Effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section

BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting maternal emotional wellbeing,daily activities,breastfeeding,and neonatal care.It may also impede maternal organ function recovery,leading to escalated opioid usage,heightened risk of postpartum depression,and the development of chronic postoperative pain.Both the Chinese Enhanced Recovery After Surgery(ERAS)guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management.Esketamine,functioning as an antagonist of the N-Methyl-D-Aspartate receptor,has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment.Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes.This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.AIM To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.METHODS A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups:low-dose esketamine(0.15 mg/kg),high-dose esketamine(0.25 mg/kg),and control(saline).Postoperative Visual Analog Scale(VAS)scores were recorded at 6 hours,12 hours,24 hours,and 48 hours.Edinburgh Postnatal Depression Scale(EPDS)scores were noted on 2 days,7 days and 42 days.Ramsay sedation scores were assessed at specified intervals post-injection.Postoperative adverse reactions were also recorded.RESULTS Low-dose group and high-dose group compared to control group,had significantly lower postoperative VAS pain scores at 6 hours 12 hours,and 24 hours(P<0.05),with reduced analgesic usage(P<0.05).EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days(P<0.05).No significant differences in first exhaust and defecation times were observed(P>0.05),but ambulation times were shorter(P<0.05).Ramsay scores were higher at 5 minutes,15 minutes,and upon room exit(P<0.05).Low-dose group and high-dose group had higher incidences of hallucination,lethargy,and diplopia within 2 hours(P<0.05),and with low-dose group had lower incidences of hallucination,lethargy,and diplopia than high-dose group(P<0.05).CONCLUSION Esketamine enhances analgesia and postpartum recovery;a 0.15 mg/kg dose is optimal for cesarean sections,balancing efficacy with minimized adverse effects.

Clinical nursing value of predictive nursing in reducing complications of pregnant women undergoing short-term massive blood transfusion during cesarean section

BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.

Merits and demerits of administering esketamine in preventing postpartum depression following cesarean section

Emergency cesarean section is associated with the development of postpartum depression.Esketamine has been demonstrated to have a rapid onset of antide-pressant effects.Randomized controlled trials and meta-analyses have demon-strated the efficacy of esketamine in preventing postpartum depression after ce-ssarean section.However,the data included in these analyses were derived from elective cesarean sections and differed in the dose and timing of esketamine ad-ministration.Esketamine is a dissociative anesthetic with a dose-dependent risk of inducing psychotic symptoms,including hallucinations.In the setting of cesarean section,esketamine should be administered with caution and only if the potential benefits outweigh the risks.

Effect of psychological nursing intervention combined with acupressure on postoperative recovery of women after cesarean section

BACKGROUND Psychological intervention nursing(PIN)has been considered to have a curative effect on cesarean section(CS)post-operative recovery.However,the therapeutic mechanisms remain obscure.AIM To explore the effects of PIN combined with acupressure massage on CS postoperative recovery.METHODS A retrospective study was conducted on 150 pregnant women admitted to an obstetrics department between January 2020 and January 2023.The control group(CG)received acupressure therapy(n=73),and the intervention group(IG)received acupressure therapy and PIN therapy(n=77).Postoperative recovery time was assessed by anal-exhausting,defecation,bed activity,breastfeeding,and hospital stay times.Adverse effects,including infection,bleeding,limb numbness,intrauterine hematoma,urinary retention,and venous thromboembolism,were recorded.the pain visual analogue scale(VAS)was used to evaluate the degree of pain.Anxiety and depression status were qualitatively assessed using the selfrating anxiety scale(SAS),self-rating depression scale(SDS),and Edinburgh postpartum depression scale(EPDS).The Pittsburgh sleep quality index(PSQI)was used to compare sleep quality between the groups.RESULTS The baseline data and SAS,SDS,EPDS,and PSQI scores did not significantly differ before CS(P>0.05)and neither did complication rates between the two groups after CS(P>0.05).However,anal-exhausting,defecation,waking up,breastfeeding,and hospitalization times were significantly shorter for participants in the IG than those for participants in the CG(P<0.05).The VAS,SAS,SDS,EPDS,and PSQI scores of the IG were significantly lower than those of the CG(P<0.05).CONCLUSION PIN,combined with acupressure massage,effectively promotes maternal recovery,reduces post-CS pain,and improves post-operative negative emotions and sleeping quality.

