European Journal of Molecular & Clinical Medicine

Caesarean section rate is increasing in the world, including India (28.1% according to Indian Council of Medical Research).¹ Because of this rising trends in caesarean section rate, World Health Organization recommends to conduct institutional audits to reduce C-section rate using Robson's ten group classification system, thus postulating the institutional protocols to reduce the C-section rate.
Objectives of the study are todescribe various indications of C-section as per Robson criteria ten group classification in our institute and to identify modifiable factors to reduce C-section rate in our institute.
Method: A record based study was conducted over a period of 12 months (July 2019 to June 2020) among the women who delivered through C-section in a government tertiary care centre, Mandya.All women who underwent C-section were classified according to Robson 10 group classification.
Results:  Out of total 7738 women delivered during study period, 3207 women (41.1%) underwent C-section. Largest contribution to the total C-section rate was group 5, 1329(41.1%) women underwent C-section. Second largest group was group 2 (nulliparous, induced or C-section before labour) contributing to 23.4% to overall C-section rates. Modifiable indications identified were failed induction (53.2%) in group 2, failure to progress (40.1%) in group1 and repeat C-section (group 5).

Delivery by caesarean section has become very common nowadays.Lower segment caesarean sections (LSCS) are now commonly performed using spinal anaesthesia. In parturients, hypotension is aggravated by compression of the inferior vena cava by gravid uterus. Its incidence has been reported as high as 40-70% and affects 90% women. For reducing the severity of maternal hypotension, many pharmacological and non-pharmacological methods are employed.
Glycopyrrolate,an anticholinergic drug with a quaternary amine structure that limits its ability to cross the blood-brain barrier and placenta and therefore has no effect on the variability of foetal heart rate (FHR) and maternal heart rate (HR).During spinal anaesthesia glycopyrrolate is expected to attenuate hemodynamic changes which makes it a popular choice for obstetric patients.

Aim: To compare the effectiveness of post caesarean section pain relief between transversus abdominis plane block and conventional parenteral opioid analgesia by comparing visual analogue pain scores.
Material and methods: The current study is a prospective randomized interventional studyobservational study. The study was conducted over the period of DNB training for a period of three years. Total 100 patients of American Society of Anesthesiologists (ASA) Grade I and II aged 18 - 45 years scheduled to undergo lower segment caesarean section under spinal anesthesia were included in this study.
Results: It is observed that to compare the effectiveness of post caesarean section pain relief between ultrasound guided transversus abdominis plane block and conventional parenteral opioid analgesia by comparing visual analogue pain scores and total opioid consumption in 24 hours. A total of 100 patients, 50 in each group were included. The distribution of patients according to age between the groups. The mean age of patients of TAP and CONT groups was 25.62±2.19 and 25.64±2.31 years respectively. There was no significant (p>0.05) difference in age between the groups showing comparability of the groups in terms of age. Additionally, the distribution of patients according to ASA grade between the groups. More than half patients of both TAP (74%) and CONT (72%) group had ASA grade I.
Conclusion:This study was carried out to adding transversus abdominis plane block as a part of multimodal analgesia in patients undergoing caesarean section prolonged pain- free duration, decreased VAS pain scores, reduced the number of patients who required rescue analgesicamount of rescue analgesia required was much less in amount and prolonged the time to first request for analgesia.

Objective: To analyse rising rates of caesarean section, its indications and effect on maternal and neonatal outcomes viz a viz vaginal deliveries with special focus on primary caesarean section.
Study design: This was a prospective observational study of 1000 deliveries after 28 weeks’ gestation. The different modes of deliveries were studied with respect to their antepartum, intrapartum and postpartum feto-maternal outcomes. A comparative analysis of caesarean and vaginal deliveries was carried out with particular focus on primary caesarean sections.
Results: The caesarean section rate was 47.1% out of which 66.2% were primary caesarean sections(PCS). The most common indication of PCS was found to be foetal distress (34.2%) and blood loss, febrile morbidity, SSI were more in caesarean sections compared to vaginal deliveries (VD). Neonatal outcomes too were relatively worse in caesarean sections compared to VD.
Conclusion: There has been an unacceptably high rise in caesarean section rates globally. It has been accepted that maternal and neonatal outcomes remain comparatively favourable with vaginal deliveries. Hence there is a need to have a closer look at the various indications of caesarean deliveries with regular caesarean audits at all levels of health care with a targeted focus on PCS, which is the genesis of the rising rates. CS should be resorted to only when there is an evidence based indication with the aim of improving the reproductive years of the mother and future development of the newborn.

