scholarly journals Pengelolaan Anestesi untuk Seksio Sesarea Kehamilan Triplet dengan Skor LAS Intraoperatif 6

2021 ◽  
Vol 4 (1) ◽  
pp. 35-42
Author(s):  
Dewi Yulianti Bisri ◽  
Tatang Bisri
Keyword(s):  
Caesarean Section ◽  
Apgar Score ◽  
Postpartum Hemorrhage ◽  
Suture Technique ◽  
Analog Scale ◽  
Triplet Pregnancy ◽  
Singleton Pregnancy ◽  
Multiple Gestations ◽  
Linear Analog ◽  
Minute Interval

Triplet (kembar tiga) dan kehamilan kembar yang lebih banyak lagi (higher multiple gestations) dihubungkan dengan peningkatan morbiditas ibu dan anak dibandingkan dengan kehamilan ganda atau kehamilan tunggal. Seksio sesarea adalah rute yang disukai untuk melahirkan pasien dengan kehamilan triplet. Seorang wanita, 31 tahun, G1P0A0 gravida aterm triplet hasil inseminasi, BB 72,5 kg, TB 168 cm, Mallampati 1, tekanan darah 130/90 mmHg, laju nadi 97x/menit, SpO2 100% dengan kanul binasal. Induksi dengan propofol 140 mg, atracurium 35 mg, intubasi dengan pipa endotrakheal no 6,5. Ventilasi mekanik dengan volume tidal 560 mL, laju nafas 12 x per menit, postive end expiratory pressure (PEEP) 5. Rumatan anestesi dengan N2O 40%, sevofluran 1-2 vol%. Analgetik fentanyl 100 ug diberikan setelah bayi lahir. Cairan RL 1500 mL, gelofusin 500 mL. Obat-obat lain: misoprostol 800 mcg perrectal, oxytocin 40 IU, methylergometrine 0,6 mg, asam traneksamat 1 gram, dextrose 40% 25 mL. Bayi ke-1 BB 2650 gr, pada jam 19.1, Apgar score 1 menit dan 5 menit 9, 10, Bayi ke-2 BB 2100 gr, Apgar score 1 menit dan 5 menit 9, 10, Bayi ke-3 BB 1900 gr, Apgar score 1 menit dan 5 menit 9, 10 lahir selang 1 menit. Tidak terjadi hipotensi, dan karena skor linear analog scale (LAS) 4-6 setelah terapi medikal maka dilakukan pengikatan uterus dengan tehnik B-Lynch suture, tidak terjadi postpartum hemorrhage, Hb postoperatif 10 g/dL, hematokrit 29%, tidak dilakukan transfusi darah. Analgetik pascabedah dengan petidin 100 mg dan dexketoprofen 100 mg dilarutkan dalam NaCl 0,9% 500 mL yang diberikan untuk 24 jam.   Anesthesia Management for Caesarean Section Triplet Pregnancy with Intraoperative LAS Score 6 Abstract Triplet and higher multiple gestations associated with increase maternal and fetal morbidity compare with twin or singleton pregnancy. Caesarean section is route for delivery patient with triplet gestations. A woman, 31 years, G1P0A0 gravida aterm triplet insemination result, BW 72,5 kg, height 168 cm, Mallampati 1, blood pressure 130/90 mmHg, heart rate 97x/minute, SpO2 100% with canul binasal. Induction anesthesia with propofol 140 mg, atracurium 35 mg, intubated with endotracheal tube no 6,5. Mechanical ventilation with tidal volume 560 mL, respiratory rate 12 x per minutes, postive end expiratory pressure (PEEP) 5. Maintenance anesthesia with N2O 40%, sevoflurane 1-2 vol%. Analgetic fentanyl 100 ug given after baby delivery. Fluids with RL 1500 mL, gelofusin 500 mL. Other drugs are misoprostol 800 mcg perrectal, oxytocine 40 IU, methylergometrine 0.6 mg, tranexamic acid 1 gram, dextrose 40% 25 mL. First baby BW 2650 gr, Apgar score 1 minute and 5 minute 9, 10 at 19.21, second baby BW 2100 gr, Apgar score 1 minute and 5 minute 9, 10, third baby BW 1900 gr, Apgar score 1 minute and 5 minute 9, 10 delivered 1 minute interval. No evidence of hypotension and linear analog scale (LAS) score is 4-6 and so needed uterus binding with B-Lynch suture technique, no evidence of postpartum hemorrhage, postoperative Hb 19 g/dL, hematocrit 29%, no blood transfusion. Postoperative analgesia with petidine 100 mg and dexketoprofen 100 mg in NaCl 0,9% 500 mL for 24 hours.

