Background: Ultrasound-guided transversus abdominis plane block is an effective method for pain relief after cesarean delivery. The gold standard to treat pain after cesarean delivery is spinal morphine administration; at the same time TAP is considered as an effective method to treat this pain. In this study, we compared efficiency and side effects of these techniques in patients undergoing elective cesarean delivery.Methods: 104 women undergoing elective cesarean delivery under spinal anesthesia were randomized to receive either TAP block with Bupivacaïne 0.25% (BUPICAÏNE, UNIMED, TUNISIA) or spinal morphine. All patients received a standard postoperative analgesia with Paracetamol intravenously. Rescue analgesia using Nefopam and morphine intravenously was given when necessary. Patients were assessed at 2, 4, 6, 12 and 24 hours after cesarean delivery. Visual analog scale (VAS) pain scores at rest and during the palpation of the uterine globe were recorded. Analgesic consumption, time to first analgesic request, heart rate, systolic and diastolic blood pressure were noted. Patients rated the severity of opoid side effects and their satisfaction with the protocol of analgesia.Results: Pain scores at rest and during the palpation of the uterine globe during the first 24 postoperative hours were similar in both groups. The number of patients who received additional analgesia was similar in both groups. The intestinal transit recovery was earlier in the TAP block group with a statistically significant difference (p < 10-3). Maternal satisfaction was similar in both groups. Conclusion:TAP block and intrathecal morphine were of similar efficiency for pain relief after cesarean section. The incidence of side effects was comparable in both groups.

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The pelvic packing should be particularly useful in developing countries where more advanced technologies such as selective arterial embolization are not always available. In developed countries, the pelvic packing may be a valuable temporary measure pending transport to a tertiary care facility.

II, prospective descriptive prognostic study.

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Uterine leiomyomas are very common tumors found in women. Rupture of veins on the surface of uterine leiomyoma is an unusual source of hemoperitoneum. It is an extremely uncommon gynaecological cause of hemoperitoneum. It is a life threatening emergency. We report a case of massive intraperitoneal hemorrhage due to rupture of vessels on the surface of subserous leiomyoma. A differential diagnosis of rupture of leiomyoma’ssurface vessel should be considered, while dealing with a case of hemoperitoneum with pelvic mass.