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Objectives: To compare the effects of whole‐body vibration (WBV) and aerobic exercise on the hormonal profile and inflammatory status in women with premenstrual syndrome (PMS). Methods: A prospective, randomized, pre–post‐test, single‐blind, controlled trial was conducted in 105 women diagnosed with PMS. They were randomized into three equal groups. All women received magnesium and vitamin B complex supplementation once daily. WBV training was added three times per week to the WBV group. The aerobic exercise group added aerobic exercise three times per week, while the control group received no additional intervention. The Premenstrual Syndrome Questionnaire (PMSQ) was used to assess PMS symptoms. Blood analysis was performed to measure hormone assays (estradiol, progesterone, prolactin, and cortisol) and high‐sensitivity C‐reactive protein at the start and after the end of the treatment program. Results: There was no statistically significant difference between WBV and aerobic exercise according to PMSQ and high‐sensitivity C‐reactive protein (P = 0.99 and P = 0.98, respectively), but there was a statistically significant difference between both groups in cortisol, progesterone, prolactin, and estradiol (P = 0.001), with more favor given to the WBV group. Conclusion: WBV and aerobic exercise have positive effects on women with PMS, with more favor given to WBV. Synopsis: Whole‐body vibration and aerobic exercise have positive effects in women with premenstrual syndrome with more favor to whole‐body vibration. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of misoprostol to minimized blood loss during and after cesarean delivery (CD). Search Strategy: Screening of MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials from inception to February 2021 using the keywords related to misoprostol, CD, postpartum hemorrhage, and intraoperative blood loss and their MeSH terms. Selection criteria: Only RCTs were included. Participants included women undergoing CD whether elective or selective. Thirty studies including 6593 women, 26 in English, 2 in Thai, 1 in French, and 1 in Chinese. Data Collection and Analysis: Data from all selected studies were extracted independently by two authors. Data extracted included location of the trial, sample size, inclusion and exclusion criteria, participants characteristics, intervention details including timing, dose, and route of drug administration. Outcomes assessed included estimated intraoperative and postoperative blood loss, occurrence of postpartum hemorrhage, the need for additional uterotonics, and hemoglobin difference. Main Results: Four studies (968 women) compared preoperative to postoperative misoprostol and found a mean difference in intraoperative blood loss of −205.00 (−339.22, −70.77), p = 0.003 and in postoperative blood loss −216.27 (−347.08, −85.46), p < 0.001 and a significantly lower need for additional uterotonics with a risk ratio of 0.54 (0.46, 0.64), p < 0.00001. Twenty‐two studies (4701 participants) compared misoprostol to oxytocin. There was a mean difference in intraoperative blood loss of −108.43 (−156.04, −60.82), p < 0.0001. Nine of these trials with 1978 participants evaluated postoperative blood loss. These found a mean difference of −64.12 (−116.19, −12.04) with a p = 0.02. Fourteen trials with 3166 participants measured the difference between preoperative and postoperative hemoglobin. These found a mean difference of −0.25 (−0.35, −0.15) with a p < 0.001. Twenty trials with 4416 participants measured the need for administration of additional uterotonics. These found a risk ratio of 0.62 (0.49, 0.78) with a p value of <0.001. Conclusion: The combined use of misoprostol and oxytocin during CD is effective in reducing blood loss during and after CD. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of rectal misoprostol with intrauterine misoprostol in the reduction of blood loss during and after cesarean delivery. Methods: Ninety‐eight pregnant women, all candidates for elective cesarean delivery, were equally randomized into two groups: the rectal group (received preoperative misoprostol rectally) and the intrauterine group (received intrauterine misoprostol after the delivery of the placenta). The primary outcome was the estimated blood loss (EBL) during cesarean delivery. Secondary outcomes included the occurrence of excessive blood loss (>1000 mL) within the first 24 hours postoperatively and the occurrence of any maternal or fetal side effects. Results: There were no statistically significant differences between the two groups regarding either the EBL (693.12 ± 139.09 vs 692.39 ± 132.83; P=0.979) or the occurrence of postpartum hemorrhage (>1000 mL) (6.1% vs 4.1%; P=0.99. Apgar