scholarly journals Maternal and Neonatal Outcome following Day Two versus Day Five or Seven Discharge after an Uncomplicated Elective Caesarean Section: A Randomized Control Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Fidelis A. Onu ◽  
Chidebe C. Anikwe ◽  
Johnbosco E. Mamah ◽  
Okechukwu B. Anozie ◽  
Osita S. Umeononihu ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Hospital Discharge ◽  
Negative Impact ◽  
Elective Caesarean Section ◽  
Early Discharge ◽  
Control Group ◽  
Maternal Satisfaction ◽  
Significant Difference ◽  
Significant Negative Impact ◽  
Maternal And Neonatal Outcomes

Background. In recent times, it has become a common practice to discharge a woman early after an uncomplicated caesarean section (CS), to satisfy their wishes, reduce cost, and maximize efficient use of healthcare system resources. Objective. To conduct a comparative analysis of maternal and neonatal outcomes following day two hospital discharge versus day 5 or 7 discharge after an uncomplicated CS. Materials and Methods. Eligible parturient (228) who met the inclusion criteria were randomized into two groups between 1st October 2018 and 30th September 2019 in two different maternity centers in Ebonyi state. The study group (114) was discharged two days after an uncomplicated CS while the control group (114) was discharged on the 5th or 7th postoperative day. Their satisfaction, cost, morbidities, and breastfeeding practices were evaluated using a pretested questionnaire. Data were analyzed using IBM SPSS version 22. Results. Day 2 discharge was not associated with a higher rate of readmission as compared with day 5-7 discharge ( χ 2 = 0.95 , P = 0.329 ). There were no statistically significant differences in cost incurred by patients discharged on day 2 after uncomplicated CS compared to the control group ( χ 2 = 1.65 , P = 0.649 ). Maternal satisfaction was high following day 2 discharge compared with day 5-7 discharge ( χ 2 = 16.64 , P = 0.0001 , OR = 0.857 , 95 % CI = 0.59 – 1.25 ). The majority of mothers (79.6%) discharged on day 2 were able to initiate and sustain breastfeeding with no statistically significant difference in the initiation and sustenance of breastfeeding with those discharged on days 5-7 ( χ 2 = 4.45 , P = 0.108 ). Early hospital discharge did not have any significant negative impact on neonatal health ( χ 2 = 1.063 , P = 0.303 ). Conclusion. Early discharge of patients after an uncomplicated CS is not associated with increased rate of readmission. It is associated with good maternal satisfaction, adequate initiation and sustenance of breastfeeding, and good neonatal wellbeing. We advocate early discharge of women following uncomplicated CS.

scholarly journals Comparative study between lumbar epidural and spinal anaesthesia in elective caesarean section: comparison of maternal status during operation and in the post operative period

2009 ◽  
Vol 21 (2) ◽  
pp. 61-66
Author(s):  
Moinul Hossain ◽  
Abu Hasanat Md Ahsan Habib ◽  
Md Mustafa Kamal ◽  
Md Mizanur Rahman
Keyword(s):  
Pain Relief ◽  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Anesthetic Technique ◽  
Maternal Satisfaction ◽  
Epidural Group ◽  
Post Operative Period ◽  
Group I ◽  
Significant Difference ◽  
Spinal Group

The caesarean section (C/S) is preferably done under regional techniques like spinal and epidural anesthesia. Both these techniques are also preferable to general anaesthesia which allows the mother to remain awake during caesarean delivery. After the approval of the institutional ethical committee, sixty (60) patients were equally divided into group-I (Spinal group) and ‘group-II (Epidural group). The intraoperative hemodynamic parameters (blood pressure & heart rate) and any event like nausea, vomiting, discomfort, shivering and the overall maternal satisfaction were compared between the groups. During post operative period mothers were interviewed for pain relief and choice of anesthetic technique. The mothers were also interviewed regarding their experiences of present anesthetic technique in comparison to the previous experiences. All data were analyzed statistically. The epidural group is significantly superior to spinal group in maternal satisfaction, frequency & magnitude of hypotension and postoperative pain relief. The hypotension that was needed to be treated with vasopressor was significantly different between the two groups (Spinal 33.33%, Epidural 10.00%, P<0.05). There is no significant difference between the groups regarding the analgesic requirement. The mothers of epidural group had chosen the technique and recommended this as the ideal technique for elective CS. But the time taken to start operation after the epidural anaesthesia was longer than spinal technique. The prolong onset to start the operation is an opportunity to make rapport between the mother and the anesthesiologist. Journal of BSA, 2008; 21(2): 61-66

