Browsing by Subject "Cesarean Section"
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Item Cesarean Section and Risk of Adenomyosis: A Retrospective Study(2022-02-01) Ford, Lauren; Allen, Regan; Wilson, Ava; Xiao, Heather; Sendukas, Emily; Chao, LisaBACKGROUND: History of uterine surgery, most notably a history of dilation and curettage (D&C), has been shown to be a risk factor for the development of adenomyosis. The association between prior cesarean sections (CS) and adenomyosis remains unclear. OBJECTIVE: The primary aim of this study is to determine if there is an association between adenomyosis and history of uterine surgery, including CS, D&C, and myomectomy. We also examine if repeat uterine surgery increases the risk of adenomyosis development. STUDY DESIGN: In this retrospective case control study we collected data from the electronic medical records of all women who underwent hysterectomy for benign indications at Parkland Hospital between January 2014 and December 2018. We then compared patients with and without adenomyosis on surgical pathology regarding history of uterine surgery, including CS, myomectomy and D&C. RESULTS: 2,911 patients were included in final analysis. History of any uterine surgery was associated with an increased risk of adenomyosis. Patients with a history of D&C were significantly more likely to have adenomyosis on surgical pathology (OR 1.57, 95% CI 1.30-1.90). There was also risk associated with repeat D&C (OR 1.31, 95% CI 1.01-1.72). The association between history of prior CS was not statistically significant (OR 1.12, 95% CI 1.00-1.37). A history of prior myomectomy was also not significantly associated with adenomyosis (OR 0.95, 95% CI 0.59-1.54). CONCLUSION: Of the risk factors explored, history of any uterine surgery, D&C and repeat D&C were associated with an increased risk of adenomyosis, which is consistent with prior studies. There was not an association between history of CS or increasing numbers of repeat cesareans with adenomyosis development. This contradicts the theory that disruption of uterine endometrium and the trauma of cesarean section predisposes individuals to developing adenomyosis. This is the largest retrospective case control study to date investigating this association, and with the results found, it can be concluded that CS individually do not increase the risk of adenomyosis.Item Reinventing Management of Fetal Head Impaction(2016-04-07) Atluru, Anupama; Walk, Daniel Beslin; Roberts, Scott; Choti, Michael; Niwagaba, LillianBACKGROUND: Fetal head impaction is a life threatening event that occurs when the baby's head does not fit through the birth canal and becomes wedged deep in the pelvis during labor. Since the baby's head cannot advance, a cesarean section must be performed, often with significant complications caused by the difficulty of dislodging the fetal head from the mother's pelvis, and elevation of the fetal head in the uterus towards the cesarean incision. Physicians use complicated and violent maneuvers such as pulling on baby's legs and pushing on the baby's head with the tips of their fingers to release the impaction. The use of these maneuvers results in poor maternal and fetal outcomes including risk of intracranial hemorrhage, lower APGAR scores, maternal hemorrhage, thromboembolism, and infection, as well as added psychological and financial burden for families. Fetal head impaction presents to some degree in 25% of all C-sections, translating to approximately 320,000 cases annually in the U.S. Although prevalent, little has yet been done to fully quantify its health burden or propose alternative ways to resolve impaction. OBJECTIVE: To determine whether a novel obstetrics device for facilitating C-section in cases of fetal head impaction would be both financially viable and technically feasible. METHODS: In order to estimate the rate of complications and healthcare costs associated with fetal head impaction in the U.S., we first used published literature to identify the diagnosis codes related to fetal head impaction. Utilizing these, we queried a national database of diagnosis codes for associated complications and then matched these complications to their corresponding hospital charges and costs. With the feedback of practicing obstetricians, we built a prototype device to facilitate delivery in cases of fetal head impaction with emergency cesarean section. We tested the device with a formal fetal head impaction simulator to measure pressure exerted and rate of disimpaction to facilitate a cesarean delivery. We then compared this to the gold standard, manual disimpaction. RESULTS: We have found that C-section deliveries with associated with failure to progress, a proxy for fetal head impaction, result in $1,444 in added direct hospital costs in cases resulting in complication versus those resulting in no complication. We have further found that our prototype device generates 94% less pressure than the current standard of care while facilitating rapid disimpactions that are difficult to achieve manually on a fetal impaction simulator. Finally, we estimate an addressable market given projected device development costs, and outline a strategy by which this novel device could be brought to patient care. CONCLUSION: Preliminary prototype testing suggests that the Safe-C Pump could improve upon the standard of care by facilitating rapid, low-pressure disimpactions. Clinical testing of efficacy will be necessary to determine whether the device will be able to achieve improved patient outcomes and healthcare cost savings. Given our findings, we believe that significant healthcare cost savings can be achieved by improving on the current standard of care for C-section deliveries in fetal head impaction. While our estimates capture direct hospital costs for associated complications, we have not yet estimated the additional associated costs of morbidity and decreased quality of life.Item [Southwestern News](2001-05-31) Hill, AmandaItem [Southwestern News](1997-12-04) Harrell, AnnItem [UT Southwestern Medical Center News](2006-06-29) McKenzie, AlineItem [UT Southwestern Medical Center News](2008-10-30) McKenzie, AlineItem [UT Southwestern Medical Center News](2006-11-22) McKenzie, Aline