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Sample records for cesarean section analysis

  1. Cesarean section

    MedlinePlus Videos and Cool Tools

    ... disease Like many surgical procedures, cesarean sections require anesthesia. Usually, the mother is given an epidural or ... with either of these incisions because of the anesthesia. The doctor will open the uterus and the ...

  2. Cesarean Section

    MedlinePlus

    A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. In the United ... three women has their babies this way. Some C-sections are planned, but many are done when ...

  3. Cesarean Section

    MedlinePlus

    A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. In the United ... four women have their babies this way. Most C-sections are done when unexpected problems happen during ...

  4. Delivery by Cesarean Section

    MedlinePlus

    ... Español Text Size Email Print Share Delivery by Cesarean Section Page Content Article Body More than one mother in three gives birth by Cesarean section in the United States (it is also called ...

  5. Cesarean Section Birth

    MedlinePlus

    ... try not to do elective deliveries before 39 weeks, which is a week before the patient's due date. And the reason ... cesarean section is typically done anywhere from 39 weeks to the patient's due date. Right. Thank you. ...

  6. [Emergency cesarean section].

    PubMed

    Kawano, Shoko; Amano, Kan; Unno, Nobuya; Okutomi, Toshiyuki

    2012-09-01

    There are abundant cases of obstetric emergencies demanding prompt intervention. Emergency cesarean sections are classified into stable, urgent and immediate surgeries, although there is significant overlap between three groups. Stable emergency cesarean sections are performed in patients with stable maternal and fetal physiology, but who need surgery before unstability occurs. Urgent cesarean sections refer to situations in which maternal and/or fetal physiology is unstable, whereas the immediate cesarean section is used for life-threatening condition such as sustained fetal bradycardia, maternal cardiopulmonary arrest. In most cases the key to proper management is the prompt communication between obstetricians and anesthesiologists. Anesthesiologists must have a clear understanding of certain obstetric emergencies. In the event of sustained fetal bradycardia caused by placental abruption, cord prolapse, uterine rupture etc, delivery by immediate cesarean section within 25 minutes improve long-term neonatal neurologic outcome. Although cardiopulmonary arrest in pregnancy is very uncommon, peripartum cesarean section should be considered within 5 minutes not only for maternal resuscitation but for neonatal survival. Only a well-coordinated teamwork of all involved specialities will guarantee optimal prognosis of mother and fetus. PMID:23012828

  7. [Cesarean section through history].

    PubMed

    Rabinerson, David; Ashwal, Eran; Gabbay-Benziv, Rinat

    2014-11-01

    According to historic documents, delivery by abdominal and uterine incision was already known to mankind at the beginning of the second millennium BC. This delivery method was eventually referred to as "Cesarean Section" because it was wrongfully attributed to the way by which Julius Caesar was born. The indications for cesarean sections performed in ancient cultures and to the end of the medieval period were mainly kings law, that mandated burial of the fetus separately from his mother, legal rights regarding inheritance of the father or religious motives mandating baptism of the newborn in order to ensure him eternal life in heaven. As from the second half of the 19th century AD, and with improvement in surgical techniques, as well as in the perioperative environment (asepsis, antibiotics, anaesthesia, blood transfusion, etc.), the obstetric outcome of cesarean sections was dramaticay improved, both in terms of maternal, as well as fetal, outcome. Hence, it became very prevalent throughout the world. The emergence of medico-legal medicine and medical ethics issues, have further contributed to the use of cesarean sections as the ultimate solution of every unusual delivery. PMID:25563029

  8. Prevalence and Causes of Cesarean Section in Iran: Systematic Review and Meta-Analysis

    PubMed Central

    AZAMI-AGHDASH, Saber; GHOJAZADEH, Morteza; DEHDILANI, Nima; MOHAMMADI, Marzieh; ASL AMIN ABAD, Ramin

    2014-01-01

    Abstract Unfortunately, the prevalence of cesarean section has increased in recent years. Whereas awareness of the prevalence and causes is inevitable for planning and effective interventions, so aim of this study has designed and conducted for reviewing of systematic Prevalence and caesarean causes in Iran. In this meta-analysis, the required information have been collected using several keywords which are Cesarean section rate, Cesarean section prevalence, delivery, childhood, childbirth, relative causes, relative frequency, Iran and their Persian equivalents have been collected from databases such as CINAHL, Science Direct, PubMed, Magiran, SID, Iranmedex. Finally, we found 706 related articles and selected 34 articles among them for studying of cesarean Prevalence. We used CMA software with random model for Meta-Analysis. The prevalence of Cesarean was estimated48%. Using content analysis, Factors influencing the incidence of cesarean section were divided to 3 categories including social and demographic factors, obstetric-medical causes and non-obstetric-medical causes. Maternal education and grand multiparity in the field of demographic and social factors, previous cesarean in the field of obstetric-medical causes and fear of normal-vaginal delivery (NVD) and doctor’s suggestion in the field of non-obstetric-medical causes were major causes of Cesarean. According to the high prevalence of caesarean section and it upward development, it seems to be essential designing and implementing of programs and interventions effectiveness including providing of Possibility of painless childbirth and education and psychological interventions, increasing of quality of natural delivery services, proper culture and prohibiting of doctors from Personal opinions and profit. PMID:26060756

  9. Pheochromocytoma after Cesarean Section

    PubMed Central

    Naghshineh, Elham; Shahraki, Azar Danesh; Sheikhalian, Somaye; Hashemi, Leila

    2016-01-01

    Pheochromocytoma is a catecholamine-producing tumor. There are a very few reported cases of clinical pheochromocytoma. Here, we report a 27-year-old woman para 1 live 1 with chief complaint of headache, confusion, nausea, and vomiting 2 days after cesarean section. She was anxious and had palpitation. On physical examination, fever, tachycardia, tachypnea, high blood pressure, and right thyroid nodule were found. She was managed as pregnancy-induced hypertension at first. In laboratory data, epinephrine, norepinephrine, metanephrine, normetanephrine, and vanillylmandelic acid were increased in 24 h urine collection. An adrenal mass was detected in abdominal computed tomography. Regarding clinical and paraclinical findings, pheochromocytoma was diagnosed. The patient received medical treatment, but it was not effective; hence, she underwent adrenalectomy. PMID:27076898

  10. [Cesarean section and eye disorders].

    PubMed

    Karska-Basta, Izabella; Tarasiewicz, Marta; Kubicka-Trząska, Agnieszka; Miniewicz, Joanna; Romanowska-Dixon, Bożena

    2016-01-01

    Recently, a growing tendency for cesarean birth has been noted both, in Poland and worldwide. Non-obstetric problems constitute a large part of indications for cesarean section. Many ophthalmologists and obstetricians still believe that high myopia, the presence of peripheral retinal degenerations, history of retinal detachment surgery, diabetic retinopathy, or glaucoma are indications for surgical termination of pregnancy. However, these recommendations are not evidence-based. The literature offers no proof that high myopia and previous retinal surgery increase the risk of retinal detachment during spontaneous vaginal delivery. There is only one indication for cesarean section in myopic patients, i.e. the presence of choroidal neovascularization, which can cause subretinal bleeding with acute visual loss. Prolonged and intensified Valsalva maneuver during labor in patients with an active proliferative diabetic retinopathy may be an indication for an elective cesarean section. Uterine contractions during the second stage of vaginal delivery lead to a marked elevation of intraocular pressure. Intraocular pressure fluctuations during the delivery may damage retinal ganglion cells, resulting in further progression of visual field. Thus, glaucoma associated with advanced visual field changes is the next ophthalmic indication for cesarean section. The report presents the current state of knowledge concerning the effect of pregnancy on pre-existing ocular disorders and the influence of physiological changes on the clinical course of these diseases during the stages of natural delivery. The authors discuss also the ophthalmic indications for cesarean section. PMID:27306132

  11. Evolution & the Cesarean Section Rate

    ERIC Educational Resources Information Center

    Walsh, Joseph A.

    2008-01-01

    "Nothing in biology makes sense except in the light of evolution." This was the title of an essay by geneticist Theodosius Dobzhansky writing in 1973. Many causes have been given for the increased Cesarean section rate in developed countries, but biologic evolution has not been one of them. The C-section rate will continue to rise, because the…

  12. Vaginal birth after cesarean section: current opinion.

    PubMed

    Weinstein, D; Benshushan, A; Ezra, Y; Rojansky, N

    1996-04-01

    Although the current literature attests to the merits of a trial of labor in the patient with a prior cesarean section, some controversies remain. For example, can women with two or more sections be allowed a trial of labor and can patients who undergo a trial of labor receive oxytocin or prostaglandins for induction? Also, do certain indications for previous cesarean section such as relative cephalopelvic disproportion/failure to progress or the diagnosis of breech or twins in the present pregnancy constitute an indication for elective repeat cesarean delivery? These questions along with some other controversies are discussed in the light of newly accumulated data in the English literature and our own experience over the last decade in a major university-based tertiary medical center. PMID:8737297

  13. Essentials in cardiac arrest during cesarean section.

    PubMed

    van Liempt, Susan W J D; Stoecklein, Katrin; Tjiong, Ming Y; Schwarte, Lothar A; de Groot, Christianne J M; Teunissen, Pim W

    2015-01-28

    Cardiac arrest during cesarean section is very rare. Obstetrical teams have low exposure to these critical situations necessitating frequent rehearsal and knowledge of its differential diagnosis and treatment. A 40-year-old woman pregnant with triplets underwent cesarean sections because of vaginal bleeding due to a placenta previa at 35.2 weeks of gestation. Spinal anesthesia was performed. Asystole occurred during uterotomy. Immediate resuscitation and delivery of the neonates eventually resulted in good maternal and neonatal outcomes. The differential diagnosis is essential and should include obstetric and non-obstetric causes. We describe the consideration of Bezold Jarisch reflex and amniotic fluid embolism as most appropriate in this case. PMID:25918626

  14. [Long-term effects of uterine cesarean section scar].

    PubMed

    Tihtonen, Kati; Nyberg, Reita

    2014-01-01

    During the last few decades the cesarean delivery rate has been around 15% in Finland. It has remained moderate compared with USA where 30% of women deliver by cesarean section. Compared with vaginal delivery, cesarean section is associated with a three- to sixfold risk of severe complications. Furthermore, it increases also long term gynecological morbidity, including intermenstrual bleeding, chronic pelvic pain and risk of secondary infertility. Scar pregnancy, uterine rupture, placenta previa and accrete are known risks after cesarean section. Because cesarean delivery is associated with increased long-term morbidity, the decision of performing cesarean section should always be carefully considered. PMID:24730196

  15. Ga-67 uptake post cesarean section

    SciTech Connect

    Lopez, O.L.; Maisano, E.R.

    1984-02-01

    Gallium-67 distribution in normal patients is well known; it is also known that the concentration in some tissues may vary according to an individual physiologic stimulus. In this report, the case of a young woman is presented who was studied 15 days after a cesarean section and showed physiologic and pathologic Ga-67 accumulation.

  16. Prevention of cesarean section. Does intracervical dinoprostone work?

    PubMed

    Gilson, G J; Izquierdo, L A; Chatterjee, M S; Curet, L B; Qualls, C R

    1993-08-01

    We investigated the effect of preinduction cervical ripening with the intracervical instillation of dinoprostone (prostaglandin E2 gel, 0.5 mg) on the results of labor induced with intravenous oxytocin. We randomly allocated 79 pregnant women to receive either the intracervial application of dinoprostone gel or placebo gel. Compared with control subjects, the group who received dinoprostone had no difference in induction-to-delivery interval or in cesarean section rate. The dinoprostone group had fewer failed inductions, but there was no difference between the two groups in the number who delivered spontaneously within 24 hours. From review of the literature and a meta-analysis, it was likewise revealed that dinoprostone did not favorably affect the cesarean section rate. Contrary to current opinion, intracervical dinoprostone gel does not appreciably lower the cesarean section rate when used at this dose and route before labor is induced. PMID:8212680

  17. Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

    PubMed Central

    Li, Cuilan; Tang, Shiyan; Gao, Xingcheng; Lin, Wanping; Han, Dong; Zhai, Jinguo; Mo, Xuetang; Zhou, Lee Jaden Gil Yu Kang

    2016-01-01

    Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum. Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery. Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p < 0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up. Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum. PMID:27066497

  18. [The Misgav Ladach method for cesarean section].

    PubMed

    Habek, Dubravko; Kulas, Tomislav; Karsa, Matija

    2007-04-01

    The Misgav Ladach method for cesarean section is based on the principles of surgical minimalism. This is based on the Joel Cohen laparotomy, somewhat higher than the Pfannenstiel incision. Subcutaneous tissue is left undisturbed apart from the midline, rectus muscles are separated by pulling. The peritoneum is opened by stretching with index fingers. The hysterotomy is closed with one layer extraendometrial continuous absorbable stitches (Vicryl), and the visceral and parietal peritoneal layers are left open. Fascia is stitched with a continuous synthetic absorbable stitch. The skin is closed with intracutaneous resorptive suture or metallic stapler sutures. The Misgav Ladach method is restrictive in the use of sharp instruments preferring manual manipulation: it gives faster recovery, shorter period to normal bowel function, less peritoneal adhesions and less scarring in the abdominal layers, less use of postoperative antibiotics, analgesics and antipyretics, and a shorter anesthetic and operative time. It is ideal for emergency and planned cesarean section. PMID:17585470

  19. Shoulder Tip Pain After Cesarean Section

    PubMed Central

    Ustunyurt, Emin; Yilmaz, Canan; Olmez, Fatma; Basar, Birsen

    2015-01-01

    Aim The aim of this study was to investigate the frequency of postoperative shoulder tip pain (STP) after cesarean section and compare spinal and general anaesthesia with respect to STP. Materials and Methods Three hundred patients who underwent cesarean section were randomly assigned to either spinal anaesthesia group (Group SA, n=143) or general anaesthesia group (Group GA, n=157). Postoperative STP was assessed at 8 hours and 24 hours after operation by Visual Analogue Scale of Pain (VAS). Results There were no statistically significant difference between the groups in terms of demographic data, operative findings, and clinical outcomes. The overall incidence of STP in study population was 35.7%. The incidence of STP in group SA (26.6%) was lower than that in group GA (43.9%)(p=0.005). Moreover VAS scores for STP at 6 hours and 24 hours were significantly lower in Group SA (p=0.001 and p<0.001, respectively). Conclusion Shoulder tip pain is a common complaint after cesarean section, which is more prevalent in general anaesthesia. PMID:26436000

  20. [The history of cesarean section].

    PubMed

    Aubard, Y; Le Meur, Y; Grandjean, M H; Baudet, J H

    1995-01-01

    The origins of the Cesarian section date back to the Classical era, and possible even earlier. Ancient India, the Hebrews, the Grecks and the Romans were all familiar with post-mortem Cesarian section. The operation marked time during the Middle Ages. The name "Cesarian section" was first used to designate this operation during the Renaissance period, when it was first carried out in live women. However, until the middle of XIX th century, a Cesarian remained a last chance option which was cautioned against by most obstetricians. It was only after the advent of the "surgical golden tripod" that the Cesarian was gradually rehabilitated through the work of Poro, Kherer and Sanger and the German School. In the XIXth century, segmental incision became the norm and fetal indications for a Cesarian emerged. PMID:7899774

  1. Complications and outcomes of repeat cesarean section in adolescent women

    PubMed Central

    Kaplanoglu, Mustafa; Karateke, Atilla; Un, Burak; Akgor, Utku; Baloğlu, Ali

    2014-01-01

    Aim: The evaluation of the effect of repeat cesarean sections in adolescent pregnancies on the morbidity, obstetric and perinatal results. Materials and methods: We reviewed the patient file and hospital records of patients who underwent at least one cesarean section among adolescent age group pregnant women who gave birth at our clinic between January 2010 and May 2013. The patients were divided into two groups as the patients who underwent the second cesarean section (116 patients) and those who underwent the third cesarean section (36 patients). The demographic data, maternal data and obstetric and perinatal results of the patients were evaluated. Results: A significant difference was present between the patients in the evaluation of the total number of examinations during pregnancy (P = 0.001), total maternal weight gain during pregnancy (P = 0.006), and the first examination gestational age (P = 0.006) and all values were less favorable in the third cesarean group. The gestational week at birth (P < 0.001), birth weight (P < 0.001), and APGAR score (P < 0.001) in the group with the third cesarean section were statistically significantly lower than the second cesarean section. The third cesarean cesarean was found to cause a significant risk increase for placenta accreta risk in adolescent pregnancies (P = 0.042). Conclusion: The increasing number of cesarean sections in the adolescent group is seen to be a significant risk factor for low gestational week of birth, low birth weight and related morbidities. The most important reason for the increased morbidity with increasing cesarean sections in the adolescent age has been defined as placenta accreta. PMID:25664081

  2. [IUD insertion during cesarean section and its most frequent complications].

    PubMed

    Alvarez Pelayo, J; Borbolla Sala, M E

    1994-11-01

    A prospective and cooperative study was done in 152 patients that were submitted to cesarean section. Seventy eight patients received intrauterine device (IUD) T CU 220 during cesarean section, and the other 74 patients only got the cesarean section without IUD. The events that were analyzed during the puerperium were pain, bleeding and infection. We didn't find any difference in the results between both groups, these were analyzed with the help of the square chi (X2). These results suggest that with an adequate selection of the patients, the insertion of the IUD during the cesarean section is a secure and helpful method for the fertility control for patients with high risk of reproduction. PMID:7821830

  3. TAP Catheters Versus Intrathecal Morphine for Cesarean Section

    ClinicalTrials.gov

    2012-05-07

    Abdominal Muscles/Ultrasonography; Adult; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Cesarean Section; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

  4. The use of midwives as first assistants in cesarean section.

    PubMed

    Marks; Thacher; Camargo

    1998-07-01

    Introduction: In 1997, medical insurance gives limited financial reimbursement to physicians who first assist cesarean sections. Therefore, a formal program was developed at our community teaching hospital using midwives in place of physicians as first assistant in cesarean section. Midwives on the midwifery service were taught the principles and procedures of obstetrical anesthesia, anatomy, and physiology of the gravid abdomen.A team approach using obstetrician/gynecologist, anesthesiologist, midwives, and operating nurses performed the tracking in a 1-day course. A 28-minute video was developed to depict the role of the midwife as first assistant. Additionally, the principles of operation room set-up and instrumentation were taught.Result: All 24 midwives on the midwifery service were involved in the teaching of first assisting an attending obstetrician. After taking the course, nurse-midwives received formal certification from the department of obstetrics and gynecology and were approved by risk management. They also received clinical privileges outlining these guidelines. Their malpractice rates have not increased. The time to complete a cesarean section has not increased for the physician, and an emergency cesarean section is no longer delayed by waiting for an assistant to arrive. Patient satisfaction has increased because of decreased waiting time for a cesarean section and increased familiarity with the entire operating team.Discussion: Midwives can be trained to first assist the obstetrician/gynecologist in a cesarean section. Since the duration of a cesarean section is not prolonged, the patient will not experience increased blood loss or infection secondary to a prolonged procedure. The patient is more relaxed since they know that their provider during labor is also one of their surgeons for the cesarean section. PMID:10838393

  5. [Bupivacaine-induced Anaphylaxis in a Parturient Undergoing Cesarean Section].

    PubMed

    Iwasaki, Mitsuo; Tachibana, Kazuya; Mitsuda, Nobuaki; Kinouchi, Keiko

    2015-02-01

    We describe a case of anaphylaxis that occurred in a 33-year-old gravida 1, para 1 term woman scheduled for cesarean delivery for breech presentation. Her past history was unremarkable except for orciprenaline allergy. Spinal anesthesia was performed at L3-4 using 2.5 ml of 0.5% hyperbaric bupivacaine and 0.1 mg morphine. Seven minutes after spinal anesthesia, she complained of hoarseness and difficulty in breathing and 3 minutes later, blood pressure decreased to 76/51 mmHg, and oxygen saturation to 87% with supplemental oxygen. Skin flushing was noted in the face and trunk of the body and anaphylaxis was diagnosed. She was treated with a rapid intravenous infusion and iv administration of phenylephrine (total dose 0.4 mg), ephedrine (total dose 25 mg), hydrocortisone and famotidine. Cesarean section was started 23 minutes after spinal anesthesia when blood pressure and oxygen saturation recovered. A male infant was delivered (18 minutes after the onset of anaphylactic event) with Apgar scores of 2 and 5 at 1 and 5 min, respectively and resuscitated with mask ventilation. Umbilical artery blood gas analysis revealed pH 6.85, base excess -20.3 mmol x l (-1) and lactate 109 mg x dl (-1). The mother was discharged from the hospital on the 6th postoperative day. The baby's electroencephalogram, however, demonstrated a pattern consistent with mild hypoxic-ischemic encephalopathy. Lymphocyte stimulation test revealed that she was allergic to bupivacaine. If maternal hypotension persists, i.m. or i.v. adrenaline should be administered immediately because maternal hypotension and hypoxemia may cause significant fetal morbidity and mortality and prompt cesarean section should be considered. PMID:26121818

  6. Cesarean Section - Multiple Languages: MedlinePlus

    MedlinePlus

    ... sharing features on this page, please enable JavaScript. Arabic (العربية) Bosnian (Bosanski) Chinese - Simplified (简体中文) Chinese - Traditional ( ... português) Russian (Русский) Somali (af Soomaali) Spanish (español) Arabic (العربية) our Recovery After Cesarean Birth: Part 2 ...

  7. Cesarean Section - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Hindi (हिन्दी) Japanese (日本語) Korean (한국어) Portuguese (português) Russian (Русский) Somali (af Soomaali) Spanish (español) Arabic ( ... 한국어 (Korean) Bilingual PDF Health Information Translations Portuguese (português) Your Recovery After Cesarean Birth Sua recuperação após ...

  8. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

    PubMed Central

    Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina

    2016-01-01

    Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are

  9. [Natural childbirth and cesarean section: social representations of women who experienced them].

    PubMed

    Velho, Manuela Beatriz; dos Santos, Evanguelia Kotzias Atherino; Collaço, Vânia Sorgatto

    2014-01-01

    Aiming to understand the social representations of natural childbirth and caesarean section for women who experienced them, it was developed a descriptive, qualitative research. Interviews were conducted from July to October 2010, with twenty women who experienced both types of birth. The number of participants was determined by theoretical saturation during data collection and content analysis. The results showed, during the experience of motherhood: the search for information, the experience of childbirth alone versus support at birth; and that the woman has no option of choice on type of birth. Natural childbirth includes important issues such as: the ambivalence of feelings, positive perception and hospitalization. Cesarean section is associated with ambivalence of feelings, understood as a solution of a problem and the preference for cesarean section. The natural childbirth is a challenge for women, but the positive feelings outweigh the difficulties, while the cesarean section is associated to the physical benefits of its execution. PMID:24861073

  10. Trial of labor in previous cesarean section patients, excluding classical cesarean sections.

    PubMed

    Stovall, T G; Shaver, D C; Solomon, S K; Anderson, G D

    1987-11-01

    The American College of Obstetricians and Gynecologists has supported the concept of a trial of labor in patients with a previous lower uterine transverse cesarean section, and its safety is generally accepted. The purpose of this report was to present the results of a year-long, prospective study in which the indications for trial of labor were liberalized. Only patients with a previous classical incision or "T" incision on the uterus were excluded. Two hundred seventy-two patients elected to undergo a trial of labor. Vaginal delivery occurred in 216 patients (76.5%). Oxytocin was used as needed, and epidural anesthesia was used in all patients who requested it. One uterine rupture occurred in a patient with a single lower transverse scar. The results of this study suggest that a trial of labor is a safe alternative for patients with a previous single or multiple lower uterine transverse incision or a lower uterine vertical incision. In addition, the use of epidural anesthesia and oxytocin appears safe in patients undergoing a trial of labor. PMID:3658277

  11. [Lucina's kidnap (or how to stop the cesarean section epidemic)].

    PubMed

    Gómez-Dantés, Octavio

    2004-01-01

    Cesarean sections rates have increased considerably in high- and middle-income countries in recent years. In Latin America the rates of surgical births reached 30% in Brazil, 40% in Chile, and 36% in Mexico. This essay describes the relationship of cesarean section with several mythological characters, presents a brief history of surgical births, and discusses the possible origin of its explosive increase. Among the factors associated to this epidemic we can mention economic incentives, a mounting supply of specialists, and the lack of comprehensive information on birth alternatives for pregnant women. The essay concludes with a call for a generalized control of this procedure based on evidence gathered through different kinds of interventions. PMID:15053399

  12. [Elective cesarean section on maternal request--what's new?].

    PubMed

    Rabinerson, David; Aviram, Amir; Gabbay-Benziv, Rinat

    2014-06-01

    Elective cesarean section on maternal request is a debatable issue with regard to all of its aspects. Current literature discusses topics such as its prevalence, risks and benefits in comparison with vaginal delivery, as well as ethical, judicial and economical questions regarding its execution. We reviewed the relevant literature from the last decade. There are no clear research findings which indicate that overall, elective cesarean section on maternal request is better, or alternatively, more perilous, in comparison with vaginal delivery, from both maternal and fetal or neonatal aspects. Due to its prevalence, there is a need for the obstetric establishment in Israel to make a formal statement regarding its attitude towards this issue. PMID:25095605

  13. Classic metaphyseal lesion following external cephalic version and cesarean section.

    PubMed

    Lysack, John T; Soboleski, Don

    2003-06-01

    We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury. PMID:12709748

  14. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    PubMed

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting. PMID:26596028

  15. Rectus abdominis muscle endometriosis after cesarean section--case report.

    PubMed

    Dordević, Momcilo; Jovanović, Bozidar; Mitrović, Slobodanka; Dordević, Gordana; Radovanović, Dragce; Sazdanović, Predrag

    2009-09-01

    Endometriosis is defined by the presence of functional endometrial tissue outside the uterus, where it is normally located. Endometriosis is one of the most common gynecologic entities affecting 8%-18% of menstrual women. Endometriosis can occur at intra- and extrapelvic localizations. The most common intrapelvic localizations are those involving the ovaries, Douglas' area, pelvic peritoneum, uterus, bladder and rectum. Abdominal endometriosis is the most common localization of extrapelvic endometriosis and usually develops in connective tissue. Extra-pelvic implantation of endometrial tissue may develop in any organ including the skin, lungs, liver, extremities, brain and stomach. Three years after cesarean section, a 35-year-old female was operated on for suspected anterior abdominal hernia at the site of previous section. An egg-sized tumor was removed from the rectus abdominis muscle and referred for histopathologic and immunohistochemical analyses. The results showed endometriosis of the muscle with positive estrogen and progesterone receptors. A year after the procedure, treatment with gonadotropin-releasing hormone analogs was continued due to recurrent pain in the scar area, along with ultrasonography and biochemical marker (carbohydrate antigen 125) follow-up. Clinical diagnosis of scar endometriosis can be made by thorough history and physical, ultrasonography and biochemical examinations. Scar endometriosis should always be considered when the symptoms occur in a cyclic and hormone-dependent pattern, mostly after gynecologic operations, and worsening during menstruation. Definitive diagnosis is based on histopathologic analysis. PMID:20405641

  16. Safety of uneventful cesarean section in terms of hemorrhage

    PubMed Central

    Bodur, Serkan; Gun, Ismet; Ozdamar, Ozkan; Babayigit, Mustafa Alparslan

    2015-01-01

    Objective: Hemorrhage still continues to be reported as one of the leading causes of maternal mortality and morbidity. Intraoperative estimation of the blood loss seems to be complex and misleading as it is impaired by the amount of amniotic fluid and blood from the placenta. The present study was aimed to investigate the safety of intraoperative deciding on an uneventful cesarean section in a low risk patient population. Material and methods: One hundred patients free from hemorrhage risks and experienced an uneventful elective cesarean section, were included to the study. The decline in hemoglobin and hematocrit values, calculated blood loss, transfusion rate and presence of hemorrhage related symptoms and signs were accepted as the main outcomes of the study. Results: The average preoperative and postoperative hemoglobin values were detected as 12.09±0.18 g/dl and 10.72±1.39 g/dl, respectively. The average decrease in hemoglobin was 1.36±1.06 g/dl. The observed decrease in hemoglobin values were less than 10% in 34.4% of the patients. The average blood loss was calculated to be 517.06±417.55 ml. There were no patients with signs and symptoms of hemorrhage. Cross match transfusion ratio, transfusion probability and transfusion index was calculated as zero. Conclusion: The decision of uneventful cesarean section provides obstetricians a safe postoperative and postpartum period after following standardized surgical procedures in terms of hemorrhage and related complications. PMID:26885120

  17. Risk factors for cesarean section and instrumental vaginal delivery after successful external cephalic version.

    PubMed

    de Hundt, Marcella; Vlemmix, Floortje; Bais, Joke M J; de Groot, Christianne J; Mol, Ben Willem; Kok, Marjolein

    2016-06-01

    Aim of this article is to examine if we could identify factors that predict cesarean section and instrumental vaginal delivery in women who had a successful external cephalic version. We used data from a previous randomized trial among 25 hospitals and their referring midwife practices in the Netherlands. With the data of this trial, we performed a cohort study among women attempting vaginal delivery after successful ECV. We evaluated whether maternal age, gestational age, parity, time interval between ECV and delivery, birth weight, neonatal gender, and induction of labor were predictive for a vaginal delivery on one hand or a CS or instrumental vaginal delivery on the other hand. Unadjusted and adjusted odds ratios were calculated with univariate and multivariate logistic regression analysis. Among 301 women who attempted vaginal delivery after a successful external cephalic version attempt, the cesarean section rate was 13% and the instrumental vaginal delivery rate 6%, resulting in a combined instrumental delivery rate of 19%. Nulliparity increased the risk of cesarean section (OR 2.7 (95% CI 1.2-6.1)) and instrumental delivery (OR 4.2 (95% CI 2.1-8.6)). Maternal age, gestational age at delivery, time interval between external cephalic version and delivery, birth weight and neonatal gender did not contribute to the prediction of failed spontaneous vaginal delivery. In our cohort of 301 women with a successful external cephalic version, nulliparity was the only one of seven factors that predicted the risk for cesarean section and instrumental vaginal delivery. PMID:26333291

  18. Cesarean section in the People’s Republic of China: current perspectives

    PubMed Central

    Feng, Xing Lin; Wang, Ying; An, Lin; Ronsmans, Carine

    2014-01-01

    Objective To review the current knowledge on the prevalence, reasons, and consequences of cesarean sections in the People’s Republic of China. Methods Peer-reviewed articles were systematically searched on PubMed. The following Chinese databases were comprehensively searched: the China National Knowledge Infrastructure, Wanfang, and the VIP information. The databases were searched from inception to September 1, 2013. Two reviewers independently screened the titles and abstracts for eligibility. Full texts of eligible papers were reviewed, where relevant references were hand-searched and reviewed. Findings Sixty articles were included from PubMed, 17 articles were intentionally picked out from Chinese journals, and five additional articles were added, for a total of 82 articles for the analysis. With a current national rate near 40%, the literature consistently reported a rapid rise of cesarean sections in the People’s Republic of China in the past decades, irrespective of where people lived or their socioeconomic standing. Nonclinical factors were considered as the main drivers fueling the rise of cesareans in the People’s Republic of China. There was a lively debate on whether women’s preferences or providers’ distorted financial incentives affected the rise in cesarean sections. However, recent evidence suggests that it might be the People’s Republic of China’s health development approach – focusing on specialized care and marginalizing primary care – that is playing a role. Although 30 articles were identified studying the consequences of cesareans, the methodologies are in general weak and the themes are out of focus. Conclusion The overuse of cesareans is rising alarmingly in the People’s Republic of China and has become a real public health problem. No consensus has been made on the leverage factors that drive the cesarean epidemic, particularly for those nonclinical factors. The more macro level structural factors may have played a part

  19. The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

    PubMed Central

    Kwon, Ha Yan; Kwon, Ja-Young; Park, Yong Won

    2016-01-01

    Objective To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section. PMID:27200306

  20. Responding to refusal of recommended cesarean section: Promoting good parenting.

    PubMed

    Malek, Janet

    2016-06-01

    Consideration of what a "good parent" would do in controversial perinatal cases has been largely absent from to ethics literature. This article argues when a cesarean section is required to prevent death or serious disability for a fetus, the pregnant woman has an ethical (although not legal) obligation to undergo that procedure even when she has concerns or conflicting commitments. Further, a clinician may be justified in using persuasive counseling when there is grave harm at stake that the patient has a moral obligation to prevent. This conclusion is tested by exploring its implications in several other analogous controversial contexts. PMID:26803168

  1. Uterocutaneous Fistula Following Cesarean Section: Successful Management of a Case

    PubMed Central

    Maddah, Ghodratollah; Fattahi, Asieh Sadat; Rahnama, Ali; Jamshidi, Shirin Taraz

    2016-01-01

    A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation — she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months’ postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management. PMID:26989289

  2. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

    PubMed Central

    Smaill, Fiona M; Gyte, Gillian ML

    2014-01-01

    Background The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms. Objectives To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (May 2009). Selection criteria Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section. Data collection and analysis Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Main results We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been

  3. Acute intestinal obstruction due to a non-involuted uterus after cesarean section: case report.

    PubMed

    Karaman, K; Ercan, M; Demir, H; Yener Uzunoglu, M; Bostanci, S

    2016-01-01

    The involution of the uterus is influenced by a number of factors such as advanced childbearing age, electrolyte disturbances, multiparity, repeated cesarean sections, and vaginal infections. The authors report the management of a clinical case of a 41-year-old female who presented with acute intestinal obstruction due to a non-involuted uterus after cesarean section. PMID:27048040

  4. [Does Surgical Safety Checklist for cesarean section improve maternal and neonatal outcome?].

    PubMed

    Sumikura, Hiroyuki

    2014-03-01

    Surgical Safety Checklist published by WHO (World Health Organization) has been widely accepted and contributed to reduce postoperative mortality and morbidity. However, the implementation of the original checklist for cesarean section has been questioned as most of the patients for cesarean section being awake at the occasion of time out, and some patients requiring emergency cesarean section. From these points of view, modified versions of the checklist for cesarean section have been proposed. Recently, NPSA (National Patient Safety Agency) and RCOG (Royal College of Obstetricians and Gynaecologists) from U. K. published a checklist specifically for obstetric surgery, and its usefulness has been evaluated. The most important modification of the checklist seems to be adoption of classification of urgency of cesarean section by NICE (National Institute of Clinical Excellence) into the time out Surgical Safety Checklist from U. K. is introduced with its recent evaluation, and its possible adoption in Japanese hospitals will be discussed. PMID:24724434

  5. Cesarean section and the manipulation of exact delivery time.

    PubMed

    Fabbri, Daniele; Monfardini, Chiara; Castaldini, Ilaria; Protonotari, Adalgisa

    2016-07-01

    Physicians are often alleged responsible for the manipulation of delivery timing. We investigate this issue in a setting that negates the influence of financial incentives on physician's behavior. Working on a sample of women admitted at the onset of labor in a big public hospital in Italy we estimate a model for the exact time of delivery as driven by individual Indication to Cesarean Section (ICS) and covariates. We find that ICS does not affect the day of delivery but leads to a circadian rhythm in the likelihood of delivery. The pattern is consistent with the postponement of high ICS deliveries in the late night\\early morning shift. Our evidence hardly supports the manipulation of timing of births as driven by medical staff's "demand for leisure". Physicians seem to manipulate the exact timing of delivery to reduce exposure to risk factors extant during off-peak periods. PMID:27263061

  6. Management of Hepatic Rupture Diagnosed after an Emergency Cesarean Section

    PubMed Central

    Damiani, Gianluca Raffaello; Merola, Viviana; Barnaba, Mario; Landi, Stefano; Cormio, Gennaro; Pellegrino, Antonio

    2014-01-01

    A careful management of hepatic capsular rupture, with massive hemoperitoneum which occurred 14 hours after an emergency cesarean section at 36 weeks of gestation, is meticulously reported. The grade of hepatic involvement varies from minor capsular laceration to extensive parenchymal rupture. Our management involved a combination of surgical interventions and aggressive supportive care. The patient was discharged after 53 days and 4 laparotomies and an unsuccessful attempt of superselective artery embolization. Ultrasound after 40 days from the last surgery showed uniform hepatic parenchyma free of focal lesions. Due to the rarity and the unpredictability nature of this devastating event we believe necessary to report our experience, reinforcing the importance of the postsurgery management. PMID:25254049

  7. Postmortem and perimortem cesarean section: historical, religious and ethical considerations.

    PubMed

    Fadel, Hossam E

    2011-12-01

    Guillimeau was the first to use the term cesarean section (CS) in 1598, but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be performed in all cultures dating to ancient times. In the past, it was mainly done to deliver a live baby from a dead mother, hence the name postmortem CS (PMCS). Many heroes are reported to have been delivered this way. Old Jewish sacred books have made references to abdominal delivery. It was especially encouraged and often mandated in Catholicism. There is evidence that the operation was done in Muslim countries in the middle ages. Islamic rulings support the performance of PMCS. Now that most maternal deaths occur in the hospital, perimortem CS (PRMCS) is recommended for the delivery of a fetus after 24 weeks from a pregnant woman with cardiac arrest. It is believed that emergent delivery within four minutes of initiation of cardiopulmonary resuscitation (CPR) improves the chances of success of maternal resuscitation and survival and increases the chance of delivering a neurologically intact neonate. It is agreed that physicians are not to be held legally liable for the performance of PMCS and PRMCS regardless of the outcome. The ethical aspects of these operations are also discussed including a discussion about PMCS for the delivery of women who have been declared brain dead. PMID:23610509

  8. Postmortem and Perimortem Cesarean Section: Historical, Religious and Ethical Considerations

    PubMed Central

    Fadel, Hossam E.

    2012-01-01

    Guillimeau was the first to use the term cesarean section (CS) in 1598, but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be performed in all cultures dating to ancient times. In the past, it was mainly done to deliver a live baby from a dead mother, hence the name postmortem CS (PMCS). Many heroes are reported to have been delivered this way. Old Jewish sacred books have made references to abdominal delivery. It was especially encouraged and often mandated in Catholicism. There is evidence that the operation was done in Muslim countries in the middle ages. Islamic rulings support the performance of PMCS. Now that most maternal deaths occur in the hospital, perimortem CS (PRMCS) is recommended for the delivery of a fetus after 24 weeks from a pregnant woman with cardiac arrest. It is believed that emergent delivery within four minutes of initiation of cardiopulmonary resuscitation (CPR) improves the chances of success of maternal resuscitation and survival and increases the chance of delivering a neurologically intact neonate. It is agreed that physicians are not to be held legally liable for the performance of PMCS and PRMCS regardless of the outcome. The ethical aspects of these operations are also discussed including a discussion about PMCS for the delivery of women who have been declared brain dead. PMID:23610509

  9. [Iliac artery occlusion balloons for suspected placenta accreta during cesarean section].

    PubMed

    Burgos Frías, N; Gredilla, E; Guasch, E; Gilsanz, F

    2014-02-01

    Massive obstetric hemorrhage still remains a major cause of maternal mortality and morbidity. The risk factors associated with this pathology must be identified in order to schedule the appropriate delivery with the necessary resources. A case is presented of an iliac artery occlusion with intravascular balloons for suspected placenta accreta during cesarean section. The perioperative treatment, as well as an analysis of the treatment options is described, along with their advantages and disadvantages, from the use of postpartum hemorrhage protocols, blood transfusion and procoagulant factors, and other maneuvers to control bleeding, until the hysterectomy. PMID:23276376

  10. Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients

    PubMed Central

    Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

    2015-01-01

    Purpose The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. Methods We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Results Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01). Conclusion Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance. PMID:26263014

  11. New Views on Cesarean Section, its Possible Complications and Long-Term Consequences for Children's Health.

    PubMed

    Kulas, Tomislav; Bursac, Danijel; Zegarac, Zana; Planinic-Rados, Gordana; Hrgovic, Zlatko

    2013-12-01

    Historical developments and advancements in cesarean section techniques and logistics have reduced the maternal and neonatal risks associated with the procedure, while increasing the number of operatively completed pregnancies for medically unjustifiable reasons. The uncritical attitude towards cesarean section and the fast emergence of 'modern' diseases such as obesity at a young age, asthma, type 1 diabetes mellitus and various forms of dermatitis have stimulated researches associating cesarean section with these diseases. Intestinal flora of the children born by cesarean section contains less bifidobacteria, i.e. their intestinal flora is similar to the intestinal flora in diabetic individuals. In children born by cesarean section, the 'good' maternal bacterial that are normally found in the maternal birth canal and rectum are lacking, while the 'bad' bacteria that may endanger the child's immune system are frequently present. In children born by vaginal delivery, the 'good' maternal bacteria stimulate the newborn's white blood cells and other components of the immune system, which has been taken as a basis for the hypotheses explaining the evident association of the above morbidities and delivery by cesarean section. PMID:25568522

  12. Incidence of cesarean section and analysis of risk factors for failed conversion of labor epidural to surgical anesthesia: A prospective, observational study in a tertiary care center

    PubMed Central

    Ismail, Samina; Chugtai, Shakaib; Hussain, Alia

    2015-01-01

    Background and Aims: This study aimed to analyze the effect of labor epidural (LE) on the incidence of cesarean section (CS) and assess the risk factors involved in failed conversion of LE to surgical anesthesia for CS. Material and Methods: A prospective observational study of 18 months from January 2012 to June 2013 was conducted on all patients who had delivered in the labor room suit of our hospital. The data collected for all 4694 patients included their demographics, parity and mode of delivery. In addition a predesigned proforma, with additional information was used for 629 parturient with LE. Results: During the study period, total numbers of deliveries performed in our hospital were 4694, with an epidural rate of 13.4% (629/4694). No significant difference (P = 0.06) was observed in the rate of CS among women with or without LE (28 % [n = 176/629] vs. 31.7 % [n = 1289/4065]), however, a statistically significant difference (P < 0.01) was observed in the rate of assisted delivery in patients receiving LE as compared to those delivering without it (8.7% [n = 55/629] vs. n = 3.7% [154/4065]). For 176 patients requiring CS, LE utilization for surgical anesthesia was 52.8% (93/176) and factors identified for not utilizing LE in 47% (83/176) were; failure to achieve surgical anesthesia in 6.8% (12/176), emergency CS in 28.4% (50/176), patient preference in 6.8% (12/176) and inadequate labor pain relief with LE in 5.1% (9/176) patients. Non-obstetric anesthesiologists were involved in 59% (49/83) of cases where LE was not used for CS. Conclusion: LE had no effect on the rate of CS; however it significantly increased (P < 0.01) the rate of assisted delivery. Factors like inadequate LE, emergency situations and non-obstetric anesthesiologists can all be responsible for failed conversion of LE to surgical anesthesia for CS. PMID:26702215

  13. The Effect of the Gelatinous Lactulose for Postoperative Bowel Movement in the Patients Undergoing Cesarean Section

    PubMed Central

    Shigemi, Daisuke; Miyazaki, Miwa; Shibata, Yoshie; Suzuki, Shunji

    2014-01-01

    Lactulose is a non-digestible disaccharide formed from fructose and galactose. The objective of this study was to assess the effect of lactulose on gastrointestinal function after cesarean section. One hundred patients who underwent cesarean section at the Japanese Red Cross Katsushika Maternity Hospital were enrolled in this study. They were divided into 2 groups by randomization: (1) an L group that was treated with gelatinous lactulose (N = 48) and (2) a control group (C group) that did not receive gelatinous lactulose (N = 52). The interval between cesarean section and first postoperative flatus, defecation, and walking; appearance of symptoms of ileus; use of other medicines for stimulating bowel movement; properties and state of feces; and duration of postoperative hospital stay were compared between the two groups. The two groups did not show a significant difference in postoperative outcomes, except for the incidence of loose or watery stools (50% in the L group and 26.9% in the C group, P = 0.03). This study could not demonstrate the apparent effectiveness of lactulose in improving bowel function after cesarean section. Therefore, a routine use of gelatinous lactulose after surgery may negatively impact the patients undergoing cesarean section.

  14. Hematocrit changes in healthy periparturient bitches that underwent elective cesarean section.

    PubMed

    De Cramer, K G M; Joubert, K E; Nöthling, J O

    2016-09-15

    Hematocrits were measured before each of 406 cesarean sections performed on 324 bitches at term and again after crystalloid fluid therapy administered at 35 mL/kg over 1½-2 hours starting from induction. The mean hematocrit was 44.2% (95% confidence interval [CI] 43.8%-44.6%) before cesarean section and 37.8% (95% CI 37.3%-38.2%) after cesarean section and fluid therapy, with a mean decrease of 6.4% points (95% CI 6.1%-6.7%) over all 406 cesarean sections. These results provide the clinician with clear guidelines of the normal expected ranges of hematocrits in bitches before and after cesarean section. Results of this study show that bitches have hematocrits at term that are at the lower end of the normal reference ranges for nonpregnant dogs and that there is no true anemia of pregnancy. It is therefore suggested that if late term bitches present with anemia, other causes besides pregnancy should be considered. PMID:27242181

  15. Evaluation of immune system function in neonatal pigs born vaginally or by Cesarean section

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Eight full term crossbred sows were selected for study of the interaction of the immune system, hypothalamus-pituitary-adrenal axis, and growth in pigs born by Cesarean section (C-section) or vaginal-birth (n=4 each for vaginal-birth and C-section). Gestation length and birth weight did not differ b...

  16. Urinary catheterization as a successful treatment option for post-cesarean section vesicouterine fistula.

    PubMed

    Rouzi, A A; Sahly, N; Mansouri, N; Khashoggi, K; Ashkar, L

    2016-01-01

    Surgery, the usual treatment option for vesicouterine fistula (VUF), is often delayed to allow involution of the uterus. The authors report a case of successful treatment with urinary catheterization. A 39-year-old, gravida 7, para 6, woman presented at term with obstructed labor. She had one previous cesarean section followed by a vaginal birth before. She underwent emergency cesarean section. She was readmitted after one week because of pelvic collection. Aspiration revealed pus and urine. Retrograde cystogram and pelvic MRI confirmed the presence of VHF. Urinary bladder catheterization for six weeks resulted in the successful treatment of the fistula. Urinary catheterization in the early postpartum period can result in resolution of post-cesarean section VUF, without delaying surgical intervention if it becomes necessary. PMID:27048039

  17. Managing anesthesia for cesarean section in obese patients: current perspectives

    PubMed Central

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  18. Managing anesthesia for cesarean section in obese patients: current perspectives.

    PubMed

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  19. Delivery by cesarean section after embolization for vaginal arteriovenous malformation.

    PubMed

    Hasegawa, Toru; Yamakawa, Yoshihiro; Ota, Satoshi; Kamei, Tetsuya; Tateno, Masaya

    2008-01-01

    Vaginal arteriovenous malformation (AVM) can lead to life-threatening complications on delivery. No deliveries have been reported after selective embolization for a vaginal AVM. A 34-year-old nulliparous woman was found to have an arterial pulsatile mass on the left vaginal wall. The findings of magnetic resonance imaging and magnetic resonance angiography were consistent with an AVM. Selective transcatheter embolization for the AVM was done and, afterwards, the patient was found to be pregnant. The prenatal course was uneventful and the patient underwent elective cesarean delivery at term. Vaginal AVM can be successfully treated with selective embolization, with a good obstetric outcome. PMID:17671389

  20. Successful management of maternal factor VII deficiency in a cesarean section.

    PubMed

    Lee, Young-Jae; Ju, Da-Hye; Yi, Sang-Wook; Lee, Sang-Soo; Sohn, Woo-Seok

    2014-07-01

    Factor VII (FVII) deficiency is an infrequent hereditary bleeding disorder that can make excessive bleeding in surgical interventions, such as a postpartum hemorrhage in a cesarean section. Although a recombinant form of activated FVII has been applied for bleeding control in FVII-deficient patients, its applications in the field of obstetrics are still limited, especially in Korea. Replacement of blood products is still preferred as first-line therapy, with antifibrinolytic agents used as adjunctive therapy. We report herein the case of a successful cesarean section in an 18-year-old woman with FVII deficiency. PMID:25105106

  1. Mortality pattern in babies delivered by cesarean section and vaginal delivery.

    PubMed

    Chaudhuri, N; Pal, S; Roy, A

    1989-03-01

    A total of 7077 cases of delivery were studied in a rural based hospital where most of the mothers come without any antenatal care, from November, 1979 to December, 1980 to observe the mortality pattern in different types of delivery. Only live born babies were included in the study in which the mortality rate in elective cesarean section was found to be nearly equal to that in vaginal delivery. The percentage of mortality was higher (5.4%) in emergency cesarean section-the chief causes being asphyxia neonatorum, low gestational age and low birth weight. PMID:2753552

  2. [Anesthetic Management of a Patient with Langerhans Cell Histiocytosis during Cesarean section].

    PubMed

    Ishii, Erika; Takaenoki, Yumiko; Shizukuishi, Masaaki; Fukuda, Isao; Kazama, Tomiei

    2015-04-01

    Langerhans cell histiocytosis is a rare disease, associated with histiocyte increases, and granuloma, in various organs. About 160 patients are reported in Japan. A pregnant patient with a pulmonary Langerhans cell histiocytosis underwent cesarean section under spinal anesthesia. She had repeated pneumothorax with bilateral pulmonary cysts rapidly becoming worse during pregnancy. She was treated with continuous oxygen after 28 weeks of the pregnancy. On 34 weeks of the pregnancy, spinal anesthesia with 0.5% hyperbaric bupivacaine (2 ml) and fentanyl (25 μg) for cesarean section was performed, and provided excellent analgesia without any side-effects. PMID:26419115

  3. The Impact of Payment Source and Hospital Type on Rising Cesarean Section Rates in Brazil, 1998 to 2008

    PubMed Central

    Hopkins, Kristine; de Lima Amaral, Ernesto Friedrich; Mourão, Aline Nogueira Menezes

    2015-01-01

    Background High cesarean section rates in Brazilian public hospitals and higher rates in private hospitals are well established. Less is known about the relationship between payment source and cesarean section rates within public and private hospitals. Methods We analyzed the 1998, 2003, and 2008 rounds of a nationally representative household survey (PNAD), which includes type of delivery, where it took place, and who paid for it. We construct cesarean section rates for various categories, and perform logistic regression to determine the relative importance of independent variables on cesarean section rates for all births and first births only. Results Brazilian cesarean section rates were 42 percent in 1998 and 53 percent in 2008. Women who delivered publicly funded births in either public or private hospitals had lower cesarean section rates than those who delivered privately financed deliveries in public or private hospitals. Multivariate models suggest that older age, higher education, and living outside the Northeast region all positively affect the odds of delivering by cesarean section; effects are attenuated by the payment source–hospital type variable for all women and even more so among first births. Conclusions Cesarean section rates have risen substantially in Brazil. It is important to distinguish payment source for the delivery to have a better understanding of those rates. PMID:24684250

  4. Intervention for Postpartum Infections Following Caesarean Section

    ClinicalTrials.gov

    2015-04-20

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  5. Eisenmenger's syndrome in pregnancy: Use of epidural anesthesia and analgesia for elective cesarean section

    PubMed Central

    Mishra, Lipi; Pani, Nibedita; Samantaray, Ramesh; Nayak, Kalyani

    2014-01-01

    We describe a case of a pregnant patient with a large ventricular septal defect (VSD) and pulmonary artery hypertension, presented to the hospital and underwent elective cesarean section under epidural anesthesia and postoperative analgesia. The procedure was uneventful till the patient was discharged on 10th day. PMID:25190960

  6. Eisenmenger's syndrome in pregnancy: Use of epidural anesthesia and analgesia for elective cesarean section.

    PubMed

    Mishra, Lipi; Pani, Nibedita; Samantaray, Ramesh; Nayak, Kalyani

    2014-07-01

    We describe a case of a pregnant patient with a large ventricular septal defect (VSD) and pulmonary artery hypertension, presented to the hospital and underwent elective cesarean section under epidural anesthesia and postoperative analgesia. The procedure was uneventful till the patient was discharged on 10(th) day. PMID:25190960

  7. Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

    PubMed Central

    Ko, Jung Hwa; Bae, Jaeman; Lee, Won Moo; Koh, A Ra; Boo, Hyeyeon; Lee, Eunhyun; Hong, Jin Hwa

    2015-01-01

    Objective To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. Methods We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. Results The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. Conclusion LAVH is effective and safe for women with anterior wall adherence after cesarean section. PMID:26623415

  8. The Phantom Urine: An Unexpected Finding during a Routine Cesarean Section

    PubMed Central

    Achtari, Chahin; Meuwly, Jean-Yves

    2014-01-01

    We present here an atypical finding during an elective repeat cesarean section. Despite urine flow through an indwelling bladder catheter, bladder remains distended during the whole procedure. Unexpected anatomical variations and malformations can make routine surgery challenging. Urinary tract anomalies should be suspected in cases of unexpected difficult bladder catheterization. PMID:24707418

  9. Intrauterine contraception after cesarean section and during lactation: a systematic review

    PubMed Central

    Goldstuck, Norman D; Steyn, Petrus S

    2013-01-01

    Background All postpartum women, including those who are breastfeeding or have had a cesarean section, appear potentially suited to intrauterine contraception, a long acting reversible contraceptive (LARC). Like any other method used after delivery, it should not interfere with lactation or be affected by cesarean section. Study design We searched the MEDLINE, PubMed, Popline, Google Scholar, and Clinicaltrials.gov databases from January 1968 through to December 2012. Studies were included if they reported event rates in women who had a cesarean section and event rates and clinical outcomes in lactating women or their infants in the breastfeeding group. Summary odds ratios were not calculated because of the diverse methods of reporting event rates in the cesarean section group and the heterogeneity of the results in the breastfeeding group. Results We found 26 articles on event rates in interval and post-placental intrauterine device (IUD) use, and 18 on event rates and clinical outcomes in breastfeeding IUD users. Four prospective studies and one retrospective study showed an increased expulsion rate in interval insertion. There were 19 studies, of which five were controlled in post-placental IUD insertion after cesarean section. Four studies had expulsion rates of 10 or more per 100 woman-years of use and 15 expulsion rates below 10 per 100 woman-years of use. Three studies showed that event rates for lactating IUD users are the same as those for non-lactating users. Fifteen controlled studies showed that the IUD had no effect on milk production and seven of these showed no effect on infant growth. Pharmacovigilance databases report an increased rate of IUD perforations in lactating women, while the event rate studies report that insertion is generally easier and less painful than expected. These were uncontrolled reports. Conclusion The IUD is a long-acting reversible method of contraception with expulsion rates of 5–15 per 100 woman-years of use when used as

  10. Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section

    PubMed Central

    Kothari, Nikhil; Bogra, Jaishri; Chaudhary, Ajay K.

    2011-01-01

    Aims and Context: The objective of the present study was to evaluate the analgesic and adverse effects of intrathecal clonidine with hyperbaric bupivacaine in spinal anesthesia. Settings and Design: Randomized single blind trial. Methods: 210 ASA I-II pregnant females undergoing emergency cesarean section were randomized in a single-blind fashion to one of the three groups. In group I (n=70) patients received 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. In group II (n=70) patients received intrathecal mixture of 0.5% hyperbaric bupivacaine (8 mg) and clonidine 50 μg. In group III (n=70), patients received 0.5% hyperbaric bupivacaine (10 mg) intrathecally along with 50 μg of clonidine. Statistical Analysis Used: Groups were compared using one-way ANOVA with the Bonferroni multiple comparison post hoc test. The proportion of adverse events was compared using the chi-square test (χ2 =57.2410). Results: On adding 50 μg clonidine, we were able to reduce intrathecal dose of bupivacaine for cesarean section to 8 mg. Patients receiving intrathecal clonidine along with bupivacaine had significantly long lasting analgesia with lower bupivacaine dose [246.21±5.15 min. (group II) vs 146.0±4.55 min (group I), P=0.021; 95% confidence interval: 238.01-257.40, group II and 134.99-157.0 group I]. Conclusions: Addition of intrathecal clonidine causes some sedation in the postoperative period, but it provides adequate analgesia and motor paralysis at lower dose of bupivacaine. It also significantly prolongs postoperative pain relief. PMID:21655013

  11. Emergency cesarean section as a result of acute eosinophilic pneumonia during pregnancy.

    PubMed

    Kotani, Yasushi; Shiota, Mitsuru; Umemoto, Masahiko; Nakai, Hidekatsu; Tobiume, Takako; Tsuritani, Hiromitsu; Shimaoka, Masao; Doh, Kunihiko; Hoshiai, Hiroshi

    2009-11-01

    Acute eosinophilic pneumonia is a disease of unknown etiology characterized by peripheral blood eosinophilia and pulmonary infiltrative shadows on radiography. Acute eosinophilic pneumonia follows an acute course within 1 week and the symptoms include fever, dyspnea, and cough. Acute eosinophilic pneumonia has a good prognosis and responds promptly to steroid treatments. Here we present a critical case of acute eosinophilic pneumonia during pregnancy, which led to emergency cesarean section because of fetal distress. The patient was a 24-year-old gravida at 34 + 6 weeks gestation, with fever, and an elevated CRP; thus antibiotics were started. At 35 + 1 weeks gestation, cardiotocography (CTG) revealed late decelerations, fetal distress was diagnosed, and an emergency cesarean section was performed. The pre-operative maternal blood gas analysis showed a low PaO(2) of 55.7 mmHg and a chest X-ray revealed ground-glass opacities and pleural effusions in the middle lower lung fields bilaterally. A male of 2,336 g in weight was delivered with Apgar scores of 8 and 8 at 1 and 5 min, respectively. Due to the clinical progress and the elevated eosinophil count (532/microl) in the peripheral blood differential leukocyte count, the diagnosis of acute eosinophilic pneumonia was made. With the administration of oxygen and steroid treatment, the patient's general condition recovered. Both the mother and the baby were discharged on the 10(th) post-operative day and the patient has been leading a normal life with no recurrence for > 3 years since delivery. PMID:19851054

  12. Effect of Multiple Repeat Cesarean Sections on Maternal Morbidity: Data from Southeast Turkey

    PubMed Central

    Kaplanoglu, Mustafa; Bulbul, Mehmet; Kaplanoglu, Dilek; Bakacak, Suleyman Murat

    2015-01-01

    Background Cesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of cesarean section has been observed in recent studies. Maternal and fetal mortality and morbidity associated with cesarean section is an important health problem worldwide. This requires the evaluation of the effect of repeated cesarean delivery on maternal morbidity. Material/Methods A total of 2460 patients who underwent delivery by CS at a center in southeast Turkey between January 2012 and January 2014 (24 months) were included in the study. The patients were divided into 5 groups according to the number of CSs, and the maternal and neonatal outcomes of the groups were retrospectively evaluated. Results A statistically significant difference was found between the groups in terms of maternal age, education level, time of hospitalization, operating time, the presence of dense adhesions, bowel and bladder injury, the presence of placenta previa, hysterectomy, blood transfusion requirements, and need for intensive care (p<0.05). Placenta previa (OR, 11.7; 95% CI, 2.6–53.2) and placenta accreta (OR, 12.2; 95% CI, 3.9–37.8) were found to be important risk factors in terms of the need for hysterectomy. No statistically significant difference was found between the groups for gestational age at birth, birth weight, fifth-minute APGAR score, preoperative and postoperative hemoglobin levels, uterine rupture, wound infection, wound dehiscence, placenta accreta, maternal death, and endometritis (p>0.05). A total of 4 or more CSs was identified as the critical level for most of the major complications. Conclusions An increasing number of CSs is accompanied by serious maternal complications. Four or more CSs are of especially critical importance. Decreasing the number of cesarean sections is required to decrease relevant complications. Vaginal birth after CS is an option that should be recommended to the patient. PMID:25989945

  13. Intra-operative complications increase with successive number of cesarean sections: Myth or fact?

    PubMed Central

    Rafique, Muhammad

    2014-01-01

    Objective To determine whether complications related to surgery increase with increasing number of cesarean sections (CSs) in upper segment placenta. To compare the complications in urgent and elective high order (4-6) repeat CSs. Methods A retrospective analysis of 519 women who underwent repeat CS was performed from January to December 2012. Women were divided into 3 groups: group 1 with previous 3 CS (n=325), group 2 with previous 4 CS (n=139), and group 3 with previous ≥5 CS (n=55). Results Statistically significant differences (P < 0.001) were observed among 3 groups, regarding mean gravidity, type of CS, midline incision and bilateral tubal ligation performed. The risks of severe intra-peritoneal adhesions, thin out lower uterine segment and bladder injury were significantly increased (P < 0.001) with increasing number of CS deliveries. Only one cesarean hysterectomy was done in group 1 due to post partum hemorrhage. No significant differences were found in blood loss, duration of surgery, post operative hospital stay as well as birth weight and Apgar scores of newborns. The elective and emergency CS groups of high order repeat CS had no remarkable differences in operative, post operative complications and fetal outcome. Conclusion Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation. PMID:24883289

  14. Beyond the simple economics of cesarean section birthing: women's resistance to social inequality.

    PubMed

    Béhague, Dominique P

    2002-12-01

    This research explored the reasons for women's preferences for cesarean section births in Pelotas, Brazil. It is argued that women strategize and appropriate both medical knowledge and the technology of cesarean sections as a creative form of responding to larger public debates (and the practices that produced them) on the need for and causes of (de)medicalization. Questioning the reasons why some women engage more actively in this process than others elucidates the ways local forms of power engage gender, economic and medical ideologies. The current debate on why some women prefer c-section deliveries, or indeed if they really do at all, has diverted attention from the utility of the technology itself. This paper argues that for some women, the effort to medicalize the birth process represents a practical solution to problems found within the medical system itself. I end by exploring the socio-biological conditions that have produced a need for the technology. PMID:12572770

  15. Concomitant Vesicouterine Rupture with Avulsion of Ureter: A Rare Complication of Vaginal Birth after Cesarean Section

    PubMed Central

    Thiek, J Lalnunnem; Sialo, Stephen; Ahanthem, Santa Singh

    2016-01-01

    Uterine rupture is the most serious and life threatening complication and occurs in 0.7-0.9% of vaginal birth after lower segment caesarean section. Cases of bladder rupture along with uterine rupture have been rarely reported and avulsion of ureter, required ureteric implantation is even rarer. This case report describe a very rare case of vesicouterine rupture with avulsion of ureter following vacuum assisted delivery in a grandmulti with previous lower segment cesarean section (LSCS). Haematuria is the most common presentation of bladder rupture. Antenatal counseling regarding this entity is recommended if woman opted for vaginal birth after cesarean section. Intrapartum and postpartum high index of suspicion are important in clinching the diagnosis. PMID:27134952

  16. [Cesarean section and sismotherapy in a severe psychotic parturient: A case report].

    PubMed

    Vermersch, C; Smadja, S; Amselem, O; Gay, O; Marcellin, L; Gaillard, R; Mignon, A

    2013-10-01

    Psychiatric disorders may complicate the pregnancy and is one of the causes of maternal and fetal morbidity. We report the case of a patient with severe decompensated schizophrenia during her pregnancy that required prolonged hospitalization in psychiatric ward. The psychiatric status of the patient required the realization of a caesarean section at 36 weeks of amenorrhea. In our case, we decided to perform this cesarean section under general anaesthesia, since regional anaesthesia was not feasible in this patient in a state of uncontrolled agitation. Moreover, general anaesthesia permitted to combine cesarean section with a first session of electroconvulsive therapy, which had been declined during pregnancy. Given the huge amount of antipsychotic agents administered to the patient, we also studied their transplacental transfer and found a very high loxapine concentration in the fetus. Finally, this case raised several important ethical issues related to the management of the mother and her fetus in case of severe psychiatric disorders. PMID:24054003

  17. Post-mortem Cesarean section and embryotomy: myth, medicine, and gender in Greco-Roman culture.

    PubMed

    do Sameiro Barroso, Maria

    2013-01-01

    This article focuses on cesarean section carried out after the mother's death to rescue the living infant and on embryotomy, a medical procedure to save the mother described as early as the Hippocratic writings (5th to 4th century B.C.) and practiced until the times of Paul of Aegina (7th century A.D). The available sources do not mention cesarean section on a living mother to save the infant. On the other side, writings on embryotomy state clearly that Greek and Roman physicians strove hard to save women's lives. Written in ancient, male-centered societies, these texts convey an unequivocal positive attitude towards women, despite current misogynist assessments by philosophers and physicians who considered women inferior, based on their organic and biological features. PMID:23883085

  18. [Anesthetic Management of a Pregnant Woman Undergoing Cesarean Section and Intestinal Tract Perforation Restoration].

    PubMed

    Takahashi, Kei; Nozawa, Mai; Hashimoto, Yuichi; Arai, Takero; Okuda, Yasuhisa

    2016-04-01

    We describe anesthetic management of a pregnant woman (weight 42 kg, height 147 cm) with ileus, requiring emergency cesarean section and ileus operation. Cesarean section was performed under spinal anesthesia and epidural anesthesia, and ileus operation was performed under total intravenous general anesthesia. During ileus operation, the blood pressure decreased to 60/30 mmHg and the heart rate increased to 140 beats x min, indicating the intestinal traction syndrome. Repeated injections of phenylephrine 0.1 mg and albumin preparation 5% 1,500 ml were required to restore blood pressure. After the operation, the patient's trachea was extubated. The last level of the spinal anesthesia was T6. PMID:27188113

  19. [Anesthetic management of cesarean section in a patient with pulmonary embolism due to protein S deficiency].

    PubMed

    Etoh, Takashi

    2014-08-01

    A 37-year-old pregnant woman (23 weeks' gestation) was consulted to us because of the left leg pain. On examination, she was diagnosed as deep vein thrombosis (DVT) and pulmonary embolism due to protein S deficiency. She was admitted to our hospital and underwent anticoagulant therapy (heparin 10,000 units per day). At 38 weeks' gestation, she was scheduled for cesarean section. Before operation, she received anticoagulant therapy with continuous infusion of heparin (30,000 units per day) and prophylactic placement of an inferior vena cava (IVC) filter. Heparin was discontinued 6 hours before operation. Spinal anesthesia using hyperbaric bupivacaine 10 mg and fentanyl 25 microg was performed and the operation was completed uneventfully. Preoperative anticoagulant therapy and placement of an IVC filter may be effective in preventing new pulmonary embolism, and regional anesthesia may be safe for cesarean section. PMID:25199326

  20. Rare Cryptococus gattii infection in an immunocompetent dairy goat following a cesarean section

    PubMed Central

    Villarroel, Aurora; Maggiulli, Tessa R.

