Perioperative SARS-CoV-2 Infection in Patients Undergoing Elective Surgery in Gynecology Clinic: Tertiary Center Experience

OBJECTIVE: The objective of this study was to determine the incidence of perioperative “severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)” infection among women, operated during Coronavirus disease-2019 (COVID-19) era. STUDY DESIGN: All patients who were operated on between March 11, 2020, and December 31, 2020, in our gynecology clinic were included in this cross-sectional study. The clinical and demographic characteristics of the patients, preoperative and postoperative SARS-CoV-2 positivity, the progress of the infection, and the survival rates in positive cases were analyzed. COVID-19 cases were diagnosed by reverse transcription-polymerase chain reaction testing for SARS-CoV-2. RESULTS: Operations of 133 (33%) of 406 patients were canceled for various reasons. 275 patients were operated on. Preoperatively three patients were diagnosed with COVID-19. One of these patients died and two were operated on after treatment and self-isolation. Only one (0.4%) patient was diagnosed with COVID-19 30 days postoperatively and completely recovered. We calculated the perioperative SARS-CoV-2 positivity rate as 1.4% (276 surgeries were planned and 4 patients were diagnosed with COVID-19). During the study, 107 physicians worked in our clinic alternately. Two (1.8%) of these physicians were diagnosed with COVID-19 and completely recovered without the need for intensive care. In addition, nine patients who were previously diagnosed with COVID-19 were operated on. Postoperative respiratory and other system complications did not occur in nine patients, previously diagnosed with COVID-19. CONCLUSION: The results of our study show that gynecological surgical procedures do not increase the transmission and mortality rates of SARS-CoV-2 among patients and healthcare professionals as long as infection control measures are followed.

Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review

Endometriosis is a debilitating disease characterized by endometrial glands and stroma outside the endometrial cavity. Abdominal wall endometriosis (AWE) indicates the presence of ectopic endometrium between the peritoneum and the skin, including subcutaneous adipose tissue and muscle layers, often following obstetric and gynecological surgical procedures. AWE is a not infrequent gynecological surgical complication, due to the increasing number of cesarean sections worldwide. In this pictorial review, we discuss the importance of medical history and physical examination, including the main ultrasound features in the diagnosis of AWE.

Randomized Clinical Trial to Evaluate the Effect of Canephron N in Comparison to Ciprofloxacin in the Prevention of Postoperative Lower Urinary Tract Infections after Midurethral Sling Surgery

Urinary tract infections (UTIs) are one of the most common reasons for antibiotic prescriptions among women worldwide. UTIs are also associated with intra- and postoperative catheterization, which is an essential component of many gynecological surgical procedures, including midurethral sling (MUS) placement. The aim of this study was to compare the incidence of UTI subsequent to a MUS procedure. The study involved 562 female patients who underwent MUS procedures due to stress urinary incontinence (SUI). Patients were assigned in a 1:1 ratio to two study groups: patients receiving 500 mg of ciprofloxacin three times a day for 3 consecutive days after surgery or patients receiving 5 mL of Canephron taken orally three times a day for 3 weeks. After analyzing the collected data, it was found that in the group of patients receiving ciprofloxacin, 29 women (10.98 %) had a UTI, whereas in the group of patients receiving Canephron, 36 women (13.64 %) had a UTI within 6 months after the patient’s MUS procedure. No statistically significant difference between the two groups was noted. Postoperative prophylaxis with a phytodrug can be perceived as an attractive option in the reduction of antibiotic consumption among female patients after a MUS procedure.

