Emergency Caesarean Section Research Articles

Risk Factors and Outcomes of Meconium Stained Liquor Babies in Tertiary Care Neonatal Unit

Objective: The purpose of this research was to examine the variables affecting the mother and the baby when amniotic fluid is tainted with meconium during pregnancy. Methodology: This cross-sectional study was conducted at PNS Shifa Hospital, Karachi, from July 15th, 2023, to December 30th, 2023. It involved non-probability consecutive sampling of patients with a gestational age over 37 weeks who presented with meconium-stained liquor during labor. Newborns with congenital defects were excluded, resulting in a study sample size where basic demographic and clinical data were collected. Data analysis was performed using SPSS 26, with continuous variables expressed as mean ± SD and categorical variables in frequency and percentages. Results: Meconium stained amniotic fluid (MASF) was seen in 60 (4.8%) of the 1232 births that occurred during the research period. Meconium aspiration syndrome affected 22 of 60 (36 %) newborns with MSAF. There was a substantial correlation between thick meconium stained liquor and a low Apgar score, an unsettling CTG, MAS, or the need for an emergency C-section. A total of 41 newborns (68% of the total) were diagnosed with thin meconium, although only 85% of those infants showed no symptoms. Important risk variables for MAS were PIH, anemia and GDM (P 0.002, 0.002, <0.0001 respectively), and parity was related in a significant manner Conclusion: Low Apgar scores, higher rates of emergency caesarean sections, and meconium aspiration syndrome were all linked to meconium-stained amniotic fluid. Risk factors for MAS included maternal anemia, hypertension, and gestational diabetes.

Impact of ‘decision-to-delivery’ interval on maternal and perinatal outcomes: a retrospective study of emergency caesarean section from 2017 to 2021 at a secondary health facility in Nigeria

BackgroundThe decision-to-delivery interval (DDI) for a caesarean section is among the factors that reflect the quality of care a pregnant woman receives and the impact on maternal and foetal outcomes and should not exceed 30 min especially for Category 1 National Institute for Health and Care Excellence (NICE) guidelines. Herein, we evaluated the effect of decision-to-delivery interval on the maternal and perinatal outcomes among emergency caesarean deliveries at a secondary health facility in north-central Nigeria.MethodsWe conducted a four-year retrospective descriptive analysis of all emergency caesarean sections at a secondary health facility in north-central Nigeria. We included pregnant mothers who had emergency caesarean delivery at the study site from February 10, 2017, to February 9, 2021.ResultsOut of 582 who underwent an emergency caesarean section, 550 (94.5%) had a delayed decision-to-delivery interval. The factors associated with delayed decision-to-delivery interval included educational levels (both parents), maternal occupation, and booking status. The delayed decision-to-delivery interval was associated with an increase in perinatal deaths with an odds ratio (OR) of 6.9 (95% CI, 3.166 to 15.040), and increased odds of Special Care Baby Unit (SCBU) admissions (OR 9.8, 95% CI 2.417 to 39.333). Among the maternal outcomes, delayed decision-to-delivery interval was associated with increased odds of sepsis (OR 4.2, 95% CI 1.960 to 8.933), hypotension (OR 3.8, 95% 1.626 TO 9.035), and cardiac arrest (OR 19.5, 95% CI 4.634 to 82.059).ConclusionThis study shows a very low optimum DDI, which was associated with educational levels, maternal occupation, and booking status. The delayed DDI increased the odds of perinatal deaths, SCBU admission, and maternal-related complications.

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 (>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.

