@article { author = {Harira, Mervat}, title = {Combined Letrozole and Clomiphene versus Letrozole with low dose gonadotropin protocol for ovulation induction in infertile clomiphene-resistant women with polycystic ovary syndrome: Comparative study}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {266-272}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20068}, abstract = {Objectives: To compare the effect of combined clomiphene citrate (100mg) and Letrozole (5mg) versus Letrozole (5mg) followed by gonadotropin injection for one cycle in CC resistant PCOs patients.Design: Prospective randomized trial.Setting: Infertility Outpatient Clinic and Cytogenetic and Endoscopy Unit of Obstetrics and Gynecology Department of Zagazig University Hospitals.Study group: About 212 PCOs patients with CC resistance (anovulatory response with CC at a dose of 100-150 mg for 3 cycles) were divided into two groups (106 in each group).Intervention: A studied group was randomly divided into two groups. Group A received combined Letrozole 5mg (2 tablets) in the morning and clomid 100 mg (2 tablets) in the evening from the 3rd day of menses for 5 days, group B received Letrozole 5 mg (2 tablets) from the 3rd day of menses for 5 days followed by human menopausal gonadotropin (hMG) injection every other day from cycle day 7. Moreover, ultrasound folliculometry started on cycle day 10 then the dose was adjusted according to follicular size. Both groups received treatment regimen for only one cycle.Results: There was higher ovulation rate (85.8%) in letrozole plus hmG group than in the other group receiving letrozole and CC (80.2%), but with no statistical significant difference (P -value =0.65). But, there was statistical significant difference between both groups regarding stimulation characters including total number of mature follicles (≥18 mm) 2.1 ± 1.01 in combined letrozole and CC was greater in group A than in group B (1.66 ± 0.98) with (P - value = 0.009). Stimulation days were longer in group B (18.2 ± 2.5) than in group A (16.2 ± 2.1). Mean total E2 on the day of hCG administration was significantly higher among patients in the clomiphene-letrozole group as compared with that in the other group of letrozole with hmG ( 650 ± 190.3 and 540 ± 180.5, respectively). Also, higher day 21 serum progesterone in group A (11 ± 1.1) than (9.5 ± 0.9) in group B. But, there was no statistical significant difference in mean endometrial thickness in both groups (A and B) (9.6 ± 1.7 versus 9.8 ± 1.5mm, respectively) (P-value = 0.41). The pregnancy rate did not show any statistical significant difference in both groups (P-value = 0.45) ; 32 patients out of 106 (30.1%) in group A compared with 27 patients (25.4%) in group B. Four cases were aborted in group A compared with 3 cases in group B. Four cases had twin pregnancy in group A with only 3 cases in group B. Also, there was no significant difference between both groups regarding ovarian hyperstimulation ; as there were 2 cases with combined clomid and letrozole group and one case only in letrozole plus hmG group.Conclusion: This study showed that lerozole is an effective medication when combined with CC or sequentially with hmG injection in improving the ovulation and pregnancy rate in CC-resistant PCOs patients with higher results when combined with hmG injection, but did not reach statistical significance.}, keywords = {CC resistance,Clomid,Combination therapy,Letrozole,polycystic ovary syndrome}, url = {https://ebwhj.journals.ekb.eg/article_22108.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22108_a3ffa54870ec700335dde63319824266.pdf} } @article { author = {Abdel-Ghany, Ahmed}, title = {The role of trans-obturator vaginal tape (TVT-O) in the management of female stress urinary incontinence: 2 years follow up, Minia University Experience}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {273-278}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20069}, abstract = {Objective: The aim of this study was to evaluate the effectiveness and safety of a new minimally invasive surgical procedure, trans-obturator vaginal tape (TVT-O), in the treatment of female stress urinary incontinence and following-up these cases for 24 months regarding effectiveness, safety and possibility of complications.Type of the Study: with a 24 -months follow-up.Setting: Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt.Patients: Thirty women with genuine stress urinary incontinence (SUI) demonstrated by history, clinical examination and urodynamic study.Methods: Thirty patients diagnosed with SUI underwent trans-obturator sling (inside-out technique) (TVT-O Gynecare®, Johnsonand Johnson, USA.).Outcome Measures: The patients were followed up for 24 - months regarding subjective and objective cure rates.Results: The mean operative time (min.) was 19.67 (±8.06). The mean intraoperative blood loss (ml) was 80 ± 30.52. There were no cases complicated with intraoperative bleeding (mild or severe), bladder, urethral, vascular injuries and anesthetic complications. Subjective and objective cure rates of these patients were (95%).Conclusion: The results of this study concluded that management of genuine stress urinary incontinence by trans-obturator vaginal tape (TVT-O) is an easy and safe method with low complications and high success rate.}, keywords = {Stress Urinary Incontinence,Transobturator vaginal tape}, url = {https://ebwhj.journals.ekb.eg/article_22110.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22110_0e363229af06612bf2875056cb60b71e.pdf} } @article { author = {Elkallaf, Hany}, title = {Prospective comparative trial to define the optimum time for insemination during stimulated intrauterine insemination cycles}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {279-287}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20070}, abstract = {Objectives: To determine the clinical pregnancy rate (CPR) of women who underwent clomiphene citrate (CC) and human menopausal gonadotropin ovarian stimulation (OS) followed by intrauterine insemination (IUI) at varied times after hCG ovulation triggering and to determine the appropriate IUI timing.  Patients and Methods: 152 women with primary infertility secondary to male subfertility were randomly allocated into groups (I-IV) according to timing of IUI at 34-35, 35-36, 36-37, and 37-38hr after ovulation triggering. OS consisted of 5-days oral CC 100 mg once daily since day-3 of the menstrual cycle followed by daily injection of human menopausal gonadotropin 150 IU since day-8 until hCG injection. Ovulation was monitored using TVU for evident ovulation with a dominant follicle size >18 mm. IUI was repeated for three cycles and women were evaluated for clinical pregnancy rate (CPR) and abortion and multiple pregnancy rates were recorded.Results: 44 women had clinical pregnancy for a total CPR of 28.9%. CPR% /patient was 15.8%, 34.2%, 42.1% and 23.7% and CPR%/cycle was 6, 14, 20 and 11 in the four groups, respectively with significant differences in favor of group III. Three women had ectopic and six women had multiple pregnancy and five women had abortion. Statistical analyses defined high number of performed IUI cycles as significantly negative, while longer time till IUI after hCG injection as significantly positive predictor for trial success. Kaplan-Meier regression analysis defined 37 hr (95% CI: 36.5-37.5) after hCG injection as the appropriate time to get the best chance for IUI success.  Conclusion: IUI after CC + GN ovarian stimulation is an appropriate policy for infertile couples secondary to male subfertility. Total motile sperm count threshold at ≥5 million gives acceptable outcome. Semen injection at 37 hr after hCG ovulation triggering gives the highest CPR.}, keywords = {Clinical pregnancy rate,Combined ovarian stimulation,Intrauterine insemination,Timing of semen injection}, url = {https://ebwhj.journals.ekb.eg/article_22113.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22113_0552c6ee51c69ba8b1752425aa36ba8c.pdf} } @article { author = {Kishk, Eman}, title = {Comparison of tamoxifen and clomiphene citrate for induction of ovulation in cases with thin endometrium}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {288-292}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20071}, abstract = {Introduction: One of the earlier and most common drugs that have been used for ovulation induction is clomiphene citrate (CC), recently, other agents have been introduced to avoid the side effects of clomiphene citrate. Tamoxifen is another anti estrogenic compound that may be effective for ovulation induction in cases with thin endometrium. The aim of the study was to compare the efficacy of tamoxifen versus low dose clomiphene citrate for ovulation induction in cases with thin endometrium.  