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Aims: To compare direct trocar (DT) to Veress needle (VN) entry for creation of pneumoperitoneum at laparoscopy regarding the duration of the procedure, volume of gas consumption, ease of performance and frequency of complications. Design: A randomized clinical trial Subjects and Methods: One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either direct trocar entry (group A=500) or Veress needle (group B=500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon. Outcomes: Duration of the procedure, volume of gas consumption, ease of performance and frequency of complications Results: Patients in the two groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group (A ) than in group (B) (2.2±0.7)(95% confidence interval [CI] ,2.14–2.26 ) Vs 8.2±1.4(95% CI ,8.08-8..32 ) minutes, respectively, p0.0001 .The mean gas consumption was significantly less in group (A) than in group B (2.6±0.9 {59% CI, 2.52-2.68}Vs 8.4±2.6({59% CI,8.17-8.63 }liters, respectively, p0.0001. No major complications in both groups were encountered. Minor complications were significantly less in DT (0.4%, 59% CI,0.77-3.23) than in VN group (14%,95%CI 10.96-17.04), p0.0001. Conclusions: Direct trocar entry is a safe alternative to Veress needle entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.

Aims: To compare direct trocar (DT) to Veress needle (VN) entry for creation of pneumoperitoneum at laparoscopy regarding the duration of the procedure, volume of gas consumption, ease of performance and frequency of complications. Design: A randomized clinical trial Subjects and Methods: One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either direct trocar entry (group A=500) or Veress needle (group B=500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon. Outcomes: Duration of the procedure, volume of gas consumption, ease of performance and frequency of complications Results: Patients in the two groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group (A ) than in group (B) (2.2±0.7)(95% confidence interval [CI] ,2.14–2.26 ) Vs 8.2±1.4(95% CI ,8.08-8..32 ) minutes, respectively, p0.0001 .The mean gas consumption was significantly less in group (A) than in group B (2.6±0.9 {59% CI, 2.52-2.68}Vs 8.4±2.6({59% CI,8.17-8.63 }liters, respectively, p0.0001. No major complications in both groups were encountered. Minor complications were significantly less in DT (0.4%, 59% CI,0.77-3.23) than in VN group (14%,95%CI 10.96-17.04), p0.0001. Conclusions: Direct trocar entry is a safe alternative to Veress needle entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.

Objective: This study aims to evaluate cardiac function in fetuses with intrauterine growth restriction (IUGR) compared with healthy fetuses, using the left modified myocardial performance index (MPI) and the association between MPI and perinatal outcome. Methods: Pregnant women between 34 and 39 weeks of gestation, who met the criteria for IUGR and were scheduled for delivery at an Egyptian tertiary medical center, were prospectively enrolled in the study. Women in the same gestational-age group with uncomplicated pregnancies were included as a control group. MPI was measured in all fetuses. The IUGR group was analyzed based on normal and abnormal umbilical artery (UA) Doppler. Perinatal outcomes were recorded. Results: The mean left MPI was significantly higher in IUGR fetuses with abnormal UA Doppler (mean 0.58 ± SD 0.093) compared with healthy fetuses (mean 0.45 ± SD 0.070) (P 0.001). IUGR fetuses with abnormal left MPI showed significantly worse perinatal outcome and increased morbidity compared with the control group. IUGR fetuses with abnormal left MPI also showed significantly worse perinatal outcome compared with IUGR fetuses with normal MPI (whether the UA Doppler was normal or abnormal). The fetal MPI was associated with the severity of fetal compromise in IUGR fetuses based on the perinatal outcome. Conclusion: MPI is a potentially useful tool in evaluating fetuses with suspected IUGR, which is crucial in classifying IUGR pregnancies into critical and non-critical cases and in predicting neonatal outcome. .

