1,028 results on '"Elective Cesarean Delivery"'
Search Results
2. Risk factors for postpartum hemorrhage after elective cesarean deliveries for twin pregnancies.
- Author
-
Xiaojie Wan, Wei Zhao, Li Zhao, Nan Li, and Hong Wen
- Subjects
HEMORRHAGE ,CESAREAN section ,TWINS ,DISEASE risk factors ,HEALTH outcome assessment - Abstract
Objectives: To identify the high-risk factors associated with postpartum hemorrhage (PPH) after an elective cesarean delivery of twins. Material and methods: This retrospective cohort study included all women with twin gestations who chose to have an elective cesarean delivery after 28 weeks of gestation at at the Women's Hospital, School of Medicine, Zhejiang University between September 2014 and April 2019. Women with an intrauterine fetal demise of one or both twins were excluded. PPH was defined as an estimated blood loss of = 1,000 mL within 24 h of birth. A total of 532 women were analyzed and classified into the PPH group (n = 70) and the no-PPH group (n = 462). Univariate and multivariate logistic regression analyses were performed to assess the independent risk factors. Results: Among the 532 women pregnant with twins, PPH occurred in 13.2% women (n = 70). There were statistically significant differences in preeclampsia (p = 0.005), premature rupture of membrane (PROM, p < 0.001), placenta previa (p < 0.001), anemia [hemoglobin (Hb) < 100 g/L; p = 0.003], and antenatal magnesium sulfate (MgSO4) use (p < 0.001) between the two groups. However, the following were the independent risk factors for PPH after an elective cesarean delivery for a twin pregnancy: preeclampsia [odds ratio (OR): 2.91; 95% confidence interval (CI): 1.33-6.36], PROM (OR: 8.57; 95% CI: 2.54-28.89), placenta previa (OR: 9.46; 95% CI: 3.59-24.89), antenatal MgSO
4 use (OR: 7.64; 95% CI; 3.18-18.41), and anemia (Hb < 100 g/L; OR: 2.68; 95% CI: 1.42-5.06). Conclusions: Preeclampsia, PROM, placenta previa, and antenatal MgSO4 use were the risk factors for PPH after an elective cesarean delivery for twin pregnancies. Risk factor identification and prevention should be a priority. [ABSTRACT FROM AUTHOR]- Published
- 2024
- Full Text
- View/download PDF
3. Naturally conceived heterotopic pregnancy: an atypical presentation rare case report and review of current literature.
- Author
-
Lugata, John, Shao, Baraka, and Batchu, Nasra
- Subjects
- *
ECTOPIC pregnancy , *CESAREAN section , *PREGNANCY , *INDUCED ovulation , *PERITONEUM - Abstract
Heterotopic pregnancy (HP) is the coexistence of living or dead intrauterine pregnancy, single or multiple, and extrauterine pregnancy located in the oviduct, ovary, uterine corner, cervix or peritoneal cavity. This condition is very rare (1:30 000 pregnancies). HP constitutes a rare obstetric condition. Its occurrence after natural conception is sparsely documented in the literature. Here in, we present a case of a 27-year-old primeparous women who presented at 18 weeks with features of ruptured ectopic pregnancy. Initial ultrasonographic imaging showed an intrauterine pregnancy corresponding to 18 weeks. It also revealed a floating fetus with significant collection of fluid in the pouch of Douglas, retroceacal recess and both hepatocellular recess. An emergency explorative laparotomy was done where right salpingectomy was performed. She was later followed up to term and delivered by elective cesarean section successfully. A brief narrative of the challenges in the management, clinical presentation and limitation in the management is highlighted in the present case report. Key message: Heterotopic pregnancy can occur in natural conception irrespective of usage of ovulation induction. Routine early pregnancy ultrasound can promote early detection with prompt surgical intervention to mitigate its complications. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
4. Perioperative Ketorolac-lidocaine in the Patients With Valvular Heart Diseases During Cesarean Delivery
- Author
-
Mohamed R El Tahan, Principal Investigator
- Published
- 2020
5. Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial
- Author
-
Chantry, Caroline J, Blanton, Aubrey, Taché, Véronique, Finta, Laurel, and Tancredi, Daniel
- Subjects
Reproductive Medicine ,Midwifery ,Biomedical and Clinical Sciences ,Health Sciences ,Perinatal Period - Conditions Originating in Perinatal Period ,Infant Mortality ,Clinical Research ,Pediatric Research Initiative ,Pediatric ,Clinical Trials and Supportive Activities ,Reproductive health and childbirth ,Good Health and Well Being ,Delayed cord clamping ,Elective cesarean delivery ,Maternal blood loss ,Newborn ,Safety pilot ,Paediatrics ,Reproductive medicine - Abstract
BackgroundDelayed cord clamping (DCC) results in decreased iron deficiency in infancy. The American College of Obstetrics and Gynecology has called for research on the optimal time to clamp the cord during cesarean deliveries (CD). Our objective was to conduct a pilot trial examining the safety of delayed cord clamping (DCC) for maternal-infant dyads during elective cesarean delivery (CD).MethodsWe enrolled 39 dyads [23 at 90 s, 16 at 120 s; (DCC Pilot)] between 10/2013 and 9/2014. We abstracted data from the electronic medical record (EMR) for historical controls (HC) birthing between 1/2012-6/2013 for whom DCC was not performed (n = 112).ResultsAvailable data for 37 mothers and 30 infants compared to HC revealed 174 (95% CI: 61-286) mL lower mean estimated maternal blood loss [(EBL) mean (SD) mL]: DCC Pilot 691(218) vs. HC 864(442), p = 0.003 and lower incidence of maternal transfusions, DCC Pilot 2.7% vs. HC 18.8%, p = 0.016. There was no significant between group difference between DCC Pilot and HC in other a priori definitions of excess maternal blood loss: a) EBL > 800 ml, 21.6% vs. 38.8%, p = 0.07 or b) post-op hgb/pre-op hgb
- Published
- 2018
6. Impact of manual removal of the placenta and intrauterine cleaning during elective cesarean delivery on maternal infectious morbidity and blood loss.
- Author
-
Hamza, Haitham, Rezk, Mohamed, Tharwat, Ahmed, Amgad, Mohamed, and Dawood, Ragab
- Subjects
- *
CESAREAN section , *BREECH delivery , *BLOOD loss estimation , *PLACENTA , *SURGICAL site infections , *PLACENTA praevia , *SATISFACTION - Abstract
Objective: to assess the impact of manual removal of the placenta and intrauterine cleaning during elective cesarean delivery on maternal infectious morbidity and blood loss. Methods: This prospective multicenter trial was conducted on 436 pregnant women at term who were intended for elective cesarean delivery and allocated into four groups; group 1 (n = 110) who underwent manual removal of the placenta with intrauterine cleaning, group 2 (n = 106) who underwent manual removal of the placenta without intrauterine cleaning, group 3 (n = 108) who underwent spontaneous placental delivery with intrauterine cleaning and group 4 (n = 112) who underwent spontaneous placental delivery without intrauterine cleaning. Maternal operative blood loss, the rate of endometritis and surgical site infections (SSIs) was assessed and recorded. Results: There was no significant difference between the four groups regarding drop of hemoglobin concentration, drop of hematocrit value, re-operation, re-admission to hospital, duration of hospital stay, the rate of endometritis and SSIs as well as maternal acceptability in terms of overall discomfort, overall satisfaction with delivery and recommendation to other women (p > .05). Intrauterine cleaning was associated with a significantly shorter duration of discharge of lochia and rapid return to daily activity compared to non-intrauterine cleaning (p < .05). Conclusion: Manual removal of the placenta and intrauterine cleaning have no deleterious impact on maternal blood loss and infectious morbidity after elective cesarean section. Also, intrauterine cleaning was associated with faster cessation of lochia and faster return to daily activity. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
7. Temporal trends of cesarean delivery on maternal request in the United States, 2016-2019.
- Author
-
Youssefzadeh, Ariane C., Mandelbaum, Rachel S., Donovan, Kelly M., Violette, Caroline J., McGough, Alexandra M., Klar, Maximilian, Ouzounian, Joseph G., and Matsuo, Koji
- Subjects
- *
CESAREAN section , *DELIVERY (Obstetrics) , *ODDS ratio , *LABOR (Obstetrics) , *MEDICAL care costs , *QUESTIONNAIRES , *RETROSPECTIVE studies , *ELECTIVE surgery - Abstract
Objective: Cesarean delivery on maternal request (elective-CD) increased between 1999 and 2015 in the United States, but multiple studies have reported the association between elective-CD and adverse maternal and neonatal outcomes. More contemporary trends and outcomes are currently unknown. The objective of the current study was to examine contemporaneous trends and outcomes of patients who had elective-CD in the United States.Methods: This is a retrospective cohort study querying the Healthcare Cost and Utilization Project's National Inpatient Sample from January 2016 to December 2019. A three-step exclusion approach was used to identify the surrogate for elective-CD (prior uterine scar, maternal / fetal indications for CD, and labor). The primary outcome was temporal trend of elective-CD. The secondary outcomes included severe maternal morbidity in low-risk vaginal delivery candidates, assessed with inverse probability of treatment weighting propensity score.Results: Among 14,648,135 all deliveries for national estimates, 184,945 (1.26 %) patients had elective-CD. The number of patients undergoing elective-CD decreased from 1.35 % to 1.13 % among all deliveries (16.3 % relative-decrease; P-trend < 0.001) and from 4.14 % to 3.51 % among all CD cases (15.2 % relative-decrease, P-trend = 0.002) between QT1/2016 and QT4/2019. The decreasing trend of elective-CD remained independent in multivariable analysis: odds ratio (OR) compared to 2016, 0.96 (95 % confidence interval [CI] 0.95-0.97) for 2017, 0.94 (95 %CI 0.93-0.95) for 2018, and 0.87 (95 %CI 0.86-0.89) for 2019. In a propensity score weighted model among low-risk vaginal delivery candidates, patients in the elective-CD group were more likely to have severe maternal morbidity compared to those in the non-elective-CD group (OR 2.01, 95 %CI 1.87-2.15).Conclusions: This national-level analysis suggests that the number of elective-CD is gradually decreasing in recent years in the United States. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
8. Ralstonia mannitolilytica sepsis after elective cesarean delivery: a case report
- Author
-
Shenglan Zhou, Dongmei Tang, Sumei Wei, Zhengchang Hu, Xuemei Wang, and Dan Luo
- Subjects
Ralstonia mannitolilytica ,Elective cesarean delivery ,sepsis ,Septic shock ,Case report ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Ralstonia mannitolilytica, a newly emerging opportunistic pathogen worldwide, has been reported to be responsible for human pneumonia, septicemia and meningitis. This is the first report of a case of Ralstonia mannitolilytica sepsis after elective cesarean delivery. Case presentation A 25-year-old woman, gravida 1 para 0, was scheduled for an elective cesarean delivery at 39+ 1 weeks of gestation. Sudden high fever and decreased blood pressure occurred a short time after the operation. Ralstonia mannitolilytica was identified in her blood culture 5 days after the operation. Based on the presence of sepsis and septic shock, massive fluid replacement, blood transfusion, vasoactive agents, imipenem/cilastatin and cefoperazone sulbactam sodium were applied. She was discharged after intensive care without complications. Conclusions Although the incidence of sepsis due to Ralstonia mannitolilytica is relatively low, once infection occurs in a puerpera, severe symptoms develop abruptly. Thus, prompt diagnosis and appropriate treatment are key to the cure.
