Ahmed Altraigey

How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

Of the different described methods of placental delivery during cesarean section (CS), manual removal and cord traction are the most commonly used techniques. The ideal method of placental delivery during CS is still a conflicting issue as the data derived from the previous studies are widely heterogeneous and inconsistent. This study has investigated the effect of two different methods of placental delivery, controlled cord traction and manual removal, on perioperative blood loss.

Oral Diclofenac Potassium Versus Hyoscine-N-Butyl Bromide In Reducing Pain Perception During Office Hysteroscopy: A Randomized Double-Blind Placebo-Controlled Trial

STUDY OBJECTIVE To compare the efficacy of oral diclofenac potassium versus hyoscine-N-butyl bromide (HBB) in reducing pain perception in patients undergoing diagnostic office hysteroscopy (OH). DESIGN A randomized double-blind placebo-controlled trial (Canadian Task Force classification I). SETTING A university hospital. INTERVENTIONS One-hundred twenty-nine patients were divided randomly into 3 groups (n = 43 in each group); group 1 received 50mg diclofenac potassium, group 2 received 20mg HBB, and group 3 received placebo tablets. All tablets were taken orally 1hour before OH. The primary outcome was the participants self-rated pain perception using the 10-point visual analog scale during the procedure. The secondary outcomes included the visual analog scale score 30 minutes after OH, ease of OH assessment using a 10-cm scale, duration of OH, and adverse effects of the study medications. MEASUREMENTS AND MAIN RESULTS Both the diclofenac and HBB groups showed significant pain score reduction compared with the placebo group (p = .001). The mean pain score in the diclofenac group was significantly lower than the HBB group (2.12 ± 1.03vs 3.02 ± 1.55, respectively; p = .002). The pain scores in the diclofenac and HBB groups immediately after OH were significantly lower than the placebo group (p = .001), and the mean pain score in the diclofenac group was significantly lower than the HBB group (1.23 ± 0.57vs 1.56 ± 0.73, respectively; p = .024). The ease of procedure score was significantly lower in the diclofenac and HBB groups than the placebo group (p = .003 and p = .005, respectively). The mean duration of the procedure was significantly less in the diclofenac group (p = .01). Fourteen women (32.6%) in the HBB group experienced dizziness and 2 women (4.6%) had nausea, whereas only 4 women (9.3%) in the diclofenac group had dizziness and 2 women (4.6%) had vomiting. CONCLUSION Oral diclofenac potassium administration 1hour before diagnostic OH reduces the procedure pain with subsequent easier and shorter OH duration. Oral HBB is less effective than diclofenac potassium with more adverse effects.

Knot positioning during McDonald cervical cerclage, does it make a difference? A cohort study

Abstract Objective: To study the effect of McDonald cerclage knot position on the different maternal and neonatal outcomes. Methods: This historical cohort study included women with singleton pregnancy who had a prophylactic McDonald cervical cerclage between 1 May 2010 and 31 September 2017. Maternal and neonatal outcome parameters were compared between the anterior and posterior knot cerclage procedures. The primary outcome measure was the rate of term birth. Results: 550 Women had a prophylactic McDonald cervical cerclage, 306 with anterior knot (Group A) and 244 with posterior knot (Group B). There were no statistically significant differences regarding gestational age (GA) at delivery (36.3 ± 4.2 versus 35.8 ± 5.3 for groups A and B respectively), term birth rate, post-cerclage cervical length, symptomatic vaginitis, urinary tract infection, difficult cerclage removal and cervical lacerations. Similarly, there were no statistically significant differences as regards the studied neonatal outcomes including take home babies, neonatal intensive care admission, respiratory distress syndrome and neonatal sepsis. Survival analysis on GA at delivery demonstrated no statistically significant difference as regards the proportion of term deliveries in the anterior and posterior knot cerclage groups (log-rank test p-value = .478). Conclusions: Knot positioning during McDonald cervical cerclage, anteriorly or posteriorly, didn’t significantly impact the studied maternal and neonatal outcomes.

The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial

Abstract Objective: To endorse the impact of chewing gum on the intestinal functions’ restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD). Methods: Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 h after recovery at least for half an hour and at 2-h interval during daytime. The second group received oral fluids 6 h postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the time of initiating breast-feeding and the cost of hospital stay. The study was prospectively registered at ClinicalTrials.gov (NCT02386748). Results: The study included 372 women randomized into three groups (124 women in each group). Chewing gum significantly improved intestinal recovery with faster onset of bowel movements, first audible intestinal sounds, passage of flatus and passage of stool (p = .0001). It was associated with significantly shorter duration of hospital stay and parenteral therapy duration (p = .0001). Abdominal distension, vomiting and ileus postoperatively were significantly higher in nonchewing gum groups. Neither paralytic ileus nor side effects were recorded with gum use. Conclusion: Chewing gum, within 2 h postoperatively, is a simple, safe and well-tolerated intervention that can boost rapid intestinal recovery and shorten hospital stay after planned cesarean deliveries.

