The Anterior Pelvic Index (API) in the Classification of the Female Pelvis and Prediction of Fetopelvic Disproportion / El Índice Pelviano Anterior (API) en la Clasificación de la Pelvis Femenina y Predicción de la Desproporción Fetopélvica

SUMMARY: Measurements of the upper strait of the pelvis can be calculated using the Anterior Pelvic Index. The objective of the study was to determine the external validity and cut-off point of the API, to classify narrow pelvises from normal ones. We selected 214 women from 15 to 55 years old, 171 had vaginal delivery and 43 by caesarean section by feto-pelvic disproportion (FPD) of maternal origin, in whom the API was calculated, of which its mean difference was established with an alpha error of <0.05. Maximum values of sensitivity and specificity, ROC curve and Youden index were determined. The student's t gave a p-value =0.000 of the mean difference between the women who had vaginal delivery and those who had cesarean section by FPD of maternal origin; the value of the area under the ROC curve was 0.758 (CI 95% 0.695 - 0.814) with a p-value=0.0001. Maximum sensitivity was 74.42 % (CI 95%: 58.8 % to 86.5 %) and maximum specificity was 73.10 % (CI 95%: 65.8 % to 79.6 %), produced a Youden index of 0.475 (CI 95% 0.283 - 0.590) which is associated with the 15.44 (CI 95% 14.19 - 15.83) of the API scale. The API is a good tool for predicting women with suspected narrow pelvis and allows its classification into three types of pelvises: an API value of more than 15.83 would indicate pelvis suitable for vaginal delivery; an API value between 14.19 and 15.83 would be suspected of pelvic narrowness; an API value less than 14.19 would confirm a narrow pelvis.

Las medidas del estrecho superior de la pelvis pueden calcularse mediante el Índice Pelviano Anterior. El objetivo del estudio fue determinar la validez externa y el punto de corte del API, para clasificar pelvis estrechas de las normales. Seleccionamos 214 mujeres de 15 a 55 años, 171 tuvieron parto vaginal y 43 mediante cesárea por DFP de origen materno, en quienes se calculó el API, del cual se estableció su diferencia de medias con un error alfa de <0,05. Se determinaron valores máximos de sensibilidad y especificidad, curva ROC e índice de Youden. La t de Student dio un p-valor=0,000 de la diferencia de medias entre las mujeres de tuvieron parto vaginal y las que fueron sometidas a cesárea por DFP de origen materno; el valor del área bajo la curva ROC fue 0,758 (IC 95% 0,695 - 0,814) con un p- valor=0,0001. La máxima sensibilidad (74,42 %. IC 95%: 58,8 % a 86,5 %) y máxima especificidad (73,10 %. IC 95%: 65,8 % a 79,6 %), produjeron un índice de Youden de 0,475 (IC 95% 0,283 - 0,590) el cual está asociado al valor 15,44 (IC 95% 14,19 - 15,83) de la escala del API. El API es una buena herramienta de predicción de mujeres con sospecha de pelvis estrecha y permite su clasificación en tres tipos de pelvis: un valor de API de mas de 15,83 indicaría pelvis aptas para un parto vaginal; un valor de API entre 14,19 y 15,83 se sospecharía de estrechez pélvica; un valor de API menor a 14,19 confirmaría una pelvis estrecha.

Pubic arch angle measurement by transperineal ultrasonography: a prospective cross-sectional study / Medida do ângulo do arco púbico por ultrassonografia transperineal: um estudo prospectivo transversal

Abstract Objective To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode. Methods The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics. Results Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5º (range, 79.3-117.7º). No statistically significant difference was observed in delivery type (102.6 ± 7.2º versus 100.8 ± 7.9º, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6º versus 102.6 ± 7.3º, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026). Conclusion Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.

