Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This
study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical
procedures.
Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and
elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time
in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during
the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after
discharge.
Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at
discharge. Patients reported being in severe pain for 10 (i.q.r. 1–30)% of the first week after discharge and rated satisfaction with
analgesia as 90 (i.q.r. 80–100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated
with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to sideeffects
of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. −1.52
to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and lowand
middle-income countries, patient-reported outcomes did not.
Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects
of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge
analgesia should be adopted routinely.

Objectives: To test the feasibility of sonographic measurement of the umbilical cord (UC) length index in prediction of UC length and subsequent abnormalities at birth.
Methods: This study was done at tertiary University. We included 300 pregnant women who were ≥37 weeks admitted to labor ward. Sonographic evaluation of UC length index was calculated by counting the UC rings in each amniotic fluid quadrant. One point was given for each quadrant that contained UC ring and 0.5 point was given for each UC ring in one quadrant then the total score was calculated. After delivery of the fetus, the UC length was measured by flexible tape in cm. Any UC abnormalities at birth as true knots and neck loops were noted.
Results: Thirty-six cases (12%) were delivered vaginally while 264 (88%) of cases were delivered by CS. The mean UC length index was 3.35±1.17. Ten cases (3.3%) had short UC and their mean UC length index was 1.9±0.51. Normal UC cases were 269 (89.7%). Their mean UC length index was 3.27±1.07. Long UC cases were 21 (7%) and their mean UC length index was 5.09±0.86. Neck loops and true knots were significantly higher among newborns with long UC; 11 (52.3%) & 6 (20.6%) cases respectively (P=0.001). Meanwhile, placental separation was significantly higher among cases with short UC; 2 (20%) (P<0.001).
Conclusions: The calculation of UC length index before delivery can be used for predicting cord abnormalities due to short and long UCs.
Keywords: Umbilical cord; Ultrasonography; True knots; Fetal distress

Background: There is no justification for any reason to have a caesarean delivery (CD) rate higher than 10–15%. CD rates higher than 10% are not associated with substantial decrease in maternal and neonatal mortality rates. Robson Group Classification System has the advantage of analyzing the caesarean delivery rate in well-defined sub-groups of women that are totally inclusive and mutally exclusive.
Objective: The aim of the current work was to make comparative analysis of increasing trends of caesarean delivery in two hospitals at Assiut Governorate in Egypt.
Patients and methods: This retrospective cross-sectional study included a total of 2702 cases, attending for delivery at Assiut University Hospital; a tertiary hospital and Assiut Police Hospital; a secondary hospital, both present in Assiut Governorate. This study was conducted over 3-month between Jan 2016 to Mar 2016.
Results: Robson Group 5 constituted the most in both hospitals regarding the relative size of the group with higher and significant percentage at the secondary hospital (53%) compared to (32.3%) at the tertiary one. Robson Group 5 contributed the most in both hospitals regarding the overall CD rate with higher and significant percentage at the secondary hospital (74.8%) compared to (49.4%) at the tertiary one. Robson Group 5 also contributed the most in both hospitals regarding the absolute contribution rate of all deliveries with higher and significant percentage at the secondary hospital (50%) compared to (28.7) at the tertiary one.
Conclusion: On the basis of the study, TGCS is only a starting point, but it is important to have a common starting point. Having implemented TGCS, we have concluded that Group 5 (previous caesarean delivery) is the largest of the overall CD rate in both secondary and tertiary hospitals.
Keywords: Caesarean delivery, Assiut Governorate, Robson Ten Group Classification