Ain Shams University Maternity Hospital Research Articles

ROLE OF MATERNAL SERUM FIBROBLAST GROWTH FACTOR 21 LEVEL IN PREDICTION OF PREECLAMPSIA

Pregnancy complications resulting from hypertensive disorders are a serious problem that impact 2-10 % of all pregnanciesglobally. Preeclampsia is defi ned as new onset hypertension and proteinuria after 20 weeks of gestation which may be associated with other maternal organ dysfunction, such as liver or renal insuffi ciency, hematological or neurological complications, uteroplacental dysfunction and fetal growth restriction.Aim of the Work: Primary outcome is to determine the correlation between fi broblast growth factor 21 level and preeclampsia & signifi cance of serum fi broblast growth factor 21 levels as a predictive tool for preeclampsia. Secondary outcome is to establish the relationship between maternal serum fi broblast growth factor 21 level and Maternal complictions: - Eclampsia (tonic clonic fi ts after 20 weeks with elevated blood pressure and proteinuria)- HELLP syndrome (hemolysis, elevated liver enzymes and low platelet occur as a complication of severe preeclampsia)- placental abruption (bleeding after 20 weeks gestation due to premature separation of a normally situated placenta)Patients and Methods: This was a Nested case-control study that was conducted on 90 primigravidas at Ain Shams University maternity hospital from April 2021 to April 2022. Ethical approval was obtained from the ethical committee at Ain- Shams university maternity hospital. Data was recruited from patient attending obstetric clinic at Ain Shams University Maternity Hospital. Blood samples were collected after 20 weeks to 28 weeks gestation. Patients was followed up until delivery and grouped according to development of preeclampsia.Random samples from 45 patients (group who develop PE) and 45 random samples from control group were assessed forfi broblast growth factor 21. Serum fi broblast growth factor 21 levels were measured by a commercially available enzyme- linked immunosorbent assay kit.Results: our study showed that there was a significant difference in FGF21 levels between the groups, patients withpreeclampsia having higher levels than controls, 15.9 % of patients with preeclampsia experienced maternal complicationscompared to none in the control group. Meanwhile, 18.2 % of patients with preeclampsia experienced fetal complicationscompared to 0 % in the control group.Conclusion: Serum FGF-21 levels are signifi cantly higher in preeclamptic pregnant women compared to healthy normotensive pregnant women. So, it can be used as a predictor for preclampsia and maternal complicationsFunding information: The article was written and published without any fi nancial support.Confl ict of interest disclosure: The authors of the article have noconfl ict of interest related to the publication of the article

Frontal Lobe Growth impairment in fetuses with congenital heart disease using Ultrasound parameters; A Comparative Cross-sectional study

Introduction and the Αim: 2D and 3D biometry measures can record the increased development of the fetal brain in the later part of gestation. The objective of this study is to determine whether or not the frontal brain regions of fetuses with congenital heart disease (CHD) are smaller than those of healthy controls. Patients and Μethods: The fetal Medicine unit of the Ain Shams University Maternity Hospital carried out a comparative cross-sectional study, including 140 normal fetuses and 140 fetuses with isolated CHD evaluated between 20 and 39 gestational weeks at our fetal medicine unit in the period November 2021–September 2023 Results: Our results showed the occipito-frontal diameter (OFD) and frontal antero-posterior diameter (FAPD) utilising ultrasonography. FAPD Mean±SD: 26.53 ± 10.44, OFD Mean±SD: 89.14 ± 28.34, and FAPD/OFD Mean±SD: 0.29 ± 0.05. The OFD Mean±SD was found to be 82.18 ± 18.42, the FAPD Mean±SD to be 31.68±6.58, and the FAPD/OFD Mean±SD to be 38.70±2.15. Our results showed that 0.7% of patients exhibited anomalies related to the central nervous system, such as dilated posterior fossa, vermis = 25 mm, and aberrant posterior cranial fossa. The percentage of those with a history of CHD was 3.9%.The history of CHD showed a statistically significant difference between the research groups. When examining comorbidities, surgical history, and the relationship between the other parameters and FAPD, OFD, and FAPD/OFD, there was no statistically significant difference between the groups under investigation, except for CNS abnormalities and gestational age. Conclusion, compared to normal fetuses, fetuses with CHD had shorter FAPDs and a lower FAPD/OFD ratio. Despite the fact that different types of CHD affect hemodynamics differently, there appears to be a common deficiency in the development of the frontal cortex.

