Post-cesarean Section Research Articles

Penerapan Teknik Relaksasi Foot Massage Untuk Mengurangi Nyeri Pada Pasien Post Sectio Caesarea Di Bangsal Firdaus PKU Gamping

Sectio caesarea delivery is a form of labor process that is carried out by making incisions in the abdominal wall and uterine wall to deliver the fetus from the uterus. Patients who give birth by cesarean section method will usually feel various discomforts. One of the discomforts felt is pain originating from an abdominal incision. So we need a management that can reduce complications and improve quality in post partum mothers, namely by doing foot massage relaxation techniques. The purpose of this case study was to determine the effect of foot massage in reducing pain in post-cesarean section patients. This study used a case study method with a nursing care approach, namely taking 1 patient as a descriptive analysis. Methods of data collection by interviews, observation, pre-test, intervention, and post-test. The research was conducted on March 16-18 2023 at the PKU Gamping Firdaus Ward. The results of the case study showed a decrease in the pain scale in post sectio caesarea patients after foot massage was performed. From the results of the case study, it can be concluded that there is a significant effect of foot massage on changes in pain in post-cesarean section patients.

Randomized comparison between transversus abdominis and erector spinae blocks in cesarean section

Introduction: Transversus abdominis plane (TAP) block provides somatic analgesia postoperatively in cesarean sections, however erector spinae plane (ESP) block has shown to provide both somatic and visceral analgesia.
 Objective: To compare the efficacy of TAP and ESP blocks for pain control after cesarean section under spinal anesthesia.
 Methods: In a double-blind superiority trial, pregnant patients undergoing cesarean section were randomized into either bilateral TAP or ESP block groups. Primary outcome was total consumption of patient-controlled analgesia (PCA) tramadol in the first 24 hours. Secondary outcomes included time required for first rescue analgesia, post-surgery visual analog score (VAS) for pain, patient satisfaction, and adverse effects.
 Results: 50 pregnant patients were randomized into TAP and ESP blocks. There was no difference in the amount of PCA tramadol within the first 24 hours between both groups [100mg (63,125) in TAP group vs 75mg (38,100) ESP group]. Pain score at rest and on movement and patient satisfaction were comparable in both groups, with no difference in adverse effects. There was a slight difference in the median time for first rescue analgesia [210min (135,315) in TAP group and 270min (225,405) ESP group] (p=0.03).
 Conclusion: TAP and ESP blocks provide similar analgesia with comparable consumption of tramadol in the first 24 hours post-cesarean section and no difference in pain scores at rest/on movement.

Postdural Puncture Headache after Spinal Anaesthesia in Parturients Undergoing Cesarean Section in the Department of Anesthesia in a Tertiary Care Center: A Descriptive Cross-sectional Study

The post-dural puncture headache is one of the common complications of spinal anaesthesia. It is one of the most frequent claims for malpractice involving obstetrics anaesthesia. Though self-limiting it is troublesome to the patient. The aim of this study was to find out the prevalence of post-dural puncture headache after spinal anaesthesia in parturients undergoing cesarean section in the Department of Anesthesia in a tertiary care centre. A descriptive cross-sectional study was done among parturients who underwent cesarean section under spinal anaesthesia from 27 June 2022 to 19 January 2023 after receiving ethical approval from the Institutional Review Committee (Reference number: MEMG/480/IRC). The pregnant patients aged 18-45 years of the American Society of Anesthesiologists Physical Status II/IIE who underwent elective or emergency cesarean section under spinal anaesthesia were included. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 385 parturients, the prevalence of post-dural puncture headache was 27 (7.01%) (4.53-9.67, 95% Confidence Interval). A total of 12 (44.44%) cases experienced post-dural puncture headache in the first 24 hours followed by 9 (33.33%) and 6 (22.22%) cases in 48 and 72 hours respectively. Moderate pain was complained of by 3 (11.11%) and 2 (7.41%) cases at 48 and 72 hours post-cesarean section respectively. The prevalence of post-dural puncture headache after spinal anaesthesia in parturients undergoing cesarean section was similar to studies done in similar settings. cesarean section; headache; prevalence.

