الفهرس | Only 14 pages are availabe for public view |
Abstract Cesarean delivery is a surgical intervention to save the lives of the mother and the baby in situations where vaginal delivery is impossible or dangerous. In general, cesarean birth is carried out utilizing regional anesthesia approaches, with spinal anesthesia being the primary option. Spinal anesthesia is now regarded as the standard for cesarean delivery, but unfortunately, it is frequently associated with bradycardia and hypotension. Spinal hypotension can occur precipitously and, if severe, can lead to significant perinatal complications. So, prevention of post spinal hypotension is critical in cesarean section for a successful maternal and fetal outcome. Current national guidelines prioritize non-pharmacological approaches to prevent physiological changes in cesarean women following spinal anesthesia. Leg compression therapy is a non-pharmacological technique that can be used to maintain women’s physiological parameters during cesarean section. It has been found that leg compression with elastic stocking can effectively decrease the occurrence of post spinal hypotension in women undergoing CS. Additionally, leg compression has been associated with higher neonatal Apgar scores. This study aimed to: Determine the effect of lower leg compression application during cesarean section on women’s physiological parameters and neonatal outcome. To fulfill the study aim: A nonrandomized controlled clinical trial was followed. Materials and method Setting: The study was carried out in the cesarean delivery room of Damanhour educational hospital, which is affiliated to the Ministry of Health in Elbehira governorate, Egypt. This hospital was particularly chosen because it is a major hospital that serves Damanhour city and the surrounding areas. Also, the turnover was satisfactory for the study. Subjects: A convenient sample of 100 women was selected from the previously mentioned setting. The selected subjects who fulfilled the inclusion criteria were assigned to one of two groups (study and control). A Pilot study: After the development of the tools, a pilot study was conducted on 10 women who were excluded from the main study sample. The pilot study revealed that the tools were clear, relevant and applicable. Tools used in this study: Three tools were used for data collection, tool I: Socio-demographic, general and reproductive history interview schedule, tool II: Maternal physiological parameters and related signs assessment sheet and tool III: Neonatal outcome assessment sheet. Data collection consumed a period of six months started from the beginning of July 2022 till the end of December 2022. The researcher interviewed each woman individually for 10-15 min before cesarean section in the waiting area to collect data of tool I. The study subjects were divided into two groups 50 study and 50 control. All of the ordinary preoperative care was administrated to women of both groups. The mother’s base line physiological parameters including: heart rate, respiration, means arterial pressure and peripheral oxygenation were recorded immediately before skin incision. The control group: included 50 women who received the ordinary pre-operative care without the application of the elastic stocking. For the study group: compromised 50 women. A long elastic stocking (ordinary pressure 20-30 mmHg) with different sizes (medium, large, and x-large) was applied before spinal anesthesia till the end of the cesarean birth and was removed prior the woman’s discharge from the operating room. For both groups, the physiological parameters including: heart rate, respiration, mean arterial pressure and peripheral oxygenation were recorded intra operatively every five min following spinal anesthesia until the end of the cesarean section. For newborns of the two groups, Apgar scores were additionally assessed immediately after delivery of the baby at the 1st and 5th minute. The main findings of the present study were: 1. Subject’s general characteristics. - There was no statistically significant difference among both groups concerning sociodemographic characteristics, general and reproductive history. 2. Baseline physiological parameters. - No statistically significant difference was observed in both groups concerning the mother’s base line physiological parameters including: heart rate, respiration, means arterial pressure and peripheral oxygenation. 3. Maternal physiological parameters. Heart rate (HR) change after spinal anesthesia - There was highly statistically significant difference between the study and control groups regarding heart rate from 5 min to 40 min. On the other hand, no statistically significant difference was observed between the study and control groups from 45 min to 60 min, where p= (0.413, 0.694, 0.139, 0.053) respectively. Respiration change after spinal anesthesia - There was no statistically significant difference among both groups regarding respiration except at 45min, where there was highly statistically significant difference among two groups where p= 0.014. Systolic BP change after spinal anesthesia - Highly statistically significant difference was observed between the study and control groups in relation to systolic BP from 5 min to 25min, where p= (0.046, <0.001, 0.038, 0.015, 0.045) respectively. Diastolic BP change after spinal anesthesia - Highly statistically significant difference was observed between the study and control groups regarding diastolic BP from 5 min to 35min. Mean arterial pressure change after spinal anesthesia - Also, highly statistically significant difference was observed between the study and control groups considering mean arterial pressure from 5 min to 35min. Peripheral oxygenation change after spinal anesthesia - Highly statistically significant difference was observed between the study and control groups concerning peripheral oxygenation at 5min, 40 min and 45min, where p= (0.029, 0.001, <0.001) respectively. 