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Results for “Cesarean Section, Repeat”

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At least 19 recordsLinked to original sources
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↗
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↗
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↗
PubMedDate not supplied

[Repeated cesarean section].

Pregnancies after repeated cesarean sections are often considered to carry high maternal and fetal risks. The pregnancy course, intraoperative and postoperative complications and conditions of newborns were compared between 53 patients who had two or more previous cesarean sections and 58 women sectioned for the second time. No statistical difference was found between the two groups except for intraoperative complications.

Abortion, Threatened↗
PubMed1994

[Clinical analysis of 36 repeat cesarean sections performed extraperitoneally].

Extraperitoneal repeat cesarean section (CS) performed in 36 women with previous intraperitoneal CS (group A) was compared with another 36 cases of intraperitoneal repeat CS (group B). The average blood loss was 146ml in group A and 230ml in group B (P < 0.01). Operation time in group A lasted 40 minutes including 9 cases of tubal ligation coincidentally and 66 minutes in B with 12 tubal ligation (P < 0.05). There were 2 cases of peritoneal damage and 1 transient hematuria in group A. Postoperative morbidity in group A was 16.7% and 38.9% in group B (P < 0.01). The average time for bowel function recurrence was 26.2 hours in A and 52.6 in B respectively. No evident complication occurred in either group. It indicated that extraperitoneal route might be superior to intraperitoneal one for repeat cesarean section.

Adult↗
PubMed1990

Vaginal birth after cesarean or repeat cesarean section: medical risks or social realities?

Despite the known medical safety and success of vaginal birth after cesarean section, rates of planned repeat cesarean sections remain high. The process involved in women's decisions to choose vaginal birth after cesarean section or repeat cesarean section was investigated by a questionnaire study at a private and a public hospital. Women were questioned regarding timing, influence of others, reasons for their choice, satisfaction with the decision, etc. Results from 160 respondents showed that over half the women identified themselves as the primary decision maker. Physicians exerted more influence on the decisions of patients at the public hospital than on the patients at the private hospital. Overall, social exigencies appeared to play a more important role than an assessment of the medical risks in making these decisions.

Cesarean Section↗
PubMedDate not supplied

Higher order multiple repeat cesarean sections: maternal and fetal outcome.

BACKGROUND: Multiple repeat cesarean delivery is common in many parts of Saudi Arabia. We conducted a retrospective analysis of patient records to determine the major and minor complications as well as the neonatal outcome associated with multiple repeat cesarean sections. METHODS: We analyzed relationships between the number of cesarean sections and various demographic and clinical variables in 150 patients undergoing 4 to 8 cesarean sections (mean 6.0) compared with a control group of 140 patients undergoing 2 to 3 cesarean sections (mean 2.5) during the period from 1996 to 2000 at the Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: Both the gestation age of the mother and birth weight of the baby were lower in the study group compared with the control group (mean gestation age 36 weeks in the study group compared with 37 weeks in the control group (P=0.001), and mean birth weight 2.9 kg for infants in the study group compared with 3.1 kg in the control group (P=0.01). The total duration of the operation was longer in the study group (63 minutes on average) compared with the control (45 minutes on average) (P=0.001). There were 80 cases of severe adhesion encountered during surgery in the study group compared with 40 cases in the control group (P=0.001). There was no difference in the Apgar score of the baby and the neonatal admission rate in the two groups. The incidence of cesarean hysterectomy, uterine scar dehiscence, placenta placenta previa, placenta accreta and bladder injury was similar in two groups. The incidence of post partum pyrexia, wound infection, urinary tract infection, and blood transfusion was also comparable in the two groups. CONCLUSION: No specific additional risk is associated with higher order (four to eight) repeat cesarean sections that is not normally encountered with lower order (two to three) repeat cesarean sections.

Journal Article↗
PubMed1999

Trial of labor versus elective repeat cesarean section for the women with a previous cesarean section: a decision analysis.

In order to reduce the cesarean-delivery rate, more and more pregnant women are offered trials of labor (TOL) after their previous cesarean sections. TOL and elective repeat cesarean section (ERCS) have different risks and benefits. We constructed a decision analysis to explore this issue. Probabilities were derived from literature reviews. Health state utilities were derived from the authors' clinical judgement. The analysis considered the disutility of the procedures and the disutilities of the morbidity. Using the baseline assumption, ERCS was superior to TOL. One-way sensitivity analyses showed that the result was insensitive to all of the probability estimates and the disutilities of the morbidity. However, the result was sensitive to the patient's preference for ERCS, successful TOL, or failed TOL. The analysis indicates that the best delivery method for a woman who has had a previous cesarean section depends on patient's preference. More patients' preference studies are needed.

Cesarean Section, Repeat↗
PubMed1996

Sequelae of repeat cesarean sections.

OBJECTIVES: To study and analyze the factors related to repeat cesarean section and to highlight the problems that may be associated with it. METHODS: The study was carried out in the Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh, Saudi Arabia, and involved 395 patients who had had two or more previous cesarean sections prior to the current pregnancy. Various factors which may be associated with repeat cesarean sections, as well as the outcome of the operations, were assessed and analyzed. The chi2-test and other analyses were used to examine the association between the number of cesarean sections and the various variables. RESULTS: Four or more previous cesarean sections was significantly associated with dense adhesions. On the other hand, height, parity, antenatal clinic attendance, postoperative complications, fetal weight and fetal outcome had no significant effect on, nor influenced, the multiplicity of cesarean sections. CONCLUSION: No specific risk is associated with repeat cesarean sections that is not normally associated with single cesarean sections.

