Science.gov

Sample records for cesarean section analysis

  1. 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 ...

  2. [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

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

    PubMed

    Azami-Aghdash, Saber; Ghojazadeh, Morteza; Dehdilani, Nima; Mohammadi, Marzieh; Asl Amin Abad, Ramin

    2014-05-01

    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.

  4. 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

  5. Cesarean Section Rate Analysis in University Hospital Tuzla - According to Robson’s Classification

    PubMed Central

    Fatusic, Jasenko; Hudic, Igor; Fatusic, Zlatan; Zildzic-Moralic, Aida; Zivkovic, Milorad

    2016-01-01

    Objective: For last decades, there has public concern about increasing Cesarean Section (CS) rates, and it is an issue of international public health concern. According to World Health Organisation (WHO) there is no justification to have more than 10-15% CS births. WHO proposes the Robson ten-group classification, as a global standard for assessing, monitoring and comparing cesarean section rates. The aim of this study was to investigate Cesarean section rate at University Hospital Tuzla, Bosnia and Herzegovina. Methods: Cross sectional study was conducted for one-year period, 2015. Statistical analysis and graph-table presentation was performed using Excel 2010 and Microsoft Office programs. Results: Out of 3,672 births, a total of 936 births were performed by CS. Percentage of the total number of CS to the total birth number was 25,47%. According to Robson classification, the largest was group 5 with relative contribution of 29,80%. On second and third place were group 1 and 2 with relative contribution of 26,06% and 15,78% respectively. Groups 1, 2, 5 made account of realtive contribution of 71,65%. All other groups had entirely relative contribution of 28,35%. Conclusion: Robson 10-group classification provides easy way in collecting information about CS rate. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS. Data from our study confirm this attitude. PMID:27594749

  6. Youssef's Syndrome following Cesarean Section

    PubMed Central

    Birge, Ozer; Ozbey, Ertugrul Gazi; Erkan, Mustafa Melih; Arslan, Deniz; Kayar, Ilkan

    2015-01-01

    Youssef's syndrome is characterized by cyclic hematuria (menouria), absence of vaginal bleeding (amenorrhea), and urinary incontinence due to vesicouterine fistula (VUF), the least common of the urogynecological fistulas. Youssef's syndrome has a variable clinical presentation. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be appropriate in some cases, but surgery is the definitive treatment. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section. Diagnostic tests as well as necessary appropriate surgery should be performed on cases with suspected vesicouterine fistula. We present a 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth. Here, we discuss our case with the help of previously published studies found in the literature. PMID:26457214

  7. Cesarean section by maternal request.

    PubMed

    Câmara, Raphael; Burlá, Marcelo; Ferrari, José; Lima, Lana; Amim, Joffre; Braga, Antonio; Rezende, Jorge

    2016-01-01

    Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks. RESUMO A cesariana a pedido materno é aquela realizada em uma gestante sem indicações médicas e sem contraindicação para tentativa do parto vaginal. Existe grande controvérsia sobre a realização da cesariana a pedido. Riscos potenciais da cesariana a pedido incluem complicações em gravidezes subsequentes, tais como: rotura uterina, placenta prévia e acretismo. Potenciais benefícios da cesariana a pedido englobam um menor risco de hemorragia pós-parto na primeira cesariana e menos complicações cirúrgicas quando comparada ao parto vaginal. A cesariana a pedido jamais deve ser realizada antes de 39 semanas.

  8. Cesarean section by maternal request.

    PubMed

    Câmara, Raphael; Burlá, Marcelo; Ferrari, José; Lima, Lana; Amim, Joffre; Braga, Antonio; Rezende, Jorge

    2016-01-01

    Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks. RESUMO A cesariana a pedido materno é aquela realizada em uma gestante sem indicações médicas e sem contraindicação para tentativa do parto vaginal. Existe grande controvérsia sobre a realização da cesariana a pedido. Riscos potenciais da cesariana a pedido incluem complicações em gravidezes subsequentes, tais como: rotura uterina, placenta prévia e acretismo. Potenciais benefícios da cesariana a pedido englobam um menor risco de hemorragia pós-parto na primeira cesariana e menos complicações cirúrgicas quando comparada ao parto vaginal. A cesariana a pedido jamais deve ser realizada antes de 39 semanas. PMID:27679953

  9. 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…

  10. Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section

    PubMed Central

    Yang, Y. Tony; Mello, Michelle M.; Subramanian, S. V.; Studdert, David M.

    2011-01-01

    Background Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior aimed at reducing obstetricians’ exposure to malpractice litigation. Objective To estimate the effects of malpractice pressure on rates of VBAC and cesarean section. Research Design, Subjects, Measures We used state-level longitudinal mixed-effects regression models to examine data from the Natality Detail File on births in the United States (1991–2003). Malpractice pressure was measured by liability insurance premiums and tort reforms. Outcome measures were rates of VBAC, cesarean section, and primary cesarean section. Results Malpractice premiums were positively associated with rates of cesarean section (β = 0.15, P = 0.02) and primary cesarean section (β = 0.16, P = 0.009), and negatively associated with VBAC rates (β = −0.35, P = 0.01). These estimates imply that a $10,000 decrease in premiums for obstetrician-gynecologists would be associated with an increase of 0.35 percentage points (1.45%) in the VBAC rate and decreases of 0.15 and 0.16 percentage points (0.7% and 1.18%) in the rates of cesarean section and primary cesarean section, respectively; this would correspond to approximately 1600 more VBACs, 6000 fewer cesarean sections, and 3600 fewer primary cesarean sections nationwide in 2003. Two types of tort reform—caps on noneconomic damages and pretrial screening panels—were associated with lower rates of cesarean section and higher rates of VBAC. Conclusions The liability environment influences choice of delivery method in obstetrics. The effects are not large, but reduced litigation pressure would likely lead to decreases in the total number cesarean sections and total delivery costs. PMID:19169125

  11. Cesarean Section and Subsequent Stillbirth, Is Confounding by Indication Responsible for the Apparent Association? An Updated Cohort Analysis of a Large Perinatal Database

    PubMed Central

    Wood, Stephen; Ross, Sue; Sauve, Reg

    2015-01-01

    Background Several studies and a recent meta-analysis have suggested that previous Cesarean section may increase the risk of stillbirth in a subsequent pregnancy. Given the high rates of Cesarean section in contemporary obstetric practice, this is of considerable public health importance. We sought to evaluate the potential that this association is the result of residual confounding bias. Methods A large perinatal database (Alberta Perinatal Health Project) was searched to identify a matched set of first and second births from the years 1992–2006. Data on pregnancy outcomes, demographics and potential confounding factors were obtained. Results The cohort was comprised of 98538 matched first and second births. Multivariate analysis did not reveal an association between previous Cesarean section and stillbirth, OR = 1.38 (0.98, 1.93). Restricting the analysis to a low risk group further attenuated the association, OR = .99 (0.62, 1.52). Analysis of the risk by indication for Cesarean section found that the risk was not increased for previous dystocia, OR = .91 (0.53, 1.55) nor for breech presentation, OR = 1.06 (0.50, 2.28) but only for other indications including non reassuring fetal status and fetal distress, OR = 1.96 (1.29, 2.98). Conclusions The results of our cohort analysis suggest that previous Cesarean section does not cause an increased risk of stillbirth. PMID:26331274

  12. Recent trends in cesarean section use in California.

    PubMed Central

    Stafford, R. S.

    1990-01-01

    Cesarean section use in the United States has increased to 24.7% of deliveries in 1988 and is the most common hospital surgical procedure. California cesarean section rates were examined to measure recent trends in obstetric practices and to project future patterns of cesarean section use. Using discharge abstracts from 1983 to 1987 California hospital deliveries, total cesarean section rates were found to increase from nearly 22% in 1983 to 25% in 1987, an increase of 15%. Using a series of least-squares regression models, time trends in the distribution of indications associated with cesarean section among all deliveries and indication-specific cesarean section rates were evaluated. Increases in the number of women with previous cesarean section and fetal distress contributed to rising cesarean section rates. In addition, indication-specific cesarean section rates increased for breech presentation and dystocia. These trends were counterbalanced, in part, by declining rates of repeat cesarean sections. Trends noted for July 1985 through 1987 did not differ substantially from those observed for January 1983 to June 1985, suggesting that recent policy attempts to alter cesarean section use have not had a measurable effect on existing trends. Projections suggest that California cesarean section rates will rise to a level of 34% by the year 2000. PMID:2260286

  13. 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

  14. Cesarean Section: A Seven-Year Study

    PubMed Central

    Weekes, Leroy R.

    1983-01-01

    This paper reports a seven-year study of cesarean section practices at the Queen of Angels Hospital, Los Angeles, California. Indications for this procedure are listed in detail and an attempt is made to explain its increasing frequency. Practicing physicians were interviewed and testimony seemed to indicate, as was suspected, that fear of malpractice suits was one of the reasons for cesarean section. The conventional wisdom of “once a section always a section” is questioned with regard to an increasing number of trials of labor and vaginal deliveries, when they are considered feasible and safe. The federal government is manifesting serious interest in this increased number of operative deliveries in the light of cost effectiveness. PMID:6864826

  15. Cesarean section in sub-Saharan Africa.

    PubMed

    Harrison, Margo S; Goldenberg, Robert L

    2016-01-01

    Cesarean section is an essential maternal healthcare service. Its role in labor and delivery care in low- and middle-income countries is complex; in many low-resource settings it is underutilized in the most needy of populations and overused by the less needy, without clear methods to ensure that universal access is available. Additionally, even if universal access were available, it is not evident that these countries would have the capacity or the finances to appropriate meet demand for the procedure, or that patients would want to utilize the care. This review summarizes the literature and illustrates the complicated relationship that cesarean section, which is rapidly on the rise around the world, has with individuals, communities, and nations in sub-Saharan Africa. PMID:27398224

  16. Uterine torsion and cesarean section in llamas and alpacas.

    PubMed

    Anderson, David E

    2009-07-01

    Dystocia occurs infrequently in llamas and alpacas. Uterine torsion is one of the more common causes of dystocia that requires veterinary care. Cesarean section may be required to resolve dystocia or uterine torsion. Correction of uterine torsion is most often successful without laparotomy. Laparotomy and cesarean section can be performed successfully in llamas and alpacas in field settings. This article discusses the indications, techniques, and expected outcomes of uterine torsion and cesarean section when performed in llamas or alpacas.

  17. Rethinking general anesthesia for cesarean section.

    PubMed

    Sumikura, Hiroyiki; Niwa, Hidetomo; Sato, Masaki; Nakamoto, Tatsuo; Asai, Takashi; Hagihira, Satoshi

    2016-04-01

    In this review, we describe the current consensus surrounding general anesthetic management for cesarean section. For induction of anesthesia, rapid-sequence induction using thiopental and suxamethonium has been the recommended standard for a long time. In recent years, induction of anesthesia using propofol, rocuronium, and remifentanil have been gaining popularity. To prevent aspiration pneumonia, a prolonged preoperative fasting and an application of cricoid pressure during induction of anesthesia have been recommended, but these practices may require revision. Guidelines for difficult airway management were developed first in obstetric anesthesia, and the use of a supraglottic airway is now recognized as an effective rescue device. After the delivery of a fetus, switching from volatile anesthetics to intravenous anesthetics has been recommended to avoid uterine atony. At the same time, intraoperative awareness should be avoided. The rate of persistent wound pain is higher when only general anesthesia was used during cesarean section than with regional anesthesia, and thus it is necessary to provide a sufficient postoperative analgesia using multimodal analgesia, including intravenous patient-controlled analgesia (IV-PCA), transversus abdominis plane (TAP) block, non-steroidal inflammatory drugs, and acetaminophen. PMID:26585767

  18. 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

  19. Cesarean section in a wedged head.

    PubMed

    Khosla, A H; Dahiya, K; Sangwan, K

    2003-05-01

    Cesarean section many a times, has to be done late in labour when the head is deeply wedged in the pelvis. The techniques described in standard text books, usually result in extension of the incision either laterally into the broad ligament or vertically upwards into the upper segment or downwards posterior to the bladder from the centre of the incision line. In this study we have reviewed the Patwardhan's technique for the extraction of baby and fetomaternal outcome was compared with cases where this technique was not used. There was no extension of the incision either laterally into broad ligament or upwards or downwards. Haemorrhage due to extension of incision requiring blood transfusion occurred in 24% of patients in group II as compared to nil in group I. PMID:14514249

  20. 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

  1. 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

  2. Cesarean Section - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Bosnian (Bosanski) Chinese - Simplified (简体中文) Chinese - Traditional (繁體中文) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) ... 繁體中文 (Chinese - Traditional) Bilingual PDF Health Information Translations French (français) Your Recovery After Cesarean Birth: Part 1 ...

  3. Report of a breech cesarean section maternal death.

    PubMed

    Lawson, Gerald Wightman

    2011-06-01

    In Australia in 2007, a woman with two previous normal vaginal deliveries underwent an emergency cesarean section at full dilatation of the cervix with a breech presentation. The woman died after a severe hemorrhage. The official Coroner's Report attributed the cause of death to postpartum hemorrhage, whereas the breech presentation was barely mentioned, suggesting that complications with breech cesarean deliveries are under-appreciated and under-reported.

  4. [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

  5. Cesarean sections, perfecting the technique and standardizing the practice: an analysis of the book Obstetrícia, by Jorge de Rezende.

    PubMed

    Nakano, Andreza Rodrigues; Bonan, Claudia; Teixeira, Luiz Antônio

    2016-01-01

    This article discusses the development of techniques for cesarean sections by doctors in Brazil, during the 20th century, by analyzing the title "Operação Cesárea" (Cesarean Section), of three editions of the textbookObstetrícia, by Jorge de Rezende. His prominence as an author in obstetrics and his particular style of working, created the groundwork for the normalization of the practice of cesarean sections. The networks of meaning practiced within this scientific community included a "provision for feeling and for action" (Fleck) which established the C-section as a "normal" delivery: showing standards that exclude unpredictability, chaos, and dangers associated with the physiology of childbirth, meeting the demand for control, discipline and safety, qualities associated with practices, techniques and technologies of biomedicine.

  6. 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

  7. [Non-indicated cesarean section--does the "Golem" counteract?].

    PubMed

    Herman, Arie

    2011-11-01

    Cesarean section rate is steadily increasing and in Israel it has risen to 20%. MultipLe and different reasons have led to this phenomenon, among them are non-indicated cesarean sections. Although health care providers disagree whether this development is medically, ethically and publically justified, national associations allow it, while respecting those obstetricians who decline to do so. In Israel there are some hospitals which allow non-indicated cesarean sections, whereas others reject them. When discussing this issue with the patients, documentation is advised concerning the reasons for approval or rejection of the patients' request in order to avoid future complaints in the case of adverse outcome. Low risk vaginal delivery should be regarded as a natural process and not as a medical treatment and keeping balanced and reasonable decisions may help to contain the phenomenon and avoid a situation in which the "Golem" created by the medical system, counteracts.

  8. 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

  9. Obstetric outcome of patients with more than one previous cesarean section.

    PubMed

    Novas, J; Myers, S A; Gleicher, N

    1989-02-01

    Records of patients with more than one previous cesarean section were reviewed for a 1-year period. Of 69 such pregnancies, 36 underwent trial of labor in concurrence with an ongoing departmental cesarean section reduction initiative; 80% culminated in vaginal delivery. Twenty of these 69 patients had three or more previous cesarean sections; 9 underwent trial of labor, with 8 subsequent vaginal deliveries. The vaginal delivery rate after more than one previous cesarean section was no different from that of patients with only one previous cesarean section. We conclude that trial of labor in patients with more than one previous cesarean section did not result in a deleterious outcome. Our findings suggest that a trial of labor after more than one previous cesarean section delivery can safely be allowed. Guidelines can be identical to those already established for patients with only one previous cesarean section.

  10. [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

  11. 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

  12. 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

  13. Asymptomatic abdominal wall endometrioma 15 years after cesarean section.

    PubMed

    Tica, V I; Tomescu, C L; Tomescu, Aneta; Micu, Luminiţa; Zaher, M; Bafani, S; Beghim, M; Serbănescu, L; Tica, Irina

    2006-01-01

    Abdominal wall endometriosis is rare and its diagnosis is difficult. However, the consequences may be serious, like recurrences or even malignant transformation. We report a rarer case of asymptomatic abdominal wall endometrioma, accidentally found during a surgical procedure for a second cesarean section, in a 39-years old patient, without any relevant history of endometriosis. The tumor was subcutaneous, 3/3 cm in size, located in the left angle of the incision from the 15 years previously performed cesarean section and freely mobile in relation with the skin and the fascia. It was excised, with clear margins (to prevent recurrences), during the procedure. The patient was discharged after five days. The postoperative period and the follow-up at one and three months were uneventful. The pathological examination clarified the diagnosis by revealing an endometrioma with decidual reaction. Such a condition may be, therefore, evoked before an abdominal wall tumor, even without specific symptoms, even in a 39-years old woman and longtime after the possible causal surgery. Pathological examination remains the ultimate diagnostic tool. Relevant prophylactic attitude at the end of the cesarean section may be considered.

  14. Cesarean section, fetal monitoring, and perinatal mortality in California.

    PubMed Central

    Williams, R L; Hawes, W E

    1979-01-01

    The rate of cesarean section in California has been growing at a compound rate of about 10 per cent per annum since 1969, coinciding with the advent of fetal monitoring. It is of interest, therefore, to study the distribution and efficacy of obstetric interventions. Information derived from the 1977 California birth cohort and a survey questionnaire was used to study the factors associated with the rate of cesarean section in 323 hospitals. Significant positive correlations were observed between the cesarean rate (CSR) and hospital factors indicative of a high degree of technology, including the proportion of labors electronically monitored. Significant negative correlations were observed between the CSR and hospital-specific variables suggestive of socioeconomically underprivileged patient populations. Other factors being constant, hospitals characterized by prepayment health care financing also had lower CSRs. A standaridized mortality ratio (SMR) based on 2.3 million births in the 1970--1976 cohorts was used to adjust the 1977 hospital specific perinatal mortality rates for birth weight, gestational age, sex, race, and plurality. The results show that hospitals which intervene technologically in a large proportion of births have lower risk adjusted perinatal mortality rates. PMID:474842

  15. Disciplinary discourses: rates of cesarean section explained by medicine, midwifery, and feminism.

    PubMed

    Lee, Amy Su May; Kirkman, Maggie

    2008-05-01

    In the context of international concern about increasing rates of cesarean sections, we used discourse analysis to examine explanations arising from feminism and the disciplines of medicine and midwifery, and found that each was positioned differently in relation to the rising rates. Medical discourses asserted that doctors are authorities on birth and that, although cesareans are sometimes medically necessary, women recklessly choose unnecessary cesareans against medical advice. Midwifery discourses portrayed medicine as paternalistic toward both women and midwifery, and feminist discourses situated birth and women's bodies in the context of a patriarchally structured society. The findings illustrate the complex ways in which this intervention in birth is discursively constructed, and demonstrate its significance as a site of disciplinary conflict.

  16. Association of electronic fetal monitoring during labor with cesarean section rate and with neonatal morbidity and mortality.

    PubMed Central

    McCusker, J; Harris, D R; Hosmer, D W

    1988-01-01

    Data from the 1980 National Natality Survey by the National Center for Health Statistics were used to assess the relation of electronic fetal monitoring (EFM) during labor with cesarean section rates and neonatal morbidity and mortality. In univariate analyses, EFM was associated with higher cesarean section rates, lower five-minute Apgar scores, and a higher rate of respiratory distress. Logistic regression analysis controlling for other risk factors for poor neonatal outcome indicated that the association of EFM with higher cesarean section rates persisted (odds ratio 1.45, 95% CI 1.16, 1.81), except in certain pregnancies at very high risk for cesarean section. EFM was associated with an Apgar score less than 6 at five minutes only if delivery was by cesarean section. EFM was not found to be independently associated with respiratory distress. Neither univariate nor multivariate analyses found an association of EFM with neonatal mortality. These results suggest that EFM may identify hypoxic infants, who are frequently delivered by cesarean section. The lack of association of EFM with beneficial neonatal outcomes is consistent either with lack of effect of EFM or with uncontrolled selection bias. PMID:3407813

  17. 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

  18. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia

    PubMed Central

    Senturk, Mehmet Baki; Cakmak, Yusuf; Atac, Halit; Budak, Mehmet Sukru

    2015-01-01

    Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P<0.01), but these were minor. The rate of blood transfusion and prevalence of changes in hemoglobin level were similar in both groups (P>0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of labor should take into consideration the patient’s preference, together with the proper setting. PMID:26203286

  19. 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

  20. 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.

  1. 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

  2. [Vesical endometriosis after cesarean section: diagnostico-therapeutic aspects].

    PubMed

    García González, J I; Extramiana Cameno, J; Esteban Calvo, J M; Díez Rodríguez, J M; Esteban Artiaga, R; Arrizabalaga Moreno, M; Paniagua Andrés, P

    1997-09-01

    Endometriosis is a benign condition with an aggressive behaviour defined by the presence of ectopic endometrial tissue, outside the uterus. It occurs in 15-20% women with child bearing potential. Most commonly it affects organs such as the ovaries, uterine ligaments, fallopian tubes, rectum and the cervico-vaginal region. Involvement of the urinary tract, however, is rare. It can be seen in just about 1% cases, vesical location being the most frequent of these presentations (84% cases). We describe one case of vesical endometriosis that developed after a cesarean section. The intra-operative findings confirmed the existence of infiltration of the detrusor muscle and the vesical mucosa by endometrial tissue from the area of the uterine incision. A discussion of the different diagnostic and therapeutic options is also included.

  3. Balloon catheters for induction of labor at term after previous cesarean section: a systematic review.

    PubMed

    Kehl, Sven; Weiss, Christel; Rath, Werner

    2016-09-01

    To systematically review the application of balloon catheters for cervical ripening and labor induction at term after previous cesarean section. All pregnancies at term with previous cesarean section were included when cervical ripening or labor induction was conducted with balloon catheters. MEDLINE, Cochrane database and bibliography of identified articles were searched for English language studies. Reviews and meta-analysis, randomized and non-randomized controlled trials, prospective and retrospective cohort studies as well as case-control studies were considered. A total of 48 potentially relevant studies were identified. The title and abstract were screened for eligibility and 32 articles were excluded. The remaining 16 publications included 1447 women (single-balloon catheter: n=1329, double-balloon catheter: n=118). There were no randomized controlled trials. Most of the trials were retrospective studies (n=10). The rate of uterine rupture after labor induction was low (n=18, 1.2%). Meta-analysis of studies comparing the risk of uterine rupture between labor induction and spontaneous onset of labor found a higher risk after induction (OR 2.45, 95%CI 1.34-4.47, NNH 186). The average rate of oxytocin application was 68.4%, and vaginal birth was achieved in 56.4%. The risk for cesarean delivery was higher when labor was induced (OR 2.63, 95%CI 2.24-3.10). Data on balloon catheters for labor induction after previous cesarean section are limited by small sample size and retrospective analyses. The present data show a moderately increased risk for uterine rupture (OR=2.45) compared to spontaneous onset of labor. However, for evidence based recommendations much more well-conducted trials are needed.

  4. A Case of Idiopathic Severe Acute Pancreatitis following Cesarean Section Delivery.

    PubMed

    Kim, Jung; Choi, Jin Ho; Shin, Bang Sup; Nam, Joon Yeul; Kang, Eun Ae; Kim, Joo Seong; Hwang, Jin Hyeok; Kim, Jaihwan

    2016-09-25

    Acute pancreatitis rarely occurs in the postpartum period. Furthermore, there are very few reports of it after cesarean section delivery. A 35-year-old woman presented with dyspnea and abdominal distension on the third day after cesarean section delivery. Under a suspicion of acute pancreatitis, she was initially managed with conservative treatment. However, she developed intra-abdominal fluid collections and gastric bleeding, which were managed with percutaneous drainage, endoscopic hemostasis, and angiographic embolization. She was discharged with good clinical recovery. Postpartum pancreatitis, especially after cesarean section, is rare; however, its management is not different from that for usual pancreatitis. PMID:27646587

  5. 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

  6. A case of Klumpke's obstetric brachial plexus palsy following a Cesarean section.

    PubMed

    Al-Qattan, Mohammad M; El-Sayed, Amel A F

    2016-09-01

    It is generally thought that Klumpke's palsy is not seen as obstetric injury. The authors present a case of Klumpke's palsy with Horner syndrome following delivery by emergency Cesarean section. Neurolysis and nerve grafting partially corrected the paralysis. PMID:27648266

  7. [Cesarean section on request because of labor pain--bioethical and legal views].

    PubMed

    Frković, Aleksandra; Bosković, Zvonko

    2010-03-01

    Non-medical reasons that influence the decision to perform cesarean section are the subject of numerous medical and bioethical debates. The questions to be answered are: can a pregnant woman demand cesarean section based on her right to make decisions, i.e. on patient rights? Do such a request and permission given by the woman justify the physician to perform the procedure without clear medical indication, knowing that cesarean section is associated with higher maternal morbidity and mortality rate than vaginal delivery? Among the numerous reasons stated by pregnant women or their families when demanding cesarean section, this paper is focused on labor pain. The experience of pain during delivery is the result of many complex physiologic and psychosocial factors that act on the woman's personal interpretation of the nociceptive delivery stimuli. A mother's request for cesarean section should not be motivated by the lack of efficiency of pain management. Such motivation points to inadequate prenatal care and patient education offered by the obstetrician and anesthesiologist. Decisions to perform cesarean section upon request are not in accordance with the guidelines of declarations and codes of medical ethics, and have no legal basis in our country.

  8. 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

  9. Risk Factors for Endometritis Following Low Transverse Cesarean Section

    PubMed Central

    OLSEN, Margaret A.; BUTLER, Anne M.; WILLERS, Denise M.; GROSS, Gilad A.; DEVKOTA, Preetishma; FRASER, Victoria J.

    2012-01-01

    Objective To determine independent risk factors for endometritis (EMM) following low transverse cesarean section (LTCS). Study design We performed a retrospective case-control study from July 1999 to June 2001 in a large tertiary-care academic hospital. EMM was defined as fever beginning > 24 hours or continuing for ≥ 24 hours after delivery plus fundal tenderness in the absence of other causes for fever. Independent risk factors for EMM were determined by multivariable logistic regression. A fractional polynomial method was used to examine risk of EMM associated with the continuous variable, duration of rupture of membranes. Results EMM was identified in 124/1605 (7.7%) women within 30 days after LTCS. Independent risk factors for EMM included age (odds ratio (OR) for each additional year 0.93; 95% confidence interval (CI): 0.90-0.97) and anemia/perioperative blood transfusion (OR 2.18; CI:1.30-3.68). Risk of EMM was marginally associated with a proxy for low socioeconomic status, lack of private health insurance (OR 1.72; CI: 0.99-3.00), amniotomy (OR 1.69; CI:0.97-2.95), and longer duration of rupture of membranes. Conclusion Risk of EMM was independently associated with younger age and anemia, and was marginally associated with lack of private health insurance, and amniotomy. Although duration of rupture of membranes was only marginally associated with increased risk of EMM, increased risk was observed very soon after rupture of membranes. Knowledge of these risk factors is important to guide selective use of prophylactic antibiotics during labor and heighten awareness of the risk in subgroups at highest risk of infection. PMID:19951198

  10. Elective Cesarean section at 37 weeks is associated with the higher risk of neonatal complications.

    PubMed

    Nakashima, Jun-ichi; Yamanouchi, Sohsaku; Sekiya, Shin-ichiro; Hirabayashi, Masato; Mine, Kenji; Ohashi, Atsushi; Tsuji, Shoji; Kasamatsu, Atsushi; Kanzaki, Hideharu; Hirano, Daishi; Kaneko, Kazunari

    2014-01-01

    Elective Cesarean section performed before 39 weeks of gestation may be associated with increased risk of neonatal complications. We retrospectively investigated differences in the neonatal complication rate between 684 newborns delivered by elective Cesarean section at 37 weeks of gestation (n = 390) and those delivered by the same procedure at 38 weeks (n = 294) between 2006 and 2012 at our hospital in order to ascertain whether adverse outcomes differ between the groups. Newborns delivered at 37 weeks had a significantly higher incidence of neonatal intensive care unit admission (p = 0.03), adverse respiratory complications (p < 0.01), low birth weight (p < 0.001), and hypoglycemia (p < 0.005) than those delivered at 38 weeks. Compared with normal weight neonates, low birth weight neonates were more likely to have hypoglycemia (p < 0.001). Multivariate logistic regression analysis revealed that an adverse respiratory outcome was independently associated with gestational age (p < 0.01; odds ratio [OR], 3.26; 95% confidence interval [CI], 1.36-7.81), while hypoglycemia was independently associated with birth weight (p < 0.01; OR, 16.34; 95% CI, 7.72-34.56). Respiratory disorders were significantly associated with gestational age even in normal birth weight newborns without any other complications such as hyperbirilubinemia, hypoglycemia or bacterial infections. In conclusion, the incidence of neonatal complications was higher in newborns delivered at 37 weeks of gestation than in those delivered at 38 weeks via elective Cesarean section. Thus, the procedure should be scheduled at 38 weeks to improve neonatal outcomes.

  11. Re-laparotomy After Cesarean Section: Risk, Indications and Management Options

    PubMed Central

    Raagab, Ahmed E; Mesbah, Yasir H.; Brakat, Rafik I; Zayed, Abdelhadi A.; Alsaammani, Mohamed Alkhatim

    2014-01-01

    ABSTRACT Aim: To identify risks, indications and outcomes for relaparotomy after cesarean delivery. Methods: A prospective case-controlled study conducted at Mansoura University Hospital, Egypt from 2009 to 2012. Each case was matched randomly to 2 cases that had delivered by cesarean section during the same period and did not undergo repeated surgical intervention. Information's on indications were obtained to gather information's on risks factors. Results: relaparotomy complicated 1.04 %(n= 26) of the total number of the cesarean section (CS) (n=2500). The principal indications for relaparotomy were internal bleeding (Intra-abdominal bleeding in 41.7% (n=10); rectus sheath hematoma in 29.2% (n=7) and uncontrolled postpartum hemorrhage (PPH) in 29.2 %(n=7) of cases, followed by infections in 7.7% (n=2) of cases. Resulting in 11.5 %(n=3) maternal death. Predictors for relaparotomy after cesarean delivery from univariate logistic model, placenta previa (OR=6.898, 95% CI=1.867- 25.4, P=.004), fetal weight greater than 4 kg (OR=6.409, 95% CI=1.444-28.44,. 015). Previous cesarean section and parity were not a risk for re-laparotomy. Conclusion: In this study, the incidence of relaparotomy after cesarean delivery was very high (1.04%). Associated with high maternal mortality (11.5%). The main predictors were placenta previa and fetal macrosomia. PMID:24783911

  12. Vaginal birth after cesarean section: an update on physician trends and patient perceptions.

    PubMed

    Penso, C

    1994-10-01

    The increased number of women having a vaginal birth after a cesarean section can be attributed to changing physician trends. Women eligible for vaginal birth after cesarean section include those with previous low vertical incisions, multiple previous incisions and even unknown scars, regardless of the method of closure or previous indication. Limited data suggest that in carefully selected women a current twin gestation, breech presentation, or the presence of fetal macrosomia are not contraindications for a trial of labor, in the presence of a uterine scar. Changing trends in the management of labor may also contribute to an increase in successful trial of labor with the use of oxytocin for the induction or augmentation of labor, the administration of epidural anesthesia for pain relief, and the instillation of prostaglandin E2 gel for cervical ripening. External cephalic version and amnioinfusion may also be reasonable alternatives in appropriately selected cases. Despite the documented safety and success of vaginal birth after cesarean section, and the lack of increased morbidity of failed trial of labor, 50% of women who are eligible for vaginal birth after cesarean section will decline an attempt, even after extensive counseling and encouragement. Patient resistance, largely attributed to the fear and inconvenience of labor, is still a major deterrent to a further rise in vaginal birth after cesarean section rates.

  13. General anesthesia for cesarean section at a tertiary care hospital 1990-1995: indications and implications.

    PubMed

    Tsen, L C; Pitner, R; Camann, W R

    1998-07-01

    Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. In addition, patients who undergo general anesthesia may have co-morbidities which, while not contraindicating regional anesthesia, may increase the risk of providing anesthesia. We reviewed the medical records of 6 calendar years (1990-1995) at our busy tertiary center, to determine patient demographics, indications for cesarean section, indications for general anesthesia, time of day, and complications related to airway management. From 1990 through 1995, cesarean sections under general anesthesia decreased from 7.2% to 3.6% (P=0.0001), however, they were performed on parturients with more maternal diseases (17.2% to 35.8%; P=0.0034). Although the incidence of difficult intubations in those years ranged from 16.3% to 1.3%, only one failed intubation with resultant maternal mortality occurred. Few residency programs offer instruction on the difficult airway in the parturient population. Organized airway management programs specifically for the obstetric population may assist efforts to decrease the morbidity and mortality associated with the provision of general anesthesia for cesarean section. PMID:15321206

  14. 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...

  15. [Failure of extension of epidural analgesia to anesthesia for emergency cesarean section].

    PubMed

    Gago, A; Guasch, E; Gutiérrez, C; Guiote, P; Gilsanz, F

    2009-01-01

    Epidural analgesia provides effective control of labor pain and allows emergency cesarean section to be performed without recourse to general anesthesia. This technique is subject to failure, however. We sought to determine the incidence of failure of extension of epidural analgesia for labor to epidural anesthesia for emergency cesarean section. We also analyzed possible risk factors for failure. A 2-month observational study was carried out in a tertiary-care university hospital in patients who had an epidural catheter inserted for labor analgesia and who later underwent emergency cesarean section. Epidural catheter failure was defined if additional analgesia was required during surgery or if general anesthesia was required. Data were gathered on possible risk factors, such as obesity, difficult epidural puncture, leakage of blood on insertion, history of cesarean delivery, need for rescue analgesia, and level of satisfaction with analgesia during dilation. In total, 134 emergency cesareans were performed in women carrying an epidural catheter. The catheter failed to administer the anesthetic in 18 patients (13.4%). General anesthesia was required in 9 cases (6.7%). Difficult insertion (more than 2 attempts) was associated with a higher failure rate (P=.064). The relative risk of epidural catheter failure was 2.86-fold higher when rescue analgesia was needed during delivery than in cases when no supplement was required (P=.021). Receiving adequate analgesia during labor seems to be a protective factor (80%) against anesthetic catheter failure during cesarean section (P=.01). We conclude that high demand for rescue analgesia and signs of inadequate analgesia during labor should warn of epidural catheter failure if extension to anesthesia becomes necessary for a cesarean delivery.

  16. Comparison of postoperative analgesic effect of tramadol and bupivacaine subcutaneous infiltration in patients undergoing cesarean section.

    PubMed

    Behdad, Shekoufeh; Sekhavat, Leila; Ayatollahi, Vida; Meshkat, Fatemah; Mortazavi, Abulghasem

    2013-03-01

    Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n = 30) or 50 mg of tramadol in 10 mL of normal saline (n = 30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Data were analyzed by SPSS software version 15 and p < 0.05 was considered significant. The VAS score did not differ significantly between the two groups at 1 and 2 hours after cesarean section, but it was higher in bupivacaine group than tramadol group 6 hours after operation (p < 0.05; Fisher exact test). Postoperative consumption of analgesic was higher in bupivacaine group than tramadol group but the difference was not significant (p > 0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.

