The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

Does local vaginal estrogen after tension-free transobturator vaginal tape reduce overactive bladder symptoms in postmenopausal women? A prospective randomized, controlled study

Objective:We aimed to evaluate the efficacy of topical estrogen after transvaginal tension-free vaginal tape-obturator(TVT-O)in the treatment of de novo overactive bladder symptoms that appear after surgery.Methods:This is a prospective randomized controlled study performed in the Urology and Gynecology Departments,Kasr Al Ainy Hospital,Cairo University,Cairo,Egypt.Two hundred and ten postmenopausal females presenting during the period between January 2017 and November 2020 with stress urinary incontinence were included in the study.Patients were divided into two groups,105 patients in Group A(treatment group)and 105 patients in Group B(control group).Patients in Group A underwent transvaginal TVT-O followed by local vaginal estrogen treatment for 6 months,while patients in Group B underwent transvaginal TVT-O only.The study included any postmenopausal female with urodynamic stress urinary incontinence.All patients had to fulfill a 3-day bladder diary,overactive bladder symptoms score,urine analysis,urodynamic study,and post-voiding residual urine measurement by abdominal ultrasound preoperatively and at 3-month and 6-month follow-ups.Results:At 6-month follow-up,daytime frequency was reduced to 8%in Group A(increased to 21%in Group B)with a statistically significant difference between both groups(p=0.009).At 6-month follow-up,nocturia was 8%in Group A(11%in Group B)with no statistically significant difference between both groups(p=0.469).There was a statistically significant difference between both groups as regards to urinary urgency at 6-month follow-up(p=0.024).There was a statistically significant difference in postoperative wound healing events as regards to cure,hyperemia,gapping,and wound infection 1 week after intervention between both groups(p=0.008).No local or systemic side-effects were reported from local estrogen use.Conclusion:Local vaginal estrogen treatment given to postmenopausal patients after midurethral sling procedures can reduce the symptoms of daytime frequency and urinary urgency.Long-term follow-up is needed.

Lupus and Pregnancy

Introduction: Systemic lupus erythematosus is a multifactorial autoimmune disease characterised by its clinical polymorphism and its course in flares. The aim of our study was to determine the effects of pregnancy on lupus and vice versa. Material and Methods: This is a retrospective study conducted over a period of 14 years from 2002 to 2015. We included cases of systemic lupus erythematosus associated with pregnancy followed at the obstetrics and gynecology department “C” of the Ibn Rochd University Hospital in Casablanca. Results: The mean age of our parturients was 31.4 years. All our patients were known to have lupus and were followed up. Pregnancy was terminated in six (20%) cases. We noted one (3%) case of intrauterine fetal death, four (13%) cases of intrauterine growth retardation, and five (16%) cases of prematurity. Lupus flare during pregnancy occurred in 16 (52%) cases, including one (3%) patient who developed superimposed pre-eclampsia, had a renal relapse in the third trimester requiring an abortion at 32 weeks of gestation with three sessions of hemodialysis, and another patient who developed eclampsia. Conclusion: A better understanding of the aggravating factors and compatible treatments has led to a more widespread authorization of pregnancy.

Factors of Low Birth Weight Risk in the Department of Gynecology-Obstetrics of the Ignace Deen National University Teaching Hospital in Conakry, Guinea

