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Effectiveness of auricular point acupressure with magnetic plate for pain management in acute postpartum Cesarean section patients in Thammasat University Hospital: a randomized clinical controlled trial

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Journal of Traditional Chinese Medicine 2022年第4期42卷 611-616页

作者： Rakchanok Tanitsookarn Komsun Suwannarurk Paradi Sangvatanakul Supapen Lertvuttivivat Junya Pattaraarchachai Kornkarn Bhamarapravatana Department of obstetrics and gynecology Faculty of medicineThammasat UniversityPathum Thani 12120Thailand Chulabhorn International College of Medicine Thammasat UniversityPathum Thani 12120Thailand Department of preclinical science Faculty of medicineThammasat UniversityPathum Thani 12120Thailand

OBJECTIVE:To compare the effectiveness of auricular acupressure with or without magnetic plates to routine post cesarean pain management.METHODS:This randomized controlled trial was conducted at Obstetrics and Gynecology Department,Thammasat University Hospital,between January and June 2020.All participants were term primigravida pregnant women who underwent cesarean delivery during the study period.Participants were divided into three groups,namely control,placebo and study groups.Study(magnetic application)and placebo(non-magnetic application)groups received magnetic and non-magnetic auricular patches at both pinnas,respectively.Randomized assignments for each group were computergenerated,printed and kept in opaque sealed envelopes.The points in this study were Shenmen(TF4),Erzhong(HX1)and Penqiang(TF5).Visual analog scale(VAS)was immediately recorded up to 72 h after the operation.RESULTS:A total of 195 cases were enrolled during the period of study.Each group had 65 participants.The mean participant’s age was 31 years old.Demographic and clinical characters among the three groups were comparable.Pain scores within 12 h postoperative period of all three groups were comparable.Between 36 and 72 h post-operation,study groups had significantly lower VAS than the control group.One-quarter of participants had comparable nausea and vomiting side effects.CONCLUSIONS:Auricular acupressure at Shenmen(TF4),Penqiang(TF5)and Erzhong(HX1)with magnetic plate attachment could significantly relieve post cesarean pain between 18 and 72 h.

关键词： Cesarean section pain acupressure magnetic plate

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The Impact of Regular Diet Recovery on Postoperative Rehabilitation After Elective Cesarean section

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Maternal-Fetal Medicine 2024年第2期6卷 78-83页

作者： Caihong Hu KuilinFei Yuelan Liu Xiaoe Jiang WenjingYong Weishe Zhang Ping Li Department of Obstetrics Xiangya HospitalCentral South UniversityChangsha 410008China Hunan Engineering Research Center of Early Life Development and Disease Prevention Xiangya HospitalCentral South UniversityChangsha 410008China.

Objective To determine the role of regular diet recovery after restoration of normal muscle strength of both lower extremities in promoting postoperative recovery in women undergoing elective Cesarean section.Methods This was a prospective observational cohort study.Patients who underwent elective Cesarean section at Xiangya Hospital,Central South University,from October 2022 to December 2022,were categorized into two groups based on the duration of postoperative fasting:the observation group resumed eating after regaining lower extremity muscle strength,while the control group adhered to traditional postoperative fasting guidelines,waiting 6 hours before eating.Primary outcomes included postoperative pain levels assessed by visual analog scale(VAS)pain scores and time to first flatus.Demographic characteristics,time to first lactation,hospital stay length,and patient satisfaction were also assessed.Statistical analysis was conducted using Student’s t test and Chi-squared test,with significance set at P0.05).Conclusion Food intake after restoration of lower extremity muscle strength improves first flatus,relieves postope

关键词： Obstetrics Cesarean section Early food intake

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The Impact of an Evidence-Based Bundle on Cesarean section-Related Surgical Site Infections:A Randomized Clinical Trial

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Maternal-Fetal Medicine 2024年第2期6卷 70-77页

作者： Aditya Gan Romana Khursheed Mahadevi Savanur Anita Dalal Arif Maldar Department of Obstetrics and Gynecology Jawaharlal Nehru Medical CollegeKLE Academy of Higher Education and ResearchBelagaviKarnataka 590009India Department of Medicine Jawaharlal Nehru Medical CollegeKLE Academy of Higher Education and ResearchBelagavi 590010India.

