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Pasokpuckdee K, Boriboonhirunsarn D. Incidence of Preeclampsia and Cesarean Section Rate According to the Robson Classification. Cureus 2023; 15:e49845. [PMID: 38169664 PMCID: PMC10758345 DOI: 10.7759/cureus.49845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives The objective of this study was to determine the incidence of preeclampsia and associated cesarean section (CS) rate according to the Robson classification. Methods A retrospective cross-sectional study was conducted on a total of 670 women who delivered at a tertiary care hospital in Thailand during January to March 2023. All women were classified into 10 groups according to the Robson classification, and preeclampsia was identified. Overall and group-specific incidence of preeclampsia and CS rate were estimated. Comparison of CS rate was made between those with and without preeclampsia using the Chi-squared test. Relative risks (RR) and corresponding 95% confidence intervals were estimated. Results The majority of women were in group 1 (34%) and group 3 (30.7%). Overall CS rate was 40.6% with highest contribution from group 1, 5, and 10. Incidence of preeclampsia was 9.1%, and the majority were in groups 10 (29.5%) and 1 (23%). Preeclampsia significantly increased the rate of overall CS (RR 1.8, p<0.001). The risk of CS significantly increased in group 1 (RR 1.8, p=0.043), group 3 (RR 3.5, p=0.025), and group 10 (RR 1.9, p=0.006). Preeclampsia accounted for 15.4% of all CS, with the highest contribution in group 2 (37.5%), group 10 (31.1%), group 3 (16.7%), and group 1 (10.8%). Without preeclampsia, the overall CS rate was relatively reduced by 6.9%, with the largest relative reduction in group 10 (14.3%), group 3 (11.5%), group 2 (6.3%), and group 1 (5.2%). Conclusion The incidence of preeclampsia was 9.1%, and preeclampsia significantly increased the rate of overall CS. Without preeclampsia, overall CS rate relatively reduced by 6.9% but did not significantly change the relative contribution of CS according to the Robson classification.
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Affiliation(s)
- Kritpol Pasokpuckdee
- Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
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102
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Auger N, Wei SQ, Ayoub A, Luu TM. Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery. J Obstet Gynaecol Res 2023; 49:2817-2824. [PMID: 37772655 DOI: 10.1111/jog.15801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
AIM To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. METHODS We conducted a population-based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). RESULTS A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80-3.16) and forceps (RR 3.35, 95% CI 3.07-3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1-26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72-32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8-36.4) and skull fractures (RR 2.04, 95% CI 1.86-2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. CONCLUSIONS Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
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103
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Mukantwari J, Gatete JDD, Niyigena A, Alayande BT, Nkurunziza T, Mazimpaka C, Boatin AA, Kateera F, Hedt-Gauthier B, Riviello R. Late and Persistent Symptoms Suggestive of Surgical Site Infections After Cesarean Section: Results from a Prospective Cohort Study in Rural Rwanda. Surg Infect (Larchmt) 2023; 24:916-923. [PMID: 38032658 PMCID: PMC10734900 DOI: 10.1089/sur.2023.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background: Women in low-resource settings will likely develop late surgical site infections (SSIs), diagnosed after post-operative day (POD) 10. We measured SSI prevalence and predictors of late and persistent SSIs-suggestive symptoms among women who delivered via cesarean section (c-section). Patients and Methods: Women who underwent c-sections at Kirehe District Hospital (KDH) between September 2019 and February 2020 were prospectively enrolled. Data were collected on POD1, POD11, and POD30. Logistic regression identified factors associated with persistent and late SSI symptoms. Results: In total, 808 women were study enrolled. Of these, 646 women physically attended the POD11 clinic visit follow-up, while 671 received the POD30 telephone-based follow-up review. Thirty-three (5.0%) women were diagnosed with an SSI on POD11, and 39 (5.3%) had an SSI diagnosis during POD11 to POD30, giving a cumulative prevalence of 10.3% late SSI rate. Of 671, 400 (59.9%) reported at least one SSI-associated symptom between POD11 and POD30. The reported symptoms included pain (56.6%), fever (19.4%), or incision drainage (16.6%). Of these, 200 women reported still having at least one of these symptoms on POD30. Of the 400 women with late SSI symptoms, 232 (58.0%) did not seek care, and of these, 80 (48.5%), 59 (35.8%), and 15 (8.9%) could not afford transport fare, did not believe symptoms were severe for a medical visit, and were not able to travel, respectively. Lower odds of late SSI-suggestive symptoms were reported among women with health insurance (adjusted odds ratio [aOR], 0.06; p = 0.013), whereas higher late SSI-suggestive symptoms odds were among women with wealthier socioeconomic status (aOR, 2.88; p = 0.004). Conclusions: Women in rural Rwanda are at risk of late and persistent SSI-suggestive symptoms. Financial barriers and the perception that their symptoms were not serious enough for the medical visit need education on early care seeking and interventions to mitigate financial barriers for optimizing perinatal care.
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Affiliation(s)
- Joselyne Mukantwari
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University London, Ontario, Canada
| | | | - Anne Niyigena
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Barnabas Tobi Alayande
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Butaro, Rwanda
| | - Theoneste Nkurunziza
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | | | - Adeline A. Boatin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Bethany Hedt-Gauthier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Butaro, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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104
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Zachariassen LF, Ebert MBB, Mentzel CMJ, Deng L, Krych L, Nielsen DS, Stokholm J, Hansen CHF. Cesarean section induced dysbiosis promotes type 2 immunity but not oxazolone-induced dermatitis in mice. Gut Microbes 2023; 15:2271151. [PMID: 37889696 PMCID: PMC10730161 DOI: 10.1080/19490976.2023.2271151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Delivery by cesarean section (CS) is associated with an altered gut microbiota (GM) colonization and a higher risk of later chronic inflammatory diseases. Studies investigating the association between CS and atopic dermatitis (AD) are contradictive and often biased by confounding factors. The aim of this study was therefore to provide experimental evidence for the association between CS and AD in a mouse model and clarify the role of the GM changes associated with CS. It was hypothesized that CS-delivered mice, and human CS-GM transplanted mice develop severe dermatitis due to early dysbiosis. BALB/c mice delivered by CS or vaginally (VD) as well as BALB/c mice transplanted with GM from CS or VD human donors were challenged with oxazolone on the ear. The severity of dermatitis was evaluated by ear thickness and clinical and histopathological assessment which were similar between all groups. The immune response was assessed by serum IgE concentration, local cytokine response, and presence of immune cells in the draining lymph node. Both CS-delivered mice and mice inoculated with human CS-GM had a higher IgE concentration. A higher proportion of Th2 cells were also found in the CS-GM inoculated mice, but no differences were seen in the cytokine levels in the affected ears. In support of the experimental findings, a human cohort analysis from where the GM samples were obtained found that delivery mode did not affect the children's risk of developing AD. In conclusion, CS-GM enhanced a Th2 biased immune response, but had no effect on oxazolone-induced dermatitis in mice.
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Affiliation(s)
- Line Fisker Zachariassen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Maria Bernadette Bergh Ebert
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Caroline Märta Junker Mentzel
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Ling Deng
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Lukasz Krych
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Dennis Sandris Nielsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Jakob Stokholm
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Camilla Hartmann Friis Hansen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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105
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Topcu EG, McClenahan P, Pule K, Khattak H, Karsli SE, Cukelj M, Ubom AE, Algurjia E, Ozpinar K, Perez YR, Bunu R, Sanabria LS, Portilla FJR, Pumpure E, Roy P, Fogarty P. FIGO best practice guidance in surgical consent. Int J Gynaecol Obstet 2023; 163:795-812. [PMID: 37807812 DOI: 10.1002/ijgo.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure-specific checklists for the most common obstetric and gynecological procedures.
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Affiliation(s)
- E Goknur Topcu
- Department of Obstetrics and Gynecology, Istanbul Health and Technology University, Istanbul, Turkey
| | - Phil McClenahan
- Department of Obstetrics and Gynecology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Koketso Pule
- Department of Obstetrics and Gynecology, Wits University, Johannesburg, South Africa
| | - Hajra Khattak
- Department of Obstetrics and Gynecology, UCL EGA Institute for Women's Health, London, UK
| | - S Eda Karsli
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Marijo Cukelj
- Department of Obstetrics and Gynecology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Akaninyene E Ubom
- Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Esraa Algurjia
- Department of Obstetrics and Gynecology, Al-Elwya Maternity Hospital, Baghdad, Iraq
| | - Kubra Ozpinar
- Department of Obstetrics and Gynecology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yotin Ramon Perez
- Department of Obstetrics and Gynecology, Hospital Central de las Fuerzas, Santo Domingo, Dominican Republic
| | - Rashid Bunu
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Leopoldo S Sanabria
- Department of Obstetrics and Gynecology, Unidad Medica de Alta Especialidad, Mexico City, Mexico
| | - Francisco J R Portilla
- Department of Obstetrics and Gynecology, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Elizabete Pumpure
- Department of Obstetrics and Gynecology, Riga East Clinical University, Riga, Latvia
| | - Priyankur Roy
- Department of Obstetrics and Gynecology, Roy's Clinic, Siliguri, West Bengal, India
| | - Paul Fogarty
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
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106
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Li P, Ma X, Han S, Kawagoe I, Ruetzler K, Lal A, Cao L, Duan R, Li J. Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2278020. [PMID: 37926901 DOI: 10.1080/14767058.2023.2278020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including the duration of labor analgesia, gestational age, and body mass index (BMI). This study aims to provide an updated analysis of the incidence of conversion from epidural analgesia to general anesthesia, while evaluating and analyzing potential risk factors contributing to the failure of this transition to cesarean section anesthesia. METHODS We conducted an extensive literature search utilizing databases such as PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WANGFANG, and the Chinese Biomedical Literature Database (CBM) up to September 30, 2022. The meta-analysis was performed using STATA 15.1 software. The quality of the included studies was assessed using the 11-item quality assessment scale recommended by the Agency for Healthcare Research and Quality (AHRQ). RESULTS A total of 9,926 studies were initially retrieved, and after rigorous selection, 19 studies were included in the meta-analysis. The overall incidence of conversion from epidural analgesia to general anesthesia was found to be 6% (95% confidence interval [CI]: 5-8%). Our findings indicate that, when compared to patients in the successful conversion group, those in the failure group tended to be younger (weighted mean difference [WMD] = -1.571, 95% CI: -1.116 to -0.975) and taller (WMD = 0.893, 95% CI: 0.018-1.767). Additionally, the failure group exhibited a higher incidence of incomplete block in epidural anesthesia, received a higher dosage of additional epidural administration, experienced a greater rate of emergency cesarean sections, and received anesthesia more frequently from non-obstetric anesthesiologists. However, no statistically significant differences were observed in gestational age, depth of the catheter insertion into the skin, epidural catheter specifics, duration of epidural analgesia, infusion rate of epidural analgesia, primiparity status, cervical dilatation during epidural placement, BMI, or weight. CONCLUSION Our study found that the incidence of conversion from epidural analgesia to cesarean section under general anesthesia was 6%. Notably, the failure group exhibited a higher rate of incomplete block in epidural anesthesia, a greater incidence of emergency cesarean sections, a more frequent provision of anesthesia by non-obstetric anesthesiologists, a higher dosage of epidural administration, and greater height when compared to the success group. Conversely, women in the failure group were younger in age compared to their counterparts in the success group.
