Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
-
Comparative Study
Anaesthesia preference, neuraxial vs general, and outcome after caesarean section.
We investigated parturients' preference for neuraxial vs general anaesthesia, while they have experienced both techniques in the past. A total of 102 parturients who underwent elective caesarean section under general or neuraxial anaesthesia at different times completed a questionnaire comparing the two techniques. ⋯ Neuraxial anaesthesia was associated with less pain assessed by the Verbal Analogue Scale (VAS) (54 ± 21 vs 72 ± 20 p < 0.001), fewer days of hospital stay (4 ± 0.5 vs 5 ± 1.5, p = 0.001) and higher satisfaction scores (77 ± 18 vs 52 ± 24, p = 0.001) vs general anaesthesia. Finally, 80% of the women would choose neuraxial anaesthesia for a future caesarean section.
-
Haemorrhage is one of the leading global causes of maternal mortality. The Rüsch balloon has been used in the treatment of postpartum haemorrhage (PPH) after failure of medical management. It is often effective in tamponading uterine bleeding, thus providing an alternative to hysterectomy. ⋯ We include a review of the current literature on balloon tamponade for PPH, including analysis of six relevant case series. This demonstrates a variety of methods based on tamponade to terminate uterine haemorrhage. Our study highlights the benefit of balloon tamponade for massive PPH and the importance of its involvement in labour ward protocols.
-
The objective of this study is to document the anaesthetic preference of pregnant women in two tertiary institutions in North-eastern Nigeria. This was a cross-sectional study of pregnant women seen at the antenatal clinics of the university of Maiduguri teaching hospital and Federal Medical Centre, Yola, from August to October 2009. A total of 254 women were interviewed. ⋯ Only age (p = 0.000, OR 8.17, CI = 0.000-1.00) retained significance after multivariate analysis. Considering the fact that the global trend is towards regional anaesthesia due to lower morbidity and mortality, the high preference for general anaesthesia in our survey is worrisome. Health education during antenatal clinics should highlight the superiority of regional over general anaesthesia for caesarean delivery.
-
This study is a review of our experience of using the cell saver in obstetrics. The main aim was to determine its role in decreasing the need for homologous blood transfusion. A retrospective study of patients identified as being at high risk of massive obstetric haemorrhage at the time of caesarean section during the period between July 2005 and August 2008, was undertaken. ⋯ A total of 13 units of salvaged blood were transfused successfully, saving approximately GB£1,800. Cell salvage in our practice has not been very effective due to non-availability of trained staff in emergencies and unfamiliarity of techniques, leading to poor salvage via suction. Most of our blood loss is swabbed not suctioned and lack of salvaging blood from swabs is a contributory factor.
-
Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. ⋯ Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section (p < 0.001, odds ratio (95% CI) 0.32 (0.2-0.6)) and a previous vaginal delivery (p < 0.0001, odds ratio (95% CI) 3.90 (2.1-7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women.