scholarly journals Association and Determinants of Decision-Delivery Interval of Emergency Caesarean Sections and Perinatal Outcome in a Tertiary Institution

2021 ◽  
Author(s):  
Peace Chinyere Igwe ◽  
John Okafor Egede ◽  
Emeka Onwe Ogah ◽  
Chidebe Christian Anikwe ◽  
Matthew Igwe Nwali ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Emergency Caesarean Section ◽  
P Value ◽  
Foetal Distress ◽  
Emergency Caesarean ◽  
Foetal Outcome ◽  
The Mean ◽  
Minute Apgar Score

Introduction: A Decision to Delivery Interval (DDI) of 30 minutes for emergency caesarean section has been widely recommended but there is little evidence to support it. This target may not be practicable in a busy maternity unity and therefore, the anticipated beneficial effect on neonatal outcome requires re-evaluation. Aim: To determine the association between decision-delivery interval and perinatal outcome of emergency caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a period of four years. Materials and Methods: This was a retrospective observational study of the cases in emergency caesarean sections performed at the Department of Obstetrics and Gynaecology, AEFUTHA from 1st January 2012 to 1st January 2016. Hospital records of the women with singleton pregnancy at term who delivered through emergency caesarean sections were retrieved. Data extracted include socio-demographic and obstetric characteristics, duration between decision for caesarean section and intervention, indications for the caesarean section, reasons for delay in DDI, association between booking status and DDI and association of DDI and foetal outcome, APGAR score at 1st and 5th minutes and admission to NICU. Data were analysed with IBM statistics version 20. The p-value <0.05 were regarded as statistically significant. Results: A total of 638 emergency caesarean sections involving singleton pregnancies at term, 522 (81.8%) of which had complete records and were analysed. The mean age of participants was 27.8±5.1 years, 89.3% were para 1-4 and 55.0% were unbooked. Only 6 (1.1%) of the emergency caesarean sections were performed within the recommended 30 minutes of DDI. The mean DDI was 189±124 minutes with range of 25 minutes to 1220 minutes. Two cases performed within 25 minutes were cases of foetal distress and cord prolapse while only a case of reduced foetal movement was delayed to 1220 minutes. The most common indications for emergency caesarean section were cephalopelvic disproportion 129 (24.7%) and foetal distress 65 (12.5%). The major cause of delay was delay in cross-matching of blood for surgery 136 (26.1%) while delay in giving informed consent contributed 67 (12.8%). There was no correlation between DDI of 75 minutes or above and the 1st minute APGAR score (AOR=2.48, CI=0.86-7.16, p-value=0.09), 5th minute APGAR score (AOR=3.08, CI=1.55-6.11, p-value=0.09), foetal outcome (AOR=0.82, CI=017-3.79, p-value=0.08) and admission to Newborn Intensive Care Unit (NICU) (AOR=2.08, CI=0.77-5.56, p-value=0.14). Conclusion: This study showed that there was no correlation between DDI>75 minutes and poor perinatal outcome. Efforts should be made to strengthen the health system and improve the quality of care in order to keep DDI within this time limit for improved perinatal health outcome and indices.

STUDY OF OBSTETRIC OUTCOMES IN ELECTIVE AND EMERGENCY CAESAREAN SECTION IN PATIENTS WITH PRIOR LOWER SEGMENT CAESAREAN SECTION

2021 ◽  
pp. 57-60
Author(s):  
Dipak S. Kolate ◽  
Meenal M. Patvekar ◽  
Shriraj Katakdhond ◽  
Yogesh Thawal ◽  
Kale DhanaLaxmi ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Perinatal Outcome ◽  
Maternal Morbidity ◽  
Caesarean Delivery ◽  
Emergency Caesarean Section ◽  
Obstetric Outcomes ◽  
Fetal Outcomes ◽  
Emergency Caesarean ◽  
Management Protocol ◽  
History Of

