Online ISSN: 2515-8260

Keywords : Cesarean section


M. Priya Darshini, MadhaviLatha pinnelli, GullapalliHanumantha Rao, Kiran Madhala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 453-460

The relationship between Post-Dural puncture headache (PDPH) and body mass index (BMI) in individuals who have just given birth has been the subject of contentious studies in the past. As a result, we decided to survey this complication in a group of patients who had cesarean sections performed under spinal anesthesia. It was predicted that people with greater BMIs would experience PDPH less frequently.The demographic data was retrieved and documented after looking over the patient files and phoning the patients. Additionally, a headache score based on a 0–10 verbal numeric rating scale (NRS) and the development of PDPH up to three days after a cesarean section in the present delivery were documented.At the Kakatiya Medical College in Warangal, 76 women who had undergone spinal anesthesia for a cesarean section participated in this study (March 2021 to February 2022). The subjects ranged in age from 20 to 40 years old (28.24 ± 3.27). The average BMI (kg/m2) before a cesarean section was 30.21 ± 2.82. 38 (50%) of the 76 parturient patients were not obese, and the remaining (50%) were (BMI > 30 kg/m2); 97.90% were non-smokers, and 92 percent had no prior history of PDPH during the previous neuro-axial anesthesia/analgesia. Only 13 participants (17.10 %) in this study experienced headaches following the current spinal anesthetic. 31 patients (81.57%) and 32 patients (84.21%) of the patients who did not develop PDPH had BMIs below 30 and over 30 respectively (P = 0.386). We concluded that increased BMI at the time of cesarean section decreased the incidence of PDPH. Increased BMI lowers the risk of PDPH because obese patients' increased intra-abdominal pressure reduces CSF leakage from the dural puncture point. Additionally, this study demonstrated that neither BMI nor weight gain during pregnancy, nor any other characteristics looked at, had a significant impact on the severity of PDPH.

Preoperative knowledge about spinal anesthesia on anxiety and pain in patients undergoing cesarean section

Dr. Shalini Nagpal, Dr. Yogesh Kumar Chhetty, Dr. Ila Agarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1808-1811

Background: Preoperative counseling is one for pregnant women help to improve the surgical outcome and also reduce the number of analgesics used. Though it is known that preoperative counseling is effective, there are limited studies to testify to its importance.
Objective: The present study was undertaken to observe the preoperative knowledge about spinal anesthesia on anxiety and pain in patients undergoing cesarean section.
Materials and methods: A total of 60 patients who were elected under CS anesthesia were part of the study after obtaining informed consent. After recording the baseline pain scores, depression, anxiety and stress scores, the participants were randomly grouped into control and intervention groups with 30 participants in each group. Preoperative counseling was offered to the participants of the intervention group. No counseling was offered to the participants of the control group. Post-surgical pain and depression, anxiety and stress scores were recorded in both groups. A visual analog scale was used to record the pain scores. Depression, anxiety and stress scores were recorded using DASS 42.
Results: There was no significant difference in the scores of depressions, anxiety and stress among the control and intervention group participants before the counseling. There was a significant decrease in the depression, anxiety and stress scores in the intervention group participants. Further, a significant decrease was observed in the pain scores also in the participants of the intervention group.
Conclusion: There was a significant decrease in the pain scores, depression, anxiety and stress scores after the surgery in the intervention group participants who underwent the preoperative counseling. The study recommends further detailed study in this area to recommend the implementation of preoperative counseling for the women undergoing cesarean section.

Effectiveness of Bakri balloon for management of postpartum haemorrhage: A two-year retrospective cohort study

Dr. Lakshmi KS, Dr. Vasanth Kabbur, Dr. Kedareshvara KS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2579-2584

