Pub Date : 2022-05-01DOI: 10.21608/ebwhj.2021.100033.1156
H. Shalan, M. Shams, A. Elawady, Mohamed Eid
Aim: Intravenous administration of MgSO4 to pregnant women with severe preeclampsia to prevent seizures in pregnant females with severe preeclampsia. Materials and Methods: This study was conducted at Mansoura University Hospital from November 2018 to December 2019. Doppler indices of uterine artery, umbilical artery (UA), fetal middle cerebral artery (MCA) were measured before, 20 minutes after IV loading dose of 6gm of MgSO4, and after administration of maintenance dose of 1gm/hr. of MgSO4 for 24 hours. Results: There was a significant difference between maternal heart rate, systolic, diastolic and mean blood pressure before and 20 minutes after administration of loading dose of MgSO4 ( p value < 0.001 ) and a significant difference also before and after completing administration of maintenance dose of MgSO4 ( p value < 0.001 ). There was a significant difference between RI, PI, and S/D ratio of uterine artery, UA, and MCA before and 20 minutes after administration of loading dose of MgSO4 ( p value < 0.001 ) and a significant difference also between before and after 24 hours ( p value < 0.001 ). The cerebroumbilical ratio had significant change as regards RI and S/D. However, there was no significant change as regards PI. The decrease in Doppler parameters of MCA was more than the decrease in those of UA. Conclusion: IV administration of the loading dose then the maintenance dose of MgSO4 resulted in decrease in Doppler indices of uterine artery, UA, fetal MCA and increased cerebroumbilical ratio indicating improved fetal cerebral perfusion and affinity of cerebral vessels to MgSO4.
{"title":"Doppler Velocimetry Changes After Administration of Magnesium Sulfate in Severe Preeclampsia : Mansoura Experience","authors":"H. Shalan, M. Shams, A. Elawady, Mohamed Eid","doi":"10.21608/ebwhj.2021.100033.1156","DOIUrl":"https://doi.org/10.21608/ebwhj.2021.100033.1156","url":null,"abstract":"Aim: Intravenous administration of MgSO4 to pregnant women with severe preeclampsia to prevent seizures in pregnant females with severe preeclampsia. Materials and Methods: This study was conducted at Mansoura University Hospital from November 2018 to December 2019. Doppler indices of uterine artery, umbilical artery (UA), fetal middle cerebral artery (MCA) were measured before, 20 minutes after IV loading dose of 6gm of MgSO4, and after administration of maintenance dose of 1gm/hr. of MgSO4 for 24 hours. Results: There was a significant difference between maternal heart rate, systolic, diastolic and mean blood pressure before and 20 minutes after administration of loading dose of MgSO4 ( p value < 0.001 ) and a significant difference also before and after completing administration of maintenance dose of MgSO4 ( p value < 0.001 ). There was a significant difference between RI, PI, and S/D ratio of uterine artery, UA, and MCA before and 20 minutes after administration of loading dose of MgSO4 ( p value < 0.001 ) and a significant difference also between before and after 24 hours ( p value < 0.001 ). The cerebroumbilical ratio had significant change as regards RI and S/D. However, there was no significant change as regards PI. The decrease in Doppler parameters of MCA was more than the decrease in those of UA. Conclusion: IV administration of the loading dose then the maintenance dose of MgSO4 resulted in decrease in Doppler indices of uterine artery, UA, fetal MCA and increased cerebroumbilical ratio indicating improved fetal cerebral perfusion and affinity of cerebral vessels to MgSO4.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84016051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.21608/ebwhj.2022.127326.1171
Hesham Gouda, A. Ragab, Khaled M. Kholaif
Aim: The aim of the study is to compare the efficacy and safety of rectal Misoprostol versus IV Tranexamic acid (TXA) in reducing intraoperative blood loss during open myomectomy. Design: A randomized comparative study. the period from April 2021 September 2021. Methods: A total of 75 patients with uterine fibroid fulfilling the inclusion criteria were scheduled for abdominal myomectomy. Patients were randomized and allocated into one of three groups with a 1:1:1 allocation ratio. The groups were coded as A,B,C (group A for tranexamic acid ,group B for oxytocin and group C for control) (n=25 per group). In the three groups the following outcomes were reached : the estimated blood loss (EBL) during open myomectomy, need for intra and post operative blood transfusion, operative time, myomectomy time, postoperative hematocrit and hemoglobin, drop in postoperative hemoglobin , drop in hematocrit, side effects of TXA and oxytocin including and post operative stay in days. Interventions: Group (A) (Tranexamic Acid group): Women received TXA as a single bolus intravenous injection of 15 mg/ kg (maximum 1 g) slowly over 10 min 20 min before skin incision. Group (B) (Misoprostol group): Women received two tablet of (200 microgram) misoprostol (Cytotec) rectally 1hr before starting of operation.. Group (C) (placebo group): Women received 500 ml saline infusion at a rate of 120 ml/h before and during the operation. Results: Regarding need for intraoperative blood transfusion; statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups (no cases needed). On the other hand there was highly significant difference with control group 33 (66.0%) (p= <0.001). Also, Regarding need for postoperative blood transfusion; tranexamic acid was significantly higher than misoprostol and control groups 6 (12.0%) vs. 0 (0.0%) vs. 3 (6.0%) respectively ( p = 0.042). Regarding intraoperative blood loss (ml); statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups 229.35 ± 41.05 and 225.80 ± 44.82. On the other hand there was highly significant higher intraoperative blood loss in control group 680.35 ±189.39 ( p = <0.001). Regarding post-operative stay (days); statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups 1.34 ± 0.48 vs. 1.32 ± 0.47. On the other hand there was highly significant longer stay in control group 1.56 ± 0.54 ( p = 0.030). Conclusion: In women undergoing abdominal myomectomies, preoperative intravenous tranexamic acid and rectal misoprostol were very effective in reducing intraoperative blood loss, need for intra and postoperative blood transfusion, post-operative stay and operation and myomectomy time compared with placebo. Regarding operation and myomectomy time (mins); statistical analysis of current results showed that there