Accuracy of 2D Greyscale and 2D and 3D Color Power Doppler Ultrasound in the Diagnosis of Morbidly Adherent Placenta (MAP)

Background Prenatal diagnosis of placental accreta (PA) is essential to carry out adequate surgical planning in centers where multidisciplinary teams are in place, which improve results and reduce complications. These ideal scenarios should be developed in countries with more significant difficulties in the availability of human and technological resources, through teamwork in the different hospital centres and the adequate transfer of patients at higher risk to centres with the best interdisciplinary management skills. Objective To evaluate the diagnostic accuracy of each sign (2D grayscale US signs), 2D Doppler signs, and 3D Doppler signs modified from Collins SL in diagnosis of morbidly adherent placenta in patients with one or more previous cesarean section diagnosed as placenta previa. Methods The present study is a diagnostic test accuracy study was carried out at Ain Shams University Maternity Hospital during the period from January 2020 to March 2021. 126 women were recruited from Special Care Center of the fetus – Ain Shams University Maternity Hospital. All included women were scanned by 2D grayscale, 3D power Doppler ultrasound. Results The current study showed that cases underwent cesarean hysterectomy had significantly higher previous cesarean sections. The results of the current study showed a significant association between all criteria of the 2D grayscale, Color Doppler, 3D Power Doppler ultrasound and presence of placental adherence, considerable intraoperative blood loss, need for added surgical steps, CS hysterectomy and bladder injury with the presence of more than 4 sign or more are predictive for placental invasion with the need of emergency hysterectomy. Conclusion The result of the current study proves the diagnostic accuracy of the ultrasound concerning the prediction of difficult placental separation, considerable intraoperative blood loss, CS hysterectomy and bladder invasion.

Effect of Laparoscopic Suturing versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy. A Randomized Controlled Trial

Background Women enter menarche with approximately 500000 primordial follicles, which slowly drop in number throughout their reproductive lifetimes. Aim of the Work to determine which hemostatic procedure (hemostatic suture or electrocautery) may be less harmful after laparoscopic cystectomy, based on the status of the ovarian reserve. Patients and Methods The study was conducted at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine. The study population comprised females in childbearing period undergone laparoscopic endometriotic ovarian cystectomy at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine. Results There was no statistically significant difference found between the two studied groups regarding AMH, AFC and FSH preoperative with p-value = 0.188, 0.533 and 0.812 respectively. While there was statistically significant increase in AMH and AFC in suturing group than cautery group postoperative with p-value < 0.001 and 0.005 respectively and also statistically significant decrease in FSH in suturing group than cautery group postoperative with p-value 0.004. Results of this study showed that there was statistically significant increase in the percentage of change of FSH in cautery group (61.59 ± 39.29) than suturing group (23.46 ± 17.87) with p-value < 0.001 while there was statistically significant lower rate of change in AFC and AMH in suturing group than cautery group with p-value = 0.001 and < 0.001 respectively. Conclusion laparoscopic cystectomy reduces the ovarian reserve, which is more affected by hemostatic electrocoagulation than hemostatic sutures.

Comparison between Intraoperative and Ultrasound Determined Cesarean Scar Thickness after Elective Cesarean Sections and Unplanned Cesarean Sections in Subsequent Term Pregnancies

