Ahmed Abdelraheim - Academia.edu (original) (raw)

Papers by Ahmed Abdelraheim

El-Minia Medical Bulletin, 2021

Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occ... more Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occur after a full-term delivery and a spontaneous miscarriage however, the risk of occurrence is more common after molar pregnancy. in this study we try to evaluate the management strategies and outcome of cases of molar pregnancies at maternity hospital Minia university over one year from July 2019 up to July 2020. Our study include 94 patients having picture of molar pregnancy. The post molar rising B-hcg titter occur more commonly with patients more than 35 years old and with patients with high parity Para five or more. while spontaneous resolution common with young, low parity patients. In our study we try to find the prediction model for the patients at high risk for developing persistent GTD. Thus we find that persistent GTD is more common in women aged 35 years old or more and women having high parity. Based on the results of the present study we concluded that molar pregnancy in patients with old age , high parity at high risk to develop persistent GTD. The early prediction and recognition of persistent GTD allow early and better treatment for patients with high risk. which lead to the better prognosis for this patients.

The Egyptian Journal of Hospital Medicine, Oct 1, 2022

Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in ... more Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in obstetrics. The major complication associated with PAS disorders is massive hemorrhage, which ultimately may lead to maternal death. Objectives: This study aimed to detect the optimum time and mode of interventions to remove the morbidly adherent placenta after leaving it in situ for conservative management. Patients and Methods: This was a cohort study carried out at the Obstetrics and Gynecology Department, Minia Maternity and Children University Hospital through the period from March 2018 to December 2020. The total number of patients with a placenta that was left in place was 20 patients out of 29 patients who were eligible for the study. Results: This approach of leaving the placenta in place then interval placental delivery was successful in 16 cases (80%). Four cases needed hysterectomy. Placental removal was through spontaneous placental resorption in one case (5%), a spontaneous expulsion of the placenta in one case (5%), in addition to a successful interval placental delivery through D & C in 2 cases (10%) as well as removal by mini-laparotomy in 12 cases (60%). The mean time between the cesarean section and the 2 nd set of interventions to remove the placenta was 48.2 ± 6.7 days. Conclusion: Conservative treatment by leaving the placenta in place followed by interval placental delivery seemed to be an appropriate management choice in selected patients desiring preservation of the uterus, but complications such as sepsis and secondary postpartum hemorrhage should be carefully diagnosed and appropriately managed.

Iranian Journal of Reproductive Medicine, Dec 1, 2017

Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despit... more Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands. Objective: To evaluate the role of laparoscopy±hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice. Materials and Methods: This case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014. Results: The causes of infertility as identified by laparoscopy±hysteroscopy were polycystic ovary syndrome (25.1%), tubal factor (30%), uterine cause (4%), and endometriosis (2.7%). No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases (15.3%). Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases (62%). Sixty cases (10%) had intrauterine insemination and sixty four cases (10.7%) underwent in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy (30%). The most favorable outcome was recorded in women with unexplained infertility (36.7% of cases got pregnant) followed by women with polycystic ovary syndrome (27.8%). Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis. Conclusion: Laparoscopy still has an important role in the diagnosis and treatment of infertility.

European Journal of Obstetrics & Gynecology and Reproductive Biology, Aug 1, 2017

