Three-dimensional power Doppler indices of ovarian stromal blood flow and serum vascular endothelial growth factor after laparoscopic ovarian drilling in women with polycystic ovary syndrome

Objective: To evaluate the effects of laparoscopic ovarian drilling (LOD) on three-dimensional (3D) power Doppler indices of ovarian stromal blood flow and serum vascular endothelial growth factor (VEGF) levels in women with polycystic ovary syndrome (PCOS). Design: Prospective controlled study. Setting: Minia University Hospital, Minia, Egypt. Material and methods: 30 clomiphene citrate resistant women with PCOS undergoing LOD and 30 fertile women with normal ovaries were recruited in this study. Hormonal profile, Doppler indices of ovarian stromal blood flow and serum VEGF assays before and after LOD were evaluated and compared between the two groups. Evaluation was done at the beginning of the study, 1 week after LOD and at 3 and 6 month follow up periods. Main outcome measures: 3-D power Doppler indices of both ovaries and serum VEGF concentration. Results: Before LOD, serum levels of VEGF, total testosterone (T), free androgen index (FAI), LH, LH:FSH ratio, total antral follicle count (AFC), total ovarian volume (OV) and the 3D power Doppler blood flow indices were significantly higher in the PCOS group than in the control group. After LOD, there was a significant reduction in the serum levels of VEGF, T, sex-hormone binding globulin (SHBG), FAI, LH, LH:FSH ratio, AFC, OV and the 3D power Doppler indices and remained all low at 3 and 6 month follow up. There were significant positive correlations between power Doppler flow indices (VI, FI, and VFI) with serum VEGF, total T, and LH before and after LOD. Conclusions: Serum VEGF and ovarian blood flow indices were higher in women with PCOS than in normal women. LOD reduced serum levels of VEGF, in addition to ovarian blood flow indices, in women with PCOS

Management of bleeding from morbidly adherent placenta during elective repeat caesarean section: retrospective -record -based study

Abstract Background Controlling massive haemorrhage from morbidly adherent placenta (MAP) at caesarean section is a major surgical challenge to obstetricians. This study compares different intra-operative interventions to control haemorrhage from morbidly adherent placenta and its impact on maternal morbidity. Methods Retrospective analysis was done for baseline characteristics, intra-operative and postoperative complications of 125 patients with morbidly adherent placenta who had elective CS at 35–38 weeks gestation in the period from 01/2012 to 01/2017. The included patients were categorized into three groups according to intra-operative interventions they had for controlling bleeding; Group A (n = 42) had only balloon tamponade, Group B (n = 40) had balloon tamponade and bilateral uterine artery ligation, in Group C (n = 43) all cases were managed by bilateral uterine artery ligation and inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment using the cervix as a natural tamponade. Results There were no differences of baseline characteristics of patients in all groups. Group C had significantly better outcomes as compared with groups A and B; less total blood loss (Group C 2869.5 ml vs Group B 4580 ml, Group A 4812 ml, P <  0.001), less requirement of blood transfusion more than 4 units (Group C 4/43, Group B 10/40,Group A 12/42, P <  0.02), significant reduction in prolonged hospital stay over 10 days (Group C 2/43, Group B 9/40,Group A 14/42, P < 0.001) and lower risk of coagulopathy (Group C 4/43, B 8/40, A 9/42), visceral injuries (Group C 4/43 vs B 8/40, A 10/42,P < 0.01) and need for hysterectomy (Group C 4/43 vs B 11/40, A 13/42,P < 0.001). Conclusion A combination bilateral uterine artery ligation and using the cervix as a natural tamponade are very effective and simple methods in controlling bleeding resulting from separated placenta accreta. Trial registration The findings are part of the research project registered in ClinicalTrials.gov NCT02590484. Registered 28 October 2015