Role of blunt suture needle in episiotomy repair at uncomplicated vaginal deliveries in reducing glove perforation rate: a randomized controlled trial.

AIM: The aim of this study was to evaluate the role of blunt suture needles for episiotomy repair at uncomplicated vaginal deliveries in reducing glove perforation rate. METHODS: This was a prospective randomized controlled trial wherein 300 nulliparous women with uncomplicated vaginal deliveries were randomized to episiotomy repair with either blunt or sharp suture needles. Patient demographics and clinical variables were collected. Postoperatively, the surgeons were surveyed regarding ease of using the needle, and glove perforation was determined by three tests: air insufflation, water filling and water load. RESULTS: A total of 41 perforations occurred in the 39 episiotomy repairs with glove perforations (13%). There was a significantly higher number of glove perforations using the sharp suture needles (28/150; 18.7%) than with the blunt suture needles (11/150; 7.3%) (P = 0.005). Glove perforation of the non-dominant hand occurred in 90% of the cases. Using a blunt suture needle took significantly more time (P < 0.001) to complete the repair than using a sharp needle. Surgeons reported that blunt needles were more difficult to use than sharp needles (P < 0.001). CONCLUSION: Blunt suture needles for episiotomy repair were shown to have a significantly lower instance of glove perforation but required more time and are perceived to be more difficult to complete the repair as compared to sharp needles.

Impact of seroconversion and antichlamydial treatment on the rate of pre-eclampsia among Egyptian primigravidae.

OBJECTIVE: To evaluate the effect of antichlamydial treatment and Chlamydia pneumoniae seroconversion on the incidence of pre-eclampsia among Egyptian primigravidae. METHODS: The present prospective study included 600 healthy normotensive primigravidae who attended an outpatient clinic at 10-16weeks of pregnancy. A single venous blood sample was collected to test for C. pneumonia-specific immunoglobulin G (IgG) antibodies using an enzyme-linked immunosorbent assay. Seropositive women were randomly allocated to receive or not receive antichlamydial treatment before 20weeks of pregnancy. Seronegative participants had another test at delivery for the presence of C. pneumonia-specific IgG to determine seroconversion. All participants were followed up for up to 8weeks postpartum and observed for the development of pre-eclampsia. RESULTS: The rate of pre-eclampsia among seropositive participants differed significantly depending on whether the women received treatment or not (6.5% and 19.1%, respectively; P=0.014). No statistically significant difference in the rate of pre-eclampsia was detected between seronegative participants who underwent seroconversion and those who did not. CONCLUSION: The present results indirectly support the hypothesis that infectious agents (in particular C. pneumoniae) have a role in the development of pre-eclampsia. The findings also indicate that antichlamydial treatment might help to reduce the incidence of pre-eclampsia.

Immunoexpression of matrix metalloproteinase-2 (MMP-2) in malignant ovarian epithelial tumours.

OBJECTIVES: This study was designed to evaluate the expression of matrix metalloproteinase-2 (MMP-2) in malignant ovarian epithelial tumours and to detect the relation between the degree of MMP-2 expression and the histological grade and surgical stage of the studied cases. METHODS: This study was conducted in Ain Shams University Maternity Hospital in Cairo, Egypt, between March 2004 and December 2005. Thirty patients with malignant ovarian epithelial tumours diagnosed after histopathological examination of the specimens were included in this study. The pathological specimens were additionally stained by the immunoperoxidase technique for MMP-2 using a monoclonal antibody against activated MMP-2. The staining intensity of MMP-2 was correlated with the clinical and pathological parameters of the studied cases, including patient's age, surgical stage, histological grade, omental metastasis, and lymph node metastasis. RESULTS: Four of the 30 cases (13.3%) were entirely negative for MMP-2, 14 (46.7%) showed weak staining for MMP-2, five (16.7%) showed moderate staining, and seven cases (23.3%) showed intense staining. The results were compared with the clinical and pathological parameters, including patient's age, tumour stage, and histological grade. The MMP-2 expression was found to be significantly correlated with the histological grade (r = 0.52, P < 0.05) and with the surgical stage (r = 0.72, P < 0.001) of the studied tumours, but not with the age of the patients. Patients with advanced ovarian tumours, ascites, omental metastasis, distant metastasis, or uterine metastasis had a significantly higher incidence of MMP-2 expression (P < 0.05). There was no significant difference in MMP-2 expression between patients when compared in terms of lymph node metastasis or the presence of bilateral tumours. CONCLUSION: MMP-2 is a marker of proliferation, invasiveness, and metastasis. In this study, there was a direct correlation between the degree of expression of MMP-2 and histologically undifferentiated or advanced stages of ovarian epithelial tumours.