Introduction: Postpartum haemorrhage (PPH) is a preventable cause of maternal mortality and Active management of the third stage of laborious considered a gold standard for the management and prevention of PPH. Oxytocics like Oxytocin, Carbetocin, Methergin and Misoprostol are the mainstays of the management of PPH. When medical methods fail intrauterine balloon, tamponade has been suggested as an effective uterine conserving procedure, minimally invasive and requires less skill. The purpose of this study was to determine the indications, complications and effectiveness of Bakri balloon insertion performed at the tertiary care teaching hospital.
Patients and Methods: All cases of Bakri balloon insertion done between 1-01-2020 to 31-12-2021 at the Department of Gynecology and Obstetrics were retrospectively collected. The study group included women for whom the balloon was inserted vaginally and after caesarean delivery when medical methods fail to control PPH and PPH following Placenta previa. Demographic data, clinical characteristics, indications of Bakri balloon, amount of normal saline used, duration of Bakri balloon inside uterus, complications and effectiveness of Bakri balloon were studied.
Results: There were 24 patients who underwent Bakri balloon insertion. 14 patients were delivered by Cesarean section and 10 patients were delivered by vaginal delivery. 16 were multigravida and the majority were from the rural population. The most common indication for a Bakri balloon in our study is the Atonic uterus. The Bakri balloon was effective in 83.33%. (20/24). Out of 4 women, two women required emergency peripartum hysterectomy and 2 women expired.
Conclusion: The Bakri balloon was highly effect vein our study and can be used when medical management fails. It reduces the need for peripartum hysterectomy and saves woman reproductive function. It avoid sun necessary blood product transfusion and reduces the duration of hospital stay.

Comparison of spinal and epidural anesthesia for caesarean section following epidural labor analgesia

Dr Manmohan Shyam, Dr Anjana Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11716-11720

Background: Epidural labor analgesia (ELA) can be extended for use as epidural surgical anesthesia (ESA) for intrapartum caesarean section. The present study was conducted to compare spinal and epidural anesthesia for caesarean section following epidural labor analgesia.
Materials & Methods: 84parturients admitted for vaginal deliveries were divided into 2 groups of 42 each. In group I, epidural painless labor was maintained by continuous infusion and patient-controlled epidural analgesia (PCEA) using 0.125% bupivacaine with fentanyl 1.25 mg/mL.In group II, SA was performed, a standardized dose of hyperbaric bupivacaine 10-12 mg with or without 100-300 mg morphine was administered through a 26- gauge spinal needle.
Results: In group I and group II, parity found to be nullipara in 30 and 34 and multipara in 12 and 8, ASA status was I in 4 and 5, II in 32 and 30 and III in 6 and 7. Cervical oswas 2.9 cm and 3.0 cm, block levelT2-T3 was seen in 0 and 2 and <T4 in 42 and 40 respectively. Failure rate was seen in 4 in group I and 6 in group II. A to S time (min) was 17.4 and 13.2. Medicine given was Ephedrine (mg) as 1.26 and 10.2, Meperidine(mg) as 11.4 and 9.2, Fentanyl (mg) as 0.014 and 0.0052, Midazolam (mg) as 0.81 and 0.23, Propofol (mg) as 8.7 and 4.6 and Ketamine (mg) as 3.16 and 1.92 in group I and II respectively. The difference was significant (P< 0.05).
Conclusion: The failure rate of sequential SA and EA for CS following successful epidural painless labor was similar

PDPH after Cesarean Section (CS) delivery under spinal anesthesia: An observational study

Dr. R. Diwakaran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 973-977

Aim: Assessment of the prevalence and associated risk factors of post dural puncture
headache (PDPH) after cesarean section delivery under spinal anesthesia
Methods: This Cross Sectional study conducted in the Department of Anesthesia, Madha
Medical College Research Institute, Kovur, Chennai, Tamil Nadu, India for the period of 1
year. The entire procedures were performed at sitting position. The backside of the patients
was cleaned with Iodine and alcohol. Spinal anaesthesia was done using a midline approach
at the L2-3 or L3-4 interspaces by using different size of spinal needles and 0.5 % isobaric
bupivacaine 2.5-3.0ml was injected.
Results: The 100 Patients were included in this study with fulfilling the criteria. 8 patients
had a previous history of spinal anesthesia exposure and 3 of them complained a PDPH like
headache after the procedure. All patients had given spinal anesthesia on sitting position. 23
G needle is the most frequently used spinal needle. There were 1 cases (1%) diagnosed as
failed block which were converted to general anesthesia. Hosmer-Lemeshow test of goodness
of fit was performed to check the appropriateness of the model for analysis. Variables found
to be significant at a binary logistic regression were: needle size and number of attempts.
After analysis with multivariate logistic regression needle size and number of attempts were
found to be significant at p-value<0.05. Size of the needle used to administer spinal
anesthesia is significantly associated with the development of PDPH. In this study PDPH
was present in 43 patients (43%).
Conclusion: In conclusion, the prevalence of PDPH was higher, 43% compared with most
other studies.

