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The NHS will have to pay millions of pounds in compensation after a baby was left severely brain damaged because his mother, a refugee, could not understand English. Barking, Havering and Redbridge University Hospitals NHS Trust was liable for Nilujan Rajatheepan’s injuries because staff failed to communicate to his mother how to feed him properly, Judge Martin McKenna ruled at the High Court. Nilujan was born by emergency caesarean section on the night of 16 July 2009 at King George Hospital in Goodmayes, Essex. His Apgar scores and blood cord readings were normal, and a consultant paediatrician who examined him had no concerns. Nilujan’s parents were Tamil refugees from Sri Lanka, and his 21 year old mother, Sinthiya, spoke only a very few words of English. She went through the formal discharge …

Over one in four pregnancies are induced in the UK. The rationale, indications, methods, advantages and disadvantages of induction of labour are reviewed. Modern induction methods have become increasingly safe and acceptable to mothers and do not result in increased medical intervention. In fact, the converse is true—lower emergency Caesarean section rates are observed in induced compared to expectantly managed pregnancies. Common areas of litigation are reviewed and the issue of whether all women should be offered induction of labour at term discussed.

Background: The volume of the gastric fluids and the gastric pH both are affected during pregnancy and surgery. The gastric fluid volume and pH are also affected by the mode of surgery (elective caesarean section and emergency caesarean). Objective: The predetermined aim of this study was to compare the gastric fluid pH in emergency with elective caesarean sections. Method: The study was conducted in Divisional Headquarters Teaching Hospital, Mirpur, Azad Kashmir and the sample population was consisted of 150 patients. The sample was divided into two groups, the patients with emergency caesarean section and elective caesarean section group. The gastric volume and gastric pH were detected in both groups of the study. Results: The group of the patients in the emergency caesarean section showed lower gastric pH value (2.16 ± 0.64) and the gastric acid volume was (26.33 ± 10.59). In comparison, the gastric pH value for elective caesarean section was (4.56 ± 1.28) and gastric acid volume was (11.65 ± 4.37) respectively. The results were found to be significant at p-value

Objective To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome. Methods Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.) is a randomized controlled trial of term (37 + 0 to 41 + 6 weeks' gestation) singleton pregnancies with cephalic presentation requiring instrumental delivery by vacuum extraction, which was conducted between April 2014 and June 2017 and involved 13 Italian maternity hospitals. Patients were randomized to assessment of fetal head position before attempted instrumental delivery by either vaginal examination (VE) alone or VE plus transabdominal sonography (TAS). Primary outcome was incidence of emergency Cesarean section due to failed vacuum extraction. A sample size of 653 women per group was planned to compare the primary outcome between the two groups. The sample size estimation was based on the hypothesis that the risk of failed vacuum delivery in the VE group would be 5% and that ultrasound assessment of fetal position prior to vacuum extraction would decrease this risk to 2%. Results On interim analysis, the trial was stopped for futility. During this period, 222 women were randomized and 221 were included in the final data analysis, of whom 132 (59.7%) were randomized to evaluation of fetal head position by VE only and 89 (40.3%) to assessment by VE plus TAS prior to vacuum extraction. No significant differences were observed between the two groups with respect to incidence of emergency Cesarean section due to failed instrumental delivery and other maternal and fetal outcomes. Women randomized to assessment by VE plus TAS showed higher incidence of non-occiput anterior position of the fetal head at randomization and lower incidence of incorrect diagnosis of occiput position compared with women undergoing assessment by VE alone. A higher rate of episiotomy was noted in the women undergoing both VE and TAS compared with those in the VE-only group. Conclusions Our prematurely discontinued randomized controlled trial did not demonstrate any benefit in terms of reduced risk of failed instrumental delivery or maternal and fetal morbidity in women undergoing sonographic assessment of fetal head position prior to vacuum extraction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Introduction: Caesarean section is one of the most performed surgical procedures all over the world. The present study was conducted to determine the maternal & neonatal outcome and complications in two groups of pregnancy among women with elective and emergency cesarean section. So that measures can be taken to reduce morbidity and mortality in near future. Material & Methods: A prospective observational study carried out in department of Obstetrics and Gynecology, M.G.M Medical College and M.Y. Hospital ,Indore (M.P). All patients who underwent caesarean section are divided into two groups as per the timing of procedure in emergency or electively. The two groups were compared on the basis of age, parity, indication, booking status, intra operative & post op complications, and maternal & fetal outcome. Results: The incidence of caesarean section was 30.25%. The proportion of elective and emergency caesarean was 21.63% and 78.37% respectively. All of the complications were significantly higher in emergency group in terms of both maternal and fetal outcome. Conclusion: The incidence of caesarean section is high in MGM medical college Indore and the overall complication rate is higher in emergency caesarean than elective caesarean section group.

