The effect of guided imagery on pain levels in post-caesarean section patients

Background: Cesarean section is one form of surgical procedure involving incision of the abdominal and uterine walls, which poses a risk of postoperative pain. Pain is a common issue experienced by women after cesarean section, particularly within the first 48 hours. Uncontrolled pain can lead to physical and psychological complications such as postpartum depression and difficulties in infant care. Pain management may involve pharmacological therapy, but non-pharmacological alternatives such as relaxation therapy like guided imagery need to be explored, which can help reduce post-cesarean section pain. Methods: This study is experimental, utilizing a randomized controlled trial pre-test and post-test control group double-blind design. The research was conducted from July to September 2022. A simple randomized sampling technique was employed, with a sample size of 32 post-cesarean section patients divided into two groups: the treatment group (guided imagery and standard therapy) consisting of 16 patients, and the control group (standard therapy) consisting of 16 patients. Results: The study revealed a decrease in visual analogue score (VAS) scores by -2.875�619 with an effect size of 0.641 in the treatment group. The study had a significant impact with a p value of 0.000 (p<0.05). Conclusions: Guided imagery is effective in reducing the pain level of post-cesarean section patients.

Anestesia combinada espinal-epidural en dos segmentos para cesárea en gestante con arteritis de Takayasu: reporte de caso y revisión de la literatura / Two-segment combined spinal-epidural anesthesia for cesarean section in a pregnant woman with Takayasu arteritis: case report and literature review

Resumen: Reportamos el manejo anestésico de una gestante con múltiples comorbilidades debido a arteritis de Takayasu programada para cesárea electiva con la autorización del comité de ética institucional. Se utilizó una técnica combinada espinal-epidural en dos segmentos para suministrar anestesia con la titulación estricta de la presión arterial invasiva y el uso de una infusión endovenosa de norepinefrina. Asimismo, se realizó una revisión sobre el uso de la técnica combinada en dos segmentos para cesárea en gestantes con esta enfermedad.

Abstract: We report the anesthetic management of a parturient with Takayasu arteritis and several comorbidities scheduled for elective cesarean section with the authorization of the institutional ethics committee. A two-segment combined spinal-epidural technique was used to provide anesthesia with close control of invasive arterial pressure and the use of Norepinephrine endovenous infusion. Likewise, a literature review of the two-segment combined technique for cesarean section in pregnant women with this disease was performed.

Factores asociados a cesárea en usuarias de una clínica privada en Chile, años 2018 a 2022 / Factors associated with cesarean section in users treated at a private clinic in Chile, years 2018 to 2022

Introducción: De acuerdo con lo reportado por la Organización para la Cooperación y el Desarrollo Económico, Chile posee una de las tasas más altas de cesárea para el continente, llegando a un 44,7% en 2013 y un 47,7% en 2017, ubicándose en tercer lugar, solo precedido por Turquía y México. Objetivo: Analizar los factores relacionados a intervención de cesárea en las mujeres que atendieron su parto en una clínica privada de la Quinta Región de Chile entre los años 2018 y 2022. Método: Estudio transversal analítico en 9041 usuarias. Se utilizó un modelo de regresión logística con odds ratio y sus intervalos de confianza del 95% para evaluar la asociación con variables sociodemográficas y obstétricas. Resultados: La prevalencia de cesárea fue del 85,1% en el periodo estudiado. La condición de gestante primípara, la cesárea previa, la presencia de patología materna o fetal, la ausencia de trabajo de parto y la esterilización quirúrgica presentaron mayor probabilidad de cesárea, mientras que para la edad gestacional, menor o igual a 36 semanas, ésta fue menor. Conclusiones: Destaca un alta prevalencia de cesáreas para el periodo de estudio, superior a lo reportado en la literatura.

Introduction: According to the Organisation for Economic Co-operation and Development, Chile has one of the highest caesarean section rates on the continent, reaching 44.7% in 20132 and 47.7% in 20173 , ranking third only to Turkey and Mexico. Objective: Analyze the factors related to cesarean section intervention in women who delivered in a private clinic in the Fifth Region of Chile, from 2018 to 2022. Method: Cross-sectional study involving 9,041 users. A logistic regression model with odds ratio and its 95% confidence intervals was used to assess associations with sociodemographic and obstetric factors. Results: The prevalence of cesarean section during the study period was 85.1%. Primiparous status, previous cesarean section, presence of maternal and fetal pathology, absence of labor and surgical sterilization were associated with an increased likelihood of cesarean section, while gestational age 36 and under weeks showed a decreased chance. Conclusions: A high prevalence of cesarean sections stands out for the study period, higher than that reported in the literature.

