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Resumen Introducción: Tanto a nivel sudamericano como mundial, el incremento de la tasa de cesáreas electivas ha sido abrumante. Esto se considera un problema de salud pública, ya que el parto vaginal es la vía más fisiológica para el nacimiento y trae beneficios de salud para la madre y el recién nacido, tanto inmediatos como a futuro. Objetivo: Evaluar la postura de mujeres nuligestas en edad fértil acerca de las vías del parto a través de sus conocimientos, percepciones y preferencias. Método: Estudio de corte transversal. Se aplicó una encuesta a estudiantes universitarias para la recopilación de datos mediante SPSS, y análisis con prueba de diferencias de proporciones y de χ2. Resultados: 210 mujeres encuestadas. Un 80% de ellas desconoce la menor morbilidad infantil asociada a un parto vaginal, más de la mitad estima una ventaja de la cesárea que evite el dolor y un gran porcentaje desconoce los riesgos médicos asociados a la cesárea. Conclusiones: Existe un alto nivel de desconocimiento respecto a beneficios, riesgos y consecuencias de las diferentes vías del parto.
Abstract Introduction: Both in South America and worldwide, the increase in the rate of elective caesarean sections has been overwhelming. This is considered a public health problem, since vaginal delivery is the most physiological route for birth and brings health benefits for the mother and the newborn, immediately and in the future. Objective: To evaluate the position of nulliparous women of childbearing age regarding the delivery pathways through their knowledge, perceptions, and preferences. Method: Cross-sectional study with an analytical component. A survey was applied to university students for data collection through SPSS, and analysis was made with the difference of proportions and χ2 test. Results: 210 women surveyed; 80% of them are unaware of the lower infant morbidity associated with a vaginal delivery, more than a half estimate an advantage of a cesarean section that it avoids pain, and a large percentage are unaware of the medical risks associated with cesarean sections. Conclusions: There is a high level of ignorance regarding the benefits, risks and consequences of the different delivery routes.
Subject(s)
Humans , Female , Adult , Young Adult , Students/psychology , Health Knowledge, Attitudes, Practice , Delivery, Obstetric/psychology , Reproductive Behavior/psychology , Parity , Perception , Universities , Cesarean Section/psychology , Cross-Sectional Studies , Surveys and Questionnaires , Age Factors , Parturition/psychology , Fertile PeriodABSTRACT
Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n=129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR]=1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR=1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR=2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR=0,732; 95%CI: 0.240-2.232), TTN (OR=0.959; 95%CI: 0.297--3.091), and NIUC admission (OR=0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.
Subject(s)
Humans , Female , Pregnancy , Prenatal Care/methods , Respiratory Distress Syndrome, Newborn/prevention & control , Cesarean Section/adverse effects , Adrenal Cortex Hormones/administration & dosage , Elective Surgical Procedures/adverse effects , Pregnancy Outcome , Intensive Care Units, Neonatal , Retrospective Studies , Gestational Age , Transient Tachypnea of the Newborn/prevention & control , Length of StayABSTRACT
Background: While the role of antenatal steroids administration to mother is proved in reducing neonatal morbidity and mortality in preterm gestation secondary to respiratory distress and hyaline membrane disease its role in patients undergoing elective cesarean deliveries at or near term appears to be controversial.Methods: This was a retrospective observational study in which women who have undergone elective cesarean delivery between 34-37 weeks of gestation were included. Those women who received two intramuscular injections of 12 mg betamethasone 24 h apart were included in group S whereas the women who didn’t receive such injections were included in group B. Outcome measures were incidence of transient tachypnea of the newborn, hyaline membrane disease and NICU admissions due to respiratory distress.Results: Neonates in the treatment group had a statistically significant lower overall incidence of transient tachypnea of newborn, respiratory distress syndrome and NICU admissions. The incidence of transient tachypnea of newborn and respiratory distress in Group S was 5% and 8.33% respectively where as TTN and respiratory distress was seen in 18.33% and 28.33% neonates in the group N. The over NICU admission rates, due to respiratory distress in group S and Group N were found to be 8.33% and 28.33% respectively.Conclusions: Antenatal administration of corticosteroids to women at or near term (34-37 weeks) is found to have a beneficial effect in reducing neonatal morbidity and NICU admissions secondary to respiratory distress in women undergoing elective CS.
