Objective of theStudy: To test the efficacy of the cerebroplacental ratio [CPR] in the prediction of early labor fetal distress and adverse neonatal outcomes in full-term [FT] low risk pregnancy. Patients and Methods: One hundred fifty pregnant women met the inclusion and exclusion criteria were subjected for the estimation of umbilical artery [UA] and middle cerebral artery [MCA] pulsatility indices [PI]]. CPR is calculated by dividing MCAPI by UAPI. All of these measures have been converted to multiple medians [MOMs]. The findings of CPR MOM were Correlated with the following; traces of cardiotocography; cesarean section [CS] for fetal distress; 5 min APGAR scoring; cord PH; and NICU admission. The ROC curve was used to test CPRMOM's predictive performance of adverse perinatal outcomes.Results: Out of 150 patients, 18 [12%] showed abnormal CPR MOM<1. All adverse perinatal outcomes were significantly higher among participants with reduced CPR MOM <1 compared to those with normal one, P value =0.000. There was negative significant correlation between CPRMOM and both of emergency CS, [r=-0.293, P<0.001] and NICU admission [r=-0.302, P<0.001. ROC curve showed that CPRMoM is good negative predictor, in both CS due to fetal distress, and NICU admission at cut off values,≤0.97 and ≤0.84 with sensitivity, 72.7 % and 75.0 %, specificity, 91.4 % and 92.3 % with AUCs, 0.778 and 0.827, P = 0.005, and < 0.001 respectively. Conclusion:Reduced CPRMOM < 1 considers a good predictor for both of CS due to fetal distress and NICU admission; however normal CPR doesn't perfectly rule them out. Reduced CPR MOM is a poor predictor for each of initial non reassuring CTG, APGAR score at 5 min and lower umbilical PH. Nevertheless, normal CPRMOM considers as good predictor for normal fetuses.
Background: to assess the possibility of hazard in early pregnancy, the first trimester 3D ultrasound can be used.Objective: to evaluate the role of 3D ultrasound measurements of yolk sac volume (YSV), gestational sac volume (GSV) and retrochorionic blood flow in predicting possibility risks in pregnancy during the first trimester.Methodology: This prospective cohort study carried out at Al-Zahraa Hospital included 100 pregnant women aged (20-35 years) at (5-11 weeks) of conception attend the outpatient obstetric clinics for antenatal care during a study period of one year (Dec.2018 and Dec.2019). They were selected by convenient sample and divided into; repeated pregnancy failure group (50) patients and normal control group (50) persons with the same criteria. Patients included in the study were offered 3D ultrasound and afterwards they were followed up till twenty weeks to predict pregnancy result. Results:The ROC curve was used to identify the area under the curve for retrochorionic arteries (RI) sensitivity was (84.0%); for gestational sac volume (77.0%); for yolk sac volume (71.0%) and for crown rump length (52.0%). Conclusion:First trimester 3D ultrasound assessments of GSV, YSV and retrochorionic blood flow give an accurate method for predicting outcome of pregnancy.
Background:The current body of evidence is limited regarding the long-term outcomes of different modalities for stress urinary incontinence (SUI). We conducted this systematic review and network meta-analysis to compare the long-term follow-up outcomes of mid-urethral slings (MUS), Burch colpo-suspension, pubo-vaginal sling (PVS), anterior colporrhaphy with Kelly's plication, and laser therapy in the treatment of SUI. Aim of the work:The current work aimed to compare the long-term follow-up outcomes of the following modalities in the management of SUI: MUS, Burch colpo-suspension, PVS, SIMS, anterior colporrhaphy with Kelly's plication, bulking agents, and laser therapy. Methods:In this systematic review and network meta-analysis, we included prospective and retrospective studies that assessed the long-term outcomes of modalities for the management of SUI. We performed an online, bibliographic, search in four bibliographic databases: Cochrane Central Register of Controlled Trials (CENTRAL), Medline via PubMed, Web of Science, and Scopus.Results: A total of 42 studies were included. For the subjective cure rate, five different interventions were compared; pooling direct and indirect comparisons revealed an advantage of tension-free vaginal tape (TVT) intervention over TVT-obturator (TVT-O), laparoscopic Burch colpo-suspension, trans-obturator tape (TOT), and TVT-sling (TVT-S). Concerning objective cure rate, the pooling direct and indirect comparisons showed an obvious advantage of TOT, followed by TVT, and then TVT-O, Burch lap, and TVT-S. For repeated surgery, four different interventions were compared, and the comparisons revealed an advantage of TVT intervention over TVT-O, PVS, and TOT. The comparisons revealed the advantage of TVT and TVT-O over other procedures for lower urinary symptoms and postoperative complications.Conclusion: MUS appears to be the most effective and safe procedure for SUI at long-term follow-up. However, these findings should be interpreted with caution as there is scarcity in the published reports assessing long-term outcomes of other modalities, especially PVS and laser therapy.
Background:The transversus abdominis plane block (TAP block) can give a good analgesia after lower abdominal surgery. The administered local anesthetics determine the TAP block duration, so administration of adjuvants can be utilized to extend local anesthesia time and increase efficiency. Aim of the work:To assess the efficacy of TAP block with dexamethasone on pain relief after lower abdominal gynecological procedures. Patients and methods: A randomized controlled study was performed on 100 women, aged 25-56 years, ASA I&II. Listed for lower abdominal gynecological procedures under general anesthesia, TAP block was performed bilaterally at the end of surgery. Patients were randomly divided into two groups: Group I (n=50) bilaterally received 15ml of 0.2% levobupivacaine plus 1.5 ml normal saline. Group II (n=50) bilaterally received 15 ml of 0.2% levobupivacaine plus1.5 ml) 6 mg (Dexamethasone. The primary outcome was visual analogue score (VAS) to assess postoperative pain. The secondary outcomes were the time to first analgesic request, number of patients needed meperidine, overall dose of analgesic consumption/24h and complications. Results: VAS was significantly lower for 12h at rest and for 10h on activity in group II compared to group I (P<0.001), prolonged time to first analgesic request (P <0.001) and less meperidine requirement in group II (P <0.001). Conclusion:Combination of dexamethasone to levobupivacaine in TAP block was effective in decreasing the severity of postoperative pain, overall meperidine consumption and prolonging the time to first analgesic request after lower abdominal gynecological procedures.
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