The patterns and criteria of vaginal douching and the risk of preterm labor among upper Egypt women.

OBJECTIVES: Our study identifies vaginal douching as a risk factor for preterm labor and specifies the risk according to the method, frequency, nature, and timing of douching. MATERIALS AND METHODS: This is a hospital-based case-control study. A total of 480 women were recruited. Women were classified into case group (history of preterm labor) and control group (no history of preterm labor). An interview questionnaire was administered, which included participants' data and criteria of douching practice. RESULTS: Among participants who regularly douched (73.13%), 281 (80.06%) used it for cleanliness and religious considerations. Women who have been regularly douched were at higher risk of preterm labor (adjusted odds ratio [OR] = 1.9; 95% CI = 1.078-3.278; p = .026). The method (fingers vs pump) and the frequency of douching were significantly relevant. The risk of douching during pregnancy was borderline (adjusted OR = 2.1; 95% CI = 1.001-4.446; p =.05). Douching several times per day has an OR of 4.05 (95% CI = 1.196-13.737; p =.025) when compared with the monthly frequency. CONCLUSIONS: Vaginal douching is associated with higher risk of preterm labor. We recommend that the risk of asymptomatic bacterial vaginosis should be considered.

Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report.

INTRODUCTION: Twin pregnancy with complete hydatidiform mole represents a very rare obstetric problem. Management of such cases is always problematic because the possibility of fetal survival should always be weighed against the risk of complications of molar pregnancy. CASE PRESENTATION: A 34-year-old Caucasian woman presented to our center with mild vaginal bleeding. Our patient was 16 weeks pregnant after a seven-year period of primary infertility. She became pregnant following a non-prescribed regimen of clomiphene citrate extending from the second day to the 13th day of her last cycle. A transabdominal ultrasound examination revealed a twin pregnancy with complete hydatidiform mole and a coexisting fetus. Serum ß human chorionic gonadotropin was falsely low as identified by serial dilution of the sample (the 'hook effect'). Our patient refused termination of pregnancy and she was hospitalized for strict observation and follow-up. Unfortunately, she developed an attack of severe vaginal bleeding and a hysterotomy was performed. The fetus died shortly after birth. CONCLUSIONS: Twin pregnancy with complete hydatidiform mole represents a matter of controversy. We suggest that conservation should always be considered whenever tertiary care services and strict observation are available.