@article { author = {Esteves, Sandro and Majzoub, Ahmad and Roque, Matheus}, title = {Sperm DNA fragmentation testing}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {325-328}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28637}, abstract = {}, keywords = {antioxidants,Assisted reproductive technology,Lifestyle,Male infertility,Recurrent pregnancy loss,sperm DNA damage,sperm DNA fragmentation,sperm DNA integrity,Unexplained infertility,Varicocele,varicocele repair}, url = {https://ebwhj.journals.ekb.eg/article_28775.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28775_9dc05f6fa9117a9b0bd84b3820c301f0.pdf} } @article { author = {Akl, Sherif and El-Mekkawi, Sherif and El-Kotb, Ahmed and Mostafa, Afaf}, title = {Role of Vitamin D Supplementation Therapy on Ovulation and Insulin Resistance in Women with PCOS: A Randomized Controlled Trial}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {329-336}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28635}, abstract = {Introduction: Polycystic ovarian syndrome (PCOS) is the most prevalent worldwide female endocrine disorder, affecting nearly 5%-12% of reproductive-aged women. PCOS is the most common cause of anovulatory infertility and its foremost clinical symptoms include anovulation or oligo-ovulation, infertility, menstrual irregularity, polycystic ovaries and hyperandrogenism. PCOS is also common among infertile Arabian female population and it is associated with significant elevations in markers of metabolic syndrome, insulin resistance and cardiovascular risks. Unfortunately, PCOS is not a simple pathophysiologic process for which one treatment is sufficient to control all manifestations. Therefore, when choosing a treatment regimen, it should target specific manifestations and individualized patient goals.Aim of the Work: The aim of this study is to assess the safety and the efficacy of vitamin D supplementation therapy on ovulation and metabolic changes in women with PCOS.Study design: Prospective randomized controlled clinical trial.Patients and Methods: The current study was conducted in the infertility clinics of Ain Shams University Maternity Hospital in the period between May 2015 and May 2017. It included 300 women diagnosed with polycystic ovary syndrome attending the infertility clinics of Ain Shams University Maternity Hospital.Results: Being a classification criterion, 25OHD level was significantly lower in the vitamin D deficient subgroup compared to the normal vitamin D subgroup; whereas no significant differences were found between the vitamin D deficient group and the control group. In the same context, 25OHD level was statistically significantly lower in the control group compared to the normal vitamin D subgroup. Vitamin D deficient PCOS women tended to have higher degree of insulin resistance. Fasting glucose was statistically significantly higher in the vitamin D deficient subgroup compared to the normal vitamin D subgroup and the control group; and higher in the control group compared to the normal vitamin D subgroup. Fasting insulin level was statistically significantly higher in the vitamin D deficient subgroup and the control group compared to the normal vitamin D subgroup; whereas no statistically significant differences were found between the former two groups. HOMA2-IR was statistically significantly higher in the vitamin D deficient subgroup and the control group compared to the normal vitamin D subgroup; whereas no statistically significant differences were found between the vitamin D deficient subgroup and the control group. No statistically significant differences were found between the three groups in the various components of the lipid profile.Conclusion: Results of the thesis showed that cumulative ovulation rate was significantly higher in the vitamin D deficient subgroup following vitamin D supplementation compared to the normal vitamin D subgroup and the control group with a rate ratio of 1.27 and 1.22, respectively. Number needed to treat was calculated to be 5.34 and 6.38 compared to normal vitamin D subgroup and control group respectively, i.e. 6.38 women are needed to be supplemented with vitamin D for one of them to benefit compared to control women. No significant differences were found between the three subgroups regarding the median ovulating dose of clomiphene citrate. Also, no significant differences in the cumulative clinical pregnancy rate between the ovulatory women of the three subgroups.}, keywords = {Ovulation,PCOs,Vitamin D}, url = {https://ebwhj.journals.ekb.eg/article_28768.