Elective Caesarean Section Research Articles

Trial of labour after caesarean section in Sub‐Saharan Africa: A systematic review and meta‐analysis

AbstractObjectiveThe objective of this study is to determine the proportion of women undergoing trial of labour after caesarean (TOLAC) and vaginal birth after caesarean (VBAC) in Sub‐Saharan Africa (SSA), and to estimate associated adverse events.MethodsWe searched PubMed, MEDLINE, CAB, EMBASE and African‐specific databases from 1966 to July 2023, including SSA studies reporting on women with previous caesarean section (CS). We extracted data on study design, planned (TOLAC versus elective repeat CS (ERCS)) and actual delivery mode, and adverse outcomes. We calculated mean TOLAC and VBAC proportions, and pooled proportion of adverse events, comparing between TOLAC and ERCS where available. We assessed bias using the methodological index for nonrandomized studies.ResultsFrom 62 studies with 36 611 births, the estimated proportion undergoing TOLAC and achieving VBAC, adjusted for study variability, were 79% (95% confidence interval [95% CI]: 74%, 85%) and 47% (95% CI: 42%, 51%), respectively, for all births. Mean estimated uterine rupture proportion and maternal mortality were 2.1% (95% CI: 1.1%, 3.2%) and 0.1% (95% CI: 0.02%, 0.2%) respectively. We found no differences between TOLAC and ERCS for uterine rupture (1.2% vs. 0.2%, pooled odds ratio [OR]: 1.54; 95% CI: 0.63, 3.8) or maternal mortality (0.3% vs. <0.1%, pooled OR: 0.77; 95% CI: 0.30, 2.0), respectively. However perinatal mortality was higher with TOLAC compared to ERCS (5% vs. 1%; pooled OR: 3.3; 95% CI: 1.5, 6.9).DiscussionWe found high proportions of women undergoing TOLAC and moderate proportions of successful VBAC across SSA, with a higher perinatal mortality associated with TOLAC. Few studies reported on adverse outcomes and used inconsistent definitions. Further research is needed to understand outcomes in this population of women in these settings.RegistrationThe study protocol was registered with PROSPERO (CRD42020175434).

Effect of Ondansetron on Maternal Hypotension During Spinal Anesthesia With Ropivacaine for Cesarean Sections: A Randomized, Double-Blind Trial.

Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, has been proven to be effective in the prevention of spinal-induced hypotension for elective cesarean section. A total of 138primigravida parturients scheduled for elective cesarean section were randomly assigned to three groups. Groups ONDA4 and ONDA8, respectively, received 4 and 8mgof ondansetron in 100 mL normal saline, before spinal anesthesia with 1.7 mL ropivacaine 0.75% and 15 mcg of fentanyl, whereas the CONTROL group received an equal volume of normal saline. Noninvasive blood pressure and heart rate were recorded upon arrival, before and after spinal injection, and thereafter every minute for a time period of 10 minutes along with total doses of phenylephrine (mcg) or ephedrine (mg). Time required for the spinal anesthesia to achieve a sensory and motor block at the T4 level andBromage 3 scale respectively, as well as to regress to the T7 level and a Bromage1 scale were noted. Maternal nausea/vomiting or shivering, umbilical artery pH, and neonatal Apgar score at 1 and 5 min were also recorded. There were no differences between groups in systolic, diastolic blood pressure, heart rate (p=0.355, p=0.550, p=0.474 respectively), doses of phenylephrine or ephedrine, (p=0.920, p=0.142 respectively), time for the block to reach T4 (p=0.889) and Bromage scale 3(p=0.269), or to regress to T7 (p=0.273) and Bromage scale 1 (p=0.392), the incidence of nausea/vomiting (p=0.898/p=0.365), umbilical artery pH (p=0.739), neonatal Apgar score at 1 and 5 min (p=0.936 and p=0.907 respectively). Our results showed no significant effect of two different doses of ondansetron, in preventing maternal hypotension, following spinal anesthesia with ropivacaine for cesarean section.

Transversus Abdominis Plane Block Following Cesarean Section: A Prospective Randomized Controlled Study Comparing the Effects on Pain Levels of Bupivacaine, Bupivacaine + Dexmedetomidine, and Bupivacaine + Dexamethasone.