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Affiliation(s)
- Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Xiaoting Ma
- Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, China
| | - Shuang Han
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Longlu Cao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Ran Duan
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
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107
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Sgayer I, Odeh M, Wolf MF, Kaiyal RS, Aiob A, Lowenstein L, Gratacos E. The impact on pregnancy outcomes of late-onset gestational diabetes mellitus diagnosed during the third trimester: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023. [PMID: 37987501 DOI: 10.1002/ijgo.15254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Evidence is inconsistent regarding the impact of late gestational diabetes mellitus (GDM) on perinatal outcomes. OBJECTIVES To evaluate associations of GDM diagnosed in the third trimester (late GDM) with adverse obstetric and neonatal outcomes. SEARCH STRATEGY We searched Embase, Medline, and Web of Science from January 1, 1990 to June 16, 2022, for observational studies. SELECTION CRITERIA Late GDM was defined as a de novo diagnosis, i.e. after a negative screening for diabetes in the second trimester, and at later than 28 weeks of pregnancy. DATA COLLECTION AND ANALYSIS Each abstract and full-text article was independently reviewed by the same two authors. Quality was assessed with the use of the Newcastle-Ottawa Scale. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effects model. MAIN RESULTS Twelve studies were identified as meeting the inclusion criteria, including 3103 patients (571 with late GDM and 3103 controls). Incidences of shoulder dystocia (OR 1.57, 95% CI 1.02-2.42, P = 0.040), 5-minute Apgar score <7 (OR 1.80, 95% CI 1.14-2.86, P = 0.024), cesarean delivery (OR 1.98, 95% CI 1.51-2.60, P < 0.001), and emergent cesarean delivery (OR 1.57, 95% CI 1.02-2.40, P = 0.040) were significantly higher among women with late GDM than among the controls. The groups showed similarity in the rates of fetal macrosomia, large-for-gestational-age fetuses, neonatal hypoglycemia, and hypertensive disorders of pregnancy. CONCLUSIONS This meta-analysis showed associations of late GDM with increased adverse perinatal outcomes. Prospective studies should evaluate the impact on perinatal outcomes of repeated third-trimester screening for late GDM.
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Raneen Sawaid Kaiyal
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Eduard Gratacos
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain
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108
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Subramanian P, Romero-Soto HN, Stern DB, Maxwell GL, Levy S, Hourigan SK. Delivery mode impacts gut bacteriophage colonization during infancy. medRxiv 2023:2023.11.13.23298307. [PMID: 38014162 PMCID: PMC10680904 DOI: 10.1101/2023.11.13.23298307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Cesarean section delivery is associated with altered early-life bacterial colonization and later adverse inflammatory and immune health outcomes. Although gut bacteriophages can alter gut microbiome composition and impact host immune responses, little is known about how delivery mode impacts bacteriophage colonization over time. To begin to address this we examined how delivery mode affected bacteriophage colonization over the first two years of life. Results Shotgun metagenomic sequencing was conducted on 272 serial stool samples from 55 infants, collected at 1-2 days of life and 2, 6, 12 and 24 months. 33/55 (60%) infants were born by vaginal delivery. DNA viruses were identified, and by host inference, 94% of the viral sequences were found to be bacteriophages. Alpha diversity of the virome was increased in vaginally delivered infants compared to cesarean section delivered infants at 2 months (Shannon index, p=0.022). Beta diversity significantly differed by delivery mode at 2, 6, and 12 months when stratified by peripartum antibiotic use (Bray-Curtis dissimilarity, all p<0.05). Significant differentially abundant predicted bacteriophage hosts by delivery mode were seen at all time points. Moreover, there were differences in predicted bacteriophage functional gene abundances up to 24 months by delivery mode. Many of the functions considered to play a role in host response were increased in vaginal delivery. Conclusions Clear differences in bacteriophage composition and function were seen by delivery mode over the first two years of life. Given that phages are known to affect host immune response, our results suggest that future investigation into how delivery mode may lead to adverse inflammatory outcomes should not only include bacterial microbial colonization but also the potential role of bacteriophages and transkingdom interactions.
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Affiliation(s)
- Poorani Subramanian
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Hector N Romero-Soto
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - David B Stern
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - George L Maxwell
- Women's Service Line, Inova Health System, Falls Church, Virginia, United States
| | - Shira Levy
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Suchitra K Hourigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
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109
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Alvarenga MB, da Gama SGN, Nakamura-Pereira M. Characteristics of women who underwent one or more previous cesarean sections according to Nascer no Brasil. Rev Saude Publica 2023; 57:89. [PMID: 37971073 PMCID: PMC10681529 DOI: 10.11606/s1518-8787.2023057004819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil. METHODS The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2). Variables with significant differences (p < 0.05) were incorporated into logistic regression. FINDINGS Out of the total of 23,894 women, 20.9% had undergone a previous cesarean section. The majority (85.1%) underwent another cesarean section, with 75.5% occurring before the onset of labor. The rate of Vaginal Birth After Cesarean (VBAC) was 14.9%, with a success rate of 60.8%. Women who underwent three or more cesarean sections displayed greater social vulnerability. The chances of VBAC were higher among those who opted for a vaginal birth towards the end of gestation, had a prior vaginal birth, underwent labor induction, were admitted with over 4 centimeters of dilation, and without partner. Receiving care from the private health care system, having two or more prior cesarean sections, obstetric complications, and deciding on cesarean delivery late in gestation reduced the chances of VBAC. Age group, educational background, prenatal care adequacy, and the reason for the previous cesarean section did not result in significant differences. CONCLUSION The majority of women who underwent a previous cesarean section in Brazil are directed towards another surgery, and a higher number of cesarean sections is linked to greater social inequality. Factors associated with VBAC included choosing vaginal birth towards the end of gestation, having had a previous vaginal birth, higher cervical dilation upon admission, induction, assistance from the public health care system, absence of obstetric complications, and without a partner. Efforts to promote VBAC are necessary to reduce overall cesarean rates and their repercussions on maternal and child health.
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Affiliation(s)
- Marina Barreto Alvarenga
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaPrograma de Epidemiologia em Saúde PúblicaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Programa de Epidemiologia em Saúde Pública, Rio de Janeiro, RJ, Brasil
| | - Silvana Granado Nogueira da Gama
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaDepartamento de Epidemiologia e Métodos Quantitativos em SaúdeRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, RJ, Brasil
| | - Marcos Nakamura-Pereira
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaPrograma de Epidemiologia em Saúde PúblicaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Programa de Epidemiologia em Saúde Pública, Rio de Janeiro, RJ, Brasil
- Instituto Fernandes FigueiraRio de JaneiroRJBrasilInstituto Fernandes Figueira, Rio de Janeiro, RJ, Brasil
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Aksoy M, Aksoy AN, Yilmaz EPT, Senocak GNC, Dostbil A, Ozkan H. The effectiveness of erector spina plane, quadratus lumborum blocks, and intrathecal morphine for analgesia after cesarean: a randomized study. Rev Assoc Med Bras (1992) 2023; 69:e20230867. [PMID: 37971133 PMCID: PMC10645188 DOI: 10.1590/1806-9282.20230867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This prospective randomized study was conducted at Ataturk University Medical Faculty Hospital, Department of Anesthesia and Reanimation, from June 2022 to May 2023. The aim of this study was to compare the effectiveness of ultrasound-guided erector spinae plane block, quadratus lumborum block, and intrathecal morphine to decrease postoperative pain after cesarean section. METHODS Sixty-term pregnant women who were scheduled for elective cesarean sections with spinal anesthesia were included. Patients were randomly divided into three groups (n=20 for each group): Group 1: Patients were administered intrathecal morphine during spinal anesthesia; Group 2: Patients performed bilateral erector spinae plane block postoperatively; and Group 3: Patients performed bilateral quadratus lumborum block postoperatively. In the postpartum care unit, patients received intravenous Patient-Controlled Analgesia. The Patient-Controlled Analgesia devices were set to administer an intravenous bolus of 25 μg fentanyl, with a lockout interval of 10 min. Opioid consumption and maximum pain score in the 24 postoperative hours were recorded. RESULTS Patients in Group 1 had a longer time to first analgesic requirement compared to Group 2 (p=0.017). Opioid consumption and resting and moving visual analog score scores in the first 24 h postoperatively were similar between groups. CONCLUSION All three methods, including intrathecal morphine, erector spinae plane block, and quadratus lumborum block, are efficacious and comparable in providing postoperative analgesia after cesarean under spinal anesthesia.
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Affiliation(s)
- Mehmet Aksoy
- Atatürk University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Erzurum, Turkey
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
| | - Ayse Nur Aksoy
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
- University of Health Sciences, Erzurum City Hospital, Department of Obstetrics and Gynecology – Erzurum, Turkey
| | - Emsal Pınar Topdagi Yilmaz
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
- Atatürk University, Faculty of Medicine, Department of Obstetrics and Gynecology – Erzurum, Turkey
| | - Gamze Nur Cimilli Senocak
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
- Atatürk University, Faculty of Medicine, Department of Obstetrics and Gynecology – Erzurum, Turkey
| | - Aysenur Dostbil
- Atatürk University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Erzurum, Turkey
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
| | - Hava Ozkan
- Atatürk University, Faculty of Health Science, Department of Midwifery – Erzurum, Turkey
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111
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Silverman M, Zwolinski N, Wang E, Lockwood N, Ancuta M, Jin E, Li J. Regional Analgesia for Cesarean Delivery: A Narrative Review Toward Enhancing Outcomes in Parturients. J Pain Res 2023; 16:3807-3835. [PMID: 38026463 PMCID: PMC10644837 DOI: 10.2147/jpr.s428332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction With the current surge on peripheral nerve blocks in post-cesarean pain management and the historical lack of unequivocal evidence supporting its universal use, this review intended to re-examine the extended scope of literature on regional anesthesia and postoperative analgesia in low-transverse cesarean section. Methods A literature search was conducted up to April 2023 using PubMed to identify articles relevant to our search words "cesarean section", "neuraxial morphine", "post-cesarean analgesia", as well as the name of each individual nerve block. The literature search was ultimately narrowed to systematic reviews and randomized controlled trials published between 2012 and 2023. We define, describe, and discuss the evidence surrounding each individual regional anesthetic technique in the presence and absence of intrathecal morphine, which is used as the gold standard when appropriate. Results In the absence of neuraxial morphine, all regional anesthetic techniques have some level of analgesic benefit in the post-cesarean analgesia. Transversus Abdominis Plane blocks continue to have the most studies in their use. Newer fascia plane blocks including the anterior Quadratus Lumborum, and Erector Spinae Plane blocks provide significant analgesia. In addition, direct comparison among peripheral nerve blocks consistently favors the more proximal, centralized techniques. Conversely, in the presence of neuraxial morphine, no peripheral anesthetic technique has reliably and reproducibly demonstrated an added analgesic benefit regardless of the peripheral nerve block technique or location of local anesthetic injection in the post-cesarean population. Conclusion Neuraxial morphine continues to be the gold standard for post-cesarean section analgesia, the benefit of additional single injection regional anesthetic is currently not evidence supported. In cases where neuraxial opioids have not or cannot be given, there is overwhelming evidence that regional anesthetic techniques improve post-cesarean section analgesia and decrease post-operative opioid consumption. Even though there is no consensus on the optimal peripheral nerve block, emerging evidence suggests more centralized abdominal fascia plane block trends towards better analgesia.
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Affiliation(s)
- Matthew Silverman
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Nicholas Zwolinski
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Ethan Wang
- Yale University School of Medicine, New Haven, CT, USA
| | - Nishita Lockwood
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Ancuta
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Evan Jin
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
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112
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Emrich NLA, Tascón Padrón L, Komann M, Arnold C, Dreiling J, Meißner W, Strizek B, Gembruch U, Jiménez Cruz J. Risk Factors for Severe Pain and Impairment of Daily Life Activities after Cesarean Section-A Prospective Multi-Center Study of 11,932 Patients. J Clin Med 2023; 12:6999. [PMID: 38002614 PMCID: PMC10672043 DOI: 10.3390/jcm12226999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry "quality improvement in postoperative pain treatment" (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS ≥ 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p < 0.001). Distraction, relaxation, mobilization, having conversations, patient-controlled analgesia (PCA) and pain monitoring were shown to be protective for severe pain (p < 0.001). Maximal pain in PCS and UCS was similar, but UCS obtained more analgesics (p < 0.001), and experienced more impairment of ambulation (p < 0.001) and deep breathing (p < 0.05). Severe pain has a major effect on daily-life activities and recovery after CS, and depends on modifiable factors. More effort is needed to improve the quality of care after CS.
