Eman Omran

PURPOSE: The study aimed at assessment of the accuracy of the β-hCG test in vaginal washing fluid for diagnosis of prelabor rupture of membranes (PROM).

PATIENTS AND METHODS: Two groups of pregnant women from 17 to 38 weeks of gestation were recruited. The first group (PROM group) included 50 pregnant women with unequivocal PROM. The other group included 50 pregnant women with intact membranes. A sterile speculum examination was performed. If less than 5 cc was collected or no fluid found, 10 cc sterile saline was sprinkled on the vaginal wall and 5 cc were recollected in a sterile syringe. Two drops of collected fluid were used for qualitative testing of β-hCG. The remaining fluid was used for quantitative assessment of β-hCG.

RESULTS: The quantitative β-hCG test results were significantly higher in PROM group (median and range: 138.5 (23-475) versus 13 (1-55); the difference in medians and 95% CI: 105 (91-166); p value: <.001). The qualitative β-hCG test was positive in 42/50 (84%) of the PROM group, while it was negative in 50/50 (100%) of the intact membranes group. Areas under receiver operating characteristics (AUC) for both the quantitative and qualitative β-hCG tests were high (0.97, 95% CI: 0.91-0.99, p value: <.001 and .92, 95% CI: 0.84-0.96, p value: <.001, respectively). The suggested cut-off of β-hCG for the quantitative test was 32 mIU/ml. The sensitivity of quantitative and qualitative tests are: 94, 95% CI: 83.5-98.7% and 84, 95% CI: 70.9-92.8%, respectively. The specificity of quantitative and qualitative tests are: 94, 95% CI: 83.5-98.7% and 100, 95% CI: 92.9-100%, respectively.

CONCLUSION: β-hCG test (either quantitative or qualitative) in vaginal washing fluid can be used in the diagnosis of PROM in both preterm and term cases.

OBJECTIVE: The aim of the study was to evaluate the value of vaginal misoprostol 6 h prior to intrauterine device (IUD) insertion in women with previous Caesarean delivery.

METHODS: A double-blind randomised controlled trial was conducted in 120 women who were eligible for IUD insertion. Participants were randomly divided to receive either 600 μg vaginal misoprostol or placebo 6 h before IUD insertion. The primary outcome measure was the pain score during the procedure. Secondary outcome measures were failure of insertion, insertion difficulty score, complications of IUD insertion and side effects related to misoprostol.

RESULTS: Pain and insertion difficulty scores were significantly lower in the misoprostol group compared with the placebo group (5.7 ± 1.4 vs. 6.5 ± 0.9 and 4.1 ± 1.1 vs. 5.4 ± 2.2, respectively; p < .001). More women experienced nausea, vomiting (5 vs. 0; p = .06) and cramps (10 vs. 0; p < .001) in the misoprostol group than in the placebo group, respectively.

CONCLUSIONS: The use of misoprostol before IUD insertion is associated with less painful and easier placement.

Purpose: The aim of the study was to evaluate the effect of clomiphene citrate on uterine artery blood flow using pulsed Doppler and endometrial and subendometrial micro vascularization using 3D power Doppler in unexplained infertility.

Patients and methods: In a prospective observational study at a university teaching hospital, the mid-luteal (peri-implantation) endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were compared between natural and clomiphene citrate stimulated cycles in the same group of 50 patients with unexplained infertility. Statistical analysis was done using paired -test to compare different study variables.

Results: The primary outcome, which was the endometrial flow index, was significantly lower in the stimulated cycles (mean ± SD: 23.89±7.96 vs 27.49±8.73, mean difference (95% CI): -3.6 (-2, -5.9); =0.03). The mean ± SD of endometrial thickness (10.92±3.04 vs 12.46±3.08 mm; =0.01), volume (4.57±1.28 vs 5.26±1.32 cm; =0.009), endometrial VI (0.86±0.15 vs 0.95%±0.21%; =0.02), VFI (0.25±0.08 vs 0.31±0.12; =0.004), subendometrial VI (1.93±0.68 vs 2.26%±0.75%; =0.02), FI (26.81±9.16 vs 30.73±9.87; =0.04), and VFI (0.68±0.18 vs 0.79±0.21; =0.006) were significantly lower in the stimulated cycles. However, there were no significant differences in the uterine artery PI (=0.12) and RI (=0.08) or serum estradiol (=0.54) and progesterone (=0.37) levels between natural and stimulated cycles.

