Elective Cesarean Research Articles

Efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta

Objective To investigate the efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta. Methods Twelve pregnant women diagnosed with pernicious placenta previa combined with placenta percreta by prenatal ultrasound in Peking University First Hospital from April 1, 2012 to November 30, 2014, were enrolled. All of them received elective cesarean delivery using ring butterfly sewing in lower uterine segment aided with tourniquet. The efficiency of this novel technique, in term of blood loss and vital signs during operation, blood transfusion, and postoperative recovery, was analyzed. Results Twelve cases were diagnosed with placenta percreta during operation, with placenta invading the perimetrium in seven cases and urinary bladder being involved in one case. Ring butterfly sewing in lower uterine segment aided with tourniquet during elective cesarean delivery was all successful in the 12 cases. The median amount of blood loss was 1 000(400-2 000) ml during operation and the amount of blood loss was lower than 1 000 ml in three cases. Two cases received no blood transfusion, and the median blood transfusion in the other 10 cases were 400(400-1 200) ml. The mean operation time was (75±22) min (43-131) min. Eleven cases had normal lochia and temperature after operation and the other one had placenta invading urinary bladder and partial placenta in situ, and developed fever at day 3 after operation, but recovered after antibiotic treatment, and no placenta tissue was seen by ultrasound at day 59 after operation. Conclusions The ring butterfly sewing in lower uterine segment aided with tourniquet is highly effective for the pernicious placenta previa combined with placenta percreta, and it is a simple, fast and fertility sparing technique with low blood loss and without usage of special equipment. Key words: Placenta previa; Placenta percreta; Tourniquets; Ligation; Suture techniques; Gynecologic surgical procedures

Efficacy of ketamine in preventing postpartum depression in patients undergoing cesarean section

Objective To evaluate the efficacy of ketamine in preventing postpartum depression in patients undergoing cesarean section. Methods One hundred and twenty ASA physical status Ⅰ patieuts, aged 18-38 yr, with body mass index <35 kg/m2, scheduled for elective cesarean section, were equally and randomly divided into 2 groups using a random number table: control group(group C)and ketamine group(group K). Postoperative analgesia was performed with sufentanil 100 μg in 100 ml of normal saline, and sufentanil was infused at 2 ml/h(bolus dose 5 μg, lockout interval 15 min)in both groups.In group K, ketamine 4 mg/kg was added to analgesic pump.VAS score was maintained<3.Before surgery and at 1, 3, 5 and 42 days after surgery, depressive symptoms were measured using the Edinburgh Postpartum Depression Survey(EPDS), and postpartum depression was defined as EPDS score≥13.Postpartum depression and ketamine-related complications occurred within 3 days after surgery in group K were recorded. Results Compared with group C, EPDS scores were significantly decreased at 1, 3 and 5 days after surgery, and the incidence of postpartum depression was decreased in group K. Ketamine-related complications were not found in group K. Conclusion Ketamine(infused starting from the end of operation, lasting for 48 h, total amount 4 mg/kg)for postoperative analgesia can prevent postpartum depression to some extent in patients undergoing cesarean section. Key words: Depression, postpartum; Ketamine

Scheduling the Stork: Media Portrayals of Women's and Physicians' Reasons for Elective Cesarean Delivery.

Media interest in cesarean delivery has grown in recent years driven both by rising cesarean delivery rates and the decision by the American College of Obstetrics and Gynecology (ACOG) to permit elective cesarean (EC) delivery. A content analysis of United States newspaper and magazine articles from 2000 to 2013 (n=131 articles) was completed to understand how the news media portrays ECs. The majority of articles (71.8%) emphasized reasons to support women having an EC, while 38.2 percent of the articles exhibited themes of physician support for ECs. Relatively few articles mentioned reasons against ECs either from the women's perspective (11.5%) or the practitioners' (3.8%). The most common themes given for women choosing ECs were convenience/scheduling (48.9%), avoidance of pain or fear of labor (29.8%), and physical harm to women from vaginal birth (17.6%). Doctors' perspectives were less prevalent in the media than women's perspectives, but when mentioned they were almost exclusively in support of ECs for reasons including avoiding malpractice (28.2%), avoiding physical harm to the woman or baby (16.8%), and timing/scheduling (14.5%). Media coverage suggests ECs are widely accepted by both women and doctors, with women choosing an EC mainly for convenience/scheduling and fear. However, 43 percent of doctors surveyed by ACOG said they were not willing to perform the procedure, and surveys report that mothers rarely request an EC.

