Misoprostol and mid trimester termination of pregnancy in patients with two previous scars and more at Elwiya Maternity Teaching Hospital / Misoprostol e interrupção da gravidez no meio do trimestre em pacientes com duas cicatrizes anteriores e mais no Elwiya Maternity Teaching Hospital

Abstract Objectives: to determine efficiency and safety of three misoprostol regimens for 2nd trimester pregnancy termination in individuals with two or more cesarean section scars. Methods: a cross-sectional study included 100 pregnant ladies at 13th-26th weeks gestation with previous two cesarean sections (CSs) who were scheduled for pregnancy termination using misoprostol. Patients were conveniently assigned to 100µg/3h, 200µg/3h or 400 µg/3h regimens. Primary outcome was time to abortion, secondary outcomes were side effect and complications. Results: a significant association was found between number previous CSs and longer time to abortion (p=0.01). A highly significant association was identified between earlier gestational age and longer time to abortion (p<0.001). Lower side effects and complications were associated with 200 µg misoprostol every 3 hours of (p<0.001). Incomplete abortion was the most frequent recorded complication for the successive doses of misoprostol. Conclusions: misoprostol is an effective drug at low doses for pregnancy termination in women with prior two or more caesarean sections. However, its safety needs monitoring of the patient in the hospital to decrease morbidity and mortality behind its use.

Resumo Objetivos: determinar a eficiência e segurança de três regimes de misoprostol para interrupção da gravidez no segundo trimestre em indivíduos com duas ou mais cicatrizes de cesariana. Métodos: um estudo transversal incluiu 100 gestantes entre 13ª e 26ª semanas de gestação com duas cesarianas (CEs) anteriores que foram agendadas para interrupção da gravidez com uso de misoprostol. Os pacientes foram convenientemente designados para regimes de 100 µg/3 horas, 200 µg/3 horas ou 400 µg/3 horas. O desfecho primário foi o tempo para o aborto, os desfechos secundários foram efeitos colaterais e complicações. Resultados: foi encontrada associação significativa entre o número de cesáreas anteriores e o maior tempo até o aborto (p=0,01). Foi identificada associação altamente significativa entre idade gestacional mais precoce e maior tempo para abortar (p<0,001). Menores efeitos colaterais e complicações foram associados com 200 µg de misoprostol a cada 3 horas (p<0,001). O aborto incompleto foi a complicação mais frequente registrada para as doses sucessivas de misoprostol. Conclusões: o misoprostol é um medicamento eficaz em doses baixas para interrupção da gravidez em mulheres com duas ou mais cesarianas anteriores. Porém, sua segurança necessita de monitoramento do paciente no hospital para diminuir a morbimortalidade por trás de seu uso.

The prevalence of undiagnosed thalassemia minor among primigravida pregnant women before 20 weeks of gestation.

Pregnancy-associated anemia is a widespread condition that can have varying impacts on both the mother and the developing fetus, depending on the level of hemoglobin in the mother's blood and the stage of pregnancy at which the anemia occurs. In Iraq, 27% of all registered thalassemia cases are thalassemia minor. Pregnancy may aggravate mild undiagnosed thalassemia early in pregnancy. The objective of the study was to access the prevalence of undetected thalassemia minor in primigravida women who received prenatal care before 20 weeks and to compare the demographic and socioeconomic characteristic features between women with iron-deficiency anemia (IDA) and those without any anemia. A total of 298 primigravida women who attended prenatal care at 20 weeks or less were recruited and their hematocrit level was assessed. Participants were segregated into two groups regarding the presence of anemia. Patients who had packed cell volume lower than 33% underwent iron study and standard Hb electrophoresis. Information about women's demographics, socioeconomic status, and family history of hereditary anemia were recorded. The participants had a mean age of 22.7 years, with an age range spanning from 16 to 43 years. 33.33% of 298 women had pathological anemia. All the participants exhibited microcytic anemia, with 26.85%, had confirmed IDA, whereas 6.71% had ß thalassemia minor (BTM) phenotype. Both BTM and IDA patients frequently reported a positive family history of anemia at 80% and 68.7%, respectively, which was significantly greater than the control group at 39.9% (P = 0.001). No significant differences were seen between BTM and IDA in terms of age or socioeconomic status. Anemia due to undetected thalassemia minor was common among primigravida women. Screening for BTM carriers pregnant can help in monitoring their status, assessing the fetus's risk of developing thalassemia, and making a diagnosis in communities with high rates of consanguineous marriages, such as Iraq.

Correlation between Neonatal Outcomes and Maternal Anemia among Attending Pregnant Women in Al-Elwiya Maternity Teaching Hospital.

Background: Anemia in pregnancy can considerably elevate the maternal mortality risk and can negatively distress the development of fetus. Object of the Current Work: To assess the association between neonatal outcomes and maternal anemia (MA) among pregnant women (PW). Subjects and Methodology: The present work is a clinical prospective one performed at Al-Elwiya Maternity Teaching Hospital in Baghdad from January 1, 2022 to June 30, 2022. Current study selected 120 term PW with anemia admitted to hospital for caesarian section. Data were collected as a questionnaire. The data were directly taken from PW. The acquired data from anemic PW were distributed as followings: Age of anemic PW, which was classified into two groups; 25-29 years and 30-35 years. The gestational age of anemic PW, which was categorized into three groups; 37th week, 38th week, and 39th week of gestation. Anemia characteristics were studied, which included hemoglobin level (Hb) and packed cell volume test (PCV), which were done by taking 5 ml blood from each PW for s. ferritin, s.iron, Hb level, and blood film in laboratory of Al-Elwiya Maternity Teaching Hospital. The Hb helped in detecting anemic PW joined this study, as Hb was <10.5 g/dl at third trimester. Results: Mean gestational age (GA) of anemic PW was 37.5 ± 0.5 weeks; 58.3% of them were at 37th week, 39.2% of them were at 38th week, and 2.5% of them were at 39th week GA. So, the mean Hb of anemic PW was 8.6 ± 1.3 mg/dl, and the mean PCV was 28.6 ± 3.6%. Anemia was classified into mild (20%) and moderate (72.5%); also, mean ultrasound fetal head circumference (HC) among PW with mild anemia was 32.3 cm and for PW with moderate anemia was 32.1 cm, and mean ultrasound fetal abdominal circumference (AC) for PW with mild anemia was 31.3 cm and with moderate anemia was 31 cm, and validity results of MCA/UA-PI ratio regarding severe anemia of anemic were as follows: sensitivity (81.8%), specificity (79.8%), +ve predictive value (29%), -ve predictive value (97.8%), and accuracy (80%). Conclusion: The gestational mean age (GA) of anaemic PW was 37.50.5 weeks; 58.3% of them were in the 37th week and 39.2% were in the 38th week. Thus, the mean ultrasound foetal head circumference (HC) was 32.3 cm for PW with mild anemia and 32.1 cm for those with moderate anaemia. The mean ultrasound foetal abdominal circumference (AC) was 31.3 cm for those with mild anaemia and 31 cm for those with moderate anaemia, but 30 cm for those with severe anaemia, with no discernible difference. The following were the MCA/UA-PI ratio's validity findings for severe anaemia of anaemic: sensitivity (81.8%) and specificity (79.8%).