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Article
Cesarean Section Rates At Al-Batool Maternity Teaching Hospital

Author: Yosra Tahir Jarjees, D.O.G., F.I.B.M.S.(Obs.Gyn) يسرى جرجيس
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 1 Pages: 1-3
Publisher: Baghdad University جامعة بغداد

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Objectives: To report the Cesarean section rate in Al-Batool Maternity Teaching Hospital and to identifyhow many of them were done for maternal and fetalcondition.Design: A statistical cross sectional study.Setting: The study was conducted at Al-BatoolMaternity Teaching Hospital (13000 deliveries peryear).Participants: The patients group consists of 4556patients admitted for delivery (vaginal and abdominal)during a period of four months commencing fromJanuary 2003.Main outcome measures: calculation of all livebirths, calculation of cesarean section rate, percentageof the primary cesarean sections and the repeatcesarean sections and listing the indications of theoperation according to maternal and fetal conditionwith their percentage.Results: Total births during the period of this studywere 4556 births, 3732 vaginal deliveries and 824cesarean sections. Cesarean section rate was found tobe 17.94% of total live births, the most frequentindication for cesarean section was malpresentation(24.3%). Primary cesarean sections contribute to 75%of cases.Conclusions: A primary cesarean section is one of themost important causes of high cesarean section rate.Decreasing the incidence of primary operations willhelp in reducing cesarean section rate.


Article
Metabolic syndrome in women with polycystic ovary syndrome

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Objectives: To report the Cesarean section rate in Al-Batool Maternity Teaching Hospital and to identifyhow many of them were done for maternal and fetalcondition.Design: A statistical cross sectional study.Setting: The study was conducted at Al-BatoolMaternity Teaching Hospital (13000 deliveries peryear).Participants: The patients group consists of 4556patients admitted for delivery (vaginal and abdominal)during a period of four months commencing fromJanuary 2003.Main outcome measures: calculation of all livebirths, calculation of cesarean section rate, percentageof the primary cesarean sections and the repeatcesarean sections and listing the indications of theoperation according to maternal and fetal conditionwith their percentage.Results: Total births during the period of this studywere 4556 births, 3732 vaginal deliveries and 824cesarean sections. Cesarean section rate was found tobe 17.94% of total live births, the most frequentindication for cesarean section was malpresentation(24.3%). Primary cesarean sections contribute to 75%of cases.Conclusions: A primary cesarean section is one of themost important causes of high cesarean section rate.Decreasing the incidence of primary operations willhelp in reducing cesarean section rate.


Article
Preemptive Analgesia For Cesarean Section in Al- Najaf City

Authors: Basima Sh. Al-Ghazali --- Majed Dayem Al-Hassani --- Amal Muner Mubark --- Hind Abd-Al Rassol mugeir Al-Shukri
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2014 Volume: 11 Issue: 4 Pages: 858-868
Publisher: Babylon University جامعة بابل

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Background: Delivery by caesarean section (CS) is becoming more frequent. Childbirth is an emotion-filled event, and the mother needs to bond with her baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation. Local anaesthetics have been employed as an adjunct to other methods of postoperative pain relief.Objective: To insure the efficacy of infiltration of lidocaine 1% in the surgical site of Cesarean Section, just before incision ,in decreasing postoperative pain , in comparison to other forms of preemptive analgesia that includes central nerve block (spinal anesthesia) , and multi modal parentral analgesia.Patients and Methods: This is a prospective, randomized, controlled trial study in which patients undergoing CS were randomly divided into four groups;- Group A Patients (control plain GA), Group B Patients with multi modal analgesiaGroup C Patients with local tissue infiltration,Group D Patients with spinal anesthesia .The protocol for induction and maintenance of general anaesthesia was similar for A , B&C groups.Group A control patients (plain GA) without supplementary analgesia. Group B parentral multi modal analgesia(Acetamenophen&Diphene) given IM. just pre operatively , and a Fentanyl 50Mg IV. just after delivery of the baby. Group C patients received 20 ml of 1% Lidocaine infiltration 1-2 minutes before skin incision. Group D have Spinal Anesthesia under Bupivacaine hyperbaric 0.5% 10mg intrathecally. Post-operative pain was evaluated in patients, at 30 min, 2, 4, 6 and 24 hr after surgery by visual analogue score (VAS), while lying still, and with movement. Time of first request for analgesia , and total amount of Pethidine consumed in 24 hr were recorded.Results: The study enrolled a total number of 100 patients, 25 in each group. No side effects were recorded in all groups.The total consumption of opioid (pethidine) after 24 hours was significantly differentamong the four groups 144.00mg in group A, 134.00mg in group B, 96.00mg in group C and 76.00mg in group D (P ≤ 0.05), SD= 54.619 , 47.258, 37.697, 35.707 for Group A,B,C and D respectively. Higher dose of analgesia was used by Group A&B, whereas lower dose used by Group C&D, so there are significant differences (p≤0.01) between the last two motheds than the former two methods.However the lowest dose was recorded in the spinal anaesthesia.The first request for opioid was statistically different among the four groups .


