@article { author = {Mohamad,, Khalid}, title = {Laparoscopic versus medical treatment of undisturbed ectopic pregnancy, Minia University Hospital}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {195-198}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15469}, abstract = {Introduction: The incidence of ectopic pregnancy (EP) increased almost up to a level of 2% in developed countries. Using of transvaginal ultrasonography and sensitive plasma-human chorionic gonadotropin (β-HCG) has enabled an early diagnosis before rupture. Early diagnosis allows the full range of treatment options. So, emergency surgery has been changed to a more benign condition. Administration of methotrexate (MTX) has an acceptance in selected patients and is considered costly effective with no need for waiting period before attempting another pregnancy. Although methotrexate is a teratogenic agent, its half-life is very short.Aim of work: To evaluate the safety and efficacy of laparoscope versus MTX of well-selected cases of undisturbed ectopic pregnancy.Materials and Methods: This is a prospective study in Minia University Hospitals during the period from March 2015 to March 2016. Forty patients of undisturbed EPs were divided randomly into two groups (20 for each group), the first group included women undergoing laparoscopic salpingostomy and the second group included women undergoing MTX. Every participant was subjected to full history taking, general, abdominal and vaginal examinations, as well as β-HCG, abdominal and vaginal ultrasound scan investigations. Only with MTX group and according to Lipscomb 2012, MTX was administrated and assessed. After full range of treatment, a close weekly follow-up of all groups was done by β-HCG level as well as abdominal and vaginal examination and ultrasonography.Results: The mean pre-therapeutic level of β-HCG was 1081.9±655.85 mIU/ml in MTX group and 2180.75±1693.51 mIU/ml in laparoscopy group. As regarding the success rate, MTX group was 70% and not significantly different from laparoscopic 85%.Conclusion: Undisturbed EP can be treated effectively by MTX, especially in selected cases depending mainly on β-HCG low levels pre-therapeutic and follow-up.}, keywords = {β-HCG and laparoscope,ectopic pregnancy,Methotrexate}, url = {https://ebwhj.journals.ekb.eg/article_15637.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15637_67ef88fffa0da5f41eedb5ad467005fe.pdf} } @article { author = {Elmantwe,, Ashraf and Elnory, Mohamed}, title = {Safety and efficacy outcomes of a novel hysterosacropexy: A fertility sparing, uterine preserving pelvic organ prolapse surgery}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {199-206}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15470}, abstract = {Objective: To access the safety and efficacy outcomes of a new abdominal Hysterosacopexy with CESA (Cervico-sacropexy) DynaMesh kit in treating advanced uterovaginal prolapse in young women aiming in uterine preservation pelvic organ prolapse (POP) surgery.Patients and Methods: Prospective nonrandomized controlled clinical trial enrolled consecutive women attending the gynecology and obstetrics Department, Benha University Hospital for treatment of POP of stage II or greater on POP quantification (POPQ) system on the apical domain. Participants underwent abdominal hysterosacropexy utilizing CESA mesh kit of DynaMesh. POPQ staging, women symptoms, and quality of life were evaluated before and after surgery, as well as surgery-related morbidity.Results: The current study enrolled 20 women, all women were followed up for a period of 18 months postoperatively. Significant post-surgical anatomical success was recorded across both POPQ anterior (point Aa, Ba) (P ≤ 0.0001, P ≤ 0.0001), apical (point c, d) (P ≤ 0.0001, P≤ 0.0001) and Posterior (point Ap, Bp) (P ≤ 0.0001, P≤ 0.0001) domains. Significant post-surgical functional improvements were recorded across prolapse symptoms, (bulge symptoms, overactive bladder, stress urinary incontinence, bowel dysfunction, sexual dysfunction) (P ≤ 0.0001, P = 0.0064, P = 0.03, P = 0.008, P ≤ 0.0001) respectively. ICIQ-VS (VS – SS – QOL) score (P≤ 0.0001, P ≤ 0.0001, P ≤ 0.0001). ICIQ – UI – SF score (P ≤ 0.0001). No major complications occurred. No mesh erosions were reported.Conclusion: Abdominal hysterosacropexy with CESA DynaMesh kit seems to be a safe and effective option for women with advanced uterovaginal prolapse aiming for uterine preserving POP surgery.