Women Undergoing Cesarean Delivery Research Articles

Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis

(Anesth Analg. 2024;138(1):70–84) Intrathecal opioids are effective for postoperative analgesia following CD, but they also have unpleasant side effects including shivering, nausea, vomiting, respiratory depression, and pruritus. The mechanisms of intrathecal opioid-induced pruritus are largely unknown. It is unknown if ondansetron has an antipruritic effect when administered with neuraxial analgesia. This study is an up-to-date systematic review that addressed the effectiveness of ondansetron for the prevention of pruritus that is associated with intrathecal opioids in women having CD.

Comparison of Clonidine with Bupivaicaine vs Plain Bupivaicaine in Transversus Abdominis Plane (TAP) Block in Women Undergoing Cesarean Delivery Under Spinal Anesthesia: Randomized Clinical Trial.

Transversus abdominis plane (TAP) block is a technique of regional anesthesia, introduced by Rafi in 2001. Various additives have been added to prolong the duration of effect of TAP block. We conducted this study to see if addition of clonidine to bupivacaine significantly increases the duration of effect of TAP block. This randomized, parallel group, placebo controlled double blind clinical trial was conducted on 100 healthy participants (ASAII) undergoing LSCS under Spinal anesthesia (SA) from Jan 2021 to July 2021 after consent of Institutional Ethics Committee. Women with contraindications to spinal anesthesia, allergy to any of the drugs or not-suitable for cesarean under SA were excluded. After written informed consent, eligible participants were randomly allocated into two groups using computer generated random number tables using serially numbered opaque sealed envelopes. 48 out of 50 participants in group A (Bupivacaine) were given TAP block with 20 ml of 0.25% bupivacaine bilaterally. 2 women were excluded because of conversion to General Anesthesia. Similarly, 47 out of 50 participants in Group B (Bupivacaine + Clonidine) were given TAP block with 20 ml of 0.25% bupivacaine plus 1.0 mcg/kg clonidine bilaterally after completion of surgery using 18 G Tuohy needle. Separate person used to fill the drugs for block. Participants were assessed for duration of analgesic effect of TAP block measured as the time to request for additional analgesia. Additional analgesic requirement was noted. Participants were assessed for side effects of clonidine like hypotension, bradycardia, sedation and dryness of mouth. Overall patient satisfaction was also noted. Data was analysed using Graphpad Prism 9, using Student's t-test for primary outcome and Mann-Whitney U test for secondary outcomes. The mean 'duration of analgesic effect with TAP block' was 6.34 (SD1.26) hrs for 'Bupivacaine' group and 10.56 (SD2.12) hrs for 'Bupivacaine + Clonidine' group. None of the patients developed hypotension or bradycardia. 25% participants in Bupivacaine only group and 40.42% in Bupivacaine + Clonidine group were sedated (P < 0.05). 20.8% in 'Bupivacaine' group and 51.06% in 'Bupivacaine + Clonidine' group had dryness of mouth (P < 0.001). Patient satisfaction was equal in both the groups. Addition of clonidine to bupivacaine in the dose of 1 mcg/kg significantly increases the duration of analgesic effect of TAP block, decreases analgesic usage without significant increase in side effects.

Obstetric Comorbidity Index and the Odds of General Versus Neuraxial Anesthesia in Women Undergoing Cesarean Delivery: A Retrospective Cohort Study

(Int J Obstet Anesth. 2022;51:103546) General anesthesia (GA) is often related to significant anesthetic exposure, tracheal intubation, risk for pulmonary aspiration, surgical site infection, and severe postpartum depression. As cesarean deliveries (CD) are common in the United States and around the world, many countries view GA during CD as an indicator that improvements could be made. In an effort to persuade more people towards neuraxial anesthesia instead of GA, this study researched the relationship between obstetric comorbidity index (OCI) risk-assessment data, a tool used by the several countries to assess the risk of surgeries and prepare for said risk, and GA, specifically in a nonemergency setting.

Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis.