- Published
- 2021
- Full Text
- View/download PDF
9. Incidental finding of meconium-stained amniotic fluid in elective cesarean deliveries: Features and perils.
- Author
-
Itzhaki-Bachar, Liora, Meyer, Raanan, Levin, Gabriel, and Weissmann-Brenner, Alina
- Abstract
Objective: To characterize pregnancies in which meconium-stained amniotic fluid (MSAF) was incidentally discovered during elective caesarean delivery (CD), and to evaluate the association with adverse neonatal outcomes. Methods: A retrospective study was performed on all patients who underwent elective CD with singleton pregnancies between March 2011 and June 2020. Data analyzed included maternal, pregnancy, and neonatal characteristics. A comparison was made between pregnancies with clear amniotic fluid, MSAF, and thick MSAF. Results: During the study period, 10 445 patients with singleton pregnancies underwent elective CD. Of them, 368 (3.5%) had MSAF and 31 (0.3%) had thick MSAF. Patients with MSAF gained more weight during pregnancy and suffered more from diabetes compared with patients with clear fluid. Significantly more pregnancies with MSAF had either oligohydramnios or polyhydramnios. Pregnancies in the thick-MSAF group had more intrahepatic cholestasis of pregnancy. No differences were found between the groups in the composite adverse neonatal outcome, including 5-min Apgar score, need for mechanical ventilation, and admission to the neonatal intensive care unit. Conclusion: The incidental finding of MSAF during elective CD is not associated with increased risks of adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
10. The Role of Corticosteroids in Prevention of Neonatal Respiratory Morbidity in Term Elective Cesarean Section A Prospective Observation Study.
- Author
-
Salama, Mohamed Hamed, Nabhan, Ashraf Fawzy, El-Posty, Faten El-Sayed, and Zeinhom, Ahmed Mohamed
- Subjects
- *
CESAREAN section , *NEONATAL intensive care units , *RESPIRATORY distress syndrome , *WOMEN'S hospitals , *CORTICOSTEROIDS - Abstract
Background: Caesarean sections continue to increase day by day in both developed and developing countries, which is associated with increased respiratory distress syndrome (RDS), the key reason for early neonatal morbidity and mortality. Objective: To assess the effect of routine prophylactic corticosteroids before elective caesarean section after 37 weeks of gestational age, on neonatal respiratory morbidity. Methods: A prospective observational study was conducted on all pregnant women undergoing elective caesarean sections between 37-42 weeks at Ain Shams University Maternity Hospital. Over an 8- month period (from November 2020 to June 2021), 1105 cases were divided into the exposed group (A), (N=877) who received prophylactic dexamethasone, and 228 cases in the non-exposed group (B) who did not receive dexamethasone. Outcome measures were the incidence of transient tachypnea of the newborn, and NICU admissions due to respiratory morbidity. Data were analyzed using SPSS 22. Results: Overall, there was no statistically significant difference in the incidence of TTN or RDS. No cases of TTN were found in exposed subgroup, versus 1 (0.4%) in non-exposed group (p=0.745). The respiratory distress (RDS) in the exposed subgroup was 4 cases (16.7%) versus 18 (7.9%) in non- exposed group (p=0.148). While the admission to the neonatal intensive care unit (NICU) due to respiratory morbidity after an elective caesarean section was 4 cases (16.7%) in the exposed subgroup versus 19 cases (8.3%) in the non-exposed group (p=0.178). Conclusion: Routine administration of prophylactic antenatal corticosteroids before elective caesarean sections at term does not reduce the risk of admission to the NICU compared to non-administration. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
11. Trial of labor versus elective cesarean delivery for patients with two prior cesarean sections: a systematic review and meta-analysis.
- Author
-
Mao H and Shen P
- Subjects
- Humans, Female, Pregnancy, Elective Surgical Procedures adverse effects, Cesarean Section statistics & numerical data, Cesarean Section adverse effects, Uterine Rupture epidemiology, Uterine Rupture etiology, Infant, Newborn, Maternal Mortality, Trial of Labor, Vaginal Birth after Cesarean statistics & numerical data, Vaginal Birth after Cesarean adverse effects, Cesarean Section, Repeat statistics & numerical data, Cesarean Section, Repeat adverse effects
- Abstract
Objective: Cesarean section (CS) rates have been on the rise globally, leading to an increasing number of women facing the decision between a Trial of Labor after two Cesarean Sections (TOLAC-2) or opting for an Elective Repeat Cesarean Section (ERCS). This study evaluates and compares safety outcomes of TOLAC and ERCS in women with a history of two previous CS deliveries., Methods: PubMed, MEDLINE, EMbase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for studies published until 30 June 2023. Eligible studies were included based on predetermined criteria, and a random-effects model was employed to pool data for maternal and neonatal outcomes., Results: Thirteen studies with a combined sample size of 101,011 women who had two prior CS were included. TOLAC-2 was associated with significantly higher maternal mortality (odds ratio (OR)=1.50, 95% confidence interval (CI)= 1.25-1.81) and higher chance of uterine rupture (OR = 7.15, 95% CI = 3.44-14.87) compared to ERCS. However, no correlation was found for other maternal outcomes, including blood transfusion, hysterectomy, or post-partum hemorrhage. Furthermore, neonatal outcomes, such as Apgar scores, NICU admissions, and neonatal mortality, were comparable in the TOLAC-2 and ERCS groups., Conclusion: Our findings suggest an increased risk of uterine rupture and maternal mortality with TOLAC-2, emphasizing the need for personalized risk assessment and shared decision-making by healthcare professionals. Additional studies are needed to refine our understanding of these outcomes in the context of TOLAC-2.
- Published
- 2024
- Full Text
- View/download PDF
12. Ralstonia mannitolilytica sepsis after elective cesarean delivery: a case report.
- Author
-
Zhou, Shenglan, Tang, Dongmei, Wei, Sumei, Hu, Zhengchang, Wang, Xuemei, and Luo, Dan
- Subjects
- *
RALSTONIA , *OPPORTUNISTIC infections , *SEPSIS , *CESAREAN section complications , *PREGNANCY complications , *SEPTIC shock - Abstract
Background: Ralstonia mannitolilytica, a newly emerging opportunistic pathogen worldwide, has been reported to be responsible for human pneumonia, septicemia and meningitis. This is the first report of a case of Ralstonia mannitolilytica sepsis after elective cesarean delivery.Case Presentation: A 25-year-old woman, gravida 1 para 0, was scheduled for an elective cesarean delivery at 39+ 1 weeks of gestation. Sudden high fever and decreased blood pressure occurred a short time after the operation. Ralstonia mannitolilytica was identified in her blood culture 5 days after the operation. Based on the presence of sepsis and septic shock, massive fluid replacement, blood transfusion, vasoactive agents, imipenem/cilastatin and cefoperazone sulbactam sodium were applied. She was discharged after intensive care without complications.Conclusions: Although the incidence of sepsis due to Ralstonia mannitolilytica is relatively low, once infection occurs in a puerpera, severe symptoms develop abruptly. Thus, prompt diagnosis and appropriate treatment are key to the cure. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
13. The majority of early term elective cesarean sections can be postponed.
- Author
-
Vigdis Rikhardsdottir, Johanna, Hardardottir, Hildur, and Thorkelsson, Thordur
- Subjects
- *
CESAREAN section , *CLINICAL indications , *BREECH delivery , *NEWBORN infants , *ULTRASONIC imaging , *GESTATIONAL age , *IN situ hybridization - Abstract
Introduction: To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 370-386 weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity.Material and Methods: Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥370 weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent.Results: There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 370-386 weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥390 weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 370-386 weeks gestation compared to 2.4% at 390-421 weeks gestation (p < .001).Conclusion: Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
14. Morbidity associated with planned cesarean deliveries performed before the scheduled date: A cohort study.
- Author
-
Sananès, Nicolas, Haller, Laure, Jochum, Floriane, Koch, Antoine, Lecointre, Lise, and Rozenberg, Patrick
- Subjects
- *
CESAREAN section , *UTERINE rupture , *UTERINE hemorrhage , *POSTPARTUM hemorrhage , *FETAL heart rate , *LABOR (Obstetrics) , *SURGICAL complications , *RETROSPECTIVE studies , *DISEASES , *DELIVERY (Obstetrics) , *APGAR score , *LONGITUDINAL method - Abstract
Objective: Women with planned cesareans can require delivery before the scheduled date. However, data describing the morbidity associated with planned cesarean deliveries performed before the originally scheduled date is lacking. The objective of this study was to compare the morbidity associated with planned cesarean delivery performed before compared with on the scheduled date.Study Design: This retrospective single-center cohort study included all 3595 women with singleton pregnancies and cesarean deliveries after 36+6 weeks. All cases were reviewed individually to identify the initial intended mode of delivery, determined before 37 weeks. We excluded the 2145 (59.7%) unplanned cesareans initially planned as vaginal deliveries. Finally, the analysis included 1450 women with planned cesareans: 1232 (85.0%) performed as scheduled, and 218 (15.0%) before that date. The composite outcomes of maternal morbidity was one or more of the morbidity measures, including surgical complications, postpartum hemorrhage, infection and thrombo-embolism. Neonatal morbidity measures included 5 min Apgar score < 7, arterial cord blood pH < 7.00, and admission to the neonatal intensive care unit (NICU).Results: Reasons for performing planned cesarean delivery before the scheduled date were as follows: onset of labor (n = 109; 50.0%), rupture of membranes (n = 85; 39.0%), preeclampsia (n = 9; 4.1%), scar pain in women with a previous cesarean (n = 6; 2.8%), unexplained vaginal bleeding (n = 5; 2.3%), and nonreassuring fetal heart rate (n = 4; 1.8%). Mean gestational age for planned cesarean deliveries before the scheduled date was 38.7 weeks ± 0.8 versus 39.2 weeks ± 0.7 for those performed when scheduled (P < 0.0001). The maternal morbidity composite outcome rate was significantly higher among planned cesareans performed early compared with those on the scheduled date: 18.3% vs 9.7%, respectively, P = 0.0002. It was still higher in the multivariable analysis: aOR 2.17, 95% CI 1.46-3.21, P = 0.0001. The neonatal composite outcome did not differ significantly between the two groups.Conclusion: In planned cesarean deliveries, maternal morbidity is higher for cesareans performed before rather than on the scheduled date. Studies without accurate intent-to-treat analyses underestimate the morbidity associated with planned cesareans. Accordingly, medical records must make it possible to distinguish planned cesarean deliveries performed before the scheduled date from those performed as planned. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
15. Does mild thrombocytopenia increase peripartum hemorrhage in elective cesarean deliveries? A retrospective cohort study.
- Author
-
Işıkalan, Mehmet Murat, Özkaya, Eren Berkay, Özkaya, Buşra, Ferlibaş, Enes, Şengül, Nurullah, and Acar, Ali
- Subjects
- *
CESAREAN section , *PLATELET count , *BLOOD loss estimation , *THROMBOCYTOPENIA , *HEMORRHAGE - Abstract
Objective: To investigate the effect of mild thrombocytopenia (platelet count: 100 000–149 000/µl) on peripartum hemorrhage in elective cesarean deliveries. Methods: This study was conducted between January 2018 and May 2019 in a hospital, located in Konya, Turkey. Uncomplicated pregnancies undergoing elective cesarean section were included. Of 1992 eligible patients, 201 women were determined as the mild thrombocytopenia group, 48 women as the severe thrombocytopenia group, and 1743 women as the control group. The estimated blood loss volume (EBLV), the need for blood transfusion, and excessive blood loss rates were compared among groups. Logistic regression analysis was performed for potential confounding factors. Results: The EBLV and excessive blood loss ratios were significantly higher in the mild thrombocytopenia group compared with the control group (P < 0.001 and P < 0.05, respectively). There was no significant difference between the mild thrombocytopenia and control groups in terms of the number of patients receiving a blood transfusion. The probability of excessive blood loss was significantly higher in the mild thrombocytopenia group, even after adjusting the odds ratio for confounding factors (adjusted odds ratio 1.94, 95% confidence interval 1.27–2.95, P = 0.002). Conclusion: Mild thrombocytopenia appears to increase the likelihood of peripartum hemorrhage in elective cesarean deliveries in uncomplicated pregnancies. Mild thrombocytopenia can increase estimated blood loss volume and the rate of excessive blood loss in elective cesarean operations. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
16. Effect of pre-operative patient anxiety on post-spinal shivering during elective cesarean delivery: a prospective observational study.
