section 21.3% (n=115).Conclusions: The rate of cesarean section is quite high than that recommended by WHO which is (10-15%). Most of the caesarean sections were emergency caesarean section with previous caesarean being the leading cause.

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Postpartum quality of life after normal vaginal delivery and caesarean section

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v2i2.20324 ◽

2015 ◽

Vol 2 (2) ◽

pp. 13-18

Author(s):

Yogendra Amatya ◽

Samita Acharya

Keyword(s):

Quality Of Life ◽

Caesarean Section ◽

Vaginal Delivery ◽

Elective Caesarean Section ◽

Family Type ◽

Normal Vaginal Delivery ◽

Cross Sectional ◽

Normal Delivery ◽

Physical Health Composite Score

Introductions: Caesarean section is rising. The best method of delivery, vaginal or caesarean, for postpartum quality of life in women is a matter of controversy both from professionals’ perspectives and from women’s experience of childbirth. This study analyses quality of life after these two methods of deliveries.Methods: This was a cross-sectional comparative study in postnatal care outpatient department at Patan Hospital. Primipara women with normal delivery and elective caesarean section done in Patan Hospital were enrolled to analyse postpartum quality of life. The SF-12 questionnaire tool at 6 weeks post delivery was used to compare age, ethnicity, education, family type and employment. Data was analysed using ANOVA test for descriptive parameters.Results: There were 468 primipara, age 30-45 years, 94% in 15-30 years77.8% educated, 74.4% in joint family,73.5% housewife. Normal vaginal delivery was 360 (72.6%) and 128 (27.4%) elective caesarean. Vaginal delivery group had average SF score of Physical Health Composite Score of 68.7, Mental Health CompositeScore69.5 and total SF score 67.7. While in caesarean group, it was 64.8,64.1 and 63.4.Conclusions: Normal vaginal delivery had better quality of life resulting in both superior physical as well as mental health.Journal of Patan Academy of Health Sciences, Vol. 2, No. 2, 2015. page:13-18

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W344 AUDIT OF 496 SETS OF TWINS. IS EMERGENCY CAESAREAN SECTION FOR THE SECOND TWIN A COMMON COMPLICATION OF TWIN VAGINAL DELIVERY?

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(12)62067-0 ◽

2012 ◽

Vol 119 ◽

pp. S816-S816

Author(s):

M. Alberry ◽

O. Greer ◽

E. Manzo ◽

D. Fraser

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Emergency Caesarean Section ◽

Common Complication ◽

Emergency Caesarean ◽

Second Twin

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Maternal and foetal outcome in elective versus emergency caesarean sections

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170927 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1222

Author(s):

Amit A. Gurunule ◽

Himangi S. Warke

Keyword(s):

Caesarean Section ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Breech Presentation ◽

Emergency Caesarean Section ◽

Tertiary Care Centre ◽

Emergency Caesarean ◽

Significant Difference ◽

Foetal Outcome ◽

Tract Infections

Background: Caesarean delivery is defined as the birth of the foetus through an incision in the abdominal wall (i.e. laparotomy) and the uterine wall (hysterotomy). The purpose was to analyze the maternal and foetal outcome in elective versus emergency caesarean sections retrospectively in a tertiary care centre and to analyze the indications of elective versus emergency caesarean sections.Methods: A retrospective observational study of the cases undergoing caesarean sections in KEM hospital, Mumbai, India was carried out during the period of September 2013 to September 2015. Maternal and foetal outcome was studied. The data was collected and analyzed from the maternal medical records. The neonatology records were also examined.Results: Out of the 600 selected patients, 300 patients in each group of elective and emergency caesarean section were studied. The usual indications of emergency caesarean sections were foetal distress, followed by meconium stained amniotic fluid (MSAF) and cephalopelvic disproportion (CPD). The most frequent indicator for elective lower segment caesarean section (LSCS) was patient with previous LSCS not willing for vaginal birth, followed by breech presentation and previous multiple LSCS. There was a significant difference seen in the occurrence of fever, urinary tract infections and wound infections in the two groups. These were more common in the emergency caesarean section group. Significant difference was also seen in the incidence of postpartum haemorrhage in the two groups, which was more in the elective caesarean section group.Conclusions: The maternal morbidity, intra operative and postoperative complications were more in the emergency LSCS group as compared to patients who underwent elective LSCS.

