Underwent Emergency Cesarean Section Research Articles

Prolonged second stage of labor and risk of postpartum hemorrhage in nullipara with epidural anesthesia and vaginal delivery: A cohort study with propensity score analysis.

To conduct an analysis using propensity score methods, exploring the association between a prolonged second stage (>3 h) and the risk of postpartum hemorrhage (PPH) in a diverse population. We conducted a prospective cohort study involving nullipara with epidural anesthesia and vaginal delivery, aged ≥18 years, presenting cephalically, and with a gestational age (GA) of ≥24 weeks at a tertiary maternity hospital in China (chictr.org.cn identifier: ChiCTR2200063094). Women undergoing emergency cesarean section in labor were excluded. The primary outcome was PPH, with secondary outcomes including severe postpartum hemorrhage and blood transfusion. We employed propensity score overlap weighting to analyze the association between prolonged second stage labor and PPH. The study included 3643 nullipara with epidural anesthesia, comprising 77 with a second stage of labor >3 h and 3566 with a second stage ≤3 h. Utilizing propensity score overlap weighting, there were no significant differences observed between the two groups regarding the risk of PPH (29.87% in >3 h group vs 17.64% in ≤3 h group; weighted odds ratio 1.01; 95% CI: 0.51-2.02). Subgroup interaction tests for PPH were not significant for assisted vaginal delivery, induction of labor, macrosomia, third-/fourth-degree perineal laceration, GA >41 weeks, twin pregnancies, episiotomy and GA >37 weeks. Sensitivity analysis did not reveal significant differences. This study did not find evidence supporting an increased risk of PPH associated with a second stage of labor lasting >3 h in our population, providing additional evidence for clinical practice.

Kangaroo Mother Care Induced Serum Oxytocin Facilitates Prolactin and IL-10 Among Emergency Cesarean Mothers.

The rate of cesarean section is increasing from 15% to 40% in recent years. The type of delivery influences the hormonal, emotional and mental health of the mother, which correlates positively or negatively with the health benefits of the newborn. There have been many published studies on kangaroo mother care for mothers undergoing elective cesarean section, but there is still a lack of understanding about emergency cesarean section. This study aimed to evaluate the benefits of KMC practice for mothers undergoing emergency cesarean section in terms of hormone levels such as oxytocin, cortisol, prolactin, interleukin-6 and interleukin-10. This retrospective analysis used remnant serum (KMC group = 16; control group = 9), and clinical data such as KMC practice (15-30 minutes three or four times daily until discharge), breastfeeding initiation time, feeding time, crying time and hospital stay were extracted from the electronic database. All hormone and cytokine expressions were quantitatively determined by ELISA. Comparisons within and between groups were performed using appropriate statistical tests. In the KMC group, increased levels of the hormone oxytocin significantly reduced cortisol and IL-6 and negatively influenced prolactin and IL-10 levels. The elevated prolactin facilitates overall lactation behaviour, of which 64% reported breastfeeding directly at the breast. The cytokine analysis revealed a reduction in pro-inflammatory cytokines and thereby an improved wound healing was seen in the KMC group. These quantitative results strongly encourage the use of KMC for mothers undergoing emergency cesarean section. These simple yet effective breastfeeding strategies promote maternal and infant health, which can reduce medication use.

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.

