Gum chewing stimulates early return of bowel motility after caesarean section.

OBJECTIVE: To evaluate the efficacy and safety of postoperative gum chewing on the recovery of bowel motility after caesarean section. DESIGN: A randomised controlled study. SETTING: Faculty of Medicine, Ain Shams University, Egypt. POPULATION: A total of 200 pregnant women delivered by elective caesarean section (CS) under general anaesthesia. METHODS: Women were randomised into two groups; group A (93 women) who received one stick of sugarless gum for 15 minutes every 2 hours after surgery, and group B (107 women) had traditional management (oral intake of clear fluids allowed after passage of flatus and regular diet with the passage of bowel movement). MAIN OUTCOME MEASURES: Time to first hearing of normal intestinal sounds, time to first flatus, time to first bowel movement and length of hospital stay. RESULTS: The mean duration of surgery was longer in group A (41.3 +/- 7.5 versus 38.4 +/- 8.1 minutes, P < 0.05). The mean postoperative time interval to first hearing of normal intestinal sounds (10.9 +/- 2.7 versus 15.6 +/- 3.7 hours), passage of flatus (17.9 +/- 4.6 versus 24.4 +/- 7.1 hours), defecation (21.1 +/- 4.7 versus 30 +/- 8.2 hours) and discharge from the hospital (40.8 +/- 10.6 versus 50.5 +/- 8.9 hours) were significantly shorter in group A (P < 0.001). Severe ileus occurred only in one woman belonging to group B. All patients in group A tolerated gum chewing beginning on the first postoperative day. CONCLUSION: Gum chewing after CS is safe, well tolerated, and associated with rapid resumption of intestinal motility and shorter hospital stay; with potential impact on reducing the overall healthcare costs in case of routine implementation.

An increased number of replaced embryos counteracts the adverse effect of hydrosalpinges on IVF/ET outcome.

PURPOSE: The relationship between the number of replaced embryos and the outcome of IVF-ET in patients with hydrosalpinges was investigated in a retrospective, nonrandomized study performed at a governmental IVF center. METHODS: One hundred patients undergoing 161 IVF cycles ending in embryo transfer were studied. Previously diagnosed hydrosalpinges were evident on transvaginal sonography in 48 cycles in 26 patients (group I) and not evident in 15 cycles in 10 patients (group II). The control group included 98 cycles in 64 patients with tubal lesions other than hydrosalpinx. Pregnancy and implantation rates were the main outcome measures. RESULTS: Replacement of three or fewer embryos was associated with significantly lower implantation rates in group I compared to controls. Despite the difference in the rank of IVF trial within the same group, significantly lower implantation rates were found when four or fewer embryos were replaced in the control group and not in group I. CONCLUSION: An increased number of replaced embryos counteracts the adverse effect of hydrosalpinges on IVF/ ET outcome.

Hydatid cyst of Morgagni: any impact on fertility?

On laparoscopy in 3 patients with primary infertility, the only pathology found was hydatid cysts of Morgagni that were excised. In one patient with monolateral hydatid cyst, pregnancy failed to be achieved. Despite prior failure of repeated trials of ovulation induction and intrauterine insemination in the other 2 patients, a spontaneous pregnancy was achieved within 2-3 months following laparoscopic extirpation of hydatid cysts of Morgagni. The hydatid cysts were bilateral in one case; and monolateral (in relation to the only present tube with a unicornuate uterus) in the other case. It is concluded that hydatids of Morgagni, as a single pelvic pathology, might hinder fertility. Laparoscopic extirpation of these cysts would improve ovum pick-up and enhance fertility.

Altered endometrial progesterone/oestrogen receptor ratio in luteal phase defect.

The total oestrogen and progesterone receptor levels (TER, TPR) were measured in endometrial biopsy samples of 10 infertile patients with luteal phase defect (LPD) and compared to those of controls. Serum levels of progesterone (P), obtained in the luteal phase, were also measured. Midluteal phase P values were significantly decreased in LPD cycles; however some overlap of values existed. LPD cycles had significantly lower endometrial TER and TPR concentrations than did control cycles. TPR/TER ratio was found to be a reliable test for diagnosis; having a sensitivity, and specificity of 90% and the odds ratio of 81. The TPR/TER ratio for inphase endometria ranged between 1.13 and 58.22, with 95% confidence. It seems that abnormal folliculogenesis, as a cause of LPD, results in wide ranges of endometrial TER and TPR concentrations, yet with well defined alteration in TPR/TER ratio. Summation of the results of the present study along with those previously reported, indicates that TPR/TER ratio may be of great value in characterisation of a well defined endometrial receptor imbalance in luteal phase defect, whatever the underlying aetiology.