Prevalence and determinants of cesarean section in a rural tertiary care hospital of Bangladesh

Background: Cesarean section (CS) stands as the foremost major surgical procedure in contemporary obstetrics. Initially developed primarily to safeguard maternal life during challenging childbirth scenarios, its prevalence has shown a concerning upward trajectory in recent times. The aim of this study was to investigate the prevalence and determinants of Cesarean section deliveries in a rural tertiary care hospital.Methods: This was a retrospective observational study and was conducted in the Department of Obstetrics and Gynaecology of Khwaja Yunus Ali Medical College & Hospital, Sirajganj, Bangladesh during the period from January 2018 to December 2019.Results: Out of a total of 1600 deliveries, 390 (24.4%) were vaginal deliveries, while 1210 (75.6%) were cesarean sections respectively. Majority 94.8% patients were 20-34 years old, 1.8% were less than or equal to 19 years and 3.4% were great than or equal to 35 years old respectively. The majority of cesarean sections, 814 (67.3%), were performed as elective procedures and 396 (32.7%) were performed as emergency procedures respectively. Majority 512 (42.3%) were performed on women who had a history of previous cesarean deliveries, 34 (2.8%) were performed due to non-progression or prolonged labor, 99 (8.2%) were performed due to malpresentation of the baby and 308 (25.5%) were performed at the request of the mother respectively.Conclusions: In conclusion, this retrospective observational study provides valuable insights into the prevalence and determinants of caesarean sections in a rural tertiary care hospital.

Partos y cesáreas en edad de riesgo en hospitales del Maule desde 2017 a 2021 / Births and cesarean sections at risk age in Maule hospitals from 2017 to 2021

Pregnancy, despite being a physiological process, can lead to morbidity and mortality, which is increased at risk ages, defined as younger or equal to15 years and older or equal to 35 years. For an adequate approach it is necessary to know the local reality of the population, therefore, the objective of this study is to describe and analyze the discharges of births and cesarean sections at risk age in the Maule Region from 2017 to 2021 using the database collected from the Biostatistics Unit of the Maule Health Service, which includes the hospitals of the region. Within the observed period, a total of 30,599 deliveries and cesarean sections were studied, being these a total of 5,581 at risk age, of which 0.65% corresponds to women younger or equal to 15 years and 17.57% to women older or equal to 35 years. There is a downward tendency in births in general, mostly evidenced in less or equal to 15 years, and on the contrary, a rise in births and cesarean sections of more or equal to 35 years, differing with the statistics at the country level. The tendency of increasing maternal age of pregnancies in the Maule region and its consequences are a fundamental factor when planning new public policies, so we consider it of vital importance to promote research and update the evidence, with a focus on the local population.

El embarazo a pesar de ser un proceso fisiológico puede conllevar morbimortalidad, la cual se acrecienta en edades de riesgo, definida como menor o igual a 15 años y mayor o igual a 35 años. Para el adecuado enfrentamiento se necesita conocer la realidad local, por ello, el objetivo de este estudio es describir y analizar los egresos de partos y cesáreas en edad de riesgo en la Región del Maule desde el año 2017 a 2021 utilizando la base de datos recogida desde la Unidad de Bioestadística del Servicio de Salud Maule, la cual incluye los hospitales de la región. Dentro del periodo observado se estudió un total de 30.599 partos y cesáreas, siendo estos un total de 5.581 en edad de riesgo, de los cuales 0.65% corresponde a mujeres menores o igual a 15 años y 17.57% a mujeres mayores o igual a 35 años. Existe una tendencia a la baja de los nacimientos en general, mayormente evidenciado en menores o igual a 15 años, y por el contrario, un alza en los partos y cesáreas de mayores o igual a 35 años, difiriendo con las estadísticas a nivel país. El aumento de la edad materna de los embarazos en la región del Maule y sus consecuencias son un factor fundamental a la hora de planificar nuevas políticas públicas, por lo que consideramos de vital importancia promover la realización de investigaciones y actualización de la evidencia sobre el tema, con un enfoque en la población local.

Comparison of risk factors of postpartum hemorrhage among normal versus cesarean delivery cases at a secondary care center in Naogaon

Background: Postpartum hemorrhage (PPH) involves excessive blood loss of 500 mL or more after vaginal delivery (NVD) or 1,000 mL or more after cesarean section within 24 hours postpartum. PPH significantly contributes to maternal mortality worldwide. Understanding the diverse effects of distinct risk factors is essential for effective mitigation. This study aimed to compare the risk factors of PPH among normal versus cesarean delivery (CD) cases at 250 bed modernized general hospital.Methods: Conducted at the department of obstetrics and gynaecology, 250 bed modernized general hospital, Naogaon, Bangladesh, this prospective study investigated PPH in 100 women from 01 July, 2022 to 30 June, 2023. Participants were divided into two equal groups in number: Group A (normal vaginal delivery) and group B (caesarean-section delivery). Data collection and analysis were performed using MS office.Results: In terms of risk factors, group A saw 4% maternal ages <19 and >40, while group B had 4% and 8% respectively. Artificial reproductive technique use was 2% in group A and 4% in group B. Weight gain >15.0 kg during pregnancy was 8% in group A and notably higher at 20% in group B. Gestational age <36 weeks affected 14% in group A and 8% in group B.Conclusions: In normal vaginal deliveries, maternal age <19 years, gestational age <36 weeks, labor induction/augmentation by oxytocin and neonatal birth weight <2499 gm are prominent risk factors. For cesarean-section deliveries, maternal age >40, weight gain >15.0 kg, pre-eclampsia, and neonatal birth weight >3500 gm also pose significant risks.

