Delivery by cesarean section can be considered as a risk factor for developing hypoglycemia in the early neonatal period, as it is preceded by a period of pre-operative fasting. One of the important components of the “fast track” concept, which is actively introduced into surgery, is “rapid metabolic optimization” aimed at reducing the period of pre-operative fasting and activating intracellular glucose transport by using combined carbohydrate-protein-glutamine drinks for the purpose of prevention of insulin resistance. The aim of the study was to determine the influence of the methods of the management in the perioperative period during abdominal delivery on the level of glucose in the blood of the puerpera and in the blood of full-term newborns Material and methods. The study was approved at the meeting of the ethical committee of the Dagestan State Medical University of the Ministry of Health of Russia on April 17, 2018. In total, in the study there were included 87 patients, whose delivery was performed in term in the Perinatal Center of the Dagestan Republican Hospital by abdominal mode and their newborns; of them, 39 patients with a common perioperative period management regimen made up a comparison group, and 48 - with abdominal delivery in the fast track strategy (with carbohydrate load) - the main group. In all puerperas the glucose level was determined in blood obtained from the vein, in the blood from the umbilical cord and in the blood taken from the newborns from the finger in the first 6 to 15 minutes of life, using the ROKI-6T biochemical analyzer. Results. The concentration of glucose in the blood of full-term newborns it was found to be significantly reduced during the management of the preoperative period without oral administration of carbohydrate mixtures. The best results were obtained in newborns whose mothers took a carbohydrate drink 2 hours prior to surgery during the perioperative period under the concept of fast track.
BACKGROUND: Cesarean delivery is associated with prolonged hospitalization compared to spontaneous delivery and the risk of intra- and postoperative complications. The introduction of an accelerated recovery program after a planned cesarean section contributes to the rapid recovery of the patient by optimizing various elements of care. AIM: To study the effect of the components of the accelerated recovery program on the severity of oxidative stress during abdominal delivery at different stages of the perioperative period. MATERIALS AND METHODS: This was a comparative study assessing conformational changes in plasma proteins and erythrocytes in the blood of puerperal women using fluorescence spectroscopy. The study included 81 patients from the perinatal center of Makhachkala who underwent a planned cesarean section under spinal anesthesia. The enrolled women were grouped into the following: control group (n=38), in which perioperative period was traditionally managed, i.e. fasting for 8 h before the operation and introducing an antibiotic after clamping the umbilical cord. Within this group, blood sampling was conducted in all 38 patients at different intervals. In total, 152 samples of the material under study were obtained from control mothers. The 2nd group was the main (n=43) and included women in labor; in this group, perioperative period was managed using accelerated recovery program, by introducing the antibiotic cefazolin and with the intake of a glucose-containing drink 2 h before the operation. In total, 172 samples of the material under study were obtained from the mothers of the 2nd group. Methods for the pre-preparation of biological material and spectral methods of analysis were used in this study. RESULTS: At all stages of preparation of delivery by cesarean section (CS) after spinal anesthesia, minor conformational changes occur in the blood plasma proteins, including umbilical cord blood. In the main group, antibiotic use an hour before delivery increased the oxidative degradation of blood plasma proteins. In the control group, a change in the structural-dynamic parameters of erythrocyte membrane proteins was observed, as indicated by the blue shift in the maximum fluorescence spectrum. This was not observed in the erythrocytes of the main group of puerperal women who received a glucose-containing drink. CONCLUSION: According to total fluorescence data of plasma proteins and umbilical cord blood, it can be assumed that using a glucose-containing drink 2 hours before CS along with an antibiotic helps restore some parameters of the fluorescence of erythrocyte membrane proteins. The data obtained do not indicate any persistent pathological phenomena in mothers body at all stages of preparation for CS delivery using spinal anesthesia against the background of antibiotic use.
Caesarean section is the most common surgical intervention over the world, so the development of the enhanced recovery after cesarean delivery is turning out to be a vital problem. The practical application of the enhanced recovery after cesarean requires multidisciplinary collaboration and well-coordinated teamwork of an anesthesiologist, an obstetrician-gynecologist, nursing staff and other specialists. In this review, we have studied recent domestic and foreign articles dedicated to the enhanced recovery after cesarean. Particular attention was paid to the case management at all stages of the perioperative period, especially preoperative preparation, postoperative care and womens awareness raising. The presented studies included such program criteria as avoidance of prolonged preoperative fasting accompanied by early postoperative feeding, early breastfeeding attachment of the newborn, the use of multimodal analgesia in the postoperative period, the early activation of the postoperative patient, and the minimization of the detention period of hospital stay. The reviewed articles indicated the positive impact of this program on maternal and newborn outcomes and demonstrated the need for detailed further study of several issues and standardization of the enhanced recovery after cesarean methods.
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