Term Pregnant Patients Research Articles

What are the neonatal outcomes in term pregnant patients complaining of decreased fetal movement?

What are the neonatal outcomes in term pregnant patients complaining of decreased fetal movement?

Association of C-reactive Protein in Preeclampsia

Introduction: Preeclampsia is a multisystemic disorder that complicate about 7-10 percent of human pregnancies.Worldwide this syndrome contributes high maternal and perinatal mortality and morbidity. C-reactive protein, a marker of tissue damage and inflammation, is elevated in seurm in overt preeclampsia. It is used as an objective and sensitive index of overall inflammatory activities in the body. Aims and Objectives: To explore the association of C-reactive protein level with the preeclampsia patients. Materials and Methods: The present study was a Case–Control study, conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of clinical pathology of Sir Salimullah Medical College Hospital, Mitford, Dhaka during the period of January 2013 to December 2013.The study population was pregnant women with preeclampsia and normal term pregnant patients admitted during study period. A total of 66 patients were included in the study. Among them 33 were clinically diagnosed preeclampsia women grouped as Cases and another 33 were age, parity and BMI matched term pregnant women as Controls. Eastmation of serum C-reactive protein was done by Nyco Card Reader-II method (Appendix-11). Statisticians analysis was perform by using SPSS. Results: C-reactive protein concentration (mg/L) was found significantly higher (p<0.001) in case group (17.93±10.5) than control group (7.45±1.80). Creactive protein was _ 6mg/L in 29(87.9%) in case group and 9 (27.3%) in control group and C-reactive protein values showed significant positive correlation with systolic and diastolic blood pressure (p<0.001) in case group. C-reactive protein concentration was found significantly higher (p<0.001) in severe preeclampsia group than mild preeclampsia group. Conclusion: Therefore, it can apparently be concluded from this study that increased maternal serum C-reactive protein level might be a strong risk factor for preeclampsia, although the precise role of C-reactive protein in this regard whether causal or consequential, is yet to be determined. Finding of this study might be helpful for formulating a guideline for management of pregnant women with preeclampsia. Medicine Today 2024, Vol.36 (2): 67-71

Comparison of oral mifepristone with intracervical foleys catheterisation for induction of labour in term pregnancy: A randomized control trial

The purpose of this study is to compare the efficacy of oral Mifepristone with the efficacy of intracervical Foley catheterisation for induction of labour in term pregnancy. The primary outcome of this study is to compare both methods of induction of labour in terms of induction to delivery interval and the secondary outcome is to compare the two methods in terms of route of delivery, indications of caesarean section and the neonatal outcomes. This study is a randomized control trial conducted from May 2022 to December 2022 in Department of Obstetrics and Gynecology, SSG Hospital, Baroda Medical College. 180 term pregnant patients were enrolled in this study based on a pre-established criteria. Patients were randomised into group A and B. Group A included patients who were given Tablet Mifepristone 200 mg PO followed by per vaginum Tablet Misoprostol and Group B included patients who underwent intracervical Foleys catheterisation followed by placement of per vaginum Tablet Misoprostol. The study concluded that there was significantly decreased induction-delivery interval in women induced with intracervical Foleys catheterisation (Group B) as compared to those given oral Tablet Mifepristone (Group A). There was no significant difference between the two groups in terms of the route of delivery, rate of C Sections and neonatal outcomes.Mifepristone is effective for inducing indicated term pregnancies, despite no decrease in induction delivery interval. Incidence of fetal distress with oral Mifepristone is comparable to intracervical foley's catheterization. Further research is needed to assess tachysystole/hyperstimulation and fetal distress caused by Mifepristone.

