value of urinary calcium in prediction of pregnancy induced hypertension [PIH]

Maternal and perinatal mortality and morbidity still remain high if PIH is diagnosed late. One hundred normotensive primigravidae participated in this work. Starting from first trimester, the 24 hour urinary calcium excretion was measured at the end of each trimester. Ninety one cases completed follow up program, of them 11 [12%] developed PIH during the third trimester [7 pre eclampsia and 4 gestational hypertension]. The mean 24 hour urinary calcium excretion was significantly reduced [P < 0.001] in patients with pre-eclampsia [172 +/- 9.8 mg / 24 hour] and in patients with gestational hypertension [249.5 +/- 5.9 mg / 24 hour] compared to the normotensive group [296.5 +/- 21.2 mg / 24 hour]. The level was significantly reduced [P < 0.001] during the second trimester in cases who ultimately developed pre eclampsia in third trimester. Similar finding was not observed in gestational hypertension group. This work shows that measurement of urinary calcium during the second trimester is a good indicator for the ultimate development of pre eclampsia in addition to its value in confirming diagnosis of already developed pre eclampsia

Impact of vulval warts on uterine cervix-new colposcopic finding

There is a growing interest in human papilloma virus [HPV] infection of the cervix. The aim of, this work, is to study the impact of vulval warts on HPV related cervical disease and to compare, the results with findings in women without vulva warts. Seventy women paticipated in this work: 30 cases with vulval warts [study group] and 40 cases withhout vulval warts [control group]. All cases were subjected for full medical history, cervicovaginal cytology, colposcopy and biopsy from colposcopically abnormal areas. Cytological examination revealed 7 cases with cervical HPV infection [23.3%] in the study group, compared to 2 cases in the control group [5%] [P<0.01]. Three study cases showed dyskaryosis [2 mild and one moderate]. Abnormal colposcopic findings were detected in 13 cases of the study group [43.2%], compared to 3 cases [7.5%] of the control group [P<0.01]. The finding of micropapillary aceto - white epithelium with partial iodine uptake was prominently associated with cervical HPV infection in cases of vulval warts. Histopathology of the colposcopically directed biopsies revealed 5 cases with HPV infection [Flat condyloma in 2 cases and flat condyloma with CINI in 3 cases] and 2 cases with CIN, [one CINI I and one CIN II] in the study group, compared to only one cases of flat condyloma in the control group. The importance of these findings are discussed

Fetal acoustic stimulation in early labour: a screening test for candidates of continuous FHR monitoring in low risk parturients

This work was done to investigate the value of fetal acoustic stimulation test in early labour as a predictor of fetal outcome and its usefulness as a screening test. One hundred and sixty four low risk parturients, with a singleton fetus in cephalic presentation, gestational age 37 - 41 weeks and in latent phase of labour with cervical dilatation less than 4cm were screened by the admission test for 20 minutes followed by fetal acoustic stimulation test. Abnormal response to fetal acoustic stimulation test [type II and III] was observed in 3.35% after reactive admission test and in 11.1% after equivocal admission test compared to 66.7% after ominous admission test [P < 0.001, < 0.05 respectively]. The incidence of fetal distress after reactive admission test and normal fetal acoustic stimulation test [type IA and IB] was 1.4% compared to 20% with reactive admission test and abnormal fetal acoustic stimulation [P < 0.01]. Equivocal or ominous admission test with normal fetal acoustic stimulation was associated with 10% incidence of fetal distress compared to 60% with equivocal or ominous admission test and abnormal fetal acoustic stimulation [P < 0.05]. The negative predictive value of fetal acoustic stimulation test was 98.1% and its positive predictive value was 40% compared to 26.7% for admission test. Fetal acoustic stimulation test in early labour appears to be a valuable screening test to label parturients for low, or high, risk category for intrapaturn fetal distress. In addition the test overcomes the problems of interpretation of equivocal traces

Cervical ripening by extra-amniotic normal saline instillation versus prostaglandin - E2 vaginal tablets

Seventy-five pregnant patients with unripe cervix [Bishop score < /= 4] were randomly subjected to two treatment protocols for cervical ripening. Group A consisted of 40 pregnant women managed by extra-amniotic saline instillation at a rate of 1 ml/minute. Group B consisted of 35 pregnant women who received prostaglandin-E2[3mg] vaginal tablets. Cervical ripening occured over a significantly shorter mean duration among group A [4.04 +/- 1.29 hours] compared to group B [7.78 +/- 2.64 hours] [P < 0,01]. Mean post-ripening Bishop score was significantly higher in group A [7.07 +/- 0.38] compared to group B [5. 2 +/- 0.77] [P < 0.01]. Oxytocin stimulation was more frequently required [P < 0.05] and at a significantly nigher mean dose [< 0.05] following cervical ripening with extraamniotic saline instillation. A significantly longer mean total induction-delivery time [P < 0.05] and a significantly higher incidence of uterine hyperstimulation and abnormal FHR tracing [P < 0.01] were encountered among the prostaglandin-treated group. There was no significant difference between the two groups regarding the mode of delivery and the neonatal condition at birth [P > 0.05]. No serious side effects were registered in either group. Thus, extra-amniotic saline instillation may be considered as a cheap, effective, safe and tolerable method of cervical ripening that is always available

Effect of percoll wash on sperm motility in artificial insemination

In this work the semen of 25 patients with initial motility 60% or less were subjected to Percoll gradient wash for sperm preparation for assisted reproductive technology. We have assessed the three motility parameters [percentage, types, longevity] before and after the wash. The mean sperm number was 50.9 +/- 16.4 million/ml. The initial sperm motility before the wash was ranging from 5% to 60% with a mean 41.12% +/- 16.44%. After percoll gradient wash sperm rnotility has been increased to 61.8 +/- 29.96% [P < 0.0025]. Percoll gradient wash eleminated sperms with motility grade O and grade 1. only sperms with motility grades 2,3 and 4 were present. We recommend the use of Percoll wash for sperm lipreparation especially in patients with asthenospermia whom will be treated by AIH

Diathermy large loop excision of thansformation zone [LLETZ] as a treatment of cervical intraepithelial neoplasia [CIN]: the use of a cheap, locally made, replacable loop

In selectcd cases with CIN, outpatient excisional procedures represent a readily accepted and highly effective modality of treatment The aim of this work is to evaluate the efficacy of a cheap, locally made, replacable stainless steel loop electrode used with an ordinary diathermy generator and local anaesthesia using a dental syringe, in LLETZ procedure. 18 patients with histologically proved CIN were selected for this study. The mean duration of the procedure was 3.94 +/- 0.72 minutes [range 3 to 5 minutes]. The procedure was well tolerated by the patients, only 2 [11.2%] experienced mild discomfort. Haemorrhagic morbidity was not a problem. one patient [5.6%] had mild operative bleeding and 2 [11.2%] had mild postoperative bleeding after 2 hours that was easily controlled. All the LLETZ specimens were adequate for histopathological diagnosis and there was a good correlation between pretreatment and LLETZ specimens, with undercall diagnosis in only one case [5.6%]. After 3 months 17 patients and 6 months 15 patients, returned for follow up. Cytological follow up was completely normal after 3 months. but showed one case of HPV after 6 months. Colposcopy was normal after 3 months with 2 unsatisfactory Colposcopy but it showed one case with acetowhite epithelium [flat condyloma on pathology] and one unsatisfactory colposcopy after 6 months. Our patient diathermy LLETZ with cheap, replacable loops and dental syringe local anaesthesia, are cost effective, and well tolerated alternative to other modalities for treatment of CIN