Effects of closure versus non-closure of the visceral and parietal peritoneum at cesarean section: does it have any effect on postoperative vital signs? A prospective randomized study

ABSTRACT Introduction The increasing incidence of cesarean sections in India has caused a rise in the incidence of postpartum hemorrhage (PPH). There has been expanding interest in the role of misoprostol and tranexamic acid (TXA) in preventing and managing PPH during lower (uterine) segment cesarean section (LSCS). However, the lack of a published study comparing the efficacies of these drugs prompted us to conduct this study. Aims and objectives To compare the efficacies of sublingual misoprostol (600 μg) and intravenous TXA injection (500 mg) in reducing blood loss during LSCS by assessing intraoperative blood loss, perioperative hemoglobin (Hb) fall, and need for additional uterotonic agents. Materials and methods A total of 163 pregnant patients undergoing emergency/elective LSCS during the study period from 2013 to 2014 were randomly assigned to two groups — group I (82) received sublingual misoprostol 600 μg and group II (81) intravenous TXA 500 mg at cord clamping. Visual estimation of blood loss was done and 48 hours postoperative Hb and packed cell volume were measured to compare with preoperative values. Need for added uterotonics, blood transfusion, and adverse effects of drugs was assessed. The two groups were again subgrouped based on presence or absence of risk factors for PPH. Results The TXA significantly reduced blood loss compared with misoprostol (416 vs 505 mL) in patients without high-risk factors for PPH. Misoprostol caused significantly higher minor side effects while TXA reduced operation time. Conclusion The TXA can be routinely used after cord clamping along with oxytocin in patients undergoing elective/emergency LSCS to reduce perioperative blood loss, especially in those without risk factors for PPH. How to cite this article Bose D, Beegum R. Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study. J South Asian Feder Obst Gynae 2017;9(1):9-13.

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Prophylactic Intramyometrial Oxytocin before Placenta Delivery during Cesarean Section Prevents Postpartum Hemorrhage: A Prospective Randomized Study of 150 Women

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1182 ◽

2012 ◽

Vol 4 (2) ◽

pp. 93-96 ◽

Cited By ~ 3

Author(s):

Divya Mangla ◽

JK Goel ◽

Ruchica Goel

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Normal Saline ◽

Postpartum Hemorrhage ◽

Uterine Contraction ◽

Randomized Study ◽

Prospective Randomized Study ◽

Group Iii ◽

Group I ◽

Oxytocin Infusion

ABSTRACT Objectives To compare efficacy of intramyometrial oxytocin vs intravenous oxytocin infusion in reducing blood loss during cesarean section. Materials and methods A prospective randomized controlled trial of 150 women undergoing cesarean section was done. Women undergoing cesarean section were randomly divided into three groups according to method of administration of oxytocin. In group I (n = 50): 20 units of oxytocin in 500 cc of ringer lactate as continuous infusion I/V after separation of placenta was given. In group II (n = 50): 5 units of oxytocin is diluted in 10 cc of normal saline and 5 cc injected in each cornu of uterus after separation of placenta. In group III (n = 50): 5 units of oxytocin is diluted in 10 cc of normal Saline and 5 cc injected in each cornu of uterus before separation of placenta. Blood loss was calculated by number of mops soaked and amount of blood in suction jar. Results Average blood loss was found to be more in group I 606 cc, while in group II average blood loss was 460 ml which further decreased to 412 cc in group III. There was an additional observation that the 6% cases where I/V oxytocin infusion could not prevent uterine atony while immediate uterine contraction was achieved with intramyometrial oxytocin. Conclusion Intramyometrial injection of oxytocin when given before separation of placenta was found to be most effective method to increase uterine contraction, reducing incidence of postpartum hemorrhage and thus decreasing cesarean morbidity. How to cite this article Mangla D, Goel JK, Goel R. Prophylactic Intramyometrial Oxytocin before Placenta Delivery during Cesarean Section Prevents Postpartum Hemorrhage: A Prospective Randomized Study of 150 Women. J South Asian Feder Obst Gynae 2012;4(2):93-96.

