safety and effectiveness of nitric oxide donor [Isosorbide Mononitrate] versus dinoprostone in induction of cervical ripening at term

A prospective randomized study for Evaluation of the safety and effectiveness of nitric oxide donor [isosorbide mononitrate] as a cervical ripening agent at term in comparison to the prostagladin E2 analogue Dinoprostone. The study included 80 palients wilh various indications for induction of labor with unriped cervix from obstetrics and Gynecology department of Menofiya University Hospital. Subjects were randomly divided into two groups. The first group [A] consisted of 40 cases used 40 mg isosorbide mononitrate [ISMN] gel intracervically. The second group [B] consisted of 40 cases used 3 mg prostaglandin E2 analogue [Dinoprostone] vaginal tablets. Patients were examined vaginally after 4 hours to detect changes in the Bishop score and any progress of labor. If no changes were detected a second dose was applied. After cervical ripening, augmentation of labor was done by oxytocin drip. Adverse effects, changes in the Bishop scores, progress and outcomes of labor were assessed. ISMN was less effective than prostaglandin E2 for preinduction ripening of the cervix with longer latent phase and induction delivery time. The need for oxytocin was also greater in ISMN group than in prostaglandin E2 group. Uterine tachysystole and hyperstimulation were the main adverse effects of PGE2. Headache, palpitations and dizziness, were more frequent with isosorbide mononitrate than with PGE2. The cesarean rate and fetal outcome were not significantly different between groups. The use of ISMN as a NO donor in preinduction cervical ripening at term is a safe and effective alternative to prostaglandin E2 for cervical ripening before induction. The lack of uterine effect with NO donors provides a merit in some conditions, where uterine contractions are unwanted prior to cervical ripening as in cases of grand multiparity or the presence of uterine scars

Thermal balloon endometrial ablation versus Roller ball ablation in treating premenopausal menorrhagia

To determine whether thermal balloon endometrial ablation can replace Roller ball ablation in treating premenopausal menorrhagia resistant to hormonal therapy. 57 premenopausal women complaining of abnormal uterine bleeding in the form of menorrhagia were enrolled in the study and were divided into 2 groups; group I included 27 women who had thermal balloon endometrial ablation while group II consisted of 30 women who had Roller ball ablation. No medication was used to suppress the endometrium in preparation for ablation in either group. Both procedures were performed under general anesthesia with pre-operative prophylactic antibiotics. All women were followed up for a period 12 months. Both groups were comparable in age, parity and body mass index. The improvement reported in the menstrual pattern after both procedures was not statistically different between both groups [p > 0.05]. Duration of ablation including the time for general anesthesia was significantly higher in group II [p < 0.05]. No significant difference was found in the intra and postoperative complications between the groups except vaginal discharge [p < 0.05]; this was a common postoperative complaint for all women [100%] in group II with a duration lasting between 9-19 days. Only 13 patient [54%] in group I complained of a serosanguious discharge for a period of 5-7 -days. No blood transfusion was required in either group. No fluid overload occurred in any case in group II. Thermal balloon endometrial ablation seems to be safe and effective alternative to Roller ball endometrial ablation in treating premenopausal menorrhagia resistant to hormonal therapy

Prediction of successful implantation after intrauterine insemination [IUI]

This study was done in the Department of Obstetrics and Gynecology, Menoufiya University Hospital. It included 57 couples with unexplained infertility. They were normal regarding semen analysis, ovulation and tubal patency, with no mechanical barrier to oocyte capture. Controlled ovarian stimulation was done using clomiphene citrate combined with human menopausal gonadotropin. Intrauterine insemination was performed at 36 hours after triggering ovulation by hCG injection. Transvaginal ultrasonography with 5 MHz pulsed Doppler system was used for the assessment of follicular development and uterine and ovarian blood flow velocity waveforms in different phases of the menstrual cycle. The study concluded that blood flow studies of uterine and ovarian vessels, measurement of endometrial thickness and pattern and the number of mature ovarian follicles before ovulation constitute good predictors for successful implantation

Relationship between iron status in pregnant women and their newborn babies

To evaluate the effect of maternal iron deficiency anemia on the iron status of the fetus at term gestation with special reference to iron stores. Also, to study the impact of maternal infection on maternal and neonatal iron status. Design: A prospective clinical and laboratory study. Setting: Department of Obstetrics and Gynecology, Menoufiya University Hospital. Patients and The study included 40 full-term pregnant patients admitted for delivery. Twenty-five of the participants were anemic [Hb <11 gm/dl] and fifteen were healthy normal controls [Hb >11 gm/dl], among the anemic group, 12 cases were infected. Hemoglobin, serum iron TIBC and serum ferritin were measured both in mothers and their neonates of both groups. In addition, maternal serum albumin was measured as an indicator of the nutritional status. Maternal hemoglobin, albumin, serum iron and serum ferritin were significantly lower in the anemic group compared to the control [p - 0.05] while TIBC was significantly higher in the anemic group [p = 0.02]. On the other hand, only serum ferritin was reduced in newborns of anemic mothers [p = 0.02] despite a significant reduction in the neonatal hemoglobin [p < 0.0001]. Iron deficiency predisposes to infection and is not a sequelae since patients with infection showed significant decrease in serum iron [p = 0.006] and serum ferritin [p = 0.01] and significant increase in TIBC [p = 0.004] compared to noninfected cases

Ductus venosus blood flow velocity wave - forms in intrauterine growth retardation [IUGR] fetuses

Identification of ductus venosus [DV] by ultrasound and description of blood flow pattern through it in intrauterine growth retarded fetuses [1UGR] in comparison to normal subjects Comparative prospective study in Menoufiya University Hospital twenty five pregnant patients complicated by IUGR [33 - 38 Weeks] compared to 25 normal healthy pregnant women [34-41 weeks] taken as control By an Esaote ultrasound scanner, DV was firstly identified by 2D-imaging, then blood flow velocity was assessed using the pulsed Doppler technique. Also umbilical artery waveform was obtained and assessed in both groups of cases. A characteristic pattern of blood flow through DV related to the cardiac cycle was obtained with a peak during ventricular systole, a second peak during ventricular diastole, and the lowest velocity was recorded during atrial contraction. Regarding the maximum velocity, there was no significant difference between the normal [73 +/- 6.2 cm/sec] and the growth retarded fetuses [72 +/- 5.9 cm/sec] [p = 0.58]. On the other hand, during atrial contraction, blood flow velocity was significantly reduced in growth retarded fetuses [28 +/- 2.4 cm/sec] compared to normal controls [37 +/- 3.1 cm/sec] [p < 0.0001]. Umbilical artery pulsatility index was significantly higher in the growth retarded cases [1.8 +/- 0.76] compared to normal subjects [0.85 +/- 0.21] [p < 0.0001]