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Introducción: La decisión de realizar la inducción anestésica con propofol o tiopental en la paciente obstétrica para operación cesárea es un tema controvertido, con resultados contradictorios entre las investigaciones. Objetivo: Presentar los resultados que se publicaron en la literatura nacional e internacional sobre el uso del propofol como agente anestésico en la inducción de la anestesia general en la operación cesárea electiva. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane; en idioma español e inglés, durante los últimos diez años, utilizando palabras clave como: (inducción anestésica OR anestesia general OR) AND (propofol OR) AND (operación cesárea OR cesárea OR). Desarrollo: Se destacaron artículos donde se comparan los resultados del uso del propofol contra el tiopental y otros barbitúricos durante la inducción anestésica en cuanto a variables hemodinámicas, efectos adversos, calidad anestésica y desenlaces neonatales como el estado físico, capacidad de adaptación neurológica y gases arteriales. Conclusiones: El propofol es el agente más común para la inducción anestésica en la paciente obstétrica que necesita cesárea electiva. Este presenta resultados adecuados maternos y fetales, y menor incidencia de efectos adversos(AU)
Introduction: The decision to perform anesthetic induction with propofol or thiopental in obstetric patients for cesarean section is a controversial issue, with contradictory oncomes among investigations. Objective: To present the results published in the national and international literature about the use of propofol as an anesthetic agent in the induction of general anesthesia in elective cesarean section. Methods: A nonsystematic review of the bibliography was carried out, with a focus on articles in Spanish and English published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, using keywords such as (inducción anestésica [anesthetic induction] OR anestesia general [general anesthesia] OR) AND (propofol OR) AND (operación cesárea [cesarean section] OR cesárea [cesarean] OR). Development: Articles were highlighted if they compared the results of propofol usage against thiopental and other barbiturates during anesthetic induction in terms of hemodynamic variables, adverse effects, anesthetic quality and neonatal outcomes such as physical state, neurological adaptation capacity and arterial gases. Conclusions: Propofol is the commonest agent for anesthetic induction in obstetric patients requiring elective caesarean section. This presents adequate maternal and fetal outcomes, as well as a lower incidence of adverse effects(AU)
Subject(s)
Humans , Female , Pregnancy , Propofol , Cesarean Section , Decision Making , Anesthesia, GeneralABSTRACT
Background: Surgical site infection (SSI) following C-section is a common encountered problem and needs to be analysed. In this study we have determined the incidence, risk factors and common bacterial pathogens in surgical site infection (SSI) following C-section at a tertiary care centre.Methods: A hospital based prospective study conducted for a period of 6 months. Those women whose C-section was complicated by SSI within 5 days postoperatively were included in the study. Risk factors for SSI were identified and microbiological pattern was studied.Results: Out of 62 women whose C-section was complicated by SSI within 5 days post-operatively, during this study period post caesarian SSI incidence was 0.34%. In this study post C-section SSI found as high as 43.55%, in lower socio-economic status. Among all patients, un-booked were 62.90%, Referred patients were as high as 67.74%. SSI developed in 69.35% patients without preoperative antibiotic prophylaxis. C-section done in PROM in 64.50% and as an elective emergency 79.03%, blood transfusion needed in 59.68% and type of incision being transverse (Pfannenstiel) in 88.71%. Subcutaneous suture technique used in 75.81% and secondary healing occurred in 67.74%. Most common organism grown was CoNS (coagulase negative staphylococcus) 29.03% in SSI.Conclusions: To reduce SSI, the hospital infection control system and surgical site infection surveillance program has to be established. Knowing the prevalence and risk factors will help optimal precaution and standard surgical technique to reduce SSI, which causes increased hospital stay of patients.
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Background: The most common cause of post-partum hemorrhage (PPH) is uterine atony. Treatment for atony follows a well-defined stepwise approach, including drugs and mechanical interventions followed by surgery as a last resort. Early use of intrauterine balloon tamponade is a way of limiting ongoing uterine blood loss while initiating other measures and can be readily implemented by providers with minimal training.Methods: This prospective interventional study was conducted in 112 consecutive patients attended department of obstetrics and gynecology, Gandhi Medical College and Associated Sultania Zanana Hospital, Bhopal, Madhya Pradesh, India, in one year of study period.Results: In this study most of the patients had gestational age >37 weeks [83 (74.1%)]. Most of the patients in the study had vaginal delivery [64 (57.1%)]. In 84 (75%) patients Bakri balloon was used followed by Burke balloon in 17 (15.2%) patients, condom catheter in 7 (6.2%) patients and CG balloon in 4 (3.6%) patients. Different types of balloons were used according to availability of balloon at the time of management. Most of the patients [71 (63.3%)] had trans-vaginal route of balloon placement and 41 (36.7%) patients underwent trans-abdominal balloon placement. Most of the patients 69 (61.65%), responded to tamponing within 20 minutes of balloon placement while 9 patients had negative tamponade and continued to bleed. Bakri balloon tamponade was most commonly used in 84 (75.0%) patients. CG balloon and condom catheter were used only in 4 (3.6%) and 7 (6.3%) patients respectively. Tamponading was effective and successful in 103 (92%) patients.Conclusions: PPH is still a leading but preventable cause of maternal morbidity and mortality. In the majority of cases, relatively simple methods are used to avert a disaster, although these are not always employed. Uterine tamponade using intrauterine balloons appears to be an effective tool in the management of PPH.
