Accidental diagnosis and conservative management of a case of first-trimester caesarean scar ectopic pregnancy

Cases of Caesarean Scar Ectopic Pregnancy (CSEP) are becoming increasingly common at tertiary care hospitals because of increase in rate of CS. It may lead to horrible consequences, such as uncontrolled bleeding and uterine rupture (UR), which might require hysterectomy and result in subsequent loss of fertility. This report covers a case of a CSEP discovered early at 9 weeks of gestation in a 25-year-old woman coming for antenatal care. Conservative management of the uterus was performed with removal of the sac and repair of the uterine scar. The patient’s postoperative period was uneventful, and she was discharged 3 days after surgery. CSEP should be detected early to prevent its catastrophic sequences. Although it is a rare complication of cesarean section, CSEP must be kept in the minds of obstetricians facing emergency cases

The maternal and neonatal outcomes of teenage pregnancy in a tertiary university hospital in Egypt

Aim: To highlight the grave complications among teenage mothers in Assiut Woman\u27s Health Hospital compared with the adult mothers. Methods: This study was a prospective case control study, conducted at the Labor Ward of Assiut Woman\u27s Health Hospital from 1st of January 2016 to 30th of June 2016. We included teenage pregnant women (13-19 completed years at delivery) as case and adult mothers (20-29 years) formed the control group. The primary outcome of the study is the rate of pregnancy complications among teenage mothers. Results: Obstetric complications were higher among the teenage mothers (p=0.0001). The teenage mothers had a higher proportion of normal vaginal delivery (p=0.005). The adult mothers reported a higher rate of elective cesarean section (CS) and operative vaginal delivery (p=0.0001, p=0.002; respectively). The infants of teenage mothers tended to have a lower birth weight and Apgar score than the adult ones. Conclusion: This study clearly states that the teenage mothers and their infants were more liable to complications during pregnancy and labor compared to adult mothers

The maternal and neonatal outcomes of teenage pregnancy in a tertiary university hospital in Egypt

Aim: To highlight the grave complications among teenage mothers in Assiut Woman\u27s Health Hospital compared with the adult mothers. Methods: This study was a prospective case control study, conducted at the Labor Ward of Assiut Woman\u27s Health Hospital from 1st of January 2016 to 30th of June 2016. We included teenage pregnant women (13-19 completed years at delivery) as case and adult mothers (20-29 years) formed the control group. The primary outcome of the study is the rate of pregnancy complications among teenage mothers. Results: Obstetric complications were higher among the teenage mothers (p=0.0001). The teenage mothers had a higher proportion of normal vaginal delivery (p=0.005). The adult mothers reported a higher rate of elective cesarean section (CS) and operative vaginal delivery (p=0.0001, p=0.002; respectively). The infants of teenage mothers tended to have a lower birth weight and Apgar score than the adult ones. Conclusion: This study clearly states that the teenage mothers and their infants were more liable to complications during pregnancy and labor compared to adult mothers

THE ANTIBACTERIAL ACTIVITY OF NIGELLA SATIVA AGAINST MULTI-DRUG RESISTANT PSEUDOMONAS AERUGINOSA ISOLATED FROM DIABETIC WOUND INFECTIONS

Thirty-five specimens were isolated from diabetic patients with superficial and deep wounds. The isolates of Pseudomonas aeruginosa were selected from cetrimide agar plates supplemented with nalidixic acid.P. aeruginosawere subjected to in vitro evaluation of antibiotic sensitivity test using antibiotics from different classes. Multi-drug resistant P. aeruginosa (MDRPA) were selected for further tests and multiple antibiotic resistance (MAR)index was calculated. Eleven commercial essential oils (EOs) were chosen to evaluate their activities as antimicrobial agents against MDRPA. The sensitivity was determined using agar disc diffusion method. The black seed oil (Nigella sativa) showed a wide spectrum of inhibition against MDRPA3. The characterization of Nigella sativa was conducted by GC-MS and FT-IR which showed the antibacterial activity and safety of this oil.&nbsp

Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman

Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and non-specific symptoms of the disease in this age group

Maternal mortality: a tertiary care hospital experience in Upper Egypt

Background: Maternal mortality is one of the major challenges which face the developing countries throughout the world. The aim of the study is to assess the causes of maternal mortality at Women Health Hospital, Assiut University, Egypt, and to identify the avoidable ones.Methods: Data were collected from records of patients who presented to and/or delivered at Women Health Hospital between 2009 and 2014. Only cases of maternal mortality were included in this study. In our study, we found 213 maternal deaths at our hospital between 2009 and 2014.Results: The maternal mortality ratio decreased progressively from 2009 to 2014 (228 and 89 per 100000 live birth respectively). Moreover, we found that the indirect causes of maternal mortality accounted for 24.9 % of all mortalities. As regards the direct causes of maternal mortality, preeclampsia remained the primary cause and represented 27.7 % of the avoidable causes. The second most frequent cause of direct maternal mortality was postpartum hemorrhage (PPH), which represented 26.8 %.Conclusions: Preeclampsia and PPH, as well as their complications are the leading causes of death in one of the biggest tertiary care university hospitals in Egypt. However, there are other important avoidable predisposing factors that should be dealt with including lack of patient education, delayed transfer from other hospitals, and substandard practice

