Ain Shams University Maternity Hospital Research Articles

A Comparative Study between Lactoferrin versus ferrous sulfate in iron-deficiency during pregnancy

Abstract Background Iron deficiency anemia (IDA) is the condition in which there is decrease in the number of red blood cells or the amount of hemoglobin in the blood. It is caused by insufficient dietary intake and absorption of iron, or iron loss from bleeding. Bleeding can be from a range of sources such as the intestinal, uterine or urinary tract. Aim of the Work to compare the efficacy and the safety of lactoferrin versus ferrous sulphate for the treatment of iron deficiency pregnant women. Patients and Methods This randomized clinical trial was conducted on 98 women selected from pregnant women attending the antenatal outpatient clinic of Ain Shams University Maternity hospital. All patients were divided into two groups; the first group included 49 pregnant women who received lactoferrin (Pravotin100 mg sachets, Hygint pharmaceuticals, Egypt) twice daily orally for 30 days which was dissolved in 1/4 glass of water before meals by 15 minutes. The second group included 49 pregnant women who received 520 mg of dried ferrous sulphate tablets (Feosol tablets, Meda pharmaceuticals, Egypt) once daily orally for 30 days on empty stomach but may be taken with meals to avoid stomach upset. Results Total increase in HB after 1month with lactoferrin was higher compared to ferrous sulfate (-13.572 gdl)(p < 0.001). Gastroinestinal adverse events occurred more frequently with ferrous sulfate than the lactoferrin group (p < 0.001).The number of women requesting change the drug was higher in the ferrous sulfate group(p < 0.001). Conclusion Oral lactoferrin was better tolerated and more acceptable with higher increase in mean hemoglobin when compared to oral iron therapy over one month treatment. Oral lactoferrin can be used as a good substitute to oral iron therapy in iron deficiency during pregnancy.

The Value of Hysteroscopy in Women with Persistently Elevated Post-Evacuation Serum Human Chorionic Gonadotropin (hCG) Level Following Evacuation of Molar Disease

Abstract Background and rational Gestational trophoblastic disease (GTD) is a spectrum of trophoblastic diseases that encompass the hydatidiform mole (both complete and partial), as well as the potentially-malignant and malignant forms: invasive mole, choriocarcinoma and placental site trophoblastic tumor. Gestational trophoblastic neoplasia (GTN) refers to persistent elevation of serum levels of human chorionic gonadotropin (hCG). The subsequentmanagement of GTD after evacuation of the uterus relies on serial surveillance of serum hCG levels. When serum hCG levels plateau or rise, chemotherapy should promptly be initiated. Patients and Methods This study for accuracy of a diagnostic test. The current study was conducted at Gynecologic Oncology Unit and Early Cancer Detection Unit at Ain Shams University Maternity Hospital during the period between January 2016 and June 2018. Results In the present study, the case who had a vascular mass, the patient was 44 years old and she was para 4, so board decision was for TAH. Postoperative serum hCG surveillance for this case showed adequately declining levels. She, accordingly, did not receive chemotherapy. For the 19/44 (43.2%) cases who had a hysteroscopic finding of ‘an empty cavity’ were diagnosed as persistent GTN and received chemotherapy according to the protocol. The remaining 25/44 (56.8%) cases, who had a hysteroscopic finding of ‘remnants’, underwent re-evacuation. Postoperative serum hCG surveillance showed persistently elevated levels in 9/44 (20.5%) cases, who, therefore, received chemotherapy according to the protocol; and adequately declining levels in 16/44 (36.4%) cases, who, accordingly, did not receive chemotherapy. Conclusion The hysteroscopy significantly reduced the risk of chemotherapy in women with hydatidiform mole and have persistent post-evacuation elevated serum hCG level and sonographic criteria of invasive disease.

