Epidural versus general anesthesia for elective caesarean section in severe pregnancy induced by hypertension

Forty women with severe pregnancy induced hypertension [PIH] were subjected randomly to general anesthesia [GA] or lumbar epidural anesthesia [LEA] for elective caesarean section [CS]. Every case received pre-operative hydration with I. V. 1500-2000 ml lactated Ringer's solution and 10 mg sublingual nifedipine [Epilat]. Hemodynamic parameters: heart rate [HR], mean arterial pressure [MAP] central venous pressure [CVP]; hemoglobin [HB] and hematocrite [Hct] values were evaluated and compared in both groups. In the [GA] group, H. R; [MAP], and [CVP] exhibited significant increases at skin incision, these were followed by reduction after delivery of the fetus and a second increase at the end of the operation. The explanation of this hemodynamic instability is discussed in the article. On the other hand LEA gp. demonstrated an initial decrease of these parameters to, a safe level, then remained relatively stable to the end of the operation. In addition GA gp. demonstrated a significantly lower HB and Hct values, if compared to LEA gp. 24 hrs after operation. The study concluded that preoperative volume expansion is mandatory for stabilization of hemodynamics of preeclampsia. Epidural block to T4 dermatome caused blunting of hemodynamic stress related reponse to [CS] and is associated with a lower surgical blood loss in severe [PIH]. So, epidural block is the method of choice for elective [CS] while general anesthesia should be restricted to emergency cases of severe [PIH]

Mansoura nomogram of cervical dimensions in normal pregnancy

A nomogram of cervical dimensions during normal pregnancy was established by prospective longitudinal comparative study of total 304 gravida in two groups : normal group [n=204] and high riskgroup [n=100] with clinical diagnosis of cervical incompetence. Normal cases were evaluated by TVS from 10th week to 38th week of pregnancy, high risk cases before and after cerclage,onward till delivery. The mean, standard deviation, minimum, maximum, range, and cut off values for each of the following 5 cervical parameters were obtained: cervical length, internal os diameter, thickness of lower uterine segment, posterior cervical angle and cervical thickness. By discriminant analysis of values for normal pregnant and those for high risk pregnant cases, we derived our sonographic criteria for diagnosis of incompetent cervix which include: cervical length < 25 mm internal os diameter > 6 mm, and posterior cervical angle > 90°. These variables can predict cervical incompetence correctly in 86.4% and exclude it in 88.9% of cases