Elective Caesarean Section Research Articles

Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study

BackgroundVaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH).MethodsAn institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of < 0.05 at the 95% confidence level (CI) was considered statistically significant.ResultsThe majority, 71.5% (95% CI: 64.7, 77.1), of participants preferred the trial of labor after cesarean (TOLAC) as their mode of delivery. Mothers who were married (AOR = 4.47, 95% CI: 1.19–16.85), had a diploma educational level (AOR = 3.77, 95% CI: 1.84–12.36), had previous post-cesarean complications (AOR = 3.25, 95% CI: 1.08–9.74), and knew about the success of the trial of labor after cesarean (AOR = 13.56, 95% CI: 4.52–37.19) were found to prefer the trial of labor compared with their counterparts.ConclusionThis study concluded that most pregnant mothers preferred labor trials after one CS, which is a bit lower but comparable with recommended practice guidelines. Providing adequate information and counseling mothers to make informed decisions about their preferred mode of delivery could be substantial.

Maternal and Fetal Outcome Following Post In vitro Fertilization and Embryo Transfer Pregnancy: A Prospective Observational Study

Abstract Background: While the majority of in vitro fertilization (IVF)-conceived children are healthy, IVF has been associated with an increased risk of adverse obstetric and perinatal outcomes including hypertensive disorders of pregnancy, preterm labor and preterm delivery, and low birth weight (LBW). Objective: The objective of the study is to assess pregnancy, maternal, and perinatal outcomes in patients undergoing IVF embryo transfer (IVF-ET) at tertiary care center in North India. Methodology: It was a prospective observational study carried out for duration of 20 months among women who conceived following an IVF-ET. The sample size was 107 consecutive mothers and data were collected using a predesigned semi-structured study pro forma. Detailed menstrual, obstetric, and medical histories of each patient were noted. Findings of the general, physical, systemic, and obstetrical and gynecological examination were noted for all patients. Results: One hundred and seven mothers who fulfilled the study criteria were included. Of these, 4 had an abortion. Rest of the 103 mothers were included in the final analysis. The mean age of the mothers was 30.39 ± 4.7, ranging from 22 to 50 years. Twin pregnancy rate was 45.7%. All were dichorionic-diamniotic twins. Based on gestational age, 5% were extreme preterm births, 14% were very preterm births, 32% were late preterm births, and 48% were early-term births. Normal vaginal delivery (NVD) occurred in 26.2% of the mothers, elective lower-segment cesarean section (LSCS) in 21.4%, emergency LSCS in 51.4%, and one case had vacuum delivery. Hence, NVD occurred in 27% and 73% had LSCS. With respect to neonates born to study participants, 8% were extremely LBW, 7.3% were very LBW, 46% were LBW, and the rest 38.7% weighed 2.5 kg or more at birth. Conclusion: IVF-ET is a safe and highly successful treatment for infertility. Many of adverse outcomes are largely due to an increased risk of multiple gestations in IVF. Patients with infertility are likely to be older and have preexisting comorbid conditions such as hypertension, diabetes, insulin resistance, or other endocrinopathies which may predispose them to adverse obstetric and perinatal outcomes. It is also recommended that patients should be given adequate preconception counseling regarding increased maternal as well as neonatal risk.

Factors affecting elective cesarean section in women with multiple pregnancy in Caruban, Indonesia.

Background: Caesarean sections have become the most popular method for delivering twin babies because of the safety concerns associated with a natural birth. This study aims to identify the maternal characteristics and obstetric parameters that serve as risk factors influencing caesarean delivery in twin pregnancies by comparing women delivering via caesarean section and vaginal birth. Methods: A retrospective chart review design was used to analyse 47 women with multiple pregnancies from the medical records at a primary referral hospital in East Java, Indonesia. Women delivering vaginally were then compared with women who underwent a caesarean section to identify any differences between the groups. Results: In our study, more women delivered by caesarean section (n=35) than by vaginal birth (n=12). Women were more likely to undergo a caesarean section if they had a previous history of undergoing a caesarean section (OR 16.5; 95% CI 1.91-142.49; p=0.02). Similar to previous studies, we found that foetal malpresentation significantly increase the risk of caesarean delivery (OR 8.25; 95%CI 0.95-71.09; p=0.03), while labour augmentation decrease the likelihood of caesarean section (OR 0.20; 95% CI 0.49-0.81; p=0.03). There was also a significant older patients in the caesarean section groups (OR 1.26; 95% CI 1.09-1.45 ; p=0.00). Conclusions: The percentage of multiple pregnancies delivered via caesarean section is quite high. Other larger cohort study are warranted, since many factors were involved in the decision of caesarean section.

