Ultrasound evaluation of the endometrial and ovarian function in infertile women
 Asim Kurjak, Radu Vlădăreanu, and Mona Zvâncă

Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia; and Elias University Hospital, Obstetrics and Gynecology Department, Bucharest, Romania

ABSTRACT

Since it was first introduced in clinical gynecological practice, ultrasound has profoundly evolved and has become an inseparable part of our diagnosis. Starting from transabdominal examination, passing to transvaginal approach and later, Doppler and three-dimensional examination, are the main steps of a technological progress that have made possible the evaluation of endometrial and ovarian function, the actual visualization of processes that we have only seen described in books.

Among all gynecological pathology, infertility seems to be the most challenging. With an increasing incidence, with deep social and psychological implications, it may be related to any kind of uterine, ovarian and, especially, fallopian anomalies. Diagnosing gross pathology is the main use of ultrasound, but lately great accent is put on depicting subtle deviations from the physiological processes that may explain cases of so called “idiopathic infertility”, one of the most frustrating diagnostics both for clinician and for the couple.

Key words: infertility, ultrasound, endometrium, ovulation, corpus luteum

(Back to index)
 

Misoprostol versus vacuum aspiration for incomplete abortion: a randomized controlled trial
 Iman AbdelMohsen, Khaled AbdelMalek, Hesham Al-Inany, and Diaa Sarhan

Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt

ABSTRACT

Objective: to evaluate the use of Misoprostol 400ug administered sublingually for women with incomplete abortion or retained products of conception as a single dose regimen comparing it with vacuum aspiration.

Design: randomized controlled trial

Materials and Methods: women with incomplete abortion or retained products of conception were randomly allocated in two groups: Group A: women managed medically by 400 mcg sublingual misoprostol sublingual Group B: Vacuum aspiration using manual vacuum aspiration. Women in both groups were seen after one week for a follow up visit to evaluate and compare the endometrial thickness between both groups using transvaginal ultrasound.

Results: Endometrial thickness has been decreased significantly either after sublingual misoprostol administration or after Vacuum aspiration. However, the sublingual misoprostol group had a thicker endometrial thickness than that of the vacuum aspiration group and this difference was highly significant statistically. 25% of women in the sublingual misoprostol group experienced second attack of hemorrhage within one week of intervention.

Conclusions: In women with incomplete abortion or retained products of conception, single dose of sublingual misoprostol 400ug is not as effective as vacuum aspiration in evacuating uterine cavity especially when gestational age is more than 10 weeks.

Key words: abortion, misoprostol, aspiration

(Back to index)
 

Preliminary study on the androgenic effects of Kigelia Africana fruit extract in male Sprague-Dawley rats
 Onyemaechi O. Azu, Francis I. Duru, Abraham A. Osinubi, Crescie C. Noronha, Steven O. Elesha, and Abayomi O. Okanlawon

Departments of Anatomy, and Morbid Anatomy, College of Medicine, University of Lagos, Lagos, Nigeria

ABSTRACT

Objective: To evaluate the androgenic properties of Kigelia Africana fruit extract (KAFE) in male Sprague-Dawley rats

Materials and Methods: Intervention was administered orally as 100 and 500mg/kg doses of KAFE over a 28 and 56 day period. Serum and testicular tissues were analyzed for light microscopy and assayed for hormones and enzymes.

Results: Administration of KAFE at 100 and 500mg/kg resulted in the significant increase in body weight (p<0.01 and 0.001), sperm count (p<0.001), testosterone levels (p<0.001), follicle stimulating hormone (p<0.001) and luteinizing hormone (p<0.001). Qualitative histopathological results did not show any deleterious alterations caused by KAFE but an enhancement of spermatogenesis with increased thickness of the seminiferous epithelium of the rats. The 100mg/kg dose produced better result in most of the parameters monitored than the higher dose of 500mg/kg used.

Conclusions: KAFE have some androgenic effects in rats; however the precise mechanism of this action needs further elucidation. It is possible that the flavonoids/saponin content may be responsible for increased androgen biosynthesis. These results suggest that KAFE might serve as a future agent for development as an androgenic drug in human.

