scholarly journals Anestesi Spinal untuk Seksio Sesarea pada Wanita Hamil dengan Obesitas Morbid

2021 ◽  
Vol 4 (1) ◽  
pp. 43-7
Author(s):  
Alfathah Bania Lubis ◽  
Tatat Agustian ◽  
Djoni Kusumah Pohan ◽  
Alexander Siagian
Keyword(s):  
Pregnant Woman ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
The Body ◽  
Obese Women ◽  
Anesthesia Technique ◽  
Morbid Obese

Obesitas adalah keadaan tubuh yang terjadi akibat akumulasi lemak yang abnormal atau berlebih sehingga dapat menimbulkan banyak implikasi klinis dalam tatalaksana anestesi. Wanita hamil dengan berat badan lebih dan obesitas merupakan kondisi yang berisiko tinggi dan terbukti berhubungan dengan peningkatan komplikasi dalam kehamilan. Wanita dengan obesitas sangat penting diberikan edukasi untuk menurunkan berat badan dalam merencanakan kehamilan dan perlu diinformasikan tentang peningkatan risiko termasuk persalinan dengan bedah sesar. Seorang wanita 34 tahun G2P0A1 hamil 41 minggu dengan obesitas morbid dengan tinggi badan 156 cm dan berat badan 124 kg dengan nilai indeks massa tubuh (IMT) 50,9 kg/meter2. Pasien menjalani seksio sesarea dengan teknik anestesi spinal, dengan puncture di L3-4 median, menggunakan obat levobupivakain 15 mg + fentanyl 25 mcg. Operasi berlangsung 1 jam 15 menit, perdarahan 350 ml, hemodinamik stabil. Lahir bayi laki-laki, BB 3100 gram, PB 51 cm, APGAR score 8-9-10. Pemilihan teknik anestesi pada wanita hamil dengan obesitas yang akan menjalani seksio sesarea dilakukan dengan jenis anestesi regional yaitu anestesi spinal dengan pertimbangan dapat mengurangi terpaparnya obat-obatan terhadap bayi, mengurangi risiko aspirasi pneumonia dan memungkinkan proses lahirnya bayi dalam keadaan ibu sadar, dapat digunakan untuk mengatasi nyeri pasca operasi, dan juga dapat menghindari risiko bila dilakukan dengan teknik anestesi umum. Simpulan: Wanita hamil dengan berat badan lebih dan obesitas perlu penilaian kondisi dan perencanaan anestesi yang tepat untuk menurunkan risiko seksio sesarea   Spinal Anesthesia for Caesarean Section in Pregnant Woman with Morbid Obese Abstract Obesity is a state of the body that occurs due to abnormal or excess fat accumulation that can cause many clinical implications in the management of anesthesia. Overweight and obese pregnant women are at high risk and have been shown to be associated with increased complications in pregnancy. Obese women are very important to be educated to lose weight in planning pregnancy and need to be informed about increased risks including delivery by cesarean section. A female, 34 years old G2P0A1, 41 weeks pregnant with morbid obese, 156 cm tall and weight of 124 kg, with BMI 50,9 kg/meter2. Carried out in spinal anesthesia technique with puncture in L3-4 median, using levobupivacain 15 mg + fentanyl 25 mcg. The operation lasted for 1 hour and 15 minutes, with 350 ml bleeding, hemodynamically stable. Born a baby boy, BW 3100 gram, BL 51 cm, APGAR score 8-9-10. Anesthesia technique for pregnant woman with obese who will undergo Caesarean Section is regional anesthesia type called spinal anesthesia with consideration to reduce drug intake for baby, lessen chance of pneumonia aspiration and enable birth process while mother still awake, can be used for overcome post-operation pain, and to avoid risk if done by general anesthesia. Conclusion: overweight and obese pregnant women need proper condition assessment and anesthetic planning to reduce the risk of cesarean section.

