Elective Caesarean Section Research Articles

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.

Apgar scores in puppies following the induction of etomidate compared with alfaxalone or propofol for cesarean section.

The Apgar score is a useful assessment of neonatal viability in dogs. The Apgar score in puppies born by cesarean section can be lower than vaginal delivery because all anesthetic drugs can cross the placenta. Therefore, anesthetic drugs with minimal cardiorespiratory effect and rapid elimination are recommended for cesarean section. The present study aimed to compare Apgar scores in puppies born after the induction of etomidate, alfaxalone or propofol, and those maintained with isoflurane inhalation during cesarean section. Thirty-six bitches were equally divided in the three anesthetic drug groups. Modified Apgar scores were assessed at 5, 15, and 60 min after delivery. Intraoperative vital signs and Apgar scores were compared using a linear mixed model and adjusted pairwise comparisons using Bonferroni analysis. A total of 125 puppies were included in this study. Age, body weight, litter size, type of surgery, delivery time, anesthetic and surgical duration, and intraoperative vital signs did not significantly differ between the groups. Puppies in the alfaxalone and propofol groups had significantly higher Apgar scores than the etomidate group in both elective and emergency surgery. In elective surgery, Apgar scores at 5 min after delivery did not differ significantly between groups. At 15 and 60 min after delivery, Apgar scores in the etomidate group were significantly lower than those in the other groups. In emergency surgery, Apgar scores were significantly lower in the etomidate group than in the alfaxalone group at all time points. Induction with alfaxalone and propofol resulted in better outcomes with higher Apgar scores and neonatal viability than etomidate. Therefore, alfaxalone and propofol should be used as anesthetic induction drugs in both elective and emergency cesarean sections.

Comparison of Phenylephrine infusion vs Nor-epinephrine Infusion on Maternal Hemodynamics and Neonatal Outcomes During Elective Lower Segment Caesarean Section under Sub-Arachnoid Block

Objective: To compare the efficacy of Phenylephrine and Nor-epinephrine IV infusions in maintaining maternal hemodynamics during EL-LSCS. Methodology: This randomized control trial study was conducted department of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad from March, 2023 to November, 2023. This study enrolled 62 patients fulfilling the inclusion criteria i.e., patient of age 18-45 years undergoing elective LSCS under SAB were enrolled in the study. While those having hypertension, pre-clampsia, eclampsia, pre-existing bradycardia, fetal distress and hypersensitivity to the medications used in the study were excluded. Enrolled patients were divided into two groups using computer generated random numbers with Group N patients received Nor-epinephrine infusion at rate of 2.5 Mcg/min while Group P patients received phenylephrine infusion at rate of 50 Mcg/min. Intraoperatively maternal hemodynamics were monitored and infusions were titrated to effect. Neonatal outcomes were assessed using APGAR score with umbilical cord ABGS carried out if clinically indicated. Results: Group P patients had statistically significant lower mean heart rate at 5,10,15 and 20 minutes as compared to group N. Similarly, pressures were significantly higher in group P than group N at 5,10,15,20 and 25 minutes. This required frequent changes in the rate of Phenylephrine infusion with the desired effect being achieved after 25 minutes of induction of Sub-Arachnoid block. Conclusion: Low dose Nor-Epinephrine infusion is safe and provides a better hemodynamic profile during Caesarean Section.

Maternal and neonatal outcomes of dichorionic twin pregnancies achieved with assisted reproductive technology: meta-analysis of contemporary data.

