@article { author = {Tharwat, Ahmed and Ghanem, Reda and El-Habian, Amany}, title = {Efficacy of pregabalin as adjuvant analgesia to diclofenac sodium in laparotomies for benign gynaecological diseases: A randomized controlled trial}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {391-398}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33482}, abstract = {Background: Abdominal surgeries are considered one of the most painful among all types of surgeries. About 70% of patients who had abdominal surgeries suffered from severe pain in the postoperative period especially the gynaecological one. This pain as well as fatigue is the two key causes of prolonged convalescence following abdominal surgery. In order to relieve pain and fatigue, a current predominant approach of multimodal postoperative analgesia is used, mostly based on a combination of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and perioperative administration of local anesthetics. Each of these different approaches has its own set of complications.Objective: The current study aimed to assess the efficacy of oral pregabalin 150 mg as adjuvant analgesic to i.v diclofenac sodium 75mg.Patients and Methods: A randomized controlled trial was done on female patients who had laparotomies for benign gynaecological diseases in Ain Shams University Maternity Hospital during duration of nine months. The trial included one hundred and sixteen patients, divided into two equal groups. The first group (group A) received oral pregabalin 150 mg with i.v diclofenac sodium 75 mg one hour before operation and 12 hours after operation and was repeated every 12 hours for the first 24 hours and/or in demand. The second group (group B) received intravenous diclofenac sodium 75 mg 12 hours after operation and was repeated every 12 hours for the first 24 hours and/or in demand. The primary objective is measuring pain six hours postoperative and every one hour by using VAS-100 score, the secondary objective is measuring patient ambulation and audible intestinal sounds 6 hours postoperative.Results: Pain perception was significantly lower among group A than group B. As on VAS study group record of 20-10, control group record 45-30. Analgesia-free time was significantly lower among study than among control by 2 hours. Side effects were more frequent among study than among control group, but the differences were significant only in somnolence. This study showed also a significant early post-operative mobilisation in those who took oral pregabalin 150 mg in comparison to those who took i.v diclofenac sodium 100 mg that is attributed to decrease pain perception. It revealed also no significant difference between both groups regarding the intestinal activity.Conclusion: Administration of oral pregabalin 150 mg preoperatively reduce post-operative pain following abdominal gynecological operation, decrease the need of usage of post-operative narcotic analgesic, early patient mobilization that finally improve the surgical outcome and the patient quality of life.}, keywords = {diclofenac sodium,gynaecological diseases,Pregabalin}, url = {https://ebwhj.journals.ekb.eg/article_33918.html}, eprint = {https://ebwhj.journals.ekb.eg/article_33918_ce2c973e3f1038d4966986d3e2b98bcf.pdf} } @article { author = {Wageh, Alaa and Nagib, Reham and Eid, Mohamed}, title = {Placenta Of Late Onset Preeclampsia Without Fetal Growth Restriction : Is It Different From The Normal?}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {399-406}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33481}, abstract = {Background: Preeclampsia (PE) is one of the most common pregnancy complications affecting approximately 5-7% of pregnant women worldwide. Pathogenesis of PE is still mysterious. Literature studies reported differences between early and late onset PE. Also, whether placenta of late-onset PE without fetal growth restriction (FGR) is different from normal one needs further declaration.Objective: This study aims at evaluating the placental microvessel density (MVD), apoptosis and endoglin (CD105) expression in late-onset PE without FGR.Patients and Methods: Placentae of 15 PE and 15 matched control ones were evaluated grossly, microscopically and by immunohistochemistry for caspase-3, CD 34 and CD105.Results: Placentas in PE group showed a statistically significant difference as regard size, syncytial knots, perivillous fibrin deposition, villous infarction increased apoptosis, and endoglin (CD105) expression. However, the percentage of terminal villi and microvessel density (MVD) were comparable in both groups.Conclusion: Placenta from late onset PE without FGR is still different from the normal placenta whatever time onset of PE pathogenesis may be similar. Absence of changes in MVD may explain good fetal outcome.