scholarly journals EPIDURAL ANALGESIA DURING VAGINAL DELIVERY AT THE WOMEN WITH THE UTERINE SCAR. IS IT RISKY? POSSIBLE? NECESSARY?

2017 ◽  
Vol 11 (3) ◽  
pp. 182-188
Author(s):  
K. A Bozhenkov ◽  
T. A Gustovarova ◽  
A. N Ivanyan ◽  
V. L Vinogradov ◽  
E. M Shifman
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
Vaginal Delivery ◽  
Total Duration ◽  
Perinatal Outcomes ◽  
Pain Syndrome ◽  
Comparative Assessment ◽  
Group A ◽  
Uterine Scar ◽  
Group B

This paper will be concerned with the results of a prospective controlled longitudinal study which has involved 132 secundiparae (among them 69 patients are with the uterine scar after cesarean section). The parturient women have been divided into 3 groups. Group “A” includes 38 women with the uterine scar after cesarean section, in this group epidural analgesia was administered during vaginal delivery. Group “B” includes 32 secundiparae without uterine scar, in this group epidural analgesia was administered during vaginal delivery. Group “C” - 31 women with the uterine scar, no epidural analgesia was administered during vaginal delivery. Based on a comparative assessment of the pain syndrome intensity in labor according to the visual analogue scale, the research has proved that delivery at the women with the uterine scar is accompanied by statistically more significant pain than at the women without uterine scar. The necessity of analgesia during vaginal delivery at the women with the uterine scar has been proved. The effectiveness and safety of epidural analgesia at patients with the uterine scar have been analyzed. It has been proved that epidural analgesia provides anesthesia during vaginal delivery at the women with the uterine scar, while it does not affect the total duration and course of labor, maternal and perinatal outcomes, and does not mask the clinical picture of the uterine rupture threat.

scholarly journals Oral and vaginal route of misoprostol for induction of labour: a comparative study

2019 ◽  
Vol 8 (5) ◽  
pp. 1956
Author(s):  
Deepti D. Sharma ◽  
Kavita A. Chandnani
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Induction Of Labour ◽  
Vaginal Route ◽  
Oral Misoprostol ◽  
Group A ◽  
The Mean ◽  
Vaginal Misoprostol ◽  
Group B ◽  
To Receive

Background: Induction of labour can be defined as “Artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods, for purpose of vaginal delivery.” The key factor for a successful induction is the status of cervix, its form, consistency and dilatation which is determined by the Bishop score. In case of unfavourable cervix or in the pregnancies remote from the term; prostaglandins are more effective than any other method of induction. Introduction of misoprostol, PGE1 analogue, for the induction of labour in 1993 and its approval for clinical use by ACOG (American College of Obstetrics and Gynecology) in 1999 has been the most significant advancement. It is the latest drug for induction of labour which is cheap and stable at room temperature and is being used worldwide in different doses and by various routes. We compared the most commonly preferred two routes; vaginal and oral in terms of success of induction and noted the adverse events and side effects in both routes.Methods: This was a prospective comparative study carried out at SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, Vadodara, Gujarat, 200 patients who required induction of labour were recruited after applying inclusion and exclusion criteria and were randomly divided in two groups- Group A meant to receive 50µg oral misoprostol, Group B - meant to receive 25µg vaginal misoprostol repeated 4 hourly up to maximum of five doses. Progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcomes and complications were observed.Results: The mean induction to delivery interval was significantly less in vaginal group than oral (23.3±12.4 hours in oral vs. 17.3±10 hours in vaginal). Vaginal delivery and cesarean section rates were comparable in both groups (76% in Group A vs. 72% in Group B for vaginal delivery, 18% vs. 20% for Cesarean section, respectively). 58% patients in Group A required more than two doses as compared to 39% in group B, though the difference was statistically not significant. Significant number of patients required added oxytocin administration in Group A (72%). No major complications or adverse events were observed. Neonatal hyperbilirubinemia was seen more in Group A.Conclusions: Both Oral misoprostol in a dose of 50μg and vaginal misoprostol 25 μg every four hours, to a maximum of five doses, have the potential to induce labour safely and effectively. The vaginal route however is beneficial in effecting delivery in lesser time with few numbers of doses as compared to oral route.

