Cesarean Delivery In Patients Research Articles

The minimum effective dose (ED90) of prophylactic oxytocin infusion during cesarean delivery in patients with and without obesity: an up-down sequential allocation dose-response study

BackgroundObesity is associated with greater oxytocin requirement during labor induction or augmentation. There are scant data exploring the intra-operative requirement during cesarean delivery in patients with obesity, and none comparing it with those without obesity. We evaluated the minimum effective dose (ED90) of an oxytocin infusion to achieve adequate uterine tone during cesarean delivery in patients with and without obesity. MethodsPatients (body mass index ≥30 kg/m2 represented patients with obesity) undergoing cesarean delivery using subarachnoid block were included. This prospective dual-arm dose-finding study used a 9:1 biased sequential allocation design. Oxytocin infusion was initiated at 13 IU/h at cord clamping in the first patient of each group. Uterine tone was graded as satisfactory or unsatisfactory by the obstetrician four minutes after initiation of the infusion. The dose of oxytocin infusion for subsequent patients was determined according to the response of the previous patient in the group. Oxytocin-associated side effects were evaluated. Dose-response data for the groups was evaluated using log-logistic function and ED90 estimates derived from fitted equations using the delta method. ResultsThe ED90 of oxytocin was significantly higher for patients with obesity (n = 40) compared with those without obesity (n = 40) [25.7 IU/h, 95% CI 18.6 to 32.9) vs. 16.6 IU/h, 95% CI 14.9 to 18.3)]; relative ratio 1.55 [95% CI 1.09 to 2.01] (P = 0.019). ConclusionsPatients with obesity require a higher intra-operative oxytocin infusion dose rate to achieve a satisfactorily contracted uterus after fetal delivery when compared with patients without obesity.

Anesthetic Management of Patients With Class 3 Obesity Undergoing Elective Cesarean Delivery: A Single-Center Historical Cohort Study

(Can J Anesth/J Can Anesth. 2023; 70:202–210) Rising obesity rates have reached a high of one third or one fourth of adults in the United States and Canada, respectively. This leads to many individuals with this condition requiring medical care including anesthesia for labor and delivery. Obesity is known to be associated with complications in the administration and effectiveness of anesthesia as well as after cesarean delivery. Prior research has not focused on the nuances of specific categories of body mass index (BMI) and their association with outcomes, specifically for anesthesia during cesarean delivery. This study aimed to describe different techniques and outcomes for anesthesia in elective cesarean delivery in patients with class 3 obesity (BMI ≥40), specifically in groups with BMI 40.0 to 49.9, 50.0 to 59.9, and >60.0.

Projected impact of guidelines on incidence of venous thromboembolism after cesarean delivery in the United States

BackgroundThere is large variation in recommended for postcesarean delivery venous thromboembolism (VTE) prophylaxis among commonly used guidelines. ObjectivesThe aim of the study is to estimate implications of adoption of VTE prevention guidelines for rates of receipt of VTE prophylactic therapy and VTE following cesarean delivery (CD). MethodsWe used administrative data from the 2015-2019 Nationalwide Readmissions Database to identify cesarean deliveries and rates of VTE stratified by risk factors, leading to different prophylactic strategies based on several national guidelines. We used input parameters from the literature to construct a hybrid decision tree/Markov model to project the implications of guideline adoption on VTE rates for the first 6 weeks following delivery. ResultsAdoption of either the 2011 American College of Obstetricians and Gynecologists or the 2018 American Society for Hematology guidelines would avert a relatively small proportion (5%) of VTE cases, albeit with little low-molecular-weight heparin (LMWH) use (87-115 doses per 1000 CD patients). The 2012 American College of Chest Physicians guidelines were predicted to be more effective at averting VTE (21.2% reduction) with more LMWH usage (570 doses per 1000 deliveries). The 2015 Royal College of Obstetricians and Gynaecologists guidelines and universal use of 6 weeks of LMWH would avert an even larger proportion of cases (37.4% and 57.6%, respectively), at the cost of much higher rates of LMWH utilization (7233 doses per 1000 patients and 38 648 doses per 1000 patients). ConclusionsAdoption of different guidelines would have notably varying implications for clinical practice and potential for alteration of the national rate of VTE following CD.