Ephedrine and dopamine's hypotension-preventative effect for CSEA in cesarean delivery-A single-blind controlled study

Objective To compare the effects of ephedrine and dopamine in the prevention of hypotension during combined spinal and epidural anesthesia(CSEA)for cesarean delivery. Methods Fifty ASAⅠorⅡpatients undergoing elective cesarean delivery were randomly divided into the two groups, Ephedrine group(n =51): intravenous injection of 10mg ephedrine before anesthesia; Dopamine group(n=52): continuous intravenous infusion at the speed of 5μg·kg-1·min-1.During the whole process, we investigated the incidence rate of adverse effects, compared the Apgar score of neonate and analyzed blood gas of umbilical artery and vein. Results Compare to the dopamine group, the incidence rate of hypotension was lower in the ephedrine group(43.1%vs 69.2%,χ2=7.06,P=0.00). The p H value of umbilical artery and 1 min Apgar score of neonate in the ephedrine group was lower compare with that in the dopamine group[(7.22±0.03)vs(7.27±0.06),t=0.62, P=0.02], there are no significant difference of 5min Apgar score in the two groups. Conclusion Compared with dopamine, ephedrine is a useful drug in the prevention of hypotension during combined spinal and epidural anesthesia(CSEA)for cesarean delivery and there are no significant differences of adverse effects of dopamine and ephedrine. Ephedrine has transient effect on the neonate, while the effect of dopamine is minor. Key words: Cesarean section; Anesthesia; Ephedrine; Dopamine

Maternal obesity, caesarean delivery and caesarean delivery on maternal request: a cohort analysis from China.

To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request (CDMR), a fast-growing component of caesarean delivery in many nations. We followed 1,019,576 nulliparous women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, kg/m(2) ), before pregnancy or during early pregnancy, was classified as underweight (<18.5), normal (18.5 to <23; reference), overweight (23 to <27.5), or obese (≥27.5), consistent with World Health Organization guidelines for Asian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log-binomial regression. During the 18-year period, 404,971 (39.7%) caesareans and 93,927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR. Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. In a large Chinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that caesarean births will increase, unless there are changes in obstetrical practice.

Efficacy of different doses of dexmedetomidine for prevention of shivering after combined spinal-epidural anesthesia in patients undergoing caesarean section

Objective To evaluate the efficacy of different doses of dexmedetomidine for prevention of shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section. Methods A total of 120 patients, of ASA physical statusⅠ or Ⅱ, aged 20-40 yr, with body mass index≤35 kg/m2, scheduled for elective caesarean section under combined spinal-epidural anesthesia, were randomly divided into 4 groups (n=30 each) using a random number table: control group (group C) and dexmedetomidine 0.1, 0.3 and 0.5 μg/kg groups (D1, D2 and D3 groups). Combined spinal-epidural anesthesia was performed at L3, 4 interspace with isobaric 0.5% bupivacaine 2 ml. In D1, D2 and D3 groups, dexmedetomidine 0.1, 0.3 and 0.5 μg/kg (in 50 ml of normal saline) were infused intravenously, respectively. In group C, normal saline 50 ml was infused at a rate of 5 ml/min. The development of shivering, bradycardia, hypotension, nausea and vomiting was recorded during the period from the end of dexmedetomidine infusion to PACU discharge time. Results Compared with group C, the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D2 and D3 groups, and no significant change was found in the parameters mentioned above in group D1. Compared with group D2, the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D3 group. Conclusion Dexmedetomidine 0.3 and 0.5 μg/kg can prevent shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section, and 0.5 μg/kg provides better efficacy. Key words: Dexmedetomidine; Shivering; Anesthesia, spinal; Anesthesia, epidural

Cesarean delivery on maternal request in China: what are the risks and benefits?

