value of ultrasonic epiphyseal ossification centers and placental grading in the predication of fetal lung maturity in normal, preeclamptic and diabetic pregnancies

In the present study, a non-invasive method for assessment of fetal lung maturity via sonographic characterization of placental maturity and fetal epiphyseal ossification centers around the knee and shoulder was evaluated. These sonographic parameters were correlated with the amniocentesis phospholipid profile as an indicator of accuracy. They were studied in 40 normal pregnancies, 40 preeclamptic and 40 diabetic pregnancies with gestational ages ranging between 32-41 weeks. It was found that in normal pregnancies, the presence of grade 3 placenta, or DFE >/5 mm or PTE >/3 mm or the presence of PHE predicts a mature phospholipid profile in 100% of patients. However, in preeclamptic patients, the presence of grade 3 placenta is not a reliable predictor of lung maturity, but the presence of DFE >/5 mm or PTE >/3 mm or the presence of PHE has 100% positive predictive value of mature phospholipid profile. On the other hand, in diabetic pregnancies neither grade 3 placenta nor DFE >/ 5 mm are reliable indicators of fetal lung maturity. Finally, the identification of PTE >/5 mm or the presence of PHE can reliably identify a mature phospholipid profile in all studied groups with 100% accuracy. Such a perfect correlation between these epiphyseal ossification dimensions and fetal lung maturity favors the use of these selective noninvasive sonographic parameters as an alternative to invasive amniocentesis phospholipid profile in prediction of fetal lung maturity. This could save time, money, emotional investment, fetal and maternal morbidity

Vaginal and laparoscopic retrieval of 100 ectopic intrauterine contraceptive devices

Over a five year period one hundred cases of translocated intrauterine devices [IUCDs] were studied. The cases were collected from Kasr El- Aini Hospital, Family of the future clinic in Saeida Zeinab and private patients in 15 cases, removal of the dislocated IUCDs was successful through the vaginal route. Twelve dislocated IUCDs were removed by doing a posterior colpotomy and three dislocated devices were removed through cutting the uterovesical pouch of peritoneum anteriorly.In one patient with dislocated copper IUCDs vaginal approach was attempted through an anterior colpotomy, but extensive fibrosis and too dense adhesions made removalimpossible and laparotomy was resorted to. Laparoscopic removal or laparotomy were done in the remaining dislocated IUCDs.The 15 cases that were retrieved vaginally included ten Lippes and five copper [Tcu 200] devices.The time interval between insertion and diagnosis of translocation ranged from one week to six months.The vaginal approach was chosen because the ectopic IUCDs were too low and they were felt vaginally.In this paper the main stress has been on the vaginal retrieval of ectopic IUCDs on account of the scanty literature on the subject