Respiratory Depression After Administration of Single-dose Neuraxial Morphine for Postcesarean Delivery Analgesia: A Retrospective Cohort Study

(Int J Obstet Anesth. 2022;52:103592) Neuraxial anesthesia is the analgesia of choice during cesarean delivery which frequently includes long‐acting morphine. While the standard practice, neuraxial morphine poses an increased risk of delayed respiratory depression. While the risk is low at 1.08 to 1.63 per 10,000 cases, patient comorbidities can increase occurrence. In 2019, the Society for Obstetric Anesthesia and Perinatology (SOAP) gave guidelines for patient surveillance following cesarean delivery (CD) with morphine though evidence-based research is lacking and is rather a result of expert opinion. The aim of this retrospective study was to determine the occurrence of respiratory depression in CD patients who received neuraxial morphine for pain management.

Efficacy of Propranolol to Reduce Cesarean Delivery in Prolonged Labor: A Randomized Controlled Trial.

To evaluate the rates of cesarean delivery in patients with prolonged labor randomized to receive intravenous (IV) propranolol compared with placebo. A double-blind, placebo-controlled, randomized trial was conducted at two hospitals within a large academic health system. Eligible patients were at 36 weeks or more with a singleton gestation and prolonged labor , defined as: 1) prolonged latent phase of labor (dilation less than 6 cm after 8 hours or more with ruptured membranes and receiving oxytocin infusion) or 2) prolonged active phase of labor (dilation 6 cm or greater and less than 1-cm cervical dilation change over 2 hours or more with ruptured membranes and receiving oxytocin infusion). Patients were excluded for severe preeclampsia, maternal heart rate less than 70 beats per minute, maternal blood pressure less than 90/50 mm Hg, asthma, diabetes requiring insulin during labor, or a cardiac contraindication to β-blockade. Patients were randomized to propranolol (2 mg IV) compared with placebo (2 mL normal saline IV), with one possible repeat dose. The primary outcome was cesarean delivery; secondary outcomes included labor duration, shoulder dystocia, and maternal and neonatal morbidity. With an estimated cesarean delivery rate of 45%, α 0.05, and 80% power, we required 163 patients per group to detect a 15% absolute reduction in cesarean delivery rate. A planned interim analysis was performed, and the trial was stopped for futility. From July 2020 to June 2022, 349 patients were eligible and approached; 164 were enrolled and randomized, with 84 in the propranolol group and 80 in the placebo group. The rate of cesarean delivery was not different between groups (57.1% propranolol vs 57.5% placebo, relative risk [RR] 0.99, 95% CI 0.76-1.29). Results were similar by subgroup of prolonged latent (n=123) and active (n=41) phases of labor and nulliparous (n=137) and multiparous (n=27) patients. Though not statistically significant, the frequency of postpartum hemorrhage was higher in the propranolol group (20% vs 10%, RR 2.02, 95% CI 0.93-4.43). In this multisite, double-blind, placebo-controlled randomized trial, there was no difference in cesarean delivery rate for patients who received propranolol compared with those who received placebo for management of prolonged labor. ClinicalTrials.gov , NCT04299438.

Adverse Pregnancy Outcomes Associated with Endometriosis and Its Influencing Factors.

To investigate the adverse pregnancy outcomes associated with endometriosis and its influencing factors. A total of 188 endometriosis patients who gave birth at our hospital between June 2018 and January 2021 were screened for eligibility and included in the research group, while a control group of 188 nonendometriosis women who delivered at our hospital during the same period were also included as healthy controls. Pregnancy outcomes were the key outcome measure, and the relationship between endometriosis and unfavorable pregnancy outcomes, as well as the influencing factors, were explored. There was no significant difference in the risk of adverse pregnancy events such as miscarriage, ectopic pregnancy, termination of pregnancy, and fetal death between the two groups (P > 0.05). The differences in hypertensive disorder in pregnancy, gestational diabetes, placental abruption, fetal growth restriction, and luteal support between the two groups also failed to reach the statistical standard (P > 0.05). The two groups significantly differed in terms of cesarean delivery, preterm delivery, and placenta previa (1.92 (95% CI 1.33-2.85), 2.43 (95% CI 1.05-5.58), and 4.51 (95% CI 1.23-16.50)) (P < 0.05). Endometriosis is an influential factor in adverse pregnancy outcomes and results in a high risk of preterm delivery, placenta previa, and cesarean delivery in patients. Mutual interactions exist among adverse pregnancy outcomes and thus require appropriate management.

