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ObjectiveTo compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage (PPH) among low‐risk women.MethodsRandomized controlled trial among 150 pregnant women with low risk of PPH admitted for vaginal delivery at Kasr Al Ainy Hospital, Cairo, Egypt, between July 2018 and May 2019. Participants were assigned to two groups by a web‐based randomization system ensuring allocation concealment. After neonatal delivery, the carbetocin group received one ampoule of carbetocin (100 μg/mL) intravenously and the misoprostol group received two rectal tablets of misoprostol (800 μg) for active management of the third stage. Blood pressure, blood loss, and hemoglobin levels were monitored. The primary outcome measure was need for additional uterotonic drugs.ResultsThe carbetocin group had significantly less blood loss (P<0.001), shorter third stage (P<0.001), and less need for additional uterotonics (P=0.013) or uterine massage (P=0.007). The two drugs were hemodynamically safe. Hemoglobin levels after delivery were comparable in the two groups (P=0.475). Adverse effects were more common in the misoprostol group (P<0.001).ConclusionAmong low‐risk women, carbetocin seems to be a better alternative to misoprostol for active management of the third stage of labor; it reduced blood loss and use of additional uterotonic drugs.ClinicalTrials.gov: NCT03556852

Rectus muscle reapproximation among women undergoing primary caesarian section is associated with significant increase in the postoperative pain and analgesic requirements.

Background: Paralytic ileus is one of the problems that are faced following abdominal surgeries including caesarean section which leads to post-operative pain, abdominal distension, delayed oral feeding, prolonged hospital stay and increased hospital cost. Objective: To assess the effectiveness of chewing gum as safe, effective and easy option to compete paralytic ileus. Patients and Methods: One hundred sixty two parturient women who had caesarean section delivery under spinal anesthesia were recruited and randomly allocated to two groups; group A the study group which were allowed to chew sugarless gums two hours after caesarean section for 30 minutes and repeated every two hours till auscultation of normal intestinal sounds or passage of flatus. Group B the control group underwent conventional care which is nothing per oral till audible intestinal sounds or passage of flatus. It was difficult to apply complete blindness due to the study design so the physician is only blinded. The primary outcome is the time of auscultation of first normal intestinal sounds and the secondary outcomes are time of passage of flatus, stools. Results: Both groups were comparable regarding to their demographic data. There was a statistical significance difference between both groups regarding auscultation of first intestinal sounds, passage of flatus, passage of stools and postoperative hospital stay (P value 0.001, 0.001, 0.001 and 0.001, respectively). No statistical significance difference between both groups regarding presence of abdominal distension, postoperative vomiting, patient satisfaction and presence of obstetric complications. Conclusion: The routine use of gum chewing together with early ambulation and no use of narcotics following caesarean section offers a safe, easy, effective option for early resumption of intestinal function and consecutively associated with short hospital stay.