Ain Shams Maternity Hospital Research Articles

The Outcomes of Second Trimesteric Induction of Abortion in Previously Scarred Uterus at Ain Shams Maternity Hospital

Abstract Back Ground Termination of pregnancy by induced abortion is one of the commonest procedures, Pregnancy termination in case with prior cesarean delivery becomes an increasingly common situation facing obstetricians due to progressive increase in the rate and incidence of cesarean births. The aim of the Study was to assess and evaluate the outcomes of second trimesteric induction of abortion in previously scarred uterus. Methods this was a retrospective study curried at Ain Shams Maternity Hospital at the period from the 1st of January 2018 till the 31st of December 2020. Results Patients subjected to hysterotomy received significantly higher dosed of misoprostol compared with those who did not undergo hysterotomy (median [IQR] = 1100 [800 – 2400] mg versus 800 [500 – 1600] mg, respectively; p= .047). Conclusion There were 15.5% suffered failed medical abortion and 1.5% rupture uterus with difficulty to correlate this event to the dose of the medication used for induction. Increased gestational age, history of 3 or more CS, and presence of > 1 gestational sac was independently associated with decreased probability of successful medical abortion. Higher total dose of misoprostol was only marginally associated with decreased probability of success. On the other hand, higher hemoglobin level is independent predictor of successful medical abortion. Patients subjected to hysterotomy received significantly higher dosed of misoprostol compared with those who did not undergo hysterotomy.

Letrozole Low Dose versus High Dose for Ovulation Induction with Timed versus Spontanous Intercourse in PCO

Abstract Objective to compare the effect of low dose and high dose of letrozole in ovulation induction in PCOS. Effect of (HCG) administration in ovulation rate and pregnancy rate. Effect of timed Versus spontaneous intercourse in pregnancy rate. Study Setting This study was carried out at. Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic. Study Design Four arm clinical randomized trial. Study Time Start from 4-October 2021 ended 10- Jan. 2023. Results The objective of this study was to investigate the effect of low dose and high dose of letrozole on ovulation induction and effect of spontaneous & timed intercourse with (HCG) on pregnancy rate in one treatment cycle. This four arm clinical randomized trial study was carried out at Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic. The current study was conducted on 136 women. They were divided into 4 equal groups: A = letrozole 2.5 mg (Femra 2.5 mg NOVARTIS) (one tablet) without HCG. B = letrozole 2.5 mg+ HCG 10.000 IU. C = letrozole 10 mg (Femra 2.5 mg NOVARTIS) (four tablets) without HCG. D = lertozole 10 mg + HCG 10.000 IU. The study started 4-October 2021.ended 10-Jan 2023. Conclusion Conclusion, the present study revealed that, applying low dose or high dose of letrozole on ovulation induction and effect of spontaneous & timed intercourse with (HCG) had similar follicular response and pregnancy rates. Recommendations Good selection of PCO patients acording to Rotirdam critaria. Start mangement of PCO patients by wieght reduction for obes patients. Start induction ovulation by letrozole as first choice. Start by smallest dose of letrozole 2.5mg & can be titrated dose for not responding patient to high dose.

Applicability and Adherence to Essential Practices of WHO Safe Childbirth Checklist at Ain Shams Maternity Hospital (ASMH)

Background It is vital to comply with evidence-based essential birth practices to improve both maternal and neonatal health. The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool that focuses on necessary care to improve intrapartum care quality. Objective To measure applicability and adherence of healthcare providers to essential practices as required by WHO safe childbirth checklist (SCC) at Ain Shams Maternity Hospital (ASMH). Methods A Prospective study was conducted to observe and follow a sample of childbirths presented at Ain Shams Maternity Hospital (ASMH) through the 4 pause points [on admission, just before the woman starts pushing (or before caesarean section), within 1 hour after births and before discharge from the facility]. Results A total of 221 childbirths were included and followed in the study, with mothers’ average age of (30+6) years and mean gestational age was (37±2) weeks. Only one WHO SCC practice (maternal referral) was not applicable in ASMH, however, the rest of the recommended practices were applicable with total adherence of 94.7%. Non adherent practices were encouraging companion to attend birth and length of stay after childbirth 24 hours. Conclusion ASMH was highly adherent to WHO SCC evidence-based practices; however, two practices were not adopted by the hospital policy. Recommendation It is recommended to review the hospital policies to allow birth companion to attend delivery and extend length of stay after vaginal delivery to 24 hours.

