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Effects of physician and patient preferences on cesarean delivery
WEDNESDAY,
SEPTEMBER
6
praevia, grand multparity, obesity, gross varicose veins) and to asses the effectiveness of AFC transfusion in their prevention. Study Methods: In 56 patients with above mentioned risk factors coagulation parameters (fibrinogen, platelet count, APTT, thrombin clotting time, and antithrombin III activity (AT III) were measured during CS and the first 5 postoperative days. This group was compared with 58 patients who met the same criteria for hemorrhage and thromboembolism. In this group (II) in the III trimester of pregnancy 600-900 ml of AFFP was collected by means of plasmapheresis and used intaoperatively to restore coagulation inhibitor AT III and to stop depletion of clotting factors. Results: In the first group haemostasiological evidences of consumption coagulopathy detected at the end of CS (reduction of fibrinogen from 4.2eO.23 g/l to 2.7eO.21 g/l and platelets from 240*7.6.10 /l to 194*6.4.10 /l) were preceded by intraoperative reduction in AT III activity (73.5*1.2%). In the second group, after intraoperative transfusion of AFFP and size of AT III level to 86.4*2.2% (~~0.05) the consumption of coagulation factors was stopped (fibrinogen - 3.84eO.36 g/l (p80% in these patients was detected during all the first 5 postoperative days, while in the fist group AT III returned to normal values only on the fifth day after operation. Conclusion: Intraoperative transfusion of AFFP increases anticoagulant activity, prevents coagulation disturbances during CS and be effectively used to reduce the incidence of hemorrhages and thromboembolic complications in patients with high risk factors delivered by CS.
P3.03.08 COMPARATIVE ANALYSIS OF OWN MODIFICATION OF MISGAV-LADACH (MML) AND PFANNENSTIEL METHODS FOR CESAREAN SECTION IN THE MATERIAL OF FETALMATERNAL MEDICINE DEPARTMENT PMMH-RI BETWEEN 1994-1999 P. Pawlowicz (l), .I. Wilczynski (l), T. Stetkiewicz (2) (1) Dept. of Fetal-Maternal Medicine, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland. (2) Dept. of Gynecology and Menopause, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland. Objectives: Comparative analysis of modification of Misgav-Ladach (MML) and Pfannenstiel methods for cesarean section in the material of Fetal-Maternal Medicine Clinical Department of PMMH-RI between 1994-99. Study Methods: Study group consists of 242 patients. In all women from this group we performed cesarean section using modification of MisgavLadach method. Among all patients from control group (counting 285 women) we performed cesarean section applying Pfannenstiel method. To analyze clinical postoperative course in both groups we took into account several parameters. Results: Statistical analysis revealed that most of clinical postoperative course parameters had significantly better values in the study group in which we performed cesarean section using the modification of MisgavLadach method. Conclusions: The benefits of modification of Misgav-Ladach method, with less pain post-operatively and quicker recovery, are all a by-product of doing the least harm during surgery and removing every unnecessary step. This method is appealing for its simplicity, ease of execution and its time saving advantage.
P3.03.09 EFFECTS OF PHYSICIAN AND PATIENT PREFERENCES ON CESAREAN DELIVERY O.A. A. Ravichander, L. Edouard, R.W. Turnell, Dept. OBIGYN, Gynecology & Reproductive Services, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Objectives: Despite and overall cesarean delivery rate below the national average, a wide range of variation exists between individual obstetricians’ rates at Saskatoon Health District. Our objective was to test the hypothesis that physician and patient preferences influenced cesarean delivery rates. We evaluated the preventability of cesarean delivery to determine the contribution of physician and patient factors.
8.5
Methods: Retrospective analysis of data on 290 unselected patients who had term primary cesarean delivery during a twelve-month period was conducted. Eighty-four percent were residents of the district whereas the other 16% had been transferred from smaller health districts. Patient characteristics, indications for, and preventability of cesarean delivery was assessed by reviewers who were blind to the identity of the obstetricians. Results: Overall, 66 (23%) of the cesarean deliveries were deemed preventable: 41 (62%) of those cases were considered preventable by patients and 25 (38%) by obstetricians. The preventable cesarean section rate was significantly higher in Saskatoon residents as compared to nonresidents (24% vs. 13%; P< 0.05). The two main indications accounting for preventable cesarean sections were breech presentation and dystocia. Conclusions: The choice of patients and individual obstetricians’ normal practice appear to influence recourse to cesarean delivery. Addressing the perspectives on breech presentation and dystocia by obstetricians for clinical management and by patients for their choice may facilitate the proper utilization of cesarean delivery.