Background Cesarean section (CS) rates are increasing worldwide. As a result, women presenting with pregnancy with previous CS are also rising. Previous CS is becoming the most common indication for CS, confirming the age old dictum proposed by Edward Craigin in 1914 “Once a cesarean always a cesarean. Aim of the Work Assessment of cesarean scar; as non-healthy or poor-healed scar are associated with some complications such as chronic pelvic pain, dyspareunia, and abnormal bleeding. Moreover, these poor-healed scars may predispose to preterm labour and uterine dehiscence or rupture in subsequent pregnancy. It was reported also that poor-healed scar may predispose to abnormal placental invasion. Patients and Methods This comparative cross-sectional study was conducted on 100 randomly selected pregnant women attending the outpatient clinic of Ain Shams University Maternity Hospital (ASUMH) in the third trimester at term aged >18 years old with single intrauterine pregnancy, previous one cesarean delivery and not in labor. Pregnant women with abnormal placentation, uterine abnormalities and/or previous uterine surgeries other than one CS delivery were excluded from current study. Results there was no significant difference betweenn two studied groups according to demographic data as age (27.0±3.9 vs. 27.6±3.6, p = 0.382) and BMI (28.2 ± 3.3 vs. 28.7 ± 2.2, p = 0.283). Both groups were comparable with statistically significant difference regarding scar thickness in (ml) and LUS staging. The scar was thicker in elective cases compared with emergency ones (8.4±1.1 vs. 7.7±1.3, p = 0.002), stage I (34 (68.0%) vs. 16 (32.0%)), stage II (15 (30.0%) vs. 25 (50.0%)), stage III (1 (2.0%) vs. 7 (14.0%)) and stage IV (0 (0.0%) vs. 2 (4.0%)). Conclusions From the results of current study we can conclude that, Maternal age and BMI had no effect on cesarean scar quality, integrity and complications incidence. The scar was thicker in elective cases compared with emergency ones.

The Effect of Intra-myometrial Methylergonovine Injection versus Placebo on Decreasing Blood Loss during Transabdominal Myomectomy: A Randomized Controlled Interventional Clinical Trial

Background Uterine leimyomas are tumors of the smooth muscles and the connective tissues of the uterus. They are considered to be the most common benign pelvic tumor affecting about 20% of women above the age of 35. Aim of the Work to compare the efficacy of intra-myometrial methylergonovine injection and placebo injection on reducing blood loss during trans-abdominal myomectomy. Patients and Methods The study was conducted in Ain Shams University Maternity Hospital, where 60 patients complaining of symptomatic myomas and fulfilling the inclusion criteria of the study were recruited from the gynecology outpatient clinic of the hospital. The patients were randomly categorized into two groups; Group A: the patients received 2 ampoules of methylergonovine (Novartis India Ltd) intra-myometrial, each ampule equals to 1 ml containing 0.2 mg (Methergine)® which was infiltrated sporadically into the myoma using a 5ml syringe and avoiding direct injection into vascular area and Group B: the patients received 2ml saline intra-myometrial which was infiltrated sporadically into the myoma using a 5ml syringe and avoiding direct injection into vascular area. Results the mean intraoperative blood loss in the methylergonovine group was 408 ± 70.9 ml and 573 ± 88.4 ml in the control group. There was high statistically significant difference between both groups regarding estimated intraoperative blood loss as methylergonovine injection decreased the blood loss by; 164.9±20.mL (Mean±SE). The mean post-operative haemoglobin was significantly greater in study group compared with control group (10.9±0.9 versus 10.3±1.1 g/dl) as methylergonovine injection decreased the hemoglobin drop by; 0.4±0.1 mL (Mean±SE). The mean post-operative haematocrit was significantly lower among control group compared with study group (21.4-34.2 versus 25.1-37.0 %) (P < 0.001). Methylergonovine injection decreased the hematocrit drop by; 1.4±0.1 mL (Mean±SE). In the present study, the mean difference in operative time in both groups was 8.4±2.5 minutes which had a high statistically significant difference. Conclusion Intra-operative intra-myometrial injection of 2ml methylergonovine during trans-abdominal myomectomy significantly reduces blood loss, operative time and the need for blood transfusion.

Prevalence of Vitamin D Deficiency in Recurrent Early Pregnancy Loss

Background Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown and there are few evidence-based diagnostic and treatment strategies. Studies on the etiology, evaluation, and management of RPL are often flawed. Aim of the Work The aim of the current study was to assess the association between vitamin D status and recurrent pregnancy loss. Patients and Methods The current study was conducted at Ain shams University Maternity Hospital during the period between October 2020 and April 2021. This research recruited 60 pregnant women categorized in to two research groups: Group A - study group: 30 pregnant women with early pregnancy loss and history of repeated pregnancy loss, Group B - control group: 30 pregnant women complete the first trimester with no early pregnancy loss. The 25(OH)D concentration measured in this case control study with predominantly first-trimester blood sampling. Results Choosing matched controls was to decrease confounders so according demographic variables; there was a statistically insignificant difference between group A (RPL) and group B (Normal pregnancy) as regards the demographic research data of study subjects recruited, the mean age was 24.5±2.6 years, the mean BMI was 25.8±2.1 Kg/m2. There was a statistically significant difference between Group A (RPL) and group B (Normal pregnancy) as regard 25(OH)D level (p < 0.001), mean was 11.9±3.2 ng/ml and 16.9±6.5 ng/ml respectively. Vitamin D was significantly associated with recurrent pregnancy loss. Conclusion The current study showed a significant association between vitamin D deficiency in pregnancy and occurrence of Recurrent pregnancy loss. A lot of researches needed to increase the quality of evidence about the association between low levels of vitamin D and recurrent pregnancy loss.

