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Muñoz-Saá LE, Sendra R, Carriles I, Sousa M, Turiel M, Ruiz-Zambrana Á, Chiva L. Maternal and Fetal Outcomes after Multiple Cesarean Deliveries. J Clin Med 2024; 13:4425. [PMID: 39124691 PMCID: PMC11313669 DOI: 10.3390/jcm13154425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Cesarean delivery (CD) is a common procedure, but it can be associated with some increasing risks as the number of previous CD increases. Although women undergoing multiple CDs is very unusual in Spain, our center serves pregnant women with a history of three or more previous CDs with some frequency. We aimed to assess whether women who undergo multiple CDs (≥4) have more risks than those who undergo a third CD. Material and Methods: A retrospective cohort study was conducted with 161 pregnant women who had undergone ≥ 2 previous CDs and were monitored during their next pregnancy. The primary endpoint was to evaluate the obstetric hemorrhage rate in the multiple CD group and compare it with that in the third CD group. Secondary outcomes regarding maternal and neonatal complications were also analyzed. Results: Hemorrhage (7% and 10%; p = 0.522) and transfusion (3% and 8%; p = 0.141) rates were similar in both groups. The risk of dehiscence of the uterine segment (6% and 24%; p < 0.006), as well as hysterectomy (0 and 6.6%, p = 0.019), difficult abdominal opening (49% and 82%; p = 0.001), peritoneal adhesions (3% and 22%; p < 0.001), and difficult bladder separation (36% and 73%; p < 0.001), was higher in the multiple CD group. No uterine rupture or maternal-neonatal mortality was observed in either of the groups. Conclusions: Since undergoing multiple CD is uncommon, our study may be the largest sample in our environment. Our findings suggest that despite the potential risks of undergoing multiple CDs, maternal and neonatal outcomes are overall favorable.
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Affiliation(s)
- Laura E. Muñoz-Saá
- Department of Obstetrics and Gynaecology, Clínica Universidad de Navarra, Marquesado de Sta. Marta St, 1, 28027 Madrid, Spain
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Weinstein J, Muhalwes R, Ronenson A, Halpern SH, Grisaru-Granovsky S, Akawi T, Gozal Y, Shatalin D, Ioscovich A. The anesthetic approach to repeated cesarean sections: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100301. [PMID: 39011056 PMCID: PMC11247144 DOI: 10.1016/j.eurox.2024.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 07/17/2024] Open
Abstract
Objective Each repeat cesarean section (CS) potentially adds surgical complexity. The determination of appropriate anesthesia strategy to meet the surgical challenge is of crucial importance for the maternal and neonatal outcome. Study design This prospective cohort study was conducted from 1-Jan-2021 to 31-Dec-2021 at a single large obstetric centre of all repeat CS. We compared the characteristics and the appropriateness of the anesthesia techniques for low-order repeat CS (LOR-CS) (1 or 2 previous CS) and high order repat CS (HOR-CS) group (3 or more repeat CS). Results During the study period, 1057 parturients met the study entry criteria, with 821 parturients in the LOR-CS group and 236 parturients in the HOR-CS group. The use of spinal anesthesia was more common for HOR-CS 84.3%. Overall surgical time varied between LOR-CS (38 min, 29-49) and HOR-CS (42 min, 31-57) (p = 0.004).The rate of moderate and severe adhesions was relatively high in HOR-CS and the duration of overall surgical time for cases with mild adhesions was 38 min (29-48), for moderate adhesions was 44 min (34.8-56.5), and for severe adhesions was 56 min (44.8-74.3). There was no significant difference in the Estimated Blood Loss (EBL) between LOR-CS and HOR-CS, with values of 653 ± 292 ml vs. 660 ± 285 ml, respectively. Conclusion Our data indicate that spinal anesthesia, standard monitoring and regular anesthetic setup are safe and suitable for the majority of HOR-CS, except in cases with high suspicion of placental accreta spectrum.
