Safe obstetric anesthesia practice-COVID-19

COVID-19 or Corona virus disease 2019 was declared a pandemic by the WHO on 11th March 2020. Cesarean delivery is a commonly performed major surgery around the world. Important considerations while performing a cesarean section on a confirmed or suspected case of COVID19 are safety of the woman and the fetus; and prevention of transmission of SARS-CoV2 infection to the fetus as well as the healthcare providers. Woman and her birthing partner should be screened for the symptoms of COVID-19 before scheduled admission. Cesarean section in a woman suffering from COVID-19 should be managed by a multidisciplinary team consisting of anesthetists, obstetricians, labor and delivery nurses, neonatologist, critical care experts and infectious disease specialists, all members working in tandem with each other. General changes in workflow, reorganization of obstetric anesthesia services and proper use of personal protective equipment (PPE) are required for safe delivery of obstetric anesthesia during the COVID pandemic. Regional anesthesia is the preferred method of anesthesia for cesarean delivery. Using regional anesthesia reduces the need of aerosol generating procedures and avoids the use of mechanical ventilation. It also decreases the possibility of exacerbating the respiratory complications due to intubation. General anesthesia is recommended when a COVID-19 parturient presents with desaturation (oxygen saturation≤ 93%) for emergency cesarean delivery. Use of mechanical barriers around patient’s head during intubation and extubation might reduce exposure. The patient should be allowed to remain in the operating room itself till sufficiently recovered to be shifted directly to the isolation room.

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The current practice of aspiration prophylaxis in obstetric anesthesia: a survey among non-physician anesthetic providers working in hospitals in Ethiopia

BMC Anesthesiology ◽

10.1186/s12871-021-01478-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Metages Hunie ◽

Efrem Fenta ◽

Simegnew Kibret ◽

Diriba Teshome

Keyword(s):

Public Sector ◽

Cesarean Section ◽

Cesarean Delivery ◽

Regional Anesthesia ◽

Current Practice ◽

Obstetric Anesthesia ◽

Pulmonary Aspiration ◽

Survey Study ◽

The Public

Abstract Background Pulmonary aspiration is one of the most important complications of obstetric anesthesia. Prevention of pulmonary aspiration is commonly performed by the application of different anesthetic maneuvers and administration of drugs. This study aimed to assess the non-physician anesthetic providers current practice of aspiration prophylaxis during anesthesia for cesarean section in Ethiopia. Methods This survey study was conducted from October 01 to November 05, 2020, on a total of 490 anesthetic providers working in hospitals in Ethiopia. A structured checklist was used to collect data from non-physician anesthetic providers. Results Four hundred and ninety (490) anesthetic providers participated in our study. The majority of the respondents (84%) were working in the public sector. Most of the cesarean delivery was done under regional anesthesia and more than half of anesthetic providers in Ethiopia administered aspiration prophylaxis routinely. Metoclopramide was the most frequently given as a prophylaxis for pulmonary aspiration. Conclusions More than half of the anesthetic providers administered aspiration prophylaxis routinely. Metoclopramide was the commonest administered aspiration prophylaxis for parturients who underwent cesarean delivery to prevent aspiration.

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Formulating an anesthetic plan using a list of high-risk pregnant women on cloud-based business communication tools: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00430-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Junnosuke Kimura ◽

Kento Kawamura ◽

Manami Minoura ◽

Ayako Hiramoto ◽

Yoshifumi Suga ◽

...

Keyword(s):

Case Report ◽

High Risk ◽

Cesarean Section ◽

General Anesthesia ◽

Pregnant Women ◽

Cesarean Delivery ◽

Business Communication ◽

Communication Tools ◽

Case Presentation ◽

Emergency Cesarean

Abstract Background We report a case in which a list of high-risk pregnant women on cloud-based business communication tools was useful in formulating an anesthetic plan for unscheduled cesarean section. Case presentation A 37-year-old woman, who had been prescribed icosapentate for hypertriglyceridemia, received an antenatal anesthetic evaluation for possible cesarean delivery, and it was agreed that the anesthetic method for emergency cesarean section was general anesthesia if the surgery would take place within 7 days after the discontinuation of the drug, and regional anesthesia if it would take place any time later. Then this agreement was uploaded on the cloud-based business communication tools, and updated until she delivered her baby via unscheduled cesarean section. Conclusions A cloud-based business communication tools was useful in formulating an anesthesia plan for a patient undergoing a cesarean delivery. However, more discussion would be needed to utilize it in security.

