Mohamed I. Ellaithy

Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: A randomised controlled trial

OBJECTIVE To assess the efficacy of electrosurgical bipolar vessel sealing using the LigaSure system during vaginal hysterectomy in comparison with conventional suture ligation method. STUDY DESIGN 103 patients undergoing vaginal hysterectomy for benign conditions were randomised to either LigaSure or Suture groups. Each group was divided into two subgroups according to the degree of surgical difficulty. RESULTS Participants in the LigaSure had shorter procedure time (52.5 min vs. 90 min; p<0.001) and less blood loss (230 ml vs. 360 ml; p<0.001). Complication rates were not statistically different between the two groups. The advantage of the LigaSure system in reducing the operative blood loss was more pronounced in the more difficult procedures. CONCLUSION The LigaSure system reduces the operating time (by reducing pedicle-securing time) and blood loss without increasing the post-operative complication rates of vaginal hysterectomy. This beneficial effect was found to be more pronounced in difficult procedures.

Prevention of preterm birth: a randomized trial of vaginal compared with intramuscular progesterone

Objective. To assess efficacy and tolerability of vaginal compared with intramuscular progesterone in reducing the rate of recurrent preterm birth before 34 weeks of gestation. Design. Prospective randomized study. Setting. Obstetrics and Gynecology Department, Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia. Sample. Five‐hundred and eighteen women with a prior history of preterm birth. Methods. Women were randomized to receive either 90 mg of vaginal progesterone gel once daily or 250 mg of intramuscular progesterone weekly. Treatment began between 14 and 18 weeks of gestation and continued until 36 complete weeks of gestation, delivery or the occurrence of premature rupture of membranes. Main outcome measures. The primary outcome measure was delivery before 34 weeks of gestation. The secondary outcome measures were PTB between 34 and 37 weeks of gestation and neonatal outcomes including birthweight, neonatal death, and the need for admission to the neonatal intensive care unit. Results. The baseline characteristics of the study participants were similar. Two‐hundred and thirty‐eight (94.1%) patients in the vaginal group and 226 (90.8%) patients in the intramuscular group were compliant with their medications. Vaginal progesterone was associated with a lower percentage of deliveries before 34 weeks of gestation than the intramuscular preparation (p= 0.02). This association was also observed at 28 and 32 weeks of gestation (p= 0.04). Adverse effects were reported in 14.1% of patients in the intramuscular group, but in only 7.5% of patients in the vaginal group (p= 0.017). Conclusions. Vaginal progesterone was more effective than intramuscular progesterone for the prevention of preterm birth and had fewer adverse effects.

Risk of postpartum uterine synechiae following uterine compression suturing during postpartum haemorrhage

Uterine compression suturing is considered a successful, safe, inexpensive and simple ‎method for the conservative treatment of atonic postpartum haemorrhage (PPH). However, insufficient data are available about the potential risk of subsequent intrauterine ‎synechiae (IUS).

First trimester assessment of pentraxin-3 levels in women with primary unexplained recurrent pregnancy loss.

OBJECTIVE To evaluate the potential role of measuring first-trimester maternal Pentraxin-3 levels in patients with primary unexplained recurrent pregnancy loss. STUDY DESIGN A case control study was conducted in Ain Shams University Maternity Hospital. Cases included 45 women with primary unexplained recurrent pregnancy loss and early pregnancy failure admitted for medical or surgical termination of pregnancy. Controls (45 women) included a matched group of apparently healthy pregnant women who had at least one previous uneventful pregnancy with no previous obstetric history of adverse pregnancy outcomes. Maternal venous blood samples were collected for assay of Pentraxin-3 using enzyme-linked immunosorbent assay. The main outcome measure was the pregnancy outcome in women with elevated Pentraxin-3 levels. RESULTS 90 participants were statistically analyzed. In the patient group, the mean Pentraxin-3 level was 12.00 ± 4.07 ng/ml, while in the control group it was 1.69 ± 0.91 ng/ml. The difference was statistically significant (p<0.001). In the patient group, Pentraxin-3 showed a significant positive correlation with the number of previous miscarriages (p=0.038). CONCLUSION Abnormally elevated Pentraxin-3 levels indicate the presence of an abnormally exaggerated intrauterine inflammatory or innate immune response that may cause pregnancy failure in women with primary unexplained recurrent pregnancy loss.

