Open Access Medical Books



Edited by Raed Salim .

210 pages . 
Open Access .

Child birth is a natural process, but in certain  circumstances,cesarean delivery is  necessary to save the life of a child or mother. This issue is more acute in low income  countries, where cesarean delivery rates are well below the acceptable minimum  standard of 5% outlined by the World Heath Organization. In this book, the authors  describe how poor healthcare access, underdeveloped healthcare infrastructure,  geographical inaccessibility, cultural mistrust, poverty, and paucity of human health resources can become barriers for providing cesarean deliveries to all women who  need them. Several studies in West Africa emphasized this gap by demonstrating  increased maternal mortality due to a smaller proportion of deliveries performed by caesarean delivery.
On the other hand, rates of cesarean delivery, especially in high income countries, have risen dramatically over the last 30 years and the worldwide increase in the cesarean delivery rate has become a major public health concern. Reasons for the dramatic increase in the cesarean delivery rate are complex. This increase was driven in part by the increased incidence of multiple gestations and the decreased incidences of vaginal births after cesarean and vaginal breech deliveries. However, lifesaving indications for cesarean delivery represent only a small proportion of this increase in the cesarean delivery rate. Much of the increase comes from unproven conjectures concerning the advantages of caesarean delivery. It seems that the cesarean delivery has become a modern standard of care, though, much controversy still exists. Recently,  demands for elective cesarean delivery have increased due to concern regarding pelvic floor disorders following vaginal delivery, a reduction in cesarean complication rates and women having fewer children.
As more women are delivering by cesarean, new concerns have emerged regarding long term maternal risks particularly placenta accreta and uterine rupture following a trial of labor. Regarding the short term complications, the rate of maternal mortality and severe morbidity that include thromboembolic events, major puerperal infection, severe hemorrhage, intestinal obstruction, injuries to the urinary tract and operative interventions after delivery is significantly more frequent among women undergoing cesarean delivery than vaginal delivery. Due to the worldwide dramatic increase in obesity during the past 20 years, these complications are expected to rise.
Additionally, more women are postponing pregnancy into the fourth and fifth decades of life for a variety of reasons. Older women are more likely to have cesarean delivery without labor. Severe complications for women older than 35 years are more frequent than for younger women. Since the rate of cesarean delivery is constantly increasing for mothers of all ages, races, and ethnic groups a growing number of women are expected to experience at least some of these complications.
In view of that, this book provides on the one hand evidence based reports and practical steps that may be adopted in an effort to reduce the cesarean delivery rate,and on the other hand, the book provides the best and up to date perioperative guidelines (where available) and tips to help improve health care quality among women undergoing cesarean delivery with special attention to obese women.
Pregnant women require special consideration when anesthesia is provided. Airway problems and difficult tracheal intubation are 10 times more frequent in the parturient than in the general population and are a major cause of maternal morbidity and mortality. Additionally, the increased use of regional anesthesia in the last decades has resulted in a lack of experienced anesthesiologists for providing general anesthesia in the emergent obstetric setting. Due to the considerable importance of this issue, broad coverage of the issue of obstetric anesthesia is provided. The book includes guidelines and a systematic review that anesthesia providers should know in obstetrics and a friendly-user review of anesthesia care for obstetric patients.

Cesarean surgery is strongly associated with delayed early breastfeeding, poorer infant suckling, more formula supplementation, and a shorter duration of breastfeeding. The book provides tips and guidelines of how to help establish and  maintain exclusive breastfeeding shortly after the procedure including in cases of  multiple gestation.
In conclusion, this book provides a convenient source that will aid to answer several  questions related to the procedure; for example what is an "appropriate" cesarean  delivery rate? Can the cesarean delivery rate be safely reduced? What are the obstacles  for an acceptable cesarean delivery rate in the sub-Saharan African countries? When to  perform an elective cesarean at term? Which anesthetic technique to use? What are the difficulties and complications that are related to obstetric anesthesia? How to perform  the procedure in 15 minutes? Why morbidly obese women need special attention? And is it feasible to breastfeed directly after a cesarean? The authors answer all these  questions through practical evidence based, comprehensive review of the clinical,  social, ethical, and economic considerations.
To succeed in these selected objectives, distinguished experts from different disciplines  were selected to ensure accurate coverage of the recent scientific and clinical advances  to bring to care providers and purchasers up to date and essential information to help  improve health care quality. I am very grateful to all my colleagues who have  contributed to this valuable book.
Last, I am very grateful to all the "InTech team" for their help and support with this  project. It has been a privilege and a pleasure to work with these dedicated personals.

Dr. Raed Salim

Department of Obstetrics and Gynecology, Emek Medical Center, Afula,
Rappaport Faculty of Medicine, Technion, Haifa,


Chapter 1 How to Manage Labor Induction or 
Augmentation to Decrease the Cesarean Deliveries Rate 1 Shi-Yann Cheng

Chapter 2 Timing of Elective Cesarean Delivery at Term 13 
Raed Salim

Chapter 3 Anesthesia for Cesarean Section 29 Sotonye Fyneface-Ogan

Chapter 4 Cesarean Delivery: Surgical Techniques – The Fifteen Minute Cesarean Section 57 Robert D. Dyson

Chapter 5 Evidence-Based Obstetric Anesthesia: 
An Update on Anesthesia for Cesarean Delivery 69 Andre P. Schmidt and Jose Otavio C. Auler Jr.

Chapter 6 Neurological Complications of Regional Anesthesia 93 
José Ricardo V. Navarro, Javier Eslava-Schmalbach, Daniel P. R. Estupiñán and Luis A. Carlos Leal

Chapter 7 Caesarean Section and Maternal Obesity 109 
Vicky O’Dwyer and Michael J. Turner

Chapter 8 Breastfeeding After a Cesarean Delivery 121 
Sema Kuguoglu, Hatice Yildiz, Meltem Kurtuncu Tanir and Birsel Canan Demirbag

Chapter 9 Determining Factors of 
Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako – Mali) 161 I. Teguete, Y. Traore, A. Sissoko, M. Y. Djire, A. Thera, T. Dolo, N. Mounkoro, M. Traore and A. Dolo .

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Published by: Unknown - Friday, February 8, 2013


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