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PubMed2002

Frequency of, indications for and clinical epidemiological characteristics of first time cesarean section, compared with repeated cesarean section.

UNLABELLED: The aim of this study was to determine the frequency of, indications for and clinical epidemiological characteristics in patients having their first cesarean section (FCS) and then to compare the data with that found in patients with repeated cesarean section (RCS). PATIENTS AND METHODS: A cross-sectional study was carried out. 493 pregnant patients who gave birth by cesarean section or vaginal delivery were seen. Some of the variables analyzed were: age, prenatal care consultations, gyneco-obstetric antecedents, cesarean section indication and neonate weight. Statistical analysis included ANOVA, chi(2) and OR, with a 95% CI. Significance was p<0.05. RESULTS: 66% of the patients had vaginal births (VB) and 33.4% had cesarean sections, with a FCS frequency of 61%. The three most frequent indications for FCS were dystocias and cephalopelvic disproportion (45%), fetal distress (12.8%), and pelvic presentation (9.9%). Meanwhile, those for RCS were previous cesarean section (51%), dystocias (20%) and pelvic presentation (6.2%). The variables significantly associated with FCS were: first pregnancy, antecedent of labor room induction and a neonate weight above 3500 g. The remaining variables were not associated with FCS. Percentages of nulliparity, secondgravidity and multigravidity were greater in RCS patients. CONCLUSION: The frequency of FCS is still high in Mexico. Adequate following of programs to diminish the percentage of FCS and increase the number of VB, would significantly reduce the prevalence of cesarean section.

Adolescent↗
PubMed2005

Repeat cesarean section and primary elective cesarean section: recently trained obstetrician-gynecologist practice patterns and opinions.

OBJECTIVE: This study was undertaken to determine opinions of obstetrician-gynecologists regarding vaginal birth after cesarean (VBAC) section and elective cesarean section. STUDY DESIGN: A questionnaire was administered to obstetrician-gynecologists attending 2 review courses. RESULTS: Of 500 obstetrician-gynecologists, 304 completed the survey for a response rate of 61%. Most (92%) counseled VBAC candidates differently, and 84% quoted differential VBAC completion rates on the basis of the indication for prior cesarean section. Uterine rupture was virtually always discussed (99%). Pelvic floor risks were infrequently discussed with urinary incontinence, pelvic organ prolapse, and fecal incontinence discussed by less than one third of obstetricians (30%, 28%, and 25%, respectively). Fifty-nine percent of physicians would perform a primary elective cesarean section, and 67% would perform a primary elective cesarean section specifically to prevent pelvic floor disorders. CONCLUSION: Two thirds of recent graduates are willing to perform an elective cesarean section to prevent pelvic floor injury. Most offer VBAC; however, less than a third include risk of pelvic floor injury in their informed consent discussions.

Adult↗
PubMed1988

[Surgical technic of cesarean section. A preparatory cesarean section method primarily for saving the amnion].

A new technique of Caesarean delivery which makes adequate room for safe and gentle extraction of the infant and prevents injury to the foetus and the uterus is presented. The method consists of careful, layer by layer dissection in the lower uterine segment while keeping - whenever possible - the amniotic membranes intact. The opening can be made as large as needed. In a second step, the amniotic sac, now in full view, is carefully opened and the foetus safely extracted. In the ideal case, the lower part of the still intact amniotic sac containing the presenting part of the infant can be lifted out in front of the incision. There the membranes are opened and the foetus delivered. Bleeding is minimal and injury to the foetus and uterus is almost impossible. The wound can be closed with a single-layer suture, which promotes rapid healing and eliminates the danger of rupture during subsequent pregnancies. Further investigations will be necessary to prove whether this technique - lower cervical transverse Caesarean section with late amniotomy - will be worthy of becoming a standard procedure.

Adult↗
PubMed2001

[Non-closure of peritoneum at cesarean section. Results from repeat cesarean sections].

OBJECTIVES: A number of publications advocate the short-term advantages of peritoneal nonclosure at cesarean section. However, currently there are no hard data available about long-term results and the repeat cesareans. MATERIAL AND METHODS: The study group of this retrospective analysis consisted of 30 women who underwent a repeat cesarean delivery, after a previous cesarean without closure of the visceral and parietal peritoneum. The control group (n = 31) had undergone peritoneal closure at the primary operation. All cesareans were performed at the same institution between 04/01/1997 and 12/31/1998 (first operation), and 01/01/1999 and 06/30/2000 (repeat operation). RESULTS: The mean operation time was 38.9 (+/- 11.6) minutes in the study group and 44.2 (+/- 13.6) minutes in controls (p = 0.05). The mean incision-delivery time was 6.7 (+/- 3.2) minutes in the study group and 9.1 (+/- 3.9) minutes in controls (p < 0.01). No difference in intraoperative blood loss was observed between the two groups. In each cohort one case with significant intraabdominal adhesions was observed. CONCLUSION: Our results indicate that nonclosure of the peritoneum at primary cesarean section does not promote intraabdominal adhesions. This appears to be beneficial for the repeat cesareans.

Abdomen↗
PubMed1981

Postpartum sterilization in cesarean section and non-cesarean section deliveries: United States, 1970-75.