The purpose of this study was to describe the risks and benefits of cesarean delivery on maternal request (CDMR) in a Chinese population. A retrospective cohort study of mode of delivery was conducted at the largest obstetric center in Shanghai, China, from 2007-2013. Eligibility criteria included singleton term nulliparous women with vertex presentation; women with major fetal anomalies or stillbirth before labor were excluded. A total of 66,226 women were included in the analysis: 40,560 women (61.2%) had planned vaginal birth, with 32,833 spontaneous vaginal deliveries (80.9%), 4990 intrapartum CDs (12.3%), and 2737 assisted vaginal deliveries (6.7%). A total of 16,333 women (24.7%) underwent CDMR. We observed no significant difference between the CDMR and planned vaginal delivery groups in the frequencies of maternal intensive care unit admission (0.2% vs 0.2%), severe postpartum hemorrhage (0.5% vs 0.5%), maternal infection (1.3% vs 1.3%), organ injuries (0.4‰ vs 0.5‰), and thromboembolic disorders (0.1‰ vs 0.1‰). The perinatal mortality rate was similar in the 2 groups (0.4‰ vs 0.6‰; adjusted odds ratio, 0.51; 95% confidence interval, 0.20-1.30; P = .159). The frequencies of birth trauma (0.2‰ vs 1.1‰), neonatal infection (0.4% vs 0.7%), hypoxic ischemic encephalopathy (0.4‰ vs 1.8‰), and meconium aspiration syndrome (0.2‰ vs 0.6‰) were lower; the frequency of respiratory-distress syndrome (0.6% vs 0.4%) was higher in the CDMR group. Compared with nulliparous women who tried vaginal delivery, women who underwent CDMR had similar short-term maternal outcomes with some neonatal benefit.

Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section.

Background:Neurologic and Adaptive Capacity Scoring (NACS) has been introduced as a screening test for diagnosis of central nervous system depression due to intrapartum drugs on the neonate. This test can show neurological and behavioral changes even in the presence of a normal Apgar score. NACS has 20 indicators, each indicator allocating to itself the score zero, one or two. The aim of this study was to compare the effects of different anesthetic techniques on the NACS values.Materials and Methods:This study was performed as a randomized, single-blind clinical trial on 75 infants born with elective cesarean in Shahid Beheshti Hospital, Isfahan. Simple Sampling method was carried out and the information was gathered by questionnaires. Anesthetic techniques included general, spinal or epidural anesthesia. NACS score was assessed at 15th min, 2 and 24 h after birth and then the anesthesia technique was recorded in the questionnaire. NACS score 35 or above was considered normal and 34 or less was abnormal.Results:In the present study, no significant correlation was found between the anesthesia techniques and NACS score. The mean NACS at 15 min after birthin the general, spinal and epidural groups were 33.5 ± 2.2, 33.0 ± 4.4 and 33.7 ± 1.6 respectively (P = 0.703).Conclusion:All three anesthetic techniques have identical effects on neurological and compatibility capacity of neonates born with elective cesarean; so, this could necessarily be a base to recommend the three methods equally.

Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section.

Background and Aims:We aimed to determine the ropivacaine concentration that provided adequate analgesia with early ambulation and minimal urinary retention or other side-effects when used with fentanyl and epinephrine for patient-controlled epidural analgesia (PCEA) after elective cesarean section.Material and Methods:Forty-eight patients were randomized to four groups in a double-blinded fashion. All groups received an initial 10 ml/h of epidural study solution for 24 h. The solution contained: 0.2, 0.1, 0.05, or 0.025% ropivacaine for Groups I-IV, respectively, with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml. Patients could administer additional PCEA doses of 4 ml of their study solution with a lock-out time of 10 min. Overall satisfaction, side-effects, motor block, neurologic function, and pain using Visual Analog Scale were assessed.Results:Patients in all groups showed no difference in sedation, pruritus, nausea, vomiting, and uterine cramps. Pain scores at rest were lower for Group IV than Groups I-III (P < 0.001). Twelve, five, one, and zero patients could not ambulate in Groups I-IV, respectively. Nine, nine, two, and zero (III <I and II, P = 0.02; IV P = 0.001) patients reported urinary retention in Groups I-IV, respectively. Overall satisfaction scores were high for all groups. Neonatal behavior score was similar and high in all groups.Conclusion:0.025% ropivacaine PCEA combined with fentanyl and epinephrine provided effective pain relief after cesarean section with early ambulation and without sensory loss, urinary retention, or increase of side-effects.

