Elective Caesarean Section Research Articles

Effect of Delayed Cord Clamping on Breastfeeding Behaviors During the First Breastfeed: A Randomized Controlled Study.

Objective: Delayed cord clamping (DCC) may increase the success of breastfeeding by improving neurological and cardiovascular function in neonates. In this study, we investigated the impact of DCC on breastfeeding behaviors, neonatal activity status, and maternal satisfaction during the first breastfeeding. Methods: This randomized controlled study was conducted in a tertiary hospital in Turkey with 100 term infants delivered by elective cesarean section with spinal anesthesia. The participants were randomly assigned to the early cord clamping (ECC) group or DCC group. The Infant Breastfeeding Assessment Tool (IBFAT) was used to assess infant alertness, breastfeeding behaviors, and maternal satisfaction with breastfeeding within the first 2 hours of life. Results: Scores on the IBFAT were significantly higher in the DCC group compared with the ECC group (p = 0.02). Maternal satisfaction with breastfeeding did not differ between the groups (p = 0.3). Infant alertness tended to be better in the DCC group, but the difference was not statistically significant (p = 0.08). Conclusion: The results of this study indicated that DCC was associated with more favorable breastfeeding behaviors compared with ECC.

Comparison of 2% lidocaine infiltration and eutectic mixture of local anesthetics cream application before spinal needle insertion for pain reduction and assessment of maternal satisfaction levels in women undergoing cesarean section at a tertiary care se.

This study aimed to compare two analgesic pretreatment techniques for assessing pain reduction before spinal needle insertion and the subsequent patient satisfaction levels in pregnant female patients undergoing cesarean sections. Sixty pregnant female patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups. The Lidocaine group received local skin infiltration with 2% lidocaine pretreatment before spinal needle introducer insertion, whereas the eutectic mixture of local anesthetics (EMLA) group received EMLA (lidocaine 2.5% and prilocaine 2.5%) cream pretreatment for at least 30 min before spinal needle introducer insertion. Subjective and objective pain scores, procedure duration, number of attempts, maternal satisfaction, and decisions regarding future numbing procedures and regional anesthesia were assessed. The demographic characteristics of the patients were similar between groups. The mean visual analogue scale pain score was significantly lower in the EMLA group compared to the lidocaine group (P < 0.05). Additionally, the objective pain score was significantly lower in the EMLA group (P < 0.05). The duration of spinal block placement was significantly longer in the lidocaine group than in the EMLA group (P < 0.05). The number of attempts to perform the spinal block placement was similar in both groups. However, women in the EMLA group expressed greater overall satisfaction than those in the lidocaine group (76.7% vs. 20.0%, P < 0.05). Analgesic pretreatment with EMLA cream is superior to local skin infiltration with lidocaine in pregnant patients undergoing elective cesarean section under spinal anesthesia.

True Umbilical Cord Knot without Adverse Perinatal Outcome: A Brief Review

True umbilical cord knots are not a common occurrence, however when they do present, it is ironic that despite having availability of antenatal ultrasound, they are not diagnosed antenatally most of the time, due to cord length and loops of cord making visibility poor. However with 4 dimension ultrasound and serial doppler study there can be better pick up rate. There is controversy around risks with true knots and cases of meconium stained liquor, low Apgar scores, hypoxic ischemic encephalopathy, other neonatal complications necessitating neonatal intensive care unit admission and fetal still birth have been reported. The umbilical cord attaches to the placenta and transfers blood, oxygen and nutrition to the fetus. A true umbilical cord knot happens when the cord loops over itself with fetal movements, a tight knot can impair the fetal circulation and lead to fetal hypoxia. In such a situation, fetal surveillance shows sub optimal cardiotocograph tracing, and when the patient is taken for emergency cesarian section, a tight umbilical cord knot is seen, which was causing fetal hypoxia. Certain conditions are more predisposed for true knots such as polyhydramnios, longer length of the cord, smaller than average size fetus, monoamniotic twins and multiparity. Our case report presents a true umbilical cord at an elective cesarian section in a primigravida. The patient had an uneventful pregnancy with regular fetal surveillance through ultrasound and doppler scans and fetal heart tracing. An elective cesarian section was performed at 38 weeks at patient’s request and at the time a nuchal cord and true umbilical cord was noted.

