Department of Surgical Sciences

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Browsing Department of Surgical Sciences by Subject "Caesarean section"

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    Evaluation of the effect of 2.5 IU vs 5 IU oxytocin on uterine tone during elective caesarean section at Windhoek hospital complex: A double-blind randomized controlled clinical study
    (University of Namibia, 2022) Nembale, Fredrika Nembale
    Introduction: Oxytocin is routinely administered during caesarean delivery to initiate and maintain uterine tone (UT) after delivery of the baby. It reduces blood loss thus preventing postpartum haemorrhage (PPH). However higher doses of oxytocin are associated with unwanted side effects namely; cardiovascular effects, headache as well as nausea and vomiting. However, the optimal dose of oxytocin at caesarean delivery remains ambiguous among various official bodies. This study compared the effect of two doses of oxytocin 2.5 IU vs 5 IU on uterine tone, haemodynamic changes, blood loss and side effects. Methodology: A double-blinded, randomized controlled clinical study was conducted at Windhoek Teaching Hospitals Complex. Eighty (80) parturients undergoing elective caesarean section under spinal anaesthesia received an intravenous bolus of either 2.5 IU (n=40) or 5 IU (n=40) of oxytocin after delivery followed by an infusion of 5 IU/hr. Uterine tone, haemodynamic changes, side effects and blood loss were compared between the two groups. The two groups were statistically compared using a two-sided, independent samples t-test with a P-value set at 0.05 (5%) critical level of significance using the per-protocol analysis. Results: The two groups were comparable in terms of demographic characteristics. Parturients in both study groups had adequate uterine tone at 3 minutes with a median (SD) score of 3.28(0.51) for the 2.5 IU group and 3.20(0.56) for the 5 IU group. A rapid increase in heart rate (HR) was seen in the 5 IU group with a mean increase of 17(17) and 12(16) beats/min at 1 min and 2 min with a p-value of 0.000 and 0.005 respectively. Higher incidence of nausea, headache and chest pain (40%, 25%, 15%) were noted in the ii 5 IU group compared to (15%, 2.5%, 0%) in the 2.5 group. Blood loss did not differ among the two groups. Conclusion: 2.5 IU of oxytocin bolus was compared and non-inferior to 5 IU oxytocin bolus in initiating and maintaining adequate uterine tone and it was associated with fewer haemodynamic changes and other adverse effects.
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    Prophylactic phenylephrine bolus versus infusion for prevention of maternal hypotension during spinal anaesthesia for caesarean section at Windhoek-based teaching hospitals, Namibia
    (University of Namibia, 2022) Shaanika, Ebba Panduleni
    Background: Maternal hypotension is a common complication of spinal anaesthesia during caesarean delivery. Injection of vasopressors with non-pharmacological measures have been investigated for prevention of martenal hypotension as well as the foeto-maternal effects of treatment. Aim: The primary aim of the study was to compare prophylactic 50 mcg phenylephrine bolus (PB) with a fixed continuous 25 mcg/min phenylephrine infusion (PI). The secondary aim was to assess the side effects and neonatal outcomes of the two treatments. Settings and design: A prospective, randomised, controlled double-blinded study was conducted in the maternity theatres of Windhoek Central Hospital and Katutura Intermediate Hospital. Methods and Materials: Ninety-two eligible parturients, ASA I and II, scheduled for elective caesarean section under spinal anaesthesia were recruited and randomised into two groups. PB group received a prophylactic 50 mcg phenylephrine (PE) bolus immediately after spinal anaesthesia whereas PI group received prophylactic 25 mcg/min PE infusion. Maternal blood pressure, heart rate and side effects were recorded every minute for the first 20 minutes while neonatal outcome was assessed with Apgar score at the 1st and 5th minute. Statistical Analysis: Categorical variables were presented in numbers and percentages. Normally distributed continuous variables were presented as mean standard deviation (±SD) and compared using t-test. Non normally distributed continuous variables were compared with Mann-Whitney test. A p-value of p< 0.05 was considered significant. Results: Parturients in the PI group had a significantly lower incidence of hypotension than PB group (32% vs 71% p = 0.0001). Nausea and vomiting was lower in PI group than PB group (13% vs 31% p = 0.033). Reflex bradycardia was comparable between groups (p= 0.489). No parturient in the PB group had reactive hypertension whereas 11% of participants in PI group did (p=0.024). Participants in the PI group received about 36% more phenylephrine than the PB group (p=0. 0277). Apgar scores between the two groups showed good neonatal outcomes. Conclusion: There was better control of blood pressure in the PI group than PB group. Both groups had similar incidence of reflex bradycardia as well as good neonatal outcomes. Intraoperative nausea and vomiting (IONV) was higher in the PB group than PI group, whereas no reactive hypertension experienced in PB group.