Adjuvant Rectal Diclofenac for Post Operative Analgesia after Caesarean Section—A Randomized Controlled Study

BACKGROUND: Pain management following caesarean section still remains a challenge in our environment. Most potent analgesics are either not readily available or expensive. Diclofenac suppository is an NSAID that can be used for postoperative analgesia. It is available and affordable. OBJECTIVE: To compare the efficacy and safety of combined rectal diclofenac and intramuscular pentazocine with intramuscular pentazocine alone for post operative pain control following lower segment caesarean section. METHODOLOGY: A total of 120 women who met the selection criteria scheduled for caesarean section under spinal anaesthesia with bupivacaine were randomized into two equal groups to receive either 75 mg diclofenac suppository 12 hourly for 24 hours or one anusol suppository (the placebo) 12 hourly for 24 hours. Both groups received pentazocine as primary analgesia. RESULT: The primary outcome measure is the proportion of patients with severe pain at 24 hours using the visual analogue rating scale. Secondary outcome measures are the time from surgery to ambulation, Passage of flatus, maternal satisfaction and presence of complications. Statistical analysis was done using spss version 22 and graph pad statistical package. Student T-test was used for continuous variables whereas chi square was used for categorical variables P CONCLUSION: Adjuvant rectal diclofenac is superior to pentazocine alone in the management of pain after caesarean section. Less number of patients had moderate to severe pain at 24 hours post operation. Maternal satisfaction in relation to pain management is better with diclofenac suppository. The levels of complications were comparable in both groups.

Effect of Single- versus Double-Layer Uterine Closure during Caesarean Section on Niche Formation and Menstrual Irregularity

Background: The myometrium at the location of the CS (caesarean section) scars, also known as residual myometrium thickness (RMT), is larger after a double-layer uterine closure procedure than following a single-layer one. It may lessen the formation of a niche that is the myometrium’s disruption at the location of the scar of the uterus. Gynecological manifestations, obstetric problems in a future pregnancy and birth, and maybe subfertility are linked to thin RMT and a niche. Objective: To ascertain if double-layer unlocked closure of the uterus is better than single-layer one in terms of post-menstrual spotting and niche development following a first CS. Patients and Methods: In this randomized clinical study, 287 patients were evaluated for qualifying. Of all eligible individuals, 57 patients were excluded from the study based on the inclusion criteria. Results: The variation in ages, gestational age, body mass index (BMI), and cesarean section indications between the two assigned groups is statistically insignificant. However, postmenstrual spotting was statistically significantly more common in single-layer group compared to in double-group. The current study revealed ultrasound findings suggestive of niche formation was statistically significantly more common in single-layer group compared to in double-layer group. Conclusion: As evident from the current study, it demonstrates the advantages of double-layer unlocked closure of the uterus over single-layer one in terms of post-menstrual spotting and niche development following first-time cs. Thus, we deduced that fewer niches are formed, and fewer menstrual spotting occurs in the presence of double unlocked layers closure. To ascertain the impact of uterus closure method on post-operative niche development and the risk of obstetrics and gynaecological problems, further prospective trials with extended follow-up periods are required.

A Review of Caesarean Delivery at the Kogi State Specialist Hospital, Lokoja, Nigeria

Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean delivery rate at the Kogi State Specialist Hospital, Lokoja, Nigeria over a one-year period. Methods: This was a prospective assessment of the demographic characteristics of patients, indications, types, rates and outcomes of Caesarean delivery in Kogi State Specialist Hospital, Lokoja, Nigeria from December 15, 2020 to December 14, 2021. Data collected were analyzed using SPSS version 20.0 statistical package (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The categorical data were displayed using tables and charts. Results: There was a total of 491 deliveries, out of which were 113 Caesarean deliveries and 378 spontaneous vaginal deliveries making the Caesarean delivery rate in Kogi State Specialist Hospital, Lokoja, Nigeria 23.0%. There were no instrumental deliveries during the study period. The commonest indication for Caesarean section was obstructed labour in 31% of cases. There was no maternal mortality. There were three early neonatal deaths due to severe birth asphyxia. Conclusion: The rate of Caesarean delivery in this study was 23.0% and obstructed labour was the leading indication in 31% of cases. The rate of Caesarean delivery in this study is high, albeit the overall outcome was good for both mother and child. Caesarean delivery, therefore, remains one of the means for reducing maternal and perinatal morbidity and mortality in Nigeria.

Balloon displacement during caesarean section with pernicious placenta previa: A case report

BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.