The Effect of Transverse Skin Incision Location on Wound Morbidity After Cesarean Delivery for Patients With Morbid Obesity [ID: 1377795

INTRODUCTION: The objective of this study was to assess whether placement of transverse skin incision below or above the panniculus for cesarean delivery in patients with morbid obesity is associated with postoperative wound complications. METHODS: We identified a cohort of all women with body mass index (BMI) higher than 40 who delivered by cesarean at our institution from 2016 to 2020, had complete postpartum records, singleton gestation, and transverse skin incision. Medical records were abstracted after IRB exemption. The primary outcome was composite wound morbidity (infection, disruption, or dehiscence). Secondary outcomes included operative time, neonatal outcome, and blood transfusion. Analysis was performed with χ2 and logistic regression including BMI percentile, diabetes, smoking, unscheduled surgery, and prior cesarean. RESULTS: Two hundred sixty-three patients had a low transverse incision and 65 had a high transverse incision. 14.6% of patients had wound morbidity. There were two reoperations and no fascial dehiscences or deep site infections. Patients with a high transverse incision had higher mean BMI (53.0 versus 45.9, P&lt;.001) and were less likely to be in labor (relative risk 0.52, 0.28–0.96) but were otherwise similar to patients with a low incision. High transverse incision was associated with composite wound morbidity (adjusted odds ratio 5.12, 2.36–11.09) and increased operative time (61 versus 54 minutes, P=.02) but not other secondary outcomes. Results did not significantly differ when analysis was restricted to patients with BMI greater than 50. CONCLUSION: Wound morbidity was more frequent after high transverse skin incision for cesarean delivery. Prospective studies are needed to determine whether incision location or other factors caused this increase.

Comparison of Feto-Maternal Outcomes Between Emergency and Elective Cesarean Deliveries in Patients with Gestational Diabetes

Aim: To compare fetal and maternal outcomes between elective and emergency cesarean sections in patients with gestational diabetes&#x0D; mellitus (GDM).&#x0D; Material and Methods: Data from patients with GDM delivered by cesarean section between January 2015 and July 2020 were&#x0D; retrospectively reviewed. Patients were grouped according to whether the cesarean section was elective (n=129) or emergency (n=158).&#x0D; Results: The cesarean section rate was higher in patients with GDM (31.16%) than in patients without GDM. There were more patients&#x0D; with inadequate maternal care in the emergency cesarean section group than in the elective cesarean section group (p=0.003). One&#x0D; neonate in the elective group and six in the emergency C/S group died, but the rates of neonatal mortality were similar (p=0.198).&#x0D; Maternal morbidity (wound infection, fever, blood transfusion, and maternal intensive care) and fetal morbidity (birth asphyxia,&#x0D; respiratory morbidity, and neonatal intensive care) were higher in the emergency C/S group (p

Perinatal outcome of oligohydramnios in academic hospitals in a low resource setting.

