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Article informationBackground: Cesarean delivery is the commonest surgical procedure practiced by Obstetricians and its incidence continues to rise. It is associated with significant morbidity, and infection is one of the most common postoperative complications. Different interventions are described to decrease the rate of infection. The use of vaginal antiseptics and antimicrobial was prescribed. However, the results are inconsistent. The aim of the work:The current work aimed to determine the value of pre-surgical vaginal cleaning by a 5% chlorhexidine gluconate solution could reduce the risk of maternal infections after cesarean delivery. Patients and Methods: This study included 400 women attending obstetrics and gynecology departments to deliver by elective cesarean section. The study had been completed between the beginning of January 2019 to the end of December 2021. All women were randomized to one of two equal groups. The first included 200 women where no wash was done [Control group]. The second included another 200 cases where wash with chlorhexidine gluconate was done [Study group]. At the time of hospital discharge and again at one month post delivery. The rate of endometritis and different wound complications were documented and compared between groups. Results:The control and study groups were comparable regarding female age, parity, gestational age at delivery, primary cesarean section, operative time. However, postoperative hospital stay duration was significantly longer in control than the study group [43.26±10.62 vs. 39.69±9.21 hours, respectively]. Hemoglobin concentrations revealed non-significant difference between the study and the control groups before and after cesarean delivery. However, it was significantly reduced in both groups after surgery than values before surgery. Endometritis was reported among 12.5% of the control group, compared to 7.0% of the study group, with no significant difference between the study and the control groups. However, the overall wound complications were significantly increased among control than study group and composite complications were also significantly increased in control than the study group [12.0% vs 4.0% respectively]. Lower preoperative hemoglobin was the only significant associated factor for development of endometritis. Conclusion:Peroperative vaginal preparation with 5.0% chlorhexidine gluconate solution is associated with a reduction in post-cesarean infectious complications [mainly endometritis] wound infection and other wound-related complications. It is recommended to be a routine practice before cesarean delivery.

Background: Preeclampsia [PE] is one of the commonest medical emergencies. It had high morbidity for the mother and her infant. Early diagnosis could reduce such morbidity. Aim of the work:To evaluate the role of maternal serum placental protein [PP13] levels and uterine artery Doppler in early prediction and prognosis of preeclampsia. Patients and Methods:The study included 60 pregnant women in their first and early second trimester with high risk for preeclampsia. Patients were divided into three groups: control, mild and sever preeclampsia. All were subjected to proper history taking, clinical and obstetrical examination, laboratory investigations and ultrasound examination. Results: Cesarean delivery was significantly increased in preeclampsia compared to controls [55% of mild and 20% of severe disease compared to 15% of controls]. Both uterine artery resistance index [RI] and pulsatility index [PI] were significantly increased in PE when compared to control and in severe when compared to mild PE groups. Finally, PP13 was significantly decreased in patients with severe PE [171.7±35.9] when compared to mild PE [213.1±41.8] or control group [254.8±51.1]. In addition, there was significant decrease in cases with mild PE when compared to control group. Finally, there was inverse [negative], moderate and statistically significant correlation between PP-13 from one side and each of systolic BP, diastolic BP, uterine artery RI and PI. In addition, both RI and PI were proportionally correlated with PI and RI. Conclusion:The present study showed that PP13 combined with PI or RI can predict PE with a good sensitivity and specificity.

Introduction and aim: Placenta praevia and accreta are associated with high morbidity and mortality. Bleeding is the sole etiology of both morbidity and mortality. Thus, anti-bleeding measures are mandatory and research continues to search for ideal prophylactic measure. This work was designed to assess the efficacy of bilateral internal iliac artery ligation followed by Transverse B-Lynch compression suturing and intrauterine balloon tamponade as a conservative methods to control placental site bleeding due to placenta praevia accreta. Methodology: The study included 24 pregnant females with placenta praevia accreta who were scheduled for elective cesarean section. All participants were subject to history taking, clinical evaluation and laboratory investigations. Ultrasound examination was carried out for assessment of: Estimated fetal weight, confirmation of gestational age, confirm diagnosis of placenta previa accreta and level of the placental edge in lower uterine segment. Deliveries were scheduled to take place between 36-37 weeks of gestation. The primary outcome was the amount of intra-operative blood loss. Results: Blood loss ranged between 249.29 and 560.43 ml, and there was statistically significant decrease of hematocrit percent and platelets after surgery when compared to corresponding values before surgery. All females need blood transfusion. However, none of them need further surgical intervention or intensive care unit admission. Conclusion: Prophylactic bilateral internal iliac artery ligations before extraction of placenta accreta followed by transverse B Lynch suture and intrauterine balloon tamponade seemed to be an effective and safe technique to reduce intrapartum and postpartum complications, and to avoid emergent peripartum hysterectomy.