Little has been reported concerning post-operative hypoglycemia in previously asymptomatic individuals. Post-operative hypoglycemic coma is one of the most perplexing problems and must be differentiated from other conditions accompaning coma. We experienced a case of hypoglycemia following emergency cesarean section in primigravida with cephalopelvic disproportion on the fourth post operative day. The comatous state appeared abruptly and developed repeatedly. The causes of post-hypoglycemic coma are discussed and the prolonged starvation before and after operation was suspected to be the cause of coma.
Cephalopelvic Disproportion ; Cesarean Section* ; Coma ; Emergencies ; Female ; Hypoglycemia* ; Pregnancy ; Starvation

PURPOSE: First, to describe a new method of assessing cephalopelvic disproportion by measuring the retropubic tissue thickness (RTT), and second, to determine whether RTT was associated with an eventual delivery by cesarean section. METHODS: Three-dimensional transperineal ultrasound scans were performed on 129 laboring nulliparous women to obtain 3-dimensional volume datasets for assessing RTT. RTT was measured off-line by three operators (A, B, and C) as the shortest distance between the capsule of the pubic symphysis and the outer border of the fetal skull. The intraoperator repeatability of operator A and the interoperator reproducibility among A, B, and C were determined. The RTT in women who were delivered by cesarean section due to failure to progress was compared to that of women who had a vaginal delivery. RESULTS: The intraoperator repeatability for RTT was 1.2 mm. The overall RTT interoperator interclass correlation was 0.97 (0.95-0.98). The RTT in women who had a spontaneous, instrumental, or cesarean delivery was 1.16±0.32 cm, 1.12±0.25 cm, and 0.94±0.25 cm, respectively. Women who were delivered by cesarean section had a significantly smaller RTT than women who had a spontaneous delivery (P=0.008). There was no statistically significant difference in RTT between patients who had a normal vaginal delivery and patients who had an instrumental delivery (P=0.990), or between those who had an instrumental delivery and those who had a cesarean delivery after the Bonferroni correction (P=0.120). CONCLUSION: RTT can be measured with satisfactory intraoperator repeatability and interoperator reproducibility. RTT was significantly smaller in women who eventually had a cesarean delivery than in those who had a vaginal delivery.
Cephalopelvic Disproportion* ; Cesarean Section ; Dataset ; Female ; Humans ; Methods ; Pregnancy ; Pubic Symphysis ; Skull ; Ultrasonography*

OBJECTIVE: To estimate the rates at which women with a previous cesarean delivery were offered and consented to trial of labor (TOL) and to investigate the factors affecting the decision making about mode of delivery METHODS: For 12 months duration, pregnant women with one previous cesarean were enrolled prospectively in this study. Eligibility to TOL was defined as pregnancy after 36 weeks of gestation without medical or obstetric indication of cesarean section. Patients were received counseling and consented to the process of TOL. The social and obstetric factors were collected through interview and the medical records were analyzed. RESULTS: Among the initial 185 patients with one previous cesarean, 106 were considered eligible to TOL. Seventy-two patients out of the 106 delivered with elective repeat cesarean while 34 patients tried TOL; 24 were delivered with vaginal birth after cesarean (VBAC), while 10 were received emergency cesarean section. The indications of cesarean section were cephalopelvic disproportion (CPD, 7 cases) and fetal distress (FD, 1 case). Two received emergency cesarean without definite obstetric indication. The rate of high education, college greaduate or more was higher in the group of TOL than in those of elective cesarean (50% vs 68%, p=0.04). The rates of patients with indication of previous cesarean, CPD, FD, or abnormal placentation were more frequent among the patient with TOL (23% vs 48%, p=0.007). CONCLUSION: These result provides clinical information about the decision making about mode of delivery among the patients eligible to TOL with one previous cesarean. More clinical studies about TOL and VBAC are required in the different setting of hospital or institute.
Cephalopelvic Disproportion ; Cesarean Section ; Counseling ; Decision Making* ; Education ; Emergencies ; Female ; Fetal Distress ; Humans ; Medical Records ; Placentation ; Pregnancy ; Pregnant Women* ; Prospective Studies ; Trial of Labor ; Vaginal Birth after Cesarean

Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants.
Adult ; Burns ; Cephalopelvic Disproportion ; Cesarean Section ; Drug-Related Side Effects and Adverse Reactions ; Emergencies ; Female ; Groin* ; Humans ; Hypesthesia ; Infant ; Mothers ; Nerve Block* ; Pregnancy

With the sharply increasing practice of cesarean section(C/S), formerly known as a landmark of developing medical technology, appropriateness of the procedure has been widely inquired into. Appropriateness of a specific procedure could be an indicator for quality, at the individual or organizational level. Cesarean section rate is regarded as a sensitive indicator reflecting clinical quality at the hospital level. We are interested in the validity and significance of C/S rate as a quality indicator in Korean hospitals, in addition to the current status of the practice. This study was carried out retrospectively based on the clinical records of cesarean sections in 32 hospitals nationwide from March to May 1996. Standardized survey format was distributed, and reviews were performed by volunteer surveyors from each hospital after two sessions of pre-survey education. The results were as follows : 1. There were 13,241 deliveries with 4,599 cases of cesarean sections, giving an incidence of 38.5%. This result shows the incidence of cesarean section was 1.6 times higher than U.S. and about four times higher than European countries. 2. The monthly incidence of cesarean section was not variable, but it shows great differences among the hospitals. 3. The incidences of cesarean sections were variable among different age groups with marked higher rate in older one. 4. Most of deliveries were with gestational period from 37 to 44 weeks(91%), in which C/S rate was 39%. For pregnancies with less than or equal to 32 weeks, the rate was 21% and for more than or equal to 45 weeks the rate was 25%. 5. The most frequent indication of cesarean birth was previous cesarean section(37.7%), followed by cephalopelvic disproportion and dystocia(24.4%). 6. There were no statistical differences in cesarean section rates by hospital variables such as ownership, teaching status, proportion of specialists, number of physicians per bed, number of nurses per bed, regional location, and number of beds. Exceptionally, hospitals with independent obstetrics department, separated from gynecology, showed significant lower rate than hospitals with conventional obstetrics-gynecology department. We could confirm higher C/S rate than any other countries. However, C/S rate, not significantly different among hospitals with variable quality level in structural aspect, was not acceptable as a sensitive indicator for clinical quality at the hospital level. Different rates between comparable organizational settings, sometimes indirectly related to the clinical quality, suggested that more studies focused on other aspects of quality than structure should be needed.
Cephalopelvic Disproportion ; Cesarean Section* ; Education ; Female ; Gynecology ; Humans ; Incidence ; Obstetrics and Gynecology Department, Hospital ; Ownership ; Parturition ; Pregnancy ; Quality Indicators, Health Care* ; Retrospective Studies ; Specialization ; Volunteers

Most elective cesarean sections are conducted under spinal anesthesia. Regional anesthesia has become the preferred technique, because general anesthesia is associated with a greater risk of maternal morbidity and mortality. In patients without absolute contraindication, spinal anesthesia is avoided, when procedural difficulty is increased by severe spinal deformity. A 41-year-old female patient was 33 weeks into pregnancy. Her height and weight were 145 cm and 45 kg. The patient was planned for emergency cesarean section, due to cephalopelvic disproportion. Spinal anesthesia was planned since she was suffering from Duchenne's muscular dystrophy, and had risks of respiratory failure and prolonged mechanical ventilation after general anesthesia. However, the patient also had severe kyphoscoliosis, maybe due to Duchenne's muscular dystrophy. We are reporting a successful spinal anesthesia using real-time ultrasound guidance, for cesarean section in this obstetric patient with severe kyphoscoliosis.
Adult ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Cephalopelvic Disproportion ; Cesarean Section* ; Congenital Abnormalities ; Emergencies ; Female ; Humans ; Mortality ; Muscular Dystrophies* ; Pregnancy ; Respiration, Artificial ; Respiratory Insufficiency ; Scoliosis ; Ultrasonography

