Farnoush Farzi; Sodabeh Kazemi; Ziba Zahiri Sorouri; Samaneh Ghazanfar; Mahin Tayefeh Ashrafiyeh; Mandana Javanak; Mohammad Shahbazi
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Having body mass index more than 29 is described as obesity in pregnancy. Anesthesia management in these patients has always been challenging. A 41-year-old woman, at 37weeks’ gestation with the weight of 200kg and body mass index of 66/05 was admitted with complaint of pain to Al-Zahra Hospital ...
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Having body mass index more than 29 is described as obesity in pregnancy. Anesthesia management in these patients has always been challenging. A 41-year-old woman, at 37weeks’ gestation with the weight of 200kg and body mass index of 66/05 was admitted with complaint of pain to Al-Zahra Hospital in Rasht. She reported a history of two previous caesarean sections and high blood sugar and hypothyroidism which were under control by drugs. The Anesthesiology team decided to choose Continuous Spinal Anesthesia method for her. After performing anesthesia, cesarean delivery was done and a female neonate was born with Apgar score of 5-9. They were discharged from the hospital in good condition after two days. Based on the results of this study, CSA approach is a suitable method for anesthesia management in cesarean section of obese patients. Also it is necessary to recommend these patients to refer to anesthesia counseling clinics before giving birth.
Obstetrics and Gynecology
Khadijeh Elmizadeh; Marziyeh khezri; Hamideh Pakniat; vahideh pandamuz; nezal Azh; Simindokht Molaverdikhani
Articles in Press, Accepted Manuscript, Available Online from 02 October 2023
Abstract
Background: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage.
Methods: In this ...
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Background: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage.
Methods: In this single-blinded randomized clinical trial, a sample of 300 women with a singleton pregnancy, at 37 to 40 weeks gestation, who were scheduled for cesarean section was divided into two groups of 150 participants. In the intervention group after placental delivery, the uterus was covered with cold saline-soaked surgical sponges at 0-4°C at the time of hysterotomy repair, and the control group received standard cesarean section. The volume of blood loss, the hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded.
Results: The bleeding volume and hemoglobin concentration reduction were significantly lower in the intervention group than in the control group (260.86± 150.25 Vs 214.35± 83.51, P<0.0001 and 1.24±0.75 Vs 1.54±0.92, P = 0.007 respectively). There were no statistically significant differences between the two groups in the frequency of need for additional uterotonic drugs. (18% vs. 21.33%, P = 0.475.)
Conclusion: The use of uterine cooling during cesarean section reduced the volume of blood loss and the rate of decline in hemoglobin concentration.
Obstetrics and Gynecology
Atefeh Kazemi; Vahideh Rashtchi; Masoomeh Ghomi
Volume 8, Issue 6 , November and December 2023, , Pages 559-565
Abstract
Background & Objective: Some types of major surgeries are associated with postoperative pain, sometimes during the days after surgery. These pains mainly lead to the use of various analgesics and, ultimately, patient dissatisfaction. In the present study, we evaluated the effect of gabapentin ...
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Background & Objective: Some types of major surgeries are associated with postoperative pain, sometimes during the days after surgery. These pains mainly lead to the use of various analgesics and, ultimately, patient dissatisfaction. In the present study, we evaluated the effect of gabapentin at doses of 600 and 1200 mg on relieving pain due to cesarean section.Materials & Methods: In this randomized clinical trial, patients were randomly divided into three equal-size groups (25 patients in each group) through balanced block randomization. The first group was given 600 mg of gabapentin, the second group was given 1200 mg of gabapentin one hour before surgery, and the control group received a placebo. The pain intensity, nausea, vomiting, and drowsiness, as well as the need for postoperative analgesics, were assessed initially and at 2, 6, and 12 hours after surgery. The occurrence of nausea and drowsiness between groups was compared using the chi-square and Fisher's exact tests.Results: The mean (SD) age of patients in the gabapentin 1200 mg, gabapentin 600 mg, and placebo groups was 26.32±6.15, 27.43±6.38, and 26.59±5.88, respectively (P=0.34). Pain intensity and the rate of analgesic consumption at different time points during the first 12 hours of surgery were significantly lower in the receiving gabapentin groups than in the placebo group (P<0.05). Comparing the prevalence rates of nausea and vomiting and also drowsiness, as the drug-related side effects don’t show a significant difference across the three groups at the different investigated time points (P>0.05).Conclusion: Gabapentin with a minimum therapeutic dose can successfully reduce postoperative pain intensity and also needs analgesic use after a cesarean section.
