Aim: This work aimed to study the efficacy and safety of preoperative intravenous tranexamic acid to reduce blood loss during and after elective lower-segment cesarean delivery. Materials and Methods: A double-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term singleton pregnancy at a center in tertiary referral hospital , Egypt, between December, 2019 and March, 2020. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1 g tranexamic acid(TXA) or 5% glucose 15 minutes before surgery. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during cesarean section, which was the primary outcome. Analyses included women who received their assigned treatment, whose surgery was 90 minutes or less, and who completed follow-up. Results: Eighty women in each group.There was no statistical difference found between women subjected to TXA and those subjected to placebo regarding maternal age, weight, gestational age or mode of previous delivery. Mean EBL was significantly higher in the placebo group (896.81 ± 519.6mL mL) than in the tranexamic acid group (583.23 ± 379.62mL; P < 0.001).
Conclusion:Preoperative administration of tranexamic acid safely reduces blood loss during elective lower-segment cesarean delivery.
Background: Infertility defined as failure to conceive after 12 months of unprotected regular intercourse. Unexplained infertility describes couples with infertility in whom standard investigations including semen analysis, tests of ovulation, and tubal patency have no gross abnormality. Aim of Study: To evaluate the endometrial and subendometrial blood flow in mid-luteal phase after measuring serum progesterone level in unexplained infertility patients and compare those parameters with fertile women in order to reveal the role of the uterine perfusion in unexplained infertility. Patients & Methods: In this study, we collected 100 participants presented to the outpatient clinic in Kasr El-Aini maternity hospital, we classify them into two groups: Group A: 50 women presented with unexplained infertility either primary or secondary (the case group). Group B: 50 women who had no history of infertility and at least have one child who came for any gynecological procedure (the control group) Primary outcome measures (VI) (FI) & (VFI) of endometrial and subendmetrial areas using (VOCAL) in mid luteal phase after measurement of serum progesterone level in both groups. Results: As regards endometrial vascularity index (VI), it was higher in control group (0.64 ± 0.05) than in case group (0.51 ± 0.09), Sub endometrial (VI) also was higher in control group (2.34 ± 0.13) than in case group (1.92 ±0.22), endometrial flow index (FI), it was higher in control group (29.26± 1.98) than in case group (24.47 ±4.19), sub endometrial flow index (FI), it was higher in control group (36.29±3.10) than in case group (30.52 ±2.52), endometrial vascular flow index (VFI), it was higher in control Group (0.36±0.05) than in case group (0.25±0.04) & subendometrial vascular flow index (VFI), it was higher in control group (1.13 ±0.25) than in case group (0.83±0.07) all of that are statistically significant. As regards to serum progesterone level it was higher in control group (12.87±2.47) than in case group (12.66 ±3.17) which was statistically insignificant. Conclusion: From our study we found that impairment of uterine perfusion could have a role in cases of unexplained infertility.
In the article titled "Efficacy and Safety of Preoperative Intravenous Tranexamic Acid to Reduce Blood Loss During and After Elective Lower-Segment Cesarean Delivery", published on pages 177-181, Issue 2, Volume 11 of Evidence Based Women's Health Journal. This article has been retracted from our journal.
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ObjectiveTo compare efficacy of lidocaine–prilocaine (LP) cream versus misoprostol versus placebo before levonorgestrel‐releasing intrauterine device (LNG‐IUD) insertion.MethodsThis randomized controlled trial (RCT) was conducted in a tertiary referral hospital from April 30, 2020 to March 1, 2021 on 210 parous women willing to receive LNG‐IUD and delivered only by elective cesarean delivery (CD). Participants received 200 μg vaginal misoprostol or 5 ml of LP cream 5% or placebo 3 h before LNG‐IUS insertion. Primary outcome was pain during LNG‐IUD insertion, while secondary outcomes were pain 10 min post‐procedure, ease of insertion, patient satisfaction, insertion time, and drug side effects.ResultsPain during LNG‐IUS insertion was reduced in LP group and misoprostol group compared to placebo group (2.1 ± 1.0 vs 3.7 ± 1.6; p <0.001) and (2.3 ± 1.3 vs 3.7 ± 1.6; p <0.001), respectively. Ease of procedure and patient satisfaction were significantly higher in LP and misoprostol groups than placebo (P <0.001). Need for additional analgesia was significantly higher in placebo group than in the other two groups (P = 0.009). Adverse events were not significantly different between the three groups except vomiting and abdominal cramps, which were higher with misoprostol.ConclusionLP cream and 200 μg of vaginal misoprostol administration before LNG‐IUD insertion in women delivered only by elective CD effectively reduced pain during insertion and 10 min post‐procedure with easier insertions, high patient satisfaction, and tolerable side effects. Pain reduction with LP cream was clinically significant.
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