Ain Shams Maternity Hospital Research Articles

Paracetamol versus Nalbuphine in Relieving Pain in the First Stage of Labour in Primigravida: Double-Blinded Randomized Controlled Trial

Abstract Background First stage of labor begins with regular uterine contractions and ends with complete cervical dilatation at 10 cm. It is divided into a latent phase and an active phase. The latent phase begins with mild, irregular uterine contractions that soften and shorten the cervix. Objectives To compare between intravenous nalbuphine and paracetamol in relieving pain in first stage of labour. Patients and Methods This double-blinded randomized controlled trial was conducted on 120 women primigravida with term and viable pregnancy, presenting with the vertex attending the labor ward for delivery in Ain Shams Maternity Hospital. Results Our study showed remarkably noticeable change on comparing the pre-injection and post-injection SPADI Scoring system at 4,8,12 and 24 weeks. There is highly statistically significant pain and disability score and percentage improvement, yet on the other hand the radiological improvement shows no statistically significant difference found between baseline tendon thickness and its follow up at 4, 8 and 12 weeks while only there was statistically significant decrease in tendon thickness found at 24 weeks with p-value = 0.043. Conclusion The ultrasound-guided PRP injection for supraspinatus tendinopathy cases is a safe, cheap, and easily prepared outpatient procedure which showed competitive, promising, and well-proved results when compared to other modalities outcomes such as conventional surgeries, arthroscopic procedures, and physiotherapy. It deserves our attention to its value and efficacy for the sake of the patient as a minimally invasive procedure providing better quality of life.

Comparison between laparoscopic and vaginal suturing in closing the vaginal vault in Total Laparoscopic Hystrectomy

Abstract Background Hysterectomy is defined as surgical removal of the uterus. It is one of the most gynecological operations all over the world. Benign diseases are responsible for more than 70% of the indications for hysterectomy. e.g: fibroids, pelvic pain and menstrual disorders. Aim of the study to compare between laparoscopic route and vaginal route in vaginal vault closure in total laparoscopic hysterectomy. Patients and Methods This comparative study was carried out between March 2018 and October 2018, at Ain Shams maternity hospital and Helwan materinity hospital, a prospective randomized control comparative study of 32 ladies undergoing total laparoscopic hysterectomy after obtaining the approval of the local ethical committee and a fully-informed written consent. Results A total of 32 patients were included in the study and they were divided into 2 groups each group consisted of 16 patients, the first group of patients underwent laparoscopic suturing and the second group underwent vaginal suturing. Each group was further subdivided into vertical (8 patients) and horizontal (8 patients). Both groups were matched for age, parity, BMI, menstrual status, comorbidities, previous cesarean sections and indications for hysterectomy. Conclusion Vaginal vault closure can be performed safely and effectively both vaginally and laparoscopically.Vaginal route for vault closure was shorter and easier than laparoscopic route.Vaginal horizontal suturing was comparable to vaginal vertical. Laparoscopic vertical was easier and faster than laparoscopic horizontal.

Antibiotic prophylaxis before skin incision versus after cord clamping in the prevention of maternal and neonatal infectious morbidity after cesarean section

Abstract Background the purpose of antibiotic prophylaxis in surgical procedures is not to sterilize tissues but to reduce colonisation pressure of microorganisms introduced at the time of the operation to a level that can be overcome by the patient’s immune system. Aim of the study to compare the effects of antibiotic prophylaxis administered in cesarean section preoperatively versus after neonatal cord clamp on postoperative infectious complications for both the mother and the neonate. Patients and Methods This comparative study was carried out between August 2017 and February 2018, at Ain Shams maternity hospital and Al-Galaa teaching hospital, a prospective randomized control comparativestudy of 874 pregnant ladies undergoing cesarean section after obtaining the approval of the local ethical committee and a fully-informed written consent. Results Of 874 pregnant ladies undergoing cesarean section, mean gestational age in group A (38.71±1.09); while in group B mean gestational age (38.86±1.06). In group A, wound infection 8 cases (1.6%), endometritis 25 cases (5.7%), UTI 18 case (4.1%). In group B, wound infection 16 cases (3.7%), endometritis 35 cases (8%), UTI 28 case (6.4%). No cases suffered from early or long term neonatal complications. Conclusion there is no significant difference between timing of antibiotic either before skin incision or after cord clamping, however there are risk factors that increase the maternal, fetal infectious morbidity as high BMI, low gestational age, previous section, general anaesthesia.

