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Background The anatomy of the fatty parts of the vulva, specifically the mons pubis and labia majora, has not been extensively studied. Objectives This study aimed to provide a comprehensive 3-dimensional picture of the mons pubis and labia majora by defining and measuring their dimensions. Furthermore, the study sought to calculate the different ratios, volumes, and weights of these structures. Methods The study included 214 women, who were divided into 2 groups based on their BMI. The researchers defined 27 dimensions to describe the width, height, and length of the mons pubis and labia majora, and specified the measuring methodology. Results The height of the mons pubis was approximately three-quarters of its length and half its width. The labia majora were wider and taller anteriorly than posteriorly, and their ratios decreased as they went posteriorly, from 4 to 2. The ratio of monal height to maximum labial height and to labial length was 3 and 1, respectively, whereas the ratio of monal width to the sum of maximum labial widths was nearly 1.5. The calculated volumes and weights of the mons pubis and labium majus were 200 mL, 30 mL, 180 g, and 27 g in Group 1, and 300 mL, 40 mL, 270 g, and 36 g in Group 2, respectively. Conclusions The dimensions, ratios, weights, and volumes defined and measured in this study can serve as the basis for any aesthetic measures involving the mons pubis and labia majora. Moreover, BMI and the different ratios should be considered in such measures.

Objective To evaluate the efficacy of carbetocin versus placebo in decreasing intraoperative blood loss and the need for blood transfusion during abdominal myomectomy. Design Randomized, double-blind, placebo-controlled trial. Setting Tertiary university hospital from September 2019 to February 2020. Patient(s) A total of 138 women with symptomatic leiomyoma who were candidates for abdominal myomectomy (n = 69 in each group). Intervention(s) We randomized the study participants in a 1:1 ratio to carbetocin and placebo groups. Intravenous 100 μg carbetocin or placebo was administered slowly after induction of anesthesia. Main Outcome Measure(s) Intraoperative blood loss, need for blood transfusion, postoperative hemoglobin, operative time, length of hospitalization, and drug side-effects. Result(s) The baseline characteristics were similar among all groups. Carbetocin had significantly lower intraoperative blood loss compared with placebo (mean difference 184 mL). Hemoglobin level 24 hours after surgery was significantly lower in the placebo group than in the carbetocin group (9.1 ± 0.8 vs. 10.3 ± 0.6 g/dL). Eight women in the carbetocin group needed blood transfusion compared with 17 in placebo group. Operative time, length of hospitalization, and side-effects were similar in both groups. Conclusion(s) A single preoperative intravenous dose of 100 μg carbetocin is a simple, practical, and effective method of decreasing intraoperative blood loss and the need for blood transfusion during abdominal myomectomy, with tolerable, few, nonsignificant side-effects. Clinical Trial Registration Number NCT04083625

Mahmoud Alalfy,1 Omneya M Osman,2 Sameh Salama,1 Yossra Lasheen,2 Mahmoud Soliman,2 Mohamed Fikry,2 Mohamed Ramadan,2 Doaaa Alaa,2 Shaimaa Elshemy,2 Rana Abdella2 1Reproductive Health and Family Planning Department, National Research Centre, Dokki, Cairo, Egypt; 2Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, EgyptCorrespondence: Mahmoud AlalfyReproductive Health and Family Planning Department, National Research Centre, P.O: 12622, Affiliation ID: 60014618, Dokki, Cairo, EgyptTel +20 1002611058Email mahmoudalalfy@ymail.comBackground: Many expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula.Objective: To compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment.Patients and Methods: This was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt.Results: The present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche.Conclusion: Scar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence).Trial Registration: Clinical Trials.gov Id NCT04076904.Keywords: cesarean, niche, two dimensional, 2D, three-dimensional, 3D, sonohysterography, SHG

A variety of pharmacological and non-pharmacological interventions have been investigated, with the goal of relieving pain after post-episiotomy repair. We aimed to compare the efficacy of tramadol versus celecoxib orally in reducing pain after mediolateral episiotomy repair in obese primigravidae undergoing spontaneous vaginal delivery. We conducted a randomized double-blinded trial in Cairo University hospital, Cairo, Egypt, from October 2018 to December 2019. We randomly assigned 200 women into two groups: group A (n = 100) received one tramadol tablet 100 mg orally whereas group B (n = 100) received one celecoxib tablet 200 mg orally. Our primary outcome was pain score using a 10-cm visual analog scale at different time intervals. Our secondary outcomes were the overall satisfaction score and drug side effects. After mediolateral episiotomy repair, the pain scores at 1, 2, and 4 h were significantly lower in the tramadol group than in the celecoxib group (p

