Effects of dexamethasone on foetal Doppler flow velocimetry.

Corticosteroid administration before anticipated preterm birth is a well known antenatal therapy available to improve newborn outcomes. Doppler studies of maternal and foetal vessels provide a way to understand how corticosteroid affects and improves foetal respiratory outcome. This study was registered on 8th of October, 2017 by Menoufia Faculty of Medicine Board with registration number 222-2-10-2017. It included 80 pregnant women divided into two groups. Each group consisted of 40 participants. Group A: participants were between 28 weeks and 34 weeks of gestation and were at risk of preterm labour. Group B: participants were those who had undergone an elective caesarean section (CS) before completing the 39th week of gestation. Each woman had received four doses of Dexamethasone 6 mg intramuscularly, 12 h apart. Doppler studies were performed before the Dexamethasone adminstration and 24 h after the Dexamethasone course. Among both groups, only pregnant women before 34 weeks of gestation showed a significant decrease in middle cerebral artery pulsatility index. However, the other Doppler parameters showed no significant effect. In conclusion, Dexamethasone administration affected only the middle cerebral artery pulsatility index before 34 weeks of gestation.IMPACT STATEMENTWhat is already known on this subject? Preterm births account for 75% of neonatal morbidity and pulmonary dysfunction plays an important role on such morbidities. Also, neonates born after an elective CS have significantly higher rates of respiratory morbidity and neonatal intensive care unit admission. Corticosteroids are wildly used to improve neonatal outcome in women who have expected preterm labour and before an elective CS.What do the results of this study add? Dexamethasone affected blood distribution of foetal brain only before 34 weeks of gestation that had been proved by changes of foetal middle cerebral artery pulsatility index without affecting other Doppler parameters of both groups. With the improvement of foetal respiratory outcome in both groups.What are the implications of these finding for clinical practice and/or further research? Maternal Dexamethasone injection is recommended for mothers at risk of preterm labour, especially if delivery is expected within six days and mothers who will undergo elective CS before completion of 39 weeks of gestation, in terms of improving neonatal respiratory functions and decreasing the possibility of admission to neonatal intensive care unit for transient tachypnoea of the newborn.

Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS.

OBJECTIVE: The study assessed the risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of either a combined oral contraceptive pill (COC) or the levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: This prospective observational study included 430 women, without active vaginitis at inclusion, who were divided into two groups according to their chosen method of contraception: COC group (n = 236) and LNG-IUS group (n = 194). Participants were examined for bacterial vaginosis, T. vaginalis and C. albicans infection initially and then at 6 weeks, 6 months and 12 months after the start of contraceptive use. Data were collected and statistically analysed. RESULTS: The rates of acquisition of bacterial vaginosis, T. vaginalis and C. albicans infection during follow-up were significantly increased and comparable between the groups (p < .001) and decreased in frequency over time (p < .05). The rates of acquisition of bacterial vaginosis among COC users (Nugent score) were 24.6, 18.6 and 15.2% and among LNG-IUS users 20.6, 13.5 and 9.3% at 6 weeks, 6 months and 12 months, respectively (p < .001). Body mass index >25 kg/m2, history of bacterial vaginosis, history of sexually transmitted infection, vaginal douching more than five times per week and coital frequency more than five times per week were strong risk factors for acquisition of bacterial vaginosis during the follow-up period (p < .001). CONCLUSIONS: The use of COCs and LNG-IUS is associated with an increased, comparable risk of acquisition of bacterial vaginosis, T. vaginalis and C. albicans infections, which is greatest during initial use of the method but which improves over time.

Sildenafil Citrate Therapy for Oligohydramnios: A Randomized Controlled Trial.