P3.03.10 FETAL SURVIVAL DESPITE UNRECOGNIZED UTERINE RUmRE RESULTING FROM PREVIOUS UNKNOWN CORPOREAL SCAR M. Erman-Akar, Z. Yilmaz, 0. GGkmen, Dept. OBIGYN, Zekai Tahir Burak Maternity Hospital, Ankara, Turkey. Cesarean scar rupture of a gravid uterus with unknown corporeal scar is common. Our case was a 35.year-old woman, gravida 2, para 1, presented at 38 weeks gestation. She was admitted to our hospital for routine follow-up. She had no signs or symptoms of labor. However, eight hours after the initial examination, she came back to the hospital with signs of shock and acute abdomen. Immediately, she was referred to surgery. Intraoperatively, a complete rupture of the classical corporeal incision was observed, but the fetus was enclosed within the anterior lying placenta. The fetus was delivered with one minute apgar score 3 and five minute apgar score 8. According to this case, we conclude that spontaneous uterine rupture of the classical uterine scar can be observed even without uterine contractions. So women with the possibility of previous classical uterine incision should be delivered once fetal maturity is documented. Key words: uterine rupture, classical incision, fetal survival.
P3.03.11 HYSTERECTOMY CAESAREA R. Liubomir Ristic, P. Branislav, R. Goran, M. Ivana, M. Nemanja, Gynecology & Obstetrics Clinic, Belgrade, Yugoslavia. The authors, in the paper, presented results of hysterectomies during Caesarean Section at the Gynecology and Obstetrics clinic at Prishtina in the period 1989.1998. During this period there were 3870 deliveries at the Gynecology clinic of which 7274 (9.84%) were with Caesarean Section. At the same period they were 73 cases (1.00%) Hysterectomy during Caesarean Section. Authors analyzed the indications of hysterectomy: Abruptio placentae 7 (9.58%), Utery-placentae apoplexy 29 (39.72%), Placenta previa centralis 14 (19.17%), Placenta accreta 13 (17.80%), Ruptura utery completa post C.S. 6 (8.21%) and Atonio utery 4 (5.47%). The authors also show that the patients were operated in a very wicked condition by reason of abundant bleeding, presentation of developed infection and exhausted patients. Operative procedures presented a big risk with the intensive preoperative reanimation of patients, and the need of a surgeon with experience, and postoperative care. The results in this paper have shown that there were no serious complications in the cases and there were no cases of mortality.
SEPTEMBER
6
praevia, grand multparity, obesity, gross varicose veins) and to asses the effectiveness of AFC transfusion in their prevention. Study Methods: In 56 patients with above mentioned risk factors coagulation parameters (fibrinogen, platelet count, APTT, thrombin clotting time, and antithrombin III activity (AT III) were measured during CS and the first 5 postoperative days. This group was compared with 58 patients who met the same criteria for hemorrhage and thromboembolism. In this group (II) in the III trimester of pregnancy 600-900 ml of AFFP was collected by means of plasmapheresis and used intaoperatively to restore coagulation inhibitor AT III and to stop depletion of clotting factors. Results: In the first group haemostasiological evidences of consumption coagulopathy detected at the end of CS (reduction of fibrinogen from 4.2eO.23 g/l to 2.7eO.21 g/l and platelets from 240*7.6.10 /l to 194*6.4.10 /l) were preceded by intraoperative reduction in AT III activity (73.5*1.2%). In the second group, after intraoperative transfusion of AFFP and size of AT III level to 86.4*2.2% (~~0.05) the consumption of coagulation factors was stopped (fibrinogen - 3.84eO.36 g/l (p
P3.03.08 COMPARATIVE ANALYSIS OF OWN MODIFICATION OF MISGAV-LADACH (MML) AND PFANNENSTIEL METHODS FOR CESAREAN SECTION IN THE MATERIAL OF FETALMATERNAL MEDICINE DEPARTMENT PMMH-RI BETWEEN 1994-1999 P. Pawlowicz (l), .I. Wilczynski (l), T. Stetkiewicz (2) (1) Dept. of Fetal-Maternal Medicine, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland. (2) Dept. of Gynecology and Menopause, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland. Objectives: Comparative analysis of modification of Misgav-Ladach (MML) and Pfannenstiel methods for cesarean section in the material of Fetal-Maternal Medicine Clinical Department of PMMH-RI between 1994-99. Study Methods: Study group consists of 242 patients. In all women from this group we performed cesarean section using modification of MisgavLadach method. Among all patients from control group (counting 285 women) we performed cesarean section applying Pfannenstiel method. To analyze clinical postoperative course in both groups we took into account several parameters. Results: Statistical analysis revealed that most of clinical postoperative course parameters had significantly better values in the study group in which we performed cesarean section using the modification of MisgavLadach method. Conclusions: The benefits of modification of Misgav-Ladach method, with less pain post-operatively and quicker recovery, are all a by-product of doing the least harm during surgery and removing every unnecessary step. This method is appealing for its simplicity, ease of execution and its time saving advantage.