Resumo Objetivo Avaliar a medida do ângulo do arco púbico (AAP) por ultrassonografia transperineal durante trabalho de parto em predizer tipo de parto e modo de desprendimento do polo cefálico. Métodos Um estudo prospectivo transversal foi conduzido com 221 mulheres em trabalho de parto com gestação única ≥ 37 semanas, com fetos em apresentação cefálica, foram submetidas à avaliação ultrassonográfica por via transperineal para aferição do AAP. Correlações com tipo de parto, modo de desprendimento do polo cefálico e características fetais e maternas foram realizadas. Resultados Um total de 153 (69,2%) mulheres apresentaram parto vaginal espontâneo, 7 (3,2%) parto a fórceps e 61 (27,6%) parto cesárea. Para fins de análise, dividiu-se os partos em dois grupos: partos vaginais e cirúrgicos (fórceps e cesáreas). A média do AAP foi 102 ± 7,5º (variação: 79,3-117,7º). Não foi observada significância estatística do AAP em relação ao tipo de parto (102,6 ± 7,2º versus 100,8 ± 7,9º; p = 0,105). Um total de 94,1% dos fetos desprenderam em variedade de posição occipito anterior e 5,8% em occipito posterior. Encontrou-se AAP mais estreitado no grupo de partos cirúrgicos (97,9 ± 9,6º versus 102,6 ± 7,3º; p = 0,049). A análise de regressão multivariada demonstrou que AAP foi uma variável de proteção para a ocorrência de desprendimento da cabeça em variedades occipito posteriores ao nascimento (odds ratio [OR]= 0,9; índice de confiança (IC) 95%: 0,82-0,99; p = 0,026). Conclusão A medida ultrassonográfica do AAP não foi preditora do tipo de parto, porém demonstrou associação com persistência de variedades occipito posteriores ao nascimento.

Análisis de la cesárea según la clasificación de Robson en un hospital público de Perú / Analysis of cesarean sections according to Robson´s classification in a public hospital in Peru

OBJETIVO: Analizar la cesárea según la clasificación de Robson en un hospital público peruano. MATERIALES Y MÉTODOS: Estudio transversal, analítico, de partos atendidos en el Hospital Hipólito Unanue de Tacna, clasificados según Robson. En dos periodos (2000-2009 y 2010-2018) se compararon las tasas de cesárea, su contribución absoluta y relativa, indicación y riesgos maternos y perinatales. Para el análisis estadístico se utilizó c2 y se consideró significación estadística al valor de p < 0.05 y razón de momios, con IC95%, con riesgo significativo cuando el IC fue mayor de 1 y p < 0.05. Los datos se obtuvieron del Sistema Informático Perinatal y se procesaron en el programa SPSS v26. RESULTADOS: De 64,375 partos analizados, la tasa global de cesárea fue de 38.6%, con incremento de 23.9% en 2000 a 55.8% en 2018, con predominio de los grupos 1, 3 y 5, que son los de mayor contribución absoluta y relativa. Las principales indicaciones de la cesárea fueron: desproporción céfalo-pélvica (grupos 1 a 4), sufrimiento fetal, cesárea anterior y preeclampsia. Los grupos 1 (OR = 2.63; IC95%: 1.28-5.39; p < 0.05) y 3 (OR = 3.06; IC95%: 1.62-5.79; p < 0.05) tuvieron significativamente mayor riesgo de muerte neonatal en comparación con los de parto. CONCLUSIONES: La tasa de cesárea se incrementó en los últimos 19 años, principalmente en los grupos 1, 3 y 5 según la clasificación de Robson. Los grupos 1 y 3 tuvieron mayor riesgo de mortalidad neonatal que el de los nacidos por parto. (AU)

OBJECTIVE: Analyze cesarean sections according to Robson's classification in peruvian public hospital. MATERIALS AND METHODS: Analytical cross-sectional study in 64375 deliveries attended at the Hipolito Unanue hospital in Tacna according to Robson´s classification. Cesarean rates, absolute and relative contribution, cesarean sections´ indications and maternal perinatal risks were compared in two periods (2000-2009, 2010-2018). Chi2 was used with statistical significance when p <0.05 and Odds Ratio (OR) with 95% Confidence Interval (95% CI) with significant risk when IC> 1 and p <0.05. The data was obtained from the Perinatal Informatic System and processed in SPSS version 25. RESULTS: The overall cesarean section rate was 38.6% with an increase of 23.9% in 2000 to 55.8% in 2018; a predominance of groups 1, 3 and 5 who had greater absolute and relative contribution. The main indications were cephalopelvic disproportion, fetal distress, previous caesarean section and preeclampsia. There was a significantly higher risk of neonatal death in groups 1 (OR = 2.6, 95% IC: 1.28-5.39, p <0.05) and 3 (OR = 3.1, 95% IC: 1.62-5, 79; p <0.05) compared with vaginal deliveries. CONCLUSIONS: The cesarean rate increased in the last 19 years, mainly in groups 1, 3 and 5 according to Robson's classification; Group 1 and 3 presented a greater risk of neonatal mortality compared with vaginal deliveries.