Prediction of recurrent ectopic pregnancy: A five-year follow-up cohort study

OBJECTIVE To evaluate the value of different clinical risk factors in the prediction of recurrent ectopic pregnancies (REP). STUDY DESIGN This cohort study was carried out at a tertiary-care maternity hospital in Saudi Arabia, between January 2010 and June 2017. All women with a primary ectopic pregnancy (EP) were consecutively recruited, thoroughly assessed and followed up for a minimum duration of five-years (5.6 ± 0.61 years) to diagnose the nature and location of the subsequent pregnancies. The primary outcome measure was the occurrence of REP, while the secondary outcomes included intrauterine pregnancy, the pregnancy of unknown location and infertility rates. RESULTS A total of 272 women with a primary ectopic pregnancy (EP) were initially recruited, 217 women were included in the final analysis, among them 41 (18.9%) women had REP. Univariate analysis showed that women who subsequently developed REP had more prevalent prior miscarriages, evacuation of retained products of conception (ERPC), pelvic inflammatory disease (PID) and consanguinity, they also had lower hemoglobin levels at the time of primary EP, and lower prevalence of surgical treatment. Among the 143 surgically treated cases, salpingectomy, when compared to salpingostomy, and laparoscopy, when compared with laparotomy, were found to be associated with a lower risk of REP [RR = 0.32 (95% CI, 0.13-0.77) and 0.40 (95% CI, 0.18-0.86) respectively]. The occurrence of a subsequent delivery at any time after the primary EP was protective against REP [RR = 0.39 (95% CI, 0.22-0.68)], this protection is increased by almost nine folds if this delivery occurred at the descendant pregnancy [RR = 0.04 (95% CI, 0.01-0.17)]. Multivariable binary logistic regression revealed that prior PID, treatment modality and presenting hemoglobin level were independent predictors of REP. Receiver operating characteristic (ROC) curve was plotted using the predicted probability values derived from the multivariable binary logistic regression model, the area under the ROC curve was 0.792 (95% CI, 0.732-0.844). CONCLUSION Careful consideration of primary ectopic pregnancy data is a valuable tool to predict the potential risk of recurrence in the future.

The maternal and neonatal outcomes of teenage pregnancy in a tertiary university hospital in Egypt

Aim: To highlight the grave complications among teenage mothers in Assiut Womans Health Hospital compared with the adult mothers. Methods: This study was a prospective case control study, conducted at the Labor Ward of Assiut Womans Health Hospital from 1st of January 2016 to 30th of June 2016. We included teenage pregnant women (13-19 completed years at delivery) as case and adult mothers (20-29 years) formed the control group. The primary outcome of the study is the rate of pregnancy complications among teenage

Scar pregnancy and spontaneous rupture uterus — a case report

Our objective is to spotlight the management of first trimester rupture uterus that is life-threatening as it is very rare and difficult to be included in the differential diagnosis of acute abdomen in early pregnancy. We report a case of a pregnant woman in her first trimester who presented with sudden onset of abdominal pain, severe vaginal bleeding and repeated syncopal attacks. A 19 year-old woman G2 P1 + 0 presented at 11 weeks of gestation to emergency unit of Benha University hospitals complaining of sudden onset generalized abdominal pain, severe vaginal bleeding and repeated syncopal attacks. By history, she was delivered through CS six months before her presentation to our hospital. Also, intrauterine contraceptive device (IUCD) was applied five months later and expelled spontaneously a week later. The case has no relevant medical history, by general examination; she was conscious with extremely pale look. Her vital signs showed blood pressure of 80/50 mm Hg, pulse of 120 bpm and a 37.2°C temperature. Her respiratory rate was 27 per minute. On abdominal examination there were generalized tenderness and rebound tenderness all over the abdomen with shifting dullness on percussion. Urine pregnancy test was positive and serum beta human chorionic Gonadotropin (b-HCG) sample was sent to laboratory. Her laboratory investigations were satisfactory. Pelvi-abdominal ultrasonography showed empty uterus, single viable foetus about 11 weeks within a protruding gestational sac, marked free intra-abdominal fluid collection. Clear informed consent was obtained from the couple after full counselling about the clinical condition and the management plan. Emergency laparotomy through pfannensteil incision was carried out after stabilizing the patient clinical condition and cross-matching four units of packed red blood cells (p-RBCs). The operative findings corresponded well with ultrasound findings. There was intact single gestational sac protruding through ruptured scar of lower uterine segment (LUS) (Fig. 1). The foetus within it was showing signs of viability by movements (Fig. 2). The gestational sac was removed and sent for histo-pathological examination as well as most of the trophoblastic tissues adherent and invading the wall of LUS (Fig. 3). The uterine defect was repaired into three layers using 2\0 Vicryl. Figure 1. Figure shows the intact gestational sac protruding through a defect in the scarred lower uterine segment