Lower Segment Caesarean Section Research Articles

Comparative Evaluation of Two Doses of IV Dexamethasone for Postoperative Analgesia in Patients Undergoing Lower Segment Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial

Comparative Evaluation of Two Doses of IV Dexamethasone for Postoperative Analgesia in Patients Undergoing Lower Segment Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial

Epidural Anesthesia in a Patient with Severe Thoracic Kyphosis Undergoing Primary Cesarean Delivery: A Case Report

The administration of neuraxial anesthesia among parturient patients with concomitant spine deformity poses challenges to anesthesiologists. The apprehension stems from the increased possibility of a failed block and complications arising from potential neurologic injury due to anatomic variance. This is a case report of a 30-year old female gravida 1 para 0 at 36 4/7 weeks age of gestation with severe thoracic kyphosis who underwent emergency primary low segment cesarean section under epidural anesthesia. Ultrasonography of the spine was done pre-induction to visualize spinal anatomy and verify anatomic landmarks. Epidural anesthesia was attempted twice before achieving adequate block to dermatomal level T4 within approximately seven minutes. The patient was able to tolerate the procedure well without significant intraoperative events. Fetal outcomes were also favorable with APGAR scores of 9,9. This case report emphasizes that with extensive preoperative evaluation and preparation, an individualized anesthetic plan may be devised. Ultrasound-guided epidural catheter insertion can be a safe option for obstetric patients with thoracic kyphosis.

Clinical audit on postpartum hemoglobin levels: A study on postpartum anemia

Objectives: The present study was carried out to assess the prevalence of anemia with reference to the Hb levels during postpartum period. The study also investigates the influence of age and mode of delivery on postpartum Hb levels. Material and Methods: It is a hospital-based retrospective descriptive study. The postpartum patients’ data were obtained from the medical records department of a tertiary care hospital. Data of the patients registered for routine blood investigation in the period of December 2023 to January 2024 were collected from the records. Based on patient’s hospital ID, other details including age, Hb level, and mode of delivery data were obtained. Statistical analysis was performed to check the effect of age and mode of delivery on postpartum Hb level by Pearson correlation using IBM Statistical Package for the Social Sciences Statistics version 24.0. Results: About 64.3% of the patients belonged to the age group of 20–30 years and remaining 35.7% within 30–40 years. The percentage of postpartum patients who underwent lower segment cesarean section (LSCS) and normal vaginal delivery (NVD) were 85.7% and 14.3%, respectively. However, cumulative percentage of NVD was higher (100%) than LSCS (85.7%). The postpartum Hb level ranged from 7.9 to 15.2 g/dL. About 54% of patients showed moderate anemia (8–10.9 g/dL), followed by 24% mild (11.9–11 g/dL) and 2% with severe anemic (<8 g/dL) condition. Conclusion: The study highlights the prevalence of PPA associated with both LSCS and NVD modes of delivery. Although the number of anemic patients was higher in LSCS (48) compared to NVD (8), the percentage remains the same at 80% each considering the total number of patients in each category. These observations point out the risk of high-volume blood loss associated with both modes of delivery and emphasize the need for adopting precautionary measures.

Fire dragon cupping in treating a parturient woman with gastrointestinal dysfunction after cesarean section: A case report.

