Farnoush Farzi; Sodabeh Kazemi; Ziba Zahiri Sorouri; Samaneh Ghazanfar; Mahin Tayefeh Ashrafiyeh; Mandana Javanak; Mohammad Shahbazi
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Having body mass index more than 29 is described as obesity in pregnancy. Anesthesia management in these patients has always been challenging. A 41-year-old woman, at 37weeks’ gestation with the weight of 200kg and body mass index of 66/05 was admitted with complaint of pain to Al-Zahra Hospital ...
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Having body mass index more than 29 is described as obesity in pregnancy. Anesthesia management in these patients has always been challenging. A 41-year-old woman, at 37weeks’ gestation with the weight of 200kg and body mass index of 66/05 was admitted with complaint of pain to Al-Zahra Hospital in Rasht. She reported a history of two previous caesarean sections and high blood sugar and hypothyroidism which were under control by drugs. The Anesthesiology team decided to choose Continuous Spinal Anesthesia method for her. After performing anesthesia, cesarean delivery was done and a female neonate was born with Apgar score of 5-9. They were discharged from the hospital in good condition after two days. Based on the results of this study, CSA approach is a suitable method for anesthesia management in cesarean section of obese patients. Also it is necessary to recommend these patients to refer to anesthesia counseling clinics before giving birth.
Atefeh Kazemi; Vahideh Rashtchi; Masoomeh Ghomi
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background: Types of major surgeries are associated with postoperative pain sometimes during the days after surgery. These pains mainly lead to the use of various analgesics and ultimately patient dissatisfaction. In the present study, we evaluated the effect of gabapentin at doses of 600 and 1200 mg ...
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Background: Types of major surgeries are associated with postoperative pain sometimes during the days after surgery. These pains mainly lead to the use of various analgesics and ultimately patient dissatisfaction. In the present study, we evaluated the effect of gabapentin at doses of 600 and 1200 mg in relieving pain due to cesarean section.Methods: In this randomized clinical trial patients were randomly divided into three equal-size groups (25 patients in each group) through balanced block randomization. The first group was given 600 mg of gabapentin the second group was given 1200 mg of gabapentin one hour before surgery and the control group received a placebo. The pain intensity, occurring nausea/vomiting and drowsiness, as well as needing postoperative analgesics were assessed initially and at 2, 6, and 12 hours after surgery. The occurrence of nausea and drowsiness between groups was compared using chi-square and exact fisher teat.Results: The mean (SD) age of patients in the gabapentin 1200 mg, gabapentin 800 mg, and placebo groups were 26.32±6.15, 27.43±6.38, and 26.59±5.88, respectively (P=0.34). Pain intensity and also the rate of analgesic consumption at the different time points during the first 12 hours of surgery were significantly lower in the receiving gabapentin groups compared to the placebo group (P<0.05). Comparing the prevalence rates of nausea and vomiting and also drowsiness as the drug-related side effects don’t show a significant difference across the three groups at the different investigated time points (P>0.05). Conclusion: Gabapentin with a minimum therapeutic dose can successfully reduce postoperative pain intensity and also needs analgesics use after cesarean section.
Anesthesia
Maryam Sadat Hosseini; Dariush Abtahi; Ardeshir Tajbakhsh; Farah Farzaneh; Shahram Sayadi; Nooshin Amjadi; Maral Hosseinzadeh
Volume 8, Issue 2 , January and February 2023, , Pages 157-166
Abstract
Background and Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels ...
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Background and Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels in postpartum hemorrhage and severe postpartum hemorrhage.Methods: This cross-sectional study was conducted on 169 term pregnant women who were candidates for an elective Cesarean section. Fibrinogen and other coagulating factors were measured before and at the end of the surgery, and twenty-four hours after surgery. Bleeding volume was also measured during and at the end of the surgery, and twenty-four hours after that. The relationship between coagulation factors and the amount of bleeding was examined using statistical tests.Results: Mean plasma fibrinogen levels measured before, at the end of, and 24 hours after surgery were 247.65±91.07 mg/dl, 219.4±75.60 mg/dl, and 223.91±65.44 mg/dl, respectively. Sixty-five patients (38.5%) had postpartum hemorrhage (1000-2000mL) and seven patients (4.1%) had severe postpartum hemorrhage (>2000mL). Of the cases with preoperative fibrinogen levels less than 200mg/dl, 72% had postpartum hemorrhage and 14% had the severe form. There was a strong association between the patient's plasma fibrinogen level with PPH and sPPH (P=0.000).Conclusion: This study showed a strong correlation between plasma fibrinogen levels and postpartum hemorrhage and severe postpartum hemorrhage. In addition, it has been shown that low plasma fibrinogen levels could be a direct prognostic factor for postpartum hemorrhage and severe postpartum hemorrhage. Younger women and preoperative anemia were other strong predictors.