General surgery
Fakhrolmolouk Yassaee; Sima Habibi; Reza Shekarriz Foumani; Seyed Mehrdad Motiei Langroudi; Elena Ghotbi
Volume 8, Issue 5 , September and October 2023, , Pages 461-467
Abstract
Background & Objective: In all surgical interventions including cesarean section, pain is a challenging issue. The aim of this study was to identify the underlying causes that affect post-cesarean pain intensity.Materials & Methods: A total of 128 consecutive patients who underwent ...
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Background & Objective: In all surgical interventions including cesarean section, pain is a challenging issue. The aim of this study was to identify the underlying causes that affect post-cesarean pain intensity.Materials & Methods: A total of 128 consecutive patients who underwent cesarean section at Taleghani hospital were included in the study. A questionnaire was used to gather the patients’ demographic and clinical data. The length of the incision was measured with a ruler on the first day following the cesarean section. In addition, the pain intensity was assessed using a Likert scale at scales: 1, 2, 4, 8, 12, and 24, on the day after surgery and 48 hours and one week later. Descriptive statistics were calculated for all variables. Analyses were conducted using SPSS version 22 and a p-value < 0.05 was considered statistically significant.Results: The study showed that overall, patient age, BMI, level of education, type of surgical incision, duration of surgery, type of cesarean section, type of anesthesia, and breastfeeding were not predictors of postoperative pain intensity. However, the study found that “indication of the cesarean section” and the “stage of labor” in which the cesarean was performed are correlated with postoperative pain intensity. (P-value<0.05).Conclusion: In this study, we were able to identify 2 parameters that were independently associated to postoperative pain scores: “underlying indication of cesarean section” and the “stage of labor” in which cesarean section is performed. This information helps clinicians to identify high-risk patients in terms of postoperative pain and take early action.
Anesthesia
Shahram Sayadi; Shideh Ariana; Maral Hosseinzadeh; Arezou Ashari; Tannaz Yeganegi; Elham Memari; Ebtehaj Heshmatkhah; Dariush Abtahi
Volume 8, Issue 3 , May and June 2023, , Pages 194-203
Abstract
Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality, which can occur unexpectedly without warning, and without any underlying causes. We hypothesized that administering fibrinogen concentrate to cesarean section patients before surgery would ...
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Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality, which can occur unexpectedly without warning, and without any underlying causes. We hypothesized that administering fibrinogen concentrate to cesarean section patients before surgery would reduce perioperative blood loss.Materials & Methods: In this double-blind randomized controlled parallel group study, a single dosage of fibrinogen concentrate or a placebo was given to 260 cesarean section patients at random (by G*Power software, Heinrich-Heine-Universität Düsseldorf, Germany) in a university-affiliated general hospital between November 11, 2022, to January 8, 2023. Individuals in the fibrinogen group received a dose of one gram of fibrinogen concentrate and those in the placebo group received normal saline solution with the same volume in the placebo group. Total blood loss was the primary outcome of this study.Results: A total of 280 cases were screened and 260 were randomized. With a P-value of 0.001, the median (IQR) volume of bleeding in the fibrinogen group was 660 (341.25) mL, as opposed to 790 (475.00) mL in the placebo group. Comparatively, only 10 (7.7%) of the fibrinogen group and 26 (20%) of the placebo group required blood transfusions (P=0.006). No adverse event related to fibrinogen was reported.Conclusion: Empiric treatment with fibrinogen concentrate results in reduced blood loss.
Obstetrics and Gynecology
Hamza Radhi; Shaymaa Abdulhameed Khudair; Miaad Adnan; Muntaha Kadhem Mejbel; Ahmed S. Abed; Nizar Awish Jassem
Volume 8, Issue 3 , May and June 2023, , Pages 249-254
Abstract
Background & Objective: The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; ...
