History of caesarean section surgery

Caesarean section is one of the oldest operations in the history of mankind and is the most common surgical intervention in obstetric practice. Translated from Latin, «caesarean section» means «royal cut», and in the days of the Roman Empire, only people marked with a special gift could be born in this way. According to one of the existing legends, this is how Gaius Julius Caesar was born, and it was the incision in his mother's womb that gave him the name «Caesar». However, given the fact that his mother died when Caesar was 46 years old, the legend still has the right to remain a legend. It is also believed that by removing the baby from the womb of the deceased mother, the ancient Greek god Asclepius, the doctor, was born — he was also Aesculapius among the Romans. His mother was struck by Zeus the Thunderer for her infidelity to her husband Apollo, but the child was taken out alive after the woman's death. Be that as it may, the first mentions of a caesarean section do not at all date back to the 16th century, as was commonly believed, but have much deeper roots. It is believed that even some famous people were born by removing them from their mother's womb, and this gave them a chance at life. The beginning of the scientific version of the appearance of the caesarean section operation can be considered the publication of the monograph by F. Rousset in 1581, in which a sufficiently detailed description of the technique of the cesarean section operation was provided and a list of indications for it was given [2]. Today, this operation is a fairly common surgical intervention that can significantly alleviate the suffering of a woman in labor, avoid a number of complications, and sometimes save the life of a mother and child.

Repeated cesarean section surgery in women with two or more scars on the uterus

Objective: To monitor the outcome of surgical delivery of pregnant women with two or more uterine scars aft er Cesarean section.Materials and Methods: A retrospective study was performed based on the Krasnoyarsk Regional Clinical Center for Maternal and Child Health. The analysis of birth histories and histories of newborns in pregnant women who delivered by Caesarean section with two or more scars on the uterus within 2020 was carried out. Inclusion criteria: single pregnancy of 22 weeks or more, the presence of two or more scars aft er Cesarean section. Exclusion criteria: pregnancy less than 22 weeks, one scar on the uterus, and a scar on the uterus aft er other operations. Pregnant women with multiple pregnancies.Results: The severity of the adhesive process in the abdominal cavity was noted only in patients with three or more uterine scars. An increase in the duration of the Cesarean section operation of more than 60 minutes was observed in the group with three uterine scars and more (40%). Low risk of injuries to neighboring organs, intestines, ureters, and bladder was observed in groups of patients with both two and three uterine scars. More oft en, intraoperative massive blood loss was noted in the group with three scars on the uterus and more (16.67%). Moderate and severe asphyxia in newborns was registered in the group with three or more uterine scars (16.65%).Conclusion: Th e presence of one and/or two scars on the uterus aft er Cesarean section allowed the authors to classify these pregnant women as a low-risk group. The presence of three or more scars on the uterus aft er Cesarean section classifi ed these pregnant women as a high-risk group.

Determınıng the Covıd-19 Exıstence in Perıtoneal Fluıd

Purpose: To determine the SARS-CoV-2 existence in the peritoneal fluid for preventing healthcare workers from surgical smoke and aerosolization of Covid-19 during laparoscopyMethods: All the data of the 6 Covid-19 positive patients included in this study were collected prospectively between the 31st August 2020 and 31st November 2020. Clinicopathologic data of the patients including age, symptoms, radiological and laboratory findings, antiviral treatment before the operation, operation, and peritoneal fluid Covid-19 existence were recorded. Covid-19 status of the patients was diagnosed with a nasal swab test. Covid-19 existence in the peritoneal fluid was determined by the RT-PCR test.Results: All the 6 Covid-19 positive patients were pregnant. Therefore, all the operations were ceserean section operation. Only one patient had high fever. The Covid-19 specific radiological finding was detected only in one patient. In laboratory findings: 4 of 6 cases had lymphopenia and all cases had D-dimer positivity. Antiviral drugs were not used in any of the cases in this study. There was no detected Covid-19 virus in the peritoneal fluid examples of any cases. Conclusion: Aerosolization of Covid-19 from the peritoneal cavity by laparoscopy or electrocautery is not a big concern under the condition of applying cautions according to the guidelines.

