oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Reduction of caesarean section rate in developing countries: The way forward
EI Archibong, SJ Etuk, AA Sobande, IH Itam, GK Oyakhire
Nigerian Journal of Clinical Practice , 2003,
Abstract: This review article highlights the obstacles and prospects of reduction of caesarean section rate in developing countries. The strategic areas targeted are: reduction of primary caesarean section and vaginal birth after primary caesarean section. These areas have been discussed with reference to findings from developed countries The population must be well informed on the values of antenatal care and there should be definite delivery room guidelines and dedication in the management of patients in labour. Annual auditing of caesarean section rate and complications will reflect the effectiveness of the applied policies KEY WORDS: caesarean section, vaginal birth, antenatal care, medical auditing Nigerian Journal of Clinical Practice Vol.6(1) 2003: 22-25
Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria
Oluwarotimi I Akinola, Adetokunbo O Fabamwo, Adetokunbo O Tayo, Kabiru A Rabiu, Yussuf A Oshodi, Chioma A Onyekwere
BMC Pregnancy and Childbirth , 2010, DOI: 10.1186/1471-2393-10-57
Abstract: Case records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed.There were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units).Even though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.Peripartal haemorrhage is still the leading cause of maternal and fetal morbidity and mortality in developing countries [1]. Despite advances in the prevention, diagnosis and treatment, massive blood loss during pregnancy and delivery remains a threat and therefore, prevention of maternal mortality involves prompt blood transfusions among other life saving measures to attain the fifth millennium development goal [2].Caesarian delivery is often performed in young patients who are free of serious cardiov
Caesarean Sections -Are we doing right ?
Vidyadhar B Bangal,Pravin S Thorat,Nisarg H Patel,Sai K Borawake
International Journal of Biomedical Research , 2013, DOI: 10.7439/ijbr.v3i6.540
Abstract: Introduction- Caesarean section is the most commonly performed major emergency surgical procedure in Obstetrics. With the improved caesarean skill of the obstetrician and techniques of anesthesia, the caesarean section has become a safe surgical procedure .The rate of caesarean section has shown progressive rise in last three decades in most part of the world .The immediate operative morbidity and the likelihood of complications in subsequent pregnancies, raise question marks regarding rising caesarean section rates. Material and methods- Retrospective analysis of 3980 caesarean sections performed at tertiary care teaching hospital over six years period, was undertaken to find out the rate of caesarean sections, indications and associated maternal morbidity and mortality . Results-The rate of caesarean section was in between 20 and 22 percent ,during the study period .The rate has been fairly constant throughout the study period. The common indications were previous caesarean section, fetal distress, cephalopelvic disproportion, pre-eclampsia or antepartum haemorrhage. Anemia and urinary infections resulted in postoperative febrile morbidity. Incidence of wound related complications were not significant .There were twelve maternal deaths ,of which six were due to severe uncontrolled hemorrhage from placental bed during caesarean section. Conclusion-Caesarean section rate can be maintained at acceptable limits by judicious selection of cases, allowing vaginal births after caesarean sections, external cephalic versions , assisted vaginal breech deliveries in selected cases and proper interpretation of results of electronic fetal monitors. Pain relief by epidural analgesia can reduce the fear of labour and rate of elective caesarean sections.
Caesarean Sections -Are we doing right ?
Vidyadhar B Bangal,Pravin S Thorat,Nisarg H Patel,Sai K Borawake
International Journal of Biomedical Research , 2012, DOI: 10.7439/ijbr.v3i6.540
Abstract: Introduction- Caesarean section is the most commonly performed major emergency surgical procedure in Obstetrics. With the improved caesarean skill of the obstetrician and techniques of anesthesia, the caesarean section has become a safe surgical procedure .The rate of caesarean section has shown progressive rise in last three decades in most part of the world .The immediate operative morbidity and the likelihood of complications in subsequent pregnancies, raise question marks regarding rising caesarean section rates. Material and methods- Retrospective analysis of 3980 caesarean sections performed at tertiary care teaching hospital over six years period, was undertaken to find out the rate of caesarean sections, indications and associated maternal morbidity and mortality . Results-The rate of caesarean section was in between 20 and 22 percent ,during the study period .The rate has been fairly constant throughout the study period. The common indications were previous caesarean section, fetal distress, cephalopelvic disproportion, pre-eclampsia or antepartum haemorrhage. Anemia and urinary infections resulted in postoperative febrile morbidity. Incidence of wound related complications were not significant .There were twelve maternal deaths ,of which six were due to severe uncontrolled hemorrhage from placental bed during caesarean section. Conclusion-Caesarean section rate can be maintained at acceptable limits by judicious selection of cases, allowing vaginal births after caesarean sections, external cephalic versions , assisted vaginal breech deliveries in selected cases and proper interpretation of results of electronic fetal monitors. Pain relief by epidural analgesia can reduce the fear of labour and rate of elective caesarean sections.
