Validity of the " modified triple test " in the first trimester screening for congenital fetal malformations in the high risk group

To assess the clinical effectiveness of the combined test using fetal nuchal translucency [NT], maternal serum free beta subunit of human chorionic gonadotrophin [beta -HCG] and pregnancy associated plasma protein -A [PAPP-A] levels during gestational weeks 10 to 14 for screening of congenital fetal malformations. Settings: Department of Obstet. and Gyn., Minia University Hospital in co-operation with Feto-Maternal Unit, Am Shams University Hospital. Study Design: One thousand pregnant women [between. 10-14 weeks' gestation] at high risk for fetal malformations were recruited. They were subjected to detailed clinical evaluation, A three-generation family history, nuchal translucency, maternal serum PAPP-A and free beta -HCG. Amniocentesis was done only for 17 cases. Ninty-four malformed fetuses were picked up out of 1000 studied high-risk pregnant women [9.4%]. The most common congenital anomalies diagnosed were the cerebrospinal anomalies [48.7%], gastrointestinal anomalies [35.4%], and cardiac anomalies [15.8%]. Anomalies detected during the first scan were 49 out of 158 [DR 31.01%, Sensitivity 41.38%, specificity 98.63%].Anomalies detected during, the second scan were 125 out of 158 [DR 86.5%, sensitivity 81.6%%, specificity 99.31%]. Amniocentesis has been done for 17 cases [DR 94.1%]. Nuchal translucency had a detection rate [DR] of 80.2% compared with 52%, 43% for free beta - HCG and PAPP-A respectively. NT + free beta -HCGhad a better DR of 86%. The sensitivity of NT in comparison with amniocentesis was 73% whereas the sensitivity of the biochemical markers [PAPP-A and free beta-hCG] was 68%, 64% respectively. When NT and the biochemical markers were combined together, the sensitivity rose up to 89.5% in relation to amniocentesis. Nuchal translucency screening for fetal malformations together with serum screening has been given grade B recommendation by the RCOG working party. As a result of advances in U/S technology; visualization of the first trimester fetus has been markedly improved. By examining fetal anatomy and NT measurement at 10-l4wk, the majority of structural [68%] and chromosomal abnormalities [79%] can be diagnosed in early pregnancy. Adding the serum markers to the age and U/S will improve detection to 90% with a 5% false positive rate

role of cervical biopsy in unexplained infertility: case conrol study

Unexplained infertility has a variable incidence. Its diagnosis and management are difficult. In the present study, 52 patients were diagnosed to have unexplained infertility according to Templeton and Penny [1982]. Cervical biopsies were taken from that group and compared to 42 controls. Chronic cervicitis was found in 28 cases [53.9%], two of them were bilharzial compared to 6 [14.3%] in the control group. In 8 patients of the unexplained infertility group, the peroxidase antiperoxidase staining [PAP] was positive for IgA [15.4%] compared to 3 cases in the control group [7.1%] suggesting an immunological cause of unexplained infertility in this subgroup. This finding in addition to the high incidence of chronic cervicitis in apprantly normal looking cervix r may recommend the use of cervical biopsy in investigation of unexplained infertility

Coagulation status and fibrinolytic activity in normal and abnormal pregnancy: case control study

Haemostatic and fibrinolytic activity changes during normal pregnancy particularly at the time of the placental separation. This study was designed to detect the changes in fibrinogen, plasminogen and factor XIII; and fibrin degradation products [FOPs], antiplasminogen and for the first time the "D-dimer" in different types of pregnancy associated complications. Twenty seven patients with aberrations of the pregnancy during first and second trimester and 26 patients with hypertensive disorders of pregnancy were compared to the 36 normal pregnancies. Plasminogen, fibrinogen and factor XIII showed a significant reduction in both abnormal groups compared to the normal pregnancy. The FOPs, antiplasminogen and the D-dimer, on the other hand showed a significant increase. These findings suggest using some of these parameters in early diagnosis of placental-associated abnormalities of the pregnancy

use of interceed [TC7] in prevention of postoperative adhesions

Interceed, a fabric composed of oxidized, regenerated cellulose specifically designed to reduce postsurgical adhesion has been used in this study. Interceed has been used in 19 patients undergoing different gynaecological surgery and 19 patients without applying Interceed served as a control in Minia University Hospital and private hospitals of Minia and Assiut. Second look laparoscopy was done within 3 months after laparotomy. Interceed treatment was associated with 42.1% of postoperative adhesion, while postoperative adhesion was 68.4% in of control group. Interceed also provided a significant benefit in reducing the severity of adhesion that did form. The score of adhesion in Interceed treated group was 11 only compared with 46 in control group. In conclusion, Interceed significantly reduced the incidence, extent and severity of postsurgical pelvic adhesions

Surgical management of female urinary fistulas

Our study included 32 female patients suffering from urinary fistula, were treated at El-Minia University Hospital in a period of 2.5 years. In 9 cases the fistulas were ureterovaginal and were treated transperitoneally by ureteroneocystostomy in 5 cases and Boari's flap in 4 cases with 100% success rate. In 22 patients with vesicovaginal fistulas, vaginal approach by flap splitting and vaginal flap techniques were applied for 8 cases with 50% success. The rest of the cases [14 plus the 4 cases of failed vaginal repair] were corrected successfully by the transabdominal approach using the bladder bisection technique with good dissection and separation of the bladder and vaginal wall and omental flap in complicated cases. One case of vesicouterine fistula also was treated in this study. All patients were continent postoperatively except 3 of them, were suffering from urge incontinence. We concluded that results of fistula repair depending mainly on surgeons clinical experience and individual technique