Ioannis Kosmas

By Anastasia Velalopoulou, Dimitrios Peschos, Mynbaev Ospan, Eliseeva Marina, Ioannis Verginadis, Yannis Simos, Tsirkas Panagiotis, Spyridon Karkabounas, Vicky Kalfakakou, Angelos Evangelou and Ioannis P. Kosmas

Part of the book: Ectopic Pregnancy

By Stelios Fiorentzis, Styliani Salta, Michail Pargianas, Artemis Pontikaki, Dimitrios P. Koutsoulis, Christodoulos Akrivis, Dimitrios Akrivis and Ioannis Kosmas

A high-order pregnancy is always a challenge not only for the couple but also for the obstetrician, the pediatricians, the midwives, and the whole stuff of an obstetric clinic. The breakthroughs of infertility treatments have made more couples to postpone the birth of their children until they feel professionally and financially safe, many times after the age of 40. The advanced age of the mother puts extra pressure to the clinician for immediate success, leading to a rise of high-order pregnancies until the introduction of regulations and laws in many countries. The cost of a quadruplet and quintuplet pregnancy can be unbearable, not only financially but also psychologically. The management of such a pregnancy is also challenging since its beginning and to the end. Modern techniques and methods can also be difficult to be implemented on a quadruplet of quintuplet pregnancy because of the fear of losing four or five embryos at once. At the same time, the limited number of cases makes it almost impossible for studies to be made and guidelines to be established for most of the cases.

Part of the book: Multiple Pregnancy

By Ospan Mynbaev, Ioannis Kosmas, Zhongjie Shi, Sergei Firichenko, Avinoam Tzabari, Lin Ma, Leila Kindarova, Tatiana Babenko, Styliani Salta, Antonio Malvasi, Ivano Raimondo, Andrea Tinelli, Victor Gomel and Michael Stark

The cesarean scar is a significant risk factor for the following pregnancies and especially deliveries. In this chapter, we discussed the diagnosis, incidence, detection, manifestations, and prognosis of pregnancy and delivery with cesarean scars. A systematic review of current literature showed that a manifestation of cesarean scars during the following pregnancies is not predictable, in general, although modern visualization technologies could reveal some specific features of scar defects that are associated with complications during pregnancy and delivery. However, there is no factor, which could serve as the main prognostic guide for obstetricians to make a decision for VBAC, thus Edwin Cragin’s phrase “once a cesarean, always a cesarean” has represented the essential healthcare issue over the century. At the moment, the most reasonable measurements to prevent uterine scar complications are reducing the rate of Cesarean Sections, opening the uterus transversely in the lower segment, and stitching the uterus with one layer only continuously using a big needle preferable by Stark technique of Cesarean section.

Part of the book: Recent Advances in Cesarean Delivery