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PubMed1990

Diclofenac sodium and low dose epidural morphine for postcesarean analgesia.

A randomized double-blind study of parturients after Cesarean section was undertaken to assess the efficacy of the combination of single dose intramuscular diclofenac sodium and low dose epidural morphine (EM) for postoperative analgesia. 50 parturients under epidural anesthesia were divided into 2 treatment groups: group A received 2 mg EM 30 min after the last dose of lidocaine and 3 ml normal saline i.m. at recovery room; group B received the same EM and 75 mg diclofenac i.m. postoperatively. Pain scores were compared at the 2nd, 4th, 8th, 12th, 18th, and 24th h. Results showed that group B was superior to group A in analgesic quality from the 8th h and thereafter (P less than 0.05) and 100% patients in group B were in the excellent to good analgesia categories at the 8th and 12th h record compared to 92% and 72% patients in group A respectively. Side effects were similar in both groups. The combination of NSAIDs with low dose EM could improve the analgesic quality after Cesarean section.

Adult↗
PubMed1995

Uterine artery ligation in the control of postcesarean hemorrhage.

The technique is described for devascularizing the post-cesarean section uterus with bilateral mass ligation of the ascending branches of the uterine arteries and veins. This 30-year clinical experience with 265 patients includes the results and complications. Ten patients required additional therapy. The effectiveness of this technique makes it a reasonable alternative to hypogastric artery ligation and reduces the need for hysterectomy.

Arteries↗
PubMed1985

Effect of anesthesia for repeat cesarean section on postoperative infectious morbidity.

It has been suggested that general anesthesia is a risk factor for postcesarean infectious morbidity. A retrospective review of 206 women who underwent repeat cesarean delivery at Duke University Medical Center was conducted. Group 1 consisted of 106 patients whose repeat cesarean section was performed with regional anesthesia, and group 2 included 100 patients whose repeat cesarean section was performed with general anesthesia. Group 2 patients were more likely to be of low socioeconomic status. There were no statistically significant differences between the two groups with regard to multiple indexes of postoperative fever or infection, including febrile morbidity, diagnosis of infection, use of therapeutic antibiotics, fever index, and postoperative hospital stay. General anesthesia, as administered to patients in the present series, does not increase the risk of infectious morbidity after repeat cesarean delivery.

Adult↗
PubMed2002

A randomized comparison of postcesarean pain between closure and nonclosure of peritoneum.

OBJECTIVE: To compare the intensity of postcesarean pain between closure and nonclosure of peritoneum in the women with a midline incision and one previous cesarean section. STUDY DESIGN: The setting was an obstetrics unit of a university teaching hospital. A double-blind randomized trial was performed on 60 pregnant women with a midline incision and one previous cesarean section who underwent elective repeated cesarean section. Thirty women each were allocated to the "closure" group and the "nonclosure" group. The principal outcome measure was the postcesarean pain assessed by visual analog scale (VAS). RESULTS: There was no difference in postoperative pain for closure and nonclosure of peritoneum groups in repeated cesarean patients; while resting (P=0.8), while moving in bed (P=0.94), and while walking (P=0.52). The use of opiate (P=0.27) and oral analgesics (P=0.37) also suggested no difference. No differences were found in duration of the operation, incidence of postoperative complications, time of returned bowel function, and length of the hospital stay. CONCLUSION: The VAS showed no difference in postcesarean pain between closure and nonclosure of peritoneum.

Blood Loss, Surgical↗
PubMed2005

The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss.

BACKGROUND: Our purpose was to determine whether blood loss during cesarean section and postoperative endometritis rate were associated with the method of placental removal and site of uterine repair. METHODS: This prospective randomized study involved 840 women who underwent cesarean section. The patients were grouped into four: (1) manual placental delivery + exteriorized uterine repair; (2) spontaneous placental delivery + exteriorized uterine repair; (3) manual placental delivery + in situ uterine repair; (4) spontaneous placental delivery + in situ uterine repair. Patients were excluded if they had received intrapartum antibiotics, had chorioamnionitis, required an emergency cesarean hysterectomy, had rupture of membranes for more than 12 hr, had bleeding diathesis, and had abnormal placentation or prior postpartum hemorrhage. The main outcome measures were postoperative hemoglobin and hematocrit values, and postcesarean endometritis. RESULTS: There were no statistically significant differences in mean maternal age, parity, gestational age, presence and duration of membrane rupture and number of vaginal examinations between the four groups. The decrease in postoperative hemoglobin (P < 0.05) and hematocrit (P < 0.001) was significantly greater in the manual removal groups (groups 1 and 3) than in the spontaneous expulsion groups (groups 2 and 4) at 48 hr postoperatively. The incidence of postoperative endometritis was significantly higher in manual removal groups (15.2%) (groups 1 and 3) than in spontaneous groups (5.7%) (groups 2 and 4) (P < 0.05). CONCLUSIONS: Manual removal of the placenta at cesarean delivery results in more operative blood loss and a higher incidence of postcesarean endometritis.

Adult↗
PubMed1984

The effect of prophylactic antibiotics on risk factors for endomyometritis in adolescent patients undergoing cesarean section.

