Search Results (79)

Background/Objections: One of the most common surgical procedures performed internationally is the cesarean section. It is known to be associated with intense postoperative pain and a slow recovery process. Focusing on surgical techniques, especially the type of fascial closure, is an area that has received very little attention when it comes to postoperative pain and rapid recovery. Using a mixed-methods approach, the primary objective of this study was to assess the impact of guide-suture-assisted modified fascial closure on postoperative pain and early mobilization after cesarean sections. Methods: Women undergoing elective cesarean sections with Pfannenstiel’s incision were the study participants of this prospective, single-center, randomized mixed-methods study. Participants were enrolled in the study and randomized to either classical continuous fascial closure or guide-suture-assisted modified fascial closure, which was carried out in a 1:1 ratio. Quantitative data assessed postoperative pain through the Visual Analog Scale (VAS), a Numeric Rating Scale (NRS), and the Short-Form McGill Pain Questionnaire (SF-MPQ), and functional recovery was assessed through walking distances at postoperative 6, 12, 24, and 48 h. Qualitative data were collected via semi-structured interviews and analyzed through conventional content analysis to understand the patients’ perceptions of pain and recovery experiences. Results: The first 24 h postoperative period pain levels were significantly lower for the modified fascial closure group versus the classical closure group (p < 0.05). Moreover, the modified closure group had a significantly better functional recovery, evidenced by walking greater distances at 12, 24, and 48 h postoperative. Qualitative results indicated improved comfort and stronger early mobilization confidence, in addition to less movement apprehension, consistent with the above results, among those with the modified technique. Conclusions: The modified fascial closure technique with guide suture was linked to less pain in the early postoperative period and better functional recovery after cesarean section. This technique is a good candidate for addition to standard obstetric procedures since it is cost effective, easily added, and surgical practice will improve comfort for mothers and assist with early mobilization. Full article

Background and Objectives. Mother-to-child transmission (MTCT) or vertical transmission of human immunodeficiency virus (HIV) is largely preventable in settings where prevention of MTCT (PVT) strategies are consistently implemented. Romania represents a particular epidemiological context, as individuals from the historical pediatric HIV cohort have now reached reproductive age. This study assessed current PVT outcomes in northeastern Romania and explored the remaining circumstances in which transmission still occurs. Materials and Methods. We performed a retrospective observational analysis at the Regional HIV/AIDS Center of Iași (“Sfânta Parascheva” Clinical Hospital of Infectious Diseases), including all pregnant women living with HIV and their HIV-exposed infants followed between 2023 and 2025. Maternal data comprised age, place of residence, origin from the Romanian pediatric cohort, antiretroviral therapy (ART) adherence, and HIV RNA viral load in the third trimester. Obstetric characteristics, delivery mode, neonatal antiretroviral prophylaxis, and infant HIV RNA PCR results during follow-up up to 18–24 months were also evaluated. Results. A total of 61 HIV-positive pregnant women and 53 HIV-exposed infants were included. Viral suppression during pregnancy was documented in 59 women (96.7%), while two cases of detectable viremia in late pregnancy were linked to poor ART adherence. All women delivered by elective cesarean section, and all infants received neonatal antiretroviral prophylaxis, with Raltegravir added in selected higher-risk situations. Overall, MTCT was 3.8% (2/53). No transmission events were recorded in 2023 or 2024; both cases occurred in 2025 (15.4% of infants born that year) and exclusively in the context of maternal viremia. Women originating from the historical pediatric HIV cohort accounted for 31.1% (19/61) of pregnancies, and no transmission was observed among their infants. Conclusions. In northeastern Romania, PVT programs remain highly effective when maternal viral suppression is achieved. Residual transmission was confined to situations of maternal viremia driven by ART non-adherence, highlighting the continued importance of adherence support during pregnancy. Full article

