Pub Date : 2024-02-01DOI: 10.21608/ebwhj.2024.259962.1287
Ahmed Fathy, Yahya Edris, Heba Abdel Razik
Background: Poor ovarian response is defined as the collection of three or fewer oocytes in two prior ovarian stimulation cycles, or collection of three or fewer oocytes in a single stimulation cycle from a woman who is over 40 years of age, or collection of three or fewer oocytes in a single stimulation cycle and an abnormal ovarian reserve test. We aimed to determine if in poor responders’ patients, the SAS stimulation protocol allows for a better number of oocytes, mature oocytes, total embryos at D2 and usable embryos in comparison with the last previous IVF attempt within the same patients. Materials and Methods: We performed a prospective observational study on 56 women aged ≥ 18 and < 43 years who undergo an IVF protocol with the “short agonist stop” (SAS) protocol compared with the same patients’ previous performance in their last IVF attempt. Enrolled patients were treated in two consecutive cycles. The first attempt was achieved with a standard protocol. Patients for whom the standard protocol has failed were treated in the subsequent cycle with the SAS protocol. Results: Regarding the cumulative outcomes, ongoing pregnancy rate was significantly higher in SAS protocol compared to IVF protocol (0% vs. 12.5%, P=0.026 ). Number of cumulative ET, cancellation before oocyte pick, no usable embryo, biochemical pregnancy, and miscarriage rate were insignificantly different between both protocols. Conclusion : The SAS stimulation protocol may offer promising results for poor responders with low prognosis and previous failed IVF.
{"title":"Assessment of The Results of Short Agonist Stop Ovarian Stimulation Protocol in Poor Responder Patients Undergoing ICSI Cycles","authors":"Ahmed Fathy, Yahya Edris, Heba Abdel Razik","doi":"10.21608/ebwhj.2024.259962.1287","DOIUrl":"https://doi.org/10.21608/ebwhj.2024.259962.1287","url":null,"abstract":"Background: Poor ovarian response is defined as the collection of three or fewer oocytes in two prior ovarian stimulation cycles, or collection of three or fewer oocytes in a single stimulation cycle from a woman who is over 40 years of age, or collection of three or fewer oocytes in a single stimulation cycle and an abnormal ovarian reserve test. We aimed to determine if in poor responders’ patients, the SAS stimulation protocol allows for a better number of oocytes, mature oocytes, total embryos at D2 and usable embryos in comparison with the last previous IVF attempt within the same patients. Materials and Methods: We performed a prospective observational study on 56 women aged ≥ 18 and < 43 years who undergo an IVF protocol with the “short agonist stop” (SAS) protocol compared with the same patients’ previous performance in their last IVF attempt. Enrolled patients were treated in two consecutive cycles. The first attempt was achieved with a standard protocol. Patients for whom the standard protocol has failed were treated in the subsequent cycle with the SAS protocol. Results: Regarding the cumulative outcomes, ongoing pregnancy rate was significantly higher in SAS protocol compared to IVF protocol (0% vs. 12.5%, P=0.026 ). Number of cumulative ET, cancellation before oocyte pick, no usable embryo, biochemical pregnancy, and miscarriage rate were insignificantly different between both protocols. Conclusion : The SAS stimulation protocol may offer promising results for poor responders with low prognosis and previous failed IVF.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"37 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140464751","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 : 2024-02-01DOI: 10.21608/ebwhj.2023.246473.1273
ahmed khedr, Kariem El Etriby, Mariam Afifi
Objective: To assess the efficacy and safety of 20 ml of 1 % buffered lidocaine paracervical block to reduce pain during IUCD placement. Materials and Methods: In randomized single blinded controlled trial, women were assigned to receive either a 20 ml buffered lidocaine or no block before IUCD insertion. Enrollment occurred at family planning clinic, Badr University Hospital. The primary outcome was pain measured with a 100-mm visual analogue scale in various steps of IUD insertion. Results: From January to july 2021, 138 women were enrolled and distributed randomly into two equal groups: group I (intervention group) included 70 women received paracervical block before IUCD insertion in form of lidocaine injection, and group II (no intervention) included 68 women. There were no differences in demographic characteristics of both groups. Women who received the paracervical block reported less pain with IUD insertion compared to women who received no block( median VAS score of 20.9 mm versus 37.4 mm, p<0.001 ). Pain with tenaculum placement was less in intervention group (28.9mm versus 58.4mm, p <0.001 ). Pain with paracervical block administration was higher for intervention group compared to the no paracervical block group (18.4mm versus 10.9mm, p<0.001 ). The mean pain intensity felt 5 minutes after IUD placement was (5.9mm versus 16.9mm, p<0.001 ) which is statistically significant. The intensity of pain was similar and there was no statistically significant difference in the median VAS scores at baseline pain or pain with speculum insertion (51mm compared with 53.4 mm, p= 0.196 ). Conclusion : 20 ml lidocaine 1% paracervical block prior to copper T380A IUD insertion significantly decrease the related pain perception when compared with no block group.
