Teses / dissertações: "Caesarean section"

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Hillan, Edith M. "Outcomes of Caesarean section". Thesis, University of Glasgow, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.257964.

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Handley-Derry, Frances. "Repeat elective caesarean: decision-making for women with a previous caesarean section". Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=119507.

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Context: Among women with a prior caesarean section, 82.2% will have another caesarean delivery. The Society of Obstetrics and Gynaecology of Canada (SOGC) recommends that physicians offer medically eligible women with a previous caesarean section a trial of labour, to attempt a vaginal delivery. With greater inclusion of the patient in medical decision-making, it is important to understand women's part in this decision-making process. Objectives: To describe women's decision-making by looking at: 1) whether the decision was reported as primarily physician- or patient-driven 2) women's reasons for repeat caesarean section, 3) women's main information sources. Methods: For one year women booked for a repeat elective caesarean section, who were eligible for a trial of labour according to the 2005 guidelines of the SOGC, were approached with the survey in hospital post-partum, and invited to participate in the study. Chart review was used to determine eligibility, and obtain other medical characteristics. Results: Most of the women (77 %) reported being involved in the decision about their caesarean section. However, almost a quarter reported wholly physician-driven decisions (23 %). The main reasons women selected for a caesarean section related to their previous birth experience, and the physician's recommendation. Women born outside of Canada, with less education or who were allophones, were less likely to report using certain information sources, such as the Internet, and to find the information in the hospital-provided pamphlet useful. All in all, the women who received less information were more likely to report solely physician-driven decisions. Conclusion: Although patient involvement in decision-making is the norm, some decisions for caesarean section are made without the patient. Women's concerns, such as fear of a failed vaginal delivery, play an important role in this decision-making. Overall, immigrant women may understand less about their birth options than their Canadian peers. Addressing these concerns during pre-natal counselling may aid more fully informed consent, help assuage women's fears of vaginal birth and may increase the number of women attempting a trial of labour.
Contexte : Parmi les femmes ayant déjà subi une césarienne, 82 % auront un autre accouchement par césarienne. La Société d'Obstétriques et Gynécologie du Canada (SOGC) conseille aux médecins d'offrir aux femmes éligibles l'option d'essayer un accouchement vaginal. Avec l'inclusion des patients dans les décisions médicales, il est important de comprendre le rôle des femmes dans ce processus de décision. Objectif : Décrire le processus de décision en évaluant : 1) si la décision vient premièrement du médecin ou du patient, 2) les raisons données par les femmes pour le choix d'une césarienne, 3) les principales sources d'information utilisées par les femmes. Méthodes : Au cours d'une année, les femmes enregistrées pour une césarienne, et éligible pour un accouchement vaginal selon le SOGC 2005, ont été approchées à l'hôpital postpartum et invitées à participer à l'étude. Le dossier médical a été utilisé pour déterminer l'éligibilité et d'autres caractéristiques médicales. Résultats : La majorité des femmes (77%) ont participé à la décision concernant le choix d'une césarienne, mais à peu près un quart (23 %) ont rapportée que la décision a été faite entièrement par le médecin. Les femmes ont indiqué que des raisons reliées aux peurs d'un accouchement vaginal, et aux recommandations du médecin, ont supporté le choix d'une césarienne. Les femmes nées ailleurs, avec moins de scolarité, ou allophones ont moins utilisé certaines sources d'informations, telles que l'Internet, et ont trouvé l'information dans le dépliant de l'hôpital moins utile. En général, les femmes ayant reçu moins d'information ont été plus susceptibles de rapporter une décision faite seulement par leur médecin. Conclusion : Bien qu'il y ait souvent la participation de la patiente dans le processus de décision, quelques décisions concernant le choix d'une césarienne sont faites sans la patiente. La peur d'un accouchement vaginal joue un rôle important dans la décision. Dans l'ensemble, les immigrantes pourraient moins bien comprendre leurs options d'accouchement que les femmes canadiennes. Considérer ces problèmes lors du suivi pré-natal pourrait aider au processus de consentement, soulager les peurs reliées à un accouchement vaginal, et peut-être augmenter l'acceptante d'un essai d'accouchement vaginal.

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Shakoor, Jenan Akbar. "Raised maternal body mass index and caesarean section". Thesis, University of Newcastle Upon Tyne, 2013. http://hdl.handle.net/10443/1800.

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Introduction Maternal obesity (defined as a body mass index (BMI) ≥30kg/m2) and overweight (defined as BMI 25-29.9kg/m2) have adverse implications for both the mother and the baby, including an increased risk of caesarean section. The prevalence of caesarean section among the UK obstetric population has been increasing in recent years. Evidence suggests that caesarean section in obese women may carry a higher risk of postoperative complications, such as haemorrhage, wound infection and delayed healing. These complications may result in a longer length of stay in hospital after caesarean delivery. To date, UK evidence on the association between maternal BMI and caesarean section has been limited. Aim The overall aim of my PhD was to investigate the association between maternal BMI and caesarean section within the North East of England. Methods and Results My PhD consists of three phases: Phase one: a review of the available published literature that investigated the association between maternal BMI and caesarean section rate. The review found that most studies been carried out in the US with only six from the UK. The review highlighted the need for further research in the UK. Phase two: an investigation of the association between maternal early pregnancy BMI and caesarean section using an existing dataset of 42,362 deliveries in five hospitals in the North East of England. The objectives of this phase were; to identify the caesarean section rate among five hospitals in the North East of England; to describe the caesarean section rate by booking BMI; and to examine the independent impact of BMI on caesarean section, adjusting for potentially confounding variables including maternal age, gestational age, birth weight, ethnicity and socio-economic status in overweight and obese pregnant women compared to pregnant women with recommended BMI. In phase two, the overall caesarean section rate was 20.6%; 28.4% of obese and 21.9% of overweight women delivered by caesarean section, compared to 17.8% of women with recommended BMI. After adjusting for available confounding factors, the adjusted odds ratio (aOR) for caesarean section among obese women was 1.81 (95%CI: 1.67-1.97; p<0.0005) and 1.29 (95%CI: 1.20-1.39; p<0.0005) among overweight women compared to women with recommended BMI. Thus, there was an almost two-fold increased risk of delivery by caesarean section among women who were obese at the start of pregnancy and an increased risk for women who were overweight. Phase three: a case note review of 205 women with a singleton pregnancy in 2008, aged ≥16 years and delivered by caesarean section in a district general hospital in the North East of England. The study hypothesis was that overweight and obese pregnant women have more post-caesarean section complications than pregnant women with recommended BMI, resulting in a longer length of stay in hospital. The results of this study showed that from 205 cases (28% of all caesarean section deliveries in 2008), 86 (42.0%) were to women with recommended BMI, 54 (26.3%) to overweight and 65 (31.7%) to obese women. The median length of maternal stay in hospital was three days, with an inter quartile range (IQR) of 2-3. Twelve (18.5%) obese women stayed in hospital after caesarean section for four days compared to five (9.3%) overweight and eight (9.4%) women with recommended BMI, (p=0.44) but this was not significant. There were no significant differences in postoperative complications or length of stay in hospital between overweight and obese pregnant women compared to women with recommended BMI. Conclusion Overall, my study confirms that obese and overweight women in the North East of England are at increased risk of caesarean section. Among women delivered by caesarean section, however, there was no association between maternal BMI and post-operative complications or length of stay in hospital.

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Naji, Osama. "Ultrasound studies of caesarean section scar in pregnancy". Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/19445.

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Incomplete healing of CS scars has become a recognised sequel to this operation, and is associated with complications in later pregnancies. These can include caesarean scar pregnancy (CSP), a morbidly adherent placenta, scar dehiscence or rupture. To date there is uncertainty relating to the recognition of poor scar healing and the factors that lead to it. In recent years, there has been an increase in studies using ultrasound imaging to describe scars as deficient, or incompletely healed. However, these studies were carried out in the non-pregnant state, with a paucity of data to associate the described morphology of these scars to the functional integrity of the lower uterine segment (LUS) in subsequent pregnancy, or the actual performance in labour. We hypothesised that unenhanced transvaginal sonography (TVS) is a valid and reproducible method of assessing CS scars in pregnant women, and it can provide relevant clinical information on the effects these scars might have in pregnancy. To investigate the validity of TVS as the imaging modality of choice, we proposed a standardised approach for obtaining scar measurements. Furthermore we established a consensus agreement for nomenclature and methodology in imaging and reporting CS scars. We tested the reproducibility of the agreed methods throughout the course of pregnancy and our data showed that TVS could reliably delineate CS scar with good interobserver and intraobserver variability (IOV). We also investigated the influence of different scar dimensions on pregnant women from early pregnancy, during placental development, throughout the antenatal course and at delivery in terms of implantation sites, vaginal bleeding, and placental location, as well as the effects of scar changes on the final scar appearance at repeat CS, or during trials of vaginal birth after caesarean section (VBAC). Our data demonstrated that women who attended the early pregnancy assessment unit (EPAU) with a previous history of CS had more vaginal bleeding but similar spontaneous miscarriage rates in comparison to women without a history of CS. However, the implantation sites in the scarred uterus were significantly different from the non-scarred uterus. In the second trimester there were also significant differences in placental location. In the CS group there were more posterior and fewer fundal placentas than in the control group. We found that CS scars underwent significant changes to their shape and dimensions from the second trimester onwards. These scars were affected by the physical expansion of the gravid uterus and expanded accordingly in a cephalo- caudal pattern. Finally, we have demonstrated that certain scar measurements in the second trimester were associated with particular scar appearance at repeat caesarean delivery, and potentially predicted the likelihood of uterine scar rupture. We integrated this information and developed a prediction model on the likelihood of achieving successful VBAC from the earlier stages of pregnancy. In conclusion our data confirms that CS scar can be reliably assessed by ultrasound scan, and certain scar features are associated with complications that can be anticipated from as early as 6 weeks gestation. The results of our study provide important new information, which if validated externally may have significant bearing on our understanding of the impact of CS on the uterus, and the management of women planning to attempt a vaginal delivery after a previous CS.

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Tikkala, Jessica. "Trends in Caesarean Section Deliveries among nulliparous women". Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-48503.

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Копиця, Тетяна Володимирiвна, Татьяна Владимировна Копица e Tetiana Volodymyrivna Kopytsia. "Relationship between abnormal placentation and previous caesarean section". Thesis, Sumy State University, 2015. http://essuir.sumdu.edu.ua/handle/123456789/41289.

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Hesselman, Susanne. "Caesarean Section : Short- and long-term maternal complications". Doctoral thesis, Uppsala universitet, Obstetrik & gynekologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-327934.

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Caesarean section is a common major surgical procedure and long-term complications have not been fully investigated. By longitudinal population based register studies, based on National health registers and medical data records, maternal complications after caesarean delivery at subsequent labour (N=7 683), among extremely preterm births (N=406), and at remote gynaecologic surgery (N=25 354) were explored. In Paper I, uterine closure was investigated in respect to uterine rupture in a subsequent delivery after caesarean section. Uterine rupture occurred in 1.3 % of women with a previous caesarean section. There was no increased risk of uterine rupture with single compared with double layers for closure of the uterus (adjusted Odds Ratio 1.17, 95 % CI 0.78-1.70). Modifiable risk factors of uterine rupture in a trial of labour after caesarean section included induction of labour and use of epidural analgesia. In Paper II, maternal outcomes and surgical aspects of caesarean section in the extremely preterm period were assessed. Maternal complications were more frequently reported in extremely preterm- compared with term caesarean delivery. No increase in short-term morbidity was observed at 22-24 compared with 25-27 gestational weeks, but uterine corporal incisions were performed more frequently (18.1 % vs. 9.6 %, p=0.02). Furthermore, risk factors for abdominal adhesions after caesarean section and organ injury in remote gynaecologic surgery were analysed (Paper III and IV). Numbers of prior caesarean sections were the most important factor for formation of adhesions. Advanced maternal age, obesity, infection and delivery year 1997-2013 were factors associated with adhesions in conjunction with caesarean section. Organ injury occurred in 2.2 % of women undergoing benign hysterectomy. A history of caesarean section increased the risk (adjusted Odds Ratio 1.74, 95 % CI 1.41-2.15), but was only partly explained by the presence of adhesions. The organ affected depended on medical history; prior caesarean predisposed for bladder injury, prior bowel/pelvic surgery for bowel injury and endometriosis was associated with ureter injury at time of hysterectomy. In conclusion; data from National health registers indicates that caesarean delivery is associated with long-term complications, although the absolute risk of severe complications for the woman is low.