- Author
-
Jeevan, S., Ashok, V., Jain, K., and Jain, V.
- Abstract
• Shivering after spinal anesthesia is common during cesarean delivery. • Intra-operative shivering could have unfavorable physiological patient effects. • High pre-operative anxiety is a potential risk factor for post-spinal shivering. • Younger patient age is another risk factor. • Reducing pre-operative anxiety might decrease obstetric post-spinal shivering. Shivering after spinal anesthesia is common during cesarean delivery (CD), and is thought to be primarily a thermoregulatory response. By inducing autonomic changes, pre-operative anxiety could alter the functioning of the thermoregulatory center, hence modifying the incidence and severity of obstetric post-spinal shivering. This prospective observational study was conducted to explore the relationship between pre-operative anxiety and obstetric post-spinal shivering. Patients ≥18 years of age and scheduled for elective CD under spinal anesthesia were enrolled. Pre-operative anxiety was measured on the day of surgery using a visual analogue scale (VAS) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and was correlated with the incidence of post-spinal shivering. Other possible risk factors for post-spinal shivering were explored using univariate and multivariate logistic regression models. Among the 150 participants, 46 (31%) experienced post-spinal shivering. The relative risk of intra-operative shivering in those with high APAIS pre-operative anxiety was 2.76 (95% CI 1.55 to 4.90; P = 0.0005). Younger patient age (aOR 0.91, 95% CI 0.83 to 0.98; P = 0.02), higher APAIS anxiety score (aOR 1.21, 95% CI 1.06 to 1.37; P = 0.005), higher VAS anxiety score (aOR 1.48, 95% CI 1.24 to 1.78; P < 0.001) were independent risk factors for post-spinal shivering. High pre-operative anxiety and younger patient age were independent risk factors for post-spinal shivering during elective CD. Targeted interventions to reduce pre-operative patient anxiety might have a positive impact in decreasing the incidence of intra-operative post-spinal shivering in this patient population. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
17. Feasibility of Conducting a Trial Assessing Benefits and Risks of Planned Caesarean Section Versus Planned Vaginal Birth: A Cross-Sectional Study.
- Author
-
Amyx, Melissa M., Althabe, Fernando, Rivo, Julie, Pingray, Verónica, Minckas, Nicole, Belizán, María, Gibbons, Luz, Murga, Gerardo T., Fiorillo, Ángel E., Malamud, Julio D., Casale, Roberto A., Cormick, Gabriela, and Belizán, José M.
- Subjects
- *
STATISTICS , *HUMAN research subjects , *CROSS-sectional method , *WOMEN'S rights , *RANDOMIZED controlled trials , *VAGINA , *RISK assessment , *SURVEYS , *SOCIOECONOMIC factors , *PUBLIC hospitals , *CESAREAN section , *DELIVERY (Obstetrics) , *PROPRIETARY hospitals - Abstract
Introduction: Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. Methods: A cross-sectional survey of low-risk, nulliparous pregnant women (N = 416) and healthcare providers (N = 168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. Results: Few women (< 15%) or professionals (33.3%) would participate in an RCT, though more would participate in PCTs (88% women; 65.9% professionals) or PRPPTs (44.4% public, 63.4% private sector women; 44.0% professionals). However, most women would choose vaginal delivery in the PCT and PRPPT (> 85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women's reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women's right to choose (RCT). Conclusions for Practice: Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
18. Correlation of palpation versus ultrasound-assisted approach for locating the level of lumbar puncture used for subarachnoid block in elective cesarean delivery.
- Author
-
Tiwari, Arjun Prasad, Shrestha, Amir Babu, Pradhan, Ritu, Baral, Bidur Kumar, Gurung, Tara, and Shrestha, Sangeeta
- Subjects
- *
CESAREAN section , *LUMBAR puncture , *PALPATION , *WOMEN'S hospitals , *ULTRASONIC imaging - Abstract
Aims: To correlate the level of lumbar puncture used for subarachnoid block in parturient undergoing elective cesarean delivery between palpation and ultrasound method; and to find its accuracy. Methods: This is an observational study, conducted in 314 parturient undergoing elective caesarean delivery under spinal anesthesia over the period of three months at Paropakar Maternity and Women's Hospital Kathmandu. The interspinous space identified by palpation method on lateral position for subarachnoid block and later the site confirmed by ultrasound. Results: In this study, intervertebral space identified by palpation was matched in 38.1% (i.e. 107 in 281 patients) when assessed with ultrasound (USG). In 166 (59.1%) patients, skin puncture level was determined by palpation was found to be one intervertebral space cephalic. In eight (2.8%) patients, one intervertebral space caudal while assed with USG. The correlation between intervertebral space determined by palpation and by ultrasonography was poor (correlation coefficient r=0.288).The kappa was 0.293±0.015. Conclusions: The level of lumbar puncture used for subarachnoid block in elective cesarean delivery by palpation method is poorly correlated (38.1%) with ultrasonographic identification of corresponding interspinous level. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
19. Risk factors for postpartum hemorrhage after elective cesarean deliveries for twin pregnancies.
- Author
-
Wan X, Zhao W, Zhao L, Li N, and Wen H
- Subjects
- Humans, Female, Pregnancy, Risk Factors, Retrospective Studies, Adult, Elective Surgical Procedures adverse effects, Elective Surgical Procedures statistics & numerical data, Placenta Previa epidemiology, Placenta Previa etiology, Pre-Eclampsia epidemiology, Postpartum Hemorrhage etiology, Postpartum Hemorrhage epidemiology, Pregnancy, Twin, Cesarean Section adverse effects, Cesarean Section statistics & numerical data
- Abstract
Objectives: To identify the high-risk factors associated with postpartum hemorrhage (PPH) after an elective cesarean delivery of twins., Material and Methods: This retrospective cohort study included all women with twin gestations who chose to have an elective cesarean delivery after 28 weeks of gestation at at the Women's Hospital, School of Medicine, Zhejiang University between September 2014 and April 2019. Women with an intrauterine fetal demise of one or both twins were excluded. PPH was defined as an estimated blood loss of ≥ 1,000 mL within 24 h of birth. A total of 532 women were analyzed and classified into the PPH group (n = 70) and the no-PPH group (n = 462). Univariate and multivariate logistic regression analyses were performed to assess the independent risk factors., Results: Among the 532 women pregnant with twins, PPH occurred in 13.2% women (n = 70). There were statistically significant differences in preeclampsia (p = 0.005), premature rupture of membrane (PROM, p < 0.001), placenta previa (p < 0.001), anemia [hemoglobin (Hb) < 100 g/L; p = 0.003], and antenatal magnesium sulfate (MgSO₄) use (p < 0.001) between the two groups. However, the following were the independent risk factors for PPH after an elective cesarean delivery for a twin pregnancy: preeclampsia [odds ratio (OR): 2.91; 95% confidence interval (CI): 1.33-6.36], PROM (OR: 8.57; 95% CI: 2.54-28.89), placenta previa (OR: 9.46; 95% CI: 3.59-24.89), antenatal MgSO₄ use (OR: 7.64; 95% CI; 3.18-18.41), and anemia (Hb < 100 g/L; OR: 2.68; 95% CI: 1.42-5.06)., Conclusions: Preeclampsia, PROM, placenta previa,and antenatal MgSO₄ use were the risk factors for PPH after an elective cesarean delivery for twin pregnancies. Risk factor identification and prevention should be a priority.
- Published
- 2024
- Full Text
- View/download PDF
20. Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial
- Author
-
Caroline J. Chantry, Aubrey Blanton, Véronique Taché, Laurel Finta, and Daniel Tancredi
- Subjects
Delayed cord clamping ,Elective cesarean delivery ,Safety pilot ,Maternal blood loss ,Newborn ,Medicine - Abstract
Abstract Background Delayed cord clamping (DCC) results in decreased iron deficiency in infancy. The American College of Obstetrics and Gynecology has called for research on the optimal time to clamp the cord during cesarean deliveries (CD). Our objective was to conduct a pilot trial examining the safety of delayed cord clamping (DCC) for maternal-infant dyads during elective cesarean delivery (CD). Methods We enrolled 39 dyads [23 at 90 s, 16 at 120 s; (DCC Pilot)] between 10/2013 and 9/2014. We abstracted data from the electronic medical record (EMR) for historical controls (HC) birthing between 1/2012–6/2013 for whom DCC was not performed (n = 112). Results Available data for 37 mothers and 30 infants compared to HC revealed 174 (95% CI: 61–286) mL lower mean estimated maternal blood loss [(EBL) mean (SD) mL]: DCC Pilot 691(218) vs. HC 864(442), p = 0.003 and lower incidence of maternal transfusions, DCC Pilot 2.7% vs. HC 18.8%, p = 0.016. There was no significant between group difference between DCC Pilot and HC in other a priori definitions of excess maternal blood loss: a) EBL > 800 ml, 21.6% vs. 38.8%, p = 0.07 or b) post-op hgb/pre-op hgb
- Published
- 2018
- Full Text
- View/download PDF
21. A randomized controlled trial of the safety and efficacy of preoperative rectal misoprostol for prevention of intraoperative and postoperative blood loss at elective cesarean delivery.
- Author
-
Maged, Ahmed M., Fawzi, Tarek, Shalaby, Mohamed A., Samy, Ahmed, Rabee, Mohamed A., Ali, Ahmed S., Hussein, Eman A., Hammad, Bahaa, and Deeb, Wesam S.
