Akmal El-Mazny

This study aims to evaluate the efficacy and side-effects of 200 μg sublingual misoprostol vs 5 IU i.m. oxytocin, administered immediately following cord clamping in normal non-augmented vaginal delivery, in prevention of postpartum haemorrhage (PPH). A total of 104 women were randomised into three groups: misoprostol group (28 patients); oxytocin group (37 patients) and control group (39 patients). Misoprostol and oxytocin significantly minimised the blood loss during the third stage of labour and reduced the need for additional treatments for PPH as compared with the control group. Oxytocin was more effective than misoprostol in minimising blood loss and the need for additional uterotonic treatments. However, a significant decrease in systolic and diastolic blood pressure, associated with tachycardia was observed in the oxytocin group. In conclusion, sublingual misoprostol appears to be less effective than i.m. oxytocin in the prevention of PPH; however, it has the potential advantages of being easily used, cost-effective and stable at room temperature. Therefore, sublingual misoprostol is still a feasible drug for routine management of third stage, especially in areas with limited medical facilities.

Objective To evaluate endometrial and subendometrial microvascularization, using three-dimensional (3D) power Doppler ultrasound, in women with intrauterine device (IUD)-induced menorrhagia; and whether those potential findings could predict the risk of bleeding before İUD\} insertion. Design Prospective clinical trial. Setting University teaching hospital. Patient(s) One hundred twenty women, who requested the insertion of a copper İUD\} for contraception. Intervention(s) Endometrial thickness and volume, uterine artery pulsatility index and resistance index, and endometrial and subendometrial 3D power Doppler vascularization index, flow index, and vascularization flow index were measured twice: immediately before and 3 months after İUD\} insertion. Main Outcome Measure(s) Doppler indices before and after İUD\} insertion. Result(s) Before İUD\} insertion, no significant difference was detected in the clinical characteristics, endometrial thickness and volume, and Doppler indices between women who had IUD-induced menorrhagia (n = 47) and those without menorrhagia (n = 73). However, after İUD\} insertion, there was a significant increase in the endometrial and subendometrial vascularization index, flow index, and vascularization flow index in women with menorrhagia, whereas other parameters remained not significantly different between the two groups. Conclusion(s) Endometrial and subendometrial microvascularization increases in women with IUD-induced menorrhagia; however, this finding has no predictive value before İUD\} insertion.

Objective To investigate whether fallopian tube sperm perfusion (FSP) would improve pregnancy rates compared with standard intrauterine insemination (IUI) in cases of male factor infertility. Methods In a randomized controlled trial at a university teaching hospital in Egypt, 120 couples with mild or moderate male factor infertility underwent a mild controlled ovarian stimulation protocol (clomiphene citrate plus human menopausal gonadotropin). Women were randomly allocated to group 1 (FSP via Foley catheter with 4 mL of inseminate) or group 2 (standard İUI\} with 0.5 mL of inseminate) (n = 60 for both). The main outcome measure was clinical pregnancy rate. Results There were no significant differences between the groups in terms of baseline clinical characteristics, semen parameters, or characteristics of stimulation cycles. The pregnancy rate was significantly higher in group 1 than in group 2 (16 [26.7%] vs 7 [11.7%]; P < 0.04). There was no significant difference in the incidence of multiple pregnancy, abortion, or ectopic pregnancy between the groups. Conclusion Fallopian tube sperm perfusion is an effective technique in the management of mild–moderate male factor infertility and should, therefore, be considered before resorting to more sophisticated techniques of assisted reproduction.

Objectives Dysregulation of ghrelin levels may lead to physiological problems including obesity and polycystic ovary syndrome (PCOS). The aim of the study was to compare ghrelin levels in women with and without PCOS. Study design Serum ghrelin levels (pre- and post-prandial) were compared between 30 Saudi women suffering from \{PCOS\} and 30 healthy controls. The relationship between circulating ghrelin levels and other hormones was investigated. Anthropometric measurements were made for all subjects. Biochemical and hormonal investigations included plasma glucose, insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17β-estradiol (E2), progesterone, testosterone and sex hormone binding globulin (SHGB), and serum ghrelin levels. The data were statistically analyzed using independent T-test and ANOVA. Correlation studies were performed between ghrelin levels and other variables. Results No differences were observed in the levels of ghrelin during fasting and the postprandial period in the \{PCOS\} (p = 0.487) and control groups (p = 0.378). A significant inverse correlation was observed in ghrelin levels (fasting and postprandial) levels and \{BMI\} (PCOS: r = −0.529; p = 0.009, controls: r = −0.670; p = 0.005); PCOS: r = −0.421; p = 0.007, controls: r = −0.491; p = 0.004 respectively). No correlations between ghrelin levels and other parameters were observed. Conclusion The findings of the study suggest that circulating plasma ghrelin levels were found to be normal and were inversely related to \{BMI\} in women with PCOS. No relationship between circulating ghrelin levels and the abnormal hormonal pattern of the \{PCOS\} were observed.

