Biofilms are colonies of microbial cells encased in a self-produced organic polymeric matrix and represent a common mode of microbial growth. Microbes growing as biofilm are highly resistant to commonly used antimicrobial drugs. We aimed to screen and characterize biofilm formation by different isolates of Candida on removed intrauterine devices (IUDs), to perform experimental biofilm formation with isolated strains, and to examine biofilm by the crystal violet and XTT reduction assays and scanning electron microscopy (SEM). A total of 56 IUDs were examined for biofilm formation using Sabouraud’s dextrose chloramphenicol agar. Suspected colonies were identified by different methods. Antifungal susceptibility testing with fluconazole (FLU) and amphotericin B for the isolated strains and in vitro experimental biofilm formation was carried out. The biofilm was quantified by crystal violet, XTT reduction assay and SEM. Among the 56 IUDs investigated, 26 were Candida positive (46.4 %). Candida albicans was recovered from 15 isolates. The biofilm MIC of FLU was increased 64 to 1000 times compared to the MIC for planktonic cells. The XTT method results were dependent on the Candida species; biofilm formation was highest in Candida krusei and Candida glabrata strains, followed by C. albicans and Candida tropicalis. SEM of Candida biofilm revealed a heterogeneous thick biofilm with a mixture of micro-organisms. The main conclusion from this study was non-albicans Candida represents more than a half of the Candida biofilm. Better understanding of Candida biofilms may lead to the development of novel therapeutic approaches for the treatment of fungal infections, especially resistant ones among IUD users.

Abstract Purpose: To determine the possible causes for IUFD and to investigate for the pattern of glucose intolerance as a cause of unexplained IUFD among pregnant women. Methods: For one year, 420 pregnant women with IUFD at or after the 28th week of pregnancy and another 200 women carrying normal looking fetuses were recruited as a control group. Random venous samples and HbA1c were tested to assess the glucose control in the studied women. Results: Of the studied women, 68.09% had unexplained cause for their IUFD. Other causes for IUFD included Hypertensive disease with pregnancy (6.9%), accidental hemorrhage (5.5%), and small for gestational age (11.4%). Overt DM was diagnosed at 1.7%. Women who had unexplained IUFD showed higher HbA1c and Random Blood Sugar (RBS) than control group. 18% of women carrying unexplained IUFD and had normal RBS showed abnormally high HbA1c level. Conclusions: Unexplained IUFD represented the major category of IUFD (68.09%). Laboratory indices of diabetes mellitus are more prevalent in this category of patients. Accordingly, screening for diabetes is recommended for these women. However, the use of RBS alone is not sufficient to exclude poor metabolic control. HbA1c may be a better alternative

Abstract: Background: The umbilical cord is usually clamped immediately after birth. There is no sound evidence to support this approach, which might deprive the newborn of some benefits such as an increase in iron storage. however, there is very little evidence to suggest that the timing of cord clamping and cutting has an impact on the incidence of postpartum hemorrhage and other maternal outcomes. Design: This study utilized an experimental research design to identify the effect of early versus late cord clamping at of term infants on the maternal and neonatal outcomes. Setting: The study was conducted at labor & delivery units EL-Minia University hospital, Egypt. Methodology: A total sample of 100 parturient and their newborns comprised the study sample after gaining the mothers’ acceptance. They were equally divided and randomly assigned to two homogenous groups according to the time of cutting their newborn cord. Early cord clamping group (at 1 min.) and late cord clamping group (at 1 to 3min.). Two tools were used for data collection namely: A structured interview questionnaire for assessing sociodemographic and obstetrical data and assessment tool for assessing maternal and neonatal haematological parameters and outcomes. Results: The findings of the present study were equivalent among both groups regards the mean maternal hemoglobin and hematocrit level, maternal blood loss, postpartum hemorrhage. For neonatal outcomes, the neonatal hematologic parameters were comparable and slightly elevated hematocrit and hemoglobin level among late cord clamping group compared to early group with no significant differences at birth and significant difference was observed at 24 hours later. This elevation was within the prespecified physiologic range. The prevalence of newborn with a hematocrit level of 45% at birth and after 24 hours was slightly higher among the early cord clamping group compared to late cord clamping with no significant differences. There were no significant differences in other neonatal and maternal outcomes. Conclusion: Delaying clamping of the cord for more than one minute to three minutes seems not to increase the risk of postpartum hemorrhage. In addition, late cord clamping can be advantageous for the infant by improving hematological values especially the status which may be of clinical value particularly in developing countries where infants access to good nutrition is poor. [Eman R Ahmad, Sahar A Aly and Kamal M. Zahran. Effect of Early Versus Late Umbilical Cord Clamping of Term Infants on Maternal and Neonatal Outcomes.