Prognostic predictive model for PONV in cesarean delivery

Introduction: Apfel simplified risk score for postoperative nausea and vomiting (PONV) has shown to be useful in anesthesia; however, since it has not been calibrated in regional anesthesia or in pregnant patients, its use in cesarean section is limited. 
 Objectives: To develop a prognostic predictive model for postoperative nausea and vomiting in pregnant patients undergoing cesarean section under spinal anesthesia. 
 Methods: In a cohort of 703 term pregnant patients scheduled of cesarean section, 15 variables were prospectively assessed, to design a prognostic predictive model for the development of postoperative nausea and vomiting. A logistic regression analysis was used to construct the model and its calibration and discrimination were based on the Hosmer-Lemeshow test, the calibration curves, and C statistic. Additionally, the internal calibration was performed with the Bootstrap resampling method.
 Results: Postoperative nausea and vomiting were experienced by 27 % of the patients during the first six hours after surgery. The model included as prognostic variables the development of intraoperative nausea and vomiting, age under 28 years, a history of PONV, the mother’s BMI and the weight of the newborn baby. The model showed an adequate calibration (χ2: 4.65 p: 0.5888), though a low discrimination (Statistic C = 0.68).
 Conclusions: A prognostic predictive model was created for the development of PONV in cesarean section. This model was used to build a prognostic scale for the classification of patients into risk groups.

In term pregnant patients, is it safe to sweep membranes in group B Streptococcus (GBS)–positive patients?

University of Colorado Family Medicine Residency, Denver, CO The corresponding author is Susana Peralta; [email protected]. The authors declare no conflicts of interest.

Comparison of ultrasound measured gastric volume in term-pregnant patients posted for elective cesarean section with nonpregnant elective surgery patients---An observational study

Background: The pregnant patients undergoing anesthesia are at increased risk of aspiration due to decreased lower esophageal sphincter tone and mass effect of gravid uterus on gastric antrum. Ultrasound used as a noninvasive bedside imaging tool to measure gastric volume in term pregnant patients immediately before elective caesarian section (CS) may help in reducing aspiration induced morbidity and mortality. Methods: This observational prospective case--control study was conducted in 33 nonlaboring term pregnant patients immediately before elective CS and 30 nonpregnant patients immediately before elective surgeries, enrolled according to inclusion and exclusion criteria. A 2-5 MHz curvilinear probe was used to scan the participants in supine and right lateral decubitus (RLD) position in pre-recovery room. Visibility, qualitative grading (0,1, 2), anteroposterior (AP), and craniocaudal (CC) diameter, and cross-sectional area (CSA) of gastric antrum was measured. Gastric volume was derived from CSA using equations formulated by previous investigators. Results: Gastric antrum was visible in 27 (82%) of pregnant and 30 (100%) of nonpregnant patients in supine position (P = 0.014). In RLD position, 25 (75.7%) pregnant and 29 (96.7%) nonpregnant patients had antrum visible (P = 0.018). The qualitative grading was comparable (P = 0.064) in both the groups. In supine position, (P = 0.615), CSA in cm2 was 3.37 ± 1.31 and 3.54 ± 1.33, while in RLD position (P = 0.012), CSA was 3.98 ± 1.13 and 5.09 ± 1.85, in pregnant and nonpregnant patients, respectively. Conclusion: Gravid uterus sometimes impedes visualization of antrum by ultrasound in term pregnant patients immediately before elective CS and shows clinically similar gastric CSA when compared to nonpregnant patients, though statistically different in RLD position. Trial registration number- NCT03380637

Panniculus retractor use during scheduled cesarean section: potential neonatal impact

