Association of gloves change and surgical site complications in elective cesarean sections of low-risk pregnancies

Background: Multiparous women who have previously delivered vaginally are generally considered to be at low risk for cesarean section. We aimed to determine the incidence rate and indications for primary cesarean section and operative vaginal deliveries among multiparous women with previous vaginal births. Patients and methods: Multiparous women who had delivered their babies in our clinic between January 2004 and December 2019 were enrolled in this retrospective observational study. The inclusion criteria were as follows: delivery at 37 weeks of gestation or more, singleton pregnancy with a live fetus, had one or more past vaginal deliveries including instrumental vaginal birth, and no history of previous cesarean section. Women with placenta previa, abruptio placentae, severe pregnancy-induced hypertension, and uncontrolled medical diseases were referred to tertiary hospitals and excluded from this study. The frequency of occurrence and indications for cesarean section and vacuum extraction, duration of labor, and the effect of induction of labor on the cesarean section rates were analyzed. Results: A total of 3094 multiparous women were enrolled. Primary cesarean section was performed in 30 women (30/3094=0.97%). The indications for cesarean section included the following: breech presentation in 28 women, myomectomy after the first vaginal birth in one (of 29 elective cesarean sections), and failed vacuum extraction after a prolonged second stage in one (one emergency cesarean section). Vacuum extraction was performed in 61 women (61/3094=2.0%), the indications for which were non-reassuring fetal status (n=38), prolonged 2nd stage of labor (n=10), and narrow pelvic outlet (n=10). Vaginal breech delivery occurred in 11 women. Induction of labor (n=402) did not affect the cesarean section rate. Conclusion: In multiparous women, breech presentation was the main indication for primary cesarean sections, and the cesarean section rate was very low in women with cephalic presentation.

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Norepinephrine as an Alternative in Hypotension Prophylaxis During Cesarean Sectionunder Spinal Anesthesia

QJM ◽

10.1093/qjmed/hcab086.068 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed I Shahin ◽

Ayman M Kamaly ◽

Mohamed Saleh ◽

Ashraf E El-Agamy

Keyword(s):

Blood Pressure ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Hypotensive Effect ◽

Maternal Blood ◽

Cesarean Sections ◽

Fluid Loading ◽

Elective Cesarean ◽

Spinal Hypotension ◽

Maternal Blood Pressure

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Thus we compare the administration of intermittent I.V. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery. Patients and Methods 120 female patients undergoing electiveC.S.were randomly divided into “group-E” for Ephedrine and “group-N” for Norepinephrine. Results Compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

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Assessment of fetal antioxidant and oxidant status during different anesthesia techniques for elective cesarean sections

Journal of Research in Medical Sciences ◽

10.4103/1735-1995.168373 ◽

2015 ◽

Vol 20 (8) ◽

pp. 739 ◽

Cited By ~ 3

Author(s):

Safinaz Karabayirli ◽

EsraAktepe Keskin ◽

Ahmet Kaya ◽

Cemile Koca ◽

Ozcan Erel ◽

...

Keyword(s):

Cesarean Sections ◽

Elective Cesarean ◽

Oxidant Status

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Anandamide Exerts a Differential Effect on Human Placenta Before and After the Onset of Labor

Frontiers in Physiology ◽

10.3389/fphys.2021.667367 ◽

2021 ◽

Vol 12 ◽

Author(s):

Paula Accialini ◽

Cyntia Abán ◽

Tomás Etcheverry ◽

Mercedes Negri Malbrán ◽

Gustavo Leguizamón ◽

...

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Endocannabinoid System ◽

Cesarean Sections ◽

Vaginal Deliveries ◽

Before And After ◽

Elective Cesarean ◽

Main Components ◽

Relevant Finding

The onset of labor involves the action of multiple factors and recent reports have postulated the endocannabinoid system as a new regulator of this process. Our objective was to study the role of anandamide, one of the main endocannabinoids, on the regulation of placental molecules that contribute to the onset of labor at term. Placental samples were obtained from patients with laboring vaginal deliveries and from non-laboring elective cesarean sections. Vaginal delivery placentas produced higher prostaglandins levels than cesarean section samples. Besides, no differences were observed in NOS basal activity between groups. Incubation of vaginal delivery placentas with anandamide increased prostaglandins concentration and decreased NOS activity. Antagonism of type-1cannabinoid receptor (CB1) did not alter the effect observed on NOS activity. Conversely, incubation of cesarean section placentas with anandamide reduced prostaglandins levels and enhanced NOS activity, the latter involving the participation of CB1. Furthermore, we observed a differential expression of the main components of the endocannabinoid system between placental samples, being the change in CB1 localization the most relevant finding. Our results suggest that anandamide acts as a modulator of the signals that regulate labor, exerting differential actions depending on CB1 localization in laboring or non-laboring term placentas.

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LB 2: Study To Reduce Infection Prior to Elective Cesarean Sections (STRIPES): Double blind RCT using CHG cloths

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.11.1276 ◽

2020 ◽

Vol 222 (1) ◽

pp. S756-S757

Author(s):

Joanne Stone ◽

Angela Bianco ◽

Johanna Monro ◽

Jessica Overbey ◽

Julie Cadet ◽

...

