Washington Global Health Alliance Discovery Series
Catherine Wilfert, MD [
December 1, 2008
'Global Prevention of Mother to Child Transmission of HIV-1'
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Indications and Outcomes of Emergency Caesarean Section at St Paul’s HospitalMedical College, Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study) by Bizuneh Ayano in Womens Health Journal
Washington Global Health Alliance Discovery Series
Catherine Wilfert, MD [
December 1, 2008
'Global Prevention of Mother to Child Transmission of HIV-1'
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Indications and Outcomes of Emergency Caesarean Section at St Paul’s HospitalMedical College, Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study) by Bizuneh Ayano in Womens Health Journal
Developing normal placental growth curves using 2 d ultrasound in a zimbabwe ...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
FIGO Initiative for Gestational diabetes as its a Global health Priority,one in sixth pregnant women have gestational Diabetes,84% of them is due to GDM.
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
Developing normal placental growth curves using 2 d ultrasound in a zimbabwe ...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
FIGO Initiative for Gestational diabetes as its a Global health Priority,one in sixth pregnant women have gestational Diabetes,84% of them is due to GDM.
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Objectives
1. Look at the prevalence of Cesarean Sections worldwide
and in Lebanon
2. Discuss the underlying factors
3. Review the short and long-term effects of C section on
the health of mothers and newborns.
4. Recommend solutions to reduce the rate of unnecessary
C Sections
5. World Health Organization
Recommended rate of C section : Not to exceed 15%
(1985)
A study published in December 2015 in JAMA indicates
that if the CS rate increases to 19%, maternal and neonatal
mortality decline
A CS rate above this level did not lead to any improvement
in maternal and neonatal mortality rates
6. PLoS ONE 11 (2): e0148343. doi:10.1371/journal.pone.0148343
7. Rising Trends of Cesarean Section Worldwide:
A Systematic Review
Soto-Vega E. et al. Obstet Gynecol Int J 2015, 3(2): 00073
8. Rising Trends of Cesarean Section Worldwide:
A Systematic Review
Soto-Vega E. et al. Obstet Gynecol Int J 2015, 3(2): 00073
9. Rising Trends of Cesarean Section Worldwide:
A Systematic Review
Soto-Vega E. et al. Obstet Gynecol Int J 2015, 3(2): 00073
10. Lebanon
The Lebanese literature demonstrated that this rate
increased alarmingly since the beginnings of the 1990s, as
it reached:
33% of total deliveries in 1996
35% in 2004
40.8% in 2008
(Abdallah et al, 2004; DeJong et al., 2010; Mroue, 2011)
Latest figures reported from the MoPH in 2013 showed
that the rate of C Section reached 44-45 % of total
deliveries covered by MoPH.
11. • The study was conducted through GlobeMed’s portfolio
• The majority of centers included in the study were private
hospitals
• Between January 2000 and December 2015 : 29,878
pregnant women were included in the study.
12. Rates of CS and NVD
from 2000 until 2015 in Lebanon
S.M. Zgheib et al. / Women and Birth 30 (2017) e265–e271
13. Maternal age and Rates of CS and NVD
from 2000 until 2015 in Lebanon
S.M. Zgheib et al. / Women and Birth 30 (2017) e265–e271
14. Region of birth and Rates of CS and NVD
from 2000 until 2015 in Lebanon
S.M. Zgheib et al. / Women and Birth 30 (2017) e265–e271
15. Complications and Rates of CS and NVD
from 2000 until 2015 in Lebanon
S.M. Zgheib et al. / Women and Birth 30 (2017) e265–e271
16. Day of birth and Rates of CS and NVD
from 2000 until 2015 in Lebanon
S.M. Zgheib et al. / Women and Birth 30 (2017) e265–e271
17. Prevalence of and risk factors associated with
cesarean section in Lebanon
A retrospective study based on a sample of 29,270 women
S.M. Zgheib et al. / Women and Birth 30 (2017) e265–e271
Prolonged labor
Breech presentation
Fetal distress
Multiple birth
Twins
Premature rupture of
membranes
Hypertensive
disorders
Oligohydramnios
Maternal age of 35
years or more
Maternal request
18. Moussawi F, Nakkash R, Jamal D, El-Jardali F.
Knowledge to Policy (K2P) Center
Reducing Rates of Unnecessary Cesarean Sections in Lebanon
Beirut, Lebanon; June 2015.