Article
RATES OF CESAREAN SECTION IN AL-IMAMEIN AL-KADHIMEIN MEDICAL CITY

Author: Qabas K. Mahdi قبس خزعل مهدي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2016 Volume: 14 Issue: 3 Pages: 206-214
Publisher: Al-Nahrain University جامعة النهرين

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Background: Caesarean section rates have been increasing dramatically in the past years in Al-Imamein Al-Kadhimein Medical City.Objective:To determine the rate of caesarean section and to analyze the indications, so as to introduce measures to control the caesarean section rate.Methods:This retrospective study was conducted in Obstetrics and Gynecology Department at Al-Imamein Al-Kadhimein Medical City from 1st Jan 2012 to 30th Apr 2013. In this study, clinical records of all the patients who underwent caesarean section were analyzed. AII cases who were underwent caesarean section whatever indication and regardless the type of caesarean section (elective, urgent, scheduled, emergent) were included in this study. Clinically diagnosed cases of ruptured uterus proved on laparotomy were excluded. Data was analyzed on SPSS version 17, Microsoft excels 2010 and frequency as well as percentages were calculated.Results:There were 10,354 deliveries during the study period (16 months) and 5897 of these were caesarean section. The rate of caesarean section was 56.95%. Scheduled caesarean section was 49.31%, elective caesarean section 43.89%, urgent caesarean section 4.32% and emergency caesarean section 2.48%.Conclusions:Caesarean section rate was high (56.95%) in Al-Imamain AlKadhimein Medical City, the majority of patients who underwent caesarean section were scheduled and elective caesarean section. The commonest indication was repeat caesarean section.Key words:Cesarean section, Indications, Frequency


Article
Obesity and its relation with cesarean sections in maternity teaching hospital in Erbil

Author: Noor Sabah Noori
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2016 Volume: 21 Issue: 1 Pages: 210-216
Publisher: Tikrit University جامعة تكريت

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Article
Rate and indications of cesarean section in the Maternity Teaching Hospital in Erbil City, Kurdistan region, Iraq
معدل ومؤشرات العملية القيصرية في مستشفى الولادة التعليمي في مدينة أربيل، إقليم كوردستان، العراق

Authors: Namir AL-Tawil Ghanim --- Hamdia Mirkahn Ahmed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2018 Volume: 22 Issue: 2 Pages: 148-154
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and objective: Knowing the rate and indications of the cesarean section will help to have an overview of this common type of obstetrical procedure and to plan for the high level of care management. This study aimed to find out the rate of cesarean section and to identify its indications.Methods: A cross-sectional study was conducted at the Maternity Teaching Hospital in Erbil city of Kurdistan Region, Iraq. Data were collected during the period of 20th of March to 30th of December 2015 by an interview with 722 women who were admitted to the hospital and underwent cesarean section out of 11881 cesarean section done during 2015.Results: Results showed the increasing rate of the cesarean section from 28.5% in 2010 to 35.77% in 2015. The main overall indications for cesarean section were a previous cesarean section (70.49%), cephalopelvic disproportion (35.31%) and mother’s request (14.26%).Conclusion: Rate of cesarean section is much higher than the optimal range recommended by the World Health Organization. Finding the appropriate strategies for decreasing the rate of primary and secondary indications is essential.

