Ain Shams University Maternity Hospital Research Articles

Burns During Pregnancy: Is the outcome still Gloomy? A follow-up case series.

Despite the incidence of burns in pregnancy not being high, its occurrence leads to high morbidity and mortality for both mother and fetus.In 1997, we published a series of 27 cases of pregnant women who were managed and followed up for fetal and maternal outcomes at Ain Shams University's burn unit and Maternity Hospital during the period from October 1995 to September 1996. Now, two decades later, we report on seven cases of burns admitted to the Burn unit and the Maternity Hospital at Ain Shams University, during the period from January 2019 through June 2022. Pregnant patients admitted to the Burn unit and the Maternity Hospital at Ain Shams University during the period from January 2019 through June 2022 were included in this case series.Demographic data and obstetric history were documented for each patient as well as total body surface area burned, degree, cause and type of burn, maternal mortalities, fetal mortalities, obstetric interventions, and surgical interventions. The total burned surface area ranged from 12-40%; No maternal mortalities occurred in this series, three miscarriages, one preterm labor and three term pregnancies with four surviving neonates.

The Role of Corticosteroids in Prevention of Neonatal Respiratory Morbidity in Term Elective Cesarean Section A Prospective Observation Study

Abstract Background Caesarean sections continue to increase day by day in both developed and developing countries, which is associated with increased respiratory distress syndrome (RDS), the key reason for early neonatal morbidity and mortality. Objective To assess the effect of routine prophylactic corticosteroids before elective caesarean section after 37 weeks of gestational age, on neonatal respiratory morbidity. Methods A prospective observational study was conducted on all pregnant women undergoing elective caesarean sections between 37-42 weeks at Ain Shams University Maternity Hospital. Over an 8- month period (from November 2020 to June 2021), 1105 cases were divided into the exposed group (A), (N = 877) who received prophylactic dexamethasone, and 228 cases in the non-exposed group (B) who did not receive dexamethasone. Outcome measures were the incidence of transient tachypnea of the newborn, and NICU admissions due to respiratory morbidity. Data were analyzed using SPSS 22. Results Overall, there was no statistically significant difference in the incidence of TTN or RDS. No cases of TTN were found in exposed subgroup, versus 1 (0.4%) in non-exposed group (p = 0.745). The respiratory distress (RDS) in the exposed subgroup was 4 cases (16.7%) versus 18 (7.9%) in non- exposed group (p = 0.148). While the admission to the neonatal intensive care unit (NICU) due to respiratory morbidity after an elective caesarean section was 4 cases (16.7%) in the exposed subgroup versus 19 cases (8.3%) in the non-exposed group (p = 0.178). Conclusion Routine administration of prophylactic antenatal corticosteroids before elective caesarean sections at term does not reduce the risk of admission to the NICU compared to non- administration.

Intra-Ovarian Platelet-Rich Plasma (PRP) Injection in Management of POSEIDON IV Poor Responders before ICSI: Pilot Study

Abstract Background Poseidon IV poor responders are 35 years old or older women with antral follicle count < 5 and anti-Mullerian hormone < 1.2 ng/ml with cumulative live birth rate (CLBR) of 22.34% - 34.46% following ICSI. Aim of the Work To assess the effectiveness of intra-ovarian platelet-rich plasma (PRP) injection in POSEIDON IV poor responders before ICSI. Patients and Methods This study was conducted on women complaining from infertility at assisted reproductive techniques unit at Ain Shams University Maternity Hospital at the period from March 2021 till January 2022. We got a 55 cases matching the inclusion and exclusion criteria among them 25 cases accepted to participate as the study group (PRP group) and the others 30 cases refused to the participate PRP group and they were enrolled as a control group. Results Endometrium thickness at day of HCG trigger was statistically significantly higher among PRP group than among control group. Ovulation statistically was non-significantly more frequent among PRP group than among control group. Fertilization statistically was non- significantly more frequent among PRP group than among control group. biochemical pregnancy, clinical pregnancy, ongoing pregnancy statistically were non-significantly more frequent among PRP group than among control group. Conclusion According to the finding in this study intra-ovarian platelet-rich plasma (PRP) injection in POSEIDON IV poor responders before ICSI had a non-significant role regarding the laboratory variables and pregnancy outcomes. Hence, further studies are required.