Assisted reproductive technology (ART) is commonly used to achieve pregnancy and often results in dichorionic diamniotic (DCDA) twin pregnancies. However, the potential risks of ART on maternal and neonatal outcomes in these pregnancies are not well understood. The objective is to compare the maternal and neonatal outcomes in DCDA twin pregnancies between those achieved through ART and those spontaneously conceived (SC). We carried out a systematic comprehensive search of electronic databases; namely, PubMed, Embase, Scopus, and the Cochrane Library, from inception to March 2023 with a study period of recruitment between 2003 and 2023. We included all studies comparing the maternal and neonatal outcomes of DCDA twin pregnancies between those achieved by ART and those SC. We analyzed data from 18 cohort studies involving 10,485 women with DCDA twin pregnancies. The meta-analysis showed that ART-conceived pregnancies had a significantly higher risk of preeclampsia or gestational hypertension (GH), gestational diabetes mellitus (GDM), placenta previa (PP), placental abruption (PA), postpartum hemorrhage (PPH), and elective and emergency cesarean sections than SC twin pregnancies. The absolute risks of these complications remained relatively low. We also found a slightly higher risk of respiratory distress syndrome (RDS) and congenital malformations in ART-conceived infants compared to the risks in SC infants. Finally, the risk of neonatal intensive care unit (NICU) admissions was significantly higher in ART-conceived infants than in SC infants, but with high heterogeneity. We found associations between DCDA twin pregnancies conceived through ART and increased frequencies of adverse maternal outcomes. However, the absolute risks of these complications remained low, and the benefits of ART for achieving successful pregnancies may well outweigh the potential risks. Additionally, ART-conceived DCDA twin pregnancies may pose higher risks of RDS, congenital malformations and NICU, admissions than SC DCDA twin pregnancies.

UNEVENTFUL PREGNANCY IN DIDELPHYS UTERUS DELIVERED THROUGH CAESAREAN SECTION: A CASE REPORT

Didelphys uterus, also known as "double uterus," is a rare congenital anomaly characterised by the presence of two separate uteri, each with its cervix. This happens as a result of the Müllerian duct embryonic fusion failing. The chance of having a pregnancy in one of the uteri without having any complications during pregnancy is relatively low. We are reporting a case of a 24-year-old primigravida woman with a didelphys uterus. The patient presented with the complaint of leaking per vaginum at term gestation in hospital IPD. She had undergone ultrasonography many times during her pregnancy, but no ultrasound finding suspects any congenital anomaly of the uterus. During the ninth month of gestation, when the patient came with leaking per vaginal, two vagina were discovered with a thick longitudinal vaginal septum, so she underwent an elective caesarean section due to the potential risks associated with vaginal delivery and under the suspicion of two separate uteri. During caesarean section, uterus didelphys was confirmed as two uteri with separate fallopian tubes and ovary; one was gravid, and another was non-gravid. The management of this condition requires careful planning and coordination among the multidisciplinary team to ensure a successful and safe outcome. The present case report reveals her history, diagnostic workup, caesarean delivery, and management outcome.

The influence of placenta microbiota of normal term pregnant women on immune regulation during pregnancy

Background The concerted regulation of placenta microbiota and the immune responses secures the occurrence and development of pregnancy, while few studies reported this correlation. This study aimed to explore the relationship between the placenta microbiota and immune regulation during pregnancy.Methods Twenty-six healthy pregnant women scheduled for elective cesarean section in the First Affiliated Hospital of Jinan University who met the inclusion criteria were recruited. Placenta and peripheral venous blood samples were collected. Microbiota in placental tissue was detected using high-throughput sequencing. Flow cytometry was used to detect immune cells in placental tissue and peripheral venous blood. ELISA and Luminex liquid chip technology were used to detect the content of cytokines in placental tissue and peripheral venous blood, respectively.ResultsThe placental microbiota has stimulating effects on the local immunity of the placenta and mainly stimulates the placental balance ratio CD56 + CD16 + /CD56 + CD16 and the placental macrophages, that is, it plays the role of immune protection and supporting nutrition. The stimulating effect of placental microbiota on maternal systemic immunity mainly induces peripheral Treg cells and B lymphocytes.ConclusionThe placental microbiota may be an important factor mediating local immune regulation in the placenta, and placental microbiota participates in the regulatory function of the maternal immune system.

