Outcomes In Parturients Research Articles

Gestational diabetes mellitus and late preterm birth: outcomes with and without antenatal corticosteroid exposure

BackgroundUnlike pregestational diabetes, ACOG recommends antenatal corticosteroids in those with GDM at risk for preterm birth. However, this recommendation is based on limited data, only 10.6% of the Antenatal Late Preterm Steroids (ALPS) study sample had GDM. There is a paucity of data on the risk of neonatal respiratory and other morbidity in this population. ObjectiveTo examine respiratory outcomes in parturients with GDM who received antenatal corticosteroids and delivered during the late preterm period versus those who did not. Material and MethodsThis population-based cohort study used the U.S. Vital Statistics dataset between 2016 to 2020. The inclusion criteria were singleton, non-anomalous individuals who delivered between 34.0 to 36.6 weeks with GDM and known status of antepartum corticosteroid exposure. The primary outcome, a composite neonatal adverse outcome (CNAO), included: Apgar score < 5 at 5 minutes, immediate assisted ventilation, assisted ventilation> 6 hours, surfactant use, seizure, or neonatal mortality. The secondary outcome was composite maternal adverse outcome (CMAO) including maternal blood transfusion, ruptured uterus, unplanned hysterectomy, and admission to the intensive care unit (ICU). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Average annual percent change (AAPC) was calculated to assess changes in rates of corticosteroid exposure over the study period. ResultsOf 19 million births during the study period, 110,197 (0.6%) met inclusion criteria, and among them, 23,028 (20.9%) individuals with GDM received antenatal corticosteroids. The rate of antenatal steroid exposure remained stable over the 5 years (APC=10.7, 95% CI: -5.4, 29.4). The CNAO was significantly higher among those who received corticosteroids than those who did not (137.1 versus 216.5 per 1,000 live births; aRR 1.24, 95% CI 1.20-1.28). Three components of the CNAO—immediate assisted ventilation, intubation > 6 hours, and surfactant use—were significantly higher with exposure than without. Additionally, the CMAO was significantly higher among those who received corticosteroids (aRR 1.34, 95% CI 1.18-1.52). Three components of CMAO—admission to ICU, blood transfusion, and unplanned hysterectomy—were significantly higher among the exposed group. Subgroup analysis, among large-for-gestational age, by gestational age, and race and ethnicity, confirm the trend of increased likelihood of adverse outcomes with exposure to corticosteroid. ConclusionIndividuals with GDM and antenatal corticosteroid exposure versus those unexposed, who delivered in the late preterm were at higher risk of neonatal and maternal adverse outcomes.

Association between neutrophil-to-lymphocyte ratio and epidural-related maternal fever in Chinese parturients: a prospective cohort study

Objective Epidural analgesia could increase the risk of maternal fever during labor, and the potential mechanisms involved inflammation. Neutrophil-to-lymphocyte ratio (NLR) was a sensitive inflammatory composite indicator and related to adverse outcomes in parturients. This study aimed to investigate the association between NLR levels and epidural related maternal fever (ERMF). Methods This prospective cohort study included 614 parturients who underwent epidural analgesia at the Women’s Hospital School of Medicine Zhejiang University from November 2021 to May 2023. NLR level was calculated before epidural analgesia for women. The outcome was ERMF. Univariate and multivariate logistic regression models were utilized to explore the association between NLR level and ERMF. And the association was further investigated in subgroups of age, body mass index (BMI) before pregnancy, and parity of delivery. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). Results Totally, 614 parturients, of whom 171 (27.85%) had ERMF. High NLR level was associated with higher incidence of ERMF (OR = 2.70, 95% CI: 1.58-4.69). Parturients with ERMF had higher proportion of postpartum hemorrhage, longer labor times, and other adverse outcomes in parturients. The association also observed in subgroups of age <35 years old (OR = 2.74, 95% CI: 1.55-4.29), BMI <24 kg/m2 before pregnancy (OR = 2.32, 95% CI: 1.32-4.13), BMI ≥24 kg/m2 before pregnancy (OR = 38.28, 95%CI: 3.67-854.66), primipara (OR = 2.26, 95% CI:1.27-4.04), and multipara (OR = 30.60, 95% CI: 3.73-734.03). Conclusion High NLR levels were associated with ERMF in women. It indicated that physicians may measure NLR levels as a regular measurement, which may beneficial for pregnancy outcomes.

