Extreme uterine torsion of 180 degrees at term is a rare obstetric event and raises several critical management considerations. We report such a case detected at laparotomy for a repeat Caesarean section. The existing literature on uterine torsion is reviewed and a plan of management is suggested, based on previous reports and our own experience.

Knowledge and acceptance of postpartum insertion is very low among antenatal women; probably because the concept is new in the community. There is a strong need to increase the knowledge and awareness about this by health education and counseling.

This study was conducted to clarify the impact of Khat chewing on maternal and fetal outcomes during pregnancy of Yemeni women.Khat chewing during pregnancy can affect maternal health with a damaging effect on the baby's health and wellbeing. This study was conducted to clarify the impact of Khat chewing on maternal and fetal outcomes during pregnancy of Yemeni women.This prospective study enrolled 60 regular Khat chewing pregnant women and 120 non-Khat chewing pregnant women, selected from those attended with singleton pregnancy in their first or second trimester from the ANC unit of AL-Gamhouri Teaching Hospital in Taiz (Republic of Yemen).Khat chewer pregnant women were having statistically significant risk of 6 times for preterm labor, 3.83 times for labor induction and statistically insignificant risk of 4.10 times for preeclampsia, 2.78 for blood transfusion and fetal distress, 2.05 for PROM, 2.03 for PPH and perineal tears and 2.02 for IUFD. There is significant lower mean hemoglobin concentration at delivery when compared with the control.Khat chewer pregnant women were having statistically significant risk of 6.56 times for breech presentation; 8.94 times to deliver fetuses with low birth weight (<2500 gm); 6.0 times for neonatal admission to the ICU and statistically insignificant risk of 3.54 times for perinatal mortality and 2.02 times for congenital malformations.This study concluded that Khat chewing is globally associated with a negative impact on maternal and fetal wellbeing. Citation: Abdel-Aleem, M., et al. Khat chewing during pregnancy: An insight on an ancient problem. Impact of chewing Khat on maternal and fetal outcome among Yemeni pregnant women (2015) J Gynecol Neonatal Biol 1(2): 28-31.

EDITORIAL COMMENT: We accepted this case for publication because it surely presents the ultimate evidence of an association between recurrent spontaneous abortion and untreated Wilson disease, in a woman with great reproductive stamina.

Background:The reliability and success of caudal epidural anesthesia depends on anatomic variations of sacral hiatus (SH) as observed by various authors. SH is an important landmark during caudal epidural block (CEB).The purpose of the present study was to clarify the morphometric characteristics of the SH in human Egyptian dry sacra and pelvic radiographs and identification of nearest ony landmarks to permit correct and uncomplicated caudal epidural accesses.Methods:The present study was done on 46 human adult Egyptian dry sacra. The maximum height, midventral curved length, and maximum breadth of each sacrum were measured and sacral and curvature indices were calculated. According to sacral indices, sacra were divided into 2 groups (22 male and 24 female sacra). SH was evaluated in each sacrum according to its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior (AP) diameter at its apex, and transverse width at its base. Linear distances were measured between the apex of SH and second sacral foramina, right and left superolateral sacral crests. The distance between the 2 superolateral sacral crests also was measured.Results:The most common types of SH were the inverted U and inverted V (in male) and inverted V and dumbbell shaped (in female). Absent SH was observed in male group only. The most common location of SH apex was at the level of S4 in all groups of dry sacra and S3 in all groups of lumbosacral spine radiographs, whereas S5 was the common level of its base. The mean SH length, transverse width of its base, and AP diameter of its apex were 2.1±0.80, 1.7±0.26, and 0.48±0.19 cm. Female sacra showed narrower SH apex than male. The distance between the S2 foramen and the apex of the SH was 4.1±1.14, 3.67±1.21, and 4.48±1.01 cm in total, female and male sacra, respectively.Conclusion:Sacrum and SH showed morphometric variations in adult Egyptians. The equilateral triangle is an important guide to detect SH easily and increases the success rate of CEB. Insertion of a needle into the SH for caudal block is suggested to be done at its base to avoid the anatomic variations of its apex.

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