Cesarean section Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):156-162
Venous thromboembolism events are important causes of maternal death during pregnancyandthepostpartumperiodworldwide.Are view of the literature with the objective of evaluating venous thromboembolism events in the puerperium according to the route of delivery was performed through a bibliographic survey in the Medline, LILACS and Scielo databases. We observed that patients submitted to cesarean sections present a significantlyhigher riskofdeveloping venousthromboembolismwhencomparedwiththose who undergo spontaneous vaginal delivery. The pathophysiological bases for this difference were explored and described in this review, as well as the indications of prophylaxis and treatment. Doctors and health professionals must be continuously vigilant regarding this condition, since it is associated with high morbidity and mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):156-162
Venous thromboembolism events are important causes of maternal death during pregnancyandthepostpartumperiodworldwide.Are view of the literature with the objective of evaluating venous thromboembolism events in the puerperium according to the route of delivery was performed through a bibliographic survey in the Medline, LILACS and Scielo databases. We observed that patients submitted to cesarean sections present a significantlyhigher riskofdeveloping venousthromboembolismwhencomparedwiththose who undergo spontaneous vaginal delivery. The pathophysiological bases for this difference were explored and described in this review, as well as the indications of prophylaxis and treatment. Doctors and health professionals must be continuously vigilant regarding this condition, since it is associated with high morbidity and mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(1):11-19
To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes.
A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequateweight, overweight, and obese. The BMIwas calculated at the first and at the last prenatal care visits, and these values were compared.
An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetalmacrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83).
Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(1):11-19
To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes.
A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequateweight, overweight, and obese. The BMIwas calculated at the first and at the last prenatal care visits, and these values were compared.
An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetalmacrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83).
Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(2):60-65
The aim of this study was to evaluate which risk factors may lead patients with gestational diabetes mellitus to cesarean delivery.
This was a retrospective, descriptive study. The subjects of the study were pregnant women with gestational diabetes mellitus attending a public maternity hospital in the south of Brazil. The primary outcomes assessed were based on maternal and fetal characteristics. The data were correlated using an odds ratio (OR) with a 95% confidence interval (95%CI), calculated using multinomial logistic regression.
A total of 392 patients with gestational diabetes mellitus were analyzed, and 57.4% of them had cesarean deliveries. Among the maternal characteristics, the mean age of the patients and the pregestational body mass index were greater when a cesarean delivery was performed (p = 0.029 and p < 0.01 respectively). Gestational age at birth, newborn weight, weight class according to gestational age, and Apgar score were not significant. The analysis of the OR showed that the chance of cesarean delivery was 2.25 times (95%CI = 1.49-2.39) greater if the pregnant woman was obese, 4.6 times (95%CI = 3.017-7.150) greater if she was a primigravida, and 5.2 times (95% CI = 2.702-10.003) greater if she had a previous cesarean delivery. The other parameters analyzed showed no differences.
The factors that led to an increase in the occurrence of cesarean deliveries included history of a prior cesarean section, first pregnancy, and obesity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(2):60-65
The aim of this study was to evaluate which risk factors may lead patients with gestational diabetes mellitus to cesarean delivery.
This was a retrospective, descriptive study. The subjects of the study were pregnant women with gestational diabetes mellitus attending a public maternity hospital in the south of Brazil. The primary outcomes assessed were based on maternal and fetal characteristics. The data were correlated using an odds ratio (OR) with a 95% confidence interval (95%CI), calculated using multinomial logistic regression.
A total of 392 patients with gestational diabetes mellitus were analyzed, and 57.4% of them had cesarean deliveries. Among the maternal characteristics, the mean age of the patients and the pregestational body mass index were greater when a cesarean delivery was performed (p = 0.029 and p < 0.01 respectively). Gestational age at birth, newborn weight, weight class according to gestational age, and Apgar score were not significant. The analysis of the OR showed that the chance of cesarean delivery was 2.25 times (95%CI = 1.49-2.39) greater if the pregnant woman was obese, 4.6 times (95%CI = 3.017-7.150) greater if she was a primigravida, and 5.2 times (95% CI = 2.702-10.003) greater if she had a previous cesarean delivery. The other parameters analyzed showed no differences.
