The Experts below are selected from a list of 38184 Experts worldwide ranked by ideXlab platform
Ja Young Kwon - One of the best experts on this subject based on the ideXlab platform.
-
efficacy of intrauterine bakri balloon tamponade in Cesarean Section for placenta previa patients
PLOS ONE, 2015Co-Authors: Hee Young Cho, Yong Won Park, Young Han Kim, Inkyung Jung, Ja Young KwonAbstract: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.
Kari Klungsoyr - One of the best experts on this subject based on the ideXlab platform.
-
maternal age and risk of Cesarean Section in women with induced labor at term a nordic register based study
Acta Obstetricia et Gynecologica Scandinavica, 2020Co-Authors: Thomas Bergholt, Steen Rasmussen, Finn Egil Skjeldestad, Aura Pyykonen, Annamaija Tapper, Ragnheiður I Bjarnadottir, Alexander Kr Smarason, Birna Bjorg Masdottir, Kari KlungsoyrAbstract:Introduction: Over the last decades, induction of labor has increased in many countries along with increasing maternal age. We assessed the effects of maternal age and labor induction on Cesarean Section at term among nulliparous and multiparous women without previous Cesarean Section. Material and methods: We performed a retrospective national registry-based study from Denmark, Finland, Iceland, Norway, and Sweden including 3 398 586 deliveries between 2000 and 2011. We investigated the impact of age on Cesarean Section among 196 220 nulliparous and 188 158 multiparous women whose labor was induced, had single cephalic presentation at term, and no previous Cesarean Section. Confounders comprised country, time-period, and gestational age. Results: In nulliparous women with induced labor the rate of Cesarean Section increased from 14.0% in women less than 20 years of age to 39.9% in women 40 years and older. Compared with women aged 25-29 years, the corresponding relative risks were 0.60 (95% confidence interval [95% CI] 0.57 to 0.64) and 1.72 (95% CI 1.66 to 1.79). In multiparous induced women the risk of Cesarean Section was 3.9% in women less than 20 years rising to 9.1% in women 40 years and older. Compared with women aged 25-29 years, the relative risks were 0.86 (95% CI 0.54 to 1.37) and 1.98 (95% CI 1.84 to 2.12), respectively. There were minimal confounding effects of country, time-period, and gestational age on risk for Cesarean Section. Conclusions: Advanced maternal age is associated with increased risk of Cesarean Section in women undergoing labor induction with a single cephalic presentation at term without a previous Cesarean Section. The absolute risk of Cesarean Section is 3-5 times higher across 5-year age groups in nulliparous relative to multiparous women having induced labor. (Less)
Lillian Skibsted - One of the best experts on this subject based on the ideXlab platform.
-
twin births Cesarean Section or vaginal delivery
Acta Obstetricia et Gynecologica Scandinavica, 2012Co-Authors: Elise Hoffmann, Anna Oldenburg, Line Rode, Ann Tabor, Steen Rasmussen, Lillian SkibstedAbstract:Objective To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery. Design Population-based retrospective cohort. Setting Fourteen obstetric departments in Denmark. Population One thousand one hundred and seventy-five twin pregnancies with two live fetuses at 36(+0) weeks of gestation. Methods Pregnancy outcomes assessed according to chorionicity and mode of delivery. Main outcome measures Poor outcome defined as five min Apgar score ≤ 7, umbilical artery pH Results Dichorionic (DC) twins, delivered after 36 gestational weeks, with intended vaginal delivery (n= 689) compared with DC twins with planned Cesarean Section (n= 371) had an increased risk of poor outcome [odds ratio (OR) 1.47, p= 0.037] after adjustment for body mass index, parity and weight discordance. There was no increased risk for poor outcome in monochorionic (MC) twins with intended vaginal delivery (n= 63) compared with planned Cesarean Section (n= 52; OR 0.87, 95% confidence interval 0.26-2.96). Nulliparity increased the risk of poor outcome in DC (OR 1.5, p= 0.03) and in MC twins (OR 4.01, p= 0.02), as well as birthweight discordance >300 g (DC, OR 1.50, p= 0.02; and MC, OR 6.02, p= 0.002). For DC twins, we found a significantly higher risk of poor outcome of the second-born twin compared with the first (OR 1.64, p= 0.001). Conclusions Dichorionic twins born after 36 weeks of gestation had a higher risk of poor outcome by intended vaginal delivery than by planned Cesarean Section. For MC twins, statistical differences in outcome by mode of delivery could not be seen.
Hee Young Cho - One of the best experts on this subject based on the ideXlab platform.
-
efficacy of intrauterine bakri balloon tamponade in Cesarean Section for placenta previa patients
PLOS ONE, 2015Co-Authors: Hee Young Cho, Yong Won Park, Young Han Kim, Inkyung Jung, Ja Young KwonAbstract: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.