703: Trial of labor after prior cesarean versus elective repeat cesarean: can a single clinic visit improve patient knowledge about risks and benefits?

703: Trial of labor after prior cesarean versus elective repeat cesarean: can a single clinic visit improve patient knowledge about risks and benefits?

Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population‐based cohort study

The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. Retrospective cohort. The Netherlands. Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. We used data from the Dutch national perinatal registry from 1999 up to 2007. Perinatal mortality and morbidity. We studied 58,320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3 0/00 vs. 0.7 0/00;odds ratio 0.51 (95% confidence interval 0.28–0.93)], whereas it remained stable in the planned vaginal birth group [1.7 0/00 vs. 1.6 0/00; odds ratio 0.96(95% confidence interval 0.52–1.76)]. The number of cesareans done to prevent one perinatal death was 338. Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.

Efficacy of small dose of dexmedetomidine for prevention of adverse effects induced by carboprost in patients undergoing caesarean section

Objective To evaluate the efficacy of small dose of dexmedetomidine for prevention of the adverse effects caused by carboprost in the patients undergoing caesarean section.Methods Forty parturients,of ASA physical status Ⅰ or Ⅱ,aged 26-30 yr,weighing 63-71 kg,scheduled for elective caesarean section under epidural anesthesia,were equally and randomly divided into control group (C group) or carboprost group (D group) by using a random number table.After delivery of the fetus,all the patients received iv infusion of 20 U oxytocin and carboprost 250 μg was injected into the myometrium simultaneously.In group D,after a loading dose of dexmedetomidine 0.1 μg/kg,dexmedetomidine was infused at a rate of 0.4 μg· kg-1 · h-1 starting from 1 min prior to carboprost injection until the end of surgery,while the equal volume of normal saline was given in group C.Adverse effects such as dyspnea,facial flushing,nausea,vomiting,hypertension and tachycardia were recorded.The OAA/S scores and time for breastfeeding initiation were also recorded at the end of surgery and 2 h after surgery.Results Compared with group C,the incidence of dyspnea,facial flushing,nausea,vomiting,hypertension and tachycardia was significantly decreased in D group.There was no significant difference in OAA/S score and the time for breastfeeding initiation after surgery between the two groups.Conclusion Small-dose dexmedetomidine (loading dose 0.1 μg/kg,followed by infusion at 0.4 μg· kg-1 · h-1 until the end of surgery) infused before carboprost administration is helpful in preventing the adverse gastrointestinal and cardiovascular reactions caused by carboprost in the patients undergoing caesarean section. Key words: Dexmedetomidine ; Cesarean section ; Carboprost

A midwifery-led care pathway for women requesting caesarean sections

The caesarean section rate in the UK has increased dramatically in the last 20 years. Subsequently, there has been a rise in caesarean sections for maternal request (CSMR) without medical indications. In 2011, the National Institute for Health and Care Excellence (NICE) added to their guidance, that if after discussion and support, a vaginal birth is not acceptable, elective caesarean should be offered. This article proposes the implementation of a midwifery-led care pathway for women requesting caesarean section without medical indication. The care pathway includes group psychoeducational therapy which has been found to reduce CSMR, emergency caesarean sections and negative birth experiences. The challenges and barriers that may be faced when leading developments in maternity services are discussed, with reference to political, economic, social and technological factors.

Cesarean section and rate of subsequent stillbirth, miscarriage, and ectopic pregnancy: a Danish register-based cohort study.

With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of stillbirth, and maternally requested cesarean section, as well as lack of data on antepartum/intrapartum stillbirth and gestational age for stillbirth and miscarriage. This study found that cesarean section is associated with a small increased rate of subsequent stillbirth and ectopic pregnancy. Underlying medical conditions, however, and confounding by indication for the primary cesarean delivery account for at least part of this increased rate. These findings will assist women and health-care providers to reach more informed decisions regarding mode of delivery. Please see later in the article for the Editors' Summary.

