Complication Of Cesarean Section Research Articles

Gravida 7 para 4 abortus 2 (G7P4A2) for multiple repeat caesarean section: general or neuroaxial anesthesia

A caesarean section (CS) is a surgical procedure that has several risks, such as uterine rupture, infection, bleeding, thrombosis, and damage to the bladder, ureters, or intestines. Compared to primary CS, multiple repeat caesarean sections (MRCS) are associated with additional risks, including placenta previa, abnormal placental invasion, difficulty in surgical dissection, longer surgeries, and greater amounts of bleeding. A woman, age 40 years, G7P4A2, gravida aterm, weight 64.4 kg, height 150 cm, Mallampati score 1, open mouth >3 cm, thyromental distance > 3 fingers, neck circumference 33 cm, former caesarean section 4 times, would have her caesarean section and sterilization at Melinda Woman Hospital Bandung-Indonesia. A caesarean section was performed under general anesthesia, induction with propofol, atracurium, and sevoflurane, and maintenance anesthesia with N2O/O2-sevoflurane. Induction-delivery time: 16 minutes, uterine incision 50 seconds, baby born with 1-minute Apgar score was 9 and 5-minute Apgar score was 10. Analgetic fentanyl is given after birth at a dose of 1.5 mcg/kgBw intravenously. There were no caesarean-section complications. Postoperatively, the patient was treated in the wards. Due to concerns about heavy bleeding, which would require massive transfusions, anesthesia was performed under general anesthesia due to the fact that massive transfusions make patient uncomfortable because of various complications of massive transfusion

Complicated infectious endocarditis in a patient with human immunodeficiency virus: A case report

INTRODUCTION: Infectious endocarditis (IE) in injecting drug patients with human immunodeficiency virus (HIV) is manifested predominantly by damage to the tricuspid valve (TV). The pathogen of the disease is Staphylococcus aureus. The IE peculiarities of the TV in this category of patients are multiple septic emboli in the small circulation, which may result from flotation vegetations, and predominance of pulmonary symptomatology over cardiac phenomena.
 CASE PRESENTATION: A 30-year-old female HIV-infected injecting drug user was dynamically monitored for the laboratory-confirmed IE development by transthoracic echocardiography during a year. The patient was twice admitted to the intensive care unit in a serious condition with purulent-septic complications in the lungs in the form of bilateral polysegmental destructive (septic) pneumonia confirmed by X-ray and multispiral computed tomography. After intensive therapy, the patient refused further ARV treatment and consultations with a cardiac surgeon. A clinical follow-up demonstrated IE of the TV and right-sided lower lobe pneumonia in an HIV-infected drug-dependent patient after a cesarean section. Immunodeficiency without appropriate ARV therapy had a negative impact on the course of the disease. According to transthoracic echocardiography, an increase in TV vegetations from 7 mm to 16 mm and regurgitation were observed, whereas left ventricular ejection fraction decreased from 60% to 47% during the follow-up. Complications of cesarean section, immunodeficiency, and absence of ARV therapy could be the trigger factors of the IE development. Injection drug use with possible violations of asepsis and circulation of microorganisms of the causative agents in the blood contributed to the rapid development of the disease and was a determining factor of the infectious process in the TV.
 CONCLUSIONS: Echocardiography remains the primary radiological diagnostic method for examining HIV-infected drug-dependent patients with fever and/or after medical manipulations. However, this group of patients more frequently clinically manifests the disease with bright pulmonary pathology. Therefore, radiological methods should necessarily be a priority during the diagnostic search. The sources of septic embolism in the small circulation in IE may be loose and floating TV vegetations.

