The anesthetic approach to repeated cesarean sections: A prospective cohort study
Objective: Each repeat cesarean section (CS) potentially adds surgical complexity. The determination of appropriate anesthesia strategy to meet the surgical challenge is of crucial importance for the maternal and neonatal outcome. Study design: This prospective cohort study was conducted from 1-Jan-...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-06-01
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| Series: | European Journal of Obstetrics & Gynecology and Reproductive Biology: X |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590161324000218 |
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| author | Jacob Weinstein Rasha Muhalwes Alexander Ronenson Stephen H. Halpern Sorina Grisaru-Granovsky Tamer Akawi Yaacov Gozal Daniel Shatalin Alexander Ioscovich |
| author_facet | Jacob Weinstein Rasha Muhalwes Alexander Ronenson Stephen H. Halpern Sorina Grisaru-Granovsky Tamer Akawi Yaacov Gozal Daniel Shatalin Alexander Ioscovich |
| author_sort | Jacob Weinstein |
| collection | DOAJ |
| description | Objective: Each repeat cesarean section (CS) potentially adds surgical complexity. The determination of appropriate anesthesia strategy to meet the surgical challenge is of crucial importance for the maternal and neonatal outcome. Study design: This prospective cohort study was conducted from 1-Jan-2021 to 31-Dec-2021 at a single large obstetric centre of all repeat CS. We compared the characteristics and the appropriateness of the anesthesia techniques for low-order repeat CS (LOR-CS) (1 or 2 previous CS) and high order repat CS (HOR-CS) group (3 or more repeat CS). Results: During the study period, 1057 parturients met the study entry criteria, with 821 parturients in the LOR-CS group and 236 parturients in the HOR-CS group. The use of spinal anesthesia was more common for HOR-CS 84.3%. Overall surgical time varied between LOR-CS (38 min, 29–49) and HOR-CS (42 min, 31–57) (p = 0.004).The rate of moderate and severe adhesions was relatively high in HOR-CS and the duration of overall surgical time for cases with mild adhesions was 38 min (29–48), for moderate adhesions was 44 min (34.8–56.5), and for severe adhesions was 56 min (44.8–74.3). There was no significant difference in the Estimated Blood Loss (EBL) between LOR-CS and HOR-CS, with values of 653 ± 292 ml vs. 660 ± 285 ml, respectively. Conclusion: Our data indicate that spinal anesthesia, standard monitoring and regular anesthetic setup are safe and suitable for the majority of HOR-CS, except in cases with high suspicion of placental accreta spectrum. |
| first_indexed | 2024-04-24T17:28:13Z |
| format | Article |
| id | doaj.art-7042f3aa8fb14b3dab12c58cb132b1de |
| institution | Directory Open Access Journal |
| issn | 2590-1613 |
| language | English |
| last_indexed | 2025-03-21T16:46:56Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Journal of Obstetrics & Gynecology and Reproductive Biology: X |
| spelling | doaj.art-7042f3aa8fb14b3dab12c58cb132b1de2024-06-16T05:46:33ZengElsevierEuropean Journal of Obstetrics & Gynecology and Reproductive Biology: X2590-16132024-06-0122100301The anesthetic approach to repeated cesarean sections: A prospective cohort studyJacob Weinstein0Rasha Muhalwes1Alexander Ronenson2Stephen H. Halpern3Sorina Grisaru-Granovsky4Tamer Akawi5Yaacov Gozal6Daniel Shatalin7Alexander Ioscovich8Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, IsraelDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, IsraelDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel; Correspondence to: Department of Anesthesiology, Perioperarive Medicine and Pain, Shaare Zedec Medical Center 12 Shmuel Bait Street, PO Box 3235, Jerusalem, IsraelDepartment of Anesthesia, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, CanadaDepartment of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, IsraelDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, IsraelDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, IsraelDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, IsraelDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, IsraelObjective: Each repeat cesarean section (CS) potentially adds surgical complexity. The determination of appropriate anesthesia strategy to meet the surgical challenge is of crucial importance for the maternal and neonatal outcome. Study design: This prospective cohort study was conducted from 1-Jan-2021 to 31-Dec-2021 at a single large obstetric centre of all repeat CS. We compared the characteristics and the appropriateness of the anesthesia techniques for low-order repeat CS (LOR-CS) (1 or 2 previous CS) and high order repat CS (HOR-CS) group (3 or more repeat CS). Results: During the study period, 1057 parturients met the study entry criteria, with 821 parturients in the LOR-CS group and 236 parturients in the HOR-CS group. The use of spinal anesthesia was more common for HOR-CS 84.3%. Overall surgical time varied between LOR-CS (38 min, 29–49) and HOR-CS (42 min, 31–57) (p = 0.004).The rate of moderate and severe adhesions was relatively high in HOR-CS and the duration of overall surgical time for cases with mild adhesions was 38 min (29–48), for moderate adhesions was 44 min (34.8–56.5), and for severe adhesions was 56 min (44.8–74.3). There was no significant difference in the Estimated Blood Loss (EBL) between LOR-CS and HOR-CS, with values of 653 ± 292 ml vs. 660 ± 285 ml, respectively. Conclusion: Our data indicate that spinal anesthesia, standard monitoring and regular anesthetic setup are safe and suitable for the majority of HOR-CS, except in cases with high suspicion of placental accreta spectrum.http://www.sciencedirect.com/science/article/pii/S2590161324000218Obstetric anesthesiaSpinal anesthesiaComplicationsRepeat cesarean section |
| spellingShingle | Jacob Weinstein Rasha Muhalwes Alexander Ronenson Stephen H. Halpern Sorina Grisaru-Granovsky Tamer Akawi Yaacov Gozal Daniel Shatalin Alexander Ioscovich The anesthetic approach to repeated cesarean sections: A prospective cohort study European Journal of Obstetrics & Gynecology and Reproductive Biology: X Obstetric anesthesia Spinal anesthesia Complications Repeat cesarean section |
| title | The anesthetic approach to repeated cesarean sections: A prospective cohort study |
| title_full | The anesthetic approach to repeated cesarean sections: A prospective cohort study |
| title_fullStr | The anesthetic approach to repeated cesarean sections: A prospective cohort study |
| title_full_unstemmed | The anesthetic approach to repeated cesarean sections: A prospective cohort study |
| title_short | The anesthetic approach to repeated cesarean sections: A prospective cohort study |
| title_sort | anesthetic approach to repeated cesarean sections a prospective cohort study |
| topic | Obstetric anesthesia Spinal anesthesia Complications Repeat cesarean section |
| url | http://www.sciencedirect.com/science/article/pii/S2590161324000218 |
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