Evaluation and Relevance of Indications for Primary Caesarean Section: A Five-Year Experience Report from Nevers Hospital Center

Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for primary caesarean sections and to find ways to reduce the increasing rates. Patients and Method: This is a longitudinal and retrospective study carried out from June 1, 2018 to July 31, 2022. The study included all patients who had a cesarean-section for the first time (primary caesarean). An anterior uterine scar was a non-inclusion criterion. Data were collected prospectively using Synfonievre and Agopra software via patients’ files and information collection sheet. Data were analyzed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentages for qualitative data. The statistical tests used were the Pearson Chi2 test. The observed differences were considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by the other indications (including preterm delivery, umbilical cord dystocia, malpresentation of fetus, foetal abnormalities, elective CS, triple gestation, mother abnormalities);dystocia or prolonged labor (18.7%), breech presentation in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation during of a twin birth and a singleton. Induction of labor can be an effective alternative in certain indications. An obstetrical audit is needed to reverse the caesarean section rate.

Effect of Intravenous Tranexamic Acid in Reducing Blood Loss during and after Elective Caesarean Section in a Third Level Health Institution: A Randomized Controlled Study

Background: Blood loss during caesarean section (C/S) may lead to postpartum haemorrhage, and is one of the direct causes of maternal mortality and morbidity globally. Tranexamic acid is recommended in the treatment of postpartum haemorrhage (PPH) if oxytocin and other utertonics are ineffective in controlling PPH. In this centre it is not used prophylactically to reduce blood during caesarean section. Aim: To assess the effect of prophylactic intravenous tranexamic acid on blood loss during and after elective C/S at the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a prospective, single-blind, randomized, placebo-controlled interventional study conducted at the Obstetric theatre of UPTH from July 2020 to March 2021. Eligible women were randomized into two groups;seventy-two women received intravenous tranexamic acid while seventy-one women received a placebo. Socio-demographic data and the result of the study were collected through a proforma. Data collected was analyzed using Statistical Package for Social Sciences (SPSS) Version 22.0. The results were expressed in tables and charts as frequencies, percentages and mean. Chi-square test, Fisher’s exact, and T-test were used to determine the relationship between variables. P-value ≤ 0.05 was considered statistically significant. Results: The findings showed that tranexamic acid significantly reduced mean blood loss during and after C/S (p-value post-surgery was significantly lower in the tranexamic acid group (624.88 ± 200.76 ml) in comparison to the placebo group (864.24 ± 229.09 ml), p-value = 0.001. The mean post-C/S packed cell volume (PCV) was significantly higher among the tranexamic acid group (30.68% ± 2.80%) in comparison to the placebo group (28.07% ± 3.27%), t = 5.131, p-value = 0.0001. The maternal side effects were nausea and vomiting, 9 (12.5%) and 1 (1.4%) participants respectively. Conclusion: Tranexamic acid significantly reduced blood loss during and after elective C/S. Maternal side effects were less with tranexamic acid use.

Analysis of the Caesarean Section Rate in Armenia for the Period 2016-2021 Based on the Results of a Single Center Study

Background: The caesarean section rate is an important factor that characterizes the effectiveness of the obstetric service. The large variability of the initial state of women in labor and the variety of indications for surgery does not allow us to identify the main determinants. We attempted to determine and analyzed the first data on the structure and frequency of caesarean section in Armenia in the hospital of the Erebоuni multidisciplinary clinic before the introduction of the M. Robson scale. Methodology: We conducted a retrospective study of the history of childbirth in 38,111 patients registered at the Erebouni Medical Center for the period 2016-2021. The materials of the study were case histories, hospitalization materials and annual reports. Results: According to the obtained data, 80.5% of caesarean section operations were performed as planned. Only 14% of pregnant women were delivered by caesarean section according to absolute indications, the frequency of that in this maternity hospital increased from 36.77% to 44.95% over the analyzed period Conclusion: Thorough psychoprophylactic preparation of pregnant women for childbirth, including those with a scar on the uterus after a previous cesarean section, can ensure a steady desire of women in labor for vaginal delivery, full mobilization of their own capabilities, and more trusting cooperation with medical staff.

