Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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The objective of this study is to document the anaesthetic preference of pregnant women in two tertiary institutions in North-eastern Nigeria. This was a cross-sectional study of pregnant women seen at the antenatal clinics of the university of Maiduguri teaching hospital and Federal Medical Centre, Yola, from August to October 2009. A total of 254 women were interviewed. ⋯ Only age (p = 0.000, OR 8.17, CI = 0.000-1.00) retained significance after multivariate analysis. Considering the fact that the global trend is towards regional anaesthesia due to lower morbidity and mortality, the high preference for general anaesthesia in our survey is worrisome. Health education during antenatal clinics should highlight the superiority of regional over general anaesthesia for caesarean delivery.
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Randomized Controlled Trial
Does saline irrigation reduce the wound infection in caesarean delivery?
The aim of this prospective randomised study was to estimate the effect of saline wound irrigation before wound closure in the prevention of infection following caesarean delivery. Participants with indications for elective or emergency caesarean section were randomly allocated to two groups. A total of 260 women who underwent wound irrigation before wound closure and 260 did not. ⋯ There were also no significant differences between the groups in terms of factors known to influence wound infection. The incidence of wound infection was 7.3% for the control group and 6.5% for the saline group; however, the difference was not significant (relative risk: 0.88; 95% confidence interval: 0.45-1.74; p=0.86). In conclusion, saline wound irrigation before wound closure did not reduce the infection rate in patients undergoing caesarean delivery.
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Randomized Controlled Trial
Randomised clinical trial of the influence of pulmonary recruitment manoeuvre on reducing shoulder pain after laparoscopy.
Shoulder pain after laparoscopy is common and its probable mechanism is residual CO(2) gas after surgery. The aim of this study was to examine the effect of pulmonary recruitment manoeuvre which means pulmonary inflation with positive pressure of 40 cm H(2)O to remove gas and reduction of shoulder pain after gynaecological laparoscopic surgery. A double-blind clinical trial on 146 patients for minor gynaecological laparoscopy was performed from May 2008 to February 2009. ⋯ Pain scores in the control and intervention group were 3.6 +/- 3.5 vs 1.28 +/- 1.7; 3.4 +/- 2.9 vs 1.19 +/- 1.7; 2.6 +/- 2.4 vs 0.89 +/- 1.3; 1.5 +/- 1.6 vs 0.46 +/- 0.7, at 4, 12, 24 and 48 h after operation, respectively (p < 0.001). The controls had greater usage of analgesics 1.12 +/- 5.67 compared with 0.95 + 0.31 in the cases. It was concluded that pulmonary recruitment manoeuvre seems to be a simple and safe way to reduce shoulder pain and analgesic use after laparoscopy.
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The incidence of morbidly adherent placenta is rising and is directly proportional to the rate of rise of caesarean deliveries. Despite improvement in antenatal diagnosis, by accuracy of ultrasound and MRI techniques, placenta accreta is still associated with a high maternal morbidity rate. Management of pregnancies with a morbidly adherent placenta is extremely challenging and is becoming an increasingly common problem for maternity units globally. ⋯ Traditionally, these cases were managed by caesarean hysterectomy. There has now been a shift towards conservative management of placenta accreta, involving uterine and placental conservation, with the aid of interventional radiology by means of insertion of occluding balloons into appropriate vessels. We describe three cases of morbidly adherent placentas, managed at our unit where meticulous preoperative planning, multidisciplinary approach and the key role of interventional radiology led to a safe outcome for both the mother and the baby.
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This study is a review of our experience of using the cell saver in obstetrics. The main aim was to determine its role in decreasing the need for homologous blood transfusion. A retrospective study of patients identified as being at high risk of massive obstetric haemorrhage at the time of caesarean section during the period between July 2005 and August 2008, was undertaken. ⋯ A total of 13 units of salvaged blood were transfused successfully, saving approximately GB£1,800. Cell salvage in our practice has not been very effective due to non-availability of trained staff in emergencies and unfamiliarity of techniques, leading to poor salvage via suction. Most of our blood loss is swabbed not suctioned and lack of salvaging blood from swabs is a contributory factor.