{"title":"Efficacy and Safety of Paracervical Block in Reducing Intrauterine Device Insertion Related Pain : A Randomized Controlled Trial","authors":"ahmed khedr, Kariem El Etriby, Mariam Afifi","doi":"10.21608/ebwhj.2023.246473.1273","DOIUrl":"https://doi.org/10.21608/ebwhj.2023.246473.1273","url":null,"abstract":"Objective: To assess the efficacy and safety of 20 ml of 1 % buffered lidocaine paracervical block to reduce pain during IUCD placement. Materials and Methods: In randomized single blinded controlled trial, women were assigned to receive either a 20 ml buffered lidocaine or no block before IUCD insertion. Enrollment occurred at family planning clinic, Badr University Hospital. The primary outcome was pain measured with a 100-mm visual analogue scale in various steps of IUD insertion. Results: From January to july 2021, 138 women were enrolled and distributed randomly into two equal groups: group I (intervention group) included 70 women received paracervical block before IUCD insertion in form of lidocaine injection, and group II (no intervention) included 68 women. There were no differences in demographic characteristics of both groups. Women who received the paracervical block reported less pain with IUD insertion compared to women who received no block( median VAS score of 20.9 mm versus 37.4 mm, p<0.001 ). Pain with tenaculum placement was less in intervention group (28.9mm versus 58.4mm, p <0.001 ). Pain with paracervical block administration was higher for intervention group compared to the no paracervical block group (18.4mm versus 10.9mm, p<0.001 ). The mean pain intensity felt 5 minutes after IUD placement was (5.9mm versus 16.9mm, p<0.001 ) which is statistically significant. The intensity of pain was similar and there was no statistically significant difference in the median VAS scores at baseline pain or pain with speculum insertion (51mm compared with 53.4 mm, p= 0.196 ). Conclusion : 20 ml lidocaine 1% paracervical block prior to copper T380A IUD insertion significantly decrease the related pain perception when compared with no block group.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"61 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140464020","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 : 2024-02-01DOI: 10.21608/ebwhj.2024.259001.1284
Ahmed K.Abbas, Wael Naeem, omar k.Naser, labiba Elsayed, Heba Khattab, Ali A.Bendary
Background: Recurrent pregnancy failure in second trimester is defined as three or more losses although most authors consider clinical treatment with 2 consecutive miscarriages at 14-18 weeks of gestation. Preterm births are more likely to occur in future pregnancies for women who have previously experienced cervical incompetence. Objective: The study's objective was to determine whether double cervical cerclage had any impact on perinatal outcomes and preterm delivery prevention in women who had experienced second-trimester foetal loss. Materials and Methods: This interventional prospective randomized controlled study included patients who attended the Outpatient Clinic with suspected cervical incompetence either by previous obstetric history or by ultrasound examination with gestational age between 14 and 18 weeks. The patients were randomly allocated into 2 groups; group 1 included 20 patients who had traditional modified MacDonald operation using a 5 mm mersilene tape in the middle third of the cervix and group 2 included 20 matched patients who had double cervical cerclage with two purse-string sutures using two 5 mm mersilene tapes; in the upper and lower third of the cervix. Results: There was no significant difference between the double cervical and single cervical group regarding weight of the baby at birth, GA at delivery, abortion, mode of delivery and admission of baby to NICU. There was no significnat difference between both groups regarding hematuria, hospital stay (hours) and neonatal death after operation ( p > 0.05 ). Conclusion : Women with cervical incompetence who undergo double cervical cerclage do not experience better perinatal or maternal outcomes.
