Lower Segment Caesarean Section Research Articles

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 (>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 <150 cm in height. Other group comprised patients who were >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 (<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

<strong>Background:</strong> 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. <strong>Case Presentation:</strong> 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. <strong>Conclusion:</strong> 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.

Validation of a Predictive Model of Vaginal Birth after Caesarean Section in Pakistani Women.

To determine the frequency of successful trials of vaginal birth after Caesarean section (VBAC) using the Flamm and Geiger model. Observational study. Place and Duration of the Study: Obstetrics and Gynaecology Unit II of Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. Women with singleton pregnancy having cephalic presentation, previous one lower segment caesarean section (LSCS), and without any contraindication for vaginal delivery were included. Women bearing foetus having estimated weight >3.5kg, morbid obesity, multiple pregnancies, non-cephalic presentation, placenta praevia, abruptio placentae, uncontrolled maternal comorbidities, or had previous two or more Caesarean sections were excluded. Flamm and Geiger score was applied to record observations of successful and unsuccessful trials. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the score were calculated by ROC curve, along with its area under the curve (AUC) and Youden's index curve, with 95% confidence interval. This study included 258 participants. Successful vaginal delivery was possible in 125 (48.4%) participants, whereas 133 (51.6%) underwent emergency Caesarean section. Cervical dilatation and effacement were the main factors assessing the success. The Flamm and Geiger score of >5 had an area under the curve of 0.813 (0.762-0.864). The score's sensitivity was 75% (67-82%), specificity 76% (68-82%), and PPV of 75% with an accuracy of 76%. The Flamm and Geiger score of >5 demonstrated high sensitivity, specificity, PPV, and accuracy in predicting later successful vaginal birth. It is recommended as a promising and valuable tool for assessing VBAC's success in low-resource countries. Vaginal birth after caesarean, Flamm and Geiger Model, Indication of caesarean, trial of labour after caesarean, VBAC risk scoring criteria.

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

Tigecycline as Salvage Therapy in a Neonate with Multidrug-resistant Klebsiella pneumoniae Meningitis and Ventriculitis – Case Report and Literature Review

Multi drug resistant (MDR) infections especially in paediatric population, with already limited treatment options, often leave clinicians at loss for an effective antimicrobial treatment making us as helpless as in pre-antibiotic era. Tigecycline is an ‘immature’ antibiotic for children. According to FDA, tigecycline is only indicated in patients 18 years of age and older for the treatment of complicated MDR infection. According to the published literature, the youngest patient on whom Tigecycline treatment has been attempted was 73 day old baby born at 27 weeks gestation with a birth weight of 1028 grams having Acinetobacter baumanii ventriculitis . Here, we discuss use of Tigecycline in a neonate with MDR Klebsiella Pneumoniae meningitis and ventriculitis who presented to us on day 12 of life. Child was born preterm at 34 weeks and 3 days by Lower Segment Caesarean Section in view of foetal distress, maternal preeclampsia and gestational hypothyroidism in a private hospital. On 12thday of life the baby presented to our hospital after being referred with complaints of abnormal body movements, lethargy, difficulty in taking feeds and difficulty in breathing. The complaints had been documented to be present since birth but were increasing over time. Aerobic culture of CSF led to isolation of multi-drug resistant (MDR) Klebsiella pneumoniae resistant to most empirical antibiotics, with intermediate susceptibility to Amikacin susceptibility to Colistin and Tigecycline. We found our isolate produced both NDM and OXA-48 contributing to the increased virulence and resistance of the strain. Considering the paucity of knowledge of Tigecycline’s efficacy and safety in children less than 8 years, lack of FDA approval and the fact that CSF bioavailability is considered low, Tigecycline therapy was deferred and infant was continued on injection Meropenem and injection Amikacin. Condition of child did not improve and marginal weight gain was documented over next 10 days. CSF culture from repeat LP again grew Klebsiella pneumoniae with same susceptibility pattern. On day 23 due adverse affects, and injection Tigecycline was added. A total of 42 days of Meropenem and 21 days of Tigecycline were completed and child was discharged after 42 days of hospital stay. Child was gaining weight, taking feeds orally and no abnormal body movements were present. The child is being followed up for long term sequelae of HIE 2 and meningitis on OPD basis

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.

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. 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. 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. 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.