Rising rates of Caesarean sections: an audit of Caesarean sections in a specialist private practice
N Naidoo, J Moodley
South African Family Practice , 2009,
Abstract: Background: Caesarean section (CS) rates are increasing worldwide; rates in the private sector in South Africa are reported to be particularly high. To the best of our knowledge there has been no recent audit of Caesarean sections performed by the private health sector in KwaZulu-Natal. The aim of this study was to carry out an audit of CS in a private practice. Methods: An audit of the patient records over a period of one year was done. No personal identifiers were noted or reported on. All relevant clinical data were pooled and used to analyse the clinical information. Results: There were 364 deliveries in the study period and 209 of these were CS, giving a rate of 60.4%. Most of the caesarean sections were carried out because of a previous CS; maternal request and HIV status also contributed to the high rate. Conclusion: The high CS rate in private practice is probably a window to the increased rates of Caesarean section being performed worldwide. This high rate is in keeping with trends in countries such as South America, and is considerably higher than the ideal rate of 10 to 15% in low-risk obstetric populations suggested by the WHO.
Preliminary report of a gas conditioner to improve operational reliability of cryotherapy in developing countries
Yancy Seamans, John Sellors, Fredrik Broekhuizen, Michelle Howard
BMC Women's Health , 2006, DOI: 10.1186/1472-6874-6-2
Abstract: The prototype conditioner device consists of an expansion chamber that filters and dries the refrigerant gas. Users in Peru and Kenya reported on their experience with the prototype conditioner. In Ghana, simulated cryotherapy procedures were used to test the effects of the prototype conditioner, as well as the commonly used "cough technique."Anecdotal reports from field use of the device were favorable. During simulated cryotherapy, the prevalence of blockage during freezing were 0% (0/25) with the device alone, 23.3% (7/30) with the cough technique alone, 5.9% (1/17) with both, and 55.2% (16/29) with neither (Pearson's Chi square = 26.6, df = 3, p < 0.001 (comparison amongst all groups)).This prototype design of a cryotherapy gas conditioner is a potential solution for low-resource settings that are experiencing cryotherapy device malfunction.Cryotherapy to treat precancerous cervical lesions in low-resource settings has been shown to be both clinically effective and logistically possible [1-4]. However, experience in developing country clinics has indicated that cryotherapy units fail due to blockage (i.e. complete stoppage of the gas flow), and that preventive measures are advisable [5,6]. This problem arises when there is an interruption in gas flow during the procedure, and results in service disruption for several minutes while the unit thaws and the blockage clears. It can be argued that such interruptions might threaten the effectiveness of cryotherapy, since the procedure usually entails two 3-minute freezes, separated by a 5-minute interval to allow thawing of the tissue [7]. Typically, failures have been attributed to gas supply line blockages caused by gas impurities, condensation and freezing of water vapor, or formation of dry ice in the gas supply lines.JHPIEGO currently advocates a "freeze-clear-freeze technique (also known as the "cough" technique) to alleviate blockages [5]. The cough technique involves briefly interrupting freezing every 15 secon
Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes
Mario R Festin, Malinee Laopaiboon, Porjai Pattanittum, Melissa R Ewens, David J Henderson-Smart, Caroline A Crowther, The SEA-ORCHID Study Group
BMC Pregnancy and Childbirth , 2009, DOI: 10.1186/1471-2393-9-17
Abstract: Data on caesarean rates, care practices and health outcomes were collected from the medical records of the 9550 women and their 9665 infants admitted to the nine participating hospitals across South East Asia between January and December 2005.Overall 27% of women had a caesarean section, with rates varying from 19% to 35% between countries and 12% to 39% between hospitals within countries. The most common indications for caesarean were previous caesarean (7.0%), cephalopelvic disproportion (6.3%), malpresentation (4.7%) and fetal distress (3.3%). Neonatal resuscitation rates ranged from 7% to 60% between countries. Prophylactic antibiotics were almost universally given but variations in timing occurred between countries and between hospitals within countries.Rates and reasons for caesarean section and associated clinical care practices and health outcomes varied widely between the four South East Asian countries.Caesarean section is a commonly performed operation on women that is globally increasing in prevalence each year [1-5]. There is a large variation in the rates of caesarean, both in high and low income countries, as well as between different institutions within these countries [3,4].In the past, recommended caesarean rates have been calculated using various methods and concepts, the most common of which is based on the number of births in a hospital. The most widely recommended upper limit rate of caesarean section was 15 percent as advocated by the World Health Organization (WHO) [6]. This was based on caesarean rates of countries with the lowest maternal and neonatal mortality rate at the time of the recommendation, and took into account both developed and developing countries [4,6]. Since then the World Health Organization has published a revision in 1994, stating that acceptable caesarean section rates should range between 5 and 15 percent [7].Caesarean section in developing countries is associated with significant increases in maternal morbidity [4,8] p
The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005