Overviews of Reviews of the comorbidities, symptoms and perinatal clinical characteristics of patients with coronavirus 2019 (COVID-19)

What is the incidence in pregnant women of: preterm labor, C-section operation, pneumonia, cough, fever, radiological alterations in the chest, alterations in the blood count, liver function, C-reactive protein, procalcitonin, high D-dimer, thrombocytopenia, globular sedimentation rate.What is the incidence in the neonate of: low birth weight, fetal well-being commitment, low Apgar score, radiological alterations in chest, alterations in the blood count, liver function, C-reactive protein, procalcitonin, high D-dimer, thrombocytopenia, and what is the globular sedimentation rate, the vertical transmission of COVID-19 symptoms, and what are the clinical characteristics?

A Comparison of Using Crystalloid Preloading and Co-Loading in Caesarean Section Operation Under Spinal Anaesthesia and Its Association with Spinal Anaesthesia Induced Hypotension and Heart Rate Variability

Context: There is lack of evidence on comparison of crystalloid pre-loading and co-loading in parturients undergoing cesarean section operation under spinal anesthesia in Bangladesh. Hence, the present study was designed to compare the efficacy of crystalloid pre-loading and co-loading in preventing spinal anesthesia induced hypotension and heart rate variability during caesarean delivery. Methods: This single blinded randomized controlled clinical trial was conducted in the Department of Anaesthesia, Analgesia & Intensive Care, Dhaka Medical College Hospital, Dhaka, Bangladesh, from January 2013 to December 2014. A total of 90 patients were selected - 45 patients of group I received co-loading with Ringer’s lactate solution, while another 45 patients of group II received a pre-loading with the same fluid. Blood pressure and heart rate were recorded in both the groups with 3-minute intervals from the beginning of the subarachnoid block for the first 20 minutes, and then with 5-minute intervals up to one hour. Ephedrine was used as the primary rescue drug to treat hypotension. When ephedrine failed to treat hypotension, adrenaline was administered as a potent vasopressor. Results: The incidence of hypotension was 17 (37.8%) in group I (co-loading group) and 27 (60%) in group II (pre-loading group), which was significantly higher in group II (p<0.05). Comparatively higher heart rate was observed in group II, but not statistically significant. Ephedrine was required in 17 cases (37.8%) in group I and 27 cases (60%) in group II. Mean ephedrine required was 9.2±3.6 mg in group I and 11.5±4.3 mg in group II. The difference was statistically significant (p<0.05). Adrenaline was administered in 1 case (2.2%) in group I and in 2 cases (4.4%) in group II, which was not statistically significant (p>0.05). Conclusion: Severity of hypotension and increased ephedrine requirement were evident in patients who received crystalloid pre-loading (group II), which means crystalloid co-loading (group I) was more capable to prevent spinal anaesthesia induced hypotension. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 12-17

TO THE TECHNIQUE OF CONSERVATIVE CESARIAN SECTION OPERATION

Caesarean section, which in the previous pre-antiseptic time gave a staggering percentage of mortality, really seemed too risky an operation; according to statistics collected by Joulin in Trait d'Acouchements, this percentage, according to different authors, fluctuated between 44.5% and 66.6%. According to Lazarevich (Course of Obstetrics published in 1892), the mortality rate in the old days was 80%. After the introduction of antiseptics and mainly after the improvements in the surgical technique proposed by Snger, the mortality rate can be so much that if the operation is performed in a good environment and by the hands of an experienced surgeon, then less than 10% is obtained; thus, Leopold's caesarean sections gave only 8% of the adverse outcomes.

Latvian experience in conservative management of abnormally invasive placenta: two case reports