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Affiliation(s)
- Jacob Weinstein
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Rasha Muhalwes
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Alexander Ronenson
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Stephen H. Halpern
- Department of Anesthesia, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Tamer Akawi
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Yaacov Gozal
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Daniel Shatalin
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
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Aboshama RA, Taha OT, Abdel Halim HW, Elrehim EIA, Kamal SHM, ElSherbiny AM, Magdy HA, Albayadi E, Elsaid RE, Abdelghany AM, Anan MA, Abdelfattah LE. Prevalence and risk factor of postoperative adhesions following repeated cesarean section: A prospective cohort study. Int J Gynaecol Obstet 2023; 161:234-240. [PMID: 36200671 DOI: 10.1002/ijgo.14498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/12/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the prevalence of intraperitoneal adhesions after repeated cesarean delivery and its associated personal and surgical risk factors. METHODS This prospective cohort study was conducted at the delivery ward at Fayoum University Hospital from October 2020 to December 2021. Women were recruited according to predetermined inclusion and exclusion criteria. Eligible women were interviewed, and data were obtained for personal history, past surgical and obstetrical history, and data about the current delivery. Nair's scoring system was used to evaluate intraperitoneal adhesions. Postoperative data and complications were reported. RESULTS Three hundred women were recruited. Moderate to severe adhesions occurred in 186 patients (62%). These patients had a significantly prolonged hospital stay and were delivered by expert surgeons (P < 0.001 and P = 0.008, respectively). The adhesion score correlated positively with patients' age (P < 0.001), parity (P < 0.001), interpregnancy interval (P = 0.033), duration of hospital admission either previously or in the current delivery (P = 0.001 and P < 0.001), time to ambulation (P < 0.001), time to intestinal movement (P < 0.001), operative time (P < 0.001), and surgeons' age and experience (both P = 0.015). CONCLUSION Adhesions led to increased maternal morbidity. Multiple contributing factors were significantly related to adhesions with multiple cesarean deliveries.
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Affiliation(s)
| | - Omima T Taha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hala Waheed Abdel Halim
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eman Ibrahim Abd Elrehim
- Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | | | - Hagar Abdelgawad Magdy
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eslam Albayadi
- Department of Anesthesia, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Rasha Ezzat Elsaid
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Amany Mohamed Abdelghany
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed A Anan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Laila Ezzat Abdelfattah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Zhang M, Su Q, Cao Y, Zhao M, Huang D. Safety and feasibility of trial of vaginal labor after cesarean section: A retrospective study. Medicine (Baltimore) 2020; 99:e22844. [PMID: 33181654 PMCID: PMC7668460 DOI: 10.1097/md.0000000000022844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/08/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
By observing and analyzing the success rate of Tai'an City central hospital TOLAC and VBNC and various indicators after delivery, we make sure whether TOLAC is safe and feasible to be promoted in Tai'an area.Between January and December 2017, data of 144 cases undergoing TOLAC, 152 cases undergoing VBNC, 152 cases undergoing RCS and 142 case undergoing PCS in Tai'an City Central Hospital were retrospectively analyzed. The success rate of vaginal delivery, labor time, 24 hours postpartum hemorrhage, hospital stay, Apgar score of newborns and puerperal morbidity were observed.Primary study outcomes: The success rates of the TOLAC and VBNC groups were 93.06% and 93.42%, respectively, where the difference was not statistically significant (P = .901). Secondary study outcomes: There were no significant differences in labor time (P = .0249), amount of 24 hours postpartum hemorrhage (P = .206), Apgar score of newborns (P = .582), hospital stay (P = .194) and puerperal morbidity (P = .942) between the VBAC group and VBNC group. There were statistically significant differences in amount of 24 hours postpartum hemorrhage (P < .001), hospital stay (P < .001) and puerperal morbidity (P = .018), but no difference in Apgar score of newborns (P = .228) between the VBAC group and RCS group. There were significant differences in operation time (P = .011), amount of 24 hours hemorrhage (P = .001), hospital stay (P = .001) and puerperal morbidity (P = .041), but no significant difference in Apgar score of newborns (P = .300) between the RCS and PCS groups.The TOLAC is as safe and feasible as VBNC, and more favorable to the safety of mother and fetus than RCS in Tai'an area.
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Affiliation(s)
| | - Qin Su
- Obstetrics Department, Tai’an City Central Hospital
| | - Yan Cao
- Obstetrics Department, Fan Zhen Hospital, Tai’an
| | - Minmin Zhao
- Obstetrics Department, Tai’an City Central Hospital
| | - Di Huang
- Gynaecology and Obstetrics Department, Tai’an City Central Hospital, Tai’an, China
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