Use of a disposable panniculus retractor (DPR) during cesarean section (CS) improves surgical site visualization in obese women. However, whether this redistribution of weight onto the uterus and abdominal vasculature just prior to delivery impacts neonatal outcomes is unclear. To assess the potential downstream effect of DPR, we investigated neonatal outcomes after scheduled CS for deliveries using DPR. A retrospective cohort study of term pregnant patients with body mass index (BMI) ≥ 40.00 kg/m2 who underwent a scheduled CS at a tertiary care center from June, 2018 to May, 2019. CS using a DPR were compared to those without. Exclusion criteria included multiple gestation, fetal anomalies and general anesthesia. Universal umbilical artery (UA) cord gas collection is performed at our institution. The primary outcome was UA pH. Secondary outcomes were UA pH< 7.1, APGAR scores at 1 min and 5 min, neonatal intensive care (NICU) admission, and other UA gas parameters. Descriptive statistics and univariate analysis were performed. Multivariable logistic regression was used to adjust for potential confounders. 91 patients met inclusion criteria, including 23 (25.3%) with intraoperative DPR use and 68 (74.7%) without. Patients in the DPR group had a higher BMI (49.4 kg/m2 ±7.8 vs 45.9 kg/m2±6.1 [p=0.03]), and higher rates of drug use (47.8% vs 16.2% [p< 0.01]). UA pH was similar between groups (7.21±0.09 vs 7.24±0.06 [p=0.13]) as was UA pH < 7.1 (4.3% vs 1.5% [p=0.56]). UA lactate was significantly higher in the DPR group (4.0mmol/l±1.9 vs 3.2mmol/l±1.2 [p=0.02]). However, the risk of UA lactate > 4 mmol/l and NICU admission were similar between groups (aRR 2.52 [0.81, 3.53] and aRR 1.92 [0.31, 8.59], respectively). Intraoperative use of DPR did not significantly impact rates of neonatal acidemia at time of delivery. However, as elevated UA lactate represents early hypoxemia, more research is needed to assess the impact of increased lactate and whether this indicates an emerging trend.

Effect of low dose phenylephrine infusion on shivering and hypothermia in patients undergoing cesarean section under spinal anesthesia: a randomized clinical trial

BackgroundShivering is a common complication of spinal anesthesia. Phenylephrine, due to its peripheral vasoconstrictive effect, may limit the core to periphery redistribution of body temperature following spinal anesthesia, and reduce hypothermia and shivering. We hypothesized that prophylactic phenylephrine infusion would reduce shivering and hypothermia in women undergoing cesarean section under spinal anesthesia. MethodsA two-arm randomized, double-blind, placebo-controlled trial in term pregnant patients undergoing cesarean section. In the phenylephrine group (n=75) prophylactic phenylephrine infusion was administered at 25 µg/min immediately after initiation of spinal anesthesia and continued until the end of the operative period. In the placebo group (n=75) a normal saline infusion was administered during the same period. The primary outcome was the incidence of shivering; secondary outcomes were severity of shivering, changes in nasopharyngeal (core) temperature, and incidence of hypotension and bradycardia. ResultsThe incidence of shivering in the phenylephrine and control groups was 24.0% (95% CI 14.3% to 33.7%) and 53.3% (95% CI 42.0% to 64.6%), respectively. The severity of shivering was greater in the control group (P=0.002) and the mean (±SD) end of surgery core temperature was significantly higher in the phenylephrine group (35.84°C ± 0.60) compared with controls (35.61°C ± 0.48) (P=0.009). The incidence of hypotension was higher in controls (53.4% vs. 2.7%; P <0.001) but bradycardia more frequent in group P (P=0.023). ConclusionThe incidence of shivering and degree of hypothermia were significantly reduced by a prophylactic phenylephrine infusion during cesarean section under spinal anesthesia.

Frequency and Outcome of Full Term Pregnant Patients with Previous Cesarean Section

