SEZARYEN AMELİYATLARI HAKKINDA...

Sağlıkta Dönüşüm ve sağlık ticaretinin kurumsallaşması sonucunda ülkemizde sezaryen varsayılan ve saygın bir doğum yöntemi haline gemiştir. Ne hekimlere ne de halka normal doğumun herşeyden önce "normal" ve "doğal" bir doğum şekli olduğunu kabul ettirmek artık mümkün değildir. Normal doğum bir hastalık,  geri ilkel, bebeğinin geleceğini düşünmeyen, sorumsuz kimselerin başvuracağı bir yöntem gibi algılanmaktadır.  

Sezaryen yapan kadınlar cerrahi bir girişim yaptığı için hastanede daha uzun kalmaktadır. Hastaneler bu fırsatı da değerlendirerek yeni doğan bebekleri bir hasta gibi ele almakta ve yoğun bakımlarda yatırmaktadırlar. Bunun nedeni de yüksek olan yoğun bakım ücretleridir. Kimse normal bebeklerin neden yoğun bakımda yatırıldığını sorgulamamaktadır. bul anne ve babalara çok ileri, modern, daha önce yapılmayan bir uygulama gibi takdim edilmektedir. Yeni doğanların sırf ticari nedenlerle yoğun bakıma yatırılması, anne sütü yerine damardan beslenmesi ve kendilerine gereksiz yere antibiyotik verilmesi bunlarda kan zehirlenmesi (sepsis) ve ölümlere yol açmaktadır. Bu nedenle, Türkiye'nin her bir bölgesinden sık sık kitlesel yeni doğan ölümlerine rastlanmaktadır.

Bu sepsislerin esas nedeni antibiyotik verilmesi ve ağzı ve sindirim sistemi normal çalışan bebeklerin damardan beslenmesidir. Yeni doğduğu için  boğaz florası (koruyucu mikroplar) oluşmamış bu bebeklerin doğar doğmaz antibiyotik tedavisine alınması dirençli mikropların boğaz engelini aşarak vücuda kolaylıkla girmesine yol açar. Çoğu antibiyotiklere dirençli bu mikroplar da vücutta kolayca sepsis ve hastane enfeksiyonu denen iatrojenik (tıbbi işleme bağlı) sepsisi ve ölümlere neden olur.  Çözüm bu bebekleri anneleri ile başbaşa bırakmaktan ve normal yoldan beslenmelerine izin vermekten geçer.

Aşağıdaki yazıda cerrahi girişime bağlı diğer tehlikeler yanında sezaryenle ilgili bazı araştırma sonuçları bulunmaktadır.

Sezaryen modası tıbbi gerekçelerle değil sağlık endüstrisinin ve ona bağlı tıp eğitiminin bir sonucu oluştuğu için, bu gibi karşı yayınlar halkın ve hekimlerin görüşlerini şüphesiz değiştirmeyecektir. Bu sağlık sisteminde vatandaş istese bile normal doğum yaptırtabilmesi mümkün değildir. Uygulayıcılar bir şekilde onları sezaryene yönlendirecektir. Ne hikmetse  her gebe ve fetüs ölüm tehlikesi yaşamaktadır (?). Bu nedenle doğum sezaryenle yapılmalıdır. Günümüzde normal doğumun olması gereken doğum şekli olduğunu kabul eden tek bir hekim bile bulmak mümkün değildir. Bu garabet de Türkiye'deki tıp eğitiminin bir sonucudur. Bu sistem sadece tıbbi bilmeyen  hekimler değil, sağlıklı düşünemeyen hekimler de yetiştirmektedir. Bu sorun tıbbi değil ekonomik ve sosyolojik bir sistem sorundur.  Sağlıkta Dönüşüm yolundan vazgeçmedikçe sezaryen doğumları giderek artacaktır. 

Regional blocks superior to general anesthesia for cesarean section
April 29th, 2009 

General anesthesia (GA) is associated with an increased risk of infant intubation and low Apgar scores, relative to regional anesthesia. An analysis of 50,806 cesarean deliveries, published in the open access journal BMC Medicine, strongly supports guidelines that regional anesthesia is to be preferred over GA for most cesarean sections. 