Effect of Preoperative Education about Spinal Anaesthesia on Anxiety and Postoperative Outcomes in Parturients undergoing Elective Caesarean Section: An Interventional Study

Effect of Preoperative Education about Spinal Anaesthesia on Anxiety and Postoperative Outcomes in Parturients undergoing Elective Caesarean Section: An Interventional Study

Regional Analgesia for Cesarean Delivery: A Narrative Review Toward Enhancing Outcomes in Parturients.

With the current surge on peripheral nerve blocks in post-cesarean pain management and the historical lack of unequivocal evidence supporting its universal use, this review intended to re-examine the extended scope of literature on regional anesthesia and postoperative analgesia in low-transverse cesarean section. A literature search was conducted up to April 2023 using PubMed to identify articles relevant to our search words "cesarean section", "neuraxial morphine", "post-cesarean analgesia", as well as the name of each individual nerve block. The literature search was ultimately narrowed to systematic reviews and randomized controlled trials published between 2012 and 2023. We define, describe, and discuss the evidence surrounding each individual regional anesthetic technique in the presence and absence of intrathecal morphine, which is used as the gold standard when appropriate. In the absence of neuraxial morphine, all regional anesthetic techniques have some level of analgesic benefit in the post-cesarean analgesia. Transversus Abdominis Plane blocks continue to have the most studies in their use. Newer fascia plane blocks including the anterior Quadratus Lumborum, and Erector Spinae Plane blocks provide significant analgesia. In addition, direct comparison among peripheral nerve blocks consistently favors the more proximal, centralized techniques. Conversely, in the presence of neuraxial morphine, no peripheral anesthetic technique has reliably and reproducibly demonstrated an added analgesic benefit regardless of the peripheral nerve block technique or location of local anesthetic injection in the post-cesarean population. Neuraxial morphine continues to be the gold standard for post-cesarean section analgesia, the benefit of additional single injection regional anesthetic is currently not evidence supported. In cases where neuraxial opioids have not or cannot be given, there is overwhelming evidence that regional anesthetic techniques improve post-cesarean section analgesia and decrease post-operative opioid consumption. Even though there is no consensus on the optimal peripheral nerve block, emerging evidence suggests more centralized abdominal fascia plane block trends towards better analgesia.

To Evaluate the Maternal and Foetal Outcome in Parturients Undergoing Caesarean Section for Pre-Eclampsia Under Spinal and General Anaesthesia: A Randomised Prospective Study

Background: Pre-eclampsia has always been a challenge to the anaesthesiologist, in terms of choosing which type of anaesthesia to prefer. This present study was done to evaluate the maternal and foetal outcome in patients of caesarean section for pre-eclampsia under spinal and general anaesthesia.&#x0D; Methods: This prospective study was conducted in 60 parturients, ASA 1 and 2 who underwent caesarean section for pre-eclampsia. These parturients were randomly and divided into two groups, Group S receiving spinal anesthesia and Group G receiving general anesthesia. For maternal outcome, the parturients were monitored for Blood Pressure, Heart Rate, Oxygen Saturation. Post-operative ICU admissions, convulsions, and pulmonary edema chances were seen. For fetal outcome, APGAR score was noted at 1 minute and 5 minutes after birth of child.&#x0D; Results: The systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were comparable in both the groups in the pre-operative period and at induction. However, intraoperatively, these parameters were significantly lower in the spinal anaesthesia group as compared to general anesthesia group (p&lt;0.05). The Apgar Score was also found to be significantly higher in the newborns in spinal anaesthesia group as compared to general anaesthesia group. Post-operatively, more number of ICU admissions were seen in general anaesthesia group as compared to spinal anaesthesia group (p&lt;0.05).&#x0D; Conclusion: Spinal Anaesthesia can be considered as a first choice of anaesthesia in parturients undergoing caesarean section for preeclampsia with better hemodynamic control in intra-operative period and lesser chances of post-operative morbidity and mortality.

Optimal Dose of Spinal Bupivacaine on Maternal and Fetal Outcomes in Parturients Undergoing Combined Technique for Labor Analgesia: A Randomized Double Blinded Prospective Study

Optimal Dose of Spinal Bupivacaine on Maternal and Fetal Outcomes in Parturients Undergoing Combined Technique for Labor Analgesia: A Randomized Double Blinded Prospective Study

Predictors for poor maternal and neonatal outcomes in parturients with intrapartum fever: a case-control study

Predictors for poor maternal and neonatal outcomes in parturients with intrapartum fever: a case-control study

Effect of epidural labor analgesia on maternal and infant outcomes in parturients with gestational diabetes mellitus-A prospective cohort study.

