scholarly journals VTE Prophylaxis in Cesarean Section

2021 ◽  
Author(s):  
Frederico José Amédeé Péret ◽  
Liv Braga de Paula
Keyword(s):  
Cesarean Section ◽  
Large Scale ◽  
Cesarean Sections ◽  
Severe Morbidity ◽  
Vte Prophylaxis ◽  
History Of ◽  
Inflammatory Bowel ◽  
Drug Prophylaxis ◽  
Acquired Thrombophilia ◽  
Active Cancer

Venous thromboembolism (VT is a major cause of maternal mortality and severe morbidity. Pharmacological and non-pharmacological methods of prophylaxis are therefore often used for women considered to be a risk including women who have given birth by cesarean section. The risk is potentially increased in women with a personal or family history of VTE, women with genetic or acquired thrombophilia, and another risk factors like sickle cell disease, inflammatory bowel disease, active cancer, obesity, preeclampsia·and SARS COVID 19 infection. However, a specific score in obstetrics has not yet been well defined. Recommendations from major society guidelines for post-cesarean section (C/S) thromboprophylaxis differ greatly; the safety and efficacy of drug prophylaxis - mainly low molecular weight heparins - has been demonstrated, but large scale randomized trials of currently-used interventions should be conducted. The purpose of this chapter is to discuss the indications and contraindications for VTE prophylaxis in cesarean sections, prophylaxis regimens and potential adverse events.

scholarly journals Pregnancy complicated by previous cesarean section: a retrospective study

2018 ◽  
Vol 7 (11) ◽  
pp. 4470
Author(s):  
Poornima M.
Keyword(s):  
Retrospective Study ◽  
Cesarean Section ◽  
Medical Records ◽  
Neonatal Outcome ◽  
Perinatal Morbidity ◽  
Cesarean Sections ◽  
Previous Cesarean Section ◽  
Exclusion Criteria ◽  
History Of ◽  
Previous Cesarean

Background: Previous Cesarean section (CS) is one of the important causes of CS in subsequent pregnancies. Moreover, repeated cesarean sections increase maternal as well as perinatal morbidity and mortality. We conducted this study to find out outcome of pregnancies in women who had a history of previous CS.Methods: This was a retrospective study of patients of previous caesarean section for either maternal or fetal indications. The duration of study was 3 years. Total 215 patients were included in this study on the basis of a predefined inclusion and exclusion criteria. The indications, maternal and neonatal outcome were studied from medical records of the patients. Statistical analysis was done using SSPE 22.0 software.Results: Out of 215 studied cases majority of the patients belonged to age group of 21-30 years (75.35%) and were 2nd gravida (61.86%). 164 (76.28%) patients attended ANC OPD at least for 3 times during pregnancy. 73 (33.95%) patients had Hb of less than 10 gms while blood transfusion was required to be given in 11 (5.12%) patients. cesarean section was required in 172 (80%) patients out of which 166 (77.21%) patients had undergone emergency LSCS while in 6 (2.79%) patients elective LSCS was done. Scar tenderness was the most common indication for repeat cesarean section. There was no maternal mortality in any patients while there was 1 still birth and 1 neonatal death.Conclusions: Previous cesarean section is one of the important causes of CS in subsequent pregnancies hence decision of doing CS, especially primigravida, must be taken in accordance with strict guidelines and the practice of “cesarean section on demand” should be discouraged.

Recurrent Primary Sclerosing Cholangitis: Current Understanding, Management, and Future Directions

2021 ◽  
Author(s):  
Kristel K. Leung ◽  
Maya Deeb ◽  
Sandra E. Fischer ◽  
Aliya Gulamhusein
Keyword(s):  
Risk Factors ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Large Scale ◽  
Related Factors ◽  
Future Directions ◽  
History Of ◽  
Inflammatory Bowel ◽  
Specific Factors ◽  
Associated Risk Factors