Oxytocin Infusion versus Vaginal Misoprostol in Reducing Blood Loss during Abdominal Myomectomy: A Randomized Controlled Trial

Background Uterine myomas are most prevalent benign tumors in reproductive-aged women. Myomectomy is an alternative to hysterectomy for women who wish to retain their uterus but it is associated with higher risk of blood loss, greater operative time and need for blood transfusion. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. Aim of the Work The aim of the study is to compare between the efficacy of intraoperative oxytocin infusion and preoperative vaginal misoprostol in reducing blood loss during abdominal myomectomies. Methods In a prospective randomized controlled trial which was conducted at Ain shams maternity Hospital in Cairo from July 2017 to May 2021.100 women who had abdominal myomectomy for symptomatic leiomyomas were enrolled. Patients were randomly assigned to 2 groups. Group O (Oxytocin group) patients (n = 50) received 30 U oxytocin in 500 ml normal saline infusion intraoperative and Group M (Misoprostol group) An hour before the operation, patients (n = 50) received a single dose of vaginal misoprostol (400 μg). The primary outcome was the operative blood loss. The secondary outcomes were the need for blood transfusion, change in hemoglobin (Hb) and hematocrit (Hct) levels 24 h after operation, conversion to hysterectomy, hospitalization and the prevalence of side effects. Results Intra-operative blood loss was significantly lower in those women randomized to receive vaginal misoprostol versus the oxytocin infusion group (458.5 ± 115.4 mL vs 618.8 ± 115.1 ml {P = < 0.001}). Misoprostol group showed lower mean blood loss by – 160.3 ml (95% CI -206.0 to -114.6) and reduced need for blood transfusion (RR 0.22, 95% CI 0.005 to 0.98) {P = 0.025}. Additionally, there was a highly significant statistical difference between Misoprostol group and Oxytocin group as regards the postoperative hemoglobin, hematocrit concentration, operative time as Misoprostol group showed a higher postoperative hemoglobin and hematocrit concentration, and less operative time. There was no difference in the patient demographics, intraoperative characteristics, postoperative stay, complications, and the side effects between the two groups. Conclusion As evident from the current study, pre-operative misoprostol in abdominal myomectomy is a safe and reliable method that offers some practical advantages, such as reducing intra-operative blood loss and blood transfusion needs

Pre-Operative Evaluation of Color Doppler Ultrasonography to Predict Malignancy in Ovarian Masses at Ain-Shams University