Patients and Methods: After the ethics committee approval, this randomized clinical study was conducted among 82 infertile women with thin endometrium (<7mm) and presented to the Gynecology outpatient clinic. The participants were divided randomly into two equal groups, seventy-eight women completed the study. Group A included 40 patients receiving tamoxifen while group B included 38 patients receiving clomiphene citrate (CC).Results: Mean number of mature follicles ≥ 18 mm was 1.7 ± 0.6 in group A and 1.9 ± 0.8 in group B ; the difference was statistically insignificant (p-value = 0.2). Endometrial thickness (ET) was significantly different between both groups; it was higher in tamoxifen group than clomiphene citrate group (8.9 ± 1.2 mm versus 7.2 ± 1.1 mm, p < 0.0001). Also, it was noted that there were significant statistical discrepancies between both groups regarding pregnancy rate and ongoing pregnancy rate, as they were 22.5% and 17.5 % in group A and 5.3% and 2.6%, respectively, in group B (p<0.05). Conclusion: Tamoxifen has valuable effect on endometrial thickness, tamoxifen increases endometrial thickness and livebirth rate in patients with thin endometrium}, keywords = {Clomiphene citrate,Ovulation Induction,tamoxifen,thin endometrium}, url = {https://ebwhj.journals.ekb.eg/article_22114.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22114_9efe37db6e6868ed0987251a5c12d201.pdf} } @article { author = {Tantawy, Waleed and Ghaleb, Mahmoud and Elsayed, Mahmoud}, title = {Vaginal versus intramuscular progesterone for prevention of preterm labour in women with a twin pregnancy: A randomized controlled trial}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {293-299}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20072}, abstract = {Background: Twins constitute 2-4% of all births and the rate of twining has increased by 76% between 1980 and 2009.Twin pregnancies, compared with singletons, are at increased risk for fetal anomalies, preterm births, aberrant fetal growth, cerebral palsy and perinatal and infant mortality. Maternal complications associated with twin pregnancies include hypertensive disorders, gestational diabetes, cesarean delivery, postpartum hemorrhage and maternal mortality.  Aim of the Work: This study aimed to assess the efficacy of vaginal progesterone compared to intramuscular therapy in  decreasing the rate of preterm birth in women with twin pregnancies.  Patients and Methods: This randomized controlled trial included women presented to Ain- Shams University Maternity Hospital. The study presented for approval from the Ethical Committee of the Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-Shams University. Informed consent was signed after explaining the study purpose and methods to the subjects. Data presentation did not include the patient name, but diagnosis was included.  Results: There was no statistically significance between the two groups regarding number of neonatal RDS, NICU admission and neonatal death. Birth weight was significantly higher among vaginal group. NICU stay was significantly higher among intramuscular group.  Conclusion: Compared with intramuscular 17-OHPC, vaginal progesterone in women with twin pregnancy is associated with lower percentage of preterm labour, less recurrent spontaneous preterm birth, less adverse maternal side effects, fewer NICU admissions and better compliance.}, keywords = {Intramuscular Progesterone,Preterm Labour,Twin Pregnancy,vaginal}, url = {https://ebwhj.journals.ekb.eg/article_22116.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22116_d1478d100a763d5949fdd027f3070be1.pdf} } @article { author = {Fathy, Hesham and Bahaa, Ahmed and Alanwar, Ahmed and Koura, Ahmed}, title = {Accuracy of the three-dimensional 3D Doppler over conventional 2D ultrasound in the diagnosis of morbid adherent placenta (MAP)}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {300-305}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20073}, abstract = {Background: Two-dimensional ultrasound [2D] is in routine use in nearly most of the hospitals and many physician clinics as it offers a lot of benefits compared to other medical imaging techniques. Ultrasonography offers unique qualities including real-time imaging, physiologic measurement, use of non-ionizing radiation and no known bio-effects in the diagnostic range, while being non-invasive. Sonographic image quality has increasingly benefited from sophisticated computer technology.Aim of the Work: Is to evaluate the diagnostic accuracy of three-dimensional (3D) power Doppler over conventional 