Background: MicroRNAs (miRs) are noncoding gene regulators that may have a role as diagnostic or prognostic biomarkers in systemic lupus erythematosus (SLE) and its complications. SLE is an autoimmune disease that may be associated with secondary antiphospholipid syndrome (APS). Aim of the work: To evaluate the plasma levels of both miR-146a and miR-126 as well as serum alpha interferon (α IFN) in Egyptian SLE patients with and without secondary APS and to investigate their potential role in disease pathogenesis and their utility as biomarkers for APS. Patients and methods: 88 SLE patients including 30 cases with secondary APS and 40 matched healthy individuals were enrolled in this study. SLE disease activity index (SLEDAI) was assessed. The plasma levels of miR-146a and miR-126 were determined by Realtime polymerase chain reaction (PCR) in all participants. Results: The mean age of the patients was 31.3 ± 9.6 years with disease duration 1–17 years. Plasma miR-146a was significantly lower and miR-126 significantly higher in SLE compared to controls. MiR126 was also higher in secondary APS patients compared to patients without. Serum IFN-α ws significantly higher in patients (71.2 ± 19.7 pg/ml) compared to control (43.2 ± 9.7 pg/ml) (p

This study aimed at investigating the efficacy and safety of dinoprostone 3 mg vaginally prior to levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in women undergoing elective cesarean delivery (CD). We conducted a prospective, randomized, double-blinded, placebo-controlled trial at family planning clinic of Cairo University hospitals from August 2019 to January 2020. We included 200 women aged ≥ 18 years who previously delivered by elective CD willing to receive LNG-IUS. Women were randomly assigned with a 1:1 allocation ratio to receive 3 mg vaginal dinoprostone or placebo tablets two hours before LNG-IUS insertion. Our main outcomes were patient-reported pain during insertion and 30 min post-procedure, ease of insertion, satisfaction, duration of insertion, and different side effects. Patient-perceived pain during LNG-IUS insertion was significantly reduced in dinoprostone compared to placebo (4.1 ± 1.7 vs 6.4 ± 1.3; p

Background Hypertensive disorders of pregnancy can cause severe maternal and fetal acute morbidity and mortality. Women with pre-eclampsia have been found to have alterations in calcium and vitamin D metabolism. There are conflicting results regarding the role of vitamin D deficiency in the development of pre-eclampsia. The aim was to compare 25 (OH) D level in patients with pre-eclampsia, eclampsia and normotensive pregnant women as well as to study the prevalence of Vitamin D deficiency among the 3 groups. Patients and methods Two hundred patients with pre-eclampsia, 100 with eclampsia and 200 normotensive pregnant controls were compared as regards vitamin D level. Results Mean 25(OH)D level was lower in the pre-eclampsia (14.8 ± 5.4 ng/mL) and in the eclampsia group (10.5 ± 1.6 ng/mL) than in the pregnant controls (19.5 ± 6.5 ng/mL) (P = 0.002). This difference was only significant between the eclampsia group and the pregnant controls (P = 0.02). All eclampsia cases had vitamin D insufficiency as compared to 17.5% in the pre-eclampsia group and 39.5% in the control group. Deficiency of vitamin D ( Conclusion Vitamin D deficiency is highly prevalent among Egyptian pregnant females. Our study supports the hypothesis that low vitamin D level can play a role in the development of pre-eclampsia and eclampsia. Thus, supplementation might prevent or delay the development of pre-eclampsia and eclampsia especially in patients at a high risk.

