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Article
Perinatal out come of Breech Presentation in the Presentation in the Pretext Mode of Delivery

Author: Abdulrazak H. Alnakash
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2007 Volume: 4 Issue: 1 Pages: 70-75
Publisher: Baghdad University جامعة بغداد

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Abstract

Objectives: To choose the best mode of delivery for term, frank or complete, breech presentation through studying the perinatal outcome of each mode of delivery decided when managing a group of pregnant ladies presented with breech delivery in our centre.
Methods: One hundred and fifty pregnant ladies presented at term with singleton, frank or complete, breech presentation for delivery in our centre during the period from May 2004 to August 2005.
Mode of delivery, parity, gestational age, maternal age, maternal medical illness, and birth weight where the variables that have been tested in each delivery included in the study to verify their relationship to perinatal outcome.
Results: No significant relationship is found between the occurrence of adverse perinatal outcome and the variables. However, mode of delivery was the major determinant of the perinatal outcome.
of the 150 pregnant ladies, 46 were delivered vaginally, 32 had elective caesarean section, and the remaining 54 pregnant, had undergone an emergency caesarean section because they were presented with labour. Thirteen (8.6 %) babies were adversely affected by the process of delivery, 9 (5%) of them were delivered by vaginal route, 3 (2 %) delivered by emergency caesarean section and one (0.6%) by elective caesarean section.
Conclusion: Elective caesarean section is regarded the safest way of delivery for those with term, frank or complete, breech presentation.
Key Words: Breech, Perinatal outcome, Cesarean Section (CS).


Article
Significance of Umbilical Cord Nucleated Red Blood Cells Count in Overdue Pregnancy

Authors: Yosve Salih --- Abdulrazak H Alnakash
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 249-252
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Elevated count of nucleated red blood cells (n-RBCs) in the cord blood of fetuses at birth as well as prolongation of pregnancy, have been suggested as predictor of adverse perinatal outcome.OBJECTIVE:A prospective cohort study to evaluate the association between umbilical cord nucleated RBCs (uc-nRBC) count in uncomplicated overdue pregnancies with their neonatal outcome.PATIENTS & METHODS:One hundred and eighty five ladies with overdue pregnancy (41-42 weeks+3days) were included in the study. Dating was confirmed by their precisely recalled last menstrual periods and early pregnancy sonographies. At their deliveries, umbilical cord nucleated red blood cells were counted and expressed per 100 white blood cells. Mode of delivery, the newborn outcome and the risk factors were all analyzed with the obtained counts of the n-RBCs using descriptive and inferential statistics.RESULT:The number of n-RBCs counted, ranged from 3-43/ 100 WBC and accordingly the cases were categorized into 3 groups. Those with more than 20 n-RBC/100 WBC (high risk group) showed higher incidence of neonatal risk outcomes (49.3% of the calculated total risks) than the group with 3-10 n-RBC (low risk group) which included about half of the participants, it exhibited only 20.5% of the total risks. The risk outcomes include; meconium staining, admission to neonatal intensive care unit, neonatal death and Apgar score at 7 minutes less than 5. Moreover, cesarean section rate in high risk group was almost double its rate in the low risk group (44.7% Vs 22.5%).The association between risk outcome and n-RBC counts is statistically highly significant P value < 0.001.CONCLUSION:In overdue pregnancy, umbilical cord n-RBC count of the new born is significantly associated with risk outcome.


Article
Role of Serum Progesterone in the Diagnosis of Ectopic Pregnancy and Missed Abortion

