Objective To evaluate our ability in classifying the fetal heart as normal or abnormal during the 1st trimester scan through fetal cardiac examination and determining the best time for this examination. Methods This was a prospective study performed on 3240 pregnant women to examine the fetal heart. Four chambers view and ventricular outflow tracts were mainly examined during the scan. We used grayscale and color mapping in the diagnosis. Color Doppler was used if additional information was needed, and all patients were rescanned during the 2nd trimester to confirm or negate our diagnosis. Results The cardiac findings were normal at both scans in 3108 pregnancies. The same cardiac abnormality was detected at both scans in 79 cases. In 36 cases there was false-positive diagnosis at the early scan; in 20 of these cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 17 fetuses, there was discordance between the early and later diagnosis due to missed or incorrect diagnoses. The best time to do fetal heart examination during 1st trimester is between 13 and 13 + 6 weeks. Conclusion A high degree of accuracy in the identification of congenital heart disease (CHD) can be achieved by a 1st trimester fetal echocardiography.

Objective This study aims to compare the efficacy and safety of different doses of vaginal misoprostol prior to IUCD insertion among women with nulliparous cervix “those who 29never delivered-vaginally”. Study design: The current study was a randomized, double-blind, placebo-controlled trial conducted in the Family Planning Clinic of Ain Shams University’s Maternity Hospital Egypt. It involved women who delivered only by elective CD (cesarean delivery). One hundred and eighty women were randomized into three groups, Group 1 received misoprostol 200 mcg. Group 2 received misoprostol 100 mcg. Group 3 received placebo. The primary outcome was pain scores which were measured using a visual analogue scale (VAS), the secondary outcome was the ease of insertion score (ES). Results VAS and ES were significantly lower in group 1 compared to group 2 and group 3 (P < 0.001).There was insignificant difference among the three groups as regards successful IUD insertion (P = 0.477). Duration of insertion was significantly lower in group 1 than group 2 (P < 0.001). Satisfaction was significantly higher in group 1 compared to group 2 and group 3 (P < 0.001) Conclusion The effect of misoprostol seems to be dose-dependent. Dose of 200mcg seems to be ideal with best efficacy and with no significant increase in the adverse effects Implications: The dose of 200mcg vaginal misoprostol prior to IUD insertion in women, who had never delivered vaginally before, seems to be the most effective dose. Trail to lower the dose to100mcg significantly compromises the efficacy without remarkable benefit on the side effect profile.

Introduction: Goal-directed fluid therapy "GDFT" is a method of oxygen delivery and hemodynamics optimization using vasoactive and fluid infusions. According to several studies, GDFT has shown better results than traditional fluid therapy to maintain hemodynamic stabilization Material and Methods: Our systematic review and meta-analysis was carried out according to the PRISMA guidelines for randomized studies. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until February 2022. All relevant outcomes were pooled in the meta-analysis using Review Manager Software Results: Our systematic review included three RCTs. All of them were included in our meta-analysis. There was no significant difference between GDFT group and the control group in the maternal adverse events except in the incidence of hypotension which was less in the intervention group. Also, there is no significant difference between the two groups in terms of PH, PO2, PCO2, lactic acid, and base deficit. GDFT group was better in SO2 than the control group in both artery and vein. Regarding the umbilical vein, the number of neonates who had PCO2 >46 mmHg and PO2 ≤21 mmHg was less in the intervention group than the control group. On the other hand, there were no significant difference between the two groups in the number of neonates whose PH <7.28. Finally, regarding the umbilical artery, the number of neonates who had PCO2 >46 mmHg and PO2 ≤21 mmHg was less in the intervention group. Conclusion: GDFT shows promising results in controlling the hypotension and blood gases in pregnant women compared with the control group. Also, GDFT may provide benefits to healthy parturient women and their newborns.

