Medicina

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10 pages, 446 KiB

Open AccessArticle

Neurodevelopment of Children Born with Forceps Delivery—A Single Tertiary Clinic Study

by Sanja Kostic, Katarina Ivanovic, Ivana Jovanovic, Milos Petronijevic, Natasa Cerovac, Jelena Milin-Lazovic, Danijela Bratic, Stefan Dugalic, Miroslava Gojnic, Milica Petronijevic, Milan Stojanovic, Ivan Rankovic and Svetlana Vrzic Petronijevic

Medicina 2024, 60(11), 1743; https://doi.org/10.3390/medicina60111743 - 24 Oct 2024

Viewed by 533

Abstract

Background and Objectives: Forceps delivery is a crucial obstetrical technique that has become increasingly underutilized in favor of cesarean delivery, despite the numerous complications related to cesarean sections. The major concerns with regard to assisted vaginal birth (AVB) are safety and long-term consequences. [...] Read more.

Background and Objectives: Forceps delivery is a crucial obstetrical technique that has become increasingly underutilized in favor of cesarean delivery, despite the numerous complications related to cesarean sections. The major concerns with regard to assisted vaginal birth (AVB) are safety and long-term consequences. We aimed to investigate a neurological outcome of neonates and children at the age of 7 who were born via forceps delivery. This would greatly improve informed decision making for both mothers and obstetricians. Materials and Methods: A single-arm cohort study was conducted from January 2012 to December 2016 among 49 women and their children born via forceps delivery at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia. The Sarnat and Sarnat classification was used to evaluate the neurological status of neonates, and logistic regression analysis was employed to explore the association with perinatal factors. Long-term neurological outcomes were assessed using the Griffiths Mental Development Scale and a questionnaire for parents based on the Motor and Social Development (MSD) scale, which was derived from the Bayley-III Scale. Results: The main indication for forceps delivery was maternal exhaustion (79.6%), followed by fetal distress (20.4%). A pathological neurological status was observed in 16.3% of newborns, with pathological ultrasound of the CNS in 3%. A statistically significant association was observed with the Apgar score, with an odds ratio of 0.575 (95% CI: 0.407–0.813, p = 0.002) and perinatal asphyxia, with an odds ratio of 9.882 (95% CI: 1.111–87.902, p = 0.04). However, these associations were unlikely to be related to the mode of delivery. Long-term adverse neurological outcomes were seen in three cases, which accounts for 6.4%. These included mild disorders such as delayed milestone, speech delay, and motor clumsiness. Conclusions: The present study highlights the safety of forceps delivery regarding children’s neurological outcomes at 7 years of age. This is an important contribution to the modern management of labor, especially in light of increasing rates of cesarean deliveries worldwide. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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17 pages, 1431 KiB

Open AccessArticle

Competence of Combined Low Dose of Human Chorionic Gonadotropin (HCG) and Clomiphene Citrate (CC) Versus Continued CC during Ovulation Induction in Women with CC-Resistant Polycystic Ovarian Syndrome: A Randomized Controlled Trial

by Mahmoud Thabet, Mohamed Sayed Abdelhafez, Maged Ragheb Elshamy, Ibrahim A. Albahlol, Emad Fayala, Alaa Wageeh, Ahmed Abdelhamid El-Zayadi, Nagwan Ahmed Bahgat, Shereen M. Mohammed, Alhussein Ahmed Mohamed, Mahmoud Mohamed Awad, Ahmed El-Menayyer, Mohamed El-Sherbiny, Dalia Mahmoud Abdelmonem Elsherbini, Rayan G. Albarakati, Ahmed Baker A. Alshaikh, Fawaz E. Edris, Nayla Jamal Bushaqer, Youstina Georges Makarious Salama and Mahmoud Mohamed Abdel-razik

Medicina 2024, 60(8), 1300; https://doi.org/10.3390/medicina60081300 - 12 Aug 2024

Viewed by 1158

Abstract

Background and Objectives: Polycystic ovarian syndrome (PCOS) is a widespread endocrine disorder affecting 5–18% of females in their childbearing age. The aim of this study is to assess the efficacy of combining a low dosage of human chorionic gonadotropin (HCG) along with [...] Read more.