Hospital Versus Home Management in Women with Pre-Labor Rupture of Membranes: RCT

Abstract Background Pre-labor rupture of membranes (premature rupture of membranes (PROM) is defined as rupture of fetal membranes before onset of labor in women after 37 weeks of gestation. And it accounts for 10% of all gestations. Latent period is the interval between PROM and time of onset of labor. More accurate prediction of latency period could help prepare patients for anticipated length of hospital stays. Objective To find out if there is difference between home management and hospital expectant management in women with PROM as regard maternal and fetal outcomes. Patients and Methods Our study is a prospective randomized controlled trial to compare hospital versus home management in women with PROM, whom came to Ain Shams Maternity Hospital, as regard latency period, successful vaginal delivery, chorioamnionitis, NICU admission, and time from rupture of membrane till delivery, who attending the emergency room during the period from June 2017 till June 2018. A total of 152 pregnant women were included in this study who met inclusion and exclusion criteria, they divided into 2 groups, each 76 woman. Group A discharged home after initial assessment, Group B admitted to hospital. Results The present study found that there was a highly statistically significant difference (p < 0.001) between home group and hospital group as regard length of hospital stay. While there was no significant correlation (p > 0.05) between the two groups as regard mode of delivery or adverse maternal or neonatal outcomes. Conclusion As regard home management for women with PROM in comparison with hospital management, they had longer latent period as well as longer time interval between PROM and delivery, but had a shorter hospitalization stay without negative impact on maternal or fetal outcome. In times of increasing financial pressure on the medical system, outpatient management for PROM seems to be a viable option. Also multiparous women were more satisfied with their care, and reported that they ‘would participate in the study again’ if they were cared for at home rather than in hospital.

Posterior cervical angle and cervical length in predicting the successful induction of labour in nulliparous woman

Objective:To assess the value of pre-induction sonographic assessment of the posterior cervical angle (PCA) and cervical length in the prediction of successful induction of labor (IOL).Patients and Methods:The present prospective observational study included IOL candidates who had their PCA and cervical length assessed by transvaginal ultrasonography and the Bishop score at the Obstetrics and Gynecology Department, Ain-Shams Maternity Hospital, Cairo, Egypt, from 1st November 2018 to 31st May 2019. The accuracy of these tests in predicting successful IOL (defined as vaginal delivery) was compared.Results: The analysis included 41 women with successful IOL and 29 women with unsuccessful IOL. The suggested cutoffs for the prediction of successful IOL were a PCA of more than 100°, a cervical length of less than 31 mm, and a Bishop score of more than four. The areas under the receiver operating characteristics curves for these three measures were not significantly different. However, a PCA of more than 100° had the best sensitivity (87.80%), specificity (86.21), positive predictive value (90%), negative predictive value (83.3%) compared with the other two predictors.Conclusion: Posterior cervical angle had the best accuracy in predicting successful induction of labor compared with the cervical length and the Bishop score

The Role of Metformin for Prevention of First Trimesteric Miscarriage in Women With Polycystic Ovary Syndrome: A Randomized Controlled Trial

Background: This study aimed to evaluate the effect of metformin on early pregnancy loss (EPL) in pregnant women with olycystic ovary syndrome (PCOS).Patients and Methods: A randomized clinical trial (Clinicaltrials.gov NCT 02498522) was conducted in Ain-Shams Maternity Hospital in the period between August 2018 and July 2019. One hundred and sixty six women previously diagnosed with PCOS and got pregnant with induction of ovulation in concomitance with Metformin were randomized either Metformin 500 mg orally every 8 hours until the end of the 1st trimester or not receiving Metformin. The primary outcome is to observe any significant decline in the incidence of EPL in PCOS patients after administration of Metformin through out 1st trimester.Results: There was a significant reduction in miscarriage rate after administration of Metformin during 1st trimester. Introduction of Metformin helped pregnancy loss rate to drop to 10.8% while the rate in the group discontinued Metformin was 42.2% (p < 0.05). The side effects rate as nausea, vomiting, gastric irritation and flatulence was significantly higher in the Metformin group.Conclusion: The use of Metformin in patients with PCOS during 1st trimester reduces the incidence of early pregnancy loss (EPL).

