Knowledge, attitude, and practice of obstetricians towards vaginal birth after caesarean in Egypt

This was a cross sectional study surveying a total of 451 physicians. A questionnaire was constructed and distributed electronically to the participants. The main outcome measure was evaluation of physicians’ knowledge, attitude, and practice towards VBAC in Egypt. Although 76.3% of the physicians agreed to present VBAC as an option, 38.1% disagreed with encouraging it. Also, a large proportion of them advised against the induction of labour and refused it if post-term (69.4% and 76.1%, respectively). The physicians’ attitude towards VBAC was to allow vaginal birth if the patient went into spontaneous labour (72.3%) and perform repeat CS if not in labour (86.7%). Fear of complications (78.71%) was the most common cause of not conducting VBAC. The consensus of practice was to present VBAC as an option for women with a single Caesarean scar; however, one-third of them did not encourage VBAC. They strongly refused the induction of labour. Impact Statement What is already known on this subject? This is the first study to evaluate physicians’ knowledge, attitude, and practice towards VBAC in Egypt and the Arab world. What do the results of this study add? From the current survey of the practice of the obstetricians in Egypt, the consensus of practice was to present VBAC as an option for women with a single Caesarean scar; however, one-third of them did not encourage VBAC. They strongly refused the induction of labour. The presence of labour pain is the strongest determinant to allow VBAC, while the vast majority of obstetricians were willing to conduct ERCS in the absence of labour pain. This contributed significantly to the rising rates of CS in Egypt. What are the implications of these findings for clinical practice and/or further research? Physicians’ attitude towards VBAC should be evaluated in countries with higher rates of CS deliveries. Women's perspectives and attitude towards VBAC should be evaluated

Factors associated with recurrent endometriomas after surgical excision

Abstract Background Endometriosis affects women in reproductive age and causes a great impact on their lives. When affecting the ovary, excision represents the main management option. However, recurrence represents a challenging situation for patients and physicians. This study aimed to determine factors contributing to endometriomas recurrence after surgical excision. Results This was a quasi-experimental study recruiting 60 patients with ovarian endometrioma. The mean age was 30.33 ± 7.95 years. The mean parity was 1.27 ± 0.69. The recurrence rate after excision was 11/60 (18.3%) after a mean follow-up period of 22.62 ± 4.96 months. None of the patients’ characteristics or endometriosis-related characteristics were significant factors contributing to cyst recurrence (age, parity, history of infertility, preoperative endometrioma diameter, preoperative AFC, preoperative AMH, degree of pelvic pain, degree of dysmenorrhea, degree of dyspareunia, pelvic tenderness, and induration) (p value > 0.05). Conclusion The patient’s related factors and endometrioma characteristics did not predict its recurrence

Metformin versus levonorgestrel-releasing intrauterine system in the management of endometrial hyperplasia: a randomized clinical trial

Abstract Background Endometrial hyperplasia is one of the common causes of bleeding in perimenopausal women. Variable treatment options aim to induce regression. The current study evaluated the regression rate of endometrial hyperplasia after treatment with levonorgestrel intrauterine system (LNG- IUS) versus Metformin. Methods This randomized clinical trial was conducted at the obstetrics and gynecology department of Suez Canal University hospital. We recruited women diagnosed with endometrial hyperplasia without atypia. Patients were allocated into two groups. Group one included patients treated with levonorgestrel-releasing intrauterine system and group two treated with Metformin. The rate of regression of hyperplasia in both groups after six months of intervention was the main outcome measure. Results Significant regression of hyperplasia was noted in the LNG-IUS group (96% versus 64%, p-value 0.009). There was a significant decrease in the endometrial thickness after treatment in both groups (17.65 ± 4.62 and 5.3 ± 2.01 in the LNG- IUS with a p-value < 0.001) (19.57 ± 6.84 and 11.22 ± 7.51 in the metformin group with a p-value < 0.001). Factors that correlated with the Δ endometrial thickness included parity in the LNG- IUS group (p-value 0.019) and age and BMI in the metformin group (p-value 0.043 and 0.004 respectively). Conclusion Metformin had a regressive effect on endometrial hyperplasia; however, it was not significant as that achieved with the levonorgestrel intrauterine system. Trial registrations PACTR201908498370196. Date of registration: 21/8/2019. Date of first patient enrollment: 25/8/2019. URL: https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=933

