The role of peritoneal lavage in benign gynecologic laparoscopic surgery.

OBJECTIVE: Laparoscopic surgery offers many advantages compared to invasive surgery but one of the main problems is postoperative pain, partially resulting from the peritoneal inflammatory process mediated by inflammatory cytokines. The rationale of this study is that intraperitoneal washing could remove inflammatory mediators that are the cause of postoperative pain and could help in the removal of CO2 from the abdominal cavity. This article aims to analyze the effects of peritoneal lavage in the reduction of postoperative shoulder pain. PATIENTS AND METHODS: 277 patients enrolled to undergo laparoscopic gynecologic surgery were included in the study. Women are randomized into two groups, according to the use or non-use of peritoneal lavage with saline solution at the end of laparoscopic gynecological major procedures. RESULTS: Data show that the peritoneal lavage can significantly reduce postoperative pain in the first 36 hours after surgery, as well as patients' requests for analgesics: during the first 3 postoperative days, requests for paracetamol were lower in the YW (Yes Washing) group than the NW (No Washing) group (77 vs. 101; p<0.05); similar results are obtained considering ketorolac administration (62 vs. 71; p<0.05). CONCLUSIONS: Peritoneal lavage after gynecological laparoscopic procedures may be effective in the reduction of postoperative pain and use of analgesics.

Transabdominal uterine artery Doppler between 11 and 14 weeks of gestation for the prediction of outcome in high-risk pregnancies.

OBJECTIVE: To assess the value of early transabdominal uterine artery Doppler ultrasound for the prediction of gestational outcomes in pregnancies at high risk for preeclampsia. METHODS: This was an observational study. Doppler ultrasound of the uterine arteries at 11-14 weeks of gestation was performed in 76 women at high risk for preeclampsia. Abnormal uterine Doppler was defined by the presence of bilateral notching or by a mean resistance index (RI) >0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death, and complications requiring delivery before 34 weeks of gestation. RESULTS: Among 76 women, 30 (39%) had abnormal uterine Doppler and 46 (61%) had normal Doppler waveform configuration and RI. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (17% vs. 0%; p = 0.0041), fetal growth restriction (27% vs. 0%; p = 0.0002), intrauterine death (13% vs. 0%; p = 0.0109), and iatrogenic preterm delivery (20% vs. 2%; p = 0.0086). When the Doppler was normal, the negative predictive value for complications requiring delivery before 34 weeks was 98%. CONCLUSIONS: Normal impedance to flow in uterine arteries between 11 and 14 weeks of gestation is strongly related to a normal pregnancy outcome in women at high risk for preeclampsia.

Bacterial vaginosis: prevalence in an Italian population of asymptomatic pregnant women and diagnostic aspects.

The present study has been carried out with the main objective of determining the prevalence rate of bacterial vaginosis (BV) in a population of asymptomatic pregnant women (8th to 9th month of pregnancy). Out of a total 1,441 patients examined BV was found to be present in 70 (4.9%). The diagnosis was made when an analysis of the vaginal discharge revealed the simultaneous presence of at least three out of four of the following laboratory indices: (1) direct Gram stain positive (bacterial flora mixed with Gram-negative coccobacilli and variable-gram predominant over the lactobacillus flora); (2) pH > 4.5; (3) positive odour test with KOH 10%; (4) presence of clue cells. After a discussion of the principal laboratory and clinical signs presently used for the diagnosis of BV, the authors suggest the exclusion of the evaluation of the appearance of the vaginal discharge from the standard diagnostic criteria. Further, three diagnostic methods are hypothesized for use in different settings.

The clinical relevance of the abdominal fetal electrocardiogram.

We investigated the duration of fetal electrocardiographic events during normal pregnancies and during pregnancies with fetal abnormalities. The fetal abdominal signal was processed and enhanced by means of the averaging technique after removing the maternal complex. In normal pregnancies P wave and QRS complex duration increases progressively from the 17th week up to the term: this increase parallels the gain in weight of the fetal heart and particularly of the ventricular mass. These results indicated that the duration of fetal complexes could be used as an index of the size, development and maturity of the fetal heart. When fetal growth retardation (FGR) is present, the weight of the fetal heart is significantly reduced, and is reflected in a decrease in QRS duration. In a series of 107 cases the sensitivity of this parameter in detecting FGR was 81% and the specificity 93%. Moreover no perinatal death nor Apgar values below 7 occurred in growth retarded fetuses with normal QRS duration, while in the group with shortened QRS neonatal deaths were 11% and Apgar scores below 7 26%. Abdominal FECG do provide important auxiliary information for prenatal diagnosis of congenital heart defects (CHD). Anomalies with abnormal atrioventricular connection were reflected in longer PR interval. Ventricular hypertrophia and hypoplasia were associated with increased or decreased QRS duration, respectively. Furthermore, the three fetuses which developed congestive heart failure showed prolonged QRS duration. In severe RH disease, chronic fetal anemia can lead to myocardial hypertrophy and cardiac enlargement.(ABSTRACT TRUNCATED AT 250 WORDS)