Aim As angiogenesis is an essential step for chorionic villi formation. Vascular endothelial growth factor (VEGF) is essential for endothelial cell proliferation. Endothelial nitric oxide synthase (eNOS) is a powerful playmaker in hypoxia-induced angiogenesis. Thrombin-activatable fibrinolysis inhibitor (TAFI) regulates both fibrinolysis and inflammation. Genetic alterations of these factors may lead to recurrent spontaneous abortion (RSA). We aimed to investigate the combined genetic variants of VEGF G-1154A and two eNOS genetic variants: T-786C promoter region and intron 4 variable number of tandom repeats in addition to TAFI C-1040T among RSA patients. Methods The study included 50 patients with RSA and 50 healthy controls. Polymerase chain reaction and restriction fragment length polymorphism were used for genotyping. Results Both genetic alterations of eNOS confirmed at least a sixfold increase of RSA risk. Interestingly, they were associated with TAFI C-1040Tgenetic variant in 21 patients, eight of them had both studied eNOS genetic alterations and TAFI C-1040Tgenetic variant, while each eNOS genetic variant associated with TAFI C-1040Tconfirmed an almost one and half fold increase risk of RSA. Conclusion These findings highlighted the role of eNOS and nitric oxide metabolism in RSA and opened the gate to investigate the interaction of vasoconstrictive and fibrinolytic inhibitor systems.

Objectives: Isolation and comparison of cellular and molecular characteristics of MSCs derived from full term amniotic membrane (AM), endometrium and ovarian tissues. Investigation of a possible therapeutic potential for AM MSCs in the female reproductive tract. Study design & methods: Human amniotic membranes (AMs) from term placentas (N = 8), endometrial/stromal (by scrapping endometrium) and ovarian tissues from premenopausal hysterectomies (N = 6) after mincing and enzymatic digestion were included in the study. Immunophenotyping by flow cytometry, Karyotyping, differentiation to mesoderm, RT-PCR analysis for transcription factors, WNT signaling pathways, pluripotency markers and HOXA genes were performed. Results: Generated cells showed morphologically and phenotypically the characteristics of MSCs from other sources with fairly comparable results. The cumulative population doubling was significantly higher in endometrium MSCs 25 ± 5.2 compared to 17.2 ± 4.5 for AM MSCs and 10.7 ± 2.4 for ovarian MSCs (P

Cytokines in follicular fluid (FF) are important for reproduction as they modulate oocyte maturation and ovulation which influence subsequent fertilization, development of early embryo and potential for implantation. We evaluated FF cytokines in women who underwent intracytoplasmic sperm injection (ICSI) and their association with fertilized oocytes, embryo quality and pregnancy outcome. FF belonging to 38 patients including 18 polycystic ovary (PCO) and 20 male/unexplained infertility patients were investigated for granulocyte colony stimulating factor (G-CSF), regulated upon activation normal T cell expressed and presumably secreted (RANTES), tumour necrosis factor (TNFα), interferon gamma (IFNγ) and interleukins (IL-4 and IL-2) by bead-based sandwich immunoassay. Our findings revealed that on the day of oocyte retrieval, G-CSF was positively correlated with the number of fertilized oocytes, while TNFα detection was associated with reduced number of fertilized oocytes. Only G-CSF showed significant positive effect to the pregnancy outcome although the cytokines studied were not associated with embryo quality. PCO as the cause of infertility did not show an association with cytokines in FF. The functions of cytokines in reproduction are likely to be complex, and cytokine evaluation may offer insight to the understanding of the mechanisms leading to success or failure of assisted reproduction.

The risk of miscarriage is enhanced by genetic and environmental factors. Several studies indicated that there was an association between endothelial nitric oxide synthase activity, implantation, and the maintenance of pregnancy. However, the results of these studies remain controversial. The aim of our study was to determine the association between recurrent spontaneous miscarriage (RSM) in Egyptian women and two common polymorphisms of the endothelial nitric oxide synthase (eNOS) gene: intron 4 and T-786C. The study was conducted on a total number of 100 participants, 50 patients with RSM and 50 age-matched healthy controls. Patients and controls were investigated for the two polymorphisms. Genotyping of the eNOS intron 4 polymorphisms was performed by PCR assay. Our results indicated that there was a significant difference in the frequencies of the genotypes between case and control groups for the polymorphisms in both intron 4 (odds ratio (OR) 5.09, 95 % confidence interval (CI) 2.091–12.396, P

