Laparoscopic resection and repair of caesarean scar pregnancy

The presented work is case series over 2 years of caesarean scar pregnancy over 2 years from January 2020 to January 2022 in Zinat Alhayat hospital of maternity in Benha city Egypt. Cases recruited from those attending  Zeinat Alhayat maternity hospital in Benha and all case proved to have caesarean scar pregnancy  by ultrasonography and quantitative HCG the total number of cases were 15 over a period of two years, most of patients complained about abnormal uterine bleeding in the first trimester with abnormal abdominal pain, all cases prepared for laparoscopy in Zinat Alyayat hospital in Benha and a written consent taken then with general anesthesia pelvis and abdomen explored by laparoscopy and  the site of the scar opened with a hook with the aid of a traumatic grasper and then sac evacuated and the old scar resected by laparoscopic scissor. Regarding epidemiological data of patients there were no statistically significant difference in age body weight age or the amount of pain by facial analogue scale of pain. All patients saved and laparoscopy done with an average time of 45 min with no operative or postoperative complications, only one of the cases with severe bleeding required blood transfusion of 2 units of blood because HB was 7.8 g/dl, so laparoscopic treatment of caesarean scar pregnancies is a good option for patients with short operative time and good outcomes without complications.

The neonatal outcomes of Dexamethasone administration before scheduled cesarean delivery at term: a randomized clinical trial

Background: Caesarean delivery (CD) rates in developing countries are rising beyond the recommended rates of World health organization. Objective of this study was to evaluate whether Dexamethasone injections reduce neonatal incubation admissions when given before scheduled caesarean delivery (CD) at term or not.Methods: A double blinded, two armed, randomized clinical trial was conducted at Tanta University hospitals in the period from October 2017 to March 2019. Four hundred pregnant women admitted for scheduled CD with gestational age ≥37 weeks were included. Patients were randomized into study group and control group. The study group was given 3 dexamethasone doses, 8 mg each while control group was given saline injections simultaneously as a placebo drug. The primary outcome was the neonatal incubatory admissions.Results: Demographic data in both groups were comparable. Transient tachypnea of newborn (TTN) was 15.47% in study group versus 20.33% in control group with p=0.227. The respiratory distress (RDS) in study group was 6.63% versus 9.89% in control group with p=0.260. The incubation admissions were nasal oxygen 12.71% versus 15.38%, continuous positive airway pressure ventilation (CPAP) 5.52% versus 8.24% and mechanical ventilation was 3.87% versus 6.59% in the study and control groups respectively.Conclusions: Although Dexamethasone administration before scheduled CD at term reduced both respiratory morbidity and incubation admissions, the differences between study and control groups were not significant

Early Versus Delayed Umbilical Cord Clamping on Physiologic Anemia of the Term Newborn Infant

AIM: Our study aims to make a comparison between the effects of milking of umbilical cord versus delayed cord clamping on Hemoglobin level at 6 weeks from delivery among term neonates and which method is more beneficial for them. DESIGN: It was a randomised control study. Participants were randomised into 2 groups; Group 1: 125 women were assigned to delay cord clamping; Group 2: 125 women were assigned to milking of the umbilical cord 5 times before cutting. Student t-test was used to compare between the two groups for quantitative data, for qualitative data chi-square test and the Correlation coefficient was done to test the association between variables. SETTING: This study was at El-Galaa Teaching Hospital, labour suite. Cairo, Egypt. PARTICIPANTS: A group of 250 pregnant women starting from ≥ 37 weeks’ gestational age. INTERVENTION: In this study, we searched if the mechanism of milking or delayed cord clamping could give some of the positive benefits for neonates or not. RESULTS: In this study, we found that milking of the umbilical cord five times as in group 1 was associated with higher hemoglobin levels at 6 weeks after birth, at physiological anemia of the fetus and significant but clinically there was no difference between the two groups (10.4 ± 0.5 and 10.6 ± 0.5 respectively, P < 0.001). Also, there was a positive correlation between haemoglobin of the mother and the newborn during the first day and after 6 weeks with r = 0.349 and 0.283 respectively and a P value < 0.001. Furthermore, there was a positive correlation between the haemoglobin of the fetus after the first day and fetus at 6 weeks with r = 0.534 and a P value < 0.001. For most other outcomes (including APGAR score, positive pressure ventilation, poor neonatal outcomes such as respiratory distress syndrome there were no significant differences between the two groups. Our study may recommend the use of umbilical cord milking in term babies when delayed cord clamping is unavailable. CONCLUSION: Umbilical cord blood milking after its clamping improves some important haematological parameters for newborns, especially in countries with high incidence of anaemia in newborns and children

The role of multidetector CT virtual hysterosalpingography in the evaluation of female infertility