{"title":"The Efficacy and Safety of Intravenous Tranexamic Acid Versus Rectal Misoprostol in Reducing Blood Loss During Abdominal Myomectomy. A Randomized Comparative Study","authors":"Hesham Gouda, A. Ragab, Khaled M. Kholaif","doi":"10.21608/ebwhj.2022.127326.1171","DOIUrl":"https://doi.org/10.21608/ebwhj.2022.127326.1171","url":null,"abstract":"Aim: The aim of the study is to compare the efficacy and safety of rectal Misoprostol versus IV Tranexamic acid (TXA) in reducing intraoperative blood loss during open myomectomy. Design: A randomized comparative study. the period from April 2021 September 2021. Methods: A total of 75 patients with uterine fibroid fulfilling the inclusion criteria were scheduled for abdominal myomectomy. Patients were randomized and allocated into one of three groups with a 1:1:1 allocation ratio. The groups were coded as A,B,C (group A for tranexamic acid ,group B for oxytocin and group C for control) (n=25 per group). In the three groups the following outcomes were reached : the estimated blood loss (EBL) during open myomectomy, need for intra and post operative blood transfusion, operative time, myomectomy time, postoperative hematocrit and hemoglobin, drop in postoperative hemoglobin , drop in hematocrit, side effects of TXA and oxytocin including and post operative stay in days. Interventions: Group (A) (Tranexamic Acid group): Women received TXA as a single bolus intravenous injection of 15 mg/ kg (maximum 1 g) slowly over 10 min 20 min before skin incision. Group (B) (Misoprostol group): Women received two tablet of (200 microgram) misoprostol (Cytotec) rectally 1hr before starting of operation.. Group (C) (placebo group): Women received 500 ml saline infusion at a rate of 120 ml/h before and during the operation. Results: Regarding need for intraoperative blood transfusion; statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups (no cases needed). On the other hand there was highly significant difference with control group 33 (66.0%) (p= <0.001). Also, Regarding need for postoperative blood transfusion; tranexamic acid was significantly higher than misoprostol and control groups 6 (12.0%) vs. 0 (0.0%) vs. 3 (6.0%) respectively ( p = 0.042). Regarding intraoperative blood loss (ml); statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups 229.35 ± 41.05 and 225.80 ± 44.82. On the other hand there was highly significant higher intraoperative blood loss in control group 680.35 ±189.39 ( p = <0.001). Regarding post-operative stay (days); statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups 1.34 ± 0.48 vs. 1.32 ± 0.47. On the other hand there was highly significant longer stay in control group 1.56 ± 0.54 ( p = 0.030). Conclusion: In women undergoing abdominal myomectomies, preoperative intravenous tranexamic acid and rectal misoprostol were very effective in reducing intraoperative blood loss, need for intra and postoperative blood transfusion, post-operative stay and operation and myomectomy time compared with placebo. Regarding operation and myomectomy time (mins); statistical analysis of current results showed that there ","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90277768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.21608/ebwhj.2022.117549.1167
Shaemaa Belal, Manal Alsayed, Hany Abdel Hamid, H. Hamed
Background: There is no uniform definition for unexplained infertility, and this varies depending on the duration of infertility and the age of the female partner. The laparoscopy plays an important role in evaluation of infertile women as it a better predictor of future fertility. Hysteroscopic procedures are highly appreciated mainly for their minimal invasiveness, suitability for office gynecology, cost effectiveness and safety.laparoscopy and hysteroscopy is considered the gold standard for evaluation infertility as the advantages of combined hysteroscopic and laparoscopic approach are proper assessment of the distal tubes and ovaries, the elimination of tubal spasm as a factor of infertility, absence of radiation, more precise application of instruments and confirmation of achievement of tubal patency during the procedure. Aim: This study was done to evaluate the role of diagnostic hysterolaparoscopy in the comprehensive work up of unexplained infertility, which would help in planning appropriate management. Methodology: In the current study, we selected 168 women with unexplained infertility. The mean age of the studied group was 30.3 ± 4.3 years. The mean duration of infertility was 5.3 ± 1.7 years; ranging between 1.5 and 9 years. As hysteroscopy provides direct visual to the uterine cavity and laparoscopy inspects the pelvic cavity, we ask the question; Do hysteroscopy and/or laparoscopy add to the infertility work-up? At this study during hysteroscopic evaluation for the (168) studied patients with unexplained infertility, we reported that 68 (40.4%) of patients had normal uterine cavity and 100 (59.5%) of patients had abnormal uterine cavity. Conclusion: In conclusion hystero-laparoscopy is benefitial in the work-up of patients with unexplained infertility and normal H.S.G findings because it has been demonstrated to be a reliable procedure in detecting infertility causes in the uterus and pelvic cavity that had not been previously detected by routine infertility work-up and that could then treat allowing post-operative pregnancies.
