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Background: In Polycystic ovary syndrome (PCOS) life style and dietary changes are recommended as the first line of management; however, the optimal nutritional management is not certain yet. Polyunsaturated fatty acids (PUFAs), particularly long-chain (omega-3) PUFAs, is known to improve overall human health and its widely used in managing infertility, but its role in PCOS management is still uncertain. Objective: The purpose of this study was to assess if omega-3 fatty acids supplementation for Polycystic ovary syndrome patients will have a positive effect on body weight, Hirsutism score, Menstrual cyclicity, hormonal status and Doppler flow to the Uterine and Ovarian stromal arteries.Study Design: A randomized prospective trial.Patients and Methods: A total of 67 patients with Polycystic ovary syndrome were randomized into two groups. Group I patients who received omega-3 fatty acid 1 gram daily capsules and group II patients who received no treatment for 3 months. Changes in weight, BMI, menstrual cycle length, modified Ferriman Gallway score, serum FSH, LH ,free Testosterone levels and Doppler of ovarian stromal and uterine arteries between baseline and the 3 months study period were compared between the 2 groups. Results: After 3 months supplementation with omega-3 fatty acid capsules, there was a statistically significant decrease in menstrual cycle length in the study group in comparison to the control group. Also, there was a statistically significant decrease in the pulsatility index (PI) of the uterine artery Doppler in the study group, but there was no change in the weight, BMI, ovarian stromal blood flow. Also, measures of FSH, LH and free testosterone did not show statistically significant changes for either group. Conclusion: Omega-3 fatty acids supplementation is effective in improving menstrual cyclicity and uterine artery blood flow in patients with PCOS and may be an helpful option for some patients with PCOS especially those who have defective endometrial receptivity and subsequent infertility or repeated miscarriages because of increased uterine artery resistance.
Objective: To determine if there is any added value of 3D US examination in diagnosis of fetal malformations during mid-trimester anomaly scan. Design: A prospective observational study. Setting: Obstetrics and Gynecology Ultrasound Unit, Zagazig University Hospitals. Patients and Methods: Pregnant women referred for mid-trimester anomaly scan were prospectively evaluated by 2D US. Fetuses suspected to have malformation by 2D US or with increased risk of a recurrence or strong family history of a congenital abnormality were evaluated by 3D US. Women confirmed to have fetal malformations postnatally were included. Results:Seven hundred and seventy-six malformations were confirmed postnatally. 2D US established the diagnosis of 752 (96.9%) malformations and 3D US diagnosed 770 (99.2%) malformations and the difference was highly significant [McNemar chi-squared statistic= 16, p=˂0.0001]. Seven hundred and fifty-two malformations were diagnosed by both 2D and 3D US. Eighteen malformations were detected exclusively by 3D US. 3D US was superior to 2D in evaluating cranial, facial and limb malformations. A cleft soft palate, hand abnormalities (n=3) and feet abnormalities (n=2) were missed by both 2D and 3D US. Conclusion: Three dimensional US added value in diagnosis of some types of fetal malformations. Rather than representing an alternative, 3D US is complementary to the conventional 2D US in the field of prenatal diagnosis.
Objective: The current study is a cohort observational prospective study with the aim of assessment and auditing of the detrimental effects and consequences of placenta previa (PP), which is considered by most obstetricians an ultimate obstetric risky condition, top surgical emergency and stressful condition for both the patient as well as the obstetrician. Such condition despite being linked to previous surgeries resulting in uterine wall scarring, yet considerably many cases with no previous uterine surgeries are presenting with such condition.Patients and Methods: Two groups of patients; group (A) including 89 patients diagnosed with PP at/or near full term and group (B) included 82 patients with high order (repeated) cesarean section (CS) were followed prior to, during and after delivery via CS with specific predetermined parameters such as hemoglobin level, postpartum hysterectomy, amount of blood transfusion and neonatal NICU admission. Those parameters used for assessment of the deleterious effects of both conditions on both the mother and newborn and both conditions were compared for the extremity of hazard.Results:There was considerably significant drop in HB level and amount of blood transfusion between both groups with drop of HB level from 11.7gm/dl to 9gm/dl in group A ladies, whereas group B ladies had a drop from 11.8gm/dl to 10.1gm/dl. Also, 35 mothers needed blood transfusion in group A compared to 6 mothers in group B. Furthermore, 7 ladies had their uterus removed in group A as a salvage procedure compared to 1 lady in group B. Concerning NICU admission, 28 neonates for the mothers in group A were admitted to the NICU compared to 12 in group B.Conclusion: PP was recognized to be an obstetrical condition with ultimate risk to both the mother and newborn in comparison to other well-known high risk obstetrical conditions such as high order (multiple repeated) cesarean delivery.
