Pregnancy outcome in rheumatic mitral stenosis patients with and without surgical correction: a prospective cohort study

Background: The aim of the current study is to assess the maternal and fetal outcomes of pregnant females with and without surgically corrected mitral stenosis (MS).Methods: A cross sectional study was carried out at Assiut Women's Health Hospital, Egypt between February 2016 and December 2016. All pregnant women diagnosed with rheumatic heart disease attending the antenatal care clinic were enrolled in the study. They were divided into two groups according to previous surgical correction of MS or not. All women were followed up during pregnancy till the end of puerperium. The primary outcome of the study was the difference in the rate of maternal cardiac complications during pregnancy between both groups.Results: The study included 48 patients (39%) with surgically corrected MS and 75 patients (61%) with uncorrected MS. All cardiac complications were significantly higher in the uncorrected MS group (p <0.05). No difference between both groups in the mode of delivery (p=0.52). Postpartum hemorrhage is more common with the corrected MS group than the uncorrected group (25% vs. 9.3% respectively, p=0.003), while the need for postpartum admission to ICU was significantly higher in the uncorrected group (p=0.006). The mean birth weight was higher in the corrected MS group (p=0.000). The percentage of stillbirths and the rate of admission to PCU was higher in the uncorrected MS group (p=0.003).Conclusions: Surgical correction of MS significantly improves the maternal and fetal outcomes of rheumatic heart pregnant females with MS

Comparison between two different regimens of anticoagulants for pregnant women with prosthetic heart valves

Background: The current study aims to assess the maternal and fetal outcomes of pregnant females with prosthetic heart valves receiving oral anticoagulants only versus the sequential regimen of heparin and OA throughout pregnancy.Methods: An observational was carried out at Assiut Women's Health Hospital, Egypt between February and December 2016. All pregnant women with prosthetic heart valves attending the emergency department during the study period were enrolled in the study. All included patients were classified into two groups; women who receive low molecular weight heparin (LMWH) during the first trimester then shift to warfarin till 36 weeks of gestation then continue on LMWH till delivery (Group I) and those who continue the all period of pregnancy on warfarin (Group II). The primary outcome of the study was the difference in the rate of maternal cardiac complications during labor between both groups.Results: The study included 72 patients have prosthetic valve replacement and on anticoagulants. Twenty-one were on oral anticoagulant; warfarin (Group II) and 51 pregnant women were on sequential regimen. Both groups were comparable in their basic and clinical data on admission. No difference between both groups in the mode of delivery (p=0.52), postpartum hemorrhage (0.09), sub rectal hematomas (p=0.08), the need for postpartum admission to ICU (p=0.93) and the duration of hospital stay (p=0.47). Additionally, no statistical significant difference between both groups as regard the mean birth weight (p=0.97), Apgar score (p=0.62), fetal sex (p=0.92) and congenital anomalies (p=0.08).Conclusions: The use of sequential LMWH and oral anticoagulants appears to be a safe option for those women although there is no difference in maternal and fetal outcomes with the use of continuous oral anticoagulants throughout the pregnancy

Clinical audit of neonatal care in Assiut Women's Health Hospital, Egypt

Background: The current study aims to auditing the current care of healthy full term newborns in the delivery room and identify the gap between the current practice and ideal practice in Assiut Women's Health Hospital, Egypt.Methods: The current study was a clinical audit carried out in Assiut Woman Health Hospital, in the period from 1 September 2016 to 28 February 2017.The study included all newborns delivered in the delivery word of gestational age after 37 week. We excluded all Preterm babies, those with congenital anomalies, pregnant women with medical disorders and multiple pregnancies. In the present work all data was collected prospectively through direct personal patient contact, direct observation of care givers, patient interactions and attitudes, from the clinical records and then recording the data in special check sheet. All basic criteria of the study participants as age, parity, gestational age at delivery and type of delivery were obtained. The neonatal gender, weight, heart rate and respiratory rate were checked. Audit criteria were selected according to the WHO 2015 and AAP 2010-2015 guidelines.Results: The study included 800 women; the mean age of the women was 26.52±5.70 years. The mean parity was 1.78±1.85. The mean gestational age at delivery was 38.81±0.96 weeks. As regard the type of delivery, 54.1% of women were delivered by cesarean section. Calling neonatologists occurred in 67.9% of deliveries. The mean birth weight was 3.17±0.39 kilograms. Nearly half of them (52%) were males.Conclusions: Application of the guidelines of the neonatal handling is important for optimum care to the neonates. Re-audit the steps of the handling is important to discuss whether practice has improved or not in our tertiary hospital