Mohamed Ibrahem Ellaithy

Objective To assess whether metoclopramide is effective in shortening the duration of the first stage of labor in primiparous women. Methods The present randomized, double‐blind, placebo‐controlled trial was conducted at King Faisal Hospital, Saudi Arabia (between July 30, 2013, and September 1, 2016), and sequentially recruited young nulliparous women admitted in spontaneous active labor with or without ruptured membranes. Eligible participants were randomly assigned to receive a slow intravenous injection of either metoclopramide or placebo and consistently managed according to the local institutional intrapartum protocol and received identical monitoring and supportive care. The primary outcome was the cervical dilatation rate. Results Fifty‐nine women were included in the metoclopramide group and 52 in the placebo group. The first stage of labor was significantly shorter in the metoclopramide group (203 minutes vs 230 minutes in the placebo group, P=0.019), with a faster cervical dilatation rate (2.4 ± 0.4 cm/hour vs 1.9 ± 0.5 cm/hour in the placebo group, P<0.001) and shorter interval from treatment administration until full cervical dilatation. There was a significantly higher probability of faster delivery among women who were treated by metoclopramide (log rank test, χ2=5.997, P=0.014). Conclusion Metoclopramide safely reduced the duration of the first stage of labor and was not associated with major maternal or neonatal adverse outcomes.

Objective: To study the association between maternal serum amyloid A (mSAA) levels and preterm birth (PTB). Methods: This prospective observational nested case control study was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between May 2017 and December 2017. The study recruited pregnant women at 26–34 weeks presented with threatened preterm labor (PTL). Women with PTB were included in cases group, while control group included women who continued pregnancy and delivered at term. Serum samples were collected to measure mSAA levels. The main outcome of the study was the association between mSAA levels and PTB. Secondary outcomes included neonatal intensive care unit admissions and neonatal mortality. Results: Fifty-eight women were included in the final analysis (29 in each group). Women with PTB had a statistically significant higher mSAA levels [5.1 (4.5–7.7) vs. 1.2 (0.0–2.5) mg/l, for cases and controls respectively, p < 0.001]. Higher mSAA levels were also observed among women whose babies were admitted to NICU, but there was no significant relation between mSAA level and neonatal death. A statistically significant negative correlation was found between mSAA and gestational age at delivery and neonatal birth weight. mSAA had an excellent value to predict PTB (AUC = 0.972 [95% CI, 0.891–0.998], p < 0.0001), fair value to predict admission to NICU and a poor value to predict neonatal death. Conclusions: mSAA Level was found to be elevated among women with threatened PTL who end with PTB; mSAA is a potentially useful predictive marker of PTB that warrant further study. CLINICALTRIALS.GOV: NCT01639027 .

Objectives: To study the relevance between cervical length (CL) and different maternal\neonatal outcomes in pregnancies complicated with placenta previa\accreta. Methods: Three hundred twenty-eight women, who had medically free singleton live pregnancies with the diagnosis of placenta previa and\or accreta, were included and divided regarding their CL into two groups. Threatened preterm labor, maternal tocolysis, multiple gestations, polyhydramnios, ruptured foetal membranes, foetal complications, history of cervical conization and the presence of cervical cerclage were the exclusion criteria. Demographic data, obstetric history as well as the courses of the complicated pregnancies were collected and statistically analyzed. Results: The short CL group had significantly less distance between placenta and the internal cervical os (p-value < 0.001) Also, they showed more ultrasound parameters of complete placenta previa with anterior location (p-value < 0.001 and 0.003 respectively) and placental adherence (21.8 versus 41.1%). Women with short cervix had significantly higher rates of preterm birth, antepartum hemorrhage, emergency caesarean sections, intraoperative estimated blood loss, massive bleeding, prevalence of placental adherence and caesarean hysterectomy (p-value < 0.001 for the entire outcomes). Multivariable binary logistic regression showed that CL (< 30 mm) was a significant independent risk factor in prediction of severe hemorrhage, PTB, emergency CS, placental adherence, cesarean hysterectomy (p-value < 0.001 for adverse maternal outcomes) and low cord Ph (p-value0.016). Conclusions: Assessment of the cervical length could be a crucial step in the work-up and decision making for pregnancies complicated with abnormally situated and\or adherent placenta as it is strongly associated with wide range of maternal and neonatal morbidities.

