Prospective, non-randomized, parallel group, comparative observational study to compare maternal and neonatal outcome after regional and general anesthesia for Lower Segment Caesarean Section

Background: LSCS is a routine obstetric procedure performed under general anesthesia (GA) or regional anesthesia (RA). Choice of anesthesia depends on factors like gestational age, parity, co-morbidities, urgency of situation, etc. Both GA and RA involve the use of various medications which may influence maternal and neonatal outcome. As there are few studies comparing maternal and fetal outcome in RA and GA for LSCS in Indian population, the present study was taken up. Objectives of the study was to compare the maternal and neonatal outcome after RA and GA for LSCS.Methods: 60 subjects with indications for LSCS were assigned non-randomly into two groups, 30 for GA and 30 for RA, at the discretion of anesthesiologist. The demographic, anthropometric and clinical data was recorded for all subjects. The maternal outcome after RA and GA for LSCS was assessed by parameters like maternal blood loss, postoperative pain, postoperative nausea and vomiting, maternal satisfaction and neonatal outcome by parameters like birth weight, APGAR scores and NICU admissions. The maternal and neonatal outcome between the two groups was compared.Results: All subjects had clear indications for CS. In most of the subjects it was undertaken as an emergency procedure. GA was preferred in high risk subjects. Maternal blood loss, postoperative pain, NICU admissions, need for resuscitation was less under RA compared to GA. There was no difference in PONV, maternal satisfaction, birth weight and need for intubation.Conclusions: LSCS under RA showed a more favourable maternal and neonatal outcome.

Role of vitamin D in prevention of adverse maternal and perinatal outcome: a randomized controlled trial

Background: Vitamin  D  deficiency  is  thought  to  be   common among  pregnant  women  and  is  associated  with  adverse  maternal  and  perinatal  outcome. Maternal  and foetal  outcome  in  pregnant  women  with  standard  obstetric  care  was compared with   women with  additional  vitamin D  supplementation.Methods: A randomized comparative  study  was  conducted  on  100  patients attending  the  antenatal  clinic at JSS Medical College and Hospital, Mysuru, Karnataka, India   who were randomly  grouped   into  group A (50 patients) who  received  standard  obstetric care  (500 mg calcium+200 IU vitamin D)  and  group  B (50 patients)  who  received  in  addition  to  standard  obstetric  care   supplementation  of   Vitamin  D  1000 IU/day starting  from  14  weeks  of  gestation  till  delivery.  Vitamin  D  levels  were assessed  in  both  the  groups  with  onset  of  labour  by  chemiluminescence immunoassay  and  obstetric  and  neonatal  outcomes  in  both  groups  were compared.Results: High  incidence  of vitamin  D  deficiency  (96%)  in  standard  care  group  compared  to  vitamin  D supplemented  group  ( p= <0.0001)  was  noted. The  study  showed  significant  reduction  in  risk  of  Preeclampsia (P=0.004),  GDM  (P= 0.02)  and  primary  caesarean  delivery  (0.008)  in  Vitamin  D  supplemented  group. Significantly  high  birth  weight  in  vitamin  D supplemented   group,  an  increase  in  320 grams  in  birth  weight  was  noted  (P <0.0001).Conclusions: There is a high incidence of subnormal vitamin D levels in antenatal women and is associated with maternal and neonatal adverse effects. Measuring Vitamin D levels and appropriate supplementation of higher dose of vitamin D is an effective strategy in prevention of adverse maternal and neonatal outcomes.