Can a smaller than expected crown–rump length reliably predict the occurrence of subsequent miscarriage in a viable first trimester pregnancy?

To elicit the diagnostic value of smaller than expected crown–rump length (CRL) to predict the occurrence of subsequent miscarriage in women with a viable first trimester pregnancy.

Women with clomiphene citrate resistant polycystic ovarian disease: predictors of spontaneous ovulation after laparoscopic ovarian drilling

OBJECTIVE To evaluate the role of different clinical, biochemical and sonographic factors as predictors of spontaneous ovulation after laparoscopic ovarian drilling (LOD) in women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD). STUDY DESIGN This prospective study recruited 251 infertile women with CCR-PCOD. Several clinical, biochemical and sonographic criteria were tested as possible predictors of spontaneous ovulation after LOD using multivariate analysis. RESULTS Women with higher preoperative levels of LH, FSH and/or androstenedione had significantly higher rates of spontaneous ovulation within the first eight weeks after LOD, but only FSH and androstenedione were found to be independent predictors. Other factors including age, BMI, type of infertility, duration of infertility, menstrual pattern, testosterone level, ovarian volume and SHBG were insignificant predictors. Receiver-operating characteristic (ROC) curves derived from FSH, LH, androstenedione, and a logistic regression model showed that the best cut-off values were 4.1IU/l, 7.8IU/l, 1.2ng/ml, and 0.4897, respectively, with sensitivity of 91.18%, 100%, 73.53%, and 88.24% and specificity of 69.57%, 69.57%, 65.22%, and 73.91% for FSH, LH, androstenedione, and logistic regression model respectively. An extended follow up (9 months after LOD) was conducted for the anovulatory and the non-pregnant ovulatory women, who were treated individually according to their clinical situation. Of these women, 53.5% (69/129) got pregnant, resulting in a cumulative pregnancy rate of 48% (82/171). Of these pregnancies, 16/82 (19.5%) were spontaneous while 35.4% (29/82) and 45.1% (37/82) occurred after ovulation induction by CC and gonadotropins, respectively. CONCLUSION This study supports the use of androstenedione, LH and FSH as a simple reliable tool in triaging patients with CCR-PCOD to select the ideal candidates for LOD.

Outcome prediction in pregnancies of unknown location using endometrial thickness measurement: is this of real clinical value?

OBJECTIVE To re-evaluate the role of measuring endometrial thickness (ET) in prediction of intrauterine pregnancy (IUP) among women with pregnancy of unknown location (PUL). STUDY DESIGN 987 women with PUL were included in a prospective observational multicenter study. Transvaginal ultrasonography was performed to measure ET and a blood sample was taken to measure serum β-hCG and progesterone levels. All patients were then managed expectantly till the final PUL outcome was diagnosed. RESULTS 78 patients (8.9%) were finally diagnosed as having IUP. The best cutoff point of ET as a possible predictor for IUP was 10mm, with an area under receiver-operating characteristic (ROC) curve of 69.0%. At this cutoff point, ET was able to predict IUP with positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of 1.43 and 0.19, respectively. Serum progesterone at a cutoff point of 50 nmol/L was able to predict IUP with PLR and NLR of 9.0 and 0.06, respectively. Variables showing statistically significant differences among those with IUP and those with the other PUL outcomes using univariate analysis (ET, gestational age, β-hCG, parity, serum progesterone and maternal age) were entered into logistic regression analysis. Logistic regression models were constructed. The performance of these models was better than using ET alone to predict the outcome of PUL. CONCLUSION Measurement of ET is not recommended as a single clinical test for intrauterine pregnancy prediction in women with pregnancy of unknown location.