The efficacy of ticarcillin and its effect on the known risk factors for endomyometritis and the prevention of postcesarean infection was studied in adolescents. Patients were randomly given the antibiotic or a placebo. The patients who received prophylactic ticarcillin had one-half the endomyometritis rate as the placebo group. Four or more vaginal examinations during labor were associated with a high incidence of endomyometritis. This was reduced by 35% with prophylaxis. When membranes were ruptured for more than 8 hours before cesarean section, the endomyometritis rate was 86% in the placebo group, as compared to 28% in the prophylactic-treated group. A similar effect occurred in the high-risk length of labor group. Ticarcillin appears to be effective in reducing the incidence of postcesarean endomyometritis in adolescent patients. The critical risk factors, in order of importance, were the number of pelvic examinations performed during labor, the length of time between rupture of membranes and cesarean section, and the length of labor before cesarean section.

Adolescent↗
PubMed1989

Subdural injection of local anesthetics and morphine: a complication of attempted epidural anesthesia.

We have reported a case of unintentional, roentgenographically proven cannulation of the lumbar subdural space. Injection of 13 ml of local anesthetic provided satisfactory anesthesia for cesarean section, and administration of 1 mg of morphine resulted in postcesarean analgesia for 22 hours. Subdural catheterization is a possible explanation for the occasionally irregular course of an apparent "epidural" anesthetic.

Adult↗
PubMed1989

[Various problems and prospects of improving the outcome of cesarean section].

A review of the outcomes of 819 cesarean sections and the causes of intranatal and early neonatal loss of full-term newborns has demonstrated that postcesarean perinatal mortality and morbidity remains fairly high. Perinatal losses are largely seen in cases of late gestosis and placental disorders, i.e. where cesarean section is performed urgently for maternal reasons. Possibilities for improving perinatal parameters are in the optimization of indications for surgical delivery and timely as well as technically correct performance of the operation and high-quality anesthesiologic support at a specialized facility, well-equipped for urgent maternal and neonatal treatment and intensive care.

Cesarean Section↗
PubMed1983

Postoperative cesarean section morbidity: a prospective study.

During a 3-year period, 1,319 women delivered of their infants by cesarean section were prospectively studied to determine the type and rate of postcesarean complications and to identify risk factors which predispose to postoperative morbidity. The overall complication rate was 14.5% and the most common complication was infection (13.3%), in particular, endometritis (6.6%), urinary tract infection (3.1%), and wound infection (1.6%). A lower complication rate was seen in elective operations (4.7%) compared with emergency operations (24.2%). Four significant factors that predispose to postoperative morbidity were identified: duration of ruptured membranes prior to operation (p less than 0.001), duration of labor prior to operation (p less than 0.001), anemia (p less than 0.01), and obesity (p less than 0.01). Patients with a combination of risk factors had an increased complication rate, in some cases as high as 91%. The clinical relevance of these findings in trying to decide possible ways to reduce the complication rate by changing the delivery routines is discussed.

Adolescent↗
PubMedDate not supplied

Heparin therapy in postcesarean septic pelvic thrombophlebitis.

Eleven cases of septic pelvic thrombophlebitis and persistant fever following cesarean section and cesarean hysterectomy are presented. Addition of heparin to the antibiotic regimen of these patients produced a clinical response within 1--5 days, except in two patients who developed septic pulmonary emboli, which finally resolved with continued heparin therapy. An incidental finding was a high incidence of pelvic thrombophlebitis following hypogastric artery ligation. The results justify a trial of heparin therapy, before resorting to exploratory laparotomy, in postpelvic surgery patients who have unexplained fever.

Adolescent↗
PubMed2002

Manual removal of the placenta and postcesarean endometritis.

OBJECTIVE: To determine if manual vs. spontaneous delivery of the placenta at cesarean section affects the rate of postoperative endometritis and amount of blood loss. STUDY DESIGN: A prospective, randomized study was carried out on patients who had cesarean delivery assigned either to spontaneous delivery of the placenta (group 1) or manual removal (group 2). We excluded patients undergoing emergency cesareans and those with possible placenta accreta or evidence of preexisting infection. Outcome measures (frequency of endometritis and quantitative decrease in hemoglobin) were compared for the two groups. RESULTS: Study criteria were met for 375 subjects: 177 in group 1 and 198 in group 2. Endometritis was diagnosed in 1.7% of the former and 2.5% of the latter. The change in hemoglobin, reflecting operative blood loss, was similar in both groups (-1.81 and -1.72 g/dL, respectively). CONCLUSION: We found no significant difference in either postoperative endometritis or blood loss regardless of the means used to effect delivery of the placenta. The frequency of febrile morbidity in our study cases was considerably lower than heretofore reported.

Adult↗
PubMed1988

Sonography of the low transverse incision, cesarean section: a prospective study.

Using sonography, the uterine incision site was prospectively studied in 36 asymptomatic patients, two days after cesarean section. The findings were compared with those seen in 21 symptomatic, postcesarean patients. In the asymptomatic patients, the incision site was visualized as an oval symmetric region of distinct echogenicity interposed between the lower uterine segment and the posterior wall of the urinary bladder. In eight of the 36 asymptomatic patients, a small (less than 1.5 cm) round hypoechoic mass was present in or adjacent to the uterine incision and distinct from the normal incision. These probably represented insignificant hematomas. Of the 21 symptomatic patients, 17 had either a subfascial hematoma, a bladder-flap hematoma, or endometritis. Two were sonographically normal, and one showed a hematoma in the paracolic gutter. In the remaining patient, there was a 5-mm asymmetrically placed hypoechoic mass representing an insignificant hematoma. Significant bladder-flap hematomas were characteristically round, greater than 2 cm masses asymmetrically placed in or adjacent to the uterine incision. Using sonography, the normal appearance of the lower uterine incision can be distinguished from significant hematomas.

Abdomen↗