Background/Objectives: Ephedrine and cafedrine/theodrenaline (C/T) are established treatments for spinal anesthesia-induced hypotension during cesarean section. Both aim to stabilize maternal blood pressure and enhance neonatal oxygenation. We compared their effects on maternal hemodynamics and neonatal acid-base status using population kinetic/pharmacodynamic (K/PD) modeling and multiple regression analysis. Methods: The multicenter, prospective, open-label, two-armed, non-interventional HYPOTENS study included 243 parturients undergoing spinal anesthesia for elective cesarean section in Germany. Hypotension was treated with intravenous boluses of either C/T (10–200 mg, 55.6%) or ephedrine (5–40 mg, 44.4%), with dosing determined by the attending anesthesiologist. Maternal mean arterial pressure (MAP), systolic blood pressure (SBP), and heart rate (HR) were recorded for 30 min after treatment. Neonatal acidosis biomarkers included umbilical arterial pH, base excess (BE), and lactate. Results: A population K/PD model captured an initial increase followed by a plateau in MAP, SBP and HR after treatment. Maximum HR (MAX_HR) was 15% higher after ephedrine than after C/T (p < 0.001). BMI and spinal block height significantly influenced maternal hemodynamics (both p < 0.001). Neonatal biomarkers were associated with the duration of maternal MAP below pre-surgery levels, gestational age, spinal block height, antihypotensive treatment, bupivacaine dose, and MAX_HR (all p < 0.05). Conclusions: Ephedrine was associated with higher maternal MAX_HR. Notably, higher maternal MAX_HR was correlated with lower neonatal BE, suggesting that lower maternal peak HR may benefit. These findings may support the use of substances that are largely inert with respect to maternal HR. Full article

Background/Objectives: Although morbidity and mortality are more pronounced in extremely and very preterm infants, there is also considerable morbidity in preterm infants of more advanced gestations. Delivery via cesarean section is associated with a higher risk of perinatal complications even when performed electively. Our aim was to examine the possible contribution of prenatal and perinatal factors to the risk for respiratory morbidity in a population of late-preterm and early-term infants delivered with a high rate of elective cesarean section. Methods: In a retrospective cohort study, all late-preterm and early-term infants (34 to 38 completed weeks of gestation) that were admitted with respiratory distress to the Neonatal Intensive Care Unit of the University Hospital of Patras over a recent period of two years were included in the study. Results: In the study period, 489 infants of all gestations were admitted to the neonatal unit, of whom 221 were born between 34 and 38 + 6 gestational weeks. Ventilated infants had a significantly lower incidence of antenatal corticosteroids (41%) compared to non-ventilated infants (51%, p = 0.036) and a higher duration of parenteral nutrition [4 (1–6) days] compared to non-ventilated infants [2 (1–3) days, p < 0.001]. The incidence of late-onset sepsis was higher in the ventilated infants (26%) compared to the non-ventilated ones (8%, p < 0.001). Conclusions: Late preterm and early term infants who were invasively ventilated had less often received antenatal corticosteroids and had a higher incidence of late-onset sepsis compared to those who were not ventilated. Full article

Background: Persistent postpartum pain (PPP) is a common condition after cesarean section (CS) that affects multiple domains of quality of life. PPP was defined as pain of any cause (not only related to surgery) appearing after CS and persisting for at least the three following months. The objective of this study was to calculate the incidence of PPP in women after elective CS and to analyze the associated risk factors. Methods: It was a retrospective cross-sectional study. An electronic patient-reported outcome tool (ePRO) was used to assess patients’ perception of their own health and to assess the presence and severity of pain. Results: Pain during pregnancy was reported by 66.14% of the study group. The most frequently reported localizations of pain were the lumbar spine, pubic symphysis, lower limbs, and sacrococcygeal region. The mean postoperative pain (day 0) defined by a Numeric Rating Scale was 5.44 (2.78 SD), and on the day of discharge (usually the third day after CS), it was 3.6 (2.29 SD). PPP occurred in 32.37% of women, was usually mild in nature, and had a little to moderate impact on function. Previous surgery raises the odds of PPP by 48.7% (OR = 1.487), pain during pregnancy raises the odds of PPP by 48.1% (OR = 1.481), and each additional point of the NRS on day 0 raises the odds of PPP by 16.6% (OR = 1.166). Conclusions: A higher risk of PPP could be found in women with pre-existing pain conditions, previous surgery, and severe postoperative pain. Persistent postpartum pain is not limited only to the area of surgery. Persistent back pain was reported by every second woman with PPP. Full article

