Vaginal progesterone for prevention of preterm delivery in women with twin pregnancy: a randomized controlled trial.

BACKGROUND: The aim of this study is to evaluate the efficacy of vaginal progesterone to prevent preterm delivery in twin pregnancies and its effect on perinatal outcome. MATERIALS AND METHODS: A randomized, open label, controlled trial (NCT02350231) was carried out over 70 women, in three different hospitals in Egypt, between February 2015 and January 2017. All eligible pregnant women with twin pregnancies were randomly allocated in a 1:1 ratio into two groups. Group I (Progesterone group) was dispensed, 400 mg of progesterone through a vaginal pessary, each day at bedtime, from the 28th week of pregnancy until delivery. Group II (Control group) received no treatment other than the normal tonics taken during pregnancy. The two study groups were followed until delivery. The primary outcome was the rate of preterm delivery <37 weeks. RESULTS: No significant differences were observed among both groups of women in terms of delivery <37 weeks (16.9% versus 25.4%; p=0.06) and mode of delivery (vaginal versus cesarean; p=0.31). The mean gestational age at delivery was comparable between both groups (p=0.09). Additionally, no difference, regarding the neonatal outcome, was observed between both groups. CONCLUSION: Dispensing vaginal progesterone [400 mg] after 28 weeks of gestation does not prevent preterm delivery in twin gestations.

Sulfatides in ovarian tumors: clinicopathological correlates.

OBJECTIVES: To investigate the expression of sulfatides in the tissue homogenates of malignant ovarian tumors, benign ovarian tumors, and control tissues and to study the relation between this marker and other clinico-pathological criteria such as the tumor type, grade of differentiation, surgical stage and ovulatory years. DESIGN: Cross-sectional study. SETTING: Department of Obstetrics and Gynecology and Department of Biochemistry, Assuit university hospital. SUBJECTS: Forty-six patients had malignant ovarian tumors. Sixteen patients had benign ovarian neoplasm. Thirty patients, with normal ovaries, represented the control group. METHODS: A sample of the tumor or from the normal ovary (the control group) was sent for histopathological and biochemical examination. Sulfatides were measured by a rapid and sensitive spectrophotometric method. RESULTS: There was a significant rise in benign tumors [median and range 43 (38-53)], than in the control group, 21 (18-31), P-value = 0.000. In malignant tumors, the median value of sulfatides was significantly higher than in benign tumors [127 (71-193), P-value = 0.000]. Sulfatides were significantly higher in patients with more ovulatory years and tumors of advanced stages (stage III/IV) and poor differentiation. CONCLUSIONS: Sulfatides may play a role in the pathogenesis of benign and malignant ovarian tumors. It may also predict advanced stages in patients who are apparently early stage. It is also a candidate to study of their association with response to chemotherapy.

Second-trimester pregnancy termination: comparison of three different methods.

The object of this study was to compare intravaginal misoprostol and dinoprostone (prostaglandin E2) for second-trimester pregnancy termination, and to examine the role of the nitric oxide donor, glyceryl trinitrate, as a possible alternative to prostaglandins to induce cervical ripening in second-trimester pregnancy termination. This was a randomised clinical trial. The trial involved pregnant women between 13 and 28 weeks' gestation admitted with clear medical or obstetric indications for pregnancy termination, and was carried out in the department of obstetrics and gynecology, Assiut University Hospital, Egypt. Patients were classified into Group A, where pregnancy termination was induced by vaginal misoprostol 100 micrograms every 4 hours with a maximum dose of 500 micrograms; Group B, where induction was by vaginal dinoprostone 6 mg every 6 hours with a maximum dose of 24 mg; and Group C, where induction involved vaginal glyceryl trinitrate 500 micrograms every 6 hours with a maximum dose of 2.5 mg. Twenty-four hours after the start of induction, the rate of complete abortion in the three groups was 100%, 66.67% and 0%, respectively. The rate of complete abortion was 100% in the nitric oxide (glyceryl trinitrate)-induced group after introducing a complementary procedure. The induction-abortion interval was significantly shorter, the number of doses needed was less and the maximum Bishop score reached was greater with misoprostol than with dinoprostone. A higher rate of side effects occurred with the misoprostol-induced group (74%) compared with the other two groups (46.6% and 0%). Misoprostol is a cheap, effective drug for second-trimester pregnancy termination with short induction abortion intervals but a higher rate of side effects. Prostin E2 is also effective in termination of second-trimester pregnancy but is expensive and may require high doses to be administered. Glyceryl trinitrate is an effective drug for cervical ripening (softening) but it has no role in the stimulation of uterine contractions.

Maternal and fetal serum nitric oxide (NO) concentrations in normal pregnancy, pre-eclampsia and eclampsia.

