Induction of labour in grandmultipara by intracervical prostaglandin E tablets

This is a prospective controlled study in which planned induction of labour was carried out in 100 grand multiparous patients between 37-43 week gestation by intracervical application of PGE tablets [induction group]. Another 100 grandmultiparous patients who went into spontaneous labour were considered as controls [control group] to determine the safety and efficacy of PGE2 tablets and to compare labour characteristics and its outcome. In the induction group, labor was successfully induced in 98 patients [98%], of whom 96% delivered vaginally. The mean duration of active labour was 2.5 + 0.63 hr. In the induction group compared to 4.6 + 1.8 hr. in the controls. The mean duration of the second and third stages were shorter in the induction group. The incidence of operative and instrumental deliveries was significantly less frequent among induction group patients [3.1% and 2.0%] respectively compared to 7.0% and 8.0% in control group patients. Similarly, they needed less oxytocin augmentation for their labour. No case of uterine rupture was reported in the study. There was no difference in fetal outcome between both groups. It is concluded that PGE intracervical tablet is a safe and effective for planned induction of labor in grandmultiparous patients

Sickle cell disease patients in pregnancy

A 4 years retrospective study of pregnancy outcome in 76 sickle cell disease [Hbsc] pregnant patients was carried out. The incidence of the disease among the general pregnant population was [0.3%]. There was an overall increased incidence of antenatal complications [75.0%] among those patients when compared to the general pregnant patients [3.1%]. The main complications included anemia [48.7%], urinary tract infection [11.8%], pulmonary infection [7.9%], hypertensive disorders [5.3%] and bone pain crisis [1.3%]. The duration of pregnancy was not different from the general pregnant population. There was an increased incidence of operative delivery [18.4%] mainly because of fetal distress during labor. Perinatal mortality were 52.6 per 1000 and no maternal mortality was reported. There was an improvement in the outcome of the sickle cell disease during pregnance and labor. Maternal and fetal morbidity and mortality could be brought down by adequate screening, antenatal and intranatal monitoring and by early treatment of complications

Perinatal morbidity and mortality in twin pregnancy

The result of a retrospective study involving 438 twin births born over a 4 years period among 25379 deliveries were presented and compared to the general singleton births with particular reference to gestational age, maternal and fetal antenatal complications, mode of delivery and birth weight. Twinning incidence was 9.4/1000. It was higher among multi-gravidae. Complications were present in 60.7% of all twin pregnancies compared to 26.1% in singleton pregnancies. The most common were threat of preterm labor [9.1%] and hypertensive disorders [8.2%]. Preterm labor occurred in [48.9%] of twin pregnancies compared to only [6.8%] in singleton pregnancies. Intrauterine growth retardation was diagnosed in [5.5%] of twin pregnancies while it was detected in [1.7%] of singleton pregnancies. Operative and forceps delivery needed in [12.1% and 7.3%] of twin deliveries, respectively, compared to [8.1% and 0.4%] in singleton deliveries. 34% of twin births suffered perinatal morbidity. The overall twins perinatal mortality rate was [43.4/1000] and the corrected perinatal mortality rate was [36.3/1000]. There was no difference in perinatal mortality rate between the first and the second twin. Early neonatal mortality rate was [22.8/1000] in twin births while it was [6.4/1000] in single births, [94.7%] of perinatal mortality rate in twin pregnancies involved newborns-weighing less than 2000 g and 88.8% of the same rate involved new borns delivered at 33 weeks of age or less. Twin pregnancies were high risk pregnancies. Early diagnosis, adequate antenatal care, early detection and prevention of preterm labor, liberal use of cesarean section for malpresentations particularly with preterm labor and active management of delivering the second twin within an optimal time were a suggested management to reduce perinatal morbidity and mortality associated with twin pregnancies

New frontier in cardiac surgery: accessory pathway resection for WPW Syndrome

Resection of atrioventricular accessory pathways [AV-AP] is the radical curative approach in symptomatic and resistant supraventricular tachycardias especially when associated with atrial fibrillation with life-threatening ventricular response. In this report, 11 cases with symptomatic SVT due to AV-AP were subjected to surgical resection of AP for the first time in Egypt. These included 9 males and 2 females with a mean age of 29.5 year, range 10-50 years. Pharmacologic treatment [an average of 3.6 drugs/pt.] in all candidates, supplemented by underdrive pacing in 3 patients, were uniformly unsatisfactory. After a detailed preoperative EPS, all patients were subjected to surgery that included predissection mapping followed by ablation of the AP using the epicardial approach in all cases except those with anterior septal AP [N= 3] and one case with Ebstein's anomaly in whom a combined epicardial and endocardial dissection was used. Evaluation of results of arrhythmogenic substrate ablation was by means of a post-dissection intraoperative mapping, by a briefed EPS 7-10 days post operatively and by follow-up at one month and six months that included clinical and electrocardiographic evaluation and if needed Holter monitoring. One case developed recurrence at early postoperative EPS and a second one, in whom blind dissection was done, had recurrence 12 days postoperative. At six months follow-up no additional cases showed evidence of recurrence