The Efficacy of Intrauterine Misoprostol during Cesarean section Plus intravenous Oxytocin In Prevention Of primary postpartum Hemorrhage (PPH)

LubnaAmmer El-Hammroni, Ali El-Shabrawy Ali, WaelSabryNossair, Safaa Abdel-Salam Ibrahim

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2809-2819

Background:The misoprostol tablet is very soluble and can be dissolved in 20
minutes when it is put under the tongue a pharmacokinetic study compared the
absorption kinetics of oral, vaginal and sublingual routes of administration of
misoprostol found that sublingual misoprostol has the shortest time to peak
concentration, the highest peak concentration and the greatest bioavailability when
compared to other routes.The aim of the present study was to to improve the
management primary postpartum hemorrhage during and after elective cesarean
section (CS). Patients and methods:This study was carried out on 46 cases admitted
for elective CS at University Hospital. They divided into two groups regarding the
protocol of treatment, was given oxytocin, 10 IU in 250 ml of Normal saline
solution over 10 minutes was administered directly after opening the
uterus.Misoprostol group was given 400 mcg misoprostol plus intra venous
Oxytocin administered directly after opening the uterus. Results: There was
statistical significantly between the two studied groups in hemoglobin and HCT
postoperatively with higher level among intra venous oxytocin plus intra uterine
misoprostol than intra venous oxytocin only group. But regarding preoperative
hemoglobin and HCT, there was no statistically significant difference before and
after treatment. Higher blood loss either intraoperative, postoperative and overall
blood loss on intra venous oxytocin only group than intra venous oxytocin plus
intra uterine misoprostol.There was statistical significantly decrease in both
hemoglobin and HCT postoperatively in the two studied groups but this decrease was
more among intra venous oxytocin only group than intra venous oxytocin plus intra
uterine misoprostol. Conclusion:Intrauterine misoprostol combined with oxytocin
infusion during caesarean section can minimise intraoperative blood loss, avoid
postpartum haemorrhage, and reduce any additional uterotonic medication

Correlation between Cesarean Section Niche Diagnosed by Hysteroscopy and Postmenstrual Bleeding

Shaimaa Mohammed Salah, Mohamed Elsayed Mohamed, Walid Abd Allah Abd El Salam, Ahmed Ismail Mohamed

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4480-4488

Background:High rate of cesarean section is accompanied by higher rate of complications.
Niche, which is a uterine wall defect is one of these recognized complications. Our study's aim
was to find out how common abnormal uterine bleeding is among women who have had
caesarean sections.
Subjects and methods: 195 women who had at least one prior cesarean section and complaining
of vaginal spotting after the menstrual period admitted at the cytogenetics endoscopic unit,
Zagazig University Hospitals.Office hysteroscopy was used to check for the presence of a
caesarean section niche in the patients.
Results: By hysteroscopy, there was a statistically significant difference between patients with
and without niche regarding age (P value, 0.001), number of previous CSs (P value < 0.001),
hypertension (P value <0.001), post-menstrual spotting (P value, 0.002), dysmenorrhea (P value
< 0.161) and chronic pelvic pain (P value, 0.547).
Conclusion: There is an association between the number of previous CS and development of a
niche.CS niche is linked to dysmenorrhea and chronic pelvic pain.

