ABSTRACT
Background: Although Oxytocin is used systematically during caesarean section, no recommendation precise optimal dose for this indication. The bolus administration of 10 IU intravenously after extraction of the newborn, is accompanied by side effects mainly hemodynamic
Objectives: To compare two Oxytocin protocols: 05 IU bolus Vs. 10 IU bolus during Cesarean section by studying their respective effectiveness [effects on uterine tone] and adverse effects
Methods: A prospective randomized double-blind study including 87 term parturients for undergoing a C-section under loco regional anesthesia. Parturients were randomized into two groups depending on the injected Oxytocine dose: - Group 1 [n = 43]: 10 IU + 25 IU IVD in 500 ml of serum / 3h - Group 2 [n = 44]: 5 IU IVD + 25 IU in 500 ml serum / 3h
Results: The variation of the heart rate and the incidence of low blood pressure were significantly greater for Group 1. No significant differences between the two groups regarding blood loss was noticed per or postoperatively. The type of digestive side effects were more common in the first group
Conclusion: Administration of 5 units of Oxytocin during the scheduled C-sections is effective for uterine tone without superimposed bleeding risk, guarantees better hemodynamic stability and less side effects than the 10 units dose
ABSTRACT
Objective: To evaluate the prognosis of the second twin according to different criteria [presentation, mode of delivery, term, weight, weight difference between twins ,twin to twin delivery time interval, studying the Apgar scores at birth and neonatal morbidity and mortality
Materials and Methods: This is a retrospective study of 183 parturients carrying twin pregnancies collected at the department of Obstetrics-Gynecology in Mahmoud Matri Hospital [Ariana] over a period of 9 years [1st January 2001 to 31st December, 2009]
Results: We recorded 357 live births [181 J1 and J2 176] and 9 stillbirths. The relationship between the order of the twin and the modality of delivery on the one hand, and between the order of twin and type of presentation was considered significant [p < 0.001]. We found no significant difference in Apgar score at 1 minute and 5 minutes between the 1st and the 2nd twins. A term = 34 weeks was a poor prognostic factor for the Apgar score at the first and the fifth minute for the 2 twins but no significant difference between the 1st and 2nd twins [1st min p=0.4623; 5th min p = 0.2899]. Low birth weight = 1500g were significantly more at risk of foetal suffering [p < 0.001]. A birth weight discordance of 25% or more was observed 36 cases [19.7 %]. The Apgar score was significantly influenced by the birth weight difference only in the first minute [p = 0.043]. Thereafter, this difference disappears in the 5th minute. The type of presentation and methods of delivery did not influence significantly the second twin morbidity. A time interval between the birth of the first and second twin greater than 15 minutes was a bad prognostic factor for the Apgar score in the 1st min [p = 0.001] and 5th min [p = 0.019]. Transfer rate in neonatology and neonatal distress was 31.2 %.The term of birth [ before 34 weeks], low birth weight [= 1500 g], and twin-to-twin delivery time interval [ >/= 15 min] are parameters that influenced significantly the rate of neonatal distress and transfer to pediatric health care unit [p <0.001, p<0.001, p = 0.004]. We found a significant increase in the transfer to pediatrics when the birth weight difference was larger than 25% [p = 0.005]. However, no significant difference was found concerning the neonatal respiratory distress [p = 0.22]. The different modes of delivery and the type of presentation of the second twin did not significantly alter the rate of neonatal respiratory distress [p = 0.28, p = 0.53] and transfer Pediatrics [p = 0,63, p = 0.38 ]. Among the live births, 5 twins had died in labor room: 1st twin in two cases and in 2nd twin in 3 cases and there was no significant correlation between neonatal mortality and the twin's order [p = 0.629]
Conclusion: A term = 34 weeks, a low birth weight = 1500g and a delay of more than 15 mn were factors that influenced significantly the Apgar score at 1st and 5th minute, and were responsible for more neonatal distress and transfer in pediatrics. A birth weight difference larger than 25% between the two twins influenced the Apgar score at the first minute and was responsible for an increase in the transfer rate
ABSTRACT
Ovarian endometriomas is a common condition among women of reproductive age and represents a major cost in terms of public health. Despite these implications for public health, it remains difficult to arrive at a consensus on the optimal surgical treatment. To study the clinical and paraclinical characteristics of this pathology and to compare two major surgical techniques: the intraperitoneal cystectomy and fenestration -coagulation in terms of recurrence and prognosis for future fertility. A retrospective study of 31 patients who underwent surgical treatment for ovarian endometrioma histologically proved. The study period covers 10 years from January 2000 to December 2009. Laparoscopy was performed in 27 patients. The endometrioma was located to the left side in 64% of cases. The main strategy performed is intraperitoneal cystectomy in 18 patients [58.8%]. In second place we find the fenestration-coagulation. The mean duration of postoperative follow-up is 10.3 months. The recurrence of the cyst and the persistence of pain symptoms were significantly less frequent in the group of patients who underwent intraperitoneal cystectomy. The laparoscopic surgery remains the first line approach in terms of ovarian endometrioma.Cystectomy offers performance equal or superior to the fenestration-coagulation technique, and exposes to fewer recurrences. For these reasons, it should be recommended. The fenestration-coagulation is possible in case the cystectomy is difficult or incomplete