Hysteroscopy in the Evaluation of Recurrent First Trimesteric Miscarriages

Abstract 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, uterine factors (acquired and congenital)are responsible for 10 to 50 %of recurrent pregnancy loss,hysteroscopy is the gold standard for evaluation of the eendometrial cavity. Aim of the work to evaluate the role of hysteroscopy in the diagnosis of possible uteri.ne congenital and acquired causes of recurrent first trimesteric miscarriages. Patients and methods This prospective cohort study was conducted on 164 patients with recurrent (3 or more), first trimester miscarriage planned to undergo office (diagnostic) hysteroscopy to assess the uterine cavity, who attend Ain Shams University maternity Hospital Early Cancer detection Unit during period from July 2018 to December 2018. Results the largest proportion 53% of our study population had abnormal hysteroscopic findings, and the uterine septum had the highest prevalence among women with recurrent first trimesteric miscarriages. Conclusion In women with recurrent pregnancy loss, hysteroscopy is a useful diagnostic tool in the diagnosis of possible uterine causes of recurrent miscarriages. Uterine septum is the most common congenital uterine abnormality found in patients with recurrent first trimesteric miscarriages.

Predictive Accuracy of Three Dimensional Ultrasound Measurement of Fetal Adrenal Gland Volume in Preterm Labor Cases

Abstract Background Preterm birth is one of the major clinical problems in obstetrics and neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. It is reported that more than 80% of all neonatal mortality and morbidity is due to preterm birth. Objective In this study fetal adrenal gland volume and fetal zone measurement were used as a predictors for occurrence of labor in singleton pregnancies complicated by threatened preterm labor in comparison to cervical length and cervicovaginal fetal fibronectin. Methodology The study was carried out at Ain Shams University Maternity Hospital. The current study include 88 pregnant women who presented with symptoms or signs of threatened preterm labor (PTL). All women were subjected to full history taking, full general, abdominal, pelvic examination, in addition to ultrasound fetal biometry, measurement of cervical length, measurement of fetal fibronectin, fetal adrenal gland volume AGV and fetal zone acquisitions. Results Our results showed high statistically significant difference between the two groups of women regarding CL measurement, FZE and cAGV with P values < 0.001 suggesting that ultrasound examination of fetal adrenal gland and assessment of FZE at time of evaluation for symptoms of PTL may be clinically beneficial in predicting the occurrence of labor in pregnant women at risk of preterm labor. Conclusion Our results demonstrate that in women presenting with threatened preterm labor, cAGV and FZE measured by 3-dimensional ultrasound seem to be significant predictors of delivery within 7 days, when compared to CL and cervicovaginal fetal fibronectin.

Transverse Supraumbilical versus Pfannenstiel Incision for Cesarean Section in Morbidly Obese Women “A Randomized Controlled Trial”

Abstract Background Cesarean section is one of the most common operative procedures performed in modern obstetrics, cesarean section is defined as the birth of a fetus through incision in the abdominal wall and the uterine wall. Obesity is currently the most prevalent health threat the world over and its influence on general health is rapidly increasing. Obesity has a dramatic impact on pregnancy outcome. Apart from an associated increased prevalence of diabetes and hypertension, obesity in pregnancy has been associated with poor perinatal and neonatal outcomes. Obese mothers have an increased risk of pregnancy complications such as anemia, hypertension, pre-eclampsia, preterm delivery, emergency cesarean section, and gestational diabetes and significantly increases the rate of cesarean section. Aim of the Work This study aimed to evaluate the efficacy and safety of transverse supraumbilical incision compared of pfannenstiel incision in morbidly obese women undergoing cesarean section. Patients and Methods This study was conducted in the casualties of Ain Shams University Maternity Hospital. Parallel, superiority randomized controlled trial with allocation ratios 1:1. All Participants 72 women will be randomly allocated into two groups; each group will be included 36 women, one group will be those who will undergo the transverse supraumbilical incision while other group will undergo pfannenstiel incision. Randomization will be performed in advance by computer using variable blocks the random number generator in MS Excel (Microsoft, Seattle, WA, USA). Results As regard risk analysis for the incidence of adverse outcomes TSU inicision is associated with significantly lower risk for wound complication compared with a pfannenstiel-type incision (RR = 0.19, 95% CI = 0.07 to 0.5, p-value=0.0008). The number needed to treat is 2.1 with a 95% CI ranging from 1.5 to 3.6. There is faster regain of intestinal motility in transverse supraumbilical incision compared with pfannenstiel incision. Mean post-operative hospital stay in transverse supraumbilical group was (2.4) hours while that of pfannenstiel group (2.9) hours with no significant difference. Conclusion The transverse supraumbilical incision showed definite advantages over pfannenstiel incision; being faster to preform, less blood loss, less post-operative pain, earlier regain of intestinal motility, earlier ambulation, shorter hospital stay. Another Aspect, being economic, saving more of the stuff’s time, utilizing less anesthesia and needing least instruments.

