Repeated Pap-smear as a screening and follow-up strategy for patients with ASCUS

The present screening study aimed to evaluate the frequency of atypical squamous cells of undetermined significance [ASCUS] in localized population using repeated 6-monthly Papanicolaou [Pap] smear and to determine its diagnostic yield for detection of squamous intraepithelial lesions [SIL]. All enrolled women underwent Pap smear; the adequacy and the cytologic features for each specimen were evaluated by cytopathologist, patients who had ASCUS received the appropriate antimicrobial treatment if there was infection otherwise underwent a follow-up smear after 6 months [2nd smear] and if the 2nd smear showed normal cytology with apparently healthy cervix patients were underwent follow-up smear 1-year later; however, for patients with smears showed ASCUS or higher lesions a colposcopy and cervical biopsy were performed and patients proved to be free of abnormal cytological changes were follow-up for another 6 months and underwent the 3rd Pap smear with application of the same protocol for 2 years. The 1st Pap smear diagnosed 89 out of 2350 screened patients as having ASCUS with a frequency of 3.8%. The 2nd Pap smear defined 71 patients had normal smear; while 15 patients still had ASCUS, 2 patients had LSIL and one patient had HSIL, these 18 patients underwent colposcopy and biopsy whenever indicated and histological examination detected 3 cases with LSIL and one case with HSIL, while 11 had chronic cervicitis and underwent a 3rd Pap smear 6-months later and 9 smears showed ASCUS, while 2 smears showed LSIL. The 4th Pap smear was conducted 6-months later for 9 patients with ASCUS and 6 smears were still showing ASCUS, 2 smears were diagnosed as LSIL and the last smear showed HSIL that was confirmed by colposcopy directed biopsy. ROC curve analysis of Pap smear cytological examination of the 2nd smear versus results of histopathological examination of 18 tissue biopsy obtained during colposcopy defined high sensitivity with AAC=0.607. It could be concluded that repeated Pap smear is a cost-effective, reliable strategy for follow-up of cases with cytological diagnosis of ASCUS on screening for cancer cervix

Randomized controlled study comparing nifedipine and atosiban for tocolysis in preterm labor

To compare the effectiveness and the safety of Nifedipine versus Atosiban as a tocolytic agent in preterm labor. This prospective randomized comparative study was conducted in the Department of Obstetrics and Gynecology, Antenatal Ward of King Khalid Military City Hospital [KKMCH], Northern Region, Saudi Arabia. It included eighty pregnant women diagnosed with preterm labor at 24 -33 gestational weeks and requiring tocolysis. They were randomized to receive Nifedipine orally [n=40] or Atosiban intravenously [n=40] for tocolysis. The primary outcome measure [examining the tocolytic effectiveness] was the proportion of women undelivered by 48 hours and 7 days from the commencement of treatment. Secondary outcome measure [examining the tocolytic safety] was perinatal morbidity and mortality, and maternal safety outcomes. Delivery was delayed for 48h and seven days in 87.5% and 72.5% respectively, of women in the nifedipine group compared with 85% and 75% respectively, of women in the Atosiban group [no statistical significant difference]. Women receiving Nifedipine were significantly more likely to experience flushing [p < 0.001] with no significant differences in other maternal side effects between the two groups. The neonatal outcomes were not significantly different in the two groups. Nifedipine was as effective as Atosiban in delaying preterm birth. Both tocolytic agents were found to be well tolerated by both mother and fetus with a comparable neonatal outcome. Considering the great saving on direct drug costs in the Nifedipine group, Nifedipine may be considered for use as a first-line tocolytic agent