scholarly journals Anesthetic management of obese and morbidly obese parturients

2021 ◽  
Vol 16 (4) ◽  
pp. 313-321
Author(s):  
Sang Tae Kim
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Anesthetic Management ◽  
Operation Time ◽  
Rapid Onset ◽  
The Body ◽  
Morbidly Obese ◽  
Single Shot ◽  
Cesarean Sections

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

scholarly journals PENGARUH HIPOTENSI IBU TERHADAP APGAR SKOR BAYI YANG LAHIR SECARA SEKSIO SESAREA DENGAN ANESTESIA SPINAL DI RSU. PROF. DR. R. D. KANDOU MANADO PERIODE APRIL-NOVEMBER 2013

e-CliniC ◽  
2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Nia J. M. Lahida
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Medical Records ◽  
Systolic Pressure ◽  
Common Complication ◽  
Sympathetic Block ◽  
Apgar Scores ◽  
New Born ◽  
Anesthesia Technique

Abstract: Spinal anesthesia is a regional anesthesia technique that is widely used in cesarean section surgery . The most common complication in spinal anesthesia is hypotension that occurs due to sympathetic block. It caused maternal hypotension and decreased uteroplacental perfusion and intervillous perfusion affecting the transfer of oxygen and nutrients to the fetus, causing fetal intrauterine stress which can lower baby’s Apgar score. Low Apgar scores can be found in women who experienced a decrease in systolic pressure reaches 90-100 mmHg for 15 minutes. The duration of hypotension has greater effect on apgar score than the severity of the hypotension. Objective: To analyze the effect of maternal hypotension to Apgar score of babies born with spinal anesthesia by cesarean section in RSU Prof. . R. D. Kandou Manado. Hypothesis: Hypotension has effect on Apgar score of new born babies with spinal anesthesia by cesarean section. Duration of hypotension has greater influence than the severity of the hypotension. Methods: Collecting data from medical records of patients who experienced maternal hypotension. The criteria of hypotension is  when there is a decrease of systolic hypotension ≤ 100 mmHg. Noting the decreased systole, duration of hypotension, and Apgar scores. Results: Out of 32 samples, most babies which is 23 cases of them ( 72 % ) has decreased Apgar scores which were categorized into mild asphyxia , and 16 of them experienced interval of hypotension in 10 minutes. The longer the hypotension that occurs decrease the Apgar scores. Conclusion: Hypotension have an effect to Apgar score of the new born babies with spinal anesthesia by cesarean section. The duration of hypotension has greater effect on apgar score than the severity of the hypotension. Keywords: spinal anesthesia, Apgar scores, hypotension.   Abstrak: Anestesia spinal merupakan salah satu teknik anestesia regional yang banyak digunakan dalam operasi seksio sesarea. Komplikasi yang tersering pada anestesia spinal adalah hipotensi yang terjadi karena blok simpatis. Hipotensi maternal menyebabkan hipoperfusi dari uteroplasental dan penurunan perfusi intervillous yang mempengaruhi transfer oksigen dan nutrisi janin sehingga menyebabkan stress janin intra uterin yang dapat mempengaruhi kondisi bayi lair dengan apgar skor yang rendah. Apgar skor rendah dapat ditemukan pada ibu yang mengalami penurunan tekanan sistolik yang mencapai 90 - 100 mmHg selama 15 menit. Faktor lamanya hipotensi lebih besar pengaruhnya daripada besarnya hipotensi. Tujuan: Menganalisis pengaruh kejadian hipotensi ibu terhadap apgar skor bayi yang lahir secara seksio sesarea dengan anestesia spinal di RSU Prof. R. D. Kandou Manado. Hipotesis: Hipotensi berpengaruh terhadap apgar skor bayi yang lahir secara seksio sesarea dengan anestesia spinal. Lamanya hipotensi lebih besar pengaruhnya daripada besarnya hipotensi. Metode: Mengumpulkan data dari rekam medik dari pasien yang mengalami hipotensi maternal. Dikatakan hipotensi bila terjadi penurunan sistol ≤100 mmHg. Mencatat tekanan darah, lama hipotensi dan apgar skor. Hasil: Dari 32 sampel yang ada, sebagian besar bayi yang lahir yaitu sebanyak 23 kasus (72%) mengalami penurunan apgar skor dan dikategorikan dalam asfiksia ringan sedang, dan 16 diantaranya mengalami interval lama hipotensi 10 menit. Semakin lama hipotensi yang terjadi semakin menurun apgar skor. Simpulan: Hipotensi berpegaruh terhadap apgar skor bayi yang lahir secara seksio sesarea dengan anestesia spinal. Faktor lamanya hipotensi besar pengaruhnya terhadap apgar skor.Kata Kunci: anestesia spinal, apgar skor, hipotensi.