Objective Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. Study Design A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. Results Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). Conclusion Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. Key Points

ObjectiveTo compare efficacy of lidocaine–prilocaine (LP) cream versus misoprostol versus placebo before levonorgestrel‐releasing intrauterine device (LNG‐IUD) insertion.MethodsThis randomized controlled trial (RCT) was conducted in a tertiary referral hospital from April 30, 2020 to March 1, 2021 on 210 parous women willing to receive LNG‐IUD and delivered only by elective cesarean delivery (CD). Participants received 200 μg vaginal misoprostol or 5 ml of LP cream 5% or placebo 3 h before LNG‐IUS insertion. Primary outcome was pain during LNG‐IUD insertion, while secondary outcomes were pain 10 min post‐procedure, ease of insertion, patient satisfaction, insertion time, and drug side effects.ResultsPain during LNG‐IUS insertion was reduced in LP group and misoprostol group compared to placebo group (2.1 ± 1.0 vs 3.7 ± 1.6; p <0.001) and (2.3 ± 1.3 vs 3.7 ± 1.6; p <0.001), respectively. Ease of procedure and patient satisfaction were significantly higher in LP and misoprostol groups than placebo (P <0.001). Need for additional analgesia was significantly higher in placebo group than in the other two groups (P = 0.009). Adverse events were not significantly different between the three groups except vomiting and abdominal cramps, which were higher with misoprostol.ConclusionLP cream and 200 μg of vaginal misoprostol administration before LNG‐IUD insertion in women delivered only by elective CD effectively reduced pain during insertion and 10 min post‐procedure with easier insertions, high patient satisfaction, and tolerable side effects. Pain reduction with LP cream was clinically significant.

Objectives:To study the detection rate of congenital fetal heart anomalies in first trimester scanning compared with second trimester scanning and to postnatal exam and neonatal echocardiography. Methods: This is a prospective observational study performed at a tertiary Fetal Medicine Unit. Patients had a first trimester scan from 11-14 weeks which included screening for Down's syndrome by measurement of the NT thickness, detection of Nasal bone, measurement of DV flow and tricuspid valve flow. Full anatomy exam was performed with special interest in the heart. Examination of the heart included; the four chamber view, intact inter-venticular septum, correct outflow tract and the three vessel view in the mediastinum. Pulsed Doppler was done at level of tricuspid valve to exclude regurgitation.A similar examination of the heart was performed at 20-24 weeks with full anatomy survey for other congenital malformations.Comparison of the two fetal heart examinations was done compared to final neonatal examination and neonatal echocardiography when indicated. Results: A total of 300 pregnant females were examined. The mean age of the patients were; 29.9 ± 6.3. Mean BMI was 32.5.The mean GA at the first trimester was 12.9 ± 0.9 and the mean GA at the second trimester was 20.4 ± 1.4.A total of 11 congenital heart anomalies were confirmed postnatally (3.7%).Seven were diagnosed and 4 were missed at the first trimester and one was falsely diagnosed as having an anomaly giving a detection rate of 63.6%, specificity 99.7%, PPV 87.5%, NPV 98.6% and agreement reached 98.3% (kappa 0.728)In the second trimester scan 9 cases were diagnosed, 2 cases were missed giving a detection rate of 81.8%, specificity 99%, PPV 75%, NPV 99.3% agreement 98.3% (kappa 0.774). Conclusions: First trimester heart examination has a good detection rate for congenital heart anomalies and should be done as a routine during first trimester screening for Down's syndrome. We describe here a remarkable case that had never been reported before. It's an antenatal diagnosis of a fistula between the rectum and the subcutaneous layer creating a meconial layer under the skin of the fetal bottom. Ultrasound and IRM showed this infiltration creating a mass extending to the caudal pole of the lumbosacral region at the root of both thighs. The surgical pediatric team confirmed the nature of the lesion after birth. Despite the important size of the mass, the pediatric and surgical cares have permitted an anatomic restitution. To our knowledge, such lesion has never been reported in the literature whether for an antenatal or a postnatal diagnosis. This case widens the range of perineal masses diagnosis. Teratoma of an undescended testicle is a rare cause of fetal abdominal cystic mass. The criteria for its prenatal diagnosis are unclear. We hereby present a prenatal diagnosis of isolated fetal testicular teratoma confirmed on early neonatal surgical excision, and describe two-and three-dimensional ultrasound, and Doppler criteria for its diagnosis. OP26.10A 31 year old ...