Background: Paralytic ileus is one of the problems that are faced following abdominal surgeries including caesarean section which leads to post-operative pain, abdominal distension, delayed oral feeding, prolonged hospital stay and increased hospital cost. Objective: To assess the effectiveness of chewing gum as safe, effective and easy option to compete paralytic ileus. Patients and Methods: One hundred sixty two parturient women who had caesarean section delivery under spinal anesthesia were recruited and randomly allocated to two groups; group A the study group which were allowed to chew sugarless gums two hours after caesarean section for 30 minutes and repeated every two hours till auscultation of normal intestinal sounds or passage of flatus. Group B the control group underwent conventional care which is nothing per oral till audible intestinal sounds or passage of flatus. It was difficult to apply complete blindness due to the study design so the physician is only blinded. The primary outcome is the time of auscultation of first normal intestinal sounds and the secondary outcomes are time of passage of flatus, stools. Results: Both groups were comparable regarding to their demographic data. There was a statistical significance difference between both groups regarding auscultation of first intestinal sounds, passage of flatus, passage of stools and postoperative hospital stay (P value 0.001, 0.001, 0.001 and 0.001, respectively). No statistical significance difference between both groups regarding presence of abdominal distension, postoperative vomiting, patient satisfaction and presence of obstetric complications.Conclusion: The routine use of gum chewing together with early ambulation and no use of narcotics following caesarean section offers a safe, easy, effective option for early resumption of intestinal function and consecutively associated with short hospital stay.
Background: Endometriosis defined as the presence of endometrial glands and stroma like tissues outside the uterine cavity. Scar endometriosis (SE) is a rare entity that is difficult to reach diagnosis due to the absence of a uniform clinical presentation with a variety in symptomatology and signs. It is usually a conflict for physicians of different specialists (surgeon, dermatologist, obstetrician, and gynecologist) that delay diagnosis. Objective Studying the effect of medical treatment with luteinizing hormone-releasing hormone (LHRH) analogue on pain and mass size as a short-term therapy for cases with scar endometriosis that help postponing and reducing dissection size of the surgical intervention. Patients and Methods: Our study included 14 patients, aged 18 to 40 y, having a previous gynecological or obstetric operation, a painful scar that may increase with menstruation, tender scar and mass palpable under scar diagnosed as scar endometriosis seen in our Mansoura University Hospital (MUH) and Private Clinic over 4.5 years. All patients underwent the following steps to reach a diagnosis ; history taking, examination and lab investigation, operative details and pain (visual analog scale). VAS scores pre-treatment were recorded then patients referred to ultrasound evaluation where any patients with suspicion of scar endometrioma underwent confirmation with FNAC (fine needle aspiration cytology). Patients diagnosed as scar endometriomas received LHRH analogue (Zoladex 3.6mg/month) for 6 months, then VAS score and ultrasound mass size were performed monthly and at the end of the medical treatment period. Patients who had no pain relief at the end of the treatment period were prepared for wide surgical excision with safety margins. Evaluation of the effect of short-term medical treatment as the post-treatment pain VAS score and mass size in comparison to their pretreatment findings were recorded in addition to its effect on surgical intervention postpone.Results: The study of the 14 patients showed that mean±SD of age was 28.79±4.99, mean±SD of BMI was 26.4 ±1.7, previous operation scar (Umbilical laparoscopic port 2 [14.3%], episiotomy 3 [21.4%] and cesarean scar (CS) scar 9[64.3%]). Cystic mass was 8[57.1%], heterogeneous mass was 6 [42.9%] and mean±SD of US size/cm was 2.42±0.67 (1.6-4.1). Median of pain duration/months was 26.0 (5.0-60.0). Mean±SD of pain VAS score before treatment was 8.0 (6.0-10.0), while after was 2.0 (0-8.0). Median of pain VAS score in cases with cystic lesions before and after treatment was 7.5 (6.0-9.0) and 1.0(0.0-7.0), respectively, with a statistically significant difference. Also, median of pain VAS score in cases with heterogeneous lesions before and after treatment was 9.0 (7.0-10.0) and 7.0 (2.0-8.0), respectively, with a statistically significant difference with more pain relieve in cystic cases than heterogenous one. Patients needed for surgical intervention and not responding to medical treatment were 8 [57.1%]. The cut of the level of US size of cystic lesions was ≤2.65cm, while for heterogeneous lesions was ≤2.20cm with an accuracy of 87.5% and 83.3 %, respectively.Conclusion: LHRH analogue short-term treatment for scar endometriosis is significantly effective in pain to relieve and decrease mass size in cystic lesions ≤2.65cm and heterogeneous lesions ≤2.05cm that allow surgical intervention postpone and minimize surgical dissection site.
