Pub Date : 2020-02-01DOI: 10.21608/ebwhj.2019.18307.1042
I. Hussein, Ahmed Abdel Shafy, H. Awwad
Background: This study aimed to evaluate the effect of metformin on early pregnancy loss (EPL) in pregnant women with olycystic ovary syndrome (PCOS).Patients and Methods: A randomized clinical trial (Clinicaltrials.gov NCT 02498522) was conducted in Ain-Shams Maternity Hospital in the period between August 2018 and July 2019. One hundred and sixty six women previously diagnosed with PCOS and got pregnant with induction of ovulation in concomitance with Metformin were randomized either Metformin 500 mg orally every 8 hours until the end of the 1st trimester or not receiving Metformin. The primary outcome is to observe any significant decline in the incidence of EPL in PCOS patients after administration of Metformin through out 1st trimester.Results: There was a significant reduction in miscarriage rate after administration of Metformin during 1st trimester. Introduction of Metformin helped pregnancy loss rate to drop to 10.8% while the rate in the group discontinued Metformin was 42.2% (p < 0.05). The side effects rate as nausea, vomiting, gastric irritation and flatulence was significantly higher in the Metformin group.Conclusion: The use of Metformin in patients with PCOS during 1st trimester reduces the incidence of early pregnancy loss (EPL).
{"title":"The Role of Metformin for Prevention of First Trimesteric Miscarriage in Women With Polycystic Ovary Syndrome: A Randomized Controlled Trial","authors":"I. Hussein, Ahmed Abdel Shafy, H. Awwad","doi":"10.21608/ebwhj.2019.18307.1042","DOIUrl":"https://doi.org/10.21608/ebwhj.2019.18307.1042","url":null,"abstract":"Background: This study aimed to evaluate the effect of metformin on early pregnancy loss (EPL) in pregnant women with olycystic ovary syndrome (PCOS).Patients and Methods: A randomized clinical trial (Clinicaltrials.gov NCT 02498522) was conducted in Ain-Shams Maternity Hospital in the period between August 2018 and July 2019. One hundred and sixty six women previously diagnosed with PCOS and got pregnant with induction of ovulation in concomitance with Metformin were randomized either Metformin 500 mg orally every 8 hours until the end of the 1st trimester or not receiving Metformin. The primary outcome is to observe any significant decline in the incidence of EPL in PCOS patients after administration of Metformin through out 1st trimester.Results: There was a significant reduction in miscarriage rate after administration of Metformin during 1st trimester. Introduction of Metformin helped pregnancy loss rate to drop to 10.8% while the rate in the group discontinued Metformin was 42.2% (p < 0.05). The side effects rate as nausea, vomiting, gastric irritation and flatulence was significantly higher in the Metformin group.Conclusion: The use of Metformin in patients with PCOS during 1st trimester reduces the incidence of early pregnancy loss (EPL).","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"201 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124503033","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 : 2020-02-01DOI: 10.21608/ebwhj.2019.18167.1040
Aly Elyan Khalaf Allah, S. Elmekkawi, A. Megahed, Ahmed Hamed Megahed
ABSTRACT Objective: This study is designed to assess the accuracy of Body Mass Index, waist circumference, waist Hip Ratio or Waist Height Ratio as a predictor of ovarian response in women undergoing ICSI. Patients and Methods: This Pilot study was done at Clinical IVF and ART unit at Faculty of Medicine, Ain-Shams University Hospital, Number of Participant women 150. Results and Conclusion: The anthropometric measures, only the waist circumference, waist/hip ratio and waist/height ratio were related to ovarian response (p-value = 0.014, 0.004 and 0.020, respectively) and to the occurrence of clinical pregnancy (p-value = 0.017, 0.030 and 0.010, respectively). The measures, however, were modest predictors for either outcome. A waist circumference ≤ 0.81 cm could predict good ovarian response with a sensitivity of 35% and specificity of 100% (AUC = 0.656) and a waist circumference >98 cm could predict clinical pregnancy with a sensitivity of 61% and specificity of 80% (AUC = 0.609). A waist/hip ratio ≤0.82 could predict good ovarian response with a sensitivity of 62.4% and specificity of 68% (AUC = 0.652) and a ratio >0.84 could predict clinical pregnancy with a sensitivity of 56.3% and specificity of 70.9% (AUC = 0.612).On the other hand, a waist/height ratio ≤0.54 could predict good ovarian response with a sensitivity of 48% and specificity of 92% (AUC = 0.651), while a waist/height ratio >0.62 cm could predict clinical pregnancy with a sensitivity of 61% and specificity of 80% (AUC = 0.609).
