Urgent Cesarean Research Articles

Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.

While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates. This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes. Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], laborin a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)). Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.

Case report of recurrent vasa previa

AbstractIntroductionVasa previa is a complication of pregnancy, which affects approximately 1:1200 pregnancies, and when undiagnosed prenatally, it can be associated with significant perinatal mortality. This condition is thought to be a sporadic entity without known genetic or familial associations and thus considered to carry a negligible recurrence risk.Key FindingsWe present a case of a 42‐year‐old gravida 3 para 2 diagnosed on transvaginal ultrasound with a vasa previa at 34 weeks associated with vaginal bleeding, which required an urgent caesarean in a prior spontaneous pregnancy. In the current pregnancy conceived with in vitro fertilisation, she was again diagnosed with a vasa previa at 30 weeks’ gestation at transvaginal ultrasound. She ultimately delivered at 37 weeks’ gestation via an uncomplicated repeat caesarean.DiscussionPatients with vasa previa in one pregnancy may be at risk for recurrence in subsequent pregnancy and thus should be screened in future pregnancies. Further research should be done to explore and identify any risk factors for recurrence of vasa previa.

Videolaryngoscopy during Urgent Cesarean Delivery: Association with Neonatal Intensive Care Unit Admission.

Parturients are at increased risk for difficult airway management with subsequent fetal complications. Videolaryngoscopy was opined to be the new standard of airway care to facilitate orotracheal intubation under urgent care conditions. We examined in parturients requiring general anesthesia for urgent cesarean delivery the association of the type of laryngoscopy technique and time required to facilitate orotracheal intubation with the incidence of subsequent neonatal intensive care unit (NICU) admission. Following institutional review board approval, 431 parturients aged 18 years and older who underwent urgent cesarean section requiring general anesthesia were entered into this study. Patient characteristics, maternal comorbidities, and indications for urgent cesarean delivery were collected from the electronic medical records from January 2013 to November 2018. Orotracheal intubation times by type of laryngoscopy (video or direct) and NICU admission rates also were collected. A measure of effect size, risk differences with 95% confidence intervals (CIs), were calculated for the likelihood of NICU admission by difficult orotracheal intubation and by type of laryngoscopy used to secure the airway. Videolaryngoscopy as the primary type of laryngoscopy was used in 24.1% (95% CI 20.3%-28.3%) of general anesthetics. The incidence of difficult orotracheal intubation was 4.4% (95% CI 2.8%-6.7%), with a higher incidence observed with videolaryngoscopy (8.7%) than with direct laryngoscopy (3.1%) and a risk difference of 5.6% (95% CI 0.001%-11.3%). The incidence of NICU admission was 38.4% (95% CI 34.0%-43.1%). Times for successful orotracheal intubation were longer with videolaryngoscopy. Videolaryngoscopy had a higher association for NICU admission (47%) than for direct laryngoscopy (36%), with a risk difference of 11.4% (95% CI 0.01%-22.3%). Videolaryngoscopy did not decrease the incidence of difficult orotracheal intubation, and it did not decrease the time associated with orotracheal intubation. Videolaryngoscopy was associated with a higher association of NICU admission. These results suggest that videolaryngoscopy does not supplant direct laryngoscopy as the standard of care for orotracheal intubation under urgent care conditions of general anesthesia for cesarean section.

Couvelaire Syndrome: A Case Report and Literature Review

Introduction. Couvelaire syndrome is a rare complication of pregnancy involving the placenta and the uterine wall. It is caused by placental abruption, preeclampsia, or other disorders that compromise the blood supply to the placenta. Diagnosis is typically made through history, clinical evaluation, and ultrasound. This study aims to report a grave case of Couvelaire syndrome complemented by presenting a review of the relevant literature, to aid the meaning of a clinical path, as well as early and adequate diagnosis and treatment of Couvelaire syndrome, to prevent feto-maternal consequences. The treatment of Couvelaire syndrome depends on the severity of the condition and the well-being of both the mother and the fetus. If the condition is severe and poses a risk to the mother or fetus, immediate delivery may be recommended, mainly with urgent Cesarean section in general endotracheal anesthesia. If there is significant blood loss leading to a decrease in hemoglobin levels, blood transfusions may be necessary to restore normal blood volume and oxygen-carrying capacity. Part of the general treatment plan should also be the management of the underlying cause of placental abruption, for example, in cases of preeclampsia, medications are prescribed to control blood pressure and prevent seizures.