Increased bladder injury rate during emergency and repeat cesarean section

Bladder injury is one of the complications of cesarean section (CS). It is reported that the overall incidence of bladder injury is 0.22-0.44% of CS. It is, however, unclear what factors influence this rate. The aim of this study was to determine if there is a difference in bladder injury rate between scheduled and emergency CS, as well as in primary and repeat CS at a large metropolitan hospital that serves a population at high risk for obstetric complications. In addition, the use of urology consultation following bladder injury and whether demographic factors and labor characteristics affect the rate of bladder injury were investigated. A total of 8,488 records were reviewed (4,292 primary CS and 4,196 repeat CS) from January 1, 2013 to December 31, 2020. The incidence of bladder injury was calculated and the rate of intraoperative urology/urogynecology consultation was recorded. Then the association between bladder injury and intraoperative urology/urogynecology consultation and between bladder injury and maternal age, body mass index (BMI), and gestational age were compared. There was a significant increase in risk of bladder injury in repeat CS versus primary CS (p=0.01). There was also a significant increase in risk of bladder injury in emergency CS versus scheduled CS (p=0.04). Intraoperative urogynecology/urology consultations were significantly higher in the bladder injury versus no bladder injury groups (p<0.0001). Both emergency CS and repeat CS are predictors of bladder injury with odd ratios of 5.7 and 7.4, respectively. These results add to the existing evidence that bladder injury is a rare complication in CS that may occur more often in women undergoing repeat or emergency CS than primary or scheduled CS. Given that the risk increases with repeat or emergency CS, patients should be made aware of such risks and surgeons should make careful intraoperative considerations with close postoperative follow-ups.

Evaluation of Complication of Repeat Cesarean Section: A Study of 100 Patients in a Tertiary Care Hospital in Bangladesh

Background: Worldwide, caesarean section (CS) is one of the most commonly performed obstetric procedures. Maternal mortality and morbidities associated with repeat caesarean section is an important health problem in global perspective that needs to be addressed. Objectives: To evaluate the complications of repeat caesarean section. Materials and Method: This cross-sectional descriptive study was conducted in the department of Obstetrics &amp; Gynaecology, Rangpur medical college hospital, Rangpur from July ’18 to June ‘20 after acceptance and ethical clearance of the protocol. During data collection total admitted patient were 2123 out of which 446 caesarean section was done among them 100 patients of my study population were selected by fulfilling inclusion and exclusion criteria. After full explanation, informing the details of the purpose of the study informed written consent was obtained from the study subjects/ or her legal gardian. After Meticulous history taking thorough physical examination was done on every patient and available investigations according to the need of management was done in the hospital. Per operative and postoperative complications were noted. Information’s were collected in predesigned questionnaire and presented in tabulated form and that was finally was analyzed with the help of computer program SPSS (Statistical Package for Social Science) version 23. Result: Total patient admitted during my data collection were 2123 and of them 446 caesarean sections were done and repeat caesarean sections were 100. The incidence of repeat caesarean section was 22.42%. 35% respondents were between &gt;25-30 years of age. Average gestational age was &gt;36 – 40 weeks. Emergency caesarean section was done in 79% cases and elective in 21% cases. 68% patients had adhesion, 38% had uterine atonicity, 26% had injury to the surrounding structure, placenta previa was found in 7% cases and morbid adhesion of placenta was found in 3% cases. Additional procedures like blood transfusion needed in 34% cases, adhesiolysis performed in 21% cases, ICU admission needed in 16% cases, caesarean hysterectomy performed in 11% cases and B-Lynch suture in 8% cases. Among the postoperative complications wound infection occurred in 20% cases, PPH in 13% cases, UTI in 9% cases, paralytic ileus in 4% cases and postpartum psychosis in 3% cases. Maternal mortality was found in only 3% cases. Conclusion: Repeat caesarean section is associated with increased number of intraoperative and postoperative complications like adhesion, placenta previa, morbid adherent placenta, PPH, wound infection thus increasing maternal morbidity. So, the best way to reduce these morbidity and mortality by reducing primary caesarean section rates by taking judicious decision and indications should be appropriate and C/S should be done by well-trained doctors and specialists in well-equipped centre.

Detoxification treatment in Gynecology using a modified molded sorbent.

