scholarly journals Maternal and Fetal Outcomes of Pregnant Women with Hepatic Cirrhosis

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Harun Egemen Tolunay ◽  
Mesut Aydın ◽  
Numan Cim ◽  
Barış Boza ◽  
Ahmet Cumhur Dulger ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Esophageal Varices ◽  
Hepatic Cirrhosis ◽  
Morbidity And Mortality ◽  
Decompensated Cirrhosis ◽  
Band Ligation ◽  
Compensated Cirrhosis ◽  
The Mean ◽  
Upper Gastrointestinal

Aim. The reproductive hormone levels and systemic physiology of women with hepatic cirrhosis are altered. Existing data have indicated the adverse effects of cirrhosis on both the mother and the fetus. Pregnancy is successful in most of the patients with chronic liver disease. But maternal and fetal complication rates are still high for decompensated hepatic cirrhosis. In this study, we aimed to evaluate the clinical features, etiological factors, medications, morbidity, mortality, and obstetric outcomes of pregnant women with hepatic cirrhosis. Methods. Pregnant women, who were diagnosed with maternal hepatic cirrhosis and followed up in our clinic between 2014 and 2017, were retrospectively evaluated. The pregnant women that had been followed up for hepatic cirrhosis were classified as compensated disease and decompensated disease. Eleven cases were included in this period. Results. The mean age of cases was 33.5±5.5 years. The mean gravida number was 3.2±1.1, and the mean parity number was 1.7±1. Six cases were in the compensated cirrhosis stage, and 5 cases were in the decompensated cirrhosis stage. A pregnancy with decompensated cirrhosis was terminated after the fetal heart sound was negative in the 9th week of pregnancy. Spontaneous abortus occurred in one case (<20 weeks). The mean gestational week of the 9 cases was 33.3±6.2. Two of the 9 cases delivered birth vaginally. Seven cases delivered by cesarean section. The mean first- and fifth-minute APGAR scores were 6.6±1.41 and 8.2±1.56, respectively. The mean birth weight was 2303±981 g. Among 9 cases with live birth, 6 had compensated cirrhosis and 3 had decompensated cirrhosis. In the second trimester, upper gastrointestinal endoscopy was performed to all patients in terms of esophageal varices. Endoscopic band ligation was performed in 3 cases with upper gastrointestinal bleeding. The postpartum mortality did not occur. Discussion. Pregnancy is not recommended for patients with hepatic cirrhosis due to high maternal and fetal morbidity and mortality. The pregnancy course of cases with cirrhosis changes according to the stage of liver injury and severity of disease. Although the delivery method is controversial, delivery by cesarean section is recommended for patients with esophageal varices by the reason of bleeding from varices after pushing during labor. The bleeding risk must be kept in mind as coagulopathy is common in hepatic diseases. The maternal-fetal morbidity and mortality rates have been decreased by the current developments in hepatology, prevention of bleeding from varices with drugs and/or band ligation, improvement in liver transplantation, and increasing experience in this issue.

scholarly journals Outcome of Esophageal Variceal Ligation in Cirrhotic Patients: Experience in a Tertiary Care Hospital in Dhaka

2019 ◽  
Vol 9 (1) ◽  
pp. 63-69
Author(s):  
Shireen Ahmed ◽  
Md Nazmul Hoque ◽  
Tareq Mahmud Bhuiyan
Keyword(s):  
Adverse Events ◽  
Esophageal Varices ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Care Hospital ◽  
Esophageal Variceal ◽  
Band Ligation ◽  
Esophageal Variceal Ligation ◽  
Upper Gastrointestinal