Objective To compare the effectiveness of an evidence-based bundle in minimizing Cesarean section(CS)-related surgical site infections(SSIs)with that of standard routine care.Methods This was a single-center,parallel,and randomized clinical trial conducted at KAHER’s Dr.Prabhakar Kore Charitable Hospital,Belagavi,India,from January 2021 to December 31,2021.Three hundred twenty women undergoing CS delivery were selected and allocated into two groups(1:1)using simple randomization with fixed allocation.An evidence-based surgical bundle(a combination of more than three perioperative interventions)was used for the intervention group,whereas the control group received routine standard perioperative care.The primary outcome was the incidence of SSI(superficial,deep,and organ or space SSIs)within 6 weeks postpartum in both groups.Categorical and continuous data were analyzed using appropriate statistical tests with a significance threshold set at P<0.05.Results In this study,16 and 17 participants each from the control and intervention groups,respectively,were lost to follow-up,resulting in a total of 144 and 143 study participants included in the respective groups.Twenty-eight(19.4%)and 14(9.8%)women developed SSI in the control and intervention groups,respectively(P=0.02).Methicillin-resistant Staphylococcus aureus was the most common cause of SSI in both groups(63.6%(7/11)and 100%(3/3)in the control and intervention groups,respectively).Conclusion The use of the evidence-based bundle for CS-related SSI prevention effectively decreased the incidence of SSI by half compared to standard routine practice.Implementing the use of this bundle in routine perioperative care will reduce the cost of CS and improve health outcomes in CS.

关键词： Cesarean section Bundle approach Infection prevention bundle Surgical site infections Evidence-based bundle

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Comparison of two vasopressor protocols for preventing hypotension post-spinal anesthesia during Cesarean section: a randomized controlled trial

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Chinese Medical Journal 2021年第7期134卷 792-799页

作者： Qian-Qian Fan Yong-Hui Wang Jing-Wen Fu Hai-Long Dong Man-Ping Yang Duo-Duo Liu Xiao-Fan Jiang Zhi-Xin Wu Li-Ze Xiong Zhi-Hong Lu Department of Anesthesiology and Perioperative Medicine Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Gynecology and Obstetrics Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Neurosurgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Anesthesiology and Translational Research Institute of Brain and Brain-like Intelligence Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200081China.

Background:Norepinephrine infusion decreases hypotension after spinal anesthesia during Cesarean section.This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.Methods:In this double-blinded,randomized controlled clinical trial,parturients scheduled for elective Cesarean section were randomly allocated to receive norepinephrine infusion(0.05μg·kg^(-1)·min^(-1))just before spinal anesthesia continuing for 30 min or ephedrine bolus(0.15 mg/kg)just before spinal anesthesia.A rescue bolus(5μg norepinephrine for the norepinephrine group,and 5 mg ephedrine for the ephedrine group)was administered whenever hypotension occurred.Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration.Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block,and neonatal cerebral oxygenation 10 min after birth.Results:In total,190 patients were enrolled;of these patients,177 were included in the final analysis.Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group(29.5%vs.44.9%,odds ratio[OR]:0.51,95%confidence interval[CI]:0.28-0.95,P=0.034).Moreover,the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group(OR:0.22,95%CI:0.11-0.44,PCesarean section with spinal anesthesia,norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia,and exhibited potential neonatal benefits.

关键词： Hypotension Spinal anesthesia Norepinephrine Ephedrine Cesarean section

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Effects of colloid preload on the incidence of hypotension in spinal anesthesia for Cesarean section:a systematic review and meta-analysis

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Chinese Medical Journal 2021年第9期134卷 1043-1051页

作者： Rui-Song Gong Xiao_Wen Liu Wei-Xia Li Jing Zhao Department of Anesthesia China-Japan Friendship HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijingChina Department of Anesthesia China-Japan Friendship HospitalBeijingChina