{"title":"Hystero-Laparoscopic Findings in Patients with Unexplained Infertility : A cross-Sectional Study","authors":"Shaemaa Belal, Manal Alsayed, Hany Abdel Hamid, H. Hamed","doi":"10.21608/ebwhj.2022.117549.1167","DOIUrl":"https://doi.org/10.21608/ebwhj.2022.117549.1167","url":null,"abstract":"Background: There is no uniform definition for unexplained infertility, and this varies depending on the duration of infertility and the age of the female partner. The laparoscopy plays an important role in evaluation of infertile women as it a better predictor of future fertility. Hysteroscopic procedures are highly appreciated mainly for their minimal invasiveness, suitability for office gynecology, cost effectiveness and safety.laparoscopy and hysteroscopy is considered the gold standard for evaluation infertility as the advantages of combined hysteroscopic and laparoscopic approach are proper assessment of the distal tubes and ovaries, the elimination of tubal spasm as a factor of infertility, absence of radiation, more precise application of instruments and confirmation of achievement of tubal patency during the procedure. Aim: This study was done to evaluate the role of diagnostic hysterolaparoscopy in the comprehensive work up of unexplained infertility, which would help in planning appropriate management. Methodology: In the current study, we selected 168 women with unexplained infertility. The mean age of the studied group was 30.3 ± 4.3 years. The mean duration of infertility was 5.3 ± 1.7 years; ranging between 1.5 and 9 years. As hysteroscopy provides direct visual to the uterine cavity and laparoscopy inspects the pelvic cavity, we ask the question; Do hysteroscopy and/or laparoscopy add to the infertility work-up? At this study during hysteroscopic evaluation for the (168) studied patients with unexplained infertility, we reported that 68 (40.4%) of patients had normal uterine cavity and 100 (59.5%) of patients had abnormal uterine cavity. Conclusion: In conclusion hystero-laparoscopy is benefitial in the work-up of patients with unexplained infertility and normal H.S.G findings because it has been demonstrated to be a reliable procedure in detecting infertility causes in the uterus and pelvic cavity that had not been previously detected by routine infertility work-up and that could then treat allowing post-operative pregnancies.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86781458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.21608/ebwhj.2022.127319.1170
H. Farouk, T. Assar, Shymaa Elsawy
Background: Amniotic fluid volume is an indicator of fetal well-being in second and third trimesters of pregnancy and oligohydramnios is diagnosed when this volume is less than 500 ml. Flow velocity waveforms of the renal arteries by doppler ultrasonography provide a sensitive method to predict changes in amniotic fluid dynamics and index in early stages of pregnancy. Aim: To determine the relation of renal artery flow velocity waveforms with normal pregnancies and with pregnancies complicated by oligohydraminos using doppler ultrasonography. Methods: A doppler ultrasound device was used to assess the renal artery pulsatility index (PI), resistance index (RI), systolic/ diastolic (S/D) ratio. 3 consecutive waveforms from each fetus were traced and the average values used for final analysis. Results: Maternal age ranged from (20 -40) years. Fetal age ranged from (21 -38) weeks. In oligohydramnios cases, median of (PI) in Lt kidney was (1.99) and in Rt kidney was (2.14), while median of (RI) in Lt kidney was (0.8372) and in Rt kidney was (0.852). While in normal cases median of (PI) in Lt kidney was (1.4584) and in Rt kidney was (1.4124), while median of (RI) in Lt kidney was (0.71) and in Rt kidney was (0.69988). Conclusion: There is a relation between renal arteries flow velocity waveforms and oligohydraminos by using doppler Ultrasonography. Oligohydramnios with markedly changes in PI & RI values especially in the third trimester is an indicator for rapid delivery to save fetal life. Oligohydramnios could be predicted according to changes in PI & RI values.