  17. 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

  18. 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

  19. 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

  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. The incidence of significant fetomaternal hemorrhage in patients undergoing cesarean section.

    PubMed

    Feldman, N; Skoll, A; Sibai, B

    1990-09-01

    To determine the incidence of fetomaternal hemorrhage in patients undergoing cesarean section, Kleihauer-Betke tests were performed in the immediate postoperative period on 199 parturients. Some degree of hemorrhage was detected in 18.5% of patients, with 2.5% demonstrating greater than 30 ml of fetal blood. Comparison of groups on the basis of indication for cesarean delivery revealed no difference in rates of fetal hemorrhage. Because patients with greater than 30 ml of fetal blood would not be adequately protected from Rh sensitization by the standard 300 micrograms dose of Rh immune globulin, we recommend screening all Rh-negative patients undergoing cesarean section for the presence of significant fetomaternal hemorrhage.

  2. The evaluation of myomectomies performed during cesarean section in our clinic

    PubMed Central

    Celal, Kadı; Hülya, Çıçek

    2011-01-01

    Background: We evaluated the data of patients who had applied myomectomy during cesarean section operation in our clinic between April, 2008 and December, 2010. Objective: I0 n this period, 3689 cesarean sections were done in our clinic, we analyzed their data retrospectively and determined 27 myomectomy cases during cesarean section operation. The age of the patients, the numbers of pregnancy, parities, the rates of abortus, indications of cesarean, pregnancy weeks, residential areas of myoms detected during the cesarean and their size, were recorded. Furthermore, pre-operative and post-operative hemoglobin (Hb) values, differences between hemoglobin values, whether there was bleeding or not, the need of blood transfusion if it occurred, the duration of operation and hospitaization and the pathological diagnoses of myomectomy materials, were examined. Materials and Methods: Retrospective study of myomectomies. Results: The mean age of patients was 29.6±5.9 (19-42) and mean gestational age was 39.2±1.0(37-42) weeks. The mean size of the fibroids was 5.94±6.29 cm3 (0.96-26.50 cm3). Subserous myoms were the most frequently seen ones (24 of 27 patients=89%) with fundal, corporal localizations in most of the instances. T0 he pre-operative and post-operative values of Hb were 11.8±1.52 (8.6-10.5) and 10.3±2.6 (6.9-13.3) g/dl respectively and the difference was statistically significant (P<0.001). Blood transfusion was not necessary in any patient. The mean duration of the operation was found to be 40.7±13.9 (13-60) minutes. Conclusion: Myomectomies can be performed safely during cesarean section by experienced obstetricians and gynecologists, and myomectomy performed for fibroids in appropriate localizations does not increase post-operative bleeding or maternal morbidity or mortality. PMID:22083246

  3. [Characteristic features of systemic hemodynamics during cesarean section under general anesthesia with ketamine].

    PubMed

    Moiseev, V N

    1983-02-01

    On the basis of a comparative investigation of the central hemodynamics by the method of integrative rheography of the body in two groups of women during the operation of cesarean section under general anesthesia with ether or ketamin the author makes a conclusion that ketamin is a good drug for anesthesia in urgent surgical situations.

  4. 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

  5. Use of methergine for the prevention of postoperative endometritis in non-elective cesarean section patients.

    PubMed Central

    Dweck, M F; Lynch, C M; Spellacy, W N

    2000-01-01

    OBJECTIVE: Methergine increases constriction of uterine musculature which may facilitate sloughing of endometrial debris, close uterine vessels, and prevent post-cesarean endometritis. The objective of this study was to evaluate the efficacy of methergine in preventing endometritis in patients undergoing non-elective cesarean section delivery. METHODS: Eighty patients undergoing non-elective cesarean section were enrolled in a prospective randomized clinical trial of methergine (41) versus no methergine (39) administration during the postpartum period. The hospital records were abstracted after discharge to compare the postpartum course. RESULTS: There were no significant demographic differences between the two groups. The women receiving methergine had a significant reduction in the rate of postoperative endometritis (10% vs. 36%, P < 0.005). In addition, the mean postoperative hemoglobin was significantly higher in the methergine treated group (P < 0.001). CONCLUSIONS: The use of methergine postpartum in women undergoing non-elective cesarean sections significantly reduces the incidence of postoperative endometritis and blood loss. PMID:10968597

  6. Intervention for Postpartum Infections Following Caesarean Section

    ClinicalTrials.gov

    2016-10-14

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

  7. 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

  8. 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

  9. 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

  10. Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section.

    PubMed

    Lomas, J; Enkin, M; Anderson, G M; Hannah, W J; Vayda, E; Singer, J

    1991-05-01

    A randomized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section. The guideline recommended clinical actions to increase trial of labor and vaginal birth rates. Charts for all 3552 cases in the study groups were audited. After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group, but rates were 46% and 85% higher, respectively, among physicians educated by an opinion leader. Duration of hospital stay was lower in the opinion leader education group than in the other two groups. The overall cesarean section rate was reduced only in the opinion leader education group. There were no adverse clinical outcomes attributable to the interventions. The use of opinion leaders improved the quality of care. PMID:2013952

  11. Amniotic fluid embolism that took place during an emergent Cesarean section -A case report-

    PubMed Central

    Lee, Jung Hyang; Kim, Ji-Hyoung; Lee, Su-Yeon; Gill, Hyun Jue; Kim, Byeong-Kuk; Kim, Min Gu

    2010-01-01

    Amniotic fluid embolism (AFE) is a rare but fatal obstetric emergency, characterized by sudden cardiovascular collapse, dyspnea or respiratory arrest and altered mentality, disseminated intravascular coagulation (DIC). It can lead to severe maternal morbidity and mortality, but the prediction of its occurrence and treatment are very difficult. We experienced a case of AFE during emergent Cesarean section in a 40+6 weeks healthy pregnant woman, age 33. Sudden dyspnea, hypotension, signs of pulmonary edema and DIC were developed during Cesarean section, and cardiac arrest followed after these events. The course of these events was so rapid and catastrophic, which was consistent with AFE. Thus, we report this case precisely and review pathophysiology, diagnosis, treatment of AFE by referring to up-to-date literatures. PMID:21286429

  12. [Cesarean Section Under Combined Spinal and Epidural Anesthesia for a Pregnant Woman with Primary Biliary Cirrhosis].

    PubMed

    Hyoda, Akira; Komasawa, Nobuyasu; Matsunami, Sayuri; Minami, Toshiaki

    2015-12-01

    We report the successful anesthetic management of a pregnant woman with primary biliary cirrhosis (PBC) and autoimmune hepatitis who underwent cesarean section. A 35 year-old pregnant woman with PBC was diagnosed with preterm rupture of membranes (PROM). Emergent cesarean section was scheduled. AST and ALT were elevated and she complained of itching due to PBC. Hydrocortisone 50 mg was intravenously administered. Spinal anesthesia was initiated with 2.4 ml of 0.5% bupivacaine hydrochloride and 10 µg fentanyl at L3-4; sensory loss (T2) was confirmed. Morphine was not included in spinal anesthesia to avoid worsening of the itching. Epidural anesthesia at T12-L1 was performed for postoperative pain control. Surgery proceeded uneventfully and postoperative pain control was satisfactory. Combined spinal and epidural anesthesia was beneficial for the perioperative management of a pregnant woman with PBC and autoimmune hepatitis. PMID:26790326

  13. [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

  14. 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

  15. Placenta previa and it's relation with maternal age, gravidity and cesarean section.

    PubMed

    Hossain, G A; Islam, S M; Mahmood, S; Chakraborty, R K; Akhter, N; Sultana, S

    2004-07-01

    The placenta provides the essential connection between the mother and the developing fetus. Placental position were routinely mentioned in an ultrasound report starting from early second trimester to the end of third trimester when asked for pregnancy evaluation. The aim of this study was to see the prevalence of lower segment placenta (placenta previa) and its relations with previous cesarean section delivery, parity and maternal age. The study conducted in Centre for Nuclear Medicine and Ultrasound (CNMU) Mymensingh in a period from January 2001 to December 2002. About 2536 pregnant women (those included in this study) underwent ultrasound examination during pregnancy at third trimester. The prevalence of lower segment placenta was 1.34%. The highest prevalence of placenta previa (2.58%) was seen in 3rd and higher gravida group. Also the highest prevalence were seen 30 yr. and above age group in compare to below 30 yr. age group. No increased prevalence of placenta previa were seen in previous cesarean section (C / S) delivery group (0.65%) in compare to normal delivery group (1.97%). From our study it was seen that development of lower segment placenta has relation with increased number of gravidity and maternal age but no increased prevalence were seen in subjects with previously done cesarean section

  16. Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section.

    PubMed

    Simon, L; Boulay, G; Ziane, A F; Noblesse, E; Mathiot, J L; Toubas, M F; Hamaza, J

    2000-01-01

    Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated in a prospective observational study the influence of injection speed on maternal hypotension. Hyperbaric bupivacaine 10 mg, sufentanil 2 microg and morphine 200 microg (total volume 4 mL) were injected either quickly (<15 s) or slowly (=120 s) in 50 women scheduled for elective cesarean section. Hypotension (systolic arterial pressure (SAP) <100 mmHg or <70% of baseline) was promptly treated with 5 mg ephedrine boluses. Slow injection significantly reduced the incidence of hypotension (68% in the 120 s group and 92% in the other, P =0.03). In addition, onset of hypotension was delayed, had a shorter duration and required less ephedrine for hypotension in the 120 s group (11.6 mg vs. 19.6 mg, P =0.019). Anesthesia was satisfactory for all women. We conclude that a 2 mL/min injection rate may be a simple and effective way to reduce the incidence and severity of hypotension during cesarean section under spinal anesthesia.

  17. 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

  18. 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.

  19. 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

  20. 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

  1. Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

    PubMed Central

    Kulkarni, Kalpana Rajendra; Naik, Amruta Girish; Deshpande, Sunetra Girish

    2016-01-01

    Background: Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia. Aims: We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section. Methods: A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to group P (n=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (n=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied and P < 0.05 was considered as significant. Results: Incidence of hypotension within 20 minutes of spinal anesthesia was significantly less in group E (28%) as compared to group P (58%) and need of rescue doses were more in group P. Adverse events like nausea vomiting and shivering were less in group E. Apgar score were better in group E than in group P delivered babies. Conclusion: Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery. PMID:27746565

  2. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section.

    PubMed

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

    2012-09-01

    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.

  3. [Parietal-scar endometriosis after cesarean section: a rare entity].

    PubMed

    El Fahssi, Mohammed; Lomdo, Massama; Bounaim, Ahmed; Ali, Abdelmounaim Ait; Sair, Khalid

    2016-01-01

    Wall endometriosis is a rare clinical entity whose pathophysiology remains unclear. It occurs most frequently after gynecologic or obstetric surgery. We report the case of a patient with cyclic pain at the caesarean section scar. Clinical examination showed a 5 cm mass in the right iliac fossa. Tomodensitometry revealed a tissue density mass (45mm on the major axis). Hence, the decision to perform a wide excision of the lesion. Anatomo-pathological examination confirmed the diagnosis of parietal endometriosis. Postoperative sequelae were simple with a follow-up period of 20 months with no recurrence of the mass or of the pain. Our study highlights the characteristics of this disease to allow the health practitioner to understand the importance of diagnosis, of early treatment of this disease as well as of the possibility to prevent it during each gynecologic or obstetric surgery. PMID:27642418

  4. 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

  5. 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

  6. Effect of Social Factors on Cesarean Birth in Primiparous Women: A Cross Sectional Study (Social Factors and Cesarean Birth)

    PubMed Central

    ONER, Can; CATAK, Binali; SÜTLÜ, Sevinç; KILINÇ, Selçuk

    2016-01-01

    Background: P Cesarean delivery rates have been increasing throughout the world. Parallel to the developments in the world the cesarean rate in Turkey has risen to 48.1% in 2013. Some of the social factors were related with cesarean births. The purpose of this study was to determine cesarean birth rates and to find out social factors affecting the cesarean birth in primiparous women. Methods: This study was conducted in Burdur Province, Turkey between the dates of 1 Jan 2012–31 Dec 2012 on 223 primiparous women. The data was collected with data collection form prepared by the researchers by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used. Results: In multivariate analyses, the place of delivery (OR: 11.2 [2.9–42.46] in private hospital and OR: 6.1 [2.6–14.1] in university hospital); time of the birth (OR: 7.1 [3.1–16.0]); doctor’s effect (OR: 4.0 [1.8–8.95]) and husband’s employment status (OR: 2.23 [1.0–4.7]) have been identified as factors affecting the caesarean delivery in primiparous women. Conclusion: Although the results do not show all of the factors affecting the caesarean delivery in primiparous women, they reveal that medical reasons are not the only reason in this increase trend. Health policy makers and health professionals are required to identify the causes of this increase and to take measures.

  7. Effect of Social Factors on Cesarean Birth in Primiparous Women: A Cross Sectional Study (Social Factors and Cesarean Birth)

    PubMed Central

    ONER, Can; CATAK, Binali; SÜTLÜ, Sevinç; KILINÇ, Selçuk

    2016-01-01

    Background: P Cesarean delivery rates have been increasing throughout the world. Parallel to the developments in the world the cesarean rate in Turkey has risen to 48.1% in 2013. Some of the social factors were related with cesarean births. The purpose of this study was to determine cesarean birth rates and to find out social factors affecting the cesarean birth in primiparous women. Methods: This study was conducted in Burdur Province, Turkey between the dates of 1 Jan 2012–31 Dec 2012 on 223 primiparous women. The data was collected with data collection form prepared by the researchers by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used. Results: In multivariate analyses, the place of delivery (OR: 11.2 [2.9–42.46] in private hospital and OR: 6.1 [2.6–14.1] in university hospital); time of the birth (OR: 7.1 [3.1–16.0]); doctor’s effect (OR: 4.0 [1.8–8.95]) and husband’s employment status (OR: 2.23 [1.0–4.7]) have been identified as factors affecting the caesarean delivery in primiparous women. Conclusion: Although the results do not show all of the factors affecting the caesarean delivery in primiparous women, they reveal that medical reasons are not the only reason in this increase trend. Health policy makers and health professionals are required to identify the causes of this increase and to take measures. PMID:27648420

  8. Cesarean section

    MedlinePlus

    ... dilate to 10 centimeters If the mother has placenta previa, where the placenta is blocking the birth canal If there are ... about 20 minutes. Afterward, the physician delivers the placenta and stitches up the incisions in the uterus ...

  9. 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 ...

  10. 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

  11. The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006

    PubMed Central

    2011-01-01

    Background In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015. Objective To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality. Methods Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05. Results Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal

  12. 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

  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. 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

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

    PubMed

    Kim, Na Eun; Lee, Jae Hyuk; Chung, In Sun; Lee, Jun Yong

    2016-06-01

    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

  16. 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

  17. Chylothorax as a rare complication of acute pancreatitis in a 25-year-old woman after cesarean section.

    PubMed

    Smędra, A; Barzdo, M; Krupińska, J; Klemm, J; Machała, W; Szram, S; Berent, J

    2015-01-01

    The paper presents the case of a 25-year-old woman who underwent cesarean section for gynecological indications in the 37(th) week of her second pregnancy. The perioperative course was uncomplicated, but one day later the general condition of the patient suddenly deteriorated: she developed respiratory disorders requiring intubation and treatment in an intensive care unit. On the 6(th) day after the surgery, the patient was diagnosed with acute pancreatitis. Appropriate conservative treatment was instituted, resulting in a gradual improvement of her condition. On the 13(th) postoperative day, a cardiac arrest in asystole occurred, with no response to the undertaken resuscitation procedures. An autopsy performed in the Department of Forensic Medicine in Łódź revealed, among other findings, acute pancreatitis with enzymatic necrosis of the adipose tissue, a significant accumulation of lymph in both pleural cavities, and pulmonary atelectasis. As demonstrated by the analysis of the case, chylothorax had most probably developed in the course of acute pancreatitis which was a complication of the cesarean section. Consequently, the prosecutor opened an investigation into the case under Article 155 of the Polish Penal Code to assess the appropriateness of medical management. The medico-legal opinion was issued by experts from outside the Department of Forensic Medicine in Łódź. In their view, the medical management of the patient was correct.

  18. 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

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

    ClinicalTrials.gov

    2016-10-17

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

  20. 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

  1. [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

  2. [Case of lymphangioleiomyomatosis (LAM) discovered during cesarean section under spinal anesthesia].

    PubMed

    Nakanishi, Mika; Okura, Nahomi; Kashii, Tomoko; Matsushita, Mitsuji; Mori, Masanobu; Yoshida, Masayo; Tsujimura, Shigehisa

    2014-02-01

    We experienced a case of scheduled cesarean section under spinal anesthesia in a patient with LAM which had been missed in spite of preoperative medical examination and consultation with specialists but discovered because of perioperative hypoxia A 35-year-old woman, Gravida 1 Para 0, with breech presentation was scheduled to undergo cesarean section under spinal anesthesia at 38 weeks of gestation. She had no history of asthma or abnormal findings at annual medical examination. She had suffered from dry cough and nocturnal dyspnea for 7 weeks and an inhaled bronchodilator was administered with diagnosis of inflammatory airway disease by her respiratory physicians. Spinal anesthesia was performed with bupivacaine 12.5 mg. At the beginning of anesthesia SPO2 was 97% in supine position, but it rapidly decreased to less than 90% and 3 l x min(-1) oxygen was supplied with a facial mask. The anesthetic level was thoracal 4 bilaterally and her breathing was stable. The circulatory state, Apgar score and other vital signs were within normal ranges. Postoperative chest X-ray showed bilateral numerous grained spots and computed tomography scans showed multiple thin-walled cysts. The characteristic history and the fluoroscopic data gave her clinical diagnosis of LAM. PMID:24601117

  3. [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.

  4. Apgar score after induction of anesthesia for canine cesarean section with alfaxalone versus propofol.

    PubMed

    Doebeli, A; Michel, E; Bettschart, R; Hartnack, S; Reichler, I M

    2013-11-01

    The effects of alfaxalone and propofol on neonatal vitality were studied in 22 bitches and 81 puppies after their use as anesthetic induction agents for emergency cesarean section. After assessment that surgery was indicated, bitches were randomly allocated to receive alfaxalone 1 to 2 mg/kg body weight or propofol 2 to 6 mg/kg body weight for anesthetic induction. Both drugs were administered intravenously to effect to allow endotracheal intubation, and anesthesia was maintained with isoflurane in oxygen. Neonatal vitality was assessed using a modified Apgar score that took into account heart rate, respiratory effort, reflex irritability, motility, and mucous membrane color (maximum score = 10); scores were assigned at 5, 15, and 60 minutes after delivery. Neither the number of puppies delivered nor the proportion of surviving puppies up to 3 months after delivery differed between groups. Anesthetic induction drug and time of scoring were associated with the Apgar score, but delivery time was not. Apgar scores in the alfaxalone group were greater than those in the propofol group at 5, 15, and 60 minutes after delivery; the overall estimated score difference between the groups was 3.3 (confidence interval 95%: 1.6-4.9; P < 0.001). In conclusion, both alfaxalone and propofol can be safely used for induction of anesthesia in bitches undergoing emergency cesarean section. Although puppy survival was similar after the use of these drugs, alfaxalone was associated with better neonatal vitality during the first 60 minutes after delivery.

  5. 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

  6. Transvaginal Management of Cesarean Scar Section Diverticulum: A Novel Surgical Treatment

    PubMed Central

    Chen, Yuqing; Chang, Yajie; Yao, Shuzhong

    2014-01-01

    Background The aim of this study was to investigate the clinical value of transvaginal management of cesarean section scar diverticulum. Material/Methods We evaluated 64 patients receiving transvaginal management of previous cesarean scar defect (PCSD). Results The PCSD was successfully treated by transvaginal surgery, without evident complications. The mean operation time was 33.6±4.1 min, blood loss was 37.9±16.8 ml, and the mean hospital stay after surgery was 6±2.9 days. Symptoms related to the prolonged menstruation in 53 patients were improved after surgery, vaginal bleeding time was reduced by an average of 7.3±2.8 days, and a significant difference was noted between the mean pre- and post-operative duration of menstruation (P<0.01). Of 11 patients with guttate between menstrual periods, guttate was absent in 9 patients and improved in 2. Clinical improvement was observed in 85.9% (55/64). Conclusions Transvaginal intervention is feasible and safe for the management of PCSD. PMID:25104647

  7. [Chemical peritonitis after a bladder lesion during a cesarean section. A case report and literature review].

    PubMed

    Castro-Cuenca, Alejandro; Ángel-Muller, Edith; González-Carrillo, Viviana Andrea

    2015-02-01

    This paper reviews the case of a patient who underwent a cesarean surgery and re-entered with an oral way intolerance, postprandial emesis, abdominal pain and clear-fluid exit from surgical wound. After possible bladder injury and secondary chemistry peritonitis, the patient was taken to surgery where the diagnosis was confirmed, and the correction of bladder injury as well as peritoneal lavage were performed, it antibiotic therapy for three days and the patient had satisfactory evolution. Bladder injury is a rare complication of cesarean section with an estimated incidence between 0.0016 and 0.94%; but if it is not diagnosed intraoperative it can trigger a clinical setting of secondary chemical peritonitis, due to secondary irritation of the peritoneum. Chemical peritonitis is among the classification of secondary peritonitis. Within the pathophysiology, the mechanical, chemical or bacterial stimulus generates an inflammatory reaction, with progressive generation of exudate, leukocytes and fibrin deposit, which injure mesothelial cells, disrupt the defense and maintenance of peritoneal homeostasis, triggering serious complications, which can lead to multiple organ failure and death. The chemical peritonitis should be suspected with the clinical setting and the risk factors of recent surgical history and timely management should be instituted properly with correction of the cause, antimicrobial treatment, blood volume therapy and nutritional support, which leads to a favorable outcome for the patient and improves survival with fewer complications. PMID:25993776

  8. [Chemical peritonitis after a bladder lesion during a cesarean section. A case report and literature review].

    PubMed

    Castro-Cuenca, Alejandro; Ángel-Muller, Edith; González-Carrillo, Viviana Andrea

    2015-02-01

    This paper reviews the case of a patient who underwent a cesarean surgery and re-entered with an oral way intolerance, postprandial emesis, abdominal pain and clear-fluid exit from surgical wound. After possible bladder injury and secondary chemistry peritonitis, the patient was taken to surgery where the diagnosis was confirmed, and the correction of bladder injury as well as peritoneal lavage were performed, it antibiotic therapy for three days and the patient had satisfactory evolution. Bladder injury is a rare complication of cesarean section with an estimated incidence between 0.0016 and 0.94%; but if it is not diagnosed intraoperative it can trigger a clinical setting of secondary chemical peritonitis, due to secondary irritation of the peritoneum. Chemical peritonitis is among the classification of secondary peritonitis. Within the pathophysiology, the mechanical, chemical or bacterial stimulus generates an inflammatory reaction, with progressive generation of exudate, leukocytes and fibrin deposit, which injure mesothelial cells, disrupt the defense and maintenance of peritoneal homeostasis, triggering serious complications, which can lead to multiple organ failure and death. The chemical peritonitis should be suspected with the clinical setting and the risk factors of recent surgical history and timely management should be instituted properly with correction of the cause, antimicrobial treatment, blood volume therapy and nutritional support, which leads to a favorable outcome for the patient and improves survival with fewer complications.

  9. 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

  10. Prolonged Paralysis Following Emergent Cesarean Section with Succinylcholine Despite Normal Dibucaine Number.

    PubMed

    Ellison, Matthew; Grose, Brian; Howell, Stephen; Wilson, Colin; Lenz, Jackson; Driver, Richard

    2016-01-01

    Prolonged paralysis due to a quantitative or qualitative deficiency of pseudocholinesterase activity is an uncommon but known side effect of succinylcholine. We describe a patient who experienced prolonged paralysis following administration of succinylcholine for general anesthesia and endotracheal intubation for an emergent cesarean section despite laboratory evidence of normal enzyme function. The patient required mechanical ventilation in the intensive care unit for several hours following surgery. The patient was extubated following return of full muscle strength and had a good outcome. The enzyme responsible for the metabolism of succinylcholine, pseudocholinesterase, was determined to be low in quantity in this patient but was functionally normal. This low level, by itself, was unlikely to be solely responsible for the prolonged paralysis. The patient likely had an abnormal pseudocholinesterase enzyme variant that is undetectable by standard laboratory tests. PMID:27025119

  11. [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.

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

    PubMed

    Moon, Kyoung Min; Han, Min Soo; 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.

  13. 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

  14. Attributable Costs of Surgical Site Infection and Endometritis After Low Transverse Cesarean Section

    PubMed Central

    Olsen, Margaret A.; Butler, Anne M.; Willers, Denise M.; Gross, Gilad A.; Hamilton, Barton H.; Fraser, Victoria J.

    2012-01-01

    BACKGROUND Accurate data on costs attributable to hospital-acquired infections are needed in order to determine their economic impact and the cost-benefit of potential preventive strategies. OBJECTIVE Determine the attributable costs of surgical site infection (SSI) and endometritis (EMM) after cesarean section using two different methods. DESIGN Retrospective cohort. SETTING Barnes-Jewish Hospital, a 1250-bed academic tertiary care hospital. PATIENTS 1,605 women who underwent low transverse cesarean section from 7/1999 – 6/2001. METHODS Attributable costs of SSI and EMM were determined by generalized least squares (GLS) and propensity score matched-pairs using administrative claims data to define underlying comorbidities and procedures. For the matched-pairs analyses, uninfected control patients were matched to patients with SSI or with EMM based on their propensity to develop infection, and the median difference in costs calculated. RESULTS The attributable total hospital cost of SSI calculated by GLS was $3,529 and by propensity score matched-pairs was $2,852. The attributable total hospital cost of EMM calculated by GLS was $3,956 and by propensity score matched-pairs was $3,842. The majority of excess costs were associated with room and board and pharmacy costs. CONCLUSIONS The costs of SSI and EMM were lower than SSI costs reported after more extensive operations. The attributable costs of EMM calculated using the two methods were very similar, while the costs of SSI calculated using propensity score matched-pairs were lower than the costs calculated by GLS. The difference in costs determined by the two methods needs to be considered by investigators performing cost analyses of hospital-acquired infections. PMID:20102279

  15. Comparison of Costs of Surgical Site Infection and Endometritis after Cesarean Section Using Claims and Medical Record Data

    PubMed Central

    Olsen, Margaret A.; Butler, Anne M.; Willers, Denise M.; Gross, Gilad A.; Fraser, Victoria J.

    2012-01-01

    We used administrative and clinical data from a case-control study to calculate the costs of surgical site infection and endometritis after cesarean section. Attributable costs determined by generalized least squares with the two data sources were similar, suggesting that administrative data can be used to calculate infection costs. PMID:20583923

  16. Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia

    PubMed Central

    Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Wiryana, Made; Aribawa, I Gusti Ngurah Mahaalit; Aryabiantara, I Wayan; Hartawan, I Gusti Agung Gede Utara; Sinardja, I Ketut; Suarjaya, I Putu Pramana; Nada, I Ketut Wibawa; Jaya, AA Gde Putra Semara

    2016-01-01

    Purpose Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia. Patients and methods Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively. Results Elevation of CRP stress response was lower in the KET group and significantly different (P≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (P>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (P>0.05), but there was a statistically significant (P≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively. Conclusion Low-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia. PMID:27703393

  17. Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section

    PubMed Central

    Nikooseresht, Mahshid; Seif Rabiei, Mohamad Ali; Hajian, Pooran; Dastaran, Razieh; Alipour, Nasim

    2016-01-01

    Background Despite controversies about the safest anesthetic technique for cesarean delivery in severely preeclamptic women, there is evidence that supports the use of spinal anesthesia in this group of patients. Objectives This prospective randomized clinical trial was designed to determine the hemodynamic effects of low-dose spinal bupivacaine and the incidence of spinal anesthesia-associated hypotension in severely preeclamptic and healthy parturients undergoing cesarean sections. Patients and Methods Spinal anesthesia was performed with 10 mg (= 2 mL) hyperbaric 0.5% bupivacaine plus 2.5 µg sufentanil in two groups of patients after they received 500 mL of IV lactated Ringer’s solution. Heart rate and blood pressure were recorded before spinal anesthesia and at two minutes intervals for 15 minutes after the block, and then every five minutes until the end of the surgery. Hypotension was defined as more than 25% of decline in the mean arterial blood pressure compared to the baseline in both groups (or systolic blood pressure < 100 mmHg in healthy parturients) and was treated with 5 mg IV ephedrine. The total amounts of intravenous administered fluid and the total doses of ephedrine were recorded for each patient as well. Results The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients, despite the former group receiving smaller volumes of intravenous fluids (P < 0.05). The total doses of IV ephedrine for treating hypotension were significantly lower among the preeclamptic patients (3.2 mg in preeclamptic patients versus 7.6 mg in normotensive patients) (P = 0.02). The one-minute Apgar score was significantly lower for the preeclamptic parturients (8.4 ± 0.7 versus 7.2 ± 1.5) (P = 0.001), but there was no significant difference in the five-minute Apgar scores between the two groups. Conclusions Our results confirm that low-dose bupivacaine spinal anesthesia is associated with a lower risk of hypotension

  18. Short-term and long-term outcomes of ewes and their offspring after elective cesarean section.

    PubMed

    Waage, Steinar; Wangensteen, Guri

    2013-02-01

    Postoperative outcomes of animals that have undergone cesarean delivery have been reported previously; however, in most studies results were influenced by a combination of surgery per se and the preoperative condition of the animal, which was frequently impaired because of the presence of dystocia. To evaluate the effects of the cesarean section itself we conducted a matched cohort study comparing postpartum complications and future reproductive performance of 162 ewes subjected to elective cesarean section and 162 ewes that had an unassisted vaginal delivery. Survival and subsequent growth of their lambs were also compared. Effect of mode of delivery on weight gain was estimated using linear mixed models. Case ewes, which underwent surgery during the period from 1996 through 2004, and control ewes were from the flock at the Animal Production Experimental Centre, Norway. Two ewes (1.2%) that underwent cesarean section died; one developed peritonitis and the other experienced uterine prolapse and did not recover. Postoperatively, four ewes suffered from metritis, three suffered a wound infection, and four a delayed wound healing; all recovered after treatment. One of the ewes that delivered vaginally died 3 days after lambing. The incidences of fetal and postnatal deaths did not differ significantly between the cesarean and the vaginal delivery groups (fetal deaths, 3.5% and 3.1%, and postnatal deaths, 9.9% and 7.1%, respectively). Survival rates and weight gains of the lambs the subsequent months were similar for the two groups. Seventy percent of the ewes that had a cesarean section and 72% of those that had a vaginal delivery were bred the next season; conception rates were 89% and 90%, respectively. However, the ewes subjected to surgery the previous year gave birth to significantly fewer live-born lambs (mean, 1.64) than those that had had a vaginal delivery (1.93). The difference was the result of a reduced litter size and an increased number of fetal deaths

  19. 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

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

    PubMed

    Daniel, J A; Carroll, J A; Keisler, D H; Kojima, C J

    2008-07-01

    Full term crossbred sows were selected to study the interaction of the immune system, hypothalamus-pituitary-adrenal axis, and growth in pigs born by Cesarean section (c-section; n=4 sows) or vaginal birth (n=4 sows). Gestation length and birth weight did not differ between vaginal birth and c-section pigs (P=0.34 and 0.62, respectively). Blood and tissue samples were collected from 44 pigs at birth. Forty-five pigs were weaned at 13 d. On d 14, pigs received an i.p. injection of lipopolysaccaride (LPS; 150 microg/kg) or saline at min 0, and blood samples were collected at -20, -10, 0, 5, 10, 20, 40, 60, 90, and 120 min. Vaginal birth pigs had 21% greater average daily gain than c-section pigs on d 14 (P<0.01). Basal serum concentrations of adrenocorticotrophin (ACTH) and cortisol were greater in c-section than vaginal birth pigs at birth (P<0.01) but were not different at 14 d (P=0.99 and 0.80, respectively). LPS increased serum concentrations of ACTH, cortisol, interferon-gamma (IFN-gamma), and tumor necrosis factor-alpha (TNF-alpha; P<0.01) but the response was not different between c-section and vaginal birth (P>0.22). Basal serum concentrations of TNF-alpha tended to be greater in c-section vs vaginal birth pigs at 14 d (P=0.0967); however, basal serum concentrations of IFN-gamma tended to be lower in c-section pigs vs vaginal birth pigs at 14 d (P=0.0787). Expression of interleukin (IL)-6, IL-6 receptor, IL-1beta, and TNF-alpha mRNA did not differ between vaginal birth and c-section pigs but changed in an age and tissue dependent manner. Thus, reduced growth rate of c-section pigs is associated with altered immune system function.

  1. Anesthetic management of a patient with multiple sclerosis undergoing cesarean section with low dose epidural bupivacaine

    PubMed Central

    Sethi, Sameer; Kapil, Sonia

    2014-01-01

    A 32-year-old Indian female 38 weeks pregnant, with a history of multiple sclerosis since 2008 was admitted in obstetric ward for safe confinement. She had a history of diminution of vision in both eyes and limb weakness, relapsing – remitting type with movement-induced muscle spasms, in all the four limbs. Her symptoms were usually diplopia, difficulty in vision and ataxic gait. Sh was then treated with methylprednisolone. She was on oral dimethyl fumarate trial, which was stopped at the beginning of pregnancy. Presently, she was completely asymptomatic. Epidural anesthesia with an indwelling catheter was administered with 15 ml of 0.25% bupivacaine in 5 ml increments. A total of 3 mg of epidural morphine was given for post-operative analgesia. The surgery evolved without any intercurrences and patient was discharged from the hospital 72 h after surgery without worsening of her symptoms. We report a safe anesthetic management of a patient with MS undergoing cesarean section with low dose epidural bupivacaine with the addition of morphine for post-operative analgesia. PMID:25191198

  2. Elective cesarean section and induction and their impact on late preterm births.

    PubMed

    Fuchs, Karin; Wapner, Ronald

    2006-12-01

    At all gestational ages, the risks of continuing a pregnancy must be carefully balanced against the risks of delivery and the associates risk of prematurity. This concept is of increasing importance in late preterm pregnancy when medical or obstetric complications frequently warrant delivery and the risk of prematurity persists. Given that morbidity exists for infants born between 34 and 37 weeks gestations, efforts should be focused on minimizing the late preterm birth rate and at improving the outcome of these infants. Published guidelines outlining the appropriate timing of elective induction of labor and elective Cesarean section should be closely followed to avoid unintended iatrogenic prematurity. Research should continue to investigate the etiology of spontaneous preterm deliveries and aim to develop strategies of primary prevention. The incidence and etiology of iatrogenic late preterm birth should also be further investigated and alternative management strategies should be considered. To gain information about the impact of elective delivery on late preterm births, the data collected from birth records should reflect the changing obstetric practices in the United States and be revised to include specific information on elective deliveries.

