Assessment of hysteroscopic role in management of women with recurrent pregnancy loss.

OBJECTIVES: To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss. METHODS: This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20 weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation. RESULTS: This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3-5) the mean number of the first trimesteric abortion was 2 with range (2-2) the mean number of second trimesteric abortion was 2 with range (1-2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG. CONCLUSIONS: It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Uterine salvage management for atonic postpartum hemorrhage using "modified lynch suture".

BACKGROUND: To assess the effectiveness of the new modified technique in order to control bleeding in women presenting with atonic, flabby uterus compared to the most commonly described technique of classic B-Lynch suture. METHOD: This study included 160 women of uncontrolled atonic postpartum hemorrhage delivered by cesarean section at Ain Shams University Maternity Hospital between January 2013 and October 2015. Participants were randomly assigned following simple randomization procedures (computerized random numbers) and divided into two groups. Group, I (80 patients) operated upon by the modified (new technique) stitch while group II (80 patients) operated upon by the classic technique. The ultimate goals were to stop blood loss after placement of the sutures and avoid life-saving hysterectomy thus preserving the life and fertility of the patient. RESULTS: The modified new technique was done in 80 patients with atonic postpartum hemorrhage and it was found to be superior to the classic technique with a success rate 95 % (4 cases needed hysterectomy as a lifesaving measure) compared to 85 % with the classic technique (in 12 cases, a life-saving hysterectomy was done). CONCLUSIONS: This technique can replace the classic B-lynch in flabby unresponsive atonic uteri as it has 8 shaped placement of the stitch which causes more firm compression on the uterus and simultaneous bilateral uterine artery ligation. This technique was proved valuable and successful in many patients who suffer from uncontrolled massive postpartum hemorrhage (PPH).

Effect of activated vitamin D on glucoparameters in HCV seropositive and seronegative patients on chronic hemodialysis.

INTRODUCTION: Many studies support the role of vitamin D in the pathogenesis of both types of diabetes. Pancreatic tissues express the vitamin D receptor (VDR) and vitamin D-binding protein; some allelic variations in genes involved in vitamin D metabolism and VDR are associated with glucose intolerance, defective insulin secretion, and sensitivity. Epidemiological links have been established between type 2 diabetes mellitus (DM) and hepatitis C virus (HCV) infection. AIM: To explore the possible therapeutic potential of pharmacologic doses of 1-α-hydroxy vitamin D therapy in improving pancreatic ß-cell function in HCV seropositive hemodialysis (HD) patients. PATIENTS AND METHODS: Twenty HCV seropositive HD patients and 20 HCV seronegative patients as control group were randomly selected from HD units. 1-α-Hydroxy vitamin D therapy was administrated in the dose ranged from 0.25 to 0.5 µg/day for 3 months. Corrected total serum calcium, phosphorus, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D [25(OH) vitamin D], 1,25-dihydroxy vitamin D, and glucoparameters [fasting blood glucose, glycohemoglobin test (HbA1c%), homeostatic model assessment (HOMA)-insulin resistance, and HOMA-ß-cell function% (B%)] were measured under basal conditions and after 3 months of therapy. RESULTS: There was highly significant improvement in the concentrations of fetal bovine serum (FBS), serum insulin, HbA1c%, 25(OH) vitamin D, and HOMA-ß-cell function in HCV seropositive and HCV seronegative groups after oral 1-alphacalcidiol therapy (p < 0.001). Positive correlation exists between the percentage increase in serum insulin and that in HOMA-ß-cell function versus 25(OH) vitamin D (p < 0.021 and p < 0.027, respectively) in HCV negative group. CONCLUSION: 1-α-Hydroxy vitamin D oral therapy may improve glycemic control in HCV seropositive and HCV seronegative HD patients.