Background: Perinatal hypoxia is a leading cause of early mortality in canine neonates and accounts for over 90% of early deaths in canine neonates. Respiratory depression may result from dystocia, prolonged labor, or anesthetic protocols used during cesarean delivery, requiring rapid pharmacological support. This study evaluated the effects of aminophylline, caffeine, and doxapram on clinical and biochemical viability parameters in hypoxic neonatal dogs. Methods: Forty-five puppies born via elective or emergency cesarean section were included, of which 35 exhibiting cardiorespiratory depression (heart rate ≤ 180 bpm, respiratory rate < 15 movements per minute, Apgar score < 7, and reflex score < 3) were randomly allocated into aminophylline group (AG; n = 12), caffeine group (CafG; n = 11), or doxapram group (DG; n = 12). Ten clinically healthy neonates constituted the physiological control group (CG). Apgar score, neonatal reflexes, lactate, blood glucose, oxygen saturation, blood gas parameters, and cardiac troponin I (cTnI) were evaluated immediately after birth (M1) and 10 min following treatment (M10). Results: No significant differences were observed in laboratory parameters among groups (p > 0.05). Although all evaluated drugs improved clinical status by increasing heart rate, respiratory rate, and reflex scores, caffeine produced the greatest enhancement in vitality. The Δ Apgar score showed a significant difference between CafG and DG (p = 0.0095), while no statistical differences were detected between AG and CafG (p = 0.08) or between AG and GD (p = 0.60). Conclusions: Aminophylline, caffeine, and doxapram supported postnatal resuscitation in hypoxic neonatal puppies; however, caffeine demonstrated superior improvement in Apgar recovery, suggesting its potential as a preferred pharmacological adjunct in neonatal canine resuscitation protocols. Full article

Background: Cesarean section (CS) frequently results in abdominal scarring, affecting recovery, aesthetics, and quality of life. Platelet-rich plasma (PRP), an autologous concentrate rich in growth factors, may enhance wound healing. This pilot trial assessed the effect of intraoperative PRP on CS scar outcomes. Methods: In this single-center, single-blind randomized controlled trial (February 2023–December 2024), 100 women undergoing elective CS were randomized to PRP treatment (n = 50) or standard care (n = 50). PRP, prepared from 20 mL autologous blood, was infiltrated into uterine incision margins and subcutaneously before skin closure. Scar healing was evaluated at day 7 and day 40 postpartum using the Patient and Observer Scar Assessment Scale (POSAS; physician and patient), Vancouver Scar Scale, Manchester Scar Scale, REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) Scale, Visual Analog Scale (VAS), and Numeric Rating Scale (NRS). Mann–Whitney U tests and Cohen’s d effect sizes were calculated. Results: Follow-up was complete for all participants. On day 7, PRP-treated patients had lower mean scores across most scales (e.g., Vancouver: 1.74 ± 1.58 vs. 2.54 ± 2.30; p = 0.063). At day 40, improvements persisted, with POSAS Patient scores significantly lower in the PRP group (7.24 ± 1.81 vs. 8.00 ± 2.06; p = 0.029). Effect sizes were small-to-moderate (<0.5), suggesting underpowering. No adverse events occurred. Conclusions: PRP administration during CS showed favorable trends toward improved scar quality and reduced patient-reported discomfort, with statistical significance for POSAS Patient scores at 40 days. Larger, multicenter trials with extended follow-up are needed to confirm these findings. Full article