A cross sectional study of indications and complications of primary cesarean section at District Hospital Patiala

Background: Caesarean section is one of the major oldest surgical procedure that has been performed all over world to save life of mother and fetus. The steadily increasing global rates of caesarean section have become one of the most debated topics in maternity care, as its prevalence has increased alarmingly in recent years. The aim is to assess the indications and complications of primary caesarean section in primigravida and multigravida.Methods: A cross sectional study carried out over a period of 1 year from April 2022 to March 2023, among 300 pregnant women from labour room in Mata Kaushalya District Hospital, Patiala by simple random sampling method.Results: Majority 54.7% of cesarean section were of primigravida and 45.3% were of multigravida. Maximum number of caesareans was between 26-30 yrs of age group. 68% women underwent emergency caesarean section and 32% underwent elective caesarean section. 6% underwent caesarean section at <37 weeks gestational age, maximum 83%caesarean section were at 37- 40 weeks gestational age and 11% caesarean section were at >40 weeks gestational age. Among primigravida, majority 35%were fetal distress, 24.29% CPD, malpresentation and malposition were 6.77%, 5.08% NPOL, 3.38% were placenta previa, 2.25% were IUGR, 3/177 (1.69%), severe oligohydroamnios 1.69%, preeclampsia and 1/177 (0.56%) were abruptio placenta. Among multigravida women 41.46% had most common indication was fetal distress, 2.43% had non progress of labour, 14.63% had malpresentations and malpositions.Conclusions: The proportion of primigravida undergoing primary Caesarean delivery was much more than multigravida. However, complications related to primary CS was much higher in multigravida.

Exploring the impact of early-term labor induction on cesarean section risk in gestational diabetes mellitus: insights from a tertiary care hospital study in Pakistan

Background: Gestational diabetes mellitus (GDM) is the most common endocrine disorder in pregnancy. It is associated with significant perinatal morbidity and mortality, therefore, an early-term delivery by routine induction of labor is proposed by some societies, to prevent/reduce these complications. Methods: This cross-sectional study was conducted between 1st January 2019 and 30th June 2020 at Aga Khan University Hospital, Pakistan to compare the pregnancy outcomes of patients with GDM when induced at 37, 38, and 39 weeks in comparison to women with GDM managed expectantly. The study included all women with singleton pregnancy and vertex presentation. Women induced after 41 weeks, previous cesarean delivery, placenta previa, major fetal anomalies, chronic maternal medical conditions that necessitate delivery, and those women presenting with spontaneous onset of labor were excluded. Data was analyzed in SPSS v.19. Results: A total of 293 women were included. The mean age of women was 27 years, and the mean BMI was 27.8 kg/m2. We found that women who were induced at earlier gestational weeks were managed with a combination of diet and pharmacological therapy in comparison to those induced at later gestational weeks and achieved glycemic control with diet and lifestyle modifications only. Around 77% of women required pharmacological therapy. The mode of delivery was not significantly different for women induced at different gestational weeks after 37 completed weeks. For neonatal outcomes, the birth weight was significantly greater for women induced at later gestational weeks. Conclusions: In women with gestational diabetes induced after 37 weeks at various gestational weeks, the mode of delivery is not significantly different.

Prevalence, common clinical presentations and severity patterns of post-dural puncture headache among parturients who underwent cesarean section using spinal anesthesia in western Uganda: a cross-sectional study

Background: Post-dural puncture headache is a complication of regional blocks that results from intentional dural puncture during spinal anesthesia and unintentional dural puncture during epidural anesthesia. The aim of the study was to determine the prevalence, common clinical presentations and severity of post-spinal puncture headache among parturients who underwent cesarean section using spinal anesthesia in western Uganda. Methods: A cross-sectional study was conducted on 249 mothers who were consecutively enrolled in their 3rd post-partum day during the period from April 2022 to July 2022 from postnatal ward of Fort portal Regional Referral Hospital. The data needed for analysis was gathered using pretested questionnaires. Data was entered into microsoft excel version 16, coded and transported into SPSS version 22 for analysis. Descriptive statistics was carried out using SPSS version 22.0. Results: The prevalence of post-dural puncture headache among parturients who underwent cesarean section using spinal anesthesia was 81 (32.5%). Commonest clinical presentation being front/back headache 59 (72.8%), worsened with upright posture 81 (100%), coughing/sneezing 81 (100%) and improved on lying flat position 81 (100%). The commonest form was mild one 35 (43.2%). Conclusions: This study revealed a high prevalence of post-dural puncture headache as compared to studies done in the region which mainly presented as frontal/back with the commonest form being mild.

