Elective Cesarean Section Delivery Research Articles

Comparative analysis of thiol-disulfide homeostasis dynamics between elective cesarean section and uncomplicated vaginal delivery: insights into perinatal oxidative balance.

Thiols are organic compounds containing sulfhydryl groups that exert antioxidant effects via dynamic thiol-disulfide homeostasis. The shift towards disulfide indicates the presence of an oxidative environment. Different modes of delivery can affect thiol-disulfide homeostasis. Accordingly, we planned this research to evaluate the effects of the mode of delivery on thiol-disulfide homeostasis in both maternal serum and fetal cord blood samples. We conducted a prospective case-control study involving two groups: vaginal delivery (n=50) and elective cesarean section (CS) (n=45). The vaginal delivery group exclusively comprised uncomplicated term deliveries, while the CS group included pregnant individuals with scheduled cesarean deliveries due to the absence of spontaneous labor onset. Maternal serum and fetal cord blood samples were collected, and thiol-disulfide exchanges were analyzed using an automated method capable of measuring both aspects of the thiol-disulfide balance. The levels of native thiol (-SH) and total thiol in both maternal serum and fetal cord blood samples were significantly higher in the vaginal delivery group than those in the CS group. An important discovery of our study was that fetal cord disulfide (-SS) level, which may reflect oxidative stress, was higher in newborns born via vaginal delivery when examined alone. However, in both maternal and fetal cord blood, the combined ratios, SS/SH ratio (%), SS/Total thiol ratio (%), and SH/Total thiol ratio (%) were observed to be similar between the groups in both maternal and fetal cord blood. It was observed that as the mother's weight gained during pregnancy increased, SS/SH and SS/total thiol increased (positive correlation), while SH/total thiol decreased (negative correlation). Our results showed that the dynamic thiol-disulfide homeostasis was greatly influenced by the way of delivery and supported the idea that vaginally-delivered infants may have more oxidative stress.

Pregnancy outcomes for women with myasthenia gravis and their newborns: A nationwide register-based cohort study.

Few large-scale studies examine whether maternal myasthenia gravis (MG) is a risk factor for complications during pregnancy and childbirth. This study evaluated whether maternal MG is associated with an increased risk of adverse pregnancy, delivery, and neonatal outcomes. We conducted a nationwide Swedish register-based cohort study of women who gave birth to singleton infants (≥22 gestational weeks) during 1987-2019. Exposed women were diagnosed with MG before or during the index pregnancy (N = 443). Unexposed women comprised 4249 women without a diagnosis of MG, matched for age, parity, hospital, and year of childbirth. The risks of adverse pregnancy, delivery, and neonatal outcomes for women with MG were estimated using regression modeling and presented as adjusted odds ratios (aOR). There was no increased risk of pregnancy complications in women with MG. Women with MG had a spontaneous onset of labor less often than women without MG (69.8% vs. 79.5%; aOR 0.59; p < 0.001) as well as higher labor induction rates and elective cesarean section deliveries (16.0% vs. 12.3%, aOR 1.42; p = 0.02 and 12.0% vs. 8.1%, aOR 1.59; p = 0.009). Infants of women with MG were born on average 2 days earlier (p = 0.002); however, these infants did not have a higher risk of having low APGAR, being small for gestational age, or having a congenital malformation. This first nationwide study of pregnancy in women with MG in Sweden demonstrates reassuring results overall, suggesting generally safe pregnancy outcomes for women with MG and their infants.

The Effect of Delivery Mode, ABO Blood Type, and Passive Smoking on Postpartum Depression: A Cross-Sectional Study in Saudi Arabia.