  3. 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

  4. The impact of nalmefene on side effects due to intrathecal morphine at cesarean section.

    PubMed

    Pellegrini, J E; Bailey, S L; Graves, J; Paice, J A; Shott, S; Faut-Callahan, M

    2001-06-01

    Nalmefene is a long-acting opioid antagonist that provides long-term relief from side effects of intrathecal morphine sulfate. A randomized, double-blind, placebo-controlled study was conducted to determine whether prophylactic nalmefene could decrease side effects of intrathecal morphine given during cesarean section, without affecting analgesia. Sixty parturients were given 0.25 mg of intrathecal morphine, 12.5 micrograms of fentanyl, and 11.25 to 15 mg of bupivacaine. A dose of 0.25 microgram/kg of nalmefene or placebo was given by intravenous piggyback immediately after delivery of the neonate. Nausea, vomiting, pruritus, and level of sedation were assessed for a 24-hour period using a 4-point ordinal scoring system. Pain was assessed by using a 0- to 10-point verbal analogue scale. A 5-point analgesic satisfaction survey also was completed. Subjects who received nalmefene required supplemental analgesia at a median of 6.00 hours after intrathecal morphine, compared with 14.12 hours in the placebo group (P = .037). No differences were found between the groups in the incidence of pruritus, nausea and vomiting, level of sedation, or analgesic satisfaction. We concluded that nalmefene at a dose of 0.25 microgram/kg does not decrease the incidence of side effects but increases the need for supplemental analgesics.

  5. [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

  6. Effect of spinal anesthesia for elective cesarean section on cerebral blood oxygenation changes: comparison of hyperbaric and isobaric bupivacaine.

    PubMed

    Kondo, Yuko; Sakatani, Kaoru; Hirose, Noriya; Maeda, Takeshi; Kato, Jitsu; Ogawa, Setsuro; Katayama, Yoichi

    2013-01-01

    We used near-infrared spectroscopy (NIRS) to evaluate cerebral blood oxygenation changes in subjects undergoing cesarean section under spinal anesthesia (SP) with hyperbaric bupivacaine (group H, 27 subjects) or isobaric bupivacaine (group I, 15 subjects). In group H, total-Hb, oxy-Hb, and mean blood pressure (MBP) within 20 min after SP were significantly lower than the baseline values. In contrast, there was no significant change from baseline in total-Hb, oxy-Hb, or MBP in group I after SP. Total-Hb and MBP in group H were significantly lower than those in group I within 10 min after SP. There was no significant change of deoxy-Hb, tissue oxygen index, or heart rate from baseline in either of the groups. These results suggest that isobaric bupivacaine may be superior to hyperbaric bupivacaine for preventing a decrease of maternal cerebral blood flow after SP for cesarean section.

  7. 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

  8. 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

  9. 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

  10. Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?

    PubMed Central

    Kinay, Tugba; Basarir, Zehra O.; Tuncer, Serap F.; Akpinar, Funda; Kayikcioglu, Fulya; Koc, Sevgi; Karakaya, Jale

    2016-01-01

    Objectives: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. Methods: We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. Results: In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding. Conclusion: A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors. PMID:27464864

  11. Oxygen Supplementation is Effective in Attenuating Maternal Cerebral Blood Deoxygenation After Spinal Anesthesia for Cesarean Section.

    PubMed

    Hirose, Noriya; Kondo, Yuko; Maeda, Takeshi; Suzuki, Takahiro; Yoshino, Atsuo; Katayama, Yoichi

    2016-01-01

    The purpose of this study was to measure changes in maternal cerebral blood oxygenation using near-infrared spectroscopy (NIRS) for 15 min after spinal anesthesia performed for cesarean section, and to determine the efficacy of supplemental oxygen in maintaining maternal cerebral blood oxygenation. Thirty patients were randomly assigned to either receive 100% oxygen via a facemask at a constant flow rate of 3 l/min throughout the study (O2 group), or were evaluated without supplemental oxygen (Air group). Changes in cerebral blood oxygenation were evaluated using the following parameters: oxy-hemoglobin (Hb), deoxy-Hb, and total-Hb concentrations, as well as tissue oxygen index (TOI), measured over the forehead by NIRS. Mean arterial pressure (MAP) and heart rate (HR) were also recorded throughout the study. Mean oxy-Hb, total-Hb, TOI, and MAP in both groups decreased significantly from baseline values (P<0.05). The reduction in oxy-Hb and TOI in the Air group was significantly greater than that in the O2 group (oxy-Hb: -4.72 vs. -2.96 μmol/l; P<0.05, TOI: -6.82 vs. -1.68%; P<0.01); however, there were no significant differences in the reduction of total-Hb and MAP between the groups. Mean deoxy-Hb in the Air group was significantly higher than that in the O2 group (0.02 vs. -1.01 μmol/l; P<0.05). The results of the present study demonstrate that oxygen supplementation attenuates cerebral blood deoxygenation secondary to the reduction in cerebral blood flow following spinal anesthesia.

  12. 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

  13. The safety of cesarean myomectomy in women with large myomas

    PubMed Central

    Kwon, Dam Hye; Yoon, Kyung Ran; Lee, Keun Young

    2014-01-01

    Objective To evaluate the safety of cesarean myomectomy in large myomas sized >5 cm. Methods One hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups. Results There were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance. Conclusion Cesarean myomectomy in patients with large myomas is a safe and effective procedure. PMID:25264526

  14. 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

  15. 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

  16. 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

  17. 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

  18. Effects of Adding Midazolam and Sufentanil to Intrathecal Bupivacaine on Analgesia Quality and Postoperative Complications in Elective Cesarean Section

    PubMed Central

    Abdollahpour, Abolfazl; Azadi, Raheleh; Bandari, Razieh; Mirmohammadkhani, Majid

    2015-01-01

    Background: Intrathecal adjutants can be used for regional anesthesia (RA) in cesarean section to improve its quality in terms of time and complications. Some previous studies focused on the effects of adding sufentanil and/or midazolam to bupivacaine and compared each with using bupivacaine alone. However, there has been no study to assess the effects of using sufentanil and midazolam in combination with bupivacaine. Objectives: The aim of this study was to evaluate and compare properties (time of achievement/recovery of sensory/motor blocks; and time to request opium), complications (nausea, vomiting, shivering and hypotension), and neonatal first minute Apgar score with and without the addition of midazolam (M) or sufentanil (S) to bupivacaine (B) through intrathecal injection for spinal anesthesia, after the cesarean section. Patients and Methods: In this double blind randomized clinical trial participants were randomly allocated to three equal groups: Group B (2.5 cc of bupivacaine 0.5% + 1 cc normal saline 0.9%), Group BM (2.5 cc of bupivacaine + 0.02 mg/kg midazolam) and Group BS (2.5 cc of bupivacaine 0.5% + 0.7 cc normal saline 0.9% + 1.5 µg of sufentanil, 0.3 cc). We used analysis of variance (ANOVA), post hoc test with Bonferroni adjustment, and chi-square test for statistical analysis; the analyses were performed using the SPSS-16 software. Given a significant level of 0.05, overall and pair-wise comparisons were made. Results: Seventy-five females participated in the study with no significant age difference (mean ± standard deviation (SD): 28.60 ± 6.06, 28.12 ± 5.29 and 28.76 ± 3.97 year; P = 0.9). Except for “time to motor block recovery” (P = 0.057), the overall differences among the three groups was significant in terms of “time to sensory/motor block” (P < 0.001), “time to sensory block recovery” (P < 0.001), and “time to request opium” (P < 0.001). In all pair-wise comparisons there was no significant difference between the BM

  19. Inadvertent venous air embolism during cesarean section: collapsible intravenous fluid bags without self-sealing outlet have risks. Case report.

    PubMed

    Bakan, Mefkur; Topuz, Ufuk; Esen, Asim; Basaranoglu, Gokcen; Ozturk, Erdogan

    2013-01-01

    The anesthesiologist must be aware of the causes, diagnosis and treatment of venous air embolism and adopt the practice patterns to prevent its occurrence. Although venous air embolism is a known complication of cesarean section, we describe an unusual inattention that causes iatrogenic near fatal venous air embolism during a cesarean section under spinal anesthesia. One of the reasons for using self-collapsible intravenous (IV) infusion bags instead of conventional glass or plastic bottles is to take precaution against air embolism. We also demonstrated the risk of air embolism for two kinds of plastic collapsible intravenous fluid bags: polyvinyl chloride (PVC) and polypropylene-based. Fluid bags without self-sealing outlets pose a risk for air embolism if the closed system is broken down, while the flexibility of the bag limits the amount of air entry. PVC-based bags, which have more flexibility, have significantly less risk of air entry when IV administration set is disconnected from the outlet. Using a pressure bag for rapid infusion can be dangerous without checking and emptying all air from the IV bag.

  20. Inadvertent venous air embolism during cesarean section: Collapsible intravenous fluid bags without self-sealing outlet have risks. Case report.

    PubMed

    Bakan, Mefkur; Topuz, Ufuk; Esen, Asim; Basaranoglu, Gokcen; Ozturk, Erdogan

    2013-01-01

    The anesthesiologist must be aware of the causes, diagnosis and treatment of venous air embolism and adopt the practice patterns to prevent its occurrence. Although venous air embolism is a known complication of cesarean section, we describe an unusual inattention that causes iatrogenic near fatal venous air embolism during a cesarean section under spinal anesthesia. One of the reasons for using self-collapsible intravenous (IV) infusion bags instead of conventional glass or plastic bottles is to take precaution against air embolism. We also demonstrated the risk of air embolism for two kinds of plastic collapsible intravenous fluid bags: polyvinyl chloride (PVC) and polypropylene-based. Fluid bags without self-sealing outlets pose a risk for air embolism if the closed system is broken down, while the flexibility of the bag limits the amount of air entry. PVC-based bags, which have more flexibility, have significantly less risk of air entry when IV administration set is disconnected from the outlet. Using a pressure bag for rapid infusion can be dangerous without checking and emptying all air from the IV bag.

  1. Physician-led, hospital-linked, birth care centers can decrease Cesarean section rates without increasing rates of adverse events

    PubMed Central

    O’Hara, Margaret H.; Frazier, Linda M.; Stembridge, Travis W.; McKay, Robert S.; Mohr, Sandra N.; Shalat, Stuart L.

    2015-01-01

    BACKGROUND This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service. METHODS Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998–2005. RESULTS Compared to hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk =0.73, 95 percent confidence interval 0.59–0.91; p<0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk=1.04, 95 percent confidence interval 0.97–1.13; p=0.25) and a higher initiation of breast feeding (adjusted Relative Risk = 1.28, 95 percent confidence interval 1.25–1.30 (p=<0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk =0.60, 95 percent confidence interval 0.55–0.66; p<0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center. CONCLUSION A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes. PMID:24635500

  2. The effects of religion and spirituality on postoperative pain, hemodynamic functioning and anxiety after cesarean section.

    PubMed

    Beiranvand, Siavash; Noparast, Morteza; Eslamizade, Nasrin; Saeedikia, Saeed

    2014-01-01

    Spiritual elements play an important role in the recovery process from acute postoperative pain. This study was conducted to assess the effect of pray meditation on postoperative pain reduction and physiologic responds among muslim patients who underwent cesarean surgery under spinal anesthesia. This double-blinded randomized clinical trial study was conducted among muslim patients who underwent cesarean surgery under spinal anesthesia during 2011-2013 at tertiary regional and teaching hospital in Lorestan, Iran. The patients were randomly divided into interventional group (n=80) and control group (n=80). For about 20 minutes using a disposable phone mentioned and listened to pray meditation "Ya man esmoho davaa va zekroho shafa, Allahomma salle ala mohammad va ale mohammad" in interventional group and phone off in control group. Before and during pray meditation, 30, 60 minutes, 3 and 6 hours after pray meditation pain intensity, blood pressure, heart rate and respiratory rate were measured. No statistically significant improvement in pain score was found before and during pray meditation, 30, 60 minutes after pray meditation (P>0.05). Statistically significant improvement in pain score was found at 3 and 6 hours after pray meditation than control group (1.5 ± 0.3 vs. 3 ± 1.3, P=0.030) and (1.3 ± 0.8 vs. 3 ± 1.1, P=0.003). However, there was no significant difference in the physiological responses (systolic and diastolic blood pressure, respiration, and heart rate) any time between the groups. Religion and spirituality intervention such as pray meditation could be used as one of non-pharmacological pain management techniques for reducing pain after cesarean surgery. Also, Pray meditation provides less postoperative nausea and vomiting (PONV) and more relaxation. PMID:25530054

  3. 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

  4. 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

  5. An operation for evangelization: Friar Francisco González Laguna, the cesarean section, and fetal baptism in late colonial Peru.

    PubMed

    Warren, Adam

    2009-01-01

    By publishing a medical-theological treatise in 1781, Friar Francisco González Laguna of Lima initiated a campaign to train Andean priests to perform postmortem cesarean sections for the purpose of baptizing the fetus. Linking González Laguna's text to European works on cesarean sections and Peruvian decrees ordering priests to train in surgery, this paper argues the friar saw the operation's utility as extending beyond saving unborn souls. Writing in the aftermath of indigenous and peasant uprisings, he argued the procedure constituted a tool for defeating the devil's presence in the Andes and carrying out evangelization, teaching parishioners by pious example. PMID:20061669

  6. 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

  7. 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.

  8. 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…

  9. 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

  10. [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.

  11. [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

  12. 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

  13. Case with pyoderma gangrenosum abruptly emerging around the wound of cesarean section for placenta previa with placenta accrete.

    PubMed

    Nonaka, Taro; Yoshida, Kunihiko; Yamaguchi, Masayuki; Aizawa, Atsuko; Fujiwara, Hiroshi; Enomoto, Takayuki; Takakuwa, Koichi

    2016-09-01

    A 39-year-old woman underwent emergency cesarean section (CS) due to placenta previa totalis with massive bleeding. Two major problems emerged in this patient after CS was carried out. One was partial retention of the placenta due to placenta accreta. Another major and more serious problem was pyoderma gangrenosum (PG) widely appearing at the skin of the abdomen around the CS wound. Conservative treatment was performed for the retained placenta, and it had completely disappeared by 76 days after the CS. The diagnosis of PG was promptly made in consultation with a plastic surgeon and a dermatologist when a wide ulcer emerged around the CS wound, and high-dose prednisolone was administered as treatment. At 90 days following the CS, near-complete epithelialization was achieved. This extremely rare case reflects the importance of rapid diagnosis and treatment of PG.

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

    PubMed

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

    2015-12-01

    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

  15. Cesarean section increases the risk of respiratory adaptive disorders in healthy late preterm and two groups of mature newborns.

    PubMed

    Offermann, H; Gebauer, C; Pulzer, F; Bläser, A; Thome, U; Knüpfer, M

    2015-12-01

    The rates of delivery by Cesarean section (CS) have been trending upwards in recent decades, perhaps leading to higher rates of dysfunction in respiratory adaptation in newborns. We present epidemiological data for pulmonary adaptation by mode of delivery for healthy late preterm and term infants born at a regional tertiary care center. The overall CS rate was 22% with the largest proportion of these in late preterms (39%). This drops to 30% in infants born after 37 weeks gestation and to 11% for those born after 40 weeks. Infants needing respiratory support decreased significantly as gestational age increased: 88% at 34 weeks, 67% at 35 weeks, 28% at 36 weeks, 17% at 37 weeks and 8% at 40 weeks. The risk of respiratory morbidity following CS as compared to vaginal delivery (VD) was substantially higher. 50% of infants born by CS needed respiratory support compared to only 12% following VD. 82% of all late preterm infants born by CS developed respiratory morbidity compared to 36% following VD. Comparable data for infants born after 37 and 40 weeks gestation were 33% compared to 9% and 26% compared to 6% respectively. Late preterm infants born after 36 weeks gestation showed the most marked difference by mode of birth with 66% needing respiratory support following CS as compared to only 9% following VD. Our data could be useful in counselling parents about risk associated with delivery by Cesarean section. A critical view should be taken of increasing CS rates worldwide because of a clear correlation in increased morbidity in infants, especially late preterm infants.

  16. 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.

  17. The effect of intravenous Dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial

    PubMed Central

    Shahraki, Azar Danesh; Feizi, Awat; Jabalameli, Mitra; Nouri, Shadi

    2013-01-01

    Objective: Any operation leads to body stress and tissue injury that causes pain and its complications. Glucocorticoids such as Dexamethasone are strong anti-inflammatory agents, which can be used for a short time post-operative pain control in various surgeries. Main purpose of this study is to evaluate the effect of administration of intravenous (IV) Dexamethasone on reducing the pain after cesarean. Methods: A double-blind prospective randomized clinical trial was performed on 60 patients candidate for elective caesarean section. Patients were randomly assigned into two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL normal saline). In both groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), pain and vomiting severity (based on visual analog scale) were recorded in different time points during first 24 h after operation. Statistical methods using repeated measure analysis of variances and t-test, Mann-Whitney and Chi-square tests were used for analyzing data. Findings: The results indicated that within-group comparisons including severity of pain, MAP, RR and HR have significant differences (P < 0.001 for all variables) during the study period. Between group comparisons indicated significant differences in terms of pain severity (P < 0.001), MAP (P = 0.048) and HR (P = 0.078; marginally significant), which in case group were lower than the control group. Conclusion: IV Dexamethasone could efficiently reduce post-operative pain severity and the need for analgesic consumption and improve vital signs after cesarean section. PMID:24991614

  18. Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off

    PubMed Central

    Barros, Aluísio J D; Santos, Iná S; Matijasevich, Alicia; Domingues, Marlos Rodrigues; Silveira, Mariângela; Barros, Fernando C; Victora, Cesar G

    2013-01-01

    OBJECTIVE To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries. METHODS All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing – either private or public healthcare (SUS) patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, χ2 tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used. RESULTS The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients. CONCLUSIONS C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor’s schedule. Drastic action is called for to change the current situation. PMID:21670862

  19. 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

  20. Oral administration of marine collagen peptides prepared from chum salmon (Oncorhynchus keta) improves wound healing following cesarean section in rats

    PubMed Central

    Wang, Junbo; Xu, Meihong; Liang, Rui; Zhao, Ming; Zhang, Zhaofeng; Li, Yong

    2015-01-01

    Background The goal of the present study was to investigate the wound-healing potential of marine collagen peptides (MCPs) from chum salmon skin administered to rats following cesarean section (CS). Methods Ninety-six pregnant Sprague-Dawley rats were randomly divided into four groups: a vehicle group and three MCP groups. After CS, rats were intragastrically given MCPs at doses of 0, 0.13, 0.38, 1.15 g/kg*bw, respectively. On postoperative days 7, 14, and 21, the uterine bursting pressure, skin tensile strength, hydroxyproline (Hyp) concentrations, and histological and immunohistochemical characteristics of the scar tissue were examined. Results In the MCP groups, the skin tensile strength, uterine bursting pressure, and Hyp were significantly higher than those in the vehicle group at all three time points (p<0.05). The formation of capillary, fibroblast, and collagen fiber, the expression of platelet-endothelial cell adhesion molecule-1, basic fibroblast growth factor, and transforming growth factor beta-1 were increased in the MCP groups (p<0.05). Conclusion MCPs could accelerate the process of wounding healing in rats after CS. PMID:25976613

  1. 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

  2. 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

  3. 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. PMID:27504275

  4. Misrecognition of need: Women’s experiences of and explanations for undergoing cesarean delivery

    PubMed Central

    Tully, Kristin P.; Ball, Helen L.

    2013-01-01

    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

  5. [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

  6. [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

  7. An Incidental Finding of Bilateral Dysgerminoma During Cesarean Section: Dilemmas in Management.

    PubMed

    Gupta, Mamta; Jindal, Rita; Saini, Vandana

    2016-08-01

    Dysgerminoma is an uncommon malignant tumour arising from germ cells of ovary. It occurs mostly in the reproductive age group. Its association with pregnancy is rare. Its management remains a challenge especially in an unsuspected case. We present a case of a woman, aged 28-year-old gravida2 para1 who reported to us at 36 weeks' pregnancy with severe preeclampsia and previous caesarean section. On ultrasound she was reported as having subserosal fibroids with single live fetus of 35 weeks and 3 days gestation. She delivered a live baby by caesarean section done for failed induction. Intraoperatively bilateral ovarian masses were found and removed which were later confirmed to be dysgerminoma on histopathological examination. As she was not diagnosed dysgerminoma pre-operatively, complete work up i.e., tumour markers and MRI was not done, leading to dilemmas in management. Though standard protocols for management of dysgerminoma with pregnancy exist, yet management of these incidentally diagnosed dysgerminomas remains a dilemma. PMID:27656514

  8. An Incidental Finding of Bilateral Dysgerminoma During Cesarean Section: Dilemmas in Management

    PubMed Central

    Jindal, Rita; Saini, Vandana

    2016-01-01

    Dysgerminoma is an uncommon malignant tumour arising from germ cells of ovary. It occurs mostly in the reproductive age group. Its association with pregnancy is rare. Its management remains a challenge especially in an unsuspected case. We present a case of a woman, aged 28-year-old gravida2 para1 who reported to us at 36 weeks’ pregnancy with severe preeclampsia and previous caesarean section. On ultrasound she was reported as having subserosal fibroids with single live fetus of 35 weeks and 3 days gestation. She delivered a live baby by caesarean section done for failed induction. Intraoperatively bilateral ovarian masses were found and removed which were later confirmed to be dysgerminoma on histopathological examination. As she was not diagnosed dysgerminoma pre-operatively, complete work up i.e., tumour markers and MRI was not done, leading to dilemmas in management. Though standard protocols for management of dysgerminoma with pregnancy exist, yet management of these incidentally diagnosed dysgerminomas remains a dilemma. PMID:27656514

  9. Effect of beta 3-adrenergic agonist (Zeneca D7114) on thermoregulation in near-term lambs delivered by cesarean section.

    PubMed

    Clarke, L; Bird, J A; Lomax, M A; Symonds, M E

    1996-08-01

    We investigated the effect of a beta 3-adrenergic agonist, Zeneca D7114, on thermoregulation in near-term lambs delivered by cesarean section. Lambs were delivered into a cool ambient temperature of 15 degrees C, and between 60 and 80 min of life were given an oral dose of Zeneca D7114 (10 mg.kg body weight-1) dissolved in 20 mL of milk, or milk alone. During the first 0.5 h of life colonic temperature decreased in all lambs, and then increased to plateau levels (39.6-40.4 degrees C) after 120-150 min of life, in 19 out of 23 lambs studied. In the remaining lambs, colonic temperature failed to return to normothermic values, plateauing at 34.3 degrees C. All control lambs were observed to shiver throughout the study, but after Zeneca D7114 treatment 7 out of 10 normothermic lambs stopped shivering, and plateau colonic temperature was 0.8 degree C higher. Hypothermic beta 3-agonist-treated lambs had significantly lower rates of heat production, breathing frequency, and plasma triiodothyronine and cortisol concentrations than normothermic lambs. the level of GDP binding and norepinephrine content of brown adipose tissue (BAT) sampled from hypothermic beta 3-agonist-treated lambs was significantly lower than in normothermic lambs. There was no difference in GDP binding in BAT between control and Zeneca D7114-treated groups, but the Hb content was higher in the latter group. It is concluded that administration of Zeneca D7114 to euthyroid lambs enhances their ability to thermoregulate and restore colonic temperature without altering the thermogenic activity of BAT. This response may be mediated by increasing blood flow to BAT and/or an improvement in the animal's thermal efficiency (i.e. decreased heat loss) due to a reduced reliance on shivering thermogenesis. PMID:8827786

  10. Cesarean Delivery Among Nulliparous Women in Beirut: Assessing Predictors in Nine Hospitals

    PubMed Central

    Tamim, Hala; El-Chemaly, Souheil Y.; Nassar, Anwar H.; Aaraj, Alia M.; Campbell, Oona M.R.; Kaddour, Afamia A.; Yunis, Khalid A.

    2007-01-01

    Background: Obstetric practice has witnessed a worldwide trend of increasing cesarean section rates in recent years. Similar trends have been observed in Lebanon, according to 2 studies conducted in 1996 and 1999. The objective of the present study was to assess the differences in predictors of cesarean delivery among nulliparous women in a “control hospital” with a low cesarean delivery rate (12.5%) and the rest of the National Collaborative Perinatal Neonatal Network (NCPNN) “study hospitals” with a higher cesarean delivery rate (31.4%). Methods: Data were collected by the NCPNN database, which covers deliveries at 9 major hospitals located in the Greater Beirut area. Data analysis was performed on the 6,668 consecutive deliveries occurring between January 1, 2001, and December 31, 2002, at the NCPNN participating centers. The questionnaires included items that cover parental sociodemographic characteristics and maternal and newborn health characteristics. Sources of data included direct interviews with mothers after delivery and before hospital discharge and reviews of obstetric and nursery medical charts. Chi-square tests and t tests were performed for categorical and continuous clinical predictors of cesarean section. Logistic regression was performed to determine the odds of having a cesarean section for the study hospitals when compared with the control hospital. Odds ratios and 95% confidence intervals are reported. Results: Variables in the study hospitals that correlated with a higher cesarean delivery rate were male obstetricians, day of the week, and mode of payment compared with the control hospital. Conclusions: In a country with a high cesarean section rate, 1 hospital met World Health Organization criteria for acceptable cesarean section rates, with no compromise in neonatal outcome. Further studies are needed to investigate potential policies to decrease the high cesarean section rate. PMID:17324173

  11. [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

  12. [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

  13. Cesarean Section: The Operation

    MedlinePlus

    ... Nursing programs Prematurityprevention.org Product Catalog Volunteer Volunteer leaders Team Youth National service partners Advocate Get informed ... Dimes Plan Aims to Make United States a Leader in Preterm Birth Prevention March of Dimes Names ...

  14. Cesarean section plus delayed cord clamping approach in the perinatal management of congenital high airway obstruction syndrome (CHAOS): a case report.

    PubMed

    Pivetti, V; Cavigioli, F; Lista, G; Napolitano, M; Rustico, M; Paganelli, A; Ferrazzi, E

    2014-01-01

    In this case, we describe a newborn with prenatal diagnosis of congenital high airway obstruction syndrome (CHAOS), successfully managed with a cesarean section with delayed cord clamping 180 seconds. In case of prenatal diagnosis of CHAOS, prompt airway intervention at delivery allows survival of this otherwise fatal condition. Ex utero intrapartum treatment (EXIT) is considered the elective procedure to secure the fetal airway before the baby is completely separated from the maternal circulation. In cases where the EXIT procedure is not possible for maternal reasons (Ballantyne's syndrome), delayed cord clamping may serve as an alternative method to manage CHAOS.

  15. Exposure analysis methods impact associations between maternal physical activity and cesarean delivery

    PubMed Central

    Bovbjerg, Marit L.; Siega-Riz, Anna Maria; Evenson, Kelly R.; Goodnight, William

    2015-01-01

    Background Previous studies report conflicting results regarding a possible association between maternal physical activity (PA) and cesarean delivery. Methods 7-day PA recalls were collected by telephone from n=1205 pregnant women from North Carolina, without prior cesarean, during two time windows: 17-22 weeks and 27-30 weeks completed gestation. PA was treated as a continuous, non-linear variable in binomial regressions (log-link function); models controlled for primiparity, maternal contraindications to exercise, pre-eclampsia, pregravid BMI, and percent poverty. We examined both total PA and moderate-to-vigorous PA (MVPA) at each time. Outcomes data came from medical records. Results The dose-response curves between PA or MVPA and cesarean risk at 17-22 weeks followed an inverse J-shape, but at 27-30 weeks the curves reversed and were J-shaped. However, only (total) PA at 27-30 weeks was strongly associated with cesarean risk; this association was attenuated when women reporting large volumes of PA (>97.5th percentile) were excluded. Conclusion We did not find evidence of an association between physical activity and cesarean birth. We did, however, find evidence that associations between PA and risk of cesarean may be non-linear and dependent on gestational age at time of exposure, limiting the accuracy of analyses that collapse maternal PA into categories. PMID:24509873

  16. Effect of preloading epidural space with normal saline on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section.

    PubMed

    Geng, Guiqi; Sun, Xingfeng; Huang, Shaoqiang

    2014-06-01

    To evaluate the effect of preloading the epidural space with normal saline (NS) on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section. Two hundred and ninety parturients at full term, who were scheduled for cesarean section under combined spinal-epidural anesthesia were randomly divided into two groups: group control (I) and group NS (II). The epidural puncture was performed at the estimated L3-4 interspace with a Tuohy needle attached to a 5 ml syringe. Loss of resistance to air was used to identify the epidural space. In group I no fluid was injected into the epidural space before insertion of the catheter; while in group II NS 5 ml was injected into the epidural space before catheter insertion. The incidence of blood vessel trauma and paraesthesia were evaluated. The effect of spinal anesthesia was evaluated. Blood vessel trauma in group II was significantly lower than in group I, P < 0.05. However, the incidence of paraesthesia was similar between the two groups, P > 0.05. Preloading the epidural space with NS can decrease the incidence of clinically apparent injury to blood vessels during epidural catheter placement, and can improve the effects of spinal analgesia, but does not reduce the incidence of paraesthesia.

  17. Comparison of Prophylactic Infusion of Phenylephrine with Ephedrine for Prevention of Hypotension in Elective Cesarean Section under Spinal Anesthesi: A Randomized Clinical Trial

    PubMed Central

    Moslemi, Farnaz; Rasooli, Sousan

    2015-01-01

    Background Spinal anesthesia is an accepted technique in elective cesarean sections. However, hypotension, resulted from sympathectomy is a common problem, especially in pregnant women. Prevention of this complication by sympathomimetic agents is of potential clinical significance. The aim of this study is to compare the effect of prophylactic infusion of Phenylephrine versus Ephedrine in the prevention of hypotension during spinal anesthesia in elective cesarean section. Methods Eighty-three patients were enrolled in this study and randomly divided into three groups. Group Ph received phenylephrine infusion, group E received ephedrine infusion while group P were delivered placebo. Vital signs (blood pressure, heart rate, and arterial oxygen saturation) were recorded throughout the surgery. Maternal and neonatal perioperative complications were also controlled and recorded. Results There was an insignificant difference in demographic data between the groups. Systolic and diastolic blood pressures were higher in the phenylephrine group than control, but not higher than the ephedrine group. Maternal dysrhythmias were more common in ephedrine and phenylephrine groups than the control group. Vomiting was more common in ephedrine group (P<0.05). In addition, the fifth-minute Apgar score of neonates was higher in phenylephrine and ephedrine groups than the control group (P<0.05). Neonates of phenylephrine group had less acidosis than the other groups. Conclusion Prophylactic infusion of phenylephrine can effectively decrease spinal anesthesia related hypotension without any significant complication for mother or her fetus. Trial Registration Number: IRCT2012120911700N1 PMID:25649721

  18. 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

  19. Risk of autism associated with general anesthesia during cesarean delivery: a population-based birth-cohort analysis.

    PubMed

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

    2015-04-01

    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 risk of autism associated with C-section and obstetric anesthesia. During a mean follow-up of 4.3 years, the incidence of autism was higher in neonates delivered by C-section with GA than in neonates delivered vaginally, with an adjusted risk of 1.52 (95% confidence interval 1.18-1.94). However, the adjusted risk of autism in neonates delivered by C-section with RA and in neonates delivered vaginally was nonsignificantly different.

  20. The Cesarean Catastrophe

    PubMed Central

    Lothian, Judith A.

    2006-01-01

    The cesarean rate has reached an all-time high at 29.1% of all births in the United States. In this column, the risks inherent in cesareans are discussed within the context of the current climate of “intervention-intensive” labor and birth, forced cesareans, the precipitate decrease in vaginal births after cesarean, and the alarming increase in primary cesarean, including “patient-choice” cesareans. Strategies to increase women's confidence and to promote, protect, and support normal birth are discussed as ways to decrease the cesarean rate. PMID:17322943

  1. 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.

  2. 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.

  3. 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. PMID:27630929

  4. 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

  5. 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

  6. 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

  7. 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

  8. Contemporary Cesarean Delivery Practice in the United States

    PubMed Central

    ZHANG, Jun; TROENDLE, James; REDDY, Uma M.; LAUGHON, S. Katherine; BRANCH, D. Ware; BURKMAN, Ronald; LANDY, Helain J.; HIBBARD, Judith U.; HABERMAN, Shoshana; RAMIREZ, Mildred M.; BAILIT, Jennifer L.; HOFFMAN, Matthew K.; GREGORY, Kimberly D.; GONZALEZ-QUINTERO, Victor H.; KOMINIAREK, Michelle; LEARMAN, Lee A.; HATJIS, Christos G.; VAN VELDHUISEN, Paul

    2010-01-01

    Objective To describe contemporary cesarean delivery practice in the U.S. Study Design Consortium on Safe Labor collected detailed labor and delivery information from 228,668 electronic medical records from 19 hospitals across the U.S., 2002 – 2008. Results The overall cesarean delivery rate was 30.5%. 31.2% of nulliparas were delivered by cesarean section. Prelabor repeat cesarean delivery due to a previous uterine scar contributed 30.9% of all cesarean sections. 28.8% of women with a uterine scar had a trial of labor and the success rate was 57.1%. 43.8% women attempting vaginal delivery had induction. Half of cesarean for dystocia in induced labor were performed before 6 cm of cervical dilation. Conclusion To decrease cesarean delivery rate in the U.S., reducing primary cesarean delivery is the key. Increasing VBAC rate is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparas and in induced labor. PMID:20708166

  9. Cesarean Section: Recovering After Surgery

    MedlinePlus

    ... Nursing programs Prematurityprevention.org Product Catalog Volunteer Volunteer leaders Team Youth National service partners Advocate Get informed ... Dimes Plan Aims to Make United States a Leader in Preterm Birth Prevention March of Dimes Names ...

  10. Effect of low dose of intrathecal pethidine on the incidence and intensity of shivering during cesarean section under spinal anesthesia: a randomized, placebo-controlled, double-blind clinical trial

    PubMed Central

    Shami, Shoaleh; Nasseri, Karim; Shirmohammadi, Mousa; Sarshivi, Farzad; Ghadami, Negin; Ghaderi, Ebrahim; Pouladi, Mokhtar; Barzanji, Arvin

    2016-01-01

    Introduction Shivering is among the unpleasant and potentially harmful side effects of spinal anesthesia. The aim of this randomized double-blind clinical trial was to compare the antishivering effect of two different doses of intrathecal pethidine on the incidence and intensity of shivering and other side effects in patients who underwent cesarean section. Methods In this study, 150 parturient females scheduled for nonemergent cesarean section were randomly allocated to three groups. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine (12.5 mg), plus 0.5 mL of 0.9% saline in the standard group (S group), and the same dose of bupivacaine with 5 mg (P5 group) or 10 mg of pethidine (P10 group). Demographic and surgical data, incidence and intensity of shivering (primary outcome), hemodynamic indices, forehead and core temperatures, maximum sensory level, Apgar scores, and adverse events were evaluated by a blinded observer. Results There were no significant differences between the three study groups regarding the demographic and surgical data, hemodynamic indices, core temperatures, and maximum sensory level (P>0.05). The incidence and intensity of shivering were significantly less in the P5 and P10 groups (P<0.001) when compared with the S group. There were no significant differences between groups for secondary outcomes, except pruritus, which was more common in the P5 and P10 groups when compared with the S group (P=0.01). Conclusion Low dose of intrathecal pethidine is safe, and can decrease the incidence and intensity of shivering during cesarean section, without having major side effects. PMID:27703328

  11. 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…

  12. 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

  13. Spontaneous torticollis in a breech-presenting fetus delivered by an atraumatic elective cesarean section: a case and review of the literature.