scholarly journals Pregnancy Outcome of Single Previous cesarean Section

1970 ◽  
Vol 7 (1) ◽  
pp. 25-28 ◽  
Author(s):  
M Jha
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Apgar Score ◽  
Postpartum Hemorrhage ◽  
Elective Caesarean Section ◽  
Previous Caesarean Section ◽  
Cephalopelvic Disproportion ◽  
Main Indication ◽  
Assisted Delivery ◽  
Vacuum Delivery

Background: The main aim of this study is to determine the maternal and fetal outcome of pregnancy among women with one previous caesarean section at term in relation to vaginal delivery, post partum complication, neonatal complication like low Apgar score, fetal weight and admission in special baby unit. Methods: This is a prospective and descriptive study done in a sample size of 100. Inclusion criteria were term pregnancy, single live fetus with cephalic presentation with one previous caesarean section. During study period total number of obstetric admissions was 3546 and 115 cases were admitted with previous one caesarean section. Result: Out of 100 cases, 31 cases had vaginal delivery and 69 cases had caesarean section. Among 31 vaginal deliveries, 24 cases had spontaneous vaginal delivery and 7 had assisted delivery with vacuum, main indication of vacuum delivery was to cut short the second stage of labor that was in 5(71.43%) cases. Among 69 caesarean section cases, 51 had emergency caesarean section and 18 had elective caesarean section and cephalopelvic disproportion was the main indication in both the groups. Most common complication was scar dehiscence and postpartum hemorrhage. There were two still births in each group and one minute APGAR score was slightly better in caesarean section. Conclusions: Patients with previous caesarean section are at high risk of repeat emergency or elective caesarean section. About one in three patients with previous caesarean section delivered vaginally. In the present study postpartum hemorrhage was the commonest complication, which was found in caesarean section, and only  one puerperal pyrexia was seen in case of vaginal delivery. Key words: Cephalopelvic disproportion, Premature rupture of membrane, Septicemia, Vacuum delivery   DOI: 10.3126/jnhrc.v7i1.2275 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 25-28

Advanced Maternal Age and Pregnancy Outcome at Manipal Teaching Hospital: Cross-sectional Analytical study

2021 ◽  
Vol 6 (1) ◽  
pp. 20-25
Author(s):  
Vibha Mahato ◽  
Pravin Shrestha ◽  
Pradeep Bhattarai
Keyword(s):  
Caesarean Section ◽  
Postpartum Hemorrhage ◽  
Perinatal Outcome ◽  
Maternal Age ◽  
Analytical Study ◽  
Fetal Distress ◽  
Advanced Maternal Age ◽  
Age Group ◽  
Cross Sectional ◽  
Very Advanced Maternal Age