The postoperative gastrointestinal dysfunction after cesarean section is commonly presented as uncomfortable symptoms such as abdominal pain and distension. As a novel traditional Chinese medicine characteristic therapy, the fire dragon cupping can effectively enhance intestinal peristalsis and improve the gastrointestinal discomforts by using the manipulation and moxibustion heat to stimulate acupuncture points. The purpose of this report is to provide a new approach and new ideas for rapid rehabilitation of gastrointestinal dysfunction after cesarean section. A parturient woman, 39 years old, pregnancy 4, delivery 2, underwent lower uterine segment cesarean section under intrathecal anesthesia due to scarred uterus. On the 3rd day after cesarean section, the anus still did not exhaust and defecate, so this parturient woman complained of obvious abdominal pain, abdominal distension, nausea, and vomiting. The measured abdominal circumference was 96 cm, and the bowel sounds weakened on auscultation; the plain abdominal radiograph indicated a small amount of pneumomediastinum, thus the incomplete intestinal obstruction was considered. The parturient woman was treated with fire dragon cupping treatment in her back and abdomen once a day, each time about 30 to 40 minutes, 3 consecutive days of treatment. On the 4th day after cesarean section, the parturient woman naturally had anal exhaust and defecated watery stools twice, without complaint of abdominal pain distension. Under the guidance of the concept of rapid rehabilitation nursing in obstetrics, according to the principle of making gradual and orderly progress, risk management of gastrointestinal dysfunction after cesarean section is carried out in the early stage, the fire dragon cupping and individualized rehabilitation scheme are implemented, and the parturient women with gastrointestinal dysfunction after cesarean section are actively treated.

A Case Report of a Suspected Neonatal Alloimmune Thrombocytopenia in a Tertiary Health Institution

Fetal and neonatal alloimmune thrombocytopenia FNAIT is the leading cause of severe thrombocytopenia in the fetus and neonate leading to serious bleeding, intracranial haemorrhage and death and also intracranial haemorrhage in full-term infants. We reported a case of a 33-year-old woman who was delivered of a male neonate via Emergency lower segment Cesarean section CS on account of premature rupture of the membrane with oligo hydramnios at an estimated gestational age EGA of 29 weeks 3 days. Her blood group is O Rhesus D positive, and Genotype HbAA. No known premorbid illness. Her last confinement was of a male child delivered via CS and died within 12 hours of birth. This reported case of suspected FNAIT was a baby received alive after CS with birthweight of 1,060g and APGAR score of 7185 transiently, and was noticed to be bleeding from the mouth and anus shortly after birth. Thereafter, he had thrombocytopenia, persistent anaemia, several apneic attacks, seizures, desaturation and died after 42 hours of life despite all prompt clinical interventions. Autopsy summary includes anaemia, central cyanosis, petechial hemorrhage, diffuse alveolar damage, cerebral edema, acute tubular necrosis, small for gestational age and placental vasculopathy. Conclusion: Fetal and neonatal alloimmune thrombocytopenia is a rare disorder and yet poses a challenging diagnosis and treatment plan in resource-limited centres especially in developing countries. Although the clinical findings of the reported suspected case were not classical as previously reported by other studies, they’re pointers to our curiosity and open to further criticism.

Congenital Heart Disease among Neonates in a Neonatal Unit of a Tertiary Care Hospital

Objective: To determine the pattern of Congenital Heart Disease among neonates in a neonatal unit of a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: The study was conducted at Neonatal Intensive Care Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2020 to Jan 2021. Methodology: A total of 287 participants were enrolled in the study using non-probability consecutive sampling. Echocardiogram was used as a tool to diagnose congenital heart disease. Results: Among 287 neonates, the mean weight was 2.36±0.73 kg with 49.5% being males and 50.5% females. Most of the neonates were delivered by Lower Segment Cesarean Section (227, 79.1%), while rest (60, 20.9%) were by spontaneous vaginal delivery. Neonates were mostly born at full term (159, 55.4%), followed by preterm (99, 34.5%), and early term (29, 10.1%). Only 34(11.8%) of the neonates showed any Congenital Heart Disease. Ventricular Septal Defect was the most common Congenital Heart Disease defect (15, 44.1%), followed by Patent Ductus Arteriosus (10, 29.4%) and Teratology of Fallot (4, 11.8%), while least common was Pulmonary Atresia (1, 2.9%). The relationship of Congenital Heart Disease with gender, mode of delivery, gestational age, and outcome of the neonate was found to be not significant. Conclusion: A small proportion of the neonates had Congenital Heart Disease with no significant relationship with gender, delivery mode, gestational age, and outcome of the neonate.

