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2018
Maged, A. M., H. Rashwan, S. Abdelaziz, W. Ramadan, W. A. I. Mostafa, A. A. Metwally, and M. Katta, "Randomized controlled trial of the effect of endometrial injury on implantation and clinical pregnancy rates during the first ICSI cycle.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 140, issue 1, pp. 211-2167, 2017 Oct 19, 2018. Abstractrandomized_controlled_trial_of_the_effect_of_endometrial_injury.pdf

OBJECTIVE: To assess whether endometrial injury in the cycle preceding controlled ovarian hyperstimulation during intracytoplasmic sperm injection (ICSI) improves the implantation and pregnancy rates.

METHODS: Between January 1, 2016, and March 31, 2017, a randomized controlled trial was conducted at a center in Egypt among 300 women who met inclusion criteria (first ICSI cycle, aged <40 years, day-3 follicle-stimulating hormone <10 IU/L, normal serum prolactin, no uterine cavity abnormality). The women were randomly allocated using a web-based system to undergo endometrial scratch in the cycle preceding controlled ovarian hyperstimulation (n=150) or to a control group (n=150). Only data analysts were masked to group assignment. The primary outcomes were the implantation and clinical pregnancy rates at 14 days and 4 weeks after embryo transfer, respectively. Analyses were by intention to treat.

RESULTS: The implantation rate was significantly higher in the endometrial scratch group (41.3% [90/218]) than in the control group (30.0% [63/210]; P<0.001). The clinical pregnancy rate was also significantly higher in the endometrial scratch group (44.2% [61/138]) than in the control group (30.4% [41/135]; P<0.001).

CONCLUSION: Endometrial injury in the cycle preceding the stimulation cycle improved implantation and pregnancy rates during ICSI. CLINICALTRIALS.GOV: NCT02660125.

Maged, A. M., W. S. Deeb, A. E. Amir, S. S. Zaki, H. Elsawah, M. A. Mohamady, A. A. Metwally, and M. A. Katta, "Diagnostic accuracy of serum miR-122 and miR-199a in women with endometriosis.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141, issue 1, pp. 14-19, 2017 Nov 17, 2018. Abstractdiagnostic_accuracy_of_serum_mir-122.pdf

OBJECTIVE: To evaluate the value of serum microRNA-122 (miR-122) and miR-199a as reliable noninvasive biomarkers in the diagnosis of endometriosis.

METHODS: During 2015-2016, at a teaching hospital in Egypt, a prospective cohort study was conducted on 45 women with pelvic endometriosis and 35 women who underwent laparoscopy for pelvic pain but were not diagnosed with endometriosis. Blood and peritoneal fluid (PF) samples were collected; interleukin-6 (IL-6) was detected by enzyme-linked immunosorbent assay and miR-122 and miR-199a expression was measured by quantitative real-time polymerase chain reaction.

RESULTS: The serum and PF levels of IL-6, miR-122, and miR-199a were significantly higher in women with endometriosis than in controls (P<0.001 for all comparisons). Serum miR-122 expression was positively correlated with serum IL-6 (r=0.597), PF IL-6 (r=0.603), PF miR-122 (r=0.934), serum miR-199a (r=0.727), and PF miR-199a (r=0.653). Serum miR-199a expression was positively correlated with serum IL-6 (r=0.677), PF IL-6 (r=0.678), PF miR-122 (r=0.744), and PF miR-199a (r=0.932). Serum miR-122 and miR-199a had a sensitivity of 95.6% and 100.0% and a specificity of 91.4% and 100%, respectively, for the detection of endometriosis.

CONCLUSION: Serum miR-122 and miR-199a were significantly increased in endometriosis, indicating that these microRNAs might serve as biomarkers for the diagnosis of endometriosis. This article is protected by copyright. All rights reserved.

Maged, A. M., Hoda Abdelaal, E. Salah, H. Saad, H. Meshaal, A. Eldaly, M. A. Katta, and W. S. Deeb, "Prevalence and diagnostic accuracy of Doppler ultrasound of placenta accreta in Egypt.", The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 31, issue 7, pp. 933-939, 2017 Mar 22, 2018. Abstractprevalence_and_diagnostic_accuracy_of_doppler_ultrasound_of_placenta_accreta_in_egypt.pdf

OBJECTIVE: The objective of this study is to assess the prevalence of placenta accrete (PA) among those with placenta implanted over cesarean section (CS) scar and to evaluate the accuracy of Doppler ultrasound in diagnosis.

METHODS: A cross-sectional study included 100 patients with placenta previa (PP) anterior with at least one previous CS. Ultrasound and color Doppler were done to all participants and correlated with operative findings.

