@article { author = {Abou-Zeid, Abla and Nassar, Eman and Swelem, Manal and Tawfik, Marian}, title = {Zinc-alpha 2-glycoprotein serum level in Egyptian females with preeclampsia and eclampsia}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {2}, pages = {145-155}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.7510}, 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}, keywords = {Adipokines,Eclampsia,preeclampsia,ZAG}, url = {https://ebwhj.journals.ekb.eg/article_7527.html}, eprint = {https://ebwhj.journals.ekb.eg/article_7527_3f20570f7992ce2bf3561f78f6be0cf2.pdf} } @article { author = {Sharafeldeen, Amr}, title = {Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {2}, pages = {156-164}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.7511}, 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}, keywords = {Calcium infusion (CI),Intracytoplasmic Sperm Injection (ICSI),oral cabergoline (OC),Ovarian hyperstimulation syndrome (OHSS),polycystic ovary syndrome (PCOS),randomized clinical trial (RCT)}, url = {https://ebwhj.journals.ekb.eg/article_7528.html}, eprint = {https://ebwhj.journals.ekb.eg/article_7528_0fc2ae8247a9b0267753d180c6750294.pdf} } @article { author = {Galal,, Ahmed and Abbassy, Hadeer and Abdelrahman, Ashraf}, title = {Polymorphisms of plasminogen activator iInhibitor-1 4G/5G, coagulation factor XIII Val34 Leu and angiotensin converting enzyme I/D impact on recurrent implantation failure}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {2}, pages = {165-170}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.7512}, abstract = {Repeated implantation failure (RIF) is recognized when transferred embryos fail to implant following repeated in vitro fertilization (IVF) cycles. A functional balance of fibrinolysis and coagulation may secure adequate trophoblast invasion, which is crucial for a regular implantation. During cytotrophoblast invasion, plasminogen activator inhibitor 1 (PAI-1) appears to be involved in controlling proteolysis and remodeling of maternal tissue. Coagulation factor XIII (FXIII) may have an impact on the ability of the trophoblast to invade into the endometrium and to stabilize attachment with fibrin cross-linking. Angiotensin converting enzyme (ACE) participates in the regulation of vascular tone and changes in vascular metabolites affect the functions of the fetoplacental complex and may induce abnormalities of blood circulation in the placenta. The aim of this study was to assess the predictive value of PAI-1 4G/5G, FXIII Val34Leu and ACE I/D polymorphisms on the IVF outcome in Egyptian women with repeated IVF failure. The present study was conducted on 60 women with repeated IVF failure, three or more previous IVF-embryo transfer cycles and 60 healthy age-matched women eligible for IVF. PCR-RFLP for the PAI-1 4G/5G, FXIII Val34Leu and ACE I/D polymorphisms was done for cases and control groups. Cases with RIF showed higher prevalence of the 4G allele of the PAI-1 -675 4G/5G polymorphism (P = 0.029). Higher frequencies of the heterozygous and homozygous FXIII polymorphism were noted in cases (P = 0.016, 0.020, respectively) together with higher risk to carry the Leu allele (P = 0.001). The heterozygous ACE I/D polymorphism was predominant in the studied cases (P = 0.011). The data point to the importance of the PAI-1 4G/5G and the FXIII Val34Leu and to a lesser extent the ACE I/D, polymorphisms as possible biomarkers to select populations at risk of implantation failure prior to attempting pregnancy. Nevertheless, larger scale studies are recommended to support the results.}, keywords = {IVF,Polymorphisms,Pregnancy,recurrent implantation failure}, url = {https://ebwhj.journals.ekb.eg/article_7529.html}, eprint = {https://ebwhj.journals.ekb.eg/article_7529_86d77344cd5de8c11a10af7c66c9d3be.pdf} } @article { author = {Galal,, Ahmed and Abbassy, Hadeer and Abdel Rahman, Ashraf}, 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}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {2}, pages = {171-177}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.7513}, 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.}, keywords = {IVF,Pregnancy,protein C receptor}, url = {https://ebwhj.journals.ekb.eg/article_7530.html}, eprint = {https://ebwhj.journals.ekb.eg/article_7530_291d1f5ed8738fc2faeb415c0313562a.pdf} } @article { author = {Murad,, Ahmed and Abdelhamid, Ayman}, title = {Maternal serum homocysteine and uterine artery pulsatility index as predictors of spontaneous preterm labor}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {2}, pages = {178-184}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.7514}, 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.}, keywords = {preterm labor,uterine artery,Doppler,Homocysteine}, url = {https://ebwhj.journals.ekb.eg/article_7531.html}, eprint = {https://ebwhj.journals.ekb.eg/article_7531_66042b834db13b1f0f2c98264827c13a.pdf} } @article { author = {Mohamad,, Khalid}, title = {Maternity outcome of primary post-partum hemorrhage cases in El-Minia Maternity Hospital 2016-2017 : 2 years study}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {2}, pages = {185-188}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.7515}, 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.}, keywords = {Avoidable deaths,causes,low-resource settings,maternal outcomes,Uterotonics}, url = {https://ebwhj.journals.ekb.eg/article_7532.html}, eprint = {https://ebwhj.journals.ekb.eg/article_7532_10bde9779e186119e059652b5f8407ed.pdf} } @article { author = {EI-Dorf, Ayman and Borg, Hesham and E. Ossman, Ahmed and Salem, Hesham and El Hamedi, Mahmoud}, title = {Combined excision-ablation laparoscopic surgery in large ovarian endometrioma}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {2}, pages = {189-194}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.7516}, 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.}, keywords = {endometrioma,Excision,Laparoscopy}, url = {https://ebwhj.journals.ekb.eg/article_15617.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15617_0a53639ea0e5d59b09f06ff3202f0342.pdf} }