0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period

Background3% chloroprocaine (CP) has been reported as the common local anesthetic used in pregnant women undergoing urgent cesarean delivery during labor analgesia period. However, 0.75% ropivacaine is considered a promising and effective alternative. Therefore, we conducted a randomized controlled trial to compare the effectiveness and safety of 0.75% ropivacaine with 3% chloroprocaine for extended epidural anesthesia in pregnant women.MethodsWe conducted a double-blind, randomized, controlled, single-center study from November 1, 2022, to April 30, 2023. We selected forty-five pregnant women undergoing urgent cesarean delivery during labor analgesia period and randomized them to receive either 0.75% ropivacaine or 3% chloroprocaine in a 1:1 ratio. The primary outcome was the time to loss of cold sensation at the T4 level.ResultsThere was a significant difference between the two groups in the time to achieve loss of cold sensation (303, 95%CI 255 to 402 S vs. 372, 95%CI 297 to 630 S, p = 0.024). There was no significant difference the degree of motor block (p = 0.185) at the Th4 level. Fewer pregnant women required additional local anesthetics in the ropivacaine group compared to the chloroprocaine group (4.5% VS. 34.8%, p = 0.011). The ropivacaine group had lower intraoperative VAS scores (p = 0.023) and higher patient satisfaction scores (p = 0.040) than the chloroprocaine group. The incidence of intraoperative complications was similar between the two groups, and no serious complications were observed.ConclusionsOur study found that 0.75% ropivacaine was associated with less intraoperative pain treatment, higher patient satisfaction and reduced the onset time compared to 3% chloroprocaine in pregnant women undergoing urgent cesarean delivery during labor analgesia period. Therefore, 0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period.Clinical trial number and registry URLThe registration number: ChiCTR2200065201; http://www.chictr.org.cn, Principal investigator: MEN, Date of registration: 31/10/2022.

6301558 Women's experiences of anesthesia care during urgent or emergent cesarean section: a qualitative study examining stressors and potential solutions

6301558 Women's experiences of anesthesia care during urgent or emergent cesarean section: a qualitative study examining stressors and potential solutions

Emergency Caesarean Section in a Patient with HELLP Syndrome and Intramural Myoma: A Case Report

Introduction: The syndrome of HELLP, often a complication of severe pre-eclampsia, is influenced by factors like multiparity, advanced maternal age, and potential genetic associations. Intramural Myoma have been linked to a 44% increased risk of hypertension in pregnant women, potentially contributing to the initiation and progression of pre-eclampsia, particularly due to their rapid expansion during pregnancy. This study reported a patient with intramural myoma and HELLP Syndrome in 35-36 weeks of gestation age. Case Presentation: A 40-year-old woman in her 35-36 weeks of gestation sought emergency care at General Hospital Dr. Saiful Anwar Malang due to escalating severe headaches. As a third-time expectant mother with a history of five antenatal visits, she presented with elevated blood pressure (219/110 mmHg), a BMI of 32 kg/m2, and various concerning findings, leading to a diagnosis of impending eclampsia, severe preeclampsia (HELLP syndrome), fetal distress, severe hypoalbuminemia, intrauterine growth restriction (IUGR), and other complications. The patient underwent an urgent cesarean section, revealing an intramural uterine myoma, followed by bilateral ligation of uterine arteries to address bleeding and myomectomy. Postoperatively, she received a magnesium sulfate infusion, her blood pressure stabilized at 143/92 mmHg and Hemoglobin 12,40 g/dl. Conclusion: Intramural myoma increases the risk of preeclampsia during pregnancy. Emergency C-section is an effective measure to address complications for both the mother and the baby, and bilateral ligation of uterine arteries can minimize surgical bleeding.