Purpose: To assess the role of 64-row multidetector computed tomography virtual hysterosalpingography (MDCT VHSG) in the evaluation of the female reproductive tract in infertile patients and compare it with conventional X-ray hysterosalpingography (HSG). Methods and material: The studied group included 25 patients with infertility. All patients were evaluated with 64-row MDCT VHSG and X-ray HSG. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both examinations for uterine pathology, fallopian tube pathology and per lesion pathology were calculated. The duration for both examinations, patient discomfort and patient effective dose were documented. Results: The mean duration for MDCT VHSG and X-ray HSG was 6.5 ± 1.9 and 26.9 ± 2.9 min respectively, MDCT VHSG has a significantly less median patient discomfort and mean patient effective dose. Sensitivity, specificity, PPV and NPV for uterine pathology were 100%, 100%, 100% and 100% respectively for MDCT VHSG and 90%, 93.3%, 90% and 93.3% respectively for X-ray HSG, the inter-method agreement for uterine pathology was k = 0.83. Sensitivity, specificity, PPV and NPV for the detection of fallopian tube pathology were 100%, 93%, 91 and 100% respectively for MDCT VHSG and 100%, 86%, 85% and 100% respectively for X-ray HSG and k = 0.76. Sensitivity, specificity, PPV and NPV for per patient pathology were 100%, 91%, 93% and 100% respectively for MDCT VHSG and 87%, 80%, 87% and 80% respectively for X-ray HSG and k = 0.75. Conclusion: MDCT VHSG could be an excellent new alternative diagnostic procedure in the infertility assessment workup

The impact of mechanical cervical dilatation during elective cesarean section on postpartum scar integrity: a randomized double-blind clinical trial

Ayman Shehata Dawood,1 Adel Elgergawy,1 Ahmed Elhalwagy,1 Walid M Ataallah,1 Shereen B Elbohoty,1 Shereef L Elshwaikh,1 Amal A Elsokary,1 Ahmed M Elkhyat,1 Amr T Elbadry,2 Ahmed M Abbas3 1Department of Obstetrics &amp; Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt; 3Department of Obstetrics &amp; Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Objective: The current study aimed to evaluate the impact of mechanical cervical dilatation during elective cesarean section (CS) on postpartum scar integrity at 6 months post operation. Methods: A randomized double-blind clinical trial (UMIN000027946) was conducted at a tertiary university hospital in the period between July 1, 2017 and April 30, 2018. The study included pregnant women with a singleton fetus at term &ge;37 weeks of gestation scheduled for elective CS. Eligible participants were allocated either to the study group (women with intraoperative cervical dilatation) or the control group (women with no intraoperative cervical dilatation). The patients were followed up at 6 months after CS by 3D ultrasonography to check for the scar integrity and quality. The primary outcome was the difference in sonographic parameters of the scar integrity between the two groups. Results: Four hundred twenty two women were approached to participate in the study. There was no statistically significant difference regarding the baseline characteristics of both the groups. Scar width and depth were significantly higher in the cervical dilatation group (P=0.002 and 0.001, respectively). Fewer cases with scar defects (niche) were found in the cervical dilatation group than in the control group (5.03% vs 11.04%, respectively, P=0.048). There was no significant difference regarding the rate of wound infection or endometritis in both the groups (P=0.717 and 0.227, respectively). The incidence of febrile morbidity was higher in the no cervical dilatation group (10.5%) compared to (5.0%) the cervical dilatation group (P=0.045). Conclusion: Cervical dilatation during elective CS is associated with thick scars with low incidence of scar defects. Keywords: cesarean section, cervical dilatation, cesarean scar defect, scar integrit

Comparison of simple uterine manipulator-injector (SUMI) with the Cohen cannula in gynecologic laparoscopy

Objective: To assess the effectiveness and safety of using simple uterine manipulator injector (SUMI) compared to Cohen cannula in laparoscopy. Design: A Pilot randomized trial, incorporating 40 patients randomized into Group I or SUMI (n = 22) and Group II or Cohen cannula (n = 18). Setting: Ain Shams Maternity Hospital, Cairo, Egypt. Material and methods: Forty patients with infertility planned to undergo laparoscopy. The assigned uterine cannula was applied according to defined rules, followed by laparoscopy. Main outcome measures were application and removal time, uterine maneuverability in sagittal and coronal planes, easiness of insertion and manipulation, dye injection and its leakage, abandonment of the use of cannula, and adverse effect or complication. Results: Application time was longer with SUMI (3.8 ± 1.3 vs. 1.3 ± 1.1 min, P < 0.001). The range of uterine maneuverability had wider angles with SUMI, both in sagittal (77.7 ± 12.7 vs. 47.2 ± 21.9, P < 0.001) and coronal (139.6 ± 30.4 vs. 89.4 ± 22.4, P < 0.001) plains. The easiness of insertion, manipulation, dye injection and removal were comparable. The incidence of dye leakage was higher with SUMI (27.3% vs. 5.9%, P < 0.05), yet minimal and not affecting dye test. Cohen cannula use was abandoned due to marked limitation of uterine maneuverability in one case and due to considerable dye leakage in another. No incidents of uterine perforation or cervical laceration requiring suturing were recorded. Conclusion: Although SUMI takes longer to insert, the ease of its use is comparable with the Cohen cannula. A major advantage of its use is increased range of uterine maneuverability with better surgical field exposure