BackgroundEclampsia is a major cause of maternal and neonatal morbidity and mortality in low and middle income countries. The aim of this study was to assess the risk factors and maternal and perinatal outcome in patients with eclampsia in order to get reliable data that helps in reducing the incidence and improving the outcome in an area with high incidence of eclampsia.MethodsRetrospective study including 250 patients diagnosed with eclampsia at Minia Maternity University Hopsital, Minia, Egypt in the period between January 2013 and December 2014.We analyzed the data obtained from medical records of these patients including patient characteristics, medical, obstetric, current pregnancy history, data on hospital admission, treatment given at hospital and maternal and perinatal outcome. Statistical analysis was done using SPSS version 21.ResultsDuring the study period, 21690 women gave birth in the hospital; of which 250 cases of eclampsia were diagnosed (1.2%).Four women died (case fatality rate 1.6%). The main risk factors identified were young age, nulliparity, low level of education, poor ante-natal attendance and pre-existing medical problems. The most common complication was HELLP syndrome (15.6%). Magnesium sulphate therapy was given to all patients but there was lack of parenteral anti-hypertensive therapy. Forty six cases delivered vaginally (18.4%). Assisted delivery was performed in 22 (8.8%) cases and caesarean section in 177 (70.8%) cases; 151(60.4%) primary caesarean sections and 26 (10.4%) intra-partum. Perinatal deaths occurred in 11.9% on cases. Prematurity and poor neonatal services were the main cause.ConclusionMorbidity and mortality from eclampsia are high in our setting. Improving ante-natal and emergency obstetric and neonatal care is mandatory to improve the outcome.

Background The intrauterine device (IUD), being a reversible and effective contraception method, is the most widely used worldwide. This study aims to demonstrate the efficacy of IUD insertion during elective lower segment cesarean section (LSCS) versus its insertion six weeks postpartum. Methods A cohort study was conducted on 200 women planned for elective cesarean delivery and desired IUD as a contraceptive method. They were allocated into two groups; group I, in which IUD was inserted during LSCS, and group II, in which IUD was inserted six weeks or more after LSCS. Both groups were compared regarding failed insertion, post-insertion pain, and uterine perforation. They were followed for one year for the incidence of menorrhagia, vaginal infection, IUD displacement/expulsion, missed threads, or unintended pregnancy. Results Women in the second group showed a significantly higher incidence of failed insertion and uterine perforation than women in the first group. On the contrary, women in the first group showed a significantly higher incidence of missed threads than women in the second group. Regarding other consequences, there were no significant differences between both groups concerning menorrhagia, vaginal infection, IUD displacement/expulsion, or unintended pregnancy. Conclusion IUD insertion during elective LSCS showed a significantly lower incidence of failed insertion and uterine perforation than its insertion six weeks postoperative.

Background This study aims to detect the effects of increased BMI on labor outcomes in primigravida pregnant women. Methods A cross-sectional study involved 600 full-term singleton primigravida pregnant women who presented in the active phase of labor to the labor ward. They were divided according to BMI into three equals groups; women with normal BMI (group I), overweight women (group II), and women with class I obesity (group III). Results We found that high BMI was associated with a significantly increased risk of Caesarean section (C.S.) (13% in group I, 18% in group II and 40% in group III). Women with higher BMI and delivered vaginally had a significantly prolonged first and second stage of labor, consequently increased the need for oxytocin augmentation as well as the oxytocin dose. Regarding the maternal and fetal outcomes, there are significantly increased risks of postpartum sepsis, perineal tears, wound infection, as well as significantly increased birth weight and longer neonatal stay in the neonatal unit (NNU). Conclusion Obese primigravida pregnant women were at higher risk of suboptimal outcomes. Besides, prolonged first and second stages of labor and the incidence of C.S. have also been increased.

Objective: The objective of this study is to evaluate the role of cervical length measurement by transvaginal ultrasonography, power Doppler of the uteroplacental circulation, electromyography and serum protein 53 level (p53) in prediction for preterm labour (PTL). Study Design : A prospective observational study. Patients and Methods: The study was conducted at the outpatient clinic of El-Minia University Hospital, Egypt during the period from January 2012 to December 2014. The study included a total of 100 pregnant women at high risk for preterm labor. All included cases were subjected to transvaginal cervical sonography, power Doppler velocimetry and uterine electromyography measurements (EMG), also, serum protein 53 level was determined. Results: The included subjects were classified into two groups according to gestational age at labor: Group (I): patients delivered before < 35 weeks (n=42) and group (II): patients delivered ≥ 35 weeks (n=58). Group (I) had significantly lower cervical length compared to group II (2.86 ± 0.81vs. 3.23 ± 0.67 cm) (P=0.013). There was a significant difference between groups as regards EMG (P = 0.006). No statistically differences were found between groups as regards Doppler indices (both resistance and pulsatility index). Group (I) had significantly higher maternal serum concentration of P53 compared to group II (473.8 ± 146.5 vs. 404.6 ± 164.7 pg/ml), (P≤ 0.01). Serum P 53 level had the higher sensitivity for prediction of PTL (78.6%), however, power Doppler indices had the lowest sensitivity (RI = 23.8% and PI =19.1%), cervical length had sensitivity of 33.3% however, EMG positive parameters had sensitivity of 40.5 % and specificity of 100.0%. Conclusion: From the studied tools for prediction of preterm delivery, different results were obtained, but serum P53 level was the most sensitive and the best option for prediction of preterm delivery, while, power Doppler indices are the least sensitive. However, EMG positive parameters are the most specific for prediction of PTL.

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