Anesthetic management of a parturient with oculo-dento-digital (ODD) syndrome for emergency cesarean section

Anesthetic management of a parturient with oculo-dento-digital (ODD) syndrome for emergency cesarean section

A case of neonatal sepsis, early diagnosis and preventive intensive care

Neonatal sepsis is a pathological process that occurs as a complication of any infectious processes and is a life-threatening condition for newborns. Aim. To inform practitioners with the case of neonatal sepsis, when timely diagnosis and intensive care helped to prevent the development of septic shock and multiple organ failure. Materials and methods. A child was treated in the Department of Anesthesiology and Intensive Care of Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using the hospital equipment. Results. The child with a complicated prenatal history was born by emergency caesarean section for severe pre-eclampsia at 34 weeks’ gestation. On the tenth day of life, the infant developed a worsening intoxication syndrome and febrile temperature. X-ray examinations revealed right-sided pneumonia; clinical blood count showed leukocytosis with acute inflammatory changes, thrombocytopenia, and an elevated procalcitonin level. A day later, the inflammatory changes dramatically deteriorated, and the cerebrospinal fluid cytosis was increased up to 850 cells and dominated by neutrophils. Blood cultures tested positive for Enterobacter cloacae. The child was prescribed antibacterial therapy according to the de-escalation principle (meronem and vancomycin) with subsequent changes according to the results of microbiological examinations, infusion therapy with parenteral nutrition, immunosupportive (intravenous immunoglobulin) and antifungal therapy. As a result of intensive therapy, clinical blood count inflammatory abnormalities were regressed, cerebrospinal fluid was completely restored to health, procalcitonin and C-reactive protein levels were normalized, and pneumonia was resolved within a week. Positive laboratory changes were correlated with the general condition: normalization of body temperature, increased activity, and enteral feeding ability. Conclusions. Timely diagnosis and intensive care of neonatal sepsis caused by gram-negative flora helped to prevent the development of multiple organ failure and septic shock. The use of antibiotic therapy according to the de-escalation principle is justified in newborns at high risk of developing septicaemia.

Increasing prevalence of cerebral palsy in children born very preterm in Denmark.

To analyse the rising prevalence of cerebral palsy (CP) in children born preterm in Denmark. We included all live-born children born preterm in Denmark from 1997 to 2013. The prevalence of CP in children born preterm was categorized by gestational age and correlated with neonatal mortality and changes in clinical factors. Among 70876 children, 824 (1.2%) had CP. The overall CP prevalence in children born preterm decreased substantially until 2001, from when it increased annually by 2.8% (95% confidence interval 0.6-5.0). When categorized, the prevalence only increased significantly in children born very preterm (gestational weeks 28-31). Neonatal mortality rates decreased steadily at all gestational ages during the entire study period. Clinical factors that changed during the study period were increasing numbers of high-risk pregnancies, maternal obesity, emergency caesarean sections, neonatal admissions, and usage of assisted ventilation. The increasing prevalence of CP in children born preterm was driven by the subgroup born very preterm and matched their decrease in neonatal mortality. In similar population studies, decreased mortality was not followed by increased CP prevalence. An increase in clinical risk factors was unlikely to explain our findings, but more active neonatal life support may have played a role.

Impact of different obstetric interventions and types of delivery on breastfeeding: a nationwide cross-sectional survey of Hungarian women

BackgroundWe assessed the effect of different obstetric interventions and types of delivery on breastfeeding.MethodsA quantitative, cross-sectional study was carried out using an online questionnaire. Data collection was performed in 2021 in Hungary. We included biological mothers who had raised their at least 5-year-old child(ren) at home (N = 2,008). The questionnaire was completed anonymously and voluntarily. In addition to sociodemographic data (age, residence, marital status, education, occupation, income status, number of biological children, and anthropometric questions about the child and the mother), we asked about the interventions used during childbirth, and the different ways of infant feeding used. Statistical analysis was carried out using Microsoft Excel 365 and SPSS 25.0. Descriptive statistics, two-sample t tests, χ2 tests and ANOVA were used to analyse the relationship or differences between the variables (p < 0,05).ResultsWe found that in deliveries where synthetic oxytocin was used for both induction and acceleration, there was a higher incidence of emergency cesarean section. However, the occurrence of vaginal deliveries was significantly higher in cases where oxytocin administration was solely for the purpose of accelerating labour (p < 0.001).Mothers who received synthetic oxytocin also received analgesics (p < 0.001). Women giving birth naturally who used oxytocin had a lower success of breastfeeding their newborn in the delivery room (p < 0.001). Children of mothers who received obstetric analgesia had a higher rate of complementary formula feeding (p < 0.001). Newborns born naturally had a higher rate of breastfeeding in the delivery room (p < 0.001) and less formula feeding in the hospital (p < 0.001). Infants who were breastfed in the delivery room were breastfed for longer periods (p < 0.001). Exclusive breastfeeding up to six months was longer for infants born naturally (p = 0.005), but there was no difference in the length of breastfeeding (p = 0.081).ConclusionsObstetric interventions may increase the need for further interventions and have a negative impact on early or successful breastfeeding.Trial registrationNot relevant.

