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Opioids in caesarean section
Nosková, Pavlína ; Bláha, Jan (advisor) ; Málek, Jiří (referee) ; Vymazal, Tomáš (referee)
The thesis is focused on perioperative use of opioids during caesarean section. The general part is concerned with pharmacology of opioids due to their practical use during general and regional anaesthesia and postoperative analgesia with particular focus on remifentanil. Emphasis is put on the placental transfer of opioids into breast milk which has the possible influence on postnatal adaptation of the newborns and breastfeeding/lactation. The first part of the research describes current anaesthetic practice and opioid use in obstetrics in the Czech Republic according to the OBAAMA-CZ study in 2011. The second study on a unique group of 151 parturients showed that bolus application of remifentanil at a dose of 1 μg/kg at the time of 30 seconds before induction of general anaesthesia for caesarean section significantly stabilizes maternal hemodynamic parameters (blood pressure, heart rate) and reduces the stress response to tracheal intubation and skin incision. On the contrary, no influence on depth of anaesthesia (monitored by BIS) was found. But we demonstrated a slight effect of remifentanil on the assessment of postnatal adaptation of newborns at first minute after delivery. However, this attenuation was very short and in the fifth minute the results were already fully comparable to the control...
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The needs of women after delivery by caesarean section
MÁCHOVÁ, Vlasta
This thesis is focused on the needs of women aftergiving birth by caesarean section. The theoretical part describes what a caesarean section is, its history, indications, the methods used to perform a caesarean section, the types of anesthesia and the complications that may occur. Subsequently, human needs are described, as well as the hierarchy of needs by A.H. Maslow, as well as the midwifery care during the preoperative preparation of the patients with acute and planned caesarean section and subsequently the midwifery care during the postoperative period. A semi-structured interview was used to collect the data, which was conducted in the postnatal ward with those women who had experienced a caesarean section. The research was conducted from April to May, 2018. The interviews with women were conducted anonymously and after their approval, they were recorded on a mobile device. Subsequently, the interviews were literally transcribed, analyzed and processed using pencil-paper encoding. The semi-structured interview consisted of 10 open questions and, if required, the questions were supplemented by subpoints. The respondents' answers were categorized into subcategories. The target research group consisted of seven women after a caesarean section between the ages of 20 and 36. The first research question identified the needs of biopsychosocial needs to be met by the midwife in women after the cesarean section. The research survey found that five out of seven women interviewed had satisfactory biopsychosocial needs and were satisfied with the care provided by the midwife. Two women said they lacked awareness of movement, nutrition, and surgical wound care. One respondent stated she was not satisfied with the midwife's communication and approach. The second research question identified the expectations of women in the postoperative period in relation to midwife care. All women were expecting the midwives to assist them with care during the postoperative period. Five respondents said they expected further physical and psychological support from midwives. The results show that all women have met their expectations regarding midwife care. The results can be presented at seminars for midwives and may be useful in meeting the biopsychosocial needs of women who had a pregnancy completed through a caesarean section.
