A Novel Method to Decrease Shoulder Tip Pain during Cesarean Section

Objective: To investigate the efficacy of the placement of two towels around uterus before delivery of fetes upon the incidence of intraoperative shoulder tip pain (STP) during cesarean section. Methods: Two hundred and sixty parturient were scheduled to undergo elective cesarean section under spinal anesthesia were randomized to do packing around the uterus before uterine incision or placebo (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were operative time, amount of intraoperative blood loss, incidence of hypotension, and the Need of post-opertive morphine. Results: Shoulder tip pain was recorded only in 7 cases (5.4%) in towel placement group compared to 25 cases (19.2%) in placebo group (P value, 0.001). The need of post-operative morphine was statistically significant lower in Towel placement group (33.8%) compared to (47.7%) in control group (P value, 0.023). Conclusion: Packing around the uterus just before uterine incision decreases the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section.

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A close call: does the location of incision at cesarean delivery matter in patients with vasa previa? A case report.

F1000Research ◽

10.12688/f1000research.2-267.v1 ◽

2013 ◽

Vol 2 ◽

pp. 267 ◽

Cited By ~ 4

Author(s):

Werner M Neuhausser ◽

Laxmi V Baxi

Keyword(s):

Case Report ◽

Cesarean Section ◽

Post Partum ◽

Elective Cesarean Section ◽

Second Trimester ◽

Uterine Incision ◽

Vasa Previa ◽

Close Call ◽

Elective Cesarean ◽

Utmost Care

We present here a case of vasa previa in a multipara, diagnosed at the time of her late second trimester ultrasonogram. The patient subsequently underwent an elective cesarean section after 37 weeks gestation, giving birth to a healthy child with an uneventful post-partum, neonatal and infant course. At the time of cesarean section, the incision was gradually deepened in layers through the myometrium by utmost care allowing the amniotic sac to protrude through the uterine incision hereby avoiding laceration of the vasa previa and its branches. Fetal exsanguination and a need for blood transfusion as well as a possible adverse neonatal course were therefore avoided.

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Minimal Local Analgesic Dose of Intrathecal Bupivacaine and Ropivacaine in Patients Undergoing Cesarean Section: A Comparative Study

Journal of Lumbini Medical College ◽

10.22502/jlmc.v7i1.250 ◽

2019 ◽

Vol 7 (1) ◽

pp. 6

Author(s):

Jeevan Singh ◽

Ashish Shrestha ◽

Kalpana Kharbuja ◽

Alex Tandukar ◽

Abha Shrestha

Keyword(s):

Cesarean Section ◽

Intrathecal Injection ◽

Epidural Injection ◽

Elective Cesarean Section ◽

P Value ◽

Safe Alternative ◽

Potency Ratio ◽

Analgesic Dose ◽

Elective Cesarean ◽

Sequential Allocation

Introduction: Spinal anesthesia is a reasonable option for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opiods. Ropivacaine is considered a valid and safe alternative to bupivacaine for intrathecal anesthesia. This study aims to determine the median effective dose (ED50) of intrathecal bupivacaine and ropivacaine for cesarean section and defines this as the minimum local anesthetic dose (MLAD). Methods: Forty pregnant women undergoing elective cesarean section were allocated and randomized into two groups. The initial dose was 13mg for both ropivacaine and bupivacaine groups and was increased or decreased of 0.3mg, using the up-down sequential allocation technique. Efficacy was accepted if adequate sensory dermatomal anesthesia to pinprick to T6 was attained within 20 minutes after intrathecal injection and required no supplemental epidural injection for procedure until at least 50 minutes after the intrathecal injection of test drugs. The MLAD for both bupivacaine and ropivacaine was calculated with 95% confidence interval using the formula of Dixon and Massey. Comparison of different variables between the groups was done using t-test with significant p value at < 0.05. Results: The two groups were comparable in terms of demographic profile and clinical characteristics. The MLAD of ropivacaine and bupivacaine were 11.63 mg (95% CI, 11.5-12.92) and 10.459 mg (95% CI, 10.12-10.87) respectively. The potency ratio between spinal ropivacaine and bupivacaine was 0.89. Conclusion: Ropivacaine provided clinically surgical anaesthesia of shorter duration without compromising neonatal outcome and can be used as a safe alternative to bupivacaine.

