Cases Of Cesarean Section Research Articles

Two Cases of Cesarean Sections Performed with Combined Spinal-Epidural Anesthesia with Perioperative Asthma Attacks

Two Cases of Cesarean Sections Performed with Combined Spinal-Epidural Anesthesia with Perioperative Asthma Attacks

ЭПИДЕМИОЛОГИЯ И ФАКТОРЫ РИСКА РАЗВИТИЯ МАТЕРИНСКОГО СЕПСИСА

In modern medicine suppurative diseases of puerperas are among the most significant medical and social problems of obstetrics, occupying a leading position in the structure of maternal morbidity and mortality throughout the world. High incidence, an upward trend, a growing number of cases of cesarean sections (CS), insufficient detection and registration, along with obstetric aggression characterize these formidable complications that can occur during pregnancy or in the postpartum period. According to the literature data, in spite of the high relevance of the problem, research on the incidence of postpartum purulent inflammatory complications, risk factors for their development, clinical picture, diagnosis, prevention, and treatment, as well as the algorithm for managing patients with these complications in Tajikistan is scarce. Keywords: Postpartum period, postpartum infection, postpartum suppurative diseases, sepsis, risk factors for sepsis. For citation: Saydalieva DA, Dodkhoeva MF, Abdullaeva RA. Epidemiologiya i faktory riska razvitiya materinskogo sepsisa [Epid

Evaluation of the Effects of Doses of Dexmedetomidine as Adjuvants to Hyperbaric Bupivacaine in Subarachnoid Blocks for Elective Caesarean Sections: A Prospective, Randomised, Triple-blind Controlled Study

Introduction: Since single-shot spinal anaesthesia for caesarean section operations provides limited postoperative analgesia, several adjuvants are employed to obtain the prolonged duration of sensory block. Dexmedetomidine (DMT) used as an adjuvant to 0.5% hyperbaric bupivacaine is found to provide a longer duration of analgesia. Aim: To evaluate the block characteristics and neonatal effects of three doses of DMT 2.5 μg, 5 μg and 7.5 μg used as adjuvants to 0.5% hyperbaric bupivacaine (10 mg). Materials and Methods: A prospective randomised multi arm triple-blind controlled study was conducted at the Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Andhra Pradesh, India from May 2020 to May 2022 on parturients who were assigned to four groups of 20 each. Parturients of Groups A, B and C were given 0.5% hyperbaric bupivacaine (10 mg) with DMT 2.5 μg (0.1), 5 μg (0.2 ) or 7.5 μg (0.3 ) ml respectively as adjuvant and those in Group D were given 2 mL of 0.5% hyperbaric bupivacaine alone and the final volume was made 2.5 in all four groups by adding sterile normal saline (0.9% NaCl). Characteristics of the mother and neonate like age, height, body weight, Body Mass Index (BMI), gravida status etc., were recorded, the duration of analgesia, the total quantity of the analgesic medicine consumed during the 1st 24 hours of the postoperative period, duration of the motor and sensory blocks, changes in haemodynamic variables were also noted. Ramsay Sedation Scores (RSS), surgeon and patient satisfaction scores were recorded for statistical analysis. Parametric data was analysed using the Analysis of Variance (ANOVA) and Tukey’s post-hoc test and non parametric data using the Chi-square test. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 20.0 and a p-value of ≤0.05 was considered statistically significant. Results: Parturients of Groups A, B and C had an earlier onset of sensory block 4.3±0.8, 3.6±0.5, 2.7±0.5 minutes respectively compared to control 5.7±0.6 minutes (p-value <0.001). They also had a longer duration of analgesia 203.6±14.4, 320.2±24.0, 340.0±14.4 minutes respectively compared to those in control 150.1±7.1 minutes (p-value <0.0001) and consumed a lesser amount of analgesic medication; 165.0±14.4, 110.0±30.7, 100.0±0.0 mg compared to control 190.0±30.7 mg (p-value <0.001). Surgeon scores regarding the anaesthetic technique were satisfactory in a greater proportion/percentage of parturients in Groups A, B and C; 13 (65%), 16 (80%) and 18 (90%), respectively vs 9 (45%) in control p-value <0.01198. Patient scores regarding the anaesthetic technique were satisfactory in a greater proportion/percentage of parturients in Groups A, B and C; 14 (70%), 17 (85%), 19 (95%), respectively vs 10 (50%) in control p-value <0.00652. Conclusion: On the basis of the results of the present study, it was concluded that 5 µg DMT added as an adjuvant to 10 mg of 0.5% hyperbaric bupivacaine intrathecally was the optimal drug combination to be used for spinal anaesthesia for caesarean section cases, whereas a higher dose of 7.5 µg DMT had resulted in greater fluctuations in Pulse Rate (PR) and Mean Arterial Pressure (MAP) and a lower dose of 2.5 µg DMT had resulted in a shorter duration of analgesia.