Íleo biliar como causa de obstrucción intestinal en una paciente de 38 años con antecedentes de tres embarazos y cesárea: reporte de caso / Gallstone ileus-induced intestinal obstruction in a 38-year-old patient with a history of three pregnancies and cesarean section: a case report

RESUMEN La obstrucción intestinal inducida por íleo biliar es una condición rara pero significativa que se produce cuando una piedra en la vesícula se aloja en el tracto gastrointestinal. Entre los principales factores de riesgo para la obstrucción intestinal inducida por íleo biliar se encuentran la edad avanzada, el sexo femenino, la diabetes, los antecedentes de enfermedad biliar como cálculos biliares, así como procedimientos quirúrgicos previos relacionados con la vesícula biliar, como la colecistectomía. También el embarazo es un factor de riesgo conocido para la enfermedad de los cálculos biliares. En este artículo, se presenta el caso de una paciente de 38 años con antecedentes de tres cesáreas previas y sin comorbilidades aparentes. Antes de acudir al departamento de emergencias, la paciente experimentó dolor abdominal con cólico moderado en la parte inferior del abdomen durante dos días. El examen físico reveló sensibilidad abdominal difusa, predominantemente en la fosa ilíaca derecha, junto con signos de irritación peritoneal. Los análisis de laboratorio mostraron un recuento de leucocitos de 11 490 células/μl y una neutrofilia del 85,6 %. Después de una laparotomía exploratoria, se confirmó el diagnóstico sospechado de íleo biliar por cálculo. Se realizó una enterolitotomía y la paciente mostró un progreso posoperatorio favorable. En conclusión, es importante considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas relevantes y antecedentes médicos. Este reporte de caso subraya la importancia de considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas gastrointestinales y antecedentes de embarazo. El diagnóstico temprano y la intervención son cruciales para prevenir complicaciones graves.

ABSTRACT Gallstone ileus-induced intestinal obstruction is a rare but significant condition that occurs when a gallstone becomes lodged in the gastrointestinal tract. Major risk factors for gallstone ileus-induced intestinal obstruction include older age, female sex, diabetes, history of gallbladder disease such as gallstones, as well as previous gallbladder-related surgical procedures such as cholecystectomy. Pregnancy is also a known risk factor for gallstone disease. We present the case of a 38-year-old patient with a history of three cesarean sections and no apparent comorbidities. Prior to her visit to the emergency department, the patient experienced moderate colicky abdominal pain in the lower abdomen for two days. The physical examination revealed diffuse abdominal tenderness, predominantly in the right iliac fossa, along with signs of irritation of the peritoneum. Laboratory tests showed a leukocyte count of 11,490 cells/µl and neutrophilia of 85.6 %. Following an exploratory laparotomy, the suspected diagnosis of gallstone ileus was confirmed. An enterolithotomy was performed, and the patient experienced good post-surgical progress. In conclusion, it is important to consider gallstone ileus-induced intestinal obstruction among patients with relevant symptoms and medical history. This case report highlights the importance of considering gallstone ileus-induced intestinal obstruction among patients with gastrointestinal symptoms and a history of pregnancy. Early diagnosis and intervention are crucial to prevent serious complications.

Effects of oral carbohydrate drinks before cesarean section on maternal and infant outcomes / 复旦学报（医学版）

Objective To study the effect of drinking carbohydrate drinks before cesarean section on mothers and neonates,and to explore the application value of drinking carbohydrate drinks before cesarean section.Methods The clinical data of 206 singleton women who underwent selective cesarean section in Obstetrics and Gynecology Hospital,Fudan University from Jun 2020 to Jun 2021 were retrospectively studied.Patients were divided into enhanced recovery after delivery(ERAD)group and control group according to whether drinking carbohydrate drinks before cesarean section.A retrospective cohort study was conducted to analyze the effect of preoperative carb drinks on preoperative fluid supplementation,postoperative rehabilitation and neonatal prognosis.Results Among patients who fasted for less than 12 hours,the ERAD group had a lower fluid supplementation rate and a smaller average fluid supplementation volume compared to the control group(P＜0.05).The ERAD group had a lower rate of prokinetic agent using after surgery(P＜0.05).Among women without a history of abdominal surgery,the ERAD group had less blood loss 24 hours after surgery(P＜0.05).There were no significant differences in postoperative fever rate,incidence of nausea and vomiting,time of first flatus,neonatal apgar score,exit observation room neonatal blood,and neonatal neonatal intensive care unit(NICU)admission rate between the two groups.Among newborns with high-risk factors for hypoglycemia,the ERAD group had lower enter observation room neonatal blood compared to the control group,and a higher incidence of hypoglycemia(P＜0.05).Conclusion Oral intake of carbohydrate drinks before cesarean section may be beneficial in reducing fluid supplementation before elective cesarean section,promoting postoperative gastrointestinal function recovery,and reducing postoperative bleeding.However,it may be related to the occurrence of neonatal hypoglycemia.

