Elective Caesarean Section Research Articles

Effect of intraoperative dexmedetomidine on recovery of gastrointestinal function after caesarean section undergoing spinal and epidural anesthesia: A randomized, double blind, placebo-controlled clinical trial

ObjectiveGastrointestinal dysfunction after cesarean section negatively affects postoperative recovery. Dexmedetomidine has been shown to improve postoperative gastrointestinal function in patients undergoing lumbar spinal fusion surgery and laparoscopic gastrectomy, but its role in cesarean section has not been fully elucidated. The study aimed to investigate the effect of dexmedetomidine on gastrointestinal function after cesarean section. Study Design220 pregnant women who underwent elective cesarean section were randomized into group D and group S. Group D patients received a loading dose of 0.5 μg/kg of dexmedetomidine for 10 mins followed by a maintenance dose of 0.5 μg/kg/h intravenously immediately after the umbilical cord was cut intraoperatively, whereas the other group (group S) received an equivalent quantity of normal saline as loading and maintenance dose IV by infusion pump. The primary outcome was time to first flatus after surgery (hours). Secondary outcomes included time to first feces and first bowel sounds (hours), incidence rates of postoperative gastrointestinal complications, and the length of postoperative hospital stay (days). ResultsModified intention-to-treat analysis showed that patients in Group D had a significantly shorter time to first flatus (21 [16 to 28.25] vs. 25 [18 to 32.25] h; P = 0.014), time to first feces (45.5 [35.75 to 55.25] vs. 53 [40 to 60] h; P = 0.019), and time to first bowel sounds (P = 0.010), a lower incidence of abdominal distension (21[20.6 %] vs. 36[34.3 %], P = 0.027), shorter length of postoperative hospital stay (P = 0.010) compared to patients in Group S. ConclusionIntraoperative dexmedetomidine infusion reduces the time to first flatus, the incidence of abdominal distension, and shortens the length of hospital stay, promoting gastrointestinal function after cesarean section.

Exploring the Utility of remimazolam in cesarean sections under general anesthesia: A preliminary retrospective analysis and Implications for future study

BackgroundRemimazolam has recently been introduced as a maintenance agent for general anesthesia. However, the effect of remimazolam on peripartum prognosis has not been reported. Therefore, this study aimed to compare the effects of remimazolam and propofol for uterotonic drugs following cesarean section. MethodsThe electronic medical records of 51 adult women who underwent elective cesarean sections by single obstetrician under general anesthesia were collected. Participants were categorized into two groups: the propofol group and the remimazolam group. General anesthesia was maintained by continuous infusion of propofol or remimazolam after delivery. The number of uterotonic drugs administered during the cesarean section, the estimated blood loss (EBL), and length of hospital stay (LOS) after delivery were assessed. ResultsOf the 51 patients included in the study, 35 were in the propofol group and 16 in the remimazolam group. In the remimazolam group, five patients (31.3%, 5/16) received more uterotonics than the standard regimen. Conversely, in the propofol group, 19 patients (54.3%, 19/35) were injected with more uterotonics than the standard regimen. Logistic regression analysis showed that abnormal positioning of the placenta (P = 0.079) and not using remimazolam (P = 0.100) were the most relevant factors associated with the increased use of uterotonics. There was no significant difference in EBL between the two groups. The use of remimazolam was clinically relevant with a shorter LOS (P = 0.059). ConclusionsThe use of remimazolam as a maintenance agent did not result in significantly higher use of intrapartum uterotonics compared to the use of propofol. These results cannot exclude all adverse effects of remimazolam during cesarean delivery. Further randomized controlled trials must be conducted to obtain high-quality evidence.

Minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion: Randomized triple-blinded trial.

