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Background: Women undergoing cesarean section have a high risk of blood loss and so are more likely to need a blood transfusion. The aim of this work was to compare the effectiveness of using carbetocin versus misoprostol versus ergometrine for controlling bleeding after cesarean section in primigravidae. Methods: This prospective randomized clinical trial was conducted on 150 patients aged from18-35 years old, primigravidae with singleton pregnancy undergoing elective cesarean section. Participants were divided into three equal groups: carbetocin group (group C) received a single 1-ml ampoule of carbetocin (100 μg/mL) added to 10 cm saline intravenously following the delivery of the neonate, misoprostol group (group M) received misoprostol 400ug per rectum immediately after induction of anesthesia in operating theater and ergometrine group (group E) received 0.2 mg of ergometrine intramuscularly in the first minute after delivery of the baby. Results: The amount of blood in suction jar, amount of blood loss, Hb change and HTC change were significantly higher in the misoprostol group and ergometrine group than in the carbetocin group (p <0.05) and in the ergometrine group than the misoprostol group (p <0.001). Post-operative Hb in the ergometrine group was significantly lower in the carbetocin group (p =0.001). Conclusions: Carbetocin can be considered a superior choice to misoprostol and ergometrine in reducing blood loss during CS in primigravidae.

Background: Changes in thymus size and histopathology have been observed both in animal models of intrauterine growth restriction (IUGR). The aim of the present study was to evaluate the size of the fetal thymus by sonography in pregnancies with IUGR and to search for a possible relationship between a fetal thymus size and adverse perinatal outcomes. Methods: This prospective observational study was carried out on 100 participants who were divided into two groups. Group A: Study group which include 50 patients with IUGR. Group B: Control group which Include 50 normal patients with appropriate gestational age. All patients were subjected to: History taking: (Personal, Obstetric History, Maternal Medical History) and trans-abdominal ultrasound. Results: IUGR group show statistically significant decrease in the estimate of fetal weight (EFW) compared to the control group (P<0.05). Doppler study of umbilical artery shows significant increase of (pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) in IUGR group when compared to control group. Doppler study of middle cerebral artery (MCA) shows significant increase in (RI, SD) in IUGR group when compared to control group while PI doesn’t show significant difference between two groups.  Thymus size decrease in IUGR group when compared to the control group. IUGR group had low survival and lower APGR Score when compared to the control group. Correlation between thymus size with the studied doppler parameters and pregnancy outcome in the current study. Umbilical Doppler RI, PI and SD showed statistically significance in this study (P<0.05) and this means that the blood flow in the umbilical arterial (UA) is important for the fetus. As regard the MCA RI and SD Doppler, they show statistically significance in this study (P<0.05) while the MCA PI Doppler did not show any statistically significance in this study (P>0.05). Conclusions: IUGR is associated with small thymus and small fetal thymus may be an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

Background: Preterm prelabor rupture of membranes (PPROM) is responsible for approximately one third of preterm deliveries. Prenatal sonographic (US) assessment of the fetal thymus has become available. This research was done to investigate the role of ultrasonographic assessment of fetal thymus size in pregnancy associated with preterm premature rupture of membrane and its relationship with fetal outcome. Methods: This prospective controlled observational study was carried out on 60 cases with maternal age from 18 to 40 years old, gestational age between 24 and 36 weeks, singleton pregnancy and associated with PROM. Cases were subdivided into two groups Group A: 30 cases with PROM, Group B: 30 normal at the same gestational age. All cases were subjected to history taking, obstetric history, maternal medical history, investigation studies and ultrasound study. Results:The amniotic fluid index had a significant decrease in group A compared with B, and the gestational diabetes mellitus had a significant increase in group A compared with B. The small fetal thymus size had a significant increase in group A compared with B (p =0.013). The Puerperal endomyometritis had a significant increase in group A (30%) compared with B (0%). The Apgar score at 5 mins (p<0.001) and Apgar score (p= 0.042) at 10 mins were significantly decreased in group A compared with B. Conclusions: In pregnancy associated with preterm premature rupture of membranes, small fetal thymus might be associated with histologic chorioamnionitis, higher rate of perinatal mortality and short-and long-term neonatal morbidity however many cases remained clinically silent.

Background: Three-dimensional sonographic technology has gained increased acceptance in clinical practice. This technique involves the gathering of a large amount of data and the quick reconstruction of pictures in the coronal, sagittal and transverse planes. The purpose of this work was to compare the diagnostic accuracy of the three-dimensional trans vaginal ultra-sonographic (3-DTVUS) and hysteroscopy in the detection of cavitary lesions in the uterus. Methods: This study was comparative cross-sectional and included 60 patients who had 2D ultrasonography or hysterosalpingography for suspected intrauterine abnormalities. Each patient underwent a thorough history taking, clinical assessment, investigations, imaging [2D transvaginal ultrasound and 3D vaginal ultrasound] and hysteroscopy. Results: 3DTVUS had a (95%) sensitivity in detecting uterine abnormalities compared to hysteroscopic examination. Also, the specificity was (88%) which indicates that only (12%) of the truly negative cases will be missed. The positive predictive values (PPV) of 3D TVUS were (99%) with an accuracy of (94%). The lowest parameter calculated was the negative predictive value (NPV) (58%). 3DTVUS had a specificity and PPV of 100% regarding the detection of all of the mentioned uterine abnormalities. Furthermore, the sensitivity was 100% for all abnormalities except the polyps and adhesions which were 91% and 67% respectively. The NPV was 100% for all abnormalities except for the polys and intrauterine adhesions (IUAs) which recorded 97%. Finally, the accuracy of 3DTVUS in comparison to hysteroscopy was 100% for all intrauterine abnormalities except the polyps and IUAS which were 98% and 97% respectively. Conclusions: 3DTVUS can be utilized in diagnosing focal lesions of the uterus with comparable outcomes to hysteroscopy.