Pruritus is a frequently reported and unpleasant side effect following intrathecal opioid use with frequency further increased among parturients. We have performed a systematic review to assess the overall efficacy of ondansetron for the prevention of pruritus in patients receiving intrathecal opioid as part of spinal anesthesia for cesarean delivery. A literature search of MEDLINE, Embase, Cochrane, and Web of Science databases was conducted from date of inception to September 2022. Studies that included patients undergoing cesarean delivery with spinal anesthesia using intrathecal opioid were included. The primary outcome was the presence of pruritus, and the secondary outcome was time to onset of pruritus. Data from included studies were pooled for analysis using an appropriately determined random-effects model. Outcomes were presented using forest plots and 95% confidence intervals. Additional sensitivity and subgroup analysis were performed. Trial sequential analysis was conducted for the primary outcome. Twenty-three randomized controlled trials with a total of 2586 patients were included: 1219 received ondansetron, 1030 received a placebo, and a further 337 received a different study drug and were excluded from analysis. Opioids used in the included studies were morphine, fentanyl, and sufentanil. Patients who received ondansetron showed a significant reduction in the incidence of pruritus compared to the control group (RR, 0.81; 95% confidence interval [CI], 0.71-0.92; I2 = 64%). There was no significant difference in pruritus onset between the groups (mean difference [MD], 17.54 minutes; 95% CI, -2.18 to 37.26; I2 = 83%). The overall Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment of quality of evidence was low. This systematic review has demonstrated a significant reduction in the incidence of pruritus following the use of ondansetron. This is in contrast to previously published meta-analyses. Studies included were of varying quality and some at high risk of bias with a high degree of statistical heterogeneity. Furthermore, high-quality and well-powered studies are required to confirm these findings.

Pharmacokinetics and Tolerability of Intraperitoneal Chloroprocaine After Fetal Extraction in Women Undergoing Cesarean Delivery

(Anesth Analg. 2022;135:777–786) When neuraxial anesthesia is inadequate, there are few analgesic supplemental options that do not cause adverse outcomes for neonate or alter the maternal birth experience. Intraperitoneal chloroprocaine has been used perioperatively for decades to compensate for suboptimal neuraxial anesthesia due to its short in vitro half-life, however, there is a lack of data regarding absorption rate. This study aims to determine intraperitoneal chloroprocaine in vivo half-life and assess tolerability in the clinical setting.

Tranexamic Acid for the Prevention of Postpartum Hemorrhage in Women Undergoing Cesarean Delivery: An Updated Meta-analysis

(Am J Obstet Gynecol. 2022;226:510–523.e22) Postpartum hemorrhage (PPH) affects 1% to 10% of pregnancies worldwide and is associated with high maternal morbidity and mortality rates. Early diagnosis, prophylactic oxytocin, and prompt treatment is the recommended strategy for reducing blood loss during PPH. Tranexamic acid (TXA) may reduce the risk of death in patients with PPH. While previous meta-analyses on the use of prophylactic TXA during cesarean delivery have only used small sample sizes, the recent Tranexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery (TRAAP2) trial is adequately powered and examined long-term risks of prophylactic TXA alongside the benefits. This meta-analysis aimed to compare prophylactic TXA with standard uterotonic agents alone in terms of efficacy and safety in patients having a cesarean delivery.

Pharmacokinetics and Tolerability of Intraperitoneal Chloroprocaine After Fetal Extraction in Women Undergoing Cesarean Delivery.

