Lower Segment Caesarean Section Research Articles

Fertility and pregnancy outcomes in women with Turner syndrome: A single centre experience.

Many women with Turner syndrome (TS) will consider fertility options and pregnancy. We wished to examine the fertility and pregnancy outcomes in women with TS undergoing oocyte donation (OD) treatment or spontaneous pregnancy in a large single-centre cohort. General population reference dataor data from those with idiopathic premature ovarian insufficiencywere used as comparators. A retrospective single-centre cross-sectional study. Seventy-four women with TS underwent OD treatment with a total of 105 pregnancies, and 31 women with TS had 71 spontaneous conceptions. Fertility outcomes included clinical pregnancy and live birth rate. Pregnancy outcomes included miscarriage rate, prevalence of hypertension, gestational diabetes, lower segment caesarean section (LSCS), small for gestational age (SGA), prematurity and vertical transmission of TS. In those with TS, OD pregnancies were associated with increased rates of LSCS and SGA compared to spontaneous pregnancies; LSCS (OR: 4.19, 95% CI: 1.6-10.8,p = .003) and SGA (OR: 2.92, 95% CI: 1.02-8.38,p = .04). There were no recorded cardiac events but 5 (17.2%) cases of vertical transmissions of TS in daughters were identified. OD in those with TS was associated with a lower live birth rate per cycle started (OR: 0.53, 95% CI: 0.34-0.84,p = .008) and a higher rate of miscarriage compared to women with POI (40% vs. 26.2%,p = .04). We show that pregnancy in women with TS, whether OD or spontaneously conceived, carries obstetric risks, and therefore, women with TS, considering pregnancy, should receive comprehensive pre-pregnancy counselling and optimal obstetric care.

Anesthetic Practices for Lower Segment Cesarean Section in the Sultanate of Oman: A National Survey

Anesthetic Practices for Lower Segment Cesarean Section in the Sultanate of Oman: A National Survey

Bone in the Womb: A Case Report of Endometrial Osseous Metaplasia

Introduction: Osseous metaplasia in the endometrium is a rare pathological condition characterised by the presence of mature bone, potentially leading to menorrhagia and infertility. The probable pathogenesis of this condition is metaplastic alterations in the endometrial stromal cells, leading to the formation of bony spicules. The gold standard for diagnosis of the condition remains histopathological examination, aided by radiological findings. Methods: This was a case report of a single case with evidence-based discussions. Informed consent was obtained. Case report: We present a case of a 26-year-old female with a previous lower segment caesarean section (LSCS) five years ago and an abortion, followed by dilation and curettage three years ago, presented with heavy menstrual bleeding. Trans-vaginal ultrasound revealed bright, highly echogenic and linear echo-reflective shadows in the endometrial cavity. The complete removal of bony spicules from the endometrium was done by hysteroscopy under sonographic guidance. On histology, a diagnosis of osseous metaplasia of the endometrium was given. Conclusion: The accuracy of the diagnosis is pivotal; it signifies a reversible factor contributing to infertility. Therefore, an accurate identification not only aids in appropriate treatment but also offers substantial relief and hope for those experiencing fertility challenges due to this condition.

Outcomes of Pregnancies in Women with Congenital Heart Disease: A Study in a Tertiary Care Hospital in Bangladesh

Background: Pregnancies in individuals with congenital heart disease (CHD) frequently pose complex challenges. The presence of CHD elevates the risks not only for the expectant mother but also for the well-being of the developing fetus. Additionally, careful monitoring and specialized medical care are crucial throughout the pregnancy to ensure the best possible outcomes for both. Objective: This study was aimed to assess the outcomes of pregnancies in women with congenital heart disease. Methods: This was a cross-sectional observational study that was conducted in the Combined Military Hospital (CMH), Dhaka, Bangladesh from January 2020 to December 2021. A total 30 pregnant women with congenital heart disease were enrolled through purposive sampling. All the demographic and clinical information was recorded. Data were processed, analyzed, and disseminated by using MS Office tools. Results: Among participants, Lower Segment Cesarean Section (LSCS) was the most common delivery (43.3%), followed by vaginal delivery (36.7%). Instrumental delivery, specifically through outlet forceps, was found in 6.7% of cases. Pregnancy termination occurred in 6.7% due to inevitable abortion and 3.3% for medical reasons, resulting in one maternal death (3.3%). Perinatal outcomes included 90% live births and 81.5% with Apgar scores ≥9. Neonatal Intensive Care Unit (NICU) admission was required for 33.3%, with a 3.3% perinatal death rate. Conclusions: In pregnant women with congenital heart diseases, common delivery modes are Lower Segment Cesarean Section (LSCS) and vaginal delivery. Termination and maternal fatality rates are low. Perinatal outcomes are generally positive, with most births resulting in live infants with Apgar scores ≥9 and high newborn survival rates, although some require Neonatal Intensive Care Unit (NICU) admission. J Rang Med Col. March 2024; Vol. 9, No. 1: 50-54

