Triple P with T-shaped lower segment suture; an effective novel alternative to hysterectomy in morbidly adherent anterior placenta previa.

PURPOSE: To evaluate the efficacy and safety of the Triple-P procedure as a conservative method in women with morbidly adherent placenta (MAP). MATERIALS AND METHODS: A prospective trial conducted on 20 women performing elective cesarean sections (CS) at 37 weeks for anterior placenta previa accreta or increta. All women were young aged with low parity and previous CS deliveries. Triple-P procedure involved delivery of the fetus through a uterine incision placed above the upper border of the placenta, bilateral uterine arteries ligation immediately after delivery of the fetus followed by placental nonseparation and myometrial excision with reconstruction of the uterine wall in a T-shaped manner. The study outcome measures included duration of surgery, amount of intra and postoperative blood loss, Percentage of hemoglobin (Hb %) reduction, the need to perform hysterectomy and postoperative complications. RESULTS: Mean duration of surgery was 58 ± 1.8 min, mean intraoperative blood loss was 1.3 ± 0.3 l, mean postoperative blood loss was 180 ± 94 ml and mean Hb % reduction was 1.5 ± 0.1 g/dl. Only one case necessitated hysterectomy for severe bleeding. CONCLUSION: Triple-P procedure is a novel effective weapon that can replace hysterectomy in suitable women with MAP, especially in young patients with low parity.

Prevalence of postpartum depression regarding mode of delivery: a cross-sectional study.

Purpose: To explore the prevalence of postpartum depression (PPD), as well as the relationship between delivery mode and postpartum depression among postnatal women utilizing the Arabic validated version of the Edinburgh Postnatal Depression Scale (EPDS).Materials and methods: 412 women with singleton gestation during their 3rd trimester without medical or psychological problems preceding or during pregnancy were included. All pregnant women were asked to fill out the Arabic version of Edinburgh Postnatal Depression Scale. Only women with EPDS score <13 during pregnancy were allowed to complete the study. 370 women were asked to repeat the EPDS at 8 and 16 weeks postnatal. The patients were divided into three groups according to their delivery mode; normal vaginal delivery, emergency or elective caesarian section.Results: Prevalence of postpartum depression was found to be significantly higher in emergency caesarian section group at the 8th and 16th postnatal weeks (25% and 19%, respectively) when compared to elective caesarian section group (21% and 13%, respectively) or normal vaginal delivery group (7% and 1.7%, respectively). The mean score of the EPDS in the normal vaginal delivery group at both assessments was significantly lower than those of the emergency and elective caesarian section groups.Conclusions: There was a strong relation between delivery mode and postpartum depression. Emergency CS showed a stronger correlation than elective caesarian section.

A new look at low-dose aspirin: Co-administration with tamoxifen in ovulation induction in anovulatory PCOS women.

BACKGROUND: To evaluate the efficacy of co-administration of low-dose aspirin (LDA) and tamoxifen on ovulation rates, endometrial thickness and clinical pregnancy rates in anovulatory PCOS women. METHODS: A randomized clinical trial was conducted among 188 anovulatory PCOS women at Suez Canal University Hospitals, Ismailia - Egypt. Patients were divided into 2 groups. The study group received a daily oral dose of 81 mg of LDA, while the control group received placebo (oral vitamin B12 tablets). Both groups started tamoxifen 10 mg twice daily from 3rd day to 7th day of the cycle. Folliculometry was performed by transvaginal sonography every other day starting from the 9th day of the cycle. Human Chorionic Gonadotrophin 5000 I.U. was given I.M. when at least one dominant follicle was present. The outcome measures included the number of mature follicles (≥18 mm in diameter), endometrial thickness and appearance in addition to the clinical pregnancy rates. RESULTS: The mean number of follicles per patient was significantly more in the study group (1.4 ± 0.8 vs. 1.1 ± 0.4; p value=<0.05). In addition, the endometrium was significantly thicker on study group (9.6 ± 1.4 mm vs. 7.8 ± 1.2 mm; p value=<0.01). Significantly, the pregnancy rate was more in the study compared to the control group (37.2% vs. 22.3% respectively; p value=<0.03). CONCLUSION: Co-administration of LDA with tamoxifen significantly improves ovarian response to stimulation, endometrial thickness and pregnancy rates in anovulatory PCOS patients. This combination is an effective, cheap and safe protocol for infertile PCOS women undergoing ovulation induction.