CAESAREAN DELIVERY DURING SECOND STAGE OF LABOR- A STUDY OF FETOMATERNAL OUTCOME IN A TERTIARY CARE HOSPITAL

Background: There is an alarming rise in Caesarean section (CS) leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery despite the efforts to limit operative abdominal deliveries. Within this increasing CS rate, there is a concerning increase in the rate of second stage cesarean section. Cesarean sections performed at full dilatation (FDCS) are becoming increasingly common in obstetric practice Aim: To analyze the indications and assess feto-maternal outcomes in caesarian section in second stage of labor. Material And Methods: This was a retrospective hospital based observational study assessed all caesarean sections performed at full cervical dilatation between September 2020 and September 2021 at King George hospital, Visakhapatnam, Andhra Pradesh. Caesarean section cases were identified through the operating theatre data log. The medical record, specifically the record of labor and operation reports, was reviewed for all CS cases over the study period. Results: During the index period, a total of 3800 women delivered by caesarean section, (2900 emergency and 900 elective cases) .A total of 340 women were at full cervical dilatation, >37 weeks gestation with a singleton fetus in cephalic presentation were studied. Mean duration of surgery was 57.68 min. Secondary arrest of descent was seen in 53.8% of cases and NICU admission in 6.76%,APGAR <7 at birth in 9.11% cases. Conclusion: Although second stage of labor was sometimes appropriate, there are no specific guidelines for safe practice. It is a technically demanding procedure. It has additional associated risks for mother and fetus due to the nature of emergency situation.

Effectiveness of Uterine Arterial Embolization and Risk Factors Associated with Its Failure in Patients with Primary Postpartum Hemorrhage After Cesarean Section

Background: Postpartum hemorrhage (PPH), a serious labor-related complication, is the leading cause of maternal mortality, which requires an emergent intervention. Uterine arterial embolization (UAE) is an effective treatment for hemostasis of intractable PPH. Several risk factors have been reported for the failure of UAE. Objectives: To evaluate the clinical outcomes of UAE for the treatment of primary PPH following cesarean section (CS) and to determine the risk factors associated with the failure of this procedure. Patients and Methods: This retrospective, single-center study was approved by the institutional review board, and the requirement to obtain informed consent was waived. All patients referred to a tertiary care center, who underwent UAE for primary PPH between January 2018 and December 2020, were included. The patients’ medical records and radiological findings, including the patients’ characteristics, mode of delivery, initial vital signs and laboratory findings after hospitalization, procedure details, and embolization outcomes, were evaluated for data collection. Technical success was defined as appropriate embolization of target vessels on a completion angiogram. Clinical success was defined as adequate cessation of bleeding after the first embolization, without any need for subsequent embolization or surgical intervention. Statistical analysis was performed to determine factors related to the clinical failure of UAE in CS cases. Results: UAE was performed for 25 patients (mean age, 37.2 years; range, 25 - 45 years). The technical success rate was estimated at 100% (n = 25), and the clinical success rate was 76% (n = 19). There were no patients with permanent adverse sequelae or death. The univariate analyses showed that hemodynamic instability (P = 0.006), lower hemoglobin levels (P = 0.02), and prolonged activated partial thromboplastin time (aPTT) (P = 0.017) were related to clinical failure. The logistic regression analysis adjusted for age showed that the area under the curve (AUC) was 0.86 for hemoglobin (95% CI: 0.7 - 1; cutoff value: 0.667), 0.816 for aPTT (95% CI: 0.625 - 1; cutoff value: 0.411), and 0.868 for hemodynamic instability (95% CI: 0.661 - 1; cutoff value: 0.622). Conclusion: UAE is a safe and effective treatment for primary PPH following CS. Hemodynamic instability, low hemoglobin levels, and prolonged aPTT can be predictive factors for the poor outcomes of UAE in CS patients. These factors are rapid and straightforward criteria, which can be simply applied, even in emergency situations.