Role of Chewing Gum in Enhancing Post-Operative Recovery 0f Bowel Function after Lower Segment Cesarean Section

Background: The frequency of cesarean sections globally exceeds the World Health Organization's recommended rates, leading to an increased focus on postoperative recovery, particularly the restoration of gastrointestinal (GIT) function. The delayed return of intestinal activity, known as postoperative ileus, can extend hospital stays and elevate healthcare costs. Chewing gum has been proposed as a simple, non-pharmacological intervention to stimulate the GIT and potentially expedite recovery. Objective: This study aimed to evaluate the efficacy of chewing gum in improving GIT activity and recovery in patients following a cesarean section, contributing to the evidence base for postoperative care practices in obstetrics and gynecology. Methods: A cross-sectional comparative analytical study was conducted at the Department of Obstetrics and Gynecology, KRL Hospital Islamabad, from May 2021 to November 2021. Two hundred patients undergoing elective cesarean sections were divided into two groups: Group A (n=100), who received chewing gum postoperatively, and Group B (n=100), who did not. The primary outcomes measured were the time to first bowel sound, time to first flatus, and time to first defecation. Data were analyzed using SPSS version 25, with a significance level set at p≤0.05. Results: Group A demonstrated a significantly faster time to first bowel sound (3.75 ± 1.31 hours vs. 7.01 ± 1.94 hours, p=0.001), first flatus (7.97 ± 1.96 hours vs. 14.75 ± 3.57 hours, p=0.001), and first defecation (32.37 ± 3.56 hours vs. 48.20 ± 6.06 hours, p=0.001) compared to Group B. These findings were consistent across age stratifications, with significant improvements in GIT recovery times in younger (18-25 years) and older (26-35 years) subsets of patients. Conclusion: Chewing gum post-cesarean section significantly accelerates the recovery of GIT functions, reducing the time to first bowel sound, flatus, and defecation. This study supports the inclusion of chewing gum as a low-cost, effective method in postoperative care protocols for cesarean section patients, potentially improving patient outcomes and reducing healthcare costs.

Exploring Barriers and Facilitators for Human Milk Donation and Acceptance Among Donors and Recipients

Background There is no ideal alternative to mother’s own milk. In circumstances where an alternative is required, donated human milk is the best available option. To promote the establishment of more human milk banks, it is necessary to know the current attitude and awareness of the general population toward human milk donation as well as its acceptance. Methods This is a qualitative study including focused group discussions and in-depth interviews. Results Major barriers found to the donation of milk were fear of the insufficient amount of milk remaining for her baby, inconvenience due to stitch pain after lower segment caesarean section, not willing for pre-donation laboratory testing, the donation process being time-consuming, misconceptions like fear of disease transmission, and so on. Factors facilitating milk donation were breast engorgement and altruism. The facilitator for the acceptance of donated human milk was the belief that donated human milk was the best available option at that time. Barriers to acceptance of donated milk were fear of transmission of infections, prevalent misconceptions about donated human milk, and a lack of awareness regarding the process of pasteurization. Conclusion Barriers to the donation of milk are related to inadequate knowledge, fear, and low awareness regarding human milk banking. Most mothers were encouraged to donate milk due to excess milk. A lack of knowledge about the process of pasteurization appears to be a significant barrier to the acceptance of donated milk. Pasteurized donated milk, being the only available superior option, made donated milk acceptable among the recipient’s relatives.

Factors Associated With Failure of Non-invasive Ventilation in Preterm Neonates Requiring Initial Respiratory Support.

Non-invasive ventilation (NIV) modalities minimize the requirement for invasive mechanical ventilation (IMV) in preterm neonates, therefore improving neonatal outcomes, as IMV is linked to increased complications. However, NIV has demonstrated an elevated likelihood of failure, for which various studies have been done, but very little research is available addressing the factors that are responsible for NIV failure in resource-limited areas of developing nations. Understanding the underlying factors and their association with NIV failure in very and moderately preterm neonates at a tertiary care hospital would be important in devising targeted strategies to increase NIV success and newborn outcomes. To compare the following factors in neonates of 28-34 weeks gestational age with or without failure of NIV: fraction of inspired oxygen (FiO2) at the time of initiating NIV, time at surfactant administration, respiratory distress syndrome presence, antenatal steroid use, time taken for post-surfactant administration stabilization, gestational age, development of bronchopulmonary dysplasia, and average weight gained or lost. This was a longitudinal observational study. One hundred two preterm neonates with a gestational age of 28-34 weeks in the neonatal intensive care unit (NICU) requiring NIV support within 24 hours of admission. Eligible newborns were re-evaluated at 72 hours after commencing NIV. Outcome was evaluated as success (no NIV or NIV with positive end-expiratory pressure (PEEP)<8 cm H2O and FiO2<0.7) or failure (NIV with PEEP≥8 cm H2O or FiO2≥0.7,intubation, or death). It was compared with regard to many parameters. About 40 (39%) study participants reported NIV failure within 72 hours of initiating NIV. In the NIV failure group, male babies constituted 75% (P = 0.027), the median gestational age (IQR) was 29 (29-31) weeks (P = 0.015), the median birth weight (IQR) was 1088 (960-1293.5) grams (P = 0.003), and the median weight gain or loss (IQR) was a loss of 21 (-70.5 to 11.75) grams (P<0.001). Vaginal birth comprised 67.5% of the NIV failure group, showing greater failure rates than births out of lower segment cesarean section (LSCS) (P = 0.003) Conclusion: NIV failure showed a significant association with lesser gestational age, male sex, lowerbirth weight, vaginal method of delivery, and lesserweight gain during hospital stay.