Anesthesia
Dariush Abtahi; Mehrdad Feizi; Shahram Sayadi; Ardeshir Tajbakhsh; Samira Abbaspour; Sara Salarian; Alireza Mirkheshti
Volume 7, Issue 4 , March and April 2022, , Pages 314-322
Abstract
Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response ...
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Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response study using a 9:1 biased-coin sequential allocation method to estimate the ED90 of prophylactic infusion of OX in women with high and low risk for uterine atony who underwent CS. The total administrated OX dose of each patient was determined in the two study groups. The primary outcome was the ED90 for desirable uterine tone based on the opinion of the in-charge obstetrician. The number of subjects receiving supplemental uterotonics was compared.Results: In the low-risk group, three (3.7%), out of the 41 parturients, did not achieve a satisfactory suitable response to OX dose of 9; on the other hand, 24 high-risk parturients (58%) did not achieve a satisfactory and reasonable response to OX dose of 9. The OX ED90 was significantly greater for the high risk-group (11.55 units, 10.39-14.86) than the low-risk group (8.13 units, 8.31-9.56). Fisher’s exact probability test showed a significant difference in ED90 of OX between the two groups (P < /em>=0.02).Conclusion: The present study results showed that the mean ED90 of OX in low-risk parturients was significantly lower than that of high-risk ones. We suggest differentiation between low-risk and high-risk parturients in the guidelines of OX administration.
Obstetrics and Gynecology
Nahid Zirak; Leila Mashhadi; Elaheh Jajarmi; Negar Morovatdar; Parisa Mohebbi; Nahid Javdani Haji; Shahrzad Maraghehmoghaddam; Leili Hafizi
Volume 7, Issue 3 , January and February 2022, , Pages 171-176
Abstract
Background & Objective: This study aimed to investigate the relationship between the level of high-sensitivity C-reactive protein (hs-CRP; as an indicator of inflammatory response) and shoulder tip pain (STP) following cesarean section (C-section).Materials & Methods: In this cohort study, a ...
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Background & Objective: This study aimed to investigate the relationship between the level of high-sensitivity C-reactive protein (hs-CRP; as an indicator of inflammatory response) and shoulder tip pain (STP) following cesarean section (C-section).Materials & Methods: In this cohort study, a total of 120 pregnant women who were candidates for elective C-section at Imam Reza Hospital were included. The level of hs-CRP was measured perioperatively. STP was measured after the operation.Results: Mean hs-CRP was significantly higher in females with STP compared to counterparts (19±13.1 vs. 7.2±4.5; P < /em><0.001). There was a positive and strong correlation between STP and postoperative hs-CRP (P < /em><0.001).Conclusion: The release of acute-phase proteins (such as hs-CRP) plays a significant role in STP after C-section; the intensity of STP is associated with the level of hs-CRP.
Obstetrics and Gynecology
Tipnaree Charoonwatana; Charuai Suwanbamrung; Udomsak Saengow
Volume 7, Issue 3 , January and February 2022, , Pages 213-220
Abstract
Background and Objective: Cesarean section (CS) rates have increased continuously worldwide in the past decades while not being associated with significant benefits for mothers and newborns. According to Robson's classification, the present research aimed to analyze the associating factor to cesarean ...