A case of anaphylactic reaction to oxytocin in a parturient undergoing emergency caesarean section

Anaphylaxis to oxytocin is a rare but critical complication that can arise during labor and delivery [1], necessitating rapid recognition and management. We describe the case of a 20-year-old term primigravida with gestational hypertension who underwent an emergency lower segment caesarean section (LSCS) due to fetal distress. After successful spinal anesthesia with 0.5% bupivacaine, an infusion of 10 U oxytocin was initiated immediately following the delivery of the infant. Shortly thereafter, the patient developed acute respiratory distress, hypotension, and swelling of the lips and tongue, which progressed to bradycardia and a drop in oxygen saturation. Emergency intubation was performed due to significant airway edema, and resuscitation included intravenous adrenaline, atropine, hydrocortisone, pheniramine, and deriphylline. The surgical procedure concluded uneventfully, and the patient was transferred to the ICU for mechanical ventilation. She was extubated the following day and discharged five days later without complications. This case underscores the rare occurrence of anaphylaxis due to oxytocin administration. It highlights the need for vigilance and preparedness for allergic reactions in obstetric settings, as well as the importance of having alternative uterotonics available.

Association of Placenta Previa with Previously Scarred and Non Scarred Uterus: A Descriptive Cross-Sectional Study

Introduction: Placenta previa, where the placenta is partially or completely placed in the lower uterine segment, is a major contributor to vaginal bleeding during pregnancy and affects 0.4-0.5% of all labors. Its exact cause is uncertain but is believed to be linked to aberrant endometrial vascularization caused by scarring or atrophy from prior trauma, surgery, or infection. Objective: The objective of this study was to establish an association between the placenta previa and the scarring of uterus. Methods: A cross-sectional study was conducted on pregnant women at Nobel Medical College Teaching Hospital, Biratnagar, from November 2021 to October, 2023. Ethical approval and written consent were obtained from all participants. Using convenient sampling technique, the study involved 57 participants out of 3576 patients who were admitted for Lower Segment Cesarian Section. Results: A study of 3576 patients admitted for Lower Segment Cesarian Section at Nobel Medical College Teaching Hospital, we found 57 cases of placenta previa over 24 months. The incidence was 1.59%, with 1.82% in patients with a previous history of LSCS and 1.51% without any history of scarring. The results showed no association between placenta previa and uterine scarring. Conclusion: The study found no association between the incidence of placenta previa and scarred/non-scarred uterus, but a slightly higher likelihood of having placenta previa in those with a history of uterine scarring.

Nomogram Predictive Model for Vaginal Birth after One Prior Cesarean Section: A Retrospective Study

Background: Repeat cesareans pose significant maternal risks, whereas vaginal birth after cesarean (VBAC) offers better outcomes, with a complication rate of 2.4% compared with 3.6% for elective repeat cesareans and 14.1% for failed trial of labor after cesarean (TOLAC). TOLAC rates are low in China, and success rates vary between 60% and 80%. This study aims to develop a nomogram-based predictive model for VBAC in China and improve existing, less rigorous scoring models. Methods: This retrospective cohort study was conducted at Hangzhou Women's Hospital from February 2015 to March 2020, and included 159 parturient attempts at labor after one prior low transverse cesarean section. The participants were divided into two groups based on their mode of delivery for comparison: the VBAC and the TOLAC failure group. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors for VBAC and develop a nomogram predictive model to estimate the success rate of TOLAC. The bootstrap method was used for internal validation of the models. Three different VBAC prediction models were evaluated by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision curves. Results: A total of 127 women had VBAC and 32 women failed TOLAC, with a success rate of 79.9%. Three independent factors affecting the VBAC were identified: gestational age at delivery, Bishop score and newborn birth weight. A predictive nomogram model for the VBAC was constructed that incorporates these three factors. The model showed a good fit (χ2 = 11.94, p = 0.154) with an overall prediction accuracy of 81.1%. The area under the ROC curve was 0.83 (95% CI (confidence interval), 0.76–0.90) (p < 0.001) and the optimal cut-off value was 83.4%. The bootstrap internal validation showed that our predictive model maintained high overall accuracy and specificity, but exhibited low sensitivity and a low Kappa coefficient. Compared to the Grobman model and Jiaming Rao et al. model, our developed prediction model possesses the strongest discriminatory ability and the highest net benefit, followed by the model by Jiaming Rao et al. All three models demonstrate a high degree of fit. Conclusions: Shorter gestational age at delivery, lower newborn birth weight and higher cervical Bishop score are favorable factors for VBAC. The predictive nomogram model for the VBAC after a single cesarean section, constructed with these three factors, has good predictive efficacy. The model is simple to calculate and has practical value in the clinical selection of suitable candidates for TOLAC after a single cesarean section.

