Effect of video-based information on preoperative State trait anxiety inventory scores in adult patients presenting for elective caesarean section: a randomized controlled trial

Background: Preoperative anxiety is a common occurrence in patients presenting for surgery with a reported incidence of up to 80%. Increased preoperative anxiety has been associated with increased morbidity. Provision of information relating to surgery and anesthesia to patients has been proven to have benefit in allaying anxiety. However, the best format of information dissemination remains unknown. Objective: To determine the effect of video information in addition to the pre-anesthetic review on the mean preoperative State anxiety inventory (STAI-S) score in adult patients presenting for elective caesarean section under spinal anesthesia at Aga Khan University Hospital, Nairobi (AKUHN), and to determine the prevalence of preoperative anxiety in the obstetric population presenting for elective caesarean section at AKUHN. Methods: Thirty-seven adult patients booked for elective caesarean section under spinal anesthesia were randomly assigned to one of two groups. In the study arm, a video was shown to the participants in addition to the standard pre-anesthetic review. In the control arm the participants only had a standard pre-anesthetic review. Results: The mean STAI-T score in the sampled population was 45.64 (SD 5.625). The mean baseline STAI-S score was 46.32 (SD 4.911). There was no statistically significant difference in change in STAI score between the video and control arms (p>0.05). Conclusion: On the basis of this study among this population, there was no benefit demonstrated from the use of an information video about spinal anesthesia on anxiety levels in obstetric patients presenting for a first time spinal

Assessing the pros and cons of vaginal birth after caesarean relative to elective repeat caesarean section

Background: Recent years have witnessed a rise in rate of primary caesarean section (CS). No. of women reporting with a previous CS scar is also increasing. Judicious trial of labor in such patients can prevent repeat caesarean section. Aim of this study was to assessing the safety and success rate of vaginal birth after caesarean (VBAC) in selected cases of patients who have undergone previous lower segment CS (LSCS) is the main aim of this study.Methods: In this prospective observational study carried out in a tertiary care teaching hospital over a period of 1 year. 375 pregnant women with a history of one previous LSCS for non-recurrent indications were enrolled. The statistical technique of t-test was administered for relative comparison with respect to maternal and neonatal complications across the two groups, i.e. repeat LSCS and vaginal delivery.Results: Out of 375 patients 187 patients (49.9%) underwent elective LSCS for recurrent indication and for non-recurrent indication associated with some complicating factor. Trial of labor in 188 (50.10%) was given out of which 59.3% had spontaneous vaginal delivery,7.20% had instrumental delivery and 33.50% landed into emergency CS. Commonest cause of Em. LSCS being Fetal distress. As regards maternal complications, no statistically significant difference was found between the Repeat LSCS and Vaginal delivery groups (t = 0.779, p > 0.05). On similar lines, there was no statistically significant difference across both groups as regards neonatal complications (t = 0.632, p > 0.05).Conclusions: Taking into account the increased trend of primary CS, trial of VBAC in selected cases is very important. It can be concluded that VBAC has chances of success in cases with previous one LSCS but it must be carefully investigated and monitored.

Evaluate The Efficacy And Safety Of Intrathecal Plain 0.75% Ropivacaine Solution For Elective Caesarean Section

Background:A prospective, randomised double blind study to evaluate the efcacy and safety of intrathecal plain 0.75% ropivacaine solution for elective caesarean section and also to study its side effects and complicationsMaterial and Methods:80 patients planned under spinal anaesthesia requiring sensory level upto T4-T6 & duration of 1-2 hours were included in the study. They were divided into two groups of 40 each & received one of the 2 drugs intrathecally. Group R - 2.4ml isobaric plain 0.75% ropivacaine(18 mg) Group B - 2ml hyperbaric 0.5% bupivacaine(10 mg)Results:In our present study, duration of sensory block was shorter in Group R (141.87±13.57 mins)than in Group B (203±18.83 mins) and it was statistically signicant. The mean duration of analgesia was less in Group R 189.25±17.30 mins than in Group B 296.25 ± 13.33 mins and the difference was statistically signicant. Mean(±SD) onset of motor block was slower in Group R (207.25±38.89 secs) as against Group B (115.12±26.34 secs) and the difference was statistically signicant. The time needed to reach Grade 3 motor block was delayed in Group R 6.19±0.88 mins, compared to Group B 4.09±0.86 mins, which is also signicant. The mean duration of motor block was signicantly less in Group R(174±24.36min) as compared to Group B (252.5±18.63mins).Conclusion:Use of Ropivacaine in caesarean section patients is associated with shorter duration of both sensory and motor block .Therefore ,ropivacaine is safe and effective without any adverse effect on maternal and neonatal outcome.