{"title":"Fetal Renal Artery Indices of Second and Third Trimesters of Pregnancy in Idiopathic Oligohydrominos by Pulsed Wave Doppler Ultrasonography","authors":"H. Farouk, T. Assar, Shymaa Elsawy","doi":"10.21608/ebwhj.2022.127319.1170","DOIUrl":"https://doi.org/10.21608/ebwhj.2022.127319.1170","url":null,"abstract":"Background: Amniotic fluid volume is an indicator of fetal well-being in second and third trimesters of pregnancy and oligohydramnios is diagnosed when this volume is less than 500 ml. Flow velocity waveforms of the renal arteries by doppler ultrasonography provide a sensitive method to predict changes in amniotic fluid dynamics and index in early stages of pregnancy. Aim: To determine the relation of renal artery flow velocity waveforms with normal pregnancies and with pregnancies complicated by oligohydraminos using doppler ultrasonography. Methods: A doppler ultrasound device was used to assess the renal artery pulsatility index (PI), resistance index (RI), systolic/ diastolic (S/D) ratio. 3 consecutive waveforms from each fetus were traced and the average values used for final analysis. Results: Maternal age ranged from (20 -40) years. Fetal age ranged from (21 -38) weeks. In oligohydramnios cases, median of (PI) in Lt kidney was (1.99) and in Rt kidney was (2.14), while median of (RI) in Lt kidney was (0.8372) and in Rt kidney was (0.852). While in normal cases median of (PI) in Lt kidney was (1.4584) and in Rt kidney was (1.4124), while median of (RI) in Lt kidney was (0.71) and in Rt kidney was (0.69988). Conclusion: There is a relation between renal arteries flow velocity waveforms and oligohydraminos by using doppler Ultrasonography. Oligohydramnios with markedly changes in PI & RI values especially in the third trimester is an indicator for rapid delivery to save fetal life. Oligohydramnios could be predicted according to changes in PI & RI values.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81143574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.21608/ebwhj.2022.116590.1165
T. Borg, Asmaa Gaballah, Mohamed Khallaf, H. Hemeda, Marwan Elkady
Aim: This study aimed to explore the effect of chromium picolinate compared to Metformin supplementation with ovulation induction in polycystic ovary syndrome, In particular, its effect on insulin sensitivity, ovarian response and pregnancy rate. Materials and Methods: This study was conducted as a prospective study, aimed to compare the effect of Chromium and Metformin supplementations on ovulation rate in Polycystic ovary patients undergoing ovulation induction. The present study included 140 women divided into 2 groups each is 70 infertile women diagnosed as polycystic ovary syndrome according to Rotterdam criteria 2017: (oligo-ovulation or anovulation, clinical or biochemical signs of hyperandrogenism, polycystic ovaries on ultrasound). Results: Fasting blood sugar (FBS) and fasting insulin level were significantly decreased in metformin group than in Chromium picolinate group after 3 months of treatment ( p=0.006 ) ( p=0.026 ) respectively. Testosterone significantly decreased in both groups at follow up as compared to basal level ( P-value <0.001, <0.001 respectively with no significant difference between the studied groups regarding testosterone reduction ( P-value=0.416 ) after 3 months of treatment. The two study groups were not significantly different regarding ovulation and pregnancy rates( P-value 0.157, 0.550 ) respectively after 3 months of treatment. The patients who received metformin experienced more side effects compared to those receiving chromium picolinate ( p=0.001 ). Conclusion: I n view of the aforementioned findings, we recommend that metformin could be replaced by chromium picolinate in some PCOS patients, as its better tolerated than metformin due to lower side effects and no significant differences were observed between the two groups regarding ovulation and pregnancy rates.
{"title":"Role of Chromium Versus Metformin Supplementations as Adjuvant for Ovulation Induction By Clomiphene Citrate in Infertile Patients With Polycystic Ovary Syndrome : Randomized Controlled Trial","authors":"T. Borg, Asmaa Gaballah, Mohamed Khallaf, H. Hemeda, Marwan Elkady","doi":"10.21608/ebwhj.2022.116590.1165","DOIUrl":"https://doi.org/10.21608/ebwhj.2022.116590.1165","url":null,"abstract":"Aim: This study aimed to explore the effect of chromium picolinate compared to Metformin supplementation with ovulation induction in polycystic ovary syndrome, In particular, its effect on insulin sensitivity, ovarian response and pregnancy rate. Materials and Methods: This study was conducted as a prospective study, aimed to compare the effect of Chromium and Metformin supplementations on ovulation rate in Polycystic ovary patients undergoing ovulation induction. The present study included 140 women divided into 2 groups each is 70 infertile women diagnosed as polycystic ovary syndrome according to Rotterdam criteria 2017: (oligo-ovulation or anovulation, clinical or biochemical signs of hyperandrogenism, polycystic ovaries on ultrasound). Results: Fasting blood sugar (FBS) and fasting insulin level were significantly decreased in metformin group than in Chromium picolinate group after 3 months of treatment ( p=0.006 ) ( p=0.026 ) respectively. Testosterone significantly decreased in both groups at follow up as compared to basal level ( P-value <0.001, <0.001 respectively with no significant difference between the studied groups regarding testosterone reduction ( P-value=0.416 ) after 3 months of treatment. The two study groups were not significantly different regarding ovulation and pregnancy rates( P-value 0.157, 0.550 ) respectively after 3 months of treatment. The patients who received metformin experienced more side effects compared to those receiving chromium picolinate ( p=0.001 ). Conclusion: I n view of the aforementioned findings, we recommend that metformin could be replaced by chromium picolinate in some PCOS patients, as its better tolerated than metformin due to lower side effects and no significant differences were observed between the two groups regarding ovulation and pregnancy rates.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"519 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77360134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.21608/ebwhj.2022.127680.1172