- Subjects
- *
CESAREAN section , *MISOPROSTOL , *RANDOMIZED controlled trials , *HEMATOCRIT , *URINARY catheters , *SURGICAL blood loss , *HEMORRHAGE prevention , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *POSTOPERATIVE period , *PUERPERAL disorders , *RECTAL medication , *RESEARCH , *EVALUATION research , *BLIND experiment , *OXYTOCICS - Abstract
Objective: To assess the safety and efficacy of preoperative rectal misoprostol for the prevention of intraoperative and postoperative blood loss in women undergoing elective cesarean delivery.Methods: A single-blind randomized controlled trial of 200 full-term pregnant women scheduled for elective cesarean delivery. Computer-generated randomization allocated women to receive 400 μg rectal misoprostol at urinary catheter insertion plus 400 μg rectally after abdominal closure (preoperative group, n=100) or 800 μg of rectal misoprostol after abdominal closure (postoperative group, n=100). Primary outcome was intraoperative blood loss.Results: Intraoperative blood loss was significantly lower in the preoperative misoprostol group compared with the postoperative group (528.7 ± 114.8 mL vs 788.6 ± 165.8 mL; P<0.001). Blood loss during the first 24 hours after delivery was also lower in the preoperative group (199.3 ± 84.5 mL vs 302.9 ± 125.6 mL; P<0.001). Fewer women in the preoperative group needed additional uterotonics (7 vs 21; P<0.001). After delivery, the decrease in both hemoglobin and hematocrit levels was significantly less in the preoperative group (-6.8 vs -12.8% and -6.05 vs -17.8%, respectively; P<0.001).Conclusion: Preoperative rectal administration of misoprostol significantly reduced intraoperative and postoperative blood loss during and after elective cesarean delivery. ClinicalTrial.gov ID: NCT03680339. Date of registration 9/2018. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
22. Comparison of standing stability with different doses in epidural fentanyl among post-cesarean delivery women: a prospective trial
- Author
-
Kazuyoshi Aoyama and Masayuki Oshima
- Subjects
Fentanyl ,Early ambulation ,Pregnancy ,medicine ,Elective Cesarean Delivery ,Humans ,Ropivacaine ,Prospective Studies ,Anesthetics, Local ,Prospective cohort study ,Adverse effect ,Pain, Postoperative ,business.industry ,Posturography ,General Medicine ,Ibuprofen ,Amides ,Analgesia, Epidural ,Analgesics, Opioid ,Standing position ,Postural balance ,Anesthesia ,Epidural ,Female ,Analysis of variance ,Analgesia ,Cesarean section ,business ,medicine.drug - Abstract
Background The study purpose was to determine the safety and efficacy of different doses of epidural fentanyl plus local anesthetics on ambulation for patients who had elective cesarean delivery. Methods A prospective study at a single community hospital used posturography to compute Sway area for assessment of standing stability [ISRCTN14517337]. Continuous epidural infusion of 0.2% ropivacaine containing either 2.5 mcg.mL-1 (Group 1, n = 8) or 5 mcg.mL-1 fentanyl (Group 2, n = 8) was randomly assigned to an individual and started at a rate of 5 mL.h-1 postoperatively and continued for 48 hours after cesarean delivery in addition to standing acetaminophen and ibuprofen. Posturography measured with SYMPACK™ was used to compute Sway area for investigation of standing stability. The unpaired t-test was used to compare continuous variables between groups. Analysis of variance (ANOVA) was used to assess differences of Sway area measured repeatedly within groups. Results Participants’ demographics, pain status, and leg motor function one day after cesarean delivery were not different between groups. Sway area in Group 1 was not different across three repeated measurements. Sway area of Group 2 on postoperative day 1, with epidural analgesia, was significantly higher than at the baseline (4.1 ± 2.8 vs. 3.1 ± 1.1 cm2, p Conclusions Because both low and high concentrations of epidural fentanyl allowed participants to ambulate with the same pain effect, the lower concentration of continuous epidural fentanyl (2.5 mcg.mL-1 at 5 mL.h-1) is warranted to avoid potential adverse events during ambulation after cesarean delivery.
- Published
- 2022
23. Enhanced Recovery after Surgery versus Standard Care for Elective Cesarean Deliveries in the Tertiary Care Center, Rajavithi Hospital, Thailand
- Author
-
Kamaitorn Tientong
- Subjects
standard care ,elective cesarean delivery ,ERAS - Abstract
Thai Journal of Obstetrics and Gynaecology, 31, 3, 174-181
- Published
- 2023
- Full Text
- View/download PDF
24. Comparison of Chloroprocaine Versus Lidocaine With Epinephrine, Sodium Bicarbonate, and Fentanyl for Epidural Extension Anesthesia in Elective Cesarean Delivery: A Randomized, Triple-blind, Noninferiority Study
- Author
-
Jill M. Mhyre, Matthew L. Williams, Prannal Bansal, Nadir Sharawi, and Horace J. Spencer
- Subjects
Lidocaine ,Local anesthetic ,medicine.drug_class ,business.industry ,Confidence interval ,Fentanyl ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Epinephrine ,030202 anesthesiology ,Anesthesia ,Management of Technology and Innovation ,Anesthetic ,medicine ,Elective Cesarean Delivery ,Elective Surgical Procedure ,business ,030217 neurology & neurosurgery ,Chloroprocaine ,medicine.drug - Abstract
Background For emergent intrapartum cesarean delivery (CD), the literature does not support the use of any particular local anesthetic solution to extend epidural analgesia to cesarean anesthesia. We hypothesized that 3% chloroprocaine (CP) would be noninferior to a mixture of 2% lidocaine, 150 µg of epinephrine, 2 mL of 8.4% bicarbonate, and 100 µg of fentanyl (LEBF) in terms of onset time to surgical anesthesia. Methods In this single-center randomized noninferiority trial, adult healthy women undergoing CD were randomly assigned to epidural anesthesia with either CP or LEBF. Sensory blockade (pinprick) to T10 was established before operating room (OR) entry for elective CD. On arrival to the OR, participants received the epidural study medications in a standardized manner to simulate the conversion of "epidural labor analgesia to surgical anesthesia." The primary outcome was the time to loss of touch sensation at the T7 level. A noninferiority margin was set at 3 minutes. The secondary outcome was the need for intraoperative analgesia supplementation. Results In total, 70 women were enrolled in the study. The mean onset time to achieve a bilateral sensory block to touch at the T7 dermatome level was 655 (standard deviation [SD] = 258) seconds for group CP and 558 (269) seconds for group LEBF, a difference in means of 97 seconds (90% confidence interval [CI], SD = -10.6 to 204; P = .10 for noninferiority). The upper limit of the 90% CI for the mean difference exceeded the prespecified 3-minute noninferiority margin. There was no meaningful difference in the requirement for intraoperative analgesia between the 2 groups. Conclusion Both anesthetic solutions have a rapid onset of anesthesia when used to extend low-dose epidural sensory block to surgical anesthesia. Data from the current study provide insufficient evidence to confirm that CP is noninferior to LEBF for rapid epidural extension anesthesia for CD, and further research is required to determine noninferiority.
- Published
- 2022
25. The role of elective and emergency cesarean delivery in maternal postpartum anhedonia, anxiety, and depression.
- Author
-
Zanardo, Vincenzo, Giliberti, Lara, Giliberti, Elia, Volpe, Francesca, Straface, Gianluca, and Greco, Pantaleo
- Subjects
- *
SURGICAL emergencies , *CESAREAN section , *ANHEDONIA , *ELECTIVE surgery , *POSTPARTUM depression , *ANXIETY diagnosis , *DELIVERY (Obstetrics) , *POSTPARTUM depression diagnosis , *ANXIETY , *MEDICAL emergencies , *PSYCHOLOGICAL tests , *PUERPERIUM , *EDINBURGH Postnatal Depression Scale , *PSYCHOLOGY - Abstract
Objective: To compare levels of anhedonia, anxiety, and depression in women following elective and emergency cesarean delivery.Methods: An observational study was conducted between January 1, 2015, and May 31, 2017, among Italian women who delivered healthy neonates at term at the Policlinico Abano Terme, Italy, by vaginal, elective cesarean delivery (ElCD) or emergency cesarean (EmCD) delivery. The women completed the Edinburgh Postnatal Depression Scale (EPDS), including specific factors within each category, 2 days post-delivery to measure postpartum depressive symptomatology.Results: Of the 2234 women enrolled in the study, 1702 (76.2%) had a vaginal delivery and 532 (23.8%) a cesarean delivery, of which 264 (11.8%) were emergency and 268 (12.0%) were elective. Mean EPDS scores (P=0.075) and the number of women with EPDS scores >12 (P=0.718) were comparable among the delivery groups. However, mean anxiety factor scores were significantly higher in the ElCD group (P=0.031), and conversely, mean anhedonia factor scores were significantly higher in the EmCD group (P=0.001).Conclusion: Postpartum depressive symptomatology of women who have had a cesarean delivery was characterized by higher levels of anxiety after ElCD and by higher levels of anhedonia after EmCD. [ABSTRACT FROM AUTHOR]- Published
- 2018
- Full Text
- View/download PDF
26. Evaluation of gastric contents using ultrasound in full-term pregnant women fasted for 8 h: a prospective observational study
- Author
-
Mona Elsherbeeny, Ahmed Hasanin, Maha Mostafa, Hany Elhadi, Reham Fouad, Amany Arafa, Ramy Melad, and Khaled Sarhan
- Subjects
medicine.medical_specialty ,Gastroenterology ,Pregnancy ,Internal medicine ,Pyloric Antrum ,medicine ,Elective Cesarean Delivery ,Humans ,Prospective Studies ,Ultrasonography ,Full Term ,Meal ,business.industry ,Stomach ,digestive, oral, and skin physiology ,medicine.disease ,Gastrointestinal Contents ,Confidence interval ,Anesthesiology and Pain Medicine ,Pulmonary aspiration ,Quartile ,Anesthesia ,Female ,Pregnant Women ,Preoperative fasting ,business - Abstract
Background We aimed to evaluate the gastric volume and contents after an 8-h fasting period in full-term, non-laboring, pregnant women following a standardized meal. Methods In this prospective observational study, we included full-term pregnant women scheduled for elective cesarean delivery. The participants were instructed to fast after a standardized meal (apple juice, bread, and cheese). Participants were scanned in the semi-recumbent and right-lateral positions 8 h after the standardized meal. The primary outcome was the proportion of patients with gastric volume > 1.5 mL kg-1 calculated by two equations. Secondary outcomes included the antral cross-sectional area and gastric volume. Data are expressed as frequency (%, 95% confidence interval [CI]), mean ± standard deviation (95% CI of the mean), or median (quartiles) as appropriate. Results Forty-one women were available for the final analysis. For the primary outcome, one participant (2.4%, 95% CI of 0.06 to 12.8%) had gastric volume > 1.5 mL kg-1, and none had solids in the antrum. For the secondary outcomes, the mean (95% CI of the mean) of the antral cross-sectional area was 2.11 ± 0.72 (1.88 to 2.34) cm2 and 4.08 ± 1.80 (3.51 to 4.65) cm2 during the semi-recumbent and right-lateral position, respectively. The median (quartiles) gastric volume was 0.53 (0.32, 0.66) mL kg-1 and 0.33 (0.13, 0.52) mL kg-1 as estimated by Perlas et al. and Roukhomovsky et al. equations, respectively. Conclusion After 8-h fasting following a standardized meal, full-term pregnant non-laboring women are less likely to have a high residual gastric volume.
