Comparison of Outcomes Following General Anesthesia and Spinal Anesthesia During Emergency Cervical Cerclage in Singleton Pregnant Women in the Second Trimester at a Single Center

Background: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn, research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. Methods: This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1 rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl. Results: There were no significant differences between Group SA, Group P, and Group T in terms of delivery time; neonatal 1- and 5-min Apgar scores; neonatal jaundice rates; neonatal systolic, diastolic, or mean blood pressure or peak heart rate; neonatal intensive care requirement; pH, PCO2, PO2 values in cord blood gas; or neonatal glucose and lactate values. The rate of ephedrine use was significantly higher in Group SA than in Group P and Group T. Maternal satisfaction score was higher in Group SA at postoperative 4 hours and in Group P at 24 hours. The number of newborns taken into intensive care unit in Group T was significantly higher in the 1st hour, 4th hour, 5th hour and total. Respectively p value (0.006, 0,048, 0,048, and 0,005). Pain on injection was present in 55% of patients (n = 81), mild in 36% (n = 54), and severe in 18% (n = 27). Myoclonies occurred in 4% of patients (n = 7) and local rash in 6% of patients (n = 10). Differences between formulations did not reach statistical significance. Conclusion: None of the three anesthesia methods showed superiority after elective cesarean delivery. However, spinal anesthesia and general anesthesia with propofol are more appropriate for pregnant women in terms of effects on the neonate.

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Scenario of General Anesthesia for Cesarean Section in Rural Tertiary Care Center in High Altitude Karnali Academy of Health Sciences

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i3.32751 ◽

2020 ◽

Vol 16 (3) ◽

Author(s):

Ramesh Bhattarai ◽

Rajiv Shah ◽

Sita Dhakal ◽

Pragya Malla ◽

Srijana Sapkota

Keyword(s):

Cesarean Section ◽

General Anesthesia ◽

High Altitude ◽

Spinal Anesthesia ◽

Neonatal Outcome ◽

Care Center ◽

Tertiary Care ◽

Health Sciences ◽

Tertiary Care Center ◽

Cord Prolapse

Background: General anesthesia for cesarean section is being less popular for cesarean section in present days but sometime general anesthesia is inevitable. The aim of the study is to assess the trends of general anesthesia, indications, clinical outcome in mother and fetus in high altitude setting of tertiary care center of Nepal. Methods: We conducted descriptive cross-sectional study all cases of cesarean section in Karnali Academy of health Sciences (KAHS) located at high altitude over three years period in our institute. Data were retrieved from the hospital records during three fiscal year (Jan 1st 2017 to Jan Dec 31st 2019). The record of all the patients who underwent cesarean section under general anesthesia was reviewed for demographic details, indication of general anesthesia, trends for general and spinal anesthesia and maternal and neonatal outcome. Results: Out of total deliveries 2175, 309 (14.2%) cases account for cesarean section. Among them, 52 (17%) required general anesthesia . Eclampsia 19(36%) remain the major indication for General Anesthesia in cesarean section followed by failure of spinal anesthesia number 14 (26%) , cord prolapse six (12%), antepartam haemorrhage five (10%), spinal site infection four (8%), Khiphoscoliosis two(4%), Patients request two (4%). Use for general anesthesia technique was consistent for three years with slow rise in use of spinal anesthesia . There was no any anesthesia related maternal mortality and nine intraoperative neonatal Conclusions: General anesthesia practices are consistently required in rural high-altitude setup. Eclampsia is the commonest indication followed by failure of spinal anesthesia and cord prolapse. Neonatal outcome is still not good.

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Comparison of Rocuronium Induced Neuromuscular Blockade in Late Second Trimester Pregnant and Non-pregnant Women

Case Medical Research ◽

10.31525/ct1-nct04253093 ◽

2020 ◽

Author(s):

Keyword(s):

Pregnant Women ◽

Neuromuscular Blockade ◽

Second Trimester

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Does Active Smoking Influence the Second Trimester Biochemical Markers Concentrations?

Revista de Chimie ◽

10.37358/rc.17.10.5862 ◽

2017 ◽

Vol 68 (10) ◽

pp. 2234-2236

Author(s):

Dan Navolan ◽

Florin Birsasteanu ◽

Adrian Carabineanu ◽

Octavian Cretu ◽

Diana Liana Badiu ◽

...

Keyword(s):

Pregnant Woman ◽

Pregnant Women ◽

Cigarette Smoke ◽

Chorionic Gonadotropin ◽

Reference Values ◽

Biochemical Markers ◽

Smoking Status ◽

Active Smoking ◽

Second Trimester ◽

Harmful Effects

Cigarette smoke contains over 7000 different substances some of them exerting harmful effects on embryo and pregnant woman. Nowadays 15 % of adult people and around 10-15% of pregnant women smoke. Previous studies showed that cigarette smoke compounds could exert pharmacodinamic effects and influence some of the second trimester biochemical markers concentration. Therefore there is a need to adjust the reference values of second trimester markers depending of the smoker status. The aim of our study was to analyse which of the markers are influenced by smoking and whether the software used to calculate the risk for aneuploidies is able to counterbalance this influence. Alpha-fetoprotein (AFP), chorionic gonadotropin hormone (hCG) and free estriol (uE3) values were measured in second trimester sera of 1242 pregnant women: 1089 non-smokers and 153 smokers. Only hCG second trimester values were influenced by smoking whereas AFP and uE3 values were not. The correction of medians according to the smoking status was able to counterbalance this effect.