Charles Algert, from the Kolling Institute at the Royal North Shore Hospital, Sydney, was part of a team of researchers who studied births in the state of New South Wales, Australia, between 1998 and 2004. He said, "We have shown that general anesthesia poses significant risks to the neonate of both resuscitation requiring intubation and of a poor Apgar score at 5 minutes. The greatest relative risk of both adverse outcomes occurred in low-risk, planned, repeat cesarean deliveries under GA, but the greatest excess in risk attributable to GA was for emergency deliveries for fetal distress where the infant would already have been compromised to some extent". 

Although current guidelines recommend regional blocks, GA was still used for 12.6% of cesareans across NSW in 2006. According to the NHS Maternity Statistics, 8.7% of cesarean sections in England in 2006-2007 were performed using GA. It is generally presumed that any harm caused by GA is short-lasting, with most studies focusing on resuscitation and the Apgar score at one minute. According to Algert, however, this may not be the case, "The increased rates of neonatal intubation after GA shown in this study represent harm in and of itself, and the persistence of low 5-minute Apgar scores suggests that deleterious effects may last longer than the immediate aftermath of delivery". 

The authors conclude, "Clinicians considering the use of GA for a cesarean delivery should be aware of these possible consequences for the infant, for both planned and emergency sections". 

More information: Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study, Charles S Algert, Jennifer R Bowen, Warwick B Giles, Greg E Knoblanche, Samantha L Lain and Christine L Roberts, BMC Medicine (in press), http://www.biomedcentral.com/bmcmed/

Source: BioMed Central (news : web)
http://www.physorg.com/news160213851.html


C-sections a critical factor in preterm birth increase
May 28th, 2008 

Cesarean sections account for nearly all of the increase in U.S. singleton preterm births, according to an analysis of nine years of national birth data. 



  


Between 1996 and 2004 there was an increase of nearly 60,000 singleton preterm births and 92 percent of those infants were delivered by a cesarean section, (c-section), according to research by investigators from the March of Dimes and the U.S. Centers for Disease Control and Prevention (CDC) that will be published in the June issue of Clinics in Perinatology. 

While singleton preterm births increased by about 10 percent during this time, the c-section rate for this group increased by 36 percent.

Preterm birth is a serious and costly health concern and is the leading cause of death in the first month of life. More than 520,000 babies – one out of every eight – are born too soon each year in the United States.

Late preterm babies, those born 34-36 weeks gestation, account for most of the increase in the US singleton preterm birth rate. These infants have a greater risk of breathing problems, feeding difficulties, temperature instability (hypothermia), jaundice, delayed brain development and death than babies born at term. This new analysis shows that that these late preterm infants had the largest increase in c-section deliveries.

“While maternal and fetal complications during pregnancy may result in the need for a c-section, we’re concerned that some early c-section deliveries may be occurring for non-medically indicated reasons,” said Alan R. Fleischman, M.D., the March of Dimes medical director and senior vice president. “We need research to determine how many c-sections that result in preterm babies are not medically indicated and may place both mother and baby at risk for little or no medical benefit. ”

C-sections are the most common major surgical procedure for women. More than 30 percent of the 4.1 million U.S. live births are delivered via c-section and the rate has increased dramatically since 1996. A c-section delivery can be lifesaving when there are complications during pregnancy, but it is a major operation with potential risks to the mother from the surgery and anesthesia and to the baby, if the delivery occurs too soon. The March of Dimes is concerned that some early deliveries may occur without good medical justification and may be done at the request of the mother or based on an inappropriate recommendation from the doctor.

Source: March of Dimes Foundation
http://www.physorg.com/news131173190.html

Caesarean babies more likely to develop diabetes

Caesarean babies more likely to develop diabetes
August 26th, 2008 

Babies delivered by Caesarean section have a 20 per cent higher risk than normal deliveries of developing the most common type of diabetes in childhood, according to a study led by Queen's University Belfast. 


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The team, led by Dr Chris Cardwell and Dr Chris Patterson, examined 20 published studies from 16 countries including around 10,000 children with Type 1 diabetes and over a million control children. 

They found a 20 per cent increase in the risk of children born by Caesarean section developing the disease. The increase could not be explained by factors such as birth weight, the age of the mother, order of birth, gestational diabetes and whether the baby was breast-fed or not, all factors associated with childhood diabetes in previous studies. 