    PubMed

    Sherer, D M

    1996-07-01

    A non-laboring patient with a breech-presenting fetus and oligohydramnios at 41 weeks' gestation underwent elective cesarean delivery. The infant was delivered atraumatically through a wide transverse incision of the lower uterine segment. Severe leftsided torticollis was noted immediately at delivery. The torticollis subsequently responded to physiotherapy with minimal residual facial asymmetry. This case and the literature suggest that torticollis itself may predispose to breech presentation. Alternatively, in the case presented, oligohydramnios with subsequent restricted posture may have contributed to the underlying pathophysiology of this phenomena, which previously has been noted as associated with and as a possible sequela of traumatic vaginal breech delivery.

  14. 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.

  15. 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

  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. 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

  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. 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

  20. Cervical insufficiency following cesarean delivery after prolonged second stage of labor: experiences of two cases.

    PubMed

    Koyama, Shinsuke; Tomimatsu, Takuji; Kanagawa, Takeshi; Sawada, Kenjiro; Tsutsui, Tateki; Kimura, Tadashi

    2010-04-01

    Cervical insufficiency is a known risk factor for preterm birth and miscarriage. The etiology of cervical insufficiency has not been fully recognized and the association between it and prior cesarean delivery is unknown. We experienced two similar characteristic cases of cervical insufficiency following term cesarean delivery. Interestingly, both cesarean sections were uneventfully performed after the prolonged second stage of labor. Our experience and recent literature strongly support the idea that an unintentional incision into the uterine cervix during a previous cesarean section may cause cervical insufficiency in subsequent pregnancies. It is important for obstetricians to take into account the possible occurrence of cervical insufficiency depending on the circumstances of previous deliveries. Our report highlights the need to alert obstetricians to take more care with their cesarean section technique.

  1. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.

    PubMed

    Tita, Alan T N; Szychowski, Jeff M; Boggess, Kim; Saade, George; Longo, Sherri; Clark, Erin; Esplin, Sean; Cleary, Kirsten; Wapner, Ron; Letson, Kellett; Owens, Michelle; Abramovici, Adi; Ambalavanan, Namasivayam; Cutter, Gary; Andrews, William

    2016-09-29

    Background The addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section. Methods In this trial conducted at 14 centers in the United States, we studied 2013 women who had a singleton pregnancy with a gestation of 24 weeks or more and who were undergoing cesarean delivery during labor or after membrane rupture. We randomly assigned 1019 to receive 500 mg of intravenous azithromycin and 994 to receive placebo. All the women were also scheduled to receive standard antibiotic prophylaxis. The primary outcome was a composite of endometritis, wound infection, or other infection occurring within 6 weeks. Results The primary outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). There were significant differences between the azithromycin group and the placebo group in rates of endometritis (3.8% vs. 6.1%, P=0.02), wound infection (2.4% vs. 6.6%, P<0.001), and serious maternal adverse events (1.5% vs. 2.9%, P=0.03). There was no significant between-group difference in a secondary neonatal composite outcome that included neonatal death and serious neonatal complications (14.3% vs. 13.6%, P=0.63). Conclusions Among women undergoing nonelective cesarean delivery who were all receiving standard antibiotic prophylaxis, extended-spectrum prophylaxis with adjunctive azithromycin was more effective than placebo in reducing the risk of postoperative infection. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; C/SOAP ClinicalTrials.gov number, NCT01235546 .). PMID:27682034

  2. Vaginal birth after cesarean delivery.

    PubMed

    Martins, M E

    1996-03-01

    The rate of vaginal birth after a previous cesarean delivery continues to rise due to both national organization recommendations and trials spanning 10 years of experience demonstrating its effectiveness and general safety. Broadening eligibility criteria and investigation of the clinical and nonclinical factors influencing this rate should place us on the glide path to reduction of the overall cesarean rate by the year 2000. Remaining controversies and management strategy will be discussed.

  3. 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

  4. 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.

  5. Adhesion barriers at cesarean delivery: advertising compared with the evidence.

    PubMed

    Albright, Catherine M; Rouse, Dwight J

    2011-07-01

    Cesarean delivery, the most common surgery performed in the United States, is complicated by adhesion formation in 24-73% of cases. Because adhesions have potential sequelae, different synthetic adhesion barriers are currently heavily marketed as a means of reducing adhesion formation resultant from cesarean delivery. However, their use for this purpose has been studied in only two small, nonblinded and nonrandomized trials, both of which were underpowered and subject to bias. Neither demonstrated improvement in meaningful clinical outcomes. In the only cost-effectiveness analysis of adhesion barriers to date, the use of synthetic adhesion barriers was cost-effective only when the subsequent rate of small bowel obstruction was at least 2.4%, a rate far higher than that associated with cesarean delivery. In fact, intra-abdominal adhesions from prior cesarean delivery rarely cause maternal harm and have not been demonstrated to adversely affect perinatal outcome. Based on our review of the available literature, we think the use of adhesion barriers at the time of cesarean delivery would be ill-advised at the present time.

  6. 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

  7. 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

  8. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

    PubMed Central

    Hasdemir, Pınar Solmaz; Guvenal, Tevfik; Ozcakir, Hasan Tayfun; Koyuncu, Faik Mumtaz; Dinc Horasan, Gonul; Erkan, Mustafa; Oruc Koltan, Semra

    2015-01-01

    Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure. PMID:26413566

  9. Cesarean delivery: counseling issues and complication management.

    PubMed

    Quinlan, Jeffrey D; Murphy, Neil J

    2015-02-01

    Nearly one-third of all deliveries in the United States are cesarean deliveries. Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased maternal and neonatal morbidity and mortality. Interventions that decrease the chance of a cesarean delivery include avoiding non-medically indicated induction of labor, avoiding amniotomy, and having a doula present. In North America, the most common reasons for cesarean delivery include elective repeat cesarean delivery, dystocia or failure to progress, malpresentation, and fetal heart rate tracings that suggest fetal distress. Post-cesarean delivery complications include pain, endomyometritis, wound separation/infection, urinary tract infection, gastrointestinal problems, deep venous thrombosis, and septic thrombophlebitis. Women with no risk factors for deep venous thrombosis other than the postpartum state and the operative delivery do not require thromboembolism prophylaxis other than early ambulation. A pregnant woman's decision to attempt a trial of labor after cesarean delivery or have a planned repeat cesarean delivery involves a balancing of maternal and neonatal risks, as well as personal preference after counseling by her physician. Approximately 75% of attempted trials of labor after cesarean delivery are successful. Provision of advanced maternity care practices by family physicians, including serving as primary surgeons for cesarean deliveries, is consistent with the goals of the patient-centered medical home. PMID:25822271

  10. [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

  11. 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.

  12. Implementing Family-Centered Cesarean Birth.

    PubMed

    Schorn, Mavis N; Moore, Elizabeth; Spetalnick, Bennett M; Morad, Anna

    2015-01-01

    Cesarean birth is recognized as a physical and psychological stressor for many women. Maternity practices during cesarean birth should meet women's needs, while maintaining safety, to optimize the experience. Family-centered cesarean birth is a package of interventions that encourages a woman to participate in choosing interventions that would be helpful when undergoing a planned or unplanned cesarean birth. Included in family-centered cesarean birth is implementation of skin-to-skin care in the operating room for neonates who appear term and healthy. The process of attempting to implement family-centered cesarean birth at one academic center is presented, including steps for implementation, benefits, challenges, and areas for continued improvement and research. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. PMID:26618328

  13. 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

  14. Safe prevention of the primary cesarean delivery.

    PubMed

    Caughey, Aaron B; Cahill, Alison G; Guise, Jeanne-Marie; Rouse, Dwight J

    2014-03-01

    In 2011, 1 in 3 women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be lifesaving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 through 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.

  15. Successful Management of a Cesarean Scar Defect with Dehiscence of the Uterine Incision by Using Wound Lavage

    PubMed Central

    Ida, Akinori; Kubota, Yoko; Nosaka, Maiko; Ito, Koichi; Kato, Hiroshi; Tsuji, Yoshiyuki

    2014-01-01

    Cesarean scar defects (CSDs) that can be visualized using transvaginal ultrasonography (TVUS) may cause prolonged menstruation, irregular genital bleeding, and secondary infertility; surgical repair is sometimes necessary. We present a case of CSD, with dehiscence of the uterine incision, which was managed using wound lavage. A 38-year-old woman (gravida 4, para 4) had delivered her third and fourth children by cesarean section. Upon the resumption of menstruation, 9 months after her second cesarean section, she demonstrated prolonged menstruation and the presence of a menstrual fistula due to dehiscence of the cesarean section incision from the myometrium to the serosa. We treated the defect by lavaging with a physiological saline solution. After lavaging the wound 3 times, spontaneous healing of the dehiscent muscle layer was successfully achieved. The treatment was complication-free and the healing of the muscle layer has been maintained for more than 8 months. PMID:25431714

  16. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications.

    PubMed

    Tower, Amanda M; Frishman, Gary N

    2013-01-01

    The gynecologic sequelae due to deficient uterine scar healing after cesarean section are only recently being identified and described. These include conditions such as abnormal bleeding, pelvic pain, infertility, and cesarean scar ectopic pregnancy, as well as a potentially higher risk of complications and difficulties during gynecologic procedures such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. The proposed mechanism of abnormal uterine bleeding is a pouch or "isthmocele" in the lower uterine segment that causes delayed menstrual bleeding. The prevalence of symptomatic or clinically relevant cesarean scar defects (CSDs) ranges from 19.4% to 88%. Possible risk factors for CSD include number of cesarean sections, uterine position, labor before cesarean section, and surgical technique used to close the uterine incision. There are no accepted guidelines for the diagnostic criteria of CSD. We propose that a CSD be defined on transvaginal ultrasound or saline infusion sonohysterography as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. We also propose a classification system to aid in standardized classification for future research. Surgical techniques for repair of CSD include laparoscopic excision, resectoscopic treatment, vaginal revision, and endometrial ablation. PMID:23680518

  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.

  18. Primary Cesarean Delivery in the United States

    PubMed Central

    Boyle, Annelee; Reddy, Uma M.; Landy, Helain J.; Huang, Chun-Chih; Driggers, Rita W.; Laughon, S. Katherine

    2013-01-01

    OBJECTIVES To characterize the indications for primary cesarean delivery in a large national cohort and to identify opportunities to lower the U.S. primary cesarean rate. METHODS A retrospective cohort study of the 38,484 primary cesarean deliveries among the 228,562 deliveries at sites participating in the Consortium on Safe Labor from 2002 to 2008. RESULTS The primary cesarean rate was 30.8% for primiparous women and 11.5% for multiparous women. The most common indications for primary cesarean delivery were failure to progress (35.4%), nonreassuring fetal heart rate tracing (27.3%), and fetal malpresentation (18.5%), although frequencies for each indication varied by parity. Among women with failure to progress, 42.6% of primiparous women and 33.5% of multiparous women never progressed beyond 5cm of dilation prior to delivery. Among women who reached the second stage of labor, 17.3% underwent cesarean delivery for arrest of descent before 2 hours and only 1.1% were given a trial of operative vaginal delivery. Of all primary cesarean deliveries, 45.6% were performed on primiparous women at term with a singleton fetus in cephalic presentation. CONCLUSION Using 6 cm as the cutoff for active labor, allowing adequate time for the second stage of labor, and encouraging operative vaginal delivery, when appropriate, may be important strategies to reduce the primary cesarean delivery rate. These actions may be particularly important in the primiparous woman at term with a singleton fetus in cephalic presentation. PMID:23743454

  19. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study.

    PubMed

    Gubbini, Giampietro; Centini, Gabriele; Nascetti, Daniela; Marra, Elena; Moncini, Irene; Bruni, Luca; Petraglia, Felice; Florio, Pasquale

    2011-01-01

    The reproductive outcome in 41 consecutive patients with cesarean-induced isthmocele and secondary infertility was evaluated prospectively. Patients included menopausal women (mean [SD; 95% CI] age, 35 [4.1; 29-42] years), with fertility duration of 3 to 8 (4.6 [28]) years with isthmocele, postmenstrual abnormal uterine bleeding, and suprapubic pelvic pain. Transvaginal ultrasound and office hysteroscopy were used to diagnosis isthmocele. Complete fertility tests were performed to exclude other causes of infertility in both female and male participants. Operative hysteroscopy was performed to correct the cesarean scar defect, and histologic findings were evaluated. Correction of isthmocele via operative hysteroscopy was successful in all cases evaluated. Patients became pregnant spontaneously between 12 and 24 months after isthmoplasty. Thirty-seven of the 41 patients (90.2%) delivered via cesarean section, and 4 (9.8%) had a spontaneous abortion in the first trimester. Isthmoplasty resulted in resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in all patients. Thus, it was concluded that surgical treatment of cesarean-induced isthmocele using a minimally-invasive approach (operative hysteroscopy) restores fertility and resolves symptoms in women with a cesarean section scar and secondary infertility. PMID:21354070

  20. Three-dimensional power Doppler ultrasound diagnosis and laparoscopic management of a pregancy in a previous cesarean scar.

    PubMed

    Wang, Chin-Jung; Yuen, Leung-To; Yen, Chih-Feng; Lee, Chyi-Long; Soong, Yung-Kuei

    2004-12-01

    An ectopic pregnancy developing in a previous Cesarean section scar is a rare event, and there is still a lack of information concerning the adequacy of management strategies. So far, no modality can guarantee the integrity of the uterus. We report the case of a 29-year-old woman with three Cesarean deliveries who was transferred to our hospital with a diagnosis of cervical pregnancy. Transvaginal three-dimensional power Doppler ultrasound revealed a well-encapsulated bulging mass displacing anteriorly over the lower anterior uterine wall sounding with an irregular course and branching vessels. The diagnosis of pregnancy in a previous Cesarean scar was made. Laparoscopic ligation of bilateral uterine arteries followed by excision of the ectopic pregnant mass was undertaken, and the patient's uterus was successfully preserved. Conservative management with the laparoscopic approach may be a safe and effective alternative to hysterectomy in patients with a pregnacy in a previous Cesarean scar.

  1. 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 ...

  2. 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

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

    PubMed Central

    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-Vina, Juana I.; Mendez, Keimari; Knight, Rob; Clemente, Jose C.

    2016-01-01

    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 are exposed to maternal vaginal fluids at birth. Similar to vaginally delivered babies, the gut, oral, and skin microbiome of these newborns during the first 30 days of life was enriched in vaginal bacteria underrepresented in unexposed C-section infants, albeit similarity to vaginally-delivered infants was higher in oral and skin than in anal samples. Although the long-term health consequences of restoring the microbiota of C-section born infants remain unclear, our results demonstrate that vaginal microbes can be partially restored at birth in C-section delivered babies. PMID:26828196

  4. Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar

    PubMed Central

    Zhang, Ningyuan; Chen, Hua; Xu, Zhipeng; Wang, Bin; Sun, Haixiang; Hu, Yali

    2016-01-01

    Background What role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar. Material/Methods The pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients’ desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group. Results The pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight. Conclusions Elective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section. PMID:27636504

  5. Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar.

    PubMed

    Zhang, Ningyuan; Chen, Hua; Xu, Zhipeng; Wang, Bin; Sun, Haixiang; Hu, Yali

    2016-01-01

    BACKGROUND What role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar. MATERIAL AND METHODS The pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients' desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group. RESULTS The pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight. CONCLUSIONS Elective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section. PMID:27636504

  6. 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 ...

  7. 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

  8. 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

  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. 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

  11. Cesarean scar pregnancy: diagnosis, management, and follow-up.

    PubMed

    Uysal, Fatma; Uysal, Ahmet; Adam, Gürhan

    2013-07-01

    Cesarean scar pregnancy is a very rare form of pregnancy and a life-threatening situation. It has become an important and serious problem over the last 10 years, as a result of the worldwide increase in cesarean births. In this retrospective series, the diagnosis of cesarean scar pregnancy, management, treatment methods, risk factors, and possibility of subsequent normal pregnancy are discussed, and case descriptions are presented.

  12. 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

  13. 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.

  14. [Cesarean delivery and exeresis of a pheochromocytoma performed under epidural and general anesthesia].

    PubMed

    García Hernández, E; González Rodríguez, J L; Vega Cruz, M S

    2004-04-01

    A 33-year-old pregnant woman with episodes of nocturnal tachycardia and anxiety diagnosed with extra-renal pheochromocytoma in her 28th month of gestation was admitted in her 38th week for an alpha-adrenergic block prior to elective cesarean section and tumor exeresis. The cesarean section was performed with the patient given an epidural lumbar block, and immediately after delivery of the fetus total intravenous anesthesia (with propofol, remifentanil, and rocuronium) was administered in addition to the continuous epidural analgesia used during tumor resection and postoperatively. No complications developed during surgery or recovery and the clinical courses were satisfactory for both mother and child. The use of propofol and remifentanil in combination with epidural anesthesia is not common in our clinical context. We point out that the multimodal technique affords good hemodynamic stability, guarantees satisfactory analgesia, and reduces the need for vasoactive drugs.

  15. Structural analysis methods development for turbine hot section components

    NASA Technical Reports Server (NTRS)

    Thompson, R. L.

    1989-01-01

    The structural analysis technologies and activities of the NASA Lewis Research Center's gas turbine engine HOT Section Technoloogy (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.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. Beyond abortion: refusal of caesarean section.

    PubMed

    Mahowald, Mary

    1989-04-01

    Social pressures and legal restrictions are proliferating against pregnant women. A dramatic infringement on women's rights is the court ordered cesarean section, as illustrated by the case of Angela C., a terminally ill cancer patient, 26 weeks pregnant, whose refusal of a cesarean section was overridden by a District of Columbia court. The premature infant and the mother died within two days. This case epitomizes a developing judicial pattern whose ethical reasoning the author criticizes. Within the context of the right to privacy and the concept of viability, which could legally override that right, Mahowald analyzes different situations where cesarean delivery is refused. After arguing that court ordered cesarean sections are inconsistent with court refusals to force persons to undergo less invasive procedures (e.g., bone marrow donation for the benefit of family members), she proposes alternatives to the present inconsistent practice.

  1. 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. PMID:27579285

  2. 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

  3. 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

  4. 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.

  5. Development of radar cross section analysis system of naval ships

    NASA Astrophysics Data System (ADS)

    Kim, Kookhyun; Kim, Jin-Hyeong; Choi, Tae-Muk; Cho, Dae-Seung

    2012-03-01

    A software system for a complex object scattering analysis, named SYSCOS, has been developed for a systematic radar cross section (RCS) analysis and reduction design. The system is based on the high frequency analysis methods of physical optics, geometrical optics, and physical theory of diffraction, which are suitable for RCS analysis of electromagnetically large and complex targets as like naval ships. In addition, a direct scattering center analysis function has been included, which gives relatively simple and intuitive way to discriminate problem areas in design stage when comparing with conventional image-based approaches. In this paper, the theoretical background and the organization of the SYSCOS system are presented. To verify its accuracy and to demonstrate its applicability, numerical analyses for a square plate, a sphere and a cylinder, a weapon system and a virtual naval ship have been carried out, of which results have been compared with analytic solutions and those obtained by the other existing software.

  6. Induction of Labor and Cesarean: What is the True Relationship?

    PubMed

    Little, Sarah E; Caughey, Aaron B

    2015-06-01

    It is a commonly held belief that labor induction increases the risk of cesarean delivery; women who are induced are at higher risk of cesarean as compared with those in spontaneous labor. This comparison group is inaccurate, however, as women and providers cannot choose spontaneous labor as the alternative to labor induction. With expectant management, spontaneous labor may occur, but as gestation advances, pregnancy complications may occur, or women may progress postterm requiring induction at a later gestation. Using the proper comparison group, studies find that labor induction is actually associated with a small decreased risk of cesarean delivery.

  7. Hysteroscopic treatment of symptomatic cesarean-induced isthmocele: a prospective study.

    PubMed

    Raimondo, Gennaro; Grifone, Gaetano; Raimondo, Diego; Seracchioli, Renato; Scambia, Giovanni; Masciullo, Valeria

    2015-02-01

    An isthmocele, also known as a cesarean scar defect, is an emerging condition that typically affects women with a history of previous cesarean section, and its presence is a novel under-recognized cause of postmenstrual abnormal uterine bleeding and/or pelvic pain. The incidence of symptoms and their resolution after hysteroscopic surgery were evaluated prospectively in 120 consecutive isthmocele patients. Patients included only symptomatic premenopausal women. Transvaginal ultrasound and office hysteroscopy were used to diagnose isthmocele. Operative hysteroscopy was performed to correct the cesarean scar defect, and histologic findings were evaluated. Correction of an isthmocele via operative hysteroscopy was successful in all cases evaluated. Isthmoplasty resulted in the resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in 80% of patients. In the remaining cases, 7% of patients had an improvement of symptoms, whereas 13% did not obtain any relief. Considering the recent diagnostic recognition of isthmoceles, we conclude that surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results. PMID:25285773

  8. 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

  9. 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

  10. The case against cesarean delivery on maternal request in labor.

    PubMed

    Burcher, Paul; Gabriel, Jazmine L; Campo-Engelstein, Lisa; Kiley, Kevin C

    2013-09-01

    The ethical obligations of an obstetrician to a patient who requests a cesarean delivery without maternal or fetal indication differ depending on whether the request is made before or during labor. Informed consent is an essential dimension of respecting patient autonomy, and the process of informed consent should be extensive for a cesarean delivery in the absence of maternal or fetal indications during active labor. For this reason, physicians should rarely grant a request for cesarean delivery made during active labor. Although physicians may think that declining a request for cesarean delivery is a violation of patient autonomy, they should also be concerned about the violation of patient autonomy that results if they are unable to adequately complete the process of informed consent during labor.

  11. Cesarean Birth Linked to Risk of Obesity in Childhood

    MedlinePlus

    ... 160810.html Cesarean Birth Linked to Risk of Obesity in Childhood Odds even greater when compared to ... from not exposing the infant to the helpful bacteria in the vagina that gives the baby "an ...

  12. Dental arch shape: a statistical analysis using conic sections.

    PubMed

    Sampson, P D

    1981-05-01

    This report addresses two problems in the study of the shape of human dental arches; (1) the description of arch shape by mathematical functions and (2) the description of variation among the dental arch shapes in a population. A new algorithm for fitting conic sections is used to model the maxillary dental arches of a sample of sixty-six subjects. A statistical model for shapes represented by arcs of conic sections is demonstrated on the sample of sixty-six dental arches. It permits the definition of an "average shape" and the graphic representation of variation in shape. The model and methods of analysis presented should help dental scientists to better define and quantify "normal" or "ideal" shapes and "normal ranges of variation" for the shape of the dental arch.

  13. 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.

  14. SCALE system cross-section validation for criticality safety analysis

    SciTech Connect

    Hathout, A M; Westfall, R M; Dodds, Jr, H L

    1980-01-01

    The purpose of this study is to test selected data from three cross-section libraries for use in the criticality safety analysis of UO/sub 2/ fuel rod lattices. The libraries, which are distributed with the SCALE system, are used to analyze potential criticality problems which could arise in the industrial fuel cycle for PWR and BWR reactors. Fuel lattice criticality problems could occur in pool storage, dry storage with accidental moderation, shearing and dissolution of irradiated elements, and in fuel transport and storage due to inadequate packing and shipping cask design. The data were tested by using the SCALE system to analyze 25 recently performed critical experiments.

  15. 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.

  16. 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

  17. [Clinical experience with a C-section surgical technique in patients with morbid obesity: a case series].

    PubMed

    Hernández Carrazco, Mayra Elena; Rodríguez Torres, Alejandra; Ortiz Pineda, Omar; Rodríguez Torres, Juan; Casas Patiño, Donovan

    2014-07-04

    Obesity is a public health challenge that has crossed into the area of reproductive health. An obese pregnant woman has multiple complications before, during, and after pregnancy. Likewise, cesarean section is more difficult and has slower recovery times in this group of patients. This paper proposes a surgical technique adapted to the morbidly obese pregnant patient that aims to reduce cesarean section complications.

  18. 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).

  19. [The position of the Brazilian Federal Board of Medicine on incentives for reimbursement of childbirth care and the impact on cesarean rates].

    PubMed

    Freitas, Paulo Fontoura; Moreira, Bianca Carvalho; Manoel, Andre Luciano; Botura, Ana Clara de Albuquerque

    2015-09-01

    This study analyzed incentives for reimbursement of childbirth care advocated by the Brazilian Federal Board of Medicine (CFM) and their impact on cesarean rates. A consecutive sample of 600 postpartum women was surveyed. The overall cesarean rate was 59.2%, as compared to 92.3% among women that had the same physician for their prenatal care and childbirth. Cesarean rates were significantly greater in the groups of women with higher prevalence of the same physician during prenatal care and delivery, that is, higher rates were associated with older maternal age (PR = 1.65), more schooling (PR = 1.25), prenatal care in the private sector (PR = 1.39) or through private health plans (PR = 1.43), previous cesarean section (PR = 2.78), and admission earlier in labor (PR = 1.93). The results challenge the position by the CFM that financial incentives for women to have the same obstetrician during prenatal care and labor would encourage normal childbirth, when these women are precisely the ones with the highest cesarean rates.

  20. Statistical analysis of arch shape with conic sections.

    PubMed

    Sampson, P D

    1983-06-01

    Arcs of conic sections are used to model the shapes of human dental arches and to provide a basis for the statistical and graphical analysis of a population of shapes. The Bingham distribution, an elliptical distribution on a hypersphere, is applied in order to model the coefficients of the conic arcs. It provides a definition of an 'average shape' and it quantifies variation in shape. Geometric envelopes of families of conic arcs whose coefficients satisfy a quadratic constraint are used to depict the distribution of shapes in the plane and to make graphical inferences about the average shape. The methods are demonstrated with conic arcs fitted to a sample of 66 maxillary dental arches.

  1. Light and heavy ion beam analysis of thin biological sections

    NASA Astrophysics Data System (ADS)

    Lee, Joonsup; Siegele, Rainer; Pastuovic, Zeljko; Hackett, Mark J.; Hunt, Nicholas H.; Grau, Georges E.; Cohen, David D.; Lay, Peter A.

    2013-07-01

    The application of ion beam analysis (IBA) techniques to thin biological sections (ThBS) presents unique challenges in sample preparation, data acquisition and analysis. These samples are often the end product of expensive, time-consuming experiments, which involve many steps that require careful attention. Analysis via several techniques can maximise the information that is collected from these samples. Particle-induced X-ray emission (PIXE) and Rutherford backscattering (RBS) spectroscopy are two generally non-destructive IBA techniques that use the same MeV ions and can be performed simultaneously. The use of heavy ion PIXE applied to thick samples has, in the past, resulted in X-ray spectra of a poorer quality when compared to those obtained with proton beams. One of the reasons for this is the shorter probing depth of the heavy ions, which does not affect thin sample analysis. Therefore, we have investigated and compared 3-MeV proton and 36-MeV carbon ion beams on 7-μm thick mouse brain sections at the ANSTO Heavy ion microprobe (HIMP). The application of a 36-MeV C4+ ion beam for PIXE mapping of ThBS on thin Si3N4 substrate windows produced spectra of high quality that displayed close to a nine-times gain in signal yield (Z2/q) when compared to those obtained for 3-MeV protons for P, S, Cl and K but not for Fe, Cu and Zn. Image quality was overall similar; however, some elements showed better contrast and features with protons whilst others showed improved contrast with a carbon ion beam. RBS spectra with high enough counting statistics were easily obtained with 3-MeV proton beams resulting in high resolution carbon maps, however, the count rate for nitrogen and oxygen was too low. The results demonstrate that on thin samples, 36-MeV C4+ will produce good quality PIXE spectra in less time; therefore, carbon ions may be advantageous depending on which element is being studied. However, these advantages may be outweighed by the inherent disadvantages including

  2. 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

  3. Cesarean scar pregnancy: uterine artery embolization combined with a hysterectomy at 13 weeks' gestation--a case report and review of the literature.

    PubMed

    Kwaśniewska, Anna; Stupak, Aleksandra; Krzyzanowski, Arkadiusz; Pietura, Radoslaw; Kotarski, Jan

    2014-12-01

    A cesarean scar pregnancy is a pregnancy located within the uterine muscle after previous cesarean sections. Recent years have shown a significant increase in the rate of CS and an improvement in the ultrasound diagnosis, and therefore a trend towards an increase in the rate of CSP cases has been reported in many countries. We report on a case of CSP diagnosed using ultrasound at 5/6 weeks'gestation and confirmedbymagnetic resonance imaging. The patient underwent surgical management at 13 weeks, combined with the chemioembolization of the uterine arteries. The current review aims to update the knowledge of the available treatment modalities.

  4. 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.

  5. 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 ...

  6. [Reflections on the excessive rates of cesareans in Brazil and the empowerment of women].

    PubMed

    Leão, Míriam Rêgo de Castro; Riesco, Maria Luiza Gonzalez; Schneck, Camilla Alexsandra; Angelo, Margareth

    2013-08-01

    The medicalization of childbirth as an outcome of social medicalization has been described as a complex sociocultural process that transforms the experiences, suffering and pain - which were formerly managed in the family or community settings - into medical needs. The scope of this paper is to reflect upon the excessive number of cesarean sections in Brazil from a critical and objective standpoint. Data on caesarean section statistics and studies on women's preference on the manner of delivery are discussed in order to contribute to the discussion on the empowerment of the health system consumers. Medicalization is a cultural change that influences the empowerment to cope with the experience of giving birth, as it involves excessive dependency on and abuse of cesarean sections. Furthermore, social networks and movements are discussed as possible facilitators of women's empowerment, as they enable mutual support, sharing of experiences and a contribution to the construction of more balanced relations between women and health professionals. Participation of these networks fosters the collective mobilization of women to insist on their rights from society as a whole.

  7. 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…

  8. Adaptation to cesarean birth: implementation of an international multisite study.

    PubMed

    Fawcett, Jacqueline; Aber, Cynthia; Weiss, Marianne; Haussler, Susan; Myers, Sheila Taylor; King, Charlette; Newton, Jennifer; Silva, Virginia

    2005-07-01

    The purpose of this column is to describe the implementation of an international multisite Roy adaptation model-based study of women's perceptions of and responses to cesarean birth. The need for the study arose from the concern that women's childbearing needs may not be met to their full satisfaction, especially if the infant is born by cesarean. Serendipity and networking played a part in the selection of four study sites in the United States (Boston, Milwaukee, Norfolk, Oklahoma City) and two in other countries (Finland, Australia). Data were collected by nursing students and staff nurses. Post-hoc consideration of the diversity of study sites revealed opportunities for examination of the influence of the contextual stimuli of culture and geographic region on the women's adaptation to cesarean birth. Strategies used to foster integration of teaching, practice, and research are discussed. PMID:15976041

  9. 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

  10. Lavender essence for post-cesarean pain.

    PubMed

    Hadi, Niaz; Hanid, Ali Akbar

    2011-06-01

    Post cesarean (CS) pain is a challenging problem for the obstetricians, because it may interfere with mother and baby's well-being. Many approaches have been ever proposed to diminish this pain, each one with particular benefits and limitations. Aromatherapy is a complementary therapy especially for controlling pain. This study aimed at evaluating the effect of lavender essence on post CS pain. In a single-blind clinical trial, 200 term pregnant women with planned elective CS were recruited in a 12 month period of time. They were randomized in two 100-patient groups; received either lavender essence (the case group) or a similar clinically neutral aromatic material (the control group) thorough oxygen mask for 3 min 3 h after receiving similar intravenous analgesics. The Visual Analogue Scale (VAS) was employed to determine the level of post CS pain. The VAS was documented half hour after first intervention. Eight and 16 h later, the aromatherapy was repeated and half hour after each intervention, corresponding VAS was documented. The two groups were matched for demographics and obstetrical history. The baseline VAS was comparable between the two groups. The mean VAS decreased significantly by 16 h after the first intervention in both groups (p < 0.001). However, this amelioration of pain was significantly more prominent in the cases group comparing with that in the controls in all documented stages half hour, 8 and 16 h after the first intervention (p < 0.001 for all measurements). In conclusion, aromatherapy by using lavender essence is a successful and safe complementary therapy in reducing pain after CS.

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. Hematometra Formation- A Rare Complication of Cesarean Delivery

    PubMed Central

    Kaur, Gurpreet; Sharma, Abha; Vaid, Neelam Bala

    2014-01-01

    Hematometra resulting from partial or complete obstruction of lower genital tract may be congenital or acquired. Commonest congenital causes are imperforate hymen and transverse vaginal septum. Acquired causes are senile atrophy of endocervical canal, scarring of the isthmus by synechiae, radiation and endocervical malignancy or due to surgical procedures. Various surgical procedures associated with hematometra are dilatation and curettage, cone biopsy, endometrial ablation, cryocoagulation and electrocautery. Hematometra following an abortion or cesarean delivery is rare. We report a case of hematometra following obstruction of outflow tract due to prior cesarean delivery. PMID:25302239

  16. 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

  17. Quantitative sectioning and noise analysis for structured illumination microscopy

    PubMed Central

    Hagen, Nathan; Gao, Liang; Tkaczyk, Tomasz S.

    2011-01-01

    Structured illumination (SI) has long been regarded as a nonquantitative technique for obtaining sectioned microscopic images. Its lack of quantitative results has restricted the use of SI sectioning to qualitative imaging experiments, and has also limited researchers’ ability to compare SI against competing sectioning methods such as confocal microscopy. We show how to modify the standard SI sectioning algorithm to make the technique quantitative, and provide formulas for calculating the noise in the sectioned images. The results indicate that, for an illumination source providing the same spatially-integrated photon flux at the object plane, and for the same effective slice thicknesses, SI sectioning can provide higher SNR images than confocal microscopy for an equivalent setup when the modulation contrast exceeds about 0.09. PMID:22274364

  18. Is non-directive counseling for patient choice cesarean delivery ethically justified?

    PubMed

    Kalish, Robin B; McCullough, Laurence B; Chervenak, Frank A

    2007-01-01

    The current controversy concerning patient choice cesarean delivery potentially affects all women of child-bearing age and the physicians who care for them. The purpose of this paper is to address three salient issues within the patient choice cesarean delivery controversy. First, is performing patient choice cesarean delivery consistent with good professional medical practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? And, third, should patient choice cesarean delivery be routinely offered to all pregnant women?

  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. Cometary particles - Thin sectioning and electron beam analysis

    NASA Technical Reports Server (NTRS)

    Bradley, J. P.; Brownlee, D. E.

    1986-01-01

    Thin sections (500 to 1000 angstroms thick) of individual micrometeorites (5 to 15 micrometers) have been prepared with an ultramicrotome equipped with a diamond knife. Electron microscope examination of these sections has revealed the internal structures of chondritic micrometeorites, and a subset of highly porous, fragile particles has been identified. Delicate meteoritic materials such as these are characteristic of debris from cometary meteors.