Abstract: Background: The umbilical cord is usually clamped immediately after birth. There is no sound evidence to support this approach, which might deprive the newborn of some benefits such as an increase in iron storage. however, there is very little evidence to suggest that the timing of cord clamping and cutting has an impact on the incidence of postpartum hemorrhage and other maternal outcomes. Design: This study utilized an experimental research design to identify the effect of early versus late cord clamping at of term infants on the maternal and neonatal outcomes. Setting: The study was conducted at labor & delivery units EL-Minia University hospital, Egypt. Methodology: A total sample of 100 parturient and their newborns comprised the study sample after gaining the mothers’ acceptance. They were equally divided and randomly assigned to two homogenous groups according to the time of cutting their newborn cord. Early cord clamping group (at 1 min.) and late cord clamping group (at 1 to 3min.). Two tools were used for data collection namely: A structured interview questionnaire for assessing sociodemographic and obstetrical data and assessment tool for assessing maternal and neonatal haematological parameters and outcomes. Results: The findings of the present study were equivalent among both groups regards the mean maternal hemoglobin and hematocrit level, maternal blood loss, postpartum hemorrhage. For neonatal outcomes, the neonatal hematologic parameters were comparable and slightly elevated hematocrit and hemoglobin level among late cord clamping group compared to early group with no significant differences at birth and significant difference was observed at 24 hours later. This elevation was within the prespecified physiologic range. The prevalence of newborn with a hematocrit level of 45% at birth and after 24 hours was slightly higher among the early cord clamping group compared to late cord clamping with no significant differences. There were no significant differences in other neonatal and maternal outcomes. Conclusion: Delaying clamping of the cord for more than one minute to three minutes seems not to increase the risk of postpartum hemorrhage. In addition, late cord clamping can be advantageous for the infant by improving hematological values especially the status which may be of clinical value particularly in developing countries where infants access to good nutrition is poor. [Eman R Ahmad, Sahar A Aly and Kamal M. Zahran. Effect of Early Versus Late Umbilical Cord Clamping of Term Infants on Maternal and Neonatal Outcomes.

Abstract Background: Abdominal pregnancy is a rare form of ectopic gestation. Early diagnosis of this rare condition is difficult, owing to its atypical presentation and low index of suspicion. The characteristic history is that of abdominal pain, vaginal bleeding, and symptoms related to the gastrointestinal tract. These symptoms are occasionally overlooked, and the diagnosis is often missed. Case: A 20 year-old woman, gravida 2, para 0 + 1, 30 weeks’ pregnant, presented with abdominal pain and absent foetal movements for 7 days. There was no history of pain prior to this episode, and she had no vaginal bleeding during pregnancy. She reported that she had regular antenatal care with 3 ultrasound scans confirming a normal pregnancy. On examination, the fetal position was transverse with easily palpable fetal parts. Fetal heart sounds were audible. Ultrasound examination revealed an unexpectedly empty uterus with a 30 week-old fetus and an extrauterine placenta. Magnetic resonance imaging (MRI) confirmed the previous findings. Laparotomy was performed to extract the fetus and the placenta. Results: The patient’s postoperative course was uneventful, and she was discharged after 5 days. The neonate died after 2 weeks because of severe respiratory distress syndrome. Conclusions: Despite being very rare, abdominal pregnancy should be suspected regardless of gestational age. The presence of easily palpable fetal parts and an empty uterus should warrant the diagnosis. Good quality antenatal care is mandatory for early detection of this rare condition, Ultrasound examination remains the ‘‘gold standard’’ for initial diagnosis. However, MRI may be necessary to confirm the diagnosis. ( J GYNECOL SURG 31:40)