Umbilical and fetal Middle Cerebral artery Doppler in Patients with Pregnancy Induced Hypertension in the Prediction of Adverse Perinatal Outcome

Abstract Context Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality. Close antenatal care is considered the corner stone in early diagnosis of the disease and picking up of the severe cases with subsequent early management and intervention. On the other hand aggressive management of severe cases of high risk pregnancy is considered the second line of defense against maternal and preinatal morbidity and mortality. Objective The aim of this work is to assess the accuracy of middle cerebral artery and umbilical artery Doppler in predicting perinatal outcome in women with PIH in the third trimester. Methodology In this study which included 100 women with pregnancy induced hypertension who admitted to Ain Shams university maternity hospital our aim was to assess the accuracy of middle cerebral artery and umbilical artery Doppler in predicting perinatal outcome in women with PIH in the third trimester including predicting admission to NICU and the duration of treatment, low Apgar score at 5 minutes, Gestational age at delivery, fetal weight at birth and perinatal mortality. Results There was a significant association between MCA PI abnormalities and higher rates of NICU admission, 5-minutes Apgar score < 7, Low gestational age at delivery, Low birth weight and perinatal mortality. We found that the MCA PI for prediction of NICU admission was the best with (sensitivity 86.8 %, specificity 55.3 %, PPV 68.7%, NPV 78.8%).This was more predictive than either the UA-PI or the MCA/UA PI ratio. In our study, MCA PI was found to be a good predictor of poor neonatal outcome in patients with pregnancy induced hypertension especially in prediction of perinatal mortality and incidence of NICU admission. Conclusion Middle cerebral artery pulsatility index is more sensitive and more sensetive than umblical artery pulsatility index and middle cerebral arery/ umblical artery pulsitility index ratio in prediction of adverse perinatal outcomes. However middle cerebral arery / umblical artery pulsitility index ratio showed more specificity in predection of perinatal outcome in patients with pregnancy induced hypertension.

Titrated oral misoprostol solution versus vaginal misoprostol for labor induction in primi gravid ladies

Abstract Background It is now generally accepted that the uterine cervix plays an important role during pregnancy and labor and that it depends on an active ripening process within the cervix; which is necessary for successful labor induction. Aim of the Work to test the safety and efficacy of titrated oral misoprostol compared to vaginal misoprostol for labor induction in term gravid ladies. Patients and Methods This prospective, single-blinded randomized controlled clinical trial was conducted at Ain-Shams University Maternity Hospital during the period between August 2017 and August 2018. 120 pregnant women planned for induction of labor were recruited in the study according to the inclusion / exclusion criteria. Subjects included in the study were randomized into two groups: patients who received oral 200 ug misoprostol in 200 ml water titrated over 24 hours and placebo tablets vaginally which resemble vagiprost tablets (25 microgram misoprostol) and the second group contained pients who received vaginal misoprostol 25microg maximum four doses, and placebo solution of 200 ml of tap water. Results titrated oral misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal misoprostol, oral Misoprostol has a similar maternal and perinatal safety profile to vaginal misoprostol. Conclusion This new approach to oral misoprostol administration was successful in minimizing the risk of uterine hyper-stimulation, which has been a feature of misoprostol use for induction of labor, at the expense of a somewhat slower response. Oral Misoprostol has a similar maternal and perinatal safety profile compared to vaginal misoprostol.

