Change in Vaginal Flora as Indicated by Pap Smear (Schröder’s Classification) in Women Using Levonorgestrel-Releasing Intrauterine System “Mirena”—Prospective Cohort Study

Background: The use of intrauterine device alters the normal balance between vaginal flora. It might change cervicovaginal environment, which was suggested to increase the risk for vulvovaginitis. It was found that up to 85% of levonorgestrel-releasing intrauterine system users become amenorrheic 4 months after insertion, or bleed only sporadically. It was hypothesized that this would have a beneficial effect on vaginal flora maintaining normal balance. Objectives: The aim of this study was to detect the effect of hormonal intrauterine system (“Mirena”: 20 microgram/24 hours intrauterine delivery system Levonorgestrel) on vaginal flora by using pap smear before and 6 months after insertion. Study design: A prospective cohort study was carried out in a university maternity hospital. 210 subjects were included with pap smear taken at time of insertion of IUS “Mirena” and another one taken 6 months later to detect percentage of incidence of infection in IUS users. Vaginal flora was studied, and lactobacilli were graded according to Schr?der’s classification. A comparison was made to allow detection of changes in vaginal flora caused by presence of hormonal IUS “Mirena”. Results: Over half of cases (57.2%) showed worse vaginal flora after hormonal IUS “Mirena” insertion than before. There was a highly statistically significant difference between Schr?der’s Grades before and after insertion (P value < 0.001) as 44.8% of cases presented by Grade I, 44.4% of cases presented by grade IIa, 38% of cases presented by grade IIb before insertion developed Grade III after insertion. Conclusion: Insertion of hormonal IUS “Mirena” results in significant change in microbial flora towards pathological bacteria.

Preoperative serum vascular endothelial growth factor correlated to three dimensional power Doppler indices in ovarian masses

Objective: To assess the preoperative serum levels of vascular endothelial growth factor (VEGF) in ovarian masses compared to normal controls and to find a correlation between VEGF and Doppler indices in ovarian masses. Methods: The study was conducted from December 2009 to September 2012 in the oncology and ultrasound units in department of obstetrics and gynecology, Ain Shams University on 150 patients with ovarian masses. During preoperative workup, serum Ca-125 levels and serum VEGF levels were obtained. Ultrasonographic examination included two and three dimensional power Doppler ultrasound (3DPD). Laparotomic approaches were undertaken to obtain the final pathologic results. VEGF was measured in one hundred normal cases as controls. Results: Final ovarian pathology revealed seventy three malignant ovarian masses and seventy seven were benign. Serum Ca-125 levels in malignant cases were higher compared to those in benign cases (p < 0.001). Preoperative serum VEGF revealed higher levels in malignant ovarian masses than benign conditions and normal controls (p < 0.001). Three dimensional power Doppler indices, vascularization index (VI), flow index (FI) and vascularization flow index (VFI), correlated positively with serum VEGF levels. Conclusion: Preoperative serum VEGF revealed higher levels in malignant ovarian masses than benign conditions and normal controls. These levels positively correlated with the Doppler vascular indices of the masses.