Cesarean Section Incision Research Articles

Porcine stomach surgical simulation model for cesarean section and cervical laceration suturing

BackgroundJunior OB/GYN residents lack opportunities for fundamental surgical skills training of cesarean section, and most OB/GYN residents lack the experience of cervical laceration suturing due to its low incidence.MethodsA porcine stomach simulation model was designed for obstetrics surgical training. The surface of the stomach simulated the uterus, and the pylorus and cardia simulated the cervical canal.ExperienceMaterials are available from the nearby market. The total cost of the model is￥41. This model can be used in the training in uterus incision and repair of cesarean section and training in cervical laceration suturing.ConclusionThe porcine stomach simulation model is pragmatic and realistic. They can be applied in the OB/GYN skill courses to introduce the fundamental obstetrics process to medical students and residents.

Assessment of Primary Cesarean Section Incision Site Early in The Purpureum to Predict Subsequent Consequences.

Assessment of Primary Cesarean Section Incision Site Early in The Purpureum to Predict Subsequent Consequences.

Clinical analysis of complete uterine rupture during pregnancy

BackgroundUterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture.MethodsData from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People’s Hospital between January 2015 and December 2022 were analyzed retrospectively.ResultsIn total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1–40+3 weeks), and the average bleeding volume was 1896.97 ml (200–6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%).ConclusionsThe site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.

The Emotional State During Cesarean Section and Vaginal Delivery

Alterations in emotional, social, or psychological factors of a woman's life in postpartum could lead to impairing mood disturbances. Depressed mood in mothers in the first days after delivery is named maternity blues and accepted as a common phenomenon in the postpartum phase. The aim of the present study is to determine the mood of the women with pregnancy after delivery. After approval of Clinical Research Ethics Committee, this cross-sectional designed study was enrolled women in postpartum period who underwent vaginal delivery or cesarean section in Department of Obstetrics and Gynaecology, Medical Faculty, Gaziosmanpasa University, Tokat, Turkey. All subjects were invited to complete the questionnaires including Pain Catastrophizing Scale, Beck Depression Inventory, Beck Anxiety Inventory and Short Form-36 in the first 24th hour of postpartum period. The lumbopelvic pain intensity associated with cesarean section incision or episiotomy was evaluated using visual analog scale. The mean age of the participants was 28.43∓5.14. In catastrophizing group, the mean role limitations due to physical health problems, Beck Depression Inventory-C, Beck Depression Inventory-S, Beck Depression Inventory, Beck Anxiety Inventory and visual analog scale in women with cesarean section, and general mental health in women with vaginal delivery were significantly higher compared to each other (p=0.037, p=0.002, p=0.003, p=0.01, p=0.042, p<0.01, p=0.005, respectively). The present study revealed that the psychological condition and quality of life of women may impair after cesarean section, hence it might be beneficial to provide emotional support for patients after cesarean section.

Association Between Cesarean Scar Length and Postoperative Pain

BACKGROUND:Early recovery is important for women caring for their newborns. A Pfannenstiel incision involves nerve pathways, causing trauma of nerves and other tissues leading to pain. This study aimed to evaluate the effect of cesarean section incision length on postoperative pain.METHODS:This was a prospective cohort study conducted at the Obstetrics and Gynecology department of a tertiary hospital from December 2019 to December 2020. We recruited 97 women who underwent cesarean section delivery for the first time with a gestation age of ≥37 weeks. Patients were requested to report the frequency and severity of pain situated close to or in their Pfannenstiel incision area using a visual analog scale on postoperative days 1 and 2 and at 6 weeks.RESULTS:The mean scar length was 11.72 ± 1.61 cm. Cesarean skin scar length correlated positively with the degree of pain on only the first postoperative day (β .209,pvalue .04, weak correlation). It also significantly predicted the degree of postoperative pain on day 1 after surgery (β .135,pvalue .012, 95% confidence interval of β .03–.24).CONCLUSION:The cesarean scar length significantly correlated with postoperative pain on day 1 after delivery. It had no association with chronic scar-related pain.

Retracted: Effect of Foot and Hand Massage on Abdominal Pain of Cesarean Section Incision under Ultrasound Guidance.

[This retracts the article DOI: 10.1155/2022/8356256.].