Assessment of Quality of Life among Pregnant Women with Systemic Lupus Erythematosus

Background: systemic lupus erythematosus (SLE) is a complex chronic autoimmune condition that represents a source of disability, creating a burden on the quality of life during pregnancy and affecting maternal, fetal and neonatal outcomes. Aim: This study aimed to assess the quality of life among pregnant women with SLE. Methods: A descriptive design was used. This study was conducted at Rheumatology Antenatal Outpatient Clinic at Ain Shams Maternity Hospital. A purposive sampling was used to recruit fifty pregnant women diagnosed as SLE, regardless of their education level. Tools: (1) an Arabic interviewing questionnaire for pregnant women with SLE, (2) a quality of life questionnaire for women with SLE, (3) a systemic lupus erythematosus disease activity index and (4) a health assessment questionnaire for women with SLE. Results: findings of the present study revealed that less than half of the study women had age range between 30 to 39 years. The quality of life of the study women was affected regarding its three domains; social, followed by physical and least the psychological domain. Conclusion: Result supported the research question, that systemic lupus erythematosus had significant negative effects on the quality of life among pregnant women with SLE. Recommendations: Awareness raising programs should be provided for pregnant women about SLE to reduce challenges of flare and remission during pregnancy and improve their quality of life and pregnancy outcomes. It is preferable to conduct the programs for women with SLE at premarital and preconception periods of life.

Effect of Self-Care Guideline on Quality of Life among Pregnant Women with Systemic Lupus Erythematosus

Context: Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune condition that represents a source of disability. In pregnant women, it can create a burden of the low quality of life and cause deleterious effects on maternal, fetal, and neonatal outcomes.&#x0D; Aim: The study aimed at evaluating the effect of self-care guidelines on the quality of life among pregnant women with SLE. &#x0D; Methods: A quasi-experimental study design (time series, one group only, and pre-post intervention assessments) used. Purposive sampling used to recruit fifty pregnant women diagnosed with SLE. The study conducted at three sites: Rheumatology Outpatient Clinic at Ain Shams University Hospital, Rheumatology Antenatal Outpatient Clinic, and Labor Unit at Ain Shams Maternity Hospital. Seven tools of data collection utilized in this study and Arabic self-care guidelines distributed as supporting educational material for the pregnant women with SLE.&#x0D; Results: Findings of the present study showed that there was a highly significant improvement on SLE activity index, follow- up lab investigations, quality of life, and health assessment through evaluation of daily living activities after using self-care guidelines.&#x0D; Conclusion: The results of the current study supported the research hypothesis that the pregnant women with SLE who exposed to self-care guidelines will have a better quality of life compared to their pre-intervention level, which reflected upon improving pregnancy outcomes. Based on the study results, the following recommendations are forwarded; application of the study intervention with the distribution of the clear Arabic self-care guidelines on a large scale in other sittings caring for pregnant women with SLE.&#x0D; Keywords: Self-Care, Guideline, Quality of Life, Pregnant Women, Systemic Lupus Erythematosus.

Transvaginal sonographic measurement of cervical length versus Bishop score in labor induction at term for prediction of caesarean delivery

Objective The current study aims to compare between a transvaginal sonographic measurement of cervical length and Bishop score in the induction of labor (IOL) at term for prediction of cesarean delivery (CD). Materials and methods A prospective cohort study included 320 full-term pregnant women attending Ain Shams Maternity Hospital in the period from August 2017 to February 2018 were enrolled. Seventy-three women were delivered by CD (positive group), and 247 women were delivered vaginally (negative group). All patients had a vaginal examination for assessing the Bishop Score before IOL then a transvaginal ultrasound for assessment of cervical length. IOL was initiated by using PGE1 analog. The primary outcome measure was the accuracy of the cervical length or the bishop score for prediction of the CD. Results In our current study, CD was achieved in 22.8% of all participants while vaginal delivery was achieved in 77.8% after IOL by misoprostol 25 micrograms within 24 h from the beginning of induction. Both the cervical length and Bishop Score had poor predictive value for CD (AUC = 0.694 and 0.623, respectively). Conclusions Both transvaginal sonography for cervical length and Bishop score are useful predictors of the need for CD following labor induction.

