Outcome of the first trimester threatened miscarriage: study of the predicting factors

Background: Threatened miscarriage is a distressing condition to both pregnant woman and gynecologist. It is important to predict the outcome of threatened miscarriage through maternal history, biochemical tests, and fetal ultrasound for patient counseling and to avoid delay in management.Study designA prospective multiple logistic regression analysis study

Objective: To assess the power of factors which are maternal history [age, vaginal bleeding, parity and hypertension], biochemical tests [beta-hCG and serum progesterone level] and fetal ultrasound [crown rump lengthand fetal heart rate] for predicting the outcome of pregnancy [fetal demise and ongoing pregnancy] complicated by threatened miscarriage between 7-11 wks and to determine the time interval from onset of symptoms to fetal demise development

Patients and Methods: The study was carried out on 80 pregnant women at their 7-11 weeks of gestation suffering from vaginal bleeding attending Al-Elwiya Maternity Teaching hospital. They were subjected to ultrasound to confirm fetal viability, assay of serum progesterone and beta-hCG levels and pain with bleeding scores. All these were repeated on weekly basis for four weeks follow up to monitor the pregnancy and identify the period to fetal demise [if happened]. The data is gathered on questionnaire paper and then subjected to statistical study

Results: The beta-hCG [human chorionic gonadotrophin hormone] level was found to be the main predictor for pregnancy outcome [miscarriage/fetal demise and ongoing pregnancy] and highly statistically significant [P value<0.0012], followed by bleeding [p <0.002] and maternal age [p<0.01] respectively, while other variables [serum progesterone, fetal ultrasound, parity] showed no statistically significant effect [P value=0.47, 0.63, 1.146 respectively] on the risk of miscarriage/fetal demise. Serum progesterone level was highly significant in predicting ongoing pregnancy [P value=0.001]

Conclusion: Measuring of beta hCG levels is found to be a good predictor for the outcome of the first trimester threatened miscarriage whether ends in to fetal demise or continuing pregnancy, while other factors like ultrasound, serum progesterone levels and parity are useful in assessing an ongoing pregnancy but have no power in predicting possibility of fetal demise. Also measuring the interval from the onset of bleeding to fetal demise development can be useful to avoid delaying pregnancy management

Role of serum progesterone in the diagnosis of ectopic pregnancy and missed abortion

Diagnosis of early pregnancy failure [ectopic pregnancy and missed abortion] still challenging even by using of serial B-HCG and ultrasound. Serum progesterone hormone level value is regarded as one of the important diagnostic tools in the diagnosis of many obstetrical and gynecological conditions; one of these is early pregnancy failure. To assess the role of serum progesterone level in early diagnosis of ectopic pregnancy and missed abortion. The study is conducted at Al-Elwiyah Maternity Teaching Hospital throughout the period between [April 2010 -July 2011]. Ninety women participated in the study, they are at their early weeks of gestation [6-10] weeks. Their ages were between 18-40 years. thirty of them served as a control group [normal intrauterine pregnancy] and sixty pregnant women included in the study group and subcategorized into 2 groups. thirty women with suspected sub-acute or chronic cases of ectopic pregnancy according to ultrasound and beta-HCG results and 30 women served as suspected missed abortion. blood samples were taken from the three groups followed by another blood samples after two-day interval to measure of serum progesterone levels. the results were compared among the three groups at first and second readings. p-value, standard deviation and 95% confidence interval calculated and statistically analyzed. P-value of the serial measurements of serum progesterone levels in two-day interval in the three groups was statistically insignificant. while serum progesterone levels of both ectopic pregnancy and missed abortion were greatly lower than serum progesterone levels of normal intrauterine pregnancy in both first and second readings, with statistically significant deference, P-value is. Serum progesterone levels has a useful role in diagnosing ectopic pregnancy and missed abortion

Whether selective or routine episiotomy is more useful to protect anal sphincter in primiparous women

Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concern for many women and in some countries has led to a large increase in the numbers of women requesting elective caesarean section. To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous women. This study is a prospective interventional clinical study conducted at AL Elwiya Maternity Teaching Hospital in Baghdad throughout the period between Jan. 2009-Dec. 2009. Three hundred term primiparous ladies at time of their delivery with cephalic presentation were collected and subdivided into 3 equal groups randomly. The first group, women who were subjected to routine mediolateral episiotomy, while the second group of the participants were delivered without doing episiotomy, and the third group, a mediolateral episiotomy was done selectively to them when we found it is necessary [selective episiotomy]. State of the perineum, length of 2[nd] stage, weight of the baby, fetal head position and the occurrence of anal sphincter injury were all notified and carefully recorded on special form designed for the study. Selective episiotomy was found to be more useful than routine episiotomy in preventing anal sphincter injury [the incidence of anal sphincter injury was 2% for those in whom episiotomy was performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered without episiotomy], and the difference is statistically significant [P value 0.045]. There was a significant effect of the length of second stage of labour on the incidence of anal sphincter injury [P value 0.017], similarly for the weight of baby [P value 0.017]. Selective episiotomy is more useful intervention than routine episiotomy in protecting the anal sphincter when delivering a primiparous lady

Perinatal outcome of breech presentation in the presentation in the pretext mode of delivery

To choose the best mode of delivery for term, frank or complete, breech presentation through studying the perinatal outcome of each mode of delivery decided when managing a group of pregnant ladies presented with breech delivery in our centre. One hundred and fifty pregnant ladies presented at term with singleton, frank or complete, breech presentation for delivery in our centre during the period from May 2004 to August 2005. Mode of delivery, parity, gestational age, maternal age, maternal medical illness, and birth weight where the variables that have been tested in each delivery included in the study to verify their relationship to perinatal outcome. No significant relationship is found between the occurrence of adverse perinatal outcome and the variables. However, mode of delivery was the major determinant of the perinatal outcome. Of the 150 pregnant ladies, 46 were delivered vaginally, 32 had elective caesarean section, and the remaining 54 pregnant, had undergone an emergency caesarean section because they were presented with labour. Thirteen [8.6%] babies were adversely affected by the process of delivery, 9 [5%] of them were delivered by vaginal route, 3 [2%] delivered by emergency caesarean section and one [0.6%] by elective caesarean section. Elective caesarean section is regarded the safest way of delivery for those with term, frank or complete, breech presentation

Effect of pentoxifylline on the outcome of artificial inseminations

To highlight the effect of Motility Stimulant Pentoxifylline [PF] used to activate semen samples when managing couples suffering from primary Infertility due to either unexplained reasons or mild male factors by Artificial Insemination. Prospective study. Institution of Infertility Treatment and Embryo Research, Al-Nahrain University, Baghdad -Iraq. Ninety four couples suffering from mild male or unexplained primary infertility were involved in this study. According to results of Postcoital test [PCT] performed to the participants prior to Insemination, they were divided into two groups. Group 1 [67 couples] women with positive [+ve] PCT [>5 motile sperm /HPF], they underwent alternative cycles of Intra- uterine and Intra-cervical Inseminations [IUI] [ICI]. Group 2 [27 couples] those with negative [-ve] PCT [< 5 motile sperm/HPF], they were inseminated by intra-uterine method only. The couples underwent 120 insemination cycles. PF was added following sperm washing in 81 inseminations. Where as 39 inseminations were performed after sperm washing technique only. The study recorded 18% pregnancy rate [17 out of 94 women]. IUI was done in 72 cycles in which PF was added following sperm washing in 48 cycles resulting in 10 pregnancies [20.8%]. While only two women conceived form 24 IUI cycles without using PF [8.3%]. This difference is statistically significant [P<0.05]. On the other hand, ICI was done in 48 cycles; PF was used in 33 cycles successfully resulting in 5 pregnancies [35.15%]. Whereas, no pregnancy recorded when PF not used in the remaining 15 ICI. PF was used in 81 insemination cycles treated by IUI or ICI had resulted in 15 pregnancies [18.5%]. This result is significantly higher [P<0.05] than the recorded pregnancy rate of the control group in whom 39 inseminations with IUI and ICI done without using PF [2/39, 5.1%]. Pentoxifylline improves pregnancy rate when used to activate sperm function in both Intrauterine and Intracervical Inseminations