Unicornuate uterus with a rudimentary horn diagnosed at scheduled third Cesarean Section.
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ABSTRACT:
SUBMITTER: Bodur S
PROVIDER: S-EPMC5510148 | biostudies-other | 2017 May-Jun
REPOSITORIES: biostudies-other
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Project description:Background: It has not been fully elucidated whether the change of the uterus flora is correlated to impaired fecundity. This case-control study aimed to analyze the differences in uterus microbial flora between women with post-cesarean section (CS) scar diverticulum (PCSD) (CS group) and women after vaginal delivery (control group), exploring the correlation between differentially expressed microbial flora and inflammation. Methods: Infertile women who underwent hysteroscopy were enrolled in this case-control study. The swab samples were classified into four subgroups: CS cervix group, CS endometrium group, control cervix group, and control endometrium group. The total DNA obtained from 16 women (a total of 31 samples, the cervix or endometrium) was extracted for 16S recombinant DNA (rDNA) analysis. The Luminex platform was used to detect the abundance of 34 kinds of local inflammatory cytokines in 32 endometrium samples, and the correlation between microbial flora and inflammatory cytokines was analyzed. Results: The alpha and beta diversity analysis indicated that the microbial diversity was higher in the CS group compared to the control group, especially in endometrium tissues. The heatmaps revealed that the microbial flora structure differs at each level of the phylum-class-order-family-genus among the groups. The analysis of four of the most prominently changed microbial flora revealed that Lactobacillus in the cervix was significantly higher in the control group when compared with the cesarean section group (P < 0.05). Furthermore, Proteobacteria and Neisseriaceae had a higher abundance in the CS groups, especially in the cervical tissue (P < 0.05), while Staphylococcaceae increased only in the CS endometrium tissue (P < 0.05). Next, these women were re-divided into the high- and low-Staphylococcaceae, and the abundance of 34 kinds of local inflammation cytokines was compared between groups. It was found that there was a positive correlation between Staphylococcaceae and IL-2, and a negative correlation between Staphylococcaceae and IL-8 (P < 0.05). Conclusion: The present results suggest that the disrupted uterus microbiota composition in women with CS may be closely associated with local inflammation. The interplay between the microbiota and the immune system may be linked to clinical disorders. The potential mechanisms require further exploration.
| S-EPMC8645650 | biostudies-literature
Project description:BackgroundRising cesarean section (CS) rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1) identify the main CS classifications used worldwide, 2) analyze advantages and deficiencies of each system.Methods and findingsThree electronic databases were searched for classifications published 1968-2008. Two reviewers independently assessed classifications using a form created based on items rated as important by international experts. Seven domains (ease, clarity, mutually exclusive categories, totally inclusive classification, prospective identification of categories, reproducibility, implementability) were assessed and graded. Classifications were tested in 12 hypothetical clinical case-scenarios. From a total of 2948 citations, 60 were selected for full-text evaluation and 27 classifications identified. Indications classifications present important limitations and their overall score ranged from 2-9 (maximum grade =14). Degree of urgency classifications also had several drawbacks (overall scores 6-9). Woman-based classifications performed best (scores 5-14). Other types of classifications require data not routinely collected and may not be relevant in all settings (scores 3-8).ConclusionsThis review and critical appraisal of CS classifications is a methodologically sound contribution to establish the basis for the appropriate monitoring and rational use of CS. Results suggest that women-based classifications in general, and Robson's classification, in particular, would be in the best position to fulfill current international and local needs and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this classification. The use of a single CS classification will facilitate auditing, analyzing and comparing CS rates across different settings and help to create and implement effective strategies specifically targeted to optimize CS rates where necessary.
| S-EPMC3024323 | biostudies-literature
Project description:BACKGROUND:The aim of this study was to evaluate the effect of vaginal repair in patients with cesarean section diverticulum (CSD) who had one or two previous cesarean sections (CSs). METHODS:From January 2012 to December 2014, 248 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital. These included 193 women with one previous cesarean section and 55 women with two previous cesarean sections. Excision and suture of CSD was performed through a vaginal approach. The duration of menstruation, the length, width and depth of the CSD and thickness of the remaining muscular layer (TRM) were evaluated before and after surgery by transvaginal three-dimensional (3D) color Doppler ultrasound. RESULTS:A total of 221 (89.11%) women were followed-up for more than 3?months, and 168 (67.74%) women were followed-up for more than 6?months. There were significant differences in the average duration of menstruation (7.77?±?2.05 and 8.02?±?2.06?days VS 13.99?±?3.71?days), the average size of CSD (5.54*9.19*5.60 and 5.75*9.04*6.18?mm VS 7.99*12.43*6.62?mm) and the TRM (7.61?±?2.52 and 7.60?±?3.00?mm VS 2.51?±?1.02?mm) after surgery compared with those figures before surgery. The results of this study reveal that vaginal repair could shorten the duration of menstruation and improve anatomical defects (P?<?0.05). Moreover, there was no significant difference in the effect of clinical repair between women with one or two previous cesarean sections (P?>?0.05). CONCLUSION:In CSD patients, the clinical effectiveness of vaginal repair was equivalent between women with one or two previous cesarean sections.