Jostein Grytten, Lars Monkerud, Terje P Hagen, Rune S?rensen, Anne Eskild, Irene Skau
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-267
Abstract: The analyses were carried out using data from the Medical Birth Registry 1976-2005 from Norway. The data were merged with data about hospital revenue, which were obtained from Statistics Norway. The analyses were carried out using annual data from 46 hospitals. A fixed effect regression model was estimated. Relevant medical control variables were included.The elasticity of the Caesarean section rate with respect to hospital revenue per bed was 0.13 (p < 0.05). This represents an increase in the Caesarean section rate from the basis year 1976 to the final year 2005 of about 35 per cent. Most of the variables measuring characteristics of the health status of the mother and child had the expected effects.The increase in hospital revenue explains only a small part of the increase in the Caesarean section rate in Norway during the last three decades. The increase in the Caesarean section rate is considerably greater than could be expected, based on the increase in hospital revenue alone. The strength of our study is that we have estimated a cause and effect relationship. This was done by using fixed effects for hospitals, a lagged revenue variable and by including an extensive set of control variables for the risk factors of the mother and the baby.There has been a marked increase in the number of Caesarean sections in many countries during the last few decades [1-5]. For example, Caesarean sections are now performed in over 22 per cent of all births in Great Britain [2] and in 30 per cent of all births in the USA [3,6]. The proportion in the Nordic countries is slightly lower - just under 20 per cent [7]. In all the Nordic countries, the Caesarean section rate was about 5 per cent or lower at the beginning of the 1970s. Caesarean section is now the most common major surgical procedure for women in the USA [3,6]. With this great increase in the number of Caesarean sections, the cost of maternity care has also markedly increased. Henderson et al. have done a systematic re
WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections
Ana P Betrán, A Metin Gulmezoglu, Michael Robson, Mario Merialdi, Jo?o P Souza, Daniel Wojdyla, Mariana Widmer, Guillermo Carroli, Maria R Torloni, Ana Langer, Alberto Narváez, Alejandro Velasco, Anibal Faúndes, Arnaldo Acosta, Eliette Valladares, Mariana Romero, Nelly Zavaleta, Sofia Reynoso, Vicente Bataglia
Reproductive Health , 2009, DOI: 10.1186/1742-4755-6-18
Abstract: We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates.The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively.The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care.Caesarean section (CS) rates have increased significantly worldwide during the last decades but in particular in middle and high income countries [1-3]. In several countries of Latin America, the proportion of deliveries by C
INFLUENCE OF THE NUMBER OF PREVIOUS CAESAREAN SECTIONS ON LOWER UTERINE SEGMENT STATE  [PDF]
Aleksandra Andri?,Mileva Milosavljevi?,Milan Stefanovi?,Predrag Vukomanovi?
Acta Medica Medianae , 2010,
Abstract: Determining the lower uterine segment (LUS) state before vaginal delivery and after Caesarean section, including pregnant women with more than one Caesarean section, may be an important step towards prevention from still high maternal and neonatal morbidity and mortality that follow uterine rupture. In pregnant women with one or more previous Caesarean sections, ultrasonic measuring of thickness and estimating the LUS integrity can objectively show the state of uterine scars. The aim of this study was to determine the influence of several previous Caesarean sections on the LUS state in term pregnant women. The prospective study included 62 pregnant women with one or more previous Caesarean sections – the examined group, and 50 pregnant women without Caesarean section – the control group, that after the 37th week of pregnancy had undergone the transvaginal ultrasonic measuring of the thickness of the LUS muscular tissue. In 57 pregnant women from the examined group delivered with another Caesarean section, we estimated, intraoperatively, the LUS integrity in the scar area. On the same occasion, in the scar area, the presence of defect – partial or complete was detected. The research pointed out that the average LUS thickness in the examined group – 1.92±0.95mm was statistically significantly lower compared to the control group – 2.68±0.97mm (p<0.001). The average LUS thickness in 52 examined women with one Caesarean section was 1.92±0.97mm, and in 9 women with two Caesarean sections the average thickness was lower – 1.78±0.82mm, which does not represent a statistically significant difference (p=0.85). In one pregnant woman with three Caesarean sections, the LUS thickness was 3.30mm. We registered the total of 13 pregnant women with a defect in the Caesarean section scar area (12 partial and 1 complete defects), in 12 women after one Caesarean section and in 1 woman after two Caesarean sections. The research results show that women with previous Caesarean section have significantly thinner LUS, compared to the group of pregnant women without scars. With the increasing number of previous Caesarean sections, the LUS thickness decreases, but the difference is not statistically significant. Intraoperatively, the presence of certain LUS classes compared to the number of previous Caesarean sections is not significantly different. Furthermore, the increase in the number of Caesarean sections does not involve a statistically significant increase in the frequency of Caesarean section scar defects, which is in accordance with other authors’ results.
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.