Cesarean section does not reduce mother-to-infant transmission of hepatitis B virus / 中华围产医学杂志

Objective To investigate whether cesarean section on pregnant women with chronic hepatitis B virus (HBV) infection may reduce mother-to-infant transmission risk of HBV.Methods Preserved serum samples of pregnant women at 15-20 weeks of gestation which were collected from July 2002 to August 2004 in 14 counties of Jiangsu Province were analyzed retrospectively.These samples were tested for HBV serologic markers with enzyme immunoassay,and 419 cases of positive hepatitis B surface antigen (HBsAg) were found.HBV DNA level of these HBsAg-positive women were further quantitatively measured with real-time polymerase chain reaction assay.Children of these 419 HBsAg-positive mothers were followed up during October 2009 to March 2010 and 298 of them were contactable (71.1％),among which 281 were enrolled in final analysis as they had complete information and had been vaccinated with three regular doses of HBV vaccine during infantile period.The 281 children were tested for serum HBV markers.The HBV infection rate in these children at age 5-7 was compared between those born by cesarean setion (CS group,n =136) and by vaginal delivery (VD group,n=145).T-test,x2 test or Fisher's exact test was used to analyze relevant parameters.Results(1) Maternal HBeAg-positive rates [25.7％ (35/136) vs 34.5％ (50/145)],HBV DNA levels in HBeAg-positive women [(2.30 × 106) IU/ml vs (2.09× 106) IU/ml],the percentages of HBIG injection after birth [38.2％ (52/136) vs 35.9％ (52/145)],breastfeeding ratios [82.4％ (112/136) vs 75.9％ (110/145)],and children' s ages at the follow-up [(5.9 ± 0.8) vs (6.0±0.6)] were comparable between CS group and VD group (all P＞0.05).(2) Among these 281 children,272 (96.8％) were HBsAg-negative,9 (3.2％) were HBsAg-positive and 163 (58.0％) were anti-HBs-positive.The prevalence of HBsAg-positive [(2.9％ (4/136) vs 3.4％ (5/145)],HBsAg negative and anti HBc positive [0.0％ (0/136) vs 1.4％ (2/145)] and anti-HBs positive [57.4％(78/136) vs 58.6％(85/145)] in CS group were similar to those in VD group.Conclusions Cesarean section does not reduce the risk of mother-to-infant transmission of HBV.In clinical practice,elective cesarean section should not be suggested in order to prevent HBV vertical infection.

Effect of oxytocin on Tp-e and QTc interval during caesarean section / 中国医师进修杂志

Objective To evaluate the effect of oxytocin on Tp-e and QTc interval during caesarean section under spinal anesthesia in healthy puerperas. Methods Forty ASA Ⅰ puerperas were selected and allocated to receive oxytocin intravenous bolus group (group-IB) or oxytocin continuous infusion group (group-CI) with 20 puerperas in each by random digits table. An intravenous bolus of 5% glucose 5 ml and 5 U oxytocin was administered after delivery a 55-60 s period. A continuous infusion of 5% glucose 5 ml and 5U oxytocin was administered after delivery a 10 min period. Measured the QTc interval,Tp-e interval,mean arterial pressure (MAP) and beart rate ( HR ) pre-operatively, then 1,3 and 5 ain after spinal anesthesia, and at least 1,3,5 and 10 min after oxytocin injection. Results In group-IB:HR was fast 1 min after oxytocin injection compared with pre-operatively [(89 ± 13) beats/min vs. (73 ± 12) beats/min] ,MAP was decreased [(69 ± 12 ) mm Hg ( 1 mm Hg= 0. 133 kPa ) vs. ( 82 ± 13 ) mm Hg] and QTc interval was prolonged [(426 ±21 ) ms vs. (405 ± 18 ) ms] (P ＜ 0.01 ); but Tp-e interval was prolonged 1,3,5 min after oxytocin injection compared with pre-operatively (P ＜ 0.01 or ＜ 0.05 ). Conclusions Single large dose of oxytocin intravenous bolus (5 U) can prolong QTc interval and Tp-e interval in healthy puerperas, and Tp-e interval can exact predict the occurrence of ventricular arrhythmias. The risk-benefit balance of oxytocin bolus during caesarean delivery should be discussed with women with a history of long QT syndrome.

Postpartum Emphysematous Cystitis after Casarean Section

Emphysematous cystitis is a rare infectious condition of the urinary bladder. Underlying diabetes mellitus is present in over half of reported cases with women being affected twice as often as men. It also occurs in alcoholism, undernutrition, radiating and immunosuppressive treatments. We present a case of postpartum emphysematous cystitis after Casarean section (C-sec) in a young female without underlying disease.

A Comparison of the Analgesic and Side Effects of Continuous Epidural Morphine and Nalbuphine after a Cesarean Section / 대한마취과학회지

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as pruritus, nausea, vomiting, and respiratory depression. The purpose of this study was to evaluate the analgesic efficacy and side effects of epidural morphine compared with epidural nalbuphine. METHODS: Fifty nine patients were randomly divided into 2 groups. For group M (n = 30), a bolus of 7 ml of saline and 2 mg of morphine were administered and for group N (n = 29), a bolus of 7 ml of saline and 4 mg of nalbuphine were administered. Continuous epidural analgesia was induced with morphine 4 mg, 0.5% bupivacaine 20 ml, 2% lidocaine 20 ml and normal saline 60 ml by a 2day infuser in group M, and with nalbuphine 20 mg, 0.5% bupivacaine 20 ml, 2% lidocaine 20 ml and normal saline 58 ml by a 2day infuser in group N. We compared the analgesic effect and side effects of the two groups for 48 hours. RESULTS: No significant hemodynamic changes were seen in any of the groups. The analgesic effects were good in the two groups (mean VAS < 3.0). The patients of group M had lower pain scores continually compared with group N and pain scores were statistically significant at 6, 12 and 24 hours. However, side effects occurred more frequently in group M. CONCLUSIONS: These results suggest that an adequate dosage of epidural morphine provides good analgesic effects and reduces the occurrence of side effects.