Background:Hypotension is a common complication caused by spinal anesthesia(SA),which may have adverse impacts on the condition of the parturient and fetus.Liquid infusion was found to be relatively effective for reducing the incidence of hypotension.However,the question of whether colloid preload can optimize hemodynamic variables in the Cesarean section remains controversial.This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective Cesarean section.Methods:Related keywords were searched on PubMed,EMBASE,and Cochrane Library from inception dates to May 2020.Studies included were evaluated for eligibility and quality.The primary outcome was the intra-operative incidence of hypotension and severe hypotension.The secondary outcomes included the lowest intra-operative systolic blood pressure,the maximal intra-operative heart rate,the intra-operative needs of ephedrine and phenylephrine,the incidence of maternal nausea and/or vomiting,and neonatal outcomes(umbilical artery pH and Apgar scores).Apart from the above,RevMan 5.3 was used for the data analysis.Results:Altogether nine randomized controlled trials were included in the meta-analysis.There were no significant differences in the incidence of intra-operative hypotension,severe hypotension,or neonatal outcomes between the colloid preload group and control group,except for the umbilical artery pH.Conclusion:This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective Cesarean section.

关键词： Colloid Preload Spinal anesthesia Cesarean section

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Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes

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Chinese Medical Journal 2020年第1期133卷 25-32页

作者： Hai-Li Jiang Chang Lu Xiao-Xin Wang Xin Wang Wei-Yuan Zhang Department of Obstetrics Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijing 100026China

Background:Preterm premature rupture of membranes(PPROM)is associated with high neonatal morbidity and mortality.However,the influences of Cesarean section(CS)on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated.The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM.Methods:A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st,2011 to December 31st,2011.A total of 2756 singleton pregnancies complicated with PPROM were included.Adverse neonatal outcomes including early neonatal death,birth asphyxia,respiratory distress syndrome(RDS),pneumonia,infection,birth trauma,and 5-min/10-min Apgar scores were obtained from the hospital records.Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression.Numerical variables were compared by multiple linear regressions.Results:In total,2756 newborns were involved in the analysis.Among them,1166 newborns(42.31%)were delivered by CS and 1590 newborns belonged to vaginal delivery(VD)group.The CS proportion of PPROM obviously increased with the increase of gestational age(x2=5.014,P=0.025).Compared with CS group,VD was associated with a higher risk of total newborns mortality(odds ratio[OR],2.38;95%confidence interval[Cl],1.102-5.118;P=0.027),and a lower level of pneumonia(OR,0.32;95%Cl,0.126-0.811;P=0.016).However,after multivariable adjustment and stratification for gestational age,only pneumonia was significantly related with CS in 28 to 34 weeks group(OR,0.34;95%Cl,0.120-0.940;P=0.038).There were no differences regarding to other adverse outcomes in the two groups,including neonatal mortality,birth asphyxia,Apgar scores,RDS,pneumonia,and sepsis.Conclusions:The proportion of CS of pregnant women with PPROM was very high in China.The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.

关键词： Preterm premature rupture of membranes Cesarean section Vaginal delivery Perinatal outcomes

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Cesarean section and risk of childhood leukemia: a systematic review and meta-analysis

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World Journal of Pediatrics 2020年第5期16卷 471-479页

作者： Li-Li Jiang Yin-Yan Gao Wen-Bo He Ting Gan Hou-Qian Shan Xue-Mei Han School of Public Health Lanzhou UniversityLanzhou 73000China

Background A large number of studies pointed that being delivered by Cesarean section(CS)would affect the health outcomes of offspring,however,whether CS would affect the risk of childhood leukemia remained uncertain.This study conducted a meta-analysis to quantitatively evaluate whether being delivered by CS would influence the onset of childhood leukemia.Methods PubMed,Embase and Web of Science databases were searched from 3rd June,1950 to 13th October,2019 to identify the literature,which examined the relationship between CS and childhood leukemia.This study used Newcastle-Ottawa Scale to assess the quality of literature.Subgroup analyses were conducted on region,mode of delivery,design of the study and number of confounders adjusted.Egger's test and Begg's test were performed to evaluate possible publication bias.Results The pooled odds ratio(OR)estimates illustrated that children delivered by CS had a higher risk of developing leukemia[OR 1.10,95%confidence interval(CI)1.04-1.17,P=0.002]and lymphoblastic leukemia(OR 1.12,95%CI 1.03-1.23,P=0.009),while a significant association for myeloid leukemia was not observed(OR 1.05,95%CI 0.92-1.20,P=0.451).Results of subgroup analyses indicated that elective CS would increase the risk of childhood lymphoblastic leukemia(OR 1.16,95%CI 1.06-1.27,P=0.002).However,a statistical relationship between emergency CS and lymphoblastic leukemia was not observed(OR 1.07,95%CI 0.93-1.23,P=0.364).Conclusions CS would increase the risk of childhood lymphoblastic leukemia.It is worth noting that subgroup analyses shows that elective CS rather than emergency CS increases the risk of lymphoblastic leukemia in offspring.