The Accuracy of Fetal Head to Perineum Distance and Cervical Length in Predicting the Outcomes of Labor Induction

Background: Induction of labor is defined as the process of artificially stimulating the uterus to start labor. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes.Aim: The aim of the study is to assess the accuracy of fetal head to perineum distance and cervical length in predicting the outcomes of labor induction.Patients and Methods: This is a prospective, observational study aimed to assess the accuracy of fetal-head to perineum distance and cervical length measurement in predicting the outcomes of labor induction. The study was performed at Ain Shams University Maternity Hospital from December 2017 to July 2018, 112 pregnant women who met inclusion criteria and admitted for labor induction at term (between 37-41 weeks).Results: In predicting the outcomes of labor either vaginal delivery or CS, Bishop Score had low diagnostic performance while cervical length, FHPD and posterior cervical angle had moderate diagnostic performance. The mean for pain perception among women who had vaginal examination was 3.6±0.9 (range: 2.0-5.0) which is significantly higher than that among women who had perineal ultrasound 1.0±0.6 (range: 0.0-2.0).Conclusion: It can be concluded that, based on this study, the FHPD, CL and posterior cervical angle are useful in predicting the outcome of labor induction in comparison to Bishop Score. Ultrasound examination is better tolerated by women than pelvic examination.

The effect of bilateral uterine artery ligation versus intermittent clamping of uterine and ovarian artery on blood loss during abdominal myomectomy : A randomized controlled trial

Background: Myomectomies are more commonly performed than hysterectomies, mainly due to the fact that patients desire to retain their uterus for psychological, reproductive and cultural reasons even after completing their families. The average volume of blood loss during abdominal myomectomy is 200 to 800 mL. Surgical hemorrhage may result in anemia, hypovolemia, and coagulation abnormalities.Aim: To compare between bilateral uterine artery ligation and intermittent clamping of uterine and ovarian artery on amount of blood loss during abdominal myomectomy.Patients and Methods: This study was conducted at Ain-Shams University Maternity Hospital on 90 women with symptomatic myomas in the postmenstrual period presented by abnormal uterine bleeding, dull aching lower abdominal pain, dyspareunia, pressure symptoms, progressive abdominal enlargement or pelvic heaviness, diagnosed based on clinical examination and ultrasound scan with pre-operative hemoglobin level above 10gm/dl.Results: The preoperative Hb was 11.6 gm % and 11.8gm% for both clamping and ligation one respectively, and post-operative Hb for the groups was 9.4 gm% and 9.2 gm% for the 2 groups respectively. There was no significant difference between both groups regarding postoperative drop of hemoglobin which was 0.8 gm % in the clamping group and 1.1 gm% in the ligation group. Estimated inraoperative blood loss start was significantly fewer among clamping group than among ligation group. Hemoglobin reduction was significantly fewer among clamping group than among ligation group.Conclusion: Based on the results obtained by this study, intermittent clamping of uterine and ovarian artery is a preferred approach than bilateral uterine artery ligation on blood loss during abdominal myomectomy.

L-Carnitine and Clomiphene Citrate for induction of ovulation in women with Polycystic Ovary Syndrome : Randomized controlled trial