Postpartum endometritis is a common complication of cesarean section, the progression of which often leads to the loss of the uterus and the patient's fertility. We evaluated a detoxification therapy for treating patients with postpartum endometritis using an intrauterine application of a modified molded sorbent containing polyvinylpyrrolidone. A retrospective, controlled study included 124 patients with postpartum endometritis. The study group, n=63, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial therapy in combination with the intrauterine application of a molded modified sorbent containing polyvinylpyrrolidone (FSMP) for 24h daily for 5 days. The control group, n=61, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial treatment only. The uterine cavity was infected by coccal flora (Enterococcus faecalis (26.6%), Staphylococcus spp. (21.3%), E. faecium (14.3%), and Gram-negative Escherichia coli (9.6%). A combination of these microorganisms was present in 40.5% of crops. Antibiotic resistance was detected in 53.6%-68.3% of the cases. In the study group, we observed: a faster and higher decrease in neutrophils (p<0.05); a lower uterine concentration of pro-inflammatory cytokines: interleukin-1 beta (IL-1β) and tumor necrosis factor α (TNFα) - 4.0 and 3.2 times, respectively, compared with the control group (p<0.05); and a significant decrease in the uterus volume and cavity (M-echo). Using a newly modified sorbent associated with antibiotic treatment in patients with postpartum endometritis, compared with antibiotics alone, we showed a sharp reduction of inflammatory parameters, residual microorganism growth, and faster uterine volume involution. Moreover, the frequency of hysterectomy decreased by 14.4 times.

A Postpartum Uterine Dehiscence in a Pregnant Woman with Brucellosis; A Cases Report

Introduction Uterine Dehiscence (UD) is a rare complication and very dangerous complication of cesarean section (CS). Brucellosis is a threatening infection in pregnant women with severe obstetrics outcomes such as spontaneous abortion, premature delivery, intrauterine infection. We presented a case with preterm delivery with continuing high fever due to uterine fascial dehiscence after CS, who were infected to brucellosis. Case: A 26-year-old woman with gravidity 1, referred to the obstetrical department at 30 weeks of gestation due to Preterm Premature rupture of membranes (PPROM). After vaginally sonography, the patient underwent emergency CS due to fetus FHR drop and umbilical cord prolapse. From second day after CS, the patients fever increased and Doppler sonography shows low fluid and hematoma in the uterus and evidence in favor of a lesion collection that was evacuated with laparotomy and uterine fascial dehiscence was detected. Moreover, wound debridement conducted and during laparotomy the adhesions were released. The Wright-Coombs 2ME test showed she was infected to brucellosis. Conclusion: Uterine fascia dehiscence in lower uterine segment incision is a rare but is a potentially dangerous for mothers. However, preterm deliveries due to PPROM and high uncontrolled fever after CS, are conditions that practitioners should considering the uterine dehiscence to their differential diagnoses. Nevertheless, the occurrence of dehiscence due to brucellosis infection is questionable and require more evaluation.

Pain score and quality of post cesarean section recovery with ERACS method

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: A cesarean section must be done when regular childbirth is impossible owing to fetal or maternal health issues. One of the complications of cesarean section is pain and quality of recovery. The strategy for managing pain and quality of recovery is using the ERACS method. This method is a new technique in anesthesia with the principles of evidence-based perioperative care, a multidisciplinary approach carried out in a team, carried out on an ongoing basis, and continues to be developed.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: The study aimed to use the ERACS method to calculate the pain score and the quality of recovery following cesarean section.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: The study was quasi-experimental with a post-test control group design. Participants in this study were mothers who had a cesarean section. The sample size in this study was 70, namely 35 treatment groups and 35 control groups. The instrument uses VAS (Visual Analog Scale) and obsQor 11&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: Statistical test for pain obtained P value = 0.000 and for quality of recovery obtained P value = 0.000&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: There is a sizable distinction in pain scores carried out by the ERACS and Non ERACS methods, where the pain scores carried out by the ERACS method are lower than the non-ERACS methods, and there are differences in the quality of recovery between the ERACS and Non ERACS methods where the recovery quality scores are given by the method. ERACS is higher than non ERACS method. &lt;/em&gt;The ERACS method can be an alternative method to reduce postoperative morbidity. Reduction of complications through reduced use of anesthetic doses. And in the future, the development of surgical techniques has reasonable goals, such as improving public health, increasing patient comfort and peace of mind during surgery, and reducing hospitalization, which indirectly reduces costs&lt;/p&gt;

Ogilvie Syndrome and Acute Kidney Injury: A Rare Complication of Cesarean Section and Preeclampsia

Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPS) is a rare occurrence, usually following surgery. It consists of a massive dilatation of the cecum, whose diameter becomes greater than 10 cm; its severity is variable, but, if not promptly recognized, it may be life-threatening. Acute kidney injury (AKI) is reported in this context due to both septic complications and to effective hypovolemia. ACPS most commonly affects males and individuals older than 60. In women, the median age at diagnosis is lower due to a strong association with Caesarean sections. The differential diagnosis after delivery may be challenging, due to a potential overlap of symptoms with preeclampsia or hemolysis low platelet elevated liver enzymes (HELLP) syndrome, both associated with AKI. The case herein discussed, regarding a 35-year-old woman, who developed AKI and Ogilvie syndrome after a Caesarean section for preeclampsia, may exemplify these diagnostic and therapeutic challenges, and is intended to raise awareness on this unusual complication of Caesarean delivery.

Caesarean section and post traumatic stress disorder

IntroductionChildbirth can be a very painful experience, especially vaginally. It can have many complications. The obstetrical complications of caesarean section are well studied but its psychological complications are little mentioned. Most women recover quickly after giving birth, but others seem to have more difficulty. Researchers have attempted to identify perinatal risk factors for the development of post-traumatic stress disorder in parturients and caesarean section seems to be one of the predictors.ObjectivesThe objective of our study is to detect post traumatic stress disorder in women after vaginal delivery.MethodsThis is a cross-sectional descriptive study conducted among women from the general population who have given birth vaginally. The information was collected using a questionnaire distributed on social networks. Symptom severity was quantified using the PTSD checklist for DSM-V (PCL-5).PCL-5 is a 20-item self-assessment that measures the 20 DSM-5 symptoms of PTSD. She rates each symptom from 0 (not at all) to 4 (extremely). The score varies from 0 to 80. A threshold of 33 allows screening for post-traumatic stress disorder.Results61 women took part in this study, 81.5% of whom gave birth vaginally between the ages of 20 and 30.70.3% of the participants gave birth vaginally once, 44.4% twice and 7.3% of the women in our sample had a caesarean three times.Regarding the indication of the high way in our sample: the narrowing of the pelvis and fetal distress were in 22.2%. Exceeding term was in 18.5% of cases.In our sample, 59.3% of the women had planned their vaginal delivery and 40.7% had given birth urgently.Regarding the results of the PCL-5 scale (PTSD checklist for DSM-V), the score varies between 0 and 48 with a median score equal to 12. 3.7% of the participants had a score greater than 33.ConclusionsPost-traumatic stress disorder can accompany childbirth, especially when it is high and in an emergency. Postpartum post traumatic stress disorder affects the mother-child relationship and can be complicated by depressive disorder. Medical monitoring of pregnancy, good medical and family support for the parturient and preparation for childbirth are necessary to better start the maternity experience.Disclosure of InterestNone Declared

A Study of Patient’s Perspectives Regarding the Adequacy of the Informed Consent Process before a Caesarean Section

Background: A better diagnosis, early referral, and greater health-care coverage have increased cesarean deliveries at tertiary care hospitals in India. While most cesareans are done in good faith, it does not escape the purview of consumer awareness and protection. Our study aims to audit the awareness, understanding, and adequacy among patients about informed consent (IC) before cesarean sections. Materials and Methods: This was a cross-sectional study. A detailed questionnaire was given to 150 postcesarean patients from July 2016 to July 2017. The questionnaire was then evaluated, and the inference was drawn based on the patients’ answers. Results: About 84.6% of patients knew the exact indication. About 79.3% were well explained the procedure. Ninety-six percentage were satisfied with the outcome of the procedure. Eighty-four percentage preferred the same institute for their subsequent delivery. Twelve percentage reported that consent was forcibly taken. Ninety-four percentage were unaware about the intraoperative complications. Only 4.6% were explained about the preferred mode of delivery for the next pregnancy. Ninety-two percentage wanted a vaginal delivery for the subsequent pregnancy. Conclusion: Thus, an adequate IC during antenatal visits brings about awareness about the risks and complications of cesarean section and helps better decision-making.

