randomized controlled trial of psychosocial counselling for first-time IVF couples

Of this study was to evaluate pre-IVF counselling using self report questionnaire on couples. The acceptability of counselling, perception of help and effects on anxiety and depression were considered. The study included 423 consecutive childless Arabic couples preparing for their first IVF. Randomization was carried out through sealed envelopes attributing participants to counselled and non-counselled groups and was accepted by 300 couples. Another 42 couples refused randomization because they wanted counselling and 81 couples because they did not. Questionnaires including the State-Trait Anxiety Inventory, the Beck Depression Inventory and assessments of help were answered by couples before IVF and counselling, and after the IVF outcome result. Counselling was accepted by 81% [342/423] of couples. There was no significant effect of counselling on anxiety and depression scores which were within normal ranges at both times. Counselling provided help for 86% [225/261] of initially non-demanding subjects and 96% [81/84] of those initially requesting a session. Help was noted in areas of psychological assistance, technical explanations and discussing relationships. This model of routine counselling provides an acceptable form of psychological assistance for pre-IVF couples

Evaluation of risk factors associated with recurrent cesarean section morbidity: a suggested score

This prospective study included 1000 women undergoing cesarean section [CS] under general anesthesia. They were divided into two groups. Group 1 [control group] included 500 patients, who underwent CS for the first time. Group 2 [study group] included 500 patients who had one or more previous CS. Simple scoring system was developed to record the possible risk factors related to CS morbidity. There were six significant preoperative risk factors [high parity, preterm delivery, placenta praevia, antepartum hemorrhage, medical disorders and bad general condition]. There were five highly significant risk factors related to intra-operative morbidity [high parity, placenta praevia, intra-peritoneal adhesions, low experienced surgeon and preterm gestational age] and five risk factors related to previous CS operation [previous three or more CS, previous CS at rural hospital or private clinic, previous upper segment CS, previous complicated CS and tender previous scar]. Eleven factors related to postoperative morbidity were more significant in the repeated CS group. The incidence of overall morbidities was significantly more in the repeated CS group. Total postoperative morbidity was highly significant starting from previous 4 or more CS. Risk factors related to intra-operative morbidity were used to develop a mortality scoring system. Based on a summation of logistic coefficient corresponding to individual risk factors, a scoring system was suggested, which can help in the prediction of CS morbidity. Further prospective evaluation of this scoring system would be helpful to confirm the usefulness and practicality of this system