Perception and attitude of women with previous caesarean section towards repeat caesarean delivery

Objective.?To explore the perception and attitude of women with previous caesarean section towards repeat caesarean section.

Method.?Observational study of women with prior caesarean delivery using an anonymous semi-structured questionnaire. Information elicited include the socio-demographic characteristics, outcome of the last caesarean delivery, experience of complications or domestic violence, acceptance of repeat caesarean section if advised by the doctor and the reason for any refusal.

Results.?One hundred thirty-nine parturients participated in the study. Seventy-seven percent had 1 previous caesarean delivery while 24.46% will decline a repeat caesarean section. Major reasons for refusal were postoperative pain, cultural aversion, fear of death, and cost of caesarean delivery. The rate of acceptance was significantly higher amongst those with more than one prior caesarean section while the rate of refusal was significantly higher amongst those who experienced perinatal death in the last caesarean delivery. Twelve percent experienced domestic violence (almost entirely psychological) mainly from the spouse or his relatives.

Conclusion.?A significant proportion of women with previous caesarean delivery will decline a repeat caesarean section if medically indicated. There is need for bahavior change communication involving the community, improved postoperative pain management, and better counseling especially on safety of the procedure.     

Survey of attitudes of pregnant women towards Down syndrome screening

This study aimed to examine whether pregnant women made informed decisions based on an accurate understanding of the antenatal screening process and to explore their attitude to screening and termination of a Down syndrome fetus. Women's aspirations were the keystone that informed the development of the first strategy for antenatal screening for congenital anomalies. Semi-structured interviews were carried out with a sample of pregnant women in South Wales in 1995. A total of 34 women aged less than 35 years, who were 20 weeks pregnant, were interviewed. These women were selected because the screening policy differed between hospitals for this age group. The majority of women were not aware that screening tests were voluntary: tests were presented as routine. About half of the sample were not well informed to make decisions. Only five out of a sampling frame of 101 women refused screening; they tended to be better educated and of higher social class. All women wanted to be given the choice whether to be screened. Seven out of 34 would not terminate an affected fetus. Staff communication skills, especially in delivering risk estimate, were criticized. The survey findings supported the view that women required an information package tailored to their individual needs.     

Unusual complication after caesarean section in a pregnant women with undiagnosed Crohn's disease

The authors have described a perforation of the colon, diagnosed during the course of cesarean section, performed as an emergency operation in 31stweek of pregnancy, in a woman with undiagnosed Lesniowski-Crohn disease. The post operation course was complicated and required a partial resection of the bowel.     

The mode of anaesthesia for caesarean section in the opinion of pregnant and delivering women

OBJECTIVES: Conduction anaesthesia is regarded as a very safe method for the mother and for a newborn. This kind of anaesthesia reduces the risk of gastric contents aspiration and does not cause the respiratory depression. However in every case it is essential to take into consideration the woman's opinion, for whom delivering of the child is the particularly important event. DESIGN: The aim of the study was the evaluation the presence and the intensification grade of side effects of the anaesthesia to the caesarean section and establishing, which kind of anaesthesia to this operation: general or conduction is assessed as the best method for the delivering women. RESULTS: In study group among 76 women after cesarean section were 49 (64.5%) after epidural anaesthesia, 22 women (28.9%)--after spinal anaesthesia, and 5 patients (6.6%) were operated in general anaesthesia. The most common side effects after anaesthesia for cesarean section were: weakness and backache. After POP the headache was much more often symptom. CONCLUSIONS: Most of pregnant women preferred epidural anaesthesia during delivering of the child by caesarean section.     

Violence towards pregnant women

The aim of this work was the evaluation of the scale of violence towards pregnant women in the westpomeranian province, the definition of the social-biological profile of women exposed to violence and social-biological profile of their partners. The evaluation of the influence of violence on pregnant women's ending term and the weight of the newborns. 481 women were enrolled and an anonymous study was used in the form of questionnaires. A questionnaire was a modified form of a query-sheet proposed by WHO. 25% of the enrolled women were exposed to physical and psychological (emotional) abuse, 7.1% to psychical violence, women and men exposed to violence in their childhood more often become violent in their adult life. Men that physically abuse pregnant women are often of primary school education, are unemployed, drink alcohol and smoke. Physical abuse by a partner during pregnancy usually experience women with primary school education, who drink and smoke. Violence during pregnancy is usually associated with premature delivery as well as low birth weight of the newborns.     

Indications of caesarean section in overweight and obese versus normal-weight pregnant women: a retrospective cohort study

Purpose: The aim of this study was to test the hypothesis that indications of c-section in overweight or obese pregnant women are different from those with normal-weight.