Real-time ultrasound-guided spinal anesthesia for cesarean section in patient with severe kyphoscoliosis and Duchenne's muscular dystrophy: A case report

Most elective cesarean sections are conducted under spinal anesthesia. Regional anesthesia has become the preferred technique, because general anesthesia is associated with a greater risk of maternal morbidity and mortality. In patients without absolute contraindication, spinal anesthesia is avoided, when procedural difficulty is increased by severe spinal deformity. A 41-year-old female patient was 33 weeks into pregnancy. Her height and weight were 145 cm and 45 kg. The patient was planned for emergency cesarean section, due to cephalopelvic disproportion. Spinal anesthesia was planned since she was suffering from Duchenne's muscular dystrophy, and had risks of respiratory failure and prolonged mechanical ventilation after general anesthesia. However, the patient also had severe kyphoscoliosis, maybe due to Duchenne's muscular dystrophy. We are reporting a successful spinal anesthesia using real-time ultrasound guidance, for cesarean section in this obstetric patient with severe kyphoscoliosis.

Measurement of retropubic tissue thickness using intrapartum transperineal ultrasound to assess cephalopelvic disproportion

PURPOSE: First, to describe a new method of assessing cephalopelvic disproportion by measuring the retropubic tissue thickness (RTT), and second, to determine whether RTT was associated with an eventual delivery by cesarean section. METHODS: Three-dimensional transperineal ultrasound scans were performed on 129 laboring nulliparous women to obtain 3-dimensional volume datasets for assessing RTT. RTT was measured off-line by three operators (A, B, and C) as the shortest distance between the capsule of the pubic symphysis and the outer border of the fetal skull. The intraoperator repeatability of operator A and the interoperator reproducibility among A, B, and C were determined. The RTT in women who were delivered by cesarean section due to failure to progress was compared to that of women who had a vaginal delivery. RESULTS: The intraoperator repeatability for RTT was 1.2 mm. The overall RTT interoperator interclass correlation was 0.97 (0.95-0.98). The RTT in women who had a spontaneous, instrumental, or cesarean delivery was 1.16±0.32 cm, 1.12±0.25 cm, and 0.94±0.25 cm, respectively. Women who were delivered by cesarean section had a significantly smaller RTT than women who had a spontaneous delivery (P=0.008). There was no statistically significant difference in RTT between patients who had a normal vaginal delivery and patients who had an instrumental delivery (P=0.990), or between those who had an instrumental delivery and those who had a cesarean delivery after the Bonferroni correction (P=0.120). CONCLUSION: RTT can be measured with satisfactory intraoperator repeatability and interoperator reproducibility. RTT was significantly smaller in women who eventually had a cesarean delivery than in those who had a vaginal delivery.

Caracterização da assistência ao parto em adolescentes primigestas no município de cuiabá-mt / Caracterización de la atención al parto en adolescentes primigestas en el municipio de cuiabá-mt / Characterization of pregnancy labor assistance of primigravida adolescents in the city of cuiabá-mt

RESUMO O objetivo foi analisar a assistência ao parto de adolescentes primigestas no contexto do Sistema Único de Saúde (SUS) no município de Cuiabá, Mato Grosso. Estudo transversal, descritivo e documental com amostragem aleatória simples composta por 164 prontuários de puérperas adolescentes coletados por meio de ficha estruturada durante os meses de dezembro de 2012 a maio de 2013. Foi realizada análise descritiva simples dos dados. Os resultados indicaram que o parto cesáreo apresentou taxa de 37,2%, a amniotomia foi adotada em 62,1%, a ocitocina em 53,4% e a episiotomia em 82,4%. A desproporção céfalo-pélvica representou 27,9% das indicações de cesariana e dentre as complicações maternas, a hemorragia destacou-se em ambos os tipos de parto. Conclui-se a existência de uma forte influência do modelo tecnicista sobre os resultados maternos na assistência obstétrica de adolescentes primigestas e que o fato do desconhecimento atrelado à vulnerabilidade deste grupo populacional evidencia a soberania do profissional em relação às decisões obstétricas.

RESUMEN El objetivo ha sido analizar la atención al parto de adolescentes primigestas en el contexto del Sistema Único de Salud (SUS) en el municipio de Cuiabá, Mato Grosso. Estudio transversal, descriptivo y documental con muestreo aleatorio simple compuesto de 164 registros médicos de puérperas adolescentes recogidos a través del formulario estructurado durante los meses de diciembre de 2012 hasta mayo de 2013. Fue realizado el análisis descriptivo simple de los datos. Los resultados indicaron que el parto por cesárea ha presentado tasa de 37,2%, la amniotomía fue adoptada en 62,1%, la oxitocina en 53,4% y la episiotomía en 82,4%. La desproporción cefalopélvica ha representado 27,9% de las indicaciones de la cesárea y entre las complicaciones maternas, la hemorragia se ha destacado en ambos tipos de parto. Se concluye que existe una fuerte influencia del modelo técnico sobre los resultados maternos en la atención obstétrica a las adolescentes primigestas y que el hecho del desconocimiento relacionado a la vulnerabilidad de este grupo poblacional evidencia la soberanía del profesional en relación a las decisiones obstétricas.