Objective: The aim of the study was to evaluate the effect of prolonged use of hormonal contraception on ovarian reserve.Patients and Methods: This study was performed on fifty (50) patients who were divided into two groups. First group (study group): included 25 participants after prolonged use of hormonal contraception (more than 3 years). Volunteers who had been using the COCP or injectable progesterone or subdermal progesterone implant for more than last 3 years. Second group: included 25 participants from non-users of hormonal contraception as controls.Results: We found that there is no significant difference between AMH and AFC between combined methods and progesterone only methods in the study group showing similar results between different types of contraception. Also, the results showed that AMH and AFC are negatively correlated with age and BMI while there is positive correlation between AMH and AFC. P value (<0.001) in both cases and controls groups.Conclusion: Actually, in this study, it was found that AMH and AFC are still considered as the best markers of ovarian reserve even in individuals who are already on hormonal contraceptive use. In addition, AMH and AFC affected negatively by age and obesity.
Objective: To compare the early recovery after surgery (ERAS) pprotocol with the conventional one in women undergoing elective CS.Patients and Methods: The study included 96 women undergoing elective cesarean section for different reasons. They were randomly divided into two groups 48 patients each, Group (A) received the ERAS regimen and Group (B) was managed with the conventional care. Women with major medical or obstetric disorders were excluded.Results: Cases' age ranged between 18- 35 years without significant difference between groups. Also, gestational age, haemoglobin concentration and platelet count were comparable between groups. Intra and post-operative nausea and vomiting were significantly higher (p value <0.0366) in the control group (8 vs 17). Group A had significantly shorter interval to oral intake, ambulation, first intestinal sound and first motion. Moreover, the need to use opiate for pain control with overall pain scores were significantly lower in study group with significantly better satisfaction rates and shorter hospital stay.Conclusion: ERAS protocol for women planned for elective CS is effective in controlling perioperative gastrointestinal symptoms, pain control and encourages early ambulation with offering earlier resumption of intestinal motility, higher satisfaction and fewer days of admission.
Objective: To investigate the impact of benign gynecological surgeries on postoperative female sexual quality of life three months after the procedure.Patients and Methods: The present study was a prospective study that included women who underwent gynecological surgeries for benign lesion such as hysterectomy, bilateral salpingo-oophorectomy (BSO), tubal ligation, anti-incontinence surgery, and pelvic organ prolapse reconstruction. All women were assessed using the sexual quality of life-female (SQOL-F) questionnaire.Results: One hundred and eighty-eight women were included. The most commonly performed procedure was hysterectomy (25%), followed by classical repair (21%) and myomectomy (7%). In addition, 78.19% of the women were multipara. Preoperatively, the mean SQOL-F total score was 56.04 ± 17.947, which increase significantly to reach 79.33 ± 17.645 at the end of the third month postoperatively (p <0.001). This significant difference was consistent regardless of the type of procedure. Regarding the domains of SQOL-F, there were statistically significant increases in the psychosexual feelings (21.16 ± 8.2 versus 30.49 ± 7.8, p <0.001), sexual and relationship satisfaction (16.71 ± 7.9 versus 21.88 ± 4.5, p <0.001), self-worthlessness (9.69 ± 3.5 versus 13.74 ± 3.13, p <0.001) and sexual repression (8.468 ± 3.7 versus 13.20 ± 3.9, p <0.001).Conclusion: In conclusion, most gynecological surgeries found to have positive impact on the female sexual function and quality of life. So that, sexual function should be taken into consideration in planning and preoperative counselling for gynecological surgery also post-operative follow-up.
Objective: To assess the association between Gestational Vitamin D (VD) deficiency and preterm birth (PTB).Patients and Methods: This prospective observational nested case control study was conducted at Ain Shams University Maternity Hospital and Dar Ismael Maternity Hospital and sequentially recruited women with singleton pregnancy at 20-28 weeks. Blood samples were collected from all eligible participants and kept frozen until further measurement of maternal VD levels. All enrolled women were followed up till delivery. Cases (PTB) group included woman who delivered before completing 37 weeks of gestation while controls, term birth (TB) group included matched group of those who delivered at or after 37 weeks. The primary study outcome measure was the correlation between VD status and PTB.Results: The final analysis of this study included 40 cases in the PTB group and 40 controls in the TB group. VD deficiency was more prevalent in PTB group (87.5% versus 22.5% in the TB group, p<0.001). PTB group had a statistically significant lower VD levels (13.34 ± 7.71 ng/ml versus 32.91 ± 18.98 ng/ml in the TB group, p<0.001) with a moderate positive linear correlation between gestational age at delivery and VD level (Pearson correlation=0.571, p<0.001). Among the studied maternal outcomes, delivery by cesarean section was more prevalent in PTB group (62.5% versus 30.0% in the TB group, p=0.004).Conclusion: Gestational VD deficiency was associated with increased risk of PTB and delivery by cesarean section