scholarly journals Review of Unsafe Changes in the Practice of Cesarean Section with Analysis of Flaws in the Interpretation of Statistics and the Evidence

2021 ◽  
pp. 1-6
Author(s):  
Shashikant L SHOLAPURKAR ◽  
Shashikant L SHOLAPURKAR
Keyword(s):  
Cesarean Section ◽  
Space Shuttle ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Operating Time ◽  
Numerical Data ◽  
Practice Change ◽  
Peritoneal Closure ◽  
Major Operation ◽  
Elective Cesarean

Cesarean section is the commonest major operation. Unfortunately, many recent practice-changes have been rushed based on flawed interpretation limited data that are debated in this review. The discussion includes non-closure of the peritoneum, the 39-week rule for elective cesarean, incorrect implementation of four-category urgency classification, and abdominal entry with excessive blunt force. It took NASA two fatal space-shuttle disasters over 18 years to change its culture of dismissing reasoning and observations in addition to numerical data. Reasoning becomes even more important when there is emerging data, especially in soft sciences like medicine. This review discusses flawed science behind the change to “non-closure of peritoneum” in details (and other changes briefly). This practice change was based on narrow mistaken considerations and solely on statistical significance, studying irrelevant short-term outcomes like increased requirement of analgesia. Several statistical mistakes in interpreting this evidence with wider applications are discussed. This weak/flawed evidence has been subsequently disproven by large randomized controlled trials. Small reduction in operating time should never have been a consideration. The merit of hypothesis favoring peritoneal closure to prevent adhesions is very strong to begin with. More importantly, the meta-analysis of available studies shows that closing peritoneum significantly reduces the formation of adhesions, particularly the severe ones. Extensive adhesion of uterus to the abdominal wall is relatively rare to reach statistical significance in small studies but is clinically highly significant due to operative complications. The rushed mistaken recommendation of non-closure of peritoneum should not have been made. However, reversing these changes is perceived as admitting errors, and there is simply no interest in doing so with detriment of the patients. Guidelines should now change their advice on many important aspects of cesarean, as discussed in this review.

Is elective cesarean section associated with a higher risk of asthma? A meta-analysis

2014 ◽  
Vol 52 (1) ◽  
pp. 16-25 ◽  
Author(s):  
Lisu Huang ◽  
Qian Chen ◽  
Yanjun Zhao ◽  
Weiye Wang ◽  
Fang Fang ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Meta Analysis ◽  
Elective Cesarean Section ◽  
Elective Cesarean

scholarly journals Gastrectomy and D2 Lymphadenectomy for Gastric Cancer: A Meta-Analysis Comparing the Harmonic Scalpel to Conventional Techniques

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Hang Cheng ◽  
Chia-Wen Hsiao ◽  
Jeffrey W. Clymer ◽  
Michael L. Schwiers ◽  
Bryanna N. Tibensky ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Harmonic Scalpel ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Operating Time ◽  
Hospital Length Of Stay ◽  
Sensitivity Analyses ◽  
Continuous Variables ◽  
Complication Risk ◽  
Study Results

The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation. To evaluate its use in gastrectomy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing the Harmonic scalpel to conventional techniques in gastrectomy for patients with gastric cancer. International databases were searched without language restrictions for comparisons in open or laparoscopic gastrectomy and lymphadenectomy. The meta-analysis used a random-effects model for all outcomes; continuous variables were analyzed for mean differences and dichotomous variables were analyzed for risk ratios. Sensitivity analyses were conducted for study quality, type of conventional technique, and imputation of study results. Ten studies (N=935) met the inclusion criteria. Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (−27.5 min;P<0.001), intraoperative blood loss (−93.2 mL;P<0.001), and drainage volume (−138.8 mL;P<0.001). Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance. Results remained robust to sensitivity analyses. This meta-analysis demonstrates the clear advantages of using the Harmonic scalpel compared to conventional techniques, with improvements demonstrated across several outcome measures for patients undergoing gastrectomy and lymphadenectomy.

scholarly journals Comparison of Anesthesia Techniques Used in Cesarean Deliveries on the Neonate - Anesthesia Techniques and Neonate?

2019 ◽  
Vol 5 (1) ◽  
pp. 014-021
Author(s):  
Bedih Balkan ◽  
Mehmet can Ozbas ◽  
Furkan Tontu ◽  
Gunes Ozlem Yıldız ◽  
Gulsum Oya Hergunsel ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Statistical Significance ◽  
Elective Cesarean Section ◽  
Cesarean Deliveries ◽  
Elective Cesarean ◽  
Thiopental Sodium

Background: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn, research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. Methods: This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1 rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl. Results: There were no significant differences between Group SA, Group P, and Group T in terms of delivery time; neonatal 1- and 5-min Apgar scores; neonatal jaundice rates; neonatal systolic, diastolic, or mean blood pressure or peak heart rate; neonatal intensive care requirement; pH, PCO2, PO2 values in cord blood gas; or neonatal glucose and lactate values. The rate of ephedrine use was significantly higher in Group SA than in Group P and Group T. Maternal satisfaction score was higher in Group SA at postoperative 4 hours and in Group P at 24 hours. The number of newborns taken into intensive care unit in Group T was significantly higher in the 1st hour, 4th hour, 5th hour and total. Respectively p value (0.006, 0,048, 0,048, and 0,005). Pain on injection was present in 55% of patients (n = 81), mild in 36% (n = 54), and severe in 18% (n = 27). Myoclonies occurred in 4% of patients (n = 7) and local rash in 6% of patients (n = 10). Differences between formulations did not reach statistical significance. Conclusion: None of the three anesthesia methods showed superiority after elective cesarean delivery. However, spinal anesthesia and general anesthesia with propofol are more appropriate for pregnant women in terms of effects on the neonate.