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Elective versus emergency caesarean section: differences in maternal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193536 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3207

Author(s):

Anshu Sharma ◽

Rajiv Acharya ◽

Yashika Pehal ◽

Bhawna Sharma

Keyword(s):

Caesarean Section ◽

Elective Caesarean Section ◽

Fetal Distress ◽

Emergency Caesarean Section ◽

Maternal Outcome ◽

Common Indication ◽

Emergency Caesarean ◽

Group A ◽

The Difference ◽

Group B

Background: Caesarean section is a life-saving surgical procedure when certain complications arise during pregnancy or labour. The use of CS worldwide has increased worldwide unprecedented levels although the gap between higher- and lower-resource settings remains. The present study evaluates the difference in maternal outcome in elective versus emergency caesarean sections in our institute.Methods: The study included first 65 cases of emergency caesarean section (group A) and during the study period, first 65 elective caesarean section (group B) if they fulfilled the inclusion criteria. Various intra operative and postoperative events were recorded which included intra operative complications, postpartum haemorrhage and transfusion indices.Results: The most common indication of caesarean section in group A was fetal distress (27.7%). In group B most caesarean sections were classified under 5 followed by class 6, the most common indication being previous caesarean section (27.6%). It was observed that pre-operative mean haemoglobin in group A was 10.6 g/dl and in group B was 11.2g/dl. A drop of 1.36 g/dl in group A and 1.10 g/dl in group B was observed in the post-op period. Cross match / transfusion ratio 1.5 in group A and 2 in group B, transfusion probability ratio was 60 % in group A and 66.7% in group B and transfusion index was 1 in group A and group B. There was significantly higher contraception acceptance in group B compared to group A.Conclusions: Elective caesarean section has more favourable maternal outcome as compared to emergency caesarean section as the former is done under controlled and planned circumstances. However, there should be stringent audit to scrutinise indication of caesarean section, outcome of caesarean and blood transfusion practices.

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Post-operative Experience following Caesarean Section in a Nigerian Obstetric Population

Annals of Basic and Medical Sciences ◽

10.51658/abms.202121.4 ◽

2021 ◽

Vol 2 (1) ◽

pp. 60-65

Author(s):

Jamila A Garba ◽

Abubakar A Panti ◽

Ahmed Yakubu ◽

Eze A Ukwu ◽

Ahmed T Burodo ◽

...

Keyword(s):

Pain Relief ◽

Caesarean Section ◽

Outcome Measures ◽

Elective Caesarean Section ◽

Cross Sectional Study ◽

Emergency Caesarean Section ◽

Secondary Outcome ◽

Cross Sectional ◽

Patient’S Satisfaction ◽

Emergency Caesarean

Background: Caesarean section is the most significant obstetrics operative intervention globally. Good postoperative experience after caesarean section is important because there is need for the mother to recover from surgery and take care of her baby. The aim of this study was to assess the experience of women that had caesarean section in the first 24 hours postoperatively. Materials/methods: This was a cross-sectional study conducted among women that had elective and emergency caesarean section. They were followed up to 24 hours post-operative. The primary outcome measures were pain score and satisfaction. Secondary outcome measures were time of mobilization, time of commencement of oral feeds and time of initiation of breastfeeding. Data analysis was carried out using Statistical Package for Social Sciences version 22. Results: The median pain scores among those that had emergency and elective caesarean section ranged between 2 and 3 at all points of pain assessment. The satisfaction was good among 66.1% that had emergency caesarean section and 71.2% among those that had elective caesarean section. However, the difference was not statistically significant (χ2 = 0.546, p = 0.761). More than 90% of the participants that had either emergency or elective caesarean section did not ambulate within the first 24 hours after caesarean section and there was no association between the time of ambulation and the type of caesarean section (χ2 = 0.005, p = 0.941). Conclusion: The participants had adequate pain relief and majority were satisfied with the pain relief. However, the optimum satisfaction was not achieved. The participants did not ambulate early and did not initiate breast-feeding early. Recommendation: Further research is recommended to assess other factors that affect patient's satisfaction and ambulation so as to improve on patient's postoperative care.

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Maternal and Fetal Outcome in Emergency versus Elective Caesarean Section

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i2.2093 ◽

2020 ◽

Vol 18 (2) ◽

pp. 186-189

Author(s):

Naveen Darnal ◽

Ganesh Dangal

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Elective Caesarean Section ◽

