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P271 Caesarean section in older mothers
S490
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P271 Caesarean section in older mothers M. Banerjee1 , G. Raje2 , M. Sule3 . 1 SpR, OBGY, The Ipswich Hospital, UK, 2 SpR, OBGY, Norfolk and Norwich University Hospital, Norwich, UK, 3 Consultant, OBGY, Norfolk and Norwich University Hospital, Norwich, UK Objectives: To study the risk of caesarean section and indications for caesarean section in women who are 40 years or more at the time of antenatal booking. Introduction: There has been an almost 50% increase in the number of women over 40 years of age having babies in the last 10 year (ONS2007). [1] Pregnancy in older mothers is associated with increased risk of preterm-term birth, low birth weight, medical complications and perinatal deaths. [2] The risk of caesarean section is also increased in this group of women. We wanted to quantify this risk and determine whether the increase in risk was statistically significant. We also wanted to study whether we could find any explanation for the increased risk of caesarean section. Setting: The study was carried out at the Ipswich Hospital which is a busy district general hospital in England. Material and Methods: Medical records of all pregnant women who were 40 years or more (n = 541) at the time of booking between Jan 1997–Dec 2007 were reviewed using a standard proforma. The caesarean section rate was compared with the caesarean section rate in women in the 20 – 30 years age group who delivered in the hospital (n = 20,212). These women were identified by the hospital protos system. Statistical analysis was carried out using the Chi-Square test. Results: The caesarean section rate was significantly higher in older mothers (33.0%) as compared to the women in the 20–30 years age group (17.8%). The increase in risk was statistically significant (p = 0.005). 53.6% of older mothers had elective caesarean section (96 out of 179 caesarean sections). Of these, 23 elective caesarean sections (24%) were performed in nulliparous women. Majority of these elective caesarean sections in nulliparous women were performed for breech presentation (8) and maternal request (7). 73 elective caesarean sections were performed in multiparous women (76%). The majority of elective caesarean sections in multiparous women were performed due to previous one or more caesarean sections (47). This seems to be a direct effect of increased elective caesarean sections in nulliparous women. 46.4% of older mothers required emergency caesarean section (83 out of 179). The majority of emergency caesarean sections were performed for fetal distress (31 out of 83, i.e. 37.4%). The other major causes were failure to progress in labour (10) and malpresentations (9). The caesarean section rate (combined elective and emergency) in nulliparous women was very high. 55 out of 107 nulliparous women in this age group required caesarean section (51.4%). Apart from fetal distress, maternal request and breech presentation, severe PET was an important factor for increase in caesarean section rate in elderly nulliparous women (7 cases). Conclusion: The women who were 40 years or more had a significantly high risk of caesarean deliveries as compared to the women in the 20–30 years age group. The risk was especially higher in elderly nulliparous women. Maternal request for caesarean section was quite high and elective caesarean section rate was increased. Higher rate of caesarean section in nulliparous women led to increased repeat caesarean section in multiparous women. Fetal distress was the major reason for performing emergency caesarean section. This could be partly explained by the presence of preeclampsia and associated medical conditions like pre-existing hypertension and diabetes. Reference(s) [1] Office of National Statistics (ONS), December 2007. [2] Orji EO, Ndububa VI. Obstetric Performance of Women ages over 40 years. East Afr Med J 2004 Mar; 81(3): 139–41.