Objectives: To determine the frequency of repeat Cesarean Section in patients with previous one cesarean section To compare the maternal and perinatal outcome in vaginal birth after Cesarean and repeat caesarean section Material and Methods: This Cross sectional study was conducted at Obstetrics &amp; Gynecology unit1 JPMC Karachi from Jan 2020 to31 Dec2020.A total of 137 women with history of previous one cesarean section were included in this study. All patients’ history and examination was taken. The data was collected on a predesigned Performa. Mean and Standard Deviation for quantitative variables and percentage for categorical qualitative variables. Maternal and perinatal outcomes was compared between women who have VBAC and those who have repeat Cesarean section by using chi-square test with P-values less than or equal to 0.05 significant. Results: The average age of the women was 29.88±3.26 years. Frequency of repeat caesarean section in patients with previous one cesarean section was 52.55%. PPH was observed in 37.96% cases while prolong hospital stay in 28.47%. There were 15.33% still birth, Apgar score less than 7 in 42.34% at 1 minute, and NICU admission was observed in 23.38%. Rate of Postpartum hemorrhage and prolong hospital stay was significantly high in repeated caesarean section. Conclusion: All of the maternal and prenatal outcomes were significantly high in repeated Cesarean section as compare to vaginal deliveries. The trial of labor in women with a single previous caesarean delivery can safely reduce rate of caesarean section. Keywords: Caesarean section, vaginal birth after Cesarean, repeats caesarean section

Frequency and Outcome of Full Term Pregnant Patients with Previous Cesarean Section

Objectives: To determine the frequency of repeat Cesarean Section in patients with previous one cesarean section To compare the maternal and perinatal outcome in vaginal birth after Cesarean and repeat caesarean section Material and Methods: This Cross sectional study was conducted at Obstetrics &amp; Gynecology unit1 JPMC Karachi from Jan 2020 to31 Dec2020.A total of 137 women with history of previous one cesarean section were included in this study. All patients’ history and examination was taken. The data was collected on a predesigned Performa. Mean and Standard Deviation for quantitative variables and percentage for categorical qualitative variables. Maternal and perinatal outcomes was compared between women who have VBAC and those who have repeat Cesarean section by using chi-square test with P-values less than or equal to 0.05 significant. Results: The average age of the women was 29.88±3.26 years. Frequency of repeat caesarean section in patients with previous one cesarean section was 52.55%. PPH was observed in 37.96% cases while prolong hospital stay in 28.47%. There were 15.33% still birth, Apgar score less than 7 in 42.34% at 1 minute, and NICU admission was observed in 23.38%. Rate of Postpartum hemorrhage and prolong hospital stay was significantly high in repeated caesarean section. Conclusion: All of the maternal and prenatal outcomes were significantly high in repeated Cesarean section as compare to vaginal deliveries. The trial of labor in women with a single previous caesarean delivery can safely reduce rate of caesarean section. Keywords: Caesarean section, vaginal birth after Cesarean, repeats caesarean section

Comparison of phenylephrine and norepinephrine for prevention of hypotension in patients undergoing cesarean section under spinal anesthesia – A randomized prospective study

Background: Hypotension is a common side effect of spinal anesthesia for cesarean section with incidence of upto 71%. Various vasopressors are available for counteracting spinal hypotension each with different pharmacological profile. Norepinephrine is currently one of the feasible options for prophylaxis of spinal induced hypotension in patients undergoing cesarean section. Aims: To compare efficacy of phenylephrine and norepinephrine for reducing incidence of hypotension in patients undergoing cesarean section under spinal anesthesia and their effect on neonatal outcome. The primary outcome compared was incidence of hypotension (defined as fall in systolic blood pressure of >20% from the baseline value or a value <90 mmHg). The secondary outcomes noted were incidence of bradycardia, nausea, vomiting in the mother, and neonatal outcome. Methodology: A total of 80 singleton full term pregnant patients of American Society of Anesthesiology (ASA) grade II scheduled for elective cesarean section were randomly assigned to 2 groups of 40 patients each. Group P received phenylephrine 50 mcg and Group N received norepinephrine 10 mcg as intravenous bolus over 1 min immediately after the patient had been made supine after giving spinal anesthesia. The vital parameters, adverse effects, and neonatal outcome were assessed and analyzed statistically. Results: Intraoperatively, norepinephrine group had a significantly higher mean heart rate than phenylephrine group. Neonatal outcome was similar in both the groups with respect to appearance, pulse, grimace, activity, and respiration (Apgar) scores and umbilical arterial pH. Conclusions: In cesarean section under spinal anesthesia, norepinephrine efficacy in rescuing maternal hypotension is similar to that of phenylephrine without obvious maternal or neonatal adverse outcomes and with a lower incidence of bradycardia.