Pulse oximetry-based perfusion index as a non-invasive indicator of systemic hemodynamics during spinal anesthesia in cesarean delivery

Background & Objectives: Placental perfusion is not autoregulated and is susceptible to effects of spinal anesthesia (SA) induced hypotension. The perfusion index (PI) is a non-invasive marker of peripheral vascular tone, and a higher PI indicates increased risk of hypotension following SA. This study aims to establish preoperative baseline PI in our local population and its correlation with incidence of intraoperative hypotension. Methods: This prospective observational study recruited 35 parturients who underwent elective lower segment cesarean section (LSCS). Preoperatively, baseline heart rate (HR), systolic blood pressure (SBP), mean arterial pressure (MAP) and PI were documented. SA was performed with 8 to 10 mg of injection bupivacaine 0.5% (hyperbaric) at L3–L4 interspace followed by co-loading with 1 L Hartmann solution. Hypotension was defined as SBP less than 80% of baseline or less than 90 mmHg. A bolus of phenylephrine 50 µg was given as rescue medication to treat the hypotension. Intraoperatively, degree of decrease in SBP, MAP and HR, as well as the amount of phenylephrine required was recorded every minute until delivery of the baby and 3 min thereafter. Results: The correlations between parturients’ baseline PI with the degree of decreases in systolic and mean arterial pressure (r = 0.81, P < 0.001 and r = 0.76, P < 0.001, respectively) and phenylephrine requirement (r = 0.761, p < 0.005) were recorded. This study identified that the patients with cut-off PI value of 3.2 were at higher risk for SA induced hypotension with a sensitivity of 85.9% and a specificity of 87.5% (P = 0.001). Conclusion: The patients with baseline cut-off perfusion index value of more than 3.2 were at higher risk for spinal anesthesia induced hypotension in elective cesarean section. Abbreviations: CO - cardiac output; LSCS - lower segment cesarean section MAP - mean arterial pressure; PI - perfusion index; SA - spinal anesthesia Keywords: Hypotension; Pulse Oximeter; Perfusion Index; Spinal Anesthesia; Cesarean section; Citation: Manap NSA, Zaini RHM, Shukeri WFWM, Omar SC, Abu Bakar MZ, Seevaunnamtum P. Pulse oximetry-based perfusion index as a non-invasive indicator of systemic hemodynamics during spinal anesthesia in cesarean delivery. Anaesth. pain intensive care 2024;28(5):927−932; DOI: 10.35975/apic.v28i5.2570 Received: July 23, 2024; Reviewed: September 02, 2024; Accepted: September 10, 2024

Topical Application of Antibiotic Prophylaxis in The Prevention of Surgical Site Infection after Elective Lower Segment Cesarean Section: A Randomized Controlled Study

Topical Application of Antibiotic Prophylaxis in The Prevention of Surgical Site Infection after Elective Lower Segment Cesarean Section: A Randomized Controlled Study

