Steiner, N., R. F. Turki, W. El-Khayat, G. A. Malki, S. Tannus, and M. H. Dahan, "Histopathological profile of women who had previously failed in-vitro fertilization and the association to the outcome in the subsequent in-vitro fertilization cycle.", Obstetrics & gynecology science, vol. 65, issue 1, pp. 64-73, 2022. Abstract

OBJECTIVE: To evaluate the endometrial histopathological profile of patients undergoing curettage and the association of the histopathological profile with the pregnancy outcome during the subsequent in-vitro fertilization (IVF) cycle.

METHODS: In this retrospective cohort study, a total of 248 women with at least one failed attempt of IVF and who underwent curettage and a subsequent IVF were included. Demographic data, endometrial histopathological records, stimulation information, and pregnancy outcomes were collected and analyzed.

RESULTS: The histopathological analysis of endometrial tissues showed that 130 women (52.4%) had endometrial pathologies. Of these women, 103 (41.5%) had endometrial polyps, 22 (8.9%) had chronic endometritis, and five (2.0%) had both polyps and endometritis. No statistical difference was observed between the normal histopathology group and the abnormal histopathology group in the outcome of the subsequent IVF cycle. Subgroup analyses were performed to further characterize and compare women with normal histopathology and women with endometrial polyps (polyp subgroup) or chronic endometritis (endometritis subgroup). No statistical differences were found among the three groups in the rates of pregnancy (44.1% vs. 49.5% vs. 45.5%, P=0.72), biochemical pregnancy loss (13.5% vs. 15.7% vs. 20.0%, P=0.86), clinical pregnancy loss (25.0% vs. 31.4% vs. 30.0%, P=0.77), and live birth (27.1% vs. 26.2% vs. 22.7%, P=0.91) during the subsequent IVF cycle.

CONCLUSION: Women with previously failed IVF and abnormal endometrial histopathology treated with curettage had the same outcome in the subsequent IVF cycle as women with normal endometrial histopathology.

Hosny, A. E. - D. M. S., M. N. Fakhry, W. El-Khayat, and M. O. N. A. T. KASHEF, "Risk factors associated with preterm labor, with special emphasis on preterm premature rupture of membranes and severe preterm labor.", Journal of the Chinese Medical Association : JCMA, vol. 83, issue 3, pp. 280-287, 2020. Abstract

BACKGROUND: Preterm labor (PTL) can lead to preterm birth, which can cause neonatal mortality and morbidity. Preterm premature rupture of membranes (PPROM) and severe PTL (SPTL) are serious PTL subtypes. Hereby, we aimed to investigate risk factors associated with PPROM and SPTL, among Egyptian women.

METHODS: In this case-control study, 117 women were enrolled without any known medical risk for PTL. The control group (n = 45) had term labor (≥37 gestational weeks), while the case group (n = 72) had PTL (<37 gestational weeks). The PTL group was subdivided into those with PPROM (n = 18) and those with intact membranes (n = 54). Fifty-two PTL women, with accurate gestational age, were subdivided into SPTL (n = 31, ≤34 gestational weeks) and mild preterm labor (MPTL; n = 21, 35-36 gestational weeks). All groups were examined for different demographic characteristics, obstetrical history, clinical signs, and vaginal and urinary tract infections. Nominal logistic regression was applied to investigate significant variables associated with PPROM and intact membranes PTL, while ordinal logistic regression was used to estimate significant variables associated with SPTL and MPTL.

RESULTS: The final multivariate nominal model identified abortion history, heavy vaginal bleeding history, and elevated vaginal pH as significant predictors of PPROM. The same model identified age <20 years old, abortion history, heavy growth of vaginal organisms, and any growth of Gram-negative bacilli as the significant predictors of intact membranes PTL. The final multivariate ordinal model identified age <20 years old, abortion history, vaginal pH, and heavy growth of vaginal organisms as the significant predictors of SPTL and MPTL.

CONCLUSION: Age <20 years old, abortion history, heavy vaginal bleeding, vaginal pH, and heavy growth of vaginal organisms were reported as risk factors for PPROM and SPTL. Most of these factors are related to infection; therefore, proper infection control is recommended during prenatal and antenatal care.