The factors that led to an increase in the occurrence of cesarean deliveries included history of a prior cesarean section, first pregnancy, and obesity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):526-532
DOI 10.1590/SO100-720320150005391
Takotsubo cardiomyopathy is characterized by acute and transient dysfunction of the apical segment of the left ventricle usually after an intense physical or emotional stress, mimicking an acute coronary syndrome. Because this is a rare syndrome, the differential diagnosis is particularly important and a high level of suspicion is essential. Obstetricians should be aware to diagnose and deal with this unexpected event. Treatment is essentially supportive, with spontaneous and complete reversal of the changes within days or weeks. The occurrence of complications may dictate a less benign prognosis. We report a case of Takotsubo cardiomyopathy in a 39-year-old woman who underwent Cesarean delivery. She presented with bradycardia, chest pain and pulmonary edema immediately after the delivery. Her echocardiography showed and apical ballooning. Cardiac biomarkers and electrocardiogram were altered and echocardiogram showed severe left ventricular dysfunction with hypokinesia of the anterior wall. Coronary angiography excluded obstructive coronary artery disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):526-532
DOI 10.1590/SO100-720320150005391
Takotsubo cardiomyopathy is characterized by acute and transient dysfunction of the apical segment of the left ventricle usually after an intense physical or emotional stress, mimicking an acute coronary syndrome. Because this is a rare syndrome, the differential diagnosis is particularly important and a high level of suspicion is essential. Obstetricians should be aware to diagnose and deal with this unexpected event. Treatment is essentially supportive, with spontaneous and complete reversal of the changes within days or weeks. The occurrence of complications may dictate a less benign prognosis. We report a case of Takotsubo cardiomyopathy in a 39-year-old woman who underwent Cesarean delivery. She presented with bradycardia, chest pain and pulmonary edema immediately after the delivery. Her echocardiography showed and apical ballooning. Cardiac biomarkers and electrocardiogram were altered and echocardiogram showed severe left ventricular dysfunction with hypokinesia of the anterior wall. Coronary angiography excluded obstructive coronary artery disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(10):446-454
DOI 10.1590/SO100-720320150005264
To reduce the percentage of cesareans among pregnant women at UNIMED Jaboticabal by redesigning the care delivery model.
Descriptive study conducted at an institution in São Paulo State starting in 2012 to propose the redesign of the care mode based on Continued Improvement Science adapted to the health area. To measure the results of changes we selected nine indicators and their targets.
The percentage of natural births reached the target of 40% after seven months of implementation of the interventions. The percentage of natural births reached 66% among pregnant women in SUS. The perinatal mortality rate decreased by 25% from 2012 to 2014, and the prematurity rate was 3 per 100 live births in 2014. The percentage of pregnant women from UNIMED with six or more prenatal consultations reached 95%. The hospital costs for childbirth care decreased by 27% compared to 2012 and 2013. This reduction was not sustainable and the per capita cost returned to the same level in 2014. The remuneration of all obstetricians increased by 72% from 2012 to 2014.Unimed's costs attributed to the neonatal intensive care unit (NICU) decreased by 61% from 2012 to 2013. The cost was the same for 2013 as it was for 2014 while the admission rate among newborns at UNIMED decreased by 55%. The percentage of pregnant women participating in courses to prepare for birth did not reach the goal set at 80%. The percentage of pregnant women satisfied and very satisfied with care delivery reached 86%.
This project achieved its objectives by reducing the percentage of C-sections among pregnant women of UNIMED Jaboticabal representing a concrete example of achieving the Triple Aim in health: to improve the experience of care and the health outcomes of populations and individuals and to perform these two tasks at a lower cost.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(10):446-454
DOI 10.1590/SO100-720320150005264
To reduce the percentage of cesareans among pregnant women at UNIMED Jaboticabal by redesigning the care delivery model.
Descriptive study conducted at an institution in São Paulo State starting in 2012 to propose the redesign of the care mode based on Continued Improvement Science adapted to the health area. To measure the results of changes we selected nine indicators and their targets.
The percentage of natural births reached the target of 40% after seven months of implementation of the interventions. The percentage of natural births reached 66% among pregnant women in SUS. The perinatal mortality rate decreased by 25% from 2012 to 2014, and the prematurity rate was 3 per 100 live births in 2014. The percentage of pregnant women from UNIMED with six or more prenatal consultations reached 95%. The hospital costs for childbirth care decreased by 27% compared to 2012 and 2013. This reduction was not sustainable and the per capita cost returned to the same level in 2014. The remuneration of all obstetricians increased by 72% from 2012 to 2014.Unimed's costs attributed to the neonatal intensive care unit (NICU) decreased by 61% from 2012 to 2013. The cost was the same for 2013 as it was for 2014 while the admission rate among newborns at UNIMED decreased by 55%. The percentage of pregnant women participating in courses to prepare for birth did not reach the goal set at 80%. The percentage of pregnant women satisfied and very satisfied with care delivery reached 86%.
This project achieved its objectives by reducing the percentage of C-sections among pregnant women of UNIMED Jaboticabal representing a concrete example of achieving the Triple Aim in health: to improve the experience of care and the health outcomes of populations and individuals and to perform these two tasks at a lower cost.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(3):127-132
DOI 10.1590/SO100-720320150005120
To describe the maternal and fetal outcomes with the use of the Foley catheter for induction of labor in high-risk pregnant women with previous caesarean section.
