METHODS: The medical records of 504 total laparoscopic hysterectomy patients operated between May 2013 and May 2017 were reviewed retrospectively. Data on age, parity, surgical indications, duration of op- eration, length of hospital stay, histopathological diagnosis and major intra and postoperative complica- tions were gathered. The patients were categorized into two groups according to their CS history, namely those with and those without previous CS. Major complications were defined as the presence of lower urinary tract injury (bladder or ureter injury), enterotomy/colostomy, bowel serosal injury or vascular injury. RESULTS: There was no difference between the groups in terms of parity, duration of operation, hos- pital stay or pre and postoperative hemoglobin levels. The conversion rates to laparotomy in the pre- vious CS and no CS groups were 2% and 1.7%, respectively. The rates of major complications in the previous CS and no CS groups were 5% and 1.3%, respectively, and these results did not differ signifi- cantly (P > 0.05).
but rather on the location of uterine scars from previous Cesa- rean sections. The authors made transvaginal examinations between 14 and 16 gestational weeks to compare uterine scars in patients who had previous elective Cesarean sections or during labor. Patients were divided into groups by asking them if the Cesareansection was performed before or after uterine contractions started. The ultrasound image corresponding to the scar was considered a hypoechogenic line in the isthmus-cervix region. Results show that the line was seen more often when the Cesareansection was performed during labor (75.7% x 52.7%), and the scar was most distant of the internal oriice of the cervix in the same conditions (17.9 x 14.6 mm). The variable prema- turity only had an impact when the previousCesareansection was elective, with the scar closer to the uterine body. Therefore, we conclude that during uterine contractions, Cesarean sections are performed on the cervical tissue, but when performed before labor they include myometrial tissue.
Statistically signiicant diferences were found among all risk groups, with a higher risk of cesareansection among women assisted in the private sector, when compared to those of the same groups who gave birth in public hospitals; these efects maintained sig- niicance after adjustment for confounders. When birth occurred in private maternities, primaparae, white-skinned women, with a higher quantity of prenatal visits, delivery during the day shift, and history of stillbirth in previous pregnancy had a higher than 50% probability of caesarean section (PR > 1.5) when compared to those assisted in public hospitals. Among women aged 35 years and over and with 8 years of schooling or more, who gave birth in private hospitals, the excess risk of caesarean section was higher than 30% (PR > 1.3). Among those who had previouscesareansection and delivery in the pri- vate system, the probability of a new cesareansection was 17% higher than among their peers assisted in public institutions.
The extrapelvic endometrial implants have been detected in various organs. Abdominal wall endometriosis, also known as scar endometrioma, is a rare site of localization, usually oc- curring ater previouscesareansection or pelvic surgery. It is thought to result from mechanical transplantation of endome- trial tissue into scars during abdominal surgery . The other possible theories in the development of extrapelvic endometrio- sis are retrograde menstruation, venous or lymphatic metasta- sis and metaplasia . In present case report, endometriosis was found within the body of the rectus abdominis muscle at the right corner of the surgical scar. It is an unusual and rare lo- calization for endometriosis since it was irst described in 1984 by Amato and Levitt .
We observe in our study a signiﬁcant relationship between a prior cesareansection and the choice for surgical delivery in women with GDM (OR ¼ 5.198, 95%CI ¼ 2.702–10.003). Even today, the occurrence of a ﬁrst cesareansection still determines a new cesareansection in the following pregnan- cy. Although some evidence shows beneﬁts of vaginal deliv- ery after cesareansection for most women with a previouscesareansection performed with a low transverse uterine incision, the fear of rupture of the uterine scar associated with the risk of fetal macrosomia leads to a surgical interruption of delivery in diabetic pregnant women. 16
After the Ethical Committee, Santa Casa de Misericórdia, Li- vramento approval and their informed consent, participated in this study 120 patients eligible for elective Cesareansection and not in labor, who were randomly distributed in two groups (according to computer-generated table) to receive ephedrine or etilefrine in case of hypotension. Exclusion criteria were patients with pre-existing hyperten- sion or with pregnancy-induced hypertension. Vasopressor drugs were prepared by diluting in a 10 mL syringe, that is 9 mL distilled water and 1 mL of the vial with 50 mg ephedrine or 10 mg etilefrine. Medication was prepared by a nurse who has not participated in the surgical procedure and before the patient was referred to the operating room.
A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleed- ing. CL tended to decrease with advancing gestational age in each group. Until 29–31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group con- tinued to gradually decrease. On multivariate analysis to determine risk factors, only admis- sions for bleeding (odds ratio, 34.710; 95% CI, 5.239–229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210–10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.
