European Journal of Molecular & Clinical Medicine

Background:High rate of cesarean section is accompanied by higher rate of complications.
Niche, which is a uterine wall defect is one of these recognized complications. Our study's aim
was to find out how common abnormal uterine bleeding is among women who have had
caesarean sections.
Subjects and methods: 195 women who had at least one prior cesarean section and complaining
of vaginal spotting after the menstrual period admitted at the cytogenetics endoscopic unit,
Zagazig University Hospitals.Office hysteroscopy was used to check for the presence of a
caesarean section niche in the patients.
Results: By hysteroscopy, there was a statistically significant difference between patients with
and without niche regarding age (P value, 0.001), number of previous CSs (P value < 0.001),
hypertension (P value <0.001), post-menstrual spotting (P value, 0.002), dysmenorrhea (P value
< 0.161) and chronic pelvic pain (P value, 0.547).
Conclusion: There is an association between the number of previous CS and development of a
niche.CS niche is linked to dysmenorrhea and chronic pelvic pain.

Background: pain after Cesarean delivery (CD) can negatively affect ambulation, breastfeeding, and maternal bonding. The aim of this study was to determine whether a correctly performed TAPB can provide better control of acute postoperative pain during the first 48 hours after CS and if it can provide a faster postoperative recovery.
Patients and methods: included 32 participants who underwent elective caesarean section assigned randomly into two groups. Group A: 16 patients received TAP block. Group B: 16 patients did not receive any block. Medicine Ten centimeters visual analog scale (VAS) was also explained during preoperative visit. The postoperative pain was evaluated at 1, 2, 4, 8, 12, 18 and 24 hours by using VAS for pain scoring that was explained to the patients
during preoperative visit as a 100 millimeter horizontal line with verbal anchors at both ends. Results: Our study showed that there is statistically significant difference between the studied groups regarding VAS pain scorebaseline or at any point of time (significantly lower in TAP block group). In each group, there is significant change (increase) in VAS pain score over time. There is statistically significant difference between the studied groups regarding time for first analgesia (significantly longer in TAP block group). Number of patients who need nalufin was significantly higher in control group (ten patients within control group versus only one in TAP block group). Also, there is statistically significant difference between the studied groups regarding patient satisfaction. More than half of patients (56.2%) within TAP block group were very satisfied while half of those within
control group felt neutral (neither satisfied or not). Conclusion: Transverse abdominis plane block represents a viable alternative to common analgesic procedures performed for acute postoperative pain control after a CS.

Objective: This study was conducted to investigate the effect of polarized light therapy on incisional pain after (SC). Methods: Forty primipara women complaining from incisional pain post CS participated in this study. They had a single full term fetus during their gestation. The participant's ages ranged from 25-35 years. The control Group (Group A) were treated by traditional medical treatment immediately after recovery from anesthesia. The Study Group (Group B) were treated by traditional medical treatment immediately after recovery from anesthesia and polarized light therapy with energy density of an average of 2.4 J/cm2 15 minutes/session, one session /day for 5 consecutive days. Visual analogue scale (VAS) and electronic algometer were used to measure intensity of incisional pain post CS in both groups (A&B) before and after treatment. Results: Results of this study found that there was significant decrease of VAS and significant increase of pressure algometer after treatment in both groups A and B when compared with corresponding pre-treatment values (p<0.05). there was significant difference in mean values of VAS and pressure algometer between both groups (A and B) after treatment (p<0.05) (with favor of group B, more decrease VAS and more increase in pressure algometer). Conclusion: It can be concluded that polarized light therapy for 5 consecutive days' post SC is an effective adjuvant therapy in treatment of incisional pain through reducing visual analogue scale (VAS) and increasing electronic algometer.