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CLINICAL STUDY OF PRIMARY CESAREAN SECTION IN MULTIPAROUS WOMEN AT OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

10.36106/ijsr/7538868 ◽

2021 ◽

pp. 7-8

Author(s):

Kumari Nisha ◽

Renu Jha ◽

Kumudini Jha ◽

Debarshi Jana

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Placenta Previa ◽

Fetal Distress ◽

Normal Vaginal Delivery ◽

Major Surgery ◽

Obstetrics And Gynaecology ◽

Emergency Cesarean ◽

Study Results ◽

Multiparous Women

Background: Caesarean section is the most commonly performed major surgery among women. The aims and objective of this study was to know the incidence of primary Caesarean section in multigravidas, its indications and to know the maternal and foetal outcome among these patients. Methodology: This was an observational study conducted at Department of Obstetrics and Gynaecology of Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Aim of the study was to study the indication, maternal and fetal outcome in primary cesarean in multiparous women. All multiparous women admitted for delivery were included in the study Results: The total number of deliveries were 3064 and cesarean section were 1026 (33%).The total number of primary cesarean section in multiparous women were 84 constituting 2.7%. In this study, majority of women were Gravida 2. 91.6% of the cases were underwent emergency cesarean section and anesthesia was spinal. Majority of patients were between age group of 22 to 27 yrs (70%). Indications for cesarean section in our study were severe oligohydroamnios (22%), fetal distress (15.4%), and breech presentation (14%), premature rupture of membrane (12%).Intra operative ndings were meconium stained liquor, post partum hemorrhage, thinned out lower segment and extension of incision. Out of 84 cases, 48 cases needed intra operative or immediate post operative blood transfusion. The post operative morbidity was present in 6 cases i.e paralytic ileus, puerperal fever, urinary tract infection and wound gaping. Majority of babies, weighed in the range of 2-3kgs (55%).Out of 84 cases 7 were causes were placenta previa, obstructed labor and fetal distress. Conclusion: Many unforeseen complications occur in women who previously had a normal vaginal delivery. It is recommended that all antenatal patients must be booked and receive proper and regular antenatal care. Also 100% deliveries in multigravida should be institutional deliveries in order to reduce maternal and perinatal morbidity and mortality.

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Supplementary Oxygen for Emergency Cesarean Section Under Regional Anesthesia

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000362080.98387.d7 ◽

2009 ◽

Vol 29 (4) ◽

pp. 197

Author(s):

K.S. Khaw ◽

C.C. Wang ◽

W.D. Ngan Kee ◽

W.H. Tam ◽

F.F. Ng ◽

...

Keyword(s):

Cesarean Section ◽

Regional Anesthesia ◽

Supplementary Oxygen ◽

Emergency Cesarean Section ◽

Emergency Cesarean

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Comparison of Melatonin Levels in the Colostrum between Vaginal Delivery and Cesarean Delivery

American Journal of Perinatology ◽

10.1055/s-0037-1608681 ◽

2017 ◽

Vol 35 (05) ◽

pp. 481-485 ◽

Cited By ~ 1

Author(s):

Ziya Kalem ◽

Tuncay Yuce ◽

Batuhan Bakırarar ◽

Feride Söylemez ◽

Müberra Namlı Kalem

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Elective Cesarean Section ◽

Enzyme Linked Immunosorbent Assay ◽

Cross Sectional ◽

Emergency Cesarean ◽

Study Results ◽

Elective Cesarean

Objective This study aims to compare melatonin levels in colostrum between vaginal and cesarean delivery. Study Design This cross-sectional study was conducted with 139 mothers who gave live births between February 2016 and December 2016. The mothers were divided into three groups according to the mode of delivery: 60 mothers (43.2%) in the vaginal delivery group, 47 mothers (33.8%) in the elective cesarean delivery, and 32 mothers (23.0%) in the emergency cesarean delivery group. Colostrum of the mothers was taken between 01:00 and 03:00 a.m. within 48 to 72 hours following the delivery, and the melatonin levels were measured using the enzyme-linked immunosorbent assay (ELISA) and compared between the groups. Results The melatonin levels in the colostrum were the highest in the vaginal delivery group, lower in the elective cesarean section group, and the lowest in the emergency cesarean group (265.7 ± 74.3, 204.9 ± 55.6, and 167.1 ± 48.1, respectively; p < 0.001). The melatonin levels in the colostrum did not differ according to the demographic characteristics of the mothers, gestational age, birth weight, newborn sex, the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores, and for the requirement for neonatal intensive care. Conclusion Our study results showed that melatonin levels in the colostrum of the mothers who delivered vaginally were higher than those who delivered by cesarean section. Considering the known benefits of melatonin for the newborns, we believe that vaginal delivery poses an advantage.