}, keywords = {Cervico-sacropexy(CESA),CESA DynaMesh,hysterosacropexy,polyvinylidene fluoride (PVDF),Spinal anesthesia}, url = {https://ebwhj.journals.ekb.eg/article_15642.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15642_eb6a6846253bd45b2a4a37a7cf9cb4f7.pdf} } @article { author = {Shaheen, Abdelhamid and Emarh, Mohamd and Magd, Heba}, title = {Three-dimensional sonographic assessment of placental volume and vascularization in pregnancies complicated by hypertensive disorders : Case control study}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {207-214}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15475}, abstract = {Introduction: Pre-eclampsia remains a leading cause of maternal and fetal morbidity and mortality.Aim of the work: To compare placental volumes and vascularization between normotensive pregnant women and women with hypertensive disorders using three-dimensional sonography.Patients and Methods: The study comprised of 60 patients divided into three groups; control group included 20 women with normal blood pressure, 20 patients with chronic hypertension (those with a diagnosis of elevated blood pressure before or within the first half of pregnancy) and 20 patients with mild pre-eclampsia (those with no history of arterial hypertension before pregnancy and a confirmed diagnosis of arterial hypertension associated with proteinuria in second half of pregnancy).Results: there was no statistical difference between the three groups as regarding the demographic data. There was statistical significant difference between the three groups as regarding PV to FWT ratio. The mean of PV to FWT ratio of group 1, group 2 and group 3 was 0.1347±0.1590, 0.1257±0.01, 0.1408±0.017, respectively, with significant statistical differences between normotensive and chronic hypertensive groups (P=0.016) and with significant statistical differences between normotensive and mild pre-eclamptic group (P=0.002). As regarding placental vascular indices, there was significant statistical differences between the three groups and VFI (P=0.03), but there was no significant statistical difference between the three groups as regarding placental FI (P=143). There was significant positive correlation between placental volume, gestational age and observed to expected PV ratio (r) 0.515, 0.797 respectively. There was significant negative correlation between PV and placental VI. (r) 0.247.Conclusion: Infertile women are susceptible to violence. All women attended infertility clinics must be screened for presence of violence and offered adequate support. Healthcare staff should consider husband attendance and good counseling about the drawback of all types of violence.}, keywords = {Hypertensive disorders,Placental Volume,Pre-eclampsia,three-dimensional ultrasound,vascular indices}, url = {https://ebwhj.journals.ekb.eg/article_15645.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15645_91059e1c6c1796a7a53de2be56f26ba2.pdf} } @article { author = {Borg, Hesham and Ossman, Ahmed and Salem, Hesham and El-Hemedi, Mahmoud and El-Shafie, Khaled and Alarabawya, Reda}, title = {Color Doppler ultrasound in diagnosis of placenta accreta}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {215-222}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15471}, abstract = {peripartum hysterectomy. The strict etiology is indefinite, but it has been postulated to be correlated to the injury of the decidua basalis, which allows for the placental attack into the myometrium.Purpose: To evaluate the accuracy of color Doppler ultrasonography in the diagnosis of placenta accreta and to compare it with the diagnostic accuracy of both 2D Ultrasonography and MRI.Material and Methods: A prospective study was done at Obstetrics and Gynecology Department of Tanta University Hospital, Egypt. The study included 100 patients with suspected placenta accreta based on 2D ultrasonography, color Doppler and MRI. The intraoperative findings of each case were compared with the preoperative imaging findings.Results: Sensitivity for the diagnosis of placenta accreta was (100%) for color Doppler ultrasound, (93.7%) for 2D ultrasound and (75 %) for MRI. Specificity was (66.6 %) with color Doppler and (77.7%) for 2D ultrasound and (55.5%) for MRI. The highest positive predictive value (PPV) was found in 2-D ultrasound (88%), MRI had the lowest PPV (75%), while color Doppler had 84%PPV. Negative predictive value (NPV) was (100%), (87.5%), (55.5%) for color Doppler, 2D ultrasound and MRI, respectively.Conclusion: Color Doppler Ultrasound is the most accurate imaging modality in the diagnosis of placenta accreta. Its accuracy, when combined with 2D ultrasound, would increase and provides the best available modality for diagnosis of placenta accreta}, keywords = {β-hCG,ectopic pregnancy,laparoscope,Methotrexate}, url = {https://ebwhj.journals.ekb.eg/article_15652.