Volume 4 Issue 2

Research Article: Early Versus Traditional Oral Hydration after Cesarean Section

Karim Ahmed Wahba, Bassem Aly Islam and Mohamed Hassan*

Background: Traditionally, Patients are not given fluids or food after abdominal surgery until bowel functions returns, as by bowel sounds, passage of flatus or stool, or a feeling of hunger, Early versus Traditional oral hydration have been studied to evaluate prospectively the benefits and safety of early hydration on bowel movement after Cesarean Section.
Aim of the work: To evaluate prospectively the benefits and safety of early hydration on bowel movement after Cesarean Section.
Patients and methods: The current study was carried out at Ain Shams University Maternity Hospital on (290) pregnant women with term singleton pregnancy, uncomplicated Elective LSCS, time of CS doesn't exceed 90 Minutes, average blood loss during and after CS (doesn't exceed 1000cc), All patients will be under spinal anesthesia, during a period from March 01, 2018 to June 30, 2018.
Results: The current study showed that among study groups: time to first intestinal sounds and time to first bowel movement were significantly shorter in early group (3.8 ± 1.0 and 10.0 ± 1.9, respectively), compared to (8.1 ± 1.7 and 15.0 ± 2.1, respectively) in traditional group. Also, amount of given IV fluids was significantly lower (2000 ml) compared to (3250 ml) in traditional group. Pain perception was significantly lower in early group compared to traditional group (3.8 ± 0.8 and 4.5 ± 0.9, respectively). Also, postoperative hospital stay was significantly shorter in early group than traditional group (11.6 ± 1.7 and 16.5 ± 2.2, respectively). Among patients with early hydration 16 cases (11%) needed extra analgesics, 42 cases (29%) suffered from anorexia, 39 cases (26.9%) suffered from nausea, 34 cases (23.4%) suffered from vomiting, 12 cases (8.1%) suffered from abdominal distension, While among the traditional group, 22 cases (15.2%) needed extra analgesics, 35 cases (24.1%) suffered from anorexia, 32 cases (22.1% suffered from vomiting, 27 cases (18.6%) suffered from vomiting, 25 cases (17.2%) suffered from abdominal distension.
No cases of paralytic ileus had been recorded among study groups.
Conclusion: Early oral hydration after C.S was beneficial and safe on bowel movement, as it was associated with faster return of bowel sounds, shorter time to bowel movement, less pain perception, higher satisfaction, less post-operative distension and earlier hospital discharge.
Recommendations: Early oral hydration can be conducted safely after caesarean delivery. More population should be investigated for more global evaluation.

Cite this Article: Wahba KA, Islam BA, Hassan M. Early Versus Traditional Oral Hydration after Cesarean Section. Int J Reprod Med Gynecol. 2018;4(2): 052-058.

Published: 14 August 2018

Research Article: Risk Factors of Surgical Site Infection of Cesarean Section and Role of Skin Cleansing and Prophylactic Antibiotic

Ameer Abdallah* and Mohamed El Sayed Rafeek

Background/Objective: The purpose of this study was to discuss some risk factors which may increase risk of infectious morbidity after cesarean section despite of applying prophylactic measures including skin cleansing and prophylactic antibiotic.
Methods: This single randomized controlled study was conducted at the Obstetrics and Gynecology department, El Minya general hospital, El Minya, Egypt, from January 2017 to January 2018. Women included in the study were: women undergoing cesarean delivery, both elective and non-elective, women with rupture of membrane and labor contractions, all maternal ages and parities, both single and multiple pregnancies. Skin cleansing with povidone-iodine was applied and antibiotic was administered to all women just before cesarean section was done. Patients were discharged after 24 hours and were recommended to re-visit on day 7 after CS and that's when our first clinical evaluation of surgical wound was performed. A second wound evaluation was scheduled on day 14. In order to assess whether individual pre-, peri- and post-operative variables affect the development of surgical site infection in women undergoing CS, a logistic regression model with forward selection was designed. The model included the following variables: age, parity, gestational age, BMI, pre-gestational or gestational diabetes mellitus, chronic or pregnancy-induced hypertension, previous CS, mode of CS, and duration of surgery. The primary outcome in this study was development of superficial or deep surgical site infection within the first 14 days after a CS.
Results: Among 1500 mothers included in the study, 250 (16.7 %) women developed SSI. The odds of SSI was increased by 9.441(95% CI: 5.872-15.180) among mothers who had prolonged rupture of membrane. Diabetic mothers were at higher risk for developing SSI with OR 7.384(95% CI: 4.591-11.874). Increasing BMI was associated with SSI with OR 1.478(95% CI: 1.388-1.573). Prolonged duration of surgery was associated with SSI with OR of 1.048 (95% CI: 1.018-1.079).
Conclusions: In view of these results, a list of factors including prolonged labor and prolonged rupture of membrane, long duration of surgery, increase in BMI and presence of DM were associated with SSI. Clinicians should consider earlier or more frequent postoperative follow-up in case of presence of one or more of these factors in patients to monitor for wound complications

Cite this Article: Abdallah A, Sayed Rafeek ME. Risk Factors of Surgical Site Infection of Cesarean Section and Role of Skin Cleansing and Prophylactic Antibiotic. Int J Reprod Med Gynecol. 2018;4(2): 047-051.

