Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

Iron versus Iron and Vitamin B6 Supplementation in Treatment of Iron Deficiency Anemia during Second Trimester of Pregnancy: Quasi Experimental Trial

Background: Anemia is one of the most prevalent complications during pregnancy. It is commonly considered a risk factor for poor pregnancy outcomes and can result in complications that threaten the life of both mother and fetus, such as preterm birth, and low birth weight. There is clear evidence to support prompt treatment in all patients with iron deficiency anemia because it is known that treatment improves quality of life and physical condition as well as alleviates fatigue and cognitive deficits. Objective: The aim of the study was to evaluate the value of addition of vitamin B6 to iron in treatment of iron deficiency anemia in pregnant women during the second trimester. Patients and Methods: The study was done by giving anemia pregnant women iron therapy and vitamin B6 which represent group A and iron therapy alone which represents group B. For each pregnant woman, age, parity and gestational history were taken before treatment. All pregnant women took their allocated treatment regularly for three weeks after diagnosis of iron deficiency anemia with complete blood picture and followed up after three weeks. Results: Results of the study revealed that there was no statistically significant difference between the two groups of therapy according to the hemoglobin level before treatment (p-value = 0.734), statistically significant higher mean value in after treatment than before treatment (p-value = 0.048), there was a significant difference in the rate of change of hemoglobin (p-value = 0.011) and body mass index (p-value 0.001). Conclusion: Iron and vitamin B6 seems to increase hemoglobin level more than iron only. Thus, in pregnant women with iron deficiency anemia iron plus vitamin B6 may be considered as a more effective alternative treatment than iron only.

Fetal Thigh Circumference versus Fetal Abdominal Subcutaneous Tissue Thickness in Prediction of Fetal Weight in Term Pregnant Women

Background: Fetal weight estimation by ultrasound is an important factor in obstetrics;it is directly related to the gestational age which helps to plan the mode of delivery and labor management. Objective: to compare between fetal thigh circumference (TC) and abdominal subcutaneous tissue thickness (SCT) in estimating birthweight in term pregnant women. Patients and Methods: This prospective cohort study was conducted at outpatient clinic or emergency room, Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from March 2022 until May 2023. During this study, 100 term pregnant females with gestational age 37 - 40 weeks attended El Demerdash Maternity Hospital and scheduled for delivery either at outpatient clinic or emergency room were enrolled, after consenting each of them. Basic fetal biometry was performed by an expert and professional medical personnel to ensure the accuracy of examination results. Fetal abdominal subcutaneous thickness and fetal thigh circumference were measured for assessment of gestational age and correlated with actual fetal body weight. In the current study, three formulas;Hadlock, Vintzileos’ and SCT formula were correlated with actual fetal body weight after birth. Results: The present study revealed that TC formula is closer to the actual birth weight, followed by Hadlock formula, while the SCT formula is the furthest from it. Conclusion: To increase the accuracy of birth estimations, regular ultrasound examinations should include fetal thigh circumference measurement.

Subrectal and Subcutaneous Wound Infiltration with Bupivacaine versus Pethidine for Post Cesarean Section Pain Relief: Randomized Controlled Trial

Background: Cesarean section (CS), one of the most common major operative procedures, performed all over the world. Incisional infiltration with local anesthetics is a simple, cheap and effective mean of providing good analgesia for surgical operations without any major side effects & allowing early patients’ mobilization & postoperative recovery, so the purpose of study is to compare between the effect of wound infiltration with bupivacaine versus pethidine for post cesarean section pain relief. Patients and Methods: A randomized controlled trial (RCT) was conducted in Ain Shams University Maternity hospital in the period from August 2016 and January 2017. 100 full term pregnant females randomized into two groups: Group A (50 patients) Bupivacaine group: Subcutaneous and subrectal infiltration with 10 ml 0.25% Bupivacaine (2.5 mg/ml) diluted in 10 ml normal saline before closure of the wound was done;Group B (50 patients) Pethidine group: Subcutaneous and subrectal infiltration with 1 ml pethidine (50 mg/ml) diluted in 19 ml normal saline before closure of the wound was done. All patients had cesarean section under spinal anesthesia. Study outcome measures post-operative pain scores using visual analogue scale, post-operative analgesia requirement time to first rescue analgesia, onset of mobilization, side effect of local anesthetic, wound infection (after one week). It was registered on clinical trials.gov with ID: NCT03652116. Results: Visual analogue scale values differ significantly between pethidine group and that of bupivacaine at rest and on coughing at 4, 8, 12, 24 hours & analgesic consumption (P value st time request analgesia per minute comparing group A to group B (P value 0.001). There is no significant difference between bupivacaine and pethidine regarding time of ambulation, side effects or complications. Conclusion: Infiltration of the wound of cesarean section with pethidine gives effective analgesia for several hours as compared to Bupivacaine.