Nagy Afifi, A., M. Ahmed Taymour, and W. Mamdouh El-Khayat, "Transabdominal versus transvaginal ultrasound to assess the thickness of lower uterine segment at term in women with previous cesarean section.", European journal of obstetrics, gynecology, and reproductive biology, vol. 271, pp. 145-151, 2022. Abstract

OBJECTIVE: This study aims to compare transvaginal (TVS) and transabdominal (TAS) ultrasonography precision in to evaluate the lower uterine (LUS) thickness in women with a previous Cesarean section at the term pregnancy; to be an effective method for assessment of previous cesarean scar strength.

MATERIAL AND METHODS: An observational cross-sectional study was conducted at kasr el-ainy Hospital in Egypt. From May to November 2020, we admitted 130 pregnant women at term with a previous cesarean section for an elective cesarean delivery. Lower uterine segment thickness was obtained using both transvaginal ultrasound and transabdominal ultrasound before the cesarean. The exact thickness of the lower uterine segment was recorded using a sterile metal ruler before the neonate had been delivered.

RESULTS: The mean thickness of the lower uterine segment obtained by transabdominal ultrasound was 5.2 ± 1.6 mm and 4.8 ± 1.33 mm by transvaginal ultrasound, then compared each of them to the mean actual thickness, which was 4.5 ± 1.22 mm. The lower uterine segment thickness with transabdominal ultrasound showed a good correlation (r = 0.722) with the actual thickness, the correlation with transvaginal ultrasound was better (r = 0.944). A cut-off value transvaginal ultrasound of 3.65 mm with 90.8% sensitivity and 65.6% specificity.

CONCLUSION: Transvaginal ultrasound is more accurate in assessing the thickness of the lower uterine segment than transabdominal ultrasound. A total lower uterine segment thickness of <3.65 is considered a thin scar, and <2.85 mm is associated with a higher risk of uterine dehiscence. The trial was registered in ClinicalTrials.gov registry with clinical trial. https://clinicaltrials.gov/ct2/show/NCT04687891.

Afifi, A. N., M. A. Taymour, and W. M. El-Khayat, "Isosorbide mononitrate for cervical ripening in induction of labor for pregnant women with PROM at or post term.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 155, issue 3, pp. 512-517, 2021. Abstract

OBJECTIVE: To evaluate the efficacy of isosorbide mononitrate (IMN) for stimulating cervical ripening among pregnant women with premature rupture of membranes (PROM) at or post term.

METHODS: A prospective randomized double-blind, placebo-controlled trial at Kasr El-Ainy Hospital, Cairo, Egypt, from October 2018 to May 2019. Pregnant women at or post term with PROM and unfavorable cervix (Bishop score ≤6) were randomly assigned to receive intra-vaginal IMN (n = 70) or placebo (n = 70) before admission for induction of labor. The main outcome was induction to the delivery interval. Data were compared between groups by t test.

RESULTS: The mean ± SD duration from the initial dose of IMN/placebo to the beginning of the active phase of labor was significantly shorter in the IMN group than in the control group (9.7 ± 5.6 h vs. 12.9 ± 5.3 h). The IMN group also had a shorter time interval from induction to delivery (P < 0.01). There was no difference in adverse effects between the groups.

CONCLUSION: Intra-vaginal IMN for cervical ripening in the induction of labor among pregnant with PROM at or post term was found to be effective and safe with minimal adverse effects, and good neonatal and maternal outcomes. ClinicalTrials.gov: NCT03665779.

El-Hamid, S. A., and W. El-Khayat, "Relationship of the protein Z intron F G79A and IL6 C634G gene polymorphisms with the risk of recurrent pregnancy loss in Egyptian women.", Journal of investigative medicine : the official publication of the American Federation for Clinical Research, vol. 59, issue 4, pp. 655-60, 2011 Apr. Abstract

PURPOSE: To investigate the relationship between recurrent pregnancy loss and single nucleotide polymorphisms in the protein Z (PZ) intron F G79A and the promoter region of the IL6 C634G genes in Egyptian women.

PROCEDURES: Single nucleotide polymorphisms in the PZ intron F G79A gene and the promoter region of the IL6 C634G gene were studied in 70 Egyptian women; 40 patients and 30 healthy and parous volunteers using the polymerase chain reaction-restriction fragment length polymorphism technique.

RESULTS: Regarding the PZ intron F G79A polymorphism; a higher prevalence of the A allele in the controls (53.3%) compared with the cases (22.5%) was found, and the difference proved to be statistically significant (P = 0.008). As for the IL6 C634G polymorphism, the frequency of the G allele was higher in the controls (100%) than in the cases (95%), but the difference did not prove to be statistically significant (P = 0.503). A statistically significant difference between the prevalence of the IL6 C634G (95%) and the PZ intron F G79A (22.5%) was detected (P ≤ 0.001).