Transverse Abdominis Plane Block For Management Of Postoperative Cesarean Section Pain

Mustapha Amin Fahmy El-Sayed; Abdulmagid Mahmoud Sarhan; Ahmed T. Abdellatif; Amr Ahmad Abdel-Rahman

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 2446-2453

Background: pain after Cesarean delivery (CD) can negatively affect ambulation, breastfeeding, and maternal bonding. The aim of this study was to determine whether a correctly performed TAPB can provide better control of acute postoperative pain during the first 48 hours after CS and if it can provide a faster postoperative recovery.
Patients and methods: included 32 participants who underwent elective caesarean section assigned randomly into two groups. Group A: 16 patients received TAP block. Group B: 16 patients did not receive any block. Medicine Ten centimeters visual analog scale (VAS) was also explained during preoperative visit. The postoperative pain was evaluated at 1, 2, 4, 8, 12, 18 and 24 hours by using VAS for pain scoring that was explained to the patients
during preoperative visit as a 100 millimeter horizontal line with verbal anchors at both ends. Results: Our study showed that there is statistically significant difference between the studied groups regarding VAS pain scorebaseline or at any point of time (significantly lower in TAP block group). In each group, there is significant change (increase) in VAS pain score over time. There is statistically significant difference between the studied groups regarding time for first analgesia (significantly longer in TAP block group). Number of patients who need nalufin was significantly higher in control group (ten patients within control group versus only one in TAP block group). Also, there is statistically significant difference between the studied groups regarding patient satisfaction. More than half of patients (56.2%) within TAP block group were very satisfied while half of those within
control group felt neutral (neither satisfied or not). Conclusion: Transverse abdominis plane block represents a viable alternative to common analgesic procedures performed for acute postoperative pain control after a CS.

Risk Factors for Cesarean Delivery in Patients of Gestational Diabetes Mellitus at a Tertiary Care Centre - A Descriptive Observational Study

Dr. Saba Musharaf; Dr. Sabha Malik; Dr. Natasha Gupta

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 11, Pages 8146-8152

Introduction Gestational diabetes mellitus (GDM) is one of the most frequent metabolic disorders during pregnancy, with incidence rates ranging from 1.1% to 14.3%. It is important to identify which risk factors may lead to a cesarean delivery, so to plan the procedure in advance and to avoid possible complications for both the mother and the fetus. Therefore this study was conducted to identify the risk factors associated with cesarean section in pregnant women with GDM. Objective : To identify the risk factors associated with cesarean section in pregnant women with GDM Study Design: This was a descriptive observational study conducted in a tertiary care centre over a period of 1 year from January 2018 to December 2018 at SKIMS, Soura, Srinagar, Kashmir Material & Methods: 100 patients of Gestational Diabetes Mellitus were recruited and mode of delivery and various risk factors associated with cesarean delivery were evaluated Results: Among the patients of GDM, who underwent LSCS & NVD, mean age was significantly more (30.8±3.75 years & 28.4±3.42 years respectively, p value -0.010) in LSCS group. BMI was significantly higher in GDM patients who underwent LSCS as compared to patients who underwent NVD (29.7±2.49 kg/m² vs 25.3±1.98 kg/m², p value <0.001). Blood sugar fasting and postprandial values were significantly higher in patients of GDM who underwent LSCS as compared to patients who underwent NVD [ BS(F) - 99±14.11 g/dl vs 87.6±7.51 g/dl, p value <0.001; BS(PP) - 127.7±30.79 g/dl vs 87.6±7.51 g/dl, p value - 0.041]. Prior cesarean section was also an independent risk factor in deciding mode of delivery in patients of GDM. Among the patients who underwent LSCS, maximum were on insulin (56%) followed by diet (33.3%). Among group B (NVD), maximum patients were on diet (56%) followed by metformin (24%) Conclusion: The mean age of patients and BMI was higher in patients who underwent cesarean section (p - 0.010 and < 0.001 respectively). High blood sugar levels (fasting and postprandial), primigravida and prior cesarean section were associated with high chances of cesarean section (p < 0.001, 0.041, 0.007 and 0.001 respectively). There were no significant difference between the 2 groups in regards to gestational age at delivery, the weight of newborn and the apgar score at 1 and 5 minutes after birth.