Background Ovarian cancer is the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy in developing countries. This cancer is characterized by high malignancy, difficult early detection, low survival rate, and high fatality rate. Transvaginal ultrasonography is the first choice for imaging to differentiate between a benign and a malignant adnexal mass. Aim of the Work The aim of the study is to determine predictive value of pre-operative resistance index (RI) of color Doppler of ovarian vessels in identifying potential ovarian malignancy at Ain Shams maternity hospital between May 2015 and May 2020. Methods this retrospective observational study, was done on total 379 patients who underwent laparotomy for adnexal masses at Ain Shams University hospitals over five years period between May 2015 and May 2020 with inclusion and exclusion criteria. Medical records of the study population were revised to assess demographic data, ultrasound criteria and histopathological result Results Thin wall and clear content are negatively correlated with ovarian malignancy and these correlators statistically significant. While presence of papillae and septation are positively correlated with ovarian malignancy and these findings were statistically highly significant. Masses proved to be ovarian malignancy were mostly unilateral, more than 5 cm size, thick wall, with turbid content, solid consistency, unilocular with papillae and septation. RI in our study was lower in malignant lesions ranging between (0.22–0.60) and the Mean±SD of resistance index values in the ovarian cancer (0.48±0.07). Resistance index at cut off value ≤0.54 had high specificity and negative predictive value but moderate sensitivity and positive predictive value in diagnosing ovarian malignancy. Conclusion As evident from the current study, thick wall, turbid content, solid consistency, papillae and septations were significantly most frequent in ovarian cancer. Resistance index was significantly highest in ovarian malignancy. In current study RI was lower in malignant lesions. From the results of current study we can conclude that the pre-operative resistance index (RI) of color Doppler of ovarian vessels had significant high diagnostic performance in predicting ovarian cancer. Resistance index at cut off value≤0.54 in diagnosis of ovarian cancer has sensitivity (85.2%), specificity (91.6%), accuracy (90.2%), positive predictive value (73.4%) and negative predictive value (95.8%).

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

Clomiphene Citrate versus Letrozole for Induction of Ovulation in Infertile women having Polycystic Ovarian Syndrome (Randomized Controlled Trial)

Background: Polycystic ovary syndrome is a disorder but with unclear etiology that its diagnosis depends on exclusion of other etiologies with ovulatory disorders and androgen excess as congenital adrenal hyperplasia, 21-hydroxylase deficient non classic congenital adrenal hyperplasia (NCAH), adrenal or ovarian androgen-secreting tumors, disorders of adrenocortical dysfunction as Cushing’s disease, and abuse of androgenic or anabolic drugs. Polycystic ovary syndrome affects approximately 6-15% of women in reproductive age and constitutes 50% of the causes of infertility in women. Aim of the Work: To compare the efficacy of letrozole on ovulation induction to that of clomiphene citrate in women suffering polycystic ovary syndrome and the effect on the follicular maturation, endometrial thickness and pregnancy rate. This study was carried in the outpatient infertility clinic of Ain-Shams Maternity Hospital during the period from November 2020 till April 2021. Patients and Methods: This study included 80 infertile women diagnosed as having polycystic ovary syndrome. Women were randomized into two groups. Letrozole group (1) included 40 women who were given the aromatase inhibitor (Letrozole) orally in a 5mg dose daily from day 3 to day 7 of the menstrual cycle. While Clomiphene citrate group (2) included 40 women who were given the clomiphene citrate orally in 100mg dose daily from day 3 to day 7 of the menstrual cycle. All women were counseled and informed consent was obtained before recruitment. Results: In this study, ovulation rate was significantly more frequent in the Letrozole group (82.5%, 33 women reached ovulation successfully) than in Clomiphene citrate group (60%, 24 women reached ovulation successfully) within P value=0.024. Clomiphene citrate at a dose of 100mg showed more efficacies in the number of follicle ≥18mm than Letrozole at a dose of 5mg. In Letrozole group, the number of follicles (≥18mm in diameter) ranged from 1 to 2 with a Mean±SD= 1.4±0.65 and in Clomiphene citrate group, the number of follicles (≥18mm in diameter) ranged from 1 to 3 with a Mean±SD= 1.9± 0.41 (P value=0.0001). Conclusion: Letrozole can be considered as a first line treatment of anovulation in polycystic ovary syndrome. But, moreover studies including larger number of cases will further confirm the efficacy of letrozole versus clomiphene citrate in induction of ovulation, reaching to the optimum doses for aromatases inhibitors, more observation on endometrial thickness, incidence of pregnancy outcomes, incidence of abortion and incidence of congenital fetal malformations.