    2012-01-01

    A 5-year-old dairy goat was presented seven weeks post cesarean section for incomplete healing of the incision site. Cytology revealed cryptococcal organisms that were confirmed by the Centers for Disease Control as Cryptococcus gattii type VGIIa. Most cryptococcomas were surgically removed, but some penetrated deep in to the muscular layers and likely into peritoneum. The goat was treated daily with oral fluconazole for 6 months, and had a normal life for almost 2 years. PMID:24371749

  1. [Case report: 40-year-old patient with massive bleeding undergoing cesarean section].

    PubMed

    Thomas, Rainer; Thal, Serge

    2016-05-01

    We report a case of a 40-year-old patient suffering major bleeding when undergoing cesarean section for delivery with placenta previa. After surgery the patient suffered from severe bleeding several times and again underwent surgery with abdominal packing. After an abdominal compartment syndrome and an ARDS a post transfusion purpura was found to be the cause of the repeated bleeding and could successfully be treated with a cycle of plasmapheresis. PMID:27213602

  2. Effects of acupressure on progress of labor and cesarean section rate: randomized clinical trial

    PubMed Central

    Mafetoni, Reginaldo Roque; Shimo, Antonieta Keiko Kakuda

    2015-01-01

    OBJECTIVE To analyze the effects of acupressure at the SP6 point on labor duration and cesarean section rates in parturients served in a public maternity hospital. METHODS This controlled, randomized, double-blind, pragmatic clinical trial involved 156 participants with gestational age ≥ 37 weeks, cervical dilation ≥ 4 cm, and ≥ 2 contractions in 10 min. The women were randomly divided into an acupressure, placebo, or control group at a university hospital in an inland city in the state of Sao Paulo, Brazil, in 2013. Acupressure was applied to the SP6 point during contractions for 20 min. RESULTS The average labor duration was significantly different between the SP6 acupressure group [221.5 min (SD = 162.4)] versus placebo [397.9 min (SD = 265.6)] and versus control [381.9 min (SD = 358.3)] (p = 0.0047); however, the groups were similar regarding the cesarean section rates (p = 0.2526) and Apgar scores in the first minute (p = 0.9542) and the fifth minute (p = 0.7218) of life of the neonate. CONCLUSIONS The SP6 acupressure point proved to be a complementary measure to induce labor and may shorten the labor duration without causing adverse effects to the mother or the newborn. However, it did not affect the cesarean section rate. PMID:25741644

  3. Six percent hetastarch versus lactated Ringer's solution – for preloading before spinal anesthesia for cesarean section

    PubMed Central

    Upadya, Madhusudan; Bhat, Sonal; Paul, Seema

    2016-01-01

    Background: Regional anesthesia has been the choice of preference for elective cesarean sections. This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence of hypotension. Materials and Methods: This study was conducted on 50 nonlaboring American Society of Anesthesiologists class I and II women undergoing elective cesarean section. Patients were randomly divided into two groups and were preloaded either with 1000 ml Ringer's lactate (RL) or 500 ml of 6% hetastarch 30 min prior to the surgery. Spinal anesthesia was performed with patients in the left lateral position and 2 cc (10 mg) of 0.5% of bupivacaine injected into subarachnoid space. Hemodynamic variables (heart rate, noninvasive blood pressure, and SpO2) were recorded from prior to preloading until the recovery from the subarachnoid blockade. Results: Our study showed the incidence of hypotension to be 28% in the hetastarch group and 80% in the RL group. Rescue ephedrine requirements for the treatment of hypotension were significantly less in patients who were preloaded with 6% hetastarch prior to cesarean section. The neonatal outcome, as determined by Apgar scores was good and similar in both groups. Conclusion: Hence, we conclude that 6% hydroxyl ethyl starch is more effective than lactated Ringers solution and that its routine use for preloading prior to spinal anesthesia should be considered. PMID:26957687

  4. Patient-Controlled Epidural Levobupivacaine with or without Fentanyl for Post-Cesarean Section Pain Relief

    PubMed Central

    Chen, Shin-Yan; Liu, Feng-Lin; Cherng, Yih-Giun; Fan, Shou-Zen; Leighton, Barbara L.; Chang, Hung-Chi; Chen, Li-Kuei

    2014-01-01

    Purpose. The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study. Methods. We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion. Results. There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups. Conclusion. Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients. PMID:24982917

  5. Vasovagal cardiac arrest during spinal anesthesia for Cesarean section -A case report-.

    PubMed

    Jang, Young-Eun; Do, Sang-Hwan; Song, In-Ae

    2013-01-01

    The vasovagal response is characterized by an inappropriate combination of bradycardia and paradoxical vasodilation. During a general or neuraxial anesthesia-induced sympathectomy, a sudden vagal activation and/or an acute reduction in sympathetic tone can cause serious vasovagal responses. Neuraxial anesthesia for Cesarean section may trigger vasovagal response, due to multiple risk factors; high neuraxial block, sudden hemorrhage, aortocarval compression, peritoneal manipulation, and emotional stress. A 39-year-old pregnant woman, at 38 weeks of gestation with episodes of non-sustained ventricular arrhythmia and newly developed vasovagal syncope during pregnancy, was scheduled to undergo a spinal anesthesia for an elective Cesarean section. Immediately after the placental expulsion, a sudden severe bradycardia, followed by a cardiac arrest occurred. The patient fully recovered after prompt cardiopulmonary resuscitation with chest compression, manual ventilation with oxygen, rapid injection of epinephrine and hydration. This case illustrates a serious potential risk of vasovagal response superimposed on neuraxial anesthesia, during a Cesarean section, especially during placental expulsion. PMID:23372892

  6. Effects of acupressure on progress of labor and cesarean section rate: randomized clinical trial.

    PubMed

    Mafetoni, Reginaldo Roque; Shimo, Antonieta Keiko Kakuda

    2015-01-01

    OBJECTIVE To analyze the effects of acupressure at the SP6 point on labor duration and cesarean section rates in parturients served in a public maternity hospital. METHODS This controlled, randomized, double-blind, pragmatic clinical trial involved 156 participants with gestational age ≥ 37 weeks, cervical dilation ≥ 4 cm, and ≥ 2 contractions in 10 min. The women were randomly divided into an acupressure, placebo, or control group at a university hospital in an inland city in the state of Sao Paulo, Brazil, in 2013. Acupressure was applied to the SP6 point during contractions for 20 min. RESULTS The average labor duration was significantly different between the SP6 acupressure group [221.5 min (SD = 162.4)] versus placebo [397.9 min (SD = 265.6)] and versus control [381.9 min (SD = 358.3)] (p = 0.0047); however, the groups were similar regarding the cesarean section rates (p = 0.2526) and Apgar scores in the first minute (p = 0.9542) and the fifth minute (p = 0.7218) of life of the neonate. CONCLUSIONS The SP6 acupressure point proved to be a complementary measure to induce labor and may shorten the labor duration without causing adverse effects to the mother or the newborn. However, it did not affect the cesarean section rate. PMID:25741644

  7. Anesthetic management of parturient with thoracic kyphoscoliosis, malaria and acute respiratory distress syndrome for urgent cesarean section

    PubMed Central

    Pandey, Ravindra Kr; Batra, Meenu M; Darlong, Vanlal; Garg, Rakesh; Punj, Jyotsna; Kumar, Sri

    2015-01-01

    The management of cesarean section in kyphoscoliotic patient is challenging. The respiratory changes and increased metabolic demands due to pregnancy may compromise the limited respiratory reserves in such patients. Presence of other comorbidities like malaria and respiratory tract infection will further compromise the effective oxygenation. We report a case of kyphoscoliosis along with malaria and acute respiratory distress syndrome for urgent cesarean section. PMID:26702219

  8. Anesthetic experience using extracorporeal membrane oxygenation for cesarean section in the patient with peripartum cardiomyopathy: a case report

    PubMed Central

    Kim, Han-Young; Jeon, Hyung-Joon; Yun, Ji-Hyun; Lee, Jong-Hyuk; Lee, Gang-Geon

    2014-01-01

    Peripartum cardiomyopathy is a rare form of cardiomyopathy that is associated with significant mortality. It can cause a cardiac arrest during cesarean section even though the patient does not have any previous symptom and sign. The most important thing of anesthesia in this patient is an optimization of hemodynamic and respiratory status. We report the successful general anesthesia using of extracorporeal membrane oxygenation for cesarean section in a 34-year-old woman with fulminant peripartum cardiomyopathy. PMID:24910733

  9. Corrected Scoliosis, Cholinesterase Deficiency, and Cesarean Section: A Case Report

    PubMed Central

    Somers, Roy; Jacquemyn, Yves; Sermeus, Luc; Vercauteren, Marcel

    2009-01-01

    We describe a patient with severe scoliosis for which corrective surgery was performed at the age of 12. During a previous caesarean section under general anaesthesia pseudocholinesterase deficiency was discovered. Ultrasound guided spinal anaesthesia was performed enabling a second caesarean section under loco-regional anaesthesia. PMID:19718241

  10. Preventive effect of ilioinguinal nerve block on postoperative pain after cesarean section

    PubMed Central

    Naghshineh, Elham; Shiari, Samira; Jabalameli, Mitra

    2015-01-01

    Background: Cesarean section is a major operation that can be the predictor of postoperative pain and discomfort and, therefore, providing the effective postoperative analgesia is an important factor to facilitate sooner movement of the patient, better care of infants. The aim of this study was to determine the preventive effect of ilioinguinal nerve block on pain after cesarean section. Materials and Methods: In a randomized clinical trial study, 80 female candidates for cesarean section under general anesthesia were selected and divided into two groups. In the first group, ilioinguinal nerve was blocked and in the control group, ilioinguinal nerve block was not done. Finally, postoperative pain was compared between the two groups. Results: The mean pain intensity at 6 and 24 h after operation had no significant difference between two groups but in the rest of the times, it was different between two groups. Furthermore, in sitting position, except for 6 h, the pain intensity at the rest of the time had a significant difference between two groups. The pain intensity in 12 h after operation had a significant difference while in 24 h after operation; there was no difference between two groups. Doing repeated measures, ANOVA also indicated that the process of changes in the pain intensity in three positions of rest, sitting and walking had no significant difference up to 24 h after operation (P < 0.001). Conclusion: Control of pain after cesarean as one of the most common factors for abdominal surgery will lead to decrease the staying of the patient in hospital, reduce morbidity and lower use of narcotics and analgesics after surgery. PMID:26623404

  11. [Vesico-uterine fistula, a rare complication of cesarean section].

    PubMed

    Medina Ramos, N; Cerezuela Requena, J F; Martín Martínez, A; García Hernández, J A; Chesa Ponce, N

    2003-03-01

    We present the case of a vesicouterine fistula secondary to a caesarean section indicated due to the disproportion the pelvis and the head of the baby. This kind of fistula is due fundamentally to obstetric causes, especially to caesarean sections in developed countries and to prolonged labour in developing countries. The commonest clinical presentation is urinary incontinence in the form of continuous or intermittent urinary leaks. Surgical treatment is generally the therapy of choice, although, in the case of small fistulas, conservative treatment is feasible. The best form of prevention is correct indication of caesarean section and careful surgical technique. PMID:12812125

  12. New Views on Cesarean Section, its Possible Complications and Long-Term Consequences for Children’s Health

    PubMed Central

    Kulas, Tomislav; Bursac, Danijel; Zegarac, Zana; Planinic-Rados, Gordana; Hrgovic, Zlatko

    2013-01-01

    Historical developments and advancements in cesarean section techniques and logistics have reduced the maternal and neonatal risks associated with the procedure, while increasing the number of operatively completed pregnancies for medically unjustifiable reasons. The uncritical attitude towards cesarean section and the fast emergence of ‘modern’ diseases such as obesity at a young age, asthma, type 1 diabetes mellitus and various forms of dermatitis have stimulated researches associating cesarean section with these diseases. Intestinal flora of the children born by cesarean section contains less bifidobacteria, i.e. their intestinal flora is similar to the intestinal flora in diabetic individuals. In children born by cesarean section, the ‘good’ maternal bacterial that are normally found in the maternal birth canal and rectum are lacking, while the ‘bad’ bacteria that may endanger the child’s immune system are frequently present. In children born by vaginal delivery, the ‘good’ maternal bacteria stimulate the newborn’s white blood cells and other components of the immune system, which has been taken as a basis for the hypotheses explaining the evident association of the above morbidities and delivery by cesarean section. PMID:25568522

  13. Successful vaginal birth after prior cesarean section in a patient with pyoderma gangrenosum.

    PubMed

    Park, Jee Yoon; Lee, JoonHo; Park, Joong Shin; Jun, Jong Kwan

    2016-01-01

    Pyoderma gangrenosum is an extremely rare chronic cutaneous disease causing severe ulceration. It can be developed after minor trauma or surgical procedure. The typical features mimic acute infection site, however the treatment methods are opposing since pyoderma gangrenosum is improved with the use of corticosteroids, not antibiotic therapy. We here report a patient who had been diagnosed for acute infection after cesarean delivery in 2011 and treated with a number of antibiotics, but failed to recover. The patient had suffered from pain of the disease and also renal failure caused by antibiotics. Ultimately she had been diagnosed as pyoderma gangrenosum and managed successfully with steroids. For her next pregnancy in 2013, we tried vaginal delivery after prior cesarean section and it was uneventful during and after delivery. PMID:26866039

  14. Successful vaginal birth after prior cesarean section in a patient with pyoderma gangrenosum

    PubMed Central

    Park, Jee Yoon; Lee, JoonHo; Park, Joong Shin

    2016-01-01

    Pyoderma gangrenosum is an extremely rare chronic cutaneous disease causing severe ulceration. It can be developed after minor trauma or surgical procedure. The typical features mimic acute infection site, however the treatment methods are opposing since pyoderma gangrenosum is improved with the use of corticosteroids, not antibiotic therapy. We here report a patient who had been diagnosed for acute infection after cesarean delivery in 2011 and treated with a number of antibiotics, but failed to recover. The patient had suffered from pain of the disease and also renal failure caused by antibiotics. Ultimately she had been diagnosed as pyoderma gangrenosum and managed successfully with steroids. For her next pregnancy in 2013, we tried vaginal delivery after prior cesarean section and it was uneventful during and after delivery. PMID:26866039

  15. Benson Relaxation Technique in Reducing Pain Intensity in Women After Cesarean Section

    PubMed Central

    Solehati, Tetti; Rustina, Yeni

    2015-01-01

    Background: Post-cesarean section women experience pain due to operative trauma. Pain sensation can be reduced by pain management. Pharmacological and non-pharmacological treatments can be used. The Benson Relaxation Technique is a non-pharmacological way suitable to reduce pain, but there are limited studies on its post-cesarean section use. Objectives: This study aimed to determine the effect of Benson Relaxation Technique in reducing pain intensity in women after cesarean section. Patients and Methods: This was a quasi-experiment study with pre and post-test design. A prospective, not blind, randomized assign, two groups parallel study was conducted in Cibabat hospital Cimahi as intervention group (IG) and Sartika Asih hospital as control group (CG). Post cesarean section women with quota sampling who met the inclusion criteria were consecutively assigned to either experimental (n = 30) or control group (n = 30). Women in the experimental group received the Benson relaxation technique and those in the control group received regular care from the health workers. The outcome pain severity was measured by visual analogue scale. Those instruments were applied before and after intervention. Results: The mean of pain score before intervention at CG was 4.43 cm. It was decreased to 4.40 cm (1 min), 4.27 cm (12 h), 4.10 cm (24 h), 4.00 cm (36 h), 3.93 cm (48 h), 3.83 cm (60 h), 3.67 cm (72 h) and 3.51 cm (84 h). Meanwhile, the IG was 4.97 cm. It was decreased to 4.90 cm (1 min), 4.23 cm (12 h), 3.57 cm (24 h), 3.03 cm (36 h), 2.77 cm (48 h), 2.73 cm (60 h), 2.67 cm (72 h) and 2.63 cm (84 h). The study found a significant difference comparing pain intensity before and after the intervention in CG and IG (P = 0.001), but pain reduced in IG more than CG. Conclusions: The Benson relaxation could reduce pain intensity in women after cesarean section. PMID:26161315

  16. [Acute pancreas necrosis with biliary peritonitis in cesarean section].

    PubMed

    Zoldos, L; Hincová, M

    1986-01-01

    The authors describe the case of a hemorrhagic pancreatitis with non-perforating biliary peritonitis. The abdomen symptomatology was hidden by the beginning contractions and due to the dystocia the delivery was finished by caesarean section. The presence of choleperitoneum required a surgical revision of the abdominal cavity which enabled to make the right diagnosis. This thesis deals with aetiology and mechanism of choleperitoneum inception during hemorrhagic pancreatitis. PMID:3788337

  17. Evaluation of the analgesic effect of subcutaneous methadone after cesarean section

    PubMed Central

    Jabalameli, Mitra; Kalantari, Forough

    2014-01-01

    Background: Inadequate pain control has a significant role in maternal and neonatal health in early post-partum period which interferes with breastfeeding and has a negative influence on child normal growth. The aim of this study is evaluation of subcutaneous methadone effectiveness on post-operative pain control. Materials and Methods: Double blind randomized prospective clinical trial involving 60 term pregnancy patients through 2008 to 2009 Undergo cesarean. Inclusion criteria: Prime gravid candidate of elective cesarean and spinal anesthesia class 1 or 2. Known case of drug allergy and methadone interaction, addiction, uncontrolled medical disease excluded. Case group injected 10 mg of subcutaneous methadone in the site of incision before final suture. Morphine was a pain reliever in follow up examination. Data include mean of pain, nausea and vomiting, MAP, etc., collected and analyzed by independent-T test and Man Whitney test. Results: Although mean usage of morphine between groups was not significant statistically but the mean pain severity (P value < 0.05) and mean satisfactory (P value = 0.02) was statistically significant between groups. Other parameters were not statistically significant. Conclusion: We suggest subcutaneous methadone as a safe pain reliever in post cesarean section patients. PMID:25337527

  18. Alternative Strategy to Decrease Cesarean Section: Support by Doulas During Labor

    PubMed Central

    Trueba, Guadalupe; Contreras, Carlos; Velazco, Maria Teresa; Lara, Enrique García; Martínez, Hugo B.

    2000-01-01

    This research was conducted in a public general hospital in Mexico City, Mexico. The objective was to evaluate efficacy of the support given by a doula during labor to reduce cesarean rate. From March 1997 to February 1998, a group of 100 pregnant women were studied. These women were at term, engaged in an active phase of labor, exhibited 3 cm. or more cervical dilatation, were nuliparous, had no previous uterine incision, and possessed adequate pelvises. The group was randomly divided into two subgroups comprising 50 women, each: The first subgroup had the support of a childbirth educator trained as a doula, while the second subgroup did not have doula support. Measurements were recorded on the duration of labor, the use of pitocin, and whether or not the birth was a vaginal birth or cesarean section. Characteristics and gestational age were similar in both groups. Results confirmed that support by doulas during labor was associated with a significant reduction in cesarean birth and pitocin administration. There was a trend toward shorter labors and less use of epidurals. The results of this study showed, as in other trials measuring the impact of a doula's presence during labor and birth, that doula support during labor is associated with positive outcomes that have physical, emotional, and economic implications. PMID:17273201

  19. Impact of a diagnosis-related group payment system on cesarean section in Korea.

    PubMed

    Kim, Seung Ju; Han, Kyu-Tae; Kim, Sun Jung; Park, Eun-Cheol; Park, Hye Ki

    2016-06-01

    Cesarean sections (CSs) are the most expensive method of delivery, which may affect the physician's choice of treatment when providing health services to patients. We investigated the effects of the diagnosis-related group (DRG)-based payment system on CSs in Korea. We used National Health Insurance claim data from 2011 to 2014, which included 1,289,989 delivery cases at 674 hospitals. We used a generalized estimating equation model to evaluate the association between the likelihood of cesarean delivery and the length of the DRG adoption period. A total of 477,309 (37.0%) delivery cases were performed by CSs. We found that a longer DRG adoption period was associated with a lower odds ratio of CSs (odds ratio [OR]: 0.997, 95% CI: 0.996-0.998). In addition, a longer DRG adoption period was associated with a lower odds ratio for CSs in hospitals that had voluntarily adopted the DRG system. Similar results were also observed for urban hospitals, primiparas, and those under 28 years old and over 33 years old. Our results suggest that the change in the reimbursement system was associated with a low likelihood of CSs. The impact of DRG adoption on cesarean delivery can also be expected to increase with time, as our finding provides evidence that the reimbursement system is associated with the health provider's decision to provide health services for patients. PMID:27173768

  20. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section.

    PubMed

    DeMuro, Jp; Hanna, Af; Chalas, E; Cunha, Ba

    2012-01-01

    We report a case of a previously healthy woman after an uneventful caesarean section who developed polymicrobial necrotizing fasciitis. She was given a non-steroidal anti-inflamatory drug (NSAID) after her delivery. Her post-delivery course was complicated by septic shock, and required multiple debridements before abdominal reconstruction. This case describes the increased risk of necrotizing fasciitis with NSAID use. Unusual were the organisms causing the polymicrobial necrotizing fasciitis: Staphylococcus aureus, Enterobacter agglomerans, Acinetobacter baumannii, and two strains of Enterobacter cloacae. PMID:24960796

  1. [Wound healing and wound irrigation in cesarean section of cattle].

    PubMed

    de Kruif, A; van den Brand, L P; van Kuyk, M M; Raymakers, R J; Sietsma, C; Westerbeek, A J

    1987-09-01

    Calves were delivered by Caesarean section in 128 cases during the early months of 1984. All animals were allocated alternately to a trial group and a group of controls. When the peritoneum and transverse muscle had been sutured, the wounds of the animals in the trial group were irrigated and washed with 300 ml. of Betadine (10 per cent of PVP-iodine in water). This was followed by closure of the wound. The animals of the group of controls were not treated. The procedure was performed in ninety-four primiparae (73 per cent) and thirty-four multiparae (27 per cent). The indication for Caesarean section consisted in fetal oversize in 119 cases (93 per cent). Eight calves (6 per cent) were stillborn or died immediately post partum. The proportion of animals in which the placentae were retained, was 9 per cent. Two animals died from peritonitis and intra-abdominal haemorrhage respectively. Irrigation of the wound did not have any effect on the number of wound infections (Table 3). Wound infection occurred in nineteen animals (15 per cent). The operations were performed by six veterinary surgeons (Table 4). The trial group and group of controls treated by each veterinarian did not differ essentially as regards wound healing. PMID:3672464

  2. Incisional Negative Pressure Wound Therapy for Prevention of Postoperative Infections Following Caesarean Section

    ClinicalTrials.gov

    2015-04-20

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  3. Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

    PubMed Central

    O'Neill, Sinéad M.; Agerbo, Esben; Kenny, Louise C.; Henriksen, Tine B.; Kearney, Patricia M.; Greene, Richard A.; Mortensen, Preben Bo; Khashan, Ali S.

    2014-01-01

    Background With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. Methods and Findings We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of

  4. [The effect of cesarean section deliveries on female sterilization in Puerto Rico].

    PubMed

    Vázquez Calzada, J L

    1989-08-01

    For the last decades Puerto Rico has had the highest rate of female sterilization of the world. However, it was to be expected that the increasing trend will slow down with the appearance of new and effective birth control methods and the increasing educational level of the population. The data obtained from an island-wide sample survey undertaken in 1982 demonstrated that this was not the case and that the rate of female sterilization continued to increase. The authors hypothesis was that this unexpected situation was a result of the remarkable increase observed in cesarean childbirth in the Island. Thus, the main objective of this study was to examine the relationship between cesarean childbirth and female sterilization. Utilizing the 1982 sample survey data the authors demonstrated that surgical deliveries had increased so rapidly during the last decades that Puerto Rico seems to be the leading country of the world, confirming the findings of a 1980 study. These data also showed that there was a very strong association between cesarean childbirth and female sterilization. A partial correlation analysis tend to demonstrate that surgical delivery in Puerto Rico, is at present, a stronger determinant of female sterilization than fertility. PMID:2616718

  5. Additive Effect between IL-13 Polymorphism and Cesarean Section Delivery/Prenatal Antibiotics Use on Atopic Dermatitis: A Birth Cohort Study (COCOA)

    PubMed Central

    Lee, So-Yeon; Yu, Jinho; Ahn, Kang-Mo; Kim, Kyung Won; Shin, Youn Ho; Lee, Kyung-shin; Hong, Seo Ah; Jung, Young-ho; Lee, Eun; Yang, Song-I; Seo, Ju-hee; Kwon, Ji-Won; Kim, Byoung-Ju; Kim, Hyo-Bin; Kim, Woo-Kyung; Song, Dae Jin; Jang, Gwang Cheon; Shim, Jung Yeon; Lee, Soo-Young; Kwon, Ja-Young; Choi, Suk-Joo; Lee, Kyung-Ju; Park, Hee Jin; Won, Hye-Sung; Yoo, Ho-Sung; Kang, Mi-Jin; Kim, Hyung-Young; Hong, Soo-Jong

    2014-01-01

    Background Although cesarean delivery and prenatal exposure to antibiotics are likely to affect the gut microbiome in infancy, their effect on the development of atopic dermatitis (AD) in infancy is unclear. The influence of individual genotypes on these relationships is also unclear. To evaluate with a prospective birth cohort study whether cesarean section, prenatal exposure to antibiotics, and susceptible genotypes act additively to promote the development of AD in infancy. Methods The Cohort for Childhood of Asthma and Allergic Diseases (COCOA) was selected from the general Korean population. A pediatric allergist assessed 412 infants for the presence of AD at 1 year of age. Their cord blood DNA was subjected to interleukin (IL)-13 (rs20541) and cluster-of-differentiation (CD)14 (rs2569190) genotype analysis. Results The combination of cesarean delivery and prenatal exposure to antibiotics associated significantly and positively with AD (adjusted odds ratio, 5.70; 95% CI, 1.19–27.3). The association between cesarean delivery and AD was significantly modified by parental history of allergic diseases or risk-associated IL-13 (rs20541) and CD14 (rs2569190) genotypes. There was a trend of interaction between IL-13 (rs20541) and delivery mode with respect to the subsequent risk of AD. (P for interaction = 0.039) Infants who were exposed prenatally to antibiotics and were born by cesarean delivery had a lower total microbiota diversity in stool samples at 6 months of age than the control group. As the number of these risk factors increased, the AD risk rose (trend p<0.05). Conclusion Cesarean delivery and prenatal antibiotic exposure may affect the gut microbiota, which may in turn influence the risk of AD in infants. These relationships may be shaped by the genetic predisposition. PMID:24848505

  6. Comparison of Adnexal Mass in Women Undergoing Mass Excision During the Antepartum Period and Cesarean Section

    PubMed Central

    Saghafi, Nafiseh; Roodsary, Zohreh Yousefi; Kadkhodaeian, Sima; Mofrad, Maliheh Hasanzadeh; Farahabadi, Elham Hosseini; Hoseinyfarahabady, Mohammadreza

    2016-01-01

    Objectives The frequency of adnexal masses in pregnant women ranges from 0.1% to 4%. Selecting the right approach to manage the subsequent intervention remains one of the most controversial challenges among gynecologists. Our aim in this cross-sectional study was to clarify the clinical-pathological differences among the adnexal masses that are excised during either the antepartum period or cesarean section (CS). Methods In this study, we assessed 11,000 pregnancy cases referred to the Qaem Hospital in the Mashhad University of Medical Sciences, Iran, between 2010 and 2014. In total, 53 pregnant women with adnexal masses (other than non-gynecological mass and ectopic pregnancy) were selected for further investigation. We divided patients into two groups (group A and group B). Patients of group A had a diagnosed tumor that was excised antepartum while patients in group B had a mass taken out during CS. We then assembled data based on maternal age, parity, gestational age, surgery type, delivery mode, size and location of the tumor, complications, presentations, histopathological diagnosis, and ultrasonography findings for further analysis. Results The major proportion of masses (62.3%) were excised during CS whereas the remainder (37.7%) were removed antepartum. The mean size of the detected tumor for benign and malignant cases was 10.0 cm and 13.8 cm in group A, and 8.0 cm and 9.3 cm in group B, respectively. There was a statistically significant difference observed between patients in the two groups regarding the benign/malignant status of the mass (p = 0.008), its size (p = 0.019) and simplicity/complexity (p = 0.004). Conclusions The rate of malignant tumors was considerably higher in women who had antepartum mass excision compared to those with mass resection during CS. Also, tumors were larger (and more complex) in patients in group A compared to group B. PMID:27162593

  7. Comparison of Intrathecal Dexmedetomidine with Morphine as Adjuvants in Cesarean Sections.

    PubMed

    Qi, Xiaofei; Chen, Daili; Li, Gehui; Huang, Xiaolei; Li, Yuantao; Wang, Xiaoguang; Li, Yong

    2016-09-01

    To compare the effects of intrathecal dexmedetomidine and intrathecal morphine as supplements to bupivacaine in cesarean sections under spinal anesthesia. Full-term parturients (n=120) undergoing elective cesarean sections under spinal anesthesia were randomly allocated into three groups: Group B received 10 mg bupivacaine, Group BD received 10 mg bupivacaine plus 5 µg dexmedetomidine, and Group BM received 10 mg bupivacaine plus 100 µg morphine. The onset and regression time of sensory and motor blockade, postoperative analgesia, and side effects were recorded. Group BD showed quicker onset time and a longer sensory and motor blockade than other groups (BD vs. B and BD vs. BM, p<0.05). The mean time of sensory regression to the S1 segment was 253.21±42.79 min in group BD, 192.50±40.62 min in group BM and 188.33±37.62 min in group B (p<0.001). Group BD showed an analgesia duration (time to requirement of first rescue analgesic) (17.59±6.23 h) similar to that of group BM (16.78±5.90 h) but longer than that of group B (3.53±1.68 h) (p<0.001). The incidence of pruritus was significantly higher in group BM compared with groups BD and B (p<0.001). Less shivering was observed in group BD than in groups BM and B (p=0.009). So intrathecal dexmedetomidine (5 µg) prolonged the motor and sensory blockade, provided a similar analgesic effect and reduced pruritus and shivering compared with morphine (100 µg) in cesarean sections. PMID:27349272

  8. Cesarean Sections

    MedlinePlus

    ... severe hydrocephalus) the mother has problems with the placenta, such as placenta previa (when the placenta sits too low in the uterus and covers ... it should (and medications aren't helping) the placenta separates from the uterine wall too soon (called ...

  9. Cesarean section

    MedlinePlus Videos and Cool Tools

    ... a few days, barring complications like wound infections. One concern that many women have is whether they' ... first place. If it was because of a one-time problem, like umbilical cord compression or breech ...

  10. Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

    PubMed Central

    Gatti, Francesca; Zerbi, Simone Maria; Colombo, Dario; Landriscina, Mario; Kette, Fulvio

    2014-01-01

    The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother's traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus. PMID:25530891

  11. Emergency cesarean section in an epidemic of the middle east respiratory syndrome: a case report

    PubMed Central

    Kim, Hee Ryun; Sung, Ji Hee; Kim, Jong Hwa

    2016-01-01

    Only a few reports have been published on women with an infectious respiratory viral pathogen, such as Middle East Respiratory Syndrome (MERS) Coronavirus delivering a baby. A laboratory confirmed case of MERS was reported during a MERS outbreak in the Republic of Korea in a woman at gestational week 35 + 4. She recovered, and delivered a healthy baby by emergency cesarean section (C-sec). We present the clinical course and the emergency C-sec in a pregnant woman with MERS. PMID:27274377

  12. Cesarean section and osteosynthesis of lower limb fractures in the same surgical procedure☆

    PubMed Central

    Wajnsztejn, Andre; Ejnisman, Leandro; Zlotnik, Eduardo; Zitron, Luiz Roberto; Ejnisman, Benno; Cohen, Moises

    2013-01-01

    INTRODUCTION Orthopedic trauma during pregnancy can cause serious complications such as premature birth, stillbirth and maternal morbidities. PRESENTATION OF CASE We report the case of a patient at 38 weeks pregnancy who fractured the left ankle and the right fifth metatarsal after falling. Cesarean section and osteosynthesis were performed in the usual manner in the same surgical procedure. There were no postoperative complications. DISCUSSION Pregnancy and puerperium are associated with a hypercoagulable state. The early mobilization provided by surgical treatment of the fractures reduced the risks of thromboembolic events. CONCLUSION The approach adopted may be used as an example for future procedures done in similar situations. PMID:24469261

  13. Anesthetic management of patient with Sjogren's syndrome who underwent cesarean section: a case report

    PubMed Central

    Kim, Na Eun; Lee, Jae Hyuk; Lee, Jun Yong

    2016-01-01

    Sjogren's syndrome is one of the most common autoimmune disorders and has a female predominance. Maternal circulating autoantibodies such as anti-Ro/SSA and anti-La/SSB antibodies can cause congenital heart block of fetus, and in severe case, emergency pacemaker implantation may be needed for neonate. Therefore, it is very important to understand maternal and fetal condition and pay attention to the status of the neonate during delivery. In this paper, we present a case of patient with Sjogren's syndrome who underwent cesarean section under spinal anesthesia. PMID:27274376

  14. A suicidal pregnant patient's request for premature Cesarean section: Clinical and ethical challenges.

    PubMed

    Teng, Jia Ying; Yin Ing Chee, Cornelia; Chong, Yap-Seng; Lee, Le Ye; Yong, Eu Leong; Chi, Claudia; Broekman, Birit

    2016-04-01

    We present the case of a 36-year-old lady with severe borderline personality disorder and depression, who made repeated requests for an immediate Cesarean section at 31 weeks of gestation. Her mood was extremely depressed and she had intense suicidal thoughts. She was worried that she would kill herself and the baby, therefore believing that early delivery would save the baby's life. This was a challenging case that required multidisciplinary collaboration, suicide risk assessment and detailed evaluation of mental capacity. The clinical and ethical dilemmas of this case are discussed by a team of psychiatrists, obstetricians and neonatologists. PMID:26826866

  15. The Relationship between Rostral Retraction of the Pannus and Outcomes at Cesarean Section.

    PubMed

    Turan, Ozhan M; Rosenbloom, Joshua; Galey, Jessica L; Kahntroff, Stephanie L; Bharadwaj, Shobana; Turner, Shafonya M; Malinow, Andrew M

    2016-08-01

    Objective Maternal obesity presents several challenges at cesarean section. In an effort to routinely employ a transverse suprapubic skin incision, we often retract the pannus in a rostral direction using adhesive tape placed after induction of anesthesia and before surgical preparation of the skin. We sought to understand the association between taping and neonatal cord blood gases, Apgar scores, and time from skin incision to delivery of the neonate. Study Design This is a retrospective study, performed using prospectively collected anesthesiology records with data supplemented from the patients' medical records. Singleton pregnancies with morbid obesity (body mass index [BMI] > 40 kg/m(2)) between 37 and 42 weeks of gestation who delivered via nonurgent, scheduled cesarean delivery under regional (spinal, combined spinal-epidural, or epidural) anesthesia between March 2007 and March 2013 were identified. Maternal demographics including BMI, comorbidities, type of anesthesia, time intervals during the surgery, cord gas results, and Apgar scores were collected. The relationship between taping and blood acid-base status, Apgar scores, and interval from skin incision to delivery was investigated using appropriate statistical tests. Results There were 2,525 (27.5%) cesarean deliveries out of 9,189 total deliveries. Applying the described inclusion/exclusion criteria, 141 patients were identified (33 taped and 108 nontaped). There was no significant difference in BMI between the taped (51.9 kg/m(2)) and nontaped groups (47.4 kg/m(2)), p > 0.05. There was no difference in type of anesthesia (p > 0.05). The only significant difference between the taped and not-taped groups was the presence of chronic hypertension in the taped group (p = 0.03). There were no significant differences in cord blood gas values, Apgar scores, or skin incision to delivery interval (p > 0.05 for all outcomes). Conclusions Taping of the pannus at cesarean section is a

  16. Analgesic Efficacy of Diclofenac and Paracetamol vs. Meperidine in Cesarean Section

    PubMed Central

    Darvish, Heidar; Memar Ardestani, Behrouz; Mohammadkhani Shali, Sara; Tajik, Ali

    2013-01-01

    Background: One of the most important complications in cesarean surgery is postoperative pain, and different ways have been proposed to control it. Objectives: The purpose of this study was to determine the efficacy of Diclofenac and Paracetamol combination in comparison with Meperidine on postoperative pain after cesarean surgery. Patients and Methods: One hundred and twenty women candidates for elective cesarean section under spinal anesthesia categorized as ASA class I were selected and randomly assigned to receive either Diclofenac suppository at the end of the operation and thereafter 1 gram infused bolus of Paracetamol (group A), or 20 mg bolus of Meperidine after transition to recovery room (group B) to control postoperative pain. Results: Postoperative pain was present in recovery in 38.3% and 23.3% in groups B and A, respectively (P = 0.009). Postoperative pain was seen after six hours of operation in 38.7% and 16.7% in groups B and A, respectively (P = 0.010). Postoperative pain was present after 12 hours of operation in 38.3% and 15% in groups B and A, respectively (P = 0.002). The additive Meperidine use was the same between the two groups in recovery (P > 0.05). The additive Meperidine use was seen after six hours of operation in 26.7% and 6.7% in groups B and A, respectively (P = 0.013). The additive Meperidine use was seen after 12 hours of operation in 16.7% and none of the patients in groups B and A, respectively (P = 0.004). The frequency of drug adverse effects was the same between the two groups (P > 0.05). Conclusions: Totally, according to the obtained results it may be concluded that Paracetamol and Diclofenac combination would have a better efficacy in postoperative pain control and need reduction to additive analgesia compared to Meperidine. PMID:24660150

  17. Efficacy of intravenous paracetamol on pressor response in patients undergoing cesarean section under general anesthesia

    PubMed Central

    Kashif, Sanum; Hamid, Mohammad

    2016-01-01

    Background and Aims: Profound hemodynamic alterations due to stress and pain during endotracheal intubation may cause deleterious effects. The purpose of this study was to evaluate the effect of intravenous (IV) paracetamol on hemodynamic changes due to endotracheal intubation during cesarean section under general anesthesia. Material and Methods: Random allocation of one hundred and ten patients in two groups (Group A - placebo and Group B - paracetamol), was achieved as per computer generated table. The placebo (normal saline) and paracetamol solutions looked identical as both were available in 100 ml piggy bags and were labeled as study drug. Infusion of the drug was given 1 h before surgery. Two baseline readings of heart rate, systolic blood pressure (BP), diastolic BP and mean BP were recorded before induction, and these readings were repeated during intubation. Detrimental effect on neonate was evaluated by Apgar score measured at 1 and 5 min after birth. Results: There were no significant demographic differences found between the two groups. Hemodyamic changes during intubation also did not differ between the two groups. Conclusion: Administration of IV paracetamol 1 h before cesarean section has no significant effect in preventing hemodynamic changes at the time of endotracheal intubation. PMID:27275051

  18. [The incredible story about the cesarean section from ancient times till nowadays].

    PubMed

    Zilberlicht, Ariel; Kedar, Reuven; Riskin-Mashiah, Shlomit; Lavie, Ofer

    2014-08-01

    During its evolution the cesarean section has meant different things to different people. The indications for it have changed throughout the course of history. From the initial purpose to retrieve an infant from a dead or dying mother in order to bury the child separately from his mother, to contemporary indications. This article strives to follow the roots of this common procedure--starting from the descriptions in the ancient Greek mythology, through the imperial Roman law, aspects of Judaism and the evolution of the procedure throughout modern history. Major improvements in the surgical techniques, the introduction of anesthesia and aseptic procedures contributed to the decline in mortality and morbidity rates. We will attempt to find the etymology for the expression "cesarean section" which has commonly been accounted to Julius Caesar's name, although history denies it. This review takes us on a historical journey, from ancient times to nowadays, in which we follow the course and nature of a procedure being performed daily in thousands of hospitals. PMID:25286639

  19. Hematoma and abscess formation caused by Mycoplasma hominis following cesarean section.

    PubMed

    Koshiba, Hisato; Koshiba, Akemi; Daimon, Yasushi; Noguchi, Toshifumi; Iwasaku, Kazuhiro; Kitawaki, Jo

    2011-01-01

    Mycoplasma species cannot be identified by routine bacteriological culture methods and are resistant to common antimicrobial agents. Mycoplasma hominis usually colonizes the lower urogenital tract and causes pyelonephritis, pelvic inflammatory disease, chorioamnionitis, rupture of fetal membranes, preterm labor, postpartum fever, postabortal fever, and neonatal infection. This organism is highly prevalent in cervicovaginal cultures of sexually active women. M. hominis, M. genitalis, Ureaplasma urealyticum, and U. parvum may invade and infect placental and fetal tissues, leading to adverse pregnancy outcomes. M. hominis occasionally causes nongenitourinary infection of the blood, wounds, central nervous system, joints, or respiratory tract. We present a case of a 27-year-old woman who developed abdominal wound hematoma and abscess after cesarean section. The wound was drained, but her high fever persisted, in spite of antibiotic treatment using flomoxef sodium and imipenem·cilastatin sodium. Because the exudate exhibited M. hominis growth in an anaerobic environment, we administered the quinolone ciprofloxacin. This therapy resolved her fever, and her white blood cell count and C-reactive protein level diminished to the normal ranges. To our knowledge, there are four published articles regarding the isolation of M. hominis from postcesarean incisions. Based on the current study and the literature, infection by this pathogen may cause hematoma formation with or without abscess after cesarean section or in immunosuppressed postoperative patients. In such cases, physicians may need to suspect Mycoplasma infection and initiate appropriate antibacterial treatment as soon as possible in order to avoid persistent fever. PMID:21339933

  20. The Effect of Honey Gel on Abdominal Wound Healing in Cesarean Section: A Triple Blind Randomized Clinical Trial

    PubMed Central

    Nikpour, Maryam; Shirvani, Marjan Ahmad; Azadbakht, Mohammad; Zanjani, Roya; Mousavi, Ensieh

    2014-01-01

    Objective To assess whether honey can accelerate the wound healing in women undergoing cesarean section. Methods This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases) and placebo (38 cases) groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges) was used to assess wound healing. Results The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008) on the 7th day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002) on the 14th day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7th and 14th days. Conclusion Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds. PMID:25170405

  1. Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section

    PubMed Central

    Weigl, Wojciech; Bierylo, Andrzej; Wielgus, Monika; Krzemień-Wiczyńska, Swietlana; Szymusik, Iwona; Kolacz, Marcin; Dabrowski, Michal J.

    2016-01-01

    Abstract Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage. This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 μg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain. Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9–51.6). The requirement for postoperative analgesics is greatest during the first 12 hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for

  2. Initial non-opioid based anesthesia in a parturient having severe aortic stenosis undergoing cesarean section with aortic valve replacement

    PubMed Central

    Podder, Subrata; Kumar, Ajay; Mahajan, Sachin; Saha, Pradip Kumar

    2015-01-01

    Pregnancy in presence of severe aortic stenosis (AS) causes worsening of symptoms needing further intervention. In the advanced stages of pregnancy, some patients may even require aortic valve replacement (AVR) and cesarean delivery in the same sitting. Opioid based general anesthesia for combined lower segment cesarean section (LSCS) with AVR has been described. However, the use of opioid may lead to fetal morbidity and need of respiratory support for the baby. We describe successful anesthetic management for LSCS with AVR in a >33 week gravida with severe AS and congestive heart failure. We avoided opioids till delivery of the baby AVR; the delivered neonate showed a normal APGAR score. PMID:25566720

  3. [Anesthetic management for elective cesarean section for a woman with beriberi].

    PubMed

    Jamart, M V; Gil, S; Raynard, M; Gascón, G; Borràs, R; Miranda, A

    2007-02-01

    Beriberi is a disease caused by thiamine (vitamin B1) deficiency. Peripheral and central nerve involvement causes psychosis and memory loss as well as cardiocirculatory effects. We report the case of a 35-year-old woman 8 weeks pregnant who came to the emergency department after bouts of nausea and vomiting over a period of 6 days, with intolerance of both solids and liquids. The initial diagnosis of gastroenteritis was later changed to hyperemesis gravidarum. Episodes of vomiting and nausea continued 48 hours after admission, accompanied by vertical nystagmus, ataxia, and diminished osteotendinous reflexes. Evaluation of the clinical picture confirmed vitamin B1 deficiency, leading to a diagnosis of Wernicke-Korsakoff syndrome. Symptoms improved with thiamine therapy but did not entirely disappear. The patient was admitted for elective cesarean section at 37 weeks' gestation. Examination revealed neurological involvement (horizontal and vertical nystagmus) and general anesthesia was therefore chosen to assure adequate hemodynamic control given the possibility of cardiocirculatory alteration. PMID:17390694

  4. [Urgent cesarean section in a pregnant woman with carbon monoxide poisoning].

    PubMed

    Gara, Edit; Gesztes, Éva; Doroszlai, Richárd; Zacher, Gábor

    2014-06-01

    Recognition of carbon monoxide is difficult due to its plain physical-chemical properties. Carbon and gas operating heating systems may cause severe poisoning. Carbon-monoxide intoxication may generate severe hypoxic damage and it may cause death. The authors present the case of severe carbon monoxide poisoning affecting one young child and five adults, including a pregnant woman. Because the availability of hyperbaric oxygen therapy is limited in Hungary, urgent cesarean section was performed to avoid intrauterine hypoxic damage. The authors note that there are no standardized non-invasive methods for measuring fetal carbon-monoxide level and that the level of carbon monoxide accumulation is higher and the clearance is longer in the fetus than in the mother. The pathophysiology of carbon monoxide intoxication and therapeutic options in pregnancy are discussed. PMID:24860052

  5. Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-

    PubMed Central

    Chung, Kum Hee; Ko, Tong Kyun; Park, Chung Hyun; Chun, Duk Hee; Yang, Hyeon Jeong; Gill, Hyun Jue; Kim, Min Ku

    2010-01-01

    Meralgia paresthetica is commonly caused by a focal entrapment of lateral femoral cuteneous nerve while it passes the inguinal ligament. Common symptoms are paresthesias and numbness of the upper lateral thigh area. Pregnancy, tight cloths, obesity, position of surgery and the tumor in the retroperitoneal space could be causes of meralgia paresthetica. A 29-year-old female patient underwent an emergency cesarean section under spinal anesthesia without any problems. But two days after surgery, the patient complained numbness and paresthesia in anterolateral thigh area. Various neurological examinations and L-spine MRI images were all normal, but the symptoms persisted for a few days. Then, electromyogram and nerve conduction velocity test of the trunk and both legs were performed. Test results showed left lateral cutaneous nerve injury and meralgia paresthetica was diagnosed. Conservative treatment was implemented and the patient was free of symptoms after 1 month follow-up. PMID:21286469

  6. Transfusion Related Acute Lung Injury after Cesarean Section in a Patient with HELLP Syndrome

    PubMed Central

    Moon, Kyoung Min; Rim, Ch'ang Bum; Kim, So Ri; Shin, Sang Ho; Kang, Min Seok; Lee, Jun Ho; Kim, Jihye; Kim, Sang Il

    2016-01-01

    Transfusion-related acute lung injury (TRALI) is a serious adverse reaction of transfusion, and presents as hypoxemia and non-cardiogenic pulmonary edema within 6 hours of transfusion. A 14-year-old primigravida woman at 34 weeks of gestation presented with upper abdominal pain without dyspnea. Because she showed the syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelet count), an emergency cesarean section delivery was performed, and blood was transfused. In the case of such patients, clinicians should closely observe the patient's condition at least during the 6 hours while the patient receives blood transfusion, and should suspect TRALI if the patient complains of respiratory symptoms such as dyspnea. Furthermore, echocardiography should be performed to distinguish between the different types of transfusion-related adverse reactions. PMID:26885326

  7. Effect of foot and hand massage in post-cesarean section pain control: a randomized control trial.

    PubMed

    Abbaspoor, Zahra; Akbari, Malihe; Najar, Shanaz

    2014-03-01

    One of the problems for mothers in the post-cesarean section period is pain, which disturbs the early relationship between mothers and newborns; timely pain management prevents the side effects of pain, facilitates the recovery of patient, reduces the costs of treatment by minimizing or eliminating the mother's distress, and increases mother-infant interactions. The aim of this study was to determine the effect of hand and foot massage on post-cesarean section pain. This study is a randomized and controlled trial which was performed in Mustafa Khomeini Hospital, Elam, Iran, April 1 to July 30, 2011; it was carried out on 80 pregnant women who had an elective cesarean section and met inclusion criteria for study. The visual analog scale was used to determine the pain intensity before, immediately, and 90 minutes after conducting 5 minutes of foot and hand massage. Vital signs were measured and recorded. The pain intensity was found to be reduced after intervention compared with the intensity before the intervention (p < .001). Also, there was a significant difference between groups in terms of the pain intensity and requests for analgesic (p < .001). According to these findings, the foot and hand massage can be considered as a complementary method to reduce the pain of cesarean section effectively and to decrease the amount of medications and their side effects. PMID:23352729

  8. Cesarean section and increased body mass index in school children: two cohort studies from distinct socioeconomic background areas in Brazil

    PubMed Central

    2013-01-01

    Background Recent studies have raised controversy regarding the association between cesarean section and later obesity in the offspring. The purpose of this study was to assess the association of cesarean section with increased body mass index (BMI) and obesity in school children from two Brazilian cities with distinct socioeconomic backgrounds. Methods Two birth cohorts respectively born in 1994 in Ribeirao Preto, a wealthy city in Southeast, and in 1997/98 in Sao Luis, a less wealthy city in Northeast of Brasil, were evaluated. After birth, 2,846 pairs of mothers-newborns were evaluated in Ribeirao Preto and 2,542 in Sao Luis. In 2004/05, 790 children aged 10/11 years were randomly reassessed in Ribeirao Preto and 673 at 7/9 years in Sao Luis. Information on type of delivery, maternal and child characteristics, socioeconomic position and anthropometric measurements were collected after birth and at school age. Obesity was defined as BMI ≥ 95th percentile at school age. Results Obesity rate was 13.0% in Ribeirao Preto and 2.1% in Sao Luis. Cesarean section was associated with obesity and remained significant after adjustment only in Ribeirao Preto [OR = 1.74 (95% CI: 1.04; 2.92)]. The association between cesarean section and BMI remained significant after adjustment for maternal schooling, maternal smoking during pregnancy, duration of breastfeeding, gender, birth weight and gestational age, type of school and, only in Sao Luis, pre-pregnancy maternal weight. In Ribeirao Preto children born by cesarean section had BMI 0.31 kg/m2 (95%CI: 0.11; 0.51) higher than those born by vaginal delivery. In Sao Luis BMI of children born by cesarean section was 0.28 kg/m2 higher (95%CI: 0.08; 0.49) than those born by vaginal delivery. Conclusion A positive association between cesarean section and increased BMI z-score was demonstrated in areas with different socioeconomic status in a middle-income country. PMID:23886115

  9. Cesarean section on maternal request: a societal and professional failure and symptom of a much larger problem.

    PubMed

    Klein, Michael C

    2012-12-01

    The scientific literature was silent about a relationship of pelvic floor, urinary, and fecal incontinence and sexual issues with mode of birth until 1993, when Sultan et al's impressive rectal ultrasound studies were published. They showed that perirectal fibers were damaged in many vaginal births, but not as a result of a cesarean section. These findings helped to pioneer a new area of research, ultimately leading to increasing support among health professionals and the public that maternal choice of cesarean delivery could be justified-even that maternal choice and autonomous decision-making trump other considerations, including evidence. A growing number of birth practitioners are choosing cesarean section for themselves-usually on the basis of concerns over pelvic floor, urinary incontinence, and sexual issues. Behind this choice is a training experience that focuses on the abnormal, interprets the literature through a pathological lens, and lacks sufficient opportunity to see normal childbirth. Cesarean section on maternal request is a complex issue based on fear and misinformation that is a symptom of a system needing reform, that is, a major change in community and professional education, governmental policy making, and creation of environments emphasizing the normal. Systemic change will require the training of obstetricians mainly as consultants and the education of a much larger cadre of midwives and family physicians who will provide care for most pregnant women in settings designed to facilitate the normal. Tinkering with the system will not work-it requires a complete refit. PMID:23281950

  10. Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus : A Case Report and Literature Review

    PubMed Central

    Farikou, Ibrahima; Bernadette, Ngo Nonga; Daniel, Handy Eone; Aurélien, Sosso Maurice

    2014-01-01

    Introduction: The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice. Case Report: The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa. Conclusion: Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures.

  11. An Analysis of Cesarean Section and Emergency Hernia Ratios as Markers of Surgical Capacity in Low-Income Countries Affected by Humanitarian Emergencies from 2008 – 2014 at Médecins sans Frontières Operations Centre Brussels Projects

    PubMed Central

    Stewart, Barclay; Wong, Evan; Papillon-Smith, Jessica; Trelles Centurion, Miguel Antonio; Dominguez, Lynette; Ao, Supongmeren; Jean-Paul, Basimuoneye Kahutsi; Kamal, Mustafa; Helmand, Rahmatullah; Naseer, Aamer; Kushner, Adam L.

    2015-01-01

    Background: Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis. Methods: All procedures performed in MSF-OCB operating theatres from July 2008 through June 2014 were reviewed. Projects providing only specialty care, not fully operational or not offering elective surgeries were excluded. Annual CSRs and EHRs were calculated for each project. Their relationship was assessed with linear regression. Results: After applying the exclusion criteria, there were 47,472 cases performed at 13 sites in 8 countries. There were 13,939 CS performed (29% of total cases). Of the 4,632 herniorrhaphies performed (10% of total cases), 30% were emergency procedures. CSRs ranged from 0.06 to 0.65 and EHRs ranged from 0.03 to 1.0. Linear regression of annual ratios at each project did not demonstrate statistical evidence for the CSR to predict EHR [F(2,30)=2.34, p=0.11, R2=0.11]. The regression equation was: EHR = 0.25 + 0.52(CSR) + 0.10(reason for MSF-OCB assistance). Conclusion: Surgical humanitarian assistance projects operate in areas with critical surgical capacity deficiencies that are further disrupted by crisis. Rapid, accurate assessments of surgical capacity are necessary to plan cost- and clinically-effective humanitarian responses to baseline and acute unmet surgical needs in LICs affected by crisis. Though CSR and EHR may meet these criteria in ‘steady-state’ healthcare systems, they may not be useful during

  12. Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

    PubMed Central

    Ayala-Yáñez, Rodrigo; Bayona-Soriano, Paulette; Hernández-Jimenez, Arturo; Contreras-Rendón, Alejandra; Chabat-Manzanera, Paulina; Nevarez-Bernal, Roberto

    2015-01-01

    Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country's high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p = 0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (p = 0.016), RR of 3.4 (95% CI: 1.15–10.04). Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications. PMID:26380111

  13. Spinal anesthesia for cesarean section in a patient with systemic sclerosis associated interstitial lung disease: a case report.

    PubMed

    Lee, Guie Yong; Cho, Sooyoung

    2016-08-01

    Systemic sclerosis or scleroderma is a rare autoimmune disorder characterized by excessive fibrosis and, vasculopathy, with multiorgan involvement. Anesthetic considerations in patients with systemic sclerosis must take into account the degree of organ dysfunction as well as airway management. Regional anesthesia is a preferable alternative to general anesthesia despite the reports of prolonged sensory block. Spinal anesthesia in patients with systemic sclerosis has been reported for only one patients undergoing cesarean section. Concurrent systemic sclerosis and pregnancy raise many obstetric and anesthetic considerations. We describe the case of a pregnant patient with systemic sclerosis who had a history of dyspnea and interstitial lung disease. The cesarean section was performed uneventfully under spinal anesthesia. PMID:27482321

  14. Spinal anesthesia for cesarean section in a patient with systemic sclerosis associated interstitial lung disease: a case report

    PubMed Central

    Cho, Sooyoung

    2016-01-01

    Systemic sclerosis or scleroderma is a rare autoimmune disorder characterized by excessive fibrosis and, vasculopathy, with multiorgan involvement. Anesthetic considerations in patients with systemic sclerosis must take into account the degree of organ dysfunction as well as airway management. Regional anesthesia is a preferable alternative to general anesthesia despite the reports of prolonged sensory block. Spinal anesthesia in patients with systemic sclerosis has been reported for only one patients undergoing cesarean section. Concurrent systemic sclerosis and pregnancy raise many obstetric and anesthetic considerations. We describe the case of a pregnant patient with systemic sclerosis who had a history of dyspnea and interstitial lung disease. The cesarean section was performed uneventfully under spinal anesthesia. PMID:27482321

  15. [Care plan for women with cesarean section and pre-eclampsia].

    PubMed

    Sabbagh-Sequera, Miriam; Loidi-García, Jose María; Romero-Vázquez, Gloria Maria

    2015-01-01

    Pregnancy pathologies in general, and pre-eclampsia in particular, are problems usually treated in post-anesthesia recovery and hospitalization units. Pre-eclampsia is the most frequent form of hypertension associated with pregnancy (50%). It affects from 7% to 10% of pregnant women. It is known as pregnancy and puerperium multisystem syndrome. It is due to a reduction of the systemic perfusion generated by the vasospasms and the activation of the coagulation systems. A clinical case is presented of the immediate post-surgery period of a patient, who has been operated on cesarean section after having been diagnosed with pre-eclampsia. A nursing care plan was prepared, based on Marjory Gordon functional patterns and guided by NANDA-NOC-NIC taxonomy, where 6 nursing diagnoses, which are the basis for the fulfillment of this nursing process, are identified: Risk of infection, excess fluid volume, risk of bleeding, insufficient knowledge about its pathological process, severe pain, and anxiety. The application of this care plan leads to an improvement in the patient care and in the work organization. PMID:25482826

  16. [Insufficient sugammadex effect in an obese pregnant woman undergoing cesarean section under general anesthesia].

    PubMed

    Kayashima, Kenji; Sozen, Reiko; Okura, Dan

    2014-02-01

    A 32-year-old pregnant woman (height 162 cm, weight 86 kg, age of fetus 25 weeks) without preoperative complications underwent an emergent cesarean section under general anesthesia. She was intubated with a 7.0-mm tracheal tube 40 s after receiving rocuronium 0.93 mg x kg(-1) and thiamilal 375 mg. Anesthesia was maintained with oxygen, air, sevoflurane 1.0-2.5%, and fentanyl 425 microg. Nine minutes after the end of surgery (operation time 71 minutes), a train-of-four count of 2 with 20 spontaneous breaths was noted, and sugammadex 2.3 mg x kg(-1) was administered. However, the train-of-four count was 3 even five minutes after sugammadex administration. Fifteen minutes after sugammadex administration (train-of-four ratio 14%), she received atropine 0.5 mg and neostigmine 1.0 mg. Ten minutes later, the train-of-four ratio increased to 89%, and the patient was successfully extubated with no respiratory suppression. We speculate that the rocuronium dose (0.93 mg x kg(-1)) was too high in this obese patient, and sugammadex dose at the end of the surgery was not enough for reversal of rocuronium-induced neuromuscular blockade. PMID:24601116

  17. [Anesthetic Management of Cesarean Section in a Pregnant Woman with Advanced Tongue Cancer].

    PubMed

    Kojima, Mikiko; Yoshie, Kazuka; Shimazaki, Azusa; Ohtsuka, Naoki; Otake, Hiroshi; Koide, Keiko; Sato, Youko

    2016-06-01

    It is very difficult to decide the best time to deliver the baby for a pregnant woman with advanced cancer. We experienced the perioperative and perinatal management of a 39-year-old pregnant woman with advanced tongue cancer. The cancer had already metastasized to the lung and lymph nodes. Furthermore a recurrent thumb-sized tumor was found in her mouth. She had firmly desired to discontinue all anticancer treatment for protecting the fetus. On the other hand, her family could not accept her determination yet. Therefore the medical team was organized with doctors and co-medicals from multiple departments such as gynecology, pediatrics, radiology, oncology, midwife, psychotherapy and anesthesiology. After several conferences including herself and family, finally cesarean section was scheduled for the 30th gestational week. Prepared for unexpected emergency delivery, airway stenosis was ruled out by fiberoptic laryngoscopy and the consent for emergency tracheostomy was obtained. The operation was performed successfully under spinal anesthesia without any severe troubles. Medical care as a team from early phase enabled elaborate observation and preparation through the perioperative and perinatal period. Furthermore, it was efficient to provide satisfaction to the patient and her family as well. PMID:27483663

  18. Epidural anesthesia: A safe option for cesarean section in parturient with severe pulmonary hypertension

    PubMed Central

    Sen, Sreyashi; Chatterjee, Sourav; Mazumder, Pinaki; Mukherji, Sudakshina

    2016-01-01

    Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease. PMID:27433072

  19. Cesarean section, gestational age, and transient tachypnea of the newborn: timing is the key.

    PubMed

    Riskin, Arieh; Abend-Weinger, Marta; Riskin-Mashiah, Shlomit; Kugelman, Amir; Bader, David

    2005-10-01

    The purpose of this study was to identify risk factors and to characterize infants with transient tachypnea of the newborn (TTN). A total of 67 newborns with TTN, born at gestational age (GA)>or=35 weeks, were studied. Newborns delivered before and after each study case served as controls. Mean GA was lower and cesarean section (CS) rate was higher in the TTN group (38.2+/-2.3 versus 39.5+/-1.4 weeks, p<0.001; 50.7% versus 22.4%, p<0.001). GA<38 weeks was found to be associated with increased risk for TTN in infants delivered by elective CS. TTN was associated with significant morbidities and longer hospital stay (7.2+/-5.6 versus 2.9+/-1.4 days; p<0.001). Delivery by CS and younger GA are risk factors for TTN. Although TTN is a self-limited disease, it is associated with significant morbidities. Scheduling elective CS at GA of not less than 38 weeks may decrease the frequency of TTN. PMID:16215925

  20. Epidural anesthesia: A safe option for cesarean section in parturient with severe pulmonary hypertension.

    PubMed

    Sen, Sreyashi; Chatterjee, Sourav; Mazumder, Pinaki; Mukherji, Sudakshina

    2016-01-01

    Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease. PMID:27433072

  1. Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature.

    PubMed

    Ranjan, R V; Ramachandran, T R; Manikandan, S; John, Roshan

    2015-01-01

    Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course. PMID:25886439

  2. Hemorrhagic Renal Angiomyolipoma in Pregnancy Effectively Managed by Immediate Cesarean Section and Elective Transcatheter Arterial Embolization: A Case Report

    PubMed Central

    Sawada, Norifumi; Miyamoto, Tatsuya; Mitsui, Takahiko; Zakoji, Hidenori; Takeda, Masayuki

    2016-01-01

    Abstract Renal angiomyolipoma (AML) is a benign renal tumor with a risk of rupture in intratumoral aneurysms. Although renal AML in pregnancy is rare, risk of rupture is greater. Management for AML and childbirth is important during pregnancy; however, it is undefined yet. We present a case of hemorrhagic angiomyolipoma in pregnancy that is effectively managed by immediate cesarean section and elective transcatheter arterial embolization.

  3. Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature

    PubMed Central

    Ranjan, R. V.; Ramachandran, T. R.; Manikandan, S.; John, Roshan

    2015-01-01

    Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course. PMID:25886439

  4. Hemorrhagic Renal Angiomyolipoma in Pregnancy Effectively Managed by Immediate Cesarean Section and Elective Transcatheter Arterial Embolization: A Case Report.