6301976 Service evaluation of current trends in rescue analgesia during Lower Segment Caesarean Sections under neuroaxial anaesthesia

6301976 Service evaluation of current trends in rescue analgesia during Lower Segment Caesarean Sections under neuroaxial anaesthesia

Effect of fetal distress on viability and yield of umbilical cord blood stem cells–a prospective comparative study

IntroductionDifferent factors affect the quality and viability of cord blood stem cells, and therefore the efficacy of umbilical cord stem cell transplantation. Fetal distress is one factor affecting the quantity of CD34+ cells in cord blood. This study was designed to compare the viability and yield of the umbilical cord blood stem cells of women who have undergone emergency lower segment caesarean section for fetal distress or for other causes. Materials and methodsThis cross-sectional analytical study was performed at a tertiary care hospital facility with a total sample size of 68: 34 participants had undergone emergency C-section for fetal distress, and 34 had undergone emergency C-section for other causes. Umbilical cord blood was collected ex-utero in a 350 mL bag with citrate-phosphate-dextrose solution with adenine. Three milliliter of blood were transferred to an ethylenediaminetetraacetic acid (EDTA) tube for cell counts and flow cytometry testing for CD34+. The chi-square test was used to compare the total mononuclear cell, CD34+, and viability between the groups. ResultsThe CD34+ count [mean 4.9 versus 1.1 (× 106 cells/unit)] and total nucleated cell count [mean 14.2 versus 7.5 (× 108/unit)] were significantly higher in cord blood units collected from women who delivered by C-section for fetal distress (p-value <0.05). However, the volume of umbilical cord stem cells and viability of stem cells did not vary significantly based on the presence or absence of fetal distress (p-value >0.05). ConclusionThe current study shows that umbilical cord blood collected during fetal distress has a significantly higher content of stem cells and total nucleated cells than the non-fetal distress group

High Risk Pregnancy and its Outcome in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: High-risk pregnancy is defined as one which is complicated by factors or factors that adversely affect the pregnancy outcome (maternal, perinatal or both). Early detection and effectivemanagement of high risk pregnancy helps in achieving favorable maternal and perinatal outcomes. This study aimed to find the prevalence of high risk pregnancy and its outcome among pregnant women admitted for delivery in the obstetrics and gynecology department of a tertiary care hospital Methods: A descriptive cross sectional study was conducted in a tertiary care hospital among high risk pregnant women admitted for delivery using structured proforma, from April 2023 to September 2023 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling was used among pregnant women who met the inclusion criteria. Data was entered in excel and analysis was done using IBM SPSS Statistics. Point estimate was calculated at 95% Confidence Interval Results: Among 350 deliveries, high risk pregnancy was seen in 91 (26%) (16.15-32.00, 95% Confidence Interval). The high risk factors were previous history of cesarean section 25 (27.47 %) followed by hypothyroidism 19 (20.87%) and gestational diabetes mellitus 15 (16.48%). Out of 90 high risk pregnancy, 84 (92.30%) had term delivery. Lower segment cesarean section was done in 69 (75.82%) patients of which 26 (28.57%) underwent emergency cesarean section. The total number of births among high risk preganancies were 93 with two sets of twin births. A total of 13 (13.97%) of the babies had low-birth weight. Conclusions: The prevalence of high risk pregnancy was found to be similar as compared to studies done in similar settings.

Acute Kidney Injury in Pregnancy: A Prospective Study.