Impact of naloxone and droperidol on postoperative epidural morphine analgesia

This study was designed to evaluate the impact of epidural naloxone [N] or droperidol [D] on the outcome of epidural morphine analgesia. The study comprised 60 females assigned to undergo abdominal hysterectomy randomly allocated into three equal groups [n=20], each received medication mixture via infusors; Group M received 3 mg morphine in 100 ml bupivacaine 0.125% at rate of 2 ml/hr; group M+N and M+D received the same mixture, but with the addition of naloxone so as to provide an infusion rate of 0.167 micro g/kg/hr of naloxone in group M+N or droperidol in a dose of 1.25 mg/day continuous infusion in group M+D. Pain sensation was evaluated using 100-mm visual analogue scale, postoperative nausea and vomiting [PONV] was monitored on a four-point scale: 0: no, 1: mild not requiring an antiemetic, 2: moderate requiring an antiemetic and 3: severe nausea/vomiting, resistant to antiemetic. Pruritus was evaluated using a four-point scale: 0=no, 1= mild, 2 moderate and 3= severe itching. Somnolence was graded as follow: 1=clear mentality, 2= good response to verbal command but drowsy and 3= poor response to repeated verbal command. Respiratory depression was assessed as 1= no respiratory depression and 2= respiratory depression exists with a respiratory rate<8 breaths/min. All parameters were assessed at 2, 4, 8, 16, 32, and 48 hr PO. At 8-hrs PO, VAS scores were significantly lower in M+N [P1 =0.017] and M+D [P1 =0.034] groups compared to group M., with a non-significant [P2>0.05] reduction of VAS scores between combination groups but in favor of group M+N. Thereafter, VAS scores were significantly lower in groups M+N and M+D compared to group M with a significant reduction of VAS scores in group M+N compared to group M+D. Epidural naloxone [Group M+N] significantly reduced the frequency and severity of side effects in comparison to group M and significantly reduced the frequency and severity of somnolence and respiratory depression and non-significantly reduced the frequency and severity of PONV in comparison to group M+D. On the other hand, epidural droperidol [Group M+D] significantly reduced the frequency and severity of pruritus and respiratory depression but reduced the frequency of PONV and somnolence non-significantly in comparison to group M. Moreover, epidural droperidol significantly reduced the frequency and severity of pruritus compared to epidural naloxone. It could be concluded that epidural co-administration of morphine and naloxone or morphine and droperidol provided more effective postoperative analgesia with a significant reduction of morphine-induced side effects; however, droperidol appears to be a better alternative when pruritus is taken into consideration, while naloxone is a better alternative when somnolence is taken into consideration

Prediction of small-for-gestational age infents by quantitative assessment of diastolic notch in uterine artery flow velocity waveforms

To assess the performance and clinical usefulness of the notch depth index [NDI] in predicting small-for-gestational age infants [SGA] in comparison to the previously defined abnormalities in uterine blood flow velocity waveforms; peak systolic over protodiastolic velocities [A/C] ratio. Presence of protodiastolic notch and resistance index [RI]. This prospective clinical study included evaluation of pulsed Doppler abnormalities uterine artery velocity waveforms in 673 nulliparae with normal singleton pregnancies at 16-18 weeks and at 26 weeks gestation. Main outcome measures: Delivery of small for gestational age [SGA] infants. SGA developed in 11% of nulliparae. Although early Doppler screening was associated with high false positive results, yet two-stage screening avoided false negative cases. NDI was found to be a better predictor than other Doppler indices [A/C ratio, protodiastolic notch and RI]. NDI improved, both sensitivity and PPV as determined by other Doppler indices. NDI measurements were clinically useful in predicting for gestational age infant than other conventional Doppler indices

Hyperhomocysteinemia at 16[th] week gestation and subsequent preeclampsia

This study was done on 197 pregnant women. Fasting plasma total homocysteine [tHcys] was measured in each woman at 16[th] week of pregnancy. They were divided into 2 groups according to development of preeclampsia. Women who did not develop preeclampsia [n= 179] comprised control group. Women who developed preeclampsia [n=18] comprised the study group. Fasting plasma tHcys at 16[th] week gestation was significantly higher in preeclampsia group compared to control group [P<0.05]. Also the number of cases with tHcys >/= 90[th] percentile of controls [>/= 5.37 ng/dl] was significantly higher in preeclampsia group compared to control group. It could be concluded that hyperhomocysteinemia at 16[th] week gestation may be an indirect risk factor for placental vasculopathy predating preeclampsia