- Published
- 2021
27. Carbetocin versus oxytocin following vaginal and Cesarean delivery: a before-after study
- Author
-
Jose C. A. Carvalho, Bernard Ma, Wendy Whittle, Kristi Downey, and Ahmad Ben Tareef
- Subjects
Blood transfusion ,business.industry ,Vaginal delivery ,Maintenance dose ,medicine.medical_treatment ,Postpartum Hemorrhage ,Uterotonic ,General Medicine ,Oxytocin ,Anesthesiology and Pain Medicine ,Controlled Before-After Studies ,Pregnancy ,Management of Technology and Innovation ,Oxytocics ,Anesthesia ,medicine ,Elective Cesarean Delivery ,Humans ,Female ,Carbetocin ,Dosing ,business ,Retrospective Studies ,medicine.drug - Abstract
A nationwide shortage of oxytocin in Canada resulted in a temporary switch from oxytocin to carbetocin for all postpartum women at our institution. This change offered a unique opportunity to conduct a pragmatic comparative assessment of the efficacy of carbetocin and oxytocin.In a retrospective before-after study, we reviewed the medical records from 641 women in the carbetocin group and 752 women in the oxytocin group . The standard carbetocin dosing was 100 µg iv following vaginal and intrapartum Cesarean delivery, while for elective Cesarean delivery it was 50 µg, with an additional 50 µg if required. The standard oxytocin dosing was 5 IU iv followed by 2.4 IU·hrThe incidence of additional uterotonic use was not different between the carbetocin and oxytocin groups (12.0% vs 8.8%; P = 0.05; odds ratio, 1.39; 95% confidence interval, 0.97 to 2.00). The incidence of postpartum hemorrhage was higher in the carbetocin group than in the oxytocin group (10.3% vs 6.6%; P = 0.01). Blood transfusion was more common in the carbetocin group (1.4% vs 0.3%; P = 0.02).There was no difference in the use of additional uterotonics when carbetocin or oxytocin were used in a cohort of women undergoing vaginal deliveries and both elective and emergency Cesarean deliveries.RéSUMé: OBJECTIF: Une pénurie nationale d’ocytocine au Canada a entraîné l’utilisation temporaire de la carbétocine en remplacement de l’ocytocine pour toutes les femmes en post-partum dans notre établissement. Grâce à cette substitution, nous avons bénéficié d’une occasion unique de mener une évaluation comparative pragmatique de l’efficacité de la carbétocine et de l’ocytocine. MéTHODE: Dans une étude rétrospective avant-après, nous avons examiné les dossiers médicaux de 641 femmes dans le groupe carbétocine et de 752 femmes dans le groupe ocytocine. Le dosage standard de carbécotine était de 100 μg iv après un accouchement vaginal et pendant un accouchement par césarienne intrapartum, tandis que pour un accouchement par césarienne élective, le dosage était de 50 μg, avec 50 μg supplémentaires au besoin. Le dosage standard d’ocytocine était de 5 UI iv suivi de 2,4 UI·h
- Published
- 2021
28. Efficacy and Safety of Corticosteroids’ Administration for Pulmonary Immaturity in Anticipated Preterm Delivery
- Author
-
Themistoklis Dagklis, Ioannis Tsakiridis, Georgios Papazisis, and Apostolos Athanasiadis
- Subjects
Pediatrics ,medicine.medical_specialty ,Gestational Age ,Betamethasone ,01 natural sciences ,Infant, Newborn, Diseases ,03 medical and health sciences ,Adrenal Cortex Hormones ,Pregnancy ,Drug Discovery ,Elective Cesarean Delivery ,Humans ,Medicine ,Dexamethasone ,030304 developmental biology ,Pharmacology ,Respiratory Distress Syndrome, Newborn ,0303 health sciences ,Respiratory distress ,business.industry ,Incidence (epidemiology) ,Infant, Newborn ,Gestational age ,medicine.disease ,0104 chemical sciences ,010404 medicinal & biomolecular chemistry ,Premature Birth ,Gestation ,Female ,business ,medicine.drug - Abstract
Preterm delivery represents the major cause of neonatal morbidity and mortality. Respiratory morbidity is the primary cause of early neonatal mortality and disability. The administration of antenatal corticosteroids, in cases of imminent preterm delivery, can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes. The scope of this narrative review was to synthesize available evidence on the efficacy and safety of corticosteroids' administration during antenatal period, in cases of anticipated preterm delivery. Hence, for those cases, a single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered. Betamethasone and dexamethasone are the most widely used drugs, with similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24- hour period. However, there is an ongoing debate regarding the gestational age of administration. Some obstetric societies recommend their administration even at 22 weeks of gestation. Conflicting is also their usefulness in late preterm cases (between 34 and 37 weeks) or in cases of elective cesarean delivery at term. The use of repeated courses of corticosteroids may be considered in specific cases, however, concerns on the long-term outcomes of repeated courses beyond 34 gestational weeks have been raised.
- Published
- 2021
29. Ketamine versus Dexmedetomidine in Local Wound Infiltration for Postoperative Pain Relief in Cesarean Section
- Author
-
Asmaa Fathelbab, Abeer E. Farhat, Amina Abdel-Fattah, and Nourhan R. Biomy
- Subjects
Bupivacaine ,Medicine (General) ,ketamine ,Visual analogue scale ,business.industry ,Analgesic ,dexmedetomidine ,wound infiltration ,Pethidine ,R5-920 ,Anesthesia ,medicine ,Elective Cesarean Delivery ,Local anesthesia ,Ketamine ,Dexmedetomidine ,local anesthesia ,business ,medicine.drug - Abstract
Background: Cesarean delivery is a frequently obstetric operation in Egypt with a recently reported over all cesarean section rate of 54% and it causes moderate to severe postoperative discomfort. Infiltration of the wound site is a method to improve postoperative analgesia. The aim of the work: To compare the pain relief effects of ketamine versus dexmedetomidine combined to bupivacaine in local wound infiltration in patients underwent cesarean section and to estimate side effects of medications. Patients and Methods: This randomized, controlled study including 90 women were subjected for elective cesarean delivery under general anesthesia and were divided at random into 3 equal groups to receive 40 ml bupivacaine (0.25%) + either 2 mg/kg ketamine in (group A), 2 μg/kg dexmedetomidine in (group B) or 2 ml saline in (group C) via local wound infiltration. The primary outcome was time of the first analgesia requested. The secondary outcomes were total dose of analgesia per 24 hours, Visual analogue scale, time of starting movement, breast-feeding, passing flatus or stool, start of eating and adverse effects of medications. Results: A significant increase in time of the first analgesic request in group A (8.4 ±1.91) h. and group B (7.5±1.81) h. than group C (4.3±1.24) h. A significant decrease in pethidine consumption in group A (59 ± 28.93 mg) than group B (72 ± 23.1 mg) and group C (102 ±16 mg). The visual analogue scale (VAS) was significantly lower (p
- Published
- 2021
30. Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae.
- Author
-
Matinnia, Nasrin, Haghighi, Mohammad, Jahangard, Leila, Ibrahim, Faisal B., Rahman, Hejar A., Ghaleiha, Ali, Holsboer-Trachsler, Edith, and Brand, Serge
- Subjects
- *
CESAREAN section , *SOCIODEMOGRAPHIC factors , *HEALTH Belief Model , *SOCIAL support , *SELF-esteem - Abstract
Objective: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress and health beliefs are under-researched. Methods: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support and relevant health-related beliefs. Results: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. Conclusions: The pattern suggests that various psychological factors such as self-esteem, self-efficacy and perceived stress underpin the decision by primigravidae to have an ECD. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
31. Surface electromyography of the pelvic floor at 6–8 weeks following delivery: a comparison of different modes of delivery
- Author
-
Lang-Chi He, Abraham Nick Morse, Liu Huang, Yan Feng, Huishu Liu, and Kai-Min Guo
- Subjects
medicine.medical_specialty ,Spontaneous vaginal delivery ,Urology ,Forceps ,Electromyography ,Logistic regression ,Pelvic Floor Disorders ,symbols.namesake ,Pregnancy ,Elective Cesarean Delivery ,Humans ,Medicine ,Pelvic floor ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Pelvic Floor ,Cross-Sectional Studies ,medicine.anatomical_structure ,Bonferroni correction ,symbols ,Female ,Analysis of variance ,business ,Muscle Contraction - Abstract
The objective of this study was to compare the impact of different modes of delivery, especially forceps delivery (FD), on pelvic floor muscles (PFMs) through vaginal surface electromyography (sEMG) in primiparous women at early (6–8 weeks) postpartum. A total of 1259 primiparous women with full-term singleton births were included in this cross-sectional study. Of these, 98 were delivered by forceps, 865 underwent spontaneous vaginal delivery (SD) and 296 underwent elective cesarean delivery (CD). Clinical demographic characteristics and vaginal sEMG variables of parturients 6–8 weeks after birth were collected and analyzed using SPSS software. One-way ANOVA with Bonferroni correction, Chi-square test or Student’s t-test was used according to the variable type. Spearman correlation and binary logistic regression analyses were also used. P/α ≤ 0.05 was considered statistically significant. Amplitude of fast and sustained contractions on sEMG in the FD group was significantly lower compared with the CD and SD groups. The sEMG amplitude of all contractions was significantly higher in the CD group compared with the FD and SD groups (P
- Published
- 2021
32. Effect of Vaginal Cleansing with Povidone Iodine Solution before Cesarean Section on Postoperative Endometritis Infection
- Author
-
Ashraf Samir Faheem, Safaa Soliman Ahmed Mohamed, and Hanan Fawzy Elsayed Ali
- Subjects
Vaginal discharge ,medicine.medical_specialty ,business.industry ,Anemia ,medicine.drug_class ,Vaginal delivery ,Obstetrics ,Mortality rate ,medicine.disease ,Antiseptic ,medicine ,Elective Cesarean Delivery ,Endometritis ,medicine.symptom ,business ,Premature rupture of membranes - Abstract
Background: Cesarean section (CS) continues to be the surgical intervention most often performed in obstetrics, with a daily increasing frequency of use. The risk for all postpartum infections is increased in CS compared to vaginal delivery. Infectious complications developing in the aftermath of CS are one of the main causes of maternal morbidity. So, the aim of this study was to investigate the effect of vaginal cleansing with Povidone Iodine solution before cesarean section on postoperative Endometritis Infection . Design: A quasi- experimental design was utilized in this study. Setting: This study was conducted at the operating room of Obstetrics and Gynecologic Department in Beni-Seuf University Hospital from the period of May 2019 until August 2019. The study Subjects included 200 pregnant women undergoing elective cesarean delivery, who were selected by purposive sampling technique. then divided into control and study group 100 per each group. The study group receive vaginal cleansing before cesarean section by antiseptic iodine solution 10% and standard abdominal scrub. Control group receive standard abdominal scrub only. Tools was used of data collection included; 1st tool: Structured interview questionnaire was designed by the researchers and included demographic characteristics and data related to the participants’ clinical profile 2nd tool: Postpartum follow-up checklist to assess presence or absence of the post CS infectious morbidity such as; endometritis (lower abdomen pain and a smelly vaginal discharge), febrile morbidity, and incisional site infection.3rd tool: Numericаl rating scale (NRЅ). Study results: Shows there was statistically significant difference regards fever and a smelly vaginal discharge among both groups, while there was no statistically significant difference was found regards wound infection and lower abdomen pain. Conclusion: Preoperative vaginal cleansing using antiseptic iodine solution 10% was an effective practice for reducing post cesarean endometritis where overall post cesarean infectious morbidity rate was lower among study group compared to control those exposed to routine care alone; supporting the study hypothesis. Recommendations: Physicians and Nurses should be used antiseptic povidone-Iodine 10% or vaginal cleaning as regular practice before cesarean deliveries. Apply vaginal preparation with anti septic solution before C.S operation for high risk group for infection as premature rupture of membranes, diabetes, and anemia.
- Published
- 2021
33. Accuro ultrasound-based system with computer-aided image interpretation compared to traditional palpation technique for neuraxial anesthesia placement in obese parturients undergoing cesarean delivery: a randomized controlled trial
- Author
-
Zhiqiang Liu, Yueqi Zhang, Zhendong Xu, Shuangqiong Zhou, Mengzhu Li, Jing Su, Xiu Ni, Li-min Zhang, and Yibing Yu
- Subjects
medicine.medical_specialty ,Ultrasound device ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Palpation ,law.invention ,Anesthesiology and Pain Medicine ,Lumbar ,Randomized controlled trial ,law ,Anesthesia ,Anesthesiology ,Elective Cesarean Delivery ,medicine ,Cesarean delivery ,business - Abstract
Recently, a new handheld ultrasound-based device, called Accuro, has been commercialized with a real-time automated interpretation of lumbar ultrasound images. We hypothesized that the handheld ultrasound device would improve the efficacy and safety of combined spinal-epidural anesthesia (CSEA) for cesarean delivery in obese parturients. Eighty parturients with a body mass index > 30 kg∙m−2 scheduled for elective cesarean delivery were randomly allocated equally (palpation group and ultrasound group). The primary outcome was the first insertion success rate. Secondary outcomes were the time taken to identify the needle puncture site, duration of CSEA procedure, the total time, the rate of parturients who require needle redirections, the number of skin punctures, changes in the intended interspace, and the incidence of complications. Compared to the palpation group, the first insertion success rate was significantly higher (72.5% vs. 40.0%; P = 0.003), and time taken to identify the needle puncture site was less (30 [26–36] vs. 39 [32–49] seconds; P = 0.001) in the ultrasound group. The rate of parturients who required needle redirections (40.0% vs. 72.5%; P = 0.003) and the incidence of paresthesia were both lower (7.5% vs. 45.0%; P
- Published
- 2021
34. Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae
- Author
-
Nasrin Matinnia, Mohammad Haghighi, Leila Jahangard, Faisal B. Ibrahim, Hejar A. Rahman, Ali Ghaleiha, Edith Holsboer-Trachsler, and Serge Brand
- Subjects
Elective cesarean delivery ,vaginal delivery ,psychological predictors ,Health Belief Model ,fear ,stress ,Psychiatry ,RC435-571 - Abstract
Objective: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched. Methods: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs. Results: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. Conclusions: The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.