Tocophobia: a nosological quagmire.

Fear of childbirth exists on a continuum of severity, and the most severe form is commonly referred to as tocophobia. Although a rare entity, tocophobia is a common reason for requesting an elective cesarean section. It is generally considered a specific phobia but is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a diagnostic entity. To improve the assessment and treatment of tocophobia, research is warranted to clarify its relationship with commonly occurring psychiatric disorders in pregnancy.

Comparing elective and emergency caesarean section by using bioimpedance method.

There are limited studies focusing on hemodynamic changes between elective and emergent C/S cases. We considered that a better understanding of the alterations and physiological reactions in both situations with non-invasive novel technologies might be useful in managing maternal and fetal sides. In this prospective observational study, non-invasive hemodynamic changes were observed by using the whole-body impedance method using the NICaS™ device. CO, cardiac index (CI), stroke volume (SV), stroke index (SI), total peripheric resistance (TPR), and cardiac reserve (GGI) parameters were evaluated with a non-invasive method. Measurements were done initiating before surgery, 9 times of 5min intervals. All 95 patients finished the study. 47 cesarean sections were in the elective group, 48 were in the emergent group. SV in 4.5.6. time intervals were statistically increased in the elective group (p values: SvMl4: 0.025, SvMl5: 0.049, SvMl6: 0.044) (p < 0.05). SI in the second-time interval was statistically increased in the emergent group (p-value SI2: 0.047) (p < 0.05). SI in the 4th time interval was statistically increased in the elective group (p-value SI4: 0.047) (p < 0.05). CO measurements were not statistically different between groups in all time intervals for all comparisons. CI in the second time interval was statistically decreased in the elective group (p-value CI2: 0.012) (p < 0.05). GGI in the 4th time interval was statistically increased in the elective group (p-value GGI4: 0.035) (p < 0.05). TPRI in the second time interval was statistically increased in the elective group (p-value TPRI 2: 0.014) (p < 0.05). Understanding normal hemodynamic values before, during, and after C/S is feasible and might help the clinician assess patients' cardiac performance with a reliable noninvasive technique. NICaS might be a reliable tool to evaluate patients' baseline values and diagnose complications earlier during the surgery.

Predictive Efficacy of the Perfusion Index for Hypotension following Spinal Anesthesia in Parturient Undergoing Elective Cesarean Section: A Systematic Review and Meta-Analysis.

This meta-analysis assessed the predictive efficacy of perfusion index for hypotension following spinal anesthesia (SA) in parturients undergoing elective cesarean section (CS). Electronic databases, including Google Scholar, EMBASE, Cochrane Library, and MEDLINE, were searched from inception to June 2023. The primary outcome was the diagnostic accuracy of the perfusion index in predicting the probability of perioperative hypotension following SA. The review included 12 studies involving 2009 patients, published between 2017 and 2023. The pooled sensitivity and specificity were 0.81 (95% confidence interval (CI) = 0.72-0.87) and 0.75 (95% CI = 0.67-0.82), respectively. Additionally, the pooled area under the curve (AUC) was calculated as 0.84 (95% CI = 0.81-0.87), suggesting a moderate to good accuracy of the diagnostic test. Using Fagan's nomogram plot, the positive likelihood ratio (LR) and negative LR were found to be 3 and 0.26, respectively. The results demonstrated that the perfusion index exhibited an acceptable level of accuracy in predicting perioperative hypotension after spinal anesthesia in parturients undergoing elective CS. These findings highlight the potential value of incorporating a perfusion index as a useful tool for clinicians to integrate into routine clinical practice, which necessitates further large-scale studies for verification.

