Tehran University Medical Journal

Background: One of the main causes of maternal death in developing countries is postpartum hemorrhage. Cesarean section is one of the most common surgeries all around the world. In comparison with normal vaginal delivery, cesarean section is a greater risk factor for postpartum hemorrhage and need for blood transfusion. The risk of postpartum hemorrhage will increase when other risk factors such as multiple pregnancies, polyhydramnios, severe preeclampsia, peripartum hemorrhage, protracted labor, labor induction, and obesity are present. Oxytocin is conventionally used for the prevention of uterine atony during the cesarean section. The aim of this study was the evaluation of the effect of sublingual misoprostol in combination with oxytocin in reducing blood loss during and after cesarean delivery.
Methods: This randomized clinical trial was performed in Ommolbanin hospital; an academic hospital that is affiliated to Mashhad University of medical sciences from September 2016 to January 2018. The subjects were 90 pregnant women with a term pregnancies who were candidates for emergent cesarean delivery under spinal anesthesia and were at high risk for postpartum hemorrhage. All participants received 40 IU oxytocin in 1 liter of normal saline after delivery, and then they were randomly assigned to the intervention group who received 400 μg sublingual misoprostol in combination with oxytocin infusion, and the control group who received only oxytocin infusion without adding misoprostol.

Background: Spinal anesthesia is a type of neuraxial anesthesia that brings ample benefits. However, due to the fear of this type of anesthesia, many pregnant people refuse to experience it. In this study, we aimed to investigate the levels and causes of fear of spinal anesthesia in candidates for cesarean section.
Methods: The current study is a cross-sctional study performed on 67 patients undergoing cesarean section who were referred to the operation room of Shariati Hospital, in Tehran from September 2018 to September 2019. Matthey questionnaire, which consisted of three sections (demographic information, history of spinal anesthesia and fear of anesthesia), was filled out by candidates and after collecting information, the data were analyzed by SPSS software.

Background: Today, the health of mothers and babies is of particular importance in health systems. So far, various interventions have been implemented to improve the health of pregnant mothers. The present study aimed to compare the effect of Entonox gas and Sufentanil epidural anesthesia in labor pain on the umbilical cord blood gas analysis and neonatal Apgar score.
Methods: The present study is a clinical trial on 800 pregnant women It was done in April 2020 to January 2022 at Shahid Akbarabadi Hospital. Mothers were divided into two groups: spinal anesthesia and the group receiving Entonox gas. To measure the effectiveness, Apgar scores were measured at 1 and 5 minutes along with BE, HCO3, and PCO2 parameters. Two independent sample t-tests and ANOVA were used in SPSS version 22 software to analyze the data.

Results: The results of the study showed that the average age of mothers participating in the study was 27 years, and the average Apgar score of 1 and 5 minutes in the group of mothers receiving Entonox gas and spinal anesthesia was 9.9 and 8.6, respectively. Also, the average Apgar score at minutes 1 and 5 in the group of mothers with spinal anesthesia was 9.8 and 8.2, respectively. The results of the analysis and comparison of the parameters obtained from the arterial gases of the umbilical cord of newborns were not significantly different between both groups of mothers. Also, no significant difference was found in Apgar scores between both groups of mothers. Conclusion: There is no significant difference between the effectiveness of using Entonox gas with spinal analgesia in the painless delivery of mothers; Therefore, considering the cost of each intervention along with their effect may cause a difference in the two interventions. This means that although both of the interventions have the same clinical and diagnostic effects, the one which costs less, will be more preferable from the point of view of the health system.

Background: More than one-third of women develop headaches in the first week after childbirth. Approximately 75% are benign primary headaches such as migraines or tension headaches. Others are secondary and include headaches of vascular origin or from hypertensive disease, infection, space-occupying lesions and dural puncture. Postdural Puncture Headache (PDPH) is a common and annoying complication of spinal anesthesia, especially in cesarean section. This study compares the impress of an Atropine-Neostigmine mixture and Ondansetron on Post Spinal Puncture Headaches in Cesarean sec.
Methods: This triple-blinded controlled randomized clinical trial was conducted on 60 pregnant women candidates for cesarean section under spinal anesthesia, that was carried out from May 2021 to August 2021 at Behshti Medical and Education Center affiliated with Isfahan University of Medical Sciences. The study was approved by the Ethics Committee of the University (IR.MUI.REC.1400.009) and informed consent was obtained from the patients/legal guardians. This clinical trial was registered at www.irct.ir with identification code IRCT 20160307026950N39.
 People were randomly assigned into three groups. A mixture of neostigmine (20 micrograms per kilogram) and atropine (10 micrograms per kilogram) in the first group and 4 mg of Ondansetron in the second group and a similar volume of normal saline in the control group were administered before surgery. Patients were followed up for headaches up to seven days after surgery. The severity of the headache was measured using the VAS scale. One-way analysis of variance (ANOVA) and non-parametric equivalent, Kruskal-Wallis, chi-square test, and repeated measure test were used to measure the relationship between the variables.

Results:  Analysis of the data did not show a significant difference between the three groups in terms of headache severity (P=0.788), headache duration, (P=0.723), the time elapsed from lumbar puncturing to the occurrence of the first headache (P=0.653), and the frequency of attempts for correct spinal tap (P=0.685). Conclusion: none of our considered interventions had a noticeable impress on preventing or reducing PDPH in Cesarean section.