Ondasetron versus dexamethazone for treating patients with intractable hyperemesis gravidarum: a randomized study

To evaluate the antiemetic effectiveness of ondasetron and dexamethasone in patients with intactable hyperemesis gravidarum. OB. and Gyn. Department, Sohag University hospital. A prospective randomized study. Sixteen patients with hyperemesis gravidarum resistant to the conventional therapy. There were randomly allocated into two groups; the 1st [8 patients] treated with ondasetron 4 mg/day I.V. as a single injection while the 2nd group was treated with dexamethazone 24 mg/day I.V. on three divided doses. The frequency of vomiting was evaluated for every patient daily every morning. At the end of the study period, the antiemetic efficacy, the duration of hospital stay and the side effects of both drugs were compared. 38% of patients receiving ondasetron [group I] showed stoppage of vomiting after a single injection. After the 2nd injection, all patients were cured of vomiting. The average duration of hospital stay was 3.8 +/- 0.8 days. In group II, only one patient [12.5%] showed improvement of vomiting after the 1st day of treatment. After the 3rd day of treatment, only 12.5% of patients were cured while 50% of patients were resistant to dexamethazone. The average hospital stay was 6.2 +/- 1.3 days. The difference between the two groups regarding the antiemetic efficacy and the duration of hospital stay was statistically significant [P < 0.05]. No side effects for both drugs have been reported. Ondasetron is a highly effective drug for treating women with intactable hyperemesis gravidarum. It is more effective than dexamethazone, associated with less frequent injection, less hospital stay and produces no significant side effects. Ondasetron should be only used as a last resort as an alternative to termination of pregnancy

Outcome of pregnancy in patients with liver cirrhosis

To evaluate the maternal and foetal outcomes in patients with liver cirrhosis and to determine the impact of pregnancy on the hepatic disease process. A prospective observational study. Setting: Sohag University hospital. Fifty one pregnant women with liver cirrhosis. They were followed throughout pregnancy to detect signs of hepatic decompensation and to detect any obstetric complication. Foetal growth curve was done bimonthly or monthly. 18% of patients developed hepatic decompensation during pregnancy; of whom 88% have occurred during the last 4 weeks of pregnancy. Only 2% of this decompensation has occurred before 32 weeks of gestation. 60% of patients developed obstetric complications. Preterm labour, HELLP syndrome, pre-eclpmsia and non-traumatic postpartum haemorrhage increase in patients with liver cirrhosis. The vast majority of these complications have occurred in patients delivered beyond 36 weeks of pregnancy. 30% of fetuses showed IUGR and 15% died intrauterine mainly in patients who developed hepatic decompensation. The maternal mortality was 8% and all were the result of hepatic coma occurring during labour. The risk of hepatic decompensation increases during the last 4 weeks of pregnancy. Preterm labour, HELLP, PET and PPH increases in decompensated patients. Hepatic coma during labour is the leading cause of maternal death. Termination of pregnancy at 36 weeks of pregnancy can decrease the maternal morbidity and mortality

Pregnancy spacing after primary cesarean section: its impact on uterine scar strength and mode of delivery

To evaluate the strength of uterine scar in pregnancy following primary cesarean section [CS] and its effect on the mode of delivery, and subsequently to define the safe interval of pregnancy spacing after primary CS. Ninety cases were recruited from the outpatient clinic of Sohag University Hospital [SUH] during the period from Feb. 2005 to Jan. 2006. All had singleton pregnancy in the third trimester and previous one uncomplicated CS for a relative indication done in the emergency sector of SUH with no other risk factors in the current pregnancy. The patients were allocated into 3 groups, G I [13 patients] who got pregnant within 6 months after CS, GII [27 patients] who got pregnant 6 months to one year after CS, and G III [50 patients] who got pregnant after more than one year of CS. During every antenatal visit, in addition to the routine evaluation, ultrasonographic measurement of the lower uterine segment [LUS] was done and a thickness < 3 mm was considered to be abnormal according to Tanik et al [1996]. Elective CS was done for those with thin LUS [<3mm] or for those who developed other complications of pregnancy. Otherwise, patients were allocated for the trial of vaginal delivery. The patients characteristics showed that most of the patients were primiparous, noneducated and from rural areas with a mean age of 28 +/- 3.7. The LUS thickness at 36 weeks was found to have a thickness of <3mm in 9 cases [69%] of GI, 7 cases [26%] of GII and 5 cases [10%] of GIII. A LUS of >/= 3mm was detected in 4 cases [30%] of GI, 20 cases [74%] of GII and 45 cases [90%] of GIII; the differences were statistically significant. With regard to the mode of delivery, 92% of patients in GI were delivered by CS [elective+emergency] compared to 20% in GIII where 80% of patients were delivered vaginally, and the difference was statistically significant. This study can conclude that the interval of 6 months or more after CS can be considered safe for pregnancy to be allowed and the safety increases with more than one year interval. An interval of less than 6 months does not seem to be safe; the LUS is frequently too thin to stand for trial of vaginal birth. Sonographic measurement of the thickness of the LUS is considered a reliable method for determining the strength of the scar and the mode of delivery

ratio of middle cerebral to umbilical artery blood velocity versus biophysical profile in post-term pregnancies for the prediction of perinatal outcome

To compare the ratio of middle cerebral artery to umbilical artery blood velocity waveform's systolic/diastolic [MCA/UA] S/D ratio and biophysical profile as regard their ability to predict adverse outcome in post-term pregnancies. A prospective observational study was done in Antenatal clinic and Emergency Department of Obstetrics and Gynecology of Sohag University hospital. Sixty pregnant women were recruited in the study fulfilling the selection criteria of being 42 weeks or more calculated from the first day of the reliable last menstrual period, having a singleton fetus in the vertex presentation. All accepted to participate in the study after explaining its nature. All cases underwent antepartum testing every other day for biophysical profile and Dopplcr ultrasound examination of the fetal middle cerebral artery and umbilical artery. Adverse post-term related outcome was defined as perinatal death, occurrence of mcconium aspiration syndrome, cesarean delivery for fetal distress, admission to the neonatal intensive care unit and low Apgar at 1 and 5 minute. The predictive values of a middle cerebral artery to umbilical artery ratio