Methods: six hundred and ninety-eight women scheduled for cesareansection were randomized to either closure of both visceral and parietal peritoneum (n = 349) or no peritoneal closure (n = 349), at the Maternidade da Encruzilhada (CISAM) in Recife, from November 1997 to December 1998. Statistical analysis compared intraoperative and postoperative outcome between the two groups. There was no difference regarding age, parity, gestational age, antibiotic prophylaxis, headache after spinal anesthesia, cystitis, ruptured membranes and indications for cesareansection.
Taking all the previous research & clinical evidences it can be assumed that an event of acute fetal hypoxia (AFH) can have three distinct outcomes; first outcome could be AFH which reverts back to normal after the event, second outcome could be worsening of AFH & progression to IUFD or the third possible outcome is adaptation to hypoxia progressing to IUGRs/SGA. There is abundant research done with regards to chronic hypoxia or the third possible outcome. Very few attempts have been made to study acute fetal hypoxia and to create a staging system for predicting AFH. Some of the reasons for the fewer attempts in this regard is because of complete patho-physiology of AFH is not yet known; repeated Doppler scans are required over shorter duration to know the progression; the Doppler findings are variable from one sonologist to another sonologist due to skill of the sonologist, fetal position, maternal condition at the time of scan. In our study we have attempted to address this issue. This particular article is a pilot study which is actually part of bigger study lasting for 10 years.
The rates of c-sections without medical or obstetric indi- cation have increased substantially in the last decades, es- pecially in developing countries. Many factors contribu- te to this increase, being the mother-requested cesarean delivery a key contributing factor. There is a major deba- te about the implementation of c-sections performed at the mother’s request without any established medical in- dication, and safety, cost, maternal autonomy, maternal and professional satisfaction, and ethics constitute im- portant factors under discussion.
A 40-yr-old woman, (85 kg, 155 cm) at 38 weeks’ gestation had uterine contractions and was scheduled for cesarean sec- tion. She was healthy (ASA physical status I) and had history of uneventful uterine (myomectomy) and thyroid (sub-total thyroidectomy) surgeries 1 and 3 years ago, respectively.
It is estimated that about 20 million cesareansection (CS) deliveries occur each year in the world [1,2] making this the most frequent abdominal surgery performed in adults. Despite the lack of scientific evidence indicating major benefits of delivering though CS for nonmedical reasons, and increased risks for mother and infants in this situation [3-6], the rates of CS have steadily in- creased in almost all middle- and high-income countries over the last three decades. According to the latest glo- bal estimates, the average CS rate is approximately 15%, with large discrepancies between and within different countries [1,7]. While several African countries have CS rates as low as 1-2% [1,8], between 20-30% of all deliver- ies in the United States and Canada are by CS, and in several Latin American countries CS rates exceed 40%, reaching 80% in the private sector [1,9,10]. Latest esti- mates indicate that in 2009, 39% of all women in Italy delivered by CS , making it the European country with the highest rate of CS.
Novikova et al. reviewed two RCTs, one of them with poor methodological quality, contained 273 vaginal delivery and the other with 180 women undergoing cesarean sections. They published it as a cochrane database review systematic in 2010. TA had been given in 2 doses of 0.5 and 1g IV in women with vaginal delivery and 1g just 10 minutes before surgical incision in CS women. Results showed prophylactic effectiveness of TA on reducing of bleeding during PPH. No serious side effects were associated with TA administration(27).
for cesareansection would be associated with worsening fe- tal acid-base status when compared to epidural and general anesthesia. The authors evaluated 27 studies including stu- dies from the decade of 1960, and concluded that the pH of patient undergoing spinal anesthesia was lower than that of patients undergoing general and epidural anesthesia, and this difference was 0.015. The concepts and strategies of spinal anesthesia in the decade of 1960 were different from current ones, and the administration of ephedrine could be responsi- ble for this difference in results. After crossing the placental
It is known that intraoperative nausea and vomiting in cesarean sections may be prevented through hypotension control and improving the use of neuraxial and intravenous opioids, which improves the anesthetic block quality, mini- mizes surgical stimulation, and reduces the use of uterotonic drugs. Whereas all pregnant women in this study received the same dose of opioids and uterotonic drugs, as well as adequate levels of anesthetic blockade, the increased incidence of nausea and vomiting caused by ephedrine is probably due to an effect of the drug itself, besides indicating that the etiology of nausea and vomiting is multifactorial. 27
Third, if meperidine suppresses shivering, it may lead to lower body temperature following regional anesthesia and this may lead to more hypothermia and also to more shiv- ering later on. Accordingly, appropriate body temperature recording after injection of meperidine during spinal anes- thesia in patients undergoing cesareansection should be considered by authors in future studies for more accurate and reliable findings.