ABSTRACT
Background: Most parturient women request analgesia, of which, there are two types; opioids and non-opioids. Opioids include morphine and meperidine, while non-opioids, which are milder forms of painkillers, include acetaminophen (paracetamol) and non-steroid anti-inflammatory drugs. The major concerns associated with opioids are the risk of neonatal respiratory depression, the cost and availability.Methods: The aim of this study was to compare the efficacy and safety of paracetamol versus meperidine for intra-partum pain relief. A total of 92 primiparous singleton term pregnant women were randomly allocated to receive intravenous paracetamol (1000 mg), or intramuscular meperidine (50 mg), at the beginning of the active phase of labor. The primary outcome was the labor pain perception, assessed using the visual analogue scale (VAS), at baseline, 15, 30, 60 and 120 minutes after administration of the drug.Results: Women of both groups showed significant reduction of the VAS after administration of the medication. There were no differences between both groups regarding the mode of delivery and the durations of the first or second stages of labor. However, meperidine was associated with higher rates of dizziness and nausea/vomiting. The 1-min Apgar scores were significantly lower in meperidine group. However, there were no differences in the 5-min Apgar score, need for neonatal resuscitation or neonatal respiratory distress.Conclusions: intravenous paracetamol as analgesia during labor is effective with no fetal or maternal adverse effects. Its use should have more chance for intrapartum pain relief. Additionally, it can be used as adjuvant with other types of analgesics.
ABSTRACT
Background: Women undergoing hysteroscopic myomectomy are prone to significant blood loss and hematological disturbances. Oxytocin is a uterotonic drug, used mainly in obstetric practice. Tranexamic acid is a haemostatic drug that has been used to reduce blood loss after trauma and in many surgeries. The aim of our study was to compare the safety and efficacy of oxytocin versus tranexamic acid in reducing perioperative blood loss during hysteroscopic myomectomy.Methods: This study included 60 patients scheduled for hysteroscopic myomectomy allocated into 2 groups: group A: received 10 mg/kg of tranexamic acid slowly intravenous after induction of anesthesia, while group B: received infusion of 10 IU of oxytocin at a rate of 400 mIU/min throughout the procedure. Preoperative and postoperative hemoglobin and hematocrit levels, need for blood transfusion, duration of operation, complications and medications adverse effects were recorded.Results: The 2 groups were comparable in terms of the mean difference between preoperative and postoperative hemoglobin a hematocrit levels, operative time, operative complication and medications’ adverse effects. No patients needed blood component transfusion in either group.Conclusions: It can be concluded that tranexamic acid and oxytocin are equally effective in reducing blood loss and transfusion requirements during hysteroscopic myomectomy with comparable good safety profiles. Both of them can be used according to availability and surgeon preferences.
ABSTRACT
Background: The endometrium plays an important role in implantation of good quality embryos in ART. Many studies have proved the negative impact of intra uterine pathologies on reproductive outcome whether spontaneous pregnancy or ART, because uterine anomalies may be associated with many obstetric complications such as miscarriage, preterm birth, premature rupture of membrane, malpresentation, postpartum bleeding and retained placenta. Aim of the work: This study aims to assess the prevalence of abnormal hysteroscopic findings among infertile women undergoing ART at Ain Shams Maternity University Hospital over the period from January 2007 to January 2017. Patients and Methods: This descriptive retrospective study was carried out on infertile couples planned for ART who were sent to ECDU for hysteroscopy in Early Cancer Detection Unit (ECDU), Ain Shams University Maternity Hospital. Case reports From January 2007 to January 2017 were reviewed. Results: The most prevalent congenital abnormality was endometrial polyp (18.4%) followed by uterine septum (6.9%). Conclusion: This study concluded that the most common uterine abnormality was endometrial polyp (18.4%), followed by uterine septum in 6.9% of patients. Also, thick endometrium was very common with a prevalence of 12.9%. Therefore, based on this high prevalence of abnormalities, this study is in agreement with the opinion that all women should be offered hysteroscopy, even if they have normal vaginal ultrasound and hysterosalpingography, because this is supposed to increase the detection rate of minor abnormalities, which theoretically will improve the reproductive outcome. Still, further interventional randomized controlled trials (RCT) are needed to verify the positive impact of routine use of hysteroscopy prior to ART