Pregnancy Outcome in Pregnancies Complicated by Fetal Growth Restriction and Severe Preeclampsia

Abstract Background common pathophysiological feature favors parallel occurrence of severe pre-eclampsia (PET) and fetal growth restriction. Objective To identify pregnancy and neonatal outcome differences between early-onset and late-onset preeclampsia, in relation to fetal growth restriction (FGR) Methods this retrospective study included 50 singleton pregnancies with FGR and severe PET who were admitted in Ain Shams University Maternity Hospital. Fetal growth restriction was defined as EFW and/or AC < 10th percentile. Preeclampsia with severe features included patients with systolic BP ≥ 160 mmHg, diastolic BP ≥ 110 mmHg, elevated liver transaminases twice the normal values, elevated serum creatinine twice the normal levels, or > 1.1mg/dl, HELLP syndrome, features of impending eclampsia, pulmonary edema, and/or thrombocytopenia with platelets level < 100 x 109/L. obstetric and neonatal outcomes were compared in early and late onset PET. Results The current study revealed that there was no difference between early and late onset PET in fetal and pregnancy outcomes while there was significant difference in neonatal outcomes. Conclusion the current study showed that risk of adverse neonatal outcomes as respiratory distress syndrome and neonatal death were higher in cases with early onset PET.

The Value of First Trimesteric 3D Ultrasound Placental Volume in Prediction of Pre-Eclampsia in High-Risk Pregnant Women

Abstract Background Hypertension with pregnancy remains a major health issue for women and neonates worldwide. Pre-eclampsia (PE) complicates 2–5% of all pregnancies and is a leading cause of maternal and neonatal mortality and morbidity. PE and eclampsia are responsible for approximately 14% of maternal mortality. PE is also associated with later-life cardiovascular disease among women and their offspring. Aim of the Work To determine the value of first trimesteric placental volume in predicting pre-eclampsia in high-risk pregnant women. Patients and Methods This Prospective observational study was conducted at tertiary care hospital at Ain Shams University hospitals from September 2019 till November 2021 and performed on a total of 125 pregnant women with high risk of PE at 12 to 12 + 6 week of gestation attending Fetal care unit, Ain Shams University Maternity Hospital. Results DBP statistically had significant moderate diagnostic performance with DBP cut-off value of ≥ 79.0 mmHg in predicting preterm delivery and SGA with significant low diagnostic performance in predicting NICU admission with DBP sensitivity of 83.3%, 67.9%, 64.5% and specificity of 74.8%, 76.3% and 76.6% in predicting preterm delivery, SGA and NICU admission respectively. Conclusion Placental volume and diastolic blood pressure (DBP) were significantly lower in cases with preeclampsia and predictive of maternal complications of HELLP syndrome, Renal impairment, ICU admission and predictive of preterm labor, SGA and NICU admission.

The Association between Parathyroid Hormone and Preterm Labor

Abstract Background Preterm labor represents the main cause of both neonatal mortality and the childhood mortality as it accounts for (35% of 2.8 million neonatal deaths) and (17% of 6.3 million childhood deaths) worldwide. Parathyroid hormone regulates feto-placental mineral homeostasis and stimulates placental calcium transfer. Myometrial activity is directly related to cytoplasmic free calcium, and reduced calcium concentrations inhibit contractions. Aim of the Work We aim to explore the possible association between PTH, calcium, magnesium, phosphorus & albumin levels and preterm labor. Thus, it might be used as a predictor to help prophylaxis, early diagnosis or add another diagnostic tool for preterm labor and further management. Patients and Methods At Ain Shams University Maternity Hospital we conducted a case control on one hundred pregnant women who were recruited from the outpatient clinic and labor ward assessed for eligibility and were enrolled in this study and classified into two groups. Group A: Cases: 50 women who were having established preterm labor and Group B: Controls: 50 matched pregnant women with gestational age (28-36 weeks). Results Mean parathyroid hormone in preterm in labor group was 42.13 while in other preterm not in labor was 50.77 and mean albumin in preterm in labor group 4.02 was while it 4.36 was in the other group so the results shows that there is no statistically-significant difference between the two studied groups regarding the laboratory data except a very small variability between the mean of albumin that can't make any difference to our conclusion. Conclusion We found that there is no obvious association between parathyroid hormone and preterm labor.