Dr Cardwell, from the School of Medicine, Dentistry and Biomedical Sciences, said: "This study revealed a consistent 20 per cent increase in the risk of Type 1 diabetes. It is important to stress that the reason for this is still not understood. It is possible that children born by Caesarean section differ from other children with respect to some unknown characteristic which consequently increases their risk of diabetes, but it is also possible that Caesarean section itself is responsible. 

"Type 1 diabetes occurs when the immune system destroys the insulin producing cells in the pancreas, and one theory suggests that being born by Caesarean section may affect the development of the immune system because babies are first exposed to bacteria originating from the hospital environment rather than to maternal bacteria." 

Dr Chris Patterson said: "The study findings are interesting, but unless a biological mechanism is established it would be unwise to read too much into this association between Caesarean section delivery and diabetes. 

"Fortunately figures from the Northern Ireland Type 1 diabetes register indicate that only around two per 1,000 children will develop diabetes by their 15th birthday so a 20 per cent increase is on quite a low baseline risk." 

Diabetes is a serious condition that, if not managed, can lead to fatal complications including heart disease, stroke, kidney failure and amputations. There are 2.3 million people in the UK diagnosed with diabetes and 250,000 with Type 1 diabetes. In Northern Ireland over 62,000 people have diabetes, 6,000 of them with Type 1 diabetes. 

Around one in four babies in Northern Ireland are delivered by Caesarean section, which is significantly higher that the World Health Organisation's recommended rate of 15 per cent. 

Iain Foster, Director of Diabetes UK Northern Ireland, said: "Not all women have the choice of whether to have a Caesarean section or not, but those who do may wish to take this risk into consideration before choosing to give birth this way. 

"We already know that genetics and childhood infections play a vital role in the development of Type 1 diabetes in children, but the findings of this study indicate that the way a baby is delivered could affect how likely it is to develop this condition later in life. Diabetes UK Northern Ireland would welcome more research in this area."

Source: Queen's University Belfast


http://www.physorg.com/news138964106.html

Laboring without the labor bed: It's a good thing

Laboring without the labor bed: It's a good thing
July 6th, 2009 

A University of Toronto pilot study that re-conceptualized the hospital labour room by removing the standard, clinical bed and adding relaxation-promoting equipment had a 28 per cent drop in infusions of artificial oxcytocin, a powerful drug used to advance slow labours. 


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The study, called PLACE (Pregnant and Labouring in an Ambient Clinical Environment) was published in the current edition of the journal Birth. 

In addition, more than 65 percent of the labouring women in the ambient room, compared to 13 per cent in the standard labour room, reported they spent less than half their hospital labour in the standard labour bed. 

Led by Dr. Ellen Hodnett, Bloomberg Faculty of Nursing professor and Heather M. Reisman Chair in Perinatal Nursing Research at the University of Toronto, PLACE included 62 women at two Toronto teaching hospitals. 

Hodnett devised a set of simple, but radical modifications to the standard hospital labour room, with the intention of surrounding the women and their caregivers with specific types of auditory, visual and tactile stimuli. 

"The removal of the standard hospital bed sent a message that this was not the only place a woman could labour," says Hodnett. A portable, double-sized mattress with several large, comfortable cushions was set up in the corner of the ambient room. Fluorescent lighting was dimmed, and DVDs of ocean beaches, waterfalls and other soothing vistas were projected onto a wall. A wide variety of music was also made available. 

"The intent was to allow the women the ability to move about freely during their labour, to permit close contact with their support people, and to promote feelings of calm and confidence," says Hodnett. 

Reaction to the ambient room was overwhelmingly positive, as respondents were pleased to have options for mobility and for helping to cope with their labour. They also indicated they received greater one-on-one attention and support from their nurses. 

"This study raises questions about the assumptions underlying the design of the typical hospital labour room," says Hodnett. "The birth environment seems to affect the behaviour of everyone in it - the laboring women as well as those who provide care for her. 

Hodnett hopes to further this study with a larger, randomized controlled trial. 