Use of the Foley catheter versus a double balloon cervical ripening catheter in pre-induction cervical ripening in postdate primigravidae.

AIM: To compare the efficacy of two mechanical devices for pre-induction of labor cervical ripening: the Foley catheter and the Cook cervical ripening balloon. METHODS: This interventional study included 78 postdate primigravid women randomly allocated into two groups: the Foley or Cook balloon catheter. Removal of the catheters was planned approximately 12 h after insertion if spontaneous expulsion had not occurred. The main outcome measures included changes in Bishop score, insertion to delivery time, mode of delivery and occurrence of adverse effects. RESULTS: Spontaneous expulsion of the Foley catheter was encountered more frequently than the Cook (89.2% vs 78.4%; P = 0.03). However, the median Bishop score was significantly higher when using the Cook compared with the Foley catheter after balloon removal (6 vs 5; P = 0.03). The duration from balloon insertion to expulsion and from insertion to delivery was significantly shorter in the Foley group compared with the Cook balloon group (6:19 ± 2:1 vs 7:26 ± 2:25 h; P = 0.03 and 13:50 ± 4:00 vs 15:16 ± 4:30 h; P = 0.03, respectively). There were no significant differences in other outcomes, such as the amount of oxytocin units used, mode of delivery, pain encountered during or after insertion and overall patient satisfaction. CONCLUSIONS: Use of the Cook cervical ripening catheter results in greater cervical ripening compared with the Foley catheter. However, the duration from balloon insertion to expulsion and then delivery were significantly shorter when using the Foley catheter; therefore, we recommend its use, particularly in low resource settings.

Maternal serum interleukin-6 in the management of patients with preterm premature rupture of membranes.

AIM: To evaluate the clinical usefulness of maternal serum interleukin-6 for the detection of subclinical chorioamnionitis and in the prediction of the latency period in patients with preterm premature rupture of membrane (PPROM). METHODS: The study group included 60 patients at 24-34 weeks of gestation complaining of PPROM. Laboratory investigations included serial measurements of IL-6, TLC and CRP. Conservative management was carried out till 36 weeks unless delivery was indicated beforehand. The main outcome measures were the latency period and the occurrence of subclinical chorioamnionitis. RESULTS: The mean gestational age at presentation was 30.9 weeks and 35.2 weeks at delivery. The mean IL-6 level at presentation was 4.7 pg/ml. There was no correlation between IL-6 at presentation and the latency period. In addition, those diagnosed as having subclinical chorioamnionitis by placental histopathology had significantly higher levels of IL-6 at delivery. Taking IL-6 level cutoff point of 8.5 pg/ml, histological chorioamnionitis, RDS and NICU admission were significantly higher above that level while neonatal birth weight, Apgar scores at one and five minutes were significantly lower. CONCLUSION: Maternal serum IL-6 at the time of PPROM has no correlation to the latency period while IL-6 levels at the time of delivery have significant correlation to the subclinical chorioamnionitis and neonatal outcome measures.

Efficacy of tranexamic acid in decreasing blood loss in elective caesarean delivery.

OBJECTIVE: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after elective caesarean section (CS). METHODS: This prospective randomized trial was conducted among 124 pregnant women subjected to term elective CS. Patients were equally divided into two groups. Study group received 10 mg/kg TA intravenously 5 min before skin incision while the control group did not. In addition, both groups received 10 units oxytocin and 1 ml ergometrine after delivery of the fetus. Blood loss in both groups was measured from placental delivery to end of the surgery and from end of the surgery to 2 h postpartum. Hemoglobin and hematocrit values were determined preoperatively and on the third day postpartum (before discharge) for all cases. Maternal and neonatal adverse effects in study groups were recorded. RESULTS: TA group showed lower amount of blood loss (391 ml) when compared to control group (597 ml). Risk estimation has revealed that treatment with TA resulted in decrease in risk of postpartum blood loss by 30%. Hemoglobin and hematocrit levels were significantly lower in the control group on the third post-operative day. CONCLUSION: TA reduces blood loss during and immediately after CS. Its use in caesarean delivery may be considered especially in cases where blood loss is expected to be high or in anemic patients.

