Evaluation of knowledge and practice of hymenoplasty among Egyptian gynaecologists: a cross-sectional study.

OBJECTIVES: The aims of the study were to evaluate the knowledge and practice of hymenoplasty among gynaecologists in Egypt. METHODS: A cross-sectional study was conducted in January 2020, in which a self-administered questionnaire was completed by 120 gynaecologists at private clinics and hospitals in Ismailia, Egypt. The questionnaire consisted of 19 items relating to participants' sociodemographic characteristics, knowledge and practice of hymenoplasty. RESULTS: Eighty-eight (73.3%) participants were not able to give an accurate definition of the hymen; furthermore, 65 (54.2%) were not aware of the different types of hymen. Forty-nine (40.8%) participants were able to define hymenoplasty and 39 (32.5%) knew the different hymenoplasty procedures. Hymenoplasty had been performed by 35 (29.2%) participants. Of these, 26 (74.3%) had carried out the procedure in a private clinic; the median annual number of procedures performed was four. Only two (5.7%) participants reported the occurrence of complications during the procedure. There were no sociodemographic differences between gynaecologists who had and had not performed hymenoplasty. CONCLUSION: There is a lack of sufficient knowledge about hymenoplasty among Egyptian gynaecologists; nevertheless, it continues to be practised in private clinics.

Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections.

BACKGROUND: The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions. METHODS: This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey's scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair's scoring system was used to evaluate intraperitoneal adhesions. RESULTS: The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey's and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001). CONCLUSION: Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.

Violence and sexual dysfunction among infertile Egyptian women.

OBJECTIVE: To evaluate domestic violence and sexual dysfunction in infertile women. MATERIALS AND METHODS: We recruited women complaining of infertility (primary or secondary infertility). A control group of fertile women attending the outpatient clinic for any concern was recruited. Domestic violence was evaluated using the Arabic validated NorVold Domestic Abuse Questionnaire (NORAQ). Female sexual function was evaluated using the Arabic validated female sexual function index. RESULTS: There was no significant difference between both groups in rates of exposure to violence (p-value 0.830). Primary infertility was a significant contributing factor in infertile women's exposure to violence (p-value 0.001). All the studied population had female sexual dysfunction, with more dysfunction was reported by the infertile women (total score 18.87 ± 5.92, 19.51 ± 5.42, p-value 0.072). They differed significantly in arousal (2.83 ± 1.33, 3.13 ± 1.29, p-value 0.001) and satisfaction (3.98 ± 1.27, 4.28 ± 1.28, p-value 0.003) which were impaired in infertile women. CONCLUSIONS: The recruited infertile women were exposed to violence. Emotional abuse was the most common reported type of violence. Sexual dysfunction was reported in the entire studied population with no significant difference relating to fertility.

Knowledge, attitude and practice towards abortion and post abortion care among Egyptian private obstetricians and gynaecologists.

OBJECTIVE: To assess the knowledge, attitude, and practice of private obstetricians and gynaecologists towards abortion, post-abortion care, and post-abortion family planning. PATIENTS AND METHODS: A cross-sectional study, from June 2017 to May 2018, using a self-administered questionnaire of 150 obstetricians/gynaecologists at private clinics, centres, hospitals in Ismailia, Egypt. The questionnaire was composed of four broad sections: section one was about the socio-demographic characteristics of the participants; section two was about physicians' knowledge, attitude and practices regarding abortion; section three was about their attitudes and practices regarding post-abortion family planning and screening for sexually transmitted diseases (STDs) in patients presenting for induced abortion; and section four was about the socio-demographic characteristics of women seeking induced abortion taken from the physicians' views. RESULTS: Only 15.2% of participants had performed an abortion for unwanted pregnancies at ≤12 weeks vs. 3.8% for unwanted pregnancies >12 weeks' gestation. The most common reason for not performing an abortion was religious prohibition (80.35% vs. 86.6% for unwanted pregnancy ≤12 and > 12 weeks, respectively). Social causes were the most common reason for seeking an induced abortion. None of the physicians used manual vacuum aspiration (MVA) for abortion or had received training in MVA. Post-abortion family planning counselling was offered by 20.5% of physicians, while 13.6% screened for STDs. CONCLUSIONS: The majority of private obstetricians/gynaecologists in Ismailia, Egypt, do not perform abortions for unwanted pregnancies because of their religious beliefs. Post-abortion screening for STDs and family planning services are not sufficiently integrated into post-abortion care.