To determine the effect of obesity on decision-to-incision and decision-to-delivery time intervals in emergency Caesarean section.We performed a retrospective study of emergency Caesarean sections performed between 2005 and 2009. Indications for emergency Caesarean section were defined as those posing an immediate threat to the life of the mother or fetus. The primary outcomes were the time intervals from decision for emergency delivery to skin incision, and decision to delivery of the infant. The secondary outcome was a composite of poor neonatal outcomes comprising umbilical cord artery pH lt; 7.20, Apgar score lt; 7 at five minutes, admission to NICU, or neonatal death.A total of 232 women underwent emergency Caesarean section, and 140 of these met the inclusion criteria. At the time of delivery, 78/140 (55.7%) patients were categorized as obese (BMI ≥ 30kg/m2). The median decision-to-incision and decision-to-delivery intervals were significantly longer in the obese group, with a median delay of 4.5 minutes in both time intervals. Time-to-event analysis demonstrated prolongation of the decision-to-incision interval in the obese group (hazard ratio 0.71, P lt; 0.05). There was no difference in the neonatal composite outcome, but there was a significant reduction in median five-minute Apgar score in the obese group (P = 0.02).Obesity is associated with prolonged decision-to-incision and decision-to-delivery intervals, without associated neonatal morbidity, in a tertiary hospital setting. Further studies are required to assess the specific factors limiting expedient delivery in this population.

Introduction: We report the case of a patient with antepartum HELLP syndrome and simultaneous rupture of the right liver lobe. An emergency caesarean section was performed and the liver rupture was managed surgically via perihepatic packing. The mother and her child recovered well and were discharged 19 days after admission. Case Report: We describe a case report and review the literature. Based on our own experience and the most common clinical presentations of such patients, we were able to establish an algorithm for managing such cases. Conclusion: An association between liver rupture and HELLP syndrome is rare but was previously described in several case reports. In pregnant women with HELLP syndrome and acute onset abdominal pain, a potential spontaneous hepatic rupture should be taken into consideration.

Pneumothorax can be primary or secondary. Primary pneumothorax is caused by rupture of undiagnosed pleural blebs or bullae.[1] The incidence of primary spontaneous pneumothorax is higher in males than females.[2,3] This article highlights the fact that spontaneous pneumothorax should be considered a differential diagnosis while managing a patient with acute onset respiratory distress in the immediate post-operative period even when the surgery (in this case a lower segment caesarean section) is performed under spinal anaesthesia.

Introduction: Caesarean section has avoidable morbidity which may lead to mortality especially in developing world. Caesarean section is a major operation which should be performed with maximum care and safety. Objectives: This study aimed to find incidence, indications, procedures and maternal outcome of re-laparotomy after caesarean delivery. Methods: This was a descriptive cross sectional prospective total coverage hospital based study conducted at Omdurman Maternity Hospital from June 2014 to January 2015. Results: The incidence for re-laparotomy after Caesarean section is (0.66%) and the main indication for re-laparotomy is hemorrhagic events. Re-laparotomy outcome reported 22 cases (64.7%) alive and well and 6 cases (17.6%) alive with morbidity (renal failure and massive blood transfusion complications) and 6 cases (17.6%) of maternal mortality mainly due to sepsis. Conclusion: Re-laparotomy after Caesarean section is contributing to morbidity and maternal mortality. The majority of re-laparotomy was done after emergency Caesarean section. Lacks of skills, experience; safety measures of perfection and infection control are points to be concern.

