Caesarean Operation Research Articles

Investigating the effects of the COVID-19 pandemic on obstetric anesthesia and perioperative outcomes in cesarean section surgery

Aim: In the literature, studies comparing the preferred anesthesia methods and related parameters in obstetric anesthesia during the pandemic period with the pre-pandemic period are limited. I n this study, primarily in patients who gave birth by cesarean section before and during the COVID-19 (Coronavirus disease 19) pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, length of hospital stay, clinical urgency of the patients and ASA (American Society of Anesthesiologists) scores. In addition, in patients who underwent cesarean section with positive and negative PCR (Polymerase Chain Reaction) tests during the COVID-19 pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, hospital stay, clinical urgency of the cases and ASA scores.
 Material and Method: In this retrospective, single-center study, we noted down and compared types of cesarean section (elective or emergency), anesthesia techniques (spinal, spinal+epidural, or general anesthesia), and patients’ ages, ASA scores, PCR test results, postoperative complications (e.g., pneumonia, excessive postpartum bleeding), and lengths of hospital stay.
 Results: We carried out this study with the data of 2,406 women, 1,458 of whom gave birth before the pandemic. The findings revealed that the rate of developing complications, the length of hospital stay, the number of patients with an ASA score of 3 and above, and the use of spinal anesthesia significantly increased during the pandemic. Moreover, 182 women were COVID-19-positive among a total of 948 applicants during the pandemic. Although the ASA scores and complication rates were significantly higher among those with a positive PCR test result, the length of hospital stay was similar between the patients by their PCR test results. 
 Conclusion: Our findings revealed a significant decrease in spinal + epidural anesthesia, which was frequently adopted before, in cases with cesarean section during the pandemic. Spinal anesthesia was mostly used alone. Despite increased complication rates in PCR-positive patients with higher ASA scores undergoing cesarean section, we concluded no significant change in the length of hospital stay. In cases of increased risk of infection and transmission (e.g., pandemic), neuraxial blocks may be preferred as an anesthesia technique to minimize the risk of infection in emergency obstetric operations. It should also be noted that the risk of developing postoperative complications always be high during pandemics.

Fetal mummification in a goat

A 5-year pet doe (unknown breed) was presented (~ 1 month after her expected day of kidding) with a history of vaginal discharge and fetal membranes hanging from the vulva. She was bright, alert, and responsive with an elevated heart rate and respiratory rate. Blood chemistry panel was unremarkable. Vaginal speculum examination was attempted; however, her vulva was 1 inch in length (dorsal to ventral commissure) making it very hard. Transabdominal uterine ultrasonography revealed no fetus and uterus had an irregular echogenicity. A small fetus was identified via transrectal uterine ultrasonography. Decision was to perform cesarean surgery (left flank approach). A mummified fetus was extracted from the left uterine horn.

Pathophysiology of Long-Term Post-Cesarean Complications: Novel Insight from Tissue Magnification Video-Recording

Just over one century ago, the Cesarean operation was almost exclusively performed on a dead or dying mother to remove an infant, either dead or alive. During this time, it was avoided because of its high mortality rate [1].

Perinatal Loss as an Urgent Issue of Obstetrics and Perinatology

Perinatal losses are an urgent medical and socioeconomic problem of obstetrics and perinatology. Perinatal mortality in the world is about 30‰, varying widely across continents and countries. Perinatal losses are one of the main indicators of the level of medical care, characterize, on the one hand, the state of health of a woman and the fetoplacental system, and therefore the degree of viability of the fetus, and on the other, the quality of medical care for the mother during pregnancy, childbirth and the child before and during childbirth, as well as after birth. In numerous studies, the study of the structure of perinatal loss factors and adverse perinatal outcomes is of paramount importance. The most significant factors, according to some researchers, are intrauterine hypoxia and fetal asphyxia in childbirth, intrauterine anomaly of fetal development, respiratory disorders, intrauterine infections, placental and umbilical cord pathology, birth injuries, intraventricular hemorrhages, neonatal infections. Perinatal losses suggest a high risk of pregnancy. This dictates the need for a correct approach to assessing perinatal risk during pregnancy during the follow-up period with an obstetrician-gynecologist, in most cases there is an underestimation of the degree of risk, incorrect management of pregnancy. Women who have undergone COVID-19 in the first trimester of pregnancy may be at increased risk of adverse perinatal and maternal complications. The increase in the number of surgical interventions in obstetric practice over the past decades, noted in all countries of the world, is directly related to the expansion of the indications for the performance of caesarean section operations to prevent perinatal pathology. At the same time, being a unique measure of preserving the health and life of a mother or fetus, a global increase in its frequency is alarming. Currently, one of the main tasks remains the development of a clear multifactorial, highly differentiated system for predicting perinatal losses in order to prevent them.