Fetal gender, serum human chorionic gonadotropin, and testosterone in women with preeclampsia.

OBJECTIVES: Evaluation of the association between fetal gender, serum beta-human chorionic gonadotropin, and serum testosterone, and preeclampsia. METHODS: Case-control study conducted at the Obstetrics and Gynecology Department. 120 patients divided into study group (patients with preeclampsia subdivided into mild and severe) and control group (normotensive women). INTERVENTIONS: Fetal gender was determined. Serum testosterone and HCG levels were estimated at 32 weeks or at the time of diagnosis of preeclampsia (study group) or recruitment (control group). RESULTS: Positive association between the male gender of the fetus and preeclampsia. Increased HCG and Testosterone were associated with developing preeclampsia. CONCLUSION: The mechanism of preeclampsia could be androgen-mediated. There is a significant correlation between serum HCG and testosterone and preeclampsia.

Carbetocin versus oxytocin for prevention of postpartum hemorrhage in hypertensive women undergoing elective cesarean section.

OBJECTIVE: Assess the efficacy and safety of carbetocin, versus oxytocin in the prevention of postpartum hemorrhage in hypertensive women. STUDY DESIGN: A randomized clinical trial. SETTING: Obstetrics and Gynecology Department of Suez Canal University Hospital. PATIENTS: One hundred and sixty hypertensive pregnant women who underwent CS. INTERVENTIONS: Patients were randomized to receive either 10 IU oxytocin or 100 µg carbetocin. Primary outcomes included estimated blood loss, blood transfusion, hemoglobin (HB), and hematocrit changes pre- and post-delivery and the use of additional uterotonics. RESULTS: The postoperative HB was not different from preoperative HB in the carbetocin group (11.8 ± 1.2 vs. 11.2 ± 1.2 g/dL) while it decreased significantly in the oxytocin group (12.1 ± 3.8 vs. 10.4 ± 1.1 g/dL, p < 0.001). Blood loss was significantly more among the oxytocin group (679.5 ± 200.25 vs. 424.75 ± 182.59 ml) in the carbetocin group (p < 0.001). Nausea, vomiting, and sweating were reported more significantly in oxytocin group patients. CONCLUSION: Carbetocin was more effective than oxytocin in reducing intraoperative and postoperative blood loss.

A randomized clinical trial of sildenafil plus clomiphene citrate to improve the success rate of ovulation induction in patients with unexplained infertility.

OBJECTIVES: To investigate the role of sildenafil citrate in improving ovulation induction success rate in women with unexplained infertility. METHODS: A randomized clinical trial from January to December 2018 of 80 women with unexplained infertility randomized into two groups. Both groups received 100 mg clomiphene citrate once daily from days 3-7 of the menstrual cycle. The study group also received 25 mg oral sildenafil citrate twice daily from days 8-12 of the same cycle. Transvaginal ultrasound assessed ovulation, endometrial thickness, and number of follicles. Pregnancy was assessed 2 weeks after ovulation. Primary outcome measures were endometrial thickness, number of mature follicles, and pregnancy rates. RESULTS: Pregnancy rates (26 (65%) and 16 (40%), P=0.043) and endometrial thickness (10.4 ± 1.4 and 9.2 ± 1.9, P=0.007) were significantly higher in the study group. More women in the study group reported adverse effects compared with the control group (17 [42.5%] vs 9 [22.5%]; P=0.034), with headache the most common adverse effect in the study group, reported by 8 (20.0%) patients. CONCLUSION: Adding sildenafil citrate improved ovulation success rate and increased pregnancy rate. PAN AFRICAN CLINICAL TRIAL REGISTRY: PACTR201907658492123.

Prevalence and risk factors for domestic violence among infertile Egyptian women: a cross-sectional study.