Analysis of risk factors for postpartum depression after cesarean section in women with early-onset preeclampsia

BACKGROUND Early-onset preeclampsia significantly increases maternal and fetal morbidity and mortality.Many pregnant women with early onset preeclampsia choose cesarean section as their delivery method.Although extensive research has explored the association between postpartum depression(PPD)and cesarean section,few studies have investigated the risk factors after cesarean section in women with early-onset preeclampsia.AIM To examine these risk factors through a retrospective,observational analysis of 287 women who underwent a cesarean section for early preeclampsia between June 2014 and March 2024.METHODS Participants were assessed in person during the 32nd week of pregnancy,2 days post-cesarean,and 6 weeks postpartum.According to the Edinburgh Postnatal Depression Scale(EPDS),participants who underwent cesarean section were divided into PPD(n=60)and non-PPD groups(n=227).Furthermore,PPD was diagnosed at 6 weeks postpartum according to depressive symptoms(EPDS score≥11).The demographic and clinical features of PPD were screened.Multivariate logistic regression analysis was used to identify PPD risk factors.RESULTS The prevalence of PPD was 20.9%(60/287)among the 287 women who underwent cesarean section for early-onset preeclampsia.Multivariate logistic regression analyses revealed that advanced age(age>40 years)[odds ratio(OR)=1.93,95%CI:1.31-2.82],previous preeclampsia(OR=7.15,95%CI:5.81-8.85),pre-pregnancy obesity(OR=2.42,95%CI:1.62-3.63),gestational diabetes mellitus(OR=3.52,95%CI:2.51-4.92),preexisting hypertension(OR=1.35,95%CI:1.03-1.89),PPD symptoms(EPDS≥11)at 2 days postpartum(OR=6.15,95%CI:1.32-28.35),high prenatal self-rating anxiety scale score(OR=1.13,95%CI:1.06-1.18),and pain at 6 weeks postpartum(OR=2.16,95%CI:1.28-3.66)were independently associated with PPD.CONCLUSION Risk factors for PPD after cesarean section in women with early-onset preeclampsia include advanced age(age>40 years),pre-pregnancy obesity,previous preeclampsia,gestational diabetes mellitus,preexisting hypertension,PPD symptoms(EPDS≥11)at 2 days postpartum,prenatal anxiety,and pain at 6 weeks postpartum.The early identi-fication of these factors and interventions can mitigate the risk of PPD.

Utero-Cutaneous Fistula after Caesarean Section Delivery: Diagnosis and Management of a Rare Complication

Utero-cutaneous fistula following cesarean section is a rare occurrence. We present the case of a 34-year-old woman who presented to our department four years after her second cesarean section with a history of pain and blood discharge from a previous Pfannenstiel incision, during menstruation, with an absence of vaginal menstrual flow. Despite a prior surgical repair operation, her symptoms persisted. A pelvic MRI was done to confirm the diagnosis of utero-cutaneous fistula, and surgical management was pursued. This case report aims to contribute to the existing literature on utero-cutaneous fistula and provide insights into the diagnostic considerations and management strategies for this rare complication.

Anesthetic Management of a Patient with Spinal Muscular Atrophy Type III Undergoing Emergent Caesarean Section: A Case Report

In this case report, we describe the anesthetic management for a 36-year-old G2P0010 at 36 weeks gestation with Spinal Muscular Atrophy Type III who underwent an emergent caesarean section due to fetal footling breech position. The patient is a wheelchair-bound quadriplegic with kyphoscoliosis and a lack of cough reflex who required nasal continuous noninvasive ventilatory support (CNVS) for chronic hypercapnic respiratory failure. Surgery was done under general anesthesia due to its emergent nature, and the patient was successfully extubated and transitioned to nasal CNVS in the operating room at the end of the case. Postoperative care was provided in the medical intensive care unit for three days without complication and the patient was discharged home uneventfully.

Vaginal Cesarean Section, an Alternative to High-Risk Trigger on Scarred Uterus

The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.

