Background: One significant procedure in the field of gynaecology with several indications is the... more Background: One significant procedure in the field of gynaecology with several indications is the hysterectomy. Hysterectomy has become less intrusive and has less risks thanks to improvements in surgical technique and materials. Total laparoscopic hysterectomy (TLH) is currently a popular practise in gynecologic surgery. Objective: To compare the effects of the laparoscopic approach versus the vaginal route for the management of vaginal cuff closure during total laparoscopic hysterectomy. Patients and methods: The present study was a randomized controlled study conducted on 40 women attending the outpatient gynecology clinic of Al-Azhar University Hospital (New Damietta) and were planned to undergo hysterectomy for benign causes according to the inclusion/exclusion included in the study. The present study was conducted on two groups Group A had vaginal suturing for vaginal vault after total laparoscopic hysterectomy; Group B had laparoscopic suturing for virginal vault after total laparoscopic hysterectomy. Results: Operative time in minutes and suturing time showed significant increase in group 2 (laparoscopic suture) when compared to group A (vaginal suture) (P=0.012 and >0.001) respectively. VAS score show significant increase in group A when compared to group 2 (p<0.001). Post-operative complications, post-operative vaginal bleeding, Vaginal cuff hematoma, Vaginal dehiscence, post-operative infection showed significant increase in group A when compared to group 2. Blood loss showed significant increase in group A when compared to group 2 (p=<0.001). Previous CS and BMI didn't significant correlation with operative time in minutes (p>0.05). Conclusion: Laparoscopic vaginal cuff closure for complete laparoscopic hysterectomy appears to be secure, simple, and efficient. However, it requires more time than vaginal suture closure.
Background: The rectus sheath is closed during a cesarean section using a variety of methods and ... more Background: The rectus sheath is closed during a cesarean section using a variety of methods and suture materials. To ensure optimal healing and minimize problems, a few general guidelines should be followed while sealing the anterior abdominal wall. All sutures used to seal the musculofascial wall must be tightened to roughly resemble the incision's margins. The tissue will become ischemic and necrosis will form if a further strain is applied. Objective: The purpose of this study was to compare the Knotless suture technique to traditional techniques in rectus sheath closure after a cesarean section. Patients and Methods: In this randomized control study 90 patients undergoing cesarean section were divided into two equal groups in the Obstetrics and Gynecology Department at Al-Azhar University hospitals of Damietta for elective cesarean section. Results: In the present study, there was no statistically significant difference between study groups as regards infection of wound dehiscence at 1 st week. Also, there was a statistical increase in the number of granulomas and discomfort in group B than in group A. Conclusion: In conclusion, we can say knotless suture for rectus sheath closure post-CS could save time and provide an effective method for closure of rectus sheath with a lower risk of complications, postoperative pain, and discomfort.
Background: Surgical management of vaginal vault prolapse post hysterectomy has improved with the... more Background: Surgical management of vaginal vault prolapse post hysterectomy has improved with the use of the recto suspension technique. The technique is also used for prolapsing of the posterior vaginal wall rectus sheath suspension was described as a quick procedure with low morbidity and a short hospital stay. Objective: This study was aimed to evaluate rectus sheath suspension used as a treatment for vaginal vault prolapse after total abdominal hysterectomy. Patients and Methods: This interrupted time series clinical trial estimated the value of rectus sheath suspension of vaginal vault which was done on 50 patients undergoing total abdominal hysterectomy, at the
Background: Human papillomavirus (HPV) infections remain a significant problem worldwide particul... more Background: Human papillomavirus (HPV) infections remain a significant problem worldwide particularly in underdeveloped countries. To develop cervical cancer, it is necessary to have a persistent infection with a high-risk or oncogenic HPV. Objectives: This study aimed to detect the HPV and its possible genotypes in cervical samples from some Egyptian female patients, histopathologically diagnosed to have cancer cervix; to guide the introduction of prophylactic vaccines. Patients and methods: Fifty women were recruited. Pap smears were taken and examined, followed by colposcopic examinations, pathologic examination, and HPV detection in cervical samples by polymerase chain reaction (PCR). Then HPV genotyping of positive samples was done by restriction fragment length polymorphism (RFLP). Results: HPV-DNA was detected in 40 % of patients. HPV 16 was detected in 25 %, HPV 31 in 20 %, HPV 11in 15 %, HPV 6 in 10 %, and HPV 18 in 5% of cases. About 25% (5/20) cervical cancer specimens exhibited multiple infections by HPV genotypes 16and 18, which showed a higher risk for development of cancer cervix. Correlations of age, age-specific prevalence, residence, multiple marriages, parity, contraceptives, and its duration, diabetes mellitus were statistically significant .while correlations of occupation, level of education, age at marriage, duration of marriage, recurrent and chronic infections, smoking, and family history of cancers were insignificant. Conclusions: The prevalence of HPV in cancer cervix was 40%.So, the association between HPV and the development of cancer cervix in the studied Egyptian women cannot be fully established. HPV infection was mostly (75%) in the form of single infections with HPV16, 18, 31, 11, and 6 genotypes. However, HPV infections in multiple forms, 16+18 genotypes were in 25% of positive cases.