Introduction: The underweight at birth is recognized as a major cause of morbidity and mortality in childhood. Objective: To identify maternal and obstetric sociodemographic factors associated with low birth weight. Patients and Methods: This is a retrospective study of analytical type that examined the records of women who gave birth in the Obstetrics and Gynecology department of Ignace Deen National University Teaching Hospital from 1st December 2016 to 30th April 2017. The analysis was made with the R version 3.3.1 software. We did a univariate and multivariate analysis. Outcomes: Out of the 1633 live births of single pregnancies that occurred during the study period, 109 children were born with a low weight (<2500 g) corresponding to a rate of 6.7%. In univariate analysis, we found a significant association between low birth weight and maternal single status (p = 0.019), maternal weight less than 60 kg (p = 0.038), primary parity (p = 0.018), maternal history of abortion (p = 0.001), history of preterm birth (p < 0.001), arterial hypertension (p < 0.001), anemia (p < 0.001) and malaria (p < 0.001). In multivariate analysis, the variables associated with low birth weight were: history of preterm delivery with OR of 8.5 [1.8 - 40.1], history of abortion (OR = 4.4 [1.4 - 13.9]), malaria (OR = 23.8 [6.1 - 92.5]), anemia (OR = 11.8 [3.7 - 38.2]) and high blood pressure (OR = 5.4 [1.6 - 17.9]). Conclusion: The decrease in frequency of low birth weight in Guinea will be done by improving the quality of prenatal care with an emphasis on screening, prevention and treatment of malaria, anemia and high blood pressure during pregnancy, prevention of abortion and premature birth.

Evaluating the Role of Measuring the Perineal Length as a Predictor of Progress of Labor and Obstetrical Trauma

Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.

Routine prenatal ultrasonography: The pregnant woman’s expectations and perspectives on safety in a Central African obstetric population

Background: Pregnant women are important stakeholders regarding prenatal ultrasound (US) scanning. Their specific needs and preferences have to be ascertained by healthcare providers to ameliorate service delivery. Objective: To assess the pregnant woman’s expectations during routine prenatal US scan and her perspective ofUSsafety during pregnancy in a Central African obstetric population. Methods: A cross-sectional descriptive survey of consenting pregnant women who reported for routine prenatal US scan using an anonymous questionnaire. A convenient sample of 200 participants was adopted. Results: Thirty-three (16.8%) respondents (on a total of 196) declared they had never done anUSscan. One hundred and eleven (58.4%) on a total of 190 stated that they had not received any information on what ultrasonography is all about. Before theUSscan the respondents would like to receive information on the aim or purpose of ultrasonography, possible inconveniences or risks, and on how to prepare before the scan. The most reported expectations were assurance of the wellbeing of the fetus (58%), gender determination (44.5%) and information on fetal position (20.5%). Thirty-four respondents considered ultrasonography as not perfectly safe for the mother or the “baby”, with the relevant reasons being the use or production of some potentially harmful “rays”. Conclusion: Pregnant women would want to be assured of the wellbeing of the fetus, the gender and position during routine prenatal US. They however need to be informed of its purpose and safety.

Sacrospinous Fixation in the Gynecology Department of Hôpital du Mali

Sacrospinous fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by securing the posterior vaginal wall to the small sacrospinous ligament. It is performed by low approach and includes a dissection of the pararectal space, visual exposure of the sacrospinous ligament and a needle with strait needle holder with nonabsorbable threads. It is often associated with a more complex corrective procedure, including cystocele cure, vaginal hysterectomy and posterior myorrhaphy. The objective of this study is to report the results of SSF in the gynecology department of Hopital du Mali. A descriptive study was conducted from September 2014 to September 2015 concerning 37 patients operated on for uterine prolapse (UP). All patients with grade III UP were included in our study in whom a unilateral hysterectomy (UH) and sacrospinous fixation (SSF) were performed. All the patients were scheduled. Preoperatively they had benefited from an assessment and a pre-anesthetic consultation. Hospitalization of at least 24 hours prior to the operation was required. Postoperative follow-up was two years with a physical examination at 3 months, 9 months and 15 months, and phone calls between physical consultations. During the study period, we performed 37 RIs. The mean age of the patients was 48 years with extremes of 41 to 73 years. The large multiparity was found out in 35 cases (94.59%), the pauciparous were two with 3 deliveries for each. Long labor of more than 18 hours was found out in 9 patients (24.32%) and home delivery in 13 cases (35.13%). The duration of the occurrence of prolapse was at least two years and 35 patients were going through menopause. The type of anesthesia used for the surgery was spinal anesthesia for all patients. The average duration of the operation was 90 minutes. Complications occurred in three patients or 8.10% of cases, two cases of acute urine retention and one case of hematoma of the para-rectal space. The medium time of hospital stay was 5 days. The anatomical result was satisfactory in all patients. However, two patients presented with grade II rectocele one year after the operation. Sacrospinous fixation is a technique suitable for our patients who present with genital prolapse with extreme laxity of the suspension ligaments. Well done, it brings anatomical satisfaction and its complications are rare and slight.