Prevalence, Indications and Morbidity of Caesarean Sections in a Referral Hospital of the Health Voucher Program: The Case of Garoua Regional Hospital in the Northern Region of Cameroon

Caesarean section (CS) is a surgical procedure performed to remove a fetus from the mother’s uterus through an incision on the abdominal wall, then on the uterine wall. The indications of CS vary not only between countries, but also from one hospital to another and from one team to another within the same hospital. Despite advances in asepsis and anesthesia/resuscitation technics, there are still complications of varying severity inherent to the gravid-puerperal state on one hand and the technics used on the other, irrespective of the operative indication. Thus, the present study was carried out with the objectives of determining the prevalence, identifying the indications, and evaluating the morbidity linked to caesarean sections in our environment. Cameroon has also set up a health voucher program in its northern region, aimed at reducing maternal and fetus morbidity and mortality. The program aims to improve financial access in antenatal care and deliveries, including caesarean sections, in this low-income region of the country. We conducted a descriptive cross-sectional study with retrospective data collection, from February 1, 2022, to May 31, 2022. We included all women who gave birth by caesarean section. In our study series, out of 905 parturient admissions into the Department of Obstetrics and Gynecology, 226 were caesarian cases. The overall frequency of CS during our study period was 25%. Fetal indications were dominated by cephalopelvic disproportion and non-reassuring fetal heart in 17.3% and 13.7% of cases respectively. Intraoperative complications were dominated by hemorrhage (15.5%). In our study, we noted an 11.1% of prevalence perinatal mortality. Cameroon is a low-income country with limited financial resources, especially in the Northern region. The health voucher program has improved financial access to caesarean sections for parturient in northern Cameroon, and consequently to emergency obstetric and neonatal care.

Ultrasound Evaluation of Caesarean Scar of Prelabour and Labour Caesarean Sections: A Cross Sectional Analytical Study

Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the size of the uterine scar and the residual myometrial thickness (RMT) are associated directly with the risk of uterine rupture and risk of dehiscence in subsequent deliveries. Impact of the prelabour and labour Cesarean section on the RMT has not been studied in detail. Objectives: To compare RMT, Caesarean scar defects and to evaluate the elasticity of the Caesarean scar between women who underwent prelabour and labour Caesarean sections. Methods: This was a Cross sectional analytical study. Women who underwent Caesarean section in their first pregnancy were recruited. Sample was stratified to prelabour and labour Caesarean section groups. Transvaginal ultrasound scan was performed six months following the Caesarean section. Dimensions of the uterus, uterine scar defect, RMT and elastosonography of the uterine scar were assessed. Results: A total of 240 postpartum women were analyzed. Uterine niche was detectable in 194 subjects. Prelabour CS group had demonstrated 91.7% (n = 110) scar defects (uterine niche) out of 120 cases and the rate among labour CS group was 70% (n = 84). There was a significant difference in the presence of uterine niche among 2 groups as Prelabour group was found to have more scar defects (p mm (SD 1.2) and 4.99 mm (SD 1.3) respectively and there was no significant difference (t = 0.38, p = 0.71). There was no significant difference between the dimensions of the uterine CS defects of the studied groups. Prelabour CS group had significantly higher Target strain [0.28 vs. 0.24 (t = 2.12, p = 0.04)] and significantly less strain ratio [1.45 vs. 1.55 (t -2.42, p = 0.04)] than labour CS group indicating a better scar in prelabour group. Conclusion: There was no significant difference in RMT and uterine scar defects between prelabour and labour Caesarean section groups. But prelabour Caesarean section scars were less stiff than labour Caesarean section scars. Further studies are warranted to elaborate on the association.

Double balloon device compared to oxytocin for induction of labour after previous caesarean section

Objective: To assess cervical changes, duration of oxytocin infusion, mode of delivery and complications after cervical ripening using a double balloon device in women with a previous caesarean section. Methods: Longitudinal study including 80 women with a previous caesarean section, no previous vaginal delivery and an unfavourable cervix (Bishop

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Background: Management of postoperative pain after caesarean section (C/S) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.

Maternal and Foetal Outcomes Associated with Caesarean Deliveries in Patients with Severe Preeclampsia in Two Teaching Hospitals, Yaoundé