    PubMed

    Kira, Satoru; Sawada, Norifumi; Miyamoto, Tatsuya; Mitsui, Takahiko; Zakoji, Hidenori; Takeda, Masayuki

    2016-01-01

    Renal angiomyolipoma (AML) is a benign renal tumor with a risk of rupture in intratumoral aneurysms. Although renal AML in pregnancy is rare, risk of rupture is greater. Management for AML and childbirth is important during pregnancy; however, it is undefined yet. We present a case of hemorrhagic angiomyolipoma in pregnancy that is effectively managed by immediate cesarean section and elective transcatheter arterial embolization. PMID:27579420

  5. Effect of Sub hypnotic Doses of Propofol and Midazolam for Nausea and Vomiting During Spinal Anesthesia for Cesarean Section

    PubMed Central

    Rasooli, Sousan; Moslemi, Farnaz; Khaki, Arash

    2014-01-01

    Background: Spinal anesthesia has been associated with intraoperative nausea and vomiting (IONV), especially during cesarean section, which is attributed to several mechanisms. Objectives: In the present study, therapeutic and preventive properties of sub hypnotic dose midazolam and propofol and their effects on the occurrence and severity of intraoperative nausea and vomiting during elective cesarean section under spinal anesthesia were evaluated. Patients and Methods: In a randomized, double-blind, and placebo-controlled clinical trial, 90 parturients, ASA class I and II, aged 20-30 years, who undergone spinal anesthesia for cesarean section were randomly allocated to one of three groups receiving midazolam (1 mg bolus and 0.1 mg/kg/hr, n=30), propofol (20 mg bolus and 0.1 mg/kg/hr, n = 30), and placebo (saline, n=30) intravenously (IV) immediately after umbilical cord clamping. Bupivacaine hydrochloride (10 mg) was used for induction of the anesthesia. Patients’ hemodynamics was monitored at 3-minute intervals. Furthermore, intraoperative and post-delivery emetic episodes, severity of emesis, scores of sedation and ephedrine consumption were recorded. Results: The incidence of nausea, retching, and vomiting was significantly higher in the control group compared to propofol and midazolam groups. Overall, PONV (postoperative nausea and vomiting) in midazolam group was as low as propofol group without any significant hemodynamic changes as seen in placebo group or even with propofol group. Conclusions: Subhypnotic doses of midazolam or propofol are effective in the prevention of nausea and vomiting during and after cesarean section with spinal anesthesia and does not significantly influence hemodynamic of the patients. PMID:25346896

  6. Comparison of spinal anesthesia dosage based on height and weight versus height alone in patients undergoing elective cesarean section

    PubMed Central

    Siddiqui, Khalid Maudood; Ullah, Hameed

    2016-01-01

    Background Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens. Methods This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted according to height and weight, and in the other, the dose was adjusted according to height only. Results Sixty women with a singleton pregnancy were included. Of the factors that could affect dose and blood pressure, including age, weight, height, and dose, only height differed between the groups. Mean heart rate was similar between the groups. Hypotension was significantly more frequent with dosage based on height alone than with two-factor dose calculation (56.7% vs. 26.7%; P = 0.018). Conclusions Adjusting the dose of isobaric bupivacaine to a patient's height and weight provides adequate anesthesia for elective cesarean section and is associated with a decreased incidence and severity of maternal hypotension and less use of ephedrine. PMID:27066205

  7. A comparative study of effects of glycopyrrolate and ondansetron on nausea and vomiting in cesarean section under spinal anesthesia

    PubMed Central

    Jain, Ragi; Sharma, Rashmi

    2015-01-01

    Background and Aim: Nausea and vomiting causes distress to patients and increases surgical complications. Though various antiemetics are available, their effectiveness and fetal safety profile when used in parturient remains debatable. This randomized, double-blind, comparative study was designed with an aim to compare the antiemetic effects of ondansetron and glycopyrrolate during cesarean section. Methods: Sixty-six parturients (American Society of Anesthesiologist physical status I-II) scheduled for elective cesarean section were randomized to receive intravenous ondansetron 4 mg (Group O, n = 32) or glycopyrrolate 0.2 mg (Group G, n = 31) before spinal anesthesia. Outcome measures studied were emesis, episodes of hypotension and bradycardia and pain, till 10 h postoperative. Statistical software used was Epi Info 7 and Microsoft Excel. Results: There was no significant difference in nausea and vomiting at all the study intervals between the two groups statistically. There was no difference in episodes of hypotension, but episodes of bradycardia were significantly less in glycopyrrolate group (26%) than in ondansetron group (56%) (P = 0.027). There was no difference in additional analgesic requirements. However, the incidence of dry mouth was significantly greater in glycopyrrolate group (21 [68%]) as compared to ondansetron group (5 [16%]) (P = 0.00). Conclusion: Effect of glycopyrrolate on nausea and vomiting during cesarean section are comparable to ondansetron, but with an increased incidence of dry mouth. Glycopyrrolate has no effect on hypotension or additional analgesic requirements, but the incidence of bradycardia is significantly less. PMID:26712972

  8. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis

    PubMed Central

    Mishanina, Ekaterina; Rogozinska, Ewelina; Thatthi, Tej; Uddin-Khan, Rehan; Khan, Khalid S.; Meads, Catherine

    2014-01-01

    Background: Induction of labour is common, and cesarean delivery is regarded as its major complication. We conducted a systematic review and meta-analysis to investigate whether the risk of cesarean delivery is higher or lower following labour induction compared with expectant management. Methods: We searched 6 electronic databases for relevant articles published through April 2012 to identify randomized controlled trials (RCTs) in which labour induction was compared with placebo or expectant management among women with a viable singleton pregnancy. We assessed risk of bias and obtained data on rates of cesarean delivery. We used regression analysis techniques to explore the effect of patient characteristics, induction methods and study quality on risk of cesarean delivery. Results: We identified 157 eligible RCTs (n = 31 085). Overall, the risk of cesarean delivery was 12% lower with labour induction than with expectant management (pooled relative risk [RR] 0.88, 95% confidence interval [CI] 0.84–0.93; I2 = 0%). The effect was significant in term and post-term gestations but not in preterm gestations. Meta-regression analysis showed that initial cervical score, indication for induction and method of induction did not alter the main result. There was a reduced risk of fetal death (RR 0.50, 95% CI 0.25–0.99; I2 = 0%) and admission to a neonatal intensive care unit (RR 0.86, 95% CI 0.79–0.94), and no impact on maternal death (RR 1.00, 95% CI 0.10–9.57; I2 = 0%) with labour induction. Interpretation: The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term and post-term gestations. There were benefits for the fetus and no increased risk of maternal death. PMID:24778358

  9. The history of cesarean technique.

    PubMed

    Lurie, Samuel; Glezerman, Marek

    2003-12-01

    Cesarean section has been practiced since ancient times. Unfortunately, no ancient medical documents describing the techniques for cesarean section are extant. In the early medieval period, cesarean section was usually performed by midwives. One of the first explicit instructions in medical literature on cesarean technique dates from about 1480 ce from southern Germany. We discuss the evolution of cesarean surgical technique and point up the contribution of many giants in the field of obstetrics and gynecology, such as Blundell, Frank, Harris, Joel-Cohen, Kehrer, Kerr, Lebas, Levret, Maylard, Pfannenstiel, Porro, Portes, and Sanger. PMID:14710118

  10. Maternal brain response to own baby-cry is affected by cesarean section delivery

    PubMed Central

    Swain, James E.; Tasgin, Esra; Mayes, Linda C.; Feldman, Ruth; Constable, R. Todd; Leckman, James F.

    2011-01-01

    A range of early circumstances surrounding the birth of a child affects peripartum hormones, parental behavior and infant wellbeing. One of these factors, which may lead to postpartum depression, is the mode of delivery: vaginal delivery (VD) or cesarean section delivery (CSD). To test the hypothesis that CSD mothers would be less responsive to own baby-cry stimuli than VD mothers in the immediate postpartum period, we conducted functional magnetic resonance imaging, 2–4 weeks after delivery, of the brains of six mothers who delivered vaginally and six who had an elective CSD. VD mothers’ brains were significantly more responsive than CSD mothers’ brains to their own baby-cry in the superior and middle temporal gyri, superior frontal gyrus, medial fusiform gyrus, superior parietal lobe, as well as regions of the caudate, thalamus, hypothalamus, amygdala and pons. Also, within preferentially active regions of VD brains, there were correlations across all 12 mothers with out-of-magnet variables. These include correlations between own baby-cry responses in the left and right lenticular nuclei and parental preoccupations (r = .64, p < .05 and .67, p < .05 respectively), as well as in the superior frontal cortex and Beck depression inventory (r = .78, p < .01). First this suggests that VD mothers are more sensitive to own baby-cry than CSD mothers in the early postpartum in sensory processing, empathy, arousal, motivation, reward and habit-regulation circuits. Second, independent of mode of delivery, parental worries and mood are related to specific brain activations in response to own baby-cry. PMID:18771508

  11. Assessment of coagulation with 6% hydroxyethyl starch 130/0.4 in cesarean section

    PubMed Central

    Oh, Chung-Sik; Kim, Seong-Hyop; Kim, Duk-Kyung; Lim, Jeong-Ae; Woo, Nam-Sik

    2012-01-01

    Background Third-generation hydroxyethyl starch (HES) solutions have been developed to minimize negative effects on hemostasis. In normal pregnancy, the coagulation activity increases, reaching a maximum around term. This study examined the effects of hemodilution with HES 130/0.4 (6%) on blood coagulation in parturients in vivo and in vitro. Methods Forty parturients scheduled for cesarean sections were assigned randomly to receive either 500 or 1,000 ml of HES 130/0.4 (6%). Rotation thromboelastometry (ROTEM®) measurements were performed before and after administering HES 130/0.4 (6%). In addition, blood samples obtained from 20 randomly selected parturients were diluted 10% to 40% using HES 130/0.4 (6%), and ROTEM® measurements were performed before and after dilution. The changes from baseline and the effects of dilution were analyzed by ROTEM® parameters. Results Infusions of 500 or 1,000 ml of HES 130/0.4 (6%) in the parturients altered the clot formation time, α angle, and maximal clot firmness, although all remained within normal ranges. HES 130/0.4 (6%) affected in vitro blood coagulation in parturients' blood containing 10, 20, 30, and 40% HES. The clotting time was prolonged at each dilution percentage, but remained within the normal range. Other parameters showed an impairment of the coagulation system. Conclusions Blood coagulation in parturients may be compromised at high dilution ratios of HES 130/0.4 (6%) to blood. Nevertheless, the infusion of 1,000 ml of HES 130/0.4 (6%) in normal parturients did not significantly affect blood coagulation. PMID:22558500

  12. Evaluation of the Adequacy of General Anesthesia in Cesarean Section by Bispectral Index

    PubMed Central

    Hadavi, Sayed Mohammad Reza; Allahyary, Elaheh; Asadi, Saman

    2013-01-01

    Background: Awareness and recall, though not common, are the major hazards of general anesthesia, especially in Cesarean section (C/S) because of the absence of benzodiazepine and opioids for a significant time during anesthesia. In this study, the Bispectral Index (BIS), end-tidal isoflurane, and hemodynamic parameters were examined to evaluate the depth of the routine general anesthetic technique in C/S. Methods: This study was carried out on 60 parturient patients undergoing elective C/S. A standardized anesthetic technique was applied: induction with Thiopental (4-5 mg/kg) and Succinylcholine (1.5-2 mg/kg) as well as maintenance with O2, N2O, and isoflurane. Electrocardiogram, heart rate, blood pressure, Spo2, end-tidal isoflurane concentration, BIS, and any clinical signs of inadequate depth of anesthesia such as movement, sweating, lacrimation, coughing, and jerking were continuously monitored and recorded at 16 fixed time points during anesthesia. Results: A median BIS of less than 70 (range: 42-68) was obtained on all occasions during surgery; however, at each milestone, at least 20% of the patients had BIS values above 60. Hemodynamic parameters increased significantly in some patients, especially during laryngoscopy and intubation. No patient experienced recall or awareness. Conclusion: The currently used general anesthetic technique in our center appears inadequate in some milestones to reliably produce BIS values less than 60, which are associated with lower risk of awareness. Therefore, with respect to such desirable outcomes as good Apgar and clinical status in neonates, we would recommend the application of this method (if confirmed by further studies) through larger dosages of anesthetic agents. PMID:24174695

  13. Intrathecal Administration of Morphine Decreases Persistent Pain after Cesarean Section: A Prospective Observational Study

    PubMed Central

    Moriyama, Kumi; Ohashi, Yuki; Motoyasu, Akira; Ando, Tadao; Moriyama, Kiyoshi; Yorozu, Tomoko

    2016-01-01

    Purpose Chronic pain after cesarean section (CS) is a serious concern, as it can result in functional disability. We evaluated the prevalence of chronic pain after CS prospectively at a single institution in Japan. We also analyzed perioperative risk factors associated with chronic pain using logistic regression analyses with a backward-stepwise procedure. Materials and Methods Patients who underwent elective or emergency CS between May 2012 and May 2014 were recruited. Maternal demographics as well as details of surgery and anesthesia were recorded. An anesthesiologist visited the patients on postoperative day (POD) 1 and 2, and assessed their pain with the Prince Henry Pain Scale. To evaluate the prevalence of chronic pain, we contacted patients by sending a questionnaire 3 months post-CS. Results Among 225 patients who questionnaires, 69 (30.7%) of patients complained of persistent pain, although no patient required pain medication. Multivariate analyses identified lighter weight (p = 0.011) and non-intrathecal administration of morphine (p = 0.023) as determinant factors associated with persistent pain at 3 months. The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%. In addition, 51.6% of patients had abnormal wound sensation, suggesting the development of neuropathic pain. Also, 6% of patients with abnormal wound sensation required medication, yet no patients with persistent pain required medication. Conclusion Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS. PMID:27163790

  14. Clinical evaluation of the flotrac/vigileo™ system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study

    PubMed Central

    Auler, José Otavio C.; Torres, Marcelo L. A.; Cardoso, Mônica M.; Tebaldi, Thais C.; Schmidt, André P.; Kondo, Mario M.; Zugaib, Marcelo

    2010-01-01

    BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01). Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. DISCUSSION AND CONCLUSIONS: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia. PMID:20835557

  15. Comparing Different Epinephrine Concentrations for Spinal Anesthesia in Cesarean Section: A Double-Blind Randomized Clinical Trial

    PubMed Central

    Hamzei, Arash; Nazemi, Seyed Hossein; Alami, Ali; Davarinia Motlagh Gochan, Arezoo; Kazemi, Azizollah

    2015-01-01

    Background Although various anesthetic techniques can be used in different kinds of surgeries, spinal anesthesia has received considerable attention for the lower abdomen and lower extremities surgeries and cesarean section. This study aimed at comparing the effect of adding epinephrine 1:1000 and 1:10000 to lidocaine and fentanyl in spinal anesthesia on the prolongation of paralysis, analgesia and hemodynamic changes in pregnant women candidate for cesarean section. Methods A double blind randomized clinical trial was carried out on 66 pregnant women (equally sized control and treatment groups of 33) in 2011. After randomizing the participants into two groups of recipients of epinephrine 1:1000 plus lidocaine 5% and fentanyl (control group) and recipients of epinephrine 1:10000 with lidocaine 5% and fentanyl, (treatment group), the participants’ systolic and diastolic blood pressure and heart rate were recorded before and 1, 3, 5, 10, 15 minutes after procedure. Besides the prolongation of paralysis and analgesia, the presence of postoperative nausea and vomiting were evaluated. The outcome of the study was analyzed using SPSS software and via t test, χ2 test and RMANOVA. Results The mean age (standard deviation) of the participants was 29.3 (4.4) and 28.2 (4.5) in the treatment and control groups, respectively. There were no statistical significance between the participants’ prolongation of paralysis, analgesia, the frequency of nausea and vomiting, and the average values of hemodynamic variables between the two groups. Conclusion The use of epinephrine 1:10000 along with lidocaine and fentanyl is recommended in spinal anesthesia in pregnant women candidate for cesarean section. Trial Registration Number: IRCT201012225445N1. PMID:26170515

  16. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

    PubMed Central

    Nofal, Walid Hamed; Mahmoud, Mohamed Sidky; Al Alim, Azza Atef Abd

    2014-01-01

    Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH), also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS) under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side-effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale (VAS) for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. Results: Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group (P < 0.05). Also, severity and duration of headache were significantly less in gabapentin group (P < 0.05). The incidence of sedation was more in gabapentin group 11 (26.19%) versus placebo group 3 (6.81%). Neonatal outcomes were statistically insignificant between both groups. Conclusion: Pre-operative administration of gabapentin has no effect on incidence of (PDPH) but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby. PMID:25191187

  17. Perioperative analgesic effects of intravenous paracetamol: Preemptive versus preventive analgesia in elective cesarean section

    PubMed Central

    Hassan, Hossam Ibrahim Eldesuky Ali

    2014-01-01

    Background: Cesarean section (CS) is the one of the most common surgical procedure in women. There is preoperative stress effect before the delivery of the baby as (intubation and skin incision). There is acute postoperative pain, which may be progressed to chronic pain. All these perioperative stress effects need for various approach of treatment, which including systemic and neuraxial analgesia. The different analgesia modalities may affect and impair early interaction between mother and infant. Preemptive intravenous (I.V.) paracetamol (before induction) may reduce stress response before the delivery of the baby, intraoperative opioids and postoperative pain. Objectives: The aim of this study to compare between the administration of I.V. paracetamol as: Preemptive analgesia (preoperative) and preventive analgesia (at the end of surgery) as regards of hemodynamic, pain control, duration of analgesia, cumulative doses of intraoperative opioids and their related side-effects and to compare between two different protocols of postoperative analgesia and their cumulative doses. Patients and Methods: Sixty patients undergoing elective CS were randomly enrolled in this study and divided into two groups of 30 patients each. Group I: i.V. paracetamol 1 g (100 ml) was given 30 min before induction of anesthesia. Group II: i.V. paracetamol 1 g (100 ml) was given 30 min before the end of surgery. Heart rate, systolic blood pressure, diastolic blood pressure, and peripheral oxygen saturation were recorded. Postoperative pain was assessed by visual analog score. Postoperative pethidine was given by two different protocols: group I: 0.5 mg/kg was divided into 0.25 mg/kg intramuscular and 0.25 mg/kg I.V. Group II was given pethidine 0.5 mg/kg I.V. Doses of intraoperative fentanyl, postoperative pethidine, duration of paracetamol analgesic time, time to next analgesia, and side-effects of opioid were noted and compared. Result: Preemptive group had hemodynamic stability

  18. Increased cesarean section rate in Central Saudi Arabia: a change in practice or different maternal characteristics

    PubMed Central

    Al-Kadri, Hanan M; Al-Anazi, Sultana A; Tamim, Hani M

    2015-01-01

    Background Cesarean section (CS) rate has shown an alarming increase. We aimed in this work to identify factors contributing to the increasing rate of CS in central Saudi Arabia. Methods A retrospective cohort study was conducted at King Abdulaziz Medical City. Two groups of women were included (G1 and G2). G1 had delivered by CS during the year 2002 (CS rate 12%), and G2 had delivered by CS during the year 2009 (CS rate 20%). We compared the included women’s characteristics, neonates, CS indications, and complications. Data were analyzed using SPSS version 15 program. Odds ratios and confidence intervals were calculated to report precision of categorical data results. A P-value of ≤0.05 was considered significant. Results A total of 198 women were included in G1 and 200 in G2. Both groups had comparable maternal and fetal characteristics; however, absence of antenatal care has resulted in 70% increase in CS deliveries for G2, P=0.008, OR =0.30, CI 0.12–0.76. Previous vaginal surgeries have contributed to tenfold increase in CS deliveries for G2, P=0.006, OR =10.37, CI 1.32–81.78. G2 had eight times increased CS deliveries than G1 due to intrauterine growth restriction, P=0.02, OR =8.21, CI 1.02–66.25, and 80% increased risk of CS was based on maternal demand, P=0.02, OR =0.20, CI 0.02–1.71. Decision taken by less-experienced staff was associated with 2.5-fold increase in CS deliveries for G2, P=0.002, OR =2.62, CI 1.39–4.93. There was a significant increase in CS deliveries under regional analgesia and shorter duration of hospital stay for G2, P=0.0001 and P=0.001, respectively. G2 women had 2.75-fold increase in neonatal intensive care unit admission, P=0.03, OR =2.75, CI 1.06–7.15. Conclusion CS delivery rate significantly increased within the studied population. The increased rate of CS may be related to a change in physician’s practice rather than a change in maternal characteristics, and it appears to be reducible. PMID:26203285

  19. Prenatal exposure to antibiotics, cesarean section and risk of childhood obesity

    PubMed Central

    Mueller, NT; Whyatt, R; Hoepner, L; Oberfield, S; Dominguez-Bello, MG; Widen, EM; Hassoun, A; Perera, F; Rundle, A

    2015-01-01

    BACKGROUND/OBJECTIVES Cesarean section (CS) and antibiotic use during pregnancy may alter normal maternal-offspring microbiota exchange, thereby contributing to aberrant microbial colonization of the infant gut and increased susceptibility to obesity later in life. We hypothesized that (i) maternal use of antibiotics in the second or third trimester of pregnancy and (ii) CS are independently associated with higher risk of childhood obesity in the offspring. SUBJECTS/METHODS Of the 727 mothers enrolled in the Northern Manhattan Mothers and Children Study, we analyzed the 436 mother–child dyads followed until 7 years of age with complete data. We ascertained prenatal antibiotic use by a questionnaire administered late in the third trimester, and delivery mode by medical record. We derived age- and sex-specific body mass index (BMI) z-scores using the CDC SAS Macro, and defined obesity as BMI z ≥ 95th percentile. We used binary regression with robust variance and linear regression models adjusted for maternal age, ethnicity, pre-gravid BMI, maternal receipt of public assistance, birth weight, sex, breastfeeding in the first year and gestational antibiotics or delivery mode. RESULTS Compared with children not exposed to antibiotics during the second or third trimester, those exposed had 84% (33–154%) higher risk of obesity, after multivariable adjustment. Second or third trimester antibiotic exposure was also positively associated with BMI z-scores, waist circumference and % body fat (all P<0.05). Independent of prenatal antibiotic usage, CS was associated with 46% (8–98%) higher offspring risk of childhood obesity. Associations were similar for elective and non-elective CS. CONCLUSIONS In our cohort, CS and exposure to antibiotics in the second or third trimester were associated with higher offspring risk of childhood obesity. Future studies that address the limitations of our study are warranted to determine if prenatal antibiotic use is associated with

  20. Comparison between modified Misgav-Ladach and Pfannenstiel-Kerr techniques for Cesarean section: review of literature

    PubMed Central

    Vitale, Salvatore Giovanni; Marilli, Ilaria; Cignini, Pietro; Padula, Francesco; D’Emidio, Laura; Mangiafico, Lucia; Rapisarda, Agnese Maria Chiara; Gulino, Ferdinando Antonio; Cianci, Stefano; Biondi, Antonio; Giorlandino, Claudio

    2014-01-01

    In the last decades cesarean section rates increased in many countries becoming the most performed intraperitoneal surgical procedure. Despite its worldwide spread, a general consensus on the most appropriate technique to use has not yet been reached. The operative technique performed is made chiefly on the basis of the individual experience and preference of operators, the characteristics of patients, timing and urgency of intervention. We compared the two most known and used techniques, modified Misgav-Ladach and traditional Pfannenstiel-Kerr, and analyzed their impact on primary, short- and long-term outcomes and outcome related to health service use. PMID:26265999

  1. Necrotizing fasciitis of anterior abdominal wall following cesarean section in a low-risk patient.

    PubMed

    Chhetry, Manisha; Banerjee, Basudeb; Subedi, Shanti; Koirala, Ashok

    2016-01-01

    We report a case of a mono-microbial post-cesarean necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus, in a low-risk healthy woman who presented with acute fulminant infection, sepsis and features of multi-organ dysfunction syndrome on sixth post-operative day. Aggressive management with multiple surgical debridement and supportive therapy was the key to favorable outcome in this case. PMID:27402541

  2. Necrotizing fasciitis of anterior abdominal wall following cesarean section in a low-risk patient

    PubMed Central

    Chhetry, Manisha; Banerjee, Basudeb; Subedi, Shanti; Koirala, Ashok

    2016-01-01

    We report a case of a mono-microbial post-cesarean necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus, in a low-risk healthy woman who presented with acute fulminant infection, sepsis and features of multi-organ dysfunction syndrome on sixth post-operative day. Aggressive management with multiple surgical debridement and supportive therapy was the key to favorable outcome in this case. PMID:27402541

  3. Effects of anesthesia type on short-term postoperative cognitive function in obstetric patients following cesarean section

    PubMed Central

    Altun, Celalettin; Borazan, Hale; Şahin, Osman; Gezginç, Kazım

    2015-01-01

    Objective We aimed to compare the effects of general and spinal anesthesia on cognitive functions in pregnant patients undergoing elective cesarean section. Material and Methods Seventy-five American Society of Anesthesiology (ASA) I pregnant patients aged 18–40 years who were scheduled to undergo elective cesarean section were divided into three groups. Group sevoflurane (Group S) and Group desflurane (Group D) were administered general anesthesia, whereas Group regional (Group R) was administered spinal anesthesia. Hemodynamic variables, bispectral index, oxygen saturation were measured at baseline, after induction, spinal injection, and during the surgery. Extubation and eye opening time and Aldrete scores were recorded. Mini-mental state examination, Trieger dot test, and clock drawing test were performed one day before the surgery and repeated at the 1st, 3rd and 24th h postoperatively. Results There was no statistically significant difference among the groups in terms of demographic data and duration of surgery (p>0.05). Durations of anesthesia for Group S, Group R, and Group D were significantly different (p<0.05). Duration of anesthesia for Group R was significantly longer than for Groups S and D (p<0.0001). Aldrete recovery scores and total remifentanil consumption were significantly higher in Group D than in Group S (p<0.05). Extubation and eye opening times were significantly shorter in Group D than in Group S (p<0.01). According to TDT, statistical significance was found among Group S, Group R, and Group D at the 3rd and 24th h postoperatively (p<0.05), and there was a statistically high significant difference in Groups S and R (p<0.0001). Conclusion We concluded that general anesthesia with sevoflurane or desflurane and spinal anesthesia had no effects on cognitive functions in patients undergoing cesarean operation. PMID:26692772

  4. Influence of dexmedetomidine on incidence of adverse reactions introduced by hemabate in postpartum hemorrhage during cesarean section

    PubMed Central

    Liu, Yang; Chen, Hong-Xia; Kang, Dao-Lin; Kuang, Xiao-Hua; Liu, Wen-Xing; Ni, Jin

    2015-01-01

    Objective: The purpose of our study was to observe the influence of dexmedetomidine on complications caused by hemabate in patients undergoing caesarean section. Methods: A total of 120 females (age range, 20-40 years) at 35-40 weeks gestation who delivered by cesarean between September, 2014 and December, 2014 were enrolled in our study. Patients were randomly allocated into three groups that received intravenously physiological saline 20 mL (placebo group), lower dose (0.5 μg kg-1) of dexmedetomidine (low-dex gruop) and higher dose (1 μg kg-1) of dexmedetomidine (high-dex group) during cesarean section, following the delivery of the infant and intramuscular hemabate injection. Results: Nausea, vomiting, chest congestion and elevated blood pressure were the most common adverse events of placebo group. Compared with placebo group, the above mentioned adverse reactions decreased significantly in both low-dex group and high-dex group (P<0.05), whereas there were no significant difference between low-dex group and high-dex group (P>0.05). As to patient satisfaction score, low-dex group and high-dex group were all higher than placebo group (P<0.05). Furthermore, there were more patients satisfied with high-dex group than low-dex group (P<0.05). Conclusion: Dexmedetomidine (0.5 μg kg-1 and 1 μg kg-1) were all effective in preventing adverse reactions introduced by hemabate and improve parturients’ satisfaction in patients undergoing cesarean delivery. And higher dose (1 μg kg-1) of dexmedetomidine is superior to lower dose (0.5 μg kg-1) in patient satisfaction. PMID:26550325

  5. Bladder Injury During Cesarean Delivery

    PubMed Central

    Tarney, Christopher M.

    2013-01-01

    Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury. PMID:24876830

  6. Case with a Nonreassuring Fetal Status Induced by Massive Hematemesis due to Mallory-Weiss Tear That Required Emergency Cesarean Section at 38 Weeks' Gestation

    PubMed Central

    Suzuki, Takashi; Wagata, Maiko; Konno, Hiroko; Ito, Takahiro; Torii, Yuichi; Murakoshi, Takeshi

    2015-01-01

    We describe a rare case of Mallory-Weiss tear with massive hematemesis at 38 weeks' gestation. A 35-year-old woman presented with epigastralgia followed by massive hematemesis. An emergency endoscopy indicated active pulsatile bleeding at the esophagocardial junction. Although an emergency endoscopic hemostasis was successful, late decelerations without acceleration on cardiotocogram were observed. Therefore, the patient underwent emergency cesarean section, along with blood transfusion, following the endoscopic hemostasis. The hemoglobin level just before the operation was 5.1 g/dL. We suspected that massive hematemesis induced maternal acute anemia and hypovolemia, which resulted in a nonreassuring fetal status. Hence, urgent endoscopic hemostasis, adequate blood transfusion, and emergency cesarean section were needed. Mallory-Weiss tear during the third trimester may have a possibility of massive hematemesis and urgent blood transfusion, emergency endoscopic hemostasis, and emergency cesarean section may be needed. PMID:26881157

  7. Risk of Autism Associated with General Anesthesia during Cesarean Delivery: A Population-Based Birth-Cohort Analysis

    ERIC Educational Resources Information Center

    Chien, Li-Nien; Lin, Hsiu-Chen; Shao, Yu-Hsuan Joni; Chiou, Shu-Ti; Chiou, Hung-Yi

    2015-01-01

    The rates of Cesarean delivery (C-section) have risen to >30 % in numerous countries. Increased risk of autism has been shown in neonates delivered by C-section. This study examined the incidence of autism in neonates delivered vaginally, by C-section with regional anesthesia (RA), and by C-section with general anesthesia (GA) to evaluate the…

  8. Planned Repeat Cesarean Section at Term and Adverse Childhood Health Outcomes: A Record-Linkage Study

    PubMed Central

    Black, Mairead; Bhattacharya, Siladitya; Philip, Sam; Norman, Jane E.; McLernon, David J.

    2016-01-01

    Background Global cesarean section (CS) rates range from 1% to 52%, with a previous CS being the commonest indication. Labour following a previous CS carries risk of scar rupture, with potential for offspring hypoxic brain injury, leading to high rates of repeat elective CS. However, the effect of delivery by CS on long-term outcomes in children is unclear. Increasing evidence suggests that in avoiding exposure to maternal bowel flora during labour or vaginal birth, offspring delivered by CS may be adversely affected in terms of energy uptake from the gut and immune development, increasing obesity and asthma risks, respectively. This study aimed to address the evidence gap on long-term childhood outcomes following repeat CS by comparing adverse childhood health outcomes after (1) planned repeat CS and (2) unscheduled repeat CS with those that follow vaginal birth after CS (VBAC). Methods and Findings A data-linkage cohort study was performed. All second-born, term, singleton offspring delivered between 1 January 1993 and 31 December 2007 in Scotland, UK, to women with a history of CS (n = 40,145) were followed up until 31 January 2015. Outcomes assessed included obesity at age 5 y, hospitalisation with asthma, learning disability, cerebral palsy, and death. Cox regression and binary logistic regression were used as appropriate to compare outcomes following planned repeat CS (n = 17,919) and unscheduled repeat CS (n = 8,847) with those following VBAC (n = 13,379). Risk of hospitalisation with asthma was greater following both unscheduled repeat CS (3.7% versus 3.3%, adjusted hazard ratio [HR] 1.18, 95% CI 1.05–1.33) and planned repeat CS (3.6% versus 3.3%, adjusted HR 1.24, 95% CI 1.09–1.42) compared with VBAC. Learning disability and death were more common following unscheduled repeat CS compared with VBAC (3.7% versus 2.3%, adjusted odds ratio 1.64, 95% CI 1.17–2.29, and 0.5% versus 0.4%, adjusted HR 1.50, 95% CI 1.00–2.25, respectively). Risk of obesity

  9. Changes in the cesarean section rate in Korea (1982-2012) and a review of the associated factors.

    PubMed

    Chung, Sung-Hoon; Seol, Hyun-Joo; Choi, Yong-Sung; Oh, Soo-Young; Kim, Ahm; Bae, Chong-Woo

    2014-10-01

    Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary. PMID:25368486

  10. In Spinal Anaesthesia for Cesarean Section the Temperature of Bupivacaine Affects the Onset of Shivering but Not the Incidence: A Randomized Control Trial

    PubMed Central

    Kishore, Nand; Kumar, Nidhi; Chauhan, Nidhi

    2016-01-01

    Introduction Postoperative shivering is a frequent event after cesarean section under spinal anaesthesia. Shivering is uncomfortable for the patient and may interfere with monitoring. The exact aetiology of shivering is unknown and therefore has no definite treatment. Aim The temperature of injectate affects the spread of drug and so its effect. Therefore the aim of this study was to compare the effect of temperature of bupivacaine on post-spinal shivering in cesarean section. Materials and Methods In this prospective, randomized, controlled, double-blind clinical trial 105 ASA-I/II pregnant women scheduled for caesarean section under spinal anaesthesia were selected and randomized into three groups of 35 each. In all pregnant women spinal anaesthesia was achieved with 2.2 ml of 0.5% hyperbaric bupivacaine given either at L3-L4 or L4-L5 interspace. The temperature of bupivacaine was adjusted to 4°C (group T4), 22°C (group T22) and 37°C (group T37). Shivering characteristic, onset and incidence was noted. All three groups were compared using analysis of variance (ANOVA), adverse effects was compared using chi-square test and Kruskal-Wallis H-test. The p-value < 0.05-considered as significant and p-value <0.01-considered highly significant Results There were no differences between the groups regarding age, weight, height, amount of fluid used and blood loss. The incidence of shivering was 51.42%, 51.42% and 45.71% in group T4, group T22 and group T37 respectively, this difference in the incidence was statistically not significant (p=0.858). However, the onset of shivering was earliest (9.87±1.82 min) in group T4 as compared to 14.27±3.02 min and 12.16±2.89 min in group T22 and group T37 respectively and this difference in the onset was highly significant (p= 0.0001) Conclusion In spinal anaesthesia for cesarean section, the temperature of bupivacaine does not influence the overall incidence of post spinal shivering; however cold bupivacaine can provoke early

  11. Incomplete Cesarean Scar Rupture

    PubMed Central

    Ahmadi, Firoozeh; Siahbazi, Shiva; Akhbari, Farnaz

    2013-01-01

    Background Uterine rupture at the site of a previous cesarean scar is an uncommon but catastrophic complication of pregnancy, which is associated with significant maternal and fetal morbidity and mortality. Case Presentation A 30-year old woman at 24th week of gestation and complaint of pain, contractions and spotting was admitted in Royan Institute in Tehran, Iran. She had a past medical history of an EP and a cesarean section delivery, respectively 4 and 2 years before hospitalization. Herniation of an amniotic membrane into the maternal bladder was found on ultrasound examination. Conclusion Risk factors of cesarean scar rupture should be considered in women undergoing subsequent pregnancies as they need extra care. Ultrasonography can be used to evaluate women with previous cesarean section to assess the risks of scar rupture during subsequent pregnancies. PMID:23926561

  12. [Emergency cesarean section and craniectomy in a patient with rupture of a cerebral arteriovenous malformation].

    PubMed

    Monsalve-Mejía, G; Palacio, W; Rodríguez, C

    2014-04-01

    The intracerebral hemorrhage in pregnancy is a rare event, but can have catastrophic consequences for both mother and fetus. The management of non-ruptured arteriovenous malformations in pregnancy is not free of controversy in the current literature, as there is the possibility of spontaneous bleeding and becoming a true emergency. We report the case of a pregnant patient of 35 weeks with a diagnosis of a cerebral arteriovenous malformation, who developed a sudden onset of headache, generalized tonic-clonic seizures, loss of consciousness, and hemiparesis with radiological images of an intracranial hematoma with a mass effect, and signs of herniation. The multidisciplinary management is discussed, emphasizing perioperative cesarean approach plus craniotomy and drainage of the hematoma, and subsequent management in intensive care, and definitive management by neuroradiology, with a successful outcome. PMID:23664062

  13. Preoperative Association of Abdominal Striae Gravidarum with Intraabdominal Adhesions in Pregnant Women with a History of Previous Cesarean Section: a Cross-sectional Study

    PubMed Central

    Dogan, A.; Ertas, I. E.; Uyar, I.; Karaca, I.; Bozgeyik, B.; Töz, E.; Ozeren, M.

    2016-01-01

    Introduction: Intraabdominal adhesions that develop because of prior abdominal or pelvic surgery may cause problems during surgery. Complications can include difficult intraabdominal entry; injury to the urinary bladder, uterus or small intestine; longer operation times, and increased blood loss. The goal of the present study was to evaluate the association between abdominal striae gravidarum and intraabdominal adhesions in the preoperative period in pregnant women with a history of cesarean section. Materials and Methods: The study included 247 pregnant women at ≥ 37 weeks of gestation admitted to the labor unit for delivery; all had undergone at least one previous cesarean section. Abdominal striae were assessed preoperatively using the Davey scoring system; the severity and intensity of adhesions were subsequently evaluated intraoperatively according to the modified Nair scoring system. Results: No striae were seen in 104 pregnant women; 41 had mild striae and 102 had severe striae. Overall, 113 cases had no adhesions (grade 0), 106 had grade 1–2 adhesions, and 28 had grade 3–4 adhesions. Among patients with grade 0 adhesions, 34 (13.7 %) had no striae, while 79 (31.9 %) had mild-to-severe striae (p < 0.001; sensitivity 55 %; specificity 67 %; positive predictive value 69 %; negative predictive value 52 %). Among women with grade 1–2 adhesions, 48 (19.4 %) had no striae, while 58 (23.4 %) had mild-to-severe striae. Finally, among women with grade 3–4 adhesions, 22 (8.9 %) had no striae, while 6 (2.4 %) had mild-to-severe striae (p < 0.001). A p-value < 0.05 was taken to indicate statistical significance. Conclusions: The abdominal adhesion score dropped as the abdominal striae gravidarum score rose during the preoperative period. Addition of this useful, easy-to-apply, inexpensive, adjunctive, observational, abdominal scoring method to the obstetrical work-up can provide important clues about the intraabdominal adhesion

  14. Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section

    PubMed Central

    Hashemi, Seyed Jalal; Jabalameli, Mitra; Mokhtary, Forough

    2015-01-01

    Background: Neurologic and Adaptive Capacity Scoring (NACS) has been introduced as a screening test for diagnosis of central nervous system depression due to intrapartum drugs on the neonate. This test can show neurological and behavioral changes even in the presence of a normal Apgar score. NACS has 20 indicators, each indicator allocating to itself the score zero, one or two. The aim of this study was to compare the effects of different anesthetic techniques on the NACS values. Materials and Methods: This study was performed as a randomized, single-blind clinical trial on 75 infants born with elective cesarean in Shahid Beheshti Hospital, Isfahan. Simple Sampling method was carried out and the information was gathered by questionnaires. Anesthetic techniques included general, spinal or epidural anesthesia. NACS score was assessed at 15th min, 2 and 24 h after birth and then the anesthesia technique was recorded in the questionnaire. NACS score 35 or above was considered normal and 34 or less was abnormal. Results: In the present study, no significant correlation was found between the anesthesia techniques and NACS score. The mean NACS at 15 min after birthin the general, spinal and epidural groups were 33.5 ± 2.2, 33.0 ± 4.4 and 33.7 ± 1.6 respectively (P = 0.703). Conclusion: All three anesthetic techniques have identical effects on neurological and compatibility capacity of neonates born with elective cesarean; so, this could necessarily be a base to recommend the three methods equally. PMID:26693474

  15. Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section: A randomized controlled study.

    PubMed

    Weigl, Wojciech; Bierylo, Andrzej; Wielgus, Monika; Krzemień-Wiczyńska, Swietlana; Szymusik, Iwona; Kolacz, Marcin; Dabrowski, Michal J

    2016-06-01

    Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage.This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 μg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain.Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9-51.6).The requirement for postoperative analgesics is greatest during the first 12 hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for intraoperative

  16. Rupture of splenic artery aneurysm in primipara five days after cesarean section: case report and review of the literature.

    PubMed

    Barišić, Tatjana; Šutalo, Nikica; Letica, Ludvig; Kordić, Andrea Vladimira

    2015-11-01

    Splenic artery aneurysm (SAA) is a rare and usually asymptomatic vascular anomaly which carries the risk of rupture and fatal hemorrhage. It is more common in women and is usually associated with pregnancy. We present the case of rupture of SAA, 5 days after giving birth by cesarean section, which was diagnosed with Multi-Slice Computed Tomografy (MSCT) angiography and was successfully operated in the second emergency laparotomy, with the final good outcome for the mother. This case indicates that in case of sudden bleeding in the abdomen, with the development of hypovolemic shock, especially in the peripartum period, should be suspected rupture of SAA. The paper presents a critical review of this case, with a review of the literature. PMID:26373746

  17. Cesarean section under epidural anesthesia in a documented case of ruptured aneurysm of the sinus of valsalva

    PubMed Central

    Divakar, S. R.; Singh, Chandrashekhar; Verma, Chandra Mohan; Kulkarni, Chaitanya D.

    2015-01-01

    Ruptured aneurysm of sinus of Valsalva (RSOV) occurring in pregnancy is a rare cardiac anomaly and it may be either congenital or acquired. Congenital sinus of Valsalva aneurysms are commonly associated with other structural defects such as ventricular septal defect (50-55%), aortic regurgitation (AR) (25-35%), bicuspid aortic valve (10-15%) and Marfan's syndrome (10%). RSOV in pregnancy accentuates the hemodynamic stress on maternal cardiovascular system and pose a significant challenge from obstetric anesthesia point of view. We report a case of 35-year-old documented patient of RSOV with mild AR presenting completely asymptomatic at 37 weeks 4 days of gestation. A successful elective lower segment cesarean section was conducted under epidural anesthesia. PMID:25788785

  18. Cesarean section under epidural anesthesia in a documented case of ruptured aneurysm of the sinus of valsalva.

    PubMed

    Divakar, S R; Singh, Chandrashekhar; Verma, Chandra Mohan; Kulkarni, Chaitanya D

    2015-01-01

    Ruptured aneurysm of sinus of Valsalva (RSOV) occurring in pregnancy is a rare cardiac anomaly and it may be either congenital or acquired. Congenital sinus of Valsalva aneurysms are commonly associated with other structural defects such as ventricular septal defect (50-55%), aortic regurgitation (AR) (25-35%), bicuspid aortic valve (10-15%) and Marfan's syndrome (10%). RSOV in pregnancy accentuates the hemodynamic stress on maternal cardiovascular system and pose a significant challenge from obstetric anesthesia point of view. We report a case of 35-year-old documented patient of RSOV with mild AR presenting completely asymptomatic at 37 weeks 4 days of gestation. A successful elective lower segment cesarean section was conducted under epidural anesthesia. PMID:25788785

  19. Low-dose spinal-epidural anesthesia for Cesarean section in a parturient with uncontrolled hyperthyroidism and thyrotoxic heart disease.

    PubMed

    Liao, Zhimin; Xiong, Yaqin; Luo, Linli

    2016-08-01

    A 29-year-old woman at 34 weeks' gestation with uncontrolled hyperthyroidism and thyrotoxic heart disease was admitted to urgency Cesarean section. After preoperative sedation and good communication, low-dose spinal anesthesia (7.5 mg 0.5 % bupivacaine) combined with epidural anesthesia (6 ml 2 % lidocaine) was performed through L3-4 inter-vertebral. Opioids were given intravenously to the mother for sedation after delivery of the baby. Satisfactory anesthesia and sedation was provided during surgery. The mother and the neonate were safe and no special complication was found after surgery. Our case demonstrated that low-dose spinal anesthesia combined with epidural anesthesia with intravenous opioids can provide satisfactory anesthesia and sedation, and reduce the risk of heart failure and thyroid storm. PMID:27216206

  20. Management of cardiac arrest in a parturient with Eisenmenger's syndrome and complete atrioventricular block during Cesarean section: a case report

    PubMed Central

    Kim, Gaab Soo; Chang, Choo Hoon; Lee, Eun Kyung; Choi, Jeong Yeon

    2015-01-01

    A 26-year-old parturient with Eisenmenger's syndrome and complete atrioventricular block was presented for emergency Cesarean section due to preterm labor. Ventricular tachycardia (VT), which progressed to ventricular fibrillation (VF), started immediately after the incision. Cardiopulmonary resuscitation with electric shocks was given by anesthesiologists while the obstetrician delivered the baby between the shocks. A cardiac surgeon was ready for extracorporeal membrane oxygenation institution in case of emergency but spontaneous circulation of the patient returned after the 3rd shock and the delivery of the baby. The newborn's Apgar score was 4 at 1 minute and 8 at 5 minutes. An implantable cardioverter-defibrillator was inserted before the discharge because the patient had recurrent episodes of VT and VF postoperatively. PMID:26634088

  1. Successful medical management of multifocal psoas abscess following cesarean section: report of a case and review of the literature.

    PubMed

    Saylam, K; Anaf, V; Kirkpatrick, C

    2002-05-10

    The psoas abscess is a rare complication in obstetric and gynaecology. Two types of psoas abscess are recognized. The primary psoas abscess is generally following haematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcus aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle. We report the case of a patient who develops a bacteremia from an infected cesarean section wound. The complications were thigh and psoas abscesses with left sacroiliitis. Medical management with prolonged antibiotherapy permit clinical, biological and radiological improvement. Although it required a long hospital stay, medical treatment alone was effective. More experience is required to determine which therapeutic option: medical treatment and/or surgery, is the best choice for this type of complication. PMID:11950495

  2. A successful cesarean section in a pregnant woman with A (H1N1) influenza requiring ECMO support

    PubMed Central

    Zaleska-Dorobisz, Urszula; Blok, Radosław; Dumański, Andrzej; Zielińska, Marzena; Kustrzycki, Wojciech; Durek, Grażyna

    2014-01-01

    A 24-year-old pregnant woman (29.4 weeks of gestation) with A (H1N1) influenza-associated adult respiratory distress syndrome was admitted to the intensive care unit. The patient was connected to femoral-jugular veno-venous extracorporeal membrane oxygenation (ECMO) 8 hours after admission. On the 7th day of ECMO support, due to the increasing threat to the life of the mother and the fetus, a decision was made to carry out a cesarean section (CS) without discontinuing the ECMO support. The CS was performed uneventfully under general anesthesia, 5 hours after the discontinuation of heparin infusion. A live, premature 1200 g female neonate was delivered. No complications occurred in the perioperative period. On the 17th day, the patient was successfully weaned off the ECMO and discharged 10 days later. The newborn was discharged from the hospital in good health 41 days after the delivery. PMID:26336425

  3. Neonatal viability evaluation by Apgar score in puppies delivered by cesarean section in two brachycephalic breeds (English and French bulldog).

    PubMed

    Batista, M; Moreno, C; Vilar, J; Golding, M; Brito, C; Santana, M; Alamo, D

    2014-05-01

    This study tried to define neonatal viability after cesarean section in brachycephalic breeds and the efficacy of an adapted Apgar test to assess newborn survival. Data from 44 cesarean sections and 302 puppies were included. Before surgery (59-61 days after ovulation), an ultrasound evaluation defined the fetal biparietal diameter (BPD). Immediately after the uterine delivery, the pups were evaluated to detect birth defects and then, a modified Apgar score (range: 0-10) was used to define neonatal health at 5min (Apgar 1) and 60min (Apgar 2) after neonatal delivery; puppies were classified into three categories: critical neonates (score: 0-3), moderate viability neonates (score: 4-6) and normal viability neonates (score: 7-10). Mean (±SEM) value of BPD was 30.8±0.1mm and 28.9±0.1mm in English and French Bull-Dog fetus, respectively. The incidence of spontaneous neonatal mortality (4.98%, 14/281) and birth defects (6.95%) were not influenced by the sex; however, congenital anomalies and neonatal mortality were higher (p<0.01) in those litters with a greater number of neonates. In Apgar 1, the percentage of critical neonates, moderate viability neonates and normal viability neonates were 20.5%, 46.3% and 33.1% respectively; sixty minutes after birth, the critical neonates only represented 10.3% of the total puppies. Almost all neonates (238/239) showing moderate or normal viability at Apgar 1, survived for the first 24h after birth. The results of the study showed a direct relationship (p<0.01) between the Apgar score and neonatal viability. Therefore, the routine performance of the Apgar score would appear to be essential in the assessment of the status of brachycephalic breed puppies. PMID:24703805

  4. [Cesarean section for case with preoperatively-suspected placenta accrete followed by hysterectomy due to uncontrollable massive bleeding].

    PubMed

    Kono, Yasuo; Sawada, Maiko; Kano, Tatsuhiko

    2007-12-01

    A 42-yr-old pregnant woman highly suspicious of the placenta accreta was scheduled for cesarean section (c-section) under general anesthesia. She had received emergency c-section for the placenta previa at 36 years of age and three episodes of intrauterine curettage for spontaneous abortion. While the possibility of placenta accreta was pointed out and the risks accompanying with it were explained at the 7th week of pregnancy, she insisted on having a baby. C-section was intended at around the 30th week of pregnancy and 1,200 ml of autologus blood was stored for the predictable massive bleeding. Bilateral embolization of the internal iliac artery was also planned. The baby was delivered uneventfully. However, the adherence of the placenta was so tight that the placenta could not be separated from the uterine wall. The arterial embolization immediately after the delivery did not work as effectively as to control massive bleeding. It took about 1 hour to control the massive bleeding of up to 9000 ml by difficult hysterectomy. Since we had prepared for such a situation, we could well catch up with the massive bleeding. The mother and baby were discharged well from the hospital 29th day after the c-section. PMID:18078102

  5. Hemodynamic effects of continuous intravenous injection and bolus plus continuous intravenous injection of oxytocin in cesarean section

    PubMed Central

    Kim, Tae-Sung; Park, Jung-Man; Kang, Sin-Kyu

    2011-01-01

    Background Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas the optimal dose of oxytocin at elective cesarean section is unclear. To determine the lowest effective dose of oxytocin, we studied the hemodynamic effects of three doses during spinal anesthesia for elective single cesarean delivery. Methods Sixty women received oxytocin by continuous (0.5 IU/min) or bolus-continuous (2 or 5 IU prior to 0.25 IU/min continuous intravenous injection) intravenous injection after clamping of the umbilical cord. We compared changes in heart rate (HR), mean arterial pressure (MAP) and estimated blood loss (EBL). Uterine tone (UT) was assessed by palpation on a linear analog scale (LAS) at 5, 10, 15, 20 and 25 minutes after the oxytocin injection. In addition, oxytocin-related side-effects such as nausea and vomiting were recorded. Results Marked hemodynamic changes such as HR and MAP occurred in the bolus-continuous groups but not in the continuous groups. Although we were not able to observe a variation of EBL in each group, the UT significantly increased in the bolus-continuous groups when compared with that the continuous groups. In addition, the hemodynamic changes such as HR and MAP were lower in the two IU bolus-continuous group than those in the five IU group. Conclusions Although bolus-continuous injection of oxytocin resulted in more hemodynamic changes than continuous injection, bolus-continuous injection had a greater effect on uterine contraction. Furthermore, two IU bolus-continuous injection showed lower hemodynamic changes than in the five IU bolus-continuous injection. PMID:22220225

  6. Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

    PubMed Central

    Gonzales, Gustavo F; Tapia, Vilma L; Fort, Alfredo L; Betran, Ana Pilar

    2013-01-01

    A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01). The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01). On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01). More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes. PMID:24124393

  7. Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy?

    PubMed

    Kanat-Pektas, Mine; Bodur, Serkan; Dundar, Ozgur; Bakır, Vuslat Lale

    2016-04-01

    This systematic review aims to analyze the case reports, case series, or clinical studies describing the women with cesarean scar ectopic pregnancy (CSEP), and thus, to determine the efficacy and safety of different primary treatment modalities in the management of CSEP. A thorough search of electronic databases showed that 274 articles on CSEP were published between January 1978 and April 2014. Systemic methotrexate, uterine artery embolization, dilatation and curettage (D&C), hysterotomy, and hysteroscopy were the most frequently adopted first-line approaches. The success rates of systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy were 8.7%, 18.3%, 39.1%, 61.6%, and 92.1%, respectively. The hysterectomy rates were 3.6%, 1.1%, 0.0%, 7.3%, and 1.7% in CSEP cases that were treated by systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy, respectively. The ability to achieve a subsequent term pregnancy is related to successful systemic methotrexate treatment (p = 0.001) or hysterotomy (p = 0.009). Future term pregnancy was significantly more frequent in the hysterotomy group (p = 0.001). Hysteroscopy and laparoscopic hysterotomy are safe and efficient surgical procedures that can be adopted as primary treatment modalities for CSEP. Uterine artery embolization should be reserved for cases with significant bleeding and/or a high suspicion index for arteriovenous malformation. Systemic methotrexate and D&C are not recommended as first-line approaches for CSEP, as these procedures are associated with high complication and hysterectomy rates. PMID:27125412

  8. Misrecognition of need: women's experiences of and explanations for undergoing cesarean delivery.

    PubMed

    Tully, Kristin P; Ball, Helen L

    2013-05-01

    International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women's accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed 'on request.' The categorization of cesareans into 'emergency' and 'elective' did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of 'choice.' The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from 'prolonged' labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the 'too posh to push' label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the 'need' for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for

  9. Placenta Percreta Invading Broad Ligament and Parametrium in a Woman with Two Previous Cesarean Sections: A Case Report

    PubMed Central

    Vahdat, Mansoureh; Mehdizadeh, Abolfazl; Sariri, Elaheh; Chaichian, Shahla; Najmi, Zahra; Kadivar, Maryam

    2012-01-01

    Introduction. The incidence of placenta accreta has dramatically increased due to increasing caesarean section rate all over the world. Placenta percreta is the most severe form of placenta accretes. It frequently results in maternal morbidity and mortality mainly caused by massive obstetric hemorrhage or emergency hysterectomy. Percreta invading into the broad ligament has rarely been previously reported. Case presenting. We presented a case of placenta percreta invading left broad ligament and parametrium in a woman with two previous cesarean sections, which led to massive intraoperative hemorrhage during hysterectomy and transient ischemic encephalopathy. Conclusion. In cases of parametrial involvement, it would be more difficult to decide whether to remove placenta or leave it in site. In surgical removal neither local excision of placental bed and uterine repair nor traditional hysterectomy is adequate if parametrium invaded by placenta. We suggest delayed elective hysterectomy in such cases. So, pregnancy-induced pelvic congestion would be decreased, we can gather an expert team of gynecologists, urologists, and vascular surgeons, we could get plenty of blood products, and we may have the chance to administer methotrexate. PMID:23097727

  10. Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia

    PubMed Central

    Voigt, Matthias; Fröhlich, Christian W.; Hüttel, Christiane; Kranke, Peter; Mennen, Jan; Boessneck, Oliver; Lenz, Christian; Erbes, Thalia; Ernst, Jürgen; Kerger, Heinz

    2013-01-01

    Background This paper describes a randomized prospective study conducted in 308 patients undergoing caesarean section in spinal anaesthesia at a single hospital between 2010 and 2012 to find a suitable anti-emetic strategy for these patients. Material/Methods Spinal anesthesia was performed in left prone position, at L3/L4 with hyperbaric 0.5% Bupivacaine according to a cc/cm body height ratio. There were no opioids given peri-operatively. The patients received either no prophylaxis (Group I) or tropisetron and metoclopramide (Group II) or dimenhydrinate and dexamethasone (Group III), or tropisetron as a single medication (Group IV). The primary outcome was nausea and/or vomiting (NV) in the intraoperative, early (0–2 h) or late (2–24 h) postoperative period. Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation. Results All prophylactic agents significantly reduced NV incidence intraoperatively. Relative risk reduction for NV by prophylaxis was most effective (59.5%) in Group II (tropisetron and metoclopramide). In Group III (dimenhydrinate and dexamethasone), NV risk was reduced by 29.9% and by 28.7% in Group IV (tropisetron mono-therapy). The incidence of NV in the early (0–2 h) and the late (2–24 h) postoperative period was low all over (7.8%), but the relative risk reduction of NV in the early postoperative period was 54.1% (Group IV), 45.1% (Group III), and 34.8% (Group II), respectively. In the late postoperative period, there was no significant difference between the 4 groups. Conclusions We recommend a prophylactic medication with tropisetron 2 mg and metoclopramide 20 mg for patients during caesarean section. These agents are safe, reasonably priced, and highly efficient in preventing nausea and vomiting. PMID:24226381

  11. Transvaginal Surgical Management of Cesarean Scar Pregnancy II (CSP-II): An Analysis of 25 Cases

    PubMed Central

    Zhang, Hui; Shi, Junrong; Yang, Yong’An; Liang, Yijuan; Gao, Xinping; Wang, Jing; Liu, Hui; Wu, Bingge; Zhao, Jinhui

    2015-01-01

    Background The aim of this study was to investigate the feasibility and clinical value of transvaginal surgical treatment for cesarean scar pregnancy (CSP-II). Material/Methods This study was a retrospective analysis of 25 CSP-II patients who received transvaginal surgical treatments. These patients were admitted in our hospital between January 2010 and June 2012. Results All surgical treatments were successful without overt complications. The average operation time was 61.5 minutes, the average intraoperative blood loss was 60.5 ml, the average hospital stay was 9.4 days and the average time that blood β-human chorionic gonadotropin (β-HCG) returned to normal range was 15 days. In all 25 patients, the cesarean scar mass located at the anterior wall of the lower uterine segment disappeared by B-ultrasound examination within 1 or 2 weeks after surgery. Postoperatively, the normal menstrual period started again with an average time of 28.9 days. No menstruation-related abnormalities, such as menstrual dripping or an abnormal amount of blood, were reported after surgery. Conclusions Transvaginal surgery for CSP-II is a novel surgical approach. It has several advantages, including a thorough one-time treatment lesion clearance, short operation time, minimized trauma, minimal intraoperative blood loss, quick reduction of blood β-HCG, and rapid menstruation recovery. It is a simple and feasible surgical approach of great clinical value and few treatment-related complications. PMID:26520674

  12. Delivery by Cesarean Section is not Associated With Decreased at-Birth Fracture Rates in Osteogenesis Imperfecta

    PubMed Central

    Bellur, S; Jain, M; Cuthbertson, D; Krakow, D; Shapiro, JR; Steiner, RD; Smith, PA; Bober, MB; Hart, T; Krischer, J; Mullins, M; Byers, PH; Pepin, M; Durigova, M; Glorieux, FH; Rauch, F; Sutton, VR; Lee, B; Nagamani, SC

    2015-01-01

    Purpose Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. Methods We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. Results When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Conclusion Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI. PMID:26426884

  13. Cesarean Sections Among Syrian Refugees in Lebanon from December 2012/January 2013 to June 2013: Probable Causes and Recommendations

    PubMed Central

    Huster, Karin M.J.; Patterson, Njogu; Schilperoord, Marian; Spiegel, Paul

    2014-01-01

    Introduction: There are nearly 3 million Syrian refugees, with more than 1 million in Lebanon. We combined quantitative and qualitative methods to determine cesarean section (CS) rates among Syrian refugees accessing care through United Nations High Commissioner for Refugees (UNHCR)-contracted hospitals in Lebanon and possible driving factors. Methods: We analyzed hospital admission data from UNHCR’s main partners from December 2012/January 1, 2013, to June 30, 2013. We collected qualitative data in a subset of hospitals through semi-structured informant interviews. Results: Deliveries accounted for almost 50 percent of hospitalizations. The average CS rate was 35 percent of 6,366 deliveries. Women expressed strong preference for female providers. Clinicians observed that refugees had high incidence of birth and health complications diagnosed at delivery time that often required emergent CS. Discussion: CS rates are high among Syrian refugee women in Lebanon. Limited access and utilization of antenatal care, privatized health care, and male obstetrical providers may be important drivers that need to be addressed. PMID:25191143

  14. Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomized prospective study

    PubMed Central

    Aksoy, Hüseyin; Aksoy, Ülkü; Yücel, Burak; Özyurt, Sezin Saygı; Açmaz, Gökhan; Babayiğit, Mustafa Alparslan; Gökahmetoğlu, Günhan; Aydın, Turgut

    2015-01-01

    Objective We aimed to compare the effect of general and spinal anesthesia on maternal blood loss in elective cesarean section (CS). Material and Methods This was a prospective randomized study and included 418 healthy pregnant women with a term uncomplicated singleton pregnancy between 37 and 41 weeks of gestation. The study participants were randomly divided into two groups: the general anesthesia group and spinal anesthesia group. CSs were all performed using the same surgical technique, and within the groups, the same anesthetic procedures were used (either general or spinal). The primary outcome for this study was operative blood loss. Hemoglobin and hematocrit concentrations were compared between the two groups. Results The preoperative hemoglobin and hematocrit levels were similar in the both groups (p=0.08 and p=0.239, respectively). Significantly lower operative blood loss was achieved using spinal anesthesia versus general anesthesia during elective CS. The differences between preoperative and postoperative blood values for both the study groups were statistically significant (p<0.001). Conclusion This study demonstrates that spinal anesthesia is associated with a lower risk of operative blood loss than general anesthesia in low risk patients undergoing elective CS. PMID:26401109

  15. [Neuro-autonomic inhibition and haemodynamics management optimization during cesarean section under spinal anaesthesia in pregnant women with gestosis].

    PubMed

    Gur'ianov, V A; Shumov, I V

    2012-01-01

    Results showed that autonomic nervous system (ANS) and blood circulation system (BCS) dysfunction in 3rd trimester pregnant women with gestosis are more pronounced, than in healthy pregnant women, despite the prescribed treatment. The most significant disturbances were vagotonia and hypokinetic haemodynamics type (often iatrogenic). Spinal anaesthesia (SA) during Cesarean section in pregnant women is accompanied by blood pressure decrease to the level demanding on vasopressors use. Considering normal indicators of SI, CI, oxygen transportation and electrocardiogram vasopressor was not introduced Apgar score assessment of newborns was within normal. However, vagotonia and hypokinetic haemodynamics type during anaesthesia that certifies autoregulation reserves insufficiency. Atropine introduction in pregnant women with vagotonia and hypokinetic haemodynamics type (often iatrogenic, owing to irrational therapy) before SA beginning of promoted neurovegetative inhibition optimization and haemodynamics stabilization in eukinetic range. Vagus blockade (elimination of ANS dysfunction) was accompanied by more physiologic sympathicotonia development with smaller decrease of blood pressure (without stroke index reduction!), absence of bradycardia and vomiting. Research showed that the blood pressure cannot be the only objective criterion of vasopressors use. PMID:23662521

  16. Comparison of Oxidative Stress Markers and Serum Cortisol between Normal Labor and Selective Cesarean Section Born Neonates

    PubMed Central

    Nejad, Rasoul Kaviany; Shfiee, Gholamreza; Pezeshki, Nasrolah; Sohrabi, Maryam

    2016-01-01

    Introduction An imbalance between antioxidant and oxidant-generating systems in newborns can cause oxidative damage. The effect of modes of delivery on oxidative stress in neonates is not fully investigated. Aim This study was aimed to examine the effects of modes of delivery on oxidative stress markers and cortisol in newborns. Materials and Methods In this study 60 term neonates {30 born via Normal Delivery (ND) and 30 born via elective Caesarean Delivery (CS)} at birth were enrolled. Glutathione Peroxidase (GPx), Catalase (CAT) and Superoxide Dismutase (SOD) activities were determined in umbilical cord blood in all neonates. Moreover serum cortisol, uric acid and Total Antioxidant Capacity (TAC) were measured. Results GPx and SOD activities in cesarean born neonates were significantly higher than those of control subjects (p<0.05). TAC and CAT were not significantly different between the two groups. Serum cortisol was lower in caesarean born subjects as compared to normal born neonates. On the other hand uric acid concentration was higher in caesarean born neonates. Conclusion The obtained data indicated that babies born via caesarean section might be predisposed to pathological conditions due to altered antioxidant levels.

  17. Hemodynamic Changes Following Endotracheal Intubation in Patients Undergoing Cesarean Section With General Anesthesia: Application of Glidescope® Videolaryngoscope Versus Direct Laryngoscope

    PubMed Central

    Amini, Shahram; Shakib, Majid

    2015-01-01

    Background Endotracheal intubation is usually associated with hemodynamic changes, especially in patients undergoing cesarean section by general anesthesia. GlideScope® videolaryngoscope (GVL) is a novel video laryngoscope, which does not need direct exposure of vocal cords and produces lesser hemodynamic changes due to lower degrees of trauma and stimuli to oropharynx than the Macintosh direct laryngoscope (MDL). Objectives The aim of this study was to compare hemodynamic changes following endotracheal intubation with GVL and MDL in patients undergoing cesarean section by general anesthesia. Materials and Methods Seventy patients undergoing elective cesarean section by general anesthesia requiring endotracheal intubation were randomly allocated to be intubated with either GVL (n = 35) or MDL (n = 35). Systolic, diastolic and mean arterial blood pressure (MAP), as well as pulse rates, and rate pressure product (RPP) were compared at baseline, after induction of anesthesia, and after intubation at one-minute interval for five minutes between the two groups. The patients were also compared for Mallampati score, sore throat, intubation time and neonates’ Apgar scores. Results The patients were similar regarding systolic, diastolic and mean arterial blood pressure. Pulse rate changes were significantly lower only at 1 and 3 minutes in the GVL group. The intubation times were 9.3 ± 1.4 and 10.6 ± 1.7 seconds in the MDL and GVL groups, respectively (P > 0.05). RPP was also lower in the GVL group at 1 and 2 minutes (P < 0.05) and returned to baseline afterwards. There was no significant difference between the groups for Mallampati score, sore throat and Apgar scores. Conclusions Our study revealed that hemodynamic parameters with GVL are only better preserved in the first three minutes after intubation in patients undergoing elective cesarean section and patients are similar regarding intubation time, sore throat and Apgar score. PMID:25866708

  18. [General Anesthesia Using Remifentanil for Cesarean Section in a Parturient with Marfan Syndrome Associated with Heart Failure due to Severe Mitral Regurgitation].

    PubMed

    Fujita, Masahide; Satsumae, Tsuyoshi; Tanaka, Makoto

    2016-05-01

    A 24-year-old woman with Marfan syndrome was scheduled for cesarean section in order to avoid progression of heart failure due to severe mitral regurgitation and aortic dissection during labor. Cesarean section was performed under general anesthesia using remifentanil. Anesthesia was induced and maintained with remifentanil (0.1-0.3 μg x kg(-1) x min(-1)) and continuous administration of propofol (target-controlled infusion, 2-3 ng x ml(-1)). The trachea was intubated without a significant hemodynamic change. The patient's systolic blood pressure was maintained between 90 and 120 mmHg during surgery. Intraoperatively, we conducted a transesophageal echocardiography examination, and no remarkable change was seen in the severity of mitral regurgitation and the size of an ascending aorta. An infant was delivered 6 minutes after anesthesia induction. The Apgar scores were 4 at 1 min, 5 at 5 min and 8 at 10 min. Postoperative course was uneventful. We conclude that remifentanil can be used successfully to manage cesarean section of a parturient with Marfan syndrome associated with heart failure due to severe mitral regurgitation under general anesthesia. PMID:27319100

  19. Uterine Healing after Therapeutic Intrauterine Administration of TachoSil (Hemostatic Fleece) in Cesarean Section with Postpartum Hemorrhage Caused by Placenta Previa

    PubMed Central

    Fuglsang, Katrine; Dueholm, Margit; Stæhr-Hansen, Estrid; Petersen, Lone Kjeld

    2012-01-01

    Background. Application of hemostatic fleece (TachoSil) directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa. Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing. Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects. Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility. PMID:22619722

  20. [Indications for cesarean section and their outcome at the Hospital Center in Libreville].