Methods: Retrospective cohort study at University Hospital of Puerto Real (Cádiz-Spain). We compared frequency distribution of c-section indications in overweight and obese versus normal-weight. The risk of c-section by different indications was calculated as relative risk.

Results: A total of 4685 births were included in the study. There are significant differences in the frequency distribution of caesarean indications among normal weight and overweight or obese women. In overweight, we found an increased risk of c-section due to previous c-section (RR: 1.73; confidence interval [CI] 95% 1.24–2.42), obstructed/non-progressive labour (RR: 1.34; CI 95% 1.03–1.75), failed induction of labour (RR: 2.38; CI 95% 1.30–4.34) and foetal distress (RR: 1.73; CI 95% 1.21–2.49). This risk was even higher in obese women: previous c-section (RR: 3.25; CI 95% 2.24–4.71), obstructed/non-progressive labour (RR: 2; CI 95% 1.45–2.77), failed induction (RR: 2.52; CI 95% 1.15–5.51) and foetal distress (RR: 2.35; CI 95% 1.51–3.65).

Conclusions: The risk of caesarean section due to previous caesarean section, obstructed/non-progressive labour, failed induction of labour or foetal distress is greater in overweight and obese than in normal-weight. This increase in risk also increases progressively as maternal BMI increases.     

The effect of caesarean section on self-esteem amongst primiparous women in South-Western Nigeria: A case-control study

Objective.?This study aims to assess the level of self-esteem of newly delivered mothers who had caesarean section (CS) and evaluate the sociodemographic and obstetrics correlates of low self-esteem in them.

Methods.?Newly delivered mothers who had CS (n?=?109) and who had spontaneous vaginal delivery (SVD) (n?=?97) completed questionnaires on sociodemographic and obstetrics variables within 1 week of delivery. They also completed the Rosenberg self-esteem scale.

Results.?Women with CS had statistically significant lower scores on the self-esteem scale than women with SVD (p?=?0.006). Thirty (27.5%) of the CS group were classified as having low self-esteem compared with 11 (11.3%) of the SVD group (p?=?004). The correlates of low self-esteem in the CS group included polygamy (odd ratio (OR) 4.99, 95% confidence interval (95% CI) 1.62–15.33) and emergency CS (OR 4.66, 95% CI 1.55–16.75).

Conclusions.?CS in South-Western Nigerian women is associated with lowered self-esteem in the mothers.     

Post-operative complications after caesarean section in HIV-infected women

This retrospective study evaluated complications associated with caesarean section in HIV-infected women. For each HIV-positive patient (n=45) a control group of ten seronegative women (n=450) was matched for age, number of foetuses, gestational age, indication for caesarean section, status of the membranes and kind of anaesthesia. All women delivered in the same hospital using a uniform protocol. We evaluated the duration of stay in hospital after operation, the need for antibiotics after caesarean section, the incidence of minor postoperative complications (mild anaemia, mild temperature or fever 24 h after surgery, wound haematoma or infection, urinary tract infection, endometritis) and major postoperative complications (severe anaemia, pneumonia, pleural effusion, peritonitis, sepsis, disseminated intravascular coagulation, thromboembolism). Most HIV-positive women (64.5%) had a complicated recovery after surgery. A higher incidence of major and minor postoperative complications were observed in the HIV-positive group than in the control group. There was a statistically significant greater incidence of mild anaemia, mild temperature or fever, urinary tract infection and pneumonia in the HIV-positive group. HIV-positive women with less than 500×10⁶ CD4⁺ lymphocytest/l had higher post-caesarean section morbidity than HIV-positive women with more than 500×10⁶ CD4⁺ lymphocytest/l. The median duration of hospital stay was significantly higher in the HIV-positive group (median 7 days) than in the HIV-negative group (median 4 days). The rate of HIV vertical transmission was 8.8%. Higher post-caesarean section morbidity was found in HIV-positive women than in controls. Unfortunately, the HIV-positive women (with low CD4 lymphocytes counts), whose infants theoretically will benefit most from caesarean delivery, are also the women who are most likely to experience post-operative complications.     

Diet restriction by pregnant women in Nigeria

The reasons for food aversions given by selected low income, illiterate women during pregnancy fell into four categories: health, tradition, economy and religion. More than two thirds of these mothers strongly avoided milk, cowpea seeds and bournvita for fear of having big babies which they thought would lead to difficult labor and cesarean section. Only one of the respondents associated infantile rickets with nutrition. Nutritional counseling, coupled with a fear-mechanism technique for a minimum of four months, served to correct these erroneous assumptions. The effects of the counseling sessions were evaluated by monitoring patterns of maternal weight gain and the baby's weight. The experimental group had a significant pattern of monthly weight gain (P less than 0.02) and heavier babies (P less than 0.01) than the control group. The authors conclude that diet restrictions of this nature can be modified positively through regular nutritional counseling and, in extreme cases, by the use of a fear-mechanism technique.     