More information: http://www3.interscience.wiley.com/cgi-bin/fulltext/122413904/HTMLSTART

Source: University of Toronto (news : web)

http://www.physorg.com/news166097618.html

Induction Of Labour Increases Risk of Amniotic of Amniotic-Fluid Embolism

Induction Of Labour Increases Risk of Amniotic of Amniotic-Fluid Embolism
October 20th, 2006 

A Canadian population-based cohort study has revealed that medical induction of labour increases the risk of amniotic-fluid embolism. The study was led by Dr. Michael Kramer, Canadian Institutes of Health Research (CIHR) Senior Investigator from McGill University, and will be published in the October 21st issue of The Lancet. 


Amniotic-fluid embolism (AFE) is a rare, but serious and even fatal maternal complication of delivery. While its cause is unknown, it is one of the leading causes of maternal mortality in developed countries, accounting for seven of 44 direct maternal deaths in Canada in the period 1997-2000.

This population-based study examined the association of AFE and medical induction of labour in a cohort of three million hospital births in Canada, for the twelve fiscal years 1991-2002.

“AFE remains a rare occurrence,” said Dr. Michael Kramer, principal investigator of the study and Scientific Director of CIHR’s Institute of Human Development, Child and Youth Health. “Of the 180 cases of AFE we found, 24 or 13% were fatal. AFE arose almost twice as frequently in women who had medical induction of labour as in those who did not; fatal cases arose 31⁄2 times more frequently.”

“Dr. Kramer's research has resulted in a discovery that will benefit physicians who look after pregnant women as they will now be aware of this potential complication should they induce labour", said Dr. Joseph Shuster, Interim Scientific Director of the MUHC. "This is an example of how academic university teaching hospitals improve the quality of patient care.”

The research team also found several other factors to be associated with higher rates of AFE, including multiple pregnancy, older maternal age (35 years or older), caesarean or instrumental vaginal delivery, eclampsia (a serious complication of pregnancy characterised by convulsions), polyhydramnios (too much amniotic fluid), abnormal placental position or separation, and cervical laceration or uterine rupture.

“Our findings confirm the hypothesis that medical induction of labour is related to an increased risk of AFE,” added Dr. Kramer. “Although the absolute risk increase of AFE for women is very small (four or five total cases and one or two fatal cases per 100,000 women induced) and is unlikely to affect the decision to induce labour in the presence of compelling clinical indications, women and physicians should be aware of this risk if the decision is elective.”

Dr. Kramer worked with Drs. K.S. Joseph and Thomas F. Baskett at Dalhousie University as well as with Mr. Jocelyn Rouleau at the Public Health Agency of Canada (PHAC). The research was conducted for the Maternal Health Study Group of the Canadian Perinatal Surveillance System, a program under PHAC auspices.

Source: Canadian Institutes of Health Research

http://www.physorg.com/news80564831.html

Growing danger from post-birth bleeding
February 25th, 2009 

Post-partum haemorrhage (PPH) immediately after giving birth is the largest threat to new mothers in high-income countries. An Australian study, featured in the open access journal BMC Pregnancy and Childbirth, shows that an increasing number of women suffered severe problems arising from blood loss after delivery. 


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Christine Roberts from the University of Sydney and Royal North Shore Hospital led a team of researchers who studied the birth-hospital discharge records of the 500,603 women who had children in New South Wales during the study period. She said, "We identified 6242 women who suffered severe adverse outcomes, including 22 who died in hospital. Of the 6242, 67% had an obstetric haemorrhage (60% PPH)". 

The consequences of adverse maternal outcomes can include infertility, psychological effects, disability and even death. According to Roberts, "Active management of the third stage of labour, delivery of the placenta, is effective in reducing PPH. Unfortunately, adherence to active third-stage management recommendations is poorly reported and/or suboptimal in Australia, and significant variations in policies and practice have been reported in Europe. Suboptimal adherence to active management guidelines could explain the rising PPH rates". 

The authors found that between 1999 and 2004 the annual rate of adverse maternal outcomes increased by 20.9%. This increase occurred almost entirely among women who had a PPH. Although adverse outcomes also increased among women with conditions related to high blood pressure, over half these women also had a PPH. Roberts said, "Women with risk factors for PPH, such as a very low placenta or a previous PPH, should give birth in hospitals with facilities to manage severe haemorrhage." 

The authors conclude, "We feel that all women should have access to active management of the third stage of labour and careful observation in the first two hours after delivery, as this may reduce the PPH rate and the potential for severe harm and death". 

