Introduction: Morocco has experienced, like the whole world, the COVID-19 pandemic. Until the writing of this article, a subjective observation of the increase in the number of anencephaly has been observed in our fac...Introduction: Morocco has experienced, like the whole world, the COVID-19 pandemic. Until the writing of this article, a subjective observation of the increase in the number of anencephaly has been observed in our facility. And since the teratogenic potential of the SARS Cov 2 virus is not sufficiently documented, we wondered if there would be a relationship between the relatively high number of anencephalic fetuses and COVID-19 infection. Aim: the objective of the study is to look for a possible correlation between the period of conception of these anencephalies and the pandemic. Material and methods: This is a retrospective study (from June 1, 2020 to May 31, 2022 in the Obstetrics Gynecology department, Faculty of Medicine and Pharmacy, CADI AYYAD UNIVERSITY Marrakech Morocco) consisting of the analysis of the number of patients in the target embryonic period (namely the closure of the neural tube: D18 to D30 of embryonic life) compared to the reference curves of the evolution of the SARS Cov2 pandemic. Results: The analysis of the number of patients at the target embryonic phase shows that many of our anencephalons (63%) were conceived during periods of high diffusion of the SARS Cov 2 virus in Morocco. Conclusion: Our study suggests a relationship between the COVID-19 pandemic and the occurrence of anencephaly, we cannot, however, highlight the type of direct or indirect relationship that binds them. Therefore, further studies should be considered to better investigate this relationship.展开更多
Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding ...Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.展开更多
Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum tim...Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.展开更多
<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and ...<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. <strong>Objectives: </strong>To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. <strong>Methods:</strong> A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. <strong>Results:</strong> In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%);all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. <strong>Conclusions:</strong> Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.展开更多
BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasoun...BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasound (TVUS) on intracytoplasmic sperm injection (ICSI) outcomes in patients with unexplained recurrent implantation failure (RIF). SETTING: ART Unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. DURATION: From April 2016 to October 2018. STUDY DESIGN: A prospective observational study. METHDS: Fifty couples with history of unexplained RIF in previous ICSI cycles and prepared for another ICSI cycle (group I) and fifty couples with unexplained infertility prepared for ICSI for the first time (group II) had been included in this study. At time of ovum pick up, 3-DTVUS was done for all cases in both groups for assessment of sub endometrial junction zone thickness and correlated with ICSI outcome. RESULTS: There were statistically significant differences between group I and group II in JZ thickness in the 3 uterine regions (fundus, anterior and posterior walls) with p 0.001, but there were mildly statistically significant differences between both groups in chemical and clinical pregnancy rates with p < 0.01. CONCLUSIONS: The thickness of JZ in patients with history of unexplained RIF was higher than those with unexplained infertility scheduled for ICSI. The JZ thickness was inversely correlated with increased embryo implantation rates in ICSI procedures, the thinner the JZ thickness was associated with higher pregnancy rates (both chemical and clinical pregnancy rates).展开更多
Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in ...Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in 1000 live births in pregnancies of 37 weeks to 2.12 in 1000 live births in pregnancies of 43 weeks gestation. Morbidities associated with postterm births include an increased risk of fetal distress, intrauterine growth restriction, dysfunctional labor, shoulder dystocia, obstetric trauma (relative risk 1.09 - 1.68) and an increase in perinatal complications, such as aspiration of meconium and asphyxia, peripheral nerve injury, greenstick bone fractures, pneumonia and septicemia (adjusted odds ratio 1.4 - 2.0). Antenatal surveillance and induction of labor may decrease the risks of an adverse outcome. In a recent review of term and postterm pregnancies in Norway, we found that there were adverse outcomes associated with both postterm pregnancy and induction of labor independently. On comparison of the two, a randomized controlled trial showed no difference in their neonatal outcome, but demonstrated a reduction in the cesarean delivery rate when labor was induced at 41 weeks. Aim of the Work: The aim of this study was to determine the effect of labor induction on maternal and fetal outcome in postterm pregnancies. Subjects and Methods: This study was carried out on 150 pregnant women who had completed 41 weeks of gestation between Jun. 1, 2012 up to Dec. 31, 2012 at Department of Obstetrics & Gynecology, Faculty of Medicine, Benghazi University, and were scheduled for induction of labor after cardiotocography (CTG) and ultrasonography (USS) have been done and Bishop’s score assessed, to determine the effects of labor induction on maternal and fetal outcome in postterm pregnancies (41 weeks plus). Results: Regarding the relationship between a history of (H/O) postdatism and fetal distress, it was found that there was no significant relationship between them. There was a significant relationship between a history of macrosomia and fetal distress. There was a significant relationship between instrumental delivery and fetal distress. The majority of the fetal distress had an indication for Caesarean section (CS) (fetal distress (FD) and fetal distress meconium (FDM) more than those without fetal distress. All fetuses that had APGAR scores of 8 were distressed. There was a significant relationship between the APGAR score at 10 minutes with fetal distress. All fetuses that had meconium aspiration had fetal distress. There was a significant increase in the amount of oxytocin in unit in distressed cases than the non-distressed ones. The total duration of induction was also significantly increased in stressed fetuses than the non-stressed ones. There was a significant increase in the weight of distressed fetuses than the non-distressed. Conclusions: In conclusion, there was no difference in the neonatal outcome or mode of delivery for postterm pregnancies managed either by immediate induction of labor or expectantly with serial antenatal surveillance. The outcomes were generally good, and neonatal morbidity, cesarean section, and operative vaginal delivery rates were low. If pregnancy is uncomplicated and continued surveillance is possible, women’s own wishes may guide the decision to induce or monitor a pregnancy beyond 41 weeks.展开更多
Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the a...Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the association between Premature Ovarian Failure and sexual dysfunctions and outcome of management with tibolone. Patients and Methods: Thirty-one women with Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital were enrolled into the study with 31 healthy women as control group. The instrument of data collection included two types of questionnaires to assess the effect of Premature Ovarian Failure on sexuality. All the women with POF had oral tibolone 2.5 mg for at least one year and the second questionnaire and the profiles were repeated. Results: Of the 31 women with POF that presented with sexual dysfunction (SD), 27 (87.1%) complained of one or more SD domains such as reduced frequency of coitus, dyspareunia, vaginal dryness, reduced libido and general sexual satisfaction (P < 0.01), amenorrhea (P < 0.01) and hot flashes compared to 5 (16.1%) control women (P < 0.01). Administration of tibolone was associated with significant increase in frequency of coitus, reduced dyspareunia and vaginal dryness, increase libido and general satisfaction and happiness. Reduction of sexual dysfunction was predicated on the estrogenic, progestogenic and androgenic metabolite of tibolone through the reduction of serum level of FSH and LH and increased levels of estrogen and testosterone (P < 0.01). Tibolone had no adverse effect on serum lipid profile. Conclusion: Premature Ovarian Failure is associated with sexual dysfunction. Tibolone provides an effective means of treating sexual dysfunction caused by Premature Ovarian Failure.展开更多
Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted i...Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted in Women Health Hospital, Assiut University, Egypt between March 2017 and May 2018 (ClinicalTrial.gov NCT03016273). Patients were divided into: Non bladder flap group: Uterine incision made 1 cm above the vesico-uterine reflection without incision and dissection of the bladder peritoneum and bladder flap group: Standard cesarean section technique with incision and dissection of a bladder flap prior to uterine incision. Results: The study included 150 patients (75 in each arm). The most common indication for CS in both groups was repeated CS. Non-bladder flap group, compared with flap group, showed shorter skin-incision to delivery time and total operative time, and significantly lower mean estimated blood loss and postoperative pain score. Non-bladder flap group, compared with flap group, was more likely to show postoperative microhematuria. The two groups required approximately the same time for post-operative defecation. Conclusion: Omission of bladder flap formation during CS is associated with shorter operative time, less blood loss, less postoperative pain and lower incidence of postoperative hematuria.展开更多
Objective: To compare the accuracy of different ultrasonographic modalities;two-dimensional ultrasound (2D-US), color Doppler and three-dimensional power Doppler (3D-PD) in the antenatal diagnosis of the morbidly adhe...Objective: To compare the accuracy of different ultrasonographic modalities;two-dimensional ultrasound (2D-US), color Doppler and three-dimensional power Doppler (3D-PD) in the antenatal diagnosis of the morbidly adherent placenta. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Study Design: A cross-sectional study. Methods: All patients fulfill the inclusions criteria: gestational age > 28 weeks, previous one or more cesarean delivery, previous uterine surgery, placenta previa, vitally stable patient and women accepted to participate in the study were included. All patients were evaluated using 2D-US, color Doppler and 3D-PD before delivery. The final diagnosis was established by laparotomy and by histopathology of hysterectomy sample if hysterectomy would be done. Results: One-hundred fifty patients were enrolled in the study. 2D-US has higher sensitivity (86.96%) than 2D color Doppler (84.06%) and 3D-PD (79.71%) in the diagnosis of placenta accreta. On the other hand, 3D-PD has slightly higher specificity (83.95%) than color Doppler (82.72%) and 2D-US (77.78%) in the diagnosis of placenta accreta. The most sensitive parameter in 2D-Us was the loss of retroplacental sonolucent zone (86.96%). As regards color Doppler, the most sensitive parameter was the hypervascularity of the uterine-bladder interface (84.06%). Tortuous vascularity with chaotic branching was the most sensitive parameter in 3D-PD with a sensitivity of 82.61%. Conclusions: The use of 3D power Doppler with both 2D-US and color Doppler as complementary techniques could improve the antenatal diagnosis or exclusion of morbidly adherent placenta.展开更多
OBJECTIVE: To assess the effect of vitamin D supplementation on enhancement of embryos implantation rates in intracytoplasmic sperm injection procedures. STUDY DESIGN: A randomized double-blinded controlled trial. SET...OBJECTIVE: To assess the effect of vitamin D supplementation on enhancement of embryos implantation rates in intracytoplasmic sperm injection procedures. STUDY DESIGN: A randomized double-blinded controlled trial. SETTING: Assisted Reproduction Unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt. DURATION: From December 1st 2017 to the end of October 2018. SUBJECTS and METHDS: Eighty infertile couples that underwent ICSI procedure were entrapped in this study. Patients were divided into two groups;Group I (Vitamin D group) = 40 patients (received vitamin D supplementation in the form of Vidrop oral drops 600 IU/day starting after ovum pickup) and Group II (placebo group) = 40 patients (received a placebo “normal saline oral drop”). RESULTS: There was a significantly increased embryo implantation rates (53.2% in vitamin D group versus 46.7% in placebo group), there was a mild statistically significant difference in the clinical pregnancy rates (45.9% in vitamin D group versus 39.4% in placebo group) with p-value < 0.05 and there was an improvement in ongoing pregnancy rate as there was a mild statistically significant difference in first trimester miscarriage rates (12.5% in vitamin D group versus 17.5% in placebo group) with p value CONCLUSIONS: Vitamin D supplementation could improve embryos implantation rates and rate of ongoing pregnancy by decline in the first trimester miscarriage rate.展开更多
