ObjectiveWe aimed to evaluate the effect of different timing of initiation of low-molecular-weight heparin (LMWH) administration on the pregnancy outcomes in women with antiphospholipid syndrome (APS).Materials and methodsA randomized controlled study was conducted on women with obstetrical APS. All participants were randomly divided at documentation of positive pregnancy test into two groups; early initiation group in which LMWH therapy was started once positive pregnancy test was established (in the fifth week of gestation), and later initiation group in which LMWH therapy was started after sonographic confirmation of fetal cardiac pulsation (in the seventh week of gestation). In both groups, LMWH (enoxaparin) was given at a dose of 40 mg/day subcutaneously and the therapy continued until end of pregnancy. The primary outcome measure was ongoing pregnancy rate and the secondary outcome measures were fetal loss, live birth rate, preterm labor before 34 weeks of gestation, intrauterine growth restriction (IUGR), and congenital fetal malformations.ResultsNinety-four women (48 in the early initiation group and 46 in the later initiation group) were subjected to final analysis. The ongoing pregnancy rate was significantly higher in the early initiation group than in the later initiation group (81.2% vs 60.9%; P=0.040). However, both groups were similar in the incidences of fetal loss, preterm labor before 34 weeks of gestation, and IUGR, and live birth rate. No recorded congenital fetal malformations in both groups.ConclusionEarly administration of LMWH for pregnant women with obstetrical APS reduces early pregnancy loss, but does not affect the incidence of late obstetrical complications.

Application of an intrauterine inflated Foley's catheter balloon during CS in cases of morbidly adherent placenta previa helps to control PPH with preservation of the uterus and decreases the need for the invasive IIA ligation.

Objective: to investigate the significance of elevated MSAFP in diagnosing pathologically adherent placenta among women with placenta previa and its predictive value for pregnancy outcome.Study Design: A retrospective study involved eighty women with placenta praevia divided into 4 equal groups according the degree of invasion as suspected by TAS, Doppler and MRI studies and confirmed postoperatively by histo-pathological examination. G1; included those with placenta pravia alone G2; those with placenta accreta, G3; those with increta degree while G4 contained those with placenta percreta. MSAFP level were evaluated for all patients between 34-36 weeks gestational age.Results: Baseline characteristics of the study group showed no significant difference among groups 1, 2, 3 as regard maternal age, gravidity, parity, fetal gestational age and body mass index (p>0.05) but when compared separately with group 4, there was significant increased mean (+SD) (P <0.05) but not in the body mass index. Maternal risk factors of placenta praevia and abnormal placental adherence proved more previous uterine scars in groups 3 and 4, (P < 0.002). MSAFP levels represented a remarkable increase in groups 2 and 3 and shooting up in group 4 (mean+SD, 91.3+19.1, 153.2+38.1, 178.3+25.2, 263.3+36.1 respectively, P value 0.001). Fetal and maternal outcomes as well as intraoperative findings showed some statistical significant differences between the studied groups as maternal intraoperative blood loss was found more evident in G4 (mean + SD 931± 312) compared to G1, 2 and 3 (640 ± 191, 767 ± 331, 834± 284; respectively, P value 0.02) with more liability for postpartum hemorrhage, 7 cases (35%) versus 0, 2 and 3 cases in G1, 2, 3. respectively (P 0.003).IIAL was resorted to in 7 cases in G4 compared to nothing in G1 and G2 while in 2 cases only in G3. Bladder injuries were reported in 5 cases in G4 and 1 case in G3 but not in G1 and 2 (P 0.002). The mean operative time in minutes (SD) was found relatively shorter in G1 but longer in G2 and 3 but longest in G4 (34 ± 9.1, 44 ± 5.1, 49 ± 9.2, 55 ± 8.1, respectively, P value 0.01). There were more need for intra and postoperative blood transfusion in cases of G4, 7 cases versus 2 cases only in G2 and 3. Again, there was more requested emergent caesarean hysterectomy in G4 (4 cases versus one case in G3, P 0.01). The postoperative data confirmed that there was evident longer duration of hospital stay in G4 (5 + 2.3) compared to other groups 1, 2 and 3 (3.2 + 1.1, 3+ 1.2, 3.5+1.3, P value 0.01). Admission to intensive care unit was recorded higher in G4, 5 cases compared to 1 case only in G3 (P 0.002). No maternal mortality recorded as well as neonatal intensive care unit admission.ROC analyses finds elevated MSAFP stated the maximum sum of sensitivity and specificity for the significant test and showed the AUC was 0.752 (95% CI: 0.505-0.979)with 83.54% sensitivity and 71.53% specificity (p = 0.042). Conclusion:Increased third trimester MSAFP levels can predict morbidly adherent placenta in pla...

Background: To study risk factors, management, and outcome of major degree placenta previa in our tertiary health care hospital. The patient criteria, method of diagnosis, management, fetal and maternal outcomes of cases with major degree PP were reported and analyzed.Results: This study included 115 cases. Mean age of our cases was 31.1 years (range: 21-40), mean gestational age at delivery was 36.8 weeks (range: 28-39). Previous cesarean deliveries were reported in 93.9% of the cases. Abnormal placental adhesions were found in 30.4%. A stepwise system was used for intraoperative interference. Peripartum hysterectomy was performed in 13 cases (11.3%). There were three cases of maternal mortality; one due to anesthetic complication, one due to uncontrolled atonic postpartum hemorrhage and the third was due to postoperative pneumonia.The mean gestational age at delivery was 36.82 ± 1.6 weeks. There were 5 cases (4.3%) of IUFD and 2 cases (1.8%) of early neonatal deaths.Conclusions: Major placenta previa with accrete had significant difference in maternal morbidity and mortality than non-accrete type. Pathological placental adhesions should be excluded by Doppler ultrasound and or MRI. All surgical procedures to control bleeding must be done including hysterectomy without hesitation to save the patient. Cases must be managed by a collaborative team work in a tertiary center with available ICU.