Background Postpartum depression (PPD) is a form of depression that can occur after childbirth and is characterized by feelings of sadness. It is a common psychological problem that affects women and children. This study aimed to assess the association between PPD and risk factors, such as delivery mode, ABO blood group, and passive smoking in Saudi Arabia. Methods PPD was assessed in this cross-sectional using an Arabic version of the Edinburgh postnatal depression scale through an online questionnaire distributed to women in Saudi Arabia between January and March 2022. The data were analyzed using SPSS version 26(IBM Corp., Armonk, NY). Results A total of 354 postpartum women completed the questionnaire within six weeks of giving birth. Their mean age and BMI were 30.1±6.78 years and 25.98±5.84 kg/m2, respectively. PPD occurred in 56.2% of the participants. Elective cesarean section and operative vaginal delivery were associated with the presence of PPD symptoms in 17.6% and 7% of the women, respectively. The majority of those with third and fourth degrees and those who had instrumental assisted delivery had postpartum depression and this was statistically significant (p=0.017). About 26.6% of the participants were exposed to passive smoking, and 21.9% of them developed PPD. However, it was not statistically significant. Moreover, women with PPD were more likely to have blood type O+, followed by A+. Demographic factors did not show a significant correlation with developing PPD except for age (p=0.01), those who developed PPD were much younger on average than those who did not develop PPD (29.28±6.61 years vs. 31.15±6.86 years). Conclusion A significant association was found between PPD and the type of delivery. The association between PPD and passive smoking, ABO blood groups was insignificant. However,women who developed PPD were younger on average than those who did not develop PPD.

Anaesthetic Management for A Patient Presenting for Caesarean Delivery with A giant Thymoma – A Case Report

Presentation of a thymoma during pregnancy means that safe delivery becomes more challenging. We present a 33-year-old pregnant woman who was diagnosed with a large thymoma causing marked compression of the tracheobronchial tree and right atrium. After various multidisciplinary meetings she presented for elective caesarean section delivery at 31 weeks of gestation. A combined spinalepidural anaesthesia was performed, along with colloid pre- and co-loading, and vasopressor support. The delivery was uneventful. The possibility of catastrophic complications was foreseen. Therefore, all requirements for the possibility of airway or haemodynamic collapse were planned carefully, including the possibility of emergent cardiopulmonary bypass.

Pre-incisional Oxytocin infusion in elective cesarean section delivery, maternal and neonatal outcome

Pre-incisional Oxytocin infusion in elective cesarean section delivery, maternal and neonatal outcome

The use of anesthetics for cesarean section delivery in women in Duhok, Kurdistan region, Iraq

Background: Limited information is available on anesthetics that are preferred or used by anesthesiologists for cesarean section (CS) delivery in Kurdistan region, Iraq. This study aims to document general or regional anesthesia use in elective CS deliveries in four major hospitals in Duhok province, Northern Iraq. Methods: A retrospective cross-sectional study was conducted from February 2019 to February 2020. The general and regional anesthetics types were recorded for each CS delivery case within the selected hospitals. Any adjuvants and medications used with the anesthetics were also recorded. Univariate and bivariate analyses were undertaken. The statistically significant was considered at less than 0.05. Results: A total of 3420 elective CS deliveries were reported. The mean age ± SD of the pregnant women was 29.6 ± 5.8 years. The anesthetics used in the four hospitals were propofol as a general anesthetic (53.0%) and bupivacaine as a spinal anesthetic (47.0%). The combination of propofol and bupivacaine was used only in 0.3%. The three most frequently and concurrently used adjuvants and medications with propofol or bupivacaine were metoclopramide (90.0%), dexamethasone (80.0%), and ephedrine (73.0%). Conclusion: Propofol and bupivacaine were the general and spinal anesthesia of choice, respectively, for elective CS delivery in Duhok province, northern Iraq. Some adjuvants and medications were supplemented to improve the quality of anesthesia and the outcome of CS delivery.

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.

Mode of Delivery Is Associated with Postpartum Depression: Do Women with and without Depression History Exhibit a Difference?

Whether the mode of birth delivery correlates with the incidence of postpartum depression (PPD) is still under debate. This study seeks to clarify such a correlation and to further investigate if there are any differences in the likelihood of PPD medical care use among women with and without a history of depression. A logistic regression at two assessment points (6-month and 12-month postpartum) on the National Health Insurance Database in Taiwan is performed. In total, 32,729 women were included who gave first birth from 2007 to 2011 via cesarean section (CS), elective CS, and vaginal delivery, of whom 3580 (10.9%) were diagnosed with a history of depression. Findings show that CS was associated with a higher likelihood of PPD doctor visits regardless of whether the women have a history of depression or not, but elective CS tended to have different impacts for these two groups of women. Mentally healthy women who experienced elective CS had 1.36- and 1.64-times higher risk of PDD medical care use than those who delivered vaginally, whereas previous depressive women undertaking an elective cesarean birth had no significant difference observed in incidences. A notably higher risk of elective CS delivery versus vaginal delivery for mentally healthy women suggests that elective CS is not clinically appropriate, yet it might be an alternative to vaginal delivery with careful counseling for pregnant women who experience a history of depression.

