Clinical Study On The Relationship Between Puerperants Shivering And Blood Contamination Of Amniotic Fluid During Cesarean Section

Objective In this study,the concentration of sTn antigen was used as a marker of amniotic fluid transfusion to explore the relationship between shivering in parturient and amniotic fluid in cesarean section,so as to provide a new way to prevent and treat shivering in cesarean section.Methods A prospective double-blind case-control study was conducted in 60 ASAⅠ^Ⅱpuerperants.Fully communicate with the pregnant women before operation.After the puerperants entered operating room,their general information were recorded.Monitor the electrocardiogram,blood pressure,pulse oxygen saturation,venous passage were established,and the anal temperature probe was placed.The operating room temperature was controlled at23℃to 24℃.The sodium lactate Ringer solution was inputted at the rate of 7¹2 ml·kg^-1·h^-1.Routine mask inhaled oxygen,oxygen concentration 3L/min.All the puerperants underwent subarachnoid block in lumbar 3⁴ space and adjusted the block level to eighth thoracic nerve.Use warm air blower to give puerperants heat preservation at 38℃.After the fetus was taken out,the grade of amniotic fluid pollution was judged by obstetrician,neonatal 1 minute apgar score was judged by midwife,the anesthesiologist judged the condition of parturient shivering until the end of operation,and the degree of shivering was graded according to the method of Dewitte shivering classification.The bleeding volume,fluid volume,operation time,neonatal weight,shivering grade and anal temperature before anesthesia,30 minutes after anesthesia,at the end of operation were recorded.At the end of the operation,all the puerperants were taken2ml blood from the contralateral arm vein of transfusion to detect concentration of sTn antigen.After centrifugation,blood samples were taken for blood smear,and three blood smears were taken from each blood sample after centrifugation.The samples were naturally dried and stored for microscopic examination.The puerperants were divided into 4 groups according to Dewitte’s shivering classification method:grade 0 was non-shivering group（group 0）,group 1-3was group 1,group 2,group 3,among them,group 1,group 2,group 3 were called shivering group.Independent sample t-test was used to compare the two groups with or without shivering,and one-way ANOVA was used to compare the groups with different degrees of shivering.The correlation between shivering degree and sTn antigen concentration,age,gestational age,bleeding volume,fluid intake,operation time,neonatal weight and anal temperature was analyzed by Spearman correlation analysis.Results 60 cases of ASAⅠ^Ⅱparturients were enrolled,3 of whom were excluded due to dexamethasone injection,sedative drugs injection and refusing to cooperate with us.Different shivering degree groups and with or without shivering:There was no significant difference in maternal age,height,weight,volume of bleeding,fluid intake,gestational age,length of operation,neonatal 1min Apgar score,neonatal weight,anal temperature of the three time points（P>0.05）.The levels of sTn antigen in group 3 and 2 were significantly higher than those in group 1 and group 0（P<0.05）,but there was no significant difference between group 2 and group 3（P>0.05）.The concentration of sTn antigen in shivering group and non-shivering group was significantly higher than that in non-shivering group（P<0.05）.The correlation coefficient between the degree of shivering and the concentration of sTn antigen was 0.895,P<0.01.However,gestational age,bleeding volume,fluid intake,operation time,neonatal weight,and anal temperature at three time points were not correlated with the degree of shivering.NO fetal vellus hair,fetal oil droplets,fetal fat were found on the 171 smears under 400 microscope.Conclusions Shivering may be one of the symptoms of blood contamination of amniotic fluid during cesarean section.Detection of sTn antigen concentration when puerperants shivering during cesarean section can diagnose blood contamination of amniotic fluid.