Preventing Isthmocele after Cesarean Section (PICS): A Pilot Randomized Controlled Trial

<h3>Study Objective</h3> An isthmocele is a cesarean scar site defect with a depth of >2mm and can lead to both obstetric and gynecologic complications. The primary objective was to evaluate the feasibility of a study protocol comparing different cesarean section closure techniques amongst our own patients/physicians, with the ultimate goal of a larger scale randomized controlled trial (RCT). Secondary objectives included isthmocele incidence, measurements on postoperative ultrasound, and adverse surgical outcomes related to suture technique. <h3>Design</h3> A single-center parallel-group pilot RCT comparing locked vs. unlocked first-layer uterine closure. Outpatient transvaginal ultrasound to evaluate isthmocele formation was performed at least six months postoperatively. <h3>Setting</h3> Operating room and outpatient ultrasound clinic. <h3>Patients or Participants</h3> All term pregnant patients >18 years old undergoing a primary caesarean section were eligible. Exclusion criteria included previous uterine hysterotomy, known uterine anomalies, active labour, and maternal bleeding and/or connective tissue disorders. <h3>Interventions</h3> Locked or unlocked closure of the first uterine layer. <h3>Measurements and Main Results</h3> Forty-one subjects were randomized, and 23 completed the follow-up ultrasound, with 12 in the locked group and 11 in the unlocked group. Barriers to feasibility included hesitance to participate in research during pregnancy, difficulty attending follow-up ultrasound with a newborn, and mainly Covid-19 pandemic related delays in study activities and fear of potential exposures. Isthmocele was present in 10/12 patients receiving locked closure, and in 11/11 of the unlocked group. Mean sagittal depth was 0.36 cm and 0.40 cm in the locked vs. unlocked groups, respectively. Sagittal adjacent myometrial thickness was 1.03 cm in the locked group, and 1.12 cm in the unlocked group. No adverse outcomes were noted with either surgical technique. <h3>Conclusion</h3> The study design is feasible outside of the pandemic setting. A larger trial is needed to determine differences regarding isthmocele rates and measurements between groups.

English

BACKGROUND Corona virus disease 2019 (COVID 19) outbreak have evolved rapidly throughout the world. The knowledge on severe acute respiratory disease-corona virus-2 (SARS-CoV-2) infection in pregnant women and newborn is incomplete. Understanding the impact of COVID 19 in pregnancy in terms of morbidity mortality, perinatal and neonatal outcome is essential to propose a strategy for the management of pregnant women with COVID 19 infection. METHOD It is a prospective study of all pregnant women who have delivered in the period of April 2020 to December 2020 at Government T.D. Medical College, Alappuzha. In this study, the mode of delivery, neonatal outcome, maternal mortality, morbidity were evaluated. The outcome of pregnancies includes vaginal delivery, caesarean delivery, vacuum delivery and intrauterine fetal demise. RESULTS A total of 265 pregnant women infected with COVID 19 delivered during the period. Out of these, 49.4 % was full term caesarean delivery, 3.8 % was preterm caesarean delivery, 39.3 % was full term vaginal delivery and 4.9 % was preterm vaginal delivery. Moreover, 1.1 % of the total pregnant women had intrauterine fetal demise on admission. Among 265 new-borns, 2.3 % babies became COVID 19 positive, of this, 83.3 % were mothers who delivered within 7 days of COVID 19 infection. 0.75 % needed resuscitative emergency caesarean delivery for COVID 19 pneumonia. 0.38 % maternal mortality occurred during the period due to COVID 19 infection. CONCLUSIONS Obstetric outcome in most COVID 19 infected term pregnant patients is comparable to non-COVID 19 pregnant women except for a higher incidence of caesarean delivery. Most of the neonates who became positive were born to mothers delivered within 7 days of COVID 19 infection. Severe morbidity among COVID 19 pregnant women were seen only in a small proportion complicated by COVID 19 pneumonia, who required ventilator support. KEYWORDS COVID 19, Pregnancy, Maternal, Perinatal, Neonatal Outcome

