A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting

Ajuzieogu, Obinna V.; Ezike, Humphrey; Amucheazi, AO; Enwereji, Jamike O

doi:10.4103/1658-354x.76480

Cited by 15 publications

(13 citation statements)

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“…Considering the neonatal outcomes after various anesthesia techniques in cesarean delivery among preeclamptic patients, no statistically significant difference was found in the one- and five-minute Apgar scores and the umbilical artery blood gas markers between the two groups of patients receiving spinal or general anesthesia ( 25 ). Other studies in support of subarachnoid block have also shown that transient neonatal depression and birth asphyxia are more common among preeclamptic women who have received general anesthesia ( 26 ). Comparing umbilical arterial fetal base deficit and other markers of maternal and neonatal well-being in 70 preeclamptic patients undergoing cesarean delivery who were randomized into groups receiving either spinal or general anesthesia, the spinal group had a higher mean umbilical arterial base deficit and a lower median umbilical arterial pH, but other markers of a compromised neonatal condition, including the requirement for neonatal resuscitation, an Apgar score < 7, an umbilical arterial pH < 7.2, and the need for neonatal intermittent positive pressure ventilation were the same among the two groups ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section

et al. 2016

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BackgroundDespite controversies about the safest anesthetic technique for cesarean delivery in severely preeclamptic women, there is evidence that supports the use of spinal anesthesia in this group of patients.ObjectivesThis prospective randomized clinical trial was designed to determine the hemodynamic effects of low-dose spinal bupivacaine and the incidence of spinal anesthesia-associated hypotension in severely preeclamptic and healthy parturients undergoing cesarean sections.Patients and MethodsSpinal anesthesia was performed with 10 mg (= 2 mL) hyperbaric 0.5% bupivacaine plus 2.5 µg sufentanil in two groups of patients after they received 500 mL of IV lactated Ringer’s solution. Heart rate and blood pressure were recorded before spinal anesthesia and at two minutes intervals for 15 minutes after the block, and then every five minutes until the end of the surgery. Hypotension was defined as more than 25% of decline in the mean arterial blood pressure compared to the baseline in both groups (or systolic blood pressure < 100 mmHg in healthy parturients) and was treated with 5 mg IV ephedrine. The total amounts of intravenous administered fluid and the total doses of ephedrine were recorded for each patient as well.ResultsThe incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients, despite the former group receiving smaller volumes of intravenous fluids (P < 0.05). The total doses of IV ephedrine for treating hypotension were significantly lower among the preeclamptic patients (3.2 mg in preeclamptic patients versus 7.6 mg in normotensive patients) (P = 0.02). The one-minute Apgar score was significantly lower for the preeclamptic parturients (8.4 ± 0.7 versus 7.2 ± 1.5) (P = 0.001), but there was no significant difference in the five-minute Apgar scores between the two groups.ConclusionsOur results confirm that low-dose bupivacaine spinal anesthesia is associated with a lower risk of hypotension than previously believed, and it can therefore be safely used in severe preeclamptic women undergoing cesarean delivery.

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Section: Discussionmentioning

confidence: 99%

Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section

et al. 2016

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“…Patients with a history of pre-eclampsia were 2.5 times more likely to have cesarean delivery (OR = 2.5; p<0.02) [ 19 ]. It is possible that cases of stillbirths and maternal mortality associated with CS could be also associated to preeclampsia [ 20 ]. Robson in 2013 suggested that satisfactory CS rate in the group 1 would be around 10% and in that for Group 3, the caesarean section rate should be no higher than 3%.…”

Section: Discussionmentioning

confidence: 99%

Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System

2016

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IntroductionCesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time.Material and MethodsData from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification.ResultsThe caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001) was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour), 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy) and 7 (multiparas with a single breech pregnancy with or without previous scars) showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17–1.72; OR 3.53, CI95% 2.95–4.2) and maternal mortality (OR 3.39, CI95% 1.59–7.22; OR 8.05, CI95% 3.34–19.41).DiscussionThe caesarean section rates increased in the last years as result of increased CS in groups with spontaneous labor and in-group of multiparas with a scarred uterus. Women included in groups 1 y 3 were associated to maternal perinatal complications. Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. The use of Robson classification becomes an useful tool for monitoring cesarean section in low human development index countries.

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“…This study found no significant differences in Apgar score (1 min) and Apgar score (5 min) for the morbid obesity group compared with non-obese patients. Ajuzieogu et al [ 14 ] and Moodley et al [ 15 ] found similar neonatal outcomes irrespective of anesthesia administered; in addition, Ajuzieogu et al [ 14 ] showed that maternal mortality rates are similar after spinal and GA modes. GA should be preferred, as well as spinal anesthesia combined with epidural anesthesia, which has quick onset with very short time of fetus disengagement and high Apgar score.…”

Section: Discussionmentioning

confidence: 99%

Risk assessment of morbidly obese parturient in cesarean section delivery

An¹,

Zhao²,

Zhang³

et al. 2017

Medicine

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A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting

Cited by 15 publications

References 11 publications

Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section

Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section

Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System

Risk assessment of morbidly obese parturient in cesarean section delivery

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