{"title":"Obesity Index That Better Predict Ovarian Response: Body Mass Index, Waist Circumference, Waist Hip Ratio, or Waist Height Ratio in Women Undergoing ICSI : A Pilot Study","authors":"Aly Elyan Khalaf Allah, S. Elmekkawi, A. Megahed, Ahmed Hamed Megahed","doi":"10.21608/ebwhj.2019.18167.1040","DOIUrl":"https://doi.org/10.21608/ebwhj.2019.18167.1040","url":null,"abstract":"ABSTRACT Objective: This study is designed to assess the accuracy of Body Mass Index, waist circumference, waist Hip Ratio or Waist Height Ratio as a predictor of ovarian response in women undergoing ICSI. Patients and Methods: This Pilot study was done at Clinical IVF and ART unit at Faculty of Medicine, Ain-Shams University Hospital, Number of Participant women 150. Results and Conclusion: The anthropometric measures, only the waist circumference, waist/hip ratio and waist/height ratio were related to ovarian response (p-value = 0.014, 0.004 and 0.020, respectively) and to the occurrence of clinical pregnancy (p-value = 0.017, 0.030 and 0.010, respectively). The measures, however, were modest predictors for either outcome. A waist circumference ≤ 0.81 cm could predict good ovarian response with a sensitivity of 35% and specificity of 100% (AUC = 0.656) and a waist circumference >98 cm could predict clinical pregnancy with a sensitivity of 61% and specificity of 80% (AUC = 0.609). A waist/hip ratio ≤0.82 could predict good ovarian response with a sensitivity of 62.4% and specificity of 68% (AUC = 0.652) and a ratio >0.84 could predict clinical pregnancy with a sensitivity of 56.3% and specificity of 70.9% (AUC = 0.612).On the other hand, a waist/height ratio ≤0.54 could predict good ovarian response with a sensitivity of 48% and specificity of 92% (AUC = 0.651), while a waist/height ratio >0.62 cm could predict clinical pregnancy with a sensitivity of 61% and specificity of 80% (AUC = 0.609).","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131832097","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 : 2018-08-01DOI: 10.21608/EBWHJ.2018.15478
Ahmed M. Abdel-Ghany, S. Mounir
Aim of work: To determine bacterial causative organisms of premature rupture of membrane (PROM) and its detrimental effect on maternal and neonatal outcome.Patients and Methods: This study included 150 pregnant females at gestational age between 28 up to39 weeks who were followed up from onset of PROM till two weeks after delivery. The study included females. High vaginal swab and amniotic fluid sample were taken for culture and sensitivity. The outcome measures were the prevalence of genital tract bacterial infection, in addition to fetal and maternal complication in swab +ve patients.Results: The mean age was 27.7±4.69 years ranged between 19-38 years, with mean gestational age of 34.81±2.7 weeks. Ninety patients (60%) were swab +ve and 60 patients (40%) were -ve cultured results. There was a significant increase in cases with positive culture results in neonatal sepsis, prematurity and early neonatal death (END). The most common organism were G(B) Beta hemolytic streptococci in mothers with Chorioamnionitis and G(A)Beta hemolytic streptococci in puerperal sepsis. The most commonest organism founded in swab +ve cases with neonatal sepsis was Coagulase -ve Staph, while it was G(b) StreptAglactiae was in premature cases, E-coli in incubated neonates, and non-hemolytic streptococci organism in cases with END.Conclusion: The screening of the vaginal infections in patients complain of PROM, can be a useful method for prediction of preterm labor. Bacterial role in the etiology of PROM has been suggested. The mother with PROM, also her neonate, might gain some benefit from this rapid tests and antibiotics treatment.
{"title":"Premature rupture of Membrane : Maternal and neonatal approach","authors":"Ahmed M. Abdel-Ghany, S. Mounir","doi":"10.21608/EBWHJ.2018.15478","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.15478","url":null,"abstract":"Aim of work: To determine bacterial causative organisms of premature rupture of membrane (PROM) and its detrimental effect on maternal and neonatal outcome.Patients and Methods: This study included 150 pregnant females at gestational age between 28 up to39 weeks who were followed up from onset of PROM till two weeks after delivery. The study included females. High vaginal swab and amniotic fluid sample were taken for culture and sensitivity. The outcome measures were the prevalence of genital tract bacterial infection, in addition to fetal and maternal complication in swab +ve patients.Results: The mean age was 27.7±4.69 years ranged between 19-38 years, with mean gestational age of 34.81±2.7 weeks. Ninety patients (60%) were swab +ve and 60 patients (40%) were -ve cultured results. There was a significant increase in cases with positive culture results in neonatal sepsis, prematurity and early neonatal death (END). The most common organism were G(B) Beta hemolytic streptococci in mothers with Chorioamnionitis and G(A)Beta hemolytic streptococci in puerperal sepsis. The most commonest organism founded in swab +ve cases with neonatal sepsis was Coagulase -ve Staph, while it was G(b) StreptAglactiae was in premature cases, E-coli in incubated neonates, and non-hemolytic streptococci organism in cases with END.Conclusion: The screening of the vaginal infections in patients complain of PROM, can be a useful method for prediction of preterm labor. Bacterial role in the etiology of PROM has been suggested. The mother with PROM, also her neonate, might gain some benefit from this rapid tests and antibiotics treatment.","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134340853","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 : 2018-05-01DOI: 10.21608/EBWHJ.2018.7510
