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caesarean section in the Mother and Child University Hospital of N’Djamena: Indications and Prognosis

Open Journal of Obstetrics and Gynecology 2024年第9期14卷 1463-1470页

作者： Gabkika Bray Madoué Mahamat Alhadi Chene Saleh Abdesalam Neramadji Doumbé Félicité Foumsou Lhagadang NDjamena Faculty of Human Health Sciences NDjamena Chad. NDjamena Mother and Child University Hospital NDjamena Chad.

Introduction: caesarean section is a surgical procedure which allows childbirth after opening the abdominal wall and the uterus. Objective: To study caesarean section in the N’Djamena Mother and Child University Hospital (NMCUH). Patients and Method: This was a cross-sectional, analytic descriptive study over a 5-month period from 10 January to 10 June 2023, focusing on caesarean sections section in the N’Djamena Mother and Child University Hospital (NMCUH). Studied variables were epidemiological, clinical and prognostic. Patients were divided according to the classification of Robson into 10 groups. Results: During the study period, we recorded 724 caesareans sections among 3,565 deliveries, giving a rate of 20.3%. The age group from 25 to 29 represented 39.2%. The average age was 31.2 ± 2.8 years, with extreme ranging from 14 to 44 years. Nulliparous women accounted for 42% and 26% had at least one previous caesarean section (n = 188). Patients with full-term pregnancies (37 - 40 gestational weeks + 6 days) represented 64.1%. Emergency caesareans accounted for 92.8% (n = 672). Robson’s group 1 was noted to be 40.3%. Hemorrhage was the main intraoperative complication, with 7.2%. In post-operatively, anemia was the main complication at 23.8%. We recorded 16 maternal deaths, giving a maternal death rate of 2.2%. Live newborns accounted for 81.1%. Conclusion: caesarean section is a common procedure in the CHUME maternity unit. The main indications are those of Robson’s group I. caesarean sections are associated with both maternal and fetal complications.

关键词： caesarean section Indications Prognosis NMCUH Tchad

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Postpartum Quality of Life in Primiparous Women after Normal Vaginal Delivery versus caesarean section

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Open Journal of Obstetrics and Gynecology 2024年第7期14卷 1027-1045页

作者： Bayan Ahmed Basma Alsayegh Fatema Ahmed Zainab Aljufari Department of Obstetrics and Gynecology Salmaniya Medical Complex Manama Kingdom of Bahrain

Background: Studies on either postnatal quality of life in general or studies that compare quality of life in new mothers after different mode of delivery are limited. An investigation on health related quality of life measures in women after different type of delivery showed that women who had vaginal delivery had better health related quality of life compared to those who had caesarean section. However, the best method of delivery, vaginal or caesarean for postpartum quality of life is a difficult question as it is a matter of controversy both from professional’s perspectives and from women’s experience during childbirth. Objective: To compare postpartum quality of life in primiparous women after vaginal delivery versus caesarean section. Methods: Prospective cross-sectional study was conducted at the department of Obstetrics and Gynecology, Salmaniya medical complex in Kingdom of Bahrain. 500 primiparous women who gave birth either vaginally or by cesarean section answered a questionnaire designed to include general information, questions from short form health survey questionnaire (SF-36) and specific questions regarding postnatal related symptoms. Results: Body pain, fatigue, wound pain, headache and backache were significantly higher in cesarean section group as compared to vaginal delivery group (p-value Conclusion: Cesarean delivery has negatively affected the quality of life (QOL) of primiparous women. More studies with larger sample sizes should be conducted to examine the effects of cesarean delivery on QOL in both primiparous and multiparas within a shorter period after delivery. .

