Background: Category-1 emergency caesarean section delivery is the commonly performed surgical procedure in pregnant women associated with significant mortality and morbidity both in the mother and fetus. The decision to delivery time interval is recommended to be less than 30 min by the Royal College of Obstetricians and Gynecologists as well as the American College of Obstetricians and Gynecologists. This study was designed to evaluate the decision to delivery time interval and its effect on feto-maternal outcomes and the associated factors during category-1 emergency caesarean section deliveries. Method: A prospective observational cohort study was conducted from March to May 2018 at the University of Gondar Comprehensive Specialized Hospital obstetrics Operation Theater and postnatal ward. A total of 163 clients who were undergone category-1 emergency caesarean section were included in this study. Statistical analysis was performed using SPSS version 20 (IBM Corporate). Bivariate and multivariate logistic regression with a 95% confidence interval was used to determine the association of decision to delivery time interval with predictor variables and feto-maternal outcomes. Results: Only 19.6% of women had a decision to delivery time interval below 30 min. The average decision to delivery time interval was 42 ± 21.4 min, the average time from the decision of category-1 emergency caesarean section arrival to the operation theater was 21.58 ± 19.76 min and from theater to delivery of anesthesia was 11.5 ± 3.6 min. Factors that were associated with prolonged decision to delivery time interval were: time taken to collect surgical materials (AOR = 13.76, CI = 1.12-168.7), time taken from decision and arrival to the operation theater (AOR = 0.75, CI = 0.17-3.25) and time taken from arrival at the operation theater to the immediate start of skin incision (AOR = 0.43, CI = 0.28-0.65). Conclusion: Delivery was not achieved within the recommended time interval in the majority of category-1 emergency caesarean sections. The average decision to delivery time interval was longer than the recommended time but it did not affect feto-maternal outcomes.

Introduction: Emergency laparotomy patients are different in pathology and surgical urgency. Mortality rates following emergency laparotomy ranges from 13% to 18% which is five times greater than high-risk elective surgery. In addition, major complication rates are as high as 50%. Limited data is available in our country regarding outcomes of emergency laparotomy. This study aimed to assess outcome of emergency laparotomy. Objective: To determine outcomes and associated factors among patients undergone emergency laparotomy. Methods: A four years institutional based retrospective observational study was conducted for patients who undergone emergency laparotomy from January 2016 to January 2020.A total of 518 patient charts were enrolled in this study. All consecutive patient charts during the study period were included. Data was entered and analyzed using SPSS version 20. Descriptive statistics, cross-tabs and logistic regression analysis were performed to identify the association between dependant and independent variables. The strength of the association was presented using adjusted odds ratio with 95% confidence interval and p-value≤0.05 was considered as statistically significant with mortality. Results: Mortality rate was 42 (8.1%) and 70(13.5%) patients were developed complication which needed surgical intervention under general anesthesia. The mean length of hospital stay was 8 ± 5.9 days. Patients age ≥65 (AOR = 9.6, CI = 3.4–27.1), ASA status of ≥III (AOR = 7.4, CI = 1.9–29.3), presence of preoperative sepsis (AOR = 6.7,(95% CI: 2.0–22.6) and intraoperative use of vasopressor (AOR = 10.5,(95% CI: 3.8–29.5) were significantly associated with mortality of emergency laparotomy patients. Conclusion: Emergency laparotomy possesses high mortality. Preoperative resuscitation and sepsis management may improve outcome following emergency laparotomy. Highlights

Background: Spinal anesthesia is the method of choice for cesarean section as it is associated with low occurrence of intra-operative and post-operative morbidities. Despite this significant move towards spinal anesthesia, it has a risk of failure reported in the range of 1–17%. Failed spinal is a disgusting event for the mother and the anesthetist that may lead to decreased maternal satisfaction and may potentially impact fetal and maternal outcomes. Objective: The study was designed to determine the incidence and factors associated with failed spinal anesthesia during cesarean section. Methods: A prospective institution based observational study was conducted on 275 parturients from October 1st to December 31st, 2019. After collection, the data was data entered and analyzed by SPSS version 21. The main outcome measure was the incidence of failed spinal anesthesia and the chi-square test was used to compare failure rates and multivariable regression analysis was performed to investigate potential factors. Results: The study involved 275 parturients and the overall incidence of failed spinal was 19.5%. Co-morbidity (OR = 9.615; CI = 1.255–7.368), emergency procedure (AOR = 2.191; CI = 1.087–4.417), needle size (2.3; CI = 0.92–0.615), anesthetist's experience (AOR = 4.23; CI = 2.14–8.34), surgeon's experience (AOR = 2.530; CI = 1.319–4.853), bloody CSF flow (AOR = 2.440; CI = 0.103–0.582), and volume of local anesthetics (AOR = 2.781; CI = 1.432–5.398) were significantly associated with failed spinal anesthesia. Conclusions and recommendations: The incidence of failed spinal anesthesia was found to be high compared to previous studies. Since the study tried to identify risk factors for failure, we should act accordingly to minimize the failure rate. Highlights:

Introduction: Labor pain is the worst imaginable pain that women experience during their childbearing years. Untreated labor pain has numerous negative consequences, for both the mother and her fetus. Low levels of awareness and attitudes among pregnant women about labor analgesia is a major challenge that affects outcomes for both the mother and fetus. Therefore, this study aimed to assess the awareness of, attitude towards and desire for labor analgesia and its associated factors among pregnant women who visited an antenatal care facility. Methods: An institution-based, cross-sectional study was conducted from February to March 2019. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data were entered using EpiData 4.2 and exported to SPSS version 20 software for analysis. Both bivariate and multivariate binary logistic regression analysis were used to identify factors associated with awareness, attitude and desire for labor analgesia among pregnant women. Crude odds ratio (COR) and adjusted odds ratio (AOR) were calculated to show the strength of association. Results: A total of 410 participants were included. Thirty-three (8%) of the pregnant women who visited the antenatal care facility were found to have an awareness of labor analgesia. In multivariate analysis, the likelihood of having awareness of labor analgesia was 7.227 times (AOR: 7.227, 95%, CI 2.406-21.720) greater among parous versus nulliparous mothers. The odds of having awareness of labor analgesia were 3.133 times (AOR: 3.133, 95%; CI 1.144-8.581) greater among government employees than among housewives. The odds of having a good attitude towards labor analgesia were 6.488 times (AOR: 6.488, 95% CI 1.894-22.227) higher in government employees than in farmers. Women in the age group of 25-31 years were 1.815 times more likely to want labor analgesia for their next delivery (AOR: 1.815, 95% CI 1.103-2.989). Conclusions: The awareness of labor analgesia among pregnant women was low. There is a need for teamwork by all stakeholders in health sectors to improve attitudes and increase the desire for labor analgesia among pregnant women who visit antenatal care facilities.

Introduction Thirst is a powerfully distressing sensation that occurs most frequently in the immediate postoperative period. Postoperative thirst is prevalent, the moderate-to-severe type is estimated to affect 53.2–69.8% of patients and causes significant patient discomfort. Objective The objective of this study was to assess the prevalence, and factors associated with postoperative thirst among surgical patients in PACU at the University of Gondar Comprehensive Specialized Hospital from April 20 to June 27, 2021. Methods An institution-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital. A total of 424 participants were included in the study. Statistical analysis had performed using SPSS 26.00 version statistical software. Binary logistic regression analysis was performed to identify the association between the prevalence of postoperative thirst and independent variables and only variables with p-value < 0.2 were entered into the multivariable analysis. The strength of the association was presented by odds ratio and 95% Confidence interval. P-value < 0.05 was considered statistically significant. Result The prevalence of postoperative thirst among postsurgical patients was 59% (95% CI = 54.74–64.13). Inadequate preloading (Adjusted odes ratio (AOR) = 2.137 95% CI 1.260–3.624), prolonged Nil Per Os (NPO) time (AOR = 13.80 95% CI 2.93–65.37), general anesthesia (AOR = 3.90 95% CI 3.56–11.25), and axillary body temperature ≥ 37.5 °C (AOR = 8.07 95% CI 3.63–17.96) were significantly associated with postoperative thirst. Low room temperature (< 20 °C) was protective for the occurrence of postoperative thirst (AOR = 0.162 95% CI 0.37–0.707). Conclusion and recommendations The prevalence of postoperative thirst remains high and need commitment in close monitoring of PACU patients and immediate intervention. We also urge that high-level, ongoing research be conducted in this area, as postoperative thirst is a very common problem with a lot to discover.