Objective: To endorse the impact of chewing gum on the intestinal functions’ restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD). Methods: Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynaecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 hours after recovery at least for half an hour and at 2-hour interval during daytime. The second group received oral fluids 6 hours postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the time of initiating breast-feeding and the cost of hospital stay. The study was prospectively registered at ClinicalTrials.gov (NCT02386748). Results: The study included 372 women randomized into three groups (124 women in each group). Chewing gum significantly improved intestinal recovery with faster onset of bowel movements, first audible intestinal sounds, passage of flatus and passage of stool (p = 0.0001). It was associated with significantly shorter duration of hospital stay and parenteral therapy duration (p = 0.0001). Abdominal distension, vomiting and ileus postoperatively were significantly higher in nonchewing gum groups. Neither paralytic ileus nor side effects were recorded with gum use. Conclusion: Chewing gum, within 2 hours postoperatively, is a simple, safe and well tolerated intervention that can boost rapid intestinal recovery and shorten hospital stay after planned cesarean deliveries.

Aim: Of the different described methods of placental delivery during cesarean section (CS), manual removal and cord traction are the most commonly used techniques. The ideal method of placental delivery during CS is still a conflicting issue as the data derived from the previous studies are widely heterogeneous and inconsistent. This study has investigated the effect of two different methods of placental delivery, controlled cord traction and manual removal, on perioperative blood loss.Methods: This randomized controlled trial recruited 345 pregnant women scheduled for elective cesarean delivery at term. Eligible participants were randomly assigned to have their placentae delivered either by manual removal or cord traction. Perioperative blood loss was the study primary outcome measure.Results: A total of 300 women were included in the final analysis. The longer placental delivery time in the cord traction group (n = 150) (60 s. [45–61.25] versus 45 s. [35–60] in the manual placental delivery group, P < 0.001) was associated with a statistically significant but clinically insignificant higher visually estimated blood loss (500 mL [interquartile range, 500–700] versus 500 mL [interquartile range, 400–500] in the manual removal group, P < 0.001). Although there were statistically significant differences in the hemoglobin levels, postoperatively, these differences were clinically insignificant and were not reflected in the corresponding deficits and percentages of deficit at 12‐ and 48‐h postoperative intervals.Conclusions: Of the studied placental delivery techniques, there were no clinically significant differences in terms of the considered intraoperative and postoperative outcomes; hence, the practice of placental delivery can be left up to obstetrician's discretion and intraoperative scenario.

Objectives: Measurement of salivary progesterone (SP4) levels and cervical length (CL) after 24 weeks to assess their potential predictive value among asymptomatic women at high risk of spontaneous preterm birth (PTB). Methods: This prospective observational (noninterventional) study consecutively recruited asymptomatic women at high risk of spontaneous PTB. SP4 and CL were measured at recruitment (24-28 weeks of gestation) then repeated after 3-4 weeks. All recruited women were followed up regularly till delivery. The primary outcome measure was the occurrence of spontaneous PTB. Results: One hundred and thirty four women completed the study, 22 (16.4%) and 32 (23.9%) women had early (<34 weeks) and late (≥34 weeks) PTB, respectively. Initially, the mean CL was 3.2 ± 0.6 cm and the mean SP4 was 4062.8 ± 814.6 pg/ml; with follow up, the mean CL became 3.0 ± 0.6 cm and the mean SP4 became 3871.6 ± 1136.9. Women with early PTB had significantly lower initial and follow up CL and SP4 measures when compared to women with late PTB and those who had birth at term. The rate of drop in SP4 and CL measurements between the two visits was also significantly higher among women with early PTB than those with late PTB and term birth. Receiver-operating characteristic (ROC) curves showed that, CL was a good predictor but SP4 was a better predictor of PTB as the area under the curve (AUC) for CL was less than that for SP4 at both visits (i.e. 0.858 and 0.868 versus 0.986 and 0.990 at the initial and follow up visits, respectively). There was a statistically significant correlation between CL and SP4 measurements. Multivariable binary logistic regression analysis revealed that follow up SP4 measurement was the only independent predictor of spontaneous PTB, and neither BMI, maternal age, SP4 nor CL were independent predictors of early spontaneous PTB. Conclusions: After 24 gestational weeks, SP4 assessment is a simple and reliable promising tool to predict spontaneous PTB among asymptomatic high-risk women, with a little superior performance than CL measurement.