scholarly journals Uterine Atony: An Innovative Dutta's Scoring System for Elective Cesarean Section

2015 ◽  
Vol 7 (3) ◽  
pp. 113-117
Author(s):  
Indranil Dutta ◽  
Indranil Dutta
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Uterine Wall ◽  
Uterine Atony ◽  
Elective Cesarean Section ◽  
Postoperative Blood Loss ◽  
Ringer’S Lactate ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

ABSTRACT Uterine atony appears suddenly and is mostly unpredictable and accounts for 80% of causes of postpartum hemorrhage (PPH), it is also one of the important causes of maternal death. Objective To analyze the efficacy of Dutta's score for early diagnosis and management of uterine atony during elective lower segment cesarean section (LSCS) to prevent PPH. Study methods: This study was undertaken at JNM, NSGH, CN at Kalyani, Nadia, West Bengal, India, from 1st June 2008 to 31st Dec 2012. Six hundred cases undergoing elective LSCS were selected for randomized trial. Clinical observations were made after placental expulsion for scoring which includes shape and size of uterus, rugosity, tone, placental localization and time of placental expulsion. Scores of 0, 1, 2 were given on each observation. Three groups are created depending on scoring: group A (n = 300)—8 to 10, group B (n = 220)—5 to 7 and group C (n = 80)—<5 for better management. Management protocols were formulated in the three groups for prevention of PPH: group A—oxytocin 10 U (5U IM + 5U IV 30 drops/min in Ringer's lactate 500 ml), group B—oxytocin 15U (5U IM + 10U IV 30 drops/min in Ringer's-lactate 500 ml) + methylergometrine (0.25 mg IM) + anterior posterior uterine wall compression, group C—oxytocin 20 U (5U IM plus 15 U IV 30 drops in ringer lactate 500 ml) + methylergometrine (0.5 mg IM) + carboprost (250 mcg IM) + lateral followed by anterior posterior uterine wall compression + isthmus compression of uterus + misoprostol 800 mg per rectal during postoperative period. Results After adopting Dutta's score and management protocols, it was interesting to observe that intra and postoperative, blood loss (within 2 hours) were found to be significantly reduced in group A—73.3% (<300 cc), 88% (<200 cc) and group B—63.6% (<300 cc), 81.8% (<200 cc). Intraoperative blood loss >500 cc were also found to be reduce in group A—14.7%, group B—16.3%. In group C, intraoperative blood loss >500 cc were seen in 41.25% and postoperative —37.5% respectively. Hemoglobin level below 11 gm% were found to be not reduced in group A (1.4%), group B (2.6%) and group C (8.7%) after 24 hours of delivery hemodynamic status in all groups were found to be uneventful. Maternal mortality was found to be nil. Conclusion Early diagnosis and management of uterine atony during elective LSCS after adopting Dutta's score were found to be not only reduce intra- and postoperative blood loss but also was found to maintain a satisfactory hemoglobin level and hemodynamic status. Maternal mortality was found to be nil. This randomized trial highlighted the importance of prompt treatment in group C to reduce intra- and postoperative blood loss and maternal mobidity and mortality. How to cite this article Dutta DK, Dutta I. Uterine Atony: An Innovative Dutta's Scoring System for Elective Cesarean Section. J South Asian Feder Obst Gynae 2015;7(3):113-117.

scholarly journals Impact of Preoperative Rectal Misoprostol on Blood Loss during and after Elective Cesarean Delivery: A Randomized Controlled Trial

2017 ◽  
Vol 11 (2) ◽  
pp. 37-41 ◽  
Author(s):  
Sarita Sitaula ◽  
DK Uprety ◽  
A Thakur ◽  
T Pradhan
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Intravenous Infusion ◽  
Postoperative Blood Loss ◽  
P Value ◽  
Elective Cesarean Delivery ◽  
Effective Measure ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