{"title":"Effectiveness of Double Cervical Cerclage in Women with at Least One Previous Pregnancy Loss in the Second Trimester","authors":"Ahmed K.Abbas, Wael Naeem, omar k.Naser, labiba Elsayed, Heba Khattab, Ali A.Bendary","doi":"10.21608/ebwhj.2024.259001.1284","DOIUrl":"https://doi.org/10.21608/ebwhj.2024.259001.1284","url":null,"abstract":"Background: Recurrent pregnancy failure in second trimester is defined as three or more losses although most authors consider clinical treatment with 2 consecutive miscarriages at 14-18 weeks of gestation. Preterm births are more likely to occur in future pregnancies for women who have previously experienced cervical incompetence. Objective: The study's objective was to determine whether double cervical cerclage had any impact on perinatal outcomes and preterm delivery prevention in women who had experienced second-trimester foetal loss. Materials and Methods: This interventional prospective randomized controlled study included patients who attended the Outpatient Clinic with suspected cervical incompetence either by previous obstetric history or by ultrasound examination with gestational age between 14 and 18 weeks. The patients were randomly allocated into 2 groups; group 1 included 20 patients who had traditional modified MacDonald operation using a 5 mm mersilene tape in the middle third of the cervix and group 2 included 20 matched patients who had double cervical cerclage with two purse-string sutures using two 5 mm mersilene tapes; in the upper and lower third of the cervix. Results: There was no significant difference between the double cervical and single cervical group regarding weight of the baby at birth, GA at delivery, abortion, mode of delivery and admission of baby to NICU. There was no significnat difference between both groups regarding hematuria, hospital stay (hours) and neonatal death after operation ( p > 0.05 ). Conclusion : Women with cervical incompetence who undergo double cervical cerclage do not experience better perinatal or maternal outcomes.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"310 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140468992","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 : 2024-02-01DOI: 10.21608/ebwhj.2024.263463.1292
Manal Moussa, Athar Shaaban, Yahia Elfaissal, Ahmed Kamel, Bassiony Bassiony
Objectives: To determine the role of normalization of FSH/LH ratio on the response to induction of ovulation and pregnancy rate in patients with polycystic ovarian disease. Materials and Methods: This is a randomized controlled trial including 126 infertile women with PCOS attending to infertility clinic, Kasr Al-Ainy Maternity Hospital, Faculty of Medicine, Cairo University, from December 2021 until May 2022. Patients were divided into 2 equal groups: - Group A (63 women): received OCPs for 3 successive cycles and after withdrawal bleeding of last cycle received clomiphene citrate 100 mg tablet orally started on 2 nd day to 6 th day of the cycle for five consecutive days for another 3 cycles. - Group B (63 women): didn’t receive pre-treatment OCPs. Results: The rate of normalization of FSH/LH ratio after COC pills was higher in group A 51/63 (81.0%). Ovulation rate, endometrial thickness at the day of HCG injection and clinical pregnancy rate after induction of ovulation were statistically significant higher in group A compared with group B. Also, total doses of gonadotropin used and percent of cases needed gonadotropin using for induction of ovulation were statistically significant lower in group A compared with group B. Conclusion : In infertile PCOS patients, normalization of FSH/LH ratio in by using of a short pretreatment course of COCs could be used as it was proved to enhance ovulation rate, endometrial thickness at the day of HCG injection and clinical pregnancy rate. Also, it decreases need for using and total doses of gonadotropin and its side effects.