Oligohydramnios has been a topical issue in obstetrics. The prevalence of oligohydramnios ranges from 1 to 5%. Conflicting data exists concerning its effects on adverse perinatal outcome. This study aims to assess perinatal outcomes of oligohydramnios at the Mekelle Public Hospitals from April 1, 2018 - March 31, 2019. This was a cross-sectional study and a total population purposive sampling method was employed to collect data prospectively. During the study period, there were a total of 10,451 deliveries in both hospitals. Oligohydramnios complicated 332 pregnancies (3.2%, 95%CI: 2.9%, 3.5%) across all gestations and 273 pregnancies (2.6%, 95% CI: 2.3%, 2.9%) at term. The composite adverse perinatal outcome rate was 29.7% (95% CI, 24.5, 35.4). Primigravidity and presenting at post-term gestation were associated with adverse perinatal outcome. Nearly 70% of mothers gave birth via Cesarean delivery. Oligohydramnios was found to be associated with a significant increase in adverse newborn and maternal outcomes in the study setting. Although a significant proportion of mothers underwent Cesarean delivery for a perceived increased complications associated with vaginal delivery in this population of patients, Cesarean delivery was found to not improve perinatal outcome. Primigravids and postdated pregnancies must receive increased surveillance to detect oligohydramnios early and to institute appropriate and timely interventions. Indications for Cesarean delivery in patients complicated by oligohydramnios must be carefully examined to balance the benefit on the perinatal outcome on the one hand and to avoid unnecessary major surgery with potential fatal maternal complications on the other.

Anesthesia during delivery in pregnant women with dilated cardiomyopathy.

Emergency cesarean delivery in patients with heart failure increases maternal and fetal mortality. The present study aimed to identify the relationship between the use of anesthesia for delivery and progressive cardiac deterioration in women with dilated cardiomyopathy (DCM) and to examine its implications on maternal and fetal outcomes. Twenty-nine pregnancies in 25 women with DCM from the National Cerebral and Cardiovascular Center Hospital (Suita, Japan) were included in this retrospective longitudinal study. Fourteen of the patients (48.3%) delivered via cesarean section. Among these, 4 patients (13.8%) experienced heart failure within 42 days of delivery. The indication for cesarean delivery was heart failure in 3 patients and induction failure in 1 patient. The types of anesthesia used for these patients included general (n = 1), combined spinal-epidural (n = 2), and epidural (n = 1). Two of these cesarean deliveries were performed preterm. The left ventricular ejection fraction of patients with heart failure was ≤ 35% before 34 weeks gestation. Among the 25 patients without heart failure, 2 exhibited a left ventricular ejection fraction of ≤ 35% before 34 weeks gestation. Meanwhile, the types of anesthesia used for remaining 10 patients who did not experience heart failure included general (n = 1), combined spinal-epidural (n = 8), and epidural (n = 1). The rate of general anesthesia was 25% in patients who experienced heart failure and 4% in others. There was no incidence of maternal or fetal death. A preterm anesthetic evaluation may be warranted to optimize anesthetic management when the ejection fraction decreases to ≤ 35% before 34 weeks gestation in patients with DCM.

Effect of panniculus elevation device on postoperative pain after cesarean delivery: a randomized controlled trial

Suboptimal treatment of postpartum pain is associated with persistent pain and postpartum depression. Multimodal analgesia can achieve superior pain relief and decreased opioid consumption after surgery. There is limited and conflicting data on abdominal support devices to reduce postoperative pain and opioid use after cesarean delivery. This study aimed to examine whether the use of a panniculus elevation device decreases opioid use and improves postoperative pain after cesarean delivery. This was an unblinded prospective trial in which eligible, consenting patients aged ≥18 years were randomized to the panniculus elevation device group or no device group within 36 hours after cesarean delivery. The device studied adheres to the abdomen and lifts the panniculus. Moreover, it can be repositioned during use. Patients with a vertical skin incision or chronic opioid use disorder were excluded. Participants were surveyed 10 and 14 days after delivery about opioid use and pain satisfaction. The primary outcome was total morphine milligram equivalents used after delivery. The secondary outcomes were inpatient and outpatient opioid use, subjective pain scores, and Patient-Reported Outcomes Measurement Information System pain interference scores. An a priori subgroup analysis was performed on participants with obesity who may uniquely benefit from panniculus elevation. Of 538 patients screened for inclusion from April 2021 to July 2022, 484 were eligible, and 278 were consented and randomized. Moreover, 56 participants (20%) were lost to follow-up, leaving 222 (118 in the device group vs 104 in the control group) for analysis. Follow-up frequency was similar between groups (P=.09). Demographic and clinical characteristics were similar between groups. There was no statistically significant difference in total opioid use, other opioid use measures, or pain satisfaction outcomes. Median device use was 5 days (interquartile range, 3-9), and 64% of participants randomized to device use stated that they would use it again. Here, similar trends were observed among participants with obesity (n=152). The use of a panniculus elevation device did not significantly reduce total opioid use after cesarean delivery in patients.

