Effects of insulin sensitizing agent on clomiphene induced ovulation in the polycystic ovary syndrome

This study aimed to determine whether reducing hyperinsulinaemia with metformin would increase the ovulatory response to clomiphene. The study was conducted at Al-Azhar University Hospitals between March 1999 to May 2001. One hundred women who met the PCOS eligibility criteria were included in the study and randomly assigned into 2 groups [50 patients each]. G-I received 50 mg of clomiphene twice daily starting from the third day of the cycle for 5 days plus 500mg of metformin 3 times daily for 6 months. G-II received clomiphene as in G-I plus placebo 3 times daily for 6 months. The main outcome measures included body weight, body mass index [BMI], menstrual pattern LH, FSH, LH: FSH ratio, free testosterone, sex hormone binding globulin [SHBG], fasting insulin and ovulation and pregnancy rate. It was found that the body weight and BMI were significantly reduced in group I while they were not significantly changed in group II. No significant changes were found in waist- hip ratio in both groups. Of 40 patients who completed 6 month course of treatment in G-I, 32 restored normal menstruation versus only 4.3% of women in G-II. After 6 months of therapy in GI, there was significant reduction in the levels of LH, LH: FSH ratio, free testosterone, fasting insulin and significant increase in SHBG, while no significant changes were observed in serum FSH concentration. On the other hand, there was no significant changes in the hormonal pattern in women in G-II. Women in G-I had a better ovulation and pregnancy rate [84% and 20%, respectively] than those in G-II [12% and 8%, respectively]

Effects of epidural anesthesia on the Doppler velocimetry of umbilical and middle cerebral arteries and feto-maternal outcome in normal term labor

This study aimed to investigate benefits and possible short-term side effects of epidural anesthesia used for pain relief in labor. It was conducted on 100 primigravida women in labor randomly assigned into two groups: Group I included 50 patients receiving continuous epidural anesthesia [CEA] of 10 ml of 0.125% bupivacaine and 15 ug fentanyl/hour and Group II included 50 patients who did not receive epidural anesthesia or analgesia. It was found that CEA resulted in a significant reduction in maternal systolic and diastolic blood pressure and an increase in heart rate. The umbilical and middle cerebral artery indices did not significantly change. Also, CEA resulted in a significant shortening of duration of the first stage of labor, while incidence of instrumental delivery was significantly higher and no significant difference was found as regard cesarean section rates

Comparative trial of prostaglandin El with standard oxytocics for management of third stage of labor

In this study, 200 women in labor were randomly allocated to receive either standard oxytocics intramuscularly or prostaglandin E1 rectally immediately after delivery of the fetus. The duration of third stage, rate of manual removal of placenta and rate of postpartum hemorrhage were similar. However, amount of blood loss, needs for additional oxytocic agent and postpartum hypertension were more common in oxytocic group. Shivering was more common in misoprostol group, while vomiting was more common in oxytocic group. Women in misoprostol group had higher postpartum hemoglobin and hematocrit levels than oxytocic group. The changes in coagulation profile were similar