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.

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.

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.

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.

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.

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.

Analysis of the Effect of Midwives’ Psychological Care Intervention on the Progress of Labor and Cesarean Rate of Elderly Women in Labor

Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.

Effects of intravenous infusion of esketamine on analgesia and postpartum antidepressant after cesarean section

Objective:Postpartum depression and postoperative pain affect postpartum physical and psychological rehabilitation.Esketamine,as a dexer of ketamine,has analgesic and antidepressant effects.This study was to investigate the effect of intravenous infusion of esmololone on postoperative analgesia and postpartum depression in parturients undergoing cesarean section.Methods:435 parturients undergoing cesarean section under combined spinal and epidural anesthesia were randomly divided into three groups.All of the subjects were given continuous intravenous infusion 5 minutes after delivery of the fetus.HE:0.4 mg/kg esketamine;LE:0.2 mg/kg esketamine;C:saline.Intraoperative records of MAP and HR at entry operating room(T0),skin resection(T1),beginning of test drug pumping(T2),10 min of pumping(T3)20min of pumping(T4),end of pumping(T5),end of operation(T6)and the adverse reactions before leaving the room were recorded.Postoperative analgesia with intravenous analgesia pump:2.5 ug/kg Sufentanil+8 mg Ondansetron+100 mL Saline.VAS score and sufentanil consumption and adverse reactions were recorded at 2 h(T0’)4 h(T1’)、8 h(T2’)、12 h(T3’)、24 h(T4’)after operation.The Edinburgh Postpartum Depression Scale(EPDS)was used to evaluate the depression status of pregnant women 1 day before operation,1 d,3 d,1 w and 6 w after operation.Result:There was no significant difference in mean arterial pressure(MAP)and heart rate(HR)among the three groups(P>0.05).Compared with C,the incidence of dizziness and diplopia was higher in HE and LE(P<0.05).Compared with C,VAS scores,the sufentanil dosage,and EPDS scores decreased at 1 and 3d postoperatively in both the HE and LE.(P<0.05).Conclusion:The analgesic effect of esketamine after cesarean section is remarkable,which can reduce the use of opioids and improve the short-term depression of pregnant women.

Effect of Height Adjusted Dose of Intrathecal Hyperbaric Bupivacine for Elective Cesarean Section: A Study of 2 Different Concentrations

Introduction: Study compare spinal anesthesia using hyperbaric bupivacine (0.5% - 0.75%) between fixed dose and height adjusted dose during elective cesarean section. Methods: Hundred parturients who had given their consent and were scheduled for elective cesarean section under spinal anesthesia, were divided into four groups—first group received 0.5% hyperbaric bupivacine fixed dose, the second group received 0.5% hyperbaric bupivacine in a dose adjusted to the height, the third received 0.75% hyperbaric bupivacine fixed dose, the fourth group received 0.75% hyperbaric bupivacine in a dose adjusted to height. The anesthesia onset time, haemodynamic changes, side effects and fetal outcome observed. Results: Spinal block provide excellent surgical anesthesia in all patients. Anesthesia onset time is longer in adjusted than fixed groups, in 0.5% (5 ± 0.816 vs. 3.84 ± 0.746) (P Conclusion: Adjusting dose of hyperbaric bupivacine (0.5% - 0.75%) to patient’s height, decreases the dose of bupivacine in use, it also provide adequate anesthesia for elective cesarean section with decrease the use of vasopressors, the incidence and severity of maternal hypotention also markedly reduced.

The Effect of Early versus Traditional Hospital Discharge on Activities of Daily Living for Women Undergoing Elective Cesarean Section. An Observational Cohort Study

Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scoring assessment was made and there was no significant difference between the two arms of the study. Initiation of successful breastfeeding, and neonatal readmission were similar in both groups. Conclusion: The policy of early discharge can be adopted in low-risk cases scheduled for elective uncomplicated CS provided that the mother and the neonate are in good general condition and proper instructions regarding red flag manifestations are given.

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.

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.

Effect of lower leg compression during cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial

Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute,Damanhour,Egypt.The sample included 120 parturients (60 intervention and 60 control).The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule,electronic monitoring of maternal hemodynamic parameters,and neonatal hemodynamic assessment sheet.All parturients received ordinary preoperative care.For the intervention group,a long elastic stocking (ordinary pressure 20-30 mmHg,1 mmHg =0.133 kPa) was applied on both legs during cesarean section.The control group received the same care without the elastic stocking.Results: Systolic blood pressure,diastolic blood pressure,and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5 -15 min.Heart rate was significantly lower in the intervention group.Only 13.3% of the intervention group took ephedrine compared with 45% of the control group.Apgar score was higher among neonates of intervention group compared with the control group at 1 min.Neonatal acidosis was significantly higher in the control group than in the contral group.Conclusion: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.