E. Gomaa, A. Shabaan, Eslam Mohamed, A. Saleh, O. Mohammed, M. Ramadan, Amr Hussein
Background: Hyoscine Butylbromide (HBB) is a potent parasympatholytic drug with strong antispasmodic action contributing to cervical dilation during labor. Objective: We aimed to determine if hyoscine butylbromide (HBB) during labor is associated with shortened duration of labor. Search Strategy: We searched several electronic databases from inception to march 2019 using various search terms. Selection Criteria: Randomized controlled trials comparing HBB vs. placebo regarding labor duration. Data Collection and Analysis: After screening and data extraction, mean difference with 95% confidence interval (CI) for continuous data and odds ratio with 95% CI for categorical data were calculated. Main Results: Fourteen articles (2287 patients) were included. HBB shortens durations of first stage (MD = -60.86, 95% CI [-82.89 to -38.84]), second stage (MD = -3.18, 95% CI [-5.12 to -1.24]) and third stage of labor (MD = -0.84, 95% CI [-1.19 to -0.50]). Indeed, overall rate of cervical dilatation was greater in HBB group (MD= 0.65-minute, 95% CI, 0.51 to 0.80). However, HBB does not affect the rate of vaginal or cesarean deliveries. Conclusions: Hyoscine Butylbromide shortens the duration of all stages of labor and increases the rate of cervical dilatation. However, it does not affect the mode of delivery
背景:丁基溴海莨菪碱(HBB)是一种有效的副交感神经溶解药物，具有很强的抗痉挛作用，有助于分娩时宫颈扩张。目的:我们旨在确定分娩时使用丁基溴海莨菪碱(HBB)是否与缩短分娩时间有关。搜索策略:从成立到2019年3月，我们使用各种搜索词搜索了多个电子数据库。选择标准:随机对照试验比较HBB和安慰剂对分娩持续时间的影响。资料收集与分析:经筛选和资料提取后，计算连续资料的95%置信区间均值差(mean difference with 95% confidence interval, CI)，分类资料的95%置信区间比值比(odds ratio with 95% CI)。主要结果:纳入文献14篇(2287例)。HBB缩短了第一阶段(MD = -60.86, 95% CI[-82.89至-38.84])、第二阶段(MD = -3.18, 95% CI[-5.12至-1.24])和第三产程(MD = -0.84, 95% CI[-1.19至-0.50])的持续时间。事实上，HBB组总体宫颈扩张率更高(MD= 0.65分钟，95% CI, 0.51 ~ 0.80)。然而，HBB并不影响阴道分娩或剖宫产的比率。结论:丁基溴莨菪碱能缩短产程，提高宫颈扩张率。但是，这并不影响交付方式
{"title":"Effect of Intrapartum Hyoscine Butylbromide Administration on Duration of Labor and Mode of Delivery: A Systematic Review and Meta - Analysis","authors":"E. Gomaa, A. Shabaan, Eslam Mohamed, A. Saleh, O. Mohammed, M. Ramadan, Amr Hussein","doi":"10.21608/ebwhj.2022.127680.1172","DOIUrl":"https://doi.org/10.21608/ebwhj.2022.127680.1172","url":null,"abstract":"Background: Hyoscine Butylbromide (HBB) is a potent parasympatholytic drug with strong antispasmodic action contributing to cervical dilation during labor. Objective: We aimed to determine if hyoscine butylbromide (HBB) during labor is associated with shortened duration of labor. Search Strategy: We searched several electronic databases from inception to march 2019 using various search terms. Selection Criteria: Randomized controlled trials comparing HBB vs. placebo regarding labor duration. Data Collection and Analysis: After screening and data extraction, mean difference with 95% confidence interval (CI) for continuous data and odds ratio with 95% CI for categorical data were calculated. Main Results: Fourteen articles (2287 patients) were included. HBB shortens durations of first stage (MD = -60.86, 95% CI [-82.89 to -38.84]), second stage (MD = -3.18, 95% CI [-5.12 to -1.24]) and third stage of labor (MD = -0.84, 95% CI [-1.19 to -0.50]). Indeed, overall rate of cervical dilatation was greater in HBB group (MD= 0.65-minute, 95% CI, 0.51 to 0.80). However, HBB does not affect the rate of vaginal or cesarean deliveries. Conclusions: Hyoscine Butylbromide shortens the duration of all stages of labor and increases the rate of cervical dilatation. However, it does not affect the mode of delivery","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82357642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-01DOI: 10.21608/ebwhj.2021.112340.1163
A. Nadim, R. Ghanem, Shereen Rady
Aim: This study aimed to compare the efficacy of using letrozole pretreatment before misoprostol versus using misoprostol alone for the medical termination of first trimester missed abortion. Materials and Methods: This clinical trial was conducted at Ain-Shams University Maternity Hospital in the period between January 2020 and August 2020, and was registered at clinical trials.gov Identifier. NCT04590482. Patients that seem to be fulfilling the inclusion criteria were recruited, then, an informed written consent was taken from every patient before starting the examination. Followed by detailed history and examination of all the patients. Hemoglobin, hematocrit, blood group, RH, and transvaginal ultrasound were done for all patients before the study. Results: The result of the study demonstrated an increase in complete abortion rate (primary outcome) at day 3 in group A (56.6%) more than group B (35.2%) which was statistically significant. Also there was an increase in the incidence of complete abortion at day 7 in group A (77.4%) more than group B (68.5%) but with no statistically significant difference between the two groups. Conclusion: Using of letrozole pretreatment with misoprostol for induction of first trimester abortion is better than using of misoprostol alone, as there was an increase in complete abortion rate in group A more than group B.
