European Journal of Molecular & Clinical Medicine

Background: The present study was conducted for evaluating anesthetic management in cesarean section of pregnant women with placental anomaly.
Materials & Methods: Records of a total of 100 patients who underwent cesarean section were enrolled. Complete demographic and clinical details of all the subjects was obtained from record files. Only those patient’s data were enrolled among which confirmed diagnosis of placental location and invasion anomaly was present. All the patients were divided into two study groups as follows: Group A: Included patients with placenta previa (PP), and Group B: patients with placenta accreta (PA). The level of emergency of the operation, anesthetic method and interventional procedures was recorded separated in a Performa.
Results: Data of 100 patients were divided into two study groups as follows: Group A: Included patients with placenta previa (PP), and Group B: patients with placenta accreta (PA); with 50 patients in each group. Significantly higher operative time and lower gestational age was seen among subjects of group B in comparison to group A. Most of the subjects of group B underwent C section under general anesthesia. Time for mechanical ventilation, duration of ICU stays and blood loss was significantly higher among subjects of group B.
Conclusion: There might be a need for numerous anesthetic interventions in subjects with placental anomalies, primarily placenta accreta (PA).

Background: This study compared the analgesic efficacy of the bilateral erector spinae plane
(ESP) with that of the bilateral transversus abdominis (TAP) postoperative delivery with
selected surgery.
Methods: Sixty mothers scheduled for caesarean section under random surgery were
randomly assigned to receive an ESP block or a TAP block. The ESP group received USG
guided block with 20 mL 0.2% of ropivacaine at the T9 level corresponding to T10 transverse
process e at the end of surgery. The TAP group received an ultrasound-guided TAP block
containing 20 mL of 0.2% ropivacaine at the end of delivery. The main effect was the
duration of analgesia achieved by each block. Measures of the second outcome were
postoperative pain severity, complete diclofenac use, patient satisfaction.
Results: The median duration (interquartile) block was longer in the ESP group than in the
TAP group (12 hours [10-14] vs 8 hours [8-10], p <0.0001). In the first 24 hours, the median
rate of analog pain observed at rest was lower in the ESP group. Intermediate diclofenac use
in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg
[100-150] vs 100 mg [75-100, p = 0.003]).
Conclusion: Compared with the TAP block, ESP block provides effective pain relief, has a
long lasting analgesic action, increases duration of first analgesic need, is associated with
minimal diclofenac use, and can be used in multimodal analgesia and opioid -sparing
medication after surgery.

Background: Increase rate of unnecessary caesarean sections has been a growing concern in the world. WHO proposed the Robson classification system as a global standard for assessing , monitoring and comparing caesarean section rates within healthcare facilities overtime and between facilities. Aim: To assess and analyze Cesarean Section Rate (CSR) of Zagazig university hospital over the period of six months using the 10 Group Robson classification system .
Patients & methods: This prospective cross sectional study was carried out in the Department of Obstetrics & Gynecology at Zagazig University Hospitals, Zagazig, Sharkia, Egypt, from January 2019 till June 2019. All women admitted for delivery were classified using Robson classification .
Results: 2333 women were admitted for delivery. 854 (36.6%) gave birth by vaginal delivery while 1479(63.4%) by CS. Women classified into Group 5 made the greatest contribution to the overall CS rate (53.2 % relative contribution). The second highest contributors were Women in Group 10, (10.2% relative contribution) to the overall CS rate. Women in group 2 made the 3rd largest contribution (8.9 % relative contribution to the overall CS rate. Then groups 4 ,7 ,8 , 6, 1 , 3 , 9 by relative contribution 8.5 % ,4.2 % , 3.9 % , 3.6 % , 3.5 % , 2.8 % , 0.8 % respectively.
Conclusion: Robson Groups 5, 10, and 2 were identified as the main contributors to the overall CS rate at our hospital.The most common indication of performing Cesarean Section was previous CS. Robson classification can be incorporated successfully into the routine maternal and perinatal data collection system to improve the monitoring and evaluation of caesarean section rate.

The AVM is a rare congenital disease that often affects the brain and only rarely we find in other organs. In this pathology there is an alteration of the vascular system, with the arteries discharging directly into the veins, bypassing the capillary system; this puts the patient at high risk of sudden hemorrhage. Today we present the case of a young woman suffering from unknown pulmonary avm. The breakdown of this avm caused a hemothorax in the immediate post-cesarean, necessitating emergency surgery and subsequent intensive care.