{"title":"The Effect of Normalization of FSH/LH Ratio on the Response to Induction of Ovulation and Pregnancy Rate in Polycystic Ovary Syndrome Patients","authors":"Manal Moussa, Athar Shaaban, Yahia Elfaissal, Ahmed Kamel, Bassiony Bassiony","doi":"10.21608/ebwhj.2024.263463.1292","DOIUrl":"https://doi.org/10.21608/ebwhj.2024.263463.1292","url":null,"abstract":"Objectives: To determine the role of normalization of FSH/LH ratio on the response to induction of ovulation and pregnancy rate in patients with polycystic ovarian disease. Materials and Methods: This is a randomized controlled trial including 126 infertile women with PCOS attending to infertility clinic, Kasr Al-Ainy Maternity Hospital, Faculty of Medicine, Cairo University, from December 2021 until May 2022. Patients were divided into 2 equal groups: - Group A (63 women): received OCPs for 3 successive cycles and after withdrawal bleeding of last cycle received clomiphene citrate 100 mg tablet orally started on 2 nd day to 6 th day of the cycle for five consecutive days for another 3 cycles. - Group B (63 women): didn’t receive pre-treatment OCPs. Results: The rate of normalization of FSH/LH ratio after COC pills was higher in group A 51/63 (81.0%). Ovulation rate, endometrial thickness at the day of HCG injection and clinical pregnancy rate after induction of ovulation were statistically significant higher in group A compared with group B. Also, total doses of gonadotropin used and percent of cases needed gonadotropin using for induction of ovulation were statistically significant lower in group A compared with group B. Conclusion : In infertile PCOS patients, normalization of FSH/LH ratio in by using of a short pretreatment course of COCs could be used as it was proved to enhance ovulation rate, endometrial thickness at the day of HCG injection and clinical pregnancy rate. Also, it decreases need for using and total doses of gonadotropin and its side effects.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"28 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465441","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 : 2024-02-01DOI: 10.21608/ebwhj.2024.259952.1286
Ashraf Elmantwe, Yehia Edris
Objective: To compare perioperative outcomes in women with one or more Cesarean section (CS) who underwent Total vaginal hysterectomy (TVH) compared to who underwent total abdominal hysterectomy (TAH) for non-prolapse indications. Materials and Methods: A retrospective observational cohort analysis included 335 women with previous ≥ one CS underwent hysterectomy (HR) performed between January 2015 and March 2023 in Benha university hospital and private center comparing the outcomes between non-descent vaginal hysterectomy (NDVH) and TAH. The NDVH group (study group) included 155 women with previous ≥ one CS who underwent TVH for non-prolapse indications. The TAH group (control group) included 180 women with previous ≥ one CS who underwent TAH for non-prolapse indications. Both groups were evaluated statistically to detect differences in pre-, intra-, and post-operative demographic characteristics as well as clinical parameters and complications. Results: Both index and study groups participants had were comparable as regards age, parity, pre-operative mean hemoglobin levels, associated comorbidities, previous CS numbers and similar indications for hysterectomy, but higher statistical preoperative HBA1c and shorter preoperative hospital administration( p<0.0001 ) supporting the NDVH group over the TAH group. There were no difference between the study and the control groups respecting operative time ,blood loss , removed uterine weight, intra-operative complications, need for blood transfusion and rates of incidental cystotomy ( p>0.05 ).while there was a high statistical differences ( p<0.0001 ) toward outcomes of NDVH over TAH including need for additional general anesthesia intraoperatively, shorter postoperative hospital stay, wound complications, less consumption of analgesic and lower amount as well as shorter need for postoperative venous thromboembolic prophylaxis (VTE) ,earlier ambulation, earlier to pass flatus ,earlier return to daily activity and the lower need to reoperate for wound related complication. Conclusion : In women with previous ≥ one CS with non-prolapsed uteri who in need later on their life for hysterectomy, NDVH is a safe choice, and the real gynecologists shouldn’t considered any more the previous CS even repeated CS as a contraindication to utilize the vaginal route for hysterectomy, even more recommending the NDVH practice as the perioperative parameters are appeasing NDVH over TAH especially regarding wound related complication.