{"title":"Use of Letrozole Pretreatment with Misoprostol for Induction of Abortion in First Trimester : A Randomized Controlled Trial","authors":"A. Nadim, R. Ghanem, Shereen Rady","doi":"10.21608/ebwhj.2021.112340.1163","DOIUrl":"https://doi.org/10.21608/ebwhj.2021.112340.1163","url":null,"abstract":"Aim: This study aimed to compare the efficacy of using letrozole pretreatment before misoprostol versus using misoprostol alone for the medical termination of first trimester missed abortion. Materials and Methods: This clinical trial was conducted at Ain-Shams University Maternity Hospital in the period between January 2020 and August 2020, and was registered at clinical trials.gov Identifier. NCT04590482. Patients that seem to be fulfilling the inclusion criteria were recruited, then, an informed written consent was taken from every patient before starting the examination. Followed by detailed history and examination of all the patients. Hemoglobin, hematocrit, blood group, RH, and transvaginal ultrasound were done for all patients before the study. Results: The result of the study demonstrated an increase in complete abortion rate (primary outcome) at day 3 in group A (56.6%) more than group B (35.2%) which was statistically significant. Also there was an increase in the incidence of complete abortion at day 7 in group A (77.4%) more than group B (68.5%) but with no statistically significant difference between the two groups. Conclusion: Using of letrozole pretreatment with misoprostol for induction of first trimester abortion is better than using of misoprostol alone, as there was an increase in complete abortion rate in group A more than group B.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85388289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-12DOI: 10.21608/ebwhj.2021.110190.1161
J. Sadek, Mahmoud M A Soliman
Background: There is shortage in clinical data determining significant benefit (i.e., decrease of severe infection outcomes) following screening and treatment of Bacterial vaginosis (BV) late in pregnancy. Due to this deficiency of data, there is controversy concerning whether ladies with BV should be screened and/or treated in late pregnancy to prevent peripartum infections. BV is a common lower genital tract infection with a global prevalence ranging between 23 and 29%. Aim: To asses if treatment of BV positive women screened at cesarean delivery significantly reduces infection rate Study Design: The trial was a randomized double-blinded, single center interventional study conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University. The study population consisted of 150 eligible pregnant women who were admitted in the labour or obstetric ward and underwent elective or emergency CS from December 2019 to February 2021. The women were randomized into either of the two arms. The study arm “Group A” participants received 500gm MTZ twice daily for one week, starting 6hrs following CS, whereas the control arm “Group B” participants received one placebo tablet twice daily for one week, 6hrs following CS. Each group comprised 75 pregnant women. Results: In total 150 patient, eight were excluded from statistical analysis for unknown infection morbidity status due to loss to follow up, leaving 142 women for analysis. Of those that were given treatment for BV, 66 women (91.7%) had a negative test for BV at one week. In this study, treatment of BV was found to be significantly associated with the reduction of post cesarean endometritis ( P value = 0.0121) (cOR = 0.2834; 95%CI = [0.2228 to 0.8627]). However, the situation was different regarding wound infection incidence. No significant difference was recognized between the treatment and control groups ( P value = 0.2048). Conclusion: Given the results of our study, which is in agreement to same evidence associating BV with intrapartum chorioamnionitis and endometritis post CS, BV screening late in pregnancy, possibly at the 35-37 week and group B streptococcus culture visit, or immediately following CS, and treatment of those positively screened could be made. With none existence of guidelines from professional societies, preoperative screening and treatment of BV could cause more reduction in surgical site infections.