Survey on Regional Hierarchical and Transferal Management of Severe Post-partum Hemorrhage in Beijing / 实用妇产科杂志

Objective:To assess the current state of care for Severe Postpartum Hemorrhage(SPPH)in refer-ral centers and non-referral centers,and to propose enhanced strategies for the regional prevention and manage-ment of SPPH.Methods:The clinical data of patients with SPPH,defined as postpartum blood loss≥1500 ml or transfusion of blood products≥1000 ml,in two districts of Beijing from January 2021 to June 2023 were retrospec-tively analyzed.A total of 201 cases of SPPH were included and they were divided into 125 cases in the referral center group and 76 cases in the non-referral center group based on whether they were city level referral centers.The clinical characteristics between these two groups were compared.Furthermore,a stratified analysis was con-ducted using a Logistic regression model to identify the risk factors associated with massive postpartum hemor-rhage,defined as postpartum hemorrhage≥4000 ml,transfusion requirements exceeding suspended red blood cells(RBC)>10 U and(or)plasma>1000 ml.Results:Analysis of cases presenting with SPPH between the two study groups showed that patients in the referral center group exhibited advanced maternal age,smaller gestation-al weeks at delivery and a higher proportion of high-risk factors compared to those in the non-referral center group,and the difference was statistically significant(P<0.05).The primary cause of SPPH in the referral center group was placental factors,while uterine atony was identified as the main factor in the non-referral center group,and this difference was statistically significant(P<0.05).Additionally,within the non-referral center group,there was a higher amount of blood loss during cesarean section,lower proportion of B-Lynch suture/vascular suture ligation,and higher proportion of uterine packing(P<0.05).Furthermore,compared to the referral center group,there were significantly higher incidences of plasma transfution volume,return to operating room for further inter-vention or exploratory laparotomy procedures after initial delivery and complications related to postpartum hemor-rhage observed in the non-referral center group(P<0.05).Moreover,it was noted that there were more cases of massive postpartum hemorrhagic disease reported in the non-referral center group than in the referral center group(P<0.05).In massive postpartum hemorrhage cases analyzed,referring centers had a higher percentage of patients presenting with multiple high-risk factors for postpartum hemorrhage during pregnancy when compared to non-referring centers(71.4%vs.33.3%,P<0.05).Placental factors accounted for majority causes leading to hemorrhage within referring centers(57.1%),whereas both uterine atony and placental factors played major roles within non-referring centers′cases(42.9%,28.6%).The multivariate Logistic regression analysis revealed that non-referral center delivery(aOR 3.47,95%CI 1.40-9.18)and a history of multiple intrauterine operations(aOR 12.63,95%CI 1.24-131.30)were identified as significant risk factors for massive postpartum hemor-rhage.Conclusions:The outcomes of high-risk pregnant women referral management in the region exhibit an im-provement,necessitating the reinforcement of training in non-referral midwifery institutions regarding identification of high-risk factors,surgical suture techniques,and comprehensive SPPH management to avert excessive bleed-ing and blood transfusion.

Effects of multiple shared decision-making mode on the mode of delivery for pregnancies with scarred uterus / 实用医学杂志

Objective To explore the effects of the multiple shared decision-making mode using a decision aid manual in conjunction with online labor and delivery decision support on the delivery mode for pregnant women with a scarred uterus.Methods A total of 94 women with scarred uterus who received prenatal care at a tertiary hospital from September 2019 to October 2022 were enrolled and assigned to experimental and control groups using the random number table method.The control group received standard prenatal education,and the experimental group received multiple shared decision-making interventions in addition to standard prenatal education.The degree of conflict in decision-making for delivery,preference for delivery mode,postpartum decision regret,and the final delivery mode between the two groups were compared,respectively.Results Following the multiple shared deci-sion intervention,decision conflict scores in the experimental group were significantly reduced(P<0.001).In the survey on delivery mode preferences,there was a reduction in the number of individuals in the experimental group expressing"uncertainty",and an increase in those choosing vaginal delivery.Ultimately,in the experimental group,30 women(68.2%)underwent cesarean sections,and 14(31.8%)had vaginal deliveries.The level of post-decision regret in the experimental group was lower than that in the control group(P<0.001).Conclusions Multiple shared decision-making for women pregnant with a scarred uterus could reduce the level of decision-making conflict,increase the willingness for vaginal delivery,and assist them in making rational and scientifically informed decisions regarding childbirth.

Umbilical cord milking on neonatal outcomes following cesarean section: a meta-analysis / 中华围产医学杂志