Umbilical and Juxtaumbilical Chronic Discharging Sinus as a Delayed Complication of Caesarean Section: A Case Series

Cutaneous or uterocutaneous sinus or fistula following caesarean section is a rare complication that can occur after the primary wound has healed. Only a few cases have been reported where a fistula or sinus tract forms after a caesarean section. These tracts can communicate externally through the scar line or the skin near the umbilicus (juxtaumbilical) and internally to the uterine scar or an unhealthy abnormal cavity. It is a delayed complication that presents with discharge from the skin opening and can be diagnosed using imaging techniques such as Ultrasonography (USG), Magnetic Resonance Imaging (MRI), Fistulogram, or Sinogram. These tracts often seek weak areas to establish external or internal connections with other organs. The management of these abnormal tracts can vary from conservative approaches to surgical excision. Herein, the authors presented a series of three cases of cutaneous and uterocutaneous fistula following caesarean section. In case 1, a 19-year-old female patient presented with a discharging sinus from the umbilicus, which was found to be a sinus tract communicating inside the abdominal wall to the external skin on imaging. The patient underwent surgery, which involved excision of the sinus tract and necrotic debridement. Two similar cases (cases 2 and 3) were infra and paraumbilical regions that presented with chronic discharges in the infra and para umbilical region following Lower Segment Caesarean Section (LSCS) delivery. Both cases were diagnosed with cutaneous sinus tracts in the juxtaumbilical region using USG and other imaging modalities. They were managed conservatively with appropriate antibiotics and achieved complete healing without any residual infection during follow-up.

COMPLICATIONS OF CAESAREAN SECTION IN A TERTIARY CARE HOSPITA

Introduction: Although caesarean section can be a lifesaving procedure, thorough knowledge about its complications is needed to reduce and prevent morbidity.Caesarean section (CS) is not a completely safe procedure. We here attempted to determine the rate of intraoperative and postoperative CS complications, and identify their risk factors among women were operated at Civil hospital Ahmedabad,a tertiary care hospital. Methods: The data about total 323 caesarean sections operated during the study period were collected. The patients were followed up in postoperative period and any postoperative complications were noted. Results: The incidence of complications of caesarean section was 20.4%. Highest incidence was of postoperative surgical site infection-11.11%.The relative risk of 2.7 suggests that patients with risk factor have 2.7 times more chances of developing intra and postoperative complications. A statistically signicant positive association between emergency LSCS and complications of the procedure was found. Conclusion: Risk factors like preexisting systemic infections, cardiac comorbidity, lower socioeconomic class, anemia and preeclampsia which would increase the morbidity of the operation were noted. Thorough knowledge about the possible complications should be there with the obstetrician. Patient should be made aware of the probable risks and complications of the procedure and general outlook of the procedure should be changed

Awareness and Knowledge of Caesarean Section Complications Among Women in Jeddah, Saudi Arabia.

To assess the awareness about and attitude towards the complications of Cesarean section in the antenatal and postnatal period among women in Jeddah, Saudi Arabia. This cross-sectional study was conducted between January 2020 and September 2020, involving 507 women in the antenatal and postnatal period in Jeddah, Saudi Arabia. Data were obtained via online surveys. The questionnaire addressed the knowledge about short and long-term complications. Results:Most participants received a poor knowledge score for the awareness of Cesarean section complications (45.4%), and only 12.6% had good knowledge. Most participants were in the age group of 32-42 years. Most participants were university-educated and had an excellent socioeconomic status. A statistically significant relationship was detected between the age group and the participant's level of knowledge regarding Cesarean sections (P = 0.030) and between the level of knowledge and experiencing Cesarean delivery by maternal request (P = 0.029). The study concluded that pregnant women had poor awareness regarding the complications of Cesarean sections. Most participants had a negative attitude toward Cesarean deliveries and preferred vaginal delivery.

Parietal Endometriosis: Imaging Features of an Unknown Late Complication of Cesarean Section

Parietal endometriosis is a rare clinical entity; it most often occurs after gynecologic or obstetric surgery. The typical clinical presentation is that of a parietal mass associated with pain punctuated by menstruation. Parietal ultrasonography finds a hypoechoic, heterogeneous formation with internal echoes. Doppler and MRI confirmed the diagnosis of parietal ́endometriosis. The diagnosis is confirmed by histology. Treatment is essentially surgical and based on the complete excision of the lesion. Through our case, we will emphasize the imaging aspects of this pathology, which will allow the practitioner to make the diagnosis.

Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study.

