Armia Michael

Topical lidocaine-prilocaine cream versus lidocaine infiltration for pain relief during repair of perineal tears after vaginal delivery: randomized clinical trial

Abstract Objective: The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with lidocaine infiltration during repair of perineal tears after vaginal delivery. Materials and methods: A single center open-labeled randomized clinical trial was carried out in a tertiary University Hospital between October 2016 and May 2017 (Clinical Trials.Gov: NCT02883179). We included parous women, who delivered at gestational age >37 weeks with first- or second-degree perineal tears. The participants were randomized in a 1:1 ratio to either lidocaine infiltration (Group I); or application of LP cream (Group II) for pain relief during perineal repair. The primary outcome was the difference in mean pain score during perineal repair. Secondary outcomes included the participants’ satisfaction, the need for additional anesthesia, the duration of perineal repair, and the rate of adverse effects of both medications. Results: The study included 144 participants randomized to both groups. The mean pain score during perineal repair was significantly lower in the LP cream group (3.86 ± 1.59) than the lidocaine infiltration group (5.99 ± 1.47) [p = .001]. The duration of repair was significantly shorter in the LP group than the lidocaine infiltration group (6.37 ± 3.68 versus 8.17 ± 2.75 min, respectively, p = .001). The need for additional anesthesia was quite similar in both groups (p = .371). More women in the LP cream group were satisfied than the other group with statistical significant difference (76.4 versus 30.6%, p = .000). No difference between side effects in both groups (p = .171) Conclusions: Topical application of lidocaine-prilocaine cream is an effective analgesic during repair of perineal tears with no harmful side effects.

Recurrent spontaneous third-trimester uterine rupture after hysteroscopic resection of myoma: a case report

Uterine rupture is a catastrophic obstetrical emergency with serious effects on both women and fetuses. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 33 weeks of gestation in a 32 years old woman with previous history of hysteroscopic resection of submucous myoma after development of acute abdomen. Uterine repair of fundal rupture was performed through emergency exploratory laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent and multiple uterine rupture in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures. Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt Faculty of Medicine; Assiut University, Assiut,

A rare case of lethal campomelic dysplasia

Campomelic dysplasia is a rare and mostly lethal congenital malformation. It is known as an autosomal dominant disorder due to mutations in SOX9, a member of the SOX (SRY-related HMG box) gene family. Here we report a case of a 26 years old primigravida married for 3 years with a history of consanguinity. She was impregnated by intracytoplasmic sperm injection (ICSI) due to male factor infertility. This mostly lethal skeletal anomaly was diagnosed by detailed ultrasonography in the late second trimester. She underwent an induction of labor termination due to intrauterine fetal demise. Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt Faculty of Medicine; Assiut University, Assiut,

Spontaneous prelabour recurrent uterine rupture after laparoscopic myomectomy

Dear Editor,Uterine fibroids are the most common tumour of the female reproductive system with an estimated cumulative incidence of >80% for black women and nearly 70% for white women by age 50 by ...

Management of Spontaneous Labor in Primigravidae: Labor Scale versus WHO Partograph (SLiP Trial) Randomized Controlled Trial

Objective We aimed to compare maternal and neonatal outcomes of spontaneous term labor among primigravidae who were monitored by the novel labor scale versus the World Health Organization (WHO) partograph. Study Design A single center, double‐blinded randomized trial had been conducted between July 2015 and June 2016. Nulliparous women in spontaneous labor with singleton term pregnancies were randomized to either labor scale or the WHO partograph for management of labor. Primary outcome was successful vaginal delivery. Secondary outcome included low APGAR scores, birth injuries, postpartum hemorrhage, and infection. Results One hundred ten patients were randomized (55 in each arm). Women managed with labor scale had significantly lower rate of cesarean deliveries than women managed with the partograph arm (3.6% versus 18.2%, P =0.03). There was a significant reduction in the rate and duration of oxytocin administration for augmentation of labor (21.8% versus 69.1%, P < 0.0001) and a significant increase in average 1‐minute APGAR score in the labor scale group. Conclusion Labor monitoring with the labor scale is associated with lower rate of cesarean section, less and shorter use of oxytocin for augmentation of labor. Monitoring of labor progress starting at 5 cm or more is also associated with lower rate of cesarean delivery.

A rare case of posterior uterine rupture with neonatal survival during trial of vaginal birth after cesarean section

Posterior wall uterine rupture is a rare complication. Trial of vaginal birth after cesarean section (CS) is a predisposing factor especially when associated with augmentation of labor. Here we report a case of intrapartum uterine rupture during the second stage of labor in a multiparous woman trying vaginal birth after previous CS. Emergency laparotomy was done and the baby was saved. Repair of the site of the rupture in layers with complete hemostasis

Herniated gravid uterus through an infra-umbilical laparotomy scar: a case report

Herniation of a gravid uterus through the abdominal wall is a rare and potentially serious condition due to its antecedent complications. Management is determined by gestational age. Simultaneous hernioplasty with cesarean section is considered safe. Clinical awareness of this complication will prevent delay in its diagnosis and treatment. Delay in recognition of this condition can lead to incarceration and subsequent strangulation of the gravid uterus. Strangulation at or near term appears to be a genuine indication for early hospitalization and elective cesarean section, possibly combined with hernia repair. Here we report the case of a middle aged woman who presented with abdominal pain at 28 weeks of gestation with an unusual bulge of her abdomen. The lower abdominal bulge turned out to be her gravid uterus herniated through the anterior abdominal wall. Cesarean delivery with herniorrhaphy was done for the large abdominal defect. Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt Faculty of Medicine; Assiut University, Assiut,

Full term delivery of a Harlequin ichthyosis baby: a case report

Harlequin ichthyosis (HI) is one of the most severe and rare autosomal recessive congenital ichthyosis (ARCI), characterized by severe hyperkeratosis, extensive fissuring and a variable degree of cutaneous malformations. Here we report a case of 22 years old female patient in her first pregnancy. The baby was born at 39 weeks of gestation from nonconsanguineous parents. At birth the baby had thick skin with deep fissures. The baby was admitted to the neonatal intensive care unit and survived for 11 days. Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt Faculty of Medicine; Assiut University, Assiut,

Recurrent second-trimester intrauterine fetal death due to undiagnosed atrioventricular block: a case report

Fetal cardiac abnormalities are one of the common causes of non-immune fetal hydrops. Early diagnosis and treatment may prevent the late consequences that can occur as heart failure and intrauterine fetal death. Herein we report the case of a 32-year-old patient with a history of recurrent second trimester intrauterine fetal death. She presented with fetal hydrops at 23 weeks. A detailed echocardiography revealed that the fetus had a third degree atrioventricular block and advanced hydropic changes due to heart failure. Corticosteroid therapy was started but the fetus died in utero after 2 weeks. Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Faculty of Medicine; Assiut University, Assiut,

A rare case of giant dermoid cyst with ipsilateral paratubal cystadenoma during pregnancy

Dermoid cysts are considered the most common ovarian cysts in adolescents and pregnant women. In rare cases, they can attain a huge size. Paratubal cysts are also common in adolescents. They are usually simple cysts present in the broad ligament. In this case, we report a giant dermoid cyst with ipsilateral paratubal serous cystadenoma discovered during pregnancy of a 20-year-old primigravida. Both cysts were managed conservatively, and then removed successfully at the time of cesarean section by cystectomy. Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt Department of Obstetrics and Gynecology, Faculty of Medicine; Beni Suef University, Beni