The goal of this study is to assess the different approaches gynecologists take while treating women with PCOS related infertility. Methodology: This is a quantitative cross-sectional study that involves 46 specialist...The goal of this study is to assess the different approaches gynecologists take while treating women with PCOS related infertility. Methodology: This is a quantitative cross-sectional study that involves 46 specialists and consultants from all over the kingdom of Saudi Arabia. The sample size was calculated based on the number of consultants and specialists members in the Saudi Obstetrical & Gynecology society “SOGS”, we could not find any statistics on how many Ob/Gyne doctors we have in Saudi Arabia. The paper is approved by the Unit of Biomedical Ethics, King Abdulaziz University. The research team prepared an online survey of 13 questions, sent to all Consultants and Specialists in the “SOGS” during the year of 2016. The SPSS was used for the analysis. Conclusion: There is no significant difference between the different approaches of the first line of management. Comparing between Metformin and Clomiphene Citrate, Thirty Seven percent of participants preferred to start by a combination while 32% preferred to start with the former and 30.4% with the latter. Most of the doctors preferred to use Metformin for the Obese patients 76.1%, a lower percentage prefers to use it with Overweight patients 54.3%.展开更多
Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with thr...Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with threatened preterm labor. Patients and Methods: The current study was randomized controlled trial conducted in Sohag Teaching Hospital between November 2015 and September 2016. Patients were divided into: Group A: 101 patients received intravenous ritodrine infusion;Group B: 101 patients received intravenous magnesium sulfate;Group C: 101 patients received oral nifedipine. Different maternal and neonatal outcomes were assessed. Results: The baseline criteria were homogenous among the study groups with no statistically significant differences. There is no difference between each other group regarding the need for additional tocolysis or the rate of recurrence of labour pains. Nifedipine was associated with the least length of hospital stay. There is no difference between all groups regarding the rate of preterm delivery before full steroid dose (p > 0.05). However, nifedipine group was the least one in the rate of occurrence of preterm delivery within 7 days from initiation of tocolytic therapy. Similarly, nifedipine group was associated with higher gestational age at delivery and significant prolongation of pregnancy than the other groups. Conclusion: Oral nifedipine use was associated with less recurrence of labor pains, less need for additional tocolysis, less duration of hospital stay, and more patient satisfaction in patients with threatened preterm labour.展开更多
Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years with consequent cessation of menstruation. The objective of study was therefore to evaluate the emotional reaction and self-...Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years with consequent cessation of menstruation. The objective of study was therefore to evaluate the emotional reaction and self-efficacy of women with POF. Forty-two women confirmed to have Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital fulfilled the study criteria, were enrolled into the study. Another group of 42 healthy women formed the control group. The instrument of data collection included three types of questionnaires to assess the depth of emotional reaction to the diagnosis of POF including the subjects’ biodata, modified Health Orientation Scale (HOS) and Stanford Chronic Disease Self-Efficacy Scale. The women with POF presented at the clinic with infertility (P P P < 0.05). The diagnosis of ovarian insufficiency was a traumatic life event similar to bereavement (grieving of no obvious loss to others), with high level of anxiety, depression, fear of divorce, lower life satisfaction and impaired self-esteem. Fertility was generally of profound concern to all of them, because fertility was a societal landmark of womanhood and youth. The Stanford Chronic Self Efficacy scores were generally low (below 7) in coping with emotion reaction to loss of fertility, loss of menstruation, loss of self-esteem and other significant emotional reactions. The present study has demonstrated that Premature Ovarian Failure is associated with severe emotional distress and impaired ability to cope with them especially low self-esteem. A multidisciplinary management team is advocated for POF.展开更多
Purpose: To evaluate the effect of balanced hypocaloric diet therapy on the anthropometric and basic metabolic indicators in obese women with infertility. Methods: The follow up interventional clinical study included ...Purpose: To evaluate the effect of balanced hypocaloric diet therapy on the anthropometric and basic metabolic indicators in obese women with infertility. Methods: The follow up interventional clinical study included 23 infertile women in reproductive age with grade I gluteofemoral obesity. All patients have prescribed a balanced hypocaloric diet (1200 kcal/day), underwent exercise and behavioral therapy. Before and after 12-month treatment, an anthropometric study was conducted, determining the level of metabolic and hormonal indicators. Results: The total final number of study participants was 20 patients. A decrease in body weight was achieved in 87% of patients from 4 to 24 kg, on the average, by 10.58 ± 5.70 kg, there was also a decrease in BMI from 32.53 ± 1.40 to 28.55 ± 2.50 kg/m2 (p 0.001). The decrease in body weight was accompanied by a statistically significant decrease in leptin levels (p 0.001), E1 (p = 0.049), E2 (p = 0.032), fasting glucose (p 0.001), HOMA-IR (p = 0.002), cholesterol (p < 0.001), TG (p = 0.004), LDL-C (p = 0.001), atherogenic index of plasma (p <0.001) and an increase in progesterone levels (p = 0.030). Ovulatory menstrual cycles were resumed in all women (p = 0.007) and pregnancy occurred within a year in 1 patient. Conclusion: The implementation of a hypocaloric diet for 12 months in infertile women with first-degree obesity helps to normalize metabolic and hormonal indicators, reduces body weight and restores ovulatory menstrual cycle in all patients.展开更多
Background: Posterior fossa anomalies (PFAs) are considered one of the commonest brain anomalies identified by the fetal imaging techniques. The current study aims to estimate the significance of cerebellar vermis ass...Background: Posterior fossa anomalies (PFAs) are considered one of the commonest brain anomalies identified by the fetal imaging techniques. The current study aims to estimate the significance of cerebellar vermis assessment by fetal MRI in fetal brain malformations. Patients and Methods: The study was conducted at a tertiary University hospital in Upper Egypt. Data were gathered prospectively from sixty pregnant women with sonographically diagnosed fetal brain malformations referred for Magnetic Resonance Imaging (MRI) between April 2015 and May 2019 followed by postpartum neonatal MRI brain examination for non-terminated and live birth cases. Results: Of the sixty fetuses with brain malformations, additional cerebellar vermis findings were seen on MRI in 10 cases (16.6%). Fetal MRI sensitivity, specificity, positive and negative predictive values were 100% that were in correlation with those of prenatal ultrasound turned out to be significantly higher. Conclusion: This study recommends fetal MRI for cerebellar vermis assessment in fetal brain malformations to guide the clinical management.展开更多
Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened pret...Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL). Patients & Methods: 37 women presenting with TPTL underwent CVF samplings before digital examination and then underwent transvaginal ultrasonography for estimation of cervical length (CL). All women received fluid and anxiolytic therapy and if uterine contractions persisted, all had received tocolytic therapy with oral nifedipine or intravenous magnesium sulphate according to requirements. Incidence of SL within Results: Incidence of SL was 13.5%, 35.2% and 51.3% within 48-hr, 2 - 7 and 7 - 14 days, respectively. Duration till labor after sampling was positively correlated with CL, while was negatively correlated with positive FFN and PAMG-1 tests. Positive FFN test had high specificity, while positive PAMG-1 test had high sensitivity for labor within 7 days. Regression analysis defined short CL and positive PAMG-1 test as significant predictors for short duration till SL. ROC curve analysis defined short cervix and positive PAMG-1 test as significant predictors for labor within 48-hr and within 2 - 7 days respectively and combined negative PAMG-1 test and CL of 20 - 25 mm were significant predictors for labor within 7 - 14 days. Conclusion: PAMG-1 test had high specificity, if positive, for predicting SL and high NPP, if negative, for excluding labor within 7 days, so it can be used as rapid adjuvant to clinical evaluation to help management decision-making. Moreover, PAMG-1 test is recommended screening test for being easy-to-use bedside test, provides rapid results, can be used after vaginal exam and coitus and does not require a speculum examination or specialized equipment to analyze results.展开更多
Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes devel...Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. Duration: From August 2017 to November 2018. Study Design: A prospective randomized controlled trial. Methods: Seventy six pregnant women recruited from attendants of outpatient antenatal care unit of obstetrics and gynecology department who planned for cesarean delivery and carried one or more risk factors for urinary tract injury. Patients randomly were classified into 2 groups (group I included 38 cases, underwent bladder inflation using triple way Foley’s catheter immediately before CS and group II included 38 cases, and underwent bladder deflation with 2 ways Foley’s catheter immediately before CS. Results: The overall incidence of urinary tract injury was significantly higher in group II (7 cases = 18.4%) than in group I (2 cases = 5.2%) with p value < 0.001. The incidence of urinary bladder injury was moderately significantly higher in group II (5 cases = 13.1%) than group I (2 cases = 5.2%) with p value 0.01;ureteric or combined vesico-ureteric injuries had been reported only in group II (1 case = 2.6% and 1 case = 2.6%) respectively with no case reported in group I (p There was a highly statistically significant difference between group I and group II as regard to hospital stay (p < 0.001) but mildly significant differences in operative time and remote urinary tract fistulae (p Conclusions: There was significant reduction in urinary bladder injury, ureteric injury, operative time and hospital stay. Urinary bladder inflation immediately before cesarean section should be applied in patients who have any risk factor of dense bladder adhesion as a protective procedure against urinary tract injuries.展开更多
Objective: To assess indications, methods of interventions and gestational age of women underwent therapeutic abortion. Method: A total of 1381 cases of pregnant women underwent therapeutic abortion with completed cha...Objective: To assess indications, methods of interventions and gestational age of women underwent therapeutic abortion. Method: A total of 1381 cases of pregnant women underwent therapeutic abortion with completed charts between 1st January, 2001 to 31st December, 2010, were enrolled in this study. The patient data including demographic data, gestational age of abortion, methods of abortion, dosage of cytotec usage, indications of abortion and length of hospital stay were recorded. RESULT: Mean maternal age, gestational age of abortion and abortus weight were 29.56 ± 7.09 years, 17.54 ± 6.05 weeks of gestation and 401.27 ± 269.49 grams, respectively. Induced abortion with cytotec and syntocinon was mostly (28.3%) and rarely used (1.3%), respectively. Dosage of cytotec usage of 400 micrograms every 6 hours regimen was mostly used (53.1%). Indications of therapeutic abortion were maternal HIV infection (18.5%), fetal structural abnormalities (17.7%) and dead fetus in utero (19.3%) and were found. Curettage alone was mostly performed in the indicated patients with gestational age of 9.07 ± 2.85 weeks. Medical cytotec and syntocinon alone were mostly performed in the indicated patients with gestational age of 19.51 ± 4.55 and 23.94 ± 4.67 weeks, respectively. Tubal sterilization and the length of hospital stay were higher in the group of therapeutic abortion with maternal indication. Therapeutic abortion by hysterotomy had higher length of hospital stay than those with curettage method. Conclusion: Indications of therapeutic abortion were mostly from maternal HIV infection, fetal structural abnormalities and dead fetus in utero. Medical and surgical interventions were mostly applied during mid and early gestation, respectively.展开更多
<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The incidence of cancer vulva is increasing. 50% of cases are occurring at y...<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The incidence of cancer vulva is increasing. 50% of cases are occurring at younger age especially the type related to Human Papilloma Virus infection. Cancer vulva can be prevented. Awareness of cancer vulva is deficient among women and healthcare providers. In this study we looked for a correlation between the most significant vulval symptoms to be associated with cancer vulva in order to educate women and to provide guidance for the health care providers. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> 569 women were enrolled in this observational cohort study. The patients were stratified according to their symptoms </span><span style="font-family:Verdana;">into 5 groups. Biopsy from the vulva, unless the lesion is obviously benign.</span> <b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Vulvar lesion, as a symptom (mass-ulcer), was significantly associat</span><span style="font-family:Verdana;">ed with detection of vulvar cancer (</span><i><span style="font-family:Verdana;">P</span></i><span> </span></span><span style="font-family:""><span style="font-family:Verdana;">≤ </span><span><span style="font-family:Verdana;">0.001). 100% of those women presented </span><span style="font-family:Verdana;">with vulvar lesions (mass or ulcer) had cancer. Positive predictive value (PPV)</span><span style="font-family:Verdana;"> of vulvar lesion alone was 1.25% but the probability of detection of a cancer dramatically increased when the lesion was accompanied with bleeding 35.2% or pain 26.9% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Presenting symptoms other than a lesion in the vulva as for example, soreness, irritation or bleeding was rarely associated with detection of cancer.</span></span></span>展开更多
