Safety of multiple repeated lower segment caesarean sections

To determine the safety [maternal and neonatal risk] of repeated multiple caesarean sections [>4] by comparing the outcome to a control group with lower number [<3] of repeated caesarean sections. Sixty patients who had previous three or more caesarean delivery [undergone caesarean section for the fourth or more time] were compared to a matched group with lower number of repeated caesarean delivery. The main outcome measures were uterine rupture, hysterectomy, adhesions, blood transfusion, abnormal placentation, postpartum hemorrhage and the perinatal morbidity. There was statistically significant increase in the operative time with higher rate of sever adhesions and blood loss during surgery in the study group compared to the control group. There was statistically significant increase in the incidence of placenta previa, blood transfusion and postpartum hemorrhage in the study group compared to the control group. Compared to the control group, the study group had significantly lower birth weight and higher risk of prematurity. Repeated multiple caesarean section more than three carries a higher incidence of serious maternal and perinatal morbidities, patients with three previous caesarean sections or more should be counseled regarding the potential complications associated with repeated caesarean sectionbefore attempting further pregnancies. Proper antenatal care, follow up and timed surgery are mandatory. The surgery should be conducted by well trained obstetricians in a well equipped obstetric center with blood bank and intensive care unit facilities

Diagnostic accuracy of hysteroscopy and transvaginal ultrasonography in postmenopausal bleeding

To determine the diagnostic accuracy of transvaginal ultrasound and hysteroscopy in women with postmenopausal bleeding. Between January 1, 2008 and June 30, 2010, 60 women presented to gynaecology outpatient clinics in Aswan, Al-Sahel and Benha teaching hospitals with postmenopausal bleeding were enrolled in this prospective study. They underwent transvaginal ultrasonography followed by hysterpscopy and were submitted to directed biopsy during hysteroscopy. Results were classified as normal/atrophic endometrium, focal lesions [benign or suspicious], and diffuse thickness [benign or suspicious]. Findings were compared with the final diagnosis established by histopathological examination. Results were statistically analyzed to determine the sensitivity, specificity, predictive values and efficacy . The findings established by histopathological examinationwere endometrial atrophy in 22 [36.7%], normal endometrium in 5 [8.33%], polyps in 21 [35%], non-atypical hyperplasia in 4 [6.7%], atypical hyperplasia in 2 [3.33%] and endometrial carcinoma in 6 [10%] cases. Transvaginal ultrasonography revealed sensitivity 81.82%, specificity 88.89%, positive predictive value 90% negative predictive value 72.72%. Hysteroscopy revealed sensitivity, specificity, positive predictive value, negative predictive value and efficacy of 90.9%, 92,59% 93.75%, 89.28%, 91.67% respectively. As transvaginal ultrasonography is relatively safe and accurate, it should be used as first choice diagnostic tool in women with postmenopausal bleeding. Hysteroscopy is superior diagnostic procedure and should be performed whenever endometrial thickness measured by transvaginal ultrasonography >4mm. In these hysteroscopic directed biopsy should be performed to achieve accurate diagnosis