Moustafa Mohamed Abbas, Alaa El Din Hamed El-Feky, Fatma Hassan Abd El-Aal
Objective: Surgical site infections (SSIs) among surgical patients are the most common nosocomial infection, accounting for 38 percent. It is estimated that SSIs develop in 2 to 5 percent of the more than 30 million patients undergoing surgical procedures each year. We aimed to assess the impact of changing sterile gloves at the time of wound closure to reduce SSI in women undergoing elective cesarean section (CS). Patients and Methods: The study was done from February 2023 to July 2023 at Ain Shams University Hospital. 220 Women were randomly distributed and blindly allocated into two groups. Group A (operative glove changing group “n=110”), Group B (usual care group “n=110”). Postoperative febrile morbidity, cellulitis, need for antibiotics for skin- or wound-related infection, and endometritis were compared between study groups. Results: Postoperative wound complications were statistically significantly higher among cases not subject to a change of sterile gloves, 28.0% vs. 9.8%. On the other hand, no differences were noted between study groups regarding operative duration 61.39 ± 7.76 vs. 59.35 ± 8.11 minutes. Conclusion: Changing sterile gloves at the time of wound closure reduces surgical site infection and associated morbidity in women undergoing elective CS.
{"title":"Impact of Changing Sterile Glove at the Time of Wound Closure to Reduce Surgical Site Infection in Women Undergoing Elective Cesarean Section; a Prospective Randomized Controlled Clinical Trial","authors":"Moustafa Mohamed Abbas, Alaa El Din Hamed El-Feky, Fatma Hassan Abd El-Aal","doi":"10.33574/hjog.0563","DOIUrl":"https://doi.org/10.33574/hjog.0563","url":null,"abstract":"Objective: Surgical site infections (SSIs) among surgical patients are the most common nosocomial infection, accounting for 38 percent. It is estimated that SSIs develop in 2 to 5 percent of the more than 30 million patients undergoing surgical procedures each year. We aimed to assess the impact of changing sterile gloves at the time of wound closure to reduce SSI in women undergoing elective cesarean section (CS). Patients and Methods: The study was done from February 2023 to July 2023 at Ain Shams University Hospital. 220 Women were randomly distributed and blindly allocated into two groups. Group A (operative glove changing group “n=110”), Group B (usual care group “n=110”). Postoperative febrile morbidity, cellulitis, need for antibiotics for skin- or wound-related infection, and endometritis were compared between study groups. Results: Postoperative wound complications were statistically significantly higher among cases not subject to a change of sterile gloves, 28.0% vs. 9.8%. On the other hand, no differences were noted between study groups regarding operative duration 61.39 ± 7.76 vs. 59.35 ± 8.11 minutes. Conclusion: Changing sterile gloves at the time of wound closure reduces surgical site infection and associated morbidity in women undergoing elective CS.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"323 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Oluwole, Obodo Chioma Ethel, A. Ugwu, C. Makwe, K. Okunade, E. Owie, Ijeoma Chinenye Ohagwu, Uzoma Chinedu Ifezue, Akase Iorhen, Ngwu Hillary, Ajachukwu Placcid
Background: Coronaviruses are a group of enveloped positive-stranded RNA viruses. They constitute a very important human and animal pathogens. COVID-19, a novel coronavirus was identified towards the end of 2019 following a cluster of pneumonia in Wuhan city in China. Our study aims to document the obstetrics parameters and outcomes of pregnant women diagnosed and managed at the Lagos University Teaching Hospital, Nigeria. Methods: The study was a retrospective review of the medical records of all pregnant women admitted to the Lagos University Teaching Hospital (LUTH) COVID 19 Isolation and Treatment Centre during the first wave (from April 2020 to October 2020) and second wave (from December 2020 to April 2021). The clinical characteristics (including COVID severity) and outcomes were retrieved. Results: During the study period thirty-four pregnant women with suspected COVID-19 symptoms for which nasopharyngeal samples for RTPCR for SARS-CoV-2 nucleic acid were positive were seen and managed following their admission into the isolation ward for COVID-19. Of the 34 women, 50.0% (17) of them were discharged to the antenatal clinic following recovery, 44.1% (15) had childbirth while on admission, and 5.9% (2) had maternal death. Of the 15 deliveries, 14 occurred at term with 15 babies (a set of twins) and one preterm stillbirth. Conclusion: The clinical manifestations of COVID-19 in pregnant mothers are similar to those described in the non-pregnant population as pregnancy does not seem to worsen the severity of the disease. Noticeably, severe infection occurred in women with comorbidities such as asthma and hypertensive disorders.
