scholarly journals Carbetocin Or Oxytocin To Prevent Postpartum Haemorrhage Due To Uterine Aony In Cases Of Elective Caesarean Section

2020 ◽  
Vol 7 (7) ◽  
pp. 739-745
Author(s):  
Mohamed S. A. Emarah
Keyword(s):  
Caesarean Section ◽  
Postpartum Haemorrhage ◽  
Elective Caesarean Section ◽  
Active Management ◽  
Technological Advancement ◽  
Uterine Arteries ◽  
Group I ◽  
Significant Difference ◽  
Prophylactic Drug ◽  
Long Acting

Background: Despite the technological advancement made in the past few decades, postpartum haemorrhage (PPH) remains one of the principal causes of maternal deaths in developing nations. The administration of uterotonic drugs widely prevents the PPH; therefore, it is the main point of active management. Among uterotonics, oxytocin has proven to be very effective in reducing the incidence of PPH. One prophylactic drug which has been introduced in recent times is carbetocin, a synthetic long-acting oxytocin analogue. It has a longer half life of 41 min, allowing it to stimulate a prolonged uterine response of up to an hour after a single intravenous dose, obviating the need for infusion. Methods: A total of 120 pregnant women divided into two groups; Group I (Carbetocin group) included 60 women who received carbetocin and delivered by caesarean section (CS), Group II (Oxytocin group) included 60 women who received oxytocin and delivered by caesarean section (CS). Results: Our result showed that, there was a statistically significant difference for the prevention of atonic postpartum hemorrhage between the two groups (p<0.01), for carbetocin group. There was also a statistically significant difference between the two groups (p < 0.01), according to need to additional procedures, such as need to modified B-lynch sutures and need to bilateral uterine arteries ligation for carbetocin group. Conclusion: We concluded that carbetocin was a better alternative to traditional oxytocin in the prevention of PPH after elective caesarean section.

Efficacy of different infusion rates of oxytocin for maintaining uterine tone during elective caesarean section: A randomised double blind trial

2021 ◽  
pp. 0310057X2098448
Author(s):  
Medha Mohta ◽  
Rohit B Chowdhury ◽  
Asha Tyagi ◽  
Rachna Agarwal
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Spinal Anaesthesia ◽  
Postpartum Haemorrhage ◽  
Elective Caesarean Section ◽  
Double Blind Study ◽  
Double Blind ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Oxytocin Infusion

Most research in this field has focused on finding oxytocin doses for initiating uterine contractions. Only limited data are available regarding the optimal rate of oxytocin infusion to maintain adequate uterine tone. This randomised, double blind study included 120 healthy term pregnant patients with uncomplicated, singleton pregnancy undergoing elective caesarean section under spinal anaesthesia. Following an initial 1 IU bolus, the patients received oxytocin infusion at 1.25 IU/hour (group 1.25), 2.5 IU/hour (group 2.5) or 5.0 IU/hour (group 5) for four hours. Uterine tone was assessed as adequate or inadequate at various intervals. If found inadequate, additional uterotonics were administered. Estimated blood loss was mean (standard deviation) 499 (172) ml, 454 (117) ml and 402 (151) ml in groups 1.25, 2.5 and 5, respectively ( P value groups 1.25 versus 5 = 0.012). Oxytocin infusion at 5 IU/hour resulted in a significantly lower incidence of minor postpartum haemorrhage, defined as blood loss greater than 500 ml, than 1.25 IU/hour ( P = 0.009). No patient had major/severe haemorrhage (>1000 ml blood loss). No significant difference was seen in haemoglobin levels ( P = 0.677) and uterine tone. Fifteen, six and nine patients, respectively, required additional oxytocin ( P = 0.151). The incidence of tachycardia ( P = 0.726), hypotension ( P = 0.321) and nausea/vomiting ( P = 0.161) was comparable. To conclude, 5 IU/hour was more effective than 1.25 IU/hour in reducing total blood loss and the incidence of minor postpartum haemorrhage. Thus 5 IU/hour appears to be an optimal oxytocin infusion rate following 1 IU slow intravenous oxytocin injection for the maintenance of adequate uterine contraction in patients undergoing elective caesarean section under spinal anaesthesia.

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

Efficiency and safety of terlipressin application during caesarian section in pregnant women with a high risk of bleeding: a multicenter comprehensive cohort study of Terli-Bleed. Part II

2021 ◽  
Vol 20 (2) ◽  
pp. 26-32
Author(s):  
Yu.S. Raspopin ◽  
◽  
E.M. Shifman ◽  
A.A. Belinina ◽  
A.V. Rostovtsev ◽  
...  
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Postpartum Haemorrhage ◽  
Research Work ◽  
Control Group ◽  
Non Invasive ◽  
Group I ◽  
Significant Difference ◽  
Invasive Hemodynamics

