Accuracy of Ultrasound in the Prediction of the FIGO Classification of Placenta Accreta Spectrum.

OBJECTIVES: To evaluate the accuracy of greyscale ultrasound (US) and colour Doppler detecting placenta accreta spectrum (PAS) based on the newly recommended International Federation of Obstetrics and Gynaecology (FIGO) grading system. METHODS: This prospective study was conducted on women diagnosed with placenta previa or low-lying placenta involving the anterior uterine wall and associated with PAS as identified by the US. Transabdominal and transvaginal greyscale US was performed on admission between 34 and 36 weeks of gestation and compared to clinical grading and histopathological examination after cesarean hysterectomy. RESULTS: In total, 36 pregnant females who underwent a cesarean hysterectomy due to placenta previa complicated by PAS were included in this study. All patients had a history of previous cesarean deliveries, ranging from 1 to 5 deliveries. The US has an overall sensitivity of 33%, 55%, and 84.62%, and specificity of 100%, 75%, and 60% in detecting the 3 degrees of PAS, respectively. US cannot differentiate between the different subtypes of PAS grade 3 (a, b, and c). CONCLUSION: The overall US evaluation was highly significant in predicting the FIGO diagnosis of PAS; however, all ultrasonographic signs were equally relevant in diagnosing grade 1 and/or 2 PAS and were inaccurate in differing the subtypes of PAS grade 3.

Role of Oral Tramadol 50 mg in Reducing Pain During Colposcopy-Directed Cervical Biopsy: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to assess safety and efficacy of 50-mg tramadol in reducing patient-perceived pain during colposcopy. MATERIAL AND METHODS: We conducted a randomized double-blind placebo-controlled trial in the colposcopy unit of a tertiary referral hospital, Cairo, Egypt, from April 2018 to October 2018. Our primary outcome was pain during colposcopy-guided ectocervical punch biopsy. Our secondary outcomes were pain during speculum insertion, acetic acid application, Lugol iodine application, endocervical curettage (ECC), endocervical brushing, 10-minute postprocedure, and additional analgesia requirement. Pain was assessed using 10-cm visual analog scale. RESULTS: One hundred fifty women were randomized into 2 groups: tramadol group (n = 75) received oral 50-mg tramadol tablets, and control group (n = 75) received placebo tablets. Both groups showed no significant difference in anticipated pain score (p = .56), pain scores during speculum insertion (p = .70), application of acetic acid (p = .40), and Lugol iodine (p = .79). However, the mean pain scores were significantly lower in tramadol group compared with placebo at ectocervical biopsy (p = .001), ECC (p = .001), endocervical brushing (p = .001), and 10 minutes after colposcopy (p = .001). Need for additional analgesia was significantly lower in tramadol group (p = .03). CONCLUSIONS: Oral tramadol 50 mg significantly reduces pain perception during colposcopy-guided ectocervical biopsy, ECC, endocervical brushing, and 10 minutes after colposcopy with tolerable adverse effects.

Key features of blend denim fabrics performance with dyed weft silk yarn and different weave structures.

This research aimed to weave the warp indigo-dyed cotton yarn with un-dyed or dyed silk yarn and analyze the impact of different weft yarn structures on the properties of denim fabrics. The dyed silk yarn was performed by a selection of different anionic indigo and non-indigo blue dyestuffs. The dyeing shades of the anionic Indigo Carmine dye on silk exhibited high build-up at the acidic pH range 2-2.5 with poor washing fastness and even so, the cationic aftertreatment of the dyed silk samples showed un-matched color with indigo-dyed cotton yarns. The dyeing properties of two commercial non-indigo reactive and acid dyes on silk add other advantages. To ascertain the dyeing shades evaluation of the non-indigo dyes on silk, two sets of blended denim fabrics were investigated. The first set included a weft-wise silk yarn dyed with reactive dye RB 5, and the second set included silk yarns dyed with acid dye AB 193. Weaving of the blended fabrics was carried out in Twill 3/1, 3/2 Z,and Satin 53 patterns and exhibited significant color effects of the dyed silk yarns to those of the un-dyed control samples. The dyeing shades of the non-indigo RB 5 and AB 193 dyed weft-wise silk yarns were found to be matched in color performance with the conventionally indigo- dyed cotton yarns. Ultraviolet resistance of the blend denim fabrics was evaluated, showing significant improvement in UPF of the weft-wise dyed silk. The study claimed that the dyed silk yarns a good candidate for newly developed blend denim fabrics.

Organoclay-assisted disperse dyeing of polypropylene nanocomposite fabrics in supercritical carbon dioxide.