Objective To report the clinicopathologic analysis of women who underwent radical cystectomy for bladder cancer in Egypt from 1997 to 2005. Methods Clinicopathologic data for 250 women who underwent radical cystectomy for bladder cancer at 3 centers in Cairo were retrospectively reviewed from hospital charts and pathology sheet records. Cystectomy specimens were evaluated pathologically for involvement of internal genitalia. Results The uterus was not available for histopathologic examination in 11 specimens; 1 ovary was absent from 18 specimens; and both ovaries were absent from 2 specimens. Uterine involvement was observed in 1 case of transitional cell carcinoma. Benign uterine pathology was detected in 25 cases. All patients had normal ovaries, and the vagina was involved in 11 cases. There was urethral involvement in 10% of patients. Of the 50 patients available for follow-up, 11 had 1 ovary preserved and 2 had the uterus plus both ovaries preserved. None of them experienced late ovarian or uterine recurrence. Conclusion Involvement of female internal genitalia in bladder cancer is uncommon. Thus, preservation of these organs in young women undergoing radical cystectomy should be considered in selected cases after careful preoperative assessment.

Background The evolution of sonohysterography (SHG) over the past years has contributed significantly to the assessment of uterine cavity. Objectives To compare \{SHG\} versus the “gold standard” diagnostic hysteroscopy (DH) for the assessment of the uterine cavity in women with previous cesarean section (CS). Design Comparative observational cross-sectional study. Setting Department of Obstetrics and Gynecology, Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University. Subjects Seventy-five women with previous CS(s), complaining of infertility, menstrual disorders or recurrent pregnancy loss. The inclusion criteria were: age between 20 and 35 years; previous 1–3 CS(s); and the duration from the last \{CS\} ranging from 1 to 5 years. Methods Transvaginal \{SHG\} with saline infusion as contrast medium for assessment of the thickness of the scar, filling defect in the scar (niche) and intrauterine adhesions. \{DH\} was performed to confirm different findings. Main outcome measures The findings at \{SHG\} were compared to DH; and the accuracy of \{SHG\} was calculated. Results The scar thickness at \{SHG\} was significantly lower in cases with scar defect at \{DH\} (P = 0.016). \{SHG\} was comparable to \{DH\} as shown by sensitivity, specificity, +ve predictive value, −ve predictive value and overall accuracy of 87%, 100%, 100%, 95% and 96%, respectively, in the diagnosis of scar defect; and 76%, 100%, 100%, 87% and 91%, respectively, in the diagnosis of intrauterine adhesions. Conclusion \{SHG\} is reliable and feasible, and may be recommended as an alternative to \{DH\} for the assessment of the uterine cavity and uterine scar in women with previous CS.

Objective To evaluate the efficacy and safety of vaginal misoprostol for cervical priming before diagnostic outpatient hysteroscopy (OH) without anesthesia. Design Double-blind randomized controlled trial. Setting University teaching hospital. Patient(s) One hundred fifty patients requiring diagnostic \{OH\} for investigation of infertility or abnormal uterine bleeding in the reproductive age. Intervention(s) Patients were randomly allocated into two equal groups (n = 75). In group I, 200 μg misoprostol was inserted into the posterior vaginal fornix 3 hours before OH; in group İI\} (control), vaginal examination was performed without misoprostol administration. A rigid 30° 4-mm hysteroscope was used in the vaginoscopic technique. Main Outcome Measure(s) Ease of cervical entry (Likert scale), procedural time, patient acceptability (Likert scale), and pain scoring (visual analog scale). Result(s) Vaginal misoprostol significantly facilitated the procedure; cervical entry was easier, procedural time was shorter, patient acceptability was higher, and pain scoring was lower in group I compared with group II. Side effects of misoprostol were infrequent, minor, and transient. No complications were reported. Conclusion(s) The regimen of 200 μg vaginal misoprostol administered 3 hours before diagnostic \{OH\} is a simple, effective, and safe method of cervical priming to facilitate the procedure without anesthesia.