MODIFIED GENERAL ANESTHESIA FOR ELECTIVE CESAREAN SECTION

Introduction: The general anesthesia for elective caesarean section is used when there are contraindications to subarachnoid anesthesia, with a total frequency up to 20%. The medical community does not have a single unified algorithm of general anesthesia for this type of surgery. The main disadvantages of the general anaesthesia for caesarean section are a high percentage of the accidental preservation of the patient's consciousness during the operation (1:670) and a pronounced stress reaction to the surgical trauma. Purpose: To compare the «routine» technique of total intravenous anesthesia with artificial lungs ventilation for elective cesarean section and the modified general anesthesia with adjuvants addition. Materials and methods: Our study is based on an examination of 60 patients. All patients were randomly divided into 2 groups. The first group is a «routine» method of general anesthesia, the second group is modified general anesthesia with adjuvants addition. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg), clonidine (100 μg), 30 minutes before surgery. Perioperative monitoring and treatment were based on the recommendations of the American Association of Anesthesiologists, the bispectral index and determination of the stress-induced substances (glucose, cortisol) blood levels were added. The newborns were evaluated with the Apgar scale and umbilical venous blood gas analysis was carried out. The two-sided Student's t-test was used for statistical data processing (p value = 0.001; Student's t-test < -3.466 and > 3.466). Results: There was no statistically significant difference in mean initial indicators between the two groups. The obtained results demonstrated the presence of statistically significant differences between the two groups: the mean blood pressure in a period after the trachea intubation/beginning of the surgery (t = 24.3); the mean blood pressure in a period of the newborn extraction (t = 25.5); the heart rate in a period after the trachea intubation/beginning of the surgery (t = 11.7); the heart rate in a period of the newborn extraction (t = 21.3); the bispectral index in a period after the trachea intubation/beginning of the surgery (t = 4); the bispectral index in a period of the newborn extraction (t = 8.2); assessment of newborns according to the Apgar scale at 1 minute (t = –4.5); pH of the umbilical venous blood (t = –5.44); PCO2 of the umbilical venous blood (t = 4.8); PO2 of the umbilical venous blood (t = –7.6); the blood glucose level in a period of the newborn extraction (t = 10.9); the plasma cortisol level in a period of the newborn extraction (t = 25.4). Conclusions: In view of the obtained results, modified general anesthesia with the adjuvants addition (clonidine, acetaminophen) in a period before the birth of a child during elective cesarean section has reasonable (statistically significant) advantages over the «routine» method of general anesthesia.

Role of Chewing Gum in Enhancing Post-Operative Recovery 0f Bowel Function after Lower Segment Cesarean Section

Background: The frequency of cesarean sections globally exceeds the World Health Organization's recommended rates, leading to an increased focus on postoperative recovery, particularly the restoration of gastrointestinal (GIT) function. The delayed return of intestinal activity, known as postoperative ileus, can extend hospital stays and elevate healthcare costs. Chewing gum has been proposed as a simple, non-pharmacological intervention to stimulate the GIT and potentially expedite recovery. Objective: This study aimed to evaluate the efficacy of chewing gum in improving GIT activity and recovery in patients following a cesarean section, contributing to the evidence base for postoperative care practices in obstetrics and gynecology. Methods: A cross-sectional comparative analytical study was conducted at the Department of Obstetrics and Gynecology, KRL Hospital Islamabad, from May 2021 to November 2021. Two hundred patients undergoing elective cesarean sections were divided into two groups: Group A (n=100), who received chewing gum postoperatively, and Group B (n=100), who did not. The primary outcomes measured were the time to first bowel sound, time to first flatus, and time to first defecation. Data were analyzed using SPSS version 25, with a significance level set at p≤0.05. Results: Group A demonstrated a significantly faster time to first bowel sound (3.75 ± 1.31 hours vs. 7.01 ± 1.94 hours, p=0.001), first flatus (7.97 ± 1.96 hours vs. 14.75 ± 3.57 hours, p=0.001), and first defecation (32.37 ± 3.56 hours vs. 48.20 ± 6.06 hours, p=0.001) compared to Group B. These findings were consistent across age stratifications, with significant improvements in GIT recovery times in younger (18-25 years) and older (26-35 years) subsets of patients. Conclusion: Chewing gum post-cesarean section significantly accelerates the recovery of GIT functions, reducing the time to first bowel sound, flatus, and defecation. This study supports the inclusion of chewing gum as a low-cost, effective method in postoperative care protocols for cesarean section patients, potentially improving patient outcomes and reducing healthcare costs.

Exploring Vaginal Birth After Cesarean: Success Rates and Cultural Decisions in the United Arab Emirates.