Impact of Diabetes in Pregnancy on Stage II Lactogenesis among Postpartum Diabetic Women Compared to Non-Diabetics

Abstract Background Diabetes in pregnancy -whether preexisting or gestational can have negative impact on pregnancy, labor and lactation. Infants of diabetic mothers benefit most from early establishment of breastfeeding as it helps them regulate their blood glucose levels on the short term and decrease their risk of developing diabetes later on life. Aim of the Work This study aims to compare diabetic and non-diabetic pregnant women regarding the onset of stage II lactogenesis at 72 hours postpartum and to associate the degree of diabetes control in antepartum period with the delay in stage II of lactogenesis. Subjects and Methods This study is an observational prospective cohort study, carried out on 203 pregnant women aged from 18 to 40 years old during their routine antenatal care visits in the third trimester of pregnancy at Ain-Shams University Maternity hospital outpatient clinic from December 2020 to August 2021, Cairo, Egypt. Results We found that Diabetes in pregnancy can cause a delay in the onset of Lactogenesis stage II regardless of the degree of control. We can also say that diabetes can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother and delayed initiation of first breastfeed which was found to cause DOLII. And early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers. Conclusion Diabetes can cause series of unfortunate events in pregnancy, labor, and lactation. Many of diabetes implications on peripartum health can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother, delayed initiation of first breastfeed and other birth complications. All these can cause DOL II. Diabetes itself is a risk factor for delayed onset of lactogenesis II which can cause further neonatal hypoglycemia and/or early introduction of infant formula. The cascade of these events can hinder the breastfeeding establishment when it is most needed. The control of diabetes was not found to have impact on DOL II. Further research needs to be done in this regard. Early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers.

The Pathognomonic ultrasonographic findings in fetus with COVID-19 infection

Aim: The main goal is to identify the pathognomonic sonographic signs for foetal SARS-CoV-2 infection and to determine whether or not transplacental SARS-CoV-2 transmission is possible. Patients and Methods: In total, 105 pregnant women with positive SARS-CoV-2 PCR swabs during the first trimester with mild or moderate infection without hospitalisation and/or oxygen support were included in this prospective comparative study, which was carried out at the ultrasound and foetal medicine unit of Ain Shams University Maternity Hospital from January 2021 to June 2023. The SARS-CoV-2 positive group was compared to the control group with inclusion and exclusion criteria. Results: In the COVID-19 group, pathognomonic ultrasonographic results were considerably more common. The COVID-19 group had a considerably higher frequency of placental calcifications and oligohydramnios. In the COVID-19 cohort, patients with positive pathognomonic ultrasonographic results had considerably higher BMIs. In the COVID-19 cohort, gestational age at infection, and BMI ≥30.0 kg/m2 were significant independent risk factors for the development of pathognomonic ultrasonographic abnormalities. Those in the control group who had positive pathognomonic ultrasonographic results were older and had higher rates of hypertension. Significant independent risk variables for the incidence of pathognomonic ultrasonographic findings in the control group included age ≥34.0 years and hypertension. Conclusion: There is no evidence of a teratogenic effect linked to maternal SARS-CoV-2 infection during the first few months of pregnancy. However, early pregnancy infection with COVID-19 is linked to pathognomonic ultrasonography findings of placental calcifications and oligohydramnios.

