Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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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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Randomized Controlled Trial Comparative Study
The effect of sublingual misoprostol versus intravenous oxytocin in reducing bleeding after caesarean section.
In this study, 100 singleton pregnant women underwent a caesarean delivery under general anaesthesia and were studied in terms of postpartum bleeding using oxytocin or misoprostol. Patients were randomly divided into two equal groups. One group received two tabs of misoprostol 200 microg sublingually and the second group took intravenous infusion of 20 units of oxytocin at the rate of 10 cc/min immediately after delivery until full contraction of the uterine. ⋯ The need to give additional oxytocin therapy in oxytocin group (36%) was significantly higher than misoprostol group (14%) (p = 0.032). It seems that the efficacy of sublingual misoprostol is equivalent to that of low dose intravenous oxytocin in reducing postpartum haemorrhage at caesarean section. Misoprostol has some other advantages like long shelf -life, stability at room temperature and oral use.
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Randomized Controlled Trial Comparative Study
A randomised controlled trial comparing the efficacy of intramuscular syntometrine and intravenous syntocinon, in preventing postpartum haemorrhage.
This randomised controlled trial aimed to compare the efficacy of intramuscular syntometrine with intravenous syntocinon, in preventing postpartum haemorrhage. A total of 686 women were randomised into two groups; one receiving intramuscular syntometrine and the other receiving intravenous syntocinon, as part of the active management of the third stage of labour. ⋯ However, there was an increased incidence of having a diastolic blood pressure of >90, 30 min after the delivery (p = 0.004), with intramuscular syntometrine. Therefore, it can be concluded that 1 ml of intramuscular syntometrine and 10 units of intravenous syntocinon are equally effective in preventing postpartum haemorrhage.
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Randomized Controlled Trial Comparative Study
Is expensive always better? Comparison of two induction agents for term rupture of membranes.
The aim of this study was to compare the clinical safety and efficacy of sublingual misoprostol with vaginal prostaglandin E2 (Prostin(R)) as an induction agent after term rupture of membranes. This was a non-blinded randomised control study involving 57 women who were >24-48 h after term rupture of membranes. In total, 29 women received sublingual misoprostol and 28 received Prostin. ⋯ In our study, sublingual misoprostol when compared with vaginal prostaglandin E2 gel (Prostin) leads to a shorter induction to labour time, and less need for second dose of induction agent or oxytocin infusion. Women were given a satisfaction questionnaire to complete after delivery. Those who were given misoprostol were satisfied with the outcome, would use it again in the future, and recommend it to friends in similar circumstances.
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Randomized Controlled Trial Comparative Study
Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate.
Currently, tranexamic acid (TXA) is used as 4 g/day in menorrhagia This prospective randomised study included 100 cases to assess efficacy and safety of 2 g/day TXA in dysfunctional uterine bleeding (DUB) vs cyclical 10 mg twice-daily medroxyprogesterone acetate (MPA) for 3 cycles. Follow-ups were made monthly for 3 months during therapy, then 3 months after. Mean pictorial blood loss assessment chart (PBAC) score decreased from 356.9 to 141.6 in the TXA group and from the pre-treatment 370.9 to 156.6 with MPA and mean reduction of blood loss was 60.3% with TXA and 57.7% with MPA after 3 months (p < 0.005 in both groups). ⋯ In patients who reported 3 months after stopping the treatment, 66.7% in TXA group and 50% in MPA had recurrence of menorrhagia, (p = 0.155). During the 6 months study period more hysterectomies were performed in the MPA than in the TXA group (17.8% vs 4%; p = 0.002). We conclude that TXA in 2 g/day dosage is an effective and safe option in DUB.