ABSTRACT
Background@#The average of cesarean has increased over the last 30 years in developed as well as in developing countries. During the last decade, cesarean surgery rates increased by 1 to 2 times. As of 2015, there were 80434 mothers gave birth nationwide. In Ulaanbaatar city, 267106 births were recorded, from which 14,327 (30.7%) was born with cesarean section. In 2015, 32.2% of all births born in Ulaanbaatar delivered by cesarean surgery, which is 2.5% higher than the previous year. The rate of cesarean surgery has increased dramatically, however, causes and complications are unclear and these subjects are rarely investigated, thus, we decided to study this important issue.@*Material and methods@#The study was carried out through a retrospective design of descriptive statistics. Using cross-sectional study, we randomly collected data from the history of total of 5125 births recorded in the Urguu Maternity Hospital, in 2015 and 408 were selected. Data was collected by using 48 questions in 5 sections. We used the Statistical Package for the Social Sciences (SPSS) 20 for data processing and estimation of survey findings.@*Results@#From the total of 408 women, who given birth by cesarean delivery, 50.2% done under cesarean surgery for the first time, 33.3% for the second time and 16.5% of them experienced with cesarean surgery 3 or more times. The impact of cesarean section on abortions was studied by comparing the rates of cesarean section compared to rates of abortion and we had revealed that 25.3% of cesarean surgery had an abortion once and 11.2% of them twice and 7.4% had 3 or more abortions.@*Conclusion@#Number of chances getting pregnant is age-related (p=0.001). Cases of first cesarean delivery have increased to 50.2%. The frequency of cesarean section and the number of pregnancies was statistically significant (p=0.001). According to the retrospective study of maternity history, 43.9% had abortions. There is an inverse correlation between the rates of cesarean section and rates of abortion (p=0.004). Combination of disorders of the organ systems do not affect the rate of the cesarean section (p= 0.941). Vaginal inflammation does not affect the frequency of cesarean section (p=0.237).
ABSTRACT
Aim: To compare the pregnancy outcomes among nulliparae, with multiparae as the control. Study Design: Retrospective cohort study. Place and Duration of Study: University of Maiduguri Teaching Hospital over a period of one year (1st January 2007 to 31st December 2007). Methodology: This retrospective cohort study reviewed the pregnancy outcome of nulliparae over one year, using multiparae as control. The data were analysed using SPSS. The χ 2-test was used to compare the sociodemographic characteristics and pregnancy outcomes of the nulliparae and the multiparae. Multivariate logistic regression analysis was used to create a model for the factors that were independently associated with nullipara. A P-value of<0.05 was considered significant. Results: Nulliparae contributed 259 (13.7%) of the 1,865 babies delivered during the period of study. The age ranged from 15 years to 42 years with mean age of 27.1 years ±5.3 years. Nulliparous women were more likely to be of younger age less than 20 years (P<0.001), educated (P=0.01) and booked early (P=0.001) when compared with multiparae. Also nulliparous women were more likely to have pregnancy induced hypertension (P=0.001) and episiotomy at delivery (P<0.001) but less likely to have anaemia (P=0.002) when compared with multiparae. Multivariate logistic regression showed that Nulliparae were more likely to be of younger age group (OR 7.22, P<0.001) and have malaria (OR 2.22, P=0.02), malpresentation (OR 5.68, P=0.02), abruptio placentae (OR 6.41, P=0.02), preterm delivery (OR 7.04, P=0.01), episiotomy (OR 7.74, P<0.001) and pregnancy induced hypertension (OR 3.53, P=0.01) but less likely to have anaemia at booking and fetal macrosomia. Conclusion: Nulliparous women are at increased risk of certain adverse pregnancy outcome including malaria, preterm delivery and pregnancy induced hypertension. These adverse factors should be looked out for and excluded in order to improve maternal and fetal health in these women.