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15652_23aae167934f357c281d410875ae9e05.pdf} } @article { author = {Fahmy, Radwa}, title = {Letrozole versus HRT in frozen-thawed embryo transfer cycles}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {223-228}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15654}, abstract = {Background: A progressive increase in FET cycles was observed in recent years. Different endometrial preparation strategies have been described, however, there is still some controversy as to the ideal endometrial preparation protocol.Objective: To evaluate the efficacy of letrozole in the endometrial preparation for frozen thawed embryo transfer cycles and to compare it to the HRT with estrogen and progesterone.The Study Design : Retrospective study.Patients and Methods: 320 cycles of endometrial preparation for frozen thawed embryo transfer were analyzed from 1st of January 2015 to 31st of June 2017, the recruited patients were divided into two groups: Group1 (n =160): Induction of ovulation group (letrozole group ) and Group 2 (n = 160): Hormonal replacement therapy group (HRT group).Results: the biochemical pregnancy rate was not significantly higher in the letrozole group 90 (56.3%) than in the HRT group 78 (48.8%) ; while the implantation rate, the clinical pregnancy rate and ongoing pregnancy rate were significantly higher in the induction group 22 (27.766), 81 (50.6%), 71 (44.4%) compared to HRT group 16.72 (24.096), 62 (38.8%), 44 (27.5%), respectively. First trimester abortion rate was significantly higher in the HRT group 19 (11.9%) compared to induction group 10 (6.3%).Conclusion: The use of letrozole in patients undergoing FET was associated with significantly higher implantation rate, clinical pregnancy rate, ongoing pregnancy rate and a lower 1st trimesteric abortion rate, than use of HRT in frozen thawed embryo transfer cycles}, keywords = {Endometrial,frozen-thawed,HRT,Letrozole}, url = {https://ebwhj.journals.ekb.eg/article_15654.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15654_6c6e1be18b2e2661856d2e909e924b2c.pdf} } @article { author = {Abdel-Ghany, Ahmed}, title = {Evaluation of transvaginal ultrasonography, power Doppler indices, electromyography and serum protein 53 level in prediction for preterm labour}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {229-235}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15473}, abstract = {Objective: The objective of this study is to evaluate the role of cervical length measurement by transvaginal ultrasonography, power Doppler of the uteroplacental circulation, electromyography and serum protein 53 level (p53) in prediction for preterm labour (PTL).Study Design : A prospective observational study.Patients and Methods: The study was conducted at the outpatient clinic of El-Minia University Hospital, Egypt during the period from January 2012 to December 2014. The study included a total of 100 pregnant women at high risk for preterm labor. All included cases were subjected to transvaginal cervical sonography, power Doppler velocimetry and uterine electromyography measurements (EMG), also, serum protein 53 level was determined.Results: The included subjects were classified into two groups according to gestational age at labor: Group (I): patients delivered before < 35 weeks (n=42) and group (II): patients delivered ≥ 35 weeks (n=58). Group (I) had significantly lower cervical length compared to group II (2.86 ± 0.81vs. 3.23 ± 0.67 cm) (P=0.013). There was a significant difference between groups as regards EMG (P = 0.006). No statistically differences were found between groups as regards Doppler indices (both resistance and pulsatility index). Group (I) had significantly higher maternal serum concentration of P53 compared to group II (473.8 ± 146.5 vs. 404.6 ± 164.7 pg/ml), (P≤ 0.01). Serum P 53 level had the higher sensitivity for prediction of PTL (78.6%), however, power Doppler indices had the lowest sensitivity (RI = 23.8% and PI =19.1%), cervical length had sensitivity of 33.3% however, EMG positive parameters had sensitivity of 40.5 % and specificity of 100.0%.Conclusion: From the studied tools for prediction of preterm delivery, different results were obtained, but serum P53 level was the most sensitive and the best option for prediction of preterm delivery, while, power Doppler indices are the least sensitive. However, EMG positive parameters are the most specific for prediction of PTL.