scores at 1 and 5 minutes were significantly higher in the intrauterine group compared to the rectal group. Conclusion: Insertion of intrauterine misoprostol is as effective as rectal insertion in reducing blood loss during and after cesarean delivery; however, it has a safer neonatal outcome and is more convenient when administered during cesarean delivery. ClinicalTrials.gov: NCT03723031. Intrauterine insertion of misoprostol is safer, more convenient, and as effective as rectal insertion in reducing blood loss during and after cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin‐releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) can improve the number of retrieved oocytes and clinical pregnancy rate in poor responders undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF‐ICSI) cycles using a GnRH‐antagonist protocol. Methods: A randomized controlled trial included poor ovarian responders indicated for ICSI using a GnRH‐antagonist protocol. They were divided equally into two groups: group I received 10 000 units of hCG plus 0.2 mg of triptorelin while group II received 10 000 units of hCG only for triggering of ovulation. The primary outcome parameter was the number of oocytes retrieved. Secondary outcomes included metaphase II oocytes number, cancellation rate, number of obtained embryos, chemical and clinical pregnancy rates. Results: One hundred and sixty women were included in the study, with 80 women in each treatment group. Dual triggering was associated with higher number of retrieved oocytes (5.3 ± 1.9 vs 4.5 ± 2.4, P=0.014), metaphase II oocytes (3.8 ± 1.4 vs 3.1 ± 1.7, P=0.004), total and grade 1 embryos (2.7 ± 1.1 and 2.3 ± 1.0 vs 1.9 ± 1.2 and 1.1 ± 0.2, P=0.001 and 0.021 respectively), and transferred embryos (2.2 ± 0.9 vs 1.6 ± 0.9, P=0.043, and lower cancellation rate (7.5% vs 20%, P=0.037) compared with single triggering. There were significantly higher chemical (25% vs 11.3%, P=0.039) and clinical (22.5% vs 8.8%, P=0.028) pregnancy rates in women with dual triggering compared with those with single triggering. Conclusion: Dual triggering is associated with better IVF outcome in poor responders compared with single trigger. Clinical trial registration NCT04008966. Synopsis: Dual triggering of final oocyte maturation is associated with better IVF outcome in poor responders compared with single trigger. [ABSTRACT FROM AUTHOR]

Objective: To compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage (PPH) among low-risk women.Methods: Randomized controlled trial among 150 pregnant women with low risk of PPH admitted for vaginal delivery at Kasr Al Ainy Hospital, Cairo, Egypt, between July 2018 and May 2019. Participants were assigned to two groups by a web-based randomization system ensuring allocation concealment. After neonatal delivery, the carbetocin group received one ampoule of carbetocin (100 μg/mL) intravenously and the misoprostol group received two rectal tablets of misoprostol (800 μg) for active management of the third stage. Blood pressure, blood loss, and hemoglobin levels were monitored. The primary outcome measure was need for additional uterotonic drugs.Results: The carbetocin group had significantly less blood loss (P<0.001), shorter third stage (P<0.001), and less need for additional uterotonics (P=0.013) or uterine massage (P=0.007). The two drugs were hemodynamically safe. Hemoglobin levels after delivery were comparable in the two groups (P=0.475). Adverse effects were more common in the misoprostol group (P<0.001).Conclusion: Among low-risk women, carbetocin seems to be a better alternative to misoprostol for active management of the third stage of labor; it reduced blood loss and use of additional uterotonic drugs. CLINICALTRIALS.GOV: NCT03556852. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of flushing the cervical canal and the uterine cavity with local anesthetic in order to reduce the pain felt by patients during office hysteroscopy.Methods: A double-blind randomized controlled trial was conducted between May 1, 2018, and February 28, 2019, involving 260 women undergoing office hysteroscopy at Kasr Al Ainy Hospital, Cairo, Egypt. Women were randomized using a computerized random number generator to intrauterine and intracervical instillation 5 minutes before the procedure of either 5 mL lidocaine 2% diluted in 15 mL normal saline, or 20 mL normal saline alone. The primary outcome measure was the visual analog scale (VAS) pain score reported by women during the procedure. Secondary outcomes included VAS score at 10 and 30 minutes after the procedure, the need for analgesia, and occurrence of vasovagal attacks.Results: Women in the lidocaine flushing group reported a significantly lower VAS score during the procedure (1.8 ± 1.1 vs 5.2 ± 1.8) and 10 and 30 minutes after it (1.3 ± 1.15 and 0.8 ± 0.9 vs 4.3 ± 2.1 and 2.98 ± 1.96) when compared with control women (P<0.001). More women without lidocaine flushing experienced vasovagal attacks (25/130 vs 9/130, P<0.001) and needed analgesia (84/130 vs 13/130, P<0.001) when compared with women with lidocaine flushing.Conclusion: Flushing of the cervical canal and uterine cavity with local anesthetic significantly decreased pain sensation in women undergoing office hysteroscopy. CLINICALTRIALS.GOV: NCT03530488. [ABSTRACT FROM AUTHOR]