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Affiliation(s)
- Norah L. A. Emrich
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Laura Tascón Padrón
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Marcus Komann
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Christin Arnold
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Johannes Dreiling
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Winfried Meißner
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Jorge Jiménez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
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Dai C, Wang X, Xu C, Bai L, Li Y. A Study on the Psychological Experience and Influential Factors of Pregnant Women Who Decided Elective Caesarean Section After Public Health Emergencies - A Cross-Sectional Survey. Int J Womens Health 2023; 15:1713-1725. [PMID: 37965076 PMCID: PMC10642347 DOI: 10.2147/ijwh.s418959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Background The COVID-19 pandemic used to be a major public health emergency which affected people worldwide, and it affected individuals' body, mood, work and lifestyle to some extent. The pregnant woman affected by the unstable hormone will be more sensitive than normal ones. Long-term depression and anxiety could feedback on their body and lead to a host of pregnancy complications. Because pregnant women who choose cesarean section are awake during the perioperative period, to ensure safety, the degree of cooperation about psychology and behavior is relatively high, so we should know the psychological state of such a group of people. Objective This study aims to explore psychological experience and influential factors of pregnant women who decided elective caesarean section after the COVID-19 pandemic. Methods This is a cross-sectional study carried out in a hospital in Shanghai, according to the inclusion and exclusion criteria, we selected pregnant women who selected elective cesarean section as the study objects, all participants provided informed consent and completed questionnaires, including sociodemographic questionnaire, Generalized Anxiety Disorder scale (GAD-7) and General Well-Being Schedule (GWBS). Software SPSS 23.0 was used to analyze and explore the influencing factors. Results Eligible 595 questionnaires were included in the study, the mean score of GAD-7 was 4.855 ± 3.254 and 90.699 ± 13.807 of GWBS. Generalized linear regression analysis revealed several factors that were statistically significant with the two scales, including birthplace, average monthly income, number of abortion and pregnancy complication (p < 0.01). Conclusion The COVID-19 infection status and symptoms around infection have no statistical difference in anxiety level and general well-being after they experience the COVID-19 pandemic. However, through this study, we found some influencing factors that worth further exploration. In the future, we will expand the sample size to explore the different situation of multi-center, and we hope provide psychological nursing interventions based on existing results to offer a better delivery experience.
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Affiliation(s)
- Chunye Dai
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xuelu Wang
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Chenying Xu
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Lina Bai
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Yuehong Li
- Nursing Department, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
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Nantume S, Baluku EM, Kwesiga D, Waiswa P. Factors Associated with High Rates of Caesarean Deliveries: A Cross Sectional Study Classifying Deliveries According to Robson in Mengo Hospital Kampala. Risk Manag Healthc Policy 2023; 16:2339-2356. [PMID: 37965117 PMCID: PMC10641024 DOI: 10.2147/rmhp.s422705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction The number of caesarean section (CS) continues to rise worldwide. CS can improve outcomes in infants and mothers. However, if used improperly, the potential harm can outweigh the potential benefits. Aim The study was to determine the factors associated with high cesarean section rates at Mengo Hospital. Methods This cross-sectional study used a mixed-method approach that included a retrospective review of 1276 casebooks using the Robson Ten Group Classification System (RTGCS) for births that occurred at Mengo Hospital in December 2018, January, and February 2019. Questionnaire was used for data collection from 200 mothers on second day after birth from 24th May to 19th July 2019. Eight key informants were interviewed within the same period. Quantitative data were analyzed using STATA V.14, thematic analysis for qualitative data. Univariate, bivariate, and multivariate analyses were performed to determine the association between predisposing factors and outcome variables using chi-square and modified Poisson. Results Caesarean section rate (CSR) from casebooks was 49% and 64% from the primary data. Group 5(Previous CS, single cephalic, >37 weeks) had (35.4%) to the total number of cesarean deliveries, followed by Group 1 (Nulliparous, single cesarean deliveries, >37 weeks in spontaneous labour), with 18.4%. Group 3 (ultiparous (excluding previous CS), single cephalic, >37 weeks of spontaneous labor) with (13.7%). The common indications from casebooks were a previous scar (32%), obstructed labor (18%), and previous scar (97.6%). Presence of an obstetric indication, influence of husband, friends, relatives, and mother's desire for a CS were closely associated with caesarean delivery. Mothers said that occurrence of CS was due to health workers reducing the stress of monitoring labour and financial benefits from CS deliveries by the hospital. Conclusion Repeat CS made the highest CSR contribution; therefore, strategies to reduce the frequency of the procedure should include avoiding medically unnecessary primary CS and encouraging vaginal birth after previous CS where applicable.
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Affiliation(s)
- Susan Nantume
- College of Health Science, Makerere University, Kampala, Uganda
| | - Eric Murungi Baluku
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Doris Kwesiga
- College of Health Science, Makerere University, Kampala, Uganda
| | - Peter Waiswa
- College of Health Science, Makerere University, Kampala, Uganda
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Manns-James L, Vines S, Alliman J, Hoehn-Velasco L, Stapleton S, Wright J, Jolles D. Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry. Birth 2023. [PMID: 37929686 DOI: 10.1111/birt.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/03/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk. METHODS National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth. RESULTS Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15-1.63), Latinx (aOR = 1.51; 95% CI, 1.32-1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19-1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02-2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity. CONCLUSIONS Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.
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Affiliation(s)
| | | | - Jill Alliman
- Frontier Nursing University, Versailles, Kentucky, USA
| | | | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Diana Jolles
- Frontier Nursing University, Versailles, Kentucky, USA
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Ferreira DP, Bolognani CV, Santana LA, Fernandes SES, de Moraes MSF, Fernandes LAS, Pereira CDS, Ferreira GB, Göttems LBD, Amorim FF. Impact of the COVID-19 Pandemic on Births, Vaginal Deliveries, Cesarian Sections, and Maternal Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study. Int J Womens Health 2023; 15:1693-1703. [PMID: 38020934 PMCID: PMC10631387 DOI: 10.2147/ijwh.s429122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in healthcare. The primary objective of the study was to assess the impact of the COVID-19 pandemic on birth, vaginal delivery, and cesarian section (c-section) rates. The secondary objective was to compare the maternal mortality before and after the pandemic. Patients and Methods Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software. Results There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: -24.0-33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9-23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53-6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect. Conclusion Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial.
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Affiliation(s)
- Dilson Palhares Ferreira
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
| | - Cláudia Vicari Bolognani
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | - Levy Aniceto Santana
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | - Sérgio Eduardo Soares Fernandes
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | | | | | - Camila de Sousa Pereira
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | | | - Leila Bernarda Donato Göttems
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | - Fábio Ferreira Amorim
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
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Sangkum L, Tangjitbampenbun A, Chalacheewa T, Brennan K, Liu H. Peripheral Nerve Blocks for Cesarean Delivery Analgesia: A Narrative Review. Medicina (Kaunas) 2023; 59:1951. [PMID: 38004000 PMCID: PMC10673165 DOI: 10.3390/medicina59111951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Effective postoperative analgesia using multimodal approach improves maternal and neonatal outcomes after cesarean delivery. The use of neuraxial approach (local anesthetic and opioids) and intravenous adjunctive drugs, such as nonsteroidal anti-inflammatory drugs and acetaminophen, currently represents the standard regimen for post-cesarean delivery analgesia. Peripheral nerve blocks may be considered in patients who are unable to receive neuraxial techniques; these blocks may also be used as a rescue technique in selected patients. This review discusses the relevant anatomy, current evidence, and advantages and disadvantages of the various peripheral nerve block techniques. Further research is warranted to compare the analgesic efficacy of these techniques, especially newer blocks (e.g., quadratus lumborum blocks and erector spinae plane blocks). Moreover, future studies should determine the safety profile of these blocks (e.g., fascial plane blocks) in the obstetric population because of its increased susceptibility to local anesthetic toxicity.
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Affiliation(s)
- Lisa Sangkum
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Amornrat Tangjitbampenbun
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Theerawat Chalacheewa
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Kristin Brennan
- Department of Anesthesiology, Penn Medicine Lancaster General Hospital, 555 N Duke St., Lancaster, PA 17602, USA;
| | - Henry Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Suzuki A, Iriyama S, Obayashi Y. Validity and reliability of the Posttraumatic Growth Inventory among Japanese women with cesarean section. Nagoya J Med Sci 2023; 85:745-757. [PMID: 38155633 PMCID: PMC10751497 DOI: 10.18999/nagjms.85.4.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2023]
Abstract
This study aimed to examine the validity and reliability of the expanded version of the Posttraumatic Growth Inventory-Japanese version (PTGI-X-J) among Japanese women who delivered by cesarean section. The study is a cross-sectional survey psychometric study. Participants were 517 Japanese women who were in the hospital after childbirth by cesarean section at six general hospitals and two obstetric clinics in Tokai Region, Japan. They completed a self-report questionnaire-which included sociodemographic and childbirth information and obstetric history, the PTGI-X-J, and the Postnatal Women Version of the Japanese-Language Version of the Impact of Event Scale-Revised (IES-R-J-PWV). We conducted an exploratory factor analysis to evaluate the factorial validity of the PTGI-X-J. We confirmed the internal consistency reliability of the Postpartum Women Version of PTGI-X-J (PTGI-X-J-PWV) using Cronbach's α coefficients and examined Spearman's correlation coefficients between the PTGI-X-J-PWV and the IES-R-J-PWV. The exploratory factor analysis resulted in a 22-item measure that comprised four factors: strength as mothers, spiritual change as mothers, new possibilities as mothers and appreciation of life, and relating to others as mothers. The PTGI-X-J-PWV exhibited good internal consistency reliability (Cronbach's α = 0.94), and a weak significant positive correlation with the IES-R-J-PWV (rs = 0.18, p < 0.001) was evident. The results of this study indicated that the PTGI-X-J-PWV was a valid and reliable tool for measuring postpartum posttraumatic growth among Japanese women who have delivered by cesarean section. By accurately measuring mothers' posttraumatic growth, midwives and nurses can provide the kind of care that encourages their growth as mothers.
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Affiliation(s)
- Asuka Suzuki
- Division of Midwifery Course, Nagoya University of Arts and Sciences, Nagoya, Japan
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigemi Iriyama
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoko Obayashi
- Department of Nursing, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
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Kasoha M, Nigdelis MP, Bishara L, Wagenpfeil G, Solomayer EF, Haj Hamoud B. Obstetric practice differences between Syrian refugees and non-Syrian nonrefugee gravidae: A retrospective cross-sectional study. Int J Gynaecol Obstet 2023; 163:430-437. [PMID: 37605949 DOI: 10.1002/ijgo.15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To assess differences in obstetric practices between Syrian war refugees (SRs) and non-Syrian nonrefugees (NSRs) in a tertiary care provider in Germany. METHODS This was a retrospective study of SRs (n = 356) and NSRs (n = 5836) giving birth between January 2015 and December 2018. Data on medical history, birth mode, complications, and neonatal parameters was extracted. Group differences were evaluated using Mann-Whitney and χ2 test. Logistic regression models were fitted to investigate the association of refugee status with mode of birth in conditions associated with increased risk of cesarean section (CS). RESULTS SRs had higher rates of adolescent pregnancies (1.7% versus 0.6%, P = 0.020) but fewer maternal diseases compared with NSRs (1.7% versus 3.9%, P = 0.035). The rate of CS was higher in the NSR group (43.9% versus 36%, P = 0.003), as well as the rates of premature rupture of membranes (P = 0.006) and steroid administration for lung maturation (P = 0.012). Cases of umbilical artery pH ≤7.0 were more common in SRs (0.4% versus 1.1%, P = 0.027). Women with previous CS had similar odds of CS in the current pregnancy irrespective of study group (odds ratio, 0.94 [95% confidence interval, 0.50-1.75]). CONCLUSION SR women had lower rates of CS but higher rates of adolescent pregnancies and neonatal pH ≤7.0 at birth compared with NSR women.
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Affiliation(s)
- Mariz Kasoha
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Meletios P Nigdelis
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Leila Bishara
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Saarbrücken, Saarland, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Bashar Haj Hamoud
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
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Hirata Y, Kawamura H, Kato M, Ezaka Y, Yoshida Y. Rectus Sheath Hematoma Triggered by Post-cesarean Anticoagulant Therapy for Intraoperative Acute Pulmonary Thromboembolism: A Case Report. Cureus 2023; 15:e49034. [PMID: 38116345 PMCID: PMC10728606 DOI: 10.7759/cureus.49034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Anticoagulant therapy is essential for the prevention or treatment of peripartum venous thromboembolism (VTE). Administration of a therapeutic dose of anticoagulant immediately after cesarean section may result in the formation of a rectus sheath hematoma. A 32-year-old Japanese woman delivered twin neonates by cesarean section at 37+5 weeks of gestation. After the removal of the placenta, the patient suddenly complained of left anterior chest pain and dyspnea with hypotension and desaturation, requiring the administration of oxygen and vasopressors. Postoperative contrast-enhanced computed tomography (CT) revealed pulmonary embolism and massive right ovarian vein thrombosis (OVT). An inferior vena cava filter was placed and continuous intravenous heparin was started. A rectus sheath hematoma was noted on postoperative day 2 (POD 2). On POD 5, heparin administration was temporarily discontinued because of an enlarged rectus sheath hematoma. Approximately 24 hours later, the hemoglobin level recovered, and heparin administration was resumed. No further expansion of the hematoma was observed. When a rectus sheath hematoma is formed due to treatment with a therapeutic dose of anticoagulant immediately after cesarean section for peripartum VTE, temporary suspension of anticoagulant administration is reasonable to prevent further expansion of the hematoma without fatal complication.
