RESUMO
BACKGROUND: The objective of this analysis was to observe whether maternal and perinatal/neonatal outcomes of birth vary by timing of repeat cesarean among women with a history of one prior cesarean birth in a Guatemalan cohort. METHODS: This secondary analysis was conducted using data from a prospective study conducted in communities in Chimaltenango, Guatemala through the Global Network for Women's and Children's Health Research. RESULTS: Between January 2017 and April 2020, 26,465 women delivered; 3,143 (11.9%) of those women had a singleton gestation and a history of prior cesarean delivery. 2,210 (79.9%) women with a history of prior cesarean birth had data available on mode of delivery and gave birth by repeat cesarean; 1312 (59.4%) were pre-labor cesareans while 896 (40.5%) were intrapartum cesarean births. Risk factors associated with an increased risk of intrapartum cesarean birth included hospital delivery as compared to "other" location (ARR 1.6 [1.2,2.1]) and dysfunctional labor (ARR 1.6 [1.4,1.9]). Variables associated with a reduced risk of intrapartum cesarean birth were hypertensive disease (ARR 0.7 [0.6,0.9]), schooling (ARR 0.9 [0.8,0.9]), and increasing age, which was associated with a very slight reduction in the outcome (ARR 0.99 [0.98,0.99]). Maternal and neonatal outcomes did not vary by type of cesarean birth. CONCLUSION: Outcomes of cesarean birth do not seem to vary by timing of repeat cesarean birth, with hypertensive disease increasing the likelihood of pre-labor cesarean. This information might be useful in counseling women that outcomes after failed trial of labor do not appear worse than those after pre-labor cesarean birth.
Assuntos
Recesariana/métodos , Recesariana/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Guatemala , Humanos , Gravidez , Fatores de Risco , Fatores SocioeconômicosRESUMO
Abstract Background and objectives: Congenital unilateral absence of a pulmonary artery (UAPA) is a rare anomaly. Although there are several reports regarding pregnancy in patients with unilateral absence of a pulmonary artery, there are no case reports describing anesthesia for Cesarean section in a patient with unilateral absence of a pulmonary artery. Case report: We present a patient with unilateral absence of a pulmonary artery who underwent Cesarean sections twice at the ages of 24 and 26 years under spinal anesthesia for surgery and epidural analgesia for postoperative pain relief. Both times, spinal anesthesia and epidural analgesia enabled successful anesthesia management without the development of either pulmonary hypertension or right heart failure. Conclusion: Spinal anesthesia combined with epidural analgesia is a useful anesthetic method for a Cesarean section in patients with unilateral absence of a pulmonary artery.
Resumo Justificativa e objetivos: A ausência congênita unilateral de uma artéria pulmonar (ACAP) é uma anomalia rara. Embora existam vários relatos sobre pacientes grávidas com ACAP, não há relatos de casos que descrevam anestesia para cesariana em pacientes com ACAP. Relato de caso: Apresentamos uma paciente com ACAP que foi submetida a duas cesarianas, aos 24 e 26 anos, sob raquianestesia para a cirurgia e analgesia epidural para a dor no pós-operatório. Nas duas cesarianas, a raquianestesia e a analgesia epidural possibilitaram o manejo bem-sucedido da anestesia, sem a ocorrência de qualquer hipertensão pulmonar ou insuficiência cardíaca direita. Conclusão: Raquianestesia combinada com analgesia epidural é um método anestésico útil para cesarianas em pacientes com ACAP.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Artéria Pulmonar/anormalidades , Cesárea/métodos , Dor Pós-Operatória/prevenção & controle , Complicações Cardiovasculares na Gravidez , Infusões Intravenosas , Midazolam/administração & dosagem , Bupivacaína/administração & dosagem , Analgesia Epidural/métodos , Recesariana/métodos , Ropivacaina , Amidas , Hipnóticos e Sedativos , Anestesia Epidural , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagemRESUMO
BACKGROUND AND OBJECTIVES: Congenital unilateral absence of a pulmonary artery (UAPA) is a rare anomaly. Although there are several reports regarding pregnancy in patients with unilateral absence of a pulmonary artery, there are no case reports describing anesthesia for Cesarean section in a patient with unilateral absence of a pulmonary artery. CASE REPORT: We present a patient with unilateral absence of a pulmonary artery who underwent Cesarean sections twice at the ages of 24 and 26 years under spinal anesthesia for surgery and epidural analgesia for postoperative pain relief. Both times, spinal anesthesia and epidural analgesia enabled successful anesthesia management without the development of either pulmonary hypertension or right heart failure. CONCLUSION: Spinal anesthesia combined with epidural analgesia is a useful anesthetic method for a Cesarean section in patients with unilateral absence of a pulmonary artery.