When acute kidney damage occurs during pregnancy, it poses a difficult clinical problem. One of the main causes of maternal and fetal morbidity and death is pregnancy-related acute kidney injury (AKI), a significant obstetric complication characterized by a fast deterioration in renal function and several subsequent clinical problems. The objective of the study is to analyze the etiological factors, clinical manifestations, and maternal and fetal outcomes of AKI during pregnancy. This prospective observational research involved patients hospitalized in the General Medicine and Obstetrics and Gynecology departments at Indira Gandhi Institute of Medical Sciences, Patna, for a year (October 2021 to September 2022) due to obstetric difficulties resulting in acute renal damage. The study included 62 patients with a mean age of 25.08±4.25 years. The majority of patients in our study were aged 18-25 years (38, 61.3%), followed by 26-30 years (19, 30.6%) and >30 years (5, 8.1%). The majority of patients in our study were non-booked (52, 83.9%) and presented as emergency cases, whereas 10 (16.1%) patients had booked. In addition, 34 (54.8%) patients were primigravida, while 28 (45.1%) were multigravida. There were 25 patients in their third trimester (40.3%), 19 who were postpartum (30.6%), 10 who were post-abortion (16.1%), and eight in their second trimester (12.9%). Upon admission, the majority of the patients showed signs of oliguria, accounting for 45 cases (72.6%). This was followed by nine cases of abnormal kidney function (14.5%) and eight cases of anuria (12.9%). Among the other symptoms, fever was observed in 25 cases (40.32%), whereas breathlessness increased to 15 cases (24.19%), edema was present in 14 cases (22.58%), vomiting and altered sensorium were observed in four cases (6.45%), abdominal pain was observed in three cases (4.83%), and burning micturition was observed in two cases (3.22%). The most common causes of AKI in pregnancy in the present study were puerperal sepsis (18 cases, 29.0%), followed by preeclampsia/eclampsia (14 cases, 22.6%), hemorrhagic shock (10 cases, 16.1%), septic abortion (six cases, 9.7%), hyperemesis gravidarum (four cases, 6.5%), acute fatty liver of pregnancy (three cases, 4.8%), disseminated intravascular coagulation (three cases, 4.8%), drug-induced sepsis (two cases, 3.2%), and urosepsis (two cases, 3.2%). Modes of delivery in this study were normal vaginal delivery (32 cases, 51.6%), lower segment cesarean section (21 cases, 33.9%), dilation and evacuation (seven cases, 11.3%), and total hysterectomy (two cases, 3.2%). Hemodialysis was performed in 39 patients (62.9%), and 51 (82.3%) received blood transfusions. The mean systolic and diastolic BP (mmHg) were 111.37±22.60 and 71.40±18.88, respectively. Maternal outcome data revealed that 48 (77.4%) women had fully recovered, eight (12.9%) had not recovered, 43 (69.4%) were lost to follow-up, and two (3.2%) had died. Neonatal outcomes in the present study were as follows: live birth, 43 (69.4%); abortion, eight (12.9%); intrauterine death of the fetus, five (8.1%); and neonatal mortality, six (9.7%). The diagnosis and treatment of AKI during pregnancy is a significant challenge for the treating physician because of the pathophysiological changes that occur during pregnancy, the variability of symptoms, and the fact that clinical and laboratory features may occasionally overlap.

Vaginal Birth after Caesarean Section (VBAC): A Case Report on V-Back in Saudi Arabia

Repeat caesarean sections increase the possibility of maternal morbidity. Worldwide, the need for a trial of labor after caesarean delivery is gaining more ground in selected cases. Here, we report a case of an unbooked 37-year-old multigravida, with a history of five (5) previous lower-segment caesarean sections who presented in spontaneous labor. A live male baby of 2900 grams was delivered following episiotomy. Post-partum, she was observed with normal findings and a serial follow-up ultrasound scan showed normal uterine contours and surrounding structures. As the evidence for the practice of vaginal delivery in women who underwent 2 or more previous LSCS are still fewer, this report intends to highlight the possibility of successful vaginal birth after multiple caesarean sections putting into consideration the optimal care of the parturient. The term ''V-back" was coined from the Roman numeral 'v' meaning five (5), the case here has had five (5) previous lower segment cesarean sections come "back" for spontaneous vaginal delivery.

Comparison of sequential and mixture injections of opioids and hyperbaric bupivacaine for subarachnoid block for lower segment caesarean section: a randomised controlled study.