Objective: To assess the safety and efficacy of preoperative rectal misoprostol for the prevention of intraoperative and postoperative blood loss in women undergoing elective cesarean delivery.Methods: A single-blind randomized controlled trial of 200 full-term pregnant women scheduled for elective cesarean delivery. Computer-generated randomization allocated women to receive 400 μg rectal misoprostol at urinary catheter insertion plus 400 μg rectally after abdominal closure (preoperative group, n=100) or 800 μg of rectal misoprostol after abdominal closure (postoperative group, n=100). Primary outcome was intraoperative blood loss.Results: Intraoperative blood loss was significantly lower in the preoperative misoprostol group compared with the postoperative group (528.7 ± 114.8 mL vs 788.6 ± 165.8 mL; P<0.001). Blood loss during the first 24 hours after delivery was also lower in the preoperative group (199.3 ± 84.5 mL vs 302.9 ± 125.6 mL; P<0.001). Fewer women in the preoperative group needed additional uterotonics (7 vs 21; P<0.001). After delivery, the decrease in both hemoglobin and hematocrit levels was significantly less in the preoperative group (-6.8 vs -12.8% and -6.05 vs -17.8%, respectively; P<0.001).Conclusion: Preoperative rectal administration of misoprostol significantly reduced intraoperative and postoperative blood loss during and after elective cesarean delivery. ClinicalTrial.gov ID: NCT03680339. Date of registration 9/2018. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of body mass index (BMI) on the outcome of IVF cycles among poor responders.Methods: A prospective cohort study in Egypt enrolled 185 poor responders who underwent intracytoplasmic sperm injection via an antagonist protocol between 2012 and 2017. Participants were classified into three groups by BMI (calculated as weight in kilograms divided by the square of height in meters): 18.5-24.9 (normal, n=48); 25-29.9 (overweight, n=54); 30 or higher (obese, n=83). Outcomes were clinical pregnancy rate, implantation rate, chemical pregnancy rate, gonadotropin dose, number of oocytes and embryos, and cancellation rate.Results: There was no significant difference among the three groups in gonadotropin dose; duration of stimulation; endometrial thickness on trigger day; number of oocytes retrieved, injected, or fertilized; number of embryos, transferred embryos, or frozen embryos; or day of embryo transfer. Frequency of implantation (11/81 [14%] vs 6/96 [6%] or 5/155 [3%]), chemical pregnancy (20 [42%] vs 14 [30%] or 12 [14%]) and clinical pregnancy (15 [31%] vs 12 [22%] and 9 [11%]) was significantly higher for normal than for overweight or obese women, respectively.Conclusion: Implantation, chemical pregnancy, and clinical pregnancy rates were inversely related to increasing BMI. CLINICALTRIALS.GOV: NCT03457233. [ABSTRACT FROM AUTHOR]

Objective: To assess the sensitivity of a urine test for high-risk HPV DNA genotypes in the detection of high-grade squamous intra-epithelial lesion (HSIL) and its correlation with pathologic precancerous lesions.Methods: The present prospective cross-sectional study included women referred to Kasr AlAiny Medical School, Cairo, Egypt, for cervical smear anomalies, a history of cervical smear anomalies, or for suspicious cervix between May 1, 2015, and April 30, 2017. Paired urine tests and cervical smears were performed. HPV DNA was detected in urine using polymerase chain reaction and cervical smears were performed with a cervical spatula and a cytobrush. Agreement between urine test results and pathology was examined.Results: In total, 1375 women were included. Urine test for high-risk HPV DNA demonstrated 97.8% (95% confidence interval [CI] 92.1%-99.7%) sensitivity and 100% (95% CI 99.7%-100.0%) specificity for HSIL. Overall, 87 women had a positive urine test for high-risk HPV; of these, 82 (94.3%, 95% CI 87.1%-98.1%) had pathologic findings of cervical intra-epithelial neoplasia 2 or 3 (CIN2/3). Similarly, 89 women had HSIL cytology; again, 82 had CIN2/3 (92.1%; 95% CI, 84.3%-96.4%).Conclusion: There was good agreement between a positive urine test for high-risk HPV DNA genotypes and pathologic findings of CIN2/3. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the value of serum microRNA-122 (miR-122) and miR-199a as reliable noninvasive biomarkers in the diagnosis of endometriosis.Methods: During 2015-2016, at a teaching hospital in Egypt, a prospective cohort study was conducted on 45 women with pelvic endometriosis and 35 women who underwent laparoscopy for pelvic pain but were not diagnosed with endometriosis. Blood and peritoneal fluid (PF) samples were collected; interleukin-6 (IL-6) was detected by enzyme-linked immunosorbent assay and miR-122 and miR-199a expression was measured by quantitative real-time polymerase chain reaction.Results: The serum and PF levels of IL-6, miR-122, and miR-199a were significantly higher in women with endometriosis than in controls (P<0.001 for all comparisons). Serum miR-122 expression was positively correlated with serum IL-6 (r=0.597), PF IL-6 (r=0.603), PF miR-122 (r=0.934), serum miR-199a (r=0.727), and PF miR-199a (r=0.653). Serum miR-199a expression was positively correlated with serum IL-6 (r=0.677), PF IL-6 (r=0.678), PF miR-122 (r=0.744), and PF miR-199a (r=0.932). Serum miR-122 and miR-199a had a sensitivity of 95.6% and 100.0%, and a specificity of 91.4% and 100%, respectively, for the detection of endometriosis.Conclusion: Serum miR-122 and miR-199a were significantly increased in endometriosis, indicating that these microRNAs might serve as biomarkers for the diagnosis of endometriosis. [ABSTRACT FROM AUTHOR]

Objective: To assess whether endometrial injury in the cycle preceding controlled ovarian hyperstimulation during intracytoplasmic sperm injection (ICSI) improves the implantation and pregnancy rates.Methods: Between January 1, 2016, and March 31, 2017, a randomized controlled trial was conducted at a center in Egypt among 300 women who met inclusion criteria (first ICSI cycle, aged <40 years, day-3 follicle-stimulating hormone <10 IU/L, normal serum prolactin, no uterine cavity abnormality). The women were randomly allocated using a web-based system to undergo endometrial scratch in the cycle preceding controlled ovarian hyperstimulation (n=150) or to a control group (n=150). Only data analysts were masked to group assignment. The primary outcomes were the implantation and clinical pregnancy rates at 14 days and 4 weeks after embryo transfer, respectively. Analyses were by intention to treat.Results: The implantation rate was significantly higher in the endometrial scratch group (41.3% [90/218]) than in the control group (30.0% [63/210]; P<0.001). The clinical pregnancy rate was also significantly higher in the endometrial scratch group (44.2% [61/138]) than in the control group (30.4% [41/135]; P<0.001).Conclusion: Endometrial injury in the cycle preceding the stimulation cycle improved implantation and pregnancy rates during ICSI. CLINICALTRIALS.GOV: NCT02660125. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of maternal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) on labor progress in nulliparous women.Methods: The present prospective cohort study enrolled primigravidae admitted to Kasr Al Ainy hospital, Cairo University, Egypt, during active labor between February 1, 2016, and February 28, 2017. Patients were classified into three equal groups using their BMI at admission: underweight (<18.5), normal weight (18.5-29.9), and obese (≥30). The primary outcome was the rate of cervical dilatation; secondary outcomes included the duration of the second stage of labor, neonatal delivery weight, and the mode of delivery.Results: Among the 600 primigravidae enrolled (200 in each group), significant differences were recorded in the rates of cervical dilatation (P<0.001), and the duration of the active labor phase (P<0.001) and the whole of labor (P<0.001); in the obese group, the cervical dilatation rate was lowest and the durations of the active phase of labor and the whole of labor were longer. The incidence of intrapartum cesarean delivery (P<0.001) and neonatal delivery weight (P<0.001) also differed between the groups; both were highest in the obese group.Conclusions: Patterns in labor progress, including cervical dilatation rate and labor duration, differed among patients with different BMI. ClinicalTrials.gov: NCT02686073. [ABSTRACT FROM AUTHOR]