Background: Childbirth is physically challenging and can be accompanied by psychological stress. ... more Background: Childbirth is physically challenging and can be accompanied by psychological stress. Women have a strong desire for safe, supportive, kind, respectful and responsive care during labor and birth. Aim: Evaluate the effect of supportive care provided to women by companion during labor on labor progress and maternal satisfaction. Subjects and Method: Design: Quasi-experimental design was used. Setting : study conduct at antenatal clinic in medical center in Damietta city at labor unit in Al-Azhar university hospital on 150 parturient women divided to to groups (control group and study group each group was 75 particioant) who attending the labor unit. Tools: data collected using structured interviewed questionnaire, Observation checklists and Satisfaction scale. Results:. 84% of the companions demonstrated adequate supportive care.Significantly shorter durations of Stage I and Stage II were revealed among women in the study group compared with control group. In total, 86.7% of the women in the study group were satisfied with the labor process, compared with 20.0% in the control group (p<0.001). Conclusion: supportive care from a companion is effective in shortening the duration of labor and higher levels of satisfaction among laboring women. Recommendations: Establish systems, protocols, policies and strategies to enhance the application of companion support during labor.
Background: Severe pre-eclampsia occurring remote from the term is a decision-making dilemma for ... more Background: Severe pre-eclampsia occurring remote from the term is a decision-making dilemma for the obstetrician, the general recommendation is that women with severe pre-eclampsia should be delivered to avoid maternal complications; others recommend prolonging pregnancy in most cases of severely premature pre-eclamptic gestation until the development of fetal lung maturity, development of fetal or maternal distress, or achievement of gestational age of 34 to 36-week of gestation. The cutoff level of pulmonary artery acceleration time to ejection time ratio [PAT/ET] that determines fetal lung maturity in cases of severe pre-eclampsia [PE] is not determined yet. Aim of the work: To study the Doppler indices of the main fetal pulmonary artery and their role in predicting respiratory distress syndrome [RDS] in severe pre-eclampsia. Patients and Methods: A prospective longitudinal cohort research was designed in which 102 pregnant women with PE were chosen and fetal pulmonary artery flow velocity data were acquired by Doppler ultrasound and linked with the development of neonatal RDS. Results: The AT/ET ratio in the fetal pulmonary artery velocity waveform was found to be directly related to the development of newborn RDS. A cutoff value of 0.3 resulted in a sensitivity of 71.4%, specificity of 79.7%, and total accuracy of 77.5%. Conclusion: A high AT/ET ratio in the fetal pulmonary artery is related to the future development of RDS in neonates of mothers with severe pre-eclampsia, implying that fetal pulmonary artery Doppler ultrasound may be a valuable tool in the identification of fetal lung maturity in situations of severe pre-eclampsia.
Background: Regular antenatal care [ANC] attendance is surely lead to healthier pregnancies and r... more Background: Regular antenatal care [ANC] attendance is surely lead to healthier pregnancies and reposeful deliveries. Therefore, women with late visits considered at risk of poor pregnancy outcomes. Aim of the work: This study aimed to explore factors affecting early initiation of ANC attendance in Damietta governorate, Egypt. Patients and Methods: An institutional based cross-sectional study of 160 pregnant women that collected for five months from October 2019 to February 2020 in public health facilities in Damietta Governorate, Egypt were included in the study. The time of their first antenatal [early or late] had been documented. In addition their sociodemographic data were registered. Other obstetric factors were collected and include parity, past history of obstetric complications, previous antenatal care visits and intention of pregnancy, access to information about ANC and interaction with health professional. Reinforcing factors [e.g., perception of mothers of the advantages of the ANC, intention of partner toward ANC service utilization, reasons that initiate mothers to start ANC after 13 weeks timing of ANC visit and frequency of the ANC, and a decision made to seek ANC]. Results: The mother's age, husband's age, number of living children and age of the youngest child were significantly lower in the early than late ANC groups [23.75±5.74, 29.11±6.54, 0.95±0.92, and 2.55±2.60 vs. 28.20±6.91, 34.16±7.98, 1.73±1.14, and 4.17±3.37, respectively]. Females from rural area were significantly increase in early ANC than late ANC [70.1% vs 29.9%], while urbans were lower in early than late ANC visits [47.9% vs 52.1%]. Early ANC visits were significantly associated with high income, gravidity, parity, mode of delivery, follow up status of the past pregnancy, number of visits in the past pregnancy, place of the last delivery, and planning for pregnancy. Conclusion: There are numerous factors affecting early or late first ANC visit including mother and husband age, residence, gravidity, parity, and mode of the past delivery.
Background: Hysterectomy is a common gynecological surgical intervention, which could be associat... more Background: Hysterectomy is a common gynecological surgical intervention, which could be associated with increased female morbidity and mortality. Bleeding and pain represent two main complications associated with hysterectomy. Hemostatic measures are in a continuous development, and LigaSure could represent one of the most important milestones in this field. Aim of the work:To compare LigaSure use versus conventional suturing in total abdominal hysterectomy. Patients and Methods:Seventy patients who were scheduled for elective hysterectomy were included. They were assigned to equal groups [Ligasure [A] and Conventional suturing [B]]. All were screened preoperatively, prepared and both intra-and post-operative outcome were registered and compared between both groups [mainly blood loss and postoperative pain]. Results: Both groups were comparable as regard to patient age, body mass index, parity, and indications for hysterectomy. Operative time was significantly reduced among vessel...
