Muhammad Fawzy

Midtrimester abortion using vaginal misoprostol for women with three or more prior cesarean deliveries

To evaluate the safety and efficacy of vaginal misoprostol for second‐trimester abortion in women with 3 or more prior cesarean deliveries.

Paraumbilical hernia repair during cesarean delivery.

Background and Objectives: Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital. Patients and Methods: In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum com--plications, , hospital stay, hernia recurrence, and patient satisfaction. Results: The combined procedure took significantly longer than cesarean delivery alone (75.2 minutes versus 60.5 minutes, P< .001)). There were no major complications. Wound infection occurred in 6 patients (4.1%). Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two pa--tients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months (range, 6-36 months). All hernia patients reported that they preferred the combined operation. Conclusions: Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single in--cision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted.

Late post‐cesarean surgical complication

Aim:  The aim of the study was to clarify the incidence, indication, and management of late surgical intervention following cesarean section (CS) in a tertiary care university hospital.

Novel modification of B-Lynch uterine compression sutures for management of atonic postpartum hemorrhage: VV uterine compression sutures.

The aim of this study was to demonstrate a novel modification of uterine compression sutures for use in women with primary postpartum hemorrhage and to evaluate its effectiveness.

Response to: a stepwise cesarean section for placenta percreta: effective only for ''separable'' placenta percreta?

Thank you for your response [1] to our manuscript [2]. Mansoura stepwise approach in placenta percreta management is a novel approach to preserve the uterus as possible and change in the concept of Placenta percreta management always mandates hysterectomy. Placenta percreta is morbidly adherent placenta (not separable) and if it is separable there was no need for stepwise approach to decrease bleeding (intraoperative or postoperative) and morbidity in the study as bladder resection or injury (table 3). With strong uterine contractions, placenta ‘‘percreta’’ not spontaneously separated or removed, early combined ecbolics (strong uterine contraction) to minimize blood loss and help manual removal of placenta adherent to uterine wall. All patients included in the study were placenta percreta, other types (accrete, increta) excluded from the study. Diagnosis confirmed by Doppler and MRI after early detection by ultrasound during pregnancy. Experienced obstetrician can distinguish intraoperative between accreta and percreta. In this study we highlight the necessity of experienced teamwork (obstetrician, anesthetist and assistant), preoperative blood and fluids preparation, control uterine blood loss (uterine incision, blood vessels) and proper identification of lower uterine segment and repair. With confirmation of steps included in the study to preserve the uterus in placenta percreta (table 2), we should also confirm the possibility of supracervical hysterectomy when repair revealed functionless uterus and life threatening intraoperative hemorrhage.

Prophylactic bilateral internal iliac artery ligation for management of low-lying placenta accreta: a prospective study

Background Morbidly adherent placenta is one of the most feared complications causing high morbidity and mortality in obstetrics. Cesarean hysterectomy is still the main procedure in the current management of patients diagnosed with morbidly adherent placenta. Objective To evaluate the efficacy of prophylactic bilateral hypogastric arteries ligation on maternal outcome in diagnosed cases of morbidly adherent placenta. Design Prospective study. Setting Obstetrics and Gynecology Department, Mansoura University Hospital, Egypt. Methods This was a prospective cohort study of 51 pregnant women with a history of previous cesarean sections and diagnosed with low-lying abnormally adherent placenta. All patients underwent prophylactic internal iliac artery ligation after fetal delivery and before extraction of the placenta, the placenta was removed manually in a piecemeal manner and any remaining bleeding points from the placental site were then controlled by hemostatic sutures. Results Bilateral internal iliac artery ligation was performed in patients with invasive placenta (accreta and increta) (46/51 = 90.1%) and satisfactory hemostasis was achieved in 38 patients (38/46 = 82.6%). In five patients with placenta previa increta (5/17 = 29.4%), there was uncontrolled blood loss; thus, we proceeded to cesarean hysterectomy. The mean intraoperative blood loss was 1255 ± 589 ml. Blood transfusion was necessary in 35 patients (35/46 = 76%) during the operations. The mean hemoglobin and hematocrit 1 day after the operation were 9.8 ± 1.3 and 31.4 ± 2.3, respectively. Conclusion Prophylactic bilateral internal iliac artery ligation before extraction of placenta accrete seemed to be an effective technique to decrease cesarean complications and avoid emergent peripartum hysterectomy.