Atypical presentation of vesicouterine fistula (Youssef’s syndrome) post-caesarean gossypiboma: a case report

Vesicouterine fistula as described by Youssef manifests with amenorrhea, and cyclic haematuria (menouria) without urinary incontinence commonly following caesarean section. Other aetiologies have been reported for this disease. The post-caesarean section gossypiboma, a dual aetiology causing this condition is rare and can make its presentation atypical, thus posing a diagnostic dilemma. The clinical evaluation alone in the atypical presentation of the vesicouterine fistula is insufficient except complemented by imaging investigations and endoscopic examination of the related organs. We report a case of vesicouterine fistula that was managed initially as chronic pelvic inflammatory disease despite urinary incontinence until further evaluation including a transvaginal ultrasound scan and urethrocystoscopy raised an index of suspicion of a vesical mass suggestive of gossypiboma. The mass was confirmed to be a foreign body, an abdominal gauze pack, or gossypiboma. Its removal and repair of the vesicouterine fistula were associated with a satisfactory outcome.

Efficacy and Safety of Carbetocin in Prevention of Postpartum Hemorrhage

Objective: The study compared the effectiveness of carbetocin and oxytocin, administered post caesarian section for prevention of postpartum haemorrhage (PPH). Study Design: This was a prospective single center, case-control, cross sectional, observational, double ended study conducted from September 2020 to January 2022, comprising 150 female patients. Methods: The study was conducted at Hameeda Memorial Hospital Lahore in women undergoing caesarean section under regional and general anesthesia. Women were randomized to receive either carbetocin or oxytocin 5 IU intravenously. Results: Average age of patients was 34.5 years with average BMI of 27. It was noted that patients who were administered drugs had 348.6ml less blood loss than those not administered in PPH. Patients who did not received the drugs had average 800 ml blood loss. Whereas those who did had the drug had average of 451ml loss of bleed in PPH. Carbetocin showed effectiveness in preventing PPH by maintaining uterine tone. It was found that it significantly reduced the need for additional uterine contractile interventions to prevent or treat excessive bleeding after cesarean. In high-risk women, carbetocin has been found to be more effective than oxytocin in preventing blood loss greater than 500 mL during the cesarean section. Practical Implication: This study will help the gynecologists in selecting potent and safe therapeutic agents for the prevention of postpartum hemorrhages in high risk females. Conclusion: Carbetocin has been shown to be a safe and effective option for the prevention of postpartum hemorrhage in high-risk women as compared to other therapeutic agents along with potential safety margins. Keywords: Carbetocin, efficacy, safety, prevention, postpartum hemorrhage, oxytocin, uterotonic

COMPARATIVE EVALUATION OF EFFICACY AND SAFETY OF INTRAVENOUS FERRIC CARBOXYMALTOSE VERSUS IRON SUCROSE COMPLEX FOR THE TREATMENT OF MODERATE GRADE ANEMIA IN POST CAESAREAN SECTION WOMEN: A RANDOMIZED AND PROSPECTIVE STUDY

Objective: Iron deficiency anemia is common in postpartum women in India. The present study is aimed at comparing the safety and efficacy ofintravenous ferric carboxymaltose (FCM) with intravenous iron sucrose complex (ISC) in patients who underwent cesarean section and havingmoderate grade anemia in postpartum period.Methods: A prospective and comparative study was carried out in 100 post-cesarean section women with moderate grade anemia hemoglobin (Hb7–9 g%) in Gajra Raja Medical College, Gwalior (M.P.) from February 2019 to August 2020. Subjects were randomly allocated to two groups, namely,FCM and ICS, 50 patients in each group. In group FCM, patients were infused with 1000 mg of FCM in a single dose on 4th post-operative day. Patients inISC group were infused with ISC 200 mg in 100 mL normal saline on 3 alternate days on 4th, 6th, and 8th post-operative day. Mean, Hb mean corpuscularvolume (MCV), mean corpuscular Hb (MCH), and MCH concentration (MCHC) were recorded before start of therapy and 15 days after treatment in allstudy subjects. Mean reticulocyte count was recorded before start of treatment and 2 days after completion of treatment that is on 6th and 10th postcesarean day in FCM and ICS group, respectively. Adverse drug reactions were recorded during the study period. Statistical analysis was done usingStatistical Package for the Social Sciences software.Results: Mean Hb increased by 27% in FCM and by 19% in ISC group and is significant (*p<0.05) from baseline values. FCM showed significantly(**p<0.01) better response, than ISC group. Mean reticulocyte percent showed significant increase by 120% and 73% in FCM and ISC group,respectively, from the baseline and change in mean reticulocyte in FCM was significant (***p<0.001) as compared to ISC. The mean rise in MCV was12% and 5% and MCH was by 10% and 1% in FCM and ISC group, respectively. FCM groups showed significantly better response (p<0.05) than ISC.However, in MCHC, there were 7% and 4% increase in FCM and ISC group, respectively, and on inter group comparison was not significant (p>0.05).Adverse effects noted during the study were mild and responded to symptomatic treatment. Sixteen percentage of FCM cases and 26% of ISC casesunderwent adverse drug reactions that included nausea, vomiting, giddiness, and injection site reactions.Conclusion: FCM is more efficacious and safer than ISC, making it the first line of management in postpartum iron deficiency anemia.