Background: Bleeding from esophageal varices in cirrhosis is an emergency condition. Esophageal varices band ligation has shown better results in terms of variceal obliteration as well as having fewer side effects like ulceration, perforation and stricture formation. Methods: This observational study was conducted at the gastroenterology department of BIRDEM general hospital, from September 2014 to March 2015. Subjects were eligible if they had a diagnosis of cirrhosis based on history, physical examination, biochemical parameters and presence of esophageal varices in upper gastrointestinal endoscopy. All patients were tested to determine the cause of liver cirrhosis. All patients under-went upper gastrointestinal endoscopy after consent. Esophageal variceal ligation was done at appropriate situation and patients were followed up later on. SPSS 23 was used for statistical analysis. Results: The sample size was 69. The cumulative mean age was 55.58±14.462 years (range: 20-90), with gender-based mean age of 54.76±15.704 years for males and 57.22±11.739 years for female. Mild portal hypertensive gastropathy (PHG) was found 31 (44.9%) patient and severe PHG 36 (52.2%). Patients were followed up for mean period of 8.52±3.6 months. Variceal obliteration was achieved in 25 (36.2%) patients, while 06 (8.7%) cases developed re-bleeding during the study period and this type of patients were managed by other modalities or combination therapies. Recurrence of varices occurred in 13 (18.8%). 25 (36.2%) patients reduction of varix size occured after esophageal variceal ligation (EVL), 32 (46.4%) required second session and 12 (17.4%) required more than second session (Table-2). Thirty nine (56.5%) patients experienced minor adverse events like GI discomfort (retrosternal pain or dysphagia), while severe adverse events were noticed in 13 (18.8%) patients. Fundal varix was found among 8 (11.6%) patient on follow up endoscopy and GAVE found in 6 (8.69%) patients. All patient developed PHG during follow up endoscopy. Conclusion: Band ligation eradicates esophageal varices with less complications and a lower re-bleeding rate, but at the same time eradication is associated with more frequent development of PHG and fundal varices. Birdem Med J 2019; 9(1): 63-69

Caffeine clearance and biotransformation in patients with chronic liver disease

1988 ◽  
Vol 74 (4) ◽  
pp. 377-384 ◽  
Author(s):  
Nigel R. Scott ◽  
Drago Stambuk ◽  
J. Chakraborty ◽  
Vincent Marks ◽  
Marsha Y. Morgan
Keyword(s):  
Liver Disease ◽  
Decompensated Cirrhosis ◽  
Control Group ◽  
Total Recovery ◽  
Control Subjects ◽  
Compensated Cirrhosis ◽  
Elimination Half ◽  
The Mean ◽  
Caffeine Metabolism ◽  
Caffeine Clearance

1. The clearance and biotransformation of caffeine (1,3,7-trimethylxanthine) were investigated in eight healthy control subjects and 16 patients with cirrhosis, by measuring serial serum caffeine concentrations and recoveries of methylxanthine metabolites in urine for 48 h after a 400 mg oral caffeine load. 2. In the control group, the mean (± sd) serum caffeine clearance was 1.3 ± 0.4 ml min−1 kg−1 and a mean of 56.4 ± 16.5% of the administered caffeine was recovered from the urine over 48 h as methyluric acids and methylxanthines. The majority of the metabolites were excreted in the first 24 h period and only 2.0 ± 1.4% of the administered caffeine was excreted unchanged. 3. Patients with compensated cirrhosis (n = 10) metabolized caffeine similarly to the control subjects. Thus the mean serum caffeine clearance was 1.4 ± 1.2 ml min−1 kg−1 and a mean of 57.2 ± 11.7% of the administered caffeine was recovered from the urine over 48 h. The majority of the metabolites were excreted in the first 24 h; the pattern of metabolic excretion was unaltered and only 2.2 ± 0.9% of the administered caffeine was excreted unchanged. 4. In the patients with decompensated cirrhosis (n = 6), significant changes were observed in caffeine metabolism. The mean serum caffeine clearance (0.4 ± 0.2 ml min−1 kg−1) was significantly impaired compared with controls (P < 0.01) and a significant delay was observed in metabolite excretion in the urine. Thus the mean recovery of metabolites in the urine during the first 24 h (25.0 ± 11.2%) was significantly reduced compared with controls (44.1 ± 12.4%, P = 0.03), whereas the mean urinary metabolite recovery in the second 24 h (20.9 ± 10.5%) was insignificantly increased compared with controls (12.3 ± 7.8%). Overall, the mean recovery of metabolites in the urine in 48 h (45.9 ± 15.4%) was similar to that in the control group. The overall recovery of unchanged caffeine was significantly greater than in controls (5.0 ± 2.8% vs 2.0 ± 1.4%, P = 0.04), but the pattern of metabolite excretion was otherwise unchanged. 5. In the patients with liver disease there were significant linear correlations between the degree of hepatocellular dysfunction and the serum caffeine elimination half-life (r = 0.774; P < 0.01) and the total recovery of methylxanthine metabolites in the urine, in the 0–24 h (r = 0.702; P = 0.002) and 0–48 h (r = 0.581; P = 0.018) periods. 6. Caffeine clearance is impaired in patients with decompensated cirrhosis either because of a reduction in hepatic caffeine uptake or else because of a reduction in ‘functioning hepatocyte mass’. However, the biotransformation of caffeine is unaltered in the presence of hepatic dysfunction.

