ABSTRACT
Background: The indication of performing lower uterine section caesarean section has been changing a lot in recent year and they are expected to go on changing on basis of continuing trials. Aims and Objectives: The aims to study are to assess rate, frequency along with complications of primary cesarean section. Along with to study the incidence and indications of primary cesarean section and causes maternal as well as fetal morbidity and mortality in these cases. Materials and Methods: This prospective study included all pregnant women after 28 weeks period of gestation who underwent caesarean section for the 1st time between December 2016 and June 2018 at Central Referral Hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim – India. Over a period of 1.5 years, 750 women at Central Referral Hospital, SMIMS, Sikkim, India, underwent primary cesarean section. Results: The percentage of primary lower uterine section cesarean section was 27.38% and total cesarean section rate was found to be 49.59% which is far more than the expected rate of 15% as proposed by the world health organization. Elective lower uterine section cesarean section was done in 341 cases (45.47%) and emergency lower uterine section caesarean section was done in 409 cases (54.53%). Patient’s desire was the most frequent indication for elective lower uterine section cesarean section (38.40%). Conclusions: There is tremendous rise in rate of primary cesarean section with patient’s request being the most common indication of elective lower uterine section cesarean section.
ABSTRACT
Background: Cesarean section is one of the most commonly performed surgical procedures in obstetrics worldwide. Over the last three decades, a tremendous increase in cesarean section rates has been observed globally, which is a cause for concern as procedure is associated with higher morbidity and mortality compared to vaginal delivery. This study was done to analyze the rate and indications for cesarean section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period of 6 months from 1st October 2017 to 31st March 2018 in the department of Obstetrics and Gynecology, Integral Institute of Medical Sciences and Research, Lucknow, India. Data of patients who were admitted for delivery in department of Obstetrics and Gynecology in OPD or emergency were recorded. Statistical analysis of various parameters namely, the cesarean section rates, its indications, the patient’s morbidity and mortality was done.Results: The total numbers of women delivered over the study period were 577, out of which 210 patients underwent cesarean sections. The overall cesarean section rate in our study was 36.39%. Previous cesarean section was the leading indication of cesarean section (31.9%) followed by arrest of labor (18.1%), CPD (14.2%), and fetal distress (12.9%). Breech presentation (5.2%), failed induction of labor (4.8%), pregnancy induced hypertension (PIH) (3.8%), oligohydramnios (3.3%), obstructed labor (2.4%), APH (1.4%), multiple pregnancy and BOH accounted for 0.95% of cesarean sections. 9% patients had few complications mainly minor wound infection (2.4%) and postpartum hemorrhage (2%). There was no mortality during this period.Conclusions: Previous cesarean section has been found to be the main indication for cesarean section. So primary cesarean section should be reduced to decrease the overall cesarean rates. A comprehensive, evidence based approach needs to be introduced to monitor indication of all cesarean section.
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The study conducted in retrospective manner in 150 bedded Government Victoria Hospital Maternity Hospital affiliated to Andhra Medical College, Visakhapatnam, Andhra Pradesh. The rates and indications of primary and repeat Cesarean section rate was compared with 2004 and 2009 Cesarean rates. In our study, the Cesarean section rate was 25.66%. There is an increase in the CS rate over last decade from 16.14% in 2004, 20.33% in 2009 to 25.66% in 2014. The main contribution to this rise in CS is due to increase in numbers of repeat sections. CS become increasingly the procedure of choice in high risk pregnancies to prevent perinatal morbidity and mortality. This has become possible due to improved patient care, availability of effective antibiotics, blood transfusion services safer anesthesia, improved surgical technique and sophisticated neonatal care services.
ABSTRACT
Objetivo: Correlacionar la pérdida sanguínea estimada visualmente (PSev) con la pérdida sanguínea calculada (PSc) que se produce durante el parto por cesárea en pacientes nulíparas. Diseño: Estudio descriptivo de correlación. Institución: Hospital Nacional Cayetano Heredia, Lima, Perú. Participantes: Gestantes nulíparas con parto por cesárea. Intervenciones: Se revisó 160 historias clínicas de pacientes nulíparas atendidas de parto por cesárea a término, en el año 2011. Los datos obtenidos fueron analizados estadísticamente según el programa STATA V10,1 para Windows. Principales medidas de resultados: Pérdida sanguínea. Resultados: Las medianas de la PSev y de la PSc fueron 500 mL (500 a 600 mL) y 421,4 mL (319,85 a 559,65 mL), siendo estadísticamente diferentes, con p 1 000 mL, la mediana fue 1 207,80 mL (1 039,60 a 1 419,00 mL) y la mediana de PSev 500mL (500 a 600 mL), siendo estadísticamente diferente, con p < 0,001. La mediana de la caída del hematocrito fue 3% (3 a 4%). El coeficiente de correlación de Spearman para PSev y PSc fue 0,302 (p < 0,001). Conclusiones: Se halló correlación débil entre la PSev y la PSc, estadísticamente significativa. Para sangrado intraparto menor a 500 mL, la PSev fue sobreestimada, y para sangrado intraparto mayor a 1 000mL (hemorragia posparto), PSev fue subestimada. La estimación visual del sangrado intraparto es un método inexacto para calcular volúmenes sanguíneos, por lo cual se requiere métodos alternativos efectivos, que incluyen el uso de una fórmula que utiliza la estimación del volumen sanguíneo materno y la variación del hematocrito.
Objectives: To correlate visually estimated blood loss (vEBL) with calculated estimated blood loss (cEBL) during cesarean delivery in nulliparous women. Design: correlation retrospective study. Setting: Cayetano Heredia National Hospital, Lima, Peru. Participants: Nulliparous women subjected to cesarean section. Interventions: Medical records of 160 nulliparous women attended for cesarean deliveries at term during 2011 were reviewed. Data were statically analyzed with STATA V10.1 for Windows program. Main outcome measures: Blood loss. Results: Median vEBL and cEBL were respectively 500 mL (500-600 mL) and 421.4 mL (319.85-559.65 mL) with statistical significant difference, p 1 000 mL median was 1 207.80 mL (1 039.60-1 419.00 mL) and vEBL median was 500 mL (500-600 mL) with statistical significant difference, p < 0.001. Hematocrit descended 3% (3-4%). Spearman correlation coefficient between vEBL and cEBL was 0.302 (p < 0.001). Conclusions: A statistically significant weak correlation was found between vEBL and cEBL. For intrapartum bleeding less than 500 mL vEBL was overestimated and for intrapartum bleeding greater than 1 000 mL (post partum hemorrhage), vEBL was also underestimated. Visual estimation of intrapartum bleeding showed inaccurate to calculate blood loss volume. Effective alternatives methods are required that include an estimated maternal blood volume formula and changes in hematocrit.