Opioids are commonly added to local anaesthetic for subarachnoid block for caesarean section due to their synergistic effects. The physiochemical characteristics of opioids suggest premixing with hyperbaric bupivacaine may limit their distribution within the CSF. We studied the effect of a separate injection with a combination of bupivacaine, morphine and fentanyl on block characteristics, haemodynamic changes, postoperative pain and patient satisfaction. Following ethical approval and informed consent, a prospective double-blinded randomised controlled trial was performed in a university hospital. A total of 126 patients undergoing caesarean section were randomised to two groups. In group M, the premixed group, patients received 12mg of hyperbaric bupivacaine, 20 mcg of fentanyl and 100 mcg of morphine injected as a single mixture. In group S, the separate injection group, patients received the same drugs in separate injections. Measurements included haemodynamics, block distribution, intra- and postoperative pain, as well as patient satisfaction. Patients in both groups had similar block height, time to maximum sensory block, time to block regression and motor block. However, haemodynamics were different between the groups. The proportion of systolic hypotension episodes was greater in group S [159/1320 (12.05%)] than group M [113/1452 (7.78%)], with P = 0.0002. Moreover, a greater amount of ephedrine was administered in group S than group M, with values 12.09 (8.1) and 9.09 (8.5) mg respectively (P = 0.001). Additionally, postoperative pain, as measured by the Visual Analogue Scale (VAS), was greater in group M, with a VAS of 4.6 (1.7), vs. group S, which recorded a VAS of 3.8 (2.0) (P = 0.017). Sequential injection of intrathecal opioids and hyperbaric bupivacaine resulted in greater early haemodynamic instability and slightly better postoperative analgesia without any difference in block height or patient satisfaction. NCT04403724.

Association of Maternal Height with Mode of Delivery and Perinatal Outcome

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (&gt;37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were &lt;150 cm in height. Other group comprised patients who were &gt;150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (&lt;150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances.

EFFECTS OF UMBILICAL CORD MILKING ON HEMATOLOGICAL PARAMETERS IN TERM NEONATES: A CASE CONTROL STUDY IN A TERTIARY CARE HOSPITAL

Delayed cord clamping (DCC) and Umbilical cord milking (UCM) are the two methods of placental transfusion. Bothinterventions improve hemoglobin, are safe with no risk of polycythemia and hyperbilirubinemia. UCM is benefi cial in situation were DCC is not feasible or contraindicated.Objectives. 1) Comparison of UCM and DCC on following hematological parameters in term neonates- Cord Hemoglobinat birth, Hemoglobin, Hematocrit and Bilirubin at 48 hours of life. 2) To compare Hb and ferritin levels of infants born withUCM to that of DCC at 6 weeks of age.Material and methods. A Prospective Case- Control Study. Newborns delivered by normal vaginal and elective lower segmentcesarean section underwent DCC. Neonates in whom DCC was not feasible underwent UCM. 56 neonates in each group were followed up to 6 weeks. Cord hemoglobin at birth, hemoglobin, hematocrit and bilirubin were sent at 48 hours, and during 6 weeks of life, Hb and serum ferritin was estimated in both groups and compared.Results: At 48 hours, mean hemoglobin is 18.75 and 19.38 g/dL, mean hematocrit is 52.20 and 53.94 %, and mean totalbilirubin is 11.56 and 10.39 mg/dL in the DCC and UCM groups, respectively. Mean hemoglobin at 6 weeks is 11.37 and 11.6 gm/dL and mean serum ferritin is 207.2 and 252.63 mcg/L in the DCC and UCM groups, respectively. No increase in the incidence of neonatal jaundice or polycythemia was observed in either group.Conclusion. Both the methods of placental transfusions DCC and UCM are equally eff ective and have comparable benefi ton hematological parameters in full term neonates at 48 hours of life and at 6 weeks of life.

A Unique Occurrence of Vesical Endometriosis 16 Years After Cesarean Section: A Case Report

&lt;strong&gt;Background:&lt;/strong&gt; The rare disorder urinary bladder endometriosis develops when endometrial tissue, which lines the uterus, grows in the bladder wall. This aberrant endometrial tissue causes hematuria, dysuria, and pelvic discomfort. Though, these symptoms are not exclusive to this illness, they make diagnosis difficult. Ultrasound, Magnetic Resonance Imaging, and cystoscopy play a crucial role in confirming the diagnosis. Treatment options range from medical management with hormonal therapies to surgical interventions like transurethral resection or partial cystectomy depending upon personal needs and endometriosis severity. &lt;strong&gt;Case Presentation:&lt;/strong&gt; We are presenting a case report highlighting this uncommon yet clinically significant presentation of urinary bladder endometriosis in a 38-year-old female, who had been experiencing cyclical dysuria for about one year. Her medical history included two previous Caesarean deliveries with last being 16 years ago. MRI revealed variable intensity lesion with internal cystic areas along left posterolateral urinary bladder wall which was inseparable from lower segment caesarean section scar, indicative of urinary bladder endometriosis. Patient received medical treatment leading to resolution of her symptoms. &lt;strong&gt;Conclusion:&lt;/strong&gt; Urinary bladder endometriosis following caesarean section is an uncommon but clinically significant condition that demands timely recognition and appropriate management. A thorough diagnostic workup, including imaging studies and cystoscopy, is crucial for accurate diagnosis. Tailored treatment plans, ranging from hormonal therapies to surgical interventions, should be considered based on disease extent, fertility desires, and overall patient health.