scholarly journals Evaluation of endoscopic secondary prophylaxis in children and adolescents with esophageal varices

2017 ◽  
Vol 54 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Júlio Rocha PIMENTA ◽  
Alexandre Rodrigues FERREIRA ◽  
Eleonora Druve Tavares FAGUNDES ◽  
Paulo Fernando Souto BITTENCOURT ◽  
Alice Mendes MOURA ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Children And Adolescents ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Bleeding ◽  
Secondary Prophylaxis ◽  
Gastric Fundus ◽  
Portal Hypertensive Gastropathy ◽  
Band Ligation ◽  
Upper Gastrointestinal

ABSTRACT BACKGROUND Bleeding of esophageal varices is the main cause of morbidity and mortality in children and adults with portal hypertension and there are few studies involving secondary prophylaxis in children and adolescents. OBJECTIVE To evaluate the efficacy of endoscopic secondary prophylaxis in prevention of upper gastrointestinal bleeding in children and adolescents with esophageal varices. METHODS This is a prospective analysis of 85 patients less than 18 years of age with or without cirrhosis, with portal hypertension. Participants underwent endoscopic secondary prophylaxis with sclerotherapy or band ligation. Eradication of varices, incidence of rebleeding, number of endoscopic sessions required for eradication, incidence of developing gastric fundus varices and portal hypertensive gastropathy were evaluated. RESULTS Band ligation was performed in 34 (40%) patients and sclerotherapy in 51 (60%) patients. Esophageal varices were eradicated in 81.2%, after a median of four endoscopic sessions. Varices relapsed in 38 (55.1%) patients. Thirty-six (42.3%) patients experienced rebleeding, and it was more prevalent in the group that received sclerotherapy. Gastric varices and portal hypertensive gastropathy developed in 38.7% and 57.9% of patients, respectively. Patients undergoing band ligation showed lower rebleeding rates (26.5% vs 52.9%) and fewer sessions required for eradication of esophageal varices (3.5 vs 5). CONCLUSION Secondary prophylaxis was effective in eradicating esophageal varices and controlling new upper gastrointestinal bleeding episodes due to the rupture of esophageal varices. Band ligation seems that resulted in lower rebleeding rates and fewer sessions required to eradicate varices than did sclerotherapy.

scholarly journals Prevalence of Cesarean Section and Analysis of Neonatal Apgar Score and the Mean Time of Second Phase of Labor in Pregnant Women

2019 ◽  
Vol 73 (6) ◽  
pp. 399
Author(s):  
Maryam Shokrpour ◽  
Parisa Reza ◽  
Mehrzad Sharifi ◽  
Alireza Kamali
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Apgar Score ◽  
Second Phase ◽  
The Mean ◽  
Mean Time