Correlation of hyperprolactinemia, Subclinical hypothyroidism with Polycystic Ovary Syndrome and infertility

Background: Polycystic ovarian syndrome (PCOS) is a hyperandrogenic condition characterized by polycystic ovarian morphology and chronic oligo-anovulation. When it is combines with hypothyroidism and hyperprolactinemia, this condition can have severe consequences, may even lead to infertility.
 Case Presentation: This case study illustrates the complexity of PCOS and the significance of a multidisciplinary approach to its diagnosis and therapy. The patient is a 24-year-old non diabetic nonsmoker female with PCOS who has been attempting to conceive for seven years. The patient presented to the hospital with irregular menstrual cycles and a desire to become pregnant. The patient had previously been unsuccessfully treated with Clomid and letrozole. The patient's BMI was determined to be 23. 3 and a pelvic scan indicated PCO ovaries. Laboratory results revealed hyperprolactinemia (53 ng/ml) and subclinical hypothyroidism (TSH 12.6 uIU/ml, T4 0.54 ng/dL- TPO antibodies:187 IU/mL, Anti thyroglobulin antibodies 235 IU/mL), but a pituitary gland MRI was normal. Thyroid US features going with Hashimoto thyroiditis. The patient's PCOS symptoms were initially managed with metformin and Duphaston, and then Cabergoline was introduced to address hyperprolactinemia. The patient became pregnant shortly following hyperprolactinemia medication. Prenatal screenings revealed elevated fasting glucose levels and gestational diabetes. The patient's blood sugar was initially controlled by Metformin, but she later required multiple insulin doses to maintain control. The patient was scheduled for induction of labor at 38 weeks, but a lower segment emergency cesarean surgery was performed due to fetal distress.
 Conclusion: Regular monitoring and management of both PCOS and related conditions such as hypothyroidism and hyperprolactinemia are crucial to ensure the best outcome for the patient. Additionally, we suggest Metformin, Duphaston, Cabergoline to treat PCOS patient having subclinical hypothyroidism and hyperprolactinemia.
 Keywords: Polycystic ovarian syndrome, subclinical hypothyroidism, hyperprolactinemia, gestational diabetes.