Objective:To evaluate the effect of umbilical cord milking (UCM) on neonatal outcomes after cesarean section.Methods:Chinese and English databases (including CNKI, Wanfang, China Biology Medicine Disc, VIP, Yiigle, PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and Google Scholar) and ClinicalTrials.gov were retrieved from the inception to July 2023. Randomized controlled trials regarding UCM in neonates from different races who were born by cesarean section were included. The outcomes were postnatal hemoglobin level, hematocrit value, peak serum bilirubin level, phototherapy, cord blood pH value, intraventricular hemorrhage, death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score. The risk of bias among the included studies was confined to low or possible risk according to the Cochrane Risk of Bias Assessment Tool 2.0. RevMan5.3 was used for meta-analysis, and subgroup analysis was performed among neonates with different gestational ages. The certainty of evidence was evaluated using the grades of recommendations assessment, development, and evaluation (GRADE) framework.Results:A total of 11 articles involving 2 347 neonates (1 322 full-term and 1 025 preterm infants) were included. Meta-analysis results showed that: (1) Compared with the immediate cord clamping, UCM increased the hemoglobin level within 24 h and 48-72 h after birth ( MD=1.40, 95% CI: 1.11-1.70, Z=9.32; MD=0.86, 95% CI: 0.69-1.02, Z=10.02, both P<0.01), hematocrit value within 24 h and 48-72 h after birth ( MD=2.73, 95% CI: 0.18-5.29, Z=2.09, P=0.04; MD=3.57, 95% CI: 2.29-4.85, Z=5.46, P<0.01). However, no significant differences were found in the peak bilirubin level, phototherapy, cord blood pH, and Apgar score at 1 and 5 min (all P>0.05). (2) Compared with delayed cord clamping, UCM increased the hemoglobin level ( MD=0.83, 95% CI: 0.75-0.91, Z=20.11, P<0.01) and hematocrit value ( MD=2.34, 95% CI: 1.25-3.43, Z=4.20, P<0.01) within 24 h after birth, but not in the hematocrit value at 48-72 h after birth ( MD=－0.38, 95% CI:－2.27-1.52, Z=0.39, P=0.70) or the peak bilirubin level ( MD=－0.65, 95% CI:－2.16-1.04, Z=0.69, P=0.49). Sensitivity analysis showed that for full-term neonates born by cesarean section, the peak bilirubin level in the UCM group was significantly lower than that in the delayed cord clamping group ( MD=－1.30, 95% CI:－2.26-0.34, Z=2.66, P<0.01). Still, the incidence of phototherapy, intraventricular hemorrhage (grade Ⅰ-Ⅳ), death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score at 1 min and 5 min showed no statistical differences (all P>0.05). Conclusions:UCM could increase the short-term postnatal hemoglobin and hematocrit levels in neonates born by cesarean section, which might prevent neonatal anemia in the short term without increasing the adverse neonatal outcomes. Little effects were observed on the peak bilirubin level, phototherapy, polycythemia, etc. More high-quality and large-sample randomized controlled trials are needed in the future.

Effect of dexmedetomidine combined with chloroprocaine on epidural anesthesia for cesarean section / 中国基层医药

Objective:To investigate the effect of dexmedetomidine combined with chloroprocaine on epidural anesthesia for cesarean section.Methods:A total of 133 women who underwent epidural anesthesia for cesarean section at the Department of Anesthesiology, Jinhua People's Hospital between January 2020 and December 2022 were included in this prospective case-control study. These women were divided into a ropivacaine group ( n = 66) and a chloroprocaine group ( n = 67) using a random number table method. The ropivacaine group received epidural anesthesia with dexmedetomidine combined with ropivacaine, while the chloroprocaine group received epidural anesthesia with dexmedetomidine combined with chloroprocaine. The anesthesia effect (anesthesia onset time, anesthesia duration, peak effect time), changes in blood pressure (systolic blood pressure, diastolic blood pressure), adverse reactions (shivering, nausea and vomiting, urinary retention, skin itching, numbness of lower limbs), and satisfaction with muscle relaxation were observed in the two groups. Results:The anesthesia onset time, anesthesia duration, and peak effect time in the chloroprocaine group were (6.91 ± 1.54) minutes, (61.54 ± 5.31) minutes, and (11.79 ± 4.12) minutes, respectively, which were significantly shorter than those in the ropivacaine group [(9.65 ± 1.92) minutes, (83.57 ± 6.69) minutes, (18.32 ± 4.81) minutes, t = 9.08, 21.05, 8.41, all P < 0.001). The systolic and diastolic blood pressure increased in both groups after 10 minutes of anesthesia and at the end of the procedure; however, the increments observed in the chloroprocaine group were relatively smaller. There were significant differences in systolic and diastolic blood pressure, measured at 10 minutes of anesthesia and at the end of the procedure, between the two groups ( F = 7.36, P < 0.001; F = 5.12, P = 0.001). There were significant differences in systolic and diastolic blood pressure between different time points ( F = 10.03, P < 0.001; F = 6.72, P < 0.001). The group-by-time interaction effect on systolic and diastolic blood pressure was also highly significant ( F = 9.83, P < 0.001; F = 8.01, P < 0.001). The chloroprocaine group exhibited a significantly lower incidence of adverse reactions compared with the ropivacaine group [4.48% (3/67) vs. 15.15% (10/66), χ2 = 4.29, P < 0.05). Additionally, the chloroprocaine group had a significantly higher satisfaction rate with muscle relaxation compared with the ropivacaine group [94.03% (63/66) vs. 81.82% (54/66), Z = 5.73, P < 0.05]. Conclusion:The combination of dexmedetomidine and chloroprocaine offers remarkable benefits in epidural anesthesia for cesarean sections. This combined approach not only enhances epidural anesthesia but also stabilizes the blood pressure of puerperants, reduces adverse reactions, and provides exceptional muscle relaxation. It deserves consideration for clinical application.

