Scientific research in obstetrics and gynecology: changes in the trends over three decades.

AIM: The aim of this work was to assess scientific research of master's and doctoral theses and essays in the Department of Obstetrics and Gynecology, Zagazig University, Egypt. MATERIALS AND METHODS: All master's and doctoral theses and essays since the foundation of Department of Obstetrics and Gynecology, Zagazig University, Egypt, in 1975 till end of 2012 were reviewed. RESULTS: A total of 703 theses and essays were reviewed. The important topics in the specialty of obstetrics and gynecology were covered and updated. Infertility, in vitro fertilization-embryo transfer (IVF-ET) and related techniques, and polycystic ovarian disease were the most common gynecologic topics (27.2%), followed by gynecologic oncology (18.5%). Preeclampsia was the most common obstetrics topic (18.8%), followed by issues of high-risk pregnancy, fetal growth restriction, and fetal well-being (11.6%). The number of researches that allow the candidates to learn skills was 183 and it was increased from 4.4% of all research in the period 1979-1988 to 33.2% in period 1989-2000 then slightly decreased to 31.2% in period 2001-2012. Ultrasonography was on the top and was present in 99 out of 183 (54.1%) followed by laparoscopy (30, 16.4%), hysteroscopy (25, 13.7%), IVF-ET and related techniques (16, 8.7%) and colposcopy (13, 7.1%) researches. Multi-disciplinary research was decreased by 61.7% in the period 2001-2012. Researches in academic fields were abandoned and in some clinically important areas like preeclampsia were decreased. CONCLUSION: Scientific research of master's and doctoral theses and essays was comprehensive, updated, and had some autonomy independent of plans. Research which enable the candidate to learn skills were increased on the expense of academic, clinical and multidisciplinary research. It could be recommended that plans for scientific research should be flexible and should leave a space for local departmental views. Proper training of residents during their rotation in these subspecialties may help to revive the lost interest in clinically important areas.

Levonorgestrel-releasing intrauterine device versus dydrogesterone for management of endometrial hyperplasia without atypia.

OBJECTIVE: To compare the efficacy and safety of the levonorgestrel-releasing intrauterine device (LNG-IUD) with dydrogesterone applied for the same duration in patients having endometrial hyperplasia (EH) without atypia. MATERIALS AND METHODS: One hundred thirty eight women aged between 30 and 50 years with abnormal uterine bleeding and diagnosed as EH by transvaginal ultrasound were randomized to receive either LNG-IUD or dydrogesterone for 6 months. Primary outcome measures were regression of hyperplasia after 6 months of therapy. Secondary outcome measures were occurrence of side effects during treatment or recurrence of hyperplasia during follow-up period. RESULTS: After 6 months of treatment, regression of EH occurs in 96% of women in the levonorgestrel-releasing intrauterine system (LNG-IUS) group versus 80% of women in the oral group (P < .001). Adverse effects were relatively common with minimal differences between the 2 groups. Intermenstrual vaginal spotting and amenorrhea were more common in the LNG-IUD group (P value .01 and .0001). Patient satisfaction was significantly higher in the LNG-IUS group (P value .0001). Hysterectomy rates were lower in the LNG-IUS group than in the oral group (P = .001). Recurrence rate was 0% in the LNG-IUD group compared to 12.5% in the oral group. CONCLUSION: In management of EH without atypia, LNG-IUS achieves a higher regression and a lower hysterectomy rate than oral progesterone and could be used as a first-line therapy.

Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach.

OBJECTIVE: The aim of this retrospective cohort study was to evaluate maternal and neonatal outcomes in patients with placenta previa (PP) and placenta accreta (PA). METHODS: The study population comprised all patients who had a cesarean section for PP and PA at a tertiary referral hospital in Taif, Kingdom of Saudi Arabia, from December 2009 to December 2012. Maternal and neonatal data were obtained from medical records and the hospital database system. PA cases were managed by a multispeciality team, including two obstetric consultants. RESULTS: In total, 122 patients with PP were identified, with PA found in 25 cases. The median intraoperative blood loss in cases of PA was 2,000 (mean 3,000) mL, with a loss of ≥2,000 mL occurring in 72%, and ≥5,000 mL in 20%. The median packed red blood cell transfusion requirement was 6 (mean 7.7) units, and 28% received ≥10 units. Fetal growth restriction was diagnosed in two cases with known maternal medical disorders. Four cases (3.3%) were diagnosed as small for gestational age. The mean birth weight of the neonates was at the 10th-50th percentile according to Hadlock fetal growth charts. CONCLUSION: The presence of a second obstetric consultant among the multispeciality team during surgery for PA was associated with a reduction in blood loss and a decreased need for large-volume blood transfusion. The rate of fetal growth restriction/small for gestational age in PP was average, but the babies were relatively small (level 2 evidence).