Patient Underwent Emergency Cesarean Section Research Articles

Correlative analysis of different treatments of persistent occipitotransverse position on the outcome for mother and infant.

To explore the clinical feasibility of different treatment methods for persistent occipitotransverse position and the influence on maternal and infant complications. During the trial of vaginal delivery from April 2020 to March 2023 in our hospital, the cervix was fully dilated and the presentation was located at +2 station. Ninety-six pregnant women with fetal presentation at +4 station, occipitotransverse fetal position, maternal complications, abnormalities in the second stage of labor, and or fetal distress were divided into two groups: 65 patients with Kielland forceps vaginal delivery and 31 patients underwent emergency cesarean section. The delivery time, vaginal laceration rate, postpartum blood loss volume, puerperal infection rate, neonatal birth injury rate, and neonatal 1 min Apgar scores were analyzed. The delivery outcomes and maternal and neonatal complications of 96 pregnant women were analyzed: the application of Kielland forceps delivery time was shorter, while the vaginal laceration rate, postpartum hemorrhage, puerperal infection rate were significantly lower than that of patients undergoing emergency cesarean section and the neonatal 1 min Apgar score was higher than that of emergency cesarean section group (p < 0.05). It was clinically appropriate to use Kielland forceps in vaginal delivery when the persistent occipitotransverse position was present and delivery needed to be expediated. Use of Kielland forceps can shorten the delivery time, improve the success rate of vaginal delivery and reduce the complications of mothers and infants.

Study of Relationship between Postpartum Umbilical Cord Blood Ph and Neonatal Outcome in Patients Undergoing Emergency Caesarean Section for Fetal Distress

Study of Relationship between Postpartum Umbilical Cord Blood Ph and Neonatal Outcome in Patients Undergoing Emergency Caesarean Section for Fetal Distress

VAGINAL CLEANSING BEFORE EMERGENCY CESAREAN SECTION AND POST-OPERATIVE INFECTIOUS MORBIDITY; CLINICAL TRIAL IN A LOW RESOURCE SETTING

Objective: To assess the effectiveness of preoperative vaginal cleansing by looking at the frequency of infectious morbidity after emergency cesarean section. Methodology: A randomized trial of patients, aged 15-45 years, in labour for &gt; 6 hours, was conducted from May 2019 to December 2019 at the Department of Obstetrics and Gynaecology, Women and children Teaching Hospital, Bannu. A total of 400 patients at term gestation were included and assigned to either the interventional; “Vaginal cleaning” or the control; “No vaginal cleaning” groups, based on whether they received vaginal cleansing only or vaginal cleansing as well as abdominal cleansing or not. The development of infectious morbidity was assessed by following all patients up to six weeks postoperatively. Results: The age of the women was in the range of 24-38 years. In interventional versus control groups, the frequency of fever was 8 (6%) versus 17 (11%) (p=0.149), and wound infection was 15 (17.5%) versus 16 (8%) (p=0.851) respectively. There was a significant reduction in the frequency of postoperative endometritis, 4 in the interventional group and 18 in the control group (p=0.00). However, on further analysis, in patients with a history of premature rupture of membranes (PROM), there was a significantly lower incidence of endometritis, fever, and postoperative wound infection in the intervention groups (p=0.00). Conclusions: Using preoperative antiseptic for vaginal cleaning decreases the incidence of postoperative endo­metritis, more significantly in women with a history of PROM in patients undergoing emergency cesarean section.

“Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section”: A cross-sectional study

BackgroundAnxiety is the most common problem in the preoperative period. This anxiety increases postoperative pain, delay healing, and prolong the hospital stay. Among the surgical population, a higher level of preoperative anxiety has been seen in obstetric patients. ObjectiveThe aim of this study was to assess the prevalence and associated factors of preoperative anxiety among obstetric patients undergoing cesarean section. MethodsAn institutional-based cross-sectional study was conducted from January 01, 2021, to May 30, 2021. A total of 376 obstetric patients who underwent cesarean sections were included. Descriptive statistics, cross-tabs, and binary logistic regression analysis were performed to identify the association shivering and independent variables. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and a p-value<0.05 was considered as statistically significant state versions of state-trait anxiety inventory scale (S-STAI) were used for this study. ResultsThe overall prevalence rate of preoperative anxiety was 63% (95% CI: 58.2, 68.1). The patient's preoperative mean anxiety score of STAI was (43.81 ± 8.81). There was a high level of preoperative anxiety in patients undergoing emergency cesarean section as compared to elective patients. Patients' age less than 30 years, level of education, and previous anesthesia and surgery exposure were also highly associated with the dependent variable. ConclusionIn this study, fear of complications and fear of death result of operation were the most common factors responsible for preoperative anxiety while few patients were anxious about financial loss and osmotic issues.

Effects of acute tocolysis using ritodrine hydrochloride on foetal heart rate patterns in intrauterine foetal resuscitation: a retrospective, single-centre observational study

No consistent recommendations concerning the preferred tocolytic agents for intrauterine foetal resuscitation are available. We evaluated the effects of acute tocolysis (AT) using ritodrine hydrochloride on foetal heart rate (FHR) patterns and neonatal outcomes. We retrospectively analysed the data of patients undergoing emergency caesarean section because of non-reassuring foetal status indicated by foetal scalp electrodes. Patients were classified into AT (ritodrine hydrochloride approximately 500 µg/min) and control groups with 15 and 12 participants, respectively. FHR patterns, Apgar scores, umbilical arterial analysis, and neonatal admission were compared. All participants had FHR category II; decelerations disappeared in all foetuses in the AT group, with no significant difference in neonatal outcomes. The AT group had a higher baseline FHR and lower short-term FHR variability than the control group, indicating foetal autonomic responses. Further studies are needed to clarify the effects of AT on FHR patterns, neonatal outcomes, and foetal and neonatal autonomic responses. Impact statement What is already known on this subject? The usefulness of acute tocolysis using ritodrine hydrochloride has been well-documented in several studies; however, such an application often induces side effects, such as maternal tachycardia, palpitations, and tremors. What the results of this study add? The short-term administration of ritodrine hydrochloride eliminated decelerations, with no significant difference in neonatal outcomes in pregnant women with foetal heart rate category II. Meanwhile, there were higher foetal heart rate and lower short-term foetal heart rate variability in pregnant women administered with ritodrine hydrochloride, indicating foetal autonomic responses. What the implications are of these findings for clinical practice and/or further research? Ritodrine hydrochloride administration, even for short-term, appears to be associated with foetal autonomic responses. Further studies with stratification of patient groups based on the severity and aetiology of non-reassuring foetal status, including pregnant women with foetal category III, would elucidate the risk and benefit of acute tocolysis using ritodrine hydrochloride, based on foetal heart rate patterns, neonatal outcomes, and foetal and neonatal autonomic responses.

Comparative study of general anaesthesia and spinal anaesthesia in severe pre-eclampsia patients undergoing emergency caesarean section in tertiary care centre

Comparative study of general anaesthesia and spinal anaesthesia in severe pre-eclampsia patients undergoing emergency caesarean section in tertiary care centre

Study to evaluate correlation between immediate fetal outcome, cord blood pH and causes of fetal distress in low risk patients undergoing emergency caesarean section

Study to evaluate correlation between immediate fetal outcome, cord blood pH and causes of fetal distress in low risk patients undergoing emergency caesarean section - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.073, Indian Journal of Obstetrics and Gynecology Res

A case of perinatal cardiomyopathy

Background : Peripartum cardiomyopathy (PPCM) is rare heart disease that threatens the lives of pregnant women. Patient : In the current report, we reported a case of a 40-week pregnant patient with PPCM. Diagnoses : The patient was diagnosed with PPCM. Intervention : The patient underwent emergency cesarean section and received other supportive treatments, mainly including cardiotonic, diuretic, bromocriptine, hemodialysis, improvement of cardiac function, blood-pressure-lowering, hepatic protection, supplementing albumin, delactation, promoting uterine contraction, the noninvasive ventilator-assisted ventilation improved oxygen delivery and CRRT reduced cardiac load. Outcomes : The relative clinical symptoms have significantly become better after 58 days treatment and the patient has discharged. Lessons : This case emphasized the significance of early diagnosis of PPCM in pregnant women.

