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At least 19 recordsLinked to original sources
PubMed2003

Postcesarean section pain prediction by preoperative experimental pain assessment.

BACKGROUND: Postcesarean section pain is a common cause of acute pain in obstetrics, yet pain relief and patient satisfaction are still inadequate in many cases. The present study was conducted to determine whether preoperative assessment of experimental pain perception by quantitative sensory tests could predict the level of postcesarean section pain. METHODS: Fifty-eight women who were scheduled for elective cesarean section were enrolled in the study. Heat pain threshold and magnitude estimation of suprathreshold pain stimuli at 44 degrees-48 degrees C were assessed for both algosity (the sensory dimension of pain intensity) and unpleasantness 1 or 2 days before surgery. The day after the operation, the women reported the level of pain at the surgical wound on a visual analog scale at rest and during activity. Regression analysis was performed to evaluate the usefulness of preoperative scores in predicting postcesarean section pain. RESULTS: Postoperative visual analog scale scores at rest and during activity significantly correlated with preoperative suprathreshold pain scores at 44 degrees-48 degrees C (r = 0.31-0.58 for algosity and r = 0.33-0.74 for unpleasantness). The stimulus of 48 degrees C was found to be the best predictor of postoperative pain for both conditions (r = 0.434-0.527; P < 0.01). In contrast to suprathreshold pain stimuli, pain threshold was not correlated with postoperative pain. CONCLUSIONS: The results show that a simple and quick preoperative test is useful in identifying those women who will experience greater pain after a cesarean section. This test may be suggested for caregivers to tailor the postoperative treatment to specific patient needs and to improve postoperative outcome and patient satisfaction.

Adult↗
PubMed1989

Ogilvie's syndrome in the postcesarean section patient.

Two cases of colonic pseudo-obstruction (the so-called Ogilvie's syndrome) are reported. Both patients were in the immediate postcesarean section puerperium. The importance of early diagnosis in these cases is stressed, because this complication has a high mortality rate, frequently in relation to delayed diagnosis and treatment. One patient was successfully treated with conservative measures because diagnosis was made early. A plain X-ray abdominal film which shows cecum dilatation, with or without ascending and transverse colon dilatation, and no distal air, makes the diagnosis. A cecum diameter of 9 cm or more is a surgical indication, because the possibility of wall perforation is high. Surgical techniques are: puncture decompression or cecostomy. When cecum diameter is less than 9 cm, non-surgical measures (nasogastric suction, correction of any fluid and electrolytic imbalance, and maybe a flatus tube) are indicated. Observation through repeated X-ray abdominal films shows when the surgical indication appears: (1) failure of the conservative treatment (cecal distension continues or increases); or (2) cecal perforation is documented.

Adult↗
PubMed1986

Cefoxitin versus clindamycin and gentamicin in the treatment of postcesarean section infections.

Cefoxitin, a cefamycin derivative, has demonstrated activity against a broad spectrum of aerobic and anaerobic bacterial pathogens. The efficacy and safety of cefoxitin were compared with that of the combination of clindamycin and gentamicin in the treatment of postcesarean section infection. Ninety-eight patients were evaluated. Cefoxitin cured 36 of 48 patients (75%); clindamycin/gentamicin cured 38 of 50 (76%) (P greater than .05). Febrile degree hours and length of hospital stay did not differ between the two study groups. No patient experienced abscess formation or septic pelvic thrombophlebitis. Both therapies were well tolerated. In the authors' experience, cefoxitin as a single agent was as effective in the treatment of postoperative pelvic infection as the combination of clindamycin and gentamicin.

Adult↗
PubMed1984

Effects of postcesarean section febrile morbidity on subsequent fertility.

The records of 1319 patients undergoing cesarean section were evaluated to determine the relationship between postoperative febrile morbidity and fertility during the five years after the operation. Infection was significantly more common among patients undergoing primary as compared with repeat cesarean section and was three times more frequent among patients with membranes ruptured for 12 hours or more compared with those with membranes ruptured less than 12 hours. After correction of the data for voluntary infertility, neither postcesarean section endometritis nor pelvic cellulitis had a demonstrable effect on the rate of pregnancy during the five years after cesarean delivery, but pelvic abscess was associated with an apparent reduction in fertility as reflected by the frequency of pregnancy among these individuals, which was approximately half the rate observed in other infected and noninfected individuals in this study.

Abscess↗
PubMed1988

Postcesarean section plasma fibronectin levels.

Decreases in plasma fibronectin levels following surgery and subsequent to trauma and sepsis have been previously reported. There have been no reports, however, regarding plasma fibronectin levels following cesarean section. Plasma fibronectin levels were followed for 3 days postpartum in 49 patients including cesarean section control patients, patients with cephalopelvic disproportion, pregnancy-induced hypertension, and endometritis. Cesarean section and cephalopelvic disproportion were not associated with a change in postpartum fibronectin levels. Pregnancy-induced hypertension and endometritis did show a significant increase (p less than 0.05) in plasma fibronectin levels. These levels are probably not decreased because of the large fibronectin pool in these otherwise healthy women.

Cesarean Section↗
PubMed1985

Relationship of ultrasound findings after cesarean section to operative morbidity.

