The overview of high cesarean section rate in Turkey through the eyes of obstetricians and midwieves [Türkiye'de kadi{dotless}n dogum hekimleri ve ebeler açi{dotless}si{dotless}ndan yüksek sezaryen orani{dotless} ni{dotless}n degerlendirilmesi]

Objective: To investigate the effect of the hospitals' conditions to high cesarean birth rates in Turkey and obstetricians and midwieves's thoughts on this issue. Material and Methods: A private hospital, a public hospital, and a university hospital in Izmir were identified as the study area. A face-to-face questionnaire was administered to midwives and obstetricians at these hospitals. Participants were asked as "Is this effective on the cesarean rate in your hospital?" and the answer was "yes or no". All the answers for each factor were evaluated. The positive response rate was grouped as partially effective (less than 50%); effective (between 50-75%) and very effective (more than 75%). Results: Four doctors and eight midwives (100%) at private hospital, 12 doctors and 15 midwives (82%) at public hospital and 35 doctors and 27 midwives (77%) at educational institution were included this study. The medico-legal reasons were the most effective on the high cesarean rates. Insufficiency of emergent conditions, doctor on call and midwives' experience were very effective factors, especially in private hospital. The doctors denoted that the avoidance from risky deliveries was very effective factor in high cesarean ratio. Except for the elective caesarean, patient -related causes were partially effective in the private hospital. Conclusion: In our country, infrastructure and working conditions of maternity services in hospitals are quite different from each other. Suggestions for the solution are improvement of medico-legal issues and emergency working conditions and increase the training and responsibilities of midwieves. copyright © 2014 by Türkiye Klinikleri

Continuous renal replacement therapy after cardiac surgery in patients with acute renal failure

Aim Acute renal failure is an important adverse effect of cardiopulmonary bypass that can result in high mortality or morbidity rates. It can be treated with continuous renal replacement therapy after cardiac surgery. The purpose of this study was to determine the factors associated with the mortality and incidence of acute renal failure in patients of post cardiac surgery. Methods Patients (1564) who underwent cardiac surgery between January 2007 and January 2012 and treated with continuous renal replacement therapy were included (N=40). Patients with previous renal disorders were excluded. A retrospective analysis was carried out. Results Overall, continuous renal replacement therapy was used in 40 (2.6%) patients. The mean age was 62.7±11 years. Mean duration of cardiopulmonary bypass was 166±80 min, and aorta cross-clamping time was 97±35 min. The patients' mean pretherapy creatinine level and mean creatinine level before hospital discharge were 3.3±1.1 mg/dL and 1.1±0.4 mg/dl, respectively. Thirty-day mortality was 35%. Only 6 patients required long-term renal replacement therapy. Conclusion Acute renal failure requiring hemodialysis after cardiac surgery is associated with higher mortality and morbidity and prolonged hospital stay. Early renal recovery with continuous renal replacement therapy seems to offer an evident survival benefit. Continuous renal replacement therapy may represent an important therapy and reduce mortality rates. We believe that these rates might decrease even more with detailed preoperative evaluation and meticulous postoperative care with collaborative management