Background: The transversus abdominis plane (TAP) block is providing effective postoperative analgesia in patients undergoing cesarean section (CS). This study aims to evaluate and compare the effects on pain levels of bupivacaine alone versus bupivacaine combined with dexmedetomidine and bupivacaine combined with dexamethasone in ultrasound-guided TAP block for postoperative pain after CS. Material and Method: In this randomized controlled trial, 120 patients with American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups. At the end of the surgery, an ultrasound-guided TAP block was performed on all patients: bupivacaine 0.5% (Group B), bupivacaine 0.5% + dexmedetomidine (1 µg/kg) (Group BD), and bupivacaine 0.5% + dexamethasone (4 mg) (Group BDx). Postoperatively, all patients were evaluated at 0, 1, 4, 8, 16, and 24 h for visual analog scores VASs, tramadol consumption, complications, and patient satisfaction. A p value of < 0.05 is statistically significant. Results: At 0 h, VASs in the sitting and supine positions were significantly higher in the BDx group (0.85 ± 1.61 and 0.85 ± 1.36, respectively) compared to the B group (0.05 ± 0.32 in both positions) and the BD group (0.15 ± 0.48 in both positions) (p = 0.005 and p = 0.001, respectively). At the 24th hour, VASs in the sitting and supine positions were significantly lower in the BDx group (1.7 ± 1.2 and 1.43 ± 1.05) compared to the B group (2.3 ± 0.68 and 2.2 ± 0.72) and the BD group (2.57 ± 1.01 and 2.28 ± 0.78) (p = 0.005 and p = 0.001, respectively). At 0 h, the tramadol requirement was highest in the BDx group at 12.5%, while it was not required in the B and BD groups (p = 0.005). At 0 h, the rate of nausea and vomiting was highest in the BDx group at 17.5%, compared to 2.5% in the BD group and 0% in the B group (p = 0.003). Patient satisfaction scores were higher in the dexamethasone group compared to the other groups. This was significant between Group B and Group BDx (p = 0.009 < 0.05). Conclusions: Adding dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks reduces postoperative pain and increases patient satisfaction after cesarean sections. Dexamethasone, due to its delayed onset but extended duration, achieves lower pain scores and higher satisfaction. Further research is necessary to confirm these findings.

Post Caesarean Surgical Site Infection: Incidence, Prevalence, Risk Factors and Microbiological Profile of Tertiary Care Hospital, Jaipur

Background: In the past few decades, the prevalence of cesarean sections (CS) has continuously increased worldwide making it one of the most frequent surgical procedures. CS can often save a patient's life, but there are chances of postoperative consequences such as surgical site infections (SSI). During this study we have determine the occurrence and risk factors associated surgical site infections in women undergoing CS. Methodology: This is a prospective study conducted in a tertiary care hospital. Total 280 women were selected whose undergoes elective or emergency CS during May 2023 – July 2023. Each woman was properly examined and followed for 7 days to developed SSI. Bacterial profile and antibiotics pattern were examined to relate other factors associated with SSI. Results: Among 280 candidate 59 candidate suspected for SSI which are 4.74%. after microbiological analysis 5 samples were failed to produce culture, 54 (5.18%) samples were identified as SSI. Among 54 samples 77. 78% (n=42) observed as Single bacterial infection and 22.22 (n=12) observed as Mixed bacterial infection. Among all Coagulase negative staphylococci spp (CoNS) showed the highest infection 22.23% followed by Staphylococcus aureus 16.95% highest infection was observed in higher age candidate (&gt;30) 37.04%, rural candidate 59.26%, obese candidate 31.48% and Lower-class candidate 53.70%. Conclusion: This study showed the high incidence of SSI after CS which highlighted the urgent need of prevent and surveillance of SSI. Considering patients demographic and medical history incidences of SSI can be reduced.

Comparison of Fentanyl With Midazolam As Adjuvants to Levobupivacaine in Spinal Anesthesia for Cesarean Sections: A Randomized Controlled Trial.