Aim: The aim of the study was to assess the efficacy of adding L-carnitine to clomiphene citrate for increasing the ovulation and the pregnancy rate in women with PCOS. The primary outcome was the ovulation rate and the secondary outcome was the pregnancy rate.Materials and Methods: This study was a randomized controlled clinical trial that was conducted on 94 women who attended at the Obstetrics and Gynecology Outpatient Infertility Clinic at Ain-Shams University Maternity Hospital, and they were diagnosed with PCOS according to the Rotterdam Criteria (11). The women were distributed randomly into two equal groups; Group L (n=47) received 100 mg of clomiphene citrate plus 3 gm of L-carnitine orally from day 3 to day 7 of the cycle with continuation of L-carnitine till the day of pregnancy test and Group C (n=47) received 100 mg of clomiphene citrate orally from day 3 to day 7 of the cycle.Results: There was a significant difference (P 0.05) between the two groups regarding the pregnancy rate (Group L: 8.5%; Group C: 6.4%). There was a highly significant difference (P 0.05) between the two groups regarding the level of progesterone after 8 days from the hCG injection.Conclusion: L-carnitine added to clomiphene citrate for induction of ovulation in PCOS women had a significant effect on the ovulation rate, but it didn’t have a significant effect on the pregnancy rate when compared to clomiphene citrate alone.

Amyloid A as a biomarker for preeclampsia

Aim:To investigate and evaluate serum levels of amyloid A in PET and healthy gestations, to help in detection of a correlation between PET and serum levels of amyloid A. Methodology: A randomized case control research study conducted at Ain-Shams University Maternity Hospital, Cairo, Egypt in a period of 6 months. There was 102 study subjects in the total cohort ; 51 cases diagnosed with preeclampsia and 51 study subjects with normal gestations as a control research group. Results: The median serum level of amyloid-A was statistically significantly higher in women of PE research group in comparison to women of the control research group (p value

Amino Acid Chelated Iron versus Ferrous Fumarate in the Treatment of Iron Deficiency Anemia with Pregnancy : Randomized Controlled Trial

Background: Anemia is a major health problem. Iron deficiency is the most common cause of anemia during pregnancy. Suboptimal iron content in the average mother’s diet and the presence of insufficient iron stores during the reproductive years are causes for this predominance. In many developing countries, iron deficiency anemia (IDA) in pregnancy is more of a rule than an exception with a prevalence of 52%. In the Western societies, the frequency of IDA is approximately 25% in pregnant women not taking iron supplements and less than 5% in women taking iron supplements. Anemia has a significant impact on the health of the fetus and the mother. It can be associated with increased preterm labour, preeclampsia, and maternal sepsis. It can also lead to fetal loss or even perinatal deaths.Aim: To find out whether there is a difference between amino acid chelated iron and iron salts (ferrous fumarate) in effect, safety, adverse effects and outcomes in treatment of iron deficiency anemia during pregnancy.Patients and Methods: The study was conducted on pregnant women attending the antenatal care in the outpatient clinic at Ain-Shams University Maternity Hospital in the period from February 2019 to July 2019, with diagnosis of iron deficiency anemia between 14 -18 weeks with hemoglobin (HB) level 8–10.5g/dL, and serum ferritin <15μg/l. One hundred fifty pregnant women who met the criteria were randomized in to 2 groups (iron chelated amino acid “IAAC” group and ferrous fumarate “FF” group). Hemoglobin level, blood indices, serum iron and serum ferritin levels were measured in both groups at 4, 8, 12 weeks of treatment.Results: There was a significant hematological improvement (mean HB level, blood indices, serum iron and ferritin levels) in both groups which was significantly higher in IAAC group.Conclusion: Iron amino acid chelate achieves faster cure rate than ferrous fumarate in women with iron deficiency anemia in pregnancy as regards mean HB and serum ferritin level. Iron amino acid chelate is associated with fewer side effects than ferrous fumarate.