Authors: Abdulrazak H Alnakash --- Zeina Abdulsahib
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 1 Pages: 22-27
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: diagnosis of early pregnancy failure (ectopic pregnancy and missed abortion) still challenging even by using of serial B-HCG and ultrasound. Serum progesterone hormone level value is regarded as one of the important diagnostic tools in the diagnosis of many obstetrical and gynecological conditions; one of these is early pregnancy failure.OBJECTIVE: To assess the role of serum progesterone level in early diagnosis of ectopic pregnancy and missed abortion.PATIENTS AND METHODS: The study is conducted at Al-Elwiyah Maternity Teaching Hospital throughout the period between (April 2010 –July 2011). Ninety women participated in the study, they are at their early weeks of gestation (6-10) weeks. Their ages were between 18-40 years. thirty of them served as a control group (normal intrauterine pregnancy) and sixty pregnant women included in the study group and subcategorized into 2 groups. thirty women with suspected sub-acute or chronic cases of ectopic pregnancy according to ultrasound and β-HCG results and 30 women served as suspected missed abortion. blood samples were taken from the three groups followed by another blood samples after two-day interval to measure of serum progesterone levels. the results were compared among the three groups at first and second readings. p-value, standard deviation and 95% confidence interval calculated and statistically analyzed.RESULTS: P-value of the serial measurements of serum progesterone levels in two-day interval in the three groups was statistically insignificant. while serum progesterone levels of both ectopic pregnancy and missed abortion were greatly lower than serum progesterone levels of normal intrauterine pregnancy in both first and second readings, with statistically significant deference, P-value is CONCLUSION: Serum progesterone levels has a useful role in diagnosing ectopic pregnancy and missed abortion.


Article
Evaluation of Amniotic Fluid volume with Ultrasound at Term Pregnancy and its Correlation to Perinatal outcome

Authors: Abdulrazak H. Alnakash --- Areej Sabah Abdul Ridha
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 202-210
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: recognition of abnormal amniotic fluid volume before delivery may alert the clinician to situations of potentially high prenatal risk. pregnancies complicated by extremes of amniotic fluid volume also experiences increase maternal & neonatal morbidity. OBJECTIVE: To identify the incidence of fetal morbidity & mortality associated with abnormal liquor volume compared with those having normal liquor volume at term pregnancy.Study design: A prospective cohort study.Setting: The study was conducted at Al-Elwiya Maternity Teaching Hospital, during the period from Mar. 2011 to Apr. 2012.PATIENTS AND METHODS: Three hundred fifty one pregnant women at their term were collected for the study. The participants were classified according to the amniotic fluid volume into 3 groups: Group 1: (244) those with normal liquor volume (maximum vertical pocket 3-8 cm), Group 2: (63) those with oligohydramnios ( maximum vertical pocket <3cm), Group 3: (44) pregnants having polyhydramnios ( maximum vertical pocket > 8 cm). Multiple pregnancy, preterm, postterm pregnancy or those with ruptured fetal membranes had been excluded. The fetal outcome of the groups were analysed & data arranged in tables & subjected to statistical study.RESULTS: In oligohydramnios group, hypertensive disorders & IUGR were 17.4% & 9.52% respectively, while in polyhydramnios women with diabetes diseases were 22.7% versus1.64% in the control group. In oligohydramnios group, low birth weight , intrapartum complications & admission to NICU were more significant with incidence of 9.59%, 39.6%, 46% respectively versus 0.04%, 5.33%, 11.07% for control respectively. Fetal congenital anomalies, early neonatal complications , macrosomia, low Apgar score& early neonatal death were more in polyhydramnios group as follow: 18.18%, 29.25%, 15.9% , 18.18% & 9.09% respectively compared with the control which were 0.41%, 8.6%, 5.74% respectively & there were no recorded cases of low Apgar score or early neonatal complications in the control group. CONCLUSION: Largest vertical pocket less than 3cm at term is associated significantly with higher incidence of hypertensive disorders & IUGR. It was highly significant in predicting neonatal admission (NICU ) & intrapartum complications. While when the largest vertical pocket is more than 8cm, diabetes disease, fetal macrosomia, congenital anomalies, low Apgar score, early neonatal complications & neonatal death are more frequently seen.