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Supplementary Oxygen for Emergency Cesarean Section Under Regional Anesthesia

Survey of Anesthesiology ◽

10.1097/01.sa.0000360608.60213.7d ◽

2009 ◽

Vol 53 (6) ◽

pp. 262-263

Author(s):

&NA;

Keyword(s):

Cesarean Section ◽

Regional Anesthesia ◽

Supplementary Oxygen ◽

Emergency Cesarean Section ◽

Emergency Cesarean

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Trial of labor after previous cesarean delivery (TOLAC) and association of BMI and previous vaginal delivery with frequency of VBAC

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i4.21687 ◽

2016 ◽

Vol 15 (4) ◽

pp. 546-550 ◽

Cited By ~ 1

Author(s):

Huma Tasleem ◽

Haider Ghazanfar

Keyword(s):

Cesarean Section ◽

Success Rate ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Health Centre ◽

Tertiary Care ◽

Vaginal Birth ◽

Trial Of Labor ◽

Emergency Cesarean ◽

Previous Cesarean

Objectives: To determine the frequency of successful Vaginal Birth after One Cesarean Section in our tertiary care institution and to determine the causes of its failure.Material and Methods: This study was conducted in department of Obstetrics and Gynecology of Shifa International Hospital and Shifa Foundation Community Health Centre Islamabad Pakistan from Feb 2011 to Dec 2014. This study included 592 patients who presented in labor room emergency reception of Obs/Gynae department at term with previous one scar having fulfilled the laid down inclusion criteria for VBAC during ante-natal care. The patients were admitted in hospital and were allowed to proceed for spontaneous labor under vigilant monitoring on complications of trial of scar. Immediate emergency cesarean sections were performed, where indicated.Results: Out of 592 patients 70.7% were delivered vaginally after previous one cesarean section and 29.3% had emergency cesarean section. Leading indications for repeat cesarean section was fetal distress, failure to progress and scar tenderness. No maternal and fetal complication occurred in our study. The success rate of Trial of labor after one previous cesarean delivery was lower in obese (64.38%) as compared to non-obese women (82.06%) (p<0.001). Women with previous successful vaginal delivery had a success rate of 88.2% compared with 62.25% in women without such a history (OR 4.4; 95% CI 2.7-7.2 p <0.001).Conclusion: Vaginal birth after one lower segment cesarean section should be encouraged with vigilant monitoring provided no obstetric contra-indication to vaginal birth exists.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.546-550

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Postpartum Depression: Is Mode of Delivery a Risk Factor?

ISRN Obstetrics and Gynecology ◽

10.5402/2012/616759 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 39

Author(s):

Asli Goker ◽

Emre Yanikkerem ◽

M. Murat Demet ◽

Serife Dikayak ◽

Yasemin Yildirim ◽

...

Keyword(s):

Postpartum Depression ◽

Cesarean Section ◽

Mode Of Delivery ◽

Healthcare Providers ◽

Depression Scale ◽

Family Type ◽

Elective Cesarean Section ◽

Emergency Cesarean ◽

Significant Difference ◽

History Of

There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinburgh postnatal depression scale (EPDS) was applied. There was no significant difference between EPDS scores when compared according to age, education, gravidity, wanting the pregnancy, fear about birth, gender, family type, and income level (). Those who had experienced emesis during their pregnancy, had a history of depression, and were housewives had significantly higher EPDS scores (). Delivering by spontaneous vaginal birth, elective Cesarean section, or emergency Cesarean section had no effect on EPDS scores. In conclusion healthcare providers should be aware of postpartum depression risk in nonworking women with a history of emesis and depression and apply the EPDS to them for early detection of postpartum depression.

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