Induction of Labor at 39 Weeks versus Expecting Labour till 41 Weeks: Randomized Controlled Trial on Class I Obese Egyptian Women, with Mode of Delivery Being a Study Endpoint

Background: Maternal obesity is reported to be associated with increased incidence of gestational diabetes mellitus and hypertension. These cause failure of labour induction, leading to higher incidence of cesarean section (CS). The aim of this study was to assess which reduces CS rate, labor induction at 39 weeks or leaving women for spontaneous labor onset till 41 weeks. Methodology: A randomized controlled trial was conducted in Ain Shams Maternity Hospital in Egypt from 2016 to 2018. Study population consisted of 200 term primigravida pregnant obese women delivered in Ain Shams Maternity Hospital. They were divided into two groups: Group A: induction of labor at 39 + 0 weeks (n = 100) by vaginal administration of 25 μg misoprostol (PGE1) every 6 hours for 5 doses;Group B: waiting spontaneous labor onset till 41 + 0 weeks (n = 100), and if no spontaneous labor occurred at 41 weeks, induction was performed in the same way. Results: Induction (Group A) vs. waiting spontaneous labor (Group B) showed the followings, which were significant: CS: 22% vs 39%, p = 0.009;maternal birth injury: 4% vs 12%, p = 0.037;non-assisted vaginal deliveries: 93.6% vs 78.7%, p = 0.034;APGAR scores at 1 & 5 min: 7.6 ± 0.8 vs 7.3 ± 1.1 p = 0.038, 8.4 ± 1.0 vs 8.1 ± 1.3 p = 0.040, respectively;birth weight;3.3 ± 0.1 vs 3.5 ± 0.2 kg, p < 0.001. The following did not show significance between Group A vs Group B but Group A showed lower incidence;postpartum hemorrhage: 3% vs 5%, blood transfusion: 1% vs 3%. Conclusion: CS rate was significantly lower in women with induction of labor at 39 weeks than those waiting for spontaneous labor onset till 41 weeks in obese Egyptian pregnant women.

Use of Basal Serum Testosterone Level as Predictor for Poor Ovarian Response in Women with Unexplained Infertility Undergoing <i>In Vitro</i>Fertilization Cycle: Prospective Study

Background: Delayed pregnancy in women and marked increase in the numbers of older women who fail to respond to ovarian stimulation had been a significant issue. This study aims to assess the value of basal serum testosterone level as a predictor of ovarian response for induction of ovulation in women with unexplained infertility undergoing IVF (in vitro fertilization) cycle. Patients and Methods: A prospective study was conducted in Ain Shams University Maternity hospital Infertility Center during a period of time from October 2016 to June 2017. This study recruited 89 women. On day 2 or 3 of a spontaneous menstrual cycle of the included women within 3 months before fresh IVF cycle, basal hormonal (FSH, LH, estradiol, total testosterone) concentrations, AFC (antral follicle count) were performed. Using the Long-protocol for induction of ovulation, serial monitoring of ovarian response was assessed by transvaginal ultrasound. When the expected ovarian response was reached (at least three oocytes ≥ 17 mm), we gave trigger dose of HCG. Ultrasound guided oocyte aspiration was performed 34 - 36 hours later. Two to three days after oocyte aspiration, we transferred the embryos according to the patient’s age and the condition of embryos available. Biochemical pregnancy was considered if serum B-hCG test was positive at day 14 from embryo transfer, where all the data were correlated with serum testosterone level and ovarian response as 1 ry outcome. Results: There were significant positive correlations between testosterone and LH, Prolactin, AFC, Number of oocytes & Number of Embryos (0.014, 0.032, 0.023, 0.004, 0.033, p 0.001 respectively). Poor responders versus good responders as regards testosterone level (0.81 ± 0.47 versus 1.08 ± 0.45) Fertilized & pregnant cases had significantly higher testosterone than non-fertilized & non pregnant had (1.20 ± 0.45, 0.92 ± 0.47 p value 0.035, 0.021 respectively). Yet, testosterone had significant low diagnostic performance in prediction of poor response and pregnancy (AUC 0.654, 0.676 respectively), (p value 0.015, 0.022 respectively). Conclusion: Basal T levels are helpful for predicting ovarian response, hence the dosage of gonadotropins used in induction. But it can’t be used as single marker for prediction of ovarian response.