Introduction: Severe preeclampsia is a frequent cause of maternal death, and also a frequent indication for caesarean deliveries when faced with the need to expedite delivery. We sought complications specific to caesarean deliveries in patients with severe preeclampsia. Methods: It was a case-control study carried out over 6 months, from December 1st, 2015 to May 31st, 2016 at the Yaoundé Central and the Yaoundé Gynaeco-Obstetric and Paediatric Hospitals. We evaluated 159 women undergoing a caesarean delivery to assess the risk of maternal and foetal postoperative complications in patients with severe preeclampsia. Significance level was set at 0.05. Results: The incidence of postoperative complications stood at 26.4%. Maternal and foetal complications were more frequent in preeclamptic women at 54.5% versus 11.5% (p < 0.05) and 47.3% versus 27.9% (p < 0.05) respectively. The incidence of adverse events was greater in women with preeclampsia: pruritus and limb pain (RR = 2.96;p < 0.001), the persistence of high blood pressure (RR = 4.51, p < 0.001), maternal death (RR = 2.93, p < 0.001), postpartum convulsions (RR = 3, p < 0.001) headaches resistant to first-line analgesics (RR = 3, p < 0.001), Disseminated Intravascular Coagulation (DIC) (RR = 2.92, p < 0.001), a cute pulmonary oedema (RR = 2.92, p < 0.001), prematurity (RR = 4.43, p < 0.001), neonatal asphyxia (RR = 2.93, p < 0.001), and hyaline membrane disease (RR = 2.93, p Conclusion: Severe preeclampsia is associated with an increased risk of postoperative complications.

Laparoscopic repair of uterine rupture following successful second vaginal birth after caesarean delivery: A case report

BACKGROUND With the increasing trend of vaginal birth after caesarean delivery(VBAC),evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering.Intrapartum uterine rupture is diagnosed in approximately one-fifth of all VBAC cases following successful vaginal delivery.To our knowledge,no report is available on the application of laparoscopy to repair postpartum uterine rupture after a successful second VBAC in China.CASE SUMMARY A 31-year-old woman(gravida 5,para 2)at 39 wk and 5 d of gestation was admitted to the hospital in labour.After a successful VBAC and observation for approximately 13 h,the patient complained of progressive abdominal pain.Given the symptoms,signs,and auxiliary examination results,intraperitoneal bleeding was considered.Because the patient was stable and ultrasound imaging was the only method available to assess the possibility of rupture,we recommended laparoscopy to clarify the diagnosis and for prompt laparoscopic uterine repair or exploratory laparotomy if necessary.Operative findings included transverse uterine scar rupture at the lower uterine segment of approximately 5.0 cm in length and 800 mL of intraoperative pelvic haemoperitoneum.Finally,she successfully underwent laparoscopic repair of uterine rupture and recovered very well according to three-dimensional magnetic resonance imaging at 42 d postpartum.CONCLUSION Routine postpartum intrauterine exploration is not beneficial to the mother and may even increase the risk of rupture.This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period.

Non-Medical Determinants of Caesarean Deliveries in Ghana: A Logistic Regression Approach

This study examined the non-medical factors that influence expectant mothers to opt for caesarean deliveries in Ghana. Data on 395 expectant mothers across the ten regions of Ghana who were located in urban, semi-rural and rural areas, and spanned a period of five years (from 2012 to 2016) were obtained from the Ghana Health Service. In fitting the logistic regression model, data on 355 expectant mothers (i.e. 89.9% of the data) was assigned to the analysis sample while 40 (i.e. 10.1%) was assigned to the hold-out sample. The hold-out sample together with other statistical measures of overall model fit, pseudo R2 measures and classification accuracy were used to validate the results obtained from the analysis sample. Significance was tested at p = 0.05. Determinants including, educational level of expectant mother, parity of expectant mother, baby’s birth weight, previous caesarean delivery, location of expectant mother, age of expectant mother and, period within the year of childbirth had a significant effect on caesarean delivery. The study recommended that health practitioners should be able to foretell expectant mothers who are likely to undergo caesarean delivery in order for them to prepare financially and psychologically to avoid further complications. Due to the significant positive attitude of women towards caesarean delivery rather than normal delivery, it is necessary to inform them about the advantages of normal delivery and the health hazards associated with caesarean delivery to the mother and child.

Application of predictive model for vaginal birth after caesarean delivery

Medical practitioners are concerned with the selection of delivery mode after caesarean delivery.Several researchers have developed numerous models for predicting vaginal birth after caesarean delivery.This study selected seven widely used and representative advanced models,such as those of Grobman,Troyer and Parisi,Schoorel,Flamm,Gonen,Weinstain and Smith et al.,analysed the constitutions and clinical applications of the models and identified the factors associated with patients to provide midwives a scientific reference for vaginal delivery evaluation of pregnant women after caesarean delivery.

Bacterial Meningitis Following Spinal Anesthesia for Caesarean Section

Bacterial meningitis has a potentially devastating outcome if there is any delay in diagnosis and treatment. There are multiple routes at which bacteria could migrate into the subarachnoid space. Lumbar puncture bypasses the natural defense barrier of central nervous system and therefore carries a risk of transmitting infection to the meninges. We report a case of post spinal bacterial meningitis in a post partum lady who underwent spinal anaesthesia for emergency lower segment caesarean section. She developed signs and symptoms of meningitis twenty-eight hours post procedure. Her cerebrospinal fluid (CSF) analysis was suggestive of bacterial meningitis and she made a full recovery.