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Early contact mothers and newborns at birth by cesarean section
VÍTOVCOVÁ, Lucie
The bachelor thesis Early contact mothers and newborns at birth by cesarean section divided to theoretical and practical part. Theoretical part focuses on caesarean section, it´s definition and reason of increasing numbers of them. The second chapter is aimed on influence of caesarean section on child and psychological aspects of woman, which is often happening with separation of child. Another chapter focuses on principles of looking after the new-born and doctor´s impropriate language in communication with parents. The fourth chapter focuses on contact of mother and newborn. There is the part about imprinting, embedding picture of mother to newborn´s subconscious. Another topic is attachment, as an emotional relationship with child. Bonding is more described in the next chapters. There are descriptions of bonding´s benefits for child or how it comes after caesarean section. The last theoretical part is focused on separation, therefore what are the consequences affecting child after separation. Research focuses on two objectives, which are related to early contact mother and newborn after caesarean section. The first one is aimed on fulfilling requirements of child and mother contact after the caesarean section. It focuses on cases when contact with mother and child is allowed after the section and how it goes. The other objective deals with problems encountered in hospital facilities in relation to fulfilling of mother´s and child´s bond. There is the description of their contacting problems and what can be done to improve. Research question focuses on realisation of mother and newborn contact after caesarean section in a practical way. Qualitative research was used to gathering data. Methods are technique of half-structured dialogue and method of questioning. As a set of researched subjects were used women in lying-in phase after caesarean section within 48-96 hours. As the result of research came up that some women can´t remember how the first contact with child went, because of sedatives. Other women remember that moment, but they regret that they were given newborn afterward in hospital room. Women usually undergo complete anaesthesia during the caesarean section. Only two respondents from all eleven underwent a nerve block. Some of the rest would take the nerve block as possibility, but without enough information they have chosen the complete anaesthesia. It´s possible that women after complete anaesthesia can remember nothing from the first contact with newborn. Separation is also happening, because of bringing the child only at the time of feeding. We can say that nerve block is more plausible path which prevents unwanted separation and it is more sensitive for newborn. It is possible to put newborn on body of mother, who undergoes nerve blocking, right in operation room to create biological relation with mother, thus bonding. The most important is well-timed education in possibilities of anaesthesia, especially of nerve blocking. This education should be made by professional anaesthesiologists and obstetricians.
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Sonographic characteristics of the abdomen within 6 weeks following cesarean section
Dosedla, Erik ; Calda, Pavel (advisor) ; Kacerovský, Marian (referee) ; Záhumenský, Jozef (referee)
Caesarean section is one of the most frequently performed surgery in medicine. The Cesarean section scar in the uterus can lead to a number of pathological conditions which affect the women reproductive health. In industrialized countries, this issue relates to at least 30% of women, which means that it is a major medical problem. Ultrasound examination of the uterus after Cesarean section includes some specific features, resulting from the rapidly changing dimensions of the uterus, as well as from patient compliance in early puerperium. When dealing with postpartum complications, it is necessary to know the normal ultrasound findings and the dynamic changes of the uterus during puerperium, so that we can better distinguish between the pathological course and the normal course of puerperium. The clinical significance of ultrasound assessment of uterine size and area of the scar after Caesarean section during the postpartum is not yet adequately described. The knowledge of normal ultrasound findings in the uterus after Caesarean section could be helpful in choosing the right treatment in severe cases. We were watching the clinical outcomes of treatment of abnormal Cesarean section scars after their laparoscopic reconstruction. In our study, we have shown that the examination of uterus in early...
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Opioids in caesarean section
Nosková, Pavlína ; Bláha, Jan (advisor) ; Málek, Jiří (referee) ; Vymazal, Tomáš (referee)
The thesis is focused on perioperative use of opioids during caesarean section. The general part is concerned with pharmacology of opioids due to their practical use during general and regional anaesthesia and postoperative analgesia with particular focus on remifentanil. Emphasis is put on the placental transfer of opioids into breast milk which has the possible influence on postnatal adaptation of the newborns and breastfeeding/lactation. The first part of the research describes current anaesthetic practice and opioid use in obstetrics in the Czech Republic according to the OBAAMA-CZ study in 2011. The second study on a unique group of 151 parturients showed that bolus application of remifentanil at a dose of 1 μg/kg at the time of 30 seconds before induction of general anaesthesia for caesarean section significantly stabilizes maternal hemodynamic parameters (blood pressure, heart rate) and reduces the stress response to tracheal intubation and skin incision. On the contrary, no influence on depth of anaesthesia (monitored by BIS) was found. But we demonstrated a slight effect of remifentanil on the assessment of postnatal adaptation of newborns at first minute after delivery. However, this attenuation was very short and in the fifth minute the results were already fully comparable to the control...