Skin test reactivity to female sex hormones in women with primary unexplained recurrent pregnancy loss

The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss might be associated with an inappropriate immunologically mediated response to progesterone and/or estrogen. This prospective study included 47 women with two or more documented consecutive early pregnancy losses of unknown etiology, and no previous history of deliveries. Intradermal skin testing was performed in the luteal phase of the cycle (days 16-20) using estradiol benzoate, progesterone, and a placebo of refined sesame oil. Immediate (20 min) and late (24h and 1 week) skin test readings for all cases were compared with those of 12 parous women of comparable age with no history of spontaneous miscarriages, premenstrual disorders, pregnancy, or sex hormone-related allergic or autoimmune diseases. Main outcome measure was skin test reactivity to estradiol and/or progesterone. Immediate skin test reactivity to both hormones was observed among half of the cases at 20 min. A papule after 24h, which persisted for up to 1 week, was observed among 32 (68.1%) and 34 (72.3%) cases at the sites of estrogen and progesterone injection, respectively. 55.3% of cases had combined skin test reactivity to both estradiol and progesterone at 1 week. All women in the control group showed absence of skin test reactivity for both estradiol and progesterone at 20 min, 24h, and 1 week. None of the subjects in either group showed skin test reactivity to placebo. There is an association between primary unexplained recurrent pregnancy loss and skin test reactivity to female sex hormones.

Diagnostic validity of cervicovaginal human chorionic gonadotrophin at 26-36 weeks of gestation as a biochemical predictor of preterm birth.

The aim of this study was to assess the diagnostic accuracy of qualitative and quantitative assay of human chorionic gonadotrophin (hCG) in cervicovaginal secretion as a biochemical predictor of preterm birth.

Can Porphyromonas gingivalis be a novel aetiology for recurrent miscarriage

Abstract Objective To study the association between Porphyromonas gingivalis (P. gingivalis) infection and recurrent miscarriage. Methods This case control study included women with early pregnancy failure admitted for surgical evacuation of retained products of conception. Cases (group 1) included 50 women with unexplained recurrent early miscarriage whereas the control group (group 2) consisted of 50 women with no such history. The evacuated products of conception, subgingival plaques, cervicovaginal secretions and saliva of all participants were examined to detect P. gingivalis deoxyribonucleic acid (DNA) using a polymerase chain reaction. Results The prevalence of P. gingivalis DNA in the chorionic villous tissue samples of group 1 was significantly higher than in group 2 (8 [16%] vs. 1 [2%], respectively; p = 0.036, odds ratio [OR]: 9.3, 95% confidence interval [CI]: 1.1–76.9). The prevalence of P. gingivalis DNA was significantly higher in cervicovaginal secretions of group 1 than in group 2 (9 [18%] vs. 1 [2%], respectively; p = 0.02, OR: 10.8, 95% CI: 1.3–88.5). On the contrary, P. gingivalis DNA could not be detected in subgingival plaques and saliva samples of either group. Conclusion The current study found an association between P. gingivalis infection of the female genital tract and the occurrence of recurrent miscarriage. Chinese Abstract 摘要 目的：研究牙龈卟啉单胞菌（P. gingivalis）感染与复发性流产的相关性。 方法：这项病例对照研究纳入的研究对象为早期妊娠失败、并需手术清除妊娠残留物的患者。病例组（组1）包括50名不明原因复发性流产的患者，而对照组（组2）包括50名没有这种病史的女性。使用聚合酶链反应检测所有参与者抽吸的妊娠物、牙龈下菌斑、宫颈阴道分泌物和唾液中的牙龈卟啉单胞菌脱氧核糖核酸（DNA）。 结果：组1的绒毛膜组织样本中牙龈卟啉单胞菌DNA的患病率明显高于组2（患病率分别为8 [ 16% ] vs 1 [ 2% ]，P = 0.036，OR：9.3，95%CI：1.1–76.9）。组1的宫颈阴道分泌物中牙龈卟啉单胞菌DNA的患病率明显高于组2（患病率分别为9 [18%]vs1 [ 2% ]，P = 0.02，OR：10.8，95%CI：1.3–88.5）。相反的，牙龈卟啉单胞菌DNA在两组的牙龈下菌斑和唾液样品中均未能检出。 结论：目前的研究发现女性生殖道的牙龈卟啉单胞菌感染与复发性流产相关。