Comparison between the adverse effects of interrupted versus continuous subcuticular sutures for transverse skin incision closure in cesarean section

Introduction: Cesarean section is one of the most common obstetric operations and paying attention to incision complications and determining its effective causes in reducing the complications is under serious concern. The purpose of this study was to compare incision complications of two different incision closure techniques (interrupted versus continuous subcuticular) in cesarean section. Methods: The study was performed in 2010 as a single blind randomized clinical trial on 1044 women who were candidates for cesarean delivery. The women were randomly assigned into two groups. In the first group, the skin was repaired using percutaneous interrupted sutures and in the second group, subcutaneous continuous suture was performed. Skin was repaired by 2-0 nylon sutures in all women. Two groups were compared in term of incision complications including infection, dehiscence, erythema and pain intensity. Data were analyzed using SPSS software version 17 and statistical tests including t-test and chi-square test. P value less than 0.05 was considered statistically significant. Results: Mean age of patients was 27.8±5.8 years. Incision complications were seen in 28 patients (42.42) of continuous group and 38 patients (57.57) of interrupted group that the difference was not significant (p=0.152). Incision infection was observed in 21 women (4.1) in interrupted group and 10 women (1.9) in continuous group (p=0.034). 2 patients (0.4) of continuous group and 6 women (1.2) in interrupted group had skin dehiscence without significant difference (p=0.140). Both groups had no significant differences in term of wound erythema (p=0.382). Severe pain was less in continuous group (p<0.001). Conclusion: TheContinuous subcuticular techniques of skin repair followed less pain and infection in compare of interrupted sutures and is considered as the preferred techniques. © 2013 All Rights Reserved

Comparison between maternal and neonatal outcome of PPROM in the cases of amniotic fluid index (AFI) of more and less than 5 cm

The study was performed on pregnant women with a gestational age of 26�32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of �5 cm and &lt;5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery. Maternal morbidities including chorioamnionitis, placental abruption, uterine atony after delivery and retention of placenta did not show significant difference between the two groups. There was no significant difference between the two groups� amniotic fluid index &lt;5 cm and amniotic fluid index �5 cm, regarding neonatal morbidities, except for neonatal sepsis and neonatal death, which were higher in the amniotic fluid index &lt;5 cm group 7(14.6%) versus 1(2.3%), p =.039, RR = 7.7 (95%CI 0.04�0.06) and 11(30.9%) versus 2(4.7%), p =.013, RR = 6.095 (95%CI = 1.26�29.31). In the subgroups of two categories of gestational ages of 260�296 and 300�346, neonatal morbidities were higher in the amniotic fluid index &lt;5 cm group. The results suggest that amniotic fluid index &lt;5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by preterm premature rupture of membranes.Impact statementWhat is already known on this subject? In a retrospective study in 1993, the relationship between oligohydramnios (which was defined as the largest single packet of fluid less than 2 � 2 cm) at the time of hospital admission, and the outcome of mother, foetus and neonates in a gestational age of less than 35 weeks of pregnancy was evaluated. In the oligohydramnios group, chorioamnionitis and funistis were more common. Also, the mean gestational age at the time of delivery and neonatal weight was less than that of the normal amniotic fluid group. According to these results, it was concluded that a low amniotic fluid volume in the women with preterm premature rupture of membranes (PPROM) can be considered as a prognostic factor in the cases of conservative management of PPROM. In contrast, the other study, which was performed on a larger sample size (290 patients), could not show more cases of amnionitis in the cases of amniotic fluid index (AFI) of less than 5 cm; however, the latency period was shorter in comparison with AFI of more than 5 cm. What do the results of this study add? Chorioamnionitis, placental abruption and uterine atony after delivery, retention of placenta and route of delivery did not show a significant difference between the two groups. Respiratory distress syndrome (RDS), need of surfactant and intubation, intra ventricular haemorrhage (IVH) and duration of neonatal intensive care unit (NICU) admission did not show a significant difference between the two groups; however, the rate of neonatal sepsis and neonatal death were higher in the AFI &lt;5 cm group. What are the implications of these findings for clinical practice and/or further research? The results suggest that AFI &lt;5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by PPROM. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group

Systematic review and meta-analysis of the prevalence of anemia among pregnant Iranian women (2005 - 2015)

Context: Anemia is a common, global health problem that has short-term and long-term effects during pregnancy. Several studies have been conducted on the prevalence of anemia among pregnant Iranian women in the last 10 years (2005-2015). The current study evaluated the prevalence of anemia among pregnant Iranian women in this time period. EvidenceAcquisition: Thecurrent study followed the Preferred Reporting Items for systematic reviewsandmeta-analyses (PRISMA) checklist. Searches for relevant literature were conducted on scientific databases such as the Iranian journal database (Magiran), Iranian biomedical journal database (IranMedex), the scientific information database (SID), global medical article Limberly (Medlib), IranDoc, Scopus, PubMed, ScienceDirect, Springer, Web of Science, Wiley online library, and Google Scholar. All population-based studiesandnational surveys that reportedonthe prevalence of anemiaamongpregnant Iranianwomenpublished between January 1st, 2005 and December 31st, 2015 were included. All related articles were considered based on inclusion criteria. Using a random effects model, data were analyzed through STATA software (ver.11.1). Results: Eighteen articles with a combined sample size of 51,521 were investigated. The prevalence of anemia in pregnant Iranian women was estimated at 17.9 (CI: 95; 14.7 - 21.1). The highest and lowest percentages were reported in Iran’s central (24.9) and western (6.3) parts, respectively. The prevalence of anemia among rural (17.6) and urban (22.1) pregnant Iranian women was also determined. Conclusions: The prevalence of anemia among pregnant Iranian women has increased in the last 10 years. Therefore, appropriate intervention plans, including training in proper nutrition during pregnancy and training in the correct use of iron, vitamins, and folic acid supplements, should be arranged and performed in prenatal clinics or before marriage. © 2016, Shiraz University of Medical Sciences