- Published
- 2017
- Full Text
- View/download PDF
35. Factors Associated with Early Breastfeeding Initiation among Women Who Underwent Cesarean Delivery at Tertiary Hospitals in Kelantan, Malaysia
- Author
-
Zaharah Sulaiman, Tengku Alina Tengku Ismail, Nazirah Johar, Noraini Mohamad, and Norkhafizah Saddki
- Subjects
Early Initiation ,medicine.medical_specialty ,business.industry ,Obstetrics ,Skin-to-Skin Contact ,Breastfeeding ,030209 endocrinology & metabolism ,Odds ratio ,Logistic regression ,Early initiation ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Cesarean Delivery ,Elective Cesarean Delivery ,Medicine ,Original Article ,030212 general & internal medicine ,Cesarean delivery ,Family Practice ,business - Abstract
Background Cesarean delivery is linked with lower rates of early breastfeeding initiation. This study aimed to determine the prevalence and associated factors of early initiation of breastfeeding among women admitted for elective cesarean delivery in Kelantan, Malaysia. Methods A total of 171 women admitted for elective cesarean delivery at two tertiary hospitals in Kelantan, Malaysia, participated in this study. On day two after cesarean delivery, face-to-face interviews were conducted with the mothers to get information on feeding practice. Descriptive statistics, including simple and multiple logistic regressions, were used for data analysis. Results Seventy-three percent of mothers initiated breastfeeding within 1 hour of birth. Approximately 15.8% and 10.5% of mothers initiated breastfeeding within 24 hours and ≥24 hours, respectively. Skin-to-skin contact between mothers and their infants occurred in 77.8% of cases after cesarean delivery. Breastfeeding initiation was significantly associated with skin-to-skin contact (odds ratio [OR], 14.42; 95% confidence interval [CI], 3.58-58.06), mothers who exclusively breastfed during hospitalization (OR, 36.37; 95% CI, 5.60-236.24), and infants who were not sleepy during attempts at breastfeeding (OR, 5.17; 95% CI, 1.32-20.21). Conclusion Based on our results, it is possible to increase the proportion of mothers initiating breastfeeding within 1 hour among women who undergo elective cesarean delivery. Therefore, it is important that health practitioners educate women beginning in the antenatal period who plan to undergo cesarean delivery by emphasizing the importance of early initiation of breastfeeding.
- Published
- 2021
36. Short-term effects of delivery methods on postpartum pelvic floor function in primiparas: a retrospective study
- Author
-
Xinxin Zhang, Xianping Huang, Ledan Wang, Yaoyao Wang, Xiangjian Zhang, and Xiangyu Chen
- Subjects
medicine.medical_specialty ,genetic structures ,Urinary incontinence ,Lower risk ,Pelvic Floor Muscle ,Pelvic Organ Prolapse ,03 medical and health sciences ,0302 clinical medicine ,Pelvic floor dysfunction ,Pregnancy ,medicine ,Elective Cesarean Delivery ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Advanced and Specialized Nursing ,030219 obstetrics & reproductive medicine ,Pelvic floor ,Vaginal delivery ,Obstetrics ,business.industry ,Postpartum Period ,Retrospective cohort study ,Pelvic Floor ,Delivery, Obstetric ,medicine.disease ,body regions ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Female ,medicine.symptom ,business - Abstract
Background The present study sought to investigate the short-term effects of different delivery methods on postpartum pelvic floor function in Chinese primiparas. Methods Primiparous women who delivered a full-term, cephalic, singleton infant at our hospital between January 1, 2018 and August 15, 2019 were recruited into this study. All women underwent pelvic floor function screening at 6-8 weeks postpartum. Tests included postpartum Pelvic Organ Prolapse Quantification (POP-Q) score, incidence of urinary incontinence, pelvic floor muscle (PFM) strength, and Pelvic Floor Distress Inventory Questionnaire-Short Form 20 (PFDI-20) score. Results A total of 284 postpartum women were recruited into the study. Of the participants, 147 had undergone vaginal delivery, 37 had undergone intrapartum cesarean delivery (ICD), and 100 had undergone elective cesarean delivery (ECD). Points Aa, Ba, Ap, and Bp showed a greater degree of prolapse in the vaginal delivery group than in the ECD group (P≤0.05). UI was less prevalent in ECD group relative to the vaginal delivery group (P≤0.05). Tonic PFM contraction was weaker in the vaginal delivery group than in the ECD and ICD groups (P≤0.05). Significant differences were also observed between the vaginal delivery group and the ECD group with respect to PFDI-20 scores (P≤0.05). Conclusions Compared with vaginal delivery, ECD was strongly linked to a lower risk of pelvic organ prolapse (POP) and UI, stronger tonic PFM strength, and lower PFDI-20 scores. ECD confers relatively better protection against pelvic floor dysfunction (PFD) than does ICD.
- Published
- 2021
37. Term Newborns with relatively low Tissue Oxygen Saturation Levels soon after Birth are predisposed to Neonatal Respiratory Disorders in Low-risk, Elective Cesarean Sections
- Author
-
Chizuko Yaguchi, Kazunao Suzuki, Masatsugu Niwayama, Yukiko Kohmura-Kobayashi, Kenta Kawai, Hiroaki Itoh, Toshiyuki Uchida, Yoshimasa Horikoshi, Tomoaki Oda, Toshiya Itoh, Naomi Furuta-Isomura, Masako Matsumoto, Mari Mukai, and Naohiro Kanayama
- Subjects
Adult ,medicine.medical_specialty ,fetal tissue oximetry ,near-infrared spectroscopy ,Gestational Age ,Transient tachypnea of the newborn ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Fetus ,Interquartile range ,Pregnancy ,Risk Factors ,Elective Cesarean Delivery ,Medicine ,Humans ,Oximetry ,parturition ,Retrospective Studies ,Respiratory Distress Syndrome, Newborn ,medicine.diagnostic_test ,Respiratory distress ,business.industry ,Vaginal delivery ,Obstetrics ,Cesarean Section ,Transient Tachypnea of the Newborn ,Infant, Newborn ,General Medicine ,medicine.disease ,Oxygen ,Pulse oximetry ,fetal tissue oxygen saturation ,Case-Control Studies ,Gestation ,030211 gastroenterology & hepatology ,Female ,business ,Neonatal resuscitation ,Research Paper ,Maternal Age - Abstract
Background: Neonatal respiratory disorders, such as transient tachypnea of the newborn and respiratory distress syndrome, occur frequently after an elective cesarean delivery. Although conventional pulse oximetry is recommended for neonatal resuscitation, it often requires several minutes after birth to obtain a reliable signal. In a previous study, we used novel tissue oximetry equipment to detect fetal and neonatal early tissue oxygen saturation (StO2) before and immediately after vaginal delivery. Therefore, we hypothesized that low neonatal StO2 levels measured by tissue oximetry may lead to neonatal respiratory disorder after a scheduled cesarean delivery. Hence, this study aimed to evaluate the StO2 levels measured by tissue oximetry in neonates with or without a respiratory disorder subsequently diagnosed after an elective cesarean delivery. Materials and methods: We enrolled 78 pregnant Japanese women who underwent an elective cesarean section at ≥36 weeks' gestation. After combined spinal and epidural anesthesia were administered to the mother, fetal StO2 levels were measured by tissue oximetry using an examiner's finger-mounted sensor during a pelvic examination immediately before the cesarean section. We measured the neonatal StO2 levels at 1, 3, and 5 minutes after birth and retrospectively compared the fetal and neonatal StO2 levels with the incidence of subsequent diagnoses of neonatal respiratory disorders. Results: The data of StO2 levels in 35 neonates were collected. Seven neonates (respiratory disorder (RD) group) were subsequently diagnosed with respiratory disorders by neonatal medicine specialists, whereas the 28 remaining neonates (NR group) were not. The median fetal StO2 (interquartile range) of the RD and NR groups was 52.0% (41.8%-60.8%) and 42.5% (39.0%-52.5%), respectively (P = 0.12). The median neonatal StO2 (interquartile range) of the RD and NR groups at 1 minute after birth was 42.0% (39.0%-44.0%) and 46.0% (42.0%-49.0%), respectively (P = 0.091). At 3 minutes after birth, the median neonatal StO2 (interquartile range) of the RD and NR groups was 41.0% (39.0%-46.0%) and 47.0% (44.3%-53.5%), respectively (P = 0.004). Finally, at 5 minutes after birth, the median neonatal StO2 (interquartile range) of the RD and NR groups was 45.0% (44.0%-52.0%) and 54.0% (49.3%-57.0%), respectively (P = 0.007). Conclusions: The StO2 values in the RD group were lower than those in the NR group at 3 and 5 minutes after birth, suggesting that neonates with low StO2 levels soon after birth may be predisposed to clinically diagnosed neonatal respiratory disorders.
- Published
- 2021
38. The effect of baricity of intrathecal bupivacaine for elective cesarean delivery on maternal cardiac output: a randomized study
- Author
-
P. Limratana, P. Somnuke, T. Kiatchai, P. Prapakorn, and Sirilak Suksompong
- Subjects
Cardiac output ,Mean arterial pressure ,Placenta ,Baricity ,Hemodynamics ,Anesthesia, Spinal ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,Pregnancy ,030202 anesthesiology ,law ,Elective Cesarean Delivery ,Anesthesia, Obstetrical ,Humans ,Medicine ,Anesthetics, Local ,Bupivacaine ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Vascular resistance ,Female ,business ,medicine.drug - Abstract
Background Hemodynamic instability during spinal anesthesia for cesarean delivery is associated with adverse maternal and fetal outcomes. Plain and hyperbaric bupivacaine are commonly used for cesarean delivery, however, their distinctive pharmacologic properties may affect maternal hemodynamic profiles differently. The aim of this study was to compare hemodynamic profiles using a suprasternal Doppler cardiac output (CO) monitor in healthy term parturients randomized to receive plain or hyperbaric bupivacaine for cesarean delivery. Methods One hundred-and-sixty-eight healthy parturients scheduled for elective cesarean delivery were randomly assigned to receive 10.9 mg of intrathecal 0.5% plain or hyperbaric bupivacaine, both with 0.2 mg morphine. The primary outcome was CO change after spinal anesthesia. Secondary outcomes were the incidence of hypotension, vasopressor use, and conversion to general anesthesia. Results The mean (±SD) CO at baseline, 1 min and 5 min after spinal anesthesia, and after placental delivery was 4.6 ± 1.2, 5.4 ± 1.3, 5.1 ± 1.4, and 6.4 ± 1.7 L/min in the plain bupivacaine, and 4.5 ± 1.1, 5.2 ± 1.3, 4.9 ± 1.3, and 6.2 ± 1.9 L/min in the hyperbaric bupivacaine group. There were no significant differences in CO, mean arterial pressure, or systemic vascular resistance. Incidences of hypotension, vasopressor and supplemental analgesic use, and conversion to general anesthesia, were not different between groups. Conclusions Cardiac output changes after plain or hyperbaric bupivacaine were not different in term parturients undergoing spinal anesthesia for cesarean delivery. Further studies comparing block quality and the rate of conversion to general anesthesia are required.