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Munday, Judy. "Perioperative temperature management for women undergoing Caesarean section". Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/103084/1/Judith%20Munday%20Thesis.pdf.

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Perioperative hypothermia is a significant problem for women undergoing caesarean section but this population has been previously neglected in internationally accepted evidence-based recommendations for thermal care in surgical patients. This three-phased, in depth exploration of the phenomenon, has advanced understanding of the effectiveness of methods to prevent perioperative maternal hypothermia, particularly for women receiving intrathecal morphine. Findings confirm that temperature decline is significant across this vulnerable population and support recommendations for the development of health service policies and thermal management guidelines that incorporate consistent use of combined, multi-modal, effective warming strategies employed both preoperatively and intraoperatively in the place of single interventions.

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Chung, Pui-yi Rebecca, e 鍾佩儀. "A clinical audit on Caesarean section indications and outcomes". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971003.

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Chung, Pui-yi Rebecca. "A clinical audit on Caesarean section indications and outcomes". Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971003.

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de, Vries Bradley Stephen. "The Prediction and Prevention of Caesarean Section in Labour". Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18544.

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Increasing caesarean section rates are a global phenomenon. It is widely believed many procedures are unnecessary and there are many opinions about what (if anything) to do about it. Attempts to limit the trend have had little noticeable success. This thesis is about reducing caesarean section in labour, and focuses on the concept that it can be predicted, and then prevented by induction of labour. Patterns of caesarean section over 27 years were described in two Sydney hospitals. The increase in primary caesarean sections was mostly due to increases in emergency procedures for slow labour, and elective procedures for malpresentation. Most of the overall increase was due to repeat procedures. Induction of labour before 40 weeks’ pregnancy reduced caesarean section rates for slow labour. Vaginal birth rates varied widely by indication for induction. Neonatal head circumference, cervical length, estimated fetal weight, and a combination of biparietal diameter and abdominal circumference were associated with caesarean section for slow labour. Demographic, clinical and ultrasound factors were included in a predictive model used in a protocol for a randomised trial of induction of labour at 39 weeks’ pregnancy. We also developed a method of creating centile birthweight standards which reflect fetal growth described by ultrasounds. Such charts could be used as part of a tool to screen for risk of perinatal mortality and enrolment into a randomised trial for improving perinatal outcomes. The work in this thesis adds to human knowledge by describing in detail how caesarean section rates and indications evolved over time. It adds to the understanding of associations between induction of labour, ultrasound, and demographic factors with caesarean section for slow progress in labour, allowing inferences to be made about how induction of labour prevents caesarean sections. It adds a new method for creating birth weight standards and a protocol for a randomised trial.

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Lam, Wai-yee Wendy. "Abdominal wound infection after caesarean delivery in a district hospital". View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36887122.

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Emmett, Clare Louise. "Decision Aids for Mode of Delivery after Previous Caesarean Section". Thesis, University of Bristol, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486120.

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Background: Pregnant women with one previous caesarean section (CS) must consider their preference for mode of delivery. For most this involves a choice between attempted vaginal birth after caesarean (VBAC) and elective CS. Decision aids are interventions designed to assist patients to make treatment choices and have been shown to be beneficial in a variety of health settings. Aim: To design and evaluate two computer-based decision aids to assist pregnant women with one previous CS with decision making about preferred mode of delivery. Methods: This thesis reports four components of the research 1) A qualitative interview study involving 21 postnatai women which explored women's experiences of decision making. 2) The developm~ntoftwo computer-based decision aids by a multidisciplinary team. 3) A qualitative piloting study involving 15 postnatal and 11 antenatal women. 4) A randomised controlled trial (RCT) to evaluate the two decision aids (Information Program or Decision Analysis Program) compared to usual care. 742 women with one previous CS participated in the RCT. The primary outcomes were decisional conflict at 37 weeks' gestation and actual mode of delivery. Results: The interview study established a need for the decision aids by highlighting potential inadequacies in the provision of information in routine care. The piloting study showed that the proposed decision aids were acceptable, usable and comprehensive. The RCT demonstrated that both decision aids reduced decisional conflict compared with usual care. There was also a suggestion that the VBAC rate was higher amongst women in the Decision Analysis Program group, in comparison with both other groups. Discussion: Pregnant women with one previous CS were found to benefit from access to either of the decision aids in addition to their routine clinical care. Further investigation is required ~o confirm whether the Decision Analysis Program could help to reduce the discrepancy between women's preferred and actual mode of delivery. Issues relating to the implementation of the decision aids must also be considered.

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Klingaman, Kristin. "Breastfeeding after a caesarean section : mother-infant health trade-offs". Thesis, Durham University, 2009. http://etheses.dur.ac.uk/102/.

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This thesis demonstrates the value of an anthropological perspective on informing appropriate breastfeeding support after caesarean section delivery. In contrast to epidemiological research that identifies distinct aspects of mother-infant interactions altered by this birth mode, my research explored the interrelated obstacles to breastfeeding from the mothers’ perspectives as the experiences were unfolding. I apply Trivers’s (1974) parent-offspring conflict model to conceptualise breastfeeding and predict realisation of infant feeding based on the interaction of maternal cost and infant benefit. The work adds the previously unstudied population of caesarean section-delivered breastfeeding dyads to the human life-history theory line of investigation. Postnatal ward and telephone semi-structured interview data were collected in Newcastle, England during 2006-09 with two groups of women. Phase 1 comprised participants who underwent either an unscheduled or scheduled caesarean section delivery (n = 75). Phase 2 involved women who experienced scheduled, non-labour caesarean section delivery and were randomly allocated an intervention or control cot for the entirety of their postnatal ward stay (n = 51). The impact of the infant side-car crib or standalone cot on breastfeeding was tested among the Phase 2 mothers by comparison of 35 overnight postnatal ward video recordings. The various aspects of women’s delivery and infant care were prioritised based on their knowledge of known risks and benefits. Intentions were carried out within the context of the support and opportunities available. Contrary to popular belief, the decision to undergo a caesarean section and deviation from prenatal breastfeeding intentions were undertaken because they seemed like the best or only option in the circumstances. Many women felt frustrated because of their postnatal limitations with caretaking for infants who were described as unexpectedly doing poorly. The absence of labour before the caesarean section was perceived to be beneficial by the mothers due to the intense pain of contractions and the undo “stress” vaginal parturition posed for the infant. However, the participants were surprised by being told by midwives after the delivery that (sub-clinically) poor infant condition was a common consequence of caesarean section. Some breastfeeding difficulty stemmed from “mucous” expulsion that had to occur before the babies could be “interested” in feeding. The peak mother-infant breastfeeding conflict was night-time after visiting hours. Midwifery and maternal concerns over the mothers’ lack of sleep prompted formula supplementation. As predicted, the side-car crib was associated with reduction of the maternal cost of breastfeeding. However, participants in the intervention group were not observed breastfeeding significantly more frequently than the control group as expected. The cost-benefit breastfeeding model suggests that high maternal cost and/or low perceived infant benefit was experienced to such a degree that mothers breastfed minimally despite the “huge difference” in infant access afforded by the side-car crib compared to the standalone cot. Regardless, data support the side-car crib as the better arrangement for mother-infant dyads who underwent a non-labour caesarean section due to the less potential infant risk observed and the benefit to maternal recovery. The utility of the parent-offspring conflict framework for predicting breastfeeding outcomes was supported by the association of reported reasons for breastfeeding intent and of bedsharing with breastfeeding frequency and duration. The thesis suggests that more detailed physiological information may enable families to better understand public health advice for exclusive breastfeeding and low caesarean section delivery rates. Breastfeeding after a caesarean section is affected by interrelated and compounding difficulties, so my single alteration in the postnatal environment did not resolve the impediments. An evolutionary perspective can assist in identifying populations at risk for suboptimal health outcomes and designing support to ameliorate mismatches between coevolved processes and routinely encountered conditions.

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Dyer, Robert A. "Haemodynamic consequences of Spinal Anaesthesia for non-emergency Caesarean section". Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3026.

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Single shot spinal anaesthesia for caesarean section is currently accepted as the favoured method in the absence of contraindications, for reasons of safety and comfort. Firstly, there is an increased risk of failed intubation associated with general anaesthesia. Secondly, spinal anaesthesia, if practiced correctly, allows for a superior experience of the delivery and improved bonding with the infant. Maternal haemodynamic stability is desirable both for maternal and neonatal safety, and to diminish maternal side-effects such as nausea and vomiting. Therefore, after an extensive literature review, clinically relevant aspects of spinal anaesthesia were studied, with a view to contributing to knowledge which could improve safety and outcome. The central themes explored in this thesis were fluid management during spinal anaesthesia for caesarean section in healthy parturients, the haemodynamic effects of the vasoactive agents ephedrine, phenylephrine and oxytocin during spinal anaesthesia for caesarean section in healthy patients and in patients with preeclampsia, and short term neonatal outcome after spinal anaesthesia in patients with severe preeclampsia. Research methodology included non-invasive measures as well as the use of a pulse wave form analysis monitor to measure maternal cardiac output. A validation study was performed comparing this method with thermodilution in patients with postpartum complications of preeclampsia. Abstract viii The results of these studies showed that: The pulse wave form monitor employed showed acceptable limits of agreement with the thermodilution method. Crystalloid coload was associated with lower vasopressor requirements than conventional preload. Spinal anaesthesia was associated with afterload reduction, which was more pronounced in healthy patients than in preeclamptics. Ephedrine maintained or increased, and phenylephrine reduced maternal cardiac output in healthy patients. Oxytocin was associated with transient haemodynamic instability in healthy and preeclamptic patients, which was obtunded by phenylephrine in the healthy population. Spinal anaesthesia for caesarean section was associated with a greater umbilical arterial base deficit than general anaesthesia in patients with preeclampsia. Overall, these studies should contribute to improved knowledge of haemodynamic responses during spinal anaesthesia for caesarean section, and ultimately to improved maternal morbidity and mortality.

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Wang, Cong Kerynn. "Caesarean delivery on maternal request: systematic review on maternal and neonatal outcomes". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46942609.

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Ahmed, Tasneem. "Trial of Labour or Elective Repeat Caesarean Section in Women who have had one previous caesarean section: An assessment of women's attitudes, knowledge and preferences". Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32431.