OBJECTIVES: To measure the maternal and fetal serum concentrations of total nitrites and nitrates (as an index of nitric oxide production) in normal pregnancy, pre-eclampsia and eclampsia. DESIGN: Three groups of women were studied cross-sectionally: late pregnant women with pre-eclampsia and eclampsia (n=31); normal late pregnant women (n=32); and age-matched healthy non-pregnant women (n=21). Venous blood samples were collected from all women and both maternal and umbilical venous samples were collected from pregnant women. METHODS: Blood samples were assayed for nitric oxide (NO) production by Greiss reaction which measures the combined oxidation products of NO (total nitrites and nitrates). RESULTS: There was a significant increase in serum total nitrites and nitrates concentrations in normal pregnant women than in the serum of age-matched normal non-pregnant women (P<0.0001). Significantly higher total nitrites and nitrates levels were found in the maternal sera of the pre-eclamptic and eclamptic women compared with those of normal pregnant women (P<0.0001). Also, fetal blood levels of total nitrites and nitrates were significantly increased in pre-eclampsia and eclampsia compared with those of normal pregnancy (P<0.0001). CONCLUSIONS: (1) Serum nitric oxide (NO) production is increased in normal pregnancy than in the normal non-pregnancy. (2) Maternal and fetal serum NO levels are increased significantly in pre-eclampsia and eclampsia, which possibly represents a compensatory/protective mechanism to maintain blood flow and limit platelets aggregation in the fetal-maternal circulations. (3) The increase in NO production is directly related to the severity of pre-eclampsia; this would be of diagnostic significance for the prediction of the severity of this syndrome.

Hysteroscopic myometrial biopsy in unexplained abnormal uterine bleeding.

OBJECTIVES: To define the value of hysteroscopic myometrial biopsy in unexplained abnormal uterine bleeding not responding to hormonal treatment and to compare two hysteroscopic biopsy techniques. DESIGN: A prospective cross-sectional comparative study. SETTING: Gynecologic Endoscopy Unit, Assiut University Hospital, Egypt. PATIENTS: It comprised 99 patients with abnormal uterine bleeding who underwent transvaginal ultrasonography, endometrial biopsy and diagnostic hysteroscopy, which revealed no local lesions. INTERVENTIONS: Operative hysteroscopy was performed for 62 of them (group A). Hysteroscopic myometrial biopsies were taken using rigid biopsy forceps and the resectoscope successively guided by the previous ultrasonography of the myometrium. Thirty-seven patients (group B) underwent total abdominal hysterectomy followed by multiple full-thickness myometrial biopsies of the specimens. RESULTS: Pathologic myometrium was diagnosed in 12 (19%), 27 (43%) and 21 (56.5%) biopsies taken with the rigid biopsy forceps and the resectoscope (group A) and full-thickness biopsies (group B) respectively. Thirty biopsies (48%) taken with the rigid biopsy forceps were inadequate for proper histopathologic assessment while thermal effect was excessive in only four biopsies (6%) taken with the resectoscope. Honeycomb sonographic appearance was specific in prediction of adenomyosis. CONCLUSIONS: Resectoscopic myometrial biopsy can explain the cause of persistent abnormal uterine bleeding in about 43% of cases. Myometrial biopsy using the rigid biopsy forceps is inadequate and is not recommended.

Simplified biophysical profile: an antepartum fetal screening test.

A total of 330 high-risk pregnant women with gestational ages of 32-42 weeks were followed until delivery using the biophysical profile (BPP) and a screening test consisting of the amniotic fluid index together with fetal acoustic stimulation under ultrasound M-mode scanning. The test was compared with the BPP and nonstress test (NST) for predicting abnormal outcome. The sensitivities of the BPP, NST and the proposed test were 100, 98.4 and 100%, respectively, the negative predictive values were 100, 99.4 and 100%, while the false-positive rates were 21.3, 39.3 and 67%. Our simplified biophysical testing method is suggested to be a good negative preliminary screening test, while positive results require further fetal testing methods. This test reduced the need for BPP in many high-risk patients and had the advantages of simplicity, low cost and less time consumption.

A study on a new intrauterine contraceptive device the Beospir in a rural community.

PIP: At the family planning centers at Damanhour and Zagazig University Hospitals, 300 women were chosen from more than 2000 volunteers to be fitted with the Beospir, a polyethylene IUD. The women were then studied for 3600 menstrual cycles. The insertion technique, which is the same as used with the Lippes Loop, is described. Junior staff were trained in the proper techniques of insertion, follow-up treatment, and removal for the study. Only 10 expulsions occurred. No IUD was removed for pain or bleeding. Only 1 pregnancy occurred in the series. The series resulted in 83.6% of symptom-free follow ups. It is concluded that the Beospir is acceptable to this population due to its ease of insertion, lack of needed follow-up, and lack of serious side effects.^ieng