ROLE OF MATERNAL SERUM FIBROBLAST GROWTH FACTOR 21 LEVEL IN PREDICTION OF PREECLAMPSIA

Pregnancy complications resulting from hypertensive disorders are a serious problem that impact 2-10 % of all pregnanciesglobally. Preeclampsia is defi ned as new onset hypertension and proteinuria after 20 weeks of gestation which may be associated with other maternal organ dysfunction, such as liver or renal insuffi ciency, hematological or neurological complications, uteroplacental dysfunction and fetal growth restriction.Aim of the Work: Primary outcome is to determine the correlation between fi broblast growth factor 21 level and preeclampsia & signifi cance of serum fi broblast growth factor 21 levels as a predictive tool for preeclampsia. Secondary outcome is to establish the relationship between maternal serum fi broblast growth factor 21 level and Maternal complictions: - Eclampsia (tonic clonic fi ts after 20 weeks with elevated blood pressure and proteinuria)- HELLP syndrome (hemolysis, elevated liver enzymes and low platelet occur as a complication of severe preeclampsia)- placental abruption (bleeding after 20 weeks gestation due to premature separation of a normally situated placenta)Patients and Methods: This was a Nested case-control study that was conducted on 90 primigravidas at Ain Shams University maternity hospital from April 2021 to April 2022. Ethical approval was obtained from the ethical committee at Ain- Shams university maternity hospital. Data was recruited from patient attending obstetric clinic at Ain Shams University Maternity Hospital. Blood samples were collected after 20 weeks to 28 weeks gestation. Patients was followed up until delivery and grouped according to development of preeclampsia.Random samples from 45 patients (group who develop PE) and 45 random samples from control group were assessed forfi broblast growth factor 21. Serum fi broblast growth factor 21 levels were measured by a commercially available enzyme- linked immunosorbent assay kit.Results: our study showed that there was a significant difference in FGF21 levels between the groups, patients withpreeclampsia having higher levels than controls, 15.9 % of patients with preeclampsia experienced maternal complicationscompared to none in the control group. Meanwhile, 18.2 % of patients with preeclampsia experienced fetal complicationscompared to 0 % in the control group.Conclusion: Serum FGF-21 levels are signifi cantly higher in preeclamptic pregnant women compared to healthy normotensive pregnant women. So, it can be used as a predictor for preclampsia and maternal complicationsFunding information: The article was written and published without any fi nancial support.Confl ict of interest disclosure: The authors of the article have noconfl ict of interest related to the publication of the article

Frontal Lobe Growth impairment in fetuses with congenital heart disease using Ultrasound parameters; A Comparative Cross-sectional study

Introduction and the Αim: 2D and 3D biometry measures can record the increased development of the fetal brain in the later part of gestation. The objective of this study is to determine whether or not the frontal brain regions of fetuses with congenital heart disease (CHD) are smaller than those of healthy controls. Patients and Μethods: The fetal Medicine unit of the Ain Shams University Maternity Hospital carried out a comparative cross-sectional study, including 140 normal fetuses and 140 fetuses with isolated CHD evaluated between 20 and 39 gestational weeks at our fetal medicine unit in the period November 2021–September 2023 Results: Our results showed the occipito-frontal diameter (OFD) and frontal antero-posterior diameter (FAPD) utilising ultrasonography. FAPD Mean±SD: 26.53 ± 10.44, OFD Mean±SD: 89.14 ± 28.34, and FAPD/OFD Mean±SD: 0.29 ± 0.05. The OFD Mean±SD was found to be 82.18 ± 18.42, the FAPD Mean±SD to be 31.68±6.58, and the FAPD/OFD Mean±SD to be 38.70±2.15. Our results showed that 0.7% of patients exhibited anomalies related to the central nervous system, such as dilated posterior fossa, vermis = 25 mm, and aberrant posterior cranial fossa. The percentage of those with a history of CHD was 3.9%.The history of CHD showed a statistically significant difference between the research groups. When examining comorbidities, surgical history, and the relationship between the other parameters and FAPD, OFD, and FAPD/OFD, there was no statistically significant difference between the groups under investigation, except for CNS abnormalities and gestational age. Conclusion, compared to normal fetuses, fetuses with CHD had shorter FAPDs and a lower FAPD/OFD ratio. Despite the fact that different types of CHD affect hemodynamics differently, there appears to be a common deficiency in the development of the frontal cortex.

Accuracy of 2D Greyscale and 2D and 3D Color Power Doppler Ultrasound in the Diagnosis of Morbidly Adherent Placenta (MAP)

Background Prenatal diagnosis of placental accreta (PA) is essential to carry out adequate surgical planning in centers where multidisciplinary teams are in place, which improve results and reduce complications. These ideal scenarios should be developed in countries with more significant difficulties in the availability of human and technological resources, through teamwork in the different hospital centres and the adequate transfer of patients at higher risk to centres with the best interdisciplinary management skills. Objective To evaluate the diagnostic accuracy of each sign (2D grayscale US signs), 2D Doppler signs, and 3D Doppler signs modified from Collins SL in diagnosis of morbidly adherent placenta in patients with one or more previous cesarean section diagnosed as placenta previa. Methods The present study is a diagnostic test accuracy study was carried out at Ain Shams University Maternity Hospital during the period from January 2020 to March 2021. 126 women were recruited from Special Care Center of the fetus – Ain Shams University Maternity Hospital. All included women were scanned by 2D grayscale, 3D power Doppler ultrasound. Results The current study showed that cases underwent cesarean hysterectomy had significantly higher previous cesarean sections. The results of the current study showed a significant association between all criteria of the 2D grayscale, Color Doppler, 3D Power Doppler ultrasound and presence of placental adherence, considerable intraoperative blood loss, need for added surgical steps, CS hysterectomy and bladder injury with the presence of more than 4 sign or more are predictive for placental invasion with the need of emergency hysterectomy. Conclusion The result of the current study proves the diagnostic accuracy of the ultrasound concerning the prediction of difficult placental separation, considerable intraoperative blood loss, CS hysterectomy and bladder invasion.

