Randomized, comparative study of clinical and metabolic parameters among continuous, extended, and cyclic combined oral contraceptive pill users

This open, prospective, randomized, comparative study evaluated clinical, metabolic, and histopathological aspects of cyclic, extended, and continuous use of a COC containing 30 micro g EE and 75 micro g gestodene [Gynera] in 245 women for 18 cycles. Continuous [82 women] and extended [80 women] pill users had significantly fewer bleeding days requiring sanitary protection than cyclic users [83 women]. Spotting increased initially in continuous and extended pill users but declined after the 4[th] cycle. Amenorrhea rates increased significantly after the 4[th] cycle reaching 85% and 71.4% in the last cycle in continuous and extended pill users, respectively. No significant changes in BP or weight as well as a significant increase in hemoglobin concentration were observed in all study groups. No significant changes in lipid profile were observed except a significant increase in HDL-cholesterol in the continuous group. Insulin levels increased significantly with no associated change in glucose levels in all study arms. A significant increase in both fibrinogen and PAI-1 and a significant reduction in PT without changes in other coagulation parameters were observed in all study arms. Continuous and extended COC pill use for 18 cycles was well tolerated with satisfactory clinical effects and good compliance without changes in BP or weight. The treatment was associated with high rates of amenorrhea after the 4[th] cycle, less severe adverse effects, and metabolic changes similar to those in cyclic users

comparison of isosorbide mononitrate, misoprostol and combination therapy for preinduction cervical ripening at term: a randomized controlled trial

The purpose of this study was to compare the efficacy, safety, and acceptability of isosorbide mononitrate [IMN], misoprostol, and the combination therapy for cervical ripening before induction of labor at term. A prospective, double-blind, placebo-controlled, randomized clinical trial in 196 term and post-term nulliparous women with unfavorable cervices who were assigned randomly to receive either 40mg of IMN [n=65], 50 micro g of misoprostol [n=65], or both of them [n=66] in the posterior vaginal fornix. Changes in Bishop score and cervical length, progress and outcomes of labor and adverse effects were assessed. The combination therapy was more effective than IMN or misoprostol. Successful induction [vaginal delivery within 24 h of initiation of cervical ripening] was significantly higher in the misoprostol [60%] and combination therapy [62.1%] groups compared with the IMN [27.7%] group [P<0.0001]. Mean duration [h] from treatment initiation to delivery was greater for IMN [26.7 +/- 7.5] than misoprostol [16.5 +/- 6.7] and combination therapy [14.8+6.2] groups [P<0.0001]. Oxytocin was needed more in the IMN group [93.8%] than in the misoprostol [21.5%] and combination therapy [25.8%] groups [P<0.0001]. IMN was safer and more acceptable than misoprostol and combination therapy. The cesarean rate was not significantly different among groups, but the major indications were different: dystocia [54.5%] in the IMN group versus persistent non-reassuring FHR pattern [57.9%] in the misoprostol and [47.6%] in the combination therapy groups [P=0.01]. The combination therapy was more effective than either IMN or misoprostol alone for preinduction cervical ripening at term. However, IMN was safer, well tolerated and more acceptable

value of routine histopathological examination of products of conception in cases of first trimester spontaneous miscarriage

To evaluate the histopathologic findings relating to tissue samples collected at surgical uterine evacuation in first trimester spontaneous miscarriage. All patients admitted to Obstetrics and Gynecology Departments, Menoufiya University and Shebin Elkom Teaching Hospital with the diagnosis of spontaneous miscarriage underwent surgical evacuation. Histopathological examination was done for the resulting tissue and the results were recorded and compared with the clinical diagnosis before the operation. Histopathological examination revealed the products of conception in 155 patients [94.5%], partial vesicular mole in 5 patients [3.1%], complete mole in 2 patients [1.2%], and 2 patients had ectopic pregnancy [1.2%]. Routine histopathological examination of the products of conception of first trimester spontaneous miscarriage is very valuable as important findings as trophoblastic diseases and ectopic pregnancy can be diagnosed in cases diagnosed before as having spontaneous miscarriage thus saving the lives of these patients