| S-EPMC7181476 | biostudies-literature
Project description:BackgroundCesarean scar defect (CSD) is a potential complication following cesarean section (CS), which has significant clinical implications, and is usually clinically diagnosed by ultrasound. However, the optimal timing for ultrasound diagnosis of CSD after CS has not been well established. This study aimed to evaluate the appropriate time for the diagnosis of CSD after CS by ultrasonography.MethodsThe prospective study involved 120 women who delivered by elective CS with single birth and term birth from January 2021 to June 2022. Sample enrollment was consecutive in the study. Each woman underwent 3 ultrasound examinations for CSD diagnosis at 6 weeks, 6 months, and 12 months postpartum according to a modified Delphi method. The ultrasound indicators about the incision situation were recorded and statistically analyzed. Paired 4-fold table chi-square test was used to evaluate the consistency between the 3 diagnoses. The diagnostic sensitivity and specificity were calculated using a 4-cell table. According to whether the diagnosis was consistent to that at 6 or 12 months, the 120 cases at week 6 were separated into a consistent group and inconsistent group for statistical evaluation of the ultrasound indicators. Additionally, the menstrual duration of the included women was also recorded to analyze the correlation to ultrasound indicators of CSD at 6 months postpartum using the Person correlation coefficient.ResultsThe included 120 women were divided into normal (3-7 days, n=52) and prolonged menstrual period (>7 days, n=68) groups. The 2 groups had no statistical differences in age, body mass index (BMI), gestational week of delivery, assisted reproduction rates, or postpartum complications. Among the 120 women, 100, 66, and 61 women were diagnosed as CSD at 6 weeks, 6 months, and 12 months postpartum, respectively. The results indicated that the diagnostic results of 6 weeks were inconsistent with those of 6 or 12 months postpartum, but the last 2 diagnostic results were consistent. The diagnostic sensitivity of 6 months was 100% and the specificity was 91.53% [95% confidence interval (CI): 85.84-95.26%]. Further, significant differences were found in depth of the defect, and the thickness (T) and ratio of residual muscle between the inconsistent group and the consistent group at 6 weeks. The patients could be considered self-recovered from CSD at 6 months when the defect depth was equal to or less than 4.04±0.82 mm at 6 weeks after CS. Additionally, in the CSD group at 6 months, the length (r=0.828, P<0.001), depth (r=0.784, P<0.001), width (r=0.787, P<0.001) of the defect, the T (r=0.831, P<0.001) and ratio of residual muscle (r=0.821, P<0.001) were strongly correlated with menstrual duration.ConclusionsCSD evaluation at week 6 after CS may cause misdiagnosis or overdiagnosis. The diagnosis of CSD was suggested to be made following 6 months or longer postpartum.
| S-EPMC11320551 | biostudies-literature
Project description:Abstract Although the blunt uterine incision expansion during a low‐transverse cesarean delivery has prevailed over the sharp technique, the latter should not be completely abandoned. The sharp method with scissors should be considered when managing patients with previous cesarean sections, although more studies are required for a definite answer. During a low‐transverse cesarean delivery, the blunt technique is the preferred modality, concerning the maternal outcomes. However, the sharp expansion of the lower uterine segment incision could have a role when delivering women with previous cesarean scars, since it is more controlled, without unintended transverse and vertical extensions, thus resulting in better closure. Nonetheless, more research is required for a definite answer to be given.