Effect of Laparoscopic Suturing versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy. A Randomized Controlled Trial

Background Women enter menarche with approximately 500000 primordial follicles, which slowly drop in number throughout their reproductive lifetimes. Aim of the Work to determine which hemostatic procedure (hemostatic suture or electrocautery) may be less harmful after laparoscopic cystectomy, based on the status of the ovarian reserve. Patients and Methods The study was conducted at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine. The study population comprised females in childbearing period undergone laparoscopic endometriotic ovarian cystectomy at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine. Results There was no statistically significant difference found between the two studied groups regarding AMH, AFC and FSH preoperative with p-value = 0.188, 0.533 and 0.812 respectively. While there was statistically significant increase in AMH and AFC in suturing group than cautery group postoperative with p-value < 0.001 and 0.005 respectively and also statistically significant decrease in FSH in suturing group than cautery group postoperative with p-value 0.004. Results of this study showed that there was statistically significant increase in the percentage of change of FSH in cautery group (61.59 ± 39.29) than suturing group (23.46 ± 17.87) with p-value < 0.001 while there was statistically significant lower rate of change in AFC and AMH in suturing group than cautery group with p-value = 0.001 and < 0.001 respectively. Conclusion laparoscopic cystectomy reduces the ovarian reserve, which is more affected by hemostatic electrocoagulation than hemostatic sutures.

Comparison between Intraoperative and Ultrasound Determined Cesarean Scar Thickness after Elective Cesarean Sections and Unplanned Cesarean Sections in Subsequent Term Pregnancies

Background Cesarean section (CS) rates are increasing worldwide. As a result, women presenting with pregnancy with previous CS are also rising. Previous CS is becoming the most common indication for CS, confirming the age old dictum proposed by Edward Craigin in 1914 “Once a cesarean always a cesarean. Aim of the Work Assessment of cesarean scar; as non-healthy or poor-healed scar are associated with some complications such as chronic pelvic pain, dyspareunia, and abnormal bleeding. Moreover, these poor-healed scars may predispose to preterm labour and uterine dehiscence or rupture in subsequent pregnancy. It was reported also that poor-healed scar may predispose to abnormal placental invasion. Patients and Methods This comparative cross-sectional study was conducted on 100 randomly selected pregnant women attending the outpatient clinic of Ain Shams University Maternity Hospital (ASUMH) in the third trimester at term aged >18 years old with single intrauterine pregnancy, previous one cesarean delivery and not in labor. Pregnant women with abnormal placentation, uterine abnormalities and/or previous uterine surgeries other than one CS delivery were excluded from current study. Results there was no significant difference betweenn two studied groups according to demographic data as age (27.0±3.9 vs. 27.6±3.6, p = 0.382) and BMI (28.2 ± 3.3 vs. 28.7 ± 2.2, p = 0.283). Both groups were comparable with statistically significant difference regarding scar thickness in (ml) and LUS staging. The scar was thicker in elective cases compared with emergency ones (8.4±1.1 vs. 7.7±1.3, p = 0.002), stage I (34 (68.0%) vs. 16 (32.0%)), stage II (15 (30.0%) vs. 25 (50.0%)), stage III (1 (2.0%) vs. 7 (14.0%)) and stage IV (0 (0.0%) vs. 2 (4.0%)). Conclusions From the results of current study we can conclude that, Maternal age and BMI had no effect on cesarean scar quality, integrity and complications incidence. The scar was thicker in elective cases compared with emergency ones.