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Affiliation(s)
- Yuki Hirata
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | | | - Masataka Kato
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | - Yukie Ezaka
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | - Yoshio Yoshida
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
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Węgrzynowska M, Baranowska B, Sys D, Kajdy A, Karzel K, Bączek G, Szlendak B, Tataj-Puzyna U. Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland. Birth 2023. [PMID: 37915248 DOI: 10.1111/birt.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten-Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. METHODS We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. RESULTS The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. CONCLUSIONS The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.
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Affiliation(s)
- Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Dorota Sys
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kajdy
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warsaw, Poland
| | - Beata Szlendak
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Coll‐Roman LM, Cabrera C, VanderBroek AR, Bauck AG, Kelleman AA, Pozor MA, Stockler JW, Wiley C, Scully C, Mackay EE, Depenbrock SM, Fecteau M, Abraham M, Leduc L, Noll CV, Hernandez JA, Luethy D. Multicenter study of uterine tears and other reproductive complications in periparturient goats presented to veterinary teaching hospitals. J Vet Intern Med 2023; 37:2623-2630. [PMID: 37698350 PMCID: PMC10658512 DOI: 10.1111/jvim.16858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Goats are increasingly popular as both production animals and pets. The frequency of and factors associated with periparturient reproductive complications in goats are largely unreported. OBJECTIVES (1) To report the frequency of periparturient reproductive complications in does presented to university veterinary hospitals and (2) to identify factors associated with uterine tears in the study population. ANIMALS A total of 198 periparturient does presented to 9 university veterinary hospitals from October 2021 to June 2022. METHODS Multicenter, cross-sectional study, with data collected from questionnaires completed by attending veterinarians. Logistic regression was used to identify factors associated with diagnosis of uterine tears. RESULTS Ninety-three (47%) does had at least 1 periparturient reproductive complication. Periparturient complications included retained fetal membranes (n = 38, 26%), vaginal or perineal trauma (n = 33, 19%), uterine tears (n = 32, 18%), metritis (n = 22, 13%), uterine or vaginal hemorrhage (n = 8, 5%), Cesarean section complications (n = 8, 8%), and uterine prolapse (n = 1, 0.5%). A positive interaction effect was found between small breeds (Nigerian Dwarf and Pygmy) and manipulation on the farm by a layperson upon diagnosis of uterine tears (odd ratios [OR], 5.48; 95% confidence interval [CI], 1.41, 21.25; P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE Periparturient reproductive complications were common. Small breed combined with manipulation on the farm by layperson was associated with diagnosis of uterine tears. Clients should be educated that in the event of dystocia, small breed does are at greater risk of uterine tears and prompt veterinary intervention is critical.
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Affiliation(s)
| | - Catalina Cabrera
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Ashley R. VanderBroek
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Anje G. Bauck
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Audrey A. Kelleman
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Malgorzata A. Pozor
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Jenna W. Stockler
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Caitlin Wiley
- Veterinary Diagnostic and Production Animal Medicine, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Clare Scully
- Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Evelyn E. Mackay
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Sarah M. Depenbrock
- Department of Veterinary Medicine and Epidemiology, School of Veterinary MedicineUC DavisDavisCaliforniaUSA
| | - Marie‐Eve Fecteau
- Department of Clinical Studies – New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Michelle Abraham
- Department of Clinical Studies – New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Laurence Leduc
- Department of Clinical Studies – New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Charlene V. Noll
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Jorge A. Hernandez
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Daniela Luethy
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
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Wang ZX, Zhao YF, Li L. Is prophylactic intraoperative abdominal aortic balloon occlusion beneficial in pregnancies with placenta previa and placenta accreta spectrum during cesarean section? A 5-year retrospective study. Int J Gynaecol Obstet 2023; 163:572-578. [PMID: 37183630 DOI: 10.1002/ijgo.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To assess whether prophylactic intraoperative abdominal aortic balloon occlusion (IAABO) is indeed beneficial in pregnancies with placenta previa (PP) and placenta accreta spectrum (PAS) during cesarean section. METHODS A retrospective case-control study included 251 pregnancies with PP and/or PAS. All enrolled patients were divided into a PP/PAS group, a PP + PAS group, and an IAABO group. The demographic characteristics and maternal and neonatal outcomes were compared. RESULTS There was no significant difference in blood loss and transfusion between the IAABO group and the PP + PAS group (P > 0.05). However, blood loss and red blood cell and fresh frozen plasma transfusion in the above two groups were significantly higher than in the PP/PAS group (P < 0.05). More pregnancies in the IAABO group had to undergo uterine artery embolization (29.2%) or hysterectomy (20.8%), and this percentage was significantly higher than that in the other two groups (P < 0.001). All neonatal characteristics did not show differences between the IAABO group and PP + PAS group (P > 0.05). IAABO led to femoral artery thrombosis in three cases and minor postoperative renal injury in one case. CONCLUSION IAABO only acted as a less important supporting technique during cesarean section. There was no evidence suggesting that IAABO could significantly control the massive hemorrhage in pregnancies with PP and PAS during cesarean delivery.
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Affiliation(s)
- Zi-Xuan Wang
- Department of Interventional Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China
| | - Yi-Fan Zhao
- Department of Interventional Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China
| | - Lin Li
- Department of Interventional Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China
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Tîrnovanu MC, Tîrnovanu VG, Toma B, Toma L, Țarcă E, Stătescu L, Tîrnovanu ȘD, Ungureanu C, Trandafirescu MF, Bernic J, Cojocaru E. Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review. J Pers Med 2023; 13:1563. [PMID: 38003877 PMCID: PMC10671948 DOI: 10.3390/jpm13111563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Placental morbid adherence is a known risk factor for postpartum hemorrhage. The incidence of abnormal placental attachment has been increasing over the past few decades, mainly due to rising rates of cesarean deliveries, advanced maternal age, and the use of assisted reproductive technologies. Cesarean section is a significant risk factor for placenta increta, as it disrupts the normal architecture of the uterine wall, making it more difficult for the placenta to detach after delivery. We present the case of a woman who underwent a cesarean section at 28 weeks due to anterior placenta previa, accompanied by hemorrhage and rupture of membranes. Following the delivery, she experienced normal postoperative bleeding and was discharged home after five days. However, six weeks later, she presented with heavy bleeding, leading to the decision to perform a total hysterectomy. The levels of HCG were found to be low. The pathological examination of the specimens confirmed a diagnosis of placenta increta, as it revealed notable placental proliferation, necrotic villi, and placental invasion near the uterine serosa. Notably, we did not find any similar cases documented in the literature. Patients experiencing prolonged vaginal bleeding after childbirth and diagnosed with placenta accreta should be closely monitored through ultrasound examinations; abnormal proliferation of the placenta can occur, and prompt detection is crucial for appropriate management.
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Affiliation(s)
- Mihaela Camelia Tîrnovanu
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (L.T.)
- “Cuza Voda” Obstetrics-Gynecology Clinic Hospital, 700038 Iasi, Romania;
| | - Vlad Gabriel Tîrnovanu
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (L.T.)
| | - Bogdan Toma
- “Cuza Voda” Obstetrics-Gynecology Clinic Hospital, 700038 Iasi, Romania;
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
| | - Loredana Toma
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (L.T.)
- “Cuza Voda” Obstetrics-Gynecology Clinic Hospital, 700038 Iasi, Romania;
| | - Elena Țarcă
- Department of Surgery II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Laura Stătescu
- Department of Dermatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefan Dragoș Tîrnovanu
- Department of Surgery II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Carmen Ungureanu
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
| | - Mioara Florentina Trandafirescu
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
| | - Jana Bernic
- Discipline of Pediatric Surgery, “Nicolae Testemițanu” State University of Medicine and Pharmacy, 2025 Chisinau, Moldova;
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
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Cheung MK, Leung TF, Tam WH, Leung ASY, Chan OM, Ng RWY, Yau JWK, Yuen LY, Tong SLY, Ho WCS, Yeung ACM, Chen Z, Chan PKS. Development of the early-life gut microbiome and associations with eczema in a prospective Chinese cohort. mSystems 2023; 8:e0052123. [PMID: 37646516 PMCID: PMC10654104 DOI: 10.1128/msystems.00521-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/20/2023] [Indexed: 09/01/2023] Open
Abstract
IMPORTANCE Eczema is a major allergic disease in children, which is particularly prevalent in Chinese children during their first year of life. In this study, we showed that alterations in the infant gut microbiota precede the development of eczema in a prospective Chinese cohort. In particular, we discovered enrichments of the genera Clostridium sensu stricto 1 and Finegoldia in the cases at 3 and 1 month of age, respectively, which may represent potential targets for intervention to prevent eczema. Besides, we identified a depletion of Bacteroides from 1 to 6 months of age and an enrichment of Clostridium sensu stricto 1 at 3 months in the eczema cases, patterns also observed in C-section-born infants within the same time frames, providing first evidence to support a role of the gut microbiota in previously reported associations between C-section and increased risk of eczema in infancy.
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Affiliation(s)
- Man Kit Cheung
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ting Fan Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Wing Hung Tam
- Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Agnes S. Y. Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Oi Man Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Rita W. Y. Ng
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Jennifer W. K. Yau
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Lai-yuk Yuen
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Sylvia L. Y. Tong
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Wendy C. S. Ho
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Apple C. M. Yeung
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Zigui Chen
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Paul K. S. Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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Murtada M, Hakami N, Mahfouz M, Abdelmola A, Eltyeb E, Medani I, Maghfori G, Zakri A, Hakami A, Altraifi A, Khormi A, Chourasia U. Multiple Cesarean Section Outcomes and Complications: A Retrospective Study in Jazan, Saudi Arabia. Healthcare (Basel) 2023; 11:2799. [PMID: 37893873 PMCID: PMC10606747 DOI: 10.3390/healthcare11202799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Given the increase in the rate of cesarean sections (CSs) globally and in Saudi Arabia, this study was conducted to assess the maternal and perinatal complications after repeat cesarean sections in the studied population. METHODS This retrospective study was conducted by reviewing the records of all women who underwent CSs between January and July 2023 in three hospitals in the Jazan region of Saudi Arabia. RESULTS Of the 268 women studied, 195 (72.7%) had a CS for the first or second time and 73 (27.3%) had two, three, or four previous CSs (repeat CS). The most common maternal intra-operative complications reported by the repeat CS group were intra-peritoneal adhesions (7.5%) and fused abdominal layers (7.1%) while the most common postoperative complications were the need for blood transfusion (22%) and UTIs (3%). The most common neonatal complications were a low Apgar score (19%), needing neonatal resuscitation (2.6%), and intensive care admission. In addition, 3.7% of mothers failed to initiate breastfeeding in the first 24 h. CONCLUSIONS The frequent complications were intra-peritoneal adhesions, fused abdominal wall layers, blood transfusion, and postoperative infections which were overcome by the optimal hospital care. However, the frequent neonatal complications were a low Apgar score, needing neonatal resuscitation, and intensive care admission.
