Local Anesthetic Requirements Are Greater in Dystocia Than in Normal Labor

2003 ◽  
Vol 98 (4) ◽  
pp. 957-963 ◽  
Author(s):  
Moeen K. Panni ◽  
Scott Segal
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Local Anesthetic ◽  
The United States ◽  
Labor Analgesia ◽  
Delivery Mode ◽  
Clinical Model ◽  
Clinically Normal ◽  
Considerable Controversy ◽  
A Prospective Study

Background Dystocia is characterized by abnormal progress of labor and is a common contemporary indication for cesarean delivery in the United States. There has been considerable controversy as to whether epidural analgesia causes dysfunctional labor leading to cesarean delivery for dystocia. The minimum local analgesic concentration (MLAC) is a clinical model used to determine the relative potencies of local anesthetics in the first stage of labor. In this article, the authors report a prospective study determining the MLAC of bupivacaine in early labor of parturients who eventually delivered either vaginally or via cesarean section. Methods An up-down sequential allocation technique was used to determine the MLAC of bupivacaine in 57 nulliparous parturients assigned to either vaginal delivery or cesarean section arms. In addition, patients were assigned to groups receiving or not receiving intravenous oxytocin at the time of epidural placement. Only patients who delivered by the assigned delivery mode were included in the MLAC analyses. Results Parturients who later delivered vaginally had 25% and 31% lower MLAC values (0.078% and 0.085% wt/vol bupivacaine, receiving or not receiving intravenous oxytocin, respectively) than those who later delivered by cesarean section (0.102% and 0.106% wt/vol bupivacaine, receiving or not receiving intravenous oxytocin, respectively). Conclusions These data suggest that an increased local anesthetic requirement for epidural labor analgesia is associated with more intense pain related to dystocia. Women in early, clinically normal labor but who later develop dystocia require more local anesthetic and, by inference, are experiencing more severe pain than women who deliver vaginally. This association should be considered when studying the relation between the method of labor analgesia and the course of labor.

scholarly journals A Prospective Investigation of Cesarean Birth with Total and Truncal Fat Mass in Early Adolescence

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1039-1039
Author(s):  
Lidia Minguez Alarcon ◽  
Sheryl Rifas-Shiman ◽  
Joanne Sordillo ◽  
Izzuddin Aris ◽  
Marie-France Hivert ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Fat Mass ◽  
Early Adolescence ◽  
Maternal Age ◽  
The United States ◽  
Delivery Mode ◽  
Linear Regression Models ◽  
Funding Sources ◽  
The Difference

Abstract Objectives Nearly 1.3 million cesarean deliveries are performed each year in the United States, resulting in the birth of one third of all children nationwide. A higher risk of childhood obesity has been observed among children born by cesarean, but this literature is inconsistent. We investigated differences in total and truncal fat mass during early adolescence among offspring born by cesarean compared to those born by vaginal delivery. Methods This prospective study includes adolescents (median age 12.8 years) whose mothers enrolled in while pregnant in Project Viva between 1999 and 2002, and who have been followed since birth. A total of 740 adolescents had available total and truncal fat mass measured using Dual Energy X-Ray Absorptiometry (DXA) at the early adolescent in-person visit. We abstracted delivery mode from electronic medical records. We used multivariable linear regression models to estimate the difference in total and truncal fat mass indices (FMI, kg/m,2) among adolescents born by cesarean compared to those born by vaginal delivery while adjusting for confounders. We used stabilized inverse probability weights to account for censoring. Results Mean (SD) maternal age was 32.2 (5.4) years and pre-pregnancy BMI was 25.0 (5.3) kg/m,2. A total of 157 (21%) of the adolescents were born by cesarean delivery and 51%were female; mean (SD) total and truncal FMI were 6.3 (3.1) and 2.4 (1.5) kg/m,2 respectively. Adolescents born by cesarean vs. vaginal delivery had significantly higher total [β (95% CI) = 0.78 (0.23, 1.33) kg/m,2] and truncal [β (95% CI) = 0.35 (0.08, 0.61) kg/m,2] FMI than those born by vaginal delivery in models adjusted for child age and sex, and maternal age, education and race/ethnicity. These associations were attenuated and no longer statistically significant after further adjusting for maternal pre-pregnancy BMI [β (95% CI) = 0.45 (−0.06, 0.96) kg/m,2 for total and 0.19 (−0.05, 0.44) kg/m,2 for truncal FMI]. Additional adjustment for gestational weight gain, smoking and paternal BMI did not substantially change the results. Conclusions These data suggest that the association between birth by cesarean delivery and adolescent adiposity is largely explained by maternal pre-pregnancy BMI. Funding Sources NIH grants R01HD093761, R01HD034568, R01ES024765, and UH3 OD023286.

