Challenges in the Caesarean Section of a Severely Kyphotic Parturient

Abstract

Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.

Caesarean section: a case report of critical attempt to abdominal wall

“…Surgical complications, such as injuries to the urinary reservoir, transection of the ureter, fistula formation, and postpartum hemorrhages, should not be underestimate (10). Abdominal entry by paramedian incision could be chosen rather than classical or transverse incisions; this technique has been proposed for women with impaired abdominal access (e.g., women with previous correction for exstrophy-epispadias complex) or severely kyphotic parturient (whose supine cannot be achieved) (11). The favorable aspects of this technique are based on the relatively avascular linea alba.…”

“…There are several reviews with regards to CS from the pre-operative to the post-operative care, in order to suggest the best standard (14,15). Unfortunately, to the best of our knowledge, there are no reviews for standard care in those patients with hostile abdomen, except of small series reporting single center experience (8,10,11). The lateral paramedian incision matches some of the advantages of the midline incision, such as wider exposure, richly vascularized wound bed, decreased risk of blood vessel dissection, and preservation of rectus muscle.…”

The use of separate‐level neuraxial anaesthesia for caesarean delivery in a patient with a history of spinal tuberculosis

“…The second patient reported by Dabrowska et al was seen antenatally and an MRI was arranged [2]. In one case, a patient underwent general anaesthesia for caesarean delivery, the decision to do so being based on the complexity of her kyphoscoliosis and the lack of previous evaluation of her spine [4]. All other patients received neuraxial anaesthesia with no reported complications afterwards, though none of the cases described a technique of combining spinal anaesthesia with an epidural.…”

“…Though TB is uncommon in the UK, it is highly prevalent worldwide and despite its prevalence, the literature on the safety of neuraxial anaesthesia in patients with a history of treated spinal TB is sparse. As far as we are aware, there are reports on the management of five obstetric patients with a history of spinal TB and kyphoscoliosis available in the literature [1][2][3][4][5]. Four of these come from the anaesthetic literature [1][2][3], and one from the obstetric literature with some mention of anaesthesia management [4].…”

“…As far as we are aware, there are reports on the management of five obstetric patients with a history of spinal TB and kyphoscoliosis available in the literature [1][2][3][4][5]. Four of these come from the anaesthetic literature [1][2][3], and one from the obstetric literature with some mention of anaesthesia management [4]. In all but one of the reported cases, the patient arrived at the care of the anaesthetist in an emergency setting.…”