Elective Caesarean Operation Research Articles

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.

COMPARISON OF HYPERBARIC LEVOBUPIVACAINE/ BUPIVACAINE FOR CESEREAN SECTION

Background : Bupivacaine is the most popular local anesthetic agent in obstetric practice Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity compared to Bupivacaine The aim of this study was to investigate the clinical efficacy of levobupivacaine compared with hyperbaric bupivacaine for spinal anesthesia for cesarean section. Methods: 60 pregnant women in ASA I - II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. 10 mg levobupivacaine (0.5%) for Group L (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) for B (n = 30) patients were intrathecally administrated a total of 2.0cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale observed hemodynamic changes and side effects were recorded. Results: The time to reach maximum dermatome for the sensory block, time to regression by two dermatomes and time to regress to T12 dermatome was found to be significantly long in Group B. It was observed that in Group B, the motor block was faster and lasted longer. Where as hypotension, bradycardia and nausea were less in Group L, the need for ephedrine was higher in Group B (p < 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, levobupivacaine can be a good alternative in cesarean sections.

Anesthesia management in a pregnant patient with neurofibromatosis

Neurofibromatosis (NF) is a genetic and multisystemic disease with autosomal dominant transition. It can affect anesthesia applications by affecting more than one system. In the presence of neurofibromas in the airway, it can cause airway obstruction and difficulties in respiratory delivery during general anesthesia. The presence of tumors affecting the central nervous system makes spinal anesthesia risky. Anesthesiologists should act with awareness of each multisystemic complication when evaluating and managing patients. This case report aims to present our general anesthesia practice in an elective cesarean operation in a pregnant patient with neurofibromatosis type 1.

The Identification of HSA-MIR-17-5P Existence in the Exosome of Adipose-Derived Stem Cells and Adipocytes

MicroRNAs (miRNAs) have ability to down-regulate gene expressions. hsa-miR-17-5p, has been confirmed as an oncogene or tumor suppressor. However, the existence on human adipose-derived stem cells (ADSCs) or adipocytes, is still unclear. Many researchers emphasizing the role of hsa-miR-17-5p on cellular senescence, aging and cancer, but not specific on the expression in the exosome of human ADSCs and adipocytes. The primary ADSCs were derived from subcutaneous adipose tissue of pregnant woman during elective cesarean operation, then processed by combining conventional and enzymatic methods. Adipocytes were differentiated by using the StemPro Adipogenesis Differentiation kit® and Oil Red-O staining. Exosomes were isolated using Exosome Purification and RNA Isolation kit® and were characterized by scanning electron microscope. The markers, CD34 and CD44, were identified and analyzed by using FACS analysis. Subsequently, microRNA was extracted and observed for hsa-miR-17-5p expression. This study showed that ADSCs and adipocytes were proved to express CD34+ and CD44+. The hsa-miR-17-5p were also detected in both the exosome of ADSCs and adipocytes. Although the source of the ADSCs was from pregnant woman, the characteristic was similar with the ones from non-pregnant woman. Our study also supports the questionable existence of CD34 in ADSCs. Having confirmed the characteristics, we proved that the exosomes of ADSCs and adipocytes expressed similar hsa-miR-17-5p despite they are from phenotypically different cell types and may have distinct roles. However, further research steps should be done in the future to verify the role of hsa-miR-17-5p towards senescent cell and ADSC differentiation.

Effect of General Anesthesia with Thiopental Sodium and Propofol on the 1- and 5 minute Apgar newborns by Cesarean

Background: The Apgar score of newborn babies is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol and thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ Apgar score. Methods: In this double-blind clinical trial, a total of 100 healthy women who volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical. Babies’ Apgar score 1 and 5 minutes after birth and recovery period and some of the critical maternal parameters after operation were recorded. The obtained data were analyzed by SPSS 19 software. Results: Apgar score I minute 1 (p=0.317) and Apgar score in minute 5 (p=1.00) for propofol group were not different meaningfully. The groups had significant differences in the indices such as first systolic (P=0.00) and diastolic (P=0.00) pressure in recovery, last diastolic pressure in recovery (P=0.001) and duration of postoperative recovery (P=0.001). Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather than the thiopental group (p=0.000). Conclusion: Propofol and thiopental did not differ significantly in Apgar score, but it seems that propofol can be a better option to induce anesthesia for an elective cesarean operation.