Effect of Intrathecal Morphine on Postdural Puncture Headache in Obstetric Anaesthesia.

Intrathecal morphine is used as an effective component of multimodal analgesia in postoperative analgesia in cesarean section patients. We aimed to analyze the relationship between intrathecal morphine administration and postdural puncture headache (PDPH), pain score and analgesia consumption in the postoperative period, and maternal fetal effects. One hundred four pregnant women aged ≥18 years (American Society of Anesthesiology physical status I or II, >36 weeks gestation) who were scheduled for elective cesarean section under spinal anaesthesia were included in this study. Spinal anesthesia consisted of bupivacaine with or without morphine (Group M: 10 mg heavy marcaine + 25 mcg fentanyl + 100 mcg morphine; Group F: 10 mg heavy marcaine + 25 mcg fentanyl). The effect of intrathecal morphine on PDPH, postoperative pain score, analgesia consumption, and maternal and fetal effects were recorded for 5 days. PDPH developed in a total of 33 patients (Group M: 18 and Group F: 15, P=0.274). When we evaluated PDPH with the VAS, there was no significant difference between the groups. The postoperative visual analogue scale (VAS) was lower in the morphine group, and no statistically significant difference was found in the VAS 1st hr and VAS 2nd hr, whereas the VAS 6th hr and VAS 24th hr were found to be statistically significant. There was no difference in terms of PDPH, the first analgesic requirement and postoperative nausea-vomiting, but meperidine consumption was lower in the morphine group. Low-dose intrathecal morphine did not affect the incidence of PDPH. It is an effective method that can be used in cesarean section patients without increasing the maternal and fetal side effects from postoperative analgesia.

Comparative study of norepinephrine and phenylephrine infusion for prophylaxis against post-spinal hypotension in patients undergoing elective cesarean section

Comparative study of norepinephrine and phenylephrine infusion for prophylaxis against post-spinal hypotension in patients undergoing elective cesarean section

Anesthetic management of a patient with pheochromocytoma and peripartum cardiomyopathy for cesarean section

Pheochromocytoma and peripartum cardiomyopathy is associated with significant maternal mortality. Cause of death can be heart failure, myocardial infarction, arrhythmias and thromboembolism. Pheochromocytoma can be one of the causes of dilated cardiomyopathy. Anesthesia in an obstetric patient with pheochromocytoma and peripartum cardiomyopathy is challenging. Early diagnosis and a multidisciplinary management is required to improve outcome. Elective cesarean section must be planned and epidural anesthesia should be the preferred technique. We present a case of 34 y old female patient with pheochromocytoma and peripartum cardiomyopathy who underwent cesarean section under epidural anesthesia and had uneventful recovery.&#x0D; Key words: Pheochromocytoma; Peripartum Cardiomyopathy; Cesarean Section; Epidural Anesthesia&#x0D; Citation: Ayesha K, Khan J, Sikander RI, Fatima N. Anesthetic management of a patient with pheochromocytoma and peripartum cardiomyopathy for cesarean section. Anaesth. pain intensive care 2023;27(4):596−599.&#x0D; DOI: 10.35975/apic.v27i4.2208&#x0D; Received: April 16, 2023; Reviewed: May 09, 2023; Accepted: June 06, 2023

Prevalence of Breech Presentation and Other Gestational/Delivery Characteristics Among Patients Born With Developmental Dysplasia of the Hip.