Article
Whether Selective or Routine Episiotomy is more Useful to Protect Anal Sphincter in Primiparous Women

Authors: Abdulrazak H. Alnakash --- Shaema Jafar --- Yousef Abdul-Raheem
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 4 Pages: 519-525
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BACKGROUND:Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concernfor many women and in some countries has led to a large increase in the numbers of womenrequesting elective caesarean section.OBJECTIVE:To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparouswomen.MATERIALS AND METHODS:This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity TeachingHospital in Baghdad throughout the period between Jan. 2009- Dec. 2009.Three hundred term primiparous ladies at time of their delivery with cephalic presentation werecollected and subdivided into 3 equal groups randomly.The first group, women who were subjected to routine mediolateral episiotomy, while the secondgroup of the participants were delivered without doing episiotomy, and the third group, a mediolateralepisiotomy was done selectively to them when we found it is necessary (selective episiotomy).State of the perineum, length of 2nd stage, weight of the baby, fetal head position and the occurrenceof anal sphincter injury were all notified and carefully recorded on special form designed for thestudy.RESULTS:Selective episiotomy was found to be more useful than routine episiotomy in preventing analsphincter injury (the incidence of anal sphincter injury was 2% for those in whom episiotomy wasperformed selectively, while it is 8% for those with routine episiotomy and 7% for those deliveredwithout episiotomy), and the difference is statistically significant (P value 0.045).There was a significant effect of the length of second stage of labour on the incidence of analsphincter injury (P value 0.017), similarly for the weight of baby (P value 0.017).CONCLUSION:Selective episiotomy is more useful intervention than routine episiotomy in protecting the analsphincter when delivering a primiparous lady.


Article
Whether Selective or Routine Episiotomy is more Useful to Protect Anal Sphincter in Primiparous Women

Authors: Abdulrazak H. Alnakash --- Shaema Jafar --- Yousef Abdul-Raheem
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 4 Pages: 519-525
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concernfor many women and in some countries has led to a large increase in the numbers of womenrequesting elective caesarean section.OBJECTIVE:To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparouswomen.MATERIALS AND METHODS:This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity TeachingHospital in Baghdad throughout the period between Jan. 2009- Dec. 2009.Three hundred term primiparous ladies at time of their delivery with cephalic presentation werecollected and subdivided into 3 equal groups randomly.The first group, women who were subjected to routine mediolateral episiotomy, while the secondgroup of the participants were delivered without doing episiotomy, and the third group, a mediolateralepisiotomy was done selectively to them when we found it is necessary (selective episiotomy).State of the perineum, length of 2nd stage, weight of the baby, fetal head position and the occurrenceof anal sphincter injury were all notified and carefully recorded on special form designed for thestudy.RESULTS:Selective episiotomy was found to be more useful than routine episiotomy in preventing analsphincter injury (the incidence of anal sphincter injury was 2% for those in whom episiotomy wasperformed selectively, while it is 8% for those with routine episiotomy and 7% for those deliveredwithout episiotomy), and the difference is statistically significant (P value 0.045).There was a significant effect of the length of second stage of labour on the incidence of analsphincter injury (P value 0.017), similarly for the weight of baby (P value 0.017).CONCLUSION:Selective episiotomy is more useful interv


Article
Outcome of the First Trimester Threatened Miscarriage: Study of the Predicting Factors

Authors: Abdulrazak H. Alnakash --- Nibras A Omar --- ,Faris Anwer Rasheed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 3 Pages: 320-328
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND:Threatened miscarriage is a distressing condition to both pregnant woman and gynecologist. It is important to predict the outcome of threatened miscarriage through maternal history, biochemical tests, and fetal ultrasound for patient counseling and to avoid delay in management.Study designA prospective multiple logistic regression analysis study.OBJECTIVE:To assess the power of factors which are maternal history (age, vaginal bleeding, parity and hypertension), biochemical tests (β-hCG & serum progesterone level) and fetal ultrasound (crown rump length& fetal heart rate) for predicting the outcome of pregnancy (fetal demise & ongoing pregnancy) complicated by threatened miscarriage between 7-11 wks and to determine the time interval from onset of symptoms to fetal demise development.PATIENTS AND METHODS:The study was carried out on 80 pregnant women at their 7-11 weeks of gestation suffering from vaginal bleeding attending Al-Elwiya Maternity Teaching hospital. They were subjected to ultrasound to confirm fetal viability, assay of serum progesterone and β-hCG levels and pain with bleeding scores. All these were repeated on weekly basis for four weeks follow up to monitor the pregnancy and identify the period to fetal demise (if happened). The data is gathered on questionnaire paper and then subjected to statistical study.RESULTS:The β-hCG (human chorionic gonadotrophin hormone) level was found to be the main predictor for pregnancy outcome (miscarriage/fetal demise & ongoing pregnancy) and highly statistically significant (P value<0.0012), followed by bleeding (p <0.002) and maternal age (p<0.01) respectively, while other variables (serum progesterone, fetal ultrasound, parity) showed no statistically significant effect (P value=0.47, 0.63, 1.146 respectively) on the risk of miscarriage/fetal demise. Serum progesterone level was highly significant in predicting ongoing pregnancy (P value=0.001)CONCLUSION:Measuring of beta hCG levels is found to be a good predictor for the outcome of the first trimester threatened miscarriage whether ends in to fetal demise or continuing pregnancy, while other factors like ultrasound, serum progesterone levels and parity are useful in assessing an ongoing pregnancy but have no power in predicting possibility of fetal demise. Also measuring the interval from the onset of bleeding to fetal demise development can be useful to avoid delaying pregnancy management.


