Summary – Conclusion& RecommendationThis study has been done in Zagazig University Hospitals, Obstetrics Department,in one year from June 2005 - June 2006.The aim of this study is to reduce maternal & fetal morbidity and mortality and this doneas regard to the incidence of Vaginal deliveries either N.V.D.( spontenous) or assistedV.D. ( Vaccum & forceps), incidence of CS., as well as maternal and fetal morbidity &mortality. In the last period it is found that rate of CS increased all over the world.In United States total cesarean rate increased every year, and in 2002 it was 26.1%, thehighest rate ever recorded. In 2004, 29.1% of all live births were delivered by cesareansection, according to the National Center for Health Statistics (NCHS).47In England, cesarean section rates have increased from 9% of deliveries in 1980 to21% in 2001 therefore about 120,000 caesarean sections are performed annually inEngland and Wales. A similar increase in CS rates has been seen in many developedcountriesIt this study all cases assessed according to : age of the mother, parity, mode ofdelivery, medical disorders, post partum complications (e.g. PPH, infection, DVT ),and neonatal outcome (live birth or stillbirth ) and this fetus need admission to NICU orno. The main goal of this study is how to reduce feto-maternal morbidity and mortality.The following Results was found :Total numbers of patients who were admitted to obstetric Department in labour duringthe period from June 2005 – June 2006 was (6350), Total number of N.V.D. was( 3821 =60.2% ), Total number of operative V.D. was ( 112 =1.8%), Total number of CSwas ( 2417 = 38.1%). And it was found that ( 43.8% ) due to previous CS,(13.8% ) due to CPD, ( 9.9% ) due to Malpresentations & Malpositions,( 9.1% ) due to APH, ( 8.3% ) due to Hypertension & preeclampsia,(13% ) due to fetal distress, ( 1.2% ) due to previous myomectomy ,( 0.95% ) due to rupture uterus, total number of live birth was ( 6243 = 98.3% ),Total number of maternal deaths was ( =0.09%),total number of still birth was ( 107 = 1.7% ) and total number of babies admitted toNICU was ( 222 = 3.5% ).By analysis of results of the study it is found that :Rate of CS increased allover the World and this is due to previous CS, delay inRecommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.