scholarly journals Comparative study of vectis versus manual method for extraction of fetal head during lower segment cesarean section

Author(s):  
Priyanka HK ◽  
Madhavi Yeddala ◽  
Vimala KR ◽  
Shailaja N. ◽  
Bhat BS ◽  
...  

Background: Delivery of fetal head through uterine incision is often the major technical problem during low transverse cesarean section when the presenting part is unengaged. Techniques to deliver head under special circumstances are traumatic to both mother and fetus. This study aims to establish the role of vectis in extraction of fetal head during lower segment cesarean section (LSCS) and to assess associated difficulties or untoward effects of use of vectis over manual method.Methods: The study was undertaken in PESIMSR, Kuppam, Andhra Pradesh over two years. Vectis was used in extraction of fetal head in LSCS in 100 cases of full term pregnancy and maternal and neonatal outcomes were compared with 100 cases of manual extraction.Results: Incision-delivery time interval was similar in both vectis and manual extraction method (p value of 0.390). Vectis group did not require any fundal pressure for extraction of head where as 100% of women in manual extraction group required fundal pressure (p value: <0.001) which is statistically significant. The length of abdominal incision for majority of cases in vectis group was smaller and statistically significant compared to manual extraction group (p value of 0.001). Neonatal outcomes were similar in both the groups.Conclusions: As per our study, usage of vectis has shown significant advantage in reducing maternal discomfort caused due to fundal pressure and length of abdominal incision required, with negligible difference in neonatal and other maternal outcomes in comparison to manual method of extraction.

2020 ◽  
Vol 24 (1) ◽  
pp. 50-53
Author(s):  
Ali Kashif ◽  
Rizwana Bashir Kiani ◽  
Syed Muhammad Asad Shabbir ◽  
Tariq Mahmood ◽  
Ghulam Sabir ◽  
...  

Aim: To compare the frequency of epigastric pain and uterotonic effect of an equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion during elective LSCS under spinal anesthesia. Methodology: We recruited 98 parturients undergoing elective LSCS under spinal anesthesia for this prospective quasi experimental study and divided them into two groups. Group-A received 5 IU of oxytocin as bolus intravenous (IV) injection in 5 sec (bolus group, n= 48), and Group-B (infusion group, n= 50) received 5 IU of oxytocin as an infusion over 5 min. Any complaint of epigastric pain by the patients was noted and its frequency was compared between the two groups. The uterine tone was assessed as adequate or inadequate by an obstetrician. The data were entered into SPSS version 22. Patient demographic data were analyzed with independent samples T-test and the study data were analyzed with Chi‑square test and presented as n (%). p < 0.05 was considered statistically significant. Results: Epigastric pain was noted in 25 (52.03%) out of 48 parturients in Group-A and 15 (30%) out of 50 in Group-B (p = 0.026). There was no significant difference in the uterotonic effect of oxytocin between the two groups (p = 0.736). Conclusion:  We conclude that oxytocin infusion is associated with lower frequency of epigastric pain in elective LSCS when compared to intravenous bolus of an equivalent dose of oxytocin, However, the effect on uterine contractions was adequate with both methods. Citation: Kashif A, Kiani RB, Shabbir SMA, Mahmood T, Sabir G, Fatima NE, Khan WA. Epigastric pain after intravenous administration of oxytocin in patients undergoing lower segment cesarean section: A quasi experimental study comparing intravenous bolus with infusion technique. Anaesth pain intensive care 2020;24(1):_ DOI: https://doi.org/10.35975/apic.v2i1. Received – 20 February 2019; Reviewed – 4, 16 March, 25 June, 9 September, 2, 25 November, 10 December 2019, 7 January 2020; Revised – 19 June, 10 August, 29 September, 1 November 2019, 6 January 2020; Accepted – 10 January 2020;


Author(s):  
P. Kalpana ◽  
T. Praveena

Background: With a steep fall in maternal mortality and morbidity and with much more liberalization of indications, the incidence of cesarean section rate has greatly increased over the last thirty years and almost doubled in the current decade. The objective of this study was to study incidence of maternal morbidity in emergency lower segment cesarean section.Methods: Hospital based prospective study was carried out among 200 women undergoing emergency lower segment cesarean section. Data relating to demographic characteristics, clinical characteristics, maternal and fetal indications, incidence of morbidity, and types of morbidities, Intra operative complications, and Post operative complications was noted down. Chi square and odds ratio was used for statistical analysis.Results: The incidence of LSCS was 24.21%. Incidence of emergency LSCS was 96.74%. 71% were having primary LSCS and 20.5% were booked cases. The most common maternal indication for emergency LSCS was pregnancy induced hypertension and eclampsia in 32.5% of the cases. The most common fetal indication for emergency LSCS was fetal distress in 60%. Incidence of morbidity was 35% and it was associated with booking status, parity and social class. Incidence of intraoperative complications was 23.5%. Majority (18.5%) developed febrile morbidity followed by wound sepsis in 12.5%, urinary tract infection in 8%, mastitis in 7.5%, respiratory tract infection in 7%, wound gaping in 4%, paralytic ileus in 3%, endometritis in 2.5%, postpartum hemorrhage in 1.5%, 2 cases of burst abdomen and one case of small bowel obstruction.Conclusions: Emergency LSCS was more common than elective LSCS and it was associated with booking status, parity and social class.


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