RESULTS: There was a significant difference between accrete and non-accrete group regarding maternal age (32.6 ± 5.01 versus 29.14 ± 4.89), and a highly significant difference regarding the postoperative hemoglobin (6.71 ± 1.156 versus 8.41 ± 1.257) and the number of previous CSs (p <.001). The abnormal Doppler findings showed a highly significant difference between the two groups as loss of retroplacental clear zone (87.3% versus 10.8%), intraplacental lacunae (93.7% versus 37.8%), hypervascularity in uterine bladder interface (47.6% versus 5.4%), and blood vessels invading myometrium (82.5% versus 18.9%) (p < .001). The sensitivity, specificity, PPV, NPV, and accuracy of loss of retroplacental clear were 87.3%, 89.19%, 93.2%, 80.49%, and 88%; intraplacental lacunae were 93.65%, 62.16%, 80.82%, 85.19%, and 82%; hypervascularity in uterine bladder interface were 47.62%, 94.59%, 93.75%, 51.47%, and 65%; dilated vessels over peripheral subplacental zone were 82.54%, 81.08%, 88.14%, 73.17%, and 82%, respectively. There was a highly significant difference between the two groups regarding surgical management with cesarean hysterectomy, occurrence of bladder injury, the need for intraoperative, and postoperative blood transfusion, ICU admission (p < .001).

CONCLUSION: The use of ultrasound together with the color Doppler allowed for better prediction of placental invasion of the myometrium prior to obstetrical intervention to improve the maternal and the fetal outcome.

Maged, A. M., M. Mosaad, A. M. AbdelHak, M. M. Kotb, and M. M. Salem, "The effect of hyoscine butylbromide on the duration and progress of labor in primigravidae: a randomized controlled trial.", The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 31, issue 22, pp. 2959-2964, 2017 Aug 02, 2018. Abstractthe_effect_of_hyoscine_butylbromide_on_the_duration_and_progress_of_labor_in_primigravidae_a_randomized_controlled_trial.pdf

OBJECTIVE: To assess the effect of hyoscine butylbromide (HBB) on duration of the first stage of labor in primigravdae.

METHODS: A case-control study conducted on 120 primigravida at term admitted in active labor were divided into three equal groups. A single dose of the drug (placebo or HBB 20 mg or HBB 40 mg) was injected intravenously slowly to groups A, B, and C. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labor until a fully dilated cervix was observed.

RESULTS: The duration of first stage was significantly shorter in women receiving 20 and 40 mg of HBB when controlled to control women (187.73 ± 20.92, 186.41 ± 19.40 versus 231.39 ± 33.14 min). There was no significant difference between the three study groups regarding duration of the second stage (36.76 ± 9.98, 35.72 ± 9.97 and 37.55 ± 10.57, respectively, p > .05), number of cases delivered by cesarean section (12.5%, 12.5%, and 15%, respectively, p > .05) and Apgar score of the neonates (p > .05). There was no significant difference between the three study groups regarding occurrence of side effects named dry mouth (7.5%, 12.5%, and 5%, p > .05), flushing (2.5%, 5% and 0%, p > .05), tachycardia (2.5%, 2.5%, and 2.5%, p > .05), or urinary retention (2.5%, 0%, and 0%, p > .05).

CONCLUSION: Intravenous injection of HBB decreases the duration of active phase of labor in primigravidae with no side effects.

Maged, A. M., W. Deeb, S. Elbaradie, A. R. Elzayat, A. A. Metwally, M. Hamed, and A. Shaker, "Comparison of local and intra venous dexamethasone on post operative pain and recovery after caeseream section. A randomized controlled trial", Taiwanese Journal of Obstetrics & Gynecology, vol. 57, issue 1, pp. 346-350, 2018.
Maged1, A. M., A. M. El‑Semary1, H. M. Marie1, D. S. Belal1, A. Hany1, E. F. Omran1, S. M. Y. Elbaradie2, and M. K. A. Mohamed1, "Effect of maternal obesity on labor induction in postdate pregnancy", Archives of Gynecology and Obstetrics, vol. 298, issue 1, pp. 45-50, 2018.
Maged, A. M., H. Rashwan, M. Mahmoud, A. El-Mazny, M. Farouk, Doaa S. Belal, and H. M. Marie, "Effect of Prolonged GnRH Agonist Downregulation on ICSI Outcome in Patients With Endometriomas of Less Than 5 cm: A Randomized Controlled Trial", Reproductive Sciences, vol. 25, issue 10, pp. 1509-1514, 2018. gnrh_in_eo_final.pdf
Ahmed Mohamed Maged1, 5, A. H. Abbassy2, H. R. S. Sakr3, H. Elsawah1, H. Wagih1, A. I. Ogila1, and A. Kotb4, "Effect of swimming exercise on premenstrual syndrome", Archives of Gynecology and Obstetrics, vol. 297, issue 1, pp. 951-959, 2018. swimming_final.pdf
Maged*, A. M., H. Saad, E. Salah, H. Meshaal, M. Abdelbar, E. Omran, and A. Eldaly, "Urine test for HPV genotypes as a predictor of precancerous cervical lesions and for cervical cancer screening", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 141, issue 1, pp. 332-336, 2018. hpv.pdf
2017
Shaltout, M. F., A. M. Maged, M. M. Elsherbini, and R. O. Elkomy, "Laparoscopic transabdominal cerclage: new approach.", The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 30, issue 5, pp. 600-604, 2017 Mar. Abstract

OBJECTIVE: To evaluate efficiency and safety of the new approach of laparoscopic cerclage.