文摘Introduction: Morocco has experienced, like the whole world, the COVID-19 pandemic. Until the writing of this article, a subjective observation of the increase in the number of anencephaly has been observed in our facility. And since the teratogenic potential of the SARS Cov 2 virus is not sufficiently documented, we wondered if there would be a relationship between the relatively high number of anencephalic fetuses and COVID-19 infection. Aim: the objective of the study is to look for a possible correlation between the period of conception of these anencephalies and the pandemic. Material and methods: This is a retrospective study (from June 1, 2020 to May 31, 2022 in the Obstetrics Gynecology department, Faculty of Medicine and Pharmacy, CADI AYYAD UNIVERSITY Marrakech Morocco) consisting of the analysis of the number of patients in the target embryonic period (namely the closure of the neural tube: D18 to D30 of embryonic life) compared to the reference curves of the evolution of the SARS Cov2 pandemic. Results: The analysis of the number of patients at the target embryonic phase shows that many of our anencephalons (63%) were conceived during periods of high diffusion of the SARS Cov 2 virus in Morocco. Conclusion: Our study suggests a relationship between the COVID-19 pandemic and the occurrence of anencephaly, we cannot, however, highlight the type of direct or indirect relationship that binds them. Therefore, further studies should be considered to better investigate this relationship.
文摘Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.
文摘Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.
文摘<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. <strong>Objectives: </strong>To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. <strong>Methods:</strong> A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. <strong>Results:</strong> In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%);all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. <strong>Conclusions:</strong> Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.
文摘BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasound (TVUS) on intracytoplasmic sperm injection (ICSI) outcomes in patients with unexplained recurrent implantation failure (RIF). SETTING: ART Unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. DURATION: From April 2016 to October 2018. STUDY DESIGN: A prospective observational study. METHDS: Fifty couples with history of unexplained RIF in previous ICSI cycles and prepared for another ICSI cycle (group I) and fifty couples with unexplained infertility prepared for ICSI for the first time (group II) had been included in this study. At time of ovum pick up, 3-DTVUS was done for all cases in both groups for assessment of sub endometrial junction zone thickness and correlated with ICSI outcome. RESULTS: There were statistically significant differences between group I and group II in JZ thickness in the 3 uterine regions (fundus, anterior and posterior walls) with p 0.001, but there were mildly statistically significant differences between both groups in chemical and clinical pregnancy rates with p < 0.01. CONCLUSIONS: The thickness of JZ in patients with history of unexplained RIF was higher than those with unexplained infertility scheduled for ICSI. The JZ thickness was inversely correlated with increased embryo implantation rates in ICSI procedures, the thinner the JZ thickness was associated with higher pregnancy rates (both chemical and clinical pregnancy rates).
文摘Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in 1000 live births in pregnancies of 37 weeks to 2.12 in 1000 live births in pregnancies of 43 weeks gestation. Morbidities associated with postterm births include an increased risk of fetal distress, intrauterine growth restriction, dysfunctional labor, shoulder dystocia, obstetric trauma (relative risk 1.09 - 1.68) and an increase in perinatal complications, such as aspiration of meconium and asphyxia, peripheral nerve injury, greenstick bone fractures, pneumonia and septicemia (adjusted odds ratio 1.4 - 2.0). Antenatal surveillance and induction of labor may decrease the risks of an adverse outcome. In a recent review of term and postterm pregnancies in Norway, we found that there were adverse outcomes associated with both postterm pregnancy and induction of labor independently. On comparison of the two, a randomized controlled trial showed no difference in their neonatal outcome, but demonstrated a reduction in the cesarean delivery rate when labor was induced at 41 weeks. Aim of the Work: The aim of this study was to determine the effect of labor induction on maternal and fetal outcome in postterm pregnancies. Subjects and Methods: This study was carried out on 150 pregnant women who had completed 41 weeks of gestation between Jun. 1, 2012 up to Dec. 31, 2012 at Department of Obstetrics & Gynecology, Faculty of Medicine, Benghazi University, and were scheduled for induction of labor after cardiotocography (CTG) and ultrasonography (USS) have been done and Bishop’s score assessed, to determine the effects of labor induction on maternal and fetal outcome in postterm pregnancies (41 weeks plus). Results: Regarding the relationship between a history of (H/O) postdatism and fetal distress, it was found that there was no significant relationship between them. There was a significant relationship between a history of macrosomia and fetal distress. There was a significant relationship between instrumental delivery and fetal distress. The majority of the fetal distress had an indication for Caesarean section (CS) (fetal distress (FD) and fetal distress meconium (FDM) more than those without fetal distress. All fetuses that had APGAR scores of 8 were distressed. There was a significant relationship between the APGAR score at 10 minutes with fetal distress. All fetuses that had meconium aspiration had fetal distress. There was a significant increase in the amount of oxytocin in unit in distressed cases than the non-distressed ones. The total duration of induction was also significantly increased in stressed fetuses than the non-stressed ones. There was a significant increase in the weight of distressed fetuses than the non-distressed. Conclusions: In conclusion, there was no difference in the neonatal outcome or mode of delivery for postterm pregnancies managed either by immediate induction of labor or expectantly with serial antenatal surveillance. The outcomes were generally good, and neonatal morbidity, cesarean section, and operative vaginal delivery rates were low. If pregnancy is uncomplicated and continued surveillance is possible, women’s own wishes may guide the decision to induce or monitor a pregnancy beyond 41 weeks.