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Background: Postpartum hemorrhage is the ugly ghost that most obstetricians believe because many cases unpredicted and may be associated with rapid patient deterioration that may lead mortality or developing serious long-term morbidities. The objective of this study is to assess the efficacy of slowly intravenous administration of tranexamic acid in prevention and decline the severity of postpartum hemorrhage immediately prior to elective caesarean section.Methods: A double blinded, randomized, case control trial carried out at Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt from May 2017 to April 2018. This study was conducted on 500 full term pregnant women underwent elective caesarean section. The patients were divided randomly into: Group A (study group) included 250 patients received tranexamic acid 1gm slowly iv over 2 minutes at least 10 minutes before operation started and Group B (control group) included 250 patients that received placebo (normal saline NaCl 0.9%).Results: Incidence of PPH in group A and group B were (4.4% and 6.8) respectively, 1.2% in group A and 2.8% in group B had severe degree of PPH. Amount of blood loss immediately after placental delivery up to first 6 hours postoperative was statistically significant increase in placebo group than tranexamic acid group with p value <0.001.Conclusions: Tranexamic acid administration few minutes prior to elective cesarean section was effective in reducing the incidence and severity of PPH and decreased the use of additional uterotonic drugs and additional surgical interventions.
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La hipotensión materna es una complicación común de la anestesia raquídea durante la cesárea. El bloqueo de receptores de serotonina 5-HT podría reducir la incidencia de hipotensión y el uso de vasopresores. Objetivo: eficacia del ondansetron como prevención de hipotensión materna posterior a anestesia raquídea. Métodos: un total de 72 pacientes de forma aleatorizada, ensayo clínico y simple ciego. Se administró ondansetron 5 minutos antes del bloqueo anestésico. Grupo O4 (4 mg), grupo O8 (8 mg) y grupo P (placebo) en jeringa de 10 ml, se midió frecuencia cardiaca, presión arterial media, nivel de dermatoma alcanzado, las puntuaciones de Apgar y complicaciones maternas. Resultados: existe diferencia significativa entre los grupos en cuanto a la incidencia de hipotensión y se observó que el requerimiento de vasopresor fue menor en el grupo O8 (p= 0,000), los eventos adversos maternos (p= 0, 087), fueron menores cuando se aplica ondansetron. Las puntuaciones del APGAR fueron similares en los grupos (p= 0,373). Conclusiones: se determina; que el uso de ondansetron atenúa la incidencia de hipotensión aunque no está claro la dosis exacta en las pacientes obstetras, además queda claro es que también disminuye el requerimiento de vasopresor, los efectos adversos como ser prurito, náuseas y vómitos. Limitaciones cantidad de pacientes de estudio y análisis gasométrico por falta de insumo en el hospital.
Maternal hypotension is a common complication of spinal anesthesia during cesarean section. Blocking serotonin 5-HT receptors could reduce the incidence of hypotension and the use of vasopressors. Objetive: efficacy of ondansetron as prevention of maternal hypotension after spinal anesthesia. Methods: a total of 72 patients randomized, clinic ensay and single-blind. Ondansetron was administered 5 minutes before the spinal anesthetic. Group O4 (4 mg), group O8 (8 mg) and group P (placeb) in a 10 ml syringe were measured heart rate, blood pressure mean, dermatome level reached, Apgar scores and maternal complications. Results: there was significant difference between the groups in terms of the incidence of hypotension and it was observed that the vasopressor requirement was lower in group O8 (p = 0,000), maternal adverse events (p = 0.087) were lower when ondansetron is applied. APGAR scores were similar in the groups (p = 0, 373). Conclusion: use of ondansetron is determined to attenuate the incidence of hypotension although the exact dose in obstetric patients is not clear, it is also clear that it also decreases the vasopressor requirement, adverse effects such as pruritus, nausea and vomiting. Limitations number of study patients and gasometric analysis due to lack of input in the hospital.
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Anesthesia, Obstetrical , Anesthesia, Spinal/methods , PregnancyABSTRACT
Objective: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched. Methods: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs. Results: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. Conclusions: The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Cesarean Section/psychology , Fear/psychology , Parity , Self Concept , Socioeconomic Factors , Stress, Psychological , Cross-Sectional Studies , Surveys and Questionnaires , Gravidity , Parturition , IranABSTRACT
Resumen OBJETIVO Evaluar si los fetos extraídos por cesárea electiva de madres VIH positivas tienen menor frecuencia de positividad en una prueba rápida al nacimiento que los nacidos por vía vaginal. MATERIALES Y MÉTODOS Estudio retrospectivo, observacional y descriptivo. Se revisaron los casos de mujeres con prueba de VIH reactiva durante el embarazo que recibieron terapia profiláctica con antirretrovirales durante los años 2014-2016 en la Secretaría de Salud de México. Se analizan los casos con prueba reactiva al nacer y se comparan las repercusiones entre el parto y la cesárea. RESULTADOS Se analizaron 1261 nacimientos y a 1245 mujeres se les practicó cesárea y 16 tuvieron parto vaginal. Se registraron 103 recién nacidos reactivos al VIH. De estos, 87 nacieron por cesárea y 16 por parto vaginal. El 7% de los nacimientos por cesárea y 100% de los nacidos por parto vaginal tuvieron prueba de VIH reactiva. La embarazada con VIH, a quien se practicó cesárea electiva, mostró un riesgo relativo de .07 con IC95%: 0.06-0.09. El riesgo de que un recién nacido por cesárea electiva resultara con prueba reactiva a VIH fue de entre 6 y 9%. CONCLUSIONES La cesárea electiva reduce el riesgo de una prueba reactiva para VIH en el neonato. El 93% de los neonatos obtenidos por cesárea resultaron negativos a la prueba rápida de VIH. Todos los recién nacidos por vía vaginal tuvieron una prueba rápida reactiva a VIH, incluso con carga viral suprimida. Lo ideal es que al momento del nacimiento de su hijo la mujer con VIH tenga carga viral indetectable. Cuando no es así se sugiere optar por la cesárea electiva como indicación absoluta.
