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Ayman Shehata Dawood,1 Adel Elgergawy,1 Ahmed Elhalwagy,1 Walid M Ataallah,1 Shereen B Elbohoty,1 Shereef L Elshwaikh,1 Amal A Elsokary,1 Ahmed M Elkhyat,1 Amr T Elbadry,2 Ahmed M Abbas3 1Department of Obstetrics & Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt; 3Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Objective: The current study aimed to evaluate the impact of mechanical cervical dilatation during elective cesarean section (CS) on postpartum scar integrity at 6 months post operation. Methods: A randomized double-blind clinical trial (UMIN000027946) was conducted at a tertiary university hospital in the period between July 1, 2017 and April 30, 2018. The study included pregnant women with a singleton fetus at term ≥37 weeks of gestation scheduled for elective CS. Eligible participants were allocated either to the study group (women with intraoperative cervical dilatation) or the control group (women with no intraoperative cervical dilatation). The patients were followed up at 6 months after CS by 3D ultrasonography to check for the scar integrity and quality. The primary outcome was the difference in sonographic parameters of the scar integrity between the two groups. Results: Four hundred twenty two women were approached to participate in the study. There was no statistically significant difference regarding the baseline characteristics of both the groups. Scar width and depth were significantly higher in the cervical dilatation group (P=0.002 and 0.001, respectively). Fewer cases with scar defects (niche) were found in the cervical dilatation group than in the control group (5.03% vs 11.04%, respectively, P=0.048). There was no significant difference regarding the rate of wound infection or endometritis in both the groups (P=0.717 and 0.227, respectively). The incidence of febrile morbidity was higher in the no cervical dilatation group (10.5%) compared to (5.0%) the cervical dilatation group (P=0.045). Conclusion: Cervical dilatation during elective CS is associated with thick scars with low incidence of scar defects. Keywords: cesarean section, cervical dilatation, cesarean scar defect, scar integrity

Background: The aim is to evaluate the effect of maternal transdermal nitro-glycerine patch administration on blood flow resistance on maternal uterine artery, fetal umbilical and middle cerebral arteries in patients with severe pre-eclampsia in early gestational age (24 weeks to 33 weeks) associated with abnormal Doppler indices (placental insufficiency) and also its effect on maternal mean arterial blood pressure.Methods: This is a prospective interventional clinical trial conducted on (50) pregnant women with singleton pregnancy diagnosed with severe pre-eclampsia admitted in high-risk pregnancy unit at the Department of Obstetrics in Tanta University Hospitals, A 50-mg transdermal GTN patch (Novartis Pharma) was applied to the abdominal skin, releasing nitroglycerin at a rate of 0.4 mg/h. Doppler ultrasonography and measurement of maternal blood pressure were performed before application of transdermal GTN patch, after 4 hours of application, after 24 hours and after 48 hours.Results: the application of a 50-mg transdermal GTN patch to the maternal abdomen was associated with a significant decline in the PI of the uteroplacental and fetoplacental blood flow. No change was observed in the PI of the cerebral circulation. And also, there was a significant decrease in maternal blood pressure (MAP).Conclusions: Nitroderm patch (nitric oxide donors) may be used as initial therapy in cases of severe preeclampsia complicated by placental insufficiency in the form of abnormal Doppler indices.