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Caesarian Section on Demand - Yes or No
Skřivanová, Eva ; Kulhavá, Miluše (advisor) ; Hrdličková, Renáta (referee)
The topic of this bachelor thesis is "Caesarean section on demand". The thesis deals with women's interest in undergoing the surgery at their own request and with the reasons behind their choice. It consists of a theoretical and an empirical part. The theoretical part of the thesis focuses on the history of obstetrics, on Caesarean section, indications for a Caesarean section, possible methods, anesthesia, potential complications and spontaneous delivery. The empirical part is based on quantitative research. By means of a questionnaire, women have been asked whether they are interested in undergoing Caesarean section at their own request and what are the reasons behind their choice. The empirical part further examines whether women are interested in choosing their preferred type of anesthesia and what this type is. The total number of respondents who participated in the survey was 82; they had been chosen randomly. The survey was conducted in January 2014. Its results have shown that only 37,80% of respondents are interested in Caesarean section at their own request. The most frequent reasons for this choice are their concern for the child's health, fear of pain and previous bad birth experience. 30 respondents out of the 31 interested in Ceasarean section on demand are interested in choosing their...
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Women opinions on Caesarean section from retrospective view
KOVÁŘOVÁ, Kristýna
This bachelor thesis focuses on women after the cesarean section and their opinions on this surgical procedure. In the theoretical part, there several poins were clarified,such as the problems of caesarean section, its definition, history, types of incisions and indications, possible complications and types of anesthesia that can be used in this operation. An integral part of the theoretical work is midwives' nursing care of a woman before and after operation and during the puerperium. The thesis is also engaged in breastfeeding and care of the newborn after the caesarean section. The aim of the research section was to find out the women's opinions on the caaesarean section from a retrospective point of view. Four research questions have emerged from this objective. The first question was how women understood the caesarean delivery. The second one was about women's satisfaction with midwife care. The third question focused on thefirst contact with the newborn and the fourth one on influencing the life of women after the caesarean section. A qualitative research survey was chosen for the research part. The survey was conducted during March 2017 with seven respondents who were, from one to five years, after the caesarean section and agreed to provide an interview. During the semi structured interview, women were asked 15 questions. Then, the conversations were literally transcribed, their analysis was done by hand coding, or pen and paper method. Women's responses were identified by individual codes and categorized. The research shows that women have a positive opinion on the C-section, Theky consider it the best choice in a situation that has been taken to save their child. Despite that most respondents were worried before surgery, their consent to the caesarean section would not change today. For more than half, the information provided by the doctor was sufficient and comprehended. Almost all surveyed women were satisfied with nursing care and information from midwives and also with the first contact with the newborn, which occurred within two hours after the procedure. However, dissatisfaction was expressed in the approach to breastfeeding and in this area most women described the difficulties. Although more than half of women responded that they did not feel limited by surgery, all respondents let family members help them during the puerperium. Nearly all respondents reported increased sensitivity in the scar that they felt at least for half a year after delivery. The bachelor's thesis may serve as an inspiration for midwives to improve thein nursing care. In addition, midwifery students can benefit it in improving thein practice experience.
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Preeclamsia and selected immunogenetic factors
Hradecký, Libor ; Ulčová-Gallová, Zdeňka (advisor) ; Madar, Jindřich (referee) ; Oborná, Ivana (referee)
Preeclampsia and selected immunogenetic factors Our objective was to evaluate plasma levels of the eight most common antiphospholipid antibodies (antiphosphatidylserine, antiphosphatidylethanolamine, antiphosphatidylinositol, antiphosphatidylglycerol, antiphosphatidic acid, antiannexin V, anticardiolipin and anti 2-glycoprotein I antibodies) by ELISA method and selected inherited thrombophilia (F V- Leiden mutation, FII mutation G20210A, C677T and A1298C variants of the gene for methylene tetrahydrofolate reductase-MTHFR) by DNA analysis of peripheral blood lymphocytes using the real-time PCR in fifty-five women with preeclampsia in the period immediately before urgent termination of pregnancy. Fifty-five healthy women without preeclampsia was considered as a controll group. Entered data were examined using a non-parametric Wilcoxon's test, univariate analysis were perfomed using the Fisher's exact test and statistical dependence between variables was assessed using Spearman's rank correlation coefficient. We demonstrated that women with preeclampsia had significantly higher levels of anticardiolipin antibodies in the isotope IgG (p <0.01) and IgM (p <0.01), elevated levels of antiphosphatidylserine antibodies in the isotope IgG(p <0.01) and antiethanolamine antibodies in the isotope IgM (p <0.01) when...
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