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The changing contribution of dystocia to cesarean section rates
TUESDAY,
SEPTEMBER
5
functionally valuable T- and B-cells increased. In the group of treated patients with SHF irradiation some positive tendency in the serum antibodies in comparison with group of patients, treated traditionally was seen. Thus, the significant decrease in Ig G level in dynamics was not revealed, increase in Ig A in a month after surgery, Ig M level in blood serum stayed on the healthy donors’ level, whereas in patients treated without SHF after surgery it was decreased. In our experiments circulating immune complexes (CIC) have been shown to be the most indicative with regard to efficiency of IWT application. Presented results approve the literature data and convince in efficiency of treatment with the application of the novel non-invasive and costeffective method as additional physiotherapeutic influence in treatment of background and pre-cancerous lesions.
FC2.03 CESAREAN
SECTION
FC2.03.01 INTRAOPERATIVE COMPLICATIONS AT CESAREAN SECTION T.Bergholt. Deptarhnent of Obstetrics and Gynecology, H:S Hvidovre University Hospital, Copenhagen, Denmark. Objectives: The aim of this study was to estimate the incidence and risk factors of intraoperative lacerations and bleeding at cesarean section. Study Methods: Observational study of 929 women (11.9%) delivered by cesarean section among 7.782 delivering women between August 1st 1995 and July 30th 1996 at the University Hospitals of Glostrup, Herlev and Gentofte in Coperhagen County, Denmark. In order to control for confounding and interaction, multiple logistic regression were used in the statistical analysis. Results: The overall intraoperative complication rate was 12.1%, of this 14.5% in emergency and 6.8% in elective sections. Two logistic regression models were employed to assess risk factors for lacerations and blood loss more than 1000 ml. Station of the presenting part, birth weight, fetal distress and dystocia as indications and maternal age were found to be significant risk factors for uterine and bladder lacerations. Placenta previa and placental abruption as indications, pre-pregnancy body mass index, duration of regular painful contractions, and birth weight demonstrated a significant association with blood loss. Emergency sections demonstrated a positive but insignificant association in both models. The educational level of the surgeon was not associated with these complications. Conclusions: The results indicate difficulty in extraction the fetus through the uterine incision as a common causal mechanism for both types of complications. In addition, other risk factors verify the importance of speed and maternal age in lacerations.
FC2.03.02 THE CHANGING CONTRIBUTION OF DYSTOCIA TO CESAREAN SECTION RATES P. L.W. Oppenheimer, S.W. Wen, Division of Maternal-Fetal Medicine, Ottawa Hospital, General Campus, Ottawa, Ontario, Canada. Objectives: Dystocia has been the single most important factor in driving cesarean section rates. The purpose of this study was to compare the incidence and timing of cesarean section for dystocia with comparable rates 1.5 years previously. Study Methods: The cesarean section rate for dystocia from a previous study in the same geographical area in 1984 (Period I) was compared with data form 1994 to 1999 (Period 2). All singleton, cephalic pregnancies in primigravid women were included. Results: In Period 1 there were 3887 eligible women, of whom 637 (17.9%) underwent cesarean section. Of these cesarean sections 68% were for dystocia, and 31% of the cesarean sections for dystocia were at less than 4cm cervical dilation. In Period 2 there were 5417 eligible women, of whom 990 (16.4%) underwent cesarean section. Of these cesarean sections 45% were for dystocia, and 10% of the cesarean sections for dystocia were at less than 4cm cervical dilation. Conclusions: The overall cesarean section rate was unchanged but the rate for dystocia fell significantly, suggesting that a much higher proportion of cesarean sections are being done for indications other than dystocia. Dystocia still constitute the largest indication for cesarean sections in primigravid woman with a singleton pregnancy and a cephalic presentation. More cesarean sections are now performed at an appropriate stage of labor, suggesting an improvement in this aspect of
23
obstetric practice, in line with the Society of Obstetricians and Gynecologists of Canada Guidelines on dystocia, published in 1993.