A Randomized Clinical Trial to Evaluate the Effect of Canephron N in Comparison to Ciprofloxacin in the Prevention of Postoperative Lower Urinary Tract Infections after Midurethral Sling Surgery

Urinary tract infections (UTIs) are one of the most common reasons for antibiotic prescriptions among women worldwide. UTIs are also associated with intra- and postoperative catheterization, which is an essential component of many gynecological surgical procedures, including midurethral sling (MUS) placement. The aim of this study was to compare the incidence of UTI subsequent to a MUS procedure. The study involved 562 female patients who underwent MUS procedures due to stress urinary incontinence (SUI). Patients were assigned in a 1:1 ratio to two study groups: patients receiving 500 mg of ciprofloxacin three times a day for 3 consecutive days after surgery or patients receiving 5 mL of Canephron taken orally three times a day for 3 weeks. After analyzing the collected data, it was found that in the group of patients receiving ciprofloxacin, 29 women (10.98%) had a UTI, whereas in the group of patients receiving Canephron, 36 women (13.64%) had a UTI within 6 months after the patient’s MUS procedure. No statistically significant difference between the two groups was noted. Postoperative prophylaxis with a phytodrug can be perceived as an attractive option in the reduction of antibiotic consumption among female patients after a MUS procedure.

Gastrointestinal injurious insults in gynecological surgical procedures at El Sahel Hospital

Background: Gastrointestinal surgical insults during operative gynecologic procedures varies considerably according to the procedure. Prognostic tools and risk factors should be elucidated by further research efforts to enhance management levels of those cases category Aim of the work: To investigate the risk factors, impact and severity as regards gastrointestinal injuries during gynecological and obstetrical operations Methodology: A retrospective case-control research study performed on cases who have underwent gynecologic surgery in the period between 2014 and 2019. Results: Risk factors for gastrointestinal injuries in which past history of abdominal operation , pelvic adhesions, previous pelvic operation have shown to be statistically significant risk factors for GIT injuries (p values = 0.007, 0.019, consecutively) Conclusions and Recommendations: Innovation of a surgical prognosis algorithm based on statistical analysis is considered the cornerstone of enhancement of surgical management of gynecologically challenging cases aiding in reducing gastrointestinal surgical insults within gynecological surgical practice.

THE COMPLICATIONS OF SPINAL ANESTHESIA IN OBSTETRIC AND GYNECOLOGICAL SURGICAL PROCEDURES

Background: The proper use of spinal anesthesia in surgical procedures will minimize patient’s referral. The objectives of the study were to determine the immediate and late complications of spinal anesthesia in obstetric and gynecological surgical procedures in our population. Material and Methods: This cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Moulvi Ameer Shah Memorial Hospital, Peshawar, Pakistan from January 2014 to December 2014. Sample size was 790, selected through consecutive sampling technique. All routine and emergency obstetrical and gynecological cases were included. The exclusion criteria were those having hypotension, shock, coagulopathy, prolonged surgeries, patient’s refusal and local spinal disease. The demographic variables were; number of attempts, failure of anesthesia, vomiting, hypotension, respiratory problems, pain, Puncture site pain, and post dural puncture headache. All variables being categorical were analyzed by frequency and percentages using SPSS Version 16.0. Results: Out of 790 obstetrics and gynecology patients undergoing spinal anesthesia, there were 752 (95.2%) patients anaesthetized on first attempt whereas 38 (4.8%) required >1 attempts. Spinal anesthesia failed in 17 (2.1%) cases, partially failed in 15(1.9%). Post-operative mild hypotension was observed in 25 (3.1%) patients and severe hypotension in 4 (0.5%) cases. Respiratory problems were noted among 12 (1.9%). Patient’s Post-operative pain was observed in 28 (3.5%) patients. Nausea and vomiting were noted in 68 patients (8.6%).Late complications include post-operative mild to moderate pain in 65 (8.2%), severe in 15 (1.9%). Puncture site pain was observed in 8 (1.0%) of patients. Severe post dural puncture headache was noted in 3 (.38%). Conclusion: Spinal anesthesia in obstetric and gynecological surgical patients is easy to administer, safer and effective.