6301668 Is TIVA in obstetrics an essential skill? An elective caesarean section in a patient with Multicore Myopathy Disease (MmD)

6301668 Is TIVA in obstetrics an essential skill? An elective caesarean section in a patient with Multicore Myopathy Disease (MmD)

6301031 The impact of constipation after elective caesarean section

6301031 The impact of constipation after elective caesarean section

6277872 Prophylactic Ondansetron Administration for Nausea Management in Elective Caesarean Sections: A Paradigm Shift in Enhanced Recovery Guidelines

6277872 Prophylactic Ondansetron Administration for Nausea Management in Elective Caesarean Sections: A Paradigm Shift in Enhanced Recovery Guidelines

6290035 An approach to prevention and treatment of hypotension in elective caesarean sections under spinal anaesthesia: A survey from a developing nation

6290035 An approach to prevention and treatment of hypotension in elective caesarean sections under spinal anaesthesia: A survey from a developing nation

Role of prophylactic tranexamic acid in reducing blood loss during cesarean section: A double-blind placebo-controlled randomized controlled trial.

Postpartum hemorrhage (PPH) is defined by the World Health Organization as blood loss of ≥500 mL within 24 h of delivery. Globally, hemorrhage accounts for 27.1% of maternal deaths, making it the leading direct cause of maternal death. PPH has been identified in more than two-thirds of reported hemorrhage-related deaths, causing 38% of maternal deaths in India. Tranexamic acid, an antifibrinolytic, has been used to control bleeding after PPH is identified. Antenatal women admitted for elective cesarean section were randomized into two arms: the case group (received one gram of tranexamic acid 20 min prior to skin incision) and the control group (received a placebo), each group consisting of 36 participants. Clinical Trials Registry - India (CTRI) registration number - CTRI/2021/02/031579. The mean (±standard deviation [SD]) intraoperative blood loss in the case group was 241.25 (±67.83) mL, and in the control group, it was 344.92 (±146.67) mL (P = 0.001), while postoperative blood loss did not differ significantly between the groups (P = 0.1470). In terms of the difference in hemoglobin, there was a significant difference between the two groups (P = 0.001). No significant maternal or neonatal side effects were found. Preoperative tranexamic acid, when given in elective cesarean section, significantly reduces intraoperative blood loss.

Trial of labour following two previous caesarean sections – A UK cohort study

ObjectivesTo assess the (i) predictors of and associated rates of success and; (ii) maternal and perinatal outcomes of women undergoing trial of labour after two previous caesarean sections (TOLA2C). Study designThis retrospective cohort study collected data from two regional obstetric centres with 12,000 deliveries per annum collectively. The population included singleton pregnancies undergoing (i) TOLA2C, (ii) elective repeat caesarean section following two caesarean sections (ERCS) and (iii) trial of labour after one caesarean section (TOLA1C). Data was collected electronically from 2013 to 2021. Statistical analysis included Fisher exact and Kruskal-Wallis test to compare unpaired samples alongside univariate and multivariable logistic regression. The primary outcome measure was maternal and perinatal outcome. ResultsThe three groups included; n = 146 TOLA2C, n = 206 ERCS and n = 99 TOLA1C. TOLA2C had a success rate of 65 % compared to 74 % for TOLA1C (p = 0.16). The optimal predictor of successful TOLA2C was previous successful TOLA1C OR 8.65 (95 % CI 2.75–38.41). TOLA2C was associated with greater risk of endometritis and/or sepsis postnatally compared to the other two groups [10.3 % (n = 15) versus 0.5 % (n = 1) and 3 % (n = 3) for ERCS and TOLA1C respectively p < 0.01]. It was also associated with longer maternal hospital stay [2.4 days (+/-1.8) versus 1.8 (+/-0.8) and 1.8 (+/-1.7) p < 0.01], a greater proportion of neonates with Apgar scores less than 7 (p=<0.01) and higher rates of neonatal unit admission [14 % (n = 20) versus 5 % (n = 11) versus 4 % (n = 4) (p=<0.01)]. ConclusionWomen considering trial of labour following two caesarean sections should be counselled regarding the potential increased risk of endometritis, sepsis and adverse neonatal outcome.