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.

The Couples’ Birth Experiences and Influencing Factors

Objective: The birth experience profoundly changes couples’ lives. The husband's role in the birth experience is to provide emotional and physical support to his wife. However, complex emotions can be experienced in the first births due to uncertainties. While birth can be positive for many couples, it can also be negative for many couples. In this context, the aim of this study was to determine the birth experiences of primiparous women and their husbands. Methods: This descriptive study included 350 couples who experienced their first birth between March 2020 and March 2021. The study was conducted in a mother-friendly hospital in Istanbul that allows spousal participation at birth. Data were collected face-to-face using a general information form and Birth Experience Questionnaire (BEQ). Data were analyzed using SPSS. Results: The mean age of the mothers was 23.60±2.69 years. The total mean BEQ scores of the mothers and their spouses were 37.89±3.25 and 46.28±5.02, respectively (p=0.00). Couples’ birth experiences were significantly associated with birth interventions. Episiotomy, enema, labor induction, emergency cesarean section, no skin-to-skin contact, and no early breastfeeding caused an increase in the negative birth experience scores of couples (p=0.000). As the BEQ total score of the mothers increased, the BEQ total score of the fathers also increased (p=0.000, r=0.57). Conclusion: In this study, participants had a neutral to slightly negative experience. Labor interventions were associated with a negative birth experience. During the antenatal period, both women and their spouses should receive training and support for possible interventions at birth and emotion management.

Frequency and determinants of Respiratory Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study

Abstract Background: Chronic obstructive pulmonary disease (COPD) is slowly and progressive disorder that is characterized by a permanent or partially reversible obstruction of airflow. A COPD exacerbation can have a variety of clinical outcomes, from self-limited sickness to progressive respiratory failure. Objective: To determine the prevalence and factors associated with respiratory failure among patients experiencing acute exacerbation of chronic obstructive pulmonary disease (COPD). Objective: The study was designed to evaluate maternal complications of emergency vs elective cesarean section for placenta previa. Material and Methods: This cross-sectional study was conducted at the Department of Pulmonology in KhalifaGul Nawaz (KGN), MTI Bannu from January 2022 to December 2022, following approval from the institutional ethical committee. A total of 385 participants were enrolled in this study. Following the documentation of the physical examination and clinical history, various demographic details were noted. The data was analyzed through SPSS Version 25.0. Results: A total of 385 patients presented with acute exacerbation of COPD were assessed. Out of which 258 were males (67%) and 127(32.9%) were females. In an acute exacerbation of COPD, the number of individuals presenting with respiratory failure was 138 (35.8%). out of which 91(23.6%) were males and 47(12.2%) were females. The age group of 51 to 60 years old had the highest number of individuals experiencing respiratory failure, which were 69 (17.9%). Conclusion: : In the current study the frequency of respiratory failure in the participants presented with acute exacerbation was high. It is crucial to create efficient plans for stopping smoking and preventing COPD exacerbations in light of its effect on health care resources

Comparison of Maternal Complications of Emergency vs Elective Caesarean Section for Placenta Previa