Urgent Caesarean Section Followed by Tumor Resection for Pregnancy-related Rapid Growth of WHO Grade 1 Pilocytic Astrocytoma (P4-5.021)

Urgent Caesarean Section Followed by Tumor Resection for Pregnancy-related Rapid Growth of WHO Grade 1 Pilocytic Astrocytoma (P4-5.021)

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

ObjectivesThe aim was to investigate, how pregnancies proceed in patients with systemic lupus erythematosus (SLE) compared to their individually matched population controls.Material and methodsAdult incident SLE patients were identified from the register of new special reimbursement decisions for SLE drugs in 2000–2014. For each patient, 1–3 randomly selected controls from the Population Register Centre were matched. Data regarding pregnancies were obtained from the Finnish Medical Birth Register, Care Register and Register of Congenital Malformations until 2018. The study utilized data from the Drug Purchase Register and educational information from Statistic Finland.ResultsA total of 163 deliveries for 103 mothers with SLE and 580 deliveries for 371 population controls were identified. The duration of pregnancies in SLE women was significantly shorter compared to controls (38.9 versus 39.6 weeks). There were more urgent Caesarean Sections. (15% versus 9%) and need for care at neonatal intensive care unit (NICU) (21% versus 11%) among deliveries in SLE mothers. No statistical difference was observed between SLE and control groups in the occurrence of preeclampsia or major congenital malformations. Gestational age was 2.5 weeks shorter when the mother experienced pre-eclampsia. Hydroxychloroquine was purchased by 30% of SLE mothers during pregnancy.ConclusionThe course of pregnancies in Finnish SLE patients seems to be quite moderate compared to controls, and no new safety issues were detected. The low utilization of hydroxychloroquine indicates that the benefits of the drug to pregnancy and disease course are not optimally recognized by specialists treating SLE mothers.

Perinatal characteristics and pregnancy outcomes of advanced maternal age women with gestational diabetes mellitus: A retrospective cohort study.

The prevalence of gestational diabetes mellitus (GDM) continues to increase, and the phenomenon of women giving birth at an older age is becoming more common worldwide. Less is known abouts the impact of GDM combined with advanced maternal age (AMA) on pregnancy outcomes. To explore the impact of AMA complicated with GDM on pregnancy outcomes. This study included 34,602 pregnancies between 2018 and 2020 in Hangzhou, China. The pregnant women were divided into four groups according to advanced age (≥35 years) and GDM as follows: AMA women without GDM (non-AGDM) group (n = 2614), young pregnant women with GDM (YGDM) group (n = 4016), AMA women with GDM (AGDM) group (n = 850), and young pregnant women without GDM (non-YGDM) group (n = 27,122). Univariate analysis was carried out by Mann-Whitney U test or Pearson's χ 2 test. Multivariate logistic regression analysis was used to investigate the effect of AMA and GDM on pregnancy outcomes. Multivariate logistic regression analysis showed that in the comparison against non-YGDM garoup, the ORs of fetal chromosome abnormality, parity, urgent cesarean section, gravidity, scheduled cesarean section, body mass index (BMI) ≥30 kg/m2, pre-eclampsia, thrombocytopenia, hyperlipidemia, BMI 25-29.9 kg/m2, blood urea nitrogen, fasting blood glucose, and creatinine in AGDM group were 16.044, 4.284, 3.530, 3.284, 3.257, 2.049, 1.935, 1.898, 1.690, 1.471, 1.304, 1.216, and 1.026 (all p < 0.05). The prevalence of pregnant women with AGDM was 2.46% in Hang Zhou, China. The increasing gravidity of AMA women was related to a greater risk of GDM. The AGDM group associated with a greater risks of chromosomal abnormality in offspring and cesarean section, especially urgent cesarean section.

Relations between maternal height, shoe size, and the success of vaginal delivery in birth weight over 4000 g

ObjectiveMacrosomia is associated with increased risk of fetal and maternal complications such as trauma during birth, cesarean delivery, postpartum hemorrhage, and shoulder dystocia. Sonographic estimation of fetal weight is imprecise particularly in excessively large fetuses, prompting the need for additional measures to assess the feasibility of vaginal delivery of a macrosomic newborn and thus improve prenatal consultation. Materials and methodsThis retrospective case–control study included women who delivered a singleton macrosomic newborn (birth weight>4,000 g), either vaginally (N = 762) or by urgent cesarean delivery during labor (N = 109). Using multivariable analysis, we examined correlations of maternal height≥170 cm and shoe size≥40 with successful vaginal delivery. ResultsWomen who delivered vaginally had lower mean intrapartum BMI (p < 0.001) and lower rate of gestational diabetes (p = 0.003). Women with a shoe size≥40 were 2.2 times more likely to give birth vaginally. Cesarean section rate was 5.9 % among women with height≥170 cm and shoe size≥40; and 16.5 % among women with height<170 cm and shoe size<40. Multivariable analysis, adjusted for gestational diabetes, parity, and BMI, revealed that shoe size≥40 and maternal height≥170 cm correlated with success in vaginal delivery, OR = 3.1 (95%CI 1.3–7.3, p = 0.009). ConclusionShoe size and maternal height may help predict success of vaginal birth of the macrosomic newborns.