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Background & Objective: The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; 90% of them rotate to the occiput anterior. This research aims to analyze the rate of delivery in the OP position (also called sunny-side-up) concerning the outcome of manual rotation carried out contingent upon the OP position remains persistent. Perinatal outcomes were the secondary goals.Materials & Methods: This prospective cohort study was carried out in Obstetrics & Gynecology Clinic (OGC) at Faruk Medical City, Iraq. The study included all women who experienced a singleton pregnancy after 36 weeks, had an effort to rotate the fetus manually and had the fetus remain in the persistent OP position. The primary result was the delivery's occiput position. Perineal injuries, labor length, and the method of delivery have been the secondary outcomes. According to the outcome of manual rotation, two groups were contrasted.Results: The overall number of women participating was 250, and the manual rotation success rate was 59.1%. The success was strongly correlated with a reduction in the OP position during vaginal, cesarean, operative vaginal delivery, episiotomy, and obstetric anal sphincter injury.Conclusion: Reduced incidence of OP position at anal sphincter injury during operative vaginal delivery is linked to attempts at manual rotation in the case of persistent OP position.
Obstetrics and Gynecology
Maral Hosseinzadeh; Ebtehaj Heshmatkhah; Dariush Abtahi
Volume 8, Issue 3 , May and June 2023, , Pages 285-294
Abstract
Background & Objective: Globally, postpartum hemorrhage (PPH) remains a leading cause of maternal deaths. However, in many low and middle-income countries, information on the magnitude of and risk factors for PPH is scarce. Understanding the relative contributions of different risk factors for ...
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Background & Objective: Globally, postpartum hemorrhage (PPH) remains a leading cause of maternal deaths. However, in many low and middle-income countries, information on the magnitude of and risk factors for PPH is scarce. Understanding the relative contributions of different risk factors for PPH is important. We assessed the incidence of and risk factors for postpartum hemorrhage among women who had a cesarean section in Iran.Materials & Methods: Between March 2021 and March 2022, a prospective cohort study was conducted at a university-affiliated general hospital for women who had a cesarean section in Iran. We used Spearman’s correlation for the variables associated with PPH.Results: Among the 300 women, the overall incidence of postpartum hemorrhage was 15.7%. Risk factors for postpartum hemorrhage among deliveries by cesarean section were: body-mass index, previous PPH, preoperative anemia, and preoperative hypofibrinogenemia.Conclusion: The incidence of postpartum hemorrhage in the cesarean section was high. Extra vigilance in all women with cesarean section could address the risk factors identified.
Anesthesia
Maryam Sadat Hosseini; Dariush Abtahi; Ardeshir Tajbakhsh; Farah Farzaneh; Shahram Sayadi; Nooshin Amjadi; Maral Hosseinzadeh
Volume 8, Issue 2 , March and April 2023, , Pages 157-166
Abstract
Background and Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels ...
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Background and Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels in postpartum hemorrhage and severe postpartum hemorrhage.Methods: This cross-sectional study was conducted on 169 term pregnant women who were candidates for an elective Cesarean section. Fibrinogen and other coagulating factors were measured before and at the end of the surgery, and twenty-four hours after surgery. Bleeding volume was also measured during and at the end of the surgery, and twenty-four hours after that. The relationship between coagulation factors and the amount of bleeding was examined using statistical tests.Results: Mean plasma fibrinogen levels measured before, at the end of, and 24 hours after surgery were 247.65±91.07 mg/dl, 219.4±75.60 mg/dl, and 223.91±65.44 mg/dl, respectively. Sixty-five patients (38.5%) had postpartum hemorrhage (1000-2000mL) and seven patients (4.1%) had severe postpartum hemorrhage (>2000mL). Of the cases with preoperative fibrinogen levels less than 200mg/dl, 72% had postpartum hemorrhage and 14% had the severe form. There was a strong association between the patient's plasma fibrinogen level with PPH and sPPH (P=0.000).Conclusion: This study showed a strong correlation between plasma fibrinogen levels and postpartum hemorrhage and severe postpartum hemorrhage. In addition, it has been shown that low plasma fibrinogen levels could be a direct prognostic factor for postpartum hemorrhage and severe postpartum hemorrhage. Younger women and preoperative anemia were other strong predictors.