Efficacy of Intravaginal Administration of Isosorbide Dinitrate Together with Misoprostol versus Misoprostol Alone in Induction of Labor

Background Cervical ripening is a complex process involving extensive remodeling and dynamic anatomic and physiologic alternations governed by hormonal changes, inflammatory responses, vasodilatory changes, and other biological processes. Prostaglandins, produced both locally in the cervix and uterus as well as originating from the fetal membranes, play a critical role in cervical ripening and uterine contractility by increasing inflammatory mediators in the cervix and inducing cervical remodeling. Objective To assess the adjunctive Role of intravaginal administration of Isosorbide dinitrate in induction of labor. Patients and Methods This randomized controlled clinical trial was conducted at tertiary care hospital at Ain Shams University Maternity hospital (labor ward) and was randomly selected from full term patients attending the labor ward and scheduled for induction of labor. Results Our results revealed that the need to cesarean section was statistically significantly less frequent among Isosorbide dinitrate group. Our results revealed that the duration of induction to active phase interval and the duration of active stage of labor were significantly shorter among Isosorbide dinitrate group than among Control group. Conclusion As evident from the current study, both intravaginal misoprostol and combination of vaginal Isosorbide dinitrate and misoprostol are safe and effective modes of labor induction. Vaginal isosorbide dinitrate and misoprostol is more effective than misoprostol alone in terms of post induction Bishop Score, shorter induction to active phase interval and induction to delivery interval. Thus, the combined use of vaginal isosorbide dinitrate with misoprostol for preinduction cervical ripening at term may prove to be a major therapeutic advance.

Assessment of Tissue Expression of PIR2/RNF144b Protein in the Different Stages of Endometrial Cancer

Background Endometrial cancer is considered as one of the most common gynaecological cancers in developed countries. Its incidence has risen about 20% over the last decade and the rate 0f death has risen >100% over the past two decades. Aim of the Work This retrospective cohort study will assess tissue expression of PIR2 protein in the different stages of endometrial cancer. Materials and Methods A retrospective cohort study was conducted at Ain Shams University Maternity Hospital (The Early Cancer Detection Unit), A Formalin fixed paraffin embedded tissues (FFPT) was collected from the patient's the pathology unit at Gynecology & Obstetrics hospital, Ain Sham University hospitals in a period of 12 months during 2017 – 2018. The study was conducted on 60 women diagnosed as endometrial cancer; they are subdivided into 2 groups: 1st group: 30 patients with stage 1 endometrial cancer by surgical staging, 2nd group: 30 patients with other advanced stages of endometrial cancer by surgical staging. Results In this study, we show that the E3-ubiquitin ligase PIR2/RNF144B is a potential targetable biomarker in endometrial cancer. There is a high significant association between the PIR2/RNF144b and different stages of EC and higher tumor grades are associated with higher protein expression. The paraffin -embedded endometrial tissue for each patient eligible for the study was analyzed for tissue expression of PIR2 protein using Immunohistochemistry. Conclusion We suggested that PIR2/RNF144b can potentially be used as a biomarker for endometrial cancer for early diagnosis and for monitoring clinical progress of cancer status and efficacy of used treatment.