}, keywords = {apoptosis,Caspase-3,CD 34,CD105,Pre-eclampsia}, url = {https://ebwhj.journals.ekb.eg/article_33921.html}, eprint = {https://ebwhj.journals.ekb.eg/article_33921_7622f0ebcc32921525d4321a136fd16e.pdf} } @article { author = {Sheir, Essam and El-Feky, Alaa Eldin and El-Sayed, Amr}, title = {Randomized controlled trial between sublingual and vaginal misoprostol for induction of labour at term}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {407-415}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33480}, abstract = {spontaneous onset of labor, with or without rupture of membranes. When the cervix is unfavorable, cervical ripening with prostaglandins to soften and open the cervix will often commenced to induce labor.Objective: To compare 50 μg of sublingual misoprostol to 50 μg of vaginal misoprostol for induction of labour at term regarding efficacy and safety.Patients and Methods: This prospective randomized controlled trial included 104 pregnant women who were recruited from Department of Obstetrics and Gynecology, Faculty of Medicine Ain-Shams University and Al-Glaa Teaching Hospital, Delivery Unit.Results: Regarding induction-delivery interval (time from given drug for both groups to vaginal delivery), there was no significant statistical difference between both groups regarding the mean time from initial dose to the delivery. Mean 15.04 ± 4.67 for sublingual group versus 14.16 ± 4.45 for vaginal group (P= 0.331). As regarding fetal and maternal complications in our study, there was significant statistical difference between the vaginal and sublingual groups according to secondary outcome (hyperstimulation). The risk of hyperstimulation was higher in vaginal group (5 cases) compared to the sublingual group (No cases) P= 0.046.Conclusion: Sublingual misoprostol 50 μg administered at 6 hourly intervals is as effective in promoting cervical ripening and inducing labor as vaginal misoprostol 50 μg administered 6 hourly intervals as regarding induction to delivery interval, number of doses, shorter hospitalization and neonatal outcome. Sublingual misoprostol 50 μg has a higher maternal and perinatal safety profile than the vaginal 50 μg misoprostol including cesarean rates due to fetal distress, adverse maternal outcomes as hyperstimulation.Recommendations: We recommend sublingual 50 μg misoprostol administered at 6 hourly intervals as an efficacious and safe option for labor induction, low cost and availability is its added benefits}, keywords = {Induction to delivery interval,induction of labor,misoprostol}, url = {https://ebwhj.journals.ekb.eg/article_34028.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34028_f7227e51e994cd893d95ff5e5537c60f.pdf} } @article { author = {El-Shourbagy, Mahamoud and Mammdouh, Ahmed and Shawky, Mohamed and Mohamed, Hamda}, title = {Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in cesarean section}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {416-424}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33474}, abstract = {Background: Post-caesarean section pain is an important issue in obstetrics. Several studies have shown the importance of adequate postoperative analgesia on mobilization, rehabilitation and decreasing the length of hospital stay. Large amounts of opioid analgesic drugs are often required in the management of intense post-operative pain. However, this option is associated with many side effects.Objective: The aim of the study was to assess the efficacy of adding dexamethasone to bupivacaine for spinal anesthesia in prolonging the duration and anesthetic effect in women undergoing cesarean section.Patients and Methods: Populations of the study were comprised of 100 pregnant full term female planed for cesarean section. All patients had cesarean section under spinal anesthesia. Pain was assessed using 10 cm visual analogue scale (VAS) after 0, 15, 30 min and 2, 4, 6 hours post-operatively and until the mother asked for an analgesic. The duration of sensory block as well as postoperative analgesia were calculated.The study population had been randomized into 2 groups: The 1st group C (n=50 women) included 50 women receiving intrathecal dexamethasone added to bupivacaine. The 2nd group B (n=50 women) included 50 women receiving placebo which was added to intrathecal bupivacaine.Results: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia as the duration of sensory block in the study group was 122 + 7.9 minutes while in the control group it was 91.8 + 10.8 minutes and p<0.001. Also, receiving time to VAS >6 and the first analgesic dose prescription in the case group was significantly longer than that in the control group (P<0.001) as the pain free period in the study group was 434.3 + 43.8 minutes while in the control group it was 215.3 + 40.3minutes. Also, the motor block duration in the study group was significantly prolonged when compared with control group (p<0.01).There was no difference in onset time between the two groups and the addition of dexamethasone cause no complications.Conclusion: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications, and has increased the pain free period statistically.Recommendations: Further studies are needed to evaluate the optimal dose of dexamethasone to be used in spinal anesthesia.