Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
228,420
result(s) for
"section"
Sort by:
Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial
Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies.
CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined five elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the five intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intra-abdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967.
Between May 20, 2007, and Dec 31, 2010, 15 935 women were recruited. There were no statistically significant differences within any of the intervention pairs for the primary outcome: blunt versus sharp entry risk ratio 1·03 (95% CI 0·91–1·17), exterior versus intra-abdominal repair 0·96 (0·84–1·08), single-layer versus double-layer closure 0·96 (0·85–1·08), closure versus non-closure 1·06 (0·94–1·20), and chromic catgut versus polyglactin-910 0·90 (0·78–1·04). 144 serious adverse events were reported, of which 26 were possibly related to the intervention. Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section.
These findings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects.
UK Medical Research Council and WHO.
Journal Article
A prospective comparative study of single-layer versus double-layer uterine closure techniques on cesarean scar formation
Background
This prospective clinical trial aimed to compare the effects of single-layer versus double-layer uterine closure techniques on cesarean scar healing in women undergoing repeat cesarean delivery.
Methods
Seventy women aged 18–50 years with a history of at least one prior cesarean delivery were randomized into two groups: single-layer non-locking closure (
n
= 35) and double-layer non-locking closure with surgical refreshing of the incision edges (
n
= 35). The primary outcome was residual myometrial thickness (RMT) measured by transvaginal ultrasonography at six months. Secondary outcomes included RMT at six weeks, healing ratios, presence of niche, operative time, transfusion need, infectious morbidity, and hospital stay duration. Sample size was based on preliminary data indicating a mean RMT of 5 mm (SD 0.6 mm). To detect a 0.5 mm difference with α = 0.05 and β = 0.8, 26 participants per group were required; 35 were enrolled per group.
Results
At six months, the double-layer group had significantly greater RMT (5.1 ± 0.4 mm vs. 4.1 ± 0.4 mm;
p
< 0.001). Similar findings were seen at six weeks. Operative time was shorter in the single-layer group. However, this group required more frequent additional uterine suturing due to suboptimal tissue approximation or bleeding, which did not significantly extend operative duration. Hemoglobin levels and hospital stay were comparable. Transfusion was needed in one patient in the single-layer group and three in the double-layer group.
Conclusion
Double-layer closure with surgical edge refreshing was associated with improved cesarean scar healing based on RMT.
Trial registration
ClinicalTrials.gov NCT03644433. Registered on 06 July 2018.
Journal Article
Short-term and long-term effects of caesarean section on the health of women and children
A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose–response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.
Journal Article
The Bounded and Precise Word Problems for Presentations of Groups
We introduce and study the bounded word problem and the precise word problem for groups given by means of generators and defining
relations. For example, for every finitely presented group, the bounded word problem is in
eBook
Global epidemiology of use of and disparities in caesarean sections
In this Series paper, we describe the frequency of, trends in, determinants of, and inequalities in caesarean section (CS) use, globally, regionally, and in selected countries. On the basis of data from 169 countries that include 98·4% of the world's births, we estimate that 29·7 million (21·1%, 95% uncertainty interval 19·9–22·4) births occurred through CS in 2015, which was almost double the number of births by this method in 2000 (16·0 million [12·1%, 10·9–13·3] births). CS use in 2015 was up to ten times more frequent in the Latin America and Caribbean region, where it was used in 44·3% (41·3–47·4) of births, than in the west and central Africa region, where it was used in 4·1% (3·6–4·6) of births. The global and regional increases in CS use were driven both by an increasing proportion of births occurring in health facilities (accounting for 66·5% of the global increase) and increases in CS use within health facilities (33·5%), with considerable variation between regions. Based on the most recent data available for each country, 15% of births in 106 (63%) of 169 countries were by CS, whereas 47 (28%) countries showed CS use in less than 10% of births. National CS use varied from 0·6% in South Sudan to 58·1% in the Dominican Republic. Within-country disparities in CS use were also very large: CS use was almost five times more frequent in births in the richest versus the poorest quintiles in low-income and middle-income countries; markedly high CS use was observed among low obstetric risk births, especially among more educated women in, for example, Brazil and China; and CS use was 1·6 times more frequent in private facilities than in public facilities.
Journal Article