Background: Oxidative stress was proposed to play a role in pathophysiology of prematurity. Nacet... more Background: Oxidative stress was proposed to play a role in pathophysiology of prematurity. Nacetylcysteine had been hypothesized to have preventive role on prematurity. Aim of the work: to study the effect of N-acetylcystiene in prevention of idiopathic preterm labor. Patients and methods: it was an clinical longitudinal prospective observational study conducted in Obstetrics & Gynecology department, Al-Azhar University hospital, New Damietta at the period from January to December 2015. It included 50 Pregnant women with previous history of idiopathic preterm labor. All included Pregnant women were submitted to: 1) Careful history taking, clinical examination and investigations. IL-8 was measured before administration of N-acetylcystiene. Then, each patient received daily dose of 0.6 g of NAC in oral effervescent from. The duration of NAC administration extended from 24 to 36 weeks’ gestation. All females were followed up for nausea, vomiting, and other side effects of (NAC), after...
Background: First-trimester ultrasound measurements of crown–rump length (CRL) have also been dem... more Background: First-trimester ultrasound measurements of crown–rump length (CRL) have also been demonstrated to be accurate predictors of birth weight; fetal growth impairment begins in the first trimester and had been shown to result in adverse pregnancy outcomes. Aim of the work: was to evaluate the correlation between first trimester CRL and macrosomia at birth. Patients and Methods: This was a prospective study included 152 pregnant women with gestational age of first trimester divided into 2 groups according to ultrasound measurement of Crownrump length and the association between CRL and macrosomia at birth was recorded and statistically analyzed. Results: There were statistical significant correlation between Actual birth weight and first trimester Crown rump length where (0.288, p-value= 0.0002). Conclusion and recommendation: The result of the present study showed if CRL more than expected, birth weight will be more than normal, so measurement of first trimester CRL is useful...
Background: Preeclampsia is one of complications of pregnancy. It is responsible for morbidity fo... more Background: Preeclampsia is one of complications of pregnancy. It is responsible for morbidity for mother and fetus. Preeclampsia is a pregnancy multisystem disorder. Abnormal lipid profile has an effect on endothelial dysfunction. The association of serum lipid profile with preeclampsia is suggested to reflect new diagnostic tools. Pregnancy dyslipidemia is associated with an increased risk of preeclampsia. Compared to healthy pregnancy, women with preeclampsia have an abnormal lipid profile. Aim of the work: The aim of this work is comparison between normotensive women and preeclamptic women by serum lipid profile at third trimester. Patients and Methods: The present study conducted on 70 pregnant women in the Department of Obstetrics and Gynecology, at Al-Azhar University hospital [Damietta], which was conducted during 2019 [from April to December]. A study comprised 35 normotensive pregnant women as controls and 35 preeclampsia cases. The blood samples were analyzed for serum t...
Background: Intrauterine growth restriction [IUGR] represented a challenging health problem, face... more Background: Intrauterine growth restriction [IUGR] represented a challenging health problem, faced during daily clinical practice. Early diagnosis is of crucial importance. Aim of the work: To determine the value of the aortic isthmic flow index and the left mod-myocardial performance index [MPI] in the prediction of adverse perinatal outcomes in fetuses affected by IUGR. Patients and Methods: Forty Singleton fetuses with IUGR between 28 and 34 weeks were recruited. The left mod-MPI and the isthmic flow index [IFI] were calculated. Ultrasound indices had been correlated with perinatal outcome. Results: There was a statistically significant association between abnormal aortic isthmus diastolic flow and low 1-minute Apgar score and neonatal intensive care unit [NICU] admission. There was a statistically significant association between the left mod-MPI and the meconium stained amniotic fluid [AF], the need for Neonatal resuscitation, NICU admission, neonatal sepsis, and neonatal death. When considering cutoff value for prediction of adverse fetal outcome by Left MPI, a cutoff of 0.53 confers 85.2% sensitivity, 80% specificity, PPV 92%, NPV 66.7%, and accuracy of 83.8%. In addition, 85% of fetuses had normal Aortic isthmus [AoI] waveform [IFI type I] and 15% had abnormal AoI waveform, and there was a statistically significant association between abnormal AoI diastolic flow and each of [IFI of II, III, V], [low 1-minute Apgar score] and [NICU admission]. Conclusion: AoI IFI and left mod-MPI could be considered valuable for the assessment of chronic placental insufficiency, and play a role in prediction of adverse perinatal outcome associated with IUGR.