Potency of Emotional Freedom Technique on Post partum blues and parenting stress among Post caesarean section mothers in selected hospitals at Erode – Partially randomized patient preference study

Context: The first months postpartum can be challenging for parents, leading to elevated symptoms of parenting stress, depression and anxiety. Methods: The aim of this study was to compare the potency of emotional freedom technique on post partum blues and parenting stress among post caesarean section mothers. The total sample size was 150 post partum caesarean section mothers. All study subjects were asked preferences about emotional freedom technique or standard methods of care. According to their strong preference the treatment conditions were allocated. 150 subjects were interviewed before intervention by assessing background variables. On the 2nd post caesarean section day, the subjects were assessed for postpartum blues by using Likert Am I Blue? Assessment scale and parental stress was measured by adopting parental stress scale. Experimental arm received emotional freedom technique for 30 minutes, twice a day (morning and evening) for 4 days. Control arm received standard methods of care. Posttest was conducted by using the same assessment techniques in experimental arm and control arm. Results: Paired‘t’ test and Unpaired‘t’ test showed statistical significance by scaling down the symptoms of post partum blues and parenting stress in experimental arm comparatively to the control arm among post caesarean section mothers. Conclusion: Emotional freedom technique was quite effective for curtailing the symptoms of post partum blues and parenting stress among post caesarean section mothers.

Prospective cohort study of the venous system through duplex mapping in the puerperal pregnancy cycle

Objective: To evaluate the changes in the venous system during pregnancy and childbirth in pregnant and postpartum women without previous venous disease. Methods: This is an observational, analytical prospective cohort study carried out from May 2021 to October 2021, in pregnant women undergoing caesarean section on their first postoperative day, with duplex mapping being performed to assess the diameter and reflux of the great and small saphenous veins, mean venous flow velocity in the common femoral veins in dorsal decubitus and the comparison of velocities when adopting the left and right lateral decubitus position before caesarean section and on the first postpartum day. Result: 49 pregnant women were evaluated, and an increase in flow velocity was observed when adopting the right and left lateral positions in relation to pre- and post-cesarean section in dorsal decubitus. The mean velocity of venous flow from the common femoral vein increased in the postpartum period, regardless of the decubitus adopted. Conclusion: There was an improvement in flow in the femoral vein with the change from dorsal decubitus to right and left lateral decubitus and after termination of pregnancy.

Post caesarian section surgical site infections. Review of current literature

Caesarean delivery rates have increased globally during the past three decades. Caesarean delivery is the most important obstetrical procedure performed with complications that consist of postpartum hemorrhage, endometritis, thromboembolic events or incision infections. While surgical site infections (SSIs) complicate 1.9% of all surgeries performed, the incidence of SSIs after caesarean delivery is significantly higher, almost 7-10%, constituting an important cause of increased morbidity, mortality, readmission, prolonged hospitalization and increased health care costs worldwide. Incisional infection after caesarean delivery happens in 2-7% of cases, necrotizing fasciitis in 0.18% and endometritis in 2-16%. Many risk factors for SSIs have been described. This review includes the several risk factors that have been identified in women who developed post-caesarean section surgical site infections. We also provide an overview of strategies for prevention of postoperative infections including antibiotic prophylaxis, surgical techniques, management of wound infections. Criteria of diagnosis for SSIs are also given, as well as current treatment regimens. Given the impact of maternal post-caesarean infection, it is important for gynecologists to understand how to prevent these postoperative infections, as well as recognize and treat them.

