Factor Analysis of Caesarean Section at Panti Waluya Hospital, Malang

The incidence of caesarean section in Indonesia has increased every year. Caesarean section is an alternative to delivery when vaginal delivery cannot be done. The problems studied are the factors that influence the action of cesarean section delivery. The purpose of the study was to analyze the factors of delivery by caesarean section at Panti Waluya Hospital, Malang. The design of the study used cross sectional. The population in this study was all parturition mothers who were in the medical records of Panti Waluya Hospital Malang in January-May 2021. The sampling technique in this study used Simple Radom sampling, obtained 55 samples that met the inclusion criteria (ie data in the medical record). The study was carried out at the Panti Waluya Hospital in Malang in May 2021. The instrument used observation sheet. The data taken came from secondary data, namely the patient's medical record. The independent variables of the study were maternal age, gestational age, employment status, parity, disease history, income, insurance, education, delivery distance. The dependent variable of the study was caesarean section. The data analysis used Fisher exact test and logistic regression test. The results showed that history of disease and delivery interval had a significant correlation with delivery, and the variable that was the determinant of CS delivery was history of disease (p=0.012; OR=8.463). It is necessary to carry out routine ANC for pregnant women, in order to avoid risk factors for childbirth by caesarean section.

The Role of Birthplace in the Mode of Delivery in Nepal

The mode of delivery is strong-minded by diverse aspects. The available data and literature argue that the birthplace and birth orders play an imperative role in determining the mode of delivery. This study has been done with the objective to examine the association between the place of delivery and cesarean section in Nepal. A descriptive cross-sectional study was conducted among women who have delivery experience in the last five years of survey, but only the last one has been included. This study is based on the data of Nepal demographic and health survey 2016 [NDHS]. The data were collected from 19 June 2016 to 31 January 2017 through the questionnaires. The sampling frame of Central Bureau of Statistics [CBS] has been updated and used by NDHS where districts and provinces are categorized into urban and rural areas. Frequency tabulation, χ2 test and multivariate binary logistic regressions are used to analyze the data. There are 10.2 percent of women who had a cesarean section. Out of 3998 total deliveries, cesarean deliveries are 406 (10.2%) at 95 percent confidence interval (9-11). The prevalence of cesarean delivery was seen in women delivered in private hospitals 36.3 percent compared to women delivered in government health facilities 12.8 percent. Among 3998 deliveries, 57.4 percent are institutional deliveries. The place of delivery, anti-natal care visit and cesarean section delivery are related to each other. Women who go to private hospitals for anti-natal care and delivery, such hospitals are found to have performed more caesarean sections than the recommended level of World Health Organization (WHO).

Antenatal Mesenchymal Stromal Cell Extracellular Vesicle Treatment Preserves Lung Development in a Model of Bronchopulmonary Dysplasia Due to Chorioamnionitis

Background: Antenatal stressors such as chorioamnionitis (CA) increase the risk for bronchopulmonary dysplasia (BPD). Studies have shown that experimental BPD can be ameliorated by postnatal treatment with mesenchymal stromal cell-derived extracellular vesicles (MEx). However, the antenatal efficacy of MEx to prevent BPD is unknown. Objective: To determine whether antenatal MEx therapy attenuates intrauterine inflammation and preserves lung growth in a rat model of CA-induced BPD. Methods: At embryonic day (E)20, rat litters were treated with intra-amniotic injections of saline, endotoxin (ETX) to model chorioamnionitis, MEx, or ETX plus MEx followed by cesarean section delivery with placental harvest at E22. Placental and lung evaluations were conducted at day 0 and day 14, respectively. To assess the effects of ETX and MEx on lung growth in vitro, E15 lung explants were imaged for distal branching. Results: Placental tissues from ETX-exposed pregnancies showed increased expression of inflammatory markers NLRP-3 and IL-1ß and altered spiral artery morphology. Additionally, infant rats exposed to intrauterine ETX had reduced alveolarization and pulmonary vessel density (PVD), increased right ventricular hypertrophy (RVH), and decreased lung mechanics. Intrauterine MEx therapy of ETX-exposed pups reduced inflammatory cytokines, normalized spiral artery architecture, and preserved distal lung growth and mechanics. In vitro studies showed that MEx treatment enhanced distal lung branching and increased VEGF and SPC gene expression. Conclusions: Antenatal MEx treatment preserved distal lung growth and reduced intrauterine inflammation in a model of CA-induced BPD. We speculate that MEx may provide a novel therapeutic strategy to prevent BPD due to antenatal inflammation.

Cesarean section incisional infiltration with lidocaine and Epinephrine versus Lidocaine alone in reducing postoperative pain. A randomized controlled double-blinded clinical trial

Background Cesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation Aim of the Work to assess the efficacy and safety adding ef Epinephrine to lidocaine 2% in dose-related manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post; caesarean section pain after general anesthesia. Patients and Methods A total number of 200 women planned for elective caesarean section at Shams University Maternity Hospital Was recruited, 2 groups were randomized with a study group included 100 women received lidocaine 2% and epinephrine in dose-related manner and a control group included 100 women received lidocaine 2% only. Results women who received lidocaine and epinephrine were more satisfied and hadsignificant more time after caesarean section free of pain in comparison to women who received lidocaine only by 120 minutes. Also. adding Of epinephrine helped in decrease in amount of analgesic consumption after caesarean section. Women who received lidocaine and epinephrine started breast feeding and mobilization earlier than women who received lidocaine only. Epinephrine prolonged the action of lidocaine as a local anesthetic, this prolongation of action of local anesthetic had a significant effect in early mobilization and breast feeding and decrease in cost of analgesics. Nobody in our candidate had a post-operative infection, past operative pyrexia, Allergic reactions tar general anesthesia or complications with local anesthesia. Conclusion Adding of epinephrine to local anesthetics (such as lidocaine 2% in dose-related manner 1:200.0000) prolonged anesthetic effect by more than double of its original anesthetic time, This prolongation on anesthetic effect of local anesthesia by epinephrine helps in eariy mobilization; early breast feeding and less hospital duration stays. No complications (local nor systemic) developed with local infiltration of post-caesarean section incision with lidocaine 2% even aficr adding epinephrine in dose-related manner 1:200.000