ABSTRACT It aimed to analyze labor assistance for primigravida adolescents in the context of the Unified Health System (SUS) in the city of Cuiabá, Mato Grosso. Cross-sectional, descriptive and documental study with a random sample composed of 164 medical records of postpartum adolescent collected through structured file during the months of December 2012 to May 2013. Data were analyzed through simple descriptive analysis. The results indicated that cesarean section showed rate of 37.2%, amniotomy was adopted in 62.1%, oxytocin 53.4% and 82.4% in the episiotomy. Cephalopelvic disproportion represented 27.9% of cesarean section indications and among maternal complications, hemorrhage stood out in both types of delivery. It is concluded that there is a strong influence of the technicist model on maternal outcomes in obstetric care to pregnant adolescents and that the lack of knowledge linked to the vulnerability of this group shows the professional sovereignty in relation to obstetric decisions.

Pelvimetry by reformatted computed tomography in 290 female pelvis: morphometric variations regarding age / Pelvimetría mediante tomografía computadorizada reformada sobre 290 pelvis femeninas: variaciones morfométricas de acuerdo a la edad

The Mexican government passed a new reform of article 11 of the General Law in 2014 regarding Women's Access to a Life Free of Violence, which states that a cesarean section may not be performed if a vaginal birth is viable. Cesarean sections are excessively indicated in Northen Mexico, using the diagnosis of cephalopelvic disproportion due to a narrow pelvis. Currently, there is no standardized morphometry of the female pelvis in a Mexican population to establish adequate diagnostic parameter. Our study measures the pelvic diameters of the birth canal using abdominopelvic computed tomography (CT). Two hundred and ninety CT from Mexican women between the ages of 18 and 50 were collected and 3D reformatted in order to morphologically measure the pelvic diameters of clinical relevance. Measurements were conducted by two diagnostic imaging specialists. The mean and standard deviation of the measured diameters were: anatomical conjugate diameter (ACD) 11.65±0.99 cm, the obstetric conjugate diameter (OCD) 11.73±0.98 cm, diagonal conjugate diameter (DCD) 12.49±0.98 cm and Interspinous distance (ISD) 10.41±0.78 cm. Significant differences were found in all four mean diameters in between the 20­29 age groups versus the >40, as well as between the 30­39 groups versus the >40. Our study shows that as Mexican women get older, the mean pelvic diameters become narrower.

El Gobierno mexicano aprobó una nueva reforma del artículo 11 de la Ley General del 2014, relativa al acceso de las mujeres a una Vida Libre de Violencia, que establece que una cesárea no se puede realizar si un parto vaginal es viable. Los partos por cesárea son indicados excesivamente en el norte de Mexico, con el diagnóstico de desproporción céfalo-pélvica debido a una estrechez de la pelvis. Actualmente, no existe una morfometría estandarizada de la pelvis femenina en una población mexicana para establecer parámetros de diagnóstico adecuado. Nuestro estudio mide los diámetros pélvicos del canal de parto mediante tomografía compudotarizada (TC) abdomino-pélvica. Se usaron 290 TC de mujeres mexicanas entre 18 y 50 años, los que fueron reformateados en 3D para medir morfológicamente los diámetros pélvicos de relevancia clínica. Las mediciones fueron realizadas por dos especialistas en diagnóstico por imagen. La Media y DE de los diámetros medidos fueron: diámetro anatómico conjugado (DAC) 11,65±0,99 cm, diámetro obstétrico conjugado (DOC) 11,73±0,98 cm, diámetro diagonal conjugado (DDC) 12,49±0,98 cm y distancia interespinosa (DIE) 10,41±0,78 cm. Se encontraron diferencias significativas en las Medias de los cuatro diámetros entre los grupos de 20­29 años de edad frente a las >40 años, así como entre los grupos de 30­39 años frente a los >40 años. Nuestro estudio muestra que a medida que las mujeres mexicanas avanzan en edad, los diámetros pélvicos medios son más estrechos.

Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery

Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants.

Determining the incidence of gynecoid pelvis using three-dimensional computed tomography in nonpregnant multiparous women

Objectives: To determine the incidence of gynecoid pelvis by using classical criteria and measured parameters obtained from three-dimensional computed tomography [3D CT] pelvimetry in nonpregnant multiparous women who delivered vaginally

Subjects and Methods: Our hospital's picture archiving and communication system was reviewed retrospectively. All adult women who had undergone CT examination with routine abdominal protocols were identified. In the pelvic inlet, midpelvis, and pelvic outlet, classical criteria and measured parameters, both alone and in combination, were used to determine the presence of gynecoid pelvis

Results: 3D CT pelvimetry was performed on 226 women aged 23-65 years without any history of cephalopelvic disproportion and who had at least one delivery of an average fetal size [>2,500 g]. The median parity was 4, and the mean [ +/- SD] birth weight was 3,700 +/- 498 g. Compared to the classical criteria, measured parameters and their combined use with the classical criteria significantly reduced the frequency of gynecoid pelvis [51.3 and 47.8%, respectively, vs. 71.6%; p = 0.001]; however, there was no significant difference between the measured parameters and their combined use with classical criteria with regard to the frequencies of gynecoid pelvis [p > 0.05]

Conclusions: With the use of measured parameters of 3D CT pelvimetry, the incidence of gynecoid pelvis reduces to a more acceptable level [51.3%] in accordance with obstetric knowledge. Since there is no considerable decrease with the addition of classical criteria, 3D CT pelvimetry alone has merit for determining a woman's pelvic capacity for obstetric needs after the improvement and standardization of measured parameters

Comparing the outcomes of physiologic delivery with non-physiologic delivery group

The main purpose of physiologic delivery is to rely on mother's body for childbirth. In physiologic delivery method pregnant women attend delivery preparation classes and they learn how to overcome fear and pain. This study compares delivery outcomes among women who participated in physiologic delivery with those who had undergone non physiologic delivery. All patients referred for physiologic delivery were assessed. Exclusion criteria were lack of PROM, post date, cephalopelvic disproportion, multi-fetal pregnancy, Meconium stain, blood pressure above 90/140, placenta previa and previous record of cesarean. Data was entered in SPSS 16 software and Fisher and Chi-square tests were used to compare vaginal laceration, episiotomy and Apgar score between two groups. Twelve out of 73 pregnant women [16.4%] in physiologic delivery group and 27 out of 69 pregnant women [39.1%] in non-physiologic delivery group needed episiotomy [P = 0.002]. Ten patients [13.7%] in physiologic delivery group and seven persons [10.1%] in the non physiologic delivery group were suffering from vaginal laceration [P = 0.51]. There was no significant statistical difference between newborns' Apgar score in two groups. Physiologic delivery can reduce the need for episiotomy without any further complications

Trends and determinants of caesarean section

To analyze different indications and frequency of caesarean section [CS] so as to provide recommendations for reduction of caesarean section rate. Descriptive case series. Obstetrics and Gynaecology Unit III, Civil Hospital and Dow University of Health Sciences Karachi, from January 2009 to December 2009. All patients who underwent CS either booked, unbooked or referred were included in the study. The data was collected and analyzed for socio-demographic parameters and indications of CS. Patients with ruptured uterus on laparotomy were excluded. Data was analyzed on SPSS 11; percentages and mean were calculated. During one year study period 778 CS were performed. The rate of CS was 27.94%. Emergency CS was performed on 85.86% and elective caesarean section on 14.14% patients. Among them 71.34% were non-booked and referred cases. The commonest indication was repeat CS [n 367 - 47.17%], followed by labour dystocia [n 78 - 10.01%], breech presentation [n 77 -9.8%], foetal distress [FD n 72 - 9.2%], cephalo-pelvic disproportion [CPD n 71 - 9.1%], hypertensive disorders of pregnancy [PID n 49 - 6.2%] and antepartum haemorrhage [APH n39 - 5.0%]. The rate of caesarean section was high. The majority of the cases were non-booked and referred patients, who mostly underwent emergency CS. The commonest indication was repeat CS

Indicações de cesariana baseadas em evidências: parte I / Evidence-based cesarean section indications: part I