OBJECTIVE: To compare sildenafil plus hydration with hydration alone in improving the amniotic fluid index and neonatal outcomes in pregnancies complicated by idiopathic oligohydramnios ( amniotic fluid index less than 5 cm without underlying maternal or fetal causes and with normal fetal growth). METHODS: This was an open-label randomized trial for women carrying singleton pregnancies at 30 weeks of gestation or more with idiopathic oligohydramnios detected during routine ultrasonogram. Women received either oral sildenafil citrate (25 mg every 8 hours) plus intravenous infusion of 2 L isotonic solution or fluids only until delivery. The primary study outcome was the amniotic fluid volume at 6 weeks of follow-up or the final volume before delivery, whichever occurred first. Secondary outcomes were duration of pregnancy prolongation, mode of delivery, and select neonatal outcomes. The study was powered to detect a 45% difference between groups, so, at an α level of 0.05 and 80% power, a sample size of 167 women was required. RESULTS: From February 24, 2015, through April 2016, 196 women were screened and 184 were randomized. Follow-up was completed in 166 (90%): 82 in the sildenafil group and 84 in the hydration group. Baseline characteristics were similar between groups. The amniotic fluid volume was higher in the sildenafil group at the final assessment (11.5 compared with 5.4 cm, P=.02). The sildenafil group delivered later (38.3 compared with 36.0 weeks of gestation, P=.001), had a lower rate of cesarean delivery (28% compared with 73%), and their neonates were less likely to be admitted to the neonatal intensive care unit (11% compared with 41%, P=.001). CONCLUSION: Sildenafil citrate increases amniotic fluid volume in pregnancies complicated by oligohydramnios. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02372487.

Different routes and forms of uterotonics for treatment of retained placenta: a randomized clinical trial.

OBJECTIVES: To compare between three different uterotonics (oxytocin, carbetocin and misoprostol) given via three different routes (intraumbilical, intravenous and sublingual, respectively) in reducing the need for manual removal of placenta (MROP). METHODS: A randomized trial for cases with retained placenta 30 min following vaginal delivery. They received intraumbilical oxytocin, intravenous carbetocin or sublingual misoprostol. Main outcome measures were delivery of the placenta within 30 min following drug administration, and need for MROP. Secondary outcome measures were injection to placental delivery time, post-delivery hemoglobin, need for blood transfusion or additional uterotonics. RESULTS: The overall success rate was 66.7% (64/96), 71.3% (67/94) and 63.7% (58/91) for oxytocin, carbetocin and misoprostol groups, respectively (p > 0.05). When time needed to achieve placental delivery considered, a significant difference was observed with the shortest time for carbetocin (16.61 ± 3.76 min), then oxytocin (18.28 ± 3.34 min) and lastly misoprostol (23.00 ± 3.38 min) (p <0.001). Again, carbetocin group needed less additional uterotonics to achieve adequate uterine contractions (p <0.001). CONCLUSIONS: Although we aimed to exploit the advantage of certain drug over another, all seemed to have close efficacy but it would be important that further research should highlight availability, cost, ease of administration and storage requirements to determine which agent would best be used in this clinical scenario.

Body mass index is linked to cervical length and duration of pregnancy: An observational study in low risk pregnancy.

In this prospective cohort study, one hundred participants were allocated into four groups according to their body mass indices. Vaginal ultrasound was performed at enrolment to measure cervical length. The shortest cervical measurement was recorded. Overweight and obese groups had significantly longer mean cervical length than women in the normal weight group when measured at 20-22 weeks of gestation (p < .001). Underweight women had the shortest mean cervical length. The incidence of preterm delivery was the highest in underweight women (RR; 1.5). The incidence of post-term delivery was 10% in total in overweight and obese women. Underweight women were more likely to have short cervical length and subsequent preterm delivery compared to overweight and obese women.

Metabolic changes in overweight and obese women above 35 years using Ethinylestradiol/drosperinone combined contraceptive pills: a 3-year case-control study.

OBJECTIVE: To assess metabolic changes in overweight and obese women above 35 years using ethinylestradiol/drosperinone combined contraceptive pills for 36 cycles. METHODS: A prospective case-control study over 3 years recruiting 202 overweight and obese women above the age of 35 years who were divided into two groups, study group (n = 90) who received Ethinylestradiol/drospirenone for 36 cycles, and control group (n = 112) to whom intrauterine device was inserted. Recording of the body weight, waist circumference, blood pressure, fasting blood glucose and fasting blood lipids including triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol before starting the method and repeated at 12, 24 and 36 cycles of use. RESULTS: No significant change was observed in body weight, waist circumference, blood pressure and fasting blood glucose between the two groups (p > 0.05).There was a significant reduction in triglycerides, total and LDL cholesterol with elevation in HDL cholesterol in the study group after 24 and 36 cycles of use (p < 0.05). CONCLUSION: Ethinylestradiol/drospirenone combined contraceptive pills do not alter blood pressure or affect the body weight, with favorable effects on blood lipids in overweight and obese women above the age of 35 years when used for 24-36 cycles.

The Effectiveness and Acceptability of Pipelle Endometrial Sampling versus Classical Dilatation and Curettage: A Three-Year Observational Study.