{"title":"Outcomes of Hysterectomy in Women with Prior Cesarean Section: Retrospective Analysis of Non-Descent Vaginal Hysterectomy (NDVH) Versus Abdominal Hysterectomy (TAH) in Benha University Hospital","authors":"Ashraf Elmantwe, Yehia Edris","doi":"10.21608/ebwhj.2024.259952.1286","DOIUrl":"https://doi.org/10.21608/ebwhj.2024.259952.1286","url":null,"abstract":"Objective: To compare perioperative outcomes in women with one or more Cesarean section (CS) who underwent Total vaginal hysterectomy (TVH) compared to who underwent total abdominal hysterectomy (TAH) for non-prolapse indications. Materials and Methods: A retrospective observational cohort analysis included 335 women with previous ≥ one CS underwent hysterectomy (HR) performed between January 2015 and March 2023 in Benha university hospital and private center comparing the outcomes between non-descent vaginal hysterectomy (NDVH) and TAH. The NDVH group (study group) included 155 women with previous ≥ one CS who underwent TVH for non-prolapse indications. The TAH group (control group) included 180 women with previous ≥ one CS who underwent TAH for non-prolapse indications. Both groups were evaluated statistically to detect differences in pre-, intra-, and post-operative demographic characteristics as well as clinical parameters and complications. Results: Both index and study groups participants had were comparable as regards age, parity, pre-operative mean hemoglobin levels, associated comorbidities, previous CS numbers and similar indications for hysterectomy, but higher statistical preoperative HBA1c and shorter preoperative hospital administration( p<0.0001 ) supporting the NDVH group over the TAH group. There were no difference between the study and the control groups respecting operative time ,blood loss , removed uterine weight, intra-operative complications, need for blood transfusion and rates of incidental cystotomy ( p>0.05 ).while there was a high statistical differences ( p<0.0001 ) toward outcomes of NDVH over TAH including need for additional general anesthesia intraoperatively, shorter postoperative hospital stay, wound complications, less consumption of analgesic and lower amount as well as shorter need for postoperative venous thromboembolic prophylaxis (VTE) ,earlier ambulation, earlier to pass flatus ,earlier return to daily activity and the lower need to reoperate for wound related complication. Conclusion : In women with previous ≥ one CS with non-prolapsed uteri who in need later on their life for hysterectomy, NDVH is a safe choice, and the real gynecologists shouldn’t considered any more the previous CS even repeated CS as a contraindication to utilize the vaginal route for hysterectomy, even more recommending the NDVH practice as the perioperative parameters are appeasing NDVH over TAH especially regarding wound related complication.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"522 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469880","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 : 2024-02-01DOI: 10.21608/ebwhj.2024.259945.1285
Nehal El-Demiry, S. Elsirgany, M. Moussa, A. Wahba
Objective: Placental involvement in pregnant women with covid–19 has been proved by postnatal histopathological examination in many studies even in absence of fetal infection. Whether this placental involvement can be detected prenatally using ultrasonography has not been investigated. Materials and Methods: This is a cross-sectional study including 40 women attending for second trimester scan divided into two groups; Group A (pregnant women with mild Covid-19 infection requiring home isolation), Group B (control group). Three-dimensional (3-D) power Doppler ultrasonography of the placenta using VOCAL technique, calculating the placental volume and placental vascular indices including Flow Index (FI), VI (Vascularity index), VFI (Vascularity flow index). The Pulsatility index (PI) of the uterine artery was also measured. Results: Baseline characteristics were similar between both groups. Placental volume was significantly higher in Covid group than control group. Mean FI was significantly less while VI and VFI were higher in Covid group compared to control group. Uterine artery doppler did not show any differences between both groups. Conclusion : Mild Covid-19 infection can have an impact on placental volume and placental vascularity and perfusion observed by three-dimensional ultrasonography. In mild cases, whether these changes are transient or permanent, and whether it can have an impact on pregnancy outcomes need to be investigated in future research.