Severe and massive bleeding remains one of the main causes of maternal mortality and morbidity. The use of terlipressin has proved to be effective in the prevention of postpartum haemorrhage in the high-risk group. Given that terlipressin is a potent vasopressor, there are concerns about its use in parturient women with hypertension. Objective. To evaluate the hemodynamic effects of terlipressin when it is injected into the myometrium during caesarean section. Patients and methods. This publication is a continuation of the research work on the effectiveness of terlipressin in the prevention of postpartum haemorrhage in high-risk pregnant women, which was conducted between February and December 2020 with the participation of 5 medical centers. The study included 454 pregnant women who delivered by caesarean section. They were divided into two groups: control group I (n = 351) and study group II (n = 103), with local application of terlipressin injected into the thickness of the myometrium. During the study, the parameters of non-invasive hemodynamics were assessed. Results. When assessing the indicators of non-invasive blood pressure, no statistically significant difference was found between the groups. The analysis of heart rate showed slight statistical difference at the stage of operation and in the postoperative period. A significant difference in values of shock index in dynamics was found between the groups, which, nevertheless, were within acceptable limits, and the difference had no clinical significance. Conclusion. The study showed that the use of terlipressin does not significantly affect the parameters of non-invasive hemodynamics, which can complicate the operation or the labor outcome. Key words: obstetric haemorrhage, terlipressin, hemodynamics

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 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 Comparison of analgesic efficacy between TAP block and local site infiltration post operatively in caesarean section

2018 ◽  
Vol 6 (4) ◽  
pp. 1407 ◽  
Author(s):  
Nabanita Das ◽  
Usha Shukla ◽  
Dheer Singh ◽  
Urvashi Yadav
Keyword(s):  
Caesarean Section ◽  
Postoperative Analgesia ◽  
Analgesic Efficacy ◽  
Tap Block ◽  
Local Site ◽  
Pain Scores ◽  
Group I ◽  
Significant Difference ◽  
Patient Pain ◽  
Study Population

Background: Patients undergoing caesarean section need to be alert, comfortable and mobile in order to take care of their babies, for which they must be pain free in post operative period. The aim of present study is to compare the analgesic efficacy of TAP block with local anaesthetic infiltration specifically in LSCS patients in reducing patient pain postoperatively, as well as to decrease the analgesic requirements.Methods: The study population consisted of 60 patients posted for elective and emergency caesarean section. They were blindly divided into two groups of 30 patients each. Group T received 40ml 0.25% Ropivacaine in Transverses abdominis plane (TAP) block for postoperative analgesia and group I received 40ml 0.25% ropivacaine as infiltration at incision site for postoperative analgesia. Patients were observed for numeric pain score NPS, analgesic requirements, total analgesic consumption and adverse effects if any.Results: There was highly significant difference in numeric pain scores at 2nd, 6th, 12th and 24th hours (p<0.0001). Both the time for first rescue analgesic and total amount of analgesic consumed are statistically significant (p<0.0001).Conclusions: TAP block is an effective postoperative analgesic procedure for post caesarean section patients.

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 of Ringer’s lactate solution and 6% hydroxyethyl starch solution as pre-loading fluid for prevention of hypotension following spinal anesthesia

2017 ◽  
Vol 5 (2) ◽  
pp. 415
Author(s):  
T. Mohan Singh ◽  
Lesley Linus
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Active Management ◽  
Ringer Lactate ◽  
Mortality And Morbidity ◽  
Arterial Blood ◽  
Significant Difference ◽  
Group A ◽  
Lactate Solution

Background: Arterial hypotension following spinal anesthesia still remains the leading cause for maternal mortality and morbidity. Active management of hypotension and more so its prevention of its ads more safety value to spinal anesthesia, which is widely practiced worldwide. Preloading of patients with either crystalloid or colloid prevents the severity of hypotension. Objectives of the study was to compare the preloading efficacy of Ringers lactate solution (20 ml/kg) and 6% hydroxyl ethyl starch at 10 ml/kg in prevention of hypotension following spinal anesthesia in elective caesarean section.Methods: 100 ASA grade I and grade II subjects for elective caesarean section were studied in two groups. Group A (Ringer lactate group) 50 subjects and Group B (hydroxyl ethyl starch group) 50 subjects. Each group was preloaded over a period of 20 minutes before spinal anesthesia with either ringer lactate solution (Group A) at 20 ml/kg or 6% hydroxyl ethyl starch group at 10 ml/kg body weight. Main outcome measures were mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate.Results: Demographic characteristics of both groups were comparable. Incidence of hypotension was significantly more in ringer lactate group. There was no significant difference of heart rate in both the groups. No allergic reaction was noted to hydroxyl ethyl starch. Vasopressor requirement was also low in hydroxyl ethyl starch group compared to ringer lactate group.Conclusions: Preloading subjects with 6% hydroxyl ethyl starch is beneficial than preloading with ringer lactate solution as it produces better hemodynamic stability to subjects.

scholarly journals Carbetocin versus Oxytocin and Misoprostol in prevention of atonic post-partum hemorrhage in high risk patients planed for cesarean delivery

2017 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Author(s):  
Abd El-Naser Abd El-Gaber Ali ◽  
Ahmed Ali M. Nasr ◽  
Hazem H. Ahmed ◽  
Mahmoud I. El- Rasheedy ◽  
Mahmoud Badawy
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Caesarean Delivery ◽  
Post Partum ◽  
Elective Caesarean Section ◽  
High Risk Patients ◽  
Post Partum Hemorrhage ◽  
Group I ◽  
Risk Patients ◽  
Group Ii

Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol.Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 µg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed.Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P <0.001), major PPH was 0, 4 and 6% for the same groups respectively (P <0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II& III (P <0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p <0.0001)Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage. 

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