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Introduction: Diagnosing parturients in risk of cesarean section early in the beginning of active phase of labor, is very important. This may let take necessary action to accelernate labor (delivery) and prevent maternal mortality and morbidity due to late cesarean section. Materials and Methods: During a period of 8 months from July 2004 to March 2005, 216 primiparous women, with term pregnancy and cephalic single fetus, referred to Imam Reza hospital in (during) active phase of labor, were studied. Changes of cervical dilatation and descent of the conceptus were observed. Parturients were devided to two groups, vaginal delivery and cesurean section. Protraction or arrest disorders were the indications of cesarean deliveries. Findings were analysed through using T-Test, unilateral variance and Chi square test. Results: The more changes in cervical dilatation in the first 2 hours of active phase of labor, the less possibility of cesarean delivery (p<0.001). Also the more rate of the conceptus descent in the first 2 hours of active phase of labor, the less rate of cesarean section (p<0.001). There was no significant statistical relationship between condition of membranes at the onset of active labor and method of delivery, however there was a significant relationship between oxytocin augmentation and method of delivery (p<0.001). Conclusion: In primiparous women with term pregnancy, vaginal delivery would be fairly predictable by observing changes of cervical dilatation and conceptus descent during the first 2 hours of active phase of labor.

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Introduction: Spinal anesthesia is a conventional way of anesthesia for cesarean section (CS), which nausea and vomiting is a common complication of it. Metoclopramide is the standard medication used for preventing intraoperative nausea and vomiting (IONV). Because of extrapyromidal side effects of Metoclopramide and known antiemetic effects of low-dose Propofol and Dexamethasone, this study was performed to compare the effectiveness of these drugs for preventing IONV. Materials and Methods: This study, is a randomized clinical trial which is done on 144 parturients who were admitted for emergency CS. Patients were divided randomly into four groups and received: Metoclopramide 0.1 mg/kg IV, Dexamethasone 150 g/kg IV, Propofol 0.1mg/kg every 5 minutes from clamping umbilical cord till the end of operation and the fourth group received 2 ml distilled water. During the operation parturients were monitored for IONV. Data was analyzed using Kruskal-Wallis and one way ANOVA. Results: The Number of patients having nausea was lowest in Propofol and highest in Dexamethasone group. There was no statistical significant difference between Dexamethasone and placebo groups. The lowest rate of vomiting was in Metoclopramide and Propofol groups and there was no significant difference between them. Also the lowest level of retching was in the Prepofol group. Conclusion: According to results, the antiemetic effects of Propofol and Metoclopramide are similar. Amount of retching in Propofol was slightly lower than Metoclopramide and administration of Propofol was simple, cheap and without serious complications, so we recommend it for emergency CS.

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Introduction: Pain relief has been received the highest level of medical attempts continuously but still many patients suffer from it. Narcotics' side-effects have led investigators to apply other techniques for controling acute postoperative pain to reduce narcotics requirements. Recently, some concepts have been presented implying that Metoclopramide does have analgesic effects and this led us to conduct the present study in order to determine Metoclopramide's effect on alleviating pain after cesarean section. Materials and Methods: In this clinical trial, 80 patients who were candidates of elective cesarean section were studied in two groups. 10 minutes before the cesarean section's ending time, the control group was given 25 mg Pethidine accompanied by 10 mg Metoclopramide and control group 25 mg Pethidine and distilled water. Then when patients were conscious after cesarean section, for a period of 6 hours received after-care for their vital signs and side-effects of prescribed drugs. Their pain score (VAS) and nausea rate was measured and if necessary, Pethidine was injected with certain dose. Injection time for first dose of Pethidine and its required amount were recorded in a checklist within first 6 hours after cesarean section. Data was analyzed using ANOVA and T tests. Results: Prescription of Metoclopramide inhaunced analgesic effect of narcotics and a meaningful decrease was found in pain score (p=0.002) and nausea rate (p<0.005). Injection time for the first dose of Pethidine was also prolonged in the group who received Metoclopramide compared to control group (p=0.019) and an obvious decrease was occurred in received Pethidine's amount within the first hours after cesarean section (p<0.005). Drugs side-effects were not found in patients. Conclusion: The results indicate that use of Metoclopramide accompanied by Pethidine in ending time of cesarean section, does have considerable effects in controlling acute pain after surgery and increasing analgesic effect of narcotic drugs. Therefore, use of Metoclopramide as a proper supplement drug with low side-effects is recommended.

