Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.
Objective To summarize our diagnostic and treatment experience for patients with acute Stanford type A aortic dissection （AAAD） during pregnancy. Methods Clinical data of 3 AAAD gravida （age of 30，32，35） who received surgical treatment in Beijing Anzhen Hospital of Capital Medical University from May 2008 to July 2010 were retros-pectively analyzed. One gravida received Sun’s procedure （total arch replacement combined with stented elephant trunk implantation） 3 days after cesarean section，but the fetus died in the uterus. Another gravida successfully underwent Bentall procedure and Sun’s procedure immediately after cesarean section and hysterectomy. The third gravida received cesarean section with the uterus in situ followed by ascending aorta replacement and Sun’s procedure. Results All the 3 puerperasrecovered uneventfully，and the 2 newborns of the second and third puerperas also lived well. The 3 puerperas were followedup for 6 months after discharge. CT scan showed organized thrombus in the aortic false lumen. During follow-up，the 3 puerperas recovered well，and the 2 infants had normal growth and development. Conclusions Management principles of AAAD during pregnancy firstly include timely and accurate diagnosis，which is of prime importance. Secondly，gravidas’hemodynamics should maintain stable. Thirdly，intraoperative hemorrhage should be satisfactorily controlled. Lastly，multi-modality treatment is very important to improve the prognosis of both gravidas and fetuses.
Objective To explore the value of lower abdominal aorta compression in emergent hysterectomy during cesarean section because of pernicious placenta previa. Method We retrospectively analyzed the clinical data of four patients who underwent hysterectomy for pernicious placenta previa with the assistance of lower abdominal aorta compression between January 2016 and March 2017 in Sichuan Provincial Hospital for Women and Children. Result The four patients were cured successfully, and the mothers and babies were all well with no pelvic organ damage or complications related to lower abdominal aorta compression. Conclusions Lower abdominal aorta compression in hysterectomy for pernicious placenta previa during cesarean section is a feasible procedure; it can effectively reduce the amount of bleeding, less affect maternal blood circulation, make surgery area clear, and give the operators the chance to do hysterectomy calmly. Lower abdominal aorta compression presents more and more advantages to treat pernicious placenta previa and may be an effective emergency measure to reduce hemorrhage during perioperative period especially under the circumstances of no chance to carry out vascular intervention treatment.
ObjectiveTo discuss the clinical characteristics, treatment and prevention of abdominal wall endometriosis (AWE). MethodsA retrospective analysis of 295 cases of AWE from February 2007 to August 2011 in our hospital was performed. ResultsAll of the patients had abdominal operations before and 99% of them had a history of caesarean section. The mean age of the patients was (31.55±4.52) years old. The average size of the mass was (2.66±1.12) cm, significantly larger than the estimation of ultrasonography before operation which was (1.91±0.83) cm (P<0.001). No relapse was discovered five months to three years after the operation. ConclusionIt is easy to diagnose abdominal wall endometriosis through medical history, clinical characteristics, physical signs and ultrasonic assessment. The prevention of AWE is very important. Operation is still the best treatment for AWE.
ObjectiveTo systematically review the prevalence and risk factors of the chronic post-cesarean section pain (CPCSP). MethodsPubMed, EMbase, The Cochrane Library, CINAHL, PsycInfo, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect studies on the prevalence and risk factors of CPCSP from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 15.1 software. ResultsA total of 43 studies involving 12 435 participants were included. The results of meta-analysis showed that the prevalence of CPCSP for 2 to 5 months, 6 to 11 months, and at least 12 months were 19% (95%CI 15% to 23%), 13% (95%CI 9% to 17%), and 8% (95%CI 6% to 10%), respectively. The risk factors included preoperative pain present elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety, postpartum depression, etc. ConclusionsThe current evidence shows that the overall prevalence of CPCSP is high. Preoperative pain presents elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety and postpartum depression may increase the risk of CPCSP.
Objective To study the clinical significance of the microorganism culture result of amniotic fluid in cesarean section in the treatment of anti-infection after operation. Methods From August 2016 to May 2017 in Women’s and Children’s Hospital of Sichuan Province, 502 amniotic fluid samples were collected in cesarean section to carry out bacteria culture. The correlations between the amniotic fluid culture result and the preoperative and intraoperative risk factors and the correlations between postoperative infection and the preoperative and intraoperative risk factors were analyzed. Results In the 502 amniotic fluid samples, there were 131 samples culture-positive. The microbiological culture results of amniotic fluid were statistically different between the puerperae with gestational age<37 weeks and the ones with gestational age≥37 weeks (P=0.001). Postoperative infection occurred in 6 puerperae, in whom the amniotic fluid culture results were positive in 3 puerperae. There was no statistical difference in the occurrence of postoperative infection between the puerperae with amniotic fluid culture-positive results and the ones with negative results (P=0.382). The occurrence of postoperative infection was associated with preoperative infections, gestational age, using time of antimicrobial, and preoperative rupture of membranes (P<0.05). Conclusions The contamination rate of amniotic fluid specimen was high, which was of low reference value to anti-infection treatment after operation. When an extension of anti-infection treatment be carried out after cesarean section, suitable specimens should be selected according to the infection site.