Clinical Value of Predictive Nursing Intervention on Deep Venous Thrombosis of Lower Extremities after Cesarean Section

[Objectives]To explore the clinical nursing value of predictive nursing intervention in patients with deep venous thrombosis of lower extremities after cesarean section.[Methods]From December 2022 to April 2023,105 pregnant and lying-in women who were hospitalized in the Gynecology Department of Pingquan Hospital and underwent cesarean section and met the inclusion criteria were included as the study objects.According to the medical records,they were divided into observation group(n=52 cases)and control group(n=53 cases).The clinical experimental subjects were divided into two groups.One group was the control group with routine nursing,and the other group was the observation group with predictive nursing intervention.The number of cases of deep venous thrombosis of lower extremities in the two groups was recorded to evaluate the clinical value.[Results]The incidence of deep venous thrombosis of lower extremities in the two groups after cesarean section was compared,and it was suggested that the incidence of the observation group was lower than that of the control group(P<0.05).[Conclusions]Special predictive nursing intervention can greatly reduce the incidence of deep venous thrombosis of lower extremities after cesarean section,improve nursing satisfaction,and improve clinical efficacy,which is worthy of recommendation.

Neuroanatomical Basis of Postoperative Pain and Assessment of Its Management in a Series of Patients Undergoing Caesarean Sections

Introduction: In recent decades, the cost of postoperative pain has been the subject of many studies based on protocols developed by scientific societies for its assessment and optimization. At the Regional Hospital of Saint-Louis (Senegal), several protocols have been developed for pain management, but no study has focused on the assessment of postoperative pain management specifically. We therefore initiated this work, the objectives of which were to remind the neuroanatomical and neurophysiological bases of postoperative pain, and to analyze the assessment and management of this pain in patients who have undergone a caesarean section. Materials and methods: This was a prospective and descriptive study, which took place in the gynecology-obstetrics department, over a period from January 2019 to July 2020. All patients who gave birth by cesarean section were included. The data was collected from a survey sheet written for this purpose. For each of the patients, the information was taken every day throughout the duration of postoperative hospitalization. Results: It appears from our work that after a cesarean section, the pain felt evolves on the first postoperative days with a peak during the second day. As in the data reported in the literature, there does not seem to be a difference in terms of pain intensity and analgesia dosage between scheduled and emergency caesarean sections. However, young age and female gender—for other types of surgeries—are risk factors associated with high postoperative pain scores. This trend is probably related to the low pain experience of tested patients. Our initial hypothesis was that acute post-operative pain after caesarean sections could be linked to defects in the perception and processing of pain by caregivers. Indeed, we have shown that awareness-raising, information, and training actions have made it possible to significantly improve the management of pain after a cesarean section. Conclusion: After a cesarean section the pain is intense, especially when the effects of the morphine wear off. However, in our context where morphine and its derivatives are only slightly used, the post-operative pain is maximal rapidly. This pain therefore needs to be researched and treated appropriately. After a campaign to raise awareness among healthcare personnel, it is possible to significantly improve the systematic administration of analgesics.

Effect and Value of Quality Nursing Intervention in Breastfeeding after Cesarean Section among Primigravid Women

Objective:To analyze the effect of using quality nursing care for primigravid women undergoing cesarean delivery.Methods:A total of 80 cases of primigravid women undergoing cesarean section from June 2022 to June 2023 were randomly selected.They were divided into two groups:Group A(40 cases)received routine care and Group B(40 cases)received quality care.The division was done using a computerized randomization method.The effects of the nursing care received in the two groups were compared.Conclusion:Quality nursing care for primigravid women undergoing cesarean section can enhance breastfeeding rates,alleviate maternal anxiety,improve feeding practices,and enhance breastfeeding self-efficacy.

The Rate and Indications of Primary Cesarean Section at Dubai Hospital, Dubai Health Authority, Dubai, UAE

The primary cesarean section rate is defined as the percentage of cesarean deliveries out of all births to women who have not had a previous cesarean delivery. Cesarean section rates steadily increased during the last two decades due to various indications. This is a retrospective study conducted at Dubai Hospital at DHA, Dubai UAE from January 2017 to December 2017, the data were collected using special data collection sheet and analyzed by Statistical package for social sciences (SPSS). The rate of primary cesarean section is 15.4% with fetal distress being the most common cause primary cesarean section. 66% of the performed cases were primigravida. 85% were done as emergency cases. Women aged 36 - 40 years were the common age group among the studied cases. Primary cesarean sections are the driving force behind the overall rate of cesarean sections and cause an increase in morbidity in future pregnancies.