    PubMed

    Picaud, A; Nlome-Nze, A R; Kouvahe, V; Faye, A; Ondo-Mve, R

    1990-06-01

    Over a 16-year period and 113,739 deliveries, the rate of caesarean sections in the Department of Gynecology-Obstetrics of the Centre Hospitalier of Libreville (Gabon) reaches 1.79 p. cent. Since 1985, there is a highly significant (p less than 0.001) of that rate reaching 2.33 p. cent. A comparative study of two 4-year periods (1981-1984 and 1985-1988) permits to analyze the evolution of caesarean sections. The increase is the result of an improved diagnosis of the pathology during pregnancy, especially pre-eclampsia (6.2 p. cent of indications), a better obstetrical monitoring in pelvic deliveries (7 p. cent) and screening of fetal distress (11 p. cent). The indications remain stable in mechanical dystocias and placenta praevia (40 p. cent) and for scarred uterus (19 p. cent) the rate of which remains at 1 p. cent of the deliveries. The decreased rate of perinatal mortality which has benefited from the improvement of the quality of care is not directly related to the increased rate of caesarean sections: in Africa, caesarean sections are still performed in harmful conditions for saving the mother. Maternal mortality remains high (160 of 100,000 NB) and the mortality of caesarean sections is 9 for 1,000, with only 4 p. 1,000 related to the C. section itself and not to the pathology requiring the procedure. The mortality of caesarean section is 5 times higher than that of vaginal deliveries. Caesarean sections results in uterine ruptures during subsequent pregnancies (2 p. cent of scarred uterus). The increased of caesarean sections may only be considered within the scope of concomitant improvement of prenatal monitoring, obstetrical monitoring and neonatal medicine. PMID:2202041

  1. The effect of the use of a new type of partogram on the cesarean section rates

    PubMed Central

    Vlachos, Georgios; Tsikouras, Panagiotis; Manav, Bachar; Trypsianis, Grigorios; Liberis, Vasileios; Karpathios, Sakellarios; Galazios, Georgios

    2015-01-01

    Objective To assess the contribution of a new type of partogram, used in labor monitoring, in caesarean section rates. Material and Methods The study included term singleton uncomplicated pregnancies divided into two groups. Two types of partogram were used in labor monitoring. In the first group, the classical WHO partogram (A) was used. In the second group, a new type of partogram, in which cervical dilatation and the position of descending head (B) (one line) were estimated and reported, was used. The labor duration and caesarean section rates were calculated and compared in the two groups. Results A statistically significant decrease in labor duration (from the initiation of the active phase of labor to the delivery time) (dt1+dt2+dt3) (p<0.001, A: median: 318.4±10.4 min, B: 246.56±8.28 min) and in caesarean section rates was noted (p<0.001, A: 89 vs B: 49). Conclusion The new type of partogram seems to have potential benefits such as reducing the incidence of prolonged labor and decreasing the caesarean section rates. PMID:26401106

  2. [Non elective cesarean section: use of a color code to optimize management of obstetric emergencies].

    PubMed

    Rudigoz, René-Charles; Huissoud, Cyril; Delecour, Lisa; Thevenet, Simone; Dupont, Corinne

    2014-06-01

    The medical team of the Croix Rousse teaching hospital maternity unit has developed, over the last ten years, a set of procedures designed to respond to various emergency situations necessitating Caesarean section. Using the Lucas classification, we have defined as precisely as possible the degree of urgency of Caesarian sections. We have established specific protocols for the implementation of urgent and very urgent Caesarean section and have chosen a simple means to convey the degree of urgency to all team members, namely a color code system (red, orange and green). We have set time goals from decision to delivery: 15 minutes for the red code and 30 minutes for the orange code. The results seem very positive: The frequency of urgent and very urgent Caesareans has fallen over time, from 6.1 % to 1.6% in 2013. The average time from decision to delivery is 11 minutes for code red Caesareans and 21 minutes for code orange Caesareans. These time goals are now achieved in 95% of cases. Organizational and anesthetic difficulties are the main causes of delays. The indications for red and orange code Caesarians are appropriate more than two times out of three. Perinatal outcomes are generally favorable, code red Caesarians being life-saving in 15% of cases. No increase in maternal complications has been observed. In sum: Each obstetric department should have its own protocols for handling urgent and very urgent Caesarean sections. Continuous monitoring of their implementation, relevance and results should be conducted Management of extreme urgency must be integrated into the management of patients with identified risks (scarred uterus and twin pregnancies for example), and also in structures without medical facilities (birthing centers). Obstetric teams must keep in mind that implementation of these protocols in no way dispenses with close monitoring of labour. PMID:26983190

  3. Sleep Trajectories of Women Undergoing Elective Cesarean Section: Effects on Body Weight and Psychological Well-Being

    PubMed Central

    Tzeng, Ya-Ling; Chen, Shu-Ling; Chen, Chuen-Fei; Wang, Fong-Chen; Kuo, Shu-Yu

    2015-01-01

    Background After cesarean section (CS), women may be at great risk for sleep disturbance, but little is known about temporal changes in their sleep patterns and characteristics. We had two aims: 1) to identify distinct classes of sleep-disturbance trajectories in women considering elective CS from third-trimester pregnancy to 6 months post-CS and 2) to examine associations of sleep trajectories with body mass index (BMI), depressive symptoms, and fatigue scores. Methods We analyzed data from a prospective cohort study of 139 Taiwanese pregnant women who elected CS. Sleep components were assessed using the Pittsburgh Sleep Quality Index in third-trimester pregnancy, 1 day, 1 week, 1 month, and 6 months post-CS. Data were collected on depressive symptoms, fatigue symptoms, and BMI. Sleep-quality trajectories were identified by group-based trajectory modeling. Results We identified three distinct trajectories: stable poor sleep (50 women, 36.0%), progressively worse sleep (67 women, 48.2%), and persistently poor sleep (22 women, 15.8%). Poor sleep was significantly associated with pre-pregnancy BMI and more baseline (third-trimester pregnancy) depressive and fatigue symptoms. At 6 months post-CS, women classified as progressively worse or persistently poor sleepers showed a trend toward higher BMI (p<0.03), more depressive symptoms (p<0.001), and higher fatigue scores (p<0.001) than those with stable poor sleep. Conclusions Women had three distinct sleep-disturbance trajectories before and after elective CS. These poor-sleep courses were associated with BMI and psychological well-being. Our findings suggest a need to continuously assess sleep quality among women considering elective CS and up to 6 months post-CS. PMID:26066326

  4. Postnatal cardiovascular and metabolic responses to a single intramuscular dose of betamethasone in fetal sheep born prematurely by cesarean section.

    PubMed

    Padbury, J F; Polk, D H; Ervin, M G; Berry, L M; Ikegami, M; Jobe, A H

    1995-11-01

    Although the benefits of antenatal hormone treatment are well accepted, most studies have reported only pulmonary effects. There is evidence of beneficial cardiovascular and metabolic effects in studies using chronically catheterized animals; however because of the route of administration, the results are not directly applicable to clinical strategies. We previously demonstrated significant pulmonary effects in animals treated antenatally with a single, direct fetal, intramuscular injection of glucocorticoids. This study was performed to determine the effects of a single fetal injection of betamethasone (BETA) alone or in combination with thyroxine (T4) on cardiovascular and metabolic responses after preterm birth. Hemodynamic and metabolic responses at birth were determined in fetuses (126-d gestation; term = 150 d) treated with ultrasound-guided intramuscular injections of 0.5 mg/kg BETA (n = 7), BETA plus 60 g/kg T4 (n = 7), or saline (SAL, n = 9). After 48 h, lambs were delivered by cesarean section and studied for 3 h. BETA treatment increased mean arterial blood pressure [56 +/- 6 (SEM) versus 42 +/- 3 mm Hg], heart rate (152 +/- 5 versus 123 +/- 4 beats/min), and cardiac output (467 +/- 17 versus 349 +/- 36 mL/min/kg) versus SAL. Responses of BETA+T4-treated animals were not different from animals treated with BETA alone. Glucose and FFA were similar among all groups. The increase in catecholamine levels normally seen at birth was significantly attenuated in both the BETA and BETA+T4-treated animals. A single, intramuscular injection of glucocorticoids 48 h before delivery improves cardiovascular responses to preterm birth. This effect is not augmented by concomitant administration of T4. PMID:8552438

  5. [Post-mortem cesarean sections in Puerto Rico, 1805-1807].

    PubMed

    Rigau-Pérez, J G; Villaizán, M

    1991-03-01

    The idea of saving an infant by incising the abdomen of the recently deceased mother was first put into practice in ancient times, and the Catholic Church endorsed its use to provide baptism for the infant's soul. The practice received official support in Madrid in 1804 with a Real Cédula (royal order) of Charles IV to the civilian and ecclesiastic officials of the Indies and the Philippines. This operation was used, before the cédula, in Spain, Mexico, Venezuela and Peru, but in Puerto Rico this order seems to have provoked the practice of post-mortem caesarean section. In a review of burial records of the San Juan cathedral for 1797 to 1814, one such operation is mentioned (1807), but the records of Cayey (a town in the mountains) from 1801 to 1812 show three cases (1805-6). We transcribe here (with modern spelling) the cédula and burial certificates, and we then comment on their significance. PMID:1854384

  6. [Comparative studies on general anesthesia versus peridural anesthesia in primary cesarean section].

    PubMed

    Traub, E; Dick, W; Knoche, E; Muck, J; Kraus, H; Töllner, U

    1984-01-01

    In a prospective interdisciplinary study involving the departments of gynaecology, anaesthetics and paediatrics, the influence on both the mother and neonate of general as opposed to epidural anaesthesia was compared in 47 planned caesarean sections. Neither maternal or foetal risk factors were present in these cases, and the cardiotocogram was always normal before the anaesthetic was applied. Methods. Systolic and diastolic blood pressure were carefully monitored. Under an identical infusion regime the following parameters were estimated in maternal blood: blood gas and acid-base status, blood sugar, lactate, beta-hydroxybutyric acid, ACTH and cortisol. These same parameters were also estimated in cord blood taken at delivery. The Apgar score at 1, 5 and 10 minutes, and a complete paediatric assessment including neurostatus at 15 minutes, 24 hours and 7 days of age were used to assess neonatal status. Some of the women given a general anaesthetic initially had marked increases in blood pressure and pulse, while about a third of the epidural cases showed a blood pressure fall despite positioning in the left lateral position in order to prevent the aorto-caval syndrome. An increase in lactate, ACTH and cortisol was found in both groups up to the time of delivery, when the ACTH level of the general anaesthetic group was significantly higher. Acid-base and PCO2 values were not markedly influenced by either of the techniques used, but the maternal capillary PO2 levels were very much higher in the general anaesthetic group. The neonates born under general anaesthetic had a lower 1 min Apgar score, as a result of the relatively long induction-delivery time, of on average 17 min. The 5 and 10 min Apgar scores and the neurophysiological development of the babies revealed no differences between the two groups. PMID:6424182

  7. Cesarean Section: The Operation

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  8. [Cesarean scar pregnancy].

    PubMed

    Matyszkiewicz, Anna; Jach, Robert; Nocuń, Agnieszka; Posadzka, Ewa; Huras, Hubert; Pityński, Kazimierz; Wolski, Hubert; Basta, Paweł

    2015-10-01

    Pregnancy in the uterine scare after previous caesarean section is the rarest type of ectopic pregnancy Due to the possibility of life-threatening complications, cesarean scar pregnancy (CSP) needs rapid and proper diagnosis and management. Hereby we present 3 cases of women with CSP, diagnosed and treated at the Department of Gynecology and Obstetrics of Jagiellonian University Medical College, in Krakow, in 2013, as well as literature review. PMID:26677591

  9. A preliminary study of patients' perceptions on the implementation of the WHO surgical safety checklist in women who had Cesarean sections.

    PubMed

    Kawano, Takashi; Tani, Megumi; Taniwaki, Miki; Ogata, Kimiyo; Yokoyama, Masataka

    2015-06-01

    The surgical safety checklist (SSCL), developed by the World Health Organization, is widely implemented by surgical staff for the improvement of their communication, teamwork, and safety culture in the operating room. However, there is no research available addressing the question of how surgical patients perceive the implementation of the SSCL. In order to address this issue, a questionnaire-based preliminary study was conducted for patients who had undergone elective Cesarean section under awake regional anesthesia. Although most participants had not been informed about the implementation of the SSCL before surgery, all of the patients were aware that the SSCL had been performed in the operating room. Over 80% of patients answered that the implementation of the SSCL could help to reduce their feelings of anxiety, tension, and fear, as well as enhance their feeling of security. Furthermore, most patients answered that they were able to understand the components as well as the purpose of the SSCL, and considered that the SSCL should be implemented. These results suggest that awake patients undergoing Cesarean section perceive the implementation of the SSCL to be a highly positive aspect of their surgical care. PMID:25374137

  10. Cesarean delivery on maternal request: wise use of finite resources? A view from the trenches.

    PubMed

    Druzin, Maurice L; El-Sayed, Yasser Y

    2006-10-01

    current evidence regarding cesarean delivery on maternal request, promotion of primary cesarean section on request as a standard of care or as a mandated part of patient counseling for delivery will result in a highly questionable use of finite resources. As of 2004, 46 million Americans did not even have basic health insurance. It is critical that we not allow ourselves to be dragged into the eye of a "perfect storm." This conference is an important step in the rational and objective analysis of this issue. PMID:17011403

  11. Maternal Position and Development of Hypotension in Patients undergoing Cesarean Section under Combined Spinal-Epidural Anesthesia of Intrathecal Hyperbaric Ropivacaine

    PubMed Central

    Wang, Xin; Xu, Jun-Mei; Zhou, Fan; He, Liang; Cui, Yu-Long; Li, Zhi-Jian

    2015-01-01

    Background Spinal anesthesia (SA) is usually associated with hypotension in pregnant women. We sought to assess the influence of various maternal positions on SA-induced hypotension. Material/Methods The study population comprised 99 women at full-term gestation scheduled for elective cesarean section. They were randomized into 3 equal groups: the LL group, in which the patient was placed in the full left-lateral position until the start of surgery with the Whitacre needle bevel oriented laterally; the LS group, in which the patient was placed in the full left-lateral position initially and then shifted to the left-tilt supine position with the needle bevel oriented laterally; and the CS group, in which the patient was initially placed in the full left-lateral position and then shifted to the left-tilt supine position with the needle oriented in the cephalad direction. Results The incidences of hypotension in the LL, LS, and CS groups were 9.7%, 54.8%, and 56.3%, respectively. Ephedrine requirements were lower in the LL group than in the LS group (P<0.01). Conclusions The maternal position during the induction of anesthesia played an important role in the development of hypotension during cesarean delivery. PMID:25557016

  12. Comparative study between nalbuphine and ondansetron in prevention of intrathecal morphine-induced pruritus in women undergoing cesarean section

    PubMed Central

    Moustafa, Ahmed A. M.; Baaror, Amr Samir; Abdelazim, Ibrahim A.

    2016-01-01

    Background: Intrathecal morphine provides effective postoperative analgesia, but their use is associated with numerous side effects, including pruritus, nausea, vomiting, urinary retention, and respiratory depression. Pruritus is the most common side effect with a reported incidence of 58–85%. Objectives: This prospective, randomized, and double-blinded study was performed for women scheduled for cesarean delivery using spinal anesthesia to compare nalbuphine and ondansetron in the prevention of intrathecal morphine-induced pruritus. Patients and Methods: Ninety women after spinal anesthesia with hyperbaric bupivacaine and intrathecal morphine patients randomly divided into three groups. Women in placebo group (P group) received 4 ml of normal saline intravenous (IV) injection, nalbuphine group (N group) received 4 ml of a 4 mg nalbuphine IV injection, and ondansetron 4 group (O group) received 4 ml of a 4 mg ondansetron IV injection, immediately after delivery of the baby. Studied women observed in postanesthesia care unit for 4 h. The primary outcome measures success of the treatment, defined as a pruritus score 1 (no pruritus) or 2 (mild pruritus - no treatment required) at 20 min after treatment. Results: Although, three was no significant difference between the three studied groups regarding; score 1 pruritus, while, score 2 pruritus (mild pruritus - no treatment requested) was significantly high in N and O groups compared to placebo group. Pruritus score 1 (no pruritus) plus pruritus score 2 were significantly high in N and O groups compared to placebo group (20 cases, 20 cases, 5 cases; respectively, P = 0.008). In addition; score 3 pruritus (moderate - treatment requested) was significantly less in N and O groups compared to placebo group. Conclusion: Nalbuphine and ondansetron were found to be more effective than placebo for prevention of intrathecal morphine-induced pruritus in women undergoing cesarean delivery and nalbuphine is preferred than

  13. [Usefullness of Beta-blocker for Hemodynamic Changes Induced by Uterotonic Drug in a Patient with Hypertrophic Obstructive Cardiomyopathy Undergoing Elective Cesarean Section].

    PubMed

    Tsukano, Yuri; Sugita, Michiko; Ikuta, Yoshihiro; Yamamoto, Tatsuo

    2015-06-01

    Combined spinal-epidural anesthesia (CSEA) was given to a 27-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) for a selective cesarean section. After the injection of uterotonic drug via uterine muscle and a vein after delivery, the patient developed dyspnea, tachycardia, ST-change on elecrocardiogram and hypotension. It is important in HOCM patients to control heart rate and left ventricular contractile force. We started to infuse beta-blocker (landiolol, 10 μg x kg(-1) x min(-1)) and improved these symptoms of the patient. This case demonstrates that CSEA is safe for HOCM patients and beta-blocker is effective to improve hemodynamic changes induced by uterotonic drug in these patients. PMID:26437557

  14. Sufentanil and Bupivacaine Combination versus Bupivacaine Alone for Spinal Anesthesia during Cesarean Delivery: A Meta-Analysis of Randomized Trials

    PubMed Central

    Yan, Jianqin; Wang, Ruike; Wang, Ying; Xu, Mu

    2016-01-01

    Objective The addition of lipophilic opioids to local anesthetics for spinal anesthesia has become a widely used strategy for cesarean anesthesia. A meta-analysis to quantify the benefits and risks of combining sufentanil with bupivacaine for patients undergoing cesarean delivery was conducted. Methods A comprehensive literature search without language or date limitation was performed to identify clinical trials that compared the addition of sufentanil to bupivacaine with bupivacaine alone for spinal anesthesia in healthy parturients choosing cesarean delivery. The Q and I2 tests were used to assess heterogeneity of the data. Data from each trial were combined using relative ratios (RRs) for dichotomous data or weighted mean differences (WMDs) for continuous data and corresponding 95% confidence intervals (95% CIs) for each trial. Sensitivity analysis was conducted by removing one study a time to assess the quality and consistency of the results. Begg’s funnel plots and Egger’s linear regression test were used to detect any publication bias. Results This study included 9 trials containing 578 patients in the final meta-analysis. Sufentanil addition provided a better analgesia quality with less breakthrough pain during surgery than bupivacaine alone (RR = 0.10, 95% CI 0.06 to 0.18, P < 0.001). Sensory block onset time was shorter and first analgesic request time was longer in sufentanil added group compared with the bupivacaine-alone group (WMD = −1.0 min, 95% CI −1.5 to −0.58, P < 0.001 and WMD = 133 min, 95% CI 75 to 213, P < 192, respectively). There was no significant difference in the risk of hypotension and vomiting between these two groups. But pruritus was more frequentely reported in the group with sufentanil added (RR = 7.63, 95% CI 3.85 to 15.12, P < 0.001). Conclusion Bupivacaine and sufentanil combination is superior to that of bupivacaine alone for spinal anesthesia for cesarean delivery in analgesia quality. Women receiving the combined two

  15. The Effects of Diclofenac Suppository and Intravenous Acetaminophen and their Combination on the Severity of Postoperative Pain in Patients Undergoing Spinal Anaesthesia During Cesarean Section

    PubMed Central

    Niaki, Alireza Seyedi; Jafari, Seyed Yaghoub; Yousefi, Zahra; Aryaie, Mohammad

    2016-01-01

    Introduction The main tasks of postoperative care are postoperative pain and complications control which play an important role in accelerating the recovery of patient’s general condition. Aim This study was performed in order to compare the effects of diclofenac suppository, intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia for cesarean section in Sayyad Shirazi teaching Hospital, Gorgon, Iran. Materials and Methods This was a double-blind clinical trial on 90 patients undergoing cesarean section. The patients were randomly divided into three groups, group A: 100 mg diclofenac suppository, group B: 1000 mg intravenous acetaminophen, group C: 100 mg diclofenac suppository and 500 mg intravenous acetaminophen. The same spinal anaesthesia circumstances were applied for all the participants. At the end of surgery, pain severity was assessed according to VAS scale at different times. Data were then analysed by SPSS 18 statistical software. Results The mean age of participants was (28.27±6.07). There was significant difference between the mean pain scores of the three groups before the intervention (p=0.018), which was considered as co-variate. This difference was more notable between the combination of acetaminophen – diclofenac group and diclofenac alone. After the intervention, significant difference was observed in mean pain severity between acetaminophen group and the combination group and also between diclofenac and the combination group. During the study, the least mean pain severity was found in the combination group and the highest was observed in the diclofenac group. Conclusion Results of this study indicates a significant effect of concomitant use of intravenous acetaminophen and diclofenac suppository on pain severity reduction and reducing the need for repeated doses of narcotics and prolonging the postoperative analgesia.

  16. Repeat spinal anesthesia in cesarean section: A comparison between 10 mg and 12 mg doses of intrathecal hyperbaric (0.05%) bupivacaine repeated after failed spinal anesthesia: A prospective, parallel group study

    PubMed Central

    Bhar, Debasish; RoyBasunia, Sandip; Das, Anjan; Chhaule, Subinay; Mondal, Sudipta Kumar; Bisai, Subrata; Chattopadhyay, Surajit; Mandal, Subrata Kumar

    2016-01-01

    Background: Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anesthesia for cesarean section fails to obtain any sensory or motor block. Very few studies and literature are available regarding repeat administration of spinal anesthesia and its drug dosage, especially after first spinal failure in cesarean section lower segment cesarean section (LSCS) due to fear of the excessive spread of drug. The aim of our study is to compare the outcome between two different doses of 0.5% hyperbaric bupivacaine repeated intrathecally after failed spinal. Materials and Methods: After taking informed consent and Ethical Committee approval this prospective, randomized single-blinded study was conducted in 100 parturients of American Society of Anesthesiologists I-II who were posted for elective LSCS and had Bromage score 0 and no sensory block even at L4 dermatome after 10 min of first spinal anesthesia; were included in the study. Group A (n = 50) patients received 2.4 ml and Group B (n = 50) patients received 2 ml of 0.5% hyperbaric bupivacaine respectively for administering repeat spinal anesthesia. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation, respiratory rate and electrocardiogram were monitored both intra- and post-operatively and complications were recorded. Results: Incidence of high spinal, bradycardia, hypotension, respiratory complications, and nausea vomiting are significantly higher in Group A compared to Group B (P < 0.05). SBP, DBP, and HR were significantly low in Group A patients compared to Group B in the first 10 min (P < 0.05). Conclusion: Spinal anesthesia can be safely repeated in the cesarean section with 10 mg of 0.5% hyperbaric bupivacaine provided after first spinal anesthesia, the level of sensory block is below L4 and motor power in Bromage scale is 0. PMID:27212775

  17. Development of Strategies to Reduce Cesarean Delivery Rates in Iran 2012–2014: A Mixed Methods Study

    PubMed Central

    Lotfi, Razieh; Tehrani, Fahimeh Ramezani; Dovom, Marzieh Rostami; Torkestani, Farahnaz; Abedini, Mehrandokht; Sajedinejad, Sima

    2014-01-01

    Background: With the change in population policy from birth control toward encouraging birth and population growth in Iran, repeated cesarean deliveries as a main reason of cesarean section are associated with more potential adverse consequences. The aim of this research was to explore effective strategies to reduce cesarean delivery rates in Iran. Methods: A mixed methodological study was designed and implemented. First, using a qualitative approach, concepts and influencing factors of increased cesarean delivery were explored. Based on the findings of this phase of the study, a questionnaire including the proposed strategies to reduce cesarean delivery was developed. Then in a quantitative phase, the questionnaire was assessed by key informants from across the country and evaluated to obtain more effective strategies to reduce cesarean delivery. Ten participants in the qualitative study included policy makers from the Ministry of Health, obstetricians, midwives and anthropologists. In the next step, 141 participants from private and public hospitals, insurance experts, Academic Associations of Midwifery, and policy makers in Maternity Health Affairs of Ministry of Health were invited to assess and provide feedback on the strategies that work to reduce cesarean deliveries. Results: Qualitative data analysis showed four concept related to increased cesarean delivery rates including; “standardization”, “education”, “amending regulations”, and “performance supervision”. Effective strategies extracted from qualitative data were rated by participants then, using ACCEPT derived from A as attainability, C as costing, C as complication, E as effectiveness, P as popularity, and T as timing table 19 strategies were detected as priorities. Conclusions: Although developing effective strategies to reduce cesarean delivery rates is complex process because of the multi-factorial nature of increased cesarean deliveries, in this study we have achieved strategies

  18. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia

    PubMed Central

    Sane, Shahryar; Hasanlui, Mohammadamin Valizadeh; Abbasivash, Rahman; Mahoori, Alireza; Hashemi, Seyed Taghi; Rafiei, Fahime

    2015-01-01

    Background: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of postdelivery intra- and post-operative nausea and vomiting during CS under spinal anesthesia. Materials and Methods: A randomized, prospective, double-blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. The patients received 4 mg ondansetron in Group O, 8 mg dexamethasone in Group D, and 4 mg ondansetron +8 mg dexamethasone in Group OD intravenously within 1–2 min after the umbilical cord was clamped. Frequency of postdelivery intra- and post-operative nausea and vomiting episodes was recorded. Results: A total of 90 eligible patients were included in the study. There were 30 patients in Group O, 30 patients in Group D, and 30 patients in Group OD. Intraoperative nausea in Group D was more than the other two groups. Postoperative nausea in group OD was lesser than the other two groups. Intraoperative vomiting in Group OD was lesser than the other two groups. There was no statistically significant difference among the groups in postoperative vomiting (P > 0.05). Conclusion: Combined use of dexamethasone and ondansetron for the same indication seems to increase the antiemetic efficacy. PMID:26623405

  19. Iliofemoral-popliteal deep vein thrombosis at 35(th) week of pregnancy: treated with cesarean section and vena cava blockage plus thrombectomy.

    PubMed

    Mehmet Burgazlı, K; Altay, Metin M; Akdere, Hakan; Bilgin, Mehmet; Kavukcu, Ethem; Kill, Horst; Päfgen, Werner; Kubilay Ertan, A

    2012-01-01

    Pregnancy, due to its adaptive physiological changes, is a risk factor for deep vein thrombosis. Incidence of thromboembolic complications during pregnancy ranges from 0.76 to 1.72 per 1000 births. We present in this case report a pregnant woman with iliofemoral-popliteal deep vein thrombosis diagnosed at the 35(th) week of her pregnancy, who was treated with vena cava blockage and thrombectomy followed by cesarean section. Unfortunately, a rethrombosis developed in the patient after three days. We determined that the a-v fistula was blocked and not working. We found additionally that the deep vein thrombosis was closing the iliac vein completely on the left side and the blockage descending down through the inferior vena cava inlet with MRI. The patient underwent insertion of a retrievable vena cava filter, two stent implantation to the venous narrowings and surgical iliofemoral venous thrombectomy with concomitant re-creation of a temporary femoral arterio-venous fistula. Anticoagulation therapy with enoxaparine was started after the operation. The patient was discharged with warfarin under control of the INR value, and also with additional compression therapy (compression stockings) from the clinic. Without jeopardizing the mother and the baby, planning a combined surgical procedure, with a multidisciplinary approach is the best way to eliminate the risks of serious complications such as pulmonary embolism and mortality. PMID:24592024

  20. Remote prognosis after primary cesarean delivery: the association of VBACs and recurrent cesarean deliveries with maternal morbidity

    PubMed Central

    Erez, Offer; Novack, Lena; Kleitman-Meir, Vered; Dukler, Doron; Erez-Weiss, Idit; Gotsch, Francesca; Mazor, Moshe

    2012-01-01

    Purpose To determine the effects of vaginal birth after cesarean (VBAC) versus repeated cesarean sections (RCS) after a primary cesarean section (CS), on the rate of intraoperative and postpartum maternal morbidity. Patients and methods This is a retrospective population-based cohort study. During the study period (1988–2005) there were 200,012 deliveries by 76,985 women at our medical center; 16,365 of them had a primary CS, of which 7429 women delivered a singleton infant after the primary CS, met the inclusion criteria, were included in our study, and were followed for four consecutive deliveries. Patients were divided into three study groups according to the outcome of their consecutive delivery after the primary CS: VBAC (n = 3622), elective CS (n = 1910), or an urgent CS (n = 1897). Survival analysis models were used to investigate the effect of the urgency of CS and the numbers of pregnancy predating the primary CS on peripartum complications. Results Women who failed a trial of labor had a higher rate of uterine rupture than those who had a VBAC. Patients who delivered by CS had a higher rate of endometritis than those giving birth vaginally. The rate of cesarean hysterectomy and transfer to other departments increased significantly at the fourth consecutive surgery (P = 0.02 and P = 0.003, respectively). VBAC was associated with a 55% reduction in the risk of intrapartum complications in comparison to a planned CS (hazard ratio [HR] 0.45; 95% confidence interval [CI]: 0.22–0.89. A greater maternal parity at the time of primary CS was associated with lower intrapartum and postpartum morbidities (HR 0.44; 95% CI: 0.24–0.79; HR 0.54; 95% CI: 0.47–0.62, respectively). Conclusions (1) A successful VBAC is associated with a reduction in the intrapartum complications; and (2) maternal morbidity increases substantially from the fourth consecutive cesarean delivery. PMID:22448111

  1. Usefulness of chewing gum for recovering intestinal function after cesarean delivery: A systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Huang, Hua-Ping; He, Mei

    2015-04-01

    Chewing gum has been reported to enhance bowel function. However, the efficacy remains unclear for women undergoing cesarean delivery. The aim of this meta-analysis is to evaluate the efficacy of chewing gum for recovering intestinal function following cesarean delivery in the early postoperative period. Electronic databases including MEDLINE, EMBASE, Cochrane Library were searched to identify English language randomized controlled trials comparing chewing gum with other procedures for promoting the recovery of intestinal function after cesarean delivery. Two of the authors independently extracted data from the eligibility studies, and Review Manager Version 5.2 was used to pool the data. Finally, five randomized controlled trials involving 882 patients were included and all the trials were considered as at high risk of bias. The pooled findings showed that chewing gum after cesarean delivery can significantly shorten the time to first flatus [standardized mean difference (SMD) = -0.73; 95% confidence interval (CI) = -1.01 to -0.14; p < 0.001]; time to first hearing of normal intestinal sounds (SMD = -0.69; 95% CI = -1.20 to -0.17; p = 0.009; I² = 92%). Time to the first defecation (SMD = -0.53; 95% CI = -1.61 to -0.07; p = 0.07; I² = 92%) and length of hospital stay (SMD = -0.59; 95% CI = -1.18 to 0.00; p = 0.05; I² = 93%) were also reduced in the chewing gum group; however, these results were not statistically significant. The current evidence suggests that chewing gum has a positive effect on intestinal function recovery following cesarean delivery in the early postoperative period. However, more large-scale and high-quality randomized controlled trials are needed to confirm these results. PMID:25951713

  2. The effect of low dose fentanyl as a premedication before induction of general anesthesia on the neonatal apgar score in cesarean section delivery: randomized, double-blind controlled trial

    PubMed Central

    Karbasy, Seyyed Hasan; Derakhshan, Pooya

    2016-01-01

    Background: The administration of opioids before induction of general anesthesia can be considered as a problem in cesarean section. The aim of this study was to compare the effects of intravenous Fentanyl as a premedication before induction of general anesthesia versus placebo on maternal hemodynamic parameters and on the first and fifth minutes Apgar score in the neonates in elective cesarean delivery. Methods: This double- blinded, randomized, clinical trial study was conducted in 2014-2015 at Vali-e-Asr hospital, Birjand, Iran. Ninety full term pregnant women undergoing elective cesarean section delivery under general anesthesia were selected. The participants were randomly classified into two groups: The Fentanyl group and the placebo. Iintravenous Fentanyl 1μg/kg was administrated three minutes before anesthesia induction for the Fentanyl group, and 2 milliliter normal saline was administered for the placebo group. Maternal mean arterial pressure, heart rate before the start of anesthesia induction and thirty seconds after intubation were measured. Also, the first and fifth minutes Apgar scores of the neonates were evaluated and recorded by a blinded anesthesiologist. The clinical trial registration number was IRCT2015010320112N3. Results: Maternal mean arterial pressure was significantly lower in the Fentanyl group than the placebo group after intubation. Heart rate was significantly higher in the placebo group before the start of anesthesia induction and after intubation compared to the Fentanyl group. The first and fifth minutes’ Apgar scores of the neonates were not statistically different between the two groups. Conclusion: Administration of 1μg/Kg intravenous Fentanyl before the induction of anesthesia for cesarean section delivery decreases maternal hemodynamic changes after intubation. In addition, it does not have any effect on Apgar scores of the neonate in the 1st and 5th minutes after birth. PMID:27493905

  3. On the cutting edge: ethical responsiveness to cesarean rates.

    PubMed

    Burrow, Sylvia

    2012-01-01

    Cesarean delivery rates have been steadily increasing worldwide. In response, many countries have introduced target goals to reduce rates. But a focus on target goals fails to address practices embedded in standards of care that encourage, rather than discourage, cesarean sections. Obstetrical standards of care normalize use of technology, creating an imperative to use technology during labor and birth. A technological imperative is implicated in rising cesarean rates if physicians or patients fear refusing use of technology. Reproductive autonomy is at stake since a technological imperative undermines patients' ability to choose cesareans or refuse use of technology increasing the likelihood of cesareans. To address practices driven by a technological imperative I outline three physician obligations that are attached to respecting patient autonomy. These moral obligations show that a focus on respect for autonomy may prove not only an ideal ethical response but also an achievable practical response to lowering cesarean rates. PMID:22694036

  4. Two syringe spinal anesthesia technique for cesarean section: A controlled randomized study of a simple way to achieve more satisfactory block and less hypotension

    PubMed Central

    Keera, Amr Aly Ismail; Elnabtity, Ali Mohamed Ali

    2016-01-01

    Background: Multiple trials have been tried to prevent hypotension during spinal anesthesia. However, the drug choice and mode of administration is still a matter of debate. Objectives: To compare the outcome of spinal injection of hyperbaric bupivacaine and fentanyl separately to standard injection of mixed fentanyl with hyperbaric bupivacaine. Settings and Design: A randomized, controlled clinical trial. Patients and Methods: One hundred twenty-four parturient scheduled for elective cesarean section were randomly allocated into two groups, each 62 parturient: Group M received spinal anesthesia using 10 mg bupivacaine 0.5% premixed with 25 μg fentanyl in the same syringe and Group S received 25 μg fentanyl in one syringe and 10 mg bupivacaine 0.5% without barbotage in a second syringe. Results: Patients with intraoperative pain that was controllable without the need for a shift to general anesthesia was significantly lower in Group S (3.2%) than in Group M (16.1%). The frequency of hypotension was significantly lower in Group S compared to Group M (P < 0.05). Time till the onset of sensory block was nonsignificantly shorter with nonsignificantly higher mean level of maximal sensory block in Group S compared to Group M (P > 0.05). There was no significant difference in the time till occurrence of hypotension, duration of hypotension, mean dose of ephedrine used for the treatment of hypotension and frequency of patients developed itching between the groups (P > 0.05). Conclusion: Separate intrathecal injection of fentanyl and hyperbaric bupivacaine provided a significant improvement in the quality of sensory block and significant reduction of the frequency of hypotension compared to injection of mixed medications. PMID:27212767

  5. Randomized Controlled Trial Evaluating Dialkylcarbamoyl Chloride Impregnated Dressings for the Prevention of Surgical Site Infections in Adult Women Undergoing Cesarean Section

    PubMed Central

    Bizoń, Magdalena; Cendrowski, Krzysztof; Sawicki, Włodzimierz

    2016-01-01

    Abstract Background: Surgical site infections (SSI) occur in 1.8%–9.2% of women undergoing cesarean section (CS) and lead to greater morbidity rates and increased treatment costs. The aim of the study was to evaluate the efficacy and cost-effectiveness of dialkylcarbamoyl chloride (DACC) impregnated dressings to prevent SSI in women subject to CS. Methods: Randomized, controlled trial was conducted at the Mazovian Bródno Hospital, a tertiary care center performing approximately 1300 deliveries per year, between June 2014 and April 2015. Patients were randomly allocated to receive either DACC impregnated dressing or standard surgical dressing (SSD) following skin closure. In order to analyze cost-effectiveness of the selected dressings in the group of patients who developed SSI, the costs of ambulatory visits, additional hospitalization, nursing care, and systemic antibiotic therapy were assessed. Independent risk factors for SSI were determined by multivariable logistic regression. Results: Five hundred and forty-three women undergoing elective or emergency CS were enrolled. The SSI rates in the DACC and SSD groups were 1.8% and 5.2%, respectively (p = 0.04). The total cost of SSI prophylaxis and treatment was greater in the control group as compared with the study group (5775 EUR vs. 1065 EUR, respectively). Independent risk factors for SSI included higher pre-pregnancy body mass index (adjusted odds ratio [aOR] = 1.08; [95% confidence interval [CI]: 1.0–1.2]; p < 0.05), smoking in pregnancy (aOR = 5.34; [95% CI: 1.6–15.4]; p < 0.01), and SSD application (aOR = 2.94; [95% CI: 1.1–9.3]; p < 0.05). Conclusion: The study confirmed the efficacy and cost-effectiveness of DACC impregnated dressings in SSI prevention among women undergoing CS. PMID:26891115

  6. What We Have Learned About Trial of Labor After Cesarean Delivery from the Maternal-Fetal Medicine Units Cesarean Registry.

    PubMed

    Landon, Mark B; Grobman, William A

    2016-08-01

    The cesarean delivery rate in the United States has risen steadily over the past 5 decades such that approximately one in three women now undergo cesarean section. The rise in repeat operations and accompanying decline in trial of labor after cesarean (TOLAC) have been major contributors to this phenomenon. The appropriate use of TOLAC continues to be a topic of interest with the recognition that most women with a history of prior cesarean are candidates for trial of labor. The NICHD MFMU Network Cesarean Registry conducted from 1999 to 2002 provided contemporary data concerning the risks and benefits of TOLAC, which in turn have helped inform practitioners and women considering their options for childbirth following cesarean delivery. PMID:27210023

  7. Women's Psychological Adjustment Following Emergency Cesarean versus Vaginal Delivery.

    ERIC Educational Resources Information Center

    Padawer, Jill A.; And Others

    1988-01-01

    Investigated psychological adjustment and satisfaction in women who had given birth vaginally or by cesarean section. Cesarean mothers reported significantly less satisfaction with the delivery than did vaginal mothers; however no differences were found in postpartum psychological adjustment as measured by depression, anxiety, and confidence in…

  8. Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System

    PubMed Central

    2016-01-01

    Introduction Cesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time. Material and Methods Data from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification. Results The caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001) was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour), 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy) and 7 (multiparas with a single breech pregnancy with or without previous scars) showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17–1.72; OR 3.53, CI95% 2.95

  9. Cesarean Section: Recovering After Surgery

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  10. The effectiveness of diclofenac gel and eutectic mixture of local anesthetic cream on vein puncture pain severity with vein catheter in patient undergoing cesarean section: A randomized, double-blind, placebo-controlled trial

    PubMed Central

    Khalili, Sediqeh; Safavi, Mahboubeh; Rezaei, Rozita; Bidmeshki, Maria; Shirzad, Fatemeh; Nasiri, Mostafa

    2014-01-01

    Aim: This study was aimed to explore the effect of applying diclofenac gel and a eutectic mixture of local anesthetic (EMLA) cream on vein puncture pain severity with vein catheter in the patients undergoing cesarean section. Materials and Methods: The sample comprised 90 women undergoing elective cesarean section that referred to Imam Ali Hospital's maternity section in Amol city (Northern Iran). Data collection tools included visual analog scale for pain severity and a checklist for short term possible side-effects of diclofenac gel, EMLA cream and Vaseline ointment as placebo. Results: The pain of vein puncture with diclofenac gel and EMLA cream was significantly lower than that with the Vaseline ointment (P = 0.001). Similarly, there was a significant difference between using diclofenac gel and EMLA cream in catheter insertion pain severity (P = 0.006). In addition, there was no short term possible side-effect with using diclofenac gel and Vaseline ointment, but a short term side-effect (blanching) was detected in 20% of subjects with EMLA cream. Conclusion: Compared to Vaseline cream, EMLA cream and diclofenac gel application significantly reduces the pain severity associated with vein catheter insertion. Use of diclofenac gel is preferred compared with EMLA cream, because of economics, more efficiency purpose, and no side-effects. PMID:25298943

  11. Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: A Cost-effectiveness Analysis

    PubMed Central

    Ivy, Julie S.; Patel, Divya A.; Patel, Sejal N.; Smith, Dean G.; Ransom, Scott B.; Fenner, Dee; DeLancey, John O.L.

    2010-01-01

    Abstract Background The potential benefit in preventing pelvic floor disorders (PFDs) is a frequently cited reason for requesting or performing cesarean delivery on maternal request (CDMR). However, for primigravid women without medical/obstetric indications, the lifetime cost-effectiveness of CDMR remains unknown, particularly with regard to lifelong pelvic floor consequences. Our objective was to assess the cost-effectiveness of CDMR in comparison to trial of labor (TOL) for primigravid women without medical/obstetric indications with a single childbirth over their lifetime, while explicitly accounting for the management of PFD throughout the lifetime. Methods We used Monte Carlo simulation of a decision model containing 249 chance events and 101 parameters depicting lifelong maternal and neonatal outcomes in the following domains: actual mode of delivery, emergency hysterectomy, transient maternal morbidity and mortality, perinatal morbidity and mortality, and the lifelong management of PFDs. Parameter estimates were obtained from published literature. The analysis was conducted from a societal perspective. All costs and quality-adjusted life-years (QALYs) were discounted to the present value at childbirth. Results The estimated mean cost and QALYs were $14,259 (95% confidence interval [CI] $8,964-$24,002) and 58.21 (95% CI 57.43-58.67) for CDMR and $13,283 (95% CI $7,861-$23,829) and 57.87 (95% CI 56.97-58.46) for TOL over the combined lifetime of the mother and the child. Parameters related to PFDs play an important role in determining cost and quality of life. Conclusions When a woman without medical/obstetric indications has only one childbirth in her lifetime, cost-effectiveness analysis does not reveal a clearly preferable mode of delivery. PMID:20088671

  12. Cesarean birth in the border region: a descriptive analysis based on US Hispanic and Mexican birth certificates.

    PubMed

    McDonald, Jill A; Mojarro Davila, Octavio; Sutton, Paul D; Ventura, Stephanie J

    2015-01-01

    Cesarean birth (CB) is more prevalent in the US-Mexico border region than among all US Hispanics. Comparable data from US and Mexican birth certificates can be used to compare prevalence and identify risk factors on either side of the border. Using 2009 US and Mexican birth certificates, we compared the characteristics of US Hispanic and Mexican CBs in six geographic subgroups: US and Mexican border counties/municipios, US and Mexican non-border counties/municipios and the US and Mexico overall. We also explored cesarean prevalence over time. During 2000-2009, CB rates increased from 22.1 to 31.6 % among US Hispanics and from 25.9 to 37.9 % among Hispanics in the US border region. 2009 rates were 44.5 % in Mexico and 43.1 % in the Mexican border region. In both countries, CB rates were similar for primiparas and multiparas. Higher education, being married and parity >4 were associated with CB in Mexico; being married was associated in the US. Hispanic rates were higher in the US border than non-border region for all age groups. Along the border, cesarean rates for Hispanics were highest in Texas (43.5 %) and neighboring Tamaulipas (49.8 %). Higher cesarean prevalence in Mexico than in US Hispanics, while unexplained, is consistent with high prevalence in some Latin American countries. Higher cesarean prevalence among Hispanics in the US border region than among Hispanics nationwide cannot be explained by maternal age or parity. Medical indications are also unlikely to explain such high rates, which are undesirable for mothers and infants. PMID:24791973

  13. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section

    PubMed Central

    Shah, Tanmay H.; Badve, Manasi S.; Olajide, Kowe O.; Skorupan, Havyn M.; Waters, Jonathan H.; Vallejo, Manuel C.

    2011-01-01

    Patients with Klippel-Feil Syndrome (KFS) have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-year-old female, G2P1A0 with KFS (fusion of cervical vertebrae) who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiber-optic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS) is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III) precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus. PMID:24765318

  14. Cultural perceptions and preferences of Iranian women regarding cesarean delivery

    PubMed Central

    Latifnejad-Roudsari, Robab; Zakerihamidi, Maryam; Merghati-Khoei, Effat; Kazemnejad, Anoshirvan

    2014-01-01

    Background: Data was reported in Iran in 2013 has shown that almost 42 percent of deliveries in public hospitals and 90 percent in private hospitals were carried out with cesarean section. This high rate of cesarean requires careful consideration. It seems that making decision for cesarean is done under the influence of cultural perceptions and beliefs. So, this study was conducted to explore pregnant women's preferences and perceptions regarding cesarean delivery. Materials and Methods: A focused ethnographic study was used. 12 pregnant women and 10 delivered women, seven midwives, seven gynecologist and nine non-pregnant women referred to the health clinics of Tonekabon, who selected purposively, were included in the study. To collect data semi-structured in-depth interviews and participant observation were used. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using thematic analysis and MAXQDA software. Results: Four themes emerged from the data including personal beliefs, fear of vaginal delivery, cultural norms and values and also social network. These concepts played main roles in how women develop meanings toward caesarean, which affected their perceptions and preferences in relation to caesarean delivery. Conclusion: Most of pregnant women believed that fear of vaginal delivery is a major factor to choose caesarean delivery. Hence, midwives and physicians could help them through improving the quality of prenatal care and giving them positive perception towards vaginal delivery through presenting useful information about the nature of different modes of delivery, and their advantages and disadvantages, as well as the alternative ways to control labor pain. PMID:25949249

  15. The birth of Caesar and the cesarean misnomer.

    PubMed

    Raju, Tonse N K

    2007-11-01

    Although cesarean section is one of the most ancient surgical procedures, the origin of its name remains obscure. The term, however, did not originate because of the birth of the Roman Emperor Julius Caesar through this route. In fact, historians are certain that Julius Caesar was not delivered by the dangerous cesarean section. The evidence for this comes from indirect inferences. Cesarean sections were rarely attempted on living women until the early 17th century, and Julius Caesar's mother was alive and well through her son's adult life. Two other possible reasons for the origin of the term are discussed in this article. Mention is also made of the cesarean birth histories of some mythological characters and a few historical personalities. PMID:17893840

  16. Continous epidural butorphanol decreases the incidence of intrathecal morphine-related pruritus after cesarean section: a randomized, double-blinded, placebo-controlled trial: Epidural butorphanol decreases the incidence of intrathecal morphine-related pruritus.

    PubMed

    Wu, Zhen; Kong, Mingjian; Chen, Jianqing; Wen, Laiyou; Wang, Jing; Tan, Jie

    2014-09-01

    This randomized, double-blinded, placebo-controlled trial investigated the effect of continuous epidural butorphanol on intrathecal morphine-related pruritus in patients undergoing cesarean section. Eighty-three patients undergoing elective cesarean section under spinal anesthesia (1.5 mL of isobaric bupivacaine 0.5 % and 0.1 mg of preservative-free morphine) were enrolled in this study. Subjects were randomized to receive epidural butorphanol (n = 43) or normal saline combined bupivacaine (n = 40). In the study group, after the umbilical cord was clamped, patients were administered an epidural loading dose of 1 mg followed by a 48-h infusion of 0.004 % butorphanol with 0.1 % bupivacaine at a rate of 2 mL/h. In the normal saline group, saline was used for the loading dose and the infusion 0.1 % bupivacaine at a same rate. Postoperatively, a blinded observer recorded the incidence/severity of pruritus, visual analog pain scores and sedation level at 1, 3, 6, 9, 12, 24 and 48 h. The 48-h consumption of breakthrough analgesic (tramadol) was also noted. The primary outcome was the incidence of pruritus at 48 h. At 48 h, the incidence of pruritus was significantly lower in the butorphanol group (16.3 vs. 52.5 %; P < 0.001). Furthermore, compared with the normal saline group, the intensity of pruritus was also decreased with epidural butorphanol at 3, 6 and 9 h (all P ≤ 0.008). The pain scores were significantly lower at 12, 24 and 48 h (all P < 0.05) in the butorphanol groups. Patients only receiving bupivacaine required a higher cumulative dose of tramadol (37.5 ± 62.8 vs. 9.3 ± 36.6; P = 0.014). In patients undergoing elective cesarean section, continuous epidural butorphanol with bupivacaine decreases the incidence and severity of intrathecal morphine-related pruritus without adversely affecting the quality of postoperative analgesia. PMID:24639106

  17. Adhesion prevention after cesarean delivery: evidence, and lack of it.

    PubMed

    Walfisch, Asnat; Beloosesky, Ron; Shrim, Alon; Hallak, Mordechai

    2014-11-01

    In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery. PMID:24858198

  18. Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section

    PubMed Central

    Cohen, Shaul; Chhokra, Renu; Stein, Mark H; Denny, John T; Shah, Shruti; Mohiuddin, Adil; Naftalovich, Rotem; Zhao, Rong; Pashkova, Anna; Rolleri, Noah; Patel, Arpan G; Hunter-Fratzola, Christine W

    2015-01-01

    Background and Aims: We aimed to determine the ropivacaine concentration that provided adequate analgesia with early ambulation and minimal urinary retention or other side-effects when used with fentanyl and epinephrine for patient-controlled epidural analgesia (PCEA) after elective cesarean section. Material and Methods: Forty-eight patients were randomized to four groups in a double-blinded fashion. All groups received an initial 10 ml/h of epidural study solution for 24 h. The solution contained: 0.2, 0.1, 0.05, or 0.025% ropivacaine for Groups I-IV, respectively, with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml. Patients could administer additional PCEA doses of 4 ml of their study solution with a lock-out time of 10 min. Overall satisfaction, side-effects, motor block, neurologic function, and pain using Visual Analog Scale were assessed. Results: Patients in all groups showed no difference in sedation, pruritus, nausea, vomiting, and uterine cramps. Pain scores at rest were lower for Group IV than Groups I-III (P < 0.001). Twelve, five, one, and zero patients could not ambulate in Groups I-IV, respectively. Nine, nine, two, and zero (III cesarean section with early ambulation and without sensory loss, urinary retention, or increase of side-effects. PMID:26702203

  19. Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study

    PubMed Central

    2013-01-01

    Background Cesarean sections are the most common surgical procedure for women in the United States. Of the over 4 million births a year, one in three are now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode, precluding accurate generalizations. This study sought to assess the extent to which primary, unscheduled cesarean deliveries and their indications vary by race/ethnicity in one academic medical center. Methods A retrospective, cross-sectional cohort study was conducted of 4,483 nulliparous women with term, singleton, and vertex presentation deliveries at a major academic medical center between 2006–2011. Cases with medical conditions, risk factors, or pregnancy complications that can contribute to increased cesarean risk or contraindicate vaginal birth were excluded. Multinomial logistic regression analysis was used to evaluate differences in delivery mode and caesarean indications among racial and ethnic groups. Results The overall rate of cesarean delivery in our cohort was 16.7%. Compared to White women, Black and Asian women had higher rates of cesarean delivery than spontaneous vaginal delivery, (adjusted odds ratio {AOR}: 1.43; 95% CI: 1.07, 1.91, and AOR: 1.49; 95% CI: 1.02, 2.17, respectively). Black women were also more likely, compared to White women, to undergo cesarean for fetal distress and indications diagnosed in the first stage as compared to the second stage of labor. Conclusions Racial and ethnic differences in delivery mode and indications for cesareans exist among low-risk nulliparas at our institution. These differences may be best explained by examining the variation in clinical decisions that indicate fetal distress and failure to progress at the hospital-level. PMID:24004573

  20. Reasons Why Some Japanese Pregnant Women Choose Trial of Labor After Cesarean

    PubMed Central

    Suzuki, Shunji; Ikeda, Mariko

    2015-01-01

    Background We examined whether or not the Japanese pregnant women with a history of a cesarean section have the knowledge about the benefits and harms of trial of labor after cesarean (TOLAC) and elective repeat cesarean delivery (ERCD). Methods We reviewed the obstetric records of 121 Japanese women with a prior cesarean section who visited our hospital for reservation of their second delivery between January and December 2013. Results Forty-five (37%) of them wanted to perform TOLAC at the first interview. Of these, 14 women (31%) with a history of an urgent cesarean chose TOLAC because of the insufficient anesthetic effect during cesarean, while 11 women (24%) with a history of an elective cesarean did not have the knowledge of the risks of TOLAC and urgent cesarean. Nineteen of those (76%) selected ERCD following the counseling. Conclusions Some Japanese pregnant women with TOLAC hope seemed to have insufficient knowledge about the benefits and harms of TOLAC and ERCD. Therefore, the improvement of the process of counseling and decision making may be needed for pregnant women with a history of a cesarean section in Japan. PMID:26124912

  1. Rupture of a cesarean-scarred uterus: a community hospital experience.

    PubMed Central

    Poma, P. A.

    2000-01-01

    Concerns that a scarred uterus may rupture during labor have contributed to increased cesarean rates. A previous cesarean has become one of the most common indications for abdominal birth. More women must deliver vaginally after cesarean if we are to reduce cesarean rates. This study evaluates the effect of decreasing cesarean rates and increased vaginal birth after cesarean (VBAC) rates on the incidence of uterine rupture in a community hospital. We studied data for women who delivered at our obstetrical unit from 1988 through 1997. During 1994 our department adopted strategies to reduce cesarean rates. Data from women who delivered from 1988 through 1993 (period A, before the policy change) were compared with data for those who delivered from 1994 through 1997 (period B, after the policy change) and evaluated by chi-square analysis. p < 0.05 was considered significant. The total cesarean rate decreased from 24.3% (period A) to 17.9% (period B) (p < 0.0001), whereas the primary cesarean rate decreased from 14.9% to 10.3% (p < 0.0001), and the repeat rate decreased from 9.4% to 7.6% (p < 0.0001). The VBAC rate increased from 13.0 to 28.6 (p < 0.0001), whereas the incidence of uterine rupture did not change. During the study period, the cesarean rate decreased while the VBAC rate safely increased. The incidence of uterine rupture remained unchanged. PMID:10918765

  2. Incidence of Incisional Hernia after Cesarean Delivery: A Register-Based Cohort Study

    PubMed Central

    Aabakke, Anna J. M.; Krebs, Lone; Ladelund, Steen; Secher, Niels J.

    2014-01-01

    Objective To estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period. Methods This population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery between 1991 and 2000. The cohort was followed from their first until 10 years after their last cesarean delivery within the inclusion period or until the first of the following events: hernia repair, death, emigration, abdominal surgery, or cesarean delivery after the inclusion period. For women who had a hernia repair, hospital records regarding the surgery and previous cesarean deliveries were tracked and manually analyzed to validate the relationship between hernia repair and cesarean delivery. Data were analyzed with a competing risk analysis that included each cesarean delivery. Results We identified 57,564 women who had had 68,271 cesarean deliveries during the inclusion period. During follow-up, 134 of these women had a hernia requiring repair. Of these 68 (51% [95% CI 42–60%]) were in a midline incision although the transverse incision was the primary approach at cesarean delivery during the inclusion period. The cumulated incidence of a hernia repair within 10 years after a cesarean delivery was 0.197% (95% CI 0.164–0.234%). The risk of a hernia repair was higher during the first 3 years after a cesarean delivery, with an incidence after 3 years of 0.157% (95% CI 0.127–0.187%). Conclusions The overall risk of an incisional hernia requiring surgical repair within 10 years after a cesarean delivery was 2 per 1000 deliveries in a population in which the transverse incision was the primary approach at cesarean delivery. PMID:25268746

  3. The Analysis of Efficacy and Failure Factors of Uterine Artery Methotrexate Infusion and Embolization in Treatment of Cesarean Scar Pregnancy

    PubMed Central

    Ming, Xu; Li, Ke; Wang, Jingbing

    2013-01-01

    Objectives. This study observes therapeutic efficacy of uterine artery embolization combined with MTX infusion which terminates cesarean scar pregnancy (CSP) and induces three factors which probably relate to failure. Methods. Twenty-three CSP patients were treated with combined uterine artery MTX infusion and embolization. Among them six patients with severe hemorrhage were immediately treated with interventional operation. Clinical effects were estimated by symptoms, serum β-hCG, ultrasound, and MR. Results. Interventional treatments were technologically successful in 22 patients except one. Immediate hemostasis was achieved in all 6 patients with massive colporrhagia. No occurrence of infection and uterine necrosis was observed, but 12 women suffered abdominal pains. Nineteen patients' uteri were preserved, whereas four underwent hysterectomy eventually. Conclusions. Transcatheter arterial chemoembolization is effective to treat high-risk CSP in preference to hysterectomy. To achieve more successful outcomes, three factors should be highlighted: adequate MTX dosage, appropriate embolic material, and complete embolization of target arteries that supply blood to embryo in the scar. PMID:24282376

  4. The Brazilian Preference: Cesarean Delivery among Immigrants in Portugal

    PubMed Central

    Teixeira, Cristina; Correia, Sofia; Victora, César G.; Barros, Henrique

    2013-01-01

    Objective To evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. Study Design Women delivered of a singleton birth (n = 8228), recruited from five public level III maternities (April 2005–August 2006) during the procedure of assembling a birth cohort, were classified according to the country of origin and her migration status as Portuguese (n = 7908), non-Portuguese European (n = 84), African (n = 77) and Brazilian (n = 159). A Poisson model was used to evaluate the association between country of birth and cesarean section that was measured by adjusted prevalence ratio (PR) and respective 95% confidence intervals (95%CI). Results The cesarean section rate varied from 32.1% in non-Portuguese European to 48.4% in Brazilian women (p = 0.008). After adjustment for potential confounders and compared to Portuguese women as a reference, Brazilian women presented significantly higher prevalence of cesarean section (PR = 1.26; 95%CI: 1.08–1.47). The effect was more evident among multiparous women (PR = 1.39; 95%CI: 1.12–1.73) and it was observed when cesarean section was performed either before labor (PR = 1.43; 95%CI: 0.99–2.06) or during labor (PR = 1.30; 95%CI: 1.07–1.58). Conclusions The rate of cesarean section was significantly higher among Brazilian women and it was independent of the presence of any known risk factors or usual clinical indications, suggesting that cultural background influences the mode of delivery overcoming the expected standard of care and outcomes in public health services. PMID:23555912

  5. Management of Cesarean Deliveries and Cesarean Scars With Osteopathic Manipulative Treatment: A Brief Report.

    PubMed

    Martingano, Daniel

    2016-07-01

    Cesarean scars pose a unique set of risks for women who have had previous cesarean deliveries. Between 1996 and 2007, the rate of trial of labor after previous cesarean delivery increased, along with reported rates of uterine rupture and other complications. Consequently, trial of labor after previous cesarean delivery and resultant vaginal birth after cesarean delivery have decreased and cesarean delivery has increased. With nearly one-third of women having cesarean delivery, the rate of rare complications such as cesarean scar ectopic pregnancy has also increased. An integration of osteopathic manipulative treatment techniques into the management of cesarean deliveries and cesarean scars has yet to be defined. The author presents 4 cases of cesarean delivery in which osteopathic manipulative treatment was integrated with successful outcomes. PMID:27367961

  6. Intrapartum Cesarean Delivery in Nulliparas: Risk Factors Compared by Two Analytical Approaches

    PubMed Central

    Kominiarek, Michelle A.; VanVeldhuisen, Paul; Gregory, Kimberly; Fridman, Moshe; Kim, Hajwa; Hibbard, Judith U.

    2014-01-01

    Objective To determine risk factors for cesarean delivery in nulliparas at labor admission. Study Design Nulliparas with liveborn, singleton gestations ≥37 weeks in spontaneous or induced labor were analyzed from the Consortium on Safe Labor database in a retrospective observational study. Classification and regression tree (CART) and multivariate logistic regression analysis determined risk factors for cesarean delivery. Result Of the 66,539 nulliparas, 22% had a cesarean delivery. In the CART analysis, the first cervical dilation exam was the first branch followed by body mass index (BMI). Cesarean deliveries occurred in 45%, 25%, 14%, and 10% of deliveries at <1cm, 1-3cm, 4cm, and ≥5cm dilated respectively. The BMI influence was most evident in the <1cm dilation category with 26% of BMI<25 and 66% of BMI≥40 having a cesarean delivery. The fewest cesarean deliveries (5%) occurred in those ≥5cm and BMI<25. In the multivariate regression analysis, first cervical dilation exam <1cm (OR 5.1, 95%CI 4.5-5.7; reference ≥5cm) and BMI≥40 (OR 5.1, 95%CI 4.6-5.7; reference BMI<25.0) had the highest odds for cesarean delivery. Conclusion Cervical dilation on admission followed by BMI were the two most important risk factors for cesarean delivery identified in both CART and multivariate regression analysis. PMID:25254334

  7. Labor Dystocia and the Risk of Uterine Rupture in Women with Prior Cesarean.

    PubMed

    Vachon-Marceau, Chantale; Demers, Suzanne; Goyet, Martine; Gauthier, Robert; Roberge, Stéphanie; Chaillet, Nils; Laroche, Jasmin; Bujold, Emmanuel

    2016-05-01

    Objective The objective of this study was to evaluate the association between labor dystocia and uterine rupture. Methods We performed a secondary analysis of a multicenter case-control study that included women with single, prior, low-transverse cesarean section who experienced complete uterine rupture during a trial of labor (TOL). For each case, three women who underwent a TOL without uterine rupture were selected as controls. Data were collected on cervical dilatations from admission to delivery. We evaluated the relationship between uterine rupture and labor dystocia according to several criteria, including the World Health Organization's (WHO's) partogram. Results Data were available for 90 cases and 260 controls. Compared with the controls, uterine rupture was associated with less cervical dilatation on admission, slower cervical dilatation in the first stage of labor and longer second stage of labor (all with p < 0.05). Performing cesarean when the labor curve crossed the ACTION line of WHO's partogram or when the second stage was greater than 2 hours could have (1) prevented up to 56% of uterine rupture and (2) reduced the duration of labor in 57% of women with failed TOL. Conclusion Labor dystocia is a significant risk factor for uterine rupture. Labor progression should be assessed regularly in women with prior cesarean. PMID:26731182

  8. Osteogenesis imperfecta: cesarean deliveries in identical twins.

    PubMed

    Dinges, E; Ortner, C; Bollag, L; Davies, J; Landau, R

    2015-02-01

    Osteogenesis imperfecta is a congenital disorder resulting in multiple fractures and extremely short stature, usually necessitating cesarean delivery. Identical twins with severe osteogenesis imperfecta each of whom underwent a cesarean delivery with different anesthetic modalities are presented. A review of the literature and anesthetic options for cesarean delivery and postoperative analgesia for women with osteogenesis imperfecta are discussed. PMID:25433579

  9. Using direct clinical observation to assess the quality of cesarean delivery in Afghanistan: an exploratory study

    PubMed Central

    2014-01-01

    Background As part of a National Emergency Obstetric and Newborn Care (EmONC) Needs Assessment, a special study was undertaken in July 2010 to examine the quality of cesarean deliveries in Afghanistan and examine the utility of direct clinical observation as an assessment method in low-resource settings. Methods This cross-sectional assessment of the quality of cesareans at 14 facilities in Afghanistan included a survey of surgeons regarding their routine cesarean practices, direct observation of 29 cesarean deliveries and comparison of observations with facility records for 34 additional cesareans conducted during the 3 days prior to the observation period at each facility. For both observed cases and record reviews, we assessed time intervals between specified points of care-arrival to the ward, first evaluation, detection of a complication, decision for cesarean, incision, and birth. Results All time intervals with the exception of “decision to skin incision” were longer in the record reviews than in observed cases. Prior cesarean was the most common primary indication for all cases. All mothers in both groups observed survived through one hour postpartum. Among newborns there were two stillbirths (7%) in observed births and seven (21%) record reviews. Although our sample is too small to show statistical significance, the difference is noteworthy. In six of the reviewed cesareans resulting in stillbirth, a fetal heart rate was recorded in the operating theater, although four were recorded as macerated. For the two fresh stillbirths, the cesarean surgeries were recorded as scheduled and not urgent. Conclusions Direct observation of cesarean deliveries enabled us to assess a number of preoperative, postoperative, and intraoperative procedures that are often not described in medical records in low resource settings. Comparison of observations with findings from provider interviews and facility records allowed us to infer whether observed practices were typical

  10. Postmyomectomic Uterine Rupture Despite Cesarean Section.

    PubMed

    Kacperczyk, Joanna; Bartnik, Paweł; Romejko-Wolniewicz, Ewa; Dobrowolska-Redo, Agnieszka

    2016-03-01

    Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus. Fibroids can develop anywhere within the muscular wall. Leiomyomas may be associated with infertility. Laparoscopic myomectomy is often used to remove symptomatic intramural or subserosal fibroids. Advantages of the procedure include short recovery time and minimal perioperative morbidity. At the same time, the multilayer suture technique is more complicated during laparoscopy. A rare but serious complication of laparoscopic myomectomies is uterine rupture. A brief review of the literature and a clinical example of a 33-year-old woman with history of infertility, laparoscopic myomectomies and uterine rupture followed by peripartum hemorrhage is presented. The treatment of leiomyomas is a challenge not only because of possible recurrence but also due to long-term consequences following successful myomectomy. Management of patients with uterine scars should include careful planning of the route of delivery, as the risk of rupture may be increased. PMID:26976991

  11. [The trend in pregnancies terminated by a cesarean operation in Mexico during 1991-1995].