Efficacy of prophylactic epidural saline for reducing postdural puncture headache in patients undergoing caesarean section

Aim: Post-Dural Puncture Headache (PDPH) is a common complication of spinal anesthesia during the postoperative period. The optimal means of prevention, management, and treatment of this disorder are uncertain. The objective of this current study was to investigate the effect of a 24 hours-continuous infusion of saline on the occurrence of PDPH in patients undergoing caesarean section and to provide a reference for the clinical prevention of PDPH. Methods: This study included 126 patients aged between 18 and 45 years with an American Society of Anesthesiology physical status (ASA) score of 1-2, who underwent elective caesarean operation. Patients were randomized into control (n=63) and study groups (n=63). Spinal anesthesia was administered to both groups via a 27-gauche spinal needle. The study group was administered normal saline infusion for 24 hours with an easy-pump device through an epidural catheter. Results: Seven control-group patients developed PDPH within the first 72 hours postoperatively while it was not observed in any of the study-group patients. Visual analogue scale and numerical rating scales were used for pain measurement. Five patients described mild pain while two described moderate pain. Severe headache was not observed in any patients at any time. Conclusion: This study demonstrated that the administration of epidural saline during an elective caesarean under spinal anesthesia significantly reduced the incidence of PDPH and was not associated with any side-effects.

Faktori koji utiču na izbor anestezije kod trudnica za porođaj carskim rezom

Objectives: In recent years, a significant increase has been observed in the prevalence of caesarean sections (CS). Although as in many other countries, CS rates in Turkey are higher than the targeted rate. This increase in the prevalence of CS also affects obstetric anaesthesia. In this study, we investigate the choice of anaesthesia among pregnant women who are scheduled for CS, as well as general anaesthesia and regional anaesthesia rates, the reasons for choosing general anaesthesia or regional anaesthesia, and the factors that affect their choices. Methods: A questionnaire consisting of 20 questions were applied to pregnant women applying for delivery by elective caesarean operation, between November 2011 to November 2012, in order to study the anaesthesia technique they prefer and the reason behind their preferences. The questionnaire was applied to pregnant women during the visit, on the day before the operation or while they were waiting in the waiting room before the CS procedure. Results: Our study revealed that age, gravida, previous type of delivery, previous anaesthesia experience, employment status, monthly income level, educational status, being given information about anaesthesia in advance, the source of information, and being diagnosed with panic disorder were all found to be influential in the decision of which type of anaesthesia to opt for. Conclusion: We have found out that the reason why pregnant women who have higher educational status, who work and have high level of monthly-income prefer regional anaesthesia method more depends on the fact that they have more information on anaesthesia method, they have more common use of the internet and the information they obtain from the people around them is not prejudiced against regional anaesthesia method. We believe that as the education levels rise in the future and the patient population becomes more aware, which will direct them to do more research, their preference rates will change.

Evaluation of the effect of pregestational and gestational body mass index on skin puncture pain during spinal anesthesia for elective cesarean operation

Objective: Skin puncture pain during spinal anesthesia is the reason of wincing from spinal anesthesia in many patients. In this study we aimed to investigate whether the body mass index in the pregestational and gestational period affects skin puncture pain during spinal anesthesia for cesarean sections.Material-Method: One hundred pregnant scheduled to undergo elective caesarean section under spinal anesthesia, were studied. Spinal anesthesia was induced with hyperbaric bupivacaine 10-15 mg via a 27G Quincke spinal needle in the sitting position at the L3–4 or L4-5 vertebral level using median approaches. Skin puncture pain during spinal anesthesia were assessed on a scale of 0 to 10, where 0 means no pain and 10 the worst possible pain.Results: There were no correlation between gestational BMI and the skin puncture pain VAS scores was found ( ρ= -0.021, p=0.835). And also no correlation between pre-pregnancy BMI and the skin puncture pain VAS scores was found ( ρ= -0.012, p=0.903). Conclusions: We believe that the pregestational and gestational body mass index does not have any effect on skin puncture pain during spinal anesthesia.

