Why group & save? Blood transfusion at low-risk elective caesarean section

2014 ◽  
Vol 54 (3) ◽  
pp. 279-282 ◽  
Author(s):  
Owen Stock ◽  
Michael Beckmann
Keyword(s):  
Caesarean Section ◽  
Blood Transfusion ◽  
Elective Caesarean Section ◽  
Low Risk

scholarly journals Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge

2019 ◽  
Vol 8 (2) ◽  
pp. e000465 ◽  
Author(s):  
Sarah Joanne Bowden ◽  
William Dooley ◽  
Jennifer Hanrahan ◽  
Chidimma Kanu ◽  
Suni Halder ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Breast Feeding ◽  
Fast Track ◽  
Physiological State ◽  
Elective Caesarean Section ◽  
Likert Scale ◽  
Low Risk ◽  
Quality Improvement Initiative ◽  
Maternity Unit ◽  
Low Risk Women

Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological state and reduced LoS for mother and baby. Baseline audit of ELCS in 2013 revealed a mean LoS of 3 days. We piloted an ERAS discharge pathway promoting day 2 discharge, which rose from 5.0% to 40.2%. 19.2% of women went home on day 1. Many women fed back that they would prefer day 1 discharge. We hypothesised that a day 1 discharge pathway for low-risk women could benefit both women and services at our maternity unit. From October 2015, we developed a ‘fast-track pathway’ (FTP) using a Plan-Do-Study-Act approach. Between October 2015 and April 2016, we prospectively audited clinical outcomes, LoS and maternal satisfaction from all women placed on the FTP. We held regular multidisciplinary team meetings to allow contemporaneous analysis. Satisfaction was analysed by Likert scale at postoperative surveys. Women were identified in antenatal clinic after meeting predefined low-risk criteria. 27.3% of women (n=131/479) delivering by ELCS entered the FTP. 76.2% of women on the FTP were discharged on day 1. Mean LoS fell to 1.31 days. 94.2% of women who established breast feeding at day 1 were still breast feeding at 7 days. Overall satisfaction at day 7 was 4.71 on a 5-point Likert scale. 73.1% of women reported good pain control. Additional financial savings are estimated at £99 886 annually. There were no related cases of readmission. Day 1 discharge after ELCS is safe and acceptable in carefully selected, low-risk women and has high satisfaction. There may be resultant financial savings and improved flow through a maternity unit with no detected adverse effect on breast feeding, maternal morbidity or postnatal readmissions.

scholarly journals Comparison of maternal and neonatal outcome in elective lower segment cesarean section done at 38 and 39 weeks

2017 ◽  
Vol 6 (4) ◽  
pp. 1604
Author(s):  
Gisi Sebastian ◽  
Seetesh Ghose ◽  
P. Soundararajan
Keyword(s):  
Caesarean Section ◽  
Blood Transfusion ◽  
Respiratory Distress ◽  
Gestational Age ◽  
Apgar Score ◽  
Elective Caesarean Section ◽  
Lower Uterine Segment ◽  
Lower Segment Cesarean Section ◽  
Significant Difference ◽  
Nicu Admission

Background: Time to perform elective LSCS is a relevant issue related to mother and foetus. LSCS can be done from 37 weeks onwards because foetal lungs mature by then. But foetuses born at 37 weeks of gestation have more risk of developing respiratory problems, transient tachypnoea of new born, hypothermia, hypoglycaemia and NICU admission.The purpose of this study is to find out appropriate gestational age at which elective LSCS can be performed without adverse maternal and neonatal outcome.Methods: This is an observational comparative study done on 209 antenatal women who underwent elective caesarean section from December 2014 to January 2016.Patients were divided into two groups after taking consent. Maternal parameters like formation of lower uterine segment need for blood transfusion. Neonatal parameters like Apgar score, respiratory distress syndrome and NICU admission with indication and duration were analyzed by chi-square test. Gestational Age and Pre-Op Hb and Post-Op Hb were analyzed by independent ‘t’test.Results: In this study 55% of the pregnant women belong to 38 weeks,45% belongs to 39 weeks. The formation of lower uterine segment was statistically significant and the need for blood transfusion was slightly increased at 39 weeks. But there was no significant difference in Apgar score, Respiratory distress, NICU admission comparing both study groups.Conclusions: Elective caesarean section can be done safely at 38 weeks without affecting maternal and perinatal outcome.

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

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