Anesthesia
Dariush Abtahi; Mehrdad Feizi; Shahram Sayadi; Ardeshir Tajbakhsh; Samira Abbaspour; Sara Salarian; Alireza Mirkheshti
Volume 7, Issue 4 , March and April 2022, , Pages 314-322
Abstract
Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response ...
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Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response study using a 9:1 biased-coin sequential allocation method to estimate the ED90 of prophylactic infusion of OX in women with high and low risk for uterine atony who underwent CS. The total administrated OX dose of each patient was determined in the two study groups. The primary outcome was the ED90 for desirable uterine tone based on the opinion of the in-charge obstetrician. The number of subjects receiving supplemental uterotonics was compared.Results: In the low-risk group, three (3.7%), out of the 41 parturients, did not achieve a satisfactory suitable response to OX dose of 9; on the other hand, 24 high-risk parturients (58%) did not achieve a satisfactory and reasonable response to OX dose of 9. The OX ED90 was significantly greater for the high risk-group (11.55 units, 10.39-14.86) than the low-risk group (8.13 units, 8.31-9.56). Fisher’s exact probability test showed a significant difference in ED90 of OX between the two groups (P < /em>=0.02).Conclusion: The present study results showed that the mean ED90 of OX in low-risk parturients was significantly lower than that of high-risk ones. We suggest differentiation between low-risk and high-risk parturients in the guidelines of OX administration.
Obstetrics and Gynecology
Nahid Zirak; Leila Mashhadi; Elaheh Jajarmi; Negar Morovatdar; Parisa Mohebbi; Nahid Javdani Haji; Shahrzad Maraghehmoghaddam; Leili Hafizi
Volume 7, Issue 3 , January and February 2022, , Pages 171-176
Abstract
Background & Objective: This study aimed to investigate the relationship between the level of high-sensitivity C-reactive protein (hs-CRP; as an indicator of inflammatory response) and shoulder tip pain (STP) following cesarean section (C-section).Materials & Methods: In this cohort study, a ...
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Background & Objective: This study aimed to investigate the relationship between the level of high-sensitivity C-reactive protein (hs-CRP; as an indicator of inflammatory response) and shoulder tip pain (STP) following cesarean section (C-section).Materials & Methods: In this cohort study, a total of 120 pregnant women who were candidates for elective C-section at Imam Reza Hospital were included. The level of hs-CRP was measured perioperatively. STP was measured after the operation.Results: Mean hs-CRP was significantly higher in females with STP compared to counterparts (19±13.1 vs. 7.2±4.5; P < /em><0.001). There was a positive and strong correlation between STP and postoperative hs-CRP (P < /em><0.001).Conclusion: The release of acute-phase proteins (such as hs-CRP) plays a significant role in STP after C-section; the intensity of STP is associated with the level of hs-CRP.
Obstetrics and Gynecology
Tipnaree Charoonwatana; Charuai Suwanbamrung; Udomsak Saengow
Volume 7, Issue 3 , January and February 2022, , Pages 213-220
Abstract
Background and Objective: Cesarean section (CS) rates have increased continuously worldwide in the past decades while not being associated with significant benefits for mothers and newborns. According to Robson's classification, the present research aimed to analyze the associating factor to cesarean ...
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Background and Objective: Cesarean section (CS) rates have increased continuously worldwide in the past decades while not being associated with significant benefits for mothers and newborns. According to Robson's classification, the present research aimed to analyze the associating factor to cesarean section to set the practice system and decrease the cesarean section rate in the near future.Methods: This is a retrospective cross-sectional analytic study of the medical record of pregnant women who delivered in 2019 at MNST Hospital. The logistic regression model carried out the adjusted odds ratio (OR) of cesarean section rate and 95% confidence intervals.Results: A total of 5,360 medical records were recruited. Of all birth, 55.4% occurred by cesarean section, most of whom were categorized in R1 to R4 of Robson classification (23.3%), followed by R5 (21.1%) and R10 (5.4%). The subgroup R1-R4 analysis demonstrated that obesity, Bachelor’s education, and private obstetrician were significantly related to the cesarean section in the group of spontaneous labor (R1, R3) and Bachelor’s education and private obstetrician were significantly related to the cesarean section in the group without spontaneous labor (R2, R4) (adjust OR 13.50, P < /em><0.001 and adjust OR 2.11, P < /em><0.001, respectively).Conclusion: Private obstetrician and education level were factors related to the obstetric indication of unnecessary cesarean section.