Background: Placenta previa, being an obstetric emergency, is managed via either emergency or elective cesarean section depending upon clinical presentation of women. Multiple maternal and neonatal complications are associated with cesarean section varying with type of cesarean section. Objective: The study was designed to evaluate maternal complications of emergency vs elective cesarean section for placenta previa. Material and Methods: This cohort study was conducted in Gynecology and Obstetrics Department, Lady Reading Hospital Peshawar after obtaining ethical approval from the Institutional Review Board in January 2024 till required sample size achieved April 2024. About 95 women with singleton pregnancy undergoing cesarean section (emergency or elective Cesarean section for placenta previa, with any maternal age included. Women were divided into two groups, emergency cesarean section (group 1) and elective cesarean (group 2).Maternal complications including post-partum hemorrhage (PPH),need for blood transfusion, post-operative fever and wound infection were recorded. Results: The study showed mean age of 29.1±6.2 and 29.6±6.4 years for Group 1 and Group 2 respectively. Statistically significant differences were found between emergency cesarean and elective cesarean section groups with respect to postpartum hemorrhage (47.9% vs 17% (P = 0.01), need for blood transfusion 91.6% vs 17% (P = 0.000),and postoperative fever (47.9% vs 12.7% (P = 0.001), while non significant difference observed for wound infection (4.1% vs 2.1% P=0.19). Conclusion: Many maternal complications like postpartum hemorrhage, blood transfusion and postoperative fever were significantly higher in emergency cesarean compared to elective cesarean group for placenta previa.

Efficacy of combined spinal-epidural anaesthesia in mitigating cardiovascular stress during emergency caesarean section in a primigravida with ruptured right sinus of Valsalva aneurysm - A case report.

Efficacy of combined spinal-epidural anaesthesia in mitigating cardiovascular stress during emergency caesarean section in a primigravida with ruptured right sinus of Valsalva aneurysm - A case report.

Proportion of Emergency Cesarean Section in Maternity Hospitals in Kirkuk Governorate, in 2022–2023

Abstract Background: Emergency cesarean sections are undertaken before or during labor when there is an immediate concern for the mother or the fetus. Inadequate maternal management and unreliable referral systems are responsible for the massive incidence of emergency cesarean section. Objectives: This study aims to identify the rate of emergency cesarean section in Kirkuk governorate. Subjects and Methods: A cross-sectional study was conducted at the postoperative Obstetrical and Gynecological wards in Azadi Teaching Hospital and Kirkuk General Hospital, Kirkuk, Iraq, from December 1st, 2022, to February 28th, 2023. Four hundred women, who have had cesarean sections, were directly interviewed using a structured questionnaire. Official approval was obtained. Categorical data were analyzed using the Chi-square or Fisher’s exact tests P &lt; 0.05 was considered statistically significant. Results: One hundred and ninety-nine (49.8%) mothers were within 26–35 years of age. One hundred and forty-three (35.8%) had an emergency cesarean section, whereas 257 (64.3%) had an elective cesarean section. Emergency indications included failure to progress 45 (31.5%), cephalopelvic disproportion (CPD) 36 (25.2%), fetal distress 32 (22.4%), and severe preeclampsia 22 (15.4%). Poor pregnancy outcomes included bad obstetrical history 49 (12.3%), macrosomia 7 (1.8%), premature rupture of membrane 4 (1.0%), and postterm 21 (5.3%). Elective cesarean sections were significantly higher in husbands &gt;35 years, with husbands’ education (primary school), parity of 2–4, and with no pregnancy-induced hypertension (P = 0.035, P = 0.034, P &lt; 0.001, and P &lt; 0.001), respectively. Emergency cesarean sections (CSs) were significantly higher among diabetic mothers; P = 0.022. Conclusions: One-third of all CSs in Kirkuk were done as emergency operations with failure to progress, CPD, and fetal distress as the main indications.

