Background: Cesarean section (CS) has been linked to a number of negative effects, such as pain, anxiety, and sleeping problems. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of preoperative melatonin on postoperative outcomes in pregnant women who were scheduled for elective CS. Methods: We systemically searched 4 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) from inception until 10 March 2023. We included randomized controlled trials (RCTs) comparing melatonin and placebo for postoperative outcomes in CS patients. For risk of bias assessment, we used the Cochrane Risk of Bias 2 tool. Continuous variables were pooled as mean difference (MD), and categorical variables were pooled as a risk ratio (RR) with a 95% confidence interval (CI). Results: We included 7 studies with a total of 754 pregnant women scheduled for CS. The melatonin group had a lower pain score (MD = −1.23, 95% CI [−1.94, −0.51], p < 0.001) and longer time to first analgesic request (MD = 60.41 min, 95% CI [45.47, 75.36], p < 0.001) than the placebo group. No difference was found regarding hemoglobin levels, heart rate, mean arterial pressure, total blood loss, or adverse events. Conclusions: Preoperative melatonin may reduce postoperative pain in CS patients without side effects. This research offers a safe and affordable pain management method for this population, which has clinical consequences. Further research is needed to validate these findings and determine the best melatonin dosage and timing.

This investigation examined the efficacy of ondansetron (intervention) versus metoclopramide (control) in managing parturient females with hyperemesis gravidarum (HG), by pooling data from randomized controlled trials (RCTs) using a meta-analysis approach. From inception until January 2022, five information sources were screened: Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, PubMed and Web of Science. Quality assessment was done through the Cochrane Risk of Bias (version 2) assessment tool. The mean difference (MD) with 95% confidence interval (CI) was used to summarize the continuous data in a fixed- or random-effects model, depending on the extent of between-study heterogeneity. Five RCTs were included, comprising a total of 695 patients (355 and 340 females were assigned to ondansetron and metoclopramide, respectively). Four RCTs had an overall ???low??? risk of bias, whereas one RCT had an overall ???some concerns??? due to lack of sufficient information about randomization. There was no significant difference between both groups regarding the pregnancy-unique quantification of emesis and nausea score [MD=0.23, 95% CI (-0.42, 0.88), p=0.49], length of hospital stay [MD=-0.17 days, 95% CI (-0.35, 0.02), p=0.08], the number of doses of drug received [MD=0.45, 95% CI (-0.08, 0.98), p=0.10], and duration of intravenous fluids [MD=-1.73 hours, 95% CI (-5.79, 2.33), p=0.40]. Among parturient females with HG, there was no substantial difference in efficacy between both agents. Nevertheless, ondansetron is favored over metoclopramide in view of its trending therapeutic efficacy and better safety profile.

Subcutaneous (SC) saline irrigation was reported as a feasible and cost-effective procedure to prevent cesarean section (CS) surgical site complications. We aim to investigate the efficacy of SC saline irrigation to prevent CS surgical site complications. A systematic review and meta-analysis were conducted synthesizing evidence from randomized controlled trial (RCT) studies obtained from PubMed, Embase Cochrane, Scopus, and Web of Science from inception to March 2024. Pooled outcomes included wound complications (superficial surgical site infections (SSI), hematoma, seroma, and wound separation) and operative time. We used RevMan v.5.4. (The Cochrane Collaboration, Oxford, UK) to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean differences (MD) with a 95% confidence interval (CI). Five RCTs with 4,025 patients were included. Four studies had a low overall risk of bias and only one trial with some concerns about selection bias. There was no difference between SC saline irrigation and no irrigation regarding the incidence of superficial SSI (five RCTs, RR: 0.72 with 95% CI [0.47, 1.10], P = 0.13), seroma (four RCTs, RR: 0.73 with 95% CI [0.32, 1.65], P = 0.45), wound separation (four RCTs, RR: 0.66 with 95% CI [0.36, 1.24], P = 0.2), and operative time (four RCTs, MD: -1.26 with 95% CI [-5.14, 2.62], P = 0.52). However, SC saline irrigation significantly decreased the incidence of hematoma (three RCTs, RR: 0.54 with 95% CI [0.45, 0.65], P = 0.00001). SC saline irrigation of the surgical site after CS was not effective in preventing the incidence of superficial SSI, seroma, or wound separation, while only preventing the incidence of hematoma.