Influence of Exteriorised versus Intra-abdominal Uterine Repair Caesarean Delivery under Spinal Anaesthesia on Intraoperative and Postoperative Complications

Introduction: Caesarean techniques have evolved over time to increase their safety. Intra-abdominal closure of uterine incision seems more physiological. Exteriorisation makes repair easier with a better exposure. But this causes tension to the supporting structures attached to uterus and stretching of vasculature with the risk of intraoperative haematoma or aneurysm later on. Aim: To compare the in-situ repair Group and exteriorised repair group caesarean delivery under spinal anaesthesia regarding occurrence of intraoperative and postoperative complications of interest. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at College of Medicine and Jawaharlal Nehru Memorial Hospital, West Bengal, India, over a period of two years from April 2014 to March 2016. Four hundred women undergoing caesarean section who fulfilled the inclusion and exclusion criteria were recruited in the study. They were randomly allocated into two study groups as per a computer generated random allocation table. In Group A (n=200) uterine incision was closed after uterus was exteriorised and in Group B (n=200) uterine incision was closed keeping it inside the abdomen. Intraoperative and postoperative parameters of interest such as nausea-vomiting, drop in pulse rate, incision closure time, drop in haemoglobin, blood transfusion rate, return of bowel sounds, febrile morbidity, surgical site infection, hospital stay etc., were noted and compared between the two groups. Numerical variables were expressed as mean and standard deviation and analysed using independent sample t-test. For qualitative variables frequency and percentage were calculated and analysed using Chi-square. Collected data was transferred and analysed using Statistical Package for Social Sciences (SPSS) version25. The p-value ≤0.05 was considered significant. Results: The demographic profiles like age, parity, gestational age etc. of both the groups were similar. There was a significant difference in uterine closure time (9±2.5 minutes in in-situ repair group vs. 10±2 minutes in exteriorisation and repair groups, respectively (p0.05). Mean drop of haemoglobin was more in the intraabdominal closure group (1.5±1.3 gm/dL) as compared to the group of closure after exteriorisation (1.4±1.3 gm/dL) though the difference was not significant statistically (p=0.44). Postpartum blood transfusion rate was 6.5% in exteriorised repair group and 9% in in-situ repair group (p=0.35). Postoperative morbidity like fever, surgical site infection, length of hospital stay was similar in both the groups. Conclusion: Choice of uterine closure method is operator dependent and either method of uterine closure is acceptable when practiced and skill is gained. Exteriorisation is advantageous when excessive bleeding is encountered. Though time taken for closure in in-situ group is statistically more it is similar practically. Bowel sounds returned earlier postoperatively in in-situ group

Hydrated hexacyanometallate(III) salts of triaqua(18-crown-6)lanthanoid(III) and tetraaqua(18-crown-6) lanthanoid(III) cations containing nine- and ten-coordinate lanthanoids

Tetraaqua( 18- crown- 6) cerium( III) hexacyanoferrate( III) dihydrate, [ Ce( C12H24O6)( H2O)(4)][ Fe( CN)(6)]center dot 2H(2)O, and tetraaqua( 18- crown- 6) neodymium( III) hexacyanoferrate( III) dihydrate, [ Nd( C12H24O6)( H2O)(4)][ Fe( CN)(6)] center dot 2H(2)O, are isomorphous and isostructural in the C2/ c space group, where the cations, which contain ten- coordinate lanthanoid centres, lie across twofold rotation axes and the anions lie across inversion centres. In these compounds, an extensive series of O - H center dot center dot center dot O and O - H center dot center dot center dot N hydrogen bonds links the components into a continuous three- dimensional framework. Triaqua( 18- crown- 6) lanthanoid( III) hexacyanoferrate( III) dihydrate, [ Ln( C12H24O6)( H2O)(3)][ Fe( CN)(6)]center dot 2H(2)O, where Ln = Sm, Eu, Gd or Tb, are all isomorphous and isostructural in the P (1) over bar space group, as are triaqua( 18- crown- 6) gadolinium( III) hexacyanochromate( III) dihydrate, [ Gd( C12H24O6)( H2O)(3)][ Cr( CN)(6)] center dot 2H(2)O, and triaqua( 18- crown- 6) gadolinium( III) hexacyanocobaltate( III) dihydrate, [ Gd( C12H24O6)( H2O)(3)][ Co( CN)(6)] center dot 2H(2)O. In these compounds, there are two independent anions, both lying across inversion centres, and the lanthanoid centres exhibit nine- coordination; in the crystal structures, an extensive series of hydrogen bonds links the components into a three- dimensional framework.</p