Published: 08 August 2018

Research Article: Endometrial Estrogen and Progesterone Receptor Expression in Women with Abnormal Uterine Bleeding in the Reproductive Age

Ahmed M. Mostafa1*, Nashwa Elsaid2, Ragaa A. Fawzy3 and Alaa Elfeky2

Introduction: Abnormal uterine bleeding is a common complaint that has negative impacts on the quality of life in females. Estrogen and progesterone hormones mediate the endometrium proliferative activity through certain receptors.
Objective: To quantitatively investigate the estrogen receptor alpha and progesterone receptor distribution in the endometrium of women complaining of abnormal uterine bleeding.
Study Design: Sixty females were included in this study. They were divided into 2 groups; 30 females each. Group I was considered control and group II included females with abnormal uterine bleeding of non-structural cause. Endometrial specimens were obtained from all females and immunohistochemically examined for the distribution Estrogen Receptor alpha (ER alpha) and Progesterone Receptor (PR) expression.
Results: Results showed that ER alpha expression is significantly higher in the endometrial glands as compared to stroma while PR expression is significantly higher in the endometrial stroma than the endometrial glands. The endometrial glands of females with abnormal uterine bleeding appeared relatively wider and longer. There was a significant increase in estrogen receptor alpha and progesterone receptor expression in the cells lining the endometrial glands and in the stroma cells in females with abnormal uterine bleeding as compared to the females of the control group.
Conclusion: Women in the reproductive age who are complaining of abnormal uterine bleeding, usually have an increase in ER alpha and PR expression in their endometrium.
Recommendation: It is recommended to take endometrial specimens from females with abnormal uterine bleeding to examine their content of estrogen and progesterone receptors and to do clinical trials to see if they will respond to hormonal medical treatment.

Cite this Article: Mostafa AM, Elsaid N, Fawzy RA, Elfeky A. Endometrial Estrogen and Progesterone Receptor Expression in Women with Abnormal Uterine Bleeding in the Reproductive Age. Int J Reprod Med Gynecol. 2018;4(2): 041-046.

Published: 02 August 2018

Research Article: Can Schistocytes Percentage in the Peripheral Blood Smear Predict Cases of Thrombotic Thrombocytopenic Purpura in Women Provisionally Diagnosed as HELLP Syndrome?

Ayman M. Abdelkader*, Ahmed H. Naguib, Mohammed A. Faris, Nermine Elserwi, Mohamed Abdel Fattah El Senity, Rasha Abd El Rahman El Gamal and Shimaa B. Mohammed

The syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP syndrome) is a serious and unclear disease. But, most patients will show evidence of improvement from the disease progress within 48 hours after delivery. However, Thrombotic Thrombocytopenic Purpura (TTP) which mimic the same clinical and biochemical findings of HELLP syndrome will lead to a worsening clinical picture. Schistocytes present in the peripheral blood film in almost all women with Thrombotic Microangiopathy Syndrome (TMA) including both HELLP syndrome and TTP. However, the schistocytes percentage is significantly higher in case of TTP. Nevertheless, until now there is no agreed protocol on how to early differentiate between both conditions in order to initiate the proper treatment which will reduce the maternal morbidity and mortality.
Synopsis: Schistocytes percentage in cases provisionally diagnosed as HELLP Syndrome might predict and red flag cases with TTP for early multidisciplinary team management.
Material and methods: The study was carried out at Ain Shams University Maternity Hospital. All patient with a provisional diagnosis of HELLP syndrome admitted in 2015 were recruited and tested for the schistocytes percentage just before delivery and then subsequently divided into two groups according to whether the condition improved or not after 48 hours of delivery.
Results: Schistocytes percentages predelivery were significantly higher in women with suspected TTP, and were exceptionally high in women who died.
Conclusion: Schistocytes percentage in peripheral blood smear in cases provisional diagnosed as HELLP Syndrome might predict cases of sustained symptoms in order to red flag cases of possible thrombotic microangiopathy as TTP/HUS who will benefit from early diagnosis and multidisciplinary team management.

Cite this Article: Abdelkader AM, Naguib AH, Faris MA, Elserwi N, El Senity MAF, et al. Can Schistocytes Percentage in the Peripheral Blood Smear Predict Cases of Thrombotic Thrombocytopenic Purpura in Women Provisionally Diagnosed as HELLP Syndrome? Int J Reprod Med Gynecol. 2018;4(2): 034-040.

Published: 30 July 2018

Research Article: Stress and Depression during Assisted Reproductive Technology Treatment - Need for Infertility Counselling

S. Thenmozhi, Saraswathi Bhaskar* and K.S. Kavitha Gautham

Infertility is considered as a basic health issue in human reproductive care. It is clinically defined as a failure to achieve natural pregnancy after twelve or more months of regular unprotected sexual intercourse [1]. Research states that there are approximately 9% of couple's worldwide experiencing involuntary childlessness [2]. Infertility has been ranked as one of the greatest sources of stress in a person's life, comparable to a somatic disease such as cancer [3]. It is believed that stress experienced due to Assisted Reproductive Technology (ART) treatment can be ranked second to that the death of a family member or divorce [4,5].

Cite this Article: Thenmozhi S, Bhaskar S, Kavitha Gautham KS. Stress and Depression during Assisted Reproductive Technology Treatment - Need for Infertility Counselling. Int J Reprod Med Gynecol. 2018;4(2): 028-033.

Published: 12 July 2018

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