Hemodynamic Changes of Women with Preeclampsia Undergoing Spinal Anesthesia for Emergency Cesarean Section: A Prospective Observational Study

Abstract Background: Preeclampsia is a multisystem disorder in pregnancy and remains a significant cause of maternal morbidity and mortality. In this prospective observational study, we used a continuous noninvasive cardiac output monitor to investigate the changes in arterial blood pressure, cardiac output, systemic vascular resistance, stroke volume, and stroke volume variation during the immediate perioperative period. Materials and Methods: Women with preeclampsia undergoing emergency cesarean section under spinal anesthesia were recruited in this prospective observational study. Cardiac output and arterial blood pressures were measured by the Nexfin monitor. Cardiovascular parameters were recorded intraoperatively and up to 48 h postoperatively. The primary outcome was to examine the differences in cardiac output between the intraoperative and postoperative periods. Results: Thirty patients included in the data analysis had a mean age of 35.6 ± 5.2 years and gestation of 35.4 ± 2.1 weeks. Post-spinal anesthesia, 50% experienced hypotension. 26.7% had nausea, 10% vomited, and other events included shivering, reactive hypertension, and bradycardia. The use of spinal anesthesia was associated with a significant reduction in systolic (126.7 ± 16.9 vs. 142.0 ± 21.2 mm Hg, P &lt; 0.001), diastolic (71.2 ± 8.4 vs. 77.0 ± 11.3 mm Hg, P &lt; 0.001), mean arterial pressure (92.6 ± 12.2 vs. 103.7 ± 15.3 mm Hg, P &lt; 0.001), cardiac output, and stroke volume compared to postoperative readings. No significant difference was found in cardiac output, cardiac index, or systemic vascular resistance indices between the intraoperative and postoperative periods. Conclusion: Spinal anesthesia may have short-term hemodynamic changes in women with preeclampsia. Continuous noninvasive cardiac monitoring can be used to monitor specific cardiac hemodynamic parameters, which may resolve in the immediate postoperative period.

Comparison of Carbetocin and Oxytocin Efficacy in Preventing Postpartum Hemorrhage after C-Section

Introduction: Postpartum hemorrhage (PPH) is defined as a blood loss of more than 0.5 liters within 24 hours of birth, and a blood loss of more than 1 liter is considered a significant PPH. In low- and middle-income countries, PPH is a major factor causing maternal morbidity and mortality, whereas in high-income countries, the mortality is comparatively lower, but still PPH poses a major risk for postpregnancy complications. Uterine atony is the most frequent cause of the PPH, and it accounts for up to 80% of PPH cases. Aim: The aim of this study is to examine the prophylactic effects of oxytocin and carbetocin in preventing atonic PPH in individuals receiving recurrent elective CS under spinal anesthesia. Materials and Methods: A computerized, randomized, cross-sectional prospective comparative study was conducted on 100 pregnant women at Konaseema Institute of Medical Sciences and Research Foundation for the time period of an year, from October 2020 to October 2021. Inclusion Criteria: This study includes patients with singleton pregnancy, gestational age &gt;38 weeks, spinal anesthesia and repeated C.S with cephalic, breech, or any malpresentations. Exclusion Criteria: Patients with placenta previa and placental abruption, uterine myomata, congenital uterine anomalies, gestational age before 38 weeks, women having emergency cesarean section for fetal or maternal distress, and patients with hepatic or pre-existing bleeding disorder were excluded from the study. The patients included based on the above criteria were split into two equal groups. Group I received carbetocin as a single dose of 100 microgram slow intravenous, and Group II received oxytocin as 5 IU intravenous drip followed by 20 IU of oxytocin infusion on 500 ml saline or lactated ringer with a rate of 150 ml per hour. Results: When compared to the oxytocin group, the blood loss was considerably reduced in the carbetocin group. The levels of Hb and hematocrit [HCT] were evaluated pre- and postoperative in both the groups. The levels of preoperative Hb and HCT showed nonsignificant difference between the two groups, while the levels of postoperative Hb and HCT were significantly higher in carbetocin group than oxytocin group concluding that carbetocin showed the better results in controlling the blood loss and maintaining the levels of Hb and HCT volume and the carbetocin group showed less need for administration of uterotonic agents (20%) in comparison with (32%) in oxytocin group but with no statistically significant difference. Only 8 (16%) patients showed PPH in carbetocin treatment, whereas 14 (28%) showed PPH in patients on oxytocin treatment.