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Is there a Need for Own Median Calculation in the Second Trimester Biochemical Markers Screening?

Revista de Chimie ◽

10.37358/rc.17.5.5613 ◽

2017 ◽

Vol 68 (5) ◽

pp. 1070-1072

Author(s):

Dan Navolan ◽

Mirela Nicolov ◽

Simona Vladareanu ◽

Ioana Ciohat ◽

Marius Craina ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Biochemical Markers ◽

Biochemical Marker ◽

Second Trimester ◽

Established Method ◽

Crown Rump Length ◽

The Difference ◽

Fetal Aneuploidies ◽

Singleton Pregnancies

Screening of fetal aneuploidies in early pregnancy is a well-established method in the materno-fetal medicine. The aim of our study was to analyze if the medians recommended by the manufacturers are adequate to perform an accurate screening or if there is a need for own laboratory medians calculation in second trimester biochemical marker screening.Sera were collected between 14 wp and 22 wp from 3374 singleton pregnancies. We analyzed three second trimester biochemical markers (AFP, hCG and free Estriol) concentration in all pregnant women and in a subgroup of pregnant women in which gestational age was determined based on crown-rump length. Our results showed that for all biochemical markers the difference between the manufacturer and the own calculated median was lower than 10% excepting the hCG value in the group of pregnant women in which the gestational age was determined on basis of crown-rump-length. Our results show it is recommended to replace the values of the median for hCG measurement with the own laboratory calculated medians. This does not seem to be necessary in the case of AFP and free Estriol measurement.

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Sertraline concentrations in pregnant women are steady and the drug transfer to their infants is low

European Journal of Clinical Pharmacology ◽

10.1007/s00228-021-03122-z ◽

2021 ◽

Author(s):

E. Heinonen ◽

M. Blennow ◽

M. Blomdahl-Wetterholm ◽

M. Hovstadius ◽

J. Nasiell ◽

...

Keyword(s):

Cord Blood ◽

Pregnant Women ◽

Plasma Concentrations ◽

Relative Difference ◽

Interindividual Variation ◽

Therapeutic Drug ◽

Cytochrome P450 Enzyme ◽

Second Trimester ◽

P450 Enzyme ◽

Placental Passage

Abstract Purpose Sertraline, a selective serotonin reuptake inhibitor (SSRI), is one of the most commonly used antidepressant during pregnancy. Plasma sertraline concentrations vary markedly between individuals, partly explained by variability in hepatic drug metabolizing cytochrome P450-enzyme activity. Our purpose was to study the variability in the plasma concentrations in pregnant women and the passage to their infants. Method Pregnant women with moderate untreated depression were recruited in 2016–2019 in Stockholm Region and randomized to treatment with sertraline or placebo. All received Internet-based cognitive behavior therapy as non-medical treatment. Sertraline plasma concentrations were measured around pregnancy weeks 21 and 30, at delivery, 1-month postpartum, in cord blood and at 48 h of age in the infant. The clinical course of the infants was followed. Results Nine mothers and 7 infants were included in the analysis. Median dose-adjusted sertraline concentration in second trimester was 0.15(ng/mL) /(mg/day), in third trimester and at delivery 0.19 and 1-month postpartum 0.25, with a 67% relative difference between second trimester and postpartum. The interindividual variation was 10-fold. Median concentrations in the infants were 33% and 25% of their mothers’, measured in cord blood, and infant plasma, respectively. Only mild and transient adverse effects were seen on the infants. Conclusion Placental passage of sertraline to the infant is low. However, the interindividual variation in maternal concentrations during pregnancy is huge, why therapeutic drug monitoring might assist in finding the poor metabolizers at risk for adversity and increase the safety of the treatment. Trial registration The trial was registered at clinicaltrials.gov July 9, 2014 with TRN: NCT02185547.