Analgesic outcomes of tramadol alone and in combination with Butorphanol or Flurbiprofen Axetil after cesarean section: a retrospective study with propensity score matching analysis

BackgroundThe Society for Obstetric Anesthesia and Perinatology recommends a multimodal analgesia regimen for cesarean delivery analgesia. This study aimed to compare the analgesic effects of tramadol alone and combined with butorphanol or flurbiprofen axetil after a cesarean section.MethodsWe performed a retrospective analysis based on the electronic medical records of a teaching hospital in China from January 2018 to January 2020. We collected data on demographic characteristics, anesthesia, analgesia strategy, and pain intensity postoperatively during the first 48 hours. Inadequate postoperative analgesia during this period was defined as an NRS score ≥ 4. We also collected data regarding off-bed activity and intestinal function recovery. Participants were classified into three groups according to analgesia regimens. Groups T, TF, and TB received tramadol, a mixture of tramadol and flurbiprofen axetil, and a combination of tramadol and butorphanol, respectively. Analgesic outcomes were compared using propensity score matching analysis.ResultsData from 2323 cases of caesarean section were included in the analysis, and 521 pairs were matched in each group according to their propensity score. Compared with group T, The inadequate analgesia on pain at rest and pain at movement was lower in group TF (RR: 0.42, 95% CI: 0.36–0.49, P = 0.001 and RR: 0.58, 95% CI: 0.48–0.69, P < 0.001, respectively),and the incidence of inadequate control of pain at movement was higher in group TB (RR: 1.38, 95% CI: 1.22–1.55, P < 0.001).Additionally, the percentage of off-bed activity at 2 days postoperatively was higher in group TB than in groups TF and T (78.7% vs. 68.5 and 78.7% vs. 64.9%, respectively, P < 0.001). The incidence of intestinal function recovery 2 days after cesarean delivery in group TB was higher than that in group TF (73.3% vs. 66.2%, P = 0.013).ConclusionsCombining tramadol and flurbiprofen axetil could enhance the analgesic effect and be safely used for analgesia after a cesarean section. However, combining tramadol and butorphanol may produce an antagonistic effect.

Changes in Maternal Serum Levels of C3 and C4 Complement Components in Different Delivery Methods and Postpartum Hemorrhage.

Activation of the complement system may play a role in the pathophysiology of human labor. Yet no unanimous conclusion has been drawn. To compare the differences in maternal complement components C3 and C4 serum levels in cesarean section and the vaginal delivery at term and in the postpartum hemorrhage. One hundred and sixty six women delivered at term were enrolled in this study. Maternal blood samples were obtained from 47 cases of elective cesarean section and 119 cases of the vaginal delivery. Serum complement levels were measured subsequently by immuno-scatter turbidimetry. The maternal complement levels declined significantly during delivery by both the cesarean section and the vaginal delivery (p＜0.01) in comparison with the baseline. A much larger drop of C3 serum level was found in the postpartum hemorrhage and in the vaginal delivery, and the incidence of the postpartum hemorrhage has a positive correlation with the complement decline rate. The complement system may be involved in the delivery process and represents a predictive value in postpartum hemorrhage.

Prenatal Monitoring of Perinatal Pregnant Women and Fetus Based on a Smart Electronic Fetal Monitoring System.