Antenatal ileal perforation in preterm neonate-a rare presentation of spontaneous intestinal perforation

We report a case of 28 weeks gestational Age preterm neonate born via lower segment cesarian section who presented with gross pneumoperitoneum immediately after birth. Abdominal drain was inserted as a lifesaving procedure followed by laparotomy after stabilizing the child. Intraoperatively there was sealed ileal perforation which was managed surgically. Pneumoperitoneum secondary to antenatal ileal perforation is a rare manifestation of spontaneous intestinal perforation (SIP).

Violent State of Postpartum Psychosis

Abstract Postpartum psychosis is an alarming health condition that affects women as well as the child if untreated. A 23-year-old female patient brought to the psychiatric unit with a 15-day urinary tract infection (UTI) and a lower segment cesarean section (LSCS) P1 A0 L1 - 20 days prior, was diagnosed with postpartum psychosis. The symptoms included abnormal behavior, irrelevant talking, fear, suspicion, sleep disturbance, delusion, and hallucination, as well as an unwillingness to breastfeed her infant and attempts to harm the newborn. Pus cells, RBCs, epithelial cells with blood traces, nitrites, and bacteria were all present in her urine analysis report. The patient was admitted for 25 days, treated with a non-pharmacological and pharmacological approach, counseled by psychiatric and was discharged after recovery.

Effect of Ayurveda Formulation in the Management of Unexplained Primary Infertility

When a couple is unable to get pregnant after a year of regular, unprotected sexual intercourse, it is referred to as infertility. The problem is defined as the absence of an obvious cause for a couple’s infertility and the female’s inability to become pregnant after at least 12 cycles of unprotected sexual relations, or after six cycles in women over 35 who meet all standard evaluation criteria. Several drugs have been listed in Ayurvedic literature to treat infertility. We are presenting a primary infertility case here. The couple spent two years trying to become pregnant. After extensive physical and scientific testing to rule out the cause, the underlying cause was found to be unexplained. Ayurvedic formulations like Tablet Leptadan, Capsule Femigrow, Phalaghrita and Tarunikusumakar Churna were given continuously for 3 months. Her 3 months of Ayurvedic intervention resulted in the conception and she delivered a full term male baby weighing 2.5kg through lower segment caesarean section.

Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia

Background: Spinal Anaesthesia is the most popular choice for elective caesarean section. Both general anaesthesia and regional anaesthesia are acceptable techniques for anaesthesia for elective and emergency caesarean sections. Objectives: The study aimed to investigate the role of the perfusion index in predicting the incidence of hypotension following spinal anaesthesia in parturients undergoing elective lower segment caesarean sections. Methods: A prospective, observational study was carried out among sixty parturients posted for elective caesarean section. The study was conducted in the operation theatres of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. About 60 participants were interviewed for the study. Data were entered and analysed with the help of the Statistical Package for Social Science (SPSS) version.16. Results: Sixty eligible ASAI (American society of anaesthesiologist’s physical status classification) parturients scheduled for elective caesarean section were divided into two groups pre-operatively after determining their baseline Perfusion Index (PI) as those with PI ≤ 3.5 and those with PI > 3.5 using a Masimo® pulse oximeter probe. When comparing the heart rate at time intervals among the two groups, it became increasingly clear that those with baseline PI > 3.5 had generally higher heart rate especially immediately after the block and at 2nd, 4th, 6th,8th, 10th, 12th, 14th and 20th minutes. Conclusion: The study concludes that a Perfusion Index > 3.5 is associated with a higher incidence of hypotension in lower segment caesarean section under spinal anaesthesia. The hemodynamic parameters such as increased heart rate and significantly lower systolic, diastolic and mean arterial pressures in parturients with baseline PI > 3.5 suggest that these patients have lower baseline SVR and depleted autonomic resilience to hypotension compared to those with baseline PI ≤ 3.5. High BMI seems to be significantly associated with high baseline PI.