THE RELATIONSHIP OF PLACENTA ACCRETA SPECTRUM WITH PREVIOUS CESAREAN SECTION IN PATIENTS WITH PLACENTA PREVIA- A CASE-CONTROL STUDY IN TERTIARY CARE HOSPITAL OF PESHAWAR

Objective: To determine the relation of placenta Acreta Spectrum with previous Cesarean section in patients with placenta previa. Material and Methods: This case-control study was conducted in a tertiary care hospital in Peshawar from 1st July 2019 to 30th June 2021. All the cases with placenta Previa were included. Women with placenta Acreta Spectrum diagnosed on obstetric ultrasound served as cases. Patients with placenta previa without accrete served as controls. Their records were studied in detail and all the data was recorded in a Proforma specially designed for this study. Odds ratios at the end of the study were calculated using SPSS-23. Results: During our study period, a total of 102 patients with placenta previa were enrolled. The ages ranged between 20-45 years. The majority of the patients were &gt; 40 years old (31.3%). On the basis of gravidity, different groups were found i.e. 45 patients (44.1 %) were between G5-G6. A total of 14 women were found with placenta accrete spectrum making an incidence of 13.72%. Of all the patients’ i.e.100% (odd ratio 1.1) were having a history of previous Cesarean birth. 6 out of 14 patients (42.8%) had a history of previous 1 Cesarean section while two patients (10%) had a history of 4 c\s in the past. Nearly all patients had major placenta previa except one patient who had minor placenta previa (7%). Conclusion: Our study highlighted the striking relationship of placenta Accreta spectrum with previous Cesarean delivery in patients with placenta previa however it was not found that increasing the number of previous Cesarean sections resulted in an increased number of placentae Accreta spectrum. Keywords: Placenta Accreta spectrum, Cesarean section.

Tranexamic acid administered during cesarean delivery in high-risk patients: maternal pharmacokinetics, pharmacodynamics, and coagulation status

Tranexamic acid is frequently administered for postpartum hemorrhage. The World Health Organization recommends 1 g intravenous dosing, repeated once after 30 minutes for ongoing bleeding. Understanding the pharmacokinetics and pharmacodynamics of tranexamic acid in patients at high risk of postpartum hemorrhage may enable dosage tailoring for optimal antifibrinolysis with minimal adverse events, such as thrombosis or renal cortical necrosis. This study aimed to report tranexamic acid pharmacokinetics and pharmacodynamics after 1 g intravenous dosing during cesarean delivery in patients at risk of hemorrhage. The primary endpoint was tranexamic acid plasma concentration of >10 μg/mL, known to inhibit 80% of fibrinolysis. In addition, the correlation between patient demographics and rotational thromboelastometry coagulation changes were analyzed. In this prospective study, 20 women aged 18 to 50 years, ≥23 weeks of gestation undergoing cesarean delivery with at least 1 major (placenta previa, suspected placenta accreta spectrum, or active bleeding) or 2 minor (≥2 previous cesarean deliveries, previous postpartum hemorrhage, chorioamnionitis, polyhydramnios, macrosomia, obesity, or suspected placental abruption) risk factors for postpartum hemorrhage were recruited. The exclusion criteria were allergy to tranexamic acid, inherited thrombophilia, previous or current thrombosis, seizure history, renal or liver dysfunction, anticoagulation, or category III fetal heart tracing. Tranexamic acid 1 g was administered after umbilical cord clamping. Blood samples were drawn at 3, 7, 15, and 30 minutes and then at 30-minute intervals up to 5 hours. Plasma concentrations were evaluated as mean (standard error). Serial rotational thromboelastometry was performed and correlated with tranexamic acid plasma concentrations. The median age of participants was 37.5 years (interquartile range, 35.0-39.5), and the median body mass index was 28.6 kg/m2 (interquartile range, 24.9-35.0). The median blood loss (estimated or quantitative) was 1500 mL (interquartile range, 898.5-2076.0). Of note, 9 of 20 (45%) received a transfusion of packed red blood cells. The mean peak tranexamic acid plasma concentration at 3 minutes was 59.8±4.7 μg/mL. All patients had a plasma concentration >10 μg/mL for 1 hour after infusion. Plasma concentration was >10 μg/mL in more than half of the patients at 3 hours and fell <10 μg/mL in all patients at 5 hours. There was a moderate negative correlation between body mass index and the plasma concentration area under the curve (r=-0.49; 95% confidence interval,-0.77 to-0.07; P=.026). Rotational thromboelastometry EXTEM maximum clot firmness had a weak positive correlation with longitudinal plasma concentration (r=0.32; 95% confidence interval, 0.21-0.46; P<.001). EXTEM maximum clot lysis was 0% after infusion in 18 patients (90%), and no patient in the study demonstrated a maximum lysis of >15% at any interval from 3 minutes to 5 hours. There was no significant correlation between EXTEM clot lysis at 30 minutes and longitudinal tranexamic acid plasma concentrations (r=0.10; 95% confidence interval,-0.20 to 0.19; P=.252). After standard 1 g intravenous dosing of tranexamic acid during cesarean delivery in patients at high risk of hemorrhage, a plasma concentration of ≥10 μg/mL was sustained for at least 60 minutes. Plasma tranexamic acid levels correlated inversely with body mass index. The concurrent use of rotational thromboelastometry may demonstrate tranexamic acid's impact on clot firmness but not a hyperfibrinolysis-derived trigger for therapy.

