Maternal, obstetric and neonatal outcome in multiparous pregnant women with hepatitis C virus infection in an Egyptian rural community

Hepatitis C virus infection is worldwide. The obstetric and perinatal outcome of chronic Hepatitis C virus Infection are variable. Vertical transmission is a serious unsettled problem. Evaluation of risk factors of HCV infection in pregnant women. Identifying the maternal, obstetric, perinatal outcome and the vertical transmission rate. A prospective clinical observational study. The studied groups included 418 pregnant women attending the Obstetric Department, Mansoura University Hospital They were tested for HCV antibodies. Seroposltive cases underwent HCV-RNA. HCV+ve were compared to the HCV-ve group. Risk-factors for HCV Infection were inquired. The maternal and perinatal morbidity together with Apgar scoring were evaluated. The rate of vertical transmission was estimated by measuring HCV antibodies and HCV-RNA in the offsprings of the HCV+ve mothers at labour and seropositive offsprings had repeated HCV-RNA at 3, 6 and 9 months after delivery. 13.16% of the studied cases were seropositive for HCV-ab and 10.05% were HCV-RNA positive. Previous genital mutilation and deliveries by traditional birth attendants were significantly higher in the HCV+ve group. No significant maternal, obstetric and perinatal complications in the diseased group except high rates of miscarriages. No significant clinical differences between the studied groups. However, significant equations in the serum bilirubin, transaminases and alkaline phosphatase and significant lowering of platelet count were found in the HCV +ve group. Vertical transmission rate was high [16.6%]. HCV infection in pregnant Egyptian rural mothers is high. Female genital mutilation and deliveries by traditional birth attendants should be abandoned. HCV antibodies testing in preconception counseling is advisable

Outcome and success rate of vaginal birth after cesarean deliveries

The aim is to define the variables associated with vaginal birth after cesarean section and to identify the possible factors for predicting its success. Prospective observational study on women with previous single cesarean section undergoing vaginal delivery. Two hundred and forty pregnant women, full term, singleton, vertex presentation, in labour with a history of one cesarean section were studied. Full history, abdominal and vaginal examination, abdominal ultrasonography, careful monitoring and continuous cardiotocography were undertaken. Fetal weight and Apgar scoring were recorded. The success rate of vaginal birth after cesarean section was significantly influenced by previous vaginal delivery, cervical dilatation at admission and fetal weight. Body mass index, age, interval from previous cesarean section, nationality, sex of the newborn, gestational age at delivery or the use of oxytocin during labour did not affect the success rate of vaginal birth after cesarean deliverles, Uterine rupture and/or dehiscence were not encountered. Post delivery haemoglobin concentrations and hematocrite values were significantly higher in cases delivered vaginally. Vaginal birth after cesarean section conducted in a well equipped hospital, with careful moni toring is safe and successful with no maternal or fetal morbidities. Previous vaginal deliveries and non macrosomic fetal weight are the main contributors for the success of vaginal birth after cesarean section

Functional status of the thyroid gland in complicated versus uncomplicated pregnancies

Many Adverse pregnancy outcome have been reported in pregnant women with thyroid dysfunction. The prevalence of thyroid dysfunction and its relation to pregnancy outcome had not been studied in our locality. To assess the magnitude of thyroid disorders during pregnancy and their relation to pregnancy outcome. A prospective clinical observational study. Subjects and One-hundred-fifty four, pregnant women attending the Ante-natal Care Unit, Mansoura University Hospital. Clinical examination was undertaken. Laboratory evaluation utilizing the highly sensitive chemiluminscent serum TSH assay was performed, together with estimation of serum total T3 and total T4. Cases with abnormal TSH levels were subjected to free T4 estimation to confirm the state of thyroid dysfunction. Urine examination, blood count, liver function tests, kidney function tests and plasma glucose were carried out. Thyroid and abdominal ultrasound were performed. The studied cases were classified into two groups; group 1; 12 women having different antenatal complications and group II; 42 women having no pregnancy complications. The studied cases were also grouped into rural and urban groups, according to their residence in villages or Mansoura town respectively No hyperthyroid cases were detected in either groups. The clinical manifestations of hypothyroidism were not fulfilled, but utilizing serum TSH and FT4 testing, forty five cases out of the 154 studied cases revealed subclincial hypothyroidism [29.2%] being significantly higher among the complicated pregnancy group [33.9%] than the non complicated group [16.7%] and significantly more frequent among the rural cases than the urban group [p<0.001]. Subclincial hypothyroidism has a tendency to increase with increasing gestational age. The most prevalent complications were severe preeclamptic toxemia in 73.7% and second trimester abortion in 15.8% of cases. Subclinical hypothyroidism is common, especially in rural localities. TSH screening of pregnant women in each trimester is suggested

Preliminary uterine artery ligation versus pericervical mechanical tourniquent during abdominal myomectomy

Interventions that reduce blood loss during myomectomy are many. The effectiveness and the adverse effects of each are still under investigation. To compare preliminary uterine artery ligation versus pericervical mechanical tourniquet during abdominal myomectomy. Randomized prospective study. Two hundreds and six patients with symptomatic myomas in premenopausal and/or childbearing period attending the gynecology department, Mansoura University Hospital. Clinical examination, urine examination, blood count, liver function tests, kidney function tests and plasma glucose were carried out. Abdominal and transvaginal ultrasound were performed. The studied cases were randomly allocated into two groups; group I; 104 patients underwent preliminary uterine artery ligation and group II; 102 women underwent pericervical mechanical tourniquet during abdominal myomectomy. The operative time and operative blood loss were significantly lower in the uterine artery ligation group [P < 0.001]. Post operative reduction of haemoglobin concentrations and haematocrite values were significantly lower in uterine artery ligation group [P 0.015 for each]. Operative complications [conversion to hysterectomy, urinary tract injury, gastrointestinal were significantly lower in the uterine artery ligation group versus the touriquet [p < 0.001]. Post operative beven the need for blood transfuion and post operative analgesia were significantly highen in touriquet group [p < 0.001]