Effects evaluation on wire polyurethane epidural tube used to epidural anesthesia for cesarean section

Objective To compare the influence of wire polyurethane epidural tube with polyvinyl chloride epidural tube on the spinal anesthesia effect in cesarean section.Methods 200 pregnant women for elective cesarean section under epidural anesthesia were selected and randomly divided into two groups:polyvinyl chloride tube group (group A,n=100) and wire polyurethane epidural tube group (group B,n=100),the effects were judged by the epidural puncture needle getting to the epidural space without any resistance.In this process,the resistance to insertion of epidural tube,the incidence of electric shock and anesthesia dose on the block level were recorded,then we compared and evaluate the efficacy of the anesthesia.Results Demographic characteristics and time of operation of two groups had no statistical significance (P ＞ 0.05).No resistance to insertion of epidural tube occurred in group A (47.0％) and 91.0％ in group B of patients; Slight resistance was 40.0％ in group A and 8.0％ in group B; mild resistance and difficulty to insertion of epidural tube was encountered 13.0％ and 1.0％ of patients in group A and group B respectively.They were all significantly different (P ＜ 0.01).The incidence of electrical sensation was 10.0％ and 1.0％ in group B,the difference had statistical significance (P ＜ 0.01).The patients in group A who needed ropivacaine dose of (133.0 ± 26.0)mg,group B was (121.0 ± 7.0) mg,the difference had statistical significance (P ＜ 0.05).Anesthesia effect score in group A was (1.45 ± 0.43),that of group B was (0.47 ± 0.14),the difference had statistical significance (P ＜ 0.05).Conclusion Wire polyurethane epidural tube applied to spinal anesthesia in cesarean section has distinct effect than others,when it' s placed in epidural space more smoothly. Key words: Consecutive epidural anesthesia; Epidural tube; Anesthetic effect; Cesarean section

Effects of dexmedetomidine on cesarean delivery women and newborn undergoing combined spinal-epidural anesthesia

Objective To investigate the effects of dexmedetomidine (Dex) on cesarean delivery women and newborn undergoing combined spinal-epidural anesthesia.Methods Ninety ASA Ⅰ-Ⅱ full-term pregnancy women who underwent elective cesarean section were randomly divided into 3 groups(n=30):control group (group A) and Dex group (group B and group C).Dex was respectively infused intravenously at 0.5 μg/kg in group B and 1 μg/kg in group C while in group A equal volume of normal saline was infused instead of Dex.The maternal mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation(SpO2),Ramsay scores of mothers were recorded at six time points:before iv(T1),5 min after iv(T2),10 min after iv(T3),15 min after iv (T4),20 min after iv (T5) and the neonate was delivered (T6).Sensory block onset time,duration,the highest level,the time required to achieve the highest level were also recorded,as well as motor block onset time,the highest scores,the time required to achieve the highest scores.Umbilical arterial blood was obtained immediately after breaking the umbilical cord for analysis of blood gas and lactic acid.Apgar scores 1 min and 5 min after labor were recorded,and neonatal behavioral neurological assessment (NBNA) scores 2 d and 14 d after labor were evaluated.Results Ramsay scores were significantly higher,MAP,HR,SpO2 were lower in group C than in group A and B(P＜0.05).Sensory block onset time,duration,the highest level median,the time required to achieve the highest level of group A,group B,group C were respectively as follows:(5.5±1.9) min vs (3.9±1.5) min vs (3.9±1.6) min,(80.1±13.4) min vs (92.0±14.5) min vs (91.3±15.5) min,5.5 (6,4) vs 4 (4,3) vs 4 (4,3),(13.2±3.2) min vs (10.4±1.9) min vs (10.2±2.5) min.The differences were statistically significant (P＜O.05) compared with group A.Motor block o nset time,the highest scores,the time required to achieve the highest scores of group A,group B,group C were respectively as follows:(4.2±1.7) min vs (3.3±1.4) min vs (3.1±1.2) min,(84.5±10.4) min vs (95.6±14.3) min vs (98.3±12.3) min,(16.5±5.8) min vs (13.3±2.7) min vs (12.4±2.7) min.The differences were statistically significant compare with group A(P＜0.05).There was no significant differences in umbilical arterial blood gas analysis,lactic acid,Apgar Scores and NBNA scores among the 3 groups (P＞0.05).Conclusions Dex can provide good sedation,shorten onset time of spinal anesthesia and extend the blocking duration with no adverse effects on Apgar scores and NBNA scores before employing combined spinal-epidural anesthesia.The effect on maternal hemodynamics was less at 0.5 μg/kg than 1 μg/kg of Dex. Key words: Dexmedetomidine; Combined spinal-epidural anesthesia; Cesarean delivery; Parturient ; Newborn

Specialized operating room for cesarean section in the perinatal care unit: a review of the opening process and operating room management.