Intraperitoneal chloroprocaine has been used during cesarean delivery to supplement suboptimal neuraxial anesthesia for decades. The short in vitro half-life of chloroprocaine (11-21 seconds) has been cited to support the safety of this approach. However, there are no data regarding the rate of absorption, representing patient drug exposure, through this route of administration. Accordingly, we designed a study to determine the in vivo half-life of intraperitoneal chloroprocaine and assess clinical tolerability. We designed a single-center, prospective, cohort, multiple-dose escalation study of women 18 to 50 years of age undergoing cesarean delivery with spinal anesthesia. Chloroprocaine (40 mL) was administered after delivery of the newborn and before uterine closure. The first cohort (n = 5) received 1%, the second cohort (n = 5) received 2%, and the third cohort (n = 5) received 3% chloroprocaine solution. Maternal blood samples were obtained before administration and 1, 5, 10, 20, and 30 minutes after dosing. The primary objective was to define the pharmacokinetic profile of intraperitoneal chloroprocaine, including in vivo half-life. The secondary objective was to evaluate tolerability through determination of peak plasma concentration and prospective assessment for local anesthetic systemic toxicity. The peak plasma concentration occurred 5 minutes after intraperitoneal administration in all 3 cohorts: 64.8 ng/mL (6.5 µg/kg), 28.7 ng/mL (2.9 µg/kg), and 799.2 ng/mL (79.9 µg/kg) for 1%, 2%, and 3% chloroprocaine, respectively. The in vivo half-life of chloroprocaine after intraperitoneal administration was estimated to be 5.3 minutes (95% confidence interval, 4.0-6.6). We did not detect clinical signs of local anesthetic systemic toxicity in any of the 3 cohorts. The in vivo half-life of intraperitoneal chloroprocaine (5.3 minutes) is more than an order of magnitude greater than the in vitro half-life (11-21 seconds). However, maximum plasma concentrations of chloroprocaine (C max range, 0.05-79.9 µg/kg) were not associated with local anesthetic systemic toxicity and remain well below our predefined safe level of exposure (970 µg/kg) and levels associated with clinical symptoms (2.6-2.9 mg/kg). Therefore, our study suggests that intraperitoneal chloroprocaine, in a dosage ≤1200 mg, administered after fetal extraction, is well tolerated during cesarean delivery.

A Risk Score for Postoperative Nausea and/or Vomiting in Women Undergoing Cesarean Delivery With Intrathecal Morphine

(Int J Obstet Anesth. 2020;44:126–130) Up to 4 of 5 cesarean delivery (CD) patients receiving intrathecal morphine are affected by postoperative nausea and/or vomiting (PONV). Existing PONV risk assessment scores including the Apfel score were developed based on the general surgical population, while none have been designed specifically for obstetric patients. This post hoc analysis aimed to develop a PONV prediction model (the Duke score) specifically for the obstetric population and compare it to the Apfel score.

Evaluation of Adjunctive Azithromycin Prophylaxis in Women Undergoing Cesarean Delivery in a Setting With Low Baseline Incidence of Surgical Site Infection.

The purpose of this quality improvement study was to determine the effect of adding azithromycin to standard antibiotic prophylaxis on the rates surgical site infection (SSI) in women undergoing both elective and non-elective cesarean deliveries at our centre. A before-and-after quality improvement study was conducted at the Regina General Hospital in Regina, Saskatchewan. Data collected from 989 women who had a caesarean delivery between June 1, 2016 and June 30, 2017 were compared with those from 1033 women who had a caesarean delivery between August 1, 2017 and July 31, 2018, after the introduction of adjunctive azithromycin prophylaxis. The primary outcome measure was the change in the incidence of SSI up to 30 days following surgery. Secondary outcome measures included timing of azithromycin prophylaxis and the number of women who did not receive azithromycin. Surgical site infection rates decreased from 3.5% to 2.9% after adjunctive azithromycin prophylaxis was introduced. The absolute reduction in SSIs of 0.6% was not statistically significant (P = 0.42). There were no differences in SSI rates between the elective and non-elective subgroups. Adding azithromycin to the standard antibiotic prophylaxis for cesarean delivery showed no statistically significant reduction in SSI rates in a population with low baseline rates of SSI.

The Effect of Spinal versus General Anesthesia on Quality of Life in Women Undergoing Cesarean Delivery on Maternal Request.