Comparitive study between levobupivacaine versus bubivacaine in spinal anesthesia for cesarean sections

Background Levobupivacaine showed a lower risk of cardiovascular and central nervous system toxicity than bupivacaine, which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to investigate the clinical efficacy of levobupivacaine 0.5% compared with bupivacaine 0.5% for spinal anesthesia for cesarean sections. Aim The aim of this study was to compare the efficacy of levobupivacaine 0.5% versus bupivacaine 0.5% in spinal anesthesia for cesarean section. Patients and methods A total of 60 pregnant women in American Society of Anesthesiologists I–II group scheduled to have an elective cesarean operation were allocated into the study. Patients were randomly divided into two groups (30 patients in each group). Group I (bupivacaine group): in this group, patients received 2.5 ml bupivacaine 0.5%. Group II (levobupivacaine group): in this group, patients received 2.5 ml levobupivacaine 0.5%. Heart rate and mean arterial blood pressure were recorded intraoperatively. The onset time of sensory block and postoperative pain were assessed by visual analogue scale; time of postoperative first rescue of analgesia and duration of motor blockade were assessed by the Bromage score postoperatively. Results There was no significant difference between both groups as regards hemodynamics (heart rate and mean arterial pressure), two-segment regression of sensory block, time of first feeling of pain, total dose of consumption of analgesia, and visual analogue score. There was a significant decrease in the time to reach maximum sensory and motor block in group II compared with group I. Time of two-segment regression of motor block was significantly lower in group II than in group I. Conclusion Adequate surgical anesthesia can be achieved with both levobupivacaine and hyperbaric bupivacaine, as tested by the loss of pinprick sensation in both groups. Levobupivacaine given intrathecally can provide a safe and effective analgesic choice for parturients undergoing elective cesarean section, as the incidence of side effects with its use was significantly lower in comparison with hyperbaric bupivacaine.

The effect of bilateral TAP block administration on analgesic consumption in cesarean operations under spinal anesthesia

Aim: The purpose of this study was determine the efficacy of ultrasound guided transverse abdominis plane (TAP) block in patients after cesarean operation under spinal anesthesia. Material and Method: In this retrospective study, we reviewed the patient files which was elective cesarean operation under spinal anesthesia between 2016 may and october. Patients were divided into two groups as non-TAP block (Group 1) and TAP block group (Group 2). Demographic data, visual analogue scale (VAS) values, nonsteroidal anti-inflammatory drug and opioid consumption were examined at postoperative 1, 2, 4, 6, 9, 12 and 24 hours. Also the first analgesic and opioid agent administration times were recorded. Results: Postoperative 1st and 4th hour VAS values of group 1 patients (n=27) were significantly higher than Group 2 (n=31). Opioids were used in 18 patients (66.6%) in Group 1 and 9 patients (29%) in Group 2. The first opioid administration time was 200.27 minutes in Group 1 and 263.33 minutes in Group 2 (p <0.05). In Group 2, the mean time of first opioid application was 263.33 min and in Group 1 200.27 min. Conclusions: We found that the TAP block decreased the postoperative VAS values and the opioid consumption after cesarean operation under spinal anesthesia.

Trends in Elective Caesarean Section at the Jos University Teaching Hospital, Jos Nigeria

<i>Context:</i> Elective caesarean sections have been considered safer for both mother and the foetus compared to emergency caesarean sections. Paradoxically emergency caesarean sections have continued to form majority of caesarean deliveries in our facility. <i>Objective:</i> The objective of this study was to determine the caesarean section rate, indications and trend associated with elective caesarean delivery. <i>Study design:</i> A retrospective study of the clinical records of all patients that had caesarean section between 1st January 2003 and 31^st December 2007 at the Jos University Teaching Hospital, Jos. Data on the number and type of caesarean section and indication for the caesarean section was analysed using descriptive statistics. <i>Results:</i> During the 5 year study period, 2666 caesarean sections were performed out of 13,611 total deliveries giving a caesarean section rate of 19.6%. Elective and emergency caesarean sections accounted for 757 (28.4%) and 1909 (71.6%) of the cases respectively. The rate of elective caesarean section increased from 25.4% in 2003 to 26.5% in 2005 and 32.6% in 2007. Repeat caesarean section (24.7%), HIV in pregnancy (23.0%), bad obstetrics history (11.4%) were the leading indications for elective caesarean operation. <i>Conclusion:</i> The rising trend in the elective caesarean section rate as identified in this study strengthens the need for better patient selection together with improved counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it also has its own short-comings and complications.

Ultrasound-guided evaluation of the lumbar subarachnoid space in lateral and sitting positions in pregnant patients to receive elective cesarean operation.