Comparison of Time spent between an electronic and a paper-based laboratory information system by laboratorians at a polyclinic in Greater Accra, Ghana: A time-motion study

2020 ◽  
Author(s):  
Philip Boakye
Keyword(s):  
Information System ◽  
Negative Impact ◽  
Laboratory Information System ◽  
Time Motion ◽  
Accessible Information ◽  
Motion Study ◽  
Significant Difference ◽  
Significant Negative Impact ◽  
Key Issues ◽  
Motion Studies

The acceptance of electronic laboratory information system (LIS) is gradually increasing in developing countries. However, the issue of time effectiveness due to computerization is less clear as there is fewer accessible information. One of the key issues for laboratorians is their indecision with LISs’ would-be effect of time on their work. A polyclinic in Ghana was in the process of implementing electronic LIS. Several of the laboratorians did not have knowledge and skill in computing and there were disagreeing views on the time effectiveness of the LIS after implementation. The management of the polyclinic laboratory was concerned to assess time advantageousness of recording data when using the electronic LIS compared with paper-based LIS. <div><br></div><div>Five randomly selected laboratorians were provided two sheets of paper with tables to document the time they spent for both paper-based and electronic LIS. Data were collected for a total of 230 records,115 electronic LIS and 115 paper-based LIS. The t-test (mean-comparison test) was computed to compare the means of both electronic and paperbased LIS times. </div><div><br></div><div>There was a statistical significant difference in the time spent between electronic and paper-based LIS. The time spent between paper-based and electronic LIS was 0.41 minutes (95% CI 0.15 to 0.66) longer than in electronic LIS. </div><div><br></div><div>LIS can be adopted in polyclinics without having significant negative impact on time spent between electronic and paper-based LIS. More time–motion studies that include laboratorians are however necessary in order to get a more complete picture of time spent between electronic and paper-based LIS. </div>

Cesarean section incisional infiltration with lidocaine and Epinephrine versus Lidocaine alone in reducing postoperative pain. A randomized controlled double-blinded clinical trial

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hazem F El-Shahawy ◽  
Sherif F El-Mekkawi ◽  
. Haitham F Mohmmed ◽  
Hend M Afifi
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Breast Feeding ◽  
Local Anesthetic ◽  
Elective Caesarean Section ◽  
Control Group ◽  
Cesarean Section Delivery ◽  
Anesthetic Effect

Abstract Background Cesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation Aim of the Work to assess the efficacy and safety adding ef Epinephrine to lidocaine 2% in dose-related manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post; caesarean section pain after general anesthesia. Patients and Methods A total number of 200 women planned for elective caesarean section at Shams University Maternity Hospital Was recruited, 2 groups were randomized with a study group included 100 women received lidocaine 2% and epinephrine in dose-related manner and a control group included 100 women received lidocaine 2% only. Results women who received lidocaine and epinephrine were more satisfied and hadsignificant more time after caesarean section free of pain in comparison to women who received lidocaine only by 120 minutes. Also. adding Of epinephrine helped in decrease in amount of analgesic consumption after caesarean section. Women who received lidocaine and epinephrine started breast feeding and mobilization earlier than women who received lidocaine only. Epinephrine prolonged the action of lidocaine as a local anesthetic, this prolongation of action of local anesthetic had a significant effect in early mobilization and breast feeding and decrease in cost of analgesics. Nobody in our candidate had a post-operative infection, past operative pyrexia, Allergic reactions tar general anesthesia or complications with local anesthesia. Conclusion Adding of epinephrine to local anesthetics (such as lidocaine 2% in dose-related manner 1:200.0000) prolonged anesthetic effect by more than double of its original anesthetic time, This prolongation on anesthetic effect of local anesthesia by epinephrine helps in eariy mobilization; early breast feeding and less hospital duration stays. No complications (local nor systemic) developed with local infiltration of post-caesarean section incision with lidocaine 2% even aficr adding epinephrine in dose-related manner 1:200.000

