No abstract available.
Cesarean Section, Repeat* ; Female ; Fistula*

This is a case report of a 42 year old parturient from Calapan City, Oriental Mindoro, who was referred for anesthetic management for repeat elective cesarean section. She had safely undergone elective cesarean section twice, 14 months apart, under spinal anesthesia.
Human ; Female ; Adult ; ANESTHESIA, CONDUCTION ; CESAREAN SECTION, REPEAT ;

Ephedrine sulfate was administrated 30 healthy parturients undergoing elective repeat cesarean section under spinal anesthesia. Fifteen patients received ephedrine infusion (0.01% solution, beginning with approximately 5 mg/min) immediately after induction of spinal anesthesia to maintain maternal systolic blood pressure between 90% and 100% of the baseline systolic blood pressure (mean dose of ephedrine 31.6 mg). Fifteen patients (control group) received 20mg of ephedrine as an intravenous bolus, and additional 10mg increments, if necessary, when systolic blood pressure decreased to 80% of the baseline systolic blood pressure (mean dose of ephedrine 26.8 mg). Nausea and/or vomiting occurred in seven women in the control group and on patient in the infusion group (p<0.001). Apgar scores, fetal blood gas tension, and time for onset of respiration was comparable in the two groups. The results suggest that prophylactic ephedrine infusion is safe and desirable in healthy parturients undergoing cesarean section under spinal anesthesia.
Anesthesia, Spinal* ; Blood Pressure ; Cesarean Section* ; Cesarean Section, Repeat ; Ephedrine* ; Female ; Fetal Blood ; Humans ; Nausea ; Pregnancy ; Respiration ; Vomiting

Involuntary movement during and after neuraxial anesthesia, such as spinal and epidural anesthesia, is rarely observed. In this report, we describe a case of myoclonus-like involuntary movement of the upper extremities in a patient undergoing a planned repeat cesarean section under spinal anesthesia with bupivacaine that completely subsided after administration of 2 mg of midazolam. The myoclonus-like movement did not recur or cause any apparent neurological side effects.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, Spinal ; Bupivacaine ; Cesarean Section* ; Cesarean Section, Repeat ; Dyskinesias* ; Female ; Humans ; Midazolam* ; Myoclonus ; Pregnancy ; Upper Extremity

OBJECTIVES: Vaginal birth or trial of labor after previous cesarean section has become one of the most remarkable changes in obstetric practice. The safety and efficacy of a trial of labor and vaginal birth after previous cesarean are well documented. The purpose of this report is to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. METHOD: In this retrospective study, 120 women who attempted vaginal birth at Kyung-Hee University Hospital from March 1997 to March 1999. An attempt to identify possible prognostic factors for success of such a trial was made and we evaluated the variables of significant predictive value and the patients' characteristics in the success group and failure group of women who attempted VBAC. RESULT: 87 cases(72.5%) in 120 cases succeeded in VBAC and 33 cases(27.5%) failed. In this comparative groups in VBAC, there was significant difference in CPD index(cephalopelvic disproportion index) and Bishop score, but no significant difference in gestational age, the estimated fetal weight by sonography and newborn birth weight. CONCLUSION: In this study, Bishop score and CPD index and age may be useful and valid predictor of success in VBAC and this information could be particularly valuable. The CPD index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.
Birth Weight ; Cesarean Section ; Cesarean Section, Repeat ; Female ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Parturition ; Pregnancy ; Retrospective Studies ; Trial of Labor ; Vaginal Birth after Cesarean*

BACKGROUND: It is commonly believed that the supine position with left uterine displacement is good for both the mother and the fetus for a cesarean section although all pregnant women do not suffer hypotension during the supine position. This study was to demonstrate whether maternal hemodynamics and infant's apgar score differences existed between the supine position with and without left uterine displacement for a cesarean section. METHODS: One hundred eighteen women for an elective repeat cesarean section were involved in this study. They were divided into 2 groups; (E) supine position (n = 65) and (C) supine position with left uterine displacement (n = 53). Hemodynamic variables (CO, CI, SVR, SVRI, SI, EF, MAP and HR) were measured at three different time points; preoperation, after intubation and 10 minutes after delivery by using a thoracic bioimpedence. The infant's apgar score was measured at 1 and 5 minutes after delivery. RESULTS: All the values of preoperation and at 10 min after delivery, were not different compared between the two groups (P > 0.05). However, after intubation, the values of HR, MBP and SVR of group C were increased significantly (P < 0.05) compared to those of group E. The infant's apgar scores (1 min, 5 min) were not different between the two groups. CONCLUSIONS: From these results, it might be thought that left uterine displacement is absolutely not necessary for an elective repeat cesarean section. However, left uterine displacement is recommended when maternal and fetal problems exist, regional anesthetic induced sympathetic blockade is done or preclampsia is diagnosed.
Anesthesia, General ; Apgar Score* ; Cesarean Section* ; Cesarean Section, Repeat ; Female ; Fetus ; Hemodynamics* ; Humans ; Hypotension ; Intubation ; Mothers ; Pregnancy ; Pregnant Women ; Supine Position*