Background: Locoregional anesthesia (LRA) during cesarean section (CS) is effective but frequently causes hypotension, affecting maternal hemodynamics and fetal outcomes. We investigated whether baseline hemodynamic characteristics predict post-LRA changes, vasopressor needs, and neonatal outcomes. Methods: Women undergoing elective CS with LRA were monitored with USCOM^® (Ultrasonic Cardiac Output Monitor), recording cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI), and systemic vascular resistance (SVR) every five minutes. Maternal demographics, vasopressor use, and neonatal outcomes were analyzed using multilevel linear regression. Results: LRA caused significant reductions in blood pressure and heart rate (p < 0.001). SV initially declined but recovered, while SVR showed minimal variation. Vasopressors were required in 63%, with choice guided by heart rate. Lower baseline SVI predicted greater vasopressor need (37.9 ± 6.7 vs. 34.5 ± 6.6, p = 0.050). Lower CO and CI before fetal extraction correlated with reduced neonatal pH, with CI significantly associated with pH < 7.20 (p = 0.043). Conclusions: USCOM^® enables real-time, non-invasive monitoring, supporting individualized management during CS. Full article

Background/Objectives: The aim of this study is to analyze the frequency and type of subjective adverse events reported after the use of oxytocin and carbetocin in women giving birth by cesarean section. Methods: A total of 70 pregnant women, previously scheduled for elective cesarean section, were enrolled in this study and divided into two groups. One group (OXY) received intrapartum oxytocin at a dose of 5 IU intravenously, and the other group (CARBE) received intrapartum carbetocin at a dose of 100 μg intravenously. Both drugs were used alternately to contract the uterus immediately after the expulsion of baby during the cesarean section. Results: An analysis of reported subjective adverse symptoms associated with the administration of uterotonic drugs showed a higher incidence of adverse effects in the group of women receiving oxytocin compared to those receiving carbetocin. Statistical significance was observed for all of the following reported symptoms: headache, chest pain, burning sensation and heaviness in the chest, and palpitations. Conclusions: Although chest pain, burning and heaviness in the chest, palpitations, and headaches are more common in women giving birth by cesarean section after administration of oxytocin than after administration of carbetocin, this fact appears to be of limited clinical significance from a clinical point of view. Full article

Background/Objectives: Hypotension is a common complication of spinal anesthesia for cesarean section. Although phenylephrine has replaced ephedrine as the first-line vasopressor, comparative data on neonatal outcomes remain important in clinical decision-making. The objective of this study was to compare the effects of prophylactic phenylephrine infusion versus interventional ephedrine boluses on umbilical artery pH and maternal hemodynamic stability in women undergoing cesarean section under spinal anesthesia. Methods: In this retrospective case-control study we analyzed perioperative and neonatal data of elective cesarian section cases where either ephedrine boluses (total dose of more than 15 mg) or prophylactic phenylephrine infusion were employed for blood pressure control following spinal anesthesia. Demographic, hemodynamic, obstetric and neonatal data were extracted from medical records. Ninety-four elective cesarean section cases were included. Umbilical artery pH, base excess, and Apgar scores were assessed as primary and secondary neonatal outcomes. The lowest recorded systolic blood pressure (SBP), mean arterial pressure (MAP), and incidence of nausea and vomiting were evaluated as maternal outcomes. Results: Umbilical artery pH and other blood gas parameters did not differ significantly between groups. Neonatal acidosis (pH < 7.2) occurred in two cases in the ephedrine group while none were noted in the phenylephrine group. Maternal hemodynamic stability was significantly better in the phenylephrine group, with higher nadir SBP and MAP (p < 0.001). Nausea was more common with ephedrine (42.5% vs. 10.6%, p < 0.001), and vomiting occurred only in this group. Conclusions: Prophylactic phenylephrine infusion provides superior maternal hemodynamic stability and better tolerance during cesarean delivery compared to interventional ephedrine boluses, without change in neonatal acid–base status. Full article