    PubMed

    Juárez Ocaña, S J; Fajardo Gutiérrez, A; Pérez Palacios, G; Guerrero Morales, R G; Gómez Delgado, A

    1999-07-01

    In the last decades has been a worldwide trend to increase the number of cesarean sections as an alternative of obstetric resolution, phenomenon for which it was proposed a variety of explanation, this fact remains practically unknown in the institutions of the National Health System (NHS) in Mexico. To identify the trend of the pregnancy to end for cesarean sections during the years of 1991-1995 in the 32 states of de country, as well as of all the institutions of the National Health System. Descriptive, cross sectional and retrospective. We use the data of the Bureau of Statistics and Informatics of de Health Ministry of each one of the 32 states of the country, of the years 1991 to 1995, and of the number of cesarean sections made in the hospitals of the different institutions of the NHS. We started off with a data-base, to calculate frequency tables, and the specific rate of the cesarean section for each year, for each one of the states and institutions of the NHS. We calculate the secular trends using the annual rates of cesarean section, for each one of the states and institutions of the NHS. We also made bivariate analysis and estimated the odds ratio (OR) and 95% Confidence Interval (95% IC); and the statistic X2 for trend, setting the two tailed statistic significance level of 0.05. During the study period, there was 7,503,817 births in all hospitals of the NHS, of these births 1,929,865 (25.72%) was resolved by cesarean section. For the whole period it there was a clear trend to increment of the cesarean section, the rate for 1991 was 20.44%, and by 1995 was 28.58%, the raise for the period was 39.82%, with values of the OR for trend of 1.56; 95% IC (1.55-1.57). "P" < 0.05. The rate for institutions attending open population had an increment of 35.08% [OR trend 1.45; 95% IC (1.43-1.46), "p" < 0.05], of them the highest rate was for the State System of Health in 1995 with 29.78%, the rates for the remaining institutions varied from 16.57% for the IMSS

  12. Abruptio Placentae in Subsequent Pregnancy after Conservative Management of Hemorrhagic Cesarean Scar Pregnancy by Transcatheter Arterial Chemoembolization

    PubMed Central

    Takeda, Akihiro; Imoto, Sanae; Nakamura, Hiromi

    2013-01-01

    Introduction Cesarean scar pregnancy is a rare but dangerous type of ectopic pregnancy in which implantation occurs within the fibrous tissue of a cesarean scar defect. Conservative management of cesarean scar pregnancy is challenging, especially when future fertility preservation is a significant concern. Furthermore, reports on significant maternal morbidity in subsequent pregnancies after successful conservative management of cesarean scar pregnancy are limited. Case report A 31-year-old woman with previous history of 2 cesarean sections transferred due to massive uterine hemorrhage 7 weeks after dilatation and curettage performed under the diagnosis of missed abortion at 7 weeks of gestation. Cesarean scar pregnancy was diagnosed and was conservatively managed by emergent transcatheter arterial chemoembolization (TACE) followed by multiple doses of systemic methotrexate administration. Seven months after TACE, she spontaneously conceived. At 36 weeks and 5 days of pregnancy, emergency cesarean section was performed due to sudden massive hemorrhage. Abruptio placentae was diagnosed when hysterotomy was performed. After manual removal of the placenta, a healthy infant was delivered. The postoperative course was uneventful. Conclusion The pregnancy course should be carefully monitored for early detection of maternal morbidity associated with placental abnormalities to achieve successful outcome in subsequent gestations after conservative management of cesarean scar pregnancy. PMID:23997578

  13. Algorithmic analysis of quantum radar cross sections

    NASA Astrophysics Data System (ADS)

    Lanzagorta, Marco; Venegas-Andraca, Salvador

    2015-05-01

    Sidelobe structures on classical radar cross section graphs are a consequence of discontinuities in the surface currents. In contrast, quantum radar theory states that sidelobe structures on quantum radar cross section graphs are due to quantum interference. Moreover, it is conjectured that quantum sidelobe structures may be used to detect targets oriented off the specular direction. Because of the high data bandwidth expected from quantum radar, it may be necessary to use sophisticated quantum signal analysis algorithms to determine the presence of stealth targets through the sidelobe structures. In this paper we introduce three potential quantum algorithmic techniques to compute classical and quantum radar cross sections. It is our purpose to develop a computer science-oriented tool for further physical analysis of quantum radar models as well as applications of quantum radar technology in various fields.

  14. Arrhythmias following spinal anesthesia for cesarean delivery - Is Wenckebach common?

    PubMed Central

    Kalra, Seema; Hayaran, Nitin

    2011-01-01

    Arrhythmias in pregnancy are common and may cause concern for the well-being of both mother and fetus. Generally, no previous history of heart disease is elicited and majority of the arrhythmias are benign. Bradycardia is commonly seen following subarachnoid block for cesarean section. However, the incidence of subsequent heart block is low. This case report highlights the occurrence of perioperative arrhythmias following sympathetic blockade in pregnant patients and their early detection by vigilant monitoring. PMID:22096293

  15. Safety of cesarean delivery through placental incision in patients with anterior placenta previa

    PubMed Central

    Hong, Deok-Ho; Kim, Eugene; Kyeong, Kyu-Sang; Hong, Seung Hwa

    2016-01-01

    Objective To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. Methods We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. Results There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. Conclusion Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique. PMID:27004200

  16. Massive pulmonary embolism in a patient undergoing Cesarean delivery.

    PubMed

    Ayad, Sabry; Tetzlaff, John E

    2012-11-01

    A case of a 40 year old, 86 kg, G7P1 woman with a history of hypercoagulability, at 39.1 weeks' gestation, who presented for elective Cesarean section during spinal anesthesia, is presented. During closure of the uterus, she became unresponsive and went into asystolic cardiac arrest. During resuscitation, clinical signs suggested pulmonary embolism, as confirmed by transesophageal echocardiogram. She was anticoagulated and taken to the Cardiac Catheterization Laboratory; there, clot lysis was performed, resulting in massive bleeding. Embolization of the uterine arteries was attempted and was only partially successful in reducing the bleeding. She then underwent Cesarean hysterectomy to control the bleeding. She had a full recovery and was discharged on the sixth postoperative day. PMID:23101774

  17. Women who conceived with infertility treatment were more likely to receive planned cesarean deliveries in Taiwan.

    PubMed

    Chien, Li-Yin; Lee, Yu-Hsiang; Lin, Yu-Hung; Tai, Chen-Jei

    2015-06-01

    The objective of this study was to examine the effect of conception with infertility treatment on planned cesarean delivery. The participants were from a panel of primiparous pregnant women in northern Taiwan. The data analysis included 771 women with a singleton pregnancy, of whom 160 had a planned cesarean delivery and 611 who had a vaginal delivery. The study women answered structured questionnaires during the second and third trimesters of pregnancy, and at one-month postpartum. Women who conceived with infertility treatment were more likely to have planned cesarean deliveries than women who conceived without it (44.7% versus 18.1%, p < 0.001; crude odds ratio: 3.66, 95% confidence interval [CI]: 2.24-5.98). After adjustment for maternal age over 35 years, whether they were currently unmarried, selection of time for birth in advance, gestational hypertension, and birthweight < 2500 g, women who conceived with infertility treatment were 2.95 times (95% CI: 1.47-5.92) more likely to have planned cesarean deliveries. The increased risk for planned cesarean deliveries among singleton women who conceived with infertility treatment cannot be explained by older maternal age or higher number of morbidities during pregnancy. Counseling for women who conceive with infertility treatments may be needed to decrease unnecessary cesarean deliveries. PMID:25581216

  18. Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database

    PubMed Central

    Kozhimannil, Katy B.; Arcaya, Mariana C.; Subramanian, S. V.

    2014-01-01

    Background Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Methods and Findings Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Conclusions Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight

  19. Cesarean Birth: A Journey in Historical Trends.

    PubMed

    Cypher, Rebecca L

    2016-01-01

    Thirty years ago seems like yesterday: a time of immense socioeconomic changes, explosion of an "Internet" computer concept, and identification of human immunodeficiency virus. Like all events of the past, transformations in obstetrics developed over time. Cesarean birth can be better understood in a broader context when one considers how the art of obstetric practice has evolved. Cesarean birth progressed from delivering a fetus perimortem or postmortem to a time of operative births that simultaneously juggle a woman's safety, satisfaction, and freedom of choice concerning birth options. Thirty years of increasing cesarean birth rates have prompted government agencies, national organizations, state-level perinatal collaborative groups, and experts to address these rates and the impact on maternal-child health and healthcare systems. The purpose of this article is to explain cesarean birth's remarkable impact on obstetrics by reviewing key historical periods, current advances, and upcoming trends. PMID:27465462

  20. ALICE tomography section: measurements and analysis

    NASA Astrophysics Data System (ADS)

    Ibison, M. G.; Hock, K. M.; Holder, D. J.; Muratori, B. D.; Wolski, A.

    2012-04-01

    The ALICE tomography section at Daresbury is a diagnostic setup in the injection line of EMMA, the world's first non-scaling FFAG accelerator. We present our measurements and analysis of the transverse emittance, Twiss parameters and phase space distribution of the electron beam that is injected into EMMA. The measurements are carried out at 12 MeV, for bunch charges from 20 to 80 pC. Quadrupole scans and tomography are used. The results show that space charge effect does not change the beam emittance significantly over the length of the tomography section. Starting from projections of the beam images, the quadrupole scan technique can be applied to give the emittance and Twiss parameters. The same projections can be processed using tomography to give the phase space distribution. A careful treatment of the background noise is required to produce consistent emittances between quadrupole scans at different locations. Extending this in a natural way to tomography, we are also able to remove most of the the streaking artefacts from reconstructions obtained using the Filtered Back Projection technique.

  1. Low Primary Cesarean Rate and High VBAC Rate With Good Outcomes in an Amish Birthing Center

    PubMed Central

    Deline, James; Varnes-Epstein, Lisa; Dresang, Lee T.; Gideonsen, Mark; Lynch, Laura; Frey, John J.

    2012-01-01

    PURPOSE Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODS We undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULT S The cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000). CONCLUSIONS Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates. PMID:23149530

  2. Cesarean Birth Linked to Risk of Obesity in Childhood

    MedlinePlus

    ... only show an association between cesarean delivery and childhood obesity, not cause and effect. Chavarro, however, believes the ... suggest that the association between cesarean delivery and childhood obesity is real, rather than an issue of inadequate ...

  3. Is a Vaginal Birth Possible After a Cesarean Delivery?

    MedlinePlus

    ... Clinical Trials Resources and Publications Is a vaginal birth possible after a cesarean delivery? Skip sharing on social media links Share this: Page Content Vaginal birth after cesarean (VBAC) describes vaginal delivery by a ...

  4. A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery

    PubMed Central

    Tuuli, Methodius G.; Liu, Jingxia; Stout, Molly J.; Martin, Shannon; Cahill, Alison G.; Odibo, Anthony O.; Colditz, Graham A.; Macones, George A.

    2016-01-01

    BACKGROUND Preoperative skin antisepsis has the potential to decrease the risk of surgical-site infection. However, evidence is limited to guide the choice of antiseptic agent at cesarean delivery, which is the most common major surgical procedure among women in the United States. METHODS In this single-center, randomized, controlled trial, we evaluated whether the use of chlorhexidine–alcohol for preoperative skin antisepsis was superior to the use of iodine–alcohol for the prevention of surgical-site infection after cesarean delivery. We randomly assigned patients undergoing cesarean delivery to skin preparation with either chlorhexidine–alcohol or iodine–alcohol. The primary outcome was superficial or deep surgical-site infection within 30 days after cesarean delivery, on the basis of definitions from the Centers for Disease Control and Prevention. RESULTS From September 2011 through June 2015, a total of 1147 patients were enrolled; 572 patients were assigned to chlorhexidine–alcohol and 575 to iodine–alcohol. In an intention-to-treat analysis, surgical-site infection was diagnosed in 23 patients (4.0%) in the chlorhexidine–alcohol group and in 42 (7.3%) in the iodine–alcohol group (relative risk, 0.55; 95% confidence interval, 0.34 to 0.90; P = 0.02). The rate of superficial surgical-site infection was 3.0% in the chlorhexidine–alcohol group and 4.9% in the iodine–alcohol group (P = 0.10); the rate of deep infection was 1.0% and 2.4%, respectively (P = 0.07). The frequency of adverse skin reactions was similar in the two groups. CONCLUSIONS The use of chlorhexidine–alcohol for preoperative skin antisepsis resulted in a significantly lower risk of surgical-site infection after cesarean delivery than did the use of iodine–alcohol. (Funded by the National Institutes of Health and Washington University School of Medicine in St. Louis; ClinicalTrials.gov number, NCT01472549.) PMID:26844840

  5. Shuttle orbiter radar cross-sectional analysis

    NASA Technical Reports Server (NTRS)

    Cooper, D. W.; James, R.

    1979-01-01

    Theoretical and model simulation studies on signal to noise levels and shuttle radar cross section are described. Pre-mission system calibrations, system configuration, and postmission system calibration of the tracking radars are described. Conversion of target range, azimuth, and elevation into radar centered east north vertical position coordinates are evaluated. The location of the impinging rf energy with respect to the target vehicles body axis triad is calculated. Cross section correlation between the two radars is presented.

  6. Uterine Closure in Cesarean Delivery: A New Technique

    PubMed Central

    Babu, KM; Magon, Navneet

    2012-01-01

    Fear of scar rupture is one of risks involved in a post caesarean pregnancy. This had led to an increased rate of repeat cesarean delivery in today's times. Closure of the uterine incision is a key step in cesarean section, and it is imperative that an optimal surgical technique be employed for closing a uterine scar. This technique should be able to withstand the stress of subsequent labor. In the existing techniques of uterine closure, single or double layer, correct approximation of the cut margins, that is, decidua-to-decidua, myometrium to myometrium, serosa to serosa is not guaranteed. Also, there are high chances of inter surgeon variability. It was felt that if a suturing technique which ensures correct approximation of all the layers mentioned above with nil or minimal possibility of inter operator variability existed, there will not be any thinning of lower segment caesarean section (LSCS). Further, a scarred uterus repaired in this manner will be able to withstand the stress of labor in future. We hereby report a new technique for uterine closure devised by us, which incorporates a continuous modified mattress suture technique as a modification of the existing surgical technique of uterine closure. PMID:22912945

  7. Vaginal birth after C-section

    MedlinePlus

    ... gov/ency/patientinstructions/000589.htm Vaginal birth after C-section To use the sharing features on this ... enable JavaScript. If you had a cesarean birth (C-section) before, it does not mean that you ...

  8. Magnetic Resonance Imaging as an Adjunct to Ultrasound in Evaluating Cesarean Scar Ectopic Pregnancy

    PubMed Central

    Wu, Rebecca; Klein, Michelle A.; Mahboob, Sabrina; Gupta, Mala; Katz, Douglas S.

    2013-01-01

    Cesarean scar pregnancies (CSPs) are a relatively rare form of ectopic pregnancy in which the embryo is implanted within the fibrous scar of a previous cesarean section. A greater number of cases of CSPs are currently being reported as the rates of cesarean section are increasing globally and as detection of scar pregnancy has improved with use of transvaginal ultrasound (TVUS) with color Doppler imaging. Delayed diagnosis and management of this potentially life-threatening condition may result in complications, predominantly uterine rupture and hemorrhage with significant potential maternal morbidity. Diagnosis of a cesarean scar pregnancy (CSP) requires a high index of clinical suspicion, as up to 40% of patients may be asymptomatic. TVUS has a reported sensitivity of 84.6% and has become the imaging examination of choice for diagnosis of a CSP. Magnetic resonance imaging (MRI) has been used in a small number of patients as an adjunct to TVUS. In the present report, MRI is highlighted as a problem-solving tool capable of more precisely identifying the relationship of a CSP to adjacent structures, thereby providing additional information critical to directing appropriate patient management and therapy. PMID:23814688

  9. Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study

    PubMed Central

    2011-01-01

    Background Women's access to vaginal birth after cesarean (VBAC) in the United States has declined steadily since the mid-1990s, with a current rate of 8.2%. In the State of Florida, less than 1% of women with a previous cesarean deliver vaginally. This downturn is thought to be largely related to the American College of Obstetricians and Gynecologists (ACOG) VBAC guidelines, which mandate that a physician and anesthesiologist be "immediately available" during a trial of labor. The aim of this exploratory qualitative study was to explore the barriers associated with the ACOG VBAC guidelines, as well as the strategies that obstetricians and midwives use to minimize their legal risks when offering a trial of labor after cesarean. Methods Semi-structured interviews were conducted with 11 obstetricians, 12 midwives, and a hospital administrator (n = 24). Interviews were recorded and transcribed verbatim, and thematic analysis informed the findings. Results Fear of liability was a central reason for obstetricians and midwives to avoid attending VBACs. Providers who continued to offer a trial of labor attempted to minimize their legal risks by being highly selective in choosing potential candidates. Definitions of "immediately available" varied widely among hospitals, and providers in solo or small practices often favored the convenience of a repeat cesarean delivery rather than having to remain in-house during a trial of labor. Midwives were often marginalized due to restrictive hospital policies and by their consulting physicians, even though women with previous cesareans were actively seeking their care. Conclusions The current ACOG VBAC guidelines limit US obstetricians' and midwives' ability to provide care for women with a previous cesarean, particularly in community and rural hospitals. Although ACOG has proposed that women be allowed to accept "higher levels of risk" in order to be able to attempt a trial of labor in some settings, access to VBAC is unlikely to

  10. Comparative Evaluation of Remifentanil and Dexmedetomidine in General Anesthesia for Cesarean Delivery.

    PubMed

    Li, Chengwen; Li, Yandong; Wang, Kun; Kong, Xiangang

    2015-01-01

    BACKGROUND Use of remifentanil and dexmedetomidine in general anesthesia for cesarean section have been described. This study was designed to evaluate the effects of remifentanil and dexmedetomidine on maternal hemodynamics and bispectral index, and neonatal outcomes in elective caesarean delivery. MATERIAL AND METHODS Forty-four women undergoing elective cesarean delivery with ASA I or II and term or near-term singleton pregnancies were randomly assigned to receive remifentanil at a loading dose of 2 μg/kg over 10 min followed by a continuous infusion of 2 μg/kg/h until about 6 min before fetal delivery (Group REM), or dexmedetomidine at a loading dose of 0.4 μg/kg over 10 min followed by a continuous infusion of 0.4 μg/kg/h until about 6 min before fetal delivery (Group DEX). Maternal hemodynamics and BIS values were recorded. Neonatal effects were assessed using Apgar scores and umbilical cord blood gas analysis. RESULTS Mean arterial pressure (MAP) increased after intubation in both groups, and the change magnitude of the MAP was higher in Group DEX (P<0.05). Patients in Group DEX had a lower BIS value at recovery and consumed less propofol during surgery (P<0.05). The incidences of neonatal resuscitation at 1 min were 81.8% in Group REM and 54.5% in Group DEX (P=0.052). There was no significant difference in either group in Apgar scores at 1 and 5 min and umbilical cord blood gas values. CONCLUSIONS Both remifentanil and dexmedetomidine are effective to blunt hemodynamic responses to intubation and also seem safe for neonates at the administrated doses, but remifentanil still has the potential to cause neonatal transient respiratory depression. PMID:26638888

  11. Comparative Evaluation of Remifentanil and Dexmedetomidine in General Anesthesia for Cesarean Delivery

    PubMed Central

    Li, Chengwen; Li, Yandong; Wang, Kun; Kong, Xiangang

    2015-01-01

    Background Use of remifentanil and dexmedetomidine in general anesthesia for cesarean section have been described. This study was designed to evaluate the effects of remifentanil and dexmedetomidine on maternal hemodynamics and bispectral index, and neonatal outcomes in elective caesarean delivery. Material/Methods Forty-four women undergoing elective cesarean delivery with ASA I or II and term or near-term singleton pregnancies were randomly assigned to receive remifentanil at a loading dose of 2 μg/kg over 10 min followed by a continuous infusion of 2 μg/kg/h until about 6 min before fetal delivery (Group REM), or dexmedetomidine at a loading dose of 0.4 μg/kg over 10 min followed by a continuous infusion of 0.4 μg/kg/h until about 6 min before fetal delivery (Group DEX). Maternal hemodynamics and BIS values were recorded. Neonatal effects were assessed using Apgar scores and umbilical cord blood gas analysis. Results Mean arterial pressure (MAP) increased after intubation in both groups, and the change magnitude of the MAP was higher in Group DEX (P<0.05). Patients in Group DEX had a lower BIS value at recovery and consumed less propofol during surgery (P<0.05). The incidences of neonatal resuscitation at 1 min were 81.8% in Group REM and 54.5% in Group DEX (P=0.052). There was no significant difference in either group in Apgar scores at 1 and 5 min and umbilical cord blood gas values. Conclusions Both remifentanil and dexmedetomidine are effective to blunt hemodynamic responses to intubation and also seem safe for neonates at the administrated doses, but remifentanil still has the potential to cause neonatal transient respiratory depression. PMID:26638888

  12. Section Builder: A finite element tool for analysis and design of composite beam cross-sections

    NASA Astrophysics Data System (ADS)

    Chakravarty, Uttam Kumar

    SectionBuilder is an innovative finite element based tool, developed for analysis and design of composite beam cross-sections. The tool can handle the cross-sections with parametric shapes and arbitrary configurations. It can also handle arbitrary lay-ups for predefined beam cross-section geometries in a consistent manner. The material properties for each layer of the cross-section can be defined on the basis of the design requirements. This tool is capable of dealing with multi-cell composite cross-sections with arbitrary lay-ups. It has also the benefit of handling the variation of thickness of skin and D-spars for beams such as rotor blades. A typical cross-section is considered as a collection of interconnected walls. Walls with arbitrary lay-ups based on predefined geometries and material properties are generated first. The complex composite beam cross-sections are developed by connecting the walls using various types of connectors. These connectors are compatible with the walls, i.e., the thickness of the layers of the walls must match with those of the connectors at the place of connection. Cross-sections are often reinforced by core material for constructing realistic rotor blade cross-sections. The tool has the ability to integrate core materials into the cross-sections. A mapped mesh is considered for meshing parametric shapes, walls and various connectors, whereas a free mesh is considered for meshing the core materials. A new algorithm based on the Delaunay refinement algorithm is developed for creating the best possible free mesh for core materials. After meshing the cross-section, the tool determines the sectional properties using finite element analysis. This tool computes sectional properties including stiffness matrix, compliance matrix, mass matrix, and principal axes. A visualization environment is integrated with the tool for visualizing the stress and strain distributions over the cross-section.

  13. Protecting effect of gabapentin for nausea and vomiting in the surgery of cesarean after spinal anesthesia

    PubMed Central

    Memari, Fereshteh; Jadidi, Rahmatollah; Noroozi, Afsaneh; Mohammadbeigi, Abolfazl; Falahati, Jamal

    2015-01-01

    Background: Nausea and vomiting are the most common effects after cesarean delivery with spinal anesthesia that was associated with problems such as pneumonia, delay in patient discharge, electrolyte abnormalities, and the maternal dissatisfaction. Objectives: The aim of this study was to evaluate the effects of gabapentin in preventing nausea and vomiting after spinal anesthesia in cesarean delivery. Patients and Methods: This study as a double-blind clinical trial was done on 200 candidates of cesarean with a random distribution. Patients without cardiovascular diseases and in 1 and 2 American Society of Anesthesiologists were divided into two groups. Treatment group received 600 mg capsule (gabapentin) 1 h before surgery and the control group received placebo. The severity of nausea and vomiting were evaluated according to 4 Scores every hour to 4 h after the withdrawal of mother from the recovery section. Results: In this study, there is no significant difference in demographic information between these two groups. In the 1st h, there is a significant difference between the severity of nausea and vomiting in these two groups, but there is not a significant difference between 2 and 4 h after surgery. However, the incidence of nausea between the two groups shows a significant correlation. Conclusions: A single dose of gabapentin 1 h before cesarean delivery decreases the incidence of nausea and vomiting after surgery. PMID:26712982

  14. Clinical Analyses of 66 Cases of Mid-trimester Pregnancy Termination in Women with Prior Cesarean

    PubMed Central

    Peng, Ping; Liu, Xin-Yan; Li, Lei; Jin, Li; Chen, Wei-Lin

    2015-01-01

    Background: The rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean. Methods: We conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL) for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS) was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture. Results: The total rate of successful abortion was 93.9% (62/66). Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%). The successful rates of abortion were 85.7% (30/35) for women treated with mifepristone-misoprostol and 86.1% (31/36) for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm) and the nonrupture group (7.0 ± 3.0 mm) (P < 0.05). The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2–2106.1) after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%). Conclusions: Both the mifepristone-misoprostol and the EL regimens were effective and safe for the

  15. STEM mode in the SEM for the analysis of cellular sections prepared by ultramicrotome sectioning

    NASA Astrophysics Data System (ADS)

    Hondow, N.; Harrington, J.; Brydson, R.; Brown, A.

    2012-07-01

    The use of the dual imaging capabilities of a scanning electron microscope fitted with a transmitted electron detector is highlighted in the analysis of samples with importance in the field of nanotoxicology. Cellular uptake of nanomaterials is often examined by transmission electron microscopy of thin sections prepared by ultramicrotome sectioning. Examination by SEM allows for the detection of artefacts caused by sample preparation (eg. nanomaterial pull-out) and the complementary STEM mode permits study of the interaction between nanomaterials and cells. Thin sections of two nanomaterials of importance in nanotoxicology (cadmium selenide quantum dots and single walled carbon nanotubes) are examined using STEM mode in the SEM.

  16. Cephalometric comparison of cesarean and normal births

    PubMed Central

    Goymen, Merve; Topcuoglu, Tolga; Aktan, Ali Murat; Isman, Ozlem

    2016-01-01

    Objective: The aim of this study was to compare cephalometric variables of subjects with normal and cesarean births. Materials and Methods: Ninety age- and gender-matched patients, who were treated in Gaziantep University, Faculty of Dentistry Orthodontics Department were equally divided into normal and cesarean groups according to the birth methods reported by their mothers. To eliminate the negative effects of being different in terms of age and gender among parameters, control, and patient groups were matched in the present study. Pretreatment cephalometrics radiographs were used. Six measurements representing sagittal and vertical relationships were evaluated from pretreatment cephalograms using Dolphin Imaging Orthodontics Software was used in this issue by an orthodontist. Kolmogorov–Smirnov test, Student's t-test, and Mann–Whitney U-test were used for statistical comparisons. Results: A point-nasion-B point angle (ANB) and Wits values were higher in the normal group, while sella-nasion-A point angle, sella-nasion-B point angle, Frankfort horizontal-mandibular plane angle, and gonion-gnathion-SN plane angle values were higher in the cesarean group. However, the groups showed no significant differences (P > 0.05). ANB angle and Wits values showed high correlation. Conclusions: Within the study limitations, the results suggest that the birth method may not have a considerable effect on the development of the craniofacial skeletal system. PMID:27095896

  17. The Regional Centralization of Electronic Fetal Heart Rate Monitoring and Its Impact on Neonatal Acidemia and the Cesarean Birth Rate

    PubMed Central

    Urabe, Hirotoshi; Tokunaga, Syuichi; Kodama, Yuki; Ikenoue, Tsuyomu

    2016-01-01

    Objective. The improvement of the accuracy of fetal heart rate (FHR) pattern interpretation to improve perinatal outcomes remains an elusive challenge. We examined the impact of an FHR centralization system on the incidence of neonatal acidemia and cesarean births. Methods. We performed a regional, population-based, before-and-after study of 9,139 deliveries over a 3-year period. The chi-squared test was used for the statistical analysis. Results. The before-and-after study showed no difference in the rates of acidemia, cesarean births, or perinatal death in the whole population. A subgroup analysis using the 4 hospitals in which an FHR centralization system was continuously connected (compliant group) and 3 hospitals in which the FHR centralization system was connected on demand (noncompliant group) showed that the incidence acidemia was significantly decreased (from 0.47% to 0.11%) without a corresponding increase in the cesarean birth rate due to nonreassuring FHR patterns in the compliant group. Although there was no difference in the incidence of nonreassuring FHR patterns in the noncompliant group, the total cesarean birth rate was significantly higher than that in the compliant group. Conclusion. The continuous FHR centralization system, in which specialists help to interpret results and decide clinical actions, was beneficial in reducing the incidence of neonatal acidemia (pH < 7.1) without increasing the cesarean birth rate due to nonreassuring FHR patterns. PMID:27379185

  18. Cephalad-caudad versus transverse blunt expansion of the low transverse uterine incision during cesarean delivery.

    PubMed

    Xodo, Serena; Saccone, Gabriele; Cromi, Antonella; Ozcan, Pinar; Spagnolo, Emanuela; Berghella, Vincenzo

    2016-07-01

    It is imperative to have evidence-based guidelines for cesarean delivery. The aim of this meta-analysis was to evaluate the effectiveness of a cephalad-caudad compared to transverse blunt expansion of the uterine incision to reduce blood loss in women who underwent low-segment transverse cesarean delivery. We therefore performed a systematic search in electronic databases from their inception until March 2016. We included all randomized trials comparing cephalad-caudad versus transverse (control group) blunt expansion of the uterine incision in women who underwent a low transverse cesarean delivery. The primary outcome was postpartum blood loss, defined as the mean amount of blood loss (mL). Two trials (921 women) were analyzed. After the transverse uterine incision in the lower uterine segment with the scalpel, the uterine incision was then bluntly expanded by the designated method. Blunt expansion of the primary incision was derived by placing the index fingers of the operating surgeon into the incision and pulling the fingers apart laterally (transverse group) or cephalad (cephalad-caudad group). Women who were randomized in the cephalad-caudad group had lower: mean of postpartum blood loss, hemoglobin drop and hematocrit drop 24h after cesarean, unintended extension, uterine vessels injury, blood loss >1500mL and need for additional stitches. There was no statistically significant difference in the incidence of blood loss >1000mL, in the operating time and in post-operative pain. In conclusion, expansion of the uterine incision with fingers in a cephalad-caudad direction is associated with better maternal outcomes and, therefore, should be preferred to transverse expansion during a cesarean delivery. PMID:27180273

  19. Determinants of cesarean delivery in the US: a lifecourse approach.

    PubMed

    Witt, Whitney P; Wisk, Lauren E; Cheng, Erika R; Mandell, Kara; Chatterjee, Debanjana; Wakeel, Fathima; Godecker, Amy L; Zarak, Dakota

    2015-01-01

    This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the US by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated cesarean section (C-section) deliveries. Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n = 9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-sections. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-sections, compared to vaginal delivery. 74.2 % of women had a vaginal delivery, 11.6 % had a non-medically indicated C-section, and 14.2 % had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we found salient differences between the risk factors for indicated and non-indicated C-sections. Surgical deliveries continue to occur at a high rate in the US despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short- and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers. PMID:24770955

  20. A Comparison of Mothers’ Quality of Life after Normal Vaginal, Cesarean, and Water Birth Deliveries

    PubMed Central

    Kavosi, Zahra; Keshtkaran, Ali; Setoodehzadeh, Fatemeh; Kasraeian, Maryam; Khammarnia, Mohammad; Eslahi, Marzieh

    2015-01-01

    Background Assessment of quality of life (QOL) is of paramount importance for improving postpartum QOL which will in turn enhance QOL of mothers, children, individuals, and the community. The present study aimed to evaluate and compare postpartum QOL after Cesarean Section (CS), Normal Vaginal Delivery (NVD), and water birth delivery. Methods This descriptive analytical, cross-sectional study was conducted on postpartum women referred to urban health centers and two public hospitals in 2012-13 in Shiraz, Iran. Overall, 59 women with NVD, 39 with CS, and 39 with water birth, all at 2 months postpartum, were recruited into the study through multi-stage sampling. Postpartum QOL was measured using Short Form Health Survey (SF-36) which hadbeen adapted previously in Iran. Then, the data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA) in SPSS, version 18. Results The results showed that the NVD group had the highest mean score in physical health domains; the women with water birth had the highest mean score in mental health domains and total QOL. Regarding postpartum QOL the results of one-way ANOVA showed no statistically significant differences between the three modes of delivery. Conclusion Women with water birth and NVD had the highest and second highest total QOL mean scores, respectively; women with NVD and water birth experienced better physical health. Thus, providing more information to pregnant women to encourage them to use NVD and water birth is suggested. PMID:26171408

  1. Use of Navier-Stokes analysis in section design

    NASA Astrophysics Data System (ADS)

    Nguyen, Phuc N.

    1990-12-01

    The Navier-Stokes analysis method and a design technique based on conformal mapping are combined to develop new 2-D thick sections. The Eppler-Somers design technique allows for fast design of arbitrary section shape. The well-validated David Taylor Navier-Stokes code is used to optimize the thickness of the section. From previous experimental results, the turbulence characteristics in the near-wake region correlate with the pressure spectra on the trailing edge of a 2-D lifting surface. Therefore, the turbulent kinetic energy, and the Reynolds shear stress are used as design parameters to develop new 2-D sections. Minimizing these parameters is assumed to provide desirable boundary layer and wake characteristics. The characteristics of one new section are compared with those of a baseline section to demonstrate the new foil design method.

  2. Effect of epidural analgesia on the primary cesarean rate.

    PubMed

    Gribble, R K; Meier, P R

    1991-08-01

    There is some concern that providing parturients with epidural analgesia increases the likelihood of cesarean delivery. Because of the widespread interest in cesarean rates and the expanding use of epidural analgesia, we believed that this contention should be assessed. Hospital records were reviewed to determine the primary cesarean rate for 1084 parturients who delivered at our institution during 15 months in which there was a 24-hour "on demand" epidural service. This was compared with our primary cesarean rate during 15 months in which epidural analgesia was not available, even on physician request. Because of the characteristics of our institution, this control group consisted of patients from the same population base managed by the same eight obstetricians using the same management techniques. For patients in labor, the primary cesarean rate overall was 9.0% before and 8.2% after the epidural service began (P = .626). When subpopulations based on parity and indication for cesarean delivery were studied, there were no significant changes in the cesarean rate. These results demonstrate that the availability of on-demand epidural analgesia for patients in labor did not increase the primary cesarean rate, either in the aggregate or for any of the subpopulations studied. PMID:2067767

  3. Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy

    PubMed Central

    2016-01-01

    Introduction. Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs. Case. A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation. Conclusion. Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality. PMID:27375911

  4. Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy.

    PubMed

    Malik, M F; Hoyos, L R; Rodriguez-Kovacs, J; Gillum, J; Johnson, S C

    2016-01-01

    Introduction. Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs. Case. A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation. Conclusion. Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality. PMID:27375911

  5. Structural Analysis Methods Development for Turbine Hot Section Components

    NASA Technical Reports Server (NTRS)

    Thompson, Robert L.

    1988-01-01

    The structural analysis technologies and activities of the NASA Lewis Research Center's gas turbine engine Hot Section Technology (HOST) program are summarized. The technologies synergistically developed and validated include: time-varying thermal/mechanical load models; component-specific automated geometric modeling and solution strategy capabilities; advanced inelastic analysis methods; inelastic constitutive models; high-temperature experimental techniques and experiments; and nonlinear structural analysis codes. Features of the program that incorporate the new technologies and their application to hot section component analysis and design are described. Improved and, in some cases, first-time 3-D nonlinear structural analyses of hot section components of isotropic and anisotropic nickel-base superalloys are presented.

  6. First birth cesarean proportion: A missed indicator in controlling policies

    PubMed Central

    Safari-Faramani, Roya; Haghdoost, Ali Akbar; Nakhaei, Nouzar; Foroudnia, Shohreh; Mahmoodabadi, Zahra; Safizadeh, Mansooreh

    2016-01-01

    Background: Around one out of two mothers give births by cesarean section (CS) surgery in Iran and about half of this number is due to previous CS. Recently Health Sector Evolution (HSEP) program (started in April 2014) targets the high rate of CS in Iran. To assess the impact of the interventions, we emphasized that the First Birth Cesarean (FBC) proportion is one of the main indicators to assess the controlling programs. Methods: Data on the mode of delivery were collected in Kerman province between 21 March and 20 March 2015 classified by hospital ownership. FBC proportion is defined as the number of CS in the first pregnancies divided by the total number of first births. Chi-square test for trend was used to assess the trends. Results: Total number of births was around 34000. There were 8.9 and 13.1 percent reduction in CS and FBC proportion respectively. CS proportion was 54.5 at the end of the first quarter of the studied period and reached to 49.6 at the end of the period (p<0.0001). Also, FBC proportion was 54.1 percent at first and reached to 47 percent at the end of the study period. The main reason for CS was due to previous CS. At the hospital level, the highest reduction in CS and FBC proportion were in public hospitals. Conclusion: Results suggested more reduction in FBC proportion than the CS proportion, so this is a very good sign since more potential CS cases will be prevented. As repeated CS is one of the main indications for the operation, in the short term, even effective policies may change the overall proportion slightly, while the FBC proportion is more sensitive to reflect the impacts. Therefore, it is necessary to target the main fuel to reduce CS proportion effectively.

  7. Declining Fertility and the Use of Cesarean Delivery: Evidence from a Population-Based Study in Taiwan

    PubMed Central

    Ma, Ke-Zong M; Norton, Edward C; Lee, Shoou-Yih D

    2010-01-01

    Objective To test the hypothesis that declining fertility would affect the number of cesarean sections (c-sections) on maternal demand, but not medically indicated c-sections. Data Sources The 1996–2004 National Health Insurance Research Database in Taiwan for all singleton deliveries. Study Design Retrospective population-based, longitudinal study. Estimation was performed using multinomial probit models. Principal Findings Results revealed that declining fertility had a significant positive effect on the probability of having a c-section on maternal request but not medically indicated c-section. Conclusions Our findings offer a precautionary note to countries experiencing a fertility decline. Policies to contain the rise of c-sections should understand the role of women's preferences, especially regarding cesarean deliveries on maternal request. PMID:20545781

  8. A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery

    PubMed Central

    Jain, Anshul; Pandey, Shivali; Kumar, Roopesh; Sethi, Chavi; Sharma, Sanjya

    2015-01-01

    Background Subarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study. Patients and methods The study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting. Results Among Group I, prevalence of hypotension, bradycardia, and hypotension together with bradycardia was 152 (41.83%) patients, eight (2.20%) patients, and seven (1.92%) patients, respectively. In Group II, the prevalence of hypotension, bradycardia, and hypotension with bradycardia was 93 (50.5%) patients, five (2.71%) patients, and six (3.2%) patients, respectively. The difference between the two groups was statistically significant for hypotension. For Group I, 152 patients (41.87%) experienced one, 23 patients (6.33%) experienced two, and three patients (0.82%) experienced three episodes of hypotension. In Group II, 93 (50.5%), 19 (7.89%), and two (1.08%) patients experienced such episodes. The difference was significant with respect of one and two episodes. The prevalence of intraoperative nausea was 11.01% (40 patients) in Group I, whereas 11.41% (21 patients) in Group II. Intraoperative vomiting occurred in 19 patients (5.23%) of Group I and 14 patients (7.60%) of Group II. The height of the

  9. Automated dimensional analysis using a light-sectioning microscope

    SciTech Connect

    Loomis, J.; Lightman, A.; Poe, A.; Caldwell, R.

    1988-12-31

    A computer vision system has been integrated with a modified light-sectioning microscope for quality control and inspection of a machined part whose critical dimensions are 30 to 300 {mu}m. Height measurements were determined by analysis of the projected light-section line. Transverse measurements were made using the microscope in a traditional configuration with illumination from selected elements of an external LED ring array. The light section irradiance was under computer control to accommodate the spatial variations in surface reflectance whose dynamic range exceeded that of the vision system. Part features are located by the vision system. Edges and line centers are then measured to sub-pixel resolution with a gray-level analysis algorithm. This paper describes the design and operation of this system. Details of the measurement process and analysis algorithms are provided.

  10. [Silent cardiotocogram during general anesthesia. Indication for emergency Cesarean section?].

    PubMed

    Bock, H; List, E; Kosmala, A; Lex, B; Moratin, P

    2012-12-01

    This case report of a silent cardiotocogram (CTG) registration during general anesthesia in a 33-week-pregnant patient undergoing non-obstetric surgery demonstrates the possibility of misinterpretation whereby typical CTG patterns of fetal reactions to anesthetics can be misinterpreted as fetal hypoxia or even asphyxia. PMID:23223840

  11. High Fidelity Failure Analysis for a Composite Fuselage Section

    NASA Technical Reports Server (NTRS)

    Li, Jain; Davila, Carlos G.; Chen, Tzi-Kang

    2001-01-01

    A high fidelity delamination failure analysis was developed by combining a local failure analysis with a global full-scale finite element structural analysis to address strength and delamination failure in a single package. The methodology was demonstrated through a local three-dimensional pull-off failure analysis and a geometrically nonlinear structural analysis of a five-foot composite helicopter fuselage section. Pull-off specimens were used to identify potential debonding failure of co-cured skin-stringer/frame fuselage structures. An investigation of the failed pull-off specimens was performed to determine the location of the failure initiation. Three-dimensional strain energy release rate analysis indicates that the delamination initiation and growth is controlled by Mode 1 opening mode. The bending moment at the delamination tip was identified as the crucial factor controlling the failure. The geometrically nonlinear structural analysis of a five-foot composite fuselage section was performed using a detailed finite element model. Loads were applied along the periphery of the subcomponent using displacement fields generated from solutions of a full-vehicle model.

  12. SEU cross sections derived from a diffusion analysis

    SciTech Connect

    Edmonds, L.D.

    1996-12-01

    A simple theoretical prediction of single-event upset (SEU) cross section versus linear energy transfer (LET) is derived from a diffusion analysis, and the result is compared to some real device curves. It was found that at least some real device curves show two regimes. One regime (high-LET) is characterized by a very good fit to the theoretical prediction, and the other (low-LET) is characterized by a very bad fit. The existence of a high-LET regime provides additional credibility for the increasingly popular postulate that diffusion has an important effect on the shape of the cross-sectional curve.

  13. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer.

    PubMed

    Dominguez-Bello, Maria G; De Jesus-Laboy, Kassandra M; Shen, Nan; Cox, Laura M; Amir, Amnon; Gonzalez, Antonio; Bokulich, Nicholas A; Song, Se Jin; Hoashi, Marina; Rivera-Vinas, Juana I; Mendez, Keimari; Knight, Rob; Clemente, Jose C

    2016-03-01

    Exposure of newborns to the maternal vaginal microbiota is interrupted with cesarean birthing. Babies delivered by cesarean section (C-section) acquire a microbiota that differs from that of vaginally delivered infants, and C-section delivery has been associated with increased risk for immune and metabolic disorders. Here we conducted a pilot study in which infants delivered by C-section were exposed to maternal vaginal fluids at birth. Similarly to vaginally delivered babies, the gut, oral and skin bacterial communities of these newborns during the first 30 d of life was enriched in vaginal bacteria--which were underrepresented in unexposed C-section-delivered infants--and the microbiome similarity to those of vaginally delivered infants was greater in oral and skin samples than in anal samples. Although the long-term health consequences of restoring the microbiota of C-section-delivered infants remain unclear, our results demonstrate that vaginal microbes can be partially restored at birth in C-section-delivered babies. PMID:26828196

  14. Toward an Ethically Responsible Approach to Vaginal Birth After Cesarean

    PubMed Central

    Lyerly, Anne Drapkin; Little, Margaret Olivia

    2010-01-01

    Determining approach to delivery after prior cesarean is among the most contentious areas of obstetrics. This paper presents a framework for ethically responsible guidelines and practice around VBAC. We describe ethical complexities of three key issues that mark the debate: the cesarean delivery rate, safety, and patient autonomy. We then describe a taxonomy of considerations that should inform a responsible framework for guideline development, and highlight critical distinctions between types of guidelines which have been blurred in the past. We then forward two central claims. First, in otherwise uncomplicated birth after a single prior cesarean, both VBAC and repeat cesarean should be regarded as reasonable options; women, rather than policymakers, providers, insurance carriers, or hospitals, should determine delivery approach. Second, in complicated cases, providers and policymakers should carefully calibrate the strength of evidence to ensure differential risk and cost are adequate to justify directive guidelines given important variations in values women bring to childbirth. PMID:20869550

  15. Examining brain microstructure using structure tensor analysis of histological sections.

    PubMed

    Budde, Matthew D; Frank, Joseph A

    2012-10-15

    The mammalian central nervous system has a tremendous structural complexity, and diffusion tensor imaging (DTI) is unique in its ability to extract microstructural tissue properties at a macroscopic scale. However, despite its widespread use and applications in clinical and research settings, accurate validation of DTI has notoriously lagged the advances in image acquisition and analysis. In this report, we demonstrate an approach to visualize and quantify the microscopic features of histological sections on multiple length scales using techniques derived from image texture analysis. Structure tensor (ST) analysis was applied to fluorescence microscopy images of rat brain sections to visualize and quantify tissue microstructure. Images were digitally color-coded based on the local orientation in the pixelwise ST implementation, which allowed direct visualization of white matter complexity at the microscopic level. A piecewise ST algorithm was also employed to quantify anisotropy and orientation at a resolution comparable to that typically acquired with DTI. Anisotropy measured with ST analysis of stained histological sections was highly correlated with anisotropy measured by ex vivo DTI of the same brains (R(2)=0.92). Furthermore, angular histograms, or Fiber Orientation Distributions (FODs), were computed to mimic similar measures derived from high angular resolution diffusion imaging methods. The FODs for each pixel were fit to a mixture of von Mises distributions to identify putative regions of multiple fiber populations (i.e. crossing fibers). Despite its current application to two-dimensional microscopy, the ST analysis is a novel approach to visualize and quantify microstructure in the central nervous system in both health and disease, and advances the available set of tools for validating DTI and other diffusion MRI techniques. PMID:22759994

  16. Patient-Perceived Pressure from Clinicians for Labor Induction and Cesarean Delivery: A Population-Based Survey of U.S. Women

    PubMed Central

    Jou, Judy; Kozhimannil, Katy B; Johnson, Pamela Jo; Sakala, Carol

    2015-01-01

    Objective To determine whether patient-perceived pressure from clinicians for labor induction or cesarean delivery is significantly associated with having these procedures. Data Sources/Study Setting Listening to Mothers III, a nationally representative survey of women 18–45 years who delivered a singleton infant in a U.S. hospital July 2011–June 2012 (N = 2,400). Study Design Multivariate logistic regression analysis of factors associated with perceived pressure and estimation of odds of induction and cesarean given perceived pressure. Principal Findings Overall, 14.8 percent of respondents perceived pressure from a clinician for labor induction and 13.3 percent for cesarean delivery. Women who perceived pressure for labor induction had higher odds of induction overall (adjusted odds ratio [aOR]: 3.51; 95 percent confidence interval [CI]: 2.5–5.0) and without medical reason (aOR: 2.13; 95 percent CI: 1.3–3.4) compared with women who did not perceive pressure. Those perceiving pressure for cesarean delivery had higher odds of cesarean overall (aOR: 5.17; 95 percent CI: 3.2–8.4), without medical reason (aOR: 6.13; 95 percent CI: 3.4–11.1), and unplanned cesarean (aOR: 6.70; 95 percent CI: 4.0–11.3). Conclusions Patient-perceived pressure from clinicians significantly predicts labor induction and cesarean delivery. Efforts to reduce provider–patient miscommunication and minimize potentially unnecessary procedures may be warranted. PMID:25250981

  17. 3D inelastic analysis methods for hot section components

    NASA Technical Reports Server (NTRS)

    Dame, L. T.; Chen, P. C.; Hartle, M. S.; Huang, H. T.

    1985-01-01

    The objective is to develop analytical tools capable of economically evaluating the cyclic time dependent plasticity which occurs in hot section engine components in areas of strain concentration resulting from the combination of both mechanical and thermal stresses. Three models were developed. A simple model performs time dependent inelastic analysis using the power law creep equation. The second model is the classical model of Professors Walter Haisler and David Allen of Texas A and M University. The third model is the unified model of Bodner, Partom, et al. All models were customized for linear variation of loads and temperatures with all material properties and constitutive models being temperature dependent.

  18. The 3D inelastic analysis methods for hot section components

    NASA Technical Reports Server (NTRS)

    Dame, L. T.; Mcknight, R. L.

    1983-01-01

    The objective of this research is to develop an analytical tool capable of economically evaluating the cyclic time dependent plasticity which occurs in hot section engine components in areas of strain concentration resulting from the combination of both mechanical and thermal stresses. The techniques developed must be capable of accommodating large excursions in temperatures with the associated variations in material properties including plasticity and creep. The overall objective of this proposed program is to develop advanced 3-D inelastic structural/stress analysis methods and solution strategies for more accurate and yet more cost effective analysis of combustors, turbine blades, and vanes. The approach will be to develop four different theories, one linear and three higher order with increasing complexities including embedded singularities.

  19. An evaluation of wind turbine blade cross section analysis techniques.

    SciTech Connect

    Paquette, Joshua A.; Griffith, Daniel Todd; Laird, Daniel L.; Resor, Brian Ray

    2010-03-01

    The blades of a modern wind turbine are critical components central to capturing and transmitting most of the load experienced by the system. They are complex structural items composed of many layers of fiber and resin composite material and typically, one or more shear webs. Large turbine blades being developed today are beyond the point of effective trial-and-error design of the past and design for reliability is always extremely important. Section analysis tools are used to reduce the three-dimensional continuum blade structure to a simpler beam representation for use in system response calculations to support full system design and certification. One model simplification approach is to analyze the two-dimensional blade cross sections to determine the properties for the beam. Another technique is to determine beam properties using static deflections of a full three-dimensional finite element model of a blade. This paper provides insight into discrepancies observed in outputs from each approach. Simple two-dimensional geometries and three-dimensional blade models are analyzed in this investigation. Finally, a subset of computational and experimental section properties for a full turbine blade are compared.

  20. Quantitative image analysis of histological sections of coronary arteries

    NASA Astrophysics Data System (ADS)

    Holmes, David R., III; Robb, Richard A.

    2000-06-01

    The study of coronary arteries has evolved from examining gross anatomy and morphology to scrutinizing micro-anatomy and cellular composition. Technological advances such as high- resolution digital microscopes and high precision cutting devices have allowed examination of coronary artery morphology and pathology at micron resolution. We have developed a software toolkit to analyze histological sections. In particular, we are currently engaged in examining normal coronary arteries in order to provide the foundation for study of remodeled tissue. The first of two coronary arteries was stained for elastin and collagen. The second coronary artery was sectioned and stained for cellular nuclei and smooth muscle. High resolution light microscopy was used to image the sections. Segmentation was accomplished initially with slice- to-slice thresholding algorithms. These segmentation techniques choose optimal threshold values by modeling the tissue as one or more distributions. Morphology and image statistics were used to further differentiate the thresholded data into different tissue categories therefore refine the results of the segmentation. Specificity/sensitivity analysis suggests that automatic segmentation can be very effective. For both tissue samples, greater than 90% specificity was achieved. Summed voxel projection and maximum intensity projection appear to be effective 3-D visualization tools. Shading methods also provide useful visualization, however it is important to incorporate combined 2-D and 3-D displays. Surface rendering techniques (e.g. color mapping) can be used for visualizing parametric data. Preliminary results are promising, but continued development of algorithms is needed.

  1. Changes in Cesarean Delivery Rates by Gestational Age: United States, 1996-2011

    MedlinePlus

    ... Cesarean delivery rates at 38 weeks declined for all maternal age groups, but increased at 39 weeks. ... Cesarean delivery rates at 38 weeks declined for all racial and ethnic groups, but rose at 39 ...

  2. Hysteroscopy and suction evacuation of cesarean scar pregnancies: a case report and review.

    PubMed

    Fylstra, Donald L

    2014-03-01

    Implantation of a pregnancy into the scar of a prior cesarean is an uncommon type of ectopic pregnancy. The incidence of cesarean scar pregnancy is thought to be one in 1800-2216 pregnancies. The increase in the incidence of cesarean scar pregnancy is thought to be a consequence of the increasing rates of cesarean delivery. The natural history of cesarean scar pregnancy is unknown. However, if such a pregnancy is allowed to continue, uterine scar rupture with hemorrhage and possible hysterectomy seem likely. Two early diagnosed cesarean scar pregnancies were treated with hysteroscopy and suction curettage removal. One required intramuscular methotrexate to resolve a persistent cesarean scar ectopic pregnancy. It would seem reasonable that simple suction evacuation would frequently leave chorionic villi imbedded within the cesarean scar, as the pregnancy is not within the endometrial cavity. PMID:24320609

  3. Multispectral Digital Image Analysis of Varved Sediments in Thin Sections

    NASA Astrophysics Data System (ADS)

    Jäger, K.; Rein, B.; Dietrich, S.

    2006-12-01

    An update of the recently developed method COMPONENTS (Rein, 2003, Rein & Jäger, subm.) for the discrimination of sediment components in thin sections is presented here. COMPONENTS uses a 6-band (multispectral) image analysis. To derive six-band spectral information of the sediments, thin sections are scanned with a digital camera mounted on a polarizing microscope. The thin sections are scanned twice, under polarized and under unpolarized plain light. During each run RGB images are acquired which are subsequently stacked to a six-band file. The first three bands (Blue=1, Green=2, Red=3) result from the spectral behaviour in the blue, green and red band with unpolarized light conditions, and the bands 4 to 6 (Blue=4, Green=5, Red=6) from the polarized light run. The next step is the discrimination of the sediment components by their transmission behaviour. Automatic classification algorithms broadly used in remote sensing applications cannot be used due to unavoidable variations of sediment particle or thin section thicknesses that change absolute grey values of the sediment components. Thus, we use an approach based on band ratios, also known as indices. By using band ratios, the grey values measured in different bands are normalized against each other and illumination variations (e.g. thickness variations) are eliminated. By combining specific ratios we are able to detect all seven major components in the investigated sediments (carbonates, diatoms, fine clastic material, plant rests, pyrite, quartz and resin). Then, the classification results (compositional maps) are validated. Although the automatic classification and the analogous classification show high concordances, some systematic errors could be identified. For example, the transition zone between the sediment and resin filled cracks is classified as fine clastic material and very coarse carbonates are partly classified as quartz because coarse carbonates can be very bright and spectra are partly

  4. Instrumental neutron activation analysis of sectioned hair strands for arsenic

    SciTech Connect

    Guinn, V.P.

    1996-12-31

    Instrumental neutron activation analysis (INAA) is a valuable and proven method for the quantitative analysis of sectioned human head hair specimens for arsenic - and, if arsenic is found to be present at high concentrations, the approximate times when it was ingested. Reactor-flux thermal-neutron activation of the hair samples produces 26.3-h {sup 76}As, which is then detected by germanium gamma-ray spectrometry, measuring the 559.1-keV gamma-ray peak of {sup 76}As. Even normal levels of arsenic in hair, in the range of <1 ppm up to a few parts per million of arsenic can be measured - and the far higher levels associated with large internal doses of arsenic, levels approaching or exceeding 100 ppm arsenic, are readily and accurately measurable. However, all phases of forensic investigations of possible chronic (or in some cases, acute) arsenic poisoning are important, i.e., not just the analysis phase. All of these phases are discussed in this paper, based on the author`s experience and the experience of others, in criminal cases. Cases of chronic arsenic poisoning often reveal a series of two to four doses, perhaps a few months apart, with increasing doses.

  5. Repeat C-Section May Have No Long-Term Health Risk for Baby

    MedlinePlus

    ... nih.gov/medlineplus/news/fullstory_157776.html Repeat C-Section May Have No Long-Term Health Risk ... has a planned cesarean delivery after a prior C-section, a new study out of Scotland finds. ...

  6. EGAF: Measurement and Analysis of Gamma-ray Cross Sections

    NASA Astrophysics Data System (ADS)

    Firestone, R. B.; Abusaleem, K.; Basunia, M. S.; Bečvář, F.; Belgya, T.; Bernstein, L. A.; Choi, H. D.; Escher, J. E.; Genreith, C.; Hurst, A. M.; Krtička, M.; Renne, P. R.; Révay, Zs.; Rogers, A. M.; Rossbach, M.; Siem, S.; Sleaford, B.; Summers, N. C.; Szentmiklosi, L.; van Bibber, K.; Wiedeking, M.

    2014-05-01

    The Evaluated Gamma-ray Activation File (EGAF) is the result of a 2000-2007 IAEA Coordinated Research Project to develop a database of thermal, prompt γ-ray cross sections, σγ, for all elemental and selected radioactive targets. No previous database of this kind had existed. EGAF was originally based on measurements using guided neutron beams from the Budapest Reactor on all elemental targets from Z=1-82, 90 and 92, except for He and Pm. The EGAF σγ data were published in the Database of Prompt Gamma Rays from Slow Neutron Capture for Elemental Analysis [1]. An international collaboration has formed to continue the EGAF measurements with isotopically enriched targets, derive total radiative thermal neutron cross sections, σ0, extend the σγ data from thermal to 20 MeV neutrons, compile a completed activation data file, improve sections of the Reference Input Parameter Library (RIPL) with more complete and up to date level and γ-ray data, evaluate statistical γ-ray data from reaction studies, and determine recommended neutron separations energies, Sn, for atomic mass evaluations. A new guided neutron beam facility has become available at the Garching (Munich) FRM II Reactor, and high energy neutron experimental facilities are being developed by a Berkeley area collaboration where 5-33 MeV neutron beams are available at the LBNL 88” cyclotron, 2.5 and 14 MeV beams at the University of California, Berkeley neutron generator laboratory, and high flux, 10 nṡcmṡ-2 s-1, neutron pulses available from the LLNL National Ignition Facility (NIF).

  7. A Java application for tissue section image analysis.

    PubMed

    Kamalov, R; Guillaud, M; Haskins, D; Harrison, A; Kemp, R; Chiu, D; Follen, M; MacAulay, C

    2005-02-01

    The medical industry has taken advantage of Java and Java technologies over the past few years, in large part due to the language's platform-independence and object-oriented structure. As such, Java provides powerful and effective tools for developing tissue section analysis software. The background and execution of this development are discussed in this publication. Object-oriented structure allows for the creation of "Slide", "Unit", and "Cell" objects to simulate the corresponding real-world objects. Different functions may then be created to perform various tasks on these objects, thus facilitating the development of the software package as a whole. At the current time, substantial parts of the initially planned functionality have been implemented. Getafics 1.0 is fully operational and currently supports a variety of research projects; however, there are certain features of the software that currently introduce unnecessary complexity and inefficiency. In the future, we hope to include features that obviate these problems. PMID:15652632

  8. Cesarean Delivery for a Life-threatening Preterm Placental Abruption

    PubMed Central

    Okafor, II; Ugwu, EO

    2015-01-01

    Placental abruption is one of the major life-threatening obstetric conditions. The fetomaternal outcome of a severe placental abruption depends largely on prompt maternal resuscitation and delivery. A case of severe preterm placental abruption with intrauterine fetal death. Following a failed induction of labor with a deteriorating maternal condition despite resuscitation, emergency cesarean delivery was offered with good maternal outcome. Cesarean delivery could avert further disease progression and possible maternal death in cases of severe preterm placental abruption where vaginal delivery is not imminent. However, further studies are necessary before this could be recommended for routine clinical practice. PMID:27057388

  9. Venous Air Embolism during Surgery, Especially Cesarean Delivery

    PubMed Central

    Kim, Chang Seok; Liu, Jia; Kwon, Ja-Young; Shin, Seo Kyung

    2008-01-01

    Venous air embolism (VAE) is the entrapment of air or medical gases into the venous system causing symptoms and signs of pulmonary vessel obstruction. The incidence of VAE during cesarean delivery ranges from 10 to 97% depending on surgical position or diagnostic tools, with a potential for life-threatening events. We reviewed extensive literatures regarding VAE in detail and herein described VAE during surgery including cesarean delivery from background and history to treatment and prevention. It is intended that present work will improve the understanding of VAE during surgery. PMID:18955777

  10. Cesarean Scar Pregnancy Managed with Conservative Treatment.

    PubMed

    Boza, Aysen; Boza, Barıs; Api, Murat

    2016-09-01

    Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options. After the treatment, serum beta human chorionic gonadotropin (ß-hCG) levels were followed weekly until they reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 6.4±0.9 weeks. Treatment was systemic methotrexate (MTX) treatment in 3 of the 4 women, requiring no further intervention. The remaining 1 woman was treated with an intragestational administration of MTX. The mean time passed until ß-hCG reached <5 mIU/mL was 10.2±2.9 (range, 8-14) weeks, and the mean time passed until the gestational sac resolved was 21.5±3.5 (range, 18-25) weeks. Based on this limited number of case-series experience, it seems that CSP should be treated conservatively even if there are visible fetal cardiac activity, fetal poles, large gestational sacs, and high initial ß-hCG levels. Although the complete remission of the lesion takes a relatively long time, medical management via a noninvasive approach and follow-up should be tried as the first choice of therapy. PMID:27582596

  11. Cesarean Scar Pregnancy Managed with Conservative Treatment

    PubMed Central

    Boza, Aysen; Boza, Barıs; Api, Murat

    2016-01-01

    Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options. After the treatment, serum beta human chorionic gonadotropin (ß-hCG) levels were followed weekly until they reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 6.4±0.9 weeks. Treatment was systemic methotrexate (MTX) treatment in 3 of the 4 women, requiring no further intervention. The remaining 1 woman was treated with an intragestational administration of MTX. The mean time passed until ß-hCG reached <5 mIU/mL was 10.2±2.9 (range, 8–14) weeks, and the mean time passed until the gestational sac resolved was 21.5±3.5 (range, 18–25) weeks. Based on this limited number of case-series experience, it seems that CSP should be treated conservatively even if there are visible fetal cardiac activity, fetal poles, large gestational sacs, and high initial ß-hCG levels. Although the complete remission of the lesion takes a relatively long time, medical management via a noninvasive approach and follow-up should be tried as the first choice of therapy. PMID:27582596

  12. Cesarean delivery and colon resection in a patient with type III osteogenesis imperfecta.

    PubMed

    Fiegel, Matthew J

    2011-09-01

    OBJECTIVE. Osteogenesis imperfecta is a connective tissue disorder that results from the inability to produce normal collagen. Eight types are described; type II is considered the lethal variant. Because of abnormal collagen production, these patients possess many anatomic and functional abnormalities. In addition to the obvious brittle bones, osteogenesis imperfecta patients may also possess respiratory, cardiac, spinal, endocrine, and hematologic abnormalities. These numerous derangements can lead to a challenging perioperative course. CASE REPORT. This report describes a case of a 27-year-old woman, G1P0 with history of type III osteogenesis imperfecta presenting at 31+ weeks with preterm premature rupture of membranes, lower extremity edema, and constipation. Because of progressive labor and cephalopelvic disproportion, an urgent cesarean section was performed under general anesthesia. Intraoperative coagulopathy was noted. After hemostasis was achieved, a colonic mass below the splenic flexure that measured 20 × 10 cm was revealed. General surgery was consulted intraoperatively, and a rectosigmoid resection was performed for a presumed colonic pseudo-obstruction. Patient tolerated the procedure well and was extubated at the completion of the case. The patient was discharged home on postoperative day 5. CLINICAL CHALLENGES. (a) Preoperative assessment of an osteogenesis imperfecta patient, (b) determination of anesthetic type, (c) management of hemorrhage/cardiovascular instability, and (d) management of hyperthermia. CONCLUSIONS. This case report illustrates that, with proper knowledge of this disease state, osteogenesis imperfecta patients can undergo a safe anesthetic during a potentially challenging combined cesarean section/colonic resection. PMID:21813546

  13. Michigan's Tax-Expenditure Limit. Issues for Implementation. (A Section-by-Section Analysis.)

    ERIC Educational Resources Information Center

    Farnum, Eugene B.; And Others

    This booklet, prepared by the Michigan senate fiscal agency, explains new amendments to the state constitution that establish tax and expenditure limitations on state and local government in the state. The purpose of the report is to help legislators implement the new law. The first part of each section analyzes the constitutional language of the…

  14. Prevalence of Myopia in France: A Cross-Sectional Analysis.

    PubMed

    Matamoros, Emilie; Ingrand, Pierre; Pelen, François; Bentaleb, Yacine; Weber, Michel; Korobelnik, Jean-François; Souied, Eric; Leveziel, Nicolas

    2015-11-01

    Refractive error (RE), particularly myopia, is the first cause of visual impairment throughout the world. This study aimed to depict the prevalence of myopia in a multicentric series of French individuals.This cross-sectional analysis was carried out between January 2012 and November 2013 in eye clinics dedicated to REs. Data collection included age, gender, best-corrected visual acuity, RE, and any relevant medical history involving laser refractive surgery and cataract surgery. Exclusion criteria consisted of monophthalm patients or those with incomplete demographic data.Prevalences in the overall population, by gender and by age groups were reported for mild myopia (-0.50 to -2.75 diopter [D]), moderate myopia (-3 to -5.75 D), high myopia (less than -6 D), and very high myopia (less than -10 D).The analysis included 100,429 individuals, mean age 38.5 years (± 16.9). Overall prevalence of myopia was 39.1% (95% CI 38.8-39.4). Prevalences of mild, moderate, high and very high myopia were respectively 25.1% (95% CI 25.4-24.9), 10.6% (95% CI 10.4-10.8), 3.4% (95% CI 3.3-3.5) and 0.5% (95% CI 0.48-0.57).Even if possible bias occurred in recruitment, our results are similar to RE data collected in nationally representative samples of Caucasians in other studies. This is to our knowledge, one of the largest European series of individuals dedicated to myopia prevalences in different age groups. These results confirm the importance of myopia as a major health issue in Western countries. PMID:26559276

  15. Numerical analysis of flow through oscillating cascade sections

    NASA Technical Reports Server (NTRS)

    Huff, Dennis L.