Intraoperative cell salvage in cesarean delivery of women with placenta previa:a meta-analysis / 中国输血杂志

【Objective】 To systematically evaluate the safety and efficacy of intraoperative cell salvage (IOCS) for placenta previa women undergoing cesarean section. 【Methods】 The PubMed, Web of Science, Embase, the Cochrane Library of clinical trials, China National Knowledge Infrastructure (CNKI) and Wan Fang databases were searched from inception to September 2022. The standardized mean differences (SMDs) or relative risk (RR) and 95% confidence intervals (CIs) and prediction intervals (PIs) regarding the comparison between the IOCS and allogeneic blood transfusion (ABT) groups were analyzed using R software Version 4.1.2 and Stata Version 12.0. 【Results】 Five RCTs and ten retrospective cohort studies were included in this meta-analysis. Analysis of cohort studies showed that compared with the ABT group, women with placenta previa who underwent IOCS had generally higher postoperative hemoglobin (Hb) (SMD, 0.626; 95% CI: 0.103 to 1.149; 95% PI: -1.320 to 2.572) and hematocrit (Hct) (SMD, 0.617; 95% CI: 0.130 to 1.104; 95% PI: -1.084 to 2.317) levels. In RCTs, we observed that placenta previa women undergoing IOCS were almost 72.7% less likely to suffer from adverse events AEs than the ABT group (RR, 0.273; 95% CI, 0.082 to 0.904). The difference in postoperative prothrombin time (PT), activated prothrombin time (APTT), fibrinogen (Fib) concentration, blood urea nitrogen (BUN) and creatinine (Cr) between the IOCS and ABT group did not reach statistical significance. 【Conclusion】 Women with placenta previa who undergo IOCS have higher postoperative Hb and Hct concentrations compared to those treated with ABT. IOCS has no major effects on postoperative coagulation parameters and renal function parameters. IOCS is associated with a significantly lower risk of transfusion-related AEs among women undergoing cesarean section.

Evaluation of the efficacy of removing uterine fibroids during cesarean section / 中国现代医生

Objective To evaluate the therapeutic effect of removing uterine fibroids by binding the lower segment of uterus with pressure pulse band and blocking uterine blood supply combined with various suture methods during cesarean section.Methods A total of 260 cases of pregnant women undergoing elective cesarean section due to cicatricial uterus treated in Ningbo Women and Children's Hospital from 2015 to 2020 were selected.They were divided into two groups using the random number table method.In study group of 130 cases,the lower section of the uterus was bound with compression vein band and uterine fibroids were removed during cesarean section.In control group,130 cases underwent pure cesarean section.Through consulting patients'medical records and telephone visits,the general data,operation related data and postoperative recovery data of patients were collected and compared.Results The operation time in study group was longer than that in control group[(72.01±22.63)min vs.(58.78±11.64)min],the amount of intraoperative blood loss was higher than that of control group[(543.52±294.79)ml vs.(412.46±98.49)ml],the proportion of postoperative fever was higher than that of control group(10.0％vs.0.8％),and the postoperative hospital stay was longer than that of control group[(5.13±1.23)d vs.(4.47±0.72)d],the difference was statistically significant(P<0.05),and there was no statistically significant difference in postoperative exhaust time[(16.07±4.90)h vs.(16.14±4.93)h],the difference was not statistically significant(P>0.05).There were no cases of re-operation or death in both groups,and the newborns were all in good condition.Conclusion In the course of cesarean section,binding the lower segment of the uterus with pressure pulse band combined with various suture methods to remove uterine fibroids,although increased intraoperative blood loss,operation time,postoperative fever incidence,hospital stay,but can help patients solve uterine fibroids disease at the same time,and without serious complications.

Clinical analysis of low forceps midwifery assistance in persistent occiput posterior dystocia / 中国现代医生

@#Objective To discuss the clinical effect of low forceps midwifery in persistent occiput posterior dystocia.Methods A retrospective analysis of 120 parturients with persistent occiput posterior dystocia were admitted to Yangzhou Maternity and Child Health Care Hospital from October 2020 to March 2023.70 cases with lower uterine cesarean section were in group A.20 cases with lower forceps midwifery were in group B.30 cases with spontaneous deliveries were in group C.Results The postoperative hospitalization time and hospitalization cost of group A were significantly higher than those of group B and group C(P<0.05).In both groups A and B,the intrapartum bleeding volume was higher than that in group C(P<0.05),but there was no significant difference in groups A and B(P>0.05);There was no significant difference in birth canal injury between groups B and C(P>0.05).Neonatal birth injuries were not significantly different among the three groups(P>0.05).Conclusion It's important for us to assist the pregnant woman of persistent occiput posterior dystocia in a natural delivery with proper management.The application of low forceps delivery midwifery can reduce the postoperative hospital stay and hospitalization cost,and does not increase the incidence of birth canal injury and neonatal birth injury.