{"title":"Obstetric Outcomes of pregnant women with Covid-19 infection during first and second waves of Covid Pandemic in Lagos Nigeria","authors":"A. Oluwole, Obodo Chioma Ethel, A. Ugwu, C. Makwe, K. Okunade, E. Owie, Ijeoma Chinenye Ohagwu, Uzoma Chinedu Ifezue, Akase Iorhen, Ngwu Hillary, Ajachukwu Placcid","doi":"10.33574/hjog.0565","DOIUrl":"https://doi.org/10.33574/hjog.0565","url":null,"abstract":"Background: Coronaviruses are a group of enveloped positive-stranded RNA viruses. They constitute a very important human and animal pathogens. COVID-19, a novel coronavirus was identified towards the end of 2019 following a cluster of pneumonia in Wuhan city in China. Our study aims to document the obstetrics parameters and outcomes of pregnant women diagnosed and managed at the Lagos University Teaching Hospital, Nigeria. Methods: The study was a retrospective review of the medical records of all pregnant women admitted to the Lagos University Teaching Hospital (LUTH) COVID 19 Isolation and Treatment Centre during the first wave (from April 2020 to October 2020) and second wave (from December 2020 to April 2021). The clinical characteristics (including COVID severity) and outcomes were retrieved. Results: During the study period thirty-four pregnant women with suspected COVID-19 symptoms for which nasopharyngeal samples for RTPCR for SARS-CoV-2 nucleic acid were positive were seen and managed following their admission into the isolation ward for COVID-19. Of the 34 women, 50.0% (17) of them were discharged to the antenatal clinic following recovery, 44.1% (15) had childbirth while on admission, and 5.9% (2) had maternal death. Of the 15 deliveries, 14 occurred at term with 15 babies (a set of twins) and one preterm stillbirth. Conclusion: The clinical manifestations of COVID-19 in pregnant mothers are similar to those described in the non-pregnant population as pregnancy does not seem to worsen the severity of the disease. Noticeably, severe infection occurred in women with comorbidities such as asthma and hypertensive disorders.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"23 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Pergialiotis, Dimitrios-Efthymios Vlachos, Loukas Feroussis, Vasilios Lygizos, I. Rodolakis, Konstantinos Bramis, E. Zachariou, Georgios Daskalakis, Nikolaos Thomakos, D. Haidopoulos
Background: Splenectomy is a very common procedure that is frequently necessary in cases requiring upper abdominal surgery for ovarian cancer. To date, the impact of postoperative thrombocytosis on ovarian cancer survival has not been studied. In the present retrospective cohort study we chose to evaluate the impact of post-splenectomy thrombocytosis on survival outcomes of patients with advanced epithelial ovarian cancer that were submitted to maximal effort cytoreductive procedures. Methods: We conducted a retrospective cohort study based on cases that had major debulking procedures, involving upper abdominal surgery for epithelial ovarian cancer. Results: Overall, 82 women had splenectomy of whom, 52 (63%) developed thrombocytosis. The results of the univariate analysis revealed that postoperative thrombocytosis did not increase the risk of disease recurrence (62.94 months (31.71, 93.27) vs 31.40 months (21.39, 41.41) log-rank=.683). Similar results were obtained for overall survival of included patients which was comparable among the two groups (87.50 months (53.47, 121.52) vs 47.78 months (34.30, 61.25), log-rank=.511). Logistic regression analysis revealed that only age was a predictive factor of postoperative thrombocytosis with an effect of minimal clinical importance (OR 0.94, 95% CI 0.89, 1.00). Conclusion: Post-splenectomy thrombocytosis does not affect the survival outcomes of patients with advanced epithelial ovarian cancer that undergo major debulking procedures. This might be explained by the underlying mechanisms which in the case of postoperative thrombocytosis seem to be completely disconnected from the pathophysiology of cancer.