FC2.03.03 THE REASONS WHY PRIMIGRAVIDAS CHOOSE A PARTICULAR METHOD OF PAIN RELIEF DURING LABOUR AND THE QUALITY OF PAIN RELIEF WITH EPIDURAL AND NON-EPIDURAL METHODS OF PAIN RELIEF VIEWS FROM ‘THE SHOP FLOOR’. Y Saiiad*, T Sajjad+, *Dept of OB & Gyn Warrington Hospital, Lovely Lane, +Dept Of Pain Relief and Anaes, Royal Liverpool Univer Hospital, Liverpool, United Kingdom. Objectives 1. To determine why only up to 30% of primigravidas request an epidural during labour. 2. To investigate whether it is the fear of complications or the desire to have a natural childbirth that influence the remainder, in choosing nonepidural methods of pain relief. 3. The intensity of pain, before and after institution of different modes of pain relief, will be assessed on a Visual Analogue Scale and Numerical Rating Scale. 5.Patients will be asked if they remembered the birth of their baby. It would be interesting to note how many of the mothers in the nonepidural group remember the event. Study Design: The is a prospective on going study, being carried out at Arrowe Park Hospital (APH), Wirral, Liverpool, UK. The hospital ethical committee has approved it and informed consent is obtained. Within 36 hours of delivery, primgravidas are provided with a questionnaire by one of the authors (YS). Conclusion. The study will help us determine why only 30% of primigravidas choose epidurals as the primary mode of pain relief in labour, secondly give us information why, during labour, approximately 70% of primigravidas elect to have non- epidurals methods of pain relief. Thirdly is it the fear of complications that is causing them to avoid epidurals. As a result we would be able to address these fears and misconceptions, if any, more effectively in the antenatal classes and lastly we would be able to compare the quality of pain relief with different modes of pain relief. FC2.03.04 GROWTH HORMONE TREATMENT AFTER CESAREAN INCREASES SCAR STRENGTH IN SUBSEQUENT PREGNANCY RATS Deborah Clifford R. Wheeless, Wayne R. Cohen. Dept of Obstetrics and Gynecology, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
IN
Objective: A method to increase the strength of a cesarean incision, thereby reducing the risk of rupture in a subsequent pregnancy would have a profound impact on clinical decisions made in women with prior cesarean deliveries. We used a rat model to test the hypothesis that growth hormone (GH) administered after cesarean delivery increases the uterine wound strength in a subsequent pregnancy. Methods: Twenty-two Sprague-Dawley rats were anesthetized at 19d of gestation. A longitudinal 1.5cm incision was made along the antimesenteric border at the midportion of each horn, through which pups and placentas were extruded. Incisions were closed with a single layer of running 5-O polyglycolic acid suture. Postoperatively, rats received either human GH (n=ll), 2.Gmg/kg/d, or an equivalent volume of saline (n=ll) subcutaneously for 7d. Dams were rebred 30.40d after their delivery, and were anesthetized at 19d of that gestation. The distal end of each uterine horn was opened and pups and placentas were delivered through it. A section of each right horn at the area of the uterine scar from the previous cesarean was excised for hydroxyproline assay. The distal end of the left horn was ligated and a polyethylene catheter was placed into the proximal end. This catheter was connected to a pressure transducer and infusion pump. The horn was perfused with saline at 3.5mL/min until bursting occurred at the site of the previous cesarean scar. Results: The bursting strength of the GH-treated animals was significantly greater than that of the controls (64.Ok12.8 mmHg vs. 29.4k6.91 mHg, P
SEPTEMBER
5
functionally valuable T- and B-cells increased. In the group of treated patients with SHF irradiation some positive tendency in the serum antibodies in comparison with group of patients, treated traditionally was seen. Thus, the significant decrease in Ig G level in dynamics was not revealed, increase in Ig A in a month after surgery, Ig M level in blood serum stayed on the healthy donors’ level, whereas in patients treated without SHF after surgery it was decreased. In our experiments circulating immune complexes (CIC) have been shown to be the most indicative with regard to efficiency of IWT application. Presented results approve the literature data and convince in efficiency of treatment with the application of the novel non-invasive and costeffective method as additional physiotherapeutic influence in treatment of background and pre-cancerous lesions.
FC2.03 CESAREAN
SECTION
FC2.03.01 INTRAOPERATIVE COMPLICATIONS AT CESAREAN SECTION T.Bergholt. Deptarhnent of Obstetrics and Gynecology, H:S Hvidovre University Hospital, Copenhagen, Denmark. Objectives: The aim of this study was to estimate the incidence and risk factors of intraoperative lacerations and bleeding at cesarean section. Study Methods: Observational study of 929 women (11.9%) delivered by cesarean section among 7.782 delivering women between August 1st 1995 and July 30th 1996 at the University Hospitals of Glostrup, Herlev and Gentofte in Coperhagen County, Denmark. In order to control for confounding and interaction, multiple logistic regression were used in the statistical analysis. Results: The overall intraoperative complication rate was 12.1%, of this 14.5% in emergency and 6.8% in elective sections. Two logistic regression models were employed to assess risk factors for lacerations and blood loss more than 1000 ml. Station of the presenting part, birth weight, fetal distress and dystocia as indications and maternal age were found to be significant risk factors for uterine and bladder lacerations. Placenta previa and placental abruption as indications, pre-pregnancy body mass index, duration of regular painful contractions, and birth weight demonstrated a significant association with blood loss. Emergency sections demonstrated a positive but insignificant association in both models. The educational level of the surgeon was not associated with these complications. Conclusions: The results indicate difficulty in extraction the fetus through the uterine incision as a common causal mechanism for both types of complications. In addition, other risk factors verify the importance of speed and maternal age in lacerations.