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Introduction: Type of anesthesia is important in the maternal and fetal well being. There are different informations about effect of general and spinal anesthesia on Apgar score, so in this study a comparision was made on Apgar scores of neonates following these two methods. Materials and Methods: This study is a clinical trial and 168 term pregnant women were selected from elective cesarean candidates and divided in to general and spinal anesthesia groups by randomized allocation method. Then Apgar scores in first, fifth and twentieth minutes were mesured in infants. Also maternal age, cause of cesarean, sex and duration of cesarean section time were all documented. Data was analyzed using T and Chi square tests. Results: Mean Apgar scores were 8.66±0.68, 9.8±0.42 and 9.970.15 at first, fifth and twentieth minutes in general anesthesia group, and 90.38, 9.880.32 and 10 at first and fifth and twentieth minutes in spinal group. The group differed significantly for first minute Apgar score (p<0.001) but there were no significant differences in fifth and twentieth minutes Apgar scores. Conclusion: First minute Apgar score of newborns of mothers under spinal anesthesia was more than those of mothers under general anesthesia but there was no difference between their five minute Apgar score.

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Background: Postoperative shivering is a common problem with multiple complications. This study was compared effect of low doses of Ketamine with Pethidine for controlling postoperative shivering. Methods and Materials: This clinical trial was done on 189 elective cesarean section with ASA class I or II who had postoperative shivering. Patients with grade 2 or higher were divided in three groups and were injected 0.3mg/kg Ketamine and 0.5mg/kg Pethidine intravenously. In 5th and 10th minutes after injection, they were investigated for shivering intensity. Results: After 5 minute of injection drugs rate and intensity of shivering in Pethedine group was less than ketamine group. Ketamine with 0.5 mg/kg was more effective than 0.3mg/kg dose of it and Ketamine(p=0.041). In group with 0.5mg/kg dose of Ketamine, rate and intensity of postoperative shivering was more reduce than group with 0.3mg/kg of it in recovery(p=0/007). In Pethedine group rate and intersity of shivering was more reduce then 0.5mg/kg dose of Ketamine(p<0/001). This demonstrated that Pethedine is more effective than Ketamine. Conclusion: Although 0.5mg/kg dose of Ketamine has considerable effect on control of shivering but Pethedine is still a better choice for this side effect.

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Background: Postoperative pain brings about undesirable effects such as medical complications, increased healthcare costs, and the need for opioids administration. The aim of this study was to determine the effect of low dose (0.15 mg/kg) ketamine in comparison with the placebo on postoperative pain and analgesics consumption after cesarean section. Materials and Methods: In a randomized clinical trial, 120 women undergoing elective cesarean section were randomly divided into case and control groups. Ketamine (0.15 mgkg-1) or an equal volume of normal saline were administered intravenously immediately after initiating spinal anesthesia to the case and control groups, respectively. The anesthesia and surgery techniques were the same for both groups. Data were analyzed using SPSS version 11. Results: Means of age in the case and control groups were 28.85±4.81 and 28.87 ±5.62 years, respectively. Analgesics consumption, pain scores, homodynamic signs, drowsiness of the mothers, and the neonates’ Apgar scores after cesarean section were similar in both groups and no significant differences were found between them (P>0.05). The mean of postoperative arterial pressure in the early hours in the ketamine group showed a significant decrease compared to the placebo group (P>0.03). The means of the first time of request for analgesics after surgery in the ketamine and placebo groups were 99.75±68.88 and 96.1±52.59 minutes, respectively (P>0.05). Conclusion: It seems that the administration of 0.15 mg/kg dose of ketamine (0.15mg/kg) does not have a significant impact on decreasing the postoperative pain in cesarean section. Therefore, in order to obtain the desirable analgesic effects of this drug, further studies should be conducted with greater doses of this drug and its use in combination with other opioids.

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Background:Hypotension is one of the common complications of spinal anesthesia. Ephedrine with sympathomimetic effects is the selective vasopressor in obstetric. The aim of this study was to compare the effect of different doses of ephedrine on hypotension due to spinal anesthesia. Materials and Methods: This randomized double-blind clinical trial included 120 parturient patients with ASA Ι and П scheduled for cesarean section under spinal anesthesia at Fatemy Hospital of Hamedan in 2008.The patients were divided into three groups. Immediately after spinal anesthesia, the patients randomly received 10 mg ephedrine, 20 mg ephedrine, or placebo intravenously. Then vital signs were recorded every minute for 5 minutes and after delivery every 10 minutes till the end of the surgery. Results: Incidence of hypotension in 10 mg ephedrine, 20mg ephedrine, and placebo groups was 37.5,12.5, 85%, respectively (P<0.001 ). The difference in the prevalanceof hypotension was significant between the three groups (P<0.05).Based on Chi2 test, the prevalence of hypotension in 20 mg ephedrine group was less than 10 mg ephedrine group, and in the 10mg ephedrine group it was less than the placebo group (P<0.05). Conclusion: Intravenous injection of 10mg and 20mg ephedrine to parturient patients undergoing cesarean section reduces the incidence of hypotension, though thisdecrease is more significant with 20 mg ephedrine.