Vasopressor usage can affect the rostral spread of intrathecal drug and, hence, its requirement during cesarean delivery. Although a decreased spread is evidenced with phenylephrine, there is no data for norepinephrine usage. The present study aimed to evaluate the minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion. Patients scheduled for elective cesarean section under combined spinal-epidural block were randomized to receive intravenous infusion of norepinephrine (0.05 μg/kg/min) or normal saline (placebo), initiated immediately after intrathecal injection. Postspinal hypotension in either group (systolic arterial pressure ≤0.8 baseline) was treated with norepinephrine 4 μg rescue. Dose of intrathecal hyperbaric bupivacaine (0.5%) was decided for individual patients using up-and-down sequential allocation method. Primary outcome measure was the minimum effective dose of intrathecal hyperbaric bupivacaine (0.5%) defined as ED50, while secondary observations included spinal block characteristics and neonatal outcomes. Demographic parameters were statistically similar between both groups (P > 0.05). ED50 of intrathecal hyperbaric bupivacaine was 7.8 mg (95% confidence interval [CI]: 6.7-8.8) and 7.4 mg (95% CI: 6.1-8.7) for normal saline and norepinephrine group respectively (P = 0.810). Block characteristics were similar between both groups as was neonatal APGAR score, but umbilical artery base excess was greater for norepinephrine versus normal saline group (-4.4 ± 3.6 vs. -6.5 ± 2.4, P = 0.038). Use of prophylactic norepinephrine (0.05 μg/kg/min) during cesarean delivery does not require adjustment of intrathecal hyperbaric bupivacaine.

Birth after Caesarean Section: A Retrospective Audit of 10 Years of State-Wide Data

Rates of Caesarean Section (CS) have been increasing worldwide with varying rates of [5] percent in Sub-Saharan Africa to 43 percent in Latin America and the Caribbean [1]. In Australia too rates have increased from 32 percent in 2011 to 38 percent in 20212. Attempts have been made to seek ways at slowing the rise in rates of CS but with little success [3]. Women who have had a previous CS may elect to have a Elective Repeat CS (ERCS) or have an attempt at a Vaginal Birth (VBAC) in their subsequent pregnancy. A planned VBAC, considering the woman’s individual history and needs, is viewed as a safe option for many women with a single previous lower segment caesarean section [4]. Studies have shown that a Trial of Labour (TOL) ending in a VBAC is most favourable for the mother, newborn, and the health service [5,6]. Likelihood of success rates are reported to be between 60 and 80 percent [7]. A recent meta-analysis [8] noted successful vaginal birth rates of 74.3 percent if labour was spontaneous and 60.7 percent if induced. Achieving successful VBAC has also been reported to be less expensive and more effective than undergoing an ERCS [9,10]. There has recently been an international multi-centre trial that aims to increase the proportion of women having VBAC by increasing woman-centred care and facilitating women’s empowerment in their choice of birth in three countries – Germany, Ireland and Italy [1]. An attempt at vaginal birth is also supported by various colleges across countries [4,7,12]. One of the reasons for the preference of ERCS may be a concern of a failed trial at vaginal birth resulting in an emergency CS. In one study of 29 352 women who attempted a vaginal birth after CS compared to 169 377 women without previous CS, Odds Ratio (OR) for emergency CS was 3.65 (CI: 3.26-4.08) higher when compared to women without previous CS [13]. The scibasejournals.org aim of this retrospective study however was to use a large dataset with a specific objective to report on the success and failure rate and to identify any specific predictors of a successful or an unsuccessful vaginal birth in women who are pregnant after one previous CS.

Mode of Deliveries and Perinatal Outcomes in Prenatal COVID-19 Infections

Background:: The Royal Thai College of Obstetricians and Gynaecologists (RTCOG) clinical practice guideline (CPG) does not recommend elective Cesarean Section (CS) in case of prenatal maternal COVID-19 infections without obstetric indication. In Thailand, little is known about the mode of deliveries and perinatal outcomes in the mentioned group of patients. Therefore, this study aims to fill the gap in knowledge. Objective:: The objective of this study was to compare the mode of deliveries and perinatal outcomes between pregnant women, who were infected with COVID-19 and those who were without COVID- 19 infection. Methods:: The retrospective cohort study was based on data retrieved between February 1st and March 31st, 2023. The primary data was collected between July 1st, 2021, and October 31st, 2022. Women with COVID-19 infection were matched with the non-COVID-19 group in a 1:1 ratio by date at antenatal care (± 7 days) and their gestational age (± 1 week). Comparison of maternal and perinatal outcomes was made by using chi-squared, Fisher’s exact, relative risk, and t-test as appropriate in STATA software version 10.0. Results:: A total of 252 participants were recruited in this study, with 126 patients in each group. Demographic data between the two groups were comparable except for previous CS. The CS rates in the COVID-19 and non-COVID-19 groups were 46.03% and 30.95%, respectively, with p = 0.009. The significantly increased relative risk of CS in COVID-19 was 1.49 (95%CI, 1.07 to 2.05, p = 0.02). Eight women out of 126 had undergone CS with a “COVID-19 infection” indication (p = 0.007). The length of the maternal hospital stay was comparable. No serious maternal complications were observed. Perinatal outcomes were similar among the two groups, except for neonatal jaundice (p = 0.029), with no reports of COVID-19 infections in delivery-related personnel. Conclusion:: Prenatal COVID-19 infections lead to an increase in CS rate, while perinatal morbidities were comparable in both groups, with COVID-19 and non-COVID-19. The RTCOG’s CPG should be modified.

