Background: Primary postpartum hemorrhage PPH is a major cause of maternal morbidity and mortality. Many risk factors for primary PPH have been evaluated, while with changes of obstetric population and technological advances, some of these factors became more important and others were less. Aim: To identify common risk factors of primary PPH and measure the association between these factors and the occurrence of primary PPH. Methods: A case control study was conducted in obstetrics and gynecology department at Zagazig University Hospitals. Participants were selected by systematic random sampling. Data were collected about the participants' age and social class as well as studied risk factors for primary PPH including previous delivery mode, previous antipartum hemorrhage APH, previous PPH, parity, birth weight, gestational age, maternal obesity, maternal hemoglobin level, labor induction, current delivery mode, delivery trauma, episiotomy, placenta previa and retained placenta. Results: Primary PPH was significantly higher among older ages (> 34 years). Primary PPH showed significant associations with the following factors; Previous APH (OR= 3.57), previous PPH (OR= 2.85), macrosomia (OR= 9.57), maternal anemia (OR= 5.37), obesity (OR= 4.01), vaginal delivery (OR= 2.13), labor induction (OR= 2.88), trauma (OR= 3.53), retained placenta (OR= 8.51), and placenta previa (OR= 3.51). Conclusion: Maternal anemia, retained placenta, Macrosomia, and previous PPH were the most significant risk factors for primary PPH. Recommendations: Organized antenatal visits are recommended to help early detection of PPH risk factors and improve females' knowledge about PPH risk. clinicians should optimize care for high risk women. Adequate supplies should be provided to health facilities for prompt management of PPH.

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Background: The laparoscopic hysterectomy of enlarge uterus is a challenge to the surgeon irrespective of the surgical route. Big leiomyomas occupy the pelvis, thus decrease the ability to see the surrounding anatomic structures and partially impairing the surgeon's perform to correctly develop the pelvic spaces. The current work compares of laparoscopic hysterectomy for large uterus (weighing ≥ 280 gm) with an abdominal hysterectomy,Methods: This prospective interventional clinical study submitted from January 2015 to December 2018 to assess the perioperative outcomes of 60 consecutive women with an enlarged uterus (weighing ≥ 280 gm determined preoperative by ultrasound), of whom 30 underwent laparoscopic hysterectomy and 30 an abdominal hysterectomy, all for benign gynecological conditions after exclusion of contraindications to laparoscopy. Results: Baseline patient characteristics were similar between the both groups, except for body mass index with laparoscopic group show higher index (34.3±1.3 kg/m2). Among the perioperative complications, only the risk of ileus was significantly higher in the group that underwent abdominal hysterectomy. Laparoscopic hysterectomy shortened the length of hospitalization significantly but did not affect the operative time and blood transfusion. Conclusion: Total laparoscopic hysterectomy of enlarged uterus is a suitable effective alternative to traditional abdominal hysterectomy when the laparoscopic team is well trained. However, more studies are necessary before this technique can become routinely preconized.

Background: The placenta is avital organ which plays an important role in the normal fetal growth and development process. The aim of work: Is to assess the relation between thickness of the placenta during the 2nd and 3rd trimesters and fetal birth weight and placental weight.Patients & Methods: 50 cases of uncomplicated pregnant women who were attended the outpatient clinic at Zagazig University Maternity Hospital were involved in this cohort studyfrom the period between June 2018 to March 2019;, The thickness of the placenta was measured by transabdominal ultrasound during second and third trimester.The relation between thickness of the placentaand fetal outcome was examined by Pearson's correlation.Results: according to our study there was positive relation between thickness of the placenta at the 2 nd trimester and 3 rd trimester with fetal birth weight, placental weight and APGAR score. The fetal outcome was better with normal placental thickness (10 th -90 th ) in comparison to that with thin (<10 th ) and thick placenta (>90 th ) &the incidence of NICU admission increased in thick placenta and thin placenta.Conclusions: The thickness of the placenta by ultrasound can be used beside other biometric parameters in predicting neonatal outcome and measurement of placental parameters should be involved in all routine antenatal ultrasounds.