Aims:The aim of this study was to evaluate the effect of preoperative administration of rectal misoprostol onblood loss during and after elective cesarean delivery.Methods:It was a randomized trial including 200 women, divided into two groups (group A and group B), who were planned for elective cesarean delivery and didn’t have risk of postpartum hemorrhage (PPH). Group A received 400μg misoprostol per-rectal preoperatively and intravenous infusion of oxytocin after delivery as hospital protocol.Group B received only intravenous infusion of oxytocin. Primary outcome measureswere the estimated amount of intraoperative and postoperative (24 hours) blood loss and changes in hemoglobin levels 48 hours after delivery.Results:Intraoperative and postoperative blood loss in rectal misoprostol and oxytocin group were significantly reducedin comparison to oxytocin only group. Mean blood loss in groupA was 326.9±116.2 mlwhereas; in group B was 397.7±110.1 ml with p value of < 0.001 which was significant.The difference between preoperative and postoperative hemoglobin level after 48 hours was also significant (1.10±0.51 vs 1.35± 0.49 g/dl with p value <0.001).Conclusion: Preoperative rectal misoprostol was found to be an effective measure to reduce the intraoperative and postoperative blood loss during elective cesarean delivery.

Pre-pregnancy obesity compromises obstetric and neonatal outcomes

2015 ◽  
Vol 43 (2) ◽  
Author(s):  
Katharina Hancke ◽  
Theresa Gundelach ◽  
Birgit Hay ◽  
Sylvia Sander ◽  
Frank Reister ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Diabetes ◽  
Cesarean Section ◽  
Neonatal Outcomes ◽  
Elective Cesarean Section ◽  
Obese Women ◽  
Elective Cesarean ◽  
Group A ◽  
Grade Ii ◽  
Group B

AbstractObesity is an important issue among fertile women as it may affect obstetric and neonatal outcomes.Obstetric and neonatal outcomes of primiparous women were retrospectively analyzed in non-obese (n=11387) and obese (n=943) women. A subgroup analysis was performed in obese women divided into three groups: Grade I obesity (Group A, n=654), Grade II obesity (Group B, n=192), and Grade III obesity (Group C, n=97). Odds ratios (OR) were expressed with the corresponding 95% confidence intervals (CI).The incidence of gestational diabetes (non-obese, 1.9%; obese, 7.6%; Group C, 19.6%) and preeclampsia (non-obese, 3.3%; obese, 13.5%; Group C, 17.5%) increased with rising weight. The risk of non-elective cesarean section was significantly higher in obese women than in non-obese women (21.7% vs. 13.2%). The risk of extreme preterm birth (before 28 weeks of gestation) doubled in the Grade I obesity group (OR, 2.1; 95% CI, 1.4–3.2) and nearly tripled in women with body mass index ≥35 kg/mPre-pregnancy obesity is associated with higher incidences of gestational diabetes and preeclampsia. Our study shows that obese women have a higher risk of non-elective cesarean section and preterm birth.

Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial

2018 ◽  
Vol 46 (7) ◽  
pp. 786-790 ◽  
Author(s):  
Magdy Refaat Ahmed ◽  
Waleed Ali Sayed Ahmed ◽  
Rasha Elsayed Khamess ◽  
Manar S. Youwakim ◽  
Khaled Mohamed EL-Nahas
Keyword(s):  
Cesarean Section ◽  
Randomized Trial ◽  
Bowel Movement ◽  
Oral Intake ◽  
Bowel Function ◽  
Elective Cesarean Section ◽  
Regular Diet ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

Abstract Aim: To compare the efficacy of three postoperative feeding regimens on bowel function recovery after term elective cesarean section (CS). Methods: Women recruited for this randomized trial were allocated into three groups. Women in group (A) were instructed to chew sugarless gum for 10 min every 2 h after surgery. Group (B) mothers received IV fluids for 6 h followed by sipping fruit juices sweetened with honey. Group (C) had oral intake of clear fluids after passage of flatus and regular diet with the passage of bowel movement. The main outcome measures were the timing of first return to bowel movement and initiation of regular diet. Results: The mean times to first hearing of bowel sounds, to first flatus passage and to first defecation were significantly lower in group A (10, 17.5 and 28.1 h, respectively) compared to groups B and C [15.1, 24.9 and 36 h (B) and 21.6, 38.8 and 49.4 h (C)]. Initiation of regular diet was significantly earlier in group A compared to groups B and C (21 vs. 27.5 and 40.3 h, respectively). Conclusion: Chewing gum appears to be more advantageous than early or traditional feeding regimens after term elective CS resulting in rapid recovery of bowel function.

scholarly journals The effect of type of anesthesia on intra-and postoperative blood loss at elective cesarean section