Pregnancies complicated with velamentous cord insertion (VCI) are at risk of adverse perinatal outcome. Placental and umbilical cord assessment should be performed during routine obstetric ultrasound. We report a case of velamentous cord insertion that was not identified antenatally. A 28-year-old primigravida at 40 weeks gestation presented in active phase of labour. Intrapartum, cardiotocography (CTG) tracing was pathological. Thus, decision was made for emergency caesarean section and a velamentous cord insertion was found. Despite a favourable outcome, this case highlighted the importance of antenatal diagnosis of VCI and thus preventing catastrophic outcome.

Peripartum cardiomyopathy is a unique and rare kind of cardiomyopathy of unknown cause that occurs during pregnancy or the postpartum period. Regional anaesthesia for anaesthetic management of this condition has been extensively described. There are limited reports of anaesthetic management of caesarean section of this case under general anaesthesia. We report a case of 32 years old lady diagnosed to have peripartum cardiomyopathy requiring emergency caesarean section that was successfully managed under general anaesthesia. Anaesthetic management was directed towards optimization of myocardial contractility, preload and after load.

We report the first case of chikungunya-dengue co-infection during pregnancy requiring emergency Caesarean section (CS) because of fetal distress in a Bangladeshi primigravida. Though previously unreported, this situation may become increasingly common.

Achondroplasia is the most common cause of dwarfism which results from a spontaneous fibroblast growth factor receptor gene mutation. Affected patients typically have short limbs and large head. The safe delivery of anaesthesia requires the understanding of the pathophysiology of this disease.

Background: The positive association between caesarean section (CS) and autism spectrum disorder (ASD) may be attributed to preterm delivery. However, due to lack of statistical power, no previous study thoroughly examined this association across gestational age. Moreover, most studies did not differentiate between emergency and planned CS.Methods: Using population-based registries of four Nordic countries and Western Australia, our study population included 4 987 390 singletons surviving their first year of life, which included 671 646 CS deliveries and 31 073 ASD children. We used logistic regression to estimate odds ratios (OR) and their 95% confidence intervals (CI) for CS, adjusted for gestational age, site, maternal age and birth year. Stratified analyses were conducted by both gestational age subgroups and by week of gestation. We compared emergency versus planned CS to investigate their potential difference in the risk of ASD.Results: Compared with vaginal delivery, the overall adjusted OR for ASD in CS delivery was 1.26 (95% CI 1.22–1.30). Stratified ORs were 1.25 (1.15–1.37), 1.16 (1.09–1.23), 1.34 (1.28–1.40) and 1.17 (1.04–1.30) for subgroups of gestational weeks 26–36, 37–38, 39–41 and 42–44, respectively. CS was significantly associated with risk of ASD for each week of gestation, from week 36 to 42, consistently across study sites (OR ranged 1.16–1.38). There was no statistically significant difference between emergency and planned CS in the risk of ASD.Conclusion: Across the five countries, emergency or planned CS is consistently associated with a modest increased risk of ASD from gestational weeks 36 to 42 when compared with vaginal delivery.

Emergency caesarean section is required when delivery can reduce the risk to the life of the mother or foetus. When a caesarean section is indicated for foetal compromise, a decision-to-delivery interval of 30 min (or less) has been suggested as the ideal time frame within which an obstetric team should achieve delivery. In theory, a short decision-to-delivery interval may minimise intra-uterine hypoxia and improve neonatal outcome. Current medical evidence does not support this time frame. There are certain indications for caesarean section that necessitate a much shorter decision-to-delivery interval, but evidence suggests that the majority of neonates may be safely delivered within a longer interval of time. Current tools available for the diagnosis of foetal distress are imperfect, and the concept of foetal distress is poorly defined. Future research should focus on finding accurate means of diagnosing foetal distress in labouring women and establishing universally agreed evidence-based decision-to-delivery targets without compromising maternal or foetal safety.

A total of bitches presented to University Veterinary Hospital Kokkalai belonging to different canine breeds where included in the study to compare between spontaneous whelping SW assisted whelping AW and emergency C section EC out of which bitches were presented with difficulty in whelping and were normal whelping Mean age of the bitches in AW EC and SW was plusmn years plusmn and plusmn years respectively Out of bitches presented with difficulty in whelping bitches were primiparous Gestational length calculated from the last breeding date was plusmn days plusmn days and plusmn days in AW EC and SW respectively Gestational age of the foetuses determined by ultrasonography in AW and EC ranged from to plusmn days and to plusmn days respectively Heart rate of the foetuses determined by ultrasonography in AW and EC ranged from bpm to plusmn bpm and bpm to bpm plusmn respectively Out of bitches presented with difficulty in whelping per cent whelpings were managed with medical therapy using ecbolics per cent whelpings were managed with medical therapy along with manipulative delivery and per cent whelpings were managed with emergency Caesarean section