Analysis of Cesarean Delivery at Ain Shams Maternity Hospital Using the Ten Group Classification System

Abstract Background Cesarean section is an invasive surgical procedure in which a baby is delivered through an abdominal and uterine incision & carries with it many immediate and delayed morbidity and mortality risks. Objective To evaluate the feasibility of using the Robson Ten Group Classification System (TGCS) for cesarean delivery indications at Ain Shams Maternity hospital. Methods This is a retrospective study on women who delivered by cesarean delivery at Ain Shams Maternity hospital between July 1, 2016 and June 30, 2018. All patient files have been revised and data has been collected then categorized. The indications for this mode of delivery: suspected fetal growth impairment, fetal distress, preeclampsia/eclampsia, pregnancy duration in weeks or more pre-partum hemorrhage, cephalopelvic disproportion, dystocia, failure of progress, multiple pregnancy, suspected/imminent uterine rupture, breech or other malpresentations, previous cesarean delivery, failed induction of labor, tubal ligation, sterilization, maternal request genital herpes, extensive condyloma, any other obstetric complication, any other fetal indication or any other maternal medical complication. Results 15808 women delivered in the hospital during the study period, The CS rate was 58.04%. According to the Robson classification, Group5 and Group 10 were the most represented groups (31.72% and 29.91% of population, respectively). The major contributors to the CS rate were group 5 (27.10%), group10 (14.02%).The most commonly reported indications for CS included past CS, suspected fetal distress, preeclampsia, eclampsia.These suggested the need for further discussion on CS practices Conclusion This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.

Effect of Metformin on Chemical Pregnancy Rate in women with Unexplained Infertility (A randomized controlled trial)

Abstract Background There is controversy regarding treatment of unexplained infertility due to absence of specific pathophysiological rational which allows curative intervention. The main three lines of treatment of such cases are confrolled ovarian hyperstimulation, IUI with spontaneous or induced ovulation and third is IVF. Aim of the Work to evaluate the effect of metformin on chemical pregnancy rate in women with unexplained infertility. Patients and Methods: This was a prospective randomized controlled trial study which was conducted on 170 women with unexplained infertility in Ain Shams Maternity Hospital. Results :. Incidence of chemical pregnancy was not statistically sigfificantly different between both groups (PR: 18.8% vs.16.5% P 0.84) in metfonnin and clomiphene y•oup respectively. (NNT) was estimated to be 42.5. Conclusion our study showed little benefit was added to the patients by using metfonnin as adjuvant therapy to clomiphene citrate during ovulation induction as regards chemical pregnancy. 42 women are needed to be freated with metformin to get one more pregnant woman by pregnancy test

Letrozole Pretreatment With Misoprostol Versus Misoprostol Alone For Induction of First Trimesteric Missed Miscarriage A Randomized Controlled Trial

Abstract Background Miscarriage or spontaneous abortion is the involuntary termination of pregnancy before 20 weeks of gestation or a fetus born weighting less than 500 grams. Objective To compare between the safety and efficacy of two treatment modalities in medical termination of first trimesteric missed miscarriage. Patients and Methods This study was conducted at outpatient Obstetric clinic of Ain Shams maternity hospital in the period between June 2017 and December 2018. The patients who were fulfilling the inclusion criteria, were recruited in the study, then an informed consent was taken before starting the trial. Results In the total of 88 patients who were recruited in the study, 3 patients dropped from the study, 2 patients from the first group and 1 patient from the second group, so 85 patients were analyzed, the complete abortion rate of the letrozole group was significantly higher than that of the misoprostol only group (83.72% compared to 64.29%). Conclusion The use of letrozole pretreatment followed by misoprostol for induction of abortion in the first trimester is associated with higher complete abortion rate than misoprostol only.