Case Report: Laparoscopy-assisted resection for intra-abdominal gossypiboma masquerading as a jejunal tumor (with video)

IntroductionIntra-abdominal gossypiboma, a cotton-based retained foreign body after an abdominal surgery, is associated with various clinical manifestations and complications. Its infrequent occurrence and unpredictability make its early diagnosis particularly challenging. We herein present an atypical case of intra-abdominal gossypiboma mistaken for a jejunal tumor.Case presentationA 33-year-old female presented to the emergency room with an acute episode of progressive abdominal pain and distention, nausea, and vomiting for 20 hours. She had undergone an urgent cesarean section due to fetal tachycardia seven years prior. The initial diagnosis of small bowel obstruction (SBO) due to a jejunal tumor was established by computed tomography. Subsequent to successful medical management of the SBO, a laparoscopy-assisted resection of the mass and the adherent jejunal segment was conducted, culminating in a primary side-to-side jejunojejunostomy. Examination of the excised tissue revealed an approximately spherical fibrous mass, 6 × 6 × 5 cm in dimension, embedded in the jejunal wall, housing a 20 × 20-cm gauze. Postoperative recovery and routine follow-up ensued without complications.ConclusionIn light of this case, the need for clinicians to maintain an elevated awareness and suspicion of gossypiboma should be accentuated when evaluating an intra-abdominal mass, especially in patients with a prior history of high-risk laparotomy. Laparoscopic surgery stands out as a technically proficient and minimally invasive strategy for diagnosing and treating intra-abdominal gossypiboma. Besides, it is imperative to emphasize the importance of meticulous surgical procedures and postoperative protocols to prevent such oversights, reaffirming the need for consistent intraoperative counts and checks of surgical items.

Anesthetic Management for Urgent Caesarean Section in Patient with Uncontrolled Hyperthyroidism and Severe Mitral Regurgitation

&lt;p&gt;&lt;strong&gt;Background :&lt;/strong&gt;The prevalence of hyperthyroidism in pregnancy approximately 0.05% to 3% and mostly caused by Graves’ Disease (GD). The prevalence of Hyperthyroid Heart Disease (HHD) in pregnancy is 3.87%. Uncontrolled hyperthyroidism during pregnancy can increase maternal and fetal mortality. We report a case of a pregnant woman with uncontrolled hyperthyroidism and severe mitral regurgitation that underwent cesarean section with spinal anesthesia for delivery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Illustration :&lt;/strong&gt;A 33 years-old patient G4P1A2 visited the Obstetric-Gynecology outpatient clinic at our hospital at 23 weeks of gestation (WoG) due to uncontrolled hyperthyroidism caused by GD that diagnosed 3 years ago and shortness of breath. The echocardiography test obtained severe mitral regurgitation and left atrial dilatation with 58% LVEF. It was decided to maintain the pregnancy till the fetus is viable while still monitoring the patient’s condition. At 32 WoG, the patient came to the ED due to shortness of breath, chest pain, and nausea. Fetal movement and fetal heart rate (FHR) were within normal limits. The patient was given a nasal cannula at 3 liters/minute, extra furosemide 20 mg, and fetal lung maturation with dexamethasone injection. The patient was prepared for termination by cesarean section. Spinal anesthesia was performed in a sitting position using a 27 G spinal needle. Inserted at L 3-4, using a low dose of heavy bupivacaine 0.5% 7.5 mg combined with 25 g fentanyl and 0.1 mg morphine intrathecally. C-section was successfully performed and hemodynamics during surgery was stable, resulting the delivery of a preterm baby who weighed 1.9 kg at birth and the baby was transferred to the NICU for further treatment.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion : &lt;/strong&gt;Spinal anesthesia with low dose bupivacaine combined with opioids for cesarean section was revealed maternal and neonate safe.&lt;/p&gt;

FOXP3-positive cell infiltration in the chorionic villi is increased in the placenta accreta and decreased in the placental abruption.