scholarly journals Cesarean section one hundred years 1920–2020: the Good, the Bad and the Ugly

2021 ◽  
Vol 49 (1) ◽  
pp. 5-16
Author(s):  
Clarel Antoine ◽  
Bruce K. Young
Keyword(s):  
United States ◽  
Black Women ◽  
Cesarean Section ◽  
Cesarean Delivery ◽  
Surgical Techniques ◽  
The United States ◽  
Delivery Rate ◽  
Mortality And Morbidity ◽  
Perceived Safety ◽  
Cesarean Delivery Rate

AbstractIn present-day obstetrics, cesarean delivery occurs in one in three women in the United States, and in up to four of five women in some regions of the world. The history of cesarean section extends well over four centuries. Up until the end of the nineteenth century, the operation was avoided because of its high mortality rate. In 1926, the Munro Kerr low transverse uterine incision was introduced and became the standard method for the next 50 years. Since the 1970’s, newer surgical techniques gradually became the most commonly used method today because of intraoperative and postpartum benefits. Concurrently, despite attempts to encourage vaginal birth after previous cesareans, the cesarean delivery rate increased steadily from 5 to 30–32% over the last 10 years, with a parallel increase in costs as well as short- and long-term maternal, neonatal and childhood complications. Attempts to reduce the rate of cesarean deliveries have been largely unsuccessful because of the perceived safety of the operation, short-term postpartum benefits, the legal climate and maternal request in the absence of indications. In the United States, as the cesarean delivery rate has increased, maternal mortality and morbidity have also risen steadily over the last three decades, disproportionately impacting black women as compared to other races. Extensive data on the prenatal diagnosis and management of cesarean-related abnormal placentation have improved outcomes of affected women. Fewer data are available however for the improvement of outcomes of cesarean-related gynecological conditions. In this review, the authors address the challenges and opportunities to research, educate and change health effects associated with cesarean delivery for all women.

scholarly journals Caesarean section on demand: a hospital-based study

2018 ◽  
Vol 7 (10) ◽  
pp. 4003
Author(s):  
Mahvish Qazi ◽  
Najmus Saqib
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Neonatal Outcome ◽  
Vaginal Birth After Cesarean ◽  
Maternal Request ◽  
Jammu And Kashmir ◽  
Personal Involvement ◽  
Vaginal Deliveries ◽  
Painless Labor ◽  
A Prospective Study

Background: The aim of the study was to find out the reasons behind healthy women preferring cesarean section (CS) in the absence of obstetric and medical indications.Methods: This was a prospective study among women who came for delivery at ASCOMS, Jammu (Jammu and Kashmir), India a tertiary level teaching hospital. All women who underwent caesarean delivery for maternal request were included in this study.Results: The total number of deliveries during the study period (9 months) were 889. There were 636 (71.54%) vaginal deliveries and 253 (28.46%) CSs. Among 253 CSs, 25 (9.88%) had maternal request as their indication. Majority 13 (52%) of them were in the age group of 20 - 25 years. Multigravida opted for CS more than primigravida (17 versus 8). Most 10 (40%) of them were Graduates and 15 (60%) were working. Majority of them 13 (52%) were in class II socioeconomic status of Kuppuswamy’s scale. The various reasons for women requesting cesarean delivery were refusal of vaginal birth after cesarean section (VBAC), simultaneous tubectomy, painless delivery, prolonged infertility, afraid of neonatal outcome and astrological concerns.Conclusions: Most of the women who opted for cesarean delivery in our study was for preventable reasons like painless labor, previous negative birth experience and simultaneous tubectomy which would have been avoided by prior counseling starting from antenatal period and by providing labor analgesia. Proper education of the patient and personal involvement of the treating obstetrician in counselling the patient and her supporters can reduce cesarean delivery for maternal request.