Comparison between two types of copper bearing intrauterine device Cu375 and Cu380Ag regarding bleeding pattern: Randomized controlled trial

Introduction: The complications of IUDs are abnormal uterine bleeding, dysmenorrhea, expulsion of the IUD or perforation of the uterus. Due to these complications, 5 to 15 percent of women will stop using the IUD during one year. The most common complication of using IUDs is bleeding that is the cause of 15 to 30 percent of the rejection and exclusion of copper IUDs by the users. Except for progesterone IUDs, all IUDs can lead 50-100 percent increase in the amount of menstrual blood than before the insertion.Aim of the work: To compare between two types of copper IUDs which are different in shape and size (Cu375 and Cu380Ag) regarding bleeding pattern.Patients and Methods: This is a randomized controlled clinical trial. The study was conducted at Family Planning Outpatient Clinic at Department of Obstetrics and Gynecology at Ain Shams Maternity Hospital on 220 patients divided into two groups with insignificant differences between two groups as regard age (p-value 0.934).Results: 110 participants recruited in each group. In group A, drop out after 1month was 6 women and only 70 women had subjective changes in bleeding pattern. After 1 year, drop out was 8 women. In group B, drop out after 1month was 4 women and only 79 women had subjective changes in bleeding pattern. After 1year, drop out was 5 women.Conclusion: One of the most common complications of IUD users is bleeding. These complications vary in the different types of IUDs. The results of this study showed that the use of the IUD ML CU 375 causes a significant decrease in the rate of bleeding.

Effectiveness of Warm Saline Distension Media on Relieving Pain in Outpatient Office Hysteroscopy: A Randomized Controlled Clinical Trial

Background: Outpatient hysteroscopy is the preferred examination procedure for diagnosis of intrauterine pathology and abnormal uterine bleeding causes, in addition for therapeutic operative management. It is desirable to apply as many procedures as possible with an office hysteroscopy, if they are implemented in a safe and effective fashion. Aim: Evaluation and investigation of the effectiveness of warm saline distensibility media in reducing the pain perceived in women undergoing diagnostic hysteroscopy procedure. Methodology: A randomized controlled clinical research trial that recruited 82 women scheduled for outpatient office hysteroscopy in Early cancer detection unit in Ain Shams Maternity Hospital from April 2017 till May 2018. Two research groups were categorized into warm saline and normal room temperature saline research groups each contained 41 cases. Comparative analysis of pain perceived in both groups was conducted to assess efficiency of warm saline to reduce pain perception. Results: Hysteroscopic findings didn’t differ significantly between the two groups, namely ease of introduction of hysteroscope, position of uterus and morphological appearance of the ectocervix, endocervical canal, endometrium, endometrial cavity, and tubal ostia. Also, no statistically significant differences were observed between the two groups in the duration of procedure. Parameters of pain assessment differed statistically significantly between the two research groups. p value &lt;0.001 .Simple analysis of VAS scores revealed a statistically significantly lower VAS score at the end of the procedure in the warm distention medium group in comparison to the room-temperature distention medium group. The same finding remained constant after 15 minutes from the end of the procedure. Assessment of variation of VAS score with combined variation of temperature of distention medium over time was assessed using repeated measure ANOVA analysis. Patient satisfaction, indicated by the proportion of the patients who would undergo the hysteroscopic examination again by usage of same method, was statistically significantly higher in the warm distention medium research group in comparison to the room-temperature medium research group (89.74% vs 71.05% consecutively).(p value &lt;0.04) Conclusions: Pain is measured by VAS score is statistical significantly lower at the end of the procedure in warm saline distension medium research group in comparison to room temperature distension medium research group (1.64+0.82vs 3.05+1.17) consecutively. Denoting possible effectiveness of warm saline in reducing pain perceived in office hysteroscopy

Induction of Labor at 39 Weeks versus Expecting Labour till 41 Weeks: Randomized Controlled Trial on Class I Obese Egyptian Women, with Mode of Delivery Being a Study Endpoint