High Risk Pregnancy and its Outcome in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: High-risk pregnancy is defined as one which is complicated by factors or factors that adversely affect the pregnancy outcome (maternal, perinatal or both). Early detection and effectivemanagement of high risk pregnancy helps in achieving favorable maternal and perinatal outcomes. This study aimed to find the prevalence of high risk pregnancy and its outcome among pregnant women admitted for delivery in the obstetrics and gynecology department of a tertiary care hospital Methods: A descriptive cross sectional study was conducted in a tertiary care hospital among high risk pregnant women admitted for delivery using structured proforma, from April 2023 to September 2023 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling was used among pregnant women who met the inclusion criteria. Data was entered in excel and analysis was done using IBM SPSS Statistics. Point estimate was calculated at 95% Confidence Interval Results: Among 350 deliveries, high risk pregnancy was seen in 91 (26%) (16.15-32.00, 95% Confidence Interval). The high risk factors were previous history of cesarean section 25 (27.47 %) followed by hypothyroidism 19 (20.87%) and gestational diabetes mellitus 15 (16.48%). Out of 90 high risk pregnancy, 84 (92.30%) had term delivery. Lower segment cesarean section was done in 69 (75.82%) patients of which 26 (28.57%) underwent emergency cesarean section. The total number of births among high risk preganancies were 93 with two sets of twin births. A total of 13 (13.97%) of the babies had low-birth weight. Conclusions: The prevalence of high risk pregnancy was found to be similar as compared to studies done in similar settings.

The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor

The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future. This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor. This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography score. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and -removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia and facilitation of timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and to validate the clinical application of these scores.

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

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

Dose Sildenafil Citrate Reduce the Incidence of Emergency Cesarean Section and Fetal Distress During Labor? A Randomized Double-Blinded Clinical Trial.

Fetal distress (FD) is one of the most frequent causes of emergency cesarean section (CS) due to the insufficient uteroplacental blood supply during labor. There is a theory that Sildenafil citrate (SC) may improve the uteroplacental blood supply and decrease fetal hypoxia and FD. In a randomized double-blinded clinical trial, a total of 208 low-risk subjects who met our stringent inclusion criteria were randomly assigned into two groups: the Sildenafil citrate group (n=104) and the placebo group (n=104). These participants were referred to our referral gynecology and obstetrics department for delivery between July 2022 to September 2022. The SC group received oral SC at a dose of 50 mg every 6 hr, up to a maximum of three times. The final maternal-fetal-neonatal results were recorded and all data were analyzed using SPSS version 23. The mean age of mothers was 28.98±5.6 years and 120 cases were primigravid (57.7%). Out of a total of 208 pregnant subjects, 168 subjects delivered through normal vaginal delivery (80.8%) and 40 cases underwent emergency CS (19.2%). The number of NVD in Sildenafil group was significantly more than placebo group (87.5% vs. 74%) and SC decreased the rate of emergency CS to 87.5% (RR=2.46%, 95%CI 1.19-5.08). Also, SC decreased the rate of FD to 53.8% (RR=2.83%, 95%CI of 1-8.24). The results showed that SC can effectively decrease the rate of emergency CS and FD during labor.

P 023: Idiopathic left fascicular ventricular tachycardia in pregnancy

Ventricular tachycardia (VT) can occasionally cause complications in pregnancy. In structurally normal heart, VT that arises in the left ventricle is uncommon and is termed as idiopathic left fascicular VT (ILVT). We report a case of 32-year-old lady, gravida 4 para 3 who presented to us at 34 weeks of pregnancy with symptomatic stable cardiac arrythmia with heart rate of 160 beats per minute. Electrocardiogram showed wide complex tachycardia with positive initial R wave at aVR and capture beats suggestive of ILVT. Echocardiogram was normal. She received IV verapamil 25 mg in total which failed to revert to sinus rhythm and hence, she underwent emergency Caesarean section followed by synchronized cardioversion urgently in operation theatre. Post cardioversion ECG showed sinus rhythm with memory T waves at chest leads. She was scheduled radiofrequency ablation later. This case highlights the importance of attaining the diagnosis of ILVT with distinctive ECG changes. Left ventricular outflow tract (LVOT) VT morphology depends on the site of origin, with either LBBB or early precordial transition in leads V1 to V2 or RBBB pattern in V1 with broad monophasic R in the precordial leads. In addition, there will be an R:S amplitude ratio of 30% or more or an R:QRS duration ratio of 50% in leads V1–2 with other features like capture beats and fusion beats. ILVT responds well with verapamil and can be cured with cardiac ablation, with success rates of more than 90%. ILVT though difficult to diagnose, it has distinctive ECG features which can lead to its diagnosis for appropriate treatment to be given accordingly. ILVT in pregnant patients generally has a good prognosis.