A Comparative Study of the Effectiveness of Prophylactic Antibiotics With or Without Additional Post-op Antibiotics Administration in Cesarean Section Patients for Prevention of Post-op Infection in a Private Hospital

OBJECTIVES: To assess the effectiveness of prophylactic antibiotics with or without additional post-op antibiotics on infectious complications in women undergoing cesarean section. MATERIALS AND METHODS: Retrospective chart review of cesarean section patients at Bangkok Hospital Chiang Mai between 1 January 2016 to 31 December 2018 was carried out. Women at 37-42 weeks’ gestational age who underwent cesarean section and received prophylactic antibiotics with or without additional post-op antibiotic administration were reviewed. They were divided into 2 groups: those who received post-delivery antibiotic vs those who did not. To compare post cesarean delivery infection rate from the delivery day until 6 weeks after. The primary end point is post cesarean section infection from delivery to 6 weeks’ post-operative RESULTS: 481 women received prophylactic antibiotic prior to delivery by cesarean section. 46 were excluded 32 due to being less than 37 weeks’ gestational age, 3 received antibiotics a week prior to delivery, 11 with history of allergic reaction to penicillin or cephalosporin. So, only 435 women met these research study criteria. Within these, 170 cases (39.1%) received additional antibiotics after cesarean delivery, 265 cases (60.9%) didn’t receive antibiotics after cesarean delivery. 20% of prophylactic antibiotic patients only spent more than 60 minutes in the operation room, while 55.29% of those with additional antibiotic post-op did so. 4 (2.4%) cases of additional antibiotic post-op group had post-delivery infection. While 2 (0.8%) cases of patient without additional post-op antibiotic developed infection. CONCLUSION: Additional post-op antibiotics didn’t decrease the incidence of post-delivery infections.

A Prospective Comparative Study of Removal of Urinary Catheter at 12 hours versus at or >24 Hours Following Elective Cesarean Section in Women

Background & Objective: To compare the outcomes of urinary catheter removal at 12 Hours versus at or >24 Hours post elective cesarean section. To assess and compare symptomatic UTI, time of ambulation, length of hospital stays and need for recatherization amongst these 2 groups.
 Methods: In all patients undergoing elective primary cesarean section, Preoperative urine routine and microscopy¯ were sent, UTI was ruled out, clinical examination was performed and were NPO at least 8 hours prior to surgery and given antibiotics. A foley catheter was inserted on the operating table immediately before starting cesarean section. Cesarean sections were performed in the usual manner under spinal anesthesia. After this, in Group 1 patients, catheter were removed 12hours post-operatively while in Group 2 it was removed 24 hours post-operatively. After catheter removal, women were encouraged to void and helped to ambulate.
 Results: 2 groups were compared and the overall rates of post caesarean section urinary complaints dysuria (8.69%), urinary frequeny(14.13%), urgency(10.86%), burning micturition(9.76%) were higher in 24 hours catheter removal group. The Mean duration of first Post-op voiding time (4 hours), ambulatory time(4 hours) and hospital stay(4 days) were shorter in 12 hours catheter removal group.
 Conclusion: Urinary catheter removal post Caesarean section at duration of 12 hours postoperatively is associated with decreased complications and morbidity in post Caesarean section women.

Effect of Hot Pack Administration on Shivering in Post Sectio Caesarea Patients with Spinal Anesthesia