Background and Objectives: Polycystic ovarian syndrome (PCOS) is a widespread endocrine disorder affecting 5–18% of females in their childbearing age. The aim of this study is to assess the efficacy of combining a low dosage of human chorionic gonadotropin (HCG) along with clomiphene citrate (CC) for stimulating ovulation in infertile women diagnosed with CC-resistant PCOS. Materials and Methods: A randomized controlled trial was carried out on 300 infertile CC-resistant PCOS women. All participants were assigned to two groups: the CC-HCG group and the CC-Placebo group. Subjects in the CC-HCG group were given CC (150 mg/day for 5 days starting on the 2nd day of the cycle) and HCG (200 IU/day SC starting on the 7th day of the cycle). Subjects in the CC-Placebo group were given CC and a placebo. The number of ovarian follicles > 18 mm, cycle cancellation rate, endometrial thickness, ovulation rate, clinical pregnancy rate, and occurrence of early ovarian hyper-stimulation syndrome were all outcome variables in the primary research. Results: Data from 138 individuals in the CC-HCG group and 131 participants in the CC-Placebo group were subjected to final analysis. In comparison to the CC-Placebo group, the cycle cancellation rate in the CC-HCG group was considerably lower. The CC-HCG group exhibited a substantial increase in ovarian follicles reaching > 18 mm, endometrial thickness, and ovulation rate. The clinical pregnancy rate was higher in the CC-HCG group (7.2% vs. 2.3%; CC-HCG vs. CC-Placebo). Upon adjusting for BMI and age, the findings of our study revealed that individuals in the CC-HCG group who had serum prolactin levels below 20 (ng/mL), secondary infertility, infertility duration less than 4 years, baseline LH/FSH ratios below 1.5, and serum AMH levels more than 4 (ng/mL) had a higher likelihood of achieving pregnancy. In the CC-Placebo group, there was a greater prediction of clinical pregnancy for those with serum AMH (<4), primary infertility, serum prolactin ≤ 20 (ng/mL), baseline LH/FSH < 1.5, and infertility duration < 4 years. Conclusions: The use of a small dose of HCG along with CC appeared to be an effective treatment in reducing cycle cancelation, improving the clinical pregnancy rate and ovulation rate in CC-resistant PCOS patients. The trial was registered with Clinical Trials.gov, identifier NCT02436226 Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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10 pages, 445 KiB

Open AccessArticle

Understanding the Benefits of CO₂ Laser Treatment for Vulvovaginal Atrophy

by Svetlana Jankovic, Marija Rovcanin, Ana Tomic, Aleksandar Jurisic, Zagorka Milovanovic and Milena Zamurovic

Medicina 2024, 60(7), 1059; https://doi.org/10.3390/medicina60071059 - 27 Jun 2024

Viewed by 1355

Abstract

Background and Objectives: Postmenopausal vaginal discomfort is often attributed to vulvovaginal atrophy (VVA). Women with VVA experience symptoms such as vaginal dryness, itching, burning, irritation, and dyspareunia. Materials and Methods: This pilot study was conducted to assess the effects of a micro-ablative fractional [...] Read more.

Background and Objectives: Postmenopausal vaginal discomfort is often attributed to vulvovaginal atrophy (VVA). Women with VVA experience symptoms such as vaginal dryness, itching, burning, irritation, and dyspareunia. Materials and Methods: This pilot study was conducted to assess the effects of a micro-ablative fractional CO₂ laser on the clinical symptoms of VVA, as well as concordant sexual function. The severity of VVA symptoms was evaluated by a visual analogue scale (VAS), while the condition of the vaginal mucosa was evaluated using the Vaginal Health Index Score (VHSI). Sexual function was evaluated using the Female Sexual Function Index (FSFI) Questionnaire. Results: Our cohort included 84 sexually active postmenopausal women with bothersome VVA, leading to sexual health complaints. The mean age of the participants in our study was 55.2 ± 5.4 years, with an average postmenopausal period of 6 ± 4.8 years. The age of our patients and the length of their postmenopausal period exhibited a significant negative correlation with VHSI scores, while a longer postmenopausal period was associated with increased severity of vaginal dryness and dyspareunia. Baseline VHSI values showed that 65% of patients had atrophic vaginitis with pronounced VVA symptoms (70.2% experienced vaginal itching, 73.8% reported vaginal burning, 95.3% had vaginal dryness, and 86.1% suffered from dyspareunia). Lower VHSI values significantly correlated with lower FSFI scores, while more severe VVA symptoms scores correlated with lower FSFI scores. VVA symptoms were significantly less severe after treatment. VHIS regained high non-atrophic values in 98.8% of patients post-treatment (p < 0.001). FSFI total and domain scores were significantly higher after treatment (p < 0.001). Conclusions: Our study revealed that fractional CO₂ laser is a useful treatment option to alleviate VVA symptoms and improve vaginal health and sexual functioning in postmenopausal women. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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11 pages, 1036 KiB