Spontaneous expulsion of sub-mucous fibroid within twelve hours of emergency caesarean section: A case- report

Spontaneous expulsion of sub-mucous fibroid within twelve hours of emergency caesarean section: A case- report

Uterine Malformations: Two Cases Report of Incidental Discovery during Emergency Caesarean Sections

Uterine Malformations: Two Cases Report of Incidental Discovery during Emergency Caesarean Sections

Trauma-informed support after a complicated childbirth – An early intervention to reduce symptoms of post-traumatic stress, fear of childbirth and mental illness

ObjectiveWomen who experience obstetric interventions and complications during childbirth have an increased risk of developing postnatal post-traumatic stress and mental illness. This study aimed to test the effect of a trauma-informed support programme based on psychological first aid (PFA) to reduce the mothers' symptoms of stress, fear of childbirth (FOC), anxiety and depression after a complicated childbirth. MethodsThe study population consisted of women ≥ 18 years old who had undergone a complicated childbirth (i.e. acute or emergency caesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, obstetric anal sphincter injury, shoulder dystocia or major haemorrhage (>1000 ml)). A total of 101 women participated in the study, of whom 43 received the intervention. Demographic questions and three self-assessment instruments measuring stress symptoms, FOC, anxiety and depression were answered one to three months after birth. ResultsThe women in the intervention group scored significantly lower on the stress symptom scale, with a halved median score compared to the control group. There was no significant difference between the groups regarding FOC, depression and anxiety. ConclusionOur results indicate that this PFA-based support programme might reduce post-traumatic stress symptoms in women who have gone through a complicated childbirth. With further studies in a larger population, this support programme has the potential to contribute to improved maternal care optimizing postnatal mental health.

Primigravida with Fetal Malpresentation and Bicornuate Uterus: A Case Report

Introduction: Malpresentation of the fetal head in left oblique presentation is a rare obstetric complication but has the potential to cause birth difficulties. This condition can be worsened by anatomical abnormalities of the uterus such as a bicornuate uterus. Case presentation: An 18-year-old primigravida presented with complaints of labor and premature rupture of membranes. Examination revealed malpresentation of the fetal head in left oblique presentation, and further ultrasound examination revealed a possible bicornuate uterus. Conclusion: Careful labor management and appropriate surgical intervention, in this case, an emergency caesarean section, resulted in the birth of a healthy baby girl. This case emphasizes the importance of early diagnosis and a multidisciplinary approach in treating complex cases of fetal malpresentation.

To Compare the Effects of IV Bolus Doses Phenylephrine, And Ephedrine Injection in Maintaining Arterial Blood Pressure During Spinal Anesthesia for Cesarean Sections-A Randomized Comparative Study

Spinal anesthesia is the preferred anesthetic approach for cesarean sections due to its benefits for both the mother and fetus. However, hypotension is a common and potentially harmful complication. Phenylephrine (PE) is frequently used as a vasopressor to manage hypotension during spinal anesthesia, but it can cause maternal sinus bradycardia. This study aimed to compare two strategies for maintaining arterial blood pressure during cesarean delivery: a 20 mcg bolus of phenylephrine followed by a 10 mcg/min infusion (Group P) versus a 6 mg bolus of ephedrine followed by a 0.1 mg/min infusion (Group E). A total of 100 pregnant women scheduled for elective or emergency cesarean sections under spinal anesthesia were randomly assigned to either Group P or Group E. Systolic blood pressure was well-maintained in both groups during the first 20 minutes. After this period, Group P’s blood pressure stabilized towards basal values, while Group E's remained slightly above basal levels—a statistically significant difference (p &lt; 0.005). Diastolic blood pressure fell in both groups, but Group E maintained slightly higher levels than Group P. Group P had a 24% incidence of bradycardia requiring atropine, while no such cases were observed in Group E. Despite these differences, overall maternal arterial blood pressure was effectively maintained in both groups, with no significant difference in uterine tone or bleeding levels.