Objective: Domestic violence (DV) is an important social and public health problem affecting women globally. This study aims to assess the prevalence and risk factors of DV among infertile Egyptian women. Patients and methods: A cross-sectional hospital-based study included infertile women attending the outpatient gynaecological clinic in a tertiary University hospital was carried out between September 2017 and October 2018. After obtaining ethical approval, 304 infertile women were enrolled in the study and investigated using an interview questionnaire of Infertile Women's Exposure to Violence Determination Scale (IWEVDS). The questionnaire was examined for accuracy after translation into the Arabic language. Results: The infertile women's reported DV resulted in an average total score on the IWEVDS of 73 ± 17. The top three domains with the highest scales were DV, punishment and exposure to traditional practices domains with scale 20.84 ± 7.67, 18.25 ± 4.15 and 14.63 ± 3.18 points, respectively. Using Multivariable linear regression analysis, we found that the best-fitting predictors for this scale were the wife's age (p = .001), residency (p = .033), previous intracytoplasmic sperm injection (ICSI) (p = .016), divorce threatens (p = .022) and fear from husband (p = .026). Conclusions: Infertile Egyptian women are at an increased risk of DV. The most common forms of DV are psychological violence and verbal abuse.

Bladder function after sacrospinous hysteropexy and vaginal wall repair in women with uterovaginal prolapse.

OBJECTIVE: To evaluate the impact of repair of uterovaginal prolapse using sacrospinous hysteropexy and vaginal wall repair on the bladder function. STUDY DESIGN: The study was conducted at the urogynecology clinic of Suez Canal University Hospitals, Ismailia from January 2014 to March 2016. This study included women with a diagnosis of uterovaginal prolapse and wishing to preserve their uteri. Bladder function was evaluated through assessment of urological symptoms using a standardized questionnaire - the urogenital distress inventory (UDI-6) - in addition to urodynamic studies just before and six-months after the sacrospinous hysteropexy ±â€¯associated vaginal wall repair operation. RESULTS: Twenty-seven patients completed the study with a mean age of 36.5 ±â€¯4 years. Only 3 women had sacrospinous hysteropexy with no additional procedures. Other procedures included anterior colporrhaphy (12), posterior colporrhaphy (9) and perineorrhaphy (15). Based on UDI-6, there was no significant difference between the pre- and post-operative symptoms of stress urinary incontinence (SUI) [8/27 (29.6%) vs. 9/27 (33.3%) respectively; p value = 0.7]. The pre- and post-operative symptoms of urge urinary incontinence were also insignificantly different [13/27 (48.1%) vs. 15/27 (55.5%); p value = 0.5]. The total score of UDI-6 increased from 24.5 ±â€¯(14.2) to 32.8 ±â€¯(29.4) which was not statistically significant (p value = 0.12). Urodynamically, voiding dysfunction was found less frequently after the operation, however the difference was statistically insignificant [9/27 (33.3%) vs. 8/27 (29.6%); p value = 0.7]. CONCLUSION: Sacrospinous hysteropexy and associated vaginal wall repair do not affect the bladder function either subjectively or objectively.

Reproductive performance in the next pregnancy for nulliparous women with history of first trimester spontaneous abortion.

OBJECTIVE: To determine whether interpregnancy interval after the first spontaneous abortion has an effect on reproductive performance of women in their next pregnancy. METHOD: A prospective cohort study was conducted on 4,619 women with history of spontaneous abortion in their first pregnancy. Of them 2,422 (52.4 %) conceived within 6 months of the miscarriage (group A) and 2,197 47.6 % after 12 months (group B). The primary outcome was abortion, live birth, termination, or ectopic pregnancy in the next pregnancy. Secondary outcomes were preterm delivery, low birth weight infants, caesarean section rate and occurrence of preeclampsia, placental abruption and induced labour in the second pregnancy. RESULTS: Women who conceived again within 6 months were less likely to have another abortion, termination, or ectopic pregnancy compared with women with interpregnancy interval more than 12 months. Women with an interpregnancy interval more than 12 months were less likely to have live birth in the second pregnancy and more likely to have a caesarean section, preterm delivery, or infant of low birth weight compared with women who conceived again within 6 months. CONCLUSIONS: Women who conceive within 6 months after their first spontaneous abortion have better reproductive outcomes and the lowest complication rates in their subsequent pregnancy.