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El partograma es una herramienta gráfica utilizada para monitorear el progreso del trabajo de parto. Este artículo revisa la literatura reciente sobre el uso del partograma, con el objetivo de evaluar si su implementación reduce la tasa de cesáreas y determinar qué modelo es más adecuado. Se analizaron estudios que compararon el uso de partograma con su no utilización, así como estudios que contrastaron distintos modelos de partograma. Los resultados indican que el uso del partograma no se asocia con una reducción significativa de la tasa de cesáreas, particularmente en países con tasas bajas de cesárea. Sin embargo, el partograma modificado de la Organización Mundial de la Salud, que elimina la fase latente, parece tener ventajas sobre el modelo clásico de 1994, presentando una tasa significativamente menor de cesáreas. Aunque el partograma no ha mostrado beneficios significativos en la reducción de cesáreas, sigue siendo una herramienta útil para documentar gráficamente el progreso del trabajo de parto, lo cual podría mejorar la toma de decisiones clínicas. En Chile, la elevada tasa de cesáreas, cercana al 45%, sugiere que la implementación del partograma OMS 2000 podría ser beneficiosa. Sin embargo, es necesario realizar estudios locales para confirmar estos posibles beneficios en la reducción de cesáreas.
The partogram is a graphic tool used to monitor labor progression. This article reviews the recent literature on the use of the partogram, aiming to evaluate whether its implementation reduces cesarean section rates and to determine which model is more appropriate. Studies that compared using the partogram with not using it were analyzed, as well as studies that contrasted different partogram models. The results indicate that partogram use is not associated with a significant reduction in cesarean section rate, particularly in countries with low cesarean section rates. However, the modified World Health Organization partogram, which eliminates the latent phase, appears to have advantages over the classic 1994 model, with significantly lower cesarean section rates. Although the partogram has not shown significant benefits in reducing cesarean sections, it is still a useful tool for graphically documenting the progress of labor, which could improve clinical decision-making. In Chile, the high cesarean section rates, close to 45%, suggest that implementing the WHO 2000 partogram could be beneficial. However, local studies are needed to confirm the potential benefits of reducing cesarean sections.
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Background: Cesarean section is one form of surgical procedure involving incision of the abdominal and uterine walls, which poses a risk of postoperative pain. Pain is a common issue experienced by women after cesarean section, particularly within the first 48 hours. Uncontrolled pain can lead to physical and psychological complications such as postpartum depression and difficulties in infant care. Pain management may involve pharmacological therapy, but non-pharmacological alternatives such as relaxation therapy like guided imagery need to be explored, which can help reduce post-cesarean section pain. Methods: This study is experimental, utilizing a randomized controlled trial pre-test and post-test control group double-blind design. The research was conducted from July to September 2022. A simple randomized sampling technique was employed, with a sample size of 32 post-cesarean section patients divided into two groups: the treatment group (guided imagery and standard therapy) consisting of 16 patients, and the control group (standard therapy) consisting of 16 patients. Results: The study revealed a decrease in visual analogue score (VAS) scores by -2.875�619 with an effect size of 0.641 in the treatment group. The study had a significant impact with a p value of 0.000 (p<0.05). Conclusions: Guided imagery is effective in reducing the pain level of post-cesarean section patients.
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Background: The cesarean section (CS) stands as a prevalent and frequently conducted surgical procedure in obstetrics, both within India and globally. The rising rates of cesarean deliveries prompt a necessity to examine the factors that influence this trend. Aims and Objectives: To analyze the proportion and different indications of CS to reduce the CS rate (CSR) in a tertiary care hospital. Materials and Methods: This was a retrospective observational study, conducted over a period of 6 months, from July 1st, 2022, to December 31st, 2022, in the Department of Obstetrics and Gynaecology at Midnapore Medical College and Hospital, West Bengal, India. The data pertaining to patients who underwent C-section deliveries at our hospital during the specified period was documented, followed by a statistical analysis conducted to assess the proportions and various indications for CS. Results: Out of 6365 women who gave birth during the study period, 2296 women underwent CS. This indicates that the proportion of CSs was 36.07%. The primary indication for CS was previous CS, accounting for 39.50%, followed by fetal distress (16.38%), preeclampsia with severe features and eclampsia (13.50%), severe oligohydramnios (7.40%), arrest of labor (5.70%), malpresentation (4.18%), antepartum hemorrhage (2.96%), premature rupture of membrane (2.70%), cephalopelvic disproportion (1.83%), induction failure (1.44%), fetal growth restriction (1.18%), multifetal gestation (1.09%), bad obstetric history (0.60), big baby (0.48%), cord prolapse (0.35%), and medical disorder (0.70%). Conclusion: As a tertiary care hospital, we observed a high rate of cesarean deliveries. However, by individualizing indications and conducting careful evaluations in accordance with standardized guidelines, practicing evidence-based obstetrics, and conducting audits within the institution, we can work towards limiting the CSR. In addition, encouraging a trial of labor after a cesarean can be beneficial in reducing the overall rate of CS.