Introduction Developmental dysplasia of the hip (DDH) is the most common congenital disability in newborns. The condition can range from a slight laxity in the hip joint to secondary femoral head injury, early osteoarthritis (OA), and mobility issues. There are several risk factors for DDH, including positive family history, female sex, breech presentation, and the presence of clubfoot. Early detection and treatment are crucial to avoidlong-term hip dysplasia and arthritis, which can cause difficulty in walking and discomfort. Breech presentation, in particular, is a significant risk factor for DDH, with spontaneous vaginal birth increasing the risk of hip pathology and instability compared to elective Caesarean section. However, whether breech presentation continues to be a risk factor for DDH in preterm children is unknown. Objective and methods This study aimed to investigate the prevalence of breech presentation and other gestational/delivery characteristics among newborns diagnosed with DDH.This retrospective study was conducted at Abha Maternity and Children Hospital,Abha, Saudi Arabia, over a period of six months. Data were collected from medical records of DDHcases diagnosed between 2016 and 2023. Data analysis was performed using Microsoft Excel (MicrosoftCorporation, Redmond, Washington, United States)and IBMSPSSStatistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Descriptive statistics and statistical tests were used to analyze the data. Results Most of the diagnosed children were female (86.7%), and bilateral hip dislocation (40%) was the most common presentation. X-ray was the most common diagnostic tool (48.3%), and operative management was the most common management strategy (73.3%). A positive family history of DDH was reported in more than one-third of cases. The study also analyzed the association between complications during pregnancy and various factors such as mode of delivery, presentation at delivery, gestational age at delivery, and associated maternal diseases. The difference in complication rates between women who delivered via C-section and those who delivered vaginally was insignificant (p = 0.14). Similarly, the difference in complication rates between women with breech and cephalic presentation was not statistically significant (p = 0.094). The difference in complication rates between women who delivered preterm, at term, or post-term was also not statistically significant (p = 0.578). Furthermore, the association between complications during pregnancy and pregnancy-associated maternal diseases was not statistically significant (p = 1.00). Conclusion DDH is a significant health issue in newborns, leading to long-term mobility problems and discomfort. Positive family history of DDH is a significant risk factor. Breech presentation was not significantly associated with DDH in preterm children, and no significant associations were found between complications during pregnancy and various factors. Early detection and treatment of DDH are crucial for preventing long-term complications. Family history should be considered an important risk factor, emphasizing the need for screening programs in families with a history of DDH.

Retrospective analysis of 277 cases of placenta accreta spectrum diagnosed with ultrasound at a single tertiary care center

Introduction :Â Placenta accreta spectrum (PAS) is characterized by abnormal placental adherence and failure to separate from the uterine wall after delivery. The PAS-associated morbidities include peripartum hysterectomy (loss of fertility), massive hemorrhage and the requirement of blood transfusion (leading to consumptive coagulopathy and multisystem organ failure), admission to the intensive care unit (ICU), injury to adjacent organs, and death. Its incidence is on the rise due to an increasing number of caesarean deliveries.Objective :Â The goal of our study is to analyze the characteristics and outcomes of PAS managed at a tertiary care center with a high volume of PAS.Methods :Â The design of analytic observation research with a retrospective cross sectional method with ultrasound diagnosis of PAS at M. Djamil Central General Hospital from January 2020 to December 2022 was reviewed. Details of obstetric backgrounds, predelivery diagnosis, peripartum management, and outcomes were analyzed with mean difference test and chi square.Results :Â Two hundred and seventy-seven women with PAS were identified with ultrasound from 4,500 deliveries during the study period (6.15%). Approximately 45.48% of women with PAS had hysterectomy, while 54.52% did not; 3 cases were conservatively performed. Emergency and elective caesarean sections were accomplished in 32.85% and 67.15%, respectively. There was 3.25% maternal mortality. Anterior PAS (83.3%) is associated with attachment to the previous uterine scar and intraoperative blood loss compared to posterior PAS (15.88%) (p&lt;0.05). The PAS patients with previous uterine surgery had the highest chance of peripartum hysterectomy (p&lt;0.001).Conclusion :Â The placenta accreta diagnosed by antepartum ultrasound is approximately 6.15%. Almost half of the women in the study had hysterectomies. Only one-third of women with PAS in our study underwent emergent surgery. Anterior PAS is associated with placental attachment to the previous uterine scar and greater intraoperative blood loss compared with posterior PAS. The history of previous uterine surgery in women with PAS increased the chance of peripartum hysterectomy even further. The placenta accreta spectrum should be managed in a center with a high level of surgical expertise.

Patient Satisfaction With General Anesthesia Compared to Spinal Anesthesia for Cesarean Section: A Multicenter Observational Study.