The use of anesthetic techniques is an option for patients with sectio caesarea because the patient is conscious and the recovery period is faster. The impact that often arises after spinal anesthesia is shivering. This study aims to determine the effect of hot packs on shivering in post-cesarean section patients with spinal anesthesia. The research design is a Quasi Experiment with a pre-test post-test control group design. The independent variable of this study is giving hot packs and the dependent variable is shivering. This research was conducted in the High Care Unit Room (HCU) of Aminah Islamic Hospital Blitar from 6 to 31 January 2020. The samples obtained were 32 respondents, 16 respondents in the treatment group and 16 respondents in the control group using accidental sampling. The results showed that the majority of respondents in the treatment and control groups experienced a shivering scale of 2 before administering the hot pack. After administration of the shivering scale hot packs in the treatment group experienced a significant decrease to 0 while the control group experienced a not very significant decrease in shivering scale, namely to 1. Statistical test This study uses Mann Whitney with a p-value of 0.000. This means that giving hot packs has an effect on shivering in post sectio caesarea patients with spinal anesthesia. After administration of hot packs, the shivering scale in the treatment group experienced a significant decrease to 0, while in the control group, the shivering scale decreased which was not too significant, namely to 1. The statistical test of this study used Mann Whitney with a p-value of 0.000. This means that giving hot packs has an effect on shivering in post sectio caesarea patients with spinal anesthesia. After administration of hot packs, the shivering scale in the treatment group experienced a significant decrease to 0, while in the control group, the shivering scale decreased which was not too significant, namely to 1. The statistical test of this study used Mann Whitney with a p-value of 0.000. This means that giving hot packs has an effect on shivering in post sectio caesarea patients with spinal anesthesia.

Efficacy of Granisetron in the Treatment of Nausea and Vomiting Post-Cesarean Section (A Single Centre Retrospective Cohort Study)

Efficacy of Granisetron in the Treatment of Nausea and Vomiting Post-Cesarean Section (A Single Centre Retrospective Cohort Study)

Effect of hypnotherapy on prolactin level in women after cesarean section

BackgroundPostpartum depression occurs in women after cesarean section, due to increased cortisol and decreased prolactin levels, leading to delayed breast milk production. Hypnotherapy is one of the most effective and efficient complementary therapy options for reducing postpartum depression. Hypnotherapy increases oxytocin secretion from the paraventricular nucleus of the anterior pituitary gland, decreases cortisol levels, and increases prolactin, thereby increasing breast milk production. This study evaluates hypnotherapy’s effect on prolactin levels after a cesarean section. MethodsThis study was an experimental non-blinded randomized controlled trial with a post-test-only control group design conducted at Dr. Moewardi General Hospital and UNS hospital. A total of 20 post-cesarean -section women were included in the study. They were randomized into two groups, a group I: given hypnotherapy, and group 2: the control group (without hypnotherapy). Both groups were tested for prolactin levels. Group I received hypnotherapy 6 to 12 hours post-cesarean section, and study participants were confirmed to be unaffected by the anesthetic. Data analysis used the independent t-test and p<0.05. ResultsAt baseline, there was no significant difference in age, parity, and indication for cesarean section between the hypnotherapy and the control groups (p>0.05). After intervention, the mean prolactin level was higher in the hypnotherapy group (247.6 ± 81.1 ng/mL) compared to the control group (120.1 ± 55.4 ng/mL) (p<0.001). ConclusionHypnotherapy increases post-cesarean prolactin levels compared to the controls. Our findings open up a wide range of potential hypnotic applications among women with postpartum depression.

Effect of Coffee Intake on Post-Dural Puncture Headache Parameters among Post-Cesarean Section Women

Effect of Coffee Intake on Post-Dural Puncture Headache Parameters among Post-Cesarean Section Women

Challenges and pitfalls of extracorporeal membrane oxygenation in critically-ill pregnant and peripartum women with COVID-19: a retrospective case series

BackgroundAvailable data identify pregnancy as a strong determinant of a severe course of COVID-19 with increased mortality. Extracorporeal membrane oxygenation (ECMO) remains the last resort treatment in the critical course of COVID-19 yet may increase the risk of excessive bleeding, especially in the immediate post-cesarean section period. One in five patients receiving ECMO during the COVID-19 pandemic were women who were pregnant or postpartum. While the risk of critical respiratory failure in the peripartum period is high, in an early survey only 52% of pregnant patients intended to receive the COVID-19 vaccine. MethodsOur study aimed to evaluate clinical characteristics and treatment modalities in a series of five pregnant and peripartum women supported with ECMO and anticoagulated with anti-Xa-guided nadroparin therapy in our center. We reviewed the full treatment courses; inflammatory, hemodynamic, and coagulation variables; and maternal and neonatal outcomes. We identified adverse events during the therapy. ResultsAll five patients developed acute respiratory distress syndrome due to COVID-19 in the third trimester of pregnancy. Termination of pregnancy occurred between 28 and 36 gestational weeks. While four of five newborns survived to hospital discharge, only two of the five mothers survived to leave hospital. ConclusionsECMO is feasible in the third trimester but not devoid of complications. The severity of respiratory failure during COVID-19 and extracorporeal support may not adversely impact neonatal outcomes.