文摘Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the association between Premature Ovarian Failure and sexual dysfunctions and outcome of management with tibolone. Patients and Methods: Thirty-one women with Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital were enrolled into the study with 31 healthy women as control group. The instrument of data collection included two types of questionnaires to assess the effect of Premature Ovarian Failure on sexuality. All the women with POF had oral tibolone 2.5 mg for at least one year and the second questionnaire and the profiles were repeated. Results: Of the 31 women with POF that presented with sexual dysfunction (SD), 27 (87.1%) complained of one or more SD domains such as reduced frequency of coitus, dyspareunia, vaginal dryness, reduced libido and general sexual satisfaction (P < 0.01), amenorrhea (P < 0.01) and hot flashes compared to 5 (16.1%) control women (P < 0.01). Administration of tibolone was associated with significant increase in frequency of coitus, reduced dyspareunia and vaginal dryness, increase libido and general satisfaction and happiness. Reduction of sexual dysfunction was predicated on the estrogenic, progestogenic and androgenic metabolite of tibolone through the reduction of serum level of FSH and LH and increased levels of estrogen and testosterone (P < 0.01). Tibolone had no adverse effect on serum lipid profile. Conclusion: Premature Ovarian Failure is associated with sexual dysfunction. Tibolone provides an effective means of treating sexual dysfunction caused by Premature Ovarian Failure.
文摘Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted in Women Health Hospital, Assiut University, Egypt between March 2017 and May 2018 (ClinicalTrial.gov NCT03016273). Patients were divided into: Non bladder flap group: Uterine incision made 1 cm above the vesico-uterine reflection without incision and dissection of the bladder peritoneum and bladder flap group: Standard cesarean section technique with incision and dissection of a bladder flap prior to uterine incision. Results: The study included 150 patients (75 in each arm). The most common indication for CS in both groups was repeated CS. Non-bladder flap group, compared with flap group, showed shorter skin-incision to delivery time and total operative time, and significantly lower mean estimated blood loss and postoperative pain score. Non-bladder flap group, compared with flap group, was more likely to show postoperative microhematuria. The two groups required approximately the same time for post-operative defecation. Conclusion: Omission of bladder flap formation during CS is associated with shorter operative time, less blood loss, less postoperative pain and lower incidence of postoperative hematuria.
文摘Objective: To compare the accuracy of different ultrasonographic modalities;two-dimensional ultrasound (2D-US), color Doppler and three-dimensional power Doppler (3D-PD) in the antenatal diagnosis of the morbidly adherent placenta. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Study Design: A cross-sectional study. Methods: All patients fulfill the inclusions criteria: gestational age > 28 weeks, previous one or more cesarean delivery, previous uterine surgery, placenta previa, vitally stable patient and women accepted to participate in the study were included. All patients were evaluated using 2D-US, color Doppler and 3D-PD before delivery. The final diagnosis was established by laparotomy and by histopathology of hysterectomy sample if hysterectomy would be done. Results: One-hundred fifty patients were enrolled in the study. 2D-US has higher sensitivity (86.96%) than 2D color Doppler (84.06%) and 3D-PD (79.71%) in the diagnosis of placenta accreta. On the other hand, 3D-PD has slightly higher specificity (83.95%) than color Doppler (82.72%) and 2D-US (77.78%) in the diagnosis of placenta accreta. The most sensitive parameter in 2D-Us was the loss of retroplacental sonolucent zone (86.96%). As regards color Doppler, the most sensitive parameter was the hypervascularity of the uterine-bladder interface (84.06%). Tortuous vascularity with chaotic branching was the most sensitive parameter in 3D-PD with a sensitivity of 82.61%. Conclusions: The use of 3D power Doppler with both 2D-US and color Doppler as complementary techniques could improve the antenatal diagnosis or exclusion of morbidly adherent placenta.
文摘OBJECTIVE: To assess the effect of vitamin D supplementation on enhancement of embryos implantation rates in intracytoplasmic sperm injection procedures. STUDY DESIGN: A randomized double-blinded controlled trial. SETTING: Assisted Reproduction Unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt. DURATION: From December 1st 2017 to the end of October 2018. SUBJECTS and METHDS: Eighty infertile couples that underwent ICSI procedure were entrapped in this study. Patients were divided into two groups;Group I (Vitamin D group) = 40 patients (received vitamin D supplementation in the form of Vidrop oral drops 600 IU/day starting after ovum pickup) and Group II (placebo group) = 40 patients (received a placebo “normal saline oral drop”). RESULTS: There was a significantly increased embryo implantation rates (53.2% in vitamin D group versus 46.7% in placebo group), there was a mild statistically significant difference in the clinical pregnancy rates (45.9% in vitamin D group versus 39.4% in placebo group) with p-value < 0.05 and there was an improvement in ongoing pregnancy rate as there was a mild statistically significant difference in first trimester miscarriage rates (12.5% in vitamin D group versus 17.5% in placebo group) with p value CONCLUSIONS: Vitamin D supplementation could improve embryos implantation rates and rate of ongoing pregnancy by decline in the first trimester miscarriage rate.