Impacted fetal head (IFH) is a challenging complication of cesarean section (CS) associated with significant morbidity. Training opportunities for IFH have been reported as inconsistent and inadequate. This study assessed the validity of a novel birth simulator for IFH at cesarean section. Obstetricians and midwives collaborated with model-making company, Limbs & Things (UK), to modify the original PROMPT Flex® simulator and develop a new "Enhanced CS Module" for IFH at cesarean section. Changes included addition of a retractable uterus and restricted pelvic inlet, and the fetal mannequin was modified to allow accurate limb articulation and flexion at the waist. Obstetricians and midwives from three maternity units in Southwest England were individually recorded, each undertaking three simulated scenarios of IFH at cesarean section. Obstetricians were asked to deliver the fetal head and midwives, to perform a vaginal push-up. Participants completed a questionnaire on realism (face validity) and usefulness for training (content validity) with five-point Likert scale responses. Construct validity was assessed by testing an a priori hypothesis that "experts" (consultant obstetricians with >7 years' experience) would be more likely to achieve delivery than "novices" (registrars with <7 years' experience). Performance variables were compared between groups using Chi-square and Mann-Whitney U-tests. In all, 105 simulated scenarios were undertaken by 35 obstetricians and midwives. A range of techniques were employed to deliver the IFH including change of hand, vaginal disimpaction and reverse breech extraction. Overall, 86% (30/35) described the model as fairly (4)/very realistic (5) (median=4, interquartile range [IQR]=4-5). The model was considered fairly (4)/very useful (5) for training by 97% (34/35; median=5; IQR=5-5). Experts delivered the fetal head in all simulations (36/36) and novices delivered the head in 76.9% (30/39) (p=0.002). Experts delivered the fetal head 58% quicker than novices (median=66.8s, IQR=53-86 vs median=104 s, IQR=67.7-137). This novel birth trainer realistically simulates IFH at cesarean section and allows rehearsal of all disimpaction techniques. It was reported to be very useful for training and distinguishes between novice and expert obstetricians. Techniques for IFH are difficult to learn experientially. Simulation is likely to provide an effective and safe form of training.

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

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

Transplantation of maternal intestinal flora to the newborn after elective cesarean section (SECFLOR): study protocol for a double blinded randomized controlled trial

BackgroundA complication of elective cesarean section (CS) delivery is its interference with the normal intestinal colonization of the infant, affecting the immune and metabolic signaling in early life— a process that has been associated with long-term morbidity, such as allergy and diabetes. We evaluate, in CS-delivered infants, whether the normal intestinal microbiome and its early life development can be restored by immediate postnatal transfer of maternal fecal microbiota (FMT) to the newborn, and how this procedure influences the maturation of the immune system.MethodsSixty healthy mothers with planned elective CS are recruited and screened thoroughly for infections. A maternal fecal sample is taken prior to delivery and processed according to a transplantation protocol. After double blinded randomization, half of the newborns will receive a diluted aliquot of their own mother’s stool orally administered in breast milk during the first feeding while the other half will be similarly treated with a placebo. The infants are clinically followed, and fecal samples are gathered weekly until the age of 4 weeks, then at the ages of 8 weeks, 3, 6, 12 and 24 months. The parents fill in questionnaires until the age of 24 months. Blood samples are taken at the age of 2–3 days and 3, 6, 12 and 24 months to assess development of major immune cell populations and plasma proteins throughout the first years of life.DiscussionThis is the first study to assess long-time effects on the intestinal microbiome and the development of immune system of a maternal fecal transplant given to term infants born by CS.Trial registrationClinicalTrials.gov NCT04173208, registration date 21.11.2019.

Post-Supravaginal Hysterectomy for Bladder Flap Hematoma in P3A0 Preterm Delivery by Cesarean Section due to Fetal Distress

Introduction: Bladder flap hematoma (BFH) is a rare complication of cesarean section (CS). BFH appears between the bladder and the lower uterine segment (LUS) when the visceral peritoneal is closed during traditional CS techniques and decreased uterine contractions. Surgery is the treatment of choice for the management of peritoneal closure in CS and the decrease in uterine contractions that cause BFH.Case Presentation: A 35-year-old G3P2A0 underwent a cesarean delivery due to fetal distress. CS was performed with the visceral peritoneal sutured as in the traditional technique. Six hours after CS, there was an increase in abdominal circumference, muscle defenses, hypotension, tachycardia, anemia, and leukocytosis. She had to undergo repeated laparotomy with acute abdomen after CS and hysterectomy because uterine atony was found.Conclusions: BFH can be caused by peritoneal closure during CS and decreased uterine contractions or uterine atony. Although there is no standard protocol for management, surgical approaches for cases with infection or bleeding and hysterectomy are performed to save the patient’s life from uterine atony.

