PubMed · 14934507
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A A MARCHETTI. 1952. [Cesarean section].. https://pubmed.ncbi.nlm.nih.gov/14934507/
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OBJECTIVES: To assess the association between elective caesarean section and postnatal depression compared with planned vaginal delivery and whether emergency caesarean section or assisted vaginal delivery is associated with postnatal depression compared with spontaneous vaginal delivery. DESIGN: Prospective population based cohort study. SETTING: ALSPAC (the Avon longitudinal study of parents and children). PARTICIPANTS: 14,663 women recruited antenatally with a due date between 1 April 1991 and 31 December 1992. MAIN OUTCOME MEASURE: Edinburgh postnatal depression scale score > or = 13 at eight weeks postnatal on self completed questionnaire. RESULTS: Albeit with wide confidence intervals, there was no evidence that elective caesarean section altered the odds of postnatal depression compared with planned vaginal delivery (adjusted odds ratio 1.06, 95% confidence interval 0.66 to 1.70, P = 0.80). Among planned vaginal deliveries there was similarly little evidence of a difference between women who have emergency caesarean section or assisted vaginal delivery and those who have spontaneous vaginal delivery (1.17, 0.77 to 1.79, P = 0.46, and 0.89, 0.68 to 1.18, P = 0.42, respectively). CONCLUSIONS: There is no reason for women at risk of postnatal depression to be managed differently with regard to mode of delivery. Elective caesarean section does not protect against postnatal depression. Women who plan vaginal delivery and require emergency caesarean section or assisted vaginal delivery can be reassured that there is no reason to believe that they are at increased risk of postnatal depression.
We hypothesized that cord blood erythropoietin (EPO), a marker of fetal hypoxia, relates to gestational factors and not solely those associated with delivery. We investigated the association between birth weight SD score (SDS) and cord blood EPO in 290 twins (145 pairs), assessing the influence of gestational versus perinatal factors by comparing the association in those who were delivered by elective cesarean (CS) with that in other delivery modes. Blood EPO values were skewed, so geometric means are presented and log EPO values were used in statistical models. The birth size-EPO association was estimated in mixed-effects models that included terms that represented difference in log EPO and mean log EPO for each twin pair. Within-pair estimates of the association were unconfounded by maternal factors (because these were perfectly controlled). Geometric mean EPO was higher in boys versus girls (24.4 versus 17.0 IU/L; p = 0.0001) and increased with gestational age (p = 0.0003) but was similar after elective CS versus other delivery modes. The negative birth size-EPO association was stronger in infants who were delivered by elective CS than by other delivery modes [beta for log(2) EPO: -0.56 (95% CI, -0.77 to -0.36) versus -0.27 (-0.42 to -0.12), respectively; p = 0.02 for interaction). Because the association was seen after elective CS delivery, cord blood EPO must relate to factors during gestation, not just perinatal factors. There was no evidence of an association between birth weight SDS and pair mean log EPO, indicating that the association is entirely due to fetus-specific rather than pair-specific factors.
OBJECTIVE: The objective of the study was to find out the indications for management and the outcomes of reopening the abdomen during the puerperium after Cesarean section. PATIENTS AND METHODS: This was a retrospective descriptive survey at the Korle Bu Teaching Hospital in Accra, Ghana. RESULTS: There were 6120 Cesarean sections (17%) out of a total of 36,010 deliveries. Re-laparotomy was done in 44 patients (0.7%) of the Cesarean sections. The indications were: hemorrhage from uterine atony, hemorrhage from placental bed after operation for placenta previa, uterine sepsis with hemorrhage, hemorrhage after Cesarean section, myomectomy and hemorrhage from anterior abdominal wound dehiscence. The main surgeries performed were: hysterectomy, ligation of ascending branches of uterine arteries, ligation of hypogastric arteries, debridement and re-suturing of the uterine incision and secondary suturing of anterior abdominal wall. There were 6 near missed fatalities. There were 4 mortalities caused by excessive hemorrhage and severe sepsis. CONCLUSION: The case fatality rate for re-laparotomy after Cesarean section is high (9%). Near missed-fatalities are common. To reduce the unfavorable outcomes, instituting more intensive education on the use of the partograph should prevent prolonged labor. Centers carrying out Cesarean section should have efficient blood transfusion service in place.