Open AccessArticle

Tapentadol Immediate Release (IR) versus Morphine Hydrochloride for Postoperative Analgesia of Patients Undergoing Total Abdominal Hysterectomy—A Prospective Cohort Study

by Sanja Starčević, Dragana Radovanović, Svetlana Škorić-Jokić, Milica Bojanić-Popovicki, Suzana El Farra, Nora Mihalek, Danica Golijanin, Tihomir Dugandžija and Ana Tomas Petrović

Medicina 2023, 59(10), 1800; https://doi.org/10.3390/medicina59101800 - 10 Oct 2023

Cited by 1 | Viewed by 1855

Abstract

Background and Objectives: This study aimed to examine the efficacy of tapentadol immediate release (IR) and morphine hydrochloride in the treatment of acute postoperative pain after total abdominal hysterectomy, as well as to examine the frequency of opioid-related side effects in observed [...] Read more.

Background and Objectives: This study aimed to examine the efficacy of tapentadol immediate release (IR) and morphine hydrochloride in the treatment of acute postoperative pain after total abdominal hysterectomy, as well as to examine the frequency of opioid-related side effects in observed patients. Materials and Methods: The prospective observational study was conducted over five months, and it included a total number of 100 patients. The two cohorts had different types of postoperative analgesia, and the effects were observed for 24 h postoperatively, by following the pain scores on NRS (Numerical Pain Scale), contentment with analgesia, and opioid-related side effects. Results: Statistical significance was found when assessing pain 24 h after surgery while coughing, where patients in the tapentadol IR group had significantly higher mean pain scores (p < 0.01). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in the tapentadol IR group (p = 0.005). Vertigo appeared significantly more in patients from the morphine group (p = 0.03). Conclusions: Tapentadol IR (immediate release) and morphine hydrochloride are both effective analgesics used in the first 24 h after total transabdominal hysterectomy. Overall satisfaction of patients with analgesia was good. The frequency of side effects was higher in the morphine group, with statistical significance regarding the vertigo. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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12 pages, 633 KiB

Open AccessArticle

Autologous Platelet-Rich Plasma (PRP) Efficacy on Endometrial Thickness and Infertility: A Single-Centre Experience from Romania

by Anca Huniadi, Ioana Alexandra Zaha, Petronela Naghi, Liana Stefan, Liliana Sachelarie, Alin Bodog, Erika Szuhai-Bimbo, Codruta Macovei and Mircea Sandor

Medicina 2023, 59(9), 1532; https://doi.org/10.3390/medicina59091532 - 24 Aug 2023

Cited by 6 | Viewed by 4213

Abstract

(1) Background: During IVF (in vitro fertilization), a proper endometrium thickness is one of the most difficult parameters to achieve and one of the most important prognostic factors of the success rate. One major problem is the high cancelation percentage in frozen [...] Read more.

(1) Background: During IVF (in vitro fertilization), a proper endometrium thickness is one of the most difficult parameters to achieve and one of the most important prognostic factors of the success rate. One major problem is the high cancelation percentage in frozen embryo transfer cycles. The focus on the adjuvant methods for improving endometrium thickness is an on-going subject of interest. (2) Methods: This prospective single-arm self-control study was conducted in an IVF centre in Oradea, Romania. The patients were divided into two groups. The control group included 51 patients with at least one attempt to transfer a good-quality blastocyst, but the endometrial thickness did not surpass 7 mm under standard endometrial preparation protocol with oestradiol and with adjuvant therapy (other than PRP, such as aspirin, vitamin C, and vitamin E), and the study group included the same 51 patients that had the embryo transfer performed under the same standard endometrial preparation protocol with oestradiol preparation protocol and intrauterine PRP infusion. (3) Results: In our study, the PRP treatment had a positive impact on the parameters that were followed for the evaluation of the success rate of the embryo transfer procedure. The endometrial thickness (an increase in endometrial thickness by 0.6 mm after PRP treatment with p = 0.0001) and the clinical pregnancy rate (having a MD ± SD of 0 ± 0.38 before PRP treatment and with an increase to 0.5 ± 0.1 after the PRP treatment, p = 0.0004) were statistically significant (4) Conclusions: PRP has a positive effect in promoting endometrial proliferation, improving embryo implantation rate and clinical pregnancy rate for women with thin endometrium. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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Graphical abstract

