Pregnancy ; Humans ; Female ; Cesarean Section/adverse effects* ; Abdominal Cavity ; Neoplasms

BACKGROUNDCesarean section births have been steadily increasing over the past decade and have become an epidemic in China. Cesarean delivery on maternal request is a major contributor to this upward trend, and there has been of much concern about its impact on maternal and child health. Most of mothers believe that cesarean delivery on maternal request can improve the child's intelligence, but direct evidence is sparse. In this cohort study, we aimed to directly assess the impact of cesarean delivery on maternal request on childhood intelligence.

METHODSIntelligence quotient (IQ) of 4144 preschool children from 21 cities/counties of Zhejiang and Jiangsu province whose mothers were registered in a population-based perinatal surveillance program during 1993-1996 was assessed with Chinese Wechsler Young Children Scale of Intelligence (C-WYCSI) in 2000. The outcomes were full-scale IQ, verbal IQ, and performance IQ of C-WYCSI. Mode of delivery and covariates were obtained from the surveillance program. We estimated unadjusted and adjusted effects of cesarean delivery on maternal request and assisted vaginal delivery on IQ scores compared with spontaneous vaginal delivery using regression analysis.

RESULTSThe mean full-scale, verbal, and performance IQ for all children was 99.3 ± 16.1, 93.6 ± 17.7, and 105.3 ± 14.3. In crude analysis, cesarean delivery on maternal request versus spontaneous vaginal delivery was associated with an increase of 3.9 (95% confidence interval, 0.6 to 7.2) points in full-scale IQ, 4.8 (1.2 to 8.4) points in verbal IQ, and 2.4 (-0.6 to 5.3) points in performance IQ. After adjusting for maternal education, occupation, and IQ, the advantage was reduced to 1.6 (-1.3 to 4.5), 2.3 (-0.8 to 5.5), and 0.6 (-2.0 to 3.3) points for full-scale, verbal, and performance IQ, respectively. Assisted vaginal delivery versus spontaneous vaginal delivery was not associated with IQ scores in any analysis.

CONCLUSIONNeither cesarean delivery on maternal request nor assisted vaginal delivery affected children's IQ.

Cesarean Section ; adverse effects ; Child ; Child, Preschool ; Female ; Humans ; Intelligence ; physiology ; Intelligence Tests ; Male ; Pregnancy

Massive postpartum haemorrhage after Cesarean section for placenta previa is a common occurrence. The bleeding is usually from the placental bed at the lower uterine segment. Uterine tamponade has a role in the management of such patients especially when fertility is desired. We describe here a case of massive postpartum haemorrhage, which was managed, with the use of a Sengstaken-Blakemore tube. This allowed us to avoid a hysterectomy for a young primiparous patient.
Balloon Dilatation/*instrumentation ; Cesarean Section/adverse effects ; Postpartum Hemorrhage/etiology ; Postpartum Hemorrhage/*therapy

Cesarean scar pregnancy is an uncommon ectopic gestation. Without timely and proper management, it may cause major bleeding, uterine rupture, and other life-threatening complications. The causes of this condition remain unclear, and no standardized management has been available, although some medical and surgical treatment modalities have been suggested. The main treatment objectives include preventing massive blood loss, preserving the uterus function, and maintain the women's health and quality of life. Current data do not support expectant management. After early diagnosis, single or combined medical and surgical treatment options should be provided to avoid uterine rupture and haemorrhage, so as to preserve the uterus and thus the fertility.
Cesarean Section ; adverse effects ; Cicatrix ; therapy ; Embolization, Therapeutic ; Female ; Humans ; Laparoscopy ; adverse effects ; Pregnancy ; Pregnancy, Ectopic ; etiology ; therapy

OBJECTIVE: To explore the effect of epidural labor analgesia duration on the outcomes of different anesthetic approaches for conversion to cesarean section. METHODS: We retrospectively collected the clinical data of pregnant women undergoing conversion from epidural labor analgesia to cesarean section at Sichuan Maternal and Child Health Hospital and Jinjiang District Maternal and Child Health Care Hospital between July, 2019 and June, 2020. For cesarean section, the women received epidural anesthesia when the epidural catheter was maintained in correct position with effective analgesia, spinal anesthesia at the discretion of the anesthesiologists, or general anesthesia in cases requiring immediate cesarean section or following failure of epidural anesthesia or spinal anesthesia. Receiver-operating characteristic curve analysis was performed to determine the cutoff value of the analgesia duration using Youden index. The women were divided into two groups according to the cut off value for analyzing the relative risk using cross tabulations. RESULTS: A total of 820 pregnant women undergoing conversion to cesarean section were enrolled in this analysis, including 615 (75.0%) in epidural anesthesia group, 186 (22.7%) in spinal anesthesia group, and 19 (2.3%) in general anesthesia group; none of the women experienced failure of epidural or spinal anesthesia. The mean anesthesia duration was 8.2±4.7 h in epidural anesthesia, 10.6±5.1 h in spinal anesthesia group, and 6.7 ± 5.2 h in general anesthesia group. Multivariate logistic regression analysis showed that prolongation of analgesia duration by 1 h (OR=1.094, 95% CI: 1.057-1.132, P < 0.001) and an increase of cervical orifice by 1 cm (OR=1.066, 95% CI: 1.011-1.124, P=0.017) were independent risk factors for epidural analgesia failure. The cutoff value of analgesia duration was 9.5 h, and beyond that duration the relative risk of receiving spinal anesthesia was 1.204 (95% CI: 1.103-2.341, P < 0.001). CONCLUSION Prolonged epidural labor analgesia increases the risk of failure of epidural analgesia for conversion to epidural anesthesia. In cases with an analgesia duration over 9.5 h, spinal anesthesia is recommended if immediate cesarean section is not required.
Analgesia, Epidural/adverse effects* ; Analgesia, Obstetrical/adverse effects* ; Anesthesia, Obstetrical ; Cesarean Section ; Child ; Female ; Humans ; Pregnancy ; Retrospective Studies