2D Doppler in diagnosis of morbidly adherent placenta in patients with one or more previous cesarean section diagnosed as placenta previa.Patients and Methods: The present study was carried out at Ain-Shams University Maternity Hospital. Women approached were recruited from Special Care Center of the fetus. After proper counseling, all women who were chosen for enrollment agreed to participate. The total number of pregnant women enrolled in the study was 120 women.Results: In the following analysis, intraoperative and placental histopathology findings were considered as golden standard test when compared to the 2D and 3D uterine ultrasonography amongst the 120 studied cases.Conclusion: The current study suggested that 3D power Doppler modality had a better screening capability for the prediction of the sequel of morbid placentation; namely, difficult placental delivery, considerable intraoperative blood loss, need for caesarean hysterectomy and bladder injury in women with placenta previa prior to cesarean (by its higher sensitivity and negative predictive value (NPV) and its lower false negative rates) when compared to the 2D ultrasound}, keywords = {Conventional 2D Ultrasound,Morbid Adherent Placenta,Three-Dimensional 3D Doppler}, url = {https://ebwhj.journals.ekb.eg/article_22119.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22119_59b080680d2b94c1cf405d4c257e34c7.pdf} } @article { author = {Kortam, Mohamed and Mohammad,, Hayam and Mobarak, Mostafa and Bazazo, Abdalla}, title = {The effect of estradiol valerate with and without oral sildenafil on endometrial thickness and pregnancy rates in infertile women: A R.C.T}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {306-310}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.22121}, abstract = {Objective: Clomiphene citrate (CC) has some negative effects on the endometrium. We evaluated the effect of concomitant administration of oral sildenafil and estrogen on endometrial thickness (ET), pattern and pregnancy rates in CC stimulated cycles in infertile women diagnosed as unexplained infertility.  Aim of the Work: Compare the effect of sildenafil‌-estrogen combination to estrogen alone on endometrium thickness in infertile women.  Materials and methods: It is a randomized controlled trial on 90 infertile women with unexplained infertility; patients were randomly divided into two equal groups. In control group, 45 patients were given ovulation induction with CC 100mg/d from 2nd to 6th day of cycle and oral estradiol valerate 2mg 12 hourly from 2nd day of the cycle till the day of trigger of ovulation. In study group, 45 patients were given ovulation induction with CC100mg/d from 2nd to 6th day of cycle, estradiol valerate 2mg 12 hourly plus oral sildenafil citrate 25mg every 8 h from 2nd day of the cycle till the day of hCG trigger. A transvaginal ultrasound was performed on day 10 to assess follicular growth until the detection of at least one dominant follicle ≥18 mm. At that time, the endometrium was evaluated as regards both endometrial thickness and pattern. Uterine artery resistive index (RI) was then measured. Qualitative serum B-hCG level was checked 14 days after ovulation to assess chemical pregnancy rate.  Results: Mean endometrial thickness at the time of hCG trigger was 9.8 mm in study group and 8.42 mm in control group (p value <0.001). 88.9% patients given sildenafil had trilaminar endometrium whereas 29% patients without sildenafil had trilaminar endometrial pattern (p value = 0.006). Mean uterine artery resistive index (RI) after adding sildenafil was non-significantly lower among study group than among control group; the values were 0.66 and 0.72, respectively (P= 0.078). Pregnancy rates in study group and control group were 17.8% and 11.1%, respectively.  Conclusion: Sildenafil‌-estrogen combination has a potent effect on improving the endometrium (thickness and pattern) in patients undergoing induction of ovulation by clomiphene citrate. This improvement in endometrial development has a weak positive feedback on pregnancy rate.}, keywords = {Endometrial Thickness,Estradiol Valerate,Pregnancy,sildenafil}, url = {https://ebwhj.journals.ekb.eg/article_22121.