The Effect of Pregabalin Levels on Pain and Substance P Level Post-Cesarean Section

BACKGROUND: Post-operative pain is a very important problem faced by post-operative patients. Antihyperalgesia is caused by the inhibition of the neurotransmitter glutamate and substance P (SP) by pregabalin. This study aimed to compare the effect of preventive administration of 50 mg oral pregabalin and 1 g paracetamol with 75 mg oral pregabalin and 1 g intravenous paracetamol on Numeric Rating Scale (NRS) scores and SP levels after cesarean section with spinal anesthesia. AIM: The objective of the study was to compare the effect of preventive administration of 50 mg oral pregabalin and 1 g paracetamol with 75 mg oral pregabalin and 1 g intravenous paracetamol on NRS scores and SP levels after cesarean section with spinal anesthesia. METHODS: This study used a double-blind randomized trial design. Samples were selected randomly and consecutively from the entire population that met the inclusion criteria. There were a total of 30 samples. SP levels were measured 2 h before cesarean section. The study drug was administered by mouth with a sip of water 1 h before the expected time of the surgical incision. SP levels were checked at the 4th h (SP 1) and 6th h (SP 2) postoperatively. The assessment of the degree of pain using the NRS was carried out at 2 h, 4 h, 6 h, 12 h, and 24 h postoperatively. This study used the Mann–Whitney U-test to compare both the levels of SP and NRS between the two groups. RESULTS: The results of this study showed that there was a significant difference in the NRS scores between the 50 mg and 75 mg pregabalin groups (p < 0.05). In the 75 mg pregabalin group, the NRS scores were lower than in the 50 mg pregabalin group in patients undergoing CS surgery under spinal anesthesia. There was a significant difference in SP levels between the 50 mg and 75 mg pregabalin groups (p < 0.05). SP levels in the 50 mg pregabalin group increased at 4 h and 6 h postoperatively, while in the 75 mg pregabalin group, it tended to decrease at 4 h and 6 h postoperatively. CONCLUSION: The quiescent and mobile NRS scores in the 75 mg pregabalin group were lower than the 50 mg pregabalin group with a combination of 1 g intravenous paracetamol after SC surgery. SP levels in the 75 mg pregabalin group decreased compared to the 50 mg pregabalin group with a 1 g intravenous paracetamol combination which experienced an increase after CS surgery. Pregabalin 75 mg is recommended for preventive use in CS surgery.

Assessment of Client Satisfaction on Post Cesarean Section and Associated Factors Among Delivered Mothers, 2021.

Mothers' delivery care satisfaction is one of the indicators used to monitor the quality of health care provision. However, there is paucity of evidence on level of maternal satisfaction and its determinants, in Ethiopia, particularly in Somali regional state. Determining the maternal delivery care satisfaction level and identifying its determinants is important to understand the gap and strengthen the existing strategies. Therefore, the study aimed to determine the level of maternal satisfaction and the associated factors among post-cesarean section delivery care at selected public hospitals in the Somali regional state of Ethiopia. An institutional-based cross-sectional study was conducted on 285 mothers who gave birth in selected public hospitals in the Somali region from June 15 to August 29, 2021. The study subjects were chosen from the hospital using simple random sampling, and data was collected by interviewing newly delivered mothers. The data was entered into EPI DATA version 3, exported and analyzed using the Statistical Package for the Social Sciences (SPSS) 26 statistical package. A multivariable logistic regression was applied to identify the factors related to maternal satisfaction at a 95% confidence interval. Variables with a P-value of less than .05 in the multivariable regression were considered to be significantly related to maternal satisfaction. The overall maternal satisfaction level with cesarean section delivery care service was 61.5% (95% CI: 56.1-66.3). Current planned pregnancy [AOR = 2.793; 95% CI: (1.42, 5.51)], antenatal care follows up [AOR = 2.008; 95% CI: (1.097, 3.67)], time spent obtaining health professionals [AOR = 4.045; 95% CI: (2.12, 7.71)], and gender of healthcare provider [AOR = 7.993; 95% CI: (4.11, 15.53)] were all associated with maternal satisfaction with cesarean. The overall maternal satisfaction level with cesarean section delivery care service was found to be low as per the national standards. Maternal satisfaction with cesarean section delivery care services was significantly associated with current pregnancy planned, antenatal care follow-up, time spent waiting for health professionals, and gender of healthcare provider. Thus, hospital administrators should focus on the cesarean section delivery service quality improvement area, and the care should be client-centered.