Background/Objectives: Oxytocin as well as carbetocin, a synthetic analog of oxytocin with a longer duration of action, can affect the cardiovascular system, which can be recorded in electrocardiographic Holter recordings. The choice of the appropriate dose of oxytocin or carbetocin should take into account potential cardiovascular effects. Methods: A total of 70 pregnant women who previously qualified for elective cesarean section and enrolled in the study were divided into two groups. The oxytocin group (OXY) received 5 IU of oxytocin intravenously (i.v.). The carbetocin group (CARBE) received 100 µg of carbetocin intravenously. Both drugs were used alternatively to contract the uterine muscle. Continuous Holter electrocardiograph recording started 30 min before the procedure and continued until about 3 h after the procedure. Results: No abnormalities were observed in either of the analyzed groups during intraoperative ECG recordings at either the highest or lowest recorded heart rate values. The incidence of ST-segment-lowering episodes, the depth of the denivelation and its duration did not differ between the groups studied. The incidence of additional ventricular beats was comparable in the OXY and CARBE groups, both before and after the administration of uterotonic drugs. In the CARBE group, no significant changes in MAP were recorded during the entire ST-segment-lowering period. Analysis of heart rate changes during ST lowering showed no differences between the study groups. Conclusions: A thorough analysis of perioperative ECG recordings revealed no significant alterations in ECG patterns, neither in response to oxytocin nor carbetocin administration during cesarean sections. Full article

Background: Postoperative pain management after a cesarean section remains a significant challenge, as inadequate control can delay maternal recovery and hinder early bonding and breastfeeding. While multimodal analgesia is the standard approach, non–pharmacological strategies like immediate skin–to–skin contact (SSC) are often underused despite their potential benefits in reducing pain, improving uterine contractions, and increasing maternal satisfaction. Objective: To evaluate the effects of immediate SSC on postoperative pain perception, uterine contraction quality, and maternal satisfaction, and to explore ways to incorporate SSC into routine post–cesarean care to promote recovery and humanized care. Method: A randomized clinical trial was conducted with 80 women undergoing elective cesarean sections, divided into two groups: SSC (40 women) and control (40 women). Postoperative pain was measured using the Visual Analog Scale (VAS) at various intervals, while uterine contraction quality and maternal satisfaction were assessed through clinical observation and a Likert scale, respectively. Results: We found that women in the SSC group experienced significantly lower pain scores (VAS2 and VAS3, p < 0.001), stronger infraumbilical uterine contractions (92.5%, p < 0.001), and higher satisfaction levels (average 9.98 vs. 6.50, p < 0.001). An inverse correlation was observed between pain intensity and satisfaction, indicating that SSC enhances both physiological and psychological recovery. Conclusions: Immediate SSC after cesarean is an effective, humanizing intervention that reduces pain, supports uterine contractions, and boosts maternal satisfaction. These findings advocate for integrating SSC into standard postoperative care, aligning with ethical principles of beneficence and autonomy. Further research with larger samples is necessary to confirm these benefits and facilitate widespread adoption in maternity protocols. Full article