BACKGROUND About 40,000 women have caesarean section in Scandinavia each year. Organizational factors for emergency caesarean section (CS), classification, anaesthetic practice, alarm chain, intrauterine resuscitation has all been investigated in the United Kingdom, but no information from the Scandinavian countries exists. METHODS Using publicly available data from the National Board of Health, obstetric anaesthetic departments were identified. The heads of the departments provided e-mail contact details of two anaesthesiologists regularly practicing obstetric anaesthesia who were then surveyed. RESULTS One hundred and forty-five specialists from 82 departments in Scandinavia replied to our survey. Ninety-five percent of Danish specialists reported a three-grade classification system for urgency CS. Where classification in Denmark was enumerative classification, Norwegians equally reported enumerative and verbal descriptors, whereas Swedish specialists mostly reported verbal descriptors. Local guidelines describing decision-to-delivery interval for emergency CS was reported by 100% of Danish specialists vs. 47% from Norway and 85% from Sweden. Mean benchmark decision-to-delivery interval for emergency CS was 12.7 min. General anaesthesia for emergency CS was highly favoured in Norway (95%) and Sweden (97%), compared to Denmark (49%). Twenty specialists reported existence of local guidelines for intrauterine resuscitation. CONCLUSION Our survey of Scandinavian specialists indicate emergency CS practise differs from United Kingdom practices in several aspects; general anaesthesia is by the majority of Scandinavian specialists reported as the default choice for emergency CS and benchmark for decision-to-delivery interval is

Background Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of our study was to determine the DDI and its associated fetalmaternal outcomes at a tertiary referral hospital in Tanzania. Methods This was a retrospectivecross-sectional study of inpatient cases who underwent emergency caesarean section from January to September 2014. Data were collected from birth registry and case files of patients. Data analysis was performed using statistical package for social science (SPSS) version 22.0. Odds ratio (ORs) and 95% confidence interval for maternal and fetal outcomes associated with DDI were estimated using Logistic regression models. A p-value of less than 5% was considered statistically significant. Results A total of 598 women who underwent emergency caesarean section were recruited. The median Decision Delivery Interval was 60 min [IQR 40–120]. Only 12% were operated within 30 min from decision time. Shortest DDI was seen in patients with Cephalopelvic Disproportion (CPD) and uterine rupture (40 min and 45.5 min) as compared to other conditions. Cases with impending uterine rupture, cord prolapse, APH and fetal distress showed to have shorter DDI. There was no significant association between DDI and neonatal transfer,1st and 5thminute Apgar score, maternal blood loss (OR: 5.79; 95% CI 0.63–1.64) and hospital stay (OR: 1.02; 95% 0.63–1.64). Conclusions Contrary to the recommended DDI by ACOG & AAP of 30 min is not feasible in our setting, time frame of 75 min could be acceptable but clinical judgment is required to assess on the urgency of caesarean section in order to prevent maternal and neonatal morbidity and mortality.

The number of caesarean sections performed worldwide has increased over the last two decades. There are many reasons for including: changing demographics, the rising age of first-time mothers, rising levels of obesity, a maternal preference in some countries for caesarean section over vaginal delivery, a rising proportion of multiple births, increasing medico-legal concerns and organizational factors. Many of these factors are interrelated.

Objective: To explore potential risk factors for the emergency caesarean section in term, singleton pregnancies. Methods: A retrospective population based case-control study in term deliveries from the University Hospital in Brno, Czech Republic collected between 2014 and 2016. Cases were deliveries by emergency caesarean section; controls were all others modes of delivery. We excluded elective caesarean from the populations.