Taxa e custos médicos diretos de cesáreas em beneficiárias da saúde suplementar no estado de São Paulo, Brasil: 2015 a 2021 / Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021

Resumo O Brasil tem a segunda maior taxa de cesárea do mundo. Há diferença dessas taxas nos setores públicos e privados. Foram utilizados dados de internação de beneficiárias residentes no estado de São Paulo, internadas entre 2015 e 2021, com idades entre 10 e 49 anos, para verificar as taxas e custos das cesáreas no setor privado. Foi realizado estudo parcial de avaliação econômica em saúde na perspectiva da saúde suplementar considerando custos médicos diretos de internação. Foram analisadas 757.307 internações, com gasto total de R$ 7,701 bilhões. As taxas de cesáreas foram de 80% no período. São menores nas gestantes mais novas (69%) e maiores nas mais velhas (86%), e sempre superiores a 67%. Essa população tem taxas 71% maiores do que aquelas do SUS. Há maior proporção de internações com uso de unidade de terapia intensiva nas cesáreas. O custo mediano da cesárea é 15% maior do que o parto normal e são duas vezes maiores nas seguradoras do que nas cooperativas médicas. Há oportunidade de aplicação de políticas públicas de saúde amplamente utilizadas no Sistema Único de Saúde visando a redução das taxas, dos custos diretos da internação e dos planos de saúde.

Abstract Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

Trend of incompleteness of the Robson Classification variables in the Live Birth Information (SINASC) in the state of Paraná, Brazil, 2014-2020 / Tendencia de incompletitud de variables de Clasificación de Robson en el Sistema de Información de Nacidos Vivos en Paraná, 2014-2020 / Tendência de incompletude das variáveis da Classificação de Robson no Sistema de Informação sobre Nascidos Vivos (Sinasc) no estado do Paraná, 2014-2020

ABSTRACT Objective: To assess the incompleteness of the Robson Classification variables in the Live Birth Information System (Sistema de Informação sobre Nascidos Vivos - SINASC), in the state of Paraná, and its trend, 2014-2020. Methods: This was a time-series study that analyzed six variables, according to health macro-regions. Incompleteness was classified (percentage of "ignored" and "blank fields") as follows: excellent (< 1.0%); good (1.0-2.9%); regular (3.0-6.9%); poor (≥ 7.0%). Prais-Winsten regression was used to estimate trends. Results: A total of 1,089,116 births were evaluated. The variable "cesarean section before the onset of labor" was classified as poor in 2014 (39.4%) and 2015 (44.3%) in the state and in all macro-regions, but with a decreasing trend in incompleteness. The variables "gestational age" in the North and Northwest macro-regions, and "parity" and "number of fetuses" in the Northwest macro-region showed an increasing trend. Conclusion: Most of the variables evaluated showed low percentages of incompleteness with a decreasing trend, but there is a need to improve the completion of some variables.

RESUMEN Objetivo: Evaluar la incompletitud de las variables de la Clasificación de Robson en el Sistema de Información de Nacidos Vivos (SINASC) de Paraná y su tendencia, 2014-2020. Métodos: Estudio de series temporales que analizó seis variables, según macrorregiones de salud. La incompletitud (percentaje de campos "ignorados" y "en blanco") se clasificó como: excelente (< 1,0%); buena (1,0-2,9%); regular (3,0-6,9%); mala (≥ 7,0%). Se utilizó la regresión de Prais-Winsten para estimar tendencia. Resultados: Se evaluaron 1.089.116 nacimientos. "Cesárea antes del inicio del trabajo de parto" se clasificó como mala en 2014 (39,4%) y 2015 (44,3%) en Paraná y en todas las macrorregiones, pero con tendencia decreciente de incompletitud. Las variables "edad gestacional", "paridad" y "número de fetos" mostraron tendencia creciente. Conclusión: La mayoría de las variables evaluadas mostraron porcentajes bajos de incompletitud, con una tendencia decreciente, pero es necesario mejorar el cumplimiento de algunas variables que mostraron una tendencia creciente de incompletitud.

RESUMO Objetivo: Avaliar a incompletude das variáveis da Classificação de Robson no Sistema de Informação sobre Nascidos Vivos (Sinasc) do Paraná e sua tendência, 2014-2020. Métodos: Estudo de séries temporais que analisou seis variáveis, segundo macrorregionais de saúde. Classificou-se a incompletude (percentual de campos "ignorados" e "em branco") em: excelente (< 1,0%); bom (1,0-2,9%); regular (3,0-6,9%); ruim (≥ 7,0%). Utilizou-se regressão de Prais-Winsten para estimar tendências. Resultados: Foram avaliados 1.089.116 nascimentos. A variável "cesárea antes do trabalho de parto iniciar" classificou-se como ruim, em 2014 (39,4%) e 2015 (44,3%), no estado, e em todas as macrorregionais, porém com tendência decrescente de incompletude. As variáveis "idade gestacional" no Norte e Noroeste, e "paridade" e "número de fetos" no Noroeste apresentaram tendência crescente. Conclusão: A maioria das variáveis avaliadas mostrou baixos percentuais de incompletude com tendência decrescente, mas é preciso melhorar o preenchimento de algumas variáveis.