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Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i2.23394 ◽

2018 ◽

Vol 1 (2) ◽

pp. 70-74

Author(s):

Rohini Sigdel ◽

Maya Lama ◽

Sanish Gurung ◽

Bishal Gurung ◽

Anil Prasad Neupane ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Controlled Study ◽

Control Group ◽

Operating Table ◽

Hemodynamic Effects ◽

Elective Cesarean ◽

Spinal Hypotension ◽

The Right

Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded. Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) and Apgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion: In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.

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Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190017 ◽

2019 ◽

Vol 8 (2) ◽

pp. 372

Author(s):

Pravin Shah ◽

Ajay Agrawal ◽

Shailaja Chhetri ◽

Pappu Rijal ◽

Nisha K. Bhatta

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Postpartum Hemorrhage ◽

Elective Cesarean Section ◽

Controlled Study ◽

Control Group ◽

Estimated Blood Loss ◽

Elective Cesarean ◽

The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

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Low Complication Rate Associated with Cesarean Section under Spinal Anesthesia for HIV-1–Infected Women on Antiretroviral Therapy

Anesthesiology ◽

10.1097/00000542-200208000-00006 ◽

2002 ◽

Vol 97 (2) ◽

pp. 320-324 ◽

Cited By ~ 44

Author(s):

Michael S. Avidan ◽

Philippa Groves ◽

Margaret Blott ◽

Jan Welch ◽

Theresa Leung ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Postoperative Complications ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Controlled Study ◽

Control Group ◽

Elective Cesarean ◽

Hiv 1

Background Elective cesarean section decreases the likelihood of vertical human immunodeficiency virus (HIV) transmission from mother to infant. This study aimed to determine whether cesarean section done with spinal anesthesia on HIV-1-infected pregnant women taking antiretroviral therapy is associated with intraoperative hemodynamic instability, postoperative complications, or changes in immune function or HIV-1 viral load. Methods A case-controlled study was conducted over a 3-year period in a London academic hospital. Forty-four women infected with HIV-1 and a control group of 45 HIV-negative women undergoing cesarean sections were included. The main outcome measures included intraoperative blood pressure, heart rate, blood loss, and ephedrine requirements, and postoperative infective complications, blood transfusion, changes in blood HIV-1 viral load and lymphocyte subsets, and time to hospital discharge. Results There were no differences in hemodynamic stability and postoperative complications between the HIV-infected group and the controls. There was an acute postoperative increase in the CD4T lymphocyte count (P = 0.01), but the CD4T:CD8T ratio and viral load did not change. Conclusions Elective cesarean section under spinal anesthesia for women infected with HIV-1 taking antiretroviral therapy was not associated with intraoperative or postoperative complications.

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Epidural Mepivacaine for Cesarean Section: Maternal and Neonatal Effects

Regional Anesthesia The Journal of Neural Blockade in Obstetrics Surgery & Pain Control ◽

10.1136/rapm-00115550-198712020-00003 ◽

1987 ◽

Vol 12 (2) ◽

pp. 76-79 ◽

Cited By ~ 5

Author(s):

Therese K. Abboud ◽

Michael J. Moore ◽

Jerry Jacobs ◽

Kazushige Murakawa ◽

Manoutchehr Soraya ◽

...