BACKGROUND: Clomiphene citrate (CC) is the most commonly used drug for treating anovulatory infer... more BACKGROUND: Clomiphene citrate (CC) is the most commonly used drug for treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS), have shown a discrepancy between ovulation and pregnancy rates. This may be partly explained by the peripheral antiestrogenic effects at the level of the endometrium and cervical mucus, by hypersecretion of LH, or due to negative effects of CC on oocytes or granulosa cells (GC). It can be argued that these negative effects are augmented by the relatively long half-life of CC which is known to be 5 days. If treatment is started late in the cycle preceding the induced cycle, those negative effects are more likely to extend into the sensitive peri-implantation period. In the present study we compare the effect of late luteal phase CC administration to early follicular phase day 3 on induction of ovulation and several ultrasonographic markers of uterine receptivity in PCOS patients. METHODS: The present study is designed as a prospective clinical study. Two hundred (200) infertile women aged 20-35 years old with the diagnosis of PCOS with oligo-hypomenorrhea were be examined at Faculty of Medicine Al-Azhar University, Damietta in department of Obstetrics and Gynecology at the Infertility Outpatient Clinic. Group I (study group, late luteal phase CC): included 100 PCO patients to whom 100 mg of clomiphene citrate were administered daily for five days starting the next day after finishing medroxyprogesterone acetate (MPA) 10 mg tablets for 5 days. Group II (control group, early follicular phase CC): included 100 PCO patients to whom 100 mg of clomiphene citrate were administered daily for five days starting in day 3 of withdrawal bleeding induced by medroxyprogesterone acetate (MPA) 10 mg tablets for 5 days. RESULTS: The proportion of women who had more than one mature follicle was significantly higher in women in study group when compared to women in control group (P=0.009).The mean endometrial thickness at day of human chorionic gonadotropin (hCG) administration was significantly higher among women in study group when compared to women in control group (P<0.001). The mean endometrial and subendometrial resistance index (RI) at day of hCG administration and midluteal was significantly lower (denoting higher subendometrial blood flow) among women in study group when compared to women in control group (P<0.05). CONCLUSIONS: Late luteal phase clomiphene citrate results in significant growth of more than one mature follicle and improve endometrial blood flow compared to early follicular phase CC.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: Congenital heart diseases are the commonest fetal congenital defects and until nowada... more Background: Congenital heart diseases are the commonest fetal congenital defects and until nowadays most of them are bypassed without prenatal diagnosis to be still considered as unexplained stillbirths or perinatal deaths. In this study, we tried to prove the importance of routine fetal cardiac screening in the ANC visits and also confirming its high accuracy. Methods: This study was prospective longitudinal one, including doing ISUOG extended fetal cardiac screening for one hundred foetuses scheduled at certain gestational age visits, whom their half were at risks for CHDs and the other were not, with comparing the results to antenatal and postnatal detailed fetal echocardiography. Results: The best gestational age for the fetal cardiac screening was at 18-22 weeks gestation. The accuracy of the screening to the antenatal echocardiogram was 96%-100% and to the postnatal one was 96%-98%. Conclusions: CHDs are still the commonest congenital fetal defects and the antenatal fetal cardiac screening by extended basic views has high accuracy. Making this screening a routine in ANC visits will be of great help in improving the fetal outcome.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: The hepatitis C treatment effect on ovarian reserve of the treated women and so on th... more Background: The hepatitis C treatment effect on ovarian reserve of the treated women and so on their reproductive potential attracting the attention and becoming an issue of concern. In this study, we examine the possible action of interferon and ribavirin regimen on the ovarian reserve through assessing the change of AMH level pre-and posttreatment. Methods: This study is a prospective longitudinal one, includes fifty women in childbearing period with chronic HCV infection fulfilling the criteria of attending the Egyptian national program for HCV treatment and has been referred for antiviral therapy with PEG IFN-α2a or PEG IFN-α2b, plus oral ribavirin for a total of 48 weeks. All patients were tested to AMH level at the beginning of the treatment program (the mean AMH level was 1ngml-3ngml) and retested at the end of treatment program. In addition, they examined by vaginal ultrasound to measure ovarian volume. Results: At the end of the treatment program 28% of the studied cases remain within pre treatment level of AMH & in 32% of the studied cases the level of AMH decreased where's in 40% of the studied cases the level of AMH increased. Conclusions: It is likely that interferon and ribavirin affect ovarian reserve of treated patients as a change occurs in the level of AMH in 72% of them.
Background: Excessive menstrual loss, or menorrhagia, is a significant health care problem in the... more Background: Excessive menstrual loss, or menorrhagia, is a significant health care problem in the developed world. Surgical management had been the standard of treatment in menorrhagia due to organic causes (eg, fibroids) or when medical therapy fails to alleviate symptoms. A number of minimally invasive treatment options are now available, but the final consensus on the best treatment modality is still to be determined. The novel operation of bilateral uterine artery ligation (BUAL operation) as an alternative to hysterectomy seems to be a promising treatment of both menorrhagia and most of the associated uterine pathology. Our objective: was to determine the feasibility of transvaginal bilateral uterine artery ligation as a conservative minimally invasive treatment for refractory menorrhagia. Methods: The study included 50 women of gynecology outpatient department of Damietta university hospital (Al-Azhar University) attendants with refractory menorrhagia; where other types of therapy as medical and hormonal had failed to control the bleeding. For all cases; pre and post-procedural clinical assessment and ultrasound Doppler study were done to evaluate the changes. Results: At 12 months postoperative, there was a statistically significant decrease in the following measured outcomes: menstrual blood loss (84%); dysmenorrhea (85.7%); dyspareunia (33.3%); uterine volume (30.1%). Conclusion: Transvaginal bilateral uterine artery ligation(VBUAL) was found to be a safe, efficacious, feasible, cost-effective procedure with good patient satisfaction rates with a conservative approach for treating refractory menorrhagia.
Objective: To identify polymorphism of methylenetetrahydrofolate reductase gene in women sufferin... more Objective: To identify polymorphism of methylenetetrahydrofolate reductase gene in women suffering from preeclampsia. Study design: From 142 pregnant women we identify 92 women suffer from preeclampsia and 50 healthy controls with normal pregnancy matched for age and socioeconomic status, preeclampsic patient classified as mild preeclampsia 42(45.7%) and severe preeclampsia 50(54.3%). Blood samples were tested for DNA polymorphism affecting thrombophilia methylenetetrahydrofolate reductase C677T and A1298C. Results: Homozygous TT genotype, T allele of C677T polymorphism has a significantly higher frequency among preeclampsic cases compared to healthy controls (OR=21.7, 1.46, respectively). Thus TT genotype and T allele may be considered as genetic risk factors for preeclampsic cases. on the other hand, non significant association in either genotype among preeclampsic cases compared to controls regarding to A1298C.