7 pages, 291 KiB

Open AccessArticle

Cardiovascular Mortality in Ovarian Cancer Patients: An Analysis of Patient Characteristics Using the SEER Database

by Ismail Abdulrahman Al-Badawi, Osama Alomar, Saud Owaimer Alsehaimi, Mohammed Ziad Jamjoom, Nadia Ahmed Abdulmalik, Ibtihal Abdulaziz Bukhari, Abdullah Alyousef, Safa Alabdrabalamir, Saeed Baradwan, Ahmad Sayasneh, Saad M. S. Alqarni and Ahmed Abu-Zaid

Medicina 2023, 59(8), 1476; https://doi.org/10.3390/medicina59081476 - 17 Aug 2023

Cited by 1 | Viewed by 2049

Abstract

Background and Objectives: Cardiovascular disease (CVD) is a major contributor to the high mortality rate among individuals with ovarian cancer. Nevertheless, there is limited understanding regarding the specific patient attributes that might impact the risk of CVD in this group. Materials and [...] Read more.

Background and Objectives: Cardiovascular disease (CVD) is a major contributor to the high mortality rate among individuals with ovarian cancer. Nevertheless, there is limited understanding regarding the specific patient attributes that might impact the risk of CVD in this group. Materials and Methods: A retrospective cohort study was performed using the SEER database to analyze primary ovarian cancer cases from 2000 to 2019. Multivariable logistic regression analysis was employed to identify patient characteristics linked to cardiovascular mortality. Results: The cohort included 41,930 cases of patients who were alive, 54,829 cases of cancer-related deaths, 3003 cases of cardiovascular-related deaths, and 10,238 cases with other causes of death. Poorly differentiated cancer cells and distant metastasis were associated with a higher risk of cardiovascular mortality. Logistic regression analysis identified age, year of diagnosis, race, laterality, and staging as significant risk factors for cardiovascular cause of death. The risk of cardiovascular cause of death was lower in patients aged 31–60 and higher in those aged over 60 years old, and the risk also increased with a later year of diagnosis. Patients who were not white were at a higher risk of cardiovascular cause of death. Additionally, bilateral ovarian cancer and distant staging disease were linked to elevated risks of cardiovascular cause of death. Conclusion: Cardiovascular mortality is a significant concern in ovarian cancer patients, and several patient characteristics are associated with an increased risk. Our study suggests that targeted interventions to improve cardiovascular health in high-risk patients, such as those with comorbidities or an advanced stage at diagnosis, may improve survival in this population. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

11 pages, 333 KiB

Open AccessArticle

Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries

by Miha Lucovnik, Ivan Verdenik and Tatjana Stopar Pintaric

Medicina 2023, 59(6), 1026; https://doi.org/10.3390/medicina59061026 - 25 May 2023

Cited by 1 | Viewed by 1849

Abstract

Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor [...] Read more.

Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor analgesia (epidural analgesia (EA) vs. remifentanil patient-controlled analgesia (PCA)) and intrapartum cesarean sections (CS), and maternal and neonatal adverse outcomes in breech and twin vaginal births. A retrospective analysis of planned vaginal breech and twin deliveries at the Department of Perinatology, University Medical Centre Ljubljana, was performed for the period 2013–2021, using data obtained from the Slovenian National Perinatal Information System. The pre-specified outcomes studied were the rates of CS in labor, postpartum hemorrhage, obstetric anal sphincter injury (OASI), an Apgar score of <7 at 5 min after birth, birth asphyxia, and neonatal intensive care admission. A total of 371 deliveries were analyzed, including 127 term breech and 244 twin births. There were no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups in any of the outcomes studied. Our findings suggest that both EA and remifentanil-PCA are safe and comparable in terms of labor outcomes in singleton breech and twin deliveries. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

12 pages, 535 KiB

Open AccessArticle

Prevalence of Stress Urinary Incontinence and Risk Factors among Saudi Females

by Abdulrahim M. Gari, Ethar H. Alhashmi Alamer, Rania O. Almalayo, Wafa A. Alshaddadi, Sadin A. Alamri, Razan S. Aloufi and Saeed Baradwan

Medicina 2023, 59(5), 940; https://doi.org/10.3390/medicina59050940 - 13 May 2023

Cited by 6 | Viewed by 2277

Abstract

Background and Objectives: Stress urinary incontinence (SUI) is involuntary urine leakage upon effort or physical exertion, sneezing, or coughing, and it is the most prevalent type of urinary incontinence (UI) in women. We aimed to estimate the prevalence of SUI and its [...] Read more.