Placenta previa: risk factors, maternal and perinatal outcomes

Introduction. Placenta previa (PP), especially invasive forms (placenta accreta spectrum PAS), is one of the leading causes of maternal and perinatal morbidity and mortality. The aim of the study is to study the features of the anamnesis, pregnancy and childbirth outcomes for the mother and fetus with placenta previa, and to identify the main risk factors for this pathology. Materials and methods. Retrospective cohort study by continuous sampling method: Group 1 – 64 patients with PP, 2 – 30 women with normal childbirth. The anamnesis of women and pregnancy outcomes were studied. Statistical calculations: Mann-Whitney criteria, χ2 Pearson, odds ratio indicator (OSH). Results. The probability of PP increases in a woman's history with cesarean section in anamnesis (OR 20.53 (7.2–58.53), p < 0.001), premature birth (OR 4.29 (1.45–12.68), p = 0.04), abortion (OR 3.77 (2.32– 6.12), p = 0.004), including induced (OR 14.16 (4.95–40.53), p = 0.001) and spontaneous (OR 3.65 (2.01–6.62), p = 0.02), as well as somatic diseases (OR 6.17 (3.8–10.02), p < 0.001), especially the presence of anemia (OR 19.84 (6.95–56.61), p < 0.001), gastrointestinal diseases (OR 13.18 (4.6–37.75), p = 0.002), overweight/obesity (OR 6.23 (2.14–18.14), p = 0.015), varicose veins (OR 5.37 (1.84–15.72), p = 0.005). The threat of miscarriage (p = 0.012), placental disorders (p = 0.012), anemia (p = 0.026), genital infection (p = 0.023) were recorded more often in women with placenta previa. All women with PP were delivered by operation caesarean section, often prematurely (45.3 %; p < 0.001), urgently (45.3 %, p < 0.001) because of bleeding (37.5 %, p < 0.001). The expansion of the volume of surgery was required in 37.5 % of cases, hemotransfusion – 50.0 %. Morphofunctional indicators of children from mothers with PP were significantly lower, and the frequency of asphyxia, respiratory distress syndrome, аrtificial lung ventilation was higher than in the control group. Discussion. PP and PASS are potentially dangerous pathologies for the life and health of women and children, which is confirmed by the results of this study. However, problems of diagnosis of this pathology were revealed at the outpatient stage. In addition to the well-known risk factors for abnormal placentation, associations of PP with a low socio-economic status of a woman and a number of somatic nosologies, such as obesity, anemia, gastrointestinal tract diseases, varicose veins, the influence of which is probably indirect. The association of abnormal placentation with excessive use of gestogens during pregnancy cannot be ruled out. Conclusions. The risk factors for PP were the presence of a history of cesarean section, abortions, premature birth, low socio-economic status, somatic pathology (overweight / obesity, anemia, gastrointestinal diseases, varicose veins). PP is associated with a high frequency of the threat of miscarriage, placental disorders, genital infection, premature birth, cesarean section operations, bleeding, decreased morphofunctional indicators of newborns, perinatal morbidity and mortality

An analysis of misoprostol effectiveness in second trimester pregnancy terminations

Background/Aim: Misoprostol is frequently used as a single agent in pregnancy terminations. However, it increases the risk of uterine rupture in patients who have had previous uterine surgery and terminations due to stillbirths. Therefore, it is used with concern by clinicians. The aim of this study was to evaluate the clinical features of the groups that responded and did not respond to termination treatment with misoprostol in a tertiary center and to investigate its efficacy and safety. Methods: The study design was comprised of a retrospective cohort study. A total of 114 second trimester pregnancies (between 13-24 weeks gestational age) were included in the study. These pregnancies were indicated for termination based on the prenatal diagnosis unit for fetal or maternal causes. According to the International Federation of Gynecology and Obstetrics (FIGO) directions, misoprostol was applied in the following dosages: for 13-17 weeks gestational ages, one tablet per 6 hours; for 18-26 gestational ages, ½ tablet per 6 hours; and for other indications 2 tablets per 3 hours were administered. If the patient had had a previous cesarean operation, all doses were halved. After the first 24 hours, the percentage and demographics results, such as age, body mass index (BMI), gravida, number of cesareans, number of curettages, cervical lengths, BISHOP scores, gestational age, amniotic fluid index, and fetal cardiac beat of the patients with miscarriage, were recorded. Results: The number of cases resulting in miscarriage within 24 hours were 84 (73.7%) and within 48 hours were 14 (12.2%). The total of misoprostol doses used were 8 tablets of 200 mg, mean time until the complete abortion was 17 hours. Sixteen patients required additional treatment, of whom four required Foley catheterization, five required D&E, seven required resting, and no one required a hysterectomy. Uterine rupture occurred in two patients who needed laparotomic surgery. The maternal age (P=0.340), BMI (P=0.790), gravida (P=0.270), previous cesarean history (P=0.390), previous curettage number (P=0.520), cervical length (P=0.380), Bishop score (P=0.190), gestational age (P=0.072), amniotic fluid index (P=0.470) and presence of fetal cardiac beat (P=0.350) were similar between groups Conclusion: Our results indicated that misoprostol is a safe, useful, and effective treatment option for second trimester medical terminations. Caution should be exercised in its use in patients with a history of uterine surgery.