External Negative Pressure Dressing System (ENPDS) vs. Traditional Wound Dressing for Cesarean Section Incision in Obese Women: A Randomized Controlled Trial

Background Obesity is associated with increased cesarean section delivery rates and surgical site wound complication with associated increased post-operative morbidity, post-operative pain and length of hospital stay. Aim of the Work The objective of this study is to determine whether negative pressure wound therapy reduces the risk of post-cesarean wound dehiscence among obese women compared with standard surgical wound care. Patients and Methods A Randomized controlled trial (RCT)was carried out at Ain-Shams University Maternity Hospital in the period between August 2020 and February 2021. The participants of this study were 260 pregnant women aged 18 years old or older who underwent cesarean delivery. Intervention group had an ENPDS placed for 4 days and control group had a traditional surgical dressing placed for 4 days and both group were followed up for 30 days post-operatively. Results The study reveal that wound dehiscence was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.002). The study also reveal and display that SSI was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.017). After adjustment for the effect of BMI and history of CS, PA surgery or SSI, ENPDS was independently associated with reduced incidence of SSI (odds ratio = 0.262, 95% CI = 0.090 to 0.759, P-value = 0.014). The study reveal that the incidence of wound dehiscence and SSI is statistically significantly lower in ENDPS group compared with traditional dressing group (p value =0.004, 0.012,) respectively. The incidence of wound seroma and haematoma was lower in ENDPS group however, not statistically significant compared with traditional dressing group (p value= 0.066, 0.498) respectively.The study reveals that using ENDPS has a beneficial/ protective effect as regards wound dehiscence and SSI with relative risk (0.25, 0.31) respectively with 95% CI (0.1 TO 0.65 - 0.12 TO 0.83) respectively and NNT (8.7, 11.8) respectively with 95% CI (5.4 to 22.2. - 6.7 to 52.2) respectively.It also shows that ENDPS has a beneficial /protective effect as regards wound seroma and wound hematoma formation with relative risk (0.14, 0.20) respectively even though the 95% CI was (0.02 to 0.14 - 0.01 to 4.13) respectively and the NNT was (21.7, 65.5) respectively. The study reveals that peri-wound blistering, the need for post-operative therapeutic anti-biotics and re-admission was statistically significantly lower in ENDPS group compared to the traditional dressing group (p value= 0.001, 0.005, 0.010) respectively. The study reveals that post-operative pain was less in ENDPS group with p value = <0.001, post-operative mobility was more limited in ENDPS group when compared with the traditional dressing group with p value = <0.001. However, the length of hospital stay was statistically significantly longer in ENDPS group with p value = <0.001 Conclusions Negative pressure wound therapy could be used to reduce the risk of wound dehiscence, surgical site infection, wound seroma, wound haematoma, peri-wound blistering, post-operative pain, post-operative anti-biotics and overall length of hospital stay for obese women undergoing cesarean delivery.

Oxytocin Versus Oral Misoprostol for Induction of Labor in Pregnant Women with Term Prelabor Rupture of Membranes: a Randomized Clinical Trial

This study compares the effectiveness and safety of oxytocin infusion against oral misoprostol for inducing labour in pregnant women with term prelabor membrane rupture. We randomized 173 pregnant women presenting with term prelabor rupture of membranes (PROM) at Ain Shams University Maternity Hospital into Group A (underwent induction of labor (IOL) by 25μg misoprostol oral tablet every 4 h, for maximum 5 doses) and an identical Group B: (underwent IOL by oxytocin infusion according to the hospital protocol). Our primary outcome was rate of vaginal delivery within 24 h, while the secondary outcomes included the time till active phase, induction to delivery interval, maternal pyrexia, nausea and vomiting, fetal distress, Apgar score, birth weight, and neonatal intensive care unit admission. Both groups showed high rates of vaginal delivery (82.4% & 87.1% for misoprostol group and oxytocin group respectively) with no significant difference between the two groups (p=0.394). However, patients induced by misoprostol took significantly less time to reach active phase with a shorter induction to delivery interval as compared to patients induced with oxytocin. This difference was clear in multiparous women, but not observed in primiparous women when subgroup analysis was done. No significant difference was found as regards other outcomes. Our study showed that both oral misoprostol and oxytocin are effective and safe for IOL in patients with PROM, with shorter induction-delivery interval in patients induced by oral misoprostol, an effect that is clear in multiparous but not primiparous women.Trial registrationNCT05215873, on 31/01/2022, “retrospectively registered”.

