BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the effic...BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the efficacy and safety of intrathecal hyper-baric bupivacaine vs hyperbaric ropivacaine for cesarean sections.AIM To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.METHODS A thorough search of electronic databases was carried out to find pertinent randomized controlled trials(RCTs)comparing intrathecal hyperbaric ropi-vacaine and hyperbaric bupivacaine during CSs.PubMed,Cochrane database,Google Scholar,and Scopus were searched,and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria.Studies were assessed for methodological quality,and data were extracted for time to adequate anesthesia(sensory and motor blockade),duration of sensory and motor block,hemodynamic changes and side effect profile.The standardized mean difference with 95%CI was used for continuous data.Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.RESULTS Total 8 RCTs were selected from a pool of 119 search results for meta-analysis.The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies.The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics.The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant(P=0.1586).However,the onset of motor blockade appeared to be faster with bupivacaine(P=0.03589).Additionally,the regression of sensory and motor blockade occurred earlier in the ropivacaine group.Furthermore,the duration of the first analgesic effect was shorter with a significance level of P<0.05.Regarding side effects profile,including hypotension,nausea,and shivering,the study did not observe any significant differences between the two groups.CONCLUSION This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections.Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine,perhaps aiding early mobilization of parturient and facilitating mother-child bonding.Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.展开更多
Objective:The objective of this study is to determine the effect of nurse-led instructional video(NLIV)on anxiety,satisfaction,and recovery among mothers admitted for cesarean section(CS).Materials and Methods:A quasi...Objective:The objective of this study is to determine the effect of nurse-led instructional video(NLIV)on anxiety,satisfaction,and recovery among mothers admitted for cesarean section(CS).Materials and Methods:A quasi-experimental design was carried out on the mothers scheduled for CS.Eighty participants were selected by a purposive sampling technique,which were divided(40 participants in each group)into an experimental group and a control group.Nurse-led informational video(NLIV)was shown to the experimental group,and routine care was provided for the control group.Modified hospital anxiety scale(HADS),scale for measuring maternal satisfaction in cesarean birth,and obstetric quality of recovery following cesarean delivery were used to assess anxiety,satisfaction,and recovery.Results:Both the experimental and control groups showed significant reductions in anxiety by the first postintervention day(P<0.001),with the experimental group experiencing a greater mean reduction(mean difference[MD]=4.37)than the control group(MD=3.35)but the intergroup difference was not statistically significant(P>0.05).The experimental group reported significantly higher satisfaction scores(175.55±9.42)on the 3rd postoperative day compared to the control group(151.93±14.89;P<0.001).Similarly,the experimental group’s recovery scores(79.90±6.24)were considerably higher than those of the control group(62.45±15.18;P<0.001).On the 3rd postintervention day,satisfaction was significantly associated with age(P<0.001),and recovery with gravidity(P<0.05).Conclusions:NLIV can be used in the preoperative period to reduce anxiety related to CS and to improve satisfaction and recovery after the CS.展开更多
Emergency cesarean section has always been a challenge for patients,surgeons,and anesthesiologists,as it endangers the safety of both parturients and fetuses.Obesity and hypertension are common among pregnant women,bu...Emergency cesarean section has always been a challenge for patients,surgeons,and anesthesiologists,as it endangers the safety of both parturients and fetuses.Obesity and hypertension are common among pregnant women,but severe obesity combined with refractory hypertension is very rare in clinical practice.The optimal anesthetic management strategy for obese pregnant women with a difficult airway and poorly controlled hypertension remains debatable.This report presents a 32-year-old woman with severe obesity and refractory hypertension at 36 weeks and 6 days of pregnancy.Owing to fetal heart rate abnormalities,she was scheduled for emergency cesarean section.Given the urgency of the fetal condition and the challenges posed by the patient's obesity for epidural puncture,the anesthesiologist opted for rapid sequence induction and tracheal intubation instead of intervertebral anesthesia.Short-acting antihypertensive medications were adminstrated preoperatively to control elevated blood pressure,and vasopressor agents were continuously infused during surgery to prevent severe hypotension induced by anesthetic drugs.The entire anesthesia and surgical procedure proceeded uneventfully,with no major adverse events observed.Both the patient and fetus achieved favorable outcomes.This case indicates that early anesthetic risk assessment and meticulous pre-delivery planning are paramount,necessitating personalized management of airway and hemodynamics to optimize outcomes in obese parturients.展开更多
BACKGROUND Oil-based iodinated contrast media have excellent contrast properties and are widely used for hysterosalpingographic evaluation of female infertility.On abdominal radiography and computed tomography(CT)scan...BACKGROUND Oil-based iodinated contrast media have excellent contrast properties and are widely used for hysterosalpingographic evaluation of female infertility.On abdominal radiography and computed tomography(CT)scans,their radiodensity is similar to that of metallic objects,which can sometimes lead to diagnostic confusion in the postoperative settings.In this case,retained oil-based contrast medium was observed on an abdominal radiograph following a cesarean section,making it difficult to differentiate from an intraperitoneal foreign body from surgery.The patient was a 37-year-old pregnant woman who was referred to our hospital at 32 weeks and 1 day of pregnancy due to complete placenta previa for mana-gement of pregnancy and delivery.An elective cesarean section was performed at 37 weeks and 3 days.A plain abdominal radiograph taken immediately after surgery revealed a near-round,hyperdense,mass-like shadow with a regular margin in the pelvic cavity.An intraperitoneal foreign body was suspected;therefore,an abdominal CT scan was performed.The foreign body was located on the left side of the pouch of Douglas and had a CT value of 7000 Hounsfield units,similar to that of metals.The CT value strongly suggested the presence of an artificial object.However,further inquiries with the patient and her previous physician revealed a history of hysterosalpingography.Accordingly,retained oil-based iodinated contrast medium was suspected,and observation of the object’s course was adopted.CONCLUSION When intraperitoneal foreign bodies are suspected on postoperative radiographs,the possibility of oil-based iodinated contrast medium retention should be considered.展开更多
Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who requ...Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.展开更多
Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial con...Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial concern that contributes to heightened morbidity and mortality. This study is designed to evaluate the frequency and key determining factors associated with surgical site infections following cesarean section procedures in a tertiary care hospital in Bangladesh. Materials and Methods: This observational cross-sectional study, conducted at the Gynecology Department of Dhaka Medical College Hospital, involved 100 patients aged 15 - 45 who had cesarean deliveries. Data was collected during hospitalization and post-discharge and analyzed to determine the prevalence and relationship between socio-demographic characteristics and surgical site infection. Results: Among the study participants, 14% developed surgical site infections following cesarean operations. More than half of these patients were under the age of 25, with a mean age of 24.45 ± 4.44 years. Surgical site infections were more prevalent in individuals over 30 years old (P-value Conclusion: Post-cesarean surgical site infections are notably prevalent among the participants in this study. Several risk factors have been identified, including age, body mass index (BMI), socioeconomic status, anemia, preterm delivery, personal hygiene practices, regular menstrual cycles, and adherence to antenatal check-ups. The implementation of an effective awareness program, coupled with updated antibiotic protocols, is crucial for significantly reducing the incidence of these infections.展开更多
OBJECTIVE:To evaluate the clinical outcome of Traditional Chinese Medicine(TCM)syndrome differentiation combined with hysteroscopic treatment for uterine incision defect after cesarean section[previous cesarean scar d...OBJECTIVE:To evaluate the clinical outcome of Traditional Chinese Medicine(TCM)syndrome differentiation combined with hysteroscopic treatment for uterine incision defect after cesarean section[previous cesarean scar defect(PCSD)]after cesarean section.METHODS:This is a single-center retrospective study.A total of 120 PCSD patients were enrolled from February 2022 to February 2023 and divided into two groups according to different treatment methods,the TCM group(n=60)and the control group(n=60).The control group was treated with hysteroscopy,and the TCM group combined TCM syndrome differentiation with hysteroscopy.Clinical outcome included menstrual scores,menstrual days,TCM symptom scores and intrauterine pregnancy recurrence rate was analyzed in two groups.RESULTS:The total response rate of the TCM group was significantly higher than that of the control group(P<0.05);after treatment,the menstrual scores,menstrual days and TCM symptoms of the two groups were decreased,and the menstrual scores,menstrual days and TCM symptoms of the TCM group were all lower than that of the control group(P<0.05);the recurrence rate of the TCM group was significantly lower than that of the control group(P<0.05).Follow-up results showed higher healing of incisional scar diverticulum in the TCM group than in the control group(P<0.05).The duration of menstruation before and after treatment,and the TCM group was better than the control group(P<0.05).CONCLUSION:TCM syndrome differentiation combined with hysteroscopy presented favorable outcome on the prolonged menstrual period of PCSD,which could significantly improve the recovery of menstruation,relief the symptoms of TCM,reduce the recurrence rate and accelerate wound healing.展开更多
Background:Postcesarean mothers often experience delayed lactogenesis II due to surgical stress and reduced oxytocin levels.Almond oil breast massage is a nonpharmacological intervention thought to enhance prolactin r...Background:Postcesarean mothers often experience delayed lactogenesis II due to surgical stress and reduced oxytocin levels.Almond oil breast massage is a nonpharmacological intervention thought to enhance prolactin release and improve milk production.Objective:The objective of the study was to evaluate the effectiveness of almond oil massage on breast milk adequacy among primigravida lower segment cesarean section(LSCS)mothers.Materials and Methods:A randomized pretest-posttest control group design was conducted among 60 primigravida mothers post-LSCS,randomly assigned to experimental(n=30)and control(n=30)groups.The experimental group received three daily almond oil breast massages(5-10 mL;5 min/breast)for 3 days;controls received routine care.Breast milk adequacy was measured using a validated 16-item rating scale at baseline and day 4 post-intervention.Results:The mean breast milk adequacy scores increased from 29.30±1.915 to 39.80±1.690 in the experimental group(t=22.15,P<0.001).Control group change(29.93±2.132-30.27±2.116)was non-significant(t=0.776,P>0.05).Posttest scores between the two groups differed significantly between groups(t=19.282,P<0.001).Conclusion:Almond oil breast massage significantly enhances breast milk adequacy in post-LSCS mothers and can be integrated into routine postnatal nursing care.展开更多
Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find o...Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.展开更多
Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most o...Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.展开更多
Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situ...Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situation occurs. The aim of the study was to investigate the maternal and fetal outcome for emergency and urgent cesarean. Study Design: A retrospective case-control study was performed;cases underwent emergency cesarean section, while controls underwent urgent cesarean section. We included 303 cases of women and 336 cases of children, and controls were matched. Maternal and fetal outcome parameters for singleton and twin pregnancies were investigated using the Wilcoxon test and the Chi-square-test. Results: Maternal outcome: Higher?blood loss (cases: mean 383.12 ± 232.89, range 100 - 2500 vs. controls: 336.06 ± 129.19, range 100?- 1000, p = 0.008), hemorrhage (34 vs. 11, p < 0.001) and puerperal anemia (30 vs. 10, p < 0.001). Neonatal outcome: One, five, and ten minutes Apgar levels and umbilical cord pH values are lower for cases (p < 0.001 and p < 0.001, respectively). Twins had lower five and ten minutes Apgar levels (p = 0.040 and 0.002), but higher umbilical cord pH values than singletons (p < 0.001). The perinatal mortality among singletons was 3.8%, among twins 8.1%. For cases the perinatal mortality among singletons was 5.7% and 17.14% for twins (control group 1.41% and 2.63%, respectively). Conclusion: The maternal and fetal outcome is poorer in emergency cesarean section. Especially the perinatal mortality is high in emergency cesarean section, particular for twins.展开更多
Background： Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined...Background： Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 （50% effective dose） and ED95 （95% effective dose） of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods： Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1-L2 vertebral interspace then lumbar puncture was performed at the L3-L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels （pinprick） were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results： ED50 （95% confidence interval） of spinal hyperbaric ropivacaine was determined to be 10.37 （5.23-11.59） mg and ED95 （95% confidence interval） to be 15.39 （13.81-23.59） mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion： The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.展开更多
Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nul...Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nulliparous pregnancies unless indicated, to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.展开更多
Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face int...Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019.Information saturationwas used to determine sample size.Data were analyzed using a thematic content analysis method.Themes were developed based on the theory of planned behavior.Results:Thirteen(68.42%)had a planned cesarean section,and six(31.58%)cesarean sections were unplanned or emergent.Three major themes emerged:ambivalent attitude about breastfeeding,motivation to comply with the traditional cultural norms,and barriers and challenges.The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk,support from healthcare professionals,and responsibility for breastfeeding.The challenges for breastfeeding after cesarean sections included physical discomfort,knowledge and skills deficit of breastfeeding,lactation deficiency,and lack of knowledge and coping skills in managing their depressive mood after cesarean sections.There were a couple of neutral factors,such as the influences of family and peers.These factors could influence women either positively as facilitators or negatively as barriers.Conclusions:The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections.To promote women’s breastfeeding behaviors after cesarean sections,it is necessary to change women’s attitudes,belief systems,and the external environments and help them become more confident.展开更多
BACKGROUND Early scar pregnancy(CSP)in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated.Transabdominal ultrasound is a common procedu...BACKGROUND Early scar pregnancy(CSP)in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated.Transabdominal ultrasound is a common procedure but is influenced by external factors.Thus,intracavitary ultrasound may have better diagnostic efficiency for CSP.AIM To assess the value of intracavitary ultrasound for diagnosing CSP in the lower uterine segment after cesarean section.METHODS Patients diagnosed with CSP in our hospital from October 2019 to April 2021 were recruited.Transabdominal and intracavitary ultrasound examinations were performed to compare the diagnostic differences for CSP and its types.RESULTS Sixty-three patients were diagnosed during the study period.The diagnostic accuracy for CSP was higher in intracavitary ultrasound(96.83%)than in transabdominal ultrasound(84.13%)(P<0.05).The missed diagnosis and misdiagnosis rates did not differ among the ultrasound types(intra:0.00%and 3.17%;trans:4.76%and 11.11%,respectively;P>0.05).For the diagnostic rates for the CSP types,the rates for gestational sac(100.00%vs 90.48%),heterogeneous mass(93.75%vs 75.00%),and part of the uterine cavity(80.00%vs 60.00%)were higher in intracavitary ultrasound than in transabdominal ultrasound,but the difference was not statistically significant(P>0.05).For gestational sac CSP patients,intracavitary ultrasound showed that the gestational sac was located in the lower uterine segment scar with abundant peripheral blood flow;the distance between the gestational sac and the serosal layer was 2.42±0.50 cm.Intracavitary ultrasound for heterogeneous mass CSP patients indicated that the mass mainly occurred in the lower anterior uterine wall,protruding into the bladder,and was surrounded by abundant internal and peripheral blood flow;the distance between the mass and serosal layer was 1.79±0.30 cm.For CSP type partly located in the uterine cavity,the gestational sac was partly located in the lower uterine cavity and partly in the scar with abundant internal and peripheral blood flow;the distance between the gestational sac and the serosal layer was 2.29±0.28 cm.CONCLUSION Intracavitary ultrasound had a higher diagnostic accuracy and application value for diagnosing CSP than transabdominal ultrasound,with reduced risk of missed diagnoses and misdiagnosis,thereby preventing delayed treatment.展开更多
Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomiz...Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomized controlled trial.Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020.One hundred thirty-two women were divided randomly into the intervention(n=66)and control group(n=66)by systematic random sampling.In the intervention group,an intervention project was implemented after Keywords:Breastfeeding Cesarean section Intervention studies Theory of planned behavior the C-section to establish positive breastfeeding attitudes,cultivate supportive subjective norms,enhance perceived behavioral control,and strengthen breastfeeding intention to change behaviors.Those in the control group received routine pre-and post-delivery care.Exclusive breastfeeding rate and breast problem were collected at 5 days,2 weeks,and 1 month after C-section.The modified Breastfeeding Attrition Prediction Tool(BAPT)on the first day in the hospital,two weeks,and one month after C-section and Numerical Rating Scale(NRS)24 h postoperatively were used to compare the intervention effect between the two groups.Results:After the intervention,the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days(86.4%vs.60.6%),two weeks(77.3%vs.57.6%),and one month(74.2%vs.50.0%)after the C-section.Besides,the intervention group was less likely to have sore nipples at five days(6.1%vs.18.2%in the control group,P<0.05)and two weeks(9.1%vs.12.1%in the control group,P<0.05).After two weeks of intervention,attitude scores(90.64±8.31 vs.87.20±8.15,P<0.05),subjective norm scores(88.07±24.65 vs.79.42±19.47,P<0.05)and behavior control scores in the intervention group were significantly higher than those in the control group.After one month of intervention,attitude scores(90.34±10.35 vs.84.22±10.51,P<0.05)and behavior control scores(43.13±5.02 vs.39.15±4.69,P<0.05)in the intervention group were significantly higher than those in the control group,which resulted in the higher breastfeeding intention in the intervention group.Conclusion:This study indicated that the TPB-based interventions effectively improved women's breastfeeding behaviors after C-sections.展开更多
Objective To evaluate the influence of uterine diverticulum patients who have a history of cesarean section on IVF-ET process and pregnancy outcome. Methods Nine patients with uterine diverticulum after cesarean were ...Objective To evaluate the influence of uterine diverticulum patients who have a history of cesarean section on IVF-ET process and pregnancy outcome. Methods Nine patients with uterine diverticulum after cesarean were retrospectively analyzed, who have received IVF-ET treatment. Clinical pregnancy rate and embryo implantation rate were measured. Results There were 9 infertility patients in all, 7 cases with tubal factor, 2 with unexplained factor; 3 cases were associated with prolonged menstruation period, including 1 patient was misdiagnosed as dysfunctioned uterine bleeding. There were a total of 16 transplantation cycles, including14 fresh cycles and 2 thawing cycles. Each cycle had at least one high-quality embryo available for transfer. Five cases were difficult to transfer. Two were clinical pregnancie, the implantation rate was 5.13% （2/39）. Conclusion In this study, 14 fresh cycles all had high-quality embryo transfer, uterine diverticulum had no effect on the development of ovums and the formation of high- quality embryos. But forming uterine diverticulum after cesarean section may lead to secondary infertility or patients with prolonged menstruation period, it also may lead it difficult to transfer during the treatment of IVF-ET and affect embryo implantation. So the patients with a history of cesarean section shall receive ultrasonic examination or hysteroscopy routinely before IVF treatment. If necessary surgical treatment is required.展开更多
BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting ma...BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting maternal emotional wellbeing,daily activities,breastfeeding,and neonatal care.It may also impede maternal organ function recovery,leading to escalated opioid usage,heightened risk of postpartum depression,and the development of chronic postoperative pain.Both the Chinese Enhanced Recovery After Surgery(ERAS)guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management.Esketamine,functioning as an antagonist of the N-Methyl-D-Aspartate receptor,has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment.Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes.This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.AIM To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.METHODS A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups:low-dose esketamine(0.15 mg/kg),high-dose esketamine(0.25 mg/kg),and control(saline).Postoperative Visual Analog Scale(VAS)scores were recorded at 6 hours,12 hours,24 hours,and 48 hours.Edinburgh Postnatal Depression Scale(EPDS)scores were noted on 2 days,7 days and 42 days.Ramsay sedation scores were assessed at specified intervals post-injection.Postoperative adverse reactions were also recorded.RESULTS Low-dose group and high-dose group compared to control group,had significantly lower postoperative VAS pain scores at 6 hours 12 hours,and 24 hours(P<0.05),with reduced analgesic usage(P<0.05).EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days(P<0.05).No significant differences in first exhaust and defecation times were observed(P>0.05),but ambulation times were shorter(P<0.05).Ramsay scores were higher at 5 minutes,15 minutes,and upon room exit(P<0.05).Low-dose group and high-dose group had higher incidences of hallucination,lethargy,and diplopia within 2 hours(P<0.05),and with low-dose group had lower incidences of hallucination,lethargy,and diplopia than high-dose group(P<0.05).CONCLUSION Esketamine enhances analgesia and postpartum recovery;a 0.15 mg/kg dose is optimal for cesarean sections,balancing efficacy with minimized adverse effects.展开更多
Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized co...Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute,Damanhour,Egypt.The sample included 120 parturients (60 intervention and 60 control).The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule,electronic monitoring of maternal hemodynamic parameters,and neonatal hemodynamic assessment sheet.All parturients received ordinary preoperative care.For the intervention group,a long elastic stocking (ordinary pressure 20-30 mmHg,1 mmHg =0.133 kPa) was applied on both legs during cesarean section.The control group received the same care without the elastic stocking.Results: Systolic blood pressure,diastolic blood pressure,and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5 -15 min.Heart rate was significantly lower in the intervention group.Only 13.3% of the intervention group took ephedrine compared with 45% of the control group.Apgar score was higher among neonates of intervention group compared with the control group at 1 min.Neonatal acidosis was significantly higher in the control group than in the contral group.Conclusion: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.展开更多
AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas...AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases. RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04). CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.展开更多