{"title":"Can Three-Dimensional Power Doppler Detect Placental Involvement in pregnant women with COVID-19? An observational study","authors":"Nehal El-Demiry, S. Elsirgany, M. Moussa, A. Wahba","doi":"10.21608/ebwhj.2024.259945.1285","DOIUrl":"https://doi.org/10.21608/ebwhj.2024.259945.1285","url":null,"abstract":"Objective: Placental involvement in pregnant women with covid–19 has been proved by postnatal histopathological examination in many studies even in absence of fetal infection. Whether this placental involvement can be detected prenatally using ultrasonography has not been investigated. Materials and Methods: This is a cross-sectional study including 40 women attending for second trimester scan divided into two groups; Group A (pregnant women with mild Covid-19 infection requiring home isolation), Group B (control group). Three-dimensional (3-D) power Doppler ultrasonography of the placenta using VOCAL technique, calculating the placental volume and placental vascular indices including Flow Index (FI), VI (Vascularity index), VFI (Vascularity flow index). The Pulsatility index (PI) of the uterine artery was also measured. Results: Baseline characteristics were similar between both groups. Placental volume was significantly higher in Covid group than control group. Mean FI was significantly less while VI and VFI were higher in Covid group compared to control group. Uterine artery doppler did not show any differences between both groups. Conclusion : Mild Covid-19 infection can have an impact on placental volume and placental vascularity and perfusion observed by three-dimensional ultrasonography. In mild cases, whether these changes are transient or permanent, and whether it can have an impact on pregnancy outcomes need to be investigated in future research.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"379 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466061","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 : 2024-02-01DOI: 10.21608/ebwhj.2023.251942.1279
Mahmoud Abdelhameed, Heba El Sawah, Marwa Sharaf, El Sayed Omran, Sally El Attar
Background: Misoprostol applied vaginally has been shown to be an effective method of inducing labor; nevertheless, pregnant women may be resistant to digital examination and there is a possibility of infection. Therefore, oral misoprostol was attempted to induce labor. Objective: The aim of this study was to evaluate the safety and effectiveness of vaginal versus oral misoprostol for inducing labor in nulliparous women at or after 41 completed weeks of pregnancy. Materials and Methods: Eighty nulliparous women, divided into two groups, were eligible for labor induction at 41 weeks or more. In Group 1, 40 pregnant women got 25 μg vaginal misoprostol every six hours until a response was achieved, with a maximum of four doses. For Group 2, 40 pregnant women took oral misoprostol at a dose of 25 μg every six hours until a response was obtained, with a maximum of four doses. Results: Oral and vaginal misoprostol were comparable regarding the duration from inducing labor to onset of the active stage, interval from inducing labor to the delivery, cesarean deliveries, dosage requirements, and maternal and neonatal outcomes. However, the process of labor augmentation with oxytocin was dramatically reduced in the vaginal group. Conclusion : 25 μg oral misoprostol is as effective and safe as 25 μg vaginal misoprostol for inducing labor in nulliparous women with an unripe cervix at or beyond completed 41 weeks.
{"title":"Comparative Study Between Oral and Vaginal Misoprostol for Induction of Labor in Nulliparous Pregnant Women at or Beyond Completed 41 Weeks","authors":"Mahmoud Abdelhameed, Heba El Sawah, Marwa Sharaf, El Sayed Omran, Sally El Attar","doi":"10.21608/ebwhj.2023.251942.1279","DOIUrl":"https://doi.org/10.21608/ebwhj.2023.251942.1279","url":null,"abstract":"Background: Misoprostol applied vaginally has been shown to be an effective method of inducing labor; nevertheless, pregnant women may be resistant to digital examination and there is a possibility of infection. Therefore, oral misoprostol was attempted to induce labor. Objective: The aim of this study was to evaluate the safety and effectiveness of vaginal versus oral misoprostol for inducing labor in nulliparous women at or after 41 completed weeks of pregnancy. Materials and Methods: Eighty nulliparous women, divided into two groups, were eligible for labor induction at 41 weeks or more. In Group 1, 40 pregnant women got 25 μg vaginal misoprostol every six hours until a response was achieved, with a maximum of four doses. For Group 2, 40 pregnant women took oral misoprostol at a dose of 25 μg every six hours until a response was obtained, with a maximum of four doses. Results: Oral and vaginal misoprostol were comparable regarding the duration from inducing labor to onset of the active stage, interval from inducing labor to the delivery, cesarean deliveries, dosage requirements, and maternal and neonatal outcomes. However, the process of labor augmentation with oxytocin was dramatically reduced in the vaginal group. Conclusion : 25 μg oral misoprostol is as effective and safe as 25 μg vaginal misoprostol for inducing labor in nulliparous women with an unripe cervix at or beyond completed 41 weeks.