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28768_10e961db0869ed4d82016507900ca95c.pdf} } @article { author = {Hagras, Ahmed and Barakat, Ehab}, title = {Letrozole Ovarian Stimulation improves Outcome of Endometrial Scratching prior to Intrauterine Insemination Procedure}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {337-343}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28636}, abstract = {(OS) followed by endometrial scratching (ES) versus after each intervention separately.Patients and Methods: This study included 90 women with primary infertility for >2years secondary to male factor and had previous failed IUI or expectant trials. All women underwent clinical examination and transvaginal ultrasonographic (TUV) examination and hormonal profile. Enrolled couples were randomly divided into three groups: Group L received oral letrozole 5 mg from day 3 to 7 of the menstrual cycle, Group S included females subjected to ES injury and Group LS included females received LET OS followed by ES injury. For all groups, ovulation was monitored and assured using TVU for evident ovulation with a dominant follicle size >18 mm. IUI was repeated for three cycles and clinical pregnancy rate (CPR) and abortion and multiple pregnancy rates were recorded.Results: The studied women gave 287 follicles of >18 mm with a mean number of follicles of 3.18/female and 1.35/cycle. Mean endometrial thickness was significantly lower, while E2 serum levels were significantly higher in women of group S compared to women of other groups. Total CPR was 41.1%/woman and 17.4%/cycle with significant difference in favor of group LS. Two patients of groups L and LE had multiple pregnancy and 5 women had abortion for a rate of 5.6%/woman and 2.3%/cycle.Conclusion: Letrozole OS did better to prepare for IUI in infertile couple secondary to male subfertility. ES prior to IUI improved the chances of clinical pregnancy and could be an alternative to OS whenever OS had failed or contraindicated. ES after letrozole OS followed by IUI augments the CPR up to 53.3%/patient.}, keywords = {Clinical pregnancy rate,Endometrial scratch,Intrauterine insemination,Letrozole ovarian stimulation,Male factor infertility}, url = {https://ebwhj.journals.ekb.eg/article_28769.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28769_6d65ca28eee14df19a8af208aa028f74.pdf} } @article { author = {Madny, Elham and Atwa, Khaled and Eid, Aida and Farag, Mohamed}, title = {Use of cervical inversion technique as a tamponade to control postpartum hemorrhage caused by placenta previa and placenta previa focal accreta}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {344-348}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28638}, abstract = {}, keywords = {}, url = {https://ebwhj.journals.ekb.eg/article_28770.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28770_b7ce893aebd07b3219aa173e22465d14.pdf} } @article { author = {Abdou, Ahmed and Elshabrawy, Arafa}, title = {Role of metformin and glibenclamidein controlling gestational diabetes mellitus}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {349-354}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28639}, abstract = {Aim of the work: The aim of this study is to compare metformin and glibenclamide in treatment of gestational diabetes mellitus regarding the efficacy in glycemic control and safety.Patients and Methods: Eighty patients aged between 18 and 40 years who were diagnosed to have gestational diabetes mellitus between 16 and 34 weeks that was failed to be controlled by diet and exercise and required medical therapy were recruited. They were allocated to either metformin or glibenclamide therapy. The primary outcome was failure of glycemic control according to fasting and postprandial glucose values. Secondary outcomes were obstetric outcomes, maternal and neonatal complications.Results: Patients in metformin group had significantly higher failure of glycemic control than patients in glibenclamide group (10 cases in metformin group versus 3 cases in glibenclamide group; p=0.003). Also, mean fasting glucose level was significantly higher in metformin group than glibenclamide group (87.38 ± 7.4 and 82.42 ± 6.4 mg/dl, respectively, p= 0.005), while both groups had comparable post-prandial glucose levels (p= 0.11).Both groups had comparable rate of maternal and neonatal complications. There was no significant difference between both groups regarding gestational age and mode of delivery.However, more neonates developed hypoglycemia <40 mg/dl in glibenclamide group than metformin group (11 and 6, respectively, p= 0.025).Conclusion: Metformin and glibenclamide are comparable oral drugs for treatment of gestational diabetes that requires medical treatment regarding maternal and fetal outcomes with preference of glibenclamide in terms of better glycemic control.}, keywords = {Gestational diabetes mellitus,Glibenclamide,Glycemic control,Metformin}, url = {https://ebwhj.journals.ekb.eg/article_28771.