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Affiliation(s)
- Maha Murtada
- Obstetrics and Gynecology Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (I.M.); (A.H.); (A.A.); (A.K.); (U.C.)
| | - Nasser Hakami
- Surgery Department, Jazan University, Jazan 82621, Saudi Arabia;
| | - Mohamed Mahfouz
- Family and Community Medicine Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (A.A.)
| | - Amani Abdelmola
- Family and Community Medicine Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (A.A.)
| | - Ebtihal Eltyeb
- Pediatrics Department, Jazan University, Jazan 82621, Saudi Arabia
| | - Isameldin Medani
- Obstetrics and Gynecology Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (I.M.); (A.H.); (A.A.); (A.K.); (U.C.)
| | - Ghadah Maghfori
- Ministry of Health Jazan City, Jazan 45142, Saudi Arabia; (G.M.); (A.Z.)
| | - Atheer Zakri
- Ministry of Health Jazan City, Jazan 45142, Saudi Arabia; (G.M.); (A.Z.)
| | - Ahlam Hakami
- Obstetrics and Gynecology Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (I.M.); (A.H.); (A.A.); (A.K.); (U.C.)
| | - Ahmed Altraifi
- Obstetrics and Gynecology Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (I.M.); (A.H.); (A.A.); (A.K.); (U.C.)
| | - Ali Khormi
- Obstetrics and Gynecology Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (I.M.); (A.H.); (A.A.); (A.K.); (U.C.)
| | - Uma Chourasia
- Obstetrics and Gynecology Department, Jazan University, Jazan 82621, Saudi Arabia; (M.M.); (I.M.); (A.H.); (A.A.); (A.K.); (U.C.)
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Guo Y, Ding X, Wang S, Wang F, Zheng Z, Zou L. Analgesic Effect of Esketamine Combined with Tramadol for Patient-Controlled Intravenous Analgesia After Cesarean Section: A Randomized Controlled Trial. J Pain Res 2023; 16:3519-3528. [PMID: 37881234 PMCID: PMC10595208 DOI: 10.2147/jpr.s427702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose High rate of cesarean section (CS) bring challenges to analgesic management after CS. Previous studies state that adjuvant treatment with a low dose of esketamine intraoperatively could reduce postoperative pain and opioid consumption, and even prevent postpartum depression. However, few researches involve in patient-controlled intravenous analgesia (PCIA) with esketamine after CS. In this trial, we explored a new combination of esketamine with tramadol for PCIA after CS with the aim to provide a better analgesic regimen for use in the clinic. Patients and Methods 170 puerperae undergoing CS were recruited for this trial and randomly assigned into 2 groups (1:1): The control group received a formula of PCIA with butorphanol 0.1mg/kg and tramadol 400mg postoperatively, while the intervention group received a formula of PCIA with esketamine 1mg/kg and tramadol 400mg. The primary outcome was the mean numerical rating scale (NRS) scores at rest, sitting, and uterine contraction at 6 hours postoperatively. The second outcomes included the mean NRS scores at rest, sitting, and uterine contraction at 12, 24, and 48 hours postoperatively. The incidence of adverse events, postoperative sedation, postoperative sleep quality, maternal satisfaction regarding postoperative analgesia and the Edinburgh postnatal depression scale (EPDS) score were also be evaluated. Results The mean (SD) of the mean NRS scores at rest, sitting, and during uterine contraction at 6 hours postoperatively were 4.8 (0.7) points in the intervention group and 5.3 (0.5) points in the control group. The estimated mean difference between the two groups at 6 hours postoperatively was -0.5 points (95% confidence interval [CI], -0.7 to -0.3; P < 0.001). Compared with the control group, the patients in the intervention group had a significantly lower mean pain intensity at 12 and 24 hours postoperatively (-0.5 points [95% CI, -0.6 to -0.3]; P < 0.001 and -0.2 points [95% CI, -0.4 to 0]; P = 0.019 respectively). Otherwise, differences at 48 hours after surgery between the two groups were nonsignificant (0 points [95% CI, -0.2 to 0.2]; P = 0.802). The incidence of adverse events in the intervention group (11.8%) was significantly lower than in the control group (24.7%) (ratio difference -12.9, [95% CI, -24.3 to -1.5]; P = 0.029). No difference was found in postoperative sleep quality (P = 0.765), analgesic satisfaction (P= 0.818) and EPDS scores (P = 0.154) between the two groups. Conclusion In this trial, among patients undergoing CS, esketamine combined with tramadol by PCIA improved pain intensity 6 hours postoperatively compared with butorphanol combined with tramadol.
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Affiliation(s)
- Yihui Guo
- Department of Anesthesiology, The People’s Hospital of Pizhou, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Pizhou Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xue Ding
- Department of Anesthesiology, The People’s Hospital of Pizhou, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Pizhou Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Sheng Wang
- Department of Anesthesiology, The People’s Hospital of Pizhou, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Pizhou Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Fei Wang
- Department of Anesthesiology, The People’s Hospital of Pizhou, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Pizhou Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Zhongyi Zheng
- Department of Anesthesiology, The People’s Hospital of Pizhou, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Pizhou Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Lifeng Zou
- Department of Anesthesiology, The People’s Hospital of Pizhou, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Pizhou Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
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Besha A, Zemedkun A, Tadesse M, Hailu S, Mossie A, Shiferaw A, Angasa D, Adamu Y. Effects of Hyperbaric and Isobaric Bupivacaine on Hemodynamic Profiles and Block Characteristics Among Parturients Undergoing Elective Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial. J Pain Res 2023; 16:3545-3558. [PMID: 37881235 PMCID: PMC10595164 DOI: 10.2147/jpr.s428314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
Background Cesarean section (CS) is a surgical procedure where the baby is delivered through incisions made in the abdomen and uterus. Bupivacaine is a widely recognized local anesthetic available in different baricity and it is frequently used for spinal anesthesia. The baricity of bupivacaine impacts hemodynamic profiles and block characteristics. Objective To compare the effects of hyperbaric and isobaric bupivacaine on hemodynamic profiles and block characteristics among parturients undergoing elective cesarean section under spinal anesthesia at Dilla University Referral Hospital. Methods 64 pregnant mothers scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups: Group A received a dose of 12.5 mg of isobaric bupivacaine (n = 32), Group B received a dose of 12.5 mg of hyperbaric bupivacaine (n = 32). Prior to conducting the study, the necessary ethical approvals were obtained. For comparing numerical variables between the two groups, the independent Sample t-test or Mann-Whitney U-test was employed as needed. Repeated measurements were analyzed using mixed ANOVA. Categorical variables were assessed using either the chi-square test or Fisher's exact test. Statistical significance was set at P < 0.05, with a power of 90%. Results The mean Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), and Mean Arterial Blood Pressure (MAP) showed significant decrement in the group receiving isobaric spinal anesthesia compared to those receiving hyperbaric bupivacaine. The decrement was observed from the 6th to 30th minute (p<0.05). Furthermore, the hyperbaric group had a faster onset time for achieving the maximum sensory block, with a median time of 3 (1) min compared to 4 (2) mins in the isobaric group (p<0.001). Conclusion and Recommendation We conclude that hyperbaric bupivacaine provides stable intraoperative hemodynamic parameters and an earlier onset of block than isobaric bupivacaine. Therefore, we recommend clinicians to use hyperbaric bupivacaine for cesarean delivery.
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Affiliation(s)
- Aschalew Besha
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Abebayehu Zemedkun
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Muhiddin Tadesse
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Seyoum Hailu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Addisu Mossie
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Adanech Shiferaw
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Dugo Angasa
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Yayeh Adamu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Zago AC, Trettim JP, Rubin BB, Scholl CC, Coelho FT, Ulguim F, Pinheiro LMDS, de Matos MB, Pinheiro RT, Quevedo LDA. Early motor development: risk factors for delay in a population study in Southern Brazil. Rev Saude Publica 2023; 57:59. [PMID: 37878845 PMCID: PMC10519674 DOI: 10.11606/s1518-8787.2023057004991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/25/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To assess risk factors associated with motor development delay at three months of age. METHODS Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.
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Affiliation(s)
- Ana Carolina Zago
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
- Centro Universitário da Região da CampanhaBagéRSBrasilCentro Universitário da Região da Campanha. Bagé, RS, Brasil.
| | - Jéssica Puchalski Trettim
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Bárbara Borges Rubin
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Carolina Coelho Scholl
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Fernanda Teixeira Coelho
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Fernanda Ulguim
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Luísa Mendonça de Souza Pinheiro
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Mariana Bonati de Matos
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Ricardo Tavares Pinheiro
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Luciana de Avila Quevedo
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
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Mezemir R, Olayemi O, Dessie Y. Incidence, Bacterial Profile and Predictors of Surgical Site Infection After Cesarean Section in Ethiopia, A Prospective Cohort Study. Int J Womens Health 2023; 15:1547-1560. [PMID: 37854040 PMCID: PMC10581010 DOI: 10.2147/ijwh.s425632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
Background Surgical site infections (SSI) after cesarean section are common in Ethiopia and result in maternal morbidity, mortality, hospitalization, and medical costs. This study aimed to determine the incidence, bacterial profile, and associated factors of surgical site infection after cesarean section (CS) in public and private referral hospitals. Methods A prospective observational cohort study was conducted on 741 pregnant women who underwent CS from July to September 2022. Women who had CS were followed up for at least 30 days. Infected wound specimens from those who had SSIs were collected and bacteriologically analyzed. The data were analyzed with SPSS version 25. The logistic regression model assessed the relationship between the independent variable and the outcome with 95% confidence interval. Results The incidence of post-cesarean surgical site infection was 11.6% (95% Cl: 9.4, 13.6). Staphylococcus aureus was the most common bacteria in CS wounds 10 (21.2%). Two to three antenatal care visits (ANC) (AOR: 3.11, 95% CI: 1.69, 5.75), delayed antenatal booking (AOR: 6.99, 95% CI: 2.09, 23.32), membrane rupture (AOR: 2.10, 95% CI: 1.04, 4.24), multiple vaginal examinations (AOR = 4.21, 95% CI: 1.35, 6.92) and public hospitals (AOR: 11.1, 95% CI: 1.48, 45, 14) were associated with increased risk of SSI after CS, in contrary shorter hospital stays (AOR = 0.37, 95% CI: 0.15, 0.91) and transversal incisions (AOR = 0.38, 95% CI: 0.15, 0.91) were associated with lower risk SSI after CS. Conclusion The incidence of SSI after CS was high. Delayed antenatal booking, two to three antenatal visits, multiple vaginal exams, membrane rupture, vertical incision, longer postoperative hospital stays, and procedures in public hospitals were associated with increased risk of SSI after CS. Therefore, intervention programs should focus on post-discharge surveillance and identification of risk to reduce and prevent SSI after CS rate.
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Affiliation(s)
- Rahel Mezemir
- Pan African University, Life and Earth Sciences Institute (Including Health and Agriculture), Ibadan, Nigeria
- St. Paul’s Hospital Millennium Medical College, School of Nursing, Addis Ababa, Ethiopia
| | - Oladapo Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institutes, University of Ibadan, Ibadan, Nigeria
| | - Yadeta Dessie
- College of Health and Medical Sciences Haramaya University, Harar, Ethiopia
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Botea MO, Lungeanu D, Petrica A, Sandor MI, Huniadi AC, Barsac C, Marza AM, Moisa RC, Maghiar L, Botea RM, Macovei CI, Bimbo-Szuhai E. Perioperative Analgesia and Patients' Satisfaction in Spinal Anesthesia for Cesarean Section: Fentanyl Versus Morphine. J Clin Med 2023; 12:6346. [PMID: 37834990 PMCID: PMC10573232 DOI: 10.3390/jcm12196346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Perioperative analgesia for cesarean section aims to ensure the mother's comfort, facilitate a smooth surgical experience, and promote a successful recovery. One-hundred-ninety patients were enrolled in a randomized double-blind study designed to assess the quality of perioperative analgesia, level of satisfaction, and incidence of adverse reactions in elective cesarean section under spinal anesthesia when fentanyl or morphine was added to bupivacaine. Two treatment groups comprising 173 subjects were compared in the per-protocol analysis: F (fentanyl, standard dose 25 μg) and M (morphine, standard dose 100 μg). Numerical pain scores were recorded perioperatively for 72 h (both at rest and on mobilization), with overall postoperative satisfaction and analgesic-related side effects. The patients in the morphine group had significantly better pain management (Mann-Whitney U test, p < 0.001) and higher level of satisfaction (Mann-Whitney U test, p < 0.001). The latter was related to the greater need for rescue medication in the fentanyl group (OR = 4.396; p = 0.019). On the other hand, fentanyl had significantly fewer non-life-threatening side effects, such as high-intensity pruritus (Mann-Whitney U test, p < 0.001), nausea (OR = 0.324; p = 0.019), vomiting and dizziness upon first mobilization (OR = 0.256; p < 0.001). It remains for future clinical trials to help establish doses that will tilt the scale to one side or the other.