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The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0464 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Murat Akbas ◽

Faik Mumtaz Koyuncu ◽

Burcu Artunç-Ülkümen ◽

Gökce Akbas

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Value Added ◽

Shear Wave Elastography ◽

Multiple Regression Model ◽

Low Risk ◽

Obstetric Outcomes ◽

Second Trimester ◽

The Mean ◽

Random Measurements

AbstractObjectivesIncreased placental stiffness is associated with various pathological conditions. Our objective was to evaluate the relation between the second-trimester placental elasticity value in low-risk pregnant women and poor obstetric outcomes.MethodsA total of 143 pregnant women were enrolled. Placental elasticity values were measured using the transabdominal point shear wave elastography method. 10 random measurements were obtained from different areas of the placenta. The mean was accepted as the mean placental elasticity value. Logistic regression analyses were performed to identify independent variables associated with obstetric outcomes.ResultsSecond-trimester placental elasticity value was significantly and positively associated with the poor obstetric outcomes (p=0.038). We could predict a poor outcome with 69.2% sensitivity and 60.7% specificity if we defined the placental elasticity cut-off as 3.19 kPa. Furthermore, in the multiple regression model, the placental elasticity value added significantly to the prediction of birth weight (p=0.043).ConclusionsOur results showed that the pregnancies with a stiffer placenta in the second trimester were associated with an increased likelihood of exhibiting poor obstetric outcomes. Also, placental elasticity was independently associated with birth weight.

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POS0058-PARE INCREASING PREECLAMPSIA KNOWLEDGE IN SLE WITH A SPECIFIC EDUCATIONAL TOOL: PRELIMINARY RESULTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1480 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 235.2-235

Author(s):

J. Y. E. Lee ◽

A. Mendel ◽

I. Malhamé ◽

S. Bernatsky ◽

E. Vinet

Keyword(s):

Systemic Lupus Erythematosus ◽

Pregnant Women ◽

Lupus Erythematosus ◽

Intervention Group ◽

Standard Of Care ◽

Vulnerable Population ◽

Control Group ◽

Educational Tool ◽

Second Trimester ◽

Systemic Lupus

Background:Pregnant women with systemic lupus erythematosus (SLE) are at high risk of preeclampsia, leading to substantial maternal and fetal morbidity. Aspirin reduces preeclampsia risk but recent studies suggest aspirin is used only in a minority of SLE pregnancies. There is an urgent need to improve preeclampsia counselling and management in this vulnerable population.Objectives:We are conducting the PREPARE (PREeclamPsia knowledge & Aspirin adheRence in lupus prEgnancies) trial, a randomized controlled trial (RCT) evaluating an educational tool on preeclampsia knowledge and aspirin adherence among pregnant women with SLE. We present preliminary analyses of the effect of this tool on preeclampsia knowledge.Methods:Consecutive pregnant SLE women are recruited until the 16th gestational week at 5Canadian Systemic Lupus International Collaborating Clinics centres (i.e. Montreal, Halifax, Quebec, Winnipeg, and Calgary) since 05/2018. Subjects are randomly assigned to receive either the specifically-designed educational tool (intervention group) or standard of care (control group). At baseline (i.e. first trimester) and second trimester visits, the participants complete self-administered preeclampsia knowledge questionnaires (scored out of 30 by the research team blinded to the intervention). We restricted the current analysis to participants enrolled in Montreal (accounting for nearly half of the total planned sample size). We performed a univariate linear regression analysis to assess the effect of the educational tool on preeclampsia knowledge (i.e. mean score difference between the two groups from baseline to second trimester visit).Results:Thirty-three pregnant SLE women were included in the study, among which 16 were exposed to the intervention and 17 were unexposed. Baseline characteristics were well balanced between the two groups with similar mean maternal age between intervention group (32.2 years, standard deviation, SD, 4.6) and control group (34.1 years, SD 4.2) and identical proportion of subjects with post-secondary education (i.e. 80%). The difference in mean preeclampsia knowledge scores between second trimester and baseline visits in the intervention group was 4.4 points (95% CI -0.1, 9.0) and in the control group was 1.5 points (95% CI -2.7, 5.7). The mean difference in knowledge scores (from baseline to second trimester) for those receiving the educational tool was 2.7 points higher (95% CI -1.5, 6.9) than those receiving standard of care.Conclusion:Approximately midway into the PREPARE trial, we observed a trend for improvement in preeclampsia knowledge from the baseline to the second trimester visit in pregnant women with SLE who received a specifically-designed educational tool compared to the control group, although the CIs included the null. Our RCT is well-poised to provide a new evidence-based approach to improve preeclampsia knowledge in pregnant women with SLE, which could help to optimize aspirin use and outcomes in this vulnerable population.References:[1]Schramm AM, Clowse ME. Aspirin for prevention of preeclampsia in lupus pregnancy. Autoimmune Dis. 2014;2014:920467. doi:10.1155/2014/920467[2]Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010;116(2 Pt 1):402-414. doi:10.1097/AOG.0b013e3181e9322a[3]Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017 Mar;76(3):476–85. doi: 10.1136/annrheumdis-2016-209770.[4]Mendel A, Bernatsky SB, Hanly JG, et al. Low aspirin use and high prevalence of preeclampsia risk factors among pregnant women in a multinational SLE inception cohort. Ann Rheum Dis. 2019;78(7):1010-1012. doi:10.1136/annrheumdis-2018-214434Disclosure of Interests:None declared.

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