背景：脾切除术是一种非常常见的手术，在需要进行上腹部手术治疗卵巢癌的病例中经常需要进行。迄今为止，尚未研究过术后血小板增多对卵巢癌生存率的影响。在本回顾性队列研究中，我们选择评估脾切除术后血小板增多对接受最大努力细胞清除术的晚期上皮性卵巢癌患者生存结果的影响。研究方法我们对因上皮性卵巢癌而接受上腹部手术的大手术切除病例进行了回顾性队列研究。研究结果共有 82 名妇女进行了脾脏切除术，其中 52 人（63%）出现血小板增多。单变量分析结果显示，术后血小板增多并不会增加疾病复发的风险（62.94 个月（31.71，93.27）vs 31.40 个月（21.39，41.41）log-rank=.683）。两组患者的总生存期相似（87.50 个月（53.47，121.52） vs 47.78 个月（34.30，61.25），log-rank=.511）。逻辑回归分析显示，只有年龄是术后血小板增多的一个预测因素，但其临床重要性极低（OR 0.94，95% CI 0.89，1.00）。结论脾切除术后血小板增多并不会影响接受主要切除术的晚期上皮性卵巢癌患者的生存结果。这可能与潜在的机制有关，而术后血小板增多似乎与癌症的病理生理学完全无关。
{"title":"Post-splenectomy thrombocytosis and survival outcomes of patients submitted to maximal effort cytoreductive surgery for advanced epithelial ovarian cancer","authors":"V. Pergialiotis, Dimitrios-Efthymios Vlachos, Loukas Feroussis, Vasilios Lygizos, I. Rodolakis, Konstantinos Bramis, E. Zachariou, Georgios Daskalakis, Nikolaos Thomakos, D. Haidopoulos","doi":"10.33574/hjog.0568","DOIUrl":"https://doi.org/10.33574/hjog.0568","url":null,"abstract":"Background: Splenectomy is a very common procedure that is frequently necessary in cases requiring upper abdominal surgery for ovarian cancer. To date, the impact of postoperative thrombocytosis on ovarian cancer survival has not been studied. In the present retrospective cohort study we chose to evaluate the impact of post-splenectomy thrombocytosis on survival outcomes of patients with advanced epithelial ovarian cancer that were submitted to maximal effort cytoreductive procedures. Methods: We conducted a retrospective cohort study based on cases that had major debulking procedures, involving upper abdominal surgery for epithelial ovarian cancer. Results: Overall, 82 women had splenectomy of whom, 52 (63%) developed thrombocytosis. The results of the univariate analysis revealed that postoperative thrombocytosis did not increase the risk of disease recurrence (62.94 months (31.71, 93.27) vs 31.40 months (21.39, 41.41) log-rank=.683). Similar results were obtained for overall survival of included patients which was comparable among the two groups (87.50 months (53.47, 121.52) vs 47.78 months (34.30, 61.25), log-rank=.511). Logistic regression analysis revealed that only age was a predictive factor of postoperative thrombocytosis with an effect of minimal clinical importance (OR 0.94, 95% CI 0.89, 1.00). Conclusion: Post-splenectomy thrombocytosis does not affect the survival outcomes of patients with advanced epithelial ovarian cancer that undergo major debulking procedures. This might be explained by the underlying mechanisms which in the case of postoperative thrombocytosis seem to be completely disconnected from the pathophysiology of cancer.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"153 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: A higher risk of birth defects in assisted reproductive technologies (ART) pregnancies compared to natural pregnancies has been previously reported. Objective: This retrospective study aimed to explore the association of male-factor related infertility with first-trimester anomalies, aneuploidy, and biochemical markers in infertile patients undergoing ART. Method: The complete medical records of infertile patients referred to the infertility and prenatal centers in Ahvaz, Iran during the past five years were assessed, which included ART-induced pregnancies due to male factors (n=124) and or other infertility causes (n=176). Results: The most common causes of infertility were respectively the male factor (41.3%), ovulation disorders (26%), and unexplained factors (13.3%). A significant correlation was found between the infertility causes and the history underlying systemic diseases and medication history (p<0.05). The serum levels of MoM β‐hCG and PAPP-A were significantly lower in the male factor-related infertilities than non-male factor-related infertilities (p=0.0001). The rate of fetal and placental anomalies was significantly higher in male factor-related infertilities than non-male factor-related infertilities (p=0.03). However, according to the results of multivariable logistic regression, association between the male factor-related infertility and fetal/placental anomalies was not independent of the effects of low levels of MoM β‐hCG and PAPP-A. Conclusion: Causes of infertility, particularly male factor, together with low levels of MoM β‐hCG and PAPP-A, might be associated with the high risk of fetal and placental anomalies in ART pregnancies. However, further large-scale multi-center and prospective investigations are needed to reach more accurate conclusion.