Objective To evaluate the importance of subjecting the patient to an outpatient (office) hysteroscopy (OH) before assisted reproductive techniques (ART) and patient compliance, possible side effects, and complications of the procedure. Design Comparative observational cross-sectional study. Setting University hospital. Patient(s) One hundred fifty-two patients attending the outpatient infertility clinic for pre-ART (IVF/intracytoplasmic sperm injection [ICSI]-ET) investigations, with normal uterine findings on hysterosalpingography (HSG). Intervention(s) Transvaginal sonography (TVS) and \{OH\} (using a rigid, 30-degree, 4-mm hysteroscope) by the vaginoscopic “no touch” technique. Main Outcome Measure(s) Diagnostic value and compliance of OH. Result(s) The procedure was successful in 145 patients (95.4%); 51 of them (35.2%) had previous \{ART\} failures. Abnormal hysteroscopic findings were observed in 48 women (33.1%), in which endometrial polyp, submucous myoma, and intrauterine adhesions were the most common findings. The \{TVS\} was specific (100%) but not sensitive (41.7%) compared with OH. Abnormal hysteroscopic findings were significantly higher in patients with previous \{ART\} failure(s). The procedure was acceptable in almost all patients with no reported complications. Conclusion(s) The \{OH\} should be part of the infertility workup before \{ART\} even in patients with normal \{HSG\} and/or TVS. This is especially relevant in cases with prior failed \{ART\} cycles.

Objective To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS). Methods Fasting glucose (G), insulin (I), and lipid levels were measured in 50 infertile women with PCOS. A fasting G/I ratio of 4.5 or less (n = 29) defined insulin resistance (IR). Results The mean levels of total cholesterol (P < 0.001), low-density lipoprotein (P = 0.02), and triglycerides (P < 0.001) were significantly higher and the mean levels of high-density lipoprotein were significantly lower (P < 0.001) in the İR\} group. The prevalence of \{MBS\} (P = 0.02) and obesity (P = 0.04), hypertension (P = 0.02), fasting hyperglycemia (P = 0.03), low high-density lipoprotein levels (P = 0.02), and hypertriglyceridemia (P = 0.02) were also significantly higher in the İR\} group. Conclusion Insulin resistance is associated with dyslipidemia and \{MBS\} in women with PCOS. Lifestyle modification and insulin-sensitizing agents should be part of the management plan.

Study Objective To compare 2-dimensional (2D) sonohysterography (SHG) and 3D-SHG with saline solution infusion vs diagnostic hysteroscopy for investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding. Design Comparative observational cross-sectional study (Canadian Task Force classification II-1). Setting University hospital. Patients Fifty perimenopausal and 20 postmenopausal women with abnormal intrauterine bleeding with clinically or ultrasonically suspected intrauterine lesions. Interventions Conventional 2D- and 3D ultrasonography and 2D- and 3D-SHG with saline solution infusion followed by diagnostic hysteroscopy, and endometrial curettage or subsequent operative treatment (e.g., hysterectomy, myomectomy, or polypectomy). Ultrasonographic and hysteroscopic findings were compared with histopathologic findings. Measurements and Main Results For 2D-SHG, sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio for a positive result, and likelihood ratio for a negative result were 79%, 72%, 89%, 54%, 76%, 2.82, and 0.29, respectively, and for 3D-SHG, were 92%, 89%, 96%, 80%, 91%, 8.36, and 0.09, respectively; and for diagnostic hysteroscopy, were 94%, 89%, 96%, 84%, 93%, 8.55, and 0.07, respectively. Thus, 3D-SHG was superior to 2D \{SHG\} (p = .02) and comparable to diagnostic hysteroscopy (p = .75) for diagnosis of intrauterine lesions. Conclusion 3D-SHG can be used in the initial investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding before resorting to invasive procedures such as diagnostic hysteroscopy. Further studies of computer-reconstructed 3D-SHG virtual hysteroscopy are recommended.