Correlation of prolonged fetal heart rate decelerations and perinatal outcome among patients undergoing emergency cesarean section: Implication to standardizing management and notification guidelines

Introduction: A prolonged fetal heart rate (FHR) decelerations reflects as a danger signal in relation to perinatal outcome.

Feto-maternal Outcomes of Emergency Caesarean Section following Residential Posting at Dhading District Hospital

Caesarean section is a commonly performed major obstetric surgery to deliver baby under certain indications which may be maternal or fetal. If performed timely, it is helpful to save the life of mother and fetus and if not, it increases both maternal and fetal risks. A hospital based descriptive cross-sectional study was conducted at Dhading district hospital from 17th October 2016 to 17th October 2017. Total of 41 patients undergoing emergency caesarean section meeting the selection criteria were included. The incidence of emergency caesarean section was 41 (5.5%). Most common indication for caesarean delivery was fetal distress in 12 (29.3%) followed by failed induction and cephalopelvic disproportion each accounting 6 (14.6%) cases. The least common causes being chorioamnionitis and cord prolapse in 1 (2.4%). Regarding perinatal outcomes, 33 (80.5%) babies delivered were of normal weight. Low Apgar score (<7) at one minute was noted in 8 (19.5%) cases. Neonatal resuscitation in the form of oxygen supplementation was required in 2 (4.9%) cases whereas bag and mask ventilation was required in 5 (12.2%) cases. Referral for neonatal intensive care unit admission was done in 6 (14.6%) cases. There were three neonatal deaths. Residential posting was fruitful to decrease feto-maternal morbidities and mortalities. Even to minimize the delay of treatment, government should provide adequate equipments and skilled man-power to run neonatal intensive care unit.

Successful management of fatal peripartum cardiomyopathy in a young pregnant woman: A case report.

Rationale:Peripartum cardiomyopathy (PPCM) is a rare and life-threatening form of pregnancy associated myocardial disease.Patient concerns:In the present report, we describe a case of a patient with PPCM at 33 weeks of gestation with stillbirth and cardiorespiratory failure.Diagnoses:Peripartum cardiomyopathy.Interventions:The patient underwent emergency cesarean section (CS) and comprehensive medical treatments, including bromocriptine, as well as positive inotropic agents and diuretics after the CS.Outcomes:She had an uneventful recovery period, and was discharged 9 days after surgery. Her heart function was restored within 6 months after CS, and follow-up echocardiographies indicated normal heart function.Lessons:This case highlights that early diagnosis and timely termination of pregnancy are crucial in the management of PPCM.

A comparative study of phenylephrine and ephedrine combination to ephedrine and phenylephrine alone for maintenance of blood pressure for caesarean delivery and their effects on foetal acid base status

Introduction: Spinal anaesthesia is the preferred technique for caesarean section. Around 80% of which is complicated by maternal hypotension. Vasopressors are currently the treatment of choice for spinal-induced hypotension but these may individually have significant maternal or foetal side effects. Aim: To compare ephedrine and phenylephrine infusion with ephedrine and phenylephrine combination for preventing the hypotension in patients undergoing emergency caesarean section under spinal anaesthesia. Materials and Methods: A prospective randomized double blind study of 90 parturients beyond 32 weeks of pregnancy for caesarean section under spinal anaesthesia. Assuming a potency ratio of 80:1 ephedrine to phenylephrine, the patients were divided into the following three groups: Group E - received infusions of ephedrine 8 mg/ml, Group P - received infusions of 100 mcg/ml phenylephrine and Group E + P received infusion of ephedrine 4 mg/ml + phenylephrine 50 mcg/ml. A predefined algorithm was used to adjust the infusion rate according to the systolic blood pressure (SBP). After spinal injection, SBP, diastolic blood pressures (DBP), heart rate (HR) were recorded every one minute until the cord was clamped. Also, the vasopressor infusion rates were collected till clamping of umbilical cord in each group. Foetal parameters were analyzed from umbilical blood gas. Results: The incidence of hypotension was significantly higher in ephedrine group. The mean rate of infusion was higher for group E (P 0.05) as compared to others. Complications of bradycardia were observed in 30% of patients receiving phenylephrine. Conclusions: Combination of both phenylephrine and ephedrine is efficacious for spinal-induced hypotension with least maternal or foetal side effects.

Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.

PurposeCesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.Patients and methodsThirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively.ResultsElevation of CRP stress response was lower in the KET group and significantly different (P≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (P>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (P>0.05), but there was a statistically significant (P≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively.ConclusionLow-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia.

Airway management in patients undergoing emergency Cesarean section.

Special care is required for airway management of patients undergoing emergency Cesarean section. Although the incidence of difficult intubation and difficult ventilation is similar between pregnant and non-pregnant women, the severity of complications in pregnant patients would be much greater than in non-pregnant patients, if tracheal intubation is found to be difficult: increased risk of pulmonary aspiration, hypoxia, airway obstruction due to laryngeal edema, and a "sleeping baby" being taken out. Rapid-sequence induction of anesthesia is generally indicated to a patient undergoing emergency Cesarean section under general anesthesia. The technique has been evolving, without losing the key premise of minimizing the period of the airway being not protected from pulmonary aspiration, and of permitting rapid wake up if tracheal intubation fails. In this review, I describe the appropriate airway management, based on the current state of knowledge, in a patient undergoing emergency Cesarean section under general anesthesia.

Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections.

BackgroundProphylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital.MethodsWe conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis.ResultsThe risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62–0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39–0.99; P value 0.036).ConclusionsGiving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis.Trial registrationPan African Clinical Trial Registry PACTR201311000610495.Date of trial registration: 12th August 2013.

Case with a Nonreassuring Fetal Status Induced by Massive Hematemesis due to Mallory-Weiss Tear That Required Emergency Cesarean Section at 38 Weeks' Gestation.

We describe a rare case of Mallory-Weiss tear with massive hematemesis at 38 weeks' gestation. A 35-year-old woman presented with epigastralgia followed by massive hematemesis. An emergency endoscopy indicated active pulsatile bleeding at the esophagocardial junction. Although an emergency endoscopic hemostasis was successful, late decelerations without acceleration on cardiotocogram were observed. Therefore, the patient underwent emergency cesarean section, along with blood transfusion, following the endoscopic hemostasis. The hemoglobin level just before the operation was 5.1 g/dL. We suspected that massive hematemesis induced maternal acute anemia and hypovolemia, which resulted in a nonreassuring fetal status. Hence, urgent endoscopic hemostasis, adequate blood transfusion, and emergency cesarean section were needed. Mallory-Weiss tear during the third trimester may have a possibility of massive hematemesis and urgent blood transfusion, emergency endoscopic hemostasis, and emergency cesarean section may be needed.

Anaesthetic management in emergency cesarean section: Systematic literature review of anaesthetic techniques for emergency C-section

The literature related with the anesthetic management of emergent C section is limited, for which reason we proposed the systematic evaluation of the existing literature on anesthetic management of obstetric patients undergoing emergency cesarean section in order to define the most appropriate interventions based on evidence. A systematic review of the literature was undertaken in MEDLINE, 1966 to December 2010, Cochrane Collaboration registry of clinical trials, Cochrane systematic review database, and LILACS. The study selection process was undertaken independently by two researcher-reviewers, who identified controlled clinical trials and cohort studies of anaesthetic management in emergency C-section. The data were extracted, reviewed and subjected to quality evaluation in duplicate fashion. In total, 2,297, 36, 221 were examined, respectively, and of those 16 potentially relevant papers, 9 clinical trials and 7 observational studies were included in the study. A heterogeneity analysis was done using I2, with a result of 52%, and for this reason no meta-analysis was conducted. ConclusionsThe anaesthetist plays a critical part in mother-and-child care, prioritization of the C-section urgency, peridural anaesthesia extension with 2% lidocaine plus adjuvants (fentanyl plus fresh adrenaline), the use of vasopressors (phenylephrine, ephedrine) for the aggressive management of hypotension, the use of oxygen supplementation and the adequate management of general anaesthesia when indicated, contributing to a favourable impact on the outcome for both the mother and the baby. Long-term neonatal outcomes are not influenced by the type of anaesthesia given to the mother.

