AmnioQuick® Duo+ for diagnosis of premature fetal membranes rupture

Background: Failure to identify women with premature fetal membranes rupture associated with infectious morbidities. Evaluation of the accuracy of AmnioQuick® Duo+ in diagnosing premature fetal membranes rupture compared to conventional diagnostic tests was the aim of this study.Methods: 220 pregnant women ≥37 and <39 weeks` gestation studied and classified into two groups; study group (premature fetal membranes rupture) and control group (no premature fetal membranes rupture). Participants examined by trans-abdominal ultrasound (TAS) and vaginal speculum to visualize amnion leaking and for collection of samples for fern, nitrazine and AmnioQuick® Duo+ tests on admission. A final diagnosis whether the studied women had PROM or not at the initial presentation made after delivery.Results: Sensitivity and specificity of the AmnioQuick® Duo+ to diagnose PROM was 93.6% and 86.4%; respectively compared with 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. Positive predictive value, negative predictive value and accuracy of AmnioQuick® Duo+ to detect PROM were 87.3%, 93.1% and 90%; respectively compared with 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick® Duo+ test had higher accuracy to detect premature fetal membranes rupture compared to conventional diagnostic tests.Conclusions: AmnioQuick® Duo+ is accurate bedside immunoassay test, better than the individual conventional diagnostic tests and can used as complementary test to improve the management of women with women premature fetal membranes rupture

Abdelazim and AbuFaza ELLP syndrome as a variant of HELLP syndrome: Case reports

Background: The hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a serious complication in pregnancy occurring in 0.5–0.9% of all pregnancies and in 10–20% of cases with severe pre-eclampsia. Previous studies described HELLP syndrome without hemolysis without any further details. Objectives: This report represents the criteria for the diagnosis of Abdelazim and AbuFaza elevated liver enzymes, low platelet count (ELLP) syndrome as a variant of HELLP syndrome. Case Reports: A 39-year-old woman, pregnant 32 weeks' gestation, previous five cesarean sections, admitted with severe pre-eclampsia (blood pressure 160/110 mmHg, proteinuria +3, 700 mg proteins/24 h urine, and protein/creatinine ratio ≥0.9 in spot urine sample). Laboratory investigation showed elevated liver enzymes, low platelet (PLT) count, and no evidence of hemolysis. A 31-year-old woman, pregnant 33+4 weeks' gestation, previous one cesarean section, admitted with severe pre-eclampsia (blood pressure 170/120 mmHg, proteinuria +2, 1200 mg proteins/24 h urine, and protein/creatinine ratio 1.1 in spot urine sample). Laboratory investigations showed elevated liver enzymes, low PLT count, and no evidence of hemolysis. Both patients delivered by cesarean section after stabilization of their blood pressure and dexamethasone for induction of fetal lung maturity and MgSO4 for prevention of eclampsia. Both patients had uneventful intraoperative and postoperative stay in the hospital. The liver enzymes and the PLT count were completely normal on the 5th postoperative day, and they were discharged from the hospital in good general condition. Conclusion: Abdelazim and AbuFaza ELLP syndrome is variant of HELLP syndrome without hemolysis in women with severe pre-eclampsia. Abdelazim and AbuFaza ELLP syndrome diagnostic criteria are as follows: (1) Elevated liver enzymes; (2) Low PLT count; and (3) Absence of hemolysis (normal total and unconjugated bilirubin, absence of schizocytes, and polychromatic red cells in peripheral blood smear, and normal reticulocyte count)

Interstitial Pregnancy a Rare form of Ectopic Pregnancy: Case Report

Interstitial pregnancy is a rare variety of ectopic pregnancy, it can have disturbed 8-16 weeks of amenorrhea (later than the distal tubal ectopic pregnancy), due to the dispensability of the myometrium covering the interstitial segment of the fallopian tube, with subsequent massive internal hemorrhage. A 29-years-old female, Gravida 3, Para 2, presented with severe abdominal pain, vomiting, and syncope 3 days after her missing period, and positive pregnancy test. Trans-vaginal ultrasound showed empty uterine cavity, free pelvic fluid with severe cervical motion tenderness. She was diagnosed with ruptured ectopic pregnancy. Ruptured ectopic pregnancy in the proximal segment of right fallopian tube was confirmed with laparotomy. The ruptured pregnancy was managed by right salpingectomy, and hemostatic stitches at the right uterine corn. Her hemoglobin was 8 gr on admission, and she received 3 units of packed RBCs (one intra-operative, and two post-operative). Her post-operative hemoglobin was 10.5 gr, and she was discharged from the hospital on the 3rd post-operative day in good general condition for follow up in the outpatients` department. This case report represents a rare variety of ectopic pregnancy, which is the interstitial pregnancy, because it can rupture few days or weeks after the missed period with subsequent massive internal hemorrhage. Interstitial pregnancy is a rare form of ectopic pregnancy, the obstetricians should be aware of rare forms of ectopic pregnancies, it can have disturbed few days or weeks after the missed period leading to subsequent significant morbidity

Complete amenorrhea following NovaSure endometrial ablation for resistant menorrhagia: a case report

Heavy menstrual bleeding (HMB) or menorrhagia is the most common form of dysfunctional uterine bleeding (DUB). In spite of medical treatment for DUB, many women will eventually require a hysterectomy, which is an invasive treatment option. NovaSure ablation offers a same day non-invasive alternative to hysterectomy and hysteroscopic ablation. A 38-year-old woman presented with HMB in 2015. The attacks of HMB interrupted her lifestyle, and she refused to continue with medical treatment, which failed to resolve her symptoms. This patient was admitted to the hospital four times over 2015 due to the anemia caused by the DUB. Medroxyprogesterone acetate and oral contraceptive pills failed to control the patient’s bleeding episodes. Hysteroscopic examination of the uterine cavity showed a normal cavity, and the endometrial biopsy showed proliferative endometrium. She was counseled about NovaSure ablation as the last treatment option before hysterectomy. The NovaSure ablation procedure took 90 s, and the patient was discharged from the hospital 6 h after the procedure. At follow-up, the patient is completely amenorrheic, and she is satisfied with her results. This study demonstrated that NovaSure endometrial ablation is a safe, effective, non-invasive alternative to hysteroscopic endometrial ablation for treatment of DUB