Key words: Kigelia Africana, testis, body weight, sperm count, hormones, histology

(Back to index)
 

Maternal serum level of granulocyte-colony stimulating factor in preterm birth
 Moustafa Ibrahim, and Amira Ibrahim Hamed

Department of Obstetrics & Gynecology, Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

ABSTRACT

Objective: to evaluate the serum levels of granulocyte-colony stimulating factor and their relation to preterm labor.

Design: prospective cross sectional study

Setting: Ain Shams University Hospital

Materials and Methods: pregnant women in their third trimester were divided into two groups: (group A): 50 pregnant women with preterm labor and (group B): 40 pregnant females coming for routine antenatal care. Maternal serum levels of Granulocyte-colony stimulating factor were measured, in addition to total leucocytic count and C-reactive protein for every participant.

Results: there was a highly significant difference (p<0.01) between both groups as regards number of positive cases for G-CSF. G-CSF was the most sensitive and specific marker in preterm labor among the studied ones followed by CRP and TLC respectively.

Conclusions: granulocyte-colony stimulating factor is a highly sensitive and specific marker for preterm labor. It is recommended to measure maternal serum level of granulocyte-colony stimulating factor at earlier stages of high risk pregnancies.

Key words: preterm labor, Granulocyte colony stimulating factor, C-reactive protein, Leukocytic count, pregnancy

(Back to index)

Dynamic monitoring of dilutional hyponatremia during hysteroscopic procedures: a possible underestimated hazard
 Ahmed H. Abdellah, Magdy Amin, Sayed A.M. Taha, Osman Abdel Kereem M, Stacey Ehrenberg-Buchner, Ahmed Y. Rezk, and Mohamed A Bedaiwy

Obstetrics and Gynecology Departments, Sohag Benha and Assuit Universities, Egypt, and University Hospitals of Cleveland Case Medical Center, Case Western Reserve University, Cleveland, Oh, USA

ABSTRACT

Objective: To determine the frequency of hyponatremic complications and fluid overload during hysteroscopic surgery.

Design and settings: A prospective study in a tertiary care facility.

Materials and Methods: The study included 60 women who were scheduled for operative hysteroscopy for a variety of indications using the conventional unipolar electro-surgical device. Fluid intravasation into the maternal circulation was carefully monitored during the entire procedure as well as biochemical assays for serum sodium at baseline, every 5 minutes, at the end of the procedure and 1,3,6 hours postoperatively. Simple linear regression was used to assess the association between the fall in serum sodium and other indices.

Results: The mean amount of total Sorbitol/mannitol consumption was 6.2±2.0L. The mean amount of fluid deficit was 701±345ml and the mean duration of hysteroscopic procedures was 25.9±11.6min. A fall in the serum sodium level occurred in 90% of patients with variable degrees. The statistically significant fall in serum sodium was directly correlated to the amount of fluid deficit. Severe hyponatremia (serum sodium concentration less than 125 mmol/L) occurred in six patients. All of these had a fluid deficit of more than 1420 ml (range between 1420-1770 ml).

Conclusions: Hyponatremia appears to be highly underestimated during hysteroscopic surgery particularly during myoma resections when the intramural component was >50%.

Keywords: Hysteroscopy, hyponatremia, myomectomy

(Back to index)

Impact of pulmonary tuberculosis on menstrual pattern and fertility
 Wafaa A. Hassan, and Atef M Darwish

Chest and Obstetric and Gynecology departments, Assiut and Woman’s Health University Hospitals, Assuit, Egypt

ABSTRACT

Objective: The association between pulmonary tuberculosis and female reproductive health problems is not well addressed in literature. This cohort study was done at Assiut University and Woman's Health Hospitals to estimate the effect of pulmonary tuberculosis (TB) on menstrual pattern and fertility of females in the childbearing period.