Several markers have been studied to diagnose PROM but there is still limitation with a gold standard test for the diagnosis [1]. Objective: To evaluate and compare the accuracy of urea, creatinine and hCG in vaginal fluid washing for diagnosis of PROM and to determine cut off levels. Type of the study: Prospective study performed on pregnant women in their third trimester who are coming to Kasr El Ainy maternity outpatient clinic with history of fluid leakage. Patients and methods: 150 patients between 26 - 40 weeks were included in the study. Group I included 50 patients with clinically confirmed ROM, group II included 50 with unconfirmed ROM and 50 controls with no complaints (group III). All patients were subjected to speculum examination for amniotic fluid pooling, nitrazine paper test, vaginal fluid washing for measurement of creatinine, urea and β-hCG, and ultrasound examination. The results were compared as regards the 3 study groups. Results: There was no statistically significant difference among the 3 study groups as regards age, parity BMI, nor gestational age. There was a statistically significant difference in creatinine level among confirmed, suspected and control groups. Urea levels showed also a statistically significant difference among the three groups. There was a positive correlation between vaginal creatinine and urea and gestational age in the 3 groups (r = 0.43, and 0.51 respectively). There was a statistically significant difference between vaginal fluid wash urea and creatinine levels and β-hCG as sensitivity, specificity, positive and negative predictive values and accuracy for urea and creatinine were all 100% and for qualitative β-hCG 83%, 100%, 100%, 85.6%, and 91% respectively. Conclusion: Urea and creatinine in vaginal washings can be accurately used in diagnosing suspected PROM and are more accurate than β-HCG.

Objectives To present the current status of the prenatal diagnosis services and results from the largest thalassaemia center in Egypt treating 3000 patients. Traditionally, prenatal diagnosis has not been successful in reducing the births of affected children in Egypt, because the majority of women undergoing prenatal diagnosis continued to have affected pregnancies. Methods Seventy-one pregnant mothers at risk for β-thalassaemia underwent prenatal diagnosis by chorionic villus sampling (n = 57) or amniocentesis (n = 14) between 11 to 14 weeks of gestation. Molecular characterization of fetal DNA by reverse dot blot hybridization and polymerase chain reaction-amplification refractory mutation system techniques was conducted in all cases. Results Twenty-four women (33.8%) were found to have affected fetuses; 100% of these women opted to terminate the pregnancy. The change in attitude towards termination of pregnancy was related to in-depth counseling of the religious aspects towards prenatal diagnosis and termination of pregnancy. Forty-eight women (66.2%) with normal or carrier fetuses for β-thal requested human leukocyte antigen typing of the fetal material to determine if the fetus was a human leukocyte antigen match for their existing thalassaemic siblings. Conclusion This study demonstrates that prenatal diagnosis is feasible and acceptable in Egypt, a Muslim country, provided an in-depth discussion, which also addresses the religious considerations of prevention, is held with the couples. © 2012 John Wiley & Sons, Ltd.

Postulated Stem/progenitor cells involved in endometrium regeneration are epithelial, mesenchymal, and endothelial. Bone marrow (BM) has been implicated in endometrial stem cells. We aimed at studying gene expression profiling of endometrial mesenchymal stem cells compared to BM MSCS to better understand their nature and functional phenotype. Endometrial tissues were obtained from premenopausal hysterectomies (n = 3), minced and enzymatically digested as well as Normal BM aspirates (n=3). Immunophenotyping, differentiation to mesoderm, and proliferation were studied. The expression profile of 84 genes relevant to mesenchymal stem cells was performed. Fold change calculations were determined with SA Biosciences data analysis software. VEGF, G-CSF, and GM-CSF in cultures supernatants of MSCs were assayed by Luminex immunoassay. Endo MSCs possess properties similar to BM MSCs. Cumulative population doubling was significantly higher in Endo MSCs compared to BM MSCs (p

OP30.01 Interobserver agreement on reporting uterine intracavity lesions at gel infusion sonography (GIS) T. Van den Bosch1, J. Luts2, T. Bourne3,1, T. Bignardi4, G. Condous4, E. Epstein5, F. Leone6, A. Testa7, L. I. Valentin8, S. Van Huffel2, D. Van Schoubroeck1, D. Timmerman1 1Obstetrics & Gynecology, University Hospitals K.U. Leuven, Leuven, Belgium; 2Electrical Engineering, ESAT-SCD, K.U. Leuven, Leuven, Belgium; 3Obstetrics and Gynaecology, Imperial College London, Hammersmith Campus, London, United Kingdom; 4Acute Gynaecology, Early Pregnancy Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Sydney, NSW, Australia; 5Obstetrics & Gynecology, Lund University Hospital, Lund, Sweden; 6Obstetrics & Gynecology, Clinical Science Institute L. Sacco, University of Milan, Milan, Italy; 7Obstetrics & Gynecology, Universita del Sacro Cuore, Rome, Italy; 8Obstetrics & Gynecology, Malmo University Hospital, Lund University, Malmo, Sweden