The risk factors and nursing countermeasures of sepsis after cesarean section: a retrospective analysis

BackgroundSepsis is a very serious complication of cesarean section, understanding the influencing factors is important to the prevention and management of sepsis. We aimed to analyze the associated risk factors of sepsis of cesarean section, to provide evidences into the clinical management and nursing care of cesarean section.MethodsPatients who underwent cesarean section surgery from January 1, 2017 to June 30, 2021 in our hospital were included. The characteristics of patients were collected and analyzed. Logistic regression analyses were conducted to analyze the influencing factors of sepsis of cesarean section.ResultsA total of 3819 patients undergoing cesarean section were included, the incidence of sepsis in patients undergoing cesarean section was 0.84%. There were significant differences in the age, vaginal delivery attempt, premature rupture of membranes, preoperative hemoglobin, estimated blood loss during surgery and postoperative urinary tube implacement between sepsis and no sepsis patients (all p < 0.05). Logistic regression analyses found that age ≥ 35y(OR3.22, 95%CI1.20 ~ 5.15), gestational diabetes(OR2.64, 95%CI1.91 ~ 4.15), vaginal delivery attempt(OR2.05, 95%CI1.70 ~ 4.42), premature rupture of membranes(OR2.42, 95%CI1.02 ~ 4.20), preoperative hemoglobin ≤ 105 g/L(OR4.39, 95%CI1.02 ~ 7.88), estimated blood loss during surgery ≥ 400 ml(OR1.81, 95%CI1.35 ~ 3.01), postoperative urinary tube implacement(OR2.19, 95%CI1.27 ~ 2.50) were the risk factors of sepsis in patients undergoing cesarean section(all p < 0.05). Escherichia Coli(46.15%), Enterococcus faecalis(17.95%) and Pseudomonas aeruginosa(12.83%) were the most commonly-seen bacteria in sepsis patients.ConclusionIn clinical practice, medical workers should carry out strict management and early prevention of related risk factors during the perioperative period of pregnant women, to effectively reduce the occurrence of sepsis after cesarean section.

Postoperative C-reactive protein as a predictive marker for surgical site infection after cesarean section: Retrospective analysis of 748 patients at a Japanese academic institution.

Surgical site infection (SSI) is a common but potentially serious maternal complication of cesarean section (CS). C-reactive protein (CRP) can be used in early detection of SSI. However, its predictive value for post-cesarean SSI has never been investigated. This study aims to evaluate the predictive value of CRP for the development of SSI. This was a hospital-based retrospective cohort study of 748 pregnant women who underwent CS at our university hospital between January 2017 and December 2019. CRP was measured on postoperative days 1, 3, and 6. The predictive values of CRP for SSI were evaluated using receiver operating characteristics analysis. Forty-seven (6.3%) patients developed SSI, of whom 38 (80.9%) underwent emergency CS. Serum CRP levels were significantly higher in the SSI group than in the non-SSI group from postoperative day 1 (64 vs. 81 mg/L, p = 0.001); the difference became more evident on postoperative days 3 and 6. The area under the receiver operating characteristic curve (AUC) for CRP on days 1, 3, and 6 was 0.58 (95% confidence interval [CI], 0.49 to 0.68), 0.70 (0.62 to 0.78) and 0.73 (0.65 to 0.81), respectively. The optimal cutoff value for day 3 and 6 CRP was 66.4 mg/L (sensitivity = 76.1% and specificity = 54.4%) and 22.2 mg/L (sensitivity = 76.5% and specificity = 63.2%), respectively. CRP on postoperative days 3 and 6 can be used as a predictive marker for the development of SSI after CS. Further studies to validate the predictive value in different populations is essential.