OBJECTIVE: To assess the effectiveness and acceptability of Pipelle endometrial sampling in comparison to dilatation and curettage (D&C). METHODS: This was a prospective observational study including a total of 538 patients with abnormal uterine bleeding who were allocated to be treated using 2 sampling techniques: Pipelle sampler (n = 270) and D&C (n = 268). The primary outcome was the adequacy of both methods and concordance rate with hysterectomy specimens. The secondary outcome included drawbacks and patients' acceptability. RESULTS: There was no significant difference between the 2 methods regarding adequacy and concordance rate with hysterectomy (p > 0.05). There was a statistically significant difference between the 2 groups regarding the requirement of analgesia and overall discomfort (p < 0.001), which was higher in the Pipelle group. No significant statistical difference was recognized between the study groups regarding the occurrence of cervical lacerations, fever or the rate of inadequate intrauterine sampling (p > 0.05). In addition, no significant statistical difference between both procedures was recognized concerning the overall satisfaction rate and the advisability of the procedure to other women (p > 0.05). CONCLUSION: Under the conditions of this study, Pipelle endometrial sampling is comparable to D&C biopsy in terms of adequacy and concordance rate with hysterectomy except that more pain and a higher overall discomfort rate were associated with it.

Impact of maternal fasting on fetal well-being parameters and fetal-neonatal outcome: a case-control study.

OBJECTIVE: To assess the impact of maternal fasting on fetal well-being parameters and neonatal outcome. METHODS: Two-hundred ten healthy women with singleton uncomplicated pregnancies at 36-40 weeks' gestation who had fasted for 12-16 h were defined as the study group with 240 healthy non-fasted pregnant women matched for age, parity and gestational age were defined as the control group. Both groups were subjected to tests of fetal well-being in the form of non-stress test (NST), modified biophysical profile and Doppler indices of the umbilical and middle cerebral arteries (MCA). Women were followed-up till delivery to record the obstetric outcome. RESULTS: There was no significant difference between the two groups regarding the reactivity of NST, modified biophysical scores, Doppler indices of the umbilical and MCA (resistive index, pulsatility index and systolic/diastolic ratio) and the cerebroplacental ratio (p > 0.05). There was no significant difference between the two groups regarding the gestational age at delivery, mode of delivery, neonatal weight, 5-min Apgar scores and admission to neonatal intensive care unit (p > 0.05). CONCLUSIONS: Short-term maternal fasting has no deleterious effect on fetal well-being parameters or neonatal outcome. Pregnant women who desire fasting, should be reassured regarding the health of their babies.

Impact of unilateral versus bilateral laparoscopic ovarian drilling on ovarian reserve and pregnancy rate: a randomized clinical trial.

OBJECTIVE: To assess the impact of unilateral dose adjusted ovarian drilling (ULOD) compared to bilateral ovarian drilling (BLOD) on ovarian reserve and pregnancy rate. METHODS: This randomized clinical study included 105 patients with polycystic ovary syndrome. Patients were assigned to two groups; group 1 (n = 52) underwent dose adjusted ULOD using 60 Joules/cm(3) applied to the larger ovary, while group 2 (n = 53) underwent BLOD with fixed doses of 1200 J. Ovulation rate, anti-Mullerian hormone (AMH), antral follicle count (AFC), and pregnancy rates were assessed at 3 and 6 months of follow-up. RESULTS: Ovulation and pregnancy rates at 3 months periods were comparable (p > 0.05), but was significantly higher in BLOD at 6 months period (p < 0.05). There was a highly significant difference between the two groups regarding the AMH level at 3- and 6-month follow-up periods (p < 0.001) with lower levels in the BLOD group. The AFC was comparable in the two groups after 3 months (p > 0.05) but became higher in the ULOD at 6-month follow-up period (p < 0.001). CONCLUSION: Dose-adjusted ULOD applied to the larger ovary has comparable ovulation and pregnancy rates to fixed dose BLOD at 3-month follow-up periods with decrease in its effectiveness after 6 months.

The relationship between term pre-eclampsia and the risk of early childhood caries.

