scholarly journals Childbearing after 40 Years: A Challenge of the Modern Obstetrics

2014 ◽  
Vol 8 (2) ◽  
pp. 144-148
Author(s):  
Florin Stamatian ◽  
Daniel Muresan ◽  
Ioana Rotar ◽  
Mariana Tanc ◽  
Paul Cotutiu ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Obstet Gynecol ◽  
Delivery Mode ◽  
Study Group ◽  
Maternal Complications ◽  
Continuous Growth ◽  
The Past ◽  
Obstetrical Interventions ◽  
Multiparous Women ◽  
Primiparous Women

ABSTRACT Aim Age at delivery has increased in the past decades, leading to a continuous growth of the number of women planning a pregnancy after the age of forty. Because delivering after this age is associated with an increased rate of maternal complications, the objective of this study was to analyze the delivery related issues in women ≥40 years of age. Materials and methods This was a retrospective study conducted in the 1st Clinic of Obstetrics and Gynecology, Cluj-Napoca in a 3-year period. One hundred and forty-two patients ≥40 years of age that delivered between 2010 and 2012 were included in the analysis. Results The frequency of deliveries after the age of 40 was 2.42% of all the deliveries. Eighty percent of nulliparous and 51.72% of multiparous women delivered by cesarean section. A significantly higher percentage of primiparous women delivered by cesarean section compared to secundiparous women (p = 0.0007). Fetal weight was significantly higher in multiparous than in primiparous women in the CS group (p = 0.01). No differences were observed between the Apgar scores according to the delivery mode or parity in the study group. Conclusion Delivery after 40 years of age is associated with an increased number of obstetrical interventions. Abbreviations CS: Cesarean section; 1p: Primiparous; 2p: Secundiparous; 3p: Tertiparous; >1p: Multiparous. How to cite this article Rotar I, Muresan D, Tanc M, Cotutiu P, Giurgiu C, Stamatian F. Childbearing after 40 Years: A Challenge of the Modern Obstetrics. Donald School J Ultrasound Obstet Gynecol 2014;8(2):144-148.

scholarly journals Women’s empowerment and elective cesarean section for a single pregnancy: a population-based and multivariate study in Vietnam

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Myriam de Loenzien ◽  
Quoc Nhu Hung Mac ◽  
Alexandre Dumont
Keyword(s):  
Cesarean Section ◽  
Partner Violence ◽  
Negative Impact ◽  
Mode Of Delivery ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
Elective Cesarean Section ◽  
Multiparous Women ◽  
Elective Cesarean ◽  
Primiparous Women

Abstract Background Women’s empowerment, and maternal and neonatal health are important targets of the Sustainable Development Goals. Our objective is to examine the relationship between women’s empowerment and elective cesarean section (ECS), focusing on Vietnam, a country where the use of CS has increased rapidly in recent decades, which raises public health concerns. Methods We hypothesized that in the context of the developing biomedicalization of childbirth, women’s empowerment increases the use of ECS due to a woman’s enhanced ability to decide her mode of delivery. By using microdata from the 2013–2014 Multiple Indicator Clusters Survey, we conducted a multivariate analysis of the correlates of ECS. We studied a representative sample of 1343 institutional single birth deliveries. Due to higher ECS rates among multiparous (18.4%) than primiparous women (10.1%) and the potential interaction between parity and other correlates, we used separate models for primiparous and multiparous women. Results Among the indicators of women’s external resources, which include a higher level of education, having worked during the previous 12 months, and having one’s own mobile phone, only education differed between primiparous and multiparous women, with a higher level among primiparous women. Among primiparous women, no resource indicator was significantly linked to ECS. However, considering women’s empowerment facilitated the identification of the negative impact of having had fewer than 3 antenatal care visits on the use of ECS. Among multiparous women, disapproval of intimate partner violence (IPV) was associated with a doubled likelihood of undergoing ECS (odds ratio = 2.415), and living in an urban area also doubled the likelihood of ECS. The positive association with living in the richest household quintile was no longer significant when attitude towards IPV was included in the model. In both groups, being aged 35 or older increased the likelihood of undergoing ECS, and this impact was stronger in primiparous women. Conclusions These results underline the multidimensionality of empowerment, its links to other correlates and its contribution to clarifying the influence of these correlates, particularly for distinguishing between medical and sociocultural determinants. The results advocate for the integration of women's empowerment into policies aimed at reducing ECS rates.

scholarly journals Oxytocin Versus Dinoprostone For Labor Induction in Multiparous Women with Unfavorable Cervix

2020 ◽  
pp. 1
Author(s):  
Gul Nihal Buyuk ◽  
Umit Yasemin Sert ◽  
Zeynep Asli Oskovi kaplan ◽  
Serkan Kahyaoglu
Keyword(s):  
Cesarean Section ◽  
Neonatal Intensive Care ◽  
Daily Practice ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Delivery Mode ◽  
Bishop Score ◽  
Multiparous Women ◽  
Group A ◽  
Group B