Aim: The aim of the study is to compare post-operative analgesic efficacy of 0.25% bupivacaine vs 0.25% bupivacaine with dexmedetomidine in transversus abdominis plane block for postoperative caesarean section.
Methodology: Prospective randomized double blinded experimental study was conducted among 60 patients posted for elective caesarean section surgery and were divided into two equal groups. Group B patients received 20ml of 0.25% Bupivacaine and Group BD patients received 20ml of 0.25% Bupivacaine with 50 mcg Dexmedetomidine. Visual Analogue Score was used to determine the pain at rest during postoperative period. The time of requirement of rescue analgesia during postoperative period was also assessed.
Results: The demographic variables such as age and sex were comparable between the two groups.VAS at rest was significantly reduced in group BD (p<0.05). Duration of analgesia was significantly prolonged in group BD when compared to group B with significant P value <0.05. Rescue analgesic consumption in 24 hours during postoperative period was significantly decreased in group BD (p<0.05). Intraoperatively the heart rate, systolic and diastolic bp was comparable between both the groups. Postoperatively there was a significant fall in heart rate systolic and diastolic bp in the group BD when compared to group B with a P value <0.05.
Conclusion: In this study we observed that Dexmedetomidine, in combination with bupivacaine when given for TAP block provided excellent postoperative analgesia, extending upto more than 12 hours. Dexmedetomidine seems to decrease postoperative analgesic consumption and improve pain scores.

Background: Hypertensive diseases of pregnancy constitute the most common cause of maternal mortality in worldwide. The present study was conducted to compare outcome of epidural anaesthesia and general anesthesia in eclampsia obstetrics patients after delivery (Spontaneous/ LSCS) in obstetric critical care unit.
Materials & Methods: 50 pregnant women with eclampsia were divided into 2 groups of 25 each. Group I were given general anaesthesia administered using a modified rapid sequence induction. Group II patients were administered epidural anaesthesia with an 18 g catheter introduced between the sacrum and fourth lumbar vertebra in the sitting position. All maternal, neonatal and anaesthetic complications were recorded.
Results: Parity was 0 seen in 5 and 3 and 1+ in 20 and 22 in group I and group II respectively. The mean SBP (mm Hg) was 104.2 and 108.4 and DBP (mm Hg) was 72.4 and 76.8 in group I and group II respectively. The highest CVP was 6 and 6 and lowest was 2 and 3. The mean pre-operative platelet count and post- operative count was 195.2 and 170.2 and 158.2 and 166.4 in group I and group II respectively. Indications for caesarean section was poor labour progress seen in 7 and 6 and cervix unfavourable for IOL seen in 18 and 19 in group I and group II respectively. The mean Apgar scores > 7 at 1 min was seen in 18 in group I and 12 in group II and at 5 minutes was seen in 23 in group I and 19 in group II. Live birth was seen in 24 in group I and 25 in group II and still birth in 1 in group I. The difference was significant (P< 0.05).
Conclusion: Maternal outcomes are not adversely affected by the use of epidural anaesthesia. The use of epidural anaesthesia avoided the known risks of general anaesthesia and was associated with a low incidence of relatively mild hypotension and no major complications. While major complications were observed in general anaesthesia.