A. Abou-Zeid, E. Nassar, Manal S. Swelem, M. Tawfik
Objective: The aim of this study was to measure serum zinc-α2-glycoprotein (ZAG) in pregnant Egyptian females with preeclampsia and eclampsia and to correlate its levels to biochemical measures of kidney function, lipid and glucose metabolism.Study Design: It was a retrospective study.Patients and Methods: This study measured ZAG levels by enzyme linked immunosorbent assay (ELISA) in pregnant females with preeclampsia (PE) (no. = 40) and eclampsia (no.=20) and were compared to healthy gestational age-matched subjects (no.=20). In addition, the association of ZAG with kidney function, lipid and glucose metabolism was studied.Results: Significant difference was detected on comparing the different groups regarding ZAG levels (p = 0.001). Furthermore, ZAG was positively correlated to systolic blood pressure, urinary protein, fasting insulin and HOMA-IR.After adjusting for other parameters,the association between ZAG and SBP, urinary protein, serum insulin and HOMA-IR remained significant by multivariate linear regression analysis.Conclusion: The study noted that maternal ZAG serum levels are significantly increased in PE
{"title":"Zinc-alpha 2-glycoprotein serum level in Egyptian females with preeclampsia and eclampsia","authors":"A. Abou-Zeid, E. Nassar, Manal S. Swelem, M. Tawfik","doi":"10.21608/EBWHJ.2018.7510","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.7510","url":null,"abstract":"Objective: The aim of this study was to measure serum zinc-α2-glycoprotein (ZAG) in pregnant Egyptian females with preeclampsia and eclampsia and to correlate its levels to biochemical measures of kidney function, lipid and glucose metabolism.Study Design: It was a retrospective study.Patients and Methods: This study measured ZAG levels by enzyme linked immunosorbent assay (ELISA) in pregnant females with preeclampsia (PE) (no. = 40) and eclampsia (no.=20) and were compared to healthy gestational age-matched subjects (no.=20). In addition, the association of ZAG with kidney function, lipid and glucose metabolism was studied.Results: Significant difference was detected on comparing the different groups regarding ZAG levels (p = 0.001). Furthermore, ZAG was positively correlated to systolic blood pressure, urinary protein, fasting insulin and HOMA-IR.After adjusting for other parameters,the association between ZAG and SBP, urinary protein, serum insulin and HOMA-IR remained significant by multivariate linear regression analysis.Conclusion: The study noted that maternal ZAG serum levels are significantly increased in PE","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121724186","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 : 2018-05-01DOI: 10.21608/EBWHJ.2018.7515
K. Mohamad
Abstract : Primary postpartum hemorrhage (PPH) is defined as blood loss from the genital tract of 500 mL or more following a normal vaginal delivery (NVD) or 1,000 mL or more following a cesarean section within 24 hours of birth. PPH contributes significantly to maternal morbidity and mortality worldwide. Women can rapidly hemorrhage and die soon after giving birth. It can be a devastating outcome to many young families. Women giving birth in low-resource settings are at a higher risk of death than their counterparts in resource-rich environments. PPH is a leading cause of maternal deaths globally, contributing to a quarter of the deaths annually.Methods: This was a descriptive study carried out at El-Minia Maternity Hospital, a tertiary referral government hospital in a low-resource setting in El-Minia. Data were obtained from the labor ward birth registers for patients who had a diagnosis of PPH during the period from January 1st, 2016 to December 31th, 2017. The cases notes were retrieved and the demographic, clinical and outcome data were gathered. Blood loss was estimated post-delivery by the attending clinician; either a midwife or a doctor. At this maternity unit, blood loss is not measured but estimated owing to prevailing resource constraints. The SPSS Version 21 statistical tool was used to calculate probability values between 2 years. Simple statistical tests were used on absolute numbers to calculate percentages.Results: There were 11057 deliveries at 2016 and 11146 deliveries at 2017 admitted to El-Minia University Maternity Hospital. In the studied groups of patients, there were 201 (1.88%) cases of PPH at 2016 and 189 cases (1.69%) at 2017. About 67.5% at 2016 and 67.7% at 2017 of the cases had NVD. The majority of the cases (77.0%) had an identifiable risk factor for developing primary PPH. The most identifiable risk factor for primary PPH was anemia. As regards lines of management, the study noticed that more cases had been explored and undergone hysterectomy in 2017 than in 2016 and this may be according to the severity of cases, general conditions of the patient and other failed medical interventions that pushed decision in this way resulting in decreasing the mortality ratio in 2017 (3.2%) than in 2016 (8.5%) with high significance (P value = 0.027) and survival of most of the cases.Conclusion: The incidence of PPH at El-Minia University Maternity Hospital was (1.88 %) in 2016 and 189 cases (1.69%) in 2017 during the study period, lower than that reported elsewhere in similar setting in the literature. Therefore, this study is important, as it documented for the first time the incidence of the most important causes of global maternal deaths in cases admitted to Maternity Unit, El-Minia University. Future studies should involve the effect on maternal outcomes of PPH. This data can help in mobilizing global efforts to improve women’s health.