Background and Objectives: Anesthetic agents may influence brain function, and emerging evidence suggests possible neurotoxicity under certain conditions. S100β is a well-established biomarker of brain injury and blood–brain barrier disruption, and its prolonged elevation beyond 6–12 h, despite a short half-life, may indicate ongoing neuronal injury. Its use in cesarean section (C-section) remains limited, despite the potential neurological implications of both surgical stress and anesthetic technique. This study evaluates potential brain injury during caesarean section by comparing maternal and neonatal S100β levels under general and spinal anesthesia. Materials and Methods: This observational prospective study compared changes in the S100β brain damage biomarker in maternal (pre- and post-surgery) and umbilical artery blood during elective c-sections under general or spinal anesthesia. The 60 parturient women who underwent a C-section from 1 July 2021 to 30 December 2023 were evenly distributed into 2 groups: General anesthesia (GA) (n = 30) and Spinal anesthesia (SA) group (n = 30). It included healthy term pregnant women aged 18–40, ASA I–II and excluded those with major comorbidities or emergency conditions. Results: S100β concentrations slightly increased once the C-section was over in both the SA and GA groups, but without notable differences. In the SA and GA groups, preoperative S100β concentration in maternal blood was 195.1 ± 36.2 ng/L, 193.0 ± 54.3 ng/L, then increased to 200.9 ± 42.9 ng/L, 197.0 ± 42.7 at the end of operation. There was no statistically significant difference in S100β concentrations between the spinal and general anesthesia groups (p = 0.86). Conclusions: S100β concentrations slightly increased after C-section in both groups. The form of anesthesia seems to be irrelevant for the S100β level. However, further research is needed to confirm these findings and fully evaluate any potential long-term effects. Full article

This study evaluates the influence of general anesthesia (GA) and spinal anesthesia (SA) on physiological and oxidative stress in parturients undergoing elective cesarean section, one of the most frequently performed surgical procedures worldwide. A total of 101 pregnant women were included, categorized into GA (n = 51) and SA (n = 50) groups. Blood samples were collected at three time points: one hour before surgery (Measurement 1), at umbilical cord clamping (Measurement 2), and two hours post-surgery (Measurement 3). Biomarkers of oxidative stress, complete blood count, and levels of biochemical parameters were measured. In second and/or third measurement, biochemical blood analysis showed increased prolactin and cortisol levels, followed by spike of glucose and insulin in the GA group. However, levels of tri-iodothyronine were reduced in both groups in the third measurement. Glutathione S-transferase (GST) activity was increased in both groups in third measurement. The results showed increased concentrations of total SH groups and decreased concentrations of non-protein SH groups in the GA group during Measurement 2. Lymphocyte count was found to be predictor of GST levels. The results indicate more a pronounced endocrine response in GA group and speak in favor of spinal anesthesia. Both kinds of anesthesia are equally safe in terms of the oxidative status of the tissue. Full article

In this study, thirty female dogs, aged one to five years and varying in weight, in the last week of gestation were evaluated. The animals were divided into two groups: GC, which comprised twenty-two bitches undergoing elective cesarean section, and GD, which consisted of eight dogs requiring therapeutic cesarean section as a treatment to dystocia. We found that cortisol levels in the amniotic fluid were significantly higher in pups delivered via elective cesareans (mean: 9.86 ng/mL) compared to those from therapeutic c-sections (mean: 4.11 ng/mL). This observation contrasted with previous studies that reported lower cortisol levels in elective procedures, suggesting complexities in the physiological responses to different delivery methods that warrant further investigation. Notably, our study observed no significant association between amniotic fluid meconium presence and other distress markers, indicating that meconium may be more closely associated with fetal maturation rather than distress (p > 0.05). Neonatal viability (Apgar score) revealed that 92.86% of the neonates from elective procedures demonstrated no distress shortly after delivery, contrasting with 56.25% in therapeutic c-section. Fetal distress can be a direct consequence of dystocia caused by various stressors, such as pain and hypoxia. These factors can impair the fetus’ ability to adapt to extrauterine life, often leading to lower Apgar scores. Notably, neonatal weight was directly related to fetal cortisol levels, while no significant associations were noted between the litter size or birth order and cortisol concentrations, irrespective of the delivery type. These findings underscore the need for ongoing investigation into the relationships between cesarean delivery types, maternal and neonatal stress markers, and resultant health outcomes, aiming to enhance care strategies for expectant canine mothers and their puppies. Full article