BackgroundA potential non-pharmacologic way to reduce postoperative pain and bleeding is using an abdominal binder during postoperative recovery. This study aims to determine the effect an elastic abdominal binder has on postoperative pain and hemorrhage after cesarean delivery.MethodsA randomized, single-site, pilot trial was conducted at two prenatal care clinics and an academic hospital in Kansas. Beginning in April 2013, 60 patients were enrolled if delivering via cesarean. Participants were randomized to receive an abdominal binder or to a control group (did not use binder). Pain levels were reported by questionnaire one day after surgery using a 0 to 10 scale, with 10 being the worst pain. Patient characteristics and blood loss were assessed by medical record review.ResultsOf the 56 patients completing the study, 29 (51.8%) were randomized to the binder group and 27 (48.2%) were randomized to the control group. The binder group reported significantly lower pain score (p = 0.019) and average pain score (p = 0.024). There was no difference in body mass index, age, previous surgery, infant birth weight, estimated blood loss, and average dose of pain medication during the first 24 hours after the cesarean delivery between the two groups. There was no difference in pre- and post-operative hemoglobin levels by treatment group (p = 0.406).ConclusionsAbdominal binders may be associated with improved postoperative pain scores but did not affect postoperative hemorrhage.
modulators. DNA methytransferases (DNMT) appear to regulate gene activity during decidualization, but relative expression level by phase is not fully understood and has not been studied in abnormal uterine bleeding.METHODS: Immunohistochemistry was performed on tissue microarrays derived from 541 endometrial samples including secretory, proliferative, atrophic histopathologic diagnoses. Baseline demographic and clinical data were collected for all 541 study participants. The expression levels of DNMT1, DNMT3a, DNMT3b, estrogen receptor, and progesterone receptor were determined by staining scores, generated as the product of staining intensity and extent. Review was completed by a pathologist blinded to the clinical information. Statistical analysis of composite scores was performed using JMP 9.0. RESULTS:For each phase of the menstrual cycle, epithelial and stromal cell nuclei immunostained for DNMT1, DNMT3a, and DNMT3b. Although tissue levels of DNMT3a and DNMT3b by staining score were lower in the midsecretory phases as compared with the proliferative phase, levels of DNMT1 were increased in the midsecretory phase. Overall expression of DNMT1 was higher in abnormal uterine bleeding, whereas DNMT3A and DNMT3b were unchanged.CONCLUSION: Our study is the largest yet to compare DNMT expression in human endometrium at different stages of decidualization and in abnormal uterine bleeding. Our study provides confirmatory evidence that DNMTs are expressed in human endometrium in a phase-specific manner. Further evaluation of a putative role for DNMTs in menstruation is warranted.
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