Study of histopathological changes in endometriumand myometrium of uteri treated with thermalablation using foley's catheter

Dysfunctional uterine bleeding is a disabling condition for which many women seek medicaladvice. Medical treatment is often initiated and is only effective in around 50% ofwomen.For those intolerantor unresponsive to medical therapy, and/or for whom fertility is no longer desired and/or for whom hysterectomy isan unaccepted choice, a number of minimally invasive surgical options now exist and are collectively termedendometrial ablation. Endometrial ablation may be performed with or without hysteroscopic guidance.This work is designed to evaluate the possible safety and efficacy of the use of Foley's catheter as anew method of endometrial thermal ablation in the treatment of DUB through the study of immediatehistopathological changes occurring in endometrium and myometrium of uteri treated with thermal ablation usingFoley's catheter with its balloon filled with boiling saline just before hysterectomy. The study included twenty pre-menopausal women with DUB, selected from the outpatient clinic ofShatby Maternity Hospital. Foley's catheter was inserted into the uterine cavity up to thefundus, its balloon was inflated by boilingsaline by a 20 ml syringe through a three way cannula till the point when the side tube just started to bulge at thetip of the syringe and as the cavity could accommodate. The catheter was left inside the uterine cavity for 9minutes. Then hysterectomy was done and the uterus was sent immediately to the histopathology laboratory tostudy histopathologlical changes in the endometrium and myometrium. On the basis of inclusion criteria of this study, and to select twenty patients fulfilling those criteria, thestudy started with a number of 149 patients complaining of abnormally excessive uterine bleeding, and afterevaluation of the cause of their bleeding we found that ninety seven patients had DUB twenty five patients hadfibroids, two patients had cervical polyps, three patients had cervical ulcers, five patients had ovarian cysts, onepatient had solid ovarian tumour, two patients were on anticoagulant therapy due to medical conditions. Twopatients had hepatic dysfunction, one patient had Von- Willbrand diease, one patient had chronic renal failure, onepatient was thyrotoxic, and nine patients were dropped out from the study.On gross cut section of specimens, there was a zone ot hyperaemia in 19 out of 20 cases [95%]. The depth of thiszone ranged from 2 to 7 mm, the corresponding histological picture of the hyperaemic zone was fragmentation ofglands and heamorrhage in the endometrium extending into the underlying myometrium at places.Fragmentationof endometrial glands involving the entire endometrium was seen in 75% of specimens. The rest showed onlypatchy fragmentation. The myometrium was also affected in 60% of biopsies by foci of haemorrhage, and in 55%of biopsies by dilated blood vessels. Thermal endometrial ablation using hot saline in balloon of Foley's catheter is simple, safe and easy.The level of difficulty of performing the balloon procedure is similar to that required for inserting an intrauterinecontraceptive device.The technique does not require the direct use of endometrial visualization, distending solutions and high energysources with their possible dangerous complications met with hysteroscopy

Study of serum vascular endothelial growth factor [VEGF] level among cases of endometrial carcinoma in postmenopausal females

The aim of this work is to correlate the preoperative serum level of vascular endothelial growth factor [VEGF] to proved cases of endometrial carcinoma among the postmenopausal females. The study included forty postmenopausal females that were divided into two subgroups: Group A [cases]: Twenty patients having endometrial carcinoma diagnosed by biopsy from endometrial tissues obtained by dilatation and curettage, admitted to the inpatient department of El Shatby Maternity University Hospital. Group B [control]: Twenty postmenopausal volunteered females with no gynecologic pathology having endometrial thickness less than 4 mm proved by transvaginal ultrasound. The selected females were subjected to thorough personal, family, obstetric, gynecological,history and Physical examination. Transvaginal ultrasound scanning: was done to all cases to measure endometrial thickness and the uterine vessels were visualized and Pulsatility index [PI] and Resistance index [RI] were calculated Estimation of serum vascular endothelial growth factor [VEGF] by enzyme immune assay [EIA] for the Detection of [i]Total human VEGF[i] was done to all patients. Total abdominal hysterectomy and bilateral salpingoophorectomy was done to group A only [patients having endometrial carcinoma] and histopathological examination of the removed tissues was done. The results of the ultrasound measurements of endometrial thickness, color Doppler velocimetry, platelet count and serum VEGF values were compared between both groups. group A [study group] and group B [control group] were compared according to normal statistical tests as regards Age and parity,Weight and height, Age of menarche, Years since menopause, Contraceptive methods used, Platelet count, Endometrial thickness by transvaginal ultrasound, Transvaginal color Doppler velocimetry including: PI, RI and endometrial texture, and Serum VEGF level. Group A [cases] had a mean age of 56.85 +/- 5.174 years and a mean parity of 2.35 +/- 0.813 children; that were not statistically different from group B [control] which had a mean age of 55.15 +/- 2.39 years and a mean parity of 2.95 +/- 1.276 children. Group A [cases] had a significantly lower mean age of menarche of 11.52 +/- 0.89 years than group B [control] which had a mean age of menarche of 12.33 +/- 0.90 years. There was no statistical significant difference between both groups as regard to years since menopause. Group A had mean years since menopause of 5.82 +/- 1.03 years while group B had mean years since menopause of 6.01 +/- 1.11 years. Group A [cases] had a significantly higher mean endometrial thickness of 21.625 +/- 2.923 mm in comparison to group B [control] which had a mean thickness of 3.03 +/- 0.66 mm. Group A [cases] showed significant higher mean serum VEGF level of 258.21 +/- 90.286 ng/ml than group B [control] which had a mean serum VEGF level of 24.415 +/- 7.167 ng/ml. Endometrial thickness measurement by transvaginal ultrasonography is efficient in suspecting endometrial carcinoma in postmenopausal females. Transvaginal color Doppler velocimetry on both uterine arteries did not add on efficacy in the diagnosis of endometrial carcinoma. Serum VEGF was found to be of precious value for the prediction of endometrial carcinoma