Abstract OBJECTIVE To assess whether neonates taken by elective cesarean from mothers infected with the Human Immunodeficiency Virus (HIV) have a lower frequency of positivity in a rapid test at birth than those born vaginally. MATERIALS AND METHODS Retrospective, observational, descriptive study. We reviewed the cases of women with reactive HIV test during pregnancy, who received prophylactic therapy with antiretroviral during the years 2014-2016. The cases are analyzed with reactive test at birth and results are compared between delivery and caesarean section. RESULTS In this studio, we analyzed 1,261 births, 1,245 women underwent caesarean section and 16 vaginal births. We observed 103 cases of babies with reactive HIV test at birth. Of these, 87 were born by caesarean section and 16 by vaginal delivery. 7% of births by caesarean section and 100% of those born by vaginal delivery, recorded reactive HIV test. The pregnant woman with HIV, who underwent elective cesarean section, showed a relative risk (RR) of .07 with a 95% confidence index (95% CI 0.06-0.09). The risk that a newborn by elective cesarean section present a reactive HIV test was between 6 and 9%. CONCLUSONS Elective cesarean reduces the risk of a reactive HIV test in the newborn. 93% of neonates obtained by caesarean section were tested negative for HIV. All neonates obtained vaginally presented a rapid test reactive to HIV even with suppressed viral load. The woman with HIV should ideally have undetectable viral load at birth. When it does not meet this requirement, it is suggested to consider the practice of an elective cesarean section as an absolute indication.
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Late preterm neonates have immature respiratory systems and higher incidence of respiratory distress syndrome compared with term neonates.With the increase rate of elective cesarean section world-wild,the association between elective cesarean section and late preterm neonates respiratory distress syndrome has attracted a huge attention.Clinical data have showed that the incidence of respiratory distress syndrome was significantly increased in late preterm neonates delivered by elective cesarean section.The delay of lung fluid movement dilutes the concentration of pulmonary surfactant and causes the alveolar collapse.Compared with early preterm neonates,the respiratory distress syndrome of late preterm neonates appears later with a worse reaction of pulmonary surfactant and higher incidence of complications.Thus,vaginal delivery of late preterm neonates is the optimal choice and early diagnosis and therapy of respiratory distress syndrome is very important.
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The rates of cesarean delivery are dramatically rising in many parts of the world due to the improved surgical techniques and broaden clinical indications,along with the inadequate recognition of potential disadvantages for neonates.This review is to investigate the short-term and long-term influence of elective cesarean section on neonatal outcomes,including neonatal respiratory morbidity,iatrogenic prematurity,postnatal development of the immune system and atopic disease.Althongh there is no evidence that cesarean section is an independent risk factor so far,present studies clearly demonstrate that it plays an important role concurrent with other factors in increasing neonatal morbidity and mortality.Consequently,efforts should be made to reduce high rate of elective cesarean sections through elaborate investigation of medical indications before the operation.
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Objective To study the application effect of clinical pathway in patients with elective caesarean section. Methods 64 patients with elective caesarean section were divided into the control group and the research group with 32 patients in each group.The control group was nursed by routine way,while the research group was nursed by clinical pathway.The satisfaction degree with nursing,puerperal infection rate,postpartum hemorrhage rate and rate of breast feeding were compared between the two groups. Results The satisfaction degree with nursing in the research group was much higher than the control group.The rate of postpartum hemorrhage in the research group was much less than the control group.The rate of breast feeding in the research group was much higher than the control group.The rate of postpartum infection in the research group was much less than the control group. Conclusions Application of clinical pathway for patients with elective caesarean section is a scientific and reasonable health education method.