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Background: Jaundice during pregnancy poses significant risks to both maternal and fetal health. This retrospective study aimed to assess the incidence, causes, and outcomes of jaundice among pregnant women admitted to a tertiary care center over a 3-year period. Aims and Objectives: The primary objectives were to identify the incidence of jaundice, analyze its causes, and evaluate the maternal and fetal outcomes in cases of jaundice during pregnancy. Materials and Methods: Conducted as a case series with clinical correlation, the study spanned 3 years (2021–2023) at the Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Science, Bangalore. Data from parturition books and case sheets were collected after institutional ethical committee approval. Investigations included a complete blood count, liver function tests, coagulation profile, and serology. Fetal and maternal outcomes were recorded. Results: Out of 9 cases, 7 were diagnosed with intrahepatic cholestasis of pregnancy (IHCP), while 1 case each involved hemolysis, elevated liver enzymes, low platelet syndrome, and unconjugated hyperbilirubinemia specific to pregnancy. IHCP is correlated with adverse perinatal outcomes, including meconium-stained amniotic fluid and fetal distress. Cesarean sections were prevalent (58%), often indicated by previous lower segment cesarean sections and non-progression of labor. Conclusion: The study underscores the substantial association between IHCP and adverse perinatal outcomes, emphasizing the heightened prevalence of cesarean sections in pregnancies complicated by jaundice. It highlights the necessity for vigilant monitoring and tailored management strategies to mitigate risks and ensure favorable maternal and fetal outcomes in cases of jaundice during pregnancy.
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Introducción: De acuerdo con lo reportado por la Organización para la Cooperación y el Desarrollo Económico, Chile posee una de las tasas más altas de cesárea para el continente, llegando a un 44,7% en 2013 y un 47,7% en 2017, ubicándose en tercer lugar, solo precedido por Turquía y México. Objetivo: Analizar los factores relacionados a intervención de cesárea en las mujeres que atendieron su parto en una clínica privada de la Quinta Región de Chile entre los años 2018 y 2022. Método: Estudio transversal analítico en 9041 usuarias. Se utilizó un modelo de regresión logística con odds ratio y sus intervalos de confianza del 95% para evaluar la asociación con variables sociodemográficas y obstétricas. Resultados: La prevalencia de cesárea fue del 85,1% en el periodo estudiado. La condición de gestante primípara, la cesárea previa, la presencia de patología materna o fetal, la ausencia de trabajo de parto y la esterilización quirúrgica presentaron mayor probabilidad de cesárea, mientras que para la edad gestacional, menor o igual a 36 semanas, ésta fue menor. Conclusiones: Destaca un alta prevalencia de cesáreas para el periodo de estudio, superior a lo reportado en la literatura.
Introduction: According to the Organisation for Economic Co-operation and Development, Chile has one of the highest caesarean section rates on the continent, reaching 44.7% in 20132 and 47.7% in 20173 , ranking third only to Turkey and Mexico. Objective: Analyze the factors related to cesarean section intervention in women who delivered in a private clinic in the Fifth Region of Chile, from 2018 to 2022. Method: Cross-sectional study involving 9,041 users. A logistic regression model with odds ratio and its 95% confidence intervals was used to assess associations with sociodemographic and obstetric factors. Results: The prevalence of cesarean section during the study period was 85.1%. Primiparous status, previous cesarean section, presence of maternal and fetal pathology, absence of labor and surgical sterilization were associated with an increased likelihood of cesarean section, while gestational age 36 and under weeks showed a decreased chance. Conclusions: A high prevalence of cesarean sections stands out for the study period, higher than that reported in the literature.
