ObjectiveWe aimed to evaluate the effect of different timing of initiation of low-molecular-weight heparin (LMWH) administration on the pregnancy outcomes in women with antiphospholipid syndrome (APS).Materials and methodsA randomized controlled study was conducted on women with obstetrical APS. All participants were randomly divided at documentation of positive pregnancy test into two groups; early initiation group in which LMWH therapy was started once positive pregnancy test was established (in the fifth week of gestation), and later initiation group in which LMWH therapy was started after sonographic confirmation of fetal cardiac pulsation (in the seventh week of gestation). In both groups, LMWH (enoxaparin) was given at a dose of 40 mg/day subcutaneously and the therapy continued until end of pregnancy. The primary outcome measure was ongoing pregnancy rate and the secondary outcome measures were fetal loss, live birth rate, preterm labor before 34 weeks of gestation, intrauterine growth restriction (IUGR), and congenital fetal malformations.ResultsNinety-four women (48 in the early initiation group and 46 in the later initiation group) were subjected to final analysis. The ongoing pregnancy rate was significantly higher in the early initiation group than in the later initiation group (81.2% vs 60.9%; P=0.040). However, both groups were similar in the incidences of fetal loss, preterm labor before 34 weeks of gestation, and IUGR, and live birth rate. No recorded congenital fetal malformations in both groups.ConclusionEarly administration of LMWH for pregnant women with obstetrical APS reduces early pregnancy loss, but does not affect the incidence of late obstetrical complications.

Background and Aim:Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects.Settings and Design:A prospective, randomized, controlled double-blind trial that was carried out at a university hospital.Patients and Methods:Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 μg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded.Statistical Analysis:Student's t-test, Mann–Whitney U-test, and Chi-square test were used.Results:Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10–19.50) mg compared to 25 (17.50–37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus.Conclusions:Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy.

Background: The high incidence rate of surgical site infections (SSIs) highlights the need for prioritizing patient demographics, procedures, and surgical factors to be controlled by programs to reduce the infection rate. Objectives: This study detects the prevalence, causative organisms, and explores the relation between the air contamination in the operative theater and the SSI. Methodology: Cross sectional one-year study from January 2019. One hundred and seventy-two women were involved underwent CD. Intraoperative air sampling was performed during 83 surgery and bacterial air contamination were identified. Follow up for the patients 30 days after surgery was done to detect hospital acquired and community acquired SSI. Two samples were taken from the patient wound with SSI. Microbiological identification and antibiotics susceptibility testing for the isolates were done. The clonal relationships between the same species of isolates from air and wound were studied by evaluating the genomic DNA with PFGE analysis. Results: 14.5 % was the total SSI rate; 6.4%, developed hospital acquired SSI and 8.1% developed community acquired SSI. Most SSI cases yielded growth of Staphylococcus spp. (39, 3%) followed by Pseudomonas spp. (32.1%) and finally Escherichia coli (28.6%). Six wound isolates belonged to two air isolates pulsotype and the rest of isolates showed unsimilar pulsotype of interest. Conclusions: air contamination one of the causes of SSI and measures are recommended to reduce its incidence, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with strict surgical techniques. Most common cause of community acquired SSI was bad hygiene.

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.