The occurrence of gestational diabetes mellitus (GDM) is caused by a variety of factors and associated with increased risks of several adverse outcomes for both mothers and infants. However, the effects of epidural labor analgesia in parturients with GDM on maternal and infant outcomes have not been characterized. According to parturients' choice, they were divided into the epidural group (n = 133) and no epidural (control) group (n = 135). Data for relative variables in the perinatal period were collected, and the potential associations of epidural labor analgesia with infant outcomes were analyzed by univariate analysis and multivariate logistic regression analyses. The rate of neonatal admission to the neonatal intensive care unit (NICU) for hypoglycemia was higher in the epidural group (7.52%) than in the control group (1.48%; P < 0.05). Epidural labor analgesia and drug-based diabetes control were independent predictors of the rate of neonate transfer to the NICU for hypoglycemia. Epidural labor analgesia was associated with an increased risk of neonatal transfer to the NICU for hypoglycemia. Thus, monitoring of neonatal blood glucose levels after administration of epidural labor analgesia in parturients with GDM may be beneficial.Trial registration: The study was registered in the China Clinical Registration Center (Registration No. ChiCTR-OOC-17013164, Registered on 30 October 2017).

Characteristics and outcomes of parturients with COVID-19, admitted to a critical care unit: A single-center retrospective observational study.

Data on outcomes of coronavirus disease 2019 (COVID-19) in pregnancy are scarce, although they represent a unique physiological state affecting both the mother and child. We present collated data from a tertiary care center in North India, encompassing the outcome, clinical characteristics, and management of these patients. Parturients ≥ 18 years old, with COVID-19 reverse transcriptase polymerase chain reaction positive for severe acute respiratory syndrome coronavirus 2, requiring intensive care unit (ICU) admission at a tertiary care hospital were included. Data were retrospectively collected from April 2020 to November 2021. In all, 26 parturients were admitted to ICU with COVID-19. Five patients were admitted during the first wave, and all were asymptomatic. Twenty-one patients presented during the second wave (March 2021 onward), among which four were asymptomatic and 17 symptomatic (all with severe pneumonia). Three patients presented in the second trimester, all with critical disease, out of which one did not survive. Two patients had twin gestation, and others were singleton pregnancies. Seven patients (27%) were primigravida, and five patients (19.2%) had more than third pregnancy. Twenty critically ill women (77%) delivered during the hospital stay. Six patients died during the second wave, and four deaths (66.7%) were because of COVID-19 acute respiratory distress syndrome (ARDS). The number of admissions and mortality related to COVID-19 ARDS was higher in the second wave than in the first. We report the safe use of remdesivir and tocilizumab in our patients.

Obstetric and perinatal outcomes in parturients with active SARS-CoV-2 infection during labor and delivery: a retrospective cohort study

BackgroundThe COVID-19 pandemic is an ongoing global healthcare crisis that negatively affects pregnant women. Although patients with an acute infection during pregnancy have been widely studied, information regarding labor and delivery while infected is sparse. The aim of the study was to ascertain maternal, obstetrical, and perinatal outcomes of women who gave birth while infected with SARS-CoV-2.MethodsPatients diagnosed with COVID-19 during pregnancy at a tertiary medical center in 4/20–2/21 were identified by a retrospective database search. Those with an active intrapartum SARS-CoV-2 infection were compared with those who recovered at least 10 days before labor and delivery.ResultsOf the 176 women included in the study, 84 had a SARS-CoV-2 infection at the time of delivery and 92 had recovered from the infection. There was no statistically significant between-group difference in mean gestational age at delivery (39 weeks for both, p = 0.71) and overall rate of cesarean delivery (26.2% vs 17.4%, respectively, p = 0.35) or non-elective cesarean delivery (10.71% vs 4.34%, respectively, p = 0.48). In the active-infection group, the rate of severe disease was 2.4%, and of critical disease (with intensive care unit admission, mechanical ventilation, and ECMO), 3.6%, compared to zero for both in the recovered group. No differences were found between the groups in adverse perinatal outcomes.ConclusionDelivery is safe and feasible in women with active SARS-CoV-2 infection. Nevertheless, we found a non-significant trend for more severe disease and for cesarean delivery and urgent cesarean delivery (for COVID-19-related indications) in women with an intrapartum SARS-CoV-2 infection.