The aim of the study is to study the prenatal monitoring of perinatal pregnant women based on a smart electronic fetal monitoring system. Through the comparative analysis of 230 pregnant women in maternal and child health care hospital who received fetal heart monitoring during the perinatal period and those who did not receive fetal heart monitoring during the perinatal period, cases of fetal distress, neonatal asphyxia, and cesarean section were observed in both groups. Results show that the incidences of fetal complications and cesarean sections in the experimental group were 16.36% and 36.82%, which was significantly higher than 4.50% and 17.50% in the control group(p < 0.05); the neonatal mild and severe asphyxia rates in the experimental group were 3.18% and 1.36%, which were significantly lower than 9.50% and 6.50% in the control group (p < 0.05). The experimental results show that the correct application of fetal heart rate monitoring in the perinatal period can aid in early detection and dealing with fetal distress and reduce the occurrence of various complications such as neonatal asphyxia. It is worthy to be popularized and applied in clinics.

Predictors of Induction of Labor and Success Rate Among Mothers Giving Birth at Jimma University Medical Centre South West Ethiopia: Unmatched Case Control Study

BACKGROUNDInduction of labor is defined as the process of artificially stimulating the uterus to start labor. Despite the unquestionable reputation of labor induction for ending pregnancies, there is a risk to the mother and/or the fetus. Studies from developed and developing countries report increased labor induction rates with additional cases of cesarean section (CS) and fetal distress.OBJECTIVEThe main aim of this study is to assess predictors of induction of labor and the success rate among mothers giving birth at Jimma University Medical Centre Southwest Ethiopia.METHODSA facility based unmatched case control quantitative study design was done among 694 (cases = 347 plus controls is 347) mothers. A systematic random sampling technique was used to select both cases and controls from the registration delivery log book. A standard document review checklist was used to collect data. Multivariate binary logistic regression analysis was done to identify predictors of the outcome of the variable.RESULTSThe study findings revealed that the success rate of induction of labor in this study was 73.8%. Mothers with stillbirth history were three times more likely to be induced compared with mothers without stillbirth history. Mothers with abortion history were seven times more likely to be induced than mothers without an abortion history. Mothers with a gestational age of ≥42 weeks were 17 times more likely to be induced than mothers with a gestational age of 38–41 weeks. Mothers who had no antenatal care follow-up were seven times more likely to be induced than mothers who had antenatal care follow-up.CONCLUSIONMaternal age, gestational age, history of abortion, and history of stillbirth were significant predictors of induction of labor which was claimed to increase the rate of uterine rupture, CS and admission to a neonatal intensive care unit (NICU).

Clinical study of hysteroscopical electroresection of FIGO type 3 myoma

Objective: To analyze the clinical application and to evaluate the efficiency of hysteroscopical electroresection of International Federation of Gynecology and Obstetrics (FIGO) type 3 myoma. Methods: The clinical data of patients who underwent hysteroscopical electroresection single FIGO type 3 myoma in Obstetrics and Gynecology Hospital of Fudan University from January 2019 to October 2021 were collected retrospectively. The clinical symptoms, myoma size, location, operation time, intraoperative bleeding, surgical complications and postoperative follow-up were recorded, and the subsequent pregnancy outcomes were followed-up. Results: Totally 35 patients with FIGO type 3 myoma were included in this study. The average age was (36.6±4.7) years old, the diameter of myoma was (4.0±1.2) cm (range: 2.0-5.8 cm). The rate of complete resection of myoma in one operation was 86% (30/35), the average operation time was (41±15) minutes (range: 20-65 minutes), and the average intraoperative bleeding was (24±18) ml (range: 5-150 ml). No complications such as uterine perforation, massive hemorrhage, hyperhyderation syndrome and infection occurred in all patients perioperation. There were 20 cases with significant increase of menstruation before operation, the cure rate and effective rate of hysteroscopical electroresection of FIGO type 3 myoma were 75% (15/20) and 95% (19/20). There were 24 patients with fertility requirements, their average follow-up time was (14.5±6.8) months, the pregnancy rate within 1 year after operation was 79% (19/24), and the average postoperative pregnancy time was (5.8±3.4) months. There were 15 cases who had completed delivery after operation, including 10 cases of vaginal delivery and 5 cases of cesarean section, and none of them had uterine rupture. Conclusions: Hysteroscopy could effectively resect FIGO type 3 myoma. Hysteroscopical electroresection of FIGO type 3 myoma is minimally invasive with rapid postoperative recovery and could achieve pregnancy in a short time, which is not only helpful to reduce the amount of menstruation, but also beneficial for the prognosis of fertility. It should be carried out by the experienced hysteroscopists.