{"title":"Treatment of bacterial vaginosis to prevent infection following caesarean delivery; a randomized control study","authors":"J. Sadek, Mahmoud M A Soliman","doi":"10.21608/ebwhj.2021.110190.1161","DOIUrl":"https://doi.org/10.21608/ebwhj.2021.110190.1161","url":null,"abstract":"Background: There is shortage in clinical data determining significant benefit (i.e., decrease of severe infection outcomes) following screening and treatment of Bacterial vaginosis (BV) late in pregnancy. Due to this deficiency of data, there is controversy concerning whether ladies with BV should be screened and/or treated in late pregnancy to prevent peripartum infections. BV is a common lower genital tract infection with a global prevalence ranging between 23 and 29%. Aim: To asses if treatment of BV positive women screened at cesarean delivery significantly reduces infection rate Study Design: The trial was a randomized double-blinded, single center interventional study conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University. The study population consisted of 150 eligible pregnant women who were admitted in the labour or obstetric ward and underwent elective or emergency CS from December 2019 to February 2021. The women were randomized into either of the two arms. The study arm “Group A” participants received 500gm MTZ twice daily for one week, starting 6hrs following CS, whereas the control arm “Group B” participants received one placebo tablet twice daily for one week, 6hrs following CS. Each group comprised 75 pregnant women. Results: In total 150 patient, eight were excluded from statistical analysis for unknown infection morbidity status due to loss to follow up, leaving 142 women for analysis. Of those that were given treatment for BV, 66 women (91.7%) had a negative test for BV at one week. In this study, treatment of BV was found to be significantly associated with the reduction of post cesarean endometritis ( P value = 0.0121) (cOR = 0.2834; 95%CI = [0.2228 to 0.8627]). However, the situation was different regarding wound infection incidence. No significant difference was recognized between the treatment and control groups ( P value = 0.2048). Conclusion: Given the results of our study, which is in agreement to same evidence associating BV with intrapartum chorioamnionitis and endometritis post CS, BV screening late in pregnancy, possibly at the 35-37 week and group B streptococcus culture visit, or immediately following CS, and treatment of those positively screened could be made. With none existence of guidelines from professional societies, preoperative screening and treatment of BV could cause more reduction in surgical site infections.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80194684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-12DOI: 10.21608/ebwhj.2021.110722.1162
B. Sakr
Aim: Determination of the impact of pregnancy in women infected or uninfected with H pylori (HP) of hemoglobin concentration (Hb. conc.) Materials and Methods: 223 women were categorized according to detection of anti-HP antibodies into HP-positive (Group A) and HP-negative (Group B). All women gave blood samples at the 6th gestational week, booking visit [T1] and at start of the 2 nd and 3 rd trimesters [T2 and T3] for estimation of Hb. conc. Anemia of pregnancy was diagnosed if Hb. conc. <11 g/dl in early or late pregnancy or <10.5 g/dl in mid pregnancy and HP infection was diagnosed by ELISA estimation of human anti-HP IgG. Study outcome was the effect of pregnancy on Hb. conc. in pregnant women infected or uninfected by HP. Results: Women of group A had significantly lower Hb. conc. at booking time with significantly higher frequency of anemic women. In T2 and T3 samples, Hb. conc. was significantly lower in women of group A and the differences in the frequency of anemic women between both groups was significant ( p =0.007) at T2, but was non-significant ( p=0.35 ) in T3 sample. Estimated Hb. conc. at booking time showed negative significant correlation with serum positivity for HP. Estimated Hb. conc. throughout the pregnancy showed negative significant correlation with progress of pregnancy and serum positivity for HP infection. Moreover, ROC curve analysis defined these both factors as specific predictors for progressive deterioration of Hb. conc., but AUC for pregnancy was the significant. Conclusion: Pregnancy is a definite risk factor for development of anemia and worsening hemoglobin concentration if it is low. Pre-pregnancy HP infection is a leading cause for preconception anemia that deteriorated as regards frequency of anemic women and hemoglobin concentration.
{"title":"Preconception H pylori Infection might worsen Pregnancy-induced Anemia","authors":"B. Sakr","doi":"10.21608/ebwhj.2021.110722.1162","DOIUrl":"https://doi.org/10.21608/ebwhj.2021.110722.1162","url":null,"abstract":"Aim: Determination of the impact of pregnancy in women infected or uninfected with H pylori (HP) of hemoglobin concentration (Hb. conc.) Materials and Methods: 223 women were categorized according to detection of anti-HP antibodies into HP-positive (Group A) and HP-negative (Group B). All women gave blood samples at the 6th gestational week, booking visit [T1] and at start of the 2 nd and 3 rd trimesters [T2 and T3] for estimation of Hb. conc. Anemia of pregnancy was diagnosed if Hb. conc. <11 g/dl in early or late pregnancy or <10.5 g/dl in mid pregnancy and HP infection was diagnosed by ELISA estimation of human anti-HP IgG. Study outcome was the effect of pregnancy on Hb. conc. in pregnant women infected or uninfected by HP. Results: Women of group A had significantly lower Hb. conc. at booking time with significantly higher frequency of anemic women. In T2 and T3 samples, Hb. conc. was significantly lower in women of group A and the differences in the frequency of anemic women between both groups was significant ( p =0.007) at T2, but was non-significant ( p=0.35 ) in T3 sample. Estimated Hb. conc. at booking time showed negative significant correlation with serum positivity for HP. Estimated Hb. conc. throughout the pregnancy showed negative significant correlation with progress of pregnancy and serum positivity for HP infection. Moreover, ROC curve analysis defined these both factors as specific predictors for progressive deterioration of Hb. conc., but AUC for pregnancy was the significant. Conclusion: Pregnancy is a definite risk factor for development of anemia and worsening hemoglobin concentration if it is low. Pre-pregnancy HP infection is a leading cause for preconception anemia that deteriorated as regards frequency of anemic women and hemoglobin concentration.