Predictability of Preoperative Carotid Artery-corrected Flow Time for Hypotension After Spinal Anaesthesia in Patients Undergoing Caesarean Section: A Prospective Observational Study

(Eur J Anaesthesiol. 2021;38:394–401) Hypotension affects more than 50% of cesarean delivery (CD) patients receiving spinal anesthesia (SA). Fluid administration (preload and co-load), as well as prophylactic use of phenylephrine, noradrenaline, and ondansetron are all used to prevent hypotension. There are a number of reasons for hypotension following SA, and predicting the pathway leading to hypotension by monitoring hemodynamics may help inform the best prevention and treatment. Corrected blood flow time (FTc) in the carotid artery is affected by left ventricular preload and associated with myocardial afterload. This study aimed to evaluate preanesthetic FTc as a predictor of hypotension in CD patients receiving spinal anesthesia.

A Retrospective Study of Acute Postoperative Pain After Cesarean Delivery in Patients With Opioid Use Disorder Treated With Opioid Agonist Pharmacotherapy.

We aimed to quantify the effect of opioid agonist pharmacotherapy on pain management after cesarean delivery, compared with patients not on these medications. Patients undergoing cesarean delivery at our institution between January 2016 and December 2018 were stratified by peripartum use of opioid agonist pharmacotherapy versus no agonist therapy. We compared 24-hour postoperative opioid consumption not including buprenorphine and methadone, in milligram morphine equivalents (MME) (primary outcome), highest pain score on a 0 to 10 numerical rating scale in the first 24 postoperative hours, and postoperative length of stay in hours (secondary outcomes) between groups. These outcomes were also compared after covariate adjustment using logistic regression. We identified 123 patients on opioid agonist pharmacotherapy - in the form of buprenorphine or methadone and 2856 patients not on these medications. The groups differed in demographic characteristics, including age, smoking, and marital status. Opioid consumption during the first 24 postoperative hours (median [interquartile range]) was 99 [75,120] MME for patients on agonist therapy and 30 [0, 64] MME among parturients not taking these medications ( P &lt; 0.001). Highest pain scores during this time were also higher for patients on opioid agonist pharmacotherapy (mean [standard deviation]: 8.2 [1.6] vs 5.5 [2.2], P &lt; 0.001 for the no agonist group). Postoperative length of stay was 73 [68, 77] hours for patients on agonist pharmacotherapy, and 71 [62, 76] hours for parturients taking no agonist ( P &lt; 0.001). All differences remained significant after covariate adjustment. Parturients on opioid agonist pharmacotherapy have markedly increased opioid utilization and pain severity after cesarean delivery.

