Cesarean sections in Dublin

Regardless of the indications cited for cesarean section, the increased frequency ha been accompanied by an absolute decrease in perinatal mortality. While it is true that the increase in cesarean section rate may have resulted in a lowering of perinatal mortality, many other factors as well may have contributed, for example, better prenatal care, electronic fetal heart rate monitoring, and advances in neonatal care. In support of the concept that the increased rate of cesarean section was not responsible for the observed decrease in perinatal mortality as the report by O’Driscoll and Foley (1983).

These authors studied the correlation of decrease in perinatal mortality and the increase in cesarean section rates from 1965 to 1980 in the United States and at the National maternity Hospital in Dublin, Ireland. They reported that while cesarean section rates were increasing in the United State from less than 5 percent in 1965 to more then 108, 000 infants born during the same period of time, the cesarean section remained virtually unchanged. Despite the unchanged rate in cesarean sections in Dublin, perinatal mortality fell to 36.

5, 24. 0, and 16. 8 per 1000 infants born during the same years. These authors concluded that these results were compatible with the view that the increased rate of cesarean sections reported in the United States had not contributed significantly to the simultaneously observed reduction in perinatal mortality. The lower cesarean section rate in Dublin was attributed to lower frequencies of cesarean section for dystocia, repeat cesarean section and breech presentations.

O’Discroll and associates (1969, 1973, 1984) attributed their apparent success to more aggressive management of dystocias with oxytoxin on nulliparous patients whose uteri they considered to be “almost immune to rupture except by manipulation,” to allowing patients with previous low transverse cesarean section sections a trial Of labor which proved successful in 610 percent, and to a liberal trail of labor in breech presentations. Although the results reported from Dublin appear impressive, the results pertain to perinatal mortality but not morbidity.

To address this, Leveno and associates (1985) compared perinatal outcomes at Parkland Hospital to those at the National Maternity Hospital. The primary cesarean section rate was 4. 4 percent in Dublin and it was 10. 1 percent ion Dallas. However, the more liberal use of cesarean section. Especially for dystocia or for fetal jeopardy, was associated with a sevenfold decreased incidence of intrapartum fetal death and a twofold decreased of incidence of neonatal seizures.

Because perinatal morbidity is much more difficult to assess, such results are still to be reported from Europe, Australia, and the United States. It seems unlikely that such low cesarean section rates as those reported from Dublin will be seen in the United States. One reason for this is the prevailing enthusiasm for sall families; which likely will result in many women, whose first infants were delivered by cesarean section, electing to have repeat section with tubal sterilization.

Another reason is the reluctance to allow vaginal delivery of breech presentations. Even if the liberal standards applied to frank breech presentations and recommended by Collea and associates (1980) were applied, we could expect only a 15 to 30 percent decrease in the cesarean section rate for all breeches. However, vaginal delivery subsequent to cesarean section is safe and efficacious, and will likely become more popular. Therefore, a reduction or certainly a cessation in the rate of increase in cesarean sections probably will follow.

The final answers with respect to frequency, indications, and results in terms of safety to the mother and fetus, and the legal, ethical, and economic consequences of cesarean section are unlikely to become apparent for several years. To the credit if the obstetrical community these questions continue to be addressed (National Institutes of Health, 1980). There are now several reports by clinical investigators of attempts to reduce the incidence of cesarean section without increasing perinatal mortality and morbidity.

These efforts appear to have been successful in university of teaching hospitals and are sometimes referred as active management of labor. It is unproved if the application of so-called active management an be transferred to community hospitals with comparable safety where large numbers of house officers, nurses, and ancillary services are not always readily available as in most teaching hospitals. The most remarkable report of the safety of cesarean delivery is that from the Boston Hospital for Women.

The authors reported a zero maternal mortality rate in 10,231 cases. Certainly, maternal and perinatal mortality and morbidity are typically higher with cesarean delivery than with vaginal delivery. Maternal mortality from cesarean section is less than 1 per 1,000. Petitti reviewed nearly 400,000 cesarean sections performed in the United States from 1965 through 1978 and reported that maternal death followed in 1 in 1,635 operations. She rightful emphasizes that only about half of these are directly attributable to the cesarean section itself.

For example, Sachs and co-workers attributed as a direct cause only 7 of 27 deaths the following more than 121,000 cesarean sections performed in Massachusetts from 1976 trough 1984. While this mortality rate was 22 per 100,000 for all cesarean sections; it was only 5. 8 per 100,000 for deaths directly due to cesarean delivery. However, even this relatively low operative mortality rate must be considered as excessive when one understands that the majority of these deaths occur in young\, healthy women undergoing a “normal physiological process. “

Caesarian section, or cesarean section, is defined as delivery of the fetus through incisions in the abdominal wall and the uterine wall (hsyerotomy). This definition does not include removal of the fetus from the abdominal cavity in case of rupture …

The moot threats to women undergoing cesarean section have been anesthesia, severe sepsis, and thromboembolic episodes. Each of these areas has been or will be considered in great detail. However, it is worth emphasizing that aspiration pneumonia, which had previously …

Eating disorders fall under the general category of psychosomatic disorders (Tam & Chung, 2007). These psychological disorders are as a result of mental and/or emotional maladjustment (Vaschenko, 2005). Postpartum depression has been widely acknowledged as a prevalent psychosomatic disorder that …

The guidelines of timing repeat cesarean section at Parkland hospital do not include mandatory amninocentesis to measure the amnionic fluid lecithin/sphingomyelin ratio. Instead, the following information is used to identify fetal maturity; (1) the date of onset of the last …

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