A study of feto maternal outcome in primary caesarean section

Background: Primary caesarean section is defined as caesarean section to be performed in women who have not had previous caesarean delivery. The increase in the rates of primary caesarean section is not only due to increased caesarean section in nulligravida but also due to upward rise in caesarean section rates in parous women. Through this study we aimed to examine the frequency and the indications of primary caesarean section in nulliparous and multiparous women.Methods: A prospective study was carried out in the OBGY department of smt. SCL Hospital, NHL municipal medical college from April 2020 to April 2021. All multiparous women with previous normal vaginal delivery who underwent caesarean section this time were included in this study. Patients with previous caesarean section <28 weeks of gestation, patients who did not give consent were excluded from the study.Results: 92% were 20-30 years and are gravida 2 or 3 patients. 85% patients were booked patients. Most common indication of primary caesarean section in parous women was MSL+FD (31%). Difficulty in delivery of the baby was encountered in 45% of cases. Major cause of admission in NICU was MAS.Conclusions: Primary caesarean section has become a major driver of overall caesarean section rate. Decision making on primary caesarean section should be carefully scrutinized, introducing a diagnostic second opinion for all primary caesarean section. Primary caesarean section in both multigravida and primigravida becomes mandatory in many cases to prevent maternal and feta morbidity.

Vaginal birth after previous caesarean section in women at Al-Wahda hospital Derna, Libya

Background: Vaginal birth after caesarean section is one strategy that has been developed to decrease the rate of caesarean section.Methods: The prospective observational study was carried out over a period of 01 January 2017 to 31 December 2018 years. VBAC was routinely offered at Al-Wahda hospital Derna to women fulfilling the criteria for trial of scar, according to the hospital protocol.Results: A total of 5018 deliveries took place in the study duration, there were 1039 (20.7%) had previous one caesarean section, out of which 319 (30.7%) were the number of underwent repeat caesarean section and 720 (69.3%) were the number of VBAC. The indications for emergency repeat caesarean section at Al-Wahda hospital was (29.3%) malpresentation, (24.45%) FD, (13.47) postdate, (11.59) obstracted lab and abruptiopl (5.95%). Anemia and difficult intubation were observed in repeated caesarean section.Conclusions: This study concluded that there is a high chance of success in a trial of labor. These findings might help clinicians and women in the decision-making for the mode of delivery when it comes to pregnancy with a previous caesarean section. Women are explained about the option of trial of scar and told about the risk associated with a repeat CS, so many CSs can be avoided.

Maternal outcome in accreta cases. Conservative surgery and hysterectomy in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2017 to January 2018

HIGHLIGHT1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed.3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital.ABSTRACTObjectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018.Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure.Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Women's experiences of VBAC in Cyprus: a qualitative study

Background and aim In 21st century, there has been an increasing interest in vaginal birth after previous caesarean section (VBAC) in Cyprus, a country with a very high operative birth rate. Research-based evidence of women’s VBAC experiences in Cyprus is non-existent, despite its significance for the well-being of mothers and families. The aim of this study is to gain insight into the women’s lived experience of VBAC in Cyprus. In this study women’s experiences of VBAC are explored for the first time in Cyprus. Method The study is qualitative and exploratory in nature. Data were collected through semi-structured interviews with 10 women, who experienced vaginal birth after a previous caesarean section (VBAC) in Cyprus. A descriptive phenomenological approach was employed for the analysis of data. Results Analysis of data yielded four major themes: (a) medicalization of childbirth, (b) preparing for a VBAC, (c) birth environment, and (d) healing through VBAC. On the whole, the women interviewed described their previous experience of CS as traumatic, in contrast to vaginal childbirth. VBAC was considered an utterly positive experience that made the women feel empowered and proud of themselves. Conclusion This study offers valuable insight into a newly researched subject in Cyprus, which is necessary for advancing perinatal care in Cyprus. The findings indicate that women need evidence-based information, guidelines on birthing options, good preparation with tailored information and personalized care for a successful vaginal birth after a previous caesarean section. Proper, non-biased, consultations are a main factor that affects women’s choice of mode of birth. The introduction of new, women-friendly perinatal strategies that respect and promote childbirth rights is imperative in the case of Cyprus. All women have the right to exercise informed choice and the choice to alternative birthing options.

Birth after previous caesarean section

Midwifery and obstetric involvement in supported decision making and subsequent clinical practice around birth after caesarean section has been much debated and negotiated for some time. This article discusses some of the clinical evidence and factors to be taken into account when providing support and information for women and birthing people considering their options for birth after caesarean. The article focuses on the currently published guidelines to support practice and guide discussions with women and birthing people. In the article, the terms ‘planned vaginal birth’ and ‘vaginal birth after caesarean’ are used interchangeably.