Introduction Gestational diabetes mellitus (GDM) is one of the most frequent metabolic disorders during pregnancy, with incidence rates ranging from 1.1% to 14.3%. It is important to identify which risk factors may lead to a cesarean delivery, so to plan the procedure in advance and to avoid possible complications for both the mother and the fetus. Therefore this study was conducted to identify the risk factors associated with cesarean section in pregnant women with GDM. Objective : To identify the risk factors associated with cesarean section in pregnant women with GDM Study Design: This was a descriptive observational study conducted in a tertiary care centre over a period of 1 year from January 2018 to December 2018 at SKIMS, Soura, Srinagar, Kashmir Material & Methods: 100 patients of Gestational Diabetes Mellitus were recruited and mode of delivery and various risk factors associated with cesarean delivery were evaluated Results: Among the patients of GDM, who underwent LSCS & NVD, mean age was significantly more (30.8±3.75 years & 28.4±3.42 years respectively, p value -0.010) in LSCS group. BMI was significantly higher in GDM patients who underwent LSCS as compared to patients who underwent NVD (29.7±2.49 kg/m² vs 25.3±1.98 kg/m², p value <0.001). Blood sugar fasting and postprandial values were significantly higher in patients of GDM who underwent LSCS as compared to patients who underwent NVD [ BS(F) - 99±14.11 g/dl vs 87.6±7.51 g/dl, p value <0.001; BS(PP) - 127.7±30.79 g/dl vs 87.6±7.51 g/dl, p value - 0.041]. Prior cesarean section was also an independent risk factor in deciding mode of delivery in patients of GDM. Among the patients who underwent LSCS, maximum were on insulin (56%) followed by diet (33.3%). Among group B (NVD), maximum patients were on diet (56%) followed by metformin (24%) Conclusion: The mean age of patients and BMI was higher in patients who underwent cesarean section (p - 0.010 and < 0.001 respectively). High blood sugar levels (fasting and postprandial), primigravida and prior cesarean section were associated with high chances of cesarean section (p < 0.001, 0.041, 0.007 and 0.001 respectively). There were no significant difference between the 2 groups in regards to gestational age at delivery, the weight of newborn and the apgar score at 1 and 5 minutes after birth.

The total real hospital costs for Social Health Insurance (BPJS) Kesehatanpatients undergoing cesarean section are much higher than the collectible costs using the Indonesia Case-Based Groups (INA-CBGs) package as the basis of their payment policy. The purpose of this study was to determine the effect of using clinical pathways as a means of controlling the total real hospital costs of BPJS Kesehatan patients undergoing cesarean section.This research used action research. The clinical pathway was applied to BPJS Kesehatan patients undergoing cesarean section from January 1 to March 31, 2014, and compared the real hospital costs between that period and BPJS Kesehatan patients undergoing cesarean section from October 1 to December31, 2013. From the 126 study groups, 65 clinical pathway forms (51, 58%) were complete. The average real hospital cost was significantly higher after the implementation of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the complete CP form group with p = 0.012, p = 0.013, and p = 0.012 respectively.This study demonstrated that implementing the clinical pathway can reduce the actual length of stay and hospital costs in C-section patients, and demonstrated that using the clinical pathway can make services more efficient.

The aim of our study was to retrospectively examine the history of childbirth and the quality of primary care for bleeding and evaluate the prescribed rehabilitation measures for women who have suffered postpartum hemorrhage and massive bleeding. The materials and methods of the study were 242 birth histories with postpartum hemorrhage for the last 6 years (2013-2018) in the city maternity hospital of Bukhara. The average age of the patients was 26.7 ± 1.2 years. The obstetric pathology leading to bleeding mainly consists of uterus hypotonia - 143 (59.1) and large fetus - 68 (28.1), and preeclampsia and DIOV are equal amounts - 33 (13.64). Only about 20% of women who had postpartum hemorrhage underwent early rehabilitation in the form of prescribing contraceptives.The aim of the research was to study the effectiveness of modern principles of stopping postpartum obstetric bleeding. From 127 cases of bleeding in 101 women (79.5%) the childbirth were with the operational method. With the development of blood loss was renderedstepwise ways to stop bleeding. During hemostasis of the bleeding, ligatures were imposed on the ovarian arteries and the ascending branch of the uterine artery for ischemicization of the uterus, which was effective in 30 (30%) women, and in 114 (89.7%) women managed to achieve organ-sparing tactics.