Routine Pfannensteil wound drainage in low risk patients of wound disruption. is it cost-effective?

To evaluate the benefit of routine wound drainage in low risk patients of wound disruption in patients undergoing caesarean section and abdominal hysterectomy through a Pfannensteil incision. A randomised controlled study. This study was carried out in Ain Shams Maternity Hospital from March 2002 to February 2003 and included forty patients undergoing abdominal hysterectomy and forty seven patients undergoing elective caesarean section. Both groups of patients were randomised into two subgroups with either a no-suction drainage or a control group with wound drainage [subfascial and subcutaneous]. Outcome parameters were perioperative decrease in haemoglobin, wound haematoma formation, infection or both, postoperative fever [> 38.5 lasting more than 48 hours], postoperative leucocytic count rise, need of postoperative analgesia, operative time and length of hospital stay. All parameters including decrease in haemoglobin, leucocytic count, degree of postoperative fever, postoperative analgesic doses, wound haematoma and infection were similar in both groups. Operative time was shorter and days of hospital stay were fewer in the two no drainage subgroups. Routine Pfannensteil wound drainage in low risk patients for wound infection and/or haematoma is not cost effective and does not alter the outcome

Maternal and umbilical cord serum insulin-like growth factor-I: correlation with patterns of fetal growth and neonatal outcome in preeclampsia

The Aim of the study is to investigate the value of insulin-like growth factor-I in the maternal serum and cord blood as possible predictors of fetal growth and neonatal anthropometric parameters, and to correlate this with the severity of preeclampsia. A cohort cross sectional study. maternal serum and cord blood from 80 pregnant patients with preeclampsia [mild and severe] were investigated for IGF-I levels using ELISA technique and the results correlated to severity of preeclampsia, pattern of intra uterine fetal growth and neonatal outcome by Apgar score. A significant positive correlation was found between fetal and maternal IGF-I levels and birth weight and neonatal length and head circumference [P < 0.001]. Cord blood but not maternal IGF-I had a highly significant negative correlation with the severity of preeclampsia. Cord blood IGF-I was significantly higher in mild compared to severe preeclampsia cases and appropriate compared to small for gestational age [65.41 +/- 25.5 vs. 41.5 +/- 11.7 and 61.05 +/- 22.76 vs. 38.57 +/- 15.05 respectively P < 0.001]. Both fetal and maternal IGF-I are good predictors of fetal growth, and neonatal outcome by Apgar score in preeclampsia, although the predictability offered by maternal IGF-I may be less reflective with advancing gestational age. Fetal but not maternal IGF-I is a good marker for the severity of preeclampsia