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Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Cesarean Section/statistics & numerical data , Logistic Models , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Sociodemographic Factors , Health Facilities, ProprietaryABSTRACT
Resumen: Reportamos el manejo anestésico de una gestante con múltiples comorbilidades debido a arteritis de Takayasu programada para cesárea electiva con la autorización del comité de ética institucional. Se utilizó una técnica combinada espinal-epidural en dos segmentos para suministrar anestesia con la titulación estricta de la presión arterial invasiva y el uso de una infusión endovenosa de norepinefrina. Asimismo, se realizó una revisión sobre el uso de la técnica combinada en dos segmentos para cesárea en gestantes con esta enfermedad.
Abstract: We report the anesthetic management of a parturient with Takayasu arteritis and several comorbidities scheduled for elective cesarean section with the authorization of the institutional ethics committee. A two-segment combined spinal-epidural technique was used to provide anesthesia with close control of invasive arterial pressure and the use of Norepinephrine endovenous infusion. Likewise, a literature review of the two-segment combined technique for cesarean section in pregnant women with this disease was performed.
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Background: Cesarean section (CS) stands as the foremost major surgical procedure in contemporary obstetrics. Initially developed primarily to safeguard maternal life during challenging childbirth scenarios, its prevalence has shown a concerning upward trajectory in recent times. The aim of this study was to investigate the prevalence and determinants of Cesarean section deliveries in a rural tertiary care hospital.Methods: This was a retrospective observational study and was conducted in the Department of Obstetrics and Gynaecology of Khwaja Yunus Ali Medical College & Hospital, Sirajganj, Bangladesh during the period from January 2018 to December 2019.Results: Out of a total of 1600 deliveries, 390 (24.4%) were vaginal deliveries, while 1210 (75.6%) were cesarean sections respectively. Majority 94.8% patients were 20-34 years old, 1.8% were less than or equal to 19 years and 3.4% were great than or equal to 35 years old respectively. The majority of cesarean sections, 814 (67.3%), were performed as elective procedures and 396 (32.7%) were performed as emergency procedures respectively. Majority 512 (42.3%) were performed on women who had a history of previous cesarean deliveries, 34 (2.8%) were performed due to non-progression or prolonged labor, 99 (8.2%) were performed due to malpresentation of the baby and 308 (25.5%) were performed at the request of the mother respectively.Conclusions: In conclusion, this retrospective observational study provides valuable insights into the prevalence and determinants of caesarean sections in a rural tertiary care hospital.
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Pregnancy, despite being a physiological process, can lead to morbidity and mortality, which is increased at risk ages, defined as younger or equal to15 years and older or equal to 35 years. For an adequate approach it is necessary to know the local reality of the population, therefore, the objective of this study is to describe and analyze the discharges of births and cesarean sections at risk age in the Maule Region from 2017 to 2021 using the database collected from the Biostatistics Unit of the Maule Health Service, which includes the hospitals of the region. Within the observed period, a total of 30,599 deliveries and cesarean sections were studied, being these a total of 5,581 at risk age, of which 0.65% corresponds to women younger or equal to 15 years and 17.57% to women older or equal to 35 years. There is a downward tendency in births in general, mostly evidenced in less or equal to 15 years, and on the contrary, a rise in births and cesarean sections of more or equal to 35 years, differing with the statistics at the country level. The tendency of increasing maternal age of pregnancies in the Maule region and its consequences are a fundamental factor when planning new public policies, so we consider it of vital importance to promote research and update the evidence, with a focus on the local population.