The clinical evaluation of IIA balloon occlusion in caesarean delivery for patients with PAS: a retrospective study

ObjectiveThe aim of this study is the clinical evaluation of IIA balloon occlusion in the caesarean delivery in patients with a diagnosis of placenta accreta spectrum.BackgroundHigh incidence of cesarean section leads to the increasing incidence of placenta accreta spectrum (PAS), which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality.MethodsFifty-eight patients with a diagnosis of PAS were retrospectively reviewed. The balloon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL). The secondary outcomes were cesarean hysterectomy, blood transferring volume, operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes.ResultsNo difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis, surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10 [43.48%] vs. 11 [31.43%], P=0.350). Complications related to occlusion of IIA did not occur. The duration of the surgery of the balloon group was significantly longer than that of the control group (123.52 min±74.76 versus 89.17±48.68, P=0.038), and the total hospitalization cost was also significantly higher than that of the control group (45116.67±9358.67 yuan versus 30615.41±11587.44 yuan, P=0.000).ConclusionIt does not permit to draw final conclusions for us on the effectiveness of the balloons IIA given the heterogeneity of selection of cases undergoing the procedures in the retrospective design. However, it is possible that IIA balloon occlusion may contribute to limiting intraoperative blood loss in more severe cases, particularly those undergoing peripartum hysterectomy.

Preoperative vaginal cleansing with chlorhexidine vs placebo in patients with rupture of membranes: a prospective, randomized, double-blind, placebo-control study

XXX OBJECTIVE: This study aimed to demonstrate that vaginal cleansing with a 4% chlorhexidine solution before cesarean delivery in patients with a history of rupture of membranes prevents postoperative infectious complications (endometritis, surgical site infections). A total of 204 patients with premature rupture of membranes or who were in labor for more than 6 hours after membranes ruptured were randomized before a cesarean delivery to preoperative vaginal cleansing with a chlorhexidine solution (n=97 patients) or to placebo cleansing with saline solution (n=107 patients). The management of the rupture of membranes and the cesarean delivery procedure were conducted according to standard local protocols for both groups, including the use of antibiotics. Vaginal cleansing with chlorhexidine reduced the risk for endometritis after cesarean delivery in patients with rupture of membranes when compared with placebo cleansing (chlorhexidine, 7.21% vs placebo, 18.8%; relative risk, 0.39; 95% confidence interval, 0.17-0.87; P=.015). Likewise, there was a statistically significant reduction in the number of cases of puerperal fever (chlorhexidine, 9.28% vs placebo, 19.8%; relative risk, 0.47; 95% confidence interval, 0.23-0.98; P=.037). There was a statistical difference between the groups in prolongation of hospitalization for >72 hours (chlorhexidine, 1.03% vs placebo, 7.55%; relative risk, 0.14; 95% confidence interval, 0.02-1.08; P=.02), although the confidence interval suggests that the effect was by chance. There were no statistical differences in surgical site infection at 7 days (chlorhexidine, 1.03% vs placebo, 0.94%; relative risk, 1.1; 95% confidence interval, 0.07-17.4; P=.94) and 15 days after the procedure (chlorhexidine, 1.03% vs placebo, 0%; relative risk, 3.31 [using a continuity correction]; 95% confidence interval, 0.14-80.21; P=.29). The use of chlorhexidine for vaginal cleansing before a cesarean delivery in patients with rupture of membranes reduced the risk for endometritis and puerperal fever. It also reduced the number of cases that required hospitalization for more than 3 days, but the confidence interval suggests that it could be by chance. It has no effect on the number of cases with surgical site infection.

Evaluation of Antepartum Factors for Predicting the Risk of Emergency Cesarean Delivery in Pregnancies Complicated With Placenta Previa.