scholarly journals Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study

2018 ◽  
Vol 7 (2) ◽  
pp. 343 ◽  
Author(s):  
Heena D. Pahuja ◽  
Megha P. Tajne ◽  
Anjali R. Bhure ◽  
Savita M. Chauhan
Keyword(s):  
Caesarean Section ◽  
Epidural Anaesthesia ◽  
Motor Block ◽  
Elective Caesarean Section ◽  
Sensory Block ◽  
Epidural Block ◽  
Elective Cesarean Section ◽  
Significant Difference ◽  
Elective Cesarean ◽  
Mean Time

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.

scholarly journals Do you pay to go private?: a single centre comparison of induction of labour and caesarean section rates in private versus public patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Simon Craven ◽  
Fionnuala Byrne ◽  
Rhona Mahony ◽  
Jennifer M. Walsh
Keyword(s):  
Decision Making ◽  
Caesarean Section ◽  
Maternity Hospital ◽  
Neonatal Outcomes ◽  
Induction Of Labour ◽  
Adjusted Relative Risk ◽  
Nulliparous Women ◽  
Significant Difference ◽  
Private And Public ◽  
Maternal And Neonatal Outcomes

Abstract Background The aim of this study was to compare rates of induction and subsequent caesarean delivery among nulliparous women with private versus publicly funded health care at a single institution. This is a retrospective cohort study using the electronic booking and delivery records of nulliparous women with singleton pregnancies who delivered between 2010 and 2015 in an Irish Tertiary Maternity Hospital (approx. 9000 deliveries per annum). Methods Data were extracted from the National Maternity Hospital (NMH), Dublin, Patient Administration System (PAS) on all nulliparous women who delivered a liveborn infant at ≥37 weeks gestation during the 6-year period. At NMH, all women in spontaneous labour are managed according to a standardised intrapartum protocol. Twenty-two thousand two hundred thirty-two women met the inclusion criteria. Of these, 2520 (12.8%) were private patients; the remainder (19,712; 87.2%) were public. Mode of and gestational age at delivery, rates of and indications for induction of labour, rates of pre-labour caesarean section, and maternal and neonatal outcomes were examined. Rates of labour intervention and subsequent maternal and neonatal outcomes were compared between those with and without private health cover. Results Women attending privately were more than twice as likely to have a pre-labour caesarean section (12.7% vs. 6.5%, RR = 2.0, [CI 1.8–2.2])); this finding persisted following adjustment for differences in maternal age and body mass index (BMI) (adjusted relative risk 1.74, [CI 1.5–2.0]). Women with private cover were also more likely to have induction of labour and significantly less likely to labour spontaneously. Women who attended privately were significantly more likely to have an operative vaginal delivery, whether labour commenced spontaneously or was induced. Conclusions These findings demonstrate significant differences in rates of obstetric intervention between those with private and public health cover. This division is unlikely to be explained by differences in clinical risk factors as no significant difference in outcomes following spontaneous onset of labour were noted. Further research is required to determine the roots of the disparity between private and public decision-making. This should focus on the relative contributions of both mothers and maternity care professionals in clinical decision making, and the potential implications of these choices.

scholarly journals Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

2019 ◽  
Vol 4 (2) ◽  
pp. 755-758
Author(s):  
Roshan Pradhan ◽  
Seema Kumari Mishra ◽  
Lalit Kumar Rajbanshi ◽  
Kanak Khanal ◽  
Batsalya Arjyal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Visual Analogue Pain ◽  
Significant Difference

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.  Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

scholarly journals Maternal and foetal outcome in elective versus emergency caesarean sections