STUDY DESIGN: Fifteen women were operated with our new technique. Their age ranged from 22 years to 35 years. Inclusion criteria included those with history of two or more second trimesteric abortions or early preterm labor. These women had at least two previous unsuccessful vaginal cerclage or vaginal insertion of cerclage is not possible because of congenitally short cervix, cervical conization or excessive cervical scarring.

RESULTS: Twelve of the participants delivered vaginally with the removal of cerclage, two had CS due to breech presentation and the cerclage was left in place and the last one has surgical evacuation. No intraoperative or postoperative complications were encountered namely; excessive bleeding, injury of uterine vessels or postoperative peritonitis. No technical difficulties upon doing the procedure or cerclage removal were met apart from one case where removal of the vaginal stitch was not possible [incision was done in the cervix over the tape and the Mersilene tape was cut followed by repair of the cervical tissue using (00) Vicryl stitches].

CONCLUSION: The new approach for laparoscopic cerclage is a safe, effective and reasonable treatment after failure of vaginal cerclage.

Maged, A. M., G. Aid, N. Bassiouny, D. S. Eldin, S. Dahab, and N. K. Ghamry, "Association of biochemical markers with the severity of pre-eclampsia.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 136, issue 2, pp. 138-144, 2017 Feb. Abstract

OBJECTIVE: To assess the association between pre-eclampsia severity and biochemical and ultrasonography markers.

METHODS: A retrospective study was undertaken of women with severe pre-eclampsia (group 1, n=90), mild pre-eclampsia (group 2, n=90), or a normal pregnancy (group 3, n=90) who attended a hospital in Egypt in October 2013-April 2015. Associations between pre-eclampsia and biochemical, cardiotocography, and ultrasonography markers were investigated.

RESULTS: There were significant differences between the groups in C-reactive protein (331.44±112.38, 251.43±59.05, and 23.81±16.19 nmol/L; P≤0.05 for all), platelet count (113.40±36.72, 172.93±57.60, and 212.68±70.00×10(9) /L; P≤0.05 for group 1 comparisons), alanine transaminase (52.24±14.83, 38.34±13.12, and 23.11±6.92 U/L; P≤0.05 for group 1 comparisons), and serum uric acid (600.80±117.19, 481.83±118.97, and 243.89±53.54 μmol/L; P=0.050 for group 3 comparisons). Cardiotocography score was worse among women with severe pre-eclampsia than among those in the other two groups (P=0.039 for both comparisons). Biophysical profile score and umbilical artery resistance index differed by group (P≤0.05 for all). Middle cerebral artery resistance index was lower among women with severe pre-eclampsia (P≤0.05).

CONCLUSION: The levels of C-reactive protein, blood urea nitrogen, serum uric acid, and alanine transaminase, and the platelet count were linked with the presence and severity of pre-eclampsia.

Maged, A. M., D. S. Belal, H. M. Marie, H. Rashwan, S. Abdelaziz, A. A. Gabr, and A. R. Elzayat, "Prospective study of the effect of maternal body mass index on labor progress in nulliparous women in Egypt.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 139, issue 3, pp. 329-335, 2017 Dec. Abstract

OBJECTIVE: To evaluate the impact of maternal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) on labor progress in nulliparous women.

METHODS: The present prospective cohort study enrolled primigravidae admitted to Kasr Al Ainy hospital, Cairo University, Egypt, during active labor between February 1, 2016, and February 28, 2017. Patients were classified into three equal groups using their BMI at admission: underweight (<18.5), normal weight (18.5-29.9), and obese (≥30). The primary outcome was the rate of cervical dilatation; secondary outcomes included the duration of the second stage of labor, neonatal delivery weight, and the mode of delivery.

RESULTS: Among the 600 primigravidae enrolled (200 in each group), significant differences were recorded in the rates of cervical dilatation (P<0.001), and the duration of the active labor phase (P<0.001) and the whole of labor (P<0.001); in the obese group, the cervical dilatation rate was lowest and the durations of the active phase of labor and the whole of labor were longer. The incidence of intrapartum cesarean delivery (P<0.001) and neonatal delivery weight (P<0.001) also differed between the groups; both were highest in the obese group.

CONCLUSIONS: Patterns in labor progress, including cervical dilatation rate and labor duration, differed among patients with different BMI. ClinicalTrials.gov: NCT02686073.