Comparative Analysis of Early Versus Traditional Feeding Protocols in Elective Lower Segment Cesarean Sections.

Background Postoperative care following elective lower segment cesarean section (LSCS) traditionally involves delayed oral feeding. However, recent evidence suggests that early feeding may enhance recovery and improve patient outcomes. This study aimed to compare the recovery outcomes of elective LSCS patients between early feeding and traditional feeding protocols. Methods This prospective, comparative study was conducted at the Department of Obstetrics and Gynecology, Government Medical College (GMC) Budaun, over nine months. Women aged 18 to 40 years undergoing elective LSCS with singleton pregnancies and gestational ages between 37 and 42 weeks were included. Participants were randomized into two groups: the early feeding group (EFG) and the traditional feeding group (TFG). The EFG received oral intake as early as two hours post-surgery, progressing to a regular diet within six to eight hours. The TFG followed standard postoperative protocols, beginning oral intake after 12-24 hours. Primary outcomes included time to return of bowel function and length of hospital stay. Secondary outcomes were patient satisfaction and complication rates. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY), with p-values < 0.05 considered statistically significant. Results The study included 94 participants (EFG: n = 44, TFG: n = 50). The EFG showed significantly faster return of bowel function, with time to first flatus (23.9 ± 6.2 vs. 34.1 ± 8.8 hours, p < 0.0001) and first stool (54.6 ± 8.5 vs. 91.3 ± 12.3 hours, p < 0.0001). Length of hospital stay was shorter in the EFG (4.3 ± 1.1 vs. 6.7 ± 1.4 days, p < 0.0001). Visual analog scale (VAS) scores before discharge were higher in the EFG (94.4 ± 8.7 vs. 81.4 ± 9.5, p < 0.0001), indicating greater patient satisfaction. Complication rates, including nausea, vomiting, abdominal distension, and wound infections, did not differ significantly between groups. Conclusion Early feeding post-elective LSCS significantly enhances recovery, as evidenced by quicker return of bowel function, reduced hospital stay, and higher patient satisfaction without increasing complication rates. These findings support revising postoperative care protocols to incorporate early feeding strategies.

An interplay between orthopaedic trauma and pregnancy—A case series of 42 patients

BackgroundPregnancy and trauma are complex situations with significant implications for maternal and fetal health. Physical and psychological trauma during pregnancy can lead to pre-term labor, abruptio-placenta, and fetal injury or death. Management of trauma is challenging due to physiological and anatomical changes, which can affect fracture management and the risk of radiation exposure. A multidisciplinary approach is beneficial for patient care. This study aimed to determine the impact of orthopaedic trauma on pregnancy and its outcome, and influence of pregnancy on fracture management. Methods and materialA retrospective-study was conducted at a Level-1 trauma-care-center, focusing on 54 pregnant women who sustained trauma between January 2015 and December 2022. The study included patients with closed or open fractures, but excluded those without fractures. Forty-two patients were available with minimum 1 year follow-up. Data was collected from hospital records and PACS, including demographic details, emergency care, and laboratory parameters. Changes made in protocol in fracture management due to pregnancy (primary definitive fixation vs staged management), and impact of trauma on pregnancy outcome; mode-of-delivery, maternal and fetal loss were evaluated. ResultsThe mean age was 30-years (range: 21–43years). Road-traffic-collision was most-common mode-of-injury (66.7 %). 38.1 % were in the first-trimester, 35.7 % in second, and 26.2 % in third-trimester. Eight patients had polytrauma, seven had multiple-injuries, and 27 had isolated-injuries. The maternal-mortality-rate was 0.45 %. Three polytraumatized patients ended up with intrauterine death, two polytrauma patients underwent elective abortion, one patient presented with spontaneous-abortion, and fetal loss was 14.3 % (6-of-42). Out of 42 patients, 10 had open-injuries and 32 had closed-injuries. Nine patients underwent LSCS(lower-segment-caesarean-section), six of them were planned for elective-LSCS due to injury and associated fractures (two patients with pelvic injuries, two neck femur fracture patients, one open distal femur fracture, and one ankle fracture dislocation). ConclusionOrthopaedic trauma during pregnancy can significantly affect pregnancy outcomes and is associated with a notably higher risk of fetal loss. An elective-caesarean-section is recommended for patients with polytrauma, pelvic-injuries, and those who are immobilized for longer-duration. During the third-trimester and in polytraumatized patients, external-fixator-application for lower-limb-injuries is a safe strategy, and definitive fixation could be performed post-delivery.