Background and Objectives: Stress urinary incontinence (SUI) is involuntary urine leakage upon effort or physical exertion, sneezing, or coughing, and it is the most prevalent type of urinary incontinence (UI) in women. We aimed to estimate the prevalence of SUI and its risk factors among Saudi females. Materials and Methods: A descriptive cross-sectional study was conducted in the Kingdom of Saudi Arabia between March 2022 and July 2022, with a total of 842 respondents. We included Saudi females over the age of 20 years. Data were collected through an online questionnaire distributed to the target group and analyzed using SPSS software. Results: The prevalence of SUI was found to be 3.3% among Saudi women. Moreover, only 41.8% of the participants had at least one pregnancy; the majority had five or more pregnancies (29%). According to our findings, the majority of the participants diagnosed with SUI had the following risk factors: increased age, widowhood, a family history of SUI, and a history of pregnancy. The results revealed that the odds of SUI increased among Saudi females with a family history of SUI by 19.68-fold compared with those who had no family history of SUI, and this was statistically significant (p < 0.001). Conclusion: The prevalence of SUI among Saudi females was found to be relatively low. The above-listed associated factors should be considered in future research and interventions. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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11 pages, 1416 KiB

Open AccessArticle

Awareness of Placental Pathologic Examination Criteria and Utilization of Pathology Reports among Obstetricians

by Amal AlOdaini, Ghaida AlKhalifah, Lina Alafghani, Nawal Bin Jalalah, Norah Alsuwailem and Zainab AlMomen

Medicina 2023, 59(3), 574; https://doi.org/10.3390/medicina59030574 - 15 Mar 2023

Viewed by 1729

Abstract

Background and Objectives: Several studies have reported a low rate of pathological examination of the placentas and a poor utilization of pathology reports. We assessed Saudi obstetricians’ awareness and utilization of the placental pathological examination guidelines of the College of American Pathologists [...] Read more.

Background and Objectives: Several studies have reported a low rate of pathological examination of the placentas and a poor utilization of pathology reports. We assessed Saudi obstetricians’ awareness and utilization of the placental pathological examination guidelines of the College of American Pathologists (CAP) and evaluated their understanding of the reports. Materials and Methods: An anonymous survey was distributed to obstetricians registered in the Saudi Commission of Health Specialties database. We examined the association between the participants’ level of training or practice as well as their institution type with the surveyed elements. Results: Of 292 respondents, 34.2% were aware of the CAP guidelines. Most of them were practicing in government hospitals. Moreover, 18.2% of them routinely sent the placenta for pathological examination, and approximately 70.5% routinely reviewed the pathology reports and understood the nomenclature used; these percentages were significantly higher among university hospital practitioners. The residents were the least aware of the CAP guidelines and the least likely to review and understand the pathology reports. Regardless of the CAP guidelines awareness, the most common indication for placental pathologic examination was fetal anomalies, followed by medicolegal reasons and infections. Conclusions: Placental pathologic examination appeared uniformly underutilized in Saudi Arabia. Obstetricians are required to generate awareness of the need to comply with the CAP guidelines and to improve the understanding and utilization of pathology reports. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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Review

Jump to: Research, Other

9 pages, 301 KiB

Open AccessReview

Premenstrual Syndrome and Premenstrual Dysphoric Disorder’s Impact on Quality of Life, and the Role of Physical Activity

by Fabrizio Liguori, Emma Saraiello and Patrizia Calella

Medicina 2023, 59(11), 2044; https://doi.org/10.3390/medicina59112044 - 20 Nov 2023

Cited by 5 | Viewed by 3943

Abstract

Most women who menstruate experience various physical, psychological, and behavioral changes during the period between ovulation and menstruation. This study focuses on defining and diagnosing premenstrual disorders, distinguishing between premenstrual symptoms (PS), PMS, and premenstrual dysphoric disorder (PMDD). It highlights the prevalence of [...] Read more.

