Effect of gum chewing on prevention of post cesarean ileus

Post cesarean ileus is a common complication that induces abdominal distention, delays feeding, and increases hospitalization. Multiple studies showed that false nutrition increases the bowel movement. This study aimed to investigate the effect of gum chewing as false nutrition on the bowel movement and prevention of post cesarean ileus. In this randomized controlled trial, a total of 400 patients who were hospitalized in Mashhad Zeinab hospital were divided into two 200-patient groups. The groups were matched for age, gravity and duration of surgery. In the intervention group, gum chewing was started after surgery, 3 times/day until the regular diet was initiated. In the control group, patients underwent routine care by restricting oral intake until the bowel function was returned. The outcomes were time of the first bowel sound, flatus passage, defecation, ambulation of patients post cesarean, initiation regular diet, and hospitalization. Statistical analysis was performed using unpaired t-test and fishers exact probability test. The mean age, parity and operation time were similar in the two groups. All patients in the intervention group tolerated gum chewing immediately after surgery. The results showed the followings among the intervention group vs. control group, respectively: post operative time intervals to bowel sounds [14.7 hours vs. 16.6 hours; P=0.569], time intervals between surgery and abdominal distention [16.59 hours vs. 14.21 hours; P=0.01], first post operative defecation [28.16 hours vs. 32.21 hours; P<0.000], post operative time interval to onset diet [19.3 hours vs. 16.54 hours; P=0.000], post operative time interval to ambulation [20.14 hours vs. 17.58 hours; P=0.000], post operative lengths of ileus [31.13 hours vs. 30.35 hours; P=0.5], hospitalization [1.84 days vs. 1.92 days; P=0.02]. Gum chewing after cesarean section is safe and well tolerated and reduces post operative ileus, shortens mean duration of first defecation, decreases the time of returning to regular oral diet, shortens the time of patient ambulation and hospital discharge. Gum chewing is offered as a physiologic and inexpensive method to prevent or reduce post cesarean ileus

[Factors influencing wound dehiscence in abdominal operation]

The purpose of this study was to review our clinical experience with abdominal wound dehiscence. During the 5-year period from [1997-2001], there were 2.761 major abdominal operations performed at the Department of Surgery Imam Reza Hospital. Mashhad, Iran. Twenty-one specific local and systemic risk factors were analyzed and compared with the control group. 31 [1%] abdominal wound dehiscence's occurred in 2.76 1 patients undergoing major abdominal surgery. Significant risk factors were found to include age over 65 year, wound infection, pulmonary disease, helnodynamic instability and ostomies through incision. Risk factors not found to be important included, sex, type of incision, type of closure, anemia-jaundice and diabetes. When dehiscence and control groups were combined 30% of patients with at least five significant risk factor developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence.There was an overall mortality of 29% which was directly related to the number of significant risk factors. The coexistence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factor died. Wound dehiscence carries a very high mortality rate and major morbidity. It is a dreaded complication that increases hospital stay and cost. We believe that serious consideration should be given to placing retention sutures in high risk patients to try to prevent evisceration and dehiscence. Serous drainage from a wound after surgery should alert the physician to possible wound dehiscence

[Seven years study of pregnant women with cardiovascular disease department of cardiology, Imam Reza Hospital, Mashhad, Iran [1996-2003]]

In this study we evaluated cardiovascular changes during pregnancy. Our main aim was, in cardiovascular disease pregnancy causing worse heart problems and increase functional classes during gestation. In which groups of patients, before pregnancy, is therapeutic management like intervention or surgery necessary to be performed, and fetal and newborn complications evaluated. In this prospective study we evaluated, 53 pregnant women with heart disease who were admitted to Dept of Cardiology, Imam Reza Hospital before or immediately after delivery. Maternal gestational age parity, the kind of heart disease history of cardiac surgery, and also Abortion, stillbirth, and functional classes based on New York Heart Association classification was done. After collection of information, percent of the data was assessed and presented. At the time of admission [47.1%] of patients were in functional class II, class I [33.9%] class III. [13.2%], class IV [5.6%]. In this study the most common cause of cardiovascular disease [Figure III] was rheumatic heart disease [69.8%] and the most common cause of patients admission to hospital [Figure I] was those, with the history of heart disease [81.1%], and most common clinical manifestation [Figure II] Was exertional dyspnea [35.8%] . Patients with MR, mild MS, AI and mild AS, VSD and functional class I and II can tolerate pregnancy and delivery well. But usually for pts in class III, IV, they will have serious problems during pregnancy and delivery. The decision of continuation or termination of pregnancy in high risk pts for example severe MS, AS and pulmonary hypertension, izenmenger's syndrome, high functional class are depending on the consultation between cardiologist, cardiac surgeon, obstetrician and pts family

Pregnancy and abdominal surgery review of 90 cases

Objective: intraabdominal surgical disease during pregnancy can present a challenge in diagnosis and management for the obstetricians and surgeons

Material and Method: we retrospectively studied all pregnants patient over a 15-year period who had undergone abdominal surgery

Results: a total of 92 abdominal operations were performed on 90 patients. Thirty-seven patients were operated on for acute appendicitis; 20 were operated on for ovarian abnormalities. There were two maternal deaths. The most common postoperative complication was premature labor [21%]. There were five fetal deaths

Conclusion: intraobdominal surgery during pregnancy carries an acceptable risk to the mother and fetus. Complications are related to severity of the disease and operative delay rather than to the operative procedure itself

Study of fatigue in working pregnant women

The purpose of the study is to show in which trimester of pregnancy is fatigue more common among working women, and whether or not there is any relationship between fatigue rate and educational level, income, etc. This is a longitudinal study. From the total number of patients who came to Zeinab University Hospital, 100 completed a demographics 50 item questionnaire and the numerical rating scale fatigue [NRS-F] was obtained. Of those, only 35 patients were in their first trimester of pregnancy and qualified for the study and filled the questionnaire again at 2nd and 3rd trimesters. The fatigue rate was higher in the first than the two other trimesters of pregnancy [f=126.78, p<0.001]. In unwanted pregnancies with no moral support by the husband or other family members, the fatigue rate was not significant. There is a relationship between fatigue rate and the education level of these women [f=8.569, p=0.001] and income [f=10.72, p<0.001]. When medical instructions had to be given to a patient to do less work or rest at home, the fatigue rate was significantly higher than those who did not [f=17.34, p<0.001]. In conclusion, it appears that health personel working with childbearing populations should counsel women about significant 1st trimester fatigue so they can prepare their work and home environments in an attempt to achieve adequate rest