use of Sengstaken - Blakemore tube to control postpartum hemorrhage: Ain Shams University experience

To evaluate the efficacy of Sengstaken - Blakemore tube to control cases of intractable postpartum hemorrhage [PPH]. Cases of intractable PPH admitted at Ain Shams University Maternity Hospital from April 2005 to December 2006 and managed by Sengstaken-Blakemore tube after exclusion of other causes of PPH are reviewed. Eighteen cases were managed by Sengstaken-Blakemore tube. The most common cause of PPH was uterine atony in 10 cases [56%] followed by coagulopathy in 5 [28%] and placenta accreta in 3 [17%]. Twelve cases [66%] were delivered vaginally and six cases had a cesarean section. The procedure successfully arrested the bleeding in 16 out of 18 cases [88.8%]. All six cases delivered by cesarean section had additionally internal iliac artery ligation before applying the Sengstaken-Blakemore tube However, in cases delivered vaginally, tile balloon was used first in order to avoid laparatomy. The mean blood transfusion unit given was 4.5 units of packed RBCs and 2.1 units fresh frozen plasma. Time mean volume of maximum balloon inflation was 225 ml and the mean duration of application was 33 hours with a mean blood loss through the drainage tube of 233.3 ml. The two unsuccessful cases followed vaginal deliveries and both were salvaged by undergoing supravaginal hysterectomy after failure of internal iliac artery ligation in controlling bleeding. The application of Sengstaken-Blakemore tube in selected cases of intractable PPH appears to be simple, safe and atraumatic sparing patients an unnecessary difficult surgical intervention

use of Sengstaken - Blakemore tube to control postpartum hemorrhage: Ain Shams University experience

To evaluate the efficacy of Sengstaken- Blakemore tube to control cases of intractable postpartum hemorrhage [PPH]. Cases of intractable PPH admitted at Ain Shams University Maternity Hospital from April 2005 to December 2006 and managed by Sengstaken Blakemore tube after exclusion of other causes of PPH are reviewed. Eighteen Cases were managed by Sengstaken- Blakemore tube. The most common cause of PPH was uterine atony in 10 cases [56%] Followed by coagulopathy in 5 [28%] and Placenta accreta in 3 [17%] Twelve cases [66%] were delivered vaginally and six cases had a cesarean section. The procedure successfully, arrested the bleeding in 16 out of 18 cases [88.8%]. All six Cases delivered by cesarean section had additionally internal iliac artery ligation before applying the Sengstaken- Blakemore tube. However, in cases delivered vaginally, the balloon Was used first in order to avoid laparatomy The mean blood transfusion unit given was 4.5 units of packed RBCs and 2.1 units fresh frozen plasma. The mean volume of maximum balloon inflation was 225 ml and the mean duration of application was 33 hours with a mean blood loss through the drainage tube of 233.3 ml. The two unsuccessful cases followed vaginal deliveries and both were salvaged by undergoing supravaginal hysterectomy after failure of internal iliac artery ligation in controlling bleeding. The application of Sengstaken- Blakemore tube in selected cases of intractable PPH appear to be simple safe and atraumatic sparing patients an unnecessary difficult surgical intervention

Randomized trial of effect of metformin on some endocrine and metabolic parameters in women with insulin resistance related polycystic ovarian syndrome