4. Incidence of hypotension. - Less than one-fifth (14%) of the study group had hypotension, compared to more than one-half (58%) of the control group. Accordingly, highly statistically significant difference was observed between the study and control groups. 5. Maternal related signs of hypotension. - Highly statistically significant difference was observed among the two groups in relation to nausea, vomiting and shivering, where p= (0.015, 0.038, 0.037). On the other hand, no statistically significant difference was found between the study and control groups concerning blurred vision, confusion and dizziness, where p= (0.161, 0.779, 1.000). 6. Neonatal outcome. - The mean APGAR score in 1st minute & APGAR score in 5th minute was higher between study group compared to control group. Moreover, none of babies of the study group need for resuscitation, while 4% of the control group had resuscitation. On the other hand, more than one-quarter (26%) of the babies of the study group admitted to intensive care unit compared to one-half (50%) of the control group. A highly statistically significant difference was observed between the both groups in relation to oxygen saturation, APGAR score at 1st minute, APGAR score at 5th minute and admission to intensive care. 7. Relation between incidence of hypotension and neonatal outcome. - Highly statistically significant difference was observed in the control group concerning the incidence of hypotension and APGAR at 1st minute, where p= (0.045). In this regard, more than three-fifths ( Systolic BP change after spinal anesthesia - Highly statistically significant difference was observed between the study and control groups in relation to systolic BP from 5 min to 25min, where p= (0.046, <0.001, 0.038, 0.015, 0.045) respectively. Diastolic BP change after spinal anesthesia - Highly statistically significant difference was observed between the study and control groups regarding diastolic BP from 5 min to 35min. Mean arterial pressure change after spinal anesthesia - Also, highly statistically significant difference was observed between the study and control groups considering mean arterial pressure from 5 min to 35min. Peripheral oxygenation change after spinal anesthesia - Highly statistically significant difference was observed between the study and control groups concerning peripheral oxygenation at 5min, 40 min and 45min, where p= (0.029, 0.001, <0.001) respectively. 4. Incidence of hypotension. - Less than one-fifth (14%) of the study group had hypotension, compared to more than one-half (58%) of the control group. Accordingly, highly statistically significant difference was observed between the study and control groups. 5. Maternal related signs of hypotension. - Highly statistically significant difference was observed among the two groups in relation to nausea, vomiting and shivering, where p= (0.015, 0.038, 0.037). On the other hand, no statistically significant difference was found between the study and control groups concerning blurred vision, confusion and dizziness, where p= (0.161, 0.779, 1.000). 6. Neonatal outcome. - The mean APGAR score in 1st minute & APGAR score in 5th minute was higher between study group compared to control group. Moreover, none of babies of the study group need for resuscitation, while 4% of the control group had resuscitation. On the other hand, more than one-quarter (26%) of the babies of the study group admitted to intensive care unit compared to one-half (50%) of the control group. A highly statistically significant difference was observed between the both groups in relation to oxygen saturation, APGAR score at 1st minute, APGAR score at 5th minute and admission to intensive care. 7. Relation between incidence of hypotension and neonatal outcome. - Highly statistically significant difference was observed in the control group concerning the incidence of hypotension and APGAR at 1st minute, where p= (0.045). In this regard, more than three-fifths ((62.1 %) of the women who experienced hypotension had moderate risk APGAR score. Recommendations: Based on the present study findings, the following are suggested: Leg compression must be employed as a crucial component of perioperative care and can be complemented with booklets and brochures. Lower leg compression application throughout CS should be considered in policies and regulations of maternal hospital for improving women’s physiological parameters and neonatal outcome. Mother classes should be conducted in antenatal settings and outpatient clinics to address the care that should be given to women underwent CS and potential complications. Recommended future studies: Further studies are recommended to identify the impact of other lower leg compression techniques throughout cesarean section on women’s physiological parameters and neonatal outcome. Non-pharmacological prophylactic approaches for management of post spinal hypotension throughout cesarean delivery. Further research about impact of applying lower leg compression on neonatal hemodynamic indicators. |