Background. Abnormally invasive placentation (AIP) is a clinical term that describes situation when placenta does not separate spontaneously after delivery and its manual removal causes excessive bleeding (1). Historically, the treatment of choice for this condition is hysterectomy. Lately, the new treatment option, conservative management of the AIP, has proven itself an effective alternative to hysterectomy in carefully selected patients (2). However, the use of conservative AIP management is limited in many countries, the reasoning being the lack of doctors’ experience in this procedure and concerns regarding a high postpartum infection rate. Case reports. We present the first two cases of conservative management of AIP in Latvia. Most of prenatally diagnosed AIP cases country-wide are referred to the Paul Stradinš University Hospital, which is a tertiary referral hospital. The annual rate of AIP in the hospital varies from five to ten cases. Two pregnant women were diagnosed with AIP prenatally, both of them refused hysterectomy and therefore went for the conservative management of AIP. During Caesarean section operation, placentas were left in situ after delivery of the baby. During the follow-up period of 12 and 14 weeks, both women developed infection complications, but complete placental tissue resolution was diagnosed in the end. Conclusion. These two cases demonstrate that conservative management of AIP can be safely applied in small countries/areas with small AIP rate and management experience.

Surgical Site Infection in Cesarean Section Operation: Risk and Management

Cesarean sections (CS) are one of the most commonly performed surgical procedures worldwide. There is great variability in the percentage of cesarean sections between countries, varying from 3% to 42.9%5. In the US, approximately 32% of deliveries occur through a cesarean section. Overall, a drastic increase in cesarean section rate has been reported reaching its highest level at the present time. In Brazil, considering the types of births by live births from 2006 to 2016, the national percentage of cesarean section was 52.37%. The variability in this percentage can still be perceived within Brazilian territory. The highest cesarean rate occurred in the Southern region, representing 58.33% of births, while the lowest rate occurred in the Northern region, with 41.79%. It is possible to see the steady increase in the percentage of CS over time, from 45.01% in 2006 to 55.39% in 2016.

Benign lesions of the sinonasal tract: clinical study

<p class="abstract"><strong>Background:</strong> Benign nasal mass lesions may remain asymptomatic for a long time. Bothersome symptoms like nasal obstruction, bleeding from nose, headache prompts the patient to visit the hospital. Although these are not life threatening, but yet timely intervention not only relieves patient symptoms but also prevents its further progress which may necessitate a more extensive surgical approach. The aim of the study was to determine the incidence of various benign nasal mass lesions presenting to the ENT outpatient department, by reviewing the histopathological report postoperatively.</p><p class="abstract"><strong>Methods:</strong> It’s a retrospective study over a period of 4 years and 1 month (from November 2012 to November 2016). Both males and females in the age group 1 yr to 70 yrs, who underwent surgery for nasal mass and histopathologically proved as benign mass, were included in the study. Patient data was collected from medical record section, operation theatre surgical records and histopathology register from the department of pathology.</p><p class="abstract"><strong>Results:</strong> Histopathology review of 146 cases was done. Majority of the patients (139/146) had non neoplastic lesions and only 7 patients had benign neoplastic lesion. Majority were males and in the age group of 20 to 60 yrs.</p><p><strong>Conclusions:</strong> Though the majority of nasal mass lesions studied are benign non neoplastic, yet these cause bothersome symptoms to the patients thereby requiring surgical intervention. </p>

Mathematical Interpretation for a Method of Rotation of a Point Around a Second Order Curved Axis

Previously, the method of rotating of flat geometric objects around curvilinear axes was described by us. The next step in the path of our research should be the development of methods for the automated creation of surfaces digital models obtained by the described rotation method. We have created models of surfaces, the axis and the forming curve of which are circles lying in the same plane. Several cases of mutual disposition for such circles were analyzed. Modeling was carried out using constructive techniques. Surfaces were created using the “surface by section” operation. The centers of such circular sections belong to the axis of rotation, if it is a circle. Using the special tools incorporated in the KOMPAS-3D program, we have cut the surfaces modeled in this way by planes, and obtained a number of flat sections. Taking into account the difficulties occurring during the study of such complex geometric objects by means of flat graphic constructions, as well as graphic computer modeling, we have realized the need to create a mathematical apparatus describing these objects’ shape. The required mechanism should be applicable to any pair of second-order curves interconnected as “axis — generatix”. We have considered an elementary example – the rotation of a point around a curve elliptical axis. In this paper a solution for the problem of finding a system of equations describing a set of point positions, which it will successively take when rotating around the elliptic axis, is presented. It is possible to apply a similar mathematical apparatus to axes having the form of other quadrics, for example, hyperbolas or parabolas, as well as to generatices consisting of more than one point, that is, to forming curves.