Decision To Delivery Time and Its Predictors Among Mothers Who Underwent Emergency Cesarean Delivery At Selected Hospitals of Northwest Ethiopia, 2023: Prospective Cohort Study.

The decision to delivery time is the interval between the decision and the childbirth by emergency caesarean delivery. The Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists recommend that the decision to delivery time interval is less than 30 min. Additionally, the decision to delivery time varies across institutions and countries. The aim of this study was to determine the decision to delivery time and its predictors among women who underwent emergency cesarean delivery at selected hospitals of Northwest Ethiopia, 2023. An institutional-based prospective cohort study was conducted at selected hospitals of Northwest Ethiopia, among women who underwent emergency cesarean delivery from November 1 to January 30, 2023. A total of 285 participants were enrolled, and data collected using structured and pre-tested questionnaires. A systematic sampling technique was used. Data were entered into Epi-Data version 4.6 and then exported to STATA 15 for further analysis. The log rank test was utilized to compare group differences. The time is estimated by using the Kaplan-Meier curve and Cox proportional-hazard regression analysis was carried out to determine the predictors. From 285 participants, 56 (21.8%) women delivered within the recommended 30 min. The overall median survival time was undetermined and the restricted mean survival time was 48.9 min (95% CI: 47.4-50.5). The average decision to delivery time is affected among women who hesitate to accept consent (AHR: 0.17, 95% CI: 0.02-1.25), cord prolapses (AHR: 1.36, 95% CI: 0.46-3.94), rank of surgeon (AHR: 0.42. 95% CI: 0.42-1.08), no free operation room table (AHR: 0.27, 95% CI: 0.28-0.94), regional anesthesia (AHR: 0.56, 95% CI: 0.25-1.28), and use of a bladder flap (AHR: 0.33, 95% CI: 0.16-0.85). Overall decision to delivery times among women who underwent emergency cesarean section at selected hospitals were longer than the recommended time.

Caesarean section under spinal anesthesia for a mother with dilated cardiomyopathy in a resource-limited setting: a case report

Introduction and importance: Peripartum cardiomyopathy is an uncommon form of cardiomyopathy that develops in the latter stages of pregnancy or in the first few weeks following delivery. Anaesthetic management of caesarean section of a parturient with dilated cardiomyopathy is challenging due to its nature of impaired ventricular contractility coupled with cardiovascular changes during pregnancy. This is significantly worse in a resource-constrained environment with restricted access to medications and equipment. Case presentation: We report a case of a 31-year-old multigravida parturient presented with a diagnosis of dilated cardiomyopathy and a low ejection fraction undergoing emergency caesarean section. Successful management of a parturient with dilated cardiomyopathy undergoing a caesarean section under spinal anaesthesia is reported in this case report. Clinical discussion: Spinal anaesthesia is another alternative for the successful management of patients with dilated cardiomyopathy (DCM) using a low dose of bupivacaine with intrathecal adjuvants. Our report indicates that caesarean section also may be managed safely with spinal anaesthesia alone in patients with DCM, by using low-dose bupivacaine and intrathecal morphine. The slight haemodynamic changes were adjusted with fluid infusion. The use of vasopressors was not required to manage the hypotension. Conclusion: General anaesthesia, epidural alone, and epidural combined with spinal anaesthesia are the widely used anaesthetics techniques for caesarean section in patients with heart disease. Spinal anaesthesia with low-dose bupivacaine with opioids is another suitable choice. The case report is written according to the CARE guideline (https://www.care-statement.org).