The Effective and Safety Use of the Epidural Analgesia at Vaginal Delivery in the Women with the Uterine Scar

10.12737/9077 ◽  
2015 ◽  
Vol 22 (1) ◽  
pp. 50-56
Author(s):  
Виноградов ◽  
V. Vinogradov ◽  
Густоварова ◽  
T. Gustovarova ◽  
Боженков ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
Vaginal Delivery ◽  
Epidural Anesthesia ◽  
Apgar Score ◽  
Negative Effects ◽  
Birth Canal ◽  
Clinical Hospital ◽  
Natural Birth ◽  
Uterine Scar

The frequency of the Cesarean section leads to increase number of the patients with the scar on the uterus. In the Clinical hospital № 1 (Smolensk, Russia) the childbirth is carried out through natural birth canal on the women having a reliable scar on the uterus. The analysis of the vaginal delivery and labour outcomes in 69 patients with the scar on the uterus is carried out. The childbirth in 38 patients was conducted with the epidurals, in 31 patients – without this type of anesthesia. The efficiency and safety of the epidural anesthesia are shown. The obtained results confirm that the epidural anesthesia doesn´t complicate the labour, doesn´t increase the hospitalization term, doesn´t influence the bleeding and negative effects on the fetus condition and the newborn assessment according to Apgar score. The possibility of using epidural anesthesia at childbirth on the women with uterine scar during the dystocia is shown.

scholarly journals Comparison of Success Rate of Vaginal Birth after Cesarean Between Women with Lower Segment Uterine Scar Thickness more than and less than 3.5mm

2021 ◽  
Vol 15 (1) ◽  
pp. 17-20
Author(s):  
Robina Ali
Keyword(s):  
Cesarean Section ◽  
Case Series ◽  
Sampling Technique ◽  
Thickness Measurement ◽  
Vaginal Birth ◽  
Case Series Study ◽  
Group A ◽  
Uterine Scar ◽  
Group B ◽  
Series Study

Background: Although scar thickness is been used for predicting vaginal birth among women with previous one cesarean section but which women are good candidates for VBAC, the value of applying sonographic LUS thickness measurement in the management of VBAC remains unclear and there are no clear guidelines in this regard. Objective: To determine the frequency of successful vaginal birth after previous one cesarean section and to compare the frequency of vaginal birth after previous one cesarean section in women with scar thickness >3.5 mm compared to those with scar thickness ≤3.5 mm. Study Design: Descriptive, Case-series study. Settings: Department of Obstetrics & Gynecology, DHQ Hospital, Faisalabad. Duration: Six months from December 15, 2017 to June 15, 2018. Methodology: The Non probability, consecutive sampling technique was used in this study. A total of 151 patients in spontaneous labor at term presented to labor room and fulfilling the inclusion criteria were enrolled in this study. After taking informed written consent, the patients were placed randomly into two groups. Group A included all the women with scar thickness >3.5 mm on ultrasonography while Group B included all the women with scar thickness ≤ 3.5mm on ultrasonography. All cases were followed till delivery and outcome variables like vaginal birth was noted. Data was entered and analyzed through SPSS version 21. Results: Mean age was 27.53 ± 4.93 years. Mean gestational age was 39.09 ± 1.13 weeks. Frequency of successful vaginal birth after previous one cesarean section was found in 131(86.75%) patients, whereas there was no VBAC in 20(13.25%) patients. The results of the study showed that women with scar thickness > 3.5 mm were more likely to have vaginal birth (96.65%) versus those with scar thickness ≤3.5mm (79.27%) (P = 0.003). Conclusion: This study concluded that the frequency of vaginal birth after previous one cesarean section in women with scar thickness > 3.5 mm is much higher as compared to those with scar thickness ≤3.5mm.

scholarly journals INDUCTION OF LABOUR

2015 ◽  
Vol 22 (04) ◽  
pp. 385-389
Author(s):  
Munawar Afzal ◽  
Uzma Asif ◽  
Bushra Miraj
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Normal Vaginal Delivery ◽  
P Value ◽  
Lower Segment Cesarean Section ◽  
Group A ◽  
Randomized Control ◽  
Group B ◽  
Present Pregnancy

