Detection of cervical dysplasia by acetic acid application to the cervix

To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening. During a 2 years period, 42 patients attending the Fertility Clinic for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious aceto-white lesions and normal Papanicolaou tests were referred for colposcopic evaluation. Findings from these examinations and corresponding biopsy results were analyzed retrospectively. Forty two women were referred for colposcopy because of abnormal aceto-white areas on the cervix. Six patients [15%] had cervical intra-epithelial neoplasia [CIN], four CIN I, two CIN II, 11 [26%] had koilocytosis, and 8 [19%] has benign histologic findings. In total, 25 patients had suspicious lesions at colposcopy for which biopsies were performed, and 17 [40%] had normal colposcopic examinations. Acetic acid visualization of the cervix can detect dysplasia otherwise missed by Papanicolaou test screening. Also, acetic acid visualization of the cervix may be useful in settings where cervical screening opportunities are limited, such as third world countries and other underserved areas. However, further refinements in technique are required to decrease false-positive findings and unnecessary referrals for colposcopy

Reliability of Ultrasonographic management of complete spontaneous abortion in the first trimester

Distinguishing between complete and incomplete abortion can be difficult when the cervix is found to be closed and bleeding minimal on empirical grounds some authorities proceed with a D and C and others leave them alone. This study aimed at finding out the reliability of ultrasound scanning of the uterus abdominally and vaginally to choose the line of treatment on sound basis. Fifty two subjects with probable complete spontaneous first trimester abortion were elected for this study, all patients had abdominal ultrasound within 62 hours and if no tissue was detected in utero, vaginal ultrasound was performed. Thirty seven patients had -ve ultrasonographic results of which 35 had good outcome without intervention. Two patients showed cramps and bleeding within 4 days and curettage revealed small amount of chorionic tissue. All patients showing intrauterine blood clots or remanents proved to have chorionic tissue on D and C. Therefore, it is concluded that ultrasound is highly reliable in the management of what is presumed to be complete spontaneous first trimester abortion

Reevaluation of low dose aspirin in prevention of preeclampsia in healthy nulliparous

Although low-dose aspirin has been reported to reduce the incidence of preeclampsia among women at high risk for this complication, its efficacy and safety in healthy, nulliparous pregnant women are not known. 62 normotensive nulliparous women who were 13 to 26 weeks pregnant were studied to determine whether treatment with aspirin reduced the incidence of preeclampsia. Of this group, 31 women received 60 mg of aspirin per day and 31 received placebo for the remainder of their pregnancies. The effect of aspirin on maternal and neonatal morbidity was also evaluated. Of the original group of 62 women, 58 [95%] were followed throughout pregnancy and the immediate pureperium. The incidence of preeclampsia was lower in the aspirin group [1 of 28 women [4.6%]] than in the placebo group [2 of 30 women [6.3%]] [relative risk, 0.7, 95% confidence interval, 0.6 to 1.0, P = 0.05], whereas the incidence of gestational hypertension was 6.7 and 5.9%, respectively. There were no significant differences in the infants' birth weight or in the incidence of fetal growth retardation, postpartum hemorrhage, or neonatal bleeding problems between the two groups

Vaginal ultrasound and transfundal pressure to evaluate the incompetent cervix

One hundred pregnant women with no prior pregnancy losses were scanned transabdominally [65 multiparas and 35 primparas], and 31 asymptomatic pregnant women with a prior history of cervical incompetency or risk for this condition were scanned transvaginally. The control patients were scanned once between 16-24 weeks, and the patients at risk were studied 73 times between 8-25 weeks. After evaluating, the cervix and its internal os, transfundal pressure was applied. Cervical cerclages were placed for cervical funneling and shortening in response to transfundal pressure or for a grossly incompetent cervix on ultrasound evaluation. Transfundal pressure elicited no changes in the internal cervical os of the 100 control patients, of whom 91 delivered at term, two miscarried at 22 and 23 weeks and seven delivered prematurely [4.7%]. Fourteen of the 31 pregnancies at risk for cervical incompetency revealed opening of the internal os or descent of the fetal membranes with transfundal pressure. Thirteen of 14 pregnancies were treated with cerclage, with nine [64%] proceeding to term, three [21%] delivering prematurely, and two [14%] aborting. The one patient who did not receive a cerclage also aborted. In six cases, the cervix and its internal os appeared normal but the membranes protruded into the endocervical canal in response to transfundal pressure. Application of transfundal pressure during transvaginal ultrasound evaluation of the cervix and its internal os may assist in detecting the asymptomatic incompetent cervix