Background and objectives Spinal anesthesia stands as a cornerstone for patients undergoing lower segment cesarean section (LSCS), offering advantages like faster onset and high block density. Levobupivacaine, known for its high potency and long-acting nature, has a slower onset. The safety of intrathecal fentanyl or midazolam is evaluated as an adjuvant to levobupivacaine in parturients. This study aims to compare the duration of postoperative analgesia provided by fentanyl or midazolam added to 0.5% hyperbaric levobupivacaine in elective cesarean sections. Secondary objectives include evaluating the onset and duration of sensory and motor blockade and the incidence of nausea and vomiting. Identifying the more effective adjuvant will help optimize spinal anesthesia protocols, improve postoperative outcomes, and enhance patient comfort and recovery. Methods This study was conducted at SRM Medical College Hospital and Research Centre, Chennai, India, over six months (May 1, 2023, to October 1, 2023). A total of 90 patients undergoing elective LSCS received spinal anesthesia in a prospective randomized double-blinded controlled trial. Patients were allocated to three groups: Group A received levobupivacaine with fentanyl, Group B received levobupivacaine with midazolam, and Group C received levobupivacaine with normal saline. Block characteristics, postoperative analgesia, hemodynamic stability, and complications were assessed. Assessments were conducted at specified time points: intraoperatively, every five minutes for the first 30 minutes, every 10 minutes for the next hour, every two hours for six hours, and every four hours up to 24 hours postoperatively. Statistical analysis utilized one-way analysis of variance (ANOVA). Results Group B (levobupivacaine with midazolam) exhibited a shorter time to sensory block onset (88 seconds) compared to Groups A and C (both 145 seconds) (p < 0.001). Group A (levobupivacaine with fentanyl) showed a shorter time to maximum motor block (p = 0.045) than Groups B and C. The sensory block duration was significantly longer in Group A (127.5 minutes) compared to Group B (60 minutes) and Group C (69 minutes) (p < 0.001). Motor block duration was also prolonged in Group A (251 minutes) compared to Group B (147 minutes) and Group C (177 minutes) (p = 0.045). The first analgesic requirement was delayed in Group A (248 minutes), whereas Groups B (115 minutes) and C (90 minutes) (p < 0.001) required more frequent analgesia. Group A experienced a higher incidence of postoperative nausea and vomiting. Conclusion Midazolam accelerated sensory block onset, while fentanyl prolonged anesthesia duration without significantly affecting motor block. Fentanyl delayed the first analgesic requirement, whereas midazolam reduced postoperative nausea, vomiting, and shivering.

Lateral quadratus lumborum block vs acupuncture for postcesarean analgesia: a randomized clinical trial

BackgroundImproved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head. ObjectiveThis study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section. Study DesignIn this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function. ResultsMedian (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2–4] vs 3 [2–4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0–19.0] hours vs 15.3 [13.3–17.0] hours, estimated median difference, 1.5; 95% CI, 1–2; P<.001). ConclusionAs a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.

The Efficacy of the B-Lynch Procedure in Reducing Labor-Related Mortality and Morbidity in Low-Income Health Facilities in Low Setting Health Facilities

Purpose: Postpartum hemorrhage is a preventable cause of maternal death, yet it is rising in underdeveloped nations with low health resources. So, this study looked into whether B-Lynch and modified B-Lynch uterine compression sutures could stop major postpartum bleeding caused by uterine atonia in EL-Obeid, Sudan. Methodology: This is a descriptive longitudinal study undertaken at the Obstetrics and Gynecology hospitals in El-Obeid and Alfayhaa, located in North Kordofan State, Sudan. The study took place from January 2019 to December 2023. This study has registered a total of 218 individuals for participation. Findings: Using uterine compression sutures resulted in a remarkably low rate of problems, with only 2.3% of individuals experiencing adverse effects. About 71.5% of the study population did not have a blood transfusion. Only 0.9% of patients undergo peripartum hysterectomy. Registrars performed surgery on around 18.8% of the patients. The majority, approximately 45.4% of the patients, underwent elective cesarean sections for delivery. The majority of the cases, amounting to 66.5%, occurred in metropolitan areas. Individuals at the primary level of education reported the majority of the instances, accounting for 36.6%. The majority of events occurred within the age range of 21 to 25 years, accounting for 24.3% of the total. Unique contribution to theory, practice and policy: When uterotonic medications fail, uterine compression sutures are a safe, effective, and simple conservative surgical method for atonic postpartum hemorrhage. Well-trained doctors, including early careerists, can execute these simple procedures

Effect of Bilateral Erector Spinae Plane Block on Postoperative Analgesia in Cesarean Section Under Spinal Anaesthesia: A Prospective Randomized Controlled Trial.