Abstract No.: ABS2092: Study of perioperative modified early obstetric warning scores among pregnancy Induced hypertensive patients posted for caesarean deliveries.

Background & Aims:This study was aimed at identifying the usefulness of Modified Early Obstetric Warning Score (MEOWS) in predicting perioperative maternal outcome in patients with pregnancy induced hypertension (PIH) presenting for caesarean delivery (CD).Methods:A prospective observational study was conducted in a tertiary hospital in New Delhi, after approval by the institutional ethics committee. Data was collected using a predesigned proforma just before and 24 hours after CD, based on which the preoperative and postoperative MEOWS were determined. The mean of preoperative and postoperative MEOWS was taken as perioperative MEOWS. Sensitivity, specificity, positive and negative predictive value were derived and ROC analysis was done to find the discriminating power of MEOWS to predict the maternal outcome.Results:A total of 106 patients with PIH were analysed. A direct linear relationship was noted between increasing mean perioperative MEOWS and poor maternal outcome. A mean perioperative MEOWS ≥ 4.25 predicted maternal morbidity and mortality with a sensitivity of 70%, specificity of 91.86 %, positive predictive value of 66.67%, negative predictive value of 92.94 % and an accuracy of 87.74%.Conclusion:Our study suggested that MEOWS is a useful tool for predicting the maternal outcome in parturients with PIH presenting for CD.

Obstetric analgesia and anaesthesia in SARS-CoV-2-positive parturients across 10 maternity units in the north-west of England: a retrospective cohort study.

SummarySince the start of the COVID‐19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS‐CoV‐2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS‐CoV‐2 across 10 hospitals in the north‐west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS‐CoV‐2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID‐19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64–1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6–96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64, 95%CI 1.19–2.22; p = 0.002); of Asian ethnicity (OR 1.54, 1.04–2.28; p = 0.03); to deliver prematurely (OR 2.16, 95%CI 1.47–3.19; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16–2.12; p = 0.008); and a higher critical care utilisation rate both pre‐ (8% vs. 0%, p = 0.001) and post‐delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83–6.52; p = 0.001). Eight neonates tested positive for SARS‐CoV‐2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78–1.57; p = 0.55). In women with COVID‐19, non‐neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID‐19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.

Acupoint Injection Decreases Anesthetic Cosumption during Combined Spinal-Epidural and Patient-Controlled Epidural Labor Analgesia.

To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia (CSEA) and patient-controlled epidural analgesia (PCEA) for labor analgesia. A total of 307 participants were prospectively collected from July 2017 to December 2019. The participants were randomized into the combined acupoint injection with CSEA plus PCEA group (AICP group, n=168) and CSEA plus PCEA group (CP group, n=139) for labor analgesia using a random number table. Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process, and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli (ST 36) and Sanyinjiao (SP 6) were selected in addition. The primary outcome was Visual Analogue Scale (VAS) score, and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses. Safety evaluations were performed after intervention. The VAS scores were significantly lower in the AICP group than in the CP group at 10, 30, 60, and 120 min after labor analgesia (all P<0.05). The latent phase of the AICP group was shorter than that of the CP group (P<0.05). There were less additional anesthetics consumption, lower incidences of uterine atony, fever, pruritus and urinary retention in the AICP group than those in the CP group (all P<0.05). Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption, improve analgesic quality, and reduce adverse reactions in the parturients. (Registration No. ChiMCTR-2000003120).

Good at Heart: Developing a Tertiary Perinatal Cardiac Service; the First Eight Years of Experience

(Aust N Z J Obstet Gynaecol. 2020;60:760–765) Improved obstetric care in high income countries has reduced overall maternal mortality and morbidity, but an increasing trend of cardiac disease contribution to adverse maternal outcomes has emerged. In developed countries, cardiac disease is now the most common cause of indirect maternal death. In 2009, Mercy Hospital for Women created a multidisciplinary perinatal cardiac service to improve outcomes in parturients with congenital and acquired cardiac disease. This study describes outcomes after the first 8 years of that service and summarizes potential needs of tertiary care related to the significant risks that maternal heart disease poses to fetal and maternal well-being.

Epidural Filling with Crystal-colloid Solution for Post Accidental Dural Puncture Headache: A Case Series.