P272 The validity of consent for caesarean section A. Raut1 , N. Raut2 , C. Rhodes. 1 Good Hope Hospital, Sutton Coldfield, UK B75 7RR, 2 George Eliot Hospital, Nuneaton, UK CV10 7DJ, 3 Background: Caesarean section rates are continuing to rise in the U.K. Consent for Caesarean section must be informed, robust and well-documented. Aims: To assess consent obtained in 40 patients undergoing Caesarean section at Good Hope Hospital against RCOG standards and the Trust guideline. Method: A prospective review of 40 cases undergoing Caesarean section was performed. Fifteen cases were elective and 25 cases were emergencies. Standards were obtained from RCOG Clinical Governance Advice no.6: obtaining valid consent on caesarean section, and the Trust guidelines about risks associated with caesarean section. Documentation of risks discussed and grade of the doctor obtaining the consent were assessed. Results: In our audit, deficiencies were identified in the documentation. In 5% of cases, the consent form was not filed in the notes. Consultant’s name was not documented on any form. In 3% of cases, risk of bleeding, infection, bowel/bladder injury was not mentioned. The risk of thromboembolism was not mentioned in 8% of cases. Risk of blood transfusion was not mentioned in 15% of cases. The risk of hysterectomy was mentioned in only 27% of cases. In 71% of the cases, the risks of fetal laceration was not explained. Neonatal respiratory morbidity was not mentioned in any elective caesarean section <39 weeks. The risks of a placenta praevia and associated morbidity in future pregnancy were not mentioned to any patient. Conclusion: The CEMACH report 2003–2005 has stated that venous thromboembolism is the leading direct cause of maternal death, yet all patients were not made aware of this risk. Consent was also substandard with respect to associated future morbidity and neonatal respiratory morbidity. Good record keeping reflects good medical practice. Recommendation: Regular training of all staff, pre printed risk label stickers, or pre printed consent forms for caesarean section are proposed. Mini–CEX assessment for junior doctors before independently obtaining consent would enable a high quality of consent documentation. P273 Sterilisation after the third caesarean section G. Relic1 , M. Bogavac2 . 1 Medical Faculty of Pristina, Department of Obstetrics and Gynaecology in Kosovska Mitrovica, 2 Clinical centre Vojvodina, Department of Obstetrics and Gynaecology, Clinical Center, Novi Sad The aim of this study was to establish necessity for sterilisation of the tubes after the third S.C. Material and Methods: With the retro-prospective study in a period of ten years from 1.01.1989 till the 31.12.1998. on the University Clinic of Gynecology and Obstetric in Prishtina there were 2474 repeted cesarean sections. With two S.C. were 2041, with three S.C. were 343, with four S.C. were 74 and with five S.C. were 16 women. We did a prospective study of the quality of the cicatrix (by counting number of the colagenic fibers) at multiple repeated S.C. in period from 01/01/1997 till 31/12/1998. Results and Conclusion: Is there a statistical importance in the quality of the cicatrix (number of the colagenic fibers in cicatrix) after the third S.C. in comparation with fourth and fifth and is there an higher intraoperation risk after third S.C. in a comparation with fourth and fifth S.C. Results of the study show that there were no statistically important differences.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P271 Caesarean section in older mothers M. Banerjee1 , G. Raje2 , M. Sule3 . 1 SpR, OBGY, The Ipswich Hospital, UK, 2 SpR, OBGY, Norfolk and Norwich University Hospital, Norwich, UK, 3 Consultant, OBGY, Norfolk and Norwich University Hospital, Norwich, UK Objectives: To study the risk of caesarean section and indications for caesarean section in women who are 40 years or more at the time of antenatal booking. Introduction: There has been an almost 50% increase in the number of women over 40 years of age having babies in the last 10 year (ONS2007). [1] Pregnancy in older mothers is associated with increased risk of preterm-term birth, low birth weight, medical complications and perinatal deaths. [2] The risk of caesarean section is also increased in this group of women. We wanted to quantify this risk and determine whether the increase in risk was statistically significant. We also wanted to study whether we could find any explanation for the increased risk of caesarean section. Setting: The study was carried out at the Ipswich Hospital which is a busy district general hospital in England. Material and Methods: Medical records of all pregnant women who were 40 years or more (n = 541) at the time of booking between Jan 1997–Dec 2007 were reviewed using a standard proforma. The caesarean section rate was compared with the caesarean section rate in women in the 20 – 30 years age group who delivered in the hospital (n = 20,212). These women were identified by the hospital protos system. Statistical analysis was carried out using the Chi-Square test. Results: The caesarean section rate was significantly higher in older mothers (33.0%) as compared to the women in the 20–30 years age group (17.8%). The increase in risk was statistically significant (p = 0.005). 53.6% of older mothers had elective caesarean section (96 out of 179 caesarean sections). Of these, 23 elective caesarean sections (24%) were performed in nulliparous women. Majority of these elective caesarean sections in nulliparous women were performed for breech presentation (8) and maternal request (7). 73 elective caesarean sections were performed in multiparous women (76%). The majority of elective caesarean sections in multiparous women were performed due to previous one or more caesarean sections (47). This seems to be a direct effect of increased elective caesarean sections in nulliparous women. 46.4% of older mothers required emergency caesarean section (83 out of 179). The majority of emergency caesarean sections were performed for fetal distress (31 out of 83, i.e. 37.4%). The other major causes were failure to progress in labour (10) and malpresentations (9). The caesarean section rate (combined elective and emergency) in nulliparous women was very high. 55 out of 107 nulliparous women in this age group required caesarean section (51.4%). Apart from fetal distress, maternal request and breech presentation, severe PET was an important factor for increase in caesarean section rate in elderly nulliparous women (7 cases). Conclusion: The women who were 40 years or more had a significantly high risk of caesarean deliveries as compared to the women in the 20–30 years age group. The risk was especially higher in elderly nulliparous women. Maternal request for caesarean section was quite high and elective caesarean section rate was increased. Higher rate of caesarean section in nulliparous women led to increased repeat caesarean section in multiparous women. Fetal distress was the major reason for performing emergency caesarean section. This could be partly explained by the presence of preeclampsia and associated medical conditions like pre-existing hypertension and diabetes. Reference(s) [1] Office of National Statistics (ONS), December 2007. [2] Orji EO, Ndububa VI. Obstetric Performance of Women ages over 40 years. East Afr Med J 2004 Mar; 81(3): 139–41.
