Elective cesarean section in case of threatened twin pregnancy: a case report

The authors present the use of computer-aided monitoring of pregnancy in case of twin. In our case one twin was threatened of intrauterine death. The frequency of antepartum death of one twin varies from 0.5%-6.8% of all twin deliveries. The underlying causes for antepartum death are multiple. It suggests that fetal growth retardation is due to competition for uteroplacental circulation and nourishment. In this case, the smaller twin was threatened of intrauterine death, because of intrauterine growth retardation, so the pregnancy was delivered on 32. week of gestational age by cesarean section.     

Outcome of labor following previous cesarean section

Four hundred fifty-one patients who had had previous lower segment cesarean section were studied for subsequent pregnancy outcome at the University Teaching Hospital, Lusaka, Zambia. Of 319 who were allowed to go into labor, 63% succeeded in delivering vaginally, while 37% had to undergo repeat intrapartum cesarean delivery. No maternal death occurred. Scar dehiscence occurred in one case only. Parturition in otherwise obstetrically normal patients seems to be safe, and the trial of labor approach is desirable as it results in a lower number of repeat cesarean deliveries.     

Ectopic pregnancy in a cesarean section scar

A combination of systemic chemotherapy, feticide with intrachest and intra-abdominal injection with methotrexate, and hysteroscopy with dilation and curettage to remove the gestational tissue was successful in the treatment of a cesarean scar ectopic pregnancy. This case presents images of the ultrasound, magnetic resonance imaging, and pathologic features unique to a cesarean scar pregnancy.     

Postterm pregnancy after previous cesarean section

In order to assess the current management of, and to develop a management scheme for, patients with postterm pregnancy and previous cesarean section (C/S), a retrospective analysis of 112 patients was done. All patients with postdates pregnancy and previous C/S were followed in a postdates clinic according to a previously published protocol. Thirty-four patients (30.4%) underwent elective repeat C/S, and 78 (69.6%) were permitted a trial of labor (TOL). Of these TOL patients, 57 (73.1%) delivered vaginally. Sixteen (42.2%) of 37 patients with a history of prior C/S for cephalopelvic disproportion delivered vaginally. Excluding 34 patients who underwent elective repeat C/S, the remaining 41 patients who had previous C/Ss for other indications delivered vaginally. This difference was statistically significant (p less than 0.001). Other factors--the number of previous vaginal deliveries, type of previous-C/S incision, the complications of the prior C/S and the interval since the previous C/S occurred--had no effect on vaginal delivery. There was no marked difference in perinatal morbidity between infants delivered vaginally and those delivered abdominally. The maternal morbidity, in terms of postpartum fever and requirement for transfusion, in patients with repeat C/S was significantly higher than that in women with vaginal deliveries. Postdates pregnancy was not associated with an increased risk of uterine rupture. On the basis of this experience we think that postterm pregnancy should not be considered a contraindication to a TOL.     

Management of pregnancy after cesarean section.

Management of 226 patients with previous low transverse cesarean section in a special obstetric clinic for high-risk pregnancies significantly and safely reduced the incidence of purely elective cesarean section to less than 10%. A substantial incidence (25%) of other high-risk factors dictating antepartum indicated cesarean section were found in this population. There was 38.5% incidence of vaginal delivery in 145 patients who underwent a trial of labor. Patients delivered vaginally followed a normal labor curve up to full dilatation. Oxytocin was required in three cases of prolonged second stage of labor and resulted in instrumental vaginal delivery in all instances. There were no uterine ruptures on vaginal exploration after delivery or at the time of repeat cesarean section during labor. There was no maternal death or perinatal loss. No justification for the present clinical practice of a 99% inicidence of elective repeat cesarean section could be found. Substantial savings in hospital cost, as well as a decreased number of diagnostic tests for the otherwise normal gravid woman, can be safely achieved.     

Iliofemoral-popliteal phlebothrombosis in twin pregnancy treated with cesarean section and thrombectomy in the same act: a case report

A case is presented of a 39-year-old primigravida who developed iliofemoral-popliteal thrombosis in the 34th week of twin pregnancy. Thrombectomy by use of a Fogarty catheter with previous protection from thrombus embolization by proximal placement of temporary occlusion was performed at the same time as the cesarean section for completion of premature delivery.     

Breech extraction versus cesarean section for the remaining second twin

All second twins delivered by cesarean section (CS) after vaginal birth of the first twin (n = 38) and all breech-extracted second twins (n = 282) in Sweden during 1973-81 were identified. Data from the medical records of all CS second twins were extracted and compared with breech-extracted second twins from the same departments born within 2 years of the CS twin (n = 25). Second twins delivered after maternal general anesthesia had lower 5-min Apgar scores, irrespective of mode of delivery. Maternal morbidity was substantial in the CS group. The results encourage the use of breech extraction under local anesthesia rather than CS when there is a need for a quick delivery of the second twin and when both alternatives are available.     

Is cesarean section justified for delivery of the second twin?

During the last 7-year period, the second twin was delivered by cesarean section in three of 161 twin pregnancies in our Department. The main reasons for this procedure were fetal distress caused by malpresentation or cord prolapse in 2 cases and in the third case placental separation. Cesarean section for delivery of the second twin is justified only in selected cases.     

Outcome of the mother and baby delivered by cesarean section in pregnancy induced hypertension. Analysis of 487 cases

We analyzed the outcome of mother and baby in 487 cases of pregnancy induced hypertension (PIH) delivered by Cesarean section (CS). The indication for CS in 70 cases was simply PIH (14.4%) and 6 out of 9 antepartum eclampsia had CS. There was no maternal or fetal death. The authors suggest that CS should be done whenever eclampsia could not be put under control in order to save both mother and baby. The incidence of postpartum hemorrhage (PPH) was lower in the CS group than in the vaginally delivered group. No late PPH occurred in our CS cases. The incidence of IUGR was 30.4%. Of these IUGR cases 43 were delivered by CS. No stillbirth occurred. The number of neonatal anoxia was less than in the vaginally delivered group (P less than 0.10).