Paraumbilical hernia repair during cesarean delivery

Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital. In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum complications, hospital stay, hernia recurrence, and patient satisfaction. The combined procedure took significantly longer than cesarean delivery alone [75.2 minutes versus 60.5 minutes, P < .001]]. There were no major complications. Wound infection occurred in 6 patients [4.1%]. Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two patients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months [range, 6-36 months]. All hernia patients reported that they preferred the combined operation. Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single incision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted

Paraumbilical hernia repair during caesarean section; maternal and neonatal outcome

A prospective study to evaluate the outcome of combined cesarean section and paraumblical hernia repair in tertiary referral university hospital. Patients and methods: 48 patients undergoing Cesarean section combined with paraumbilical hernia repair versus 100 patients undergoing cesarean section alone. Main Outcome Measures: Operation time, Apgar Score, blood loss, uterine atony, breast feeding initiation, pain sensation, periparturn complications, prolonged lochia [more than 42 days], deep venous thrombosis, hospital stay, hernia recurrence, and patient choice. The combined procedure consumed significantly longer time than cesarean section alone in the mesh hernioplasty subgroup. There were no major complications. Apgar Score, uterine atony, initiation of breastfeeding, prolonged tochia, wound infection and hospital stay did not differ significantly from those of controls. Pain at hernia site repair in two patients, one hernia recurred in the primary repair subgroup during follow up period which reach up to 3 years. All hernia group patients reported that they prefere the combined operation. Combined cesarean section and paraumbilical hernia repair had the advantage of single incision, single anesthesia, and single hospital stay. The combination approach proved to be safe, effective, and well accepted

Prenatal diagnosis of congenital heart diseases in northern east of Egypt: evaluation of indication and yield of fetal echocardiography in tertiary care facility

Antenatal detection of congenital heart diseases [CHD] is crucial because obstetric and neonatal management is likely to be altered. Aim of this study was to evaluate indications of fetal echocardiography in Mansoura University teaching hospitals, and evaluate its yield and impact on obstetric and neonatal management. Inclusive of 152 fetal echocardiograms were performed in Mansoura pediatric cardiology unit for 120 high risk pregnant women over 33 months duration. Triplex ultrasound machine was used with 3.5 or 5 MHz transabdominal probes. Mean maternal age was 27.51 +/- 4.7 years [range 18-39 years], mean gestational age at referral was 26.8 +/- 5.2 weeks [range 18-39 weeks]. Most common indications for referral were family history of CHD [n=34], extracardiac anomalies [n=26], maternal diabetes [n=20]. Abnormal cardiac findings on antenatal sonographic scanning [n=4] were one of less common referral indications. CHDs were accurately predicted in 16 cases [13.3%], 3 cases had echogenic intracardiac foci [EIF] [2.5%]. Abnormal fetal Doppler velocimetries were detected in 4 cases [3.3%] with structurally normal heart indicating abnormal fetal status, and obstetric decision was altered accordingly. Association with extracardiac anomalies were present in 7cases [43.7%], abnormal karyotype was detected in one case [6.2%] with CHD. Fourteen cases [12.06%] had CHDs out of 116 cases with primary indication for fetal echocardiography and normal antenatal obstetric scan, 2 cases [50%] out of 4 with abnormal cardiac findings on antenatal scan had CHDs. Small muscular ventricular septal defect was detected postnatally in one case with EIF giving sensitivity of 94.4% and specificity of 100%. Four cases with complex CHDs were transferred to pediatric cardiac facility center for appropriate management. Elective termination of pregnancy was offered to 2 cases. Neonatal death occurred in 7 [37.5%] cases with CHD and in two cases [50%] with abnormal Doppler velocimetry. Fetal echocardiography is valuable tool in diagnosis of fetal CHDs in high risk pregnant women with high sensitivity and specificity. Abnormal cardiac findings during prenatal sono graphic scanning are more yielding for identifying CHDs. Fetal Doppler velocimetry is useful in evaluating fetal homodynamic status