Genital Chlamydia trachomatis infection in Egyptian women: incidence among different clinical risk groups.

OBJECTIVE: To investigate genital Chlamydial infection incidence among high risk clinical conditions in Egyptian women. METHODS: A case control study in Ain Shams University Hospital involving 501 patients with cervicitis (n = 58), abnormal cervical smear (n = 256), tubal infertility (n = 85), ectopic pregnancy (n = 22), preterm labour (n = 80) and 192 controls. Active cervical Chlamydial infection was diagnosed using direct immunofluorescent technique. Data were analyzed by Chi-square (chi 2) and Z tests. RESULTS: Significant increase of Chlamydial infection among different clinical conditions compared to controls. The percentage of positive chlamydial infection was 79.3% among cervicitis group, 33.3% among subjects with inflammatory smear, 75.2% among those with cervical condyloma, 82.6% among those with cervical intraepithelial neoplasia, 51.8% among tubal infertility subjects, 77.2% among ectopic patients and 56.3% among subjects with preterm labour. CONCLUSION: The incidence of Chlamydial infection in these high risk Egyptian patients is relatively high. Emperical treatment is recommended as the diagnosis is costly and usually not available.

Rectal suppository: commonsense and mode of insertion.

Rectal suppository is a well-known form of medication and its use is increasing. The commonest shape is one with an apex (pointed end) tapering to a base (blunt end). Because of a general lack of information about mode of insertion, we asked 360 lay subjects (Egyptians and non-Egyptians) and 260 medical personnel (physicians, pharmacists, and nurses) by questionnaire which end they inserted foremost. Apart from 2 individuals, all subjects suggested insertion with the apex foremost. Commonsense was the most frequent basis for this practice (86.9% of lay subjects and 84.6% of medical personnel) followed by information from a relative, a friend, or medical personnel, or from study at medical school. Suppository insertion with the base or apex foremost was compared in 100 subjects (60 adults, 40 infants and children). Retention with the former method was more easily achieved in 98% of the cases, with no need to introduce a finger in the anal canal (1% vs 83%), and lower expulsion rate (0% vs 3%). The designer of the "torpedo-shaped" suppository suggested its insertion with apex foremost. Our data suggest that a suppository is better inserted with the base foremost. Reversed vermicular contractions or pressure gradient of the anal canal might press it inwards.

Ovulation induction for in-vitro-fertilization and embryo transfer applying decapeptyl (DTRP-6 LH/RH) in combination with HMG or FSH.

47 patients out of the IVF-program of the Department of Obstetrics and Gynecology University of Kiel, who demonstrated in previous stimulation cycles premature LH surges, were treated in two modalities with a down regulation applying the GnRN-analogue decapeptyl (DTRP-6 LH/RH) and a concomitant HMG- or FSH-stimulation. The down-regulation was started after ovulation up to a negative LH/RH test followed by a concomitant gonadotropin stimulation in group 1. In group 2 a parallel treatment with decapeptyl and HMG or FSH was performed from day 2 of the cycle. 10 husbands of the punctured patients had pathological sperm. In both groups 6 patients were discarded from of the stimulation protocol as their oestradiol responses were not adequate, sperm contamination was detected late in one case, and in one patient a premature LH surge occurred once again. In 36 patients vaginal follicular punctures were performed. With respect to pregnancies group 1 revealed a much higher pregnancy rate than group 2. It seemed better to start the down-regulation with the GnRH-analogue decapeptyl in the luteal phase of the previous cycle. The treatment with decapeptyl should not only be applied in patients with previous LH surges but also in order to establish a synchronous follicular maturation in ovulating patients treated for in-vitro fertilization, or gamete-intra-Falloppian-tube-transfer.