Predicting severe pain after cesarean section: prospective cohort study

BACKGROUND: Severe and unbearable pain after abdominal delivery is recorded in 20% of cases, indicating the limitations of the applied methods of postoperative pain relief and the need for a personalized approach. Tests assessing preoperative pain threshold and anxiety have the greatest sensitivity and specificity as predictors of intense postoperative pain. The informative value of these tests in the Russian obstetric population has not been assessed. OBJECTIVE: This study aimed to determine the optimal method for predicting severe pain after cesarean section (CS). MATERIALS AND METHODS: This prospective cohort study included 212 women who underwent elective CS under spinal anesthesia. The Hospital Anxiety and Depression Scale (HADS) anxiety rating scale, pressure algometry, and cutaneous infiltration anesthesia pain intensity assessment were used as predictors of high-intensity pain. Postoperative pain intensity was assessed using a 10-point Numeric Rating Scale (NRS). The maximum level of pain according to the central pain level at rest (NRSr) and during movement (NRSa) was recorded 24 hour postoperatively. The number of requests for “rescue analgesia” was recorded. The predictive value of the studied methods was determined based on ROC curve analysis. RESULTS: Median (interquartile range) NRSa was 5 [4–5]. Severe pain was recorded in 14% of the patients. The area under the ROC-curve (AUC), reflecting the relationship between severe postoperative pain and pressure-pain threshold, was 0.91±0.03 with 95% confidence interval (CI) of 0.84–0.97 (p 0.001). The relationship between pain intensity during infiltration anesthesia and postoperative pain severity had AUC=0.88 ± 0.04 with 95% CI of 0.81–0.96 (p 0.001). The HADS anxiety score demonstrated the lowest predictive ability (AUC=0.69±0.06; 95% CI, 0.81–0.96; p 0.001). When all three techniques were used together, the AUC was 0.924±0.024 with 95% CI 0.88–0.97 (p=0.001). CONCLUSION: Preoperative pressure-pain threshold and pain severity during infiltration anesthesia are reliable predictors of severe pain after CS. Assessment of preoperative anxiety using HADS has low sensitivity and specificity. However, its use in conjunction with methods for assessing the pain threshold increases the predictive value of the combined model compared with the results of using the methods separately.

Effects of Elective Caesarean Sections in Healthy Near-Term Ewes on Subsequent Reproductive Performance.

Post-surgical reproductive performance following ovine caesarean section has not been well studied. To assess any direct effects of surgical delivery in the absence of confounders such as dystocia or underlying diseases, we studied elective surgery performed in healthy animals for teaching purposes. Four hundred and eleven paired breeding records following vaginal delivery (n = 233), elective caesarean section (n = 122), and subsequent further vaginal deliveries in animals with a history of one prior elective caesarean operation (n = 56) were evaluated retrospectively. The overall subsequent pregnancy rate was 95%. Multivariable statistical analyses did not reveal any significant influence of planned caesarean surgery on subsequent conception, stillbirth, perinatal lamb mortality, lamb birth weights, or the incidence of premature foetal death (mummification and abortion). A significantly higher number of mating attempts was, however, necessary. Also, a significant reduction in litter size was seen in the first pregnancy immediately following a surgical delivery in comparison to animals which had previously only delivered vaginally (p = 0.001), but litter size returned to pre-caesarean levels in further follow-up pregnancies in animals with a history of one elective caesarean section (p = 0.436). Subsequent long-term reproductive performance of sheep following elective caesarean section is thus excellent, and the results encourage retention for breeding.