Dyeing using supercritical carbon dioxide (SC-CO2) is carried out on the polypropylene (PP) nanocomposite fabrics with model disperse dye compared with their regular fabric at various dyeing temperatures and pressures. The results are compared with those obtained in aqueous dyeing method. The PP nanocompsite fabrics dyed in SC-CO2 medium exhibited higher colour strength (K/S) values compared with their PP regular fabric. The PP nanocompsite fabrics and their regular fabric dyed in SC-CO2 medium have higher K/S values than those dyed in aqueous medium. The color coordinates of all PP fabrics dyed in SC-CO2 and aqueous medium were positive with respect to a* and b* coordinates depending on the disperse red dye uptake. The PP nanocomposite fabrics dyed in SC-CO2 and aqueous medium exhibited higher antibacterial properties than their regular fabrics. All PP fabrics dyed in SC-CO2 and aqueous medium present very good washing, perspiration and light fastness.

Kasr Alainy simplified uterine preserving surgery for conservative management of placenta accreta spectrum (PAS): A modified surgical approach.

OBJECTIVE: The incidence of placenta accreta spectrum (PAS) is rising rapidly due to the global surge in Caesarean delivery. It is associated with significant maternal morbidity and mortality. It is usually managed with Caesarean hysterectomy. However, uterine preserving surgeries can have advantages over Caesarean hysterectomy and intentional placental retention techniques. STUDY DESIGN: We present a modified technique of uterine preserving surgery that uses a safe approach for placental bed surgical devascularization. This is followed by resection of the invaded uterine segment and uterine wall reconstruction. RESULTS: The technique was used in the management of 20 patients with antenatally suspected PAS that were confirmed at laparotomy. It was successful in preserving the uterus in 18/20 (90 %) women. The mean intraoperative blood loss in was 1305 CC (SD: +361.6) with a mean operative time of 123 min (SD: ±38.7). There was only one urinary bladder injury and no other maternal morbidity. CONCLUSION: Our surgical technique is safe and may be useful for conservative surgical management of PAS, particularly in low- and middle-income countries, where access to complex resources, such as interventional radiology, is limited.

Simultaneous dyeing and antibacterial finishing of polypropylene using vinyl sulfone dye under supercritical carbon dioxide.

Polypropylene fibres are difficult to dye using commonly used techniques due to the high crystallinity and non-polar aliphatic structure, that lack reactive places for dyes in the molecule. Dyeing PP fabric in scCO2 with antibacterial dyes merged the dyeing and finishing methods, resulting in a more productive technique in terms of water and energy consumption. Unmodified polypropylene fabric was dyed with 4-[2-[4-(ethenylsulphonyl)phenyl]diazenyl]-N,N-diethylbenzenamine antibacterial dye under scCO2 medium. The influences of scCO2 working parameters, such as dye concentration, pressure, dyeing time, and temperature, on fabric dye absorption expressed as color strength were studied. The color strength (K/S) was measured as well as CIELAB color parameters. The results were compared with its water dyeing analogue and it was observed that color strength as well as color depth (L) of the samples dyed in scCO2 were noticeably better than its water counterpart. In both scCO2 and water, the fastness properties (washing, rubbing, and light) of the dyed samples were excellent. Antibacterial activity of the dyed polypropylene sample in scCO2 was estimated and the results indicated good antibacterial efficiency.

Budd-Chiari syndrome diagnosed with pregnancy in a patient with inherited thrombophilia.

An 18-year-old primigravida was referred to our high risk pregnancy (HRP) department at 34 weeks of gestation for birth panning as she has Budd-Chiari syndrome (BCS). Her history was significant for familial thrombophilia. She had portal hypertension manifestations. Her work-up revealed factor V Leiden gene mutation, hepatic and portal vein thrombosis. A multidisciplinary team of physicians from the gastroenterology and hepatology, haematology and HRP departments puts a management plan; it culminated into safe delivery of the patient at 36 weeks of gestation. The patient was referred to a specialised BCS centre where she had successful liver transplantation done.

Accidentally discovered high INR in pregnancy unmasks an inherited factor VII (FVII) deficiency that is paradoxically associated with thrombotic tendency.

A 32-year-old multiparous obese woman was referred to our center at 37 weeks of twin gestation. She was referred for birth planning following an accidentally discovered high international normalised ratio (INR) in routine preoperative labs. Her history was significant for recurrent pregnancy-associated deep venous thrombosis as well as two early pregnancy losses. Further work-up revealed transaminitis, mild splenomegaly and high lupus anticoagulant titre. A multidisciplinary team of physicians from the high-risk pregnancy, anaesthesiology, haematology, gastroenterology and hepatology departments put a management plan; it culminated into uncomplicated delivery of the patient by repeated caesarian section. The team was also able to figure out the cause of the patient's high INR that is associated with thrombophilia rather than haemophilia.