We report a case of twin pregnancy in a malformed uterus incidentally discovered during an emergency caesarean section relating to a primigravida at CHU-MEL in Cotonou. The patient is a 25-year-old woman referred from a neighbourhood center, without particular antecedents, admitted there because of an acute fetal distress at 38 weeks of amenorrhea +1 day. The objective examination presents two hemi-vaginas and two hemi-cervixes. The Acute fetal distress diagnosis is confirmed. By means of a caesarean section on 10th June 2016, two male twins have been removed by the cephalic pole from a bicornuate bicervical uterus, J2 being mature and weighing 2700 g and J1 the other presenting signs of prematurity and weighing 1200 g. Referred to the neonatal unit, J2 is allowed to leave after 24 hours of hospitalization and J1 after 5 days of hospitalization. Postoperative care has been simple for the mother and the new-born babies are healthy. Both mother and children are allowed to leave the 5th day after operation.

Anesthesia for emergency caesarean section for a pregnant patient with severe dorsolumbar kyphoscoliosis and severe anemia is associated with potential risks for both mother and the fetus due to alterations in maternal physiology and the pathological changes associated with kyphoscoliosis. In an emergency situation, the anesthesiologist has to quickly choose the anesthetic technique depending on the cardiopulmonary status of the patient and feasibility. We present a case of a 20 year old parturient in labour with severe kyphoscoliosis and severe anemia who was posted for emergency caesarean section. In view of severe anemia, anticipated technical difficulties with central neuraxial blocks and emergency situation, she was administered general anesthesia (GA) with uneventful recovery.

The SAFE handover tool was developed to reduce critical omissions during handovers in obstetric anaesthesia. It comprises a simple proforma onto which the outgoing team documents patients who fall into one of four anaesthetically relevant categories: Sick patients; At-risk patients (of emergency caesarean section, major haemorrhage or anaesthetic problems); Follow-ups; and Epidurals. We hypothesised that its use would reduce the number of critical omissions at handover.The efficacy of the SAFE handover tool was assessed through several audit cycles in a single maternity unit. The four SAFE categories were considered the gold standard, since they encompassed the consensus opinion of senior obstetric anaesthetists with respect to parturients they most wanted to know about at handover. Against these criteria it was possible to compare the number of cases that should have been handed-over against the number that were actually handed-over.After implementation of the handover tool, patients were four times more likely to be handed-over than without the use of the tool: an increase from 49% to 79% of relevant cases (P0.0001, OR 4.1, 95% CI 2.19-7.6). The handover tool was particularly effective at increasing the handover rates of Sick and At-risk parturients, which increased from 21% to 67% (P0.0001, OR 7.7, 95% CI 2.7-21.7) and 25% to 78% (P0.01, OR 9.9, 95% CI 1.6-61.6), respectively.The SAFE handover tool significantly increased handover rates of anaesthetically relevant parturients. It is easy to remember and consistent with UK National Health Service Litigation Authority's guidance on risk management in maternity units.

Residents' competency-based training and multidisciplinary cooperation are needed for rapid sequence spinal anaesthesia for fetal distress. Multiple standard but 'crash' spinal anaesthesia for non-obstetric procedures is imperative for acquisition of experienced hands. The purpose of this review is to share our modest experiences in the use of rapid spinal anaesthesia for emergency Caesarean delivery in pregnant women complicated with fetal distress. Fetal distress diagnosis is made promtly, intravenous line put in place in labour ward. Pre-loading or not, one-touch, non-touch spinal technique prevents unnecessary delay and further fetal hypoxic injury. Spinal pack is on stand by in the operating room at all time. Preloading is possible during the waiting period for other care providers otherwise coloading is used. A single wipe of the back with chlorhexidine lotion is frequently used for scrubbing. Lidocaine infiltration or spay is essential and does not waste time but opioid as adjuvant to bupivacaine wastes a lot of time to constitute and measure. So, opioid should be avoided. Average of 2.5 ml of 0.5% hyperbaric bupivacaine is frequently used in our centres. Surgery starts almost immediately after cleaning and drapping of the patient by the obstetrician. Ephedrine is made handy and constituted in case there is hypotension which fluid alone cannot treat.

Heterotaxy syndromes refer to disorders of lateralisation whereby the arrangement of abdominal and thoracic viscera differ from normal and are mirror-images of normal.[1] They are classified into two main subgroups, right-sided isomerism with asplenia, and left-sided isomerism with polysplenia. The patients of right-sided isomerism with asplenia have more severe congenital heart diseases and lateralisation defects when compared with left-sided isomerism.[2] We present a primigravida with single ventricle heterotaxy syndrome for emergency caesarean section managed under graded lumbar epidural anaesthesia.