scholarly journals Anesthesia for caesarean section in pregnant women with kyphoscoliosis: neuraxial or general?

Pain medicine ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. 63-66
Author(s):  
Rostyslav Chaplynskyi ◽  
Andrii Horiainov ◽  
Anna Omelchenko-Seliukova
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Neuraxial Anesthesia ◽  
Anatomical Features

Аnesthetic management of cesarean section in pregnant women with severe kyphoscoliosis is quite debatable. It is believed that kyphoscoliosis is a contraindication to neuraxial anesthesia methods. The article presents a successful experience of spinal anesthesia in pregnant women with severe kyphoscoliosis. Authors believe that spinal anesthesia can be successfully performed in pregnant women with severe kyphoscoliosis – paramedian access at the L5–S1 level, due to the anatomical features of these vertebrae.

scholarly journals Bupivacaine-Fentanyl vs Ropivacaine-Fentanyl: Evaluation of two Spinal Anesthesia Protocols for Emergency Cesarean Section

2020 ◽  
Vol 10 (6-s) ◽  
pp. 3-7
Author(s):  
Moustapha Diedhiou ◽  
E.B. Ba ◽  
D Barboza ◽  
A. Diouf ◽  
M. Dieng ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Randomized Study ◽  
Bivariate Analysis ◽  
P Value ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
The Mean

Objective: Evaluation of the hemodynamic, respiratory and fetal side effects of two protocols for spinal anesthesia (P1: bupivacaine-fentanyl; P2: ropivacaine-fentanyl). Material and Method: Prospective pseudo-randomized study comparing two spinal anesthesia protocols for emergency cesarean section conducted in the operating room of the regional hospital center of Saint Louis in Senegal. Study duration was 4 months. We studied, age, indication for Caesarean section, medical and surgical history, P1 and P2 protocols, hypotension, bradycardia, Apgar scores at birth and at 5min. Univariate and bivariate analysis was performed on the R software. Result: A total of 115 patients were collected, with a mean age of 27.1 years (E: 15 - 45) and a standard deviation of 7.6. Indications for Caesarean section were maternal and fetal dystocia for 67 patients (58%), fetal distress for 39 parturients (34%), and pre-eclampsia for 5 patients (4%). The P1-Bupi spinal protocol was used in 42 patients (36.5%) and the P2-Ropi spinal protocol was used in 73 patients (63.5%). Anesthetic complications such as low blood pressure, bradycardia and desaturation were found in a total of 30 patients, i.e. in 26% of cases. The mean Apgar score at birth for newborns from the P1-Bupi protocol was 8 (Extremes: 7, 9); the mean Apgar score at birth for newborns from the P2-Ropi protocol was 7.5 (Extremes: 2, 10). There was a significantly negative correlation between the P1-bupi protocol and the appearance of hypotension with p-value: 0.04 and a significantly positive correlation between the P2-ropi protocol and the appearance of hypotension with p-value: 0.04. Discussion/ Conclusion: Ropivacaine certainly has a better cardiovascular and neurological tolerance and a better efficacy in terms of analgesia. However, during caesarean sections, it is important to consider the risk of hypotension and possible fetal complications related to its use. Keywords: Ropivacaine - Bupivacaine - Spinal anesthesia - Caesarean section

scholarly journals Maternal and Neonatal Effects of Vasopressors Used for Treating Hypotension after Spinal Anesthesia for Caesarean Section: A Randomized Controlled Study