Keywords

Cesarean section --- Indication --- Rate --- Kurdistan


Article
Perinatal out come of Breech Presentation in the Presentation in the Pretext Mode of Delivery

Author: Abdulrazak H. Alnakash
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2007 Volume: 4 Issue: 1 Pages: 70-75
Publisher: Baghdad University جامعة بغداد

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Objectives: To choose the best mode of delivery for term, frank or complete, breech presentation through studying the perinatal outcome of each mode of delivery decided when managing a group of pregnant ladies presented with breech delivery in our centre.
Methods: One hundred and fifty pregnant ladies presented at term with singleton, frank or complete, breech presentation for delivery in our centre during the period from May 2004 to August 2005.
Mode of delivery, parity, gestational age, maternal age, maternal medical illness, and birth weight where the variables that have been tested in each delivery included in the study to verify their relationship to perinatal outcome.
Results: No significant relationship is found between the occurrence of adverse perinatal outcome and the variables. However, mode of delivery was the major determinant of the perinatal outcome.
of the 150 pregnant ladies, 46 were delivered vaginally, 32 had elective caesarean section, and the remaining 54 pregnant, had undergone an emergency caesarean section because they were presented with labour. Thirteen (8.6 %) babies were adversely affected by the process of delivery, 9 (5%) of them were delivered by vaginal route, 3 (2 %) delivered by emergency caesarean section and one (0.6%) by elective caesarean section.
Conclusion: Elective caesarean section is regarded the safest way of delivery for those with term, frank or complete, breech presentation.
Key Words: Breech, Perinatal outcome, Cesarean Section (CS).


Article
Effectiveness of lactation counseling on maintenance of breastfeeding

Authors: Rajaa T. Hasan --- Iqbal M. Abass
Journal: Iraqi National Journal of Nursing Specialties المجلة العراقية الوطنية للاختصاصات التمريضية ISSN: 18122388 Year: 2012 Volume: 25 Issue: 3 Pages: 20-34
Publisher: Baghdad University جامعة بغداد

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Objective(s): To determine the effectiveness of lactation counseling on maintenance of breastfeeding after cesarean section for study group.Methodology: A quasi-experimental study was conducted on non probability sample (purposive) of (60) women who had cesarean section and sample divided in to two groups (30) of them as a study group from Fatima Al-Zahra'a Maternity and Pediatric Teaching Hospital & implement lactation counseling on it and another group (30) as control group from Baghdad Teaching Hospital in Baghdad City. Study implemented for the period of April 24th 2011 to August 2nd 2011. A questionnaire was used as a tool of data collection to fulfill with objective of the study and consisted of three parts, including demographic, reproductive characteristics and maintenance of breastfeeding of the sample. A pilot study was carried out to test the reliability of the questionnaire and content validity was carried out through the 11 experts. Descriptive and inferential statistical analyses were used to analyze the data. Results: The results of the study revealed that most mothers their ages within ideal fertility age which ranged between (20-24) years, and most of them had low educational level, and were housewives, and live in urban area, with moderate socioeconomic status, and (53.3%), (50%) respectively of them were primigravida. The study shows that (100%) of the study group had continued breastfeeding, while (76.7%) of the control group had continued breastfeeding and the reasons for discontinuation of breastfeeding for control group are not enough milk and newborn refuse lactation, (73.3%) of the study group had exclusive breastfeeding, while (26%) of the control group had exclusive breastfeeding.Recommendations: The study recommended to reactivate the role of Baby-Friendly Hospitals Initiative in promoting of breastfeeding by implementation of ten steps successful of breastfeeding, and breastfeeding counseling for women during pregnancy and after birth especially who have cesarean section which has important role on maintenance of breastfeeding up to 6 months after birth.

