South African obstetricians' views on caesarean section.

The widespread increase in the rate of caesarean sections performed in the Western world has become a cause for concern. In this country, two systems of health care exist, one provided by the State and the other based on private practice. A high incidence of caesarean sections has been reported, especially among private practitioners. This study investigated doctors' perceptions of caesarean section practices and explored the availability of facilities which could help to reduce the high caesarean section rate. Questionnaires were mailed to all registered obstetricians. Of these 45.2% (233) responded. Findings indicate that private obstetricians are more likely to perform caesarean sections even though they do have good facilities available to monitor or assess difficult deliveries. Other factors influencing their practice are also explored.     

Anaesthesia for caesarean section in a patient with Ehlers-Danlos syndrome associated with postural orthostatic tachycardia syndrome

We report the use of regional anaesthesia for elective caesarean section in a primigravida with hypermobility type Ehlers-Danlos syndrome (type III) associated with postural orthostatic tachycardia syndrome. Single-shot spinal anaesthesia was performed after failed epidural anaesthesia. This genotype, although generally associated with fewer antenatal and peripartum complications, is more likely than other types to display dysautonomia and orthostatic intolerance. This requires careful management for delivery.     

Anaesthesia for caesarean section

Although anaesthesia for Caesarean section is predominantly performed using regional techniques of anaesthesia, general anaesthesia will remain essential for subgroups of obstetric patients, especially those who are at high risk of complications. In the present review, recent reports that addressed issues regarding general and regional anaesthesia in Caesarean section will be discussed.     

Cimetidine premedication in elective caesarean section

A single intramuscular injection of Cimetidine was compared to oral antacid premedication in 17 patients undergoing elective Caesarean section. Seven patients in the Cimetidine group and four in the antacid group had gastric volumes in excess of 50 ml after induction of anaesthesia, while two patients in each group had gastric pH less than 2.5 after induction. Cimetidine was as effective as antacid in raising gastric pH but neither was completely reliable. This study reconfirms the high gastric volumes in pregnant patients with the need for preventative measures against aspiration during the induction of anaesthesia.     

Thromboembolic deterrent stockings fail to prevent hypotension associated with spinal anaesthesia for elective caesarean section

This study was carried out to determine whether the use of thrombo-embolic deterrent (TED) stockings, in combination with an intravenous crystalloid preload, would prevent hypotension following spinal anaesthesia for caesarean section. Fifty parturients undergoing elective caesarean section under spinal anaesthesia were randomly allocated into two groups. TED stockings were applied to the study group 1 h before spinal anaesthesia but none were applied to the control group. Both groups received a crystalloid preload of 15 ml kg(-1) over 15 min before spinal injection. Significant hypotension, defined as an absolute value of systolic arterial pressure (SAP) of less than 90 mmHg and a decrease of more than 20% from baseline SAP was treated with 3 mg bolus of ephedrine as required. The difference in SAO between the two groups was not statistically significant. In the control group, 80% of parturients required ephedrine as opposed to 56% in the TED group; a difference that was also not statistically significant.     

Prevalence and associated risk factors of retention of urine after caesarean section

Caesarean section poses higher risk of postpartum urinary retention (PUR) than vaginal delivery. The aim of this study was to identify the prevalence and the associated risk factors of PUR after caesarean section. Two hundred seven parturients (mean age = 31.26 years old, median parity = 0) who delivered by caesarean section were recruited from the postnatal unit of a tertiary hospital in Hong Kong. Voiding was encouraged 6 h after removal of Foley catheters. Transvaginal ultrasound scan was performed immediately after voiding to estimate the postvoid residual bladder volume (PVR). PUR after caesarean section was defined as PVR of more than 150 ml. The results indicated a prevalence of 3.38%. Logistic regression analysis indicating ‘lack of progress of labor’ was the only significant associated factor (p < 0.001). The findings of this study provide information for further exploration on how to reduce the morbidity caused by PUR in the postoperative period of caesarean section.     

Takayasu's disease and caesarean section

This case report describes a patient with Takayasu's disease requiring anaesthesia for caesarean section. Her pregnancy was complicated by serious exacerbation of her hypertension. The choice of anaesthetic technique in this setting is discussed, as are potential problems with monitoring. The relevant literature is described and suggestions are made for the management of such a case, particularly the preoperative assessment.