AbstractPatients with primary sclerosing cholangitis (PSC) constitute 5 to 15% of patients listed for liver transplantation worldwide. Although post-transplant outcomes are favorable, recurrent PSC (rPSC) occurs in an important subset of patients, with higher prevalence rates reported with increasing time from transplant. Given its association with poor graft outcomes and risk of retransplant, effort has been made to understand rPSC, its pathophysiology, and risk factors. This review covers these facets of rPSC and focuses on implicated risk factors including pretransplant recipient characteristics, inflammatory bowel-disease-related factors, and donor-specific and transplant-specific factors. Confirming a diagnosis of rPSC requires thoughtful consideration of alternative etiologies so as to ensure confidence in diagnosis, management, subsequent risk assessment, and counseling for patients. Unfortunately, no cure exists for rPSC; however, future large-scale efforts are underway to better characterize the natural history of rPSC and its associated risk factors with hopes of identifying potential key targets for novel therapies.

scholarly journals A Planned Cesarean Section-Hysterectomy For Placenta Previa Totalis Percreta In Patient With History Of Two Cesarean Sections

Medicinus ◽  
2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Julita Nainggolan
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Health Resources ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cesarean Sections ◽  
History Of ◽  
Rising Incidence ◽  
Previous Cesarean

<p><em>The presence of placenta previa may be associated with placenta accreta</em><em><sup>[1]</sup></em><em>.<sup>  </sup></em><em>Maternal and fetal morbidity and mortality from placenta previa accreta are considerable and are associated with high demands on health resources. With the rising incidence of caesarean sections combined with increasing maternal age, the number of cases of placenta praevia and its complications, including placenta accreta, will continue to increase</em><em><sup>[2]</sup></em><em>. </em><em>Here, we present a case of  placenta previa totalis percreta in previous cesarean section twice. In this case, patient with placenta previa totalis-percreta we diagnosed and prepared  proper management with the involvement of multidisciplinary team. We reduced blood loss by performing total abdominal hysterectomy immediately after delivered the baby and the postoperative course was uneventful.</em></p><p><strong><em>Keywords: Cesarean Section-Hysterectomy, placenta accreta, placenta percreta, placenta previa</em></strong></p>

scholarly journals Evaluation of Uterine Scar on Repeat Second Cesarean Section in Patients with Previous Cesarean Section

1970 ◽  
Vol 3 (1) ◽  
pp. 16-19
Author(s):  
N Nargis ◽  
AK Al-Mahmood ◽  
D Akhter
Keyword(s):  
Cesarean Section ◽  
Tertiary Care ◽  
Cesarean Sections ◽  
Previous Cesarean Section ◽  
History Of ◽  
Uterine Scar ◽  
One Year ◽  
Operative Findings ◽  
A Prospective Study ◽  
Previous Cesarean

To evaluate the safety and integrity of uterine scar at repeat cesarean section in patients with previous one cesarean section (C/S). A prospective study was Carried out in a tertiary care, obstetric unit over a period of one year, 2010. All pregnant mothers who underwent cesarean section either emergency or elective with history of previous one cesarean sections were included in this study. The variables noted were age, parity, socioeconomic status, residential area, location of previous cesarean section, previous wound infection and associated complaints. Data was analyzed on SPSS 11 Operative findings during cesarean sections were recorded in terms of thinning of scar, dehiscence or rupture. One hundred and twenty cesarean section patients were included in the study. Out of all patients, extreme thinning of scar was noted in 28 (23.33%) patients. Four patients (3.33%) had scar dehiscence,only 3( 2.5%) patients with scar dehiscence had associated complaint of scar tenderness, while 17 (14.16%) of 120 cases of scar thinning were having scar tenderness. All 4 cases of scar dehiscence had their previous c/s at peripheral hospitals. No patient underwent hysterectomy and all patients with scar dehiscence had successful repair. Our findings shows relatively inadequate scar thickness rate but at the same time relatively acceptable scar dehiscence rate. Thus it seems to be a safe approach to make trial of labour after meticulous scrutinization and individualization. DOI: http://dx.doi.org/10.3329/akmmcj.v3i1.10108 AKMMCJ 2012; 3(1): 16-19

scholarly journals Elective versus Emergency Cesarean Sections : Mother and Fetal Outcome

2021 ◽  
pp. 90-94
Author(s):  
Christofer J. H. Ladja ◽  
IMS Murah Mano ◽  
Andi M. Tahir ◽  
St. Maisuri T. Chalid
Keyword(s):  
Cesarean Section ◽  
Operating Time ◽  
Total Duration ◽  
Fetal Outcome ◽  
Elective Cesarean Section ◽  
Cesarean Sections ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Elective Cesarean ◽  
History Of

