Microsurgical Cesarean Section

Worldwide, not only is cesarean section (CS) the most commonly performed major surgery, but it is also the commonest obstetric operation. CD is associated with some chronic maternal morbidities including pelvic pain, adhesions and adverse reproductive effects. CS carries long‐term sequele which can adversely affect subsequent pregnancies. Why do some women develop bad sequele of CS‐like adhesions, and infertility is well demonstrated in this chapter. Fertility‐oriented step‐by‐step description of CS techniques is extensively described. Some recent controversial issues related to CS like the development of uterine nitche (isthmocele) at the CS scar site, placenta accrete and the role of cesarean myomectomy are discussed in details. At the end of this chapter, the reader will conceive enjoy fertility‐oriented concept of CS

Unexplained Female Infertility Alert Over Overt and Hidden Genital Infections

Female genital tract infections represents a real challenge for the gynecologists. The exact role of these infections in infertility induction is not clear. The impact of uterine infections on implantation is not clearly defined. This chapter will discuss the implication of overt as well as hidden genital tract infection among women with unexplained infertility. Whether these infections cause infertility or induced by infertility diagnostic as well as therapeutic procedures will be addressed. In short, this chapter will attract attention of gynecologists to put the possibility of genital tract infections in every case of infertility particularly cases with unexplained infertility

Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynecological Laparoscopy: A randomized controlled trial

Objectives: To describe a modified curved deep bidirectional intra-umbilical vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with infra-umbilical incision in gynecologic laparoscopy. Methods: Between August 2019 and March 2021, 110 patients subjected to direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision while a modified curved longitudinal bidirectional deep intra-umbilical incision was used in group B (55 cases). Intraoperative and postoperative assessments were performed. Results: There was statistically significant increased numbers of parity, gravidity, and previous cesarean sections; and a smaller number of infertility complaints in group B. Likewise, group B expressed a statistically significant less peri-trocar CO2 leakage (46 patients, 83.6% versus 28 patients, 50.9%) and more tightness of the primary portal entry (45 patients, 81.8% versus 30 patients, 54.5%) if compared to group A throughout the whole operation. On follow-up after one month, there was a statistically significant (p-value = 0.029) decreased OSAS and PSAS in group B (10.4 ± 4.2 and 11.8 ± 4.3) i.e., better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8) respectively. Conclusion: Performing a modified curved deep bidirectional intra-umbilical vertical incision for insertion of primary laparoscopic trocar is a simple and fast step that results in elimination of intraoperative gas leakage and trocar slippage without the need of any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses if compared to infra-umbilical incision. Keywords: Laparoscopy; Trocar; Entry

Complementary health education and clinical guidance for treating women experiencing infertility along with unexplained resistant hyperprolactinemia

This study prospective randomized controlled trial aims to test the impact of adding health education, awareness of some contributing factors and clinical guidance to therapeutic cabergoline given to infertile women with unexplained resistant hyperprolactinemia. It comprised 120 infertile women with unexplained persistent hyperprolactinemia not responding to therapeutic doses of cabergoline 1.5-2 mg/week who were subjected to proper history taking to exclude concomitant drug intake or possible brain problems in all cases. They were classified into group A (60 cases) who received health education and clinical guidance to search for possible contributing factors and were instructed to avoid them in addition to proper therapeutic doses of cabergoline, while group B (60 cases) received proper therapeutic doses of cabergoline only without clinical guidance. After 1 month, serum prolactin (PRL) was measured for all cases. All cases had high PRL level at the start of the study (79.9±28.4 [39-195] and 78.2±19.9 [42-189] in group A and B, respectively) without any significant difference. Pretreatment counselling revealed that lifestyle factors, sexual behaviors or feeding habits may contribute to resistant hyperprolactinemia in all cases without a significant difference between both groups. Serum PRL dropped significantly more in group A (20.14±10.31 [11-45] vs. 49.32±37.03 [12-100]) after combined health education, clinical guidance of the couple and proper treatment. It is concluded that lifestyle factors, sexual behaviors, and feeding habits would affect the response of hyperprolactinemia to treatment. Health education and clinical guidance with some advice to avoid them, would concomitantly improve the response of resistant hyperprolactinemia to therapeutic doses of dopamine agonists