OBJECTIVETo evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes.

METHODSA retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007.

RESULTSThe incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8 weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than that in FCS group (38.9+/-2.1 weeks, all P<0.01). The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P<0.05). Dense adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P<0.01) and uterine rupture (1.0% vs. 0, P<0.05) were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups (P>0.05).

CONCLUSIONSRepeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.

Adult ; Cesarean Section ; adverse effects ; Cesarean Section, Repeat ; adverse effects ; China ; epidemiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Postoperative Complications ; epidemiology ; Pregnancy ; Pregnancy Complications ; epidemiology ; Pregnancy Outcome ; Retrospective Studies

Shunt malfunctions that require surgical intervention during pregnancy and the postpartum period are rare. Furthermore, no study has reported on an acute shunt malfunction immediately after cesarean section. Here, we describe the case of a 32-yr-old woman who became drowsy 12 hr after cesarean section delivery of her second child. She had a ventriculoperitoneal shunt placed to treat hydrocephalus associated with meningitis at 26 yr of age. Marked ventriculomegaly was seen on brain computed tomography and her consciousness recovered temporarily after aspirating cerebrospinal fluid from the flushing device. At surgery, the distal catheter tip was plugged by a blood clot. We believe that the blood spilled over during the cesarean section. The clogged catheter end was simply cut off and the remaining catheter was repositioned in the peritoneal cavity. Her consciousness recovered fully.
Adult ; *Cesarean Section ; *Equipment Failure ; Female ; Humans ; Hydrocephalus/etiology/surgery ; Meningitis/complications ; Pregnancy ; *Ventriculoperitoneal Shunt/adverse effects/instrumentation

OBJECTIVETo investigate the effects of hysteroscopic treatment of women with previous cesarean scar defect (PCSD).

METHODSFrom May 2006 to October 2008, 12 patients with PCSD were diagnosed and treated hysteroscopically in our hospital, all of them were successful followed-up for one year postoperatively, and their clinical data were analyzed.

RESULTSAll 12 hysteroscopic procedures were completed successfully, and there were no surgical complications. Nine patients with longer periods and 1 patient with intermenstrual spotting preoperatively remained asymptomatic after hysteroscopic surgery, and 1 patient with longer periods and infertility experienced normal periods, while remained infertility, and the remaining 1 patient complaining postcoital bleeding preoperatively had recurrence of the bleeding.

CONCLUSIONHysteroscopic surgery of women with PCSD was minimally invasive and effective.

Adult ; Cesarean Section ; adverse effects ; Cicatrix ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hysteroscopy ; Postoperative Complications ; surgery ; Uterine Diseases ; surgery

OBJECTIVETo explore the effect and feasibility of acupuncture in uterine involution after cesarean section.

METHODSSeventy cases of cesarean section in primipara were randomized into an observation group (33 cases) and a control group (37 cases). In the control group, the conventional treatment was adopted after cesarean section. In the observation group, on the basic treatment as the control group, acupuncture was applied at Sanyinjiao (SP 6), Hegu (LI 4), Qihai (CV 6) and Guanyuan (CV 4). In 2 h after operation, acupuncture started, once a day, continuously for five times. The daily height of uterine fundus, daily uterine fundus decreasing degree, postpartum blood loss, lochia duration and ultrasonic B test in 42 days of postpartum were compared between the two groups.

RESULTSThe therapeutic methods of the two groups all promoted uterine contraction. The postpartum height of uterine fundus in the observation group was lower than that in the control group (all P<0.05) and the uterine fundus decreasing degree was higher than that in the control group (all P<0.05). The blood loss in 2 h, 6 to 12 h and 24 to 48 h of postpartum was less than that in the control group (all P<0.05). The lochia duration in the observation group was shorter than that in the control group (P<0.05).

CONCLUSIONAcupuncture promotes uterine contraction, reduces postpartum blood loss and lochia duration and benefits uterine involution after cesarean section.

Acupuncture Therapy ; Adult ; Cesarean Section ; adverse effects ; Female ; Humans ; Postoperative Complications ; physiopathology ; prevention & control ; therapy ; Uterine Contraction ; Young Adult

Human ; Female ; Pregnancy ; Carboprost ; Uterine Inertia ; Postpartum Hemorrhage ; Oxytocin ; Maternal Mortality ; Cesarean Section ; Drug-related Side Effects And Adverse Reactions