关键词： Quality of Life Primiparous Vaginal Delivery caesarean section

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Effect of Single- versus Double-Layer Uterine Closure during caesarean section on Niche Formation and Menstrual Irregularity

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 57-68页

作者： Mohamed Samy Esraa Hussein Fouad Ghoneimy Walid Hitler Department of Obstetrics and Gynaecology Faculty of Medicine Ain Shams University Cairo Egypt

Background: The myometrium at the location of the CS (caesarean section) scars, also known as residual myometrium thickness (RMT), is larger after a double-layer uterine closure procedure than following a single-layer one. It may lessen the formation of a niche that is the myometrium’s disruption at the location of the scar of the uterus. Gynecological manifestations, obstetric problems in a future pregnancy and birth, and maybe subfertility are linked to thin RMT and a niche. Objective: To ascertain if double-layer unlocked closure of the uterus is better than single-layer one in terms of post-menstrual spotting and niche development following a first CS. Patients and Methods: In this randomized clinical study, 287 patients were evaluated for qualifying. Of all eligible individuals, 57 patients were excluded from the study based on the inclusion criteria. Results: The variation in ages, gestational age, body mass index (BMI), and cesarean section indications between the two assigned groups is statistically insignificant. However, postmenstrual spotting was statistically significantly more common in single-layer group compared to in double-group. The current study revealed ultrasound findings suggestive of niche formation was statistically significantly more common in single-layer group compared to in double-layer group. Conclusion: As evident from the current study, it demonstrates the advantages of double-layer unlocked closure of the uterus over single-layer one in terms of post-menstrual spotting and niche development following first-time cs. Thus, we deduced that fewer niches are formed, and fewer menstrual spotting occurs in the presence of double unlocked layers closure. To ascertain the impact of uterus closure method on post-operative niche development and the risk of obstetrics and gynaecological problems, further prospective trials with extended follow-up periods are required.

关键词： Single-Layer Double caesarean section Residual Myometrium Thickness

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Adjuvant Rectal Diclofenac for Post Operative Analgesia after caesarean section—A Randomized Controlled Study

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Open Journal of Obstetrics and Gynecology 2024年第4期14卷 591-609页

作者： Eziaha Eric S. Ede Ayodele A. Olaleye John C. Irechukwu Uchenna Nelson Nwaedu Borniface N. Ejikeme Vincent Chidiebere Ali Bartholomew I. Olinya Department of Obstetrics and Gynaecology Alex Ekwueme Federal University Teaching Hospital Abakaliki Nigeria

BACKGROUND: Pain management following caesarean section still remains a challenge in our environment. Most potent analgesics are either not readily available or expensive. Diclofenac suppository is an NSAID that can be used for postoperative analgesia. It is available and affordable. OBJECTIVE: To compare the efficacy and safety of combined rectal diclofenac and intramuscular pentazocine with intramuscular pentazocine alone for post operative pain control following lower segment caesarean section. METHODOLOGY: A total of 120 women who met the selection criteria scheduled for caesarean section under spinal anaesthesia with bupivacaine were randomized into two equal groups to receive either 75 mg diclofenac suppository 12 hourly for 24 hours or one anusol suppository (the placebo) 12 hourly for 24 hours. Both groups received pentazocine as primary analgesia. RESULT: The primary outcome measure is the proportion of patients with severe pain at 24 hours using the visual analogue rating scale. Secondary outcome measures are the time from surgery to ambulation, Passage of flatus, maternal satisfaction and presence of complications. Statistical analysis was done using spss version 22 and graph pad statistical package. Student T-test was used for continuous variables whereas chi square was used for categorical variables P CONCLUSION: Adjuvant rectal diclofenac is superior to pentazocine alone in the management of pain after caesarean section. Less number of patients had moderate to severe pain at 24 hours post operation. Maternal satisfaction in relation to pain management is better with diclofenac suppository. The levels of complications were comparable in both groups.