Maged, A. M., A. E. - M. Ramzy, M. Aboulghar, S. G. H. Allah, A. H. Wahba, A. A. Y. ElKateb, and N. Hwedi, "3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles", European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 212, issue 1, pp. 160-165, 2017. jz.pdf
Mohamed, A. M. M., G. Eid, N. Bassiony, D. S. Eldin, S. Dahab, and N. ElGhamry, "Association of biochemical markers with severity of preeclampsia and its correlation with pregnancy outcome", International journal of gynecology and obstetrics, vol. 136, issue 2, pp. 138 - 144, 2017. markers_in_pih.pdf
Maged, A. M., E. Salah, A. M. Kamel, A. M. Hussein, H. Saad, H. Meshaal, and W. M. Kamal, "Effect of oral contraceptives on balance in women: A randomized controlled trial", Taiwanese Journal of Obstetrics & Gynecology, vol. 56, pp. 463 -366, 2017. ocps_and_balance.pdf
Shaltout, M. F., A. M. Maged, M. M. Elsherbini, and R. O. Elkomy, "Laparoscopic transabdominal cerclage: new approach", The journal of maternal-fetal & neonatal medicine, vol. 30, issue 5, pp. 600-604, 2017.
Shaltout, M. F., A. M. Maged, M. M. Elsherbini, and R. O. Elkomy, "Laparoscopic transabdominal cerclage: new approach", The journal of maternal-fetal & neonatal medicine, vol. 30, issue 5, pp. 600-604, 2017.
Motawi, T. M. K., S. M. Rizk, N. W. Maurice, A. M. Maged, A. N. Raslan, and A. H. Sawaf, "The role of gene polymorphisms and AMH level in prediction of poor ovarian response in Egyptian women undergoing IVF procedure", J Assist Reprod Genet, 2017. gene_polymorphism_and_amh.pdf
Maged, A., G. Youssef, A. Hussein, H. Gaafar, M. elsherbiny, R. Elkomy, M. Eid, N. Abdelhamid, and A. R. AbdelRazek, "The role of three-dimensional ultrasonography fetal lung volume measurement in the prediction of neonatal respiratory function outcome", Journal of Maternal- Fetal and Neonatal Medicine , 2017.
2016
Maged, A. M., A. G. M. A. Hassan, and N. A. A. Shehata, "Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial.", Archives of gynecology and obstetrics, vol. 293, issue 5, pp. 993-9, 2016 May. Abstract

OBJECTIVE: The objective of this study is to compare the effectiveness and safety of carbetocin vs. oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery.

METHODS: A prospective randomised study was conducted in which 100 pregnant women were randomised into 2 equal groups: group 1 received Carbetocin 100 µgm (Pabal(®) Ferring, UK) and group 2 received oxytocin 5 IU (Syntocinon(®), Novartis, Switzerland).

RESULTS: The amount of blood loss and the need for other uterotonics were significantly lower in the carbetocin group (811 ± 389.17 vs. 1010 ± 525.66 and 10/50 vs. 21/50). There was no significant difference between the carbetocin and oxytocin groups regarding occurrence of major PPH (6 vs. 11), the need for blood transfusion (6 vs. 9), the difference between blood haemoglobin levels before delivery and 24 h after delivery (0.6 ± 0.28 vs. 0.56 ± 0.25), respectively. There was no significant difference between the 2 study groups regarding both systolic and diastolic blood pressure measured immediately after the drug administration and at 30 and 60 min later. Regarding the drugs side effects, there was no significant difference between the 2 groups in the occurrence of nausea, vomiting, tachycardia, flushing, dizziness, headache, shivering, metallic taste, dyspnea, palpitations and itching.

CONCLUSIONS: Carbetocin is a better alternative to oxytocin in management of atonic PPH with non-significant hemodynamic changes or side effects .

Maged, A. M., H. Al-Inany, K. M. Salama, I. I. Souidan, H. M. Abo Ragab, and N. Elnassery, "Endometrial Scratch Injury Induces Higher Pregnancy Rate for Women With Unexplained Infertility Undergoing IUI With Ovarian Stimulation: A Randomized Controlled Trial.", Reproductive sciences (Thousand Oaks, Calif.), vol. 23, issue 2, pp. 239-43, 2016 Feb. Abstract

OBJECTIVE: To explore the impact of endometrial scratch injury (ESI) on intrauterine insemination (IUI) success.

METHODS: One hundred and fifty four infertile women received 100 mg of oral clomiphene citrate for 5 days starting on day 3 of the menstrual cycle. Patients were randomized to 2 equal groups: Group C received IUI without ESI and group S had ESI. Successful pregnancy was confirmed by ultrasound.