Anaesthetic management of a case of non-cirrhotic portal hypertension with severe thrombocytopenia for elective cesarean section

Pregnancy with non-cirrhotic portal hypertension usually presents with portal hypertension due to Physiological hemodynamic changes associated with pregnancy, thereby putting the mother at risk of potentially dangerous complications like variceal bleeding and splenic aneurysmal rupture. Management of such cases requires a multidisciplinary approach involving obstetricians, gastroenterologist and, anesthesiologist Here through the case report of a 36-year-old primigravida with Non Cirrhotic portal hypertension with at 37 weeks gestational age in labor. We intend to focus upon different aspects of anesthetic management of pregnancy with portal hypertension and its complications.

The effect of hip shoulder width ratio and vertebral column length on sensory level in term participants posted for lower segment caesarean section under spinal anaesthesia in Indian population: A prospective observational study

Hypotension is the most common complication of spinal anesthesia with high intrathecal spread of local anaesthetic drug especially during caesarean section. Hip Shoulder width Ratio (HSWR) is one of the factors which affects spread of spinal anaesthesia.85 ASA II participants with singleton term pregnancy undergoing elective caesarean section received 12mg hyperbaric bupivacaine intrathecally with 26G Quincke’s spinal needle in L3-4 intervertebral subarachnoid space via midline approach. Post spinal anaesthesia haemodynamic parameters were monitored every 5 minutes for the first 20 minutes and at the end of surgery. Sensory level was assessed by a pinprick test every 5 minutes till 20 minutes and post-surgery. Hypotension was defined as 20% fall from baseline systolic blood pressure at 15 minutes post spinal anaesthesia.We found significant positive correlation between high shoulder width ratio and highest sensory level achieved (p - 0.0005) using mutiple regression analysis and pearson's correlataion. With every unit increased in high shoulder width ratio spinal level significantly increased by 5 units. Hip shoulder width ration and age were significantly correlatwd with incidence of hypotension.Hip-shoulder Width Ratio has a positive effect on cephalad spread of spinal anaesthesia and thus incidence of hypotension. By knowing the Hip-shoulder Width Ratio, it can help anaesthesiologists to predict the spread of spinal anaesthesia and titrate the dose of 0.5% hyperbaric bupivacaine.

The impact of ultrasound- guided neuraxial blockade on anaesthetic outcomes in morbidly obese parturients: A case report

Obesity being a global epidemic is increasing in parturients nowadays, leading to super morbid obese parturient undergoing caesarean section. Caesarean section in morbidly obese poses many anaesthetic challenges under general anaesthesia a well as neuraxial anaesthesia. We report a case of super-super obese parturient with body mass index (BMI) of 63kg/m who underwent elective caesarean section under combined spinal epidural anaesthesia with ultrasound guidance successfully. We aim to highlight the anaesthetic considerations and implications associated with such patients.

Comparison of analgesic effects between programmed intermittent epidural boluses and continuous epidural infusion after cesarean section: a randomized controlled study.

This study aimed to compare the analgesic effects of programmed intermittent epidural boluses (PIEB) and continuous epidural infusion (CEI) for postoperative analgesia after elective cesarean section (CS). Seventy-four women who underwent elective CS were randomized to receive either PIEB or CEI. The PIEB group received 4 ml-intermittent boluses of 0.11% ropivacaine every hour at a rate of 120 ml/h. The CEI group received a constant rate of 4 ml/h of 0.11% ropivacaine. The primary outcome was the pain score at rest at 36 h after CS. Secondary outcomes included the pain scores during mobilization, time-weighted pain scores, the incidence of motor blockade, and complications-related epidural analgesia during 36 h after CS. The pain score at rest at 36 h after CS was significantly lower in the PIEB group compared with that in the CEI group (3.0 vs. 0.0; median difference: 2, 95% CI [1, 2], P < 0.001). The mean time-weighted pain scores at rest and during mobilizations were also significantly lower in the PIEB group than in the CEI group (pain at rest; mean difference [MD]: 37.5, 95% CI [24.6, 50.4], P < 0.001/pain during mobilization; MD: 56.6, 95% CI [39.8, 73.5], P < 0.001). The incidence of motor blockade was significantly reduced in the PIEB group compared with that in the CEI group (P < 0.001). PIEB provides superior analgesia with less motor blockade than CEI in postpartum women after CS, without any apparent adverse events.

Efficacy of ShotBlocker device versus vapocoolant spray for spinal needle pain relief during spinal anaesthesia in elective caesarean section - A randomised controlled trial.