Split Hand/Foot Malformation about Two Family Cases

Split hand/foot malformation (SHFM), formerly known as ectrodactyly is a rare congénital anomaly, its incidence varies from 1/8.500 to 1/25.000 live birth. It mainly affects the development of the limbs, its clinical variability is standard, can present as an isolated feature or as a syndrome associated with other congenital anomalies. Our objective was to present the two cases of SHFM, and to review the literature on the clinical aspects and discuss a probable origin. The father went to school and is a driver because the malformations concerned only the fingers, were less severe, and did not prevent the realization of certain simple gestures of the daily life. On the other hand, the malformations of the fingers of the newborn were severe and the absence of the thumbs compromised the later prehension function. Also the association of a microglossia and a cleft palate contributed to a weight loss that justified hospitalization. The clinical presentation of split hands and feet is variable and the prognosis depends on the type of anomaly. Familial cases suggest a probable genetic origin. Genetic testing is necessary to establish genetic counseling.

Review of Maternal Deaths in Two Health Regions of Togo: About 69 Cases (Epidemiological and Sociodemographic Aspects)

Introduction: Maternal mortality is a public health problem. It is common in hospitals in Togo. From 401 per 100,000 live births in 2013, in 2017 we are 396 per 100,000 live births. Despite several programs ranging from subsidized caesarean section (CARMA) yezou (assistance for pregnant women), the establishment of maternal death reviews in maternity wards to compensate for avoidable causes;we are seeing preventable maternal and fetal deaths in our hospitals. No study on these reviews has been done since its establishment. The objective of our study was to determine the frequency of reviews of maternal deaths, the epidemiological, sociodemographic aspects and the causes of these reviewed maternal deaths. Method: This was a descriptive and cross-sectional, multicenter study lasting four and a half years, from the 1st of January 2018 to the 30th of June 2022, relating to the review of maternal deaths in three reference hospitals of two health regions of south Togo. Any maternal death occurring in one of these hospitals during the study period was included in this survey. The data collected using a collection sheet were analyzed using Epi Info version 7 software. Results: During the study period, the maternal mortality ratio in the three hospitals was 722.3 per 100,000 live births. Only 12.2% of maternal deaths were reviewed in the three hospitals. The patients were young with an average age of 29.9 years, housewives (71%), uneducated (21.7%). The causes of maternal deaths were dominated by direct obstetric causes (89.7%). The main cause was hemorrhage (72.5%), the main cause being immediate postpartum hemorrhage (50.7%). Conclusion: This study shows that the maternal mortality ratio still remains high in our country with a low frequency of maternal death reviews. Young, poor, uneducated women are the most affected by these deaths, the main cause of which remains hemorrhage. Preventive measures deserve to be taken at all levels with a view to reducing maternal mortality.