Analysis of the application effect of a rapid response team in emergency cesarean section

Introduction Emergency cesarean section is one of the most critical methods in the treatment of high-risk emergency obstetric cases. The aim of this study was to explore the clinical effect of constructing a Rapid Response Team (RRT) in emergency cesarean section. Methods This is a pre- and post-implementation study. The patients who underwent emergency cesarean section were retrospectively analyzed and divided into an experimental group and a control group. There were 52 patients (June–December 2020) in the control group who underwent routine emergency cesarean section without an RRT, and 51 patients (January–June 2021) in the experimental group who underwent emergency cesarean section with an RRT. The operation time indexes (DOI, decision-to-operating room interval; O-I, operating room-to-incision interval; DII, decision-to-incision interval; I-D, incision-to-delivery interval; DDI, decision-to-delivery interval), DDI pass rate, neonatal Apgar score and maternal complications in the two groups were compared. Moreover, the management time trends (DOI, DII, and DDI) in the experimental group were analyzed. Results The DDI, DII, DOI, and O-I of the experimental group were shorter than those of the control group, and the differences were significant (p < 0.05). The DDI pass rate in the experimental group was higher than that in the control group, and the difference was significant (p < 0.01). The 1-min Apgar score of the experimental group was higher than that of the control group (p < 0.05). The key intervals of emergency cesarean section in the experimental group leveled off after approximately 3 to 4 months. Conclusion In the face of emergency situations, the implementation of an emergency cesarean section RRT can improve delivery intervals for emergency cesarean and would be conducive to maternal and infant safety.

Progression of antenatal preeclampsia in the postpartum period (clinical cases)

Background. Preeclampsia is recognized as one of the leading causes of maternal morbidity and mortality. In the majority of observations in the postpartum period, symptoms of preeclampsia appear in patients with antenatal hypertensive complications. These symptoms appear within the first 710 days after delivery and are accompanied by high blood pressure (BP) and neurologic symptoms, commonly presenting as headaches. According to the literature, common risk factors for the progression of preeclampsia in the postpartum period include maternal age over 3540 years, obesity, cesarean section delivery, and non-Hispanic black race. Patients with progression of antenatal preeclampsia in the postpartum period often require readmission after discharge from the hospital.&#x0D; Description of clinical cases. The first clinical observation involves a 25-year-old female patient was transferred to the cardiology department of the hospital on the fourth day after her first spontaneous labor due to a significant increase in BP combined with complaints of intense headache, nausea, and itching of the palms. Progression of antenatal preeclampsia complicated by the cholestasis was detected. The implementation of a complex treatment led to the normalization of clinical and laboratory parameters. In the second clinical observation, a 31-year-old first-pregnant patient at the gestational age of 27 weeks underwent emergency cesarean section due to the development of eclampsia. The patient developed thrombocytopenia and massive proteinuria a day after delivery for the first time, along with high BP, which was not present during pregnancy. The application of a personalized approach to treatment helped stabilize the maternity patients condition.&#x0D; Conclusion. The presented clinical observations demonstrate the progression of antenatal preeclampsia in the postpartum period. In both cases, disturbances of laboratory parameters, high arterial hypertension, resistant to previously conducted antihypertensive therapy, were noted. Given that preeclampsia is a risk factor for severe complications, patients should not be discharged after delivery until clinical and laboratory parameters have completely normalized.

Decision to Delivery Interval of Emergency Caesarean Sections: Evaluating Adherence to Timeframe and its Impact on Feto-Maternal Outcomes

