Closure or Non-Closure of Peritoneum in Cesarean Section: Outcomes of Short-Term Complications

Background: Cesarean section (CS) is one of the most frequently performed surgical procedures worldwide. The complications following a CS include fever, wound infection, post-operative pain and bleeding which are not usually found in a normal vaginal delivery. Traditionally, suturing of peritoneal layers for CS patients has been done, but in some studies it has been shown that this procedure could be eliminated without affecting the rate of morbidity. Objectives: The objective of this study was to assess the short-term outcomes of two different cesarean delivery techniques. Patients and Methods: A total of 100 cases who underwent CS were randomly assigned equally to either closure of both the visceral and parietal peritoneum or no peritoneum closure. Duration of operation, pain scores, analgesic requirements, alterations in hemoglobin levels and febrile morbidity were assessed accordingly. Results: Pain scores, analgesic requirements assessed at 24 hours and operation duration were significantly lower in the non-closure group as compared to the closure group. Febrile conditions and changes in hemoglobin levels were similar in both groups. Conclusions: Non-closure of both visceral and the parietal peritoneum when performing a CS produces a significant reduction in pain, fewer analgesic requirements and a shorter operation duration without increasing the febrile morbidity and changes in hemoglobin levels as compared to the standard methods

Comparing the effects of vaginal misoprostol, laminaria, and extra amniotic saline infusion on cervical ripening and induction of labor

Objective This study aimed to compare the effects of vaginal misoprostol, laminaria, and extra-amniotic saline infusion (EASI) on cervical ripening. Methods This randomized controlled trial was conducted on 195 women with singleton pregnancies and unripe cervices. Participants were randomly allocated to 3, 65-person groups: a misoprostol, a laminaria, and an EASI group. The interventions in the misoprostol, laminaria, and EASI groups included a single 25-μg vaginal misoprostol suppository, an intracervical laminaria, and a transcervical Foley catheter, respectively. The groups were compared with each other regarding time intervals from labor induction to labor active phase and delivery, cervical dilation, Bishop scores 6 hours after induction, delivery type, length of hospital stay, and complications. Results There were no significant differences among the groups regarding maternal ages, gestational ages, body mass indices, baseline cervical dilations, and Bishop scores (P>0.05). Six hours after induction, the Bishop score and cervical dilation were significantly greater in the EASI group than in the other 2 groups (P<0.001). Moreover, time intervals from labor induction to labor active phase and delivery in the EASI group were significantly short (P<0.001). The rates of cesarean section, fetal distress, placental abruption, and meconium staining in the misoprostol group were significantly high (P<0.05), and the length of hospital stay in the EASI group was significantly short (P<0.001). Conclusion EASI is a safer and more effective method for cervical ripening. Considering its inexpensiveness, easy accessibility, and greater effectiveness, EASI is recommended for cervical ripening. Trial Registration Iranian Center for Clinical Trials Identifier: IRCT20170513033941N39. © 2020 Korean Society of Obstetrics and Gynecology

EFFECTS OF ORAL IRON SUPPLEMENT ON BREATH-HOLDING SPELLS IN CHILDREN

Objectives:Breath holding spells are one of the most frequent and important diagnostic challenges in pediatrics. The aim of this study, conducted on pediatric patients referring to the pediatric neurology clinic in Hormozgan province, was to evaluate therapeutic effects of iron on breath holding spellsMaterials and Methods:35 children (19 males and 16 females), aged between 3 to 60 months, with a history of breath-holding spells, were included in the trial. To obtain all relevant data a specifically designed questionnaire requiring information on sex, age, age of onset of spells, type of spells, frequency of attacks before and after treatment with oral iron supplement, and determinants of body iron stores was completed for all the patients, based on the mother's statements. The patients were treated by an oral iron preparation for three months.Results:The age of onset of spells ranged between 6 to 24 months. The cyanotic type of spell was detected in 31 children, the pallid type in 3, and the mixed type in one child. There were 14 children with iron deficiency anemia and 20 children with reduced iron stores. Just one child had a normal iron profile. Complete therapeutic response was documented in 24 children, good response in 9, and poor response in one and in one child no change in frequency of spells was seen.Conclusion:Although no significant therapeutic difference was seen in the different response groups, it seems that iron supplement may play an important role in reducing breath holding spells in children.Keywords:Iron, Breath holding spell, children, Iron deficiency Anemi