The Use of Glycated Albumin in the Diagnosis of Gestational Diabetes Mellitus

Gestational diabetes mellitus is the most common endocrine disorder in pregnancy and a cause of maternal and fetal morbidities and mortalities. The oral glucose tolerance test is the gold standard for diagnosing gestational diabetes mellitus. Nevertheless, the oral glucose tolerance test is time-consuming and requires patient preparation. On the contrary, Glycated albumin does not require patient preparation or administration of any substance. Most studies on glycated albumin in pregnancy were among the non-African population, and black Americans have higher glycated albumin levels than Caucasians. This study determined the use of glycated albumin in diagnosing gestational diabetes mellitus among pregnant women. The study was a prospective study of 160 pregnant women between 24 and 28 weeks of gestation at the University of Port Harcourt Teaching Hospital. The diagnosis of gestational diabetes mellitus was based on the World Health Organization 2013 criteria. The diagnostic value of glycated albumin was determined using the area under the receiver operator characteristic curve. The prevalence of gestational diabetes mellitus was 9.4% and the mean glycated albumin was 16.91% (±2.77). The area under the receiver operator characteristic curve for glycated albumin was 0.845 (95% CI 0.733 - 0.956;p = 0.0001). The optimal cut-off value of glycated albumin in the diagnosis of gestational diabetes mellitus was 18.9%. Glycated albumin was useful in the diagnosis of gestational diabetes mellitus at 24 to 28 weeks of gestation.

Migration of a Progestin Implant into a Pulmonary Artery: Observation of a Case at the Reference Health Center of Commune III of the District of Bamako in Mali

It was a 36-year-old patient, 5th Pregnancy, 5th Delivery, 4 live children, and I deceased, had a consultation in the department for the removal of implants. Questioning revealed that she had had the implant three years ago without medical follow-up. It was in view of the difficulties in extracting the capsule that the chest X-ray and CT scan carried out concluded that the implant had migrated into a branch of the left pulmonary artery. Therapeutic abstention has been the attitude of cardiovascular surgeons.

Umbilical Cord Prolapse Managed by Assisted Vacuum Delivery

G4P3L3 was at 40 weeks of gestation who was admitted in active stage of labor with normal fetal heart rate. At 8 cm cervical dilatation she experienced spontaneous rupture of membrane with clear liquor. Cord prolapse was detected and was prepared for caesarian section meanwhile she was kept in knee chest position and bladder was filled with normal saline 0.9%. 30 min before operation she was fully dilated with signs of Non reassuring fetal status, vacuum extraction was done to assist delivery as soon as possible. The APGAR score was 6 and 10 in the first and fifth minutes respectively. Mother and the baby were discharged the next day in good condition.

Pelvic floor muscle training as a persistent nursing intervention: Effect on delivery outcome and pelvic floor myodynamia

Purpose:To evaluate the effect of pelvic floor muscle training as a nursing intervention on delivery outcomes and postpartum pelvic floor myodynamia.Methods:In total,106 nulliparas were randomised into an intervention group and control group.All nulliparas participated in a pelvic floor training programme led by a midwife.A pelvic floor physical therapist measured the women’s pelvic floor myodynamia and taught them how to correctly perform pelvic muscle contractions before the intervention.A registered nurse monitored the intervention group via twice-weekly telephone checkups.The control group did not receive individual direction.Results:There were no differences in the rate of Caesarean section or elective Caesarean section between the two groups(χ^(2)=3.446,p=0.076 and χ^(2)=2.343,p=0.185,respectively).There was a difference in the timing of the second stage of labour between the two groups(t=2.101,p=0.040);no difference was observed in the timing of the other two stages of labour(t=1.771,p=0.081 and t=1.142,p=0.263,respectively).In addition,no differences were observed in the gestational weight gain(t=0.196,p=0.845),neonatal weight(t=0.113,p=0.911),rate of episiotomy(χ^(2)=0.932,p=0.351)or rate of perineal laceration(χ^(2)=0.022,p=0.982)between the two groups.The pelvic floor myodynamia of the intervention group had improved to a greater degree than that in the control group at 6 weeks and 3 months after delivery(p<0.005).Conclusion:Persistent nursing intervention for pregnant/postpartum women helped to shorten the second stage of labour and contributed to the recovery of postpartum pelvic floor myodynamia.The influence of this intervention on the delivery mode,and rates of episiotomy and perineal laceration remains unknown.Medical staff should strengthen health education programmes that involve pelvic floor functional rehabilitation.