Article
Fetal Body Weight: How Far the Clinical and Sonographic Estimations Can Coincide and their Correlation with the Actual Birth Weight
وزن جسم الجنين:مامدى تطابق قياس الوزن سريريا وبالسونار مع الوزن الحقيقي للمولود

Authors: Abdulrazak H. Alnakash عبد الرزاق حسين النقاش --- Deniz Rashad Mandan دنيس رشاد مندان
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 2 Pages: 180-183
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractObjective: To evaluate how far clinical and sonographic fetal weight assessment done by obstetrician can coincide and outline their correlation with the actual birth weight of the newborn.Study design and setting: This cross-sectional study was conducted at AL-Elwiya Maternity Teaching Hospital in Baghdad between Sept. 2009 to Sept. 2010.Material and methods: The study sample consisted of 100 singleton term pregnant women (completed 38 weeks) with cephalic presentation and intact membranes; they were admitted for early labour or for induction of labour or cesarean section. Their gestational age determination depended on precise LMP and early pregnancy ultrasound (<20 weeks). Fetal weight estimation was done using Johnson's formula and sonographic weight estimation by Hadlock's formula. Immediately after delivery the newborns were weighed by using digital balance.Results: Fetal weight estimation by clinical method is relatively accurate and comparable to ultrasound. The clinical fetal weight estimation is more accurate than ultrasound method when fetal weight is >3kg (p-value 0.907), while ultrasound is more accurate than clinical when fetal weight is <3kg (p-value 0.535). Conclusion: Clinical fetal weight estimation is proved to be a relatively accurate and comparable to ultrasound. The study also proved that clinical estimation is better than ultrasound when actual fetal weight is more than 3 kg.Key Words: Fetal weight, Johnson's formula, Hadlock's formula

الملخصالأهداف: تقييم مدى تطبق قياس وزن الجنين بالطريقه السريريه وبواسطة السونار ومقارنتها بالوزن الحقيقي للمولودنوع الدراسه ومكانها: تمت الدراسه على عينه من الحوامل في مستشفى العلويه التعليمي للولادة خلال الفتره بين ايلول 2009- وايلول 2010الطريقه: عينة الدراسه تشمل على مائة امراه حامل بعد الاسبوع 38 مع جنين منفرد راسي الوضع مع عدم تمزق الاغشيه, تم ادخالهم في المستشفى لغرض اجراء الولاده الاصطناعي هاو العملي القيصريه. تم تحديد فترة احمل اعتمادا على تاريخ اخر دوره شهريه وسونار الحمل فس بداية الحمل.قياس وزن الجنين بطريقة معادلة جونسون وبطريقة السونار باستعمال معادلة هادلوك. مباشرة بعد الولاده يتم وزن المولود باستمال الميزان الرقمى.النتائج: ظهر ان قياس وزن الجنين بالطريقه السريريه دقيق نسبيا ومقارن للقياس بالسونار. قياس وزن الجنين سريريا اكثر دقه من القياس بالسونارعندما يكون وزن الجنين اكثر من 3 كغم بينما السونار اكثر دقه من القياس السريري عنجما يكون وزن الجنين اقل من 3 كغم .الخلاصه: قياس وزن الجنين سريريا مقارن للقياس بالسونار. قياس وزن الجنين سريريا اكثر دقه من القياس بالسونارعندما يكون وزن الجنين اكثر من 3 كغم. مفتاح الكلمات: وزن الجنين, قياس الوزن سريريا, وبالسونار