The Effect of Intra-myometrial Methylergonovine Injection versus Placebo on Decreasing Blood Loss during Transabdominal Myomectomy: A Randomized Controlled Interventional Clinical Trial

Background Uterine leimyomas are tumors of the smooth muscles and the connective tissues of the uterus. They are considered to be the most common benign pelvic tumor affecting about 20% of women above the age of 35. Aim of the Work to compare the efficacy of intra-myometrial methylergonovine injection and placebo injection on reducing blood loss during trans-abdominal myomectomy. Patients and Methods The study was conducted in Ain Shams University Maternity Hospital, where 60 patients complaining of symptomatic myomas and fulfilling the inclusion criteria of the study were recruited from the gynecology outpatient clinic of the hospital. The patients were randomly categorized into two groups; Group A: the patients received 2 ampoules of methylergonovine (Novartis India Ltd) intra-myometrial, each ampule equals to 1 ml containing 0.2 mg (Methergine)® which was infiltrated sporadically into the myoma using a 5ml syringe and avoiding direct injection into vascular area and Group B: the patients received 2ml saline intra-myometrial which was infiltrated sporadically into the myoma using a 5ml syringe and avoiding direct injection into vascular area. Results the mean intraoperative blood loss in the methylergonovine group was 408 ± 70.9 ml and 573 ± 88.4 ml in the control group. There was high statistically significant difference between both groups regarding estimated intraoperative blood loss as methylergonovine injection decreased the blood loss by; 164.9±20.mL (Mean±SE). The mean post-operative haemoglobin was significantly greater in study group compared with control group (10.9±0.9 versus 10.3±1.1 g/dl) as methylergonovine injection decreased the hemoglobin drop by; 0.4±0.1 mL (Mean±SE). The mean post-operative haematocrit was significantly lower among control group compared with study group (21.4-34.2 versus 25.1-37.0 %) (P < 0.001). Methylergonovine injection decreased the hematocrit drop by; 1.4±0.1 mL (Mean±SE). In the present study, the mean difference in operative time in both groups was 8.4±2.5 minutes which had a high statistically significant difference. Conclusion Intra-operative intra-myometrial injection of 2ml methylergonovine during trans-abdominal myomectomy significantly reduces blood loss, operative time and the need for blood transfusion.

Prevalence of Vitamin D Deficiency in Recurrent Early Pregnancy Loss

Background Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown and there are few evidence-based diagnostic and treatment strategies. Studies on the etiology, evaluation, and management of RPL are often flawed. Aim of the Work The aim of the current study was to assess the association between vitamin D status and recurrent pregnancy loss. Patients and Methods The current study was conducted at Ain shams University Maternity Hospital during the period between October 2020 and April 2021. This research recruited 60 pregnant women categorized in to two research groups: Group A - study group: 30 pregnant women with early pregnancy loss and history of repeated pregnancy loss, Group B - control group: 30 pregnant women complete the first trimester with no early pregnancy loss. The 25(OH)D concentration measured in this case control study with predominantly first-trimester blood sampling. Results Choosing matched controls was to decrease confounders so according demographic variables; there was a statistically insignificant difference between group A (RPL) and group B (Normal pregnancy) as regards the demographic research data of study subjects recruited, the mean age was 24.5±2.6 years, the mean BMI was 25.8±2.1 Kg/m2. There was a statistically significant difference between Group A (RPL) and group B (Normal pregnancy) as regard 25(OH)D level (p < 0.001), mean was 11.9±3.2 ng/ml and 16.9±6.5 ng/ml respectively. Vitamin D was significantly associated with recurrent pregnancy loss. Conclusion The current study showed a significant association between vitamin D deficiency in pregnancy and occurrence of Recurrent pregnancy loss. A lot of researches needed to increase the quality of evidence about the association between low levels of vitamin D and recurrent pregnancy loss.

Efficacy of Intravaginal Administration of Isosorbide Dinitrate Together with Misoprostol versus Misoprostol Alone in Induction of Labor

Background Cervical ripening is a complex process involving extensive remodeling and dynamic anatomic and physiologic alternations governed by hormonal changes, inflammatory responses, vasodilatory changes, and other biological processes. Prostaglandins, produced both locally in the cervix and uterus as well as originating from the fetal membranes, play a critical role in cervical ripening and uterine contractility by increasing inflammatory mediators in the cervix and inducing cervical remodeling. Objective To assess the adjunctive Role of intravaginal administration of Isosorbide dinitrate in induction of labor. Patients and Methods This randomized controlled clinical trial was conducted at tertiary care hospital at Ain Shams University Maternity hospital (labor ward) and was randomly selected from full term patients attending the labor ward and scheduled for induction of labor. Results Our results revealed that the need to cesarean section was statistically significantly less frequent among Isosorbide dinitrate group. Our results revealed that the duration of induction to active phase interval and the duration of active stage of labor were significantly shorter among Isosorbide dinitrate group than among Control group. Conclusion As evident from the current study, both intravaginal misoprostol and combination of vaginal Isosorbide dinitrate and misoprostol are safe and effective modes of labor induction. Vaginal isosorbide dinitrate and misoprostol is more effective than misoprostol alone in terms of post induction Bishop Score, shorter induction to active phase interval and induction to delivery interval. Thus, the combined use of vaginal isosorbide dinitrate with misoprostol for preinduction cervical ripening at term may prove to be a major therapeutic advance.