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INTRODUCTION Caesarean section (CS) is one of the most frequently performed major abdominal surgeries in the world. There has been a global increasing trend in CS rates over the past three decades, particularly in women who have had one previous CS. Vaginal birth after caesarean section (VBAC) is a safe option and is still strongly recommended by all international authorities with success rates ranging from 60% to 80%. However, women's preference for VBAC vs elective repeat caesarean section (ERCS) remains very poorly understood in South Africa (SA) as very few studies have addressed women's preference for mode of delivery. Repeat caesarean delivery (CD) is reported as the single largest contributor to the escalating CS rate worldwide. So why do women choose repeat CD? Evidence suggests that fear, health care worker influence, social stigma, cultural practise and religious beliefs can significantly influence the attitude toward CS. South African data remains limited and we are yet to ascertain how women make their choice and what drives their specific preferences. The rationale behind this study therefore was to gain better insight into why the women in Cape Town choose VBAC or ERCS and to ascertain to what extent their knowledge, attitude and preferences influence their choice. In so doing, we were able to highlight key findings in order to attempt to reduce the increasing CS rate in our country. AIMS AND OBJECTIVES The primary objective was to explore women's knowledge, attitudes and preferences for VBAC or ERCS after one previous CS, from 36 weeks gestation, attending antenatal care at Mowbray Maternity Hospital (MMH) and New Somerset Hospital (NSH). The secondary outcome was to describe the major reasons for their preferred mode of delivery. METHODOLOGY A prospective descriptive study was conducted over four months, of pregnant participants with one previous lower uterine segment caesarean section (LUSCS), attending antenatal care at MMH and NSH. Participants were recruited from 36-41weeks gestation. Participants over the age of 18 years with one previous LUSCS were eligible for inclusion. Participants with a medical indication for CS were excluded. An interview-based questionnaire, previously 11 adapted for use in a Cape Town antenatal population regarding women's knowledge, attitudes and preferences for mode of delivery was conducted at a routine antenatal visit. In addition, basic obstetric and socio-demographic data was abstracted from their folders. A descriptive analysis of participants' preferences for mode of delivery was completed, with subgroup comparisons. The Fisher's Exact test was used in all the statistical analyses that involved categorical variables whilst continuous variables were analysed using t-tests. RESULTS The study included 100 participants who were eligible for VBAC. Of the participants, 51% preferred ERCS whilst 49% preferred VBAC. Married couples and those in co-habiting relationships, more frequently chose VBAC compared to single participants, who more frequently chose ERCS. Participants were greatly influenced by the opinion of the HCW, particularly if ERCS was suggested, they were likely to choose a CS (p=0.001). If a previous history of long or obstructed labour was reported, participants were inclined to choose ERCS. Fear was identified as a major determinant as 78.4% cited fear of vaginal birth as their reason for preferring a CS. History of previous CS (88.2%) and fear of the risks associated with VBAC were the main reasons cited for their preference. In the group who preferred VBAC, 89.8% were of the perception that VBAC would allow them to recover faster and 87.7% desired to be home sooner therefore, favouring their choice. Whether or not the participants had a previous vaginal delivery or VBAC, it did not affect their preference for mode of delivery in a statistically significant manner. CONCLUSION This study which explored knowledge, attitudes and preferences of women who had had one previous CS, concerning their preference for mode of delivery, is one of the first to be done in South Africa. Despite all participants being medically eligible for VBAC, only 49% preferred this option, the remaining 51% preferring ERCS. Significant determinants of their choice were unstable relationships, influence of the doctor, concern about uterine rupture and fear of labour and unpredictability. Knowledge of the complications of ERCS and VBAC was very limited. This information is useful to design further research to improve understanding of these issues and to design services in a way to overcome the identified problems. In particular, women must be provided non-biased evidence-based information in order to foster a relationship of trust with the health care worker, in assisting her to make an informed decision. Similarly improving respectful competent care of women in labour with better attention to alleviating labour pain, will assist in reducing fear.

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Mennill, Sally Elizabeth. "Prepping the cut : caesarean section scenarios in English Canada, 1945-1970". Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/41975.

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At the beginning of the 21st century, Canadian public debates about caesarean section centre on the relative agency of mothers and medical professionals in choosing the preferred birthing method. A 2006 study at the University of British Columbia aims to determine why the Pacific has the highest caesarean rate in the country. According to its authors, BC’s rate is 27% despite the World Health Organization’s advocacy of a rate between 10 and 15 percent. The highlighting of this discrepancy in the pages of the popular Vancouver Sun typifies the public concern that today so commonly echoes professional unease. Sandwiched between the era of development and professionalization – 1900 to 1950 – explored in Mitchinson’s critical chapter on c-sections, and the widespread acceptance that occurred in the 1970s and beyond, lie the often overlooked years, 1945-1970, which first saw c-sections solidified in treatment and entrenched in medical and social discourses. At the end of WWII, Canadian mothers and medical professionals were about to embark on a quarter-of-a-century consideration of how reduction of risk in c-sections could contribute to positive outcomes. This dissertation examines the social, technological, professional, and discursive factors that converged throughout the post-war period in Canada, arguing that medical technological developments of this time period coupled with developments in the professionalization of obstetrics, the substantial broadening of state health infrastructure post-WWII, and a significant shift in ideological constructions of motherhood according to white, middle-class standards contributed to an increased comfort with the practice of caesarean section.

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Chaplin, Jacqueline. "Breastfeeding difficulty after caesarean section under regional anaesthesia: A phenomenological study". Thesis, Australian Catholic University, 2011. https://acuresearchbank.acu.edu.au/download/746c1902dd8ccfd6b3e0172f69a17cb7df9938b35d6f4372ef17368f5953bdf3/2392115/64821_downloaded_stream_46.pdf.

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This study explored the experiences of women with breastfeeding difficulties following a caesarean section under regional anaesthesia. Further, this research aimed to explore the difficulties women experienced initiating and establishing breastfeeding when their babies seemed indifferent or unable to latch to the breast. Caesarean delivery rates have increased progressively in Australia over the last decade creating new challenges for breastfeeding mothers and caregivers. The advantages of breastfeeding to both the mother and baby are well recognised. However, breastfeeding problems are common in the initial postpartum period, particularly with mothers who have had a caesarean section. Despite high breastfeeding initiation rates, duration rates of exclusive breastfeeding continue to fall. An extensive review of the literature revealed that there are a number of factors that lead to difficulties breastfeeding following a caesarean section. These included the effects of caesarean delivery and regional anaesthesia, lack of skin to skin contact, formula supplementation, and inadequate postnatal care on infant behaviour and the initiation, establishment and duration of breastfeeding. However, no qualitative research was identified specifically relating to the lived experience of women having difficulties breastfeeding after caesarean section, identifying a significant gap in the literature. This study explores the lived experience of a group of mothers with breastfeeding difficulties after delivering by caesarean section under regional anaesthesia. The difficulties they were having centred on problems initiating and establishing breastfeeding their babies who seemed indifferent or unable to latch to the breast. Interpretive phenomenology was considered the most relevant approach for this research due to the methodologies ability to produce rich data in order to explore the essence of the lived experience. Purposeful sampling was employed to select eight participants who were interviewed in their homes two to three weeks after birth. Interviews were recorded, transcribed verbatim, and analysed using van Manen’s circular process of hermeneutical writing, underpinned by Heidegger’s hermeneutic V circle of understanding. The hermeneutical circle is a circle of interpretation that moves forward and backward between the parts and the whole. Through this interaction and understanding the data was reflected on and sub themes and themes were identified. Key themes included Unnatural birth, Natural instincts compromised, Helping mothers to mother, and Sabotage and defeat. These themes reflected the mothers’ journey through birth, the baby’s difficulty feeding, postnatal challenges and how the mothers’ felt in response to these challenges. Overall, the data illustrated that the mode of birth can interfere with the normal mechanisms of birth and the intrinsic desire of a baby held skin to skin to effectively latch and suckle. The key findings of the study included the concept that the four themes are bound inextricably together. Unnatural birth causes natural instincts to be compromised. Helping mothers to mother in a sensitive and supportive manner will help those instincts both maternal and infant, to be strengthened. Ensuring only breastmilk is consumed by breastfed infants helps ensure breastfeeding is not compromised and mothers can be assisted in their desire to breastfeed. These findings were further synthesised to create a supportive framework for breastfeeding after caesarean section. Central to this framework is the notion that encouraging and valuing normal birth, supporting the natural instincts of mother and baby and increasing breastfeeding support for mothers who birth by caesarean section is fundamental to midwifery care. These concepts formed the basis of recommendations for changes to midwifery clinical practice that could improve breastfeeding outcomes for women.

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Lam, Wai-yee Wendy, e 林慰儀. "Abdominal wound infection after caesarean delivery in a district hospital". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B39724335.

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Johnson, Gina. "Exploring healthy pregnant women's decisions to opt for an elective caesarean section". Thesis, University of East London, 2006. http://roar.uel.ac.uk/3825/.

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The rate of Caesarean sections (CS) in the UK is on the increase. In the year 1989-90 the rate was 11.3% rising to 17% for the year 1997-98 (Marx et al, 2001). The World Health Organisation (WHO) recommends that no more than 15% of all births are by CS. Today in the UK 22% of all babies are born by CS (Song et al, 2004). Research by Jackson and Irvine (1998) and Marx et al (2001) suggests that maternal requests are an important factor in the increase. Marx et al (2001) report that the rate of elective CS has doubled in the UK in the last 10 years. However, there is little consensual information as to why more pregnant women are choosing Caesarean delivery. The media frequently portray such choices in terms of personal convenience, employing phrases such as "too posh to push". Such stereotypes, however, are unhelpful for understanding what may be a decision informed by complex social changes in attitudes to surgery and childbirth. Recently published NICE Guidelines (2004) have suggested that women who opt for elective CS may need to be counselled. However, this group of women may be well informed about the risks and benefits of Caesarean delivery, so this suggestion may be experienced as intrusive or undermining of their autonomy. The aim of this study was to explore factors that influence and inform a decision to have an elective CS. Participants were 6 women attending a London teaching hospital who indicated at their 20 week scan that they wished to have a CS. Inclusion criteria were: 1) singleton pregnancy deemed 'low risk' by a consultant obstetrician, 2) no previous history of CS or 3) a previous history of CS but vaginal birth was medically feasible, and 4) without acute mental health problems. Data were collected using individual semi-structured interviews. These were recorded on tape, transcribed and analysed using Interpretative Phenomenological Analysis. The 6 main themes that emerged in the analysis were general attitudes around childbirth, the decision to have children and experiences of pregnancy, the importance of choice, the perception of risks & benefits of Caesarean section and vaginal birth, the salience of knowledge and the influence of relationships with maternity staff. These findings are discussed in terms of their implications for understanding the decision making process leading to an elective CS and the ways in which women are advised and supported in coming to this decision.

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Paranjothy, Shantini. "Caesarean section rates in England and Wales : investigating variation between maternity units". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2004. http://researchonline.lshtm.ac.uk/682225/.

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In England and Wales, the Caesarean section (CS) rate is 21.5%, ranging from 6% to 66% between maternity units. The impact of a high CS rate on women's health and NHS resources is not clear. Case-mix differences should be taken into account to enable valid comparisons and exploration of factors contributing to this variation. An understanding of these factors is important to ensure quality of obstetric care. The aim of this thesis was to explore the variation in CS rates between maternity units and evaluate the impact of (I) case-mix and (ii) women's birth preferences using National Sentinel Caesarean Section Audit (NSCSA) data. Summary of NSCSA data: Phase 1 (01.05.2000 to 31.07.2000) • Information on 150,139 women giving birth in 216 maternity units in England and Wales. Variables collected include age, ethnicity, parity, number of previous CS, mode of onset of labour, gestation, presentation, mode of delivery and birth weight. Phase 2 (01.12.2000 to 31 .01 .2001) • Survey of 2,475 pregnant women from 40 selected maternity units. Variables include preferred type of birth. Case-mix data were also collected for all 32,536 women giving birth in these maternity units. The relationship between case-mix variables and CS (i) before labour and (ii) during labour was demonstrated using logistic regression. Using tese results, standardised CS rates were calculated for individual maternity units. Using meta-analytical techniques, the amount of variation in CS rates explained by case-mix adjustment was quantified. Data on preferred type of birth were available for 7% of women in Phase 2. Therefore various techniques for handling 'missing data' including multiple imputations were researched and applied to these data. Key findings: . The association between CS and case-mix variables vary for CS before labour and CS during labour. The odds of CS (before and in labour) increase with maternal age. Women from ethnic minority groups have lower odds of CS before labour, and increased odds of CS in labour. Women with a previous vaginal delivery have lower odds of CS, although the magnitude of this for CS before and in labour is markedly different. . Adjustment for case-mix explained 34% of the variance in CS rates between maternity units. • Adjustment for case-mix differences and women's birth preferences explained 45% of the variance in CS rates between maternity units in England and Wales. 3

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Magni, Bridget. "Incidence of intraoperative nausea and vomiting during spinal anaesthesia for caesarean section". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20291.