El embarazo a pesar de ser un proceso fisiológico puede conllevar morbimortalidad, la cual se acrecienta en edades de riesgo, definida como menor o igual a 15 años y mayor o igual a 35 años. Para el adecuado enfrentamiento se necesita conocer la realidad local, por ello, el objetivo de este estudio es describir y analizar los egresos de partos y cesáreas en edad de riesgo en la Región del Maule desde el año 2017 a 2021 utilizando la base de datos recogida desde la Unidad de Bioestadística del Servicio de Salud Maule, la cual incluye los hospitales de la región. Dentro del periodo observado se estudió un total de 30.599 partos y cesáreas, siendo estos un total de 5.581 en edad de riesgo, de los cuales 0.65% corresponde a mujeres menores o igual a 15 años y 17.57% a mujeres mayores o igual a 35 años. Existe una tendencia a la baja de los nacimientos en general, mayormente evidenciado en menores o igual a 15 años, y por el contrario, un alza en los partos y cesáreas de mayores o igual a 35 años, difiriendo con las estadísticas a nivel país. El aumento de la edad materna de los embarazos en la región del Maule y sus consecuencias son un factor fundamental a la hora de planificar nuevas políticas públicas, por lo que consideramos de vital importancia promover la realización de investigaciones y actualización de la evidencia sobre el tema, con un enfoque en la población local.
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Humans , Female , Pregnancy , Adolescent , Adult , Cesarean Section/statistics & numerical data , Maternal Health Services/statistics & numerical data , Chile/epidemiology , Epidemiology, Descriptive , Incidence , Hospital Statistics , Risk Factors , Maternal Age , Pregnancy, High-Risk , Parturition , Hospitals, Public/statistics & numerical dataABSTRACT
Introduction: Acute fatty liver of pregnancy remains an elusive and potentially fatal complication of a rare liver disease in late pregnancy. Due to sparse research, diagnostic dilemmas, and multi?organ involvement of the disease, it is imperative to elaborate the evaluation and management principles to confine the outcomes. Case Reports: Here, we aim to discuss in detail the peripartum manifestations and goal?directed management protocols in a case series of four patients managed at a tertiary care setup in India. Conclusion: It was found that all four cases had varied presentations ranging from asymptomatic hypoglycemia to liver failure and multiorgan dysfunction requiring a multidisciplinary perioperative care approach to prevent complications by incorporating supportive care along with latest available point of care diagnostics, interventional care, Extracorporeal Membrane Oxygenation (ECMO) and Continuous renal replacement therapy (CRRT).
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Background External cephalic version (ECV)is manipulations performed through the abdominal wall that yield a cephalic presentation,it is typically done around 37 weeks of pregnancy.before 36 weeks of pregnancy ,there is a chance to rotate to head down position on its own ,after 38 weeks of pregnancy moving is difficult ,that's why 37 weeks is the recommended time and improves the chances of having a vaginal birth.ECV reduces the rate of non-cephalic presentation at birth and success rate is 50 to 60 percent[1]. To evaluate the external cephalicAims And Objectives: version (ECV) procedure for the management of at term breech presenting foetus[2]. Inclusive Criteria: 1. Term with malpresentation 2. Abundant amniotic fluid 3. Unengaged presenting part 4. Non Anterior placenta 5. Multiparity 6. Non obese patient 7. Viable foetus 8. No previous cesarean scar Exclusive Crietria 1. Placenta previa 2. Early labour 3. Oligohydrominos 4. Ruptured membranes 5. Structural Uterine abnormalities 6. Foetal growth restrictions 7. Multi foetal gestation 8. Uterine incision 9. Hyper extended head Methods- Source for this study: In this prospective, interventional study, 10 patients with uncomplicated breech presentations at 37 weeks' gestation were considered for ECV. This was performed in our teaching hospital between January 2023 and December 2023. The main outcome measure was assessed as the success rate of ECV attempt and the rate of cesarean section following a successful procedure. Parity,abundant amniotic fluid, type of breech, placental location, and birth weight were evaluated as predictors of success. Also, any fetal or maternal complications during the procedure were evaluated. In our study, The success rate was 60%. The rate of cesarean section followingResults successful procedure was only 10% and emergency cesarean section performed in 10%. Prognostic parameters associated with successful ECV were multi parity and flexed type of breech. There were no serious fetal or maternal complications associated with the attempt. With appropriate selection of patients, ECV is highly successfulConclusion and is a safer alternative to vaginal breech delivery or cesarean delivery. ECV should be usually performed inAdvice: center where an all the emergency facilities and operating facilities available.You need to monitor to ensure that patient is not in labour and baby is not in distress,.