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Background: The UN report on the 41% increase of cesarean labor and its risks in Iran in recent years on the one hand and its association with cognitive and psychological factors on the other motivated us to identify the involving variables so as to control unnecessary cesarean sections. The aim of this study was to investigate the role of fear of pain and related psychological variables (pain catastrophizing, catastrophic cognition, childbirth attitude, depression-anxiety-stress, and experience of pre-menstruation (PMS) in prediction of cesarean labor. Materials and Methods: In this cross-sectional study, 300 pregnant women from Atieh private and Shahid Akbar Abadi public Hospitals (150 participants from each) were selected and matched by variables, such as age, level of education, month of pregnancy, previous experience of deliveries, tendency to cesarean, type of hospital, and having PMS. To collect data, a battery of questionnaires, including fear of pain, pain catastrophising, catastrophic cognition, childbirth attitude, and depression-anxiety-stress (DASS) were used. The results were analyzed through correlation coefficient and logistic regression. Results: Education, previous experience of deliveries, month of pregnancy were not significant but such variables as the tendency to cesarean, type of hospital, and age were significant (P<0.05). Such variables as pain catastrophizing, catastrophic cognition, and childbirth attitude were significant but other variables, including fear of pain , depression-anxiety-stress, experience of PMS were not significant (P>0.05). Conclusion: Such variables as the experience of cesarean, type of hospital, and age as well as pain catastrophizing, childbirth attitude, and catastrophic cognition are significant variable in prediction of cesarean labor in pregnant women.

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Background: Caesarean section is one of the most common gynecologic surgeries. Nausea and vomiting after pain is the most common side effect of surgeries, today, we most widely use of serotonin receptor antagonists, that are most effective antiemetic and have less side effect rather than other drug. Ondansetron is typical serotonin antagonists.

Materials and Methods: This is a randomized, double-blind clinical trial on 162 women undergoing cesarean section. 4mg intravenous ondansetron was given to first group and 8mg oral ondansetron was given to second group and thired group recived placebo. Blood pressure and heart rate were measured before and immediately after performing spinal and every 5 minute until 20 minute. Post operative nausea and vomiting and APGAR score were recorded after operation in recovery and 2, 4, and 6 houres after surgery.

Results: There was no significant difference among 3 groups according to age, gravidity, mean atrial pressure and heart rate before and during surgery. Nausea and vomiting in oral and intravenous groups at recovery, 2 and 4 hours after surgery were significantly less nausea and vomiting than placebo group (p<0.05). Whereas there was no significant difference between oral and intravenous groups.

Conclusion: It was concluded that using oral ondansetron with the same antiemetic effect is more convience to women undergoing cesarean section with spinal anesthesia.

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Background: Unpleasant side effect of awareness within general anesthesia is potentially an important concern in patients. The patient may sleep during anesthesia and feels the pain due to loss of pain suppression of sensory perception of pain during surgery. The aim of this study is to determine the effect of BIS monitoring on level of awareness during anesthesia in women undergoing elective caesarean section.

Materials and Methods: In this double-blind, randomized clinical trial, 214 ASAI–II patients, over 15 years of age, candidate for elective cesarean section were included in the study. Patients randomly divided to two groups of anesthesia with and without BIS monitoring. Patients were assessed for awareness within anesthesia immediately, 24 hours, and 3-6 days after operation.

Results: From 107 patients without BIS monitoring, 8 patients (7.4%) suffered from awareness during anesthesia and their awareness score was two and greater than two. While none of the patients in the BIS group experienced awareness during anesthesia. Level of awareness during anesthesia in the control group was significantly more than the BIS group (p<0.0000).

Conclusion: The incidence of awareness during anesthesia is significantly lower in BIS monitored group than the control group.

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Background: MgSo4 (magnesium sulfate) is the first therapeutic line for preeclampsia. Recently, there have been many debates on pain relief property on MgSo4. The purpose of this study is to evaluate the effect of MgSo4 on pain relief after cesarean in preeclampsia parturient

Materials and Methods: In this analytic and cross-sectional clinical trial study, 88 pregnant wowen with mild preeclampsia who received MgSo4 (14g loading dose and 5 g/4h maintenance dose) (n=88, P group), were compared with 88 normal pregnant women(n=88, N group), according to the duration of paim relief and the amount of diclofenac suppository consumption after cesarean section from March 2013 to October 2014. After cesarean section, the assessment of pain relief performed with NRS (numerical rating scale), and diclofenac consumption.

Results: P group had a longer analgesic duration than N group. NRS in P group was significantly longer than N group(6.89 ±3.34 vs. 3.55± 2.13 hr, p=0.0001). The dose of diclofenac suppository in P group was significantly lower than N group (225mg±147 vs. 365.9±92mg, p<0.0001).

Conclusion: Post cesarean pain in preeclamptic group was significantly lower than non-preeclamptic group. This finding is probabley because of MgSo4 administration in preeclamptic group.