scholarly journals Indications of Primary Cesarean Section In Multipara

2019 ◽  
Vol 09 (02) ◽  
pp. 105-108
Author(s):  
Shazia Aftab ◽  
Nazish Ali ◽  
Fehmida Saleh ◽  
Saira Ghafoor Ghafoor ◽  
Aasha Mahesh ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Fetal Distress ◽  
Morbidity And Mortality ◽  
Outcome Study ◽  
Obstetric Outcome ◽  
Cesarean Sections ◽  
Vaginal Route ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Objective: To evaluate the indications of primary cesarean section in multipara and to assess the obstetric outcome including maternal, fetal morbidity and mortality, perinatal outcome. Study Design and Setting: It was a hospital based study of primary caesarean sections (CS) done on multiparous patients in duration of two years between January 1, 2016, and December 2017 at Jinnah medical college hospital Karachi. Methodology: Multiparous patients were those who had delivered through vaginal route one or more times (i.e. 28 weeks of gestation or above) or had 1–4children and grand-multiparous are those who had 5 or more children. All the cases included in the study were hospital based and cesarean section was decided by specialist. The procedure was performed by registrars and specialists. The selected patients were followed up till they were discharge from the ward with minimum hospital stay of three days. Data was compiled and results were carried out by SPSS version 23. Results: During the two years of study period, the number of total deliveries were 2064. The primary CS rate in multipara was 37.17%. These women have more likely to have an emergency cessarean sections compared to elective i.e. 85% and15%. The mean age of women was 29.5 years, booked cases were 72.5% and unbooked were 27.5%. Regarding indications for cesarean sections, non-progress of labour ranked first 25.5% followed by fetal distress 20%, pre eclampsia 12 % and ante partum hemorrhage 10.5% etc. Increase incidence of morbidity and mortality was seen in patients undergoing cesarean section due to different reasons. Conclusion: Primary caesarean sections in multipara comprise only a small percentage (37.17%) of total deliveries but were related to high maternal and fetal morbidity

scholarly journals Manajemen Anestesi untuk Seksio Sesarea pada Pasien Pre Eklampsia Berat yang Terinfeksi Covid-19

2021 ◽  
Vol 4 (1) ◽  
pp. 18-25
Author(s):  
RTH Supraptomo
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Early Warning ◽  
The United States ◽  
Morbidity And Mortality ◽  
Early Warning Score ◽  
Anesthesia Management ◽  
History Of ◽  
Level 3 ◽  
Anesthesia Technique

Komplikasi hipertensi tercatat 6–8% pada kehamilan dan menjadi kontributor yang signifikan morbiditas dan mortalitas maternal dan perinatal. Di Amerika Serikat, preeklamsia menjadi satu dari tiga besar penyebab utama kematian ibu hamil. Penanganan yang tidak sesuai dengan standar, sering menjadi penyebab utama yang menyebabkan peningkatan morbiditas dan mortalitas pada ibu hamil. Seorang wanita 30 tahun early warning score (EWS) score 6 dengan preeklampsia pada sekundigravida (G2P1A0) hamil preterm belum dalam persalinan, riwayat seksio sesarea 1x pro seksio sesarea transperitoneal emergensi dengan status fisik ASA IIE, direncanakan dilakukan anestesi dengan teknik regional anestesi sub-arachnoid block (SAB). Manajemen anestesi pada kehamilan dengan pre-eklampsia meliputi preoperatif, intraoperatif dan postoperatif. Pada masa pandemi COVID-19 dibutuhkan penggunaan alat pelindung diri (APD) yang memadai selama tindakan perioperatif. Perhatian khusus pada anestesi pasien terinfeksi COVID-19 meliputi penggunaan ruangan bertekanan negatif, meminimalisir instrumentasi jalan nafas, serta penggunaan APD level 3.   Anesthesia Management for Caesarean Section in Severe Pre-Eclampsia Patients Infected with Covid-19 Abstract Hypertensive complications account for 6-8% of pregnancy and are a significant contributor to maternal and perinatal morbidity and mortality. In the United States, preeclampsia is one of the top three causes of death for pregnant women. Handling that is not in accordance with standards is often the main cause that causes increased morbidity and mortality in pregnant women. A 30-year-old woman with early warning score (EWS) score 6 with preeclampsia in secondary pregnancy (G2P1A0) who is preterm pregnant yet in labor, a history of cesarean section 1x pro-cesarean section emergency transperitoneal with ASA IIE physical status, planning to perform anesthesia with regional anesthesia technique. sub-arachnoid block (SAB). Anesthesia management in pre-eclampsia pregnancy includes preoperative, intraoperative and postoperative. During the COVID-19 pandemic, adequate personal protective equipment (PPE) is required during perioperative measures. Special attention to anesthesia for patients infected with COVID-19 includes the use of negative pressure rooms, minimizing airway instrumentation, and the use of level 3 PPE.

