A review of issues surrounding medically elective cesarean delivery

The rate of cesarean delivery has increased dramatically over the past decade. Medically elective cesareans are a major factor contributing to this rise. This article discusses the most recent evidence on the perinatal risks of cesarean delivery versus vaginal birth, the economic impact of elective cesarean delivery, and ethical principles related to cesareans performed without medical indication. Physicians' rationales and responses to the issues are reviewed and the recommendations and guidelines of professional organizations are summarized. Available evidence does not lend support to a current shift in clinical practice. Research is needed to adequately compare outcomes of planned cesarean delivery and planned vaginal birth. Until evidence supports medically elective cesarean as a birth option that optimizes outcomes for low-risk mothers and their infants, obstetric care providers should continue to support evidenced-based decision making that includes advocacy for vaginal delivery as the optimal mode of birth.     

Once a cesarean always a cesarean? A computer-assisted decision analysis

Objective A previous decision analysis models for two strategic choices for trial of labor or repeated cesarean after prior cesarean concluded that the degree of wish for an additional future pregnancy appeared to be a major determinant for choice between the two strategic options. We had extended the analysis model to stillbirth and hypoxic-ischemic encephalopathy in addition to placental complications while updating most of the outcomes in the decision tree. Study design A model was formulated using a decision tree based on reported probabilities for various outcomes and estimated utilities. The question asked was should trial of labor or repeated cesarean be performed after a prior cesarean, with a varying desire for an additional pregnancy. The highest expected outcome determines the preference of our model. Results Our model favors repeated elective cesarean (0.9947) over trial of labor (0.9917) after a previous cesarean and is the preferred approach. This approach was preferable irrespective of the probability of additional pregnancy. Conclusion In contrary to previous models, when taking into account the occurrence of a live infant birth, birth of an infant with hypoxic-ischemic encephalopathy stillbirth, neonatal death, abnormal placental implantation, hysterectomy and maternal death the preferred approach for women with previous cesarean is an elective repeated cesarean rather than trial of vaginal delivery.     

Evaluation of pregnant women with scarred uterus in a low resource setting

AIM: Management of post cesarean pregnancy continues to be a dilemma. The present study was undertaken to evaluate the outcome of such pregnancies in a resource constrained setting so that an appropriate management protocol can be decided. METHODS: An observational study was conducted in the Department Of Obstetrics And Gynecology, King George's Medical University, Lucknow, India. The outcome of all of the women admitted with pregnancy with a previous cesarean section was noted. RESULTS: A total number of 447 women with a post cesarean pregnancy underwent delivery. These comprised 13.7% of total deliveries over the same period. 124 women (27.7%) had successful vaginal delivery while 323 (72.3%) had a repeat cesarean section. Maternal morbidity and perinatal mortality were both significantly higher in the vaginal delivery group (P = 0.00211 and P = 0.0426, respectively). CONCLUSIONS: Vaginal birth after cesarean (VBAC) is associated with higher maternal morbidity and perinatal mortality. Therefore the decision for VBAC must be taken only after proper consideration and counseling of the couple.     

A review of factors associated with dystocia and cesarean section in nulliparous women

The primary indication for cesarean section in nulliparous women continues to be clinical diagnoses that fall under the rubric of dystocia. These diagnoses account for approximately two-thirds of all cesareans experienced by otherwise healthy nulliparous women. Contemporary research evidence suggests that this clinical phenomenon is complex and multifactorial. This review explores factors associated with the phenomenon of dystocia in the context of a conceptual model that considers women's physical and psychological characteristics, fetal factors, intrapartum care and interventions, assessments and clinical decision-making of health care providers, the sociopolitical environment, and the social and physical environment of childbirth. Clinical recommendations include emphasis on the maintenance of normal weight and weight gain during pregnancy, delaying the admission of nulliparous women to the hospital until active labor is established, avoiding elective induction for nulliparous women, keeping women well-hydrated and well-fed during labor, providing high-quality supportive care during labor, staying the course with effective treatment when dystocia is encountered, and a renewed emphasis on the psychobehavioral preparation of nulliparous women for the realities of labor.     