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Cesarean scar pregnancy is a rare type of ectopic pregnancy but potentially life threatening. The incidence of this ectopic pregnancy continues to rise due to global increase in cesarean sections rates as well as the diagnosis with wide use of transvaginal ultrasound. Delay or wrong diagnosis may result to uterine rupture and life-threatening bleeding with potential maternal morbidity and mortality. Endo-vaginal ultrasound has a reported sensitivity of 85-90% for detection. In difficult cases, magnetic resonance imaging is often useful as second line imaging. Treatment may be ranging from conservative to medical therapy or surgery. We present a series of three illustrative cases successfully managed with medical management and sequential treatment of medical and surgical management. We discuss diagnostic challenges and review of literature on updates on management strategies.
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Introduction: Spinal anesthesia is most widely used for both elective and emergency cesarean section. Hyperbaric bupivacaine (0.5%), an amide-type of local anesthetic, has been the gold standard for intrathecal but has certain side effects including cardiotoxicity. Levobupivacaine is a safer and more equipotent option. This study is done to compare the sensory and motor block characteristics, and hemodynamic changes occurring with 0.5% hyperbaric bupivacaine and 0.5% hyperbaric levobupivacaine when given intrathecally for categories 3 and 4 cesarean section. Materials and Methods: After Institutional Ethical Committee approval, 100 categories 3 and 4 pregnant females (American Society of Anesthesiologists I?II, aged 18–40 years) and after obtaining written informed consent to receive spinal anesthesia for cesarean section were randomized into two groups. Group A: received intrathecal 12.5 mg hyperbaric bupivacaine Group B: Received intrathecal 12.5 mg hyperbaric levobupivacaine. Sensory and motor block characteristics of the groups were assessed at desired intervals; observed hemodynamic changes and side effects were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software windows. A P < 0.05 was considered significant. Results: There was no statistical difference in all other sensory parameters in both groups. The mean time for the onset of motor block in Group A was faster compared to Group B, with a P = 0.008. The mean time to regression in motor characteristics in Group A was longer than Group B and the difference was found to be statistically significant. The hemodynamic parameters did not reveal any significant difference between the groups. The frequency of side effects (hypotension, bradycardia, and nausea) was more in Group A but the difference was not significant. Conclusion: Hyperbaric bupivacaine is superior in terms of motor block characteristics as compared to levobupivacaine as seen in the study. However, levobupivacaine can be used as a safer alternative to bupivacaine due to its hemodynamic stability, lesser side effects (cardiotoxicity), and satisfactory sensory and motor block characteristics for cesarean section.
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Background: Postpartum hemorrhage (PPH) involves excessive blood loss of 500 mL or more after vaginal delivery (NVD) or 1,000 mL or more after cesarean section within 24 hours postpartum. PPH significantly contributes to maternal mortality worldwide. Understanding the diverse effects of distinct risk factors is essential for effective mitigation. This study aimed to compare the risk factors of PPH among normal versus cesarean delivery (CD) cases at 250 bed modernized general hospital.Methods: Conducted at the department of obstetrics and gynaecology, 250 bed modernized general hospital, Naogaon, Bangladesh, this prospective study investigated PPH in 100 women from 01 July, 2022 to 30 June, 2023. Participants were divided into two equal groups in number: Group A (normal vaginal delivery) and group B (caesarean-section delivery). Data collection and analysis were performed using MS office.Results: In terms of risk factors, group A saw 4% maternal ages <19 and >40, while group B had 4% and 8% respectively. Artificial reproductive technique use was 2% in group A and 4% in group B. Weight gain >15.0 kg during pregnancy was 8% in group A and notably higher at 20% in group B. Gestational age <36 weeks affected 14% in group A and 8% in group B.Conclusions: In normal vaginal deliveries, maternal age <19 years, gestational age <36 weeks, labor induction/augmentation by oxytocin and neonatal birth weight <2499 gm are prominent risk factors. For cesarean-section deliveries, maternal age >40, weight gain >15.0 kg, pre-eclampsia, and neonatal birth weight >3500 gm also pose significant risks.