Background: The optimal delivery timing for patients with placenta previa remains controversial in the literature. To reduce spontaneous vaginal bleeding rates, which occur increasingly with advancing gestational weeks, elective cesarean delivery is advocated between 360/7 and 376/7 weeks of gestation, but this clinical approach does not take into consideration numerous patient variables. Few papers identify the risk factors for emergency cesarean delivery in patients with placenta previa. An enhanced understanding of these variables could help with determining patients at high risk for emergency cesarean delivery and individualizing delivery date scheduling. This study sought to identify predictor variables associated with emergency cesarean delivery in pregnant patients with placenta previa in a tertiary referral hospital. We also investigated differences in maternal and perinatal outcomes between patients with placenta previa who underwent emergency vs planned cesarean delivery.Methods: This retrospective cohort study included 208 singleton pregnancy patients who had a confirmed diagnosis of placenta previa at the time of delivery and who underwent cesarean delivery in our hospital beyond 24 weeks of gestation. To define risk factors of the outcome variable (emergency vs planned cesarean delivery), univariate and multiple logistic regression analysis and adjusted odds ratios with their confidence intervals were calculated.Results: Ninety-seven patients (46.6%) required emergency cesarean delivery, and 111 patients (53.4%) underwent planned cesarean delivery. Antepartum bleeding episode (37.1% and 20.7%, P=0.013) and first antepartum bleeding episode ≤28 weeks of gestation (36.1% and 14.4%, P<0.001) were significantly higher in the emergency group than the planned group. Antepartum bleeding episode (odds ratio [OR]=1.968, 95% CI 1.001-4.200, P=0.042), first antepartum bleeding episode ≤28 weeks of gestation (OR=2.750, 95% CI 1.315-5.748, P=0.007), and preoperative hemoglobin level (OR=0.713, 95% CI 0.595-0.854, P<0.001) were the independent predictors significantly associated with emergency cesarean delivery.Conclusion: Three factors—antepartum bleeding episode during pregnancy, first antepartum bleeding episode ≤28 weeks of gestation, and lower preoperative hemoglobin level—might be useful in predicting emergency cesarean delivery in pregnancies complicated with placenta previa.

Prediction model for primary cesarean delivery in patients with gestational diabetes mellitus

To identify predictors of primary cesarean delivery (PCD) in patients with gestational diabetes mellitus (GDM) and to develop and validate a clinically relevant prediction model to assist in patient counseling.

Emergent versus planned delivery in patients with placenta accreta spectrum disorders: A retrospective study.

The aim of this study is to compare the clinical outcomes and to identify risk factors for emergent cesarean delivery and planned cesarean delivery in patients with placenta accreta spectrum (PAS) disorders in Vietnam.The medical records of patients admitted to our hospital with a diagnosis of PAS disorders >5 years were retrospectively reviewed.A total of 255 patients with PAS disorders were identified, including 95 cases in the emergent delivery group and 160 cases in the planned delivery group. The percentage of complete/partial placenta previa in the planned delivery group was significantly higher than that in the emergent delivery group (59.22% vs 32.16%, P = .027). Fewer patients in the planned group had vaginal bleeding compared with those in the emergent group (29 vs 36 cases, P < .001). The percentage of blood transfusion was similar between the 2 groups; however, the transfused units of pack red blood cells were greater in the emergent delivery group (5.3 ± 0.33 vs 4.5 ± 0.25 U, P = .036). When considering the neonatal outcomes, the data demonstrated that the planned delivery group had a significantly higher birth weight and a lower rate of preterm delivery than the emergent group (P < .001). The mean gestational age at delivery for the emergent group was 35.1 ± 0.27 weeks compared with 38.0 ± 0.10 weeks for the planned group (P < .001). The increased risk factors for emergent delivery were vaginal bleeding (odds ratio 2.86, 95% confidence interval 1.59–5.26) and preterm delivery (odds ratio 5.26, 95% confidence interval 2.13–14.29).Planned delivery is strongly associated with a lower need for blood transfusion and better neonatal outcomes compared with emergent delivery. Antenatal vaginal bleeding and preterm labor are risk factors for emergent delivery among patients with PAS disorders. Based on the results of this study, we recommend that the management strategies for patients with PAS disorders should be individualized to determine the optimal timing of delivery and to decrease the rate of emergent cesarean delivery.