}, keywords = {electromyography,Preterm Labour,prediction,power Doppler indices,protein 53,Transvaginal ultrasonography}, url = {https://ebwhj.journals.ekb.eg/article_15655.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15655_20ad908445dc3c50ceeaa1c73c04bb6f.pdf} } @article { author = {Edris, Yehia and Barakat, Ehab}, title = {Supplementation with L-Carnitine improves uterine receptivity in women with prior implantation failure during frozen embryos transfer: A double-blinded, randomized, placebo-controlled clinical trial}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {236-244}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15474}, abstract = {Aim: To evaluate the impact of adding L-carnitine (LC) to usual endometrial preparation on endometrial receptivity in women with at least one prior implantation failure during intra-cytoplasmic sperm injection (ICSI)/frozen embryo transfer (FET) cycles.Methods: This prospective, double-blinded, placebo-controlled, randomized, parallel-group, concealed allocation, superiority trial was conducted at a private specialized IVF center at Benha, El-Qalubia, Egypt, between November 2015 and May 2017. The study included 124 infertile couples with at least one prior implantation failure (PIF) in ICSI/FET cycles ; they were allocated to receive usual endometrial preparation plus 3 gm LC/daily until transfer (62) or received placebo (62) plus usual estradiol valerate. Outcomes were endometrial thickness, implantation rate, chemical pregnancy rate, clinical pregnancy rate, ongoing implantation rate, ongoing pregnancy rate, live birth rate and live borne babies rate.Results: Infertile women with at least one prior implantation failure in ICSI/FET cycles co-treated with L-Carnitine showed significantly thicker endometrium (mm) 9.8 ± 1.2 in LC vs 8.4 ± 0.7 in non LC with Δ (95% CI) = 1.4 (1.74, 1.05) and higher chemical pregnancy rate 46 (74.2%) in LC vs 22 (35.4%) in non LC with ΔPP (95% CI) = 38.8 (71.46; 52.96) and RR (95% CI) = 2.09 (1.44, 30.1) and NNT (95% CI) = 3 (2, 5). Also, higher clinical pregnancy rate was (34 (54.8%)) in LC vs 14 (22.6%) in non LC with ΔPP (95% CI) = 32.2% (15.13, 46.77) and RR (95% CI) = 2.4 (1.45, 40.5) and NNT (95% CI) = 4 (3-7) as well as higher live birth rate and live bone rate of singletons fetus (P < 0.05).Conclusion: Data presented in this trial supported the supplementation of LC to usual endometrial preparation in women with at least one prior implantation failure in ICSI/FET cycles as it improved endometrial receptivity indicated by improved implantation rate, clinical pregnancy rate and live birth rate.}, keywords = {Estradiol Valerate,frozen embryos transfer,Intra-cytoplasmic sperm injection,L-carnitine supplementation,prior implantation failure,recurrent implantation failure}, url = {https://ebwhj.journals.ekb.eg/article_15659.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15659_b1aeedb56d525733f13939892b802da3.pdf} } @article { author = {Abd Elbar, Mostafa and Abdelhak,, Ahmed and Askalany, Ahmed}, title = {Effect of fasting during Ramadan on fetal Doppler indices and amniotic fluid volume}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {245-249}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15661}, abstract = {Aim of work: To assess the effect of fasting for a whole month during Ramadan on the fetal Doppler indices and amniotic fluid index.Patients and Methods: The study involved 240 healthy women in the third trimester of a normal singleton pregnancy. The umbilical artery resistance index (RI) and middle cerebral artery (MCA) pulsatility index (PI) and the amniotic fluid index were measured at the beginning of Ramadan and at the end of the month. Of the included women, 157 (65.4%) chose to fast (Group 1) and 83 (34.6%) were not fasting (Group 2).Results: On reassessment, 9 participants were lost to follow up, 2 women developed hypertension and another woman had preterm