Adhesion barriers and intraperitoneal or uterine infections after cesarean section: A retrospective cohort study

BackgroundIntraperitoneal adhesion is a common complication of cesarean section, and adhesion barriers are often used to prevent postoperative adhesion. However, the association between the use of adhesion barriers and infections after cesarean section remains unknown. This study aimed to evaluate the association. MethodsUsing the administrative claims database of a single prefecture in Japan, we identified all patients who underwent cesarean section from June 2014 to February 2019. A multivariable logistic regression model fitted with a generalized estimating equation was used to compare the postoperative outcomes between patients who received intraperitoneal adhesion barriers during cesarean section and those who did not. The primary outcome was intraperitoneal or uterine infections within 3 months after cesarean section, including intraperitoneal abscess, pelvic inflammatory disease, peritonitis, uterine wound infection, endometritis, and adnexitis. ResultsA total of 1,392 patients with 1,498 cesarean section cases were reviewed. Adhesion barriers were used in 1,153/1,498 (77.0%) cases. One hundred and fourteen (9.9%) intraperitoneal or uterine infections occurred in the group with and 15 (4.3%) in the group without adhesion barriers. The proportion of intraperitoneal or uterine infections was significantly higher in the group with than in the group without adhesion barriers (9.9% and 4.3%, respectively; adjusted odds ratio = 2.59; 95% confidence interval, 1.40–4.77; P = .002). ConclusionThe use of adhesion barriers was associated with an increase in intraperitoneal or uterine infections after cesarean section.

Study some characteristics of electronic fetal monitoring to diagnose fetal compromise

ABSTRACT Background: Assessing fetal health during pregnancy and labor is important in reducing neonatal morbidity and mortality. In which electronic fetal monitoring is the most commonly used obstetric procedure. The false-positive rate of electronic fetal monitoring to predict adverse outcomes is high. Therefore, the study of fetal heart rate charts to confirm the diagnosis of fetal compromise is very necessary to limit cases of unreasonable cesarean section. Therefore, we conduct this study to: (1) Survey the characteristics of electronic fetal monitoring (EFM) to diagnose fetal compromise. (2) Find out the association between EFM and obstetrical outcomes Methods: Observative cross-sectional study recruited 336 term singleton pregnant women with occipital presentation, presenting with labour symptoms at Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, between June 2019 to June 2021. All participants accepted to participate in the research and fetal being was assessed by EFM using FIGO 2015 classification. Exclusion criteria were multiple gestation, congenital malformation, placenta previa, placenta abruptio, maternal disease affecting the fetus and using medication which can affect the fetus. Results: Among 336 pregnant women, 31 cases (11%) were diagnosed with fetal compromise. Deceleration had the highest sensitivity while baseline heart rate had the lowest to diagnose fetal compromise. Base line heart rate had the highest specificity while acceleration had the lowest to diagnose fetal compromise. There was an association between EFM and Neonatal Intensive Unit Care admission (p&lt;0.001). There was no association between EFM and gestational age, birth weight, nuchal cord, amniotic fluid’s color and first-minute APGAR score. Conclusions: EFM should be indicated for labour women to screen the fetal compromise. However, abnormal EFM was associated with increased c-section rate, operative delivery and Neonatal Intensive Unit Care admission. Therefore, close monitoring should be combined with clinical and subclinical results to prevent unnecessary intervention

COVID-19 pandemic facilitate the adoption of Enhanced Recovery After Surgery in a public hospital in Korea (332)

