The purpose of this study is to stress the value of using intermittent pneumatic compression (IPC) in immobile patients. The use of IPC helps prevent limb oedema and the associated skin changes frequently seen on the legs of the immobile patient. Oedema formation is caused by an increase of fluid extravasation, while skin changes including leg ulcers are mainly because of a deficiency of the venous and lymphatic pumps. Conventional compression stockings and bandages impede leg swelling but are less efficient in supporting the deficient veno-lymphatic pump when patients are unable to move. In this situation, actively compressing the limb using IPC is a very meaningful and effective treatment option. Because of a lack of literature on the specific indication of IPC in immobile patients, experimental studies and randomised controlled trials in similar situations are reviewed. IPC is a very effective although underused treatment modality, especially in immobile, wheelchair-bound patients. By inflation and deflation of the air-filled garments, IPC produces cycles of pressure waves on the leg, thus mimicking the working and resting pressures applied by compression bandages. IPC not only reduces leg swelling but also augments the veno-lymphatic pump, which is essential for the restoration of the damaged microcirculation of the skin.

Intermittent pneumatic compression in immobile patients.

Maternal obesity and venous thromboembolism.

https://kclpure.kcl.ac.uk/portal/files/103266139/Women_s_views_adherence_and_GUIMICHEVA_Firstonline22November2018_GREEN_AAM_CC_BY_NC_ND_.pdf

Women's views, adherence and experience with postnatal thromboprophylaxis.

Objective: To analyze the difference in obstetric morbidity associated with utilization and non-utilization of prenatal care. Design: Case control study. Setting & Duration: Department of Obstetrics and Gynaecology, Unit V, Dow Medical College and Lyari General Hospital, Karachi from January 2007 to December 2007. Methodology: All women admitted for delivery and during puerperium. Details of all cases including booking status, demographic details, pre-existing problems and complications occurring during delivery and postnatal stay were noted on pre-designed proforma. Neonates were examined for APGAR score, weight and abnormality. Significance of difference of each morbidity in the booked and nonbooked patients was calculated using Pearson’s chi square test. Results: 735 women were recruited to study, of which 47.2% were nonbooked. 15 patients were admitted with a complication after delivering elsewhere. Six patients were readmitted after discharge with a morbidity. Overall maternal morbidity rate was 8.2%, with significant difference (p=0.001) between the 2 groups. Commonest morbidity was major hemorrhage and it was more frequently found in the nonbooked group (p=0.003). Overall perinatal morbidity was 5.5%. The difference in the study groups was remarkable (0.001). 9.1% babies of nonbooked and 4% of booked cases (p=0.000) needed NICU care. Conclusion: Poor utilization of prenatal care is associated with maternal and perinatal morbidity and mortality.

Obstetric morbidity in the booked versus non-booked patients - a comparative study at lyari general hospital

Objective Despite the modern appeal of wearing compressive garments during physical activities, the literature is lacking in quality data and controversial in the investigations dealing with the pathophysiologic mechanism by which graduated compression stockings (GCS) affect the calf pump activation in healthy individuals. The aim of the investigation was to provide insight into the clinical effects of GCS use during a standardized walking exercise. Methods Twenty physically active healthy volunteers (mean age, 34 ± 5 years; body mass index, 22 ± 2 kg/m2) underwent lower limb ultrasound scanning to exclude vascular impairment. All individuals performed continuous aerobic exercise, walking for 30 minutes on a treadmill, under cardiac monitoring, at 70% of individual estimated maximal heart rate according to the Tanaka equation. The study population performed the standardized walk without GCS (baseline) and at 1 week performed the same standardized walk wearing knee-length 20 to 30 mm Hg GCS (compression). All individuals underwent a lower limb volume assessment by truncated cone formula before and after the walk and a perceived exertion assessment by means of the validated Borg scale at the end of the exercise protocol. Results All individuals had normal venous and arterial ultrasound examination findings. No significant postural defects were reported. Both legs were assessed in all 20 individuals for a total of 40 cases with and 40 cases without GCS. In the baseline group, the median (interquartile range) lower limb volume changed from 2496 (770) mL before exercise to 2512 (805) mL (P = .2597) after exercise. The compression group reported a significant lower limb volume change from 2466 (670) mL before exercise to 2276 (567) mL (P = .0001) after exercise. Mean perceived exertion was 13 (11) and 11 (1) in the baseline and compression groups, respectively (P = .0001). The interface pressure exerted by the GCS was 24 (2) mm Hg. No complaints in terms of discomfort were reported after use of GCS. Conclusions In healthy individuals, GCS (24 [2] mm Hg) use during a continuous standardized walk of 30 minutes is associated with a significant decrease in lower limb volume and a decrease in perceived exertion. The mechanism by which GCS impart their effect during physical activity may involve improved muscle pump function and reductions in inflammatory pathways. Further study will need to validate the mechanisms of the function of GCS used during physical exercise.

Lower limb volume in healthy individuals after walking with compression stockings.

Pulmonary thromboembolism is the leading direct cause of maternal death in the UK. This direct approach structured questionnaire survey was carried out on 100 randomly chosen pregnant in-patients in a London teaching hospital: (a) to assess the quality and frequency of advice given to them by the healthcare professionals on the use of graduated elastic compression stockings (GECS) as a primary physical prophylaxis against venous thromboembolism (VTE) and (b) to find out the rate of compliance and the possible reasons for non-compliance of their use. The information and advice given to pregnant patients by healthcare professionals are generally of good-to-excellent quality, but not universally offered. A total of 40% of mothers wore the GECS all the time, while 38% did not wear them at all. Among the non-wearers, the two major groups were those who did not receive any advice (28%) and those who found them uncomfortable (18%). All healthcare professionals should be aware of the potential risks of VTE, and routinely educate and advise the pregnant women-at-risk on the use of GECS.

A survey of pregnant women on the use of graduated elastic compression stockings on the antenatal ward.

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A survey of pregnant women on the use of graduated elastic compression stockings on the antenatal ward.