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Background: Hypertensive disorder of pregnancy complicates 5 to 8% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Hypertensive disorders of pregnancy account for nearly 18% of all maternal deaths worldwide, with an estimated 62000-77000 deaths per year.Methods: This one-year prospective case control study total 200 pregnant women attending antenatal care and admitted in Eclampsia ward fulfilling the inclusion criteria were studied. Fetal and maternal outcomes data recorded and documented. Statistical analysis of data was done by student’s t-test and p-value.Results: In PIH 68% women had normal vaginal delivery (p=0.004) 10% women had instrumental delivery. In PIH group 22% women had emergency caesarian section and in normotensive group 10% women had emergency caesarian section. In PIH group 58% delivered at term and 42% had preterm delivery. In normotensive 95% delivered at term and 5% had preterm delivery (p <0.001). PIH group 29% women developed IUGR whereas in normotensive group all women had normal growth velocity (p <0.001). In PIH group 69% mothers had newborn with birth weight <2.5 kg and 31% women had newborn with birth weight >2.5 kg (p=0.0009). While In normotensive group only 9% women had newborn with birth weight <2.5 kg. In PIH group, 24% newborn babies needed NICU admission and in normotensive group only 5% newborn needed NICU admission (p=0.001). In PIH group 76% women had normal maternal outcome (p <0.001). 11% had associated abruption (p=0.0019). In the rest 13% patient develop PRES.Conclusions: We concluded that there is a significant rise of complication in mothers having PIH and also there is an increased risk of delivering low birth weight and preterm babies. The early use of antihypertensive drugs, optimum timing of delivery and strict fluid balance, anticonvulsants in cases of eclampsia will help to achieve successful outcome.
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Background: Spinal anaesthesia used in caesarian section is associated with hypotension which can have maternal and fetal side effects. To determine the efficacy and ideal dosing of Phenylephrine in attenuating the hypotensive episodes during caesarean section under spinal anaesthesia.Methods: 100 patients were allocated to four groups, placebo group (PE 0) and 3 fixed phenylephrine infusion regimens, phenylephrine 25 μg/min-1 (PE 25), phenylephrine 50 μg/min-1 (PE 50), and phenylephrine 75 μg/min-1 (PE 75). Blood pressure, heart rate were noted among primary variables and fetal parameters like umbilical blood pH and lactate were recorded as secondary parameters.Results: There was a significant reduction in heart rate with increasing the infusion dosage of phenylephrine, with a mean of 86.8 beats/min at the end of procedure in placebo group and 69.4 beats/min in 75 μg group (p value <0.001). There was significant statistical difference among systolic blood pressure in the four groups after 7 min of the procedure and p-value of <0.05 with better attenuation of hypotension in infusion groups as compared to placebo. Similarly there was significant statistical difference in diastolic blood pressure among the four groups after 8 min of the procedure with p values <0.05.Conclusions: Prophylactic phenylephrine infusions reduced the incidence and severity of maternal pre-delivery hypotension. Among the fixed rate phenylephrine infusion regimens investigated, infusion rates of 50 μg/min-1 were associated with greater maternal hemodynamic stability compared with 25 and 75 μg/min-1, with minimal side effects and intervention.
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Background: Color code was described for the first time in 2003 was described for the first time in 2003 by since and al. The objective of this study was to accomplish urgent caesarian sections according to color code over delays indications-births (DIN) in Motherhood Befelatanana, Antananarivo, Madagascar.Methods: It was about a longitudinal prospective, analytical study of caesarian sections performed in emergency in CHUGOB going from June 1st till December 31st, 2017.Results: Authors took a census 193 caesarian sections of emergency. Among these patients 28 (14.50%) had a caesarian section encode red, 42 (21.76%) an orange code and 123 (63.73%) a green code. The medium age of the patients was of 26.4 years and that of the gestation was of 37SA and 6 days. The delay indication-birth (DIN) medium was of 102.9 minutes for red code, 99.7 minutes for orange code and 75 minutes for green code.Conclusions: Authors could not attain DIN of 30 minutes shape in international recommendations. Authors must improve the delay indication entered in the surgical unit by reinforcing knowledge of the agents of support on the management of emergency obstetrical. The possibility of leading to a very quick birth is an indisputable progress in obstetrics but she should not make forget risks inherent in such procedure.