Post dural puncture headache (PDPH) is a common anesthetic complication caused by expected spinal puncture or accidental dural puncture during intraspinal anesthesia operation. The purpose of this study was to retrospectively analyze the clinical features and outcomes of parturients with accidental dural punctures (ADP). (All cesarean sections at the Chongqing Health Center for Women and Children (Chongqing, China) carried out under neuraxial anesthesia from January 1, 2017 to December 31, 2018 were reviewed and data from 20 parturients with ADP were collected and analyzed. Seventeen individuals received crystal-colloid solution fillers and three did not. The median epidural catheter retaining time was 40 hours; the median frequency of epidural filling was three times, with a median total volume of 60 ml. One patient developed tinnitus and three complained of head swelling during filling. The median bed-stay duration was 73 hours, with total intravenous infusion volume of 7.3 L in the first three postoperative days. Two patients complained of slight dizziness and mitigation, and five felt weak. One individual had intermittent headaches and dizziness till the seventh postoperative day. Epidural injection of crystal-colloid solution, combined with hydration, maybe a useful preven-tive strategy for ADP-induced headache after cesarean section.

P.33 A five-year review of parturients with valvular heart disease: Experience in a tertiary obstetric centre

Introduction: Cardiac disease remains the leading cause of indirect maternal death and the commonest cause of maternal death worldwide. [1] MBRRACE-UK. Saving Lives, Improving Mothers’ Care-Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015 –17. Oxford: The National Perinatal Epidemiology Unit, University of Oxford 2020. Google Scholar It is therefore important to identify and optimise patients with cardiac disease during their pregnancy and birth. For this project, we reviewed the anaesthetic management and outcomes of parturients with valvular heart disease presenting to our institution over a five-year period.

STUDY OF THE INCIDENCE AND EFFECT OF MECONIUM STAINED AMNIOTIC FLUID ON FETAL MORBIDITY AND MORTALITY OF NEONATES BORN

Aims and objectives: Meconium stained amniotic fluid was considered a sign of fetal distress and associated with poor fetal outcome, but others considered physiological phenomena to be meconium passage through the fetus and create environmental threats to the fetus before birth. Such magnitude of different opinions was the object behind taking up this study and the aim was to find out the incidence and effect of meconium in terms of morbidity and mortality. Material and Methods: The present study was undertaken to evaluate the significance of MSAF and its fetal outcome in parturients admitted to a tertiary care hospital between June 2012 to June 2014. Detection of MSAF during delivery and follow-up of mother and baby during hospital stay was done. A total number of 100 cases were studied in each group as a prospective study. Results: The total numbers of deliveries during the study period were 850 of which 100 cases had meconium staining of AF (11.6%). Thin meconium staining was seen in 37 cases (4.35%) and Thick meconium was seen in 63 cases (7.41%). The major neonatal complication was birth asphyxia in MSG (19%) which was more in thick MSG (14%). Neonatal morbidity was more in the newborn with the thick meconium group (36.5%) compared to the thin meconium-stained group (29.7%). Early neonatal mortality was 100% associated with thick MSG. Early neonatal death was 2 in thick MSG and it was due to MAS. Stillbirth was 100% associated with thick MSG and it was 4. Whereas stillbirth in the control group was 1. Perinatal mortality was 6% in MSG that was associated with thick MSG. In the control group, it was 1%. Consistency of meconium has a direct bearing on the fetal outcome. In the thick meconium-stained group, Neonatal morbidity was (in our study group) 23 out of 63 cases. Stillbirth was 4; early neonatal death was 2 out of 63 cases. Whereas in thin MSG neonatal morbidity was 11 out of 37 cases. No stillbirth or neonatal death occurred in thin MSG. Conclusion: Immediate airway management, need for suction, and intubation should be guided by the state of the newborn rather than the presence of meconium. Timely diagnosis and management of amniotic fluid stained with meconium can enhance the fetal outcome. The authors of the current study conclude that MSAF adversely affects the fetal outcome mainly by thick meconium.

Progress of labor and obstetric outcome in parturients with combined spinal-epidural analgesia for labor: A comparative study.

