جستجوی مقالات مرتبط با کلیدواژه « cesarean » در نشریات گروه « پزشکی »

To describe the management and treatment outcomes of cesarean scar pregnancies diagnosed in a tertiary care center.

This study retrospectively described all cases of cesarean scar pregnancy diagnosed and managed at a tertiary care center over a 3-year period. Maternal demographics, clinical presentation, treatment methods, and outcomes were all included in the analysis.

uring the study period, 5 cases of cesarean scar pregnancy were diagnosed and managed. The median gestational age at diagnosis was 8 weeks, and all fetuses had positive cardiac activity. All cases were initially treated with systemic intramuscular (IM) methotrexate (MTX), but only one case responded well due to fetal bradycardia present prior to treatment. One patient received further management with transvaginal intracardiac potassium chloride (KCL) injection, which resulted in maternal sepsis, hemorrhage, and ICU admission. The other 3 cases were managed by transabdominal intra-gestational sac MTX +/- KCL and showed good clinical response. Two of these cases required an interval dilation & curettage (D&C) due to persistent vaginal spotting with no complications.

It is recommended to avoid using systemic IM MTX as the first-line treatment for scar pregnancy unless the pregnancy is failing or non-viable. Intra-gestational sac treatment may cause persistent retained products of conception, leading to bothersome vaginal spotting. An interval ultrasound guided D&C appears to be safe for managing this complication, but the exact interval needs to be determined through further studies. Sepsis is a rare complication of invasive medical treatment, and close surveillance is advised.

There are different ways to make a surgical incision. The most widely used ones are the use of scalpel and electrosurgery. Each of these methods has advantages and disadvantages that affect its use.

This study aimed to compare scalpel and electrosurgery methods in cutting the anterior abdominal wall during Cesarean section.

This double-blind clinical trial manner was conducted by permuted block randomization. The participants were placed in two groups. In the scalpel group, incisions were made with a scalpel, and in the electrosurgery group, incisions were made with an electrosurgical pencil. This clinical trial was conducted on 86 pregnant women who were candidates for Cesarean section with spinal anesthesia. The inclusion criteria were an age range of 18 - 45 years, gestational age of 37 - 41 weeks, Pfannenstiel skin incision, and willingness to participate. The exclusion criteria were emergency Cesarean section, vertical skin incisions, incomplete medical files, chronic skin diseases, allergy to antibiotics, consuming anticoagulants, cardiovascular and pulmonary problems, and underlying diseases.

There was no significant difference between the two groups in terms of intraoperative bleeding, newborn Apgar score, postoperative pain, and wound complications. However, the duration of surgery (P = 0.012), incision time (P = 0.049), and hemodynamic status showed a significant difference (P < 0.05).

The use of electrosurgery to make a surgical incision does not pose a risk to the patient if safety points are followed.

A high level of hemoglobin at birth is one of the iron reserves needed by infants to deal with iron deficiency anemia. This study aimed to assess the iron status in neonates born by cesarean section and the effect of maternal characteristics and other laboratory measures on neonatal iron levels. Moreover, it was designed to investigate anemia and identify its factors. This descriptive correlational study was conducted in 2022 on 50 neonates by caesarean section in Babylon Hospital, Iraq. Serum ferritin and other laboratory parameters from neonatal umbilical cord blood were measured in addition to others that had been recorded for both neonates and their mothers. The data were analyzed using the t-test. Out of 50 neonates, 8 infants had low serum ferritin levels and 4 of these 8 had anemia, and 6 of them were born to mothers from rural areas. The mean maternal age of neonates with low serum ferritin was significantly higher than those with normal or high serum ferritin. The results showed that the place of residence and its clean climate and healthy nutrition can have a direct effect on the ferritin level. No significant effect of serum ferritin on WBC, reticulocytes, and platelet counts was observed in this study. Anemia is significantly associated with low serum ferritin neonates; in addition, maternal age and residence have significant effects on neonatal serum ferritin. Considering the high prevalence of iron deficiency anemia in mothers and even in mothers with proper nutrition, iron deficiency in the mother leads to a decrease in the baby's reserves and makes him susceptible to iron deficiency in the first months after birth. The importance of using iron supplements during pregnancy becomes clearer, and one should not be satisfied only with diet. Due to the adverse effects of increasing the number of pregnancies on the mother's iron reserves, appropriate spacing should be observed.

