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CESAREAN DELIVERY Edited by Raed Salim Cesarean Delivery Edited by Raed Salim Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Marina Jozipovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published May, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Cesarean Delivery, Edited by Raed Salim p. cm. ISBN 978-953-51-0638-8 Contents Preface VII Chapter 1 How to Manage Labor Induction or Augmentation to Decrease the Cesarean Deliveries Rate 1 Shi-Yann Cheng Chapter 2 Timing of Elective Cesarean Delivery at Term 13 Raed Salim Chapter 3 Anesthesia for Cesarean Section 29 Sotonye Fyneface-Ogan Chapter 4 Cesarean Delivery: Surgical Techniques – The Fifteen Minute Cesarean Section 57 Robert D. Dyson Chapter 5 Evidence-Based Obstetric Anesthesia: An Update on Anesthesia for Cesarean Delivery 69 Andre P. Schmidt and Jose Otavio C. Auler Jr. Chapter 6 Neurological Complications of Regional Anesthesia 93 José Ricardo V. Navarro, Javier Eslava-Schmalbach, Daniel P. R. Estupiñán and Luis A. Carlos Leal Chapter 7 Caesarean Section and Maternal Obesity 109 Vicky O’Dwyer and Michael J. Turner Chapter 8 Breastfeeding After a Cesarean Delivery 121 Sema Kuguoglu, Hatice Yildiz, Meltem Kurtuncu Tanir and Birsel Canan Demirbag Chapter 9 Determining Factors of Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako – Mali) 161 I. Teguete, Y. Traore, A. Sissoko, M. Y. Djire, A. Thera, T. Dolo, N. Mounkoro, M. Traore and A. Dolo Preface Child birth is a natural process, but in certain circumstances, cesarean delivery is necessary to save the life of a child or mother. This issue is more acute in low income countries, where cesarean delivery rates are well below the acceptable minimum standard of 5% outlined by the World Heath Organization. In this book, the authors describe how poor healthcare access, underdeveloped healthcare infrastructure, geographical inaccessibility, cultural mistrust, poverty, and paucity of human health resources can become barriers for providing cesarean deliveries to all women who need them. Several studies in West Africa emphasized this gap by demonstrating increased maternal mortality due to a smaller proportion of deliveries performed by caesarean delivery. On the other hand, rates of cesarean delivery, especially in high income countries, have risen dramatically over the last 30 years and the worldwide increase in the cesarean delivery rate has become a major public health concern. Reasons for the dramatic increase in the cesarean delivery rate are complex. This increase was driven in part by the increased incidence of multiple gestations and the decreased incidences of vaginal births after cesarean and vaginal breech deliveries. However, lifesaving indications for cesarean delivery represent only a small proportion of this increase in the cesarean delivery rate. Much of the increase comes from unproven conjectures concerning the advantages of caesarean delivery. It seems that the cesarean delivery has become a modern standard of care, though, much controversy still exists. Recently, demands for elective cesarean delivery have increased due to concern regarding pelvic floor disorders following vaginal delivery, a reduction in cesarean complication rates and women having fewer children. As more women are delivering by cesarean, new concerns have emerged regarding long term maternal risks particularly placenta accreta and uterine rupture following a trial of labor. Regarding the short term complications, the rate of maternal mortality and severe morbidity that include thromboembolic events, major puerperal infection, severe hemorrhage, intestinal obstruction, injuries to the urinary tract and operative interventions after delivery is significantly more frequent among women undergoing cesarean delivery than vaginal delivery. Due to the worldwide dramatic increase in obesity during the past 20 years, these complications are expected to rise. VIII Preface Additionally, more women are postponing pregnancy into the fourth and fifth decades of life for a variety of reasons. Older women are more likely to have cesarean delivery without labor. Severe complications for women older than 35 years are more frequent than for younger women. Since the rate of cesarean delivery is constantly increasing for mothers of all ages, races, and ethnic groups a growing number of women are expected to experience at least some of these complications. In view of that, this book provides on the one hand evidence based reports and practical steps that may be adopted in an effort to reduce the cesarean delivery rate, and on the other hand, the book provides the best and up to date perioperative guidelines (where available) and tips to help improve health care quality among women undergoing cesarean delivery with special attention to obese women. Pregnant women require special consideration when anesthesia is provided. Airway problems and difficult tracheal intubation are 10 times more frequent in the parturient than in the general population and are a major cause of maternal morbidity and mortality. Additionally, the increased use of regional anesthesia in the last decades has resulted in a lack of experienced anesthesiologists for providing general anesthesia in the emergent obstetric setting. Due to the considerable importance of this issue, broad coverage of the issue of obstetric anesthesia is provided. The book includes guidelines and a systematic review that anesthesia providers should know in obstetrics and a friendly-user review of anesthesia care for obstetric patients. Cesarean surgery is strongly associated with delayed early breastfeeding, poorer infant suckling, more formula supplementation, and a shorter duration of breastfeeding. The book provides tips and guidelines of how to help establish and maintain exclusive breastfeeding