Objective: To evaluate the decision to delivery interval (DDI) of category-1 and category-2 emergency caesarean section (ECS) and its effect on neonatal and maternal outcomes.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at Combine Military Hospital (CMH), Kharian, Pakistan from February 2022 to February 2023.Methods: Data from 332 patients who underwent emergency caesarean section (ECS) at a tertiary care hospital were collected on a structured proforma and analyzed. Feto-maternal outcomes were dependent, and time to decision to delivery interval were independent variables.Results: Out of 332 ECS, 126 were Category 1, and 206 were category 2. The percentages of emergency caesarean section (ECS) done within the recommended DDI were 39.5% for category 1 and 20.5% for category 2. The median (IQR) of DDI was 45 (37–54) min and 90 (75–98) min for category 1 and category 2. Eclampsia, fetal distress and failed progress of labor were the most typical indications. In both types, there was no statistically significant poor neonatal outcome related to APGAR at 1 min and 5 min. Delays were associated with more cases of post-operative fever 74 (36) and 22(13.3) in category 2 than in category 1 ECS.Conclusion: Our study found delays in the decision-to-delivery interval (DDI) for both category 1 and category 2 emergency Caesarean sections. However, no statistically significant association was found between neonatal and maternal outcomes.&#x0D; How to cite this: Parveen S, Waqar S. Decision to Delivery Interval of Emergency Caesarean Sections: Evaluating Adherence to Timeframe and its Impact on Feto-Maternal Outcomes. Life and Science. 2023; 4(4): 445-451. doi: http://doi.org/10.37185/LnS.1.1.424

Experience of VBAC in A Private Hospital

Background: Vaginal birth after cesarean section (VBAC) for a non-recurring indication has been described by several authors as safe &amp; having a success rate of 60-80%. VBAC increases the possibilities of subsequent vaginal deliveries &amp; reduces the rate of repeat cesarean section with associated postoperative morbidity. Objective: To estimate the success rate &amp; risks of an attempted vaginal birth after one cesarean delivery (VBAC). Materials &amp; Methods: The study was conducted as a private hospital based cross sectional descriptive study from July2021 to December 2021. Total 176 patients were admitted with history of prior CS in this study. Among these cases common indications of primary CS were caesarean delivery on maternal request (CDMR), fetal distress, less fetal movement etc. All cases with previous one cesarean section who delivered vaginally within the study period comprised the study population. Women with 1 previous cesarean section, singleton pregnancy, cephalic presentation &amp; term gestation were included in this study. However, women with history of 2 or more C/S, previous uterine surgery like myomectomy &amp; classical C/S were excluded. Result: Out of 37 cases enrolled in the study, 24 (64.86%) successfully delivered vaginally without any complication. 11(29.73%) cases needed repeat cesarean section and 2 (5.41%) cases had to undergo emergency cesarean section for scar tenderness, those were found to be uterine scar rupture. Conclusion: This study suggested that trial of labour after caesarean section (TOLAC) was effective in decreasing CS in this study population. TOLAC and VBAC can be offered to pregnant women without contraindication. To establish the finding definitively, large multicenter prospective studies are required. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 28-31

An unusual presentation of severe preeclampsia presenting with maternal collapse in the post-cesarean section secondary to drug toxicity associated with pituitary hemorrhage: a case report

BackgroundSevere preeclampsia presenting with maternal collapse post-cesarean section secondary to drug toxicity associated with pituitary hemorrhage is rare.Case presentationA 24-year-old primigravida 27 weeks of gestation presented with severe preeclampsia, and underwent emergency cesarean section; postoperatively, she had a sudden maternal collapse and cardiac arrest while on labetalol and magnesium infusion. Following the return of spontaneous circulation (ROSC), the patient was found to have severe bradycardia with prolonged QTc interval and recurrent hypoglycemic episodes. Investigations had revealed low serum cortisol with the brain showing pituitary hemorrhage with features of atypical Sheehan’s syndrome without lactation failure.ConclusionsDrug toxicity is an important cause of maternal collapse and cardiac arrest. Pituitary hemorrhage needs to be suspected in maternal patients with recurrent hypoglycemic episodes with or without postpartum hemorrhage (PPH). Continuous monitoring, use of maternal early warning scoring systems (MEWS), and prudence in the perioperative period/labor room will help in reducing the complications.

