[Contribution to the historical and iconographical study of the cesarean section (cesarean section in the 15th centry)].
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Cesarean Section↗
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[On subsequent parturition after cesarean section; on repeated cesarean section; and on cesarean section after early vaginal delivery].
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Cesarean Section↗
Early developmental profiles of plasma corticosterone are altered by birth condition in the rat: a comparison of vaginal birth, cesarean section, and cesarean section with added anoxia.
Circulating glucocorticoids play a role during the immediate postnatal period in adapting the neonate to extrauterine life and are also thought to influence tissue development and function in the later postnatal period. In the present study we have used a rat model to test whether birth by cesarean section (C-section), either alone or with an added period of acute anoxia, affects the development profile of basal corticosterone secretion during the first 5 wk of life. Plasma levels of total corticosterone and of corticosteroid-binding globulin were measured at various times after birth in rats born vaginally, by C-section, or by C-section with 15 min of added anoxia. These measures allowed for calculation of levels of free, biologically active, corticosterone. Under all conditions, total corticosterone appeared to accurately reflect levels of free corticosterone. Plasma corticosterone levels measured immediately (< 5 min) after birth were similar in male rat pups born vaginally, by C-section, or by C-section with added anoxia, whereas female pups born by C-section showed a significant increase in free corticosterone at birth, in comparison with vaginally born females. Both male and female animals born by C-section showed a reduction in plasma corticosterone at 1 h (male: 31% of control, p < 0.01; female: 45% of control, p < 0.05) and at 7 d (male: 61% of control, p < 0.01; female: 55% of control, p < 0.05) after birth, in comparison with vaginally born controls. In animals born by C-section with added anoxia, significant reductions in plasma corticosterone were observed for males at 1 h (58% of control; p < 0.05) and for females at 7 d (62% of control; p < 0.05) after birth. At 14 d of age, corticosterone levels were higher in male rats born by C-section either with (227% of control; p < 0.05) or without (239% of control; p < 0.05) added anoxia, in comparison with vaginally born controls. Thus C-section birth produces an early rise in plasma corticosterone on d 14 away from the low values associated with the adrenal quiescent period in the first 1-2 wk in the rat. By 35 d of age, there were no differences in plasma corticosterone attributable to C-section birth and/or acute birth anoxia, in either male or female rats. It is concluded that, in a rat model, birth by C-section has significant effects on the profile of plasma corticosterone during the early weeks of development, a period though to be critical for effects of corticosteroids on developing tissues. Because the rat at birth is developmentally less mature than is the term human neonate, these findings may have implications for development of the premature human neonate.
Animals↗
Changes in plasma coagulation markers with prophylactic treatment of low molecular weight heparin after cesarean section.
Cesarean section has been identified as a major risk factor for thromboembolism, and additional risk factors place some women at a much higher risk during puerperium. Recently, low molecular weight heparins (LMWHs) have been used for thromboembolism prophylaxis after cesarean section. We investigated the effect of risk factors of thromboembolism on plasma coagulation markers when the LMWH dalteparin was used following cesarean section. Twenty-four women with risk factors other than cesarean section (high-risk group) and 13 without any other risk factors (low-risk group) received dalteparin starting immediately after cesarean section until the patients were mobilized. Sixteen women without any other risk factors served as controls (control group). Activated partial thromboplastin times, thrombin-antithrombin complex, alpha (2)-plasmin inhibitor-plasmin complex, and activated factor X levels were not different between the high-risk and the low-risk groups. However, fibrinogen/fibrin degradation products D-dimer levels were higher in the high-risk group than in the low-risk and control groups on days 3 and 7 after cesarean section. These findings suggest that the D-dimer levels may be elevated by some risk factors and that postoperative D-dimer determinations may be useful in assessing the risk of thromboembolism during LMWH treatment after cesarean section.
Adult↗
[A breech presentation after a cesarean section--is cesarean section always needed?].
The author has made a survey of published materials supporting the conception of selective vaginal delivery in cases of breech presentation after a previous Caesarean section. A number of such cases have been studied with expected fetus weight between 2500 and 3500 g and there have been no complications for mother or child. Vaginal delivery in cases of breech presentation and a previous Caesarean section seems acceptably safe. The possibility for a vaginal delivery provided that all obstetric requirements as regards the mother and fetus are observed has been considered.
Apgar Score↗
[Once cesarean section--always cesarean section?].
Between 1975 and 1985 from 522 patients, who had undergone caesarean section during their previous delivery or deliveries, per cent 63 have been delivered vaginally and 37 per cent with a caesarean section (52.8% primary, 47.2% secondary). The rate of spontaneous labour was higher, if patient had a spontaneous delivery before caesarean section or the first caesarean section has been performed because of a placenta praevia, a breech presentation or a fetal distress syndrome. Cephalopelvic disproportion went on in 67.2 per cent with a caesarean section. Rupture of the scare occurred in 2.9 per cent. Expectative management of delivery is justified following previous caesarean section. Oxytocin infusions are possible in cases if internal tocography will be done.