2017 ◽  
Vol 6 (4) ◽  
pp. 1222
Author(s):  
Amit A. Gurunule ◽  
Himangi S. Warke
Keyword(s):  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
Breech Presentation ◽  
Emergency Caesarean Section ◽  
Tertiary Care Centre ◽  
Emergency Caesarean ◽  
Significant Difference ◽  
Foetal Outcome ◽  
Tract Infections

Background: Caesarean delivery is defined as the birth of the foetus through an incision in the abdominal wall (i.e. laparotomy) and the uterine wall (hysterotomy). The purpose was to analyze the maternal and foetal outcome in elective versus emergency caesarean sections retrospectively in a tertiary care centre and to analyze the indications of elective versus emergency caesarean sections.Methods: A retrospective observational study of the cases undergoing caesarean sections in KEM hospital, Mumbai, India was carried out during the period of September 2013 to September 2015. Maternal and foetal outcome was studied. The data was collected and analyzed from the maternal medical records. The neonatology records were also examined.Results: Out of the 600 selected patients, 300 patients in each group of elective and emergency caesarean section were studied. The usual indications of emergency caesarean sections were foetal distress, followed by meconium stained amniotic fluid (MSAF) and cephalopelvic disproportion (CPD). The most frequent indicator for elective lower segment caesarean section (LSCS) was patient with previous LSCS not willing for vaginal birth, followed by breech presentation and previous multiple LSCS. There was a significant difference seen in the occurrence of fever, urinary tract infections and wound infections in the two groups. These were more common in the emergency caesarean section group. Significant difference was also seen in the incidence of postpartum haemorrhage in the two groups, which was more in the elective caesarean section group.Conclusions: The maternal morbidity, intra operative and postoperative complications were more in the emergency LSCS group as compared to patients who underwent elective LSCS.

scholarly journals Improving Pediatric Hearing Testing for Children with Developmental Delays: The Effects of Video Modeling on Child Compliance and Caregiver Stress

2020 ◽  
Vol 31 (05) ◽  
pp. 310-316
Author(s):  
Megan Y. Roberts ◽  
Jennifer Rosenwasser ◽  
Jennifer Phelan ◽  
Lauren H. Hampton
Keyword(s):  
Video Modeling ◽  
Developmental Delays ◽  
Negative Impact ◽  
Autism Spectrum ◽  
Control Group ◽  
Hearing Tests ◽  
Child Outcome ◽  
Double Blind ◽  
Testing Procedures ◽  
Significant Difference

Abstract Background For children with developmental delays (DDs) of any kind (e.g., global DDs, autism spectrum disorder, and Down syndrome), it is essential to understand if a hearing loss may be contributing to these delays. However, toddlers with DDs may have difficulty understanding directions, may be uncomfortable with a new situation, or may simply not want to complete the hearing testing tasks. Regardless of the reasons, noncompliant behaviors have a negative impact on hearing testing, which requires reliable behavioral responses from the child. Purpose The purpose of this study was to test a video intervention to improve hearing testing compliance in toddlers with developmental disabilities. Research Design Double-blind randomized clinical trial. Study Sample Twenty-four children with DDs between 24 and 36 months of age. Intervention Video model of the hearing testing procedures. Data Collection and Analysis The primary child outcome measure was the number of hearing tests completed by the audiologist. Caregiver outcome included a parent survey of perceived stress level before and after the evaluation. Results There was no significant difference between treatment and control groups regarding the number of hearing tests that were completed. Parents in the treatment group reported less stress following the evaluation as compared with parents of children in the control group. Conclusions Pre-exposure to the hearing testing procedures did not significantly improve patient compliance but may reduce caregiver stress. Given the high rates of noncompliance in toddlers with DDs, audiologists may benefit from multiple strategies to help improve testing compliance.