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The incidence of intraoperative nausea and vomiting during spinal anaesthesia for caesarean section. Background: Nausea and vomiting (IONV) during spinal anaesthesia (SA) for caesarean section (CS) is unpleasant and may interfere with surgery. We studied the incidence of IONV during elective CS, as well as the influence of ethnicity on this outcome. Methods: Two hundred and fifty eight healthy term patients undergoing SA for elective CS were recruited to this prospective observational study conducted at two Cape Town Level 2 hospitals. Standard practice was employed for SA for CS at UCT (University of Cape Town): 2 mL hyperbaric bupivacaine plus 10 μg fentanyl at the L3/4 interspace, and 15 mL/kg cry stalloid co - load. Spinal hypotension was managed with phenylephrine boluses according to a standard protocol. Nausea and/or vomiting were treated by restoration of blood pressure, and metoclopramide. Intraoperative complaints of nausea, and vomiting, were noted. Patients were also interviewed postoperatively as to any experience of intraoperative - or previous history of nausea. Results: Of the 258 patients enrolled in the audit, 112 (43.4%) were non - African and 146 (56.6%) were Black African patients. The overall incidence (95% CI) of nausea was 32% (0.27 - 0.38), with 20% occurring prior to - and 11% after the delivery. The overall incidence of vomiting was 7% (0.05 - 0.11), with 3.2% occurring prior to, and 3.8% after, delivery. The incidence of nausea and/or vomiting was 33% (0.28 - 0.40). Black Africans experienced significantly less nausea than non - African patients (36/145 [24.8%] vs 47/112 [42.0%] respectively, p = 0.004). There was no significant difference in the incidence of vomiting (10/14 5 [6.8%] vs. 8/112 [7.1%] respectively, p = 0.865). The odds of experiencing intraoperative nausea for patients with any blood pressure value <70% of baseline, were 2.46 (95% CI 1.40 - 4.33). Conclusions Though in keeping with international standards, the clinically significant incidence of nausea and/or vomiting of 33% requires adjustments to the management protocol for spinal hypotension. The inclusion of ethnicity as a risk factor for nausea during SA for CS should be considered.

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De, Cramer Kurt Guido Mireille. "Preparturient caesarean section in the bitch : justification, timing, execution and outcome evaluation". Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/62575.

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It is known that the prevalence of CSs in some breeds approaches 100%. In addition, this study identified previous CSs, fewer than eight and more than 11 puppies per litter in Boerboel bitches as obstetric risk factors (resulting in emergency CSs and stillbirths). It also showed that a trial of labour after caesarean section was associated with considerable obstetric risks. In such high-risk pregnancies, using the signs of parturition to time elective CSs in the bitch is problematic, as by then there may already be foetal distress or demise. Also, the signs of parturition may present at an inconvenient time of the day, when staff shortages may impede professional service. This study aimed at solving these problems by investigating various means of predicting the day and time of onset of parturition (cervical dilatation) in the bitch. This study showed that a chemiluminescent immunoassay (Immulite® 1000 LKPW1) is a reliable replacement for a discontinued radio immune assay to measure PC in serum or plasma. It proved that the first day of cytological dioestrus (D0) is the most precise peri-oestrous predictor of the day of cervical dilatation. This study showed that the variation in the foetal biparietal diameter is too large to accurately predict readiness for CS and that the preparturient PC may be used to predict the time of cervical dilatation, thereby allowing timeous planned CSs in bitches where D0 is unknown. The use of medetomidine hydrochloride as premedicant combined with propofol as induction agent and sevoflurane as maintenance, is safe and is associated with good maternal and puppy survival rates at delivery, 2 h and 7 d after CSs. Performing elective CSs upon the first appearance of any degree of cervical dilatation proved successful. For bitches in this study with high-risk pregnancies, we proved that it is safe to perform fixed date preparturient CSs on D57 if the cervix has not dilated by then. This study showed that bitches have haematocrits at the time of cervical dilatation that are at the lower end of the normal reference ranges for non-pregnant dogs and that the decline in haematocrit associated with CS is similar for parturient (open cervix) and preparturient (closed cervix) CSs. As incidental findings, this study discovered two puppies sharing one placenta in each of two litters. The one case of placenta sharing proved to be monozygotic twins whilst the other case proved to be a case of dizygotic monochorionic canine foetuses with blood chimaerism and suspected freemartinism. This study provides the veterinary obstetrician with a protocol that can be used to safely perform elective CSs in a large proportion of the obstetric population at a convenient time of the day but more research is required with larger numbers to establish whether this practice is routinely safe and safe in all breeds.
Die voorkoms van keisersnitte bereik 100% in sommige rasse. Hierdie studie het getoon dat ŉ vorige keisersnit, kleiner werpsels as agt en groter werpsels as 11 in die Boerboel, verloskundige risikofaktore is. Dit het ook getoon dat ŉ poging tot spontane kraam nadat ŉ teef voorheen ŉ keisersnit ondergaan het, geassosieer is met 'n aansienlike risiko van noodkeisersnitte en doodgebore hondjies. Om in sulke hoë risiko dragtighede te wag vir tekens van kraam voordat ŉ elektiewe keisersnit uitgevoer word is riskant, omdat fetale nood of dood reeds kon intree. Die tekens van kraam verskyn dikwels op ŉ ongeleë tyd van die dag, wanneer ŉ personeeltekort ŉ professionele diens belemmer. Hierdie studie was daarop gemik om hierdie probleme op te los deur verskeie metodes te ondersoek om die dag en tyd van aanvang van servikale ontsluiting in die teef te voorspel. Verskeie bevindings spruit uit die studie: ŉ Chemiluminessensie immunotoets (Immulite® 1000 LKPW1) is ŉ betroubare plaasvervanger vir ŉ gestaakte radioimmunotoets. Die eerste dag van sitologiese diestrus (D0) is die mees presiese en praktiese peri-estrus voorspeller van die dag van servikale ontsluiting. Die bipariëtale deursnit van honde fetusse tydens laat dragtigheid varieer soveel binne rasse en binne werpsels dat dit ongeskik is vir die akkurate en betroubare voorspelling van gereedheid vir keisersneë. Die voorgeboortelike progesteroon konsentrasie in die bloedplasma of serum dien as ŉ voorspeller van kraam in tewe waarvoor D0 nie bekend is nie. Die binneaarse toediening van 7 mg/kg medetomidine hidrochloried as premedikasie, gekombineer met 1–2 mg/kg propofol as induksiemiddel en 2% sevoflurane in suurstof vir die onderhoud van narkose vir keisersnit in tewe is veilig en lewer hoë oorlewings peile in tewe en kleintjies by geboorte, 2 ure en 7 dae na keisersnit. Keisersnitte wat uitgevoer word sodra die eerste tekens van servikale ontsluiting waargeneem word, is suksesvol. Hierdie studie het getoon dat vir tewe met hoë risiko swangerskappe, dit veilig is om preparturiente keisersnitte uit te voer in tewe met n geslote serviks, sewe en vyftig dae (D57) na D0 vir tewe met werpsels > 1 as die serviks teen daardie tyd nog nie ontsluit het nie. Tewe se hematokrit aan die begin van kraam stem ooreen met die laer normale waardes van vir nie-dragtige honde en dat vermindering in hematokrit geassosieer met parturiente keisersnitte (oop serviks) soortgelyk is aan bloedverlies geassosieer met preparturiente (geslote serviks) keisersnitte. Toevallige bevindings was dat twee fetusse uit elk van twee werpsels ŉ plasenta gedeel het. In een geval was die fetusse monosigotiese tweelinge en in die ander geval was hulle monochorionies en disigoties, met moontlike freemartinisme. Hierdie studie stel die veterinêre verloskundige in staat om elektiewe preparturiënte keisersnitte op ŉ geleë tyd van die dag uit te voer in ŉ hoë persentasie van die obstetriese populasie maar verdere navorsing met groter getalle word benodig om vas te stel of dit roetine gewys veilig is en veilig is in alle rasse.
Thesis (PhD)--University of Pretoria, 2017.
Production Animal Studies
PhD
Unrestricted

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Heasman, Lindsay. "Nutritional and endocrine manipulation of development and thermoregulation in the newborn lamb". Thesis, University of Nottingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285771.

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Golois, Eleni. "Caesarean section : the perspectives of obstetricians in a South Australian tertiary referral hospital /". Title page, table of contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09HS/09hsg627.pdf.

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Carter, Sarah Anne. "The cascade of intervention : labour induction and caesarean section in the United Kingdom". Thesis, University of Southampton, 2018. https://eprints.soton.ac.uk/422170/.

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Labour induction and caesarean section are childbirth interventions experienced by a growing number of women globally each year. These two medical procedures are often linked in maternal health literature through the cascade of interventions, an intervention pathway defined by labour induction at the start of birth and operative delivery at the end. While the maternal indicators of labour induction have been well documented in countries such as the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom, and how the risk of labour induction is associated with operative delivery in the UK. This project examines the maternal risk factors of labour induction in the United Kingdom and how these indicators are related to the likelihood of operative delivery, using data from the Millennium Cohort Study. The thesis first uses logistic regression to explore which maternal characteristics are associated with labour induction in the United Kingdom, and determines that maternal educational qualifications and the deprivation of a woman’s electoral ward have significant associations with likelihood of labour induction. In the second analysis chapter, this project examines health care context by utilizing multilevel logistic regression to analyse if risk of labour induction varies by NHS Trust. Results from these analyses determine that risk of labour induction does vary by NHS Trust, the influence of maternal educational qualifications on labour induction risk varies by NHS Trust, and country of NHS Trust is a significant predictor of labour induction. Finally, in order to better understand how the cascade of intervention operates in the United Kingdom, the third analysis investigates the link between labour induction and type of delivery using multinomial logistic regression and KHB mediation analysis. This analysis finds that women who are induced are more likely to experience operative delivery, and that this relationship is mediated by epidural anaesthesia. Additionally, maternal height moderates the associations between labour induction, epidural, and delivery type, such that women between 1.60 and 1.69 metres tall are more at risk of operative delivery after labour induction and epidural than women at shorter or taller heights. This project finds that maternal demographic and socioeconomic indicators influence the risk of labour induction, and that the association between labour induction and operative delivery can be mediated by epidural anaesthesia and moderated by maternal height, within the health care context of the United Kingdom. Determining which women are more likely to experience labour induction and operative delivery in the UK can allow women to make more informed choices about their health care and can help support efforts to provide women with individualized, patient-centred care during their labours and births.

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Bayes, Sara Jayne. "Becoming Redundant: women’s experience of unwanted scheduled caesarean section - a grounded theory study". Thesis, Curtin University, 2010. http://hdl.handle.net/20.500.11937/294.

