Castor oil for labor initiation in women with a previous cesarean section: a double-blind randomized study.

Objective: To evaluate the efficacy of castor oil in initiation of labor in women who had one previous cesarean section. This study was conducted as a trial to increase the rate of vaginal birth after cesarean (VBAC) and decrease the rate of elective repeated cesarean section (ERCS).Methods: A double-blinded randomized controlled study was conducted in an Egyptian University Hospital from July 2019 to July 2020. The participants were 70 pregnant women who had one previous cesarean section, singleton pregnancy in cephalic presentation, with a Bishop score ≤6 attempting to perform a trial of labor. Sixty mL castor oil was administered to group A and 60 mL sunflower oil was administered to group B (as a placebo) for initiation of labor at the start of week 39. Primary outcomes were the percentage of women entering the active phase of labor within 24 h after receiving castor oil or placebo and the number of successful VBAC deliveries.Results: Labor started in 16 patients (45.7%) within 24 h in the castor oil group and in 3 patients in the placebo group (8.5%), while the rate of successful VBAC was 65.7% (23 patients) in the castor oil group and 48.5% (17 patients) in the placebo group.Conclusion: Castor oil appears to be an effective, low-cost, and non-harmful method for the initiation of labor in patients with a previous cesarean section.

Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h following cesarean section? A prospective randomized observational study on 2998 patients.

OBJECTIVE: To compare the incidence of postpartum maternal and neonatal complications and hospital readmission in patients discharged 24 versus 72 h after cesarean section. METHODS: Using randomization, 1495 patients were discharged after 24 h and 1503 patients were discharged after 72 h. All patients fulfilled the discharge criteria. Patients were assessed 6 weeks after delivery, any maternal or neonatal problems or hospital readmissions during this time interval were reported. RESULTS: There was no difference in maternal hospital readmission between the two groups, but there was a significantly higher neonatal readmission rate in the 24-h group mainly due to neonatal jaundice. As for the complications reported after 6 weeks, the only two significant outcomes were initiating breast feeding, being significantly higher in the 72-h group [OR and 95% CI 0.77 (0.66-0.89)] and the mood swings being significantly lower in the 72-h group [OR and 95% CI 2.28 (1.94-2.68)]. CONCLUSION: Our recommendation is still in favor of late discharge, after cesarean delivery. Bearing in mind, that an early 24-h discharge, after cesarean delivery is feasible, but with special care of the neonate, with early visit to the pediatrician and early establishment of effective lactation.

Is intracytoplasmic sperm injection (ICSI) associated with higher incidence of congenital anomalies? A single center prospective controlled study in Egypt.

OBJECTIVE: To compare the incidence of congenital anomalies by ultrasound in intracytoplasmic sperm injection (ICSI) pregnancies and in spontaneous pregnancies with correlation to the neonatal outcome. METHODS: This is a prospective comparative study carried out in Kasr Al Aini Hospital Cairo University from January 2010 to December 2012, comparing 739 pregnant women conceived through ICSI and 843 pregnant women conceived spontaneously as regard to incidence of congenital anomalies, multiple pregnancy, preterm labor, cesarean section and neonatal outcome. RESULTS: The number of anomalies diagnosed by antenatal ultrasound in ICSI group was 14 (1.62%) while in spontaneous group was 13 (1.51%). The number of anomalies detected by postnatal examination in ICSI group was 20 (2.31%) while in spontaneous group was 16 (1.86%) (Odds ratio [OR] 1.438; 95% confidence interval [CI] 0.739-2.796). ICSI group was associated with higher incidence of twins 12.7% (p < 0.001), preterm labor 3.8% (p 0.022), preterm premature rupture of membranes 4.6% (p 0.001), cesarean section 74.1% (p < 0.001) and neonatal deaths 10.4% (p < 0.001). CONCLUSION: ICSI was associated with higher incidence of multiple pregnancy and cesarean section, with no difference in the incidence of congenital anomalies compared to spontaneous conception.