A Survey on Comparison Between Blood Loss During Cesarean Section with Use of Calculation Method and Visual Estimation

Abstract Context: Cesarean section (CS) is a life-saving alternative to vaginal delivery in several maternity units globally and is a risk factor for postpartum hemorrhage (PPH). Its rate has increased globally with wide variability amongst and within various countries. Aim: The aim of the study was to compare blood loss with the calculation method and visual estimation during a CS. Materials and Method: A randomized, double-blind, two-center study of 130 consenting pregnant women who were scheduled for either elective or emergency Lower segment caesarean section (LSCS) at the Institute of Maternal and Child Health, Lagos State University Teaching Hospital (LASUTH) and the Federal Medical Center, Ebute-Metta (FMCEB), Lagos. Data Analysis: Data were imported into Stata version 17 (StataCorp, USA) software for analysis. Student’s t-test or Mann-Whitney U test was utilized to compare continuous variables such as age and estimated blood loss among the tranexamic and placebo groups. Result: The mean age of the participants was 30.8 ± 4.76 years, and about 16% of the participants were nulliparous. There was a statistically significant difference in the calculated estimated blood loss between the intervention and the placebo arm of the study (P value &lt; 0.0001). The mean postoperative blood loss was about 347 ml higher among the placebo group as compared to the intervention (tranexamic acid) group (835.61 ± 400.03 ml vs. 488.12 ± 289.90 ml). Conclusion: Prophylactic use of intravenous tranexamic acid as an adjunct to uterotonic at CS is efficacious in the optimal estimation of blood loss and prevention of post-partum hemorrhage.

6301070 What Women Want (To Know) – Exploring women's information needs prior to elective caesarean section

6301070 What Women Want (To Know) – Exploring women's information needs prior to elective caesarean section

6299074 Regional survey of anaesthetic technique for a parturient with high body mass index undergoing elective Caesarean section

6299074 Regional survey of anaesthetic technique for a parturient with high body mass index undergoing elective Caesarean section

VALIDATION OF THE SMARTPHONE BLOOD PRESSURE MEASUREMENT SOLUTION OPTIBP™ TO TRACK BLOOD PRESSURE CHANGES IN PREGNANT WOMEN

Objective: Hypertensive disorders present significant morbidity and mortality during pregnancy. While ambulatory blood pressure measurement remains the standard of care for normotensive women, self-monitoring at home is increasingly prevalent. The widespread use of smartphones worldwide has sparked interest in mobile applications that leverage the built-in hardware for blood pressure estimation, yet few trials have assessed their accuracy. Design and method: This prospective, longitudinal and monocentric study evaluated the accuracy of the OptiBP algorithm against standard oscillometric blood pressure measurements in a sample of pregnant women. Patients scheduled for elective caesarean sections were enrolled during the preoperative anesthesia consultations. Paired blood pressure measurements using OptiBP and the reference method were obtained at multiple time-points in late pregnancy and the post-partum period. Agreement between methods was assessed using the AAMI/ESH/ISO 81060-2:2018 standard thresholds of 5±8 mmHg for mean ± standard deviation of the error (criterion 1) and patient-specific standard deviation of the mean error (criterion 2) and represented graphically by Bland-Altman scatterplots. Results: Twenty-four women were enrolled of which 15 completed the protocol, yielding 166 total valid measurement pairs. Mean and standard deviation of the error were -0.74 ± 8.38 and 0.99±6.88, and the patient-specific standard deviation of the mean error was 5.84 and 3.36, for SBP and DBP respectively. Conclusions: Compared with blood pressure measure with an oscillometric device, OptiBP's blood pressure estimates meet the AAMI/ESH/ISO 81060-2:2018 criteria for DBP.