摘要:原发性产后出血(PPH)是指正常阴道分娩(NVD)后24小时内生殖道出血500 mL及以上或剖宫产术后出血1000 mL及以上。PPH是全世界孕产妇发病率和死亡率的重要因素。妇女在分娩后会迅速出血并很快死亡。对许多年轻家庭来说，这可能是一个毁灭性的结果。在资源匮乏环境中分娩的妇女比在资源丰富环境中分娩的妇女面临更高的死亡风险。产后早产是全球孕产妇死亡的主要原因，每年造成四分之一的死亡。方法:这是在El-Minia妇产医院进行的一项描述性研究，该医院是El-Minia资源匮乏的三级转诊政府医院。数据来自2016年1月1日至2017年12月31日诊断为PPH的分娩病房出生登记簿。检索病例记录，收集人口学、临床和结局数据。失血量在分娩后由主治医生估计;不是助产士就是医生。在这个产科单位，由于普遍的资源限制，出血量不是测量的，而是估计的。使用SPSS Version 21统计工具计算2年之间的概率值。对绝对数字使用简单的统计检验来计算百分比。结果:2016年在El-Minia大学妇产医院分娩11057例，2017年分娩11146例。研究组患者中，2016年PPH 201例(1.88%)，2017年PPH 189例(1.69%)。2016年和2017年分别有67.5%和67.7%的病例患有NVD。大多数病例(77.0%)具有可确定的发生原发性PPH的危险因素。原发性PPH最明显的危险因素是贫血。在治疗路线方面，研究注意到2017年有更多的病例被探索并接受了子宫切除术，这可能是根据病例的严重程度、患者的一般情况和其他失败的医疗干预措施推动了决策，导致2017年的死亡率(3.2%)比2016年(8.5%)降低，且具有很高的显著性(P值= 0.027)，并且大多数病例的存活率。结论:El-Minia大学妇产医院在研究期间PPH的发病率为2016年(1.88%)，2017年为189例(1.69%)，低于文献中其他类似环境的报道。因此，这项研究很重要，因为它首次记录了在El-Minia大学产科病房收治的病例中全球孕产妇死亡的最重要原因的发生率。未来的研究应涉及PPH对产妇结局的影响。这些数据有助于动员全球努力改善妇女健康。
{"title":"Maternity outcome of primary post-partum hemorrhage cases in El-Minia Maternity Hospital 2016-2017 : 2 years study","authors":"K. Mohamad","doi":"10.21608/EBWHJ.2018.7515","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.7515","url":null,"abstract":"Abstract : Primary postpartum hemorrhage (PPH) is defined as blood loss from the genital tract of 500 mL or more following a normal vaginal delivery (NVD) or 1,000 mL or more following a cesarean section within 24 hours of birth. PPH contributes significantly to maternal morbidity and mortality worldwide. Women can rapidly hemorrhage and die soon after giving birth. It can be a devastating outcome to many young families. Women giving birth in low-resource settings are at a higher risk of death than their counterparts in resource-rich environments. PPH is a leading cause of maternal deaths globally, contributing to a quarter of the deaths annually.Methods: This was a descriptive study carried out at El-Minia Maternity Hospital, a tertiary referral government hospital in a low-resource setting in El-Minia. Data were obtained from the labor ward birth registers for patients who had a diagnosis of PPH during the period from January 1st, 2016 to December 31th, 2017. The cases notes were retrieved and the demographic, clinical and outcome data were gathered. Blood loss was estimated post-delivery by the attending clinician; either a midwife or a doctor. At this maternity unit, blood loss is not measured but estimated owing to prevailing resource constraints. The SPSS Version 21 statistical tool was used to calculate probability values between 2 years. Simple statistical tests were used on absolute numbers to calculate percentages.Results: There were 11057 deliveries at 2016 and 11146 deliveries at 2017 admitted to El-Minia University Maternity Hospital. In the studied groups of patients, there were 201 (1.88%) cases of PPH at 2016 and 189 cases (1.69%) at 2017. About 67.5% at 2016 and 67.7% at 2017 of the cases had NVD. The majority of the cases (77.0%) had an identifiable risk factor for developing primary PPH. The most identifiable risk factor for primary PPH was anemia. As regards lines of management, the study noticed that more cases had been explored and undergone hysterectomy in 2017 than in 2016 and this may be according to the severity of cases, general conditions of the patient and other failed medical interventions that pushed decision in this way resulting in decreasing the mortality ratio in 2017 (3.2%) than in 2016 (8.5%) with high significance (P value = 0.027) and survival of most of the cases.Conclusion: The incidence of PPH at El-Minia University Maternity Hospital was (1.88 %) in 2016 and 189 cases (1.69%) in 2017 during the study period, lower than that reported elsewhere in similar setting in the literature. Therefore, this study is important, as it documented for the first time the incidence of the most important causes of global maternal deaths in cases admitted to Maternity Unit, El-Minia University. Future studies should involve the effect on maternal outcomes of PPH. This data can help in mobilizing global efforts to improve women’s health.","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132411496","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 : 2018-05-01DOI: 10.21608/EBWHJ.2018.7514
A. Murad, Ayman A AbdelHamid
Objective: The aim of this cohort study was to investigate the uterine artery Doppler indices and the maternal serum homocysteine concentrations as predictors of spontaneous preterm delivery (sPID).Setting: Obstetrics and Gynecology Department, Benha University Hospital.Materials and Methods: The study population included 200 singleton pregnant women with threatened preterm labor at 28-35 gestational weeks. The participants underwent uterine artery (UtA) Doppler examination, estimation of maternal serum homocysteine levels and routine management preterm labor. Participants were scheduled according to the gestational age at delivery into; preterm group (n= 45) and term group (n= 155). The diagnostic significance of both parameters for prediction of spontaneous preterm birth was calculated.Results: Both maternal serum homocysteine (Hcy) and uterine artery pulsatility index (PI) were significantly higher in preterm group compared to term group (8.52± 2.36 vs. 4.62± 2.07; p < 0.0001 for Hcy and 1.18± 0.42 vs. 0.76± 0.29; p < 0.0001 for PI). For the prediction of sPTD, the maternal serum Hcy levels at a cut-off value 7.09 multiple of the median showed 55.56% sensitivity, 83.87% specificity, 50% PPV, and 86.67% NPV, and the UtA PI, the cut-off value of 0.99 showed 62.22% sensitivity, 83.87% specificity, 53.83% PPV, 88.44% NPV. However, both Hcy and UtA PI showed 71.11% sensitivity, 87.1% specificity, 61.54% PPV, 91.22% NPV for prediction of sPTD,Conclusion: Maternal serum homocysteine levels and uterine artery pulsatility index are two promising predictors of spontaneous preterm delivery. The combination of the two parameters improves their diagnostic performance.