An interventive and descriptive study was conducted from November 2013 to June 2014. A total of 39 pregnant women at term, with a live fetus, cephalic presentation, estimated fetal weight <4,000 g, with previous cesarean section, medical indications for induction of labor, Bishop score ≤6 and amniotic fluid index >5 cm were included. A number 16F Foley catheter was introduced for a maximum of 24 hours, and was considered to be satisfactory when the patient began labor within 24 hours.
Labor was successfully induced in 79.5% of pregnant women. Nine women achieved vaginal delivery (23.1%), with a frequency of 18% of vaginal births occurring within 24 hours. The main indications for the induction of labor were hypertensive disorders (75%). The mean interval between the placement of the Foley catheter and the beginning of labor and delivery were 8.7±7.1 and 14.7±9.8 hours, respectively. Meconium-stained amniotic fluid was observed in two patients; and an Apgar score <7 in the first minute was detected in 5 newborns (12.8%).
The Foley catheter is an alternative for the induction of labor in women with previous caesarean section, despite the low vaginal delivery rate.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(3):127-132
DOI 10.1590/SO100-720320150005120
To describe the maternal and fetal outcomes with the use of the Foley catheter for induction of labor in high-risk pregnant women with previous caesarean section.
An interventive and descriptive study was conducted from November 2013 to June 2014. A total of 39 pregnant women at term, with a live fetus, cephalic presentation, estimated fetal weight <4,000 g, with previous cesarean section, medical indications for induction of labor, Bishop score ≤6 and amniotic fluid index >5 cm were included. A number 16F Foley catheter was introduced for a maximum of 24 hours, and was considered to be satisfactory when the patient began labor within 24 hours.
Labor was successfully induced in 79.5% of pregnant women. Nine women achieved vaginal delivery (23.1%), with a frequency of 18% of vaginal births occurring within 24 hours. The main indications for the induction of labor were hypertensive disorders (75%). The mean interval between the placement of the Foley catheter and the beginning of labor and delivery were 8.7±7.1 and 14.7±9.8 hours, respectively. Meconium-stained amniotic fluid was observed in two patients; and an Apgar score <7 in the first minute was detected in 5 newborns (12.8%).
The Foley catheter is an alternative for the induction of labor in women with previous caesarean section, despite the low vaginal delivery rate.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(12):548-554
DOI 10.1590/So100-720320140005038
To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing.
This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05.
Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period.
Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(12):548-554
DOI 10.1590/So100-720320140005038
To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing.
This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05.
Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period.
Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(9):387-392
DOI 10.1590/SO100-720320140005053
To evaluate the cases of uterine rupture and dehiscence of the uterine scar at a low-risk maternity and to point out possibilities for an improved approach to these complications.
A descriptive study was conducted at a 30-bed low-risk maternity hospital that provides care to users of the public health system. The investigation was carried out by searching for cases in the delivery room registry book and later reading the medical records in order to obtain the data. The information was inserted on a form previously elaborated for this study. Cases of uterine rupure and dehiscence of the uterine scar diagnosed from 1998 to 2012 were included, with the determination of incidence, aspects related to risk factors and diagnosis, association with the use of misoprostol and oxytocin, and the outcomes observed.
A total of 39,206 deliveries were performed in this maternity during the study period, with 12 cases of uterine rupture and 16 cases of dehiscence of uterine scar being observed. The most relevant results were a high perinatal mortality associated with uterine rupture and the unsuccessful diagnosis of this complications. It was not possible to demonstrate an association with the use of misoprostol or oxytocin.
The adverse outcomes of uterine rupture could be minimized if efforts were directed at improving the diagnostic performance of the assisting teams.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(9):387-392
DOI 10.1590/SO100-720320140005053
To evaluate the cases of uterine rupture and dehiscence of the uterine scar at a low-risk maternity and to point out possibilities for an improved approach to these complications.
A descriptive study was conducted at a 30-bed low-risk maternity hospital that provides care to users of the public health system. The investigation was carried out by searching for cases in the delivery room registry book and later reading the medical records in order to obtain the data. The information was inserted on a form previously elaborated for this study. Cases of uterine rupure and dehiscence of the uterine scar diagnosed from 1998 to 2012 were included, with the determination of incidence, aspects related to risk factors and diagnosis, association with the use of misoprostol and oxytocin, and the outcomes observed.
A total of 39,206 deliveries were performed in this maternity during the study period, with 12 cases of uterine rupture and 16 cases of dehiscence of uterine scar being observed. The most relevant results were a high perinatal mortality associated with uterine rupture and the unsuccessful diagnosis of this complications. It was not possible to demonstrate an association with the use of misoprostol or oxytocin.
The adverse outcomes of uterine rupture could be minimized if efforts were directed at improving the diagnostic performance of the assisting teams.