Elective versus emergency caesarean section: differences in maternal outcome

Background: Caesarean section is a life-saving surgical procedure when certain complications arise during pregnancy or labour. The use of CS worldwide has increased worldwide unprecedented levels although the gap between higher- and lower-resource settings remains. The present study evaluates the difference in maternal outcome in elective versus emergency caesarean sections in our institute.Methods: The study included first 65 cases of emergency caesarean section (group A) and during the study period, first 65 elective caesarean section (group B) if they fulfilled the inclusion criteria. Various intra operative and postoperative events were recorded which included intra operative complications, postpartum haemorrhage and transfusion indices.Results: The most common indication of caesarean section in group A was fetal distress (27.7%). In group B most caesarean sections were classified under 5 followed by class 6, the most common indication being previous caesarean section (27.6%). It was observed that pre-operative mean haemoglobin in group A was 10.6 g/dl and in group B was 11.2g/dl. A drop of 1.36 g/dl in group A and 1.10 g/dl in group B was observed in the post-op period. Cross match / transfusion ratio 1.5 in group A and  2 in group B, transfusion probability ratio was 60 % in group A and  66.7%  in group B and transfusion index was 1 in group A and  group B. There was significantly higher contraception acceptance in group B compared to group A.Conclusions: Elective caesarean section has more favourable maternal outcome as compared to emergency caesarean section as the former is done under controlled and planned circumstances.  However, there should be stringent audit to scrutinise indication of caesarean section, outcome of caesarean and blood transfusion practices.

Effect of elective caesarean section and vaginal delivery on maternal pelvic floor dysfunction / 局解手术学杂志

Objective To explore the impact of elective caesarean section and vaginal delivery on maternal pelvic floor dysfunction. Methods A total of 131 pregnant women from January 2014 to March 2015 in our hospital were divided into observation group which re-ceived elective caesarean section and control group which received vaginal delivery.All the maternal and neonatal clinical data were counted. The occurrence of pelvic floor dysfunction disease in postpartum women after 6 to 8 weeks was observed.The occurrence of vaginal wall pro-lapse,uterine prolapse,stress urinary incontinence (SUI)and maternal pelvic floor muscle damage between two groups were compared and analyzed.Results There were varying degrees anterior vaginal wall prolapse phenomenon occured on 31 cases in obervation group,the pro-lapse rate was 67.39%,compared with 92.94% of the control group,the difference was statistically significant (P 0.05).Conclusion To adopt elective cesar-ean section has a lower probabilities of postpartum pelvic floor dysfunction disease than that by vaginal delivery for maternal women,which is propitious to the recovery of pregnant women,while it has nothing to do with pelvic floor muscle damage.

Clinical analysis of respiratory distress syndrome of infants at term and near term delivered by elective cesarean section / 中华实用儿科临床杂志

Objective To access the incidence,clinical characteristics and the factors affecting therapy of respiratory distress syndrome (RDS) in the infants at term and near term delivered by elective cesarean section.Methods A retrospective cohort study among consecutively admitted infants with RDS at the Neonatal Intensive Care Unit of the Department of Neonatology,Xiangya Hospital,Central South University from Jan.2004 to Dec.2011 were conducted.The inborn infants at 36-42 weeks gestation with RDS,whom were delivered by Elective Cesarean Section from January 1 st,2004 to December 31st,2011 were enrolled.These cases with the timing of elective caesarean section,gestational age,intrauterine infection,asphyxia at birth,which affecting the occurrence of RDS were compared.Results Fifty one infants were entered into the study,which were all met standard of Elective Cesarean Section.Among these infants,33 cases (64.7％,33/51 cases) were delivered by cesarean section without any reason.In these 51 cases,the constituent ratio of elective caesarean section in gestational age ＞ 39 weeks was lower than in gestational age ＞ 36-＜39 weeks,and the difference was significant (31.4％ vs 68.6％,x2 =0.560,P ＜0.01).Asphyxia at birth was the main risk factors of term and near term with RDS (OR =7.306,95％CI:0.018-51.101,P =0.041).Compared to the infants whom born without asphyxia,the infants born with asphyxia usually came out to RDS right after born (x2 =0.080,P ＜ 0.01),required longer time of mechanical ventilation and had significant lower effective ratio (x2 =0.071,8.843,all P ＜ 0.01).Conclusions Asphyxia is the first manifestations of term and near term infants with RDS.These infants often can be onset after birth.

New problem and progress of transient tachypnea of the newborn / 中华实用儿科临床杂志

Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress.TTN is a self-limiting disease which has a good prognosis but sometimes severe cases may cause pulmonary edema,respiratory distress,pulmonary air leak or persistent pulmonary hypertension.Researchers have many studies about pathogenesis,clinical features,treatment of TTN at home and abroad,and they have new progress.This article will summarize recent research progress on TTN.