Article
Relation between thyroid disorders and polycystic ovary syndrome
العلاقه بين اضطرابات الغدة الدرقيه ومتلازمة تكيس المبايض

Authors: Abdulrazak H. Alnakash عبد الرزاق النقاش --- Suhayla Abass سهيلة عباس --- Sahar Jassim Abid سحر جاسم
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2017 Volume: 30 Issue: 2 Pages: 68-75
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstact:Background: Polycystic ovarian syndrome which is the most common endocrinopathy of women at their reproductive age seems to be associated with thyroid dysfunction, but it’s true patho¬genesis is far from being elucidated. Both have independent risks of ovarian dysfunction and pregnancy related complications.Objective: To evaluate the association between thyroid dysfunction and polycystic ovary syndrome (PCOS).Study Design: Prospective Case-Control Study.Setting: Department of Obstetrics and Gynecology/ AL-Elwiya Maternity Teaching Hospital, Baghdad - IraqPatients and Methods: The study included 100 women at reproductive age, 50 of them were defined as having polycystic ovary syndrome (study group), another 50 healthy women served as control group. Thyroid function and morphology were evaluated by measuring serum thyroid stimulating hormone (TSH), free thyroxine levels (free T3 and free T4), anti thyroperoxidase antibody (anti TPO Antibody) and anti-thyroglubulin antibody (anti-TG Antibody) and by clinical and ultrasound examination of thyroid gland. Results: The study revealed statistically higher prevalence of autoimmune thyroiditis in patients with PCOS (12% vs. 4% of control) as evidenced by raised anti-TPO antibody levels (means125.91±333.39 and 88.19±316.18 respectively; P =0.563). PCOS patients were found to have higher mean TSH level than that of the control group (3.14±2.74and 2.24±1.81respectively; P value < 0.05). There was high prevalence of goiter among PCOS patients (10.0%vs. 4% of control, P value > 0.001). On thyroid ultrasound, a significantly higher percentage of PCOS patients (10%; controls 2.5%) had hypoechoic ultrasound pattern which also compatible with diagnosis of autoimmune thyroiditis.Conclusions: Higher prevalence of thyroid disorders in the form of autoimmune thyroiditis in patients suffering from PCOS (12%) compared with control group (4%).


Article
A STUDY OF SERUM MAGNESIUM AND CALCIUM LEVELS IN MISSED ABORTION

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Abstract

Background:Pregnancy is considered as a physiological stress, normal static metabolism of a woman is changed into dynamic anabolism, calcium (Ca) is the first most abundant cation in the human body, whereas magnesium (Mg) is the fourth most abundant one, role of calcium and magnesium in enzymatic activity of cell to release energy is well established.Objective:To assess the relation of serum magnesium and calcium levels in cases of missed abortion.Methods:Eighty two pregnant women at their 1st and 2nd trimester of pregnancy (before 24 completed weeks of pregnancy), 42 of them with missed abortion compared with 40 normal pregnancies served as a control group. Calcium analysis done using manual colorimetric method while magnesium analysis was done by magnesium calmogite method at the hospital laboratories.Results:Serum calcium was found to be insignificantly altered while serum magnesium was found to be significantly reduced in cases of missed abortion compared with normal pregnancy. Serum Ca/Mg ratio was found to be significantly elevated in cases of missed abortion compared with normal controls.Conclusion:Estimation of serum magnesium and Ca/Mg ratio in selected pregnancies can be valuable parameters for predicting missed abortion.Keywords:Missed abortion, Serum Calcium, Serum Magnesium.

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