RESULTS: 13, 21, and 10 women got pregnant after the first, second, and third IUI trials, respectively, with 28.6% cumulative pregnancy rate (PR). The cumulative PR was significantly higher in group S (39%) compared to group C (18.2%). The PR in group S was significantly higher compared to that in group C at the second and third trials. The PR was significantly higher in group S at the second trial compared to that reported in the same group at the first trial but nonsignificantly higher compared to that reported during the third trial, while in group C, the difference was nonsignificant. Eight pregnant women had first trimester abortion with 18.2% total abortion rate with nonsignificant difference between studied groups.

CONCLUSION: The ESI significantly improves the outcome of IUI in women with unexplained infertility especially when conducted 1 month prior to IUI.

Maged, A. M., H. Torky, M. A. Fouad, S. H. Gad Allah, N. M. Waked, A. S. Gayed, and A. K. Salem, "Role of antioxidants in gestational diabetes mellitus and relation to fetal outcome: a randomized controlled trial.", The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 29, issue 24, pp. 4049-54, 2016 Dec. Abstract

OBJECTIVE: To examine the effect of antioxidant administration on the oxidative parameters in both blood and placental tissue and its relation to fetal outcome in women with GDM.

PATIENTS AND METHODS: Two-hundred pregnant women with gestational diabetes mellitus (GDM) were randomized into 2 groups, Group1 received 1 gram L-ascorbic acid per day and Group2 received placebo.

RESULTS: The use of antioxidants significantly lower the needed insulin dose for blood sugar control (25.6 ± 20.3 versus 40.5 ± 23.7, respectively). In placental tissue homogenates, glutathione (GSH) was 49.6 ± 5.9 versus 62.34 ± 4.99, malondialdahyde (MDA) was 165.7 ± 9.2 versus 264.15 ± 12, superoxide dismutase (SOD) was 0.3 ± 0.3 versus 0.054 ± 0.16 while catalase (CAT) was 14.06 ± 2.4 versus 15.52 ± 3.97 and glutathione peroxidase (GPx) was 14 ± 4.1 versus 26.3 ± 4.26 in antioxidant group compared to the control group (p < 0.001). In maternal blood, GSH was 1.5 ± 0.3 versus 0.74 ± 0.088, CAT was 380.7 ± 11 versus 325.44 ± 21.8, GPx was 52.3 ± 8.7 versus 75.82 ± 6.84 and SOD was 188 ± 15.3 versus 98.56 ± 11.05 in antioxidant group compared to control group (p < 0.001). In neonatal blood, the level of MDA and SOD showed a statistically significant difference between antioxidants and control groups (4 ± 0.7 versus 6.6 7 ±0.66 and1 8 8 ± 15.3 versus 98.5 ± 11.05, respectively) (p < 0.001). The neonatal blood sugar after 1 and 2 hours of delivery was more stable in antioxidant group (56.7 ± 10.9 versus 39.7 ± 11.1 and 58.5 ± 10.8 versus 41.7 ± 13.1, respectively) (p <0.05). The neonates NICU admission was lower in antioxidant group (5 versus 11) (p <0.05).

CONCLUSION: The use of antioxidants markedly reverses the oxidative stresses in women with GDM with marked improvement on neonatal outcome.

Maged, A. M., A. G. M. A. Hassan, and N. A. A. Shehata, "Carbetocin versus oxytocin for prevention of postpartum hemorrhage after vaginal delivery in high risk women.", The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 29, issue 4, pp. 532-6, 2016. Abstract

OBJECTIVE: To compare effectiveness and tolerability of carbetocin versus oxytocin in prevention of postpartum hemorrhage (PPH) after vaginal delivery.

METHODS: A prospective double-blinded randomized study conducted on 200 pregnant women randomized into two groups: Group 1 (100 women) received single 100 μg IM dose of carbetocin and Group 2 received of 5 IU oxytocin IM. Both groups received their drug after fetal and before placental delivery.

RESULTS: There was a statistically significant difference between the two study groups regarding amount of bleeding (337.73 ± 118.77 versus 378 ± 143.2), occurrence of PPH (4 versus 16%), need for other uterotonics (23 versus 37%) and hemoglobin difference between before and after delivery (0.55 ± 0.35 versus 0.96 ± 0.62) (all being lower in carbetocin group) and measured hemoglobin 24 h after delivery (being higher in carbetocin group); however, there was no significant difference between the two study groups regarding occurrence of major PPH and the need for blood transfusion. Women in carbetocin group showed a statistically significant lower systolic and diastolic blood pressure immediately after delivery and at 30 and 60 min than women in oxytocin group. There was no significant difference between the two study groups regarding occurrence of nausea, vomiting, flushing, dizziness, headache, shivering, metallic taste, dyspnea, palpitation and itching. Women in carbetocin group experienced tachycardia more than women in oxytocin group.

CONCLUSIONS: Carbitocin is a better alternative to traditional oxytocin in prevention of PPH after vaginal delivery with minimal hemodynamic changes and similar side effects.