Background: Maternal obesity is reported to be associated with increased incidence of gestational diabetes mellitus and hypertension. These cause failure of labour induction, leading to higher incidence of cesarean section (CS). The aim of this study was to assess which reduces CS rate, labor induction at 39 weeks or leaving women for spontaneous labor onset till 41 weeks. Methodology: A randomized controlled trial was conducted in Ain Shams Maternity Hospital in Egypt from 2016 to 2018. Study population consisted of 200 term primigravida pregnant obese women delivered in Ain Shams Maternity Hospital. They were divided into two groups: Group A: induction of labor at 39 + 0 weeks (n = 100) by vaginal administration of 25 μg misoprostol (PGE1) every 6 hours for 5 doses; Group B: waiting spontaneous labor onset till 41 + 0 weeks (n = 100), and if no spontaneous labor occurred at 41 weeks, induction was performed in the same way. Results: Induction (Group A) vs. waiting spontaneous labor (Group B) showed the followings, which were significant: CS: 22% vs 39%, p = 0.009; maternal birth injury: 4% vs 12%, p = 0.037; non-assisted vaginal deliveries: 93.6% vs 78.7%, p = 0.034; APGAR scores at 1 & 5 min: 7.6 ± 0.8 vs 7.3 ± 1.1 p = 0.038, 8.4 ± 1.0 vs 8.1 ± 1.3 p = 0.040, respectively; birth weight; 3.3 ± 0.1 vs 3.5 ± 0.2 kg, p Conclusion: CS rate was significantly lower in women with induction of labor at 39 weeks than those waiting for spontaneous labor onset till 41 weeks in obese Egyptian pregnant women.

Effect of intramuscular administration of dexamethasone on the duration of labor induction

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.

Maternity Nurses Hospitals' Perception Concerning Preconception Risk Factors

Objective: The aim of the study was to assess maternity nurses’ hospitals' Perception Concerning preconception risk factors. Background: Preconception care means interventions required for maternal and fetal health care and detection of pre-pregnancy risk factors. The present study aimed to determine maternity nurses’ Perception in Ain shams maternity &gynecology hospital toward preconception risk factors. Subject and Methods: This descriptive study which was conducted among (200) Maternity Nurses working at Maternity & Gynecology Hospitals at Ain Shams University. From of January 2017 and finished at June. Data collection tool was a researcher made 'Structured Interviewing questionnaire to a convenient sample and data were analyzed using SPSS software, descriptive statistics and chi-square test. Result: The result showed that nearly to three fourth of maternity nurse’s level of total perception regarding preconception risk factors was very good, while more than one quarter of their level of total perception was good .Also less than one fourth of maternity nurse’s level of total perception was poor. There were statistical significant relation between maternity nurse`s age, their educational level, their years of experience, and their perception concerning to preconception risk factors. Conclusion: The present study findings revealed that nearly to three quarters of the maternity nurses of Ain Shams maternity hospital had very good perception regarding preconception risk factors. While the maternity nurses’ perception regarding preconception risk factors found to be affected significantly by their age, level of education and years of experience of their work. Recommendations: preconception health care must be involved in the pre-employment orientation program for new nursing staff in the hospital. Also Unique specified instructions through specified protocol for counseling.Key words: Preconception risk factors, mater

Improving Mother's Care of Low Birth Weight at Home

Low birth weight infants are a special group that needs attention and care. The study aims to improve mother’s care of low birth weight infants at home. Research design: It is A quasi- experimental design were used in this study. Setting: This study were conducted at Neonatal Intensive Care Unit (NICU) of Ain Shams Maternity Hospital and at mother’s home. Sampling: A purposeful sample were used in this study, 20% of total admitted rate equal to 122 of mothers of low birth weight infant and were chosen randomly according to criteria.Tools: Two tool were used for data collection, An interviewing questionnaire for mothers to assess their socio demographic characteristics and their knowledge, checklist to assess mothers’ practices, and Observational checklist for assessing home environment. Results: The study showed highly statistically significance differences between the mother’s socio-demographic and their knowledge and practice, highly statistically significance positive correlation between mothers and their practice and knowledge. Recommendation: the study recommended to conduct an educational program for the high risk pregnant women in the follow up clinic to raise their knowledge and practices related to their low birth weight infant..

Comparison between Two Types of Copper Bearing Intrauterine Device Cu375 and Cu380Ag Regarding Bleeding Pattern: (Randomized Controlled Trial)