Materials and Methods: A total of 429 females with pulmonary TB in the child bearing period (study group) and 100 age matched healthy volunteers (control group) from October 2004 to October 2008 were included in this study. The study was done at TB outpatient clinic of Assiut University hospital which is the biggest referral tertiary care hospital in Upper Egypt. A detailed history taking, clinical examination, routine investigations of pulmonary TB, and transvaginal ultrasonography (TVS) were done for all cases. Hysterosalpingography ± combined laparoscopy and hysteroscopy were done whenever indicated.

Results: Menstrual abnormalities were reported in 66% of cases (286 patients). Secondary amenorrhea (112 cases, 26.5%, p, 0.001) and hypomenorrhea (86 cases, 20%, p, 0.001) were significantly higher in the study group than controls. After completed antituberculous treatment 76 % of the study group resumed normal cycles. TVS diagnosed functional ovarian cysts in 85 cases (19.8%). Among 68 cases who sought fertility, peritubal and intrauterine adhesions were diagnosed by laparoscopy and hysteroscopy in 2 and 1 infertile case respectively.

Conclusions: TB had marked reversible effect on menstrual function but minimal association with genital TB and infertility. Persistence of menstrual abnormality or the presence of infertility after completion of treatment should attract attention about the possibility of genital tract involvement.

Key words: Pulmonary tuberculosis, infertility, menstrual abnormality

(Back to index)

Prolactin level in women with polycystic ovary before and after laparoscopic ovarian drilling
 Moustapha Ibrahim, Hatem El Gamal, Heba El Sawah,  Mohamed Farahat, and Rania S. Shahin

Departments of Obstetrics and Gynecology, Ain Shams University, Cairo University, Al-Azhar University,  Egypt

ABSTRACT

Objective: to detect the changes in the serum prolactin level in women with polycystic ovary syndrome (PCOS) before and after laparoscopic ovarian drilling (LOD).

Design: prospective controlled trial

Setting: Ain Shams University and private hospitals

Materials and Methods: fifty subfertile women with PCOS and resistant to clomiphene citrate (CC) were subjected to laparoscopic ovarian drilling. Women with PCOS were diagnosed according to (ESHRE/ASRM, Rotterdam Consensus Workshop Group, 2003). Blood sample for serum prolactin assay was withdrawn before and three month after LOD and results were compared.

Results:  Thirty three women achieved ovulation (66 %) while pregnancy rate was 10 %. (five cases) It is found that there is significant elevation of serum prolactin levels after LOD in non-ovulating patient. The mean prolactin levels before LOD 11.44 ± 3.68 ng/dl (range 5.6 - 20) when compared with post operative mean prolactin levels 20.21± 12.13 ng/dl (range 6.83 - 40.7). Hyperprolactinemia was found in six women (29.41 %) in those non-ovulation patients 3 months after operation.

Conclusions: In women who remain anovulatory after laparoscopic ovarian drilling, prolactin assay is recommended.

Key words: prolactin, PCOS, laparoscopy, ovarian drilling

(Back to index)

Bleeding patterns associated with progestin-only contraceptives: a prospective controlled trial comparing Mirena versus progestin-only pill
Samah Aboul Gheit

Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt

ABSTRACT

Objective: To compare the menstrual pattern in women using progestin only contraception whether POP or Mirena.

Design: Prospective cohort study.

Setting: Kasr El-Aini Hospital.

Materials and Methods: Participants were divided into Group 1: 30 women using Mirena coil and not using any other hormonal treatment, Group 2: 30 women using Progestin-only pills for contraception. Follow up for 6 month after starting use.

Results: From the Mirena group 13 cases had regular menstruation; while in the POP group only 6 had regular menses with no significant difference. As for amenorrhea it was a common finding in both groups with no statistically significant difference. Concerning spotting 1 case from the Mirena group and 7 cases from the pop group experienced this condition with no statistical significance.

Conclusions: We may assume that LNG-IUS could achieve better menstrual pattern than progestin only pills. Further studies are needed to confirm this finding through evaluating the endometrial perfusion with these preparations.

Keywords:   Mirena, pills, levonorgestrel, IUD, bleeding

(Back to index)