ABSTRACT
Background: labour is a stressful event for the fetus but is well tolerated by most fetuses. However, in some infants stress of labour in terms of metabolic acidosis can lead to Hypoxic Ischemic Encephalopathy [HIE]. HIE around term remains a major cause of neonatal mortality and morbidity with lifelong chronic disabilities. Such insults are not limited to high risk pregnancies but can also occur in about 50% of low risk pregnancies. On current evidence, it is estimated that in about 10 of brain damaged infants, the cause is hypoxia during labour.There has been considerable interest in magnesium sulfate [MgSO4] because magnesium alleviates excitotoxic damage by binding to the magnesium site on the NMDA [N-methyl-Daspartate] glutamate channel
Aim of the Work: magnesium sulphate [MgSo4] for fetal neuroprotection in patients presenting by intrapartum fetal distress at term
Patient and Methods: this is a randomized controlled trial [RCT]. The current study was conducted to single term pregnant women who developed intrapartum fetal distress [as defined later] and need emergency CS [ceaseran section] according to Ain Shams protocol. This study was carried on 200 pregnant females, recruited from observation and labour wards of Ain Shams University Maternity Hospital. The current study was conducted to single term 200pregnant women who developed intrapartum fetal distress and needs emergency CS [cesarean section] according to Ain Shams protocol to examine the effects of administered magnesium sulphate .patient were invited to participate in the study after providing clear explanation of the study and its expected values
Result: patients were invited to participate in this study after providing clear explanation of the study and its expected values. The demographic data of included women showed no significant difference between groups in the age and gestational age There was a significant difference in Apgar score at 5 min between MgSo4 and placebo.MgSo4 had significantly lower the risk of decrease Apgar score < 7 at 5min[p:0.029] .Mgso4 also had significantly lower seizure attacks [p:0.002] and had highly significantly reduce NICU admission rate [MgSo4 group 20[20%] and placebo group 43[43%][p: 0.001]].In MgSo4 group, 23 women reported adverse reactions associated with procedure. Among them, 16 [16%] reported only flushing and 7 [7%] reported only nausea. In placebo group, were 8 [8%] reported flushing and 2 [2%] reported nausea
Conclusion and Recommendation: magnesium sulfate is effective in reducing risk of Apgar score <7 at 5min. Magnesium sulfate appear to be effective in reducing seizure and NICU admission. Magnesium sulphate is associated with maternal morbidity rather than non exposure in the form of nausea and flushing. The improvement in short-term outcomes without significant increase in side effects indicate the need for further trials to determine if there are long-term benefits of magnesium and to confirm its safety
ABSTRACT
Objectives: The current study aimed at comparing the efficacy of Clomiphene Citrate [CC] for the expectant management of unexplained infertility in females over 3 successive cycles
Materials: The present randomized, controlled, clinical trial was carried out at Ain Shams University Maternity Hospital. Females with unexplained infertility for at least 12 months of unprotected regular marital life were enrolled. Eligible females were randomly assigned into one of the 2 following groups: group 1 received 100 mg CC once a day for 5 days, and group 2 was expectantly followed up without induction of ovulation. The primary outcome was the clinical pregnancy rate
Results: A total of 113 females were enrolled in the current trial. The mean age of the subjects was 25.3+/-3.1 years; ranged 20 to 33. The clinical pregnancy rate was slightly, but significantly, higher in CC group compared with the controls; both per case [7/57 vs. 4/56, 12.3% vs. 7.1%, respectively; P=0.357; Relative Risk [RR]=1.72; 95% Confidence Interval [CI]=0.53, 5.55; Number Needed to Treat [NNT]=19] and per cycle [7/163 vs. 4/160, 4.3% vs. 2.5%, respectively; P=0.374; RR=1.72; 95% CI=0.51, 5.75; NNT=56]
Discussion: CC seems to be not effective in improving clinical pregnancy outcome compared with observation alone in females with unexplained infertility