A RETROSPECTIVE STUDY OF MATERNAL AND FETAL OUTCOMES IN PLACENTAL ABRUPTION

Introduction:Placental abruption (PA) is a critical obstetrical emergency characterized by the premature separation of a normally implanted placenta, leading to maternal and fetal complications. It is unpredictable, with a sudden onset, often associated with risk factors like advanced maternal age, multiparity, pre-eclampsia, and history of high-risk pregnancy (HRP). Clinically, PA presents with abdominal pain, vaginal bleeding, uterine tenderness, and fetal distress.Patho physiologically, PA occurs when maternal vessels tear away from the placenta, causing a hematoma that disrupts maternal-fetal circulation, leading to hemodynamic instability, coagulation abnormalities, and potential fetal demise. The severity of PA varies, classified from asymptomatic (Class 0) to severe (Class 3), based on clinical symptoms and the extent of placental separation. Management strategies depend on the severity and gestational age, ranging from conservative management in mild cases to urgent delivery in severe cases.PA is associated with significant maternal and fetal morbidity and mortality, including hemorrhage, fetal demise, and potential recurrence in future pregnancies. Prompt recognition and management are essential to improve outcomes. Aim:To study the maternal and perinatal outcomes associated with placental abruption Material and Methods:This retrospective study was conducted on 22 cases of placental abruption in the Department of Obstetrics and Gynecology at MRMC Kalaburagi, covering the period from January 2023 to December 2023. The study exclusively included women diagnosed with placental abruption. Cases involving placenta previa and other extraplacental causes of antepartum hemorrhage were excluded from the analysis. Results:In the retrospective study of 22 cases of placental abruption, the age distribution of patients varied: 2 were 19 years old, 17 were between 21 and 30 years old, and 3 were over 30 years old. Among the women, 45% were primigravida, and 54% were multigravida. Delivery methods were split, with 40.9% undergoing a lower segment caesarean section (LSCS) and 59% delivering vaginally 7 patients required induction. Blood transfusion was necessary for 16 cases, which accounts for 72% of the sample. Couvelaire uterus was observed in 3 cases (13.6%). The study reported one maternal mortality, representing 4.5% of the cases. Conclusion:This study highlights significant maternal and perinatal outcomes associated with placental abruption. The majority of the women were within the 21-30-year age group, with a notable percentage being multigravida. A substantial portion of deliveries required lower segment cesarean section, and many patients underwent blood transfusions, reflecting the severity of the condition. Couvelaire uterus was observed in a notable subset of cases, and maternal mortality was relatively low but significant. These findings underscore the critical need for vigilant management and monitoring of placental abruption cases to improve both maternal and fetal outcomes.

