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Research Journal of Obstetrics and Gynecology
eISSN: 2077-222X
pISSN: 1994-7925

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Research Article
Spinal Versus General Anesthesia in an Elective Cesarian Section Due to Major Placenta Previa
Magdy Abdelrahman Mohamed, Wael Alham Mahmoud and Ramadan Aboelhasan Mahmoud
Background and Objective: Placenta previa is a prominent complication of pregnancy. There is increase in rate of placenta previa and accreta secondary to increase rate of cesarean section. This study aimed to compare the effects of spinal versus general anesthesia on the maternal aspects regarding morbidities and mortalities and the neonatal outcomes. Materials and Methods: This is randomized controlled study was carried out at Sohag University hospital. Women with major placenta previa (3rd or 4th degree) and delivered by caesarean section were included. The 1st group received spinal anaesthesia while second group received general anaesthesia. Both group were compared as regard operative time, estimated blood loss, amount of blood transfusion, hypotension in addition to neonatal outcomes. Results: Eighty patients were included. Forty patients received spinal anesthesia and the same number received general anesthesia. Operative time was statistically significant more prolonged in general anaesthesia than spinal group (104.7±23.5 vs. 93.2±20.4, p-value is 0.021), estimated blood loss (2086±549 vs. 1835±477, p-value is 0.032) and amount of blood transfusion (3.2±0.65 vs. 2.7±0.57, p-value is 0.039) were increased in general anaesthesia, in contrast to hypotension that observed more frequently in spinal group (70%) compared to 42.5. Neonatal outcomes were comparable in both groups apart from Apgar score at 1 min which was better in spinal group. Conclusion: Spinal anesthesia is comparable to general anesthesia in elective caesarean section of placenta previa major degree with better maternal and neonatal outcomes. However all measures should be taken to manage expected hypotension.
Research Article
Prevalence of Thrombophilia in Palestine and the Association of Thrombophilic Gene Polymorphisms with Recurrent Pregnancy Loss
Rozan Attili, Ayman Hussein, Hilal Odeh and Hatem Hejaz
Background and Objectives: Inherited thrombophilia may be caused by mutations, polymorphisms in a variety of genes mainly involved in haemostatic pathways. The aims of this study to estimate the prevalence of thrombophilia and to determine the correlation of specific inherited thrombophilias and recurrent pregnant loss (RPL) among Palestinian women. Materials and Methods: For this purpose, 11 thrombophilic gene polymorphisms the including Factor V Leiden and MTHFR C677T polymorphisms were evaluated. Two thousands women who were referred for thrombophilc genetic screen test between the years 2013 and 2018 were included in the study and evaluated for the presence of thrombophilic gene polymorphisms and compared to 200 healthy volunteers. Results: The prevalence of thrombophilia in Palestine is 11.7-27.2% among normal population in contrast to 39.90% MTHFR C677T gene polymorphism and FVL gene polymorphism 14.20%. The most common thrombophilia in our study group was MTHFR C677T mutation with 39.90% followed by MTHFR MTHFR 1298A/C with a prevalence of 31.70%, β-Fibrinogen (-455 G>A) with a prevalence of 23.60%, Factor XIII with a prevalence of 16.40%, FVL (H1299R) with a prevalence of 13.40, followed by FV Leiden 11.49% and the least common was Prothrombin (G20210A) with a prevalence of 5.30%. The MTHFR MTHFR C677T would be expected to play a major role to recurrent pregnancy loss (RPL). These findings indicate that RPL with homozygous genotype for (C677T and A1298C) either alone or compound heterozygous genotypes have a high risk of pregnancy loss in Palestine. Present study result also shows that a significantly higher frequency of factor V leiden polymorphism among the patients compared to control groups. The importance of determining at least 6 thrombophilic gene polymorphisms are most effective in increasing the risk of RPL in patients experiencing recurrent abortion losses. Conclusion: The study suggests the high need to determine at least 6 thrombophilic gene polymorphisms and provides evidence for a significant correlation between recurrent miscarriages and MTHFR C677T and Factor V mutation in our population.