الهدف: تحديد فاعلية المشورة في الإرضاع على مداومة الإرضاع من الثدي بعد العملية القيصرية للمجموعة التجريبية.المنهجية: أجريت دراسة شبه تجريبية على عينة غير احتمالية (غرضية) من (60) امرأة لديها عملية قيصرية وقسمت العينة إلى مجموعتين (30) منهن اعتبرت كعينة تجريبية من مستشفى فاطمة الزهراء التعليمي للولادة والأطفال، ونفذت المشورة في الإرضاع عليهن والمجموعة الأخرى (30) كعينة ضابطة من مستشفى بغداد التعليمي في مدينة بغداد.نفذت الدراسة للمُدّة من 24 نيسان إلى 2 آب 2011. استعملت الاستبانة كأداة لجمع البيانات لتحقيق هدف الدراسة وتتكون من ثلاث أجزاء تتضمن الخصائص الديموغرافية، الإنجابية ومداومة الإرضاع من الثدي للعينة. تمّ إجراء الدراسة الاستطلاعية لاختبار ثبات الاستبانة وجرى صدق المحتوى من خلال 11 خبير وأستخدم الإحصاء الوصفي والاستدلالي في تحليل البيانات.النتائج: أظهرت النتائج إن معظم الأمهات أعمارهن ضمن سن الإنجاب المثالي يتراوح من (20-24) سنة ومعظمهن ذوات مستوى تعليمي واطئ و ربات بيوت و يعيشون في مناطق حضرية مع مستوى اجتماعي اقتصادي متوسط، و(3‚53%) (50%) على التوالي منهن بكريات. تبين الدراسة إن (100%) من المجموعة التجريبية استمروا بالإرضاع من الثدي بينما (76.7%) من المجموعة الضابطة استمروا بالإرضاع من الثدي وأسباب عدم الاستمرار بالإرضاع من الثدي هي عدم كفاية الحليب والوليد يرفض الرضاعة، (73.3%) من المجموعة التجريبية ارضعن رضاعة خالصة بينما (26%) من المجموعة الضابطة ارضعن رضاعة خالصة. التوصيات: أوصت الدراسة بإعادة تفعيل دور المستشفيات الصديقة للأطفال في تعزيز الإرضاع من الثدي بوساطة تنفيذ الخطوات العشرة لإنجاح الإرضاع من الثدي ومشورة النساء في الإرضاع خلال الحمل وبعد الولادة وبخاصة التي لديها عملية قيصرية ومالها من دور مهم في مداومة الرضاعة من الثدي لمدة ستة أشهر بعد الولادة.


Article
Analytic study of the intraoperative surgicalcomplications of elective & emergency cesarean sections: incidence & risk factors
دراسة تحليلية للمضاعفات الجراحية اثناء العمليات القيصرية الباردة والطارئة: نسبة الحدوث وعوامل الخطورة

Authors: Basima Shamkhi Al-Ghazali --- Luma Saad Zeiny
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2013 Volume: 3 Issue: 3 Pages: 85-95
Publisher: University of Kufa جامعة الكوفة

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Background: Cesarean section accounts for a substantial proportion of total deliveries & is associated with higher rates of maternal & neonatal morbidity.Objective: to determine the effect of the risk factors on the incidence of intraoperative surgical complications in elective & emergency cesarean sections. Methods: This study was conducted in AL-Zahra'a Teaching Hospital of Maternity & Pediatrics in Najaf city, from June to December 2011. A total of 600 patients who had lower-segment cesarean section (280 patients with elective cesareans &320 patients with emergency procedures) participated in the study. A comparison was done between major & minor surgical complications&neonatal outcome in both groups with estimation of the effect of maternal age, body mass index, parity, previous C/S & placenta previa on the incidence of intraoperative surgical complications. Results:Intra-operative surgical complications& poor neonatal outcomewere more commonly associated with emergency than with elective procedures (P<0.05).Uterocervical laceration& blood loss requiring blood transfusion were the most frequent complications & they were more commonly associated with increased maternal age, parity, body mass index, placenta previa&abruption, previous cesarean & emergency conditions.Statistical analysis: The data were analyzed using spss version 15 with the chi –squared test to determine the association between the various factors under investigation. Conclusion: every effort should be directed to affect planned cesarean section with evaluation of risk factors during the antenatal period if possible, so as to reduce the various problems associated with emergency cesarean section.Recommendations: owing to the higher incidence of intraoperative complications if C/S is undertaken in the emergency situations, it is recommended to be accomplished as an elective procedure.