Effect of Body Mass Index on Anesthesia Characteristics and Vasopressor Requirements during Spinal Anesthesia for Elective Cesarean Section

Background: There is a debate about the dose of hyperbaric bupivacine for spinal anesthesia for cesarean delivery in obese parturients. While it is concessive that the dose of spinal bupivacine is reduced in pregnant compared with non-pregnant parturient due to many factors. But it is still controversial whether local anesthetic should further reduce in obese patients or not. In this perspective, observation study, we tested the influence of BMI on vasopressor requirements and block height. Methods: Three groups of 40 parturients, group A (Body mass index (BMI) 2), group B (BMI 30 - 45 Kg/m2) and group C (BMI > 45 kg/m2) requiring elective cesarean section were recruited all patients received 12.5 mg subarachnoid hyperbaric bupivacine combined with 20 ug fentanyl. Dermatomal levels were assessed after subarachnoid injection using touch sensation at 2 minutes interval for first 10 minutes then every 5 minutes. Vasopressor requirements in the first 45 minutes after subarachnoid injection, and maximum block heights using touch sensation were assessed as primary outcomes. Secondary outcomes were extent of motor block (peak flow rate), technique difficulty (number of attempts), maternal side effects and neonatal outcomes. Results: There was no significant difference in mean blood pressure (MBP) between group A and B but the difference was significant in group C in relation to other two groups, mean number of hypotensive episodes was significantly higher in group C than group A, B with no significant difference in incidence between group A and B (P Conclusion: Sensory testing using touch modality to detect extent of anesthesia, showed at 25 minutes after spinal anesthesia induction, significantly higher level in group C than the other two groups. Vasopressor requirements during the first 45 minutes of spinal anesthesia were not different between group A, B but significantly higher in group C. Time for regression of anesthesia was longer in group C, which may be helpful regarding longer surgical time. Single shots spinal anesthesia of 12.5 mg hyperbaric bupivacine produce clinically equivalent effect in parturients with BMI 2 with no need for dose reduction but caution and dose adjustment recommended in parturients with BMI > 45 Kg/m2.

Effects of auricular-plaster therapy on pain and serum levels of cortisol and IL-6 after cesarean section

Purpose:To evaluate APT(APT)for its analgesic effects and influence on serum cortisol and IL-6 levels after cesarean section.Methods:108 puerperae prepared for cesarean section were randomly divided into three treatment groups:APT,patient-controlled intravenous analgesia(PCIA),and a combination of APT and PCIA.The degrees of incision pain(including pain at rest and pain evoked by changing position in bed)and oxytocin-mediated uterine cramping pain were determined using a visual analogue scale(VAS).The serum concentrations of cortisol and IL-6 were measured preoperatively and postoperatively.Results:Uterine cramping pain was lower in the APT group than the PCIA group and lowest in the combination therapy group.Incision pain was similar between the APT group and the PCIA group but lower in the combination therapy group.On the second morning after surgery,the serum concentrations of cortisol and IL-6 were similar between the APT group and the PCIA group but lower in the combination therapy group.The extent of pain was highly related to cortisol levels and moderately related to IL-6 levels.Conclusion:APT can relieve uterine cramping pain after cesarean section,and in combination with PCIA can decrease serum levels of cortisol and IL-6.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

Effects of Cesarean Section on Infant Health in China:Matched Prospective Cohort Study

Objective To compare the medical outcomes of infants delivered by cesarean section with those of infants delivered vaginally. Methods A total of 301 healthy women with cesarean section and a matched control group of 301 women delivered vaginally were identified at three district-level hospitals in Shanghai from May 2001 to February 2003. Two groups were matched according to their medical indications for cesarean section. Their infants were assessed at delivery, 1 month, 6 month and 1 year after birth. Results The incidence of neonatal complications and infant morbidities at all measurement occasions did not differ significantly between groups. Rehospitalization was found to be more likely among infants delivered by cesarean section in the first month after birth. However, there was no difference between two groups in the incidence of rehospitalization in the first year after birth. Cesarean section was also associated with a higher risk of infant diarrhea （adjusted relative risk=1.25, 95% CI： 1.01, 1.56）. Conclusion Infants did not have health benefits from cesarean section if the pregnancy was at low risk.

Effect of intraoperative cell rescue on bleeding related indexes after cesarean section

BACKGROUND Obstetric hemorrhage is the leading cause of maternal mortality globally,especially in China.The key to a successful rescue is immediate and rapid blood transfusion.Autotransfusion has become an integral part of clinical blood transfusion,with intraoperative cell salvage(IOCS)being the most widely used.AIM To investigate the application of IOCS in cesarean section.METHODS A total of 87 patients who underwent cesarean section and blood transfusion in our hospital from March 2015 to June 2020 were included in this prospective controlled study.They were divided into the observation(43 cases)and control(44 cases)groups using the random number table method.The patients in both groups underwent lower-segment cesarean section.The patients in the control group were treated with traditional allogeneic blood transfusion,whereas those in the observation group were treated with IOCS.Hemorheology[Red blood cell count,platelet volume,and fibrinogen(FIB)]and coagulation function(partial prothrombin time,prothrombin time(PT),platelet count,and activated coagulation time)were measured before and 24 h after transfusion.In the two groups,adverse reactions,such as choking and dyspnea,within 2 h after cesarean section were observed.RESULTS Before and after transfusion,no significant differences in hemorheology and coagulation function indices between the two groups were observed(P>0.05).About 24 h after transfusion,the erythrocyte count,platelet ratio,and FIB value significantly decreased in the two groups(P<0.05);the PLT value significantly decreased in the two groups;the activated partial thromboplastin time,PT,and activated clotting time significantly increased in the two groups(P<0.05);and no statistical differences were observed in hemorheology and coagulation function indices between the two groups(P>0.05).Furthermore,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION In patients undergoing cesarean section,intraoperative cell salvage has a minimum effect on hemorheology and coagulation function and does not increase the risk of amniotic fluid embolism.