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Background: Prematurity is the second leading cause of death in the first month of life. Objective of present study was to evaluate the effectiveness of vaginal progesterone and cervical cerclage each alone and in combination in improving gestational age in twin pregnancy and its subsequent impact on perinatal outcome.Methods: A sample size of seventy-five patients has been calculated out of those recruited from outpatient clinic at menoufia university hospital. All fulfilled eligibility criteria of having a twin pregnancy with a history of spontaneous preterm labour, or with a sonographic short cervical length <25mm in mid trimester. The participants were randomly assigned to three groups. Group 1 (N-25): received vaginal progesterone supplementation of 200 mg from 20 weeks until 34 weeks of gestation. Group2 (N-25): were remedied with cervical cerclage of Mc Donald type at 14-16 weeks of gestation Group 3 (N-25): received both vaginal progesterone as well as cervical cerclage. The primary outcome measure was spontaneous delivery between 34-37 weeks of gestation. Secondary outcomes were delivery prior 34 weeks of gestation as well as some parameters of neonatal morbidity and mortality.Results: There was a statistically significant higher gestational age in combination group when compared to progesterone group or cerclage group (P<0.001). Comparison between progesterone and cerclage groups did not reach statistical significance(P=-0.85). Both progesterone and cerclage groups demonstrated significantly lower birth weights, lower Apgar scores and a higher NICU admission rate than in combination group(P<0.001), while such significant difference did not exist between progesterone and cerclage groups.Conclusions: Combination of vaginal progesterone and cervical cerclage can improve gestational age at delivery as well as some parameters of perinatal morbidity and mortality in twin pregnancy.

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aim of this review was to compare the use of diathermy versus scalpel in making skin incision during abdominal operations to judge the variations in post operative pain, incision time, incisional blood loss, and wound complications. Materials and MethodsThis review was performed according to the guidelines developed by the center for review and dissemination. It was used to assess the outcome of the studies. The guidance published by the Centre for Reviews and Dissemination was used to assess the methodology and outcomes of the studies. This review was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. An institutional review board and ethics committee approved this study.Search strategy: we reviewed papers that compared the use of scalpel versus the use of diathermy in making skin incision during abdominal surgical operations, from Medline databases which are Abstract Objectives: To compare the use of diathermy versus scalpel in abdominal skin incisions to see the variations in post operative pain, incision time, incision blood loss and wound complication rate.Background: Surgical scalpels are traditionally used for making skin incisions during abdominal surgical operations. The great evolutions in the electrosurgical devices nowadays bring an alternative method for making skin incision by the usage of diathermy skin incision.Data Sources: Medline databases (Cochrane reviews, PubMed, Medscape, Science Direct) and all materials available in the Internet from 2011 to 2017. Study Selection:The initial search presented 157 articles of which 8 met the inclusion criteria. The articles were randomized controlled trials compared the use of surgical scalpel versus cutting diathermy in making skin incisions during abdominal operations. Data Extraction:If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information and defined assessment measures.Data Synthesis: Comparisons were made by structured review with the results tabulated. Findings:The studies indicated that cutting diathermy could be accepted as an alternative method for abdominal skin incisions. Conclusion:The studies stated that, the use of diathermy in skin incision during abdominal surgical operations was associated with less blood loss and shorter incision time than the scalpel skin incision. No increase in the postoperative pain and wound complications rate reported with the use of cutting diathermy for abdominal skin incisions.