Assuntos
Cesárea/métodos , Artéria Pulmonar/anormalidades , Adulto , Amidas , Analgesia Epidural/métodos , Anestesia Epidural , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Recesariana/métodos , Feminino , Humanos , Hipnóticos e Sedativos , Infusões Intravenosas , Midazolam/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Gravidez , Complicações Cardiovasculares na Gravidez , Ropivacaina , Adulto JovemRESUMO
BACKGROUND: Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies. METHODS: CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined five elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the five intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intra-abdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967. FINDINGS: Between May 20, 2007, and Dec 31, 2010, 15â935 women were recruited. There were no statistically significant differences within any of the intervention pairs for the primary outcome: blunt versus sharp entry risk ratio 1·03 (95% CI 0·91-1·17), exterior versus intra-abdominal repair 0·96 (0·84-1·08), single-layer versus double-layer closure 0·96 (0·85-1·08), closure versus non-closure 1·06 (0·94-1·20), and chromic catgut versus polyglactin-910 0·90 (0·78-1·04). 144 serious adverse events were reported, of which 26 were possibly related to the intervention. Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section. INTERPRETATION: These findings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects. FUNDING: UK Medical Research Council and WHO.
Assuntos
Cesárea/métodos , Complicações na Gravidez/cirurgia , Prática Profissional/estatística & dados numéricos , Adulto , Argentina , Cesárea/estatística & dados numéricos , Recesariana/métodos , Recesariana/estatística & dados numéricos , Chile , Feminino , Gana , Humanos , Índia , Quênia , Paquistão , Gravidez , Resultado da Gravidez , Sudão , Técnicas de Fechamento de Ferimentos/estatística & dados numéricosRESUMO
The placenta accreta is the second leading cause of obstetric hemorrhage in the world. In many occasions it is necessary to make an obstetric hysterectomy, a circumstance that increases morbidity, and maternal mortality. Communicates a surgical alternative to hysterectomy obstetric that has enabled us to reduce until the time to zero our rate of maternal deaths by obstetric hemorrhage, in addition to reducing the surgical time and the associated morbidity, without changing the perinatal outcome.
Assuntos
Cesárea/métodos , Histerectomia/métodos , Placenta Acreta/cirurgia , Recesariana/métodos , Emergências , Exsanguinação/etiologia , Exsanguinação/mortalidade , Exsanguinação/prevenção & controle , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Recém-Nascido , Paridade , Placenta Prévia/cirurgia , Gravidez , Hemorragia Uterina/etiologia , Hemorragia Uterina/mortalidade , Hemorragia Uterina/prevenção & controle , Adulto JovemRESUMO
We report the case of Ileal resection, in a woman aged 27 during Kerr Caesarean section, we observe two ileum bag located at 20 and 40 cm, from the ileocecal valve, the farthest and largest containing air with breaking risk. Ileal surgical excision was performed with entero-entero anastomosis with silk sutures number 00. Postoperative treatment: antibiotics for 7 days: amikacin 500 mg intravenously every 12 hours and ceftriaxone 1 g every 8 hours. Fasting for 5 days diet progression to oral tolerance and normal bowel movements. Discharged from hospital on the seventh day after surgery in good condition. Medical examination at 7, 15 and 30 days without complications. Pathological report of 2 Meckel diverticulum without ectopic tissue.