{"title":"Maternal serum homocysteine and uterine artery pulsatility index as predictors of spontaneous preterm labor","authors":"A. Murad, Ayman A AbdelHamid","doi":"10.21608/EBWHJ.2018.7514","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.7514","url":null,"abstract":"Objective: The aim of this cohort study was to investigate the uterine artery Doppler indices and the maternal serum homocysteine concentrations as predictors of spontaneous preterm delivery (sPID).Setting: Obstetrics and Gynecology Department, Benha University Hospital.Materials and Methods: The study population included 200 singleton pregnant women with threatened preterm labor at 28-35 gestational weeks. The participants underwent uterine artery (UtA) Doppler examination, estimation of maternal serum homocysteine levels and routine management preterm labor. Participants were scheduled according to the gestational age at delivery into; preterm group (n= 45) and term group (n= 155). The diagnostic significance of both parameters for prediction of spontaneous preterm birth was calculated.Results: Both maternal serum homocysteine (Hcy) and uterine artery pulsatility index (PI) were significantly higher in preterm group compared to term group (8.52± 2.36 vs. 4.62± 2.07; p < 0.0001 for Hcy and 1.18± 0.42 vs. 0.76± 0.29; p < 0.0001 for PI). For the prediction of sPTD, the maternal serum Hcy levels at a cut-off value 7.09 multiple of the median showed 55.56% sensitivity, 83.87% specificity, 50% PPV, and 86.67% NPV, and the UtA PI, the cut-off value of 0.99 showed 62.22% sensitivity, 83.87% specificity, 53.83% PPV, 88.44% NPV. However, both Hcy and UtA PI showed 71.11% sensitivity, 87.1% specificity, 61.54% PPV, 91.22% NPV for prediction of sPTD,Conclusion: Maternal serum homocysteine levels and uterine artery pulsatility index are two promising predictors of spontaneous preterm delivery. The combination of the two parameters improves their diagnostic performance.","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125690807","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 : 2018-05-01DOI: 10.21608/EBWHJ.2018.7511
Amr Sharafeldeen
Aim: To evaluate the interaction of adding oral cabergoline (OC) to calcium infusion as a preventive modality for ovarian hyperstimulation syndrome (OHSS) in risky women undergoing controlled ovarian hyperstimulation (COH) in context of in- vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI).Patients and Methods: This prospective, double-blind, randomized, placebo-controlled trial was conducted at Benha IVF center of Obstetrics and Gynecology Department of Benha University and Nour Al Hayah Fertility Center Between January 2015 and February 2016. 220 risky women for OHSS undergoing ICSI were included, they were randomized to 110 women received once daily OC for eight days, starting at HCG triggering and infusion of calcium gluconate 10 ml 10% in 200 ml 0.9% saline daily for 4 days beginning at ovum pick up (OPU), coined as calcium infusion plus group (CI+) and 110 women received only calcium infusion in the same fashion as in CI+ coined as calcium infusion minus group (CI-). The primary outcome was the overall incidence of OHSS while the secondary issues were OHSS types and grades as well as other ICSI outcomes.Results: The incidence of overall OHSS was significantly lower in calcium infusion plus oral cabergoline (CI+) group compared to calcium infusion alone (CI-) group [8/110(7.2%) in CI+ versus 18/110 (16.3%) in CI- with difference in proportion percentage point (ΔPP)=-9.1%, 95% CI: -0.49, -17.4; P = 0.036]. Despite the incidence of moderate and severe OHSS was lower in CI+ than in CI-, this difference didn't reach the significance level (2.7% vs 5.4%; p = 0.3) and (0.9% versus 2.7%; ), respectively. The other COH and ICSI outcomes didn't show any statistically significant differences.Conclusion: Adding oral cabergoline to calcium infusion is effective than calcium infusion alone in the reduction of overall OHSS incidence as well as its severity at comparable pregnancy outcomes