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Currently, one third of Australian childbearing women per annum have a caesarean section. Evidence strongly indicates, however, that most women enter into pregnancy expecting and wanting to give birth naturally. While a body of research exists that accounts for some aspects of how women experience caesarean section, the phenomenon has not previously been described in depth. The purpose of this study was to uncover and theorise how women processed and experienced a first caesarean recommended in pregnancy for a health reason.This Western Australian investigation was conducted using the Glaserian version of Grounded Theory methodology. Twenty-eight pregnant women who had been anticipating giving birth naturally, but were advised during pregnancy that they would need to give birth by caesarean section, agreed to participate in the study. Five sets of data were collected. The first comprised semi-structured in depth interviews with the 28 women both before and after the birth of their baby. Non-participant observations of women’s behaviours and interactions whilst they were in the operating theatre, including situation maps, written notes and pencil sketches, formed the second data set. The third and fourth sets of data consisted of semi-structured interviews held with participating women’s partners and with maternity health care professionals. Field notes formed the final set.The Grounded Theory that emerged was labelled Becoming Redundant. The theory comprises the core problem that anticipating and experiencing a scheduled caesarean section posed for women, namely Being Made Redundant, and the psychosocial process they undertook to manage it, labelled Regrouping. In total, eight major categories were identified. The four categories that contributed to the core problem were labelled Being robbed, Becoming a ‘persona non grata’, Off everyone’s radar and Left wanting. The categories in the regrouping process were labelled Trying to make it feel real, Travelling a new path blindly, Striving to be included whilst trying to behave and Treading water. In addition, four factors emerged from the data that moderated, or limited, women’s regrouping endeavours. These were titled Expecting birth would be natural, Hurtling towards ‘D-day’, The green drape and Caesarean section is hospital not women’s business.For 25 of the 28 women, needing and having a caesarean section was frightening, disempowering, distressing and in complete contrast with how they had expected and wanted their baby’s birth to be. The childbirth expectations of these 25 women were shattered as the hospital effectively took over their baby’s birth, and they were left with feelings of loss, grief and, in some cases, symptoms of emotional trauma. In response, women set about trying to accommodate the personal losses they incurred, and to transition to their ‘new reality’. The effect of the moderating factors, however, was to thwart women’s adaptation efforts. Consequently, when they were interviewed between 10 and 14 weeks after their caesarean section, these 25 women reported feeling cognitively and emotionally ‘stuck’ in their childbearing experience. They also described spending considerable energy and attention on trying to work out what had happened to them rather than focusing on their new baby.The remaining three women either experienced or responded to their scheduled caesarean section differently to the other 25; this was because of the absence of one or more of the moderating factors. Ultimately, however, only one of the women was left feeling positive, emotionally on a ‘high’ and free of regret after her baby’s birth.This Western Australian research highlights significant new findings about women who require a caesarean section for a health reason. The work makes an important and original contribution not only to the maternity literature, but to the body of knowledge concerning grief, traumatic stress and dissociation, and change transition. The theory of Becoming Redundant provides maternity care professionals, academics and consumers with previously unknown information about how women might experience, manage and be affected by unforeseen and unwelcome change during the childbearing episode, and has direct and important implications for the care of childbearing women. The disappointment, grief and/or traumatic stress that is likely to arise for a woman when her childbearing expectations can no longer be fulfilled must be anticipated, recognised, acknowledged and forestalled where possible. For women to integrate and move on from their childbirth experience and become fully engaged in motherhood, those who have had to ‘change track’ must be afforded the time, space and support to explore the meaning of the change, to fully mourn what they lose because of it, and to recapture their losses to the greatest extent possible.

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Colais, Paola <1975&gt. "Validity of Robson Ten Group Classification System for comparative evaluation of caesarean section". Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2009. http://amsdottorato.unibo.it/1688/1/Colais_Paola_tesi.pdf.

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Colais, Paola <1975&gt. "Validity of Robson Ten Group Classification System for comparative evaluation of caesarean section". Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2009. http://amsdottorato.unibo.it/1688/.

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Kwinda, Munyadziwa Albert. "Informed consent procedures for pregnant women before undergoing caesarean section at Donald Fraser Hospital, Limpopo Province, South Africa". Thesis, University of Limpopo ( Medunsa Campus ), 2010. http://hdl.handle.net/10386/422.

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Thesis ( M Med (Family Medicine))--University of Limpopo, 2010.
nformed consent procedures in pregnant women before undergoing caesareaction at Donald Fraser Hospital, Limpopo Province, South Africa Aim: To determine the adequacy of information received by pregnant women before undergoing caesarean section Study Design: Cross – sectional descriptive quantitative study Setting: Donald Fraser Hospital maternity ward Methods: 128 patients where surveyed using a standardized questionnaire 2 – 3 days after caesarean section. The study extended from November 2009 to May 2010. Data was collected by a trained research assistant. The data entered on the questionnaire was entered and frequencies and percentages were analyzed on Stata. Results: 126(98.44%) admitted that they were informed of the reason why a caesarean section had to be performed and 124(98.41) could recall the information provided. 108(84.38%) of participants admitted to being informed about the benefits of having a caesarean section as a mode of delivering their babies, however, only 7(6.48%) participants remembered the information provided. 6(4.69%) and 3(2.34%) of the participants admitted to being informed about complications that may occur during and after caesarean section, respectively; and 33.33% could recall the information provided for both. 50(39.06%) admitted to being informed about the implications of the caesarean section to future pregnancies and 12(24%) could remember the information provided. Majority of participants, 124(96.88%) admitted to being informed about the type of anaesthesia to be administered, however, 89(71.77%) could remember the information provided and 10(7.81%) were informed about the viii possible complications of anaesthesia although only 4(40%) could remember the information provided. The strength of association between participants’ profile and their responses was generally weak, except those with previous caesarean section and their responses to the question that seek to understand if they were informed about the future implications of the caesarean section to future pregnancies. Conclusions: Pregnant women are not informed about the complications or risks associated with caesarean section and anaesthesia to be administered. This makes informed consent procedures to be inadequate.

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Nippita, Tanya Ai Choo. "Variations in obstetric interventions in New South Wales, Australia". Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17181.

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Aims To describe variation in caesarean section (CS) and induction of labour (IOL) rates and outcomes; determine ways of classifying IOL; describe variation in current IOL methods. Methods A systemic review examined different methods of IOL classification. Variation in hospital CS and IOL rates and outcomes used two linked population datasets and multilevel logistic regression models. To understand clinical decision-making around IOL, interviews were conducted in New South Wales (NSW) hospitals. Midwifery unit managers completed surveys for current IOL methods. Results  For nulliparae at term in NSW, overall variation in hospital CS rates decreased by 78% for prelabour CS, 52% for intrapartum CS following spontaneous labour and 9% following IOL after adjustment. Severe maternal and neonatal morbidity rates were not significantly different between hospitals.  A 10 group classification system for IOL was developed based on parity, previous CS, gestational age, number and presentation of the fetus.  In NSW 2010-2011, there was high unexplained variation in hospital IOL rates despite adjusting for patient factors. The greatest variation was for hospital rates of IOL among nulliparae at full term. There was generally no relationship between hospital IOL rate and adverse outcomes or intrapartum CS rates.  Variation in decision-making was based on the obstetrician’s perception of risk, their relationship with the woman, and resource availability. There was wide variation in clinical decision-making practices of obstetricians and less accountability for decision-making in hospitals with high IOL rates.  From 2008 to 2014, for district hospitals, there was an increase in balloon catheter use for cervical ripening and a significant increase in use of postmaturity protocols for IOL but no difference in use of prostaglandin protocols. For both district and tertiary hospitals, there was a reduction in the variation in the minimum and maximum oxytocin dosages. Conclusion There was much unexplained variation in hospital CS and IOL rates in NSW, which did not appear to result in differences in adverse outcomes. A novel classification system for women having an IOL was developed to allow similar populations of women having an IOL to be compared for research and quality improvement. Increased accountability and less variation in decision-making were associated with a lower hospital IOL rate. Increased use of protocols was associated with a reduction in practice variation, but it is uncertain whether it translates to better outcomes for mothers and babies.

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Shoemaker, Esther Susanna. "Childbirth Decision Making Processes: Influences on Mode of Birth After a Previous Caesarean Section". Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35504.

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Background: An increasing proportion of Canadian women are experiencing a Caesarean section (CS) and a subsequent repeat CS. While CS can be necessary and lifesaving for mothers and their infants in some situations, it is also associated with greater morbidity risks to women and infants than vaginal birth. Clinical practice guidelines recommend the involvement of pregnant women in making decisions about mode of birth and shared decision making improves the informed consent process. This research examines the factors that influence mode of birth after a previous CS. Methods: Two cross sectional descriptive studies and a prospective pre-post cohort study with control were conducted to investigate the high use of repeat CS at the levels of health care providers, maternity care clients, and the organizational structure of a birthing unit. 1. Interviews and surveys with obstetricians, family physicians, midwives, and nurses were conducted to investigate the attitudes, values, and perceptions that guide their care practices for clients with a previous CS. The specific research question was: What are the factors that influence the practices of maternity care providers (obstetricians, family physicians, midwives, and nurses) regarding mode of birth after a previous CS? Data was analyzed using iterative deductive and inductive coding. 2. Interviews and surveys were conducted during pregnancy and after giving birth with healthy women who have had a previous CS to explore their decision making processes regarding mode of birth after a previous CS. The specific research question was: How do women eligible for a VBAC make decisions about their upcoming mode of birth? A thematic framework approach was used for data analysis. 3. Data from the Better Outcomes Registry and Network (“BORN”) Ontario was analyzed to examine the effectiveness of a hospital based strategy on overall proportions of CS and within Robson groups 1, 2a, and 5. The Caesarean section reduction (CARE) strategy includes interventions that target health care providers, pregnant women, and hospital policies. Results: 1. Maternity care providers would recommend a vaginal birth after CS (VBAC) for healthy pregnant women with a previous CS. They had different perceptions of the safety of birth to the health of women and infants and different approaches to engage in decision making during consultation. Providers believed women make their decision about mode of birth outside of the clinical consultation and often prior to their subsequent pregnancy. 2. The main themes that influenced the decisions of maternity care clients about mode of birth were mothers’ experiential reasoning regarding mode of birth and recovery, experiential knowledge from significant others, scheduling of CS regardless of the mode of birth decision, rating and prioritizing risks, fear of risks, and decisional conflict. When women discussed the factors that impacted their decisions about mode of birth six to eight weeks after they had given birth, the main themes were the recovery experience and fear related to the mode of birth. A lack of time during consultation was identified as a major barrier inhibiting shared decision making, specifically among clients of obstetricians. Other barriers included reliance on routine obstetric practices that are not evidence based. 3. Proportions of CS decreased at the intervention hospital by 3.9% (p=0.0006), from 30.3% (n=964) in 2009/10 to 26.4% (n=803) in 2012/13. During the same time frame, proportions of CS in the control group were stable with 28.1% (n=23,694) in 2009/10 and 28.2% (n=23,683) in 2012/13. Within the Robson classification system, the proportions of repeat CS among all low risk women with a previous CS decreased at the intervention hospital by 5.6% (p=0.0044) from 84.3% to 78.7%. In the control group, also fewer women had a repeat CS over the study period, but the decrease was smaller with 3.9% (p<0.0001) from 84.5% to 80.6%. Conclusion: A true shared decision making process addresses the power imbalance between providers and women through an incorporation of the clinical expertise of providers and the experiential expertise of pregnant women before reaching a decision about mode of birth. The use of routine obstetric practices that are not evidence based inhibited women to make decisions about their mode of birth. The introduction of the CARE strategy to a hospital birthing unit was associated with improvements in proportions of CS and VBAC among low risk women.

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34

Cluver, Catherine Anne. "Maternal position during caesarean section for preventing maternal and neonatal complications : a cochrane review". Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17831.