scholarly journals Intrauterine Gauze Packing in Primary Post Partum Hemorrhage following Caesarean section: A Clinical study

2013 ◽  
Vol 7 (1) ◽  
pp. 33-36
Author(s):  
Shao Yong ◽  
M Pradhan
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Placenta Previa ◽  
Post Partum ◽  
Cost Effective ◽  
Invasive Technique ◽  
Safe Procedure ◽  
Post Partum Hemorrhage ◽  
Gauze Packing ◽  
A Prospective Study

Aims: To study the effectiveness of uterine gauze packing to manage and prevent primary postpartum haemorrhage during cesarean delivery. Methods: This was a prospective study that was conducted in the department of obstetrics and gynecology, first affiliated hospital of Chongqing Medical University from Jan to May 2011. Patients included in the study were those with intractable postpartum hemorrhage not responding to medical treatment and for prevention of hemorrhage that could develop during cesarean section. Exclusion criteria included cases of ruptured uterus and vaginal deliveries.Packing was done using 2 m long and 10 cm wide sterilized gauze from the fundus through the cesarean incision with its end passing through cervix into the vagina and left for 24-48 hours or removed earlier in cases of failure to control hemorrhage. Results: Intrauterine gauze packing during cesarean section to arrest primary postpartum hamorrhage is a successful non-invasive technique. Intractable primary postpartum hamorrhage encountered in 42 (30.9%) cases had PPH after cesarean section. Placenta previa found in 48 (35.3%) cases unresponsive to uterotonics drugs was the commonest cause of uterine gauze packing. Intrauterine gauze packing was successful in 130 (95.6%) cases. Conclusions: Uterine packing is a cost effective, quick and safe procedure to manage and prevent primary PPH during cesarean delivery. Uterine packing is of benefit in achieving hemostasis particularly in cases of post partum hemorrhage due to low-lying placenta previa/accreta associated with lower segment bleeding conserving the uterus in women with cesarean delivery. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 33-36 DOI: http://dx.doi.org/10.3126/njog.v7i1.8833

scholarly journals A Look into Women’s Preventative Care, Contraception Practices and Cesarean Delivery Rates in Rural Guanajuato, Mexico in Comparison to the United States

2021 ◽  
Vol 1 (1) ◽  
pp. 15-25
Author(s):  
Nafiah Enayet ◽  
Joi McLaughlin ◽  
Portia Nleya ◽  
Colin Godwin ◽  
Vashti Bandy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Cesarean Section ◽  
Women’S Health ◽  
Women's Health ◽  
Cesarean Delivery ◽  
Statistical Significance ◽  
Pap Test ◽  
The United States ◽  
The Past