Analysis of Cesarean section delivery in Ain Shams University hospital according to the Robson’s 10-group classification system

Background Cesarean delivery is increasing worldwide in the last few years, unnecessary CS is a growing problem affecting both developed as well as developing countries. There is no benefits either to mother or neonate when the procedure is not medically indicated. The ideal rate of CS is considered between 10%-15%, beyond which there is no benefits for either mother or fetus. However recent studies showed a much higher rate of CS. WHO proposes that health care facilities use the Robson's 10 group classification system to monitor their CS rates. This classification helps to understand the internal structure of the CS rates at each health facilities, the indications in each group and formulate strategies to reduce these rates. Objectives the aim is to describe the frequency of CS delivery in Ain Shams University Maternity Hospital by Robson classification. And to describe maternal and neonatal outcomes. Methods The study was a descriptive cross sectional study conducted at labor ward of Ain Shams University Maternity Hospital (a tertiary care center). All women delivered by CS during a period of six months were recruited and classified into 10-Robson's groups. The overall CS rate were calculated, and also the contribution of each groups to the overall CS rate. Results The highest contribution to the overall CS was by group five 38.98%, followed by group ten 34.20%. While group 9 was lowest frequency 0.50% of overall CS rates. Conclusion s: The use of Robson’s classification system allows to monitor the CS rates which helps to identify the main contributors for the increasing CS rates, also helps to identify the target groups that may benefit from implementations of interventions for reducing CS rates. Women with previous CS were an important determinant of overall CS rates, reducing primary CS rates, counselling for VBAC, encouraging versions when available, could reduce the CS rates.

Factors Associated with Discontinuing Exclusive Breastfeeding among Mothers of Infants Aged 0-6 Months

IntroductionKnowing breastfeeding is one of the easiest and cost-effective ways to maintain a good childhealth, majority infants are not exclusively breastfed for the recommended 6 months of age.Thus, the aim of the study was to find out the factors associated with discontinuing exclusivebreastfeeding (EBF) among mothers of infants’ aged 0-6 months. MethodsA analytical study design was used to find out the factors associated with discontinuing EBFamong mothers of infants’ aged 0-6 months in Nepal. A total of 380 mothers of infants whosechild were 0-6 months old were selected using non-probability purposive sampling techniquethrough online survey as people are advised to stay at home during the Covid-19 outbreak. Datawas collected using structured questionnaire with interview technique. ResultsStudy findings revealed that half (50.5%) of the mothers exclusive breastfed their infants withmother’s mean age being 27.39 ± 3.64 years. Discontinuation of EBF varied with mothers age,ethnicity, mother’s educational level, initiation of breastfeeding and sources of informationregarding EBF as newspaper/articles and relatives/friends/neighbors (p=<0.005). The factorsrelated to mother that are associated with discontinuation of EBF were found to be perceivedinsufficient milk, cesarean section delivery, jobholder mother (p= <0.001) respectively. ConclusionsOnly half of respondents exclusively breastfed their infants for the recommended age in whichonly factors related to mother were significant with discontinuation of EBF rather than infants’.Findings of the study emphasizes on counselling the mothers regarding the benefits of EBF toboth child and mother during hospital visits. Keywords: exclusive breastfeeding; factors; under 6 months; EBF.

Vacuum Extractor Versus Manual Head Extraction During Cesarean Section

Background: For multifactorial reasons, the rate of cesarean deliveries increased clearly over a decade; decreased in vaginal births after cesarean (VBAC), multiple gestation, maternal obesity, pre-term labor, gestational diabetes or hypertension, increased number of high-risk expectant mothers and the obstetrical medico-legal environment. Delivering the fetal head at cesarean section can also be a lengthy operation and can result in maternal or fetal Complications. The vacuum extractor allows for the application of traction on the fetal head. In this study we aim to compare the safety (for mother and infant) and efficacy of delivery of the fetal head in cesarean section using vacuum extractor with the manual extraction. Methods: This study was conducted on 60 pregnant women undergoing cesarean section. All patients were between 37 and 42 weeks of pregnancy with signs of healthy fetus and were divided into 2 groups; Group I- 30 patients subjected to vacuum extraction at the cesarean section, Group II- 30 patients subjected to the conventional cesarean method. The result: The BMI of women in group I was 27.90 ± 0.96 and in group II was 28.0 ± 0.98. The gestational age of the babies in Group I and II were 39.0 ± 1.02 and 39.0 ± 0.98 weeks. U-D interval for Group I and Group II were 48.40 ± 17.63 and 73.87 ± 16.76 days respectively. The estimated blood loss in group I and group II were 478.0 ± 59.62 and 464.7 ± 52.57 respectively. The birth weight of the babies delivered in Group I and Group II were 4253.33 ± 118.72 and 4246.67 ± 135.58 KG respectively. The five minutes Apgar score for Group I and Group II were 8.50 ± 0.68 and 8.57 ± 0.57. Conclusion: The use of the vacuum extractor at cesarean section may be a safe and effective method to facilitate delivery of the large fetal head and cesarean section delivery can be simplified by this technique.