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28771_70fbb09fc0a6801f0194d4c780c1fcf5.pdf} } @article { author = {Abdel-Megeed, Abdel-Megeed and Riad, Amr and Mohamed,, Shaimaa}, title = {Effect of maternal anemia on fetal Doppler indices during the last trimester of pregnancy}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {356-362}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28640}, abstract = {Aim of the work: The aim of this study was to evaluate the effect of maternal anemia on fetal Doppler indices ; namely, umbilical artery and middle cerebral artery in the last trimester of pregnancy.Patients and Methods: This study was designed as a prospective case control clinical trial carried out in obstetric outpatient clinics and inpatient ward, Ain Shams University Maternity Hospital on 200 patients. The patients must follow these criteria:Gestational age between 28-40 weeks of singleton pregnancy (calculated by their last menstrual period or by earlier ultrasound), fetus is alive and normal fetal ultrasound parameters.Results: The umbilical artery resistance index showed a significant increase in moderate severe anemic patients more than the control group. Umbilical artery pulsatility index showed a significant increase in severe anemic group more than the other 3 groups.Umbilical artery systolic/diastolic ratio showed a significant increase in severe anemic more than the other groups. Finally, the umbilical artery cerebral/umbilical artery resistance ratio showed a significant increase in severe anemic more than the other groups.Conclusion: GA at delivery in different groups was matched, i.e. there was no statistical significant difference between different studied groups regarding GA at delivery (P > 0.05). Neonatal ICU admission were 2(4%), 2(4%), 4(8%) and 9(18%) in different groups, respectively. There was statistical significant difference between different studied groups regarding Neonatal ICU admission (P < 0.05).}, keywords = {Cerebral/umbilical artery resistance ratio,hemoglobin concentration,red blood cells}, url = {https://ebwhj.journals.ekb.eg/article_28772.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28772_2de5d4f621669416e8ff60892e471c49.pdf} } @article { author = {Mohamed, Sabry and Mansour, Dina and Shaker,, Ahmed}, title = {The effect of misoprostol on intra-operative blood loss during myomectomy operation: Randomized controlled trial}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {363-371}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28641}, abstract = {Introduction: Uterine myomas are most prevalent benign tumors in reproductive-aged women. Myomectomy is a surgical treatment for symptomatic uterine myomas for women who want to preserve fertility. Uncontrolled intraoperative bleeding with others life-threatening complications make the surgery risky even more than the hysterectomy and require a skilled surgeon, several methods have been developed to reduce this complications. Misoprostol PE1 analogue, which is recently used as treatment and prophylaxis of postpartum hemorrhage, may reduce intra-operative blood loss during abdominal myomectomies when bleeding constitutes a major problem.Aim of the work: Was to assess the effect part of a single dose of Misoprostol (400 microgram) given rectally one hour preoperative on the amount of blood loss during open Myomectomy.Patients and Methods: In a prospective randomized double-blind placebo-controlled trial which was conducted at Ain shams maternity Hospital in Cairo from October 2017 to May 2018, 50 women undergoing abdominal myomectomy for symptomatic uterine myomas were randomly divided into 2 groups : Group I (control group) consisted of 25 patients, each patient was given 2 tablets of placebo trans-rectally one hour preoperatively and without any intervention to reduce blood loss and Group II (study group) consisted of 25 patients, each patient was given 400 micrograms of misoprostol trans-rectally one hour preoperatively. The primary outcome was intraoperative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT03483142.Results: Intra-operative blood loss was significantly lower in those women randomized to receive rectal misoprostol versus the placebo group (460.8- 155.2 mL vs. 815.4 - 187.7 mL). Misoprostol group showed lower mean blood loss (P<0.01) ; additionally, there was a highly significant statistical difference between Misoprostol group and placebo group as regards the postoperative hemoglobin, hematocrit concentration, operative time and IV fluid infusion during surgery (P<0.01) as Misoprostol group showed a higher postoperative hemoglobin and hematocrit concentration, and less operative time and infused IV fluid. There was no statistical significant difference between both groups as regards the blood transfusion.Conclusion: Preoperative single dose of rectal misoprostol (400 micrograms) is an effective simple method for reducing intra-operative bleeding, operative time, mean post-operative HB and Hct drop.}, keywords = {Intra-operative blood loss,misoprostol,myomectomy operation}, url = {https://ebwhj.journals.ekb.eg/article_28773.