背景：以前曾有报道称，与自然妊娠相比，辅助生殖技术（ART）妊娠出现出生缺陷的风险更高。研究目的这项回顾性研究旨在探讨接受 ART 的不孕患者中，与男性因素相关的不孕症与第一胎畸形、非整倍体和生化指标的关联。研究方法对过去五年中转诊至伊朗阿瓦士市不孕不育和产前中心的不孕不育患者的完整病历进行评估，其中包括因男性因素（124 例）或其他不孕原因（176 例）导致的 ART 诱导妊娠。结果显示最常见的不孕原因分别是男性因素（41.3%）、排卵障碍（26%）和不明原因（13.3%）。不孕原因与基础系统疾病史和用药史之间存在明显相关性（P<0.05）。男性因素相关不孕症患者的血清 MoM β-hCG 和 PAPP-A 水平明显低于非男性因素相关不孕症患者（P=0.0001）。男性因素相关性不孕症的胎儿和胎盘异常率明显高于非男性因素相关性不孕症（P=0.03）。然而，根据多变量逻辑回归的结果，男性因素相关不孕症与胎儿/胎盘畸形之间的关联并不独立于低水平 MoM β-hCG 和 PAPP-A 的影响。结论不孕的原因，尤其是男性因素，加上低水平的 MoM β-hCG 和 PAPP-A，可能与 ART 妊娠中胎儿和胎盘异常的高风险有关。然而，要得出更准确的结论，还需要进一步开展大规模的多中心前瞻性研究。
{"title":"Exploring the association of male-factor related infertility with first-trimester anomalies, aneuploidy, and biochemical markers in infertile patients undergoing ART","authors":"M. Zargar, Batool Asarzadeh, M. Barati","doi":"10.33574/hjog.0562","DOIUrl":"https://doi.org/10.33574/hjog.0562","url":null,"abstract":"Background: A higher risk of birth defects in assisted reproductive technologies (ART) pregnancies compared to natural pregnancies has been previously reported. Objective: This retrospective study aimed to explore the association of male-factor related infertility with first-trimester anomalies, aneuploidy, and biochemical markers in infertile patients undergoing ART. Method: The complete medical records of infertile patients referred to the infertility and prenatal centers in Ahvaz, Iran during the past five years were assessed, which included ART-induced pregnancies due to male factors (n=124) and or other infertility causes (n=176). Results: The most common causes of infertility were respectively the male factor (41.3%), ovulation disorders (26%), and unexplained factors (13.3%). A significant correlation was found between the infertility causes and the history underlying systemic diseases and medication history (p<0.05). The serum levels of MoM β‐hCG and PAPP-A were significantly lower in the male factor-related infertilities than non-male factor-related infertilities (p=0.0001). The rate of fetal and placental anomalies was significantly higher in male factor-related infertilities than non-male factor-related infertilities (p=0.03). However, according to the results of multivariable logistic regression, association between the male factor-related infertility and fetal/placental anomalies was not independent of the effects of low levels of MoM β‐hCG and PAPP-A. Conclusion: Causes of infertility, particularly male factor, together with low levels of MoM β‐hCG and PAPP-A, might be associated with the high risk of fetal and placental anomalies in ART pregnancies. However, further large-scale multi-center and prospective investigations are needed to reach more accurate conclusion.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"263 11‐15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mostafa Hassan Ragab, Mohamed Elsherbiny Hamed, Waleed Hitlar Ahmed
Aim: The main goal is to identify the pathognomonic sonographic signs for foetal SARS-CoV-2 infection and to determine whether or not transplacental SARS-CoV-2 transmission is possible. Patients and Methods: In total, 105 pregnant women with positive SARS-CoV-2 PCR swabs during the first trimester with mild or moderate infection without hospitalisation and/or oxygen support were included in this prospective comparative study, which was carried out at the ultrasound and foetal medicine unit of Ain Shams University Maternity Hospital from January 2021 to June 2023. The SARS-CoV-2 positive group was compared to the control group with inclusion and exclusion criteria. Results: In the COVID-19 group, pathognomonic ultrasonographic results were considerably more common. The COVID-19 group had a considerably higher frequency of placental calcifications and oligohydramnios. In the COVID-19 cohort, patients with positive pathognomonic ultrasonographic results had considerably higher BMIs. In the COVID-19 cohort, gestational age at infection, and BMI ≥30.0 kg/m2 were significant independent risk factors for the development of pathognomonic ultrasonographic abnormalities. Those in the control group who had positive pathognomonic ultrasonographic results were older and had higher rates of hypertension. Significant independent risk variables for the incidence of pathognomonic ultrasonographic findings in the control group included age ≥34.0 years and hypertension. Conclusion: There is no evidence of a teratogenic effect linked to maternal SARS-CoV-2 infection during the first few months of pregnancy. However, early pregnancy infection with COVID-19 is linked to pathognomonic ultrasonography findings of placental calcifications and oligohydramnios.