Full term delivery of a Harlequin ichthyosis baby: a case report

Harlequin ichthyosis (HI) is one of the most severe and rare autosomal recessive congenital ichthyosis (ARCI), characterized by severe hyperkeratosis, extensive fissuring and a variable degree of cutaneous malformations. Here we report a case of 22 years old female patient in her first pregnancy. The baby was born at 39 weeks of gestation from non-consanguineous parents. At birth the baby had thick skin with deep fissures. The baby was admitted to the neonatal intensive care unit and survived for 11 days

The effect of regular daily walking on adverse pregnancy outcomes among overweight primigravidas: a prospective cohort study

Objective: The study aims to evaluate the effect of regular daily walking on the occurrence of adverse pregnancy outcomes among overweight primigravidas. Materials and Methods: A prospective cohort study conducted at Aswan University Hospital from March 2015 to December 2016. The study included 360 overweight primigravidas, with singleton pregnancies, who were divided into two groups: Group I (control group) and Group II (study group) under supervised regular walking 5 times per week for 30 minutes, starting from 10-12 weeks of gestational age to 38-39 weeks of gestational age. The primary outcome of the study was the rate of gestational weight gain in participants in both groups. Secondary outcomes included the rate of gestational diabetes mellitus, gestational hypertension, preeclampsia, preterm labor ( 4 kg), excessive maternal weight gain (>11.5 kg), and the rate of cesarean delivery. Results: There were no significant differences between groups with regard to the basic criteria. The exercise program decreased the incidence of preeclampsia (OR=0.120; 95% CI=0.015-0.970; p=0.037), postdate (OR=0.274; 95% CI= 0.099-0.759); p=0.008), excessive weight gain (OR=0.220; 95% CI=0.114-0.424), p=0.000), and cesarean delivery (OR=0.519; 95% CI=0.316-0.841, p=0.007). Conclusion: Regular maternal walking throughout the pregnancy may be a preventive tool for preeclampsia, postdate pregnancy, excessive weight gain and may decrease the incidence of cesarean delivery in primigravidas

Pregnancy outcome according to body mass index in primigravidas: a prospective cohort study

Objective: The study aims to evaluate the association between Body Mass Index (BMI), gestational weight gain (GWG) and adverse obstetric outcomes among primigravidas. Material and methods: This was a prospective cohort study conducted at a tertiary University Hospital between June 2015 and May 2017. The study included 480 primigravidas, with singleton pregnancies, who were divided into three groups: women with a healthy weight (BMI: 18.5–24.9 kg/m2) overweight (BMI: 25 – 29.9 kg/m2) and obese (BMI ≥ 30 kg/m2). The primary outcome of the study was the rate of GWG in the participants. Secondary outcomes included the rate of gestational diabetes mellitus (GDM), gestational hypertension, pre-eclampsia, preterm labor (PTL), postdate pregnancy, fetal macrosomia and the rate of birth by cesarean (CB). Results: There were no significant differences between groups regarding the socio-demographic criteria. The rate of GWG was significantly higher in obese women versus average weight women (11.4±1.73 vs. 10.49±1.09, p=0.0001). There was an increased incidence of GDM (p=0.008), gestational hypertension (p=0.001), pre-eclampsia (p=0.0001), PTL (p=0.002), postdate (p=0.0001) and macrosomia (p=0.0001) in women who were obese compared with women with a healthy weight. Additionally, there was an increased incidence of CB with increasing body mass (p=0.0001) Conclusions: Higher BMI in primigravidas is associated with increased GWG and with adverse pregnancy outcomes such as GDM, gestational hypertension, pre-eclampsia, PTL, postdate, fetal macrosomia and cesarean birth

Does lidocaine gel produce an effective analgesia prior to copper IUD insertion? Randomized clinical trial

Background: IUD is a small contraceptive device, often containing either copper or levonorgestrel, which is inserted into the uterus. Objective of present study was to determine if lidocaine gel prior to intrauterine device (IUD) insertion decreases pain with the insertion procedure among multiparous women choosing the copper T380A-IUD.Methods: It is a randomized double-blind controlled trial carried out at Assiut Women's Health Hospital, Assiut, Egypt. Parous women eligible for Copper IUD insertion attended the Family Planning Clinic were recruited and randomized in a 1:1 ratio to lidocaine gel or placebo. Two ml of the study medications were topically placed on the cervix 3 minutes before IUD insertion. The primary outcome was the difference in pain scores using a 10-cm Visual Analogue Scale (VAS) during IUD insertion. We considered a 1.5 cm difference in VAS scores between study groups as clinically significant.Results: One hundred women consented to participate and randomized either to group I:  lidocaine group or group II: placebo group. Both groups were homogenous in baseline socio-demographic data. There was significant difference in mean pain scores for IUD placement between women who received lidocaine gel and placebo at two steps of insertion (at vulsellum application and at uterine sounding) while the rest of steps show no statistical significant difference (p=0.000). There were no statistical significant differences between both group as regard the ease of insertion, the duration of insertion and the satisfaction score after the procedure (p>0.05).Conclusions: This study depicts that the use of lidocaine gel prior to copper IUD insertion in multiparous women could partially reduce the pain during tenaculum placement and uterine sounding