Background Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. Methods This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A) , ( n = 38) underwent cesarean hysterectomy, group (B) , ( n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C) , ( n = 16): the placenta was left in place. Results The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. Conclusions The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling. Trial registration Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

High expression of cell division cycle 20 homolog (CDC20), a key component of the spindle assembly checkpoint (SAC), has been reported in various malignancies and plays a vital role in tumorigenesis and progression. The goal of this study was to evaluate the utility of CDC20 immunostaining in a wide range of malignant tumors. CDC20 immunohistochemistry was evaluated in normal tissues and compared to the most frequently occurring malignant tumors in these tissues (bladder, breast, cervical, colonic, endometrial, gastric, head and neck, liver, lung, ovarian, pancreatic, prostatic, renal, thyroid carcinomas, and testicular seminoma). Normal/non-neoplastic tissues showed positive CDC20 expression in 19.44 % of all examined cases. CDC20 staining was negative in normal and non-neoplastic tissues from the bladder, cervix, liver, stomach, and thyroid. From the all malignant tumors examined 55.7 % showed high CDC20 expression while low expression was found in 44.3 %. High expression of CDC20 was associated with high tumor grade in the bladder (p = 0.027), cervical (p = 0.032), colonic (p = 0.026), endometrial (p = 0.016), gastric (p = 0.033), liver (p = 0.028), ovarian (p = 0.044), prostatic (p = 0.040), and renal (p = 0.048) carcinomas. There was a significant correlation between high CDC20 expression and advanced tumor stage in carcinoma of the breast, colon, endometrium, and prostate (p = 0.021, p = 0.040, p = 0.047, p = 0.031, respectively). CDC20 expression may be useful as a biomarker of tumor prognosis and as a therapeutic target of human cancer.

Introduction In low-resource settings (LRSs), pain relief during labor is often neglected. Women and health professionals (HPs) may lack awareness of analgesic options, may not accept these options, or may have concerns regarding their safety. Furthermore, even if women or HPs preferred labor analgesia, options may not be available at the hospital. This study was carried out to explore how HPs perceive and practice pain management during labor in Minia maternity units in Egypt. Methods A structured, self-administered questionnaire from 306 HPs in Minia maternity units from August 1, 2016, to August 30, 2017, after approval by the organizational Ethical Review Committee. Results The response rate was 76.5%. The majority, 78.2% of participants, believed in pain relief during labor. However, their practices are different. In the first stage of labor, almost 44.9% used nonpharmacological methods, whereas 36.8% used neither pharmacological nor nonpharmacological methods. Hospital-related factors were the major barriers against using pain-relief methods, as stated by HPs. Conclusion Although most HPs understand the role of analgesia in labor pain relief, there is a wide gap between the use of pain-relief methods and women's need in Minia, Egypt; HPs claim this is due to health care facilities. There is an urgent need to identify the barriers against and raise the awareness among the community and HPs of the need to use pain-relief methods as part of improving the quality of care during labor.

Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%. Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

Background Reducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services’ coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR. This study aims to examine the contribution of the three delays in relation to maternal deaths. Methods During a 10 year period (2008–2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model. Results From 2008 to 2017 MMR in this hospital was 186/100.000 live births. Most frequent causes of maternal mortality were postpartum hemorrhage, hypertensive disorders of pregnancy and sepsis. Third phase delay occurred in 184 deaths (88.9%), second phase delay was observed in 104 deaths (50%), always together with other phases of delay. First phase delay alone was observed in 13 deaths (6.3%) and in 82 deaths (40%) with other phases of delay. One fifth of the women had experienced all three phases of delay together. Major causes of third phase delay were delayed referral from district hospitals, non-availability of skilled staff, lack of blood transfusion facilities and shortage of drugs. Conclusions There is a paradigm shift from first and second phases of delay to the third phase of delay as a major contributor to maternal mortality. Reduction of maternal mortality can be achieved through improving logistics, infrastructure and health care providers’ training. Trial registration This study is a retrospective study registered locally and approved by the ethical committee of the Department of Obstetrics and Gynaecology, Minia University Hospital on 1/4/2016 (Registration number: MUEOB0002).

CondensationSerum relaxin levels are reduced in pregnant women with a history of recurrent miscarriage, and correlate with maternal uterine artery Doppler indices in first trimester. 3 ABSTRACTObjectives: Defective implantation is a mechanism for recurrent pregnancy loss (RPL). We sought to determine whether the serum expression of human relaxin 2 (RLX) is impaired in women with a history of RPL.Study Design: Employing a prospective case-controlled design we studied 20 pregnant women with a history of RPL and 20 age-matched women with no history of RPL (NRPL). We measured serum relaxin 2 levels by ELISA at 6-8, 10-12, 20, 34 wks gestation and in cord blood, and maternal uterine artery Doppler resistance index (RI) at ≥ 10 wks gestation.Results: Relaxin rose to a peak at 12 wks, and gradually declined towards term. At all gestations, women with a history of RPL had lower RLX levels than women without. At 10-12 wks uterine artery, uterine artery RI correlated with serum RLX for both RPL and NRPL and the presence of a notched waveform in the NRPL group was associated with higher RLX levels than the absence of a notch (mean 2.1 vs.1.3ng/ml, P < 0.05 respectively), and also at 20 wks (2.1 vs. 0.95 ng/ml, P < 0.05 respectively), but did not differ in the RPL group. Umbilical venous RLX was 4-fold higher in the RPL group than the NRPL group. Conclusion.Women with a history of RPL demonstrate attenuated levels of serum RLX across all pregnancy trimesters. How dysregulated RLX metabolism may contribute to adverse pregnancy outcome in RPL requires further investigation.

Awareness of RH is poor in Egypt, even among young women attending institutions of higher education. The present study not only highlights the persistent need for the ongoing RH information programs, but may also provide policy makers with data that will inform new strategies.

BackgroundPlacenta previa and placenta accreta carry significant maternal and fetal morbidity and mortality. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections. The objective of this study was to evaluate the efficacy and safety of the use of the cervix as a natural tamponade in controlling postpartum hemorrhage caused by placenta previa and placenta previa accreta.MethodsThis prospective study was conducted on 40 pregnant women admitted to our hospital between June 2012 and November 2014. All participating women had one or more previous cesarean deliveries and were diagnosed with placenta previa and/or placenta previa accreta.Significant bleeding from the placental bed during cesarean section was managed by inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment.ResultsThe technique of cervical inversion described above was successful in stopping the bleeding in 38 out of 40 patients; yielding a success rate of 95 %. We resorted to hysterectomy in only two cases (5 %). The mean intra-operative blood loss was 1572.5 mL, and the mean number of blood units transfused was 3.1. The mean time needed to perform the technique was 5.4 ± 0.6 min. The complications encountered were as follows: bladder injury in the two patients who underwent hysterectomy and wound infection in one patient. Postoperative fever that responded to antibiotics occurred in 1 patient. The mean duration of the postoperative hospital stay was 3.5 daysConclusionsThis technique of using the cervix as a natural tamponade appears to be safe, simple, time-saving and potentially effective method for controlling the severe postpartum hemorrhage (PPH) caused by placenta previa/placenta previa accreta. This technique deserves to be one of the tools in the hands of obstetricians who face the life-threatening hemorrhage of placenta accreta.Trial registrationClinicalTrials.gov NCT02590484. Registered 28 October 2015Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0731-9) contains supplementary material, which is available to authorized users.