External Negative Pressure Dressing System (ENPDS) vs. Traditional Wound Dressing for Cesarean Section Incision in Obese Women: A Randomized Controlled Trial

Background Obesity is associated with increased cesarean section delivery rates and surgical site wound complication with associated increased post-operative morbidity, post-operative pain and length of hospital stay. Aim of the Work The objective of this study is to determine whether negative pressure wound therapy reduces the risk of post-cesarean wound dehiscence among obese women compared with standard surgical wound care. Patients and Methods A Randomized controlled trial (RCT)was carried out at Ain-Shams University Maternity Hospital in the period between August 2020 and February 2021. The participants of this study were 260 pregnant women aged 18 years old or older who underwent cesarean delivery. Intervention group had an ENPDS placed for 4 days and control group had a traditional surgical dressing placed for 4 days and both group were followed up for 30 days post-operatively. Results The study reveal that wound dehiscence was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.002). The study also reveal and display that SSI was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.017). After adjustment for the effect of BMI and history of CS, PA surgery or SSI, ENPDS was independently associated with reduced incidence of SSI (odds ratio = 0.262, 95% CI = 0.090 to 0.759, P-value = 0.014). The study reveal that the incidence of wound dehiscence and SSI is statistically significantly lower in ENDPS group compared with traditional dressing group (p value =0.004, 0.012,) respectively. The incidence of wound seroma and haematoma was lower in ENDPS group however, not statistically significant compared with traditional dressing group (p value= 0.066, 0.498) respectively.The study reveals that using ENDPS has a beneficial/ protective effect as regards wound dehiscence and SSI with relative risk (0.25, 0.31) respectively with 95% CI (0.1 TO 0.65 - 0.12 TO 0.83) respectively and NNT (8.7, 11.8) respectively with 95% CI (5.4 to 22.2. - 6.7 to 52.2) respectively.It also shows that ENDPS has a beneficial /protective effect as regards wound seroma and wound hematoma formation with relative risk (0.14, 0.20) respectively even though the 95% CI was (0.02 to 0.14 - 0.01 to 4.13) respectively and the NNT was (21.7, 65.5) respectively. The study reveals that peri-wound blistering, the need for post-operative therapeutic anti-biotics and re-admission was statistically significantly lower in ENDPS group compared to the traditional dressing group (p value= 0.001, 0.005, 0.010) respectively. The study reveals that post-operative pain was less in ENDPS group with p value = <0.001, post-operative mobility was more limited in ENDPS group when compared with the traditional dressing group with p value = <0.001. However, the length of hospital stay was statistically significantly longer in ENDPS group with p value = <0.001 Conclusions Negative pressure wound therapy could be used to reduce the risk of wound dehiscence, surgical site infection, wound seroma, wound haematoma, peri-wound blistering, post-operative pain, post-operative anti-biotics and overall length of hospital stay for obese women undergoing cesarean delivery.

DS25 Postsurgical pyoderma gangrenosum successfully managed with skin grafting in a breastfeeding postpartum patient

Abstract A 32-year-old woman who was breastfeeding presented 7 weeks postpartum with right breast pain, swelling and erythema. A clinical diagnosis of mastitis was confirmed on ultrasound, and she was started on intravenous (IV) flucloxacillin. Initial cultures grew methicillin-sensitive Staphylococcus aureus, and clindamycin was added. She failed to improve and 6 days later an abscess was incised and drained. A vacuum-assisted closure (VAC) dressing was placed over the wound postoperatively. Over the following 3 days, she deteriorated clinically with markedly increased pain, spiking temperatures and malaise. Linezolid and metronidazole were added. On return to theatre for wound review, she had an 18 cm × 10 cm deep necrotic ulcer with purulent discharge, sparing the nipple. The breast surgeon’s concern was that of necrotizing fasciitis, and an immediate wider debridement was performed, removing all breast skin except for the nipple. Dermatology was then consulted, and a diagnosis of pyoderma gangrenosum (PG) was made. The patient was commenced on IV methylprednisolone 1 g daily for 3 days. Her temperature normalized immediately, and her C-reactive protein dropped from 141 to 27 mg L−1 in 24 h. The previously rolled, violaceous wound edges settled with no further progression. Following 3 days of steroid, ciclosporin 5 mg kg−1 daily was commenced. The right breast continued to lactate, and the very large defect now present was anticipated to pose many difficulties for the young mother. Five weeks after the initial presentation, and following multidisciplinary discussion, a biodegradable temporizing matrix (BTM; NovoSorb®) was applied, under continued dermatologist-supervised immunosuppression. The BTM took with good effect. Two weeks later, a split-thickness skin graft was applied to the BTM. The skin grafting took successfully, with no reactivation of PG postoperatively. Three months postgrafting, the patient is now being weaned off ciclosporin and remains well. Postpartum PG is rare and is predominantly reported at the site of caesarean section incision. Surgery is typically discouraged in PG owing to the risk of disease reactivation. However, surgery in this case was considered appropriate due to the rapid disease control with immunosuppression, the extent of ulceration, the expected prolonged healing period requiring exposure to the toxicity of ciclosporin and the avoidance of cribriform scarring often seen with PG. This case highlights how PG should always be considered in postpartum patients presenting with rapidly progressing, nonhealing ulcers. It also shows that, despite our usual treatment practices, in certain cases, early surgical intervention can be considered alongside ongoing immunosuppression resulting in positive patient outcomes.