CONCLUSION: A statistically significant difference of the frequency of the A allele of the PZ intron F G79A polymorphism was found with a higher prevalence of the A allele among the controls compared with the patients, suggesting a lower risk of recurrent pregnancy loss among the studied patients, but the IL6 C634G polymorphism did not prove to have an equivalent effect.

Mansour, R., A. Nada, W. El-Khayat, A. Abdel-Hak, and H. Inany, "A simple and relatively painless technique for hysterosalpingography, using a thin catheter and closing the cervix with the vaginal speculum: a pilot study.", Postgraduate medical journal, vol. 87, issue 1029, pp. 468-71, 2011 Jul. Abstract

OBJECTIVE: To evaluate the use of a thin catheter for hysterosalpingography (HSG) for reducing the pain experienced during the procedure.

METHODS: Infertile women undergoing tubal patency tests were randomised into two groups. In the study group (n=66) a thin catheter originally designed for intrauterine insemination was used to inject the dye. Leakage of the dye was prevented using a vaginal speculum to press on the portiovaginalis of the cervix. The control group (n=23) underwent HSG using the standard metal cannula. Visual analogue scale (VAS) was used to evaluate the level of pain immediately after the procedure. The main outcome measures were the level of pain experienced by the patient during the procedure and the efficacy of the new technique.

RESULTS: The mean (±SD) VAS was 11.2±3.1 in the study group and 54.7±10.1 in the metal cannula group (p<0.0001). During the dye injection, the VAS was 10.3±5.2 in the study group compared to 64.1±17.3 in the metal cannula group (p<0.0001). The new technique was successful in filling the uterine cavity with the dye and studying the fallopian tubes.

CONCLUSIONS: Using a thin catheter for HSG and pressing on the cervix with the vaginal speculum to prevent leakage of the dye is a successful method to study the uterine cavity and fallopian tubes, and it significantly reduces the pain as compared to a metal cannula.

Kamal, M., and W. El-Khayat, "Do serum angiopoietin-1, angiopoietin-2, and their receptor Tie-2 and 4G/5G variant of PAI-1 gene have a role in the pathogenesis of preeclampsia?", Journal of investigative medicine : the official publication of the American Federation for Clinical Research, vol. 59, issue 7, pp. 1147-50, 2011 Oct. Abstract

OBJECTIVE: To evaluate whether serum angiogenesis markers such as angiopoietins (Ang-1, Ang-2) and their receptor (Tie-2) are altered in women with preeclampsia. We also performed genotyping to determine if the 4G/5G genotypes of -675 PAI-1 gene may play a role in the pathogenesis of preeclampsia.

MATERIALS AND METHODS: Sixty-eight pregnant women with preeclampsia were compared to 35 normotensive pregnant women and 24 normotensive nonpregnant women in a cross-sectional study. Using enzyme-linked immunosorbent assay, levels of serum Ang-1 and Ang-2, and Tie-2 were measured. A single base pair insertion/deletion 4G/5G polymorphism of the PAI-1 gene was determined by polymerase chain reaction.

RESULTS: Serum levels of Ang-1 and Tie-2 were significantly different among the study groups (P = 0.001 and P = 0.025, respectively) being lower in the preeclamptic group. Positive significant correlation was found between Ang-2 and Tie-2, (r = 0.26, P = 0.024). The frequency of the genotypes (4G/5G, 4G/4G, and 5G/5G) differed among the groups (P = 0.001). Also, the mean of systolic and diastolic blood pressures differed significantly according to the PAI-1 genotype being higher in those bearing the 4G allele; P = 0.04 and P = 0.023, respectively.

CONCLUSION: Sera Ang-1 and Ang-2, and Tie-2 as well as variants of 4G/5G of PAI-1 polymorphism have positive implications in the pathogenesis of preeclampsia.

Hosny, A. E. - D. M. S., W. El-Khayat, M. O. N. A. T. KASHEF, and M. N. Fakhry, "Association between preterm labor and genitourinary tract infections caused by Trichomonas vaginalis, Mycoplasma hominis, Gram-negative bacilli, and coryneforms.", Journal of the Chinese Medical Association : JCMA, vol. 80, issue 9, pp. 575-581, 2017 Sep. Abstract

BACKGROUND: Preterm labor (PTL) is responsible for most cases of neonatal death. In most of these cases, the causes of PTL have not been established although several risk factors have been described. Therefore, the aim of this study was to investigate risk factors for PTL before 37 gestational weeks among Egyptian women.

