BackgroundOxytocin for postpartum hemorrhage (PPH) prophylaxis is commonly administered by either intramuscular (IM) injection or intravenous (IV) infusion with both routes recommended equally and little discussion of potential differences between the two. This trial assesses the effectiveness and safety of 10 IU oxytocin administered as IM injection versus IV infusion and IV bolus during the third stage of labor for PPH prophylaxis.MethodsIn two tertiary level Egyptian maternity hospitals, women delivering vaginally without exposure to pre-delivery uterotonics were randomized to one of three prophylactic oxytocin administration groups after delivery of the baby. Blood loss was measured 1 h after delivery, and side effects were recorded. Primary outcomes were mean postpartum blood loss and proportion of women with postpartum blood loss ≥500 ml in this open-label, three-arm, parallel, randomized controlled trial.ResultsFour thousand nine hundred thirteen eligible, consenting women were randomized. Compared to IM injection, mean blood loss was 5.9% less in the IV infusion arm (95% CI: -8.5, − 3.3) and 11.1% less in the IV bolus arm (95% CI: -14.7, − 7.8). Risk of postpartum blood loss ≥500 ml in the IV infusion arm was significantly less compared to IM injection (0.8% vs. 1.5%, RR = 0.50, 95% CI: 0.27, 0.91). No side effects were reported in any arm.ConclusionsIntravenous oxytocin is more effective than intramuscular injection for the prevention of PPH in the third stage of labor. Oxytocin delivered by IV bolus presents no safety concerns after vaginal delivery and should be considered a safe option for PPH prophylaxis.Trial registrationclinicaltrials.gov #NCT01914419, posted August 2, 2013.

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Aim: Cesarean delivery is one of the most common surgical procedures in obstetric practice and its incidence is rising worldwide. In Egypt, the past decade has witnessed a sharp increase in the CS rate to reach about 52 %. Post cesarean section (CS) infectious morbidity is a major health problem, which can lead to maternal health morbidities in addition to economic burden. Endometritis, febrile morbidity and wound infection are considered of the most frequent complications of post cesarean infections. Endometritis is the commonest complication as it accounts up to 27%, followed by clinically significant fever, which was reported as 5-24%, while the incidence of wound infection is about 2-9%. This complication, up to 10 times more frequent after a cesarean delivery than after vaginal delivery. Materials and Methods: This study was conducted on 54 females undergoing elective cesarean section, admitted to El-Shatby Maternity University Hospital. Patients were divided into two groups, each group contained 27 cases. The first group received Preoperative vaginal cleaning with10% povidone iodine for 30 seconds. The second group did not receive preoperative vaginal cleaning. Results: The Comparison between the two studied groups regarding incidence of febrile morbidity, post-operative endometritis and wound infection were statistically significant; P = (0.009), (0.024) and (0.018) respectively. Appling povidone iodine reduced the rate from 37 % in the control group to 7.4 % in the treatment group, post-operative endometritis rate from 29.6 % in the control group to 3.7% in the treatment group and post-operative wound infection rate from 33.3 % in the control group to 7.4 % in the treatment group. Conclusion:This study has shown that vaginal cleaning with povidone iodine prior to cesarean section can prevent postoperative febrile morbidity.

Labour augmentation aims to shorten labour so prevent complications related to prolonged labour. There is evidence that a significant proportion of women with uncomplicated pregnancies are subjected to routine augmentation of labour with oxytocin in spite of the general rule that labour augmentation should only be performed for valid indications. Obstetric hemorrhage is one of the leading causes of maternal mortality in developing countries, accounting for 10%-30% of direct maternal deaths. The aim of the study was to compare between labour augmentation with oxytocin and no augmentation on the total volume of blood loss during vaginal delivery. The study included 250 cases admitted to the emergency department in El-Shatby maternity university hospital, group A (Oxytocin group) 125 cases received augmentation by oxytocin infusion using 2.5 IU oxytocin in 500 cc saline with a slow rate of 20-30 drops/minute, group B (Control group) 125 cases received only 500 cc saline. The amount of blood loss during the 3 rd stage of labor and the 1 st hour after delivery of the placenta (4 th stage) have been estimated.Results showed that the total volume of blood loss in group A ranged from 100 to 700 ml with the mean of 230.9 ± 99.3 ml, on the other hand it ranged from 100 to 650 ml with mean of 181.5 ± 83.1 ml in group B. the calculated p value was 0.001, so there was a significant statistical difference between both groups regarding the total volume of blood loss, so we concluded that use of oxytocin in labor augmentation increase the volume of blood loss.

Objectives:To compare transvaginal sonography for cervical length measurement and digital examination for Bishop score assessment in women undergoing labor induction at term. Patients and Methods:A prospective study involved 140 women subjected to induction of labor. Preinduction assessment of Modified Bishop score and transvaginal ultrasound measurement of cervical length was done. Results:One hundred and forty nulliparous women had CL <28 mm and modified Bishop score of ≥7; 84.8% (123/140) of them delivered vaginally and (17/140) delivered by cesarean section Analysis of the ROC curves for cervical length and Modified Bishop score indicated that both were predictors of Successful vaginal delivery (area under the curve 0.766 vs. 0.728; with optimal cutoffs for predicting Vaginal delivery of ≤ 18 mm for cervical length and Bishop score >7. Cervical length had superior sensitivity (83.74% vs. 65.4%) and marginally better positive (95.4% vs. 94.1%) and negative (37.5% vs. 21.8%) predictive values. Conclusions:Transvaginal sonography for cervical length measurement is better tolerated than digital examination for Modified Bishop score assessment.