Comparison of the Intra-abdominal and Extra-abdominal Techniques in the Repair of Cesarean Section Incision

To compare the intra-abdominal and extra-abdominal techniques in the repair of uterine incisions in cesarean delivery is the objective of this research. In this study, we analyzed the data of patients that underwent a cesarean section in Viranşehir State Hospital, a secondary care center. The present retrospective study included a total of 574 patients, of whom 288 underwent intra-abdominal uterine repair and 286 underwent extra-abdominal uterine repair in cesarean delivery. The groups were compared in terms of clinical characteristics, operation time, blood loss, and length of hospital stay. In patients who underwent extra-abdominal uterine repair, the operation time was significantly shorter than those who underwent intra-abdominal uterine repair (44.8 ± 11.8 and 51.4 ± 12.6 min, respectively; p < 0.001). Another significant finding was that blood loss was less in patients who underwent extra-abdominal uterine repair than in patients who underwent intra-abdominal uterine repair (1.3 ± 0.8 g/dl and 1.5 ± 0.9 g/dl, respectively; p = 0.002). Other parameters (age, blood transfusion requirement, preoperative and postoperative hemoglobin levels, length of hospital stay, and bowel movements) were statistically similar in the two groups. Our study showed that extra-abdominal repair shortened the operation time and less blood loss. Further randomized controlled studies are needed to conclude the superiority of the two techniques over each other.

Incidence of Infectious Morbidity Following Single Dose of Prophylactic Antibiotics In Women Undergoing Elective Cesarean Section

Introduction: Cesarean delivery is a major obstetrical surgicalprocedure aiming to save the lives of mothers and fetuses.The incidence of cesarean section varies between 10.0% and25.0% in most developed countries.1Material and Methods: 80 cases for elective cesarean sectionadmitted in ward/labour room of Department of Obstt andGynae, SRMSIMS were studied to determine the incidenceof infectious morbidity, i.e., UTI, SSI, puerperal sepsis andendometritis on different occasions that are immediatepostoperatively, 48 hours post-operative, on discharge (4–5thday) and upto 6 weeks post-partum.Preoperative routine blood and urine examination were doneto recruit low-risk patients.Preoperative part preparation with betadine was done the nightbefore surgery, followed by intraurethral catheterization with 3swabs under all aseptic precautions.Results: There is a relationship between the timing ofadministration of prophylactic antibiotics and infectiousmorbidity. On comparing demographic factors concerninginfectious morbidity, a statistically significant p-value wasobserved with the women's age, parity and BMI.Conclusion: Single dose of prophylactic antibiotics shouldbe effective if given within 30 minutes of skin incision in anelective cesarean section, especially in women with mean age26.2 ± 4.2 years, low parity and with mean BMI of 24.9±2.4(kg/m2). The neonatal outcome is not much affected on givingprophylactic antibiotics before cord clamping. Despite ofprophylactic antibiotics aseptic technique during intraurethralcatheterization and check dressing at 48 hours postoperativelyof the surgical site is the most important factor in preventinginfectious morbidity.