Maternal and neonatal outcomes for the gentle caesarean section in breech presentation

2020 ◽  
Vol 28 (9) ◽  
pp. 660-664
Author(s):  
Christa H Brethouwer ◽  
Sicco A Scherjon ◽  
Ayten Elvan-Taşpinar
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Neonatal Outcome ◽  
Breech Presentation ◽  
Neonatal Outcomes ◽  
Chi Square ◽  
Significant Difference ◽  
Mother And Child ◽  
Maternal And Neonatal Outcomes ◽  
Clinically Significant

Background The gentle caesarean section (GCS) is an alternative to the conventional caesarean section. It aims to optimise the wellbeing of mother and child by mimicking certain aspects of a vaginal delivery when a caesarean section is indicated. Aim To compare the maternal and neonatal outcomes of a GCS in cephalic and breech presentation. Methods In this retrospective study, the outcomes of 180 women who underwent a GCS were analysed, where 120 fetuses were in cephalic and 60 were in breech position. Comparisons were made using Chi-square, Mann-Whitney U and t-tests. Maternal and neonatal outcomes were analysed. Results Apgar 1 was significantly lower for breech position (P=0.019). The Apgar 5 and 10 showed no difference. Neonatal temperature was slightly lower in breech position (36.8°C ± 0.36 versus 36.9°C ± 0.39, P=0.046). Birthweight was significantly lower for breech position (P=0.009). Blood loss was significantly higher in cephalic position (441 ± 230 versus 353 ± 151, P=0.002). Conclusions When performing a GCS, there is no clinically significant difference in maternal or neonatal outcome between a cephalic and a breech presentation. It seems safe to perform a GCS for breech presentation.

scholarly journals Urinary Effects of Routine Urethral Catheterisation during Elective Caesarean Section in Enugu, Nigeria: A Randomised Controlled Study

2021 ◽  
Author(s):  
Elijah Nduka Onwudiwe ◽  
Hyginus Uzo Ezegwui ◽  
Cyril Chukwudi Dim ◽  
Chibuike Ogwuegbu Chigbu ◽  
Chinyere Florence Onwudiwe ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Urinary Bladder ◽  
Urinary Retention ◽  
Elective Caesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Catheter Group ◽  
Urethral Catheterisation ◽  
Significant Bacteriuria ◽  
Randomised Controlled

Introduction: Routine urinary catheterisation during elective caesarean section is a common practice. However, this practice involves some urinary bladder morbidities. Aim: To determine the effect of non-catheterisation of the urinary bladder on the incidence of significant bacteriuria and other perioperative urinary bladder morbidities during elective caesarean section in Enugu, Nigeria. Materials and Methods: A multicentre, non-inferiority randomised controlled study was conducted. The study centres were the University of Nigeria Teaching Hospital (UNTH), Mother of Christ Specialist Hospital (MOCSH), and Blessed Assurance Specialist Hospital (BASH), all in Enugu State, Southeast Nigeria. A total of 264 eligible consenting term pregnant women who had a caesarean section in these three specialist centres in Enugu, Nigeria over a one-year period were recruited and they completed the study and their results were analysed. Study group (A) did not receive urethral catheterisation while the control group (B) had urethral catheterisation on the operating table and the catheters were removed 24 hours after the surgery. Clean catched urine samples were collected from each participant 72 hours after the surgery for urine microscopy and culture. The primary outcome measure was the incidence of significant bacteriuria 72 hours postoperatively while the secondary outcome measures included incidence of intraoperative bladder injury (accidental cystostomy), primary postpartum haemorrhage and urinary retention. Results: Nine (6.8%) women in the non-catheter group (n=132) had significant bacteriuria as against 17 (12.9%) women in the catheter group (n=132), (Relative Risk (RR)=0.5 (95% CI: 0.24-1.14) p=0.098). Urinary retention was observed in 10.6% (14/132) of the non-catheter group while there was no case of urinary retention in the control group (p<0.001). There was neither a case of accidental cystostomy nor postpartum haemorrhage in either group. Conclusion: Non-catheterisation of the urinary bladder during elective caesarean section had no significant relationship with the incidence of significant bacteriuria in Enugu, Nigeria. Rather, it was associated with postoperative urinary retention when compared to women who had a urinary catheter.

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