Maternal Fetal Medicine
mandana Mansour Ghanaie; Roxana Mansour Ghanaie; Seyed Mohammad Asgari Galebin; Seyedeh Hajar Sharami; Mojgan Mohebalizade
Volume 7, Issue 1 , September and October 2021, , Pages 25-31
Abstract
Background & Objective: Nucleated red blood cells (NRBCs) enter the circulation in response to hypoxia, but it remains unknown how physiological delivery without fetal distress can change the NRBC level. Accordingly, in the present study, we compared the mean NRBCs per white blood cell (WBC) in the ...
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Background & Objective: Nucleated red blood cells (NRBCs) enter the circulation in response to hypoxia, but it remains unknown how physiological delivery without fetal distress can change the NRBC level. Accordingly, in the present study, we compared the mean NRBCs per white blood cell (WBC) in the umbilical cord of normal vaginal delivery (NVD) with cesarean section (C/S). To compare the mean NRBCs per WBC within umbilical cord in normal term newborns who were born by NVD with those delivered by C/S. Methods: This case-control study was conducted for 305 neonates in two different groups, i.e., NVD (case) and C/S (control) groups. The blood samples were taken from umbilical veins to evaluate fetal NRBCs and WBC count after recording their demographic characteristics. Finally, all data were assessed using SPSS 16.Results: The average age of mothers was 25.79±5.35 years. The average Apgar score of neonates was 8.23±0.6. The average NRBC count was 4.63±5.2. There was no significant difference in maternal age, parity, neonatal weight, and NRBC count per 100 WBCs between the two groups. Conclusion: In the present study, the mean NRBC count within the umbilical cord of neonates born by elective C/S was less than those delivered by NVD, although this difference was not significant.
Obstetrics and Gynecology
Shiva Hadadianpour; Nasim Sanjari; Masoumeh Fallahian
Volume 6, Issue 4 , August 2021, , Pages 209-216
Abstract
Background & Objective: To determine the factors affecting Iranian obstetricians and gynecologists’ (OB/GYNs’) decision about performing a cesarean section on maternal request.Materials & Methods: A four-part questionnaire was designed and distributed between 150 randomly ...
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Background & Objective: To determine the factors affecting Iranian obstetricians and gynecologists’ (OB/GYNs’) decision about performing a cesarean section on maternal request.Materials & Methods: A four-part questionnaire was designed and distributed between 150 randomly selected OB/GYNs in Iran during a national conference. One hundred questionnaires were sent back by the participants. The data were analyzed using SPSS 25. The influential factors on OB/GYNs’ decision about the mode of delivery, as well as the correlations between their knowledge, attitude, practice, gender, and years of work experience, were assessed.Results: A positive correlation was found between OB/GYNs’ knowledge and attitude about the benefits of cesarean section and performing a cesarean section on maternal request in public and private hospitals. We did not find any correlation between age, gender, and years of practice with the practice of cesarean section on demand. Approximately 52.8% of female participants and 38.5% of male participants recommend cesarean section to their immediate families, and 81% of participants accepted the pregnant mother’s request for cesarean section. The stress of the potential impact of vaginal delivery on the pelvic floor and sexual function is the leading reason behind this decision. Conclusion: Since the views and concerns of OB/GYNs have a significant role in guiding pregnant women to decide the mode of delivery, and the fear of future sexual dysfunction is an important issue affecting obstetricians’ perspective, it should be taken into consideration.