Effect Of Polarized Light Therapy On Incisional Pain After Cesarean Section

Anan Abd El Shafey Anter Ahmed; Khadyga Said Abdel-Aziz; Mohamed Ahmed Mohamed Awad; AbdelRahman Hegazy AbdelWahab Mahmoud; Ahmed Aref Ahmed Hussein

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 3445-3453

Objective: This study was conducted to investigate the effect of polarized light therapy on incisional pain after (SC). Methods: Forty primipara women complaining from incisional pain post CS participated in this study. They had a single full term fetus during their gestation. The participant's ages ranged from 25-35 years. The control Group (Group A) were treated by traditional medical treatment immediately after recovery from anesthesia. The Study Group (Group B) were treated by traditional medical treatment immediately after recovery from anesthesia and polarized light therapy with energy density of an average of 2.4 J/cm2 15 minutes/session, one session /day for 5 consecutive days. Visual analogue scale (VAS) and electronic algometer were used to measure intensity of incisional pain post CS in both groups (A&B) before and after treatment. Results: Results of this study found that there was significant decrease of VAS and significant increase of pressure algometer after treatment in both groups A and B when compared with corresponding pre-treatment values (p<0.05). there was significant difference in mean values of VAS and pressure algometer between both groups (A and B) after treatment (p<0.05) (with favor of group B, more decrease VAS and more increase in pressure algometer). Conclusion: It can be concluded that polarized light therapy for 5 consecutive days' post SC is an effective adjuvant therapy in treatment of incisional pain through reducing visual analogue scale (VAS) and increasing electronic algometer.

Retrospective analysis of the birth histories of women who have suffered bleeding in order to optimize approaches to the prediction and prevention of postpartum bleeding

Poyonov O. Yoldoshevich; Karimova N. Nabidjanovna

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 6236-6243

The aim of our study was to retrospectively examine the history of childbirth and the quality of primary care for bleeding and evaluate the prescribed rehabilitation measures for women who have suffered postpartum hemorrhage and massive bleeding. The materials and methods of the study were 242 birth histories with postpartum hemorrhage for the last 6 years (2013-2018) in the city maternity hospital of Bukhara. The average age of the patients was 26.7 ± 1.2 years. The obstetric pathology leading to bleeding mainly consists of uterus hypotonia - 143 (59.1) and large fetus - 68 (28.1), and preeclampsia and DIOV are equal amounts - 33 (13.64). Only about 20% of women who had postpartum hemorrhage underwent early rehabilitation in the form of prescribing contraceptives.The aim of the research was to study the effectiveness of modern principles of stopping postpartum obstetric bleeding. From 127 cases of bleeding in 101 women (79.5%) the childbirth were with the operational method. With the development of blood loss was renderedstepwise ways to stop bleeding. During hemostasis of the bleeding, ligatures were imposed on the ovarian arteries and the ascending branch of the uterine artery for ischemicization of the uterus, which was effective in 30 (30%) women, and in 114 (89.7%) women managed to achieve organ-sparing tactics.

Implementation of Clinical Pathways as an Instrument for Controlling Service Costs in Hospitals

S A Andri; T P Bangun; J P Widodo; ThinniNurul Rochmah

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 5, Pages 831-835

The total real hospital costs for Social Health Insurance (BPJS) Kesehatanpatients undergoing cesarean section are much higher than the collectible costs using the Indonesia Case-Based Groups (INA-CBGs) package as the basis of their payment policy. The purpose of this study was to determine the effect of using clinical pathways as a means of controlling the total real hospital costs of BPJS Kesehatan patients undergoing cesarean section.This research used action research. The clinical pathway was applied to BPJS Kesehatan patients undergoing cesarean section from January 1 to March 31, 2014, and compared the real hospital costs between that period and BPJS Kesehatan patients undergoing cesarean section from October 1 to December31, 2013. From the 126 study groups, 65 clinical pathway forms (51, 58%) were complete. The average real hospital cost was significantly higher after the implementation of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the complete CP form group with p = 0.012, p = 0.013, and p = 0.012 respectively.This study demonstrated that implementing the clinical pathway can reduce the actual length of stay and hospital costs in C-section patients, and demonstrated that using the clinical pathway can make services more efficient.