Frequency and risk factors of ventilator associated pneumonia at neonatal intensive care unit of Nishtar Hospital, Multan.

Objective: To determine the frequency and risk factors of ventilator associated pneumonia at neonatal intensive care unit (NICU). Study Design: Cross-sectional study. Setting: NICU of Nishtar Hospital Multan, Pakistan. Period: January 2023 to June 2023. Material &amp; Methods: We analyzed babied of both genders aged between 1 to 28 days admitted in NICU and undergoing mechanical ventilation (MV) due to any reasons for a minimum duration of 2 days. Information like gender, age, residential status, gestational age, birth weight and mode of delivery were noted. During MV period, neonates were closely observed for VAP. Results: In a total of 189 neonates, 104 (55.0%) were boys. The mean age at the time of NICU admission was 4.6±4.2 days while 128 (67.7%) neonates were aged below 7 days. The mean gestational age was 33.5±4.6 weeks while 156 neonates were pre-term. The mean birth-weight was 1914±640 grams. Residential status of 113 (59.8%) neonates was rural. Mode of delivery was lower segment cesarean section in 160 (84.7%). The frequency of VAP was found in 51 (27.0%) neonates who underwent MV. Relatively young age (below 7 days, p=0.0089), pre-term birth (37 weeks, p=0.0342) and low birth weight (&lt;2500 grams, p&lt;0.0001) were found to have significant association with VAP. Conclusion: The frequency of VAP was high among neonates. Younger age, less gestational age and low birth weight were associated with VAP.

Comparison Between 3 Different Norepinephrine Bolus Doses for Management of Postspinal Hypotension During the Caesarean Section for Patients with Preeclampsia: A Randomized Controlled Trial

Background: There is no established dose for norepinephrine (NE) in the management of postspinal hypotension. The data on its use in women with preeclampsia (PE) are limited. Objectives: This study aimed to compare the effect of using different NE bolus doses for the management of postspinal hypotension during lower segment cesarean section for patients with PE. Methods: This randomized, double-blind trial included mothers with PE scheduled for cesarean delivery who developed postspinal hypotension. Sixty participants were allocated to receive 3, 4, or 5 µg of NE bolus. The primary outcome was the neonatal bicarbonate level. The secondary outcomes were successful management of hypotension, incidence of reactive hypertension, nausea, vomiting, systolic blood pressure (SBP), and heart rate (HR) readings through the operation, umbilical blood gases, and Apgar scores. Results: The number of hypotensive episodes, bradycardia episodes, successfully treated hypotensive episodes, and total NE dose per patient were lower in the 4- and 5-µg groups compared with the 3-µg group. Systolic blood pressure was generally higher in the 4- and 5-µg groups than in the 3-µg group starting from 12 min postspinal till 28 min postspinal. The heart rate decreased compared to the baseline reading starting from 4, 6, and 2 min postspinal in the 3-, 4-, and 5-µg groups, respectively, till 28 min postspinal. Also, HR was higher in the 4- and 5-µg groups compared to the 3-µg group at 6-12 min postspinal. Following the first NE bolus, SBP remained lower than the baseline reading in the 3 groups, and HR decreased compared to the baseline reading in the 3- and 5-µg groups only. Conclusions: The 3-, 4-, and 5-µg doses had comparable efficacy in managing the first hypotensive episode and comparable neonatal outcomes. The 4- and 5-µg doses significantly decreased the total NE requirements and the number of hypotensive episodes. The incidence of maternal bradycardia was not significantly different between the groups.