Introduction: Advanced and very advanced maternal age are associated with several adverse maternal and fetal outcome. The objective of this study was to find out the possible association between advance maternal age and adverse pregnancy outcomes at Manipal Teaching Hospital.Methods: A cross sectional analytical study conducted at department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara, Nepal. A total of 198 patient who were ≥30 years and >24 weeks pregnant admitted in obstetric ward were selected. These patient were divided into three groups according to their age (30-34, 35-39 and ≥ 40years). We compared the incidence of adverse maternal and perinatal outcome among these groups. We also calculated odds ratio of maternal and perinatal outcomes in 35-39 years and ≥ 40years women, compared with women aged 30-34 years.Results: Comparison of the three age groups revealed that advanced maternal age constitute a predisposing factor for malpresentation, gestational diabetes mellitus, placenta previa, fetal distress and caesarean section. Whereas, risk of non progress of labour, preterm birth, postpartum hemorrhage, perinatal death and congenital anomalies were increased in very advanced maternal age group. From these, statistical significance was reached in case of greater risk of malpresentation (p=0.01,OR=6.66), fetal distress (p=0.04, OR=2.6) and caesarean section(p=0.02,OR=2.06) in advanced age group when compared to the patients aged 30-34. Furthermore, very advanced age group were higher risk of postpartum hemorrhage (p=0.03, OR=2.47) and congenital anomalies, which were statistically significant (p=0.04, OR=29.57) when compared to the 30-34 years.Conclusion: Advanced and very advanced maternal age is associated with several adverse maternal and perinatal outcome. The risk of perinatal complication begin to increase after the age of 35 but significantly increased after 40 years.

scholarly journals Influence of Spinal and General Anesthesia on Newborn’s Status

2015 ◽  
Vol 69 (2) ◽  
pp. 65-70
Author(s):  
Emilija Ivanov ◽  
Dafina Karadzova ◽  
Sotir Nikolovski ◽  
Atanas Sivevski ◽  
Kiro Curlinov ◽  
...  
Keyword(s):  
Caesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Base Excess ◽  
Rocuronium Bromide ◽  
Apgar Scores ◽  
Ph Values ◽  
Vital Parameters

AbstractIntroduction. The number of caesarean sections has drastically increased and thus arose the idea to examine the effect of the type of anesthesia on the neonates. The objective was to compare vital parameters in the neonates, born under general and spinal anesthesia.Method. A total of 120 patients with need for caesarean section have been divided in two groups of 60, of which the first was lead in general and the second one in spinal anesthesia. The first one was given propophol (2.0-2.5 mg/kg/tt) and succinil colin (1-1.5 mg/kg/tt). The anesthesia was lead with fentanil 0,005 mg/kg/tt and rocuronium bromide 0.4-0.6 mg/kg/tt. O2:N2O was 3:3 l/min. The second group was lead in spinal anesthesia. 2-3 ml Bupivacain 0.5% was spinally applied between L2-L3. Apgar score was defined in the neonates in the first and fifth minutes. The acido-basic status of the neonate was examined through pH values in the blood and the base excess.Results. In the first minute after birth giving with Apgar, 8 newborns 37(61,67%) were born to the group of patients with SA and 29 (48.33%) to the group of patients with GA. In 11 (18.33%) newborns born to the patients led with SA had Apgar score of 9-10, while only 3 (5%) of the newborns born to the patients led with GA had Apgar score of 9-10. Similar ratio was noted in the fifth minute after birth. Ph of the newborns’ blood as well as the base excess (BE) demonstrated significantly lower values in the group of patients led with SA than in the group of patients led with GA. Ph = 7.33 vs 7.37; BE=-4.57±1.8 vs -2.96±2.3.Conclusion. The newborns from the second group had significantly higher Apgar scores than those in the first group. The newborns’ relative acidose (lower SpO2and BE) did not affect the newborns’ Apgar score in the first and fifth minute.

scholarly journals A Case of BeckwithWiedemann Syndrome with Polyhydramnios

2017 ◽  
pp. 185
Author(s):  
Yusrawati Yusrawati ◽  
Reno Muhatiah
Keyword(s):  
Birth Weight ◽  
Prenatal Diagnosis ◽  
Caesarean Section ◽  
Apgar Score ◽  
Rare Case ◽  
Obstet Gynecol ◽  
Fetal Distress ◽  
Polycystic Kidney ◽  
Prenatal Diagnostic ◽  
Female Baby