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22121_abcb7aba6d86ce094b7ea08d86807e73.pdf} } @article { author = {Elmaraghy, Mohammed and El Refaie, Tamer and Labib, Kareem and Mohamed, Marwa}, title = {Effect of intramuscular administration of dexamethasone on the duration of labor induction}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {311-317}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20075}, abstract = {Introduction: induction of labor is a common obstetric procedure which is performed for a variety of medical and non-medical indications. If the cervix is unfavorable, prior ripening of the cervix makes induction of labor easier and more successful. There are different methods for ripening of the cervix and making it ready for induction. These methods included medical methods such as the administration of prostaglandins and mechanical methods such as extra amniotic saline infusion, traction on the cervix with Foley catheter and laminaria.  Aim: The aim of the study is to evaluate the efficacy of intramuscular dexamethazone injection prior to induction in improving progression and duration of labour phases.  Subjects and Methods: This study started with 100 Nulliparous Pregnant women who were conducted at the labor wards of Ain-Shams Maternity Hospital. The studied subjects were randomized into two groups ; dexamethasone group (group A) including 50 Nulliparous women (N=50) and control group (group B) including 50 Nulliparous woman (N=50).Results: In this study, the duration of active and second stages decreased without changing the mode of delivery. The study showed no significant statistical differences between the two studied groups regarding fetal heart rate. The duration of second stage in dexamethasone group was shorter than in the control group. Dexamethasone intramuscularly prior to induction significantly shortens duration of normal labor in normal parturient with minimal complications.Conclusion: An intramuscular injection of dexamethasone before labor induction shortens the duration of labor induction by decreasing the interval between the initiation of induction and the beginning of the active phase, duration of active phase and duration of second stage of labor with no observed maternal or neonatal complications.Recommendation: Further research with more patients undertaken for the assessment of the effects of the corticosteroids on the duration of labor on the patients with unfavorable cervix as well as maternal and perinatal morbidity and mortality rate.}, keywords = {dexamethasone injection,Duration of labour phases}, url = {https://ebwhj.journals.ekb.eg/article_22330.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22330_5df524c97f87b18a1301909383d6655a.pdf} } @article { author = {Amer, Mohamed and Nageeb, Laila and Mohammed, Walid and Hefny, Ahmed}, title = {Histologic Features of Uterine Septum}, journal = {Evidence Based Women's Health Journal}, volume = {8}, number = {4}, pages = {318-323}, year = {2018}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2018.20076}, abstract = {Aim of the Work: was the assessment of the histological features of the uterine septum as regard the proportion of muscle fibers in relation to fibrous tissue to decide the best management whether incision or excision.Patients and Methods: this study was carried out on 16 women with uterine septum in childbearing period complaining of either infertility or recurrent miscarriage fulfilling the inclusion criteria, attending to Ain Shams University Maternity Hospital between May 2017 and April 2018. The septum was incised or excised by scissors or by resectoscope, and then specimen was taken from the middle of the septum sample (A) and another specimen from the uterine wall sample (B). The retraction of the septal tissue on both sides was observed. The study included 16 specimens of uterine septum (A) and 16 specimens from uterine wall (B). Histopathological examination was done Results: There was a statistical significant difference between the uterine septum and uterine wall regarding amount of fibrous tissue, number of cells in connective tissue, amount of muscle tissue, amount of capillaries and number of vessels with muscle wall (P < 0.05). Poor retraction of the septal tissue was found in the muscular septum in contrast to good retraction that found in fibrous septum.  Conclusion: poor retraction of the septal tissue was found in the muscular septum in contrast to good retraction that found in fibrous septum.}, keywords = {Histologic Features,septal tissue retraction,uterine Septum}, url = {https://ebwhj.journals.ekb.eg/article_22331.html}, eprint = {https://ebwhj.journals.ekb.eg/article_22331_38f12d294272d874419b1195d7c24472.pdf} }