Keyword(s):

Cesarean Sections ◽

Double Blind ◽

Elective Cesarean

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Analgesic Effect Comparison Between Nalbuphine and Sufentanil for Patient-Controlled Intravenous Analgesia After Cesarean Section

Frontiers in Pharmacology ◽

10.3389/fphar.2020.574493 ◽

2020 ◽

Vol 11 ◽

Author(s):

Shen Sun ◽

Yundong Guo ◽

Tingting Wang ◽

Shaoqiang Huang

Keyword(s):

Adverse Events ◽

Cesarean Section ◽

Analgesic Effect ◽

Receptor Agonist ◽

Cesarean Sections ◽

Pain Scores ◽

Intravenous Analgesia ◽

Degree Of Satisfaction ◽

Elective Cesarean ◽

Κ Receptor

Background: Efficient maternal pain relief after cesarean delivery remains challenging, but it is important to improve outcomes for the mother and the newborn during the puerperium. We compared the analgesic effect of nalbuphine (a κ receptor agonist/μ receptor antagonistic) with that of sufentanil (a µ-receptor agonist) in patient-controlled intravenous analgesia (PCIA) after cesarean section.Methods: We enrolled 84 patients scheduled for elective cesarean sections with spinal anesthesia and randomized them into either nalbuphine or sufentanil groups (42 patients each). Pain scores, PCIA drug consumptions, degree of satisfaction, and adverse events were recorded as outcome measures.Results: The pain scores at rest and uterine cramping pain scores in the nalbuphine group were lower than those in the sufentanil group at 6, 12, and 24 h after the operation. Also, the pain scores while switching to a seated position were lower in the nalbuphine group than in the sufentanil group at 6 and 12 h after the operation (p < 0.05). We found no significant differences in the PCIA drug consumption between the two groups. The degree of satisfaction in patients in the nalbuphine group was higher than that of patients in the sufentanil group (p = 0.01). Adverse events did not differ in the two groups.Conclusion: PCIA with nalbuphine provides better analgesia and higher patient satisfaction than sufentanil after cesarean section.

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Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries?

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.364 ◽

2019 ◽

Vol 35 (1) ◽

Author(s):

Necati Hancerliogullari ◽

Selen Yaman ◽

Rifat Taner Aksoy ◽

Aytekin Tokmak

Keyword(s):

Placenta Previa ◽

Low Risk ◽

Neonatal Outcomes ◽

Late Preterm ◽

Cesarean Sections ◽

Intraperitoneal Adhesions ◽

Group I ◽

Significant Difference ◽

Maternal And Neonatal Outcomes ◽

Group Ii

Objective: To compare surgical complications and maternal and neonatal outcomes of low-risk, late preterm and term pregnant women who have had one or two previous cesarean sections (CSs) with those who have had three or more CSs. Methods: We conducted a retrospective study of 850 patients undergoing repeat CS at a tertiary level maternity hospital in Ankara, Turkey. Of those, 380 had previously undergone one or two CSs (Group-I: second or third CS) and 470 had previously undergone three or four CSs (Group-II: fourth or fifth CS). Outcomes and complications were compared between the groups. Results: The two groups were statistically significantly different in terms of maternal age, parity, body mass index, maternal weight gain during pregnancy, and length of hospital stay (all p<0.001). Although the prevalence of intraperitoneal adhesions and placenta previa was higher in Group-II than in Group-I (p<0.001), there was no statistically significant difference in terms of cesarean hysterectomy and adjacent organ injuries (p>0.05). There were also no significant differences between the groups in terms of neonatal outcomes (p>0.05). Conclusion: Although the increase in the number of CSs appears to be associated with intraperitoneal adhesions and placenta previa, adverse maternal and neonatal outcomes were not observed in those women with low-risk pregnancies who underwent CS for the fourth or fifth time. Therefore, fourth and fifth CSs may be considered relatively safe surgical procedures in this cohort. How to cite this:Hancerliogullari N, Yaman S, Aksoy RT, Tokmak A. Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries? Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.364 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Safety of Scar on Repeat Second Cesarean Section in Patients with Previous One Cesarean Section

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1024 ◽

2009 ◽

Vol 1 (2) ◽

pp. 26-28

Author(s):

Shahnaz Kouser ◽

Shaheen Kouser ◽

Bushra Anwar

Keyword(s):

Cesarean Section ◽

Tertiary Care ◽

Teaching Hospitals ◽

Cesarean Sections ◽

Previous Cesarean Section ◽

Medical Disorders ◽

Elective Cesarean ◽

One Year ◽

Operative Findings ◽

Previous Cesarean

ABSTRACT Objective To evaluate the safety and integrity of scar at repeat cesarean section, in patients with previous one cesarean section performed at different settings. Study design A reterospective study in a tertiary care obstetric unit over a period of one year (2006). Material and methods All patients with previous one cesarean section, undergoing emergency and elective cesarean sections were enrolled at our institution. The variables noted were age, parity, residential area, location of previous cesarean section and associated complaints, e.g uterine contractions, vaginal leaking/ bleeding and comorbid medical disorders. Outcome measures Operative findings in terms of thinning of scar, dehiscence or rupture were recorded. The effects of skill level of surgeon and set-up of previous cesarean section were analyzed. Results Two hundred and seventy cesarean sections were performed for different indications in patients with previous one cesarean section over a period of one year. Out of all patients, extreme thinning of scar was noted in 36 (13.3%) patients. Seven patients(2.6%) had scar dehiscence. Only 3 (42.8%) patients with scar dehiscence had associated complaint of scar tenderness, while 22 (61%)of 36 cases of scar thinning were having scar tenderness. All 7 cases of scar dehiscence had their previous cesarean sections at teaching hospitals. No patient underwent hysterectomy and all patients with scar dehiscence had successful repair. Conclusion The study concludes relatively inadequate scar thickness rate but at the same time relatively acceptable scar dehiscence rate. Thus it will still be safe to subject the patients to trial of labor after meticulous scrutinization and individualization. At the same time adequate surgical training of doctors (trainees and community doctors) through different formats is recommended.

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