Background: Increasing maternal age is independently associated with specific adverse pregnancy outcome. But, it was noted when patients of advanced maternal age were followed and delivered their infants in modern tertiary care center, no increase in adverse outcome was noted. Objectives: This prospective study in which maternal and perinatal outcome in pregnant women aged 40 years and above compared with those of young women aged 25-35 who delivered in El-Eman General Hospital. Patients and methods: 422 women were divided into 2 groups. The first group contain 211 women whose age ranges from 25-35 years, the second group contain 211 women whose age 40 years and above. Results: There were significant increases in rates of Pregnancy Induced Hypertension among pregnant women aged over 40 years (12.3%) compared to older primigravida aged over 40 years. There was significant increase in the rate of preeclampsia among women aged over 40 years (18.5%). Incidence of preeclampsia increase in grand muliparus women aged ≥ 40 years (18.5%) and among women aged 25-23 years (7.6%). Risk of bad perinatal outcomes increases in relation to medical diseases with pregnancy. Conclusion: Women aged ≥ 40 years have higher risk of Cesarean section than young women. There were statistically significant increases in the rate of NICU referral due to perinatal problems among women with advanced age. The mother's high age can be an independent factor for adverse pregnancy outcomes, complete awareness of pregnancy outcomes in these age groups for midwives and gynecologist is needed to protect health of mothers.

Introduction: Hemodynamic stability is one of the main goals of any anesthesiologist. Aim of the work: The aim of this study is to evaluate the effect of two different adjuvants (fentanyl and magnesium sulphate) on hemodynamic response and arousal reactions as indicated by BIS values following laryngoscopy and endotracheal intubation, and to detect the related side effects. Patient and methods: After approval of the university ethical committee and obtaining informed consent from all patients, this prospective randomized double-blind controlled study was conducted in El-Minia university hospital during the period form may 2017 to December 2017. A total of 60 adult female patients, between 20 and 60 years, American society of anesthesiologists grade I and II patient scheduled to undergo elective surgery under general anesthesia with endotracheal intubation were included in the study. Results: Demographic data of the three studied groups were comparable. Discussion: Endotracheal tube remains the gold standard airway device for securing the airway during general anesthesia . however, laryngoscopy and intubation is associated with hemodynamic stress response manifested as tachycardia, hypertension and a variety of cardiac arrhythmias in addition to those hemodynamic changes, arousal reactions as indicated by increase the BIS values also occur with laryngoscopy and intubation. Summary and conclusion: This prospective randomized controlled study was conducted in El-Minia university hospital during the period from May 2017 to December 2017.

Objectives: Airway manipulations induce marked fluctuations in heart rate and blood pressure. Strict narcotic legislations limit availability of fentanyl. This study was designed to compare the attenuating effects of intravenous magnesium sulfate with fentanyl on cardiovascular and arousal response following laryngoscopy and intubation, while ensuring anesthetic depth with Bispectral index monitoring. Methods: Seventy-five female patients ASA 1 or 2, scheduled for elective surgery under general anesthesia were randomized into three groups: Group M received 40 mg/kg magnesium sulfate, Group F, 2 μg/kg fentanyl, and Group C received saline prior to induction of anesthesia. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and bispectral index (BIS) were measured at various time points. Maximum change in hemodynamic parameters and arousal response were calculated (ΔSBP, ΔDBP, ΔHR, ΔBIS). Adverse effects related to study drugs were recorded. Results: There was a statistically significant increase in BP and HR following intubation in all three groups compared to prelaryngoscopy levels. ΔSBP and ΔDBP were comparable in M and F groups, but p < 0.000 when compared with control group. Following infusion of the study drug, HR increased in M group p = 0.002, while decreased in F group, p < 0.001. BIS also increased significantly after intubation compared to prelaryngoscopy levels, ΔBIS was 9.2 (SD 2.4)%, 9.9 (1.9)% in F and M groups compared to 31.8 (7.8) in group C, p < 0.000. Hypertension, although transient, occurred in 44% in control group compared to none in other groups. Conclusion: Magnesium sulfate infusion prior to anesthesia induction effectively attenuated hemodynamic and arousal response to tracheal intubation comparable to fentanyl in normotensive patients.

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