Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes

3:10 PM Posted by Dr Subhash Kumar, MBBS, MD, DM

have a look at the following article
but why should it be in a neurointervention blog?
because we all are physicians and human and i am a to be father
and because unwanted caesareans are rampant and kill mothers and babies and put strain over the economy
we must detest theses so called advancements

The article
Caesarean section without medical indications is associated with an increased
risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global
Survey on Maternal and Perinatal Health
BMC Medicine 2010, 8:71 doi:10.1186/1741-7015-8-71
Joao P Souza (souzaj@who.int)
Ahmet M Gulmezoglu (gulmezoglum@who.int)
Pisake Lumbiganon (pisake@kku.ac.th)
Malinee Laopaiboon (laopaiboonmalinee@yahoo.co.uk)
Guillermo Carroli (gcarroli@crep.com.ar)
Bukola Fawole (fawoleo@yahoo.co.uk)
P Ruyan (pangruyan@yahoo.com)
Abstract
Background
There is worldwide debate about the appropriateness of caesarean sections
performed without medical indications. In this analysis, we aim to further
investigate the relationship between caesarean section without medical indication
and severe maternal outcomes.
Methods
This is a multicountry, facility-based survey that used a stratified multistage cluster
sampling design to obtain a sample of countries and health institutions worldwide.
A total of 24 countries and 373 health facilities participated in this study. Data
collection took place during 2004 and 2005 in Africa and the Americas and during
2007 and 2008 in Asia. All women giving birth at the facility during the study period
were included and had their medical records reviewed before discharge from the
hospital. Univariate and multilevel analysis were performed to study the
association between each group’s mode of delivery and the severe maternal and
perinatal outcome.
Results
A total of 286,565 deliveries were analysed. The overall caesarean section rate
was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections
without medical indications, either due to maternal request or in the absence of
other recorded indications. Compared to spontaneous vaginal delivery, all other
modes of delivery presented an association with the increased risk of death,
admission to ICU, blood transfusion and hysterectomy, including antepartum
caesarean section without medical indications (Adjusted Odds Ratio (Adj OR),
5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean
section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In
addition, this association is stronger in Africa, compared to Asia and Latin America.
Conclusions
Caesarean sections were associated with an intrinsic risk of increased severe
maternal outcomes. We conclude that caesarean sections should be performed
when a clear benefit is anticipated, a benefit that might compensate for the higher
costs and additional risks associated with this operation.
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neurointervention in spinal vascular malformations

11:19 PM Posted by Dr Subhash Kumar, MBBS, MD, DM

Spinal vascular malformations are rare entities and misunderstood

their treatment is also under constant modification with better understanding of disease process and evolving diagnostic and therapeutic techniques.
Hereby i am putting up a presentation in pdf format made by one of my dear colleagues
hope it is useful in any way whateoever

download from the following link (1.5 mb)


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AJNR -- Table of Contents (31, [10])

11:09 PM Posted by Dr Subhash Kumar, MBBS, MD, DM

The latest edition of AJNR (Nov-Dec 2010) has two poignant and very important articles in it
see AJNR -- Table of Contents (31, [10])
1st article I recommend is
A.C. Mamourian, H. Young, and M.F. Stiefel

 
AJNR Am J Neuroradiol 2010 31: 1787-1790 originally published online on July 1 2010, 10.3174/ajnr.A2192 . [Abstract] [Full Text] [Figures Only] [PDF]  
The cumulative radiation to SAH patient is very high with serial CT scans, diagnostic angiograms
 (CTA/DSA), coiling, chest radiographs etc.
The authors have given a value of upto 1.8 Gy, however in practice, in may instances this is sure
 to exceed especially
if redo interventions, interventions for vasospasm and repeated check angiograms are needed.
From 3 Gy onwards, depilation starts, at 2 Gy erythema starts, and out doses are not very from
 this value.
There has to be more better techniques for reducing the dosage during these procedures.
However, till the technology is not available, we must be very selective and careful in our usage
 of x-ray based machines.


2nd  article is
P. Jun, N.U. Ko, J.D. English, C.F. Dowd, V.V. Halbach, R.T. Higashida, M.T. Lawton, and S.W. Hetts

AJNR Am J Neuroradiol 2010 31: 1911-1916 originally published online on July 8 2010, 10.3174/ajnr.A2183 . [Abstract] [Full Text] [Figures Only] [PDF]  




SAH leads to vasospasm in 25-30% patients, and leads to prolonged morbidity and poor neurological outcome
 and even death in few.
Traditional treatment with Triple H therapy is helpful many a times, however, endovascular treatment is needed
 sometimes.
The authors have discussed in detail this very important component of SAH management.


Another article in this edition also discusses usage of intra arterial verapamil for vasospam treatment.


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List of useful websites related to Interventional Neuroradiology

7:51 PM Posted by Dr Subhash Kumar, MBBS, MD, DM

Journal of Stroke & Cerebrovascular Diseases
http://www.strokejournal.org/
Journal of Interventional Neuroradiology
http://www.centauro.it/
American Journal of Neuroradiology
http://www.ajnr.org/
American Association of Neurological Surgeons
http://www.aans.org/
Radiological Society of North America
http://www.rsna.org/
American Society of Neuroradiology
http://www.asnr.org/
American Society of Pediatric Neuroradiology
http://www.asnr.org/aspnr
Association of Vascular and Interventional Radiographers
http://www.avir.org/
American Society of Spinal Radiography
http://www.asnr.org/assr
Centers for Disease Control and Prevention
http://www.cdc.gov/
European Society of Neuroradiology
http://www.esnr.org/
European Association of Radiology
http://www.eurorad.org/
American Society of Interventional & Therapeutic Neuroradiology
http://www.asitn.org/
Italian Association of Neuroradiology
http://www.ainr.it/
National Stroke Association
http://www.stroke.org/
Neurosciences on the Internet
http://www.neuroguide.com/
Society of Cardiovascular & Interventional Radiology
http://www.scvir.org/
French Society of Neuroradiology
http://perso.wanadoo.fr/sfnr-valimage/cadreExpo.html
American Society of Head & Neck Radiology
http://www.ashnr.org/
Southeastern Neuroradiological Society
http://www.asnr.org/etc/otherorgs/senrs.html
Western Neuroradiological Society
http://www.asnr.org/etc/otherorgs/wnrs.html
World Federation of Neuroradiological Societies
http://www.wfnrs.org/


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