- Published
- 2021
39. A prospective observational study to investigate the relationship between local anesthetic infiltration pain before spinal anesthesia and acute and chronic postsurgical pain in women undergoing elective cesarean delivery
- Author
-
M.P. Jensen, S. Siripreukpong, V. Chongsuvivatwong, W. Wongwiwattananon, and S. Nimmaanrat
- Subjects
Lidocaine ,Anesthesia, Spinal ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Pregnancy ,030202 anesthesiology ,Rating scale ,Local anesthetic infiltration ,Elective Cesarean Delivery ,Anesthesia, Obstetrical ,Humans ,Medicine ,Prospective Studies ,Anesthetics, Local ,Prospective cohort study ,Pain, Postoperative ,030219 obstetrics & reproductive medicine ,Morphine ,Cesarean Section ,business.industry ,Obstetrics and Gynecology ,Spinal anesthesia ,Bupivacaine ,Anesthesiology and Pain Medicine ,Anesthesia ,Female ,Observational study ,business ,medicine.drug - Abstract
Cesarean delivery is one of the most common procedures performed worldwide. We conducted this prospective cohort study to evaluate the association between local anesthetic infiltration (LAI) pain prior to spinal anesthesia and pain and morphine consumption within 24 h after cesarean delivery (primary outcomes). A secondary objective was to assess the association between LAI pain and pain at one month postoperatively.Recruitment of 216 eligible women scheduled for elective cesarean delivery. Local infiltration before spinal anesthesia was performed using a 24-gauge needle and 3 mL 2% plain lidocaine. All subjects received 2.2 mL 0.5% hyperbaric bupivacaine with 200 µg morphine for spinal anesthesia. A 0-10 verbal numerical rating scale was used to assess LAI pain severity, and subsequent pain at 24 h, 1, 3 and 12 months.We found a moderate correlation between LAI pain intensity and severity of acute pain at rest (rho=0.56, P0.001) and with movement (rho=0.58, P0.001) and a weak correlation with morphine consumption (rho=0.17, P=0.01) within 24 h postoperatively. We also found a positive correlation between LAI pain and the severity of persistent wound pain at rest (rho=0.30, P0.001) and with movement (rho=0.52, P0.001) at 1 month. The incidence of wound pain at 1, 3 and 12 months postoperatively was 37.1%, 7.0% and 1.4%, respectively.Pain from LAI prior to spinal anesthesia is significantly associated with subsequent postoperative pain both acutely and at one month in women scheduled for elective cesarean delivery under spinal anesthesia.
- Published
- 2021
40. Post-spinal backache after cesarean section: A systematic review
- Author
-
I Gusti Agung Gede Utara Hartawan, Adinda Putra Pradhana, Tjahya Aryasa, and Christopher Ryalino
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Caesarean delivery ,spinal ,back pain ,Emergency Nursing ,anesthesia ,Critical Care and Intensive Care Medicine ,Critical Care Nursing ,Hematoma ,needle ,Anesthesiology ,medicine ,Back pain ,Elective Cesarean Delivery ,Caesarean section ,RD78.3-87.3 ,Abscess ,cesarean section ,business.industry ,Spinal anesthesia ,Paramedian approach ,medicine.disease ,Surgery ,Anesthesiology and Pain Medicine ,Emergency Medicine ,medicine.symptom ,business - Abstract
The most frequent patients’ complaints of spinal anesthesia are post-spinal headache and post-spinal backache. As many as 13.4% of the patients have backache as the major reason for refusing spinal anesthesia. This systematic review was conducted using keywords: “post spinal backache,” “post spinal backpain,” “caesarean section,” “caesarean delivery,” and “obstetric,” which were combined using Boolean operator “OR” and “AND.” The time filter was set from 2000 until 2020. We included six studies that included a total of 2721 subjects who underwent elective cesarean delivery under spinal anesthesia, of which 675 subjects or about 24% of them experienced backache. Many factors were thought to be responsible for the incidence of post-spinal backache. Trauma due to needle injection, hematoma, and excessive stretching of ligaments until infection which leads to abscess are possibly being the main causes of post-spinal backache. There are several efforts that can be made to reduce the risk of post-spinal backache, such as using a small needle without an introducer, performing spinal anesthesia with a paramedian approach, and reducing the number of attempts.
- Published
- 2021
41. The role of saline irrigation of subcutaneous tissue in preventing surgical site complications during cesarean section: A prospective randomized controlled trial
- Author
-
Derya Kanza Gül
- Subjects
Medicine (General) ,medicine.medical_specialty ,RD1-811 ,medicine.medical_treatment ,surgıcal site infection ,Cesarean section,subcutaneous tissue irrigation,surgıcal site infection,wound seperatıon,seroma,hematoma ,law.invention ,R5-920 ,Hematoma ,wound seperatıon ,Randomized controlled trial ,law ,Elective Cesarean Delivery ,medicine ,Caesarean section ,Saline ,cesarean section ,Wound dehiscence ,business.industry ,subcutaneous tissue irrigation ,hematoma ,Obstetrics and Gynecology ,medicine.disease ,Kadın Hastalıkları ve Doğum ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,seroma ,Seroma ,Medicine ,business ,Subcutaneous tissue - Abstract
Aim: Following cesarean section, wound complications develop in 3 to 30% of the patients. The purpose of this study is to evaluate the effect of subcutaneous saline irrigation during caesarean section on postoperative surgical site complications. Methods: This prospective randomized controlled study was conducted between November 17, 2020 and December 16, 2020 at Medipol University, Private Nisa Hospital. A total of 230 women undergoing elective cesarean delivery were divided into 2 groups. The subcutaneous tissue was irrigated with saline solution in group 1 (n=115), and not irrigated in the control group (n=115). On the 7th postoperative day, the surgical site was evaluated for hematoma, seroma, wound dehiscence, and superficial surgical site infection. Results: The incidences of seroma (7% vs. 15.7%, P=0.013), hematoma (6.1% vs. 15.7%, P=0.024) and superficial surgical site infection (4.3% vs. 11.3%, P=0.035) were significantly lower in the saline irrigation group, while the groups were similar in terms of wound dehiscence (P=0.176). Conclusion: Saline irrigation of the subcutaneous tissue during cesarean section decreased the rates of seroma, hematoma, and superficial surgical site infections significantly.
- Published
- 2021
42. Accuracy of the SpineNav3DTM Ultrasound Technology in Estimating the Epidural Space Depth for Epidural and Spinal Insertion in Pregnant Obese Patients
- Author
-
Giorgio Capogna, Matteo Velardo, Simone Baglioni, and Stefano Paolatti
- Subjects
medicine.medical_specialty ,Handheld ultrasound ,business.industry ,Ultrasound ,Significant difference ,Spinal anesthesia ,Epidural space ,medicine.anatomical_structure ,Lumbar ,Elective Cesarean Delivery ,Medicine ,Needle insertion ,Radiology ,business - Abstract
Introduction: Ultrasound facilitates neuraxial puncture in obese parturients. Unfortunately, the widespread adoption of neuraxial ultrasound may be limited by the lack of technical expertise or the limited availability of the equipment. A wireless portable ultrasound device (Accuro, Rivanna Medical, Charlottesville, VA) with automated pattern recognition software (SpineNav3DTM technology) has been introduced to obtain the automated real-time identification of interspaces and epidural depth. The primary objective of this study was to assess the accuracy of the SpineNav3DTM ultrasound technology (Accuro) in estimating the epidural space depth compared to the standard ultrasound examination in pregnant obese patients. The secondary aim was to compare the ultrasound measurements with the measured needle depth during epidural and spinal insertion. Methods: The study was conducted at S Gerardo Hospital, Monza, Italy from March 2021 to April 2021. Obese laboring women requesting epidural analgesia or undergoing elective cesarean delivery under spinal anesthesia were recruited. All the subjects had their lumbar area scanned for the measurements of the depth of the epidural space by the SpineNav3DTM ultrasound technology and by the standard US and then both compared with the needle insertion depth in a double-blind fashion. Results: Forty-eight women were enrolled in the study. There was agreement (±0.25 cm) between the epidural depth (in cm) measured with the Accuro, versus the standard ultrasound. There was a significant difference between the mean depth of epidural space s measured by Accuro or Standard US and needle insertion depth (P Conclusions: The handheld ultrasound system with 3D spine navigation technology can automatically identify and measure the epidural depth with the same accuracy as the standard ultrasounds in obese pregnant women.
- Published
- 2021
43. EFFICACY OF PROPHYLACTIC CORTICOSTEROIDS PRIOR TO CESAREAN SECTION TO PREVENT RESPIRATORY COMPLICATION
- Author
-
Amir Mohamed Said Ali, Mohamed Khaled Mostafa, and Mohamed Mohamed Farahat
- Subjects
Mechanical ventilation ,Neonatal intensive care unit ,Respiratory distress ,business.industry ,medicine.medical_treatment ,medicine.disease ,Placebo ,law.invention ,Placenta previa ,Randomized controlled trial ,law ,Anesthesia ,Elective Cesarean Delivery ,Gestation ,Medicine ,business - Abstract
Background: Cesarean section (CS) is a risk factor for the development of neonatal respiratory complications, mostly respiratory distress syndrome (RDS) and transient tachypnea of the new-born, both in term and preterm infants. Infants born at term by elective cesarean delivery are more likely to develop respiratory morbidity than infants born vaginally. Objective: To assess the effect of prophylactic corticosteroid administration before elective cesarean section at term, as compared to usual management without corticosteroids, in reducing neonatal respiratory morbidity and admission to special care with respiratory complications. Patients and methods: This was a prospective study that was conducted on 200 women from the Out-Patient Clinic at Al-Hussein Hospital, Al-Azhar University from September 2018 to November 2019. Randomized controlled trials comparing prophylactic antenatal corticosteroid administration (dexamethasone) with placebo or with no treatment, given before elective cesarean section at term (at or after 37 weeks of gestation). Results: PG represented 60% of 1st group while represented 50% of 2nd group without significant difference between them. There was no significant difference between groups as regard co-morbidity. There was no significant difference between groups regard causes of CS, and the major causes were previous CS and placenta previa. There was no significant difference between groups as regard postpartum hemorrhage or maternal complication in general. APGAR1 was significantly higher among corticosteroid group. Overall respiratory complication was significantly lower among corticosteroid group, respiratory distress (RD), need of neonatal intensive care unit (NICU) and mechanical ventilation and mortality were lower among the same group than control but not significantly. Conclusion: A single course of corticosteroids (four 6mg doses of dexamethasone administered intramuscular every 12 hours) should be considered for women undergoing planned cesarean at 37 or more weeks’ gestation.
