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Elective Caesarean Delivery (elective + caesarean_delivery)
Selected AbstractsOral nifepidine versus subcutaneous terbutaline tocolysis for external cephalic version: a double-blind randomised trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2009R Collaris Objective, To evaluate oral nifedipine versus subcutaneous terbutaline tocolysis for external cephalic version (ECV). Design, A double-blind randomised trial. Setting, A university hospital in Malaysia. Population, Non-labouring women with a term singleton fetus in breech presentation or transverse lie suitable for elective ECV. Methods, Participants were randomised to either 10 mg oral nifedipine tablet and subcutaneous saline placebo or oral placebo tablet and 250 microgram bolus terbutaline subcutaneously. Participants and providers were blinded. Ultrasound assessment and cardiotocogram were performed prior to ECV. ECV was commenced 20,30 minutes after treatment. A maximum of two ECV attempts were permitted. Elective caesarean delivery or a repeat ECV attempt at a later date was offered to participants following failed ECV. After successful ECV, management was expectant. Main outcome measures, Primary outcomes were successful ECV (cephalic presentation immediately after ECV) and caesarean delivery. Results, Ninety women were randomised: 44 to nifedipine and 46 to terbutaline. Initial ECV success rate was 15/44 (34.1%) versus 24/46 (52.2%) (relative risk [RR] 0.7, 95% CI 0.4,1.1; P= 0.094), and caesarean delivery rate was 34/44 (77.3%) versus 26/46 (56.5%) (RR 1.4, 95% CI 1.01,1.85; numbers needed to treat to benefit 5, 95% CI 2.5,55; P= 0.046) for nifedipine and terbutaline groups, respectively. Neonatal outcome was not different. Conclusions, Bolus subcutaneous terbutaline tocolysis for ECV compared with oral nifedipine resulted in less caesarean deliveries. ECV success rate was not significantly higher. Larger studies are indicated. [source] The optimal mode of delivery for the haemophilia carrier expecting an affected infant is caesarean deliveryHAEMOPHILIA, Issue 3 2010A. H. JAMES Summary., While a majority of affected infants of haemophilia carriers who deliver vaginally do not suffer a head bleed, the outcome of labour cannot be predicted. A planned vaginal delivery puts a woman at risk of an abnormal labour and operative vaginal delivery, both of which predispose to intracranial haemorrhage. Furthermore, vaginal delivery does not eliminate the risk to the haemophilia carrier herself. Overall, maternal morbidity and mortality from planned vaginal delivery are not significantly different from those from planned caesarean delivery. Caesarean delivery is recommended or elected now in conditions other than haemophilia carriage, where the potential benefits are not nearly as great. Additionally, vaginal delivery of the haemophilia carrier poses medical/legal risks if the infant is born with cephalohaematoma or intracranial haemorrhage. Caesarean delivery allows for a planned, controlled delivery. Caesarean delivery reduces the risk of intracranial haemorrhage by an estimated 85% and the risk can be nearly eliminated by performing elective caesarean delivery before labour. Therefore, after a discussion of the maternal and foetal risks with planned vaginal delivery versus planned caesarean delivery, haemophilia carriers should be offered the option of an elective caesarean delivery. [source] Intrathecal sufentanil decreases the median effective dose (ED50) of intrathecal hyperbaric ropivacaine for caesarean deliveryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010X. CHEN Background: The addition of opioid to local anaesthetics has become a well-accepted practice of spinal anaesthesia for caesarean delivery. Successful caesarean delivery anaesthesia has been reported with the use of a low dose of intrathecal hyperbaric ropivacaine coadministered with sufentanil. This prospective, double-blinded study determined the median effective dose (ED50) of intrathecal hyperbaric ropivacaine with and without sufentanil for caesarean delivery, to quantify the sparing effect of sufentanil on the ED50 of intrathecal hyperbaric ropivacaine. Methods: Sixty-four parturients undergoing elective caesarean delivery with combined spinal,epidural anaesthesia were randomized into two groups: Group R (ropivacaine) and Group RS (ropivacaine plus sufentanil 5 ,g). The initial dose of ropivacaine was 13 mg in Group R and 10 mg in Group RS. The effective dose was defined as a T6 level attained within 10 min and no supplemental epidural anaesthetic required during surgery. Effective or ineffective responses determined, respectively, a 0.3 mg decrease or increase of the dose of ropivacaine for the next patient using an up,down sequential allocation. Results: The ED50 of intrathecal ropivacaine was 11.2 mg [confidence interval (CI) 95%: 11.0,11.6] in Group R vs. 8.1 mg (CI 95%: 7.8,8.3) in Group RS. Motor block was markedly more intense in Group R than in Group RS, and the incidence of shivering was lower in Group RS than in Group R. There were no differences in the onset time of sensory block or motor block, in the incidence of hypotension, nausea and vomiting. Conclusion: Intrathecal sufentanil 5 ,g produced a 28% reduction of ED50 of intrathecal hyperbaric ropivacaine for caesarean delivery. [source] Original Article: Amniotic fluid lamellar body concentration as a marker of fetal lung maturity at term elective caesarean deliveryAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Susan P. WALKER Background:, Caesarean birth, without prior labour, is associated with an increased risk of neonatal respiratory morbidity among term infants. The concentration of lamellar bodies in amniotic fluid reflects pulmonary surfactant production and release, and is thus used in preterm populations as a marker of fetal lung maturity. Whether amniotic fluid lamellar body concentration (AFLBC) may correlate with risk factors for term respiratory distress has not previously been evaluated. Aims:, To determine the relationship between AFLBC and risk factors for respiratory distress following term caesarean birth. Methods:, The AFLBC of 249 women at the time of term caesarean birth was examined for an association with gestational age, gender, presentation and neonatal respiratory distress requiring special care nursery (SCN) admission. Results:, There was a significant increase in AFLBC with gestation. When compared with caesarean deliveries performed during the 37th week of gestation, there was a 50%, 54% and 56% increase in lamellar body concentrations (LBCs) taken during the 38th, 39th and 40th week of gestation respectively (P < 0.05 for all). Female fetuses had a 16% higher LBC than males (P < 0.05). An LBC <100 × 109 mL,1 was associated with increased risk of admission to the SCN with respiratory distress (RR = 5.6; 1.2,26.5, P < 0.05). Conclusion:, Known risk factors for term respiratory distress are reflected in the AFLBC. A significant relationship exists between AFLBC and respiratory morbidity following term caesarean birth. However, the low prevalence of this condition limits the clinical role of AFLBC as a predictive test for term respiratory morbidity. [source] | ||||||||||