Mother Lactation in The Postpartum Period
Condition: Maternal-Fetal Relations
Study type: Observational [Patient Registry]

Summary: 
      In our study we aimed to compare the lactation process by mothers who were undergoing
      elective Caesarian section under general anesthesia, spinal anesthesia, epidural anesthesia
      and normal vaginal birth.
    

Detailed description: 
      Patients were randomly divided into 4 groups: group G (general anesthesia for Caesarean
      section, n=21), group S (spinal anesthesia for Caesarean section, n=21), group E (epidural
      anesthesia for Caesarean section, n=21), group V (normal vaginal birth without anesthesia,
      n=21). Blood sample of 3 mililiters was taken from all patients 2,5 hours before procedure
      and oxytocin and prolactin levels in this blood samples were determined. No patient received
      premedication. Group G (general anesthesia for Caesarean section) received preoxygenation
      with 100% oxygen for 3-5 minutes before intubation. In order to let fetus minimally affected
      by the anesthetic agents, induction was performed after the disinfection and covering up of
      surgery area. Induction was performed with propofol (2 mg/ kg) and rocuronium (0,6 mg/kg).
      After onset of neuromuscular block, patients were intubated with compression maneuver of
      cricoid cartilage. Controlled ventilation was provided with anesthesia machine Datex Ohmeda
      S/5 Avance with tidal volume of 8-10 ml/kg, respiration frequency of 10-12 min. Anesthesia
      was maintained with oxygen (50%) , air (50%), sevoflurane of 1 MAC. When necessary rocuronium
      0,15 mg/kg was administered. After delivery of the newborn, fentanyl 1-1,5 mcg/ kg was
      administered.

      Patients in group S (spinal anesthesia for Caesarean section) received 750-1000 mL of 0,9%
      NaCI solution (10-15 mL/kg) as infusion in 20-30 minutes. Under strict aseptic precautions a
      25G Quincke spinal needle was introduced into L3-L4 or L4-L5 intervertebral space in midline
      approach in sitting posture, and, after confirming free flow of CSF, predetermined 10-11 mg
      of drug solution (hypertonic bupivacaine 0,5%) was injected. We let the operation begin when
      sensory and motor blockade were verified. Oxygen of 100% (3 L. min) was administered
      throughout the operation via nasal cannula.

      Patients in group E (epidural anesthesia for Caesarean section) received 750-1000 mL of 0,9%
      NaCI solution (10-15 mL/kg) as infusion in 20-30 minutes. We conducted epidural anesthesia
      with 18-gauge Tuohy needle at L3-L4 or L4-L5 epidural space by midline approach at sitting
      position. 3 -5 minutes after injection of 3 ml lidocaine as test-dose, when the patient has
      no sign of subarachnoid injection like prickling in lower extremities or of intravascular
      injection like nausea, vomiting, tachicardia, tinnitus, a 20-gauge epidural catheter was
      inserted to cephalad. We injected 10 ml of 0.5% bupivacaine via epidural catheter. We let the
      operation begin when sensory and motor blockade were verified. Oxygen of 100% (3 L. min) was
      administered throughout the operation via nasal cannula.

      Patients in all 3 groups were monitorised in the operation room with a monitor of
      Datex-Ohmeda and electrocardiogram (ECG), systolic blood pressure (SBP), diastolic blood
      pressure (DBP), mean blood pressure (MBP), heart rate (HR), peripheral oxygen saturation
      (SPO2) were recorded. Efedrin 5-10 mg and/or atropin 0,5 mg was administered when significant
      hypotension and bradicardia occurred. After delivery of the newborn 30 IU of oxytocin in a
      1000cc solution of 0,9% NaCI was infused and if patient was not hypertensive,
      methylergonovine of 0,2 mg was administered intramuscular.

      Patients in group V (spontaneous vaginal birth without anesthesia) were spectated by
      gynecologists in the Clinic of Gynecology and Obstetrics during the delivery. They received
      no anesthesia.

      In all groups blood samples were taken at the 24th hour after delivery and oxytocin and
      prolactin levels were measured. Plasma of blood samples taken before and after delivery were
      stored at a temperature of -80°C. Prolactin levels were determined with chemiluminescense
      immunoassay technique Cobas e 601 (Roche® Diagnostics, Mannheim, Germany) using a commercial
      kit (Roche®). Oxytocin levels were determined with a commercial ELISA kit (Cusabio Biotech
      CO. Ltd). By all patients onset time of lactation was recorded.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        84 patients were included. 63 of them were undergoing elective caesarian section and 21
        patients had normal vaginal delivery in the Clinic of Gynecology and Obstetrics. All
        patients were between 18-40 years old and with the risk of ASA II.
      
Keywords: Anesthesia , lactation, birth