Effect of Foot and Hand Massage on Abdominal Pain of Cesarean Section Incision under Ultrasound Guidance.

In order to relieve the pain of incision after cesarean section, a method of foot and hand massage for abdominal pain of cesarean section incision under ultrasound guidance was proposed in this paper. In this paper, the experimental control method and retrospective analysis were used to relax the patients through massage, so that the pregnant women could focus on the reaction caused by hand and foot massage, distract their attention, and reduce the pain. The results showed that 60 cases of puerpera after cesarean section were divided into two groups with 30 cases in each group. The control group was only given routine care. The intervention group received 20 min hand and foot massage on the basis of routine care. The visual analog scale (VAS) of pain before, immediately after, 30 min after, and 60 min after massage in the intervention group was evaluated and recorded, and the VAS scores of the control group at the corresponding time points were recorded. The VAS score of the intervention group at each time point after massage was significantly lower than that before massage (P < 0.05), and the VAS score of the intervention group at each time point was significantly lower than that of the control group (P < 0.01). Hand and foot massage can effectively relieve incision pain after cesarean section.

Review on a cesarean section in the cow: Its incision approaches, relative advantage, and disadvantages.

Dystocia is an abnormal and difficult birth in which the first or the second stage of labour is markedly prolonged and subsequently found impossible for the dam to deliver without artificial aid. In cattle, it can be relieved by different obstetric methods, including the cesarean operation and fetotomy. Caesarean section is the extraction of the fetus or foeti from the dam, through a surgical opening in the abdominal wall and the uterus. This surgical method can be performed by about eight alternative surgical approaches in bovines with its advantages and disadvantages. However, the selection is dependent on many factors like the type of dystocia, the cows and environmental conditions, the availability of assistants, and the surgeon's preference. For cows, most surgeons use a standing left paralumbar celiotomy. However, the left oblique approach is also preferable under most circumstances because the uterus is readily exteriorized, limiting peritoneal cavity contamination. Besides, alternative approaches are also available that will further limit the potential for contamination but many junior surgeons perform the left paralumbar celiotomy using the same approach each time due to their comfort with one specific approach or lack of familiarity with other available options. Therefore, the objective of this review is to provide basic insights and highlight the cesarean section incision approaches with their relative advantages and disadvantages in cows.

Thrombocytopenia among pregnant women in Africa: a systematic review and meta-analysis.

Introductionthrombocytopenia is a common hematological disorder during pregnancy next to anemia. Pregnant women with thrombocytopenia have complications of excessive bleeding during or after childbirth, cesarean section incision site oozing, stillbirth and neonatal thrombocytopenia. Findings on the magnitude of thrombocytopenia among pregnant women were inconsistent. Therefore, this review aimed to estimate the pooled prevalence of thrombocytopenia among pregnant women in Africa.Methodsthis systematic review and meta-analysis were performed based on PRISMA guidelines. The databases (PubMed, PubMed Central, Hinari, Science Direct, Pop line, Google Scholar, and African Journals Online) were searched to identify relevant studies. Data were analyzed using STATA 11 statistical software. A random-effect model was fitted to estimate the pooled prevalence of thrombocytopenia. I2 test statistics were done to test the heterogeneity of included studies. Funnel plots analysis and Egger weighted regression tests were done to detect publication bias.Resultsof the total 1,517 articles retrieved, 15 articles which involved 8,380 pregnant women were eligible for meta-analysis. The overall pooled prevalence of thrombocytopenia among pregnant women in Africa was 10.23% (95% confidence interval (CI): 7.44, 13.02%). Its level of severity showed that, 77.95% (I2=43.1%), 15.62% (I2=53.4%), and 5.60 (I2=0.0%) of pregnant women had mild, moderate and severe thrombocytopenia, respectively. The highest prevalence of thrombocytopenia was occurred in the third trimester of pregnancy (54.05% (95% CI: 29.48, 78.61)).Conclusionthis systematic review and meta-analysis showed that the pooled prevalence of thrombocytopenia among pregnant women in Africa was found to be relatively higher compared with the globe. Therefore, routine screening and follow-up programs are needed to identify pregnant women with thrombocytopenia and provide them with the necessary interventions.

Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section

IntroductionA retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section.MethodsThe medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively.ResultsNo significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III–V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05).ConclusionFibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.