ABSTRACT
Maternal Age of 35 years or more at first pregnancy and childbirth is considered advanced reproductive age and a high pregnancy risk associated with increased adverse maternal and perinatal outcomes. The industrialized and developing countries are replete with supporting scientific literatures but only a few data on nulliparous women in our setting hence our interest to appraise the correlates of advanced maternal age at first childbirth and obstetric performance in Nigerian women. The objectives were to determine the influence of advanced maternal age at first pregnancy on the obstetric and perinatal outcomes. To compare the obstetric performance of women advanced in maternal age at first delivery with their younger counterparts and to determine the trend of identifiable adverse outcomes with increasing maternal age at first delivery. This was a retrospective comparative study of 1684 nulliparous women that had their childbirth between 2009 and 2013 at a mission Hospital. Those aged 35 years and above were the study subjects while those aged 20 - 34 years the control. Relevant database was raised from the case files. The prevalence of elderly nullipara in this study was 1.6%. They were statistically significant different in primary level of education (OR = 4.1, P = 0.02), prenatal care lack (OR = 2.6, P = 0.02), caesarean section (OR = 2.5, P = 0.0006), incidental myomectomy (OR = 19.1, P < 0.0001), prolonged pregnancy (OR = 0.6, P = 0.04) and episiotomy at vaginal delivery (OR = 0.5, P = 0.01). They were also insignificantly worse in ante partum hemorrhage (APH), induction of labor, perineal tear, HIV infection, postpartum hemorrhage (PPH), preterm birth, Low birth weight (LBW), Intrauterine growth restriction (IUGR), stillbirth ,neonatal birth asphyxia and Perinatal mortality. Caesarean section rate, caesarean myomectomy, APH, induction of labor, stillbirth rate, LBW and Perinatal mortality each maintained a statistical significant linear tendency (P < 0.05) with maternal age. First pregnancy at advanced maternal age is fraught with increased maternal morbidity, perinatal morbidity and mortality. We proffer early education, marriage or and childbearing, quality prenatal care and skilled attendance at delivery for safe motherhood.
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OBJECTIVE: To compare the safety and efficacy of oral misoprostol, vaginal misoprostol, and oxytocin-only users for cervix ripening and labor induction in nulliparous women. METHODS: Randomly selected 11 patients were orally administered 50 microgram of misoprostol at first and then 100 microgram every 4 hours and the other 9 patients were vaginally administered 25 microgram of misoprostol at first after then the same doses every 4 hours. They all were nulliparous women with Bishop score 6 or less. Another 19 patients were oxytocin only users for cervical ripening and labor induction, who were nulliparous women with Bishop score 6 or less, and reviewed these medical records retrospectively. RESULTS: There were no differences among these three groups in patient characteristics such as maternal age, gestational age, parity and initial Bishop score. In oral misoprostol group, it took shorter time to get Bishop score 8 or more and become effacement 60% or more than vaginal misoprostol group. On the contrary, in vaginal misoprostol group, it took shorter time to become full dilatation and deliver than oral misoprostol group. However there were no significant statistical differences between two groups in obstetric and neonatal outcomes. CONCLUSION: Oral and vaginal misoprostol are effective in cervical ripening but there were no significant statistical differences in perinatal outcomes. Among many regimens of misoprostol administration for cervix ripening in nulliparous women, there is no standardized method until now. More studies will be needed for safe application of this drug.
Subject(s)
Female , Humans , Pregnancy , Cervical Ripening , Cervix Uteri , Dilatation , Gestational Age , Maternal Age , Medical Records , Misoprostol , Oxytocin , Parity , Prospective Studies , Retrospective StudiesABSTRACT
OBJECTIVE: This study was designed to compare the vaginal hysterectomy and abdominal hysterectomy for a non-prolapsed, benign uterus in women without vaginal delivery. METHODS: A retrospective study in Hallym-university hospital analysed 182 total hysterectomies in women without vaginal delivery performed from January 2000 to December 2001. Vaginal route was used for 98 (53.8%) patients and 84 (46.2%) had laparotomies. RESULTS: The mean uterine weight was 217 g in vaginal route, 270 g in abdominal route. Mean operation time was 70 minutes in vaginal route, 125 minutes in abdominal route. There was one serious re-operation due to hemorrhge in each group and other complication was not much different at each gruops. The hospital stay was 6.2 days in vaginal route and 8.4 days in abdominal route. CONCLUSION: Vaginal hysterectomy for a non-prolapsed uterus is indicated for women without vaginal delivery and is feasible to performance. Vaginal hyterectomy is less morbidity, shorter hospitalization and faster convalescence. So training in vaginal surgury should allow safe performance of the procedure at most center.