Airway safety for difficult intubation or failure to intubate is important during anesthesia. This study assessed the airway before anesthesia, and the diagnostic value of neck circumference (NC) and sternomental distance (SMD) tests was investigated in predicting difficult tracheal intubation during cesarean section. In a cross-sectional study, 101 women who were candidates for cesarean section were selected through the convenience and non-random sampling method. The modified Mallampati test (MMT), upper lip bite (ULBT), thyromental distance (TMD), neck circumference (NC), and sternomental distance (SMD) tests were performed to estimate the laryngoscopy problem. The success rate of airway assessment by SMD and NC was evaluated using the Cormack-Lehane score. Data analysis was performed using the software SPSS version 16.0. TMD (p=0.034) and NC (p<0.001) indicated substantial association with laryngoscopy grades. The sensitivity was 35.29% and 58.82%, and the specificity was 93.93% and 59.09% for NC and SMD. The accuracy, NPV, and PPV of NC was higher than the SMD test (74% vs. 59%, 73.80% vs. 73.58, and 75% vs. 42.55%). The PPV and NPV were 43.63% and 77.77% for TMD. MMT, with high sensitivity (73.52%) and specificity (90.90%), increased the risk of difficult laryngoscopy up to 24-fold when adjusted for TMD, SMD, and NC [p<0.001; OR=24.38 (6.31-94.25)]. Although NC indicated low sensitivity, it had maximum specificity (93.93%) in predicting difficult intubation. High Mallampati grades increase the risk of difficult laryngoscopy. NC presented low predictive values, and SMD and TMD lack predictive values for difficult intubation.

The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; 90% of them rotate to the occiput anterior. This research aims to analyze the rate of delivery in the OP position (also called sunny-side-up) concerning the outcome of manual rotation carried out contingent upon the OP position remains persistent. Perinatal outcomes were the secondary goals.

This prospective cohort study was carried out in Obstetrics & Gynecology Clinic (OGC) at Faruk Medical City, Iraq. The study included all women who experienced a singleton pregnancy after 36 weeks, had an effort to rotate the fetus manually and had the fetus remain in the persistent OP position. The primary result was the delivery's occiput position. Perineal injuries, labor length, and the method of delivery have been the secondary outcomes. According to the outcome of manual rotation, two groups were contrasted.

The overall number of women participating was 250, and the manual rotation success rate was 59.1%. The success was strongly correlated with a reduction in the OP position during vaginal, cesarean, operative vaginal delivery, episiotomy, and obstetric anal sphincter injury.

Reduced incidence of OP position at anal sphincter injury during operative vaginal delivery is linked to attempts at manual rotation in the case of persistent OP position.

Meany factors lead to myocardial infarction in a pregnant woman, resulting in the increasing prevalence of women with cardiac diseases during pregnancy. There are special considerations for anesthetic care under this condition. This report presents a 40- year-old woman admitted for emergent cesarean section due to acute myocardial infraction (AMI). Providing safe and balanced anesthesia while managing cardiac events was challenging; however, it was performed in accordance with standard anesthesiologic rules. 

Childbirth is one of the most significant experiences in the lives of women. In some studies conductedon the psychology of childbirth, it has been defined by most women and their spouses as the mostsignificant and challenging experience.

With the increasing prevalence of coronavirusdisease 2019 (COVID-19), the number of pregnant women with this virus who give birth is also increasing. This study evaluates the clinical features and consequences of COVID-19 infection in pregnant women undergoing delivery in Kurdistan Province, Iran.

In this descriptive study, we analyzed the clinical characteristics and delivery outcomes of pregnant women with laboratory-confirmed COVID-19 disease admitted to Besat Hospitalof Kurdistan University of Medical Sciences, Sanandaj, Iran, from February 25, 2020, to August 21, 2020.

Among 192 pregnant women with laboratory-confirmed COVID-19 infection during the study period, 37 were admitted for delivery. Out of the 37 patients, 15 patients had a normal vaginal delivery, and 22 patients were delivered by cesarean. Fever and cough (32.40%) and shortness of breath (11.37%) were the main symptoms of the pregnant women in our study. None of our patients needed ventilator support or died.

Based on the results of our survey, pregnancy augments neither the signs and symptoms of COVID-19 nor the mortality rate. However, the rate of cesarean and preterm delivery increased.

Spinal anesthesia is the mostcommonanesthesia technique used for cesarean section. Postdural puncture headache (PDPH) is one of the consequences following spinal anesthesia.

The primary aim of this study was to compare the incidence of PDPH with 25-gauge Quincke and Whitacre’s spinal needles. Secondary outcomes were mean severity of PDPH, need for analgesic, movement limitation, and associated symptoms and signs followed up for 1 week after surgery.

In this randomized trial study, 130 women were randomly divided into 2 equal groups based on the excel file and random between function. They received spinal anesthesia with either Quincke or Whitacre spinal needles. The incidence of PDPH was followed up 1 week later. Among PDPH women, secondary outcomes and symptoms/signs (such as nausea, vomiting, neck pain, and shoulder pain) were evaluated for 1 week after surgery.

All 130 women completed the study. PDPH was observed in 16 women (12.3%), including 6 (9.2%) in the Whitacre group and 10 (15.4%) in the Quincke group, which was not statically significant (P = 0.424). However, secondary outcomes and associated signs and symptoms were more common in the Whitacre group than in the Quincke group, followed up for 1 week in this trial. It can be related to more primary headache history in the Whitacre group than in the Quincke group.

