Middle eastern college of obstetricians and gynecologists (MCOG) practice guidelines: Role of prediction models in management of trial of labor after cesarean section. Practice guideline no. 05-O-22✰,✰✰,★,★★

Cesarean delivery rates have been steadily rising since the beginning of the 21st century. The growing incidence is even more prominent in developing countries owing to lack of evidence-based guidance and audit, and the expansion of private practice. The uprise in Cesarean delivery rate has been associated with considerable financial burden and has increased the risk otherwise uncommon serious complications such as placenta accreta disorders and uterine rupture. In addition to primary prevention of Cesarean delivery, trial of labor after cesarean section is one of the most successful strategies to reduce Cesarean deliveries and minimize risks associated with higher order Cesarean deliveries. This guideline appraises patient selection strategies and use of prediction model to promote counseling and enhance safety in women considering vaginal birth after Cesarean.

Middle-East obgyn graduate education (MOGGE) foundation practice guidelines: diagnostic approach to pregnancy of unknown location: practice guideline no. 03-O-21

Background

Pregnancy of unknown location (PUL) is a term used to describe failure of visualization of intrauterine or extrauterine gestational sac in a woman with a positive pregnancy test.

Body of the abstract

Ectopic pregnancy (EP) accounts for 1–2 % of all pregnancies. EP contributes to maternal mortality of a known cause by 4% in developed countries. However, case fatality rate may be 10 times higher in low-resource countries. This may be attributed to delayed diagnosis and lack of resources. PUL is a temporary term that may eventually lead to diagnosis of viable intrauterine pregnancy, pregnancy loss, or more seriously, EP.

Conclusion

This guideline appraises current evidence on assessment of PUL and early diagnosis of EP particularly in low-resource settings.

Placenta accreta risk-antepartum score in predicting clinical outcomes of placenta accreta spectrum: A multicenter validation study

OBJECTIVE

To validate the use of placenta accreta risk-antepartum (PAR-A) score as a predictive tool of clinical outcomes of placenta accreta spectrum (PAS).

METHODS

This is a prospective study, conducted in six PAS specialized centers in six different countries. The study was conducted between October 1, 2020 and March 31, 2021. Women who were provisionally diagnosed with PAS during pregnancy were considered eligible. A machine-learning-based PAR-A score was calculated. Diagnostic performance of the PAR-A score was evaluated using a receiver operating characteristic curve, for perioperative massive blood loss and admission to intensive care unit (ClinicalTrials.gov identifier NCT04525001).

RESULTS

Of 97 eligible women, 86 were included. PAS-associated massive blood loss occurred in 10 patients (11.63%). Median PAR-A scores of massive blood loss in the current cohort were 8.9 (interquartile range 6.9-14.1). In predicting massive blood loss, the area under the curve of PAR-A scores was 0.85 (95% confidence interval [CI] 0.74-0.95), which was not significantly different from the original cohort (P = 0.2). PAR-A score prediction of intensive care unit admission was slightly higher compared with the original cohort (0.88, 95% CI 0.81-0.95; P = 0.06).

CONCLUSION

PAR-A score is a novel scoring system of PAS outcomes, which showed external validity based on current data.

Middle-East OBGYN graduate education (MOGGE) foundation practice guidelines: use of labor charts in management of labor. Practice guideline no. 04-O-21

Since the 50 s of the last century, labor charts have been proposed and appraised as a tool to diagnose labor abnormalities and guide decision-making. The partogram, the most widely adopted form of labor charts, has been endorsed by the world health organization (WHO) since 1994. Nevertheless, recent studies and systematic reviews did not support clinical significance of application of the WHO partogram. These results have led to further studies that investigate modifications to the structure of the partogram, or more recently, to reconstruct new labor charts to improve their clinical efficacy. This guideline appraises current evidence on use of labor charts in management of labor specially in low-resource settings.

Middle-East OBGYN Graduate Education (MOGGE) Foundation practice guidelines: prevention of group B Streptococcus infection in pregnancy and in newborn. Practice guideline no. 02-O-20

Rectovaginal colonization with group B streptococcus (GBS) is commonly encountered in pregnancy. GBS is the most common cause of early onset neonatal sepsis, which is associated with 12% case-fatality rate. Although screening protocols and prophylactic treatment are readily available worldwide, practice in low-resource countries is challenged by lack of awareness and limited implementation of these protocols. In addition, antibiotic susceptibility pattern may vary globally owing to different regulations of antibiotic prescription or prevalence of certain bacterial serotypes. This guideline appraises current evidence on screening and management of GBS colonization in pregnancy particularly in low-resource settings.

Seasonal variations of steroid hormones and triiodothyronine concentrations in migratory northern shovelers

Endogenous serum testosterone, estradiol, and triiodothyronine concentrations were measured in the northern shoveler (Anas clypeata, n = 20) during different stages of migratory condition at their wintering grounds to look at how these hormones may be linked to the development of migratory condition. These hormones were assayed by enzyme-linked immunosorbent assay (ELISA). The changes in hormones concentrations were parallel to each other and correspond to the increasing day lengths of spring. Furthermore, the northern shovelers showed a distinct seasonal cycle in serum concentrations of triiodothyronine, estradiol, and testosterone. It is suggested that these seasonal cycles in the northern shovelers are endogenously programmed and their entrainment to the environmental photoperiod ensures the occurrence of different physiological functions at temporally fixed time of the year. The results of this study offer a captive model of the seasonal changes in physiology and behavior that occur in the months preceding and including vernal migration of the northern shovelers.

Morphology of the spermatid and spermatozoon of Amblyomma hebraeum Koch (Acarina; Ixodidae)

Spermatids and spermatozoa of Amblyomma hebraeum were examined by scanning and transmission electron microscopy as well as by freeze-etch and freeze-fracture techniques. The external surface of the spermatid is smooth except for a rim of two parallel grooves near the anterior apex. This rim probably marks the level at which a cap detaches, permitting extrusion of the inner cord during spermatozoon maturation. Both ends of the spermatid are closed, the anterior part being slightly thicker than the posterior. The spermatozoon is clavate anteriorly and tail-like posteriorly. The tip of the anterior part is a hemispherical structures carrying numerous bulbous expansions. Apart from the hemispherical structure, the entire spermatozoon surface is covered with parallel longitudinal cellular processes. Waves of constrictions on the tail-like part of the spermatozoon and undulations of the cellular processes are considered to be involved in sperm motility.