Most women who menstruate experience various physical, psychological, and behavioral changes during the period between ovulation and menstruation. This study focuses on defining and diagnosing premenstrual disorders, distinguishing between premenstrual symptoms (PS), PMS, and premenstrual dysphoric disorder (PMDD). It highlights the prevalence of these conditions and their impact on women’s quality of life, including social, occupational, and psychological aspects. Furthermore, the study examines the role of physical activity, particularly aerobic exercise, in managing premenstrual symptoms. Several systematic reviews are cited, suggesting that regular physical activity can effectively reduce both physical and psychological symptoms associated with PMS. In conclusion, the management of PMS involves a multifaceted approach, with exercises, dietary modifications, stress management, cognitive-behavioral therapy, and medications all playing roles. Physical activity, especially aerobic exercise, has been found to be an effective non-pharmacological therapy for alleviating PMS symptoms and improving overall well-being. However, more research is needed to determine the optimal type and dosage of exercise for individual women with PMS. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

12 pages, 2059 KiB

Open AccessReview

Analgesic Efficacy of Intraoperative Superior Hypogastric Plexus (SHP) Block during Abdominal Hysterectomy: A Systematic Review and Meta-Analysis of Controlled Trials

by Hany Salem, Ibtihal Abdulaziz Bukhari, Maha Al Baalharith, Nasser AlTahtam, Safa Alabdrabalamir, Mohammed Ziad Jamjoom, Saeed Baradwan, Ehab Badghish, Mohammed Abuzaid, Fatimah Shakir AbuAlsaud, Osama Alomar, Abdullah Alyousef, Ahmed Abu-Zaid and Ismail Abdulrahman Al-Badawi

Medicina 2023, 59(5), 893; https://doi.org/10.3390/medicina59050893 - 6 May 2023

Cited by 2 | Viewed by 2283

Abstract

Background and Objectives: Abdominal hysterectomy is a major surgery that is often associated with pronounced postsurgical pain. The objective of this research is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and nonrandomized comparative trials (NCTs) that have [...] Read more.

Background and Objectives: Abdominal hysterectomy is a major surgery that is often associated with pronounced postsurgical pain. The objective of this research is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and nonrandomized comparative trials (NCTs) that have surveyed the analgesic benefits and morbidity of intraoperative superior hypogastric plexus (SHP) block (intervention) compared with no SHP block (control) during abdominal hysterectomy. Materials and Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, Web of Science, PubMed, Scopus, and Embase were searched from inception until 8 May 2022. The Cochrane Collaboration tool and Newcastle–Ottawa Scale were used to evaluate the risk of bias of RCTs and NCTs, respectively. In a random effects mode, the data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results: Five studies (four RCTs and one NCT) comprising 210 patients (SHP block = 107 and control = 103) were analyzed. The overall postsurgical pain score (n = 5 studies, MD = −1.08, 95% CI [−1.41, −0.75], p < 0.001), postsurgical opioid consumption (n = 4 studies, MD = −18.90 morphine milligram equivalent, 95% CI, [−22.19, −15.61], p < 0.001), and mean time to mobilization (n = 2 studies, MD = −1.33 h, 95% CI [−1.98, −0.68], p < 0.001) were significantly decreased in the SHP block group contrasted with the control arm. Nevertheless, there was no significant variance between both arms regarding operation time, intraoperative blood loss, postsurgical NSAID consumption, and hospital stay. There were no major side effects or sympathetic block-related aftermaths in both groups. Conclusions: During abdominal hysterectomy and receiving perioperative multimodal analgesia, the administration of intraoperative SHP block is largely safe and exhibits better analgesic effects compared to cases without administration of SHP block. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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Other

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7 pages, 1690 KiB

Open AccessCase Report

Incisional Small-Bowel Strangulation after a Caesarean Section: A Case Report

by Agne Plume, Arnoldas Bartusevicius, Saulius Paskauskas, Laura Malakauskiene and Egle Bartuseviciene

Medicina 2024, 60(1), 190; https://doi.org/10.3390/medicina60010190 - 22 Jan 2024

Viewed by 1809

Abstract

Background and Objectives: Every surgical procedure has the possible risk of complications, and caesarean sections (CSs) are no exception. As CS rates are increasing worldwide, being familiar with rare but possible complications has become extremely important. Case report: We present a [...] Read more.