Background: Pregnant women's body mass index (BMI) has increased recently, reflecting a general increase in the prevalence of obesity. High BMI before to conception and/or excessive gestational weight gain (GWG) have a negative impact on pregnancy outcomes, which raises the burden of chronic illnesses and jeopardies the health of both the mother and the unborn child.Aim:To study first trimester maternal Body Mass Index and gestational weight gain and their association with maternal and perinatal outcomes. Objective: To evaluate the effect of maternal BMI and gestational weight gain on fetomaternal outcome.Material & Methods:This was a prospective observational clinical study conducted in patients presenting to OPD of OBGY DEPARTMENT over a period of 18 months.The study was conducted among primigravida women visiting obstetrics OPD of our hospital during their first trimester pregnancy was comprise of my study population. Results:In present study, out of total 196 cases, first trimester BMI of 72 (36.7%) were found normal (<18.5-24.9 kg/m²) followed by 66 (33.7%) were found overweight (25.0-29.9 kg/m²). 35 (17.9%) were found in underweight (<18.5 kg/m²) whereas 23 (11.7%) were found Obese (>=30.0 kg/m²).out of total 46 cases in LWG, 42 (91.3%) cases were found Normal BW, 4 (8.7%) were found Low BW, none was found Macrosomia and 3 (6.5%) were required NICU admission. Out of total 92 cases in NWG, 88 (95.7%) were found Normal BW, 3 (3.3%) were found Low BW, 1 (1.1%) were found Macrosomia and 9 (9.8%) were required NICU admission. Out of total 58 cases in HWG, 53 (91.4%) cases were found Normal BW, 1 (1.7%) were found Low BW, 4 (6.9%) were found Macrosomia and 7 (12.1%) were required NICU admission.Conclusion: In clinical practice, this study recommend that women of childbearing age can be advised on the importance of maintaining an optimal BMI when planning to become pregnant.

Introduction: The addition of intrathecal opioids to local anaesthetics has been found to improve the quality and duration of sensory and motor blockade, providing post-operative pain relief for a longer period.
Method: 60 parturients of ASA grade I and II scheduled for elective LSCS under subarachnoid block were randomly allocated into 2 groups. Group A were administered 2ml of 0.5% hyperbaric bupivacaine with 90 µg of buprenorphine (0.3 ml). Group B were administered 2ml of 0.5% hyperbaric bupivacaine with 15 µg of fentanyl (0.3 ml). Efficacy of buprenorphine and fentanyl as adjuvants in terms of haemodynamic variables, onset and duration of sensory block and motor block along with side effects were recorded.
Results: There were no significant hemodynamic changes between the two groups. There was significant decrease in the time required to reach peak sensory blockade in fentanyl when compared to buprenorphine group compared to control group (p value <0.0001). Mean duration of analgesia was significantly prolonged in Group A (309.23±14.32 min) than Group B (284 ± 15.22min). There was no significant effect on Apgar score of the neonate.
Conclusion: Intrathecal hyperbaric bupivacaine with opioid as adjuvants are well tolerated by the parturient and neonate during caesarean section with quality analgesia and increased duration of post-operative analgesia

Maternal health refers to the health of women during pregnancy, childbirth and the postnatal period. the international healthcare community has considered the ideal rate for caesarean sections to be between 10% and 15%. There is a need to understand the possible factors of the high C-section rates in India.
Methodology: A prospective study was carried out in maternity hospital for 6 months. Out of total caesarean sections, 500 subjects were studied after resorting to random sampling. A predesigned audit Proforma was used to study the caesarean delivery.
Results: Majority were in the age group 30-40 yrs. (54%), 76% were subjected to partograph, 96% trial of trial of labor. 100% subjects delivered live births with 96% babies stable. Majority 24% had previous C sections as a sole reason for LSCS and belonged to Group eight.
Conclusion: In conclusion the findings of our study established that high rate of caesarean section was observed in comparison to available literature on the subject. High rates of caesarean section were complimented with approximately 100 percent positive fetal outcome and negligible maternal mortality

Background and Aims: Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of pregnant women. The aim of this study is to examine severity of COVID-19 disease and maternal and foetal outcome among COVID-19 positive pregnant women undergoing caesarean section. Methods: This retrospective observational study was conducted at a tertiary teaching hospital in Karnataka between 1stApril to 31st July 2021, during which 100 COVID-19 positive pregnant women with ASA physical class II, III and IV who have undergone lower segment emergency caesarean section were selected on the basis of simple random sampling method. Results: A total of 100 women who had undergone caesarean section under spinal anaesthesia with positive SARS-CoV-2 PCR tests were assessed. Mean age was 24.45± 4.3 years, eight women were having severe covid-19 infection and overall mortality rate was 5% (5/100) in women and 1 woman had HELPP syndrome and one met with PPH (post-partum haemorrhage). Seven (7%) COVID-19 pregnant women required intensive care in the perioperative period. Eight neonates required NICU admission and had APGAR score less than 7. Fifty-five (55%) women were asymptomatic. While the rate of pneumonia in symptomatic women was 3.6% (8/45), the pneumonia incidence among all SARS-CoV-2 PCR (+) pregnant women was 8% (8/100). Conclusion: In our study, 61% of patients had pulmonary involvement and the mortality rate was 8% among mothers and 1% in neonates.

