Técnicas quirúrgicas en cesárea segmentaria. Revisión de evidencias

Aim: To know which have been the variations of the Pfannenstiel-Kerr technique and how they have influenced maternal morbidity and mortality. Methods: An electronic search was carried out in PubMed, Medline and Cochrane, of works in English and Spanish languages, regardless of the country of origin, preferably randomized and controlled between 2010 and 2020, on variations in the original surgical technique, with emphasis on the differences between the PfannenstielKerr and Miglav-Ladash techniques. Results: The more importants variations regarding morbidity and mortality were: 1. Preferring the transverse skin incision, especially the Joel Cohen type; 2. Lateral blunt dissection of the subcutaneous and cranio-caudal aponeurosis, after its incision; 3. Digital and lateral separation of the rectus abdominis muscles; 4. Digitally and laterally prolong the hysterotomy; 5. Uterine incision closure, without externalizing the uterus, in one or two suture planes, indifferently; 6. Do not suture the visceral and parietal peritoneum or approach the rectus abdominis; 7. Closure of the subcutaneous to separate points, if the thickness is greater than 2 cm. Conclusions: Modifications to the original technique achieved a statistically significant decrease in operative time, the number of sutures, the requirement for analgesics, blood loss, febrile morbidity, as well as operative wound infection and hospital stay. Keywords: Cesarean section, Surgical technique, Pfannenstiel-Kerr, Misgav-Ladach.

Placental Location in Maternal-Fetal Surgery for Myelomeningocele

Introduction: Uterine incision based on placental location in open maternal-fetal surgery (OMFS) has never been evaluated in regards to maternal or fetal outcomes. Objective: To investigate whether an anterior placenta was associated with increased rates of intraoperative, perioperative, antepartum, obstetric, or neonatal complications in mothers and babies who underwent OMFS for myelomeningocele (fMMC) closure. Methods: Data from the international multi-center prospective registry of patients who underwent OMFS for fMMC closure (fMMC Consortium Registry, 12/15/2010-7/31/2019) was used to compare fetal and maternal outcomes between anterior and posterior placental locations. Results: Placental location for 623 patients was evenly distributed between anterior (51%) or posterior (49%). Intraoperative fetal bradycardia (8.3% vs 3.0%, p=0.005) and performance of fetal resuscitation (3.6% vs 1.0%, p=0.034) occurred more frequently in cases with an anterior placenta when compared to those with a posterior placenta. Obstetric outcomes including membrane separation, placental abruption, and spontaneous rupture of membranes were not different among the two groups. However, thinning of the hysterotomy site (27.7% vs 17.7%, p=0.008) occurred more frequently in cases of anterior placenta. Gestational age at delivery (p=0.583) and length of stay in the neonatal intensive care unit (p=0.655) were similar between the two groups. Fetal incision dehiscence and wound revision were not significantly different between groups. Critical clinical outcomes including fetal demise, perinatal death, and neonatal death were all infrequent occurrences and not associated with placental location. Conclusions: Anterior placental location is associated with increased risk of intraoperative fetal resuscitation and increased thinning at the hysterotomy closure site. Individual institutional experiences may have varied but the aggregate data from the fMMC Consortium did not show a significant impact on the gestational age at delivery or maternal or fetal clinical outcomes.

Intrauterine Bakri balloon tamponade plus cervical cerclage for the prevention and treatment of postpartum haemorrhage in late pregnancy complicated with acute aortic dissection: Case series

In this study, a treatment method was assessed for the prevention and treatment of postpartum bleeding after combined surgery in patients having late pregnancy with the complication of acute Stanford type A aortic dissection. The clinical records of ten patients receiving treatment at the Second Xiangya Hospital of Central South University between March 2012 and March 2021 were retrospectively analysed. All patients were diagnosed with acute Stanford type A aortic dissection according to computed tomography angiography of the thoracic and abdominal aorta. Aortic valve function was assessed using two-dimensional echocardiography. All patients experienced uterine-incision delivery under systemic anaesthesia. During the operation, intrauterine Bakri balloon tamponade and cervical cerclage were performed. Postpartum bleeding was effectively controlled for all patients. The extracorporeal circulation time was 230–295 min, the postpartum 24 h bleeding volume was 500–870 mL, the volume of physiological saline injected into the balloon was 290–515 mL, and the intrauterine balloon compression time was 28–51 h. No postpartum bleeding occurred. A 42-days follow-up showed no late postpartum bleeding, poor uterine incision healing, or puerperal infection, and no uterine removal was performed. Intrauterine Bakri balloon tamponade plus cervical cerclage can effectively prevent intra- and postoperative postpartum bleeding in pregnant patients with aortic dissection.