Background and Objective:The aim was to compare visibility of the spinal space in sitting and lateral positions, number of attempts, spinal needle depth, skin-dura mater distance and the possible complications; in application of spinal anesthesia, using ultrasound in pregnant patients scheduled to receive elective cesarean operations.Methods:The study was conducted prospective-randomly after receiving approval from the ethics committee and the patients’ permission. ASA I-II 50 pregnant patients were divided into two groups. The patients in Group SP were those placed in a sitting position and the patients in Group LP were those placed in a lateral position. In both groups, the skin-dura mater distance was recorded through an out-of plane technique accompanied by ultrasound. The depth of the spinal needle was measured. The number of attempts, the level of attempts recorded. The degree of visibility of the vertebral space was observed through ultrasound and was numerically scored. Intraoperative and postoperative complications were recorded.Results: There was no difference between the number of attempts, Modified Bromage Scale and mean measurements of skin-dura mater distance observed through ultrasound. The mean needle depths of Group LP were statistically found significantly higher than Group SP (p=0.002).Conclusion:Our study supports the notion that access to the skin-dura mater distance is longer in the lateral decubitus position when skin-dura mater distance is evaluated by measuring needle depth.

Elektif Sezaryen Ameliyatlarında İntratekal İzobarik Levobupivakain İle Hiperbarik Bupivakain Kullanımının Karşılaştırılması

Elektif Sezaryen Ameliyatlarında İntratekal İzobarik Levobupivakain İle Hiperbarik Bupivakain Kullanımının Karşılaştırılması

A Comparison of Spinal Anesthesia with Levobupivacaine and Hyperbaric Bupivacaine for Cesarean Sections: A Randomized Trial

Purpose: Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to investigate the clinical efficacy of levobupivacaine compared with hyperbaric bupivacaine for spinal anesthesia for cesarean section. Methods: 60 pregnant women in ASA I - II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. The combinations 10 mg levobupivacaine (0.5%) + fentanyl (15 μcg) for Group LF (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) + fentanyl (15 μcg) for BF (n = 30) patients were intrathecally administrated a total of 2.3 cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale; observed hemodynamic changes and side effects were recorded. Results: The time to reach maximum dermatome for the sensory block, time to regression by two dermatomes and time to regress to T12 dermatome was found to be significantly long in Group BF. It was observed that in Group BF, the evolution of the motor block was faster and lasted longer. Whereas hypotension, bradycardia and nausea were less in Group LF, the need for ephedrine was higher in Group BF (p < 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, the combination of levobupivacaine + fentanyl can be a good alternative in cesarean sections.

Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria.

Background:Elective caesarean sections have been considered safer for both mother and the fetus compared to their emergency counterpart. However, emergency caesarean sections have continued to form bulk of caesarean deliveries in our facility.Objective:The objective of this study was to determine the caesarean section rate together with the trend, indications, and maternal mortality associated with elective caesarean operation.Materials and Methods:A retrospective analysis of clinical records of all the patients that had caesarean section between January 2002 and December 2010 (9 years) at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria was conducted.Results:During the 9 year study period, 2284 caesarean sections were performed out of 22,985 total deliveries at UDUTH Sokoto, thus giving a caesarean section rate of 9.9%. Emergency and elective operations accounted for 1784 (78.2%) and 498 (21.8%) of the cases respectively. The rate of elective caesarean section increased from 1.7% in 2002 to 3.2% in 2007. Thereafter it declined gradually to 1.8% in 2010. Repeat caesarean section (30.7%) and malpresentation (17.1%) were the most common indications for elective caesarean operation. There were 18 maternal deaths from caesarean section and only one from the elective caesarean procedure.Conclusion:The rising trend in the elective caesarean section rate in this study underscores the need for better and improved patient selection together with counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it is not entirely devoid of complications. Routine use of spinal anesthesia in performing the procedure should be encouraged.

