ObjectiveTo compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage (PPH) among low‐risk women.MethodsRandomized controlled trial among 150 pregnant women with low risk of PPH admitted for vaginal delivery at Kasr Al Ainy Hospital, Cairo, Egypt, between July 2018 and May 2019. Participants were assigned to two groups by a web‐based randomization system ensuring allocation concealment. After neonatal delivery, the carbetocin group received one ampoule of carbetocin (100 μg/mL) intravenously and the misoprostol group received two rectal tablets of misoprostol (800 μg) for active management of the third stage. Blood pressure, blood loss, and hemoglobin levels were monitored. The primary outcome measure was need for additional uterotonic drugs.ResultsThe carbetocin group had significantly less blood loss (P<0.001), shorter third stage (P<0.001), and less need for additional uterotonics (P=0.013) or uterine massage (P=0.007). The two drugs were hemodynamically safe. Hemoglobin levels after delivery were comparable in the two groups (P=0.475). Adverse effects were more common in the misoprostol group (P<0.001).ConclusionAmong low‐risk women, carbetocin seems to be a better alternative to misoprostol for active management of the third stage of labor; it reduced blood loss and use of additional uterotonic drugs.ClinicalTrials.gov: NCT03556852

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Purpose To detect the widening of the tunnel of the coracoid process after arthroscopic fixation of acute acromioclavicular joint (ACJ) dislocation using the TightRope system and its correlation with loss of reduction and functional scores. Methods From 2016 to 2018, a prospective study was performed on twenty-three patients with acute grade III–V ACJ dislocation. Arthroscopic TightRope repair of the ACJ was performed. Coracoid tunnel widening was measured by CT, and the coracoclavicular distance was measured on the radiographs immediately postoperatively and at 12 months. The Constant Shoulder Score, Oxford Shoulder Score, Nottingham Clavicle Score and Visual analog scale were used as outcome measures at 12 months. Results The coracoid tunnel diameter to horizontal coracoid diameter ratio increased from 22.8 ± 3.7% immediately postoperatively to 38.5 ± 5.5% at 12 months (p < 0.001). The coracoclavicular (CC) distance showed an increase from a mean of 10.8 ± 1.7 mm to a mean of 11.8 ± 2.5 at 12 months (p < 0.001). There was no correlation between the increase in the coracoclavicular distance and the patients’ functional clinical scores or coracoid tunnel widening. Conclusion Coracoid tunnel widening and radiological loss of reduction occur after arthroscopic fixation of acute ACJ dislocation with the TightRope system. However, they do not correlate with each other or with the functional scores of the patient. Level of evidence Level IV.

To correlate histomorphology of the placenta with Doppler studies of uterine and umbilical arteries. A comparative observational study conducted on 75 pregnant women divided into 2 groups: Group 1 included 25 women with appropriate for gestational age fetuses. Group 2 included 50 women with FGR. Uterine and umbilical artery Doppler, study of placental pathology and immunohistochemistry of placental villous tissues were evaluated. There was a significant difference between the two study groups regarding both abnormal uterine (0 vs. 58%) and umbilical artery (0 vs. 58%) Doppler (p \ 0.001). Syncytial knots [ 30% (44 vs. 60%), fibrinoid necrosis [ 5% (8 vs. 46.7%), placental infarction [ 5% (0 vs. 15%), perivillous fibrinoid deposition [ 5% (1.8 vs. 16.7%) (p \ 0.001) but not calcifications (56 vs. 60%, p = 0.121) were significantly higher in FGR placentas. A statistically significant (p \ 0.001) increase in the expression of VEGF in FGR placentas when compared with normal placentas. Abnormal uterine artery but not umbilical artery Doppler was significantly associated with abnormal placental pathology. Women with both abnormal uterine and umbilical artery Doppler velocimetries were delivered earlier and their babies had lower mean birth and placental weight (p \ 0.001). Incidence of abnormal placental pathology was significantly higher in this specific group of FGR pregnancies (p \ 0.001). There is high association between abnormal uterine and umbilical artery Doppler and placental pathology in FGR associated pregnancies.Trial Registration NCT03081754.

Revision anterior cruciate ligament surgery is a technically demanding procedure. Mal-positioned tunnels together with bone loss and its management are some of the difficulties and challenges faced. Two-staged procedures have successfully been used to tackle those challenges. We present a technique that is safe, reliable, reproducible, and economic in the management of bone defects faced in anterior cruciate ligament revision surgery by using iliac crest bone graft. Preoperative assessment of tunnel position and size is done by computed tomography. Tri-cortical iliac crest bone graft is harvested through a trap door. It is then shaped to fit the tunnels to be filled. It is tapered at the advancing end to facilitate introduction. Mounted on a passing pin and a drill bit, the graft is arthroscopically introduced into the femoral and tibial tunnels. The second stage is performed after the graft has incorporated, as seen on postoperative computed tomography, done at approximately 3 months after the first stage. Iliac crest provides a natural abundant reservoir for bone graft and has all the advantages of being an autograft. With good meticulous technique, complications can be avoided with less donor-site morbidity. This technique is safe, reliable, and reproducible. It provides an ample amount of graft and harvest does not rely on implants; hence, it is economic.