  1. Amnioinfusion among women attempting vaginal birth after cesarean delivery.

    PubMed

    Strong, T H; Vega, J S; O'Shaughnessy, M J; Feldman, D B; Koemptgen, J G

    1992-05-01

    Eighteen of 901 women (2%) attempting vaginal birth after cesarean delivery (VBAC) received amnioinfusion. No untoward effects occurred in the subjects or their fetuses. We conclude that, though amnioinfusion in the setting of a VBAC attempt is needed only infrequently, it appears to be a reasonable intrapartum management option. The usual safeguards for a VBAC attempt should be followed.

  2. Myoclonus-like involuntary movements following cesarean delivery epidural anesthesia.

    PubMed

    Kang, Hee Yong; Lee, Sang Wook; Hong, Eun Pyo; Sim, Yeo Hae; Lee, Su-Mi; Park, Sung Wook; Kang, Jong-Man

    2016-11-01

    Spinal myoclonus following neuraxial anesthesia is rare. This report describes a case of myoclonus-like involuntary movement that occurred during the recovery from epidural anesthesia for a cesarean delivery. The patient's symptom improved with the administration of benzodiazepine, and the patient recovered with no neurological sequelae. In conclusion, epidural anesthesia can cause spinal myoclonus, which can be treated with a benzodiazepine. PMID:27687419

  3. 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

  4. Fear, guilt, and debt: an exploration of women’s experience and perception of cesarean birth in Burkina Faso, West Africa

    PubMed Central

    Richard, Fabienne; Zongo, Sylvie; Ouattara, Fatoumata

    2014-01-01

    Background This paper explores women’s experience and perception of cesarean birth in Burkina Faso and its social and economic implications within the household. Methods Five focus groups comprising mothers or pregnant women were conducted among residents of Bogodogo Health District in Ouagadougou to assess the perceptions of cesarean section (CS) by women in the community. In addition, 35 individual semistructured interviews were held at the homes of women who had just undergone CS in the referral hospital, and were conducted by an anthropologist and a midwife. Results Home visits to women with CS identified common fears about the procedure, such as “once you have had a CS, you will always have to deliver by CS”. The central and recurring theme in the interviews was communication between patients and care providers, ie, women were often not informed of the imminence of CS in the delivery room. Information given by health care professionals was often either not explicit enough or not understood. The women received insufficient information about postoperative personal hygiene, diet, resumption of sexual activity, and contraception. Overall, analysis of the experiences of women who had undergone CS highlighted feelings of guilt in the aftermath of CS. Other concerns included the feeling of not being a “good mother” who can give birth normally, alongside concerns about needing a CS in future pregnancies, the high costs that this might incur for their households, general fatigue, and possible medical complications after surgery. Conclusion Poor quality of care and the economic burden of CS place women in a multifaceted situation of vulnerability within the family. CS has a medical, emotional, social, and economic impact on poor African women that cannot be ignored. Managers of maternal health programs need to understand women’s perceptions of CS so as to overcome existing barriers to this life-saving procedure. PMID:24851057

  5. Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

    PubMed Central

    2010-01-01

    Background The efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed. Methods Women scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed. Results One hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004 - July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p = 0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p = 0.004), membrane rupture for more than 6 hours (p = 0.08) and blood loss greater than 500 ml (p = 0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p = 0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p = 0.004). Conclusions Ampicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery. Trial registration Clinicaltrials.gov identifier: NCT01138852 PMID:21118502

  6. 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.

  7. Simultaneous uterine and urinary bladder rupture in an otherwise successful vaginal birth after cesarean delivery.

    PubMed

    Ho, Szu-Ying; Chang, Shuenn-Dhy; Liang, Ching-Chung

    2010-12-01

    Uterine rupture is the primary concern when a patient chooses a trial of labor after a cesarean section. Bladder rupture accompanied by uterine rupture should be taken into consideration if gross hematuria occurs. We report the case of a patient with uterine rupture during a trial of labor after cesarean delivery. She had a normal course of labor and no classic signs of uterine rupture. However, gross hematuria was noted after repair of the episiotomy. The patient began to complain of progressive abdominal pain, gross hematuria and oliguria. Cystoscopy revealed a direct communication between the bladder and the uterus. When opening the bladder peritoneum, rupture sites over the anterior uterus and posterior wall of the bladder were noted. Following primary repair of both wounds, a Foley catheter was left in place for 12 days. The patient had achieved a full recovery by the 2-year follow-up examination. Bladder injury and uterine rupture can occur at any time during labor. Gross hematuria immediately after delivery is the most common presentation. Cystoscopy is a good tool to identify the severity of bladder injury.

  8. Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial

    PubMed Central

    Mokhtar, Ali M.; Elsakka, Ahmed I.; Ali, Hassan M.

    2016-01-01

    Background: Anxiety is a concern in obstetrics, especially in preeclamptic mothers. Sedation is not commonly used in parturients for fear of adverse neonatal effect. We investigated maternal and neonatal outcome of midazolam as an adjuvant to spinal anesthesia for elective cesarean delivery. Methods: A prospective randomized controlled trial, in which eighty preeclamptic parturients received either an intravenous dose of 0.035 mg/kg of midazolam or an equal volume of normal saline, 30 min before spinal anesthesia. Maternal anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS); postoperative maternal satisfaction was assessed using Maternal Satisfaction Scale for Cesarean Section (MSSCS). Newborns were assessed using Apgar score, Neonatal Neurologic and Adaptive Capacity Score (NACS), and umbilical artery blood gases. Results: Mothers premedicated with midazolam showed a lower level of preoperative anxiety and a higher degree of postoperative satisfaction than the control group. There were no between-group differences regarding the neonatal outcome. Conclusion: Preeclamptic parturients premedicated with midazolam (0.035 mg/kg) before spinal anesthesia have lower anxiety and higher postoperative satisfaction levels, with no adverse effects on the newborns. PMID:27746564

  9. Investigation of Long- and Short-Term Relationships Between Cesarean Delivery and Its Effective Factors in Malayer

    PubMed Central

    Alinejad, V.; Mahmodi, M.; Alinejad, M.; Besharat, E.; Gholizade, R.; Tabbakhi, E.; Pour, A. Shojaei; Gharaaghaji, R.

    2014-01-01

    Introduction: Recently, there has been significant increase in the number of operated cesarean compared to the overall number of birth giving. There are several factors affecting the operated cesarean in Iran compared to the birth giving which are to be reviewed in this study. Procedure: The data of the study has been obtained from the registered information in Assistance Section of Health at Hamedan Faculty of Medicine which includes the seasonal data having to do with giving birth of Malayer since the beginning of Winter 2006 to the end of Fall 2013. The assimilation techniques, namely ARDL method and Error Correction Method (ECM) are the main methods to be used in this study. Results: The short-term and long-term coefficients of abnormal view, incongruent status of fetus and pelvis, lack of progression, and the lengthy status are considered significant statistically. The ecm coefficient is -1.3456 in short-term. Also, his coefficient is significant which shows the short-term balance trend to the long-term one. Conclusion: The most indispensable affective factor on demanding to run the cesarean operation in short-term and long-term in Malayer are the lengthy-status, lack of progression, abnormal view, and incongruent status of fetus and pelvis, respectively. PMID:25363171

  10. 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…

  11. 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…

  12. Analysis of charged-current neutrino-nucleus cross section

    SciTech Connect

    Megias, G.; Caballero, J. A.

    2013-06-10

    A study of the cross section for chaged-current quasielastic (CCQE) scattering on nuclei has been performed using a description of nuclear dynamics based on the Relativistic Fermi Gas model (RFG). The role played by different parametrizations for the weak nucleon form factors is analyzed taking into account the relevance of the axial mass value. The results obtained are compared with the recent data for neutrinos measured by the MiniBooNE Collaboration.

  13. 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.

  14. 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.

  15. 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.

  16. Patient Counseling and Preferences for Elective Repeat Cesarean Delivery.

    PubMed

    Folsom, Susan; Esplin, M Sean; Edmunds, Sean; Metz, Torri D; Jackson, G Marc; Porter, T Flint; Varner, Michael W

    2016-04-01

    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

  17. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries.

    PubMed

    Kim, Ju Hyun; Joung, Eun-Ju; Lee, Soo-Jung; Kwack, Jae Young; Kwon, Yong Soon

    2015-11-01

    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.

  18. Nonclinical factors affecting women's access to trial of labor after cesarean delivery.

    PubMed

    Korst, Lisa M; Gregory, Kimberly D; Fridman, Moshe; Phelan, Jeffrey P

    2011-06-01

    The use of trial of labor after cesarean (TOLAC) has declined in the last decade, and the clinical risks of TOLAC remain low. Nonclinical factors continue to affect women's access to TOLAC. This article considers 5 categories of factors that seem to be influencing rates of TOLAC and vaginal birth after cesarean: opinion leaders and professional guidelines, hospital facilities and cesarean availability, reimbursement for providing TOLAC, medical liability, and patient-level factors. An evidence base and strategies to provide guidance to create a safe environment for vaginal birth after cesarean are needed. Obstetric information systems are critical to this effort.

  19. 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.

  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. 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.

  2. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery.

    PubMed

    2014-03-01

    In 2011, one in three women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. Resonance analysis and evaluation of the sup 235 U neutron induced cross sections

    SciTech Connect

    Leal, L.C.

    1990-06-01

    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 {sup 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}{sub 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 results of the analysis consists of a set of resonance parameters which describe the {sup 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 {sub 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. 44 refs., 21 figs., 8 tabs.

  9. 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).

  10. 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.

  11. Phosphoproteome analysis of formalin-fixed and paraffin-embedded tissue sections mounted on microscope slides.

    PubMed

    Wakabayashi, Masaki; Yoshihara, Hiroki; Masuda, Takeshi; Tsukahara, Mai; Sugiyama, Naoyuki; Ishihama, Yasushi

    2014-02-01

    Formalin-fixed and paraffin-embedded (FFPE) sections mounted on microscope slides are one of the largest available resources for retrospective research on various diseases, but quantitative phosphoproteome analysis of FFPE sections has never been achieved because of the extreme difficulty of procuring sufficient phosphopeptides from the limited amounts of proteins on the slides. Here, we present the first protocol for quantitative phosphoproteome analysis of FFPE sections by utilizing phase-transfer surfactant-aided extraction/tryptic digestion of FFPE proteins followed by high-recovery phosphopeptide enrichment via lactic acid-modified titania chromatography. We established that FFPE sections retain a similar phosphoproteome to fresh tissue specimens during storage for at least 9 months, confirming the utility of our method for evaluating phosphorylation profiles in various diseases. We also verified that chemical labeling based on reductive dimethylation of amino groups was feasible for quantitative phosphoproteome analysis of FFPE samples on slides. Furthermore, we improved the LC-MS sensitivity by miniaturizing nanoLC columns to 25 μm inner diameter. With this system, we could identify 1090 phosphopeptides from a single FFPE section obtained from a microscope slide, containing 25.2 ± 5.4 μg of proteins. This protocol should be useful for large-scale phosphoproteome analysis of archival FFPE slides, especially scarce samples from patients with rare diseases.

  12. Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review.

    PubMed

    Medeiros, L R; Rosa, D D; Edelweiss, M I; Stein, A T; Bozzetti, M C; Zelmanowicz, A; Pohlmann, P R; Meurer, L; Carballo, M T

    2005-01-01

    A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3-10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94-96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101-605) increased the probability of ovarian cancer to 98% (95% CI, 97-99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45-106) increased the probability of borderline tumors to 79% (95% CI, 71-85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13-26) increased the probability of borderline tumors to 51% (95% CI, 42-60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

  13. 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

  14. Paratesticular fibrous pseudotumour: Intraoperative frozen section analysis can help prevent unnecessary orchiectomy

    PubMed Central

    DeCoste, Ryan C.; Carter, Michael D.; Bagnell, Scott; Merrimen, Jennifer

    2015-01-01

    Paratesticular fibrous pseudotumours are rare intrascrotal lesions, most frequently affecting the testicular tunics. They are benign in nature; however, their pathogenesis is not completely understood. Presenting features are similar to testicular malignancy, which may result in unnecessary radical surgery. It has been suggested that additional diagnostic imaging combined with frozen section analysis may help prevent orchiectomy in these patients. We describe a case of paratesticular fibrous pseudotumour in a 40-year-old male treated with testicle-sparing surgery aided by intraoperative frozen section analysis. PMID:26664509

  15. Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery.

    PubMed

    Smid, Marcela C; Vladutiu, Catherine J; Dotters-Katz, Sarah K; Manuck, Tracy A; Boggess, Kim A; Stamilio, David M

    2016-10-01

    Objective To estimate the association between maternal super obesity (body mass index [BMI] ≥ 50 kg/m(2)) and neonatal morbidity among neonates born via cesarean delivery (CD). Methods Retrospective cohort of singleton neonates delivered via CD ≥ 37 weeks in the Maternal-Fetal Medicine Unit Cesarean Registry. Maternal BMI at delivery was stratified as 18.5 to 29.9 kg/m(2), 30 to 39.9 kg/m(2), 40 to 49.9 kg/m(2), and ≥ 50 kg/m(2). Primary outcomes included acute (5-minute Apgar score < 5, cardiopulmonary resuscitation and ventilator support < 24 hours, neonatal injury, and/or transient tachypnea of the newborn) and severe (grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, seizure, respiratory distress syndrome, hypoxic ischemic encephalopathy, meconium aspiration, ventilator support ≥ 2 days, sepsis and/or neonatal death) neonatal morbidity. Odds of neonatal morbidity were estimated for each BMI category adjusting for clinical and operative characteristics. Results Of 41,262 maternal-neonatal dyads, 36% of women were nonobese, 49% had BMI of 30 to 39.9 kg/m(2), 12% had BMI of 40 to 49.9 kg/m(2), and 3% were super obese. Compared with nonobese women, super obese women had twofold odds of acute (5 vs. 10%; adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.59-2.73) and severe (3 vs. 6%; aOR: 2.08; 95% CI: 1.59-2.73) neonatal morbidity. Conclusion Among term infants delivered via CD, maternal super obesity is associated with increased risk of neonatal morbidity.

  16. Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery.

    PubMed

    Smid, Marcela C; Vladutiu, Catherine J; Dotters-Katz, Sarah K; Manuck, Tracy A; Boggess, Kim A; Stamilio, David M

    2016-10-01

    Objective To estimate the association between maternal super obesity (body mass index [BMI] ≥ 50 kg/m(2)) and neonatal morbidity among neonates born via cesarean delivery (CD). Methods Retrospective cohort of singleton neonates delivered via CD ≥ 37 weeks in the Maternal-Fetal Medicine Unit Cesarean Registry. Maternal BMI at delivery was stratified as 18.5 to 29.9 kg/m(2), 30 to 39.9 kg/m(2), 40 to 49.9 kg/m(2), and ≥ 50 kg/m(2). Primary outcomes included acute (5-minute Apgar score < 5, cardiopulmonary resuscitation and ventilator support < 24 hours, neonatal injury, and/or transient tachypnea of the newborn) and severe (grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, seizure, respiratory distress syndrome, hypoxic ischemic encephalopathy, meconium aspiration, ventilator support ≥ 2 days, sepsis and/or neonatal death) neonatal morbidity. Odds of neonatal morbidity were estimated for each BMI category adjusting for clinical and operative characteristics. Results Of 41,262 maternal-neonatal dyads, 36% of women were nonobese, 49% had BMI of 30 to 39.9 kg/m(2), 12% had BMI of 40 to 49.9 kg/m(2), and 3% were super obese. Compared with nonobese women, super obese women had twofold odds of acute (5 vs. 10%; adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.59-2.73) and severe (3 vs. 6%; aOR: 2.08; 95% CI: 1.59-2.73) neonatal morbidity. Conclusion Among term infants delivered via CD, maternal super obesity is associated with increased risk of neonatal morbidity. PMID:27464019

  17. Emergency cesarean delivery in a parturient who had an intractable paroxysmal supraventricular tachycardia -A case report-

    PubMed Central

    Chang, Eun-Jung; Han, Jin; Cho, Hun

    2012-01-01

    Paroxysmal supraventricular tachycardia (SVT) is a common arrhythmia in the parturient and can occur with or without an underlying organic heart disease. A woman of 35 weeks' gestation, who had a paroxysmal SVT that was resistant to antiarrhythmic drugs and electric cardioversion, required emergency Cesarean delivery. The Cesarean delivery was performed under spinal anesthesia and a healthy baby was delivered uneventfully. SVT spontaneously converted to normal sinus rhythm right after delivery of the baby. PMID:23115691

  18. 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

  19. Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.

    PubMed

    Quiroz, Lieschen H; Chang, Howard; Blomquist, Joan L; Okoh, Yvonne K; Handa, Victoria L

    2009-04-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.

  20. Maternal goals for childbirth associated with planned vaginal and planned cesarean birth.

    PubMed

    Quiroz, Lieschen H; Blomquist, Joan L; Macmillan, Deborah; McCullough, Alexis; Handa, Victoria L

    2011-10-01

    We describe maternal childbirth goals among women planning either cesarean or vaginal birth. Women in the third trimester planning cesarean or vaginal birth were asked to report up to five childbirth goals. Goal achievement was assessed postpartum. Based on free-text responses, discrete goal categories were identified. Goals and goal achievement were compared between the two groups. Satisfaction was rated on a visual analogue scale and was compared with goal achievement. The sample included 163 women planning vaginal birth and 69 women planning cesarean. Twelve goal categories were identified. Only women planning vaginal birth reported a desire to achieve fulfillment related to childbirth. Women planning cesarean were less likely to express a desire to maintain control over their own responses during childbirth and more likely to report a desire to avoid complications. The 72 women who achieved all stated goals reported significantly higher mean satisfaction scores than the 94 women reporting that at least one goal was not achieved (P  =  0.001). Goal achievement was higher among women planning cesarean than among those planning vaginal birth (52.2% versus 23.1%, P  <  0.001). This research furthers our understanding of women's attitudes regarding cesarean childbirth and definitions of a successful birth experience.

  1. 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)…

  2. Cross Section Sensitivity and Uncertainty Analysis Including Secondary Neutron Energy and Angular Distributions.

    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).

  3. 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.

  4. 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

  5. Optimization of multi-group cross sections for fast reactor analysis

    SciTech Connect

    Chin, M. R.; Manalo, K. L.; Edgar, C. A.; Paul, J. N.; Molinar, M. P.; Redd, E. M.; Yi, C.; Sjoden, G. E.

    2013-07-01

    The selection of the number of broad energy groups, collapsed broad energy group boundaries, and their associated evaluation into collapsed macroscopic cross sections from a general 238-group ENDF/B-VII library dramatically impacted the k eigenvalue for fast reactor analysis. An analysis was undertaken to assess the minimum number of energy groups that would preserve problem physics; this involved studies using the 3D deterministic transport parallel code PENTRAN, the 2D deterministic transport code SCALE6.1, the Monte Carlo based MCNP5 code, and the YGROUP cross section collapsing tool on a spatially discretized MOX fuel pin comprised of 21% PUO{sub 2}-UO{sub 2} with sodium coolant. The various cases resulted in a few hundred pcm difference between cross section libraries that included the 238 multi-group reference, and cross sections rendered using various reaction and adjoint weighted cross sections rendered by the YGROUP tool, and a reference continuous energy MCNP case. Particular emphasis was placed on the higher energies characteristic of fission neutrons in a fast spectrum; adjoint computations were performed to determine the average per-group adjoint fission importance for the MOX fuel pin. This study concluded that at least 10 energy groups for neutron transport calculations are required to accurately predict the eigenvalue for a fast reactor system to within 250 pcm of the 238 group case. In addition, the cross section collapsing/weighting schemes within YGROUP that provided a collapsed library rendering eigenvalues closest to the reference were the contribution collapsed, reaction rate weighted scheme. A brief analysis on homogenization of the MOX fuel pin is also provided, although more work is in progress in this area. (authors)

  6. 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.

  7. 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.

  8. 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.

  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.

  10. 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.

  11. Effect of preoperative administration of intravenous paracetamol during cesarean surgery on hemodynamic variables relative to intubation, postoperative pain and neonatal apgar.

    PubMed

    Ayatollahi, Vida; Faghihi, Safa; Behdad, Shokoufeh; Heiranizadeh, Najmeh; Baghianimoghadam, Behnam

    2014-09-01

    Selection of anesthetic drugs for cesarean section requires many considerations. Anesthetic drugs for this purpose must prevent hemodynamic stress due to tracheal intubation, while inducing neonatal complications. This study was conducted to determine the effects of paracetamol given before induction of anesthesia on cardiovascular responses to tracheal intubation and postoperative pain in the mother, and on neonatal Apgar score. This double-blind randomized placebo-controlled trial included 60 women in ASA I, without underlying diseases and fetal distress, who were candidates for elective cesarean section under general anesthesia. Patients were divided into two groups of 30 patients. Patients in the paracetamol group received 1 g intravenous (IV) paracetamol 20 min before the operation, while those in the placebo group received 1 cc normal saline at the same time. In both groups, anesthesia was induced by sodium thiopental and succinylcholine. Maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured before and immediately upon induction of anesthesia, and at first and fifth minute after tracheal intubation. Neonatal effects were assessed by Apgar score. Postoperative pain was assessed by use of the visual analog scale (VAS). The dose of analgesic used and the time of the first analgesic request by patients postoperatively were recorded. The SBP, DBP, MAP and HR were controlled significantly better in paracetamol group than in placebo group (P < 0.05). The mean 1-min and 5-min Apgar scores of neonates did not differ between the groups. The VAS pain score was significantly lower in paracetamol group than in placebo group at all measuring times (P < 0.05). Also, paracetamol caused later first analgesic request and lower dose of analgesic needed to control pain postoperatively (P < 0.05). In conclusion, the results of our study suggested IV paracetamol to be an efficacious agent to decrease

  12. [Informed Consent in the Humanization of the Cesarean: A Preliminary Study].

    PubMed

    Castaño Molina, M Ángeles; Carrillo Navarro, Francisco; Pastor, Luis Miguel

    2016-01-01

    The informed consent (IC) is a process based on dialogue between the professional and the patient in which he freely decides on possible interventions in their health. This is applicable to caesarean delivery and if it meets a number of conditions will help to improve the process of ″humanization″ of birth. The overall objective of this study is to analyze preliminarily in several hospitals in the Region of Murcia the IC in caesarean delivery. To this end, we have revised the documents of IC and we studied who, where, when and how the IC process is done. The results show that all hospitals are based on the same document, and although the documents take into account all the elements of a IC, do not indicate the date of their design or subsequent revisions. It does not contemplate the risks and complications that caesarean section can have on the newborn, mother, and mother-child relationship later. It is noted that the document of IC normally is delivers by gynecologist in the consultation, when intervention is programmed, although it are sometimes nurses, who after admission to the hospital give it to sign the patient. In urgent caesarean sections, there are some hospitals that in life-threatening situation, do not offer the document of IC to women. In others, it is offered hastily by the gynecologist or midwife. In conclusion, the IC is a process which used correctly, favors the relationship between women and health professionals in the intervention of cesarean section. Although this process and the documents of IC examined in our study, have presented many positive aspects, the humanization of caesarean could be increased improving with the preparation and updating of these documents and coordinating the various professionals.

  13. [Informed Consent in the Humanization of the Cesarean: A Preliminary Study].

    PubMed

    Castaño Molina, M Ángeles; Carrillo Navarro, Francisco; Pastor, Luis Miguel

    2016-01-01

    The informed consent (IC) is a process based on dialogue between the professional and the patient in which he freely decides on possible interventions in their health. This is applicable to caesarean delivery and if it meets a number of conditions will help to improve the process of ″humanization″ of birth. The overall objective of this study is to analyze preliminarily in several hospitals in the Region of Murcia the IC in caesarean delivery. To this end, we have revised the documents of IC and we studied who, where, when and how the IC process is done. The results show that all hospitals are based on the same document, and although the documents take into account all the elements of a IC, do not indicate the date of their design or subsequent revisions. It does not contemplate the risks and complications that caesarean section can have on the newborn, mother, and mother-child relationship later. It is noted that the document of IC normally is delivers by gynecologist in the consultation, when intervention is programmed, although it are sometimes nurses, who after admission to the hospital give it to sign the patient. In urgent caesarean sections, there are some hospitals that in life-threatening situation, do not offer the document of IC to women. In others, it is offered hastily by the gynecologist or midwife. In conclusion, the IC is a process which used correctly, favors the relationship between women and health professionals in the intervention of cesarean section. Although this process and the documents of IC examined in our study, have presented many positive aspects, the humanization of caesarean could be increased improving with the preparation and updating of these documents and coordinating the various professionals. PMID:27637198

  14. 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.

  15. 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.

  16. Cross-sectional TEM analysis of solvent-cast SBS thin films

    SciTech Connect

    Kim, G.; Libera, M.

    1996-12-31

    Block copolymers can assume a range of microphase-separated morphologies, and the dependence of morphology on temperature and composition is an area of active research. Our work has been studying the morphology of solvent-cast thin films of polystyrene-polybutadiene-polystyrene (SBS) as a function of solvent evaporation rate and post-specimen annealing. This paper describes the analysis of thin film cross-sections to distinguish between possible morphologies.

  17. 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…

  18. 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.

  19. 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.

  20. 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

    2010-11-23

    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.

  1. 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.

  2. 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

  3. Anesthetic Management of Urgent Cesarean Section with Undiagnosed Transposition of Great Arteries

    PubMed Central

    Yilmaz, Nurullah; Koksal, Ersin; Ozgen, Gokce Ultan; Ozen, Ersan; Dilek, Ahmet; Karakaya, Deniz; Ulger, Fatma

    2016-01-01

    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

  4. 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

  5. Uterine Leiomyomata and Cesarean Birth Risk: A Prospective Cohort with Standardized Imaging

    PubMed Central

    Michels, Kara A.; Edwards, Digna R. Velez; Baird, Donna D.; Savitz, David A.; Hartmann, Katherine E.

    2014-01-01

    Purpose To determine if women with leiomyomata detected using uniform ultrasound methods are at increased risk of cesarean birth, without regard to indication. Methods Women were enrolled in Right from the Start (2000-2010), a prospective pregnancy cohort. Leiomyomata were counted, categorized, and measured during first trimester ultrasounds. Women provided information about demographics and reproductive history during first trimester interviews. Route of delivery was extracted from medical records or vital records, if the former were unavailable. Generalized estimating equations were used to calculate risk ratios (RRs) and 95% confidence intervals (CIs) for the risk of cesarean birth by leiomyoma presence and characteristics. Results Among 2,635 women, the prevalences of leiomyomata and cesarean birth were 11.2% and 29.8%, respectively. Women with leiomyomata, compared to those without, had a 27% increase in cesarean risk (RR 1.27, CI [1.17, 1.37]). The association was weaker following adjustment for maternal body mass index and age (adjusted RR (ARR) 1.11, CI [1.02, 1.20]). The adjusted risk was elevated for women with a single leiomyoma ≥3 centimeters in diameter (ARR 1.22, CI [1.14, 1.32]) and women with the largest total leiomyoma volumes (ARR 1.59, CI [1.44, 1.76]). Conclusions Women with leiomyomata were at increased risk for cesarean birth particularly, those with larger tumor volumes. PMID:24321612

  6. Effectiveness of a Novel Device in the Reduction of Cesarean Deliveries

    PubMed Central

    Burns, Daniel A.

    2013-01-01

    Objective. To test the hypothesis that the use of the HEM-AVERT Perianal Stabilizer will result in a reduction of cesarean births and shorter duration of second-stage labor. Study Design. In a prospective controlled trial, 102 women scheduled for vaginal delivery were randomized to either the HEM-AVERT investigational device or control group. Ninety eight (98) patients completed the study. A chi-square test was used to evaluate the difference in the number of cesarean deliveries between the investigational and control groups. Duration of second-stage labor was assessed as a secondary outcome. Results. Six (6) of the 50 patients in the investigational group (12%) failed to deliver vaginally and required cesarean delivery. Comparatively, 19 of the 48 control patients (39.6%) required cesarean delivery. Duration of second-stage labor was shorter in the investigational group, but the difference was not statistically significant. Results from 4 patients were excluded due to protocol violations. Conclusion. The HEM-AVERT device effectively reduced the incidence rate of cesarean deliveries in the investigational group when compared to women who delivered without use of the device. This trial is registered with ClinicalTrials.gov NCT01739543. PMID:24078876

  7. Effectiveness of a novel device in the reduction of cesarean deliveries.

    PubMed

    Burns, Daniel A

    2013-01-01

    Objective. To test the hypothesis that the use of the HEM-AVERT Perianal Stabilizer will result in a reduction of cesarean births and shorter duration of second-stage labor. Study Design. In a prospective controlled trial, 102 women scheduled for vaginal delivery were randomized to either the HEM-AVERT investigational device or control group. Ninety eight (98) patients completed the study. A chi-square test was used to evaluate the difference in the number of cesarean deliveries between the investigational and control groups. Duration of second-stage labor was assessed as a secondary outcome. Results. Six (6) of the 50 patients in the investigational group (12%) failed to deliver vaginally and required cesarean delivery. Comparatively, 19 of the 48 control patients (39.6%) required cesarean delivery. Duration of second-stage labor was shorter in the investigational group, but the difference was not statistically significant. Results from 4 patients were excluded due to protocol violations. Conclusion. The HEM-AVERT device effectively reduced the incidence rate of cesarean deliveries in the investigational group when compared to women who delivered without use of the device. This trial is registered with ClinicalTrials.gov NCT01739543. PMID:24078876

  8. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery.

    PubMed

    Landon, Mark B

    2010-08-01

    Uterine rupture is the most serious complication for women undergoing trial of labor (TOL) after prior cesarean delivery. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0.5 and 4 percent. Previous vaginal delivery and prior successful vaginal birth after cesarean delivery confer the lowest risk of rupture on women attempting TOL. In contrast, multiple prior cesareans, short interpregnancy interval, single layer uterine closure, prior preterm cesarean, labor induction and augmentation have all been suggested in some studies as factors which may increase the rate of uterine rupture. While considering these risk factors is important in counseling women regarding childbirth following cesarean delivery, the infrequency of uterine rupture coupled with relatively weak associations for most risk factors has prevented the development of an accurate prediction tool for uterine rupture. Preliminary studies suggest that sonographic evaluation of the uterine scar may hold some promise for identifying women at risk.

  9. 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…

  10. Boltzmann equation analysis of electron-molecule collision cross sections in water vapor and ammonia

    NASA Astrophysics Data System (ADS)

    Yousfi, M.; Benabdessadok, M. D.

    1996-12-01

    Sets of electron-molecule collision cross sections for H2O and NH3 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 H2O and NH3 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).

  11. Static and dynamic experimental analysis of the galloping stability of porous H-section beams.

    PubMed

    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.

  12. 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

  13. Analysis of the Korean Orthopedic In-Training Examination: The Hip and Pelvis Section

    PubMed Central

    Cho, Yohan; Kim, Joon Yub

    2016-01-01

    Purpose The purpose of this study was to analyze the questions in the hip and pelvis section of the Korean Orthopaedic In-Training Examination (KOITE). Materials and Methods We analyzed all KOITE questions pertaining to hip and pelvis surgery between 2010 and 2014. A thorough analysis of the contents was performed after categorizing as tested topics, imaging modalities used, taxonomic classification, and recommended references. We also analyzed the scores of the hip and pelvis section of the KOITE. Results Seventy-five of five-hundred questions (weight, 15.0%) were related to the hip and pelvis. Trauma including fracture and dislocation (26/75, 34.7%) was asked more commonly than disease and basics. The description-only questions (65/75, 86.7%) were the most frequently asked. According to taxonomic classification, taxonomy 3 (decision; 39/75, 52.0%) was most frequently asked. Campbell's Operative Orthopedics (52/75, 69.3%) was the reference that covered most of the questions. Conclusion This analysis of the hip and pelvis section of KOITE could be used for resident training programs in teaching hospitals. PMID:27777918

  14. Partial-wave analysis of n +241Am reaction cross sections in the resonance region

    NASA Astrophysics Data System (ADS)

    Noguere, G.; Bouland, O.; Kopecky, S.; Lampoudis, C.; Schillebeeckx, P.; Plompen, A.; Gunsing, F.; Sage, C.; Sirakov, I.

    2015-07-01

    Cross sections for neutron-induced reactions of 241Am in the resonance region have been evaluated. Results of time-of-flight cross section experiments carried out at the GELINA, LANSCE, ORELA and Saclay facilities have been combined with optical model calculations to derive consistent cross sections from the thermal energy region up to the continuum region. Resolved resonance parameters were derived from a resonance shape analysis of transmissions, capture yields, and fission yields in the energy region up to 150 eV using the refit code. From a statistical analysis of these parameters, a neutron strength function (104S0=1.01 ±0.12 ), mean level spacing (D0=0.60 ±0.01 eV) and average radiation width (<Γγ 0>=43.3 ±1.1 meV) for s -wave resonances were obtained. Neutron strength functions for higher partial waves (l >0 ) together with channel and effective scattering radii were deduced from calculations based on a complex mean-field optical model potential, applying an equivalent hard-sphere scattering radius approximation.

  15. 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.

  16. 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.

  17. Multi-Dimensional, Discrete-Ordinates Based Cross Section Sensitivity and Uncertainty Analysis Code System.

    SciTech Connect

    KODELI, IVAN-ALEXANDER

    2008-05-22

    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.

  18. Multi-Dimensional, Discrete-Ordinates Based Cross Section Sensitivity and Uncertainty Analysis Code System.

    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

  19. 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

  20. 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

  1. Maternal and neonatal morbidity and mortality rate in caesarean section and vaginal delivery

    PubMed Central

    Ghahiri, Ataollah; Khosravi, Mehrnoush

    2015-01-01

    Background: The cesarean section is one of the most common procedures to prevent health-threatening risks to the mother and infant. Increasing rate of cesarean section attracted the attention of professionals and the overall objective of this study was to determine the frequency of maternal and neonatal morbidity and mortality rates in the two methods of delivery. Materials and Methods: In a comparative cohort study, 300 cases undergoing caesarean section and 300 cases with vaginal delivery were selected in two main hospitals of Isfahan, Iran during 2013 and 2014. Demographic characteristics and factors related to mortality and morbidity of mothers and infants were studied. Mothers were also recruited 6 weeks after delivery to ask for complications. Mothers and infants mortality and morbidity were studied and analyzed by SPSS 22 software. Results: Follow-up of deliveries up to 1-month after delivery suggested 2 cases of infant death (7%) in vaginal delivery group, while no case of infant death was reported in cesarean delivery group (P = 0.5). Incidence of fever was observed in first 10 days after delivery in 7 cases in the vaginal delivery group and 11 cases in the cesarean delivery group (2.3% vs. 3.7%, P = 0.4). Conclusion: Despite all the benefits of vaginal delivery compared with cesarean section, in many cases, especially in emergency cesarean section delivery can substantially reduce the maternal and neonatal mortality and morbidity. It is recommended to assess the complications of each method in all pregnant women about to give birth, and then decide on the method of delivery. PMID:26605232

  2. R-matrix analysis of the /sup 235/U neutron cross sections

    SciTech Connect

    Leal, L.C.; de Saussure, G.; Perez, R.B.