<p><strong>OBJECTIVE:</strong> Dinoprostone is a drug of choice in our daily practice for the induction of labor. The aim of our study; to compare the use of oxytocin with dinoprostone (PGE2- Propess©) used in term multiparous pregnant women to ripen the cervix.</p><p><strong>STUDY DESIGN:</strong> A total of 507 patients were included in the study. Group A, consisted of 262 women with term multiparous pregnancy Bishop score ≤6 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (Propess© -prostaglandin E2). Group B, consisted of 245 cases of pregnancy with Bishop score ≤6 underwent induction of labor with iv oxytocin and was matched for the patient's age and parity. The following data were recorded: age, gestational age, body mass index, the time from the drug administration to the vaginal labor, delivery mode, indications of induction, cesarean indication, birth weight, Apgar score, and need of neonatal intensive care unit. </p><p><strong>RESULTS:</strong> The primary outcome of the in group B interval from induction to vaginal delivery was similar between the two groups. In group A, 41 patients and in group B, 23 patients had a cesarean section. Cesarean section rate was lower in the oxytocin group (cesarean rate 15.6% versus 9.3%, p&lt;0.05). </p><p><strong>CONCLUSION:</strong> It appears; Dinoprostone ovule increases the cesarean rate in terms, multiparous cases with inappropriate cervical score and does not shorten the duration of delivery. Therefore, the use of oxytocin for cervical ripening in multiparous women may be a more appropriate option.</p>

scholarly journals Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Nevein Gerges Fahmy ◽  
Fahmy Saad Latif Eskandar ◽  
Walid Albasuony Mohammed Ahmed Khalil ◽  
Mohammed Ibrahim Ibrahim Sobhy ◽  
Amin Mohammed Al Ansary Amin
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Study Group ◽  
Mortality And Morbidity ◽  
Lower Segment Cesarean Section ◽  
Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

Effect of the Modified Surgeon Assisted Bilateral Transversus Abdominis Plane Block on Time Required for First Analgesic Dose after Cesarean Section under Spinal Anesthesia: Randomized placebo-control

2021 ◽  
Vol 4 (3) ◽  
pp. 01-05
Author(s):  
Ahmed Mamdouh
Keyword(s):  
Placebo Group ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Interquartile Range ◽  
Transversus Abdominis ◽  
Secondary Outcome ◽  
Control Group ◽  
Placebo Control ◽  
Study Group ◽  
Tap Block

Background: The transverses abdominis plane block (TAP block) is one of the widely used regional analgesic techniques in cesarean section. There are different variations of the procedure. The aim of the present study was to evaluate the analgesic effect of the modified surgeon assisted bilateral TAP block in patients undergoing cesarean section Patients&Methods: Sixty patients undergoing cesarean section under spinal anesthesia were randomized into two groups to receive either TAP block with 40 ml of bupivacaine 0.25%(study group) or 40 ml normal saline as placebo after obtaining informed consent. All patients will receive intravenous diclofencac75mg every 12 hrs postoperatively. Postoperatively, there was an assessment every 2hrs during the first 24hrs by the visual analogue pain scale (VAPS). Time to the first analgesic request will be measured as primary outcome and all patients will receive opioid on demand or VAPS > 4 with 25mg pethidine intramuscularly. Moreover, total opioid requirement in 24hrs will be measured as secondary outcome along with postoperative complications as nausea, vomiting and abdominal distention. Complications related to the TAP procedure will be also assessed. Results: The median (interquartile range) time to the first analgesic request in the first 24hrs postoperatively was significantly shorter in the placebo group compared to the study group; 4h (4, 6) and 24h (10, 24) with p value < 0.001. Postoperative opioid requirement was significantly higher in the control group (30/30{100%}) than the study group (13/30{43.3%}). The median (interquartile range) number of opioid doses was significantly higher in the placebo group compared with the study group; 2(2, 2) and 0(0, 1) respectively. At all points in the study, pain scores both were lower in the study group (p < 0.0001). Conclusion: The modified surgeon assisted bilateral TAP block is relatively new, safe and cost effective technique which provides adequate postoperative analgesia allowing for better maternal ambulation and better postoperative recovery. Trial registration: Clinicaltrial.gov registration number: NCT04623632

CLINICAL AND SUBCLINICAL CHARACTERICTIS AND PREGNANCY OUTCOME OF FETAL MACROSOMIA AT OBSTETRIC DEPARTMENT AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

2020 ◽  
pp. 78-84
Author(s):  
Giang Truong Thi Linh ◽  
Quang Mai Van
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Birth ◽  
Fetal Macrosomia ◽  
Major Influence ◽  
Maternal Complications ◽  
Perineal Tear ◽  
History Of