Adult↗
PubMed1978

The management of elective, repeat cesarean section.

The perinatal outcome of 252 consecutive, elective, repeat cesarean section was studied retrospectively. One hundred fifty patients (60%) were scheduled for delivery within approximately seven days of their expected delivery, cesarean (EDC), designated on the basis of rigorous clinical criteria and corroborative sonographic biparietal diameters. One hundred two patients (40%) did not meet these criteria and required analysis of amniotic fluid for L/S ratio and creatinine prior to their operations. Forty-three patients (17%) labored prior to their scheduled procedure or amniocentesis and underwent cesarean section shortly after admission. No cases of the respiratory distress syndrome were noted in the electively delivered patients. The authors conclude that careful clinical assessment of gestational age will prevent the occurrence of iatrogenic hyaline membrane disease in infants born to mothers by elective, repeat cesarean section. When the EDC is in question, however, amniotic fluid phospholipid analysis is clearly advisable.

Amniocentesis↗
PubMed1993

[Complications for the mother in vaginal delivery after a prior cesarean section and in parturients with a planned repeat cesarean section].

Over a period of 10 years (1980-1989) in the Clinic of Obstetrics and Gynaecology in Stara Zagora 740 women have delivered children after a previous caesarean operation. On the basis of this material the author has studied the vaginal delivery complications for the mother after a previous caesarean operation and in the cases of a second planned caesarean operation. The alternative and correlational analysis of the clinical data has shown that the complications for the mother in the latter group are 3 times more than those in the former group.

Bulgaria↗
PubMed1993

Elective repeat cesarean sections: how many could be vaginal births?

OBJECTIVE: To determine (a) the proportion of women undergoing elective repeat cesarean section without a trial of labour who were eligible for such a trial by the 1986 guidelines of the panel of the National Consensus Conference on Aspects of Cesarean Birth, (b) whether vaginal birth after cesarean section (VBAC) was discussed with these women and (c) the reasons cited for not having a trial of labour. DESIGN: Chart audit. SETTING: Level 2 perinatal care centre in a general teaching hospital. PATIENTS: All 313 women with a history of previous cesarean section who gave birth at the centre during 1989. RESULTS: Only 93 (30%) of the 313 women underwent a trial of labour. According to the 1986 guidelines 71% were eligible. A further 13% would have been eligible according to the revised 1991 guidelines. Of the 220 women who underwent elective repeat cesarean section, only 24 (11%) had a discussion of VBAC noted in their hospital charts. However, of all 117 patients whose charts indicated discussion of VBAC 93 (79%) chose to try it. Most of the women had either questionable indications or no indication noted for undergoing repeat cesarean section. CONCLUSION: Most of the women who underwent repeat cesarean section were eligible for a trial of labour. However, few charts noted a discussion of VBAC. Further physician and patient education is necessary to promote the appropriate use of VBAC and repeat cesarean section.

Attitude of Health Personnel↗
PubMed1985

The scheduling of repeat cesarean section operations: prospective management protocol experience.

There are benefits to patients and a busy obstetric service if repeat cesarean section operations are performed on a scheduled basis. Optimum management avoids prematurity and reduces the need for amniocentesis. Over a period of 20 months repeat cesarean sections were performed at Tripler Army Medical Center while a protocol with the following elements was used: (1) known last menstrual period; (2) landmarks: positive urine human chorionic gonadotropin test by 6 weeks, Doppler fetal heart tone by 12 weeks, date determination by examination before 10 weeks, fetoscope fetal heart tone by 20 weeks, and date determination by size before 30 weeks; (3) date determination by midtrimester sonogram(s); (4) normal third-trimester glucose screening; (5) biparietal diameter of 9.2 or 9.5 cm before scheduling. With two or more clinical landmarks and one date by sonogram or one landmark and date by two sonograms, elective repeat cesarean section was scheduled at 39 weeks if the biparietal diameter was greater than or equal to 9.2 cm (127). If dates by sonogram were less than dates by last menstrual period but greater than 1 week or if last menstrual period was unknown, dates by sonogram and landmarks corresponding to dates by sonogram were used to electively schedule, with biparietal diameters of 9.2 or 9.5 cm respectively required (28). If protocol criteria were not met or earlier delivery was indicated (e.g., vertical scar or diabetes), amniocentesis was performed (42), except when not possible, advisable, or refused when patients either elected labor (20) or were scheduled if three or more criteria for 40+ weeks were met (18). Of 225 patients (70.5%) scheduled by protocol (173), amniocentesis (34), or medical indication (18), 188 (58.9%) were delivered without labor. In the 147 patients (46.1%) delivered electively by protocol without labor or amniocentesis, there were no cases of respiratory distress syndrome and the mean birth weight was 3517 gm. With early care and better patient compliance nearly all repeat cesarean sections can be safely delivered electively with the use of this protocol.

Appointments and Schedules↗