Ahmed E.H. Elbohoty

Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor

To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50 mg of pethidine hydrochloride for intrapartum analgesia.

Endometrial Injury May Increase the Pregnancy Rate in Patients Undergoing Intrauterine Insemination: An Interventional Randomized Clinical Trial.

Objective: This study aimed to investigate the effect of endometrial injury using Pipelle catheter in the follicular phase (cycle day 5, 6, or 7) of the stimulation cycle on pregnancy rates in patients undergoing intrauterine insemination. Methods: This prospective randomized controlled study was carried out in the Assisted Reproductive Technology Unit of Ain Shams University Maternity Hospital, Cairo, Egypt, from July 1, 2013 to August 31, 2015. Three hundred sixty women, 20 to 35 years of age, with patent fallopian tubes, mild male factor infertility, or unexplained infertility were recruited. Participants were allocated randomly into 2 groups: experimental arm and control arm. Women in the experimental arm underwent endometrial biopsy using a Pipelle catheter on day 5, 6, or 7 of the stimulation cycle combined with intrauterine insemination. Women in the control group underwent intrauterine insemination with no endometrial biopsy done. The primary outcomes were the clinical and chemical pregnancy rates. Results: Data of 344 participants were statistically analyzed. The chemical pregnancy rate was 23.66% in the experimental arm and 10.85% in the control arm (P = .002). The clinical pregnancy rate was 18.93% in the experimental arm and 7.42% in the control arm (P = .003). Conclusion: Endometrial injury using a Pipelle catheter in the stimulation cycle may improve pregnancy rates in women undergoing intrauterine insemination.

Randomized controlled trial comparing carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following an elective cesarean delivery

To compare the effectiveness and safety of carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following cesarean deliveries.

Diathermy versus scalpel in transverse abdominal incision in women undergoing repeated cesarean section: A randomized controlled trial.

The aim of this study was to evaluate the volume of blood loss, wound incision time and wound complication according to use of scalpel or electrosurgery during the creation of transverse abdominal incisions during repeated cesarean section (CS).

Vaginal acidity enhancement with a 3% acetic acid gel prior to misoprostol treatment for pregnancy termination in the midtrimester

To investigate whether enhancing vaginal acidity improves the success of medical abortions in the midtrimester.

Intravenous infusion of paracetamol for intrapartum analgesia

To evaluate the efficacy and adverse effects of an i.v. infusion of paracetamol during the active phase of labor as compared with sterile water (placebo) as a method for intrapartum analgesia.

Antral Follicle Count versus Basal Follicle Stimulating Hormone as Predictors of Ovarian Response in Women Undergoing Superovulation with Long Protocol for Assisted Reproduction

Background: the prediction of ovarian response before undertaking the expensive IVF treatment is quite important; it seemed that Patient characteristics, rather than the stimulation protocol are the determinant of the individual response. Advance identification of patient who will elicit a poor response or hyper response to standard treatment would be of great clinical advantage. Several parameters have been postulated as predictors of the ovarian response. Aim of work: to compare between bFSH and AFC in predicting the ovarian response in women undergoing super-ovulation with long protocol for assisted reproduction. Patients and Methods: this is an observational cohort study that included 80 infertile women who performed IVF/ICSI. It took place at Assisted Reproductive Technology (ART) Unit. Ain shams University Maternity hospital. No extra interventional measures were taken in the study apart from routine investigations and procedures done during ART therapy, being already approved in signed consent to undergo treatment. Patients who are fulfilling the inclusion and exclusion criteria were enrolled in the study. They all underwent superovulation with long GnRH agonist. They were followed up through the stimulation protocol steps, then data were analysed. Results: all basal measured data such as Age p. value =0.035, AFC p. value =0.000, basal FSH p. value =0.000 and basal E2 p. value =0.020 showed statistical significant difference between the good responders and poor responders when both groups were compared, When we apply ROC curve to compare between AFC and basal FSH as regards both (good and poor responders) to detect which one of them is better, there was no statistical significance difference between them with p. value = 0.371, the best cut off point for AFC as a predictor for good responders was found > 3 follicles with sensitivity of 90.5%, specificity of 94.1% and area under curve (AUC) of 97.5%, while while the best cut off point for basal FSH level was found ≤ 8 with sensitivity of 77.78%, specificity of 100% and AUC of 93.7%. Conclusion: AFC and basal FSH are good predictors of ovarian response in women undergoing superovulation with long protocol. There was no absolute superiority of AFC on basal FSH in predicting ovarian response. Age and basal E2 are also considered good predictors of ovarian response.

3D Ultrasonography Compared with Magnetic Resonance Imaging for the Diagnosis of Adenomyosis

Background: Adenomyosis is a common benign gynecological affecting premenopausal woman, in which there is increased overgrowth of the endometrium with invasion of the underlying myometrium. The precise pathogenesis of adenomyosis remains unknown with many theories being proposed that consider it to be a pathology that initially affects the endomyometrial junctional zone (JZ). Aim of the Work: The study aims to compare 3D transvaginal ultrasound with MRI in diagnosing adenomyosis in comparison with the gold standard histopathology. Patients and Methods: This cross-sectional study was carried out on 77 patients who were recruited from women presenting to the outpatient clinic at Ain Shams University Maternity Hospital planned to undergo hysterectomy (abdominal, vaginal or laparoscopic assisted hysterectomy) for adenomyosis according to the inclusion/ exclusion criteria. Results: Out of 77 patients included in the study, 67(87%) were +ve for adenomyosis by 3D TVUS, confirmed in 46(59.74%) by histopathology, while 52(67.53%) were +ve by MRI, confirmed in 39(50.64%) by histopathology.3D transvaginal US was able to diagnose adenomyosis in 67(87%) patients and fibroid in 23(29.9%) patients, while MRI was able to diagnose adenomyosis in 52(67.5%) and fibroid in 36 (46.8%). Conclusion: our study results indicated that, 3D transvaginal ultrasound is highly accurate as MRI in diagnosing adenomyosis and leiomyoma as a preoperative diagnostic tool. Recommendations: As the 3D ultrasonography is more available, cheaper, less time consuming and easier technique, it is recommended to be used in every day clinical practice, helping the clinicians to reach an accurate diagnosis, select an appropriate treatment, and individualize management for each patient to reach the best outcome therapeutic rates.

Clomiphene citrate before and after withdrawal bleeding for induction of ovulation in women with polycystic ovary syndrome: Randomized cross-over trial.

To compare the ovarian response to early versus late clomiphene citrate (CC) in women with polycystic ovary syndrome (PCOS).