Assessment of blood loss during cesarean section under general anesthesia and epidural analgesia using different methods

Obstetric blood loss is usually a big issue when dealing with obstetric morbidity and mortality. Blood loss during cesarean section [CS] is usually underestimated; therefore this study addressed that problem by comparing 3 different methods for assessment of blood loss during CS under general anesthesia and epidural analgesia. The study included 100 informed and consented full-term pregnant women undergoing elective CS fulfilling the inclusion criteria. Intraoperatively, for each patient blood loss was assessed by: subjectively by visual estimation by the attending staff [obstetrician, anesthetist and the scrub nurse], by weighing of blood-soaked surgical swabs and by calculation using the formula described by Bourke and Smith [15]. The results showed that visual estimation of blood loss gave the lowest estimated value while the calculation gave the highest estimate of blood loss. Anesthetists gave more accurate visual estimation of blood loss than obstetricians, while scrub nurses gave the lowest estimation. Past history of CS, breech presentation, placenta previa and manual separation of the placenta were associated with more blood loss during CS. Neither the type of anesthesia nor the patients' parity had a positive correlation with blood loss while, the weight of the patient had a positive correlation with blood loss. Conclusively, the present study pointed out that calculation of intraoperative blood loss during CS was overestimated by the formula used and was underestimated visually by the obstetricians and scrub nurses involved. Reliably, anesthetists gave a close estimation to that obtained by weighing of swabs method. The study recommended spontaneous removal of the placenta to reduce intraoperative blood loss during elective CS

Effect of different Analgesic modalities during normal labor on changes in peripheral leucocytic counts and interleukin - 2 and - 6 serum concentrations in healthy parturients

Many analgesic techniques are nowadays applied during labor; each has its own advantages and drawbacks. Little has been reported about the immunologic impact of analgesia during labor. Many immunologic changes occurring during labor may be affected by pain relief. Cytokines such as IL-2 and IL-6 and white blood cell count may give a clue about such immunologic changes during labor. Thirty parturients in labor were investigated and divided into 3 equal groups according to the analgesia offered during labor: epidural group I, pethidine group II, and N2O group III. The results revealed good analgesic outcome and fetal profile in group I whereas fetal outcome in group II was the worst. IL-2 was lowest in cord blood of group I while it increased in both cord blood and postpartum samples in group III.IL-6 increased in cord blood in group I and II and decreased at cervical full dilatation in group I and III. Leucocytosis was significantly increased in group I and II with neutrophilia specially at full cervical dilatation. Cord blood showed neutropenia in group II cord blood. Lymphocytosis was highest in group II while lymphopenia was significant in cord blood of group I.The present study showed that epidural analgesia during labor offered good labor milieu regarding pain relief and neonatal outcome with better immunological condition.Nitrous oxide had significant immunosuppressive effect, while pethidine did not show any significant immunologic impact during spontaneous labor. Further studies are recommended to include more immune parameters and to establish reference values for assessment of peripartum immunologic status for both mother and newborn during labor under different analgesic techniques