Randomized Double Blind Comparison of Prophylactic Tramadol and Tramadol Plus Ketamine for Prevention of Shivering after Spinal Anesthesia in Lower Segment Caesarian Section

Randomized Double Blind Comparison of Prophylactic Tramadol and Tramadol Plus Ketamine for Prevention of Shivering after Spinal Anesthesia in Lower Segment Caesarian Section

Placenta Accreta Spectrum in Normal Situated Placenta and Unscarred Uterus

Placenta accreta, one of the morbidly adherent placenta components and currently known as placenta accreta spectrum (PAS), is a condition characterized by abnormal adherence of the placenta to the uterine wall. This can lead to significant blood loss and may lead to high morbidity and mortality rates for the mother. It is a failure of placenta separation during the third stage of labor, which is thought to be high prevalence in those with previous cesarean delivery, especially with the presence of placenta previa. However, PAS is possible in cases of a normally-situated placenta without previous cesarean delivery. We reported an interesting case of a 41-year-old woman, gravida 8 para 7, admitted to the labor room for augmentation of labor, who needed emergency lower segment cesarean section. The incidental finding of PAS was made intraoperatively and was complicated with a hysterectomy. PAS in a normally situated placenta (upper segment) in a virgin abdomen that has been discovered during emergency lower segment cesarean section could cause a nightmare to the obstetrician as it leads to massive postpartum hemorrhage, ureteric injury, and high maternal morbidity and mortality.

The effect of hip shoulder width ratio and vertebral column length on sensory level in term participants posted for lower segment caesarean section under spinal anaesthesia in Indian population: A prospective observational study

Hypotension is the most common complication of spinal anesthesia with high intrathecal spread of local anaesthetic drug especially during caesarean section. Hip Shoulder width Ratio (HSWR) is one of the factors which affects spread of spinal anaesthesia.85 ASA II participants with singleton term pregnancy undergoing elective caesarean section received 12mg hyperbaric bupivacaine intrathecally with 26G Quincke’s spinal needle in L3-4 intervertebral subarachnoid space via midline approach. Post spinal anaesthesia haemodynamic parameters were monitored every 5 minutes for the first 20 minutes and at the end of surgery. Sensory level was assessed by a pinprick test every 5 minutes till 20 minutes and post-surgery. Hypotension was defined as 20% fall from baseline systolic blood pressure at 15 minutes post spinal anaesthesia.We found significant positive correlation between high shoulder width ratio and highest sensory level achieved (p - 0.0005) using mutiple regression analysis and pearson's correlataion. With every unit increased in high shoulder width ratio spinal level significantly increased by 5 units. Hip shoulder width ration and age were significantly correlatwd with incidence of hypotension.Hip-shoulder Width Ratio has a positive effect on cephalad spread of spinal anaesthesia and thus incidence of hypotension. By knowing the Hip-shoulder Width Ratio, it can help anaesthesiologists to predict the spread of spinal anaesthesia and titrate the dose of 0.5% hyperbaric bupivacaine.

Efficacy of ShotBlocker device versus vapocoolant spray for spinal needle pain relief during spinal anaesthesia in elective caesarean section - A randomised controlled trial.

Apprehension of pain due to a spinal needle is often a cause of anxiety and refusal. ShotBlocker provides non-painful physical stimulation, inhibiting pain perception. The vapocoolant spray contains ethyl chloride vapours, rapidly raising the skin temperature and hampering the transmission of noxious stimuli. The present study compared the effectiveness of the ShotBlocker device and the vapocoolant spray in reducing spinal needle-associated pain in primigravida women undergoing elective lower-segment caesarean section (LSCS). We enroled 144 primigravida women undergoing elective LSCS and were randomised to Group SB (the ShotBlocker device was firmly pressed over the skin, and the spinal needle was inserted through its slit), Group V (the vapocoolant spray was applied at the puncture site before spinal needle insertion), and Group C (received local infiltration before spinal anaesthesia (SA)). The groups were compared for needle-associated pain and patient satisfaction using a 10-point visual analogue scale (VAS) and a 3-point Likert scale. The mean (standard deviation) [95% confidence interval (CI)] VAS scores of Group SB 3.85 (0.74) [3.64, 4.07] and Group V 3.04 (0.74) [2.83, 3.26] were significantly lower than that of Group C 5.19 (0.92) [3.28, 3.62]). On the Likert scale, the maximum number of patients in the vapocoolant group (64.6%) responded satisfactorily, while in the control group, the majority (62.5%) of participants responded dissatisfied (P < 0.001). Both the ShotBlocker and vapocoolant spray reduce needle puncture-associated pain before SA in primigravida patients undergoing elective LSCS. However, the vapocoolant spray is more beneficial in reducing spinal needle-associated pain than the ShotBlocker device.

