Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the foundation in management. Aim of This Study. To evaluate efficacy of metformin in comparison to insulin for managing GDM. Methods. In prospective randomized comparative study, 150 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at Obstetrics Department in Zagazig University Hospitals from November 2012 to December 2014. They were divided randomly into two groups, 75 patients in each, and were subjected to either insulin or metformin medication. Outcomes were comparing the effects of both medications on maternal glycemic control, antenatal complications, and neonatal outcome. Results. No significant difference in controlling high blood sugar in GDM with the use of metformin or insulin (P = 0.95, 0.15). Maternal complications in both groups had no significant difference and fetal outcomes were as well similar except the fact that the hypoglycemia occurred more in insulin group with P value 0.01. Conclusion. Glycaemic control in GDM can be achieved by using metformin orally without increasing risk of maternal hypoglycemia with satisfying neonatal outcome.

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A single 100-µg IV carbetocin is more effective than IV oxytocin infusion for maintaining adequate uterine tone and preventing postpartum bleeding in obese nulliparous women undergoing emergency cesarean delivery, both has similar safety profile and minor hemodynamic effect.

Objective: To assess the effectiveness and safety of doubledose methotrexate in comparing to single-dose methotrexate for management of ectopic pregnancy.Methods: A prospective randomized-controlled trial was conducted on 200 patients with ectopic pregnancy at the Obstetrics and gynecological Departments of Zagazig University, Egypt between June, 2011 to May 2014. Patients were randomized into two groups, ( group 1 ) who received a single dose 50 mg per meters squared surface area methotraxate (50 mg/m 2 IM on day 1) intramuscularly or (group 2), who received double-dose methotrexate regimen (50 mg/m2 intramuscularly on days 0 and 4). The outcomes were; success rate, time duration of fall down of b-hcg to <15 mlU/mL and undesirable effects of methotrexate. Results:In general, there is significant differences between both groups as regard the success rate and the duration of fall down β-hCG. The success rate was better in group 2 than in group 1 (90% versus 78.75%, P=0.01). The duration of fall down β-hCG until <15 mlU/mL was shorter in group 2 (P=0.01). There was no significant difference between groups in adverse effects. Conclusion:Double-dose methotrexate as one of regimens of medical management of undisturbed ectopic pregnancy had more effectiveness and success rate than that of singledose regimen with equivalent safety.

Background: Prospective cohort observational study to compare the efficacy low doses (25 micrograms misoprostol) tablet with dinoprostone gel (1 mg) introduced vaginally in term pregnancy for induction of labor as regard maternal and fetal outcome. Methods: Three hundred pregnant women in full term (40-41 weeks) pregnancy were assigned for induction of labor either intravaginal misoprostol tablet or dinoprostone gel. They were divided into 2 groups (A, B). Group A (150 ladies) obtained tablet misoprostol 25 micrograms vaginally 4 hourly and Group B (150 ladies) received dinoprostone gel 1 mg vaginally every 6 hourly, both medications were not to be repeated more than 3 doses. Outcomes were: expression of time interval of induction of labor, augmentation requirement, operative and instrumental rate, expenditure efficiency and neonatal outcome. Results: The demographic criteria as regard the age, body mass index, gestational age, initial Bishop's score and final Bishop's score were analogous in both group (the misoprostol and dinoprostone groups), respectively with no significant differences but about parity there was significant difference between them with p value 0.4. No significant differences between both group as regard occurrence of non-reassuring FHR, uterine hyper stimulation and meconium stained amniotic fluid but there was significant differences in spontaneous rupture of the membranes and uterine tachysystole with p value 0.02 and 0.01, respectively. Time of labor induction was shorter in the misoprostol group with p<0.001. The need of more doses was fewer in G1 than G2 with p value 0.03. Also the need to oxytocin for augmentation was lesser in G1 than G2 with p value 0.02. In misoprostol group more deliveries within 24 hour, p<0.04. The vaginal deliveries were more in misoprostol group with lesser percentage of CS but with no significant difference. The fetal outcome in both group was similar according to birth weight, Apgar score and at 5, the requirement for neonatal resuscitation and neonatal intensive care unit admission. Conclusions: The time interval for induction of labor by misoprostol tablet vaginally was shorter than dinoprostone gel, associated with fewer requirements to augmentation of labor with oxytocin and more deliveries in the first 24 hours of induction.