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Background: Caesarean section is one of the major oldest surgical procedure that has been performed all over world to save life of mother and fetus. The steadily increasing global rates of caesarean section have become one of the most debated topics in maternity care, as its prevalence has increased alarmingly in recent years. The aim is to assess the indications and complications of primary caesarean section in primigravida and multigravida.Methods: A cross sectional study carried out over a period of 1 year from April 2022 to March 2023, among 300 pregnant women from labour room in Mata Kaushalya District Hospital, Patiala by simple random sampling method.Results: Majority 54.7% of cesarean section were of primigravida and 45.3% were of multigravida. Maximum number of caesareans was between 26-30 yrs of age group. 68% women underwent emergency caesarean section and 32% underwent elective caesarean section. 6% underwent caesarean section at <37 weeks gestational age, maximum 83%caesarean section were at 37- 40 weeks gestational age and 11% caesarean section were at >40 weeks gestational age. Among primigravida, majority 35%were fetal distress, 24.29% CPD, malpresentation and malposition were 6.77%, 5.08% NPOL, 3.38% were placenta previa, 2.25% were IUGR, 3/177 (1.69%), severe oligohydroamnios 1.69%, preeclampsia and 1/177 (0.56%) were abruptio placenta. Among multigravida women 41.46% had most common indication was fetal distress, 2.43% had non progress of labour, 14.63% had malpresentations and malpositions.Conclusions: The proportion of primigravida undergoing primary Caesarean delivery was much more than multigravida. However, complications related to primary CS was much higher in multigravida.
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Background: Cesarean section has increased from year to year. The 2018 Indonesia Basic Health Research found that the percentage of cesarean deliveries was 17.6% of 78.736 deliveries. It has almost twice from the 2013 Indonesia Basic Health Research of 9.8%. Various reasons were given by mothers for choosing cesarean section. Aims: To explore differences in mothers' perceptions of cesarean section and normal birth. Here clearly write the aims of this study. Study Design: This study used a comparative study. Place and Duration of Study: This study was conducted in Simalungun Regency (North Sumatera, Indonesia) between July and September 2022. Methodology: We conducted on 106 women after 24 hours of labor (normal labor and cesarean section). Sampling was done by consecutive sampling. Data were collected using the Perception of Birth Scale/PBS questionnaire (29 questions) with a Likert scale of 1-5 and the Labor Agentry Scale/LAS (10 questions) with a Likert scale of 1-7 that had been translated and validated. Statistical test using Mann-Whitney U. Results: The mean PBS scores in the normal labor vs cesarean section group were 105.68 ± 10.95 and 109.09 ± 8.79 (p=0.026). The mean LAS score in the normal labor vs cesarean section group was 34.57 ± 5.27 vs 31.51 ± 4.37 (P value 0.000). Conclusion: Mothers who gave birth by cesarean section had a positive perception. Mothers who gave birth normally had high birth control. Education and information about the risks of the cesarean section should be promoted and mothers are supported to give birth naturally.
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Background: Gestational diabetes mellitus (GDM) is the most common endocrine disorder in pregnancy. It is associated with significant perinatal morbidity and mortality, therefore, an early-term delivery by routine induction of labor is proposed by some societies, to prevent/reduce these complications. Methods: This cross-sectional study was conducted between 1st January 2019 and 30th June 2020 at Aga Khan University Hospital, Pakistan to compare the pregnancy outcomes of patients with GDM when induced at 37, 38, and 39 weeks in comparison to women with GDM managed expectantly. The study included all women with singleton pregnancy and vertex presentation. Women induced after 41 weeks, previous cesarean delivery, placenta previa, major fetal anomalies, chronic maternal medical conditions that necessitate delivery, and those women presenting with spontaneous onset of labor were excluded. Data was analyzed in SPSS v.19. Results: A total of 293 women were included. The mean age of women was 27 years, and the mean BMI was 27.8 kg/m2. We found that women who were induced at earlier gestational weeks were managed with a combination of diet and pharmacological therapy in comparison to those induced at later gestational weeks and achieved glycemic control with diet and lifestyle modifications only. Around 77% of women required pharmacological therapy. The mode of delivery was not significantly different for women induced at different gestational weeks after 37 completed weeks. For neonatal outcomes, the birth weight was significantly greater for women induced at later gestational weeks. Conclusions: In women with gestational diabetes induced after 37 weeks at various gestational weeks, the mode of delivery is not significantly different.
