Community Hospital Experience of Surgical Times and Outcomes in Patients Undergoing Cesarean Deliveries for Non-Reassuring Fetal Tracing: A Retrospective Cohort

Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room and a choice of anesthesia for cesarean deliveries. Objective: This study was designed to compare times from the arrival to the OR to the delivery of the fetus between regional and general anesthesia along with maternal and fetal outcomes, for patients undergoing cesarean sections for non-reassuring fetal tracing. Study Design: Records were reviewed for patients who underwent cesarean delivery for non-reassuring fetal heart rate tracing from February 2012 to May 2018. A total of 190 charts were selected. Seven patients who received epidural or spinal anesthesia and then converted to general anesthesia (GA) were excluded. The primary outcomes were: 1) entering the operating room to skin incision (min);2) the time from entering the operating room to delivery of the fetus (min). These times were compared among the patients who underwent epidural, spinal and general anesthesia. The secondary criteria included time from skin incision to delivery of the fetus (min), estimated blood loss (ml), Apgars scores, Arterial/venous cord pH, NICU admissions and fetal complications. ANOVA or Kruskal-Wallis Test was used for the continuous variable and Fisher’s exact test was used for the categorical variable to test the differences between groups. Logistic regression model was used for the binary outcomes after adjusting for age, BMI and number of prior laparotomies. Results: Infants in the GA group were delivered significantly faster when compared to epidural and spinal group separately with a P-value of 0.001. The mean time from arrival to OR to delivery of the newborn in GA group was 12.7 minutes, compared to 27 minutes in epidural group and 32.7 minutes in the spinal group. Time intervals from time in the OR to incision and time from incision to delivery of the fetus were also calculated and were significantly shorter in the GA group when compared to spinal and epidural groups, P Conclusion: The induction of general anesthesia for emergency cesarean section resulted in shorter times to delivery compared to spinal and epidural. General anesthesia was associated with lower, albeit not statistically significant Apgar scores and higher NICU admissions, and had similar cord gases compared to neuraxial anesthesia group.

Abnormal Placental Findings Associated with Non-Reassuring Fetal Monitoring and Excellent Neonatal Outcomes

Objective: Obstetricians, Neonatologists, and Pathologists have studied gross histological analysis of human placentas in search of specific alterations in placental functions that can be correlated with neonatal outcomes. Our study assessed the prevalence of abnormal placental findings associated with non-reassuring fetal monitoring in labor requiring emergent instrumental or cesarean delivery, followed by an excellent neonatal outcome. Study Design: One hundred consecutive emergency deliveries, instrumental or cesarean, performed due to non-reassuring fetal monitoring while in labor were retrospectively evaluated. All patients were low-risk for obstetric complications, and had a singleton, term pregnancy. They had a normal antenatal routine testing and a normal anatomy ultrasound scan at 20 to 22 weeks gestation. Results: There were 35 placentas (35%) with gross placental anomalies at the delivery triage. Additionally 7 placentas (7%) were reported to be abnormal at the pathology examination. Conclusion: The prevalence of abnormal placental findings in our studied population was 42%.

Caesarian Section for Placenta Praevia: Does Booking Status Affect Maternofetal Outcome?

Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remains a difficult challenge for obstetricians. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1st 2004 and December 31st 2008 with respect to maternal and fetal outcome. Result: Out of 14,344 deliveries during study period, 123 cases of placenta praevia that underwent caesarian delivery were identified giving a prevalence rate of 0.86%. 49 subjects were booked while 74 were unbooked. There was no statistically significant difference between booked and unbooked cases with respect to risk factors (30.6% of booked and 23% of unbooked), X2(4) = 7.203, P = 0.126 and the mean blood loss at surgery (870.4 ± 486.9 ml in booked versus 779.7 ± 380.96 ml in unbooked), X2(1) = 0.202, P = 0.653. However, antepartum transfusion (12.2% booked versus 34.7% unbooked) and postpartum transfusion (51% booked versus 72% unbooked) showed statistically significant difference, X2(1) = 9.744, P = 0.002. One maternal death occurred amongst the unbooked cases and none among the booked cases. Statistically significant differences were also noted in the apgar score at 1 minute X2(3) = 15.528, P = 0.001 and 5 minutes X2(3) = 12.912, P = 0.005 respectively. More babies died in the unbooked group (19) compared to two (2) in the booked mothers. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased preterm delivery, poorer apgar scores and higher perinatal mortality rate.

Status Epilepticus and Coma in Pregnancy. Management Dilemma in a Resource Limited Setting (Monatele, Cameroon): Case Report

Epilepsy is a leading neurological condition characterized by recurrent seizures and affecting more than 50 million people worldwide. Status epilepticus (SE) is a neurological emergency associated with a high mortality rate and long-term cognitive sequelae. In pregnancy, status epilepticus poses a tremendous threat to both mother and fetus. We report a case of status epilepticus in pregnancy complicated by coma, where obstetrical ultrasound revealed fetal demise in utero followed by rapid maternal deterioration and demise later. There was management challenge of a comatose pregnant mother in very poor and deteriorating hemodynamic state with fetal demise in a low economic and limited resource setting.

Effects of Late Preterm Birth on the Incidence of Developmental Delays among Children at 3 Years of Age: A Matched-Pair Case-Control Study

Purpose: To investigate the relationship between preterm delivery and developmental outcomes in children born at 34 - 36 weeks of gestation (late preterm period). Methods: This study reviewed the cases of singleton late preterm children and full-term (38 - 40 weeks of gestation) children born at Showa University Hospital. The developmental outcomes at 3 years of age were assessed based on the results of questionnaires sent to the families by mail. In addition, the incidence of developmental delays was compared between the late preterm and full-term children. In the full-term control group, perinatal characteristics (neonatal gender, Apgar score, Cesarean delivery, birth weight < 10th percentile, birth weight < 3rd percentile) were matched with those of the late preterm cases. We compared categorical variables using Fisher’s exact test. For variables with a non-normal distribution, Welch’s t-test was applied. A p-value of <0.05 was considered to be statistically significant. Results: The rate of return of the questionnaires was 25.9% (121) among the cases and 25.8% (163) among the controls. The frequency of developmental delays was 6.6% among the cases, compared with 4.3% among the controls. Conclusions: Matching the perinatal characteristics of the subjects, the frequency of developmental delays was similar between the two groups.