关键词： Cesarean section Leukemia Lymphoblastic leukemia Meta-analysis

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Analysis of risk factors related to severe postpartum hemorrhage of twin pregnancies delivered by Cesarean section

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Gynecology and Obstetrics Clinical Medicine 2022年第3期2卷 136-140页

作者： Fufen Yin Ruixue Li Junshu Xie Xiaohong Zhang Department of Obstetrics and Gynecology Peking University People’s HospitalBeijingChina Department of Obstetrics and Gynecology Liupanshui Maternal and Child Health Care HospitalGuizhouChina

Objective:To investigate the risk factors of severe postpartum hemorrhage(PPH)in Cesarean section of twin pregnancy,and to provide clinical basis for pregnancy management and perioperative obstetric management of twin pregnancy.Methods:The clinical data of 631 twin pregnancies with gestational age28 weeks delivered by Cesarean section at Peking University People's Hospital(PKUPH)from January 2004 to January 2017 were retrospectively analyzed.Methods of conception,the combined weight of twins,serum albumin level before Cesarean section,operation time and other factors on the amount of blood loss during Cesarean section were analyzed.Results:The proportion of severe PPH was significantly higher in in vitro fertilization-embryo transfer(IVF-ET)group,the combined weight of twins>6000g group,serum albumin before Cesarean section0.05).Moreover,according to the surgical indications,the emergency surgery group was divided into premature rupture of membranes(PROM),labor,fetal distress and others groups,no significant difference were detected among these groups(P>0.05).Conclusion:IVF-ET,the combined weight of twins,serum albumin before operation were significantly correlated with severe PPH of twin pregnancies delivered by Cesarean section,revealing that it is necessary to strengthen pregnancy management of twin pregnancy.

关键词： Twin pregnancy Cesarean section Severe postpartum hemorrhage Risk factors

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Effect of lower leg compression during Cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial

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International Journal of Nursing Sciences 2019年第3期6卷 252-258页

作者： Wafaa Taha Ebrahim Elgzar Hanan Ebrahim Said Heba Abdelfatah Ebrahim Department of Obstetrics and Gynecology Nursing Faculty of Nursing University of Damanhour Egypt Department of Obstetrics and Woman Health Nursing Faculty of Nursing University of Benha Egypt

Objectives: This study aimed to determine the effect of lower leg compression during Cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute,Damanhour,Egypt.The sample included 120 parturients (60 intervention and 60 control).The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule,electronic monitoring of maternal hemodynamic parameters,and neonatal hemodynamic assessment sheet.All parturients received ordinary preoperative care.For the intervention group,a long elastic stocking (ordinary pressure 20-30 mmHg,1 mmHg =0.133 kPa) was applied on both legs during Cesarean section.The control group received the same care without the elastic stocking.Results: Systolic blood pressure,diastolic blood pressure,and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5 -15 min.Heart rate was significantly lower in the intervention group.Only 13.3% of the intervention group took ephedrine compared with 45% of the control group.Apgar score was higher among neonates of intervention group compared with the control group at 1 min.Neonatal acidosis was significantly higher in the control group than in the contral group.Conclusion: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.

关键词： Cesarean section Hemodynamics Hypotension Leg Neonatal Stockings,compression

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Effect of Cesarean section on the Severity of Postpartum Hemorrhage in Chinese Women： The Shanxi Study

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Current Medical Science 2018年第4期38卷 618-625页

作者： Chang XU Qiang FU Hong-bing TAO Xiao-jun LIN Man-li WANG Shu-xu XIA Hao-ling XIONG Department of Health Administration School of Medicine and Health Management Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China Department of Epidemiology and Biostatistics College for Public Health and Social Justice Saint Louis University Saint Louis 63104 USA

Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different Cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nul

关键词： postpartum hemorrhage Cesarean section parity indications

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