P272 The validity of consent for caesarean section A. Raut1 , N. Raut2 , C. Rhodes. 1 Good Hope Hospital, Sutton Coldfield, UK B75 7RR, 2 George Eliot Hospital, Nuneaton, UK CV10 7DJ, 3 Background: Caesarean section rates are continuing to rise in the U.K. Consent for Caesarean section must be informed, robust and well-documented. Aims: To assess consent obtained in 40 patients undergoing Caesarean section at Good Hope Hospital against RCOG standards and the Trust guideline. Method: A prospective review of 40 cases undergoing Caesarean section was performed. Fifteen cases were elective and 25 cases were emergencies. Standards were obtained from RCOG Clinical Governance Advice no.6: obtaining valid consent on caesarean section, and the Trust guidelines about risks associated with caesarean section. Documentation of risks discussed and grade of the doctor obtaining the consent were assessed. Results: In our audit, deficiencies were identified in the documentation. In 5% of cases, the consent form was not filed in the notes. Consultant’s name was not documented on any form. In 3% of cases, risk of bleeding, infection, bowel/bladder injury was not mentioned. The risk of thromboembolism was not mentioned in 8% of cases. Risk of blood transfusion was not mentioned in 15% of cases. The risk of hysterectomy was mentioned in only 27% of cases. In 71% of the cases, the risks of fetal laceration was not explained. Neonatal respiratory morbidity was not mentioned in any elective caesarean section <39 weeks. The risks of a placenta praevia and associated morbidity in future pregnancy were not mentioned to any patient. Conclusion: The CEMACH report 2003–2005 has stated that venous thromboembolism is the leading direct cause of maternal death, yet all patients were not made aware of this risk. Consent was also substandard with respect to associated future morbidity and neonatal respiratory morbidity. Good record keeping reflects good medical practice. Recommendation: Regular training of all staff, pre printed risk label stickers, or pre printed consent forms for caesarean section are proposed. Mini–CEX assessment for junior doctors before independently obtaining consent would enable a high quality of consent documentation. P273 Sterilisation after the third caesarean section G. Relic1 , M. Bogavac2 . 1 Medical Faculty of Pristina, Department of Obstetrics and Gynaecology in Kosovska Mitrovica, 2 Clinical centre Vojvodina, Department of Obstetrics and Gynaecology, Clinical Center, Novi Sad The aim of this study was to establish necessity for sterilisation of the tubes after the third S.C. Material and Methods: With the retro-prospective study in a period of ten years from 1.01.1989 till the 31.12.1998. on the University Clinic of Gynecology and Obstetric in Prishtina there were 2474 repeted cesarean sections. With two S.C. were 2041, with three S.C. were 343, with four S.C. were 74 and with five S.C. were 16 women. We did a prospective study of the quality of the cicatrix (by counting number of the colagenic fibers) at multiple repeated S.C. in period from 01/01/1997 till 31/12/1998. Results and Conclusion: Is there a statistical importance in the quality of the cicatrix (number of the colagenic fibers in cicatrix) after the third S.C. in comparation with fourth and fifth and is there an higher intraoperation risk after third S.C. in a comparation with fourth and fifth S.C. Results of the study show that there were no statistically important differences.