Growing data suggest a role of Treg cells in placentation. The aim of the study was to evaluate Treg cells (FOXP3-positive cells) placental bed infiltration in patients with placenta accrete syndrome (PAS) and patients who experienced placental abruption. The study group included 13 patients with PAS and the control group consisted of 66 women who had caesarean (CD) delivery of whom, 44 patients with elective caesarean (EC) delivery, and 22 patients with urgent caesarean (UC) delivery due to placental abruption. FOXP3 cell infiltration was assessed by means of immunohistochemistry in placental chorionic villous (CV) and in the decidua (D) and cumulatively in the placental bed (PB). We observed significant difference in the degree of FOXP3-positive cell CV infiltration between studied groups (p = 0.04). FOXP3-positive cells were the most commonly observed in PAS patients, while, they were the least frequently presented in patients after UC. The immunoreactivity for FOXP3-positive cells in CV were as follows: PAS 5 (38%), urgent CS 1 (5%) and elective CS 8 (18%) subjects. We found no difference in the presence of FOXP3-positive cells in the D (p = 0.35) and in the PB (p = 0.23) of analyzed groups. FOXP3-cell infiltration was not related with patient age, BMI, gestational age and neonatal birth weight. Our study provides further evidence that abnormal invasive placentation is an associated disturbance of the maternal immune response. Accordingly, we have theorized that alteration of the FOXP3-positive Treg cell infiltration into the placental bed allows trophoblast cell invasion.

Rare malignant tumors of the ovary during pregnancy: a clinical case report

This article describes a clinical case of a malignant ovarian neoplasm, which was first detected during an urgent visit of a pregnant woman with signs of fetal distress in the third trimester of pregnancy. The relevance of this problem lies in the possibility of early diagnosis of adnexal tumors during routine ultrasound screenings, the lack of definitive recommendations for the management of such patients and the limited range of treatment methods during pregnancy. The aim of the study is to demonstrate a clinical case of pregnancy with late-detected ovarian malignancy. A 39-year-old pregnant woman at 35 weeks and 4 days' gestation consulted the antenatal clinic of a city maternity hospital with complaints of a decrease in the number and change in the nature of fetal movements over the past 24 hours. After assessment of the fetal condition (cardiotocography, ultrasound), the woman was hospitalized with a diagnosis: Pregnancy III, 35 weeks and 4 days. Fetal distress in the antenatal period. Fetal growth restriction, stage I. Gestational hypertension without significant proteinuria. Multicompartmental cyst of the right ovary. An urgent cesarean section was performed. Clinical diagnosis: рremature delivery by cesarean section. Medical care for the mother with fetal growth restriction of the first degree, fetal distress in the antenatal period. Cyst of the right ovary. Right-sided adnexectomy. Omental resection. Gestational hypertension. On the 5th day, the patient was discharged in a satisfactory condition with a recommendation for further examination in an oncology hospital. Pathological examination of the right ovary: morphological picture, taking into account the results of immunohistochemical examination, in favor of undifferentiated carcinoma; on repeated viewing - granular cell tumor of the ovary of adult type. The patient was routinely hospitalized at the city oncology center for surgical treatment and further examination. Clinical diagnosis: Bl ovarii gr I, adult-type granulosa cell tumor, T1Nx Mx. Condition after surgical treatment: lower midline laparotomy. Pangisterectomy, omentectomy. Sampling of the retroperitoneal lymph nodes on the right. Sanitation and drainage of the abdominal cavity. Clinical group II. The results of this article are of great practical importance for obstetricians-gynecologists, general surgeons and ultrasound diagnosticians in the differential diagnosis of indirect signs of malignant tumors during pregnancy, in the need to examine all pelvic organs during routine ultrasound screening of pregnant women and in establishing cause and effect relationships in the diagnosis of obstetric complications.

Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study.