Knowledge and Attitude Regarding Elective Caesarean Section and NormalVaginal Delivery among Pregnant Women Attending OPD in a SelectedHospital at Bangalore with a View to Develop an Information Booklet

Background: Pregnancy and childbirth are universally celebrated events. Yet, every minute, every day, a woman dies as a result of pregnancy or childbirth or both somewhere in the world. Every year, approximately 6,00,000 women die of pregnancy and child birth related causes. Hence it is essential to assess the knowledge and attitude of pregnant women regarding elective caesarean section and normal vaginal delivery and develop an information booklet which will help the healthcare professionals to gain an insight to educate the pregnant women about the benefits and risks of different modes of delivery in order to become healthy mothers and have healthy babies. Methodology: A descriptive study was conducted among 100 pregnant women who were selected through convenient sampling technique and attending outpatient department of St Philomena’s Hospital, Bangalore. Data were collected using structured knowledge questionnaire and attitude rating scale though an interview schedule. Conceptual framework adopted for the study was Pender’s health promotion model. Results: The results showed that the overall mean knowledge and attitude score was 23.58 and 75.77 respectively. A positive correlation existed between knowledge and attitude among pregnant women. It has been found that occupation, number of living children, type of family, family income per month and previous normal vaginal delivery had significant association with knowledge levels. The number of living children, type of family, family income per month, parity and previous caesarean section had significant association with attitude levels. Conclusion: The study concluded that higher the knowledge, positive was the attitude regarding elective caesarean section and normal vaginal delivery

Effect of Perioperative Music Therapy/Medicine on Postoperative Pain in Women Undergoing Elective Lower Segment Caesarean Section Delivery under Spinal Anaesthesia: A Case-control Study

Introduction: Women undergoing elective Lower Segment Caesarean Section (LSCS) delivery under spinal anaesthesia usually experience anxiety and stress due to unpleasant operative environment. Music therapy/music medicine has been found to relieve anxiety and stress besides decreasing pain and stable cardiorespiratory parameters. Aim: To assess the effect of perioperative music therapy/music medicine on pain and cardio respiratory parameters in women undergoing elective LSCS under spinal anaesthesia. Materials and Methods: The present study was case-control study in which 60 consecutive parturient women, planned for elective LSCS delivery under spinal anaesthesia, were randomly divided into music and non music groups of 30 each. Demographic characteristics of women were recorded. The ‘music group’ received preselected music three times for 20 minutes each along with standardised analgesia protocol. The ‘non music group’ received standardised analgesia protocol only. Respiratory and haemodynamic parameters were assessed during perioperative period. Postoperative pain was assessed using Visual Analogue Scale (VAS) scores in addition to comparisons of time for rescue analgesia between study and control groups. Statistical differences were derived using Mann-Whitney U-test. Results: Demographic characteristics of women were statistically insignificant. Significant differences were observed in Heart Rate (HR) at 30, 45 and 60 minutes Postanaesthesia Care Unit (PACU) (p-value 0.0278, 0.0151 and 0.02852, respectively) and Respiratory Rate (RR) at 60 minutes PACU (p-value 0.04884). This study found beneficial effect of music on pain as assessed by VAS in the postoperative period. Beneficial effect of music on pain observed in study group vs. controls at 1 hour (0.64 vs. 1.51), 2 hours (1.88 vs. 2.76) and 3 hours (3.07 vs. 3.47) of PACU stay (p-value 0.0003, 0.00152 and 0.02444, respectively). The study also detected a significant delay (29 minutes) in time for first rescue analgesia in music group (p-value 0.01732). Conclusion: Music therapy/medicine during elective LSCS delivery is beneficial on HR, respiratory rate, VAS and time to rescue analgesia.

