Moustafa I. Ibrahim

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.

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。

Treatment of stress urinary incontinence with a generic transobturator tape

To evaluate the efficacy and safety of using a generic tape tailored from type 1 monofilamentous, macroporous polypropylene mesh during transobturator tape (TOT) surgery.

The association between pentraxin 3 in maternal circulation and pathological intrauterine fetal growth restriction

OBJECTIVE To assess the diagnostic accuracy of maternal serum pentraxin 3 (PTX3) in identifying pathological intrauterine fetal growth restriction (IUFGR) among women presented in the third trimester of pregnancy with a small for gestational age (SGA) fetus. STUDY DESIGN This case control study was conducted in Ain-Shams University Maternity Hospital, Abbasiya Square, Cairo, Egypt and included women diagnosed at the third trimester of pregnancy as having a SGA fetus. Cases included pregnant women with pathological IUFGR, while women with physiologically SGA fetus were included in the control group. Diagnosis of antenatal SGA fetus was based on the presence of abdominal circumference <10th percentile. Pathological IUFGR was provisionally diagnosed antenatally by the presence of falling percentiles on serial ultrasound scans and then the definitive diagnosis was established postnatally after comprehensive neonatal evaluation. Maternal venous blood samples were collected from the eligible participants, once at the time of enrollment, to assess serum PTX3 levels using enzyme-linked immunosorbent assay (ELISA). Both groups were then followed up till delivery to confirm the diagnosis. RESULTS Among the 68 pregnant included in the study, PTX3 was found to be significantly elevated in women with SGA fetus due to pathological IUFGR (n=34) than those with physiologically SGA fetus (n=34) [6.5 ng/ml (2.5-11.0) versus 1.2 ng/ml (0.8-2.5) respectively], with a best cutoff value of ≥1.3 ng/ml [sensitivity of 85.3% (95% confidence interval (CI), 68.9-95.0) and a specificity of 73.5% (95% CI, 55.6-87.1)]. Using multivariable binary logistic regression model, amniotic fluid index (AFI) (P=0.010), estimated fetal weight (EFW) (P=0.016), PTX3 level (P=0.041), and umbilical artery pulsatility index (UA-PI) (P=0.027) were all found to be independent diagnostic markers for pathological IUFGR. CONCLUSION PTX3 is a promising marker that deserves further evaluation as it may differentiate normal and abnormal fetal growth among women presenting at third trimester of pregnancy with a SGA fetus.

Drotaverine to improve progression of labor among nulliparous women.

To reevaluate the role of the antispasmodic drug drotaverine in shortening the length of the active first stage of labor among nulliparous women.

Validity of the pelvic mass score in comparison with other scoring systems in preoperative evaluation of ovarian masses

Objective To evaluate the value of the pelvic mass score (PMS) in the prediction of the nature of ovarian masses in women presenting to a large tertiary gynecological center, namely, the Ain Shams University Maternity Hospital. Study design The study included women presenting to the outpatient clinic of Ain Shams University Maternity Hospital with a diagnosis of an ovarian mass, and planned for surgical intervention. The following scoring systems were used in the current study: risk of malignancy index (RMI), Sassone score, ovarian tumor index (OTI), and the PMS. All the women included underwent a surgical intervention in the form of laparotomy for cytoreduction, oophorectomy/adnexectomy, ovarian cystectomy, or just deroofing and biopsy. Results A total of 176 women with ovarian masses were included in the study. The mean age of the women included was 42.94±13.53 years (range 18–76 years). The ovarian mass was of a benign nature in 98 (55.7%) women, of a borderline nature in eight (4.5%), and of a malignant nature in 70 (39.8%). PMS was the most significant predictor among all these variables and score by having the largest area under the curve [AUC 0.919, 95% confidence interval (CI) 0.878–0.960, P<0.001], followed by RMI (AUC 0.900, 95% CI 0.850–0.951, P<0.001). Conclusion PMS seems to be a significant preoperative predictor of ovarian malignancy in women with a diagnosis of an ovarian mass. It incorporates sonographic, biochemical, and Doppler parameters as well as the patient’s menopausal status in one scoring system. It, therefore, showed a slightly higher sensitivity, and a lower, yet comparable, specificity, when compared with the widely acceptable RMI.

Diagnostic value of serum human epididymis protein 4 versus carbohydrate antigen 125 in ovarian cancer

Objective The aim of the study was to evaluate the diagnostic value of serum human epididymis protein 4 (HE4) in patients with ovarian masses in comparison with serum carbohydrate antigen 125 (CA125). Study design A diagnostic accuracy study was conducted in gynecological oncology unit at Ain-Shams University Maternity Hospital. A total of 110 patients were consecutively recruited on the basis of radiologic and clinical findings. Preoperative serum HE4 was assessed using enzyme immunometric assay technique, whereas CA125 assay was performed using electrochemiluminesence immunoassay. All patients underwent exploratory laparotomy. Preoperative serum levels of both markers were correlated to histopathological findings obtained from each patient. Results A total of 96 patients were finally analyzed. Of the included 96 patients, 58 (60.4%) had a benign ovarian lesion, whereas 38 (49.6%) had a malignant one. The diagnostic sensitivity and specificity of HE4 and CA125 were 76.6/86.7% and 94.7/56.9%, respectively. Combination of both markers revealed diagnostic sensitivity and specificity of 76.7 and 100%, respectively. Conclusion In ovarian cancer, HE4 seems to have higher specificity than CA125. Combination of both markers was a more accurate predictor of ovarian cancer than either marker alone.

Sacrospinous colpopexy using Masson luethy needle holder

OBJECTIVE Sacrospinous colpopexy (SSC) is a well-known surgical technique to correct apical support defect, however its approach is still challenging. The current study describes an alternative and economic approach for suture placement in the sacrospinous ligament during SSC using Masson luethy needle holder. STUDY DESIGN A prospective study was conducted in a tertiary care center. The study recruited women with uterovaginal prolapse or post hysterectomy vaginal vault prolapse scheduled for SSC as a constructive surgery for vaginal superior segment defect. Eligible women were assigned to have SSC using Masson luethy needle holder (Group I) for suture placement in the sacrospinous ligament. The control group (Group II) consisted of a group of patients who had SSC using Deschamps ligature carrier. RESULTS By the end of the study, 104 women underwent SSC. (Group I) included 55 women while (Group II) included 49 women. The mean SSC operative time was significantly shorter in (Group I) [109±33min versus 206±67min in (Group II), p<0001], with a mean difference of 10.5min [95% CI, 74-136]. This difference in SSC operative time was due to faster suture placement in (Group I) [47±14min versus 153±46min in (Group II), p<0001]. The mean SSC related operative blood loss was significantly less in (Group I) [582±349ml versus 985±463ml in (Group II), p<0001]. The perioperative complications, recurrence and cure rates were similar in both groups. CONCLUSION Using Masson luethy needle holder reduced the difficulty associated with suture placement during SSC and allowed the completion of the procedure within a significantly shorter time.