Outcome analysis of pregnancy termination and expectant treatment in pregnant women with suspected invasive placenta accreta spectrum disorders in the second trimester

Objective: To investigate the maternal and fetal outcomes of expectant treatment and early termination of pregnancy in pregnant women with suspected invasive placenta accreta spectrum disorders (PAS) in the second trimester. Methods: A retrospective cohort study was performed on 51 pregnant women with suspected invasive PAS (ultrasound score ≥10) evaluated by ultrasound with gestational age <26 weeks and confirmed as invasive PAS by intraoperative findings or postoperative pathology in Peking University Third Hospital from January 2015 to January 2022. According to the informed choice of pregnant women and their families, they were divided into expectant treatment group (37 cases) and mid-term termination group (14 cases). The general clinical data and outcome indexes of the two groups were analyzed by χ2 test, Mann-Whitney U rank sum test, logistic regression and linear regression. Results: (1) General clinical data: among 51 pregnant women who were assessed as suspected invasive PAS by ultrasonography in the second trimester, invasive PAS was finally diagnosed by intraoperative findings and postoperative pathology, among which 46 cases (90%) were placenta percreta and 5 cases (10%) were placenta increta. (2) Outcome indicators: univariate analysis showed that there were no statistically significant differences in the intraoperative blood loss (median: 2 200 vs 2 150 ml), the proportion of blood loss >1 500 ml [73% (27/37) vs 9/14], the hysterectomy rate [62% (23/37) vs 8/14], the rate of intensive care unit (ICU) admission [78% (29/37) vs 9/14] between the expectant treatment group and the mid-term termination group (all P>0.05). Multivariate analysis showed that the rate of intraoperative blood loss >1 500 ml (aOR=0.481, 95%CI: 0.017-13.958; P=0.670), hysterectomy (aOR=0.264, 95%CI: 0.011-6.569, P=0.417) and ICU admission (aOR=1.327, 95%CI: 0.048-36.882, P=0.867) between the two groups showed no statistical differences. (3) Outcome analysis: all 37 cases in the expectant treatment group had live births and no early neonatal death. Five pregnant women (14%, 5/37) in the expectant treatment group underwent emergency cesarean section in the course of expectant treatment. In the mid-term termination group, all pregnancies were terminated by operation, including 9 cases of hysterectomy and 5 cases of placental hysterectomy. There was 1 fetal survival (gestational age of termination: 27+4 weeks) and 13 fetal death in the mid-term termination group. Conclusions: Pregnant women who are diagnosed as suspected invasive PAS, especially those with placenta percreta, have the risk of uterine rupture and emergency surgery in the course of expectant treatment. However, early termination of pregnancy does not reduce the risk of intraoperative blood loss and hysterectomy.

Anaesthesia Management of a Parturient with Klippel Feil Syndrome Undergoing Emergency Cesarean Section

Klippel Feil syndrome (KFS) is a rare autosomal genetic disorder comprising of classical triad of short neck, low hairline, and limited neck mobility. Parturient with KFS syndrome presents with difficult airway and needs individualized consideration for Anaesthesia. Management with Regional Anaesthesia has its pros and cons and can be considered in parturient with KFS as General Anaesthesia in pregnancy poses increased risk of aspiration, difficult mask ventilation and endotracheal intubation. We present a case of a 25-yr old parturient G3A2 with 34+4 weeks of gestation with KFS syndrome posted for emergency caesarean section managed successfully under spinal anaesthesia.