Obstructive sleep apnea syndrome and non-arteritic anterior ischemic optic neuropathy: A case control study

Background: Sleep apnea is temporary cessation or absence of breathing during sleep. Significant increase in blood pressure is clinically seen in apneic episodes. The aim of this study was to examine sleep apnea syndrome as a risk factor for non- arthritic anterior ischemic optic neuropathy (NAION) in a case control study. Methods: Nineteen NAION patients (9 men and 10 women) and 31 age and sex matched control participants (18 men and 13 women) were evaluated for obstructive sleep apnea syndrome (OSAS). Full night polysomnography was performed and proportion of OSAS was compared between the NAION patients and the control group. Other risk factors for NAION such as hypertension, diabetes, hyperlipidemia, ischemic heart disease and tobacco consumption were also evaluated. Chi square test and independent samples t-test were used for statistical analysis. Results: OF the 19 NAION patients, 18 (95) had OSAS, and of the control group 13 (41.9) had OSAS. The frequency of OSAS was significantly higher among NAION patients compared to the controls (p < 0.001). The Mean Respiratory Disturbance Index (RDI) was 37.65/h SD = 37.61/h in NAION patients and it was 15.05/h SD = 11.97/h (p = 0.018) in controls. The frequency of diabetes and hypertension was significantly higher in the NAION patients than in controls. Conclusion: based on the results of this study, it seems that there is an association between NAION and OSAS

Prevalence of manual removal of placenta and its complications in vaginal delivery

Background : Manual removal of placenta is a major concern during delivery. Its prevalence and complications vary in our region, thus, the present study was conducted to determine the prevalence of manual removal of placenta and its complications in vaginal delivery in Shabih Khani hospital in Kashan in 2002 and 2003. Materials and methods : This cross sectional study was performed on all parturients referring during the study period. Prevalence of manual removal of placenta, demographic and midwifery factors as well as complications were all recorded. Results : Of 3633 vaginal deliveries with gestational age of greater than 20 weeks, 136 cases (3.7) referred for evacuating corpus luteum. Manual removal of the placenta was performed due to incomplete placenta or decidua formation in 111 cases (81.6) and massive bleeding in 6 cases (4.4). Most of the studied subjects (64.7) were 20-29 years old, and 8.8 had gestational age of less than 37 weeks. 62 were primigravida and gravidity of ³ 3 was reported in 3 cases (9.5). Previous history of evacuating corpus luteum was found in 12.5, uterine scar in 0.7 and manual removal of placenta in 5.4. Postpartum bleeding was the most common complication (12.5). Endometriosis was found in 4.4 and uterine rupture and hysterectomy in 0.07 of the cases. Conclusion : High prevalence of evacuating corpus luteum and its complications are matter of concerns. Therapeutic and preventive interventions are highly recommende

Report on a case of conjoined twins in Kashan

History and Objectives: Due to the rarity of birth of conjoined twins and the few reports of their birth in the world and also the high mortality of these twins, this article reports on a case of conjoined twins that were born in the Tir of 1378 in Kashan. Case report and Findings: A 28-year-old woman delivered at her third pregnancy a pair of conjoined twins with the gestational age of 36 weeks and 5 days by cesarean section. These twins had two heads, two necks, a laterally conjoined thorax and common abdomen, pelvis and male genitalia. The anus was imperforated and a fistula was present in the perineal area. These twins died twenty hours after birth because of cardio respiratory failure and the existing anomalies (Lung hypoplasia). Conclusion: Not only the birth of conjoined twins with partially divided bodies is very rare but also the male sex of the reported case is another rare phenomenon. Death of these twins in the first 24 hours of life can be due to congenital anomalies