Objective: To compare the outcomes of mothers and newborns in emergency cesarean section and elective cesarean section.Methods: A prospective cohort study included 120 pregnant women consists of 60 women who performed an emergency cesarean section and 60 women who underwent elective cesarean section. Age, education level, occupation, income, history of comorbidities, history of abortion or miscarriage, antenatal care history, decision-making time until surgery is performed along with other components required, duration of operation, outcome of mother and fetal were obtained through interviews and questionnaires. Data were analyzed regarding fetal outcome and cesarean sections indications.Results: The maternal and fetal outcome between emergency and elective cesarean section were not significantly  different regarding on hospital stay, dehiscence, NICU admission, Apgar score and newborn status (dead or alive). Blood transfusion is the main difference signifi cant indication for maternal outcome between emergency and elective procedure (p less than 0.05). The total duration of procedure  less than 60 or more than 60 minutes and maternal-fetal outcome not signifi cantly different between two type of procedures.Conclusions: Emergency cesarean section at preterm gestational age with an operating time less than equal to 60 minutes leads to greater transfusion blood requirements compared with elective cesarean section.Keywords: emergency cesarean section, elective cesareansection, mother-infant outcome. AbstrakTujuan: Membandingkan luaran ibu dan bayi baru lahir di seksio sesarea emergensi dan elektif.Metode: Penelitian kohort prospektif melibatkan 120 perempuan hamil terdiri atas 60 perempuan yang melakukan operasi seksio sesarea emergensi dan 60 perempuan melakukan operasi elektif. Usia, tingkatpendidikan, pekerjaan, pendapatan, riwayat komorbiditas, riwayat aborsi atau keguguran, riwayat asuhan antenatal, waktu pengambilan keputusan sampai operasi dilakukan bersamaan dengan komponen lain yang diperlukan, lamanya operasi, luaran ibu dan bayi diperoleh melalui wawancara dan kuesioner. Data yang dianalisis mengenai luaran ibu dan bayinya.Hasil: Luaran ibu dan bayi antara seksio sesarea emergensi dan elektif tidak berbeda bermakna dalam hal lama rawat inap, dehisensi, admisi, skor Apgar dan status bayi baru lahir (meninggal atau hidup). Transfusi darah adalah indikasi penting utama yang berbeda untuk luaran ibu antara prosedur emergensi dan elektif (p kurang dari 0,05). Durasi total prosedur kurang dari 60 atau lebih dari 60 menit dan luaran ibu tidak berbeda secara signifikan antara kedua jenis seksio sesarea.Kesimpulan: Tindakan seksio sesarea emergensi pada usia gestasi prematur dengan waktu operasi kurang dari sama dengan 60 menit menyebabkan kebutuhan transfusi darah lebih besar dibandingkan seksio sesarea elektif.Kata kunci: luaran ibu-bayi, seksio sesarea elektif, seksio sesarea emergensi.

scholarly journals Outcome of Pregnancy with History of Previous Cesarean Section

2017 ◽  
Vol 9 (4) ◽  
pp. 308-311
Author(s):  
Reena J DSouza ◽  
Bandeppa H Narayani ◽  
Smitha B Rao
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Perinatal Death ◽  
Placenta Previa ◽  
Birth Asphyxia ◽  
Cesarean Sections ◽  
Previous Cesarean Section ◽  
History Of ◽  
Previous Cesarean

ABSTRACT In modern obstetric practice, pregnancy with history of previous cesarean section is quite common. A cesarean section poses some documented risks to the mother's health in subsequent pregnancies like placenta previa or accreta and uterine scar rupture. It is also associated with increased likelihood of preterm delivery, low birth weight, and perinatal death. Repeat cesarean section is technically difficult and there is chance of injury to surrounding structures. The retrospective study was done in Yenepoya Medical College Hospital during the period of January 2014 to January 2015 to find out the maternal antepartum and intrapartum complications as well as perinatal outcome in patients with a history of cesarean section. A total number of 143 pregnant patients with history of one or more cesarean section who underwent repeat cesarean sections were included. Previous classical cesarean, extreme prematurity, and those who opted for vaginal birth after cesarean (VBAC) were excluded. Mean age of the study population was 27.4 years. Here, 72.12 and 20.98% cases had history of previous one and two cesarean sections respectively. Important antepartum complications were placenta previa (3.50%), scar tenderness (8.39%), gestational diabetes mellitus (GDM; 4.90%), pregnancy-induced hypertension (PIH; 6.99%), etc. There were extensive peritoneal and bladder adhesions in 13.99 and 16.78% cases respectively, causing much preoperative difficulties and in one case urinary bladder was injured during operation. Postoperative period was uneventful in 72.72% cases. In this study, 20.28% neonates developed some complications like prematurity, low birth weight, birth asphyxia, and neonatal jaundice. Here the rate of perinatal mortality was 1.4%. How to cite this article DSouza RJ, Narayani BH, Rao SB. Outcome of Pregnancy with History of Previous Cesarean Section. J South Asian Feder Obst Gynae 2017;9(4):308-311.