Overall, the Whitacre spinal needle is better than Quincke in reducing the incidence of PDPH, but primary headache history in young women causes higher mean severity of PDPH in them. Also, primary headache history causes more associated symptoms and signs in women with PDPH.

Nowadays cesarean increased in most countries in the world such as Iran while cesarean is considered as a major surgery and it is often associated with very dangerous complications, like other major surgeries. The purpose of this study was determining effect of education in choosing the type of delivery in primiparous pregnant women.

This randomized controlled trial conducted on 190 primiparous pregnant women applicant cesarean in third trimester of pregnancy, referred to health centers in Ramhormoz, Iran in 2018 (95 experimental group and 95 control group). The educational  program about cesarean include of 4 sections of 1.5 hours in the form of group education. The study outcomes included knowledge and attitude and were measured at the onset and at two months post-intervention. Data was analyzed by using SPSS 19.0.

After intervention; the mean score of knowledge in the experimental group was significantly higher than the control group . The mean score of attitudes about cesarean after intervention in the experimental group  was significantly lower than in the control group .

Educational intervention used was effective in enhancing knowledge and attitude of pregnant women in choosing the type of delivery

The Apgar score of newborn babies is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol and thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ Apgar score.

In this double-blind clinical trial, a total of 100 healthy women who volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical. Babies’ Apgar score 1 and 5 minutes after birth and recovery period and some of the critical maternal parameters after operation were recorded. The obtained data were analyzed by SPSS 19 software.

Apgar score I minute 1 (p=0.317) and Apgar score in minute 5 (p=1.00) for propofol group were not different meaningfully. The groups had significant differences in the indices such as first systolic (P=0.00) and diastolic (P=0.00) pressure in recovery, last diastolic pressure in recovery (P=0.001) and duration of postoperative recovery (P=0.001). Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather than the thiopental group (p=0.000).

Propofol and thiopental did not differ significantly in Apgar score, but it seems that propofol can be a better option to induce anesthesia for an elective cesarean operation.

Neonatal jaundice affects one of two newborns around the Worldand occurs when a baby has a high level of bilirubin in the blood. In recent decades, the cesarean section has increased, accompanied by higher neonatal jaundice risks compared with vaginal delivery. This study aimed to investigate the relationship between the jaundice severity and the delivery type and gender among newborns referred toa Qamar Bani Hashem HospitalinKhoy city(WestAzerbaijan Province, Iran).

In this cross-sectional study, we investigated randomly 309 newborns with asymptomatic jaundice, who referred to the hospital, from 2014 to 2018. The results of laboratory tests were recorded for all participatinginfants.

49.19% of newborns with jaundice were born by cesarean section, and 49.19% were born by vaginal delivery. 141 (45.63%) of babies with jaundice were males, and 168 (54.37%) were females. Mean blood sugar (BS) (p=0.52), urea (p=0.48), creatinine(Cr) (p=0.69), Na (p=0.46), K (p=0.69), Ca (p=0.29), TB (p=0.58) and neonatal weight (p=0.14) within days 3 to 10 were not significantly different between vaginal delivery group and cesarean section group (p>0.05), while direct bilirubin showed significant variations (p<0.05). Mean serum direct bilirubin was 0.22±0.07 mg/dLin the normal vaginal delivery group and 0.25±0.09 mg/dLin the cesarean section group (p<0.05). Also, the level of K (P=0.04) was significantly higher in the male group compared to the female group.

Based on our study, there is no significant relationship between the severity of jaundice and the type of delivery and gender in newborns.

A complete heart block is a cardiac electrical conduction disorder with a very rare occurrence in pregnancy, which may be asymptomatic. There are no specific guidelines for the management of asymptomatic complete heart block in labor, vaginal delivery, and cesarean with only a few reports of cesarean management of patients with complete heart block.

A 30-year-old woman, Gravida 4, abortion 3, gestational age of 41 weeks without any specific problems, was referred to our maternity hospital. The pulse rate and blood pressure were 68 and 60/110, respectively. Labor was induced with oxytocin and, after three hours, was discontinued due to late decelerations of fetal heart rate. Electrocardiography confirmed a maternal pulse rate of 42. Cardiac consultation led to the diagnosis of a complete heart block. Due to the frequent late decelerations of fetal heart rate and no response to atropine therapy, the patient was a candidate for a cesarean. Before cesarean, the pacemaker was installed. Cesarean was performed with general anesthesia, and the infant was delivered in good condition. In Postpartum, the pacemaker was removed (PR=55, BP=125/80), and the mother was discharged the next day. Due to the lack of specific guidelines, fetal indication for an emergency cesarean, mother poor obstetrics history, and none response to atropine therapy, we chose to incorporate pacemakers and remove it after cesarean safely.

Vital signs assessment during pregnancy and childbirth is recommended to detect cases of complete heart block and provide optimal care.