Effect of enhanced recovery after surgery for elective cesarean deliveries on neonatal outcomes.

OBJECTIVE: To evaluate the impact of initiation of an enhanced recovery after cesarean delivery (ERAC) protocol for elective cesarean delivery (CD) on neonatal outcomes. STUDY DESIGN: We performed a retrospective analysis of elective CD at ≥39 weeks gestational age between September 2014 and August 2018 at a single institution before and after ERAC protocol implementation. Our primary outcome was composite neonatal complication rate and secondary outcome was rate of breastfeeding. We performed univariate analyses to detect differences in outcomes between the pre-ERAC and post-ERAC groups. RESULTS: We included 362 neonates born via elective CD before (n = 135) and after (n = 227) ERAC implementation. The post-ERAC group experienced fewer composite neonatal complications (33.0% vs. 47.4%, p = 0.009) and greater breastfeeding rates (80.2% vs. 67.4%, p = 0.009) compared to the pre-ERAC group. CONCLUSION: ERAC protocol implementation does not negatively impact neonates and may benefit both mother and baby.

Extracorporeal Membrane Oxygenation Therapy After Amniotic Fluid Embolism With Undetectable ROTEM FIBTEM Activity: A Case Report.

Amniotic fluid embolism (AFE) is a rare but devastating condition with mortality rates as high as 60%-80%., We report a case of AFE complicating the labor of a parturient with no reported risk factors. She received general anesthesia for emergent cesarean delivery (CD), after which she developed a pulseless electrical activity (PEA) event requiring resuscitation, disseminated intravascular coagulation, and postpartum hemorrhage with undetectable fibrinogen activity by ROTEM FIBTEM assay. Extracorporeal membrane oxygenation (ECMO) therapy was successfully initiated, and she was discharged home without neurologic sequelae. ECMO therapy can be considered for the treatment of AFE even in the absence of fibrinogen activity.

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis.

BACKGROUND: Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. METHODS: We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group). RESULTS: Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intraoperative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group. CONCLUSIONS: Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.