To evaluate the two-week referral system by analysing the 2-week wait (2WW) referrals to the rapi... more To evaluate the two-week referral system by analysing the 2-week wait (2WW) referrals to the rapid access gynaecology clinic over one year. We have also sought to identify the risk factors for endometrial cancer to help setting criteria that can be used to prioritise urgent appointments, refine subsequent management strategies. Study design: Retrospective review of the data of all women referred for suspected gynaecological cancers over one year via the 2 WW office at Queen's Hospital, Romford, UK. Data of all other women in whom a diagnosis of a gynaecological malignancy was made during the same period following non-urgent (non-2WW) referrals were also collected. Results: Over one year, a total of 1105 women were referred under the 2WW for suspected gynaecological malignancy. A total of 765 patients (69.23%) were referred with suspected endometrial cancer and the main indication for referral was postmenopausal bleeding. Hundred-seventy nine women (16.20%) were referred with suspected ovarian cancer. A pelvic mass found in 62 of these women and this was the main indication of referral. The number of women referred with suspected cervical cancer was 117 (10.59%) and the main indication for referral was postcoital bleeding. Forty-four women (3.98%) referred with suspected vulvo-vaginal cancer and the main presentation was vulval lesion. The positive predictive value of referrals for diagnosing endometrial, ovarian, cervical and vulvo-vaginal malignancy was 8.1%, 9.5%, 5.98% and 13.64% and the overall predictive value for diagnosing gynaecological malignancy was 8.33%. The predictive values of the 2WW referrals for diagnosing different types of gynaecological cancers in premenopausal women are low compared to postmenopausal women (1.86% and 9.89% respectively, p < 0.001). The number of cancers diagnosed through non-urgent system was higher than the number diagnosed through urgent system (95 vs. 92). Presence of diabetes mellitus, increased endometrial thickness, prolonged bleeding and advancing age represent the best model for predicting endometrial cancer. Conclusion: The overall predictive value of the 2WW system for suspected gynaecological malignancies is low particularly in premenopausal women. The current referral criteria need to be modified with a view to incorporating risk factors to prioritise urgent appointments and refine subsequent management plans.

Minia Journal of Medical Research

Introduction: Premature membrane rupture (PROM) is generally characterized as membrane rupture at... more Introduction: Premature membrane rupture (PROM) is generally characterized as membrane rupture at any point prior to the initiation of uterine contractions. PROM, which occurs before 37 weeks of gestation, is referred to as preterm premature membrane rupture (PPROM), while PROM, which occurs after 37 weeks of gestation, is referred to as the term premature membrane rupture. The latent phase is known as the duration of the rupture of the membranes until the onset of true labor. (1) Aim of the Work: This study was conducted to evaluate the maternal and perinatal outcome of PPROM (between 24 and 37 weeks) among pregnant women attending Minia University Maternity Hospital [MUMH]. Patients and Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Minia University Maternity Hospital (MUMH) during the period from march 2021 to august 2021 and after being approved by the local department ethical committee of MUMH. All patients diagnosed by PPROM during this study period were recruited into this study. Results: This prospective observational study was conducted in MUMH during the period from march to December 2021. 110 pregnant females presented with PPROM between 24 and 37weeks' gestation were recruited in this study

Minia Journal of Medical Research, 2021

Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occ... more Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occur after a full-term delivery and a spontaneous miscarriage however, the risk of occurrence is more common after molar pregnancy. in this study we try to evaluate the management strategies and outcome of cases of molar pregnancies at maternity hospital Minia university over one year from July 2019 up to July 2020. Our study include 94 patients having picture of molar pregnancy. The post molar rising B-hcg titter occur more commonly with patients more than 35 years old and with patients with high parity Para five or more. while spontaneous resolution common with young, low parity patients. In our study we try to find the prediction model for the patients at high risk for developing persistent GTD. Thus we find that persistent GTD is more common in women aged 35 years old or more and women having high parity. Based on the results of the present study we concluded that molar pregnancy in patients with old age , high parity at high risk to develop persistent GTD. The early prediction and recognition of persistent GTD allow early and better treatment for patients with high risk. which lead to the better prognosis for this patients.

The Egyptian Journal of Hospital Medicine

Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in ... more Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in obstetrics. The major complication associated with PAS disorders is massive hemorrhage, which ultimately may lead to maternal death. Objectives: This study aimed to detect the optimum time and mode of interventions to remove the morbidly adherent placenta after leaving it in situ for conservative management. Patients and Methods: This was a cohort study carried out at the Obstetrics and Gynecology Department, Minia Maternity and Children University Hospital through the period from March 2018 to December 2020. The total number of patients with a placenta that was left in place was 20 patients out of 29 patients who were eligible for the study. Results: This approach of leaving the placenta in place then interval placental delivery was successful in 16 cases (80%). Four cases needed hysterectomy. Placental removal was through spontaneous placental resorption in one case (5%), a spontaneous expulsion of the placenta in one case (5%), in addition to a successful interval placental delivery through D & C in 2 cases (10%) as well as removal by mini-laparotomy in 12 cases (60%). The mean time between the cesarean section and the 2 nd set of interventions to remove the placenta was 48.2 ± 6.7 days. Conclusion: Conservative treatment by leaving the placenta in place followed by interval placental delivery seemed to be an appropriate management choice in selected patients desiring preservation of the uterus, but complications such as sepsis and secondary postpartum hemorrhage should be carefully diagnosed and appropriately managed.