Maged, A. M., A. M. T. Hashem, S. H. Gad Allah, M. E. Mahy, W. A. I. Mostafa, and amal Kotb, "The effect of loading dose of magnesium sulfate on uterine, umbilical, and fetal middle cerebral arteries Doppler in women with severe preeclampsia: A case control study.", Hypertension in pregnancy, vol. 35, issue 1, pp. 91-9, 2016. Abstract

UNLABELLED: SYNOPSIS IV MgSO4 administration in women with severe preeclampsia resulted in a decrease in umbilical artery, uterine artery, and fetal middle cerebral artery Doppler indices.

OBJECTIVE: To evaluate Doppler parameters of the umbilical artery (UmA), uterine artery (UA), and fetal middle cerebral artery (MCA) before and after MgSO4 administration in women with severe preeclampsia.

METHODS: A case control study included 100 pregnant women with severe preeclampsia. Umbilical artery, uterine artery, and fetal middle cerebral artery Doppler were measured before and 20 minutes after intravenous administration of 6 g of magnesium sulfate.

RESULTS: There was a significant difference between maternal systolic blood pressure (173.20 ± 22.72 vs. 156.60 ± 19.18), diastolic blood pressure (109.60 ± 9.14 vs. 101.90 ± 10.05), and heart rate (80.52 ± 11.52 vs. 88.48 ± 12.08) before and after administration of MgSO4 in the studied patients (p value < 0.001). There was a significant difference between umbilical artery, middle cerebral artery, and uterine artery Doppler parameters before and after administration of MgSO4 in the studied patients (p value < 0.001). There was no significant difference between umbilical artery/middle cerebral artery with regard to RI and PI. However, there was significant difference with regard to the S/D ratio (p value < 0.001). The decrease in the values of Doppler parameters before and after administration of MgSO4 was more in the middle cerebral artery than in the umbilical artery.

CONCLUSION: Intravenous administration of magnesium sulfate in pregnant women with severe preeclampsia resulted in a decrease in umbilical artery, uterine artery, and fetal middle cerebral artery Doppler indices with reduced resistance to blood flow in these vessels.

Maged, A. M., G. Aid, N. Bassiouny, D. S. Eldin, S. Dahab, and N. K. Ghamry, "Association of biochemical markers with the severity of pre-eclampsia", International journal of gynecology and obstetrics, 2016.
Maged, A. M., A. G. M. A. G. Hassan, and N. A. Shehata, "Carbetocin versus oxytocin for prevention of postpartum hemorrhage after vaginal delivery in high risk women", J Matern Fetal Neonatal Med, vol. 29, issue 4, pp. 532-536., 2016. carbetocin.pdf
Maged, A. M., A. G. M. A. Hassan, and N. A. A. Shehata, "Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial", Archives of gynecology and obstetrics, vol. 293, pp. 993-999, 2016. 13_carbetocin_ttt_arch.pdf
Maged, A. M., A. M. T. Hashem, S. G. H. Allah, M. E. Mahy, W. A. I. Mostafa, and amal Kotb, "The effect of loading dose of magnesium sulfate on uterine, umbilical, and fetal middle cerebral arteries Doppler in women with severe preeclampsia: A case control study", Hypertension in Pregnancy, vol. 35, issue 1, pp. 91-99, 2016. 14_mgso4.pdf
Maged, A. M., M. Elsherbini, W. Ramadan, R. Elkomy, O. Hilal, D. Hatem, M. Fouad, and H. Gaafar, "Periconceptional risk factors of spina bifida among Egyptian population: a case–control study", Journal of maternal fetal and neonatal medicine, vol. 29, issue 14, pp. 2264–2267, 2016. 15_spina_bifida_final.pdf
Maged, A. M., H. Torky, M. A. Fouad, S. H. Gad Allah, N. M. Waked, A. S. Gayed, and A. K. Salem, "Role of antioxidants in gestational diabetes mellitus and relation to fetal outcome: a randomized controlled trial", The journal of maternal-fetal & neonatal medicine, vol. 29, issue 24, pp. 4049–4054, 2016. 7_antioxidants.pdf
Maged, A. M., A. A. Hafiz, W. A. I. Mostafa, N. El-Nassery, M. Fouad, E. Salah, and amal Kotb, "The role of prophylactic use of low dose aspirin and calheparin in patients with unexplained recurrent abortion", Gynecological Endocrinology, vol. 32, issue 12, pp. 970–972, 2016. 5the_role_of_prophylactic_use_of_low_dose_aspirin_and_calheparin_in_patients_with_unexplained_recurrent_abortion.pdf
2015
Maged, A. M., N. Elnassery, M. Fouad, A. A. Hafiz, and W. Al Mostafa, "Third-trimester uterine artery Doppler measurement and maternal postpartum outcome among patients with severe pre-eclampsia.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 131, issue 1, pp. 49-53, 2015 Oct. Abstract

OBJECTIVE: To evaluate the association between uterine artery Doppler measurements and maternal complications among women with severe pre-eclampsia.