Monozygotic Triplets and Dizygotic Twins following Transfer of Three Poor-Quality Cleavage Stage Embryos

Background. Assisted reproductive technology has been linked to the increased incidence of monozygotic twinning. It is of clinical importance due to the increased risk of complications in multiple pregnancies in general and in monozygotic twins in particular. Case. A 29-year-old female, nulligravida underwent her first IVF cycle. Three poor-quality cleavage stage embryos were transferred resulting in monochorionic triamniotic triplets and dichorionic diamniotic twins. Selective embryo reduction was performed at 12 weeks leaving dichorionic twins. The patient underwent emergency cesarean section due to preterm labor and nonreassuring fetal heart tracing at 30 weeks of gestation. Conclusion. Our case emphasizes that even embryos with significant morphological abnormalities should be considered viable and the possibility of simultaneous spontaneous embryo splitting must be factored into determining number of embryos to transfer.

帝王切開術後の膀胱損傷にMycoplasma hominis感染による膿瘍を併発した症例

A 21-year-old female patient underwent emergency cesarean section and a postoperative hematoma occurred at the site of the uterine incision. The patient underwent laparotomy for hemostasis. An 3 cm perforation at the posterior wall of the bladder was identified. The bladder was repaired in two layers with an absorbable suture. Three days later she developed a fever of over 38 degrees C. Despite therapy with several antimicrobial agents, her fever persisted and the wound was opened. Computed tomography scan revealed an abscess at the site where the hematoma had formed. We present a case of severe wound infection that was caused by Mycoplasma hominis infection after cesarean section. Bladder perforation associated with cesarean section is uncommon. Mycoplasma hominis should be considered as a causative organism if an antimicrobial resistant infection occurs at the surgical site after a cesarean section.

Acute Aortic Dissection

A 27-year-old previously healthy woman presented to the emergency room after the sudden onset of severe chest pain and shortness of breath during the 37th week of pregnancy. Her examination was remarkable for a blood pressure of 118/70 mm Hg, heart rate of 100 bpm, and respiratory rate of 24 breaths per minute. The cardiovascular examination was notable for a soft systolic ejection murmur, and the pulmonary and general examinations were unremarkable. ECG demonstrated sinus tachycardia, and her chest x-ray was normal. A D-dimer level was elevated. She underwent a spiral computed tomography scan to evaluate for pulmonary embolism, which instead demonstrated an acute type A aortic dissection and a very small patent ductus arteriosus. The patient underwent emergency cesarean section, which delivered a viable baby, and repair of the type A dissection. Her aortic valve was trileaflet. She had no features on examination to suggest Marfan syndrome or Loeys-Dietz aneurysm syndrome. Her father had died suddenly at 31 years of age of a “presumed heart attack,” and her paternal uncle had undergone ascending aortic aneurysm resection at 42 years of age. Mutation analysis in this woman detected a heterozygous mutation in MYH11 , confirming familial thoracic aortic aneurysm/dissection (TAA/D). Acute aortic dissection is the most common life-threatening disorder affecting the aorta.1 The immediate mortality rate in aortic dissection is as high as 1% per hour over the first several hours, making early diagnosis and treatment critical for survival. Classification schemes for aortic dissection are based on anatomic involvement of the aortic dissection (Figure 1).2 In the DeBakey classification, type I dissections originate in the ascending aorta and extend to at least the aortic arch; type II dissections involve the ascending aorta only; and type III dissections begin in the descending aorta, usually just distal to the …