BJOG: An International Journal of Obstetrics & Gynaecology, 2012

Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of ... more Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. Objective To evaluate factors affecting uptake of risk-reducing salpingo-oophorectomy(RRSO) over time in women at high-risk of familial ovarian cancer. Design Prospective observational cohort Setting Tertiary high-risk familial gynaecological cancer clinic Population/Sample New clinic attendees between March-2004 and November-2009, fulfilling high-risk criteria for the UK Familial Ovarian Cancer Screening Study. Methods Risk management options discussed included RRSO and ovarian surveillance. Outcomes data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function(CIF) of RRSO over time, and Sub-Hazard ratio(SHR) to assess the strength of association of variables of interest with RRSO. Gray's test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis to model the cumulative probabilities of co-variates on the CIF. Results Of 1133 eligible women 265(21.4%) opted for RRSO and 868(69.9%) for screening. Women undergoing RRSO were older (49years,IQR-12.2) than those preferring 3 screening (43.4years,IQR-11.9)(p<0.0005). The cumulative probability(CIF) for RRSO at 5years was 0.55(CI0.45,0.64) for BRCA1/2 carriers and 0.22(CI0.19,0.26) for women of unknown mutation status(p<0.0001); 0.42(95%CI0.36,0.47) for postmenopausal women(p<0.0001); 0.29(95%CI0.25,0.33) for parity ≥1(p=0.009) and 0.47(95%CI 0.39,0.55) for a personal history of breast cancer(p<0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation(SHR 2.31(CI 1.7, 3.14)), postmenopausal status(SHR2.16(CI 1.62,2.87)) and a personal history of breast cancer(SHR1.5(CI 1.09,2.06)). Conclusions Decision making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.

Background: Pain relief modalities during labour are an essential part of the labour process. Aim... more Background: Pain relief modalities during labour are an essential part of the labour process. Aim: This study aimed to determine the most common barriers encountered among obstetric health professionals regarding utilization of labour pain relief methods. Study Design: Hospital-based, cross- sectional study design was utilized. Sample: Purposive sampling technique was used to enroll 234 health professional personnel. Setting: This study conducted in maternity units in Minya Governorate including Minya Maternity and Children University Hospital. Methods: Data were collected by using a structured, self-administrated questionnaire which was designed for this research. Results: most of the participants (98.7%) thought that hospital-related barriers were the main barrier encountered among participants regarding utilization of both pharmacological and no pharmacological methods of pain relief. Followed by mixed barriers fluctuating between hospital, patient and clinician related barriers ...

Cervical Inversion_placenta accreta. This is a movie file showing detailed steps of the technique... more Cervical Inversion_placenta accreta. This is a movie file showing detailed steps of the technique of cervical inversion. (XML 7 kb)

Indian Journal of Anaesthesia, 2020

Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (S... more Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH. Methods: This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25. Results: Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively (P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group (P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group. Conclusion: Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

BMC Pregnancy and Childbirth, 2019

Background: The incidence of post cesarean intra-abdominal infection (IAI) and the independent ri... more Background: The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. Methods: The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. Results: During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15-16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69-10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS > 1 h (AOR 3.42; 95% CI =2.45-5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14-4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04-3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78-3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26-2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11-2.39; p = 0.021). Conclusions: The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.

