Background: Women with previous two or
more caesarean deliveries are usually
managed by elective cesarean section to avoid
the possible risks of labor.
Objective: To compare the relative risks of
maternal and fetal outcomes in emergency
versus elective previous two or more
caesarean deliveries
Design: Randomized prospective clinical
study
Setting: Al-Elweya Maternity Teaching
Hospital, from 1st of March to 31st of
September 2008.
Methods: The study groups, those who had
previous two or more caesarean deliveries,
were included from the hospital admissions.
The 1st group (102 women) presented in labor
and was managed by caesarean delivery as
soon as it was possible. The second group (78
women) was admitted for elective cesarean
delivery.
The main maternal outcomes were intra
operative complications, including
hysterectomy, scar dehiscence, bladder
injuries, uterine and internal iliac arteries
ligation, and blood transfusion. Postoperative
maternal outcomes were severe morbidity
including bleeding, fever, urinary tract
infection, blood transfusion, the need to
Intensive Care Unit admission and
readmission. The fetal outcomes measures
were Apgar score at one and five minutes,
respiratory distress syndrome (RDS),
admission to the neonatal intensive care unit
and fetal loss up to hospital discharge.
Results: Both groups were comparable in
demographic, social and past obstetric history
characteristics. Intra operative complications
showed significant difference in bowel
adhesions (RR 0.35, 95% CI 0.14- 0.88), and
blood transfusion (RR 0.51, 95% CI 0.28-
0.94). There was statistical significant
difference in the mobilization time 7.2 hours
and 9.3 hours in emergency and elective
groups respectively (p= 0.0009), also in
feeding time, it was shorter after emergency
caesarean section (P=0.0224), and in the
hospital stay 24.6 and 32.6 hours respectively
(p=0.0001). There was no statistical difference
in post operative complications. Fetal
outcomes showed no statistical significant
difference in fetal loss, respiratory distress and
readmission.
Conclusion: Women with previous two or
more caesarean deliveries can wait until
starting labor for doing cesarean delivery
without increasing risks to the mother and
fetus.
Success in selecting the best among the sources of supply is one of the most important factors in the efficiency of the procurement activity in the company, because the proper selection of the source of the supply significantly affect the achievement of what is desired by the factors of quality, quantity, price and service, and the ability of the competent supplier to meet everything associated with this Factors of commitments, hereby supporting the procurement function's efforts to fully discharge its responsibilities, and in view of adopting of Al-Furat company quality management system by applying the standards of ISO (9001: 2015) and purpose of getting the on-demand benefits from the application of international standards reg
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I dealt with in the first chapter (the methodological framework), which includes the research problem identified
Which was entitled : Aesthetic and dramatic dimensions of silence in the feature film , and the researcher clearly define after removing the confusion existing in some authorized sources , as for the concept of silence , adopted in this research is : the death of the audio stream , Hence the researcher shed a light on the aesthetic and the dramatic role of silence in the feature film , through the handing of the silent scenes ( absolute silence ) in the film research divided this research into four chapters . This first Chapter includes : methodological framework , which represents the research problem , which came with the following question : what is the mechanism of productive silence to the
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