Research Article
Correlation Between Fibrinogen Level with Placenta Infarct to Missed Abortion
Dyah Permatahayyu, Efendi Lukas and Andi Mardiah Tahir
Background and Objective: Missed abortion is a failed pregnancy due to the death of the embryo conception product or a fetus. This research aims to identify the correlation between fibrinogen level on pregnancy and the age of the conception product during abortion, abortion progress and appearance of placental infarct on missed abortion cases. Materials and Methods: The research method used is a cross sectional analysis. The study was done in Budi Mulia Maternal Hospital and Network Hospital in Makassar city. The study sample is patient with early pregnancy, whom after the researchers do anamnesis, physical examination, supporting examination (blood fibrinogen level and ultrasonography) showed the potential for missed abortion, the sampling was done since March, 2017. The data was analyzed using version 17.0 of SPSS. Results: The study resulted that there were significant increases of fibrinogen (p = 0.015) on missed abortion during 6th-10th week pregnancy, that had been measured since the beginning of the last menstruation period and on fibrinogen level increased on early pregnancy according to the ultrasonography (64.3%) (p = 0.007). Conclusion: The abnormally elevated pregnancy fibrinogen concentration during abortion age is equivalent to hypercoagulation that has potential on abnormal hyper coagulability, tend to create thrombosis.
Research Article
Lower Uterine Scar Thickness Predicts Timing of Next Cesarean Section in Iraqi Pregnant Women with Previous Multiple Operations
Ulfat Mohammad Ali Al-Nakkash, Marwa Malik Anas, Alaa Ali Hussein, Faris Anwer Rasheed and Saad Abdulrahman Hussain
Background and Objective: Caesarean section is considered as the most common obstetrical operation worldwide. The ultrasonography-aided assessment of the lower uterine segment scar is crucial in determining the time of the next cesarean section. The present study aims to determine the optimal time of the next cesarean section according to gestational age and lower uterine segment thickness measured by transabdominal ultrasound. Methodology: Three hundred pregnant women were enrolled in a prospective follow up study at Al-Elweyia Maternity Teaching Hospital/Baghdad/Iraq from January, 2016-January, 2017 with two or more cesarean sections, all assessed for lower uterine segment thickness at term by ultrasonography and followed up for one month after labor. Results: The lower uterine segment thickness was significantly associated with the earlier gestational age of the pregnant women (p = 0.01), dehiscent uterine scar (p<0.001), low APGAR score (p<0.001) and low birth weight of neonates (p = 0.006). The lower uterine segment thickness cutoff value in predicting dehiscent scar was 3.9 mm (78.2% sensitivity and 82.3% specificity); while it was 3.9 mm in predicting shorter gestational age but with lower validity scores (69% sensitivity and 50% specificity). Conclusion: The lower uterine segment thickness can be considered as an appropriate predictor of dehiscent scars and shorter gestational age of pregnant women with previous two or more cesarean section in subsequent pregnancies.
Research Article
Metformin Versus Insulin in Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Trial
Mohammad Galal, Walaa Mohammad El Bassioune and Lobna Sherif
Background and Objective: Metformin as an oral anti-diabetic drug is an attractive option for control of gestational diabetes. However, its safety during pregnancy needs further evaluation. This study aimed to evaluate the safety and efficacy of oral medication (metformin) in comparison to insulin as regard maternal and neonatal outcome. Materials and Methods: Comparative prospective randomized controlled study was carried out in Obstetrics and Gynaecology Department, Al-Azhar University hospital (New Damietta) during the period from January, 2017-October, 2018. Pregnant women diagnosed with gestational diabetes mellitus were included. The first group received insulin while second group received metformin. Both groups were compared as regard maternal and neonatal outcome. Results: About 106 patients were included. About 50 patients received insulin and 56 patients received metformin. There were statistically significant differences as regard mean fasting and post prandial blood glucose level (92.42±4.93, 129.82±7.88 vs. 86.88±5.02, 117.30±8.84) and mean birth weight ( 3.52±0.14 vs. 2.99±0.12) in insulin and metformin group, respectively. Also, increased CS rate (81.5% vs. 57.7%) between insulin and metformin group, respectively. Conclusion: It was concluded that Metformin is more effective in controlling mild GDM with comparable maternal and neonatal outcomes to insulin therapy.

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