Immediate compared with on-demand maternal full feeding after planned caesarean delivery: a randomised trial.

OBJECTIVE: To evaluate immediate compared with on-demand full maternal oral feeding after caesarean delivery STUDY DESIGN: A randomised trial. SETTING: Obstetric unit of a university hospital in Kuala Lumpur, Malaysia. POPULATION: Women admitted for a planned caesarean under spinal anaesthesia. METHODS: Participants were randomised to a sandwich meal served immediately on return to the ward or on-demand. MAIN OUTCOME MEASURES: Primary outcomes were patient satisfaction VAS (visual analog scale of 100 mm) on the feeding regimen and vomiting at 24 hours. RESULTS: 453 women were initially enrolled, 395 were randomised and available for analysis. Median (full range) patient satisfaction VAS scores were 82 (15-100) versus 84 (0-100) mm, P = 0.88 and vomiting rates were 1/197 (0.5%) versus 2/198 (1.0%), P > 0.99 for immediate compared with on-demand feeding, respectively. The immediate versus on-demand arms first ate at a median of 105 (35-210) versus 165 (45-385) minutes, P < 0.001, had second meal at 5.3 (1.2-15.5) versus 5.8 (2.2-29.7), P < 0.001, flatus passage at 9.5 (3.1-29.0) versus 10.3 (2.8-24.6), P = 0.023 hours post-caesarean and opiate analgesia use was 10/197 (5.1%) versus 23/198 (11.6%), P = 0.028, RR 0.4 (95% CI 0.2-0.9), NNTb 16 (95% CI 8-89). The median visual numerical rating scale (0-10 scale) for nausea and bloating at 8, 16 and 24 hours was similarly scored at zero in both arms. Other outcomes were similar. CONCLUSION: Immediate full feeding has some advantage over on-demand feeding. Both regimens are tolerated well. Patients probably should be fed as soon as practicable after a caesarean. TWEETABLE ABSTRACT: Full maternal oral feeding should commence as soon as practicable after an uncomplicated caesarean section.

Sustainable complete remission in recurrence yolk sac tumor patient treated with tandem high-dose chemotherapy and autologous stem cell.

A 21-year-old lady diagnosed with Stage 3 ovarian yolk sac tumor (YST) underwent primary cytoreductive fertility sparing surgery, followed by conventional courses of platinum-based chemotherapy and etoposide. Recurrence at cul-da-sac was noted after a short period of remission and secondary debulking performed followed by four cycles of conventional chemotherapy. The patient's disease progressed despite courses of treatments. A joint team management including a hematologist was commenced following the failure of conventional chemotherapies. Two cycles of high-dose chemotherapy (HDCT) with ifosfamide/cisplatin/etoposide (ICE) regimen, followed by autologous stem cell transplantation (ASCT) were given. With this salvage treatment, she remained in complete remission and disease-free for more than 30 months, while maintaining her reproductive function. These approaches appear to be effective as a salvage treatment in selected cases of patients with ovarian germ cell tumor, especially those who failed primary conventional chemotherapy.