The aim of the study was to ascertain risk factors and outcomes of elective cesarean deliveries performed urgently prior to their scheduled date. Women carrying a viable singleton fetus who were scheduled for elective cesarean delivery at a tertiary medical center between 2012-2020 were identified by retrospective database. Differences in maternal and neonatal parameters between those who ultimately required urgent cesarean delivery and those who underwent the procedure as scheduled were analyzed. Of 4403 women who met the inclusion criteria, 559 underwent urgent cesarean delivery before the scheduled date. On multivariate analysis, factors significantly associated with a risk of transformation to an urgent cesarean delivery were chronic hypertension (aOR 1.92, 95% CI 1.30-2.83 P = 0.001), antenatal corticosteroids administration (aOR 3.26, 95% CI 2.38-4.47, P <0.001), and contraindication for vaginal delivery as the reason for elective cesarean delivery (aOR 1.67, 95% CI 1.32-2.12, P <0.001). Neonates born via urgent cesareans had an increased risk of 1-minute Apgar <7 (6% vs. 1.7%, P <0.001), intensive care unit admission (6.6% vs. 2.5%, P <0.001); their mothers were at risk of postpartum hemorrhage (5.9% vs. 3%, P = 0.001). The present study sheds light on the risk factors and maternal and fetal morbidities associated with elective cesarean deliveries that become urgent before the originally scheduled date. Physicians should take this information into account when planning an optimal date for elective cesarean delivery.

Decreasing Decision-to-Incision Times for Unscheduled, Urgent Cesarean Deliveries.

To standardize the preprocedure process for urgent, unscheduled cesarean deliveries to decrease the time from decision to skin incision to improve maternal and fetal outcomes. In our quality-improvement project, we selected indications that require urgent cesarean deliveries, created a standard algorithm, then implemented a multidisciplinary process intended to reduce decision-to-incision time. This initiative was conducted from May 2019 to May 2021, with a preimplementation period from May 2019 to November 2019 (n=199), implementation period from December 2019 to September 2020 (n=283), and postimplementation period from October 2020 to May 2021 (n=160). An interrupted time series calculation was performed, with stratification by patient race and ethnicity. The primary process measure was mean decision-to-incision time. The secondary outcomes were neonatal status as measured by 5-minute Apgar score and quantitative blood loss during the cesarean delivery. We analyzed 642 urgent cesarean deliveries; 199 were preimplementation of the standard algorithm, and 160 were postimplementation. The mean decision-to-incision time improved from 88 minutes (95% CI 75-101 min) to 50 minutes (95% CI 47-53 min) from the preimplementation period to the postimplementation period. When stratified by race and ethnicity, the mean decision-to-incision time among Black non-Hispanic patients improved from 98 minutes (95% CI 73-123 min) to 50 minutes (95% CI 45-55 min) (t=3.27, P <.01); it improved from 84 minutes (95% CI 66-103 min) to 49 minutes (95% CI 44-55 min) among Hispanic patients (t=3.51, P <.001). There was no significant improvement in decision-to-incision time among patients in other racial and ethnic groups. When the cesarean delivery was performed for fetal indications, Apgar scores were significantly higher in the postimplementation period compared with the preimplementation period (8.5 vs 8.8 beta=0.29, P <.01). Development and implementation of a standard algorithm to expedite decision-to-incision time for unscheduled, urgent cesarean deliveries led to a significant decrease in decision-to-incision time.

BMI Had a Negative Effect on Decision-to-Incision Times for Urgent Cesarean Deliveries [ID: 1377147