}, keywords = {Bupivacaine,cesarean section,intrathecal dexamethasone,Spinal anesthesia}, url = {https://ebwhj.journals.ekb.eg/article_34029.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34029_da0a43c8b0b1b7770b59c310b1d37db5.pdf} } @article { author = {Hendawy, Sherif and Mohamed, Mohamed and Allam, Heba and Zaghalil, Elsayed}, title = {Comparative Study of Laparoscopic Assisted Vaginal Hysterectomy versus Vaginal Hysterectomy as Regards Blood Loss: Randomized Control Trial}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {425-431}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33476}, abstract = {Objective: A comparative research study conducted to evaluate and asses blood loss issues between laparoscopic assisted vaginal hysterectomy and vaginal hysterectomy.Patients and Methods: A prospective randomized controlled research study trial to investigate blood loss and other surgical and clinical outcomes in comparison between VH and LAVH.Results: No statistically significant difference was displayed between the research study groups concerning demographic parameters (age, BMI, parity uterine size) with p values= 0.224, 0.845, 0.296, 0.175 prospectively. No statistically significant difference between the research study groups concerning preoperative hemoglobin with p value =0.379. However, postoperative Hb was statistically significantly greater within VH research group than within LAVH research group with p value =0.021. Hemoglobin reduction was statistically significantly lower within VH than within LAVH with p value <0.001.Conclusion: our research group came to the conclusion that vaginal hysterectomy has a shorter operative time as well as less postoperative bleeding leading to lower Hb and Hct drop. Therefore it is better to conduct vaginal hysterectomy when surgically possible.}, keywords = {blood loss,laparoscopic assisted vaginal hysterectomy,vaginal hysterectomy}, url = {https://ebwhj.journals.ekb.eg/article_34030.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34030_55c7a839e06d4829bc56580a84e29da8.pdf} } @article { author = {Elhoussieny, Amro and Ibrahim, Ahmed and Hassanin, Alaa and Abd El-Azeem, Shaimaa}, title = {Efficacy and Safety of Ultrasound Guided versus Blind Technique for Office Insertion of Intrauterine Contraceptive Device: A Randomised Clinical Trial}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {432-440}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33478}, abstract = {Background: Intrauterine devices are highly, if not the most effective method of contraception with typical use related failure rates of between 0.2-0.8%. Difficulties with IUD insertion, failure and complications can lead to decreasing utilization of such an effective method.Objective: To compare between ultrasound guided and blind IUD insertion technique as regards proper fundal location of IUD, incidence of complications, time consumption and patient satisfaction.Patients and Methods: A randomized clinical trial was conducted on 100 women at Ain-Shams University Maternity Hospital in Birth Control Clinic during the period from 1st of August 2016 till 30th of April 2017.Results: Proper Fundal distances after insertion were significantly more frequent among group U than among group B (p=0.009) and the over all complications were significantly less frequent in group U than in group B (p=0.016). Also pain perceiption (VAS-100), procedure duration and unsatisfaction were significantly lower among group U than among group B. These results point out that in women undergoing IUD insertion, ultrasound guided insertion is more effective, safe, less painful, less time consuming and result in better patient satisfaction.Conclusion: This study suggests that ultrasound guided IUD insertion is more effective than blind technique with proper fundal position of IUD and lesser incidence of complications. It is also less painful with better patient satisfaction.}, keywords = {Blind technique,office insertion intrauterine contraceptive device,Ultrasound}, url = {https://ebwhj.journals.ekb.eg/article_34031.