Congenital adrenal hyperplasia (CAH) during pregnancy is a rare condition. Only a few cases have been reported in the literature. CAH patients has lower pregnancy rate compared to normal women. A 27-year-old nulliparous woman, a diagnosed case of 21-hydroxylase deficient simple virilising form of classic CAH visited. She got pregnant spontaneously without any trial of assisted reproductive technology. At the age of 12, she underwent clitoral resection and vaginoplasty. She took dexamethasone or prednisolone after operation. She delivered healthy singleton female baby by cesarean section. Four years later, she delivered healthy singleton female baby by repeat cesarean section. Two female babies have shown normal external genitalia. Here, we report a case of successful pregnancy and delivery in a patient with CAH.
Adrenal Hyperplasia, Congenital* ; Adult ; Cesarean Section ; Cesarean Section, Repeat ; Dexamethasone ; Female ; Fertility ; Genitalia ; Humans ; Prednisolone ; Pregnancy Rate ; Pregnancy* ; Reproductive Techniques, Assisted ; Steroid 21-Hydroxylase

It is usual for cesarean aection using minimal concentration of anesthetics for fetal and maternal safety without inhibiton of postpartum uterine contraction. So, there is increased incidence of maternal awareness and complaint of intraoperative pain experience in postoperative period. We studied the effect of N2O-O2-Fentanyl anesthesia for cesarean section for 115 healthy parturients. The patients were questioned for awareness and intraoperative pain experience during anesthesia and unpleasant dreams at first postoperative day. The results were as follows; 1. The 29 patients have positive reactions. Among them, 18 patients have auditory awareness, 18 patients have intraoperative pain experience, 5 patients have dreams and 3 patients have a awareness of endotracheal tube. Among them 6 patients wanted other anesthetic method, if they have to have cesaiean section, again. 2. There are significant difference in the occurence of recall in group of first cesarean section compared with the group repeat cesarean section(P<0.05). 3. No statistical relationship between recall and use of Thalamonal, elective or emergency, skin to delivery time, uterine to delivery time and patient age. It is recommended that quietness and low concentration of inhalation anesthetics at delivery of fetus during general anesthesia for cesarean section, especially for repeat cesarean section.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Anesthetics, Inhalation ; Cesarean Section* ; Cesarean Section, Repeat ; Dreams ; Emergencies ; Female ; Fentanyl ; Fetus ; Humans ; Incidence ; Postoperative Period ; Postpartum Period ; Pregnancy ; Skin ; Uterine Contraction

Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications such as urinary tract infection, voiding difficulty, abortion, and preterm labor may develop. Conservative management consisted of bed rest and use of a pessary. An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. We present a case of a patient developing uterine prolapse at 12 weeks of gestation, treated with bed rest and use of a pessary. A repeat cesarean section was performed at 38 weeks of gestation and report with a brief review of literatures.
Bed Rest ; Cervix Uteri ; Cesarean Section ; Cesarean Section, Repeat ; Female ; Humans ; Obstetric Labor, Premature ; Pessaries ; Pregnancy ; Prolapse ; Urinary Tract Infections ; Uterine Prolapse

OBJECTIVE: To evaluate chronological pattern of the frequencies and indications for cesarean section performed at one university hospital for 24 years. METHODS: This study was carried out retrospectively based on the clinical records of 6,051 patients who had cesarean sections among total 28,836 delivery cases at our hospital from January, 1980 to December, 2003 to show the frequencies and indications for cesarean section. RESULTS: The relative frequencies of cesarean section among total delivery cases for 24 years was 21.0%. The frequencies was 16.6% in the 1980s, 21.9% in the 1990s and 34.3% in the 2000s, which shows a tendency to marked increment. The common indications of cesarean section for 24 years was previous cesarean section (40.9%) followed by abnormal presentation (16.3%), dystocia (12.2%), fetal distress (7.9%), placenta previa (6.8%). Repeat cesarean section showed increasing frequencies from 1980 to 1992 and dropped again from 2002. Dystocia and abnormal presentation showed decreasing frequencies, but multiple pregnancy, placenta previa and other indications showed increasing frequencies, especially in late 1990s and 2000s. CONCLUSION: The frequencies for cesarean section was increasing, especially from 1990s. There are many changes in indications for cesarean section. Recent changes was decreasing frequencies for repeat cesarean section, increasing for multiple pregnancy, placenta previa and other indications. This might be related to low birth rate and high elderly mother's proportion.
Aged ; Birth Rate ; Busan* ; Cesarean Section* ; Cesarean Section, Repeat ; Dystocia ; Female ; Fetal Distress ; Humans ; Placenta Previa ; Pregnancy ; Pregnancy, Multiple ; Retrospective Studies