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Thesis (MMed)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: Background: During caesarean section mothers can be in different positions. Theatre tables could be tilted laterally, upwards, downwards or flexed and wedges or cushions could be used. There is no consensus on the best positioning at present. Objectives: We assessed all available data on positioning of the mother to determine if there is an ideal position during caesarean section that would improve outcomes. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009), PubMed (1966 to 14 September 2009) and manually searched the references of retrieved articles. Selection criteria: Randomised trials of women undergoing caesarean section comparing different positions. Data collection and analysis: Two authors assessed eligibility, trial quality and extracted data. Results: We identified 17 studies with a total of 683 woman included. We included nine studies and excluded eight studies. Included trials were of variably quality with small sample sizes. Most comparisons had data from single trials. This is a shortcoming and applicability of results is limited. The incidence of air embolism was not affected by head up versus horizontal position (risk ratio (RR) 0.91; 95% confidence interval (CI) 0.65 to 1.26). We found no change in hypotensive episodes when comparing left lateral tilt (RR 0.11; 95% CI 0.01 to 1.94), right lateral tilt (RR 1.25; 95% CI 0.39 to 3.99) and head down tilt (mean difference (MD) -3.00; 95% CI -8.38 to 2.38) with horizontal positions or full lateral tilt with 15-degree tilt (RR 1.20; 95% CI 0.80 to 1.79). Hypotensive episodes were decreased with manual displacers (RR 0.11; 95% CI 0.03 to 0.45), a right lumbar wedge compared to a right pelvic wedge (RR 1.64; 95% CI 1.07 to 2.53) and increased in right lateral tilt (RR 3.30; 95% CI 1.20 to 9.08) versus left lateral tilt. Position did not affect systolic blood pressure when comparing left lateral tilt (MD 2.70; 95% CI -1.47 to 6.87) or head down tilt (RR 1.07; 95% CI 0.81 to 1.42) to horizontal positions, or full lateral tilt with 15-degree tilt (MD -5.00; 95% CI -11.45 to 1.45). Manual displacers showed decreased fall in mean systolic blood pressure compared to left lateral tilt (MD -8.80; 95% CI -13.08 to -4.52). Position did not affect diastolic blood pressures when comparing left lateral tilt versus horizontal positions. (MD-1.90; 95% CI -5.28 to 1.48). The mean diastolic pressure was lower in head down tilt (MD -7.00; 95% CI -12.05 to -1.95) when compared to horizontal positions. There were no statistically significant changes in maternal pulse rate, five-minute Apgars, maternal blood pH or cord blood pH when comparing different positions. Authors' conclusions There is limited evidence to support or clearly disprove the value of the use of tilting or flexing the table, the use of wedges and cushions or the use of mechanical displacers. Larger studies are needed.
AFRIKAANSE OPSOMMING: Agtergrond: Tydens keisersnitte kan moeders in verskillende posisies wees. Teater tafels kan lateraal, opwaarts, afwaarts of gebuig word, of 'n wig en kussings kan gebruik word. Op die oomblik is daar geen konsensus oor die beste posisie nie. Doelwitte: Ons het alle beskikbare data oor die plasing van die moeder ondersoek, met die doel om 'n ideale posisie vir 'n verbeterde uitkoms tydens 'n keisersnit vas te stel. Metodes: Ons het die “Cochrane Pregnancy and Childbirth Group's Trials Register“ (September 2009), PubMed (1966 tot 14 September 2009) deursoek en die herwinde artikels se verwysings per hand nagegaan. Keuringskriteria: Gerandomiseerde proewe van vroue wat keisersnitte ondergaan het, is in verskillende posisies vergelyk. Data insameling en analise: Twee outeurs het die kwaliteit, die geskiktheid en data van die studie beoordeel. Resultate: Ons het 17 studies geidentifiseer wat 'n totaal van 683 vroue ingesluit het. Ons het nege studies ingesluit en agt uitgesluit. Die ingeslote studies was van wisselvallige gehalte en die monster groepe was klein. Die meeste vergelykings het data van enkele studies gegee. Dit is 'n tekortkoming en die bruikbaarheid van die resultate is beperk. Die plasing van kop-op teenoor horisontale posisie het die voorkomssyfer van lug embolisme nie geaffekteer nie.(risiko verhouding RR 0.91;95% 95% vertroue interval Cl 0.65 tot 1.26). Daar is geen hipotensiewe veranderinge gevind toe 'n vergelyking gemaak is tussen linker laterale kantel (RR 0.11; 95% Cl 0.01 tot 1.94) regter laterale kantel (RR 1.25; 95% Cl 0.39 tot 3.99) en kop-af kantel (“mean difference” MD -3.00; 95%Cl -8.38 tot 2.38) teenoor horisontale posisies of volle laterale kantel met 'n 15 grade kantel nie (RR 1.20;95% Cl 0.8. tot 1.79). Hipotensiewe episodes het verminder met hand verplasers (RR 0.11; 95% Cl 0.03 tot 0.45), 'n regter lumbale wig in vergelyking met 'n regter bekken wig (RR 1.64; 95% Cl 1.07 tot 2.53) en 'n vermeerdering van die regter laterale kantel (RR3.30; 95% Cl 1.20 tot 9.08) teenoor die linker laterale kantel. In die vergelyking tussen die posisie van linker laterale kantel (MD 2.70; 95% Cl -1.47 tot 6.87) of kop-af kantel (RR 1.07; 95% Cl 0.81 tot 1.42) teenoor horisontale posisies, of volle laterale kantel met 15 grade kantel (MD -5.00; 95% Cl -11.45 tot 1.45) het die posisie nie die sistoliese bloeddruk geaffekteer nie. Hand verplasers het 'n verminderde daling in gemiddelde sistoliese bloeddruk veroorsaak in vergelyking met linker laterale kantel plasing (MD -8.80;95% Cl-13.08 tot -4.52). In die vergelyking tussen linker laterale kantel en horisontale posisie was daar geen effek op die diastoliese bloeddruk nie (MD -1.90; 95% Cl -5.28 tot1.48). Die gemiddelde diastoliese druk was laer in die kop-af kantel (MD -7.00; 95% Cl -12.05 tot -1.95) in vergelyking met horisontale posisies. In die vergelyking tussen die verskillende posisies was daar geen betekenisvolle statistiese veranderinge in die moeder se polstempo, vyf minute Apgartellings, moederlike bloed pH of naelstringbloed pH nie. Outeur se gevolgtrekkings: Daar is beperkte getuienis om die waarde van kantel, buiging van tafel, die gebruik van wieë en kussings of die gebruik van maganiese verplasers te ondersteun of totaal te verwerp. Groter studies is nodig.

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35

Venter, Eben Kruger. "The Caesarean Section rate at Mowbray Maternity Hospital: Applying Robson's Ten group classification system". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29234.

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Background The United Nations (UN) aims to reduce the maternal mortality ratio (MMR) and improve access to reproductive health services. Caesarean sections (CS) are known to be associated with a raised mortality rate by a factor of 2.8 in addition to the raised morbidity rate (OR 3.1; 95% CI 3.0-3.3) compared to vaginal deliveries (VD). Globally, there has been a concerning trend in the caesarean section rate (CSR), rapidly increasing since the 1970’s, with some countries reporting CS rates as high as 40.5%. South Africa has a CSR of 25.7%, which is higher than the suggested rate by the World Health Organization (WHO) of 15%; a rate above which the WHO suggests no maternal and fetal benefit exists. Robson introduced a universal classification system for caesarean sections with 10 totally inclusive and mutually exclusive groups. Horak made use of the ten group classification system (TGCS) to calculate the CSR at Mowbray Maternity Hospital (MMH) and its referring midwife obstetric units (MOU) for 2009, and reported it as 20.7%. Since the completion of her study, the referral routes to MMH have changed and the management of HIV-associated illnesses has markedly improved. A period of 7 years has elapsed and it was thought to be an optimal time to repeat a review of the CSR and compare it with the rates from 2009. Objectives The study aims to calculate the CSR for MMH from January 2016 to June 2016. Analyses of the CSR within each Robson group will be done and compared to the rates from 2009. This will allow us to make recommendations, if appropriate, aimed at reducing the CSR. Methods A retrospective, observational study was performed at MMH in Cape Town. Data was collected from birth registers for January 2016 – June 2016. All women who delivered, including all caesarean sections and vaginal births, were entered into the study, provided the newborn was viable with a birth weight >500g. Parameters were recorded onto an electronic and password-protected Microsoft Excel® spreadsheet and were used to classify deliveries according to the Robson Classification system. To allow for comparison with Horak’s study, deliveries at MMH for January 2009 – June 2009 were selected and analyzed. All the data was analyzed with STATA software and presented in various graphical formats. Ethics approval was obtained from University of Cape Town’s Human Research Ethics Committee (HREC Ref: 539/2016). Results There were 4727 deliveries from January to June 2016, of which 2472 were vaginal births and 2255 were caesarean sections, giving rise to a CSR of 47.70% (95% CI 46.28- 49.13). Of all the caesarean sections performed, 62.7% were primary caesarean sections and 37.3% were repeat caesarean sections. Nulliparous women, compared to multiparous women without a history of a prior CS, were at higher risk for a CS if in spontaneous labour (OR 2.02; 95% CI 1.71-2.38) and if induced (OR 2.75; 95% CI 2.13- 3.53). Group 5 (women with a previous CS), with a CSR of 85.34% (95% CI 82.82-87.61) made the greatest contribution to the overall CSR. The overall CSR from January to June 2009 was 44.10% (95% CI 42.63-45.57), calculated from 4379 deliveries. There was a statistically significant increase in the CSR of 3.60% from 2009 to 2016. A similar significant increase was observed in the respective CS rates of Group 1 (5.59%), Group 2 (11.63%) and Group 10 (8.73%). Group 4 was the only group with a statistically significant decrease of 4.48% in its CSR. An additional 308 labour inductions were performed in 2016, however, women in 2016 were statistically significantly less likely to be successful in a vaginal delivery (OR 0.67; 95% CI 0.55-0.81 p<0.001) compared to women in 2009. Conclusion A CSR of 47.70% is acceptable for a secondary level hospital such as MMH. This figure is elevated, but appropriate, as the referral units that perform only low risk vaginal deliveries are excluded. A surge in the number of repeat caesarean sections performed and lower success rates for labour inductions were mostly responsible for the rise. Primary caesarean sections performed on patients directly result in a higher risk patient profile in the future, coupled with more repeat caesarean sections in subsequent pregnancies. This is supported by a 17.5% prevalence of previous CS in women in 2009 as opposed to the 20.79% of women with a prior CS in 2016. This study shows that a CS in the index pregnancy has sizeable effects on the care of a woman in subsequent pregnancies. This places more strain on the health system and ultimately affects service delivery to all patients. Theoretically it is possible to explore changes in management to curb the ever-increasing CSR, but one has to consider if such changes is acceptable and appropriate to the setting of MMH and the population it serves.

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36

Sonntag, Kim. "A retrospective review of surgical site infection following caesarean section at Mowbray Maternity Hospital". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22808.