Background:Alleviation of labour pain is known to improve maternal and fetal outcome. Combined Spinal-Epidural (CSE) analgesia is an excellent method.Aim and objectives:In view of reports of its concerns on labour, this study was conducted to evaluate the progress of labour, obstetric outcome in cases with and without CSE analgesia, the maternal pain relief and fetomaternal adverse effects.Materials and methods:In this comparative study, 60 parturients were allocated into case and control groups of 30 each. CSE analgesia was administered utilizing 0.5 ml of 0.125% Levobupivacaine / 0.2% Ropivacaine with 2 mcg/ml fentanyl. Progress of labour was recorded in partogram including duration of labour, mode of delivery, pain relief - Visual Analogue Scale (VAS) score, development of motor block, maternal satisfaction and Apgar score. Data was analyzed by Descriptive and Inferential statistics.Results:Mean duration of first and second stage of labour among cases was 530±44.1 minutes, 61.5±12.7 minutes respectively and that of control was 526.6±64.9 minutes, 60±10.8 minutes respectively with no prolongation of labour P > 0.05. CSE analgesia did not alter the mode of delivery P=0.145 with rapid onset of pain relief. Apgar score was normal in both groups. Total 29 (97%) parturients experienced effective labour analgesia following CSE analgesia with VAS score 0. Maternal adverse effects included pruritus, transient initial motor blockade and post spinal headache.Conclusion:CSE analgesia did not affect the duration of labour, mode of delivery with minimal fetomaternal adverse effects and provides rapid onset of pain relief. CSE analgesia can be considered for safe and effective labour analgesia.

The Effects of Pre-emptive Single Dose Oral Pregabalin on Maternal Anxiety and Stress Response to Laryngoscopic intubation During Caesarean Section

ABSTRACT Background: Parturients scheduled to elective cesarean section usually develop higher anxiety and stress symptoms. Pregabalin decreases preoperative anxiety and intubation stress response; however, its effects on mother and newborn have not been investigated yet. The primary aim of this study was to investigate the effect of single-dose oral pregabalin on preoperative maternal anxiety, and the secondary aims were to assess its effect on attenuating the stress response to laryngoscopic intubation, maternal sedation, and neonatal clinical outcomes in parturients undergoing cesarean section. Methods: A prospective double-blind randomized-controlled clinical study. Sixty minutes before induction of anesthesia, 74 parturients scheduled for elective cesarean section under general anesthesia were randomly allocated into two groups: Group A (n = 37) received single oral pregabalin 150 mg capsule and Group B (n = 37) received oral multivitamin capsule. Results: Group A showed statistically significant lower number of parturients with moderate and high anxiety [11(29.73%) and 2(5.41%)], respectively, and increasing number of parturients with low anxiety [24(64.86%)] using STAI compared to [13(35.13%) and 14(37.84%)] for moderate and high anxiety, respectively, and [10(27.03%)] for low anxiety in group B and to basal numbers (p = 0.001). Rise in mean (heart rates and arterial blood pressures) from baseline values in both groups at 0 min (at intubation) and both groups were comparable at all measured time points (p > 0.05). Also, rising of mean serum glucose and cortisol levels at 10 min post-intubation from basal in both groups and both groups were comparable (p > 0.05). Mean APGAR scores were normal and both groups were comparable. All parturients were alert by AVPU score and no side effects were detected in both groups. Conclusion: Pre-emptive single oral 150 mg pregabalin is effective in decreasing maternal anxiety with good neonatal outcomes, but has no effect on stress response of laryngoscopic intubation during cesarean section.

Anesthesia for Cesarean Section and Postpartum Cardiovascular Events in Congenital Heart Disease: A Retrospective Cohort Study

To clarify the association between anesthetic technique and maternal and neonatal outcomes in parturients with congenital heart disease (CHD). Retrospective, observational cohort study. An academic hospital. A total of 263 consecutive parturients with CHD who underwent cesarean section from 1994 to 2019. None. The authors compared postpartum cardiovascular events (composite of heart failure, pulmonary hypertension, arrhythmia, and thromboembolic complications) and neonatal outcomes (intubation and Apgar score <7 at one or five minutes) by anesthetic technique. Among 263 cesarean sections, general anesthesia was performed in 47 (17.9%) parturients and neuraxial anesthesia in 214 (81.3%) parturients. Cardiovascular events were more common in the general anesthesia group (n = 7; 14.9%) than in the neuraxial anesthesia group (n = 17; 7.9%). Generalized linear mixed models assuming a binomial distribution (ie, mixed-effects logistic regression), with a random intercept for each modified World Health Organization classification for maternal cardiovascular risk, revealed that general anesthesia was not significantly associated with cardiovascular events (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.30-3.29). In addition, general anesthesia was associated with composite neonatal outcomes (Apgar score <7 at one or five minutes or need for neonatal intubation; OR, 13.3; 95% CI, 5.52-32.0). Anesthetic technique is not significantly associated with postpartum composite cardiovascular events. General anesthesia is significantly associated with increased need for neonatal intubation and lower Apgar scores.