Localized endometrioid cancer in the abdominal wall with synchronous early-stage endometrial cancer

Presented herein is the only case in literature with the synchronous development of endometrioid-type endometrium cancer and endometrioid carcinoma originating from the endometriosis foci in a scar tissue. A 44-year-old female patient presented with complaints of abnormal uterine bleeding, swelling at the rectus muscle level in the abdominal wall, and cyclic pain close to the old cesarean section incision scar. Pathological findings of the rectus muscle and endometrial biopsies revealed endometrioid adenocarcinoma (grades 2 and 1, respectively). Positron emission tomography, performed for primary focus investigation, revealed pathologic fluorodeoxyglucose uptake in the uterine cavity and biopsy site, consistent with residual tumor without any pathologic uptake elsewhere. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic and para-aortic lymphadenectomy, and the residual tumor in the left rectus muscle was excised. The patient was followed up for 3 years. At a postoperative follow-up in the 4th year, no relapsed tumor or metastasis was seen on imaging.

Clinical analysis of endoscopic pregnancy sac aspiration in the treatment of cesarean section incision pregnancy after uterine artery embolization and chemotherapy.

article: Clinical analysis of endoscopic pregnancy sac aspiration in the treatment of cesarean section incision pregnancy after uterine artery embolization and chemotherapy - Minerva Surgery 2021 Sep 21 - Minerva Medica - Journals

Transverse versus longitudinal blunt extension of the uterine incision during cesarean section in women with a uterine scar of previous cesarean delivery: A randomized controlled trial

ObjectiveTo compare two different blunt extension techniques of the lower segment transverse uterine incision at cesarean delivery in women with a uterine scar of previous cesarean delivery. MethodsStudy design: Prospective single-blinded parallel multi-center randomized controlled trial involving 392 cases equally divided into two groups. Group one had their incision extended transversely, while group two had their incision extended longitudinally. Outcome measures: The primary outcome was the unintended extension of the uterine incision, while the secondary outcomes included the need for additional stitches to achieve hemostasis, the drop in hemoglobin level, uterine vessels injury, and the need for blood transfusion. ResultsNo significant difference between the transverse and longitudinal extension of the uterine incision during cesarean section as regards unintended uterine extension (P = 0.860), uterine vessel injury (P = 0.501), and cases requiring blood transfusion (P = 0.814). Significantly lower drop in hemoglobin level (P ≤ 0.001) and significantly less need for additional stitches (P ≤ 0.001) in cases with the longitudinal extension of uterine incision. ConclusionIn women with a uterine scar of previous cesarean delivery, the blunt longitudinal extension of the uterine incision in the lower segment cesarean section didn't differ from the blunt transverse extension as regards unintended uterine extension but is associated with less hemoglobin drop and less need for additional stitches as compared to transverse extension of the incision. Further studies are needed to assess the long-term complications of both techniques.

Effect of Amh in Patients with Polycystic Ovarian Syndrome on Pregnancy Rate in Icsi Cycle

Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy &amp; safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution (1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them. Postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, in obese women undergoing elective CS, wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy &amp; safety.

Subcutaneous Antibiotic Irrigation to Prevent Wound Infection in Obese Patients Undergoing Cesarean Section

Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy &amp; safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution ( 1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them . postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, In obese women undergoing elective CS , wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy &amp; safety.

Endometriosis of the Rectus Abdominis Muscle: A Rare Cause of Emergency Department Visit; Case Report

Introduction: Endometriosis affects approximately 10% of the reproductive age woman. Although the most common affected sites are ovaries, sacrouterine ligament, rectovaginal septum, and pelvic peritoneum, it can be located in any organ. Endometriosis of rectus abdominal muscle independent from the cesarean section incision is extremely rare.&#x0D; Case Presentation: A 31-years-old female was admitted to the emergency department with periodical abdominal pain and distension complaints. Ultrasonography and computed tomography revealed a heterogeneous mass in the rectus abdominis muscle. Surgical excision was performed. Histopathologic examination showed endometrial tissue with glandular and stromal elements within the muscularis propria.&#x0D; Conclusion: Endometriosis should be kept in mind in the differential diagnosis of atypical pain and mass of the abdominal wall in the emergency settings.