خلفية الدراسة : تمثل الولادة بواسطة العمليات القيصرية نسبة كبيرة من الولادات العامة مع احتمالية أعلى في حدوث المضاعفات و الوفيات عند الام و الطفل. الاهداف: كان الهدف من الدراسة بيان تأثير عوامل الخطورةعلى نسبة حدوث المضاعفات الجراحية أثناء العمليات الباردة والطارئة.الطريقة:أجريت الدراسة في الفترة من حزيران إلى كانون الاول 2011 واشتملت على 600 مريضة من اللواتي يراجعن صالة الولادة والعيادة الخارجية في قسم النسائية والتوليد في مستشفى الزهراء التعليمي للولادة والأطفال في النجف الاشرف قسموا الى مجموعتين: تضمنت الاولى (280) عملية قيصرية باردة وتضمنت الثانية (320) عملية قيصريةطارئة حيث أجريت المقارنة بين العمليات الباردة والعمليات الطارئة من ناحية المضاعفات الجراحية ومقارنة الحالة العامة للطفل بعد العملية.تم تسجيل المعلومات عن العمر ,عدد الولادات السابقة, عدد العمليات القيصرية السابقة, وزن الأم,حركة الطفل, حالة النزف والأمراض المصاحبة للحمل مثل السكر وارتفاع ضغط الدم.كما واجري الفحص على نسبة الدم ونسبة السكر وفحص السونار لتحديد عمر وحجم الطفل ومكان المشيمة.النتائج:بينت دراستنا من خلال تحليل الإحصائيات التي جمعت خلال العمليات القيصرية إن هناك تأثير واسع وكبير لنوع العملية (باردة اوطارئة) على مجريات سير العملية القيصرية ومضاعفاتها الجراحية الكبيرة والبسيطة بحيث تكون المضاعفات اكثرنسبة مع العمليات الطارئة بفارق معتد به احصائيا كما وجد إن هناك تأثيرواضح ومعتد به احصائيا لعوامل الخطورة (عمر الحامل,عدد الولادات السابقة,وزن الحامل,عدد العمليات السابقة,وضع المشيمة) على المضاعفات الحاصلة أثناء العملية الجراحية.الوسائل الاحصائية: تمت مقارنة النتائج باستخدام اختبارالكاي سكوير.ألاستنتاج: ان أجراء العمليات بطريقة مخطط لها مسبقا مع تحديد عوامل الخطورة اثناء فترة الحمل يقلل من نسب المضاعفات المتوقعة في الظروف الطارئة.التوصيات: نظرا لكون نسب المضاعفات الجراحية الحاصلة اثناء العمليات القيصرية اعلى عند اجرائها في الظروف الطارئة, فانه من الموصى به ان يتم اجرائها في ظروف باردة.


Article
Hemodynamic Changes During Spinal Anesthesia For Elective Cesarean Section With Hyperbaric Bupivacaine: Effect Of Volume And Concentration
التغيرات في جهاز الدوران أثناء العمليات القيصرية غير الطارئة بأستعمال التخدير الشوكي بواسطة البابيفاكائين الثقيل: تأثير الحجم والتركيز