Statement of Significance: According to the World Health Organization (WHO), a third of health issues for women aged 15 and 44 years are sexual and reproductive health problems with unsafe sex practices being a major risk factor.1 Additionally, “every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth.”2 Although there have been improvements in prenatal and postpartum care, these benefits do not extend worldwide. Cervical and breast cancer represent additional issues in women’s health wherein adequate preventative medicine can dramatically improve patient outcomes. Our findings provide insight into the use of accessible contraception, preventive screenings, and cesarean deliveries based on the self-reported experience of a rural population near Guanajuato, Mexico. The results stand to inform future research and public health efforts in the region aiming to improve knowledge and use of contraception, investigate increasing cesarean delivery rates, and improve screening rates for cervical and breast cancer. Background: The objective of this study was to evaluate preventative screening for breast and cervical cancer, contraceptive practices, and cesarean section rates for women in rural Guanajuato Mexico. Understanding this data is important because such accessibility and healthcare practices can influence the safety of this population’s lives as well as provide insight to the impact of public healthcare programs. Methods: A twenty-one question oral survey was administered to both male and female participants of health fairs and screenings in seven rural communities around the cities of Juventino Rosas and San Miguel de Allende. The survey covered diet and exercise habits as well as women’s health topics for participants who self-identified as female. Women’s health topics included questions about mammography & Papanicolaou test (Pap test) history as well as contraception use and cesarean section history. Results: A total of 155 participants. Mean respondent age was 46 years and a majority of respondents were female (81%, n = 155). Of female respondents, almost half reported a previous cesarean section. More women in the younger cohort (aged <50 years) reported a history of cesarean section compared to the older cohort (aged >50 years), but not at a level of statistical significance. Almost half of the women of childbearing age denied contraception utilization. Most women (72%, n = 110) reported a Pap test within the past five years and about a third had one within the past year. Of the women aged >40 years, almost half had not received mammography. Conclusions: Younger women appeared more likely to have had at least one cesarean delivery than older women, but the sample size provided inadequate power for statistical significance. Access to contraception did not appear to be a barrier to contraception utilization in this region, an important finding for future investigations of associated topics, such as rates of unplanned pregnancies or the spread of communicable sexual diseases. Though the Pap test rates were comparable to that of the United States, mammogram rates lagged. Further studies should investigate increasing cesarean delivery rates in rural Guanajuato, Mexico, strategies to increase education regarding contraceptive modalities, and approaches to improve screening and treatment of cervical and breast cancer.

scholarly journals An institutional study of cesarean delivery on maternal request

2017 ◽  
Vol 6 (7) ◽  
pp. 2879
Author(s):  
A. Shanti Sri ◽  
Nazia Khanam
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Neonatal Outcome ◽  
Maternal Request ◽  
Cesarean Deliveries ◽  
Vaginal Deliveries ◽  
Painless Labor ◽  
One Year ◽  
Primary Cesarean Delivery ◽  
A Prospective Study

Background: Cesarean delivery on maternal request refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of a standard medical/obstetrical indication for avoiding vaginal birth. The aim of the study was to find out the reasons behind, and the incidence of women preferring Cesarean section in the absence of obstetric and medical indications.Methods: This was a prospective study among women who came for delivery at Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, over a period of one year from 1st April 2015 to 31st March 2016. All women who underwent Cesarean delivery for maternal request were included in this study.Results: The total number of deliveries during the study period of one year was 2574. There were 1346 (52.29%) vaginal deliveries and 1228 (47.7%) cesarean deliveries. Among 1228 Cesarean deliveries, 87 (7.08%) had maternal request as their indication. Majority of them were in the age group of more than 35 years. Multigravidae opted for Cesarean delivery more than primigravidae (59 multigravidae vs 28 primigravidae). Among the various reasons for women requesting delivery cesarean were tocophobia, refusal of trial of labor after Cesarean section (TOLAC), concurrent sterilization, prolonged infertility and treatment conception, afraid of neonatal outcome (previous adverse neonatal outcome) and astrological concerns.Conclusions: Many of the women opted for Cesarean delivery in our study for preventable reasons like painless labor and concurrent sterilization which would have been easily avoided by prior counseling starting from antenatal period and by providing labor analgesia. Patient education and personal involvement of the treating obstetrician in counseling the patient and emotional support during labor can reduce Cesarean delivery for maternal request.

scholarly journals Association of Chorioamnionitis With Failed Conversion of Epidural Labor Analgesia to Cesarean Delivery Anesthesia: a Retrospective Cohort Study

2020 ◽  
Author(s):  
Yumi Katakura ◽  
Yusuke Nagamine ◽  
Takahisa Goto ◽  
Hiroyuki Sumikura
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Cesarean Delivery ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Labor Analgesia ◽  
University Hospital ◽  
Emergency Cesarean