More information: Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity, Christine L Roberts, Jane B Ford, Charles S Algert, Jane C Bell, Judy M Simpson and Jonathan M Morris, BMC Pregnancy and Childbirth (in press), http://www.biomedcentral.com/bmcpregnancychildbirth/

Source: BioMed Central


http://www.physorg.com/news154767601.html

Patience during stalled labor can avoid many C-sections, study shows
November 1st, 2008 

Pregnant women whose labor stalls while in the active phase of childbirth can reduce health risks to themselves and their infants by waiting out the delivery process for an extra two hours, according to a new study by researchers at the University of California, San Francisco. 

By doing so, obstetricians could eliminate more than 130,000 cesarean deliveries – the more dangerous and expensive surgical approach – per year in the United States, the researchers conclude.

The study examined the health outcomes of 1,014 pregnancies that involved active-phase arrest – two or more hours without cervical dilation during active labor – and found that one-third of the women achieved a normal delivery without harm to themselves or their child, with the rest proceeding with a cesarean delivery.

The findings appear in the November, 2008 issue of Obstetrics and Gynecology, the official journal of the American College of Obstetricians and Gynecologists (ACOG).

While ACOG already recommends waiting at least two hours with adequate contractions in the setting of no progress in active labor, it is routine practice in many clinical settings to proceed with a cesarean for "lack of progress" before those ACOG criteria have been met, according to Aaron Caughey, MD, PhD, an associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, and senior author on the paper.

"One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year," said Caughey, who is affiliated with the UCSF National Center of Excellence in Women's Health. "In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach."

The cesarean delivery rate reached an all-time high in 2006 of 31.1 percent of all deliveries, according to the UCSF study. Arrest in the active phase of labor has been previously shown to raise the risk of cesarean delivery between four- and six-fold.

"Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection," Caughey said. "After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture."

The ten-year study identified all women who experienced what is known as active-phase arrest during their delivery at UCSF from 1991 to 2001. The study only included women with live, singleton deliveries who were delivered full-term.

The researchers examined maternal outcomes such as maternal infection, endomyometritis, postpartum hemorrhage and the need for blood transfusions. It also examined the infant's Apgar score, rates of infection and frequency of admission to the neonatal intensive care unit, among other health indicators.

The study found an increased risk of maternal health complications in the group that underwent cesarean deliveries, including postpartum hemorrhage, severe postpartum hemorrhage and infections such as chorioamnionitis and endomyometritis, but found no significant difference in the health outcomes of the infants.

It concluded that efforts to continue with a normal delivery can reduce the maternal risks associated with cesarean delivery, without a significant difference in the health risk to the infant.

"Given the extensive data on the risk of cesarean deliveries, both during the procedure and for later births, prevention of the first cesarean delivery should be given high priority," Caughey said.

Source: University of California - San Francisco


http://www.physorg.com/news144769920.html

Repeat C-section before 39 weeks raises risk of neonatal illness
January 7th, 2009 

Women choosing repeat cesarean deliveries and having them at term but before completing 39 weeks gestation are up to two times more likely to have a baby with serious complications including respiratory distress resulting in mechanical ventilation and NICU admission. 



UAB researchers, led by Alan T.N. Tita, M.D., Ph.D., assistant professor in the UAB Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, and colleagues reported in a study published January 8 in the New England Journal of Medicine that women who choose to have their babies delivered via repeat cesarean at 37 or 38 weeks without a medical or obstetric indication, risk serious complications for their child.

"The cesarean rate in the United States has risen dramatically, from 20.7 percent in 1996 to 31.1 percent in 2006. A major reason is the decline in attempted vaginal births after cesarean. Because elective cesareans can be scheduled to accommodate patient and physician convenience, there is a risk that they may be performed earlier than is appropriate." Tita said. "We knew from previous small studies that infants born before 39 weeks' gestation are at increased risk for respiratory distress. Because nearly 40 percent of the cesareans performed in the United States each year are repeat procedures, we undertook this large study to describe the timing of elective repeat cesareans and assess its relationship with the risk of various adverse neonatal outcomes."

