Caesarean section done at full cervical dilatation (second stage of labour) has been on the rise globally and comes with its own unique challenges and complications. This commentary highlights the peculiar challenges associated with caesarean section in second stage of labour and gives an overview on various principles to be followed and techniques to employ to reduce fetal and maternal morbidity.
Background: Vesicovaginal fistula (VVF) is an embarrassing condition for women. Various routes of surgical intervention exist for the management of VVF. Laparoscopic repair is safe and effective. Aim and objective: To review the success rate of laparoscopic repair of VVF and to highlight the benefits/advantages of the laparoscopic approach. Materials and methods: Using various databases, previous studies of patients who underwent laparoscopic VVF repair between 2008 and 2018 were reviewed. Outcome measures from these studies were success rate, mean blood loss, mean operating time, length of hospital stay, major intraoperative complications, and conversion to open surgery. Results: Fourteen retrospective studies (full-text articles) were retrieved and reviewed. Two hundred and sixty-nine patients had a laparoscopic repair. The pooled success rate was 96.7%. Mean blood loss ranged from 30 to 400 mL, length of hospital stay ranged from 1.1 to 7.8 days while the mean operating time ranged from 54 to 229 minutes. There was only one major intraoperative complication. Only four patients had to be converted to open surgery. Conclusion: Laparoscopic repair of VVF has a high success rate and is a safe, patient-friendly, and cost-effective route for surgical management of VVF.
Introduction: Pain control during Manual Vacuum Aspiration is one of the most important aspects of postabortion care. This study assessed the analgesic efficacy, requirement for additional analgesia, and overall satisfaction using Paracervical blocks of 1% lignocaine compare with normal saline as placebo among women undergoing manual vacuum aspiration for incomplete abortion in OAUTHC, Ile-Ife. Methods: This was a double blind randomized controlled trial that occurred between January 2019 and February 2020. We randomized one hundred and twenty eligible women equally into 2 groups. Group A received paracervical block using 1% lignocaine while those in group B received paracervical block using normal saline as placebo. We obtained ethical clearance from the Ethics and Research Committee of the hospital. Preoperatively, we obtained relevant data and evaluated the degree of anxiety and pain on a visual analog scale (VAS). Intraoperative pain was evaluated from 2 viewpoints: that of the external observer on a 0 -4 scale and that of the patient scale of 0 -10 in the immediate postoperative period, followed by overall satisfaction at the point of discharge. We analyzed the data using SPSS version 20. Paired T test, independent T test Chi square, and Fishers' exact tests were applied for continuous and categorical variables as appropriate. P value < 0.05 was considered as statistically significant. Results: The Intra-operative and Postoperative VAS was significantly higher in the placebo group compared to the analgesia group (t = −3.39, CI −4.11 -−2.69. P < 0.05 intra-operative, t = 7.18, CI 2.62 -4.
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