Sexual and reproductive function in end-stage renal disease and effect of kidney transplantation

Advanced chronic kidney disease is associated with impaired spermatogenesis and testicular damage. Semen analysis typically shows a decreased volume of ejaculate, oligo-or complete azoospermia, and a low percentage of motile sperm. Erectile dysfunction （ED） is also common in patients with chronic renal failure （CRF） and is observed in excess of 50% of these patients. There have been ongoing improvements in survival and quality of life after renal transplantation. One of the most impressive aspects of successful renal transplantation in the young people is the ability of the male patient to father a child. In this article we first review pathophysiology of reproductive failure in end-stage renal disease （ESRD）, then ED in ESRD and its management are discussed, finally sexual function in renal transplant patients and management of ED in these patients are reviewed.

Proteomic analysis of gastric cancer and immunoblot validation of potential biomarkers

AIM： To search for and validate differentially expressed proteins in patients with gastric adenocarcinoma.METHODS： We used two-dimensional gel electrophoresis and mass spectrometry to search for differentially expressed proteins in patients with gastric adenocarcinoma. A set of proteins was validated with immunoblotting.RESULTS： We identified 30 different proteins involved in various biological processes： metabolism, development, death, response to stress, cell cycle, cell communication, transport, and cell motility. Eight proteinswere chosen for further validation by immunoblotting. Our results show that gastrokine-1, 39S ribosomal protein L12 （mitochondrial precursor）, plasma cell-induced resident endoplasmic reticulum protein, and glutathione S-transferase mu 3 were significantly underexpressed in gastric adenocarcinoma relative to adjacent non-tumor tissue samples. On the other hand, sep- tin-2, ubiquitin-conjugating enzyme E2 N, and transaldolase were significantly overexpressed. Translationally controlled tumor protein was shown to be differentially expressed only in patients with cancer of the gastric cardia/esophageal border.CONCLUSION： This work presents a set of possible diagnostic biomarkers, validated for the first time. It might contribute to the efforts of understanding gastric cancer carcinogenesis,

Assisted Hatching in Couples with Advanced Maternal Age： A Systematic Review and Meta-analysis

This systematic review aimed to evaluate the efficacy and safety of assisted hatching （AH） performed in couples with advanced maternal age. We searched for randomized controlled trials （RCTs） in electronic databases, including MEDLINE, EMBASE and CENTRAL （from inception to January 2018）; in addition, we hand-searched the reference lists of included studies and similar reviews. We included RCTs comparing AH versus no treatment （control）. The meta-analysis was performed by RevMan 5.3 software. The search retrieved 943 records and 8 RCTs were included, comprising 870 cycles （n=440 for AH, and n=430 for control）. There was no significant difference in the rates of live birth （RR 0.88, 95% CI 0.65 to 1.18, 3 RCTs, n-427,I^2=0%）, clinical pregnancy （RR 1.00, 95% CI 0.83 to 1.19, 8 RCTs, n=870, I^2=22%）, implantation （RR 1.07, 95% CI 0.83 to 1.39, 4 RCTs, n=1359, I^2=0%）, miscarriage （RR 1.13, 95% CI 0.66 to 1.94, 2 RCTs, n=116, I^2=0%） and multiple pregnancy （RR 0.89, 95% CI 0.31 to 2.52, 1 RCT, n=97,I^2=not applicable） between the treatment group and control group. No reasonable conclusions could be drawn regarding reproductive outcomes after AH in patients with advanced maternal age due to the small sample pooled in meta-analyses. Studies of high methodological quality and with adequate power are necessary to further investigate the value of AH in assisted conception of those patients.