Background:Acomprehensive study of maternal morbidity and mortality with perinatal outcome in patients with prior LSCS undergoing elective or emergency caesarean section was carried out. With the sky rocketing caesarean section rates worldwide an increasing number of women face the issue of mode of delivery in their current pregnancy. There are conicting reports regarding the safety of a trial for vaginal birth after caesarean delivery (VBAC) in terms of uterine rupture, maternal and perinatal morbidity. The purpose of this study was to evaluate the obstetric and fetal outcomes of patients presenting at term with a history of previous one or more LSCS. Methods:Asix months prospective, observational study was conducted where all patients who had a term pregnancy with a history of previous one or more LSCS were included after obtaining their consent for participation. The obstetric and fetal outcomes of these patients with elective or emergency LSCS in the present pregnancy were noted and tabulated. Adescriptive analysis of these outcomes was carried out. Results: 100 Patients at term, with a history of previous one or more LSCS were studied. 38 patients underwent an elective repeat caesarean delivery and 62 in emergency.Scar dehiscence was seen in 35.5 % of the patients who were presented in emergency with uterine contractions or lower abdominal pain and those were not candidate for a trial for VBAC.All of the complications were signicantly higher in emergency group in terms of both maternal (83.9 % Vs 31.6%) and perinatal outcome (6.5% Vs 0 %). Conclusion:With an increase in the proportion of patients with a history of previous LSCS, it is essential for health care institutions to have proper antenatal counseling regarding plan of delivery and vigilance while operating patients with prior history of LSCS , especially in emergency situation. There should be a well dened management protocol in an effort to decrease the number of complications and bring down the overall maternal morbidity & mortality .

scholarly journals Maternal and foetal outcome in elective versus emergency caesarean sections

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.

scholarly journals Anaesthetic management for combined emergency caesarean section and craniotomy tumour removal

2017 ◽  
Vol 04 (01) ◽  
pp. 053-056
Author(s):  
Dewi Bisri ◽  
Caroline Wullur ◽  
Tatang Bisri
Keyword(s):  
Caesarean Section ◽  
Brain Tumour ◽  
Clinical Symptoms ◽  
Anaesthetic Management ◽  
Emergency Caesarean Section ◽  
Intracranial Tumour ◽  
Foetal Distress ◽  
Computed Tomographic ◽  
Emergency Caesarean ◽  
Tumour Removal

AbstractPresentation of primary intracranial tumour during pregnancy is extremely rare. Symptoms of brain tumour include nausea, vomiting, headache and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. In very few cases, craniotomy tumour removal is performed earlier or even simultaneously with foetal delivery. A 40-year-old woman at 32 weeks of gestation in foetal distress presented to the emergency room with decreased level of consciousness Glasgow Coma Scale 6 (E2M2V2). Computed tomographic scan revealed a mass lesion over the left temporoparietal region with midline shift and intratumoural bleeding. In view of high risk of herniation and foetal distress, she underwent emergency caesarean section followed by craniotomy tumour removal. In parturient with brain tumour, combined surgery of tumour removal and caesarean section is decided based on clinical symptoms, type of tumour and foetal viability. Successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of mother and foetus.

scholarly journals Comparison between Vacuum and Forceps Extraction to Neonatal outcome on Prolonged Second Stage of Labor

2016 ◽  
Author(s):  
Kurdi Syamsuri
Keyword(s):  
Apgar Score ◽  
P Value ◽  
Vacuum Extraction ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Significant Difference ◽  
The Subject ◽  
The Common ◽  
The Mean ◽  
Minute Apgar Score

Objective: To assess the effectiveness of vacuum and forceps extraction in prolonged second stage in Dr. Mohammad Hoesin Hospital Palembang. Methods: A retrospective study for 5 years (2005-2009) by doing a prognostic test on prolonged second stage of labor. Results: The subject age most commonly ranges from 20 to 35 years (84.8% in the forceps extraction group and 86% in the vacuum group). The common parity was nulliparity (58.1% in the forceps extraction group and 61.58% in the vacuum extraction). In the forceps extraction group, 76.7% scores >7 in the 1 minute APGAR score with the mean score of 7.14±1.62, whilst in the vacuum extraction group, 79.1% scores >7 in the 1 minute APGAR score, with the mean score of 7.16±1.78. And in the forceps extraction group, 94.2 scores >7 in the 5 minute APGAR score with mean score of 8.62±1.11, whilst in the vacuum extraction group, 93% scores >7 in the 5 minute APGAR score with the mean score of 8.65±1.08. It is concluded that there is no significant differences on both 1 and 5 minute APGAR scores (p value is 0.713 and 0.755, respectively). Maternal complication of extended episiotomy and perineal rupture were found more often in forceps extraction, but with no statistically significant difference (p=0.324). Conclusion: There is no difference of effectiveness between forceps extraction and vacuum extraction in the case of prolonged second stage. Physicians are free whether to use the vacuum or foceps according to their own desirability and skill. [Indones J Obstet Gynecol 2012; 36-1:28-31] Keywords: forceps extraction, prolonged second stage, vacuum extraction

