Intrapartum ultrasonographic assessment of foetal occiput position a comparison with transvaginal digital examination during the second stage of labor

To compare between digital vaginal examination [DVE], transabdominal sonography [TAS] and transvaginal sonography [TVS] as regards accuracy and time requirements for determination of foetal occiput position during the second stage of labor. Prospective randomized blinded study. 120 laboring patients in the second stage of labor. An informed consent was obtained. A detailed sterile digital vaginal examination was performed immediately before transabdominal and transvaginal examinations. Each sonographer was blinded to the finding of the other as well as to the DVE finding. The findings of digital and ultrasonic examinations were compared with the actual position of the vertex, as determined by direct visualization at vaginal delivery after spontaneous restitution of the foetal head or at cesarean delivery. The foetal head position was assessed by determining the foetal occiput as "the time on a 12-hour clock" into eight categories. The findings of DVE and TAS were considered to be correct if the foetal occiput position was within +/- 45° of TVS finding. The time required by the three methods was recorded. Sensitivity, specificity and diagnostic accuracy of DVE, TAS, combined DVE and TAS and TVS [gold standard] in the determination of the foetal head positions in the second stage of labor were calculated. TVS diagnosed correctly the foetal head position in all cases [100% accuracy] when compared with the actual foetal head position at delivery and thus was considered as the gold standard. The accuracy of DVE in determining foetal head position in the second stage of labor was 72%, being higher for occiput anterior positions. DVE was inaccurate in 26.7% of cases, the majority of which were in occiput posterior positions and was unable to determine 5% of cases. The accuracy of TAS in diagnosing the foetal head position was 80.5%. TAS was inaccurate in 9.16% of cases, the majority of which were in the occiput anterior positions and was unable to determine 4.16% of cases. The accuracy of TVS was significantly higher than DVE and TAS [P= 0.001]. However, combining DVE and TAS increased the sensitivity and diagnostic accuracy than using either alone. The time required for determining foetal head position was significantly shortest for TVS in comparison to TAS or DVE [8.17 +/- 2.15 vs 29.4 +/- 2.81 or 22.27 +/- 3.59 seconds, P= 0.0001]. Transvaginal sonography is the preferred imaging method for the determination of foetal head position in the second stage of labor. However, combining DVE and TAS was more accurate in the assessment of the foetal head position than using either alone and can be used as an alternative to TVS

Successful repair of chronic unhealed rectovaginal septal defect with proper methodical retrieval and repair of the sphincter ani externus

The repair of chronic unhealed rectovaginal septal defect is a problem tackled only by the expert gynaecologic surgeon. Proper preoperative, operative and postoperative measures include vaginal antiseptics, preoperative treatment of any cervicitis, as well as, broad spectrum antibiotics. Postoperative laxatives are a must to keep the stools soft. The surgeon can choose between one of two methods of repair, either dissection at the junction of vagina and rectum or the vaginal flap reflection off the rectal wall. The Levator ani and sphincter ani externus are exposed and repaired ending by building up a perineal body. Over the past 10 years, the author has performed 18 surgical repairs for such perineal tears. Simple as it looks, yet breakdown of the repair may occur. As described in the control group [group 1]. The anal external sphincter, may evade recognition or repair without undue tension. Failure to repair the sphincter ani externus or breakdown of its repair will result in persistence of flatus and loose stool incontinence, a highly embarrasing inconvenience, especially so in the refined and socially conscious lady. For the past 4 years the author has been following a technique for the repair of chronic unhealed complete perineal tears introduced in the early seventies and described in 1978. The sphincter ani externus is properly traced, retrieved, mobilized and sutured without undue tension. The ten cases repaired by the direct dissection between the anorectal canal and vagina, augmented by the method to be shortly described Azab's techinque resulted in complete continence of flatus, soft and hard stools

Packing of the lower uterine segment, following the seperation of theplacenta praevia due to uncontrollled haemorrhage from the opensinuses of the lower uterine segment

In the current obstetric practice, cases of placenta praevia suffering from hemorrhage at term pregnancy or with fetalmaturity, elective lower segment caesarean section is the best treatment.Cases of placenta praevia early in labor with moderate or sever bleeding should be treated by immediate were segment caesarean section.The separation of the praevia placenta may be followed by sever hemorrhage from the open sinuses of the loweruterine segment The treatment followed by us in the last 18 of such cases was firm compression of these sinuses bywarm saline soaked towel for sometime till the ooze stops with clotting of the sinuses. If that measure failed, which itdid in 14 of these cases of sever hemorrhage tight packing of the uterus, particularly the lower uterine segment, theredundant reformed cervix, vaginal fornices and canal, with counter pressure against a vagino- perineal pad. Thatprocedure succeeded in 13 out of these 14 cases, the remaining case was operated upon by subtotal abdominalhysterectomy