Objective: This study aims to evaluate cardiac function in fetuses with intrauterine growth restriction (IUGR) compared with healthy fetuses, using the left modified myocardial performance index (MPI) and the association between MPI and perinatal outcome. Methods: Pregnant women between 34 and 39 weeks of gestation, who met the criteria for IUGR and were scheduled for delivery at an Egyptian tertiary medical center, were prospectively enrolled in the study. Women in the same gestational-age group with uncomplicated pregnancies were included as a control group. MPI was measured in all fetuses. The IUGR group was analyzed based on normal and abnormal umbilical artery (UA) Doppler. Perinatal outcomes were recorded. Results: The mean left MPI was significantly higher in IUGR fetuses with abnormal UA Doppler (mean 0.58 ± SD 0.093) compared with healthy fetuses (mean 0.45 ± SD 0.070) (P 0.001). IUGR fetuses with abnormal left MPI showed significantly worse perinatal outcome and increased morbidity compared with the control group. IUGR fetuses with abnormal left MPI also showed significantly worse perinatal outcome compared with IUGR fetuses with normal MPI (whether the UA Doppler was normal or abnormal). The fetal MPI was associated with the severity of fetal compromise in IUGR fetuses based on the perinatal outcome. Conclusion: MPI is a potentially useful tool in evaluating fetuses with suspected IUGR, which is crucial in classifying IUGR pregnancies into critical and non-critical cases and in predicting neonatal outcome. .

Objective: This study aims to evaluate cardiac function in fetuses with intrauterine growth restriction (IUGR) compared with healthy fetuses, using the left modified myocardial performance index (MPI) and the association between MPI and perinatal outcome. Methods: Pregnant women between 34 and 39 weeks of gestation, who met the criteria for IUGR and were scheduled for delivery at an Egyptian tertiary medical center, were prospectively enrolled in the study. Women in the same gestational-age group with uncomplicated pregnancies were included as a control group. MPI was measured in all fetuses. The IUGR group was analyzed based on normal and abnormal umbilical artery (UA) Doppler. Perinatal outcomes were recorded. Results: The mean left MPI was significantly higher in IUGR fetuses with abnormal UA Doppler (mean 0.58 ± SD 0.093) compared with healthy fetuses (mean 0.45 ± SD 0.070) (P 0.001). IUGR fetuses with abnormal left MPI showed significantly worse perinatal outcome and increased morbidity compared with the control group. IUGR fetuses with abnormal left MPI also showed significantly worse perinatal outcome compared with IUGR fetuses with normal MPI (whether the UA Doppler was normal or abnormal). The fetal MPI was associated with the severity of fetal compromise in IUGR fetuses based on the perinatal outcome. Conclusion: MPI is a potentially useful tool in evaluating fetuses with suspected IUGR, which is crucial in classifying IUGR pregnancies into critical and non-critical cases and in predicting neonatal outcome. .

Objective: This study aims to evaluate cardiac function in fetuses with intrauterine growth restriction (IUGR) compared with healthy fetuses, using the left modified myocardial performance index (MPI) and the association between MPI and perinatal outcome. Methods: Pregnant women between 34 and 39 weeks of gestation, who met the criteria for IUGR and were scheduled for delivery at an Egyptian tertiary medical center, were prospectively enrolled in the study. Women in the same gestational-age group with uncomplicated pregnancies were included as a control group. MPI was measured in all fetuses. The IUGR group was analyzed based on normal and abnormal umbilical artery (UA) Doppler. Perinatal outcomes were recorded. Results: The mean left MPI was significantly higher in IUGR fetuses with abnormal UA Doppler (mean 0.58 ± SD 0.093) compared with healthy fetuses (mean 0.45 ± SD 0.070) (P 0.001). IUGR fetuses with abnormal left MPI showed significantly worse perinatal outcome and increased morbidity compared with the control group. IUGR fetuses with abnormal left MPI also showed significantly worse perinatal outcome compared with IUGR fetuses with normal MPI (whether the UA Doppler was normal or abnormal). The fetal MPI was associated with the severity of fetal compromise in IUGR fetuses based on the perinatal outcome. Conclusion: MPI is a potentially useful tool in evaluating fetuses with suspected IUGR, which is crucial in classifying IUGR pregnancies into critical and non-critical cases and in predicting neonatal outcome. .

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