    1988-01-01

    The ENDFB-V representation of the /sup 235/U neutron cross sections in the resolved resonance region is unsatisfactory: below 1 eV the cross sections are given by ''smooth files'' (file 3) rather than by resonance parameters; above 1 eV the single-level formalism used by ENDFB-V necessitates a structured file 3 contribution consisting of more than 1300 energy points; furthermore, information on level-spins has not been included. Indeed the ENDFB-V /sup 235/U resonance region is based on an analysis done in 1970 for ENDFB-III and therefore does not include the results of high quality measurements done in the past 18 years. The present paper presents the result of an R-matrix multilevel analysis of recent measurements as well as older data. The analysis also extends the resolved resonance region from its ENDFB-V upper limit of 81 eV to 110 eV. 13 refs., 2 figs., 1 tab

  3. Robotic-assisted laparoscopic removal of cesarean scar ectopic and hysterotomy revision.

    PubMed

    Siedhoff, Matthew T; Schiff, Lauren D; Moulder, Janelle K; Toubia, Tarek; Ivester, Thomas

    2015-05-01

    A 38-year-old gravida 6 para 2042 woman presented in consultation regarding management of a uterine defect, or "niche," following resolution of a cesarean scar ectopic pregnancy. She had 3 prior losses, followed by in vitro fertilization that resulted in 2 healthy births, both delivered by cesarean. A third in vitro embryo transfer resulted in the cesarean scar ectopic. After consideration of treatment options, she underwent multiple-dose parenteral methotrexate with eventual termination of the ectopic. Magnetic resonance imaging demonstrated a uterine defect, suspected to contain residual pregnancy tissue. Questions considered in her consultation included whether the defect should be repaired and, if so, from a hysteroscopic or laparoscopic approach, as well as her risk of intrauterine scarring, when, or if, it would be safe to pursue another pregnancy, and her subsequent risk of uterine rupture. Literature review regarding cesarean niche was helpful, but did not seem to completely inform this particular clinical scenario. She elected to proceed with robotic-assisted laparoscopic repair. The vesicovaginal space was opened to expose the defect. Dilute vasopressin was injected circumferentially around the defect to help minimize the use of electrosurgery in opening the hysterotomy. Scar overlying the defect was resected and pregnancy tissue removed. The hysterotomy was closed with delayed-absorbable barbed suture, extrapolating technique from laparoscopic myomectomy. The first layer was imbricated with a second, similar to a 2-layer closure in cesarean delivery. Follow-up magnetic resonance imaging revealed resolution of the defect. After several failed attempts at repeat in vitro fertilization, spontaneous pregnancy was achieved 18 months postoperatively. The pregnancy was uncomplicated and she underwent scheduled cesarean delivery of a healthy neonate at 37 weeks' gestation. The lower uterine segment was thick and developed, with no evidence of a dehiscence

  4. 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

  5. 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.

  6. Three-dimensional vibration analysis of a torus with circular cross section.

    PubMed

    Zhou, D; Au, F T K; Lo, S H; Cheung, Y K

    2002-12-01

    The free vibration characteristics of a torus with a circular cross section are studied by using the three-dimensional, small-strain, elasticity theory. A set of three-dimensional orthogonal coordinates system, comprising the polar coordinate (r, theta) at each circular cross section and the circumferential coordinate phi around the ring, is developed. Each of the displacement components u(r), v(theta), and w(phi) in the r, theta, and phi directions, respectively, is taken as a product of the Chebyshev polynomials in the r direction and the trigonometric functions in the theta and phi directions. Eigenfrequencies and vibration mode shapes have been obtained via a three-dimensional displacement-based extremum energy principle. Upper bound convergence of the first seven eigenfrequencies accurate to at least six significant figures is obtained by using only a few terms of the admissible functions. The eigenfrequency responses due to variation of the ratio of the radius of the ring centroidal axis to the cross-sectional radius are investigated in detail. Very accurate eigenfrequencies and deformed mode shapes of the three-dimensional vibration are presented. All major modes such as flexural thickness-shear modes, in-plane stretching modes, and torsional modes are included in the analysis. The results may serve as a benchmark reference for validating other computational techniques for the problem.

  7. Bibliometric Analysis of Journal of Clinical and Diagnostic Research (Dentistry Section; 2007-2014)

    PubMed Central

    Basavaraj, P; Singla, Ashish; Singh, Khushboo; Kundu, Hansa; Vashishtha, Vaibhav; Pandita, Venisha; Malhi, Ravneet

    2015-01-01

    Background: The role of scientific journals in diffusion of data concerning researches in the field of Public Health Dentistry is of premier importance. Bibliometric analysis involves analysis of publications reflecting the type of research work. Aim: The present study was conducted with an aim to determine the number and trends of published articles in Journal of Clinical and Diagnostic Research (JCDR) from Feb. 2007 to Oct.2014. Settings and Design: A retrospective observational study was conducted for JCDR. Materials and Methods: All issues of JCDR were electronically searched for the parameters : study design, area of interest of research, state /college where research was conducted, authorship pattern, source of articles published each year, changing study trends, disease under study and publication bias. Statistical Analysis used: The data was organized and analyzed using software SPSS - version 21.0; descriptive statistics was used. Results: Bibliometric analysis was done for 601 articles of JCDR published from Feb. 2007 to Oct. 2014. The total number of articles published under Dentistry section have tremendously increased from mere 2 articles in 2007 to 328 articles in 2014.Majority of the study designs published in both the journal were case reports (42.6%) followed by cross sectional studies (24.8%). 96.3% of the articles were from India. Majority of the articles published were of multi authors (65.2%) and from Educational institutes (98.4%). The trends of the articles published indicated that the case reports/series formed the major bulk (others=59.1%) followed by research studies (21.3%). Conclusion: It was concluded that most articles published were case reports followed by researches indicating an inclination towards better quality methodology. The SJR and the citation count of the articles published also indicated the quality of the scientific articles published. PMID:26023643

  8. 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.

  9. 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

  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. 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

  12. 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.

  13. Bayesian Rainfall Variability Analysis in West Africa along Cross Sections in Space Time Grid Boxes.

    NASA Astrophysics Data System (ADS)

    Tapsoba, Dominique; Haché, Mario; Perreault, Luc; Bobée, Bernard

    2004-03-01

    This paper proposes an approach for analyzing rainfall variability over West Africa during the 1950 90 period. Three grid boxes, corresponding to three selected areas over West Africa, have been constructed. For each candidate area the set of annual grid maps are stored in 3D matrices, reflecting time and geographical position, called here space time grid boxes. Each space time grid box contains grid points corresponding to a given gauging year. The Bayesian procedure, based on a single-shifting model, is applied to grid points extracted from mean meridional and latitudinal cross sections of each space time grid box. Two different problems are considered: the first is the detection of a change, while the second is the estimation of the changepoint and its amplitude under the assumption that a change has occurred. The Bayesian single-shift model is applied on grid points extracted from each cross section. A latitude latitude and longitude longitude analysis of the rainfall climatology changes is, thus, carried out. It is pointed out that the most significant rainfall climatological changes in the Sahel most probably occurred between 1965 and 1970 with the decrease of the mean level of annual rainfall. This deficit is very high over the coastal region of Senegal (25%) and over the central region of the Sahel (15% 20%). Under approximately 9° 10°N, over the humid West Africa region, a zone without any significant change extending from 6° to 10°N was highlighted. A similar zone with nonsignificant rainfall change was identified along the cross section at 1.5°E, which follow the border of Togo and Benin. However, over the zones in edge of the coast of Ivory Coast, a deficit about 17% is observed.

  14. Phylogenetic analysis of Primula section Primula reveals rampant non-monophyly among morphologically distinct species.

    PubMed

    Schmidt-Lebuhn, Alexander N; de Vos, Jurriaan M; Keller, Barbara; Conti, Elena

    2012-10-01

    The type section of Primula (Primulaceae), here considered to include seven species, is phylogenetically quite isolated in its genus. Although its species are popular ornamentals, traditional medicinal plants and model organisms for the study of heterostyly, the section has not yet been studied from a phylogenetic or evolutionary perspective. Using phylogenetic analysis of nuclear ITS and plastid data from all species and subspecies, we find that widespread Primula elatior is genetically heterogeneous and non-monophyletic to most if not all of the other ingroup taxa. The Genealogical Sorting Index (GSI) indicates that the assumption of all currently accepted species being independent lineages is consistent with the data. It is possible that P. elatior in its current circumscription may represents the disjointed remnant of an ancestral species from which the other recognized species diverged. However, based on available data, the alternative possibility of introgression explaining the non-monophyly of this species cannot be excluded. Species trees show P. elatior and P. veris as sister species. Primula vulgaris and P. juliae are closely related, while, in contrast to previous assumptions, P. renifolia does not appear to be a close relative of P. megaseifolia. With the section's isolation from the rest of the genus and very short internal branches, our dataset also presents a case study of the confounding effects of different branch length priors on the Bayesian estimation of resulting branch length estimates. Experimental runs using different priors confirm the problem of resulting estimates varying by orders of magnitude, while topology and relative branch lengths seem unaffected.

  15. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature.

    PubMed

    Api, Murat; Boza, Aysen; Gorgen, Husnu; Api, Olus

    2015-01-01

    Several obstetric complications due to inappropriately healed cesarean scar such as placenta accreta, scar dehiscence, and ectopic scar pregnancy are increasingly reported along with rising cesarean rates. Furthermore, many gynecologic conditions, including abnormal uterine bleeding, pelvic pain and infertility, are imputed to deficient cesarean scar healing. Hysteroscopy is the most commonly reported approach for the revision of cesarean scar defects (CSDs). Nevertheless, existing evidence is inadequate to conclude that either hysteroscopy or laparoscopy is effective or superior to each other. Although several management options have been suggested recently, the laparoscopic approach has not been thoroughly scrutinized. We present a case and reviewed the data related to the laparoscopic repair of CSDs and compared the hysteroscopic and laparoscopic management options based on the data from previously published articles. As a result of our analyses, the laparoscopic approach increases uterine wall thickness when compared with the hysteroscopic approach, and both surgical techniques seem to be effective for the resolution of gynecologic symptoms. Hysteroscopic treatment most likely corrects the scar defect but does not strengthen the uterine wall; thus, the potential risk of dehiscence or rupture in subsequent pregnancies does not seem to be improved. Because large uterine defects are known risk factors for scar dehiscence, the repair of the defect to reinforce the myometrial endurance seems to be an appropriate method of treatment. PMID:26122897

  16. 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.

  17. 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.

  18. Three-dimensional microscopic elemental analysis using an automated high-precision serial sectioning system.

    PubMed

    Fujisaki, Kazuhiro; Yokota, Hideo; Furushiro, Naomichi; Komatani, Shintaro; Ohzawa, Sumito; Sato, Yoshimichi; Matsunaga, Daisuke; Himeno, Ryutaro; Higuchi, Toshiro; Makinouchi, Akitake

    2011-04-01

    The elemental composition and microscopic-level shape of inclusions inside industrial materials are considered important factors in fracture analytical studies. In this work, a three-dimensional (3D) microscopic elemental analysis system based on a serial sectioning technique was developed to observe the internal structure of such materials. This 3D elemental mapping system included an X-ray fluorescence analyzer and a high-precision milling machine. Control signals for the X-ray observation process were automatically sent from a data I/O system synchronized with the precision positioning on the milling machine. Composite specimens were used to confirm the resolution and the accuracy of 3D models generated from this system. Each of the two specimens was composed of three metal wires of 0.5 mm diameter braided into a single twisted wire that was placed inside a metal pipe; the pipe was then filled with either epoxy resin or Sn. The milling machine was used to create a mirror-finish cross-sectional surface on these specimens, and elemental analyses were performed. The twisted wire structure was clearly observed in the resulting 3D models. This system enables automated investigation of the 3D internal structure of materials as well as the identification of their elemental components.

  19. 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.

  20. Analysis of influential factors on a space target's laser radar cross-section

    NASA Astrophysics Data System (ADS)

    Han, Yi; Sun, Huayan; Guo, Huichao

    2014-03-01

    This paper utilises the idea of theoretical analysis to introduce a fast and visual laser radar cross-section (LRCS) calculation method for space targets that is implemented with OpenGL. We chose the cube, cylinder and cone as targets based on the general characteristics of satellite shapes. The four-parameter mono-station BRDF is used, and we assume the surface materials are either purely diffuse, purely specular or mixed. The degree of influence on a target's total LRCS of the target's shape and size and the surface materials' BRDF are described. We describe the general laws governing influential factors by comparing simulated results. These conclusions can provide a reference for new research directions and methods to determine a target's laser scattering characteristics.

  1. 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

  2. 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

  3. 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. PMID:27630910

  4. Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery.

    PubMed

    Kottwitz, Anita

    2014-05-01

    Access to health care is an important factor in explaining health inequalities. This study focuses on the issue of access to health care as a driving force behind the social discrepancies in cesarean delivery using data from 707 newborn children in the 2006-2011 birth cohorts of the German Socio-Economic Panel Study (SOEP). Data on individual birth outcomes are linked to hospital data using extracts of the quality assessment reports of nearly all German hospitals. Geographic Information Systems (GIS) are used to assess hospital service clusters within a 20-km radius buffer around mother׳s homes. Logistic regression models adjusting for maternal characteristics indicate that the likelihood to deliver by a cesarean section increases for the least educated women when they face constraints with regard to access to hospital care. No differences between the education groups are observed when access to obstetric care is high, thus a high access to hospital care seems to balance out health inequalities that are related to differences in education. The results emphasize the importance of focusing on unequal access to hospital care in explaining differences in birth outcomes.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. Variation in caesarean section rates in the US: outliers, damned outliers, and statistics.

    PubMed

    Smith, Gordon C S

    2014-10-01

    Gordon C. Smith discusses the study by Katy Kozhimannil and colleagues that examines variations in cesarean section rates in the US and argues for the need for high-quality routine data collection to better understand the reasons for these variations. Please see later in the article for the Editors' Summary.

  12. Design optimization of skeletal hip implant cross-sections using finite-element analysis.

    PubMed

    Beulah, Pearline; Sivarasu, Sudesh; Mathew, Lazar

    2009-01-01

    The major causes for revision surgery after total hip arthroplasty are aseptic loosening, dislocation, wear, design factors, stress shielding on the bone, and mechanical and biological factors. A material with toughness and high wear properties is essential for a good hip implant because these implants fail due to design. Stress shielding is found to be the major cause for the failure of hip implants, and can lead to the implant needing to be replaced or revised, which is painful for the patient and costly for the health care industry. The hip stem designs developed by various manufacturers are solid stems with indentations; stems with collars; collarless, tapered stems; and teardrop-shaped, polished stems without indentations. They are found to have a greater rigidity, and therefore they transfer less load proximally, which results in high proximal stress shielding of the proximal femur. A stem of low stiffness alone would not suffice in achieving a reduced or optimal stress shielding. The existing design proposals to minimize the effect of stress shielding are focused on the use of lightweight materials, composite materials, circular and longitudinal hole patterns, and different hollow-bore depths. A skeletal hip implant with varying cross-sections was designed and finite-element analysis was performed. The skeletal hip implant with a hexagonal cross-section was optimized based on the mass of the implant and the load-bearing capacity. This lightweight, novel design ameliorates implant fixation, minimizes stress shielding, enhances the longevity of the implant, and offers better mobility to the patient. PMID:21083533

  13. 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

  14. SENSIT: a cross-section and design sensitivity and uncertainty analysis code. [In FORTRAN for CDC-7600, IBM 360

    SciTech Connect

    Gerstl, S.A.W.

    1980-01-01

    SENSIT computes the sensitivity and uncertainty of a calculated integral response (such as a dose rate) due to input cross sections and their uncertainties. Sensitivity profiles are computed for neutron and gamma-ray reaction cross sections of standard multigroup cross section sets and for secondary energy distributions (SEDs) of multigroup scattering matrices. In the design sensitivity mode, SENSIT computes changes in an integral response due to design changes and gives the appropriate sensitivity coefficients. Cross section uncertainty analyses are performed for three types of input data uncertainties: cross-section covariance matrices for pairs of multigroup reaction cross sections, spectral shape uncertainty parameters for secondary energy distributions (integral SED uncertainties), and covariance matrices for energy-dependent response functions. For all three types of data uncertainties SENSIT computes the resulting variance and estimated standard deviation in an integral response of interest, on the basis of generalized perturbation theory. SENSIT attempts to be more comprehensive than earlier sensitivity analysis codes, such as SWANLAKE.

  15. 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.

  16. 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

  17. Thermoeconomic design and analysis of constant cross-sectional area fins

    NASA Astrophysics Data System (ADS)

    Shuja, S. Z.; Zubair, S. M.; Khan, M. S.

    A closed-form model for the second-law-based thermoeconomic optimization of constant cross-sectional area fins, is discussed with an example problem. In this approach, different monetary values are attached to the irreversible losses caused by the finite temperature difference heat transfer (T0ΔT) and pressure drop (T0ΔP) in the fin application. In addition, a simplified closed-form solution is presented for the case when the capital cost of the fin is negligible and only operational costs are considered. To illustrate the usefulness of the present analytical approach, the simplified cost optimized results are compared with the numerical results obtained from Poulikakos and Bejan's analysis, who have assumed same monetary values for T0ΔT and T0ΔP. Furthermore, the influence of important fin thermal, physical, geometrical and cost parameters on the optimum Reynolds numbers ReDopt and ReLopt are presented in algebraic forms, and also graphical results are shown for the case of pin and plate fin, as examples.

  18. 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.

  19. 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.

  20. Frailty and telomere length: cross-sectional analysis in 3537 older adults from the ESTHER cohort.

    PubMed

    Saum, Kai-Uwe; Dieffenbach, Aida Karina; Müezzinler, Aysel; Müller, Heiko; Holleczek, Bernd; Stegmaier, Christa; Butterbach, Katja; Schick, Matthias; Canzian, Federico; Stammer, Hermann; Boukamp, Petra; Hauer, Klaus; Brenner, Hermann

    2014-10-01

    Both telomere length and frailty were observed to be associated with aging. Whether and to what extent telomere length is related to frailty is essentially unknown. In this cross-sectional analysis of baseline data of 3537 community-dwelling adults aged 50 to 75 years of a large German cohort study, we assessed the hypothesis that shorter telomere length might be a biological marker for frailty. Using whole blood DNA we examined mean telomere repeat copy to single gene copy number (T/S ratio) using quantitative PCR. Construction of a frailty index (FI) was based on a deficit accumulation approach, which quantifies frailty as ratio of the deficits present divided by the total number of deficits considered. Mean FI was determined according to age by tertiles of T/S ratio. Furthermore, we used correlation analyses stratified for gender and age groups to examine the association of the T/S ratio with frailty. Mean FI value was similar across tertiles of the T/S ratio (0.24±0.14, 0.24±0.14 and 0.23±0.14, respectively (p=0.09)), and FI and the T/S ratio were uncorrelated in gender- and age-specific analyses. In conclusion, T/S ratio and frailty were unrelated in this large sample of older adults. T/S ratio may therefore not be a meaningful biological marker for frailty.

  1. Age of thelarche and menarche in contemporary US females: a cross-sectional analysis

    PubMed Central

    Cabrera, Susanne M.; Bright, George M.; Frane, James W.; Blethen, Sandra L.

    2014-01-01

    Aim A recent secular trend towards earlier thelarche has been suggested. The aim of this study is to examine normative ages of thelarche and menarche in contemporary US females. Methods Trained physicians documented Tanner breast stage by observation in a cross-sectional cohort. Age of menarche was self-reported. The subjects were healthy female children and adolescents. The mean age of thelarche was determined by probit analysis and the mean age of menarche was determined by using a normal time-to-event model. Results Mean age of thelarche was 9.7 years among 610 females aged 3.0–17.9 years (70% non-Hispanic Caucasian (NHC), 14% African-Americans, 7% Hispanic, 9% “other”). The mean age of menarche was 12.8 years for NHC, with African-Americans having menarche 0.6 years earlier. Conclusions Thelarche occurred earlier than recently reported, while age of menarche remained unchanged, this supported a persistent secular trend towards earlier thelarche but stable age of menarche. This suggests that the observed thelarche is gonadotropin-independent or the tempo of pubertal advancement has slowed. PMID:23959659

  2. 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

  3. Mapping of Aspergillus Section Nigri in Southern Europe and Israel based on geostatistical analysis.

    PubMed

    Battilani, P; Barbano, C; Marin, S; Sanchis, V; Kozakiewicz, Z; Magan, N

    2006-09-01

    Geostatistical analysis was applied to the incidence of Aspergillus Section Nigri and A. carbonarius in Southern Europe and Israel for the 3-year period 2001-2003 to facilitate identification of regions of high risk from contamination with these fungi and production of ochratoxin. The highest incidence of black aspergilli was normally observed at harvesting. At this grape growth stage, spatial variability of black aspergilli was significantly related to latitude and longitude, showing a positive West-East and North-South gradient. Predictive maps of infected berries incidence were drawn and showed the same trend in the 3 years, but incidence was highest in 2003, followed by 2001 and 2002. The highest incidence was always observed in Israel, Greece and Southern France, associated with the highest incidence of A. carbonarius. Southern Spain and Southern Italy also had relevant incidence of black aspergilli. The thermo-wetness maps for the 3 years showed a trend similar to the incidence of black aspergilli. The coldest and wettest year was 2002, while 2003 was the hottest and driest, particularly during August, with Israel being the hottest and driest country, followed by Greece and Southern Italy. This indicates that meteorological conditions can contribute to explain spatial distribution variation of black aspergilli within the Mediterranean basin. PMID:16737756

  4. 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.

  5. Effect of preoperative administration of intravenous paracetamol during cesarean surgery on hemodynamic variables relative to intubation, postoperative pain and neonatal apgar.

    PubMed

    Ayatollahi, Vida; Faghihi, Safa; Behdad, Shokoufeh; Heiranizadeh, Najmeh; Baghianimoghadam, Behnam

    2014-09-01

    Selection of anesthetic drugs for cesarean section requires many considerations. Anesthetic drugs for this purpose must prevent hemodynamic stress due to tracheal intubation, while inducing neonatal complications. This study was conducted to determine the effects of paracetamol given before induction of anesthesia on cardiovascular responses to tracheal intubation and postoperative pain in the mother, and on neonatal Apgar score. This double-blind randomized placebo-controlled trial included 60 women in ASA I, without underlying diseases and fetal distress, who were candidates for elective cesarean section under general anesthesia. Patients were divided into two groups of 30 patients. Patients in the paracetamol group received 1 g intravenous (IV) paracetamol 20 min before the operation, while those in the placebo group received 1 cc normal saline at the same time. In both groups, anesthesia was induced by sodium thiopental and succinylcholine. Maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured before and immediately upon induction of anesthesia, and at first and fifth minute after tracheal intubation. Neonatal effects were assessed by Apgar score. Postoperative pain was assessed by use of the visual analog scale (VAS). The dose of analgesic used and the time of the first analgesic request by patients postoperatively were recorded. The SBP, DBP, MAP and HR were controlled significantly better in paracetamol group than in placebo group (P < 0.05). The mean 1-min and 5-min Apgar scores of neonates did not differ between the groups. The VAS pain score was significantly lower in paracetamol group than in placebo group at all measuring times (P < 0.05). Also, paracetamol caused later first analgesic request and lower dose of analgesic needed to control pain postoperatively (P < 0.05). In conclusion, the results of our study suggested IV paracetamol to be an efficacious agent to decrease

  6. Labor management evidence update: potential to minimize risk of cesarean birth in healthy women.

    PubMed

    Simpson, Kathleen Rice

    2014-01-01

    New evidence regarding normal parameters of labor progress for healthy women has the potential to minimize risk of cesarean birth and thereby enhance current and future maternal well-being if clinicians apply the research findings to obstetric practice. The economic and reproductive health consequences of the increasing cesarean birth rate in the United States are considerable; therefore, action on this issue by all stakeholders is necessary. Review and integration of the recent recommendations for labor management from experts convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine are required to make maternity care in the United States as safe as possible.

  7. 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.

  8. 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…

  9. 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.

  10. 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

  11. 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

  12. 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

  13. A Descriptive Analysis of Oral Health Systematic Reviews Published 1991–2012: Cross Sectional Study

    PubMed Central

    Saltaji, Humam; Cummings, Greta G.; Armijo-Olivo, Susan; Major, Michael P.; Amin, Maryam; Major, Paul W.; Hartling, Lisa; Flores-Mir, Carlos

    2013-01-01

    Objectives To identify all systematic reviews (SRs) published in the domain of oral health research and describe them in terms of their epidemiological and descriptive characteristics. Design Cross sectional, descriptive study. Methods An electronic search of seven databases was performed from inception through May 2012; bibliographies of relevant publications were also reviewed. Studies were considered for inclusion if they were oral health SRs defined as therapeutic or non-therapeutic investigations that studied a topic or an intervention related to dental, oral or craniofacial diseases/disorders. Data were extracted from all the SRs based on a number of epidemiological and descriptive characteristics. Data were analysed descriptively for all the SRs, within each of the nine dental specialities, and for Cochrane and non-Cochrane SRs separately. Results 1,188 oral health (126 Cochrane and 1062 non-Cochrane) SRs published from 1991 through May 2012 were identified, encompassing the nine dental specialties. Over half (n = 676; 56.9%) of the SRs were published in specialty oral health journals, with almost all (n = 1,178; 99.2%) of the SRs published in English and almost none of the non-Cochrane SRs (n = 11; 0.9%) consisting of updates of previously published SRs. 75.3% of the SRs were categorized as therapeutic, with 64.5% examining non-drug interventions, while approximately half (n = 150/294; 51%) of the non-therapeutic SRs were classified as epidemiological SRs. The SRs included a median of 15 studies, with a meta-analysis conducted in 43.6%, in which a median of 9 studies/1 randomized trial were included in the largest meta-analysis conducted. Funding was received for 25.1% of the SRs, including nearly three-quarters (n = 96; 76.2%) of the Cochrane SRs. Conclusion Epidemiological and descriptive characteristics of the 1,188 oral health SRs varied across the nine dental specialties and by SR category (Cochrane vs. non-Cochrane). There is a

  14. Higher order representation of the beam cross section deformation in large displacement finite element analysis

    NASA Astrophysics Data System (ADS)

    Li, Pengfei; Gantoi, Florentina M.; Shabana, Ahmed A.

    2011-12-01

    Most existing beam formulations assume that the cross section of the beam remains rigid regardless of the amplitude of the displacement. The absolute nodal coordinate formulation (ANCF); however, allows for the deformation of the cross section and leads to a more general beam models that capture the coupling between different modes of displacement. This paper examines the effect of the order of interpolation on the modes of deformation of the beam cross section using ANCF finite elements. To this end, a new two-dimensional shear deformable ANCF beam element is developed. The new finite element employs a higher order of interpolation, and allows for new cross section deformation modes that cannot be captured using previously developed shear deformable ANCF beam elements. The element developed in this study relaxes the assumption of planar cross section; thereby allowing for including the effect of warping as well as for different stretch values at different points on the element cross section. The displacement field of the new element is assumed to be cubic in the axial direction and quadratic in the transverse direction. Using this displacement field, more expressions for the element extension, shear and the cross section stretch can be systematically defined. The change in the cross section area is measured using Nanson's formula. Measures of the shear angle, extension, and cross section stretch can also be systematically defined using coordinate systems defined at the element material points. Using these local coordinate systems, expressions for a nominal shear angle are obtained. The differences between the cross section deformation modes obtained using the new higher order element and those obtained using the previously developed lower order elements are highlighted. Numerical examples are presented in order to compare the results obtained using the new finite element and the results obtained using previously developed ANCF finite elements.

  15. 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.

  16. Surgical Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial

    PubMed Central

    Figueroa, Dana; Jauk, Victoria Chapman; Szychowski, Jeff M.; Garner, Rachel; Biggio, Joseph R.; Andrews, William W.; Hauth, John; Tita, Alan T. N.

    2013-01-01

    Objective To compare the risk of cesarean wound disruption or infection after closure with surgical staples compared with subcuticular suture. Methods Women with viable pregnancies at 24 weeks of gestation or greater undergoing scheduled or unscheduled cesarean delivery were randomized to wound closure with surgical staples or absorbable suture. Staples were removed at postoperative days 3-4 for low transverse incisions and days 7-10 for vertical incisions. Standardized wound evaluations were performed at discharge (days 3-4) and 4-6 weeks post-operatively. The primary outcome was a composite of wound disruption or infection within 4-6 weeks. Secondary outcomes included operative time, highest pain score on analog scale, cosmesis score and patient scar satisfaction score. Analyses were by intent-to-treat. Results Of 398 patients, 198 were randomized to staples and 200 to suture (but four received staples). Baseline characteristics including body mass index, prior cesarean, labor, and type of skin incision were similar by group. The primary outcome incidence at hospital discharge was 7.1% for staples and 0.5% for suture; P <0.001 (RR 14.1; 95% CI 1.9-106). Of 350 (87.9%) with follow up at 4-6 weeks, the cumulative risk of the primary outcome at 4-6 weeks was 14.5% for staples and 5.9% for suture; P=0.008 (RR 2.5; 95% CI 1.2-5.0). Operative time, pain scores at 72-96 hours and at 6 weeks, cosmesis score, and patient satisfaction score did not differ by group. Conclusion Staples closure compared with suture is associated with significantly increased composite wound morbidity after cesarean delivery. PMID:23262925

  17. 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

  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. Rates and success rates of trial of labor after cesarean delivery in the United States, 1990-2009.

    PubMed

    Uddin, Sayeedha F G; Simon, Alan E

    2013-09-01

    This study compares rates of trial of labor after Cesarean delivery (TOLAC) and rates of successful TOLAC between 1990 and 2009. Serial cross-sectional analyses were performed using the National Hospital Discharge Survey data to compare rates of TOLAC and TOLAC success between 1990 and 2009. Joinpoint regression was used to assess trends over time, and logistic regression with marginal effects was used to examine the unadjusted and adjusted significance and magnitude of trends. The rate of TOLAC reached a high of 51.8 % (95 % CI 47.8-55.8 %) in 1995 and a low of 15.9 % (95 % CI 13.8-18.0 %) in 2006, declined, on average, 4.2 (95 % CI -4.8 to -3.9) percentage points per year between 1996 and 2005. Rates increased significantly from 1990 to 1996 and 2005 to 2009. TOLAC success was at its highest rate in 2000, 69.8 % (95 % CI 65.2-74.3 %) and its lowest in 2008, 38.5 % (95 % CI 28.1-48.8 %). The rate of TOLAC success increased significantly between 1990 and 2000, but declined thereafter an average of 3.4 % points per year (95 % CI -4.3 to -2.5). The rate of TOLAC in the US decreased between 1996 and 2005 and the rate of successful TOLAC has declined from 2000 to 2009.

  20. Comparative analysis of characteristic electron energy loss spectra and inelastic scattering cross-section spectra of Fe

    NASA Astrophysics Data System (ADS)

    Parshin, A. S.; Igumenov, A. Yu.; Mikhlin, Yu. L.; Pchelyakov, O. P.; Zhigalov, V. S.

    2016-05-01

    The inelastic electron scattering cross section spectra of Fe have been calculated based on experimental spectra of characteristic reflection electron energy loss as dependences of the product of the inelastic mean free path by the differential inelastic electron scattering cross section on the electron energy loss. It has been shown that the inelastic electron scattering cross-section spectra have certain advantages over the electron energy loss spectra in the analysis of the interaction of electrons with substance. The peaks of energy loss in the spectra of characteristic electron energy loss and inelastic electron scattering cross sections have been determined from the integral and differential spectra. It has been shown that the energy of the bulk plasmon is practically independent of the energy of primary electrons in the characteristic electron energy loss spectra and monotonically increases with increasing energy of primary electrons in the inelastic electron scattering cross-section spectra. The variation in the maximum energy of the inelastic electron scattering cross-section spectra is caused by the redistribution of intensities over the peaks of losses due to various excitations. The inelastic electron scattering cross-section spectra have been analyzed using the decomposition of the spectra into peaks of the energy loss. This method has been used for the quantitative estimation of the contributions from different energy loss processes to the inelastic electron scattering cross-section spectra of Fe and for the determination of the nature of the energy loss peaks.

  1. Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

    PubMed Central

    2014-01-01

    Background Uterine artery pseudoaneurysms are dangerous and can lead to severe hemorrhage. We report an uncommon cause of a giant pseudoaneurysm in a missed miscarriage in a woman with a cesarean scar pregnancy. Case presentation The patient was a 25-year-old Chinese woman with a missed miscarriage in a cesarean scar pregnancy. Curettage was performed under ultrasound monitoring. A uterine artery pseudoaneurysm measuring 71 × 44 × 39 mm was detected the next day by Doppler ultrasonography. While waiting for admittance to an advanced institution to undergo embolization treatment, the pseudoaneurysm ruptured spontaneously. The subsequent severe hemorrhage necessitated hysterectomy. Conclusion A delay in diagnosis of uterine artery pseudoaneurysms may result from a long period between the curettage and follow-up examination. Ultrasound and Doppler ultrasonography should be performed repeatedly at short intervals to rule out them, especially in cesarean scar pregnancies. For a giant uterine artery pseudoaneurysm, interventional embolization might be the first treatment choice. If time allows, intra-operative ligation of the feeding vessels should be attempted before any decision to perform a hysterectomy is made. However, hysterectomy remains a possibility when severe bleeding occurs. PMID:25070087

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. Uncertainty in [ital K][sup +]-nucleus total cross section analysis

    SciTech Connect

    Arima, M. ); Masutani, K. )

    1993-03-01

    There exists a basic uncertainty in the extraction method of [ital K][sup +]-nucleus total cross sections with the usual transmission experimental data. Although the errors are very small for light nuclei, they amount to about 10% for medium and heavy nuclei. When nontraditional effects of [ital K][sup +]-nucleon interactions within the nucleus, such as swelling of nucleon, are investigated, only the total cross sections on light nuclei should be used in order to avoid this uncertainty.

  7. 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.