Introduction: Spinal anaesthesia is one of the widely used anaesthetic techniques among obstetric patients due to its safety. Despite having high success, there are several instances where anaesthetists have found spinal anaesthesia difficult. Several factors influence the anaesthetic difficulty during the technique. We did this study to determine the anatomical factors influencing difficult spinal anaesthesia among women who underwent cesarean section
Methods: We included a total of 100 pregnant women who underwent spinal anaesthesia during the cesarean section. The women were enrolled consecutively during the study period using specific inclusion and exclusion criteria. Difficult spinal anaesthesia was determined based on the scores developed through various parameters. Adjusted analysis was done to determine the independent factors influencing difficult spinal anaesthesia.
Results: All women consented for the study. In multivariable logistic regression analysis, we observed that age group of >35 years, (aOR 1.3 95% CI 1.1 – 1.9), being overweight/obese (aOR 1.7 95% CI 1.2 – 2.3), with previous history of spinal anaesthesia (aOR 1.9 95% CI 1.2 – 2.3), having scoliosis (aOR 1.7 95% CI 1.1 – 2.4), lordosis (aOR 2.9 95% CI 1.7 – 5.3) and kyphosis (aOR 1.8 95% CI 1.2 – 2.7), non-palpable anatomical signs (aOR 1.7 95% CI 1.1 – 3.1) and less narrow non-palpable intervertebral space (aOR 1.9 95% CI 1.2 – 3.8) as independent risk factors for spinal anaesthesia.
Conclusion: Our study results highlight the importance of pre anaesthetic determination of anatomical indices among women who undergo C section to predict difficult spinal anaesthesia among them

INTRODUCTION: There is growing international concern about the increased use of
caesarean sections (CS), particularly in high-income countries. Caesarean procedures
performed in the absence of a clinical justification do not reduce maternal or infant death
rates if carried out at a rate higher than 10%–15%. Dr Michael Robson in 2001 introduced
“Robson classification” (also known as the “TGCS-Ten Groups Classification System”).
“All women” who deliver at a specific setting (e.g. a maternity or a region) and not only
for the women who deliver by CS. It is a complete perinatal classification.

Background and Aim: Maternal hypotension is the common complication encountered after subarachnoid block (SAB).
This needs attention and treatment for the better maternal and foetal outcome. Administration of SAB with bolus dose of local anaesthetic produce faster onset and precipitate maternal hypotension. Injecting fractionated dose provides dense block and haemodynamic stability. Aim of this study was to compare fractionated and bolus dose of SAB in terms of haemodynamic stability and duration of analgesia.
Methodology: Eighty parturients undergoing caesarean delivery under SAB were included in the study. They were divided into Group B or F according to computer randomization. Group B parturients received bolus dose SAB with 2ml of 0.5% hyperbaric bupivacaine and 10µg of fentanyl. Group F parturients received fractionated dose of 2ml of 0.5% hyperbaric bupivacaine and 10µg of fentanyl. In which, from the total dose two-third was given initially. After 90 sec remaining one third of the dose was injected. Haemodynamic parameters and analgesia period were analyzed using Student’s unpaired t‑test. 
Results: The haemodynamic parameters were better in group F than group B. The number of patients required vasopressor in group F were six and group B were seventeen. There was a prolonged analgesia period in group F than group B (214.40 + 15.48 and 195.95 + 8.98 min respectively).
Conclusion: The patients in fractionated dose group were haemodynamically better with longer analgesia period than bolus dose group. It is a newer technique to prevent maternal hypotension after SAB.

