Alalfy modified cervical inversion technique as a tamponade in controlling PPH in placenta previa, a multicentric double blind randomized controlled trial.

INTRODUCTION: Postpartum hemorrhage that occurs frequently with placenta previa is one of the causes of maternal mortality in 14% in developing countries. OBJECTIVE: To assess efficacy of cervical inversion as a tamponade in controlling bed of placenta in cases of placenta previa. PATIENTS AND METHOD: A prospective randomized controlled study was conducted among a total of 240 pregnant women with placenta previa (120 subjected to Alalfy modified cervical inversion technique plus hemostatic sutures and 120 was not subjected cervical inversion and only was subjected to hemostatic sutures in Obstetrics and Gynecology Department at Suez Canal University hospital, Helwan University and Algezeerah hospital for a planned cesarean section). RESULTS: The mean intraoperative blood loss, the intraoperative time, and the postoperative hemoglobin show a statistically significant difference between cases with placenta previa who were exposed to cervical inversion in comparison to cases that had no cervical inversion with a p-value <.001. CONCLUSION: Modified cervical inversion (Alalfy technique) as a tamponade when added to hemostatic sutures to the placental bed is an easy, rapid, and efficient procedure that can decrease the amount of blood loss, time needed to stop bleeding per bed, total operative time, also it can decrease the need for blood transfusion.

Routine cervical dilatation at caesarean section and its influence on postoperative pain and complications in obese women: a double blind randomized controlled trial.

INTRODUCTION: Numerous surgical techniques regarding cesarean section performance were assessed. The usefulness of cervical dilatation during cesarean section, are still based on restricted research obtained data. PURPOSE: To assess the impact of intraoperative digital dilatation of cervix on postoperative pain. MATERIAL AND METHODS: The current research study is a Prospective parallel group randomized controlled double blind research trial that was conducted in obstetrics and gynecology hospital, Faculty of Medicine, Cairo University and Algezeera Hospital, Egypt from the period May 2018 until February 2018. RESULTS: The visual analog scale scoring level was statistically significantly higher in noncervical dilatation research group at 8th, 30th, 48 hours and 7th day postoperative (p values <.001, .001, .001, and .001, respectively). On the other hand at the 4th day postoperative, there was no statistical significant difference concerning VAS scoring level. CONCLUSIONS: Manual cervical dilatation during cesarean section is an innovative procedure to reduce postoperative pain in obese women. We thought that according to the results of the present study, cervical dilatation leads to proper continuous adequate evacuation and drainage of the intracavitary contents that leads to decrease the uterine subinvolution, retained blood and so, decreased postoperative pain and postoperative blood loss. CLINICALTRIALS.GOV ID: NCT03513237.