Assessment of Tissue Expression of PIR2/RNF144b Protein in the Different Stages of Endometrial Cancer

Background Endometrial cancer is considered as one of the most common gynaecological cancers in developed countries. Its incidence has risen about 20% over the last decade and the rate 0f death has risen >100% over the past two decades. Aim of the Work This retrospective cohort study will assess tissue expression of PIR2 protein in the different stages of endometrial cancer. Materials and Methods A retrospective cohort study was conducted at Ain Shams University Maternity Hospital (The Early Cancer Detection Unit), A Formalin fixed paraffin embedded tissues (FFPT) was collected from the patient's the pathology unit at Gynecology & Obstetrics hospital, Ain Sham University hospitals in a period of 12 months during 2017 – 2018. The study was conducted on 60 women diagnosed as endometrial cancer; they are subdivided into 2 groups: 1st group: 30 patients with stage 1 endometrial cancer by surgical staging, 2nd group: 30 patients with other advanced stages of endometrial cancer by surgical staging. Results In this study, we show that the E3-ubiquitin ligase PIR2/RNF144B is a potential targetable biomarker in endometrial cancer. There is a high significant association between the PIR2/RNF144b and different stages of EC and higher tumor grades are associated with higher protein expression. The paraffin -embedded endometrial tissue for each patient eligible for the study was analyzed for tissue expression of PIR2 protein using Immunohistochemistry. Conclusion We suggested that PIR2/RNF144b can potentially be used as a biomarker for endometrial cancer for early diagnosis and for monitoring clinical progress of cancer status and efficacy of used treatment.

External Negative Pressure Dressing System (ENPDS) vs. Traditional Wound Dressing for Cesarean Section Incision in Obese Women: A Randomized Controlled Trial

Background Obesity is associated with increased cesarean section delivery rates and surgical site wound complication with associated increased post-operative morbidity, post-operative pain and length of hospital stay. Aim of the Work The objective of this study is to determine whether negative pressure wound therapy reduces the risk of post-cesarean wound dehiscence among obese women compared with standard surgical wound care. Patients and Methods A Randomized controlled trial (RCT)was carried out at Ain-Shams University Maternity Hospital in the period between August 2020 and February 2021. The participants of this study were 260 pregnant women aged 18 years old or older who underwent cesarean delivery. Intervention group had an ENPDS placed for 4 days and control group had a traditional surgical dressing placed for 4 days and both group were followed up for 30 days post-operatively. Results The study reveal that wound dehiscence was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.002). The study also reveal and display that SSI was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.017). After adjustment for the effect of BMI and history of CS, PA surgery or SSI, ENPDS was independently associated with reduced incidence of SSI (odds ratio = 0.262, 95% CI = 0.090 to 0.759, P-value = 0.014). The study reveal that the incidence of wound dehiscence and SSI is statistically significantly lower in ENDPS group compared with traditional dressing group (p value =0.004, 0.012,) respectively. The incidence of wound seroma and haematoma was lower in ENDPS group however, not statistically significant compared with traditional dressing group (p value= 0.066, 0.498) respectively.The study reveals that using ENDPS has a beneficial/ protective effect as regards wound dehiscence and SSI with relative risk (0.25, 0.31) respectively with 95% CI (0.1 TO 0.65 - 0.12 TO 0.83) respectively and NNT (8.7, 11.8) respectively with 95% CI (5.4 to 22.2. - 6.7 to 52.2) respectively.It also shows that ENDPS has a beneficial /protective effect as regards wound seroma and wound hematoma formation with relative risk (0.14, 0.20) respectively even though the 95% CI was (0.02 to 0.14 - 0.01 to 4.13) respectively and the NNT was (21.7, 65.5) respectively. The study reveals that peri-wound blistering, the need for post-operative therapeutic anti-biotics and re-admission was statistically significantly lower in ENDPS group compared to the traditional dressing group (p value= 0.001, 0.005, 0.010) respectively. The study reveals that post-operative pain was less in ENDPS group with p value = <0.001, post-operative mobility was more limited in ENDPS group when compared with the traditional dressing group with p value = <0.001. However, the length of hospital stay was statistically significantly longer in ENDPS group with p value = <0.001 Conclusions Negative pressure wound therapy could be used to reduce the risk of wound dehiscence, surgical site infection, wound seroma, wound haematoma, peri-wound blistering, post-operative pain, post-operative anti-biotics and overall length of hospital stay for obese women undergoing cesarean delivery.