METHODS: As part of a cross-sectional study, women with a single intrauterine pregnancy of more than 28 weeks and a diagnosis of severe pre-eclampsia were enrolled at a unit in Cairo, Egypt, between December 2012 and September 2014. Uterine artery Doppler was evaluated and maternal complications were recorded.

RESULTS: Among the 100 participants, 76 (76%) experienced maternal complications. There were significant differences in resistance index (RI) and pulsatility index (PI) between women who experienced no complications and those who had accidental hemorrhage, HELLP syndrome, and acute pulmonary edema (P<0.001 for all), and postpartum hemorrhage (P=0.004 and P<0.001, respectively). There was no significant difference in RI for women with postpartum fits (P=0.360). There was a statistically significant difference regarding RI (P<0.001) and PI (P=0.005) between cases presenting with complications and those without. There was a significant negative correlation between PI and gestational age (r=-0.988; P<0.001) and between RI and gestational age (r=-0. 854; P<0.001), but no significant correlation between PI or RI and age, systolic blood pressure, or diastolic blood pressure.

CONCLUSION: Increased uterine artery resistance in the third trimester of pregnancy could be used to predict postpartum maternal complications.

Maged, A. M., M. Mohesen, A. Elhalwagy, and A. Abdelhafiz, "Salivary progesterone and cervical length measurement as predictors of spontaneous preterm birth.", The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 28, issue 10, pp. 1147-51, 2015 Jul. Abstract

OBJECTIVE: To evaluate the efficacy of salivary progesterone, cervical length measurement in predicting preterm birth (PTB).

METHODS: Prospective observational study included 240 pregnant women with gestational age (GA) 26-34 weeks classified into two equal groups; group one are high risk for PTB (those with symptoms of uterine contractions or history of one or more spontaneous preterm delivery or second trimester abortion) and group 2 are controls.

RESULTS: There was a highly significant difference between the two study groups regarding GA at delivery (31.3 ± 3.75 in high risk versus 38.5 ± 1.3 in control), cervical length measured by transvaginal ultrasound (24.7 ± 8.6 in high risk versus 40.1 ± 4.67 in control) and salivary progesterone level (728.9 ± 222.3 in high risk versus 1099.9 ± 189.4 in control; p < 0.001). There was a statistically significant difference between levels of salivary progesterone at different GA among the high risk group (p value 0.035) but not in low risk group (p value 0.492). CL measurement showed a sensitivity of 71.5% with 100% specificity, 100% PPV, 69.97% NPV and accuracy of 83%, while salivary progesterone showed a sensitivity of 84% with 90% specificity, 89.8% PPV, 85.9% NPV and accuracy of 92.2%.

CONCLUSION: The measurement of both salivary progesterone and cervical length are good predictors for development of PTB.

Maged, A. M., A. M. Nada, F. Abohamila, A. T. Hashem, W. A. I. Mostafa, and A. R. Elzayat, "Delayed Start Versus Conventional GnRH Antagonist Protocol in Poor Responders Pretreated With Estradiol in Luteal Phase: A Randomized Controlled Trial.", Reproductive sciences (Thousand Oaks, Calif.), vol. 22, issue 12, pp. 1627-31, 2015 Dec. Abstract

OBJECTIVE: To compare the new delayed start protocol against the conventional gonadotropin (Gn)-releasing hormone antagonist protocol in poor responders (PORs).

STUDY DESIGN: A total of 160 women with poor response to previous in vitro fertilization (IVF) cycle were randomized either to start Gn then Cetrotide 0.25 subcutaneously (sc) added when leading follicle (DF) reach >12 mm or Cetrotide 0.25 mg sc started first from day 2 to day 8 then Gn therapy was added and Cetrotide restarted when DF reach >12 mm.

RESULTS: There was a statistically significant difference between conventional and delayed start protocols regarding the needed dose of Gn for stimulation (4368 ± 643 and 3798 ± 515), level of estradiol (E2; 778 ± 371 and 1076 ± 453), and endometrial thickness at human chorionic gonadotropin triggering (8.6 ± 1.8 and 9.8 ± 1.9), the number of DF (3.4 ± 1.5 and 4.9 ± 2.1), the number of retrieved follicles (2.4 ± 2.1 and 4.3 ± 2.5), and successful embryo transfer (13 vs 16), respectively (P < .05). There was a highly statistically significant difference between the 2 study groups regarding the number of oocytes fertilized (1.2 ± 2.0 vs 3.3 ± 1.4), metaphase II oocytes (0.9 ± 1.0 vs 2.7 + 1.6), and grade I embryos (0.7 ± 0.9 vs 2.1 + 1.1; P < .001). The chemical pregnancy, clinical pregnancy, and abortion rate showed a statistically significant difference between the 2 study groups (P value .003 and .006, respectively).