A pilot study to compare propranolol and misoprostol versus misoprostol and placebo for induction of labor in primigravidae; a randomized, single-blinded, placebo-controlled trial

BackgroundThe Induction of labor is the most common obstetric procedure in daily practice. Introducing propranolol as a new drug to augment the action of prostaglandins will help in the induction process and decrease CS rates. Several researchers have used propranolol in the augmentation of labor.AimThis pilot study compares propranolol and misoprostol versus misoprostol alone for labor induction in primigravids.MethodsThis is a Randomized clinical trial, single-blinded, placebo-controlled trial at Ain Shams University Maternity hospital. This study included 128 pregnant full-term primigravid women candidates for labor induction, randomized into two groups. All candidates underwent labor induction with 25 µg of vaginal misoprostol. Group I received 20 mg of oral propranolol tablets, while group II received sugary pills as a placebo. Candidates who responded successfully to induction were assessed for possible augmentation of labor by amniotomy or oxytocin infusion. The Primary outcome was induction to delivery interval, while the secondary outcomes were the duration of the latent phase, mode of delivery, and APGAR score of the neonate.ResultsThe induction-delivery time was (11.8 ± 8.1 h. vs. 12.6 ± 8.9 h., P value = 0.027) and the duration of the latent phase of labor (7.9 ± 5.6 h. vs. 9.2 ± 6.03 h., P value = 0.017) were significantly shorter in the group of misoprostol and propranolol compared to the group of misoprostol and placebo. There was no statistically significant difference between both groups’ mode of delivery, indications for cesarean section, misoprostol, and oxytocin doses, or neonatal outcome. (P value > 0.05).ConclusionPropranolol, when used with misoprostol for induction of labor, results in augmentation of action of misoprostol and a significantly shorter induction-delivery interval.Trial registrationWe retrospectively registered this trial in clinicaltrial.gov on 01/09/2020 (NCT04533841). https://clinicaltrials.gov/ct2/show/NCT04533841

Antenatal azithromycin to prevent preterm birth in pregnant women with vaginal cerclage: A randomized clinical trial.

To assess whether antenatal azithromycin given to pregnant women with vaginal cerclage can reduce preterm birth or not. We randomized 50 pregnant ladies who underwent cerclage at Ain Shams University Maternity Hospital in group A (receiving 500 mg Azithromycin oral tablets (Zithrokan®, Hikma, Egypt) one tablet orally twice daily for three days in 3 courses at 14th, 24th and 32nd week, plus usual antenatal care) and an identical group B (receiving usual antenatal care). Our primary outcome was gestational age at delivery, and secondary outcomes were birthweight, mode of delivery, and maternal, and perinatal complications. This study was registered on ClinicalTrials.gov with number: NCT04278937. Pregnancy was more prolonged in the Azithromycin group (delivery at 36.8 weeks vs 34.1 weeks; p=0.017). Also, a higher birthweight was observed in the Azithromycin group (2932.6 gm vs 2401.8 gm; p=0.006). No significant difference was found between the two groups as regards to other outcomes (miscarriage, stillbirth, neonatal intensive care unit admission, antepartum hemorrhage, postpartum pyrexia, need for blood transfusion). Adding antenatal azithromycin to women undergoing cerclage prolongs pregnancy and reduces the risk of preterm birth, with a slight increase in birthweight.

Frequency of third trimester umbilical artery Doppler for improving neonatal outcomes in high-risk pregnancies: a randomized trial.

Umbilical artery Doppler ultrasonography is useful for high-risk prenatal surveillance. However, according to a systematic review and meta-analysis by the Cochrane pregnancy and childbirth group, the optimal frequency with which such surveillance should occur remains unclear. In the current study, we aimed to investigate whether performing umbilical artery Doppler on a weekly basis enables earlier detection of changes in utero-placental blood flow than the recommended bi-weekly (i.e., fortnightly) regimen and its impact on perinatal outcomes. This randomized controlled study included 292 high-risk pregnant women in their third trimester who attended the Ain Shams University Maternity Hospital in Egypt from January 2018 to September 2019. The women were randomly assigned to two groups to undergo either bi-weekly or once-weekly umbilical artery Doppler ultrasound. In the primary analysis performed according to the intention-to-treat basis, we observed no difference in the primary outcome of fetal admission to the neonatal intensive care unit (NICU) within the first 24 hours (risk difference, -2.63; 95% confidence interval, -12.92 to 7.65). Furthermore, no significant differences in secondary outcomes were observed (apart from stillbirth). Weekly umbilical artery Doppler is not superior to bi-weekly surveillance in preventing admission to the NICU and most other studied outcomes. Therefore, the bi-weekly regiment may be more convenient for women and more cost-effective for health care organizations (trial registration: NCT03584763 at clinicaltrials.gov).