Background Satisfaction in patients undergoing cesarean section (CS) is of great importance in every hospital. There are big differences between spinal and general anesthesia for CS in terms of outcome, recovery times, and quality of service. Methods This multicenter observational study included 1443 patients who had elective (n=622) or emergency (n=821) CS in five medical centers over the period of 16 months. Bauer questionnaire was used for measuring patient satisfaction after CS. The questionnaire contained 15 questions about anesthesia-related discomfort and satisfaction with anesthesia care. Results During the study period, 1161 (80%) patients underwent CS under general anesthesia (GA) and 282 of them (20%) received spinal anesthesia (SA) for CS. The most frequently reported anesthesia-related discomfort was pain at the surgical site (>70%), drowsiness (68%), and thirst (60%). The data on patient satisfaction showed high satisfaction that exceeded 90%. Anesthesia side effects were less frequent and the general satisfaction rate was higher in the SA group compared to the GA group (P < .001). Conclusion SA for CS had less frequent side effects and a better satisfaction rate compared to GA for CS. Hospitals need to make room for improvement of postoperative acute pain control and introduction to Enhanced Recovery After Surgery (ERAS) protocols for elective CS.

Risk indicators for obstetrical anal sphincter injury in vaginal birth after caesarean section compared to first vaginal delivery

ObjectivesComparison of the rate of obstetric anal sphincter injury (OASI) between women having their first vaginal birth after caesarean section (CS) and true nulliparous women with a vaginal delivery. Assessment of risk indicators for OASI in women with vaginal birth after one CS (VBAC). Study design28 535 women with their first VBAC and a cohort of 275 439 nulliparous women with a vaginal delivery of a liveborn infant in a cephalic position from the Dutch perinatal registry were analyzed. We compared the OASI rate with univariate and multivariate analysis. In women with VBAC possible risk indicators for OASI were assessed using univariate and multivariate logistic regression analysis. ResultsThe rate of OASI was 5.2% in women with vaginal birth after CS and 4.0% in women with a first vaginal delivery. The adjusted OR (aOR) for vaginal birth after an elective CS was higher (aOR 1.34, 95% CI 1.23–1.47) compared to vaginal birth after an emergency CS (aOR 1.16, 95% CI 1.08–1.25). In women with vaginal birth after emergency CS, the aOR for the indication non-progressive labor was 1.18 (95% CI 1.08–1.29), whereas CS for suspected fetal distress was not significantly associated with obstetric anal sphincter injury in VBAC.In the 28 535 women with a VBAC, mediolateral episiotomy (MLE), birth weight < 3000 g and maternal age < 25 years were associated with a significantly lower rate of OASI. A gestational age of 42 weeks, birth weight ≥ 3500 g, operative vaginal delivery and duration of the 2nd stage of labour of ≥ 60 min were associated with a significantly higher rate of OASI. ConclusionsWomen with a VBAC have a higher rate of OASI in comparison with women with a first vaginal delivery, with the exception of women with a vaginal birth after an emergency CS for suspected fetal distress. Factors associated with a significantly lower rate for OASI were MLE, maternal age < 25 and birth weight < 3000 g. A gestational age of 42 weeks, birth weight between 3500 and 4000 g and ≥ 4000 g, operative vaginal delivery and duration of the 2nd stage of delivery longer dan 60 min were associated with a significantly higher rate of OASI.

A case report on primigravida with myasthenia gravis: outcome of pregnancy

Primigravida refers to a woman who is pregnant for the first time. It is a unique experience for the woman. Usually, any minor alignment during this time will lead to anxiety. The prevalence rate of myasthenia gravis in pregnancy is 1 in 20,000. The main reason behind the cause of the disease is improper secretion of acetylcholine, huge secretion of cholinesterase, and non-responsive muscle fibers. The purpose of this case study is to introduce the outcome of pregnancy with myasthenia gravis. This case was taken at X private hospital. A 27-year-old primigravida woman with 38 weeks of pregnancy was the first known case of myasthenia gravis. She was diagnosed with myasthenia gravis thymic hyperplasia in November 2020. The patient is then managed with a surgical procedure, i.e., thymectomy, on 18 September 2021. The patient was receiving distinon (pyridostigmine) 60 mg. It requires the intraoperative collaboration of the neurology and obstetrics departments in managing myasthenia gravis during pregnancy. A successful elective caesarean section was done on the patient's request under spinal anaesthesia on 13 April 2023. The male newborn, with a birth weight of 2.825 gm was delivered. The newborn was transferred to the NICU for further surveillance and did not show any sign of muscular weakness. The baby was healthy at the time of discharge.

