ABSTRACT
We evaluated maternal complications in relation to number of previous caesarean sections in Princess Badea Teaching Hospital, Irbid, Jordan. Analysis of the medical records of 1739 patients delivered by caesarean section was conducted. It revealed a 14-fold increase in the risk of caesarean hysterectomy in patients with placenta praevia and previous caesarean section compared to patients with placenta praevia and no previous caesarean section. The risk of caesarean hysterectomy increased with increasing number of previous caesarean sections. Those with 3 or more previous caesarean sections were at significantly higher risk of blood transfusion. Post-operative pyrexia was commoner in women with 3 or more previous caesarean sections compared to those undergoing their first one.
Subject(s)
Cesarean Section/adverse effects , Pregnancy Outcome/epidemiology , Puerperal Disorders , Blood Transfusion/statistics & numerical data , Cesarean Section, Repeat/adverse effects , Female , Fever/epidemiology , Fever/etiology , Gestational Age , Hospitals, Teaching , Humans , Hysterectomy/statistics & numerical data , Jordan/epidemiology , Maternal Age , Maternal Mortality , Parity , Placenta Previa/epidemiology , Placenta Previa/etiology , Pregnancy , Pregnancy, High-Risk , Puerperal Disorders/epidemiology , Puerperal Disorders/etiology , Retrospective Studies , Risk Factors , Sterilization, Tubal/statistics & numerical data , Surgical Wound Dehiscence/epidemiology , Surgical Wound Dehiscence/etiology , Surgical Wound Infection/epidemiology , Surgical Wound Infection/etiology , Uterine Rupture/epidemiology , Uterine Rupture/etiologyABSTRACT
We evaluated maternal complications in relation to number of previous caesarean sections in Princess Badea Teaching Hospital, Irbid, Jordan. Analysis of the medical records of 1739 patients delivered by caesarean section was conducted. It revealed a 14-fold increase in the risk of caesarean hysterectomy in patients with placenta praevia and previous caesarean section compared to patients with placenta praevia and no previous caesarean section. The risk of caesarean hysterectomy increased with increasing number of previous caesarean sections. Those with 3 or more previous caesarean sections were at significantly higher risk of blood transfusion. Post-operative pyrexia was commoner in women with 3 or more previous caesarean sections compared to those undergoing their first one
Subject(s)
Cesarean Section , Maternal Mortality , Pregnancy Outcome , Obstetric Labor ComplicationsABSTRACT
BACKGROUND: Local anesthesia at the trocar site in laparoscopic cholecystectomy is expected to decrease postoperative pain and hence expedite recovery. The aims of this prospective randomized study were to investigate the effect of local anesthesia and to discover whether it is cost effective. METHODS: For this study, 100 patients undergoing laparoscopic cholecystectomy were randomized into two groups. The 43 study patients were injected with 0.5% bupivacaine hydrochloride at the trocar site before the trocars were inserted. They then were compared with 41 control patients who received no local anesthesia. The remaining 16 patients were excluded from the study. The postoperative pain was evaluated at the standard four trocar sites at 4 h and 24 h after surgery on a scale 1 (the mildest pain the patient had ever experienced) to 10 (the most severe pain the patient had ever experienced). Postoperative pain medications and their cost were evaluated. RESULTS: There was no difference between the two groups with regard to gender, age, weight, operative time, estimated operative blood loss, and bile culture. The patients who received bupivacaine at the trocar site clinically had less pain (p < 0.001 for all four sites) both at 4 and 24 h after surgery. The treatment group patients used less mepiridine and promethzine than the control group (p = 0.001 and 0.002, respectively) postoperatively. Overall, the patients who had local anesthesia used less postoperative pain and antiemetic medication than the control patients (p = 0.02). This afforded a significant decrease in the costs and charges of these medications (p = 0.004 and 0.005, respectively). Three patients in the study group were discharged from the hospital the day of surgery. CONCLUSION: Preinsertion of local anesthesia at the trocar site in laparoscopic cholecystectomy significantly reduces postoperative pain and decreases medication usage costs.
Subject(s)
Anesthesia, Local/methods , Cholecystectomy, Laparoscopic/economics , Cholecystectomy, Laparoscopic/methods , Cholelithiasis/surgery , Pain/prevention & control , Perioperative Care , Abdominal Muscles/surgery , Bupivacaine/administration & dosage , Bupivacaine/therapeutic use , Cholelithiasis/economics , Cost Control , Health Care Costs , Humans , Meperidine/administration & dosage , Meperidine/therapeutic use , Pain, Postoperative/prevention & control , Promethazine/administration & dosage , Promethazine/therapeutic use , Surgical Instruments , Treatment OutcomeABSTRACT
A young female who had been investigated for vague abdominal complaints and marked loss of weight was discovered only after laparotomy, carried out for acute appendicitis, to have primary tuberculosis of the vermiform appendix with perforation. The rarity of tuberculosis of the appendix, the types of presentation and the pitfalls of diagnosis are discussed. The literature on appendicular tuberculosis is reviewed.