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Affiliation(s)
- Mihai O. Botea
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.O.B.); (M.I.S.)
- Pelican Clinic, Medicover Hospital, 4104869 Oradea, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alina Petrica
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.B.); (A.M.M.)
- Emergency Department, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania
| | - Mircea I. Sandor
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.O.B.); (M.I.S.)
| | - Anca C. Huniadi
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.O.B.); (M.I.S.)
- Pelican Clinic, Medicover Hospital, 4104869 Oradea, Romania
| | - Claudiu Barsac
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.B.); (A.M.M.)
- Clinic of Anaesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania
| | - Adina M. Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.B.); (A.M.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Ramona C. Moisa
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.O.B.); (M.I.S.)
| | - Laura Maghiar
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.O.B.); (M.I.S.)
| | - Raluca M. Botea
- Oradea County Clinical Emergency Hospital, 410169 Oradea, Romania
| | - Codruta I. Macovei
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.O.B.); (M.I.S.)
- Pelican Clinic, Medicover Hospital, 4104869 Oradea, Romania
| | - Erika Bimbo-Szuhai
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.O.B.); (M.I.S.)
- Pelican Clinic, Medicover Hospital, 4104869 Oradea, Romania
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Tamdoğan İ, Turunç E, Kocamanoğlu İS. Comparison of the Efficacies of Three Different Intrathecal Doses of Morphine in Achieving Postcesarean Delivery Analgesia. J Perianesth Nurs 2023; 38:717-723. [PMID: 36997388 DOI: 10.1016/j.jopan.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 03/30/2023]
Abstract
PURPOSE The objective of this study is to compare the efficacies of 3 different intrathecal doses (80, 120, and 160 mcg) of morphine in achieving postcesarean delivery analgesia and the severity of the side effects thereof. DESIGN A prospective, randomized, double-blind study. METHODS A total of 150 pregnant women between the ages of 18 and 40, with a gestational week >36, who were planned to have elective cesarean section were included in the study. Patients were randomized into 3 groups based on the dosages of intrathecal doses of morphine (80, 120, and 160 mcg) they will receive in addition to 10 mg 0.5% hyperbaric bupivacaine and 20 mcg fentanyl. Intravenous (IV) patient-controlled analgesia (PCA) prepared with fentanyl was administered to each patient after the surgery. Postoperative 24-hour total IV PCA-fentanyl consumption was recorded. The patients were evaluated for side effects such as pain, nausea-vomiting, pruritus, sedation score, and respiratory depression after the surgery. FINDINGS PCA-fentanyl consumption was significantly higher in Group 1 compared to Group 2 and 3 (P = .047). There was no significant differences between the groups in terms of nausea-vomiting scores. The pruritus scores were significantly higher in Group 3 compared to Group 1 (P = .020). The pruritus scores were significantly higher in all groups at the postoperative 8th-hour (P = .013). Respiratory depression, which would require treatment, was not observed in any patient. CONCLUSIONS Based on the study findings, it was concluded that 120 mcg intrathecal morphine provides adequate analgesia with minimal side effects in cesarean sections.
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Affiliation(s)
- İlke Tamdoğan
- Department of Anaesthesiology and Reanimation, Obstetrics and Pediatrics Training and Research Hospital, The Ministry of Health and Giresun University, Giresun, Turkey
| | - Esra Turunç
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - İsmail Serhat Kocamanoğlu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Zhou L, Zhao X, Xu D, Pang S, Mao X, Feng S, Yue Y. Placental Area in the Lower Uterine Segment, Cervical Length, and Clinical Outcome in Pregnancies With Complete Placenta Previa. J Magn Reson Imaging 2023; 58:1047-1054. [PMID: 36847772 DOI: 10.1002/jmri.28617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Complete placenta previa is associated with a higher percentage of adverse clinical outcomes and magnetic resonance imaging (MRI) is widely used in the preoperative examination of patients with placenta previa. PURPOSE To evaluate the effectiveness of the placental area in the lower uterine segment and cervical length in identifying the adverse maternal-fetal outcomes in women with complete placenta previa. STUDY TYPE Retrospective. POPULATION A total of 141 pregnant women (median age, 32; age range, 24-40 years) with complete placenta previa were examined by MRI to evaluate the uteroplacental condition. FIELD STRENGTH/SEQUENCE A 3 T with T1 -weighted imaging (T1 WI), T2 -weighted imaging (T2 WI), and half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence. ASSESSMENT The association of the placental area in the lower uterine segment and cervical length measured using MRI with the risk of massive intraoperative hemorrhage (MIH) and maternal-fetal perinatal outcomes were determined. The adverse neonatal outcomes (preterm delivery, respiratory distress syndrome [RDS], admission to neonatal intensive care unit [NICU]) were analyzed in different groups. STATISTICAL TESTS The t-test, Mann-Whitney U test, Chi-square, Fisher's exact test, and receiver operating characteristic (ROC) curve were used, and a P < 0.05 indicated a statistically significant difference. RESULTS The mean operation time, intraoperative blood loss, and intraoperative blood transfusing were significantly higher in patients with large placental area and short cervix than in patients with the small placental area and long cervix, respectively. The incidence of adverse neonatal outcomes was significantly higher in the large placenta area group and short cervix group than in the small placenta group area and long cervix group, respectively, such as preterm delivery, RDS, and NICU. By combining placental area with cervical length sensitivity and specificity increased to 93% and 92%, respectively, for the identification of MIH > 2000 mL with area under the receiver operating curve (AUC) 0.941. DATA CONCLUSION Large placental area and short cervical length may be associated with a high risk of MIH and adverse maternal-fetal perinatal outcomes in patients with complete placenta previa. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE 2.
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Affiliation(s)
- Liping Zhou
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Xuepiao Zhao
- Department of Obstetrics and Gynecology, The Affiliated SuQian first people's Hospital of Nanjing Medical University, SuQian, Jiangsu, China
| | - Duo Xu
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Suhua Pang
- Department of Obstetrics and Gynecology, The Affiliated SuQian first people's Hospital of Nanjing Medical University, SuQian, Jiangsu, China
| | - Xiuzhen Mao
- Department of Obstetrics and Gynecology, The Affiliated SuQian first people's Hospital of Nanjing Medical University, SuQian, Jiangsu, China
| | - Shixiang Feng
- Department of Obstetrics and Gynecology, The Affiliated SuQian first people's Hospital of Nanjing Medical University, SuQian, Jiangsu, China
| | - Yongfei Yue
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
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134
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Hasan SH, Haji Qadir R, Mohammed HN. Fentanyl Versus Ondansetron for Shivering Prevention in Cesarean Section: A Comparative Study. Cureus 2023; 15:e46817. [PMID: 37954712 PMCID: PMC10636264 DOI: 10.7759/cureus.46817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND PURPOSE The incidence of postoperative shivering (PS) following intrathecal anesthesia is a common complication, with potential negative impacts on patient outcomes. This study aims to evaluate the effectiveness of intrathecal fentanyl versus intravenous ondansetron in preventing post-spinal anesthesia shivering in cesarean section patients. EXPERIMENTAL APPROACH A randomized controlled trial was conducted from July 2021 to April 2023, involving pregnant women scheduled for cesarean section under intrathecal anesthesia. The participants were divided into three groups: group F received intrathecal fentanyl (15 μg) with spinal anesthesia, while group O received intravenous ondansetron (8 mg) added to the usual saline solution. The control group (group C) received only intravenous fluid before spinal anesthesia and intrathecal bupivacaine without fentanyl. Shivering occurrences were observed and recorded during the procedure. KEY RESULTS The incidence of shivering was significantly lower in the fentanyl and ondansetron groups compared to the control group (p=0.0123). Both intrathecal fentanyl and intravenous ondansetron administration showed effectiveness in reducing shivering during spinal anesthesia. CONCLUSION The administration of intrathecal fentanyl and intravenous ondansetron significantly reduced the occurrence of shivering during spinal anesthesia in cesarean section patients. This study contributes to advancing knowledge in the field by providing evidence of the preventative effects of these medications on post-spinal anesthesia shivering.
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Affiliation(s)
- Shaimaa H Hasan
- Anesthesia Department, College of Health Sciences, University of Duhok, Duhok, IRQ
| | - Reabar Haji Qadir
- Anesthesia Department, College of Health Sciences, University of Duhok, Duhok, IRQ
| | - Haider N Mohammed
- Anesthesia Department, College of Health Sciences, University of Duhok, Duhok, IRQ
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135
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Alhashim ZG, Alzayer ZA, Alensaif AA, Al Darwish HA, Almomen MA, Alnsaif JM. Blood Transfusion Predictors in Cesarean Sections for Pregnancies With Placenta Accreta and Placenta Previa: A Monocentric Tertiary Experience. Cureus 2023; 15:e47648. [PMID: 38021778 PMCID: PMC10668624 DOI: 10.7759/cureus.47648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The objective of this study was to analyze the possible predictors of the need for intraoperative blood transfusion in cesarean sections for pregnancies with abnormal placentation. Methods This was a retrospective study based on data from patients' electronic medical records. A total of 44 patients who were diagnosed as placenta previa or placenta accreta who delivered through cesarean section at King Fahad University Hospital, Al-Khobar, Saudi Arabia, from June 1997 to January 2021 were included in the study. Seventeen patients received intra-operative blood transfusion. The other 27 patients did not receive any blood transfusions and served as controls. Demographic data, antepartum profiles, and obstetric history were compared between the two groups. Univariate analysis and multivariate logistic regression were used to analyze the correlations between related risk factors and the need for intraoperative blood transfusion. Results Univariate analysis (χ2 test) has shown multiple factors that correlated significantly (p<0.05) with blood transfusion requirement. These factors include the presence of placenta accreta, general anesthesia, preoperative hematocrit < 33%, preoperative hemoglobin ≤ 10 g/dL, and preterm delivery at 35-36 weeks of gestation. None of these factors showed any statistical significance in multivariate analysis (logistic regression). Conclusion General anesthesia, placenta accreta, delivery at 35-36 weeks of gestation, and pre-operative anemia are possible risk factors for blood transfusion during cesarean sections for abnormal placentation. Identifying patients at increased risk is necessary to optimize pre-operative and intraoperative management.
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Affiliation(s)
- Zainab G Alhashim
- Department of Anesthesiology, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, SAU
- Department of Anesthesiology, King Fahad University Hospital, Al-Khobar, SAU
| | - Zainab A Alzayer
- Department of Anesthesiology, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, SAU
- Department of Anesthesiology, King Fahad University Hospital, Al-Khobar, SAU
| | - Alwi A Alensaif
- College of Medicine, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, SAU
| | - Hussain A Al Darwish
- College of Medicine, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, SAU
| | - Mohammed A Almomen
- College of Medicine, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, SAU
| | - Jawad M Alnsaif
- College of Medicine, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, SAU
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136
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Özmen N, Bayraktar E. Does Preoperative Pain Belief Affect Postoperative Pain and Breastfeeding? J Perianesth Nurs 2023; 38:e8-e14. [PMID: 37354144 DOI: 10.1016/j.jopan.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 01/02/2023] [Accepted: 01/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE This research was carried out to determine the relationship between pain belief of women who experienced cesarean section for the first time and their postcesarean pain and breastfeeding self-efficacy levels. DESIGN The research is a descriptive study. METHODS The study was conducted with 144 patients who had not undergone any surgical operation and had their first cesarean section. Data were collected with an introductory information form, pain beliefs questionnaire (PBQ), visual analog scale (VAS), and breastfeeding self-efficacy scale (BSES). FINDINGS The patients' PBQ organic belief score (3.06 ± 0.61) was higher than their PBQ psychological belief score (1.87 ± 0.83), and their pain beliefs were based on an organic cause. The postcesarean section pain of the women was moderate-severe (6.75 ± 1.71), breastfeeding self-efficacy levels were high and sufficient (57.88 ± 4.86), and their pain beliefs were of organic origin. There was no significant relationship between patients' pain beliefs and postcesarean pain and breastfeeding self-efficacy levels. CONCLUSIONS The results of our study indicate that working status, income status, and chronic illness were associated with patients' pain beliefs, but we observed no relationship between pain beliefs and postcesarean pain and breastfeeding self-efficacy levels.