Fiona Smaill - One of the best experts on this subject based on the ideXlab platform.
-
antibiotic prophylaxis versus no prophylaxis for preventing infection after Cesarean Section
Cochrane Database of Systematic Reviews, 2014Co-Authors: Fiona Smaill, Rosalie M GrivellAbstract:Background The single most important risk factor for postpartum maternal infection is Cesarean Section. Although guidelines endorse the use of prophylactic antibiotics for women undergoing Cesarean Section, there is not uniform implementation of this recommendation. This is an update of a Cochrane review first published in 1995 and last updated in 2010. Objectives To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing Cesarean Section. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved papers. Selection criteria Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing Cesarean Section. Data collection and analysis Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. The clinically important primary outcomes were wound infection, endometritis, serious maternal infectious complications and adverse effects on the infant. We presented dichotomous data as risk ratios (RR), with 95% confidence intervals (CIs) and combined trials in meta-analyses. We assessed the quality of evidence using the GRADE approach. Main results We identified 95 studies enrolling over 15,000 women. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing Cesarean Section reduced the incidence of wound infection (RR 0.40, 95% CI 0.35 to 0.46, 82 studies, 14,407 women), endometritis (RR 0.38, 95% CI 0.34 to 0.42, 83 studies, 13,548 women) and maternal serious infectious complications (RR 0.31, 95% CI 0.20 to 0.49, 32 studies, 6159 women). When only studies that included women undergoing an elective Cesarean Section were analyzed, there was also a reduction in the incidence of wound infections (RR 0.62, 95% CI 0.47 to 0.82, 17 studies, 3537 women) and endometritis (RR 0.38, 95% CI 0.24 to 0.61, 15 studies, 2502 women) with prophylactic antibiotics. Similar estimates of effect were seen whether the antibiotics were administered before the cord was clamped or after. The effect of different antibiotic regimens was studied and similar reductions in the incidence of infections were seen for most of the antibiotics and combinations. There were no data on which to estimate the effect of maternal administration of antibiotics on infant outcomes. No studies systematically collected and reported on adverse infant outcomes nor the effect of antibiotics on the developing infant immune system. No studies reported on the incidence of oral candidiasis (thrush) in babies. Maternal adverse effects were also rarely described. We judged the evidence for antibiotic treatment compared with no treatment to be of moderate quality; most studies lacked an adequate description of methods and were assessed as being at unclear risk of bias. Authors' conclusions The conclusions of this review support the recommendation that prophylactic antibiotics should be routinely administered to all women undergoing Cesarean Section to prevent infection. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing Cesarean Section reduced the incidence of wound infection, endometritis and serious infectious complications by 60% to 70%. There were few data on adverse effects and no information on the effect of antibiotics on the baby, making the assessment of overall benefits and harms difficult. Prophylactic antibiotics given to all women undergoing elective or non-elective Cesarean Section is beneficial for women but there is uncertainty about the consequences for the baby.
-
antibiotic prophylaxis for Cesarean Section
Cochrane Database of Systematic Reviews, 2010Co-Authors: Justus G Hofmeyr, Fiona SmaillAbstract:Background The single most important risk factor for postpartum maternal infection is Cesarean delivery. Objectives The objective of this review was to assess the effects of prophylactic antibiotic treatment on infectious complications in women undergoing Cesarean delivery. Search strategy We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001). Selection criteria Randomized trials comparing antibiotic prophylaxis or no treatment for both elective and non-elective Cesarean Section. Data collection and analysis Two reviewers assessed trial quality and extracted data. Main results Eighty-one trials were included. Use of prophylactic antibiotics in women undergoing Cesarean Section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after Cesarean Section. The reduction in the risk of endometritis with antibiotics was similar across different patient groups: the relative risk (RR) for endometritis for elective Cesarean Section (number of women = 2037) was 0.38 (95% confidence interval (CI) 0.22 to 0.64); the RR for non-elective Cesarean Section (n = 2132) was 0.39 (95% CI 0.34 to 0.46); and the RR for all patients (n = 11,937) was 0.39 (95% CI 0.31 to 0.43). Wound infections were also reduced: for elective Cesarean Section (n = 2015) RR 0.73 (95% CI 0.53 to 0.99); for non-elective Cesarean Section (n = 2780) RR 0.36 95% CI 0.26 to 0.51]; and for all patients (n = 11,142) RR 0.41 (95% CI 0.29 to 0.43). Authors' conclusions The reduction of endometritis by two thirds to three quarters and a decrease in wound infections justifies a policy of recommending prophylactic antibiotics to women undergoing elective or non-elective Cesarean Section.