OBJECTIVE: To test the hypothesis that pre-eclampsia is associated with higher incidence of early childhood caries in children aged between 3 and 5 years old. DESIGN: An observational non concurrent cohort study. SETTING: Al-Hayat National Hospital, Khamees Mushyat, Saudi Arabic Kingdom. POPULATION: Two hundred children aged 3-5 years who fulfilled the inclusion criteria. METHOD: A detailed dental examination was carried out for all children enrolled. We obtained all relevant obstetric data from mothers' and pediatric's medical records. Thirty cases were excluded due to missing data and therefore, only 170 children were considered for the statistical analysis. Results were tabulated and statistically analyzed. MAIN OUTCOME MEASURE: Early childhood caries. RESULTS: Sixty-three children (37%) of the 170 were affected with early childhood caries; 6 were delivered to pre-eclamptic and 57 to non pre-eclamptic mothers. Using logistic regression curve, early childhood caries was significantly associated with low birthweight, low Apgar score at 1st min and with the pattern of infant feeding but not with pre-eclampsia. The relative risk for early childhood caries was 2.84 among low birthweight infants (95%CI: 1.47-5.49), 1.95 among non breast fed children (95% CI: 1.11-4.20) and 2.64 among those delivered with an Apgar score less than 5 at 1 minute (95%CI:1.46-4.77). CONCLUSION: Pre-ecalampsia may not be associated with early childhood caries. A larger study and/or a study addressing the relation between pre-eclampsia and caries inducing lesions may provide more significant results.

Laparoscopic trocar management of a giant paraovarian cyst: a case report.

A 17-year-old woman had undergone exploratory laparotomy because of a huge cystic pelviabdominal mass equivalent of 36 weeks' gestation. A closed system drainage maneuver was applied via using a laparoscopic trocar to drain a revealed large left paraovarian cyst. This maneuver was found to be a simple and effective method to safely aspirate giant paraovarian cysts; thus allowing their total excision.

Foley catheter versus intra-vaginal misoprostol for induction of labor in post-term gestations.

OBJECTIVE: To investigate whether a fluid filled intra-uterine extra-amniotic Foley catheter is an effective alternative to vaginal misoprostol in inducing labor in primigravid women with post-term gestations. PATIENTS AND METHODS: A prospective quasi-randomized controlled trial was designed and 100 primigravid women with post-term gestations were enrolled and equally allocated into two groups. A fluid filled intra-uterine extra-amniotic Foley catheter was inserted in women of group I. Women in group II received 25 microgram misoprostol vaginally every 4 h. Artificial rupture of membranes was performed for all women when their cervices reached 3-4 cm dilatation followed by oxytocin infusion if needed. The main primary outcome parameter was the induction to delivery interval. Results were tabulated and statistically analyzed. RESULTS: No significant difference was noted in any of the demographic data between both groups. The induction to delivery interval was shorter in the Foley group (897.36 ± 116.0 vs. 960.98 ± 94.18 min; P = 0.003). There were 34 cases which needed oxytocin augmentation in group I compared to 11 cases in group II (P < 0.01). Abnormal uterine activity occurred in three cases in the misoprostol group, but none in the Foley group. Ominous fetal heart rate was noted in one case in group I but three in group II. CONCLUSION: Fluid filled Foley catheter seems to be superior to 25 µg vaginal misoprostol regimen, when used to induce labor in primigravidae with post-term gestations with the advantage of having a shorter induction delivery interval, but more need for oxytocin augmentation.

Medication errors in the obstetrics emergency ward in a low resource setting.

OBJECTIVE: To investigate the patterns of medication errors in the obstetric emergency ward in a low resource setting. MATERIAL AND METHODS: This prospective observational study included 10,000 women who presented at the obstetric emergency ward, department of Obstetrics and Gynecology, Menofyia University Hospital, Egypt between March and December 2010. All medications prescribed in the emergency ward were monitored for different types of errors. The head nurse in each shift was asked to monitor each pharmacologic order from the moment of prescribing till its administration. Retrospective review of the patients' charts and nurses' notes was carried out by the authors of this paper. Results were tabulated and statistically analyzed. RESULTS: A total of 1976 medication errors were detected. Administration errors were the commonest error reported. Omitted errors ranked second followed by unauthorized and prescription errors. Three administration errors resulted in three Cesareans were performed for fetal distress because of wrong doses of oxytocin infusion. The rest of errors did not cause patients harm but may have lead to an increase in monitoring. Most errors occurred during night shifts. CONCLUSION: The availability of automated infusion pumps will probably decrease administration errors significantly. There is a need for more obstetricians and nurses during the nightshifts to minimize errors resulting from working under stressful conditions.