  8. Fracture toughness of esthetic dental coating systems by nanoindentation and FIB sectional analysis.

    PubMed

    Pecnik, Christina Martina; Courty, Diana; Muff, Daniel; Spolenak, Ralph

    2015-07-01

    Improving the esthetics of Ti-based dental implants is the last challenge remaining in the optimization process. The optical issues were recently solved by the application of highly and selectively reflective coatings on Ti implants. This work focuses on the mechanical durability of these esthetic ceramic based coating systems (with and without adhesion layers). The coating systems (Ti-ZrO2, Ti-Al-ZrO2, Ti-Ti-Al-ZrO2, Ti-Ag-ZrO2, Ti-Ti-Ag-ZrO2, Ti-Bragg and Ti-TiO2-Bragg) were subjected to nanoindentation experiments and examined using scanning electron microscopy and focused ion beam cross sectional analysis. Three coating systems contained adhesion layers (10nm of Ti or 60nm of TiO2 layers). The fracture toughness of selected samples was assessed applying two different models from literature, a classical for bulk materials and an energy-based model, which was further developed and adjusted. The ZrO2 based coating systems (total film thickness<200nm) followed a circumferential cracking behavior in contrast to Bragg coated samples (total film thickness around 1.5μm), which showed radial cracking emanating from the indent corners. For Ti-ZrO2 samples, a fracture toughness between 2.70 and 3.70MPam(1/2) was calculated using an energy-based model. The classical model was applied to Bragg coated samples and their fracture toughness ranged between 0.70 and 0.80MPam(1/2). Furthermore, coating systems containing an additional layer (Ti-Ti-Al-ZrO2, Ti-Ti-Ag-ZrO2 and Ti-TiO2-Bragg) showed an improved adhesion between the substrate and the coating. The addition of a Ti or TiO2 layer improved the adhesion between substrate and coating. The validity of the models for the assessment of the fracture toughness depended on the layer structure and fracture profile of the samples investigated here (classical model for thick coatings and energy-based model for thin coatings). PMID:25837339

  9. Fracture toughness of esthetic dental coating systems by nanoindentation and FIB sectional analysis.

    PubMed

    Pecnik, Christina Martina; Courty, Diana; Muff, Daniel; Spolenak, Ralph

    2015-07-01

    Improving the esthetics of Ti-based dental implants is the last challenge remaining in the optimization process. The optical issues were recently solved by the application of highly and selectively reflective coatings on Ti implants. This work focuses on the mechanical durability of these esthetic ceramic based coating systems (with and without adhesion layers). The coating systems (Ti-ZrO2, Ti-Al-ZrO2, Ti-Ti-Al-ZrO2, Ti-Ag-ZrO2, Ti-Ti-Ag-ZrO2, Ti-Bragg and Ti-TiO2-Bragg) were subjected to nanoindentation experiments and examined using scanning electron microscopy and focused ion beam cross sectional analysis. Three coating systems contained adhesion layers (10nm of Ti or 60nm of TiO2 layers). The fracture toughness of selected samples was assessed applying two different models from literature, a classical for bulk materials and an energy-based model, which was further developed and adjusted. The ZrO2 based coating systems (total film thickness<200nm) followed a circumferential cracking behavior in contrast to Bragg coated samples (total film thickness around 1.5μm), which showed radial cracking emanating from the indent corners. For Ti-ZrO2 samples, a fracture toughness between 2.70 and 3.70MPam(1/2) was calculated using an energy-based model. The classical model was applied to Bragg coated samples and their fracture toughness ranged between 0.70 and 0.80MPam(1/2). Furthermore, coating systems containing an additional layer (Ti-Ti-Al-ZrO2, Ti-Ti-Ag-ZrO2 and Ti-TiO2-Bragg) showed an improved adhesion between the substrate and the coating. The addition of a Ti or TiO2 layer improved the adhesion between substrate and coating. The validity of the models for the assessment of the fracture toughness depended on the layer structure and fracture profile of the samples investigated here (classical model for thick coatings and energy-based model for thin coatings).

  10. Quantization of polyphenolic compounds in histological sections of grape berries by automated color image analysis

    NASA Astrophysics Data System (ADS)

    Clement, Alain; Vigouroux, Bertnand

    2003-04-01

    We present new results in applied color image analysis that put in evidence the significant influence of soil on localization and appearance of polyphenols in grapes. These results have been obtained with a new unsupervised classification algorithm founded on hierarchical analysis of color histograms. The process is automated thanks to a software platform we developed specifically for color image analysis and it's applications.

  11. 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

  12. 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)…

  13. Automated image analysis of skeletal muscle fiber cross-sectional area

    PubMed Central

    Mula, Jyothi; Lee, Jonah D.; Liu, Fujun; Yang, Lin

    2013-01-01

    Morphological characteristics of muscle fibers, such as fiber size, are critical factors that determine the health and function of the muscle. However, at this time, quantification of muscle fiber cross-sectional area is still a manual or, at best, a semiautomated process. This process is labor intensive, time consuming, and prone to errors, leading to high interobserver variability. We have developed and validated an automatic image segmentation algorithm and compared it directly with commercially available semiautomatic software currently considered state of the art. The proposed automatic segmentation algorithm was evaluated against a semiautomatic method with manual annotation using 35 randomly selected cross-sectional muscle histochemical images. The proposed algorithm begins with ridge detection to enhance the muscle fiber boundaries, followed by robust seed detection based on concave area identification to find initial seeds for muscle fibers. The final muscle fiber boundaries are automatically delineated using a gradient vector flow deformable model. Our automatic approach is accurate and represents a significant advancement in efficiency; quantification of fiber area in muscle cross sections was reduced from 25–40 min/image to 15 s/image, while accommodating common quantification obstacles including morphological variation (e.g., heterogeneity in fiber size and fibrosis) and technical artifacts (e.g., processing defects and poor staining quality). Automatic quantification of muscle fiber cross-sectional area using the proposed method is a powerful tool that will increase sensitivity, objectivity, and efficiency in measuring muscle adaptation. PMID:23139362

  14. 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.

  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. 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.

  17. 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.

  18. Effect of the 2 p 2 h cross-section uncertainties on an analysis of neutrino oscillations

    NASA Astrophysics Data System (ADS)

    Ankowski, Artur M.; Benhar, Omar; Mariani, Camillo; Vagnoni, Erica

    2016-06-01

    We report the results of a study aimed at quantifying the impact on the oscillation analysis of the uncertainties associated with the description of the neutrino-nucleus cross section in the two-particle-two-hole sector. The results of our calculations, based on the kinematic method of energy reconstruction and carried out comparing two data-driven approaches, show that the existing discrepancies in the neutrino cross sections have a sizable effect on the extracted oscillation parameters, particularly in the antineutrino channel.

  19. Thin-sectioning and analysis of fine-grained meteoritic materials

    NASA Technical Reports Server (NTRS)

    Brooks, Donald A. (Editor); Bradley, John P.

    1992-01-01

    The overall theme of the work was the identification of the sources and formation/aggregation mechanisms of the various classes of interplanetary dust particles (IDP's) and to clarify the relationship between IDP's and conventional meteorites. IDP's are believed to be derived from a much broader range of parent bodies than conventional meteorites. Some of these parent bodies (e.g., comets) have escaped that post accretional processing that has affected the parent bodies of meteorites. Therefore, IDP's are likely to preserve a record of early solar system and possibly presolar grain forming reactions. Using analytical electron microscopy (AEM) and more recently micro-infrared (IR) microspectroscopy to examine ultramicrotomed thin sections, we have addressed the questions of IDP formation mechanisms, sources, and their relationship to conventional meteorites. The following sections describe specific findings resulting from these studies.

  20. The use of cross-section warping functions in composite rotor blade analysis

    NASA Technical Reports Server (NTRS)

    Kosmatka, J. B.

    1992-01-01

    During the contracted period, our research was concentrated into three areas. The first was the development of an accurate and a computationally efficient method for predicting the cross-section warping functions in an arbitrary cross-section composed of isotropic and/or anisotropic materials. The second area of research was the development of a general higher-order one-dimensional theory for anisotropic beams. The third area of research was the development of an analytical model for assessing the extension-bend-twist coupling behavior of nonhomogeneous anisotropic beams with initial twist. In the remaining six chapters of this report, the three different research areas and associated sub-research areas are covered independently including separate introductions, theoretical developments, numerical results, and references.

  1. The LAW Library -- A multigroup cross-section library for use in radioactive waste analysis calculations

    SciTech Connect

    Greene, N.M.; Arwood, J.W.; Wright, R.Q.; Parks, C.V.

    1994-08-01

    The 238-group LAW Library is a new multigroup neutron cross-section library based on ENDF/B-V data, with five sets of data taken from ENDF/B-VI ({sup 14}N{sub 7}, {sup 15}N{sub 7}, {sup 16}O{sub 8}, {sup 154Eu}{sub 63}, and {sup 155}Eu{sub 63}). These five nuclides are included because the new evaluations are thought to be superior to those in Version 5. The LAW Library contains data for over 300 materials and will be distributed by the Radiation Shielding Information Center, located at Oak Ridge National Laboratory. It was generated for use in neutronics calculations required in radioactive waste analyses, although it has equal utility in any study requiring multigroup neutron cross sections.

  2. ORACLE: an adjusted cross-section and covariance library for fast-reactor analysis

    SciTech Connect

    Yeivin, Y.; Marable, J.H.; Weisbin, C.R.; Wagschal, J.J.

    1980-01-01

    Benchmark integral-experiment values from six fast critical-reactor assemblies and two standard neutron fields are combined with corresponding calculations using group cross sections based on ENDF/B-V in a least-squares data adjustment using evaluated covariances from ENDF/B-V and supporting covariance evaluations. Purpose is to produce an adjusted cross-section and covariance library which is based on well-documented data and methods and which is suitable for fast-reactor design. By use of such a library, data- and methods-related biases of calculated performance parameters should be reduced and uncertainties of the calculated values minimized. Consistency of the extensive data base is analyzed using the chi-square test. This adjusted library ORACLE will be available shortly.

  3. Analysis of lichen thin sections by PIXE and STIM using a proton microprobe

    NASA Astrophysics Data System (ADS)

    Clark, B. M.; Mangelson, N. F.; St. Clair, L. L.; Gardner, J. S.; Cooper, L. S.; Rees, L. B.; Grant, P. G.; Bench, G. S.

    1999-04-01

    In order to better understand the distribution pattern of mineral elements in lichen tissues, thin sections (15 μm) of the foliose, vagrant soil lichen Xanthoparmelia chlorochroa were examined using proton microprobe Particle induced X-ray emission (PIXE). This technique was used to make two-dimensional scans, with 5 μm resolution, across tissue cross sections of the test species. Element maps for Si, P, S, Cl, K, Ca, Ti, Mn, Fe, Cu, Zn, and As have been prepared. Several elements are strongly localized in the element maps. PIXE data are complimented with STIM, light micrographs, and SEM images. Preliminary data suggest that nuclear microprobe techniques may be useful in elucidating element absorption and transport mechanisms in lichens.

  4. Predicting Children's Media Use in the USA: Differences in Cross-Sectional and Longitudinal Analysis

    ERIC Educational Resources Information Center

    Lee, Sook-Jung; Bartolic, Silvia; Vandewater, Elizabeth A.

    2009-01-01

    The purpose of this paper is to examine the predictors of children's media use in the USA, comparing cross-sectional and longitudinal analyses. Data come from Waves 1 and 2 of the Child Development Supplement (CDS-I; CDS-II), a nationally representative sample of American children aged 0-12 in 1997 and 5-18 in 2002. Twenty-four hour time use…

  5. Results of the task analysis study sports physical therapy section american physical therapy association.

    PubMed

    Skovly, R C; Davies, G J; Mangine, R E; Mansell, R E; Wallace, L A

    1980-01-01

    A survey instrument containing 1 13 sports physical therapy job tasks was developed by a committee of experts at the Combined Sections Meeting, American Physical Therapy Association (APTA), in Orlando, FL, on February 8-1 1, 1978. The committee was assisted by the Committee on Competencies, APTA, and a representative from Courseware, Inc. The instrument was then sent to 1074 members of the Section for the purposes of identifying the clinical tasks in which competency is essential to practice effectively and of determining to what extent members are practicing these clinical tasks. Two major mailings were sent, in October 1978 and January 1979; 573 forms were returned for a response rate of 53.4%. Seventy returned forms were not used because they were incomplete or incorrectly filled out (35), were not deliverable (23), or were sent to those that were no longer members of the Section (12). The response rate of usable forms was 50.1 %.J Orthop Sports Phys Ther 1980;1(4):229-238. PMID:18810174

  6. A Meta-Analysis of Cross Sectional Studies Investigating Language in Maltreated Children

    ERIC Educational Resources Information Center

    Lum, Jarrad A. G.; Powell, Martine; Timms, Lydia; Snow, Pamela

    2015-01-01

    Purpose: In this review article, meta-analysis was used to summarize research investigating language skills in maltreated children. Method: A systematic search of published studies was undertaken. Studies were included in the meta-analysis if they investigated language skills in groups comprising maltreated and nonmaltreated children. Studies were…

  7. Cross-sectional analysis of W-cored Ni nanoparticle via focused ion beam milling with impregnation.

    PubMed

    Jeong, Saeeun; Na, Hyunwoong; Lee, Gwangyeob; Son, Seong Ho; Choi, Hanshin

    2014-01-01

    Tungsten and nickel bimetallic nanoparticle is synthesized by radio frequency thermal plasma process which belongs to the vapor phase condensation technology. The morphology and chemical composition of the synthesized particle were investigated using the conventional nanoparticle transmission electron microscopy (TEM) sample. A few part of them looked like core/shell structured particle, but ambiguities were caused by either TEM sample preparation or TEM analysis. In order to clarify whether a core/shell structure is developed for the particle, various methodologies were tried to prepare a cross-sectional TEM sample. Focused ion beam (FIB) milling was conducted for cold-compacted particles, dispersed particles on silicon wafer, and impregnated particles with epoxy which is compatible with electron beam. A sound cross-sectional sample was just obtained from cyanoacrylate impregnation and FIB milling procedure. A tungsten-cored nickel shell structure was precisely confirmed with aid of cross-sectional sample preparation method.

  8. Descriptive analysis of childbirth healthcare costs in an area with high levels of immigration in Spain

    PubMed Central

    2011-01-01

    Background The aim of this study was to estimate the cost of childbirth in a teaching hospital in Barcelona, Spain, including the costs of prenatal care, delivery and postnatal care (3 months). Costs were assessed by taking into account maternal origin and delivery type. Methods We performed a cross-sectional study of all deliveries in a teaching hospital to mothers living in its catchment area between October 2006 and September 2007. A process cost analysis based on a full cost accounting system was performed. The main information sources were the primary care program for sexual and reproductive health, and hospital care and costs records. Partial and total costs were compared according to maternal origin and delivery type. A regression model was fit to explain the total cost of the childbirth process as a function of maternal age and origin, prenatal care, delivery type, maternal and neonatal severity, and multiple delivery. Results The average cost of childbirth was 4,328€, with an average of 18.28 contacts between the mother or the newborn and the healthcare facilities. The delivery itself accounted for more than 75% of the overall cost: maternal admission accounted for 57% and neonatal admission for 20%. Prenatal care represented 18% of the overall cost and 75% of overall acts. The average overall cost was 5,815€ for cesarean sections, 4,064€ for vaginal instrumented deliveries and 3,682€ for vaginal non-instrumented deliveries (p < 0.001). The regression model explained 45.5% of the cost variability. The incremental cost of a delivery through cesarean section was 955€ (an increase of 31.9%) compared with an increase of 193€ (6.4%) for an instrumented vaginal delivery. The incremental cost of admitting the newborn to hospital ranged from 420€ (14.0%) to 1,951€ (65.2%) depending on the newborn's severity. Age, origin and prenatal care were not statistically significant or economically relevant. Conclusions Neither immigration nor prenatal care

  9. 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

  10. Validation of the Prediction Model for Success of Vaginal Birth after Cesarean Delivery in Japanese Women

    PubMed Central

    Yokoi, Akira; Ishikawa, Kaoru; Miyazaki, Ken; Yoshida, Kana; Furuhashi, Madoka; Tamakoshi, Koji

    2012-01-01

    Aim: To validate a previously developed prediction model for vaginal birth after cesarean (VBAC) using a Japanese cohort. Methods: We performed a cohort study of all term pregnant women with a vertex position, singleton gestation, and one prior low transverse cesarean delivery attempting a trial of labor between April 1985 and March 2010. Variables necessary for the prediction of successful VBAC were maternal age, pre-pregnancy body mass index, ethnicity, prior vaginal delivery, prior VBAC, and indication for prior cesarean delivery. They were extracted from medical records and put into the formula that calculates an individual woman's predicted VBAC success rate. The predicted rates were then partitioned into deciles and compared with the actual VBAC rates. The predictive ability of the model was assessed with a receiver operating characteristic and the area under the curve (AUC) was determined. Results: Seven hundred and twenty-five women who met the inclusion criteria had complete data available, of which 664 (91.6%) had VBAC. The predicted probability of VBAC, as calculated by the regression equation, was significantly higher in those who had a successful trial of labor (median 80.1%, interquartile range 71.5-88.7) than those who did not (median 69.4%, interquartile range 59.9-78.9, P<0.001). The predictive model had AUC of 0.80, which was comparative to the originally described one. When the predicted rates were each deciles of over 70%, the actual success rates were more than 90%. Conclusion: The previously published prediction model for VBAC developed in the USA is also available to Japanese women. PMID:22927774

  11. 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

  12. Microelectronics Instrument Products Shock and Vibration Electro-Optics. Section D; Strength Analysis

    NASA Technical Reports Server (NTRS)

    1994-01-01

    The strength analysis report for FRR shall include only revisions to update the strength analysis reports for the flight design configuration. Since there have been no revisions to the design configuration since the PDR and the CDR this report shall consist of re-submitting the analysis previously performed. In addition the motors have been subjected to Sine vibration, Random vibration, and shock per the SXI specification. Both motor/encoders have passed all three tests. There was no evidence of damage to the motor/encoder and the motor/encoder performed as required by the Acceptance test procedure. No degradation was seen between the before and after performance tests. The testing verified the analysis that there were adequate mf@ty margins with regard to structural integrity. Separate reports are available from the test facility and are apart of the FRR submittal.

  13. Energy dispersive x-ray analysis of the cornea. Application to paraffin sections of normal and diseased corneas

    SciTech Connect

    Robinson, M.R.; Streeten, B.W.

    1984-11-01

    The distribution of chemical elements in the normal human cornea was studied by energy dispersive x-ray analysis and scanning electron microscopy of routinely prepared paraffin sections. Calcium, phosphorus, and sulfur were consistently present in quantities above background and varied in concentration regionally. Analysis of fresh-frozen tissue, an approximation of the in vivo state, gave a similar elemental profile to paraffin sections, except for the loss of diffusable electrolytes in the latter. After fixation, S was the most abundant element and was highest in Descemet's membrane. Corneas with granular, lattice, macular, and Fuchs endothelial dystrophies, band keratopathy, and spheroidal degeneration were also examined. Characteristic patterns of abnormal S and Ca distribution were found in each of the dystrophies. The relative proportions of Ca, P, and S gave diagnostic profiles for distinguishing band keratopathy and spheroidal degeneration.

  14. A double fluorescence staining protocol to determine the cross-sectional area of myofibers using image analysis

    NASA Technical Reports Server (NTRS)

    Mozdziak, P. E.; Fassel, T. A.; Schultz, E.; Greaser, M. L.; Cassens, R. G.

    1996-01-01

    A double fluorescence staining protocol was developed to facilitate computer based image analysis. Myofibers from experimentally treated (irradiated) and control growing turkey skeletal muscle were labeled with the anti-myosin antibody MF-20 and detected using fluorescein-5-isothiocyanate (FITC). Extracellular material was stained with concanavalin A (ConA)-Texas red. The cross-sectional area of the myofibers was determined by calculating the number of pixels (0.83 mu m(2)) overlying each myofiber after subtracting the ConA-Texas red image from the MF-20-FITC image for each region of interest. As expected, myofibers in the irradiated muscle were smaller (P < 0.05) than those in the non-irradiated muscle. This double fluorescence staining protocol combined with image analysis is accurate and less labor-intensive than classical procedures for determining the cross-sectional area of myofibers.

  15. Analysis of Charge Changing Cross Sections with the Glauber-Abrasion-Ablation Model

    NASA Astrophysics Data System (ADS)

    Akaishi, Tomohide; Hagino, Kouichi

    We calculate the charge changing cross sections (CCCS) for 28Si + 12C reaction using the Glauber-abrasion-ablation model, which considers a fragment-production in two stages, that is, a fragmentation and particle evaporations. We show that this model underestimates CCCS in a wide energy region if only the first stage is taken into account. This is the case both in the optical limit approximation (OLA) and in the beyond OLA calculation. This indicates that the second stage for the particle evaporation has to be taken into account in order to quantitatively estimate CCCS.

  16. Two-photon double ionization of the H2 molecule: Cross sections and amplitude analysis

    NASA Astrophysics Data System (ADS)

    Ivanov, I. A.; Kheifets, A. S.

    2013-02-01

    We perform time-dependent calculations of triply differential cross sections (TDCS) of two-photon double-electron ionization of the aligned H2 molecule. Our TDCS results for equal energy sharing between photoelectrons agree quite well with a recent time-dependent calculation by Guan [X. Guan, K. Bartschat, and B. I. Schneider, Phys. Rev. APLRAAN1050-294710.1103/PhysRevA.77.043421 77, 043421 (2008)] who employed a slightly different numerical technique. We supplement these studies by calculating TDCS at an unequal energy sharing and by generating symmetrized ionization amplitudes.

  17. Delivery by caesarean section and risk of childhood obesity: analysis of a Peruvian prospective cohort

    PubMed Central

    Miranda, J. Jaime; Bernabé-Ortiz, Antonio

    2015-01-01

    Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and family-related (e.g., maternal nutritional status) variables. Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up. Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood. PMID:26137427

  18. 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

  19. Brain-Wide Mapping of Axonal Connections: Workflow for Automated Detection and Spatial Analysis of Labeling in Microscopic Sections.

    PubMed

    Papp, Eszter A; Leergaard, Trygve B; Csucs, Gergely; Bjaalie, Jan G

    2016-01-01

    Axonal tracing techniques are powerful tools for exploring the structural organization of neuronal connections. Tracers such as biotinylated dextran amine (BDA) and Phaseolus vulgaris leucoagglutinin (Pha-L) allow brain-wide mapping of connections through analysis of large series of histological section images. We present a workflow for efficient collection and analysis of tract-tracing datasets with a focus on newly developed modules for image processing and assignment of anatomical location to tracing data. New functionality includes automatic detection of neuronal labeling in large image series, alignment of images to a volumetric brain atlas, and analytical tools for measuring the position and extent of labeling. To evaluate the workflow, we used high-resolution microscopic images from axonal tracing experiments in which different parts of the rat primary somatosensory cortex had been injected with BDA or Pha-L. Parameters from a set of representative images were used to automate detection of labeling in image series covering the entire brain, resulting in binary maps of the distribution of labeling. For high to medium labeling densities, automatic detection was found to provide reliable results when compared to manual analysis, whereas weak labeling required manual curation for optimal detection. To identify brain regions corresponding to labeled areas, section images were aligned to the Waxholm Space (WHS) atlas of the Sprague Dawley rat brain (v2) by custom-angle slicing of the MRI template to match individual sections. Based on the alignment, WHS coordinates were obtained for labeled elements and transformed to stereotaxic coordinates. The new workflow modules increase the efficiency and reliability of labeling detection in large series of images from histological sections, and enable anchoring to anatomical atlases for further spatial analysis and comparison with other data. PMID:27148038

  20. The MHOST finite element program: 3-D inelastic analysis methods for hot section components. Volume 3: Systems' manual

    NASA Technical Reports Server (NTRS)

    Nakazawa, Shohei

    1989-01-01

    The internal structure is discussed of the MHOST finite element program designed for 3-D inelastic analysis of gas turbine hot section components. The computer code is the first implementation of the mixed iterative solution strategy for improved efficiency and accuracy over the conventional finite element method. The control structure of the program is covered along with the data storage scheme and the memory allocation procedure and the file handling facilities including the read and/or write sequences.

  1. Brain-Wide Mapping of Axonal Connections: Workflow for Automated Detection and Spatial Analysis of Labeling in Microscopic Sections

    PubMed Central

    Papp, Eszter A.; Leergaard, Trygve B.; Csucs, Gergely; Bjaalie, Jan G.

    2016-01-01

    Axonal tracing techniques are powerful tools for exploring the structural organization of neuronal connections. Tracers such as biotinylated dextran amine (BDA) and Phaseolus vulgaris leucoagglutinin (Pha-L) allow brain-wide mapping of connections through analysis of large series of histological section images. We present a workflow for efficient collection and analysis of tract-tracing datasets with a focus on newly developed modules for image processing and assignment of anatomical location to tracing data. New functionality includes automatic detection of neuronal labeling in large image series, alignment of images to a volumetric brain atlas, and analytical tools for measuring the position and extent of labeling. To evaluate the workflow, we used high-resolution microscopic images from axonal tracing experiments in which different parts of the rat primary somatosensory cortex had been injected with BDA or Pha-L. Parameters from a set of representative images were used to automate detection of labeling in image series covering the entire brain, resulting in binary maps of the distribution of labeling. For high to medium labeling densities, automatic detection was found to provide reliable results when compared to manual analysis, whereas weak labeling required manual curation for optimal detection. To identify brain regions corresponding to labeled areas, section images were aligned to the Waxholm Space (WHS) atlas of the Sprague Dawley rat brain (v2) by custom-angle slicing of the MRI template to match individual sections. Based on the alignment, WHS coordinates were obtained for labeled elements and transformed to stereotaxic coordinates. The new workflow modules increase the efficiency and reliability of labeling detection in large series of images from histological sections, and enable anchoring to anatomical atlases for further spatial analysis and comparison with other data. PMID:27148038

  2. 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

  3. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

    PubMed Central

    Tawfik, Mohamed Mohamed; Badran, Basma Abed; Eisa, Ahmed Amin; Barakat, Rafik Ibrahim

    2015-01-01

    The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby. PMID:25829914

  4. Workplace Bullying and Mental Health: A Meta-Analysis on Cross-Sectional and Longitudinal Data

    PubMed Central

    2015-01-01

    Background A growing body of research has confirmed that workplace bullying is a source of distress and poor mental health. Here we summarize the cross-sectional and longitudinal literature on these associations. Methods Systematic review and meta-analyses on the relation between workplace bullying and mental health. Results The cross-sectional data (65 effect sizes, N = 115.783) showed positive associations between workplace bullying and symptoms of depression (r = .28, 95% CI = .23–.34), anxiety (r = .34, 95% CI = .29–.40) and stress-related psychological complaints (r = .37, 95% CI = .30–.44). Pooling the literature that investigated longitudinal relationships (26 effect sizes, N = 54.450) showed that workplace bullying was related to mental health complaints over time (r = 0.21, 95% CI = 0.13–0.21). Interestingly, baseline mental health problems were associated with subsequent exposure to workplace bullying (r = 0.18, 95% CI = 0.10–0.27; 11 effect sizes, N = 27.028). Limitations All data were self-reported, raising the possibility of reporting- and response set bias. Conclusions Workplace bullying is consistently, and in a bi-directional manner, associated with reduced mental health. This may call for intervention strategies against bullying at work. PMID:26305785

  5. Computational analysis of asymmetric water entry of wedge and ship section at constant velocity

    NASA Astrophysics Data System (ADS)

    Rahaman, Md. Mashiur; Ullah, Al Habib; Afroz, Laboni; Shabnam, Sharmin; Sarkar, M. A. Rashid

    2016-07-01

    Water impact problems receive much attention due to their short duration and large unsteady component of hydrodynamic loads. The effect of water entry has several important applications in various aspects of the naval field. Significant attention has been given to various water entry phenomena such as ship slamming, planning hulls, high-speed hydrodynamics of seaplanes, surface-piercing propellers and the interaction of high-speed liquid drops with structural elements. Asymmetric water entry may be caused by various natural phenomena such as weather conditions or strong winds. Since the determination of hydrodynamic impact load plays a vital role in designing safe and effcient vessels, an accurate and reliable prediction method is necessary to investigate asymmetric water entry problems. In this paper, water entry of a two-dimensional wedge and ship section at constant velocity in asymmetric condition will be analysed numerically and the effects of asymmetric impact on the velocity and pressure distribution will be discussed. The finite volume method is employed to solve the dynamic motion of the wedge in two-phase flow. During the water entry, the air and water interface is described implicitly by the volume of fluid (VOF) scheme. The numerical code and method was first validated for symmetric condition by one of the present author is applied for asymmetric wedge and ship section. The free surface, velocity and pressure distribution for asymmetric water entry are investigated and visualized with contour plots at different time steps.

  6. Uncertainty analysis of Lead cross sections on reactor safety for ELECTRA

    NASA Astrophysics Data System (ADS)

    Alhassan, Erwin; Sjöstrand, Henrik; Duan, Junfeng; Gustavsson, Cecilia; Pomp, Stephan; Österlund, Michael; Rochman, Dimitri; Koning, Arjan J.

    2014-06-01

    The Total Monte Carlo (TMC) method was used in this study to assess the impact of Pb-206, 207 and 208 nuclear data uncertainties on keff , βeff, coolant temperature coefficient, the coolant void worth for the ELECTRA reactor. Relatively large uncertainties were observed in the keff and the coolant void worth for all the isotopes with significant contribution coming from Pb-208 nuclear data. The large Pb-208 nuclear data uncertainty observed was further investigated by studying the impact of partial channels on the keff and the βeff. Various sections of ENDF file: elastic scattering (n, el), inelastic scattering (n, inl), neutron capture (n, γ), (n, 2n), resonance parameters and the angular distribution were varied randomly and distributions in keff and the βeff obtained. The dominant contributions to the uncertainty in the keff from Pb-208 came from uncertainties in the resonance parameters; however, elastic scattering cross section and the angular distribution also had significant impact. The impact of nuclear data uncertainties on the βeff was observed to be small.

  7. Safety review of the design, operation, and radiation sections of the General Electric Morris Operation Consolidated Safety Analysis Report

    SciTech Connect

    McBride, J.P.

    1981-01-30

    A safety review was made of Sections 4 through 9 of the Consolidated Safety Analysis Report (CSAR) for the GE Morris Operation spent-fuel storage facility. The sections reviewed include Design Criteria and Compliance, Facility Design and Description, Radiation Protection, Accident Analysis, and Conduct of Operations. The safety review was performed in accordance with the Code of Federal Regulations, Title 10, Part 72, ''Licensing Requirements for the Storage of Spent Fuel in an Independent Spent Fuel Storage Installation'' and contains independent estimations of source terms and dose-commitments from postulated accidents in the storage facility and a structural analysis of the Morris Operation cranes as an appendix. The review confirms that the features of the facility as described in Sections 4 through 9 of the CSAR fulfilled the safety requirements of 10 CFR 72, and it is concluded that spent-fuel handling and storage at the Morris Operation do not present significant risks to public health and safety. 15 refs., 3 tabs.

  8. Forced cesareans: the most unkindest cut of all.

    PubMed

    Annas, G J

    1982-06-01

    The author reviews and criticizes two recent cases in which the Georgia Supreme Court and a juvenile court in Denver, Colorado, ordered women who were refusing surgical interventions during labor to undergo them. He contends that the judges had to decide too hastily for adequate analysis of the legal precedents, and argues that medical, ethical, legal, and practical considerations support the right of a pregnant woman to refuse surgery recommended for the sake of her fetus.

  9. Single copy nuclear gene analysis of polyploidy in wild potatoes (Solanum section Petota)

    PubMed Central

    2012-01-01

    Background 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 polyploid or with diploid and polyploid cytotypes. However, the group is poorly understood at the genomic level and the series is ideal to study polyploid evolution. Two separate studies using the nuclear orthologs GBSSI and nitrate reductase confirmed prior hypotheses of polyploid origins in potato and have shown new origins not proposed before. These studies have been limited, however, by the use of few accessions per polyploid species and by low taxonomic resolution, providing clade-specific, but not species-specific origins within clades. The purpose of the present study is to use six nuclear orthologs, within 54 accessions of 11 polyploid species, 34 accessions of 29 diploid species of section Petota representing their putative progenitors, and two outgroups, to see if phenomena typical of other polyploid groups occur within wild potatoes, to include multiple origins, loss of alleles, or gain of new alleles. Results Our results increase resolution within clades, giving better ideas of diploid progenitors, and show unexpected complexity of allele sharing within clades. While some species have little diversity among accessions and concur with the GBSSI and nitrate reductase results, such as S. agrimonifolium, S. colombianum, S. hjertingii, and S. moscopanum, the results give much better resolution of species-specific progenitors. Seven other species, however, show variant patterns of allele distributions suggesting multiple origins and allele loss. Complex three-genome origins are supported for S. hougasii, and S. schenckii, and one of the ten accessions of S. stoloniferum. A very unexpected shared presence of alleles occurs within one clade of S

  10. Heavy ion induced mutations in mammalian cells: Cross sections and molecular analysis

    NASA Technical Reports Server (NTRS)

    Stoll, U.; Schmidt, P.; Schneider, E.; Kiefer, J.

    1994-01-01

    Our investigations of heavy ion-induced mutations in mammalian cells, which had been begun a few years ago, were systematically continued. For the first time, it was possible to cover a large LET range with a few kinds of ions. To do this, both UNILAC and SIS were used to yield comparable data for a large energy range. This is a necessary condition for a comprehensive description of the influence of such ion parameters as energy and LET. In these experiments, the induced resistance against the poison 6-thioguanin (6-TG), which is linked to the HPRT locus on the genome, is being used as mutation system. In addition to the mutation-induction cross-section measurements, the molecular changes of the DNA are being investigated by means of Multiplex PCR ('Polymerase Chain Reaction') gene amplification. From these experiments we expect further elucidation of the mutation-inducing mechanisms composing the biological action of heavy-ion radiation.

  11. Untangling inconsistent magnetic polarity records through an integrated rock magnetic analysis: A case study on Neogene sections in East Timor

    NASA Astrophysics Data System (ADS)

    Aben, F. M.; Dekkers, M. J.; Bakker, R. R.; van Hinsbergen, D. J. J.; Zachariasse, W. J.; Tate, G. W.; McQuarrie, N.; Harris, R.; Duffy, B.

    2014-06-01

    polarity patterns in sediments are a common problem in magnetostratigraphic and paleomagnetic research. Multiple magnetic mineral generations result in such remanence "haystacks." Here we test whether end-member modeling of isothermal remanent magnetization acquisition curves as a basis for an integrated rock magnetic and microscopic analysis is capable of isolating original magnetic polarity patterns. Uppermost Miocene-Pliocene deep-marine siliciclastics and limestones in East Timor, originally sampled to constrain the uplift history of the young Timor orogeny, serve as case study. An apparently straightforward polarity record was obtained that, however, proved impossible to reconcile with the associated biostratigraphy. Our analysis distinguished two magnetic end-members for each section, which result from various greigite suites and a detrital magnetite suite. The latter yields largely viscous remanence signals and is deemed unsuited. The greigite suites are late diagenetic in the Cailaco River section and early diagenetic, thus reliable, in the Viqueque Type section. By selecting reliable sample levels based on a quality index, a revised polarity pattern of the latter section is obtained: consistent with the biostratigraphy and unequivocally correlatable to the Geomagnetic Polarity Time Scale. Although the Cailaco River section lacks a reliable magnetostratigraphy, it does record a significant postremagnetization tectonic rotation. Our results shows that the application of well-designed rock magnetic research, based on the end-member model and integrated with microscopy and paleomagnetic data, can unravel complex and seemingly inconsistent polarity patterns. We recommend this approach to assess the veracity of the polarity of strata with complex magnetic mineralogy.

  12. Microfacies Analysis and Paleoenvironmental Interpretation of the Eocene Kohat Formation, Gumbat Section, Himalayan Fold and Thrust Belt, Northern Pakistan.