We have opened an operating room in the perinatal care unit (PNCU), separate from our existing central operating rooms, to be used exclusively for cesarean sections. The purpose is to meet the increasing need for both emergency cesarean sections and non-obstetric surgeries. It is equipped with the same surgical instruments, anesthesia machine, monitoring system, rapid infusion system and airway devices as the central operating rooms. An anesthesiologist and a nurse from the central operating rooms trained the nurses working in the new operating room, and discussed solutions to numerous problems that arose before and after its opening. Currently most of the elective and emergency cesarean sections carried out during the daytime on weekdays are performed in the PNCU operating room. A total of 328 and 347 cesarean sections were performed in our hospital during 2011 and 2012, respectively, of which 192 (55.5 %) and 254 (73.2 %) were performed in the PNCU operating room. The mean occupancy rate of the central operating rooms also increased from 81 % in 2011 to 90 % in 2012. The PNCU operating room was built with the support of motivated personnel and multidisciplinary teamwork, and has been found to be beneficial for both surgeons and anesthesiologists, while it also contributes to hospital revenue.

Mode of delivery at birth and the metabolic syndrome in midlife: the role of the birth environment in a prospective birth cohort study

ObjectivesThe aim of this study is to examine the hypothesis that mode of delivery at birth may be associated with metabolic disorders in adult midlife.SettingPopulation cohort studyParticipantsThe National Child Development...

Elective caesarean section for breech presentation in first pregnancy and subsequent mode of labour.

To determine the effect on subsequent mode of labour in case of previous elective caesarean for breech presentation in primiparous women. A cohort study. Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, Unit-1 and 1V, from January 2005 to December 2009. All women with previous one elective caesarean section for breech or cephalic presentation visited OPD for antenatal checkup or admitted in emergency in maternity or labour ward were recruited for the study, while the women with previous 2 and 3 caesarean section were excluded from the study. The case records of these women were reviewed thoroughly, and entered in predesigned pro forma. The main outcome measure was mode of labour in current pregnancy decided electively or adopted in emergency. Out of the total, 131 (16.92%) women had previous elective caesarean section due to breech presentation while 643 (83.07%) women had previous elective caesarean section with cephalic presentation. Overall repeat caesarean section rate was 92 (70.22%) in women with previous breech presentation (n=131) in comparison with 475 (73.87%) women with previous cephalic presentation n=643 (RR=1.04, p=0.32). The vaginal birth rate after elective caesarean section due to breech presentation was 39 (29.77%) in comparison with 168 (26.12%) cases with previous cephalic presentation (RR=0.98, p=0.83). Women having elective caesarean section for breech presentation in their previous pregnancy had about 1 in 6 chance of having repeat elective caesarean section.

Decreased risk of prematurity after elective repeat cesarean delivery in Hispanics

Background: The current recommendation is to delay elective repeat cesarean deliveries (ERCD) until 39 weeks to decrease prematurity risks. Prior reports suggest accelerated maturity of fetuses according to race (African-Americans and Asians).Objective: To analyze the effect of the Hispanic ethnicity on the prematurity risk after ERCD. Methods: The US Natality Database from 2004 to 2008 was reviewed. Inclusion criteria were singleton delivery, no trial of labor, repeat cesarean. Exclusion criteria were fetal anomalies, history of diabetes/hypertension related disorders. Outcomes analyzed were Apgar score, assisted ventilation, intensive care admission, surfactant/antibiotic use and seizures. Two groups were identified: non-Hispanic Whites (NHW) and Hispanic Whites (HW). Regression analysis was performed to calculate adjusted odds ratios. Deliveries at 36–40 weeks were studied with 40 weeks as the reference group.Results: A total of 930 421 ERCDs were identified, 396 823 NHW and 236 733 HW. For NHW, the risk of prematurity was lower at 39 weeks. For HW, there was no difference in the risks of prematurity at/beyond 38 weeks.Conclusion: There appears to be accelerated maturity with no increase in prematurity risk at 38 weeks in HW delivered by ERCD. Ethnicity can be considered for patient counseling and decision making regarding optimal timing of elective interventions.