P3.03.09 EFFECTS OF PHYSICIAN AND PATIENT PREFERENCES ON CESAREAN DELIVERY O.A. A. Ravichander, L. Edouard, R.W. Turnell, Dept. OBIGYN, Gynecology & Reproductive Services, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Objectives: Despite and overall cesarean delivery rate below the national average, a wide range of variation exists between individual obstetricians’ rates at Saskatoon Health District. Our objective was to test the hypothesis that physician and patient preferences influenced cesarean delivery rates. We evaluated the preventability of cesarean delivery to determine the contribution of physician and patient factors.
8.5
Methods: Retrospective analysis of data on 290 unselected patients who had term primary cesarean delivery during a twelve-month period was conducted. Eighty-four percent were residents of the district whereas the other 16% had been transferred from smaller health districts. Patient characteristics, indications for, and preventability of cesarean delivery was assessed by reviewers who were blind to the identity of the obstetricians. Results: Overall, 66 (23%) of the cesarean deliveries were deemed preventable: 41 (62%) of those cases were considered preventable by patients and 25 (38%) by obstetricians. The preventable cesarean section rate was significantly higher in Saskatoon residents as compared to nonresidents (24% vs. 13%; P< 0.05). The two main indications accounting for preventable cesarean sections were breech presentation and dystocia. Conclusions: The choice of patients and individual obstetricians’ normal practice appear to influence recourse to cesarean delivery. Addressing the perspectives on breech presentation and dystocia by obstetricians for clinical management and by patients for their choice may facilitate the proper utilization of cesarean delivery.
P3.03.10 FETAL SURVIVAL DESPITE UNRECOGNIZED UTERINE RUmRE RESULTING FROM PREVIOUS UNKNOWN CORPOREAL SCAR M. Erman-Akar, Z. Yilmaz, 0. GGkmen, Dept. OBIGYN, Zekai Tahir Burak Maternity Hospital, Ankara, Turkey. Cesarean scar rupture of a gravid uterus with unknown corporeal scar is common. Our case was a 35.year-old woman, gravida 2, para 1, presented at 38 weeks gestation. She was admitted to our hospital for routine follow-up. She had no signs or symptoms of labor. However, eight hours after the initial examination, she came back to the hospital with signs of shock and acute abdomen. Immediately, she was referred to surgery. Intraoperatively, a complete rupture of the classical corporeal incision was observed, but the fetus was enclosed within the anterior lying placenta. The fetus was delivered with one minute apgar score 3 and five minute apgar score 8. According to this case, we conclude that spontaneous uterine rupture of the classical uterine scar can be observed even without uterine contractions. So women with the possibility of previous classical uterine incision should be delivered once fetal maturity is documented. Key words: uterine rupture, classical incision, fetal survival.
P3.03.11 HYSTERECTOMY CAESAREA R. Liubomir Ristic, P. Branislav, R. Goran, M. Ivana, M. Nemanja, Gynecology & Obstetrics Clinic, Belgrade, Yugoslavia. The authors, in the paper, presented results of hysterectomies during Caesarean Section at the Gynecology and Obstetrics clinic at Prishtina in the period 1989.1998. During this period there were 3870 deliveries at the Gynecology clinic of which 7274 (9.84%) were with Caesarean Section. At the same period they were 73 cases (1.00%) Hysterectomy during Caesarean Section. Authors analyzed the indications of hysterectomy: Abruptio placentae 7 (9.58%), Utery-placentae apoplexy 29 (39.72%), Placenta previa centralis 14 (19.17%), Placenta accreta 13 (17.80%), Ruptura utery completa post C.S. 6 (8.21%) and Atonio utery 4 (5.47%). The authors also show that the patients were operated in a very wicked condition by reason of abundant bleeding, presentation of developed infection and exhausted patients. Operative procedures presented a big risk with the intensive preoperative reanimation of patients, and the need of a surgeon with experience, and postoperative care. The results in this paper have shown that there were no serious complications in the cases and there were no cases of mortality.