Oxytocin Versus Oral Misoprostol for Induction of Labor in Pregnant Women with Term Prelabor Rupture of Membranes: a Randomized Clinical Trial.

This study compares the effectiveness and safety of oxytocin infusion against oral misoprostol for inducing labour in pregnant women with term prelabor membrane rupture. We randomized 173 pregnant women presenting with term prelabor rupture of membranes (PROM) at Ain Shams University Maternity Hospital into Group A (underwent induction of labor (IOL) by 25µg misoprostol oral tablet every 4 h, for maximum 5 doses) and an identical Group B: (underwent IOL by oxytocin infusion according to the hospital protocol). Our primary outcome was rate of vaginal delivery within 24 h, while the secondary outcomes included the time till active phase, induction to delivery interval, maternal pyrexia, nausea and vomiting, fetal distress, Apgar score, birth weight, and neonatal intensive care unit admission. Both groups showed high rates of vaginal delivery (82.4% & 87.1% for misoprostol group and oxytocin group respectively) with no significant difference between the two groups (p=0.394). However, patients induced by misoprostol took significantly less time to reach active phase with a shorter induction to delivery interval as compared to patients induced with oxytocin. This difference was clear in multiparous women, but not observed in primiparous women when subgroup analysis was done. No significant difference was found as regards other outcomes. Our study showed that both oral misoprostol and oxytocin are effective and safe for IOL in patients with PROM, with shorter induction-delivery interval in patients induced by oral misoprostol, an effect that is clear in multiparous but not primiparous women. TRIAL REGISTRATION: NCT05215873, on 31/01/2022, "retrospectively registered".

Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial.

PURPOSE: To compare total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) using electrosurgical bipolar vessel sealing (EBVS) technique regarding operative time, intra and postoperative complications. METHODS: The current prospective randomized controlled clinical trial was conducted at Ain-shams University maternity Hospital, Cairo, Egypt. Ninety patients who were admitted from gynecologic outpatient clinic to undergo hysterectomy were enrolled. The study population was randomized according to type of hysterectomy done into 3 groups: group 1: VH; group 2: AH and group 3: TLH. EBVS was used in all groups. Three staff members' surgeons were also randomized to operate on the patients and they were all equally competent in all the procedures. Main outcome measures were operative time, operative blood loss, operative complications, postoperative pain assessment using the visual analogue scale (0-10), and the need for analgesics as well as the postoperative hospital stay. RESULTS: Ninety patients were randomized to undergo VH, TAH or TLH for benign pathology using EBVS. Postoperative pain score and the need for analgesia were least in TLH compared to the other two groups, (p < 0.001). The hospital stay in TLH group was shorter than the other two groups, but there was no significant difference between VH group and TAH group with regard to hospital stay, (p < 0.001). The total operative time was shortest in the VH group (100.4 ± 35.8 min) compared to TLH (126 ± 42.7 min) and TAH (123.6 ± 44.5 min) (p = 0.033). The operative complications were more with VH and TAH groups. The blood loss was more with VH (p = 0.039). CONCLUSION: TLH had a longer operation time, yet, less blood loss, shorter hospital stay, less postoperative pain and fewer complications, compared to TAH and VH using EBVS.

Fetal mid-thigh soft-tissue thickness: a novel method for fetal weight estimation.