Comparison of the Effect of Preoperative Anxiety on the Oxidative Stress Biomarkers in Umbilical Cord Blood After Vaginal and Cesarean Delivery

AbstractObjective This study examined the independent effect of delivery type and preoperative anxiety on placenta oxidative stress response.Materials and methods A total of 126 patients who gave birth were divided into two groups according to delivery type: vaginal delivery group (VD) (n=56) and elective cesarean section delivery group (CS) (n=70). The preoperative anxiety levels of pregnant women who came to the delivery room were evaluated with the State Anxiety Inventory (SAI) scale. Malonyldialdehyde (MDA), superoxide dismutase (SOD), total antioxidative status (TAS), total oxidative state (TOS), and oxidative stress index (OSI) levels in umbilical cord blood were compared according to preoperative anxiety level and type of delivery.Results The CS group had significantly higher MDA (0.88±0.15 versus 0.79±0.09, p=0.001) and TOS (8.37±1.81 versus 7.53±0.77, p=0.019) values compared to the VD group. TAS levels did not differ significantly between the groups. SOD levels were higher in VD group compared to CS group (p=0.049). When the factors affecting oxidative stress biomarkers are analyzed by regression analysis, factors affecting MDA were found to be SAI score (Beta=0.358), CS (Beta=0.212), the factor affecting SOD was found to be VD (Beta=0.318), the factors affecting TOS were found to be SAI score (Beta=0.317) and CS (Beta=0.183).Conclusıon Oxidative stress biomarker levels in umbilical cord blood and preoperative anxiety levels were higher in patients who underwent elective caesarean section than those who delivered vaginally. Preoperative anxiety was the factor that increased oxidative stress biomarkers of umbilical cord blood the most.

Pelvic floor function and morphological abnormalities in primiparas with postpartum symptomatic stress urinary incontinence based on the type of delivery: a 1:1 matched case-control study.

The aim of this study was to assess pelvic floor muscle (PFM) morphology and function in primiparas with postpartum symptomatic SUI after different types of delivery. Retrospective analyses were carried out with individuals with postpartum symptomatic stress urinary incontinence (SUI). Among the women screened in our center from January 2018 to December 2019, participants were divided into elective cesarean section (eCS) and spontaneous vaginal delivery (sVD) groups, while being matched 1:1 on age (±5years), body mass index (BMI; ±0.5kg/m2), neonatal birth weight (±300g), gestational age (±1week), degree of pelvic organ prolapse quantification (POP-Q), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) degree, Incontinence Impact Questionnaire short form (IIQ-7) score, and postpartum days (±10days); all participants had no sphincter defects or levator ani muscle avulsion. The bioelectrical activity of the PFM was collected using an endovaginal electrode with the Glazer protocol. For the assessment of PFM function, PFM morphometry was evaluated with 3D/4D transperineal ultrasound. A total of 78 matched pairs were recruited based on delivery mode. Regarding functional differences, both fast-twitch and slow-twitch fiber strengths in the eCS group were significantly higher than those in the sVD group, but PFMs were more hyperactive in the eCS group. Regarding morphometric differences, the retrovesical angle (RVA) and bladder neck position were not significantly different in the resting state between the two groups, nor was the RVA during the Valsalva maneuver (eCS group: 130.68 ± 17.08°, sVD group: 136.33 ± 23.93°), p >0.05. There were differences in bladder neck descent (BND; eCS group: 16.51 ± 7.55mm, sVD group: 23.92 ± 8.47mm) and urethral rotation angle (URA; eCS group: 37.53 ± 26.05°, sVD group: 59.94 ± 25.87°), all p < 0.05. BND showed a negative correlation with PFM strength, p < 0.05. URAs and RVAs showed no correlation with PFM strength, p > 0.05. Pelvic floor muscle function disorder, hyperactivity, and instability also occurred after eCS, which resulted in postpartum symptomatic SUI. The effects of sVD compared with eCS on abnormalities in the lower urinary tract were related to bladder neck and urethral hyperactivity, without an RVA increase.

Correlation of perilipin 2 and lipid metabolism in elective cesarean section and vaginal delivery: a prospective study with oxidative and apoptotic pathways.