Accuracy of Transvaginal Ultrasound in Prediction of Latency Period in Women with Preterm Premature Rupture of Membranes

Background: Preterm prelabor rupture of membranes (PPROM) is a major cause of Pretem Birth (PTB), Pretem Birth (PTB) is the most significant cause of perinatal morbidity and mortality worldwide. Cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) have been postulated in several studies to have an important role in prediction of PTB. Up to our knowledge, this is the first study that combines the three cervical parameters in prediction of latency period in women with PPROM. Aim of the Work: To assess the accuracy of cervical length, posterior uterocervical angle and anterior uterocervical angle in prediction of latency period in women with Preterm prelabor rupture of membranes. Subjects and Methods: A Prospective cohort study on 205 women with PPROM was held at Ain Shams University Maternity Hospital, a transvaginal ultrasound was performed to measure cervical length, posterior uterocervical angle, anterior uterocervical angle. Results: A total of 205 pregnant women with PPROM were included in this study, the latency grade was within 2 days in 57 (27.8%) of cases while was after 2 days in 148 (72.2%) of cases. As regards cervical length cut-off value 25.0 mm, sensitivity was 78.9%, specificity was 65.5%, posterior uterocervical angle cut-off value 108.0°, sensitivity was 93.0%, specificity was 60.1%, and anterior uterocervical angle cut-off value 106.0°, sensitivity was 93.0%, specificity was 71.6%. Conclusion: The combination of cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) measurements greatly predicts the latency period in women with PPROM, and Anterior uterocervical angle (AUCA) ≥ 106.0° had the highest diagnostic value in predicting latency period within two days.

Transvaginal Sonographic Assessment of the Cervix for Prediction of Successful Induction of Labor in Nulliparous Women

Background: Induction of labor is commonly performed in obstetric practice. Many methods have been suggested as good predictors of the outcome of labor induction, yet none of them is satisfactory enough. Our study aims to assess cervical length and uterocervical angle measured by transvaginal ultrasound as predictors of successful induction of labor. Methods: Prospective cohort study conducted in Ain Shams University Maternity hospital over 150 nulliparous women undergoing induction of labor, in the period between May 2018 and August 2019. Transvaginal sonographic measurement of cervical length and uterocervical angle was done before induction of labor by prostaglandins. The patients were followed up till delivery and the outcome was recorded. Results: The best cut-off value of cervical length for prediction of success of labor induction was 32.3 mm with 60% sensitivity and 56% specificity and the best cut-off value of uterocervical angle was 110.2 degrees with 87% sensitivity and 93% specificity. The cervical length showed a significant negative correlation while the uterocervical angle showed a significant positive correlation with the success of labor induction. Conclusion: Cervical length and uterocervical angle are good predictors of successful labor induction.

Effect of Nursing Guideline Regard Passive Smoking Hazards on Pregnancy Outcome

Background: Passive smoking is unintentional breathing in of smoke that gets permeated into the environment due to smoking by an “active” smoker. The study aim: was to evaluate the effect of nursing guideline of reducing passive smoking hazards on pregnancy outcome. Research design: A quasi-experimental study sample: a purposive sample include 214 pregnant women with passive smoking exposure from Ain Shams university maternity hospital. The total No. of the sample divided into two groups (control group and study group). Tools:five tools were used for data collection; structured interviewing questionnaire sheet, written exam tool (Pre/post/follow up test), attitude assessment tool, maternal and fetal assessment sheet & maternal and neonatal observation sheet, plus educational supportive material about effect of passive smoking on pregnant women and prevention. The results revealed that, there were more than two-thirdof pregnant mothers among control group suffered from abnormal vital signs(temperature, pulse rate, respiratory rate, and blood pressure) during pregnancy & 2 hours immediately after labor & there were more than two-third of mothers among study group delivered vaginally and one-tenth only of them delivered by caesarean section while two-third of mothers among control group delivered vaginally and one-third of them delivered by caesarean section also the majority of mother in study group had newborn with good health conditions and good APGAR score in 1&5 minutes after labor compared with more than one-half of mothers in control group had newborn with abnormal fetal heart rate ,weight and APGAR score at first & fifth minutes after birth. conclusion revealed that, more than two third of studied sample “both group” had unsatisfactory knowledge and negative attitude about passive smoking hazards on pregnancy at 1 st trimaster while more than three quarter of study group who received specific nursing guideline were /satisfactory knowledge & positive attitude about passive smoking hazards at 2 nd and 3 rd trimaster of pregnancy. The study recommended that the nursing guide line intervention for pregnant women in first trimaster through session/ booklet or brochures and follow up tests were improved the women knowledge &attitude for reducing passive smoking hazards on pregnancy outcome.