Antenatal steroids at 37 weeks, does it reduce neonatal respiratory morbidity? A randomized trial.

OBJECTIVE: To assess the effect of prophylactic corticosteroids administration at 37 weeks before term elective cesarean section (CS) in reducing neonatal respiratory morbidity and admission to neonatal intensive care unit (NICU). METHODS: This randomized trial was conducted focusing on women subjected to term elective CS. Women who were eligible for the study were divided into two groups. At 37 weeks' gestation; study group received two intramuscular doses of 12 mg dexamethasone 24 h apart, while the control group given the usual care without steroids. Outcome measures were adverse neonatal respiratory outcomes (respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN)) and rates of admission to NICU. RESULTS: Neonates in the treatment group had lower overall incidence of respiratory distress morbidity 7.9% versus 23% when compared to the control group. The main morbidity was TTN (7% in study versus 19.6% in control group). There was significantly lower incidence of both mild and moderate degrees of respiratory distress in the study group (7 and 0.9%, respectively) compared to 17 and 5.3% in the control group. The most significant benefit of steroid administration was noted in those babies 37-37(+6) weeks. CONCLUSION: Antenatal administration of steroids at 37 weeks appears to be beneficial in reducing neonatal respiratory morbidity in women undergoing elective term CS.

Maternal serum leptin as a marker of preeclampsia.

PURPOSE: To assess maternal leptin levels as a marker for preeclampsia (PE) and to explore the possibility of leptin being a marker of severity of preeclampsia. PARTICIPANTS AND METHODS: Comparative prospective study was conducted among a total of 72 pregnant women at 28-38 weeks of gestation. They were divided into two groups (control and study) according to the absence or presence of clinical parameters of preeclampsia. Leptin was measured for both groups at the time of presentation, once weekly and at the termination of pregnancy. RESULTS: Leptin levels were found to be significantly higher among all preeclampsia patients when compared to the control group; whether at admission or at the time of delivery. Mean serum leptin level at admission in control group was 9.8 ng/ml versus 10.9 ng/ml in mild cases and 17.6 ng/ml in severe cases. At the time of delivery, mean serum leptin in control group decreased to 4.7 ng/ml while in preeclampsia patients it increased up to 22 ng/ml in mild cases and 42.6 ng/ml in severe cases. ROC curve analysis has shown that a cut off value >13.7 ng/ml can be used to detect presence of preeclampsia with a sensitivity of 91% and specificity 100% while a cut off value >22.5 ng/ml can be used to detect severity of preeclampsia with a sensitivity of 85% and specificity 100%. CONCLUSION: Maternal serum leptin is significantly elevated in preeclampsia, also it can be used as a marker for the presence of preeclampsia and to differentiate patients with mild preeclampsia from those with severe disease.

Prevalence and risk factors for female sexual dysfunction among Egyptian women.

PURPOSE: To assess sexual function among married women and determine associated risk factors for sexual dysfunction. PARTICIPANTS AND METHOD: Cross-sectional hospital-based study involving 509 non-pregnant married females 20-59 years old who were enrolled into the study after approval of the ethics committee. The study population was recruited among women attending gynecology outpatient clinic or their relatives visiting inpatients of obstetrics and gynecology department at Suez Canal University Hospital. Female and male partner-related data were collected using an interview questionnaire. Sexual dysfunction was assessed using female sexual function index (FSFI). RESULTS: Mean female age was 39.5 years. About half of the participants were premenopausal (48.7 %). Most of the females were circumcised (71.7 %). Desire and Orgasm domains were the most affected with 52.8 % of the participants having sexual dysfunction. Total FSFI score of ≤26.55 was the cutoff value for diagnosis of FSD and female age, postmenopausal status, duration of marriage, circumcision, partner's age, and the presence of male sexual dysfunction were found to be significant associated factors with FSD. CONCLUSION: FSD is highly prevalent in Egypt and orgasm and desire scores were the most affected domains. Several personal (female age, postmenopausal status, duration of marriage and circumcision) and male partner (age, and the presence of sexual dysfunction) factors were significantly associated.