- Published
- 2021
44. Feasibility of Conducting a Trial Assessing Benefits and Risks of Planned Caesarean Section Versus Planned Vaginal Birth: A Cross-Sectional Study
- Author
-
Fernando Althabe, Nicole Minckas, Gabriela Cormick, Veronica Pingray, José M. Belizán, Julio D Malamud, Melissa Amyx, Julie Rivo, María Belizán, Gerardo T Murga, A.E. Fiorillo, Roberto A Casale, and Luz Gibbons
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Health Personnel ,medicine.medical_treatment ,Population ,Argentina ,Prenatal care ,Risk Assessment ,Article ,law.invention ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Pregnancy ,law ,Informed consent ,Elective Cesarean Delivery ,medicine ,Humans ,Caesarean section ,030212 general & internal medicine ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Vaginal delivery ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Patient Preference ,Middle Aged ,Delivery, Obstetric ,Delivery mode ,Cross-Sectional Studies ,Elective Surgical Procedures ,Family medicine ,Pediatrics, Perinatology and Child Health ,Feasibility Studies ,Female ,business - Abstract
INTRODUCTION: Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. METHODS: A cross-sectional survey of low-risk, nulliparous pregnant women (N=416) and healthcare providers (N=168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. RESULTS: Few women (85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women’s reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women’s right to choose (RCT). CONCLUSIONS FOR PRACTICE: Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications.
- Published
- 2021
45. Comparative Study between Intrathecal Morphine and Nalbuphine Added to Hyperbaric Bupivacaine 0.5% in Elective Cesarean Delivery
- Author
-
Hamza Aboalam Mahmood, Khaled Mohammed Hassan, Islam Khaled Moustafa, and Ghada Abd el-Gaber Rezk
- Subjects
Respiratory rate ,business.industry ,Hemodynamics ,Nalbuphine ,law.invention ,Randomized controlled trial ,law ,Anesthesia ,Elective Cesarean Delivery ,Morphine ,Medicine ,Apgar score ,medicine.symptom ,business ,Postoperative nausea and vomiting ,medicine.drug - Abstract
Background: Many additives have been used to improve spinal anesthesia; morphine and nalbuphine are commonly used drugs. Objective: This work aimed to compare intrathecal morphine and different doses of nalbuphine in elective cesarean section (CS). Patients and Methods: This double-blinded, randomized controlled study was done on 150 patients, American Society of Anesthesiologist (ASA) grade I to II undergoing elective CS. Patients underwent spinal anesthesia 3 ml with 10 mg hyperbaric bupivacaine 0.5 % with the addition of a 1 ml volume (morphine or nalbuphine) according to the group; Group M: 150 μg morphine, Group N1: 1 mg nalbuphine, and Group N2: 2 mg nalbuphine. Results: Intraoperative and postoperative hemodynamics, respiratory rate, SPO2 and Apgar score were insignificantly different in all groups. Postoperative VAS was significantly decreased in group M and was insignificantly different between group N1 and group N2. Postoperative BROMAGE was significantly higher in group M. Time of rescue analgesia was significantly increased in group M and was insignificantly different between group N1 and group N2. Postoperative nausea and vomiting (PONV) was insignificantly different in all groups, and pruritus was significantly decreased in group N1. Conclusions: As additives to hyperbaric bupivacaine in the spinal block, morphine was superior to nalbuphine in decreasing VAS and increased time for rescue analgesia by prolonged sensory block. Increasing the dose of nalbuphine up to 2 mg did not increase the analgesic effect. Nalbuphine is superior to morphine in decreasing pruritus, and both drugs have similar effects on neonatal APGAR score and hemodynamics
- Published
- 2021
46. EFFECTIVENESS OF LOWER LEG COMPRESSION MANEUVER IN REDUCING SPINAL ANESTHESIA INDUCED HYPOTENSION FOR WOMEN UNDERGOING CESAREAN SECTION
- Author
-
AyaHamdino Mohamed Rashad, Mohamed Nezar Elshahat, Inaam Hassan Abd Elati, and Maha Ramadan Ali
- Subjects
Mean arterial pressure ,business.industry ,Anesthesia ,Anesthetic ,Elective Cesarean Delivery ,medicine ,Spinal anesthesia ,Hemodynamics ,Cesarean delivery ,Risk factor ,business ,Induced Hypotension ,medicine.drug - Abstract
Background: Hypotension during spinal anesthesia for caesarean delivery remains a common clinical problem. It has a risk factor for adverse maternal and fetal events. This study aimed to evaluate the effectiveness of lower leg compression maneuver in reducing spinal anathesia induced hypotension for women undergoing cesarean Section. A Quasi-experimental designwas utilized in the current study.Setting: The study was conducted at cesarean delivery unit in Mansoura University Hospital during the period from October 2016 to March 2017.Asystematic random sample was calculated to be 220 of women underwent elective cesarean delivery with spinal anesthesia to be recruited in both study group and control group. Pre-hydration and anesthetic technique standardized protocol was followed. Hypotension defined as a decrease in any mean arterial pressure (MAP) measurement by more than 20% of the baseline. Tools:Three tools were used in the current study to collect the necessary data, Structured interviewing questionnaire sheet, maternal hemodynamic and signs of hypotension record, and neonatal assessment sheet. Results: A highly statistical significant difference was found between study group and control group regarding mean arterial pressure and neonatal acidosis .Conclusion: lower leg compression for women under elective cesarean with spinal anesthesia is more effective measure to reduce spinal anathesia induced hypotension during cesarean delivery. Recommendations: lower leg compression during cesarean delivery should be included in maternal hospitals protocol for reducing spinal induced hypotension during cesarean delivery.
- Published
- 2020
47. Combined Uterine Artery Ligation, Segmental Myometrial Resection and Intrauterine Balloon to Control Bleeding from Placenta Previa Accreta during Caesarean Section
- Author
-
Rashed Mohamed Rashed, Mohammed Galal Nasr, Alaa Eldin Mahmoud Megahed, and Asmaa Ibrahim Mohamed
- Subjects
medicine.medical_specialty ,Medicine (General) ,Blood transfusion ,medicine.diagnostic_test ,placenta ,business.industry ,medicine.medical_treatment ,Physical examination ,medicine.disease ,Placenta previa ,Surgery ,medicine.anatomical_structure ,R5-920 ,Placenta ,medicine.artery ,Elective Cesarean Delivery ,caesarean ,Medicine ,previa ,Medical history ,Caesarean section ,hemorrhage ,business ,Uterine artery ,accreta - Abstract
Background: Morbidity attached placenta (MAP) remain a major surgical problem for obstetricians due to severe hemorrhage and its incidence had been continually increased due to increased rate of cesarean deliveries. Aim of the work: To evaluate the safety and efficacy of a conservative intervention for management of placenta accreta.Patients and methods: Forty-eight, pregnant females with a confirmed diagnosis of placenta previa accreta had been scheduled for elective cesarean delivery had been included. All females had been screened by full history taking, clinical examination, ultrasound and lab investigations. Blood loss, operative time, need for transfusion and need for other surgical interventions represented the main outcome and other complications were documented.RESULTS: The blood loss (ml) ranged between 850 to 1300 ml; the mean values were 1082.29±105.89 ml. The operative time ranged between 60 to 130 minutes; the mean values were 87.92±19.35 minutes. There was significant decrease of post-partum hemoglobin when compared to corresponding pre-partum values (9.29±0.76 vs 10.71±0.54 mg/dl respectively). Four patients [8.3%] need ICU admission, and nine patients [18.75%] need blood transfusion. However, no patients need further surgical intervention or developed DIC. In addition, no mortality had been reported in the current work. Conclusion: Combined uterine artery ligation, partial segmental myometrial resection and intrauterine balloon as a conservative treatment modality or placenta previa accreta is safe and effective
- Published
- 2020
48. Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans.
- Author
-
Hamadneh, Jehan, Alchalabi, Haifaa, Hamadneh, Shereen, Amarin, Zouhair, Khader, Yousef S., Kassab, Manal, and Bani ‐ Hani, Mahmoud
- Subjects
- *
CESAREAN section , *PREGNANCY , *MULTIVARIATE analysis , *RESPIRATORY distress syndrome , *RETROSPECTIVE studies , *COMPARATIVE studies , *GESTATIONAL age , *RESEARCH methodology , *EVALUATION of medical care , *MEDICAL cooperation , *RESEARCH , *SURGICAL complications , *ELECTIVE surgery , *TIME , *EVALUATION research , *SPECIALTY hospitals , *ODDS ratio - Abstract
Objective: To assess the impact of delivery at 37 weeks of pregnancy versus 38 weeks or later on maternal and neonatal outcomes among women with multiple previous cesareans.Methods: In a retrospective study, data were assessed from women with at least two previous cesareans who delivered by cesarean at 37 weeks of pregnancy or later at a tertiary referral hospital in Jordan between January 2013 and November 2015.Results: Among 886 eligible women, 505 (57.0%) delivered at 37 weeks (group 1) and 381 (43.0%) delivered at 38 weeks or later (group 2). There was no difference in intraoperative or postoperative complications between the two groups. In multivariate analysis, women in group 2 had lower odds of delivering neonates with respiratory distress syndrome than did those in group 1 (adjusted odds ratio 0.3, 95% confidence interval 0.2-0.5; P=0.046). However, neonatal jaundice was more common in group 2 (adjusted odds ratio 2.1, 95% confidence interval 1.7-2.7; P=0.035).Conclusion: Among women with multiple cesareans, delivery at 37 weeks was associated with increased risk of neonatal respiratory morbidity and decreased risk of neonatal jaundice, but not with a reduction in maternal complications, as compared with delivery at 38 weeks or later. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
49. O efeito de epinefrina, norepinefrina e fenilefrina no tratamento da hipotensão pós‐raquianestesia: estudo clínico comparativo
- Author
-
Mete Sucu, Ebru Biricik, İlker Ünal, Feride Karacaer, and Hakkı Ünlügenç
- Subjects
business.industry ,medicine.medical_treatment ,Norepinephrine (medication) ,Anesthesiology and Pain Medicine ,Epinephrine ,Blood pressure ,Maternal Hypotension ,Anesthesia ,medicine ,Elective Cesarean Delivery ,Ephedrine ,business ,Phenylephrine ,Saline ,medicine.drug - Abstract
Background and objectives: Limited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal-hypotension. This was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal-hypotension and ephedrine requirement during cesarean delivery. Methods: 160 parturient with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 μg.mL-1 (n = 40), epinephrine 5 μg.mL-1 (n = 40), phenylephrine 100 μg.mL-1 (n = 40) or 0.9% saline infusions (n = 40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of IV ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded. Results: There was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p Conclusion: There is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered as an alternative agent for management of spinal hypotension.
- Published
- 2020
50. Accuracy of noninvasive blood pressure measured at the ankle during cesarean delivery under spinal anesthesia
- Author
-
Nadeem Rujubali, Reham Fouad, Ahmed Hasanin, Maha Mostafa, Yasmin Hassabelnaby, and Sherin Refaat
- Subjects
medicine.medical_specialty ,Mean arterial pressure ,Blood Pressure ,Health Informatics ,Critical Care and Intensive Care Medicine ,Anesthesia, Spinal ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030202 anesthesiology ,Oscillometry ,Internal medicine ,Anesthesiology ,medicine ,Elective Cesarean Delivery ,Humans ,Cutoff ,Receiver operating characteristic ,business.industry ,Blood Pressure Determination ,030208 emergency & critical care medicine ,Confidence interval ,Anesthesiology and Pain Medicine ,Blood pressure ,medicine.anatomical_structure ,Cardiology ,Female ,Ankle ,business - Abstract
In this study, we evaluated the accuracy of oscillometric noninvasive blood pressure (NIBP) measured at the ankle in detecting low arm NIBP during cesarean delivery under spinal anesthesia. In this prospective observational study, a cohort of full-term mothers undergoing elective cesarean delivery under spinal anesthesia was examined. Simultaneous NIBP measurements were obtained from the arm and the ankle. The primary outcome was the accuracy of the ankle NIBP in detecting arm systolic blood pressure (SBP)
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.