Sclerosing stromal tumor of the ovary with masculinization,Meig’s syndrome and CA125 elevation in an adolescent girl:A case report

BACKGROUND Sclerosing stromal tumor (SST) is an extremely rare sex cord stromal tumor of theovary. It was first reported and named in 1973. These tumors typically presentwith pelvic/abdominal pain and tenderness, a mass, and/or abnormal menses,but rarely present with masculinity in children and adolescents. Only 2 cases ofthese tumors have been reported in premenarchal girls, who demonstratedhormonal activity, with a history of the development of a virilizing female due tohyperandrogenism. Here, we report a case of a giant SST with obviousmasculinity combined with Meig’s syndrome and CA125 elevation.CASE SUMMARY A 17-year-old female presented with a 7-year history of the development ofmasculinity and a 2-year history of amenorrhea. She had hirsutism, acne, obviouslaryngeal prominence, and voice deepening. Physical examination showed a malesuprapubic hair pattern and a 4.0 cm × 1.5 cm enlarged clitoris. Laboratory testsshowed that the testosterone level was > 15.00 ng/mL (normal range: 0.14-0.76ng/mL), and androstenedione level was > 10.00 ng/mL (normal range: 0.3-3.3ng/mL). A computed tomography scan of the abdomen and pelvis was carriedout and showed a large, solid and cystic, partly calcified pelvic mass in the rightovary measuring 27.1 cm × 20.0 cm × 11.0 cm, 15 cm above the umbilicus (to thelevel of the upper part of L1). Intraoperative findings at laparotomy revealed alarge tumor arising from the right ovary. Approximately, 500 mL of pale-yellow clear liquid was found in the pelvic cavity. A right salpingo-oophorectomy wasperformed. Microscopic examination and immunohistochemical staining of thesurgical specimen showed an SST of the ovary.CONCLUSION This report is remarkable as our patient was not only diagnosed with an SST ofthe ovary, which is extremely rare in this age group, but was the largest and mostobvious reported patient with this tumor who presented with virilization.Therefore, gynecologists should be aware of this potential complication inadolescent girls with a mass in the ovary.

Prevalence of Maternal Anemia in Pregnancy: The Effect of Maternal Hemoglobin Level on Pregnancy and Neonatal Outcome

Objective: The aim of our study is to assess the prevalence of anemia in pregnant women, and to evaluate the effect of severity of anemia on maternal and perinatal outcome. Methods: This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology from hospital records. Study population of all pregnant women who had delivered in our hospital after twenty weeks gestation between July 2014 and December 2016. Results: A total of 2654 pregnant women fulfilled the inclusion criteria, 42% were anemic, 83.3% mild anemia group (I) which represents the majority of patients and 16.7% moderate to severe anemia group (II). The majority of cases were due to iron deficiency anemia 92.8%, while 7.2% were due to sickle cell trait, B-thalassemia intermedia, and other causes. The incidence of postpartum hemorrhage, cesarean delivery, and infections was significantly higher in group II compared to group I (5.4%, 40.3%, 3.8% Vs, 2.9%, 31.0%, 2.0%;p = 0.007, 0.041, 0.043 respectively). Low Apgar score, preterm labor, and low birth weight babies were significantly higher in group II compared to group I (11.8%, 12.9%, 11.3% Vs 8.7%, 9.0%, 7.4%;p = 0.034, 0.046, 0.032). Conclusions: This study clarified that anemia is prevalent among pregnant women particularly mild anemia. Early diagnosis and treatment from first trimester has an essential role in managing maternal anemia and it reflects directly on the perinatal outcome. Prematurity, low birth weight infants, and postpartum hemorrhage are the commonest maternal and neonatal complications.

Comparison between Azithromycin and Cephalexin for Preventing Infection after Cesarean Section in Obese Patient

