Articles Tagged With: cesarean
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Ketamine Use in the Prevention of Postpartum Depression Is Premature
A double-blinded, randomized clinical trial of 134 low-risk pregnant women in Iran undergoing scheduled cesarean deliveries was conducted to address if a single dose of ketamine during anesthesia induction has a role in the prevention of postpartum depression. The authors reported that depression scores using the Edinburgh Postnatal Depression Scale at two and four weeks after the cesarean delivery were significantly lower in the ketamine group vs. the control group.
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Standard-Dose vs. High-Dose Oxytocin for Labor Augmentation
In this randomized clinical trial of standard-dose vs. high-dose oxytocin regimens for labor augmentation among 1,003 nulliparous women, the primary outcome (cesarean delivery) was similar between the two groups. However, secondary outcomes were lower, labor duration was shorter, and umbilical artery acidemia occurred less frequently.
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What Is the Optimal Mode of Delivery of the Second Twin?
In this randomized clinical trial, 343 pregnant women with twin gestations were randomized to planned cesarean delivery and planned vaginal delivery groups (208 patients vs. 135 patients, respectively) between October 2013 and March 2015. The cesarean delivery rate in the planned vaginal delivery arm was 49% compared to the cesarean rate of 99% in the planned cesarean delivery arm. If all criteria for vaginal delivery are met, it would be reasonable and appropriate to offer women with diamniotic twin gestations planned vaginal delivery between 34 0/7 to 37 6/7 weeks of gestation.
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Maternal Sepsis: Risk Factors that Could Lead to Postpartum Readmission
In this analysis of California deliveries between 2008 and 2011, risk factors for maternal readmission for sepsis were found to include preterm birth, hemorrhage, obesity, and a primary cesarean delivery.
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Outcomes in Pregnant Women Treated with Anti-Tumor Necrosis Factor-Alpha Biologic Therapy
In this population-based cohort study of 1,027 infants born to women treated with anti-TNF-α biologic therapy, there was an increased prevalence of preterm birth (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.29-2.02), cesarean delivery (aOR, 1.57; 95% CI, 1.35-1.82), and small for gestational age neonates (aOR, 1.36; 95% CI, 0.96-1.92) when treatment with anti-TNF was compared to non-biologic systemic treatment. Since disease processes varied greatly in these pregnant women, it was difficult to rule out confounding by disease severity (confounding by indication).
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Is Nitrous Oxide an Effective Analgesic During Labor?
In this prospective cohort study at one large academic medical center in Colorado, 31% of women who opted for nitrous oxide for analgesia during labor did not require any other source of analgesia, such as an epidural or intravenous opioids. Risk factors for conversion to other modalities included labor induction, oxytocin augmentation, and labor after cesarean.
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Does a Standardized Recovery Bundle After Cesarean Delivery Decrease Length of Stay?
Implementation of an enhanced recovery bundle after cesarean delivery reflected diverse positive outcomes. However, length of stay was reduced only by an average of two hours.
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Multimodal Stepwise Post-Cesarean Pain Control Reduces Opioid Use
These investigators found that the routine use of acetaminophen alone rather than a combination acetaminophen-opioid significantly reduced overall and daily opioid use. In addition, there was no worse effect on overall pain score or length of stay.
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The Changing Face of Labor Management
Throught the years, clinicians' understanding of the conduct of labor has undergone periodic re-evaluation. In the 1950s, cesarean delivery was a major operation. Today, the procedures are shorter, accompanied by less surgical fanfare, and associated with fewer days in the hospital. Nevertheless, as the only other option to vaginal delivery, the operation, performed in 35% of cases for failure to progress, still should be considered “major” considering its potential for maternal complications.
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Ultrasound vs. MRI in Diagnosis of Placenta Accreta
The authors of this two-center study found that magnetic resonance is not superior to ultrasound in diagnostic accuracy for placenta accreta spectrum disorders, and its usefulness is tempered particularly by a tendency to falsely upgrade the stage of severity.