Tita and colleagues studied 13,258 women who had elective repeat cesarean sections at the 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network from 1999 through 2002. They were selected from the Cesarean Section Registry of the network. The registry contains detailed, prospectively collected information on nearly 50,000 women with a prior cesarean who underwent either repeat cesarean delivery or a trial of labor at the 19 centers over the 4-year period. The 13,258 women studied were those who underwent an elective cesarean of a viable infant at 37 weeks gestation or later in the absence of labor or other obstetric or medical indications for early cesarean delivery (prior to 39 weeks). 

The researchers looked at whether an infant who was delivered at 37 weeks later died or was diagnosed with a number of conditions, including respiratory distress syndrome and/or transient tachypnea of the newborn, newborn sepsis, seizures, necrotizing entercolitis, hypoxic ischemic encephalopathy, required ventilator support within 24 hours of birth, had umbilical cord arterial pH (a measure of oxygenation) below 7.0, an Apgar score at five minutes of three or below, was admitted to a neonatal intensive care unit or required prolonged hospitalization. 

Of the 13,258 women who had elective repeat cesarean sections, as many as 35.8 percent were delivered before 39 weeks. Babies born at 37 weeks, were two times more likely to suffer with conditions common to babies born too soon, and at 38 weeks, they were one and a half times more likely. 

Tita said these findings, along with other studies, underscore the importance of not delivering a baby before 39 weeks for the sake of convenience.

"Unfortunately, these early deliveries are associated with a preventable increase in neonatal morbidity and NICU admissions, which carry a high personal and economic cost. These findings support recommendations to delay elective delivery until 39 weeks gestation and should be helpful in counseling women on the necessity of waiting to deliver."

Source: University of Alabama at Birmingham

http://www.physorg.com/news150571274.html

Caesarean births pose higher risks for mother and baby

Caesarean births pose higher risks for mother and baby
October 31st, 2007 

Women having a non-emergency caesarean birth have double the risk of illness or even death compared to a vaginal birth, according to a study from Latin America published today on British Medical Journal website. 


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However, the researchers found caesarean delivery prevented deaths in breech born babies.

The risks linked to caesarean births (whether chosen by the woman or her clinicians) are higher, regardless of variables such as demographics, medical and pregnancy history, gestational age of the foetus, pregnancy complications, where the baby is born and the skills of those helping to deliver the baby.

Researchers randomly selected eight Latin American countries and from those, 120 also randomly selected health facilities provided complete data on 97,307 deliveries of babies during a three-month study period. These data came from the Latin American component of the WHO Global Survey on Maternal and Perinatal Health, specifically carried out for this study in 2005.

They wanted to compare the risks and benefits of caesarean delivery compared to vaginal delivery. Of the 97,307 cases, 33.7% were caesarean and 66.3% vaginal. Overall, perinatal outcomes were good in these 120 hospitals, not far from those in developed countries.

They found that a woman having a caesarean delivery had twice the risk of illness and mortality (including death, hysterectomy, blood transfusion and admission to intensive care) as a woman having a vaginal delivery.

There was a five times higher risk of having to have antibiotic treatment after birth for women who had a caesarean delivery (elective or decided by clinicians) than those who had a vaginal delivery.

Risk of having to stay in a neonatal intensive care unit for newborn babies who were born head-first was doubled after a caesarean delivery compared to a vaginal birth.

The authors also found that the risk of neonatal death was also significantly increased (more than 70% higher) up to hospital discharge for babies who were born head first from both an elective and a clinician chosen caesarean delivery, compared to a vaginal delivery.

However, caesarean delivery had a large protective effect in preventing foetal deaths in cases of breech born babies and reduced overall risks in those cases.

The authors conclude that there are no net benefits from the very liberal use of caesarean delivery on maternal and neonatal outcomes, both at the institutional or individual level, and it can do harm. The exceptions are fewer postpartum severe vaginal complications, and better foetal outcomes among breech presentations.”

An accompanying editorial says that more accurate estimates of probabilities from other populations are needed to support informed childbirth choices.

Source: British Medical Journal
http://www.physorg.com/news113054276.html

Study: Caesarean babies more likely to die

Study: Caesarean babies more likely to die
September 7th, 2006 

A U.S. study finds babies born by Caesarean section are nearly three times more likely to die during the first month of life than those born naturally. 


The research by the Centers for Disease Control and Prevention in Atlanta is said to be the first to examine death rates of babies born by elective Caesarean or when there's no medical need for the procedure.

