Introduction and aim: Placenta praevia and accreta are associated with high morbidity and mortality. Bleeding is the sole etiology of both morbidity and mortality. Thus, anti-bleeding measures are mandatory and research continues to search for ideal prophylactic measure. This work was designed to assess the efficacy of bilateral internal iliac artery ligation followed by Transverse B-Lynch compression suturing and intrauterine balloon tamponade as a conservative methods to control placental site bleeding due to placenta praevia accreta. Methodology: The study included 24 pregnant females with placenta praevia accreta who were scheduled for elective cesarean section. All participants were subject to history taking, clinical evaluation and laboratory investigations. Ultrasound examination was carried out for assessment of: Estimated fetal weight, confirmation of gestational age, confirm diagnosis of placenta previa accreta and level of the placental edge in lower uterine segment. Deliveries were scheduled to take place between 36-37 weeks of gestation. The primary outcome was the amount of intra-operative blood loss. Results: Blood loss ranged between 249.29 and 560.43 ml, and there was statistically significant decrease of hematocrit percent and platelets after surgery when compared to corresponding values before surgery. All females need blood transfusion. However, none of them need further surgical intervention or intensive care unit admission. Conclusion: Prophylactic bilateral internal iliac artery ligations before extraction of placenta accreta followed by transverse B Lynch suture and intrauterine balloon tamponade seemed to be an effective and safe technique to reduce intrapartum and postpartum complications, and to avoid emergent peripartum hysterectomy.
Background: Miscarriage is the most common adverse pregnancy outcome which has detrimental psychological consequences for the woman and her partner and delays successful childbearing. Normal embryonic heart rate is about [100-200] bpm at 5 weeks gestation then it increases progressively over the subsequent 2-3 weeks. Fetal demise often occurs within one week after the slow embryonic heart rate and always occurs by the end of the first trimester. Aim of the work: The aim of the present study was to investigate the relation between first trimester miscarriage and slow embryonic heart rate at sixth week of gestational age and other risk factors of miscarriage. Patients and methods: A prospective observational cohort study was conducted in the department of Obstetrics and Gynecology, Al-Azhar Faculty of medicine [Damietta] during the period from September 2017 to September 2018 on 90 pregnant women who had slow embryonic heart rate [80-100] bpm at sixth week of gestational age. All were submitted to full history taking, clinical and ultrasound examination and followed up till the end of their pregnancy and outcome was documented. Results: Percentage of aborted cases at the 8 th week of gestational age was [38.9%], while, [20%] at the 10 th week and [15.4 %] at 13 th week. Whom fetus had a heart rate less than 90 were at risk 23.8 times for experiencing abortions more than other females. Conclusion: Slow embryonic heart rate is one of the earliest predictors for the first trimester fetal demise and it is one of the newest studies.
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