Incidence of and factors associated with emergency caesarean section in pregnant women with gestational diabetes mellitus: A retrospective cohort study

AIM

The incidence of factors associated with emergency cesarean section (ECS) in patients with gestational diabetes mellitus (GDM) have not been well investigated.

METHODS

We conducted a retrospective cohort study of patients diagnosed with GDM between 2011 and 2020 at a tertiary care hospital in Japan. Clinical data, vital signs, and laboratory results of the patients were collected from electronic medical records. We constructed a multivariate logistic regression model to identify the clinical characteristics associated with ECS.

RESULTS

We included 1189 patients diagnosed with GDM, the mean maternal age was 33 years, and 507 (42.6%) patients were aged ≥35 years. In total, 114 patients underwent ECS (9.6%). The previous assisted reproductive technology (ART) use (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.12-2.93), previous artificial abortion (OR, 1.94; 95% CI, 1.13-3.33), high pre-pregnancy body mass index (BMI) (OR, 1.07; 95% CI, 1.02-1.11), and late diagnosis of GDM (OR, 1.02; 95% CI, 1.003-1.05) were independently associated with ECS.

CONCLUSIONS

One of every 10 GDM patients required ECS. Previous ART use, previous artificial abortion, high pre-pregnancy BMI, and late diagnosis of GDM were risk factors for ECS in GDM patients.

The analgesic efficacy of oxycodone hydrochloride versus fentanyl during outpatient artificial abortion operation: A randomized trial

BACKGROUND

Problems like body movement, respiratory depression, and complained of pain are still common phenomenon in outpatient artificial abortion general anesthesia. Oxycodone hydrochloride is a semisynthetic opioid and has a good therapeutic effect on visceral pain. We hypothesize that oxycodone hydrochloride would be superior to fentanyl in outpatient artificial abortion surgery.

METHODS

In this clinical trial 149 American Society of Anesthesiologists (ASA) I or II female outpatients scheduled for elective artificial abortion surgeries under general anesthesia were randomly divided into 3 groups: oxycodone hydrochloride 0.06 mg/kg group (group A), oxycodone hydrochloride 0.08 mg/kg group (group B), and control group fentanyl 2 ug/kg (group C). The primary outcome was level body movement and respiratory depression during the surgery, the second outcome included the visual analogue scale (VAS) score 30 minutes after waking.

RESULTS

A total of 120 participants completed the study, n = 40 in each group. There was no significant difference in patients' age, body mass index (BMI), preoperative heart rate, mean arterial blood pressure, consumption dose of propofol, intraoperative body movement type and times, and duration of surgery among the 3 groups (P > .05). Comparing the incidence of intraoperative respiratory depression and SPO2 < 90% among the 3 groups, group C's was significantly higher than those of groups A and B, and the difference was statistically significant (P < .05). Group A had no difference compared with group B. In VAS score 30minutes after waking, group C was the highest, followed by group A, with group B as the lowest. The difference among the 3 groups was statistically significant (P < .05), but a difference delta less than 1 on the VAS scale is not clinically significant.

CONCLUSION

The analgesic effect of oxycodone hydrochloride at 0.06 mg/kg applied to painless artificial abortion surgery is not superior than that of fentanyl, but the incidence of intraoperative respiratory depression and hypoxemia is significantly lower than fentanyl.

[Optimal acupoint combination of transcutaneous electrical stimulation in artificial abortion operation]

OBJECTIVE

To observe the clinical effects on analgesia, tranquilization and prevention of abortion syndrome of artificial abortion operation treated with transcutaneous electrical acupoint stimulation (TEAS) with different acupoint combination and explore the optimal acupoint combination of TEAS in artificial abortion operation.

METHODS

Two hundred patients intended to artificial operation were randomized into No.1 group[Sanyinjiao (SP 6) + Zusanli (ST 36)], No.2 group[Sanyinjiao (SP 6) + Diji (SP 8)], No.3 group[Sanyinjiao (SP 6) + Taichong (LR 3)], No.4 group (cervical blockage anesthesia with lidocaine) and No.5 group (blank group, without any analgesia measure applied), 40 cases in each one. In the No.1, No.2 and No.3 groups, Sanyinjiao (SP 6) was the main acupoint, combined with Zusanli (ST 36), Dijin (SP 8) and Taichong (LR 3) respectively. TEAS was given 30 min before the operation till the end of operation. Mean arterial pressure, heart rate and oxygen saturation during operation, as well as bleeding amount were observed in the five groups. The visual analogue scale (VAS) score was observed during and 30 min after operation, and Ramsay score was observed during operation. Cervical relaxation degree and the incidence of artificial abortion syndrome were recorded.

RESULTS

For VAS score during and 30 min after operation and Ramsay score during operation, the differences were significant statistically in the No. 1, No.2, No.3 and No.4 groups as compared with the No.5 group (P<0.01, P<0.05). The results in the No.2 group were better than those in the No.1, No.3 and No.4 groups (all P<0.05). For cervical relaxationdegree, the result in the No.2 group was better than that in each of the rest groups (P<0.01, P<0.05). For artificial abortion syndrome, the incidences in the No.2 and No.3 groups were lower than those in the No.4 and No.5 groups (all P<0.05). For bleeding amount and hemodynamic changes, the differences were not significant statistically among the five groups (all P>0.05).

CONCLUSIONS

TEAS apparently reduces pain score during and 30 min after artificial abortion operation and achieves the satisfactory tranguilization effects. The combination of Sanyinjiao (SP 6) and Diji (SP 8) achieves the optimal effect of analgesia, tranquilization, dilating cervix and preventing from artificial abortion syndrome in the operation.

Pulmonary Endometriosis which Probably Occurred through Hematogenous Metastasis after Artificial Abortion

Pulmonary endometriosis (PEM) is a rare disease characterized by the proliferation of ectopic endometrial tissue in the lungs, which presents as catamenial hemoptysis. A 20-year-old-woman was admitted for repeated hemoptysis. Chest CT revealed a ground-glass opacity that appeared consistently with her menstrual cycle. Our detailed inquiry revealed a history of artificial abortion, which was followed by the use of oral contraceptives and catamenial hemoptysis after the discontinuation of these medications. Surgical removal was performed and histopathological examinations confirmed PEM. This clinical course suggested hematogenous metastasis. An inquiry regarding the patient's history of uterine procedures and use of oral contraceptives was suggestive for the diagnosis of this disease.