A Single-center Retrospective Cohort Study on Cesarean Section under General Anesthesia

Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.

Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women： The Shanxi Study

Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nulliparous pregnancies unless indicated, to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

Background： Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 （50% effective dose） and ED95 （95% effective dose） of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods： Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1-L2 vertebral interspace then lumbar puncture was performed at the L3-L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels （pinprick） were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results： ED50 （95% confidence interval） of spinal hyperbaric ropivacaine was determined to be 10.37 （5.23-11.59） mg and ED95 （95% confidence interval） to be 15.39 （13.81-23.59） mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion： The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.

Diagnosing early scar pregnancy in the lower uterine segment after cesarean section by intracavitary ultrasound

BACKGROUND Early scar pregnancy(CSP)in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated.Transabdominal ultrasound is a common procedure but is influenced by external factors.Thus,intracavitary ultrasound may have better diagnostic efficiency for CSP.AIM To assess the value of intracavitary ultrasound for diagnosing CSP in the lower uterine segment after cesarean section.METHODS Patients diagnosed with CSP in our hospital from October 2019 to April 2021 were recruited.Transabdominal and intracavitary ultrasound examinations were performed to compare the diagnostic differences for CSP and its types.RESULTS Sixty-three patients were diagnosed during the study period.The diagnostic accuracy for CSP was higher in intracavitary ultrasound(96.83%)than in transabdominal ultrasound(84.13%)(P<0.05).The missed diagnosis and misdiagnosis rates did not differ among the ultrasound types(intra:0.00%and 3.17%;trans:4.76%and 11.11%,respectively;P>0.05).For the diagnostic rates for the CSP types,the rates for gestational sac(100.00%vs 90.48%),heterogeneous mass(93.75%vs 75.00%),and part of the uterine cavity(80.00%vs 60.00%)were higher in intracavitary ultrasound than in transabdominal ultrasound,but the difference was not statistically significant(P>0.05).For gestational sac CSP patients,intracavitary ultrasound showed that the gestational sac was located in the lower uterine segment scar with abundant peripheral blood flow;the distance between the gestational sac and the serosal layer was 2.42±0.50 cm.Intracavitary ultrasound for heterogeneous mass CSP patients indicated that the mass mainly occurred in the lower anterior uterine wall,protruding into the bladder,and was surrounded by abundant internal and peripheral blood flow;the distance between the mass and serosal layer was 1.79±0.30 cm.For CSP type partly located in the uterine cavity,the gestational sac was partly located in the lower uterine cavity and partly in the scar with abundant internal and peripheral blood flow;the distance between the gestational sac and the serosal layer was 2.29±0.28 cm.CONCLUSION Intracavitary ultrasound had a higher diagnostic accuracy and application value for diagnosing CSP than transabdominal ultrasound,with reduced risk of missed diagnoses and misdiagnosis,thereby preventing delayed treatment.

Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar

AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases. RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04). CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.

An exploration of the breastfeeding behaviors of women aftercesarean section: A qualitative study

Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019.Information saturationwas used to determine sample size.Data were analyzed using a thematic content analysis method.Themes were developed based on the theory of planned behavior.Results:Thirteen(68.42%)had a planned cesarean section,and six(31.58%)cesarean sections were unplanned or emergent.Three major themes emerged:ambivalent attitude about breastfeeding,motivation to comply with the traditional cultural norms,and barriers and challenges.The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk,support from healthcare professionals,and responsibility for breastfeeding.The challenges for breastfeeding after cesarean sections included physical discomfort,knowledge and skills deficit of breastfeeding,lactation deficiency,and lack of knowledge and coping skills in managing their depressive mood after cesarean sections.There were a couple of neutral factors,such as the influences of family and peers.These factors could influence women either positively as facilitators or negatively as barriers.Conclusions:The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections.To promote women’s breastfeeding behaviors after cesarean sections,it is necessary to change women’s attitudes,belief systems,and the external environments and help them become more confident.