Assessment of accuracy of two dimensions ultrasonography of fetal thigh soft tissue versus Hadlock's formula in estimation of fetal weight

Abstract Objective The current study aims to compare between mid-thigh soft tissue formula and modified mid-thigh soft tissue formula with Hadlock formula in estimation of fetal weight. Materials and methods Two hundred full term pregnant women attending Ain Shams Maternity Hospital in the period from April 2018 and April 2019 were included in this comparative study. Whole study group (200 women) had 2D ultrasonography using Hadlock's formula, thigh soft tissue formula and Modified thigh soft tissue formula. Results In our current study Hadlock's formula was better than thigh soft tissue and modified thigh soft tissue formula in estimation of fetal weight. Conclusions Fetal mid-thigh SST is a simple, useful, and easily applicable parameter for fetal weight estimation.

Effect of Pudendal Nerve Block versus Perineal Local Infiltration of Analgesia In Post Episiotomy Pain Relief A randomized Controlled Clinical Trial

Abstract Background Episiotomy or tearing of perineal tissues during childbirth is associated with significant pain in the postpartum period. Although the use of episiotomy is often debated, it remains the most common surgical procedure experienced by women. Pain from episiotomy is poorly treated, though it may be severe and can result in significant discomfort and interference with basic daily activities and adversely impact motherhood experiences. Local infiltration analgesia is the most commonly used method of analgesia during normal labor. This type of local analgesia is achieved by injecting the analgesic agent into the perineum just before delivery with crowning of the fetal head. It is also widely used just before an episiotomy. This study compares the efficacy and duration of pudendal nerve block versus local infiltration on post episiotomy pain relief. Aim of the Work: This study aims to compare the effect of Pudendal Nerve Block with perineal local infiltration of analgesia in post episiotomy pain relief. Study design:Prospectiverandomizedcontrolledclinicaltrial. Patients & Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between August 2018 and Jan 2019. It included 100 primigravida women in labor meeting inclusion criteria attending the causality of Ain Shams Maternity Hospital. Results Our study showed statistically significant decrease mean of study group compared to control group according VAS score from after 1hr to after 6hrs. Also there was statistically significant decrease in patients' need for analgesia in study group compared to control group from after 1hr to after 6hrs. Patients were asked about episiotomy pain and were advised not to be distracted by pain of uterine contraction or any other pain she complains of as much as possible not to alter the study results Regarding the pudendal nerve block group none of the patients receiving effective bilateral pudendal nerve block asked for analgesia during the first hour post injection. Two patients representing 4.4% of the study group asked for analgesia after two hours post injection, by the 3rd hour 6 patients representing 13.3% of the study group asked for analgesia. After completing 6 hours post injection follow up only 21 patients asked for analgesia representing 46.7% of the study group while 24 patients (53.3%) did not require any analgesia for the first 6 hours after injection of pudendal nerve block Conclusion There is statistically significant decrease in mean VAS in pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. Also there is statistically significant decrease in patients' need for analgesia in case of pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. There is highly statistically significant increase mean of delivery time after injection (min) in pudendal nerve block compared to local perineal infiltration of analgesia but it has no clinical significance. There are no neonatal side effects or complications of pudendal nerve block.

Neonatal outcomes in case of euglycemic control in gestational diabetes using insulin versus metformin. Randomized controlled trial