Transverse ultrasound scanning of lumbar-epidural depth and its co-relation with conventional method: A prospective observational study in obese Indian parturients

Pre-procedural ultrasound (US) imaging as a tool of determining the proper insertion site and assessing lumbar-epidural depth in obese Indian parturients. The current study’s goal was to assess the epidural depth space in obese Indian parturients by ultrasound imaging with conventional technique and also to assess whether if it decreases the failure rate and number of attempts. Twenty-five obese parturients with a BMI of more than 30 kg/m who were scheduled for elective lower segment caesarean sections under lumbar epidural anesthesia and were classified as American Society of Anaesthesiology grade I &amp; II were included. Using a curvilinear US probe (frequency 2–5 MHz), ultrasound depth-UD (lumbar epidural) was recorded in the transverse axial plane at the L3–L4 and L4–L5 intervertebral regions. Afterwards, the needle depth (ND) was monitored using a sterile linear scale during the epidural administration process using the traditional loss of resistance (LOR) approach. Any modifications to the intervertebral spacing, needle reorientation, or the quantity of tries were recorded. The results showed that UD and ND were, respectively, 4.6140 ± 0.252 cm (range 4.20–5.30 cm) and 4.720 ± 0.271 cm (range 4.2–5.5 cm). Pearson's correlation coefficient (r) for UD and ND was 0.953 (95% confidence interval: 0.8948–0.9793, r = 0.908, P &amp;#60; 0.001), and the 95% limits of agreement were found to be 0.266 to 0.546 cm using Bland-Altman analysis. Of all the subjects, 92% needed only one try to put the epidural, whereas 8% needed two. The current study demonstrates a significant association of ultrasound (UD) and needle depth (ND) in obese pregnant females (BMI &amp;#62;30 kg/m). For lumbar epidurals, a preprocedural US scan in the transverse-axial plane provides a precise needle entry site with a high success rate.

Chewing Gum Versus Standard Care for Enhanced Bowel Recovery After Cesarean Section: A Randomized Clinical Trial.

Background and objective Cesarean sections (CS) are common and occasionally critical surgical procedures. Nausea, vomiting, and postoperative ileus (POI) frequently occur in patients undergoing cesarean delivery with regional anesthesia. These issues affect patient comfort, slow down wound healing, and prolong hospital stays. Studies have employed various strategies to address these challenges. Chewing gum post-surgery is a cost-effective approach to stimulate intestinal movement, promoting early initiation of oral intake, early mobilization, shorter hospital stays, and reduced overall hospitalization time. In this study, we aimed toinvestigate the potential benefits of chewing gum in thispatient population. Methodology We randomly assigned a total of 314 women scheduled for elective or emergency lower segment CS (LSCS) to either a gum-chewing group (Group A, n=157) or a control group receiving standard postoperative care(Group B, n=157). Participants in the gum-chewing group chewed sugar-free gum for one hour postoperatively in sessions lasting 15 minutes each, continuing until bowel sounds resumed, and were allowed to have oral sips of water. In contrast, the control group's bowel sounds were checked every half hour till they appeared, and women were allowed to have sips of water once the bowel sounds were heard. The primary comparisons between the groups focused on the timing of first bowel sounds, first passage of flatus, and first bowel movement. Secondary endpoints included time to mobilization, removal of the catheter, and subjective sense of well-being. Results The average age of women in both groups was 24 years. There were no statistically significant differences between the study and control groups concerning age, parity, occupation, type of CS, reasons for CS, skin incision, or intraperitoneal adhesions. In Group A, the mean time for bowel sounds to appear was 3.39 hours, compared to 6.91 hours in Group B. For flatus passage, the mean time was 12.74 hours in Group A and 20.51 hours in Group B. Stool passage took an average of 41.59 hours in Group A and 64.03 hours in Group B. Conclusions Chewing gum, a type of simulated eating, is linked to faster restoration of gastrointestinal function following CS. This study elucidates the mechanisms behind the benefits of chewing gum and explores its potential in diverse surgical populations. Ultimately, integrating chewing gum into postoperative caremay offer a valuable tool for enhancing patient outcomes and accelerating recovery, provided it is used in conjunction with comprehensive and personalized postoperative care strategies. It isa cost-effective approach that accelerates the recovery of intestinal movement post-surgery, decreasing the length of hospital stay and overall burden on patients.