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Introduction: Pregnancy related sepsis is a major cause of maternal mortality and morbidity in South Africa. Caesarean section (CS) is the most important risk factor in the development of puerperal infection, and surgical site infection (SSI) after CS increases maternal morbidity as well as medical costs. Mowbray Maternity Hospital (MMH), is a secondary level, public maternity hospital. The caesarean section rate at MMH has increased considerably over the last fifteen years, and the perception has been that there have been increasing numbers of patients developing SSI post-CS. This study was designed to look more closely at the incidence of SSI and to describe the patients identified with SSI. Methods: This was a retrospective observational study. Cases of severe SSI, as defined by the Centres for Disease Control and Prevention (CDC), following CS at MMH from December 2011 to December 2014 were identified. Following ethical approval, patient records were sourced, data collected and analysed using Stata and Statistica. Results: In the 3-year study period, 14982 CS were performed with 98 patients identified with severe SSI. Folders were retrieved for 96 patients, with 2 patients' folders missing and 29 patients with a missing maternity case record (MCR). The overall incidence of severe SSI was 0.65%, with an incidence of 0.88% in Year 1, 0.90 in Year 2 and 0.70 in Year 3. Of the cases, 79 (80.6%) had been in labour, 16 (16.3%) patients had had prolonged rupture of membranes (PROM) and 32 (32.7%) had prolonged labour, with a median of 5 vaginal examinations. An emergency CS was performed in 90 (91.8%) patients, 7 (7.2%) had an elective CS and 1 (1.0%) patient had this data missing. Deep incisional SSI was diagnosed in 74 (75.5%) patients and 24 (24.5%) patients were identified with organ/space SSI. Intravenous (IV) antibiotics was the main treatment in all 96 cases, with 23 (23.5%) patients requiring a wound debridement, 17 (17.2%) a laparotomy, which proceeded to a hysterectomy in 12 (12.3%) patients. In the majority of cases, no organism was cultured, Whereas multiple organisms were cultured in 16 cases, of which 12 were identified as MRSA, and 18 as Klebsiella pneumoniae. There were no maternal deaths or Intensive Care Unit (ICU) admissions. Discussion and Conclusion: The incidence of severe SSI is in keeping with other institutions, with the lowest incidence being found in Year 3, which may be explained by the change in referral population and/ or the full implementation of the Best Care Always (BCA) bundles of care. Of the 98 patients with severe SSI, 80.6% had been in labour, 32.7% had prolonged labour and 91.8% had an emergency CS performed. These are all factors which are known to increase the likelihood for development of post-CS SSI.

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37

Schoenwald, Anthony V. "Nurse practitioner led pain management the day after Caesarean section : a randomised controlled trial". Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/103760/1/Anthony_Schoenwald_Thesis.pdf.

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Caesarean pain is a major problem for women in the days after childbirth and is often not well controlled with the routine practice of twice daily controlled-release oxycodone. This randomised controlled trial demonstrated that a nurse practitioner intervention designed to support maternal participation using immediate-release oxycodone and supportive educational strategies was a safe and effective approach for pain management after caesarean section. At three months follow-up, a small subset of women had persistent pain which was strongly correlated with postnatal depression. Nurse practitioners have the potential to transform acute pain management by meeting individual patient needs over their healthcare journey.

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Arthur, Dianne. "Maternal request for an elective caesarean section an interpretive descriptive study of primigravid women's request for an elective caesarean section : a dissertation [thesis] presented in partial fulfilment of the requirements for the degree of Masters of Health Science, Auckland University of Technology, March 2003". Full thesis. Abstract, 2003.

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Thesis (MHSc--Health Science) -- Auckland University of Technology, 2003.
Appendices D, E, F and G not included in e-thesis. Also held in print (87 leaves, 30cm.) in Akoranga Theses Collection (T 618.86 ART)

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39

Watkyns, Ann Frances. "Sensory over-responsivity in children of 3-5 years: A descriptive, analytical study". Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30806.

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BACKGROUND: Sensory over-responsivity (SOR) is a type of Sensory Modulation Disorder (SMD), where the individual has an over-responsive behavioural reaction to non-harmful or non-threatening sensory stimulation, which is out of proportion to the stimulus. SOR can negatively impact a child’s engagement and performance in their daily life. SOR is frequently diagnosed by occupational therapists, and deep pressure is an important facet of the treatment of SOR by occupational therapists. Prior research (Alberts & Ronca, 2012) indicates that the component of pressure in the vaginal birth process aids the infant’s neurophysiological adaption to extra-uterine life. This component is absent in elective caesarean section births. This study therefore set out to determine whether method of birth could be associated with SOR, as well as investigating demographic and other variables linked to SOR. It was hypothesised that there would be a higher prevalence of SOR in children aged 3-5 years born by elective caesarean section compared to those born by vaginal birth. The study objectives were: • To establish a profile (demographic and variables linked to SOR) of participants (mother-child dyads) by birth method group (CS or vaginal delivery) • To determine the prevalence of SOR by birth method • To establish if there is a statistically significant difference in SOR and birth method • To establish which variables (for example birth weight, jaundice, birth complications) are associated with SOR METHOD: A quantitative, descriptive, analytical study was conducted with a sample of 91 children between the ages of 3 years 0 months and 4 years 11 months. Children across various language, cultural and socio-economic groups were recruited and allocated to two groups based on their method of birth - vaginal delivery and elective caesarean section. Caregivers of each child completed the Short Sensory Profile 2 (SSP2) questionnaire as well as a demographic information questionnaire. The scores for SOR were calculated for each participant, and prevalence of SOR between the two birth method groups was compared. Demographic variables were tested for significance between the two groups. The variables showing a significant difference were further analysed to determine any association with SOR. RESULTS: There were 91 participants, 58 in the VB group and 33 in the CS group. Mothers in the VB group gave birth at a younger age (U = 499.0, p < .001), were of a lower income level (chi-square = 11.49, df = 2, p = .003) and more likely to be single (Fishers exact p (2-tailed) = .037). The children in the VB group were of a greater gestational age (U = 472.5, p = .001), had a shorter time period before the first breastfeed (U = 478.0, p = .006), and had fewer sleeping difficulties (Fishers exact p (2-tailed) = .003). The prevalence of SOR for the total sample was 22%. There was a significant association in SOR prevalence and birth method (Fishers exact p (2-tailed) = .034), with greater prevalence in the VB group (29%) as opposed to the elective CS group (9%). There were statistically significant associations between SOR and maternal age (U = 380.5, p = .004), marital status (Fishers exact p (2-tailed) = .003) and time after birth to the first breastfeed (U = 394.5, p = .049). CONCLUSION: There was a statistically significant difference in SOR between the two birth method groups, with higher prevalence in the VB group. This was thought to be linked to cultural and language challenges associated with the use of the SSP2, and the impact of low socio-economic circumstances on child development and the ability to regulate sensory input. Recommendations include developing and validating a culturally appropriate sensory profile questionnaire, available in the most common official languages to facilitate the accurate assessment of sensory modulation of all children living in South Africa. In addition, there is a need to test the birth method hypothesis in demographically balanced groups.

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Maruta, Anna. "Surveillance of surgical site infections following caesarean section at two central hospitals in Harare, Zimbabwe". Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/98019.

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Thesis (MSc)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Background Caesarean section deliveries are the most common procedures performed by obstetricians in Zimbabwe. Surgical site infections (SSI) following caesarean section delivery result in increased hospital stay, treatment, cost, hospital readmission rates and related maternal morbidity and mortality. There is no national surveillance system for SSIs in Zimbabwe, however, information is available on number of cases of post-operative wound infection after caesarean section, but the denominator and definition used is not consistent. The objective of this study were develop and strengthen the surveillance system in Zimbabwe, to establish a clinical-based system in a setting with limited microbiological access, to measure post-operative SSI after caesarean section and to describe the associated risk factors and to determine whether feedback of SSI data has any effect on the surgical site infection incidence rate. Methodology This was a before and after study with two rolling cohort periods conducted at two Central hospitals in Harare, Zimbabwe. An Infection Prevention and Control (IPC) intervention was conducted in-between. During the pre-intervention period, baseline demographic and clinical data were collected using a structured questionnaire, and during the post-intervention period the impact of the interventions was measured. Convenience sampling was employed. Results A total of 290 women consented to participate in the study in the pre intervention period, 86.9% (n= 252) completed the 30-days post-operative follow-up and the incidence rate of SSI was 29.0% (n=73, 95% CI:23.4-35.0) Interventions developed included: training in Infection Prevention and Control for health workers; implementation of a protocol for cleaning surgical instruments; dissemination of information on post-operative wound management for the women. After implementation of the intervention, 314 women were recruited for the post-intervention, 92.3%(n= 290) completed the 30-day follow-up and there was a significant (p<0.001) reduction in the incidence rate of SSIs to 12.1 % (n=35, 95% CI: 8.3 -15.8) during this period. Development of SSI after caesarean section was found to be significantly associated with emergency surgery (p<0.001), surgical wound class IV (p=0.001) and shaving at home (p<0.001) at both pre- intervention and post-intervention periods. Stellenbosch University https://scholar.sun.ac.za iii Conclusion This study shows that caesarean section can be performed with low incidence of SSI if appropriate interventions such as training in IPC, adequate cleaning of equipment and education in wound-care for the mother are adhered to. It also demonstrated a simple surveillance data collection tool can be used on a wide scale in resource limited countries to assist policy makers with monitoring and evaluation of SSI rates as well as assessment of risk factors.
AFRIKAANSE OPSOMMING: Agtergrond Keisersnitte is die mees algemene prosedure wat uitgevoer word deur obstetriese dokters in Zimbabwe. Chirurgiese wond infeksies wat op keisersnitte volg lei tot verlengde hospitaal verblyf, behandeling, koste, heropname koerse en verwante moederlike morbiditeit en mortaliteit. Alhoewel daar geen nasionale waaktoesig sisteem vir chirurgiese wondinfeksies is nie, is informasie beskikbaar vir ‘n aantal gevalle wat post-operatiewe wondinfeksie na ‘n keisersnit onwikkel het, maar die noemer en definisie word inkonsekwent gebruik. Die doel van hierdie studie was om die waaktoesig sisteem in Zimbabwe te ontwikkel en te versterk, om ‘n klinies-gebasseerde sisteem te vestig in ‘n opset met beprekte mikrobiologiese toegang, om postoperatiewe chirurgiese wond infeksies na keisersnitte te meet en om die geassosieerde risikofaktore te beskryf en om vas te stel of terugvoering van chirurgiese wondinfeksie data enige effek op die infeksiekoerse na keisersnitverlossings gehad het. Metodologie Hierdie was ‘n voor-en-na studie met twee kohort periodes uitgevoer by twee sentrale hospitale in Harare, Zimbabwe. ‘n Infeksievoorkoming en –beheer intervensie was tussenin uitgevoer. Tydens die pre-intervensie periode was basislyn demografiese en kliniese data ingesamel deur middel van ‘n gestruktureerde vraeboog, en gedurende die post-intervensie fase was die impak van die intervensies gemeet. Gerieflikheidsteekproefneming was geimplementeer. Resultate ‘n Totaal van 290 vroue het toestemming verleen om aan die studie deel te neem in die pre-intervensie periode, waarvan 86.9% (n=252) die 30 day post-operatiewe opvolg voltooi het en die insidensiekoers van chirurgiese wondinfeksies was 29.0% (n=73, 95% CI:23.4-35.0) Intervensies wat onwikkel was het ingesluit: opleiding in Infeksie Voorkoming en -Beheer vir gesondheidswerkers; die implementering van ‘n protokol om chirurgiese instrumente skoon te maak; disseminering van informasie oor post-operatiewe wondhantering vir vroue. Na die implimentering van die intervensie was 314 vroue gewerf in die post-intervensie fase, waarvan 92.3% (n=290) die 30 dae opvolg voltooi het. Daar was ‘n beduidende (p<0.001) verlaging in die insidensiekoers van chirurgiese wondinfeksies na 12.1% (n=35, 95% CI: 8.3-15.8) gedurende hierdie periode. Stellenbosch University https://scholar.sun.ac.za v Daar was bevind dat chirurgiese wondinfeksies beduidend geassosieer was met noodchirurgie (p<0.001), chirurgiese wondklassifikasie IV (p=0.001) en skeer van hare by die huis (p<0.001) by beide die pre-intervensie en post-intervensie periodes. Gevolgtrekking Hierdie studie wys dat keisersnitte uitgevoer kan word met ‘n lae insidensie van chirurgiese wondinfeksies indien toepaslike intervensies, soos opleiding in infeksievoorkoming en beheer, voldoende skoonmaak van toerusting en opvoeding in wondsorg vir die moeders. Dit het ook aangedui dat ‘n eenvoudige data-insameling instrument op ‘n wye basis gebruik kan word in beperkte-hulpbron lande om beleidmakers te help met monitering en evaluering van chirurgiese wondinfeksie koerse, asook die assessering van risikofaktore.