Maged, AM, Ogila, AI, Mohsen, RA, et al. Endometrial scratch injury in infertile women seeking conception through natural or intrauterine insemination cycles: A systematic review and meta‐analysis. Int J Gynecol Obstet. 2021; 00: 1–20. doi:10.1002/ijgo.14030 The above article, published online on 17 November 2021 on Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal's Editor‐in‐Chief, Professor Michael Geary, the International Federation of Gynecology and Obstetrics and John Wiley & Sons Ltd. The journal was made aware of concerns regarding the considerable overlap with a previously published systematic review.[1] The authors responded to the concerns raised and it was found that some of the source clinical trial data could not have been accessed in this systematic review. As a result, the journal is issuing this retraction. [1] Bui BN, Lensen SF, Gibreel A, Martins WP, Torrance H, Broekmans FJ. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database of Systematic Reviews 2022, Issue 10. Art. No.: CD011424. DOI: 10.1002/14651858.CD011424.pub4. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between pre-eclampsia severity and biochemical and ultrasonography markers.Methods: A retrospective study was undertaken of women with severe pre-eclampsia (group 1, n=90), mild pre-eclampsia (group 2, n=90), or a normal pregnancy (group 3, n=90) who attended a hospital in Egypt in October 2013-April 2015. Associations between pre-eclampsia and biochemical, cardiotocography, and ultrasonography markers were investigated.Results: There were significant differences between the groups in C-reactive protein (331.44±112.38, 251.43±59.05, and 23.81±16.19 nmol/L; P≤0.05 for all), platelet count (113.40±36.72, 172.93±57.60, and 212.68±70.00×109 /L; P≤0.05 for group 1 comparisons), alanine transaminase (52.24±14.83, 38.34±13.12, and 23.11±6.92 U/L; P≤0.05 for group 1 comparisons), and serum uric acid (600.80±117.19, 481.83±118.97, and 243.89±53.54 μmol/L; P=0.050 for group 3 comparisons). Cardiotocography score was worse among women with severe pre-eclampsia than among those in the other two groups (P=0.039 for both comparisons). Biophysical profile score and umbilical artery resistance index differed by group (P≤0.05 for all). Middle cerebral artery resistance index was lower among women with severe pre-eclampsia (P≤0.05).Conclusion: The levels of C-reactive protein, blood urea nitrogen, serum uric acid, and alanine transaminase, and the platelet count were linked with the presence and severity of pre-eclampsia. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy and safety of preoperative intravenous tranexamic acid to reduce blood loss during and after elective lower-segment cesarean delivery.Methods: A single-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term singleton pregnancy at a center in Cairo, Egypt, between November 2013 and November 2014. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1g tranexamic acid or 5% glucose 15 minutes before surgery. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during cesarean, which was the primary outcome. Analyses included women who received their assigned treatment, whose surgery was 90 minutes or less, and who completed follow-up.Results: Analyses included 100 women in each group. Mean EBL was significantly higher in the placebo group (700.3 ± 143.9 mL) than in the tranexamic acid group (459.4 ±7 5.4 mL; P<0.001). Only six women, all in the placebo group, experienced an EBL of more than 1000 mL. There were no reports of thromboembolic events up to 4 weeks postoperatively.Conclusion: Preoperative administration of tranexamic acid safely reduces blood loss during elective lower-segment cesarean delivery. Australian New Zealand Clinical Trials Registry:ACTRN12615000312549. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between uterine artery Doppler measurements and maternal complications among women with severe pre-eclampsia.Methods: As part of a cross-sectional study, women with a single intrauterine pregnancy of more than 28 weeks and a diagnosis of severe pre-eclampsia were enrolled at a unit in Cairo, Egypt, between December 2012 and September 2014. Uterine artery Doppler was evaluated and maternal complications were recorded.Results: Among the 100 participants, 76 (76%) experienced maternal complications. There were significant differences in resistance index (RI) and pulsatility index (PI) between women who experienced no complications and those who had accidental hemorrhage, HELLP syndrome, and acute pulmonary edema (P<0.001 for all), and postpartum hemorrhage (P=0.004 and P<0.001, respectively). There was no significant difference in RI for women with postpartum fits (P=0.360). There was a statistically significant difference regarding RI (P<0.001) and PI (P=0.005) between cases presenting with complications and those without. There was a significant negative correlation between PI and gestational age (r=-0.988; P<0.001) and between RI and gestational age (r=-0. 854; P<0.001), but no significant correlation between PI or RI and age, systolic blood pressure, or diastolic blood pressure.Conclusion: Increased uterine artery resistance in the third trimester of pregnancy could be used to predict postpartum maternal complications. [ABSTRACT FROM AUTHOR]