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Objective-to overview, compare and generalize results of randomized clinical trials analyzing different oxytocin doses to prevent postpartum hemorrhage, initiate and maintain uterine contraction after Caesarean delivery. Methods-'PubMed', 'EMBASE', 'CENTRAL', and 'CINAHL' electronic databases were searched for clinical trials analyzing the effectiveness of different dose of oxytocin given intravenously during surgery for uterine contraction and to reduce postpartum hemorrhage. A systematic review of relevant literature sources was performed. Results-our search revealed 813 literature sources. A total of 15 randomized clinical trials, comparing different doses of oxytocin bolus and infusion used after caesarean delivery have met the selection criteria. Conclusion-oxytocin bolus 0.5-3 UI is considered an effective prophylactic dose. Recommended effective prophylactic oxytocin infusion dose is 7.72 IU/h, but it is unanswered whether we really need a prophylactic infusion of oxytocin if we choose effective bolus dose size and rate. Adverse hemodynamic effects were observed when a 5 UI oxytocin bolus was used. However, topics such as bolus dose size, infusion dose size and requirement as well as bolus injection rate, still remain unanswered. The doses that are recommended in the guidelines of peripartum hemorrhage prophylaxis are not confirmed by randomized controlled double-blind trials and more research should cover this topic.

HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome is a severe and rapidly progressing condition that requires distinct diagnostic considerations. The aim of this study was to evaluate the impact of the Mississippi triple-class system on the HELLP syndrome diagnosis, treatment, and outcomes in a perinatology centre during a 10-year period, and consider its effectiveness and necessity in everyday practice. A retrospective observational cohort study was carried out using the medical records of a tertiary perinatology centre with the diagnosis of HELLP syndrome from the period of time between 2005 and 2014. The patients who fit the HELLP syndrome diagnosis were grouped by the Mississippi triple-class system. The means of diagnosis and treatment outcomes within those groups were analysed statistically. There was insufficient statistical evidence of the blood pressure levels corresponding to the severity of patients' condition ( p > 0.05 in all of the groups). The clinical presentation varied within all of the classes, and the only objective means of diagnosis and evaluation of progression of the condition were laboratory tests. Even though HELLP syndrome is considered a hypertensive multi-organ disorder of pregnancy, the level of hypertension does not correlate to the severity of the condition; hence, the diagnosis should be based on biochemical laboratory evidence. Vigilance in suspicion and the recognition of HELLP syndrome and appropriate treatment are essential in order to ensure better maternal and neonatal outcomes.

Unlabelled: The aim of this study was to determine the effect of dexamethasone and ketolgan on postoperative nausea and vomiting and to evaluate risk factors for postoperative nausea and vomiting., Material and Methods: A prospective, double-blind, randomized clinical study was carried out. One hundred fifty-three ASA I-II women undergoing laparoscopic gynecologic operations were randomized into three groups: dexamethasone group (n=51), ketolgan group (n=51), and control group (n=51). Patients in the dexamethasone group were given 4 mg of dexamethasone intravenously before the induction of general anesthesia, the ketolgan group received 30-mg ketolgan intravenously, and control group did not receive any medication. The incidence and severity of postoperative nausea and vomiting were registered 24 hours after the surgery., Results: The incidence of postoperative nausea and vomiting in the dexamethasone group was 13.8%; in the ketolgan group, 37.3%, and in the control group, 58.9% (P=0.026). Patients with a history of migraine suffered from postoperative nausea and vomiting in 70.3% of cases and migraine-free patients in 25.8% of cases (P=0.015). Opioids for postoperative analgesia increased the incidence of postoperative nausea and vomiting as compared with nonsteroidal anti-inflammatory drugs (P=0.00002)., Conclusions: Preoperative medication with dexamethasone significantly reduces the incidence of postoperative nausea and vomiting. Avoidance of opioids for postoperative analgesia reduces the incidence of postoperative nausea and vomiting. Migraine and motion sickness are independent risk factors for postoperative nausea and vomiting.

