The Role of Delivery Route on Colostrum Melatonin and Serum Il-6 Levels: a Prospective Controlled Study

Introduction the aim of this study was to determine whether maternal serum IL-6 and postnatal melatonin levels change with the mode of delivery. Materials and Methods a prospective controlled study was performed on pregnant women (17–43 years) over 37 weeks of pregnancy. Patients were divided into three groups according to the route of delivery: Group 1) 30 women delivering by vaginal route; Group 2) 30 delivering by iterative cesarean section (CS); Group 3) delivering by emergency CS. Maternal serum IL-6 levels were measured before and after delivery, and maternal colostrum melatonin levels after delivery, and the results between the 3 groups compared. Results pre-delivery and post-delivery maternal serum IL-6 levels were significantly higher in patients who delivered vaginally than in patients who delivered by the abdominal route (p<0.01). Maternal colostrum melatonin levels of patients after delivery were significantly higher in patients who delivered vaginally (32.88±7.16 ng/L) than in patients who delivered by elective and emergent cesarean deliveries (24.86±2.40 ng/L and 23.73±4.03 ng/L, respectively) (p<0.01). Conclusion These data support, should there ever be a further need, the benefit of vaginal delivery over cesarean section, in which cytokine and melatonin levels are reduced compared to vaginal delivery.

Natural Orifice Non-Descent Hysterectomy - Revisiting Fading Surgical Art

BACKGROUND We wanted to assess the feasibility of natural orifice non-descent hysterectomy (NONH) for various benign gynaecological indications. METHODS This retrospective study was conducted at a tertiary care centre including patients requiring hysterectomy for various gynaecological indications over 12 months. Outcomes including time of surgery, blood loss, intraoperative surgical technique, complications, and conversion to the abdominal route were noted. RESULTS A total of 68 cases of natural orifice non-descent hysterectomy were performed. The uterine fibroid was the most common (50 %) indication for surgery followed by adenomyosis. Uteri with previous multiple surgeries were also successfully operated vaginally. The average surgical time was 60 min, with minimal blood loss. Post-operative recovery was good and patients were discharged after 48 hours. CONCLUSIONS This article concludes that natural orifice is a safe route of non-descent hysterectomy even for larger and scarred uteri using various debulking and surgical techniques but requiring good anatomical knowledge, surgical expertise and teamwork. KEY WORDS Natural Orifice Non-Descent Hysterectomy (NONH); Surgical Variations; Debulking Technique; Post-Operative Recovery

Surgical repair of Vesico-Vaginal: Vaginal route versus abdominal route.

Objective: To determine outcomes and complications of vesico-vaginal fistula repair via vaginal and abdominal route. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation, Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: January 2020 to December 2020. Material & Methods: Patients having vesicovaginal fistula irrespective of age and fulfilling our inclusion criteria were included in the study using non-probability consecutive sampling technique. Patients having very large fistula, fistula involving neck of urinary bladder, failure of previous operation, patients with malignancy or co-morbidities were excluded from the study. Vaginal and abdominal approaches were used for fistula repair depending upon the level of fistula. Those operated via vaginal route were kept in trans-vaginal group and those operated via abdominal route were assigned trans-abdominal group. Results: Total 35 cases were studied having age 16-45 years with mean age of 32.6 ± 4.2 years. Transvaginal fistula repair was done in 37.1% and transabdominal repair was done in 62.8% cases. Most common cause of VVF was previous gynecological surgery in 77% cases. Success rate was 100% in transvaginal fistula repair as compared to 95.4% success rate achieved in transabdominal repair of fistula. Conclusion: Trans abdominal and transvaginal route both are good approaches but Transvaginal route of fistula repair is associated with high success rate than transabdominal route with minimum complications and better outcomes but it needs expert surgeon.

Diagnosis and Management of Uterine Fibromyomas in the Obstetric Gynecology Department of the Regional Hospital of Labe. Guinea

Objectives: To calculate the frequency of uterine fibromyomas, to describe the epidemiological profile, to describe the management and to establish the prognosis of women with uterine fibromyomas in the gynaecology-obstetrics department of the Regional Hospital of Labé. Methodology: This was a retrospective descriptive study lasting three (3) years from 1 January 2017 to 31 December 2019. All patients admitted and operated on in the department for uterine fibromyomas during the study period were included. Patients who were not operated for uterine fibromyomas in the department and incomplete records were not included. Our data were collected and analysed using Epi-Info software version 7.2.2.6. Word, Excel and Power point software from Pack office 2016 were used for data entry and presentation. The study involved a continuous series of 115 anaemic pregnant women. We proceeded with an exhaustive recruitment of pregnant women according to the criteria defined above. Results: The frequency of uterine fibromyomas among gynaecological pathologies was 44.75%. The epidemiological profile was that of a 30-39% (40.87%), housewife (53.91%) and nulliparous (40%) woman. Pelvic pain was the dominant reason for consultation (75.65%) and 46.08% of patients had no particular history. Intramural or interstitial uterine fibromyomas were the most common (49.57%) and ultrasound was performed in all patients. The surgical indications were dominated by large polymyomatous uterus 37.39%, followed by haemorrhagic fibroid 26.09%. Myomectomy was performed in 75.65% of cases, exclusively via the abdominal route (100%), while hysterectomy was performed via the abdominal route in 17.39% of cases and vaginal route in 6.96%. The postoperative course was simple in 75.65% of cases and complicated in 24.35%. Complications were dominated by anaemia (13.04). The average length of stay was 6.05 days with extremes of 3 and 13 days. Conclusion: The frequency of the uterine fibromyomas is raised in the region of Labé and the hold in charge is often surgical