| S-EPMC9587506 | biostudies-literature
Project description:BackgroundCesarean section (CS) rate has increased rapidly over the past two decades in China mainly driven by non-medical factors. This study was to compare recalled preferences for CS among first-time mothers in early and late pregnancy with actual delivery mode; to explore factors related to CS preference and CS performed without medical indications; and to consider the role of healthcare providers in delivery mode preferences.MethodsAn anonymous questionnaire survey, combined with data on CS indications taken from the patient record, was conducted among 272 first-time mothers having their first postnatal check-up in one university affiliated obstetrics and gynecology hospital in Shanghai, China, between September 2006 and January 2007. Logistic regression was used to study factors related to the recalled preference for CS and CS performed without medical indication, adjusting for maternal age, education and income.ResultsThe CS rate was 57% (151/263) among all women, 17% with medical indications and 40% without medical indications. For women without medical indications for CS (n = 215), there was no significant difference between women's preference for CS in early (25%) and late pregnancy (28%); 48% of women actually had CS. Women recalled preferring a vaginal delivery but who had CS were more likely to have had a CS suggested by a prenatal care doctor [OR (95% CI): 20 (3.88-107.1)] or by a delivery obstetrician [OR (95% CI): 26 (6.26-105.8)]. Among women recalled preferring and having CS, a suggestion from the prenatal care doctor to have CS was very common.ConclusionsIn the primiparous women without a medical indication for CS, women recall of a provider suggestion for CS was a strong predictor of CS both among women who recalled a preference for CS and among women who recalled a preference for vaginal delivery. Public health education needs strengthening, including discussion of the risks associated with CS and psychological and social support given to women to help them prepare for and cope with childbirth.
| S-EPMC4148545 | biostudies-literature
Project description:BackgroundCardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital.Case presentationA full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications.ConclusionsThe diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.
| S-EPMC10823749 | biostudies-literature
Project description:BackgroundSimulation-based education enhances fundamental and clinical knowledge, procedural abilities, teamwork, and communication skills, as well as quality of care and patient safety. Due to excessive clinical loads and a lack of physicians, even classic teaching methods like bedside instruction are constrained in low-income settings. Thus, this study aimed to ascertain if simulation-based cesarean section education successfully raises non-physician clinician midwives' competency in Ethiopia.MethodsA quasi-experimental study design triangulated with a qualitative design was implemented. Sixty Masters Clinical Midwifery students (29 intervention and 31 control) were taken in 5 universities. Three questionnaires (knowledge, confidence levels, and skills) were used. Qualitative data was also collected from 14 participants. The data were analyzed using SPSS version 25. Descriptive and inferential analyses were conducted. P < 0.05 was used for statistical significance. A difference-in-difference with a 95% confidence level was employed to control the potential confounders for knowledge and self-confidence. Multiple linear regression was fitted to identify the independent effect of simulation-based education interventions while controlling for other variables. Thematic analysis was performed using MAXQDA 2020.ResultThe age of the respondents varies from 24 to 34 years, with the control group's mean age being 28.8 (± 2.3) years and the intervention group's mean age being 27.2 (± 2.01) years. The intervention and control groups' pre-intervention and post-intervention knowledge scores showed a statistically significant difference. There was a substantial increase in self-confidence mean scores in both the intervention and control groups and between the pre-intervention and post-intervention periods in both the intervention and control groups. Furthermore, there was a substantial improvement in cesarean section skills in the intervention group as compared to the control group (59.6 (3.3) vs. 51.5 (4.8). The qualitative findings supported these.ConclusionsThe study showed that simulation-based education improved students' procedural knowledge, self-confidence, and skills. As a result, professional care teams can create simulation-based teaching packages to help students prepare for their residency.
| S-EPMC10722683 | biostudies-literature
Project description:The impact of microbial colonization during early life on immune system development and host health is well-established. Therefore, we investigated whether alterations in the intestinal microbiota resulting from cesarean section (CS) would affect the colonic immune system.
2023-11-22 | GSE231473 | GEO
Project description:Differentially expressed mRNA transcripts in the placenta delivered by term spontaneous labour compared to those delivered by elective term cesarean section. We hypothesized that the labour process involves changes in mRNA expression in the placenta. To test this hypothesis, we interrogated the mRNA levels of >50,000 genes and transcript variants using gene expression microarray (Human Genome U133 Plus 2.0 Array, Affymetrix) on 5 placentas collected from term spontaneous delivery and another 5 placentas collected from elective term cesarean delivery. To minimize the effect of gestational age on gene expression, these two groups of placentas were matched for their gestational ages at delivery. We have identified 134 and 128 genes that were up- or down-regulated, respectively, for more than 3-fold in the term (spontaneous) labour placentas compared to the term (elective) cesarean placentas (Mann-Whitney Rank Sum Test, p-value <= 0.05 after Benjamini and Hochberg adjustment for multiple testing).
2009-11-02 | GSE18850 | GEO