Hany F. Sallam

A sandwich technique (N&H variation technique) to reduce blood loss during cesarean delivery for complete placenta previa: a randomized controlled trial

Abstract Objective: To investigate the effect of A sandwich technique Nahla & Hany variation (N&H) technique versus stepwise uterine devascularization on blood loss during cesarean section (CS) in patients with complete placenta previa. Methods: The study was single-blind randomized controlled trial carried out in a tertiary University Hospital between March 2015 to March 2018. We included patients scheduled for CS due to complete placenta previa. They were randomly allocated to group (I) managed by stepwise uterine devascularization, group (II) managed by double transverse compression suture at the lower uterine segment plus intrauterine inflated Foley’s catheter Balloon (H&N variation sandwich) at the lower uterine segment. The primary outcome was the amount of total estimated blood loss both intra- and post-operative. Results: One hundred and six patients were enrolled (nu2009=u200953 in each group). There was a great reduction in intraoperative blood loss in group II 570 (400–1300) compared with Group I 1030 (500–1540) (pu2009=u2009.0001), or blood in the intraabdominal drain in group II than group I (pu2009=u2009.0001) Also, there was no significant reduction in postoperative vaginal bleeding. Hence, the total estimated blood loss in group II 750 (550–1580) showed significant reduction compared with group I 1350 (780–1800) (pu2009=u2009.0001). Conclusions: N&H variation sandwich technique in the management of complete placenta previa is a simple technique, safe and effective to decrease blood loss.

Reducing Blood Loss During Abdominal Hysterectomy with Intravenous Versus Topical Tranexamic Acid: A Double-Blind Randomized Controlled Trial

ObjectivesTo assess the effect of intravenous versus topical tranexamic acid in reducing intraoperative and postoperative blood loss in women withxa0abdominal hysterectomy.Materials and MethodsThe study was a randomized double-blind placebo-controlled trial, carried out in a tertiary university hospital in Egypt, from November 2015 to October 2017. A total of 129 women undergoing abdominal hysterectomy for benign etiology were randomly assigned to three groups: Group I [43 patients received 110xa0ml normal saline IV just before skin in scion], Group II [43 patients received 1xa0g tranexamic acid in 100xa0ml saline IV just before skin in scion], and Group III [43 patients received 2xa0g topical tranexamic acid applied intra-abdominal after hysterectomy]. The primary outcome was intraoperative, postoperative, and all blood loss estimation.ResultsBoth Group II (IV tranexamic acid) and Group III (topical tranexamic acid application) showed great reduction in intraoperative and postoperative blood loss (blood in the intra-abdominal drain) compared with Group I (placebo group), (Pu2009=u20090.0001, 0.0001, 0.0001, 0.0001), so the overall estimated blood loss in groups II and III showed highly reduction compared with Group I (Pu2009=u20090.0001, 0.0001).ConclusionIntravenous and topical tranexamic acid application is a safe and reliable method to help decrease blood loss during and after abdominal hysterectomy.

Adjunctive intrauterine Foley’s Catheter Balloon adding to hypogastric artery ligation in the conservative management of morbid adherent placenta previa

Background: Objective of present study was to demonstrate the efficacy of Foley’s catheters balloon tamponade as an adjuvant to control blood loss during and after a caesarian section in patient undergone hypogastric artery ligation (HAL) due to morbid adherent placenta previa (MAPP). Methods: A single-center retrospective case-control clinical trial was carried out in a tertiary university hospital between March 2015 and March 2018, 124 women were undergoing cesarean delivery for MAPP, were managed conservatively either with HAL or HAL plus inflated Intrauterine Foley’s Catheter Balloon to control post-partum hemorrhage secondary to MAPP. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed. Results: 124 women were enrolled (n=62 in each group). group of women received HAL plus Intrauterine Foley’s Catheter Balloon (group II)) showed a significant reduction in intraoperative and 4 hours post-operative blood loss compared with (Group I) which received HAL without Intrauterine Foley’s Catheter Balloon. (P = 0.0001,0.0.015), so the overall estimated blood loss in group II showed significant reduction compared with group I (P = 0.0001). Conclusions: Adjunctive intrauterine Foleys catheter balloon adding to HAL ligation in the management of MAPP is a novel combination approach have proved to be effective to control of intraoperative and PPH and to preserve the uterus as possible and change in the concept of MAPP management always mandates hysterectomy. And may become an alternative valid option to planned cesarean-hysterectomy in well-selected cases who have a strong desire for future fertility.

The effect of regular daily walking on adverse pregnancy outcomes among overweight primigravidas: a prospective cohort study

Objective: The study aims to evaluate the effect of regular daily walking on the occurrence of adverse pregnancy outcomes among overweight

The effect of prophylactic oral tranexamic acid plus buccal misoprostol on blood loss after vaginal delivery: a randomized controlled trial

Abstract Objective: The objective of this study is to evaluate the effect of prophylactic oral tranexamic acid (TA) plus buccal misoprostol on the amount of blood loss after vaginal delivery in women at low risk for post-partum hemorrhage (PPH). Materials and methods: The study was a randomized open label clinical trial conducted in a tertiary University Hospital between January 2016 and June 2017. We included women who delivered vaginally with a singleton pregnancy. They were randomized into three groups: group I (women received 10u2009IU oxytocin IV after delivery of the baby), group II (women received 600u2009µg buccal misoprostol after delivery of the baby), and group III (women received 1000u2009mg oral TA at the end of the first stage of labor plus 600 µg buccal misoprostol after delivery of the baby). In each group, pre- and post-delivery pulse rate, blood pressure, temperature, and hemoglobin level were evaluated. Additionally, the amount of blood loss, need for blood transfusion, need for additional uterotonics, and side effects of the study medications were recorded. Results: There was a statistically significant lower hemoglobin level and higher blood loss in the misoprostol group compared with oxytocin group and TA plus misoprostol group (pu2009=u2009.0001). There was a statistically significant higher hemoglobin level and lower blood loss in the TA plus misoprostol group compared with the oxytocin group (pu2009=u2009.004 and .043, respectively). PPH occurred in 16.7% of women in the misoprostol group compared 1.7% in the oxytocin group and no cases of PPH in the TA plus misoprostol group (pu2009=u2009.0001). Conclusions: In settings like rural area or home delivery in which oxytocin is not available, alternative oral TA plus buccal misoprostol may be considered as an effective line in prevention of PPH.