Vaginal delivery (VD) and elective cesarean (CS) delivery modes may cause significant differences in maternal and fetal metabolism. In this study, we aimed to investigate changes in lipid metabolism, oxidative and apoptotic signaling pathways during VD and CS in maternal and cord blood and placenta tissue. The study included two groups of participants delivered via 90 CS and 90 VD. Maternal and cord blood samples were collected from the participants. In addition, placenta samples were also taken after delivery. Total oxidant (TOS), malondialdehyde (MDA), total antioxidant (TAS), glutathione (GSH), cleaved caspase 3 (CASP3) and perilipin 2 (PLIN2) levels were measured to determine oxidative stress, antioxidant levels and apoptosis status in the VD and CS groups. Besides, PLIN2 mRNA expressions in placental specimens were analyzed. We found no statistically significant difference in maternal age, body mass index, gestational age, birth weight and Apgar scores in both groups (P > 0.05). The increase in MDA, TOS, GSH and TAS levels was higher in the VD group compared to the CS group (P < 0.05). Similarly, PLIN2 levels and lipid profiles showed an increase in the VD group (P < 0.05 vs CS group). Likewise, PLIN2 expression enhanced in the VD group (P < 0.05 vs CS group). However, CASP3 activity reduced in maternal and cord blood in the VD group compared to the CS group. Our results support that the delivery mode may cause differences in lipid profile, oxidative and apoptotic status by affecting PLIN2 levels in both maternal and cord blood and placenta tissue.

Are there adverse outcomes for child health and development following caesarean section delivery? Can we justify using elective caesarean section to prevent obstetric pelvic floor damage?

Elective pre-labour Caesarean section (CS) delivery is widely regarded as the panacea for all pelvic floor dysfunction despite substantial epidemiological evidence that it is only partially protective. To demand a CS is also considered a right for the well-counselled patient, even without an elevated risk of incontinence or prolapse. In recent years there has been increasing data on possible adverse health outcomes for children delivered by CS over those delivered vaginally. This includes respiratory illness, atopic conditions, obesity, diabetes and other severe auto-immune diseases. Concern has also been raised over possible impacts on cognitive and neuropsychological development in these children. Often the response has been to dismiss these outcomes as a result of the indication for the CS birth such as antenatal compromise or maternal disease. However the marked increase in non-medical Caesarean delivery throughout many regions of the world has allowed us to better distinguish these contributing factors. This narrative review looks at some of the more recent evidence on adverse health and developmental outcomes associated with CS, particularly pre-labour CS and the implications for the long term health of our society. Epidemiological studies and animal research indicate an increased risk of negative impacts on child physical health and neuro-cognitive development aftercaesarean section delivery, particularly pre-labour Caesarean section, compared with vaginal delivery. This elevated risk persists after correction forobstetric and maternal factors. Caesarean section delivery can result in adverse outcomes for infant, maternal and societal wellbeing. Elective Caesarean section, purely to potentiallyminimise pelvic floor dysfunction, cannot be justified.

Global Changes of 5-mC/5h-mC Ratio and Methylation of Adiponectin and Leptin Gene in Placenta Depending on Mode of Delivery.

It was suggested that the epigenetic alterations of the placenta are associated with obesity, as well as the delivery mode. This study aimed to assess the effect of maternal outcome and delivery procedure on global placental DNA methylation status, as well as selected 5’-Cytosine-phosphate-Guanine-3’ (CpG) sites in ADIPOQ and LEP genes. Global DNA methylation profile in the placenta was assessed using the 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) ratio evaluated with the ELISA, followed by target gene methylation patterns at selected gene regions which were determined using methylation-specific qPCR in 70 placentas from healthy, pregnant women with single pregnancy. We found no statistically significant differences in 5-mC/5-hmC ratio between intrapartum cesarean sections (CS) and vaginal deliveries (p = 0.214), as well as between elective cesarean sections and vaginal deliveries (p = 0.221). In intrapartum cesarean sections, the ADIPOQ demethylation index was significantly higher (the average: 1.75) compared to elective cesarean section (the average: 1.23, p = 0.010) and vaginal deliveries (the average: 1.23, p = 0.011). The LEP demethylation index did not significantly differ among elective CS, intrapartum CS, and vaginal delivery groups. The demethylation index of ADIPOQ correlated negatively with LEP in the placenta in the vaginal delivery group (r = −0.456, p = 0.017), but not with the global methylation. The methylation of a singular locus might be different depending on the mode of delivery and uterine contractions. Further studies should be conducted with locus-specific analysis of the whole genome to detect the methylation index of specific genes involved in metabolism.