文摘BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the efficacy and safety of intrathecal hyper-baric bupivacaine vs hyperbaric ropivacaine for cesarean sections.AIM To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.METHODS A thorough search of electronic databases was carried out to find pertinent randomized controlled trials(RCTs)comparing intrathecal hyperbaric ropi-vacaine and hyperbaric bupivacaine during CSs.PubMed,Cochrane database,Google Scholar,and Scopus were searched,and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria.Studies were assessed for methodological quality,and data were extracted for time to adequate anesthesia(sensory and motor blockade),duration of sensory and motor block,hemodynamic changes and side effect profile.The standardized mean difference with 95%CI was used for continuous data.Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.RESULTS Total 8 RCTs were selected from a pool of 119 search results for meta-analysis.The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies.The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics.The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant(P=0.1586).However,the onset of motor blockade appeared to be faster with bupivacaine(P=0.03589).Additionally,the regression of sensory and motor blockade occurred earlier in the ropivacaine group.Furthermore,the duration of the first analgesic effect was shorter with a significance level of P<0.05.Regarding side effects profile,including hypotension,nausea,and shivering,the study did not observe any significant differences between the two groups.CONCLUSION This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections.Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine,perhaps aiding early mobilization of parturient and facilitating mother-child bonding.Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.
文摘Objective:The objective of this study is to determine the effect of nurse-led instructional video(NLIV)on anxiety,satisfaction,and recovery among mothers admitted for cesarean section(CS).Materials and Methods:A quasi-experimental design was carried out on the mothers scheduled for CS.Eighty participants were selected by a purposive sampling technique,which were divided(40 participants in each group)into an experimental group and a control group.Nurse-led informational video(NLIV)was shown to the experimental group,and routine care was provided for the control group.Modified hospital anxiety scale(HADS),scale for measuring maternal satisfaction in cesarean birth,and obstetric quality of recovery following cesarean delivery were used to assess anxiety,satisfaction,and recovery.Results:Both the experimental and control groups showed significant reductions in anxiety by the first postintervention day(P<0.001),with the experimental group experiencing a greater mean reduction(mean difference[MD]=4.37)than the control group(MD=3.35)but the intergroup difference was not statistically significant(P>0.05).The experimental group reported significantly higher satisfaction scores(175.55±9.42)on the 3rd postoperative day compared to the control group(151.93±14.89;P<0.001).Similarly,the experimental group’s recovery scores(79.90±6.24)were considerably higher than those of the control group(62.45±15.18;P<0.001).On the 3rd postintervention day,satisfaction was significantly associated with age(P<0.001),and recovery with gravidity(P<0.05).Conclusions:NLIV can be used in the preoperative period to reduce anxiety related to CS and to improve satisfaction and recovery after the CS.
文摘Emergency cesarean section has always been a challenge for patients,surgeons,and anesthesiologists,as it endangers the safety of both parturients and fetuses.Obesity and hypertension are common among pregnant women,but severe obesity combined with refractory hypertension is very rare in clinical practice.The optimal anesthetic management strategy for obese pregnant women with a difficult airway and poorly controlled hypertension remains debatable.This report presents a 32-year-old woman with severe obesity and refractory hypertension at 36 weeks and 6 days of pregnancy.Owing to fetal heart rate abnormalities,she was scheduled for emergency cesarean section.Given the urgency of the fetal condition and the challenges posed by the patient's obesity for epidural puncture,the anesthesiologist opted for rapid sequence induction and tracheal intubation instead of intervertebral anesthesia.Short-acting antihypertensive medications were adminstrated preoperatively to control elevated blood pressure,and vasopressor agents were continuously infused during surgery to prevent severe hypotension induced by anesthetic drugs.The entire anesthesia and surgical procedure proceeded uneventfully,with no major adverse events observed.Both the patient and fetus achieved favorable outcomes.This case indicates that early anesthetic risk assessment and meticulous pre-delivery planning are paramount,necessitating personalized management of airway and hemodynamics to optimize outcomes in obese parturients.
文摘BACKGROUND Oil-based iodinated contrast media have excellent contrast properties and are widely used for hysterosalpingographic evaluation of female infertility.On abdominal radiography and computed tomography(CT)scans,their radiodensity is similar to that of metallic objects,which can sometimes lead to diagnostic confusion in the postoperative settings.In this case,retained oil-based contrast medium was observed on an abdominal radiograph following a cesarean section,making it difficult to differentiate from an intraperitoneal foreign body from surgery.The patient was a 37-year-old pregnant woman who was referred to our hospital at 32 weeks and 1 day of pregnancy due to complete placenta previa for mana-gement of pregnancy and delivery.An elective cesarean section was performed at 37 weeks and 3 days.A plain abdominal radiograph taken immediately after surgery revealed a near-round,hyperdense,mass-like shadow with a regular margin in the pelvic cavity.An intraperitoneal foreign body was suspected;therefore,an abdominal CT scan was performed.The foreign body was located on the left side of the pouch of Douglas and had a CT value of 7000 Hounsfield units,similar to that of metals.The CT value strongly suggested the presence of an artificial object.However,further inquiries with the patient and her previous physician revealed a history of hysterosalpingography.Accordingly,retained oil-based iodinated contrast medium was suspected,and observation of the object’s course was adopted.CONCLUSION When intraperitoneal foreign bodies are suspected on postoperative radiographs,the possibility of oil-based iodinated contrast medium retention should be considered.