Dominance of private sector
Absence of national guidelines
Diversity in medical schools
Opposition of stakeholders
Higher benefit
Competition between insurance
companies
Lack of coverage for epidurals
Excessive physicians supply
Poor prenatal education and
preparation
Practice of defensive medicine
Mandatory second opinion
Group practice
More implication of midwives
Increase the doctor fees for NVD
Cover for epidurals
Prenatal awareness campaign
Factors Recommendations
Rate of C sections in Lebanon in 2015
44%
19. Moussawi F, Nakkash R, Jamal D, El-Jardali F.
Knowledge to Policy (K2P) Center
Reducing Rates of Unnecessary Cesarean Sections in Lebanon
Beirut, Lebanon; June 2015.
Dominance of private sector
Absence of national guidelines
Diversity in medical schools
Opposition of stakeholders
Higher benefit
Competition between insurance
companies
Lack of coverage for epidurals
Excessive physicians supply
Poor prenatal education and
preparation
Practice of defensive medicine
Mandatory second opinion
Group practice
More implication of midwives
Increase the doctor fees for NVD
Cover for epidurals
Prenatal awareness campaign
Factors Recommendations
26. More convenient
1. To Obstetricians
* 20-25 minutes programmed during working hours V/S
unpredictable long night hours
* More profitable
2. To Hospitals
* Prolonged LOS
* More profitable
3. To Mothers?
* Scheduled delivery timing
* No labor pain, no episiotomy
27. More convenient
1. To Obstetricians
2. To Hospitals
3. To Mothers
4. But not to the baby !!!
Have more breathing problems and NICU admissions
His microbiome is negatively disturbed
He has a higher risk of developing Obesity, Asthma,
Metabolic syndrome and Diabetes
28. More convenient
1. To Obstetricians
2. To Hospitals
3. To Mothers
4. But not to the baby
Have more respiratory distress and NICU admissions
His microbiome is negatively affected
He has a higher risk of developing Obesity, Asthma,
Metabolic syndrome and Diabetes
29. Financial issues
Class Normal
Vaginal
Cesarean
section
First class (Obstetrician) 680 USD 920 USD
First class (Hospital) 1550 USD 3200 USD
CNSS (Obstetrician) 450,000 LL 680,000 LL
CNSS (Hospital) 785,000 LL 1790,000 LL
MOPH (Obstetrician) 375,000 LL 500,000 LL
MOPH (Hospital) 735,000 LL 1,790,000 LL
31. Malpractice suits
Obstetrics is a high-risk specialty in terms of malpractice
allegations.
Obstetricians have the third-highest lawsuit rate among
physician specialties, third only to plastic surgeons and
neurosurgeons
Almost every obstetrician will be sued before age 65.
32. A typical Lebanese anomaly
Choosing a “cool” date
12/12/12
11/12/13
18/08/18
33. A typical Lebanese anomaly
Choosing a “cool” date
12/12/12
11/12/13
18/08/18
Choosing a
“cool” mobile number
34. 1 in 3 women with diabetes is of reproductive age
1 in 7 births is affected by gestational diabetes
The incidence of GD in the gulf region reaches in some parts
40%
Gestational
Diabetes
Macrosomia C section
35. Prevalence and Causes of Cesarean Section in
Iran
Systematic Review and Meta-Analysis
Saber AZAMI-AGHDASH et al. Iran J Public Health. 2014 May; 43(5): 545–555.
36. No preparation for the pregnant mom
Prenatal classes
Relaxation methods
Breathing
Physical activity and muscle strengthening
37. Once a C section, always a C section!
Vaginal Birth after CS (VBAC) that is rising in developing
countries and contributing to the reduction of repeated CS
rate constitutes only 0.2% of deliveries in Lebanon.
This low rate indicates that women who undergo primary CS
are more likely to go through repeated CS in Lebanon (WHO,
2010)
38. Non-reassuring fetal heart rate
Almost all hospital births include continuous monitoring of
the fetal heart beat.
These monitors are highly unreliable, which means that a
majority of babies identified to have “non-reassuring”
heart rate patterns by continuous electronic monitoring
may not be compromised at birth.
Graham et al. Obstet Gynecol. 2014 Sep;124(3):507-13.
