Impact of Cesarean-pregnancy interval on maternal obstetric outcome

To evaluate the impact of Cesarean Pregnancy Interval [CPI] [The time in months between the prior cesarean delivery and the next pregnancy] on the maternal obstetrics outcomes. Prospective descriptive study. Assuit University Women's Health Center. Five hundred pregnant women with uncomplicated previous one or more lower segment transverse cesarean delivery were recruited for this study. They were divided into groups according to CPI and compared with in respect to maternal obstetric outcomes. Clinical assessment of all the participants was carried out at ante partum, intra partum and postpartum period. Ante partum maternal and fetal monitoring included, blood pressure, pulse rate, scar tenderness, vaginal bleeding, fetal heart rate, progress of labor and final maternal outcome. The mean interval of CPI with in all groups was [21.82 +/- 15.92] months and the majority of cases were among the CPI of 24-<60 months [171 women, 34.2%]. Cesarean section was carried out in [445/500. 89%], 37 women delivered vaginally [7.4%], 17 had abortions [3.4%] and one case laparotomy for ectopic pregnancy [0.2%]. For patients who underwent repeated cesarean section, the intraoperative assessment revealed that the uterine scar dehiscence was significantly higher among CPI of < 12 months. [P value=0.012] and on other hand the rate of adhesions was significantly higher among CPI of >/= 12 months, [P value= 0.006], and secondary to that the maternal hospital stay was significantly higher among those with CPI of >/= 60 months [3.5 days]. No reported cases of hysterectomy or maternal death among the studied women. Cesarean pregnancy Interval of less than 12 months was associated with the higher risk of uterine scar dehiscence and CPI more than 12 months was associated with increased rate for adhesions

Luteal phase defect with different lines of treatment for induction of ovulation

The prevalence of luteal phase defect [LPD] with different drugs, for induction of ovulation, was studied in 71 infertile women. LPD was diagnosed when an endometrial biopsy, obtained on the 22nd day, showed a histologic lag of 2 days or more. Ultrasound scan [USS] was used for study of follicular growth and prediction of ovulation. Insler cervical score from day -4 to day 0 was done, estradiol [E2] in serum in day 0 and mid-luteal, and progesterone [P] mid-luteal were measured. Prevalence of LPD with antiestrogen, bromocriptine and HMG/HCG was 38%, 15.4% and 22%. Cervical score showed good predictive value for LPD from day -2 to day 0 [F 0.0001]. Neither serum E2 nor P showed predictive value of LPD

Ultrasonography as a sole method in the monitoring of ovulation induction

Two hundred and eighty-three stimulated cycles were monitored with ultrasonography. The corpus luteum was visualized in 198 of ovulatory cycles in the mid-luteal phase. The ovulation rates were 84.7%, 73.3% and 88.7%, while the conception rates were 24%, 40% and 20% for the anti-estrogen, bromocriptine and HMG groups, respectively. Ultrasonography was used for timing of HCG administration in 80% of anti-estrogen group and all HMG stimulated cycles with preovulatory follicular diameter >18 mm which followed by subsequent ovulation in 96% and 100%, respectively. Cumulus oophorus was visualized in 20 cycles [8.5% of ovulatory cycles]. In 18 of these cycles, ovulation was diagnosed in the subsequent day after cumulus oophorus appearance which when visualized could be used as a predictor of ovulation. Ovulatory dysfunctions were detected ultrasonographically in 48 cycles. Twenty-seven cycles showed no follicular activity or follicular atresia, eight cycles showed follicular cyst formation, four cycles showed LUF which correlated with laparoscopy findings and P production. Mild ovarian hyperstimulation was diagnosed in six cycles, two in clomiphene citrate stimulated cycles and four in HMG stimulated cycles which regressed spontaneously

Conservative management of post-date pregnancy

This study was conducted to evaluate the management of postdate pregnancy. Ninety-nine patients with a firmly established gestational age of more than 294 days were admitted to the Department of Obstetrics and Gynecology, Assiut University. They had no other complications. They compromised two groups, Group I consisted of 49 patients who were actively managed due to the presence of an abnormal finding suggesting fetal compromise. Group II consisted of 50 patients who were managed conservatively without intervention until the spontaneous onset of labor. The mean age, parity and gestational age were significantly higher in group II. The mean duration of the second stage of labor was longer in group I. Spontaneous vaginal delivery was more in group II, while ventouse extraction was more in group I. The mean birth weight was higher in group I. The mean Apgar score was significantly higher in group II. Meconium aspiration was present in eight babies of group I and in none of group II. Nineteen babies in group I needed admission to the Neonatal Intensive Care Unit, while only five in group II needed so. The incidence of CS was significantly higher among patients more than 30 years. Postdating was more in younger age group. The incidence of vaginal delivery was significantly higher in younger age group while that of CS showed the reverse

comparative study of the clinical performance of norplant-2 versus norplant subdermal contraceptive implants

Three hundred and seventy-five fertile healthy women were randomized in the ration of 2: 1 to the use of either norplant-2 covered rods or norplant six capsules, respectively. They were followed up for a period of one year. The one year continuation rate was 86.0 +/- 2.3/100 women in norplant-2 group and 87.2 +/- 3.0/100 women in norplant group. The commonest causes of discontinuation in both groups were menstrual bleeding problems. The use of both types of implants is commonly associated with menstrual disruption but women commonly bear them particularly if they were counseled as regards the possibility of their occurrence. On the whole, manifestation of reduced menstrual bleeding are commoner amongst NORPLANT-2 users than NORPLANT users during the first year of observation. The latter group showed higher incidence of manifestation of increased bleeding than the former group. No significant effect could be found on the body weight or hemoglobin concentration of the users of both implants at the end of the first year of use. NORPLANT-2 is well comparable to the original NORPLANT six capsules system as regards its efficacy, continuation rates and side effects. However, it is superior to NORPLANT in its easy and less expensive manufacture and easier insertion as well as removal procedures in addition to its effect in reducing menstrual blood loss