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28773_e3d41d02c7dab83764d33d56db8656df.pdf} } @article { author = {ElSherbieny, Mohamed and Hussein, Ahmed and Rafat,, Ragaa}, title = {Comparison between two types of copper bearing intrauterine device Cu375 and Cu380Ag regarding bleeding pattern: Randomized controlled trial}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {372-380}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28642}, abstract = {Introduction: The complications of IUDs are abnormal uterine bleeding, dysmenorrhea, expulsion of the IUD or perforation of the uterus. Due to these complications, 5 to 15 percent of women will stop using the IUD during one year. The most common complication of using IUDs is bleeding that is the cause of 15 to 30 percent of the rejection and exclusion of copper IUDs by the users. Except for progesterone IUDs, all IUDs can lead 50-100 percent increase in the amount of menstrual blood than before the insertion.Aim of the work: To compare between two types of copper IUDs which are different in shape and size (Cu375 and Cu380Ag) regarding bleeding pattern.Patients and Methods: This is a randomized controlled clinical trial. The study was conducted at Family Planning Outpatient Clinic at Department of Obstetrics and Gynecology at Ain Shams Maternity Hospital on 220 patients divided into two groups with insignificant differences between two groups as regard age (p-value 0.934).Results: 110 participants recruited in each group. In group A, drop out after 1month was 6 women and only 70 women had subjective changes in bleeding pattern. After 1 year, drop out was 8 women. In group B, drop out after 1month was 4 women and only 79 women had subjective changes in bleeding pattern. After 1year, drop out was 5 women.Conclusion: One of the most common complications of IUD users is bleeding. These complications vary in the different types of IUDs. The results of this study showed that the use of the IUD ML CU 375 causes a significant decrease in the rate of bleeding.}, keywords = {Bleeding pattern,copper bearing,intention-to-treat}, url = {https://ebwhj.journals.ekb.eg/article_28774.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28774_836cf832943430209bec2aa22b55b06b.pdf} } @article { author = {Ibrahim, M. and Abdel-Rahman, Rehab and El-Kateb, Marwa}, title = {Association of vitamin D deficiency in pregnancy and risk of preterm labor}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {383-389}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28643}, abstract = {Introduction: Prematurity represents around 50-75% of the perinatal mortality causes. It is considered a challenging clinical scenario faced in every day practice. Preterm labor is clinically definedas the beginning of regular uterine contractions accompanying cervical changes before 37 gestational week’s completion with or without intact fetal membranes.Aim of the work: To assess the association between vitamin D status and preterm labor.Patients and Methods: 80 pregnant study subjects with singleton pregnancy between 20-28 gestational weeks were followed up for any sign or symptom of preterm labor. Study subjects that completed 37 gestational weeks were considered controls, others delivered before 37 gestational weeks were considered cases. A blood sample was collected from cases and controls and was frozen till reaching our target of PTBs then serum 25(OH) VD was assayed by ELISA.Results: Vitamin D levels were less in the preterm research group in statistically significant fashion (p value =0.000). GA age at delivery was statistically significantly correlated to vitamin D levels in which Pearson correlation = 0.571 (p value =0.000). Vitamin D deficiency was statistically significantly more prevalent in preterm research group ; while vitamin D sufficiency and insufficiency were more prevalent in full term research group in statistically significant manner (p value =0.000).Conclusion: A significant association between vitamin D deficiency in pregnancy and occurrence of preterm labor. Future research studies should in addition consider racial, ethnic differences between study subjects recruited in a comparative manner and seasonal variabilities that could affect vitamin D status.}, keywords = {preterm birth,preterm labor,Vitamin D}, url = {https://ebwhj.journals.ekb.eg/article_28777.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28777_f12cf14c2377404953602df9aa0c84e9.pdf} } @article { author = {Mugdha, Raut and Raut, Mohan}, title = {Role of immunomodulation with lymphocyte immunization therapy (LIT) in a couple with 15 unexplained repeated miscarriages}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {1}, pages = {390-393}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/EBWHJ.2019.28644}, abstract = {The problem of repeated miscarriages affects 0.5-2% of population. The current case is with history of 15 unexplained miscarriages following both, spontaneous conceptions and after IVF. All the routine investigations were normal. She had been treated with all the established methods of treatment without success. She was diagnosed with allo-immune cause of miscarriages and was given Lymphocyte Immunization Therapy (LIT). Her pregnancy successfully went till term. There were no side effects of the LIT to the mother or the baby. A case with higher number of repeated miscarriages is more likely to be due to allo-immune rejection of pregnancy. Immunomodulation with active immunotherapy in the form of LIT is still an effective therapy in properly selected cases.}, keywords = {Allo-immunity,Immunotherapy,lymphocyte immunization therapy (LIT),unexplained repeated miscarriages,unexplained recurrent miscarriages}, url = {https://ebwhj.journals.ekb.eg/article_28776.html}, eprint = {https://ebwhj.journals.ekb.eg/article_28776_1b9eefb1f774e6ba16914a52f4e8c176.pdf} }