Background: Gestational diabetes mellitus (GDM) is a major global public health issue, with prevalence increasing in recent years due to the epidemic of obesity and type 2 diabetes. Aim of the Work: to compare different neonatal outcomes according to the different treatment modalities used in the management of GDM. Our hypothesis was that Metformin is as effective and safe as insulin in patients with gestational diabetes. Patients and Methods: The current non inferiority-Randomized controlled trial was conducted at Ain Shams Maternity hospital between June 2020 to February 2021. The study included 140 outpatient cases or admitted patients for antenatal care: Group A: women were given Metformin (Total 70) and Group B: Women were given insulin. (Total 70). Results: there was no significant difference between Metformin and Insulin groups regarding age, enrollment BMI, parity and family history of DM. There was no significant difference between Metformin and Insulin groups regarding gestational age at enrollment and delivery as well as pregnancy duration after intervention. BMI at delivery, BMI increase as well as BMI increase rate were significantly lower in Metformin group. There were no significant differences between Metformin and Insulin groups regarding fasting, two-hour postprandial and HbA1c blood glucose at enrollment and throughout treatment as well as their reduction after intervention. Maternal complications as hypoglycemia, hyperglycemia and preeclampsia were non-significantly less frequent among Metformin group than among Insulin group. Compliance to treatment was significantly more frequent among Metformin group than among Insulin group. Cesarean delivery was non­significantly less frequent among Metformin group than among Insulin group. There was no significant difference between Metformin and Insulin regarding birth weight APGAR-1, but APGAR-5 was significantly higher in Metformin group. Neonatal complications as IUFD, IUGR, macrosomia, congenital anomalies, neonatal hypoglycemia, respiratory distress and NICU admission were non-significantly less frequent among Metformin group. Conclusions: From the results of current study we can conclude that: Oral metformin was effective as insulin injection in control and management of GDM. BMI was controlled with oral metformin better than insulin injection. Maternal and neonatal complications specially birth weight were the same with both types of treatment. Women had better compliance to metformin treatment. Type of delivery wasn’t affected by type of treatment.

Bone Health Assessed by Calcaneal Quantitative Ultrasound among Cohort of Pregnant Egyptian Women.

Aim:The aim was to assess the risk of osteopenia and osteoporosis and to identify possible risk factors affecting bone density (BD) during pregnancy as parity, body mass index (BMI), Vitamin D, and calcium supplementation using quantitative ultrasound (QUS) of the calcaneus among first- and third-trimester pregnant women.Methods:It is a case–control study conducted at Ain Shams Maternity Hospital, Egypt, from May 7 to December 14, 2015. One hundred and thirty-two women in the third trimester and 33 matched controls in the first trimester were screened for BD at the calcaneus by QUS. Stiffness index (SI), QUS-T, and Z scores were measured.Results:Comparing both the groups regarding QUS-T score, Z score, and SI showed a statistically significant difference between both groups. Third-trimester participants had lower scores (−0.72 ± 1.0, −0.63 ± 0.99, and 88.53 ± 14.81, respectively) compared to their matched controls (1.05 ± 0.89, 1.16 ± 0.91, and 113.79 ± 12.49, respectively). According to QUS-T scores, 82 women (62.1%) in the third-trimester group were assessed as having normal BD, whereas 47 women (35.6%) were at risk of being osteopenic and 3 women (2.3%) were at risk of being osteoporotic. All women of the first trimester were assessed as having normal BD. Logistic regression was performed to identify possible risk factors affecting BD among third-trimester patients. BMI was the only statistically significant predictor for changes in bone health in those women (P = 0.001, odds ratio: 0.857, 95% confidence interval: 0.786–0.936).Conclusion:With one-unit rise in BMI, a 14% reduction in risk of decreased bone health is obtained.

Maternal and Fetal Outcome of Placenta Previa Patients Attending Ain Shams University Maternity Hospital -Prospective Study

Methods:A prospective study was conducted in Ain shams Maternity Hospital, in the period between Sep '18 and Feb '19.Outcome measures:Maternal outcome measures included: Estimated blood loss, Amount of blood transfusion, Mode of delivery, Complications, pre and postoperative hemoglobin level, Postoperative fever, Postoperative wound infection, ICU admission.Neonatal outcome measures included: Neonatal weight, APGAR score, Prematurity, NICU admission, IUFD.ResultsMean age (31.82 yrs), gravidity (4.06), parity (2.71), previous CS deliveries (2.52). Other RF: EC normal(42.4%), moderately depressed (40%), severely depressed(17.6%). At 5 minutes; normal(85.9%) moderately depressed(10.6%), severely depressed(3.5%). NICU admission(22.4%). IUFD (5.9%). ConclusionPlacenta previa patients at risk of numerous maternal and neonatal morbidities, maternal morbidities include life threatening haemorrhage, caesarean hysterectomy, blood component transfusion, prolonged hospital stay and ICU admission. Neonatal morbidities include premature delivery, low birth weight, intrauterine foetal death and NICU admission.

