Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study

Maternal hypothermia during elective caesarean delivery: A prospective observational study

BACKGROUND

Patients undergoing caesarean delivery are at risk of developing unintended perioperative hypothermia, defined as a core temperature <36.0°C. Most previous studies of core temperature in caesarean delivery patients have not been conducted with accurate measurements for the complete perioperative period. Therefore, we conducted a prospective observational study to identify the incidence and duration of pre- and post-operative maternal hypothermia with a high accuracy continuous temperature monitoring system.

METHODS

Women ≥18 years old presenting for elective caesarean delivery under spinal anaesthesia were invited to participate in the study. The primary outcomes were the incidence and duration of perioperative maternal hypothermia (<36.0°C). Maternal core temperatures were measured with the non-invasive zero-heat-flux thermometer (Bair Hugger Temperature Monitoring System, 3M) throughout the perioperative course.

RESULTS

A total of 40 participants were recruited to the study. The incidence of perioperative hypothermia was 32.5%, with a duration of 77 ± 40 min (mean ± standard deviation). The hypothermic patients had similar core temperature as the normothermic patients at baseline preoperatively, but significantly lower temperature at operating room arrival and during the remaining study period. Forty percent of all patients reported thermal discomfort and felt cold on admission to post anaesthesia care unit, whereas 33% had shivering. Neither thermal discomfort nor shivering were associated with hypothermia.

CONCLUSION

In the present study almost a third of the women undergoing elective caesarean delivery developed perioperative hypothermia with a core temperature <36.0°C. The mean duration of maternal hypothermia was 77 min, lasting well into the postoperative period for many patients. These data should remind healthcare professionals of the importance of measuring core temperature in all phases of the perioperative setting and to consider optimal warming measures to avoid and treat hypothermia.

Effect of Low-Frequency Electric Pulse Technique Combined with Carboprost Methylate Suppositories on Recovery of Gastrointestinal Function and Postoperative Complications of Patients with Scarred Uterus Undergoing Secondary Cesarean Section

The study aims to explore the effect of low-frequency electric pulse technique combined with carboprost methylate suppositories on recovery of gastrointestinal function and postoperative complications of patients with scarred uterus undergoing secondary cesarean section (C-section). The clinical data of 120 patients with scarred uterus undergoing secondary C-section treated in our hospital from February 2019 to February 2020 were retrospectively analyzed, and the patients were equally divided into experimental and control groups according to their admission order, where each group included 60 patients. After the operation, patients in the control group received routine nursing and conducted breastfeeding, and carboprost methylate suppositories were used for postoperative hemostasis. Those in the experimental group received low-frequency electric pulse technique for comprehensive treatment to compare their coagulation function indicators, recovery of gastrointestinal function, incidence rates of postoperative complications, and involution of uterus. No significant between-group differences in patients' general information such as gestational weeks, gravidity, and number of times receiving C-section were observed (P > 0.05). Compared with the control group after the operation, patients in the experimental group obtained significantly better coagulation function indicators (P < 0.001) and presented better gastrointestinal function recovery (P < 0.001), significantly lower incidence rates of postpartum hemorrhage, retention of urine, deep venous thrombosis of lower limb, rupture of uterus, and endometrial cavity fluid (P < 0.05), and significantly better involution of uterus (P < 0.001). In conclusion, combining low-frequency electric pulse technique with carboprost methylate suppositories can lower the incidence rates of postoperative complications for patients with scarred uterus undergoing secondary C-section, improve their coagulation function, promote the recovery of gastrointestinal function, and present the desirable involution of uterus, which should be promoted in practice.

Forced-air warming and continuous core temperature monitoring with zero-heat-flux thermometry during cesarean section: a retrospective observational cohort study

Background

Over 30% of parturients undergoing spinal anesthesia for cesarean section become intraoperatively hypothermic. This study assessed the magnitude of hypothermic insult in parturients and newborns using continuous, high-resolution thermometry and evaluated the efficiency of intraoperative forced-air warming for prevention of hypothermia.

Methods

One hundred and eleven parturients admitted for elective or emergency cesarean section under spinal anesthesia with newborn bonding over a 5-month period were included in this retrospective observational cohort study. Patients were divided into two groups: the passive insulation group, who received no active warming, and the active warming group, who received convective warming through an underbody blanket. Core body temperature was continuously monitored by zero-heat-flux thermometry and automatically recorded by data-loggers. The primary outcome was the incidence of hypothermia in the operating and recovery room. Neonatal outcomes were also analyzed.

Results

The patients in the passive insulation group had significantly lower temperatures in the operating room compared to the actively warmed group (36.4°C vs. 36.6°C, p = 0.005), including temperature at skin closure (36.5°C vs. 36.7°C, p = 0.017). The temperature of the newborns after discharge from the postanesthetic care unit was lower in the passive insulation group (36.7°C vs. 37.0°C, p = 0.002); thirteen (15%) of the newborns were hypothermic, compared to three (4%) in the active warming group (p < 0.01).

Conclusion

Forced-air warming decreases perioperative hypothermia in parturients undergoing cesarean section but does not entirely prevent hypothermia in newborns while bonding. Therefore, it can be effectively used for cesarean section, but special attention should be given to neonates.

Maternal and fetal hypothermia: more preventive compliance is required for a mother and her fetus while undergoing cesarean delivery; a quality improvement review

OBJECTIVE

Cesarean delivery is common, involves two patients, has numerous multi-disciplinary health care providers involved in the delivery management, but has variable levels of anesthesia and health services implementation for decreasing maternal hypothermia and the maternal and neonatal morbidity (and mortality). Limited implementation for either of the ERAS-CD or the ERAC guidelines, for inadvertent or preventive maternal hypothermia, is likely to be occurring on labor delivery floors. This Quality Improvement (QI) review focuses on cesarean delivery and maternal hypothermia.

METHODS

This quality and safety initiative used SQUIRE 2.0 methodology and concurrent PubMed searches to identify systematic review, meta-analysis, topic directed studies, additional published cohorts in the topic area not included in SR/MA, limited case reports that had specific clinical outcomes related to maternal hypothermia and fetal effects.

RESULTS

Two quality and safety improvement guidelines have defined the hypothermia activity element differently, with ERAS-CD recommending to prevent hypothermia, while ERAC recommending to maintain normothermia. The peer-reviewed literature indicates that the knowledge associated with surgical hypothermia outcome is known but it is not implemented for maternal cesarean delivery care. Increased maternal-effect recognition, surveillance, triage, and evidenced-based protocol management is required for the maternal - neonatal dyad undergoing cesarean delivery for the clinical reduction/prevention of neonatal hypothermia that has proven evidence-based maternal morbidity and neonatal morbidity/mortality.

CONCLUSION

TEAM-based anesthesia, obstetrical, neonatology-pediatrics and nursing research collaboration is required through quality-safety-ERAS-ERAC directed processes. Healthcare system recognition and financial support is required for maternal-fetal-neonatal hypothermia prevention protocols implementation.