Analytic Study of Indications and Complications Associated with Cesarean Section in Omar AL-Mukhtar Hospital

Cesarean section (C-section) is a surgical procedure designed to ensure the safety of the mother and the child when vaginal delivery is not possible. There is a progressive increase in cesarean deliveries across the world. C-section is associated with increased morbidity and mortality in pregnant mothers and infants, particularly in developing countries. The aim of the current study was designed to determine the rate and identify the indications and find out complications associated with C-sections in Omar AL-Mukhtar hospital. The descriptive retrospective study was carried out with data retrieved from statistics files from January 2018 to December 2018. A total of 754 births during the study period, out of the 226 were delivered by C-section. The overall C-section rate was 29.9%. The maximum number of C-sections was in the age group of 31-40 years (42%) followed by 41.2% of women in the age group of 21-30 years. The most common indication was elective repeated C-section (17%) followed by previous one C-section with other causes (10.6%), fetal distress (9.29%). The complications in our study were about 47 cases and were less accounted for (20.79%), like, postpartum and intraoperative hemorrhage, and anesthetic complications, which represented 5.75%, and 10.62% respectively. In conclusion: The cesarean delivery rate in this study was higher than the WHO recommendation, and elective repeat cesarean delivery was a major common indicator. Keywords: C-section; Indication; Complication of C- section

Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

This article provides a summary of a landmark study in obstetrics. The article provides insight on a pivotal question; Is delivery before 39 weeks among patients undergoing elective repeat cesarean delivery associated with increased risk of adverse neonatal outcomes? The authors describe the basics of the study, including study location, study population, number of patients, study design, endpoints, results, and limitations. The article briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The article places these finding in contemporary context and highlights its impact on obstetric care. In addition, the author reference updated national guidelines developed as a result of this study.

Fetal Malpresentation in Pregnancy

Fetal presentation refers to that anatomical part of the fetus that presents at the maternal pelvic inlet. The most common and most desirable fetal presentation is cephalic (head first). Any presentation other than cephalic is referred to as a malpresentation. Breech is the most common fetal malpresentation. The prevalence of breech presentation varies with gestational age (25% at 28 weeks and 3-5% of at term). Ultrasound evaluation is the gold standard for the diagnosis of fetal presentation. External cephalic version (ECV) refers to a series of manual manipulations designed to convert a malpresenting fetus to cephalic to promote vaginal delivery. There are two strategies around the timing of ECV; at 36-37 weeks and/or at or shortly after 39 weeks’ gestation. Each has advantages and disadvantages. Currently, most breech pregnancies at term are delivered by cesarean at 39 weeks prior to the onset of labor. Malpresentation is the second most common indication for planned cesarean (behind elective repeat cesarean). Vaginal delivery for a breech fetus at term should only be attempted if the mother is strongly motivated, if the obstetric care provider is experienced, and if the medical center has the requisite facilities to manage any and all complications. This review contains 3 figures, 2 tables, and 66 references. Keywords: fetal presentation, malpresentation, breech presentation, ultrasound evaluation, external cephalic version (ECV), cesarean delivery, vaginal breech delivery