Anomalies of uterus might be encountered at Caesarean Section or routine investigation. In this article, we present a rare case of double horns of uterus completely separated. One of them is situated retroperitoneally. Therefore, MRI or CT scans is recommend for unclassified Mullerian anomalies, to confirm pelvic or other anomalies and to reduce the likelihood of complications arising during the operation or delivery.

Diabetes mellitus still represents an important medical problem during pregnancy, causing perinatal morbidity and mortality. Despite improved outcome reflected by a steep decline in perinatal mortality over the past few decades, controversy still exists regarding the care of the pregnant woman with both pre-existing and gestational Diabetes Mellitus. Doppler ultrasound is especially valuable during pregnancy because fetal maternal and placental circulations can be studied. The aim of this work was to study the vascular changes in the uteroplacental and fetoplacental circulations, and to correlate these findings with histopathology of the placenta and placental bed, which may occur in association with diabetic pregnancies. The study was carried out on 100 pregnant women of comparable age and parity. They were divided into 2 groups. The control group comprising 20 normal non-diabetic pregnant women and the normotensive diabetic group comprising 80 pregnant diabetic women. All were singleton pregnancies of 34 weeks or more and were delivered by C.S the control and the study cases were subjected to history taking and thorough physical examination. They were also subjected to ultrasonographic examination for fetal biometric parameters and for Doppler examination. Doppler examination included umbilical artery, uterine arteries fetal middle cerebral artery. At the time of C.S the placenta and placental bed biopsy was obtained. After delivery, the Apgar score of the newborn was assessed at 1 and 5 minutes, the body weight was measured, and the fetus was followed up for any complications. Result: There was a positive correlation between the umbilical artery PI and the mean blood glucose levels indicating that poor diabetic control is probably associated with increased umbilical artery PI. However, there was no significant difference between the mean value of the umbilical artery PI in the diabetic and control groups. The uterine arteries Doppler indices showed no significant findings between the diabetic and the control groups. Neither did the uterine arteries Doppler indices show a correlation with the mean blood glucose levels. There was no significant difference between the middle cerebral artery PI in the diabetic and control groups. This observation indicates that there was no redistribution in the fetal circulation in the fetuses of the diabetic group. There was also non correlation between the MCA Doppler indices and the glycemic control. Histopathologic studies of the placental bed showed marked difference between the diabetic group and the control group as regards lack of physiologic changes and arteriosclerotic changes, which emphasizes the effect of diabetes on the placental bed vasculature. Conclusion: Abnormal umbilical artery waveform analysis is one of significant predictors of fetal compromise in diabetic pregnancy, but fetal compromise can occur in association with normal Doppler waveform analysis. In maternal diabetes the classic redistribution seen in fetal hypoxemia due to uteroplacental insufficiency may not occur in diabetic patient even in severely compromised fetuses. In maternal diabetes mellitus, maternal glycemic control has no effect on impedance to flow in the uterine and middle cerebral arteries. No relationship was found between the uterine or umbilical arteries Doppler indices and the placental bed decidual vascular pathology in diabetic pregnancies. There was no correlation between placental findings and the Doppler waveform analysis of the umbilical and the uterine arteries.

Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy & safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution ( 1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them . postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, In obese women undergoing elective CS , wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy & safety.

Background: The transverses abdominis plane block (TAP block) is one of the widely used regional analgesic techniques in cesarean section. There are different variations of the procedure. The aim of the present study was to evaluate the analgesic effect of the modified surgeon assisted bilateral TAP block in patients undergoing cesarean section Patients&Methods: Sixty patients undergoing cesarean section under spinal anesthesia were randomized into two groups to receive either TAP block with 40 ml of bupivacaine 0.25%(study group) or 40 ml normal saline as placebo after obtaining informed consent. All patients will receive intravenous diclofencac75mg every 12 hrs postoperatively. Postoperatively, there was an assessment every 2hrs during the first 24hrs by the visual analogue pain scale (VAPS). Time to the first analgesic request will be measured as primary outcome and all patients will receive opioid on demand or VAPS > 4 with 25mg pethidine intramuscularly. Moreover, total opioid requirement in 24hrs will be measured as secondary outcome along with postoperative complications as nausea, vomiting and abdominal distention. Complications related to the TAP procedure will be also assessed. Results: The median (interquartile range) time to the first analgesic request in the first 24hrs postoperatively was significantly shorter in the placebo group compared to the study group; 4h (4, 6) and 24h (10, 24) with p value < 0.001. Postoperative opioid requirement was significantly higher in the control group (30/30{100%}) than the study group (13/30{43.3%}). The median (interquartile range) number of opioid doses was significantly higher in the placebo group compared with the study group; 2(2, 2) and 0(0, 1) respectively. At all points in the study, pain scores both were lower in the study group (p < 0.0001). Conclusion: The modified surgeon assisted bilateral TAP block is relatively new, safe and cost effective technique which provides adequate postoperative analgesia allowing for better maternal ambulation and better postoperative recovery. Trial registration: Clinicaltrial.gov registration number: NCT04623632