文摘The goal of this study is to assess the different approaches gynecologists take while treating women with PCOS related infertility. Methodology: This is a quantitative cross-sectional study that involves 46 specialists and consultants from all over the kingdom of Saudi Arabia. The sample size was calculated based on the number of consultants and specialists members in the Saudi Obstetrical & Gynecology society “SOGS”, we could not find any statistics on how many Ob/Gyne doctors we have in Saudi Arabia. The paper is approved by the Unit of Biomedical Ethics, King Abdulaziz University. The research team prepared an online survey of 13 questions, sent to all Consultants and Specialists in the “SOGS” during the year of 2016. The SPSS was used for the analysis. Conclusion: There is no significant difference between the different approaches of the first line of management. Comparing between Metformin and Clomiphene Citrate, Thirty Seven percent of participants preferred to start by a combination while 32% preferred to start with the former and 30.4% with the latter. Most of the doctors preferred to use Metformin for the Obese patients 76.1%, a lower percentage prefers to use it with Overweight patients 54.3%.
文摘Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with threatened preterm labor. Patients and Methods: The current study was randomized controlled trial conducted in Sohag Teaching Hospital between November 2015 and September 2016. Patients were divided into: Group A: 101 patients received intravenous ritodrine infusion;Group B: 101 patients received intravenous magnesium sulfate;Group C: 101 patients received oral nifedipine. Different maternal and neonatal outcomes were assessed. Results: The baseline criteria were homogenous among the study groups with no statistically significant differences. There is no difference between each other group regarding the need for additional tocolysis or the rate of recurrence of labour pains. Nifedipine was associated with the least length of hospital stay. There is no difference between all groups regarding the rate of preterm delivery before full steroid dose (p > 0.05). However, nifedipine group was the least one in the rate of occurrence of preterm delivery within 7 days from initiation of tocolytic therapy. Similarly, nifedipine group was associated with higher gestational age at delivery and significant prolongation of pregnancy than the other groups. Conclusion: Oral nifedipine use was associated with less recurrence of labor pains, less need for additional tocolysis, less duration of hospital stay, and more patient satisfaction in patients with threatened preterm labour.
文摘Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years with consequent cessation of menstruation. The objective of study was therefore to evaluate the emotional reaction and self-efficacy of women with POF. Forty-two women confirmed to have Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital fulfilled the study criteria, were enrolled into the study. Another group of 42 healthy women formed the control group. The instrument of data collection included three types of questionnaires to assess the depth of emotional reaction to the diagnosis of POF including the subjects’ biodata, modified Health Orientation Scale (HOS) and Stanford Chronic Disease Self-Efficacy Scale. The women with POF presented at the clinic with infertility (P P P < 0.05). The diagnosis of ovarian insufficiency was a traumatic life event similar to bereavement (grieving of no obvious loss to others), with high level of anxiety, depression, fear of divorce, lower life satisfaction and impaired self-esteem. Fertility was generally of profound concern to all of them, because fertility was a societal landmark of womanhood and youth. The Stanford Chronic Self Efficacy scores were generally low (below 7) in coping with emotion reaction to loss of fertility, loss of menstruation, loss of self-esteem and other significant emotional reactions. The present study has demonstrated that Premature Ovarian Failure is associated with severe emotional distress and impaired ability to cope with them especially low self-esteem. A multidisciplinary management team is advocated for POF.
文摘Purpose: To evaluate the effect of balanced hypocaloric diet therapy on the anthropometric and basic metabolic indicators in obese women with infertility. Methods: The follow up interventional clinical study included 23 infertile women in reproductive age with grade I gluteofemoral obesity. All patients have prescribed a balanced hypocaloric diet (1200 kcal/day), underwent exercise and behavioral therapy. Before and after 12-month treatment, an anthropometric study was conducted, determining the level of metabolic and hormonal indicators. Results: The total final number of study participants was 20 patients. A decrease in body weight was achieved in 87% of patients from 4 to 24 kg, on the average, by 10.58 ± 5.70 kg, there was also a decrease in BMI from 32.53 ± 1.40 to 28.55 ± 2.50 kg/m2 (p 0.001). The decrease in body weight was accompanied by a statistically significant decrease in leptin levels (p 0.001), E1 (p = 0.049), E2 (p = 0.032), fasting glucose (p 0.001), HOMA-IR (p = 0.002), cholesterol (p < 0.001), TG (p = 0.004), LDL-C (p = 0.001), atherogenic index of plasma (p <0.001) and an increase in progesterone levels (p = 0.030). Ovulatory menstrual cycles were resumed in all women (p = 0.007) and pregnancy occurred within a year in 1 patient. Conclusion: The implementation of a hypocaloric diet for 12 months in infertile women with first-degree obesity helps to normalize metabolic and hormonal indicators, reduces body weight and restores ovulatory menstrual cycle in all patients.
文摘Background: Posterior fossa anomalies (PFAs) are considered one of the commonest brain anomalies identified by the fetal imaging techniques. The current study aims to estimate the significance of cerebellar vermis assessment by fetal MRI in fetal brain malformations. Patients and Methods: The study was conducted at a tertiary University hospital in Upper Egypt. Data were gathered prospectively from sixty pregnant women with sonographically diagnosed fetal brain malformations referred for Magnetic Resonance Imaging (MRI) between April 2015 and May 2019 followed by postpartum neonatal MRI brain examination for non-terminated and live birth cases. Results: Of the sixty fetuses with brain malformations, additional cerebellar vermis findings were seen on MRI in 10 cases (16.6%). Fetal MRI sensitivity, specificity, positive and negative predictive values were 100% that were in correlation with those of prenatal ultrasound turned out to be significantly higher. Conclusion: This study recommends fetal MRI for cerebellar vermis assessment in fetal brain malformations to guide the clinical management.