Background: One significant procedure in the field of gynaecology with several indications is the... more Background: One significant procedure in the field of gynaecology with several indications is the hysterectomy. Hysterectomy has become less intrusive and has less risks thanks to improvements in surgical technique and materials. Total laparoscopic hysterectomy (TLH) is currently a popular practise in gynecologic surgery. Objective: To compare the effects of the laparoscopic approach versus the vaginal route for the management of vaginal cuff closure during total laparoscopic hysterectomy. Patients and methods: The present study was a randomized controlled study conducted on 40 women attending the outpatient gynecology clinic of Al-Azhar University Hospital (New Damietta) and were planned to undergo hysterectomy for benign causes according to the inclusion/exclusion included in the study. The present study was conducted on two groups Group A had vaginal suturing for vaginal vault after total laparoscopic hysterectomy; Group B had laparoscopic suturing for virginal vault after total laparoscopic hysterectomy. Results: Operative time in minutes and suturing time showed significant increase in group 2 (laparoscopic suture) when compared to group A (vaginal suture) (P=0.012 and >0.001) respectively. VAS score show significant increase in group A when compared to group 2 (p<0.001). Post-operative complications, post-operative vaginal bleeding, Vaginal cuff hematoma, Vaginal dehiscence, post-operative infection showed significant increase in group A when compared to group 2. Blood loss showed significant increase in group A when compared to group 2 (p=<0.001). Previous CS and BMI didn't significant correlation with operative time in minutes (p>0.05). Conclusion: Laparoscopic vaginal cuff closure for complete laparoscopic hysterectomy appears to be secure, simple, and efficient. However, it requires more time than vaginal suture closure.
Background: The rectus sheath is closed during a cesarean section using a variety of methods and ... more Background: The rectus sheath is closed during a cesarean section using a variety of methods and suture materials. To ensure optimal healing and minimize problems, a few general guidelines should be followed while sealing the anterior abdominal wall. All sutures used to seal the musculofascial wall must be tightened to roughly resemble the incision's margins. The tissue will become ischemic and necrosis will form if a further strain is applied. Objective: The purpose of this study was to compare the Knotless suture technique to traditional techniques in rectus sheath closure after a cesarean section. Patients and Methods: In this randomized control study 90 patients undergoing cesarean section were divided into two equal groups in the Obstetrics and Gynecology Department at Al-Azhar University hospitals of Damietta for elective cesarean section. Results: In the present study, there was no statistically significant difference between study groups as regards infection of wound dehiscence at 1 st week. Also, there was a statistical increase in the number of granulomas and discomfort in group B than in group A. Conclusion: In conclusion, we can say knotless suture for rectus sheath closure post-CS could save time and provide an effective method for closure of rectus sheath with a lower risk of complications, postoperative pain, and discomfort.
Background: Surgical management of vaginal vault prolapse post hysterectomy has improved with the... more Background: Surgical management of vaginal vault prolapse post hysterectomy has improved with the use of the recto suspension technique. The technique is also used for prolapsing of the posterior vaginal wall rectus sheath suspension was described as a quick procedure with low morbidity and a short hospital stay. Objective: This study was aimed to evaluate rectus sheath suspension used as a treatment for vaginal vault prolapse after total abdominal hysterectomy. Patients and Methods: This interrupted time series clinical trial estimated the value of rectus sheath suspension of vaginal vault which was done on 50 patients undergoing total abdominal hysterectomy, at the
Background: Human papillomavirus (HPV) infections remain a significant problem worldwide particul... more Background: Human papillomavirus (HPV) infections remain a significant problem worldwide particularly in underdeveloped countries. To develop cervical cancer, it is necessary to have a persistent infection with a high-risk or oncogenic HPV. Objectives: This study aimed to detect the HPV and its possible genotypes in cervical samples from some Egyptian female patients, histopathologically diagnosed to have cancer cervix; to guide the introduction of prophylactic vaccines. Patients and methods: Fifty women were recruited. Pap smears were taken and examined, followed by colposcopic examinations, pathologic examination, and HPV detection in cervical samples by polymerase chain reaction (PCR). Then HPV genotyping of positive samples was done by restriction fragment length polymorphism (RFLP). Results: HPV-DNA was detected in 40 % of patients. HPV 16 was detected in 25 %, HPV 31 in 20 %, HPV 11in 15 %, HPV 6 in 10 %, and HPV 18 in 5% of cases. About 25% (5/20) cervical cancer specimens exhibited multiple infections by HPV genotypes 16and 18, which showed a higher risk for development of cancer cervix. Correlations of age, age-specific prevalence, residence, multiple marriages, parity, contraceptives, and its duration, diabetes mellitus were statistically significant .while correlations of occupation, level of education, age at marriage, duration of marriage, recurrent and chronic infections, smoking, and family history of cancers were insignificant. Conclusions: The prevalence of HPV in cancer cervix was 40%.So, the association between HPV and the development of cancer cervix in the studied Egyptian women cannot be fully established. HPV infection was mostly (75%) in the form of single infections with HPV16, 18, 31, 11, and 6 genotypes. However, HPV infections in multiple forms, 16+18 genotypes were in 25% of positive cases.
