Incomplete healing of the uterine incision after elective second cesarean section.

PURPOSE: To evaluate the possible associations between the single-layer locked- and unlocked-uterine closure technique and closure area biometry, and cesarean scar healing in recurrent cesarean section. MATERIAL AND METHODS: In this randomized prospective study, elective second cesarean section of 120 singleton pregnant women were randomized into the single-layer locked- and unlocked-continuous uterus closure technique. During the operation, the upper and lower edge thickness of the uterine incision were measured. In order to evaluate the healing in the cesarean scar area, all women were examined with vaginal ultrasonography 6-8 months after the cesarean section. The possible associations between locked- and unlocked-uterine closure technique and closure area biometry and cesarean scar healing were evaluated. RESULTS: After the drop-outs, a total of 86 women, 45 in the locked-continuous closure group and 41 in the unlocked-continuous closure group were evaluated. There was no statistically significant difference between the groups in terms of demographic and clinical parameters, such as perioperative uterine closure area biometry, need for additional suture, duration of operation and amount of bleeding. However, a significantly greater number of additional sutures for hemostasis was necessary in the unlocked-continuous compared to the locked-continuous closure group. The rate of cesarean scar defect (CSD) and residual myometrium thickness were comparable whereas the healing rate was significantly higher in the locked-continuous closure group compared to the unlocked-continuous closure group (0.71 ± 0.90 vs. 0.64 ± 0.10, p = .032). In women with CSD, the lower edge was 4 mm thinner than the women without CSD (10.48 ± 6.13 mm vs. 14.53 ± 7.13 mm, p = .006). Moreover, the thickness difference between the lower and upper edge was significantly greater if CSD was present compared to the absence of CSD (5.88 ± 4.04 mm vs. 3.70 ± 3.00 mm, p = .006). CONCLUSIONS: There was no association between CSD and locked versus unlocked suture technique used for the closure of uterine incision in the second cesarean section. The biometric evaluation of the scar area has shown that the thin lower wound edge and unevenness between the lower and the upper wound edges may play a role in incomplete healing of the uterine incision.

Effects of Intradermal Sterile Water Injections in Women with Low Back Pain in Labor: A Randomized, Controlled, Clinical Trial.

BACKGROUND: In addition to the pain caused byuterine contractions during labour, continuous and severe back pain is observed in 33% of women. Several pharmacological and nonpharmacological methods are available for managing this pain. Sterile water injection is considered as alternative method for nonpharmacological pain management. AIMS: To assess the satisfaction level and effectiveness of sterile water injection for back pain among women in labour. STUDY DESIGN: Randomized controlled trial. METHODS: A total of 168 term, healthy women with labour pain and severe back pain were randomized into the sterile water injection (study) and dry injection (placebo) groups. Injections were applied to the rhombus of Michaelis in the sacral area. Pain scores were assessed at 10, 30, 60, 120, and 180 min using a visual analogue scale. Additionally, the need for epidural analgesia, Apgar score, mode of delivery, time of delivery, maternal satisfaction, and breastfeeding score were assessed. RESULTS: The mean back pain scores at 30 min after injections were significantly lower in the study group (study group: 31.66±11.38; placebo: 75±18.26, p<0.01). The mean decrease in pain scores after 30 min according to baseline was significantly higher in the study group (study group: 54.82±7.81; placebo: 13.33±12.05, p<0.01). The need for epidural analgesia, time of delivery, mode of delivery, and Apgar and breastfeeding scores were similar in both groups. Maternal satisfaction from the analgesic effect was significantly higher in the study group (study group: 84.5%; placebo: 35.7%, p<0.01). CONCLUSION: The application of sterile water injection is effective for relieving back pain in the first stage of labour and has a sufficient satisfaction level among women.

Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes.

OBJECTIVE: Preterm premature rupture of membranes (PPROM) is closely related with maternal and fetal complications. Therefore, early diagnosis is extremely important to provide maternal and fetal well-being. Many inflammatory markers have been evaluated for their ability to diagnose membrane rupture at early stages. We aimed to investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and preterm premature membrane rupture. MATERIAL AND METHODS: In this study, 121 pregnant women with PPROM and 96 age-matched pregnant women with spontaneous preterm labor who were admitted to our hospital between January 2014 and December 2015 were enrolled. Demographic data, complete blood cell count results, and neonatal outcomes were recorded. RESULTS: The neutrophil and platelet counts were higher in the PPROM group (9948.4±3393.2 vs. 7466.1±1698.5/mm3 and 244.5±60 vs. 210.6±64.8/mm3, respectively, p<0.001). The PLR and neutrophil-to-lymphocyte ratios (NLR) were both significantly higher in the PPROM group (p<0.001). Correlation analysis revealed that the PLR was positively correlated with the NLR (r=0.10, p=0.031). The ability of the PLR to diagnose preterm premature rupture of membranes was evaluated using an ROC curve. The sensitivity and specificity of the PLR was 57.8% and 73.7%, respectively, at a threshold >117.14 (p<0.001). CONCLUSION: The PLR might be a cost effective, easy to use, and practical marker for the early diagnosis of PPROM, which can help to determine the appropriate waiting time for delivery and provide maternal and fetal well-being.