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Affiliation(s)
- Nurten Özmen
- Department of Surgery Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Evrim Bayraktar
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
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137
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Ba-Shammakh SA, Al-Samnah A, Zidan MK, Abdallah HM. Navigating the Dry Tap Conundrum: A Successful Spinal Anesthesia for a Cesarean Section. Cureus 2023; 15:e46726. [PMID: 38021515 PMCID: PMC10631228 DOI: 10.7759/cureus.46726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
A "dry tap" in spinal anesthesia is characterized by the lack of cerebrospinal fluid (CSF) after needle insertion and poses unique challenges for anesthesiologists. We present an uncommon case of a 30-year-old female undergoing a cesarean section who experienced this situation. Despite the absence of CSF after several attempts, the patient's sensory alterations post-anesthesia administration confirmed intrathecal placement. This successful administration of spinal anesthesia in the face of a dry tap emphasizes the value of clinical observation and adaptability, offering an innovative perspective on addressing such rare occurrences.
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Affiliation(s)
| | - Ahmad Al-Samnah
- Department of Anesthesiology and Reanimation, The Islamic Hospital, Amman, JOR
| | - Mohammad K Zidan
- Department of Anesthesiology and Reanimation, The Islamic Hospital, Amman, JOR
| | - Haitham M Abdallah
- Department of Anesthesiology and Reanimation, The Islamic Hospital, Amman, JOR
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138
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Niu X, Gong Y, Luo X. Case report: Successful pregnancy complicated with non-cirrhotic portal hypertension in a lady who suffered from postpartum hemorrhage previously. Medicine (Baltimore) 2023; 102:e34659. [PMID: 37773790 PMCID: PMC10545017 DOI: 10.1097/md.0000000000034659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/19/2023] [Indexed: 10/01/2023] Open
Abstract
RATIONALE Non-cirrhotic portal hypertension (NCPH) is characterized by the absence of cirrhotic modification of the liver and the patency of the portal and hepatic veins. When compared to the general population, NCPH is associated with an increased risk of maternal and perinatal morbidity and mortality during pregnancy. NCPH was present in the majority (74.1%) of pregnant women with portal hypertension. One (25%) out of every 4 pregnancies was complicated by variceal hemorrhage while pregnant. So far, there is still no consensus in the world about the treatment of this rare condition. PATIENT CONCERNS We have specifically illustrated a rare instance where the patient was diagnosed with NCPH and hypersplenism at the age of 8 and experienced a 3 L massive hemorrhage during labor induction as a result of her first pregnancy loss due to hypertension. DIAGNOSES AND INTERVENTIONS The diagnosis of threatened preterm labor with cervical dilatation, gestational diabetes mellitus, massive splenomegaly with hypersplenism, portal vein hypertension, and parenchymal damage of kidney with impaired renal function led to the cesarean delivery of the second pregnancy at 29+3 weeks gestation without splenectomy after been evaluated by multispecialty team. OUTCOMES She and her child were both in generally good condition 3 months after the operation. LESSONS Preconception counseling, ongoing follow-up, and monitoring are crucial in pregnant women with NCPH. A multidisciplinary team approach, with timely intervention and intensive monitoring, can help achieve optimal maternal-perinatal outcomes in pregnancies complicated with portal hypertension. Our case provided a successful treatment, but more guidelines for the management of NCPH are needed.
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Affiliation(s)
- Xiaoxi Niu
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Yanmin Gong
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Xia Luo
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, Jinan, Shandong, China
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139
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Asgarlou Z, Mohammadian ED, Houshmandi S, Mohseni M, Sheyklo SG, Moosavi A, Ahmadi S. Comparative Efficacy of Different Classes of Antiemetic Medications for the Prevention of Nausea and Vomiting in Cesarean Section: A Network Meta-Analysis. Int J Prev Med 2023; 14:116. [PMID: 38264568 PMCID: PMC10803683 DOI: 10.4103/ijpvm.ijpvm_250_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2024] Open
Abstract
Background Antiemetic medications have been associated with the prevention of nausea and vomiting in cesarean section, although less is known about the comparative efficacy of different medication classes. Methods We conducted a systematic review with network meta-analyses to compare and rank antiemetic medication classes (5-HT3 receptor antagonists, dopamine receptor antagonists, corticosteroids, antihistamines, anticholinergic agents, sedatives, and opioid antagonists or partial agonists) in terms of preventing intra- and postoperative nausea and vomiting among patients undergoing cesarean section. We included all randomized controlled trials (RCTs) that evaluated any antiemetic medication classes' treatment for target outcomes. Network meta-analysis was conducted with a frequentist approach using the R netmeta package. A total of 58 trials were included (6,665 women undergoing cesarean section; mean age, 28.1 years). Results: Compared with placebo, all interventions reduced the odds of intraoperative nausea (except antihistamines), intraoperative vomiting (except antihistamines), postoperative nausea (except anticholinergic agents and opioid antagonists), and postoperative vomiting (except opioid antagonists). In terms of intraoperative nausea and both intra- and postoperative vomiting, sedatives ranked first among other medication classes. Conclusions The relative effect sizes for various classes of antiemetic medication in preventing nausea and vomiting in the cesarean section were modeled using the principles of network meta-analysis which may facilitate informed clinical decision-making.
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Affiliation(s)
- Zoleykha Asgarlou
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Sousan Houshmandi
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Mohseni
- Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sepideh Gareh Sheyklo
- Department of Obstetrics and Gynecology, Dezful University of Medical Sciences, Dezful, Iran
| | - Ahmad Moosavi
- Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Shiler Ahmadi
- Department of Nursing and Midwifery, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
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140
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Liu Y, Xiang J, Ren J, Gu L, Wang Y, Liu X, Wen J. Factors affecting gastrointestinal function recovery after cesarean section among Chinese mothers: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35200. [PMID: 37746982 PMCID: PMC10519505 DOI: 10.1097/md.0000000000035200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
This study was conducted to explore the influencing factors of gastrointestinal function recovery after cesarean section (CS), which could provide a reference for the enhanced recovery after surgery in obstetrics. This is a cross-sectional survey on Chinese mothers receiving CS. The participants's socio-demographic characteristics, perioperative diet, medical condition and gastrointestinal function after surgery were collected by a self-designed questionnaire. Binary logistic regression analysis was employed to explore the influencing factors of gastrointestinal function recovery after CS. A total of 1501 (94.76%) valid questionnaires were collected. The first borborygmus was 2.21 ± 0.63 hours, and the first anal exhaust was 35.73 ± 14.85 hours after the CS. The incidence of abdominal distension and intestinal obstruction were 15.1% and 0.7%, respectively. The parity, type of CS, 2-hours bleeding after surgery, time of first meal after surgery, whether taking peppermint water after surgery were the independent influencing factors for gastrointestinal function recovery after CS. We should pay more attention to the mothers with scarred uterus, manage the labor process strictly, and reduce 2-hours bleeding after surgery. The mothers with CS should also be encouraged to eat early and take peppermint water to promote intestinal peristalsis actively.
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Affiliation(s)
- Yi Liu
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jie Xiang
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jianhua Ren
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Li Gu
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yu Wang
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiuping Liu
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jiao Wen
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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141
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Li Y, Shuai B, Huang H. Prophylactic intravenous norepinephrine for the prevention of hypotension during spinal anesthesia for elective cesarean section: a systematic review and dose-response meta-analysis of randomized controlled trials. Front Pharmacol 2023; 14:1247214. [PMID: 37795034 PMCID: PMC10546307 DOI: 10.3389/fphar.2023.1247214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction: In this study, we aimed to evaluate the potential dose-response relationship between prophylactic norepinephrine (NE) infusion rates and the risks of hypotension during cesarean section following spinal anesthesia. Methods: Randomized controlled trials with two or more NE doses for post-spinal hypotension prophylaxis during cesarean section were systematically searched in the MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and US Clinical Trials Registry databases until 31 July 2022. The primary outcome was the relative risk of maternal hypotension with different NE regimens (infusion rates or bolus doses). Secondary outcomes included the relative risks of maternal and fetal adverse events with different NE regimens. Results: Ten studies with 1,144 parturients were included for final analysis using restricted cubic splines and random-effects dose-response meta-analysis models. A significant dose-response relationship existed between NE infusion rates and the relative risks of maternal hypotension. Every 0.01 μg/kg/min increment in the NE infusion rate was associated with a 14% decrease in the incidence of post-spinal hypotension. ED50 and ED95 of NE infusion rates for post-spinal hypotension prophylaxis were estimated to be 0.046 (95% CI from 0.032 to 0.085) and 0.2 (95% CI from 0.14 to 0.37) μg/kg/min, respectively. However, a higher NE infusion rate was associated with a higher incidence of maternal hypertension. Conclusion: An increased NE infusion rate was associated with a decreased incidence of post-spinal hypotension but an increased incidence of hypertension. Therefore, 0.07 μg/kg/min was recommended as the initial NE infusion rate for clinical practice, as it was associated with the lowest risk of physician intervention for unstable hemodynamics after spinal anesthesia for cesarean delivery. Systematic Review Registration: (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=349934), identifier (CRD42022349934).
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Affiliation(s)
- Yuan Li
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital of Sichuan University, Sichuan University, Chengdu, China
| | - Bingxing Shuai
- Department of Medical Affairs, West China Hospital, Sichuan University, Chengdu, China
| | - Han Huang
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital of Sichuan University, Sichuan University, Chengdu, China
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142
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Hansu K. A comparison of the rates of and indications for cesarean delivery between Syrian refugee women and Turkish women. Rev Assoc Med Bras (1992) 2023; 69:e20230326. [PMID: 37729365 PMCID: PMC10508940 DOI: 10.1590/1806-9282.20230326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/08/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of this study was to compare the rates of and indications for cesarean delivery among Syrian refugee women and local Turkish women. METHODS The study included 74,864 pregnant women, of whom 52,145 were Turkish and 22,719 were Syrian refugee women and who gave birth at our hospital between January 2013 and December 2021. In this study, the pregnant women were divided into two groups: Syrian refugee women and Turkish women, and primary cesarean delivery rates were calculated separately for each group. Cesarean delivery rates for Syrian refugee women and Turkish women were compared separately for each year. Indications for cesarean delivery were determined separately for each group and compared between the groups. RESULTS The overall cesarean delivery rate was 56% among Turkish women and 32% among Syrian women (p<0.05). The primary cesarean delivery rate was 18.4% for local Turkish women versus 10.7% among Syrian refugee women (p<0.05). The most common indication for cesarean delivery among both Syrian refugee women and local Turkish women was previous cesarean delivery, followed by acute fetal distress and cephalopelvic disproportion. CONCLUSION Indications for cesarean delivery were similar for Syrian refugee women and local Turkish women, but both overall and primary cesarean delivery rates were higher among local Turkish women compared with Syrian refugee women.
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Affiliation(s)
- Kemal Hansu
- Necip Fazil City Hospital, Department of Obstetrics and Gynecology – Kahramanmaraş, Turkey
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143
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Liu S, Liu S, Gu D, Zhao X, Zhang H, Deng C, Gu Y. Exploring the Effect of Pain Sensitive Questionnaire on Guiding Intravenous Analgesia After Cesarean Section: A Randomised Double Blind Controlled Trial. J Pain Res 2023; 16:3185-3196. [PMID: 37744183 PMCID: PMC10516306 DOI: 10.2147/jpr.s412131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Objective This study investigates the effect of the Pain Sensitivity Questionnaire (PSQ) in guiding patient controlled intravenous analgesia (PCIA) on postoperative analgesia in women undergoing cesarean section. Methods A total of 160 women who were to undergo a cesarean section under combined spinal and epidural anaesthesia were included in this study. Women with a preoperative PSQ <4 were randomly divided into a low pain-sensitive control group (LC group), and a low pain-sensitive observation group (LO group), and women with preoperative PSQ >6 were randomly divided into a high pain-sensitive control group (HC group) and a high pain-sensitive observation group (HO group). After the surgery, patients received the pump butorphanol concentration was 3.5 µg·kg-1·h-1 in the LC and HC groups, 3.0 µg·kg-1·h-1 in the LO group and 4.0 µg·kg-1·h-1 in the HO group.To compare the analgesic effects of postoperative PCIA and postoperative recovery in women. Results Wound pain and uterine contraction pain VAS scores at rest and activity were significantly lower in the LC group than in the LO group at 4 and 8 h postoperatively (P<0.05). Similarly, wound pain and uterine contraction pain VAS scores at rest and activity were significantly lower in the HO group than in the HC group at 8, 12, and 24 h postoperatively (P<0.05). The Ramsay scores were significantly higher in the LC than in the LO groups at 4, 8, 12, 24, and 48 h postoperatively (P<0.05), but there was no statistically significant difference between the Ramsay scores in the HC group and the HO group. There was no statistical difference in any of the post-operative recoveries (P>0.05). Conclusion Compared to the weight-based postoperative PCIA, the PSQ-based postoperative PCIA has better analgesic effects and can improve maternal satisfaction with postoperative analgesia.