OBJECTIVES: Although pregnancy in women who are 35 years old or more is considered a high risk pregnancy, it has occurred more frequently in recent years. The aim of our study was to evaluate the course of delivery and perinatal outcomes in women who are 35 years old or more. METHOD: We have compared 765 cases of the elderly gravida over the age of 35 at the department of Obstetrics and Gynecology, Mokpo, Catholic Hospital, from January 1, 1997 to December 31, 1999, with 800 cases of randomly chosen young pregnant women during the same period. RESULTS: There were 765 cases of the elderly gravida among total 8285 deliveries and the incidence of the elderly gravida for 3 years was 9.2%. The rate of elderly gravida was increased from 8.2% in 1997 to 10.0% in 1999. 46.9% were in the age group of 35 to 36 years. The incidence of primigravida was 13.9%. 93.6% of total cases was vertex presentation breech presentation was 5.2%, and transverse lie was 1.2%. The percentage of preterm pregnancy was 9.5% in elderly gravida, and 4.0% in control group. post-term pregnancy was 2.0% in elderly gravida, and 1.0% in control group.The rate of cesarean section was 48.8%, compared with 26.7% in the control group. Among the indications of cesarean section, the highest incidence was previous cesarean section (40.0%) and elderly primigravida (18.0%), fetal distress (10.7%), cephalopelvic disproportion (7.5%), and abnormal presentation (6.7%). Concerning the prenatal complications, the incidence of hypertensive disorder was 4.3%, and 2.6% in control group. The incidence of low birth weight and macrosomia were 8.9%, 8.8% in elderly gravida, and 5.5%, and 9.3% in control group. The incidence of IUFD was 3.1% in elderly gravida, and 0.63% in control group. Male-to-female sex ratios were 1.12:1 in elderly gravida, 1:1.16 in elderly primigravida, 1.17:1 in elderly multi gravida, and 1.20:1 in control group. CONCLUSION: The rate of elderly gravida increased in recent years, and the cesarean rate was higher compared with the control group. But there was no difference in perinatal mortality. The reasons for increasing rate of cesarean delivery may be due to physician and patient concern over pregnancy outcome in older women. Therefore it is necessary to exert more attention to pregnancies in those over the age of 35.
Adult ; Aged ; Breech Presentation ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Distress ; Gynecology ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Jeollanam-do ; Obstetrics ; Perinatal Mortality ; Pregnancy ; Pregnancy Outcome ; Pregnancy, High-Risk ; Pregnant Women* ; Sex Ratio

OBJECT: In order to compare several Obstetric characteristics and outmmes of teenage pregnancy. METHODS: The 10 year clinical records of 11,583 women undergoing Cesarean section and delivery were reviewed in the department of Obstetrics and Gynecology, Incheon Christian Hospital from July 1, 1989 to June 30, 1999. There were seventy-eight pregnancies under age 20 and we compared them with two hundred pregnancies aged 20-29 who were randomly chosen during the same periods as the control group. RESULT: The following results were obtained. The proportion of birth by teenagers increased from 0.5% of all birth in 1989 to 2.61% in 1999. The most of cases were in high teen group, age 14- 19.The majority(50.5%) were in the age of 19. Seventy two cases(92.3%) had no previous pregnant history. Six cases had one previous pregnant history. The frequencies of prenatal care were significantly lower than that of the control group(p<0.05). The mean gestational period was 36+4weeks, and showed significant difference between the study group and the control group(39+3 weeks). The incidence of preterm labor was significantly different between the two proups(p<0.05). But the incidence of postterm delivery were not significantly different between the two groups. The mean weight gain of pregnant teenagers revealed 10.64kg, significantly less profound than the control group. The matemal weight gain of control group revealed 12.95kg, respectively. The mean birth weight(2.54kg) of infant was significantly less profound than the control group. The incidence of birth of small for gestational age(birth weight 1,500-2,499gm ; 14.5%) was significantly increased among study group than the control group(1%). The rate of abdominal delivery(21.8%) were not significantly decreased than the control group(47%). The incidence of cephalopelvic disproportion and malpresentation for cesarean section were somewhat higher than the control group, and were statistically significant(p<0.05). During the antepartun period, anemia, pyelonephritis, and preterm labor occurred more frequently in the teenage pregnancy than the control group, but not statistically significant. Among postpartum complications, incidence of anemia(51.3%) increased significantly. The perinatal mortality, intrauterine growth retardation, congenital anomaly occurred more frequently than the control group. CONCLUSION: These results show that pregnancy of teenage will be comeout high risk and complications. And then we will be more concern and study about teenage pregnancy.
Adolescent ; Anemia ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Growth Retardation ; Gynecology ; Humans ; Incheon ; Incidence ; Infant ; Obstetric Labor, Premature ; Obstetrics ; Parturition ; Perinatal Mortality ; Postpartum Period ; Pregnancy ; Pregnancy in Adolescence* ; Prenatal Care ; Pyelonephritis ; Weight Gain