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Perioperative visual loss (POVL), a rare but devastating complication, has been reported after spine, cardiac, and head–neck surgeries.The various causes include ischemic optic neuropathy, central or branch retinal artery occlusion, and cortical blindness. The contributory factors described are microvascular diseases and intraoperative hemodynamic compromise. However, the exact association of these factors with post‑operative blindness has not yet been confirmed. A case of POVL with caesarian section surgery is being presented. The visual loss occurred due to a combined occlusion of central retinal artery and vein.The causes, presentation, and risk factors of POVL after non‑ocular surgery are being discussed.
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Caesarian section (C/S) is a very common obstetric procedure. It had many advantages and disadvantages. In this age of consumer awareness, patient has to give an informed consent before the procedure – means merits and demerits of the procedure shall be known to the patient. She also has the right to choose between different procedures, type of incision and anesthesia, where possible. We have studied that status amongst 100 such patients, only 7% of them being illiterate, who had undergone elective C/S in SNP Hospital, a two tier hospital of Kolkata. The result was shocking. 65% of the mothers did not have any idea regarding the procedure they are undergoing. 1/3rd of the patients even did not know why they are having C/S. None of them was given any choice regarding anesthesia and only 9% regarding incision. A detail of the study is presented.
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Adult , Awareness , Cesarean Section/education , Cesarean Section/methods , Cesarean Section/statistics & numerical data , Elective Surgical Procedures/education , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Female , Humans , India , Informed Consent , Pregnancy , Surveys and QuestionnairesABSTRACT
Rupture uterus is a rare and often catastrophic condition. It is associated with a high incidence of fetal and maternal mortality and morbidity. Our objective in this study is to determine incidence, etiology, trend, management, maternal and fetal outcome of uterine rupture in Faridpur Medical College Hospital. This is a prospective cross-sectional study of patients with ruptured uterus from the period of January 2011 to December 2011 admitted at Faridpur Medical College Hospital. All the cases of ruptured uterus who were either admitted with uterine rupture or who developed it in hospital were included in the study. Patients having ruptured uterus due to congenital anomaly were excluded from the study. Patients were initially assessed in labour ward, relevant sociodemographic data, previous antenatal and surgical history recorded. Ways of management, maternal and fetal outcome were taken for analysis. There were 30 cases of ruptured uterus out of total 3606 deliveries (including 1809 caesarian sections) over a one year time period, with a prevalence of 0.83%. The most common age group was 21-30 years. A majority of patients 16(53.3%) were cases of unscarred uterus presenting with rupture; the common cause of rupture in scarred uterus was injudicious use of oxytocin (13,43.33%). Proper antenatal care, appropriate counseling of patients with history of previous caesarian section for hospital delivery, training of skilled birth attendant can reduce mortality and morbidity due to rupture uterus.
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The use of neuroaxial blocks in patients with multiple sclerosis has been controversial, because the effect of local anesthetic drugs on the course of the disease is unclear. We report an obstetric patient with multiple sclerosis whose caesarian section was performed successfully under combined spinal-epidural anesthesia and postoperative pain control was managed using patient-controlled epidural analgesia. There were no exacerbation of neurologic symptoms and no relapse of disease at two month follow-up. We suggest that the choice of anesthetic technique for patients with multiple sclerosis should be determined after evaluation of the course of the disease and informed consent. The obstetric patients with multiple sclerosis should not be denied the neuroaxial block for labor and caesarian section.
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Humans , Analgesia, Epidural , Anesthesia , Anesthetics , Follow-Up Studies , Informed Consent , Multiple Sclerosis , Neurologic Manifestations , Pain, Postoperative , RecurrenceABSTRACT
Objective To investigate the clinical characteristics, diagnosis and treatment of placenta increta.Methods A retrospective analysis was carried out on 13 admitted cases of placenta increta from 1989～2006. Results Among the 13 cases analysed, 5 cases with a history of Caesarian section had a 0% success rate of treatment with conservative care (0/5), 100% less than that of cases with no history of Caesarian section (8/8), P＜0.05; the success rate of treatment of partial placenta increta with methotrexate with Jia Wei Sheng Hua Tang was 100%. Conclusion Caesarian section is a risk factor of placenta increta, and its prognosis is poor; however, Jia Wei Sheng Hua Tang has proven satisfactory as a supplementary treatment for placenta inereta.
