Episiotomy repair different suture materials and different techniques

The aim of this work is to find out the role of different types of suturing material namely chronic catgut, polyglactin 910 and polyglycolic acid using different methods of episiotomy repair as regard immediate and 3 months post-partum complications. This study was carried out on 90 primigravidae who were randomly selected from full term pregnant females who had episiotomy done and repaired during normal vaginal delivery with exclusion of the following groups [1] Age below 18ys or above 35ys old. [2] Vaginal delivery of less than 37 weeks gestation. [3] Instrumental delivery. [4] Unhealthy perineum as vaginal discharge, infection, perineal oedema and varicose of the vulva. [5] History of perineal surgery expects circumcision. [6] History of blood disease and bleeding tendency e.g. hemophilia and ITP. Cases of this study were randomly classified into 3 groups each include 30 patients: Group I: episiotomy was repaired using chromic catgut no 2/0. Group II: episiotomy was repaired using polyglactin 910 [Coated vicryl] No. 2/0. Group III: episiotomy was repaired using polyglycolic acid [Dexon] No 2/0. Each of the above groups was subdivided into 2 equal subgroups A and B: Subgroup A: episiotomy was sutured as continuous suturing of vaginal mucosa, perineal muscles and continuous subcuticular skin closure. Subgroups B: episiotomy was sutured by continuous suturing of vaginal mucosa and interrupted suturing perineal muscles and skin. In all groups the sutures were left un-removed in the wound unless needed in any of the follow up visit. This study is a 3x2 factorial design to compare: [a] Three absorbable suture materials for repair of vaginal mucosa, perineal muscles and skin, [b] Two suturing techniques of episiotomy repair. Cases of the study were evaluated by the same investigator in the 2[nd] day, 2 weeks and 3 months after delivery as regard: short term perineal pain, dosage of oral analgesia needed for perineal pain [using oral ketoprofen in all groups], healing of the wound, removal of sutures, wound infection pain and dyspareunia. Episiotomy is the most commonly done obstetrical operation. Although it is a simple easy operation, it is not without risks or complications. The techniques of repair as well as the suture material used can affect very much the occurrence and severity of possible complications of episiotomy repair whether immediate or delayed. Evidence- based medicine is the state of the art today. This is a prospective randomized study of episiotomy repair. 90 primigravidae full- term cases that had episiotomy done and repair in the course of vaginal delivery were included. Cases of the study were divided equally into 3 groups where episiotomy was repaired using chromic-catgut 2/0. Each of the groups divided further into 2 equal subgroups where episiotomy repair done as continuous with subcuticular skin closure or interpreted suturing of perineal muscle and skin. Cases were followed through 3x2 factorial design to compare various parameters of assessment in the second postpartum day, two weeks later, at six weeks postpartum and at 3 months. Polyglycolic acid and polyglactin appeared superior to chromic catgut in term of short-terms outcome. Continuous subcuticular closure was superior to interrupted closure in short and long-term outcomes. Synthetic absorbable suture materials using the subcuticular closure technique seems to offer best results. 1- Comparing the two closure techniques [A and B] regardless suture material, it was shown that perineal pain as well as oedema and inflammation were significantly lower in sub group A than group B on 2[nd] day, 2 weeks and 6 weeks assessment. Presence of infection was more frequent in sub group A than sub group B on the 2[nd] week assessment.2- Comparing between the three suture materials regardless the closure techniques. Women in group III [polyglycolic acid] reported slightly lower rates of perineal pain than those of group II, and both are lower than group I. There is no significant difference between the these groups on the 2[nd] day as regards perineal oedema and inflammation, but by time group I was much less than the other two groups on the 2 weeks assessment. Wound infection was found in one case of each group on the 2 weeks assessment, on the six weeks assessment, infection disappeared from 2 cases and was still present in one case which was in group II. On the 6 weeks assessment, the 3 groups were nearly equal as regards to dyspareunia. In view of the results obtained, episiotomy repair with absorbable synthetics [polyglycolic acid and polyglactin 910] as continuous subcuticular closure seemed to achieve best result because the absorbable synthetics are superior to chromic catgut in terms of short-term perineal pain and the use of oral analgesia. Also continuous closure in episiotomy appeared to be superior than interrupted closure as looking to short and long term perineal pain, use of oral analgesia, oedema and inflammation, removal of suture material and the need for wound resulting

maternal oxygen tension in normal and abnormal pregnancy

The oxygen tension of the maternal arterial blood in 135 pregnant females in the third trimester was studied. 35 cases as normal control group and 100 cases of hypertension with pregnancy. 20 more cases of I.U.F. death were studied as well, of whom four cases of recent [2-7] days and 19 of prolonged [8 days- 8 weeks] duration of death. The maternal arterial P02 in normal pregnant cases was found lower than the accepted mean of non pregnant, again the maternal arterial P02 in hypertensive cases and I.U.F.D, cases were found significantly lower than in normal cases

Acupuncture analgesia in obstetric surgery in Alexandria. A preliminary report on 19 cases of lower segment caesarean sections and one case of abdominal hysterotomy and stcrilizatoin

Acupuncture analgcsisa was tried in 19 cases of lower segment Caesorean sections and one case of abdominal hysterotomy and sterilization. The technique Proved to be simple, safe and reliable especially when traditional anaesthsia proves to be risk