Comparison between Effects of Intravenous Labetalol and Hydralazine on Control of Hypertension and Maternal and Neonatal Outcomes in Severe Preeclamptic Patients: A Randomized Clinical Trial

Background and Objectives: Severe preeclampsia and eclampsia are responsible for 25% of maternal mortality, especially in developing countries. Considering the importance of this complication, the present study aimed to compare between effects of labetalol and hydralazine on control of hypertension and the maternal and neonatal outcomes in severe preeclamptic patients.Methods: This clinical trial study was conducted on 190 severe preeclamptic patients classified into two groups (95 subjects in each group). Two groups were randomly received hydralazine (5 mg intravenously,, every 20 minutes, up to a maximum of five doses) or labetalol (at first 20 mg intravenously, and if not effective, 40, 80, 80, 80 mg respectively, every 20 minutes, up to a maximum of five doses). In both groups, blood pressure and heart rate were recorded 20 minutes after drug administration. Blood pressure control, as well as the maternal and neonatal outcomes, compared between two groups. Maternal and neonatal outcomes were compared using chi-square, Fisher's exact, Mann-Whitney, and t tests. All significant differences were at p<0.05. Results: Demographic characteristics and blood pressure control were similar in both groups, only five women in the hydralazine group and four women in labetalol group had persistent severe hypertension after maximum of five doses. Hypotension was not observed in both groups. Maternal tachycardia was similar in two groups. Others maternal and neonatal outcomes had no significant differences between two groups.Conclusion: According to the results of this study, the effect of labetalol and hydralazin is similar in the control of hypertension in severe preeclamptic patients and there isn’t significant different in maternal and neonatal outcome in two groups

Effects of General and Spinal Anesthesia With Marcaine on Maternal Hemodynamic and Newborns' Apgar Score

Background: Several investigations on safe anesthesia in preeclamptic parturients show that general anesthesia has greater risk than spinal anesthesia. This study was conducted on preeclamptic parturients to show spinal anesthesia with slow acting drugs not only accompanying stable maternal hemodynamic but also can bypass difficult intubation and consecutive hypoxia.Materials and Methods: It was a randomized clinical trial study (RCT). After we received institutional ethics committee approval and informed patient consent, all preeclamptic parturients aged 18-40 yr and scheduled to undergo elective cesarean section, were randomly divided in two groups: general anesthesia with sodium thiopental 5 mg/kg and succinylcholine 1.5 mg/kg IV, and spinal anesthesia with marcaine 2mg plus epinephrine 0.2 mg CSF. Blood pressure was measured at 1st, 5th, 10th & 15th minutes and Apgar scores of 1st and 5th minutes were recorded. Data analysis was achieved using chi-square test and SPSS soft ware. Results: There was no significant difference regarding the age and body weight prior to study. IV fluid intake was greater in spinal than general anesthesia (P=0.026). There was no significant difference between desirable and undesirable apgar score of 5th minute (P>0.05). Undesirable apgar score of first minute was greater in general than spinal anesthesia (P=0.004). At the first minute of anesthesia all blood pressures in the spinal anesthesia were desirable but 68.8 of them were desirable in general anesthesia. (P=0.0002). At 15th minute in the spinal anesthesia only 85.4 of blood pressures were desirable but in general anesthesia all blood pressures were desirable. (P=0.0123) Conclusion: In preeclamptic parturients undergoing cesarean section spinal anesthesia with marcaine is safer than general anesthesia

Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

AbstractBackground and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003), analgesic consumption (P=0.0003) and time of operation (P=0.004). In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.Conclusion: The Findings showed that non-closure of peritoneal layers as a shorter and simpler procedure has no influence on increasing post cesarean morbidity. Therefore, due to maternal health promotion and early neonatal breastfeeding, non closure of peritoneal layers is recommended.Keywords: Caesarean Section; Pain; Hemorrhage; Bleeding; Peritoneal Clousure