Besides crystalloids, colloids are used for the treatment of hypovolemia and shock. They are high-molecular-weight proteins of bovine origin with properties of more rapid replacement of circulating blood volume. Iso-oncotic character provides the volume effect (approximately equal to 100%) close to the volume intravenously infused with the duration of action for 2-4 hours. Gelatin solutions are excreted with urine and feces in unchanged form without prolonged fixation in organism. Even in case of acute renal failure, gelatin peptides do not accumulate due to increased activity of proteolytic enzymes; therefore, they are the first-choice colloids. Gelatin solutions do not change coagulation as other colloids; just they may cause hemodilution as crystalloids do, so they are safe in case of hemorrhage and thrombocytopenia. There is a decreased risk of bleeding when gelatin solutions are used in surgery as compared with other colloids; in addition, they protect from hypotension due to vasodilatation in epidural or spinal analgesia. Gelatin solutions may cause compensatory hyperemia and increase of cardiac output, cardiac index, myocardial contractility, mean arterial blood pressure, and diuresis; in addition, oxygen delivery to the tissues improves. The dosage depends on clinical condition of a patient, and it is suggested to be 100-2000 mL and even more, for isovolemic hemodilution--20 mL/kg of body weight. Adverse reactions such as anaphylactoid or anaphylactic to gelatin derivates are rare and similar to other colloids.

HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is a severe, life-threatening pregnancy pathology, which occurs in 0.2-0.8% of all pregnancies, and approximately 10% (2-20%) of pregnancies are complicated with severe preeclampsia. This syndrome usually develops in the third trimester of pregnancy in preeclamptic patients, sometimes it occurs in the second trimester of pregnancy, and very rarely HELLP syndrome may develop within 48-72 hours after delivery. Diagnosis is complicated as there are no specific clinical signs, therefore, this syndrome may be confused with other pathologies like acute fatty liver of pregnancy, idiopathic thrombocytopenia, hemolytic uremic syndrome, appendicitis, and etc. The patients with HELLP syndrome should be treated in the tertiary care hospital, where appropriate diagnostics and multidisciplinary help for mother and fetus can be assured. When the syndrome was described for the first time, L. Weinstein recommended prompt delivery as the only possible treatment. Current studies show that conservative treatment of patients with HELLP syndrome is safe, without an increase in morbidity and mortality. That is why now many authors agree that treatment approach should be based on the estimated gestational age and the condition of the mother and fetus.

Background: The purpose of our study is to compare two methods of postoperative analgesia in colorectal cancer patients after resectional operations, and to evaluate advantages and limitations of each method on the postoperative course of these patients., Methods: One hundred patients scheduled to undergo elective colorectal cancer surgery were randomized into two groups; after general anesthesia, one group received epidural analgesia (n=50) and the second one - intramuscular pethidine analgesia (n=50). Visual analogue scale at rest and on coughing was used to compare intensiveness of pain between the two groups during the day of surgery and first three postoperative days. Patients' mood and self-satisfaction were evaluated using self-assessment manikin scale. Side effects of both analgesia techniques were registered. All complications and postoperative hospital stay were also evaluated., Results: Visual analogue scale pain scores at rest and on coughing were significantly better in epidural analgesia group as compared to systemic intramuscular pethidine analgesia group (p<0.05). Additional analgesics were needed for 10 (20%) and 28 (56%) patients respectively to keep visual analogue scale pain scores below 5. Adverse effects such as profound sedation, nausea and vomiting were more frequent in systemic intramuscular pethidine group, but pruritus - very uncommon to compare with epidural analgesia group (p<0.05). There were no significant differences between the two groups in respect to complications and postoperative hospital stay., Conclusions: Epidural analgesia has demonstrated significantly better effectiveness than intramuscular pethidine analgesia after colorectal cancer surgery with fewer adverse events. Self-assessment manikin scores showed better self-satisfaction in patients of epidural analgesia group as compared to patients in systemic pethidine group.