目的:探讨在体外受精(IVF) /胞浆内单精子注射(ICSI)条件下，口服卡麦角林(OC)与钙输注作为卵巢过度刺激综合征(OHSS)预防方式的相互作用。患者和方法:该前瞻性、双盲、随机、安慰剂对照试验于2015年1月至2016年2月在Benha大学妇产科Benha IVF中心和Nour Al Hayah生育中心进行。纳入220名接受ICSI的OHSS高危妇女，她们被随机分为110名妇女，每天接受一次OC，持续8天，从HCG触发开始，每天输注葡萄糖酸钙10 ml, 10%在200 ml 0.9%生理盐水中，持续4天，从取卵(OPU)开始，称为钙输注加组(CI+)， 110名妇女仅接受钙输注，与CI+相同的方式，称为钙输注减组(CI-)。主要结果是OHSS的总发生率，次要问题是OHSS的类型和分级以及其他ICSI结果。结果:钙输注加口服卡麦角林(CI+)组总OHSS发生率显著低于单独钙输注(CI-)组[CI+为8/110(7.2%)，CI-为18/110(16.3%)，比例百分点差异(ΔPP)=-9.1%， 95% CI: -0.49， -17.4;P = 0.036]。尽管CI+组中重度OHSS发生率低于CI-组，但差异未达到显著性水平(2.7% vs 5.4%;P = 0.3)和(0.9% vs . 2.7%;),分别。其他COH和ICSI结果没有统计学上的显著差异。结论:在同等妊娠结局下，口服卡麦角林联合钙输注比单独钙输注更能有效降低OHSS的总发生率和严重程度
{"title":"Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial","authors":"Amr Sharafeldeen","doi":"10.21608/EBWHJ.2018.7511","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.7511","url":null,"abstract":"Aim: To evaluate the interaction of adding oral cabergoline (OC) to calcium infusion as a preventive modality for ovarian hyperstimulation syndrome (OHSS) in risky women undergoing controlled ovarian hyperstimulation (COH) in context of in- vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI).Patients and Methods: This prospective, double-blind, randomized, placebo-controlled trial was conducted at Benha IVF center of Obstetrics and Gynecology Department of Benha University and Nour Al Hayah Fertility Center Between January 2015 and February 2016. 220 risky women for OHSS undergoing ICSI were included, they were randomized to 110 women received once daily OC for eight days, starting at HCG triggering and infusion of calcium gluconate 10 ml 10% in 200 ml 0.9% saline daily for 4 days beginning at ovum pick up (OPU), coined as calcium infusion plus group (CI+) and 110 women received only calcium infusion in the same fashion as in CI+ coined as calcium infusion minus group (CI-). The primary outcome was the overall incidence of OHSS while the secondary issues were OHSS types and grades as well as other ICSI outcomes.Results: The incidence of overall OHSS was significantly lower in calcium infusion plus oral cabergoline (CI+) group compared to calcium infusion alone (CI-) group [8/110(7.2%) in CI+ versus 18/110 (16.3%) in CI- with difference in proportion percentage point (ΔPP)=-9.1%, 95% CI: -0.49, -17.4; P = 0.036]. Despite the incidence of moderate and severe OHSS was lower in CI+ than in CI-, this difference didn't reach the significance level (2.7% vs 5.4%; p = 0.3) and (0.9% versus 2.7%; ), respectively. The other COH and ICSI outcomes didn't show any statistically significant differences.Conclusion: Adding oral cabergoline to calcium infusion is effective than calcium infusion alone in the reduction of overall OHSS incidence as well as its severity at comparable pregnancy outcomes","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115951185","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 : 2018-05-01DOI: 10.21608/EBWHJ.2018.7516
Ayman A. EI-Dorf, H. Borg, Ahmed M. E. Ossman, H. Salem, Mahmoud A. El Hamedi
Objective: To evaluate the effect of laparoscopic treatment of large ovarian endometrioma >3cm by two modalities ; namely, cystectomy and a combination of partial cystectomy with ultrasound power, ablation on the ovarian reserve and recurrence.Method: A prospective randomized clinical study at Obstetrics and Gynecology Department at Tanta University Hospital, Egypt, included 40 women less than 35 years with large ovarian endometrioma >3 cm complaining of infertility and/or pelvic pain with no previous history of medical or surgical treatment of endometriosis. These patients were randomized for either laparoscopic complete cystectomy (Cystectomy group; 20 patients) or partial cystectomy combined with ultrasound power ablation (Combined group, 20 patients). Main outcome measures included the changes in levels of AMH. Basal serum levels of FSH and LH, and AFC before laparoscopy and six months later. Recurrence and spontaneous pregnancy rates were recorded.Results: Mean serum AMH was significantly decreased in cystectomy group from 3.1±0.28 to 1.8±0.5 ng/ml compared with the nonsignificant decrease in combined group from 3.9±0.27 to 3.1±0.4 ng/inl. Also, AFC was significantly decreased in cystectomy group from 4.1±0.4 to 2.7±l.l compared with the nonsignificant change in combined group from 3.8± 0.6 to 4.l±l.9. Basal serum levels of FSH and LH did not change in the two groups. Spontaneous pregnancy and recurrence were comparable in both groups.Conclusion: Combination of partial cystectomy with ultrasound powered ablation yielded better results than complete cystectomy with regard to the ovarian reserve.