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82082302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-12DOI: 10.21608/ebwhj.2021.110185.1160
J. Sadek, M. Soliman
Background: Urinary tract infection (UTI) during pregnancy is common due to a unique state of physiological, immunological and hormonal changes, increased vesicoureteral reflux and urinary tract obstruction by the uterus. Vitamin D is important for human health, being more crucial during pregnancy. A third of the population are estimated to suffer from Vitamin D deficiency. Studies recently have been focused on the effect of vitamin D deficiency on the immune system, both the innate and adaptive. Vitamin D has been found to enhance the innate immune system Aim: We aim in this study to investigate the link between serum vitamin D levels and UTI in pregnant women. Materials and Methods: A case control study conducted between September 2020 and June 2021 at the prenatal care clinic of the Kasr Al-Ainy University Hospital. The study population consisted of 200 eligible pregnant women, screened and recruited from pregnant women seeking management for symptomatic UTI or for routine prenatal care. Results: In total of 200 pregnant women referred to prenatal care clinics, 100 pregnant women with UTI (case group) and 100 pregnant women without UTI (control group). Serum vitamin D levels were significantly lower in the cases compared to the control group (14.51 ± 5.32 versus 18.7 ± 7.05; p <0.001). The multivariate logistic regression analysis shows the association between adjusted risk factors (age, BMI, education, frequency of intercourse and serum vitamin D levels) and UTI. Deficient serum vitamin D levels was significantly associated with a risk of UTI in pregnant women (OR = 0.221; 95% CI: 0.100-0.487) after adjusting for these confounders Conclusion: Vitamin D deficiency has a significant and direct relationship with the prevalence of UTI in pregnant women. RCTs are needed to assess the optimum vitamin D threshold, and to assess levels that could prevent the complication of UTI in pregnant women.
背景:妊娠期尿路感染(UTI)是常见的，这是由于妊娠期生理、免疫和激素变化的独特状态，膀胱输尿管反流增加以及子宫引起的尿路阻塞。维生素D对人体健康很重要，在怀孕期间尤为重要。据估计，三分之一的人口患有维生素D缺乏症。最近的研究集中在维生素D缺乏对先天和适应性免疫系统的影响上。维生素D已被发现能增强先天免疫系统目的:本研究旨在探讨孕妇血清维生素D水平与尿路感染之间的联系。材料和方法:2020年9月至2021年6月在Kasr Al-Ainy大学医院产前护理诊所进行的病例对照研究。研究人群包括200名符合条件的孕妇，从寻求症状性尿路感染管理或常规产前护理的孕妇中筛选和招募。结果:共有200名孕妇转诊到产前保健诊所，其中有尿路感染的孕妇100名(病例组)，无尿路感染的孕妇100名(对照组)。患者血清维生素D水平显著低于对照组(14.51±5.32 vs 18.7±7.05;p < 0.001)。多因素logistic回归分析显示调整后的危险因素(年龄、BMI、教育程度、性交频率和血清维生素D水平)与UTI之间存在相关性。血清维生素D水平缺乏与孕妇尿路感染风险显著相关(OR = 0.221;95% CI: 0.100-0.487)。结论:维生素D缺乏与孕妇尿路感染的患病率有显著的直接关系。需要随机对照试验来评估最佳维生素D阈值，并评估可以预防孕妇尿路感染并发症的水平。
{"title":"The correlation between serum vitamin D and urinary tract infection in pregnant woman: A case control study","authors":"J. Sadek, M. Soliman","doi":"10.21608/ebwhj.2021.110185.1160","DOIUrl":"https://doi.org/10.21608/ebwhj.2021.110185.1160","url":null,"abstract":"Background: Urinary tract infection (UTI) during pregnancy is common due to a unique state of physiological, immunological and hormonal changes, increased vesicoureteral reflux and urinary tract obstruction by the uterus. Vitamin D is important for human health, being more crucial during pregnancy. A third of the population are estimated to suffer from Vitamin D deficiency. Studies recently have been focused on the effect of vitamin D deficiency on the immune system, both the innate and adaptive. Vitamin D has been found to enhance the innate immune system Aim: We aim in this study to investigate the link between serum vitamin D levels and UTI in pregnant women. Materials and Methods: A case control study conducted between September 2020 and June 2021 at the prenatal care clinic of the Kasr Al-Ainy University Hospital. The study population consisted of 200 eligible pregnant women, screened and recruited from pregnant women seeking management for symptomatic UTI or for routine prenatal care. Results: In total of 200 pregnant women referred to prenatal care clinics, 100 pregnant women with UTI (case group) and 100 pregnant women without UTI (control group). Serum vitamin D levels were significantly lower in the cases compared to the control group (14.51 ± 5.32 versus 18.7 ± 7.05; p <0.001). The multivariate logistic regression analysis shows the association between adjusted risk factors (age, BMI, education, frequency of intercourse and serum vitamin D levels) and UTI. Deficient serum vitamin D levels was significantly associated with a risk of UTI in pregnant women (OR = 0.221; 95% CI: 0.100-0.487) after adjusting for these confounders Conclusion: Vitamin D deficiency has a significant and direct relationship with the prevalence of UTI in pregnant women. RCTs are needed to assess the optimum vitamin D threshold, and to assess levels that could prevent the complication of UTI in pregnant women.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82153059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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