scholarly journals Elective versus Emergency Cesarean Sections : Mother and Fetal Outcome

2021 ◽  
pp. 90-94
Author(s):  
Christofer J. H. Ladja ◽  
IMS Murah Mano ◽  
Andi M. Tahir ◽  
St. Maisuri T. Chalid
Keyword(s):  
Cesarean Section ◽  
Operating Time ◽  
Total Duration ◽  
Fetal Outcome ◽  
Elective Cesarean Section ◽  
Cesarean Sections ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Elective Cesarean ◽  
History Of

Objective: To compare the outcomes of mothers and newborns in emergency cesarean section and elective cesarean section.Methods: A prospective cohort study included 120 pregnant women consists of 60 women who performed an emergency cesarean section and 60 women who underwent elective cesarean section. Age, education level, occupation, income, history of comorbidities, history of abortion or miscarriage, antenatal care history, decision-making time until surgery is performed along with other components required, duration of operation, outcome of mother and fetal were obtained through interviews and questionnaires. Data were analyzed regarding fetal outcome and cesarean sections indications.Results: The maternal and fetal outcome between emergency and elective cesarean section were not significantly  different regarding on hospital stay, dehiscence, NICU admission, Apgar score and newborn status (dead or alive). Blood transfusion is the main difference signifi cant indication for maternal outcome between emergency and elective procedure (p less than 0.05). The total duration of procedure  less than 60 or more than 60 minutes and maternal-fetal outcome not signifi cantly different between two type of procedures.Conclusions: Emergency cesarean section at preterm gestational age with an operating time less than equal to 60 minutes leads to greater transfusion blood requirements compared with elective cesarean section.Keywords: emergency cesarean section, elective cesareansection, mother-infant outcome. AbstrakTujuan: Membandingkan luaran ibu dan bayi baru lahir di seksio sesarea emergensi dan elektif.Metode: Penelitian kohort prospektif melibatkan 120 perempuan hamil terdiri atas 60 perempuan yang melakukan operasi seksio sesarea emergensi dan 60 perempuan melakukan operasi elektif. Usia, tingkatpendidikan, pekerjaan, pendapatan, riwayat komorbiditas, riwayat aborsi atau keguguran, riwayat asuhan antenatal, waktu pengambilan keputusan sampai operasi dilakukan bersamaan dengan komponen lain yang diperlukan, lamanya operasi, luaran ibu dan bayi diperoleh melalui wawancara dan kuesioner. Data yang dianalisis mengenai luaran ibu dan bayinya.Hasil: Luaran ibu dan bayi antara seksio sesarea emergensi dan elektif tidak berbeda bermakna dalam hal lama rawat inap, dehisensi, admisi, skor Apgar dan status bayi baru lahir (meninggal atau hidup). Transfusi darah adalah indikasi penting utama yang berbeda untuk luaran ibu antara prosedur emergensi dan elektif (p kurang dari 0,05). Durasi total prosedur kurang dari 60 atau lebih dari 60 menit dan luaran ibu tidak berbeda secara signifikan antara kedua jenis seksio sesarea.Kesimpulan: Tindakan seksio sesarea emergensi pada usia gestasi prematur dengan waktu operasi kurang dari sama dengan 60 menit menyebabkan kebutuhan transfusi darah lebih besar dibandingkan seksio sesarea elektif.Kata kunci: luaran ibu-bayi, seksio sesarea elektif, seksio sesarea emergensi.

Propofol Versus Barbiturates as an Inducing Agent in Elective Cesarean Section: Systematic Review and Meta-Analysis

2021 ◽  
Vol 01 (01) ◽  
Author(s):  
Marcelino Sánchez Tamayo ◽  
Miguel Liván Sánchez Martín ◽  
Eivet García Real ◽  
Dianamary Brito Herrera ◽  
Lisbet Díaz Fonseca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cesarean Section ◽  
Meta Analysis ◽  
Elective Cesarean Section ◽  
Elective Cesarean

Acute Dystonia after a Single Dose of Intravenous Metoclopramide during Elective Cesarean Section: A Case Report.

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Danielle Levin
Keyword(s):  
Single Dose ◽  
Case Report ◽  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Elective Cesarean Section ◽  
Single Administration ◽  
Dystonic Reaction ◽  
Elective Cesarean ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We would like to present the first report of severe acute dystonic reaction after a single administration of metoclopramide during cesarean section under combined spinal-epidural anesthesia.  During elective cesarean section, a 30-year-old female vomited four times and was treated with 10mg intravenous metoclopramide and 8mg intravenous ondansetron.  Nausea subsided with the antiemetic treatment, but two minutes later, patient had rapid eye blinking, uncontrollable head movement, and became unresponsive.  Bolus of 50mg intravenous diphenhydramine resolved the acute dystonic symptoms within seconds.  Patient was again oriented times three, with no recollection of symptoms, and remained symptom free for the rest of admission. 

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