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Cauda equina syndrome develops as rapidly progressive neurologic deficit of lower extremities and urogenital system often resulting in serious outcome such as complete irreVersible paraparesis. Therefore prompt diagnosis and decompression is mandatory. However, if it occurs after childbirth, it may be overlooked being regarded as symptoms related to pregnancy and delivery. We experienced a cauda equina syndrome by ruptured disc in a 32-year-old woman just after Caesarian section in a local obstetric clinic who was transferred to us 2 days after development of progressive neurologic deficits. We managed her with prompt decompressive surgery and achieved favorable result. Because of the importance of early detect and prompt decompression for cauda equina syndrome and possible occurrence at perinatal period, we report this case reviewing the literature especially concerning about pregnancy and cauda equina syndrome.
Subject(s)
Adult , Female , Humans , Pregnancy , Cauda Equina , Decompression , Diagnosis , Lower Extremity , Neurologic Manifestations , Paraparesis , Parturition , Polyradiculopathy , Urogenital SystemABSTRACT
Cauda equina syndrome develops as rapidly progressive neurologic deficit of lower extremities and urogenital system often resulting in serious outcome such as complete irreversible paraparesis, therefore prompt diagnosis and decompression is mandatory. However, if it occurs after childbirth, it may be overlooked being regarded as symptoms related to pregnancy and delivery. We experienced a cauda equina syndrome by prolased disc in a 32-year-old woman just after Caesarian section who was managed with prompt decompressive surgery and achieved favorable result. Because of the importance of early detect and prompt decompression for cauda equina syndrome and possible occurrence at perinatal period, we report this case reviewing the literature especially concerning about changes of spine and disc during pregnancy and after delivery.
Subject(s)
Adult , Female , Humans , Pregnancy , Cauda Equina , Decompression , Diagnosis , Lower Extremity , Neurologic Manifestations , Paraparesis , Parturition , Polyradiculopathy , Prolapse , Spine , Urogenital SystemABSTRACT
BACKGROUND: A light plane of general anesthesia is chosen for fetal safety during a cesarean section. Therefore an experience of wakefulness and pain perception is not infrequent and can be distressful to patients. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study was designed to assess the adequacy of general anesthesia and to evaluate the usefulness of the BIS in monitoring the awareness during a cesarean section. METHODS: Twenty one parturients undergoing general anesthesia for an elective caesarean section were examined. Anesthesia was induced with 4 mg/kg thiopental and 1 mg/kg succinylcholine, and then followed with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min. Before administration of succinylcholine, a tourniquet was applied to the free arm and inflated to 250 mmHg. Responsiveness to verbal commands using the Tunstall isolated forearm technique was detected and the BIS was monitored throughout the study period. RESULTS: The incidence of responsiveness to verbal commands were 33% at the time of skin incision and fetal delivery respectively. BIS values of response to commands were significantly higher than that of no respose at both time points (p < 0.05). Fisher's exact test suggested that the BIS value less than 75 was related to unresponsiveness to verbal commands at time of skin incision (p < 0.05) and the BIS less than 85 at fetal delivery (p < 0.05). CONCLSIONS: These results suggest that adequate anesthesia is not provided with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min at the time of skin incision and fetal delivery. In addition BIS could be a predictor of awareness during cesarean section under general anesthesia.
Subject(s)
Female , Humans , Pregnancy , Anesthesia , Anesthesia, General , Arm , Cesarean Section , Consciousness Monitors , Enflurane , Forearm , Incidence , Pain Perception , Skin , Succinylcholine , Thiopental , Tourniquets , WakefulnessABSTRACT
A prospective study was conducted to evaluate the storage period and sterility of placental blood from neonates delivered by caesarian section. Following caesarian section of the infant and placenta, the placenta was immediately placed in a sterile tray and the umbilical cord near the clamps was rinsed with sterile saline and cut 2 cm below the clamps with sterile scissors. An Fr 8 feeding tube was inserted into an umbilical vein and 43 ml of placental blood was drawn into a 50 ml disposable syringe which contained 7 mls of CPDA-1 solution. Five-ml aliquots of blood retrieved from the placenta were inoculated into aerobic and anaerobic blood culture bottles. Sixty-four specimens of CODA-1 anticoagulant blood were retrieved from the placenta and evaluated for biochemical changes to determine the recommended storage period. The mean plasma potassium concentrations were 4.9 + 1.1, 9.1 + 2.6, 13.1 + 2.0 mM/l at 0, 48 and 72 hours after collection, respectively. The 72-hour potassium concentration was higher than the value in adult whole blood stored for 7 days, which is considered fresh blood and recommended for transfusing newborn infants. The 107 paired aerobic/anaerobic culture specimens showed an overall contamination rate of 13%. These findungs suggest that placental blood in CPDA-1 can be stored for 48 hours for autologous transfusion and that rinsing the umbilical cord in sterile saline cannot prevent bacterial contamination in the retrieved placental blood.