Carbetocin versus Oxytocin and Misoprostol in prevention of atonic post-partum hemorrhage in high risk patients planed for cesarean delivery

Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol.Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 µg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed.Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P <0.001), major PPH was 0, 4 and 6% for the same groups respectively (P <0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II& III (P <0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p <0.0001)Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage.

Predictive values of ultrasound-based scoring system in morbidly adherent placenta for high risk group

Background: The objective of the present study was to find out the predictive values of an ultrasound-based scoring system in diagnosis of morbidly adherent placenta (MAP) for high risk group. Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt.Methods: 63 full term pregnant women (≥37 weeks of gestation) with high risk of morbidly adherent placenta underwent elective cesarean section. Placental assessment by 2 D ultrasound based on ultrasound scoring system in morbidly adherent placenta, these data were recorded for further comparison with intraoperative data for degree of placental adherence.Results: Incidence of MAP was 7.93% (4.76% had a focal form and 3.17% had a complete form of accreta). As regarding to scoring system, 82.5 of cases had a low risk (< 5), 9.5% had a moderate risk (6-7) and 7.93% had a high risk (8-12) of development of morbidly adherent placenta with p value <0.0001. The sensitivity, specificity, positive and negative predictive values of the US scoring system for morbidly adherent placenta were (92.3%, 94.1%, 87.453% and 98.2%) respectively.Conclusions: Ultrasound based scoring system had a high predictive value (sensitivity, specificity, positive and negative predictive values) in diagnosis of morbidly adherent placenta for pregnant women have any risk factors for developing MAP

Feasibility and ability of laparoscopy to predict respectability in ovarian cancer: Review article

Background: Epithelial ovarian cancer is one of the leading causes of death in gynecological malignancies and the seventh most common cancer in the world among women. Aim and objectives: The main aim of this study was to study the feasibility and ability of laparoscopy in predicting optimum respectability in cases of ovarian cancer. Conclusion: Laparoscopy has an effective feasibility and ability in predicting optimum respectability in cases of ovarian cancer. As laparoscopy before starting treatment was a reliable additional diagnostic tool in predicting result of PDS, this can prevent laparotomies. This will optimize treatment for the individual patient

Carbetocin versus Oxytocin and Misoprostol in prevention of atonic post-partum hemorrhage in high risk patients planed for cesarean delivery

Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol.Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 µg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed.Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P &lt;0.001), major PPH was 0, 4 and 6% for the same groups respectively (P &lt;0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II&amp; III (P &lt;0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p &lt;0.0001)Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage.

Sexual function assessment in women with rheumatoid arthritis: Correlation with psychological states and hormonal profile

Background: Rheumatoid arthritis (RA) is a common disabling joint disease affecting both males and females. Sexual dysfunction (SD) is a common association with RA. Aim and objectives: The aim of this study was to assess the frequency rates of sexual problems and associated factors in a cohort of married females with Rheumatoid arthritis (RA), and to investigate the correlation between hormonal profile (serum testosterone level, estrogen and progesterone level) and female sexual function in RA patients. Subjects and methods: This cross-sectional analytical study included 100 female RA patients and 80 age matched healthy control female from Rheumatology and Rehabilitation Clinic in Qena University Hospital. Results: there were a highly statistically significant negative correlation between Female Sexual Function Index (FSFI) and each of DAS, VAS, MHAQ, HAM-A and Testosterone level while it showed statistically significant positive correlation between Female Sexual Function Index (FSFI) and each of Estrogen and Progesterone. Conclusion: Our study suggests that rheumatoid arthritis has a negative impact on patients' sexuality. Age of patients and partners, pain, and tender joints appear to be the main factors influencing sexual function