• Title/Summary/Keyword: 제왕절개

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Decision-making process and satisfaction of pregnant women for delivery method (임산부의 분만방법 결정과정과 만족도)

  • Jun, Hae-Ri;Park, Jung-Han;Park, Soon-Woo;Huh, Chang-Kyu;Hwang, Soon-Gu
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.4 s.63
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    • pp.751-769
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    • 1998
  • This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband (0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand (12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9% . However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.

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Maternal Factors Affecting Delivery Mode of the Previous Cesarean Delivery Mothers (선행 제왕절개분만 산모의 제왕절개 후 질식분만과 반복 제왕절개분만 관련 요인)

  • Kim, Yun-Mi;Kim, Myung-Hee;Kim, Kyo-Hyun
    • Women's Health Nursing
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    • v.17 no.4
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    • pp.359-368
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    • 2011
  • Purpose: To examine delivery type of mother who have had a previous cesarean and identify maternal factors related to type of delivery. Methods: The study sample included 60,504 mothers who had delivered through cesarean section. Related variables were categorized as sociodemographic factors (age, residence, health insurance type, income level) and clinical characteristics (14 maternal factor, 4 fetal factor and pre-term). For data analysis, $x^2$ and multivariate logistic regression were conducted. Results: Among the 60,504mothers, 3,075 were delivered through Vaginal Birth After C-Section (VBAC) and the VBAC rate was 5.1%. Underage 34, the VBAC rate increased according to age increases up to 3%. Mothers residing in urban areas had VBAC more frequently than mothers in rural area. Mothers in the high and middle income levels had a greater possibility of having VBAC than mothers in lower income levels. A greater likelihood of increase in repeated cesarean section were found in mothers with maternal and fetal factors. Conclusion: Evidence based nursing practice guidelines and education programs for previous cesarean section mothers and health policy are needed to increase VBAC.

Clinical Evaluation of Cesarian Section Anerohesia (제왕절개술 마취에 대한 임상적 고찰)

  • Park, Dae-Pal
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.63-66
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    • 1986
  • Maternal and fetal effects of anesthesia for 423 cesarian section, performed during the past three and quarter years period in this hospital, have been evaluated. It is emphasized that the selection of anesthetic agent and method should depend upon the physical status of the patients and the ability of both obstetrician and anesthesiologists. Author results were as follows: 1. The incidence of c-section was 13.9% of total deliveries. 2. More than about three fourths of total cases were emergency cases. 3. Almost all cases were operated under general anesthesia. 4. The good physical states of patients resulted in better Apgar score of infants. 5. The shorter the interval from induction of anesthesia to delivery, the better was the Apgar score of infants.

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Comparative Analysis of Delivery Management in Various Medical Facilities (의료기관별 분만관리 양상의 비교 분석)

  • Park, Jung-Han;You, Young-Sook;Kim, Jang-Rak
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.4 s.28
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    • pp.555-577
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    • 1989
  • This study was conducted to compare the delivery management including laboratory tests, medication and surgical procedures for the delivery in various medical facilities. Two university hospitals, two general hospitals, three hospitals, two private obstetric clinics, and two midwifery clinics in a large city were selected as they permitted the investigators to abstract the required data from the medical and accounting records. The total number of deliveries occurred at these 11 facilities between 15 January and 15 February, 1989 was 789 among which 606(76.8%) were vaginal deliveries and 183 (23.3%) were C-sections. For the normal vaginal deliveries, CBC, Hb/Hct level, blood typing, VDRL, hepatitis B antigen and antibody, and urinalysis were routinely done except the private clinics and midwifery clinics which did not test for hepatitis B and Hb/Hct level at all. In one university hospital ultrasonography was performed in 71.4% of the mothers and in one general hospital liver function test was done in 76.7% of the mothers. For the C-section, chest X-ray, bleeding/clotting time and liver function test were routinely done in addition to the routine tests for the normal vaginal deliveries. Episiotomy was performed in 97.2% of the vaginal deliveries. The type and duration of fluid infused and antibiotics administered showed a wide variation among the medical facilities. In one university hospital antibiotics was not administered after C-section at all while in the general hospitals and hospitals one or two antibiotics were administered for one week on the average. In one private clinic one pint of whole blood was transfused routinely. A wide variation was observed among the medical facilities in the use of vitamin, hemostatics, oxytocics, antipyreptics, analgesics, anti-inflammatory agents. sedatives. digestives. stool softeners. antihistamines. and diuretics. Mean hospital day for the normal vaginal deliveries of primipara was 2.6 days with little variation except one hospital with 3.5 days. Mean hospital day for the C-section of primipara was 7.5 days and that of multipara was 7.6 days and it ranged between 6.5 days and 9.4 days. Average hospital fee for a normal vaginal delivery without the medical insurance coverage was 182,100 Won for the primipara and 167,300 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 82,400 Won and a multiparous mother paid 75,600 Won. Average hospital fee for a C-section without the medical insurance was 946,500 Won for the primipara and 753,800 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 256,200 Won and a multiparous mother paid 253,700 Won. Average hospital fee for a normal vaginal delivery in the university hospitals showed a remarkable difference, 268,000 Won vs 350,000 Won, as well as for the C-section. A wide variation in the laboratory tests performed for a normal vaginal delivery and a C-section as well as in the medication and hospital days brought about a big difference in the hospital fee and some hospitals were practicing the case payment system. Thus, standardization of the medical care to a certain level is warranted for the provision of adequate medical care for delivery.

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Factors on the Gap between Predicted Cesarean Section Rate and Real Cesarean Section Rate in Tertiary Hospitals (상급종합병원의 예측 제왕절개분만율과 실제 제왕절개분만율의 격차 관련요인)

  • Kim, Yun-Mi;Kim, Se-Young
    • Women's Health Nursing
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    • v.18 no.3
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    • pp.200-208
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    • 2012
  • Purpose: This study was aimed to examine the gap between predicted cesarean section rate and real cesarean section rate and it's determining factors of 44 tertiary hospitals. Method: This study is a cross-sectional analysis using the data of 25,623 deliveries in 2009 drawn from homepage of Health Insurance Review and Assessment Service. Data were analyzed with t-test, F-test, Scheff$\acute{e}$ test, and logistic regression. Result: There were statistically significant differences in the gap of cesarean section rate (more gap indicates higher quality of delivery) by grade of nurse staffing and delivery cases. Hospitals with nurse staffing grade 1 to 2 had more possibility to be classified into higher grade in quality of delivery (OR 5.67, 95% CI 1.07-30.08). Also hospitals with over 500 delivery cases had more possibility be classified into higher grade in quality of delivery (OR 4.92, 95% CI 1.14-21.23, respectively). Conclusion: The finding suggests that grade of nurse staffing may influence the real cesarean section rate because nurses do a vital role to prevent unnecessary cesarean section. Further study is required to provide evidence that nurse staffing influence on patient outcome and cost-effectiveness in order to obtain adequate number of nursing staffs.