Introduction: Postcesarean infection can cause maternal mortality and morbidity. Use of prophylactic antibiotics could decrease surgical site infection. Despite using prophylactic antibiotics in obese women, compared to normal weighted women the rate of wound infection is higher in this group. The aim of this study is to compare prophylactic effect of azithromycin and cephalexin on febrile morbidity and postcesarean infection in women with BMI > 30. Methods and Materials: This randomized controlled double blind clinical trial was done on 231 women with BMI > 30 who underwent elective cesarean section. Patients were randomly divided to intervention and control groups. Keflin 2 gr IV was administered 0.5 hr before surgery for both intervention and control groups. Cefalexin (placebo) every 6 hr and azythromycin (placebo) every 12 hr for control group and cephalexin 500 mg every 6 hr and azithromycin 250 mg every 12 hr for intervention group were administered for 48 hrs. Patients were under observation till 1 month after surgery. Fever, wound infection, endometritis and hospitalization were compared between two groups with SPSS v. 18. Results: A total of 231 patients 113 (48.9%) were enrolled in intervention group and 118 (51.1%) in control group with mean age of (28.53 ± 5.51) recruited. BMI distribution did not differ in the two groups. Hospitalization in control group was significantly higher than that in intervention group (2.58 ± 0.99) vs (2.11 ± 0.45) (P value < 0.001). BMI in intervention group with and without fever was (34.62 ± 2.64) and (30.89 ± 2.80), respectively (P value < 0.001). In control group, BMI in patients with and without fever was (38.60 ± 2.80) and (31.29 ± 1.28), respectively (P value = 0.001). Fever and endometritis simultaneously was seen in 3 (2.7%) of intervention group and 8 (6.8%) of control group. In interventions 3 (2.7%) had fever but no endometritis and 2 (1.8%) had endometritis but no fever (P < 0.001). In control group, 23 (19.5%) patients had fever but no endometritis and 4 (3.4%) patients had endometritis but no fever (P value < 0.001). Febrile patients in control group 31 (26.3%) were significantly more than those in intervention group 6 (5.3%) (P value < 0.001). Discussion: Administration of prophylactic azithromycin and cephalexin resulted in a decrease in febrile morbidity and length of hospital stay and is recommended. BMI of patients with fever was significantly higher in both intervention and control groups compared to those who didn’t experience fever. Postcesarean endometritis wasn’t significantly different in two groups. Postcesarean wound infection wasn’t seen in any group.

The Impact of Third Trimester Maternal Serum Vitamin B12 and Folate Status on Fetal Birth Weight. Is Maternal Serum Homocysteine a Predictor of Low Birth Weight Infants?

Objective: The aim of this study is to evaluate vitamin B12, folate, and homocysteine status in pregnant women in the third trimester of pregnancy and their relationship to fetal birth weight and their correlation to corresponding neonatal cord blood levels, and in addition, to evaluate the possibility of maternal serum homocysteine level as a predictor of low birth weight infants. Subjects and Methods: In this cross-sectional study, a total of two hundred pregnant women in third trimester (≥28 weeks) were recruited. After a detailed obstetrical and medical history, and clinical assessment, participants were subdivided into two groups: Group (A)—pregnant women who delivered average birth weight (ABW) infants and Group (B) for those who delivered low birth weight (LBW) infants between completed 37 and 42 weeks. Results: Vitamin B12 deficiency was observed in 24.1% of the total cohort. The mean vitamin B12 level was significantly lower in group (B) compared to group (A) (195.2 ± 38.9 vs. 225.9 ± 66.59 respectively P = 0.008). The mean level of homocysteine for women in group (B) was significantly higher than those determined from women in group (A) (9.10 ± 5.9 vs. 7.6 ± 3.83 respectively, P = 0.042). On the other hand, the mean folate levels showed statistically insignificant differences between both groups. The mean cord vitamin B12 level was significantly lower in LBW infants in comparison to ABW infants (277 ± 61.93 vs. 312.03 ± 81.87 respectively, P = 0.015), while the mean level of cord homocysteine for LBW infants was significantly higher than those levels determined from ABW infants (7.9 ± 3.79 vs. 6.6 ± 2.09 respectively P = 0.0049). Conclusion: Maternal micronutrients particularly cobalamin deficiency could be significant risk for LBW infants. Hyperhomocysteinemia has been shown to be a predictor for adverse pregnancy outcomes particularly LBW.