Objectives: Despite an increasing number of reports on the adoption of the enhanced recovery after surgery program (ERAS) in gynecology in Western countries, there are very few reports on this topic in Korea. Distinct characteristics for infrastructure and insurance systems may attribute to the slow adoption of ERAS. The COVID-19 pandemic forced rearrangement of medical resources, especially in public hospitals dealing with the disease in the frontline. This study aimed to investigate how a public hospital deals with gynecologic surgeries in the circumstances of limited resources caused by the pandemic.Methods: As the COVID-19 developed as a pandemic, the Seoul Metropolitan Government Boramae Medical Center hospital evacuated several wards to admit patients severely suffering COVID-19 since March 2020. The bed count assigned for the obstetrics and gynecology (OBGY) department was forced to decrease from 28 beds to 16 beds (-42%). The availability of outpatient clinics and the surgical facility was not affected. In order to maintain surgical volume, we promptly adopted ERAS in the whole OBGY surgery. Early feeding and individualized discharge planning were applied for all inpatient surgical cases to cope with reduced inpatient volume. The number of surgeries and average hospital stay were compared before and after inpatient volume reduction.Results: There was a slight decrease in the number of total surgeries due to the reduction of Cesarean section cases (1335 in 2018, 1331 in 2019, 1279 in 2020). However, the number of surgeries for benign and malignant gynecologic diseases was not reduced (771 and 94 in 2019, 737 and 94 in 2020, respectively). The proportion of minimally invasive hysterectomy for benign diseases increased (58.8% in 2019, 72.2% in 2020, p=0.03). Single site laparoscopic surgery for the benign adnexal disease increased (40.8% in 2019, 56.1% in 2020, p<0.001). The hospital stay for cesarean section, abdominal hysterectomy, laparoscopic hysterectomy, oncologic staging surgery, laparoscopic adnexal surgery significantly decreased with an average difference of one day. The 90-days re-admission rate was not different between 2019 and 2020.Conclusions: COVID-19 pandemic-related medical resource shortage accelerated adaptation of ERAS in OBGY surgery. Repositioning the medical resources more efficiently is imperative as the COVID-19 pandemic gain momentum.

A Case Series of Uterine Prolapse in Pregnancy

Pelvic organ prolapse is a common gynecological problem in developing countries, but pelvic organ prolapse occurrencein pregnancy is a rare phenomenon. We present a case series of pelvic organ prolapse during pregnancy. All four caseswere treated conservatively. Half of the patients had cesarean sections and the other half delivered vaginally. One ofthe cases of cesarean section was done in view of cervical dystocia. Of the four cases, half presented with early ruptureof membranes. There was one patient who delivered prematurely at 36 weeks of gestation. The postnatal period wasuneventful and the prolapse regressed in all patients spontaneously.

Preoperative antibiotic prophylaxis in a single tertiary hospital in Slovenia—the role of education in recommendation compliance

Purpose: The aim of the present study was to evaluate the impact of an educational intervention package on perioperative antimicrobial prophylaxis (PAP) prescription practice in three elective procedures—total hip arthroplasty (THA), caesarean section (CS), and radical prostatectomy (RP)—in a single tertiary care hospital in Slovenia.&#x0D; Methods: An interventional study was performed to evaluate the impact of an educational intervention package on PAP compliance. PAP prescription practices for three elective types of surgery (THA, CS, and RP) were observed. Thirty operative reports for each type of surgical procedure were evaluated according to indication, timing of preoperative prophylaxis administration, antibiotic selection and dosage, and total prophylaxis duration. This was followed by an educational intervention package that included a discussion with department leaders led by an infectious disease specialist and an educational seminar and discussion for surgeons, supplemented by PAP recommendations provided as pocket reminders. Then, the compliance with PAP recommendations for the same types of procedures performed in the post-interventional period (3–6 months after the intervention) was evaluated again.&#x0D; Results: Complete pre-interventional compliance with local guidelines was observed in 67%, 70%, and 3.3% of THA, CS, and RP cases, respectively. A major deviation from PAP recommendations was observed in the timing of preoperative PAP administration before surgery and in the total PAP duration A deviation from recommendations for RP, which is a major surgical procedure, was observed as a longer postoperative PAP duration compared to the intraoperative course. In the post-interventional period, an improvement in total compliance with PAP recommendations was observed in 80.0%, 90.0%, and 50.0% of THR, CS, and RP procedures, respectively.&#x0D; Conclusion: Our study revealed an improvement in adherence to PAP recommendations after an educational intervention package for selected procedures at the University Medical Centre Maribor. This simple intervention can have an important impact on patient care quality by reducing antimicrobial medication use, resistance development, and treatment cost.

Risk Factors Associated with Surgical Site Infection following Cesarean Section in Tertiary Care Hospital, Nepal.