The Efficiency of Temporary Uterine Artery Ligation on Prevention of the Bleeding in Cesarean Section

<b><i>Objective:</i></b> We aimed to evaluate the effect of temporary ligation of the uterine artery on postpartum bleeding during uncomplicated cesarean section. <b><i>Design:</i></b> This was a prospective, randomized, and controlled study. We recruited a total of 200 patients, including 100 cases and 100 controls. <b><i>Methods:</i></b> The bilateral uterine artery was temporarily clamped 2 cm below the uterine incision in the study group and compared with controls. Patient demographics, the amount of intraoperative bleeding, the duration of the operation, the closure time of the uterine incision, the need for additional uterotonics, the need for additional sutures, and the hemoglobin values before and after birth were assessed. <b><i>Results:</i></b> The mean value of the amount of bleeding in the clamped and control groups was 267.3 ± 131.8 mL and 390.2 ± 116.4 mL, respectively. The amount of bleeding was significantly decreased for clamped group (<i>p</i> &#x3c; 0.001). A significant reduction occurred in the results of pre- and postoperative values of hemoglobin and hematocrit difference, operation duration, and the closing time of the uterine incision in the experimental group which has temporary uterine artery clamping. <b><i>Limitations:</i></b> The cases of recurrent cesareans were not included in this study. <b><i>Conclusion:</i></b> Temporary uterine artery ligation can be used to reduce the amount of bleeding during uncomplicated cesarean delivery and prevent postpartum hemorrhage.

THE EFFECT OF FINGER-GRIP RELAXATION TECHNIQUE ON REDUCING ANXIETY IN PREOPERATIVE CAESAREAN SECTIO PATIENTS IN THE MIDWIFERY ROOM OF KEPAHIANG REGIONAL HOSPITAL

ABSTRACT Sectiocaesarea is an artificial childbirth, ie the fetus is born through an intact abdominal wall and uterine incision that is still intact with the requirement, that the uterus is intact and the fetus weighs above 500 gr.The purpose of this study was to determine the effect of hand-held relaxation techniques on anxiety reduction in caesarean sectio patients in the midwifery room of Kepahiang Regional Hospital in 2019.The design of this study used the pre-experimental method, with the One Group Pretest-Posttest design approach. The population used in this study was about 80 women giving birth with caesarean section from March to May 2019 in Kepahiang District Hospital. Samples were taken using 45 accidental sampling techniques. Data were analyzed using univariate analysis, data normality test and bivariate analysis using Wilcoxon sign rank test.The results of the study were obtained from 45 patients before hand held finger relaxation that experienced mild anxiety by 22 respondents (48.9%), moderate anxiety by 11 respondents (24.4%) and severe anxiety by 12 respondents (26.7%), after they were performed there are 10 respondents (22.2%) not hand worried, 27 respondents (60.0%) have mild anxiety and 8 respondents (17.8%) have severe anxiety, there is an influence between finger grip relaxation with pre-operative patient anxiety cesarean section.It is expected to provide input to Kepahiang Regional Hospital regarding the effect of hand-held relaxation techniques on reducing anxiety in patients with Preoperative Caesarea in the Midwifery Room of Kepahiang Regional Hospital in 2019

Comparison of intra operative hemorrhage by blunt and sharp expansion of uterine incision at cesarean section

Objectives: To compare the effect of blunt and sharp incision of uterus at cesarean section on intra-operative haemorrhage. Methods: This trial was conducted at the Department of Obstetrics and Gynaecology, Pakistan Ordinance Factory Hospital, Wah Cantt from 14th January to 13th July 2012. Total 80 women planned for lower segment cesarean section through Pfannensteil incision were randomized to either blunt uterine incision (Group-A, n=40) or sharp uterine incision (Group-B, n=40). The fall in Haemoglobin and HCT was compared in two groups and analyzed with help of SPSS version 10. Results: Both groups were similar in terms of demographic features like age, parity, gestational age and indication for cesarean section. The participants in Group-A reveled significantly less drop of mean Hb concentration as compared to Group-B (1.47±1.08 and 1.95±0.85 respectively, P value 0.031). Similarly, the fall in mean HCT was significantly less in Group-A in comparison to Group-B (3.21±1.3 and 4.21±2.17 respectively, P-value 0.015) Conclusion: Blunt expansion of uterine incision during caesarean section is associated with less fall in Haemoglobin and HCT as compared to sharp expansion. doi: https://doi.org/10.12669/pjms.37.7.4159 How to cite this:Faiza, Sadaf F, Ameena B, Khan NR. Comparison of intra operative hemorrhage by blunt and sharp expansion of uterine incision at cesarean section. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4159 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.