Heterotopic pregnancy is the simultaneous occurrence of two or more implantation sites. A 25-year-old infertile patient with a history of bilateral salpingectomy, uterine septum resection, and left cornual resection was diagnosed with heterotopic pregnancy in her second in vitro fertilization trial. She attended our clinic when she was 7-week pregnant, complaining initially of severe abdominal pain. Findings associated with peritoneal irritation were positive during the physical examination. Transvaginal ultrasound revealed right cornual ectopic pregnancy with a live fetus in the middle of the uterine cavity. Also free fluid was noted in the pelvis. A diagnosis of heterotopic pregnancy with rupture of the cornual pregnancy was made. She underwent emergency laparoscopy with aspiration of the ruptured ectopic pregnancy, suturing to the entire visible cornual margins, and assurance of good haemostasis. Her recovery was uneventful and she continued receiving care in our obstetric unit. She delivered a healthy newborn by cesarean section at term.

Öz Amaç: Postoperatif dönemde flatulans ve defekasyon zamanı hasta konforu ile morbiditesini belirleyen ana etmenlerden biridir. Bu çalışmada komplikasyonsuz term sezaryen doğumlarda postoperatif sakız çiğneme ve kafeinsiz kahve içiminin barsak motilitesine etkisi prospektif randomize kontrollü klinik çalışma ile test edilmiştir. Gereç ve Yöntem: Çalışmaya sezaryen ile komplikasyonsuz doğum yapan 100 gebe basit randomizasyon yöntemiyle 4 gruba ayrıldı: Grup 1 (postoperatif 2. saaten sonra defekasyon olana kadar 4 saat arayla şekersiz sakız çiğnetilenler) n:25; Grup 2 (postoperatif 2. saatten itibaren defekasyon olana kadar 4 saat arayla günde 3 kez olmak kaydıyla 100 ml kahve içirilenler) n:25; Grup 3 (postoperatif 2. saatten itibaren defekasyon olana kadar 4 saat arayla 3 kez 100 ml sıcak su içenler: Sham grubu) n:25; Grup 4 (kontrol grubu) n:25. Hastaların ilk barsak hareketini hissettikleri, ilk gaz çıkışının gerçekleştiği ve defekasyon zamanları gruplar arasında karşılaştırıldı. Bulgular: Olguların ilk barsak hareketi hissi ve ilk gaz çıkış zamanı Grup 1'de sham ve kontrol gruplarına göre anlamlı olarak daha kısa saptandı. Gruplardaki hastaların defekasyon zamanı karşılaştırıldığında kontrol grubuna göre Grup 1, 2 ve 3'deki hastalarda süre anlamlı olarak daha kısa saptandı. Tüm gruplar arasında ise anlamlı farklılık bulunmadı. Tartışma: Sezaryen sonrası postoperatif dönemde şekersiz sakız çiğneme ve kafeinsiz kahve içilmesi uygulamaları ile hastaların gaz çıkışı ve defekasyon zamanları, dolayısıyla hospitalizasyon süreleri kısaltılabilir.Abstract Aim: The time to first postoperative flatulence and defaecation are two of the main factors that determine caesarean patient comfort and morbidity. In this study, the effect of postoperative gum chewing and decaffeinated coffee consumption on intestinal motility was tested in full-term caesarean sections without complication with a prospective, randomised controlled trial. Material and Method: 100 women who underwent caesarean section without a complication were divided into 4 groups using the simple randomisation method: Group 1 (women given sugar-free gum at 4-hour intervals after postoperative hour 2 until defaecation) n:25; Group 2 (women given 100 mL coffee at 4-hour intervals beginning from postoperative hour 2 until defaecation for three times a day) n:25; Group 3 (Sham group-women given 100 ml hot water at 4-hour intervals beginning from postoperative hour 2 until defaecation for three times a day) n:25; and Group 4 (control group) n:25. Time to sensation of first bowel movement and time to passage of first flatus and defaecation were compared between the groups. Results: Times to sensation of first bowel movement and passage of first flatus were significantly shorter in Group 1 compared to the sham and control groups. Time to first defaecation was also detected to be significantly shorter in Groups 1, 2, and 3 compared to the control group. No significant difference could be detected between the groups. Discussion: Sugar-free gum chewing and decaffeinated co...

The preoperative vaginal cleansing with povidone iodine could reduce the postoperative pain, analgesic need and infection parameter.

A high percentage of patients with genital fistulae can be rendered dry and continent by assessment of these conditions; meticulous attention must be applied for the absence of inflammation and infection at the fistula site before the operation. Surgical team must be experienced at both abdominal and vaginal repair. Broad-spectrum antibiotics and continuous bladder drainage must be applied to all patients for at least 2 weeks. Interposition flaps must be used in complex cases.

No abstract