OBJECTIVE: Under the definition of macrosomia where the birth weight of the fetus being 4,000 grams or more, we analyzed and studied the obstetrical problems, complications of both mother and the fetus and the predisposing factors of macrosomia in this report. METHODS: A study was done on 231 cases of macrosomia infants weighing 4,000 grams or more out of 5220 full-term delivered cases in Dongguk University, Kyung-ju hospital from January, 1998 to December, 2002. RESULTS: The frequency of macrosomia ranged from 4.18% in 4,000 g or more to 0.42% in 4,500 g or more. In macrosomia frequency correlations to parity showed 41.13% (95 cases) in primiparous women, 58.87% (134 cases) in multiparous women. According to the type of delivery, normal vaginal delivery has proven to be the most, consuming 52.38% (121 cases), where Cesarean section was 47.61% (110 cases). Indications for Cesarean section ranged from cephalopelvic disproportion (27.3%) to previous Cesarean section (25.4%), in the order of frequency. Maternal complications due to delivery showed highest incidence in postpartum hemorrhage (13.63%), followed by birth canal laceration (12.12%). As of fetal complications, 3 cases (2.72%) of cephalhematoma existed, and 1 brachial plexus palsy and clavicle fracture were reported and 1 case of fetal death was reported. CONCLUSION: It would be appropriate to have definite diagnostic schemes and adequate choice of delivery method for macrosomia. Therefore, the complications of macrosomia could be decreased by a well-trained delivery coming in forehand.
Birth Weight ; Brachial Plexus ; Causality ; Cephalopelvic Disproportion ; Cesarean Section ; Clavicle ; Female ; Fetal Death ; Fetal Macrosomia* ; Fetus ; Gyeongsangbuk-do ; Humans ; Incidence ; Infant ; Lacerations ; Mothers ; Paralysis ; Parity ; Parturition ; Postpartum Hemorrhage ; Pregnancy

The intrauterine fetal death(IUFD) is the death of the fetus prior to complete expulsion or extraction from its mother when the fetus is over 20 weeks gestation or weights more than 500 gm. This is a clinical study of 262 cases of IUFD and 262 control cases among 18542 deli-veries at Chung Goo Sung Sim Hospital during 10 years from 1987 to 1996. The results obtain-ed were as follows: 1. The incidence of IUFD was 1.41%. 2. The risk of IUFD was high in women older. 3. The risk of IUFD was high in women with parity of three or more, there was a previous history of IUFD in 11.2% of the IUFD cases and in 6.3% of the control cases, but there was no difference between the two groups of women in history of spontaneous abortion. 4. The sex ratio of male versus female was 1.24:1 in the IUFD cases, 1.11:1 in the control cases. 5. The low birth weight and preterm infants were much more frequent in the IUFD cases. 6. The mode of delivery IUFD was induced labor(77.5%), laparotomy(12.2%), spontaneo- us delivery(10.3%). The indications for laparotomy were placental abruption, placenta previa, transverse lie, previous cesarean section status, cephalopelvic disproportion and uterine rupture. 7. The most common cause of IUFD was unexplained causes(45.1%). 8. There were 67 cases(25.6%) of maternal complication, and the most common complica- tion was fever(35.8%). 9. In the incidence of abnormal coagulation test, the low platelet count(<100,000/mm3) was 8.0%, the prolonged prothrombin time(>14 seconds) was 7.2%, the prolonged partial thr- omboplastin time was 1.0%, the hypofibrinogenemia(<150mg/dl) was 7.2% and the elevated fibrinogen degradation products(>40 ug/ml) was 8.4%. 10. The risk of IUFD was lowered as the number of antenatal care was increased.
Abortion, Spontaneous ; Abruptio Placentae ; Blood Platelets ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Death* ; Fetus ; Fibrinogen ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Laparotomy ; Male ; Mothers ; Parity ; Placenta Previa ; Pregnancy ; Prothrombin ; Sex Ratio ; Uterine Rupture ; Weights and Measures