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Affiliation(s)
- Shuxin Liu
- Department of Anesthesiology, First Affiliated Hospital, Shihezi University, Shihezi, People’s Republic of China
| | - Siqi Liu
- Department of Anesthesiology, First Affiliated Hospital, Shihezi University, Shihezi, People’s Republic of China
| | - Dengfeng Gu
- Department of Anesthesiology, First Affiliated Hospital, Shihezi University, Shihezi, People’s Republic of China
| | - Xiaona Zhao
- Department of Obstetrics, First Affiliated Hospital, Shihezi University, Shihezi, People’s Republic of China
| | - Hong Zhang
- Department of Anesthesiology, First Affiliated Hospital, Shihezi University, Shihezi, People’s Republic of China
| | - Chao Deng
- Department of Anesthesiology, First Affiliated Hospital, Shihezi University, Shihezi, People’s Republic of China
| | - Yajuan Gu
- Department of Obstetrics, First Affiliated Hospital, Shihezi University, Shihezi, People’s Republic of China
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Martin-Alonso R, Rolle V, Akolekar R, de Paco Matallana C, Fernández-Buhigas I, Sánchez-Camps MI, Giacchino T, Rodríguez-Fernández M, Blanco-Carnero JE, Santacruz B, Gil MM. Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies. Medicina (Kaunas) 2023; 59:1670. [PMID: 37763790 PMCID: PMC10535994 DOI: 10.3390/medicina59091670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40-42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes.
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Affiliation(s)
- Raquel Martin-Alonso
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Valeria Rolle
- Statistics and Data Management Unit, iMaterna Foundation, Alcalá de Henares, 28806 Madrid, Spain
- Facultad de Estudios Estadísticos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Gillingham M75NY, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham CT11QU, UK
| | - Catalina de Paco Matallana
- Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, 30120 Murcia, Spain
| | - Irene Fernández-Buhigas
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
| | | | - Tara Giacchino
- Facultad de Estudios Estadísticos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Miguel Rodríguez-Fernández
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
| | | | - Belén Santacruz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - María M. Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
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145
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Ozden MGN, Koruk S, Collak Z, Panik N. Comparison of the effects of general and spinal anesthesia for cesarean delivery on maternal and fetal outcomes: A retrospective analysis of data. North Clin Istanb 2023; 10:575-582. [PMID: 37829746 PMCID: PMC10565739 DOI: 10.14744/nci.2023.25593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE General or single-shut spinal anesthesia (SA) is applied for cesarean section and both methods of anesthesia have different effects on the mother and newborn. This retrospective study, in which 1-year data were analyzed, was aimed to examine the effects of general or SA on maternal and neonatal outcomes. METHODS Anesthesia technique, mother's age, gestational age, number of pregnancies, previous cesarean delivery number, maternal complications, and indications for cesarean delivery were analyzed in 883 cesarean deliveries. In addition, weight and Apgar scores of newborn and umbilical cord blood gas values were examined. RESULTS Neonatal intensive care need was higher in the general anesthesia (GA) group, Apgar scores were higher in the SA group, but neonatal mortality was similar. The umbilical cord Ph and lactate were lower; PCO2 values were higher in the GA group. Neonatal weight, mother's age, gestational age, and Apgar scores were predictive for neonatal mortality, but anesthesia technique was not. CONCLUSION While umbilical cord blood gas values were less affected and the need for neonatal intensive care was lower with SA, we believe that both anesthesia methods can be used safely for mother and neonatal in cesarean anesthesia considering maternal and neonatal morbidity and mortality.
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Affiliation(s)
- Mesure Gul Nihan Ozden
- Department of Anesthesiology and Reanimation, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Senem Koruk
- Department of Anesthesiology and Reanimation, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Zeynep Collak
- Department of Anesthesiology and Reanimation, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye
| | - Nur Panik
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Bursa, Turkiye
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146
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Birinci Ş, Parpucu ÜM. When a caesarean section is necessary: Analysis of cesarean sections performed in the Republic of Turkey in 2022 in accordance with the World Health Organization Multi-Country Research Guidelines. Turk J Obstet Gynecol 2023; 20:184-190. [PMID: 37667478 PMCID: PMC10478727 DOI: 10.4274/tjod.galenos.2023.35919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 09/06/2023] Open
Abstract
Objective The aim of our study, in light of the World Health Organization Multi-Country Survey (WHO-MCS) data examining the data of the Ministry of Health for the year 2022, comparing the cesarean sections (C/S) performed in the Republic of Turkey (TR) with the WHO-MCS data, and comparing the number of cesarean sections applied more than the reference values. Materials and Methods According to the database of the Turkish Ministry of Health, in 2022, 1166175 deliveries took place in the Republic of Turkey, and 706370 (60.5%) cesarean section deliveries were recorded as 365764 (51%) primary C/S. Using the Ministry of Health registration system based on the Robson classification. Results The number and rate of C/S operations performed per birth in 2022 in TR (n=706370; 60.50%) were found to be significantly higher when compared to the number and rate of C/S on a global scale (n=246062; 21.10%), (p<0.001). When cesarean section operations performed in the Ministry of Health hospitals, private institutions, foundation universities, public universities and other public unit hospitals were compared with WHO MCS reference values and C/S ratios, 44.2% versus 24.7% (p=0.05), versus 77.4%, versus 34.2% (p<0.001), 74.3% versus 29.5% (p<0.001), 75% versus 35.8% (p<0.001), 69.3% versus 35.9% (p<0.001). Conclusion The amount of cesarean sections performed according to the total number of births in the Turkish Republic is relatively high and its cost nearly 1 billion 750 million TL.
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Affiliation(s)
| | - Ümit Murat Parpucu
- University of Health Sciences Turkey, Vocational School of Health, İstanbul, Turkey
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147
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Wu DM, Zhu L, Lin T, Chen S, Wu SS, Lin N. The Application Value of Contrast-Enhanced Ultrasonography in Assessing the Efficacy of Ultrasound-Guided Lauromacrogol Injections in Cesarean Scar Pregnancies. J Ultrasound Med 2023; 42:2125-2133. [PMID: 37129166 DOI: 10.1002/jum.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To investigate the application value of contrast-enhanced ultrasonography (CEUS) in ultrasound-guided lauromacrogol injections in patients with cesarean scar pregnancies (CSP). METHODS A total of 31 patients diagnosed with CSP, who underwent an ultrasound-guided lauromacrogol injection + curettage in our hospital between February 2019 and December 2020 and had a complete recovery confirmed by a postoperative ultrasound review and serum β-human chorionic gonadotropin (β-hCG) assay, were enrolled as the study subjects. According to the volume of intraoperative blood loss and the duration of postoperative vaginal bleeding, the patients were divided into two groups, with 19 in the significantly effective group (Group A) and 12 in the effective group (Group B). The recorded clinical data, including age, duration of amenorrhea, number of pregnancies, number of deliveries, time since last cesarean delivery, number of cesarean deliveries, and preoperative serum β-hCG levels, were retrospectively analyzed. The morphological indicators in CEUS before the lauromacrogol injection, as well as immediately and 12-24 hours after the injection, were compared between the groups. RESULTS In Group A, the post-injection CEUS showed no enhancement, single strip enhancement, and sparse punctate enhancement, while in Group B, it showed a more irregular ring and local patch enhancement. In addition, the number of cases where the CEUS showed no enhancement 12-24 hours after the injection was more than that of the immediate CEUS after the injection. In Group A, four (21.1%) cases showed a single strip-like blood flow on the immediate postoperative CEUS, four (21.1%) cases showed a sparsely dotted blood flow on the immediate postoperative CEUS, and three cases turned into no enhancement 12-24 hours after the injection. A total of four cases in Group B showed that the contrast enhancement range 12-24 hours after the injection was reduced compared with that of the immediate contrast after the injection. CONCLUSION Contrast-enhanced ultrasonography can guide the location selection of the lauromacrogol injection in patients with CSP, and its postoperative morphological indicators can adequately predict the therapeutic effect after curettage and guide clinical management.
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Affiliation(s)
- Dao-Ming Wu
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Lin Zhu
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Tan Lin
- Department of Obstetrics and Gynecology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Song-Song Wu
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ning Lin
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
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148
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Lin R, DiCenzo N, Rosen T. Cesarean scar ectopic pregnancy: nuances in diagnosis and treatment. Fertil Steril 2023; 120:563-572. [PMID: 37506758 DOI: 10.1016/j.fertnstert.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
A cesarean scar ectopic pregnancy (CSEP) occurs when the embryo implants on the scar of a previous cesarean delivery. The number of births delivered by cesarean section has climbed by 50% over the last decade, from a nadir of 20.7% in 1996 to 32.1% in 2021. As a result, the incidence of CSEP has also increased. Because CSEP may cause serious morbidity such as life-threatening hemorrhage, uterine rupture, placental accreta spectrum, hysterectomy, and even mortality, accurate diagnosis and appropriate management of this condition are essential. This review focuses on the etiology, incidence, clinical diagnosis, and management of CSEPs.
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Affiliation(s)
- Ruby Lin
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | - Natalie DiCenzo
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Todd Rosen
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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149
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Muto M, Kurokawa Y, Horinouchi T, Yokomine M, Yoshizato T, Tsuda N. Unraveling the enigma: A case of dynamic morphological changes in the niche at 25 weeks of gestation recapitulating the ontogenesis of uterine scar dehiscence. J Clin Ultrasound 2023; 51:1179-1181. [PMID: 37571810 DOI: 10.1002/jcu.23534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
We present the first report of a case with a peculiar configurational change in the lower uterine segment detected during transvaginal ultrasonography observation over a short period of time at 25 weeks of gestation, predicting the presence of uterine scar dehiscence at term.
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Affiliation(s)
- Megumi Muto
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Yusuke Kurokawa
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Takashi Horinouchi
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Masato Yokomine
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Toshiyuki Yoshizato
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Naotake Tsuda
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
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150
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Alshami A, Alkharat B, Alwattar Z, Safadi MF. Pyogenic Spondylodiscitis Following Nonspinal Cesarean Section. Cureus 2023; 15:e45966. [PMID: 37900374 PMCID: PMC10600641 DOI: 10.7759/cureus.45966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Pyogenic spondylodiscitis is an uncommon bacterial infection of the intervertebral disc and the vertebral endplates. It usually affects elderly patients with comorbidities but may be also seen after surgical procedures in young patients, mostly after spinal interventions and genitourinary procedures. This article describes a rare case of pyogenic spondylodiscitis in a young female patient after a cesarean section without spinal anesthesia. The patient presented with a three-month history of lower back pain, and the inflammatory markers were elevated. The magnetic resonance imaging showed the involvement of the L5-S1 disc space and the adjacent vertebral bodies. The diagnosis was confirmed with needle aspiration of purulent material. The patient was treated with antibiotics for a total of six weeks. After a follow-up of about one year, the patient showed slight degenerative vertebral changes with no signs of residual infection. This case highlights the importance of the early recognition of pyogenic spondylodiscitis as one cause of postoperative back pain after urogenital procedures, even without spinal anesthesia. Only a few similar cases were reported in the literature.
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Affiliation(s)
- Amani Alshami
- Rheumatology Department, Al-Badr International Hospital, Ibb, YEM
| | - Banan Alkharat
- Infectious Disease Department, Al-Mowasat University Hospital, Damascus University, Damascus, SYR
| | - Zeina Alwattar
- Internal Medicine Department, Al Razi Hospital, Homs, SYR
| | - Mhd Firas Safadi
- General and Visceral Surgery Department, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, DEU
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