Aim: Evaluate The Intraoperative Anaesthesia Management and Postoperative Pain Scores
after Caesarean Section.
Methods: This analytical observational study conducted in the Department of
Anaesthesiology, Madha Medical College Kovur Chennai, India during Feb 2021 to Feb
2022. All patients either receiving GA or spinal anaesthesia for CS receive IV tramadol
infusion for post-operative pain control, which is started either at the request for first
analgesia in the PACU or at 60 min, whichever comes first. Patients are assessed for pain
using numerical rating scale (NRS) immediately in the PACU and at regular intervals. Any
patient having NRS >4 is given rescue analgesia.
Results: Percentage of patients having NRS >4 and who required rescue analgesia on
immediate assessment (time zero) was 15 (15%). After that, 13 patients (13%) at 30 min, 10
(10%) patients at 45 min and 5 (5%) patients at 60 min had NRS of >4 and required first
rescue analgesia. There was no statistically significant difference among patients in PACU
having NRS >4 from those having NRS <4 in terms of the type of incision, ASA grading and
duration of surgery. Patients receiving RA had a statistically significant (P-value < 0.01) low
percentage of patients with NRS >4 and need for first rescue analgesia at time zero and at 30
min when compared to the percentage of patients operated under GA. The difference became
insignificant after 30 min. Overall, 18% of patients received some sort of co-analgesia,
mainly in the form of IV paracetamol 15% and only two patients received TAP block.
Conclusion: The pain management in the PACU was adequate as all patients were given
rescue analgesia if they had NRS of >4 and no patient was shifted from PACU with NRS of
>4.

Caesarean sections are routinely done under spinal anaesthesia using 0.5% hyperbaric bupivacaine that has a long duration of action. As most of the caesarean sections are of short duration, we decided to compare 1% 2-chloroprocaine with routinely used bupivacaine as chloroprocaine has rapid onset of action, producing an excellent sensory and motor blockade. After ethical committee clearance and informed written consent, 70 uncomplicated singleton parturients of ASA I and II posted for elective caesarean section were randomised into chloroprocaine (CP) and bupivacaine (B) group of 35 each.
Onset of sensory block in group CP was 1.71±0.62min and in group B was 2.31±0.63min. Onset of motor block in group CP was 2.54±0.88min and in group B was 2.66±0.76min. Mean time for maximum sensory block in group CP was 12.77±3.52min and in group B was 22.34±6.46min and time for maximum motor block in group CP was 9.14±2.23min and in group B was 10.86±2.18min. Two segment regression time in group CP was 39.34±4.46min and in group B was 63.14±4.7min. Mean duration of sensory block in group CP was 2.08±0.25hr and in group B was 3.60±0.27hr and duration of motor block in group CP was 1.07±0.14hr and in group B was 3.42±0.41hr. VAS scores in first 6hrs were lesser in group CP than group B. Onset, maximum time, duration of sensory and motor block were lower in group CP than group B. hemodynamic parameters were comparable between the groups with no side effects.

Background: Relaparotomy (RELAP) after caesarean section is a serious complication and is associated with maternal morbidity and mortality. The data of re-laparotomy after caesarean section is limited. So in the present study, we will evaluate the risk factors and outcome of relaparotomy after cesarean section in our study population.
Objective: To identify the risk factors and complications and outcomes associated with re- laparotomy after caesarean section.
Materials and Methods: It is a retrospective study, a total of 16 relaparotomy cases were included in this study. Data such as age, parity, period of gestation, comorbidities, indication for C-section and relaparotomy, a procedure during relaparotomy and the interval between two surgeries are recorded. Using SPSS software statistical analysis is done.
Results: Incidence of re-laparotomy is found to be 0.25% and the mean age was found to be 25.5±4.2 years with 37.5% primigravidae. The Major indication for C-section and Relaparotomy was Placenta previa (37.5%) and hemoperitoneum (37.5%). The mean time interval between C-section and relaparotomy was 6.8 ± 1.2 days and the major procedure done during relaparotomy is tension suture (31.25%). The rate of recovery and maternal death was found to be 93.8% and 6.3% respectively.
Conclusion: Caesarian section will be done due to clinical complications in delivery. After C-section, women are treated conservatively, but in some cases, there is a need for relaparotomy. It will be performed when the patient’s condition is too critical. Relaparotomy is a life-saving procedure to save the life of patients. Proper care should be taken during primary and secondary surgery to prevent postoperative infection and other complications which will decrease the clinical complication and mortality rate.