METHODS: In this case-control study, 117 pregnant women without risk factors for PTL were chosen. The control group (n=45) had term labor (gestational weeks≥37 weeks), and the case group (n=72) had PTL (gestational weeks < 37 weeks). The two groups were screened for urinary and vaginal infections. The role of different demographic characteristics, patient history, and clinical signs were also investigated.

RESULTS: Several risk factors were identified in this study, including age<20 years, nulliparity, previous abortion and previous preterm birth, menses vaginal bleeding, a vaginal pH>5, a positive whiff test, Trichomonas vaginalis infection, Mycoplasma hominis infection, coryneforms heavy vaginal growth, and any vaginal growth of Gram-negative bacilli. Urinary tract infection with any colony count was not associated with PTL.

CONCLUSION: Our study demonstrated that the main risk factors for PTL were vaginal infection with T. vaginalis, M. hominis, coryneforms, and Gram-negative bacilli, and their determinants (vaginal pH>5, positive whiff test, heavy vaginal bleeding). Both young age (< 20 years) and poor obstetric history were also the risk factors. Therefore, screening for genitourinary tract infections is strongly recommended to be included in prenatal care.

Abulata, N. N., I. A. Shaheen, O. M. Osman, A. M. Hussein, and W. M. El-Khayat, "The prevalence of combined vascular endothelial growth factor, endothelial nitric oxide synthase and thrombin-activatable fibrinolysis inhibitor genetic polymorphisms among Egyptian patients with recurrent spontaneous abortion.", The journal of obstetrics and gynaecology research, vol. 45, issue 6, pp. 1106-1113, 2019 Jun. Abstract

AIM: As angiogenesis is an essential step for chorionic villi formation. Vascular endothelial growth factor (VEGF) is essential for endothelial cell proliferation. Endothelial nitric oxide synthase (eNOS) is a powerful playmaker in hypoxia-induced angiogenesis. Thrombin-activatable fibrinolysis inhibitor (TAFI) regulates both fibrinolysis and inflammation. Genetic alterations of these factors may lead to recurrent spontaneous abortion (RSA). We aimed to investigate the combined genetic variants of VEGF G-1154A and two eNOS genetic variants: T-786C promoter region and intron 4 variable number of tandom repeats in addition to TAFI C-1040T among RSA patients.

METHODS: The study included 50 patients with RSA and 50 healthy controls. Polymerase chain reaction and restriction fragment length polymorphism were used for genotyping.

RESULTS: Both genetic alterations of eNOS confirmed at least a sixfold increase of RSA risk. Interestingly, they were associated with TAFI C-1040Tgenetic variant in 21 patients, eight of them had both studied eNOS genetic alterations and TAFI C-1040Tgenetic variant, while each eNOS genetic variant associated with TAFI C-1040Tconfirmed an almost one and half fold increase risk of RSA.

CONCLUSION: These findings highlighted the role of eNOS and nitric oxide metabolism in RSA and opened the gate to investigate the interaction of vasoconstrictive and fibrinolytic inhibitor systems.

El-Khayat, W., M. Elsharkawi, and A. Hassan, "A randomized controlled trial of uterine exteriorization versus in situ repair of the uterine incision during cesarean delivery.", International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 127, issue 2, pp. 163-6, 2014 Nov. Abstract

OBJECTIVE: To compare extra-abdominal repair of the uterine incision at cesarean delivery with in situ repair.

METHODS: The present study was a double-blind randomized controlled trial conducted at a university hospital in Egypt during 2012-2013, and included women with an indication for cesarean delivery. Extra-abdominal repair was used in group 1 (n=500) and in situ repair in group 2 (n=500). The primary outcome measure was the surgery duration.

RESULTS: Surgery duration was significantly longer in group 1 than group 2 (49.9±2.3 minutes vs 39.9±1.8 minutes; P<0.001). More patients in group 1 than in group 2 had postoperative moderate-to-severe pain (165 [33.0%] vs 115 [23.0%]; P=0.001) and needed additional postoperative analgesia (100 [20.0%] vs 50 [10.0%]; P<0.001). Moreover, mean time to bowel movement was longer in group 1 than in group 2 (17.0±2.7 hours vs 14.0±1.9 hours; P<0.001).

CONCLUSION: In situ uterine closure is more advantageous than extra-abdominal repair in terms of surgery duration, postoperative pain and need for additional analgesia, and return of bowel movement. ClinicalTrials.gov:NCT01723605.

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