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"823 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465907","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 : 2023-11-01DOI: 10.21608/ebwhj.2023.231834.1260
Sally Mohammed Khashaba, Osama Warda, Ahmed Gibreel, Maher Elesawi
Objective: Despite the availability of interventions for controlling bleeding during myomectomy, the superiority of one over another is still unclear. Materials and Methods: This prospective study was conducted at Mansoura University Hospital, Mansoura, Egypt, between July 2019 and July 2021, after approval from the Mansoura Faculty of Medicine Institutional Research Board (IRB: MS.19.05.629) on 40 cases divided into two equal groups. Patients in the tourniquet group: A Foley catheter of 16F size surrounded the cervix at the level of the internal os and tightened to occlude the uterine arteries. The epinephrine group: a solution of 1/250,000 epinephrine )produced by dilution of 1 ampule epinephrine(1mg/1ml Epinephrine: chemical industries development (CID), Giza, Egypt) in 250 ml saline( was infiltrated at the myoma bed and beneath the covering myometrium until the infiltrated areas became paler. Results: The blood loss was significantly lower in the epinephrine group (362.50± 61.12) versus (452.95± 70.72) ( p < 0.001). Blood transfusion was non significantly higher in the tourniquet group (55%) versus (25%) ( p = 0.053). The operative time was considerably shorter ( p < 0.001) in the epinephrine group (36.65±4.38) compared with the tourniquet group (41.65±3.77). The hospital stay wasn’t statistically longer in the tourniquet group compared to the epinephrine group (2(1-3)) (1(1-2)) respectively, ( p = 0.147. Fortunately, no cases of hysterectomy or relaparotomy in both groups. Conclusion: Injecting Epinephrine during myomectomy reduces intraoperative blood loss and blood transfusion and shortens the operative time.
{"title":"Local Epinephrine Versus Uterine Artery Tourniquet to Reduce Bleeding During Myomectomy: A Prospective Clinical Trial","authors":"Sally Mohammed Khashaba, Osama Warda, Ahmed Gibreel, Maher Elesawi","doi":"10.21608/ebwhj.2023.231834.1260","DOIUrl":"https://doi.org/10.21608/ebwhj.2023.231834.1260","url":null,"abstract":"Objective: Despite the availability of interventions for controlling bleeding during myomectomy, the superiority of one over another is still unclear. Materials and Methods: This prospective study was conducted at Mansoura University Hospital, Mansoura, Egypt, between July 2019 and July 2021, after approval from the Mansoura Faculty of Medicine Institutional Research Board (IRB: MS.19.05.629) on 40 cases divided into two equal groups. Patients in the tourniquet group: A Foley catheter of 16F size surrounded the cervix at the level of the internal os and tightened to occlude the uterine arteries. The epinephrine group: a solution of 1/250,000 epinephrine )produced by dilution of 1 ampule epinephrine(1mg/1ml Epinephrine: chemical industries development (CID), Giza, Egypt) in 250 ml saline( was infiltrated at the myoma bed and beneath the covering myometrium until the infiltrated areas became paler. Results: The blood loss was significantly lower in the epinephrine group (362.50± 61.12) versus (452.95± 70.72) ( p < 0.001). Blood transfusion was non significantly higher in the tourniquet group (55%) versus (25%) ( p = 0.053). The operative time was considerably shorter ( p < 0.001) in the epinephrine group (36.65±4.38) compared with the tourniquet group (41.65±3.77). The hospital stay wasn’t statistically longer in the tourniquet group compared to the epinephrine group (2(1-3)) (1(1-2)) respectively, ( p = 0.147. Fortunately, no cases of hysterectomy or relaparotomy in both groups. Conclusion: Injecting Epinephrine during myomectomy reduces intraoperative blood loss and blood transfusion and shortens the operative time.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139297450","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 : 2023-11-01DOI: 10.21608/ebwhj.2021.76595.1137