2015 ◽  
Vol 4 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Alma Soxhuku-Isufi ◽  
Vjollca Shpata ◽  
Hektor Sula
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Double Blind ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Acid Base Status

AIM: The aim of the study was to examine whether ephedrine and phenylephrine were different in their efficacy for managing maternal hypotension and their effect of adverse maternal and neonatal outcome.METHODS: A double-blind randomized controlled study in healthy pregnant women ASA physical status 2, which underwent elective caesarian delivery under spinal anesthesia. Patients were randomized to receive an intravenous bolus of either phenylephrine (Ph group) or ephedrine (E group) immediately after the episode of hypotension after spinal anesthesia. Maternal and neonatal outcomes were recorded.RESULTS: Two hundred and two (202) pregnant women at term were entered in this study. There were no differences between group E and group Ph regarding the incidence of hypotension after vasopressor therapy, and the incidence of nausea and vomiting. There was no significant difference between groups in the first-minute and the 5th minute Apgar score, none of the neonates had the true fetal acidosis.CONCLUSIONS: Ephedrine and phenylephrine have the same efficacy in treating hypotension after spinal anesthesia for caesarean section. The use of Phenylephrine was associated with better fetal acid-base status, and there were no differences on Apgar score values and on the incidence of maternal bradycardia and hypotension.

CLINICAL AND SUBCLINICAL CHARACTERICTIS AND PREGNANCY OUTCOME OF FETAL MACROSOMIA AT OBSTETRIC DEPARTMENT AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

2020 ◽  
pp. 78-84
Author(s):  
Giang Truong Thi Linh ◽  
Quang Mai Van
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Birth ◽  
Fetal Macrosomia ◽  
Major Influence ◽  
Maternal Complications ◽  
Perineal Tear ◽  
History Of

Background: Fetal macrosomia has a major influence on maternal, neonatal and pregnancy outcomes.Objective: To describe the clinical and subclinical features and the management of fetal macrosomia on pregnancy outcomes. Subjects and methods: Study subjects including pregnant women and babies born ≥ 3500 g with nulliparous and over 4000 grams with primiparous or multiparous at Departement of Obstetrics and Gynecology in Hue University of Medicine and Pharmacy Hospital. The time of choosing subjects to enter the research group is that after birth, the weight is above 3500/4000 grams, then follow up the pregnancy result and retrospect the clinical and subclinical characteristics. Results: From May 2019 to April 2020, there were 223 pregnant women with the birth weight ≥ 3500 g in this study. The mean neonatal weight for macrosomia was 3869.96 ± 315.72 (g). The birth weight ≥ 4000 g, the rate of cesarean section was 91.5%, vaginal birth was 8.5%. The birth weight 3500 - under 4000 g, the rate of cesarean section was 76%, vaginal birth was 24%. 1.1% maternal complications was perineal tear. Conclusion:Factors related to fetal macrosomia: Maternal age, gender of fetus, parity, a history of fetal macrosomia, maternal height, pregnancy weight gain. Caesarean section is the majority. Key words: Fetal macrosomia, gestational diabetes mellitus, normal labor, caesarean section.

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.

Fetal and Maternal Outcome Asymptomatic vs. Symptomatic Covid Positive Pregnant Women

2021 ◽  
Vol 15 (10) ◽  
pp. 3423-3425
Author(s):  
Amna Najam ◽  
Samreen Fakeer Muhammad ◽  
Samia Saifullah ◽  
Maryam Shoaib ◽  
Maria Anwar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Apgar Score ◽  
Adverse Outcomes ◽  
Maternal Outcomes ◽  
Group A ◽  
Nicu Admission ◽  
Group B