Background: Childbirth is physically challenging and can be accompanied by psychological stress. ... more Background: Childbirth is physically challenging and can be accompanied by psychological stress. Women have a strong desire for safe, supportive, kind, respectful and responsive care during labor and birth. Aim: Evaluate the effect of supportive care provided to women by companion during labor on labor progress and maternal satisfaction. Subjects and Method: Design: Quasi-experimental design was used. Setting : study conduct at antenatal clinic in medical center in Damietta city at labor unit in Al-Azhar university hospital on 150 parturient women divided to to groups (control group and study group each group was 75 particioant) who attending the labor unit. Tools: data collected using structured interviewed questionnaire, Observation checklists and Satisfaction scale. Results:. 84% of the companions demonstrated adequate supportive care.Significantly shorter durations of Stage I and Stage II were revealed among women in the study group compared with control group. In total, 86.7% of the women in the study group were satisfied with the labor process, compared with 20.0% in the control group (p<0.001). Conclusion: supportive care from a companion is effective in shortening the duration of labor and higher levels of satisfaction among laboring women. Recommendations: Establish systems, protocols, policies and strategies to enhance the application of companion support during labor.
Background: Severe pre-eclampsia occurring remote from the term is a decision-making dilemma for ... more Background: Severe pre-eclampsia occurring remote from the term is a decision-making dilemma for the obstetrician, the general recommendation is that women with severe pre-eclampsia should be delivered to avoid maternal complications; others recommend prolonging pregnancy in most cases of severely premature pre-eclamptic gestation until the development of fetal lung maturity, development of fetal or maternal distress, or achievement of gestational age of 34 to 36-week of gestation. The cutoff level of pulmonary artery acceleration time to ejection time ratio [PAT/ET] that determines fetal lung maturity in cases of severe pre-eclampsia [PE] is not determined yet. Aim of the work: To study the Doppler indices of the main fetal pulmonary artery and their role in predicting respiratory distress syndrome [RDS] in severe pre-eclampsia. Patients and Methods: A prospective longitudinal cohort research was designed in which 102 pregnant women with PE were chosen and fetal pulmonary artery flow velocity data were acquired by Doppler ultrasound and linked with the development of neonatal RDS. Results: The AT/ET ratio in the fetal pulmonary artery velocity waveform was found to be directly related to the development of newborn RDS. A cutoff value of 0.3 resulted in a sensitivity of 71.4%, specificity of 79.7%, and total accuracy of 77.5%. Conclusion: A high AT/ET ratio in the fetal pulmonary artery is related to the future development of RDS in neonates of mothers with severe pre-eclampsia, implying that fetal pulmonary artery Doppler ultrasound may be a valuable tool in the identification of fetal lung maturity in situations of severe pre-eclampsia.
Background: Regular antenatal care [ANC] attendance is surely lead to healthier pregnancies and r... more Background: Regular antenatal care [ANC] attendance is surely lead to healthier pregnancies and reposeful deliveries. Therefore, women with late visits considered at risk of poor pregnancy outcomes. Aim of the work: This study aimed to explore factors affecting early initiation of ANC attendance in Damietta governorate, Egypt. Patients and Methods: An institutional based cross-sectional study of 160 pregnant women that collected for five months from October 2019 to February 2020 in public health facilities in Damietta Governorate, Egypt were included in the study. The time of their first antenatal [early or late] had been documented. In addition their sociodemographic data were registered. Other obstetric factors were collected and include parity, past history of obstetric complications, previous antenatal care visits and intention of pregnancy, access to information about ANC and interaction with health professional. Reinforcing factors [e.g., perception of mothers of the advantages of the ANC, intention of partner toward ANC service utilization, reasons that initiate mothers to start ANC after 13 weeks timing of ANC visit and frequency of the ANC, and a decision made to seek ANC]. Results: The mother's age, husband's age, number of living children and age of the youngest child were significantly lower in the early than late ANC groups [23.75±5.74, 29.11±6.54, 0.95±0.92, and 2.55±2.60 vs. 28.20±6.91, 34.16±7.98, 1.73±1.14, and 4.17±3.37, respectively]. Females from rural area were significantly increase in early ANC than late ANC [70.1% vs 29.9%], while urbans were lower in early than late ANC visits [47.9% vs 52.1%]. Early ANC visits were significantly associated with high income, gravidity, parity, mode of delivery, follow up status of the past pregnancy, number of visits in the past pregnancy, place of the last delivery, and planning for pregnancy. Conclusion: There are numerous factors affecting early or late first ANC visit including mother and husband age, residence, gravidity, parity, and mode of the past delivery.
Background: Hysterectomy is a common gynecological surgical intervention, which could be associat... more Background: Hysterectomy is a common gynecological surgical intervention, which could be associated with increased female morbidity and mortality. Bleeding and pain represent two main complications associated with hysterectomy. Hemostatic measures are in a continuous development, and LigaSure could represent one of the most important milestones in this field. Aim of the work:To compare LigaSure use versus conventional suturing in total abdominal hysterectomy. Patients and Methods:Seventy patients who were scheduled for elective hysterectomy were included. They were assigned to equal groups [Ligasure [A] and Conventional suturing [B]]. All were screened preoperatively, prepared and both intra-and post-operative outcome were registered and compared between both groups [mainly blood loss and postoperative pain]. Results: Both groups were comparable as regard to patient age, body mass index, parity, and indications for hysterectomy. Operative time was significantly reduced among vessel...