Objective: To report a rare case of Beckwith-Wiedemann Syndrome with polyhydramnios. Methods: Reporting a case of Beckwith-Wiedemann syndrome with polyhydramnios. Results: Case of Mrs. Y, 27 years old woman, G2P1A0L1 preterm pregnancy (30-31 weeks) with polyhidramnios. From ultrasound found renomegaly, bilateral hyperechogenic polycystic kidney, and the karyotype result was 46,XX. Caesarean section was performed due to fetal distress. A female baby was born by caesarean section with birth weight of 1300 grams, 37 centimeters of body length, and APGAR score of 6/8. The congenital anomalies found were hepatomegaly, renomegaly, bilateral hyperechogenic renal polycystic, low set ears. The baby was died in NICU on day care 5th, with suspected of sepsis. Conclusion: Prenatal diagnosis of Beckwith-Wiedemann syndrome on fetus with polyhydramnios. [Indones J Obstet Gynecol 2017; 5-3: 185-188] Keywords: amniocentesis, beckwith-wiedemann syndrome, polyhydramnios, prenatal diagnostic, USG

scholarly journals MATERNAL COMPLICATIONS OF MULTIPLE GESTATIONS IN SECOND AND THIRD TRIMESTER OF PREGNANCY.

1969 ◽  
Vol 5 (1) ◽  
pp. 591-596
Author(s):  
SAIMA KHATTAK ◽  
MUHMMAD BILAL AWAN ◽  
MUHMMAD DANYAL AWAN
Keyword(s):  
Twin Pregnancy ◽  
Reproductive Technologies ◽  
High Order ◽  
Multiple Gestation ◽  
Third Trimester ◽  
Triplet Pregnancy ◽  
Maternal Complications ◽  
Multiple Gestations ◽  
Risk Pregnancy

BACKGROUND: In recent times, the incidence of multiple pregnancies has significantly increased dueto medication for induced ovulation and other reproductive technologies. The present study is designedto see the maternal complication of multiple gestations in pregnancy.OBJECTIVE: To determine the maternal complications associated with multiple gestation in secondand third trimester of pregnancy.METHODOLOGY: This descriptive study was carried out in the department of obstetrics andGynaecology unit at Lady Reading Hospital Peshawar. Duration of the study was 06 months from 1stJanuary 2012 to 1st July 2012. All patients with twin gestations, triplets and high order multiples visitingobstetrics and Gynaecology unit at Lady Reading Hospital Peshawar and who were admitted in wardwere included in the study and after taking informed consent their characteristics were recorded byfilling proforma.RESULTS: Sixty patients with multiple gestations were included in the study. Fifty four (90%) of themhad twin pregnancy and 06 (10%) had triplet pregnancy. The antenatal complications detected in thesepatients were preterm labour 23(32.3%), anaemia 18(30%), pregnancy induced hypertension, preeclamptic toxaemia, eclampsia 13(21.7%), Malpresentation 13(21.7%), Antepartum Haemorrhage 5(8.3%), 5 patients (8.3%) had PROM, 4 (6.7%) had polyhydramnios, 3(5%) had miscarriages, 5 (8.3%)had postpartum haemorrhage, 44(73.3%) patients had spontaneous vaginal delivery and 15(25%)underwent caesarean section. In 28(46.7%) patients cephalic/cephalic was the most commonpresentation.CONCLUSION: Multiple gestation is a high risk pregnancy and is associated with both maternal andfetal complications. Patient needs to be educated about the importance and advantages of early antenatalbooking and regular antenatal follow-up to reduce the risks to the mother and the babies.KEY WORDS: Twin pregnancy, Triplets, High-order multiplets; Complications-Second Trimester,Third trimester.

scholarly journals Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

2014 ◽  
Vol 52 (193) ◽  
pp. 668-676 ◽  
Author(s):  
Meena Pradhan ◽  
Yong Shao
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Uterine Atony ◽  
Previous Caesarean Section ◽  
Peripartum Hysterectomy ◽  
Incidence Risk ◽  
Emergency Peripartum Hysterectomy