Summary Globally, the emergency caesarean section rate has been rising. The majority of caesarean sections are done using regional techniques rather than general anaesthesia. For general anaesthesia, the use of supraglottic airway devices can be considered and an obstetric difficult airway algorithm is vital in the management of the difficult airway. Regional anaesthesia can be done through various techniques, including single shot spinal, epidural and combined spinal epidural anaesthesia, as well as less commonly used methods, such as rapid sequence spinal and continuous spinal anaesthesia. This article discusses the indication for different methods of anaesthesia and their advantages and risks. There are also some updates regarding decision-to-delivery time, prophylactic antibiotic administration and preoxygenation duration based on recent guidelines and studies.

Uterine prolapse is herniation of the pelvic organ to vaginal walls or beyond the vaginal, walls as well as it is the most common gynecologic problem that has made by stretching and weakening of muscles and connective tissues. Incidence of total and partial uterine prolapse is around one per 10000 to 15000 deliveries. This study is about a 33- year-old Iranian (Balouch lady) G5P4L4 who had been reffered to maternal ward of Emam Ali hospital of Zahedan city in the 35 weeks and 3 dayes of gestation age with uterine prolapse and labor pain. She was prepared to Cesarian Section with normal lab analysis and was done emergency caesarean section and was born a baby boy with 2150 g and Apgar score10/10.

It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward. Objective To investigate the intensive care nurses’ experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections. Design Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis. Setting The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study. Result The analysis yields the theme ‘The challenges of caring for infants on a postoperative unit’ covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant.

Background To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference in the rates. Methods Cross-sectional analysis using a combination of two routinely collected administrative databases was performed. A non-linear extension of the Oaxaca-Blinder method is used to decompose the difference between public and private ELCS and EMCS rates into the proportion explained by the differences in observable maternal, clinical, and hospital characteristics and the proportion that remains unexplained. Results Of the 29,870 babies delivered to nulliparous women, 7,792 were delivered via CS (26.1 %), 79.6 % of which were coded as EMCS. Higher prevalence of ELCS was associated with breech presentation, other malpresentation, and the mother being over 40 years old. Higher prevalence of EMCS was associated with placenta praevia or placental abruption, diabetes (pre-existing and gestational), and being over 40 years old. The private model of care is associated with ELCS and EMCS rates 6 percentage points higher compared than the public model of care but this differential is insignificant in the fully adjusted models for EMCS. Just over half (53 %) of the 6 percentage point difference in ELCS rates between the two models of care can be accounted for by maternal, clinical and hospital characteristics. Almost 80 % of the difference for EMCS can be accounted for. Conclusions The majority of the difference in EMCS rates across models of care can be explained by differing characteristics between the two groups of women. The main contributor to the difference was advancing maternal age. The unexplained component of the difference for ELCS is larger; an excess private effect remains after accounting for maternal, clinical, and hospital characteristics. This requires further investigation and may be mitigated in future with the introduction of clinical guidelines related to CS. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1494-3) contains supplementary material, which is available to authorized users.

To identify risk factors for emergency caesarean section in women attempting a vaginal breech delivery at term.Data from 1092 breech deliveries performed between 1998 and 2013 at a Swiss cantonal hospital were extracted from an electronic database. Of the 866 women with a singleton, full term pregnancy, 464 planned a vaginal breech delivery. Fifty-seven percent (265/464) were successful in delivering vaginally. Multivariate regression analyses of risk factors were performed, and neonatal and maternal complications were compared.Risk factors for failed vaginal delivery were peridural anaesthesia (OR 2.05; 95 % CI 1.09-3.84; p = 0.025), nulliparity (OR 2.82; 95 % CI 1.87-4.25; p 0.001), high birth weight (OR 1.17; 95 % CI 1.04-1.30; p = 0.006) and induction of labour (OR 1.56; 95 % CI 1.003-2.44; p = 0.048). Maternal age, height and weight; gestational age; or newborn length and head circumference were not associated with an unplanned caesarean section. The rate of successful vaginal delivery in the low risk sub-group (multiparous women without induction of labour) was 58-83 %, depending on birth weight category. The likelihood of success for the high risk sub-group (nulliparous women with induction of labour) fell below a third at neonatal birth weights3250 g. Complication rates were low in the cohort.Use of peridural anaesthesia, nulliparity, high birth weight and induction of labour were risk factors for unsuccessful vaginal breech delivery requiring an unplanned caesarean section. Awareness of these risk factors is useful when counselling women who are considering a vaginal breech delivery.