Effect of age of gravida on post-cesarean section pain: An observational study

Objective: Preoperative identification of women at greater risk of post-cesarean pain might allow more intensive analgesic interventions. This study aimed to assess the effect of age of a parturient on post-cesarean section (CS) pain. Methods: 100 pregnant females were enrolled and divided into 4 groups: group A (age 18–24 years), group B (25–30 years), group C (31–35 years), and group D (≥36 years). Patient-controlled epidural analgesia was started postoperatively in all patients. Pain on a 0- to 10-point visual analog scale (VAS), a number of attempts tried for patient-activated dose delivery of ropivacaine, and successful delivery of patient-activated dose of ropivacaine were recorded for 72 hours. Breastfeeding was initiated as early as possible. The effect of breastfeeding on post-CS pain was observed for 72 hours in terms of increase, decrease, or no change in VAS scores with breastfeeding. Results: The peak VAS scores over 72 hours were 4.10 ± 0.60, 4.00 ± 0.67, 3.75 ± 0.45, and 3.42 ± 0.67, respectively, in groups A, B, C, and D, showing a significant declining trend (P = 0.007). The mean VAS scores decreased from 4.08 to 1.69 (group A, P < 0.0001), from 4.00 to 1.64 (group B, P < 0.0001), from 3.67 to 1.25 (group C, P < 0.0001), and from 3.33 to 1.50 (group D, P < 0.0001) over 72 hours. A statistically significant decline in patient-activated rescue drug delivery attempts, the number of times the rescue analgesic was delivered, and 24-h cumulative ropivacaine dose requirement was seen. Conclusions: In this study, it was found that post-cesarean pain decreases significantly with increasing age, as evidenced by reduced pain scores, reduced attempts at rescue drug delivery, and reduced rescue analgesic requirements.

Risk factors and predictability of severe post-caesarean section adhesions

We aimed to assess risk factors and prediction tools for severe post-CS adhesion formation. Women who underwent CS in a single university-affiliated tertiary medical center were enrolled. Questionnaires assessing adhesions were filled out by the surgeons and were limited to four main anatomical sites: 1. abdomen-to-uterus, 2. uterus-to-bladder, 3. skin-to-fascia, and 4. Other sites. Each site scored between 0-2; sum score range was 0-8. Severe adhesions (score of ≥5) were the primary outcome measure. All cases of CS between January to July 2021 were included and cases with adhesions assessing questionnaires were not completed were excluded. Uni and multivariable logistic regressions were applied to calculate the odds ratio for severe adhesion. Finally, a prediction model was built by a backward variable selection including significant multivariable logistic regression variables and variables with a significant likelihood ratio (LRT) P value. A total of 351 women were included in the study. Women with severe adhesions had significantly higher BMI (26.1 vs. 24.0), had more previous cesarean sections (more than 3 in 12.9% vs. 6.2%), higher rates of gestational diseases (diabetes and Hypertensive disorders) during the current and previous pregnancy (39.8% vs. 23.3% and 31.2% vs. 16.7%, respectively) and a longer previous surgery duration (39.2 vs. 32.2 minutes). In multivariable logistic regressions, previous surgery duration (OR 1.03, CI 1.01-1.04), number of previous CS – two and three or more (OR 3.078, CI 1.66-5.67 and OR 3.32, CI 1.26-8.73, respectively) and gestational disease during the current pregnancy (diabetes and Hypertensive disorders) (OR 2.70, CI 1.39-5.24) had a significant effect on adhesions formation. Furthermore, maternal age was found to have a significant positive contribution to the prediction model (P value LRT < 0.001). The model predicts 75% of severe adhesions. The majority of cases of post-CS adhesions are predictable, based on common risk factors. Our study may contribute to surgeons counseling patients regarding operative risks of adhesionsView Large Image Figure ViewerDownload Hi-res image Download (PPT)