Gestation at delivery, birthweight and pregnancy outcome of surviving fetuses from 127 multifetal pregnancies undergoing embryo reduction to twins were compared to 354 chromosomally normal non-reduced dichorionic twin pregnancies. First-trimester embryo reduction was carried out by intracardiac injection of KCl. In 16 (12.6%) of the 127 multifetal pregnancies reduced to twins, there was miscarriage of both fetuses before 24 weeks of gestation. The median interval between reduction and fetal loss was 5 weeks (range 1-12). In livebirths, the median gestation at delivery was 36 weeks (range 24-41) and the median difference in birthweight from the appropriate mean was -0.94 SD (range -3.89-1.73 SD). Both fetal loss before 24 weeks and the interval between embryo reduction and delivery were significantly associated with the gestation at reduction (r = 0.40, P < 0.001 and r = -0.57, P < 0.001 respectively). In the pregnancies reduced to twins compared to the non-reduced twins, the percentage of miscarriages was higher (12.6 compared to 2.5%; chi 2 = 19.2, P < 0.001), the median gestation at delivery was lower (36 compared to 37 weeks; t = -1.74, P < 0.05), and the median birthweight deficit was greater (-0.94 compared to -0.65 SD: t = -4.1, P < 0.001).
The study was planned to assess the effect of Kangaroo Mother Care on preterm and stable neonates in reducing neonatal morbidity and mortality. This is a case series design of 121preterm and low birth weight neonates, weighing less than 2500 gram, enrolled from 1 August 2016 till31 January 2017.Kangaroo Mother Care is initiated after birth, after performing early essential newborn care practices. Weight gain of 20-30 gram for three consecutive days, establishment of breast-feeding for 20-30 minutes every two hourly and maintenance of body temperature at 37 degree centigrade is the discharge criteria. During the periodof six months, total number of deliveries was 6459, out of them spontaneous vaginal deliveries were 52.2% (3372) and caesarean sections were 47.7% (3087). In 55.4%neonate’s(both preterm and term)early essential newborn care was practiced.Total preterm were 290 (4.5%), out of them 121 (2%) neonates were kept inKangaroo Mother Care position and 129 (44%) were shifted to neonatal intensive care unit. 14% parents refused for KMC position and discharged. Mortality in preterm newborn in neonatal unit was 29.4% (without KMC) but no mortality occurred after 3 months follow up in KMC babies. All the neonates from KMC unitwere discharged in satisfactory condition and called for follow up investigations. All Kangaroo Mother Care babies had exclusive breast-feeding. Taken together, the results indicate that prolonged skin-to-skin contact and exclusive breast feeding reduces neonatal mortality and morbidity in birth weight 1.5 to 2.5 kg in stable neonates in hospital. However KMC is limited to SHL at present. Workshops are being conducted to teach other doctors and nurses for early essential newborn care and kangaroo mother care. They are still facing controversies and challenges in initiation of KMC in many hospitals. However it is essential to strengthen KMC services in healthcare facilities as it significantly reduces neonatal mortality.
Embryo transfer is a critical final step in the in vitro fertilization (IVF) cycle. Much attention has been paid to standardizing the procedures of embryo transfer to improve pregnancy outcome. Objective. To identify the impact of embryo thawing-loading interval (the time interval passing from thawing to loading of frozen embryo into the catheter) on pregnancy outcome. Results. The study was divided into quartiles according to thawing-loading interval in minutes (G I: <60; G II: 60–119; G III: 120–239; G IV: 240 and above). Numerical variables are presented as median and interquartile range, and inter-group differences are compared using the Mann-Whitney U test. Categorical variables are presented as numbers and percentages, and differences are compared using the chi-square test for trend. After adjustment for the age of women, time of previous failed ICSI (Intracytoplasmic sperm injection) trials, number and maturity of transferred embryos, a thawing-loading interval between 60–119 minutes (adjusted odds ratio = 2.222, 95% CI = 1.370 to 3.603, p-value = 0.001) or between 120–239 minutes (adjusted odds ratio = 1.924, 95% CI = 1.172 to 3.161, p-value = 0.010) was independently associated with increased probability of clinical pregnancy compared with a thawing-loading interval of <60 minutes. On the other hand, a thawing-loading interval of ≥240 minutes significantly decreased the probability of clinical pregnancy (adjusted odds ratio = 0.378, 95% CI 0.215 to 0.664, p-value = 0.001). Conclusion. After adjusting for potential confounders, this analysis found that a thawing-loading interval between 60–239 minutes was independently associated with better pregnancy outcomes compared with a thawing-loading interval of <60 minutes. On the other hand, a thawing-loading interval of ≥240 minutes was significantly associated with a worse outcome. Key words: embryo transfer, IVF (in vitro fertilization), frozen embryo, thawing-loading interval
The aim of this study was to identify the value of hysteroscopy in detection of the relationship between missed miscarriage and intrauterine pathologies. The study was held at the Department of Obstetrics and Gynaecology, Benha University. It included 90 women with 1 st trimester missed miscarriage who were examined by diagnostic hysteroscopy immediately before dilatation and curettage (D&C) and 6-8 weeks after D&C (second look hysteroscopy). Incomplete uterine septum was found in 22.2% of cases; 70% of them had a previous history of missed miscarriage. Intrauterine adhesions were found in 6.7% of cases before D&C and in 16.7% after D&C. In cases of missed miscarriage either before or after D&C, hysteroscopy is an easy and effective tool for diagnosis of the site of the sac and the presence of intrauterine pathology.Abstract
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