文摘Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.
文摘Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial concern that contributes to heightened morbidity and mortality. This study is designed to evaluate the frequency and key determining factors associated with surgical site infections following cesarean section procedures in a tertiary care hospital in Bangladesh. Materials and Methods: This observational cross-sectional study, conducted at the Gynecology Department of Dhaka Medical College Hospital, involved 100 patients aged 15 - 45 who had cesarean deliveries. Data was collected during hospitalization and post-discharge and analyzed to determine the prevalence and relationship between socio-demographic characteristics and surgical site infection. Results: Among the study participants, 14% developed surgical site infections following cesarean operations. More than half of these patients were under the age of 25, with a mean age of 24.45 ± 4.44 years. Surgical site infections were more prevalent in individuals over 30 years old (P-value Conclusion: Post-cesarean surgical site infections are notably prevalent among the participants in this study. Several risk factors have been identified, including age, body mass index (BMI), socioeconomic status, anemia, preterm delivery, personal hygiene practices, regular menstrual cycles, and adherence to antenatal check-ups. The implementation of an effective awareness program, coupled with updated antibiotic protocols, is crucial for significantly reducing the incidence of these infections.
文摘OBJECTIVE:To evaluate the clinical outcome of Traditional Chinese Medicine(TCM)syndrome differentiation combined with hysteroscopic treatment for uterine incision defect after cesarean section[previous cesarean scar defect(PCSD)]after cesarean section.METHODS:This is a single-center retrospective study.A total of 120 PCSD patients were enrolled from February 2022 to February 2023 and divided into two groups according to different treatment methods,the TCM group(n=60)and the control group(n=60).The control group was treated with hysteroscopy,and the TCM group combined TCM syndrome differentiation with hysteroscopy.Clinical outcome included menstrual scores,menstrual days,TCM symptom scores and intrauterine pregnancy recurrence rate was analyzed in two groups.RESULTS:The total response rate of the TCM group was significantly higher than that of the control group(P<0.05);after treatment,the menstrual scores,menstrual days and TCM symptoms of the two groups were decreased,and the menstrual scores,menstrual days and TCM symptoms of the TCM group were all lower than that of the control group(P<0.05);the recurrence rate of the TCM group was significantly lower than that of the control group(P<0.05).Follow-up results showed higher healing of incisional scar diverticulum in the TCM group than in the control group(P<0.05).The duration of menstruation before and after treatment,and the TCM group was better than the control group(P<0.05).CONCLUSION:TCM syndrome differentiation combined with hysteroscopy presented favorable outcome on the prolonged menstrual period of PCSD,which could significantly improve the recovery of menstruation,relief the symptoms of TCM,reduce the recurrence rate and accelerate wound healing.
基金funded by the Sum Nursing College,SOA University,Bhubaneswar,Odisha.
文摘Background:Postcesarean mothers often experience delayed lactogenesis II due to surgical stress and reduced oxytocin levels.Almond oil breast massage is a nonpharmacological intervention thought to enhance prolactin release and improve milk production.Objective:The objective of the study was to evaluate the effectiveness of almond oil massage on breast milk adequacy among primigravida lower segment cesarean section(LSCS)mothers.Materials and Methods:A randomized pretest-posttest control group design was conducted among 60 primigravida mothers post-LSCS,randomly assigned to experimental(n=30)and control(n=30)groups.The experimental group received three daily almond oil breast massages(5-10 mL;5 min/breast)for 3 days;controls received routine care.Breast milk adequacy was measured using a validated 16-item rating scale at baseline and day 4 post-intervention.Results:The mean breast milk adequacy scores increased from 29.30±1.915 to 39.80±1.690 in the experimental group(t=22.15,P<0.001).Control group change(29.93±2.132-30.27±2.116)was non-significant(t=0.776,P>0.05).Posttest scores between the two groups differed significantly between groups(t=19.282,P<0.001).Conclusion:Almond oil breast massage significantly enhances breast milk adequacy in post-LSCS mothers and can be integrated into routine postnatal nursing care.
基金Fund supported by the CAMS Innovation Fund for Medical Sciences(CIFMS:2016-12M-3-024)~~
文摘Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.
文摘Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.