National Hospital Discharge Survey data indicate that the overall postpartum sterilization rate per 100 deliveries increased by 75 per cent from 4.0 in 1970 to 7.0 in 1975; by type of delivery, rates rose from 18.0 per 100 cesarean section deliveries and 3.2 for all other deliveries in 1970 to 19.0 and 5.6 respectively in 1975. The South had the highest postpartum sterilization rates overall. Deliveries to older mothers and cesarean section deliveries in hospitals with less than 100 beds were more often characterized by higher sterilization rates.

Adult↗
PubMed2003

Vaginal birth after cesarean section: trial of labor or repeat cesarean section? A decision analysis.

OBJECTIVE: The risk of perinatal death associated with labor after previous cesarean section appears higher than with a repeated cesarean section. On the other hand, repeated cesarean sections are associated with increased maternal morbidity and mortality from placental pathologic conditions (previa or accreta) on subsequent pregnancies. The study was undertaken to analyze the decision for a trial of labor or a repeated cesarean section, after a prior cesarean section, with varying desire for an additional pregnancy. STUDY DESIGN: A model was formulated using a decision tree, based on the reported risks of the two approaches. Sensitivity analysis was performed over a variety of probabilities (eg, chance of uterine rupture or neonatal death, chance of rescue cesarean section, desire for an additional pregnancy) and utilities (eg, use of hysterectomy or neonatal death). RESULTS: The model favors a trial of labor if it has a chance of success of 50% or above and if the wish for additional pregnancies after a cesarean section is estimated at near 10% to 20% or above because the delayed risks from a repeated cesarean section are greater than its immediate benefit. The model was robust over a wide range of assumptions. CONCLUSION: An optimal decision for a trial of labor or a repeated cesarean section is substantially determined by the wish for future pregnancies. The default option of a repeated cesarean section is not directly applicable in populations in which family planning often extends over two children.

Cesarean Section, Repeat↗
PubMed1987

Trial of labor in previous cesarean section patients, excluding classical cesarean sections.

The American College of Obstetricians and Gynecologists has supported the concept of a trial of labor in patients with a previous lower uterine transverse cesarean section, and its safety is generally accepted. The purpose of this report was to present the results of a year-long, prospective study in which the indications for trial of labor were liberalized. Only patients with a previous classical incision or "T" incision on the uterus were excluded. Two hundred seventy-two patients elected to undergo a trial of labor. Vaginal delivery occurred in 216 patients (76.5%). Oxytocin was used as needed, and epidural anesthesia was used in all patients who requested it. One uterine rupture occurred in a patient with a single lower transverse scar. The results of this study suggest that a trial of labor is a safe alternative for patients with a previous single or multiple lower uterine transverse incision or a lower uterine vertical incision. In addition, the use of epidural anesthesia and oxytocin appears safe in patients undergoing a trial of labor.

Anesthesia, Epidural↗
PubMed1999

The effect of public accountability on hospital performance: trends in rates for cesarean sections and vaginal births after cesarean section in Cleveland, Ohio.

The article reports a study that was designed to identify whether hospitals in the Cleveland, Ohio area have responded to public concern about improving their cesarean section and vaginal birth after cesarean section (VBAC) rates. A 14-item survey based on the Joint Commission on Accreditation of Healthcare Organizations' 1997 Codman Quality Award was administered to 20 hospitals. Respondents self-scored the survey based on a 5-point Likert scale. Three hospitals provided a detailed description of their efforts. Results showed that all hospitals are at various stages of the process to improve their cesarean section and VBAC rates. From this, it is proposed that public accountability encourages quality improvement.

Cesarean Section↗
PubMed1998

Psychological impact of emergency cesarean section in comparison with elective cesarean section, instrumental and normal vaginal delivery.

The purpose of the study was to compare the psychological reactions of women after emergency Cesarean section (EmCS), elective Cesarean section (ElCS), instrumental vaginal delivery (IVD) and normal vaginal delivery (NVD). The participants (EmCS, n = 71, ElCS, n = 70, IVD, n = 89, and NVD, n = 96) answered questionnaires a few days postpartum and 1 month postpartum. The EmCS group reported the most negative delivery experience at both times, followed by the IVD group. At a few days postpartum the EmCS group experienced more general mental distress than the NVD group, but not when compared with the ElCS or the IVD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ElCS and NVD groups, but not when compared to the IVD group. An unplanned instrumental delivery (EmCS or IVD) should be regarded as a pointer with respect to possible post-traumatic stress.

Adolescent↗
PubMed1976

Elective cesarean hysterectomy: a 5 year comparison with cesarean section.

Elective cesarean sections performed on the obstetric service at the University of Arkansas Medical Center were reviewed for the period January 1, 1970, through December 31, 1974. The purpose of the review was to compare operative and postoperative complications of cesarean section, cesarean section and tubal ligation, and cesarean section and elective hysterectomy. A total of 1,255 cesarean sections were performed of which 207 (17 per cent) were associated with tubal ligation and 242 (18 per cent) with hysterectomy. Elective cesarean hysterectomies were performed for elective sterilization (68 per cent), for medically indicated sterilizations (11 per cent), or for definitive treatment of uterine pathology(21 per cent). All cesarean sections were obstetrically indicated with the exception of 34 primary cesarean hysterectomies performed as definitive treatment of carcinoma in situ of the cervix. The operative procedures were compared in regard to the following characteristics or complications: operating time; incidence of blood transfusions, urinary tract injuries, postoperative bleeding, febrile morbidity, and other postoperative complications; and postoperative hospital days.

Adolescent↗