Cardiotocography↗
The "intra-abdominal version technique" for delivery of transverse lie by low-segment cesarean section.
Cesarean section is the delivery method of choice in all shoulder presentations of viable fetuses. The classic cesarean section is usually recommended when there is a transverse lie because of the potential technical difficulties associated with extraction of the fetus when a low-segment incision is used. This paper illustrates a technique that avoids the need of a classic cesarean section and permits the use of the more desirable low-segment cesarean section. The advantages of the procedure are discussed.
Cesarean Section↗
Cesarean section.
Cesarean section has become a common operation, but its complexity should not be underestimated. Often it must be done as an emergency without skilled assistants; at the same time the surgeon must deal with the maternal disorder that prompted the cesarean section and ensure the well-being of the fetus. Of further concern is the operative blood loss, which can be massive, and the postoperative morbidity, which is often high. The operative technique has evolved from an intraperitoneal vertical incision on the body of the uterus (classical cesarean section) to a near-complete reliance on a retroperitoneal transverse incision (lower segment cesarean section). The historic reason for this change was the fear of peritonitis postoperatively. Present-day practice favours the lower segment operation and emphasizes the reduced operative blood loss and the more secure uterine scar as reasons for the choice. Operative complications (injury to the fetus, lacerations of the uterus and vagina) are the result of inadequate uterine incisions. The classical incision has the advantage of being easily extended and thus has a continued purpose. Postoperative febrile morbidity is attributed to endometritis; the mixed aerobic and anaerobic bacteria of the vagina are the causal organisms. Febrile morbidity can be prevented by antibiotics given prophylactically.
Cesarean Section↗
[Surgical contraception after cesarean section].
Cesarean section is a routine operation in the obstetric practice and is performed by medical indications only taking into consideration life and functional integrity both of the mother and the fetus. Our studies show that operative contraception together with cesarean section is made in 92% of parturients over 30 years of age in accordance with the required practice. The physician proposes in 16% of women, but in the remaining parturients as in all cases the the consent is documented by the signature of the parturient. Death of children (it is assumed that 2 children are indication for sterilization) due to various causes and operative deprivation of the woman from her child-bearing capability raises moral, ethic and legal questions. On the first place-indications for sterilization during cesarean section. How such type of operation should be made either by the initiation of the physician or after premeditated desire of the parturient. Is it sufficient her consent orally or written. Is the consent of the husband needed and under what form, since he could raise the question about punishment of the physician-obstetrician. The question about danger of healthy and life is not on the last place as well. Our studies during the last 5 years show that this type of intervention is frequent phenomenon--16.34% of the undergone operative deliveries. Furthermore this type of intervention should be performed only by medical indications, having in mind their significance for the future mother, family and society.
Bulgaria↗
Cesarean section.
Cesarean section has become a common surgical procedure and there is a tendency for both veterinarians and their clients to regard it as routine. It is important to remember, however, that a cesarean section entails major abdominal surgery, with inherent risks, irrespective of the prevailing conditions or personnel involved.
Anesthesia↗
Usefulness of continuous fetal heart rate monitoring during cesarean section.
Cesarean section performed because of fetal distress routinely leaves the fetus unmonitored for a variable period of time (perioperatively and intraoperatively). We present in this report two cases in which continuous fetal heart rate monitoring during cesarean section modified the obstetric management for the benefit of the mother and of the fetus.
Adult↗
Pre-preparation of the sterile instrument table for emergency cesarean section.
Cesarean section instrument tables are often not prepared in advance because of concern of contamination risk. The Association of Operating Room Nurses Standards decries the use of pre-preparation of surgical instrument tables because of this risk, although there are no scientific data to support this claim. We evaluated the contamination risk of pre-preparation of surgical instrument tables, prolonged table coverage and table uncovering using a specific technique referred to as the "sardine can roll." Colony counts were positive in only seven of 180 cultures (< or = 15 colonies per plate in each instance) from six tables evaluated after prolonged coverage or uncovering, or both. These data suggest that contamination risk is slight for the uncovering technique described herein and advance table preparation (24 hours or less, never recovered) is a reasonable clinical option in units in which table preparation reduces response time in emergent clinical situations, such as cesarean section for acute fetal distress.
Cesarean Section↗
Surgical techniques for cesarean section.
Cesarean section is probably one of the oldest and certainly one of the most commonly performed surgical procedures in obstetrics and gynecology. There is always a risk in attempting to elaborate excessively on such a common operation. Each of us will develop our own personal biases based on individual experience and expertise. These differences are superficially distinct but usually have underlying similarities that allow us to achieve similar outcomes and expectations. At the same time, however, it is important to recognize that there is a difference between repetition and habit as opposed to altering a technique in order to meet a specific end. Obviously, with cesarean section, there can be several ways to accomplish the same result, and certain situations will dictate the individualization (patient, not physician) of technique. Certainly, one has to be aware of his or her own expertise and at the same time know his or her options. It seems best not to limit oneself to the same technique under all circumstances but to be able to anticipate problems and know how to rectify them in a manner that will avoid undue injury or compromise to the infant and mother.