INTRODUCTION: Greater maternal body mass index (BMI) is associated with worse maternal and fetal outcomes. Intrapartum care of patients may be more difficult with higher BMIs. We studied the effect of BMI on decision-to-incision times less than 30 minutes for urgent cesarean sections. METHODS: After IRB approval, a retrospective chart review of 186 consecutive urgent cesarean deliveries during 2020 at an academic medical center were examined. Data were abstracted from patient and neonate charts. Statistical analysis was performed using χ2, t test, and Pearson’s r test. RESULTS: Seventy-one percent of patients with BMI greater than 30 had decision-to-incision times of more than 30 minutes, compared to 46% with BMI less than 30 (P=.03). The mean time from decision-to-incision with BMI greater than 30 was 44 minutes, and 36 minutes with BMI less than 30 (P=.005). When BMI was greater than 40, the mean time was 50 minutes (P=.03). 16% of patients with BMI greater than 30 had decision-to-incision times of more than 60 minutes, compared to 2% with BMI less than 30 (P=.007). BMIs greater than 30 had longer decision-to-operating room (OR) entry (22 versus 17 minutes, P=.02) and OR entry-to-incision times (22 versus 19 minutes, P=.053). Body mass indexes of greater than 40 had both longer decision-to-OR entry (24 versus 19 minutes) and OR entry-to-incision times (25 versus 19 minutes, P=.005). Mothers with BMI greater than 50 had the longest times from OR entry-to-incision and had babies most likely to go to the neonatal intensive care unit (NICU) (50% versus 16%). CONCLUSION: Greater maternal BMIs had longer times for urgent cesarean sections for decision to incision, decision to OR entry, and OR entry to incision. There was a lengthening of decision-to-incision times with increasing BMI. The highest maternal BMIs were most likely to result in NICU admissions. Decision-to-incision time of greater than 30 minutes did not affect umbilical cord arterial pH or NICU admission.

The Majority of Urgent Cesarean Sections Had a Decision-to-Incision Time of Greater Than 30 Minutes [ID: 1377172

INTRODUCTION: The American College of Obstetricians and Gynecologists has recommended that hospitals providing obstetrical care should have the capability to begin cesarean deliveries within 30 minutes. This has been taken out of context in that failure to meet a 30-minute decision-to-incision time for urgent cesarean sections may be criticized litigiously if a poor neonatal outcome occurs. METHODS: After IRB approval, a retrospective chart review of 186 consecutive urgent cesarean deliveries during 2020 at an urban academic medical center was performed. Data were abstracted from patient and neonate charts. Statistical analysis was performed using χ2, t test, and Pearson’s r test. RESULTS: Sixty-seven percent of urgent cesarean section had a decision-to-incision time greater than 30 minutes. Mean time was 42 minutes and median time was 36 minutes (8–194 minutes). Seventy-one percent of patients with body mass index (BMI) greater than 30 had decision-to-incision times greater than 30 minutes, compared to 46% with BMI less than 30 (P=.03). Seventy-eight percent of patients without an epidural took more than 30 minutes, compared to 64% with an epidural (P=.09). Sixty-four percent of urgent cesarean sections occurring between 7 am and 5 pm had decision-to-incision times of greater than 30 minutes, compared to 69% between 5 pm and 7 am (P=.54). CONCLUSION: Sixty-seven percent of urgent cesarean sections had a decision-to-incision time greater than 30 minutes at an academic medical center. Deliveries with BMI greater than 30 were associated with failure to meet a 30-minute threshold. Not having an epidural trended towards failure to meet a 30-minute threshold. Whether delivering during the daytime or nighttime, race, and insurance status did not affect decision-to-incision times. Decision-to-incision time greater than 30 minutes did not affect umbilical cord arterial pH or neonatal intensive care unit admission.

Hemihydranencephaly of Premature Infant - Case Report

Abstract Hydranencephaly represents a rare anomaly of the central nervous system and is characterized by the parenchymal absence which is replaced with a membranous sac filled with cerebrospinal liquid, glial tissue and ependyma. When it is manifested as hemihydranencephaly, the patient’s prognosis is better. We presented a case of a premature infant with hemihydranencephaly in twin pregnancy that had a fatal outcome. A premature infant in a controlled pregnancy was delivered at 31 weeks of gestational age. The mother of the newborn was hospitalized in the Clinic for Infective Diseases since she had tested positive for SARS-Covid- 19. Following an urgent Caesarean section, the newborn was tested for Covid 19 using the rapid antigen and PCR test and the results were negative. In the delivery room, the tactile stimulation, aspiration, positive pressure ventilation of the infant were applied, after which it was intubated. After the intubation, a manual heart massage was performed, after which the cardiac activity and agonal breathing movements were detected.” Three hours later, cardiorespiratory arrest happened, following unsuccessful resuscitation. The other twin was born with no anomalies, but showed signs of respiratory distress syndrome. Autopsy revealed that there was a thin-walled cavity filled with clear, yellowish liquid in the right hemisphere. Documenting cases of newborns with hydranencephaly is of a great importance for counseling parents regarding length of survival, successful management of pregnancy, and performance of prenatal diagnostic procedures.