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Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

10.21203/rs.2.255/v3 ◽

2019 ◽

Author(s):

wei yan ◽

Yun Xiong ◽

Yu Yao ◽

Feng-jiang Zhang ◽

Li-an Yu ◽

...

Keyword(s):

Adverse Effects ◽

Cesarean Section ◽

Epidural Anesthesia ◽

Intravenous Infusion ◽

Randomized Study ◽

Vital Signs ◽

Continuous Intravenous Infusion ◽

Epidural Group ◽

Vas Scores ◽

Baseline Characteristics

Abstract Background: Unsatisfactory analgesia would occur frequently during repeated cesarean section under epidural anesthesia. The aim of this study is to observe the effects of intravenous remifentanil on maternal comfort, maternal and neonatal safety during repeated cesarean section under epidural anesthesia.Methods: A total of 80 parturients undergoing repeated cesarean section were involved in the study. The patients were randomly divided into the intravenous remifentanil- assisted epidural group (group R) and epidural group (group E), respectively (n=40). In group R, the remifentanil was continuously intravenously infused as an adjuvant to epidural anesthesia. In group E, 0.75% ropivacaine epidural or intravenous ketamine was administered as needed. Parturient baseline characteristics, vital signs, VAS scores, and comfort scores during surgery were recorded. Adverse effects were also recorded.Results: A total of 80 patients were enrolled in the current study and the final analyses included 39 patients in group R and 38 patients in group E. No differences in patients’ baseline characteristics were found between the two groups (p > 0.05). Compared with group E, the comfort score was significantly higher in group R (9.1±1.0 vs. 7.5±1.3, p<0.001), whereas the maximum VAS score was significantly lower in group R (1.8±1.2 vs. 4.1±1.0, p<0.001). Maternal and neonatal adverse effects did not differ between the two groups during surgery (p>0.05).Conclusions: Continuous intravenous infusion of low-dose remifentanil can significantly improve the experience of parturients undergoing repeated cesarean section under epidural anesthesia, without noticeable maternal or neonatal adverse effects.

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Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

10.21203/rs.2.255/v2 ◽

2019 ◽

Author(s):

wei yan ◽

Yun Xiong ◽

Yu Yao ◽

Feng-jiang Zhang ◽

Li-an Yu ◽

...

Keyword(s):

Adverse Effects ◽

Cesarean Section ◽

Epidural Anesthesia ◽

Intravenous Infusion ◽

Randomized Study ◽

Vital Signs ◽

Continuous Intravenous Infusion ◽

Epidural Group ◽

Vas Scores ◽

Baseline Characteristics

Abstract Abstract Background: Unsatisfactory analgesia would occur frequently during repeated cesarean section under epidural anesthesia. The aim of this study is to observe the effects of intravenous remifentanil on maternal comfort, maternal and neonatal safety during repeated cesarean section under epidural anesthesia. Methods: A total of 80 parturients undergoing repeated cesarean section were involved in the study. The patients were randomly divided into the intravenous remifentanil- assisted epidural group (group R) and epidural group (group E), respectively (n=40). In group R, the remifentanil was continuously intravenously infused as an adjuvant to epidural anesthesia. In group E, 0.75% ropivacaine epidural or intravenous ketamine was administered as needed. Parturient baseline characteristics, vital signs, VAS scores, and comfort scores during surgery were recorded. Adverse effects were also recorded. Results: A total of 80 patients were enrolled in the current study and the final analyses included 39 patients in group R and 38 patients in group E. No differences in patients’ baseline characteristics were found between the two groups (p > 0.05). Compared with group E, the comfort score was significantly higher in group R (9.1±1.0 vs. 7.5±1.3, p<0.001), whereas the maximum VAS score was significantly lower in group R (1.8±1.2 vs. 4.0±0.9, p<0.001). Maternal and neonatal adverse effects did not differ between the two groups during surgery (p>0.05). Conclusions: Continuous intravenous infusion of low-dose remifentanil can significantly improve the experience of parturients undergoing repeated cesarean section under epidural anesthesia, without noticeable maternal or neonatal adverse effects.

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