Maternal and infant outcomes of pregnancy associated with anti-SSA/RO antibodies: a systematic review and meta-analysis

ObjectiveThe relationship between anti-SSA/RO antibodies and pregnancy has been reported previously, and we aim to visualize the rates of maternal and infant outcomes with anti-SSA/RO.MethodsWe systematically searched records from Pubmed, Cochrane, Embase, and Web of Science databases, pooled incidence rates of adverse outcomes of pregnancy, and 95% confidence intervals (CIs) were performed with RStudio.ResultsA total of 890 records comprising 1675 patients and 1920 pregnancies were searched from the electronic databases. For maternal outcomes, the pooled estimate rates were 4% for termination of pregnancy, 5% for spontaneous abortion, 26% for preterm labor, and 50% for cesarean operation. While for fetal outcomes, the pooled estimate rates were 4% for perinatal death, 3% for intrauterine growth retardation, 6% for endocardial fibroelastosis, 6% for dilated cardiomyopathy, 7% for congenital heart block, 12% for congenital heart block recurrence, 19% for cutaneous neonatal lupus erythematosus, 12% for hepatobiliary disease and 16% for hematological manifestations. A subgroup analysis of congenital heart block prevalence was performed, diagnostic method and study region were found to affect heterogeneity to some extent.ConclusionCumulative analysis of data from real-world studies confirmed adverse pregnancy outcomes of women with anti-SSA/RO, serves as a reference and a guide for the diagnosis and subsequent treatment of these women, thereby enhancing maternal and infant health. Additional studies with real-world cohorts are required to validate these results.

Diaphragmatic hernia involving gravid uterus in a dog

A 4-year German Shorthair Pointer pregnant dog was presented for severe tachypnea and depression. She had 1 natural breeding 52 days ago. Diaphragmatic hernia with intrathoracic displacement of the uterus was diagnosed via radiography and ultrasonography. Emergency herniorrhaphy was elected and the owner requested to save the litter if possible. Right uterine horn tip, spleen, part of liver, pancreas, and part of greater omentum were in the thorax. Intraoperative transuterine ultrasonography confirmed live fetuses and pregnancy was permitted to continue. Patient received supportive medical care for 3 days. Based on ultrasonography findings (eminent danger to litter), decision was made to perform an emergency cesarean surgery (56 days after breeding). Six of 11 pups were alive and 1 mummified fetus had an elongated neck (perhaps due to entrapment in the diaphragmatic hernia).

Case Report Isolated Umbilical Cord Cyst in Second and Third Trimesters

The cyst might be solitary or numerous (more frequent). While single cysts are attributed to favorable perinatal outcomes during the initial stages of pregnancy, the presence of numerous different umbilical cord cysts, their persistence in the second and third trimesters, and their conjunction with other ultrasonographic anomalies are linked to a higher probability of a miscarriage, aneuploidy, or other complexation. The majority of the material on postoperative complications and treatment adherence of foetuses with umbilical cord cysts is minimal. We wanted to show the result of a third-trimester foetus with an isolated umbilical cord cyst. Due to foetal distress, the baby was delivered by emergency caesarean surgery at 39 weeks gestation. The infant seemed fine and cried immediately. It should be taken into account that large umbilical cysts, in the event of rapid proliferation, may pressure the cord vessels and cause foetal discomfort. It is essential to consider the ultrasound examination of the umbilical cord as one of the essential aspects of the test. In addition, it is advised to ascertain that a karyotype is necessary when we discover this issue with related abnormalities.

Cholecystitis Associated with HELLP Syndrome in Previously Preeclampsia Patient

In this article, we report a pregnant woman with HELLP syndrome (hemolysis findings, elevated liver enzymes, and low platelets) and acute cholecystitis. She was first admitted due to epigastric pain, nausea, and vomiting, which was managed and discharged after three days. She was admitted due to severe right upper quadrant pain, which sonography showed cholecystitis; however, the levels of lactate dehydrogenase level, ALT, AST, and platelet suspects to HELLP syndrome, and after two days of current admission, these parameters became 2148 IU/L, 199 U/L, 230 U/L, and 43000 respectively, which led us to a definitive diagnosis of HELLP syndrome patient underwent cesarean section surgery, which led to significant improvement in laboratory findings Afterward, on day 3, the patient went on laparoscopic cholecystectomy surgery. Finally, on the seventh day of admission, all parameters were normal, and the patient was discharged without complications.