It is now widely accepted that trial for vaginal delivery should be attempted unlessa genuine indication exists for C- section. Objective: To determine the efficacy of membranesweeping for onset of labor till 41 weeks of gestation and mode of delivery in patients withprevious one cesarean section (C-Section). Study Design: Randomized control trial. Setting:Department of Obstetrics & Gynaecology, Benazir Bhutto hospital, Rawalpindi. Period: Jan2008 to Dec 2008. Methods: Pregnant women with previous one C- section were randomlyallocated to Group-A (sweeping of membrane) and Group-B (no intervention) each having 55patients. There was no absolute indication of cesarean section in present pregnancy. Aftercomplete antenatal examination, tests like CBC, urine DR, BSR, urea, creatitnine, screening forhepatitis B and C were done. In group A, digital sweeping of fetal membranes was started a37 weeks and was done every 3rd day till she went into the labor or she reached 41 weeks. At41 weeks of gestation, if she did not go into labor, induction with prostaglandin or elective Csectionwas done depending upon the bishop score. In group B, patients awaited spontaneousonset of labor till 41 weeks. After 41 weeks induction with prostaglandin or elective C- cesareansection was done. Results: In Group A, 43 (78.18%) patients had onset of labour aftersweeping of membranes while 12 (21.82%) patients had no onset of labour. In Group-B, 28patients (50.90%) had spontaneous onset of labor while 27 (49.10%) had no onset of labours.In Group-A, 34 (61.82%) patients and in Group-B only 14 (25.45%) were delivered vaginally (pValue 0.001). In Group-A, lower segment cesarean section was done in 6 (10.91%) patientswhile in Group-B, 23 (41.82%) had cesarean section (p Value 0.001). Assisted vaginal deliverywas done in 15 (27.27%) in Group-A while 18 (32.73%) patients in Group-B had assistedvaginal delivery (p Value 0.533). Conclusions: In patients with previous one cesarean section,the efficacy of membrane sweeping in terms of onset of labor and normal vaginal delivery issignificantly higher as compared to patients who had no sweeping of membranes.

scholarly journals Obstetric outcome in primigravida with unengaged versus engaged fetal head at term

2020 ◽  
Vol 10 (1) ◽  
pp. 251
Author(s):  
Vandana Sai Sirisha ◽  
Mahantappa A. Chiniwar ◽  
Sharada B. Menasinkai
Keyword(s):  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Total Duration ◽  
The Elderly ◽  
High Risk Group ◽  
P Value ◽  
Fetal Head ◽  
Surgical Interventions ◽  
Group A ◽  
Group B

Background: Labour although a physiological process can present challenges to clinician and patient. Primigravida and nulliparae are obstetric high-risk group, especially the very young and the elderly, where pregnancy and labour must be supervised. The study was done to compare the maternal and fetal outcome in primigravida with unengaged and engaged head at term.Methods: A prospective study was done for a period of 18 months from June 2018 to December 2019 in Department of Obstetrics and Gynaecology Adichunchanagiri Institute of Medical Sciences and Research Center. 100 women with unengaged head at term (group A) and 100 women with engaged head at term (group B) as controls were selected.  All the relevant data was filled in the partogram. Following observations were made, station of fetal head at the onset of labour, course of labour, duration of labour, any medical or surgical interventions or caesarean delivery. Data was analysed by SPSS 20.0 software and p value<0.05 was taken as statistically significant.Results: in group A 49% and 63% in group B had vaginal delivery. 17% of group A and 14% of group B had instrumental vaginal delivery. Caesarean delivery was 34% in group A and 23% in group B. The mean total duration of labour was 13.53 hours in group A and 9.73 hours in group B. P value was 0.000.Conclusions: Duration of labour was more in group A than group B.  Proper supervision and timely intervention in cases with an unengaged head can have vaginal delivery.