Research Paper: Clomiphene Citrate to Inducte Ovulation in Females With Unexplained Infertility: A Randomized, Controlled, Clinical Trial

Objectives: The current study aimed at comparing the efficacy of Clomiphene Citrate (CC) for the expectant management of unexplained infertility in females over 3 successive cycles. Materials: The present randomized, controlled, clinical trial was carried out at Ain Shams University Maternity Hospital. Females with unexplained infertility for at least 12 months of unprotected regular marital life were enrolled. Eligible females were randomly assigned into one of the 2 following groups: group 1 received 100 mg CC once a day for 5 days, and group 2 was expectantly followed up without induction of ovulation. The primary outcome was the clinical pregnancy rate. Results: A total of 113 females were enrolled in the current trial. The mean age of the subjects was 25.3±3.1 years; ranged 20 to 33. The clinical pregnancy rate was slightly, but significantly, higher in CC group compared with the controls; both per case (7/57 vs. 4/56, 12.3% vs. 7.1%, respectively; P=0.357; Relative Risk (RR)=1.72; 95% Confidence Interval (CI)=0.53, 5.55; Number Needed to Treat (NNT)=19) and per cycle (7/163 vs. 4/160, 4.3% vs. 2.5%, respectively; P=0.374; RR=1.72; 95% CI=0.51, 5.75; NNT=56). Discussion: CC seems to be not effective in improving clinical pregnancy outcome compared with observation alone in females with unexplained infertility.

Women’s Expectations and Experiences Regarding Nursing Support during Childbirth

Context: Women giving birth always need to be provided by support and care during childbirth, trustful relationships with the health professionals, mainly childbirth nurses. The midwife can promote women feeling of being empowered and subsequently having positive experience and satisfaction during childbirth.&#x0D; Aim: The study aimed to assess the women's expectations and experiences regarding nursing support during childbirth.&#x0D; Methods: A descriptive design utilized in carrying out this study. A purposive sample of 400 women recruited in this study that conducted at the antenatal clinic and postnatal room, Ain Shams University Maternity Hospital. The study utilizes three tools: A structured interview questionnaire to assess socio-demographic characteristics of the study sample, the expectations of nursing support during labor and birth, and the childbirth experience questionnaire.&#x0D; Results:58.3% of the studied sample had negative expectations toward nursing support.62.6% of the studied sample had negative experiences toward childbirth.&#x0D; Conclusions: The study concluded that more than half of the studied sample had negative expectations toward nursing support. Besides, slightly less than two-thirds of the studied sample had negative experiences toward childbirth. Also, there was a highly significant correlation between the total expectations of the nursing support score of the studied sample and their total childbirth experiences. The study recommended conducting an educational program to childbirth nurses regarding expectant mothers' expectations, wishes, and needs during labor.

The association between gestational vitamin D deficiency and preterm birth : A case control study

Objective: To assess the association between Gestational Vitamin D (VD) deficiency and preterm birth (PTB).Patients and Methods: This prospective observational nested case control study was conducted at Ain Shams University Maternity Hospital and Dar Ismael Maternity Hospital and sequentially recruited women with singleton pregnancy at 20-28 weeks. Blood samples were collected from all eligible participants and kept frozen until further measurement of maternal VD levels. All enrolled women were followed up till delivery. Cases (PTB) group included woman who delivered before completing 37 weeks of gestation while controls, term birth (TB) group included matched group of those who delivered at or after 37 weeks. The primary study outcome measure was the correlation between VD status and PTB.Results: The final analysis of this study included 40 cases in the PTB group and 40 controls in the TB group. VD deficiency was more prevalent in PTB group (87.5% versus 22.5% in the TB group, p<0.001). PTB group had a statistically significant lower VD levels (13.34 ± 7.71 ng/ml versus 32.91 ± 18.98 ng/ml in the TB group, p<0.001) with a moderate positive linear correlation between gestational age at delivery and VD level (Pearson correlation=0.571, p<0.001). Among the studied maternal outcomes, delivery by cesarean section was more prevalent in PTB group (62.5% versus 30.0% in the TB group, p=0.004).Conclusion: Gestational VD deficiency was associated with increased risk of PTB and delivery by cesarean section