Oxytocin Versus Oral Misoprostol for Induction of Labor in Pregnant Women with Term Prelabor Rupture of Membranes: a Randomized Clinical Trial

This study compares the effectiveness and safety of oxytocin infusion against oral misoprostol for inducing labour in pregnant women with term prelabor membrane rupture. We randomized 173 pregnant women presenting with term prelabor rupture of membranes (PROM) at Ain Shams University Maternity Hospital into Group A (underwent induction of labor (IOL) by 25μg misoprostol oral tablet every 4 h, for maximum 5 doses) and an identical Group B: (underwent IOL by oxytocin infusion according to the hospital protocol). Our primary outcome was rate of vaginal delivery within 24 h, while the secondary outcomes included the time till active phase, induction to delivery interval, maternal pyrexia, nausea and vomiting, fetal distress, Apgar score, birth weight, and neonatal intensive care unit admission. Both groups showed high rates of vaginal delivery (82.4% & 87.1% for misoprostol group and oxytocin group respectively) with no significant difference between the two groups (p=0.394). However, patients induced by misoprostol took significantly less time to reach active phase with a shorter induction to delivery interval as compared to patients induced with oxytocin. This difference was clear in multiparous women, but not observed in primiparous women when subgroup analysis was done. No significant difference was found as regards other outcomes. Our study showed that both oral misoprostol and oxytocin are effective and safe for IOL in patients with PROM, with shorter induction-delivery interval in patients induced by oral misoprostol, an effect that is clear in multiparous but not primiparous women.Trial registrationNCT05215873, on 31/01/2022, “retrospectively registered”.

A pilot study to compare propranolol and misoprostol versus misoprostol and placebo for induction of labor in primigravidae; a randomized, single-blinded, placebo-controlled trial

BackgroundThe Induction of labor is the most common obstetric procedure in daily practice. Introducing propranolol as a new drug to augment the action of prostaglandins will help in the induction process and decrease CS rates. Several researchers have used propranolol in the augmentation of labor.AimThis pilot study compares propranolol and misoprostol versus misoprostol alone for labor induction in primigravids.MethodsThis is a Randomized clinical trial, single-blinded, placebo-controlled trial at Ain Shams University Maternity hospital. This study included 128 pregnant full-term primigravid women candidates for labor induction, randomized into two groups. All candidates underwent labor induction with 25 µg of vaginal misoprostol. Group I received 20 mg of oral propranolol tablets, while group II received sugary pills as a placebo. Candidates who responded successfully to induction were assessed for possible augmentation of labor by amniotomy or oxytocin infusion. The Primary outcome was induction to delivery interval, while the secondary outcomes were the duration of the latent phase, mode of delivery, and APGAR score of the neonate.ResultsThe induction-delivery time was (11.8 ± 8.1 h. vs. 12.6 ± 8.9 h., P value = 0.027) and the duration of the latent phase of labor (7.9 ± 5.6 h. vs. 9.2 ± 6.03 h., P value = 0.017) were significantly shorter in the group of misoprostol and propranolol compared to the group of misoprostol and placebo. There was no statistically significant difference between both groups’ mode of delivery, indications for cesarean section, misoprostol, and oxytocin doses, or neonatal outcome. (P value > 0.05).ConclusionPropranolol, when used with misoprostol for induction of labor, results in augmentation of action of misoprostol and a significantly shorter induction-delivery interval.Trial registrationWe retrospectively registered this trial in clinicaltrial.gov on 01/09/2020 (NCT04533841). https://clinicaltrials.gov/ct2/show/NCT04533841