Inferior vena cava assessment in term pregnant women using ultrasound: A comparison of the subcostal and right upper quadrant views.

Point-of-care ultrasound can be used at the bedside to assess the haemodynamic status and fluid responsiveness of a pregnant woman. Previous studies demonstrated that views from the apical and parasternal windows are readily obtainable in labouring women. However, using the subcostal window to assess the inferior vena cava can be challenging because of the gravid uterus. A potential alternative is the right upper quadrant transhepatic window. We sought to compare visualisation of the inferior vena cava via the subcostal and right upper quadrant windows, in full-term pregnant women. This was a prospective pilot study carried out in a tertiary academic obstetric centre. Thirty pregnant non-labouring women at full term were recruited. In each patient, the inferior vena cava was visualised through both the subcostal and the right upper quadrant windows. Time to acquire each image, acquisition success rates and ease of obtaining images were compared for both approaches. Image quality was then reviewed and rated by two independent expert reviewers. There was a significant difference in the time required to obtain each view; subcostal median (interquartile range): 52 (35-59) seconds, right upper quadrant median (interquartile range): 23 (11-55) seconds (P=0.0045). Operator-defined successful image acquisition was 100% for the right upper quadrant window compared to 80% for the subcostal window. Ease of obtaining the view, as rated by the operator, was significantly easier in the right upper quadrant window compared to the subcostal window (P <0.0001). Both reviewers independently rated image adequacy to be significantly greater in the right upper quadrant window (73% and 57%) compared to the subcostal window (40% and 10%) (P=0.0213 and P=0.0005, respectively). Inter-rater agreement ranged between good (Cohen's kappa coefficient 0.64) for right upper quadrant windows to fair (Cohen's kappa coefficient 0.29) for subcostal windows. Inferior vena cava visualisation in term pregnant patients may take less time, be easier and provide better quality images when the right upper quadrant window is used compared to the subcostal window.

Efficacy of different infusion rates of oxytocin for maintaining uterine tone during elective caesarean section: A randomised double blind trial.

Most research in this field has focused on finding oxytocin doses for initiating uterine contractions. Only limited data are available regarding the optimal rate of oxytocin infusion to maintain adequate uterine tone. This randomised, double blind study included 120 healthy term pregnant patients with uncomplicated, singleton pregnancy undergoing elective caesarean section under spinal anaesthesia. Following an initial 1 IU bolus, the patients received oxytocin infusion at 1.25 IU/hour (group 1.25), 2.5 IU/hour (group 2.5) or 5.0 IU/hour (group 5) for four hours. Uterine tone was assessed as adequate or inadequate at various intervals. If found inadequate, additional uterotonics were administered. Estimated blood loss was mean (standard deviation) 499 (172) ml, 454 (117) ml and 402 (151) ml in groups 1.25, 2.5 and 5, respectively (P value groups 1.25 versus 5 = 0.012). Oxytocin infusion at 5 IU/hour resulted in a significantly lower incidence of minor postpartum haemorrhage, defined as blood loss greater than 500 ml, than 1.25 IU/hour (P = 0.009). No patient had major/severe haemorrhage (>1000 ml blood loss). No significant difference was seen in haemoglobin levels (P = 0.677) and uterine tone. Fifteen, six and nine patients, respectively, required additional oxytocin (P = 0.151). The incidence of tachycardia (P = 0.726), hypotension (P = 0.321) and nausea/vomiting (P = 0.161) was comparable. To conclude, 5 IU/hour was more effective than 1.25 IU/hour in reducing total blood loss and the incidence of minor postpartum haemorrhage. Thus 5 IU/hour appears to be an optimal oxytocin infusion rate following 1 IU slow intravenous oxytocin injection for the maintenance of adequate uterine contraction in patients undergoing elective caesarean section under spinal anaesthesia.