CAESAREAN SCAR ECTOPIC -A RARE ENTITY

Caesarean scar pregnancy (CSP) is an ectopic pregnancy implanted in (1) the myometrium at the site of a previous caesarean section scar Its incidence is rising with the increase in number of caesarean sections .Very rst case was reported in 1978

Obstetric Anal Sphincter Injuries – Maternal, Foetal and Sociodemographic Risk Factors: A Retrospective Register-Based Study

Objective. To determine risk and protective factors of obstetric anal sphincter injuries (OASIS). Design. A retrospective register-based observational study. Setting. Sweden. Population. A cohort of 988, 988 singleton term deliveries 2005-2016 were included. Methods. Data from the Swedish Medical Birth Registry and Statistics Sweden were extracted to identify cases of OASIS and maternal and foetal characteristics. Modified Poisson Regression analyses were performed to assess risk factors. Main outcome measures. Risk ratios for OASIS with 95% confidence interval associated with maternal and foetal risk factors were calculated. Results. The rate of OASIS was 3.5% (n=34, 583). Primiparity (aRR 3.13 95% CI 3.05–3.21), vacuum extraction (aRR 2.79 95% CI 2.73–2.86), forceps (aRR 4.27 95% CI 3.86–4.72) and high birth weight (aRR 2.61 95% CI 2.50–2.72) were associated with a significantly increased risk of OASIS. Increasing maternal age and decreasing maternal height increased the risk of OASIS. Smoking (aRR 0.74 95% CI 0.70–0.79) and low maternal education (aRR 0.87 95% CI 0.83–0.92) were associated with a decreased frequency of reported OASIS. Obesity decreased the risk of OASIS (aRR 0.90 95% CI 0.87–0.94), but only after adjusting for foetal birth weight. Previous caesarean section increased the risk of OASIS (aRR 1.41; 95% CI 1.36–1.47). Conclusion. Primiparity, instrumental delivery and high birth weight increased the risk of OASIS. Risk factors including BMI, height, age, smoking, maternal education, ethnicity and previous caesarean section also contribute to the overall risk of OASIS. Keywords. Obstetric sphincter injuries, risk factors, pregnancy.

Conducción del trabajo de parto en gestantes con cesárea previa en el Hospital Central Universitario Dr. Jesús María Casal Ramos. Acarigua-Estado Portuguesa.

Objective: To estimate the safety of vaginal delivery in pregnant women at term in spontaneous labor with previous cesarean section who attended the Obstetric Emergency Service of the Dr. Jesús María Casal Ramos University Hospital, in the period January-June 2018. Methods: A prospective, descriptive, cross-sectional and non-causal correlational study was conducted in pregnant women at term with a previous caesarean section in labour. The medical records of full-term pregnant women who entered into spontaneous labor and who underwent conduction of labor were reviewed if the indication for cesarean section did not persist, recording maternal, fetal and neonatal complications. Results: We attended 245 pregnant women, with previous cesarean section, 108 patients were included of which 99 (92 %) did not present complications and of the remaining nine, 4 (44 %) presented grade I tear, 4 (44 %) grade II tear and only 1 (12 %) grade III tear. The most frequent anatomical location was vaginal in 6 (67 %), cervical in 3 (33 %); the size of the same was not described; the grade III vaginal tear was sutured, did not require blood transfusion and the product weighed 4000 kg. There were no maternal deaths or fetal complications or fetal deaths. Conclusions: Spontaneously initiated vaginal delivery in pregnant women with previous caesarean section is 92% safe. Keywords: Vaginal Birth, Prior caesarean, Interpartum interval, Labor conduction.

ANAESTHETIC MANAGEMENT IN CAESAREAN SECTION IN A PARTURIENT WITH KYPHOSCOLIOSIS : A CASE REPORT

Alterations in maternal physiology and pathological changes in kyphoscoliosis results in anaesthetic complications for caesarean section with potential risk for both mother and fetus. Safe and skilled anaesthetic management to minimize risk to mother and fetus is required. We report a case of 25-year-old female, with G2P1L1, with 28 weeks of period of gestation, with history of previous caesarean section, with pre-eclampsia, with kyphoscoliosis in labour with contracted pelvis, managed by general anaesthesia for caesarean section.

Frequency of Placenta Previa in Women with Previous Caesarean Section

Objectives: To determine the frequency of placenta previa in women with previous caesarean section presenting at Obstetrics and Gynecology department. Study Design: Descriptive (cross-sectional) study Setting and Duration: The study was carried out in the Department of Obstetrics and Gynecology of Abbottabad Medical Complex, Abbottabad and Mufti Mehmood Teaching Hospital, D. I. Khan during from December 2020 to May 2021. Methodology: The study population included those who have had at least one or more caesarean section, whether emergency or elective and irrespective of the cause of previous caesarean section with age group of 20 to 45 years of age. Patients fulfilling the inclusion and exclusion criteria were enrolled in the study after taking the informed consent. The aims and objectives of the study were explained to the patients being enrolled and their relatives and assured about confidentiality of information. Women included in the study underwent complete history, physical and gynecological examination. Results: A Total of 147 patients were included in the study sample with placenta previa. Mean age of the patients was 28.69±6.086, ranging from 20 to 45 years. Mean value of the parity was 3.18±1.141 ranging from 2 to 7 in the descriptive analysis, and the mean of gestational age (weeks) was 39.029±1.5618 ranging from 36.4 to 41.0 weeks. Out of 147 patients, Placenta previa diagnosed by ultrasound was found in 26(17.7%) patients. Conclusion: The study concludes that the frequency of PP in this setting is in keeping with globally cited frequencies. Other findings such as causes of PP and maternal morbidity data also agree with most national and international studies on this topic. Key Words: Placenta previa, Previous Caesarean Section