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Background: The escalating global prevalence of Cesarean section (CS) deliveries raises concerns. To address this, the World Health Organization (WHO) suggests employing Robson’s ten-group classification system (RTGCS) for assessing and comparing CS rates among obstetric units. The aim of our study was to assess our hospital’s CS rate per group and juxtapose it with WHO Multi-Country Survey (MCS) population reference data. Furthermore, we delve into prevalent obstetric Indications for CS and examine potential strategies for mitigating the high CS rate. Materials and Methods: This observational cross-sectional study occurred at an Indian tertiary care teaching hospital from October 2018 to May 2020. Women delivering during this period were classified based on RTGCS, and Cesarean rates were computed across various groups. These rates were then compared with the WHO’s MCS population reference guidelines. Additionally, we investigated obstetric Indications for CS within these groups. Results: Of 2994 deliveries during the study period, 42.55% were CS. Notably, group 5 (29.75%) and group 1 (21.74%) had the highest CS rates. The CS rate of nulliparous women was 40.9%. Primary CS groups frequently cited fetal distress as the reason, while group 5 showed repeat CS due to previous CS with obstetric complications, on-demand CS, and scar integrity concerns. Conclusion: Despite our hospital’s overall high CS rate, group-specific contributions align with existing research. High-risk pregnancies, previous CS cases, and preterm CS for neonatal care notably contribute. Efforts should target in reducing CS in low-risk groups.
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Background: Post-dural puncture headache is a complication of regional blocks that results from intentional dural puncture during spinal anesthesia and unintentional dural puncture during epidural anesthesia. The aim of the study was to determine the prevalence, common clinical presentations and severity of post-spinal puncture headache among parturients who underwent cesarean section using spinal anesthesia in western Uganda. Methods: A cross-sectional study was conducted on 249 mothers who were consecutively enrolled in their 3rd post-partum day during the period from April 2022 to July 2022 from postnatal ward of Fort portal Regional Referral Hospital. The data needed for analysis was gathered using pretested questionnaires. Data was entered into microsoft excel version 16, coded and transported into SPSS version 22 for analysis. Descriptive statistics was carried out using SPSS version 22.0. Results: The prevalence of post-dural puncture headache among parturients who underwent cesarean section using spinal anesthesia was 81 (32.5%). Commonest clinical presentation being front/back headache 59 (72.8%), worsened with upright posture 81 (100%), coughing/sneezing 81 (100%) and improved on lying flat position 81 (100%). The commonest form was mild one 35 (43.2%). Conclusions: This study revealed a high prevalence of post-dural puncture headache as compared to studies done in the region which mainly presented as frontal/back with the commonest form being mild.
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RESUMEN La obstrucción intestinal inducida por íleo biliar es una condición rara pero significativa que se produce cuando una piedra en la vesícula se aloja en el tracto gastrointestinal. Entre los principales factores de riesgo para la obstrucción intestinal inducida por íleo biliar se encuentran la edad avanzada, el sexo femenino, la diabetes, los antecedentes de enfermedad biliar como cálculos biliares, así como procedimientos quirúrgicos previos relacionados con la vesícula biliar, como la colecistectomía. También el embarazo es un factor de riesgo conocido para la enfermedad de los cálculos biliares. En este artículo, se presenta el caso de una paciente de 38 años con antecedentes de tres cesáreas previas y sin comorbilidades aparentes. Antes de acudir al departamento de emergencias, la paciente experimentó dolor abdominal con cólico moderado en la parte inferior del abdomen durante dos días. El examen físico reveló sensibilidad abdominal difusa, predominantemente en la fosa ilíaca derecha, junto con signos de irritación peritoneal. Los análisis de laboratorio mostraron un recuento de leucocitos de 11 490 células/μl y una neutrofilia del 85,6 %. Después de una laparotomía exploratoria, se confirmó el diagnóstico sospechado de íleo biliar por cálculo. Se realizó una enterolitotomía y la paciente mostró un progreso posoperatorio favorable. En conclusión, es importante considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas relevantes y antecedentes médicos. Este reporte de caso subraya la importancia de considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas gastrointestinales y antecedentes de embarazo. El diagnóstico temprano y la intervención son cruciales para prevenir complicaciones graves.