Wagdy Amer, Hamasat A Alnoury
Objectives: Evaluation of the effect of 8-wk supplemental therapy (ST) with vitamin D (VD), vitamin E (VE) and calcium on clinical and laboratory findings of women with polycystic ovary syndrome (PCOS). Patients & Methods: 67 PCOS women fulfilling at least two of the Rotterdam criteria were evaluated clinically and by ultrasonography and gave blood sample for estimation of serum total cholesterol (TC), triglyceride (TG), low-density and high-density lipoprotein-cholesterol (LDL-c & HDL-c), insulin, total testosterone and dehydroepiandrosterone sulfate (DHEA-S) and ELISA estimation of VD, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, superoxide dismutase (SOD) and malonaldehyde (MDA). All patients received 8-wk ST consisted of daily dose of VD and VE and calcium citrate twice daily, and re-evaluated thereafter (T2). Study outcome was the extent of change in clinical, US and laboratory data obtained at T2 in relation to T1 data. Results: At T1, all studied PCOS women had vitamin D deficiency (VDD) and high serum levels of TC, TG, LDL-c, testosterone, DHEA-S, insulin, MDA, TNF-α and IL-1β, but had low levels of HDL-c and SOD. At T2, all parameters were improved. Spearman's correlation showed negative significant correlations between the extent of change in serum 25OH-VD level and changes of clinical and other laboratory finings and a positive significant correlation with SOD activity level. Regression analysis defined decreases of HOMA-IR score, IL-β and serum TG as the significant predictor for decreased ovarian diameter, while decreases in serum levels of cholesterol, MDA, IL-1β were defined as the predictors for decreased serum testosterone and provision of ST was the significant predictor for increased activity levels of SOD. Conclusion: PCOS is associated with disturbed immune and redox statuses in conjunction with metabolic and hormonal disturbances. Supplemental therapy with VD, VE and Calcium significantly improved these disturbances with minimal effect on body mass index.
{"title":"Vitamin D & E Supplemental Therapy could reduce Insulin resistance and control PCOS-specific Inflammatory and Oxidative Stresses","authors":"Wagdy Amer, Hamasat A Alnoury","doi":"10.21608/ebwhj.2021.76595.1137","DOIUrl":"https://doi.org/10.21608/ebwhj.2021.76595.1137","url":null,"abstract":"Objectives: Evaluation of the effect of 8-wk supplemental therapy (ST) with vitamin D (VD), vitamin E (VE) and calcium on clinical and laboratory findings of women with polycystic ovary syndrome (PCOS). Patients & Methods: 67 PCOS women fulfilling at least two of the Rotterdam criteria were evaluated clinically and by ultrasonography and gave blood sample for estimation of serum total cholesterol (TC), triglyceride (TG), low-density and high-density lipoprotein-cholesterol (LDL-c & HDL-c), insulin, total testosterone and dehydroepiandrosterone sulfate (DHEA-S) and ELISA estimation of VD, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, superoxide dismutase (SOD) and malonaldehyde (MDA). All patients received 8-wk ST consisted of daily dose of VD and VE and calcium citrate twice daily, and re-evaluated thereafter (T2). Study outcome was the extent of change in clinical, US and laboratory data obtained at T2 in relation to T1 data. Results: At T1, all studied PCOS women had vitamin D deficiency (VDD) and high serum levels of TC, TG, LDL-c, testosterone, DHEA-S, insulin, MDA, TNF-α and IL-1β, but had low levels of HDL-c and SOD. At T2, all parameters were improved. Spearman's correlation showed negative significant correlations between the extent of change in serum 25OH-VD level and changes of clinical and other laboratory finings and a positive significant correlation with SOD activity level. Regression analysis defined decreases of HOMA-IR score, IL-β and serum TG as the significant predictor for decreased ovarian diameter, while decreases in serum levels of cholesterol, MDA, IL-1β were defined as the predictors for decreased serum testosterone and provision of ST was the significant predictor for increased activity levels of SOD. Conclusion: PCOS is associated with disturbed immune and redox statuses in conjunction with metabolic and hormonal disturbances. Supplemental therapy with VD, VE and Calcium significantly improved these disturbances with minimal effect on body mass index.","PeriodicalId":12080,"journal":{"name":"Evidence Based Women's Health Journal","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139303121","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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