Diagnostic accuracy of PremaQuick in detection of preterm labor in symptomatic women

Objectives: Failure to identify women at risk of preterm labor (PTL) leads to failure to implement standard measures. This study designed to evaluate the accuracy of PremaQuick test in detection of PTL in women presented with threatened preterm labor (TPTL). Material and methods: One hundred and twenty-two (122) pregnant women, singleton pregnancy, < 37 weeks, admitted with TPTL included in this study, and were compared to 122 controls. After thorough evaluation, participants were examined using sterile vaginal speculum for cervico-vaginal fluid (CVF) sampling, and PremaQuick test. The CVF sampling was followed by trans-vaginal sonographic (TVS) assessment of cervical length (CL). Participants were managed according to hospitals policy thorough their admission, and after discharge in the ante-natal clinics till delivery. After delivery, the delivery data were compared by the recorded participants` data on admission. Results: The PremaQuick test had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL < 25 mm (p = 0.005, 0.005, 0.01, 0.002; respectively). Conclusions: The PremaQuick is an accurate bedside test in detection of PTL in women presented with TPTL. It had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% overall accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL < 25 mm

Protein/Creatinine ratio versus 24-hours urine protein in preeclampsia

Objectives: Proteinuria is one of the diagnostic criteria of preeclampsia (PE). Measurement of 24-hour urine protein is the gold standard method for detection of proteinuria in PE. The 24-hour urine sampling is time-consuming, and inconvenient. To evaluate the accuracy of protein/creatinine (P/C) ratio in detection of significant proteinuria ( > 1 g/24-hours urine) in PE. Material and methods: One hundred and ten (110) preeclamptic women were included in this study and admitted for blood pressure monitoring, 24-hour urine collection, fetal well-being assessment and spot urine sample for measuring of P/C ratio. After thorough history and clinical examination, routine antenatal investigations were done for the women included in the study according to the hospital protocol, and to excluded pre-existing chronic renal disease. Twenty-four-hour urine collection started on the morning following hospital admission. Spot urine samples were obtained shortly before the 24-hour urine collection for measuring of P/C ratio. Collected data statistically analyzed to evaluate the accuracy of P/C ratio in detection of significant proteinuria in PE. Results: The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% positive predictive value (PPV), 90.2% negative predictive value (NPV), and 94.5% overall accuracy in detection of significant proteinuria ( > 1 g/24-hour urine) in PE. Conclusions: The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% PPV, 90.2% NPV, and 94.5% overall accuracy in detection of significant proteinuria ( > 1 g/24-hour urine) in PE. This study suggests the use of P/C ratio as an alternative to 24-hour urine protein to detect significant proteinuria in PE

Abdelazim and Shikanova suggested protocol of Ain Shams and West Kazakhstan Universities for management of delayed-interval delivery of the second twin: Case report

Background: The incidence of multiple gestations increased after the assisted reproductive techniques. Preterm labor and preterm premature rupture of fetal membranes are the most common complications of multiple gestations. Traditionally, if one fetus is delivered preterm in twin pregnancies, the situation is managed by delivery of the second fetus. Recently, there are reported cases of delayed-interval delivery (DID) of the second twin, with good outcome without established protocol for management of such cases. This report presents the protocol suggested by Abdelazim and Shikanova for the management of DID of the remaining second twin. Conclusion: The birth weight and the survival rate increased after Abdelazim and Shikanova suggested protocol for management of DID of the remaining second twin without any maternal risks or complications. DID should be done in tertiary centers after informing the parents about the possible risks of keeping the live second twin in the hostile intrauterine environment

Intra-leiomyoma hemorrhage in postmenopausal woman presented with acute abdominal pain

Intra-leiomyoma hemorrhage in postmenopausal woman is a very rare complication. This case report represents a case report of spontaneous hemorrhage inside the uterine leiomyoma in postmenopausal woman who presented with acute abdomen. A 55-year-old woman, multipara, postmenopausal for 7 years, known case of multiple fibroid uteruses, was presented to the emergency department of Ahmadi Hospital, Kuwait Oil Company, with acute abdominal pain and vomiting, without any reported trauma and/or associated vaginal bleeding. The studied woman was generally stable regarding her vital signs, her hemoglobin dropped from 12 to 10.2 g/dl. Abdominal examination revealed; palpable pelvi-abdominal mass firms in consistency with tenderness and guarding which provisionally support the diagnosis of degenerated fibroids or intra-leiomyoma hemorrhage. The diagnosis was confirmed by basic pelvi-abdominal ultrasound, followed by correction of the patient's general condition and total abdominal hysterectomy with bilateral salpingo-oophrectomy (TAHBSO). Bisected largest cystic fibroid showed brownish serous fluid inside with organized clotted hematoma which confirmed the diagnosis of intra-leiomyoma hemorrhage. Postoperatively, the studied woman received an unit of packed red blood cells for correction of the postoperative anemia and discharged from the hospital in good general condition for postoperative follow-up in the outpatients' department on iron tablets. This case report represents a rare complication of intra-leiomyoma hemorrhage in postmenopausal, diagnosed by the basic clinical and ultrasound findings. The case was managed by TAHBSO after correction of the general condition because of the increased risk of the sarcomatous changes of the uterine fibroid in postmenopausal women

Uterine suspension using I. Abdelazim sacrohysteropexy technique for treatment of uterine prolapse: Case series

Surgical treatment of uterine prolapse in woman who wishes to preserve her uterus remains a major surgical challenge. This case series describes a new surgical technique for uterine suspension in women who wish to preserve their uteri, using the Mersilene tape as an artificial uterosacral ligament to suspend the uterus to the sacral promontory. Four women with genital prolapse (two with stage 1 uterine prolapse and two with stage 2 uterine prolapse and stage 1 vaginal walls prolapse) who requested a uterine conserving procedure were offered I. Adelazim sacrohysteropexy technique as a new surgical option for treatment of the uterine prolapse. This surgical technique is formed of three basic steps: (1) exposure of the anterior longitudinal ligament over the sacral promontory and exposure of the uterosacral ligaments on the back of the uterine cervix; (2) fixation of the Mersilene tape as Y-shaped artificial uterosacral ligament extended from the sacral promontory to the back of the uterine cervix; and (3) closure of the incised visceral peritoneum over the artificial Y-shaped uterosacral ligament. The mean operative duration of I. Abdelazim sacrohysteropexy technique was 50.5 ± 8.4 min and the mean estimated blood loss was 480 ± 67.8 ml. No intraoperative or postoperative complications or recurrence of the uterine prolapse were recorded in the studied cases. I. Abdelazim sacrohysteropexy technique is an effective uterine suspension technique for treatment of uterine prolapse in women who wish to preserve their uteri, using the Mersilene tape as an artificial uterosacral ligament to suspend the uterus to the sacral promontory