RESUMEN
Background: the use of anti-diabetic drugs to control gestational diabetes [GDM] was controversial. Some studies suggested a possible link between the use of oral anti-diabetics and fetal anomalies, fetal macrosomia and neonatal hypoglycemia whereas others have demonstrated no such relationship. Metformin is a biguanide hypoglycemic agent that reduces hepatic gluconeogenesis and increases peripheral insulin sensitivity. Although it crosses placenta, metformin appears to be safe in pregnancy
Aim of the Work: this study aimed to assess the efficacy of metformin in controlling maternal blood glucose level compared to insulin in women with GDM
Patients and Methods: this randomized controlled trial was conducted on 116 patients with GDM recruited from the outpatient clinic of Ain Shams University Maternity Hospital [ASMH], Cairo, Egypt from February, 2016 to January, 2017
Results: macrosomic baby was significantly less frequent among metformin group than among insulin group [p= 0.047]
Conclusion: metformin has efficacy as that of insulin in glycemic control of GDM and has the following beneficial effects: reduction the rate of shoulder dystocia, reduction the rate of cesarean section and reduction the rate of macrosomia more than insulin
Recommendations: metformin is recommended as an alternative to insulin therapy in control of blood glucose in patient with GDM when diet therapy and exercise fail to reduce blood glucose values sufficiently. The time for metformin as an alternative treatment to insulin has come; however, it should be prescribed after careful consideration of these patient characteristics to minimize the need for supplemental insulin
RESUMEN
Background: Abnormal uterine bleeding is a bleeding from uterine compose that is abnormal in volume, regularity and/or timing that has been present for the majority of the last 6 months. Evaluation of women with abnormal uterine bleeding should comprise history taking, systemic and local examination, laboratory investigations, imaging and different diagnostic procedures including hysteroscopy
Aim of the Work: to assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine bleeding
Patients and Methods: This prospective observational study was conducted on 114 patients attended the Early Cancer Detection Unit, Faculty of Medicine, Ain Shams University between July 2017 and April 2018, to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding
Results: Hysteroscopy had a sensitivity of 91.9%, specificity of 86.5%, positive predictive value of 93.2%, and negative predictive value of 84.2% and diagnostic accuracy of 90.1% for diagnosing the etiology of abnormal uterine bleeding
Conclusion: Hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value and the results of hysteroscopy are immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with abnormal uterine bleeding for accurate diagnosis and further treatment