Fathers' subjective childbirth stress predicts depressive symptoms at six months postpartum

BackgroundChildbirth is a seminal experience in parents' lives. However, little research has investigated the link between fathers' birth experiences and their postpartum mental health. We hypothesized that a more subjectively stressful birth will predict greater self-reported depressive symptoms in fathers at six months postpartum. We also investigated the association between mode of delivery and paternal subjective stress. MethodsSeventy-seven heterosexual fathers expecting their first child and cohabiting with their pregnant partners participated in the study. Depressive symptoms were assessed in pregnancy and again at six months postpartum. Subjective birth stress was measured within the first few days of the birth, and birth charts were collected to examine mode of delivery. ResultsFathers' ratings of subjective birth stress significantly predicted postpartum depressive symptoms at six months postpartum. Subjective birth stress ratings varied significantly for fathers whose partners delivered via emergency cesarean section compared to those whose partners gave birth via both medicated and the unmedicated vaginal delivery. LimitationsThe study was limited by its small community (non-clinical) sample, which was restricted to heterosexual, cohabitating couples. Additionally, births were mostly uncomplicated and only 14 mothers underwent emergency cesarean section. ConclusionThese findings highlight that the days immediately following childbirth are a window of opportunity for early intervention in new fathers at risk for postpartum depression.

Effectiveness of an Early Skin-to-Skin Contact Program for Pregnant Women with Cesarean Section: A Quasi-Experimental Trial.

This study aimed to clarify the effectiveness of early skin-to-skin contact (SSC) after a cesarean section (CS) program. An "early SSC after CS" program was implemented at a tertiary care hospital in Tanzania. A non-equivalent group design was used. A questionnaire was used to collect data on exclusive breastfeeding, breastfeeding intention, Birth Satisfaction Scale-Revised Indicator (BSS-RI) score, perioperative pain with a visual analogue scale, and infant hospitalization for infectious diseases and diarrhea at 2-3 days postpartum. Follow-up surveys were conducted until 4 months postpartum regarding exclusive breastfeeding, breastfeeding intention, and hospitalization of the infants. This study involved 172 parturient women who underwent CS, with 86 in the intervention group and 86 in the control group. The exclusive breastfeeding rates at 4 months postpartum were 57 (76.0%) in the intervention group and 58 (76.3%) in the control group, with no significant difference. The BSS-RI score was higher in the intervention group (7.91, range 4-12, SD 2.42) than in the control group (7.18, range 3-12, SD 2.02) (p = 0.007) for women who underwent emergency CS. The survival probability for infants hospitalized owing to infectious diseases, and diarrhea was significantly higher in the intervention group (98.5%) than in the control group (88.3%) (χ2 = 5.231, p = 0.022) for multiparas. The early SSC after CS program showed a positive effect on the birth satisfaction of women undergoing emergency CS. It also reduced the incidence of infants hospitalized owing to infectious diseases and diarrhea for multiparas.

A Postpartum Uterine Dehiscence in a Pregnant Woman with Brucellosis; A Cases Report

Introduction Uterine Dehiscence (UD) is a rare complication and very dangerous complication of cesarean section (CS). Brucellosis is a threatening infection in pregnant women with severe obstetrics outcomes such as spontaneous abortion, premature delivery, intrauterine infection. We presented a case with preterm delivery with continuing high fever due to uterine fascial dehiscence after CS, who were infected to brucellosis. Case: A 26-year-old woman with gravidity 1, referred to the obstetrical department at 30 weeks of gestation due to Preterm Premature rupture of membranes (PPROM). After vaginally sonography, the patient underwent emergency CS due to fetus FHR drop and umbilical cord prolapse. From second day after CS, the patients fever increased and Doppler sonography shows low fluid and hematoma in the uterus and evidence in favor of a lesion collection that was evacuated with laparotomy and uterine fascial dehiscence was detected. Moreover, wound debridement conducted and during laparotomy the adhesions were released. The Wright-Coombs 2ME test showed she was infected to brucellosis. Conclusion: Uterine fascia dehiscence in lower uterine segment incision is a rare but is a potentially dangerous for mothers. However, preterm deliveries due to PPROM and high uncontrolled fever after CS, are conditions that practitioners should considering the uterine dehiscence to their differential diagnoses. Nevertheless, the occurrence of dehiscence due to brucellosis infection is questionable and require more evaluation.