Assessing the Premedication Properties of Sublingual Melatonin in Young Women Undergoing Cesarean Section With Spinal Anesthesia: A Double-Blind Randomized Study.

Preoperative anxiety can negatively impact patient outcomes by influencing the intraoperative requirements for anesthetics and analgesics, increasing postoperative pain intensity, and augmenting the need for analgesia. Moreover, it may contribute to higher rates of postoperative morbidity and mortality following certain types of surgery. This study investigates the anxiolytic and sedative properties of sublingual melatonin as a premedication agent in young females undergoing cesarean section under spinal anesthesia. A double-blind, randomized, placebo-controlled trial was conducted in Nasiriyah, Iraq. Eighty females were included, 40 in each group, based on specific inclusion and exclusion criteria. Premedication was administered in the morning, 60 minutes before the procedure. In the melatonin group (M), patients received 10 mg of sublingual melatonin, while the placebo group (P) received placebo premedication. Anxiety and sedation levels were evaluated three times: before taking premedication, five minutes before the insertion of the spinal needle, and one hour postoperatively, using the visual analog scale and Richmond Sedation Scale. The results show a highly significant P-value regarding anxiety levels between the M Group and P Group (p-value < 0.001). There was a significant difference in the median sedation scores between the studied groups at pre-spinal insertion and postoperatively (p-value < 0.001). The mean heart rate in the M Group was significantly lower than in the P Group (p-value = 0.0019). Significant differences were noted in systolic and diastolic blood pressures between the two groups, measured five minutes before and after spinal needle insertion (p-value < 0.001). These findings contribute to understanding the impact of sublingual melatonin as an anxiolytic and sedative premedication agent on patients undergoing elective cesarean sections under spinal anesthesia. Further research is warranted to fully elucidate the benefits and implications of melatonin administration in such procedures.

6301642 A needle free induction: Managing a parturient with severe treatment-resistant needle phobia, presenting for elective caesarean section

6301642 A needle free induction: Managing a parturient with severe treatment-resistant needle phobia, presenting for elective caesarean section

The role of corticosteroids in prevention of neonatal respiratory morbidity in term elective cesarean section: A prospective: observation study

The role of corticosteroids in prevention of neonatal respiratory morbidity in term elective cesarean section: A prospective: observation study

6289348 A national survey of attitudes towards ‘Sip ’til Send’ protocols for women undergoing elective caesarean section under planned regional anaesthesia

6289348 A national survey of attitudes towards ‘Sip ’til Send’ protocols for women undergoing elective caesarean section under planned regional anaesthesia

Comparison of the Adjunctive Effect of Tranexamic Acid and Infusion Oxytocin on Blood Loss at Caesarean Section - A Randomised Study

Background: Postpartum haemorrhage is a major complication at caesarean section. Tranexamic acid and oxytocin infusion have been used for prophylaxis. Aim: To compare the effectiveness of prophylactic adjunctive use of Tranexamic acid and oxytocin infusion at caesarean section to reduce blood loss. Method: A randomised study at ABUTH, Zaria, in which 144 women, scheduled for elective or emergency caesarean section at term, were sequentially randomised into two groups of 72 each. The Tranexamic acid group received 1g intravenous and 500ml of Normal saline as placebo while the oxytocin group received placebo and 500ml of Normal saline containing 20IU of oxytocin after delivery of the neonate. Both adjunctive groups received 10IU Oxytocin as part of AMTSL. Trial registry: PACTR 202004568331645. Ethical approval: ABUTHZ/HREC/D37/2018. Result: There was no significant difference in parity, gestational age and indication for caesarean section in both groups p&lt;0.287, 0.270 and 0.095 respectively. There was no significant difference in primary outcome with mean blood loss 561.06 ± 209.23ml versus 567.78 ± 205.91ml in the Tranexamic acid and oxytocin group respectively, p&lt;0.847. Need for additional uterotonic agent and side effect profile were significantly reduced in the Tranexamic acid group. There was no significant difference in need for blood transfusion and haemodynamic status of parturient in both groups. There was no significant difference in mean blood loss at emergency versus elective caeserean section, 565.83± 205.51ml versus 567.97± 217.42ml respectively, p&lt;0.921.Blood loss in those with 1 previous CS was comparable in both groups 537.75± 209.69ml versus 522.05± 176.43ml respectively, p&lt;0.374, however, for those with 2 or more CS, while there was a clinical (reduction) difference of 80ml in the Tranexamic acid group, it was not statistically significant. 594.55± 0.91ml versus 674.06± 1.99ml respectively, p&lt;0.476. Conclusion: There is comparative adjunctive efficacy of Tranexamic acid and oxytocin infusion at caesarean section. Keywords: Caesarean delivery, Oxytocin infusion, Tranexamic acid, Postpartum haemorrhage