Development of a Framework for On-Demand Caesarean Section in Romania.

Caesarean section rates have continued to trend upward in most countries, including Romania, creating a number of economic challenges. In the public health system, there is no regulation for performing Caesarean sections on demand; it is often done unlawfully, and in private hospitals, it is a real business. Thus, this study aims to investigate the budgetary impact at a hospital level and the profit per procedure by introducing on-demand caesarean sections for a fee. This study was conducted in one of the largest maternity units in Western Romania-the "Bega" Maternity Clinic of the Timisoara County Emergency Hospital. For the analysis, the difference between a proposed occupancy rate (between 50 and 85%, increasing every 5 percent) and the actual occupancy rate was calculated. Considering that this difference can be used to admit patients to receive Caesarean sections on demand for a fee, the profit that could be obtained during the study period was calculated. It is reported that between 238 (proposed occupancy rate of 50%) and 4683 patients (a proposed occupancy rate of 85%) could have benefited from on-demand caesarean section surgery in 2017-2019. Between RON 419,999 and RON 8,551,636 could be obtained in the 3 years of study by implementing caesarean section against payment. The implementation of a system of on-demand payment for caesarean sections in Romania would bring significant profits to the hospital budget.

Study of foetomaternal outcomes in COVID-19 afflicted parturients who underwent operative delivery - A retrospective analysis.

Parturients with coronavirus disease (COVID)-19 are increasingly presenting for operative delivery. The aim of this study was to outline the foetomaternal outcome in COVID-19-afflicted pregnant women who underwent lower segment caeserean section (LSCS). Data of all COVID-19 positive pregnant females who underwent caesarean section surgery between 1 April and 30 June 2021 was collected. Clinical parameters, including oxygen requirement, laboratory investigations, treatment measures, complications, length of hospital and intensive care unit/neonatal intensive care unit stay, and outcome of parturients and neonates, were collected and analysed. All patients were followed up either during their visits to the obstetric outpatient department or by making phone calls between 1 and 2 months of discharge. Statistical Package for the Social Sciences statistical software 16.0 was used for analysis. Independent group t-test or Mann-Whitney test was used for mean of continuous data. Chi-square test or Fisher's test was used for proportion of categorical data. A P value of <0.05 was considered significant. A total of 71 parturients delivered by caesarean section. 36.51% had mild COVID-19, and 87.5% had moderate COVID-19 at admission. One each with mild and moderate disease expired. The median (interquartile range) length of hospital stay was 7 (5-5.9) days for those with mild disease, and it was significantly longer for those with the moderate disease at 14 (9.5-17.5) days. Our study found that after a mean of 41.72 days of follow-up, of the 69 surviving mothers, 17 complained of fatigue, five complained of myalgia and one needed intermittent supplemental oxygen. Out of 74 babies born, seven died, which is 94.6 per 1000 live births. COVID-19 parturients delivered by LSCS stand a higher risk of maternal and neonatal mortality and adverse effects, including more hospital stay and increased mortality.

Intraoperative complications of multiple caesarean sections (literature review)

Multiple caesarean sections increase the risk of intraoperative complications: adhesions, damage to the pelvic organs (bladder, ureters, intestines), bleeding with the need for blood transfusion, abnormal placentation, hysterectomy for cae- sarean section, failure of the uterine scar, uterine rupture. The frequency of these complications increases in proportion to the number of previous caesarean sections. Although a causal relationship is often difficult to establish, some of these complications are likely related to surgically induced adhesions. Repeated cesarean section operations are associated with more complex surgical interventions: difficulties in opening the abdominal cavity, difficult separation of the uterus, bladder and ureters from adhesions, the need for blood transfusion and surgical correction of damage to neighboring organs (bladder, ureters, intestines), the need for additional surgical intervention such as hysterectomy . Reducing unnecessary primary caesarean sections and repeat caesarean sections, post-caesarean vaginal delivery, and careful surgical technique can significantly reduce intraoperative surgical complications.