Fetal Outcome ◽

Emergency Caesarean Section ◽

P Value ◽

Age Group ◽

Common Indication ◽

Emergency Caesarean ◽

Emergency Cesarean

Background: Caesarean section is one of the most performed surgical procedures all over the world. It is associated with high morbidity and mortality as compared to vaginal delivery. The present study was carried out to evaluate the maternal and neonatal outcome and complications in two groups of pregnant women who underwent elective and emergency cesarean section, so that measures can be taken to reduce morbidity and mortality in near future.Methods: It was hospital based descriptive cross-sectional study carried out at Paropakar Maternity and Women’s Hospital from October to December 2018. There were 340 patients enrolled in the study 170 in elective and 170 in emergency caesareans selected randomly. Ethical approval was obtained from the Institutional Review Board and informed consent was taken from the patients and patients’ guardians. Data were collected daily from the Operation Theater. Results: The rate of caesarean section in the hospital was 30.7%. Proportion of emergency caesarean section was 1324 (74.4%) and elective caesarean section was 456 (25.6%). Emergency Caesarean section was more common in younger age group and in primigravida while elective Caesarean section was more common in advanced age group and in multigravida. The most common indication for emergency Caesarean section was Fetal Distress and the most common indication for elective Caesarean section was previous cesarean with refused vaginal delivery after cesarean section. The maternal outcome in terms of post-operative wound infection, (post-partum hemorrhage, urinary tract infection need for blood transfusion, fever and need for maternal intensive care unit admission was significantly (p- value <0.05) higher in emergency Caesarean section than in elective Caesarean section .The fetal outcome in terms of birth asphyxia, meconium stained liquor and need for Neonatal ICU admission were significantly (p – value <0.05) higher in emergency Caesarean section than in elective Caesarean section. Conclusions: Maternal and fetal complications were significantly higher in the emergency caesarean section as compared to elective caesarean section group.Keywords: Fetal outcome; emergency cesarean section; elective cesarean section; maternal outcome.

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Evaluation of Maternal and Fetal Stress Hormones During the Process of Birth

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2017.753 ◽

2018 ◽

Vol 24 (2) ◽

pp. 65

Author(s):

Burcu Kisa Karakaya ◽

Ozlem Moraloglu ◽

Rahime Bedir Findik ◽

Necati Hancerliogullari ◽

Hatice Celik ◽

...

Keyword(s):

Stress Response ◽

Caesarean Section ◽

Vaginal Delivery ◽

Umbilical Cord ◽

Elective Caesarean Section ◽

Mode Of Delivery ◽

Normal Vaginal Delivery ◽

Singleton Pregnancy ◽

Beta Endorphin ◽

Tertiary Center

Objective: This study aims to determine whether mode of delivery is associated with the endocrine stress response in mother and newborn.Study Design: This prospective observational study was conducted with 86 women with a normal singleton pregnancy who delivered healthy infants between 37 and 41 weeks of gestation in a tertiary center. Study groups included; (1) women undergoing normal vaginal delivery with epidural anesthesia, (2) women undergoing vaginal delivery with immersion in water for pain relief during labor, (3) women delivered through elective caesarean section without labor. After delivery, thyroid stimulating hormone, cortisol, insulin, prolactin and Beta-endorphin levels were measured in maternal and umbilical cord serum and their relationships between modes of delivery were investigated.Results: It was found that the concentrations of cortisol and beta-endorphin after vaginal delivery with immersion in water group in both mothers and infants were higher than other two modes of delivery and these differences were statistically significant. Umbilical cord concentration of cortisol was the lowest in the caesarean section group.Conclusions: Maternal and fetal stress response was found to be associated with the mode of delivery and labor.

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First-trimester maternal serum vitamin D and mode of delivery

British Journal Of Nutrition ◽

10.1017/s0007114512000207 ◽

2012 ◽

Vol 108 (11) ◽

pp. 1972-1975 ◽

Cited By ~ 19

Author(s):

Makrina D. Savvidou ◽

Mahlatse Makgoba ◽

Pedro T. Castro ◽

Ranjit Akolekar ◽

Kypros H. Nicolaides

Keyword(s):

Vitamin D ◽

Caesarean Section ◽

Vaginal Delivery ◽

Elective Caesarean Section ◽

Mode Of Delivery ◽

First Trimester ◽

Maternal Serum ◽

Emergency Caesarean Section ◽

Maternal Vitamin ◽

Vitamin D Levels

Low maternal vitamin D levels have been associated with adverse pregnancy outcome. A recent study has suggested that low maternal vitamin D levels at the time of delivery are also associated with an almost fourfold increase in caesarean section risk. The aim of the present study was to investigate whether there is a difference in maternal serum 25-hydroxyvitamin D (25(OH)D) levels at 11–13 weeks' gestation according to the mode of delivery. Maternal serum 25(OH)D levels were measured at 11–13 weeks' gestation in 995 singleton pregnancies resulting in the birth of phenotypically normal neonates at term. The measured 25(OH)D levels were adjusted for maternal age, BMI, racial origin, smoking, method of conception and season of blood testing, and the adjusted levels (multiple of the median; MoM) were compared between those who subsequently delivered vaginally and those that delivered by caesarean section. Delivery was vaginal in 79·6 % of cases, by emergency caesarean section in 11·6 % and by elective caesarean section in 8·8 %. The median 25(OH)D level in our population was 46·82 (interquartile range (IQR) 27·75–70·13) nmol/l. The adjusted maternal median 25(OH)D levels in the emergency and elective caesarean section groups (0·99, IQR 0·71–1·46 MoM and 0·96, IQR 0·73–1·27 MoM, respectively) were not significantly different from the vaginal delivery group (0·99, IQR 0·71–1·33 MoM; P = 0·53 and P = 0·81, respectively). First-trimester maternal serum 25(OH)D levels are similar between women who subsequently have a vaginal delivery and those who deliver by elective or emergency caesarean section.

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