Combined low dose aspirin and 17 alpha hydroxyl progesterone versus 17 alpha hydroxyl progesterone alone study in pregnancy: a randomized clinical trial for prevention of spontaneous preterm birth

Background: Preterm birth: defined as any live birth occurring through the end of the last day of the 37th week [259th day] following the onset of the last menstrual period. Low-dose aspirin [LDA] has been noted to reduce the preterm birth [PTB] rate in multiple meta-analyses of the preeclampsia [PreE] prevention trials. It is unclear if this effect of LDA is entirely due to a reduction in indicated PTB versus reductions in preterm premature rupture of membranes [PPROM] or spontaneous PTB. In the Maternal-Fetal Medicine Unit [MFMU] high-risk aspirin [HRA] study, a near significant decrease in PTB was found despite no effect on preeclampsia. The objective of this study was to assess the impact of LDA on indicated PTB, spontaneous PTB, and PPROM PTB in the MFMU HRA study population

Aim of the work: This study aim to assess the efficacy of 17 alpha hydroxyl progesterone and low dose aspirin in reducing the rate of preterm birth in pregnant women at this risk

Patients and Methods: Study type: A double blinded randomized placebo controlled clinical trial

Study settings: This study conducted at outpatient clinic of Ain Shams University Maternity Hospital

Time of the study: The study was held from August 2016 to November 2017

Results: Data was analyzed according to the intention-to-treat principle. In a total 400 women whom recruited in the study, 160 were excluded. So we ended in to 240 women whom randomized and allocated in to 2 groups to intervention. Primary outcome measure was preterm birth. The most important secondary outcome is a composite of poor neonatal outcome [including bronchopulmonary dysplasia [BPD], periventricular leucomalacia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity [ROP], sepsis and perinatal death].There was no statistically significant difference between both groups as regarding to age, gravidity, parity, body mass index, mean cervical length, and number of previous preterm labor. There was no significant difference between two groups as regard preterm premature rupture of membranes [P.PROM].There was no significant difference between two groups as regard time of delivery there was no significant difference between both groups in Need for NICU admission, neonatal birth weight, APGAR score, fetal complications [RDS, jaundice, BPD, HIE, NEC, bleeding, sepsis or even neonatal death].Long term neurodevelopmental complications was not conducted at this study as it needs more time.In maternal complications there was no significant difference between both groups

Conclusion: Further randomized controlled trials with larger sample size should be done to demonstrate the efficacy of low dose Aspirin in prevention of preterm labor and its complications

Lidocaine for pain control during intrauterine device insertion: a randomized clinical trial

Background: Intrauterine contraceptive device [IUCD] is one of the most common contraception methods. In a survey of female Fellows of the American College of Obstetricians and Gynecologists, the prevalence of personal IUCD use was >20-fold higher than among women in the general population. In statistical terms, The IUCD is used by approximately 15% of reproductive-aged women in developing countries and 8% in developed countries

Aim of work: To compare the safety and efficacy of different local lidocaine preparations [spray, cream and injection] for reducing pain associated with IUCD insertion

Patients and Methods: This is a prospective randomized clinical trial. The study was conducted at Ain Shams University Maternity hospital at family planning outpatient clinic during the period between December 2017 and June 2018

Results: Results proved that lidocaine 10% spray application to the cervix during IUCD insertion effectively reduce pain felt during stages of IUCD insertion and is good option for reduction of pain associated with IUCD insertion in compared with lidocaine injection or cream

Conclusion: Our study demonstrated that local lidocaine spray 10% is effective in control of pain associated with IUCD insertion when compared with lidocaine cream or injection because its application is easy and rapid, while lidocaine injection can also reduce pain but injection itself is painful that makes it unfavorable method

Assessment of optic disc perfusion in open angle glaucoma [oag] using optical coherence tomography angiography [octa]

Background: glaucoma is a major disease that potentially results in irreversible blindness, some prospective studies demonstrated that in primary open-angle glaucoma [POAG], blood flow is diminished in the ophthalmic, retinal, choroid and retro-bulbar circulations

Aim of the Work: this study aimed to compare Optic disc perfusion in normal healthy persons with that of Open Angle Glaucoma [OAG] patients by using Optical Coherence Tomography Angiography [OCTA] and to see if a correlation exists between optic disc perfusion, visual field changes and retinal nerve fiber layer thickness in normal healthy persons and in OAG patients

Patients and Methods: we did an analysis of optic disc perfusion in two groups of normal healthy persons and primary open angle glaucoma patients who were previously diagnosed and attended follow up in outpatient clinic in Sayed Galal University Hospital located in Cairo. In our study we included 22 eyes of 12 people, [10 normal eyes and 12 Open angle glaucoma patients eyes] aged between 20 and 78 years old

Results: there was a statistically significant relationship between optic disc perfusion and glaucoma group in comparison with normal group, thus in normal group the optic disc perfusion indicated good optic disc perfusion which was significantly lower in glaucoma group. Also we discovered that there was a statistically significant correlation between optic disc perfusion with [Visual field changes and RNFL thickness]

Conclusion: optic disc perfusion assessment by using OCT angiography could be beneficial in evaluation of glaucoma and assessment of disease progression and it's follow up together with Visual Field assessment and clinical examination

Placental cord drainage versus no placental crainage in the management of third stage of labour: randomized controlled trial

Back ground: the third stage of labour begins immediately after the birth of the baby and ends with the expulsion of the placenta and fetal membranes. It is preceded by contraction and retraction of the uterus to reduce uterine size and expel the placenta with minimal haemorrhage. Placental cord drainage involves clamping and cutting of the umbilical cord after the birth of a baby and then, immediately unclamping the maternal side of the cord so the blood can drain freely into a container

Aim of the work: the aim of this study is to assess the effect of placental cord drainage during active management of the third stage of labour on reducing both blood loss and the length of the third stage

Materials and Methods: a randomized controlled trial was carried out on180 patients who underwent vaginal delivery at Ain Shams University Maternity Hospital labour ward. Population of this study were randomly assigned to either: Group A: 90 patients was the study group [cord drainage]. Group B: 90 patients was the control group [no cord drainage]. Moreover, the duration of third stage was compared as the primary outcome. The incidence of postpartum hemorrhage, retained placenta, manual removal of placenta, and the need for blood transfusion were compared

Results: the duration and amount of blood loss of third stage of labour was significantly lower in study group than control group. Furthermore, the Postoperative pulse rate, Systolic Blood Pressure, Diastolic Blood Pressure, Hemoglobin and hematocrit value were significantly higher in study group than control group. The retained placenta [manual removal], Postpartum hemorrhageand Blood transfusion were non-significantly less frequent among study group than among control group

Conclusion: active management of the third stage of labour with the cord drainage method significantly reduced postpartum hemorrhage and the duration of the third stage