Objectives: To estimate serum 25-hydroxy vitamin D (25OHD) levels in newly pregnant women and to evaluate its relation to development of gestational diabetes mellitus (GDM) and maternal and fetal outcome. Patients & Methods: The study included 328 pregnant women, and at 6 th week gestational age (GA), women's clinical and obstetric data were collected and blood samples were obtained for estimation of baseline blood glucose (BG) and serum 25OHD levels. Studied women were divided into two equal groups: Group A included pregnant women received supplemental vitamin D3 in a daily dose of 1000 IU oral capsule starting since 6 th week GA till delivery. Group B included pregnant women who completed their pregnancy without vitamin D supplementation. All women underwent the 75g Oral Glucose Tolerance Test (75-OGTT) at the 20 th , 28 th and 36 th week for detection of GDM. All women were followed up till delivery and maternal and neonatal outcome. Results: Serum 25OHD levels were sufficient, insufficient and deficient in 42, 142 and 144 women, respectively. Forty-three women (13.1%) developed GDM and 62 women (18.9%) had emergency and 23 women had elective CS. Moreover, 48 neonates (14.6%) required NICU admission; 15 for respiratory-aid, 22 for phototherapy and 11 neonates for management of sepsis, but 4 neonates died. Women of group A showed significantly lower frequency of GDM with significantly lower BG levels, significantly lower frequency of CS especially emergency CS and significantly lower frequency of NICU admission. Conclusion: Low serum 25OHD levels are a widespread problem among pregnant women and are associated with higher frequency of GDM, CS delivery especially emergency ones and NICU admission rate. Supplemental vitamin D therapy did well for reducing the frequencies of these events. Supplemental daily dose of 1000 IU appears appropriate and convenient as it was taken in the form of oral capsules.

Partogram (Partograph) is a graphical tool represents the events during labor, that helps the care provider to recognize slow progress of labor early, and to start appropriate interventions to prevent prolonged and obstructed labor. In this study, we compared between the percentage of birth trauma which occurred during labor for patients that crossing the alert line of partograph (Group I), and those who crossing the action line (Group II). This study showed that there is no difference statistically between Group I and Group II according to gravida and maternal age. while Group I is higher than Group II according to APGAR score >7 (P value =0.001). There is statistical differences between Group I & II , that Group I is lower than Group II according to perineal tear, fetal birth injuries and rate of C sections ( P value: 0.004 , 0.009 and 0.000). In conclusion: partograph may be a scientific evidence based to manage labour by early diagnosis, identifying and preventing problems during delivery.

Total abdominal hysterectomy, visual analogue scale, Bupivacaine, transversus abdominis plane block, local anesthetic wound infiltration, opioids consumption.Aim: to compare bilateral ultrasound guided transversus abdominis plane (TAP) block with single -shot -local anesthetic subcutaneous and sub facial wound infiltration (LWI) for analgesia after total abdominal hysterectomy (TAH) under general anesthesia. Patients and methods: This prospective randomized, parallel group, concealed allocation, patients and observers blinded superiority trial, conducted at Benha University Hospital, including 87 women undergoing TAH, 43 women received 40 ml 0.25 bupivacaine as bilateral ultrasound guided TAP block and 44 women received 40 ml, 0.25% bupivacaine as subcutaneous and sub facial local wound infiltration at the end of TAH performed under general anesthesia. Main outcomes were total cumulative Nalbuphine consumption and post TAH pain at rest and with movement using visual analogue scale (VAS) as well as incidence of nausea, vomiting, other analgesic requirements, time spent in post anesthesia care unit (PACU), time to get out of bed, deepest sedation, patient satisfaction regards analgesia in First 24 hour postoperative. Results: Total Nalbuphine consumption were significantly lower in TAP block group at 2, 4, 8, 12, 24 hours and at discharge (P < 0.0001). The mean post TAH pain VAS score both at rest and on movement were significantly lower in TAP block group at PACU, 2h, 8h, 12h (P < 0.05) as well as at 4h on movement (P < 0.05). Also, total non-steroidal anti-inflammatory drugs (NSAIDs) consumption were lower in TAP block up to twenty-four hours postoperatively (P < 0.005), time to get out of bed (P = 0.03) and time to first flatus (P = 0.0002). Conclusion: Bilateral ultrasound guided TAP block is superior to local anesthetic wound infiltration in analgesia for post TAH pain as Tap block was associated with reduced both rest and on movement postoperative pain and total cumulative opioids analgesia as well as promotes early mobilization and gut recovery.

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