Atieh Mirfendereski; Khadigeh Abadian
Volume 3, Issue 4 , November and December 2018, , Pages 177-180
Abstract
Background & Objective: Given the impact of endometriosis on patients’ social lives, marital relationships, and fertility and on reducing these people’s quality of life, its proper diagnosis and treatment seem vital. This study aimed to report a case of rectus muscle endometriosis and ...
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Background & Objective: Given the impact of endometriosis on patients’ social lives, marital relationships, and fertility and on reducing these people’s quality of life, its proper diagnosis and treatment seem vital. This study aimed to report a case of rectus muscle endometriosis and the way it was managed.
Case Report: The patient was a 30-year-old woman who had a history of dysmenorrhea and chronic pain for 2 years after her first delivery which was performed by cesarean section. During ultrasonography conducted on the anterior abdominal wall of the midline, a mass indicating endometriosis was observed in the abdominal wall at the site of the cesarean section incision scar and in the thickness of the rectus muscle. After the termination of pregnancy and during the cesarean section, the mass was removed and the patient’s symptoms subsided.
Conclusion: To manage endometriosis a patient’s complete records and imaging techniques can be effective.
Zahra Rezaei; Zahra Shahraki; Mahboobeh Shirazi
Volume 2, Issue 3 , September and October 2017
Abstract
Introduction: Utero-cutaneousfistulaisarareconditionfollowinguterinesurgeriesespeciallycesareansection. Thiskindof fistula has various etiologies including drain use, iatrogenic trauma, endometriosis, multiple abdominal surgeries, incomplete closure of uterine wound during cesarean delivery, inflammatory ...
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Introduction: Utero-cutaneousfistulaisarareconditionfollowinguterinesurgeriesespeciallycesareansection. Thiskindof fistula has various etiologies including drain use, iatrogenic trauma, endometriosis, multiple abdominal surgeries, incomplete closure of uterine wound during cesarean delivery, inflammatory processes related to intra-abdominal sepsis or infectious, and dislocation of intrauterine devices.
Case Presentation: This report deals with two unusual cases of utero-cutaneous fistula. The patients referred with discharge from abdominal wall. The first one had vesico-cutaneous fistula simultaneously. Both of them had a second cesarean section. After four months of cesarean section, in fistulography report of the first case, it was found irregular fistula tract associated with vagina following cannulation and contrast injection. In the second case, ultrasonography revealed the attachment of uterus to abdominal wall as well as accumulation and communication of the small amounts of fluid from uterine cavity to abdomen wall. After confirming the diagnosis, the repairing surgery was successfully planned.
Conclusions: Cesarean has some rare morbidity such as uterocutaneous fistula that needs awareness of physician and patient. The early diagnosis and repairing of this abnormality is essential.
Soodabeh Darvish; Koorosh Etemad; Azar Mosaheb; Ghasem Yazdanpanah
Volume 2, Issue 2 , May and June 2017
Abstract
Objectives: This study aimed to compare maternal and neonatal side effects of natural vaginal delivery (NVD) under neuro-axial analgesia with usual NVD and C-section.
Methods: In this single center prospective cohort study, deliveries carried out in a 7 months’ period were evaluated after getting ...
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Objectives: This study aimed to compare maternal and neonatal side effects of natural vaginal delivery (NVD) under neuro-axial analgesia with usual NVD and C-section.
Methods: In this single center prospective cohort study, deliveries carried out in a 7 months’ period were evaluated after getting informed consent. The study is approved by the ethics committee of Shahid Beheshti University of Medical Sciences. Mothers were categorized into 3 groups of C-section, NVD with an analgesia, intervention, and usual NVD. Afterwards, maternal and neonatal side effects after delivery were assessed using physical examinations, laboratory results, and interviews.
Results: Overall, 121 mothers were equally assigned to 3 groups. No significant differences were found in the first and fifth-minute APGAR scores of the neonates born in these 3 groups. Moreover, none of the neonates’ fifth-minute APGAR scores were less than 7. In addition, hypoxia (umbilical artery pH < 7.2) was observed more in the neonates delivered by NVDs with analgesia interventions compared to the other 2 groups. In comparison with the mothers in the other 2 groups, headache and pruritus were more prevalent among the mothers who had NVDs under neuro-axial analgesia.