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34031_d93b40e223ccfc6c9d735d53c58bf251.pdf} } @article { author = {Khamis, Yasser and Tohamy, Mohammed}, title = {Atrial fibrillation with pregnancy: A prospective controlled study}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {441-446}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33479}, abstract = {Background: Atrial fibrillation (AF) has been associated with numerous morbidities and mortalities. Pregnant women are at higher risk to develop AF.Objective: This study aims at investigating the maternal and fetal complications in women who developed AF during pregnancy compared to a control group.Patients and Methods: A prospective study was conducted on 2 groups; women with AF and women without AF. The included women were recruited from Beni-Suef University Hospital and Beni-Suef General Hospital after obtaining their informed consents. The maternal and fetal complications have been reported and compared between both groups.Results: The rates of placental complications, vaginal hematoma, congenital anomalies and the need for neonatal ICU were relatively higher amongst women with AF than those without AF but no statistically significant differences have been noticed (p>0.05). Rupture uterus, abortion and post-partum hemorrhage were statistically higher amongst women with AF in comparison to women without AF; 37.5% versus 2.6%, 50% versus 17.4%, and 37.5% versus 5.3%, respectively (p<0.05). Warfarin, Metoprolol and Digoxin were the most commonly reported medications amongst women with AF. The prescribed medications did not affect the likelihood of maternal or fetal complications (p>0.05).Conclusion: Women who develop AF during pregnancy are more likely to develop maternal complications.}, keywords = {Abortion,Atrial Fibrillation,maternal complications,Pregnancy}, url = {https://ebwhj.journals.ekb.eg/article_34033.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34033_d86624923f33eaf8726e41598026f912.pdf} } @article { author = {Ahmad,, Reda}, title = {Three-dimensional transvaginal ultrasonographic and power Doppler features of adenomyosis : Are they related to symptoms?}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {447-457}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33485}, abstract = {Aim of the work: To investigate the relationship between specific 2D and 3D ultrasound and power Doppler features of adenomyosis and the commonly associated adenomyosis symptoms in absence of other pelvic pathologies.Patients and Methods: This is a prospective observational study done at the Obstetrics and Gynecology Ultrasound Unit, Zagazig University Hospitals. This study was carried out from September 2015 to February 2017. It included all premenopausal women complaining of abnormal uterine bleeding, pain, subfertility and others. Cases without ultrasound detected pathology were collected as a control group (273), while cases having only adenomyosis ultrasonographic features by 2D-transvaginal sonography were collected as adenomyosis group (148). 2D-TVS myometrial assessment was performed for all women. 3D-TVS was then performed for full visualization of the junctional zone. VOCAL was used to calculate the Doppler indices of the myometrium.Results: The number of ultrasound findings was independent predictor for occurrence of menstrual disorders and chronic pelvic pain. Junctional zone irregularity was a predictor for heavy menstruation and chronic pelvic pain, increased uterine volume and asymmetry were significantly correlated with chronic pelvic pain, while subfertility might be predictable with fan shaped shadowing and myometrial cysts. All myometrial Doppler indices were significantly higher in adenomyotic cases compared to control group. Increased myometrial VI and VFI were strongly correlated with the occurrence of heavy menstruation and inter-menstrual bleeding.Conclusion: We found a relationship between certain ultrasound features of adenomyosis and some of associated symptoms. This relationship can help in understanding the pathophysiology of symptoms related to adenomyosis.}, keywords = {Adenomyosis,Doppler,symptoms,three-dimensional,Ultrasound}, url = {https://ebwhj.journals.ekb.eg/article_34034.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34034_f92259a73d37718733377e18ae8198ad.pdf} } @article { author = {Elnory, Mohamed and Elmantwe, Ashraf}, title = {Impact of bilateral total salpingectomy versus standard tubal ligation at time of cesarean section on ovarian reserve: A randomized controlled trial}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {458-467}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33486}, abstract = {Aim of the work: The objective of this trial was to compare between bilateral total salpingectomy (BTS) as a theoretically more effective ovarian cancer (OvCa) risk-reducing primary prevention and bilateral partial salpingectomy (BPS) [stander tubal ligation (STL)] procedures at time of cesarean section (CS) for parturients who completed their reproductive desire and requesting permanent sterilization regard to the impacts of both procedures on ovarian reserve parameters at one year post-sterilization as well as the surgical consequences of both procedures.Patients and Methods: This is a prospective, randomized, open-label, concealed allocation, parallel group, superiority trial was conducted at three surgical sites in El-Qulobia, Egypt including Benha University Hospital, Obstetrics and Gynecology Department between October 2015 and October 2017. 