Maternal and Neonatal Outcome of Teenage Pregnancy at Al-Galaa Maternity Teaching Hospital, Cairo, Egypt

Backgrounds: Teenage pregnancies are generally considered as a high-risk however, sufficient data is lacking in the area, Cairo Egypt. We attempted to determine whether teenage pregnancies show poorer outcomes than adult-age pregnancies. Objectives: Finding out the prevalence of teenage pregnancy and its maternal and fetal outcome in comparison. Subjects and methods: A retrospective analytical case-control study was conducted on patients who had attended for delivery at Al-Galaa Maternity Teaching Hospital during the period of one year from March 2015 to February 2016. A total of included 538 patients aged 16 - 19 years as study group and adult age group: included 609 patients aged 25 - 29 years as the control group. The only primigravid was enrolled. The study records were retrieved for review. Comparisons were made between the two groups regarding maternal demographics, socioeconomic status, medical disorders, major antenatal complications, the outcome of labor, mode of delivery, and perinatal complications. Results: The prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered the significant prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered significant. Teenagers had a lower antenatal care attendance (63.8% vs 76.7%;P = 0.001), a higher incidence of Eclampsia (2.1% vs 0%;P = 0.000), vaginal deliveries (70.1% vs 51.9%;P = 0.000). And a higher maternal ICU admission (1.4% vs 0.0.7%), and maternal death (0.5% vs 0%),especially in low socioeconomic. On the other hand, the adult group pregnancies had a higher incidence of gestational hypertension, gestational diabetes, and cesarean delivery. Conclusions: Teenager primigravid women should be considered as a high-risk pregnancy and thus require special medical attention to avoid adverse maternal and neonatal outcomes.

Oral medications regarding their safety and efficacy in the management of patent ductus arteriosus

Patent ductus arteriosus(PDA) is a common clinical condition in preterm infants which is inversely related to birth weight and gestational age. Cyclooxygenase inhibitors such as indomethacin and ibuprofen which block the prostaglandin conversion from arachidonic acid are the most commonly used drugs for ductal closure. This review focuses on the safety and efficacy oral medications in the management of PDA in preterm infants. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects when compared to indomethacin. PDA closure rates are better with oral than with intravenous ibuprofen probably due to the pharmacokinetic of the drug. However, these medications were reported to be associated with several adverse including transient renal failure, gastrointestinal bleeding and perforation, hyperbilirubinemia and platelet dysfunction. Paracetamol seems be an alternative to PDA therapy with lower adverse events and side effects.

Pulsed Umbilical Artery Doppler Ultrasound Findings in Management of High-Risk Term Pregnant Women during Labour

Purpose: Intrapartum Doppler velocimetry is a non-invasive investigation method. This method is useful for evaluating the pathophysiological mechanisms underlying changes in fetal heart rate. This study aimed to determine the usefulness of Doppler ultrasound findings during labor in high-risk women on determining the mode of delivery and outcome of the newborn. Methods: A cross-sectional study was conducted from January 1, 2015 to December 31, 2015 on 100 high-risk pregnant women during labor. The study was performed in the Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq. Results: The majority of women (77%) had a normal end-diastolic blood flow pattern through the umbilical artery. A total of 76.9% of those with abnormal Doppler results had a Cesarean delivery compared with only 9.5% of those with normal Doppler results (p p p = 0.07) and fifth minutes (p = 0.01). Conclusions: Abnormal umbilical artery Doppler ultrasound findings in high-risk pregnancies for women in labor are associated with increased rates of emergency cesarean sections and a poor outcome of the newborn.

Association between Early Marriage and Other Sociomedical Characteristics with the Cervical Pap Smear Results in Iraqi Women

Background: The standard screening test for cervical cancer is the Pap smear and cervical cancer is a significant health issue worldwide. Early sexual activity, multiple sexual partnerships, parity, young age at first pregnancy and early marriage are traditional risk factors for developing cervical cancer. The aim of the present study was to assess the effect of early marriage in on the results of Pap smear in Iraqi women. Methods: A cross-sectional study was carried out on 200 women who attended the Women Health Clinic of Al-Elwiya Maternity Teaching Hospital, Baghdad for the period from November 2013 to April 2014. Data were collected through direct interview and a prepared questionnaire including patients’ characteristics and Pap smear results. Results: Mean age of studied women was 39.9 ± 11.4 years and mean age of marriage was 19 ± 5 years. Abnormal Pap results were reported in 63.5% of them. A significant association was observed between abnormal Pap smear and each of age 20 - 30 years, ≤18 years age at marriage, marriage duration >10 years, irregular menstrual cycle, tubal ligation and abnormal medical history (P < 0.05). Conclusions: Early marriage was strongly associated with abnormal Pap smear results in Iraqi women.