Risk of early onset neonatal septicemia in babies born to mothers with pre-eclampsia

The effects of maternal pre-eclampsia on fetal outcome has been a subject of concern for a long time. This prospective study aimed to find out the risk factors of early onset septicemia and its relation to neutropenia in the neonates of the pre-eclamptic mothers. Ninety newborn babies born to mothers with pre-eclampsia and 90 matched born to normal mothers were included. The results showed that the IPETMs and INMs groups demographic data were comparable [p >0.05]. Six neonates of IPEMs developed early onset sepsis versus 2 among INMs. The difference was not statistically significant [p<0.05]. Neutropenia was three-fold more frequent in IPETMs when maternal hypertension was severe

Conclusion: babies of pre-eclamptic mothers had relatively more risk of developing early onset septicemia than those of normal mothers. This risk was significantly more in neutropenic babies than non-neutropenic ones of pre-eclamptic mothers

What is the optimal gestational age for twin delivery

Optimal gestational age for twins remains unclear. The Objective of this study was to evaluate the timing of twin delivery associated with perinatal outcome in gestations of at least 36 weeks. The study was a retrospective analysis of infant and maternal hospital records for a consecutive series of twin deliveries at El-Shatby Hospital. The inclusion criteria were delivery after 36 weeks' gestation during a two-year period, without congenital anomalies or early fetal demise. Adverse perinatal outcome was significantly higher among the twin pregnancies that delivered before 38 weeks' gestation. Twin pregnancies that delivered between 36 and 37 weeks' gestation were 13 times more likely to require neonatal intensive care compared with those who delivered at or after 38 weeks' gestation [95% confidence interval 1.8 to 95.9, p < 0.001]

Conclusion : In uncomplicated twin gestations, delivery at between 36 and 37 weeks' gestation was not assonated with a reduction in neonatal complications compared with deliveries at or after 38 weeks' gestation

Study of the effect of low-dose aspirin in pregnancy on maternal and neonatal aspirin concentrations

The objective of this study is to evaluate maternal and neonatal plasma concentrations of acetylsalicylic acid and salicylic acid and the neonatal endogenous prostanoid formation during Iow-dose aspirin prophylaxis [LDA; 75 mg daily] in pregnant women. Concentrations of acetylsalicylic acid and salicylic acid in maternal plasma after at least 4 weeks of LDA [n = 14] and in umbilical cord plasma of newborns after maternal LDA [n = 7] were determined by gas chromatography-mass spectrometry. Platelet and renal formation of thromboxane A2 and the formation of prostaglandin E2 and prostacyclin were evaluated in vivo by quantification of index metabolites in plasma and urine by gas chromatographymass spectrometry in neonates after maternal LDA [n = 14] and in a control group. The results proved that in the pregnant women, acetylsalicylic acid and salicylic acid concentrations rapidly increased after ingestion of LDA. Acetylsalicylic acid was completely eliminated within 4 hours, whereas salicylic acid was detected with low concentrations at 18 and 21 hours after dosing. In the neonates, acetylsalicylic acid was not detected. Salicylic acid was detected in 1 infant only. Platelet thromboxane A2 formation in the newborn infants was significantly suppressed but recovered within 2 to 3 days after discontinuation of LDA. Renal thromboxane A2 formation and the formation of prostaglandin E2 and prostacyclin were not affected by LDA

Conclusion: In pregnant women who are treated with LDA, acetylsalicylic acid is not completely inactivated in the portal circulation but reaches the uteroplacental circulation and exerts antiplatelet effects in the fetus and newborn

Effect of cleansing the birth canal with antiseptic solution on maternal and neonatal mortality in Alexandria

The objective of this study was to determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnataly. The design was that of a clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. The study took place at El-Shatby University Maternity Hospital [tertiary care hospital], Alexandria, Egypt. A total of 1742 women giving birth in a six month period and their 1790 babies. Cleansing was done as a manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine. The Main outcome measures were the effects of the intervention on neonatal and maternal morbidity and mortality. The results showed that 909 women giving birth to 936 babies were enrolled in the intervention phase and 833 women giving birth to 854 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced [158/936] [16.9%] v 165/854 [19.3%], P< 0.01], as were admissions for neonatal sepsis [7.5 v 17.6 per 1000 live births, P<0.002], overall neonatal mortality [28.9 v 37.5 per 1000 live births, P<0.06], and mortality due to infectious causes [2.1 v 7.0 per 1000 live births, P<0.005]. Among mothers receiving the intervention, admissions related to delivery were reduced [30.0 v 40.8 per 1000 deliveries, P<0.02], as were admissions due to postpartum infections [2.2 v 4.8 per 1000 deliveries, P<0.02] and duration of hospitalization [Wilcoxon P=0.008]. Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality

Fetal pulse oximetry and neonatal outcome

The purpose of this study was to compare the predictive value of intrapartum fetal pulse oximetry with that of fetal blood analysis for an abnormal neonatal outcome in case of abnormal feta heart rate. Fetal oxygen saturation was continuously monitored with Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal heart rate and fetal blood analysis obtained before birth were compared with neonatal status. Abnormal neonatal outcome was defined as umbilical arterial pH