Elective Caesarean Operation in the Bitch Using Aglepristone Before the Pre‐Partum Decline in Peripheral Progesterone Concentration

The aim of this study was to investigate caesarean operation (CO) undertaken before the pre-partum decrease of progesterone but following administration of a progesterone receptor antagonist and to evaluate the innocuity of this procedure for the dam and pups. Thirty seven bitches of 15 different breeds, received an injection of 15 mg/kg aglepristone 59 or 60 days after the estimated day of ovulation, determined by progesterone quantitative assays, and caesarean section (CS) was performed between 20 and 24 h after administration. Progesterone remained above 6 nmol/l at the time of CS (mean = 15.75, SD = 3.84). No post-operative clinical complications were reported in any of the bitches. All bitches were able to nurse and feed their puppies in the first 24 h following surgery. No pups showed any signs of prematurity and 5 out of 188 pups (2.6) died in the first 2 weeks after delivery. This small study demonstrates that a CS may be safely and successfully performed an average of 2 days before the expected date of parturition following the administration of aglepristone, without any harmful consequence for the dam and her neonates.

Simplified disposable abdominal and vulvar drapes for cesarean section in maternal HIV-1 infection

This paper presents the simplified disposable abdominal and vulvar drape technique for the prevention of surgical soiling during elective cesarean section in cases of maternal HIV-1 infection. The abdominal drape consists of: 1) an ordinary polyethylene plastic bag; 2) transparent polyethylene acrylate glued sticker with paper backing which is mounted on the other surface of the plastic bag; and 3) two pieces of water-repellant nonwoven cloths attached to the upper and lower ends of the plastic bag. An ordinary polyethylene plastic bag with its anterior portion cut off in a V-shape makes up the disposable vulvar drape. Two ovoid-shaped apertures are made along the borders of the V-shaped plastic edges. The abdominal and vulvar drapes are placed on the patients. A large rectangular pouch with sustainable upright barriers covers the operative area to collect potentially contaminated fluid and thus prevents surgical soiling during an elective cesarean operation. From March through September 1999 this new technique was performed on 17 patients aged 18-36 years with HIV-1 infection. Postoperatively the prepped abdominal surface surrounding the incision site caused no allergic reaction and there was no febrile morbidity. In conclusion the hospital-made simplified disposable abdominal and vulvar drapes provide efficient collection and disposal of amniotic fluid and blood via abdominal incision and vaginal canal thereby reducing the risk of exposure to the surgeons.

Plasma enzymes and metabolites as potential prognostic indices of ovine pregnancy toxaemia—A preliminary study

Three ewes with naturally occurring pregnancy toxaemia and increased plasma glucose concentrations within 24 h of the onset of clinical signs, made a complete recovery following treatment with a concentrated oral rehydration solution. Four ewes in which plasma glucose concentrations fell did not recover. Ewes with elevated plasma alkaline phosphatase concentrations were slower to recover than ewes with normal plasma alkaline phosphatase concentrations. These findings suggest that plasma alkaline phosphatase concentration and change in plasma glucose concentration might offer useful prognostic indices in cases of ovine pregnancy toxaemia, and influence a decision to perform an elective caesarean operation. Further studies using a larger number of ketotic ewes are necessary before firm conclusions can be made.

Appendices Removed at Cesarean Section

Appendices removed from 100 healthy Nigerian Igbo women during elective cesarean operation and examined microscopically as three random cross sections showed that lesions categorized as luminal pus, luminal fibrosis, mucosal ulceration, muscular inflammation, crypt abscess and crypt necrosis were present in numerous sections. As elsewhere, these asymptomatic patients might have had clinical acute appendicitis in the puerperium. To explain the possible outcome in the rest of such patients, The crypt of Lieberkuhn was advanced as a researchworthy histopathologic unit. Thus, in the natural history of the disease, both crypt abscess and crypt necrosis are contrastable bipolar lesions. In all probability, worldwide research on these intriguing lesions will reveal crucial clues to one or more facets of the pathogenesis of appendicitis.

Appendices removed at cesarean section: histopathology.

Appendices removed from 100 healthy Nigerian Igbo women during elective cesarean operation and examined microscopically as three random cross sections showed that lesions categorized as luminal pus, luminal fibrosis, mucosal ulceration, muscular inflammation, crypt abscess and crypt necrosis were present in numerous sections. As elsewhere, these asymptomatic patients might have had clinical acute appendicitis in the puerperium. to explain the possible outcome in the rest of such patients, the crypt of Lieberkühn was advanced as a research-worthy histopathologic unit. Thus, in the natural history of the disease, both crypt abscess and crypt necrosis are contrastable bipolar lesions. In all probability, worldwide research on these intriguing lesions will reveal crucial clues to one or more facets of the pathogenesis of appendicitis. [Key words: Appendicitis, pathogenesis; appendix, histopathology]