Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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HbA1c testing provides average blood glucose control, an elevated result may be associated with adverse post-operative outcomes. Our objective was to evaluate the association between elevated pre-operative HbA1c and post-operative complications in patients undergoing major gynaecological oncology surgery. HbA1c was measured pre-operatively in 364 patients. ⋯ This suggests that pre-operative HbA1c should be used routinely to guide care rather than diabetic status alone to prevent post-operative infections. Whatthe implicationsareof these findings for clinical practice and/or further research? More research needs to be carried out to find the optimal pre-operative HbA1c targets to reduce post-operative infection rates. Work needs to be done in conjunction with general practitioners to help patients to reduce their HbA1c prior to treatment.
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Observational Study
The influence of Body Roundness Index on sensorial block level of spinal anaesthesia for elective caesarean section: an observational study.
In this prospective trial, we investigate the effectiveness of maternal Body Roundness Index in predicting the spread of spinal anaesthesia and vasopressor requirement in parturients receiving spinal anaesthesia during the elective caesarean section. We prospectively enrolled 175 parturients. Spinal anaesthesia performed with 10 mg 0.5% hyperbaric bupivacaine at the L3-L4 intervertebral space and the optimal cut-off points of the BRI evaluated as 6.59 by receiver operating characteristic analysis calculating area under the curve. ⋯ An ellipsoid body shape might affect the spread of spinal anaesthesia. What do the results of this study add? Our results show that the BRI was as an independent risk factor associated with maximum sensory block level in term parturients undergoing caesarean delivery. What are the implications of these findings for future clinical practice and/or further research? A future study would present the possibility to design a formula for the exact amount of local anaesthetic to be used in spinal anaesthesia with the aid of maternal BRI.
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In this study, we conducted a retrospective investigation of all cases of placenta previa and accreta that were treated at a tertiary-level hospital to assess the effectiveness of balloon catheterisation at different levels. We evaluated the surgical and neonatal outcomes of 586 cases of placenta previa and accreta that were treated at our facility. This is the largest study of its kind. ⋯ We also analysed the difference in the complications across different periods of the study period and observed a clear improvement in the operative procedures over time. What the implications are of these findings for clinical practice and/or further research: Our study revealed that the surgeons' proficiency increases over time, leading to improved results and a lower rate of hysterectomy over the course of several years. We recommend that the choice for balloon catheter occlusion be made with caution and after careful consideration.
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Randomized Controlled Trial
Effect of elastic abdominal binder on pain and functional recovery after caesarean delivery: a randomised controlled trial.
The Elastic abdominal binder has been widely employed by clinicians for pain relief, wound complications prevention, improved pulmonary function, and stabilisation. However, these proposed benefits have not been properly examined in women following caesarean delivery. We aimed to examine the effects of post-caesarean elastic abdominal binder use on recovery by comparing post-operative pain, mobility and quality of life. ⋯ What do the results of this study add? In contrast to the results of the previous study, the beneficial effects of abdominal binder on pain reduction, functional recovery, and quality of life following caesarean delivery could not be demonstrated in this study. What are the implications of these findings for clinical practice and/or further research? The use of elastic abdominal binder after caesarean delivery is not associated with reduction of postoperative pain, faster functional recovery, and improved quality of life in our population. Further studies in other population with different characteristics may be worthwhile.
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The objective of this study was to evaluate the value of clinical and ultrasound risk factors in predicting severe postpartum haemorrhage (PPH) (≥1.5 L) in pregnancies undergoing caesarean section for placenta praevia. This cohort consists of all cases of placenta praevia undergoing caesarean delivery over a period of 5 years in a service unit. Patients and their delivery data were retrieved from an obstetric database. ⋯ More importantly, the absence of APH, a posterior minor praevia, was associated with a negative predictive value of 99.1% of severe PPH, implying that such cases could be treated as 'normal' low risk caesarean sections. What the implications are of these findings for clinical practice and/or further research? This simple model would allow differential pre-operative counselling of patients on risks and complications, planning and preparation of operation, allocation of staff as well as in contingency measures to be taken during operation. The establishment of a differential protocol for placenta praevia based on these simple risks factors and a prospective trial of such a protocol is suggested.