SUMMARY The author of Master’s thesis: Edita Puskunigytė The title of Master’s thesis: Successful natural childbirth of newborns who weigh more than 4250 g. The Head of thesis: Assoc. Prof. Daiva Simanavičiūtė Research performed at: Faculty of medicine, Medical academy, Lithuanian University of Health Sciences. Kaunas, 2016, 33 p. The aim of work: To determine how many natural childbirths were successful in newborns who weigh more than 4250 g at Department of Obstetrics and Gynaecology in 2014. Methods and materials: This is a retrospective study where case histories of women who gave birth to newborns weighing more than 4250 grams at Department of Obstetrics and Gynaecology in 2014 and data of newborn registry were analysed. This study enrolled 151 patients. The results were assessed using the statistical analysis method of “IBM SPSS Statistics”. Results: 59.6% of newborns bigger than 4250 grams were born naturally, 1.99% - using vacuum extractor and 38.41% by C-section. 24.1% of C-sections were performed electively and 22.4% were emergency C-sections because of cephalo-pelvic disproportion. The necessary diagnostic criteria were matched for cephalo-pelvic disproportion in all cases of emergency c-section. Duration of childbirth was statistically significantly longer in patients who developed cephalo-pelvic disproportion in comparison to those who gave birth naturally (p=0.002). Half of the women (50%) who gave birth naturally needed episiotomy or suffered IIº perineal tear and 2.22% of the women had severe perineal tears. One third (33.33%) had no perineal tears despite size of the newborn. The most common complication to newborns who were born naturally was acromial dystocia (7.78%) and lower Apgar score, p

The study explored the decisions women made in relation to mode of birth following a previous emergency lower segment caesarean section (emLSCS), particularly focusing on what different factors influenced women to choose a particular mode of birth and what they described as the rationale underpinning that decision. \ud \ud Participants were recruited from a population of students and staff within the School of Human and Health Sciences at a university in the north of England. Sixteen individuals were selected using convenience sampling, who then completed open-ended questionnaires. The questions were non-leading and asked the women to identify and expand upon factors that influenced their decision on mode of birth. Data were analysed using a basic thematic framework analysis. \ud \ud Many of the identified themes mirrored those well recognised in existing research: the woman’s previous birth, her perception of risks, the influence of professionals and the influence of peers were all apparent. One factor not explored in existing literature, namely a sense of duty to existing children, appeared to be strongly influential in this data set. Interestingly, it was observed that each woman’s philosophical framework and her relationship with the element of control substantially underpinned her consideration of key factors, leading her to an individual decision. \ud \ud This article provides an interesting insight into the complexity of individual decision making in maternity care. The findings highlight the fact that professional guidelines may fail to meet the personal and individual needs of their subjects. This is a thought-provoking topic for policy and guideline authors, as well as for the professionals who counsel patients through decision-making processes in maternity care and wider fields of healthcare.

For the purpose of clinical definition, pregnancy is divided into two halves, each of 20 weeks. Any pregnancy loss before 20 weeks is classified as abortion and after 20 weeks, when the fetus is well-formed, as fetal loss.

You have just examined Mrs X in the postpartum clinic. She is complaining of breast pain and discomfort. You have established a diagnosis of postpartum mastitis.

A 20 year old female with Klippel Feil Syndrome was scheduled for emergency caesarian section during her 1st pregnancy. We present the successful anaesthetic management of this patient highlighting the various anomalies associated with Klippel Feil Syndrome and the presence of a difficult airway.

A 32-year-old is in labour for the last 8 h. She had a previous uneventful vaginal birth at term. She has just broken her waters and there is meconium staining of the liquor amnii. The CTG shows late decelerations. Per vaginam examination shows that the cervix is 6 cm dilated with presenting part at −3 station. You suggest an emergency caesarean section in view of fetal distress, but she declines the same and wants to continue trying for a vaginal birth as she believes she will be fine as it is her second delivery. What should you do?