This study explores the success rates and cultural influences on the decision-making process for vaginal birth after cesarean (VBAC) in the United Arab Emirates (UAE). An observational cohort study was conducted at a hospital in the UAE accredited by Joint Commission International, enrolling 263 women eligible for VBAC from March 1, 2018, to February 28, 2019. The study focused on maternal-fetal outcomes, the proportions of women opting for trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (ERCS), and the impact of cultural backgrounds on these decisions. The study found significant cultural variations in VBAC acceptance and success rates. Among local Emirati/Omani women, 86% (152 out of 177) opted for TOLAC, with an 83% success rate (126 out of 152). In contrast, lower TOLAC uptake and success rates were observed among other nationalities, such as Egyptian and other Arab women. The study also noted higher VBAC success rates in women with prior vaginal deliveries and those who experienced spontaneous labor. NICU admissions and maternal readmissions were lower in the TOLAC group (1% NICU admissions and 2% maternal readmissions) compared to the ERCS group (8.2% NICU admissions). The study underscores the influence of cultural factors in VBAC decision-making and outcomes, highlighting the need for culturally tailored counseling and care. It also confirms the safety and efficacy of VBAC in appropriately selected cases, advocating for more research into counseling practices and long-term outcomes in culturally diverse populations. Impact statement: This research adds to the understanding of how cultural and ethnic backgrounds influence VBAC decisions and outcomes, offering critical insights for clinical practice, especially in multicultural societies like the UAE. It emphasizes the role of tailored counseling and suggests avenues for future research in this domain.

The duration of spinal anaesthesia in elective caesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial.

One of the common methods of anaesthesia for caesarean sections (CSs) involves the use of spinal anaesthesia in mothers. Various positions are utilized in this method. This study aims to compare the evaluation of two positions, Trendelenburg and reverse Trendelenburg, in candidates for CS to assess the duration of anaesthesia and changes in vital signs in women. This study was a randomized clinical trial in which 60 pregnant mothers who met the inclusion criteria entered the study. These mothers were randomly allocated into two equal groups using block randomization. One group of patients received spinal anaesthesia in the Trendelenburg position, while the other group received it in the Reverse Trendelenburg position. Vital signs (systolic and diastolic blood pressure, heart rate, Apgar score, and SPO2) of participants from both groups were evaluated for 1 h after the induction of anaesthesia. Additionally, sensory level and duration of anaesthesia were measured. Finally, the data from both groups were subjected to statistical analysis using SPSS version 26 software. The mean (SD) age of participating mothers in the Reverse Trendelenburg and Trendelenburg groups was 28.93 (5.82) and 30.97 (4.94), respectively. The two study groups did not significantly differ in baseline characteristics such as age, BMI, which could potentially impact vital sign outcomes or anaesthesia duration, and education (P>0.05). The mean (SD) duration of anaesthesia in the Trendelenburg position was significantly higher than in the Reverse Trendelenburg position [221.57(min) vs. 159.00(min)] (P<0.0001). There was no significant difference between the two positions, Trendelenburg and Reverse Trendelenburg, in terms of sensory level and its extent (P=0.08). The two study groups did not significantly differ in hemodynamic changes measured 13 times, including heart rate, systolic and diastolic blood pressure, and Apgar score (P>0.05). In spinal anaesthesia with the Trendelenburg position compared to the Reverse Trendelenburg position, there is a longer duration of anaesthesia. This is while the two positions did not differ in terms of hemodynamic changes and sensory level.

Association between the Mode of Delivery and Vertical Transmission of Human Papillomavirus.

Human papillomavirus (HPV) can be vertically transmitted. Our objective was to measure the association between the mode of delivery and the detection of HPV in infants. We used data collected from pregnant women during the HERITAGE study. Self-collected vaginal samples from the first and third trimester were obtained for HPV testing. Specimens from oral, pharyngeal, conjunctival and anogenital mucosa were collected from infants 36-48 h after delivery and at 3 months of age. All samples were tested for HPV DNA by the Linear Array assay. Adjusted odd ratios (aOR) and 95% confidence interval (CI) were estimated using multivariate logistic regressions. From the 282 women revealed to be HPV-positive in both the first and third trimesters, 25 infants were born HPV-positive. The overall probability of transmission was 8.9% (25/282); 3.7% (3/81) in participants with a caesarean section and 10.9% (22/201) for those who delivered vaginally. Vaginal delivery increased the risk of HPV in infants compared to caesarean (aOR: 3.63, 95%CI: 1.03-12.82). Infants born after a caesarean with ruptured membranes were not at increased risk of HPV compared to infants born after an elective caesarean section with intact membranes (aOR: 1.31, 95%CI: 0.10-17.76). Our results support the hypothesis that transmission occurs mostly during the passage in the vaginal canal.