159 Utility of universal preadmission COVID-19 testing in labor and delivery unit at local community hospital

To estimate prevalence of asymptomatic SARS-CoV-2 positive pregnant (carriers) through universal preadmission L&D screening at local community hospitals system located in northwest Ohio and southeast Michigan. Retrospective cohort analysis of universal COVID-19 testing in pregnant was performed at ProMedica Health care system from March to September 2020 during COVID-19 pandemic. During COVID-19 pandemic our health care elected to follow universal preadmission L&D screening and universal use of PPE strategy aimed to protect healthcare workers and prevent spread of new coronavirus infection. It was believed that pregnant women are at higher risk for COVID-19 as compared to general population. All scheduled term pregnant patients underwent universal nasopharyngeal COVID-19 qRT-PCR 48 hours prior to delivery. Positive patients were triaged over the phone for symptoms. Positive patients were identified as asymptomatic, mild, moderate, severe or critical disease according to SMFM guidelines. 2357 deliveries occurred during study timeframe, out of which 1399 pregnant patients (59.4%) were eligible for universal testing. Among 1399 pregnant who were scheduled for preadmission L&D SARS-CoV-2 screening, 1165 (83.3%) underwent testing prior to scheduled hospital admission, 202 (14.4%) delivered prior to scheduled test and 32 (2.3%) patient declined testing. Out of 1165 screened, 10 (0.9%) were tested SARS-CoV-2 positive. Two out of 1165 (0.2%) developed mild symptoms and 8 (0.7%) were asymptomatic. 1155 (99.1%) were tested SARS-CoV-2 negative (Fig.1). The estimated prevalence of SARS-CoV-2 carriers among scheduled for L&D admission in ProMedica Health care system were 0.7% from March to August 2020. This carrier rate is almost similar to general population rate in Ohio (1.2%)2 and Michigan (1.2%)2 during both surges in cases (Fig. 2). Based on our small cohort, it appears that COVID-19 carrier rate is similar between pregnant and general population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

To Study The Correlation Between Preoperative Inferior Vena Cava Diameter And Intraoperative Hypotension During Spinal Anaesthesia In Caesarean Section

BACKGROUND: Assessment of maternal intravascular volume status during and after gestation is most crucial in the setting of complications that affect hemodynamic stability. The goal of the perioperative fluid management is to avoid acute kidney injury due to hypovolemia and hypotension due to spinal anaesthesia. Ultrasound measurements of dynamic change in inferior vena cava diameter (IVC) and collapsibility index are used to predict and prevent the hypotension after spinal anaesthesia.OBJECTIVES: To correlate the IVC diameter in expiration and incidences of intraoperative hypotension after spinal anaesthesia in full term pregnant patients posted for elective caesarean section.MATERIALS AND METHOD: Total 50 young female patients having full term pregnancy scheduled for elective caesarean sections were included in the study after taking informed consent. Preoperative assessment of all patients was done. Preoperative inferior vena cave diameter in expiration was measured by ultrasound guidance by subcostal approach. Spinal anaesthesia was given with injection bupivacaine heavy 0.5% 2ml between L3-L4 subarachnoid space after taking all aseptic precaution. Pulse, blood pressure was measured at regular interval. Incidence of intraoperative hypotension, bradycardia was noted. Results were expressed as mean ±SD and analysed by paired’ test and correlation coefficient was calculated.RESULTS: The mean inferior vena cava diameter in expiration was 17.4 ± 0.04 and collapsibility index was less than 36 in 80% of patients, and only one patient had developed hypotension after spinal anaesthesia. Correlation coefficient was -0.9.CONCLUSION: Preoperative inferior vena cava measurement is a reliable predictor of hypotension after spinal anaesthesia.