Objective: The aim of this study is to compare the fetal and maternal outcomes in between asymptomatic and symptomatic COVID positive pregnant women. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Gynae and Obs department of Sandeman Provincial Hospital, Quetta for duration of six months from November 2020 to April 2021. Methods: One hundred and ten pregnant women with ages 18-45 years had corona virus disease were presented. Informed written consent was taken from all patients for detailed demographics. COVID -19 was diagnosed by PCR. 55 patients had symptoms of coronavirus were included in group A and 55 patients did not show symptoms were included in group B. Frequency of pre-eclampsia, gestational diabetes mellitus and post-partum haemorrhage were calculated. Maternal adverse outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor, hypertensive disorder) were calculated among both groups. Fetal outcomes perinatal mortality, Low birth weight, Low Apgar score and NICU admission were observed. SPSS 20.0 version was used to analyze all data. Results: Mean age of the patients in group A was 28.47±3.18 years with mean BMI 24.03±5.24 Kg/m2 and in group B mean age was 27.99±4.17 years with mean BMI 24.44±6.41 Kg/m2. Maternal outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor,) in symptomatic group were significantly higher than that of asymptomatic group. Fetal outcomes, perinatal mortality in group A 9 (16.4%) and in group B was 5 (9.1%), low birth weight in group A was among 21 (38.2%) and in group B was 10 (18.2%), low apgar score in group A was 11 (20%) and in group B was 8 (14.4%), 15 (27.3%) in group A went to NICU admission and 3 (5.5%) patient in group II admitted to NICU. Conclusion: In this study we concluded that adverse outcomes among symptomatic COVID pregnant women were higher than that of asymptomatic coronavirus pregnant women in terms maternal and perinatal outcomes. Keywords: Pregnant women, Coronavirus, Symptomatic, Asymptomatic, Adverse Outcomes

scholarly journals Evaluation of safety of caesarean myomectomy: A prospective study

2019 ◽  
Vol 7 (1) ◽  
pp. 40-43
Author(s):  
Nazlima Nargis ◽  
Md Iqbal Karim ◽  
Salma Loverine
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Prospective Study ◽  
Reproductive Tract ◽  
Female Reproductive Tract ◽  
The Body ◽  
College Hospital ◽  
Average Value ◽  
The Difference ◽  
Cesarean Myomectomy

Background: Uterine myomas are the most common benign tumour of female reproductive tract and the prevalence of myomas in pregnancy has been reported to be 2%to 5% . Myomectomy during cesarean section has traditionally been discouraged due to risk of intractable haemorrhage and fear of hysterectomy. But recently large scaled studies indicated that cesarean myomectomy could be safely performed in majority of cases without any serious or life threatening complications. Materials and Methods: This prospective study was done at Ibn Sina Medical College Hospital, Dhaka, Bangladesh between January 2016 and December 2016. Fifty patients were recruited into the study, 25 patients had undergone myomectomy during cesarean section and 25 patients had undergone only cesarean section. Results: Average value of haemoglobin both pre and post-operatively was 12.31±1.22 g/dl and 10.64±1.51 g/dl for patients who had cesarean section with myomectomy and 11.61±1.3 g/dl and 10.3±1.7 g/dl in the other group in which cesarean section without myomectomy was performed. The difference in average haemoglobin for patients who had a cesarean section and myomectomy was 1.41 while those who had caesarean section alone was 1.32±1.12. This was not significant. The average duration of operation was longer in patient who had cesarean section and myomectomy (54.32±18.06 mins) than those who had caesarean section alone (38.54±8.42mins). The incidence of hemorrhage was5.45±1.23% and 5.23±1.03% respectively and the mean length of postoperative hospitalization was2.42±1.45and 2.17±0.70 days and no hysterectomy was needed in any group. Blood transfusion was given in 6 patients with 3 patients in each group. Sixty eight percent of the fibroids were subserous and in the body of the uterus. Conclusion: Cesarean myomectomy is a safe and effective procedure and does not increase the incidence of intraoperative and postoperative complications. Bangladesh Crit Care J March 2019; 7(1): 40-43

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