No Brasil, as taxas de cesárea variam bastante entre as regiões, principalmente quando se compara a assistência realizada pelo Sistema Único de Saúde (SUS) com a assistência privada. A taxa de cesarianas no setor de saúde suplementar chega próximo de 80%, enquanto no SUS fica próxima de 30%, muito acima do recomendado pela Organização Mundial de Saude (OMS). Realizou-se uma revisão da literatura em busca das melhores evidências disponíveis sobre indicações de cesariana. Analisaram-se as principais indicações de cesárea, como distocia ou falha na progressão do parto, desproporção cefalopélvica, má posição fetal nas variedades de posição posteriores e transversas persistentes, apresentação pélvica, de face e córmica, cesárea anterior, frequência cardíaca fetal não-tranquilizadora, presença de mecônio e centralização fetal. Em nenhuma dessas situações existe indicação absoluta de cesariana, uma vez que mesmo na apresentação córmica o parto normal pode ser tentado, mediante versão cefálica externa (VCE). Nas distocias de progressão, o parto normal pode ser alcançado mediante correção da contratilidade uterina, porém a cesariana encontra-se indicada quando a desproporção cefalopélvica é diagnosticada pelo uso judicioso do partograma. A apresentação pélvica também pode ser corrigida com VCE a termo, mas a via de parto deve ser discutida com a gestante quando a VCE falha ou não é realizada. Embora os riscos relativos neonatais sejam maiores para o parto vaginal, os riscos absolutos são baixos, e a opinião da gestante deve ser considerada

Rates of cesarean in Brazil vary widely among the regions, especially when Single Health System (SUS, acronym in Portuguese) assistance is compared with private clinics. In the supplementary health system the rates of cesarean section are around 80% and in SUS are about 30%, above the rates recommended by World Health Organization (WHO). A literature review was performed searching the best evaluable evidences. The main indications for cesarean section were considered such as dystocia or failure to progress, cephalopelvic disproportion, abnormal fetal positioning in occiput posterior and transverse presentations, breech, face and transverse lie, previous cesarean section, non-reassuring fetal heart rate, meconium and brain-sparing effect. Most of these situations do not represent absolute indications for cesarean section. Even in transverse lie an external cephalic version (ECV) could be tried and a trial of labor can be conducted. When a progress failure occurs, vaginal delivery can be achieved using measures as correction of contractility disorders, although cesarean should be indicated when cephalopelvic disproportion is diagnosed using correctly the partograma. Breech presentation can also be corrected with an ECV at term but the mode of delivery has to be discussed with the patient when ECV fails or it is not performed. Although neonatal relative risks are higher with vaginal delivery, absolute risks are small, and the pregnant women opinion has to be considered

Incidencia y principales causas de cesárea en pacientes atendidas en la maternidad Enrique C. Sotomayor, período comprendido entre julio 2005 a septiembre 2005 / Incidence and principal causes of cesarean section of patients at Enrique C. Sotomayor Maternity Hospital during the period from June to September 2005

Debido a una variedad de factores médicos y sociales, el índice de cesáreas ha aumentado; se deduce que dicho aumento se debe a procesos que no son justificados. Tipo de estudio: descriptivo y prospectivo. Objetivos: determinar la incidencia y las causas de las cesáreas realizadas en el Hospital maternidad “Enrique C. Sotomayor”, para comprobar si esta intervención quirúrgica esta justificada. Promover alternativas para reducir el índice de cesáreas injustificadas. Resultados: El universo fue de 563 pacientes cesareadas. La principal causa de cesárea en pacientes sin antecedentes de cesárea fue la desproporción cefalopélvica. En los pacientes con antecedente(s) de cesárea, la cicatriz uterina previa (CUP) fue la principal causa por la cual se realizó la siguiente cesárea. Conclusión: Las cesáreas realizadas en pacientes sin antecedentes de cesárea son justificadas. Las cesáreas realizadas en pacientes con antecedentes de cesárea no son justificadas en su totalidad. Existen casos en este estudio de pacientes que pudieron ser sometidos a diferentes opciones de parto y no acudir a la cesárea.

According to a variety of medical and social factors, the cesarean rate has increased; this increase might be due to unjustified processes. Type of study: descriptive and prospective. Objective: to determine the incidence and the causes of cesarean practiced at “Enrique C. Sotomayor” Maternity hospital, to check if the surgery is justified. To promote alternatives to reduce unjustified cesarean rate. Results: the sample group was of 563 patients. The main cause of cesarean in patients without history of cesarean was a cephalopelvic disproportion. In patients with history of cesarean, previous uterine scar (PUS) was the main cause of another cesarean. Conclusions: the cesarean sections carried out in patients without history of cesarean are justified. All the cesarean sections carried out in patients with history of cesarean are not totally justified. In this study there are cases of patients who could have undergone different options of labour instead of the cesarean.

