Magnitude and associated factors of intraoperative nausea and vomiting among parturients who gave birth with cesarean section under spinal anesthesia at South Gondar zone Hospitals, Ethiopia

Prevalence and associated factors of intraoperative Nausea and Vomiting of mothers who gave birth with cesarean section under regional anesthesia: a systematic review and meta-analysis; 2023

INTRODUCTION

Cesarean section is one of the most common obstetric procedures performed worldwide under spinal anesthesia which is a commonly practiced rapid, simple, and safe method. Vomiting and nausea are frequent side effects of many surgical procedures. However, with cesarean sections performed under regional anesthesia, this issue occurs even more frequently. The existing evidence regarding the prevalence and associated factors of intraoperative nausea and vomiting is inconsistent. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence and associated factors of intraoperative nausea and vomiting.

METHODS

This is a systematic review and meta-analysis study that was done based on studies published within the last 10 years on the prevalence and associated factors of intraoperative nausea and vomiting during cesarean section under regional anesthesia. After PubMed, Google Scholar, HINAR, Scopus, Science Direct, and grey literature extensive search for primary studies, their quality was assessed with JBI and modified Newcastle Ottawa appraisal assessment tool and data was extracted. STATAMP version 17.0 was used for all possible analyses of the study.

RESULTS

Twenty-nine studies were met the inclusion criteria of this systematic review and meta-analysis. However, only 21 studies were included by excluding eight studies due to inappropriate method & outcomes and language other than English. The pooled prevalence of intraoperative nausea and vomiting was 36% (95% CI- 31%, 41%) with heterogeneity (I2-93.1%). Premedicated with metoclopramide, uterus exteriorization, motion sickness, preeclampsia, and intraoperative propofol were associated with the prevalence of intraoperative nausea and vomiting significantly.

CONCLUSION

The pooled prevalence of intraoperative nausea and vomiting during cesarean section under regional anesthesia was high (36%) which needs more strategies for prevention.

Magnitude of cesarean section and its associated factors among mothers who gave birth in public hospitals in East Wollega Zone, Oromia, Ethiopia

BACKGROUND

Globally, there has been an explosive rise in the cesarean section rate that exceeds the World Health Organization rate of 10-15% and in the past fifteen years the rates was doubled in some countries including Ethiopia. Therefore, it is essential to recognize the current magnitude and the factors that contribute to increasing cesarean section rates beyond the World Health Organization recommendations and specifically in the study areas.

OBJECTIVE

This study aimed to assess the magnitude of cesarean sections and its associated factors among mothers who gave birth in public hospitals in East Wollega Zone, Oromia Ethiopia 2022.

METHODS

A Facility-based cross-sectional study design supplemented by the qualitative study was conducted among 403 mothers, and an in-depth interview was held with purposefully selected 18 post-cesarean section mothers who gave birth at public hospitals. The study subject for quantitative data was selected by a systematic random sampling method. Face-to-face interviews and a chart review checklist were used for data collection. Data were entered into EPI Data Version 3.1 and analyzed by SPSS version 25 for quantitative data and thematic analysis for qualitative data. Bivariate and multivariable logistic regression was used to assess the association between dependent and independent variables. Variables that were statistically significant at bivariate logistic regression with a p-value < 0.25 were entered into the multivariable logistic regression. Statistical significance was declared at a p-value less than 0.005 RESULT: The finding of this study revealed that the magnitude of the cesarean section was 31.5% (95% CI: 27.4%-36.5%). Factors such as living in an urban area (AOR = 2.87, 95%CI (1.63,5.05)), a mother who attained college and above (AOR = 3.48, 95% CI (1.72, 7.06)), being a referred mother (AO R = 2.27, 95% CI (1.31, 3.94)), being induced labor (AOR = 4.83, 95% CI (1.93,12.06)) and lack of antenatal care follow up (AOR=7.84, 95% CI (4.26, 14.44)) were significantly associated with an increased likelihood of cesarean section.

CONCLUSION

and Recommendation The study indicates a high cesarean section rate that exceeds the World Health Organization recommendation 10-15%. Therefore, improving antenatal care, referral systems, and labor induction management needs concern to mitigate unnecessary cesarean deliveries.

Prevention and management of postoperative nausea and vomiting after cesarean section: A systematic literature review

Introduction

Post-operative nausea and vomiting (PONV) are a common post-operative problem in anesthesia. The incidence of PONV in patients undergoing cesarean sections is very high. Post-operative nausea and vomiting have many negative impacts on the patient, baby, family, and health care system. Therefore, appropriate evidence-based knowledge regarding the prevention and management of PONV for those high-risk patients is a timely and very important issue to address to decrease the associated complications.

Methods

A comprehensive literature search was conducted in Pubmed/Medline, Cochrane reviews, and google scholar including those studies published in the English language from 2010 up to 2021. The methodological quality of the included studies was appraised by the Cochrane risk of a biased assessment tool for intervention and non-interventional studies.

Result

The search strategy identified a total of 10,540 articles from different electronic databases. 33 articles were selected for screening after duplicates were removed; finally, 17 articles were included for critical appraisal and 16 articles were excluded with reasons. The included articles consist of 15 RCT, 1 non-control prospective cohort, and 1 cross-sectional study.

Conclusion

Pieces of evidence revealed that all obstetrics patients undergoing cesarean section should be given multimodal PONV prophylaxis. It is shown that a multimodal approach by a combination of different antiemetic agents should be preferred and most effective in preventing intraoperative and postoperative nausea and vomiting for patients undergoing cesarean section because of the complex pathophysiology of nausea and vomiting.

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What are PONV prevention strategies for C/S?

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What are the treatment approaches for PONV after C/S?

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Which one is best option for the prevention of PONV after C/S?

Comparison of three neuraxial anesthesia approaches in parturient women with obesity and pregnancy-induced hypertension who underwent cesarean section

OBJECTIVE

To compare the effectiveness of different approaches of neuraxial anesthesia in parturient women with obesity and pregnancy-induced hypertension (PIH) who undergo cesarean section (CS).

METHODS

We retrospectively analyzed data from 108 parturient women with obesity and PIH who underwent CS. All women were divided into the following three groups according to the neuraxial anesthesia approach: spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal-epidural anesthesia (CSE). Clinical variables were compared.

RESULTS

The mean age of the patients was 27.3 ± 2.2 years. Women in the CSE group had a longer duration from puncture to surgery, smaller intraoperative change in mean arterial pressure, higher Apgar scores at 1 and 5 minutes, shorter surgery time, lower rates of nausea and vomiting, and lower rate of intraoperative hypotension compared with those in the SA and EA groups.

CONCLUSION

CSE takes longer to administer in parturient women with obesity and PIH who undergo CS compared with those who have SA or EA. However, CSE has several advantages over SA or EA, including a shorter surgery time, more stable intraoperative mean arterial pressure, lower rates of nausea, vomiting, and intraoperative hypotension, and better Apgar scores at 1 and 5 minutes.