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

scholarly journals Uterine torsion of 90 degrees: case report

2020 ◽  
Vol 9 (4) ◽  
pp. 1743
Author(s):  
S. Tanouti ◽  
M. Chakri ◽  
H. Taheri ◽  
H. Saadi ◽  
A. Mimouni
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Emergency Caesarean Section ◽  
Third Trimester ◽  
Singleton Pregnancy ◽  
The Third ◽  
Emergency Caesarean ◽  
Uterine Torsion ◽  
Vaginal Deliveries ◽  
Obstetrical Unit

Uterine torsion is defined as a rotation of uterus more than 45 degrees along its long axis. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice, authors report a case of torsion of the uterus by 90 degrees. The patient, a 30-year-old gravida 3 para 2 at 37 weeks’ gestation with a singleton pregnancy, her prior obstetrical history included two uncomplicated term vaginal deliveries, and the current pregnancy had been uncomplicated until the date of presentation was admitted to the obstetrical unit  with  labour at 37 weeks 5 days ,on obstetric examination the patient was in labour with transversal presentation of the fetus so an emergency caesarean section (CS) was carried out for. At the time of CS, the diagnosis of uterine torsion of 90 degrees was made. After the delivery of the baby, uterus returned to anatomical position and the torsion corrected spontaneously. The patient recovered and was discharged home with her baby on the third postoperative day. Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester.

Impacting Quality of Life for Patients With Advanced Cancer With a Structured Multidisciplinary Intervention: A Randomized Controlled Trial

2006 ◽  
Vol 24 (4) ◽  
pp. 635-642 ◽  
Author(s):  
Teresa A. Rummans ◽  
Matthew M. Clark ◽  
Jeff A. Sloan ◽  
Marlene H. Frost ◽  
John Michael Bostwick ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Analog Scale ◽  
Multidisciplinary Intervention ◽  
Linear Analog

Purpose The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. Patients and Methods Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. Results Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period. Conclusion Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.

scholarly journals Apgar Scoring System in Brazil's Live Births Records: Differences between Home and Hospital Births

2018 ◽  
Vol 41 (02) ◽  
pp. 076-083
Author(s):  
Jordana Bessa ◽  
Naieli Bonatto
Keyword(s):  
Apgar Score ◽  
Hospital Setting ◽  
Home Birth ◽  
Informed Choice ◽  
Singleton Pregnancy ◽  
Apgar Scores ◽  
Unified Health System ◽  
Preliminary Study ◽  
Hospital Births ◽  
Birth Records

Objective To promote informed choice for women and to compare home and hospital births in relation to the Apgar score. Methods Mother's profile and Apgar score of naturally born infants (without forceps assistance) in Brazil between 2011 and 2015, in both settings—hospital or home—were collected from live birth records provided by the Informatics Department of the Unified Health System (DATASUS, in the Portuguese acronym). For the analysis, were included only data from low-risk deliveries, including gestational time between 37 and 41 weeks, singleton pregnancy, at least four visits of prenatal care, infants weighing between 2,500 g, and 4,000 g, mother age between 20-40 years old, and absence of congenital anomalies. Results Home birth infants presented significantly higher risk of 0-5 Apgar scores, both in 1 minute (6.4% versus 3%, odds ratio [OR] = 2.2, confidence interval [CI] IC 2–2.4) and in 5 minutes (4.8% versus 0.4%, OR = 11.5, CI 10.5–12.7). Another finding is related to recovery estimates when from an initially bad 1-minute Apgar (< 6) to a subsequently better 5-minute Apgar (> 6). In this scenario, home infants had poorer recovery, Apgar score was persistently < 6 throughout the fifth minute in most cases (71% versus 10.7%, OR 20.4, CI 17–24.6). Conclusion The results show worse Apgar scores for babies born at home, compared with those born at the hospital setting. This is a pioneer and preliminary study that brings attention concerning differences in Apgar score related to home versus hospital place of birth in Brazil.

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