Peritoneal non-closure at cesarean section - A study of short term post-operative morbidity

To assess the intra-operative and immediate post-operative effects of non-closure of parietal and visceral peritoneum during caesarean section Randomized control trial Department of Gynaecology and Obstetrics, Combined Military Hospital, Lahore; from 1 Jan 05 to 30 Jun 05 [6 months]. A total of 306 women undergoing caesarean section were randomly allocated to standard routine closure [control group n= 157], and non-closure of both peritoneal layers [study group n=149]. Preoperative, intra and postoperative management decisions were made without reference to either group specifically. Statistical analysis compared incidences of immediate post operative complications. Main outcome measures were mean operative and anesthesia time, intra operative blood loss, post operative febrile morbidity and analgesia requirements, post operative bowel function and paralytic ileus, rate of wound infection/dehiscence and length of hospital stay in both groups. The mean operative time was reduced by seven minutes [p< 0.01], and hospital stay was 01 day less [p< 0.01] in study group. There was no difference in rate of febrile and infectious morbidity or in level of post operative pain and number of analgesic doses in both groups. The difference b/w the frequency of postoperative items was also insignificant [p>0.05] Peritoneal non-closure is recommended during caesarean section because it results in significantly shorter operative time and hospital stay, decreased anesthetic dosage, quicker return of bowel activity and thus conferred significant patient and economic benefit

comparison of two protocols of intravaginal misoprostol for second trimester medical termination of pregnancy

To compare the efficacy and side effect profiles of two different dosage protocols of intra-vaginal misoprostol. Randomized control trial. Department of Gynaecology and Obstetrics, Combined Military Hospital, Lahore. From March 2004 to May 2005. Total of 128 women, aged 19-39 years, planned for 2nd trimester pregnancy termination, was randomly assigned to two groups of 64 women each. Group-I women received vaginal misoprostol 200æg four hourly for a maximum of 6 doses in 24 h. Women in group-II received vaginal misoprostol 200æg six hourly for a maximum of four doses in 24 hours. If abortion did not occur in 24 h, the same regimens were repeated. Without successful abortion in 48 hours, misoprostol administration was abandoned in favour of surgical induction. The median induction to abortion interval in group-I [14.4 h was significantly shorter than in group-II [18 h] [p<0.01]. The incidence of fever was more common in group-I [p=0.01]. The pregnancy related symptoms decreased in both groups after misoprostol and decrease in breast tenderness was most marked two to three hours after administration. Misoprostol induced fever at least five hours after administration in up to 37.5% women, this peak being slightly higher and occurring earlier in group-I than in group-II. Lower abdominal pain peaked after three to four hours in group-I and after five to six hours in group-II, with no significant difference in pain intensity or analgesic requirements. Other common side effects were diarrhea followed by nausea and vomiting in both the groups. Protocol of 200æg misoprostol administered four hourly/24 hours is more effective in reducing induction-abortion interval and inducing successful abortion within 48 hours without any major increase in side effects