    1989-01-01

    The design of turbomachinery blades requires the prevention of flutter for all operating conditions. However, flow field predictions used for aeroelastic analysis are not well understood for all flow regimes. The present research focuses on numerical solutions of the Euler and Navier-Stokes equations using an ADI procedure to model two-dimensional, transonic flow through oscillating cascades. The model prescribes harmonic pitching motions for the blade sections for both zero and non-zero inter-blade phase angles. The code introduces the use of a deforming grid technique for convenient specification of the periodic boundary conditions. Approximate nonreflecting boundary conditions have been coded for the inlet and exit boundary conditions. Sample unsteady solutions have been performed for an oscillating cascade and compared to experimental data. Also, test cases were fun for a flat plate cascade to compare with an unsteady, small-perturbation, subsonic analysis. The predictions for oscillating cascades with non-zero inter-blade phase angles are in good agreement with experimental data and small-perturbation theory. The zero degree inter-blade phase angle cases, which were near a resonant condition, differ from the experiment and theory. Studies on reflecting versus non-reflecting inlet and exit boundary conditions show that the treatment of the boundary can have a significant effect on the first harmonic, unsteady pressure distributions for certain flow conditions. This code is expected to be used as a tool for reviewing simpler models that do not include the full nonlinear aerodynamics or as a final check for designs against flutter in turbomachinery.

  16. Analysis of a Hybrid Wing Body Center Section Test Article

    NASA Technical Reports Server (NTRS)

    Wu, Hsi-Yung T.; Shaw, Peter; Przekop, Adam

    2013-01-01

    The hybrid wing body center section test article is an all-composite structure made of crown, floor, keel, bulkhead, and rib panels utilizing the Pultruded Rod Stitched Efficient Unitized Structure (PRSEUS) design concept. The primary goal of this test article is to prove that PRSEUS components are capable of carrying combined loads that are representative of a hybrid wing body pressure cabin design regime. This paper summarizes the analytical approach, analysis results, and failure predictions of the test article. A global finite element model of composite panels, metallic fittings, mechanical fasteners, and the Combined Loads Test System (COLTS) test fixture was used to conduct linear structural strength and stability analyses to validate the specimen under the most critical combination of bending and pressure loading conditions found in the hybrid wing body pressure cabin. Local detail analyses were also performed at locations with high stress concentrations, at Tee-cap noodle interfaces with surrounding laminates, and at fastener locations with high bearing/bypass loads. Failure predictions for different composite and metallic failure modes were made, and nonlinear analyses were also performed to study the structural response of the test article under combined bending and pressure loading. This large-scale specimen test will be conducted at the COLTS facility at the NASA Langley Research Center.

  17. Maintaining perioperative normothermia in the patient undergoing cesarean delivery.

    PubMed

    Carpenter, Lavenia; Baysinger, Curtis L

    2012-07-01

    Anesthesia and surgery interfere with normal thermoregulation, and nearly all patients will become hypothermic unless compensatory measures are used. Preoperative patient warming and intraoperative methods using forced air and warmed intravenous fluids are important methods for maintaining patient's core temperature during the perioperative period. The benefits of maintaining normothermia include reductions in postoperative wound infection, the risk of perioperative coagulopathy, and myocardial ischemia. These advantages, demonstrated in patients undergoing general surgery, would be expected in patients undergoing gynecological surgery but have not been specifically studied in that population. Few studies have examined the maternal and neonatal effects of hypothermia after cesarean delivery. The results conflict as to the effectiveness of maternal warming techniques used to prevent it and the effects on neonatal temperature and acid-base status at delivery. Large prospective studies will be required to show significant effects on rates of maternal wound infection after cesarean delivery. European and American national obstetrical organizations have not published recommendations regarding the perioperative thermal regulation for cesarean delivery. We review the physiology of thermal regulation and perioperative thermal management in surgical patients and the literature that has examined perioperative maternal warming for cesarean delivery. PMID:22926250

  18. Perimortem cesarean delivery: its role in maternal mortality.

    PubMed

    Katz, Vern L

    2012-02-01

    Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compressions cannot deliver sufficient cardiac output to accomplish resuscitation. Paradoxically, after a postmortem cesarean delivery is performed, effective CPR was seen to occur. Mothers were revived. Thus, the procedure was renamed the perimortem cesarean. Because brain damage begins at 5 minutes of anoxia, the procedure should be initiated at 4 minutes (the 4-minute rule) to deliver the healthiest fetus. If a mother has a resuscitatable cause of death, then her life may be saved as well by a prompt and timely cesarean delivery during CPR. Sadly, too often, we are paralyzed by the horror of the maternal cardiac arrest, and instinctively, we try CPR for too long before turning to the perimortem delivery. The quick procedure though may actually improve the situation for the mother, and certainly will save the child. PMID:22280869

  19. Analysis of cross sections using various nuclear potential

    SciTech Connect

    Aziz, Azni Abdul; Kassim, Hasan Abu; Yusof, Norhasliza; Muhammad Zamrun, F.

    2014-05-02

    The relevant astrophysical reaction rates which are derived from the reaction cross sections are necessary input to the reaction network. In this work, we analyse several theoretical models of the nuclear potential which give better prediction of the cross sections for some selected reactions.

  20. Efficacy of prophylactic intravenous ondansetron on the prevention of hypotension during cesarean delivery: a dose-dependent study

    PubMed Central

    Wang, Meng; Zhuo, Lang; Wang, Qun; Shen, Ming-Kun; Yu, Yan-Yun; Yu, Jun-Jing; Wang, Zhi-Ping

    2014-01-01

    Objective: This study was to determine the optimal dosage of ondansetron for preventing maternal hypotension during cesarean delivery. Methods: One hundred and fifty parturient women scheduled for elective cesarean section were randomly assigned to five groups (n=30). Five minutes prior to spinal anesthesia, women were injected with 5 ml of physiological saline (S), 2 mg (O2), 4 mg (O4), 6 mg (O6), or 8 mg (O8) of ondansetron in saline, respectively. Maternal blood pressure and heart rate were measured at 2-min intervals for 30 min. The serum parameters in umbilical cord blood were analyzed after delivery. Results: Compared with group S, the incidence of maternal hypotension was significantly lower in groups O4 and O6 (P < 0.05). The umbilical venous pH was significantly higher in group O4 (P < 0.05); while the partial pressure of carbon dioxide (Pco2) was significantly lower in groups O4, O6, and O8 (P < 0.05); and the bicarbonate (Hco3 -) and base excess in extracellular fluid (BEecf) were significantly lower in groups O6 and O8 (P < 0.05). Moreover, minimal changes of systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were observed in group O4 (P < 0.05). Conclusion: The optimal dose of ondansetron preloading was 4 mg during cesarean delivery. PMID:25664023

  1. Experimental nuclear cross sections for spacecraft shield analysis

    NASA Technical Reports Server (NTRS)

    Peelle, R. W.

    1972-01-01

    Experiments have been performed to validate and to supplement the intranuclear cascade model as a method for estimating cross sections of importance to spacecraft shield design. The experimental situation is inconclusive particularly for neutron-producing reactions, but is relatively sound for reaction cross sections and for proton spectra at several hundred MeV at medium forward angles. Secondary photon contributions are imprecisely known.

  2. Systematic analysis of reaction cross sections of carbon isotopes

    SciTech Connect

    Horiuchi, W.; Suzuki, Y.; Abu-Ibrahim, B.; Kohama, A.

    2007-04-15

    We systematically analyze total reaction cross sections of carbon isotopes with N= 6-16 on a {sup 12}C target for wide range of incident energy. The intrinsic structure of the carbon isotope is described by a Slater determinant generated from a phenomenological mean-field potential, which reasonably well reproduces the ground-state properties for most of the even N isotopes. We need separate studies not only for odd nuclei but also for {sup 16}C and {sup 22}C to improve their wave functions. The density of the carbon isotope is constructed by eliminating the effect of the center-of-mass motion. For the calculations of the cross sections, we take two schemes, the Glauber approximation and the eikonal model using a global optical potential. Both the reaction models successfully reproduce low and high incident energy data on the cross sections of {sup 12}C, {sup 13}C, and {sup 16}C on {sup 12}C. The calculated reaction cross sections of {sup 15}C are found to be considerably smaller than the empirical values observed at low energy. We find a consistent parametrization of the nucleon-nucleon scattering amplitude, differently from previous ones. Finally, we predict the total reaction cross section of {sup 22}C on {sup 12}C.

  3. Damage Analysis of Rectangular Section Composite Beam under Pure Bending

    NASA Astrophysics Data System (ADS)

    Liu, Yiping; Xiao, Fan; Liu, Zejia; Tang, Liqun; Fang, Daining

    2013-02-01

    Laminated composite beams are commonly used in engineering applications involving macro to nano structures. Based on the assumption that plain sections remain plain after deformation, this paper analyzes stress distributions in cross-ply laminated composite beams with rectangular cross-sections, and formulates the basic damage equations through Kachanov's damage definition and Janson's failure criterion. The location of the neutral axis and the ultimate bending moment are obtained for pure bending cases. The effect of the elastic modulus of the two layers on the damage evolution is analyzed; a reasonable damage composite beam model is proposed to predict the ultimate bending moment.

  4. Cross section measurements via residual nuclear decays: Analysis methods

    SciTech Connect

    Zhou Fengqun; Gao Lei; Li Kuohu; Song Yueli; Zhang Fang; Kong Xiangzhong; Luo Junhua

    2009-11-15

    We develop an approach to calculating the pure cross section of the ground state of artificial radioactive nuclides that subtracts the effect of an excited state on the ground state. We apply a formalism to obtaining pure cross sections by subtracting the effect of excited states in the reactions {sup 122}Te(n,2n){sup 121}Te{sup g} and {sup 128}Te(n,2n){sup 127}Te{sup g}, induced by neutrons of about 14 MeV. The cross sections are measured by an activation relative to the {sup 93}Nb(n,2n){sup 92}Nb{sup m} reaction and are compared with results that take into account the effect of the excited state. Measurements are carried out by {gamma} detection using a coaxial high-purity germanium (HPGe) detector. As samples, spectroscopically pure Te powder is used. The fast neutrons are produced by the {sup 3}H(d,n){sup 4}He reaction. The neutron energies in these measurements are determined using the method of cross-section ratios between the {sup 90}Zr(n,2n){sup 89}Zr{sup m+g} and {sup 93}Nb(n,2n){sup 92}Nb{sup m} reactions.

  5. Commentary: Mediation Analysis, Causal Process, and Cross-Sectional Data

    ERIC Educational Resources Information Center

    Shrout, Patrick E.

    2011-01-01

    Maxwell, Cole, and Mitchell (2011) extended the work of Maxwell and Cole (2007), which raised important questions about whether mediation analyses based on cross-sectional data can shed light on longitudinal mediation process. The latest article considers longitudinal processes that can only be partially explained by an intervening variable, and…

  6. A Genre Analysis of Preface Sections of Textbook

    ERIC Educational Resources Information Center

    Asghar, Samina Ali; Asghar, Zobina Muhammad; Mahmood, Muhammad Asim

    2015-01-01

    This study aims to analyze the preface section of the fifteen English academic text book related to the field of linguistics. Researcher adapted the move structure pattern proposed by Abdollahzadeh & Salarvan (2013) on the notion of Swales (1990) and Bhatia (1993). Fourteen moves were identified employed by preface authors to indicate…

  7. Molecular analysis of Aspergillus section Flavi isolated from Brazil nuts.

    PubMed

    Gonçalves, Juliana Soares; Ferracin, Lara Munique; Carneiro Vieira, Maria Lucia; Iamanaka, Beatriz Thie; Taniwaki, Marta Hiromi; Pelegrinelli Fungaro, Maria Helena

    2012-04-01

    Brazil nuts are an important export market in its main producing countries, including Brazil, Bolivia, and Peru. Approximately 30,000 tons of Brazil nuts are harvested each year. However, substantial nut contamination by Aspergillus section Flavi occurs with subsequent production of aflatoxins. In our study, Aspergillus section Flavi were isolated from Brazil nuts (Bertholletia excelsa), and identified by morphological and molecular means. We obtained 241 isolates from nut samples, 41% positive for aflatoxin production. Eighty-one isolates were selected for molecular investigation. Pairwise genetic distances among isolates and phylogenetic relationships were assessed. The following Aspergillus species were identified: A. flavus, A. caelatus, A. nomius, A. tamarii, A. bombycis, and A. arachidicola. Additionally, molecular profiles indicated a high level of nucleotide variation within β-tubulin and calmodulin gene sequences associated with high genetic divergence from RAPD data. Among the 81 isolates analyzed by molecular means, three of them were phylogenetically distinct from all other isolates representing the six species of section Flavi. A putative novel species was identified based on molecular profiles. PMID:22805966

  8. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

    PubMed Central

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2014-01-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  9. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery.

    PubMed

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2015-04-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  10. Nonlinear analysis of a prestressed concrete pole section

    SciTech Connect

    Healy, G.S.

    1982-08-01

    This paper attacks the analysis of prestressed concrete structures. The attack is made assuming that the steel prestress members behave linearly and that the concrete is a nonlinear material obeying a second order stress-strain relationship. The entire analysis depends only on one empirical assumption and is developed from fundamental concepts of statics. The theoretical ground work is presented; and, then, a familiar example is solved. Additional theoretical development is presented as the solution of the example problem develops. This particular method of analysis presents an alternative to the empirically based ACI method.

  11. [Maternal refusal to consent to a cesarean delivery, stillbirth].

    PubMed

    Defline, A; Obadia, M; El Djerbi, A; Plevy, P; Lepercq, J

    2014-01-01

    The doctor-lawyer perspective that we discuss is a maternal refusal to consent to a cesarean delivery for a fetal indication in June 2011. Despite repeated information of the risks during a three-week hospitalization for pre-eclampsia, after being assured of the proper understanding of the seriousness of the situation by the patient and spouse, and after consideration to transfer to another hospital, the reiterated refusal led to a late fetal extraction resulting in term stillbirth. PMID:23972774

  12. On 3D inelastic analysis methods for hot section components

    NASA Technical Reports Server (NTRS)

    Mcknight, R. L.; Chen, P. C.; Dame, L. T.; Holt, R. V.; Huang, H.; Hartle, M.; Gellin, S.; Allen, D. H.; Haisler, W. E.

    1986-01-01

    Accomplishments are described for the 2-year program, to develop advanced 3-D inelastic structural stress analysis methods and solution strategies for more accurate and cost effective analysis of combustors, turbine blades and vanes. The approach was to develop a matrix of formulation elements and constitutive models. Three constitutive models were developed in conjunction with optimized iterating techniques, accelerators, and convergence criteria within a framework of dynamic time incrementing. Three formulations models were developed; an eight-noded mid-surface shell element, a nine-noded mid-surface shell element and a twenty-noded isoparametric solid element. A separate computer program was developed for each combination of constitutive model-formulation model. Each program provides a functional stand alone capability for performing cyclic nonlinear structural analysis. In addition, the analysis capabilities incorporated into each program can be abstracted in subroutine form for incorporation into other codes or to form new combinations.

  13. The 3D inelastic analysis methods for hot section components

    NASA Technical Reports Server (NTRS)

    Mcknight, R. L.; Maffeo, R. J.; Tipton, M. T.; Weber, G.

    1992-01-01

    A two-year program to develop advanced 3D inelastic structural stress analysis methods and solution strategies for more accurate and cost effective analysis of combustors, turbine blades, and vanes is described. The approach was to develop a matrix of formulation elements and constitutive models. Three constitutive models were developed in conjunction with optimized iterating techniques, accelerators, and convergence criteria within a framework of dynamic time incrementing. Three formulation models were developed: an eight-noded midsurface shell element; a nine-noded midsurface shell element; and a twenty-noded isoparametric solid element. A separate computer program has been developed for each combination of constitutive model-formulation model. Each program provides a functional stand alone capability for performing cyclic nonlinear structural analysis. In addition, the analysis capabilities incorporated into each program can be abstracted in subroutine form for incorporation into other codes or to form new combinations.

  14. Patient Counseling and Preferences for Elective Repeat Cesarean Delivery

    PubMed Central

    Folsom, Susan; Esplin, M. Sean; Edmunds, Sean; Metz, Torri D.; Jackson, G. Marc; Porter, T. Flint; Varner, Michael W.

    2016-01-01

    Objective We sought to identify factors influencing a woman's decision to have an elective repeat cesarean delivery (ERCD) versus vaginal birth after cesarean (VBAC). Methods and Materials A prospective study at two academic medical centers of women with one prior cesarean, and no contraindication to a trial of labor, delivered by ERCD from October 2013 to June 2014. Participants completed anonymous surveys during their delivery hospitalization. Counseling was considered adequate if women reported being counseled, recalled being quoted a VBAC success probability, and this probability was within 20% of that derived from an established VBAC success prediction model. Participants were also asked why they chose ERCD. Results Of 68 participants, only 8 (11.8%) had adequate counseling. Of those with inadequate counseling, 21.7% did not recall being counseled, 63.3% were not quoted a chance of success, and 60.0% had more than a 20% discrepancy between their recalled and predicted success rates. Eighteen women were calculated to have more than 70% chance of successful VBAC. Of these, 16 (88.9%) were not adequately counseled. Conclusion Most women were inadequately counseled about delivery options. The most important factors influencing the choice of ERCD over VBAC were patient preferences, risk for fetal injury, and perceived physician preference. PMID:27308098

  15. Analysis of viscous transonic flow over airfoil sections

    NASA Technical Reports Server (NTRS)

    Huff, Dennis L.; Wu, Jiunn-Chi; Sankar, L. N.

    1987-01-01

    A full Navier-Stokes solver has been used to model transonic flow over three airfoil sections. The method uses a two-dimensional, implicit, conservative finite difference scheme for solving the compressible Navier-Stokes equations. Results are presented as prescribed for the Viscous Transonic Airfoil Workshop to be held at the AIAA 25th Aerospace Sciences Meeting. The NACA 0012, RAE 2822 and Jones airfoils have been investigated for both attached and separated transonic flows. Predictions for pressure distributions, loads, skin friction coefficients, boundary layer displacement thickness and velocity profiles are included and compared with experimental data when possible. Overall, the results are in good agreement with experimental data.

  16. Low-dose combined spinal-epidural anesthesia for cesarean delivery: a comparison of three plain local anesthetics.

    PubMed

    Coppejans, H C; Vercauteren, M P

    2006-01-01

    The new local anesthetics have been poorly studied for intrathecal use during Cesarean section surely in low doses and in combination with an opioid substance. The purpose of the present study was to compare bupivacaine and the newer local anesthetics in equipotent doses. During the induction of combined spinal-epidural anesthesia, 91 elective Cesarean section patients were randomly assigned to receive a spinal injection of either 10 mg ropivacaine or 6.6 mg bupivacaine or levobupivacaine both combined with sufentanil 3.3 microg. After securing the epidural catheter patients were turned to the supine position respecting a 15 degrees left lateral tilt. The three local anesthetics were compared with respect to sensory and motor block, the need for epidural supplementation, the severity of hypotension and neonatal outcome. More patients in bupivacaine had a Bromage-3 motor block at incision. The ropivacaine group required additional local anesthetics by the epidural route in 23% of the cases versus 10% in the bupivacaine group and 9% with levobupivacaine. This caused the interval between the spinal injection and the end of surgery to be longer in the ropivacaine group. Hemodynamic values were comparable between the three groups although a trend towards better systolic blood pressures and a lower incidence of severe hypotension were noticed in favor of levobupivacaine. Apgar scores and umbilical pH values did not differ. When performing a low-dose combined spinal-epidural technique for Cesarean section, the present study confirms that the new local anesthetics can be used successfully, induce less motor block but that ropivacaine requires at least a 50% larger dose than bupivacaine or levobupivacaine. PMID:16617756

  17. Determinants of Cesarean Delivery in the U.S.: A Lifecourse Approach

    PubMed Central

    Witt, Whitney P.; Wisk, Lauren E.; Cheng, Erika R.; Mandell, Kara; Chatterjee, Debanjana; Wakeel, Fathima; Godecker, Amy L.; Zarak, Dakota

    2014-01-01

    Objectives This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the United States by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated Cesarean section (C-section). Methods Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n=9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-section. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-section, compared to vaginal delivery. Results 74.2% of women had a vaginal delivery, 11.6% had a non-medically indicated C-section, and 14.2% had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we find salient differences between the risk factors for indicated and non-indicated C-sections. Conclusions Surgical deliveries continue to occur at a high rate in the United States despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers. PMID:24770955

  18. Theme section: Multi-dimensional modelling, analysis and visualization

    NASA Astrophysics Data System (ADS)

    Guilbert, Éric; Çöltekin, Arzu; Castro, Francesc Antón; Pettit, Chris

    2016-07-01

    Spatial data are now collected and processed in larger amounts, and used by larger populations than ever before. While most geospatial data have traditionally been recorded as two-dimensional data, the evolution of data collection methods and user demands have led to data beyond the two dimensions describing complex multidimensional phenomena. An example of the relevance of multidimensional modelling is seen with the development of urban modelling where several dimensions have been added to the traditional 2D map representation (Sester et al., 2011). These include obviously the third spatial dimension (Biljecki et al., 2015) as well as the temporal, but also the scale dimension (Van Oosterom and Stoter, 2010) or, as mentioned by (Lu et al., 2016), multi-spectral and multi-sensor data. Such a view provides an organisation of multidimensional data around these different axes and it is time to explore each axis as the availability of unprecedented amounts of new data demands new solutions. The availability of such large amounts of data induces an acute need for developing new approaches to assist with their dissemination, visualisation, and analysis by end users. Several issues need to be considered in order to provide a meaningful representation and assist in data visualisation and mining, modelling and analysis; such as data structures allowing representation at different scales or in different contexts of thematic information.

  19. Intravenous granisetron attenuates hypotension during spinal anesthesia in cesarean delivery: A double-blind, prospective randomized controlled study

    PubMed Central

    Eldaba, Ahmed A.; Amr, Yasser M.

    2015-01-01

    Background and Aims: This study was conducted to determine the effectiveness of intravenous (IV) granisetron in the prevention of hypotension and bradycardia during spinal anesthesia in cesarean delivery. Material and Methods: A total of 200 parturients scheduled for elective cesarean section were included in this study. They were randomly divided into two groups. Group I was given 1 mg granisetron diluted in 10 ml normal saline slowly IV, 5 min before spinal anesthesia. Group II was given 10 ml of normal saline, 5 min before spinal anesthesia. Mean arterial blood pressure and heart rate (HR) were recorded every 3 min until the end of surgery (for 45 min). The total consumption of vasopressors and atropine were recorded. Apgar scores at 1 and 5 min were also assessed. Results: Serial mean arterial blood pressure and HR values for 45 min after onset of spinal anesthesia were decreased significantly in group II, P < 0.0001. The incidence of hypotension after spinal anesthesia was 64% in group II and 3% in group I (P < 0.0001). The total doses of ephedrine (4.07 ± 3.87 mg vs 10.7 ± 8.9 mg, P < 0.0001), phenylephrine (0.0 microg vs 23.2 ± 55.1 microg, P < 0.0001), and atropine (0.0 mg vs 0.35 ± 0.49 mg P < 0.0001) consumed in both the groups respectively, were significantly less in group I versus group II. Conclusion: Premedication with 1 mg IV granisetron before spinal anesthesia in an elective cesarean section significantly reduces hypotension, bradycardia and vasopressors usage. PMID:26330710

  20. Sequelae of Cesarean and Vaginal Deliveries: Psychosocial Outcomes for Mothers and Infants.

    ERIC Educational Resources Information Center

    Durik, Amanda M.; Hyde, Janet Shibley; Clark, Roseanne

    2000-01-01

    Compared psychosocial outcomes for mothers and their infants who had been delivered vaginally or by planned or unplanned cesarean deliveries. Found that women low in neuroticism who delivered by unplanned cesarean showed less positive affect toward infants at 4 months than did women in other groups. Found some evidence that maternal appraisal of…

  1. The effect of an instructional program based on health belief model in decreasing cesarean rate among primiparous pregnant mothers

    PubMed Central

    Hassani, Laleh; Aghamolaei, Teamur; Ghanbarnejad, Amin; Dadipoor, Sakineh

    2016-01-01

    Introduction: Although cesarean section has saved many mothers’ and infants’ lives, the problem is in its increasing prevalence. According to recent statistics, the current rate of cesarean in Iran is in fact 3–4 times as more than the standard rate defined by WHO. Therefore, the present study is aimed to estimate the effect of an instructional program based on health belief model on reducing cesarean rate among primiparous pregnant women. Materials and Methods: In this semi-experimental research, 60 primiparous women who had visited Bandar Abbas Healthcare Centers were selected as the subjects. They were in their 26–30th week of pregnancy. They were selected in a multi-stage cluster sampling method (a combination of clustering and simple randomization), and were divided into two groups, subjects and control group. The data were gathered using a valid and reliable questionnaire. The instructional intervention was done after the completion of the pretest questionnaire based on the sub-constructs of the health belief model in six instructional sessions. 1 month after the intervention, posttest questionnaires were completed by the subjects in both groups. The data were analyzed using descriptive statistics, standard deviation, independent t-test, and paired t-test. The significance level was set at <0.05. Results: Two groups had a significant difference between awareness score, perceived sensitivity, intensity, benefits, barriers, self-efficacy, and the performance (P < 0.001). In the experimental group, nine subjects (30%) had a natural delivery. Conclusion: According to the findings of the current research, an instructional program illuminated (designed) by the health belief model can significantly influence pregnant women's awareness, intention, and choice of delivery type. PMID:27512693

  2. Fatal respiratory thermal injury following accidental administration of carbon dioxide using the circle system for a cesarean delivery.

    PubMed

    Aghdashi, M M; Abbasivash, R; Hassani, E; Pirnejad, H

    2009-10-01

    A 37-year-old parturient underwent emergency cesarean delivery because of severe preeclampsia. After induction of general anesthesia, the oxygen saturation decreased. Volatile anesthetics were discontinued and examination of the anesthetic circuit and machine revealed a soda lime canister that was extremely hot. The patient was detached from the anesthetic machine and hand-ventilated with an external oxygen cylinder. The surgery was cancelled and the patient was extubated. Analysis of the cylinder connected to the anesthesia machine displayed 100% carbon dioxide. The patient developed progressive respiratory failure. Bronchoscopic examination revealed burn scars from the carina to the main bronchi. The patient died within four months of the incident. PMID:19734035

  3. An Abdominal Wall Desmoid Tumour Mimicking Cesarean Scar Endometriomas: A Case Report and Review of the Literature

    PubMed Central

    Vural, Fisun; Müezzinoglu, Bahar

    2015-01-01

    Abdominal wall desmoid tumours (DT) are rare, slow-growing benign muscular-aponeurotic fibrous tumours with the tendency to locally invade and recur. They constitute 0.03% of all neoplasms and high infiltration and recurrence rate, but there is no metastatic potential. Although surgery is the primary treatment modality, the optimal treatment remains unclear. Abdominal wall endometriosis is also an unusual disease, and preoperative clinical diagnosis is not always easy. The preoperative radiologic imaging modalities may not aid all the time. Herein, we report an abdominal mass presenting as cyclic pain. Forty-two years old woman who gave birth by cesarean section admitted the complaints of painful abdominal mass (78x45 mm in size) under her cesarean incision scar. She had severe pain, particularly during menstruation. The clinical and radiological imaging findings mimicking endometrioma. We performed wide surgical excision of mass with a 1 cm tumor-free margin with the diagnosis of a benign mesenchymal tumor in the frozen section. The postoperative course was uneventful and recovered without any complication and recurrence three years after surgery. This report presents a case of abdominal wall desmoid tumor mimicking endometrioma. In this paper, shortcomings in diagnosis, abdominal wall endometriomas, and DTs were discussed in the view of literature. PMID:26500967

  4. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study 1

    PubMed Central

    Mendes, Edilaine de Paula Batista; de Oliveira, Sonia Maria Junqueira Vasconcellos; Caroci, Adriana de Souza; Francisco, Adriana Amorim; Oliveira, Sheyla Guimaraes; da Silva, Renata Luana

    2016-01-01

    ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength. PMID:27533267

  5. Unified nonlinear analysis for nonhomogeneous anisotropic beams with closed cross sections

    NASA Technical Reports Server (NTRS)

    Atilgan, Ali R.; Hodges, Dewey H.

    1991-01-01

    A unified methodology for geometrically nonlinear analysis of nonhomogeneous, anisotropic beams is presented. A 2D cross-sectional analysis and a nonlinear 1D global deformation analysis are derived from the common framework of a 3D, geometrically nonlinear theory of elasticity. The only restrictions are that the strain and local rotation are small compared to unity and that warping displacements are small relative to the cross-sectional dimensions. It is concluded that the warping solutions can be affected by large deformation and that this could alter the incremental stiffnes of the section. It is shown that sectional constants derived from the published, linear analysis can be used in the present nonlinear, 1D analysis governing the global deformation of the beam, which is based on intrinsic equations for nonlinear beam behavior. Excellent correlation is obtained with published experimental results for both isotropic and anisotropic beams undergoing large deflections.

  6. The Association between Cesarean Delivery on Maternal Request and Method of Newborn Feeding in China

    PubMed Central

    Liu, Xinxue; Zhang, Jun; Liu, Yinghui; Li, Yangmei; Li, Zhu

    2012-01-01

    Background Cesarean delivery has increased significantly during the last decades. This study aimed to investigate the association between planned mode of delivery and method of feeding. Methodology/Principal Findings A cohort was created retrospectively using data from a population-based maternal and child health surveillance system, which covers 27 study sites in China from 1993 to 2006. The cohort consisted of 431,704 women for analysis, including 22,462 women with planned cesarean delivery on maternal request (CDMR) and 409,242 women with planned vaginal delivery (VD). Logistic regression models were used to examine the association between mode of delivery and method of feeding adjusting for selected covariates. In this cohort, 398,176 (92.2%) women exclusively breastfed their baby, 28,798 (6.7%) women chose mixed feeding, and 4,730 (1.1%) women chose formula feeding before hospital discharge. Women who planned CDMR were less likely to exclusively breastfeed and more likely to formula feed their babies than those who planned VD. After adjusting for covariates, the odds ratios were 0.85 (95% CI: 0.81–0.89) for exclusive breastfeeding and 1.61 (95% CI: 1.45–1.79) for formula feeding. Associations between planned mode of delivery and method of feeding in the south, north, rural and urban areas yielded similar results. Conclusion This study demonstrated that planned CDMR was associated with a lower rate of exclusive breastfeeding and a higher rate of formula feeding in a low-risk Chinese population. PMID:22624019

  7. Building-Integrated Photovoltaics (BIPV) in the Residential Section: An Analysis of Installed Rooftop Prices (Presentation)

    SciTech Connect

    James, T.; Goodrich, A.; Woodhouse, M.; Margolis, R.; Ong, S.

    2012-06-01

    This powerpoint presentation to be presented at the World Renewable Energy Forum on May 17, 2012, in Denver, CO, discusses building-integrated photovoltaics (BIPV) in the residential section and includes an analysis of installed rooftop prices.

  8. Covariance of Neutron Cross Sections for {sup 16}O through R-matrix Analysis

    SciTech Connect

    Kunieda, S.; Kawano, T.; Paris, M.; Hale, G.M.; Shibata, K.; Fukahori, T.

    2015-01-15

    Through the R-matrix analysis, neutron cross sections as well as the covariance are estimated for {sup 16}O in the resolved resonance range. Although we consider the current results are still preliminary, we present the summary of the cross section analysis and the results of data uncertainty/covariance, including those for the differential cross sections. It is found that the values obtained highlight consequences of nature in the theory as well as knowledge from measurements, which gives a realistic quantification of evaluated nuclear data covariances.

  9. Analysis of approximations used in calculations of radiative corrections to electron-proton scattering cross section

    SciTech Connect

    Gerasimov, R. E. Fadin, V. S.

    2015-01-15

    An analysis of approximations used in calculations of radiative corrections to electron-proton scattering cross section is presented. We investigate the difference between the relatively recent Maximon and Tjon result and the Mo and Tsai result, which was used in the analysis of experimental data. We also discuss the proton form factors ratio dependence on the way we take into account radiative corrections.

  10. Resonance Analysis and Evaluation of the Uranium -235 Neutron-Induced Cross-Sections

    NASA Astrophysics Data System (ADS)

    Leal, Luiz Carlos

    Neutron cross sections of fissile nuclei are of considerable interest for the understanding of parameters such as resonance absorption, resonance escape probability, resonance self-shielding, and the dependence of the reactivity on temperature. In the present study, new techniques for the evaluation of the ^{235}U neutron cross sections are described. The Reich-Moore formalism of the Bayesian computer code SAMMY was used to perform consistent R-matrix multilevel analyses of the selected neutron cross-section data. The Delta_3 -statistics of Dyson and Mehta, along with high -resolution data and the spin-separated fission cross-section data, have provided the possibility of developing a new methodology for the analysis and evaluation of neutron -nucleus cross-sections. The result of the analysis consists of a set of resonance parameters which describe the ^{235}U neutron cross sections up to 500 eV. The set of resonance parameters obtained through a R-matrix analysis are expected to satisfy statistical properties which lead to information on the nuclear structure. The resonance parameters were tested and showed good agreement with the theory. It is expected that the parametrization of the ^{235}U neutron cross sections obtained in this dissertation represents the current state of art in data as well as in theory and, therefore, can be of direct use in reactor calculations.

  11. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries

    PubMed Central

    Kim, Ju Hyun; Joung, Eun-Ju; Lee, Soo-Jung; Kwack, Jae Young

    2015-01-01

    There are few methods to control heavy intra-operative bleeding during cesarean delivery of placenta previa. Transient occlusion of uterine arteries (TOUA) during operation has previously been reported as a quick and safe method to control intra-operative uterine bleeding. We reported 2 cases of cesarean delivery with complete placenta previa in which TOUA was performed to safely reduce intra-operative complication, especially heavy intra-operative bleeding. In the 2 cases, cesarean deliveries were safe and without any complications under the TOUA method. TOUA can be a good method to control heavy intra-operative bleeding during cesarean delivery of complete placenta previa with risk of heavy bleeding. PMID:26623419

  12. Management of Pregnant Patients Who Refuse Medically Indicated Cesarean Delivery

    PubMed Central

    Deshpande, Neha A; Oxford, Corrina M

    2012-01-01

    The doctrine of informed refusal may become difficult to adhere to in obstetric practice, especially in situations in which the fetus’s life is at risk. One rare yet potentially problematic situation of informed refusal is the case of a pregnant woman who refuses to undergo a medically indicated cesarean delivery that would ensure the well-being of her fetus. Although some would argue that patient autonomy takes precedence and the woman’s informed refusal should be respected, others would argue that beneficence, justice, and doing no harm to the viable fetus should ethically overrule the refusal of a surgery. This article explores the profound conflict between maternal autonomy and the rights of the fetus, provides a framework to address when the two diverge, and poses suggestions for how providers can better navigate this dilemma. PMID:23483714

  13. Visualization and analysis of gene expression in tissue sections by spatial transcriptomics.

    PubMed

    Ståhl, Patrik L; Salmén, Fredrik; Vickovic, Sanja; Lundmark, Anna; Navarro, José Fernández; Magnusson, Jens; Giacomello, Stefania; Asp, Michaela; Westholm, Jakub O; Huss, Mikael; Mollbrink, Annelie; Linnarsson, Sten; Codeluppi, Simone; Borg, Åke; Pontén, Fredrik; Costea, Paul Igor; Sahlén, Pelin; Mulder, Jan; Bergmann, Olaf; Lundeberg, Joakim; Frisén, Jonas

    2016-07-01

    Analysis of the pattern of proteins or messengerRNAs (mRNAs) in histological tissue sections is a cornerstone in biomedical research and diagnostics. This typically involves the visualization of a few proteins or expressed genes at a time. We have devised a strategy, which we call "spatial transcriptomics," that allows visualization and quantitative analysis of the transcriptome with spatial resolution in individual tissue sections. By positioning histological sections on arrayed reverse transcription primers with unique positional barcodes, we demonstrate high-quality RNA-sequencing data with maintained two-dimensional positional information from the mouse brain and human breast cancer. Spatial transcriptomics provides quantitative gene expression data and visualization of the distribution of mRNAs within tissue sections and enables novel types of bioinformatics analyses, valuable in research and diagnostics. PMID:27365449

  14. Improving resolution of crosswell seismic section based on time-frequency analysis

    SciTech Connect

    Luo, H.; Li, Y.

    1994-12-31

    According to signal theory, to improve resolution of seismic section is to extend high-frequency band of seismic signal. In cross-well section, sonic log can be regarded as a reliable source providing high-frequency information to the trace near the borehole. In such case, what to do is to introduce this high-frequency information into the whole section. However, neither traditional deconvolution algorithms nor some new inversion methods such as BCI (Broad Constraint Inversion) are satisfied because of high-frequency noise and nonuniqueness of inversion results respectively. To overcome their disadvantages, this paper presents a new algorithm based on Time-Frequency Analysis (TFA) technology which has been increasingly received much attention as an useful signal analysis too. Practical applications show that the new method is a stable scheme to improve resolution of cross-well seismic section greatly without decreasing Signal to Noise Ratio (SNR).

  15. Emerging Manifestations of Cesarean Scar Defect in Reproductive-aged Women.

    PubMed

    Tulandi, Togas; Cohen, Aviad

    2016-01-01

    The objective of this study was to evaluate the prevalence of cesarean scar defects and its clinical manifestations in reproductive-aged women. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement using keywords of "cesarean scar defect, uterine scar defect, uterine diverticulum niche, isthmocele, pouch, or sacculation" and their combination. Thirty-two trials met the inclusion criteria. Cesarean scar defects are commonly found on ultrasound examination (24%-88%). Their presence could be asymptomatic or related to postmenstrual spotting, postmenstrual bleeding, or infertility. The prevalence of this condition is related to the number of cesarean deliveries. Hysteroscopic repair of a cesarean scar defect or isthmoplasty is associated with an improvement in uterine bleeding in 59% to 100% of cases and a pregnancy rate of 77.8% to 100%. An improvement in uterine bleeding after vaginal repair occurred in 89% to 93.5% of cases. Laparoscopic repair led to uterine bleeding improvement in 86% of cases and a pregnancy rate of 86%. The association between cesarean scar defect and infertility, pelvic pain, and dysmenorrhea require more studies. Treatment of uterine scar defects should be performed after eliminating other causes of postmenstrual bleeding or infertility. Hysteroscopic isthmoplasty appears to be the most popular treatment. However, in the absence of randomized trials, the efficacy of different surgical approaches remains to be seen. Until we have concrete evidence, the treatment should be reserved for selective cases. PMID:27393285

  16. Wave Propagation in Exponentially Varying Cross-Section Rods and Vibration Analysis

    SciTech Connect

    Nikkhah-Bahrami, Mansour; Loghmani, Masih; Pooyanfar, Mostafa

    2008-09-01

    In this paper vibration as propagating waves is used to calculate frequencies of exponentially varying cross-section rods with various boundary conditions. From wave standpoint, vibrations propagate, reflect and transmit in structures. The propagation and reflection matrices are combined to provide a concise and systematic approach to free longitudinal vibration analysis of exponentially varying cross-section rods. The results are compared with another method.

  17. Shielding analysis at the upper section of the accelerator-driven system.

    PubMed

    Sasa, Toshinobu; Yang, Jin An; Oigawa, Hiroyuki

    2005-01-01

    The proton beam duct of the accelerator-driven system (ADS) acts as a streaming path for spallation neutrons and photons and causes the activation of the magnets and other devices above the subcritical core. We have performed a streaming analysis at the upper section of the lead-bismuth target/cooled ADS (800 MWth). MCNPX was used to calculate the radiation dose from streamed neutrons and photons through the beam duct. For the secondary photon production calculation, cross sections for several actinides were substituted with plutonium because of the lack of gamma production cross section. From the results of this analysis, the neutron dose from the beam duct is seen to be about 20 orders higher than that of the bulk shield. The magnets and shield plug are heavily irradiated by streaming neutrons according to the DCHAIN-SP analysis. PMID:16604639

  18. Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys

    PubMed Central

    Campbell, Oona M. R.; Cegolon, Luca; Macleod, David; Benova, Lenka

    2016-01-01

    Background Following childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants. Methods and Findings We described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (<24 h for vaginal deliveries and <72 h for cesarean-section deliveries). Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries. Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation. Conclusions Length of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough

  19. Analysis of components effecting free convection intensity in steel rectangular sections

    NASA Astrophysics Data System (ADS)

    Wyczółkowski, Rafał

    2015-09-01

    Free convection is one of the heat transfer modes which occurs within the heat-treated bundles of steel rectangular section. A comprehensive study of this phenomenon is necessary for optimizing the heating process of this type of charge. The free convection intensity is represented by the Rayleigh number Ra. The value of this criterion depends on the following parameters: the mean section temperature, temperature difference within the section, kinematic coefficient of viscosity, volume expansion coefficient and the Prandtl number. The paper presents the analysis of the impact of these factors on free convection in steel rectangular sections. The starting point for this analysis were the results of experimental examinations. It was found that the highest intensity of this process occurs for the temperature of 100 °C. This is mainly caused by changes in the temperature difference observed in the area of sections and changes in kinematic coefficient of viscosity of air. The increase in the value of the Rayleigh number criterion at the initial stage is attributable to changes in the parameter of temperature difference within the section. After exceeding 100 °C, the main effect on convection is from changes in air viscosity. Thus, with further increase in temperature, the Rayleigh number starts to decline rapidly despite further rise in the difference in temperature.

  20. Analysis of variation in charges and prices paid for vaginal and caesarean section births: a cross-sectional study

    PubMed Central

    Hsia, Renee Y; Akosa Antwi, Yaa; Weber, Ellerie

    2014-01-01

    Objective To examine the between-hospital variation of charges and discounted prices for uncomplicated vaginal and caesarean section deliveries, and to determine the institutional and market-level characteristics that influence adjusted charges. Design, setting and participants Using data from the California Office of Statewide Health Planning and Development (OSHPD), we conducted a cross-sectional study of all privately insured patients admitted to California hospitals in 2011 for uncomplicated vaginal delivery (diagnosis-related group (DRG) 775) or uncomplicated caesarean section (DRG 766). Outcome measures Hospital charges and discounted prices adjusted for each patient's clinical and demographic characteristics. Results We analysed 76 766 vaginal deliveries and 32 660 caesarean sections in California in 2011. After adjusting for patient demographic and clinical characteristics, we found that the average California woman could be charged as little as US$3296 or as much as US$37 227 for a vaginal delivery, and US$8312–US$70 908 for a caesarean section depending on which hospital she was admitted to. The discounted prices were, on an average, 37% of the charges. We found that hospitals in markets with middling competition had significantly lower adjusted charges for vaginal deliveries, while hospitals with higher wage indices and casemixes, as well as for-profit hospitals, had higher adjusted charges. Hospitals in markets with higher uninsurance rates charged significantly less for caesarean sections, while for-profit hospitals and hospitals with higher wage indices charged more. However, the institutional and market-level factors included in our models explained only 35–36% of the between-hospital variation in charges. Conclusions These results indicate that charges and discounted prices for two common, relatively homogeneous diagnosis groups—uncomplicated vaginal delivery and caesarean section—vary widely between hospitals and are not well

  1. Transport model based on three-dimensional cross-section generation for TRIGA core analysis

    SciTech Connect

    Kriangchaiporn, N.; Ivanov, K.; Haghighat, A.; Sears, C. F.

    2006-07-01

    The development of a three-dimensional (3-D) transport model for TRIGA core analysis based on the discrete ordinates (S{sub n}) method has been conducted. The effective fine- and broad- group structures for the TRIGA cross-section libraries were selected based on CPXSD (Contribution and Point-wise Cross-Section Driven) methodology. Different 3-D pin/core configurations are used to verify and validate the selected effective group structures. Thirteen-group structure was finally selected to be used for core analysis. The results agree with continuous energy cross-section Monte Carlo calculations for eigenvalues and normalized pin power distributions, which are used as a reference in this research. (authors)

  2. Slow Wave Vane Structure with Elliptical Cross-Section Slots, an Analysis

    NASA Technical Reports Server (NTRS)

    Kosmahl, Henry G.

    1994-01-01

    Mathematical analysis of the wave equation in cylinders with elliptical cross-section slots was performed. Compared to slow wave structures with rectangular slots higher impedance and lower power dissipation losses are evident. These features could lead to improved designs of traveling wave magnetrons and gigahertz backward-wave oscillators as well as linear traveling wave tubes with relatively shallow slots.

  3. Cross Section Sensitivity and Uncertainty Analysis Including Secondary Neutron Energy and Angular Distributions.

    Energy Science and Technology Software Center (ESTSC)

    1991-03-12

    Version 00 SUSD calculates sensitivity coefficients for one- and two-dimensional transport problems. Variance and standard deviation of detector responses or design parameters can be obtained using cross-section covariance matrices. In neutron transport problems, this code can perform sensitivity-uncertainty analysis for secondary angular distribution (SAD) or secondary energy distribution (SED).

  4. A Guide for Planning Drafting and Design Technology Programs. Section III, Data Collection and Analysis.

    ERIC Educational Resources Information Center

    1971

    This document, the second of three related reports, constitutes the data collection and analysis section of the study designed to provide information for preparing a planning guide for drafting and design technology programs. The curriculum survey instrument mailed to 26 schools, contained questions regarding: (1) length of semesters, (2)…

  5. A Framework for 3D Vessel Analysis using Whole Slide Images of Liver Tissue Sections

    PubMed Central

    Liang, Yanhui; Wang, Fusheng; Treanor, Darren; Magee, Derek; Roberts, Nick; Teodoro, George; Zhu, Yangyang; Kong, Jun

    2015-01-01

    Three-dimensional (3D) high resolution microscopic images have high potential for improving the understanding of both normal and disease processes where structural changes or spatial relationship of disease features are significant. In this paper, we develop a complete framework applicable to 3D pathology analytical imaging, with an application to whole slide images of sequential liver slices for 3D vessel structure analysis. The analysis workflow consists of image registration, segmentation, vessel cross-section association, interpolation, and volumetric rendering. To identify biologically-meaningful correspondence across adjacent slides, we formulate a similarity function for four association cases. The optimal solution is then obtained by constrained Integer Programming. We quantitatively and qualitatively compare our vessel reconstruction results with human annotations. Validation results indicate a satisfactory concordance as measured both by region-based and distance-based metrics. These results demonstrate a promising 3D vessel analysis framework for whole slide images of liver tissue sections. PMID:27034719

  6. Analysis of human hair cross sections from two different population groups by Nuclear Microscopy

    NASA Astrophysics Data System (ADS)

    Pineda-Vargas, C. A.; Eisa, M. E. M.

    2010-06-01

    Trace element analysis of hair is used as a screening technique to assess body-nutrient levels and/or toxicity due to environmental pollutants. With the aim to compare element content and spatial distribution within scalp hair-shaft cross sections of two distinct human population groups, and to assess possible similarities and/or differences, hair samples from Sudan and South Africa were collected. Proton backscattering and Micro-PIXE were used to determine the matrix composition and content of light and middle transition elements, with beam energies of 1.5 and 3.0 MeV. Mapping analysis showed a relatively similar content distribution for S, Cl, K and Ca within each group. However significant differences, particularly for heavier metals, such as Fe and Zn were also found. Correspondence Analysis of the data showed a clear separation between the two groups when the total content over the hair cross section was considered.

  7. Buckling analysis for structural sections and stiffened plates reinforced with laminated composites.

    NASA Technical Reports Server (NTRS)

    Viswanathan, A. V.; Soong, T.-C.; Miller, R. E., Jr.

    1972-01-01

    A classical buckling analysis is developed for stiffened, flat plates composed of a series of linked flat plate and beam elements. Plates are idealized as multilayered orthotropic elements; structural beads and lips are idealized as beams. The loaded edges of the stiffened plate are simply supported and the conditions at the unloaded edges can be prescribed arbitrarily. The plate and beam elements are matched along their common junctions for displacement continuity and force equilibrium in an exact manner. Offsets between elements are considered in the analysis. Buckling under uniaxial compressive load for plates, sections and stiffened plates is investigated. Buckling loads are found as the lowest of all possible general and local failure modes and the mode shape is used to determine whether buckling is a local or general instability. Numerical correlations with existing analysis and test data for plates, sections and stiffened plates including boron-reinforced structures are discussed. In general, correlations are reasonably good.

  8. Quantitative analysis of chromosome in situ hybridization signal in paraffin-embedded tissue sections.

    PubMed

    Dhingra, K; Sneige, N; Pandita, T K; Johnston, D A; Lee, J S; Emami, K; Hortobagyi, G N; Hittelman, W N

    1994-06-01

    Interphase cytogenetic analysis using chromosome-specific probes is increasingly being used to detect chromosomal aberrations on paraffin-embedded tissue sections. However, quantitative analysis of the hybridization signal is confounded by the nuclear slicing that occurs during sectioning. To determine the sensitivity and accuracy of chromosome in situ hybridization for detecting numerical chromosomal aberrations on paraffin-embedded sections, in situ hybridization was performed on sections derived from mixtures of cell populations with known frequencies of numerical chromosomal aberrations and the Chromosome Index (CI) was calculated (i.e., total number of signal spots/number of nuclei counted) as a quantitative measure of chromosome copy number. The presence of 25% or more monosomic or tetrasomic cells in a given population was easily detected as a change in CI (P < 0.05). Lower degrees of polysomy could be detected as a small percentage of nuclear fragments with > 2 signal spots. The CI was not significantly influenced by a change in section thickness from 4 to 8 microM, by an increase in cell size from 478 to 986 microM3, or by the choice of detection method (fluorescence vs. conventional bright-field microscopy). Comparative analysis of touch preparations and tissue sections from the corresponding breast tumors showed that CI accurately reflects the average copy number of chromosomes in intact nuclei and may actually be superior to in situ hybridization on whole nuclei for the detection of numerical chromosomal changes in defined histologic areas. This method is thus a sensitive and accurate means of studying genetic changes in premalignant and malignant tissue, and of assessing the genetic changes associated with specific phenotypes. PMID:7924678

  9. Utility of Fresh Frozen Section Analysis in Foot and Ankle Surgery: A Pilot Study.

    PubMed

    Monaco, Spencer J; Manway, Jeffery M; Burns, Patrick R

    2016-01-01

    The use of intraoperative fresh frozen section (FFS) analysis to determine the presence of infection has been well reported in orthopedic studies. Specifically, the number of polymorphonuclear leukocytes per high-power field has been used to diagnose total joint arthroplasty-related infection. Less commonly, reconstructive surgeons have extended the use of FFS analysis for intraoperative evaluation when suspicion of deep infection with or without hardware is high. The purpose of the present study was to retrospectively review the data from 11 patients undergoing foot and ankle reconstruction in the setting of possible deep infection and determine the usefulness of FFS analysis. A retrospective review of the medical records of patients who had undergone reconstructive foot and ankle revision surgery with intraoperative FFS analysis and tissue/swab cultures available was performed. A positive FFS was defined as >5 polymorphonuclear leukocytes per high-power field. A positive frozen section was associated with a positive tissue culture 4 of 7 times (57%). The sensitivity and specificity of FFS analysis for infection was 80% and 50%, respectively. The positive and negative predictive value of the FFS result was 57.1% and 75%, respectively. In conclusion, FFS analysis and intraoperative cultures correlated only 57% of the time in the present series. This test had moderate sensitivity for detecting infection at 80%, but the specificity was poor (50%). More research is needed to further evaluate the role of FFS analysis in foot and ankle surgery. PMID:27068638

  10. An analysis of MCNP cross-sections and tally methods for low-energy photon emitters

    NASA Astrophysics Data System (ADS)

    DeMarco, John J.; Wallace, Robert E.; Boedeker, Kirsten

    2002-04-01

    Monte Carlo calculations are frequently used to analyse a variety of radiological science applications using low-energy (10-1000 keV) photon sources. This study seeks to create a low-energy benchmark for the MCNP Monte Carlo code by simulating the absolute dose rate in water and the air-kerma rate for monoenergetic point sources with energies between 10 keV and 1 MeV. The analysis compares four cross-section datasets as well as the tally method for collision kerma versus absorbed dose. The total photon attenuation coefficient cross-section for low atomic number elements has changed significantly as cross-section data have changed between 1967 and 1989. Differences of up to 10% are observed in the photoelectric cross-section for water at 30 keV between the standard MCNP cross-section dataset (DLC-200) and the most recent XCOM/NIST tabulation. At 30 keV, the absolute dose rate in water at 1.0 cm from the source increases by 7.8% after replacing the DLC-200 photoelectric cross-sections for water with those from the XCOM/NIST tabulation. The differences in the absolute dose rate are analysed when calculated with either the MCNP absorbed dose tally or the collision kerma tally. Significant differences between the collision kerma tally and the absorbed dose tally can occur when using the DLC-200 attenuation coefficients in conjunction with a modern tabulation of mass energy-absorption coefficients.

  11. A New Signal Processing Technique for Neutron Capture Cross Section Measurement Based on Pulse Width Analysis

    NASA Astrophysics Data System (ADS)

    Katabuchi, T.; Matsuhashi, T.; Terada, K.; Mizumoto, M.; Hirose, K.; Kimura, A.; Furutaka, K.; Hara, K. Y.; Harada, H.; Hori, J.; Igashira, M.; Kamiyama, T.; Kitatani, F.; Kino, K.; Kiyanagi, Y.; Koizumi, M.; Nakamura, S.; Oshima, M.; Toh, Y.

    2014-05-01

    A fast data acquisition method based on pulse width analysis was developed for γ-ray spectroscopy with an NaI(Tl) detector. The new method was tested in experiments with standard γ-ray sources and pulsed neutron beam from a spallation neutron source. Pulse height spectra were successfully reconstructed from pulse width distribution by use of an energy calibration curve. The 197Au(n, γ)198Au cross section was measured by this method to test the viability. The obtained experimental cross section showed a good agreement with a calculation using the resonance parameters of JENDL-4.0.

  12. Analysis and Parametric Investigation of Active Open Cross Section Thin Wall Beams

    NASA Astrophysics Data System (ADS)

    Griffiths, James

    The static behaviour of active Open Cross Section Thin Wall Beams (OCSTWB) with embedded Active/Macro Fibre Composites (AFCs/MFCs) has been investigated for the purpose of advancing the fundamental theory needed in the development of advanced smart structures. An efficient code that can analyze active OCSTWB using analytical equations has been studied. Various beam examples have been investigated in order to verify this recently developed analytical active OCSTWB analysis tool. The cross sectional stiffness constants and induced force, moments and bimoment predicted by this analytical code have been compared with those predicted by the 2-D finite element beam cross section analysis codes called the Variational Asymptotic Beam Sectional (VABS) analysis and the University of Michigan VABS (UM/VABS). Good agreement was observed between the results obtained from the analytical tool and VABS. The calculated cross sectional stiffness constants and induced force/moments, the constitutive relation and the six intrinstic static equilibrium equations for OCSTWB were all used together in a first-order accurate forward difference scheme in order to determine the average twist and deflections along the beam span. In order to further verify the analytical code, the static behaviour of a number of beam examples was investigated using 3-D Finite Element Analysis (FEA). For a particular cross section, the rigid body twist and displacements were minimized with the displacements of all the nodes in the 3-D FEA model that compose the cross section. This was done for a number of cross sections along the beam span in order to recover the global beam twist and displacement profiles from the 3-D FEA results. The global twist and deflections predicted by the analytical code agreed closely with those predicted by UM/VABS and 3-D FEA. The study was completed by a parametric investigation to determine the boundary conditions and the composite ply lay-ups of the active and passive plies that

  13. 3-D inelastic analysis methods for hot section components. Volume 2: Advanced special functions models

    NASA Technical Reports Server (NTRS)

    Wilson, R. B.; Banerjee, P. K.

    1987-01-01

    This Annual Status Report presents the results of work performed during the third year of the 3-D Inelastic Analysis Methods for Hot Sections Components program (NASA Contract NAS3-23697). The objective of the program is to produce a series of computer codes that permit more accurate and efficient three-dimensional analyses of selected hot section components, i.e., combustor liners, turbine blades, and turbine vanes. The computer codes embody a progression of mathematical models and are streamlined to take advantage of geometrical features, loading conditions, and forms of material response that distinguish each group of selected components.

  14. An analytical approach to grid sensitivity analysis for NACA four-digit wing sections

    NASA Technical Reports Server (NTRS)

    Sadrehaghighi, I.; Tiwari, S. N.

    1992-01-01

    Sensitivity analysis in computational fluid dynamics with emphasis on grids and surface parameterization is described. An interactive algebraic grid-generation technique is employed to generate C-type grids around NACA four-digit wing sections. An analytical procedure is developed for calculating grid sensitivity with respect to design parameters of a wing section. A comparison of the sensitivity with that obtained using a finite difference approach is made. Grid sensitivity with respect to grid parameters, such as grid-stretching coefficients, are also investigated. Using the resultant grid sensitivity, aerodynamic sensitivity is obtained using the compressible two-dimensional thin-layer Navier-Stokes equations.

  15. Examination of the influence of coatings on thin superalloy sections. Volume 1: Description and analysis

    NASA Technical Reports Server (NTRS)

    Kaufman, M.

    1974-01-01

    The effects of an aluminide coating and of section thickness were investigated on two cast nickel-base superalloys. Cast section thickness ranged from 0.038 cm to 0.15 cm. Simulated engine exposures in a jet fuel burner rig with cyclic air cooling were studied. The effects of surface machining before coating and re-machining and re-coating after exposures were examined. The properties evaluated included tensile strength, stress rupture, high-cycle mechanical fatigue, and thermal fatigue. A metallurgical analysis was made of the microstructures of the coated and uncoated alloy.

  16. Advance prediction of hypotension at cesarean delivery under spinal anesthesia.

    PubMed

    Kinsella, S M; Norris, M C

    1996-01-01

    Cardiovascular responses to supine inferior vena cava compression might predict hypotension risk during elective cesarean delivery using spinal anesthesia. In this pilot study we investigated 27 women before operation by taking blood pressure and heart rate measurements for 5 min in the left lateral position, 5 min supine, and then performed one further reading in the left lateral position and one sitting. Anesthesia with hyperbaric bupivacaine was rigorously standardised. A pre-operative 'supine stress test', combining an increase in maternal heart rate of greater than 10 beats/min or leg flexion movements while supine, was analysed. A positive supine stress test (SST) was 4.1 times more frequent in those with severe systolic hypotension below 70% of baseline (12 out of 16 women) than in those without (2 out of 11 women), with a sensitivity of 75% (95% C.I. 48% to 93%) and specificity of 82% (95% C.I. 48% to 98%). A positive test was associated with twice as much vasopressor use as a negative test (30.7 +/-/14.5 mg versus 13.5 +/-/ 9.9 mg; P = 0.0014). Unlike the SST, cardiovascular responses to the change from recumbent to sitting (tilt test) were not useful as a predictor of hypotension. PMID:15321375

  17. Pharmacokinetics of Prophylactic Cefazolin in Parturients Undergoing Cesarean Delivery

    PubMed Central

    Elkomy, Mohammed H.; Sultan, Pervez; Epshtein, Ekaterina; Galinkin, Jeffery L.; Carvalho, Brendan

    2014-01-01

    The objectives of this work were (i) to characterize the pharmacokinetics of cefazolin in pregnant women undergoing elective cesarean delivery and in their neonates; (ii) to assess cefazolin transplacental transmission; (iii) to evaluate the dosing and timing of preoperative, prophylactic administration of cefazolin to pregnant women; and (iv) to investigate the impact of maternal dosing on therapeutic duration and exposure in newborns. Twenty women received 1 g of cefazolin preoperatively. Plasma concentrations of total cefazolin were analyzed from maternal blood samples taken before, during, and after delivery; umbilical cord blood samples obtained at delivery; and neonatal blood samples collected 24 h after birth. The distribution volume of cefazolin was 9.44 liters/h. The values for pre- and postdelivery clearance were 7.18 and 4.12 liters/h, respectively. Computer simulations revealed that the probability of maintaining free cefazolin concentrations in plasma above 8 mg/liter during scheduled caesarean surgery was <50% in the cord blood when cefazolin was administered in doses of <2 g or when it was administered <1 h before delivery. Therapeutic concentrations of cefazolin persisted in neonates >5 h after birth. Cefazolin clearance increases during pregnancy, and larger doses are recommended for surgical prophylaxis in pregnant women to obtain the same antibacterial effect as in nonpregnant patients. Cefazolin has a longer half-life in neonates than in adults. Maternal administration of up to 2 g of cefazolin is effective and produces exposure within clinically approved limits in neonates. PMID:24733461

  18. On 3-D inelastic analysis methods for hot section components. Volume 1: Special finite element models

    NASA Technical Reports Server (NTRS)

    Nakazawa, S.

    1988-01-01

    This annual status report presents the results of work performed during the fourth year of the 3-D Inelastic Analysis Methods for Hot Section Components program (NASA Contract NAS3-23697). The objective of the program is to produce a series of new computer codes permitting more accurate and efficient 3-D analysis of selected hot section components, i.e., combustor liners, turbine blades and turbine vanes. The computer codes embody a progression of math models and are streamlined to take advantage of geometrical features, loading conditions, and forms of material response that distinguish each group of selected components. Volume 1 of this report discusses the special finite element models developed during the fourth year of the contract.

  19. DIFFERENTIAL CROSS SECTION ANALYSIS IN KAON PHOTOPRODUCTION USING ASSOCIATED LEGENDRE POLYNOMIALS

    SciTech Connect

    P. T. P. HUTAURUK, D. G. IRELAND, G. ROSNER

    2009-04-01

    Angular distributions of differential cross sections from the latest CLAS data sets,6 for the reaction γ + p→K+ + Λ have been analyzed using associated Legendre polynomials. This analysis is based upon theoretical calculations in Ref. 1 where all sixteen observables in kaon photoproduction can be classified into four Legendre classes. Each observable can be described by an expansion of associated Legendre polynomial functions. One of the questions to be addressed is how many associated Legendre polynomials are required to describe the data. In this preliminary analysis, we used data models with different numbers of associated Legendre polynomials. We then compared these models by calculating posterior probabilities of the models. We found that the CLAS data set needs no more than four associated Legendre polynomials to describe the differential cross section data. In addition, we also show the extracted coefficients of the best model.

  20. On 3-D inelastic analysis methods for hot section components. Volume 1: Special finite element models

    NASA Technical Reports Server (NTRS)

    Nakazawa, S.

    1987-01-01

    This Annual Status Report presents the results of work performed during the third year of the 3-D Inelastic Analysis Methods for Hot Section Components program (NASA Contract NAS3-23697). The objective of the program is to produce a series of new computer codes that permit more accurate and efficient three-dimensional analysis of selected hot section components, i.e., combustor liners, turbine blades, and turbine vanes. The computer codes embody a progression of mathematical models and are streamlined to take advantage of geometrical features, loading conditions, and forms of material response that distinguish each group of selected components. This report is presented in two volumes. Volume 1 describes effort performed under Task 4B, Special Finite Element Special Function Models, while Volume 2 concentrates on Task 4C, Advanced Special Functions Models.

  1. Application of color digital holographic microscopy for analysis of stained tissue sections

    NASA Astrophysics Data System (ADS)

    Mo, Xiaoli; Kemper, Björn; Langehanenberg, Patrik; Vollmer, Angelika; Xie, Jinghui; von Bally, Gert

    2009-07-01

    The analysis of stained tissue sections represents an important tool in medical diagnostics. Color digital holographic microscopy offers subsequent multi-focus true color imaging with simultaneous quantitative phase contrast analysis. Investigations on digital recording and numerical reconstructions of color digital holographic images have been performed by applying a transmission microscope experimental setup in holographic off-axis geometry. Three monochromatic digital holograms with different wavelengths in red, green and blue spectral range are recorded. After digital holographic refocusing and compensation for aberrations of the microscope imaging system by digital image correlation the numerically reconstructed amplitude distributions are combined into color images. The applicability of the method is demonstrated by results obtained from stained intestine tissue sections.

  2. Autism Symptoms across Adulthood in Men with Fragile X Syndrome: A Cross-Sectional Analysis

    ERIC Educational Resources Information Center

    Hartley, Sigan L.; Wheeler, Anne C.; Mailick, Marsha R.; Raspa, Melissa; Mihaila, Iulia; Bishop, Ellen; Bailey, Donald B.

    2015-01-01

    A cross-sectional analysis was used to examine age-related differences in ASD symptoms and corresponding differences in disruptive behavior and social skills in 281 adult men with fragile X syndrome. Four age groups were created: 18-21, 22-29, 30-39, and 40-49 years. The 18-21 year-old group was reported to have more impairments in verbal…

  3. On 3-D inelastic analysis methods for hot section components (base program)

    NASA Technical Reports Server (NTRS)

    Wilson, R. B.; Bak, M. J.; Nakazawa, S.; Banerjee, P. K.

    1986-01-01

    A 3-D Inelastic Analysis Method program is described. This program consists of a series of new computer codes embodying a progression of mathematical models (mechanics of materials, special finite element, boundary element) for streamlined analysis of: (1) combustor liners, (2) turbine blades, and (3) turbine vanes. These models address the effects of high temperatures and thermal/mechanical loadings on the local (stress/strain)and global (dynamics, buckling) structural behavior of the three selected components. Three computer codes, referred to as MOMM (Mechanics of Materials Model), MHOST (Marc-Hot Section Technology), and BEST (Boundary Element Stress Technology), have been developed and are briefly described in this report.

  4. Finite Element Analysis and Test Results Comparison for the Hybrid Wing Body Center Section Test Article

    NASA Technical Reports Server (NTRS)

    Przekop, Adam; Jegley, Dawn C.; Rouse, Marshall; Lovejoy, Andrew E.

    2016-01-01

    This report documents the comparison of test measurements and predictive finite element analysis results for a hybrid wing body center section test article. The testing and analysis efforts were part of the Airframe Technology subproject within the NASA Environmentally Responsible Aviation project. Test results include full field displacement measurements obtained from digital image correlation systems and discrete strain measurements obtained using both unidirectional and rosette resistive gauges. Most significant results are presented for the critical five load cases exercised during the test. Final test to failure after inflicting severe damage to the test article is also documented. Overall, good comparison between predicted and actual behavior of the test article is found.