Postcesarean section febrile morbidity remains a common problem on obstetric services. Although a few preliminary studies have reported on the use of ultrasound to assess the postcesarean section patient, they have not compared sonographic findings with either intraoperative or postoperative events. These reports have noted fluid collections around the incision site. In this report of 100 postcesarean section patients, it is noted that echo-free areas anterior to the incision site, which correspond to the described fluid collections, were present in 29% of patients and were more frequently found in patients with excess blood loss at surgery. Patients whose echo-free areas were greater than or equal to 3.5 cm were significantly more likely to have postoperative morbidity. The significance of these findings and the role of ultrasound in the evaluation of the postcesarean section patient are discussed.

Abscess↗
PubMed1983

Prophylactic cefoxitin in cesarean section.

The effectiveness of prophylactic cefoxitin in preventing postcesarean section infection was studied in a high risk population. One hundred women were evaluated, and on a random double-blind basis 50 received placebo and 50 received cefoxitin. There were three doses of drug given intravenously, either placebo or 1 gram of cefoxitin at the time of cord clamping and again four and eight hours later. Those receiving cefoxitin had significantly less postoperative infections, fewer had bacteremia and there was less postoperative fever as measured by the fever index. The patient with the most protracted infection in this study received cefoxitin. Problems with the use of systemic antibiotic prophylaxis in preventing postcesarean section infection are discussed. Cefoxitin is an effective agent to use in patients undergoing cesarean section who are at high risk for infection.

Adult↗
PubMed1980

Endometritis following cesarean section. A controlled study of the increased duration of hospital stay and direct cost of hospitalization.

The increased hospital stay and direct costs of hospitalization as a result of postcesarean section endometritis were evaluated in a case-matched and controlled study (N = 20 in each group). Endometritis increased postcesarean section hospital stay by 3 days and increased hospital cost by $850. Fifteen to 20% of women delivered by cesarean section develop postpartum endometritis. The success of future antibiotic or surgical intervention studies in reducing this high complication rate can be more accurately evaluated by comparison with these now established parameters of morbidity and cost.

Adult↗
PubMed1985

Comparative clinical evaluation of ceftizoxime with clindamycin and gentamicin and cefoxitin in the treatment of postcesarean endomyometritis.

New third generation cephalosporins have been recommended as single agent antibiotic therapy in the treatment of postoperative infections. This study compares the new third generation cephalosporin ceftizoxime with cefoxitin, clindamycin and gentamicin in the treatment of postcesarean section endomyometritis. The results indicate that the clindamycin and gentamicin regimen is more efficacious in the treatment of severe infection after cesarean section than either ceftizoxime or cefoxitin regimens. Therefore, the results of this study suggest caution in substituting single drug antibiotic therapy with cefoxitin or the third generation cephalosporins for the standard clindamycin and gentamicin regimen in the treatment of postcesarean section endomyometritis until more clinical data are available.

Adult↗
PubMed1991

Prevention of postcesarean infectious morbidity with a single dose of intravenous metronidazole.

The efficacy of intravenous metronidazole for the prevention of postcesarean section infectious morbidity was studied in 100 healthy women, randomly given either the drug or a placebo. The metronidazole group received 1.0 g intravenously, immediately after cord clamping. Among the 50 patients who received metronidazole, endometritis developed in 7 (14%) as it did in 15 (30%) of the placebo group (P less than 0.01); wound infection was found in 1 (2%) and 4 (8%), respectively (P less than 0.01). If both infectious complications are compared together, the difference (16% versus 38%) is more significant (P less than 0.001). Metronidazole was well tolerated by the mother and with this type of administration regimen, the fetus is not exposed to the drug. It is concluded that metronidazole, used as here reported, is effective in reducing the frequency of postcesarean section endometritis and wound infection with the consequent clinical and economic impacts.

Adult↗
PubMed1992

Epidural clonidine after cesarean section. Appropriate dose and effect of prior local anesthetic.

Epidurally administered clonidine represents a new approach to postcesarean section pain therapy, yet the appropriate bolus dose and infusion to provide effective pain relief have not been defined. In addition, whether 2-chloroprocaine, a commonly used local anesthetic for intraoperative anesthesia, interferes with clonidine's analgesia, as it does with that of opioids, has not been examined. In this study, using a randomized, blinded design, 63 women received either bupivacaine or 2-chloroprocaine for epidural anesthesia for cesarean section and then received, upon request for analgesia in the recovery room, epidural clonidine 400 micrograms or 800 micrograms bolus, each followed by a 24-h infusion of 40 micrograms/h, or an equivalent volume bolus and infusion of saline. In the bupivacaine group, both clonidine doses produced equivalent analgesia, as determined by pain scores and time to first supplemental intravenous morphine request, and sustained analgesia was produced by clonidine infusion, as measured by need for supplemental morphine. In contrast, 2-chloroprocaine diminished analgesia from 800 micrograms by 21% and abolished analgesia from 400 micrograms clonidine. After 2-chloroprocaine, sustained analgesia from continuous clonidine infusion was present only in the group who had received 800 micrograms clonidine. Clonidine did not alter resolution of residual local anesthetic sensory blockade, as measured by 2- or 4-segment regression following either local anesthetic, but did prolong duration of motor blockade in women receiving bupivacaine. Clonidine produced small decreases in heart rate and blood pressure. One patient received iv fluids for hypotension; one had asymptomatic bradycardia resolving without therapy; and one had mild hypoxemia with snoring during clonidine-induced sedation, responding to supplemental oxygen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