Maternal complications after caesarean section in HIV infected women

OBJECTIVE: To assess the intervention related risk in HIV-infected women, undergoing caesarean section (CS). SETTING: Tertiary care center for high risk obstetrics and infectious diseases in pregnancy. PATIENTS AND METHODS: Thirty-three HIV-positive women and one hundred and sixty-eight controls, cross matched for age, weight, parity, obstetrical characteristics at delivery and indication for CS, were prospectively recruited for the study. Infection related characteristics, as mode of acquisition, drug abuse, immune status and stage of disease were also recorded. Complications of the intervention were evaluated according to infectious status and risk factors. RESULTS: Post-operative complications were significantly more frequent among HIV-infected mothers. More advanced disease and maternal age were the risk factors statistically related to complications. DISCUSSION: According to our data, CS carries a higher chance of post-operative complications in HIV-infected women, these complications being also related with the severity of infection (stage and duration of the disease). Given the characteristics of the population in the study (mode of acquisition, prevalence of early stage of the disease), the rate of complication is still relatively low compared to non-western, malnourished, drug-abusers groups.     

HIV infection among pregnant women in Nigeria.

OBJECTIVES: To determine risk factors for HIV among pregnant women (N = 2657) receiving antenatal services in Jos, Plateau state, Nigeria. METHODS: Information about potential risk factors was obtained at interview. Biological samples were collected for detection of HIV and other sexually transmitted infections (STIs). RESULTS: The prevalence of HIV was 8.2%. Women aged 20-29 years had more than 4-fold increased risk of HIV. Women of Catholic (adjusted odds ratio (AOR) = 1.72, 95% CI = 1.01-2.95) and Pentecostal (AOR = 2.57, 95% CI = 1.46-4.52) denominations were more likely to be HIV-infected when compared to Moslem women. The risk of HIV was also increased among women with multiple marriages and in women married to a banker/accountant. Other predictors of HIV were having a husband with other partners, perceived risk of HIV, STIs, candidiasis and bacterial vaginosis. CONCLUSIONS: Development of effective interventions, including behavioral change, expansion of perinatal HIV prevention services and STI control, should be given the highest priority.     

Abortion attitudes of pregnant women in prenatal care

OBJECTIVE: This study was undertaken to describe abortion attitudes in a diverse cohort of pregnant women enrolled in prenatal care. STUDY DESIGN: A cross-sectional interview study of 1082 demographically diverse gravid women enrolled in prenatal care at less than 20 weeks' gestation was performed. RESULTS: Most participants (92%) supported abortion availability. Half (50%) who were willing to consider an abortion would do so only in the first trimester. Among the gravid women willing to consider an abortion in the first or second trimester, 84% would do so after rape/incest or if their life was endangered and 76% would if their fetus had Down syndrome. Gravid women considering abortion were more likely to be white, older, have had a previous abortion, and to express distrust in the health care system. Women who would not consider abortion were more likely to be multiparous, married/living with partner, and to express greater faith and fatalism about their pregnancy outcome. CONCLUSION: Although most pregnant women enrolled in prenatal care support abortion availability, about half would only consider a first-trimester procedure. These findings underscore the need for early prenatal genetic counseling, screening, and testing.     

The development and process evaluation of an information-based intervention for pregnant women aimed at addressing rates of caesarean section

OBJECTIVE: Few strategies aimed at addressing rising rates of caesarean section have explicitly involved information-based approaches for pregnant women. This study describes the development and evaluation of such an intervention for pregnant women, encompassing pamphlets and a peer support network (PSN). DESIGN: Process evaluation. SETTING: The study was undertaken at a metropolitan teaching hospital in Adelaide, South Australia. POPULATION: A consecutive sample of pregnant women attending the ultrasound clinic over a two-month period, recruited at 18 weeks of gestation. METHODS: Participants received two pamphlets at 18 weeks of gestation and information on a PSN at around 28 weeks of gestation. A questionnaire was sent to women at seven weeks postnatal, asking them to evaluate the intervention. MAIN OUTCOME MEASURES: The extent to which the intervention resources were used and participants were satisfied with the resources they received. RESULTS: Ninety-two women returned questionnaires (response rate of 62%). Women generally resisted engaging with the informational resources, citing irrelevance to their situation, for example, 53% (49/92) read all of the pamphlets. None of the women used the PSN. Women who had experienced childbirth previously and those of higher education were significantly more likely to read the pamphlets. While generally satisfied with pamphlet content, one in five women reported feeling distressed by some of the information. CONCLUSIONS: This exploratory study casts doubt on the notion of information provision for pregnant women as a panacea for addressing rising rates of caesarean section.     