COMPARATIVE STUDY OF MATERNALAND NEONATAL OUTCOME OF ELECTIVE INDUCTION OF LABOUR VS EXPECTANT MANAGEMENT AT 40- 40+6 WEEKS OF GESTATION

2021 ◽  
pp. 37-39
Author(s):  
Indrani Mandal ◽  
Bivash Mondal ◽  
Debarshi Jana
Keyword(s):  
Vaginal Delivery ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Instrumental Delivery ◽  
Special Care Unit ◽  
Management Group ◽  
Elective Induction ◽  
Group A ◽  
Group B

OBJECTIVES: To compare and analyse in each group- delivery complications like postpartum haemorrhage, obstetric anal sphincter injury at 40-40+6 Week of Gestation. To compare and analyse in each group- perinatal outcomes, mainly perinatal mortality and special care unit admission. METHODS: This prospective comparative observational study was conducted in the Department of Gynaecology & Obstetrics, R. G. Kar Medical College and Hospital. For my study I had taken a total of 276 mothers whom I had subdivided into 2 groups. Group Ahad 138 mothers who had induction of labour (I) by some method. Remaining 138 mothers were allocated to Group B who had only watchful expectancy with monitoring and labeed as expectant management group(EM). RESULT: In group-A (I), 5(3.6%) patients had instrumental delivery in comparison to group B(EM) which had 15(10.9%) of instrumental delivery. LSCS was also higher in group B i.e 36(26.1%) as compared to group A i.e 25(18.1%). 108(78.3%) mothers had vaginal delivery who were induced whereas 87(63.0%) had vaginal delivery in expectant management group. Therefore, induction group had better outcome in terms of mode of delivery.It was also statistically signicant (p=0.0098). The distribution on the basis of APGAR score at 5 minutes of babies in between two groups was signicant. CONCLUSION: Elective induction at 40+ weeks is associated with a lower rate of caesarean delivery and does not increase the risk of major complications for newborns and can be offered to mothers having low risk and crossed their expected date of delivery.The ACOG says elective induction at 40+ weeks is a reasonable option for healthy women. Induction of labour at 40+ weeks should not be routine for women but it is important to counsel them and let them decide whether they want to be induced and when.

Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

2020 ◽  
Vol 15 ◽  
Author(s):  
Arash karimi ◽  
Jahanbakhsh Nejadi ◽  
Mahnaz Shamseh ◽  
Nooshin Ronasi ◽  
Mehdi Birjandi
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Postoperative Nausea ◽  
Demographic Data ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Group A ◽  
Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

scholarly journals Patient-Controlled Epidural Levobupivacaine with or without Fentanyl for Post-Cesarean Section Pain Relief

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shin-Yan Chen ◽  
Feng-Lin Liu ◽  
Yih-Giun Cherng ◽  
Shou-Zen Fan ◽  
Barbara L. Leighton ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
University Hospital ◽  
Control Regimen ◽  
Background Infusion ◽  
Continuous Background ◽  
American Society ◽  
Group B ◽  
Double Blinded ◽  
American Society Of Anesthesiologists

Purpose.The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study.Methods.We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion.Results.There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups.Conclusion.Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.

scholarly journals Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

2017 ◽  
Vol 6 (7) ◽  
pp. 2836
Author(s):  
Ashima Taneja ◽  
Kamaldeep Arora ◽  
Isha Chopra ◽  
Anju Grewal ◽  
Sushree Samiksha Naik ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Epidural Analgesia ◽  
Comparative Study ◽  
Satisfaction Score ◽  
Epidural Group ◽  
Patient Satisfaction Score ◽  
Vaginal Deliveries ◽  
Group A ◽  
Group B

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group.

scholarly journals Vernix Caseosa Peritonitis after Vaginal Delivery

2013 ◽  
Vol 6 ◽  
pp. CCRep.S12771 ◽  
Author(s):  
Shameema A. Sadath ◽  
Fathiya I. Abo Diba ◽  
Surendra Nayak ◽  
Iman Al Shamali ◽  
Michael F. Diejomaoh
Keyword(s):  
Cesarean Section ◽  
Acute Abdomen ◽  
Vaginal Delivery ◽  
Vacuum Extraction ◽  
Unusual Complication ◽  
Case Presentation ◽  
Vernix Caseosa ◽  
First Case ◽  
Surgical Emergencies ◽  
Uterine Scar

Introduction Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section. Case presentation We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP. Conclusion Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.

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