IntroductionThe proportion of women electing for cesarean delivery has increased in both developed and developing countries. Cesarean delivery on maternal request (CDMR) refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of standard medical/obstetrical indications.Several studies compared anesthesia modalities in cesarean section regarding clinical outcomes such as maternal mortality, post-operative pain and bleeding, but only a few compared health-related quality of life (HRQoL) of women undergoing general anesthesia versus spinal anesthesia. The aim of this study was to determine whether pregnant women who undergo general anesthesia (GA) for cesarean delivery compared with spinal anesthesia (SA) differ regarding their perceived HRQoL.MethodologyWe enrolled 160 pregnant women with American Society of Anesthesiologists (ASA) class II, scheduled for CDMR with GA or SA. Anesthesia modality was based on patient’s preference. Participants assessed their state of health with the EuroQoL-5 Dimensions-3 Levels (EQ-5D-3L) self-administered questionnaire at four time points: six hours before cesarean delivery, 24 hours after cesarean delivery, one week and one month after cesarean delivery. Patients also rated their health on the EQ visual analog scale (EQ-VAS) from 100 mm “best imaginable health state” to 0 mm “worst imaginable health state”.ResultsMore women who underwent spinal anesthesia reported “no problem” with regards to “mobility’ (64% vs. 30%, p = 0.00), “usual activities” (90% vs. 38%, p = 0.00), and “pain/discomfort” (20% vs. 5%, p = 0.007). Repeated measurement analysis showed that the two groups started off with the same EQ-VAS score, however, both decreased over time with different slope resulting in different scores at 24 hours after CS. Then the scores increased in both groups over time and ended up being rather close at one month after CS.DiscussionUnless there is a contraindication, neuraxial anesthesia is the anesthetic technique of choice for cesarean delivery in all parturient in general. This concept is based on more mortality and morbidity that have been seen with general anesthesia in this particular population. Our study demonstrated significant advantages of spinal anesthesia compared to general anesthesia in cesarean section regarding postoperatively perceived HRQoL. We showed that more pregnant women who chose spinal anesthesia as their anesthesia modality reported “no problem” with respect to “mobility” and “Self-care” 24 hours after cesarean section. On the top of that, more women in this group had “no problem” in their “usual activities” at one week and one month after cesarean delivery time points. Moreover, EQ-5D general health score was higher 24 hours after cesarean delivery with regional anesthesia comparing to general anesthesia.ConclusionWe determined that compared to general anesthesia, spinal anesthesia is the technique of choice for cesarean section because not only it avoids a general anesthetic and the risk of failed intubation, but also because it provides effective pain control, mobility and fast return back to daily activities for new mothers and increase their quality of life.

The Effect of Blood Loss on Cefazolin Levels in Women Undergoing Cesarean Delivery.

To quantify the effects of operative blood loss during cesarean on tissue and plasma cefazolin concentrations. This was a prospective observational study of singleton pregnancies undergoing scheduled cesarean between 34 and 40 weeks. Cefazolin administered prior to skin incision. Maternal plasma samples were obtained (Time 1[T1]: immediately, T2: 20 minutes, T3: 40 minutes, and T4: 60 minutes after cefazolin infusion). Subcutaneous adipose tissue sampled before and after fascia. Primary outcome was subcutaneous adipose cefazolin level after fascial closure. Formal quantitative blood loss (QBL) performed. Women with higher QBL, those at/above 75% of QBL in this population, were compared with those with lower QBL (QBL below 75%). Data analyzed using bivariable statistics. Ninety-two women were screened, 32 were eligible, and 20 enrolled. Median QBL was 630 mL (interquartile range [IQR]: 473-818) and 1,160 mL (IQR: 1,000-1,560) in the low and high QBL groups, respectively. Demographics and operative characteristics were similar. Median adipose cefazolin level after fascial closure did not differ between the groups (3.5 vs. 3.9 μg/g, p = 0.75). No differences in maternal plasma cefazolin concentrations between the groups at any time point or in pharmacokinetic parameters were seen. Intraoperative maternal plasma concentrations and adipose levels of cefazolin are similar between women with high and low blood loss at the time of cesarean delivery.