Zinc and copper concentration in plasma of pregnant women in Nigeria

The concentration of plasma zinc and copper were determined by atomic absorption spectrophotometry in 58 Nigerian women at various times in pregnancy and compared with those of 11 non-pregnant controls. The results showed 67.5% decrease in zinc and 100% increase in copper over non-pregnant levels at the end of pregnancy. The mean plasma zinc levels were appreciably lower and copper the same as published values for Caucasian women at similar periods in pregnancy. Furthermore, there was no correlation between plasma zinc and copper and neonatal birthweight. We conclude that (1) a significant proportion of pregnant women in Nigeria have biochemical hypozincemia; (2) this hypozincemia is not responsible for fetal growth retardation in this population and (3) there is at present no justification for giving routine zinc supplementation to pregnant women in Nigeria.     

Vaginal delivery after one caesarean section in Nigerian women.

A total of 120 Nigerian women at term pregnancy with one previous caesarean delivery were studied between June 1988 and May 1993. Elective caesarean section was performed in 3 (2.5%). Vaginal delivery was achieved in 101 (86.5%) of those allowed a trial of labour. Intrapartum caesarean section was done in 16 (13.7%) cases. Rupture of the uterus occurred in 3 cases (2.6%) with perinatal loss of 2 babies. There was no maternal mortality. There was no significant correlation between vaginal delivery and birth weight, gestational age or initial indication for the primary caesarean section. It is concluded that trial of labour is safe after a previous caesarean section in selected patients.     

Few women wish to be delivered by caesarean section

Objective To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish.
Design National survey.
Setting Swedish antenatal clinics.
Population 3283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999–2000).
Methods A questionnaire was mailed shortly after the first antenatal visit.
Main outcome measures Women's preferences for mode of delivery.
Results 3061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience.
Conclusions Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.     

Nutrition of pregnant women in rural and urban areas

The purpose of the study was to gain information on the present state of nutrition of pregnant women in rural areas and towns, and on the level of their knowledge of adequate nutrition. The study covered 300 women in villages and 258 in towns. The selection of women was done randomly, the method of the study was interviewing of the women. The questions concerned consumption of milk, cheese, meat and its products, eggs, vegetables and fruit during the whole pregnancy, and separately the data on potato consumption were obtained. The women were questioned also about the read publications on rational nutrition of pregnant women. The answers were obtained from mothers aged 18-42 years in labour rooms, clinics for children or in homes. The answers were noted during interviews by experienced interviewers. It was found that 26.6% of pregnant women in towns and 16.2% in villages were not consuming daily milk or cheese, while 6.2% of these women in towns and 4.3% in villages consumed no milk at all. Only 41.1% of these women in towns and 19% in villages took meat and processed pork everyday. Most frequently the women consumed meat and processed pork 4 times weekly (39.6% in towns and 60.3% in villages). Eggs were consumed daily by only 13% of women in towns and villages, and they were eaten most frequently 4 times weekly (30.2% in towns and 45.7% in villages). In a week meat, processed pork and eggs were eaten 5 to 7 times by only 43.8% of pregnant women in towns and 21.3% in villages.(ABSTRACT TRUNCATED AT 250 WORDS)     

Perceptions and attitudes of Nigerian women about the menopause.

The attitudes of women to the menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment for or perception of its symptoms. The object of this study was to determine the perception and attitude of post-menopausal Nigerian women to the menopause. We interviewed 676 women who had experienced at least 24 months of amenorrhoea using a structured questionnaire. Menopause was considered a normal physiological manifestation of the ageing process by 95.56% of the respondents while 2.66% believed it was a disease condition. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71.13%), sexual life ended with menopause. None of the women was on hormone replacement therapy but among those sexually active, reduced libido/frequency and vaginal dryness were reported by 24.59%. The most commonly reported advantage of menopause was freedom from cyclical bleeding. We conclude that although Nigerian post-menopausal women have a positive disposition towards menopause, they may have a significant reproductive health burden which has been tolerated for so long. It is important to determine the influence of sociocultural belief on sexuality after menopause and also evaluate the benefits of hormone replacement therapy in our environment.