Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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This study evaluated the surgical and neonatal outcomes of 71 patients diagnosed with placenta accreta before caesarean section with or without placement of a prophylactic abdominal aorta balloon catheter. This study took place at our hospital from January 2013 to May 2015. Thirty patients had a prophylactic balloon catheter inserted (balloon group), and 41 patients did not receive the intervention (control group). ⋯ Impact statement Prophylactic placement of endovascular balloon catheters for controlling intraoperative haemorrhage in women with placenta accreta has been a topic of debate for nearly 2 decades. The most common type of occlusion is internal iliac artery balloon occlusion, only a few studies have focused on intraoperative aortic balloon occlusion This retrospective case-control study included relatively large number of cases and the result shown this technique can effectively reduce intraoperative haemorrhage in patients with placenta accreta, without causing any obvious adverse maternal or neonatal outcomes. It provides another safe and effective method for intraoperative haemorrhage control and even uterine preservation.
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Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylaxis with oxytocic medication is recommended by the WHO to prevent its occurrence. Carbetocin is a newer oxytocic, with potential to lower PPH rates, reduce the total use of oxytocic drugs and lead to financial savings. ⋯ The implications of these findings are of reduced morbidity, faster recovery and cost savings in these times of austerity in the UK. It allows more efficient labour distribution of midwives, particularly in the setting of staff shortages across the NHS. A randomised control trial in this area needs to be conducted to determine the cost benefit of carbetocin and with this and post-partum haemorrhage rates as the primary outcome measures.
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Randomized Controlled Trial
Bolus administration of intravenous lidocaine reduces pain after an elective caesarean section: Findings from a randomised, double-blind, placebo-controlled trial.
We conducted a randomised double-blind, placebo-controlled trial to assess whether a bolus dose of lidocaine during the induction of general anaesthesia would reduce postoperative pain over 24 h. Level of satisfaction with pain control at 48 h after surgery and Apgar score were also examined. A total of 100 women aged 20-35 years, who were candidates for elective caesarean section (CS) were randomised to receive either 1.5 mg/kg lidocaine or placebo during the induction of general anaesthesia. ⋯ In this randomized, placebo-controlled trial the use of a bolus dose of 1.5 mg/kg lidocaine 2%, compared with placebo, during the induction of general anaesthesia for elective CS resulted in a significant decrease in postoperative pain score as well as decreased postoperative morphine consumption over 24 h. Lidocaine use was not associated with any side effect in participants and newborns. • This study provides the first evidence that a bolus dose of lidocaine may be a safe and simple alternative therapeutic intervention for enhanced postoperative recovery in terms of pain and postoperative opioid consumption. Future studies are needed to examine pain reducing effect of perioperative bolus dose of lidocaine after CS under spinal or epidural anesthesia.
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The aim of this study was to show a different technique for a gasless laparoendoscopic single-site (LESS) hysterectomy and to present advantages and limitations of this technique. Women undergoing gasless LESS hysterectomy with a different technique were evaluated. A total of 14 LESS hysterectomies were performed using this gasless technique and rigid laparoscopic instruments by one surgeon. ⋯ This technique can be used safely in patients with poor cardiopulmonary reserve. Also, by means of its cost effectiveness, it can be preferred in developing countries. As a result, it may be a good alternative to conventional LESS hysterectomy.