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Background and Objective: Cesarean section (CS) rates have increased continuously worldwide in the past decades while not being associated with significant benefits for mothers and newborns. According to Robson's classification, the present research aimed to analyze the associating factor to cesarean section to set the practice system and decrease the cesarean section rate in the near future.Methods: This is a retrospective cross-sectional analytic study of the medical record of pregnant women who delivered in 2019 at MNST Hospital. The logistic regression model carried out the adjusted odds ratio (OR) of cesarean section rate and 95% confidence intervals.Results: A total of 5,360 medical records were recruited. Of all birth, 55.4% occurred by cesarean section, most of whom were categorized in R1 to R4 of Robson classification (23.3%), followed by R5 (21.1%) and R10 (5.4%). The subgroup R1-R4 analysis demonstrated that obesity, Bachelor’s education, and private obstetrician were significantly related to the cesarean section in the group of spontaneous labor (R1, R3) and Bachelor’s education and private obstetrician were significantly related to the cesarean section in the group without spontaneous labor (R2, R4) (adjust OR 13.50, P < /em><0.001 and adjust OR 2.11, P < /em><0.001, respectively).Conclusion: Private obstetrician and education level were factors related to the obstetric indication of unnecessary cesarean section.
Maternal Fetal Medicine
mandana Mansour Ghanaie; Roxana Mansour Ghanaie; Seyed Mohammad Asgari Galebin; Seyedeh Hajar Sharami; Mojgan Mohebalizade
Volume 7, Issue 1 , September and October 2021, , Pages 25-31
Abstract
Background & Objective: Nucleated red blood cells (NRBCs) enter the circulation in response to hypoxia, but it remains unknown how physiological delivery without fetal distress can change the NRBC level. Accordingly, in the present study, we compared the mean NRBCs per white blood cell (WBC) in the ...
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Background & Objective: Nucleated red blood cells (NRBCs) enter the circulation in response to hypoxia, but it remains unknown how physiological delivery without fetal distress can change the NRBC level. Accordingly, in the present study, we compared the mean NRBCs per white blood cell (WBC) in the umbilical cord of normal vaginal delivery (NVD) with cesarean section (C/S). To compare the mean NRBCs per WBC within umbilical cord in normal term newborns who were born by NVD with those delivered by C/S. Methods: This case-control study was conducted for 305 neonates in two different groups, i.e., NVD (case) and C/S (control) groups. The blood samples were taken from umbilical veins to evaluate fetal NRBCs and WBC count after recording their demographic characteristics. Finally, all data were assessed using SPSS 16.Results: The average age of mothers was 25.79±5.35 years. The average Apgar score of neonates was 8.23±0.6. The average NRBC count was 4.63±5.2. There was no significant difference in maternal age, parity, neonatal weight, and NRBC count per 100 WBCs between the two groups. Conclusion: In the present study, the mean NRBC count within the umbilical cord of neonates born by elective C/S was less than those delivered by NVD, although this difference was not significant.
Obstetrics and Gynecology
Shiva Hadadianpour; Nasim Sanjari; Masoumeh Fallahian
Volume 6, Issue 4 , August 2021, , Pages 209-216
Abstract
Background & Objective: To determine the factors affecting Iranian obstetricians and gynecologists’ (OB/GYNs’) decision about performing a cesarean section on maternal request.Materials & Methods: A four-part questionnaire was designed and distributed between 150 randomly ...
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Background & Objective: To determine the factors affecting Iranian obstetricians and gynecologists’ (OB/GYNs’) decision about performing a cesarean section on maternal request.Materials & Methods: A four-part questionnaire was designed and distributed between 150 randomly selected OB/GYNs in Iran during a national conference. One hundred questionnaires were sent back by the participants. The data were analyzed using SPSS 25. The influential factors on OB/GYNs’ decision about the mode of delivery, as well as the correlations between their knowledge, attitude, practice, gender, and years of work experience, were assessed.Results: A positive correlation was found between OB/GYNs’ knowledge and attitude about the benefits of cesarean section and performing a cesarean section on maternal request in public and private hospitals. We did not find any correlation between age, gender, and years of practice with the practice of cesarean section on demand. Approximately 52.8% of female participants and 38.5% of male participants recommend cesarean section to their immediate families, and 81% of participants accepted the pregnant mother’s request for cesarean section. The stress of the potential impact of vaginal delivery on the pelvic floor and sexual function is the leading reason behind this decision. Conclusion: Since the views and concerns of OB/GYNs have a significant role in guiding pregnant women to decide the mode of delivery, and the fear of future sexual dysfunction is an important issue affecting obstetricians’ perspective, it should be taken into consideration.