Background: Oxidative stress was proposed to play a role in pathophysiology of prematurity. Nacet... more Background: Oxidative stress was proposed to play a role in pathophysiology of prematurity. Nacetylcysteine had been hypothesized to have preventive role on prematurity. Aim of the work: to study the effect of N-acetylcystiene in prevention of idiopathic preterm labor. Patients and methods: it was an clinical longitudinal prospective observational study conducted in Obstetrics & Gynecology department, Al-Azhar University hospital, New Damietta at the period from January to December 2015. It included 50 Pregnant women with previous history of idiopathic preterm labor. All included Pregnant women were submitted to: 1) Careful history taking, clinical examination and investigations. IL-8 was measured before administration of N-acetylcystiene. Then, each patient received daily dose of 0.6 g of NAC in oral effervescent from. The duration of NAC administration extended from 24 to 36 weeks’ gestation. All females were followed up for nausea, vomiting, and other side effects of (NAC), after...
Background: First-trimester ultrasound measurements of crown–rump length (CRL) have also been dem... more Background: First-trimester ultrasound measurements of crown–rump length (CRL) have also been demonstrated to be accurate predictors of birth weight; fetal growth impairment begins in the first trimester and had been shown to result in adverse pregnancy outcomes. Aim of the work: was to evaluate the correlation between first trimester CRL and macrosomia at birth. Patients and Methods: This was a prospective study included 152 pregnant women with gestational age of first trimester divided into 2 groups according to ultrasound measurement of Crownrump length and the association between CRL and macrosomia at birth was recorded and statistically analyzed. Results: There were statistical significant correlation between Actual birth weight and first trimester Crown rump length where (0.288, p-value= 0.0002). Conclusion and recommendation: The result of the present study showed if CRL more than expected, birth weight will be more than normal, so measurement of first trimester CRL is useful...
Background: Preeclampsia is one of complications of pregnancy. It is responsible for morbidity fo... more Background: Preeclampsia is one of complications of pregnancy. It is responsible for morbidity for mother and fetus. Preeclampsia is a pregnancy multisystem disorder. Abnormal lipid profile has an effect on endothelial dysfunction. The association of serum lipid profile with preeclampsia is suggested to reflect new diagnostic tools. Pregnancy dyslipidemia is associated with an increased risk of preeclampsia. Compared to healthy pregnancy, women with preeclampsia have an abnormal lipid profile. Aim of the work: The aim of this work is comparison between normotensive women and preeclamptic women by serum lipid profile at third trimester. Patients and Methods: The present study conducted on 70 pregnant women in the Department of Obstetrics and Gynecology, at Al-Azhar University hospital [Damietta], which was conducted during 2019 [from April to December]. A study comprised 35 normotensive pregnant women as controls and 35 preeclampsia cases. The blood samples were analyzed for serum t...
Background: Intrauterine growth restriction [IUGR] represented a challenging health problem, face... more Background: Intrauterine growth restriction [IUGR] represented a challenging health problem, faced during daily clinical practice. Early diagnosis is of crucial importance. Aim of the work: To determine the value of the aortic isthmic flow index and the left mod-myocardial performance index [MPI] in the prediction of adverse perinatal outcomes in fetuses affected by IUGR. Patients and Methods: Forty Singleton fetuses with IUGR between 28 and 34 weeks were recruited. The left mod-MPI and the isthmic flow index [IFI] were calculated. Ultrasound indices had been correlated with perinatal outcome. Results: There was a statistically significant association between abnormal aortic isthmus diastolic flow and low 1-minute Apgar score and neonatal intensive care unit [NICU] admission. There was a statistically significant association between the left mod-MPI and the meconium stained amniotic fluid [AF], the need for Neonatal resuscitation, NICU admission, neonatal sepsis, and neonatal death. When considering cutoff value for prediction of adverse fetal outcome by Left MPI, a cutoff of 0.53 confers 85.2% sensitivity, 80% specificity, PPV 92%, NPV 66.7%, and accuracy of 83.8%. In addition, 85% of fetuses had normal Aortic isthmus [AoI] waveform [IFI type I] and 15% had abnormal AoI waveform, and there was a statistically significant association between abnormal AoI diastolic flow and each of [IFI of II, III, V], [low 1-minute Apgar score] and [NICU admission]. Conclusion: AoI IFI and left mod-MPI could be considered valuable for the assessment of chronic placental insufficiency, and play a role in prediction of adverse perinatal outcome associated with IUGR.