Acute pain after cesarean section (CS) can affect the quality of life of patients. This study aimed to assess the impact of bilateral erector spinae plane block (ESPB) under spinal anaesthesia on postoperative pain, analgesic usage, and patient satisfaction in elective CS. A total of 116 ASA II females aged 18-45 years who had elective CS were included in this prospective randomized study. Adjusted for the patient's height and weight, 0.5% bupivacaine and 12.5 μg fentanyl were administered for spinal anaesthesia. In the ESPB group, ultrasonography-guided ESPB with 10 mL 0.5% bupivacaine+10 mL saline was applied bilaterally at the T12 vertebrae level at the end of the surgery. Postoperative analgesia was planned with diclofenac and paracetamol. Patients' satisfaction, analgesic usage, rest, movement, cough, and low back pain were evaluated using a visual analogue scale (VAS) at postoperative hours 2, 4, 6, 12, and 24. The extent of the sensory block level of ESPB was evaluated after the spinal anaesthesia had worn off. The analysis included 49 patients in the ESPB group and 50 in the control group with comparable demographics. Rest, movement, and cough VAS scores were substantially lower at the 2nd, 4th, 6th, and 12th h in the ESPB group, and satisfaction was better. Total analgesic consumption and the need for rescue analgesics were higher in the control group. VAS scores and ESPB spread levels are negatively correlated. As a safe component of multimodal analgesia following CS, bilateral ESPB can be effectively performed.

Knowledge and Practices Regarding Antenatal Care and Care After Elective Caesarean Section Among Pregnant Mothers

Knowledge and Practices Regarding Antenatal Care and Care After Elective Caesarean Section Among Pregnant Mothers

Risk Factors and Outcome of Early Puerperium Following Caesarean Section

Introduction: The postpartum period, or puerperium, typically lasts six weeks following childbirth and is crucial for the reversal of pregnancy-induced anatomical and physiological changes. This period is often divided into three stages: immediate, early, and remote puerperium. Early puerperium, the first week after childbirth, is critical due to the heightened risk of complications, especially following cesarean sections (CS). Objective: This study aims to investigate the prevalence and types of early puerperal complications in women undergoing elective and emergency cesarean sections. Methods: A retrospective observational study was conducted in the Obstetrics and Gynecology department at Enam Medical College Hospital, Savar, Dhaka, Bangladesh. Hospital records from January 2015 to December 2015 were reviewed, including 100 women who had undergone cesarean sections. Data on demographic characteristics, antenatal care, risk factors, and types of early puerperal morbidities were collected and analyzed using SPSS version 20. Results: The study found that 55% of the participants were aged 21-30 years, 70% belonged to poor socioeconomic backgrounds, and 90% were housewives. A significant 70% of the women had not received any antenatal care. The most prevalent risk factors for early puerperal morbidities were obstructed labor (40%) and prolonged labor (30%). Common complications included wound infections (50%), endomyometritis (45%), and urinary tract infections (35%). Conclusion: Early puerperal complications are prevalent among women who undergo cesarean sections, particularly those from low socioeconomic backgrounds with inadequate antenatal care. Addressing these issues through improved prenatal and postnatal care and better access to skilled birth attendants can potentially reduce these complications and enhance maternal health outcomes.

Risk factors for postpartum readmission: a prediction model in Iranian pregnant women

BackgroundPostpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran.MethodsThis retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019–2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05.ResultsAmong 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery.ConclusionThe method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.