文摘Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL). Patients & Methods: 37 women presenting with TPTL underwent CVF samplings before digital examination and then underwent transvaginal ultrasonography for estimation of cervical length (CL). All women received fluid and anxiolytic therapy and if uterine contractions persisted, all had received tocolytic therapy with oral nifedipine or intravenous magnesium sulphate according to requirements. Incidence of SL within Results: Incidence of SL was 13.5%, 35.2% and 51.3% within 48-hr, 2 - 7 and 7 - 14 days, respectively. Duration till labor after sampling was positively correlated with CL, while was negatively correlated with positive FFN and PAMG-1 tests. Positive FFN test had high specificity, while positive PAMG-1 test had high sensitivity for labor within 7 days. Regression analysis defined short CL and positive PAMG-1 test as significant predictors for short duration till SL. ROC curve analysis defined short cervix and positive PAMG-1 test as significant predictors for labor within 48-hr and within 2 - 7 days respectively and combined negative PAMG-1 test and CL of 20 - 25 mm were significant predictors for labor within 7 - 14 days. Conclusion: PAMG-1 test had high specificity, if positive, for predicting SL and high NPP, if negative, for excluding labor within 7 days, so it can be used as rapid adjuvant to clinical evaluation to help management decision-making. Moreover, PAMG-1 test is recommended screening test for being easy-to-use bedside test, provides rapid results, can be used after vaginal exam and coitus and does not require a speculum examination or specialized equipment to analyze results.
文摘Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. Duration: From August 2017 to November 2018. Study Design: A prospective randomized controlled trial. Methods: Seventy six pregnant women recruited from attendants of outpatient antenatal care unit of obstetrics and gynecology department who planned for cesarean delivery and carried one or more risk factors for urinary tract injury. Patients randomly were classified into 2 groups (group I included 38 cases, underwent bladder inflation using triple way Foley’s catheter immediately before CS and group II included 38 cases, and underwent bladder deflation with 2 ways Foley’s catheter immediately before CS. Results: The overall incidence of urinary tract injury was significantly higher in group II (7 cases = 18.4%) than in group I (2 cases = 5.2%) with p value < 0.001. The incidence of urinary bladder injury was moderately significantly higher in group II (5 cases = 13.1%) than group I (2 cases = 5.2%) with p value 0.01;ureteric or combined vesico-ureteric injuries had been reported only in group II (1 case = 2.6% and 1 case = 2.6%) respectively with no case reported in group I (p There was a highly statistically significant difference between group I and group II as regard to hospital stay (p < 0.001) but mildly significant differences in operative time and remote urinary tract fistulae (p Conclusions: There was significant reduction in urinary bladder injury, ureteric injury, operative time and hospital stay. Urinary bladder inflation immediately before cesarean section should be applied in patients who have any risk factor of dense bladder adhesion as a protective procedure against urinary tract injuries.
文摘Objective: To assess indications, methods of interventions and gestational age of women underwent therapeutic abortion. Method: A total of 1381 cases of pregnant women underwent therapeutic abortion with completed charts between 1st January, 2001 to 31st December, 2010, were enrolled in this study. The patient data including demographic data, gestational age of abortion, methods of abortion, dosage of cytotec usage, indications of abortion and length of hospital stay were recorded. RESULT: Mean maternal age, gestational age of abortion and abortus weight were 29.56 ± 7.09 years, 17.54 ± 6.05 weeks of gestation and 401.27 ± 269.49 grams, respectively. Induced abortion with cytotec and syntocinon was mostly (28.3%) and rarely used (1.3%), respectively. Dosage of cytotec usage of 400 micrograms every 6 hours regimen was mostly used (53.1%). Indications of therapeutic abortion were maternal HIV infection (18.5%), fetal structural abnormalities (17.7%) and dead fetus in utero (19.3%) and were found. Curettage alone was mostly performed in the indicated patients with gestational age of 9.07 ± 2.85 weeks. Medical cytotec and syntocinon alone were mostly performed in the indicated patients with gestational age of 19.51 ± 4.55 and 23.94 ± 4.67 weeks, respectively. Tubal sterilization and the length of hospital stay were higher in the group of therapeutic abortion with maternal indication. Therapeutic abortion by hysterotomy had higher length of hospital stay than those with curettage method. Conclusion: Indications of therapeutic abortion were mostly from maternal HIV infection, fetal structural abnormalities and dead fetus in utero. Medical and surgical interventions were mostly applied during mid and early gestation, respectively.
文摘<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The incidence of cancer vulva is increasing. 50% of cases are occurring at younger age especially the type related to Human Papilloma Virus infection. Cancer vulva can be prevented. Awareness of cancer vulva is deficient among women and healthcare providers. In this study we looked for a correlation between the most significant vulval symptoms to be associated with cancer vulva in order to educate women and to provide guidance for the health care providers. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> 569 women were enrolled in this observational cohort study. The patients were stratified according to their symptoms </span><span style="font-family:Verdana;">into 5 groups. Biopsy from the vulva, unless the lesion is obviously benign.</span> <b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Vulvar lesion, as a symptom (mass-ulcer), was significantly associat</span><span style="font-family:Verdana;">ed with detection of vulvar cancer (</span><i><span style="font-family:Verdana;">P</span></i><span> </span></span><span style="font-family:""><span style="font-family:Verdana;">≤ </span><span><span style="font-family:Verdana;">0.001). 100% of those women presented </span><span style="font-family:Verdana;">with vulvar lesions (mass or ulcer) had cancer. Positive predictive value (PPV)</span><span style="font-family:Verdana;"> of vulvar lesion alone was 1.25% but the probability of detection of a cancer dramatically increased when the lesion was accompanied with bleeding 35.2% or pain 26.9% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Presenting symptoms other than a lesion in the vulva as for example, soreness, irritation or bleeding was rarely associated with detection of cancer.</span></span></span>