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

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

Comparison of infusions of phenylephrine, norepinephrine, and mephentermine on maternal hemodynamics and neonatal outcomes in caesarean section under spinal anaesthesia

Although the subarachnoid block is the preferred anesthetic technique for the caesarean section, on the downside it is often associated with complications like maternal hypotension. We compared phenylephrine, norepinephrine, and mephentermine infusions to maintain blood pressure during the caesarian section under subarachnoid block. Our study included 240 parturients with singleton-term pregnancies undergoing a caesarian section under spinal anesthesia. Following spinal anesthesia till the delivery of the baby, parturients randomly assigned to three groups received phenylephrine, norepinephrine, and mephentermine infusions.Heart rate, blood pressure, intra-operative nausea and vomiting, neonatal Apgar score, and total rescue vasopressors required were analyzed. Except at 4 min (p=0.006), ANOVA revealed no statistically significant difference in systolic blood pressure between the groups across all time points. Systolic blood pressure showed a significant difference between the mephentermine group versus the phenylephrine group (p=0.013) and the norepinephrine group versus the phenylephrine group (p=0.022) at four minutes post hoc Bonferroni. Except at 15 and 60 minutes (p=0.02 and p=0.001, Refer This Article Amit Pradhan, Rasulata Swain, Priyadarsini Samanta, Laxman K Senapati, Ganesh C Satapathy, 2024. Comparison of infusions of phenylephrine, norepinephrine, and Mephentermine on maternal hemodynamics and neonatal outcomes in caesarean section under spinal anaesthesia. . Journal of medical pharmaceutical and allied sciences, V 13 - I 1, Pages- 6392 – 6400. Doi: https://doi.org/10.55522/jmpas.V13I1.5919.respectively), the mean heart rate was comparable among the three groups. The Chi-square test revealed no statistically significant difference in the requirement of rescue drugs among the groups (ϰ2=1.57, p=0.45) except at the time point of 4 minutes (p=0.01) when the highest requirement was observed in the phenylephrine group. The Apgar scores amongst the groups were comparable at 1 min (p=0.99) and 5 min (p=0.98). In the lower segment caesarian section under the subarachnoid block, infusions of phenylephrine, norepinephrine, and mephentermine were equally effective in managing maternal hypotension and achieving favorable neonatal outcomes.

Induction of Labour in a District Hospital of Rural Nepal: A Descriptive Cross-sectional Study

Introduction: Induction of labour, a medical intervention before spontaneous onset, is employed when the risk of continuing pregnancy is elevated. Common indications include intrauterine growth restriction, preeclampsia, gestational diabetes, placental abnormalities, prelabor rupture of membranes, post-term pregnancy, and intrauterine foetal demise. The objective of this study was to find out the prevalence of induction of labour in a rural setting in Nepal.Methods: We conducted a descriptive cross-sectional study in the District Hospital Tehrathum using patients’ record files from 14 January 2021 to 14 January 2023. Ethical approval was obtained from Nepal Health Research Council. Demographic variables were collected along with maternal outcomes which include indication of induction of labour, mode of delivery, indication of lower segment caesarean section and foetal outcomes include APGAR score at one and five minutes, birthweight and liquor colour. A total population sampling method was used in the study and 95% confidence Interval was used to calculate the point estimate. Results: Among 640 deliveries during the study period 118 (18.43%) (15.43- 21.43, 95% Confidence Interval) underwent induction of labour. Sixty-three (53.4%) of the 118 patients who underwent induction of labour were primigravida.Conclusions: The prevalence of induction of labour was comparable with previous studies. Neonatal outcome, rate of vaginal and lower segment C-section deliveries after induction of labour using misoprostol is comparable with other studies.