scholarly journals A Survey of Venous Thromboembolism (VTE) Prophylaxis in Obstetrics Patients in Iran

2019 ◽  
Author(s):  
Majid Mokhtari ◽  
Khadijeh Nasri ◽  
Fatemeh Tara ◽  
Elahe Zarean ◽  
Sedigheh Hantoushzadeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Varicose Veins ◽  
Multiple Pregnancy ◽  
Final Analysis ◽  
Theory And Practice ◽  
Secondary Outcome ◽  
Vte Prophylaxis ◽  
History Of ◽  
Drug Prophylaxis

Objective: The purpose of the present study was a survey of venous thromboembolism (VTE) prophylaxis in obstetrics patients in Iran. Materials and methods: A national, multicenter, non-interventional, prospective study was performed on 1000 women at 11 different parts of Iran. Primary outcome was to assess the situation of VTE prophylaxis in pregnant and postpartum women and the secondary outcome was risk stratification in obstetrics patients and to evaluate the guideline adherence in physician’s practice of VTE prophylaxis. Results: 1,036 women entered the final analysis. The three main VTE risk factors before hospitalization were BMI > 30 kg/m2, history of oral contraceptive (OCP) use, and the age over 35.VTE risk factors upon enrollment were detected in 780 (75.28%) patients. 219 women (28.07%) were deemed eligible for drug prophylaxis, however, only 37 women (17%) received it. A total of 113 (10.9%) patients received VTE prophylaxis, of which 76 (67.25%) women had no clear indications. Concordance between theory and practice was detected with a Cohen’s Kappa coefficient to be 0.74 (p < 0.001), which fell within “good agreement”. Multivariate analysis for association between VTE prophylaxis and VTE risk factors showed that history of VTE [OR = 9.06 (CI 95% 1.16 – 70.8) p = 0.036] was the most frequent risk factor for receiving VTE prophylaxis followed by obesity (BMI > 30 Kg/m2); [OR = 3.74 (CI 95% 1.79 – 5.69), p = <0.001], multiple pregnancy [OR= 2.81 (CI 95% 1.70 – 4.64), p = < 0.001] and age > 35 years; [OR =1.09 (CI 95% 0.82 – 1.21), p = 0.026]. Varicose Veins [OR= 0.22 (CI 95% 0.56 – 0.87), p = 0.031], PROM / PPROM [OR= 0.33 (CI 95% 0.12 – 0.91), p = 0.032] and history of using OCP [OR= 0.36 (CI 95% 0.24 – 0.53), p = < 0.001] were the most missed risk factors for receiving VTE prophylaxis respectively. Conclusion: History of VTE, obesity, multiple pregnancy and age > 35 years were the most frequent risk factors for receiving VTE prophylaxis and varicose veins, PROM / PPROM and history of using OCP were the most missed risk factors for receiving VTE prophylaxis.

scholarly journals Audit: The Strategy to Reduce the Rising Cesarean Section Rates

2012 ◽  
Vol 4 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Malik Goonewardene ◽  
Miyuru H Manawadu ◽  
DV Priyaranjana
Keyword(s):  
Clinical Practice ◽  
Cesarean Section ◽  
Detailed Analysis ◽  
South Asian ◽  
Group Classification ◽  
Adverse Outcomes ◽  
Cesarean Sections ◽  
Severe Morbidity ◽  
Global Increase