2012 ◽  
Vol 62 (2) ◽  
pp. 125 ◽  
Author(s):  
Jeong Eun Kim ◽  
Ji Hyang Lee ◽  
Eun Ju Kim ◽  
Myung Woo Min ◽  
Jong Seouk Ban ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Elective Cesarean Section ◽  
Postoperative Blood Loss ◽  
Elective Cesarean

scholarly journals Dutta’s Scoring Technique for Early Detection and Management of Uterine Atony during Emergency LSCS – A Randomized Trial

2013 ◽  
Vol 5 (2) ◽  
pp. 40-45
Author(s):  
Dilip Kumar Dutta ◽  
Indranil Dutta
Keyword(s):  
Blood Loss ◽  
Randomized Trial ◽  
Uterine Wall ◽  
Hemoglobin Level ◽  
Uterine Atony ◽  
Ringer Lactate ◽  
Operative Blood Loss ◽  
Group A ◽  
Group B ◽  
Anterior Posterior

Background: Uterine atony accounts for 80 % of causes of PPH and is one of the important cause of maternal death. Objective: To analyze the efficacy of Dutta’s score for early detection and management of uterine atony during emergency LSCS to prevent PPH. Study methods: This study was undertaken at JNM, NSGN, CN at Kalyani, Nadia, West Bengal India from 1st January 2007 to 31st December 2011. Three hundred cases undergoing emergency LSCS were selected for randomized trial. Clinical observations were made after placental expulsion for scoring which includes shape and size of uterus, rugosity, tone, placental localization and time of placental expulsion. Score of 0, 1, 2 were given on each observation. Three groups are created depending on scoring-Group A (130) -8 to 10, Group B (N-100) -5 to 7 and Group C (N-70) - <5 for better management. Management protocols were formulated in the three groups for prevention of PPH Group A:- Oxytocin 10U (5U IM + 5U IV 40drops/min in Ringer Lactate 500ml) Group B:- Oxytocin 15U (5U IM + 10U IV 40drops/min in Ringer lactate 500 ml) + methyl ergometrine (0.25mg IM) + anterior posterior uterine wall compression Group C:- Oxytocin 20 U- (5U IM plus 15 U IV 40 drops in Ringer Lactate 500 ml) + methyl ergometrine (0.5mg IM) + carboprost (250 mcg IM) + lateral followed by anterior posterior uterine wall compression + compression of isthmic region of uterus + misoprostol 800mg per rectal during post operative period. Results: After adopting Dutta’s score and management protocols it was interesting to observe that intra and post operative blood loss within 2hr were found to be significantly reduced in group A-69.3% (<300CC), 84.6%(<200CC) and group B-70%(<300cc), 72%(<200CC). Intra operative blood loss >500cc were also found to be reduce in group A- 7.6%, group B-14%. In group C intra operative blood loss >500cc were seen in 47.1 % and post operative -32.9% cases. Hemoglobin level <11gms after 24 hrs of LSCS was found to be minimally reduced (in comparison to preoperative hemoglobin level) in group A (1.5%), group-B (2%) and group C (11.4%). Conclusion: Early diagnosis and management of uterine atony during emergency LSCS after adopting Dutta’s score were found to be not only reduce intra and post operative blood loss but also was found to maintain a satisfactory hemoglobin level and hemodynamic status. Maternal mortality was found to be nil. This randomized trial highlighted the importance of prompt treatment in group C to reduce intra and post operative blood loss and maternal morbidity and mortality. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8531   sian Journal of Medical Science, Volume-5(2) 2014: 40-45

scholarly journals Comparison of Tramadol Versus Tramadol and Paracetamol in Postop Pain Management after C-Section

2021 ◽  
Vol 15 (5) ◽  
pp. 1035-1037
Author(s):  
Usman Salamat ◽  
M.Baqir Ali Khan ◽  
Liaqat Ali ◽  
Tahir Nazeer ◽  
Amna Tahir ◽  
...  
Keyword(s):  
Body Weight ◽  
Pain Management ◽  
Cesarean Section ◽  
Pain Control ◽  
Elective Cesarean Section ◽  
Post Surgery ◽  
Postop Pain ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