39. Cesarean Delivery on Maternal Request:
A Western North Carolina Perspective
S Romero et al. Matern Child Health J (2012) 16:725–734
Patients’ opinion about cesarean versus vaginal delivery
40. Cesarean Delivery on Maternal Request:
A Western North Carolina Perspective
S Romero et al. Matern Child Health J (2012) 16:725–734
Patients’ opinion about cesarean versus vaginal delivery
42. Risks of C section (Mother)
C Section increases adverse health consequences such as:
Need for antibiotic treatment (Smaill & Gyte, 2010)
Blood transfusion (Rouse et al., 2006)
Urinary tract infections, bladder damage, uro-genital tract
injury, backache, thromboembolism … (Carayol et al., 2008;
Mazzoni et al., 2010; Khunpradit et al. 2011; Lavender et al., 2012; Main et al.,
2012; Huster, 2013; Teixeira et al., 2013)
Hysterectomy (Rooney et al., 2005; Whiteman et al., 2006)
Death (Kacmar et al., 2003; Rooney et al., 2005)
43. Long-term risks and benefits associated with cesarean
delivery for mother, baby, and subsequent pregnancies:
Systematic review and meta-analysis
Lower rate of fertility
Pregnancy after cesarean delivery was associated with
increased risk of miscarriage (OR 1.17) and stillbirth (OR
1.27), but not perinatal mortality (OR 1.11)
Pregnancy following cesarean delivery was associated
with increased risk of placenta previa (OR 1.7), placenta
accreta (OR 2.95), and placental abruption (OR 1.38)
Oonagh E. Keag et al. PLOS Medicine | https://doi.org/10.1371/journal.pmed.1002494 January 23, 2018
44. Elective C section and the late preterm
Pregnancy dating has an error margin of 2-3 weeks
Most elective C-sections are performed around 36 weeks of GA
The late preterm newborn (34-37 weeks GA) is prone to the
following risks:
1. Hypothermia
2. Respiratory distress and TTN (3 x more than at 39 weeks)
Stutchfield P, Br Med J 331(7518):662; 2005
3. Hyperbilirubinemia and Hypoglycemia
45. Risks of C section (Baby)
Neonatal intensive care unit admission (Hannah et al., 2000;
Stutchfield et al., 2005)
Many systematic reviews showed that C sections are highly
associated with childhood overweight and obesity (Li et al,
2013; Huh et al., 2012; Barros et al., 2012) respiratory complications
like pulmonary hypertension and asthma besides brain
damage in some occasions (Main et al., 2012; Zanardo et al., 2004;
MacDorman, 2008).
CS were also associated with a decrease of breastfeeding
rates (Rowe-Murray & Fisher, 2002; Zanardo et al., 2010; Merten et al., 2007;
Labbok & Taylor, 2008).
46. Fluid in the lungs of the fetus
Lungs are full of fluid in fetal life (38 ml/Kg)
Resorbed shortly after birth
In NVD with natural labor 40% of the alveolar fluid is
resorbed before birth due to the action of stress
hormones
In elective C section there is no labor and no stress
hormones, therefore the baby frequently ends up in the
NICU
Lucky Jain, Physiology of fetal lung fluid clearance and the effect of labor Semin Perinatol 30, 2006
47. Breastfeeding after cesarean delivery:
a systematic review and meta-analysis of
world literature
The systematic review included 53 studies (554,568
subjects, 33 countries); 25 authors contributed additional
data (245,455 subjects), and 48 studies (553,306 subjects,
31 countries) were included in the meta-analysis.
Rates of early breastfeeding were lower after CD compared
with after VD (pooled OR: 0.57; P < 0.00001)
Prior E. Am J Clin Nutr. 2012 May;95(5):1113-35
48. Birth by cesarean section
in relation to adult offspring overweight
and biomarkers of cardio-metabolic risk
Methods:
The Danish Fetal Origins Cohort enrolled 965 pregnant women
in 1988–1989.
In 2008, a follow-up study of the offspring was completed.
Results:
Birth by C-section was associated with increased odds of
overweight or obesity at 20 years (OR=2.17 ) after adjustment
for potential confounders.
Birth by C-section was also associated with higher serum
concentrations of total cholesterol (8.5%), LDL cholesterol
(12.6%), leptin (73.1%) and Apolipoprotein B (0.08 g/l)
S. Hansen et al. International Journal of Obesity 42, 15–19 (2018)
49. Long-term risks and benefits associated with cesarean
delivery for mother, baby, and subsequent pregnancies:
Systematic review and meta-analysis
One RCT and 79 cohort studies were included, involving
29,928,274 participants.
Children delivered by cesarean delivery had increased risk
of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n
= 887,960; 13 studies) and obesity up to the age of 5 years
(OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies).
Oonagh E. Keag et al. PLOS Medicine | https://doi.org/10.1371/journal.pmed.1002494 January 23, 2018
50. Caesarean Section is associated with reduced perinatal
cytokine response, increased risk of bacterial
colonization in the airway, and infantile wheezing
Children delivered by CS were associated with
increased risk of wheezing (aHR 1.63; 95% CI: 1.01–
2.62) and decreased compliance of the respiratory
system at 12 months (p = 0.045).
CS was associated with reduced TLR1–2- triggered TNF-
α and IL-6 responses at birth.
By 12 months of age, children delivered by CS had
significantly less airway bacterial clearance.