Comparative Study of Prophylactic Vs Conventional Phenylephrine Administration in Preventing Spinal Anaesthesia-Induced Hypotension in Elective caesarean Section Patients: A Quasi Experimental Trial

Objective: To determine the prophylactic effect of phenylephrine in patients undergoing spinal anaesthesia in comparison to the conventional group. Study design: Quasi experimental trial. Place and duration of study: HIT Hospital Taxila in the period of 6 months. Materials and methods: This quasi-experimental trial was conducted in HIT Hospital. Total 68 females were divided into two groups: Control group and Experimental group. Each group consisted of 34 patients aged between 20 to 40 years. The patients were scheduled for elective cesarean section deliveries under spinal anaesthesia. All patients of the experimental group were given prophylactic dose of phenylephrine 100mcg diluted in normal saline after undergoing spinal anaesthesia before the start of procedure. Control group patients were only given normal saline as a placebo after undergoing spinal anaesthesia before the start of procedure. Control group patients were given phenylephrine as conventional treatment only if they experienced hypotension during the procedure. Results: Among the patients in the experimental group none experienced hypotension. Their blood pressure remained fairly constant in the normal range. In the control group, 4 out of 34 patients (11.7%) had their blood pressure dropped below the cutoff point of 90/60 mmHg. Conclusions: Our results show that a prophylactic dosage regimen i.e., 100mcg of phenylephrine is effective in controlling spinal -anaesthesia -induced hypotension in patients undergoing Caesarean-section. In comparison with conventional group where hypotension occurs only in few patients.

The Role of Corticosteroids in Prevention of Neonatal Respiratory Morbidity in Term Elective Cesarean Section A Prospective Observation Study

Abstract Background Caesarean sections continue to increase day by day in both developed and developing countries, which is associated with increased respiratory distress syndrome (RDS), the key reason for early neonatal morbidity and mortality. Objective To assess the effect of routine prophylactic corticosteroids before elective caesarean section after 37 weeks of gestational age, on neonatal respiratory morbidity. Methods A prospective observational study was conducted on all pregnant women undergoing elective caesarean sections between 37-42 weeks at Ain Shams University Maternity Hospital. Over an 8- month period (from November 2020 to June 2021), 1105 cases were divided into the exposed group (A), (N = 877) who received prophylactic dexamethasone, and 228 cases in the non-exposed group (B) who did not receive dexamethasone. Outcome measures were the incidence of transient tachypnea of the newborn, and NICU admissions due to respiratory morbidity. Data were analyzed using SPSS 22. Results Overall, there was no statistically significant difference in the incidence of TTN or RDS. No cases of TTN were found in exposed subgroup, versus 1 (0.4%) in non-exposed group (p = 0.745). The respiratory distress (RDS) in the exposed subgroup was 4 cases (16.7%) versus 18 (7.9%) in non- exposed group (p = 0.148). While the admission to the neonatal intensive care unit (NICU) due to respiratory morbidity after an elective caesarean section was 4 cases (16.7%) in the exposed subgroup versus 19 cases (8.3%) in the non-exposed group (p = 0.178). Conclusion Routine administration of prophylactic antenatal corticosteroids before elective caesarean sections at term does not reduce the risk of admission to the NICU compared to non- administration.

Intravenous Dexamethasone versus intrathecal Dexamethasone in Prolonging the Duration of Spinal Anesthesia and Postoperative Analgesia in Elective Cesarean Section

Abstract Background Spinal anesthesia is the most commonly used technique for cesarean section as it is very economical and easy to administer. The short duration of action of local anesthetic drugs has created a matter of concern for anesthesiologists. Aim of the Work To compare the efficacy of intrathecal dexamethasone with intravenous dexamethasone as an adjuvant to prolong the sensory block obtained by spinal anesthesia and postoperative analgesia in cesarean section. Participants and Methods 66 pregnant women scheduled for cesarean section were randomly allocated to one of three groups including (22) patients each. All the patients received injection of heavy bupivacaine 0.5% 10 mg through spinal anesthesia, with adding 1 mL of 0.9% saline and normal saline 2 mL intravenously (control group), or 0.5 mL (2mg) dexamethasone diluted in 0.5 ml of 0.9% saline intrathecally with normal saline 2 mL intravenously (IT group ), or dexamethasone 2 mL (8mg) intravenously with intrathecal injection of heavy bupivacaine 0.5% 2 mL plus 1 mL of 0.9% saline (IV group ) with overall 3 ml volume intrathecally in each group. Duration of sensory block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Results The study groups, There was significantly higher post-operative analgesic duration (8.73 ± 2.64) hours compared to addition of Intravenous Dexamethasone (4.91 ± 1.02) hours or using hyperbaric bupivacaine alone (3.43 ± 0.71) hours with p-value &amp;lt;0.001. There was no effect on the time of onset of sensory block with no significant complications were detected. Conclusion The addition of 2mg dexamethasone intrathecally as an adjuvant to spinal anesthesia during cesarean section prolong the duration of sensory block and postoperative analgesia.