Fetal evaluation in post-term pregnancy using vibroacoustic stimulation and amniotic fluid index versus modified biophysical profile [a comparative study]

The appropriate management of post-term pregnancy is controversial. Several methods of fetal surveillance are used to differentiate compromised from non-compromised fetuses. The study compares the modified fetal biophysical profile [FBP] with vibro-acoustic stimulation [VAS] and amniotic fluid index [AFI] in post-term pregnancy. Sixty cases of uncomplicated singleton post-term pregnancies [> 41 w] are enrolled in the study. The cases are randomly allocated into one of 2 groups for biweekly fetal surveillance. Group [I]: Comprises 30 cases for whom VAS/AFI are performed. Group [II]: Comprises 30 cases for whom modified FBP is performed. The specificity, positive predictive value and overall accuracy of VAS/AFI in predicting abnormal neo-natal outcome is higher than that of the FBP. Fetal BP is associated with higher incidence of false abnormal results and subsequent induction of labour. These abnormal results are attributable to BPP score 6, a poor predictor of perinatal outcome. This study indicates that VAS/AFI test in a better predictor of the development of intrapartum fetal distress in post-term pregnancy

Immediate postoperative oral feeding following uncomplicated cesarean section

The objective of the present study was to evaluate the effect of immediate oral feeding on gastrointestinal functions in patients undergoing cesarean section [CS]. A prospective randomized study was conducted in which patients were randomly allocated in two study groups, the first group patients were allowed to feed immediately and in the second group, feeding was delayed. Results obtained showed a non-sign d between both studied groups with respect to the incidence of gastrointestinal symptom. We could conclude that immediate post-cesarean section oral feeding has no complications, furthermore it enhances early bowel activity as well as it is simple, convenient, safe and economic

Low-pressure pneumoperitoneum: a modality to reduce shoulder-tip pain mid hemodynamic consequences after laparoscopic gynecologic surgery

Laparoscopic gynecologic surgery [LGS] is an advantageous procedure that widely replaced the traditional open laparotomy especially for dingnostic purposes. However, high-pressure pneumoperitoneum was accused for precipitating some intraoperative hemodynamic effects and postoperative shoulder-tip pain [STP]. The objectives of this study were to determine the influence of low-pressure pneumoperitoneum on the frequency and intensity of shoulder-tip pain and body hemodynamics in patients undergoing LGS. The study comprised 87 female patients divided into two study groups: Group I, comprised 49 female assigned to undergo LGS under high-pressure [13-15 mmHg] and 38 patients under low-pressure [7-9 mmHg] [Group II]. Intraoperative monitoring included measurement of heart rate [HR], systolic and diastolic blood pressure, and mean arterial blood pressure [MAP] was calculated. The frequency of postoperative STP was determined and its intensity was determined using visual analogue scale charts VAS]. There was a significant [P<0.05] increase in MAP in both groups at 5 min after Insufflation, but there was a significant decrease of MAP in Group II as compared to Group I [x2=7.716, P<0.05]. There was a significant reduction of both frequency [15.8% vs. 26.5%] and intensity of STP in low-pressure group compared to high-pressure group. This difference was especially significant 6, 12.24 hours postoperatively. Moreover there was a positive significant correlation between the insufflated pressure and the frequency [r=0.691, P<0.05] and intensity [r=0.612, P<0.05] of STP. There was a significant reduction of the amount consumed of rescue analgesic [declphenac potassium 75 mg/cc, amp.] in low-pressure group compared to high-pressure group. We can conclude that reduction of the pressure of the pneumoperitoneum to 7-9 mmHg results in a significant reduction of both the frequency and intensity of shoulder-tip pain and allows more stable hemodynamics of the patients through the duration of LGS On the basis of these results, the widespread use of low-pressure pneumoperitoneum throughout most of a laparoscopic gynecologic procedure is recommended