Background: Midazolam and propofol by virtue of their antiemetic effect were found
individually to reduce the incidence of intraoperative nausea and vomiting. This study
compares the effects of midazolam and propofol in decreasing the incidence of nausea and
vomiting in pregnant women undergoing lower segment caesarean section (LSCS) under
spinal anaesthesia. It also assesses maternal sedation, neonatal outcome and other side effects.
Aim: To compare the effects of subhypnotic dose of midazolam and propofol in prevention
of intraoperative nausea and vomiting in lower segment caesarean section under subarachnoid
block.
Methods: With ethical committee permission the 60 pregnant women were randomly
allocated into 2 groups after taking informed consent. Group M received 0.03mg/kg
midazolam immediately after cord is clamped, Group P received 10 mg propofol immediately
after cord is clamped. Incidence of nausea and vomiting was not according to Bellville
scoring system (0-novomiting, 1-Nausea, 2-Retching, 3_vomiting). The degree of sedation,
hemodynamic changes were noted baseline, after induction, after drug administration, 30
mins after drug administration, 60 mins after drug administration, neonatal out come and side
effects were recorded.
Results: Statistically significant decrease in intraoperative nausea and vomiting in patients
undergoing LSCS under spinal anaesthesia with 10 mg propofol compared to 0.03 mg
midazolam is observed. Degree of sedation, respiratory rate, mean mephentermine
consumption were comparable between two groups and no difference found.
Conclusion: Propofol significantly decreases incidence of intraoperative nausea and
vomiting inches are in section under spinal anaesthesia as compared to midazolam.

Background:Cholestasis is defined as impairment of bile flow due to intrahepatic or extrahepatic
causes, leading to retention of hepatotoxic compounds; specifically bile acids. The present study was
conducted to evaluate the feto-maternal outcome in patients with intrahepatic cholestasis of
pregnancy.
Materials & Methods:It included 190 subjects in the study. Group A consisted of 95 women who
presented with pruritis in their second & third trimester of pregnancy with associated abnormal liver
function in the absence of other liver and skin disease. 95 women with uncomplicated pregnancy and
no history of pruritis& with normal liver function test were taken as Group B/control.
Results: out of 95 participants total induction were 45 (47.36%) in group A and 13 (13.68%) in group
B. Out of 45 (47.36%) total induction, 30 (31.57%) had vaginal delivery and 15 (15.78%) had LSCS
in group A. Similarly, out of 13 (13.68%) total induction, 11 (11.57%) had vaginal delivery and 2
(2.10%) had LSCS in group B. ICP was significantly associated with induction of labour. There is
higher incidence of caesarean section in induced patients. There is significant correlation in group A
and group B in terms of fetal complications (p<0.001). 1 (1.05%) participants of APGAR score <7 at
5 minutes of age in group A and group B each. The risk of adverse fetal outcomes increases with
increasing levels of maternal serum bile acid. 24 (25.26 %) babies of group A and 7 (7.36 %) babies
of group B were admitted in NICU.
Conclusion: Higher rates of gestational diabetes and pre-eclampsia are new findings, and need to be
considered in management of ICP pregnancies. Caesarean section as mode of delivery found
significantly associated with ICP. Maternal outcomes have good prognosis but foetal outcomes can be
improved by timely and effective interventions.

The association between age of the woman and reduced fecundability has been well documented. This decline in fecundability beginning in the early thirties and accelerates in the late thirties and early forties. The age related decline in fertility appears to be attributable to cocyte depletion. Another factor which contributes to reduced female fecundability. Is age-related decline in male fertility? A retrospective comparative study was done at Tertiary Institute. There were 85 Primigravida above 35 years of age (Group III) admitted during this period in the obstetric units of tertiary hospitals. These women were compared with two control groups comprising of 85 Primigravida in each groups aged between 20 to 25 years (Group I) and 30 to 34 years (Group II) of age by a random selection of consecutive Primigravida admitted during the same period. Rate of caesarean section was high (47.06%) in Group III and 37.65% in Group II and 15.29% in Group I. The difference is statistically significant (p<0.01). New born admission to intensive care unit was highest (28.24%) among babies born to group II mother, (17.65%) babies in group III and (9.41%) babies in group I required NICU admission.