Imbalance between free radical propagation and some antioxidants in patients with cataract

The relation of oxidative stress to the occurrence of cataract remains to be undetermined and must be clarified. So, the aim of this work was to study the effect of O2-free radical and some antioxidants in the pathogenesis of senile and diabetic cataract. This work was carried on 30 patients and 10 healthy subjects as control. They were 23 males and 17 females. Their ages ranged from 50 to 64 years. Patients were classified into senile cataract, diabetic without cataract and diabetic cataract groups. Each group included 10 patients. The results of this work showed that, in patients with senile cataract, were non-significant increase of fasting serum glucose [FSG] and serum total bilirubin [serum T. bilirubin] compared with the control group. Serum lipid peroxide [S. LP] and serum ceruloplasmin [S. Cp] were. significantly increased [P<0.05] while plasma superoxide dismutase [SOD] and serum uric acid were significantly decreased [P<0.05] compared with the control group. Moreover, diabetic patients with and without cataract showed a significant increase of FSG, S. total bilirubin. S. LP, S. Cp, and S. uric acid [P<0.05] while plasma SOD was significantly decreased [P<0.05] compared with the control group. Comparative study of the diabetic cataract versus senile cataract and diabetic without cataract, our results showed a significant increase of FSG, S. LP, S. total bilirubin and S. Cp, while there was significant decrease of plasma SOD in diabetic cataract compared with both senile cataract and diabetic without cataract [P1<0.05 and P2<0.05], respectively. S. uric acid was significantly increased in diabetic cataract compared with senile cataract group [P1<0.05] while it was non-significantly increased compared with diabetic without cataract group. Also, aqueous humor study of diabetic cataract group versus senile cataract group showed that LP and uric acid were significantly increased [P<0.05] while SOD was significantly decreased [P<0.05]. Correlation study revealed that, age was significantly and positively correlated with LP, but negatively correlated with SOD both in serum and aqueous in all patient groups. FSG was significantly and directly correlated with serum and aqueous LP, uric acid, S. total bilirubin, and S. Cp in diabetics with and without cataract. Moreover, serum and aqueous LP was significantly and inversely correlated with serum and aqueous SOD in all patient groups, while, it was positively correlated with S. total bilirubin, and S. Cp in diabetics with and without cataract. We could conclude that the imbalance between generation of O2-free radical and plasma SOD may have an etiological implication in the occurrence of cataract

rational treatment of eclampsia built on proper understanding of the pathophysiology of the nervous system

In normal pregnant women, a normal external or internal stimulus reaching the brain produces a physiological response. In eciamptic patients, normal or even subnormal stimuli produce a massive response: namely a convulsion. A correlation between the pathophysiology of the nervous system in eclampsia and the state of neuroal hype; excitability is discussed. A rational for treatment in 20 eclamptic cases is outlines

Eight years trial of the limited traction obstetric forceps

Injuries to the foetus or mother from forceps delivery are still a significant obstetrical problem. Trauma by forceps is usually due to excessive traction. To prevent such occurrence Azab et al. [1971] introduced the concept of "limited tract ion". We presented a modification of Luikart-Simpson forceps with a built in negator spring de vice to limit traction to the safe 50 pounds. In 1973 Arab and Gaafar applied the same negator spring system to the Nveille's axis traction piece. The following communication deals with the first forty, limited traction forceps operations

Twelve years trial of a modified Kelly's repair for stress incontinence of urine

In 1967, we described a modified Kelly's technique for vaginal repair of stress incontinence. The repair came at the conclusion of an extensive study on different aspects of stress urinary incontinence [Azab, 1967]. In that year we presented a preliminary report of a few cases with immediate results. Following is a report about a 12 years experience, involving 35 cases with only one failure

Experience with ultrasonography in Riyad maternity hospital a preliminary report

Ultrasonics is now occupying a very important place in modern obstetrics. The instrumentology is now highly developed. The technique, simple, rapid, free from inconvnience and safe. The present communication deals with the experience in ultrasonography in Riyad Maternity Hospital

Ultrasonic investigation of a huge mucocele of the uterus and vagina in a case of imperforate hymen in a three month old infant

Ultrasonic investigation of a huge mucocele of the uterus and vagina, showed a clear and characteristic picture, pointing of the value of such tool of investigation in the study of female pelvi-abdominal masses