Background Cesarean section (CS) is one of the most performed surgeries in obstetrics. Surgical site infection is the major cause of morbidity and mortality causing an increase in the duration of hospitalization as well as the cost of admission for the patient. Objective To determine incidence of surgical site infection following cesarean section, classify them according to CDC criteria, and identify the different risk factors. Methodology. This is a case-control study conducted at the Department of Obstetrics and Gynecology at Tribhuvan University Teaching Hospital (TUTH), main campus of Institute of Medicine (IOM), Kathmandu, Nepal. Surgical site infections (SSI) in patients who underwent cesarean sections from February 2019 to August 2019 were taken as cases, while the patients who underwent cesarean section before or after the procedure and did not develop SSI comprised the controls. Visual inspection during ward rounds, reports from laboratory, and postprocedure follow-ups for up to 30 days formed the basis of identifying infections on the patients. Risk factors were identified by bivariate and multivariate logistic regression. Results Out of 1135 cases of cesarean sections, 97 of them developed SSI with incidence rate of 8.54%. Among them, 94.85% were superficial incisional and 5.15% were deep incisional type of SSI with no organ space type. Cases had higher mean age 26.88 ± 4.38 years compared to 24.81 ± 5.08 years in controls. Host-related risk factors which led to higher odds of developing surgical site infection (SSI) were obesity with adjusted odds ratio (AOR) 15.72 (confidence interval (CI): 4.60-53.67), diabetes/hypertension in pregnancy with AOR 4.75(CI 1.69-13.32), and other medical diseases with AOR 9.38 (CI 2.89-30.46). Duration of the rupture of membrane for more than 18 hours with AOR 8.38 (CI 1.48-47.35), more than five per vaginal (PV) examination with AOR 1.93 (95% CI 1.03-3.64), and in labor status with AOR 6.52 (CI 1.17-36.38) were some procedure-related factors resulting into higher odds of infection. Conclusion Multiple risk factors like age, obesity, medical complications during pregnancy, occurrence of labor status during cesarean section, prolonged duration of rupture of membrane for more than 18 hours, and more than five vaginal examinations before the procedure increases the chance of surgical site infection (SSI) following cesarean section.

Safety and Feasibility of Vaginal Delivery in Full-Term Pregnancy After Transvaginal-Natural Orifice Transluminal Endoscopic Surgery: A Case Series.

Study ObjectiveThe aim was to investigate the outcome of vaginal delivery of full-term pregnancies in patients after transvaginal-natural orifice transluminal endoscopic surgery (vNOTES) treatment for gynecological disorders.DesignA case series report.SettingA medical university hospital.Patients12 cases of successful delivery after transvaginal-natural orifice transluminal endoscopic surgery.InterventionsLong-term follow-up of patients with fertility needs after transvaginal-natural orifice transluminal endoscopic surgery.Measurements and Main ResultsFrom 2018 to 2021, 163 cases of gynecological diseases were treated by vNOTES. One hundred forty-seven patients were followed up, with a follow-up rate of 90.1%. The average follow-up time was 28 (15–47) months, including 66 cases with fertility requirements. Among these 66 patients, 12 patients successfully got pregnant and completed delivery, including 10 cases of vaginal delivery and 2 cases of cesarean section, with no adverse pregnancy outcomes associated with vNOTES arising.ConclusionVaginal delivery of a full-term pregnancy after transvaginal-natural orifice transluminal endoscopic surgery appears to be safe and feasible and would not be one of the bases for elective cesarean delivery.

Validity of Administrative Data for Identifying Birth-Related Outcomes with the End Date of Pregnancy in a Japanese University Hospital.