Women’s experiences of postpartum contraceptive services when elective caesarean section is the method of birth: a qualitative study

BackgroundThe unmet need for postpartum contraception is a global challenge. Postpartum placement of an intrauterine device (IUD) within 48 hours of vaginal delivery is available in many settings worldwide, but...

Disparities in Elective and Emergency Caesarean Section Rates Among Public and Private Hospitals in the Districts of Andhra Pradesh, India.

Background In India, there has been a steady increase in the rate of caesarean section (C-section) deliveries over the past decade, rising from 17% during National Family Health Survey-4 (NFHS-4 (2015-16)) to as high as 21.5% during NFHS-5 (2019-21). Andhra Pradesh,India, is experiencing a particularly high rate of 42.4% as per NFHS-5, which is the highest among the states in the country. This study aims to investigate the prevalence of C-section deliveries across the districts of Andhra Pradesh and to identify the disparities in elective and emergency C-section rates among public and private hospitals in districts of Andhra Pradesh, India. Methods The study utilized secondary data from theNFHS-5conducted by the International Institute for Population Sciences, Mumbai. A statistical software package was used to perform the analysis, while a quantum geographic information system​​​​​​​ (QGIS) was used to prepare a map. Descriptive statistics, bivariate analysis, and multivariate binary regression were used for statistical analysis. Results Significant variations in the prevalence of C-section deliveries were found across the districts in Andhra Pradesh. The prevalence ranged from 22.2% in Anantapur to 66% in Krishna. It was also found that private hospitals were the primary drivers of the high prevalence of C-section deliveries. Approximately 31.51% of women underwent C-sections in public institutions, whereas it was 68.49% in private institutions. The overall occurrence of C-section deliveries in Andhra Pradesh was 65% for elective cases and 35% for emergency cases, indicating a relatively higher prevalence for elective procedures. Conclusion The choice of the medical institution, whether private or public, is the most significant factor influencing the high prevalence of C-section deliveries. Additionally, C-section deliveries were found with higher complication rates than normal deliveries. Elective C-sections are more prevalent in the state, and factors such as wealth quintile and birth order are impacting the likelihood of elective versus emergency C-section deliveries. The study suggests that the government should provide awareness and regulations to promote vaginal deliveries and prevent unnecessary C-sections in hospitals.

Socio-economic disadvantage and utilisation of labour epidural analgesia in Scotland: a population-based study†.

Socio-economic deprivation is associated with adverse maternal and childhood outcomes. Epidural analgesia, the gold standard for labour analgesia, may improve maternal well-being. We assessed the association of socio-economic status with utilisation of epidural analgesia and whether this differed when epidural analgesia was advisable for maternal safety. This was a population-based study of NHS data for all women in labour in Scotland between 1 January 2007 and 23 October 2020, excluding elective caesarean sections. Socio-economic status deciles were defined using the Scottish Index of Multiple Deprivation. Medical conditions for which epidural analgesia is advisable for maternal safety (medical indications) and contraindications were defined according to national guidelines. Of 593,230 patients in labour, 131,521 (22.2%) received epidural analgesia. Those from the most deprived areas were 16% less likely to receive epidural analgesia than the most affluent (relative risk 0.84 [95%CI 0.82-0.85]), with the inter-decile mean change in receiving epidural analgesia estimated at -2% ([95%CI -2.2% to -1.7%]). Among the 21,219 deliveries with a documented medical indication for epidural analgesia, the socio-economic gradient persisted (relative risk 0.79 [95%CI 0.75-0.84], inter-decile mean change in receiving epidural analgesia -2.5% [95%CI -3.1% to -2.0%]). Women in the most deprived areas with a medical indication for epidural analgesia were still less likely (absolute risk 0.23 [95%CI 0.22-0.24]) to receive epidural analgesia than women from the most advantaged decile without a medical indication (absolute risk 0.25 [95%CI 0.24-0.25]). Socio-economic deprivation is associated with lower utilisation of epidural analgesia, even when epidural analgesia is advisable for maternal safety. Ensuring equitable access to an intervention that alleviates pain and potentially reduces adverse outcomes is crucial.