Fetal gender, serum human chorionic gonadotropin, and testosterone in women with preeclampsia

Objectives Evaluation of the association between fetal gender, serum beta-human chorionic gonadotropin, and serum testosterone, and preeclampsia. Methods Case-control study conducted at the Obstetrics and Gynecology Department. 120 patients divided into study group (patients with preeclampsia subdivided into mild and severe) and control group (normotensive women). Interventions Fetal gender was determined. Serum testosterone and HCG levels were estimated at 32 weeks or at the time of diagnosis of preeclampsia (study group) or recruitment (control group). Results Positive association between the male gender of the fetus and preeclampsia. Increased HCG and Testosterone were associated with developing preeclampsia. Conclusion The mechanism of preeclampsia could be androgen-mediated. There is a significant correlation between serum HCG and testosterone and preeclampsia

Umbilical cord diameter in the prediction of foetal growth restriction: a cross sectional study

This was a cross sectional study with a prospective design conducted from October 2018 to October 2019. We recruited patients at risk for FGR and normal pregnant women. Each patient had ultrasound examination for the umbilical cord diameter in the 28th, 32nd, 36th, and the 40th week, Foetal growth restriction developed in 10/76 (13.2%) patients in the at risk group. The umbilical cord diameter was significantly lower in the at risk group (1.8 ± 0.2 versus 2.0 ± 0.2 in the control group with a p value of <.001). The umbilical cord diameter was highly predictive for the occurrence of FGR at each antenatal care visit as well as at delivery. We concluded that the umbilical cord diameter was a significant predictor of foetal growth restriction when applied through the antenatal care visits. It is a simple and easy method causing no distress for the patients.IMPACT STATEMENT What is already known on this subject? Conflicting results exist regarding the predictive role of the umbilical cord in foetal growth restriction. What do the results of this study add? Foetal umbilical cord diameter was correlated significantly to foetal weight and had a significant predictive role in the prediction of FGR. The cut off values for the umbilical cord diameter in women with FGR were not evaluated before. What are the implications of these findings for clinical practice and/or further research? Comparing the ultrasound findings with histopathologic examination of the umbilical cord and the placentas would be recommended

Carbetocin versus oxytocin for prevention of postpartum hemorrhage in hypertensive women undergoing elective cesarean section

Objective Assess the efficacy and safety of carbetocin, versus oxytocin in the prevention of postpartum hemorrhage in hypertensive women. Study design A randomized clinical trial. Setting Obstetrics and Gynecology Department of Suez Canal University Hospital. Patients One hundred and sixty hypertensive pregnant women who underwent CS. Interventions Patients were randomized to receive either 10 IU oxytocin or 100 μg carbetocin. Primary outcomes included estimated blood loss, blood transfusion, hemoglobin (HB), and hematocrit changes pre- and post-delivery and the use of additional uterotonics. Results The postoperative HB was not different from preoperative HB in the carbetocin group (11.8 ± 1.2 vs. 11.2 ± 1.2 g/dL) while it decreased significantly in the oxytocin group (12.1 ± 3.8 vs. 10.4 ± 1.1 g/dL, p < 0.001). Blood loss was significantly more among the oxytocin group (679.5 ± 200.25 vs. 424.75 ± 182.59 ml) in the carbetocin group (p < 0.001). Nausea, vomiting, and sweating were reported more significantly in oxytocin group patients. Conclusion Carbetocin was more effective than oxytocin in reducing intraoperative and postoperative blood loss