Management of early missed abortion by methotrexate and/or misoprostol

The purpose of this study was to compare the efficacy and side effects of the use of either intramuscular [i.m.] methotrexate or vaginal misoprostol alone or in combination in women with early 1[st] trimester missed abortion. Ninety women with early missed 1[st] trimester intrauterine pregnancy at < 9 weeks gestation were included in this study. The study sample was randomized into 3 groups. The 1[st] group included 30 women who received 50mg/m[2] i.m. methotrexate on day 1 and then followed up at weekly intervals up to day 21. The 2[nd] group included 30 women who received 800 micro g vaginal misoprostol on day 1 and if there was no response on day 4, they received a repeat dose and were reassessed on day 7. The 3[rd] group included 30 women who received 50 mg/m[2] i.m. methotrexate followed 3 days later by 800 micro g vaginal misoprostol and were reassessed on day 7. All women were recruited from the attendants of Gynecology Department, El-Minia University Hospital. Complete abortion occurred in 53.33% in 1[st] group, 86.66% in 2[nd] group and 93.33% in the 3[rd] group. The complete abortion rate in the 3[rd] group was significantly higher than that of both 1[st] and 2[nd] groups [p < 0.05]. The failure rate was 46.66% in 1[st] group, 13.33% in 2[nd] group and 6.66% in the 3[rd] group. No serious side effects were found in all study groups. The combination of methotrexate and misoprostol is more effective method for early missed abortion than when either drug is used alone

Vascular and hormonal changes before and after laparoscopic ovarian electrocautery in patients with polycystic ovarian disease

Forty infertile patients with PCOD were enrolled in the study, they were undergone laparoscopic ovarian electrocautery. Before the operation, all cases were subjected to a good history with a thorough clinical examination together with transvaginal ultrasonic examination, hormonal profile [FSH, LH, prolactin and DHEA] in the early follicular phase and color Doppler of uterine and ovarian arteries with determination of pulsatility index [PI] were done to all patients. After operation hormonal profile was assessed one day, one month and three months after electrocautery, Doppler study of ovarian and uterine arteries, folliculometry for three consecutive cycles. As regard Doppler before drilling, flow velocity patterns of uterine and ovarian vessels showed high pulsatility index [PI], which showed gradual decrease along the three cycles after drilling. As regard, hormonal profile, FSH showed significant rise, while LH and LH/FSH ratio showed significant fall along the three cycles, DHEA showed no significant change one day after drilling, but significantly decreased one month and three months after drilling. On the other hand, prolactin showed no significant change