Conclusions: Given the advantages of natural vaginal deliveries for mothers and their fetuses and considering the side effects of C-sections without medical indications, propagating painless NVDs could be a proper solution for increasing the prevalence rate of NVDs in the society. Conducting further studies on larger samples is recommended.
Shilan Amir Hosseini; Bakhtiar Piroozi; Mohammad Amerzade; Hooman Ghasri; Salah Aldin Farshadi; Hossein Safari; Seyfollah Moradi
Volume 2, Issue 1 , March and April 2017
Abstract
Background: Since April 22, 2014, the natural childbirth promotion package has been implemented in the form of the Health Transformation Plan (HTP) to decrease the cesarean section rate in Iran. This study aimed to determine the amount of subsidy allocated to the natural childbirth package and to examine ...
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Background: Since April 22, 2014, the natural childbirth promotion package has been implemented in the form of the Health Transformation Plan (HTP) to decrease the cesarean section rate in Iran. This study aimed to determine the amount of subsidy allocated to the natural childbirth package and to examine its effects on the cesarean section rate in hospitals affiliated with Kurdistan University of Medical Sciences (KUMS), Kurdistan Province, Iran.
Methods: This is a descriptive study implemented by retrospective and longitudinal design. The population in this study to determine the budget amount allocated to “childbirth promotion package” and all mothers that had natural childbirth deliveries from May 5, 2014 (beginning of HTP) to September 2015 in hospitals affiliated with KUMS. Study populations to determine the C-section ratio included all mothers who had deliveries in hospitals affiliated with KUMS from December 2012 to May 4, 2014 (before HTP) and from May 5, 2014 to September 2015 (after HTP). Using a checklist, the required data was collected from the Statistics and Health Economics Department of Treatment Deputy of KUMS. Afterwards, the obtained data were described using the descriptive statistical indicators including frequency, percent, and mean via Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA).
Results: Since the beginning of implementing the natural childbirth promotion package until September 21, 2015, a total of 23 566 mothers had natural childbirth deliveries in the hospitals affiliated with KUMS. These mothers benefited from a total amount of 23 939 046 090 IRR provided by the natural childbirth package. In addition, the cesarean ratio has decreased 7% after implementing HTP.
Conclusions: It seems that HTP caused for the cesarean ratio to decrease in hospitals affiliated to KUMS. Further studies are recommended to determine the causality between a decrease in cesarean rate and HTP.
Soghra Khazardoost; Fahimeh Ghotbizadeh; Sahar Latifi; Maryam Tahani; Mohammad Ali Ali Rezaei; Masoomeh Shafaat
Volume 1, Issue 2 , September and October 2016
Abstract
Objectives: Determining the necessity of cesarean section (C/S) due to failure of induction of labor (IOL) is essential to avoid fetus distress. In this study, the performance of the Bishop score and trans-vaginal ultrasound measurements were compared to predict successful IOL, and the most useful cut-off ...
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Objectives: Determining the necessity of cesarean section (C/S) due to failure of induction of labor (IOL) is essential to avoid fetus distress. In this study, the performance of the Bishop score and trans-vaginal ultrasound measurements were compared to predict successful IOL, and the most useful cut-off points were estimated.
Methods: Nulliparous women with gestation age of > 37 weeks with a live fetus in cephalic presentation were invited to participate in this study. Bishop score was assessed by digital examination, and trans-vaginal ultrasound was used to measure cervical length. Trans-abdominal ultrasound was utilized to determine the fetal head position.
Results: One hundred women entered the study. Multiple regression analysis revealed that the Bishop score and cervical length had a reliable predictive value in determining successful IOL. The cut-off points for predicting successful induction were 16 mm for cervical length and 5 for the Bishop score, using receiver operating characteristic curves (ROC). Both cervical length and Bishop score were good predictors for vaginal delivery (sensitivity and specificity of 85% and 67%, respectively for cervical length; and 84% and 70%, respectively for Bishop score).
Conclusions: Cervical length is a good predictor of successful IOL. Considering the painful process of digital exam, implementing trans-vaginal ultrasound is preferred.