Study leader Marian MacDorman of the CDC said: "Neonatal deaths are rare for low-risk women -- of the order of one death per 1,000 live births. But even after we adjusted for socioeconomic and medical risk factors, the difference persisted."

The study involved more than 5.7 million U.S. births and 12,000 deaths occurring within 28 days of birth from 1998-2001.

In women defined as low-risk, the average rate of neonatal death was 0.62 per 1,000 vaginal births. In Caesarean births, low-risk mothers were nearly three times more likely to lose their child, at a rate of 1.77 per 1,000 births.

The research appears in the journal Birth: Issues in Perinatal Care.

Copyright 2006 by United Press International

http://www.physorg.com/news76869556.html

C-sections a critical factor in preterm birth increase
May 28th, 2008 

Cesarean sections account for nearly all of the increase in U.S. singleton preterm births, according to an analysis of nine years of national birth data. 




Between 1996 and 2004 there was an increase of nearly 60,000 singleton preterm births and 92 percent of those infants were delivered by a cesarean section, (c-section), according to research by investigators from the March of Dimes and the U.S. Centers for Disease Control and Prevention (CDC) that will be published in the June issue of Clinics in Perinatology. 

While singleton preterm births increased by about 10 percent during this time, the c-section rate for this group increased by 36 percent.

Preterm birth is a serious and costly health concern and is the leading cause of death in the first month of life. More than 520,000 babies – one out of every eight – are born too soon each year in the United States.

Late preterm babies, those born 34-36 weeks gestation, account for most of the increase in the US singleton preterm birth rate. These infants have a greater risk of breathing problems, feeding difficulties, temperature instability (hypothermia), jaundice, delayed brain development and death than babies born at term. This new analysis shows that that these late preterm infants had the largest increase in c-section deliveries.

“While maternal and fetal complications during pregnancy may result in the need for a c-section, we’re concerned that some early c-section deliveries may be occurring for non-medically indicated reasons,” said Alan R. Fleischman, M.D., the March of Dimes medical director and senior vice president. “We need research to determine how many c-sections that result in preterm babies are not medically indicated and may place both mother and baby at risk for little or no medical benefit. ”

C-sections are the most common major surgical procedure for women. More than 30 percent of the 4.1 million U.S. live births are delivered via c-section and the rate has increased dramatically since 1996. A c-section delivery can be lifesaving when there are complications during pregnancy, but it is a major operation with potential risks to the mother from the surgery and anesthesia and to the baby, if the delivery occurs too soon. The March of Dimes is concerned that some early deliveries may occur without good medical justification and may be done at the request of the mother or based on an inappropriate recommendation from the doctor.

Source: March of Dimes Foundation

http://www.physorg.com/news131173190.html

Caesarean section -- no consensus on best technique

Caesarean section -- no consensus on best technique
July 16th, 2008 

Despite the routine delivery of babies by caesarean section, there is no consensus among medical practitioners on which is the best operating method to use. In a systematic review published in The Cochrane Library, researchers call for further studies to establish the safest method for both mother and infant. 



"Caesarean section is a very common operation, yet there is a lack of high quality information available to inform best practice," says researcher Simon Gates of the Clinical Trials Unit at the University of Warwick.

Techniques used during caesarean section operations depend largely on the preferences of individual surgeons. Their personal preference can affect the length of the operation, amount of blood lost, risk of infection and the level of pain experienced by a woman following surgery.

The review includes 15 trials that together involved 3,972 women. Although results from several of these trials suggest that single layer closure of the uterus after delivery reduces blood loss and operation times compared to double layer closure, there was no information on other important outcomes such as infection and subsequent complications. The researchers found only very limited data on incision techniques and instruments, as well as methods used to close the uterus. They were therefore unable to make recommendations as to the most appropriate surgical procedure.

"Future research on Caesarean techniques needs to focus on the most suitable methods for uterine incision and closing. We need more high quality studies that address the most important outcomes such as pain, infections and complications" says Gates.

Source: Wiley
http://www.physorg.com/news135402908.html

Caesarean sections associated with risk of asthma

Caesarean sections associated with risk of asthma
June 18th, 2008 

Babies born by Caesarean section have a 50 % increased risk of developing asthma compared to babies born naturally. Emergency Caesarean sections increase the risk even further. This is shown in a new study based on data from 1.7 million births registered at the Medical Birth Registry at the Norwegian Institute of Public Health. 