Indicators of Elective and Indicative Caesarean Section at Teaching Hospitals in Mosul City

Indicators of Elective and Indicative Caesarean Section at Teaching Hospitals in Mosul City

Post-cesarean Delivery Analgesia Using Spinal Anesthesia: Ropivacaine-Fentanyl vs. Ropivacaine-Sufentanil.

To improve the quality of intraoperative and postoperative analgesia during spinal anesthesia, intrathecal opioids are used as adjuvant drugs in combination with local anesthetics. This study aimed to compare the intrathecal injection of ropivacaine-fentanyl with ropivacaine-sufentanil in terms of the duration of analgesia after cesarean section (CS). This randomized, double-blind clinical trial study was conducted on women referred to Imam Khomeini Hospital of Ahvaz City for elective CS in 2021. A total of 51 patients were randomly divided into 2 groups. The first group (n = 25) received ropivacaine (17.5 mg) + fentanyl (25 μg), while the second group (n = 26) received ropivacaine (17.5 mg) + sufentanil (2.5 μg) for spinal anesthesia. Eventually, several parameters were investigated, including the duration of sensory and motor block, duration of analgesia (based on the Visual Analog Scale (VAS)), hemodynamic parameters, and possible complications. The duration of surgery (P = 0.059) and the duration of motor block (P = 0.962) were not significantly different between the 2 groups. The mean duration of analgesia (from the time of entering recovery to reaching VAS = 3) was 203.12 ± 72.93 and 207.46 ± 69.59 minutes in the fentanyl and sufentanil groups, respectively (P = 0.658). Systolic and diastolic blood pressure (SBP/DBP) drops in minute 5 were observed more frequently in the sufentanil group than in the fentanyl group (P = 0.027 and P = 0.002, respectively). At the other time points, however, no significant difference was observed between the 2 groups in terms of hemodynamic variables (P > 0.05). Finally, the frequency of pruritus was higher in the sufentanil group than in the fentanyl group (26.9% vs. 4.0%; P = 0.024). Adding fentanyl or sufentanil to intrathecal ropivacaine provides a similar duration of analgesia. However, fentanyl was associated with better hemodynamic stability and a lower incidence of pruritus.

Comparison between Effects of Fentanyl and Dexmedetomidine as Sedative in Elective Caesarean Section Under Subarachnoid Anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (Subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. This study compares Fentanyl and Dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia.&#x0D; Materials and methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients between age 20-40 years undergoing elective caesarean sections under subarachnoid anaesthesia during the period January 2022 to June 2022.Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Dexmedetomidine group (Group D, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (Intravenous) injection of Fentanyl or Dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (Patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’&#x0D; Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (p&gt;0.05). Time of onset of sedation was comparable between Fentanyl and Dexmedetomidine (p value 0.210). The arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine than Fentanyl (p&lt;0.05). Fentanyl was associated with significantly higher incidence of some adverse effects like nausea, vomiting than Dexmedetomidine (46.66% vs 13.33%, p&lt;0.05). Significant percentage of patients was satisfied with Dexmedetomidine than Fentanyl (86.66% vs 20%,p&lt;0.001).&#x0D; Conclusion: The study showed that the arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine which is beneficial for the patient in single dose technique for sedation. Moreover, Fentanyl was associated with high incidence of some adverse effects like nausea, vomiting. Thus it is recommended that Dexmedetomidine is a better choice than Fentanyl for sedation in single dose technique during subarachnoid block for caesarean section.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 48-52