Correlation between Diameter of Yolk Sac on Transvaginal Ultrasonography at 6-12 Weeks of Gestation and Adverse Pregnancy Outcomes.

To evaluate the correlation between yolk sac diameter at 6 to 12 weeks of gestation measured via transvaginal ultrasound and adverse pregnancy outcomes. This prospective cohort study was conducted at the Ain Shams University Maternity Hospital from July 1, 2019 to January 30, 2020. It included 120 pregnant women attending the outpatient clinic at 6 to 12 weeks of gestation. Transvaginal ultrasound was performed to measure inner yolk sac diameter. Normal diameter was considered to be 2-5 mm. Cases were followed up in routine antenatal care until the 16th week of gestation. Significant associations were found between maternal age and yolk sac diameter; yolk sac diameter and early miscarriage; a high percentage of cases of positive fetal life occurred when a normal yolk sac diameter (2-5 mm) was present (p<0.001); in yolk sac diameters <2mm positive fetal life was 0.0% and negative fetal life was 42.9%; in yolk sac diameters of 2-5mm positive fetal life was 81.1% and the negative fetal life was 7.1%; and in yolk sac diameters >5mm positive fetal life was 18.9% and negative fetal life was 50.0% (p<0.001), x2 60.094; and the best cutoff value for yolk sac diameter was >0.56, with a sensitivity of 78.6%, a specificity of 84.3%. We found a highly significant correlation between yolk sac diameter and early pregnancy loss.

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

Effect of Aromatic Massage on Somatic Problems among a Cohort of Menopausal Women

Context: Menopause is a significant event in women's lives. It marks the end of a woman's natural reproductive life; it is usually accompanied by symptoms that affect the women's ability to perform their normal daily activities. Massage is one of the non-pharmacological methods that can help women cope with menopausal symptoms.&#x0D; Aim: The study aimed to evaluate the effect of aromatic massage on somatic problems among a cohort of menopausal women.&#x0D; Methods: A comparative quasi-experimental time serial (pre-posttest, study/control) design was used. The study was conducted at outpatient clinics of Ain shams University Maternity Hospital. A purposive sample of 74 menopausal women with menopausal symptoms was recruited in this study and divided randomly into an intervention group (Aromatic massage) and a control group (Massage only). Data were collected through three tools. A structured interviewing questionnaire is divided into three parts: general data, obstetrics, and menstrual history, the Kupperman index (menopausal assessment symptoms tool) to assess somatic menopausal symptoms, and the Visual Analogue Scale to assess the history of menstrual pain degree among menopausal women.&#x0D; Results: It revealed two matched groups of women with a mean age of 47.83±5.23 vs. 49.05±3.98 in the aromatic and massage-only groups, respectively. The pre/post-intervention results revealed a significant improvement in most somatic menopausal symptoms, decreasing the frequency of hot flushes attacks, paresthesia, vertigo, fatigue, myalgia, headache, heart palpitation, and formication in the aromatherapy massage group post-intervention and in the follow up (p&lt;0.05). The comparison between the aromatic and massage-only groups revealed a significant difference between the two groups with a significantly lower mean score in total menopausal somatic symptoms.&#x0D; Conclusion: Aromatic massage with lavender, clary sage, jasmine, and rose dissolved in almond oil was effective in easing somatic menopausal symptoms compared to their pre-intervention level and compared to the massage-only group. The study recommended developing counseling programs for women about aromatic massage therapy at gynecological clinics.

Transcerebellar diameter versus biparietal diameter for the measurement of gestational age in third trimester.

AimTo compare the accuracy of biparietal diameter and transcerebellar diameter in measuring the gestational age during the third trimester of pregnancy.Material and methodsIn this prospective observational study, 275 pregnant women with singleton pregnancy between 32 and 37 weeks gestational age were recruited from the outpatient clinics of both Helwan University Hospital and Ain Shams University Maternity Hospital, Cairo, Egypt, during the period from February 2021 to August 2021. Transcerebellar and biparietal diameters of the fetus were measured by a radiologist blinded to the women’s gestational age, and compared to the gestational age acquired from a reliable date of first day of last menstrual period.ResultsThe gestational age calculated by first day of last menstrual period ranged from 32 to 37 weeks (34.35 ± 1.4), while estimated by transcerebellar and biparietal diameters ranged from 31 to 37 weeks (34.31 ± 1.39) and 31 to 39 weeks (34.32 ± 1.44), respectively. There was a strong positive correlation between gestational age and transcerebellar diameter (r = 0.98, p <0.001) as well as biparietal diameter (r = 0.87, p <0.001), yet a stronger correlation was with transcerebellar diameter. 93.6% of gestational age assessment by transcerebellar diameter was correct compared to only 79.9% by biparietal diameter.ConclusionsTranscerebellar diameter is a reliable single sonographic fetal biometric parameter for the assessment of gestational age in third trimester of pregnancy.