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The goal of the study was to investigate the possible link between being born by Caesarean section and later development of asthma.

Summarised results from the study:

-- Compared to children born in the natural way (i.e. spontaneously and vaginally), children born by Caesarean section had an approximately 50 % increased risk of developing asthma.

-- Children born vaginally, but with assistance from vacuum or forceps, had a 20 % increased risk of asthma.

-- For children born between 1988 and 1998, planned Caesarean section was associated with an approximately 40 % increased risk of asthma while emergency Caesarean section was associated with a 60 % increased risk.

Why do Caesarean sections give an increased risk of asthma?

"We found a moderately strong association between birth by Caesarean section and asthma in childhood", says doctor and research fellow Mette Christophersen Tollånes, who works for both the Norwegian Institute of Public Health and the Department of Public Health and Primary Health Care at the University of Bergen, Norway.

She is first author of the article "Cesarean Section and Risk of Severe Childhood Asthma: A Population-Based Cohort Study" which is published in the Journal of Pediatrics.

Tollånes explains that there are two main theories about why Caesarean sections could cause asthma.

"The first is that babies who are born by Caesarean section are not exposed to their mothers' bacteria during birth, which is detrimental for development of the immune system. The other is that babies born by Caesarean section have more breathing problems after birth because they are less exposed to stress hormones and compression of the chest, since these mechanisms contribute to emptying the lungs of amniotic fluid. Maybe this can negatively affect lung function in the long term. The fact that emergency Caesarean section apparently has a stonger effect on the risk of asthma than planned Caesarean section cannot easily be explained by any of these theories. It is possible that there are other common causes that can induce the need for Caesarean section and the development of asthma" says Tollånes.

Information from 1.7 million births

The authors looked at over 1.7 million births reported to the Medical Birth Registry at the Norwegian Institute of Public Health in the period 1967-1998. Multiple births and children with congenital malformations were excluded. The children were monitored until they became 18 years old or through 2002.

The study compared the proportions of children who received a basic -and/or attendance benefit for asthma from the Social Security office after spontaneous vaginal birth, assisted vaginal birth (forceps or vacuum), and Caesarean section (planned Caesarean section and emergency Caesarean section separate from and including 1988), respectively. 4 out of 1 000 children received benefits for asthma.

Source: Norwegian Institute of Public Health

http://www.physorg.com/news133003692.html

Genetic changes after Caesarean section may explain increased risk of developing disease

Genetic changes after Caesarean section may explain increased risk of developing disease
June 29th, 2009 

(PhysOrg.com) -- Researchers at Karolinska Institutet have discovered that babies born by planned Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery. The findings, presented in the July issue of the scientific journal Acta Paediatrica, may be a part of an explanation for why babies born by Caesarean section have an increased risk of developing certain disease in later life. 



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"Our results provide the first pieces of evidence that early so called epigenetic programming of the immune system during birth may have a role to play", says Professor Mikael Norman at the Department of Clinical Science, Intervention and Technology. 

Caesarean section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. It is now thought that early genetic changes could explain why people delivered by Caesarean section in later life are more susceptible to immunological diseases such as diabetes, asthma or leukaemia than those born by normal vaginal deliveries. 

In the presented study, blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then again three to five days after the birth. The blood samples were analysed to see the degree of DNA-methylation (chemical altering of the DNA) in the white blood cells, a vital part of the immune system. This showed that the 16 babies born by Caesarean section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by Caesarean section so that there were no longer significant differences between the two groups.

The researchers point out, that the reason why DNA-methylation is higher after Caesarean section deliveries still is unclear and that further research is needed. 

"Although we do not know yet how specific gene expression is affected after Caesarean section deliveries, or to what extent these genetic differences related to mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research" concludes lead author Titus Schlinzig, a research fellow at Karolinska Institutet.

More information: Schlinzig T, Johansson S, Gunnar A, Ekström TJ, Norman M. "Epigenetic modulation at birth, altered DNA-methylation in white blood cells after Caesarean section", Acta Paediatrica 2009, 98, 1096-99 (Invited commentary on pp 1082-84 in same issue of the journal). 

Provided by Karolinska Institutet (news : web)

http://www.physorg.com/news165508836.html