剖宫产术中子宫肌瘤剔除术92例临床研究

目的探讨妊娠合并子宫肌瘤行剖宫产术中子宫肌瘤剔除术对术中和术后的影响。方法对92例妊娠合并子宫肌瘤剖宫产术中子宫肌瘤剔除术情况进行分析。结果肌瘤剔除术组手术时间、手术出血量、住院天数、产褥病率及切口愈合情况与单纯剖宫产术组比较差异无统计学意义(P>0.05)。结论剖宫产术中行子宫肌瘤剔除术是可行的。     

剖宫产的社会因素分析及护理干预效果

目的：探讨护理干预对社会因素剖宫产的影响。方法：将200例产妇随机均分为2组,对照组按常规分娩期护理要求实施护理,观察组通过社会因素剖宫产原因分析,采取护理干预措施,对2组效果进行比较。结果：2组产妇及家属产前分娩方式选择剖宫产率差异无统计学意义（P〉0.05）。经过护理干预实施后,观察组产妇及家属最终分娩方式选择剖宫产率明显低于对照组（P〈0.01）。结论：护理干预能减少产妇分娩疼痛,有效降低社会因素剖宫产,减少产后母婴并发症,提高其对医护人员的信赖度,从而提高产科护理质量。     

143例凶险型前置胎盘发病的影响因素及围生期结局分析

目的 探讨凶险型前置胎盘发病的影响因素及围生期结局分析.方法 回顾分析2011年1月至2015年12月在百色市两所三甲医院住院分娩的143例凶险型前置胎盘孕产妇(研究组)和286例非凶险型前置胎盘孕产妇(对照组)的临床资料.结果 研究组孕产妇的平均年龄高于对照组(t=2.92,P=0.004);研究组孕产妇既往孕次、既往产次、既往流产次数、既往剖宫产次数、既往前置胎盘发生率均高于对照组(P＜0.01),研究组孕产妇的既往前置胎盘发生率高于对照组(x2=7.60,P=0.006);研究组孕产妇的产前孕周小于对照组(t=-12.33,P＜0.01).多因素分析显示,年龄、既往流产次数、既往剖宫产次是发生凶险型前置胎盘的影响因素,其中既往剖宫产次是3个影响因素中最主要的危险因素.研究组的产前出血发生率、产后出血发生率、子宫切除率、早产儿发生率均高于对照组(P＜0.01);研究组的术中出血量均高于对照组(P＜0.05);研究组的新生儿体质量和新生儿1 min Apgar评分等均低于对照组(P＜0.05).结论 年龄、既往流产次数、既往剖宫产次与凶险型前置胎盘的发生有关.     

评价健康信念模式指导下的孕期护理干预对剖宫产率的影响

目的：：评估在孕妇孕期护理干预服务中运用健康信念模式指导对剖宫产率影响情况。方法：随机选择2015年3月-2016年3月进入本院接受产检及相应护理的117例孕妇,将其划分为研究、对照两组,研究组59例于妊娠期内施行基于健康信念模式的系统化护理干预服务,对照组58例于妊娠期内施行基础性的相关护理干预服务,探究产妇剖宫产率情况,对比两种护理法的效果。结果：研究组干预护理前、后选择破宫产的孕妇例数减少,占比下降显著,有统计学方面的意义（P＜0.05）。对照组干预护理前、后孕妇选取生产方式的占比情况没有较大变化,差异不具统计学方面的意义(P＞0.05)。结论：产科护理服务当中引入以健康信念为导向的干预模式,可降低剖宫产率,效果较好。     

剖宫产术后使用镇痛泵的护理及体会

目的探讨剖宫产术后应用镇痛泵的临床护理并总结相关体会。方法对我院2009年6月至2011年6月120例剖宫产术后应用镇痛泵的产妇的临床资料进行回顾性分析。结果镇痛效果均可达到临床要求,术后使用镇痛泵的产妇满意率达96．7％（116／120）。不良反应包括呼吸抑制的有1例,低血压的有3例,恶心和呕吐的有7例,尿潴留的有2例,术后24h内泌乳的有112例。结论对剖宫产产妇的术后镇痛护理应逐步完善,观察的重点为呼吸和血压的变化,同时恶心、呕吐以及尿潴留等并发症同样不能忽视。