PURPOSE: To derive a novel formula for fetal weight estimation utilizing the linear measurement of mid-thigh soft-tissue thickness (STT). METHODS: 300 women, with singleton uncomplicated pregnancy, were included in a prospective cross-sectional study. The study included four consecutive phases: phase (1) validated the original Scioscia's formula, phase (2) derived a novel modified formula for fetal weight estimation, phase (3) validated the novel modified formula, and phase (4) evaluated the agreement between the modified and original formulae. RESULTS: A statistically significant correlation was found between actual fetal weight (AFW) and various sonographic biometric measurements including mid-thigh STT (r (2) = 0.656, p < 0.001), femur length (FL) (r (2) = 0.573, p < 0.001), bi-parietal diameter (BPD) (r (2) = 0.250, p < 0.001), abdominal circumference (AC) (r (2) = 0.310, p < 0.001), and estimated fetal weight (EFW) using the original Scioscia's formula (r (2) = 0.644, p < 0.001). The modified formula showed a better signed % difference (median = -0.41 %, IQR -1.88 to 2.03) than the original formula (median = -0.51 %, IQR -2.33 to 2.00). It was noted that, using the original formula, 88.7 % of the sample had absolute error below 5 and 98.3 % of the sample had absolute error below 10 %. On the other hand, using the modified formula, 87.3 % of the sample had absolute error below 5 %, while 97.3 % had absolute error below 10 %. The agreement between the two formulae was moderate as 134 patients out of 150 had similar ranking (κ = 0.57). CONCLUSION: Fetal mid-thigh SST is a simple, useful, and easily applicable parameter for fetal weight estimation.

Caesarean deliveries by Pfannenstiel versus Joel-Cohen incision: A randomised controlled trial.

OBJECTIVE: This study was designed to compare the Pfannenstiel versus Joel-Cohen incisions during caesarean deliveries. MATERIAL AND METHODS: Women undergoing caesarean deliveries (n=153) were randomly assigned to the conventional Pfannenstiel or the Joel-Cohen incision. The outcome measures included postoperative pain, requirement for analgesics, operative time and other postoperative data. RESULTS: Maternal age, parity, gestational age and indications for caesarean delivery were similar across groups. Total operative time, postoperative recovery duration, time to get out of bed, to walk straight without support, to detect audible intestinal sounds and to pass gases or stools were shorter in the Joel-Cohen group. Postoperative haematocrit decreases and estimated intraoperative blood loss were similar between the two techniques. Moderate and severe pain at 6, 12 and 18 hours postoperatively was less frequent after the Joel-Cohen technique. CONCLUSION: Joel-Cohen incision in the non-scarred abdomen may provide a faster technique for caesarean section with less postoperative pain and probably early postoperative recovery in our circumstances.

The outcome of isolated fetal ascites.

OBJECTIVE: To describe the outcome of pregnancies complicated by isolated fetal ascites. STUDY DESIGN: This is a review of 12 cases of isolated fetal ascites managed at the fetal medicine unit at the Royal Victoria Infirmary in Newcastle. The work-up for ascites included detailed ultrasound examination, checking maternal blood group and testing for the presence of antibodies, as well as maternal infection screening and fetal karyotyping. RESULTS: Ten out of the 12 pregnancies had a viable fetal outcome, with two babies (20%) requiring further bowel surgery. Ascites resolved spontaneously in three pregnancies (30%) antenatally and in two babies (20%) few weeks after delivery. CONCLUSION: Isolated fetal ascites with normal karyotype and negative infection screen carries a good prognosis, with spontaneous resolution in most of the cases. However the parents should be counselled as regards the possibility of need for surgery or the presence of underlying syndromes.

Randomised controlled trial comparing three methods of presenting risk of Down's syndrome.

OBJECTIVE: To compare three simple methods of presenting information to patients about the risk of Down's syndrome. STUDY DESIGN: Randomised controlled trial of 150 " low risk" women booking for antenatal care before 19 weeks gestation at Sunderland Royal Hospital. After informing the women about the purpose of the study and reassuring them that they were "low risk", each patient was given a questionnaire, which used one of three different methods (graphic, written and interactive) to present information about the risk of Down's syndrome. A visual analogue scale allowed us to assess their level of understanding and anxiety before and after the information about risk was given to them. RESULTS: All three methods significantly altered patients' perception and anxiety about the risk of Down's syndrome. The interactive method was found to be the most effective of the three. CONCLUSION: This pilot study suggests that discussing the patients' worries about fetal anomalies with medical staff can markedly reduce their degree of anxiety. The interactive method was most effective at putting information across to the patient. It significantly reduced their level of anxiety as well as their overall worry about pregnancy.