Shymaa S. Ali

The labour scale – Assessment of the validity of a novel labour chart: A pilot study

Labour dystocia is the most common indication for caesarean section (CS). This study assessed the validity of the labour scale (WHO partograph modification) as an intrapartum management tool to minimise over‐diagnosis of labour dystocia.

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,

Intravenous lidocaine before caesarean section

We read with great interest the paper titled ‘Bolus administration of intravenous lidocaine reduces pain after an elective caesarean section: Findings from a randomised, double-blind, placebo-controlled trial’ by Gholipour Baradari et al. (2017) that was published in your esteemed journal. We have some comments on the study methods that need clarification for proper evaluation of the study results. The authors reported that they only included patients who underwent an elective caesarean section (CS) under general anaesthesia. All guidelines stress that any woman scheduled for elective CS should be offered regional anaesthesia because it is safer and results in less maternal and neonatal morbidity than general anaesthesia (Fyneface-Ogan, 2012). I wonder why the authors used general anaesthesia in their study. In the postoperative follow-up, the authors reported that women were administered a 100mg diclofenac suppository when they reported a pain score >3 cm on the visual analogue scale (VAS); and morphine 3mg each time when they reported a VAS score >5 cm. We could not estimate the frequency of use of both drugs according to the previous statement. Did the authors administer morphine for example every 2 h if the scores were repeatedly >5 cm? We think that the authors should report the frequency of use of both analgesics in their results. The authors calculated the sample size of the study based on detecting a difference of 1 in the mean VAS scores at 24 h post-operation. They did not provide any citation for the basis of sample size calculation. A clinically significant difference in VAS pain score has been defined as 1.3–2.0 cm (Todd et al. 1996; Rowbotham 2001). Therefore, a difference of 1 cm is not clinically significant. This means actually that the difference in pain scores between lidocaine and placebo groups reported in their results has no clinical significance in spite of the statistical significant difference. The authors stated that Mann–Whitney U test was used for comparing morphine and diclofenac consumption between the two groups as the data were not normally distributed. However, they were presented the data in the results as mean (standard deviation) not as median (interquartile range) as it should be. Moreover, the p value was reported by Student t-test (p1⁄4 .345). Finally, the authors stated that one of the aims of the study was to evaluate the effect of lidocaine on newborns, including the Apgar score. However, no report on this outcome was in the study results. Additionally, the level of satisfaction was not truly reported. They only asked the women if they were satisfied or not. The satisfaction level is either measured with a VAS-like scale (expressed from 0 to 10 cm) or with a five point Likert-type scale.

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.

The effect of regular daily walking on adverse pregnancy outcomes among overweight primigravidas: a prospective cohort study

Objective: The study aims to evaluate the effect of regular daily walking on the occurrence of adverse pregnancy outcomes among overweight

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,

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

Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman

Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and nonspecific symptoms of the disease in this age group. Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Introduction Adnexal torsion is defined as twisting of the adnexa, including ovary and/or fallopian tube, around its own vascular axis. However the torsion may also affect only the ovary or fallopian tube. Although the exact incidence of adnexal torsion is unknown, it was reported to be diagnosed in 2.7% of gynecologic emergent surgeries. Most cases of adnexal torsion are in women of reproductive age; therefore, accurate diagnosis and treatment are essential to minimize ovarian injury and to preserve ovarian function. However, on some rare occasions, it is reported during pregnancy or in postmenopausal women. Furthermore, torsion of para ovarian and para fimbrial cysts may also occur. The differential diagnosis of adnexal torsion includes a list of gynecological conditions, such as pelvic inflammatory POG in Press, August 2017 Hydrosalpinx-induced adnexal torsion 2 disease (PID), twisted ovarian cyst and degenerated myoma, as well as nongynecological conditions, such as acute appendicitis. Because the clinical symptoms of adnexal torsion are nonspecific, the diagnosis is considered to be difficult, and a correct preoperative diagnosis is made in only 44% of cases. However, hydrosalpinx, a blocked, dilated, fluidfilled fallopian tube usually caused by a previous tubal infection, could be a risk factor. Here we report a case of a postmenopausal woman who presented with acute abdomen due to hydrosalpinx induced adnexal torsion.

The effect of prophylactic oral tranexamic acid plus buccal misoprostol on blood loss after vaginal delivery: a randomized controlled trial

Abstract Objective: The objective of this study is to evaluate the effect of prophylactic oral tranexamic acid (TA) plus buccal misoprostol on the amount of blood loss after vaginal delivery in women at low risk for post-partum hemorrhage (PPH). Materials and methods: The study was a randomized open label clinical trial conducted in a tertiary University Hospital between January 2016 and June 2017. We included women who delivered vaginally with a singleton pregnancy. They were randomized into three groups: group I (women received 10 IU oxytocin IV after delivery of the baby), group II (women received 600 µg buccal misoprostol after delivery of the baby), and group III (women received 1000 mg oral TA at the end of the first stage of labor plus 600 µg buccal misoprostol after delivery of the baby). In each group, pre- and post-delivery pulse rate, blood pressure, temperature, and hemoglobin level were evaluated. Additionally, the amount of blood loss, need for blood transfusion, need for additional uterotonics, and side effects of the study medications were recorded. Results: There was a statistically significant lower hemoglobin level and higher blood loss in the misoprostol group compared with oxytocin group and TA plus misoprostol group (p = .0001). There was a statistically significant higher hemoglobin level and lower blood loss in the TA plus misoprostol group compared with the oxytocin group (p = .004 and .043, respectively). PPH occurred in 16.7% of women in the misoprostol group compared 1.7% in the oxytocin group and no cases of PPH in the TA plus misoprostol group (p = .0001). Conclusions: In settings like rural area or home delivery in which oxytocin is not available, alternative oral TA plus buccal misoprostol may be considered as an effective line in prevention of PPH.