关键词： Pain caesarean section Diclofenac Placebo Suppository

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Thrombotic pulmonary embolism of inferior vena cava during caesarean section:A case report and review of the literature

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World Journal of Clinical Cases 2022年第13期10卷 4226-4235页

作者： Lan Jiang Wei-Xiang Liang Yi Yan Shou-Ping Wang Li Dai Dun-Jin Chen Department of Medical Ultrasound The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510150Guangdong ProvinceChina Department of Cardiology The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510150Guangdong ProvinceChina Department of Anesthesiology The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510015Guangdong ProvinceChina Department of Obstetrics and Gynecology The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510015Guangdong ProvinceChina

BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to *** case report of TPE during CS was recorded by transthoracic echocardiography(TTE)and can provide a reference for the differential diagnosis of critical illnesses in *** SUMMARY A 37-year-old pregnant woman with rheumatic heart disease(RHD),gravida 5 and para 1(G5P1),presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure,pulmonary hypertension and *** placental removal during CS,TTE revealed a nascent thrombus in the inferior vena cava(IVC)that elongated,detached and fragmented leading to acute thromboembolic events and acute *** report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the *** case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for *** case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during *** Pregnancy with heart failure could trigger inferior vena cava(IVC)-origin TPE during *** and timely treatment can avoid serious consequences.

关键词： caesarean section Pulmonary embolism Thrombosis Heart failure Echocardiography Case report

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Balloon displacement during caesarean section with pernicious placenta previa: A case report

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World Journal of Clinical Cases 2023年第36期11卷 8574-8580页

作者： Deng-Feng Gu Chao Deng Department of Anesthesiology The First Affiliated Hospital of Shihezi UniversityShihezi 832000Xinjiang Uighur Autonomous RegionChina

BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta ***,there are still few reports on surgical complications related to interventional therapy,and its safety should be a *** SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean ***,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the ***,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage *** It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse *** is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.

关键词： Pernicious placenta previa caesarean section Abdominal aortic balloon Case report

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Evaluation of “J”-shaped Uterine Incision during caesarean section in Patients with Placenta Previa:A Retrospective Study

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2010年第2期30卷 212-216页

作者：邹丽钟少平赵茵朱剑文陈莉娟 Department of Obstetrics and Gynecology Union HospitalTongji Medical CollegeHuazhong University of Science and Technology

This study evaluated the efficacy and safety of ＂J＂-shaped uterine incision for caesarean section for patients diagnosed with placenta previa. A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months. The subjects were divided into two groups with respect to the uterine incision. Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new ＂J＂-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision. The two groups were compared in terms of operation time, estimated blood loss, infant expulsion time, exhaust time and postoperative recovery. Meanwhile, comparison was also made in neonatal clinical data between the two groups. Compared with the ＂J＂-shaped incision group, the traditional incision group had a lower Apgar scores （P〈0.05）. However, there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind （P〉0.05）. It is concluded that, with caesarean section for placenta previa patients, the ＂J＂-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.

关键词： "J"-shaped incision caesarean section placenta previa

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Longitudinal Epigastric Incision for caesarean section in a Morbidly Obese Patient in a Low-Resource Setting (Cameroon): A Case Report

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Open Journal of Obstetrics and Gynecology 2021年第8期11卷 929-934页

作者： Florent Ymele Fouelifack Wilfried Loic Tatsipie Armand Kamga Talom Anyimbi Ofeh Mosman Hortence Fouedjio Department of Surgery and Specialties Higher Institute of Medical Technology of Nkolondom Yaounde Cameroon Obstetrics and Gynecology Unit Yaounde Central Hospital Yaounde Cameroon Research Education and Health Associative Group GARES-Falaise Dschang Cameroon Department of Gynecology and Obstetrics Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon

Obesity is a metabolic condition associated with a significant morbidity and mortality rate. In the pregnant context, this risk is even higher because of the contingent of metabolic and haemodynamic complications present in the ante-, intra- and post-partum periods. In these people, the recommended delivery method is caesarean section, which is not easy to perform. Our aim is to explain the particularities and advantages of epigastric incision in obese women during a caesarean section. The authors report the case of a patient who was admitted to the maternity ward of the Yaounde Central Hospital for management of a post-date, and in whom an elective caesarean section was indicated with an epigastric approach. The vertical supra umbilical incision should be recommended because it is subject to fewer complications and reduces the operating time and hospital stay.