SUI-Ling LIAO et al. Scientific Reports | 7: 9053 | DOI:10.1038
51. The Elevated Rate of Cesarean Section and Its Contribution to
Non-Communicable Chronic Diseases in Latin America:
The Growing Involvement of the Microbiota
Conclusion : The establishment of the gut microbiota is
delayed in infants born by C-section during the postnatal
period, during a critical developmental window for the
maturation of the newborn’s immune system.
This delay may favor the subsequent development of
inflammatory and metabolic disorders during childhood
Magne F et al. Front. Pediatr. 5:192. doi: 10.3389/fped.2017.00192
52.
53.
54.
55.
56. The mother's vaginal bacterial community was similar to
her own baby's microbiota (vertical transmission)
In contrast, skin bacterial communities of C-section
mothers were not that similar to their own babies
These results suggest that incidental exposures to skin
bacteria in the hospital environment could contribute to
the microbiota of C-section delivered babies
57. • Mice receiving Penicillin
during weaning gained total
mass and fat mass in adult
age
• Mice receiving penicillin-
altered microbiata from 18
week-old penicillin treated
mice to 3 week-old Germ Free
Mice gained fat mass at a
significantly faster rate
Altering the intestinal microbiota during a
critical developmental window has lasting
metabolic consequences
Cox et al. Cell. 2014 Aug 14;158(4):705-721
60. Moussawi F, Nakkash R, Jamal D, El-Jardali F.
Knowledge to Policy (K2P) Center
Reducing Rates of Unnecessary Cesarean Sections in Lebanon
Beirut, Lebanon; June 2015.
Dominance of private sector
Absence of national guidelines
Diversity in medical schools
Opposition of stakeholders
Higher benefit
Competition between insurance
companies
Lack of coverage for epidurals
Excessive physicians supply
Poor prenatal education and
preparation
Practice of defensive medicine
Mandatory second opinion
Group practice
More implication of midwives
Increase the doctor fees for NVD
Cover for epidurals
Prenatal awareness campaign
Factors Recommendations
61. Partial restoration of the microbiota
of cesarean-born infants via
vaginal microbial transfer
Samples from 18 infants and their mothers, including 7 born vaginally and
11 delivered by scheduled C-section, of which 4 were exposed to the
maternal vaginal fluids at birth.
Briefly, the microbial restoration procedure consists of incubating a sterile
gauze in the vagina of mothers that are negative for Group B streptococcus
(GBS) during the hour preceding the C-section.
Before C section the gauze is withdrawn and put in a sterile container at
room temperature
Within the first two minutes of birth, babies were swabbed with the gauze,
starting with the mouth, then the face, and finally the rest of the body
Maria Dominiguez-Bello et al. Nat Med. 2016 March ; 22(3): 250–253.
62. Partial restoration of the microbiota
of cesarean-born infants via
vaginal microbial transfer
Maria Dominiguez-Bello et al. Nat Med. 2016 March ; 22(3): 250–253.
63. Cesarean section without medical indication and risks
of childhood allergic disorder, attenuated by
breastfeeding
12,639 children included
CS without medical indication and CS for fetal complications
were associated with increased risks of childhood allergic
rhinitis, respectively.
In contrast, in children fed by exclusive formula milk, CS was
highly significantly associated with childhood asthma and
allergic rhinitis
Shuyuan Chu et al. Nature Scientific Reports, 2017, 7: 9762 | DOI:10.1038/s415
64. Cesarean section and risks of childhood allergic
disorder, attenuated by breastfeeding
Shuyuan et al. Nature Scientific Reports | 7: 9762 | DOI:10.1038/s41598-017-10206-3
66. The Dutch experience
C section rate 14% in 2000-2001
Increased to 16.7% in 2010
Fetal and early neonatal morbidity decreased in the same time
period from 0.53% to 0.21%
30 % of all deliveries were done at home assisted by the
midwife
There are no epidurals at homes
All expenses at home are for free
Non-indicated C sections at hospital are self-payed by the
patient
Zhao Y, et al. (2016) Modest Rise in Caesarean Section from 2000-2010: The Dutch Experience.
PLoS ONE 11(5): e0155565.
67. Take home message
1. The rate of C section in Lebanon has reached unacceptable
levels
2. Improving women's knowledge about the risks and
benefits of different modes of delivery can lead to a
positive maternal attitude towards vaginal delivery.
3. Prenatal classes (Free and monthly)
4. Increase the quality of vaginal delivery services ( and
possibly fees) and cover for epidurals by official 3d party
payers
5. Prevent the first cesarean delivery.
6. Encourage breast-feeding
68. Thank you for your attention
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