scholarly journals Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

2017 ◽  
Vol 77 (11) ◽  
pp. 1200-1206 ◽  
Author(s):  
Mehmet Senturk ◽  
Mesut Polat ◽  
Ozan Doğan ◽  
Çiğdem Pulatoğlu ◽  
Oğuz Yardımcı ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Blood Transfusion ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Maternal Age ◽  
Hemoglobin Level ◽  
Safe Procedure ◽  
The Mean ◽  
Cesarean Myomectomy ◽  
Duration Of Operation

Abstract Objective Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. Method A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant. Results While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05). Conclusion This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.

scholarly journals Five-Year Retrospective Evaluation of large for gestational age (LGA) infants who Birth Weight of Over 90% Percentile

2020 ◽  
Vol 2 (1) ◽  
pp. 1-4
Author(s):  
Hüseyin Altaş ◽  
Mehmet Sait İçen ◽  
Hıdır Budak ◽  
Rezan Bugday ◽  
Mehmet Şükrü Budak ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Normal Delivery ◽  
Gynecology And Obstetrics ◽  
The Mean

Objective: The aim of this study is to evaluate the obstetric and neonatal outcomes of pregnant women delivering large for gestational age (LGA) infants. Material and Methods: A total of 399 pregnant women giving birth to LGA infants in the Gynecology and Obstetrics Department of Dicle University Medical Faculty Hospital between January 2014 and December 2018 were included in this retrospective study. Demographic features, pregnancy and infant data, delivery type (vaginal delivery/cesarean delivery), and patients’ indications for cesarean section were assessed. Results: The mean age of the patients was 32.34±6.63, their gravida was 5.16±2.65 and parity was 3.55±2.36. The mean gestational week was 37.12±2.840 weeks and the mean birth weight was 3922.46±643.546 g. Of all patients, diabetes was detected in 28.5%, polyhydramnios in 11.3%, placental invasion anomaly in 4%, and preeclampsia in 9%. While 83.7% (334) of the patients underwent cesarean section, the remaining 16.3% (65) underwent normal delivery. 3.25% (13) of the patients developed complications during delivery. The rate of fetal anomaly was 11.7% (47) in existing pregnancies while the rate of fetal death was 5.01% (20). Conclusion: A cesarean delivery was performed in the majority of pregnant women with a suspected LGA infant. This group of patients exhibited a very high rate of gestational diabetes mellitus and diabetes mellitus. Existing pregnancies constitute a specifical pregnancy population that should be taken into consideration regarding probable complications and problems with the infant.

Investigation of the Effect of Operating Room Environment and Cesarean Section Orientation on Physiological Parameters (BP, heart rate, respiration) in Mothers of Candidate for Cesarean Section in Shiraz, a Clinical Trial Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Jamshid Eslami ◽  
Neda Hatami ◽  
Aazadeh Amiri ◽  
Marzieh Akbarzadeh
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Operating Room ◽  
Intervention Group ◽  
Physiological Parameters ◽  
Control Group ◽  
The Mean

Background: : Changes in physiological parameters in pregnant women are important factors in mothers who are candidates for cesarean section. Objective:: The aim of present study was to investigate the effect of operating room and cesarean section orientation on the physiological parameters (BP, heart rate, respiration) of pregnant women undergoing cesarean section. Materials and Methods:: This clinical trial study was performed on 80 pregnant women referring to cesarean section in hospitals affiliated to Shiraz University of Medical Sciences in 2019. The samples were randomly divided into two control (n = 40) and intervention groups (n = 40). The intervention group participated in 4 sessions of training classes. The control group used routine hospital trainings. The parameters were measured before and after the intervention in two groups. Data were analyzed using SPSS software (version 21), independent t-test and analysis of covariance. Results: The mean of post-training blood pressure in the intervention group 82.78(7.86) and in the control group 84.08 (7.44) was not statistically significant (p < .487). After intervention, the mean of heart rate in the intervention group 82.15 (8.10) and in the control group 83.43 (8.54) was statistically significant (p <0.0001). After intervention, the mean of respiratory rate in the intervention group was 94.28 (0.96) and in the control group was 75.96 (1.08) (P <0.0001). Conclusions: Although the patient's operating room and cesarean section orientation did not affect mothers' mean blood pressure; it reduced the mean of their heart rate and respiratory rate. It is important for medical staff to play an important role in identifying important strategies in managing the anxiety of pregnant women in order to improve their physiological indicators.

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