关键词： Obesity caesarean section Epigastric Incision

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Why Do Pregnant Women Choose a Planned caesarean section in Burkina Faso? A Qualitative Study

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Open Journal of Obstetrics and Gynecology 2022年第5期12卷 408-416页

作者： Nestor Bationo Noufou G. Nana Adama Ouattara Patrice A. Ngangue Dieudonné Soubeiga Ahmed Kabore Maxime Drabo Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l’Education Ouagadougou Burkina-Faso Université Joseph Ki-ZERBO Ouagadougou Burkina-Faso Centre National pour la Recherche Scientifique et Technologique Ouagadougou Burkina-Faso

Despite the complications related to the caesarean section, some couples choose it by desirability. This study aimed to understand the reasons for maternal requests for a planned caesarean section in Burkina Faso, in the absence of obstetric indications. A qualitative descriptive study was conducted in March 2019, consisting of twelve semi-structured interviews with women requesting caesarean section at Tingandogo Teaching Hospital in Burkina Faso. The operative reports were also examined. Thematic analysis based on Braun and Clarke approach was performed with QDA Miner software. Twelve patients were involved in the study. The mean age was 33 years. The majority had a higher level of education. Half were employees. The mean stay duration was 72 hours, with an estimated cost of CFA 300.000 (457,347 EUR). The choice of a planned caesarean was motivated by fear of birth (tokophobia), the positive feeling associated to the surgical technology, the doctor-patient relationship and the confidence in the quality of healthcare services such as reception and hygiene. Maternal reasons for requesting a planned caesarean section in Burkina Faso are multifactorial. Information, education and communication and shared decision-making strategies concerning the different modes of delivery and complications at the end of pregnancy, may contribute to reducing this problem.

关键词： caesarean section Maternal Request Qualitative Study Tokophobia Burkina-Faso

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Antiseptic Skin Preparation for Preventing Surgical Site Infection at caesarean section

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Open Journal of Obstetrics and Gynecology 2016年第4期6卷 246-251页

作者： Olufemi Aworinde Kehinde Olufemi-Aworinde Akintunde Fehintola Babalola Adeyemi Musliudin Owonikoko Adewale Samson Adeyemi Department of Obstetrics and Gynaecology LAUTECH Teaching Hospital Ogbomoso Nigeria Department of Haematology and Blood Transfusion Bowen University Teaching Hospital Ogbomoso Nigeria Department of Obstetrics and Gynaecology Bowen University Teaching Hospital Ogbomoso Nigeria Department of Obstetrics and Gynaecology Obafemi Awolowo University Teaching Hospital Ile-Ife Nigeria

Purpose: To compare the effect of chlorhexidine-alcohol and povidone iodine on surgical site infection (SSI) after caesarean section. Methodology: A randomized control trial of 374 patients (188 in the chlorhexidine-alcohol group and 186 in the povidone iodine group) who had elective caesarean section with no overt risk for SSI was done. Patients were followed up until thirty days after delivery to assess for symptoms and signs of SSI. Results: Fifty-one (13.6%) of the study population developed SSI. Although the incidence of SSI was lower in the chlorhexidine-alcohol group than the povidone iodine group (12.2% vs. 15.1%;p = 0.26);the difference was not statistically significant. The incidence of adverse skin reaction in Chlorhexidine-alcohol vs. povidone iodine was also not statistically significant (4.0% vs. 5.4%;p = 0.40). Conclusion: The study demonstrates that there was no statistically significant difference in antiseptic property and side effect profile of chlorhexidine-alcohol and povidone-iodine when used as skin antisepsis in caesarean section.

关键词： Antisepsis Infection Chlorhexidine Povidone Iodine caesarean section

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