Apprehension of pain due to a spinal needle is often a cause of anxiety and refusal. ShotBlocker provides non-painful physical stimulation, inhibiting pain perception. The vapocoolant spray contains ethyl chloride vapours, rapidly raising the skin temperature and hampering the transmission of noxious stimuli. The present study compared the effectiveness of the ShotBlocker device and the vapocoolant spray in reducing spinal needle-associated pain in primigravida women undergoing elective lower-segment caesarean section (LSCS). We enroled 144 primigravida women undergoing elective LSCS and were randomised to Group SB (the ShotBlocker device was firmly pressed over the skin, and the spinal needle was inserted through its slit), Group V (the vapocoolant spray was applied at the puncture site before spinal needle insertion), and Group C (received local infiltration before spinal anaesthesia (SA)). The groups were compared for needle-associated pain and patient satisfaction using a 10-point visual analogue scale (VAS) and a 3-point Likert scale. The mean (standard deviation) [95% confidence interval (CI)] VAS scores of Group SB 3.85 (0.74) [3.64, 4.07] and Group V 3.04 (0.74) [2.83, 3.26] were significantly lower than that of Group C 5.19 (0.92) [3.28, 3.62]). On the Likert scale, the maximum number of patients in the vapocoolant group (64.6%) responded satisfactorily, while in the control group, the majority (62.5%) of participants responded dissatisfied (P < 0.001). Both the ShotBlocker and vapocoolant spray reduce needle puncture-associated pain before SA in primigravida patients undergoing elective LSCS. However, the vapocoolant spray is more beneficial in reducing spinal needle-associated pain than the ShotBlocker device.

Comparison of the effect of intravenous phenylephrine and norepinephrine boluses for post-spinal hypotension on neonatal outcome in elective caesarean section: A randomised controlled trial.

There is limited data on the effects of norepinephrine on neonatal outcomes and maternal complications relative to other vasopressors. The study aimed to compare neonatal outcomes and maternal complications after bolus intravenous doses of phenylephrine and norepinephrine for post-spinal hypotension in elective caesarean section women. This randomised study was done on 100 elective caesarean section women under spinal anaesthesia. Block randomisation divided women into two groups to receive intravenous phenylephrine 50 μg bolus (Group A) or norepinephrine 5 μg bolus (Group B) following post-spinal hypotension. Groups were evaluated and compared for umbilical arterial blood gas analysis, birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) score, maternal haemodynamics, and complications. Kolmogorov-Smirnov and Shapiro-Wilk tests were used to verify data normality. Independent samples t-test or Mann-Whitney U test was employed to compare continuous variables based on data normality, and the Chi-square test was used to determine categorical variable associations. Demographic characteristics of women were found to be comparable between groups. Umbilical arterial potential of hydrogen, partial pressure of oxygen, partial pressure of carbon dioxide, base excess, bicarbonate, birth weight, and APGAR scores were comparable across groups, showing no significant differences (P > 0.05). Groups had similar maternal haemodynamic characteristics and episodes of nausea, vomiting, and chest pain across groups without statistical significance (P > 0.05). No notable distinction was found between neonatal outcomes and maternal complications between phenylephrine and norepinephrine bolus regimens. Norepinephrine can be used as an alternative to phenylephrine post-spinal hypotension in women undergoing elective caesarean section.

Effect of Uterine Artery Clamping in Reducing Cesarean Hysterectomy in Pregnancies Complicated by Placenta Accrete Spectrum

Background and objective: The placenta accreta spectrum is a major public health problem. Many interventional measures are used for controlling hemorrhage and preventing emergency caesarean hysterectomy. The aim of this study was to evaluate the role of uterine artery clamping in reducing maternal morbidity and mortality in pregnancies complicated by placenta accrete spectrum. Methods: This is a retrospective case-control study implemented in the Sulaymaniyah Maternity Teaching Hospital in Sulaymaniyah city, Kurdistan region-Iraq through the period of 2 years from 1st of June 2020, to 31st of May, 2022. A sample of sixty pregnant women with placenta accreta spectrum surgically managed by elective cesarean section and divided into two study groups (32 women underwent elective cesarean section with uterine artery clamping [interventional group] and 28 women underwent elective cesarean section without uterine artery clamping [control group]). Results: The postoperative hemoglobin level was significantly higher in women of the interventional group with a mean of (10.1±0.7 gm/dL) compared to (9.3±1 gm/dL) in women of the control group. The mean of units of blood transfused was significantly lower in women of the interventional group with a mean of (1.3±0.6 units) compared to (3.1±1.4 units) in women of the control group. Also, there was a significant reduction in units of fresh frozen plasma in women of the interventional group with a mean of (0.9±0.6 units) compared to (2.9±1.5 units) in women of the control group. Conclusions: The uterine artery clamping before placental separation is helpful in reducing the rate of maternal morbidity and mortality in pregnancies complicated by placenta accreta spectrum.