Keyword(s):

Cesarean Section ◽

Blood Gases ◽

Maternal Blood ◽

Elective Cesarean Section ◽

Control Group ◽

Blood Levels ◽

Acid Base ◽

Apgar Scores ◽

Elective Cesarean ◽

Acid Base Status

The effects of epidural anesthesia using mepivacaine on maternal blood pressure, newborn Apgar scores, neonatal acid-base status, and the Early Neonatal Neurobehavioral Scale (ENNS) were studied in 21 pregnant women undergoing cesarean section. Maternal and neonatal blood levels of mepivacaine were also determined. Neonatal outcome was compared with a control group of 14 neonates of healthy mothers who received 3% 2-chloroprocaine for elective cesarean section. All patients had satisfactory anesthesia for cesarean section with an onset of 19 ± 1.8 minutes (mean ± SEM) and duration of 95 ± 11.9 minutes. Hypotension developed in two patients, and they were treated with intravenous ephedrine. All neonates had Apgar scores of 8 or more at 1 and 5 minutes and normal blood gases and acid-base status. None of the variables of the ENNS differed significantly between the mepivacaine and the chloroprocaine control group with the exception of truncal tone, which was significantly higher in the mepivacaine group ( p < 0.05). Mepivacaine was detected in all maternal and fetal samples, and the umbilical venous to maternal venous ratio was 0.57 ± 0.17 (mean ± SEM).

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Phenylephrine Effectiveness in Handling Hypotensive Issues During Spinal Anesthesia Conductance for Cesarean Section Deliveries

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm.04.03.02 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Research Group ◽

Elective Cesarean Section ◽

Control Group ◽

P Values ◽

Management Protocol ◽

Significant Difference ◽

Elective Cesarean ◽

The Impact

Background: Hypotension is frequent clinical challenge during spinal mode of anesthetic induction for cesarean delivery. Requiring an effective and prompt management mode since it has unfavorable clinical outcomes such as hemodynamic cardiovascular instability issues besides reduced uteroplacental perfusion. Aim: Investigating the impact and effectiveness of different prophylacticdosages of Phenylephrine on hypotensive issues during spinal anesthesia for cesarean section deliveries. Methodology:A prospective, randomized, clinical research study involved 184 cases That are classified as American Society of Anesthesiologists physical status I and II with term singleton pregnancies scheduled for elective cesarean section under spinal anesthesia randomized to receive 0.9% saline 2 mL (Control Group) or phenylephrine1.0 ug/kg (PHE1 research Group), 1.5 ug/kg (PHE1.5 research Group), or 2.0 ug/kg (PHE2 research Group) immediately after induction of spinal anesthesia. Results: The adverse effects of prophylactic bolus ofPhenylephrine among the research groups control, Phenylephrine 1, 1.5,2 in which there was statistically significant difference as regards hypotension, rescue Phenylephrine,lowest SBP,highest SBP,early highest SBP,mean SBP, occurrence of hypertension (p values= <0.001, <0.001, 0.002, <0.001, <0.001, <0.001, <0.001consecutively) there was no statistical significant difference as regards nausea and bradycardia (p values=0.929, 0.823consecutively). Conclusions: The research findings obtained denote and imply that a prophylactic Phenylephrine 1.5 ug/kg bolus followed by additional boluses when necessary could be an alternative management protocol to decrease the frequency of hypotensive issues occurrence during spinal anesthetic mode for cesarean deliveries.

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SAT-400 Pregnancy Outcome in Women with Hypoparathyroidism:Aswedishpopulation-Based Cohort Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1415 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Sigridur Bjornsdottir ◽

