Sublingual administration of misoprostol for treatment of postpartum hemorrhage

To examine the effectiveness and safety of high-dose sublingual misoprostol for treatment of postpartum hemorrhage compared to methylergometrine by means of a double blind randomized clinical trial. After active management of third stage of labor, 94 women with atonic postpartum hemorrhage were randomized between misoprostol treatment [4 x 200 ug sublingual and IV saline] or four placebo tablets and IV 0.25 mg methylergometrine injection. The primary outcome variable was the measured blood loss >/= 500 ml in one hour after enrolment. The significance level was chosen at P < .05. The measured blood loss > 500 ml in one hour after enrollment was not significantly different between misoprostol and ergometrine groups [p = 0.77]. Other estimations of blood loss showed no significant differences between the groups, though, more patients in misoprostol group needed additional uterotonics to stop their bleeding [27 [57.45%] vs. 16 [34.04%], p = .04]. With misoprostol side-effects were increased, namely shivering and pyrexia > 38.5°C [p = .01]. compared with methylergometrine, misoprostol provides nearly equal effect against postpartum hemorrhage but associated with more side effects and more demands of additional uterotonics

randomized controlled trial comparing the use of prolene suture and nylon tape in modified Shirodkar operation: a clinical-microbiological study

A short cervix during pregnancy offers less resistance to ascending infection, which is related to the occurrence of preterm birth, preterm premature rupture of the membranes, and mid-trimester abortion. All these events significantly increase the incidence of perinatal mortality and morbidity. Cervical cerclage is a procedure used to increase the functional length of the cervix during pregnancy, by placement of a tape at the level of the internal os to support the cervical musculature. Much controversy is present about the value of cervical cerclage in improving perinatal outcome. The use of a braided synthetic material, that will significantly change the bacterial milieu in the upper vagina and cervix, might in itself play a role in promoting infection, and might contribute to this controversy. On the other hand, the use of a monofilament suture material as Prolene, might obviate the changes in the bacterial milieu of the high vagina after the procedure, and might help improve the perinatal outcome. To identify the microbiological changes of the cervico-vaginal flora in women undergoing modified Shirodkar operation using two different suture materials, and to compare the pregnancy outcomes as an indicator of operation effectiveness. A randomised controlled trail was conducted at Ain Shams University Maternity Hospital [ASUMH] from September 2000 through February 2002. Bacteriological indicators of infection [Number and type of colony forming units]; fetal salvage ratio; prematurity ratio. 44 Cases with clinical and/or dynamic ultrasonographic criteria of cervcial incompetence underwent cervical cerclage operation using either Prolene suture or Nylon-tape according to the modified Schirodkar technique. 4 cases dropped out. The rest [40 cases] were followed up till they ended their pregnancy spontaneously. Bacteriological swabs were obtained pre- and 4 weeks post operatively and aerobic and anaerobic cultures were performed and analysed. No difference was observed between the two groups in any of the major confounding variables. The Prolene group had statistically significantly less post-operative bacterial colonizaton compared to the Nylon-tape group. The Prolene group showed better fetal-salvage and prematurity ratois; the results reaching statistical significance. Elective cervical cerclage by modified Shirodkar technique at 12 to 18 weeks' gestation using Prolene suture improves the fetal salvage as well as the prematurity ratio in patients at risk of fetal wastage due to cervical incompetence. Prolene suture was statistically significantly superior to Nylon tape as regards the microbiological and perinatal outcome measures. Intervention on the basis of dynamic ultrasono graphic parameters was related to a better fetal survival outcome

Antiprothrombin autoantibodies in patients with pre-eclampsia

Sixty women in their third trimester were included in this study. They were divided to three groups: Group I: Included 30 pregnant women with documented Pre-eclampsia. Group II: Included 20 normotensive women with uncomplicated pregnancy. Group III: included 10 healthy non-pregnant women. There was highly significant difference as regards weight of the newborn between patients with Pre-eclampsia and normal pregnant group [with mean value of 2792.3 gm and 3436.8 gm respectively]. There was no significant difference as regards hematological data [Hb, platelet count, PT and PTT] between the three studied groups. There was highly significant difference as regards antiprothrombin IgG antibody between the three studied groups [with a mean value of 18.8 U/ml in patients with Pre-eclampsia, 6.5 U/ml in normal pregnant women and 3.1 U/ml in non pregnant women]. There was highly significant difference as regards antiprothrombin IgM antibody between the three studied groups [with a mean value of 27.1 U/rnl in patients with Pre-eclampsia, 11.5 U/ml in normal pregnant women and 3.6 U/ml in non pregnant women]. There was also strong positive correlation between weight of the newborn in patients with Pre-eclampsia on one hand and PT, PTT, ALT, AST, uric acid antiprothrombin IgG and IgM antibodies on the other hand. There was strong positive correlation between the level of antiprothrombin IgG in patients with Pre-eclampsia on one hand and blood pressure, PT, PTT, platelets, ALT, AST and uric acid. There was strong positive correlation between the level of antiprothrombin IgM in patients with Pre-eclampsia on one hand and blood pressure, PT, PTT platelets, ALT, AST and uric acid. There was also strong positive correlation between the levels of antiprothrombin IgG antibody and that of antiprothrombin IgM antibody in all studied groups. There was strong positive correlation between the levels of antiprothrombin IgG and IgM antibodies and the severity of Pre-eclampsia. There were no similar correlations found between the levels of antiprothrombin IgG and IgM antibodies in either normal pregnant women or non pregnant women and different studied parameters. The level of antiprothrombin IgG and IgM antibodies was higher in patients with Pre-eclampsia and it correlates well with different clinical and laboratory data and the severity of Pre-eclampsia