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BACKGROUND: Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas the optimal dose of oxytocin at elective cesarean section is unclear. To determine the lowest effective dose of oxytocin, we studied the hemodynamic effects of three doses during spinal anesthesia for elective single cesarean delivery. METHODS: Sixty women received oxytocin by continuous (0.5 IU/min) or bolus-continuous (2 or 5 IU prior to 0.25 IU/min continuous intravenous injection) intravenous injection after clamping of the umbilical cord. We compared changes in heart rate (HR), mean arterial pressure (MAP) and estimated blood loss (EBL). Uterine tone (UT) was assessed by palpation on a linear analog scale (LAS) at 5, 10, 15, 20 and 25 minutes after the oxytocin injection. In addition, oxytocin-related side-effects such as nausea and vomiting were recorded. RESULTS: Marked hemodynamic changes such as HR and MAP occurred in the bolus-continuous groups but not in the continuous groups. Although we were not able to observe a variation of EBL in each group, the UT significantly increased in the bolus-continuous groups when compared with that the continuous groups. In addition, the hemodynamic changes such as HR and MAP were lower in the two IU bolus-continuous group than those in the five IU group. CONCLUSIONS: Although bolus-continuous injection of oxytocin resulted in more hemodynamic changes than continuous injection, bolus-continuous injection had a greater effect on uterine contraction. Furthermore, two IU bolus-continuous injection showed lower hemodynamic changes than in the five IU bolus-continuous injection.
Subject(s)
Female , Humans , Pregnancy , Anesthesia, Spinal , Arterial Pressure , Cesarean Section , Constriction , Heart Rate , Hemodynamics , Hypotension , Injections, Intravenous , Nausea , Oxytocin , Palpation , Tachycardia , Umbilical Cord , Uterine Contraction , VomitingABSTRACT
OBJECTIVE: The purposes of this study were to estimate the success rate of vaginal delivery after trial of labor (TOL) and to analyze the neonatal outcome of vertex-vertex (V-V) and vertex-nonvertex (V-NV) second twin according to the mode of delivery. METHODS: We reviewed retrospectively the medical records of V-V and V-NV twin delivered between December 1996 and February 2006. The patients were classified as TOL group and elective cesarean delivery (ECD) group to compare of the neonatal morbidity and mortality in second twin. Neonatal morbidity included intraventricular hemorrhage, respiratory distress syndrome, disseminated intravascular coagulopathy, sepsis, necrotizing enterocolitis, and birth trauma. Student t-test, Mann-Whtiney U test, Pearson's chi-square, and Fisher's exact were performed for the comparison of the neonatal outcome in second twin according to the groups. RESULTS: There are 349 eligible cases within given period. The proportions of TOL and ECD were 49% (n=170) and 51% (n=179), respectively. The success rates of vaginal delivery after TOL were 75% (n=93) in V-V twin and 70% (n=32) in V-NV twin. There were no significant differences in the neonatal outcome between TOL and ECD group. Additionally there were no significant differences in the neonatal outcome between cesarean delivery after the failure of TOL (n=45) and ECD group. CONCLUSION: Our results suggest that TOL in V-V and V-NV twin may be a safe method and can reduce the rate of ECD without adverse effect on neonatal outcome of second twin unless there are other obstetrical indications for cesarean delivery.
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Humans , Enterocolitis, Necrotizing , Hemorrhage , Medical Records , Mortality , Parturition , Retrospective Studies , Sepsis , Trial of Labor , TwinsABSTRACT
Aspiratian of gastric contents during anesthesia is the most common cause of maternal anesthetic death. Particularly, the parturient is predisposed to the catastrophe of aspiration for many reasons. So, the effect of cimetidine premedication on gastric pH and volume were studied. 120 ASA Class I patients scheduled for elective obstetric and gynecologic surgery were randomly divided into six groups as follows: Class A(n=80) is pregnant women scheduled for elective cesarean section. In the class A, group 1(n=20)(control group) was received no cimetidine premedication, group 2(n=20) was received cimetidine 300 mg p.o. hs. group 3(n=20) was received cimetidine 300 mg p.o. 2hrs before anesthesia, and group 4(n=20) was received cimetidine 200 mg iv 2hrs before anesthesia. Class B (n=40) is 20-40 aged non-pregnant women scheduled for elective surgery. ln the class B, group 5(n=20)(control group) was received no cimetidine premedication and group 6(n=20) was received cimetidine 200 mg iv 2hrs before anesthesia. Immediately following induction of anesthesia, the gastric fluid was obtained by suction on a nasogastric tube and its volume and pH were measured. The results were as follows: 1) When cimetidine is not premedicated, number of patient with a gastric pH less than 2,5 and gastric volume greater than 25 ml was increased in the group 1 compared with group 5. 2) In the class A, there was significant increased gastric pH and decreased gastric volume in the group 2, 3, and 4 compared with group l. 3) In the class B, there was significant increased gastric pH and decreased gastric volume in the group 6 compared with group 5. In conclusion, it would seem that the risk of aspiration pneumonitis can be increased in the pregnant women compared with nonpregnant women. The authors recommend that the incidence of severe aspiration pneumonia can be decreased by cimetidine premedication before general anesthesia even though there is any gastric aspiration.