Introduction:The subarachnoid block is a safe and time-tested technique for
administering anesthesia for cesarean section due to its rapid onset and effective
sensory and motor blockade. Bupivacaine is available as a racemic mixture of its
enantiomers, dextrobupivacaine and levobupivacaine [1] and is the most frequently used
anesthetic agent for cesarean section.
Aims: This study was performed to compare the anaesthetic efficacy and safety of two
local anaesthetic agents: Hyperbaric Bupivacaine and Isobaric Levobupivacaine, in
patients undergoing elective caesarean section.
Methods and materials: It is prospective study in 100 patients, ASA I-II, were
randomized to receive an intrathecal injection of Hyperbaric Bupivacaine or Isobaric
Levobupivacaine. Group B (n = 50) received 2 ml of Hyperbaric Bupivacaine 5 mg/ml
(10 mg). Group L (n = 50) received 2 ml of Isobaric Levobupivacaine 5 mg/ml (10 mg).
The onset and duration of sensory and motor blockade, recovery parameters,
hemodynamic changes and side effects for the two agents were compared.
Results: The time of onset of sensory block was faster in Group B (1.80 ± 0.404) when
compared with Group L (2.02 ± 0.473). In Group B the time to two segment regression
was prolonged (74.68 ± 12.916) when compared with Group L (69.08 ± 3.349) and it is
statistically significant. Duration of motor blockade was prolonged in Group B (135.52
± 4.781) when compared with Group L (100.04 ± 9.165). Hemodynamic variables were
more stable in Group L than Group B. Twenty patients in Group B had adverse effects
when compared with ten patients in Group L.
Conclusion: 0.5% Isobaric Levobupivacaine 10mg for intrathecal injection of caesarean
section produces adequate sensory and motor blockade and stable hemodynamic
parameters with minimum adverse effects than 0.5% Hyperbaric Bupivacaine 10mg.
We concluded that Isobaric Levobupivacaine is a better alternative for caesarean
section.

Background: Pain management following caesarean section still remains a challenge in our
environment. Diclofenac suppository is an effective adjunct analgesic for post-operative pain
control. Over the last two decades the number of caesareans being performed has increased
dramatically. High quality postoperative analgesia is important because the new mother has
to recover from major intra-abdominal surgery while also caring for her newborn baby. Many
options are available but tailoring the method to the individual can be problematic because it
has been difficult to predict the severity of postoperative pain or the individual response to a
regimen.

Aim: To determine the demographic profile of pregnant females with COVID-19 infection.
The outcome and prognosis in pregnant women with COVID-19 infection was also
evaluated.
Method and material:The study included 38 pregnant women with COVID-19 infection and
hospital admission for at least 24 hours. Cause of admission was classified as obstetric and
COVID-19-related. All the patients were COVID positive and were referred from other
centres/ hospital to this facility andwas admitted to this hospital for delivery. Primary
outcomes included maternal admission to intensive care unit (ICU), COVID-19 pneumonia,
maternal mortality. The information on socio-demographic factors, pre-gestational chronic
diseases (including cardiac, renal, endocrine, psychiatric, hematologic and autoimmune
disease, cancer and HIV)and mode of delivery was collected.
Results:The mean age of the patients was 28.8±6.2 years. The mode of delivery for
60.5%patients(23) was normal vaginal delivery and lower segmentcaesarean section in
39.5%(15) patients.94.7%(36) patients were asymptomatic in the present study. Maximum
patients in the present studywere hospitalized for 3-5 days.
Conclusion: COVID-19 infection was associated with higher rates of caesarean section in
pregnant women. However, COVID-19 cannot be considered as an indication for
caesareansectiondelivery. Patients with increased age have more days of hospitalization than
younger patient.

Background: The physiological changes of pregnancy deem nausea and vomiting infallible complications associated with obstetric anaesthesia, resulting in significant morbidity and longer recovery time. The aim of our randomised control trial was to investigate the efficacy of propofol in addition to the currently accepted regimen of ranitidine and metoclopramide in the prevention of nausea and vomiting in this high risk group undergoing spinal anesthesia during caesarean section.
Methods: Eighty fasted term pregnant women scheduled for elective caesarean section were given ranitidine 150mg and metoclopramide 10mg orally 2 hours prior to spinal anaesthesia following which they received either propofol 200µg /kg IV or placebo as a single bolus dose. Intraoperative and post-delivery emetic episodes experienced were recorded at intervals and the intensity of nausea was assessed using the visual analogue scale (VAS).
Results: The incidence of nausea during the intraoperative period in propofol group was 5 % as compared with placebo group in which it was 32.5%, while that of vomiting in propofol group was 5% as compared with placebo group in which it was 22.5%. Both were found to be statistically significant (p= 0.002, p= 0.023 respectively). The incidence of nausea and vomiting during the entire postoperative period of 0-24 hours between the two groups was found to be statistically insignificant.
Conclusion: The prophylactic administration of a subhypnotic dose of propofol with ranitidine and metoclopramide was effective in the prevention of nausea and vomiting after neuraxial blockade during the intraoperative period but not during the postoperative period.