Midazolam deep sedation versus metoclopramide to prevent nausea and vomiting during small dose bupivacaine spinal anesthesia for cesarean section

Nausea and vomiting during regional anesthesia for Cesarean section are very common and unpleasant events. They cause significant distress to the patient and also interfere with the surgical procedure. They have multiple etiologies, which include psychological [anxiety] factor, arterial hypotension, and hypo perfusion of the central nervous system. The trials for prevention and treatment of IONV still not definite. In the present study we evaluate the efficacy of hypnotic doses of midazolam in comparison with metoclopramide to prevent nausea and vomiting during spinal anesthesia for elective Cesarean section. One hundred [100] pregnant females were divided to two groups. Group [A] receives [midazolam, n=50], Group [B] receives [metoclopramide, n= 50], the two groups received spinal anesthesia with 8 mg of bupivacaine to avoid sever hypotension and decrease incidence of nausea and vomiting. Nausea and vomiting occurred in 5% of the total cases. IONV was absent in 97% in the midazolam group, 96% in metoclopramida group [p <0.001] for both group, no significant difference between two groups. The results showed a significant lower incidence of IONV in the deep sedation with midazolam and metoclopramide, without significant difference between two groups. The results confirmed and explained that, IONV during spinal anesthesia for Cesarean Section can be caused by psychological [anxiety] factors

Expectant management of premature rupture of membranes remote from term

To evaluate maternal and neonatal outcomes of singleton pregnancies complicated by PROM from 16 to 28 weeks gestation, and exposed to conservative management, in a local at Ibn Sina College of Medicine, hospital in Jeddah, Saudia Arabia. When PROM occurred and fetuses were at viable gestational age, pregnant patients were managed aggressively with tocolytic therapy, antenatal corticosteroids and antibiotic therapy. The relevant data related to the maternal and neonatal outcomes as well as maternal and neonatal morbidity were recorded and evaluated. During the study period, there were 4,665 deliveries, and 44 women admitted to the hospital with PROM at 16-28 weeks of gestation. Two women were excluded from the study, one of whom developed chorioamnionitis and the other experienced prolapsed fetal parts outside the vagina. Eight cases [19%] of PROM occurred in women at 16-19 weeks gestation, 14 cases [33.33%] occurred at 19-24 weeks gestation, and 20 cases [47.6%] occurred at 24-28 weeks gestation. Among the 42 pregnant patients, there were 23 [54.7%] still births and 5 [11.9%] neonatal deaths, resulting in a total death rate of 66.66%. Therefore the perinatal survival rate was 33.33%. The survival rate based on gestational age at the onset of PROM was "nil" at 16-24 weeks gestation [4 cases early neonatal deaths and 18 cases were still births]. The survival rate at 24-28 weeks gestation was 70% [14 out of 20]. There was no maternal mortality, however, four women [9.5%] experienced puerpural endometritis. One patient receive blood transfusion for a significant blood loss after a curettage to remove retained placenta. Among the surviving newborn infants, 100% had respiratory distress syndrome; 2 of them [14.2%] developed pneumothorax, and 8 [57.1%] experienced apnea. Intraventricular hemorrhage occurred in one case [7.1%] as did necrotizing enterocolitis. Three cases [21.4%] developed neonatal sepsis and 6 [42.8%] suffered from anemia. Physicians should council their patients thoroughly and well in advance with regard to the poor outcomes and the potential complications for neonates anticipated after this type of delivery. Aggressive expectant management does not seem to increase maternal morbidity