Induction of labor using double balloon cervical device in women with previous cesarean section: Experience and review

Induction of labour remains one of the most challenging interventions in current obstetrics. Different pharmaceuticals have been used for cervical ripening such as prostaglandins;however they can lead to a number of potential inconvenient risks namely uterine tachysystole and pathological fetal cardiotocography (CTG). In cases of women with previous caesarean births, using prostaglandins would pose even higher risks such as uterine rupture and perinatal mortality. A mechanical method of cervical ripening could represent an alternative for these women. We report the use of the extra-amniotic double balloon cervical device (Cook’s device) for ripening of unfavourable cervix in seventeen women attempting vaginal birth after cesarean section (VBAC). Using Bishop scoring system to assess cervical dilatetion, position, consistency, fetal station and effacement, the unfavourable cervix is the cervix that scores less than 6. We review the relevant literature discussing this method of induction focusing on its effectiveness, simplicity, safety and efficacy, low cost and any associated serious side effects. Conclusion: Success was estimated to be over 50% with no serious life threatening maternal or fetal complications. We considered the process satisfactory and practical. We recommend larger studies to assess safety and efficacy of Cook’s device in vaginal birth after caesarean section before embarking on routine elective caesarean delivery. Objectives: To estimate success rate for vaginal delivery after previous caesarean section using cervical double balloon device (Cook’s device). Design: Three-year observational study. Setting: Maternity unit in district general hospital, UK. Population: Women who had one previous lower segment caesarean section and unfavourable cervix identified as having Bishop Score less than 6. Methods: Data were obtained from the birth registry over 3 years from January 2008 until December 2010. Main outcome: Measure successful vaginal delivery. Results: Out of 25 cases that had induction of labour with history of one previous lower segment caesarean section, 17 patients did fit in the inclusion criteria and were studied. 53% had a successful vaginal delivery while 47% had to have cesarean section either due to failure to progress or pathological cardiotocography. 82% required to have syntocinon infusion for augmentation as per local unit protocol. All newborn babies were in good condition and did not require admission to neonatal intensive care unit.

Effects of a theory of planned behavior-based intervention on breastfeeding behaviors after cesarean section:A randomized controlled trial

Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomized controlled trial.Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020.One hundred thirty-two women were divided randomly into the intervention(n=66)and control group(n=66)by systematic random sampling.In the intervention group,an intervention project was implemented after Keywords:Breastfeeding Cesarean section Intervention studies Theory of planned behavior the C-section to establish positive breastfeeding attitudes,cultivate supportive subjective norms,enhance perceived behavioral control,and strengthen breastfeeding intention to change behaviors.Those in the control group received routine pre-and post-delivery care.Exclusive breastfeeding rate and breast problem were collected at 5 days,2 weeks,and 1 month after C-section.The modified Breastfeeding Attrition Prediction Tool(BAPT)on the first day in the hospital,two weeks,and one month after C-section and Numerical Rating Scale(NRS)24 h postoperatively were used to compare the intervention effect between the two groups.Results:After the intervention,the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days(86.4%vs.60.6%),two weeks(77.3%vs.57.6%),and one month(74.2%vs.50.0%)after the C-section.Besides,the intervention group was less likely to have sore nipples at five days(6.1%vs.18.2%in the control group,P<0.05)and two weeks(9.1%vs.12.1%in the control group,P<0.05).After two weeks of intervention,attitude scores(90.64±8.31 vs.87.20±8.15,P<0.05),subjective norm scores(88.07±24.65 vs.79.42±19.47,P<0.05)and behavior control scores in the intervention group were significantly higher than those in the control group.After one month of intervention,attitude scores(90.34±10.35 vs.84.22±10.51,P<0.05)and behavior control scores(43.13±5.02 vs.39.15±4.69,P<0.05)in the intervention group were significantly higher than those in the control group,which resulted in the higher breastfeeding intention in the intervention group.Conclusion:This study indicated that the TPB-based interventions effectively improved women's breastfeeding behaviors after C-sections.