Background: Fetal macrosomia has a major influence on maternal, neonatal and pregnancy outcomes.Objective: To describe the clinical and subclinical features and the management of fetal macrosomia on pregnancy outcomes. Subjects and methods: Study subjects including pregnant women and babies born ≥ 3500 g with nulliparous and over 4000 grams with primiparous or multiparous at Departement of Obstetrics and Gynecology in Hue University of Medicine and Pharmacy Hospital. The time of choosing subjects to enter the research group is that after birth, the weight is above 3500/4000 grams, then follow up the pregnancy result and retrospect the clinical and subclinical characteristics. Results: From May 2019 to April 2020, there were 223 pregnant women with the birth weight ≥ 3500 g in this study. The mean neonatal weight for macrosomia was 3869.96 ± 315.72 (g). The birth weight ≥ 4000 g, the rate of cesarean section was 91.5%, vaginal birth was 8.5%. The birth weight 3500 - under 4000 g, the rate of cesarean section was 76%, vaginal birth was 24%. 1.1% maternal complications was perineal tear. Conclusion:Factors related to fetal macrosomia: Maternal age, gender of fetus, parity, a history of fetal macrosomia, maternal height, pregnancy weight gain. Caesarean section is the majority. Key words: Fetal macrosomia, gestational diabetes mellitus, normal labor, caesarean section.

Primary cesarean section in term, low-risk multiparous women: a single clinic retrospective observational study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Kimitoshi Imai MD
Keyword(s):  
Observational Study ◽  
Cesarean Section ◽  
Breech Presentation ◽  
Vaginal Birth ◽  
Low Risk ◽  
Retrospective Observational Study ◽  
Vacuum Extraction ◽  
Cesarean Sections ◽  
Vaginal Deliveries ◽  
Multiparous Women

Background: Multiparous women who have previously delivered vaginally are generally considered to be at low risk for cesarean section. We aimed to determine the incidence rate and indications for primary cesarean section and operative vaginal deliveries among multiparous women with previous vaginal births. Patients and methods: Multiparous women who had delivered their babies in our clinic between January 2004 and December 2019 were enrolled in this retrospective observational study. The inclusion criteria were as follows: delivery at 37 weeks of gestation or more, singleton pregnancy with a live fetus, had one or more past vaginal deliveries including instrumental vaginal birth, and no history of previous cesarean section. Women with placenta previa, abruptio placentae, severe pregnancy-induced hypertension, and uncontrolled medical diseases were referred to tertiary hospitals and excluded from this study. The frequency of occurrence and indications for cesarean section and vacuum extraction, duration of labor, and the effect of induction of labor on the cesarean section rates were analyzed. Results: A total of 3094 multiparous women were enrolled. Primary cesarean section was performed in 30 women (30/3094=0.97%). The indications for cesarean section included the following: breech presentation in 28 women, myomectomy after the first vaginal birth in one (of 29 elective cesarean sections), and failed vacuum extraction after a prolonged second stage in one (one emergency cesarean section). Vacuum extraction was performed in 61 women (61/3094=2.0%), the indications for which were non-reassuring fetal status (n=38), prolonged 2nd stage of labor (n=10), and narrow pelvic outlet (n=10). Vaginal breech delivery occurred in 11 women. Induction of labor (n=402) did not affect the cesarean section rate. Conclusion: In multiparous women, breech presentation was the main indication for primary cesarean sections, and the cesarean section rate was very low in women with cephalic presentation.

scholarly journals Prelabour Rupture of Membranes: Mode of Delivery and Outcome

2015 ◽  
Vol 3 (2) ◽  
pp. 237-240 ◽  
Author(s):  
Vlora Ademi Ibishi ◽  
Rozalinda Dusan Isjanovska
Keyword(s):  
Cesarean Section ◽  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Maternal Complications ◽  
Cephalopelvic Disproportion ◽  
Cesarean Section Delivery ◽  
Clinical Center ◽  
Failed Induction ◽  
The University

BACKGROUND: Pre-labour Rupture of Membranes (PROM) is an important cause of maternal and fetal morbidity and increased rate of cesarean section delivery. AIM: The aim of this study is to investigate the clinical characteristics, PROM-delivery interval, mode of delivery, and early maternal neonatal outcome among pregnant patients presenting with pre-labour rupture of membranes.MATERIAL AND METHODS: This prospective case control study is implemented at the Obstetric and Gynecology Clinic of the University Clinical Center of Kosovo. The study included 100 pregnant patients presenting with prelabour rupture of membranes of which 63 were primigravida and 37 patients were multigravida.RESULTS: The incidence of cesarean section in this study is 28 % and the most common indications for cesarean delivery were fetal distress, malpresentation, cephalopelvic disproportion, and failed induction. The most common maternal complications in this study are chorioamnionitis, retained placenta and postpartum hemorrhage. Neonatal infectious morbidity was present in 16 % of cases.CONCLUSION: PROM is a significant issue for obstetricians and an important cause of maternal and neonatal morbidity and increased rate of cesarean section delivery.

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