Role of Granisetron in Reducing Spinal Anesthesia Induced Hypotension during Cesarean Section

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Although it has been considered as a safe technique, spinal anesthesia has many side effects, including hypotension, bradycardia, nausea, and vomiting. Factors influencing the level and the intensity of block include the injected drug, the level of injection, the needle type, the patient position, and patient characteristics, such as age, height, weight, pregnancy, and spinal anatomy. Objective To evaluate the efficacy of different doses of granisetron, a 5-HT3 receptor inhibitors, on reducing the incidence of hypotension after subarachnoid block for cesarean section. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent this study was conducted in the operating theatres of Ain Shams University Hospitals. Results In our study we compared the effect of different doses of granisetron in reducing the hypotension occurring as a result of spinal anesthesia in parturients undergoing elective LSCS. The result of the study showed that compared to placebo group, there was a reduction in the degree of hypotension in group who was pre-medicated with IV grainsetron, and this reduction was more with increasing the dose of granisetron. Conclusion IV granisetron can be used as a pre-medication to reduce spinal anesthesia induced hypotension in parturients undergoing elective lower section cesarean section.

Comparative Study between Fentanyl and Dexmedetomidine as Adjuvants to Bupivacaine 0.5% in Ultrasound-Guided TAP Block for Postoperative Pain Management after Elective Cesarean Section

Abstract Background Analgesia is very important after cesarean section because it improves ambulation and enables the mother to give optimal care for the neonate in the immediate postoperative period. Opioids are widely used, but their side effects limit their application. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries. Objective to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to bupivacaine in TAP block under ultrasound-guidance after cesarean section in a randomized controlled trial. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. The control group received 50 mcg of fentanyl added to bupivacaine on each side. The study group received 50 mcg of dexmedetomidine added to bupivacaine on each side. All patients received equal volumes. Our study showed that addition of a 50 mcg of dexmedetomidine to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the hemodynamic stability of the patients. In addition, dexmedetomidine prolonged the duration of analgesia significantly, as proved by the time of request of first rescue analgesia. Moreover, in dexmedetomidine group, postoperative analgesic requirements were greatly lesser than that of fentanyl group. This makes dexmedetomidine with bupivacaine more superior than the use of fentanyl with bupivacaine. Results In our study, the total rescue analgesia consumed in 24 h postoperatively which was pethidine was less in the TAP-D group (75 ± 25.6 mg) than in the TAP-F group (112.5 ± 42.5 mg). In this study, regarding the measurement the time to the first dose of analgesic received postoperatively, there was a long duration needed in TAP-D group compared to the TAP-F (control group) with the p- value &amp;lt; 0.0001. The time to the first rescue analgesia in the TAP-D group was (659.7 ± 20.99 min.) and for the TAP-F group, it was (512.75 ± 18.1 min.). Conclusion Dexmedetomidine delayed the time to first rescue analgesia when added to bupivacaine in TAP block using ultrasound-guided technique and improved patients’ outcome with decrease in the total pethidine consumption and more hemodynamic stability in comparison to the addition of fentanyl to bupivacaine.