Conclusion: Peri-implantation endometrial perfusion is significantly lower in clomiphene citrate stimulated cycles when compared to natural ones in patients with unexplained infertility.

OBJECTIVE: To test the hypothesis that there is a higher rate of unsuccessful induction of labor (IOL) in post-term obese pregnant women compared to non-obese ones.

METHODS: In this prospective cohort study, 144 obese (BMI > 30) and 144 non-obese (BMI < 29.9) post-term (> 41 weeks) pregnant women were recruited. IOL was done by misoprostol or amniotomy and oxytocin infusion according to the Bishop score. Comparison of percentage of failed IOL in both groups (primary outcome) was performed by the Chi-test. Logistic regression and multivariable regression were performed to assess the odds ratio (OR) of cesarean section (CS) and coefficient of delay in labor till vaginal delivery (VD) in obese versus (vs) non-obese groups. Adjustment for gestational age, parity, Bishop Score, membrane rupture and amniotic fluid index was done in both regression analyses.

RESULTS: CS rate was significantly higher in obese group [26.4 vs 15.9%; difference in proportion (95% CI) 0.1 (0.01, 0.19); P value 0.02]. 106 (73.6%) obese women and 121 (84.1%) non-obese women delivered vaginally. In addition, the duration till VD was significantly higher in obese group (22 vs 19 h, P value 0.01). After adjustment for possible confounding factors, the CS was still higher in the obese group in comparison to non-obese group (OR 2.02; 95% CI 1.1, 3.7; P value 0.02). This finding suggested that obesity was an independent factor for failure of IOL. In addition, after adjustment for these confounders, obesity had the risk of increasing labor duration by 2.3 h (95% CI 0.1, 4.5) in cases that ended in VD.

CONCLUSION: Based on our results, we conclude that there is a higher risk of CS in obese postdate pregnant women undergoing IOL in comparison to non-obese counterparts. Therefore, obstetricians should pay more attention to advising pregnant women about optimal weight gain during pregnancy and counseling about the chances of VD in cases of IOL. CLINCALTRIAL.

GOV ID: NCT02788305.

OBJECTIVE: To assess the sensitivity of a urine test for high-risk HPV DNA genotypes in the detection of high-grade squamous intra-epithelial lesion (HSIL) and its correlation with pathologic precancerous lesions.

METHODS: The present prospective cross-sectional study included women referred to Kasr AlAiny Medical School, Cairo, Egypt, for cervical smear anomalies, a history of cervical smear anomalies, or for suspicious cervix between May 1, 2015, and April 30, 2017. Paired urine tests and cervical smears were performed. HPV DNA was detected in urine using polymerase chain reaction and cervical smears were performed with a cervical spatula and a cytobrush. Agreement between urine test results and pathology was examined.

RESULTS: In total, 1375 women were included. Urine test for high-risk HPV DNA demonstrated 97.8% (95% confidence interval [CI] 92.1%-99.7%) sensitivity and 100% (95% CI 99.7%-100.0%) specificity for HSIL. Overall, 87 women had a positive urine test for high-risk HPV; of these, 82 (94.3%, 95% CI 87.1%-98.1%) had pathologic findings of cervical intra-epithelial neoplasia 2 or 3 (CIN2/3). Similarly, 89 women had HSIL cytology; again, 82 had CIN2/3 (92.1%; 95% CI, 84.3%-96.4%).

CONCLUSION: There was good agreement between a positive urine test for high-risk HPV DNA genotypes and pathologic findings of CIN2/3.