BACKGROUND: Clomiphene citrate (CC) is the most commonly used drug for treating anovulatory infer... more BACKGROUND: Clomiphene citrate (CC) is the most commonly used drug for treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS), have shown a discrepancy between ovulation and pregnancy rates. This may be partly explained by the peripheral antiestrogenic effects at the level of the endometrium and cervical mucus, by hypersecretion of LH, or due to negative effects of CC on oocytes or granulosa cells (GC). It can be argued that these negative effects are augmented by the relatively long half-life of CC which is known to be 5 days. If treatment is started late in the cycle preceding the induced cycle, those negative effects are more likely to extend into the sensitive peri-implantation period. In the present study we compare the effect of late luteal phase CC administration to early follicular phase day 3 on induction of ovulation and several ultrasonographic markers of uterine receptivity in PCOS patients. METHODS: The present study is designed as a prospective clinical study. Two hundred (200) infertile women aged 20-35 years old with the diagnosis of PCOS with oligo-hypomenorrhea were be examined at Faculty of Medicine Al-Azhar University, Damietta in department of Obstetrics and Gynecology at the Infertility Outpatient Clinic. Group I (study group, late luteal phase CC): included 100 PCO patients to whom 100 mg of clomiphene citrate were administered daily for five days starting the next day after finishing medroxyprogesterone acetate (MPA) 10 mg tablets for 5 days. Group II (control group, early follicular phase CC): included 100 PCO patients to whom 100 mg of clomiphene citrate were administered daily for five days starting in day 3 of withdrawal bleeding induced by medroxyprogesterone acetate (MPA) 10 mg tablets for 5 days. RESULTS: The proportion of women who had more than one mature follicle was significantly higher in women in study group when compared to women in control group (P=0.009).The mean endometrial thickness at day of human chorionic gonadotropin (hCG) administration was significantly higher among women in study group when compared to women in control group (P<0.001). The mean endometrial and subendometrial resistance index (RI) at day of hCG administration and midluteal was significantly lower (denoting higher subendometrial blood flow) among women in study group when compared to women in control group (P<0.05). CONCLUSIONS: Late luteal phase clomiphene citrate results in significant growth of more than one mature follicle and improve endometrial blood flow compared to early follicular phase CC.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: Congenital heart diseases are the commonest fetal congenital defects and until nowada... more Background: Congenital heart diseases are the commonest fetal congenital defects and until nowadays most of them are bypassed without prenatal diagnosis to be still considered as unexplained stillbirths or perinatal deaths. In this study, we tried to prove the importance of routine fetal cardiac screening in the ANC visits and also confirming its high accuracy. Methods: This study was prospective longitudinal one, including doing ISUOG extended fetal cardiac screening for one hundred foetuses scheduled at certain gestational age visits, whom their half were at risks for CHDs and the other were not, with comparing the results to antenatal and postnatal detailed fetal echocardiography. Results: The best gestational age for the fetal cardiac screening was at 18-22 weeks gestation. The accuracy of the screening to the antenatal echocardiogram was 96%-100% and to the postnatal one was 96%-98%. Conclusions: CHDs are still the commonest congenital fetal defects and the antenatal fetal cardiac screening by extended basic views has high accuracy. Making this screening a routine in ANC visits will be of great help in improving the fetal outcome.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: The hepatitis C treatment effect on ovarian reserve of the treated women and so on th... more Background: The hepatitis C treatment effect on ovarian reserve of the treated women and so on their reproductive potential attracting the attention and becoming an issue of concern. In this study, we examine the possible action of interferon and ribavirin regimen on the ovarian reserve through assessing the change of AMH level pre-and posttreatment. Methods: This study is a prospective longitudinal one, includes fifty women in childbearing period with chronic HCV infection fulfilling the criteria of attending the Egyptian national program for HCV treatment and has been referred for antiviral therapy with PEG IFN-α2a or PEG IFN-α2b, plus oral ribavirin for a total of 48 weeks. All patients were tested to AMH level at the beginning of the treatment program (the mean AMH level was 1ngml-3ngml) and retested at the end of treatment program. In addition, they examined by vaginal ultrasound to measure ovarian volume. Results: At the end of the treatment program 28% of the studied cases remain within pre treatment level of AMH & in 32% of the studied cases the level of AMH decreased where's in 40% of the studied cases the level of AMH increased. Conclusions: It is likely that interferon and ribavirin affect ovarian reserve of treated patients as a change occurs in the level of AMH in 72% of them.
Background: Excessive menstrual loss, or menorrhagia, is a significant health care problem in the... more Background: Excessive menstrual loss, or menorrhagia, is a significant health care problem in the developed world. Surgical management had been the standard of treatment in menorrhagia due to organic causes (eg, fibroids) or when medical therapy fails to alleviate symptoms. A number of minimally invasive treatment options are now available, but the final consensus on the best treatment modality is still to be determined. The novel operation of bilateral uterine artery ligation (BUAL operation) as an alternative to hysterectomy seems to be a promising treatment of both menorrhagia and most of the associated uterine pathology. Our objective: was to determine the feasibility of transvaginal bilateral uterine artery ligation as a conservative minimally invasive treatment for refractory menorrhagia. Methods: The study included 50 women of gynecology outpatient department of Damietta university hospital (Al-Azhar University) attendants with refractory menorrhagia; where other types of therapy as medical and hormonal had failed to control the bleeding. For all cases; pre and post-procedural clinical assessment and ultrasound Doppler study were done to evaluate the changes. Results: At 12 months postoperative, there was a statistically significant decrease in the following measured outcomes: menstrual blood loss (84%); dysmenorrhea (85.7%); dyspareunia (33.3%); uterine volume (30.1%). Conclusion: Transvaginal bilateral uterine artery ligation(VBUAL) was found to be a safe, efficacious, feasible, cost-effective procedure with good patient satisfaction rates with a conservative approach for treating refractory menorrhagia.
Objective: To identify polymorphism of methylenetetrahydrofolate reductase gene in women sufferin... more Objective: To identify polymorphism of methylenetetrahydrofolate reductase gene in women suffering from preeclampsia. Study design: From 142 pregnant women we identify 92 women suffer from preeclampsia and 50 healthy controls with normal pregnancy matched for age and socioeconomic status, preeclampsic patient classified as mild preeclampsia 42(45.7%) and severe preeclampsia 50(54.3%). Blood samples were tested for DNA polymorphism affecting thrombophilia methylenetetrahydrofolate reductase C677T and A1298C. Results: Homozygous TT genotype, T allele of C677T polymorphism has a significantly higher frequency among preeclampsic cases compared to healthy controls (OR=21.7, 1.46, respectively). Thus TT genotype and T allele may be considered as genetic risk factors for preeclampsic cases. on the other hand, non significant association in either genotype among preeclampsic cases compared to controls regarding to A1298C.
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