Increasing rate of Caesarean Section Due to Non-Reassuring Cardiotocography

Objective: To evaluate increasing rate of caesarean section due to non-reassuring cardiotocography. Methods: This study is carried out in obs/gyn department of Liaquat university hospital from 2012 to 2013. After permission from ERC, patients enrolled for study meeting inclusion criteria with non-reactive cardiotocography undergo caesarean section, and results are analysis through SSPS version 17. Results: There was wide variation of maternal age ranging from a minimum of 20 years to 30 years. The mean age was 26 ± 2.1 years. In our study mostly patients were primigravida 58 (58%) between 2 - 4 were 22 (22%) more than para 5 were 20 (20%) patients. In our study mostly patients undergone caesarean section 81 (81%) 19 delivered vaginally (19%). In our study the gestational age was >37 weeks, ranging from a minimum of 37 weeks to 42 weeks. The mean age was 37 + 2.4 week. Mostly patients observed 37 - 38 wks in (52.67%), 39 - 40 wks in (32.14%) and 41 - 42 wks in (15.17%). In our study mostly Apgar score were more than 7 was 63 (63%) cases and less than 7 Apgar score in 37 (37%). Conclusion: Cardiotocography is a useful and indispensable adjunct to monitor the condition of endangered fetus. However, there is a need to develop a standardized and unambiguous definition of FHR tracing to reduce the incidence of false positive findings that may result in increased incidence of unnecessary intervention particularly caesarean section.

Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

Background: Quality control of care aims to reduce or eliminate unnecessary care and to improve the quality of those who are useful both in their indication and in their implementation. Objective: We conducted this study to assess the rate of caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean deliveries from other health structures and referred to Laquintinie Hospital due to morbid operative follow-up. The variables collected were grouped under 3 main headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out of a total of 967 deliveries;a caesarean section rate of 29.06% in 4 months. After data mining, 250 caesarean sections were included in the study because 31 cases of caesarean deliveries were unusable. Referred pregnancies accounted for 46.8% of the total population and the most common reason for referral was stationary labour (23% of cases). All caesareans were performed by the gynaeco-obstetricians. Women who had caesarean deliveries were informed by the operator of the surgical procedure in 28.4% of cases and 27.6% were notified of the indication for surgery. The operative kit was present in 98% of cases. The operating room was available in 93% of cases. Caesareans were performed mostly in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative complications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal deaths out of which 8 were still births. Regarding the postoperative period, 78% of the operated patients did not have a good immediate postoperative monitoring. The post-operative protocol was not respected in 17% of cases. Postoperative complications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal suppurations). Conclusion: The frequency of Caesarean sections at Laquintinie Hospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time of emergency caesareans, far above the international standards despite the quasi-availability of operating kits and the operating theatre. The state of the premises reveals a sub-workforce creating work overload and therefore a demotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative follow-up and significant neonatal morbidity and mortality. Hence the need to initiate a staff satisfaction survey.

Trial of Labour after Caesarean Section: A 5-Year Review

Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.

Caesarean Scar Ectopic Pregnancies—Case Series from a District General Hospital

Caesarean Scar Ectopic Pregnancy (CSEP) is a rare, but potentially catastrophic complication of a previous Caesarean Section (CS) birth. This is a review of 5 cases of CSEP managed in our Early Pregnancy Unit at Watford General Hospital within a 10-month period. Two patients had only one previous CS, whilst 2 had two and the last had 3 previous CS. All our patients presented within the first trimester of pregnancy (range 6 to 11 weeks’ gestation) with light vaginal bleeding;4 of them had associated mild to moderate abdominal pain. All were diagnosed using transvaginal ultrasound scan. Three of our patients were managed surgically by Suction Evacuation under Ultrasound guidance and insertion of a Foley’s catheter prophylactically for tamponade in order to reduce blood loss both intra- and post-operatively. One of our patients had a heterotopic pregnancy with a viable intrauterine pregnancy and a live CSEP. She declined any intervention so she was managed conservatively with weekly Consultant appointments and scans. There was a subsequent demise of the CSEP and she continued with a singleton pregnancy. None of our patients were managed medically. There is no absolute consensus on diagnostic criteria and there is no standard management protocol so each woman should be given all the available information and the opportunity to decide on the management of her pregnancy. The risk of a CSEP in a subsequent pregnancy should be part of the consent process for CS.