Author: Ali Nima Hassan
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2015 Volume: 5 Issue: 3 Pages: 98-104
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Spinal anesthesia for cesarean section with hyperbaric Bupivacaine is widely used. The course of the procedure is frequently troubled by hemodynamic instability that is determined by the level of spinal block and this in turn depends on the spread of the local anesthetic within the CSF. By fixing the dose of the local anesthetic any increase in its volume leads to a decrease in its concentration because these factors are closely related to each other and they can affect the spread of the local anesthetic.Objective: To compare between large volume but lower concentration (4 ml of 0.25%) and small volume but higher concentration (2 ml of 0.5% ) of hyperbaric Bupivacaine solutions used for spinal anesthesia for elective cesarean section in respect to hemodynamic changes.Method: A clinical interventional study was Performed at Al-Zahra'a Teaching Hospital (Najaf ) from 18th Jun.-18th Jul. 2013. Forty patients scheduled for elective cesarean section were randomly selected and randomly divided into two equal groups (A and B). Both groups received hyperbaric Bupivacaine via intrathecal route, group (A) received 4 ml of 0.25% solution while group (B) received 2 ml of 0.5% solution. Hemodynamic variables (blood pressure and heart rate) were recorded throughout the time of anesthesia. Data was analyzed by using SPSS version 20.Results: There was no significant difference in the incidence of hypotension (P value=1.0) between the two groups while the incidence of bradycardia was equal between the two groups (10%) but there was a need for significantly higher average dose of Ephedrine that was used to treat hypotension in group (A) than in group (B) (P value=0.49%) reflecting more severe hypotension in group (A) than group (B).Conclusion: we conclude that the volume factor has more influence than the concentration on blood pressure with regard to hyperbaric intrathecal Bupivacaine solutions used for elective cesarean section.Recommendation: the use of smaller volume but higher concentration of intrathecal Bupivacaine is advisable in elective cesarean section.

خلفية البحث: يستعمل التخدير النصفي بواسطة دواء البابيفاكائين الثقيل للعمليات القيصرية على نطاق واسع. يعاني جهاز الدوران أثناء هذا النوع من التخدير من تغيرات مهمة يعتمد حصولها على المستوى الذي يصل اليه الدواء في الحبل الشوكي والذي يحدده أنتشار الدواء داخل السائل الشوكي. بتثبيت الجرعة فأن أي زيادة في الحجم تؤدي الى تقليل تركيز الدواء لأن هذه العوامل مرتبطة مع بعضها ارتباطا وثيقا وكل عامل بمفرده يؤثر بدرجة معينة على أنتشار الدواء داخل السائل الشوكي.الهدف: المقارنة بين الحجم الأكبر بتركيز أقل (4 ملل وتركيز 0,25%) والحجم الأصغر بتركيز أعلى (2 ملل وتركيز 0,5%) لمحاليل البابيفاكائين الثقيل في التخدير الشوكي (النصفي) للعمليات القيصرية غير الطارئة من حيث التأثير على جهاز الدوران.المنهجية: تم أجراء دراسة تداخلية سريرية في مستشفى الزهراء التعليمي في النجف من 18 حزيران ولغاية 18 تموز 2013. تم اختيار عينة عشوائية مكونة من أربعين مريضة ستجرى لهن عمليات قيصرية غير طارئة حيث قسمت العينة عشوائيا الى مجموعتين متساويتين (أ,ب). كلا المجموعتين أعطيت البابيفاكائين الثقيل داخل السائل الشوكي, المجموعة (أ) بحجم 4 ملل بتركيز 0,25% بينما المجموعة (ب) بحجم 2 ملل بتركيز 0,5% . تم تسجيل متغيرات جهاز الدوران (ضغط الدم و معدل ضربات القلب) خلال وقت التخدير. أنجزت التحاليل الإحصائية بواسطة برنامج (SPSS version 20).النتائج: لم يلاحظ أي اختلاف مهم في نسبة حصول انخفاض ضغط الدم (P value=1.0) بين المجموعتين كما كانت نسبة حصول تباطؤ معدل ضربات القلب متساوية بين المجموعتين (10%) ولكن لوحظ أن معدل جرعة دواء الأقدرين المستخدم لمعالجة انخفاض ضغط الدم كانت أعلى في المجموعة (أ) من المجموعة (ب) (P value=0.49%) مما يعني أن شدة انخفاض ضغط الدم في المجموعة (أ) أكثر من المجموعة (ب).الأستنتاج: نستنتج من هذا البحث أن عامل الحجم له تأثير أكبر من عامل التركيز على ضغط الدم بالنسبة لمحلول البابيفاكائين الثقيل المستخدم في التخدير الشوكي (النصفي) للعمليات القيصرية غير الطارئة.التوصيات: ينصح باستعمال دواء البابيفاكائين الثقيل بحجم أقل وتركيز أعلى للتخدير الشوكي (النصفي) في العمليات القيصرية غير الطارئة.

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