To evaluate the effect of metformin [3-6 months therapy] on the clinical, endocrinal, metabolic, and ovulatory performance in women with insulin resistance-related polycystic ovarian syndrome [PCOS]. 60 women with insulin resistant polycystic ovarian syndrome [PCOS] were included and divided equally between clomiphene citrate [100 mg daily for five days], metformin [500 mg tablet 3 times per day] and combined clomiphene citrate and metformin treatments for 3-6 months. All the women had a fasting insulin level of > 10 micro U/ml and an accumulated insulin level [area under the curve for insulin during a 2-hour, 75-g oral glucose tolerance test] of > 5,000 micro U/ml/min. The primary outcome variable was the rate of ovulation. Our secondary outcome variables included clinical variables [menstrual pattern, body weight, BMI, hirsuitism score], endocrine variables [levels of LH, FSH, testosterone, SHBG] and metabolic variables [fasting glucose, fasting insulin, accumulated insulin level, LDL, HDL, cholesterol, triglycerides]. Statistical analysis included X2, Fisher exact for count variables and the ANOVA test for parametric continuous data. Kolmogoroy-Smirnov test was used to examine he distributional characteristics of the continuous variable. The significance level was chosen at P <.05. Patients who were treated with Metformin and Clomiphene have a significantly higher ovulation rate [69. 7%] than those treated with clomiphene [35.5%] or metformin alone [44.5%]. Clomiphene therapy was associated with significant reduction of oligomenorrhea and amenorrhea, significant increase in tile frequency of regular cycles and significant increase in the serum progesterone level but no significant difference regarding the other clinical and endocrine parameters nor any effect on the metabolic parameters. The use of metformin either alone or in addition to clomiphene was associated with significant reduction of body weight, BMI, hairsuitism and the frequency of amenorrhea/oligomenorrhea. Regarding the endocrine parameters, it's associated with significant reduction of LH level, testosterone level and sign increase in SHBG and serum progesterone level. It's also associated with significant reduction of the fasting glucose level, fasting insulin level, AUC insulin, total cholesterol, triglycerides, LDL and significant increase in HDL. There was no difference among the three study groups as regards the body weight, BMI, hairsuitism score, frequency of regular menses, serum FSH level, serum progesterone level, fasting glucose level and serum LDL level. Patients who were treated with either Metfarmin or Metformin and Clomiphene, had a significant lower level of LH/FSH ratio, testosterone, fasting insulin level, AUC insulin, total cholesterol and serum triglycerides level, and significant higher level of SHBG and serum HDL. This study concluded that metformin plus clomiphene is more effective than clomephine alone in inducing ovulation in patients with insulin-resistant PCOS. Moreover, it's more effective in reducing the testosterone level, normalizes the glucose tolerance and improves lipid profile

Can antioxidants prevent preeclampsia?

To investigate the role of superoxide dismutase [SOD] in healthy pregnant women and in pregnant women with preeclampsia. The study was carried out on 80 pregnant ladies selected from the outpatient clinic of the Ain Shams University Maternity Hospital. They were classified into two groups: The control group: Consisting of 50 healthy pregnant ladies. The patients groups: Consisting of 30 ladies diagnosed as preeclamptic patients. All patients were subjected to history taking, clinical examination and blood chemistry for evaluation of SOD level using spectrophotometric assay. Compared with values in normotensive pregnant women. Preeclamptic patients had significantly lower SOD level being 1.54 +/- 0.60 vs. 0.63 +/- 0.36 Units/ml respectively. A cut-off point was detected below which preeclampsia supervenes. This level was calculated to be 1.01 U/ml. The decreased activity of the antioxidant enzyme superoxide dismutase may play an important role in the pathogenesis of preeclampsia and hence the possibility of the use of antioxidant drugs in high-risk patients which may be of a prophylactic value. The presence of a cut-off point of SOD level may be of value in the preeclampsia prediction issue in high-risk patients

Value of single progesterone evaluation versus doubling of beta-hCG as predictors of unhealthy pregnancies in patients with first trimesteric threatened abortion

To assess the ability to use Progesterone as a predictor of spontaneous first trimesteric miscarriage, in patients complaining of threatened abortion, also, to compare Progesterone with Beta-hCG doubling as another predictor of unhealthy [non-viable] first trimesteric pregnancies. Fifty patients complaining of threatened abortion were recruited in this study. All of them underwent evaluation of serum Progesterone level at eight weeks of pregnancy, as well as Beta-hCG measurement two times, 48 hours apart. All the subjects were then followed up till the end of the first trimester by Ultrasound to check fetal life. showed that correlation between both parameters and prognosis of pregnancy is strong. Also, low levels of Progesterone below 15 ng/ml, were associated with increased risk of abortion, lastly, the study demonstrated that a single measurement of Progesterone can be used alone at eight weeks to evaluate the prognosis of patients with first trimesteric abortion. From the study, we can conclude that the single evaluation of serum Progesterone, in patients with first trimesteric threatened abortion, as early as 8 weeks of pregnancy, is comparably effective with Beta-hCG doubling, in predicting pregnancy outcome