International Journal of Reproductive BioMedicine, 2017

Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despit... more Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands. Objective: To evaluate the role of laparoscopy±hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice. Materials and Methods: This case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014. Results: The causes of infertility as identified by laparoscopy±hysteroscopy were polycystic ovary syndrome (25.1%), tubal factor (30%), uterine cause (4%), and endometriosis (2.7%). No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases (15.3%). Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases (62%). Sixty cases (10%) had intrauterine insemination and sixty four cases (10.7%) underwent in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy (30%). The most favorable outcome was recorded in women with unexplained infertility (36.7% of cases got pregnant) followed by women with polycystic ovary syndrome (27.8%). Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis. Conclusion: Laparoscopy still has an important role in the diagnosis and treatment of infertility.

International Journal of Gynecological Cancer, 2012

Diathermy induced injury may affect detection of occult tubal lesions at risk reducing salpingo-o... more Diathermy induced injury may affect detection of occult tubal lesions at risk reducing salpingo-oophorectomy (RRSO). Background Electro-surgery induced tubal thermal injury obscures cellular detail and hampers histo-morphological assessment for occult pathology. Objective To report on diathermy related thermal injuries to the fallopian tube observed at RRSO and explore its potential impact on the detection of occult tubal epithelial lesions. Design High-risk women from breast and/or ovarian cancer families attending a tertiary highrisk familial gynaecological cancer clinic. Retrospective case control analysis of high-risk women who underwent RRSO. Cases: All women detected to have occult lesions (tubal atypia/carcinoma in situ/cancer) between January-2005 and December-2010. Controls: All women with normal tubal/ovarian histology between August-2006 and December-2007 Methods Two pathologists performed histopathological assessment for grade of thermal injury. Tubal diathermy injury rates were compared between cases and controls. Statistical analysis was undertaken using SPSS-18. The Mann-Whitney test compared age distributions, Chi-Square / Fisher's tests the difference between proportions and Gamma test the difference in ordinal variables between the groups. Results 3 A novel tubal thermal index to describe the severity of injury is reported. Lack of fimbrial thermal injury is twice as likely (odds ratio 2.04, 95%CI 1.06,3.92) to be associated with detection of occult tubal pathology, whereas isthmic injury does not affect detection rate (p=0.744). The groups were comparable with respect to age at RRSO (p=0.531) and the presence of BRCA mutations (p=0.192). Conclusions This report highlights the potential impact of electrosurgical thermal injury on detection of occult tubal pathology following RRSO. It is important for surgeons to avoid thermal injury to the distal end of the tube.

Archives of Gynecology and Obstetrics, 2012

Middle East Fertility Society Journal, 2015

Abstract Objective & Aim: The objective of this study was to analyze the usefulness of office... more Abstract Objective & Aim: The objective of this study was to analyze the usefulness of office microlaparoscopy in the re-assessment of ovarian morphological picture, relevant clinical types and future fertility prognosis of primary ovarian insufficiency (POI). Methods: Forty-five patients with POI diagnosed in a private fertility care center between October 2009 and December 2014, who gave informed consent and underwent office microlaparoscopy were studied. Pelvic ultrasound had failed to visualize and morphologically assess both ovaries in the women included. The cases were divided into four groups based on the microlaparoscopic ovarian morphology: Group N (near to normal), Group G (Gyrus shaped), Group A (atrophied), and Group S (streak shaped). These groups were analyzed with respect to patient background, blood hormone levels, the level of antinuclear antibodies measured, and their individual fertility prognosis. Result: No significant differences in patient background and serum hormone levels were observed between groups. There was complete absence of both ovaries in 5 patients included. Groups N and G had shown some improvement, such as regular spontaneous menstruation, and forthcoming pregnancy, which happened once in Group N. Many other internal genital anomalies could be diagnosed during the same office procedure. Conclusion: Office microlaparoscopy under augmented local anesthesia is a useful procedure in the definite demarcation, and the differentiation between the types of POI, regarding their menstrual regularity and future fertility prognosis.

BJOG: An International Journal of Obstetrics & Gynaecology, 2011

BMC Pregnancy and Childbirth

Background: Placenta accreta spectrum (PAS) disorders have become a significant life-threatening ... more Background: Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. Methods: This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n = 38) underwent cesarean hysterectomy, group (B), (n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place. Results: The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. Conclusions: The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling.

BMC Pregnancy and Childbirth

Background Surgical site infection (SSI) is one of the commonest complications following cesarean... more Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean se...