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41

Rumboll, Charles Knight. "The use of phenylephrine to obtund oxytocin induced hypotension and tachycardia during elective caesarean section". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22807.

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Background: Oxytocin causes clinically significant hypotension and tachycardia. This study examined whether the prior administration of phenylephrine obtunds these unwanted haemodynamic effects. Methods: Forty pregnant women undergoing elective caesarean section under spinal anaesthesia were randomised to receive either a 50 μg bolus of phenylephrine (Group P) or saline (Group S) immediately prior to oxytocin (3 IU over 15 seconds). Systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP] and heart rate [HR]) were recorded using a continuous non-invasive arterial pressure device. Baseline values were averaged for 20 seconds post-delivery. Between-group comparisons were made of the mean peak changes in BP and HR, and the mean percentage changes from baseline, during the 150 seconds after oxytocin administration. Results: The mean peak percentage change (SD) in SBP was -16.9% (2%) in Group P, and -19.0% (1.9%) in Group S and the estimated mean difference was 2.1% (95% CI: -3.5 to 7.8 %) and P =0.44; corresponding changes in HR were 13.5% (2.3%) and 14.0% (1.5%) and the mean estimated difference was 0.5% (95% CI -6.0 to 5%) and P=0.87. The mean percentage change from the baseline measurements during the 150 s period of measurement was greater for Group S than Group P: SBP -5.9% vs -3.4%; P =0.149; DBP -7.2% vs -1.5%, P =0.014; MAP -6.8% vs -1.5%, P =0.007; HR 2.1% vs -2.4%, P =0.033. Conclusion: Intravenous phenylephrine 50 μg immediately before 3 U oxytocin during elective caesarean section does not prevent maternal hypotension and tachycardia.

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Jordaan, Meandra. "Retrospective observational study of the choice of anaesthesia for caesarean section in patients with eclampsia". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32742.

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Background Anaesthesia for ceasarean section (CS) in women with eclampsia is a major clinical challenge, and there are limited data concerning the rationale for the choice of technique, and the short-term outcomes. A retrospective audit was performed on practice at a tertiary referral centre in Cape Town. Methods The primary outcome of the audit was the proportion of patients with eclampsia receiving either spinal anaesthesia (SA) or general anaesthesia (GA) for CS, and the assessment of the rationale for the choice of method. A convenience sample of the records of one hundred consecutive patients with eclampsia admitted to the Maternity Centre at Groote Schuur Hospital from 2009- 2013, were studied. Patient demographics, clinical details and outcomes (including relevant results of special investigations), were recorded. The number and percentage of patients receiving GA or SA were documented. The presence or absence of factors influencing selection of the method of anaesthesia, including Glasgow Coma Scale (GCS), degree of urgency of CS, trauma to the oropharynx, number of seizures, control of blood pressure, and the availability of and/or platelet count prior to anaesthesia, were noted. In addition, complications of anaesthesia were described, and short-term maternal and neonatal outcomes were recorded. Results One hundred patient records were screened, and there were 11 exclusions; therefore 89 patient records were analysed. Seven/89 (7.9%) received SA and 82/89 (92.1%) GA. One patient required conversion to GA because of the occurrence of a seizure during attempted SA. All patients receiving spinal anaesthesia were stable and had no postoperative complications. Overall, 63 (70.8%) had a preoperative GCS< 14, and 26 (29.2%) patients had GCS ≥14. Seven patients in the subgroup with GCS ≥14 had SA, and the remaining 19 received GA. GA was performed because there was no platelet count available in 3, pulmonary oedema in 2, difficult airway due to a bitten tongue during a seizure in 2, fetal bradycardia in 2, HELLP syndrome in 1, renal failure in 1, and patient refusal in 1 patient. In 7 women, there was no clear reason why GA was chosen. The median [IQR] Apgar scores at 1 minute were lower in patients receiving GA [(5) (1-9) and 4 (1-9)] in patients with GCS ≥14 and < 14 respectively, versus 8 (6-9) for SA. The number (%) of neonates with Apgar scores ≥ 7 at 1 minute in patients who had SA, was 6 (85.7), compared with 3 (13.6) and 12 (17.9) in patients having GA with GCS ≥14 and < 14 respectively. There were 2 stillbirths and 2 neonatal deaths in the GA group. The median [IQR] length of stay in patients with GCS ≥ 14 was 1 day in the group receiving SA and 2 days in those who had GA; patients with GCS< 14 were ventilated for 3 days. No patients receiving SA required postoperative ventilation, whereas 5/19 (26.3%) patients with GCS ≥14 who received GA required ventilation, for 2 days. Seven patients with GCS< 14 had cerebral oedema, and 2 had cerebral infarcts. There were 2 maternal deaths. Conclusions In this audit, a small percentage of women with eclampsia received SA for CS. A review of the case records suggests that more patients could have safely received SA. A larger prospective audit is required to establish factors influencing safety of spinal anaesthesia for CS in women with eclampsia.

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Shorten, Allison. "Making choices for childbirth after caesarean section : a randomised controlled trial of a decision-aid". Phd thesis, Faculty of Nursing and Midwifery, 2005. http://hdl.handle.net/2123/7741.

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Carrillo, Larco Rodrigo M., J. Jaime Miranda e Antonio Bernabe-Ortiz. "Delivery by caesarean section and risk of childhood obesity: analysis of a Peruvian prospective cohort". PeerJ, Inc, 2015. http://hdl.handle.net/10757/558501.

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Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and familyrelated (e.g., maternal nutritional status) variables. Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up. Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.
RMC-L, JJM, AB-O, and the CRONICAS Center of Excellence in Chronic Diseases were supported by the National Heart, Lung, and Blood Institute Global Health Initiative under the contract Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases (Project Number 268200900033C-1-0-1). AB-O is currently supported by a Wellcome Trust Research Training Fellowship in Public Health and Tropical Medicine (Grant 103994/Z/14/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Klimpel, Jill M. "Performing Modernity through Birth: Exploring High Rates of C-Sections in São Paulo, Brazil". Ohio University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1321638880.

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Danielsson, Malin, Lina Lennartsson e Sandra Olsson. "Women’s thoughts, expectations and desires in the presence of their next delivery after a caesarean section". Thesis, Kristianstad University College, Department of Health Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-4919.

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Introduction: The caesarean section rate has increased significantly in the last twenty years. The fact that a woman has delivered by caesarean section once does not automatically mean that she will again. Some women want a repeat caesarean section while others want a vaginal birth. Objective: The aim of this study was to describe women’s thoughts, expectations and desires in the presence of their delivery after a previous caesarean section. Methods: A systematic literature review through study of scientific articles. Thirteen articles were analyzed and combined. Results: Yearning for a vaginal delivery was what most of the women expressed. To be involved in the decision making process was important. The women wanted individually suited information and support. The women had a more realistic understanding of the birthing experience after the previous caesarean and had a greater understanding for the fact that caesarean sometimes is inevitable. Their attitude was to expect the unexpected and to be more humble in their expectation. Conclusion: Through increased knowledge regarding women’s thoughts, expectations and desires in the presence of their next delivery after a previous caesarean section, the caregivers can give support and individual information at a greater extent.

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Roux, Samantha Lynne. "An exploratory study of mothers perceptions and experiences of an unplanned Caesarean section / Samantha Lynne Roux". Thesis, North-West University, 2010. http://hdl.handle.net/10394/4943.

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Objective The present study aimed to explore women's perceptions and experiences of childbirth by unplanned Caesarean section. Background New motherhood is characterised as a profound change, and research suggests that the psychological effects of childbirth can be significant and far–reaching for some women. The processes occurring during a traumatic birth experience could affect a woman's emotional and psychological state, and she may experience considerable adjustment difficulties in adapting to unfulfilled expectations of delivering her baby naturally. Methods In–depth interviews explored 10 women's lived experiences of childbirth, after which thematic content analysis was used to synthesise data. The elements of phenomenological theory served as a broad framework for the structuring, organizing and categorizing of data, with interpretation aimed at gaining a greater understanding of women's internalised childbirth accounts. Findings Women described their contact with medical personnel, as well as the physical, environmental, and emotional aspects of their unplanned Caesarean sections, as distressing and traumatic. A sense of loss of control was the most significant contributor to women's negative childbirth experiences. Feelings of failure and disappointment were primarily related to unmet expectations and a lack of preparedness. Negative experiences were mediated by attentive caregiving, inclusion in decision–making, and support from loved ones.
Thesis (M.Sc. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2011.

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Van, Griensven Hubert. "The impact of caesarean section scar problems and the individual's perception of associated health care needs". Thesis, University of Brighton, 2013. https://research.brighton.ac.uk/en/studentTheses/315b5642-c32a-4237-9e4d-01036eeea8b0.

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Introduction. Persistent pain in the operated region is a common complication of many types of surgery. Previous research suggests that at least 5-10% of women experience persistent scar pain following caesarean section (CS), but does not explain why women rarely access health care, how this pain may affect them or what their perceived health care needs are. This study employed a mixed methods approach to establish the impact of caesarean scar problems and any associated healthcare needs, from the perspective of the individual. Permissions for the study were received from the University of Brighton, Research Ethics & Governance Committee, National Information Governance Board and the researcher's NHS Trust. The study was conducted in three sequential phases. Phase 1. Self report. Women rarely visit clinics for persistent post-CS pain, so their perspective was gained initially by investigating informal discussions on publicly accessible internet sites. Findings: Pain in the scar area, but also healing difficulties and scar shape, were a problem for some women. There might be a need for improved information, advice and treatment. Phase 2. Survey. In order to overcome the bias inherent in internet reporting, a postal questionnaire was designed to explore the issues identified in Phase 1 in the local population. The questionnaire was sent out to 630 women, all of whom had undergone CS at the researcher's NHS Trust 6 to 30 months previously. Findings: Scar related issues from phase 1 were confirmed. CS scars clearly affected participants in various ways and some were troubled by them, but it was not clear why few sought professional help. Phase 3. Qualitative interviews. In order to explore the findings in greater depth, 19 respondents from Phase 2 were interviewed. Topics were the impact of the CS scar on the individual, concerns related to the scar and perceived associated healthcare needs. Themes were identified and analysed using a Framework approach. Findings: Most participants had learned to live with any CS scar problems they might have. Their main concerns were related to a potential subsequent pregnancy. However, many felt that information and advice received before and immediately after CS had not met their needs, making recovery from CS and learning to cope with any remaining problems difficult. Conclusion. This study identified problems with effective provision of information to service users. Women feel poorly prepared for potential consequences of CS such as slow recovery, impact on activity, scar shape, and altered body image and confidence. This raises questions over the issue of informed consent and shared decision making.

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Calistus, Wilunda. "Caesarean delivery and anaemia risk in children in 45 low- and middle- income countries". Kyoto University, 2018. http://hdl.handle.net/2433/232310.

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Yu, Sui-cheung. "Cost effectiveness of intravenous patient controlled analgesia versus intrathecal morphine for post-operative pain after caesarean section : a randomised controlled trial /". Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39724311.

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