The effect of subcutaneous saline irrigation on wound complication after cesarean section: a randomized controlled trial

Cesarean delivery (also called cesarean section and cesarean birth) is often cited as the most common surgical procedure performed in an operating room in the United States. Over 1.2 million cesarean deliveries are performed yearly in the United States and comprise almost one-third of births. It is also a common procedure in many countries worldwide, and the rate is generally rising. Objective. The aim of the present study was to assess of the efficacy of subcutaneous saline irrigation of the wound on postoperative surgical site complications. Patients and methods. This prospective randomized controlled trial included 2890 women attending for elective cesarean section the Obstetrics and Gynecology Department, Ain Shams University Maternity Hospital. Results. The main results of the study revealed that wound irrigation was an independent predictor of reduced incidence of wound complications. Conclusion. This study found that the irrigation of subcutaneous tissue decreases postoperative hematoma and seroma formation in women undergoing primary cesarean section. Key words: subcutaneous saline irrigation, wound complication, cesarean section

Hydroxychloroquine therapy in women with autoimmune recurrent pregnancy loss, refractory to low dose aspirin and heparin: a randomized controlled trial

Hydroxychloroquine (HCQ) is a novel medication for women suffering from autoimmune-related recurrent pregnancy loss. Many autoimmune disorders have been related to poor obstetric outcomes; anti-phospholipid syndrome (APS) is the only autoimmune disorder in which pregnancy loss is a diagnostic requirement. The goal of this study is to see how beneficial it is to provide hydroxychloroquine (HCQ) in addition to low-molecular-weight heparin (LMWH) and low-dose aspirin (LDA) to females having a record of autoimmune-related recurrent pregnancy loss and refractoriness to low-dose aspirin and LMWH in previous pregnancies, both during preconception and gestation. Patients and methods. Between January 2019 and January 2021, 120 females with a history of autoimmune recurrent pregnancy loss at Ain Shams University Maternity Hospital were examined. Participants were divided into two classes using computer-based randomization procedures. During preconception and gestation, class A (60 cases) received hydroxychloroquine (HCQ), while class B (60 cases) received a placebo. Also, they received LDA and LMWH. The primary outcome measure in this study was the rate of live births. Secondary outcomes included gestational age at delivery, birth weight, mode of delivery, Apgar score at 5 minutes, neonatal morbidity, rate of neonatal intensive care unit (NICU) admission, and postneonatal mortality rate. Results. The live birth rate was 66% in class A and 42.3 % in class B. So, it was significantly higher in class A than in class B (p-value = 0.016). Additionally, gestational age at delivery was substantially greater in class A than in class B. In terms of live births, C-section was slightly less common in class A than in class B (p-value = 0.015). Notably, the mean birth weight was 2.509 kg in class A and 1.972 kg in class B, indicating that neonatal birth weight was substantially greater in class A than in class B (p-value = 0.003). Finally, NICU admission was significantly less common in class A than in class B (p-value = 0.044). Conclusion. HCQ is a potent, safe, and cost-effective medication used to prevent adverse obstetric outcomes in females with a history of autoimmune-related recurrent pregnancy loss with refractoriness to LDA and LMWH in previous pregnancies. This randomized controlled trial (RCT) provided additional evidence to support previous studies (non-criteria or seronegative APS), in which the diagnosis of APS is made solely based on the medical history, regardless of laboratory findings for antiphospholipid antibodies (aPL). Trial registration: Pan African Clinical Trial registration number is: PACTR2021104858485905. Key words: hydroxychloroquine; anti-phospholipid syndrome; heparin; low dose aspirin; autoimmune recurrent pregnancy loss