120 parturients undergoing CS were allocated to BTS (intervention group) (60) and BPS (control group) (60). Main outcomes were one year post-sterilization differences in ovarian reserve (OR) parameters including hormonal as well as two-dimensional and three-dimensional transvaginal ultrasonographic parameters ; namely, anti-müllerian hormone (AMH) (ng/ml), follicular stimulating hormone (FSH) (mIu/ml), peak systolic velocity (PSV) (cm/s), antral follicle count (AFC) (n), vascular index (VI) (%), flow index (FI) (0-100), vascular flow index (VFI) (0-100), calculated ovarian age [OvAge (year)] and ovarian volume. Ancillary outcomes were surgical feasibility and surgical consequences.Results: 102 women completed the one-year follow up (85%), 50 in the BTS group and 52 in the BPS group and there were no statistically significant differences regarding the ovarian reserve parameters at one year post-sterilization including AMH, FSH, AFC, VI, FI, VFI OvAge and ovarian volume (P > 0.05). Also, there were no statistically significant differences regarding items included in surgical. consequences comparison (P > 0.05) as well as surgical sterilization feasibility (100% vs 100%, p = 1). Also, there were no apparent complications due to sterilization procedures in both groups.Conclusion: Impacts of bilateral total salpingectomies (BTS) on ovarian reserve as sterilizing procedure during cesarean section as well as rates of surgical consequences are similar with that of bilateral partial salpingectomies (BPS) (STL). So, BTS could be recommended over BPS (STL) for women completing their reproductive desire, despite its better efficacy as ovarian cancer reducing surgery as well as its better clinical and sterilizing efficacy remained to be elucidated. .}, keywords = {Anti-müllerian hormone,cesarean section,ovarian cancer,ovarian reserve,sterilization,total salpingectomy,tubal ligation}, url = {https://ebwhj.journals.ekb.eg/article_34035.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34035_2f578272a4c34a06e89876f0e2c77475.pdf} } @article { author = {Kishk, Eman}, title = {Letrozole versus tamoxifen for ovulation induction in non-polycystic ovarian syndrome anovulatory infertile females}, journal = {Evidence Based Women's Health Journal}, volume = {9}, number = {2}, pages = {468-473}, year = {2019}, publisher = {Evidence Based Women’s Health Society}, issn = {2090-7265}, eissn = {2090-7257}, doi = {10.21608/ebwhj.2019.33487}, abstract = {Background: Anovulation is the most common cause for infertility, different oral agents are used for induction of ovulation, tamoxifen may be effective as letrozole in this era.Objective: The aim of this study was to compare the effectiveness of tamoxifen and letrozole in terms of ovulation induction outcomes in non PCOS anovulatory patients.Patients and Methods: This randomized single blinded clinical trial was conducted among a total of 120 patients with anovulatory infertility that were randomized to one of two treatment arms: Letrozole group and Tamoxifen group. The treatment was continued for three consecutive cycles. Main outcome measures were number of follicles ≥ 18mm, endometrial thickness and ovulation rate. Secondary outcomes measures were cumulative pregnancy rate and spontaneous abortion rates.Results: Mean number of mature of follicles ≥ 18 mm was statistically significantly higher in Tamoxifen group (1.9 ± 1.1) when compared to Letrozole group (1.5 ± 0.9) with p-value=0.03. Also, endometrial thickness was significantly different between both groups; as it was higher in Tamoxifen group (8.2 ± 1.6 mm versus 7.08 ± 2.4 mm) in Letrozole group (p-value=0.02). No significant difference was reported between both groups as regarding ovulation rate, pregnancy rate and spontaneous abortion rate, ovulation rate was 73.3% with Letrozole and 63.3% with Tamoxifen (P =0.3), cumulative pregnancy rate was 30% with Letrozole group and 23.3% with Tamoxifen group (p=0.5) and spontaneous abortion rate was 3.3% in Letrozole group and 5% in Tamoxifen group (p=0.9).Conclusion: Tamoxifen drug has comparable ovulation induction outcomes to letrozole with very low costs and side effects. Tamoxifen could be considered suitable for ovulation induction in developing countries}, keywords = {Anovulation,Infertility,Letrozole,Ovulation Induction,tamoxifen}, url = {https://ebwhj.journals.ekb.eg/article_34037.html}, eprint = {https://ebwhj.journals.ekb.eg/article_34037_93a8a2d617b5034f3cf0e620a93c50e4.pdf} }