Measurement of maternal serum amyloid A as a novel marker of preterm birth

Objective To study the association between maternal serum amyloid A (mSAA) levels and preterm birth (PTB). Methods This prospective observational nested case control study was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between May 2017 and December 2017. The study recruited pregnant women at 26–34 weeks presented with threatened preterm labor (PTL). Women with PTB were included in cases group while control group included women who continued pregnancy and delivered at term. Serum samples were collected to measure mSAA levels. The main outcome of the study was the association between mSAA levels and PTB. Secondary outcomes included neonatal intensive care unit admissions and neonatal mortality. Results Fifty-eight women were included in the final analysis (29 in each group). Women with PTB had a statistically significant higher mSAA levels [5.1 (4.5–7.7) vs. 1.2 (0.0–2.5) mg/l, for cases and controls respectively, p < .001]. Higher mSAA levels were also observed among women whose babies were admitted to NICU, but there was no significant relation between mSAA level and neonatal death. A statistically significant negative correlation was found between mSAA and gestational age at delivery and neonatal birth weight. mSAA had an excellent value to predict PTB (AUC = 0.972 [95% CI, 0.891–0.998], p < .0001), fair value to predict admission to NICU and a poor value to predict neonatal death. Conclusions mSAA level was found to be elevated among women with threatened PTL who end with PTB; mSAA is a potentially useful predictive marker of PTB that warrant further study. CLINICALTRIALS.GOV: NCT01639027

Intrauterine Instillation of Tranexamic Acid in Hysteroscopic Myomectomy: A Double-Blind, Placebo-Controlled, Parallel-Group Randomized Clinical Trial

To evaluate the hemostatic effect of intrauterine instillation of tranexamic acid (TXA) with the distention medium during hysteroscopic myomectomy. Prospective, parallel-group, double-blind, placebo-controlled randomized clinical trial. Early Cancer Detection Unit in Ain Shams University Maternity Hospital, Cairo, Egypt. Eighty women with type 0 or I submucous myoma undergoing hysteroscopic myomectomy using unipolar resectoscope. The participants were randomly assigned to receive either 1 g of TXA for every 1000 mL of the distending medium (intervention group) or 10 mL of placebo (10 mL of 1.5% glycine) in the same form inside every 1000 mL of the distention medium. The primary outcome was a change in hemoglobin level 24 hours after surgery compared with preoperative values, and the secondary outcomes were the surgeon's rating of intraoperative bleeding and the quality of operative view, the duration of surgery, the volume of injected media, intraoperative complications, and the completion of myomectomy in 1 procedure. The mean difference in hemoglobin level was 1.11 ±.58 g/dL in the TXA group and 1.46 ± 0.61 g/dL in the placebo group (p = .015). The quality of hysteroscopic view was better in the TXA group (p = .001), with good operative view in 23 (60.5%) cases in TXA vs 8 (20.5%) in the placebo group. The surgeon's rating of bleeding as excessive was reported in 1 (2.6%) case in the TXA group and in 9 (23.1%) cases in the placebo group. There was no difference between the groups regarding the duration of surgery, the volume of injected media, completion of myoma resection in 1 session, and intraoperative complications. Three cases of uterine perforation with the thermal loop were reported, and all were associated with poor operative field in the placebo group. Intrauterine instillation of TXA with the distention medium during hysteroscopic myomectomy resulted in a statistically significant decrease in hemoglobin level 24 hours after surgery, albeit with minimal clinical significance. TXA resulted in better visualization of the field throughout the procedure.