Birth by caesarean section and semen quality in adulthood: a Danish population-based cohort study

BackgroundThe caesarean section (CS) rate has increased worldwide and there is an increasing public and scientific interest in the potential long-term health consequences for the offspring. CS is related to persistent aberrant microbiota colonization in the offspring, which may negatively interfere with sex hormone homeostasis and thus potentially affect the reproductive health. It remains unknown whether adult sons’ semen quality is affected by CS. We hypothesize that CS is associated with lower semen quality.MethodsThis study was based on the Fetal Programming of Semen Quality cohort (FEPOS, enrolled from 2017 to 2019) nested within the Danish National Birth Cohort (DNBC, enrolled from 1996 to 2002). A total of 5697 adult sons of mothers from the DNBC were invited to the FEPOS cohort, and 1044 young men participated in this study. Information on mode of delivery was extracted from the Danish Medical Birth Registry, and included vaginal delivery, elective CS before labor, emergency CS during labor and unspecified CS. The young men provided a semen sample for analysis of semen volume, sperm concentration, motility and morphology. Negative binomial regression models were applied to examine the association between CS and semen characteristics with estimation of relative differences in percentages with 95% confidence intervals (CIs).ResultsAmong included sons, 132 (13%) were born by CS. We found a slightly lower non-progressive sperm motility (reflecting higher progressive sperm motility) among sons born by CS compared to sons born by vaginal delivery [relative difference (95% CI): − 7.5% (− 14.1% to − 0.4%)]. No differences were observed for other sperm characteristics. When CS was further classified into elective CS, emergency CS and unspecified CS in a sensitivity analysis, no significant differences in non-progressive motility were observed among sons born by any of the three types of CS compared to sons born vaginally.ConclusionsThis large population-based cohort study found no significant evidence for an adverse effect on semen quality in adult sons born by CS.

Measurement Of Umbilical Venous Lactate Levels For Predicting Poor Neonatal Outcomes

Objectives: To determine the utility of umbilical venous lactate measurements for predicting poor neonatal outcomes. Method: This observational study was conducted at Kahuta Research Laboratories (KRL) hospital, Islamabad from May 2019 to October 2019. Singleton pregnancies with no known fetal congenital anomalies and gestational age greater than 28 weeks were included. Descriptive statistics were used to analyse the characteristics of study subjects and also composite neonatal outcomes. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Result: Umbilical venous lactate levels were found to be highest in instrumental deliveries (48.7%) and lowest in those delivered by elective cesarean section (25.7%). Low APGAR score, need for initial resuscitation &amp; neonatal intensive care unit admission, mechanical ventilation and neonatal morbidity were all associated with significantly higher lactate levels. Based on the maximal yield index, the optimal cut-off point for predicting neonatal morbidity was 46.5mg/dl (area under the receiver operating characteristics curve was 0.8). Based on this optimal cut-off point, it has a sensitivity of 62%, specificity of 92%, PPV 51% and NPV 94% for neonatal morbidity. Conclusion: Umbilical venous lactate measurement is a good predictor of poor neonatal outcome especially in situations when umbilical arterial blood cannot be taken due to technical difficulty. Mode of delivery has a strong association with fetal hypoxia and raised umbilical lactate levels. Keywords: lactate, neonatal outcomes, labour ward.