Bupivacaine 0.25% versus Bupivacaine 0.125% with Dexmedetomidine for Transversus Abdominis Plane Block for Post-operative Analgesia in Cesarean Section

Abstract Background Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action. Objectives The aim of this study is to compare two different concentration of Bupivacaine 0.25% versus 0.125% added to Dexmedetomidine as adjuvant in TAP block on quality of analgesia for postoperative pain for parturients undergoing elective CS as regard: VAS score for pain after TAB block, hemodynamics stability, first dose of rescue analgesia and the side effects. Results We found that Bupivacaine 0.125% with dexmedetomidine is recommended regarding their analgesic properties, and moreover, Bupivacaine 0.25% with dexmedetomidine was proved to prolong the analgesic effect of TAP block in elective CS even with the higher concentrations of local anesthetics is our concern. Conclusion TAP block with bupivacaine 0.125% with dexmetomidine is an effective combination used for postoperative pain relief after elective Cs with lower incidence of LAST, hemodynamic stability and lower opioids consumption.

A Retrospective Exploration of Pre-operative Antibiotic Prophylaxis with Cefazolin in Cesarean Sections: Implications for Obstetrics and Gynecologic Surgery.

Background: Post-partum infection is a major contributor to maternal mortality and is responsible for approximately 10% of maternal fatalities worldwide. The risk of infection is substantially higher in cesarean section procedures. Approximately 8% of women who undergo cesarean sections are susceptible to infection. Although the body of evidence supporting the regular pre-operative utilization of prophylactic antibiotic treatment is steadily expanding, its usefulness in cesarean sections has not yet been standardized, and post-partum infection is still a serious medical challenge. We aimed to retrospectively assess the prophylactic effectiveness of cefazolin in combination with other antibiotic agents in cesarean sections. Materials and Methods: Both uni-variable and multi-variable analyses were conducted to identify factors that may affect cefazolin pre-operative antibiotic prophylaxis in elective cesarean section operations. The uni-variable analysis included timing of administration, operation duration, body mass index (BMI), and wound type. A multi-variable logistic regression model was then created to determine which variables provide independent information in the context of other variables. Results: Time of administration did not affect prophylactic cefazolin efficacy. However, prophylactic cefazolin was 1.43 and 1.77 times more effective when the operation lasted for 45 minutes or more, compared with operations that were shorter than 45 minutes. Patients with a BMI ranging from 18 to 29 kg/m2 showed increased efficacy of prophylactic cefazolin compared with obese patients with a BMI exceeding 30 kg/m2. The effectiveness of prophylactic cefazolin decreased by 95% in patients with clean-contaminated surgical incisions compared with those with clean surgical incisions. Conclusions: Our findings demonstrate that administering pre-operative prophylactic antibiotic agents to women undergoing cesarean section resulted in a reduction in post-partum infections, thereby reducing maternal mortality. Furthermore, optimal timing of administration, re-dosing if necessary, length of prophylactic medication, and dosing adjustments for obese patients are crucial factors in preventing surgical site infections and promoting antimicrobial stewardship.

Efficacy of Combination Therapy Using Crystalloid, Colloid and Ephedrine in Prevention of Post Spinal Hypotension at Cesarean Delivery

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Objective To determine the most effective strategy to decrease the incidence and severity of post spinal hypotension by comparing three different combination therapies using crystalloid, colloid and ephedrine at cesarean delivery. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent from all parturients this study was conducted in the operating theatres of Ain Shams Obstetric and Gynecology University Hospitals. Results In our study we found that a combination of an ephedrine infusion at 1.25 mg, minute with a crystalloid co-load was more effective in the prevention of hypotension. Conclusion Employing all mentioned combination treatments reduced the rate of hypotension occurrence following spinal anesthesia in parturients undergoing cesarean delivery. The most effective method was administration of crystalloid coloading plus ephedrine infusion.

Norepinephrine versus Ephedrine in Prevention of Hypotension after Spinal Anesthesia in Cesarean Section

Abstract Background Spinal anesthesia is the preferred anesthetic method for elective cesarean section in obstetric anesthesia practice. Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported in up to 80% of spinal anesthesia cases. Aim of the Work This study aims to compare norepinephrine versus ephedrine in Prevention of hypotension in CS under spinal anesthesia. Patients and Methods The study was a clinical Prospective, double–blinded and randomized study, the operating theatres of Ain Shams University Hospitals over one year. Results We administered the vasopressors by iv infusion when SBP drops 20% below the baseline. We found that no significant difference between both groups regarding fetal Apgar score. We compared two different vasopressors and we chose the regimen of iv infusion. Conclusion We found lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia in the patients treated with norepinephrine.