This study aimed to develop and validate claims-based algorithms for identifying live birth, fetal death, and cesarean section by utilizing administrative data from a university hospital in Japan. We included women who visited the Department of Obstetrics at a university hospital in 2018. The diagnosis, medical procedures, and medication data were used to identify potential cases of live birth, fetal death, and cesarean section. By reviewing electronic medical records, we evaluated the positive predictive values (PPVs) and the accuracy of the end date of pregnancy for each claims datum. “Selected algorithm 1” based on PPVs and “selected algorithm 2” based on both the PPVs and the accuracy of the end date of pregnancy were developed. A total of 1757 women were included, and the mean age was 32.8 years. The PPVs of “selected algorithm 1” and “selected algorithm 2” were both 98.1% for live birth, 99.0% and 98.9% for fetal death, and 99.7% and 100.0% for cesarean section, respectively. These findings suggest that the developed algorithms are useful for future studies for evaluating live birth, fetal death, and cesarean section with an accurate end date of pregnancy.

Ilioinguinal and Iliohypogastric Nerve Block for Acute and Chronic Pain Relief After Caesarean Section: A Randomized Controlled Trial.

BackgroundThere is an increasing cesarean section (CS) rate in Egypt. Multiple methods are used to manage pain after CS. ObjectivesThis study aimed to assess the effect of ultrasound-guided bilateral ilioinguinal and iliohypogastric nerve block on pain reduction after CS.MethodsWe classified 64 cases of elective CS into two equal groups. The block group underwent the nerve block, and the control group did not. Postoperative pain, morphine consumption, time to analgesic request, and complications were compared between the two groups. ResultsNo significant difference was detected between the two groups regarding patient characteristics or operation duration. However, pain scores during rest and movement were significantly lower in the block group than in controls, especially within the first 12 hours following the operation. Morphine consumption was significantly lower in the block group (4.53 ± 1.456) in group B vs. (8.87 ± 2.013) in group C with P-value < 0.001. Time to the first rescue analgesia was significantly longer in the intervention group than in the other group (12.25 vs. 3.81 hours). Pruritis and nausea incidence was significantly higher in controls than in the block group. The incidence of chronic postoperative pain was significantly lower in the block group.ConclusionsThe ilioinguinal and iliohypogastric nerve block is efficient and safe for managing postoperative pain following CS. It is associated with significant improvement of acute and chronic pain after such operations.

Experience of a tertiary pandemic centre on the labour and delivery of 337 pregnant women with COVID-19: a prospective cohort study from Turkey

The aim of the present study is to share the experience of a tertiary reference pandemic centre on the labour and delivery of pregnant women with coronavirus disease 2019 (COVID-19). This prospective cohort study was conducted on pregnant women with COVID-19 (n = 337). Patients were divided into two groups based on their severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) positivity (n = 103 positive and n = 234 negative) during the delivery. Thereafter, clinical characteristics and perinatal outcomes were compared between the groups. Moreover, delivery characteristics and clinical features were compared between primary caesarean section (n = 117) and normal spontaneous vaginal delivery cases (n = 100). Labour induction was performed in 16% of cases with a failure rate of 35%. Caesarean rate was 70% and the most common indication was worsening in maternal condition. Significant, positive and moderate correlations were observed between COVID-19 severity at admission (r = 0.422, p<.001), radiologic findings consistent with COVID-19 (r = 0.400, p<.001), the necessity for oxygen support during the delivery (r = 0.406, p<.001) and postpartum worsening in maternal condition. A significant, positive weak correlation was found between caesarean delivery and postpartum worsening in maternal condition (r = 0.176, p<.001). COVID-19 seems to be associated with increased rates of obstetric complications and caesarean delivery. Impact Statement What is already known on this subject? Increased rates of foetal distress and caesarean section were reported in pregnant women with COVID-19. Appropriate management of labour and delivery in infected pregnant women is crucial to obtain favourable perinatal outcomes. What do the results of this study add? COVID-19 seems to be associated with increased rates of obstetric complications and caesarean delivery. PCR positive group had significantly higher primary and prelabor caesarean delivery rates. Severe/critic COVID-19 infection rate was significantly higher in the primary caesarean group. Significant, positive and moderate correlations were observed between COVID-19 severity at admission, radiologic findings consistent with COVID-19, the necessity for oxygen support during the delivery and postpartum worsening in maternal condition. A significant, positive weak correlation was found between caesarean delivery and postpartum worsening in maternal condition. What are the implications of these findings for clinical practice and/or further research? Management and delivery of pregnant women with COVID-19 should be individualised. The findings of the present study may lead to the establishment of future obstetric protocols in this special population.