Maged Shendy

By Maged Shendy and Rami Atalla

Part of the book: Ectopic Pregnancy

By Maged Shendy, Hend Hendawy, Amr Salem, Ibrahim Alatwi and Abdurahman Alatawi

Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality and accounts for 5–10% of all deliveries. Cervical length assessment between 16–24 weeks and positive fetal fibronectin beyond 21 weeks gestation are proved to useful tools in prediction of preterm labour. Treating asymptomatic bacteruia and bacterial vaginosis in high-risk women reduces the incidence of preterm labour. Cervical cerclage is recommended to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation. Atosiban and nifidipine are currently the agents of choice in tocolysis. Antenal steriods in womens with threating preterm labour reduces the perinatal morbidties. Magnisum sulphate role is established for neuroprotection especially in extreme gestations between 24–30 weeks. Vaginal delivery is mode of choice for delivery with consideration to avoid fetal blood sampling, fetal scalp electrodes and ventouse prior to 34 weeks gestations. Caesarean section is considered for obstetric reasons that guide labour management at term.

Part of the book: Empowering Midwives and Obstetric Nurses

By Maged Shendy, Sonia Abhishek, Lisa Dhege and Ibrahim Alatwi

Methotrexate is the standard medical management for ectopic pregnancy. Pharmacologically, it is a folic acid antagonist which inhibits DNA synthesis. 90% of appropriately selected un-ruptured none live ectopic pregnancy respond to methotrexate treatment with no further management is required. In the UK, NICE guidance has identified the selection criteria to achieve the best and safest outcome in ectopic pregnancy treatment with methotrexate. Methotrexate also has a role in management of pregnancy of unknown location. Single administration of 50 mg/m2 body surface area is the most widely acceptable regimen for methotrexate in treatment of ectopic pregnancy. Post treatment b-HCG checks at day 0, 4 and 7 are also a widely accepted follow up regimen to ensure satisfactory decline in b-HCG levels. Methotrexate has a role also in managing none tubal ectopic pregnancies where surgical risks are high. Post treatment transient pain is common and represent a clinical challenge as it can also be failed treatment with ruptured ectopic pregnancy.

Part of the book: Ectopic Pregnancy and Prenatal Diagnosis

By Maged Shendy, Delia Marinceu, Mohua Roy, Amar Siddique and Hanadi Dakhilallah

Nursing role in urogynaecology has expanded in the modern practice especially with emerging of formulated protocols and guidelines In urogynaecology. Furthermore, conservative approaches and its success in improving patients quality of life is currently led by trained nursing staff, these areas includes pelvic floor training, bladder retraining, fluid intake modification such as explanation of the impact of caffeinated drinks on bladder activity. The adoption of pessary led nurse clinics are well established model in the current urogynaecology with significant improvement in patients flow rate across urogynaecology service provision. On the investigation side of practice, nurse led uroflowmetry and urodynamics are currently expanding with good outcomes for the patients and service capacity. Nursing role in teaching patients how self catheterise is important in those with voiding dysfunction and also prior to incontinence surgery due to associated risk of voiding difficulty.

Part of the book: Nursing