Alfa-fetoproteins in high risk pregnancies and perinatal outcome

In this study 70 subjects and 70 controlled were examined. All patients had serum alpha-fetoprotein screening between 17 and 22 ws. with Abbott enzyme immunoassay. Ultrasonography was done on the 20th week. The ages of the patients ranged from 18 to 41 years and risk factors were present in 50% in subjects found to have unexplained elevated alpha-fetoprotein in maternal serum. However, no statistical difference was found in adverse outcome of the perinates reaching 31.4% in patients with risk factors and 34.2% in control without risk factors. It is therefore concluded that in presence or absence of risk factors of pregnancy the maternal serum alpha fetoprotein did not appear to have additional predictive value for adverse perinatal outcome

Oxytocin infusion regimens for induction of labor at term in primigravidas

To compare induction of labor by intravenous oxytocin in regimens increasing incrementally at 15 and 30-minute intervals. In a randomized controlled trial, 62 primingravidas requiring induction of labor by oxytocin infusion were randomly allocated to incremental increases at 30-minute intervals [31 patients] or 15-minute intervals [31 patients]. The main outcomes assessed were mode of delivery, complications of labor and delivery [precipitate labor, hyperstimulation postpartum hemorrhage, perineal tears, puerperal pyrexia, and number of days in the hospital]. The 30-minute incremental regimen resulted in less precipitate labor, uterine hyperstimulation, and reduced length of stay in the hospital [difference in medians 3 days]. The induction delivery interval was longer with 30 minutes [median 8 hours] than with 15 minutes [median 5 hours] [difference in median 2 hours 95% confidence intervals in median 0-3 hours]. With the 30-minute interval, there was a reduction in the occurrence of postpartum hemorrhage, perineal tears, and puerperal pyrexia, but these differences did not reach statistical. For the indiction of labor in primigravidas, 30 minute incremental increases in the infusion rate of oxytocin were superior to a 15-minute incremental protocol in reducing the incidence of hyperstimulation and precipitous labor

Perinatal outcome in subclinical hypothroid pregnancies

To relate hypothyroidism to perinatal outcome, a 23 hypothyroid patients with no other medical illnesses was divided into two groups according to the initial thyroid function tests. The purpose of the study was to report the pregnancy outcomes of gestational hypertension, low birth weight, fetal death, congenital anomalies, maternal anemia, and postpartum hemorrhage. Gestational hypertension, namely, eclampsia, preeclampsia, and pregnancy induced hypertension was significantly more common in subclinical hypothyroid patients than in the general population with rates of 22, 15 and 7.6%, respectively. In addition, 25% of the subclinical hypothyroid subjects who remained hypothyroid at delivery developed gestational hypertension. Low birth weight in subclinical hypothyroid patients was secondary to premature delivery for gestational hypertension. Except for one stillbirth and one case of clubfeet, hypothyroidism was not associated with adverse fetal and neonatal outcomes. Normalization of thyroid function tests may prevent gestational hypertension and its attendant complications in hypothyroid patients

Platelet aggregation and adenosine triphosphate with hormonal replacement in postmenopausal women

