Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

Lower Segment Caesarean Section Audit Is a Promising Tool to Improve the Quality of a Standard Care at a Tertiary Hospital in Kuwait “Cross-Section Study”

Aim: Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to a standard parameter will lead to strategies to avoid unnecessary intervention and to advice uniform practice. The aim was to evaluate the current practice and audit against international standards for various parameters relating to elective lower segment caesarean section and to assess compliance of physicians to audit standards. Subject and methods: This is a cross-sectional study which was in a tertiary hospital in Kuwait from 1st October 2019 until 1st October 2020. The hospital medical, electronic records and case notes of three hundred and twenty-six (326) cases of elective caesarean sections were reviewed for study participants. Those women were booked under the care of internal and external physicians. Demographic data and primary outcomes were collected. Results: Outcome was measuring the compliance to the recognized Caesarean Section international standards: consent form, grade of LSCS, antacid and anti-emetics, type of anesthesia, uses of antibiotics, umbilical cord blood PH, and thromboprophylaxis. The compliance for a signed consent form and cord blood PH was (100%), the use of preoperative antacid and antiemetic was (99.4%), combined regional anesthesia was given in (53.4%) of cases, preoperative antibiotics prophylaxis of second generation cephalosporin was to (61.3%) of cases, post-operative thromboprophylaxis was given in (78.5%) of cases of which (33.6%) completed a 10 days duration. There was a statistically significant difference between internal and external physicians’ compliance regarding, type of anesthesia 2.3 (95% CI, 1.3 - 4.1, p = 0.004), type and timing of antibiotics 0.42 (95% CI 0.22 - 0.79, p = 0.007) and 0.33 (95% CI 0.172 - 0.63, p = 0.0006) and thromboprophylaxis 8.1 (95% CI 2.80 - 23.23, p = 0.000). Conclusion: The results are encouraging, but suboptimal compliance is noticed mainly among external physicians.

Analysis of new bone,cartilage,and fibrosis tissue in healing murine allografts using whole slide imaging and a new automated histomorphometric algorithm

Histomorphometric analysis of histologic sections of normal and diseased bone samples,such as healing allografts and fractures,is widely used in bone research.However,the utility of traditional semi-automated methods is limited because they are labor-intensive and can have high interobserver variability depending upon the parameters being assessed,and primary data cannot be re-analyzed automatically.Automated histomorphometry has long been recognized as a solution for these issues,and recently has become more feasible with the development of digital whole slide imaging and computerized image analysis systems that can interact with digital slides.Here,we describe the development and validation of an automated application（algorithm）using Visiopharm＇s image analysis system to quantify newly formed bone,cartilage,and fibrous tissue in healing murine femoral allografts in high-quality digital images of H＆E/alcian blue-stained decalcified histologic sections.To validate this algorithm,we compared the results obtained independently using OsteoMeasureTM and Visiopharm image analysis systems.The intraclass correlation coefficient between Visiopharm and OsteoMeasure was very close to one for all tissue elements tested,indicating nearly perfect reproducibility across methods.This new algorithm represents an accurate and labor-efficient method to quantify bone,cartilage,and fibrous tissue in healing mouse allografts.