Institutional Protocols for Vaginal Preparation With Antiseptic Solution and Surgical Site Infection Rate in Women Undergoing Cesarean Delivery During Labor.

To evaluate the association of institutional protocols for vaginal preparation with antiseptic solution and the surgical site infection rate in women undergoing cesarean delivery during labor. This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for cesarean delivery performed in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria. Maternal secondary outcomes included a composite of endometritis, wound infection or other infections, postoperative maternal fever, length of hospital stay, and the rates of hospital readmission, unexpected office visits, and emergency department visits. A total of 523 women delivered in institutions with vaginal antisepsis policies before cesarean delivery and 1,490 delivered in institutions without such policies. There was no difference in superficial and deep surgical site infection rates between women with and without vaginal preparation (5.5% vs 4.1%; odds ratio [OR] 1.38, 95% CI 0.87-2.17), even after adjusting for possible confounders (adjusted OR 0.86, 95% CI 0.43-1.73). The lack of significant benefit was noted in all other maternal secondary outcomes. Institutional policies for vaginal preparation before cesarean delivery were not associated with lower rates of surgical site infection in women undergoing cesarean delivery during labor.

Use of Tranexamic Acid to Prevent Postpartum Hemorrhage in Women Undergoing Cesarean Delivery: A Meta-Analysis [14H

INTRODUCTION: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Multiple clinical trials evaluated tranexamic acid (TXA) for treatment and prevention of PPH, but there is currently insufficient evidence to support prophylactic use. Our objective was to conduct a systematic review and meta-analysis using available data from randomized clinical trials (RCT) that evaluated the efficacy of TXA prophylaxis during cesarean section. METHODS: A systematic literature review was conducted using PUBMED and MEDLINE 1966-2017 with relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCTs were abstracted and meta-analysis performed using the Mantel-Haenszel fixed effects model with test of heterogeneity. RESULTS: 27 RCTs were identified for prophylactic use of TXA at cesarean section; which included 4728 women. Only a single study included women at high risk for PPH. Administration of TXA was significantly associated with reduction of mean estimated blood loss (EBL) (27 studies, n=4728, OR 0.45, 95% CI 0.41–0.50), PPH&gt;1000 mL (6 studies, n= 1986, OR 0.27, 95% CI 0.18-0.43), use of blood transfusions (12 studies, n=2813, OR 0.33, 95% CI 0.20-0.54), and need for other medical interventions (9 studies, n=2577, OR 0.39, 95% CI 0.29-0.53). Only 4 cases of VTE in 4366 women were reported which occurred similarly in controls and TXA. CONCLUSION: In an overall low risk patient population, prophylactic TXA at cesarean section was effective in reducing mean EBL, PPH&gt;1000, blood transfusions, and need for other medical interventions. Additional research is needed to elucidate optimal regimens to maximize efficacy and minimize risk.

Post-Operative Outcomes of Oxidized Regenerated Cellulose Use in Women Undergoing Cesarean Delivery

Post-Operative Outcomes of Oxidized Regenerated Cellulose Use in Women Undergoing Cesarean Delivery

Intrathecal Morphine–Related Perioperative Hypothermia in Women Undergoing Cesarean Delivery: A Retrospective Case-Control Study