{"title":"The Pathognomonic ultrasonographic findings in fetus with COVID-19 infection","authors":"Mostafa Hassan Ragab, Mohamed Elsherbiny Hamed, Waleed Hitlar Ahmed","doi":"10.33574/hjog.0567","DOIUrl":"https://doi.org/10.33574/hjog.0567","url":null,"abstract":"Aim: The main goal is to identify the pathognomonic sonographic signs for foetal SARS-CoV-2 infection and to determine whether or not transplacental SARS-CoV-2 transmission is possible. Patients and Methods: In total, 105 pregnant women with positive SARS-CoV-2 PCR swabs during the first trimester with mild or moderate infection without hospitalisation and/or oxygen support were included in this prospective comparative study, which was carried out at the ultrasound and foetal medicine unit of Ain Shams University Maternity Hospital from January 2021 to June 2023. The SARS-CoV-2 positive group was compared to the control group with inclusion and exclusion criteria. Results: In the COVID-19 group, pathognomonic ultrasonographic results were considerably more common. The COVID-19 group had a considerably higher frequency of placental calcifications and oligohydramnios. In the COVID-19 cohort, patients with positive pathognomonic ultrasonographic results had considerably higher BMIs. In the COVID-19 cohort, gestational age at infection, and BMI ≥30.0 kg/m2 were significant independent risk factors for the development of pathognomonic ultrasonographic abnormalities. Those in the control group who had positive pathognomonic ultrasonographic results were older and had higher rates of hypertension. Significant independent risk variables for the incidence of pathognomonic ultrasonographic findings in the control group included age ≥34.0 years and hypertension. Conclusion: There is no evidence of a teratogenic effect linked to maternal SARS-CoV-2 infection during the first few months of pregnancy. However, early pregnancy infection with COVID-19 is linked to pathognomonic ultrasonography findings of placental calcifications and oligohydramnios.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"32 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elpida Ralli, Kyriaki Mitta, Eirini Toulika, I. Tsakiridis, A. Mamopoulos, I. Kalogiannidis, A. Athanasiadis, T. Dagklis
Introduction: There has been a notable worldwide rise in the percentage of women delivering via cesarean section. Although cesarean section is generally considered safe, there is a possibility of significant health risks and even mortality associated with it. The aim of this study was to collect pertinent data on the perspectives of healthcare providers, particularly obstetricians, who are involved in the field of labor and delivery in Greece, regarding the choice of Trial Of Labor After Cesarean (TOLAC). Material and Methods: This was a cross-sectional study, conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; obstetricians were interviewed via certain questionnaires. Detailed analysis of the different characteristics regarding obstetricians’ background, workplace, preferences, willingness to take risks and safety concerns was conducted. These variables were compared and correlation between them was thoroughly investigated. Results: In total, 333 responses to the questionnaire were collected through Google online forms. Few obstetricians seem to enjoy taking risks, while most of them are neutral and willing to perform a planned TOLAC. It seems that as the experience of obstetricians increases, their tendency to recommend TOLAC on their own does not increase. The majority of obstetricians who had a failed TOLAC were more negative than those who had not had a failed attempt; whereas, they were willing to undertake TOLAC when the time required to transfer the women from the labor ward to the operating table was the minimum possible. Concerning the security as an important element in every aspect of obstetricians’ lives, the majority of them responded neutrally or positively. Following gender analysis, results showed that both male and female obstetricians were neutral or would avoid situations that have an uncertain outcome. Conclusion: Obstetricians and healthcare providers are willing to offer TOLAC as an option, provided that certain criteria are met and safety considerations are addressed. Finally, the acceptance and practice of TOLAC may vary between different regions, hospitals and individual healthcare providers.