{"title":"Combined excision-ablation laparoscopic surgery in large ovarian endometrioma","authors":"Ayman A. EI-Dorf, H. Borg, Ahmed M. E. Ossman, H. Salem, Mahmoud A. El Hamedi","doi":"10.21608/EBWHJ.2018.7516","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.7516","url":null,"abstract":"Objective: To evaluate the effect of laparoscopic treatment of large ovarian endometrioma >3cm by two modalities ; namely, cystectomy and a combination of partial cystectomy with ultrasound power, ablation on the ovarian reserve and recurrence.Method: A prospective randomized clinical study at Obstetrics and Gynecology Department at Tanta University Hospital, Egypt, included 40 women less than 35 years with large ovarian endometrioma >3 cm complaining of infertility and/or pelvic pain with no previous history of medical or surgical treatment of endometriosis. These patients were randomized for either laparoscopic complete cystectomy (Cystectomy group; 20 patients) or partial cystectomy combined with ultrasound power ablation (Combined group, 20 patients). Main outcome measures included the changes in levels of AMH. Basal serum levels of FSH and LH, and AFC before laparoscopy and six months later. Recurrence and spontaneous pregnancy rates were recorded.Results: Mean serum AMH was significantly decreased in cystectomy group from 3.1±0.28 to 1.8±0.5 ng/ml compared with the nonsignificant decrease in combined group from 3.9±0.27 to 3.1±0.4 ng/inl. Also, AFC was significantly decreased in cystectomy group from 4.1±0.4 to 2.7±l.l compared with the nonsignificant change in combined group from 3.8± 0.6 to 4.l±l.9. Basal serum levels of FSH and LH did not change in the two groups. Spontaneous pregnancy and recurrence were comparable in both groups.Conclusion: Combination of partial cystectomy with ultrasound powered ablation yielded better results than complete cystectomy with regard to the ovarian reserve.","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114248151","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 : 2018-05-01DOI: 10.21608/EBWHJ.2018.7513
H. Abbassy, A. Galal, Ashraf Hany Abdel. Rahman
Hypercoagulability could be intrinsic or caused by the hormone treatment preceding the IVF procedure. Endothelial cell protein C receptor (EPCR) enhances the generation of activated protein C by the thrombin–thrombomodulin complex. Soluble EPCR plays a role in the maintenance of pregnancy evidenced by the findings that EPCR expression is critical for embryo development. Specific gene variants linked with altered soluble EPCR levels were associated with poor pregnancy outcome. The aim of this study was to assess the predictive value of EPCR gene polymorphisms (6936A/G, 1651C/G, and 4678C/G) and sEPCR level on the IVF outcome in Egyptian women with repeated IVF failure. They were compared to healthy control patients eligible for IVF. The present study was conducted on 45 women with repeated IVF failure, three or more previous IVF-embryo transfer cycles, and 45 healthy age-matched women eligible for IVF. PCR-RFLP for the EPCR polymorphisms (6936A/G, 1651C/G, 4678G/C) was done for cases and control groups. Plasma-soluble EPCR levels were measured with ELISA. As regards the mutant, EPCR (6936A/G) genotypes (AG, GG) were higher than the wild type (AA) (P < 0.001, OR 4.125, 95% CI 2.198–7.740). The homozygous mutant genotype (GG) was higher in comparison to the wild type (AA). The mutant allele (G) was higher than the wild allele (A) (P < 0.001, or 2.549, 95% CI 1.601–4.061). Higher frequencies of the (1651C/G) genotype and lower soluble EPCR levels were noted both in (C/C) (P = 0.004; Z = −0.2867) and (C/G) (P = 0.006; Z = −0.2767) genotype carriers. Regarding, EPCR polymorphism (4678G/C), the homozygous mutant genotype (CC) was significantly lower than the homozygous wild type (GG), (P = 0.014, OR 0.289, 95% CI 0.108–0.776). Our data suggest that the 6936A/G and 1651C/G EPCR gene variants coupled with procoagulant diminished levels of sEPCR may be associated with a higher tendency for repeated implantation failure.
高凝可能是内在的，也可能是体外受精前激素治疗引起的。内皮细胞蛋白C受体(EPCR)通过凝血酶-血栓调节蛋白复合物增强活化蛋白C的生成。可溶性EPCR在维持妊娠中发挥作用，EPCR的表达对胚胎发育至关重要。与可溶性EPCR水平改变相关的特定基因变异与妊娠结局不良相关。本研究的目的是评估EPCR基因多态性(6936A/G、1651C/G和4678C/G)和sEPCR水平对反复IVF失败的埃及女性体外受精结果的预测价值。将他们与符合试管婴儿条件的健康对照患者进行比较。本研究的对象是45名多次试管婴儿失败、3次或更多试管婴儿胚胎移植周期的女性，以及45名符合试管婴儿条件的健康年龄匹配的女性。对病例和对照组的EPCR多态性(6936A/G、1651C/G、4678G/C)进行PCR-RFLP分析。ELISA法检测血浆可溶性EPCR水平。突变体中EPCR (6936A/G)基因型(AG、GG)高于野生型(AA) (P < 0.001, OR 4.125, 95% CI 2.198 ~ 7.740)。纯合突变基因型(GG)高于野生型(AA)。突变等位基因(G)高于野生等位基因(A) (P < 0.001，或2.549,95% CI 1.601 ~ 4.061)。(C/C)基因型(1651C/G)频率较高，可溶性EPCR水平较低(P = 0.004;Z =−0.2867)和(C/G) (P = 0.006;Z =−0.2767)基因型携带者。在EPCR多态性(4678G/C)方面，纯合子突变型(CC)显著低于纯合子野生型(GG) (P = 0.014, OR 0.289, 95% CI 0.108 ~ 0.776)。我们的数据表明，6936A/G和1651C/G EPCR基因变异加上促凝剂sEPCR水平降低可能与重复植入失败的更高倾向相关。
