Background To evaluate the impact of interval between induction of spinal anesthesia to delivery of the fetus by elective cesarean section on umbilical arterial pH and neonatal outcome. Patients and methods Two hundred and twenty pregnant women who were planned for elective cesarean section at term under spinal anesthesia were recruited. Minimum systolic, diastolic and mean arterial blood pressures (SBP, DBP, MAP) and largest pressure decrease (SBP, DBP, MPA) were also recorded. Induction of spinal anesthesia to delivery interval was measured. Following delivery, umbilical arterial cord analysis for pH and base deficit were done. Apgar scores at 1 min and at 5 min, neonatal intensive care unit (NICU) admission, need for mechanical ventilation and incidence of hypoxemic-ischemic encephalopathy were recorded. Results Induction of spinal anesthesia to delivery interval was 25.7 ± 5.6 min. Lowest SBP and MAP reached during cesarean delivery were 88.9 ± 7.3 mmHg and 60.4 ± 5.6 mmHg, respectively. MAP < 65 mmHg was reached in 136 (62%) patients with a decrease of MAP of > 20% in 149 (68%) patients. Duration of the longest hypotension episode was 3.3 ± 2.2 min. All patients required ephedrine administration for hypotensive episodes with an average dosage of 11.4 ± 3.2 mg. Umbilical pH of 7.3 ± 0.1 and base deficit of 8.3 ± 4.4 mmol/l were recorded. Apgar scores at 5 min were 8.5 ± 1.2. Eight (3.6%) neonates were admitted in the NICU. One neonate needed mechanical ventilation. There were no cases of hypoxemic-ischemic encephalopathy. There were inverse correlations between induction of spinal anesthesia to delivery interval, body mass index (BMI) and duration of longest hypotension episode in relation to umbilical pH (r = -0.817, -0.395 and -0.268, respectively). Cut off value for induction of spinal anesthesia to delivery interval greater than 27 min predicted an umbilical pH of < 7.2. Cut off value for the duration of the longest hypotension episode greater than 5 min predicted an umbilical pH of < 7.2. Cut off value for BMI greater than 35 kg/m2 predicted an umbilical pH of < 7.2. Conclusion Prolonged interval between induction of spinal anesthesia to delivery could be associated with neonatal acidosis. This could be aggravated by maternal obesity and prolonged duration of hypotension episodes during cesarean delivery.

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Background: Preterm birth is the leading cause of newborn deaths and also the leading cause of death in children under 5 years of age. There is wide spread suspicion that subclinical infection is a common accompaniment and cause of preterm labour. Ferritin is an acute phase reactant and it increases during inflammation. Aim: The objective of this study is to measure serum ferritin level in cases of established preterm labour (PTL) as a possible marker of infection. Study Setting: This study conducted at Ain Shams University Maternity Hospital from March 2015 to November 2015. Study design: A case-control study. Patients and Methods: The study involved 2 groups. Study population: 60 cases divided into two groups:  Group (I): included 30 patients with established (PTL) between 30 to 34 weeks gestational age (GA).  Group (II): (Control group) 30 patients with uncomplicated pregnancies between 30 to 34 weeks GA. Serum ferritin was analyzed in the 2 groups. Results: The results pointed out that there was statistically significant difference between two groups as regarding serum ferritin level as p value was <0.0001. The median serum ferritin level in preterm labour group and control group was 150 (100-150) ng/ml and 20 (15-25) ng/ml respectively. The best cut off value of serum ferritin as predictor of preterm labour was >55 ng/ml with a sensitivity of 96.7% and specificity of 96.7 %. Conclusion: Serum ferittin can be used as a marker of preterm labour.

Background: Medical abortion, the termination of pregnancy through the use of a drug or a combination of drugs, has the potential to reduce complications and to expand access to abortion provided not only by specially trained clinicians but also by other health care providers who may or may not have training in surgical methods of abortion. Aim: This study aimed to elicit the safety and efficacy of intravenous injection of dexamethasone with vaginal misoprostol for shortening the induction abortion interval in the second trimester of pregnancy. Materials and Methods: This study was conducted in Ain-Shams Maternity University Hospital where 140 pregnant females were included for induction of second trimester abortion from June 2018 till December 2019. Results: There was significant statistical difference between the two groups as regard induction-expulsion interval (P >0.001) and length of hospital stay (P > 0.001), mean induction-expulsion interval in dexamethasone group was 10.5 hours; while in the control group was 17.5 hours, the mean length hospital stay was 16 hours in the dexamethasone group while it was 23 hours in the control group. There was significant statistical difference between the two groups as regard dose of misoprostol used (P>0.001), mean dose of misoprostol in the dexamethasone group was 800 mcg while it was 1600 mcg in the control group. Conclusion:It was suggested that use of intravenous injection of dexamethasone with misoprostol was effective in shortening the induction-abortion interval, the length of hospital stay and reducing the misoprostol doses.

Background Cesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation Aim of the Work to assess the efficacy and safety adding ef Epinephrine to lidocaine 2% in dose-related manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post; caesarean section pain after general anesthesia. Patients and Methods A total number of 200 women planned for elective caesarean section at Shams University Maternity Hospital Was recruited, 2 groups were randomized with a study group included 100 women received lidocaine 2% and epinephrine in dose-related manner and a control group included 100 women received lidocaine 2% only. Results women who received lidocaine and epinephrine were more satisfied and hadsignificant more time after caesarean section free of pain in comparison to women who received lidocaine only by 120 minutes. Also. adding Of epinephrine helped in decrease in amount of analgesic consumption after caesarean section. Women who received lidocaine and epinephrine started breast feeding and mobilization earlier than women who received lidocaine only. Epinephrine prolonged the action of lidocaine as a local anesthetic, this prolongation of action of local anesthetic had a significant effect in early mobilization and breast feeding and decrease in cost of analgesics. Nobody in our candidate had a post-operative infection, past operative pyrexia, Allergic reactions tar general anesthesia or complications with local anesthesia. Conclusion Adding of epinephrine to local anesthetics (such as lidocaine 2% in dose-related manner 1:200.0000) prolonged anesthetic effect by more than double of its original anesthetic time, This prolongation on anesthetic effect of local anesthesia by epinephrine helps in eariy mobilization; early breast feeding and less hospital duration stays. No complications (local nor systemic) developed with local infiltration of post-caesarean section incision with lidocaine 2% even aficr adding epinephrine in dose-related manner 1:200.000