{"title":"Obstetrical attitude towards performing a trial of labor after cesarean section in Greece: A cross-sectional study","authors":"Elpida Ralli, Kyriaki Mitta, Eirini Toulika, I. Tsakiridis, A. Mamopoulos, I. Kalogiannidis, A. Athanasiadis, T. Dagklis","doi":"10.33574/hjog.0564","DOIUrl":"https://doi.org/10.33574/hjog.0564","url":null,"abstract":"Introduction: There has been a notable worldwide rise in the percentage of women delivering via cesarean section. Although cesarean section is generally considered safe, there is a possibility of significant health risks and even mortality associated with it. The aim of this study was to collect pertinent data on the perspectives of healthcare providers, particularly obstetricians, who are involved in the field of labor and delivery in Greece, regarding the choice of Trial Of Labor After Cesarean (TOLAC). Material and Methods: This was a cross-sectional study, conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; obstetricians were interviewed via certain questionnaires. Detailed analysis of the different characteristics regarding obstetricians’ background, workplace, preferences, willingness to take risks and safety concerns was conducted. These variables were compared and correlation between them was thoroughly investigated. Results: In total, 333 responses to the questionnaire were collected through Google online forms. Few obstetricians seem to enjoy taking risks, while most of them are neutral and willing to perform a planned TOLAC. It seems that as the experience of obstetricians increases, their tendency to recommend TOLAC on their own does not increase. The majority of obstetricians who had a failed TOLAC were more negative than those who had not had a failed attempt; whereas, they were willing to undertake TOLAC when the time required to transfer the women from the labor ward to the operating table was the minimum possible. Concerning the security as an important element in every aspect of obstetricians’ lives, the majority of them responded neutrally or positively. Following gender analysis, results showed that both male and female obstetricians were neutral or would avoid situations that have an uncertain outcome. Conclusion: Obstetricians and healthcare providers are willing to offer TOLAC as an option, provided that certain criteria are met and safety considerations are addressed. Finally, the acceptance and practice of TOLAC may vary between different regions, hospitals and individual healthcare providers.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"20 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. I. Kamel, H. M. Samour, M. F. Gomaa, S. A. Mohamed
Background: Laparoscopic hysterectomy patients report high levels of postoperative pain and inadequate pain relief. This minimally invasive procedure is difficult to manage and leads to increased opioid use, limited mobility, and higher risks of complications, delayed rehabilitation and prolonged hospital stay. Objective: To determine the analgesic efficacy of bupivacaine’s intraperitoneal instillation (IP) with dexmedetomidine as an adjuvant for postoperative pain management in laparoscopic hysterectomy. Methods: This study is a randomized control clinical trial done at the Obstetrics and Gynecology Department, Ain Shams University Hospital, within 11 months (from September 2021 to August 2022). This study’s target population was all patients enrolled in laparoscopic hysterectomy. A total of 30 patients participated in this study, and we randomly divided it into two groups equally (15 patients per group). Results: There was no significant difference between groups regarding body mass index, age, parity, obstetric history, medical history, surgical history, indication of hysterectomy, type of hysterectomy, duration of surgery, and uterus size. Visual analog scores for patients at 1-, 6-, 12-, and 24-hours post-operatively increased significantly in Group B than in Group A. Furthermore, the time required for first rescue analgesia increased significantly more in Group A than in Group B. Group A required substantially less analgesic amount than Group B. Group A had significantly shorter hospital stays than Group B. There was no statistically significant difference between groups A and B in terms of adverse effects like nausea and vomiting (p>0.05) although they were less frequent in group A. Conclusion: Intraperitoneal instillation of bupivacaine combined with dexmedetomidine during laparoscopic hysterectomy substantially reduces postoperative pain and the requirement for analgesics in the postoperative period, compared to the control group, with no adverse side effects.
{"title":"Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy: Randomized Controlled Trial","authors":"O. I. Kamel, H. M. Samour, M. F. Gomaa, S. A. Mohamed","doi":"10.33574/hjog.0566","DOIUrl":"https://doi.org/10.33574/hjog.0566","url":null,"abstract":"Background: Laparoscopic hysterectomy patients report high levels of postoperative pain and inadequate pain relief. This minimally invasive procedure is difficult to manage and leads to increased opioid use, limited mobility, and higher risks of complications, delayed rehabilitation and prolonged hospital stay. Objective: To determine the analgesic efficacy of bupivacaine’s intraperitoneal instillation (IP) with dexmedetomidine as an adjuvant for postoperative pain management in laparoscopic hysterectomy. Methods: This study is a randomized control clinical trial done at the Obstetrics and Gynecology Department, Ain Shams University Hospital, within 11 months (from September 2021 to August 2022). This study’s target population was all patients enrolled in laparoscopic hysterectomy. A total of 30 patients participated in this study, and we randomly divided it into two groups equally (15 patients per group). Results: There was no significant difference between groups regarding body mass index, age, parity, obstetric history, medical history, surgical history, indication of hysterectomy, type of hysterectomy, duration of surgery, and uterus size. Visual analog scores for patients at 1-, 6-, 12-, and 24-hours post-operatively increased significantly in Group B than in Group A. Furthermore, the time required for first rescue analgesia increased significantly more in Group A than in Group B. Group A required substantially less analgesic amount than Group B. Group A had significantly shorter hospital stays than Group B. There was no statistically significant difference between groups A and B in terms of adverse effects like nausea and vomiting (p>0.05) although they were less frequent in group A. Conclusion: Intraperitoneal instillation of bupivacaine combined with dexmedetomidine during laparoscopic hysterectomy substantially reduces postoperative pain and the requirement for analgesics in the postoperative period, compared to the control group, with no adverse side effects.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"37 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Koutras, Z. Fasoulakis, G. Asimakopoulos, K. Tasias, G. Daskalakis, M. Theodora, P. Antsaklis
Isolated dextrogastria is an uncommon congenital abnormality defined by rightward stomach rotation. Although it was usually thought to be a harmless discovery with no long-term implications, potential connections with other congenital malformations have been documented. In our case, a 30-year-old primigravida’s fetus with isolated dextrogastria and an abdominal cyst gave birth at 38 weeks of pregnancy and later received a biliary atresia diagnosis. This case report contributes to the expanding collection of literature on solitary dextrogastria and highlights the importance of ongoing monitoring for any related anomalies and long-term repercussions.