文摘Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situation occurs. The aim of the study was to investigate the maternal and fetal outcome for emergency and urgent cesarean. Study Design: A retrospective case-control study was performed;cases underwent emergency cesarean section, while controls underwent urgent cesarean section. We included 303 cases of women and 336 cases of children, and controls were matched. Maternal and fetal outcome parameters for singleton and twin pregnancies were investigated using the Wilcoxon test and the Chi-square-test. Results: Maternal outcome: Higher?blood loss (cases: mean 383.12 ± 232.89, range 100 - 2500 vs. controls: 336.06 ± 129.19, range 100?- 1000, p = 0.008), hemorrhage (34 vs. 11, p < 0.001) and puerperal anemia (30 vs. 10, p < 0.001). Neonatal outcome: One, five, and ten minutes Apgar levels and umbilical cord pH values are lower for cases (p < 0.001 and p < 0.001, respectively). Twins had lower five and ten minutes Apgar levels (p = 0.040 and 0.002), but higher umbilical cord pH values than singletons (p < 0.001). The perinatal mortality among singletons was 3.8%, among twins 8.1%. For cases the perinatal mortality among singletons was 5.7% and 17.14% for twins (control group 1.41% and 2.63%, respectively). Conclusion: The maternal and fetal outcome is poorer in emergency cesarean section. Especially the perinatal mortality is high in emergency cesarean section, particular for twins.
文摘Background： Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 （50% effective dose） and ED95 （95% effective dose） of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods： Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1-L2 vertebral interspace then lumbar puncture was performed at the L3-L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels （pinprick） were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results： ED50 （95% confidence interval） of spinal hyperbaric ropivacaine was determined to be 10.37 （5.23-11.59） mg and ED95 （95% confidence interval） to be 15.39 （13.81-23.59） mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion： The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.
基金This study was supported by the National Natural Science Foundation of China （No. 71173081）.
文摘Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nulliparous pregnancies unless indicated, to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.
基金We thank all the mothers who participated in this study.
文摘Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019.Information saturationwas used to determine sample size.Data were analyzed using a thematic content analysis method.Themes were developed based on the theory of planned behavior.Results:Thirteen(68.42%)had a planned cesarean section,and six(31.58%)cesarean sections were unplanned or emergent.Three major themes emerged:ambivalent attitude about breastfeeding,motivation to comply with the traditional cultural norms,and barriers and challenges.The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk,support from healthcare professionals,and responsibility for breastfeeding.The challenges for breastfeeding after cesarean sections included physical discomfort,knowledge and skills deficit of breastfeeding,lactation deficiency,and lack of knowledge and coping skills in managing their depressive mood after cesarean sections.There were a couple of neutral factors,such as the influences of family and peers.These factors could influence women either positively as facilitators or negatively as barriers.Conclusions:The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections.To promote women’s breastfeeding behaviors after cesarean sections,it is necessary to change women’s attitudes,belief systems,and the external environments and help them become more confident.
文摘BACKGROUND Early scar pregnancy(CSP)in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated.Transabdominal ultrasound is a common procedure but is influenced by external factors.Thus,intracavitary ultrasound may have better diagnostic efficiency for CSP.AIM To assess the value of intracavitary ultrasound for diagnosing CSP in the lower uterine segment after cesarean section.METHODS Patients diagnosed with CSP in our hospital from October 2019 to April 2021 were recruited.Transabdominal and intracavitary ultrasound examinations were performed to compare the diagnostic differences for CSP and its types.RESULTS Sixty-three patients were diagnosed during the study period.The diagnostic accuracy for CSP was higher in intracavitary ultrasound(96.83%)than in transabdominal ultrasound(84.13%)(P<0.05).The missed diagnosis and misdiagnosis rates did not differ among the ultrasound types(intra:0.00%and 3.17%;trans:4.76%and 11.11%,respectively;P>0.05).For the diagnostic rates for the CSP types,the rates for gestational sac(100.00%vs 90.48%),heterogeneous mass(93.75%vs 75.00%),and part of the uterine cavity(80.00%vs 60.00%)were higher in intracavitary ultrasound than in transabdominal ultrasound,but the difference was not statistically significant(P>0.05).For gestational sac CSP patients,intracavitary ultrasound showed that the gestational sac was located in the lower uterine segment scar with abundant peripheral blood flow;the distance between the gestational sac and the serosal layer was 2.42±0.50 cm.Intracavitary ultrasound for heterogeneous mass CSP patients indicated that the mass mainly occurred in the lower anterior uterine wall,protruding into the bladder,and was surrounded by abundant internal and peripheral blood flow;the distance between the mass and serosal layer was 1.79±0.30 cm.For CSP type partly located in the uterine cavity,the gestational sac was partly located in the lower uterine cavity and partly in the scar with abundant internal and peripheral blood flow;the distance between the gestational sac and the serosal layer was 2.29±0.28 cm.CONCLUSION Intracavitary ultrasound had a higher diagnostic accuracy and application value for diagnosing CSP than transabdominal ultrasound,with reduced risk of missed diagnoses and misdiagnosis,thereby preventing delayed treatment.