ABSTRACT The global increase of cesarean sections (CS) is causing great concern because of the associated increased maternal mortality and severe morbidity, even after adjusting for risk factors. To address this issue an audit is required. Robson's 10 group classification of CS, in which all pregnant women are categorized into 10 prospectively determined, mutually exclusive, totally inclusive and clinically relevant groups, modified by the inclusion of a few subgroups, has been used in certain centers in Sri Lanka from 2010. Using this classification, it is possible to study the pattern of CS in a particular unit during a specific period of time and compare the data prospectively, as well as carry out comparisons with data from another unit which has adopted this classification. Audits and comparisons at local, regional, national and even international levels are possible. When the pattern of CS in a particular unit is recognized, a detailed analysis of CS including the indications for CS is required to decide whether the CS rate needs to be reduced and if so how it could be reduced. A subsequent reaudit using the same categories would demonstrate reducing trends if any, after the adoption of appropriate changes in clinical practice, and also identify areas which require further improvements. Important differences between units have been observed in those groups which contribute to almost half the total CS; viz 5A and 5B (repeat CS), 2B (nulliparous term singleton vertex—NTSV, prior to the onset of labor), 2A (NTSV after induction of labor) and 1 (NTSV in spontaneous labor). Detailed analysis of indications for CS in these groups have revealed possible areas where clinical practice can be changed and CS rates safely reduced, without increasing the risk of adverse outcomes for the mother or her baby. How to cite this article Goonewardene M, Manawadu MH, Priyaranjana DV. Audit: The Strategy to Reduce the Rising Cesarean Section Rates. J South Asian Feder Obst Gynae 2012;4(1):5-9.

scholarly journals A Planned Cesarean Section-Hysterectomy for Placenta Previa Totalis Percreta in Patient with History of Two Cesarean Sections

Medicinus ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 13
Author(s):  
Julita Nainggolan
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Health Resources ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cesarean Sections ◽  
History Of ◽  
Rising Incidence ◽  
Previous Cesarean

<p class="Default">The presence of placenta previa may be associated with placenta accreta<sup>[1]</sup>.<sup>  </sup>Maternal and fetal morbidity and mortality from placenta previa accreta are considerable and are associated with high demands on health resources. With the rising incidence of caesarean sections combined with increasing maternal age, the number of cases of placenta praevia and its complications, including placenta accreta, will continue to increase<sup>[2]</sup>. Here, we present a case of  placenta previa totalis percreta in previous cesarean section twice. In this case, patient with placenta previa totalis-percreta we diagnosed and prepared  proper management with the involvement of multidisciplinary team. We reduced blood loss by performing total abdominal hysterectomy immediately after delivered the baby and the postoperative course was uneventful.<strong></strong></p>

scholarly journals Risk Factors and Pregnancy Outcome in Women With a History of Cesarean Section Complicated by Placenta Accreta

2020 ◽  
Author(s):  
Yingyu Liang ◽  
lizi Zhang ◽  
Shilei Bi ◽  
Jingsi Chen ◽  
Shanshan Zeng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Cesarean Sections ◽  
Han Ethnicity ◽  
Parity Number ◽  
History Of ◽  
Independent Risk Factors ◽  
Previous Cesarean

Abstract Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta.Methods: This retrospective study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in 7 provinces of China between January 2017 and December 2017. According to the intraoperative findings or the pathologic diagnosis after delivery, the study population was divided into placenta accreta (PA) and non-PA groups. We compared the pregnancy outcomes between the 2 groups, used multivariate logistic regression to analyze the risk factors for placental accreta, and used receiver operating characteristic curves to evaluate the value of the risk factors.Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage, severe postpartum hemorrhage, diffuse intravascular coagulation, puerperal infection, intraoperative bladder injury, hysterectomy, and blood transfusion was significantly increased in the placenta accreta group (P<0.05)). At the same time, the rate of neonatal low-birth weight, the probability of neonatal comorbidities, and the rate of neonatal intensive care unit admission also increased significantly (P<0.05). Weight, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membrane, previous cesarean-section transverse incisions, history of placenta previa, and the combination of prenatal hemorrhage and placenta previa were all independent risk factors for placenta accreta; while non-Han ethnicity was an independent protective factor for placenta accreta (P<0.05). The area under the ROC curve (AUC) was 0.93 (95% CI=0.92-0.94); and the specificity, sensitivity, and accuracy rate were 0.87, 0.93, and 0.93, respectively.Conclusions: There was an increased risk of adverse outcomes in pregnancies complicated by placenta accreta in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, Han ethnicity, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with placenta accreta in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placental accreta in pregnancies of women with a history of cesarean section.

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