Abdomen↗
[A case of delayed diagnosis of pulmonary thromboembolism in a patient with mitral stenosis undergoing cesarean section].
Cesarean section was performed under general anesthesia in a 38-year-old patient with congestive heart failure due to severe mitral stenosis. During surgery, pulmonary hypertension, right ventricular distension and the dissociation of PETCO2 and PaCO2 were observed. However, pulmonary thromboembolism (PTE) was proved after the operation when she developed severe hypotension in the intensive care unit. Although she recovered once from circulatory unstability with the use of percutaneous cardiopulmonary support (PCPS) and she could be weaned from PCPS at the 4th postoperative day, she died from tracheal bleeding and recurrent cardiopulmonary collapse 22nd day after the surgery. It should be noted that the increasing dissociation of PETCO2 and PaCO2 may be an early sign of PTE even in a patient with severe mitral stenosis and pulmonary hypertension.
Adult↗
Comparison of morbidity in cesarean section hysterectomy versus cesarean section tubal ligation.
This study was undertaken to compare the morbidity of cesarean section hysterectomy (C-HYST) and cesarean section bilateral tubal ligation (C-BTL) in a nonemergency or elective environment. Charts were reviewed for patients who underwent elective C-HYST or elective C-BTL before the onset of labor, without the use of antibiotics. Demographics, maternal morbidity, operative difficulties and postoperative complications were compared. Statistically significant differences in patient demographics include a higher maternal age in the C-HYST group than for those in the C-BTL group (31.0 +/- 5.8 versus 27.7 +/- 5.4 years; p = 0.002). C-BTL patients had higher gestational ages (39.4 +/- 1.6 versus 38.7 +/- 1.3 years; p = 0.0017). The C-HYST group had a higher estimated blood loss (1,201 +/- 472 versus 718 +/- 364 milliliters; p = 0.001), change in hematocrit level (6.0 +/- 4.4 percent versus 4.5 +/- 3.4 percent; p = 0.013) and operating time (115 +/- 37 versus 74 +/- 26 minutes; p = 0.0001). Blood transfusion was similar in both groups. Febrile morbidity was higher in the C-BTL group (68.0 percent versus 50.0 percent; p = 0.01). Endometritis was the significant determinant of febrile morbidity for the C-BTL group (41.7%) and cuff cellulitis in the C-HYST group (25.6 percent). Intraoperative and postoperative complications between the two groups were rare and not statistically different. Clinical morbidity for C-HYST is not significantly different than C-BTL. Elective C-HYST may be used in place of C-BTL when indications for hysterectomy are present.
Adult↗
Antibiotic prophylaxis for cesarean section.
BACKGROUND: The single most important risk factor for postpartum maternal infection is Cesarean delivery. OBJECTIVES: The objective of this review was to assess the effects of prophylactic antibiotic treatment on infectious complications in women undergoing Cesarean delivery. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials comparing antibiotic prophylaxis or no treatment for both elective and non-elective Cesarean section. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Sixty-six trials were included. Use of prophylactic antibiotics in women undergoing Cesarean section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after Cesarean section. The reduction in the risk of endometritis with antibiotics was similar across different patient groups. The relative risk for elective Cesarean section was 0.24, 95% confidence interval 0.11 to 0.48. The relative risk for non-elective Cesarean section was 0.30, 95% confidence interval 0.25 to 0.35. The relative risk for undefined or all patients together was 0.29, 95% confidence interval 0.26 to 0.33. Despite the large number of trials, different populations and different antibiotic regimens, there was no statistically significant heterogeneity. REVIEWER'S CONCLUSIONS: The reduction of endometritis by two thirds to three quarters justifies a policy of administering prophylactic antibiotics to women undergoing elective or non-elective Cesarean section.
Antibiotic Prophylaxis↗
Once a Cesarean section, always a Cesarean section: back to the future?
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Cesarean Section↗
Responses to stress and novelty in adult rats born vaginally, by cesarean section or by cesarean section with acute anoxia.
The aim of this study was to test the hypothesis that alterations in birth conditions, specifically vaginal birth vs. birth by Cesarean section (C-section) vs. birth by C-section with an added period of acute global anoxia, produces long-term differences in behavioral responses to stress or novelty in the rat at adulthood. In comparison to animals born by rapid C-section alone, animals born by C-section with 10 or 15 min of added anoxia were significantly more immobile during forced swim stress administered for 6 trials over several weeks. In a step-down passive avoidance task, there were no group differences in acquisition or retention of the avoidance response. However, when initially placed in the passive avoidance apparatus before delivery of shock, animals born by C-section with 15 min of anoxia required significantly more pretrials to step down from the wooden platform, than did vaginally born or C-sectioned animals. No group differences were observed on measures of exploratory behavior in an elevated plus-maze or of approach behavior either to food or to a novel object in an open field. These findings suggest that birth conditions which include a degree of perinatal hypoxia can contribute to variability in selective responses to stress and novelty in the adult rat.
Acute Disease↗