CONCLUSION: Delayed start protocol significantly improved clinical pregnancy rate and IVF cycle parameters in PORs.

Maged, A. M., O. M. Helal, M. M. Elsherbini, M. M. Eid, R. O. Elkomy, S. Dahab, and M. H. Elsissy, "A randomized placebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 131, issue 3, pp. 265-8, 2015 Dec. Abstract

OBJECTIVE: To study the efficacy and safety of preoperative intravenous tranexamic acid to reduce blood loss during and after elective lower-segment cesarean delivery.

METHODS: A single-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term singleton pregnancy at a center in Cairo, Egypt, between November 2013 and November 2014. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1g tranexamic acid or 5% glucose 15 minutes before surgery. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during cesarean, which was the primary outcome. Analyses included women who received their assigned treatment, whose surgery was 90 minutes or less, and who completed follow-up.

RESULTS: Analyses included 100 women in each group. Mean EBL was significantly higher in the placebo group (700.3 ± 143.9 mL) than in the tranexamic acid group (459.4 ±7 5.4 mL; P<0.001). Only six women, all in the placebo group, experienced an EBL of more than 1000 mL. There were no reports of thromboembolic events up to 4 weeks postoperatively.

CONCLUSION: Preoperative administration of tranexamic acid safely reduces blood loss during elective lower-segment cesarean delivery. Australian New Zealand Clinical Trials Registry:ACTRN12615000312549.

Maged, A. M., H. Elsawah, A. Abdelhafez, A. Bakry, and W. A. I. Mostafa, "The adjuvant effect of metformin and N-acetylcysteine to clomiphene citrate in induction of ovulation in patients with Polycystic Ovary Syndrome.", Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, pp. 1-4, 2015 Aug 04. Abstract

OBJECTIVES: To assess the adjuvant effect of metformin and N-acetylcysteine (NAC) to clomiphene citrate (CC) in induction of ovulation in Polycystic Ovary Syndrome (PCOS) patients.

STUDY DESIGN: 120 women with PCOS were randomly divided into three equal groups: group I received CC only, group II received CC plus NAC and group III received CC plus metformin.

RESULTS: There was a significant difference between group II and other two groups regarding average number of ovulatory follicles >18 mm (2.25 versus 1.75 and 1.89, respectively), but no significant difference between the three study groups regarding number of intermediate follicles 14-18 mm (4, 10 and 4, respectively). There was no significant difference between the three study groups regarding occurrence and laterality of ovulation, pregnancy rate per cycle but a significant difference between group II and other two groups regarding pregnancy rate per patient (20% versus 10% and 10%, respectively, p value 0.05). There was a highly statistically significant difference between group II and other two groups regarding peak endometrial thickness (7.3 ± 1.1 versus 5.4 ± 0.6 and 5.3 ± 0.6, respectively).

CONCLUSIONS: NAC as an adjuvant to CC for induction of ovulation improves ovulation and pregnancy rates in PCOS patients with beneficial impacts on endometrial thickness.

Maged, A. M., H. Elsawah, A. Abdelhafez, A. Bakry, and W. A. I. Mostafa, "The adjuvant effect of metformin and N-acetylcysteine to clomiphene citrate in induction of ovulation in patients with Polycystic Ovary Syndrome.", Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, vol. 31, issue 8, pp. 635-8, 2015. Abstract

OBJECTIVES: To assess the adjuvant effect of metformin and N-acetylcysteine (NAC) to clomiphene citrate (CC) in induction of ovulation in Polycystic Ovary Syndrome (PCOS) patients.

STUDY DESIGN: 120 women with PCOS were randomly divided into three equal groups: group I received CC only, group II received CC plus NAC and group III received CC plus metformin.

RESULTS: There was a significant difference between group II and other two groups regarding average number of ovulatory follicles >18 mm (2.25 versus 1.75 and 1.89, respectively), but no significant difference between the three study groups regarding number of intermediate follicles 14-18 mm (4, 10 and 4, respectively). There was no significant difference between the three study groups regarding occurrence and laterality of ovulation, pregnancy rate per cycle but a significant difference between group II and other two groups regarding pregnancy rate per patient (20% versus 10% and 10%, respectively, p value 0.05). There was a highly statistically significant difference between group II and other two groups regarding peak endometrial thickness (7.3 ± 1.1 versus 5.4 ± 0.6 and 5.3 ± 0.6, respectively).

CONCLUSIONS: NAC as an adjuvant to CC for induction of ovulation improves ovulation and pregnancy rates in PCOS patients with beneficial impacts on endometrial thickness.

Maged, A. M., A. H. Gebril, and A. Abdelhafez, "2D and 3D ultrasound assessment of cesarean section scars and its correlation to intraoperative findings", Uterus & Ovary, vol. 2, issue e919, pp. 1-7, 2015. 919-5321-2-pb.pdf
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