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MATERNAL AND FETAL OUTCOMES IN EMERGENCY VERSUS ELECTIVE TWO OR MORE PREVIOUS CAESAREAN DELIVERIES

Authors: Yousif A AL-Raheem يوسف عبد الرحيم --- Thikra Najim ذكرى نجم --- Faris A Rasheed فارس رشيد
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2010 Volume: 6 Issue: 1 Pages: 108-117
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Women with previous two or more caesarean deliveries are usually managed by elective cesarean section to avoid the possible risks of labor. Objective: To compare the relative risks of maternal and fetal outcomes in emergency versus elective previous two or more caesarean deliveriesDesign: Randomized prospective clinical studySetting: Al-Elweya Maternity Teaching Hospital, from 1st of March to 31st of September 2008.Methods: The study groups, those who had previous two or more caesarean deliveries, were included from the hospital admissions. The 1st group (102 women) presented in labor and was managed by caesarean delivery as soon as it was possible. The second group (78 women) was admitted for elective cesarean delivery.The main maternal outcomes were intra operative complications, including hysterectomy, scar dehiscence, bladder injuries, uterine and internal iliac arteries ligation, and blood transfusion. Postoperative maternal outcomes were severe morbidity including bleeding, fever, urinary tract infection, blood transfusion, the need to Intensive Care Unit admission and readmission. The fetal outcomes measures were Apgar score at one and five minutes, respiratory distress syndrome (RDS), admission to the neonatal intensive care unit and fetal loss up to hospital discharge.Results: Both groups were comparable in demographic, social and past obstetric history characteristics. Intra operative complications showed significant difference in bowel adhesions (RR 0.35, 95% CI 0.14- 0.88), and blood transfusion (RR 0.51, 95% CI 0.28-0.94). There was statistical significant difference in the mobilization time 7.2 hours and 9.3 hours in emergency and elective groups respectively (p= 0.0009), also in feeding time, it was shorter after emergency caesarean section (P=0.0224), and in the hospital stay 24.6 and 32.6 hours respectively (p=0.0001). There was no statistical difference in post operative complications. Fetal outcomes showed no statistical significant difference in fetal loss, respiratory distress and readmission.Conclusion: Women with previous two or more caesarean deliveries can wait until starting labor for doing cesarean delivery without increasing risks to the mother and fetus.


Article
Comparison of the Effects of Spinal Anaesthesia Vs General Anaesthesia on Apgar Score in Neonates Born after Elective Caesarean Section

Authors: Hassan Sarhan Haider, --- Faez Ahmed Mahdi --- Mohammed Abbas Kadhim
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 482-487
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Delivery of baby by caesarean section has become increasingly common, Caesarean section can be performed under general or regional anaesthesia like spinal or epidural technique, and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is safest for the mother and baby. OBJECTIVE: To compare the effect of spinal anaesthesia versus general anaesthesia on Apgar score of neonates born by elective caesarean section in Baghdad teaching hospital. MATERIAL AND METHODS: The study was carried out in Baghdad teaching hospital from February 2011 to July 2011 .this study was performed on 60 women presenting for Elective lower segment caesarean section .thirty mothers were given general anaesthesia and other 30 mothers received spinal anaesthesia. The Apgar score was recorded at1 minute and 5 minute interval after each delivery.RESULTS: Out of 30 mothers, who received general anaesthesia, 25 patients (83.3%) give birth to neonates having Apgar score ≤ 6 at one minute after birth and the remaining 5 neonates (16.7%) had Apgar score of ≥7.On the other hand out of 30 mothers who received spinal anaesthesia only 10 mothers give birth to neonate having Apgar score ≤ 6 at one minute after birth, who improved at 5 minutes interval, and their Apgar score were ≥7.It had been found that those neonates who were born under G.A were ten folds more likely to have Apgar score less than or equal to 6 at first minute compared to those with spinal anaesthesia, the odds ratio=10 and 95%confidence interval of the odds ratio (2.94-34) and p=0.00024 which is highly significant, G.A had greater risk on infant at the first minute. CONCLUSION: There is a significant difference between the effects of general anaesthesia and spinal anaesthesia on Apgar score of neonate one minute after delivery of full term neonate by elective caesarean section, but there is no significant difference between the effect of general anaesthesia and spinal anaesthesia on Apgar score 5minutes after birth.

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