Histerectomía obstétrica en el Hospital Sor Juana Ines de la Cruz 2001-2008 / Obstetric hysterectomy in the Hospital Sor Juana Ines de la Cruz 2001-2008

Se realizó una investigación observacional, descriptiva, presentando la revisión de 3 pacientes con Histerectomía Obstétrica periparto ocurridas en el Hospital Sor Juana de la Cruz en el período 2001-2008. Siendo en el 100 por ciento de los casos el parto por operación cesárea. Las principales causas de interrupción fueron: en cesárea electiva: desproporción cefalo-pélvica en 0,40 por ciento, Útero cicatrizal por cesárea anterior en 1,36 por ciento y en la cesárea de urgencia el Sufrimiento Fetal agudo en el 0,40 por ciento. La principal causa clínica de Histerectomía Obstetricia es la atonia uterina en 2 casos, acretismo placentario en 1 caso (Realizándose la Biopsia y confirmando el diagnóstico). La Histerectomía obstétrica susbtotal se realizó en los 3 casos y solo en 1 caso y salpingooferectomía derecha por estallido ovárico. No se registró muerte materna ni muerte fetal. La mayor proporción de pacientes eran nulípara y con edad gestacional comprendida entre las 39-41 semanas.

Identificación de factores de riesgo más frecuentes en embarazadas cuyos partos fueron atendidos desde enero hasta diciembre 2006: en el Hospital Rural Tipo 1 Coloncito estado Táchira / Identification of risk factors more common in pregnant women whose births were attended from January to December 2006 in the Rural Hospital type 1 Coloncito Tachira

El control pre-natal (CPN) es el conjunto de acciones y procedimientos destinados a la prevención, diagnóstico y tratamiento de los factores que puedan condicionar morbimortalidad materna y perinatal. La mayoría de los modelos de CPN actualmente en uso en el mundo no han sido sometidos a una evaluación científica rigurosa para determinar su efectividad. En los países en desarrollo la implementación de los programas de CPN ha sido deficiente, con visitas clínicas irregulares, con largos tiempos de espera y mala respuesta en el cuidado de las mujeres, lo cual no constituye una excepción en nuestro país ni en el caso específico de nuestro estado y del centro asistencial tomado para el estudio. Debido a la gran preocupación que esta situación representa, surge la necesidad de realizar una rigurosa revisión de las historias clínicas de las madres cuyos partos fueron atendidos en esta institución en el 2006, así como buscar respaldo en bibliografías, manuales y publicaciones para identificar los factores de riesgo (FR) más frecuentes en dichas madres y proponer estrategias sencillas de prevención, detección temprana y manejo de los mismos, entendiendo que de nosotros como personal de salud depende hacer el embarazo un estado fisiológico femenino y no una enfermedad de nueve meses.

Causes and management of high fetal head in primigravidae at term

To determine the causes of high foetal head and their relative frequencies in primigravidae presenting at term and to determine the proportion of these patients undergoing lower segment caesarean section or vaginal delivery. A descriptive study. The study was carried out at CMIH Rawalpindi from April 2002 to March 2003. A total of 100 primigravidae patients presenting at term and having a single pregnancy were randomly selected. On the basis of history, Physical examination and abdominal ultrasonography, patients having a high foetal head were recognized and their causes documented. Out of 100 primigravidae, 58 had high foetal head. A discernable cause was found in the 39 [67.2%] patients. Cephalopelvic disproportion [20.7%] and foetal ma! position [17.2%] were the leading cause of high foetal head Lower segment Caesarian section [50%] was the management of choice in half of the patients with high foetal head. Cephalopelvic disproportion and foetal malposition were the major cause of high foetal head in this study and lower segment Caesarean section was the mode of delivery in only 50% of these high risk subjects

Indications for cesarean section at Thammasat University Hospital.

OBJECTIVE: To present the indications associated with the increase in cesarean section rate at Thammasat University Hospital during the past three years. MATERIAL AND METHOD: This was a cross-sectional study. Pregnant women who underwent cesarean section between January 2003 and December 2005 at Thammasat University Hospital were recruited for the present study. Cases of fetal anomaly or intrauterine fetal death were excluded. Demographic and obstetric data including indications of cesarean section and pregnancy outcomes were collected and analyzed RESULTS: Among the 1328, 1402, and 1522 cases of cesarean section (27.31, 27.94, and 29.26%) in 2003, 2004 and 2005 respectively, the major indication was previous cesarean section (29%). Cephalopelvic disproportion (CPD), and elective cesarean section were second, and third most common indication (24.64%, 11.23%) respectively. CONCLUSION: The increasing cesarean section rate was due to rising of elective cesarean section or patient's request. Cesarean section without obstetric indication should be reconsidered to lower the cesarean section rate.