    NASA Astrophysics Data System (ADS)

    Mirza, Kamran

    2015-04-01

    A section of the Middle Eocene Kohat Formation has been measured and sampled systematically for the microfacies analysis and paleoenvironmental interpretation from the Gumbat Section, Kohat Basin, Himalayan Fold and Thrust Belt, Northern Pakistan. The section of Kohat Formation is 84 m thick in this area. A total number of 45 samples were collected from bottom to top in such a way that minor lithological variations were noticed and sampled. Out of these samples, 67 thin sections were made that were later on studied under the microscope for microfacies analysis and paleoenvironmental interpretation. Four microfacies and eight subfacies have been identified in the section. These microfacies and their subfacies are: Lime Mudstone Facies Benthic Foraminiferal Wackstone Facies This microfacies is further divided into five subfacies: Nummulites-Milliolid Wackestone Facies, Nummulites-Alveolina-Milliolid Wackestone Facies, Nummulites-Alveolina Wackestone Facies, Alveolinid Wackestone Facies, Nummulites-Coskinolina Wackestone Facies, Benthic Foraminiferal Packstone Facies This microfacies is again divided into three subfacies namely: Nummulites-Alveolina Packstone Facies, Milliolid-Peloid Packstone Facies and Nummulites-Assilina Packstone Facies. And Milliolid-Peloid Grainstone Facies. These microfacies indicate some interesting results about the paleoenvironments at the time of deposition of the Kohat Formation in this area. The larger benthic foraminifera of different groups have been used for the interpretation of paleoenvironments. These micro organisms show a great susceptibility to the minor changes in climate, depth zone and the nature of substrate. These can safely be used for the paleoenvironmental interpretation of any carbonate system deposited in the marine realm. On the basis of above mentioned microfacies, it can be concluded that the Kohat Formation in Gumbat area was deposited in low to moderate energy conditions, open marine, shallow shelf environments.

  13. Computer image analysis for measuring lean and fatty areas in cross-sectioned dry-cured hams.

    PubMed

    Carnier, P; Gallo, L; Romani, C; Sturaro, E; Bondesan, V

    2004-03-01

    The aims of this study were 1) to apply computer image analysis to obtain measures of lean and fatty areas on the cross section of dry-cured hams, 2) to investigate variation of these measures, and 3) to evaluate reproducibility and repeatability of these techniques. Traits of concern were the cross-sectional area (SA), lean, or muscles, area (LA), and the fatty area (FA) centered on the cross section and surrounded by biceps femoris, semimembranosus, semitendinosus, and quadriceps femoris, as well as the FA-to-SA ratio (FESR). Hams were obtained from crossbred pigs (n = 279) slaughtered at 9 mo of age (mean BW of 169 +/- 17 kg). Digital images of the cross section of dry-cured hams were captured using standardized procedures. Three replicated measures of areas were collected by three operators using three image analysis techniques (automatic, automatic-assisted, and manual). Variance components were estimated using a linear model that included slaughter group, gender, and gender x slaughter group as fixed effects and operators, pig, and operator x pig as random effects. Statistical analyses considered all measures (n = 7,533) or measures collected after reinstruction of all operators for spatial calibration of the analysis system (n = 4,428). Average SA, LA, FA, and FESR were 350 cm2, 220 cm2, 8.7 cm2, and 2.5%, respectively. Variability of FA (CV = 42%) and of FESR (CV = 39%) was four times greater than that of SA and LA. Slaughter group, pig, operator, and operator x pig effects were the most (P < 0.01) important sources of variation of measures. Correlations between measures obtained with different techniques were greater (P < 0.01) than 0.90, with the exception of LA measures. Coefficients of reproducibility for SA and LA ranged from 87 to 94%, whereas those for FA and FESR ranged from 88 to 98%. Coefficients of repeatability ranged from 92 to 99%. Automatic-assisted and manual methods provided more reproducible and repeatable measures than the automatic

  14. A Cross-Sectional Behavioral Genetic Analysis of Task Persistence in the Transition to Middle Childhood

    ERIC Educational Resources Information Center

    Deater-Deckard, Kirby; Petrill, Stephen A.; Thompson, Lee A.; DeThorne, Laura S.

    2005-01-01

    Task persistence, measured by a composite score of independent teacher, tester and observer reports, was examined using behavioral genetic analysis. Participants included 92 monozygotic and 137 same-sex dizygotic twin pairs in Kindergarten or 1st grade (4.3 to 7.9 years old). Task persistence was widely distributed, higher among older children,…

  15. Economic impacts of a hypothetical H1N1 pandemic : a cross-sectional analysis.

    SciTech Connect

    Smith, Braeton J.; Shaneyfelt, Calvin R.

    2010-06-01

    A NISAC study on the economic effects of a hypothetical H1N1 pandemic was done in order to assess the differential impacts at the state and industry levels given changes in absenteeism, mortality, and consumer spending rates. Part of the analysis was to determine if there were any direct relationships between pandemic impacts and gross domestic product (GDP) losses. Multiple regression analysis was used because it shows very clearly which predictors are significant in their impact on GDP. GDP impact data taken from the REMI PI+ (Regional Economic Models, Inc., Policy Insight +) model was used to serve as the response variable. NISAC economists selected the average absenteeism rate, mortality rate, and consumer spending categories as the predictor variables. Two outliers were found in the data: Nevada and Washington, DC. The analysis was done twice, with the outliers removed for the second analysis. The second set of regressions yielded a cleaner model, but for the purposes of this study, the analysts deemed it not as useful because particular interest was placed on determining the differential impacts to states. Hospitals and accommodation were found to be the most important predictors of percentage change in GDP among the consumer spending variables.

  16. Introduction to special section on sensitivity analysis and summary of NCSU/USDA workshop on sensitivity analysis.

    PubMed

    Frey, H Christopher

    2002-06-01

    This guest editorial is a summary of the NCSU/USDA Workshop on Sensitivity Analysis held June 11-12, 2001 at North Carolina State University and sponsored by the U.S. Department of Agriculture's Office of Risk Assessment and Cost Benefit Analysis. The objective of the workshop was to learn across disciplines in identifying, evaluating, and recommending sensitivity analysis methods and practices for application to food-safety process risk models. The workshop included presentations regarding the Hazard Assessment and Critical Control Points (HACCP) framework used in food-safety risk assessment, a survey of sensitivity analysis methods, invited white papers on sensitivity analysis, and invited case studies regarding risk assessment of microbial pathogens in food. Based on the sharing of interdisciplinary information represented by the presentations, the workshop participants, divided into breakout sessions, responded to three trigger questions: What are the key criteria for sensitivity analysis methods applied to food-safety risk assessment? What sensitivity analysis methods are most promising for application to food safety and risk assessment? and What are the key needs for implementation and demonstration of such methods? The workshop produced agreement regarding key criteria for sensitivity analysis methods and the need to use two or more methods to try to obtain robust insights. Recommendations were made regarding a guideline document to assist practitioners in selecting, applying, interpreting, and reporting the results of sensitivity analysis.

  17. Gene expression analysis in sections and tissue microarrays of archival tissues by mRNA in situ hybridization.

    PubMed

    Henke, R T; Maitra, A; Paik, S; Wellstein, A

    2005-01-01

    Altered expression of genes in diseased tissues can prognosticate a distinct natural progression of the disease as well as predict sensitivity or resistance to particular therapies. Archival tissues from patients with a known medical history and treatments are an invaluable resource to validate the utility of candidate genes for prognosis and prediction of therapy outcomes. However, stored tissues with associated long-term follow-up information typically are formalin-fixed, paraffin-embedded specimen and this can severely restrict the methods applicable for gene expression analysis. We report here on the utility of tissue microarrays (TMAs) that use valuable tissues sparingly and provide a platform for simultaneous analysis of gene expression in several hundred samples. In particular, we describe a stable method applicable to mRNA expression screening in such archival tissues. TMAs are constructed from sections of small drill cores, taken from tissue blocks of archival tissues and multiple samples can thus be arranged on a single microscope slide. We used mRNA in situ hybridization (ISH) on >500 full sections and >100 TMAs for >10 different cDNAs that yielded >10,000 data points. We provide detailed experimental protocols that can be implemented without major hurdles in a molecular pathology laboratory and discuss quantitative analysis and the advantages and limitations of ISH. We conclude that gene expression analysis in archival tissues by ISH is reliable and particularly useful when no protein detection methods are available for a candidate gene.

  18. The effect of family size on savings: a cross-sectional analysis.

    PubMed

    Esquerra-powers, V

    1978-01-01

    An analysis of rising population on economic growth was conducted in the Philippines through the effects on savings and investment. Census data were used to extract income, expenditure, and consumption for 1957, 1961, and 1965. Regression analysis on income by income class showed rural families have the highest marginal savings potential when the effect of family size was not a factor. However, when family size was considered, the expenditure-income coefficients were reduced for all areas except rural areas which remained relatively high. Family size coefficients were absolutely greater for urban areas, but proportionately greater for rural areas in relation to expenditure. The study did not show that economies of scale in family spending were important.

  19. Modeling and Analysis of Composite Wing Sections for Improved Aeroelastic and Vibration Characteristics Using Smart Materials

    NASA Technical Reports Server (NTRS)

    Chattopadhyay, Aditi

    1996-01-01

    The objective of this research is to develop analysis procedures to investigate the coupling of composite and smart materials to improve aeroelastic and vibratory response of aerospace structures. The structural modeling must account for arbitrarily thick geometries, embedded and surface bonded sensors and actuators and imperfections, such as delamination. Changes in the dynamic response due to the presence of smart materials and delaminations is investigated. Experiments are to be performed to validate the proposed mathematical model.

  20. Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis.

    PubMed

    Heesen, M; Kölhr, S; Rossaint, R; Straube, S

    2014-02-01

    We conducted a systematic review to determine the harm and benefit associated with prophylactic phenylephrine for caesarean section under spinal anaesthesia. We included 21 randomised controlled trials with 1504 women. The relative risk (95% CI) of hypotension with phenylephrine infusion – as defined by authors – before delivery was 0.36 (0.18–0.73) vs placebo, p = 0.004; 0.58 (0.39–0.88) vs an ephedrine infusion, p = 0.009; and 0.73 (0.55–0.96) when added to an ephedrine infusion, p = 0.02. After delivery, the relative risks of hypotension and nausea and vomiting with phenylephrine compared with placebo were 0.37 (0.19–0.71), p = 0.003, and 0.39 (0.17–0.91), p = 0.03, respectively. There was no evidence that hypertension, bradycardia or neonatal endpoints were affected. Phenylephrine reduced the risk for hypotension and nausea and vomiting after spinal doses of bupivacaine generally exceeding 8 mg, but there was no evidence that it reduced other maternal or neonatal morbidities.

  1. Community characteristics associated with where urgent care centers are located: a cross-sectional analysis

    PubMed Central

    Le, Sidney T; Hsia, Renee Y

    2016-01-01

    Objectives To determine the community characteristics associated with non-hospital-based urgent care centres wherever they are located. Design National cross-sectional study evaluating the association between non-hospital-based urgent care centers, and their demographic characteristics in a community, using descriptive statistics and multivariate logistic regressions. Setting Communities in the USA with non-hospital-based urgent care centers, as identified using a 2014 national database from the Urgent Care Association of America. Participants 31 022 communities encompassing 6898 urgent care centers across the USA. Primary and secondary outcome measures Presence of a non-hospital-based urgent care center within a community. Results Communities with non-hospital-based urgent care centers are urban (75.7% with vs 22.2% without; p<0.001 across rural urban commuting area levels), and are located in areas with higher income levels (38.6% in highest quartile with vs 22.3% without; p<0.001 across quartiles) and higher levels of private insurance (29.6% in highest quartile with vs 23.9% without; p<0.001 across quartiles). Conclusions While the growth of the urgent care industry may have other promising implications, policymakers should recognise that it may exacerbate disparities in access to acute care faced by poorer, uninsured patients, and may also have financial implications for providers that are providing overlapping services, such as emergency departments and primary care practices. PMID:27056591

  2. Biostratigraphic sequence analysis of Oligocene-Lower Miocene sections in the Orocual Field, Eastern Venezuela Basin

    SciTech Connect

    Giffuni, G.; Castro-Mora, M.

    1996-08-01

    A detailed biostratigraphic study of the Oligocene-Miocene boundary was carried out in sections 1000 ft thick of ten wells of the Orocual Field, Eastern Venezuela, The sequences under investigation carry a rich microfauna of benthic and planktonic foraminifera and calcareous nannoplankton. About 500 samples were analyzed and nearly 150 species of foraminifera and 60 of nannoplankton calcareous were identified. The planktonic assemblages allow the identification of zones N3 and N4 of Blow, 1969; zones NP23, NP24, NP25 and NN1 of Martini, 1971; and zones F and E of Stainforth et al., 1959 of the Carapita Formation. The paleoenvironments of these sediments were determined rather precisely and vary from inner shelf to middle slope. Paleobathymetric curves of several wells are included. High and low fossil abundance and diversity peaks were used to recognize two sequences of the third order and five of the fourth order between 24.8 Ma and 26.5 Ma. A generalized transgressive trend is evident from the Late Oligocene to the Early Miocene.

  3. Analysis and Design of Rectangular-Cross-Section Nozzles for Scramjet Engine Testing

    NASA Technical Reports Server (NTRS)

    Gaffney, Richard L., Jr.; Korte, John J.

    2004-01-01

    The flow in the square-cross-section Mach-6 nozzle used in the NASA Langley Research Center Arc-Heated Scramjet Test Facility has been analyzed using three-dimensional viscous CFD methods. The primary cause of the non-uniform flow exiting the nozzle is identified as cross-flow pressure gradients imposed on wall boundary layers. The cross-flow pressure gradients cause the boundary layer to roll up into counter-rotating vortex pairs on each of the four sides of the nozzle. These four vortex pairs produce significant non-uniformity in the nozzle-exit flow. In order to improve the quality of the test flow in the facility, two alternative nozzle designs (one axisymmetric and one rectangular with a 2-D contour) have been investigated. While the axisymmetric design produced the most uniform flow, the 2-D design also produced very good flow. The 2-D design was selected for further refinement, resulting in a new nozzle design which has been constructed and awaits calibration.

  4. Ego defense mechanisms in Pakistani medical students: a cross sectional analysis

    PubMed Central

    2010-01-01

    Background Ego defense mechanisms (or factors), defined by Freud as unconscious resources used by the ego to reduce conflict between the id and superego, are a reflection of how an individual deals with conflict and stress. This study assesses the prevalence of various ego defense mechanisms employed by medical students of Karachi, which is a group with higher stress levels than the general population. Methods A questionnaire based cross-sectional study was conducted on 682 students from five major medical colleges of Karachi over 4 weeks in November 2006. Ego defense mechanisms were assessed using the Defense Style Questionnaire (DSQ-40) individually and as grouped under Mature, Immature, and Neurotic factors. Results Lower mean scores of Immature defense mechanisms (4.78) were identified than those for Neurotic (5.62) and Mature (5.60) mechanisms among medical students of Karachi. Immature mechanisms were more commonly employed by males whereas females employed more Neurotic mechanisms than males. Neurotic and Immature defenses were significantly more prevalent in first and second year students. Mature mechanisms were significantly higher in students enrolled in Government colleges than Private institutions (p < 0.05). Conclusions Immature defense mechanisms were less commonly employed than Neurotic and Mature mechanisms among medical students of Karachi. The greater employment of Neurotic defenses may reflect greater stress levels than the general population. Employment of these mechanisms was associated with female gender, enrollment in a private medical college, and students enrolled in the first 2 years of medical school. PMID:20109240

  5. Sectional Finite Element Analysis on Viscous Pressure Forming of Sheet Metal

    NASA Astrophysics Data System (ADS)

    Liu, Jianguang; Wang, Zhongjin; Liu, Yan

    2007-05-01

    Viscous pressure forming (VPF) is a recently developed sheet flexible-die forming process, which uses a kind of semi-solid, flowable and viscous material as pressure-carrying medium that typically applied on one side of the sheet metal or on both sides of sheet metal. Different from traditional sheet metal forming processes in which sheet metal is the unique deformation-body, VPF is a coupling process of visco-elastoplastic bulk deformation of viscous medium and elasto-plastic deformation of sheet metal. A sectional finite element model for the coupled deformation between visco-elastoplastic body and elasto-plastic sheet metal was proposed to analyze VPF. The resolution of the Updated Lagrangian formulation is based on a static approach. By using static-explicit time integration strategy, the deformation of elasto-plastic sheet metal and visco-elastoplastic body can keep stable. The frictional contact between sheet metal and visco-elastoplastic body is treated by penalty function method. Using the proposed algorithm, sheet metal viscous pressure bulging (VPB) process is analyzed and compared with experiments. A good agreement between numerical simulation results and experimental ones proved the efficiency and stability of this algorithm.

  6. Improved formulation of global QCD analysis with zero-mass hard cross sections

    SciTech Connect

    Nadolsky, Pavel M.; Tung, W.-K.

    2009-06-01

    The zero-mass (ZM) parton formalism is widely used in high-energy physics because of its simplicity and historical importance, even while massive quarks (c,b,t) are playing an increasingly prominent role in particle phenomenology, including global QCD analyses of parton distributions based on the more precise general-mass (GM) QCD formalism. In view of this dichotomy, we show how the obvious inconsistencies of the conventional implementation of the ZM formalism can be corrected, while preserving the simplicity of its hard matrix elements. The resulting intermediate-mass (IM) scheme for perturbative QCD calculation can be considered either as improved ZM formulation with realistic treatment of heavy-flavor kinematics; or as a simplified GM formulation with approximate ZM hard cross sections. Phenomenologically, global analyses based on IM calculations can effectively reproduce, within the present estimated uncertainty bands, the more correct GM results on parton distributions, as well as their predictions for a wide range of collider processes of current interest.

  7. Three-dimensional analysis by serial sectioning of cubic zirconia sinters

    SciTech Connect

    Bobrowski, P. Faryna, M.; Pędzich, Z.

    2015-03-30

    Three-dimensional electron backscatter diffraction technique was used for the characterization of grain boundary geometry and pore morphology in cubic zirconia. A set of three samples composed of cubic yttria stabilized zirconia, sintered under different conditions was investigated. Analysis of grain boundaries and pore structure was carried out in a dual-beam scanning electron microscope. For each sample, a volume of 15·10{sup 3} μm{sup 3} was investigated. The results of three-dimensional microstructure analysis were compared to the results derived from regular, two-dimensional maps of the area of 2500 µm{sup 2}. Based on two-dimensional and three-dimensional data the average grain diameter, number of grains, average number of neighbors and porosity were calculated. The average grain diameter varied in the range from 2.39 µm to 2.91 µm and from 3.00 µm to 3.79 µm, while the level of porosity varied in the range from 1.22% to 1.77% and from 1.30% to 5.61% for two-dimensional and three-dimensional data, respectively. The analysis of grain boundary networks revealed a strong dependence between grain boundary density and sample preparation parameters. The parameters of the sintering process affected also the size and distribution of pores. The comparison of the results of 2D and 3D materials characterization revealed significant differences in the values of calculated microstructure parameters.

  8. Chromatin Isolation and DNA Sequence Analysis in Large Undergraduate Laboratory Sections

    NASA Astrophysics Data System (ADS)

    Hagerman, Ann E.

    1999-10-01

    A pair of exercises that introduce undergraduate students to basic techniques and concepts of molecular biology and that are appropriate for classes with large enrollments are described. One exercise is a simple laboratory experiment in which chromatin is isolated from chicken liver and is resolved into histone proteins and DNA by ion-exchange chromatography. The other is a series of computer simulations that introduce DNA sequencing, mapping, and sequence analysis to the students. The final step of the simulation is submission of a sequence to a database on the World Wide Web for identification of the protein product of the gene.

  9. Section 2: Corrosion and failure analysis studies in support of the pulp and paper industry

    SciTech Connect

    Keiser, J.R.; Pawel, S.J.; Swindeman, R.W.; Longmire, H.F.

    1997-04-01

    Technical support is being provided to various pulp and paper companies and related industries to help determine the cause of material degradation problems and to identify alternate materials to prevent such degradation. During the past year, examinations have included parts from several sootblowers, two failed economizer tubes, and inspection of a continuous digester. The results of the analyses and inspections were communicated to the plant operators, and, in some cases, recommendations were made. This article discusses examination of sootblower nozzles, which evidenced intergranular cracking. Analysis indicated the presence of chromium carbide precipitates along the grain boundaries, which can cause the sample to be sensitized to grain boundary attack.

  10. Individual and interpersonal triggers to quit smoking in China: a cross-sectional analysis

    PubMed Central

    Im, Pek Kei; McNeill, Ann; Thompson, Mary E.; Fong, Geoffrey T.; Xu, Steve; Quah, Anne C. K.; Jiang, Yuan; Shahab, Lion

    2015-01-01

    Aims To determine the most prominent individual and interpersonal triggers to quit smoking in China and their associations with socio-demographic characteristics. Methods Data come from Waves 1-3 (2006-2009) of the ITC China Survey, analysed cross-sectionally as person-waves (N=14,358). Measures included socio-demographic and smoking characteristics. Those who quit between waves (4.3%) were asked about triggers that “very much” led them to stop smoking, and continuing smokers about triggers that “very much” made them think about quitting. Triggers covered individual (personal health concerns, cigarette price, smoking restrictions, advertisements, warning labels) and interpersonal factors (family/societal disapproval of smoking, setting an example to children, concerns about second-hand smoke). Results Over a third of respondents (34.9%) endorsed at least one trigger strongly; quitters were more likely than smokers to mention any trigger. While similar proportions of smokers endorsed individual (24.4%) and interpersonal triggers (24.0%), quitters endorsed more individual (61.1%) than interpersonal (48.3%) triggers. However, the most common triggers (‘personal health concerns’; ‘setting an example to children’) were the same, endorsed by two-thirds of quitters and a quarter of smokers, as were the least common triggers (‘warning labels’; ‘cigarette price’), endorsed by one in ten quitters and one in twenty smokers. Lower dependence among smokers and greater education among all respondents were associated with endorsing any trigger. Conclusions Individual rather than interpersonal triggers appear more important for quitters. Major opportunities to motivate quit attempts are missed in China, particularly with regard to taxation and risk communication. Interventions need to focus on more dependent and less-educated smokers. PMID:25888422

  11. Sodium and potassium urinary excretion and dietary intake: a cross-sectional analysis in adolescents

    PubMed Central

    Gonçalves, Carla; Abreu, Sandra; Padrão, Patrícia; Pinho, Olívia; Graça, Pedro; Breda, João; Santos, Rute; Moreira, Pedro

    2016-01-01

    Background Hypertension is the leading cause for heart disease and stroke, for mortality and morbidity worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension than sodium alone. Objective This study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents. Design A cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h dietary recall. Results Valid urine collections were provided by 200 adolescents (118 girls) with a median age of 14.0 in both sexes (p=0.295). Regarding sodium, the mean urinary excretion was 3,725 mg/day in boys and 3,062 mg/day in girls (p<0.01), and 9.8% of boys and 22% of girls met the World Health Organization (WHO) recommendations for sodium intake. Concerning potassium, the mean urinary excretion was 2,237 mg/day in boys and 1,904 mg/day in girls (p<0.01), and 6.1% of boys and 1.7% of girls met the WHO recommendations for potassium intake. Major dietary sources for sodium intake were cereal and cereal products (41%), meat products (16%), and milk and milk products (11%); and for potassium intake, main sources were milk and milk products (21%), meat products (17%), and vegetables (15%). Conclusions Adolescents had a high-sodium and low-potassium diet, well above the WHO recommendations. Health promotion interventions are needed in order to decrease sodium and increase potassium intake. PMID:27072344

  12. Phylogenetic analysis in Myrcia section Aulomyrcia and inferences on plant diversity in the Atlantic rainforest

    PubMed Central

    Staggemeier, Vanessa Graziele; Diniz-Filho, José Alexandre Felizola; Forest, Félix; Lucas, Eve

    2015-01-01

    Background and Aims Myrcia section Aulomyrcia includes ∼120 species that are endemic to the Neotropics and disjunctly distributed in the moist Amazon and Atlantic coastal forests of Brazil. This paper presents the first comprehensive phylogenetic study of this group and this phylogeny is used as a basis to evaluate recent classification systems and to test alternative hypotheses associated with the history of this clade. Methods Fifty-three taxa were sampled out of the 120 species currently recognized, plus 40 outgroup taxa, for one nuclear marker (ribosomal internal transcribed spacer) and four plastid markers (psbA-trnH, trnL-trnF, trnQ-rpS16 and ndhF). The relationships were reconstructed based on Bayesian and maximum likelihood analyses. Additionally, a likelihood approach, ‘geographic state speciation and extinction’, was used to estimate region- dependent rates of speciation, extinction and dispersal, comparing historically climatic stable areas (refugia) and unstable areas. Key Results Maximum likelihood and Bayesian inferences indicate that Myrcia and Marlierea are polyphyletic, and the internal groupings recovered are characterized by combinations of morphological characters. Phylogenetic relationships support a link between Amazonian and north-eastern species and between north-eastern and south-eastern species. Lower extinction rates within glacial refugia suggest that these areas were important in maintaining diversity in the Atlantic forest biodiversity hotspot. Conclusions This study provides a robust phylogenetic framework to address important ecological questions for Myrcia s.l. within an evolutionary context, and supports the need to unite taxonomically the two traditional genera Myrcia and Marlierea in an expanded Myrcia s.l. Furthermore, this study offers valuable insights into the diversification of plant species in the highly impacted Atlantic forest of South America; evidence is presented that the lowest extinction rates are found inside

  13. Rasch analysis of the London Handicap Scale in stroke patients: a cross-sectional study

    PubMed Central

    2014-01-01

    Background Although activity and participation are the target domains in stroke rehabilitation interventions, there is insufficient evidence available regarding the validity of participation measurement. The purpose of this study was to investigate the psychometric properties of the London Handicap Scale in community-dwelling stroke patients, using Rasch analysis. Methods Participants were 170 community-dwelling stroke survivors. The data were analyzed using Winsteps (version 3.62) with the Rasch model to determine the unidimensionality of item fit, the distribution of item difficulty, and the reliability and suitability of the rating process for the London Handicap Scale. Results Data of 16 participants did not fit the Rasch model and there were no misfitting items. The person separation value was 2.42, and the reliability was .85; furthermore, the rating process for the London Handicap Scale was found to be suitable for use with stroke patients. Conclusions This was the first trial to investigate the psychometric properties of the London Handicap Scale using Rasch analysis; the results supported the suitability of this scale for use with stroke patients. PMID:25077991

  14. Section-level relationships of North American Agalinis (Orobanchaceae) based on DNA sequence analysis of three chloroplast gene regions

    PubMed Central

    Neel, Maile C; Cummings, Michael P

    2004-01-01

    Background The North American Agalinis are representatives of a taxonomically difficult group that has been subject to extensive taxonomic revision from species level through higher sub-generic designations (e.g., subsections and sections). Previous presentations of relationships have been ambiguous and have not conformed to modern phylogenetic standards (e.g., were not presented as phylogenetic trees). Agalinis contains a large number of putatively rare taxa that have some degree of taxonomic uncertainty. We used DNA sequence data from three chloroplast genes to examine phylogenetic relationships among sections within the genus Agalinis Raf. (=Gerardia), and between Agalinis and closely related genera within Orobanchaceae. Results Maximum likelihood analysis of sequences data from rbcL, ndhF, and matK gene regions (total aligned length 7323 bp) yielded a phylogenetic tree with high bootstrap values for most branches. Likelihood ratio tests showed that all but a few branch lengths were significantly greater than zero, and an additional likelihood ratio test rejected the molecular clock hypothesis. Comparisons of substitution rates between gene regions based on linear models of pairwise distance estimates between taxa show both ndhF and matK evolve more rapidly than rbcL, although the there is substantial rate heterogeneity within gene regions due in part to rate differences among codon positions. Conclusions Phylogenetic analysis supports the monophyly of Agalinis, including species formerly in Tomanthera, and this group is sister to a group formed by the genera Aureolaria, Brachystigma, Dasistoma, and Seymeria. Many of the previously described sections within Agalinis are polyphyletic, although many of the subsections appear to form natural groups. The analysis reveals a single evolutionary event leading to a reduction in chromosome number from n = 14 to n = 13 based on the sister group relationship of section Erectae and section Purpureae subsection Pedunculares

  15. The Accuracy Analysis of Lidar-Derived Elevation Data for the Geometric Description of Cross-Sections of a Riverbed

    NASA Astrophysics Data System (ADS)

    Caroti, G.; Camiciottoli, F.; Piemonte, A.; Redini, M.

    2013-01-01

    The work stems from a joint study between the Laboratory ASTRO (Department of Civil and Industrial Engineering - University of Pisa), the municipality of Pisa and the province of Arezzo on the advanced analysis and use of digital elevation data. Besides, it is framed in the research carried on by ASTRO about the definition of the priority informative layers for emergency management in the territory, as of PRIN 2008. Specifically, this work is in continuity with other already published results concerning rigorous accuracy checks of LIDAR data and testing of the procedures to transform raw data in formats consistent with CTR and survey data. The analysis of sections of riverbed, derived from interpolation by DTMs featuring different grid density with those detected topographically, is presented. Validation by differential GNSS methodology of the DTMs used showed a good overall quality of the model for open, low-sloping areas. Analysis of the sections, however, has shown that the representation of small or high-sloping (ditches, embankments) morphological elements requires a high point density such as in laser scanner surveys, and a small mesh size of the grid. In addition, the correct representation of riverside structures is often hindered by the presence of thick vegetation and poor raw LIDAR data filtering.

  16. Practice size and quality attainment under the new GMS contract: a cross-sectional analysis

    PubMed Central

    Wang, Yingying; O'Donnell, Catherine A; Mackay, Daniel F; Watt, Graham CM

    2006-01-01

    Background The Quality and Outcomes Framework (QOF) of the new General Medical Services contract, for the first time, incentivises certain areas of general practice workload over others. The ability of practices to deliver high quality care may be related to the size of the practice itself. Aim To explore the relationship between practice size and points attained in the QOF. Design of study Cross-sectional analyses of routinely available data. Setting Urban general practice in mainland Scotland. Method QOF points and disease prevalence were obtained for all urban general practices in Scotland (n = 638) and linked to data on the practice, GP and patient population. The relationship between QOF point attainment, disease prevalence and practice size was examined using univariate statistical analyses. Results Smaller practices were more likely to be located in areas of socioeconomic deprivation; had patients with poorer health; and were less likely to participate in voluntary practice-based quality schemes. Overall, smaller practices received fewer QOF points compared to larger practices (P = 0.003), due to lower point attainment in the organisational domain (P = 0.002). There were no differences across practice size in the other domains of the QOF, including clinical care. Smaller practices reported higher levels of chronic obstructive pulmonary disease (COPD) and mental health conditions and lower levels of asthma, epilepsy and hypothyroidism. There was no difference in the reported prevalence of hypertension or coronary heart disease (CHD) across practices, in contrast to CHD mortality for patients aged under 70 years, where the mortality rate was 40% greater for single-handed practices compared with large practices. Conclusions Although smaller practices obtained fewer points than larger practices under the QOF, this was due to lower scores in the organisational domain of the contract rather than to lower scores for clinical care. Single-handed practices, in common

  17. Exchange of intraoperative balloon occlusion of the internal iliac artery for the common iliac artery during cesarean hysterectomy in a patient with placenta percreta

    PubMed Central

    Hishikawa, Kenji; Koshiyama, Masafumi; Ueda, Masashi; Yamaguchi, Ayaka; Ukita, Shingo; Yagi, Haruhiko; Kakui, Kazuyo

    2013-01-01

    Patient: Female, 36 Final Diagnosis: Pregnancy – placenta increta Symptoms: — Medication: — Clinical Procedure: Cesarean hysterectomy Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: The generally accepted treatment for placenta percreta is cesarean hysterectomy without attempts to detach the placenta. Preoperative internal iliac artery balloon occlusion (IIABO) has been widely performed to minimize blood loss during cesarean hysterectomy for an abnormal attachment of the placenta. Our case is the first reported case of common iliac artery balloon occlusion (CIABO) being more effective than IIABO for reducing blood loss during a cesarean hysterectomy in the same patient. Case Report: We performed cesarean hysterectomy with IIABO in a 36-year-old Japanese female who had placenta percreta. However, there was still a large amount of blood loss. We immediately changed the balloon from the internal iliac artery to the common iliac artery, which visibly reduced the amount of blood loss. We finally achieved cesarean hysterectomy. Conclusions: CIABO was found to be more effective than IIABO for reducing blood loss during cesarean hysterectomy. Failure of IIABO can be explained by the presence of extensive anastomoses in the pelvic vasculature. PMID:24147189

  18. Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis

    PubMed Central

    2012-01-01

    Background Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly. Methods Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate), utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors Results Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Those who had a higher probability of being frail included women (OR

  19. A cross-sectional analysis of how young adults perceive tobacco brands: implications for FCTC signatories

    PubMed Central

    2012-01-01

    Background The Framework Convention on Tobacco Control calls for the elimination of tobacco advertising, promotion and sponsorship. To test whether tobacco packaging functions as advertising by communicating attractive and distinctive brand attributes, we explored how young adult smokers and non-smokers interpreted familiar and unfamiliar tobacco brands. Methods We conducted an on-line survey of 1035 young adult smokers and non-smokers aged 18–30. Participants evaluated eight tobacco brands using ten attributes based on brand personality scales. We used factor analysis and ANOVA to examine patterns in brand-attribute associations. Results Young adults distinguished between brands on the basis of their packaging alone, associated each brand with specific attributes, and were equally able to interpret familiar and unfamiliar brands. Contrary to our expectations, non-smokers made more favourable brand-attribute associations than smokers, but both groups described Basic, a near generic brand, as ‘plain’ or ‘budget’. There were no significant gender or ethnicity differences. Conclusions Tobacco packaging uses logos, colours and imagery to create desirable connotations that promote and reinforce smoking. By functioning in the same way as advertising, on-pack branding breaches Article 13 of the FCTC and refutes tobacco companies’ claims that pack livery serves only as an indentifying device that simplifies smokers’ decision-making. Given this evidence, signatories should see plain packaging policies as a priority consistent with their FCTC obligations to eliminate all tobacco advertising and promotion. PMID:22985407

  20. An Odontometric Approach for Estimation of Stature in Indians: Cross- Sectional Analysis

    PubMed Central

    Yadav, Sumit Kumar; Kedia, Neal Bharat; Singh, Abhinav Kumar

    2016-01-01

    Introduction Height/stature is one of the useful anthropometric parameter for individual identification. Correlation of stature to long bones, even fragmentary bones is frequently reported among various populations. As teeth have the advantage of being composed largely of hard tissue which is relatively indestructible, the careful study of these can enable reliable determination of stature of the person in life. Aim The present study was designed to elucidate the anthropometric correlation of tooth dimensions with stature and also devises regression formulae. Materials and Methods This study was carried out on 361 Indian students (151 males and 210 females) in the age range of 21- 45 years to estimate stature using odontometry. Stature and tooth measurements were taken on each partcipant following standard methods and techniques. Karl Pearson’s correlation co-efficient and linear regression was used to estimate stature. Results Regression analysis showed that the canine width can aid in estimation of stature as an adjunct when only teeth are available for identification. Conclusion Tooth dimensions can be used only as a supplementary approach for the estimation of stature but with caution. PMID:27134995