Abstract Background: This study examined the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia.Methods: This retrospective cohort study, conducted in a single-center university hospital, enrolled term parturients undergoing emergency cesarean section after induction of epidural labor analgesia between September 2015 and May 2019. For the purpose of the study, all cases were re-examined to ensure that they fulfilled the criteria of chorioamnionitis, regardless of the actual indication for cesarean section proposed by obstetricians at the time of application. The primary outcome was failure of conversion of epidural labor analgesia to cesarean delivery anesthesia. Multivariable logistic regression analysis was performed to investigate the association between chorioamnionitis and failure of anesthesia for cesarean section.Results: Among the 180 parturients, it was found that 58 parturients (43.9%) fulfilled the criteria of chorioamnionitis. Failure of epidural conversion in the chorioamnionitis (+) group was significantly higher than that in the chorioamnionitis (-) group (46.6 % [27/58] vs. 18.9% [14/74], crude odds ratio = 3.7, 95% confidence interval 1.7-8.3). After adjustment for potential confounders (age, body mass index, multiparity, and duration for epidural labor analgesia), chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections (adjusted odds ratio = 3.6, 95% confidence interval 1.6-8.4). Conclusions: Chorioamnionitis is associated with the failed conversion of epidural labor analgesia to cesarean delivery anesthesia.

scholarly journals Anesthesia practice in cesarean delivery in tertiary care hospital: a retrospective observational study

2018 ◽  
Vol 1 (1) ◽  
pp. 13-15
Author(s):  
Rohini Sigdel ◽  
Maya Lama ◽  
Sanish Gurung ◽  
Sushil Timilsina
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Tertiary Care ◽  
Regional Hospital ◽  
Elective Cesarean Section ◽  
Delivery Mode ◽  
Emergency Cesarean ◽  
Elective Cesarean

Background: Regional anesthesia is being utilized as the preferred anesthetic technique for cesarean delivery worldwide. This study was performed to review cesarean delivery anesthetic practice in our institute which represents a tertiary care regional hospital. Methods: Data was collected regarding the number of cesarean delivery performed during the period of six months from January 2017 to June 2017 at Western Regional Hospital. Number of elective versus emergency cesarean delivery, mode of anesthesia and the reason for general anesthesia and complications was recorded. Results: The number of cesarean delivery was found to be 1174(26.41%) of total deliveries during the study period. Out of which, 64.82% were for emergency indication and 35.18% were elective cesarean delivery. Spinal anesthesia was utilized in 99.03% of elective cesarean section and 97.63% of emergency cesarean section. The percentage of cases performed under general anesthesia was 1.87%. Reasons for general anesthesia included inadequate subarachnoid block, fetal malpresentation, eclampsia and maternal comorbidities. Complications related to general anesthesia like failed intubation, airway difficulty related to general anesthesia and anesthesia related mortality was not encountered. Conclusion: Spinal anesthesia is utilized widely and safely in obstetric practice at our hospital. Use of labour epidural analgesia should be introduced and encouraged in our setting to minimize the side effects of single shot spinal anesthesia and to avoid general anesthesia when indicated.

Local anesthetic resistance in a Crohn’s patient undergoing cesarean delivery

2020 ◽  
Vol 45 (8) ◽  
pp. 669-670
Author(s):  
Soleil S Schutte ◽  
Tammy Euliano
Keyword(s):  
Chronic Pain ◽  
Case Report ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Continuous Spinal Anesthesia ◽  
Patient Resistance

IntroductionPatient resistance to local anesthetics is rarely considered as the cause of regional anesthesia failure.Case reportWe report a case of resistance to local anesthetics in a patient with Crohn’s disease who underwent cesarean section under continuous spinal anesthesia.DiscussionResistance to local anesthetics may be more common than we think, especially among patients with chronic pain. Providers should consider local anesthetic resistance when regional anesthesia is unsuccessful. Further research is needed to determine if skin wheal tests and/or a different local anesthetic could improve results.

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