The aim of the present work was to evaluate the effect of hormone replacement therapy on platelet function in postmenopausal women. In 51 postmenopausal women, platelet aggregation and adenosine triphosphate [ATP] release were studied before and after estrogen and progestogen treatment and compared with that in untreated patients. An incubation study evaluated platelet function after incubation with estrogen and progestogen. Significant decreases in adrenaline-induced platelet aggregation [P <0.01] and ATP release [P <0.02] were observed 3 months after initiation of estrogen replacement regimens consisting of estrogen opposed by progestogen or progestogen alone showed nonsignificant changes in platelet aggregation and release. The most pronounced decrease in platelet function in the incubation assay was detected after incubation with estrogen plus progestogen. Results were similar in the spontaneous- and surgical menopause patients. Estrogen replacement therapy may inhibit the atherosclerotic process by suppressing platelet function

Outcome in pregnancies with unexplained antepartum hemorrhage

A prospective study of 48 women with bleeding from genital tract after 26 weeks gestation are included. None of them had a clinical diagnosis of abruption or ultrasound evidence of placenta previa, so they were diagnosed as unexplained antepartum hemorrhage. 15 of the 48 had poor outcome, 7 of them were premature deliveries. The results of Doppler studies of uterine and umbilical arteries, fetal biophysical profile or FHR variation were not significantly different between the 2 outcome groups. There was no significant difference in outcome between the women with unexplained APH and the matched comparison group. It was concluded that morbidity related to unexplained APH is associated with preterm delivery rather than with damaged utero-placental function

Perinatal fetal outcome in mild polyhydramnios

Mild polyhydramnios was defined sonographically as an amniotic fluid index of 24.1-39.9 during fetal biophysical testing. All subjects had singleton gestations not complicated by conditions known to predispose to polyhydramnios. Mild polyhydramnios was diagnosed in 48 of 279 patients [8.2%] undergoing fetal testing at 26-42 gestational weeks. Premature delivery, intrapartum complications, and neonatal depression were no more frequent in the pregnancies complicated by mild, unexplained polyhydramnios than in a comparable control group with normal fluid volume. The mild polyhydramnios group showed a significantly higher incidence of birth weight greater than 4000 g than did the control group [18.66 versus 8.6%, P <0.05]. It was concluded that mild idiopathic polyhydramnios in late gestation is relatively common. Except for a higher incidence of large for gestational age fetuses, this condition by itself is not associated with an increased risk of adverse perinatal outcomes

Role of prostaglandin in the management of prelabour of the membranes at term

To compare conservative versus prostaglandin augmentation of prelabor rupture of membranes [P.R.O.M.] in healthy primigravidae women at term, 50 patients were chosen for conservative management [group 1] and 50 patients for active management [group 2]. Group 1 was observed up to 24 hours after P.R.O.M. in hospital, while group 2 was managed with PGE2 gel [2 mg] installed into the posterior fornix and repeated after 6 hours [1 mg] in both groups. If labor was not established 24 hours later, intravenous [I.V.] oxytocin was given by titration. There was a significant reduction in the [P.R.O.M.] to delivery time in the prostaglandin group without a significant increase in infective morbidity or cesarean section rate, and fewer women required oxytocin augmentation. In the conservative group, [51%] required oxytocin augmentation compared with [31%] in the PGE2 group

Doppler umbilical artery flow velocity waveforms in relation to birth weight in high risk pregnancy

High risk population at Um El-Queen Hospital were investigated with the Doppler umbilical artery FVW forms and correlated with cardiotocography and biophysical profile. There were 56 high risk patients including insulin dependent diabetes, pregnancy induced hypertension [P.I.H.], chronic hypertension, suspected intrauterine growth retardation [I.U.G.R.], and 70 control patients. 9 of high risk patients showed abnormal umbilical artery FVW values but only 3 of them showed antenatal fetal compromise. Only 5 of this 9 cases had intrauterine growth retardation [I.U.G.R.] with birth weight less than 50th centile. It is shown that umbilical artery FVW may be normal yet fetal compromise may be present or occurs shortly with possible I.U.F.D., this is more true in cases of diabetic pregnancy. There is more positive correlation between umbilical artery FVW and biophysical profile and N.S.T. in other types of high risk pregnancies including pregnancy induced hypertension growth retardation. FVW can not be relied on in diabetic pregnancy