shortly after the procedure including in cases of multiple gestation. In conclusion, this book provides a convenient source that will aid to answer several questions related to the procedure; for example what is an "appropriate" cesarean delivery rate? Can the cesarean delivery rate be safely reduced? What are the obstacles for an acceptable cesarean delivery rate in the sub-Saharan African countries? When to perform an elective cesarean at term? Which anesthetic technique to use? What are the difficulties and complications that are related to obstetric anesthesia? How to perform the procedure in 15 minutes? Why morbidly obese women need special attention? And is it feasible to breastfeed directly after a cesarean? The authors answer all these questions through practical evidence based, comprehensive review of the clinical, social, ethical, and economic considerations. To succeed in these selected objectives, distinguished experts from different disciplines were selected to ensure accurate coverage of the recent scientific and clinical advances to bring to care providers and purchasers up to date and essential information to help improve health care quality. I am very grateful to all my colleagues who have contributed to this valuable book. Preface IX Last, I am very grateful to all the "InTech team" for their help and support with this project. It has been a privilege and a pleasure to work with these dedicated personals. Dr. Raed Salim Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel [...]... groups according to the delivery method adopted: elective cesarean delivery, emergent cesarean delivery, and vaginal delivery Only elective cesarean delivery was protective They concluded that the key to the best protection against postpartum urinary incontinence seems to lie in the timing of the cesarean delivery; that is, the cesarean delivery Timing of Elective Cesarean Delivery at Term 21 has to... all been 18 Cesarean Delivery reported from the use of the scalpel or scissors at the time of cesarean delivery [3] Although traumatic delivery is still associated with cesarean delivery, it is uncommon with elective, compared to non-elective cesarean delivery of the vertex fetus at term (Hankins et al., 2006) In the term breech trial, 6% of women who were assigned to a planned cesarean delivery, delivered... according to the mode of delivery After forceps delivery, the incidence was 35%, 23% after spontaneous vaginal delivery, 9% after cesarean during labor and 4% after cesarean before labor By 6 months, these prevalence figures were 33%, 22%, 12%, and 5%, respectively (Farrell et al., 2001) Chin et al assessed the impact of delivery on the pelvic floor and to what degree could cesarean delivery prevent pelvic... Introduction The rate of cesarean delivery is constantly increasing for mothers of all ages, races, and ethnic groups (Martin et al., 2005) In view of that, timing of elective cesarean delivery at term has an essential public health implication Term gestation, by definition, is a gestation of 37 weeks to 42 weeks from the day of the last menstrual period Though infants born by elective cesarean delivery within... degree, cesarean delivery may protect child-bearing women from developing urinary incontinence is an unresolved issue Several prospective studies evaluated the risk of postpartum urinary incontinence by delivery type, grouping all cesarean deliveries together and reported inconsistent results The best data to investigate in order to evaluate the impact of cesarean delivery is that which separates out cesarean. .. operative interventions after the delivery was significantly more frequent after non-elective cesarean delivery than after elective cesarean delivery There were more severe complications in the group of women older than 35 years than in the younger women (Pallasmaa et al., 2008) In another retrospective study, the prevalence and risk factors for bladder injury during cesarean delivery were investigated Operator... delivered by elective cesarean section In a retrospective study of 1,284 elective cesarean deliveries, Zanardo et al reported that respiratory distress syndrome was diagnosed at a rate of 25 per 1,000 live births when cesarean delivery occurred between 37 0⁄7 weeks and 38 6⁄7 weeks of gestation, versus a significantly lower rate of respiratory distress syndrome, 7 per 1,000, with cesarean delivery after... elective cesarean delivery from 38 to 39 weeks may have maternal and other fetal consequences that are not always addressed in studies that recommend delaying delivery to 39 weeks (Salim et al., 2009; Salim & Shalev, 2011) Delaying delivery for an additional week increases the time that the woman and her fetus is vulnerable to a number of unexpected complications and increases the proportion of women 14 Cesarean. .. cesarean delivery, delivered vaginally because cesarean delivery was not possible due to imminent vaginal delivery (Hannah et al., 2000) Perinatal mortality and serious neonatal morbidity of the breech presenting fetus are significantly lower in planned cesarean delivery than for vaginal birth according to the term breech trail Delaying an elective cesarean delivery scheduled for breech presentation may... of when to schedule elective cesarean delivery; 38 or 39 weeks Since several studies indicated that neonatal outcomes are improved by delaying cesarean until 39 weeks of gestation, the American College of Obstetricians and Gynecologists as well, recommended delaying cesarean delivery until 39 weeks of gestation in the absence of obstetric or medical indications for early delivery However, if dating . CESAREAN DELIVERY Edited by Raed Salim Cesarean Delivery Edited by Raed Salim Published by InTech Janeza. hard copies can be obtained from orders@intechopen.com Cesarean Delivery, Edited by Raed Salim p. cm. ISBN 978-953-51-0638-8 Contents