Hemodynamic Changes in Elective Cesarean Section, Under Spinal Anesthesia: A Prospective Randomized Controlled Double-Blind Comparison Study with Preoperative Ondansetron Administration

The most widely used anesthesia technique for cesarean delivery is the spinal anesthesia (SA). In Bnai-Zion Medical Center over than 90% of the elective cesarean sections performed under SA. However, this type of anesthesia frequently associated with side effects that primarily affect the parturient and the fetal health [1]. Nearly, 70-80% of obstetric patients experience spinal anesthesiainduced hypotension (SAIH) without pharmacological prophylaxis [2]. This hypotension is commonly accompanied with reflex tachycardia, nausea and vomiting, and in rare occasions bradycardia can be observed. Most authors agree that hypotension presents when systolic blood pressure (SBP) reduced from baseline of more than 20% [3]. The main mechanism of SAIH is decreased systemic vascular resistance resulting from arterial vasodilation [4].

Induction of human-fetal-membrane remodeling in-vitro by the alpha hemolysin of Escherichia coli

IntroductionAlmost 80% of urinary tract infections during pregnancy are caused by uropathogenic strains of Escherichia coli. Alpha-hemolysin, toxin secreted by them, has a fundamental role in this pathology development. Considering that urinary tract infections are related with premature rupture of fetal membranes, we proposed to evaluate the effects that alpha-hemolysin induces on human-fetal-membranes. MethodsThirteen fetal membranes obtained from elective cesarean sections (>37 weeks) were mounted in a transwell-device generating two independent chambers. To mimic an ascendant-urinary-tract infection, membranes were incubated with different concentrations of pure alpha-hemolysin from the choriodecidual side during 24h. Extensive histological analyses were performed and transepithelial electrical-resistance were determined. Cell viability, metalloproteinase activity and cyclooxygenase-2- gene expression was estimated by lactate-dehydrogenase–release assay, zymography and RT-qPCR, respectively. Finally, four fetal membranes were treated with hemolysin preincubated with polyclonal anti-hemolysin antibodies. Cell viability and metalloproteinase activity were monitored. ResultsAfter 24 h of treatment, fetal membranes evidenced a structural damage and a decrease in membrane resistance that progressed as the concentration of alpha hemolysin increased. While the amniotic-epithelial-layer remained practically unaffected, the chorion cells manifested an increase in vacuolization and necrosis. In addition, the extracellular matrix exhibited collagen-fiber disorganization, a marked decrease in fiber content, and became thicker in presence of the toxin. Cyclooxigenase-2 expression and metalloproteinase activity were also higher in the treated groups than in untreated ones. Finally, a preincubation of hemolysin with specific antibodies prevented the cytotoxicity on the chorion cells and the increase in metalloproteinase activity. DiscussionHemolysin induces structural and molecular changes associated with the remodeling of human-fetal-membranes in-vitro.

Comparison of the Effect of Ondansetron and Dexamethasone on Postoperative Shivering After Cesarean Section in Patients Undergoing Spinal Anesthesia

Background: Shivering is one of the most common problems after spinal anesthesia, which can cause many complications. Various methods and drugs have been used to prevent and treat postoperative shivering. In the present study, the pretreatment effect of ondansetron and dexamethasone in reducing the incidence of shivering after elective caesarean section by the spinal method has been investigated. Methods: In this study, 78 patients undergoing elective cesarean surgery who were eligible to enter the study were evaluated and randomly divided into two groups: 8mg of ondansetron and 4mg of dexamethasone 15 minutes before the end of surgery. Then, the incidence of shivering was measured at specific time intervals after surgery. Statistical analysis was done using SPSS software. Results: The two groups were similar in terms of age, height, weight, and BMI (p-value &gt; 0.05). The incidence of shivering at the time of entering the recovery, 10, 20, and 30 minutes in the ondansetron group was 23.1%, 20.5%, 12.8% and 0% and in the dexamethasone, group was 20.5%, 15.4%, 5.2% and 0%, respectively. Statistical analysis showed that these differences are not significant at the significance level of 0.05. These two drugs have the same effectiveness in controlling shivering after cesarean section under spinal anesthesia (p-value &gt; 0.05). Conclusion: Dexamethasone and ondansetron will be able to control shivering after caesarean section with spinal anesthesia.