EXPLORING LIPID VARIATIONS IN UMBILICAL CORD BLOOD ACROSS DIFFERENT DELIVERY MODES

Objective: The mode of delivery (vaginal or cesarean) may affect the lipid profile of the newborn, which has implications for their future health. Methods: The study included 150 mothers who gave birth vaginally and 50 mothers who underwent elective cesarean sections. All mothers were aged between 21 and 44 years. The main outcome measures were the serum lipid levels of umbilical cord blood of newborns. The lipid levels included total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol, very low-density lipoprotein (VLDL-D), and low-density lipoprotein (LDL-C). The study compared the obstetric variables and the serum lipid levels between the two groups of mothers. Results: The two groups did not differ significantly in terms of maternal age, neonatal weight, gestational duration, placental weight, and neonatal gender distribution. The newborns delivered by normal vaginal delivery had higher levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol, VLDL-D, and LDL-C than those delivered by cesarean section, but the difference was not statistically significant. Conclusions: This study suggests that the mode of delivery does not have a significant impact on umbilical cord serum lipid levels. However, the sample size was small, and the results may not be generalizable to other populations.

A Prospective Comparative Study of Application of Enhanced Recovery After Surgery (ERAS) in Patients Undergoing Elective Caesarean Section

A Prospective Comparative Study of Application of Enhanced Recovery After Surgery (ERAS) in Patients Undergoing Elective Caesarean Section

Obstetric Outcome in Patients with Previous Abdominal Myomectomy at a Tertiary Hospital in South-South Nigeria

Background: Abdominal myomectomy refers to the surgical removal of fibroids from the uterus through an abdominal incision. It is one of the treatment options for uterine fibroids. Women who had this form of treatment may be faced with increased risks and complications during future pregnancies and deliveries. Aim: To assess the obstetric risk and delivery outcome of pregnancies achieved after abdominal myomectomy. Methodology: This was a retrospective study of pregnancy outcome in women who had abdominal myomectomy at University of Port Harcourt Teaching Hospital (UPTH) from 2018 to 2022. The case records of the patients were retrieved, and data on socio-demographic characteristics, mode of delivery, obstetric complications, and foetal outcome was extracted and analysed using SPSS version 25. Results: There were 7,602 antenatal clinic attendees during the study period, out of which 83 of the women had previous myomectomy and were delivered in UPTH. This accounted for 1.1% of booked patients who attended antenatal care and delivered at the hospital. Seventy-two case notes were retrieved, giving a case retrieval rate of 86.7%. The mean age was 34.89 ± 4.27 years (range from 18 to 47 years). The total Live birth post myomectomy was 56 (77.8%). There were 14 (19.4%) miscarriages and 2 (2.8) stillbirths. Patients that conceived spontaneously were 61 (84.7%), while 11 (15.3%) had in-vitro fertilization (IVF). Caesarean section was used in 67 (93.1%) of deliveries with elective caesarean section accounting for 45 (62.5%) of the deliveries. The commonest indication for caesarean section was previous myomectomy with breached endometrium in 53 (79.1%) cases. Forty-one (56.9%) of the deliveries occurred at 38-40 weeks of gestation. Conclusion: Obstetric outcome after abdominal myomectomies was good with high live birth rate and no maternal mortality recorded. Women who had abdominal myomectomy should be counselled to attend antenatal care and deliver in adequately equipped centres with skilled personnel to avert adverse pregnancy outcomes.

Beyond Birth: Pioneering Insights into Colostrum Quality Variation among Bitches with Different Types of Parturition.

This study deals with the immunological quality of canine colostrum in relation to the different parturition modes in bitches. It included four groups of bitches, who underwent vaginal parturition (VP), emergency cesarean section (EM-CS), elective cesarean section (EL-CS), or elective cesarean section with aglepristone injection 24 h prior to surgery (EL-A). Colostrum samples from 40 bitches of 18 breeds were taken immediately after the birth of the first puppy or directly after surgery, and four hours later. The concentrations of immunoglobulin G (IgG) and IgA were measured using ELISA tests. The initial IgG concentration was 18.3 ± 10.2 g/L, and the IgA concentration was 13.7 ± 5.8 g/L, respectively. Significantly lower IgG and IgA concentrations were observed in the EL-CS group compared to other groups. The administration of aglepristone led to an increase in IgG and IgA concentrations. Despite the lower immunoglobulin levels with EL-CS, the survival rate of the puppies was not affected. The study shows that immunoglobulin concentrations in colostrum vary between bitches, with the type of birth significantly influencing the levels. Progesterone withdrawal before birth could play a decisive role in increasing IgG and IgA concentrations in the mammary glands of the bitches.