周産期の危機的病態にVA–ECMOを導入し良好な結果を得た3例(Three peripartum patients in critical condition successfully treated with extracorporeal circulation)

要旨周産期において急激に循環虚脱へ陥った産科救急3例に対して体外循環を導入し良好な結果を得た。3例はそれぞれ肺血栓塞栓症による呼吸循環不全，羊水塞栓症による肺水腫，周産期心筋症による心不全であった。うち1例は帝王切開後の子宮出血が止まらないなかでvenoarterial extracorporeal membrane oxygenation（VA–ECMO）を使用し，子宮摘出術を行った。もう1例はVA–ECMO導入後に緊急帝王切開を行った。3例とも危機的病態であったにもかかわらず神経学的異常はほとんどなく母児ともに良好な転帰を得ることができたが，うち2例の体外循環は標準的な妊産婦の蘇生治療ではないため今後の症例の集積が待たれる。急変した妊産婦の救命ならびに神経学的転帰の改善のためには，カンファレンスやシミュレーションによる母体救命システムについての意思統一が有効である。さらには，地域の産婦人科医，周産期センターと救命救急センターが日頃から産科救急に柔軟に協働し，必要に応じて循環虚脱や重症呼吸不全に対して迅速に体外循環を導入できる体制が重要である。

ERACS Method as a Solution to Allow Hospital and Patient Financing

ERACS (Enhanced Recovery After Caesarian Surgery) is a fast post-SC recovery program, namely a series of treatments starting from preoperative preparation, during surgery, and postoperative care to patient discharge. The ERACS concept is the development of the Enhanced Recovery After Surgery (ERAS) concept, where the ERAS concept was originally used in digestive surgery. The purpose of this study was to find out whether the eracs method could be used as a solution to ease the burden on hospital and patient costs. This research method was carried out using a literature review approach with a library approach. The nature of the research used in this research is a prescriptive design. The results of this study were then analyzed qualitatively. Based on the results of the study it can be concluded that the Enhanced Recovery After Caesarean Surgery (ERACS) method is the newest method performed for cesarean delivery. This method emphasizes reducing the anesthetic dose so that the patient does not need to spend a long time in the hospital. Because, if the patient stays in the hospital for too long, this will have an impact on increasing the cost of hospitalization. This method can reduce the financial burden on both patients and healthcare facilities. This will help a mother to care for her baby much earlier without compromising her safety and satisfaction. Hospitals will have an advantage in terms of decreased beds and thus the number of patients treated will increase and healthcare resources will be increased efficiently used.

Transversus Abdominis Plane (TAP) Steroid Block for Chronic Abdominal Pain Caused by Chronic Postoperative Pain

Introduction: Various factors including surgical, psychological, amount of acute pain relief have been proposed as risk factors for developing CPSP. Different treatment modalities like nerve and plane blocks, psychiatric counselling have been described to counter this pain.&#x0D; Case: The patient was a 30-year-old female with complaints of severe pain in the right lower quadrant of the abdomen and found a surgical scar with hyperalgesia and a history of open appendicectomy surgery, two times section caesarean section surgery. The patient experienced pain after section caesarean section surgery 6 months ago. Because the pain was also felt in the right hypochondrium, the patient was unable to move his body, unable to sit and stand. The patient was diagnosed as a case of chronic post surgical pain syndrome (CPSP). We performed transversus abdominis plane block (TAP) with ultrasound guidance and lidocaine 15 ml combined with 40mg methylprednisolone. VAS scores showed significant improvement from 8/10 and 2/10 during the 10-day follow-up. We conclude that ultrasound-guided TAP block can be a treatment option for CPSP cases.&#x0D; Conclusion: Chronic post surgical pain (CPSP) is a definite clinical entity after laparatomy. We report a successful management of such a case with ultrasound guided transversus abdominis plane block. The patient had very significant pain relief after procedure follow up continue until today without any side effects.