{"title":"The influence of endothelial cell protein C receptor gene 6936A/G, 1651C/G, 4678G/C polymorphisms and soluble endothelial protein C receptor levels on in vitro fertilization outcomes","authors":"H. Abbassy, A. Galal, Ashraf Hany Abdel. Rahman","doi":"10.21608/EBWHJ.2018.7513","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.7513","url":null,"abstract":"Hypercoagulability could be intrinsic or caused by the hormone treatment preceding the IVF procedure. Endothelial cell protein C receptor (EPCR) enhances the generation of activated protein C by the thrombin–thrombomodulin complex. Soluble EPCR plays a role in the maintenance of pregnancy evidenced by the findings that EPCR expression is critical for embryo development. Specific gene variants linked with altered soluble EPCR levels were associated with poor pregnancy outcome. The aim of this study was to assess the predictive value of EPCR gene polymorphisms (6936A/G, 1651C/G, and 4678C/G) and sEPCR level on the IVF outcome in Egyptian women with repeated IVF failure. They were compared to healthy control patients eligible for IVF. The present study was conducted on 45 women with repeated IVF failure, three or more previous IVF-embryo transfer cycles, and 45 healthy age-matched women eligible for IVF. PCR-RFLP for the EPCR polymorphisms (6936A/G, 1651C/G, 4678G/C) was done for cases and control groups. Plasma-soluble EPCR levels were measured with ELISA. As regards the mutant, EPCR (6936A/G) genotypes (AG, GG) were higher than the wild type (AA) (P < 0.001, OR 4.125, 95% CI 2.198–7.740). The homozygous mutant genotype (GG) was higher in comparison to the wild type (AA). The mutant allele (G) was higher than the wild allele (A) (P < 0.001, or 2.549, 95% CI 1.601–4.061). Higher frequencies of the (1651C/G) genotype and lower soluble EPCR levels were noted both in (C/C) (P = 0.004; Z = −0.2867) and (C/G) (P = 0.006; Z = −0.2767) genotype carriers. Regarding, EPCR polymorphism (4678G/C), the homozygous mutant genotype (CC) was significantly lower than the homozygous wild type (GG), (P = 0.014, OR 0.289, 95% CI 0.108–0.776). Our data suggest that the 6936A/G and 1651C/G EPCR gene variants coupled with procoagulant diminished levels of sEPCR may be associated with a higher tendency for repeated implantation failure.","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122867789","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 : 2018-03-04DOI: 10.21608/EBWHJ.2018.5582
Mohamed Mourad El Abd, Dalal Nasr-El Din El Kaffash, M. Samra, Nooman Sallam
Objective: The aim of this study was to evaluate 3 methods of embryo selection in predicting the embryos with the best method of achieving pregnancy in single embryo transfer cycles, namely embryo morphology, glucose concentration and β-HCG concentration in the embryo culture medium.Patients and Methods: A total of 66 embryos in 66 ICSI cycles were studied: 33 pregnant and 33 non-pregnant cycles. Each embryo was scored using the Veeck's scoring method and the spent culture medium of each embryo was analyzed for its content of glucose and β-HCG using previously validated methods.Results: The results showed that the Veeck's embryo score, the measurement of glucose levels and the measurement of β-HCG levels in the spent culture medium are all reliable and practical methods to be used for this purpose. The Veeck's embryo score had the best predictability followed by β-HCG levels, followed by glucose levels in the culture medium. Combining the 3 methods was superior to each methods studied alone as well as any combination of 2 methods.Conclusion: The measurement of glucose and β-HCG in the spent culture medium of individual embryos is an effective and practical method for embryo selection in patients treated with ICSI. Combining both methods with the Veeck's embryo score gives the best predictability. However, these findings should be confirmed by a prospective randomized study, preferably in single embryo transfer cycles.
{"title":"Predictive Value Of Glucose And β-Hcg Concentration In The Embryo Culture Medium Of Patients Undergoing Intracytoplasmic Sperm Injection","authors":"Mohamed Mourad El Abd, Dalal Nasr-El Din El Kaffash, M. Samra, Nooman Sallam","doi":"10.21608/EBWHJ.2018.5582","DOIUrl":"https://doi.org/10.21608/EBWHJ.2018.5582","url":null,"abstract":"Objective: The aim of this study was to evaluate 3 methods of embryo selection in predicting the embryos with the best method of achieving pregnancy in single embryo transfer cycles, namely embryo morphology, glucose concentration and β-HCG concentration in the embryo culture medium.Patients and Methods: A total of 66 embryos in 66 ICSI cycles were studied: 33 pregnant and 33 non-pregnant cycles. Each embryo was scored using the Veeck's scoring method and the spent culture medium of each embryo was analyzed for its content of glucose and β-HCG using previously validated methods.Results: The results showed that the Veeck's embryo score, the measurement of glucose levels and the measurement of β-HCG levels in the spent culture medium are all reliable and practical methods to be used for this purpose. The Veeck's embryo score had the best predictability followed by β-HCG levels, followed by glucose levels in the culture medium. Combining the 3 methods was superior to each methods studied alone as well as any combination of 2 methods.Conclusion: The measurement of glucose and β-HCG in the spent culture medium of individual embryos is an effective and practical method for embryo selection in patients treated with ICSI. Combining both methods with the Veeck's embryo score gives the best predictability. However, these findings should be confirmed by a prospective randomized study, preferably in single embryo transfer cycles.","PeriodicalId":224226,"journal":{"name":"Evidence Based Womenʼs Health Journal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121103638","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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