Estimation of Gastric Volume Before Anesthesia in Term-Pregnant Women Undergoing Elective Cesarean Section, Compared With Non-pregnant or First-Trimester Women Undergoing Minor Gynecological Surgical Procedures

Background: Traditionally, intubation of pregnant women has been performed using a rapid sequence induction. This is due to the classical concept that women with more than 18 weeks of pregnancy (mid-second trimester) are always considered to have an increased risk of aspiration due to a number of factors, regardless of the fasting duration. Rapid sequence induction is associated with a higher rate of adverse events. Aims: Our study aimed to illuminate the hypothesis that there is no difference in gastric volume between term-pregnant women and non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Accordingly, we measured gastric volume and content before anesthesia in term-pregnant women undergoing elective cesarean section, and to compare it with non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Methods: In this single-center prospective study, the gastric volume and content were assessed by abdominal ultrasound (AUS) just prior to the scheduled procedure. AUS was performed in the sagittal or para-sagittal plain in the upright position and the stomach content was estimated according to the antral circumferential area. Group 1 consisted of 50 term-pregnant women scheduled for cesarean section. Group 2 consisted of 45 non-pregnant or first-trimester pregnant women who were scheduled for minor gynecologic procedure. Results: Despite significant longer fasting time prior to the interventional procedure in the non-pregnant or first-trimester women group, there was no significant difference in gastric volume between term-pregnant and first-trimester pregnant women (3.2 ± 0.97 cm2 vs 3.2 ± 0.79 cm2; P = .97). Gastric volume was small in the two groups. Conclusion: Fasting gastric volume before cesarean section in term-pregnant women is small and is not different than in non-pregnant or first-trimester women undergoing minor gynecologic procedures. Ultrasound estimation of gastric volume is a reliable and easy-to-perform technique which might help in decision-making regarding the airway management prior to induction of anesthesia in pregnant women.

Psychiatric disorders following hysterectomy

Hysterectomy is one of the most commonly performed gynecological surgical procedures on the uterus which are thought to be an insult to the women’s emotional equilibrium. It leads to the feeling of reduced femininity which may develop psychiatric disorders. The objective of the study was to evaluate the proportion and pattern of psychiatric disorders among the hysterectomized women. This was a cross sectional and comparative study, conducted in the department of Psychiatry in collaboration with the outpatient department of Gynecology and Obstetrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh during the period from January 2012 to December 2012. For this purpose 365 married women of reproductive age group, after 3 to 6 months of planned hysterectomy fulfilling the inclusion and exclusion criteria were selected consecutively as a case group and age matched 365 healthy women were selected as control group. The result showed that, the mean age of the respondents was 41.48 (SD±3.79) years which was almost identical to control group (p=0.953). Most (49.5%) of the women were below the age of 40 years. Psychiatric disorders were most frequent in hysterectomized group (38.3%) as compared to control group (28.1%) (p<0.001). The most common psychiatric disorder was major depressive disorder (26.5%) followed by panic disorder (5.2%), obsessive compulsive disorder (3.8%) and conversion disorder (2.7%).The results of this study suggest that a significant number of women suffer from psychiatric disorders after hysterectomy than the age matched control.Bang J Psychiatry December 2015; 29(2): 44-47

Spinal Anesthesia and Spinal Anesthesia with Subdiaphragmatic Lidocaine in Shoulder Pain Reduction for Gynecological Laparoscopic Surgery: A Randomized Clinical Trial

Objective. The aim of this study was to compare the effectiveness of spinal anesthesia with subdiaphragmatic lidocaine at the beginning of surgery versus spinal anesthesia in pain reduction for gynecological laparoscopic surgery. Methods. This was a clinical trial conducted in Arash Hospital, Tehran, Iran. Eighty-four patients were randomized to either spinal anesthesia with subdiaphragmatic lidocaine, spinal anesthesia, or general anesthesia (GA). The primary outcome was patients’ pain perception during surgery, 2, 4, 6, and 12 hours after surgery, and prior to discharge and was assessed by visual analogue scale (VAS). Results. The results showed that there are no significant changes in pain perception over time in none of the three groups (F(4,76) = 0.37, P=0.82). The severity of pain experienced by patients at all-time interval after surgery was similar between groups [F(2,79) = 0.54, P=0.58]. Conclusion. The use of subdiaphragmatic lidocaine at the beginning of surgery combined with spinal anesthesia was not associated with a statistically significant difference in patients’ postoperative VAS scores compared to spinal anesthesia and GA during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial by the number of IRCT2016022226698N1.