delivery. Thus, results at the end of Ramadan were presented for 228 women; 152 in the fasting and 76 in the non-fasting group. On initial assessment, there was no significant difference between fasting and non-fasting women regarding umbilical artery RI (p = 0.645), MCA PI (p = 0.581) and AMF (p = 0.070). During re-assessment at the end of Ramadan, there was no significant difference between the two groups regarding umbilical artery RI (p = 0.519), MCA PI (p = 0.383) and AMF (p = 0.339). At the end of Ramadan, there was a statistically significant decrease of Doppler indices and AFI. However, all values were within the clinically accepted range.Conclusion: Maternal fasting during Ramadan does not adversely affects fetal condition based on finding of normal Doppler indices and amniotic fluid index, provided woman is young and healthy.}, keywords = {Fasting during Ramadan,fetal Doppler}, url = {https://ebwhj.journals.ekb.eg/article_15661.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15661_9d672c022b2fef32cbea8e43795efc67.pdf} } @article { author = {Barakat, Ehab and Edris, Yehia and Al-Kholy, Adel}, title = {Insulin resistance, obesity and hypovitaminosis D adversely affect pregnancy utcome: Can Supplemental vitamin D cut this risk?}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {250-258}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15477}, abstract = {Aim of work: To estimate serum 25-hydroxy vitamin D (25OH-VD) and insulin, and fasting blood glucose (FBG) early in pregnancy, determine the frequency and severity of insulin resistance (IR), gestational diabetes mellitus (GDM) and pre-eclampsia (PE) during pregnancy and the impact of VD supplemental therapy (VD-ST) on these effects.Patients and Methods: 494 pregnant women fulfilling the inclusion criteria were randomly divided into two equal groups: Study group received VD-ST as a daily oral dose of 1000 IU soft gels with meal since 6th week till delivery, while control group did not receive VD-ST. All women gave blood samples for colorimetric estimation of FBG and ELISA estimation of serum insulin and 25-OH-VD levels. Evaluated parameters included body mass index (BMI), VD sufficiency status and homeostasis model assessment IR (HOMA-IR) score. Oral glucose tolerance test for diagnosis of GDM was performed at the 20th, 28th and 36th week GA and blood pressure was measured regularly at follow-up visits for diagnosis of PE.Results: At time of enrolment, 405 women (81.9%) were overweight-obese, 86 women (17.4%) had IR and only 63 women (12.8%) had sufficient serum 25OH-VD level. At 3rd trimester, 68 women (13.8%) developed GDM, 71 women (14.4%) developed PE and 23 women (4.7%) developed both with significantly lower incidence in women who received VD-ST. Frequency of GDM and PE showed positive significant correlation with BMI and HOMA-IR score, while showed negative significant correlation with serum 25OH-VD. ROC curve analysis defined low 25OH-VD level and high HOMA-IR score as significant sensitive predictors for development of both GDM and PE ; while receiving VD-ST was the significant specific predictor for possibility of amelioration of such event. Kaplan-Meier regression curve defined a cumulative hazard for developing both GDM and PE of <20% with and 60% without VD-ST.Conclusion: VD deficiency-insufficiency is a problem that requires national evaluation for predisposition and progress. The triad of maternal hypovitaminosis D, obesity and IR is associated with development of GDM and/or PE. The proposed VD supplementation regimen effectively reduced the frequencies of pregnancy-associated or induced complications; so it is effective to break that triad.}, keywords = {Gestational diabetes mellitus,hypovitaminosis D,Insulin Resistance,Pre-eclampsia,Pregnancy,vitamin D supplemental therapy}, url = {https://ebwhj.journals.ekb.eg/article_15662.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15662_2ea1d8672b051b802a1402896939a56e.pdf} } @article { author = {Abdelghany, Ahmed and Mounir, Samir}, title = {Premature rupture of Membrane : Maternal and neonatal approach}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {3}, pages = {259-265}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.15478}, 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.}, keywords = {}, url = {https://ebwhj.journals.ekb.eg/article_15666.html}, eprint = {https://ebwhj.journals.ekb.eg/article_15666_34f41f97271352069106f4b19cb67363.pdf} }