Intrauterine Use of Autologous Platelet-Rich Plasma in Management of Asherman Syndrome: A Randomized Controlled Trial

Background: Operative hysteroscopy with lysis of intrauterine adhesions is a viable treatment option for Asherman syndrome. However, with all forms of adhesion resection, there is a high rate of reformation of intrauterine adhesions. The current study will focus on a unique technique to evaluate the use of platelet rich plasma over an inflated balloon versus conventional method (inflated balloon).Aim: This study aim to assess the efficacy of the platelet rich plasma in preventing reformation of intrauterine adhesions after adhesiolysis in cases of Asherman syndrome.Materials and Methods: This study was conducted in Ain-Shams Maternity Hospital (Early Cancer Detection and Endoscopy Unit) during the period between July 2019 and February 2020. Forty patients seeking for conception with a history of primary or secondary infertility with severe intrauterine adhesions; 20 patients (case) injected with PRP and 20 patients (control) with IU balloon.Results: Our study showed a significant increase of menses duration among the PRP group post-operative (3.0±1.1) days and preoperative menses duration (1.5±1.4) days compared to balloon post-operative (1.9±1.6) and preoperative (1.5±1.6) days. The study also showed significant increase of menses amount among the PRP group post-operative (5.2±3.7) pads, and preoperative menses duration (1.0±1.0) pads compared to balloon post-operative (2.9±3.2) and preoperative (0.9±0.9) pads.Conclusion: Platelet rich plasma after operative hysteroscopy has high efficacy and safety in improvement of menses duration, amount and adhesion score in cases suffering from severe intrauterine adhesions and decreasing postoperative adhesions.

Complications Associated with First-trimester Surgical Abortion at Ain-Shams Maternity Hospital over the period from January 1, 2016 to December 31, 2017

Background: First trimester surgical abortion is a common obstetric procedure with some known complications.Objective: The aim of this study was to examine the incidence of major complications of first trimester surgical abortion in Ain-Shams Maternity Hospital.Patients and Methods: Retrospective record-based case series in which records of patients who underwent first trimester surgical abortion in the period from January 1st, 2016 till December 31st, 2017 were examined.Results: A total of 1003 patients underwent first trimester surgical abortion. The overall major complication rate was 18.2%. There was a higher incidence of one or major complications in patients with previous abortions (P-value <0.002), valve replacement (P- value 0.001), missed and septic abortions, those requiring cervical dilatation, less hemoglobin, higher total leucocytic count, higher PTT.Conclusion: First trimester surgical abortion is a relatively safe procedure with hemorrhage being the most common complication.

Comparing Transcervical Intrauterine Lidocaine Instillation with Rectal Diclofenac for Pain Relief During Outpatient Hysteroscopy: A Randomized Controlled Trial

Background: Outpatient hysteroscopy is a clinical procedure that is used for several diagnostic and therapeutic purposes. However, the most common adverse event and reason for procedure failure is pain. Several strategies were developed to manage pain during outpatient hysteroscopy.Aim: The aim of the present study is to compare the efficacy of intrauterine lidocaine instillation and rectal diclofenac in reducing pain associated with outpatient hysteroscopy.Materials and Methods: The present study was a randomized, comparative, trial that included. 200 female patients who underwent outpatient hysteroscopy at office hysteroscopy room at early cancer detection unit of Ain-Shams Maternity Hospital. The patients were randomly allocated to receive transcervical intrauterine instillation of 5 ml 2% lidocaine or 100 mg rectal diclofenac.Results: The most common cause for undergoing infertility, followed by menorrhagia and irregular uterine bleeding. In addition, the most common findings were submucous fibroid, endometrial polyp, and intrauterine adhesion. Regarding the primary outcome of the present study, it was found that the 100 mg rectal diclofenac was more effective than intrauterine instillation of 5 ml 2% lidocaine for pain relief during outpatient hysteroscopy. Both drugs were tolerable with no observed adverse events.Conclusion: Rectal diclofenac was more effective than local anesthetic in pain relief during outpatient hysteroscopy. This technique may be ideal for outpatient diagnostic hysteroscopy. However, further well-designed studies are still needed to confirm this finding.