scholarly journals Maternal and Fetal Outcome in Emergency versus Elective Caesarean Section

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.

scholarly journals Study to evaluate association of umbilical coiling index and perinatal outcome

2017 ◽  
Vol 6 (2) ◽  
pp. 408 ◽  
Author(s):  
Deepika Chholak ◽  
Pratiksha Gupta ◽  
Santosh Khajotia
Keyword(s):  
Caesarean Section ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
P Value ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Umbilical Coiling Index ◽  
Meconium Staining ◽  
Umbilical Cords

Background: To correlate the perinatal outcome by noting the umbilical coiling index.Methods: The umbilical cords of the babies born to 500 women, who delivered either vaginally or by lower segment caesarean section, were examined and umbilical coiling index was calculated.Results: There was significant correlation (p value 0.003) between. Hypercoiling (UCI >90th percentile) is associated with IUGR. Hypocoiling (UCI <10th percentile) is associated with: - Meconium staining liquor, high LSCS rates, low Apgar score <7 at 1 min and at 5 min respectively and NICU admissions of babies.Conclusions: Hypercoiling (UCI >90th percentile) is associated with IUGR Hypocoiling (UCI <10th percentile) is associated with meconium staining liquor, high LSCS rates, low Apgar score <7 at 1 min and at 5 min respectively and NICU admissions of babies.

scholarly journals National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section

BMJ ◽  
2004 ◽  
Vol 328 (7441) ◽  
pp. 665 ◽  
Author(s):  
Jane Thomas ◽  
Shantini Paranjothy ◽  
David James
Keyword(s):  
Caesarean Section ◽  
Absolute Threshold ◽  
Routine Care ◽  
Emergency Caesarean Section ◽  
Special Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
England And Wales ◽  
Emergency Caesarean ◽  
Minute Apgar Score

AbstractObjective To examine the association between decision to delivery interval and maternal and baby outcomes.Design National cross sectional survey.Setting Maternity units in England and Wales.Subjects reviewed 17 780 singleton births (99% of all births) delivered by emergency caesarean section in England and Wales between 1 May 2000 and 31 July 2000.Main outcome measures Association between decision to delivery interval and baby outcomes (Apgar scores of < 7 and < 4 at five minutes and stillbirth) and maternal outcomes (requirement for special care additional to routine care after caesarean section and where care was provided).Results Compared with babies delivered within 15 minutes, there was no difference in maternal or baby outcome for decision to delivery interval between 16 and 75 minutes. After 75 minutes, however, there was a significantly higher odds of a five minute Apgar score of < 7 (odds ratio 1.7, 95% confidence interval 1.2 to 2.4), and 50% increase in odds of special care additional to routine care for mothers.Conclusion A decision to delivery interval of 30 minutes is not an absolute threshold for influencing baby outcome. Decision to delivery intervals of more than 75 minutes are associated with poorer maternal and baby outcomes and should be avoided.

scholarly journals Effect of anaesthetic technique on neonatal morbidity in emergency caesarean section for foetal distress

PLoS ONE ◽  
2018 ◽  
Vol 13 (11) ◽  
pp. e0207388 ◽  
Author(s):  
Ipek Saadet Edipoglu ◽  
Fatma Celik ◽  
Elif Cirakoglu Marangoz ◽  
Gulin Haroglu Orcan
Keyword(s):  
Caesarean Section ◽  
Neonatal Morbidity ◽  
Emergency Caesarean Section ◽  
Anaesthetic Technique ◽  
Foetal Distress ◽  
Emergency Caesarean

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

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