Retroperitoneal Hematoma Following Cesarean Section: A Case Report

Background: In this case report, a retroperitoneal hematoma developed after an uncomplicated cesarean section. Case report: A 37-year-old patient with a term pregnancy was hospitalized for elective cesarean section with the diagnosis of repeated cesarean section. A live female baby of 3040 grams was delivered. There was no complication during surgery. The patient was transferred to the service postoperatively. Fainting sensation, tachycardia, tachypnea, and hypotension occurred in the first postoperative hour. In the CT scan, a 108x105 mm hematoma was observed in the right lateral retroperitoneal area of the uterus. When the hemoglobin value was 6.9 on the postoperative 1st day, 2 Units of erythrocyte suspension and 2 Units of fresh frozen plasma were given to the patient, The patient's vital signs remained stable for 4 days postoperatively. Conclusion: The retroperitoneal hematoma is a potentially life-threatening condition. Conservative or surgical treatment should be applied according to clinical findings.

The perception of obstetric healthcare workers to the partners’ presence in the operating room-a phenomenological study

Objective: It is current practice in our setting to not admit a partner in theatre during cesarean section (CS) even though this is becoming commonplace in various countries. This study is designed to determine the views of healthcare workers, postpartum mothers and their accompanying partners on having a partner present in the operating roon (OR) during an elective CS at Port of Spain General Hospital, Trinidad, West Indies.&#x0D; Materials and Methods: The study’s theoretical model was based on a constructionist, interpretivist framework as well as phenomenological research. A semi-structured interview was conducted and a thematic approach was used to develop codes. This was analyzed by Qualitative Data Analysis (QDA miner) software and the following themes emerged: ‘Maternal support’; ‘Fathers’ marginalization’; ‘Nurses’ perception of fathers’ role’; ‘Healthcare workers’ perception of litigation and ‘Limiting factors’.&#x0D; Results: 70% of respondents were in favor of a partner being present in the operating room for an elective CS and thought it would help to keep the mother at ease by allowing her to hold hands with the partner, talk to them and be accompanied by them to the recovery room. Healthcare workers did think that male partners might not have much of an impact in the operating room as they would not know what to do and may actually pose a security threat if things did not go exactly as planned.&#x0D; Conclusions: Healthcare professionals were neutral about partners being present in the operating room but had concerns regarding partner’s presence in the operating room. &#x0D; Key words: Anesthesia; Cesarean section; Health personnel; Parturients; Obstetric; Perception&#x0D; Citation: Ventour D, Gardiner K. The perception of obstetric healthcare workers to the partners’ presence in the operating room-a phenomenological study. Anaesth. pain intensive care 2023;27(4):528−534; DOI: 10.35975/apic.v27i4.2276&#x0D; Received: May 08, 2023; Reviewed: June 22, 2023; Accepted: June 28, 2023

Effects of perioperative use of esketamine on postpartum depression risk in patients undergoing cesarean section: A randomized controlled trial

BackgroundPostpartum depression (PPD) is a prevalent public health issue. Although ketamine has prophylactic effects on PPD in women undergoing cesarean section, the effects of esketamine on PPD remain unclear. This trial aimed to evaluate the efficacy of perioperative esketamine infusion on PPD risk by assessing Edinburgh Postnatal Depression Scale (EPDS) scores and blood biomarkers. MethodsA total of 150 participants undergoing elective cesarean section were randomly allocated to receive either esketamine or normal saline. Since 27 participants were excluded due to consent withdrawal or loss to follow-up, 123 patients were included. The primary outcome was the prevalence of PPD risk. Secondary outcomes included the prevalence of postpartum anxiety (PPA) risk, levels of biomarkers, postoperative pain intensity, and cumulative sufentanil consumption. ResultsThe prevalence of PPD and PPA risk at 3 days, 42 days, 3 months, and 6 months postpartum did not differ between the two groups. Furthermore, EPDS scores, pain intensity at rest, and during coughing on postoperative days (POD) 1 and 2 did not differ between the two groups. Sufentanil consumption during 0–12 h, 12–24 h, 0–24 h, and 0–48 h postoperatively were significantly lower in the esketamine group compared to the control group. Blood biomarkers did not differ between the two groups on POD 3. LimitationsThe sample size was small. PPD risk was simply screened, not diagnosed. ConclusionsPerioperative administration of esketamine did not decrease the incidence of PPD risk in women after elective cesarean section. However, esketamine reduced opioid consumption.