【摘要】 目的 觀察小劑量氯胺酮在健忘鎮痛麻醉輔助局部麻醉（局麻）剖宮產中的應用。方法 選擇1200例剖宮產的孕婦,隨機分為單純局麻組(L組)、氟芬強化局麻組(F組)和健忘鎮痛麻醉組(J組),每組400例。L組單純局麻;F組局麻術中輔以氟哌利多500 mg,芬太尼015 mg;J組在F組基礎上輔以氯胺酮,觀察各組患者麻醉誘導至胎兒娩出時間;新生兒1、5 min Apgar評分;手術中血壓相對于基礎值的波動情況;手術中及手術后出血情況及麻醉滿意度。 結果 J組與L組和F組比較,胎兒娩出時間無顯著差別;Apgar評分提高;手術中孕婦血壓波動不明顯;手術中及手術后出血量無明顯增加,麻醉滿意度明顯提高。 結論 由小劑量氯胺酮輔助實施的健忘鎮痛麻醉在局麻剖宮產中優于單純局麻和氟芬強化局麻,在剖宮產中尤其急診剖宮產中值得推廣。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.
ObjectiveTo systematically review the effect of dexamethasone in preventing post-operative nausea and vomiting (PONV) associated with epidural opioids for post-cesarean section analgesia. MethodsWe searched PubMed, EMbase, CNKI, WanFang Data and CBM databases from inception to Dec. 31th 2015, to collect randomized controlled trials (RCTs) comparing dexamethasone with placebo/blank for the prevention of PONV associated with epidural opioids for postcesarean section analgesia. Two reviewer independently screened literature, extracted data, and assess the risk of bias of included studies. Then, meta-analysis was conducted by using RevMan 5.3 software. ResultsA total of 11 RCTs from 10 papers involving 1 011 patients were included. The results of meta-analysis showed that, compared with the placebo/ blank group, the dexamethasone group had lower incidence rates of post-operative nausea (RR=0.50, 95% CI 0.39 to 0.65, P < 0.000 01), postoperative vomiting (RR=0.39, 95% CI 0.29 to 0.52, P < 0.000 01), PONV (RR=0.37, 95% CI 0.30 to 0.46, P < 0.000 01), and rescue antiemetic (RR=0.34, 95% CI 0.19 to 0.62, P=0.000 5). ConclusionsCurrent evidence indicates that dexamethasone is effective for preventing PONV after epidural opioids for post-cesarean section analgesia. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
ObjectiveTo compare the anesthetic potency and influence on maternal hemodynamics among spinal anesthesia (SA), epidural anesthesia (EA) and combined spinal epidural anesthesia (CSEA) for women undergoing cesarean sections. MethodsA total of 180 singleton term nulliparous pregnancies of American Sociaty of Anethesiologists physical status Ⅰor Ⅱ for cesarean sections in Guangyuan Central Hospital from January to December 2012 were allocated into three groups using the method of random number table. Patients in group SA received SA (n=60), group EA underwent EA (n=60) and patients in group CSEA accepted CSEA (n=60). Patients wderwent punere all placed in left lateral position. Group EA patients unctures at the L1-2 interspace and the volume of carbonated lidocaine used initially was 12-15 mL. Group SA and CSEA accepted the anesthesia at either L2-3 or L3-4 interspace. The volume for group SA was 0.75% bupivacaine 1.2 mL with 10% glucose solution 1 mL, and for group CSEA was 0.5% bupivacaine 1.4 mL with 10% glucose solution 0.8 mL. A catheter was inserted into the epidural space for 3-4 cm after spinal needle exit so as to add additional epidural medication according to the block level and the level of anesthesia subsidence. The values of the basis of blood pressure and heart rate, the lowest blood pressure and heart rate, umbilical venous blood gas, start effect and induction time of anesthesia and the highest block level of anesthesia were record. ResultsThere were statistically significant differences in terms of start effect time of anesthesia among the three groups (F=24.642, P<0.001). The start effect time of anesthesia in group SA and CSEA was significantly shorter than that in group EA (t=8.076, 7.996; P<0.05). The induction time of anesthesia in group SA was significantly shorter than those in group EA and CSEA (P<0.05). The lowest blood pressure and heart rate in group SA and CSEA were significantly lower than the values of basis (P<0.05). The lowest blood pressure and heart rate in group SA was significantly lower than that in group EA (P<0.05). The incidence of hypotension and bradycardia in group SA and CSEA was significantly higher than that in group EA (P<0.05). The block level of anesthesia in the three groups were at thoracic 8.12±1.22, 8.36±1.88 and 8.52±1.92 respectively, and there was no significant difference among the three groups (F=0.081, P=0.923). ConclusionEA and CSEA surpass SA in the choice of neuraxial anesthesia for cesarean sections, and 1.73% carbonated lidocaine for EA can improve anesthetic potency and better maintain relatively stable hemodynamic indexes.
ObjectiveTo systematically review the effectiveness and safety of combined spinal-epidural anesthesia for cesarean section. MethodsWe searched The Cochrane Library (Issue 10, 2013), PubMed, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data for randomized controlled trials on combined spinal-epidural anesthesia for cesarean section up to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2.9 software. ResultsA total of 9 studies containing 616 delivery women were included. The results of meta-analysis showed that:compared with epidural anesthesia, combined spinal-epidural anesthesia was superior in the time of sensory blockade to T4 (MD=-7.38, 95%CI-9.54 to-5.23, P < 0.000 01), muscle relaxation (OR=6.09, 95%CI 2.65 to 13.97, P < 0.000 1), and recovery of motor block (MD=-41.57, 95%CI-58.98 to-24.17, P < 0.000 01). Compare with spinal anesthesia, combined spinal-epidural anesthesia was superior in lowering the incidence of low blood pressure (OR=0.49, 95%CI 0.29 to 0.81, P=0.006). ConclusionCurrent evidence shows that combined spinal-epidural anesthesia could increase the effectiveness and safety of combined spinal-epidural anesthesia for cesarean section.