  5. JULIDE: a software tool for 3D reconstruction and statistical analysis of autoradiographic mouse brain sections.

    PubMed

    Ribes, Delphine; Parafita, Julia; Charrier, Rémi; Magara, Fulvio; Magistretti, Pierre J; Thiran, Jean-Philippe

    2010-01-01

    In this article we introduce JULIDE, a software toolkit developed to perform the 3D reconstruction, intensity normalization, volume standardization by 3D image registration and voxel-wise statistical analysis of autoradiographs of mouse brain sections. This software tool has been developed in the open-source ITK software framework and is freely available under a GPL license. The article presents the complete image processing chain from raw data acquisition to 3D statistical group analysis. Results of the group comparison in the context of a study on spatial learning are shown as an illustration of the data that can be obtained with this tool. PMID:21124830

  6. Analysis of the cross section for {sup 232}Th photofission in the subbarrier energy region

    SciTech Connect

    Blokhin, A. I. Soldatov, A. S.

    2009-06-15

    A theoretical analysis of the most detailed experimental data on the subbarrier fission of {sup 232}Th is performed. The energy dependences of the components of the cross sections for photofission through specific channels characterized by the quantum numbers J{sup {pi}K} are obtained on the basis of previously measured total photofission cross sections and angular distributions of fission fragments. A theoretical analysis of the subbarrier photofission of {sup 232}Th is performed on the basis of the results obtained for these components. This analysis relies on the one-dimensional fission model within which one assumes a three-humped structure of the fission barrier and introduces damping in the second and third wells by including an imaginary part in the potential used. Values are selected for the parameters of the fission barriers and are compared with similar data from other studies. It is shown that the energy dependences of the photofission cross sections in question can be described adequately.

  7. Tracing Developmental Changes through Conversation Analysis: Cross-Sectional and Longitudinal Analysis

    ERIC Educational Resources Information Center

    Lee, Yo-An; Hellermann, John

    2014-01-01

    The descriptive focus of conversation analysis (CA) has not been considered optimal for second language (L2) acquisition research. Recently, however, some CA researchers have addressed the developmental agenda by examining longitudinal data (e.g., Brouwer, C., 2004; Ishida, M., 2009; Markee, N., 2008; Pekarek-Doehler, S., 2010). The present…

  8. Hyperbaric spinal anesthesia with ropivacaine coadministered with sufentanil for cesarean delivery: a dose-response study

    PubMed Central

    Zheng, Dongyue; Wu, Guowei; Qin, Peishun; Ji, Bin; Ye, Lisha; Shi, Tong; Huang, Huang; Jin, Lexiao

    2015-01-01

    Adjuvant sufentanil could achieve effective spinal anesthesia with low dose of hyperbaric ropivacaine for cesarean delivery. Two previous studies had calculated the 50% effective dose (ED50) of intrathecal ropivacaine coadministered with sufentanil for cesarean delivery. However, the 95% effective dose (ED95) of intrathecal hyperbaric ropivacaine coadministered with sufentanil for cesarean delivery remains uncertain. This study determined the ED95 of intrathecal hyperbaric ropivacaine coadministered with sufentanil for cesarean delivery. 80 ASA physical status I or II parturients undergoing elective cesarean delivery were enrolled in this prospective, randomized, double-blind investigation. A combined spinal and epidural anesthesia was performed at the L3-L4 interspace. Patients received a dose of spinal ropivacaine coadministered with sufentanil 5 μg diluted to 3.0 ml with normal saline and 0.5 ml of 10% dextrose: 7.5 mg (n = 20), 9.0 mg (n = 20), 10.5 mg (n = 20), or 12 mg (n = 20). An effective dose was defined as a dose that provided bilateral sensory block to T7 within 10 min after intrathecal drug administration and required no epidural top-up for surgery to be completed. The ED50 and ED95 values for successful anesthesia were determined using a logistic regression model. The ED50 (95% confidence interval [CI]) for successful anesthesia was 8.4 (4.0-9.8) mg and the ED95 (95% CI) was 11.4 (9.7-13.9) mg. The results show that the ED95 of intrathecal hyperbaric ropivacaine coadministered with sufentanil 5 μg for cesarean delivery was 11.4 mg. The addition of sufentanil could significantly reduce the dosage of ropivacaine. PMID:26131159

  9. Large doses of uterotonic drugs caused type II second degree sinoatrial block during cesarean section.

    PubMed

    Quan, Zhe-Feng; Tian, Ming; Chi, Ping

    2016-01-01

    In China, it is a routine procedure to inject 250 μg of hemabate (sterile solution, an oxytocic, contains the tromethamine salt of the (I5S)-15 methyl analogue of naturally occurring prostaglandin F2α in a solution suitable for intramuscular injection) into the myometrium of patients experiencing uterine inertia after delivery, with an additional dose given in the event that the efficacy is not obvious. Although hemabate is prohibited from being used in patients with active liver disease, there are no restrictions regarding the application of hemabate in positive hepatitis B surface antigen (HbsAg)-positive subjects with normal liver function. Here we report adverse effects of hemabate in 1 HbsAg-positive subject with normal liver function. This subject experienced increased blood pressure, chest tightness, and type II second degree sinoatrial block 25 minutes after an additional injection of hemabate. Thus, special attention should be paid when applying hemabate in HbsAgpositive subjects with normal liver function. PMID:26636420

  10. [Effective epidural anesthesia for cesarean section in parturient woman with type I mucopolysaccharidosis (Hurler's syndrome)].

    PubMed

    2011-01-01

    Mucopolysaccharidosis is genetically determined disease caused by the deficiency of one of the lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. This metabolic block leads to the accumulation of GAG in various organs and tissues and affects nerve system, eyes, internal organs and musculoskeletal system. The reviewer of various articles on pubmed showed only one article about epidural anesthesia in patient with type I mucopolysaccharidosis. Our observation allows to consider that epidural anesthesia with ropivacaine is possible and safe in patients with type I mucopolysaccharidosis. PMID:22379910

  11. Anesthetic Management of Urgent Cesarean Section with Undiagnosed Transposition of Great Arteries.

    PubMed

    Yilmaz, Nurullah; Koksal, Ersin; Ozgen, Gokce Ultan; Ozen, Ersan; Dilek, Ahmet; Karakaya, Deniz; Ulger, Fatma

    2016-06-01

    We consider that general anesthesia will be an appropriate and safe method as regional methods could lead to significant time loss in the prevention or minimization of complications. High blockage required for regional anesthetic methods in pregnant women with TGA and the maintenance of hemodynamic stability may become difficult due to neuroaxial sympathectomy even if a successful neuroaxial block has been provided. Agents with minimal effect on cardiovascular functions should be preferred for anesthesia induction and maintenance and close hemodynamic monitoring should be done during intraoperative and postoperative periods. PMID:27594753

  12. Successful Surgical Pulmonary Embolectomy for Massive Perinatal Embolism after Emergency Cesarean Section.

    PubMed

    Colombier, Sébastien; Niclauss, Lars

    2015-10-01

    Pregnant women are exposed to an increased risk for developing pulmonary embolism (PE), a main cause for maternal mortality. Surgical pulmonary embolectomy is one important therapeutic and potential life-saving armamentarium, considering pregnancy as a relative contraindication for thrombolysis. We present a case of a 36-year-old woman with massive bilateral PE after emergent caesarean delivery, requiring reanimation by external heart massage. The onset of massive intrauterine bleeding contraindicated thrombolysis and emergency surgical pulmonary embolectomy, followed by a hysterectomy, were preformed successfully. Acute surgical pulmonary embolectomy may be an option in critically diseased high-risk patients, requiring a multiteam approach, and should be part of the therapeutic armamentarium of the attending cardiac surgeon. PMID:26122422

  13. Anesthetic management for cesarean delivery of a parturient with impetigo herpetiformis.

    PubMed

    Duffield, Adrienne T; Smith, Kathleen A

    2013-10-01

    Impetigo herpetiformis (IH), or generalized pustular psoriasis of pregnancy, is an exceedingly rare, generalized pustular skin eruption occurring during pregnancy associated with hypovolemia, sepsis, hypocalcemia, and airway edema. Fetal outcomes are generally poor, and parturients with IH may present with emergent indications for cesarean delivery due to placental insufficiency. We present a case of IH in a 19-year-old G1P0 who underwent successful general anesthesia for cesarean delivery. Her case highlights the anesthetic implications for patients afflicted with this rare disease, including perioperative pain management, airway concerns, considerations for neuraxial anesthesia, and monitoring challenges. PMID:25611605

  14. Boltzmann equation analysis of electron-molecule collision cross sections in water vapor and ammonia

    SciTech Connect

    Yousfi, M.; Benabdessadok, M.D.

    1996-12-01

    Sets of electron-molecule collision cross sections for H{sub 2}O and NH{sub 3} have been determined from a classical technique of electron swarm parameter unfolding. This deconvolution method is based on a simplex algorithm using a powerful multiterm Boltzmann equation analysis established in the framework of the classical hydrodynamic approximation. It is well adapted for the simulation of the different classes of swarm experiments (i.e., time resolved, time of flight, and steady state experiments). The sets of collision cross sections that exist in the literature are reviewed and analyzed. Fitted sets of cross sections are determined for H{sub 2}O and NH{sub 3} which exhibit features characteristic of polar molecules such as high rotational excitation collision cross sections. The hydrodynamic swarm parameters (i.e., drift velocity, longitudinal and transverse diffusion coefficients, ionization and attachment coefficients) calculated from the fitted sets are in excellent agreement with the measured ones. These sets are finally used to calculate the transport and reaction coefficients needed for discharge modeling in two cases of typical gas mixtures for which experimental swarm data are very sparse or nonexistent (i.e., flue gas mixtures and gas mixtures for rf plasma surface treatment). {copyright} {ital 1996 American Institute of Physics.}

  15. Analysis of a Measurement of 12C(n,2n)11C Cross Sections

    NASA Astrophysics Data System (ADS)

    Hartshaw, Garrett; Love, Ian; Yuly, Mark; Padalino, Stephen; Russ, Megan; Bienstock, Mollie; Simone, Angela; Ellison, Drew; Desmitt, Holly; Massey, Thomas; Sangster, Craig

    2013-10-01

    In inertial confinement fusion (ICF), nuclear fusion reactions are initiated by bombarding a small fuel pellet with high power lasers. One ICF diagnostic tool involves placing graphite discs within the reaction chamber to determine the number of high-energy neutrons. This diagnostic requires accurate 12C(n, 2n)11C cross sections, which have not been previously well measured. An experiment to measure this cross section was conducted at Ohio University, in which DT neutrons irradiated polyethylene and graphite targets. The neutron flux was determined by counting recoil protons from the polyethylene in a silicon dE-E detector telescope. Preliminary cross sections were calculated using the incident neutron flux and the number of 11C nuclei in the graphite and polyethylene targets determined by counting, in a separate counting station, the gamma rays resulting from the positron decay of 11C. This poster will present the data analysis techniques used to determine these cross sections and the MCNPX simulation used to compute the corrections needed to account for the detector and target geometry. Funded in part by a LLE contract through the DOE.

  16. Spatially-resolved protein surface microsampling from tissue sections using liquid extraction surface analysis.

    PubMed

    Wisztorski, Maxence; Desmons, Annie; Quanico, Jusal; Fatou, Benoit; Gimeno, Jean-Pascal; Franck, Julien; Salzet, Michel; Fournier, Isabelle

    2016-06-01

    Tissue microenvironment characterization presents a challenge for a better understanding of the full complexity of a pathology. Unfortunately, making a precise "picture" of the disease needs an efficient microsampling method coupled to an accurate localization for performing region-dependent proteomics. Here, we present a method that enables rapid and reproducible extraction of proteins from a tissue section to analyze a specific region at a millimeter scale. The method used a liquid-microjunction extraction with conventional detergent solution for proteomics analysis. We successfully performed immunoblotting experiments and showed the possibility to retrieve and identify more than 1400 proteins from a 1-mm diameter spot size on tissue sections with a high degree of reproducibility both qualitatively and quantitatively. Moreover, the small size of the extracted region achieved by this sampling method allows the possibility to perform multiple extractions on different tissue section points. Ten points on a sagittal rat brain tissue section were analyzed and the measured proteins clearly distinguished the different parts of the brain, thus permitting precise functional mapping. We thus demonstrate that with this technology, it is possible to map the tissue microenvironment and gain an understanding of the molecular mechanisms at millimeter resolution. PMID:26929135

  17. Static and Dynamic Experimental Analysis of the Galloping Stability of Porous H-Section Beams

    PubMed Central

    Gandia, F.; Meseguer, J.; Sanz-Andrés, A.

    2014-01-01

    The phenomenon of self-induced vibrations of prismatic beams in a cross-flow has been studied for decades, but it is still of great interest due to their important effects in many different industrial applications. This paper presents the experimental study developed on a prismatic beam with H-section. The aim of this analysis is to add some additional insight into the behaviour of the flow around this type of bodies, in order to reduce galloping and even to avoid it. The influence of some relevant geometrical parameters that define the H-section on the translational galloping behaviour of these beams has been analysed. Wind loads coefficients have been measured through static wind tunnel tests and the Den Hartog criterion applied to elucidate the influence of geometrical parameters on the galloping properties of the bodies under consideration. These results have been completed with surface pressure distribution measurements and, besides, dynamic tests have been also performed to verify the static criterion. Finally, the morphology of the flow past the tested bodies has been visualised by using smoke visualization techniques. Since the rectangular section beam is a limiting case of the H-section configuration, the results here obtained are compared with the ones published in the literature concerning rectangular configurations; the agreement is satisfactory. PMID:25541626

  18. Analysis and testing of two-dimensional slot nozzle ejectors with variable area mixing sections

    NASA Technical Reports Server (NTRS)

    Gilbert, G. B.; Hill, P. G.

    1973-01-01

    Finite difference computer techniques have been used to calculate the detailed performance of air to air two-dimensional ejectors with symmetric variable area mixing sections and coaxial coverging primary nozzles. The analysis of the primary nozzle assumed correct expansion of the flow and is suitable for subsonic and slightly supersonic velocity levels. The variation of the mixing section channel walls is assumed to be gradual so that the static pressure can be assumed uniform on planes perpendicular to the axis. A test program was run to provide two-dimensional ejector test data for verification of the computer analysis. A primary converging nozzle with a discharge geometry of 0.125 inch x 8.0 inch was supplied with 600 SCFM of air at about 35 psia and 180 F. This nozzle was combined with two mixing section geometries with throat sizes of 1.25 inch x 8.0 inch and 1.875 inch x 8.0 inch and was tested at a total of 11 operating points.

  19. Nonlinear Analysis and Preliminary Testing Results of a Hybrid Wing Body Center Section Test Article

    NASA Technical Reports Server (NTRS)

    Przekop, Adam; Jegley, Dawn C.; Rouse, Marshall; Lovejoy, Andrew E.; Wu, Hsi-Yung T.

    2015-01-01

    A large test article was recently designed, analyzed, fabricated, and successfully tested up to the representative design ultimate loads to demonstrate that stiffened composite panels with through-the-thickness reinforcement are a viable option for the next generation large transport category aircraft, including non-conventional configurations such as the hybrid wing body. This paper focuses on finite element analysis and test data correlation of the hybrid wing body center section test article under mechanical, pressure and combined load conditions. Good agreement between predictive nonlinear finite element analysis and test data is found. Results indicate that a geometrically nonlinear analysis is needed to accurately capture the behavior of the non-circular pressurized and highly-stressed structure when the design approach permits local buckling.

  20. Structural Design and Analysis of the Upper Pressure Shell Section of a Composite Crew Module

    NASA Technical Reports Server (NTRS)

    Sleight, David W.; Paddock, David; Jeans, Jim W.; Hudeck, John D.

    2008-01-01

    This paper presents the results of the structural design and analysis of the upper pressure shell section of a carbon composite demonstration structure for the Composite Crew Module (CCM) Project. The project is managed by the NASA Engineering and Safety Center with participants from eight NASA Centers, the Air Force Research Laboratory, and multiple aerospace contractors including ATK/Swales, Northrop Grumman, Lockheed Martin, Collier Research Corporation, Genesis Engineering, and Janicki Industries. The paper discusses details of the upper pressure shell section design of the CCM and presents the structural analysis results using the HyperSizer structural sizing software and the MSC Nastran finite element analysis software. The HyperSizer results showed that the controlling load case driving most of the sizing in the upper pressure shell section was the internal pressure load case. The regions around the cutouts were controlled by internal pressure and the main parachute load cases. The global finite element analysis results showed that the majority of the elements of the CCM had a positive margin of safety with the exception of a few hot spots around the cutouts. These hot spots are currently being investigated with a more detailed analysis. Local finite element models of the Low Impact Docking System (LIDS) interface ring and the forward bay gussets with greater mesh fidelity were created for local sizing and analysis. The sizing of the LIDS interface ring was driven by the drogue parachute loads, Trans-Lunar Insertion (TLI) loads, and internal pressure. The drogue parachute loads controlled the sizing of the gusset cap on the drogue gusset and TLI loads controlled the sizing of the other five gusset caps. The main parachute loads controlled the sizing of the lower ends of the gusset caps on the main parachute fittings. The results showed that the gusset web/pressure shell and gusset web/gusset cap interfaces bonded using Pi-preform joints had local hot spots

  1. Multi-Dimensional, Discrete-Ordinates Based Cross Section Sensitivity and Uncertainty Analysis Code System.

    Energy Science and Technology Software Center (ESTSC)

    2008-05-22

    are the latest versions available from NEA-DB). o The memory and data management was updated as well as the language level (code was rewritten from Fortran-77 to Fortran-95). SUSD3D is coupled to several discrete‑ordinates codes via binary interface files. SUSD3D can use the flux moment files produced by discrete ordinates codes: ANISN, DORT, TORT, ONEDANT, TWODANT, and THREEDANT. In some of these codes minor modifications are required. Variable dimensions used in the TORT‑DORT system are supported. In 3D analysis the geometry and material composition is taken directly from the TORT produced VARSCL binary file, reducing in this way the user's input to SUSD3D. Multigroup cross‑section sets are read in the GENDF format of the NJOY/GROUPR code system, and the covariance data are expected in the COVFIL format of NJOY/ERRORR or the COVERX format of PUFF‑2. The ZZ‑VITAMIN‑J/COVA cross section covariance matrix library can be used as an alternative to the NJOY code system. The package includes the ANGELO code to produce the covariance data in the required energy structure in the COVFIL format. The following cross section processing modules to be added to the NJOY‑94 code system are included in the package: o ERR34: an extension of the ERRORR module of the NJOY code system for the File‑34 processing. It is used to prepare multigroup SAD cross sections covariance matrices. o GROUPSR: An additional code module for the preparation of partial cross sections for SAD sensitivity analysis. Updated version of the same code from SUSD, extended to the ENDF‑6 format. o SEADR: An additional code module to prepare group covariance matrices for SAD/SED uncertainty analysis.« less

  2. Nonlinear analysis of cantilever shape memory alloy beams of variable cross section

    NASA Astrophysics Data System (ADS)

    Ashiqur Rahman, Muhammad; Arefin Kowser, Muhammad

    2007-04-01

    Cantilever beams, made of shape memory alloy (SMA), undergo much larger deflection in comparison to those made of other materials. Again, cantilever beams with reducing cross section along the span show much larger deflections compared to those of constant cross section beams. Analysis was conducted for such a cantilever beam with reducing cross-sectional area made of SMA, taking into account its highly nonlinear stress-strain curves. A computer code in C has been developed using the Runge-Kutta technique for the purpose of simulation. For rigorous analysis, the true stress-strain curves in tension as well as in compression have been used for the study. Moment-curvature and reduced modulus-curvature relations are obtained from the nonlinear stress-strain relations for different sections of the beam and used in the simulation. It is seen that load-deflection curves are initially linear but nonlinear and convex upward at a high load. Furthermore, the compressive stress in the beam is significantly higher than the tensile stress because of asymmetry. Interestingly, for the different cases considered, it is found that part of the SMA beam material may remain in the parent austenite phase, mixed phase or in the stress-induced martensitic phase. Importantly, it is found that more material can be removed from an SMA beam of uniform strength, originally designed without considering geometric nonlinearity and the effect of end-shortening. Comparison of the numerical results with the available theory shows very good agreement, verifying the soundness of the entire numerical simulation scheme.

  3. Modeling of gas absorption cross sections by use of principal-component-analysis model parameters.

    PubMed

    Bak, Jimmy

    2002-05-20

    Monitoring the amount of gaseous species in the atmosphere and exhaust gases by remote infrared spectroscopic methods calls for the use of a compilation of spectral data, which can be used to match spectra measured in a practical application. Model spectra are based on time-consuming line-by-line calculations of absorption cross sections in databases by use of temperature as input combined with path length and partial and total pressure. It is demonstrated that principal component analysis (PCA) can be used to compress the spectrum of absorption cross sections, which depend strongly on temperature, into a reduced representation of score values and loading vectors. The temperature range from 300 to 1000 K is studied. This range is divided into two subranges (300-650 K and 650-1000K), and separate PCA models are constructed for each. The relationship between the scores and the temperature values is highly nonlinear. It is shown, however, that because the score-temperature relationships are smooth and continuous, they can be modeled by polynomials of varying degrees. The accuracy of the data compression method is validated with line-by-line-calculated absorption data of carbon monoxide and water vapor. Relative deviations between the absorption cross sections reconstructed from the PCA model parameters and the line-by-line-calculated values are found to be smaller than 0.15% for cross sections exceeding 1.27 x 10(-21) cm(-1) atm(-1) (CO) and 0.20% for cross sections exceeding 4.03 x 10(-21) cm(-1) atm(-1) (H2O). The computing time is reduced by a factor of 10(4). PMID:12027171

  4. Image Analysis And Pattern Recognition For Porosity Estimation From Thin Sections

    NASA Astrophysics Data System (ADS)

    Richa, R.; Mukerji, T.; Keehm, Y.; Mavko, G.

    2005-12-01

    Estimating porosity from thin sections is one of the key steps in many different rock physics and petrologic analyses. The estimated porosity is a critical input for computing transport properties of rocks from thin sections. The porosity estimate and its uncertainty depend, amongst other things, on the image analyses techniques used. In this poster, we present the results of exploring different image analysis algorithms for estimating porosity from thin section. The general methodology for calculating porosity from thin section involves conversion of a colored image to a binary image. The average of the binary image gives us the porosity. As most thin sections use blue epoxy impregnation, the conversion to binary image requires computationally identifying pixels that are blue. One of the challenges is to capture the variability of the color value, all of which are nominally blue. We compared two different color spaces, RGB and HSV color space, which can be used to specify the blue color. Two different approaches were tried for converting the colored image in different color spaces to a binary image. The first approach involved using thresholds for conversion. A single dimension threshold based on the intensity histogram as well as a multiple dimension threshold based on (RGB) and (HSV) pixel values were explored. In general, multiple dimension thresholding in HSV space gave better results but the choice of threshold is subjective. The second approach involved statistical pattern recognition and classifying of grains and pores. We tested both discriminant analysis and neural network classification. A training data was defined using different groups of pixels from selected pore and grain regions of the thin section. The trivariate training data consists of the range of HSV values for each group (grain or pore). A misclassification error was calculated for the different classification algorithms as the fraction of the observations in the training data that are

  5. Three dimensional dual labelled DNA fluorescent in situ hybridization analysis in fixed tissue sections

    PubMed Central

    Kernohan, Kristin D.; Bérubé, Nathalie G.

    2014-01-01

    Emerging studies demonstrate that three-dimensional organization of chromatin in the nucleus plays a vital role in regulating the genome. DNA fluorescent in situ hybridization (FISH) is a common molecular technique used to visualize the location of DNA sequences. The vast majority of DNA FISH studies are conducted on cultured cells due to the technical difficulties encountered using fixed tissue sections. However, the use of cultured cells poses important limitations that could yield misleading results, making in vivo analysis a far superior approach. Here we present a protocol for multiplexed three dimensional DNA FISH in mouse brain sections, which is also applicable to other tissues. Paraffin-embedded tissues could be used but the embedding and preparation of the samples is time-consuming and often associated with poor antigenicity. To overcome this problem we:•developed a FISH technique using fixed, frozen cryosections;•provide specific instructions for tissue processing for proper fixation and freezing, including equilibration in sucrose gradients to maintain proper cellular structure;•include optimized permeabilization and washing steps to achieve specific signal and to limit background fluorescence in tissue sections. PMID:26150931

  6. Incidentally diagnosed post-cesarean vesicouterine fistula (Youssef’s syndrome)

    PubMed Central

    Keskin, Mehmet Zeynel; Budak, Salih; Can, Ertan; İlbey, Yusuf Özlem

    2015-01-01

    Vesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only 1–4% of all genitourinary fistulas; 90% of cases are Youssef syndrome, which is accompanied by amenorrhea and cyclic hematuria (menouria). In this article, a renal transplant donor who was incidentally diagnosed with Youssef syndrome 20 years after a second cesarean delivery. PMID:26834907

  7. Cesarean Scar Dehiscence Associated with Intrauterine Balloon Tamponade Placement After a Second Trimester Dilation and Evacuation

    PubMed Central

    Aeby, Tod; Kaneshiro, Bliss

    2011-01-01

    While surgical abortion is a safe procedure, the most common complication is excessive bleeding. Methods to conservatively manage hemorrhage are gaining popularity. The authors present a case of a Cesarean scar rupture that occurred after an intrauterine balloon tamponade was placed to treat postabortion bleeding. PMID:21886300

  8. 75 FR 3745 - NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights; Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-22

    ... baby through an incision made in the abdominal wall and uterus), many clinicians believed that all of... of uterine rupture during labor because a cesarean delivery leaves a scar in the wall of the uterus... associated with endometritis (infection of the lining of the uterus), the need for a hysterectomy (removal...

  9. Is Cesarean Delivery Preferable in Twin Pregnancies at >=36 Weeks Gestation?

    PubMed Central

    Dong, Yu; Luo, Zhong-Cheng; Yang, Zu-Jing; Chen, Lu; Guo, Yu-Na; Branch, Ware; Zhang, Jun; Huang, Hong

    2016-01-01

    Background The optimal mode of delivery in twin pregnancies remains controversial. A recent randomized trial did not find any benefit of planned cesarean vs. vaginal delivery at 32–38 weeks gestation, but the trial was not powered to detect a moderate effect. We aimed to evaluate the impact of cesarean delivery on perinatal mortality and severe neonatal morbidity in twin pregnancies at ≥32 weeks through a large database exploration approach with the power to detect moderate risk differences. Methods In a retrospective birth cohort study using the U.S. matched multiple births, 1995–2000 (the available largest multiple birth dataset), we compared perinatal outcomes in twins (n = 181,810 pregnancies) delivered at 32–41 weeks gestation without congenital anomalies. The primary outcome was a composite of perinatal death and severe neonatal morbidity. Cox regression was used to estimate the adjusted hazard ratio (aHR) controlling for the propensity to cesarean delivery, fetal characteristics (sex, birth weight, birth weight discordance, same-sex twin or not) and twin-cluster level dependence. Prospective risks were calculated using the fetuses-at-risk denominators. Results The overall rates of the primary outcome were slightly lower in intended cesarean (6.20%) vs. vaginal (6.45%) deliveries. The aHRs of the primary outcome were in favor of vaginal delivery at 32 (aHR = 1.06, p = 0.03) or 33 (aHR = 1.22, p<0.001) weeks, neutral at 34–35 weeks, but in favor of cesarean delivery at 36 (aHR = 0.94, p = 0.004), 37, 38 and 39+ weeks (aHR: 0.72 to 0.78, all p<0.001). The lower risk of the primary outcome for cesarean vs. vaginal deliveries at 36+ weeks of gestation remained when the analyses were restricted to different-sex (dichorionic) twins (aHR = 0.84, 95% CI 0.80–0.88). Conclusion Cesarean delivery may be beneficial for perinatal outcomes overall in twin pregnancies at ≥36 weeks gestation. PMID:27227678

  10. Options for Optimal Coverage of Free C-Section Services for Poor Mothers in Indian State of Gujarat: Location Allocation Analysis Using GIS

    PubMed Central

    De Costa, Ayesha; Mavalankar, Dileep V.

    2015-01-01

    Background Gujarat, a western state of India, has seen a steep rise in the proportion of institutional deliveries over the last decade. However, there has been a limited access to cesarean section (C-Section) deliveries for complicated obstetric cases especially for poor rural women. C-section is a lifesaving intervention that can prevent both maternal and perinatal mortality. Poor women bear a disproportionate burden of maternal mortality, and lack of access to C-section, especially for these women, is an important contributor for high maternal and perinatal mortality in resource limited settings. To improve access for this underserved population in the context of inadequate public provision of emergency obstetric services, the state government of Gujarat initiated a public private partnership program called “Chiranjeevi Yojana” (CY) in 2005 to increase the number of facilities providing free C-section services. This study aimed to analyze the current availability of these services in three districts of Gujarat and to identify the best locations for additional service centres to optimize access to free C-section services using Geographic Information System technology. Methodology Supply and demand for obstetric care were calculated using secondary data from sources such as Census and primary data from cross-sectional facility survey. The study is unique in using primary data from facilities, which was collected in 2012–13. Information on obstetric beds and functionality of facilities to calculate supply was collected using pretested questionnaire by trained researchers after obtaining written consent from the participating facilities. Census data of population and birth rates for the study districts was used for demand calculations. Location-allocation model of ArcGIS 10 was used for analyses. Results Currently, about 50 to 84% of populations in all three study districts have access to free C-section facilities within a 20km radius. The model suggests that

  11. Normoglycemic Diabetic Ketoacidosis in a Pregnant Patient with Type II Diabetes Mellitus Presenting for Emergent Cesarean Delivery.

    PubMed

    Cardonell, Bradford L; Marks, Barry A; Entrup, Michael H

    2016-04-15

    The development of acute abdominal pain in a laboring parturient after a previous cesarean delivery is of concern and may be the result of a potentially life-threatening condition such as uterine rupture. We present a case of a parturient with type II diabetes mellitus, who had undergone 2 previous cesarean deliveries and now presented in labor with increasing abdominal pain. An emergency cesarean delivery was performed for probable uterine rupture. Intraoperatively, the patient was noted to be severely hypocarbic with significant metabolic acidosis, and the diagnosis of diabetic ketoacidosis was established. PMID:26825994

  12. Analysis and testing of two-dimensional vented Coanda ejectors with asymmetric variable area mixing sections

    NASA Technical Reports Server (NTRS)

    Maroti, L. A.; Hill, P. G.; Armstrong, R. L.; Haines, D. M.

    1976-01-01

    The analysis of asymmetric, curved (Coanda) ejector flow has been completed using a finite difference technique and a quasi-orthogonal streamline coordinate system. The boundary layer type jet mixing analysis accounts for the effect of streamline curvature in pressure gradients normal to the streamlines and on eddy viscosities. The analysis assured perfect gases, free of pressure discontinuities and flow separation and treated three compound flows of supersonic and subsonic streams. Flow parameters and ejector performance were measured in a vented Coanda flow geometry for the verification of the computer analysis. A primary converging nozzle with a discharge geometry of 0.003175 m x 0.2032 m was supplied with 0.283 cu m/sec of air at about 241.3 KPa absolute stagnation pressure and 82 C stagnation temperature. One mixing section geometry was used with a 0.127 m constant radius Coanda surface. Eight tests were run at spacing between the Coanda surface and primary nozzle 0.01915 m and 0.318 m and at three angles of Coanda turning: 22.5 deg, 45.0 deg, and 75.0 deg. The wall static pressures, the loci of maximum stagnation pressures, and the stagnation pressure profiles agree well between analytical and experimental results.

  13. Effect of Normal Saline on Cleaning Uterine Cavity During Cesarean Delivery

    PubMed Central

    Hojjati, Hajar

    2016-01-01

    Introduction Cesarean delivery is the most common and costly gynaecologic surgery, with an increase in rate all over the world. Aim The present study aimed to estimate the effect of uterine cavity cleansing with normal saline solution during cesarean delivery on the rate of infection, fever, bleeding and postoperative gastrointestinal complications. Materials and Methods This study was a clinical trial carried out on 90 pregnant women who underwent elective cesarean delivery. The subjects were randomly assigned into two groups of 45 individuals, including rinsing in 500ml of normal saline solution during cesarean delivery (intervention group) and non-rinsed (control group). Postoperative complications include bleeding, fever, wound infection were examined. The data related to postoperative gastrointestinal complications and endometritis at the second day and one and six weeks after surgery were collected and data were analysed through SPSS 17. Results There was no significant difference between two groups regarding febrile morbidity two days after the surgery. The rate of one-week postoperative febrile morbidity was higher in the control group but not statistically significant. The difference in the incidence of fever, wound infection and endometritis on the second day and on the first week was not statistically significant but the incidence of endometritis on the sixth week after surgery was significant in the intervention group than control group and was less in the intervention group, the wound infection at sixth week after surgery was fewer in the intervention group but not statistically significant. There was no significant difference between two groups in terms of gastrointestinal complications. Conclusion Uterine cavity cleansing with normal saline solution during cesarean delivery may decrease postoperative complication, although the reduction is not statistically significant.

  14. Application of scanning electron microscopy to x-ray analysis of frozen- hydrated sections. I. Specimen handling techniques

    PubMed Central

    1981-01-01

    X-ray microanalysis of frozen-hydrated tissue sections permits direct quantitative analysis of diffusible elements in defined cellular compartments. Because the sections are hydrated, elemental concentrations can be defined as wet-weight mass fractions. Use of these techniques should also permit determination of water fraction in cellular compartments. Reliable preparative techniques provide flat, smooth, 0.5 micrometers-thick sections with little elemental and morphological disruption. The specimen support and transfer system described permits hydrated sections to be transferred to the scanning electron microscope cold stage for examination and analysis without contamination or water loss and without introduction of extraneous x- ray radiation. PMID:7204491

  15. Injection of MTX for the treatment of cesarean scar pregnancy: comparison between different methods

    PubMed Central

    Yin, Xiang-Hua; Yang, Shi-Zhang; Wang, Zhong-Qin; Jia, Hong-Yan; Shi, Min

    2014-01-01

    The aim of this study was to analyze clinical treatment and outcome of injection MTX for Cesarean scar pregnancy (CSP). We use retrospective study to compare the time in CSP of blood chorionic gonadotropin (β-HCG) and progesterone drooped to the normal, blood flow resistance and hospitalization days. 34 patients diagnosed with CSP were reviewed in our department from 2000 to 2013, including clinical characteristics, early diagnosis, treatment methods and treatment outcome. All patients were divided into B ultrasound-guided gestational MTX inject group (Group one), local intramuscular treatment group (Group two) and uterine artery perfusion MTX group (Group three). All cases had responded well to treatment. Except three cases of local intramuscular serum β-HCG decreased slowly MTX 10 mg intramuscular again, the average serum β-HCG decline of 65% the 4th day after treatment. In intramuscular group, the average length of stay is 19 ± 2.1 days. Serum β-HCG, progesterone recovery time were 20 to 89 days, an average of 54.5 days. B ultrasound-guided group hospital stay were 15 ± 3.1 days, serum β-HCG, progesterone recovery time were 18 to 71 days, an average of 44.5 days. In Uterine artery embolization group, the average length of stay is 16 ± 2.4 days, serum β-HCG, progesterone recovery time were 20 to 70 days, an average of 45 days. Statistical data results using T-test and chi-square test analysis. Three groups of β-HCG, progesterone decreased to normal days the difference was statistically significant (P < 0.05), but uterine artery embolization group and ultrasound-guided group B showed no significant difference (P > 0.05). B ultrasound-guided gestational injection of MTX and uterine artery embolization perfusion MTX are the better ways to treat uterine scar pregnancy. PMID:25126192

  16. Feature-based analysis of mouse prostatic intraepithelial neoplasia in histological tissue sections

    PubMed Central

    Ruusuvuori, Pekka; Valkonen, Mira; Nykter, Matti; Visakorpi, Tapio; Latonen, Leena

    2016-01-01

    This paper describes work presented at the Nordic Symposium on Digital Pathology 2015, in Linköping, Sweden. Prostatic intraepithelial neoplasia (PIN) represents premalignant tissue involving epithelial growth confined in the lumen of prostatic acini. In the attempts to understand oncogenesis in the human prostate, early neoplastic changes can be modeled in the mouse with genetic manipulation of certain tumor suppressor genes or oncogenes. As with many early pathological changes, the PIN lesions in the mouse prostate are macroscopically small, but microscopically spanning areas often larger than single high magnification focus fields in microscopy. This poses a challenge to utilize full potential of the data acquired in histological specimens. We use whole prostates fixed in molecular fixative PAXgene™, embedded in paraffin, sectioned through and stained with H&E. To visualize and analyze the microscopic information spanning whole mouse PIN (mPIN) lesions, we utilize automated whole slide scanning and stacked sections through the tissue. The region of interests is masked, and the masked areas are processed using a cascade of automated image analysis steps. The images are normalized in color space, after which exclusion of secretion areas and feature extraction is performed. Machine learning is utilized to build a model of early PIN lesions for determining the probability for histological changes based on the calculated features. We performed a feature-based analysis to mPIN lesions. First, a quantitative representation of over 100 features was built, including several features representing pathological changes in PIN, especially describing the spatial growth pattern of lesions in the prostate tissue. Furthermore, we built a classification model, which is able to align PIN lesions corresponding to grading by visual inspection to more advanced and mild lesions. The classifier allowed both determining the probability of early histological changes for uncategorized

  17. Feature-based analysis of mouse prostatic intraepithelial neoplasia in histological tissue sections.

    PubMed

    Ruusuvuori, Pekka; Valkonen, Mira; Nykter, Matti; Visakorpi, Tapio; Latonen, Leena

    2016-01-01

    This paper describes work presented at the Nordic Symposium on Digital Pathology 2015, in Linköping, Sweden. Prostatic intraepithelial neoplasia (PIN) represents premalignant tissue involving epithelial growth confined in the lumen of prostatic acini. In the attempts to understand oncogenesis in the human prostate, early neoplastic changes can be modeled in the mouse with genetic manipulation of certain tumor suppressor genes or oncogenes. As with many early pathological changes, the PIN lesions in the mouse prostate are macroscopically small, but microscopically spanning areas often larger than single high magnification focus fields in microscopy. This poses a challenge to utilize full potential of the data acquired in histological specimens. We use whole prostates fixed in molecular fixative PAXgene™, embedded in paraffin, sectioned through and stained with H&E. To visualize and analyze the microscopic information spanning whole mouse PIN (mPIN) lesions, we utilize automated whole slide scanning and stacked sections through the tissue. The region of interests is masked, and the masked areas are processed using a cascade of automated image analysis steps. The images are normalized in color space, after which exclusion of secretion areas and feature extraction is performed. Machine learning is utilized to build a model of early PIN lesions for determining the probability for histological changes based on the calculated features. We performed a feature-based analysis to mPIN lesions. First, a quantitative representation of over 100 features was built, including several features representing pathological changes in PIN, especially describing the spatial growth pattern of lesions in the prostate tissue. Furthermore, we built a classification model, which is able to align PIN lesions corresponding to grading by visual inspection to more advanced and mild lesions. The classifier allowed both determining the probability of early histological changes for uncategorized

  18. Impact of Obstetrician/Gynecologist Hospitalists on Quality of Obstetric Care (Cesarean Delivery Rates, Trial of Labor After Cesarean/Vaginal Birth After Cesarean Rates, and Neonatal Adverse Events).

    PubMed

    Iriye, Brian K

    2015-09-01

    Care via obstetric hospitalists continues to expand, quickly becoming an integral part of labor and delivery management in urban and suburban areas. Overall lower cesarean delivery rates have been found with obstetric hospitalist care. Continuous 24-hour coverage of labor units has displayed lower rates of neonatal adverse events and likely reduces time in decision to delivery. Further study is needed on maternal and neonatal outcomes to corroborate earlier observations, and to closely examine the type of obstetric hospitalist model being observed to aid in planning the ideal deployment of providers in this workforce of the future. PMID:26333637

  19. Temperature Analysis of Coronal Loop Cross-Sections: Monolithic vs. Nanoflare Heating

    NASA Astrophysics Data System (ADS)

    Aschwanden, Markus J.; Boerner, P.

    2011-05-01

    We present a first systematic study on the cross-sectional temperature structure of coronal loops using the six coronal temperature filters of the Atmospheric Imaging Assembly (AIA) instrument on the Solar Dynamics Observatory (SDO). We analyze a sample of 100 loop snapshots measured at 10 different locations and 10 different times in active region NOAA 11089 on 2010 July 24, 21:00-22:00 UT. The cross-sectional flux profiles are measured and a cospatial background is subtracted in 6 filters in a temperature range of T ≈ 0.5-16 MK, and 4 different parameterizations of differential emission measure (DEM) distributions are fitted. We find that the reconstructed DEMs consist predominantly of narrowband peak temperature components with a thermal width of σlog(T) ≤ 0.11±0.02, close to the temperature resolution limit of the instrument, consistent with earlier triple-filter analysis from TRACE by Aschwanden and Nightingale (2005) and from EIS/Hinode by Warren et al. (2008) or Tripathi et al. (2009). We find that 66% of the loops could be fitted with a narrowband single-Gaussian DEM model, and 19% with a DEM consisting of two narrowband Gaussians (which mostly result from pairs of intersecting loops along the same line-of-sight). The mostly isothermal loop DEMs allow us also to derive an improved empirical response function of the AIA 94 [[Unable to Display Character: Ǻ

  20. Comparative analysis of numerical estimation methods of epithelial nerve fibers using tissue sections.

    PubMed

    Hilliges, M; Johansson, O

    1999-01-01

    The proper assessment of neuron numbers in the nervous system during physiological and pathological conditions, as well as following various treatments, has always been an important part of neuroscience. The present paper evaluates three methods for numerical estimates of nerves in epithelium: I) unbiased nerve fiber profile and nerve fiber fragment estimation methods, II) the traditional method of counting whole nerve fibers, and III) the nerve fiber estimation method. In addition, an unbiased nerve length estimation method was evaluated. Of these four methods, the nerve length per volume method was theoretically optimal, but more time-consuming than the others. The numbers obtained with the methods of nerve fiber profile, nerve fragment and nerve fiber estimation are dependent on the thickness of the epithelium and the sections as well as certain shape factors of the counted fiber. However for those, the actual counting can readily be performed in the microscope and is consequently quick and relatively inexpensive. The statistical analysis showed a very good correlation (R > 0.96) between the three numerical methods, meaning that basically any method could be used. However, dependent on theoretical and practical considerations and the correlation statistics, it may be concluded that the nerve fiber profile or fragment estimation methods should be employed if differences in epithelial and section thickness and the nerve fibers shape factors can be controlled. Such drawbacks are not inherent in the nerve length estimation method and, thus, it can generally be applied. PMID:10197065

  1. New applications of computer-based section construction: strain analysis, local balancing, and subsurface fault prediction

    SciTech Connect

    Geiser, J.; Geiser, P.A.; Kligfield, R.; Ratliff, R.; Rowan, M.

    1988-04-01

    An increase in the use of computers in structural geology now encourages practical investigation of several topics which are of considerable importance to the explorationist. Computer-based cross section construction and analysis is one such application. Algorithms based on the geometry of flexural slip or flow deformation styles permit rapid construction restoration, and balancing of geological cross sections, which in turn allow evaluation of multiple working hypotheses in a time frame previously unattainable. These same techniques also simplify the application of several analytical methods which have tended to be restricted to structural geologists: predicted finite and incremental strain patterns within folds can be utilized in studies of porosity and permeability variation; the detailed geometry of fold can be evaluated and modified using local balancing methods when constraints provided by well, seismic, and surface data leave room for differing interpretations; and subsurface fault trajectories can be quickly and accurately predicted from knowledge or near-surface fold geometry. These and other methods discussed in the text permit the non-specialist to apply complex structural concepts of exploration in a practical and timely manner.

  2. Determination of single photon ionization cross sections for quantitative analysis of complex organic mixtures.

    PubMed

    Adam, Thomas; Zimmermann, Ralf

    2007-11-01

    Soft single photon ionization (SPI)-time-of-flight mass spectrometry (TOFMS) is well suited for fast and comprehensive analysis of complex organic gas mixtures, which has been demonstrated in various applications. This work describes a calibration scheme for SPI, which enables quantification of a large number of compounds by only calibrating one compound of choice, in this case benzene. Photoionization cross sections of 22 substances were determined and related to the yield of benzene. These substances included six alkanes (pentane, hexane, heptane, octane, nonane, decane), three alkenes (propene, butane, pentene), two alkynes (propyne, butyne), two dienes (butadiene, isoprene), five monoaromatic species (benzene, toluene, xylene, styrene, monochlorobenzene) and NO. The cross sections of organic compounds differ by about one order of magnitude but the photoionization properties of compounds belonging to one compound class are rather similar. Therefore, the scheme can also be used for an approximate quantification of compound classes. This is demonstrated by a fast characterization and pattern recognition of two gasoline samples with different origins (Germany and South Africa) and a diesel sample (Germany). The on-line capability of the technique and the scheme is demonstrated by quantitatively monitoring and comparing the cold engine start of four vehicles: a gasoline passenger car, a diesel van, a motorbike and a two-stroke scooter. PMID:17874081

  3. Transitions, cross sections and neutron binding energy in 186Re by Prompt Gamma Activation Analysis

    NASA Astrophysics Data System (ADS)

    Lerch, A. G.; Hurst, A. M.; Firestone, R. B.; Revay, Zs.; Szentmiklosi, L.; McHale, S. R.; McClory, J. W.; Detwiler, B.; Carroll, J. J.

    2014-03-01

    The nuclide 186Re possesses an isomer with 200,000 year half-life while its ground state has a half-life of 3.718 days. It is also odd-odd and well-deformed nucleus, so should exhibit a variety of other interesting nuclear-structure phenomena. However, the available nuclear data is rather sparse; for example, the energy of the isomer is only known to within + 7 keV and, with the exception of the J?=1- ground state, every proposed level is tentative in the ENSDF. Previously, Prompt Gamma Activation Analysis (PGAA) was utilized to study natRe with 186,188Re being produced via thermal neutron capture. Recently, an enriched 185Re target was irradiated by thermal neutrons at the Budapest Research Reactor to build on those results. Prompt (primary and secondary) and delayed gamma-ray transitions were measured with a large-volume, Compton-suppressed HPGe detector. Absolute cross sections for each gamma transition were deduced and corrected for self attenuation within the sample. Fifty-two primary gamma-ray transitions were newly identified and used to determine a revised value of the neutron binding energy. DICEBOX was used to simulate the decay scheme and the total radiative thermal neutron capture cross section was found to be 97+/-3 b Supported by DTRA (Detwiler) through HDTRA1-08-1-0014.

  4. Water mass analysis for the U.S. GEOTRACES (GA03) North Atlantic sections

    NASA Astrophysics Data System (ADS)

    Jenkins, W. J.; Smethie, W. M.; Boyle, E. A.; Cutter, G. A.

    2015-06-01

    We present the distributions of hydrographic properties (potential temperature, salinity, dissolved oxygen, and micromolar level inorganic macronutrients) along two sections occupied in the subtropical North Atlantic as part of the first U.S. GEOTRACES (GA03) survey during 2010 and 2011. The purpose of this work is to place subsequent papers in this special issue in a general context and to provide a framework in which the observed distributions of Trace Elements and Isotopes can be interpreted. Using these hydrographic properties we use a modified Optimum Multiparameter water mass analysis method to diagnose the relative contributions of various water types along the sections and rationalize their distributions. The water mass compositions appear largely consistent with what is understood from previous studies about the large scale circulation and ventilation of the North Atlantic, with perhaps one exception. We found that the North Atlantic Deep water both east and west of the Mid Atlantic Ridge is more strongly influenced by Iceland Scotland Overflow Water relative to Denmark Straits Overflow Water (about 3:1) than inferred from other tracer studies (typically 2:1). It remains unclear whether this is an artifact of our calculation or a real change in deep water composition in the decades between the determinations.

  5. High resolution image analysis of cell nuclei in tissue sections of primary and metastatic carcinomas.

    PubMed

    Theissig, F; Dimmer, V; Kunze, K D

    1986-01-01

    The present study examines whether certain histological tumour types can be differentiated on account of their nuclear image with the aid of automated image analysis. For karyometric investigations three tumour types (adenocarcinomas, squamous cell carcinomas and mammary carcinomas) were chosen, which occur frequently as occult primary tumours. From each type ten primary tumours with their corresponding lymph node metastases were examined. 100 cell nuclei were measured from each case using 4 micron thick paraffin sections stained with gallocyanin-chromalum. For each cell nucleus 21 contour and texture features were determined. Through the application of linear classifiers 41 out of 52 cases (25 primary tumours, 27 metastases) of these three tumour types were correctly classified. Eight cases could not be classified with certainty and only three cases were wrongly classified. In addition, within the group of adenocarcinomas differences due to localisation were detected which allow us to draw conclusions on the seat of the primary tumour. PMID:3019272

  6. Numerical analysis of supersonic flow through oscillating cascade sections by using a deforming grid

    NASA Technical Reports Server (NTRS)

    Huff, Dennis L.; Reddy, T. S. R.

    1989-01-01

    A finite difference code was developed for modeling inviscid, unsteady supersonic flow by solution of the compressible Euler equations. The code uses a deforming grid technique to capture the motion of the airfoils and can model oscillating cascades with any arbitrary interblade phase angle. A flat plate cascade is analyzed, and results are compared with results from a small-perturbation theory. The results show very good agreement for both the unsteady pressure distributions and the integrated force predictions. The reason for using the numerical Euler code over a small-perturbation theory is the ability to model real airfoils that have thickness and camber. Sample predictions are presented for a section of the rotor on a supersonic throughflow compressor designed at NASA Lewis Research Center. Preliminary results indicate that two-dimensional, flat plate analysis predicts conservative flutter boundaries.

  7. Principal-components analysis of fluorescence cross-section spectra from pathogenic and simulant bacteria

    NASA Astrophysics Data System (ADS)

    Heaton, Harold I.

    2005-10-01

    Principal-components analysis of a new set of highly resolved (<1 nm) fluorescence cross-section spectra excited at 354.7 nm over the 370 646 nm band has been used to demonstrate the potential ability of UV standoff lidars to discriminate among particular biological warfare agents and simulants over short ranges. The remapped spectra produced by this technique from Bacillus globigii (Bg) and Bacillus anthracis (Ba) spores were sufficiently different to allow them to be cleanly separated, and the Ba spectra obtained from Sterne and Ames strain spores were distinguishable. These patterns persisted as the spectral resolution was subsequently degraded in processing from ˜1 to 34 nm. This is to the author's knowledge the first time that resolved fluorescence spectra from biological warfare agents have been speciated or shown to be distinguishably different from those normally used surrogates by optical spectroscopy.

  8. Fourier Transform Methods Applied To The Analysis Of Microphotometric Images Of Histologic Sections

    NASA Astrophysics Data System (ADS)

    Dytch, Harvey E.; Wied, George L.

    1989-06-01

    Implementation of one-dimensional Fourier transform techniques for the analysis of histologic sections is discussed, as is the motivation for their use. Features of the frequency domain representation derived by such a transform are shown to be related to several important diagnostic clues. The interpretation of the Fourier magnitude spectrum in histologically relevant terms is examined by means of Fourier transforms of idealized tissue simulations. Some of the perturbations of these ideal spectra produced by biologic reality are discussed. Three classic types of cervical epithelial tissue are modeled, and their representation as Fourier magnitude spectra interpreted in the light of the previous results: characteristic frequency domain signatures are obtained for each. It is concluded that these techniques may provide diagnostically important objective measures, and may be applied to otherwise intractable histologic specimens with crowded and overlapping nuclei.

  9. Utilization of Advanced Diagnostic Methods for Texture and Rut Depth Analysis on a Testing Pavement Section

    NASA Astrophysics Data System (ADS)

    Slabej, Martin; Grinč, Michal; Kotek, Peter; Kováč, Matúš; Decký, Martin

    2015-05-01

    Qualitative characteristics of pavement in wide range reflects the pavement serviceability, which is a summary of the characteristics of the pavement, providing a fast, smooth, economical and especially safe driving of motor-vehicles. The target factor of pavement serviceability and safety of roads represents the quality of their surface properties. In the framework of research activities performed in the Research Centre founded under the auspices of University of Žilina, individual parameters of pavement serviceability were monitored by pavement surface scanning. This paper describes the creation of a 3D - road surface model and its analysis and evaluation from the viewpoint of two pavement serviceability parameters - the rut depth and texture. Measurements were performed on an experimental pavement section used contemporary in an Accelerated Pavement Testing experiment. The long-term goal is to ascertain functions predicting degradation of these two pavement serviceability parameters.

  10. Cross sections for n+{sup 14}N from an R-matrix analysis of the {sup 15}N system

    SciTech Connect

    Hale, G.M.; Young, P.G.; Chadwick, M.B.

    1994-06-01

    As part of the Hiroshima-Nagasaki Dose Reevaluation Program, a new evaluation of the neutron cross sections for {sup 14}N was made for ENDF/B-VI, based at energies below 2.5 MeV on a multichannel R-matrix analysis of reactions in the {sup 15}N system. The types of data used in the analysis, and the resulting cross sections and resonance structure for {sup 15}N are briefly described. The resonant features of the neutron cross sections were especially well determined by including precise, high-resolution neutron total cross section measurements from ORNL. While the new evaluated cross section appear to be significant improvements over the earlier ones, they still need to be tested more extensively against recent measurements of the differential elastic cross section from Oak Ridge.

  11. The age of peak performance in Ironman triathlon: a cross-sectional and longitudinal data analysis

    PubMed Central

    2013-01-01

    Background The aims of the present study were, firstly, to investigate in a cross-sectional analysis the age of peak Ironman performance within one calendar year in all qualifiers for Ironman Hawaii and Ironman Hawaii; secondly, to determine in a longitudinal analysis on a qualifier for Ironman Hawaii whether the age of peak Ironman performance and Ironman performance itself change across years; and thirdly, to determine the gender difference in performance. Methods In a cross-sectional analysis, the age of the top ten finishers for all qualifier races for Ironman Hawaii and Ironman Hawaii was determined in 2010. For a longitudinal analysis, the age and the performance of the annual top ten female and male finishers in a qualifier for Ironman Hawaii was determined in Ironman Switzerland between 1995 and 2010. Results In 19 of the 20 analyzed triathlons held in 2010, there was no difference in the age of peak Ironman performance between women and men (p > 0.05). The only difference in the age of peak Ironman performance between genders was in ‘Ironman Canada’ where men were older than women (p = 0.023). For all 20 races, the age of peak Ironman performance was 32.2 ± 1.5 years for men and 33.0 ± 1.6 years for women (p > 0.05). In Ironman Switzerland, there was no difference in the age of peak Ironman performance between genders for top ten women and men from 1995 to 2010 (F = 0.06, p = 0.8). The mean age of top ten women and men was 31.4 ± 1.7 and 31.5 ± 1.7 years (Cohen's d = 0.06), respectively. The gender difference in performance in the three disciplines and for overall race time decreased significantly across years. Men and women improved overall race times by approximately 1.2 and 4.2 min/year, respectively. Conclusions Women and men peak at a similar age of 32–33 years in an Ironman triathlon with no gender difference. In a qualifier for Ironman Hawaii, the age of peak Ironman performance remained unchanged across years. In contrast, gender

  12. Racial and Ethnic Differences in Indication for Primary Cesarean Delivery at Term: Experience at One U.S. Institution

    PubMed Central

    Washington, Sierra; Caughey, Aaron B.; Cheng, Yvonne W.; Bryant, Allison S.

    2012-01-01

    Background Black and Latina women in the United States are known to undergo cesarean delivery at a higher rate than other women. We sought to explore the role of medical indications for cesarean delivery as a potential explanation for these differences. Methods A retrospective cohort study was conducted of 11,034 primiparas delivering at term at the University of California, San Francisco, between 1990 and 2008. We used multivariable analyses to evaluate racial and ethnic differences in risks of, and indications for, cesarean delivery. Results The overall rate of cesarean delivery in our cohort was 21.9 percent. Black and Latina women were at significantly higher odds of undergoing cesarean delivery than white women (adjusted odds ratio (AOR) 1.54; 95% CI: 1.30, 1.83, and 1.21; 95% CI: 1.03, 1.43, respectively). Black women were at significantly higher odds of undergoing cesarean delivery for nonreassuring fetal heart tracings than white women (AOR: 2.19; 95% CI: 1.55, 3.09), and black women (AOR: 1.55; 95% CI: 1.21, 1.98), Latina women (AOR: 1.48; 95% CI: 1.19, 1.85), and Asian women (AOR: 1.47; 95% CI: 1.22, 1.85) were at significantly higher odds of undergoing cesarean delivery for failure to progress. Black, Latina, and Asian women were at significantly lower odds of undergoing cesarean delivery for malpresentation than white women (AORs: 0.56; 95% CI: 0.34, 0.89, 0.66, 95% CI: 0.44, 0.98, and 0.55, 95% CI: 0.40, 0.76, respectively). Conclusions Racial and ethnic differences exist in specific indications for cesarean delivery among primiparas. Clarifying the possible reasons for increased cesareans for nonreassuring fetal heart tracing in black women, in particular, may help to decrease excess cesarean deliveries in this racial and ethnic group. (BIRTH 39:2 June 2012) PMID:23281861

  13. An Interprofessional Quality Improvement Project to Implement Maternal/Infant Skin-to-Skin Contact During Cesarean Delivery

    PubMed Central

    Brady, Karen; Bulpitt, Denise; Chiarelli, Caren

    2014-01-01

    Immediate skin-to-skin contact between a mother and her newborn has been associated with successful breastfeeding outcomes. One of the challenges nurses face in promoting skin-to-skin occurs in the operating room during a cesarean delivery. Utilizing an interprofessional approach for this quality improvement project, we successfully implemented skin-to-skin contact for all eligible mother/infant couplets after cesarean birth. Exclusive breastfeeding rates for these women increased as a result. PMID:24981767

  14. Semi-automated porosity identification from thin section images using image analysis and intelligent discriminant classifiers

    NASA Astrophysics Data System (ADS)

    Ghiasi-Freez, Javad; Soleimanpour, Iman; Kadkhodaie-Ilkhchi, Ali; Ziaii, Mansur; Sedighi, Mahdi; Hatampour, Amir

    2012-08-01

    Identification of different types of porosity within a reservoir rock is a functional parameter for reservoir characterization since various pore types play different roles in fluid transport and also, the pore spaces determine the fluid storage capacity of the reservoir. The present paper introduces a model for semi-automatic identification of porosity types within thin section images. To get this goal, a pattern recognition algorithm is followed. Firstly, six geometrical shape parameters of sixteen largest pores of each image are extracted using image analysis techniques. The extracted parameters and their corresponding pore types of 294 pores are used for training two intelligent discriminant classifiers, namely linear and quadratic discriminant analysis. The trained classifiers take the geometrical features of the pores to identify the type and percentage of five types of porosity, including interparticle, intraparticle, oomoldic, biomoldic, and vuggy in each image. The accuracy of classifiers is determined from two standpoints. Firstly, the predicted and measured percentages of each type of porosity are compared with each other. The results indicate reliable performance for predicting percentage of each type of porosity. In the second step, the precisions of classifiers for categorizing the pore spaces are analyzed. The classifiers also took a high acceptance score when used for individual recognition of pore spaces. The proposed methodology is a further promising application for petroleum geologists allowing statistical study of pore types in a rapid and accurate way.

  15. [Development of the Coparental Regulation Inventory and cross-sectional analysis of mothers' encouragement and criticism].

    PubMed

    Kato, Michiyo; Kurosawa, Tai; Kamiya, Tetsuji

    2014-02-01

    We developed the Coparental Regulation Inventory to assess the regulatory behavior of the mothers in involving fathers with child rearing. We translated and modified the short form of the Parental Regulation Inventory (PRI) for Japanese couples in different stages of child rearing. An online questionnaire was conducted with mothers (n = 500) and fathers (n = 500) whose youngest child was less than 21-years-old. Exploratory factor analysis identified two factors, which were labeled "encouragement" and "criticism". The resulting Coparental Regulation Inventory (the modified PRI) had high internal consistency and test-retest reliability. The construct validity of the scale was supported by its correlation with parenting alliance, marital satisfaction, and the father's involvement. These findings suggest that the scale is an adequate instrument for identifying the behaviors of mothers related to coparenting. In addition, we examined the frequency of encouragement and criticism used by the mother in relation to the child-rearing stage using cross-sectional analysis. In the mothers' reports, mothers with infants and children encouraged fathers more than mothers with early and late adolescents. Mothers with late adolescents criticized fathers less than mothers with infants. In the fathers' reports, mothers gave more encouragement to fathers who had infants than at any other age, whereas the child's age was not related to mothers' criticism perceived by the fathers. PMID:24669497

  16. Hyperspectral microscopic analysis of normal, benign and carcinoma microarray tissue sections

    NASA Astrophysics Data System (ADS)

    Maggioni, Mauro; Davis, Gustave L.; Warner, Frederick J.; Geshwind, Frank B.; Coppi, Andreas C.; DeVerse, Richard A.; Coifman, Ronald R.

    2006-02-01

    We apply a unique micro-optoelectromechanical tuned light source and new algorithms to the hyper-spectral microscopic analysis of human colon biopsies. The tuned light prototype (Plain Sight Systems Inc.) transmits any combination of light frequencies, range 440nm 700nm, trans-illuminating H and E stained tissue sections of normal (N), benign adenoma (B) and malignant carcinoma (M) colon biopsies, through a Nikon Biophot microscope. Hyper-spectral photomicrographs, randomly collected 400X magnication, are obtained with a CCD camera (Sensovation) from 59 different patient biopsies (20 N, 19 B, 20 M) mounted as a microarray on a single glass slide. The spectra of each pixel are normalized and analyzed to discriminate among tissue features: gland nuclei, gland cytoplasm and lamina propria/lumens. Spectral features permit the automatic extraction of 3298 nuclei with classification as N, B or M. When nuclei are extracted from each of the 59 biopsies the average classification among N, B and M nuclei is 97.1%; classification of the biopsies, based on the average nuclei classification, is 100%. However, when the nuclei are extracted from a subset of biopsies, and the prediction is made on nuclei in the remaining biopsies, there is a marked decrement in performance to 60% across the 3 classes. Similarly the biopsy classification drops to 54%. In spite of these classification differences, which we believe are due to instrument and biopsy normalization issues, hyper-spectral analysis has the potential to achieve diagnostic efficiency needed for objective microscopic diagnosis.

  17. Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis

    PubMed Central

    2013-01-01

    Background The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across

  18. Comparative Finite Element Method Analysis of Spiroid Worm Gear Drives Having Arched Profile and Having Linear Profile in Axial Section

    NASA Astrophysics Data System (ADS)

    Bodzás, Sándor; Dudás, Illés

    2014-12-01

    With the knowledge of the advantageous characteristics of the cylindrical worm gear drives having arched profile in axial section and the conical worm gear drives having linear profile in axial section, a new geometric type conical worm gear drive has been designed and then manufactured, that is the conical worm gear drive having arched profile in axial section. Beside similar charging and marginal conditions in case of the same geometric spiroid worm gear drives having arched profile and having linear profile in axial section we have done comparative finite element method analysis for awarding of the strains, deformations and stresses of this gear drives.

  19. The Neutron Time-of-Flight Cross Section Program at the University of Kentucky - Adventures in Analysis II

    NASA Astrophysics Data System (ADS)

    Vanhoy, J. R.; Hicks, S. F.; Combs, B. C.; Crider, B. P.; French, A. J.; Garza, E. A.; Henderson, S. L.; Howard, T. J.; Liu, S. H.; Nigam, S.; Pecha, R. L.; Peters, E. E.; Prados-Estévez, F. M.; McEllistrem, M. T.; Rice, B. J.; Ross, T. J.; Santonil, Z. C.; Sidwell, L. C.; Steves, J. L.; Yates, S. W.

    2015-05-01

    Elastic and inelastic neutron differential cross sections are measured at the University of Kentucky Accelerator Laboratory (www.pa.uky.edu/accelerator/) at incident energies in the fast neutron region. The labo- ratorys facilities and instrumentation will be described and our measurement and analysis procedures outlined. Many corrections are required for neutron scattering experiments and the analysis utilizes information from many other cross section data sets and model calculations. Exploring and understanding the limitations of the foundational information and procedures are important for controlling the accuracy of the cross section results. We are examining the limitations in neutron detection efficiency, the normalization of (n,n'γ) cross sections,background reduction, spectrum stripping techniques, and attenuation and multiple scattering corrections. The resulting differential cross sections provide information on the compound elastic and coupled channels reaction mechanisms important for advanced reactor designs

  20. Statistical Model Analysis of (n, α) Cross Sections for 4.0-6.5 MeV Neutrons

    NASA Astrophysics Data System (ADS)

    Khuukhenkhuu, G.; Odsuren, M.; Gledenov, Y. M.; Zhang, G. H.; Sedysheva, M. V.; Munkhsaikhan, J.; Sansarbayar, E.

    2016-02-01

    The statistical model based on the Weisskopf-Ewing theory and constant nuclear temperature approximation is used for systematical analysis of the 4.0-6.5 MeV neutron induced (n, α) reaction cross sections. The α-clusterization effect was considered in the (n, α) cross sections. A certain dependence of the (n, α) cross sections on the relative neutron excess parameter of the target nuclei was observed. The systematic regularity of the (n, α) cross sections behaviour is useful to estimate the same reaction cross sections for unstable isotopes. The results of our analysis can be used for nuclear astrophysical calculations such as helium burning and possible branching in the s-process.

  1. Concomitant ultrasound-guided intra-gestational sac methotrexate-potassium chloride and systemic methotrexate injection in the recurrent cesarean scar pregnancy.