Bart Lyman Clarke ◽

Outi Makitie ◽

Tim Spelman ◽

Olle Kampe

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Pregnancy Outcomes ◽

Population Based ◽

Elective Cesarean Section ◽

Control Group ◽

National Patient Register ◽

National Patient ◽

Elective Cesarean ◽

The Mean

Abstract Context: The majority of patients with hypoparathyroidism (HypoPT) are women. It is not known whether the presence of hypoparathyroidism influences the pregnancy outcomes. Sweden has excellent conditions for research in this area, with high-quality population-based registers covering essentially all inpatient care and birth records. In this study, data were linked from the Swedish National Patient Register and Swedish Medical Birth Register to examine the potential influence of maternal hypoPT on the number of childbirths and various pregnancy outcomes. Design and Setting: Population-based cohort study in Sweden. Patients: Through the Swedish National Patient Register and the Total Population Register, we identified 1267 women with HypoPT and 12 670 age-matched controls who gave birth between 1997 and 2016. Results: There was no significant difference in mean age at delivery for women with HypoPT (32 (SD, 5.2)) years and controls (32.5 (5.0)). There were significantly more women with HypoPT who smoked at baseline (p= 0.007) and within 3 months of pregnancy (p=0.022) compared to controls. Significantly more women with HypoPT had part time work or were not working during pregnancy compared to controls (p = 0.002). The mean number of infants per woman was 0.30 (SD, 0.62) in the HypoPT group and 0.33 (SD, 0.60) in the control group (p=0.644). Compared with the control group, the risk of elective cesarean section was higher in the HypoPT group (p=0.002). However, there was no difference in the proportion of women undergoing an acute cesarean section between cases and controls (p=0.754). The mean pregnancy duration in women with HypoPT was 38.87 (2.11) weeks compared to 39.23 (2.04) weeks for the controls (p= 0.001). Infants born to mothers with HypoPT were significantly shorter (p=0.016), but no difference was seen in weight or head circumference compared to infants born to controls. No difference was observed in prevalence of small- or large-for gestational age compared to controls. There were no differences between groups with respect to infant sex or Apgar scores at 1, 5 and 10 min, congenital malformations or stillbirth. There was furthermore no difference in pain medication use by mothers during delivery between the groups (p=0,733). Conclusion: The majority of women with HypoPT had normal pregnancy outcomes, and the overall risks must be considered to be low. Still, our findings are of importance for antenatal counseling in women with HypoPT as their risk for elective cesarean section was significantly higher compared with controls. Their children were shorter and the higher rate of smoking among HypoPT women may be an additional risk factor.

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COMPARISON OF NEONATAL APGAR SCORES AND PATIENT SATISFACTION LEVELS IN SPINAL VERSUS GENERAL ANESTHESIA IN ELECTIVE CESAREAN SECTIONS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.3296 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1183-87

Author(s):

Syed Khurram Naseer ◽

Aijaz Ali ◽

Shizan Hamid Feroz ◽

Dr Danish ◽

Amir Sohail

Keyword(s):

Patient Satisfaction ◽

Cesarean Section ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Military Hospital ◽

P Value ◽

Apgar Scores ◽

Significant Difference ◽

Elective Cesarean

Objective: To compare patients undergoing cesarean section under spinal and general anesthesia in terms of neonatal APGAR scores and patient satisfaction. Study Design: Comparative cross-sectional study. Place and Duration of Study: Departments of Anesthesia and Gynecology and Obstetrics, Combined Military Hospital Peshawar, for six months from Mar to Aug 2019. Methodology: In this study, 120 females with a singleton pregnancy of 36-40 weeks, and requiring a non-emergency elective cesarean section were enrolled through consecutive sampling in the study. The patients were randomly allocated into two equal groups of 60 women each through random table numbers. Group A received spinal anesthesia and group B general anesthesia. APGAR score was assessed at 5 minutes after delivery, and score of ≥7 was taken as satisfactory. Patient's satisfaction level regarding anesthesia was recorded on a visual analogue scale of 0 (extremely unsatisfied) to 10 (completely satisfied), and score of ≥7 was taken as satisfactory. Results: Women receiving general anesthesia were more satisfied as compared to receiving spinal anesthesia (95% vs. 78.3%; p-value 0.007). There was no significant difference in terms of APGAR scores in general anesthesia and spinal anesthesia (83.33% versus 90%; p-value 0.283). Conclusion: After an elective caesarean section, more mothers were satisfied after receiving general anesthesia as compared to spinal anesthesia. However, both types of anaesthesia were found to be equally safe for babies born in terms of APGAR scores at 5 minutes.

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