Insulin Difference of Boys and Girls at Birth

Different opinions exist whether girls show higher insulin levels than boys at birth. Insulin values of 863 consecutively born babies whose mothers had no screening for gestational diabetes may provide clarification. Cord serum, measured with a commercially available insulin assay, is therefore retrospectively analyzed for insulin differences in boys and girls. Girls show higher insulin values than boys (♀6.0/♂5.2 µU/ml). Insulin-sex-difference amounts to 0.8 µU/ml [95% CI 0.3 to 1.3]; p-value 0.003. It is also found in AGA babies, in children of multiparous women, after elective caesarean section and spontaneous vaginal delivery (0.8/1.2/1.7/0.9 µU/ml; p-values 0.003/0.001/0.025/0.006). Girls of multiparous women with macrosomia (LGA/≥ 4000 g) show the highest values of insulin (13.8/13.8 µU/ml) and of insulin-sex-difference (5.5/5.6 µU/ml, p-value 0.001/0.001). This insulin difference can be seen in firstborn babies weighing less than 3640 g, but ≥ 4060 g an inverse insulin sex difference (-5.4 µU/ml; p-value 0.023) with higher insulin values in boys exists (11.3 µU/ml). Children with hyperinsulinaemia (≥20 µU/ml) (17♀, 11♂) show no insulin difference, girls weigh more than boys (154 g, p-value 0.463) and later born babies more (695 g, p-value 0.0001) than firstborns. Higher insulin values of girls have been confirmed. An as yet unknown inverse insulin difference with higher insulin values of firstborn boys with macrosomia has been proved.

Risk factors for excessive gestational weight gain in a UK population: a biopsychosocial model approach

BackgroundGestational weight gain (GWG) can have implications for the health of both mother and child. However, the contributing factors remain unclear. Despite the advantages of using a biopsychosocial approach, this approach has not been applied to study GWG in the UK. This study aimed to investigate the risk factors of excessive GWG in a UK population, employing a biopsychosocial model.MethodsThis study utilised data from the longitudinal Grown in Wales (GiW) cohort, which recruited women in late pregnancy in South Wales. Specifically, data was collected from midwife recorded notes and an extensive questionnaire completed prior to an elective caesarean section (ELCS) delivery. GWG was categorised according to Institute of Medicine (IOM) guidelines. The analysis was undertaken for 275 participants.ResultsIn this population 56.0% of women had excessive GWG. Increased prenatal depression symptoms (Exp(B)=1.10, p=.019) and an overweight (Exp(B)=4.16, p<.001) or obese (Exp(B)=4.20, p=.010) pre-pregnancy BMI, consuming alcohol in pregnancy (Exp(B)=.37, p=.005) and an income of less than £18,000 (Exp(B)=.24, p=.043) and £25–43,000 (Exp(B)=.25, p=.002) were associated with excessive GWG.ConclusionGWG is complex and influenced by a range of biopsychosocial factors, with the high prevalence of excessive weight gain in this population a cause for concern. Women in the UK may benefit from a revised approach toward GWG within the National Health Service (NHS), such as tracking weight gain throughout pregnancy. Additionally, this research provides evidence for potential targets for future interventions, and potentially at-risk populations to target, to improve GWG outcomes.