FC2.03.02 THE CHANGING CONTRIBUTION OF DYSTOCIA TO CESAREAN SECTION RATES P. L.W. Oppenheimer, S.W. Wen, Division of Maternal-Fetal Medicine, Ottawa Hospital, General Campus, Ottawa, Ontario, Canada. Objectives: Dystocia has been the single most important factor in driving cesarean section rates. The purpose of this study was to compare the incidence and timing of cesarean section for dystocia with comparable rates 1.5 years previously. Study Methods: The cesarean section rate for dystocia from a previous study in the same geographical area in 1984 (Period I) was compared with data form 1994 to 1999 (Period 2). All singleton, cephalic pregnancies in primigravid women were included. Results: In Period 1 there were 3887 eligible women, of whom 637 (17.9%) underwent cesarean section. Of these cesarean sections 68% were for dystocia, and 31% of the cesarean sections for dystocia were at less than 4cm cervical dilation. In Period 2 there were 5417 eligible women, of whom 990 (16.4%) underwent cesarean section. Of these cesarean sections 45% were for dystocia, and 10% of the cesarean sections for dystocia were at less than 4cm cervical dilation. Conclusions: The overall cesarean section rate was unchanged but the rate for dystocia fell significantly, suggesting that a much higher proportion of cesarean sections are being done for indications other than dystocia. Dystocia still constitute the largest indication for cesarean sections in primigravid woman with a singleton pregnancy and a cephalic presentation. More cesarean sections are now performed at an appropriate stage of labor, suggesting an improvement in this aspect of
23
obstetric practice, in line with the Society of Obstetricians and Gynecologists of Canada Guidelines on dystocia, published in 1993.
FC2.03.03 THE REASONS WHY PRIMIGRAVIDAS CHOOSE A PARTICULAR METHOD OF PAIN RELIEF DURING LABOUR AND THE QUALITY OF PAIN RELIEF WITH EPIDURAL AND NON-EPIDURAL METHODS OF PAIN RELIEF VIEWS FROM ‘THE SHOP FLOOR’. Y Saiiad*, T Sajjad+, *Dept of OB & Gyn Warrington Hospital, Lovely Lane, +Dept Of Pain Relief and Anaes, Royal Liverpool Univer Hospital, Liverpool, United Kingdom. Objectives 1. To determine why only up to 30% of primigravidas request an epidural during labour. 2. To investigate whether it is the fear of complications or the desire to have a natural childbirth that influence the remainder, in choosing nonepidural methods of pain relief. 3. The intensity of pain, before and after institution of different modes of pain relief, will be assessed on a Visual Analogue Scale and Numerical Rating Scale. 5.Patients will be asked if they remembered the birth of their baby. It would be interesting to note how many of the mothers in the nonepidural group remember the event. Study Design: The is a prospective on going study, being carried out at Arrowe Park Hospital (APH), Wirral, Liverpool, UK. The hospital ethical committee has approved it and informed consent is obtained. Within 36 hours of delivery, primgravidas are provided with a questionnaire by one of the authors (YS). Conclusion. The study will help us determine why only 30% of primigravidas choose epidurals as the primary mode of pain relief in labour, secondly give us information why, during labour, approximately 70% of primigravidas elect to have non- epidurals methods of pain relief. Thirdly is it the fear of complications that is causing them to avoid epidurals. As a result we would be able to address these fears and misconceptions, if any, more effectively in the antenatal classes and lastly we would be able to compare the quality of pain relief with different modes of pain relief. FC2.03.04 GROWTH HORMONE TREATMENT AFTER CESAREAN INCREASES SCAR STRENGTH IN SUBSEQUENT PREGNANCY RATS Deborah Clifford R. Wheeless, Wayne R. Cohen. Dept of Obstetrics and Gynecology, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
IN
Objective: A method to increase the strength of a cesarean incision, thereby reducing the risk of rupture in a subsequent pregnancy would have a profound impact on clinical decisions made in women with prior cesarean deliveries. We used a rat model to test the hypothesis that growth hormone (GH) administered after cesarean delivery increases the uterine wound strength in a subsequent pregnancy. Methods: Twenty-two Sprague-Dawley rats were anesthetized at 19d of gestation. A longitudinal 1.5cm incision was made along the antimesenteric border at the midportion of each horn, through which pups and placentas were extruded. Incisions were closed with a single layer of running 5-O polyglycolic acid suture. Postoperatively, rats received either human GH (n=ll), 2.Gmg/kg/d, or an equivalent volume of saline (n=ll) subcutaneously for 7d. Dams were rebred 30.40d after their delivery, and were anesthetized at 19d of that gestation. The distal end of each uterine horn was opened and pups and placentas were delivered through it. A section of each right horn at the area of the uterine scar from the previous cesarean was excised for hydroxyproline assay. The distal end of the left horn was ligated and a polyethylene catheter was placed into the proximal end. This catheter was connected to a pressure transducer and infusion pump. The horn was perfused with saline at 3.5mL/min until bursting occurred at the site of the previous cesarean scar. Results: The bursting strength of the GH-treated animals was significantly greater than that of the controls (64.Ok12.8 mmHg vs. 29.4k6.91 mHg, P