Combined low dose aspirin and 17 alpha hydroxyl progesterone versus 17 alpha hydroxyl progesterone alone study in pregnancy: a randomized clinical trial for prevention of spontaneous preterm birth

Background: Preterm birth: defined as any live birth occurring through the end of the last day of the 37th week [259th day] following the onset of the last menstrual period. Low-dose aspirin [LDA] has been noted to reduce the preterm birth [PTB] rate in multiple meta-analyses of the preeclampsia [PreE] prevention trials. It is unclear if this effect of LDA is entirely due to a reduction in indicated PTB versus reductions in preterm premature rupture of membranes [PPROM] or spontaneous PTB. In the Maternal-Fetal Medicine Unit [MFMU] high-risk aspirin [HRA] study, a near significant decrease in PTB was found despite no effect on preeclampsia. The objective of this study was to assess the impact of LDA on indicated PTB, spontaneous PTB, and PPROM PTB in the MFMU HRA study population

Aim of the work: This study aim to assess the efficacy of 17 alpha hydroxyl progesterone and low dose aspirin in reducing the rate of preterm birth in pregnant women at this risk

Patients and Methods: Study type: A double blinded randomized placebo controlled clinical trial

Study settings: This study conducted at outpatient clinic of Ain Shams University Maternity Hospital

Time of the study: The study was held from August 2016 to November 2017

Results: Data was analyzed according to the intention-to-treat principle. In a total 400 women whom recruited in the study, 160 were excluded. So we ended in to 240 women whom randomized and allocated in to 2 groups to intervention. Primary outcome measure was preterm birth. The most important secondary outcome is a composite of poor neonatal outcome [including bronchopulmonary dysplasia [BPD], periventricular leucomalacia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity [ROP], sepsis and perinatal death].There was no statistically significant difference between both groups as regarding to age, gravidity, parity, body mass index, mean cervical length, and number of previous preterm labor. There was no significant difference between two groups as regard preterm premature rupture of membranes [P.PROM].There was no significant difference between two groups as regard time of delivery there was no significant difference between both groups in Need for NICU admission, neonatal birth weight, APGAR score, fetal complications [RDS, jaundice, BPD, HIE, NEC, bleeding, sepsis or even neonatal death].Long term neurodevelopmental complications was not conducted at this study as it needs more time.In maternal complications there was no significant difference between both groups

Conclusion: Further randomized controlled trials with larger sample size should be done to demonstrate the efficacy of low dose Aspirin in prevention of preterm labor and its complications

Placental cord drainage versus no placental crainage in the management of third stage of labour: randomized controlled trial

Back ground: the third stage of labour begins immediately after the birth of the baby and ends with the expulsion of the placenta and fetal membranes. It is preceded by contraction and retraction of the uterus to reduce uterine size and expel the placenta with minimal haemorrhage. Placental cord drainage involves clamping and cutting of the umbilical cord after the birth of a baby and then, immediately unclamping the maternal side of the cord so the blood can drain freely into a container

Aim of the work: the aim of this study is to assess the effect of placental cord drainage during active management of the third stage of labour on reducing both blood loss and the length of the third stage

Materials and Methods: a randomized controlled trial was carried out on180 patients who underwent vaginal delivery at Ain Shams University Maternity Hospital labour ward. Population of this study were randomly assigned to either: Group A: 90 patients was the study group [cord drainage]. Group B: 90 patients was the control group [no cord drainage]. Moreover, the duration of third stage was compared as the primary outcome. The incidence of postpartum hemorrhage, retained placenta, manual removal of placenta, and the need for blood transfusion were compared

Results: the duration and amount of blood loss of third stage of labour was significantly lower in study group than control group. Furthermore, the Postoperative pulse rate, Systolic Blood Pressure, Diastolic Blood Pressure, Hemoglobin and hematocrit value were significantly higher in study group than control group. The retained placenta [manual removal], Postpartum hemorrhageand Blood transfusion were non-significantly less frequent among study group than among control group

Conclusion: active management of the third stage of labour with the cord drainage method significantly reduced postpartum hemorrhage and the duration of the third stage

Effect of normal saline infusion versus dextrose 5% infusion on the duration of labor in nulliparous women: randomized controlled trial

Background: during labor, it is common for women to have no or little nutrient intake, inspite of the fact that the demand of energy increases as a result of skeletal and smooth muscle contraction

Aim of the Work: this study aims to evaluate the effect of intravenous dextrose-saline infusion compared with intravenous normal saline infusion in acceleration of active phase of labor in nulliparous women

Patients and Methods: this prospective randomized controlled trial was conducted on nulligravida patients recruited from those attending labor ward of Ain Shams University, Maternity hospital who are, singleton gestation, 36 weeks or more

Results: total duration of first and second stages of labor was significantly shorter among Dextrose 5% group than among Normal saline group

Conclusion: dextrose 5% solution administration is associated with shortened duration of labor because it provides the required energy for pregnant mothers during the labor procedure through the detraction of harmful metabolites produced together with ATP production and results in acceleration of the labor process

Recommendations: dextrose 5% administration during labor is associated with shortened duration of labor. Further studies with larger sample sizes, more outcomes and different dextrose concentration is required to determine the exact effect of dextrose