Term Pregnant Patients have Similar Gastric Volume to Nonpregnant Females: A Single-Center Cohort Study

(Br J Anaesth. 2019;122(1):79–85. Doi: 10.1016/j.bja.2018.07.025) Current studies suggest that gastric emptying time is not prolonged in pregnancy. However, these data come from small samples. Pulmonary aspiration of gastric contents during obstetric anesthesia remains a concern. In the present study, authors assessed the range of gastric fluid volume in fasted nonlaboring term pregnant patients and fasted nonpregnant female patients scheduled for surgery.

STUDY OF THE EFFECT OF MIDAZOLAM PRIOR TO ELECTIVE CESAREAN SECTION ON MOTHER AND NEONATE UNDER SPINAL ANESTHESIA

Background: Spinal anesthesia is the most popular form of regional anesthesia used for Cesarean delivery. Like all surgical patients, obstetric patients also feel operative stress and anxiety. The pharmacological sedation in spinal anesthesia is not commonly applied. Objectives: This work aimed to determine the effect of premedication with midazolam on preoperative maternal anxiety, neonatal outcome regarding respiratory depressant effect and muscle tone, and also postoperative satisfaction of parturients scheduled for elective cesarean delivery under spinal anesthesia. Patients and Methods: After approval of Institutional ethical committee and obtaining written informed consent from eligible parturient women, 80 full term pregnant patients aged between 18 and 40 years were classified according to American Society of Anesthesiologist I and II and scheduled for elective cesarean section. The study was conducted in the Obstetrics Department of Al-Azhar University Hospitals (Al-Hussein and Bab-Al-Shaarya), from December 2018 till June 2019. Results: Midazolam intravenously at a dose of 0.035 mg/kg before spinal anesthesia for patients undergoing cesarean section were effective in relieving maternal anxiety with no adverse effect on neonates or maternal hemodynamic instability. Conclusion: Preoperative sedation 30 mins pre anesthetichally was found to be associated with improved preoperative anxiety, postoperative satisfaction, and maternal hemodynamics in parturients scheduled for elective cesarean delivery.

STUDY OF THE EFFECT OF MIDAZOLAM PRIOR TO ELECTIVE CESAREAN SECTION ON MOTHER AND NEONATE UNDER SPINAL ANESTHESIA

Background: Spinal anesthesia is the most popular form of regional anesthesia used for Cesarean delivery. Like all surgical patients, obstetric patients also feel operative stress and anxiety. The pharmacological sedation in spinal anesthesia is not commonly applied. Objectives: This work aimed to determine the effect of premedication with midazolam on preoperative maternal anxiety, neonatal outcome regarding respiratory depressant effect and muscle tone, and also postoperative satisfaction of parturients scheduled for elective cesarean delivery under spinal anesthesia. Patients and Methods: After approval of Institutional ethical committee and obtaining written informed consent from eligible parturient women, 80 full term pregnant patients aged between 18 and 40 years were classified according to American Society of Anesthesiologist I and II and scheduled for elective cesarean section. The study was conducted in the Obstetrics Department of Al-Azhar University Hospitals (Al-Hussein and Bab-Al-Shaarya), from December 2018 till June 2019. Results: Midazolam intravenously at a dose of 0.035 mg/kg before spinal anesthesia for patients undergoing cesarean section were effective in relieving maternal anxiety with no adverse effect on neonates or maternal hemodynamic instability. Conclusion: Preoperative sedation 30 mins pre anesthetichally was found to be associated with improved preoperative anxiety, postoperative satisfaction, and maternal hemodynamics in parturients scheduled for elective cesarean delivery.