    PubMed

    Lee, Ju Hak; Kwon, Dae Hui; Ahn, Ki Hoon; Hong, Soon Cheol; Kim, Tak

    2016-05-01

    Recurrent ectopic pregnancy of cesarean scar is very rare and its therapeutic management is still not established. We reported the first case of recurrent cesarean scar pregnancy that was successfully treated with concomitant intra-gestational sac methotrexate-potassium chloride injection and systemic methotrexate injection. This case study provides physicians with a safe and effective minimally invasive treatment option for recurrent cesarean scar pregnancy. PMID:27200318

  2. Concomitant ultrasound-guided intra-gestational sac methotrexate-potassium chloride and systemic methotrexate injection in the recurrent cesarean scar pregnancy

    PubMed Central

    Lee, Ju Hak; Kwon, Dae Hui; Ahn, Ki Hoon; Hong, Soon Cheol

    2016-01-01

    Recurrent ectopic pregnancy of cesarean scar is very rare and its therapeutic management is still not established. We reported the first case of recurrent cesarean scar pregnancy that was successfully treated with concomitant intra-gestational sac methotrexate-potassium chloride injection and systemic methotrexate injection. This case study provides physicians with a safe and effective minimally invasive treatment option for recurrent cesarean scar pregnancy. PMID:27200318

  3. Development and analysis of elastically tailored composite star shaped beam sections

    NASA Astrophysics Data System (ADS)

    Kim, Inn B.

    Elastically tailored composite materials provide an extra degree of freedom to meet design requirements efficiently and economically. In particular, extension-twist coupled laminates have potential for use in rotary wing aircraft where an increase in centrifugal load can result in a sectional change in pitch angle of the rotor blades. Consequently, the propulsive efficiency could be improved by utilizing this concept in tilt rotor aircraft application. To this end, a family of new open cross-sectional configuration is developed and analyzed to tailor the torsional and bending rigidities compared to those of flat strips without a loss in the level of extension-twist coupling. In addition, the developed configurations are modified by incorporating closed-cell cores with variable diameters and wall thickness to further tailor the torsional stiffness more effectively. A closed form analytical model for the configuration without a core is obtained based on an extension of the analytical model of flat strips and compared with the finite element analysis. Several star shaped composite beams are manufactured using a custom designed mold. The manufactured beams are tested and used as an experimental verification of analytical model predictions as well as finite element results. It is found that analytical predictions, finite element analysis and experimental results are in good agreement. Similarly, a set of modified star configurations that incorporate closed-cell cores is analyzed. The configurations are prismatic and of variable diameter and wall thickness leading to tailorable torsional stiffness and large extension-twist coupling with constant axial stiffness. A parametric study is performed using a linear as well as a geometrically nonlinear finite element codes. Several composite modified star beam configurations are manufactured and tested to provide an experimental verification of the finite element predictions. The comparison of test results and finite element

  4. Emergency cesarean delivery in primigravida with portal hypertension, esophageal varices, and preeclampsia.

    PubMed

    Khanna, Puneet; Garg, Rakesh; Roy, Kajari; Punj, Jyotsna; Pandey, Ravindra; Darlong, Vanlal

    2012-10-01

    The incidence of cirrhosis and advanced portal hypertension during pregnancy is very low, and the literature is scarce with regard to the anesthetic management of a parturient with this coexisting disease. We report the successful perioperative management of a parturi- ent with a history of cirrhosis and portal hypertension with esophageal varices and mild preeclampsia who presented at 38 weeks' gestation in active labor with a breech presentation requiring emergency cesarean delivery. She required endoscopic esophageal varices banding during the second trimester of pregnancy. After correction of her coagulopathy, she was administered subarachnoid block and cesarean delivery, which was conducted uneventfully. Anesthetic management of these patients depends on understanding and avoiding variceal hemorrhage, encephalopathy, renal failure, and careful fluid and electrolyte management. PMID:26050279

  5. REM Sleep Behavior and Motor Findings in Parkinson's Disease: A Cross-sectional Analysis

    PubMed Central

    Mahajan, Abhimanyu; Rosenthal, Liana S.; Gamaldo, Charlene; Salas, Rachel E.; Pontone, Gregory M.; McCoy, Arita; Umeh, Chizoba; Mari, Zoltan

    2014-01-01

    Background Parkinson's disease (PD) represents a major public health challenge that will only grow in our aging population. Understanding the connection between PD and associated prodromal conditions, such as rapid eye movement sleep behavioral disorder (RBD), is critical to identifying prevention strategies. However, the relationship between RBD and severity of motor findings in early PD is unknown. This study aims to examine this relationship. Methods The study population consisted of 418 PD patients who completed the Movement Disorders Society-United Parkinson's Disease Rating Scale (MDS-UPDRS) and rapid eye movement sleep (REM) disorder questionnaires at the baseline visit of the Michael J. Fox's Parkinson's Progression Markers Initiative (PPMI). Cross-sectional analysis was carried out to assess the association between REM Sleep Behavior Screening Questionnaire score and MDS UPDRS-3 (motor) score categories. Correlation with a higher score category was described as “worse motor findings”. A score of 5 on the REM disorder questionnaire was defined as predictive of RBD. Results Out of the 418 PD patients, 113 (27.0%) had RBD. With univariate logistic regression analysis, individuals with scores predictive of RBD were 1.66 times more likely to have worse motor findings (p = 0.028). Even with age, gender, and Geriatric Depression Scale scores taken into account, individuals with scores predictive of RBD were 1.69 times more likely to have worse motor findings (p = 0.025). Discussion PD patients with RBD symptoms had worse motor findings than those unlikely to have RBD. This association provides further evidence for the relationship between RBD and PD. PMID:25009765

  6. Health insurance selection in Chile: a cross-sectional and panel analysis.

    PubMed

    Pardo, Cristian; Schott, Whitney

    2014-05-01

    In Chile, workers are mandated to choose either public or private health insurance coverage. Although private insurance premiums depend on health risk, public insurance premiums are solely linked to income. This structure implies that individuals with higher health risks may tend to avoid private insurance, leaving the public insurance system responsible for their care. This article attempts to explore the determinants of health insurance selection (private vs public) by individuals in Chile and to test empirically whether adverse selection indeed exists. We use panel data from Chile's 'Encuesta de Proteccion Social' survey, which allows us to control for a rich set of individual observed and unobserved characteristics using both a cross-sectional analysis and fixed-effect methods. Results suggest that age, sex, job type, income quintile and self-reported health are the most important factors in explaining the type of insurance selected by individuals. Asymmetry in insurance mobility caused by restrictions on pre-existing conditions may explain why specific illnesses have an unambiguous relationship with insurance selection. Empirical evidence tends to indicate that some sorting by health risk and income levels takes place in Chile. In addition, by covering a less healthy population with higher utilization of general health consultations, the public insurance system may be incurring disproportionate expenses. Results suggest that if decreasing segmentation and unequal access to health services are important policy objectives, special emphasis should be placed on asymmetries in the premium structure and inter-system mobility within the health care system. Preliminary analysis of the impact of the 'Garantias Explicitas de Salud' plan (explicit guarantees on health care plan) on insurance selection is also considered. PMID:23558960

  7. A comparison of micro-CT and thin section analysis of Lateglacial glaciolacustrine varves from Glen Roy, Scotland

    NASA Astrophysics Data System (ADS)

    Bendle, Jacob M.; Palmer, Adrian P.; Carr, Simon J.

    2015-04-01

    Despite the prevalence of thin section analysis in studies of Quaternary sediments, there are limitations associated with the production of thin sections (sediment modification) and the inherently 2D view that a thin section affords. Non-destructive and rapid scanning technologies such as X-ray computed microtomography (μCT) enable material samples to be visualised and analysed in 3D. In a Quaternary context, however, such techniques are in their infancy. This paper assesses the optimum approach to μCT analysis of Quaternary sediments, applying the method on Lateglacial glaciolacustrine varves from Glen Roy, Scotland. Scan datasets are examined at each stage of the thin section process and comparisons are made between 2D μCT images and thin sections for the recognition of 2D sediment features, with further appraisal of 3D models to identify 3D sediment structures. Comparable sediment features are observed in 2D μCT images and thin sections, however, the μCT imaging resolution determines the precision of microfacies descriptions. Additional 3D structures are distinguished from volumetric models that are otherwise impossible to identify in thin section slides. These 3D structures can locally alter sediment properties (e.g. layer thickness) as seen in 2D thin sections and/or digital images, although such variation cannot be detected with these media. It has been demonstrated that clear benefits exist in understanding the 3D structure of Quaternary sediments, both prior to thin-sectioning to avoid complicating (e.g. deformation) structures, and after thin-sectioning to establish the complex 3D context of 2D datasets. It is recommended that μCT and thin section techniques are applied in parallel in future studies, which will profit from the integration of 'true' 3D data. It is also advised that samples are scanned soon after field sampling, due to the significant modification of in situ sediment structures that can occur during thin section processing.

  8. Generalized warping effect in the dynamic analysis of beams of arbitrary cross section

    NASA Astrophysics Data System (ADS)

    Dikaros, I. C.; Sapountzakis, E. J.; Argyridi, A. K.

    2016-05-01

    In this paper a general formulation for the nonuniform warping dynamic analysis of beams of arbitrary simply or multiply connected cross section, under arbitrary external loading and general boundary conditions is presented taking into account the effects of rotary and warping inertia. The nonuniform warping distributions are taken into account by employing four independent warping parameters multiplying a shear warping function in each direction and two torsional warping functions, respectively, which are obtained by solving the corresponding boundary value problems, formulated exploiting the longitudinal local equilibrium equation. A shear stress "correction" is also performed in order to improve the stress field arising from the employed kinematical considerations. Ten initial boundary value problems are formulated with respect to the displacement and rotation components as well as to the independent warping parameters and solved using the Analog Equation Method, a Boundary Element Method based technique in combination with an appropriate time integration scheme. The warping functions and the geometric constants including the additional ones due to warping are evaluated employing a pure BEM approach.

  9. Numerical analysis of composite STEEL-CONCRETE SECTIONS using integral equation of Volterra

    NASA Astrophysics Data System (ADS)

    Partov, Doncho; Kantchev, Vesselin

    2011-09-01

    The paper presents analysis of the stress and deflections changes due to creep in statically determinate composite steel-concrete beam. The mathematical model involves the equation of equilibrium, compatibility and constitutive relationship, i.e. an elastic law for the steel part and an integral-type creep law of Boltzmann — Volterra for the concrete part. On the basis of the theory of the viscoelastic body of Arutyunian-Trost-Bažant for determining the redistribution of stresses in beam section between concrete plate and steel beam with respect to time "t", two independent Volterra integral equations of the second kind have been derived. Numerical method based on linear approximation of the singular kernal function in the integral equation is presented. Example with the model proposed is investigated. The creep functions is suggested by the model CEB MC90-99 and the "ACI 209R-92 model. The elastic modulus of concrete Ec(t) is assumed to be constant in time `t'. The obtained results from the both models are compared.

  10. Numerical analysis of composite STEEL-CONCRETE SECTIONS using integral equation of Volterra

    NASA Astrophysics Data System (ADS)

    Partov, Doncho; Kantchev, Vesselin

    2011-09-01

    The paper presents analysis of the stress and deflections changes due to creep in statically determinate composite steel-concrete beam. The mathematical model involves the equation of equilibrium, compatibility and constitutive relationship, i.e. an elastic law for the steel part and an integral-type creep law of Boltzmann — Volterra for the concrete part. On the basis of the theory of the viscoelastic body of Arutyunian-Trost-Bažant for determining the redistribution of stresses in beam section between concrete plate and steel beam with respect to time "t", two independent Volterra integral equations of the second kind have been derived. Numerical method based on linear approximation of the singular kernal function in the integral equation is presented. Example with the model proposed is investigated. The creep functions is suggested by the model CEB MC90-99 and the "ACI 209R-92 model. The elastic modulus of concrete E c (t) is assumed to be constant in time `t'. The obtained results from the both models are compared.

  11. A pooled cross-section analysis of the health care expenditures of the OECD countries.

    PubMed

    Gerdtham, U G; Søgaard, J; Jönsson, B; Andersson, F

    1992-01-01

    This paper has two purposes. The first, empirical purpose is to estimate and evaluate the effects of aggregate income, institutional and socio-demographic factors on health care expenditures in the OECD countries. The second purpose is methodological, and comprises assessment of temporal instability, the choice of functional form, and misspecification of the estimated relationships. Data compiled over three years (1974, 1980 and 1987) from 19 OECD countries are used in a pooled cross-section regression analysis. Like previous studies, this one concludes that aggregate income measured by Gross Domestic Product per capita is the statistically most important factor in cross-national variation in health care expenditures, and that the aggregate income elasticity exceeds one. However, the data analyzed in this study also show some evidence that public financing of health care services is associated with lower expenditures per capita, and that countries with fee for service as the dominant form of remuneration have higher expenditures. The examined relationships appear to be temporally stable over the three years except for upward shifts, and there is no indication of statistical misspecification. This does not necessarily imply a correct specification, and we do note the presence of measurement errors in some of the variables. Moreover, the selected log-linear functional form appears to be non-optimal according to a likelihood criterion, and is rejected against a quadratic form. Based on the analyses from this study the results do not appear to be sensitive to use of the quadratic form specification. PMID:10172496

  12. Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysis

    PubMed Central

    Hsia, Renee Y; Akosa Antwi, Yaa; Nath, Julia P

    2014-01-01

    Objectives To determine the variation in charges for 10 common blood tests across California hospitals in 2011, and to analyse the hospital and market-level factors that may explain any observed variation. Design, setting and participants We conducted a cross-sectional analysis of the degree of charge variation between hospitals for 10 common blood tests using charge data reported by all non-federal California hospitals to the California Office of Statewide Health Planning and Development in 2011. Outcome measures Charges for 10 common blood tests at California hospitals during 2011. Results We found that charges for blood tests varied significantly between California hospitals. For example, charges for a lipid panel ranged from US$10 to US$10 169, a thousand-fold difference. Although government hospitals and teaching hospitals were found to charge significantly less than their counterparts for many blood tests, few other hospital characteristics and no market-level predictors significantly predicted charges for blood tests. Our models explained, at most, 21% of the variation between hospitals in charges for the blood test in question. Conclusions These findings demonstrate the seemingly arbitrary nature of the charge setting process, making it difficult for patients to act as true consumers in this era of ‘consumer-directed healthcare.’ PMID:25127708

  13. Aloe Vera Gel and Cesarean Wound Healing; A Randomized Controlled Clinical Trial

    PubMed Central

    Molazem, Zahra; Mohseni, Fatemeh; Younesi, Masoumeh; Keshavarzi, Sareh

    2015-01-01

    Background: Failure in complete healing of the wound is one of the probable complications of cesarean. The present study aimed to determine the effectiveness of dressing with aloe vera gel in healing of cesarean wound. Methods: This prospective randomized double-blind clinical trial was conducted on 90 women who had undergone cesarean operation in Amir-al-Momenin hospital (Gerash, Iran). The participants were randomly divided into two groups each containing 45 patients. In one group, the wound was dressed with aloe vera gel, while simple dressing was used in the control group. Wound healing was assessed 24 hours and 8 days after the cesarean operation using REEDA scale. The data were analyzed through Chi-square and t-test. Results: The participants’ mean age was 27.56±4.20 in the aloe vera group and 26.62±4.88 in the control group, but the difference was not statistically significant. However, a significant difference was found between the two groups concerning body mass index, heart rate, and systolic blood pressure (P<0.05). Also, a significant difference was observed between the two groups with respect to the wound healing score 24 hours after the operation (P=0.003). After 8 days, however, the difference in the wound healing score was not significant (P=0.283). Overall, 45 participants in the aloe vera group and 35 ones in the control group had obtained a zero score 24 hours after the operation. These measures were respectively obtained as 42 and 41eight days after the operation. Conclusion: According to the findings of this study, the women are recommended to be informed regarding the positive effects of dressing with aloe vera gel. PMID:25560349

  14. Safe Prevention of the Primary Cesarean Delivery: ACOG and SMFM Change the Game

    PubMed Central

    Lothian, Judith A.

    2014-01-01

    Safe Prevention of the Primary Cesarean Delivery, a joint statement of the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, changes the rules of maternity care management. The statement reviews the research and uses the findings to make practice recommendations. This article discusses the major recommendations and their importance in decreasing risk and increasing safety for mothers and babies. The articles in the current issue of the journal are also reviewed.

  15. Anesthetic Management Guided by Transthoracic Echocardiography During Cesarean Delivery Complicated by Hypertrophic Cardiomyopathy.

    PubMed

    DesRoches, Jaclyn M; McKeen, Dolores Madeline; Warren, Andrew; Allen, Victoria M; George, Ronald B; Kells, Catherine; Shukla, Romesh

    2016-03-15

    We describe the management of a parturient woman with hypertrophic cardiomyopathy who developed a symptomatic accelerated idioventricular rhythm who required an urgent cesarean delivery at 32 weeks. Transthoracic echocardiography helped guide anesthetic management, including epidural dosing, fluid management, and phenylephrine infusion rates. This case demonstrates the application of transthoracic echocardiography to guide anesthetic management in a parturient woman at risk for cardiovascular compromise. PMID:26720049

  16. Biopharmaceuticals and monoclonal antibodies in oncology trials--a cross-sectional analysis.

    PubMed

    Janowitz, T

    2011-01-01

    intervention in cancer trials (14%) compared with trials in non-cancer conditions (6%). Further subgroup analysis based on the 20 cancer subtypes with the highest mortality revealed that biological therapeutics comprise 43% in malignant melanoma trials and more than 20% in five other cancer types. Two-thirds of all monoclonal antibody are registered in cancer trials (1033, 4.6% of all cancer trials). The subgroup analysis demonstrated a predominance of lymphoma and leukaemia trials for antibody interventions, with 204 and 163 trials registered, respectively. In non-cancer conditions only 503 (0.9%) trials investigate monoclonal antibody interventions. A retrospective longitudinal analysis of the trials demonstrated that monoclonal antibody trials are increasingly frequently registered in non-cancer as well as cancer conditions. However, biopharmaceutical trials continue to be registered more frequently only in non-cancer conditions, but have come to a plateau in cancers. This study is limited by analysis of data from one database only. While the NIH Clinical Trials Database used is the most comprehensive and internationally recognised of its kind, it is possible that the results may have been modified if other databases were also included. Protein engineering has paved the way for biopharmaceutical clinical interventions. A cross-sectional analysis of trials registered on the NIH Clinical Trial Database shows that biological interventions are increasingly entered into clinical trials. While oncological diseases used to lead this effort, biotherapeutic trials in non-cancer conditions have now become more frequent in comparison. Monoclonal antibodies, however, are still mainly investigated in oncological conditions. Haemato-oncological diseases are most frequently investigated for mAb interventions, although they are not among the eight most common causes of cancer mortality. This may reflect the fact that pre-clinical research, understanding of molecular mechanisms and target

  17. Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery.

    PubMed

    Kim, Eun Soo; Kim, Hae Kyu; Baik, Ji Seok; Ji, Young Tae

    2016-07-01

    Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants. PMID:27413486

  18. Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery

    PubMed Central

    Kim, Eun Soo; Baik, Ji Seok; Ji, Young Tae

    2016-01-01

    Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants. PMID:27413486

  19. Adding Sufentanil to TAP Block Hyperbaric Bupivacaine Decreases Post-Cesarean Delivery Morphine Consumption.

    PubMed

    Eslamian, Laleh; Kabiri-Nasab, Motahareh; Agha-Husseini, Marzieh; Azimaraghi, Omid; Barzin, Gilda; Movafegh, Ali

    2016-03-01

    Pain management is crucially important in the postoperative period as it increases patient comfort and satisfaction. The primary outcome of present study was to evaluate the effect of sufentanil added to hyperbaric bupivacaine solution 0.25% in transversus abdominis plane (TAP) block, on postoperative analgesic consumption. Fifty ASA physical status I-II term primiparous single-tone pregnant women aged 20-40 years scheduled for elective cesarean delivery with Pfannenstiel incision under general anaesthesia were enrolled in this randomized, double-blind, placebo-controlled trial. Ultrasound guided TAP block was performed at the end of surgery. Patients were randomly enrolled into two groups. Patients in the study group received 20 ml of hyperbaric bupivacaine 0.25% plus 1mL of sufentanil on either side while patients in the placebo group were administered 20 ml of hyperbaric bupivacaine 0.25% along with 1mL of placebo. Post-cesarean delivery visual analogue scale (VAS) for pain and morphine usage were measured and recorded. The morphine consumption was significantly less in the study group (37.2 ± 16.1 mg) than the control group (52.8 ± 16.7 mg, P =0.002).The VAS for pain both in rest and coughing were same in groups. Sufentanil added to 0.25% hyperbaric bupivacaine in TAP block decreases post cesarean delivery morphine consumption. PMID:27107523

  20. Functional mitochondrial analysis in acute brain sections from adult rats reveals mitochondrial dysfunction in a rat model of migraine

    PubMed Central

    Fried, Nathan T.; Moffat, Cynthia; Seifert, Erin L.

    2014-01-01

    Mitochondrial dysfunction has been implicated in many neurological disorders that only develop or are much more severe in adults, yet no methodology exists that allows for medium-throughput functional mitochondrial analysis of brain sections from adult animals. We developed a technique for quantifying mitochondrial respiration in acutely isolated adult rat brain sections with the Seahorse XF Analyzer. Evaluating a range of conditions made quantifying mitochondrial function from acutely derived adult brain sections from the cortex, cerebellum, and trigeminal nucleus caudalis possible. Optimization of this technique demonstrated that the ideal section size was 1 mm wide. We found that sectioning brains at physiological temperatures was necessary for consistent metabolic analysis of trigeminal nucleus caudalis sections. Oxygen consumption in these sections was highly coupled to ATP synthesis, had robust spare respiratory capacities, and had limited nonmitochondrial respiration, all indicative of healthy tissue. We demonstrate the effectiveness of this technique by identifying a decreased spare respiratory capacity in the trigeminal nucleus caudalis of a rat model of chronic migraine, a neurological disorder that has been associated with mitochondrial dysfunction. This technique allows for 24 acutely isolated sections from multiple brain regions of a single adult rat to be analyzed simultaneously with four sequential drug treatments, greatly advancing the ability to study mitochondrial physiology in adult neurological disorders. PMID:25252946

  1. Correlation analysis of optical absorption cross section and rate coefficient measurements in reacting systems

    SciTech Connect

    Hessler, J.P.; Ogren, P.J.

    1992-08-31

    A technique was developed for determining relative importance and correlation between reactions making up a complex kinetic system. This technique was used to investigate measurements of optical absorption cross sections and the correlation between cross sections and measured rate coefficients. It is concluded that (1) species, initial conditions, and temporal regions may be identified where cross sections may be measured without interference from the kinetic behavior of the observed species and (2) experiments designed to measure rate coefficients will always be correlated with the absorption cross section of the observed species. This correlation may reduce the accuracy of rate coefficient measurements.

  2. Evaluation of the COPD Assessment Test and GOLD patient types: a cross-sectional analysis

    PubMed Central

    Lopez-Campos, Jose Luis; Fernandez-Villar, Alberto; Calero-Acuña, Carmen; Represas-Represas, Cristina; Lopez-Ramírez, Cecilia; Fernández, Virginia Leiro; Soler-Cataluña, Juan Jose; Casamor, Ricard

    2015-01-01

    Background The COPD Assessment Test (CAT) has been recently developed to quantify COPD impact in routine practice. However, no relationship with other measures in the Global Initiative for Obstructive Lung Disease (GOLD) strategy has been evaluated. The present study aimed to evaluate the relationship of the CAT with other GOLD multidimensional axes, patient types, and the number of comorbidities. Methods This was a cross-sectional analysis of the Clinical presentation, diagnosis, and course of chronic obstructive pulmonary disease (On-Sint) study. The CAT score was administered to all participants at the inclusion visit. A GOLD 2011 strategy consisting of modified Medical Research Council scale (MRC) scores was devised to study the relationship between the CAT, and GOLD 2011 axes and patient types. The relationship with comorbidities was assessed using the Charlson comorbidity index, grouped as zero, one to two, and three or more. Results The CAT questionnaire was completed by 1,212 patients with COPD. The CAT maintained a relationship with all the three axes, with a ceiling effect for dyspnea and no distinction between mild and moderate functional impairment. The CAT score increased across GOLD 2011 patient types A–D, with similar scores for types B and C. Within each GOLD 2011 patient type, there was a considerably wide distribution of CAT values. Conclusion Our study indicates a correlation between CAT and the GOLD 2011 classification axes as well as the number of comorbidities. The CAT score can help clinicians, as a complementary tool to evaluate patients with COPD within the different GOLD patient types. PMID:26064045

  3. Molecular Structures and Ion Mobility Cross Sections: Analysis of the Effects of He and N2 Buffer Gas.

    PubMed

    Bleiholder, Christian; Johnson, Nicholas R; Contreras, Stephanie; Wyttenbach, Thomas; Bowers, Michael T

    2015-07-21

    An empirically observed correlation between ion mobility cross sections in helium and nitrogen buffer gases was examined as a function of temperature, molecular size, and shape. Experimental cross sections were determined for tetraglycine, bradykinin, angiotensin 2, melittin, and ubiquitin at 300 K and in the range from 80 to 550 K on home-built instruments and calculated by the projection superposition approximation (PSA) method. The PSA was also used to predict cross sections for larger systems such as human pancreatic alpha-amylase, concanavalin, Pichia pastoris lysyl oxidase, and Klebsiella pneumoniae acetolactate synthase. The data show that the ratio of cross sections in helium and nitrogen depends significantly on the temperature of the buffer gas as well as the size and shape of the analyte ion. Therefore, the analysis of the data indicates that a simple formula that seeks to quantitatively relate the momentum transfer cross sections observed in two distinct buffer gases lacks a sound physical basis. PMID:26076363

  4. High contrast and homogeneous staining of paraffin sections of whole human brains for three dimensional ultrahigh resolution image analysis.

    PubMed

    Schmitt, O; Eggers, R

    1998-01-01

    The gallocyanin chromalum stain belongs to the classical DNA-RNA staining techniques in histochemistry. It has some important features for successful object orientated image analysis of whole sections of the human brain. To obtain reproducible staining results with these large sections, the method of Einarson was adapted to image analytical requirements. We discuss staining in a warm staining solution, pH adjustment, and optimal stain composition. The embedding procedure for whole human brains is considered as well. PMID:9554583

  5. Automated image analysis applied to the odontoblast-predentine region in undemineralized sections of human permanent third molars.

    PubMed

    Bjørndal, L; Darvann, T; Bro-Nielsen, M; Larsen, R; Thylstrup, A

    1997-04-01

    A computerized histomorphometric analysis was made by Karnovsky-fixed, hydroxethylmethacrylate embedded and toluidine blue/pyronin-stained sections to determine: (1) the two-dimensional size of the coronal odontoblasts given by their cytoplasm:nucleus ratio; (2) the ratio between the number of coronal odontoblasts and dentinal tubules; and (3) the relation between odontoblast size and adjacent predentine. All conditions were measured in relation to three well-defined sectioning profiles of the dentinal tubules. The sections were randomly taken from 10 unerupted and erupted third-molar crowns. Sixty-three photomicrographs (x100), equally distributed among the three sectioning profiles, were scanned in a high-resolution scanner to produce images for the analysis. After initial user interaction for the description of training classes on one image, an automatic segmentation of the images with respect to odontoblast cell nuclei, cytoplasm and background was computed by statistical discriminant analysis. In longitudinal profiles of the dentinal tubules the cytoplasm:nucleus ratio in erupted teeth was 3.1 +/- 0.54, and the mean of the odontoblast cell:dentinal tubule ration was 1.19 +/- 0.20. Analysis of cytoplasm:nucleus ratio and the adjacent predentine in relation to the chosen sectioning profiles disclosed that there was less variation in the predentine measurements in the longitudinal sections. Thus, in future two-dimensional studies of the odontoblast-predentine region only longitudinal sectioning profiles should be analysed. The use of advanced image processing on undemineralized tooth sections provides a rational foundation for further work on the reactions of the odontoblasts to external injuries including dental caries. PMID:9222453

  6. Prevalence of Smokeless Tobacco among Low Socioeconomic Populations: A Cross-Sectional Analysis

    PubMed Central

    Azam, Mohammad Nurul; Shahjahan, Mohammad; Yeasmin, Mahbuba; Ahmed, Nasar U.

    2016-01-01

    Background Cost, social acceptability and non-stringent regulations pertaining to smokeless tobacco (SLT) product sales have made people choose and continue using SLT. If disaggregated data on smokeless forms and smoked practices of tobacco are reviewed, the incidence of SLT remains static. There is a strong positive correlation of SLT intake with the occurrence of adverse cardiovascular disease, particularly in the low socioeconomic populations. Aims To investigate the prevalence of smokeless tobacco, its initiation influence and risk factors associated with the practice among lower socioeconomic populations of Bangladesh. In this study, we explore the utilization of SLT among lower socioeconomic populations in industrialized zone of Bangladesh. Methods A cross-sectional analysis using both quantitative and categorical approaches was employed. Using systematic random sampling method, four focus group discussions (FGDs) were conducted and 459 participants were interviewed. Multiple logistic regression model was applied to distinguish the significant factors among the SLT users. Results Almost fifty percent of the respondents initiated SLT usage at the age of 15–24 years and another 22 percent respondents were smoking and using SLT concurrently. The bulk of the women respondents used SLT during their pregnancy. Nearly twenty five percent of the respondents tried to quit the practice of SLT and one-quarter had a plan to quit SLT in the future. More than twenty percent respondents were suffering from dental decay. A noteworthy correlation was found by gender (p<0.01), sufferings from SLT related disease (p<0.05). The multiple logistic regression analysis suggested that, males were 2.7 times more knowledgeable than that of females (p<0.01) about the adversative health condition of SLT usage. The respondents suffering from SLT related diseases were 3.7 times as more knowledgeable about the effect of the practice of SLT than the respondents without diseases (p<0

  7. Publication and reporting of clinical trial results: cross sectional analysis across academic medical centers

    PubMed Central

    Chen, Ruijun; Desai, Nihar R; Ross, Joseph S; Zhang, Weiwei; Chau, Katherine H; Wayda, Brian; Murugiah, Karthik; Lu, Daniel Y; Mittal, Amit

    2016-01-01

    Objective To determine rates of publication and reporting of results within two years for all completed clinical trials registered in ClinicalTrials.gov across leading academic medical centers in the United States. Design Cross sectional analysis. Setting Academic medical centers in the United States. Participants Academic medical centers with 40 or more completed interventional trials registered on ClinicalTrials.gov. Methods Using the Aggregate Analysis of ClinicalTrials.gov database and manual review, we identified all interventional clinical trials registered on ClinicalTrials.gov with a primary completion date between October 2007 and September 2010 and with a lead investigator affiliated with an academic medical center. Main outcome measures The proportion of trials that disseminated results, defined as publication or reporting of results on ClinicalTrials.gov, overall and within 24 months of study completion. Results We identified 4347 interventional clinical trials across 51 academic medical centers. Among the trials, 1005 (23%) enrolled more than 100 patients, 1216 (28%) were double blind, and 2169 (50%) were phase II through IV. Overall, academic medical centers disseminated results for 2892 (66%) trials, with 1560 (35.9%) achieving this within 24 months of study completion. The proportion of clinical trials with results disseminated within 24 months of study completion ranged from 16.2% (6/37) to 55.3% (57/103) across academic medical centers. The proportion of clinical trials published within 24 months of study completion ranged from 10.8% (4/37) to 40.3% (31/77) across academic medical centers, whereas results reporting on ClinicalTrials.gov ranged from 1.6% (2/122) to 40.7% (72/177). Conclusions Despite the ethical mandate and expressed values and mission of academic institutions, there is poor performance and noticeable variation in the dissemination of clinical trial results across leading academic medical centers. PMID:26888209

  8. Essential Indicators Identifying Chronic Inorganic Mercury Intoxication: Pooled Analysis across Multiple Cross-Sectional Studies

    PubMed Central

    Doering, Stefan

    2016-01-01

    Background The continuous exposure to inorganic mercury vapour in artisanal small-scale gold mining (ASGM) areas leads to chronic health problems. It is therefore essential to have a quick, but reliable risk assessing tool to diagnose chronic inorganic mercury intoxication. This study re-evaluates the state-of-the-art toolkit to diagnose chronic inorganic mercury intoxication by analysing data from multiple pooled cross-sectional studies. The primary research question aims to reduce the currently used set of indicators without affecting essentially the capability to diagnose chronic inorganic mercury intoxication. In addition, a sensitivity analysis is performed on established biomonitoring exposure limits for mercury in blood, hair, urine and urine adjusted by creatinine, where the biomonitoring exposure limits are compared to thresholds most associated with chronic inorganic mercury intoxication in artisanal small-scale gold mining. Methods Health data from miners and community members in Indonesia, Tanzania and Zimbabwe were obtained as part of the Global Mercury Project and pooled into one dataset together with their biomarkers mercury in urine, blood and hair. The individual prognostic impact of the indicators on the diagnosis of mercury intoxication is quantified using logistic regression models. The selection is performed by a stepwise forward/backward selection. Different models are compared based on the Bayesian information criterion (BIC) and Cohen`s kappa is used to evaluate the level of agreement between the diagnosis of mercury intoxication based on the currently used set of indicators and the result based on our reduced set of indicators. The sensitivity analysis of biomarker exposure limits of mercury is based on a sequence of chi square tests. Results The variable selection in logistic regression reduced the number of medical indicators from thirteen to ten in addition to the biomarkers. The estimated level of agreement using ten of thirteen medical

  9. Community factors affecting rising caesarean section rates in developing countries: an analysis of six countries.

    PubMed

    Leone, Tiziana; Padmadas, Sabu S; Matthews, Zoë

    2008-10-01

    Caesarean section rates have risen dramatically in several developing countries, especially in Latin America and South Asia. This raises a range of concerns about the use of caesarean section for non-emergency cases, not least the progressive shift of resources to non-essential medical interventions in resource-poor settings and additional health risks to mothers and newborns following a caesarean section. There are only a few studies that have systematically examined the factors influencing the recent increase in caesarean rates. In particular, it is not clear whether high elective caesarean rates are driven by medical, institutional or individual and family decisions. Where a woman's decisions predominate her interaction with peers and significant others have an impact on her caesarean section choices. Using random intercept logistic regression analyses, this paper analyses the institutional, socio-economic and community factors that influence caesarean section in six countries: Bangladesh, Colombia, Dominican Republic, Egypt, Morocco and Vietnam. The analyses, based on data from over 20,000 births, show that women of higher socio-economic background, who had better access to antenatal services are the most likely to undergo a caesarean section. Women who exchange reproductive health information with friends and family are less likely to experience a caesarean section than their counterparts. The study concludes that there is a need to pursue community-based approaches for curbing rising caesarean section rates in resource-poor settings. PMID:18657345

  10. Numerical analysis of combustion characteristics of hybrid rocket motor with multi-section swirl injection

    NASA Astrophysics Data System (ADS)

    Li, Chengen; Cai, Guobiao; Tian, Hui

    2016-06-01

    This paper is aimed to analyse the combustion characteristics of hybrid rocket motor with multi-section swirl injection by simulating the combustion flow field. Numerical combustion flow field and combustion performance parameters are obtained through three-dimensional numerical simulations based on a steady numerical model proposed in this paper. The hybrid rocket motor adopts 98% hydrogen peroxide and polyethylene as the propellants. Multiple injection sections are set along the axis of the solid fuel grain, and the oxidizer enters the combustion chamber by means of tangential injection via the injector ports in the injection sections. Simulation results indicate that the combustion flow field structure of the hybrid rocket motor could be improved by multi-section swirl injection method. The transformation of the combustion flow field can greatly increase the fuel regression rate and the combustion efficiency. The average fuel regression rate of the motor with multi-section swirl injection is improved by 8.37 times compared with that of the motor with conventional head-end irrotational injection. The combustion efficiency is increased to 95.73%. Besides, the simulation results also indicate that (1) the additional injection sections can increase the fuel regression rate and the combustion efficiency; (2) the upstream offset of the injection sections reduces the combustion efficiency; and (3) the fuel regression rate and the combustion efficiency decrease with the reduction of the number of injector ports in each injection section.

  11. Section 504 Compliance in Missouri School Districts: A Problem-Based Discrepancy Analysis

    ERIC Educational Resources Information Center

    Wilson, Suzanne; Steffes, Terri; Spurgin, Armand

    2013-01-01

    This report describes a problem based learning project focusing on Section 504 Compliance in the State of Missouri. Additionally it provides information about Superintendent's perceptions and levels of knowledge about Section 504 compliance in their districts. The project team sought to learn and understand the historical timeline of legislation…

  12. Single copy nuclear gene analysis of polyploidy in wild potatoes (Solanum section Petota)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Recent genomic studies have drastically altered our knowledge of polyploid evolution. Wild potatoes (Solanum section Petota) are a highly diverse and economically important group of about 100 species widely distributed throughout the Americas. Thirty-six percent of the species in section Petota are ...

  13. FTR Set 500: a multigroup cross-section set for FTR analysis

    SciTech Connect

    Mann, F M

    1982-02-01

    FTR Set 500 is a 53-neutron-group, 20-photon-group, cross-section set based on ENDF/B-V cross sections and neutron spectra typical of the Fast Test Reactor (FTR). This report describes the specifications and processing of Set 500 and provides one-group values of this set for use in limited FTR analyses.

  14. Capture cross section measurement analysis in the Californium-252 spectrum with the Monte Carlo method.

    PubMed

    Manojlovič, Stanko; Trkov, Andrej; Žerovnik, Gašper; Snoj, Luka

    2015-07-01

    Absolute average capture cross sections of gold, thorium, tantalum, molybdenum, copper and strontium in (252)Cf spontaneous fission neutron spectrum were simulated for two types of experiment setups preformed by Z. Dezso and J. Csikai and by L. Green. The experiments were simulated with MCNP5 using cross section data from the ENDF/B-VII.0 library. The determination of neutron backscattering was calculated with the use of neutron flagging. Correction factors to experimentally measured values were determined to obtain average cross sections in a pure (252)Cf spontaneous fission spectrum. Influence of concrete wall thickness, air moisture and room size on the average cross section was analyzed. Correction factors amounted to about 30%. Corrected values corresponding to average cross sections in a pure (252)Cf spectrum were calculated for (197)Au, (232)Th, (181)Ta, (98)Mo, (65)Cu and (84)Sr. Average cross sections were also calculated with the RR_UNC software using IRDFF-v.1.05 and ENDF/B-VII.0 libraries. The revised average radiative capture cross sections are 75.5±0.1 mb for (197)Au, 87.0±1.6 mb for (232)Th , 98.0±4.5 mb for (181)Ta, 21.2±0.5 mb for (98)Mo, 10.3±0.3 mb for (63)Cu, and 34.9±6.5 mb for (84)Sr. PMID:25880611

  15. Preliminary Analysis of the Jobs and Economic Impacts of Renewable Energy Projects Supported by the ..Section..1603 Treasury Grant Program

    SciTech Connect

    Steinberg, D.; Porro, G.; Goldberg, M.

    2012-04-01

    This analysis responds to a request from the Department of Energy Office of Energy Efficiency and Renewable Energy to the National Renewable Energy Laboratory (NREL) to estimate the direct and indirect jobs and economic impacts of projects supported by the Section 1603 Treasury grant program. The analysis employs the Jobs and Economic Development Impacts (JEDI) models to estimate the gross jobs, earnings, and economic output supported by the construction and operation of the large wind (greater than 1 MW) and solar photovoltaic (PV) projects funded by the Section 1603 grant program.

  16. An analysis of the load-bearing capacity of members of square cross section with a series of perpendicular notches

    NASA Astrophysics Data System (ADS)

    Miastkowski, Jozef; Szczebiot, Ryszard

    The authors analyze the load-bearing capacity of structural members with square cross sections which have been weakened on their perimeters by a series of perpendicular notches. The analysis is based on complete solutions for axisymmetric bars with perpendicular notches and estimates of load-bearing capacity obtained from kinematically acceptable failure mechanisms. A procedure for determining the optimal distance (spacing) between the notches in the case of bars weakened by a series of perpendicular notches is described. The practical value of the analysis presented was confirmed by the results of experiments conducted on aluminum alloy test pieces of square cross section for plastic working weakened by two peripheral perpendicular notches.

  17. Cross-section Effects in the Super-Kamiokande Tau Appearance Analysis

    SciTech Connect

    Walter, Christopher

    2011-11-23

    In this talk, I explain the search for tau neutrino appearance in the atmospheric neutrino flux at Super-Kamiokande with a particular emphasis on the effect deep inelastic cross section uncertainties have on interpreting the result. In particular, I explain why the normalization of the DIS cross-section also needs to be treated as a parameter in the fit of tau normalization, and show how a neural net based on event parameters can separate various cross-section modes in the background sample.

  18. Semi-Automated Atlas-based Analysis of Brain Histological Sections

    PubMed Central

    Kopec, Charles D.; Bowers, Amanda C.; Pai, Shraddha; Brody, Carlos D.

    2011-01-01

    Quantifying the location and/or number of features in a histological section of the brain currently requires one to first, manually register a corresponding section from a tissue atlas onto the experimental section and second, count the features. No automated method exists for the first process (registering), and most automated methods for the second process (feature counting) operate reliably only in a high signal-to-noise regime. To reduce experimenter bias and inconsistencies and increase the speed of these analyses, we developed Atlas Fitter, a semi-automated, open-source MatLab-based software package that assists in rapidly registering atlas panels onto histological sections. We also developed CellCounter, a novel fully-automated cell counting algorithm that is designed to operate on images with non-uniform background intensities and low signal-to-noise ratios. PMID:21194546

  19. Analysis of the influence of MOS device geometry on predicted SEU cross sections

    SciTech Connect

    Warren, K.; Massengill, L.; Schrimpf, R.; Barnaby, H.

    1999-12-01

    An investigation into the single-event sensitive area geometry of a body-tied-to-source (BTS) SOI nMOS transistor has been performed through a novel simulation technique. Results are presented which demonstrate the influence of spatial variations in charge collection efficiency on the shape of the predicted upset cross section curve. Observations are made on a technique for inferring sensitive area or intra-cell collection efficiencies from cross section data.

  20. Observational intensity bias associated with illness adjustment: cross sectional analysis of insurance claims

    PubMed Central

    Staiger, Douglas O; Sharp, Sandra M; Gottlieb, Daniel J; Bevan, Gwyn; McPherson, Klim; Welch, H Gilbert

    2013-01-01

    Objective To determine the bias associated with frequency of visits by physicians in adjusting for illness, using diagnoses recorded in administrative databases. Setting Claims data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design Cross sectional analysis. Participants 20% sample of fee for service Medicare beneficiaries residing in the United States in 2007 (n=5 153 877). Main outcome measures The effect of illness adjustment on regional mortality and spending rates using standard and visit corrected illness methods for adjustment. The standard method adjusts using comorbidity measures based on diagnoses listed in administrative databases; the modified method corrects these measures for the frequency of visits by physicians. Three conventions for measuring comorbidity are used: the Charlson comorbidity index, Iezzoni chronic conditions, and hierarchical condition categories risk scores. Results The visit corrected Charlson comorbidity index explained more of the variation in age, sex, and race mortality across the 306 hospital referral regions than did the standard index (R2=0.21 v 0.11, P<0.001) and, compared with sex and race adjusted mortality, reduced regional variation, whereas adjustment using the standard Charlson comorbidity index increased it. Although visit corrected and age, sex, and race adjusted mortality rates were similar in hospital referral regions with the highest and lowest fifths of visits, adjustment using the standard index resulted in a rate that was 18% lower in the highest fifth (46.4 v 56.3 deaths per 1000, P<0.001). Age, sex, and race adjusted spending as well as visit corrected spending was more than 30% greater in the highest fifth of visits than in the lowest fifth, but only 12% greater after adjustment using the standard index. Similar results were obtained using the Iezzoni and the hierarchical condition categories conventions for measuring comorbidity. Conclusion The

  1. Personal Health Record Reach in the Veterans Health Administration: A Cross-Sectional Analysis

    PubMed Central

    Brandt, Cynthia A; Feng, Hua; McInnes, D Keith; Rao, Sowmya R; Rothendler, James A; Haggstrom, David A; Abel, Erica A; Cioffari, Lisa S; Houston, Thomas K

    2014-01-01

    Background My HealtheVet (MHV) is the personal health record and patient portal developed by the United States Veterans Health Administration (VA). While millions of American veterans have registered for MHV, little is known about how a patient’s health status may affect adoption and use of the personal health record. Objective Our aim was to characterize the reach of the VA personal health record by clinical condition. Methods This was a cross-sectional analysis of all veterans nationwide with at least one inpatient admission or two outpatient visits between April 2010 and March 2012. We compared adoption (registration, authentication, opt-in to use secure messaging) and use (prescription refill and secure messaging) of MHV in April 2012 across 18 specific clinical conditions prevalent in and of high priority to the VA. We calculated predicted probabilities of adoption by condition using multivariable logistic regression models adjusting for sociodemographics, comorbidities, and clustering of patients within facilities. Results Among 6,012,875 veterans, 6.20% were women, 61.45% were Caucasian, and 26.31% resided in rural areas. The mean age was 63.3 years. Nationwide, 18.64% had registered for MHV, 11.06% refilled prescriptions via MHV, and 1.91% used secure messaging with their clinical providers. Results from the multivariable regression suggest that patients with HIV, hyperlipidemia, and spinal cord injury had the highest predicted probabilities of adoption, whereas those with schizophrenia/schizoaffective disorder, alcohol or drug abuse, and stroke had the lowest. Variation was observed across diagnoses in actual (unadjusted) adoption and use, with registration rates ranging from 29.19% of patients with traumatic brain injury to 14.18% of those with schizophrenia/schizoaffective disorder. Some of the variation in actual reach can be explained by facility-level differences in MHV adoption and by differences in patients’ sociodemographic characteristics (eg

  2. Transport model based on three-dimensional cross-section generation for TRIGA core analysis

    NASA Astrophysics Data System (ADS)

    Kriangchaiporn, Nateekool

    This dissertation addresses the development of a reactor core physics model based on 3-D transport methodology utilizing 3-D multigroup fuel lattice cross-section generation and core calculation for PSBR. The proposed 3-D transport calculation scheme for reactor core simulations is based on the TORT code. The methodology includes development of algorithms for 2-D and 3-D cross-section generation. The fine- and broad-group structures for the TRIGA cross-section generation problems were developed based on the CPXSD (Contributon and Point-wise Cross-Section Driven) methodology that selects effective group structure. Along with the study of cross section generation, the parametric studies for SN calculations were performed to evaluate the impact of the spatial meshing, angular, and scattering order variables and to obtain the suitable values for cross-section collapsing of the TRIGA cell problem. The TRIGA core loading 2 is used to verify and validate the selected effective group structures. Finally, the 13 group structure was selected to use for core calculations. The results agree with continuous energy for eigenvalues and normalized pin power distribution. The Monte Carlo solutions are used as the references.

  3. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

    PubMed Central

    2014-01-01

    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  4. Measurement of the D ∗± cross section using a soft-pion analysis in two-photon processes

    NASA Astrophysics Data System (ADS)

    Enomoto, R.; Abe, K.; Abe, T.; Adachi, I.; Aoki, M.; Aoki, M.; Awa, S.; Belusevic, R.; Emi, K.; Fujii, H.; Fujii, K.; Fujii, T.; Fujimoto, J.; Fujita, K.; Fujiwara, N.; Hayashii, H.; Howell, B.; Iida, N.; Ikeda, H.; Itoh, R.; Iwasaki, H.; Iwasaki, M.; Kajikawa, R.; Kaneyuki, K.; Kato, S.; Kawabata, S.; Kichimi, H.; Kobayashi, M.; Koltick, D.; Levine, I.; Minami, S.; Miyabayashi, K.; Miyamoto, A.; Muramatsu, K.; Nagai, K.; Nagira, T.; Nakano, E.; Nakabayashi, K.; Nitoh, O.; Noguchi, S.; Ochiai, F.; Ohnishi, Y.; Okuno, H.; Okusawa, T.; Shimozawa, K.; Shinohara, T.; Sugiyama, A.; Sugiyama, N.; Suzuki, S.; Takahashi, K.; Takahashi, T.; Takemoto, M.; Tanimori, T.; Tauchi, T.; Teramae, F.; Teramoto, Y.; Toomi, N.; Toyama, T.; Tsukamoto, T.; Uno, S.; Watanabe, T.; Watanabe, Y.; Yamaguchi, A.; Yamamoto, A.; Yamauchi, M.; Topaz Collaboration

    1994-06-01

    The differential cross section of {dσ(e +e - → e +e - D ∗± X) }/{dP T} was measured using a soft-pion analysis D ∗± → π s± D 0overline(D 0) at TRISTAN. The average s was 58.7 GeV and the integrated luminosity used in this analysis was 198 pb -, respectively.

  5. CFD-based numerical analysis of a variable cross-section cylinder

    NASA Astrophysics Data System (ADS)

    Duan, Jinlong; Huang, Weiping

    2014-08-01

    Using ANSYS-CFX, a general purpose fluid dynamics program, the vortex-induced vibration (VIV) of a variable cross-section cylinder is simulated under uniform current with high Reynolds numbers. Large eddy simulation (LES) is conducted for studying the fluid-structure interaction. The vortex shedding in the wake, the motion trajectories of a cylinder, the variation of drag and lift forces on the cylinder are analyzed. The results show that the vortices of variable cross-section cylinder are chaotic and are varying along the cylinder. In places where cross-sections are changing significantly, the vortices are more irregular. The motion trail of the cylinder is almost the same but irregular. The drag and lift coefficients of the cylinder are varying with the changes of diameters.

  6. Genetic diversity analysis in the section Caulorrhizae (genus Arachis) using microsatellite markers

    PubMed Central

    2010-01-01

    Diversity in 26 microsatellite loci from section Caulorrhizae germplasm was evaluated by using 33 accessions of A. pintoi Krapov. & W.C. Gregory and ten accessions of Arachis repens Handro. Twenty loci proved to be polymorphic and a total of 196 alleles were detected with an average of 9.8 alleles per locus. The variability found in those loci was greater than the variability found using morphological characters, seed storage proteins and RAPD markers previously used in this germplasm. The high potential of these markers to detect species-specific alleles and discriminate among accessions was demonstrated. The set of microsatellite primer pairs developed by our group for A. pintoi are useful molecular tools for evaluating Section Caulorrhizae germplasm, as well as that of species belonging to other Arachis sections. PMID:21637613

  7. Genetic diversity analysis in the section Caulorrhizae (genus Arachis) using microsatellite markers.

    PubMed

    Palmieri, Darío A; Bechara, Marcelo D; Curi, Rogério A; Monteiro, Jomar P; Valente, Sérgio E S; Gimenes, Marcos A; Lopes, Catalina R

    2010-01-01

    Diversity in 26 microsatellite loci from section Caulorrhizae germplasm was evaluated by using 33 accessions of A. pintoi Krapov. & W.C. Gregory and ten accessions of Arachis repens Handro. Twenty loci proved to be polymorphic and a total of 196 alleles were detected with an average of 9.8 alleles per locus. The variability found in those loci was greater than the variability found using morphological characters, seed storage proteins and RAPD markers previously used in this germplasm. The high potential of these markers to detect species-specific alleles and discriminate among accessions was demonstrated. The set of microsatellite primer pairs developed by our group for A. pintoi are useful molecular tools for evaluating Section Caulorrhizae germplasm, as well as that of species belonging to other Arachis sections. PMID:21637613

  8. Results Sections in Sociology and Organic Chemistry Articles: A Genre Analysis

    ERIC Educational Resources Information Center

    Bruce, Ian

    2009-01-01

    This paper reports a genre study of the Results sections of two samples of 20 research-reporting articles from two disciplines: sociology and organic chemistry. Following the proposal of Bhatia (2004) that genre knowledge needs to be investigated from two perspectives, an "ethnographic perspective" and a "textual perspective," the Results sections…

  9. Improving the Memory Sections of the Standardized Assessment of Concussion Using Item Analysis

    ERIC Educational Resources Information Center

    McElhiney, Danielle; Kang, Minsoo; Starkey, Chad; Ragan, Brian

    2014-01-01

    The purpose of the study was to improve the immediate and delayed memory sections of the Standardized Assessment of Concussion (SAC) by identifying a list of more psychometrically sound items (words). A total of 200 participants with no history of concussion in the previous six months (aged 19.60 ± 2.20 years; N?=?93 men, N?=?107 women)…

  10. An X-Ray Analysis Database of Photoionization Cross Sections Including Variable Ionization

    NASA Technical Reports Server (NTRS)

    Wang, Ping; Cohen, David H.; MacFarlane, Joseph J.; Cassinelli, Joseph P.

    1997-01-01

    Results of research efforts in the following areas are discussed: review of the major theoretical and experimental data of subshell photoionization cross sections and ionization edges of atomic ions to assess the accuracy of the data, and to compile the most reliable of these data in our own database; detailed atomic physics calculations to complement the database for all ions of 17 cosmically abundant elements; reconciling the data from various sources and our own calculations; and fitting cross sections with functional approximations and incorporating these functions into a compact computer code.Also, efforts included adapting an ionization equilibrium code, tabulating results, and incorporating them into the overall program and testing the code (both ionization equilibrium and opacity codes) with existing observational data. The background and scientific applications of this work are discussed. Atomic physics cross section models and calculations are described. Calculation results are compared with available experimental data and other theoretical data. The functional approximations used for fitting cross sections are outlined and applications of the database are discussed.

  11. A Cross-Sectional Multivariate Analysis of Children's Attitudes towards Disabilities

    ERIC Educational Resources Information Center

    Nowicki, E. A.

    2006-01-01

    Background: Past research has shown that children can be biased against peers with disabilities, but the association of attitudes with gender, age and disability preferences, as well as interactions between these variables, are unclear. The objectives of this study were to examine these issues in a cross-sectional, split-plot study to clarify: (1)…

  12. Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures.

    PubMed

    Armstrong, Joanne C; Kozhimannil, Katy B; McDermott, Patricia; Saade, George R; Srinivas, Sindhu K

    2016-02-01

    This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use. PMID:26593970

  13. A Journey to Zero: Reduction of Post-Operative Cesarean Surgical Site Infections over a Five-Year Period

    PubMed Central

    Hickson, Evelyn; Harris, Jeanette

    2015-01-01

    Abstract Background: Surgical site infections (SSI) are a substantial concern for cesarean deliveries in which a surgical site complication is most unwelcome for a mother with a new infant. Steps taken pre- and post-operatively to reduce the number of complications may be of substantial benefit clinically, economically, and psychologically. Methods: A risk-based approach to incision management was developed and implemented for all cesarean deliveries at our institution. A number of incremental interventions for low-risk and high-risk patients including pre-operative skin preparations, standardized pre- and post-operative protocols, post-operative nanocrystalline silver anti-microbial barrier dressings, and incisional negative pressure wound therapy (NPWT) were implemented sequentially over a 5-y period. A systematic clinical chart review of 4,942 patients spanning all cesarean deliveries between 2007–2012 was performed to determine what effects the interventions had on the rate of SSI for cesarean deliveries. Results: The percentage of SSI was reduced from 2.13% (2007) to 0.10% (2012) (p<0.0001). There were no substantial changes in the patient population risk factors over this time. As a result of the changes in incision management practice, a total of 92 cesarean post-operative SSIs were avoided: A total cost saving of nearly $5,000,000. Conclusion: Applying a clinical algorithm for assessing the risk of surgical site complication and making recommendations on pre-operative and post-operative incision management can result in a substantial and sustainable reduction in cesarean SSI. PMID:25826622

  14. Numerical analysis of flows of rarefied gases in long channels with octagonal cross section shapes

    SciTech Connect

    Szalmas, L.

    2014-12-09

    Isothermal, pressure driven rarefied gas flows through long channels with octagonal cross section shapes are analyzed computationally. The capillary is between inlet and outlet reservoirs. The cross section is constant along the axial direction. The boundary condition at the solid-gas interface is assumed to be diffuse reflection. Since the channel is long, the gaseous velocity is small compared to the average molecular speed. Consequently, a linearized description can be used. The flow is described by the linearized Bhatnagar-Gross-Krook kinetic model. The solution of the problem is divided into two stages. First, the local flow field is determined by assuming the local pressure gradient. Secondly, the global flow behavior is deduced by the consideration of the conservation of the mass along the axis of the capillary. The kinetic equation is solved by the discrete velocity method on the cross section. Both spatial and velocity spaces are discretized. A body fitted rectangular grid is used for the spatial space. Near the boundary, first-order, while in the interior part of the flow domain, second-order finite-differences are applied to approximate the spatial derivatives. This combination results into an efficient and straightforward numerical treatment. The velocity space is represented by a Gauss-Legendre quadrature. The kinetic equation is solved in an iterative manner. The local dimensionless flow rate is calculated and tabulated for a wide range of the gaseous rarefaction for octagonal cross sections with various geometrical parameters. It exhibits the Knudsen minimum phenomenon. The flow rates in the octagonal channel are compared to those through capillaries with circular and square cross sections. Typical velocity profiles are also shown. The mass flow rate and the distribution of the pressure are determined and presented for global pressure driven flows.

  15. Analysis of delamination in thick section composite materials using homogenized FE modeling

    NASA Astrophysics Data System (ADS)

    Lee, One-Chul

    Composite materials have various failure modes, which often coexist and interact. Interply delamination is the most frequently observed of these failure modes in laminated composite. Much previous research has been conducted to investigate the delamination phenomenon, often using computational mechanics approaches. The majority of the existing analytical models employ a zero thickness interface element to represent the delaminating interply region. This type of modeling requires explicit modeling of the delamination, which is not suitable for thick section composites. This type of modeling also introduces difficulties in predicting mode mixture. Two structural modeling approaches are proposed herein. The first one involves explicit modeling of the delamination crack, which is suitable for thin section composites. The second incorporates the delamination behavior into a homogenized constitutive model, which is appropriate for thick section composites. Both approaches utilize a nonlinear interface model with finite thickness, which models the resin rich interply zone explicitly. The thickness of the interface is treated as a constitutive parameter. An Elastic damaging model is adopted to characterize the nonlinear behavior of the interface. Several interlaminar fracture toughness tests are simulated for calibration and validation purposes. Pure mode nonlinear properties of the interface are calibrated by trial-and-error matching of P-delta curves from selected experiments. These properties are then used to simulate independent mixed mode tests for validation. Predictions of behavior and mode mixture are reasonably good, and dissipated energy due to damage also exhibits good agreement with experimentally obtained energy release rate values. For thick section composites, the proposed interface model is incorporated into an existing homogenized constitutive model. The interface is treated as one of the layers constituting the repeating sublaminate, which is the basic

  16. Combined SERS and Raman analysis for the identification of red pigments in cross-sections from historic oil paintings.

    PubMed

    Frano, Kristen A; Mayhew, Hannah E; Svoboda, Shelley A; Wustholz, Kristin L

    2014-12-21

    The analysis of paint cross-sections can reveal a remarkable amount of information about the layers and materials in a painting without visibly altering the artwork. Although a variety of analytical approaches are used to detect inorganic pigments as well as organic binders, proteins, and lipids in cross-sections, they do not provide for the unambiguous identification of natural, organic colorants. Here, we develop a novel combined surface-enhanced Raman scattering (SERS), light microscopy, and normal Raman scattering (NRS) approach for the identification of red organic and inorganic pigments in paint cross-sections obtained from historic 18th and 19th century oil paintings. In particular, Ag nanoparticles are directly applied to localized areas of paint cross-sections mounted in polyester resin for SERS analysis of the organic pigments. This combined extractionless non-hydrolysis SERS and NRS approach provides for the definitive identification of carmine lake, madder lake, and vermilion in multiple paint layers. To our knowledge, this study represents the first in situ identification of natural, organic pigments within paint cross-sections from oil paintings. Furthermore, the combination of SERS and normal Raman, with light microscopy provides conservators with a more comprehensive understanding of a painting from a single sample and without the need for sample pretreatment. PMID:25340987

  17. Effect of stage of initial labor dystocia on vaginal birth after cesarean success

    PubMed Central

    Lewkowitz, Adam Korrick; Nakagawa, Sanae; Thiet, Mari-Paule; Rosenstein, Melissa Greer

    2016-01-01

    OBJECTIVE The objective of the study was to examine whether the stage of labor dystocia causing a primary cesarean delivery (CD) affects a trial of labor after cesarean (TOLAC) success. STUDY DESIGN This was a retrospective cohort study of women who had primary CD of singleton pregnancies for first- or second-stage labor dystocia and attempted TOLAC at a single hospital between 2002 and 2014. We compared TOLAC success rates between women whose primary CD was for first- vs second-stage labor dystocia and investigated whether the effect of prior dystocia stage on TOLAC success was modified by previous vaginal delivery (VD). RESULTS A total of 238 women were included; nearly half (49%) achieved vaginal birth after cesarean (VBAC). Women with a history of second-stage labor dystocia were more likely to have VBAC compared with those with first-stage dystocia, although this trend was not statistically significant among the general population (55% vs 45%, adjusted odds ratio, 1.4, 95% confidence interval, 0.8–2.5]). However, among women without a prior VD, those with a history of second-stage dystocia did have statistically higher odds of achieving VBAC than those with prior first-stage dystocia (54% vs 38%, adjusted odds ratio, 1.8 [95% confidence interval, 1.0–3.3], P for interaction = .043). CONCLUSION Nearly half of women with a history of primary CD for labor dystocia will achieve VBAC. Women with a history of second-stage labor dystocia have a slightly higher VBAC rate, seen to a statistically significant degree in those without a history of prior VD. TOLAC should be offered to all eligible women and should not be discouraged in women with a prior second-stage arrest. PMID:26348381

  18. The efficacy and safety of low dose epidural butorphanol on postoperative analgesia following cesarean delivery.

    PubMed

    Pokharel, K; Rahman, T R; Singh, S N; Bhattarai, B; Basnet, N; Khaniya, S

    2008-01-01

    Butorphanol is considered an effective and safe analgesic after cesarean delivery but is associated with profound dose-dependent sedation. Somnolence may cause hindrance in early mother-baby interaction. This study was designed to assess the analgesic efficacy and to monitor side-effects of low doses (0.5 mg and 0.75 mg) of epidural butorphanol with bupivacaine compared to bupivacaine alone in parturients following cesarean delivery. One hundred and twenty parturients (American Society of Anesthesiologists physical status 1 and 2) undergoing cesarean delivery were allocated into three groups: group 1 received epidural 0.125% bupivacaine while group 2 and 3 received an additional 0.5 mg and 0.75 mg butorphanol respectively. A combined spinal, epidural technique was used. Spinal anaesthesia was used for surgery. The epidural route was used for postoperative analgesia with the study drug. Onset, duration and quality of analgesia, lowest visual analogue scales (VAS) score, and side effects were noted. The onset and duration of analgesia in group 2 (4.1+/-2.6 min and 202.4+/-62.8 min) and group 3 (4.0+/-2.5 min and 192.3+/-69.1 min) were significantly different (P<0.01) from group 1 (6.6+/-2.7 min and 145.7+/-89.6 min). The quality of analgesia in terms of time to first independent movement and satisfactory VAS were statistically better (P<0.01) in group 2 (3.9+/-0.3 hour and 8.1+/-0.1 mm) and group 3 (3.8+/-0.4 hour and 8.1+/-0.9 mm) than in group 1 (5.2+/-0.4 hour and 6.3+/-1.3 mm). The incidence of sedation was 5% in all the three groups. A lower dose of epidural butorphanol with bupivacaine produces a significantly earlier onset, longer duration and better quality of analgesia than bupivacaine does. PMID:18709032

  19. Raman spectroscopic analysis of human skin tissue sections ex-vivo: evaluation of the effects of tissue processing and dewaxing

    NASA Astrophysics Data System (ADS)

    Ali, Syed M.; Bonnier, Franck; Tfayli, Ali; Lambkin, Helen; Flynn, Kathleen; McDonagh, Vincent; Healy, Claragh; Clive Lee, T.; Lyng, Fiona M.; Byrne, Hugh J.

    2013-06-01

    Raman spectroscopy coupled with K-means clustering analysis (KMCA) is employed to elucidate the biochemical structure of human skin tissue sections and the effects of tissue processing. Both hand and thigh sections of human cadavers were analyzed in their unprocessed and formalin-fixed, paraffin-processed (FFPP), and subsequently dewaxed forms. In unprocessed sections, KMCA reveals clear differentiation of the stratum corneum (SC), intermediate underlying epithelium, and dermal layers for sections from both anatomical sites. The SC is seen to be relatively rich in lipidic content; the spectrum of the subjacent layers is strongly influenced by the presence of melanin, while that of the dermis is dominated by the characteristics of collagen. For a given anatomical site, little difference in layer structure and biochemistry is observed between samples from different cadavers. However, the hand and thigh sections are consistently differentiated for all cadavers, largely based on lipidic profiles. In dewaxed FFPP samples, while the SC, intermediate, and dermal layers are clearly differentiated by KMCA of Raman maps of tissue sections, the lipidic contributions to the spectra are significantly reduced, with the result that respective skin layers from different anatomical sites become indistinguishable. While efficient at removing the fixing wax, the tissue processing also efficiently removes the structurally similar lipidic components of the skin layers. In studies of dermatological processes in which lipids play an important role, such as wound healing, dewaxed samples are therefore not appropriate. Removal of the lipids does however accentuate the spectral features of the cellular and protein components, which may be more appropriate for retrospective analysis of disease progression and biochemical analysis using tissue banks.

  20. Primary cesarean delivery results in emergency hysterectomy due to placenta accreta: a case study.

    PubMed

    Humphrey, Jaclyn

    2015-02-01

    Placenta accreta is a major cause of obstetric hemorrhage, a situation that remains the most significant cause of maternal morbidity and mortality worldwide. It is generally recognized that a previous cesarean delivery increases the risk of placenta accreta. However, the risk also increases with previous intrauterine procedures. In 2010, The Joint Commission released a sentinel event alert regarding the prevention of maternal death, which recommended the adoption of protocols to treat postpartum hemorrhage. This case study demonstrates the success of quickly initiating protocol interventions necessary to prevent disseminated intravascular coagulation and maternal mortality, while reviewing current literature on risk identification, management, and treatment of obstetric hemorrhage resulting from placenta accreta. PMID:25842631