ABSTRACT Gallstone ileus-induced intestinal obstruction is a rare but significant condition that occurs when a gallstone becomes lodged in the gastrointestinal tract. Major risk factors for gallstone ileus-induced intestinal obstruction include older age, female sex, diabetes, history of gallbladder disease such as gallstones, as well as previous gallbladder-related surgical procedures such as cholecystectomy. Pregnancy is also a known risk factor for gallstone disease. We present the case of a 38-year-old patient with a history of three cesarean sections and no apparent comorbidities. Prior to her visit to the emergency department, the patient experienced moderate colicky abdominal pain in the lower abdomen for two days. The physical examination revealed diffuse abdominal tenderness, predominantly in the right iliac fossa, along with signs of irritation of the peritoneum. Laboratory tests showed a leukocyte count of 11,490 cells/µl and neutrophilia of 85.6 %. Following an exploratory laparotomy, the suspected diagnosis of gallstone ileus was confirmed. An enterolithotomy was performed, and the patient experienced good post-surgical progress. In conclusion, it is important to consider gallstone ileus-induced intestinal obstruction among patients with relevant symptoms and medical history. This case report highlights the importance of considering gallstone ileus-induced intestinal obstruction among patients with gastrointestinal symptoms and a history of pregnancy. Early diagnosis and intervention are crucial to prevent serious complications.
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Objective:To investigate the effect of dexmedetomidine combined with chloroprocaine on epidural anesthesia for cesarean section.Methods:A total of 133 women who underwent epidural anesthesia for cesarean section at the Department of Anesthesiology, Jinhua People's Hospital between January 2020 and December 2022 were included in this prospective case-control study. These women were divided into a ropivacaine group ( n = 66) and a chloroprocaine group ( n = 67) using a random number table method. The ropivacaine group received epidural anesthesia with dexmedetomidine combined with ropivacaine, while the chloroprocaine group received epidural anesthesia with dexmedetomidine combined with chloroprocaine. The anesthesia effect (anesthesia onset time, anesthesia duration, peak effect time), changes in blood pressure (systolic blood pressure, diastolic blood pressure), adverse reactions (shivering, nausea and vomiting, urinary retention, skin itching, numbness of lower limbs), and satisfaction with muscle relaxation were observed in the two groups. Results:The anesthesia onset time, anesthesia duration, and peak effect time in the chloroprocaine group were (6.91 ± 1.54) minutes, (61.54 ± 5.31) minutes, and (11.79 ± 4.12) minutes, respectively, which were significantly shorter than those in the ropivacaine group [(9.65 ± 1.92) minutes, (83.57 ± 6.69) minutes, (18.32 ± 4.81) minutes, t = 9.08, 21.05, 8.41, all P < 0.001). The systolic and diastolic blood pressure increased in both groups after 10 minutes of anesthesia and at the end of the procedure; however, the increments observed in the chloroprocaine group were relatively smaller. There were significant differences in systolic and diastolic blood pressure, measured at 10 minutes of anesthesia and at the end of the procedure, between the two groups ( F = 7.36, P < 0.001; F = 5.12, P = 0.001). There were significant differences in systolic and diastolic blood pressure between different time points ( F = 10.03, P < 0.001; F = 6.72, P < 0.001). The group-by-time interaction effect on systolic and diastolic blood pressure was also highly significant ( F = 9.83, P < 0.001; F = 8.01, P < 0.001). The chloroprocaine group exhibited a significantly lower incidence of adverse reactions compared with the ropivacaine group [4.48% (3/67) vs. 15.15% (10/66), χ2 = 4.29, P < 0.05). Additionally, the chloroprocaine group had a significantly higher satisfaction rate with muscle relaxation compared with the ropivacaine group [94.03% (63/66) vs. 81.82% (54/66), Z = 5.73, P < 0.05]. Conclusion:The combination of dexmedetomidine and chloroprocaine offers remarkable benefits in epidural anesthesia for cesarean sections. This combined approach not only enhances epidural anesthesia but also stabilizes the blood pressure of puerperants, reduces adverse reactions, and provides exceptional muscle relaxation. It deserves consideration for clinical application.