文摘Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomized controlled trial.Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020.One hundred thirty-two women were divided randomly into the intervention(n=66)and control group(n=66)by systematic random sampling.In the intervention group,an intervention project was implemented after Keywords:Breastfeeding Cesarean section Intervention studies Theory of planned behavior the C-section to establish positive breastfeeding attitudes,cultivate supportive subjective norms,enhance perceived behavioral control,and strengthen breastfeeding intention to change behaviors.Those in the control group received routine pre-and post-delivery care.Exclusive breastfeeding rate and breast problem were collected at 5 days,2 weeks,and 1 month after C-section.The modified Breastfeeding Attrition Prediction Tool(BAPT)on the first day in the hospital,two weeks,and one month after C-section and Numerical Rating Scale(NRS)24 h postoperatively were used to compare the intervention effect between the two groups.Results:After the intervention,the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days(86.4%vs.60.6%),two weeks(77.3%vs.57.6%),and one month(74.2%vs.50.0%)after the C-section.Besides,the intervention group was less likely to have sore nipples at five days(6.1%vs.18.2%in the control group,P<0.05)and two weeks(9.1%vs.12.1%in the control group,P<0.05).After two weeks of intervention,attitude scores(90.64±8.31 vs.87.20±8.15,P<0.05),subjective norm scores(88.07±24.65 vs.79.42±19.47,P<0.05)and behavior control scores in the intervention group were significantly higher than those in the control group.After one month of intervention,attitude scores(90.34±10.35 vs.84.22±10.51,P<0.05)and behavior control scores(43.13±5.02 vs.39.15±4.69,P<0.05)in the intervention group were significantly higher than those in the control group,which resulted in the higher breastfeeding intention in the intervention group.Conclusion:This study indicated that the TPB-based interventions effectively improved women's breastfeeding behaviors after C-sections.
文摘Objective To evaluate the influence of uterine diverticulum patients who have a history of cesarean section on IVF-ET process and pregnancy outcome. Methods Nine patients with uterine diverticulum after cesarean were retrospectively analyzed, who have received IVF-ET treatment. Clinical pregnancy rate and embryo implantation rate were measured. Results There were 9 infertility patients in all, 7 cases with tubal factor, 2 with unexplained factor; 3 cases were associated with prolonged menstruation period, including 1 patient was misdiagnosed as dysfunctioned uterine bleeding. There were a total of 16 transplantation cycles, including14 fresh cycles and 2 thawing cycles. Each cycle had at least one high-quality embryo available for transfer. Five cases were difficult to transfer. Two were clinical pregnancie, the implantation rate was 5.13% （2/39）. Conclusion In this study, 14 fresh cycles all had high-quality embryo transfer, uterine diverticulum had no effect on the development of ovums and the formation of high- quality embryos. But forming uterine diverticulum after cesarean section may lead to secondary infertility or patients with prolonged menstruation period, it also may lead it difficult to transfer during the treatment of IVF-ET and affect embryo implantation. So the patients with a history of cesarean section shall receive ultrasonic examination or hysteroscopy routinely before IVF treatment. If necessary surgical treatment is required.
基金the Project of Science and Technology Bureau of Shijiazhuang,Hebei Province,No.201460823.
文摘BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting maternal emotional wellbeing,daily activities,breastfeeding,and neonatal care.It may also impede maternal organ function recovery,leading to escalated opioid usage,heightened risk of postpartum depression,and the development of chronic postoperative pain.Both the Chinese Enhanced Recovery After Surgery(ERAS)guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management.Esketamine,functioning as an antagonist of the N-Methyl-D-Aspartate receptor,has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment.Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes.This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.AIM To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.METHODS A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups:low-dose esketamine(0.15 mg/kg),high-dose esketamine(0.25 mg/kg),and control(saline).Postoperative Visual Analog Scale(VAS)scores were recorded at 6 hours,12 hours,24 hours,and 48 hours.Edinburgh Postnatal Depression Scale(EPDS)scores were noted on 2 days,7 days and 42 days.Ramsay sedation scores were assessed at specified intervals post-injection.Postoperative adverse reactions were also recorded.RESULTS Low-dose group and high-dose group compared to control group,had significantly lower postoperative VAS pain scores at 6 hours 12 hours,and 24 hours(P<0.05),with reduced analgesic usage(P<0.05).EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days(P<0.05).No significant differences in first exhaust and defecation times were observed(P>0.05),but ambulation times were shorter(P<0.05).Ramsay scores were higher at 5 minutes,15 minutes,and upon room exit(P<0.05).Low-dose group and high-dose group had higher incidences of hallucination,lethargy,and diplopia within 2 hours(P<0.05),and with low-dose group had lower incidences of hallucination,lethargy,and diplopia than high-dose group(P<0.05).CONCLUSION Esketamine enhances analgesia and postpartum recovery;a 0.15 mg/kg dose is optimal for cesarean sections,balancing efficacy with minimized adverse effects.
文摘Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute,Damanhour,Egypt.The sample included 120 parturients (60 intervention and 60 control).The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule,electronic monitoring of maternal hemodynamic parameters,and neonatal hemodynamic assessment sheet.All parturients received ordinary preoperative care.For the intervention group,a long elastic stocking (ordinary pressure 20-30 mmHg,1 mmHg =0.133 kPa) was applied on both legs during cesarean section.The control group received the same care without the elastic stocking.Results: Systolic blood pressure,diastolic blood pressure,and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5 -15 min.Heart rate was significantly lower in the intervention group.Only 13.3% of the intervention group took ephedrine compared with 45% of the control group.Apgar score was higher among neonates of intervention group compared with the control group at 1 min.Neonatal acidosis was significantly higher in the control group than in the contral group.Conclusion: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.
文摘AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases. RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04). CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.
