SummaryBackgroundThe CORONIS trial reported differences in short-term maternal morbidity when comparing five pairs of alternative surgical techniques for caesarean section. Here we report outcomes at 3 years follow-up.MethodsThe CORONIS trial was a pragmatic international 2 × 2 × 2 × 2× 2 non-regular fractional, factorial, unmasked, randomised controlled trial done at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. In this follow-up study, we compared outcomes at 3 years following blunt versus sharp abdominal entry, exteriorisation of the uterus for repair versus intra-abdominal repair, single versus double layer closure of the uterus, closure versus non-closure of the peritoneum, and chromic catgut versus polyglactin-910 for uterine repair. Outcomes included pelvic pain; deep dyspareunia; hysterectomy and outcomes of subsequent pregnancies. Outcomes were assessed masked to the original trial allocation. This trial is registered with the Current Controlled Trials registry, number ISRCTN31089967.FindingsBetween Sept 1, 2011, and Sept 30, 2014, 13 153 (84%) women were followed-up for a mean duration of 3·8 years (SD 0·86). For blunt versus sharp abdominal entry there was no evidence of a difference in risk of abdominal hernias (adjusted RR 0·66; 95% CI 0·39–1·11). We also recorded no evidence of a difference in risk of death or serious morbidity of the children born at the time of trial entry (0·99, 0·83–1·17). For exteriorisation of the uterus versus intra-abdominal repair there was no evidence of a difference in risk of infertility (0·91, 0·71–1·18) or of ectopic pregnancy (0·50, 0·15–1·66). For single versus double layer closure of the uterus there was no evidence of a difference in maternal death (0·78, 0·46–1·32) or a composite of pregnancy complications (1·20, 0·75–1·90). For closure versus non-closure of the peritoneum there was no evidence of a difference in any outcomes relating to symptoms associated with pelvic adhesions such as infertility (0·80, 0·61–1·06). For chromic catgut versus polyglactin-910 sutures there was no evidence of a difference in the main comparisons for adverse pregnancy outcomes in a subsequent pregnancy, such as uterine rupture (3·05, 0·32–29·29). Overall, severe adverse outcomes were uncommon in these settings.InterpretationAlthough our study was not powered to detect modest differences in rare but serious events, there was no evidence to favour one technique over another. Other considerations will probably affect clinical practice, such as the time and cost saving of different approaches.FundingUK Medical Research Council and the Department for International Development.

Background:Urinary tract infections (UTIs) are common during pregnancy. Asymptomatic bacteriuria(ASB) can lead to the development of cystitis or pyelonephritis if left untreated and could eventually result in very serious sequelae.Objectives: To determine bacterial isolates and drug susceptibility patterns of mid-stream urinary specimens among pregnant women who were asymptomatic for UTIat their first antenatal attendance (booking).Subjects and methods: A retrospective review of urine results of antenatal attendants with no symptoms of UTI at booking from January 2010 to December, 2012 was done. As part of routine investigations at booking women provided mid-stream urinary specimens and bacterial isolates and drug susceptibility patterns were determined.Results: The total number of women was 453 and significant bacteriuria was found in 45/453(9.9%) . The commonest bacterial isolates were Staphylococcus aureus18/45 (40%) and E. coli 15/45 (33.3%). All the bacterial isolates were sensitive to nitofurantoin and theleast sensitivities were to erythromycin 13/45 (28.9%) and ampicillin 11/45 (24.4%).Conclusion: All pregnant women should be screened for bacteriuria at booking since the asymptomatic ones may have significant bacteriuria which could later result in serious infections and poor pregnancy outcomes. The choice of antibiotics used should bebased on maternal factors and the gestational age.