Cesarean sections at prince Ali Ben Al-Hussein military hospital-Jordan: rate and indications

To determine the rates and indications of cesarean sections at Prince Ali Ben Al-Hussein Military Hospital, Karak - Jordan. This retrospective study was carried out between 1[st] January 2003 and 30[th] December 2003. The medical records of all patients who underwent abdominal delivery were reviewed and analyzed. During the study period, 251 cesarean sections were performed. The rate of cesarean sections was 13.8%. The commonest indications of all cesarean sections [primary and repeated] were failure of progress in labor [21.5%], fetal distress [16.3%] and history of two or more cesarean sections [12.3%]. There were 104 [41.4%] primary and 147 [58.6%] repeated cesarean sections. Of the primary cesarean sections group, the commonest indication was failure of progress in labor [26.9%] and of the repeated cesarean sections group the commonest indication was two or more cesarean sections [21.1%]. This study showed a lower cesarean section rate in our hospital as compared with the international rates. The ideal cesarean section rate remains uncertain, but it is clearly rising all over the world. If we have to reduce cesarean delivery rate safely, we should concentrate on reducing the number of primary cesarean deliveries

Validation of risk scoring scheme for cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital.

OBJECTIVE: To validate the risk scoring scheme for cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital. MATERIAL AND METHOD: A case-control study was conducted between January 1st, 2005 and April 30th, 2006, including, prospectively collected, 132 women who had cesarean delivery due to cephalopelvic disproportion (CPD) as cases and 394 women who delivered by normal labor as controls. Cases and controls were evaluated for risk scores, the scoring scheme of which had previously been developed. The prediction by the risk score was tested with an area under the receiver operating characteristic (ROC) curve of a logistic regression. Another independent set of obstetric cases referred form community hospitals in Lamphun were also evaluated for the risk scores. RESULTS: The risk scores explained 84.5% of the probability of CPD as demonstrated by the area under the ROC curve. The scores of pregnant women referred from rural hospital underwent cesarean delivery were higher than those with vacuum extraction and with normal delivery (mean = 9.2 +/- 2.4, 7.5 +/- 3.2 and 6.4 +/- 2.3 respectively). The score of cesarean delivery was significantly higher than normal delivery (p < 0.001) while the score of vacuum extraction was in between and only slightly higher (p = 0.116). CONCLUSION: Risk scores obtained form this scoring scheme predicted cesarean delivery with high precision. The scores also discriminated cesarean deliveries from normal deliveries among cases referred from community hospitals. Community hospitals may gain benefit by adopting this simple scoring scheme into their practices.

Maternal height and the risk of cesarean delivery in nulliparous women.

OBJECTIVES: To evaluate the relationship between maternal height of < 155 cm and the risk of caesarean delivery due to cephalo-pelvic disproportion (CPD) among nulliparous women. DESIGN: Retrospective cohort study MATERIAL AND METHOD: A total of 660 term (GA > or = 37 weeks), uncomplicated singleton nulliparous pregnant women were enrolled on admission to labour room. The patients were divided into two groups based on maternal height, < or = 155 cm (440 cases) as control and < 155 cm (220 cases) as study group. The medical records of these women were reviewed. Various baseline clinical characteristics were collected. Intrapartum characteristics and maternal and neonatal outcomes were recorded. RESULTS: The rate of caesarean section of all indications was only slightly higher among study group than control group (16.4% and 13.7% respectively, p = 0.514). No significant difference was observed in the rate of caesarean delivery due to CPD (7.3% and 10.5% in control and study group respectively, p = 0.376). The rate of caesarean delivery due to CPD was highest among those with height < 150 cm (p < 0.001). Mean birth weight was significantly lower among study group than control group (2,927.7 +/- 368.1 g and 3,068.4 +/- 358.5 g respectively, p < 0.001). Low birth weight (< 2,500 g) was significantly higher among study group than control group (10.9% and 3.2% respectively, p < 0.001). CONCLUSION: Term singleton nulliparous pregnant women with maternal height < 155 cm were not associated with a greater likelihood of caesarean section for CPD. However, mean birth weight was significantly lower and low birth weight was significantly increased among mothers with short stature.