Background: Placenta accreta is a major source of maternal morbidity and mortality and is currently the major reason for peripartum hysterectomy. The strict etiology is indefinite, but it has been postulated to be correlated to the injury of the decidua basalis, which allows for the placental attack into the myometrium. Purpose: To evaluate the accuracy of color Doppler ultrasonography in the diagnosis of placenta accreta and to compare it with the diagnostic accuracy of both 2D Ultrasonography and MRI. Material and Methods: A prospective study was done at Obstetrics and Gynecology Department of Tanta University Hospital, Egypt. The study included 100 patients with suspected placenta accreta based on 2D ultrasonography, color Doppler and MRI. The intraoperative findings of each case were compared with the preoperative imaging findings. Results: Sensitivity for the diagnosis of placenta accreta was (100%) for color Doppler ultrasound, (93.7%) for 2D ultrasound and (75 %) for MRI. Specificity was (66.6 %) with color Doppler and (77.7%) for 2D ultrasound and (55.5%) for MRI. The highest positive predictive value (PPV) was found in 2-D ultrasound (88%), MRI had the lowest PPV (75%), while color Doppler had 84%PPV. Negative predictive value (NPV) was (100%), (87.5%), (55.5%) for color Doppler, 2D ultrasound and MRI, respectively. Conclusion: Color Doppler Ultrasound is the most accurate imaging modality in the diagnosis of placenta accreta. Its accuracy, when combined with 2D ultrasound, would increase and provides the best available modality for diagnosis of placenta accreta.

Objective: To assess the attitude of Egyptian gynecologists towards the route of hysterectomy in benign pathologies. Materials and methods:A survey was supplied to a sample of gynecologists in Egypt either in conferences or electronically to be filled and returned.Results: In this study the addressed gynecologist' age below or equal to 48 years were 50.6% and those above 48years were 49.4%. Majority of gynecologists had more than 12yearexperience (59.3%). The abdominal route with subtotal hysterectomy type represented (71.5%). This prevalence was attributed to fear of complications of total hysterectomy in about (90.1%). Majority of gynecologists had no adherence to postoperative follow up (98.3%).Conclusions: Subtotal hysterectomy is the prevalent type of hysterectomy in Egypt owing to fear of complications and medico-legal issues. Regular training courses are required to encourage gynecologists in Egypt to practice total hysterectomy with safe approaches and fewer complications.

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Background: First-trimester pregnancy loss is the most common complication of human reproduction with an incidence ranging between 50 and 70% of all conceptions. The uterine cervix has to be firm enough to retain the conceptus through the pregnancy. Cervical ripening and maturation is very important prerequisite for the successful termination of pregnancy. Misoprostol softens the cervix and cause uterine contractions used for ripening of the cervix before surgical or for medical abortion. Isosorbide mononitrate promote cervical smooth muscle relaxation has been applied clinically as cervical ripening agents. First trimester abortion is terminated by surgical evacuation of the uterus.Conclusion: Cervical preparation is beneficial prior to surgical abortion and should be routine if gestation more than 10 weeks using one of cervical ripening agents Misoprostol or IMN. Aim of Study:To compare efficacy and safety of Isosorbide Mononitrate (IMN) and misoprostol for cervical ripening prior to surgical termination of missed abortion aged between 8 and 12 weeks. Patients and Methods:Eighty patients aged between 20 & 35 years presenting with missed abortion in early weeks of gestation and requiring medical or surgical evacuation of the retained products of conception were included in this prospective clinical study. Number of doses required to achieve cervical ripening, Induction-Ripening interval (I/R) was recorded. Amount of operative blood loss and other safety indices were assessed.Results: Number of doses to achieve cervical ripening using (Misoprostol) was significantly less than number of the (IMN) doses and with further analytical statistics about 66% of cases have successful ripening using (Misoprostol) compared to only 31% using (IMN). The mean (I/R interval) was as follows; 18.5 hours for (Misoprostol) and 22.5 hours for (IMN); with much less operative blood loss for the Misoprostol group than the IMN group.

Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) for diagnosis of premature rupture of membranes (PROM). Material and Methods: A diagnostic study conducted on 70 patients. The patients were divided into three groups: Group A (n = 25): (Confirmed PROM group) patients who were either in labor or not in labor, Gestational age was from 24 weeks onwards and fulfilled the following criteria and/or two of these criteria with low AFI positive pooling, positive nitrazine paper test, positive fern test. Group B (n = 25): (Suspected PROM group) patients who fulfilled the following criteria: Patients with fluid leakage complaint with negative pooling and/or negative nitrazine paper test and/or negative fern test. Group C (n = 25): (Control group with no PROM) patients that were admitted to prenatal clinic for their regular prenatal control visit with 24 -42 weeks of gestational age without any complaint or complication and with negative pooling, negative nitrazine paper test and/or negative fern test. The vaginal washing fluid urea, creatinine, Beta-Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) were determined for diagnosis of premature rupture of membranes (PROM). Results: PAMG-1 detection in cervico vaginal discharge was a very good test for diagnosis of PROM with high sensitivity, specificity, positive predictive value, negative predictive value, accuracy and P-value (96%, 100%, 100%, 95.84%, 97.78% and <0.0001 respectively). Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Furthermore they were more accurate than β-HCG. Conclusion: Detection of PAMG-1 in cervico vaginal discharge is promising How to cite this paper: Borg, H.M., Omar, M. and Suliman, G.A. (2019) The Study of Vaginal Fluid Urea, Creatinine, B-HCG and Placental Alpha-1 Microglobulin in Diagnosis of Premature Rupture of Membranes. Open Journal of Obstetrics and Gynecology, 9, 811-826.