Evaluation of thalamus echogenicity by ultrasound as a marker of fetal lung maturity

The present study evaluated fetal thalamic echogenicity by ultrasound as a possible marker of fetal lung maturity in comparison with other ultrasound makers. A prospective longitudinal study performed in Al-Elwiya Maternity Teaching Hospital in Baghdad, Iraq during the period from April 2010 to March 2011. One hundred and forty two pregnant women (36 to 42 weeks of gestation) who were admitted for elective cesarean section and referred for an obstetric ultrasound scan at the same day of their elective cesarean section were included. Scanning with linear ultrasound with convex transducer frequency of 3.5 MHz was utilized to measure the biparietal diameter and the state of echogenicity was recorded as echogenic or echolucent, in addition to amniotic fluid vernix and the placental changes. The presence of echogenic thalamus as a sign of fetal lung maturity had a specificity of 86.53% which is higher than the three other signs of lung maturity;the positive predictive value was (89.6%) which is also higher than the three other signs, but the sensitivity was 63.33% and negative predictive value was 57.69% which is lower than the presence of vernix in the amniotic fluid, 86.66 and 67.56 respectively. In conclusion, evaluation of echogenic thalamus is beneficial, and can be considered as a new marker of fetal lung maturity;however, further studies are required to strengthen such idea.

Vaginal Trachelectomy for Retained Cervical Stump after Supracervical Hysterectomy: Technical Tips and Outcomes

Background and Objectives: The supracervical hysterectomy (SCH) has resulted in a group of patients with a retained cervix at risk of persistent symptoms, who may require a trachelectomy in the future. This study was to evaluate the efficacy of vaginal trachelectomy (VT) after a previous SCH. Methods: This was a prospective study that includes 13 cases with different ages and different complaints, sharing the same primary operation supracervical hysterectomy. They have different pathologies of the SCH specimen but they share the same completion surgery. The surgical outcome was analyzed. Results: Thirteen patients underwent vaginal trachelectomy for recurrent symptoms. The ages of patients were ranged from 37 years to 68 years (Mean ± SD, 56.4 ± 10.7). SCH was most commonly performed for abnormal uterine bleeding AUB (7/13, 53.8%), pelvic mass (5/1, 38.5%), and pelvic pain (1/13, 7.7%), the symptoms leading to vaginal trachelectomy were the same as those leading to supracervical hysterectomy. The median interval time from SCH to seeking medical help for the persistence or recurrence of symptoms and to VT was 2 weeks (1 to 96 weeks). Concomitant procedures were laparoscopic removal of both ovaries in 2 cases and pelvic lymphadenectomy in 1 case. The median length of operation was 45 minutes. In all cases, symptoms leading to trachelectomy resolved completely after surgery, and patients reported a significant improvement. Conclusions: The cervix, left behind at subtotal hysterectomy, requires removal, the vaginal route is probably the safest, and least traumatic. Vaginal radical trachelectomy appears to be feasible and safe for the treatment of endometrial malignancy discovered after supracervical hysterectomy.

A Rare Case of Pyogenic Spondylodiscitis after Laparoscopic Sacro-Hysteropexy

Introduction: Pyogenic spondylodiscitis is a rare and severe complication of laparoscopic Sacro-Hysteropexy with a polypropylene mesh. The proper and early diagnosis following by medical treatment, if not responding, so we shift to surgical approach is very important to prevent irreversible complications. Case Presentation: A female patient 32 years old admitted to our Gyne-Oncology unit in El-Galaa Maternity Teaching Hospital, in Jan 2022 with a significant weakness in both lower limbs up to complete paralysis, by history she has done a laparoscopic Hystero-Sacro-Pexy with synthetic polypropylene mesh 2 weeks ago, all investigations were normal except WBCs was 14,000 and CRP was 28, MRI Finding was an Encysted collection likely seroma at sacral promontory 4 × 3 cm, surgical removal of the mesh was done, the mesh related to the sacrum was severely infected and pus formation was noticed, 4 hours after the operation there was a Dramatic response and complete resolution of symptoms within few days. Conclusion: Because of the rarity of this complication in the literature, Spondylodiscitis awareness of symptoms, timely diagnosis, and treatment including surgical removal of synthetic mesh after Sacro-Pexy are fundamental to prevent irreversible complications.