Background and Objectives: Every surgical procedure has the possible risk of complications, and caesarean sections (CSs) are no exception. As CS rates are increasing worldwide, being familiar with rare but possible complications has become extremely important. Case report: We present a case of 25-year-old nulliparous patient who came to our hospital with twin pregnancy for a scheduled induction of labour. An urgent CS was performed due to labour dystocia. On the second postoperative day, the patient started to complain about pain in the epigastrium, but initially showed no signs of bowel obstruction, passing gas, and stools, and could tolerate oral intake. After a thorough examination, an early postoperative complication—small-bowel strangulation at the incision site—was diagnosed. Small bowels protruded in between sutured rectus abdominis muscle causing a strangulation which led to re-laparotomy. During the surgery, there was no necrosis of intestines, bowel resection was not needed, and abdominal wall repair was performed. After re-laparotomy, the patient recovered with no further complications. Conclusions: Although there are discussions about CS techniques, most guidelines recommend leaving rectus muscle unsutured. This case demonstrates a complication which most likely could have been avoided if the rectus muscle had not been re-approximated. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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7 pages, 4710 KiB

Open AccessCase Report

Persistent Reverse End Diastolic Flow in Fetal Middle Cerebral Artery: A Rare Finding with Poor Outcomes

by Dani Setiawan, Johanes Cornelius Mose, Nuniek Kharismawati, Fatima Zahra and Muhammad Gilang Dwi Putra

Medicina 2023, 59(9), 1648; https://doi.org/10.3390/medicina59091648 - 12 Sep 2023

Viewed by 3867

Abstract

Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. Reverse end-diastolic [...] Read more.

Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. Reverse end-diastolic flow in the middle cerebral artery is an advanced hemodynamic event. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain. Reverse flow in the middle cerebral arteries describes the loss of this autoregulatory process. PREDF is a sequence that occurs due to increased extracranial or intracranial pressure. Previous case reports mentioned intracranial hemorrhage, fetal growth restriction, fetal anemia, and fetal hepatic abnormalities as problems leading to PREDF. This condition presumably arises due to cerebral edema associated with severe hypoxemia. We reported Doppler findings of PREDF MCA in a 33-year-old female patient at 30 weeks gestation who was referred to the hospital with severe preeclampsia accompanied by fetal growth restriction and oligohydramnios. A cesarean section was performed due to severe preeclampsia and a low bishop score. Hypotheses on various etiologies and their association with intrauterine/neonatal death as well as the best management still require further investigation. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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14 pages, 2524 KiB

Open AccessSystematic Review

Efficacy and Safety of Preoperative Melatonin for Women Undergoing Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

by Wardah Albzea, Lolwa Almonayea, Marah Aljassar, Mousa Atmeh, Khaled Al Sadder, Yousef AlQattan, Raghad Alhajaji, Hiba AlNadwi, Inaam Alnami and Fatima Alhajaji

Medicina 2023, 59(6), 1065; https://doi.org/10.3390/medicina59061065 - 1 Jun 2023

Viewed by 2373

Abstract

Background: Cesarean section (CS) has been linked to a number of negative effects, such as pain, anxiety, and sleeping problems. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of preoperative melatonin on postoperative outcomes in [...] Read more.

Background: Cesarean section (CS) has been linked to a number of negative effects, such as pain, anxiety, and sleeping problems. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of preoperative melatonin on postoperative outcomes in pregnant women who were scheduled for elective CS. Methods: We systemically searched 4 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) from inception until 10 March 2023. We included randomized controlled trials (RCTs) comparing melatonin and placebo for postoperative outcomes in CS patients. For risk of bias assessment, we used the Cochrane Risk of Bias 2 tool. Continuous variables were pooled as mean difference (MD), and categorical variables were pooled as a risk ratio (RR) with a 95% confidence interval (CI). Results: We included 7 studies with a total of 754 pregnant women scheduled for CS. The melatonin group had a lower pain score (MD = −1.23, 95% CI [−1.94, −0.51], p < 0.001) and longer time to first analgesic request (MD = 60.41 min, 95% CI [45.47, 75.36], p < 0.001) than the placebo group. No difference was found regarding hemoglobin levels, heart rate, mean arterial pressure, total blood loss, or adverse events. Conclusions: Preoperative melatonin may reduce postoperative pain in CS patients without side effects. This research offers a safe and affordable pain management method for this population, which has clinical consequences. Further research is needed to validate these findings and determine the best melatonin dosage and timing. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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