{"title":"A Case Report Of An Isolated Dextrogastria Diagnosed In First Trimester Ultrasound Screening","authors":"A. Koutras, Z. Fasoulakis, G. Asimakopoulos, K. Tasias, G. Daskalakis, M. Theodora, P. Antsaklis","doi":"10.33574/hjog.0569","DOIUrl":"https://doi.org/10.33574/hjog.0569","url":null,"abstract":"Isolated dextrogastria is an uncommon congenital abnormality defined by rightward stomach rotation. Although it was usually thought to be a harmless discovery with no long-term implications, potential connections with other congenital malformations have been documented. In our case, a 30-year-old primigravida’s fetus with isolated dextrogastria and an abdominal cyst gave birth at 38 weeks of pregnancy and later received a biliary atresia diagnosis. This case report contributes to the expanding collection of literature on solitary dextrogastria and highlights the importance of ongoing monitoring for any related anomalies and long-term repercussions.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"92 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Proshchenko, I. Ventskivska, Serhii Vasyliuk, A. Mykytiuk
Background and aims. The principles of enhanced recovery in operative gynecology, comorbidity, and a multimodal approach in perioperative support require comprehensive study and optimization, and the ambiguity of literature reports determines the relevance of this study. The aim of this study was to evaluate the parameters of perioperative monitoring after hysterectomy for uterine leiomyoma in patients of reproductive age using enhanced recovery after surgery protocols and their impact on quality of life indicators. Materials and methods. To evaluate the effectiveness of the enhanced recovery protocol after hysterectomy, two groups were formed: the main prospective group, which included 46 patients, who underwent vaginal hysterectomy without appendages and 36 patients with abdominal hysterectomy, who used enhanced recovery after surgery (ERAS) protocols. The comparison group (group of standard management) included 44 patients who underwent vaginal hysterectomy without appendages and 34 patients with abdominal hysterectomy. The main parameters of monitoring were the postoperative pain level, intraoperative blood loss, diuresis rate, the timing of urinary catheter removal and recovery of peristalsis, as well as individual activation of motor activity. Results. When using the principles of ERAS, the quantitative assessment of pain level (“absence of pain”) was 1.6 times more severe compared to the data of the comparison group; the timing of urinary catheter removal was 2.0 times shorter, drain removal – 2.7 times shorter, recovery of peristalsis – 1.9 times shorter and individual activation of motor activity – 2.9 times earlier than in patients of the comparison group. Conclusions. Studies have demonstrated the feasibility of using laparoscopic technology in combination with the ERAS, which demonstrates a fall in the volume of intraoperative blood loss, a decrease in blood and fluid balance, a shortening of the time of invasive intravascular intervention, allows to improve the course of the early postoperative period, relieve postoperative pain syndrome, reduce the risk of intestinal paresis, shorten the rehabilitation period, and, as a result, improve quality of life indicators.
