Assessment of the prevalence of pelvic floor disorders in both vaginal and cesarean deliveries and their impact on the quality of life

Background: pelvic floor disorders [PFDs] occurring in women comprises a broad range of clinical scenarios such as pelvic organ prolapse [POP] and stress urinary incontinence [SUI]

Aim of the work: the objectives of the present study were to estimate differences in the prevalence of pelvic floor disorders [POP and SUI] in Egyptian women by mode of delivery and their impact on patients' quality of life using assessment questionnaire

Materials and Methods: this observational [non-interventional] cohort study was conducted on 464 parous women from the gynecologic out-patient clinic of Ain Shams Maternity University Hospital for measuring the prevalence of POP and UI regards the mode of delivery in women delivered 5 years back or more and its impact on the quality of their lives. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification method [POP-Q], and pelvic floor symptoms were evaluated using assessment questionnaire

Results: our study found that compared to Cesarean Section [CS; 32.8%], vaginal delivery [VD] was associated with statistically significant increase in the occurrence [43.5%] and severity [Moderate-to-severe UI [39.6% in VD vs. 10.5% in CS]] of UI especially SUI [VD vs. CS: 62.4% vs. 51.3%]. Vaginal delivery was associated with more than double the occurrence of POP [19.4% vs. 8.2% in CS], and more than triple the concomitant occurrence of both POP and SUI [9.9% vs. 2.6% in CS]

Conclusion: there is a positive correlation between the mode of delivery - as an independent factor - and the prevalence of pelvic floor disorders [both pelvic organs prolapse and urinary incontinence] in parous women

Thrombophilia and pregnancy outcomes

Pregnancy complications are still a challenge for physicians, because knowledge of pathomechanisms and prophylactic measures is still limited. In recent years thrombophilia as a risk factor for pregnancy complications has gained much attention in the scientific community. To study the rate of thrombophillia gene in cases with recurrent abortion. In the period between January 2006 and May 2007, 40 consecutive patients with a history of recurrent failed IVF and abortion, defined as fetal loss before 16 weeks' gestational age, were screened by the following tests: Molecular diagnosis of 11 thromobophilia gene mutation, ACL IgG and IgM. PtC, PtS. ATIII and Lupus anticoagulants. 40 patients were included in this study and the following data was recorded: All cases were negative to protein C, S and anti T Ill. One case showed positive anti cardiolipin Ig M-3 cases positive for Lupus anticoagulant, all the cases were positive for multiple thrombophillia genes. The observed rate of successful pregnancies of women treated with aspirin, who had mild thrombophilia and a history of a single abortion, is much lower than it would haye been expected from patient treated with combined therapy

Epidural dexamethasone reduces postoperative pain and analgesic requirements after major gynecological operations

Epidural steroids may have potential advantages for providing postoperative analgesia. This study was done to evaluate the efficacy of epidurally administered dexamethasone in reducing postoperative morphine requirements, as a measure of analgesia following major gynecological operations. In a randomized, double-blind study, 75 patients undergoing major gynecological operations were randomly assigned to three equal groups. Group I [control] patients received dexamethasone 5mg iv with epidural injection of 0.25% bupivacaine 8ml and normal saline 2ml, Group 2 [D[1]] patients received normal saline 2ml iv with epidural injection of 0.25% bupivacaine 8ml and dexamethasone 5mg in normal saline 2ml, and Group 3 [D[2]] patients received normal saline 2ml iv with epidural injection of dexamethasone 5mg in normal saline 10ml. After surgery, morphine 2-4mg iv was administered as needed for analgesia. Postoperative morphine requirements, visual analogue scale [VAS] pain scores at rest and with effort, and time to first analgesic administration were recorded. Total morphine consumption for the first 24 hours following surgery was significantly lower in both epidural dexamethasone groups [D[1], D[2]] compared to the control group [p<0.05]. The percentage reduction in morphine consumption in Group D[1] was 56.9% and Group D[1] was 51.4% in the first 24 hr. Postoperatively at 12 hr, 18 hr, 24 hr, the VAS scores at rest and during effort were also significantly lower in the epidural dexamethasone groups [D[1], D[2]] compared to the control group [p < 0.05]. Preoperative epidural administration of dexamethasone 5 mg, with or without bupivacaine, reduces postoperative pain and morphine consumption following major gynecological operations

Early detection of fetal gender from maternal blood using polymerase chain reaction

Molecular analysis of serum and plasma DNA during human pregnancy has led to the discovery that maternal blood contains fetal DNA. This valuable source of fetal DNA opens up new possibilities for noninvasive detection of fetal sex or prenatal diagnosis of various sex linked diseases. DNA was extracted from each serum and plasma sample of 25 cases of normal pregnancy, ranging from 10-16 weeks gestation to detect the Y chromosome specific sequences DYS14 in maternal blood, polymerase chain reaction [PCR] were carried out for each DNA extract. The result revealed that 13 out of 25 pregnant women had a Y chromosome specific sequence in their serum samples and 11 of them had Y chromosome specific sequence in their plasma, when doing pelvic U/S at 21 weeks gestation, all 13 cases were diagnosed having male fetus and this was confirmed after delivery