Background: Multimodal technique of pain control is better than unimodal technique in perioperative time. Both tramadol and paracetamol are commonly used for pain control. Aim: To compare the tramadol alone versus tramadol with paracetamol in pain management after C- section. Method: 150 patients with ASA class P1&P2 undergoing elective cesarean section under general anesthesia were included in this study and were divided into group A & B by random number table. In both group tramadol 1mg/kg body weight intravenous was given after delivery of baby and in group B intravenous paracetamol 15 mg/kg body weight was given additionally and same doses were given in postop after 8 hours for 24 hs of post-surgery. Result: Mean age in group A was 31.04±5.35 years and in group B it was 29.64±5.92. Mean pain score in group A was 1.19±0.81 and in group B it was 0.60±0.75. The degree of pain was low in group B and patients were more comfortable as compared to group A patients. Conclusion: Tramadol plus paracetamol has better pain control as compared to tramadol alone. Keywords: Tramadol, Paracetamol, Cesarean Section, VAS.

scholarly journals The effect of clonidine with bupivacaine on perioperative hemodynamics and post-operative analgesia in cesarean section cases

2021 ◽  
Vol 10 (8) ◽  
pp. 3049
Author(s):  
Priti Kumar ◽  
Sangeeta Arya ◽  
Sushil Kr. Singh ◽  
Sunil Kumar
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Intraoperative Hypotension ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

Background: Cesarean section is the commonest procedure in Obstetric practice and postoperative pain can be a major factor for wound healing as well as mother and baby bonding. Spinal anesthesia is considered to be safest and easiest modality for cesarean section cases. Bupivacaine is the commonest drug given in spinal anesthesia, but many additive drugs have been introduced to cover post-operative analgesia. Clonidine is an alpha 2 agonist which can be used as an adjunct to heavy bupivacaine to extend analgesic effects.Methods: A randomized double-blind study was performed in 100 women undergoing elective cesarean section under spinal anaesthesia. After proper informed written consent patient undergoing cesarean section were divided by computerized method into group A (Given 10.0 mg 0.5% hyperbaric Bupivacaine) and Group B (Given 9.0 mg 0.5% hyperbaric bupivacaine and 30 μg clonidine).Results: Intraoperative hypotension is the most worrisome factor but it is transient and can be managed by ephedrine effectively. Intraoperative nausea and vomiting are slightly higher with clonidine as occurrence of hypotension is more. VAS scoring in post-operative period was better and need of first analgesic dose was much delayed in women been given clonidine with bupivacaine.Conclusions: Clonidine can be considered as adjunct in spinal anesthesia to extend post-op analgesic cover. 

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.

Recurrent large uterine fundal dehiscence during cesarean section after hysteroscopic uterine septum resection with uterine perforation

2016 ◽  
Vol 5 (2) ◽  
pp. 85-87
Author(s):  
İbrahim Alanbay ◽  
Mustafa Öztürk ◽  
Mustafa Ulubay ◽  
Uğur Keskin ◽  
Emre Karaşahin
Keyword(s):  
Cesarean Section ◽  
Uterine Rupture ◽  
Late Complication ◽  
Uterine Wall ◽  
Elective Cesarean Section ◽  
Uterine Perforation ◽  
Elective Cesarean ◽  
Uterine Septum ◽  
Uterine Fundus ◽  
Previous Cesarean

Abstract Septum resection using hysterescopy is safe, rapid and efective, but some late complication of it may be seen as uterine rupture or dehiscence of uterine wall during pregnancy due to myometrial damage. We present a case of recurrent large uterine fundal dehiscence conscecutive to cesarean section in a patient who had previously undergone a uterine septum resection. The patient was a 35-year-old who presented at 39 weeks of gestation (Gravida 2, Parity 1) and was admitted for an elective cesarean section. Her reproductive history included a septum resection which resulted in uterine perforation, and one previous cesarean section in which a large fundal defect was found and repaired. Then the examination had shown an aproximately 5 cm large uterine fundus defect including all three layers of uterus which had been repaired. Perforation or excessively deep incision of uterine fundus during hysteroscopic metroplasty may cause chronic weakness of the uterine wall especially at fundal localization. Our case was an incidental uterine wall dehiscence during cesarean section. Patients with an uterine septum resection history should be followed up carefully for uterine rupture during pregnancy.

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