Three kinds of caesarean sections: the foetal/neonatal perspective

In the age of hospital births, it is commonplace to contrast the vaginal route and the abdominal route as the basic classification. From the “point of view” of the foetus/neonate, we provide reasons to contrast “birth without labour” (that is birth by pre-labour caesarean section) and all the other vaginal and abdominal modes of birth. From a great diversity of theoretical reasons, one can anticipate that babies born by pre-labour caesarean sections are different from the others. We also provide reasons to popularize the concepts of “in labour non-emergency caesarean sections” and “planned in-labour caesarean sections”.

Assessment of physical and sexual quality of life in women undergoing planned hysterectomy in tertiary care hospital

Background: The objective of the study was physical and sexual quality of life (SQOL) in women undergoing elective hysterectomy following six months after surgery.Methods: This was a prospective observational study in which all women undergoing elective hysterectomies in the department and fulfilling inclusion criteria through any routes and benign indication were recruited after taking informed written consent. Women with endometriosis, previous pelvic surgery and emergency hysterectomies were excluded from study. Each woman was subjected quality QOL questionnaires-SF-36 and SQOL-F prior and six months after surgery. Questionnaires used were in their own language, validated and already tested in pilot study. The required sample size was 65 (taking 20% lost to follow up) by using Epi-info software, total 78 eligible women taken in the present study. All data was recorded on excel spread sheet and analysis done by SPSS-21.0 and Wilcoxon-test as appropriate.Results: All aspects of physical and sexual quality of life was found to have improved following hysterectomy. However, only emotional wellbeing worsened.Conclusions: Hysterectomy improves physical and sexual quality of life post-surgery but sexual quality of life improves more in abdominal route than vaginal route.

Enfermedad de Von Willebrand como factor de riesgo para hemorragia postparto. Reporte de caso

The Von Willebrand´s disease is the most common inherited bleeding disorder, with higher prevalence in women in fertile age. There are three principle types, that are caused by either a quantitative or qualitative defect in von Willebrand factor and in severe cases, the coagulation factor VIII is affected too. The incidence in pregnancy is relatively infrequent, however there are worldwide reports where it has been considered a risk factor for bleeding during the resolution of pregnancy. We present the case of a 20-year-old woman on her second pregnancy, with a previous abortion, who had a full-term pregnancy with a diagnosis of Von Willebrand disease since she was twelve years old, treated with nasal desmopression only in the presence of hemorrhagic events. Gestation was terminated via abdominal route due to failed induction, and in spite of preoperative hematologic and anesthetic prophylactic management, she presented postpartum hemorrhage, according to current definitions based on national and international guidelines, attributing the cause of the bleeding to the patient's coagulopathy. Keywords: Von Willebrand´s disease; pregnancy; postpartum hemorrhage.

Table Sugar and Salt for the Reduction of Incarcerated Prolapse with Vescical Calculi- A Case Report

Incarcerated prolapse in association with bladder calculi is a rare occurrence. Table sugar and salt, which are both hygroscopic agents, have been used to reduce incarcerated bowel prolapse. Table sugar and salt was used in the following case of incarcerated procidencia with vescical calculi. Cystotomy with bladder stone removal was done by abdominal route. Total abdominal hysterectomy with bilateral salpingoopherectomy was done with pelvic floor repair and vault suspension.

Treatment of Pelvic Suppuration by abdominal section without Hysterectomy

Dr. R. considers in this article the question of: 1) in what cases it is necessary to operate with suppuration in the pelvis by the abdominal route, and besides, 2) in which of these cases is it possible to simultaneously cut out the uterus? The author excludes from his analysis abscesses of puerperal origin with an acute course, without participation in the process of the Fallopian tubes or ovaries, and is limited to examining purulent or cheese-like accumulations in the pelvis with or without the participation of the Fallopian tubes and ovaries.

Epigenetics, exposome and development of the intestinal microbiota in the neonate

The intestinal microbiota is currently known as a "metabolic organ" that significantly influences the health of the host from the first years of life, being a crucial factor for optimal development of immunity and regulation of different physiological processes such as digestion, absorption, metabolism and synthesis of nutrients. This work aims to show the relationship between epigenetics, the exposome and the development of the intestinal microbiota in the newborn according to the route of birth. A documentary review of the literature of the last 5 years was carried out and it was found that the majority of non-communicable diseases are due to epigenetic modifications that can occur in the prenatal stages, together with environmental factors that also contribute to these epigenetic changes, term known as an exposome. In this sense, the greatest exposure of microorganisms for the development of intestinal colonization is at the time of birth, being Bifidobacterium one of the most important genera that contribute to immune function, found to a lesser extent in newborns born by abdominal route (cesarean section ), this type has been associated with dysbiosis of the intestinal microbiota, generating consequences in the development of diseases such as obesity, diabetes, asthma, food allergy and autism spectrum disorder. Allowing to conclude that both epigenetics and the exposome and the intestinal microbiota are simultaneously related from the early stages of life and can be the cause of various non-communicable diseases.