COMPARASION OF LEVICA AND BUNASCAN IN SPINAL ANESTHESIA ACTION ON WORK ONCE AND SENSORIC BLOCKED IN ANALGESIA IN SECTIO CAESAREAN PATIENTS

The use of bunascan drugs was carried out when the Bontang Islamic Hospital was established, while the levica drug is still relatively new and has not been widely used in caesarean section surgery. This study aims to determine the comparison of levica with bunascan in spinal anesthesia on the onset of action and blockade of sensory analgesia in cesarean section patients at the Bontang Islamic Hospital. This research method uses a pre-experimental design with a type of one-shot case study. sampling technique with accidental sampling of as many as 78 respondents. The results showed that there was a significant difference between bunascan and levica on the onset of action and blockade of sensory analgesia, with a sensory block p-value of 0.007 and an onset of action p-value of 0.024. The average value of bunascan drugs is 62.9 seconds (sensory block) and 84.78 seconds (start of action), while levica is 87.3 seconds (sensory block) and 102.4 seconds (start of action). So the drug levica 15 mg has a sensory block of analgesia and a slower onset of action than bunascan 15 mg for spinal anesthesia in caesarean section.

Rupture of the Prepubic Tendon in a Quadruplet Pregnant Romanov Ewe

A case of prepubic tendon rupture in a Romanov ewe in which four live lambs were removed by cesarean section is presented. A three-year-old ewe, on the 142±3 days of the second gestation was brought to the Siirt University Animal Health Application and Research Center with a sudden downward expansion of the abdomen during the last one day. When ewe was examined reluctance to locomotion, mild depression, tachycardia, tachypnea and abdominal peculiar enlargement on the left side more than right side were noticed. Because of this case was detected early the general condition was not so bad and clinical examination revealed that swelling was non-painful and non-edematous. Ultrasonography was performed to detect viability of the fetuses, and to eliminate possibility of hernia of the abdominal muscles. Based on anamnesis, abdominal palpation, and clinical examination, this case was diagnosed with prepubic tendon rupture. The prognosis of saving the lives of ewe and fetuses depends on successfully handling all aspects of the case in the last period of pregnancy. Although it is not possible to repair the abdominal integrity surgically in cases of prepubic tendon rupture in the ewe, a planned cesarean operation is indicated to increase the survival rates of both ewe and lambs.

VARYING CLINICAL PRESENTATIONS OF CESAREAN SCAR ECTOPIC IN TERTIARY CARE CENTRE

Introduction: Cesarean scar pregnancy [CSP] is the implantation of gestational sac within the myometrium of prior caesarean surgery scar. The incidence of caesarean scar ectopic is 1 in 2000 normal pregnancies. CSP possess great risk for maternal haemorrhage, placenta accreta spectrum and uterine rupture. Women with caesarean scar ectopic usually present early. Pain and bleeding are common. However 40% of women are asymptomatic. Diagnosis is made by routine USG examination. Rarely early rupture can lead to abdominal pregnancy. To study various Aims And Objectives: clinical presentations, management, outcome of 3 caesarean scar pregnancies at a tertiary care centre. Materials And Methods: Retrospective study done in Department of Obstetrics and Gynaecology at Government Hospital Guntur from June 2021- June 2022. Sample size -3 Results: Out of 3 cases Ÿ One was presented with bleeding p/v as ?incomplete abortion Ÿ Other 2 cases were presented with pain abdomen with ?unruptured tubal ectopic Procedure: Ÿ Exploratory laparotomy with scar ectopic excision and repair Ÿ Exploratory laparotomy followed by sub total hysterectomy Conclusion: Cesarean scar ectopic is a rare and potentially life threatening ectopic pregnancy. Diagnosis of CSP could be done by comprehensive history taking and examination. Ultrasound is the main modality to identify. Early diagnosis and intervention is very important to decrease morbidity and mortality of Cesarean Scar Ectopic