Hemodynamics following Prophylactic Phenylephrine Infusion in patients undergoing Cesarean Section under Spinal Anesthesia

Introduction: Phenylephrine is considered the vasopressor of choice in hypotension associated with obstetric spinal anesthesia. But the dose and mode of administration that is effective yet safe in mother as well as fetus remains controversial. We studied the hemodynamics of parturients who received prophylactic infusion of phenylephrine 50µg/min following spinal anesthesia. Methods: Patients posted for elective cesarean section received a prophylactic phenylephrine infusion of 50µg/min immediately after spinal anesthesia for 30 minutes. Parturients were also co-loaded with lactated Ringer’s solution 1litre. Blood pressure and heart rate was monitored at an interval of 3min initially and after the delivery of baby interval was increased to 5min. Episodes of hypotension, reactive hypertension and bradycardia in mother were recorded. Neonatal APGAR score at 1 and 5min was also recorded. Results: One hundred and forty parturients were included in the study. Twenty patients (14.28%) developed hypotension. Out of 20 patients who developed hypotension, 3 patients (15%) had a single episode, 11 patients (55%) had 2 episodes and 6 patients (30%) had 3 episodes of hypotension. Three patients (2.14%) had reactive hypertension. None of the patients had bradycardia. There was no episode of hypotension induced nausea vomiting. Mean APGAR score at 1min and 5min was 8 and 9 respectively. Conclusion: The prevalence of hypotension with prophylactic phenylephrine infusion was low. We found minimal episodes of reactive hypertension, no episodes of bradycardia and no adverse effect on fetus. It can be regarded a safe means to minimize hypotension in obstetric spinal anesthesia.

Changes in the Cesarean Section Rate Following the Implementation of Guidelines Concerning Cesarean Section on Maternal Request

Traditionally, cesarean delivery on maternal request (CDMR) has been defined as a cesarean section performed at the request of the pregnant woman rather than for medical necessity. It was thought to provide minimal benefits to both the pregnant woman and the fetus and was seen as an inefficient use of healthcare resources. However, the recent rise in the choice and use of cesarean sections is influenced not only by obstetrical factors but also by psychological and socio-cultural factors of the mother, the desire among medical providers to avoid uncertainty, and the pursuit of time and economic convenience, among other complex factors. In particular, there is a growing trend among medical professionals who prefer cesarean sections to avoid costly medical lawsuits. However, if a pregnant woman opts for an elective cesarean section due to the convenience of medical professionals or fear of litigation, even if she prefers a vaginal delivery, it would be considered an unnecessary cesarean section. When a pregnant woman desires CDMR, medical professionals should thoroughly explain the advantages and disadvantages of both attempting vaginal delivery and CDMR so that she can make an informed decision. Nevertheless, if a pregnant woman still chooses a cesarean section after being fully informed, her autonomy should be respected. In such cases, it is recommended that medical practitioners use a minimally invasive surgical method, along with appropriate preoperative and postoperative care, to reduce the morbidity of both the mother and infant and to support a rapid recovery.