Case Report on Elective Lower Segment Cesarian Section for Indication of Previous History of Complete Perineal Tear Repair

Case Report on Elective Lower Segment Cesarian Section for Indication of Previous History of Complete Perineal Tear Repair

Low transverse caesarean section through the posterior uterine wall in a pregnant patient with asymptomatic uterine torsion of 180°: A case report

IntroductionExcessive torsion of a pregnant uterus is a rare and potentially extremely dangerous pathology for both the mother and fetus. The diagnosis is most often made intraoperatively.AimThe main aim was to show that when it is impossible to detort the uterus, a low transverse caesarean section through the posterior uterine wall can be safely performed.Case studyWe report a case of a 41-year-old multiparous woman at G II P II 39/40 weeks' gestation, who presented to the Gynecology and Obstetrics Department for an elective caesarean section due to a breech presentation of the fetus. During the caesarean section, a uterine torsion of 180° was found. As the uterus could not be detorted to its normal position, a low transverse caesarean section was performed through the posterior uterine wall. At follow-up visits after 8 weeks and 12 months, normal healing of the uterine muscle was confirmed.Results and discussionThe treatment of torsion of the pregnant uterus depends on gestational age and symptoms, in particular the presence of significant hemodynamic and ischemic lesions.ConclusionsThe procedure of choice in a full-term pregnancy should be an attempt to detort the uterus to its normal position and then perform a cesarean section through the anterior uterine wall. If detorsion of the uterus is not possible, a caesarean section through the posterior uterine wall should be performed. Based on the literature review and the case presented, it appears that this procedure is safe.

Classical TAP vs. I TAP Using the Same Dose of Local Anesthetic in Elective Cesarean Section: A Randomized Controlled Trial.

The effectiveness of postoperative pain control following a Cesarean section influences mother-child attachment, improves early healing, and undoubtedly hastens discharge. Transverse abdominis plane (TAP) and ilioinguinal iliohypogastric (ILIH) blocks have been used to minimize postoperative opioid intake, although their relative effectiveness is unknown. The study aims to determine which procedure was more effective at reducing the need for postoperative rescue analgesics after lower segment Cesarean section (LSCS). TAP block or I TAP (TAP block plus ilioinguinal iliohypogastric nerve block). Both procedures used the same amount of local anesthetic. A sealed envelope technique was used to randomly assign 210 patients who received LSCS into two equal groups to receive either ultrasound (US)-guided TAP block or US-guided ILIH nerve block with US-guided TAP block at the conclusion of the procedure. As per the study protocol, the charge nurse in the postoperative ward gave rescue analgesics to patients who complained of discomfort. At hours 0, 2, 4, 6, 8, 10, and 24 following surgeries, a blinded observer checked on the patient and noted the effectiveness of pain management, the quantity of rescue analgesics used, and patient satisfaction. While there was a substantial decrease in pain score while resting at 2, 3, 4, 8, 12, 16, 20, and 24 postoperative hours in the ITAP group, there was not a significant change in visual analogue scale (VAS) score at the first postoperative hour. However, there was a large delay in the first request for analgesia in the ITAP group (13.15 ± 1.85) as opposed to the TAP group (10.06 ± 1.61) and there was a significant decline in nalbuphine use as well as a higher satisfaction score in the ITAP group. Following LSCS, ITAP block offered better postoperative analgesia than TAP block in terms of quality.

A study on hearing screening using oto-acoustic emissions in newborns delivered by normal vaginal delivery and lower segment caesarean section

Background: Hearing is one of the most complex systems of the human body and is a skill involved in the human social evolution. It has been estimated that around 900 million people by the end of 2050, will probably suffer from hearing loss. Our study aims to find out the correlation between the mode of delivery and the effect it has on newborn hearing screening. Methods: The Prospective study on 136 Newborn babies who were delivered in JLN Hospital &amp; Research Centre, Bhilai, Chhattisgarh during October 2020 to August 2021. After obtaining detailed history all newborns underwent TEOAE screening and the data were then compared with the available literature. Results: We observed normal vaginal delivery newborns have passed the test by 97.91% and 89.58% when compared to LSCS delivered infants 97.15% and 86.36% in screening and diagnostic frequency respectively. COVID-19 infection was seen in 2.94% of pregnant mothers in the 3rd trimester. There were no babies who required BERA in our study Conclusions: Normal vaginally delivered newborns have higher pass rate in TEOAE test when compared with LSCS delivered babies. Covid-19 infection in antenatal mother can influence the outcome in 1st TEOAE tests. The pass rate in TEOAE hearing test in the screening frequency is found to be greater when compared with diagnostic frequencies. In a developing country like India, Universal hearing screening programs needs to be reached out to the most remote parts of the country, in order to identify at risk infants for hearing loss.