Epidural Versus General Anaesthesia for Elective Caesarean Section Effect on Apgar Score and Acid-Base Status of the Newborn

Background: The main aim of this study is to determine the maternal and fetal outcome of pregnancy among women with one previous caesarean section at term in relation to vaginal delivery, post partum complication, neonatal complication like low Apgar score, fetal weight and admission in special baby unit. Methods: This is a prospective and descriptive study done in a sample size of 100. Inclusion criteria were term pregnancy, single live fetus with cephalic presentation with one previous caesarean section. During study period total number of obstetric admissions was 3546 and 115 cases were admitted with previous one caesarean section. Result: Out of 100 cases, 31 cases had vaginal delivery and 69 cases had caesarean section. Among 31 vaginal deliveries, 24 cases had spontaneous vaginal delivery and 7 had assisted delivery with vacuum, main indication of vacuum delivery was to cut short the second stage of labor that was in 5(71.43%) cases. Among 69 caesarean section cases, 51 had emergency caesarean section and 18 had elective caesarean section and cephalopelvic disproportion was the main indication in both the groups. Most common complication was scar dehiscence and postpartum hemorrhage. There were two still births in each group and one minute APGAR score was slightly better in caesarean section. Conclusions: Patients with previous caesarean section are at high risk of repeat emergency or elective caesarean section. About one in three patients with previous caesarean section delivered vaginally. In the present study postpartum hemorrhage was the commonest complication, which was found in caesarean section, and only one puerperal pyrexia was seen in case of vaginal delivery. Key words: Cephalopelvic disproportion, Premature rupture of membrane, Septicemia, Vacuum delivery DOI: 10.3126/jnhrc.v7i1.2275 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 25-28

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Prophylactic Intramuscular Ephedrine Prior to Caesarean Section

Anaesthesia and Intensive Care ◽

10.1177/0310057x9202000408 ◽

1992 ◽

Vol 20 (4) ◽

pp. 448-452 ◽

Cited By ~ 29

Author(s):

C. C. Rout ◽

D. A. Rocke ◽

R. Brijball ◽

R. V. Koovarjee

Keyword(s):

Caesarean Section ◽

General Anaesthesia ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

Maximum Increase ◽

Arterial Ph ◽

Maternal Hypertension ◽

Acid Base Status ◽

Umbilical Arterial Ph

Thirty healthy parturients, having given informed consent, were randomly allocated in a double-blind study to receive an intramuscular injection of either 0.9% sodium chloride (control), ephedrine 25 mg, or ephedrine 50 mg, 30 minutes prior to general anaesthesia for caesarean section. Nine patients (90%) in the 50 mg group and five patients (50%) in the 25 mg group demonstrated reactive hypertension of 20% or greater from control. The mean maximum increase in the 50 mg group was 28.2% (range 4.4–38.3%). Maternal pH was significantly lower (P = 0.03) in the ephedrine 50 mg group. Neonatal acid base status was significantly impaired in the ephedrine 50 mg group with umbilical venous pH (P = 0.0001) and umbilical arterial pH (P = 0.001) being significantly lower than the control group. The associated increase in umbilical arterial base deficit suggests a metabolic component due to fetal asphyxia related to decreased uterine blood flow. We conclude that the prophylactic administration of intramuscular ephedrine prior to spinal anaesthesia is associated with an unacceptably high incidence of maternal hypertension, and should the spinal fail and general anaesthesia be required, also results in adverse neonatal biochemical changes. The technique is therefore not to be recommended.

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The Contrasting Effects of Enflurane on Transplacental Exchange after Methohexitone and Ketamine Induction of Anaesthesia for Caesarean Section

Anaesthesia and Intensive Care ◽

10.1177/0310057x7800600311 ◽

1978 ◽

Vol 6 (3) ◽

pp. 239-242 ◽

Cited By ~ 1

Author(s):

J. W. Downing ◽

P. J. C. Houlton ◽

J. G. Brock-Utne ◽

R. J. R. Buley

Keyword(s):

Caesarean Section ◽

Beneficial Effect ◽

General Anaesthesia ◽

Elective Caesarean Section ◽

Volatile Agent ◽

Inhalational Agent ◽

Induction Of Anaesthesia ◽

Uterine Relaxation

Supplementation of general anaesthesia with enflurane 0.6% before delivery of the foetus by elective Caesarean section, produced contrasting effects after methohexitone and ketamine administration. Enflurane, an inhalational agent causing vasodilation and uterine relaxation, enhanced maternal to foetal transplacental exchange following methohexitone induction of narcosis. This beneficial effect of the volatile agent was not seen after ketamine, a vasoconstrictor drug which stimulates myometrial contraction.

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