Ahmed Y. Abdelbadee

Partial tubal devascularisation: a novel procedure for tubal conservation in ectopic pregnancy

Abstract Ectopic pregnancy is a serious condition that complicates 1–2% of pregnancies. Using surgical management is efficient, but may have an impact on future fertility. Although conservative tubal surgery has not been shown to have a significant advantage over a salpingectomy in terms of the future fertility potential, the conservative surgical techniques remain widely-utilised, particularly in the context of a contralateral diseased or absent tube. We hereby report a case series of a novel procedure to conserve the fallopian tube with the minimal risk of an incisional site bleeding through a partial segmental devascularisation. This technique seems to be an efficient method to minimise the intraoperative bleeding, limit the need for a blood transfusion, and yields a higher success rate of the procedure without jeopardising the blood supply and vitality of the tubes. Impact Statement What is already known on this subject? Conservative surgery has a significant value in women with a contralateral absent or diseased tube. However, a conservative management could be challenging due to the significant bleeding which can be encountered during the surgery. What the results of this study add? The partial devascularisation technique could achieve an adequate haemostasis by blocking the ascending blood supply only to the affected segment of the fallopian tube. What the implications are of these findings for clinical practice and/or further research? A partial devascularisation is a successful conservative surgical treatment option in most patients when the procedure is indicated.

Oral Diclofenac Potassium Versus Hyoscine-N-Butyl Bromide In Reducing Pain Perception During Office Hysteroscopy: A Randomized Double-Blind Placebo-Controlled Trial

STUDY OBJECTIVE To compare the efficacy of oral diclofenac potassium versus hyoscine-N-butyl bromide (HBB) in reducing pain perception in patients undergoing diagnostic office hysteroscopy (OH). DESIGN A randomized double-blind placebo-controlled trial (Canadian Task Force classification I). SETTING A university hospital. INTERVENTIONS One-hundred twenty-nine patients were divided randomly into 3 groups (n = 43 in each group); group 1 received 50mg diclofenac potassium, group 2 received 20mg HBB, and group 3 received placebo tablets. All tablets were taken orally 1hour before OH. The primary outcome was the participants self-rated pain perception using the 10-point visual analog scale during the procedure. The secondary outcomes included the visual analog scale score 30 minutes after OH, ease of OH assessment using a 10-cm scale, duration of OH, and adverse effects of the study medications. MEASUREMENTS AND MAIN RESULTS Both the diclofenac and HBB groups showed significant pain score reduction compared with the placebo group (p = .001). The mean pain score in the diclofenac group was significantly lower than the HBB group (2.12 ± 1.03vs 3.02 ± 1.55, respectively; p = .002). The pain scores in the diclofenac and HBB groups immediately after OH were significantly lower than the placebo group (p = .001), and the mean pain score in the diclofenac group was significantly lower than the HBB group (1.23 ± 0.57vs 1.56 ± 0.73, respectively; p = .024). The ease of procedure score was significantly lower in the diclofenac and HBB groups than the placebo group (p = .003 and p = .005, respectively). The mean duration of the procedure was significantly less in the diclofenac group (p = .01). Fourteen women (32.6%) in the HBB group experienced dizziness and 2 women (4.6%) had nausea, whereas only 4 women (9.3%) in the diclofenac group had dizziness and 2 women (4.6%) had vomiting. CONCLUSION Oral diclofenac potassium administration 1hour before diagnostic OH reduces the procedure pain with subsequent easier and shorter OH duration. Oral HBB is less effective than diclofenac potassium with more adverse effects.

Use of Foley's catheter balloon tamponade to control placental site bleeding resulting from major placenta previa during cesarean section

Aim: To evaluate the effect of 2-way Foleys catheter balloon tamponade on controlling immediate postpartum hemorrhage (PPH) in cases of major placenta previa during cesarean

Uterus didelphys with multiple fibroids: A case report

Uterine anomalies are congenital malformations caused by fusion or resorption defects during embryogenesis. Uterus didelphys, or a double uterus, is a rare condition that occurs in female fetuses as they develop in the womb. Here we report a case of a 46 year old virginal female with uterus didelphys along with multiple fibroids of both uteri and a right ovarian cyst. The patient underwent a total abdominal hysterectomy with adnexa removal. The specimen showed leiomyoma of uterus with ovarian endometriosis. 1

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder. It is characterized by pruritus, jaundice, and elevated serum bile acids, mainly in the third trimester, with different fetal outcomes. The pathophysiology involves abnormal bile acid metabolism, with deposition of bile acids in the maternal tissues and the placenta. It is commonly (∼70% of cases) accompanied by elevated maternal serum total bile acids. Abnormal liver function tests (transaminase levels in the 60–200 range U/l and alkaline phosphatase 200–400 U/l range) are typically present, but hyperbilirubinemia with clinical jaundice is rare. The etiology of intrahepatic cholestasis of pregnancy is complex and not fully understood, but it is likely to result from the cholestatic effects of reproductive hormones and their metabolites.