Faculty of Medicine
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Item type:Publication, ROBSON CLASSIFICATION OF CESAREAN SECTION IN NORTH MACEDONIA - CURRENT TRENDS(Македонско лекарско друштво = Macedonian medical association, 2021); ; ; ; Dalipi, AdelinaAbstract Introduction. Over the last few decades, the global cesarean section rate has significantly increased and reached an unprecedented level. The World Health Organization (WHO) has advised that cesarean section (CS) rates should not rise above 15%. Several classify¬cation systems have been proposed to tackle the increased cesarean section epidemic. Most of the countries have adopted and started using the Robson (10 groups) classification as the best and the one that is the easiest internationally applicable CS classification. Aim. To present the Robson classification as a way to start better classification of cesarean section and hence to reduce the number of unnecessary cesarean section deliveries. Methods: This study was realized at the University Clinic for Gynecology and Obstetrics in Skopje, North Macedonia. It is a retrospective study where two years were compared. Results. The rate of cesarean sections for 2017 was 38.5% and for 2019 42.6%. Categorization of deliveries according to Robson criteria showed a different rate of cesarean section for each subgroup. Discussion. The implementation of the Robson classi-fication in most countries has shown a reduction in the number of cesarean deliveries and thus a reduction in overall maternal and neonatal morbidity and mortality. The analysis has shown that group 5 had the largest number of cesarean section deliveries in both years, 2017 and 2019; these were patients with previous cesarean sections. They were followed by group 1 and 2, or pri¬mi¬para with spontaneous onset and induced delivery. Conclusion. The goal of Robson clasification is to identify the target groups that contribute most in the percentage of cesarean sections and to act on these tar-get groups through appropriate education and training. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute appendicitis in the third trimester of a pregnancy finished with spontaneous vaginal delivery(Asclepius, 2018); ; ; Acute appendicitis is the most common surgical problem occurring during pregnancy. Its incidence is more common in the second trimester and is confirmed in 1/1000 pregnancies. Clinical manifestations of acute appendicitis in pregnant patients are generally very similar to non- pregnant patients. We present, here, the case of a 29-year-old pregnant patient at 35+4 weeks of gestation with the signs of acute appendicitis. The patient underwent a successful open appendectomy of her perforated appendix, without performing a cesarean section (CS) at the same time. 5 weeks postoperatively, at term, labor was induced with vaginal prostaglandins and the patient delivered a healthy female baby without any complications. Immediate diagnosis of acute appendicitis during pregnancy is recommended and management with the suitable surgical intervention should not be delayed for >24 h as it increases the risk of perforation with its subsequent critical complications. The treatment of acute appendicitis is always surgical, with an appendectomy and perioperative broad-spectrum antibiotics. Except in cases of high maternal and fetal mortality, a CS should not be done simultaneously with the appendectomy in cases of a perforated appendix with diffuse peritonitis, due to the very high risk of dehiscence of the uterus.