Atieh Mirfendereski; Khadigeh Abadian
Volume 3, Issue 4 , November and December 2018, , Pages 177-180
Abstract
Background & Objective: Given the impact of endometriosis on patients’ social lives, marital relationships, and fertility and on reducing these people’s quality of life, its proper diagnosis and treatment seem vital. This study aimed to report a case of rectus muscle endometriosis and ...
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Background & Objective: Given the impact of endometriosis on patients’ social lives, marital relationships, and fertility and on reducing these people’s quality of life, its proper diagnosis and treatment seem vital. This study aimed to report a case of rectus muscle endometriosis and the way it was managed.
Case Report: The patient was a 30-year-old woman who had a history of dysmenorrhea and chronic pain for 2 years after her first delivery which was performed by cesarean section. During ultrasonography conducted on the anterior abdominal wall of the midline, a mass indicating endometriosis was observed in the abdominal wall at the site of the cesarean section incision scar and in the thickness of the rectus muscle. After the termination of pregnancy and during the cesarean section, the mass was removed and the patient’s symptoms subsided.
Conclusion: To manage endometriosis a patient’s complete records and imaging techniques can be effective.
Zahra Rezaei; Zahra Shahraki; Mahboobeh Shirazi
Volume 2, Issue 3 , September and October 2017
Abstract
Introduction: Utero-cutaneousfistulaisarareconditionfollowinguterinesurgeriesespeciallycesareansection. Thiskindof fistula has various etiologies including drain use, iatrogenic trauma, endometriosis, multiple abdominal surgeries, incomplete closure of uterine wound during cesarean delivery, inflammatory ...
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Introduction: Utero-cutaneousfistulaisarareconditionfollowinguterinesurgeriesespeciallycesareansection. Thiskindof fistula has various etiologies including drain use, iatrogenic trauma, endometriosis, multiple abdominal surgeries, incomplete closure of uterine wound during cesarean delivery, inflammatory processes related to intra-abdominal sepsis or infectious, and dislocation of intrauterine devices.
Case Presentation: This report deals with two unusual cases of utero-cutaneous fistula. The patients referred with discharge from abdominal wall. The first one had vesico-cutaneous fistula simultaneously. Both of them had a second cesarean section. After four months of cesarean section, in fistulography report of the first case, it was found irregular fistula tract associated with vagina following cannulation and contrast injection. In the second case, ultrasonography revealed the attachment of uterus to abdominal wall as well as accumulation and communication of the small amounts of fluid from uterine cavity to abdomen wall. After confirming the diagnosis, the repairing surgery was successfully planned.
Conclusions: Cesarean has some rare morbidity such as uterocutaneous fistula that needs awareness of physician and patient. The early diagnosis and repairing of this abnormality is essential.
Soodabeh Darvish; Koorosh Etemad; Azar Mosaheb; Ghasem Yazdanpanah
Volume 2, Issue 2 , May and June 2017
Abstract
Objectives: This study aimed to compare maternal and neonatal side effects of natural vaginal delivery (NVD) under neuro-axial analgesia with usual NVD and C-section.
Methods: In this single center prospective cohort study, deliveries carried out in a 7 months’ period were evaluated after getting ...
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Objectives: This study aimed to compare maternal and neonatal side effects of natural vaginal delivery (NVD) under neuro-axial analgesia with usual NVD and C-section.
Methods: In this single center prospective cohort study, deliveries carried out in a 7 months’ period were evaluated after getting informed consent. The study is approved by the ethics committee of Shahid Beheshti University of Medical Sciences. Mothers were categorized into 3 groups of C-section, NVD with an analgesia, intervention, and usual NVD. Afterwards, maternal and neonatal side effects after delivery were assessed using physical examinations, laboratory results, and interviews.
Results: Overall, 121 mothers were equally assigned to 3 groups. No significant differences were found in the first and fifth-minute APGAR scores of the neonates born in these 3 groups. Moreover, none of the neonates’ fifth-minute APGAR scores were less than 7. In addition, hypoxia (umbilical artery pH < 7.2) was observed more in the neonates delivered by NVDs with analgesia interventions compared to the other 2 groups. In comparison with the mothers in the other 2 groups, headache and pruritus were more prevalent among the mothers who had NVDs under neuro-axial analgesia.
