Journal of Fertility, Gynecology and Andrology
Volume:1 Issue: 1, Dec 2021

 The reduction of shoulder pain and postoperative nausea and vomiting (PONV), causing great discomfort for patients after gynecological laparoscopy, requires preventive or treatment strategies.

 The present study aimed to determine the efficacy of intraperitoneal (IP) dexamethasone in the reduction of shoulder pain and PONV after gynecological laparoscopy.

 In this double-blind, randomized clinical trial, 130 consecutive patients undergoing gynecological laparoscopy were randomly assigned to two groups of 65 patients within May 2015 to May 2016. One group received 16 mg IP dexamethasone before the end of the surgery, and the other group received the placebo (i.e., the IP infusion of distilled water). Patients' age and body mass index (BMI), and surgery duration were recorded in this study. The severity of shoulder pain was evaluated by the visual analog scale (VAS) at recovery and 2, 6, 12, and 24 h after the surgery. Moreover, the need for opioid use and PONV were recorded within the first 24 h after the surgery. The study outcomes were compared between the two study groups and among the different intervals using SPSS software (version 21).

 The groups had similar demographics (i.e., age and BMI) and mean surgery duration (P > 0.05). The mean values of VAS scores of the intervention group were lower than those of the placebo group at five intervals (P = 0.001). The frequency of opioid use was significantly lower in the dexamethasone group (P = 0.010). In addition, 20% and 60% of the patients in the dexamethasone and placebo groups had PONV, respectively (P < 0.001).

 The IP dexamethasone is effective in the reduction of shoulder pain and nausea/vomiting after gynecological laparoscopy and can significantly reduce opioid requirement within the first 24 h after surgery; however, IP dexamethasone does not increase surgery duration. Therefore, it is recommended to use this technique during gynecological laparoscopy.

 This study aimed to evaluate the feasibility of using a computerized machine to predict a successful normal vaginal delivery and determine the antepartum factors involved in failed labor induction in nulliparous term women.

 This prospective cohort study was conducted in Yas Hospital affiliated with Tehran University of Medical Sciences from 2017 to 2019. The data used for the computerized system were obtained during the admission of the term nulliparous women with singleton pregnancy in cephalic presentation. The cesarean delivery rate, as well as maternal and perinatal outcomes, were evaluated. The input variables were maternal age, gravida, gestational age at birth, necessity and type of labor induction, presentation of the baby at birth, Bishop Score, fetal weight, and fetal head circumference, and maternal disorders. The outputs were vaginal deliveries or cesarean sections.

 The rate of cesarean section was 41.8% (n = 287). Higher maternal age (OR = 1.044, P = 0.018, CI = 1.007 - 1.082), lower Bishop Score (OR = 0.192, P < 0.001, CI = 0.139 - 0.256) and non-occiput anterior position (OR = 82.194, P < 0.001, CI = 15.888 - 425.214) were significantly associated with failed induction.

 The result of this study may be beneficial for healthcare providers to predict the delivery route, the risk of labor induction failure and make a personal decision according to each individual.

 Delayed or avoided medical care due to coronavirus disease 2019 (COVID-19) related concerns may increase morbidity and mortality associated with both acute and chronic health conditions. Thymoma is uncommon in pregnancy, although it could be accompanied with unfavorable outcomes. We report a puerperal woman presented with dyspnea and cardiac arrest with a recent diagnosis of thymoma that led to maternal mortality.

 A 38-year-old woman with occasional dyspnea during pregnancy without medical referral was admitted to the hospital with severe dyspnea and orthopnea three days after cesarean section. Spiral computed tomography (CT) angiography showed a 64 × 84-centimeter mass with soft tissue density in the left perivascular that was originated from the anterior mediastinum; in biopsy, thymoma was suggested. She died shortly after due to severe dyspnea and cardiac arrest.

 Prenatal care during COVID-19 pandemic should not be postponed. Indeed, any symptom similar to the physiologic changes in pregnancy needs to be evaluated for optimal clinical management.

 Fetal cardiac monitoring indications during labor and near delivery in high- and low-risk pregnancies and their effects on neonatal outcomes have been investigated in previous studies; however, the data of nonreassuring cardiotocography (CTG) near delivery on neonates are insufficient.

 This study aimed to compare fetal distress with nonreassuring CTG in high- and low-risk pregnancies to see if high-risk pregnancies need different or more care or not.

 This retrospective cohort study was conducted on pregnant women candidates for vaginal delivery in an academic hospital within 2017 - 2020. The participants were divided according to maternal and fetal risk factors into two groups of low-risk and high-risk pregnancies (including preeclampsia/eclampsia, diabetes, placenta abruption, and intrauterine growth restriction). Three obstetricians, blinded to the participants and neonatal outcomes, reviewed the CTG tracing near delivery individually. The features of nonreassuring CTG 30 minutes before delivery, including variable deceleration, late deceleration, slow return to base, tachycardia, and shoulder and overshoot patterns, were detected in the traces. Then, the neonatal outcomes, including umbilical artery pH at birth, Apgar scores at the 1st and 5th minutes, and admission to the neonatal intensive care unit (NICU), were compared between the groups.

 A total of 622 participants, including 322 high-risk and 300 low-risk pregnancies, with nonreassuring CTG, were recruited into the study. The adverse neonatal outcomes, such as NICU admission, low Apgar scores in the 1st and the 5th minutes, and pH < 7.1, were significantly different between high-risk and low-risk pregnancies with variable deceleration, tachycardia, and overshoot patterns. High- and low-risk pregnancies with late deceleration had only significantly different Apgar scores in the 5th minute. In the slow return to base features, the Apgar scores in the 1st and 5th minutes and NICU admission were significantly different in high- and low-risk groups. Additionally, NICU admission and low Apgar score in the 1st minute were higher in high-risk women in shoulder patterns.

 Nonreassuring CTG near delivery might be accompanied by more fetal distress in high-risk pregnancies. Therefore, the nonreassuring features of CTG in high-risk pregnancies should be considered more important and might need prompt and timely action to decrease the adverse outcomes.

 It is essential to maintain the hemodynamic state of mothers during delivery in cesarean section (CS). Research has shown that hypotension can be controlled by applying a 15° left lateral tilt. This can be achieved using an obstetric wedge or by tilting the operating table leftward. A systematic review of further research shows insufficient evidence to suggest whether it is effective or practical.

 This study aims to evaluate the effectiveness of manual left tilting of the uterus on maintaining the hemodynamic status of mothers undergoing a CS delivery, where a spinal anesthetic has been given.

 Seventy women who were candidates for CS deliveries were randomly assigned into 2 groups as follows: group 1, the anaesthesiologist manually maneuvered the mother’s uterus to the left shortly after spinal anesthesia; group 2, the mothers’ uteruses were not displaced to the left. Sixty-seven of 70 participants completed the study. The hemodynamic status of the mother was reported before, during, and after surgery. The total doses of inotropic-vasopressors used to maintain hemodynamic stability were recorded.

 The mother’s age, vital signs, and body mass index (BMI) before pregnancy and near term were not significantly different. Mothers maintained a significantly higher systolic blood pressure (SBP) when the uterus was displaced to the left (group 1). The mothers also required less ephedrine. Mothers in group 2 suffered a greater decrease in their SBP both after induction and before incision of the abdomen (group 2, P < 0.05).

 The manual tilting of the uterus to the left during CS is effective in maintaining blood pressure and decreases the need for vasopressors.