In Depth Analysis of Maternal Mortality in Ain Shams University Maternity Hospital in 2014-2017

Abstract Background Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. To facilitate the identification of maternal deaths in circumstances in which cause of death attribution is inadequate, a new category has been introduced: Pregnancy-related death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. Aim of the Work is to determine outline and asses the magnitude and the factors contributing to maternal mortality, especially the avoidable factors and to evaluate the possibility of prevention of such factors, to decrease the incidence of maternal mortality to the least possible value, and finally to make some recommendations and comments for possible preventive measures. Patients and Methods This retrospective study was be done to detect accurate prevalence and most common causes of maternal deaths in Ain Shams maternity hospital over the last four years from 1 January 2014 to end of December 2017. Ain Shams Maternity hospital is one of Ain Shams University teaching hospitals located at Abbaseya district serving large population area, producing its governmental medical services by low fees and nominal prices. Results The substandard care cases were only (21) cases from total of (161) mortality cases representing (13.043%) from total mortalities, so MMR was (0.4937) per 1000 live births. This was the real MMR that the hospital and health system might had the ability to prevent their occurance. Conclusion For improving maternal heath, four essential elements should be done: adequate primary health care at all levels, and an adequate share of the available food for girls from infancy to adolescence, and family planning universally available, to avoid unwanted or high risk pregnancies. After pregnancy begins, good prenatal care, including nutrition with efficient and early detection and referral of high risk patient. The assistance of a trained person for all women in child birth, at home or in the hospital. Women at higher risk must all have effective access to the essential elements of obstetric care.

Fetal and Maternal Outcome in Preterm Premature Rupture of Membranes (PPROM) at Ain Shams Maternity Hospital: A Retrospective Analysis of Last Five Years Admissions

Abstract Background PPROM is defined as spontaneous rupture of the membranes before the onset of labour prior to 37 weeks gestation. It complicates 2-4% of all singletons and 7-20% of twin pregnancies and is associated with over 60% of preterm births. Aim of the Work to retrospectively compare the neonatal and maternal outcomes in women with preterm prelabor rupture of the membranes (PPROM) who delivered before versus who delivered after 34 weeks of gestation over a 5-year period (between January 2011 and December 2015). Patients and Methods This retrospective case-control study was conducted at Ain Shams University Maternity Hospital. The analysis covered the period between January 2011 and December 2015. The study included all women admitted to Ain Shams University Maternity Hospital during the period between January 2011 and December 2015 with a diagnosis of preterm prelabor rupture of the membranes (PPROM). Results The incidence of chorioamnionitis (p-value &amp;lt;0.001) and maternal sepsis (p-value = 0.001) were both significantly higher in those delivering before 34 weeks. The gestational age at ROM was significantly lower and the latent period was significantly shorter in patients delivering before 34 weeks of gestation (p-values &amp;lt;0.001). The Apgar score at 1 and 5 minutes as well as the birth weight were significantly lower in the group delivering before 34 weeks of gestation (p-values &amp;lt;0.001). The incidence of low Apgar score at 1 and 5 minutes (p-value &amp;lt;0.001 and 0.002, respectively), NEC (p-value = 0.006), IVH (p-value &amp;lt;0.001), RDS (p-value = 0.005) and neonatal death (p-value &amp;lt;0.001) were all significantly higher in patients delivering before 34 weeks of gestation. Conclusion In women with premature preterm rupture of membrane neonatal and maternal outcomes is better in those who delivered after 34 weeks of gestation when compared to those who delivered before 34 weeks of gestation.