Rates of inadvertent perioperative hypothermia among women undergoing spinal anesthesia for cesarean delivery are reported to be high. Intrathecal morphine has been noted to have a potentially potent effect on thermoregulation. This retrospective case-control study sought to investigate the incidence of perioperative hypothermia in women undergoing cesarean delivery with and without intrathecal morphine and to describe any clinical factors associated with the condition, the identification of which would provide direction for nursing priorities in the care of the condition. A retrospective case-controlled study design was used. The charts of 358 women who had undergone emergency or elective cesarean delivery under spinal anesthesia were reviewed: 179 having received intrathecal morphine and 179 having received spinal anesthesia without intrathecal morphine (control group). SPSS (IBM, Armonk, New York), version 22, was used for data analysis, including logistic regression to predict the outcome of hypothermia across the study population. There was no significant difference (P=.62; 95% confidence interval, -0.09 to 0.15) in mean postoperative temperature for the morphine group (mean postanesthesia care unit arrival temperature, 35.91°C; standard deviation, 0.59) and the no morphine group (mean postanesthesia care unit arrival temperature, 35.88°C; standard deviation, 0.52). However, within groups, the temperature decline preoperatively to postoperatively was statistically (and clinically) significant. The results refute the suggestion that intrathecal morphine contributes to greater core temperature decline in this population; however, it does confirm that perioperative hypothermia is a prevalent concern for women undergoing cesarean delivery and that pre-emptive measures should be routinely considered by health care providers.

Postoperative Outcomes of Oxidized Regenerated Cellulose Use in Women Undergoing Cesarean Delivery [2C

ACOG.org ACOG Clinical Green Journal For Patients Store ACOG.org ACOG Clinical Green Journal For Parents Store

Patterns of Use and Predictors of Receipt of Antibiotics in Women Undergoing Cesarean Delivery

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious Issues Collections Obstetric Airway ManagementMaternal EmbolismRegional Anesthesia for Cesarean SectionGeneral Anesthesia for Cesarean SectionAnalgesia for LaborObstetric HemorrhagePre-Eclampsia/EclampsiaPharmacologyTraumaInfection and SepsisMaternal ObesityMaternl Morbidity and MortalityNeonatal Morbidity and MortalityObstetric ComplicationsAnesthetic ComplicationsNon-Obstetric Maternal DiseaseCritical CareDrug Abuse in PregnancyEthicsSystems Based Practice For Authors Information for AuthorsLanguage Editing Services Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search

Influence of Preoperative Anxiety on Hypotension After Spinal Anesthesia in Women Undergoing Cesarean Delivery

Influence of Preoperative Anxiety on Hypotension After Spinal Anesthesia in Women Undergoing Cesarean Delivery

A Dose-response Study of Remifentanil for Attenuation of the Hypertensive Response to Laryngoscopy and Tracheal Intubation in Severely Preeclamptic Women Undergoing Caesarean Delivery Under General Anaesthesia

A Dose-response Study of Remifentanil for Attenuation of the Hypertensive Response to Laryngoscopy and Tracheal Intubation in Severely Preeclamptic Women Undergoing Caesarean Delivery Under General Anaesthesia

Alcohol Use Disorders and Hospital-Acquired Infections in Women Undergoing Cesarean Delivery

To determine the risk of hospital-acquired infection in women with alcohol use disorders undergoing cesarean delivery. Using the Nationwide Inpatient Sample, we conducted a retrospective cohort study of women undergoing cesarean delivery from 2002 to 2010. Women with a diagnosis of alcohol use disorder were compared with women without alcohol use disorders. Hospital-acquired infections include surgical site infection, endometritis, urinary tract infection, sepsis, and pneumonia. A total of 12,081 women with alcohol use disorders were identified and matched with 11,960 women without alcohol use disorders. Women with alcohol use disorders were more likely to have development of urinary tract infection and sepsis. By multivariable analyses, women with alcohol use disorders had higher odds of hospital-acquired infections (odds ratio 2.2, 95% confidence interval [CI] 1.9-2.7; P=2×10; 397 among those with alcohol use disorders and 179 among those without alcohol use disorders; number needed to harm 55). Length of stay was longer in women with alcohol use disorders, but this was unexplained by hospital-acquired infection (3.3 days; 95% CI 3.2-3.3 compared with 3.1 days; 95% CI 3.0-3.1; P=4×10). Women with alcohol use disorders undergoing cesarean delivery have increased risk of hospital-acquired infections. Interventions aimed at decreasing alcohol use disorders during pregnancy may reduce maternal and fetal complications. II.