Background: The complications of IUDs are abnormal uterine bleeding, dysmenorrhea, expulsion of the IUD or perforation of the uterus. Due to these complications, 5 to 15 percent of women will stop using the IUD during one year. The most common complication of using IUDs is bleeding that is the cause of 15 to 30 percent of the rejection and exclusion of copper IUDs by the users. Except for progesterone IUDs, all IUDs can lead 50-100 percent increase the amount of menstrual blood than before the insertion. Purpose: To compare between two types of copper IUDs different in shape and size Cu375 & Cu380Ag regarding bleeding pattern. Patients and Methods: This is a randomized controlled clinical trial. The study was conducted at Family Planning Outpatient Clinic at Department of Obstetrics & Gynecology at Ain Shams Maternity Hospital on 220 patients divided into two groups with insignificant differences between two groups as regard age (p-value 0.934). Results: 110 participants recruited in each group. In group A, drop out after 1month was 6 women and only 70 women had subjective changes in bleeding pattern. After 1year, drop out was 8 women. In group B, drop out after 1month was 4 women and only 79 women had subjective changes in bleeding pattern. After 1year, drop out was 5 women. Conclusion: One of the most common complications of IUD users is bleeding. These complications vary in the different types of IUDs. The results of this study showed that the use of the IUD ML CU 375 causes a significant decrease in the rate of bleeding.

Effect of Intramuscular Administration of Dexamethasone on the Duration of Labor Induction

Background: induction of labor is a common obstetric procedure which is performed for a variety of medical and non-medical indications. If the cervix is unfavourable, prior ripening of the cervix makes induction of labor easier and more succeful. 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 of the Work: 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. Patients 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: This group included 50 Nulliparous women (N=50), called A group. Control group: This group included 50 Nulliparous woman (N=50), called B group. Results: in this study the duration of active and second stages was decreased without change on mode of delivery. The study no significant statistical differences between the two studied groups as regards 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 parturants with minimal complications. Conclusion: an intramuscular injection of dexamethasone before labor induction is found to shorten 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.

Discontinuation Rates among Copper Intrauterine Device Users in Primary Healthcare Unit and University Clinic. Is There a Difference?

Background: in Egypt, despite the high percentage of women using IUD according to Demographic and Health Surveys (DHS) 2014 (52.9%) of total women using contraceptive methods, the discontinuation rates among Cu-IUD users (within 12 months of use) reaches 14.3% in 2014. Aim of the Work: the aim of the study was to compare between primary health care unit and university family planning clinic in discontinuation rate among copper IUD users. Patients and Method: study design: prospective analytical observational study. Study setting: This study was conducted at Family planning Outpatient clinic of Ain Shams Maternity Hospital and El-Zahraa primary health care unit for a year. This study included 260 women whom attending family planning clinic for Cu- IUD insertion. Total 100 subjects was enrolled from each clinic. Rest of subjects was lost on follow up either after 6 months or 12 months. Some others refused to participate or gave wrong personal contacts. Results: preliminary results of the study revealed that there is no statistically significant difference between discontinuation rate among Copper IUD users in university clinic and primary healthcare clinic (p-value = 0.095). Conclusion: in our Study, analysis of data revealed that age, parity and previous usage of IUD may affect discontinuation rate after 12 months of IUD use. The mean cause of IUD discontinuation was bleeding and Anemia was present in 66.6% of patients complaining from bleeding.

Prevalence and outcome of Preterm Premature Rupture of Membranes (PPROM) among pregnant women attending Ain Shams maternity hospital

Prevalence and outcome of Preterm Premature Rupture of Membranes (PPROM) among pregnant women attending Ain Shams maternity hospital

Assessment of Vitamin D Levels in Women with Polycystic Ovarian Syndrome

Background: polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with a prevalence of 6–10% in the general population. PCOS is characterized by the following: ovulatory dysfunction resulting in oligo-amenorrhea and/or anovulation, hyperandrogenism and/or hirsutism and the presence of polycystic ovarian morphology by ultrasound. Vitamin D also plays a physiologic role in reproduction including ovarian follicular development and luteinization via altering anti-Mullerian hormone (AMH), signaling, follicle-stimulating hormone sensitivity and progesterone production in human granulosa cells. Aim of the Work: this study aimed to compare levels of vitamin D in women with PCOS and healthy fertile women. Patient and Methods: this case control study was conducted in Ain Shams Maternity hospital in outpatient infertility clinics and family planning clinic during the period from March 2017 to October 2017. It was included 40 women diagnosed with PCOS based on Rotterdam criteria and 40 fertile women without PCOS who were recruited from family planning clinic. Results: 25(OH) vitamin-D level was significantly lower in PCOS group than in the control group. Conclusion: 25(OH) vitamin-D was significantly lower in PCOS group than in the control group, but not sufficient to be a diagnostic tool for PCOS. Recommendation: larger studies are still needed to clarify the rule of vitamin D in infertility.