Intravenous Use of Metoclopramide and Sustained Hypotension: A Case Report

Introduction: Transient hypotension has been commonly associated with metoclopramide hydrochloride, particularly with intravenous use. However, the risk of sustained hypotension that lasts for hours has not been previously associated with metoclopramide, except for one published case report. This case report is aimed at documenting the second case of unusual and serious sustained hypotension that lasted for more than six hours following rapid intravenous use of metoclopramide prescribed for the prevention of cesarean section delivery related intra/postoperative nausea and vomiting. Case Report: A 33-year-old gravida III and para II woman was admitted to a hospital for an elective cesarean section delivery with normal baseline blood pressure. Following metoclopramide 10 mg intravenous push administration, over 5-10 seconds, the mother encountered sustained hypotension (60/40 mmHg) that lasted for 120 minutes. After resuscitation, her blood pressure raised to 105/60 mmHg. However, after spinal anesthesia with bupivacaine hydrochloride, her diastolic arterial blood pressure dropped back again to 40 mmHg which persisted for about six hours post-operation. Upon investigation, the sustained hypotension was found to be probably related to inappropriate and rapid administration of intravenous bolus dose of metoclopramide hydrochloride that could have been prevented since it should be administered slowly over at least three minutes. Conclusion: The risk of metoclopramide-induced hypotension should not be underestimated as it sometimes might be much severe than the risk of nausea and vomiting that warrants immediate attention from healthcare professionals and program managers.

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

Background: Cesarean section is a worldwide common surgery that requires anesthetic techniques. Many local anesthetics are being now used, but are associated with, dose- dependent and at different level, some side effects including toxicity. Hypotension was described as the first and threat side effect associated to neuraxial techniques. Despite many preventive strategies, it continues to challenge anesthesia providers around the world. Lidocaine was found to be less toxic compared with others commonly used and has been recommended for anesthesia procedures requiring large dose of local anesthetic including epidural anesthesia. The main purpose of this research was to determine the incidence of hypotension and identify the possible risk factors associated with it and thus, assess the efficacy and safety when lidocaine is applied together with epinephrine, in epidural anesthesia for elective cesarean delivery. Materials and methods: This retrospective observational institutional-based study, recruited 612 parturients who underwent elective cesarean section under epidural anesthesia with 2% lidocaine and 1/200000 epinephrine, at 1st affiliated hospital of Chongqing Medical University in 2019. Exclusion criteria included any contraindication to elective cesarean section delivery, general anesthesia, baseline systolic blood pressure &lt; 100mmh and &gt; 140 mm hg, gestational age &lt; 37 weeks and &gt; 42 weeks etc. SPSS 26.0 version and different appropriated tests were used for statistical analysis. P value &lt; 0.05 was accepted as statistically significant. Results: The hypotension incidence was 13.2%, and identified factors associated with it were Baseline Systolic Blood Pressure &lt; 120mmhg, gestational age &lt; 40 weeks, maternal body weight ≤ 60 kg and duration of cesarean delivery (surgery) &gt; 45 minutes. Conclusion: The variables in correlation with increased hypotension rate are baseline systolic blood pressure, gestational age, maternal weight, and surgery duration. 2%Lidocaine with epinephrine as adjuvant presented best outcomes towards both mother and neonates, was therefore efficacy and safe under the anesthetic conditions of our study.

Oral Gabapentin versus Pregabalin for Postoperative Pain Relief in Elective Cesarean Section Patients under Spinal Anesthesia

Background: Pain after Cesarean delivery is the main postoperative complain in parturients, pregabalin and gabapentin have been shown to decrease acute postoperative pain in parturient. Objective: The aim of the study was to compare gabapentin and pregabalin as oral premedication in patients for elective cesarean section under spinal anesthesia for postoperative pain relief and the need to rescue analgesia. Methods: This study was carried out at Obstetric Operating Rooms, Zagazig University Surgical Hospitals. The study included 54 consenting women aging 20–40 yrs old with uncomplicated pregnancies that were scheduled to undergo elective Cesarean section delivery under spinal anesthesia. They were randomly allocated into three equal groups. Group (P) received 300 mg pregabalin, group (G) received 900 mg gabapentin, and control group (C). The study medication given orally one hour before the anticipated time of the surgical incision, and data measured included visual analogue scale (VAS), the total doses of analgesia, the incidence of post-operative nausea and vomiting (PONV) and the level of sedation. Results: The VAS was comparatively low in patients of group P as compared to G and C groups (P value < 0.05). Total analgesic requirement of pethidine in first 24 h was significantly lower in groups P as compared to groups G & C (P value < 0.001). We found that there was statistically significant increase in the sedation scores of the patients in P group as compared to G & C groups. Conclusion: Pregabalin 300 mg was more effective than gabapentin300 mg in reducing post Cesarean section pain, opioid consumption, nausea, and vomiting.