{"title":"Accelerated rehabilitation after hysterectomy in reproductive age patients","authors":"O. Proshchenko, I. Ventskivska, Serhii Vasyliuk, A. Mykytiuk","doi":"10.33574/hjog.0526","DOIUrl":"https://doi.org/10.33574/hjog.0526","url":null,"abstract":"Background and aims. The principles of enhanced recovery in operative gynecology, comorbidity, and a multimodal approach in perioperative support require comprehensive study and optimization, and the ambiguity of literature reports determines the relevance of this study. The aim of this study was to evaluate the parameters of perioperative monitoring after hysterectomy for uterine leiomyoma in patients of reproductive age using enhanced recovery after surgery protocols and their impact on quality of life indicators. Materials and methods. To evaluate the effectiveness of the enhanced recovery protocol after hysterectomy, two groups were formed: the main prospective group, which included 46 patients, who underwent vaginal hysterectomy without appendages and 36 patients with abdominal hysterectomy, who used enhanced recovery after surgery (ERAS) protocols. The comparison group (group of standard management) included 44 patients who underwent vaginal hysterectomy without appendages and 34 patients with abdominal hysterectomy. The main parameters of monitoring were the postoperative pain level, intraoperative blood loss, diuresis rate, the timing of urinary catheter removal and recovery of peristalsis, as well as individual activation of motor activity. Results. When using the principles of ERAS, the quantitative assessment of pain level (“absence of pain”) was 1.6 times more severe compared to the data of the comparison group; the timing of urinary catheter removal was 2.0 times shorter, drain removal – 2.7 times shorter, recovery of peristalsis – 1.9 times shorter and individual activation of motor activity – 2.9 times earlier than in patients of the comparison group. Conclusions. Studies have demonstrated the feasibility of using laparoscopic technology in combination with the ERAS, which demonstrates a fall in the volume of intraoperative blood loss, a decrease in blood and fluid balance, a shortening of the time of invasive intravascular intervention, allows to improve the course of the early postoperative period, relieve postoperative pain syndrome, reduce the risk of intestinal paresis, shorten the rehabilitation period, and, as a result, improve quality of life indicators.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128304060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Chatziioannou, Z. Fasoulakis, M. Theodora, G. Daskalakis, P. Antsaklis
Backround: The term “hydrops fetalis” refers to excessive accumulation of pathologic serous fluid within the fetal soft tissues and body cavities. There are two categories, the immune and the nonimmune hydrops (NIHF). Currently 90 percent of cases of hydrops are nonimmune, because of the decrease of incidence of immune with the advent of anti-D immune globulin. Case presentation: We present a case of Parvovirus B19 (PB19) infection that resulted in NIHF. Fetus had severe ascites, mild pericardial effusion and mild myocardial dilation, that appeared during the 30th gestational week. Fetal evaluation with sonography was repeated every week and the fetal growth curves, Dopplers and amniotic fluid index were normal. Each week there was a gradual recession of the effusions until the 36th gestational week, when they eventually resolved without any treatment. After delivery, the neonate was symptom – free. Conclusions: The cause of NIHF is identified in at least 60 percent prenatally and in more than 80 percent postnatally, while only 40 percent of pregnancies with NIHF result in a liveborn neonate. The prognosis is heavily dependent on etiology. Diaplacental transmission of PB19 on second trimester can cause fetal complications like hydrops, premature rapture of membranes, even fetal loss in about 30 percent. These cases should be closely followed in a Fetal Medicine Unit, especially if there is evidence of fetal anemia or hydrops.
{"title":"Non immune hydrops fetalis due to Parvovirus B19 infection. A case report","authors":"M. Chatziioannou, Z. Fasoulakis, M. Theodora, G. Daskalakis, P. Antsaklis","doi":"10.33574/hjog.0527","DOIUrl":"https://doi.org/10.33574/hjog.0527","url":null,"abstract":"Backround: The term “hydrops fetalis” refers to excessive accumulation of pathologic serous fluid within the fetal soft tissues and body cavities. There are two categories, the immune and the nonimmune hydrops (NIHF). Currently 90 percent of cases of hydrops are nonimmune, because of the decrease of incidence of immune with the advent of anti-D immune globulin. Case presentation: We present a case of Parvovirus B19 (PB19) infection that resulted in NIHF. Fetus had severe ascites, mild pericardial effusion and mild myocardial dilation, that appeared during the 30th gestational week. Fetal evaluation with sonography was repeated every week and the fetal growth curves, Dopplers and amniotic fluid index were normal. Each week there was a gradual recession of the effusions until the 36th gestational week, when they eventually resolved without any treatment. After delivery, the neonate was symptom – free. Conclusions: The cause of NIHF is identified in at least 60 percent prenatally and in more than 80 percent postnatally, while only 40 percent of pregnancies with NIHF result in a liveborn neonate. The prognosis is heavily dependent on etiology. Diaplacental transmission of PB19 on second trimester can cause fetal complications like hydrops, premature rapture of membranes, even fetal loss in about 30 percent. These cases should be closely followed in a Fetal Medicine Unit, especially if there is evidence of fetal anemia or hydrops.","PeriodicalId":194739,"journal":{"name":"Hellenic Journal of Obstetrics and Gynecology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134028254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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