Conclusions: Given the advantages of natural vaginal deliveries for mothers and their fetuses and considering the side effects of C-sections without medical indications, propagating painless NVDs could be a proper solution for increasing the prevalence rate of NVDs in the society. Conducting further studies on larger samples is recommended.
Shilan Amir Hosseini; Bakhtiar Piroozi; Mohammad Amerzade; Hooman Ghasri; Salah Aldin Farshadi; Hossein Safari; Seyfollah Moradi
Volume 2, Issue 1 , March and April 2017
Abstract
Background: Since April 22, 2014, the natural childbirth promotion package has been implemented in the form of the Health Transformation Plan (HTP) to decrease the cesarean section rate in Iran. This study aimed to determine the amount of subsidy allocated to the natural childbirth package and to examine ...
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Background: Since April 22, 2014, the natural childbirth promotion package has been implemented in the form of the Health Transformation Plan (HTP) to decrease the cesarean section rate in Iran. This study aimed to determine the amount of subsidy allocated to the natural childbirth package and to examine its effects on the cesarean section rate in hospitals affiliated with Kurdistan University of Medical Sciences (KUMS), Kurdistan Province, Iran.
Methods: This is a descriptive study implemented by retrospective and longitudinal design. The population in this study to determine the budget amount allocated to “childbirth promotion package” and all mothers that had natural childbirth deliveries from May 5, 2014 (beginning of HTP) to September 2015 in hospitals affiliated with KUMS. Study populations to determine the C-section ratio included all mothers who had deliveries in hospitals affiliated with KUMS from December 2012 to May 4, 2014 (before HTP) and from May 5, 2014 to September 2015 (after HTP). Using a checklist, the required data was collected from the Statistics and Health Economics Department of Treatment Deputy of KUMS. Afterwards, the obtained data were described using the descriptive statistical indicators including frequency, percent, and mean via Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA).
Results: Since the beginning of implementing the natural childbirth promotion package until September 21, 2015, a total of 23 566 mothers had natural childbirth deliveries in the hospitals affiliated with KUMS. These mothers benefited from a total amount of 23 939 046 090 IRR provided by the natural childbirth package. In addition, the cesarean ratio has decreased 7% after implementing HTP.
Conclusions: It seems that HTP caused for the cesarean ratio to decrease in hospitals affiliated to KUMS. Further studies are recommended to determine the causality between a decrease in cesarean rate and HTP.
Soghra Khazardoost; Fahimeh Ghotbizadeh; Sahar Latifi; Maryam Tahani; Mohammad Ali Ali Rezaei; Masoomeh Shafaat
Volume 1, Issue 2 , September and October 2016
Abstract
Objectives: Determining the necessity of cesarean section (C/S) due to failure of induction of labor (IOL) is essential to avoid fetus distress. In this study, the performance of the Bishop score and trans-vaginal ultrasound measurements were compared to predict successful IOL, and the most useful cut-off ...
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Objectives: Determining the necessity of cesarean section (C/S) due to failure of induction of labor (IOL) is essential to avoid fetus distress. In this study, the performance of the Bishop score and trans-vaginal ultrasound measurements were compared to predict successful IOL, and the most useful cut-off points were estimated.
Methods: Nulliparous women with gestation age of > 37 weeks with a live fetus in cephalic presentation were invited to participate in this study. Bishop score was assessed by digital examination, and trans-vaginal ultrasound was used to measure cervical length. Trans-abdominal ultrasound was utilized to determine the fetal head position.
Results: One hundred women entered the study. Multiple regression analysis revealed that the Bishop score and cervical length had a reliable predictive value in determining successful IOL. The cut-off points for predicting successful induction were 16 mm for cervical length and 5 for the Bishop score, using receiver operating characteristic curves (ROC). Both cervical length and Bishop score were good predictors for vaginal delivery (sensitivity and specificity of 85% and 67%, respectively for cervical length; and 84% and 70%, respectively for Bishop score).
Conclusions: Cervical length is a good predictor of successful IOL. Considering the painful process of digital exam, implementing trans-vaginal ultrasound is preferred.