El-Minia Medical Bulletin, 2021

Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occ... more Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occur after a full-term delivery and a spontaneous miscarriage however, the risk of occurrence is more common after molar pregnancy. in this study we try to evaluate the management strategies and outcome of cases of molar pregnancies at maternity hospital Minia university over one year from July 2019 up to July 2020. Our study include 94 patients having picture of molar pregnancy. The post molar rising B-hcg titter occur more commonly with patients more than 35 years old and with patients with high parity Para five or more. while spontaneous resolution common with young, low parity patients. In our study we try to find the prediction model for the patients at high risk for developing persistent GTD. Thus we find that persistent GTD is more common in women aged 35 years old or more and women having high parity. Based on the results of the present study we concluded that molar pregnancy in patients with old age , high parity at high risk to develop persistent GTD. The early prediction and recognition of persistent GTD allow early and better treatment for patients with high risk. which lead to the better prognosis for this patients.

The Egyptian Journal of Hospital Medicine, Oct 1, 2022

Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in ... more Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in obstetrics. The major complication associated with PAS disorders is massive hemorrhage, which ultimately may lead to maternal death. Objectives: This study aimed to detect the optimum time and mode of interventions to remove the morbidly adherent placenta after leaving it in situ for conservative management. Patients and Methods: This was a cohort study carried out at the Obstetrics and Gynecology Department, Minia Maternity and Children University Hospital through the period from March 2018 to December 2020. The total number of patients with a placenta that was left in place was 20 patients out of 29 patients who were eligible for the study. Results: This approach of leaving the placenta in place then interval placental delivery was successful in 16 cases (80%). Four cases needed hysterectomy. Placental removal was through spontaneous placental resorption in one case (5%), a spontaneous expulsion of the placenta in one case (5%), in addition to a successful interval placental delivery through D & C in 2 cases (10%) as well as removal by mini-laparotomy in 12 cases (60%). The mean time between the cesarean section and the 2 nd set of interventions to remove the placenta was 48.2 ± 6.7 days. Conclusion: Conservative treatment by leaving the placenta in place followed by interval placental delivery seemed to be an appropriate management choice in selected patients desiring preservation of the uterus, but complications such as sepsis and secondary postpartum hemorrhage should be carefully diagnosed and appropriately managed.

Iranian Journal of Reproductive Medicine, Dec 1, 2017

Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despit... more Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands. Objective: To evaluate the role of laparoscopy±hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice. Materials and Methods: This case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014. Results: The causes of infertility as identified by laparoscopy±hysteroscopy were polycystic ovary syndrome (25.1%), tubal factor (30%), uterine cause (4%), and endometriosis (2.7%). No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases (15.3%). Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases (62%). Sixty cases (10%) had intrauterine insemination and sixty four cases (10.7%) underwent in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy (30%). The most favorable outcome was recorded in women with unexplained infertility (36.7% of cases got pregnant) followed by women with polycystic ovary syndrome (27.8%). Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis. Conclusion: Laparoscopy still has an important role in the diagnosis and treatment of infertility.

European Journal of Obstetrics & Gynecology and Reproductive Biology, Aug 1, 2017

To evaluate the two-week referral system by analysing the 2-week wait (2WW) referrals to the rapi... more To evaluate the two-week referral system by analysing the 2-week wait (2WW) referrals to the rapid access gynaecology clinic over one year. We have also sought to identify the risk factors for endometrial cancer to help setting criteria that can be used to prioritise urgent appointments, refine subsequent management strategies. Study design: Retrospective review of the data of all women referred for suspected gynaecological cancers over one year via the 2 WW office at Queen's Hospital, Romford, UK. Data of all other women in whom a diagnosis of a gynaecological malignancy was made during the same period following non-urgent (non-2WW) referrals were also collected. Results: Over one year, a total of 1105 women were referred under the 2WW for suspected gynaecological malignancy. A total of 765 patients (69.23%) were referred with suspected endometrial cancer and the main indication for referral was postmenopausal bleeding. Hundred-seventy nine women (16.20%) were referred with suspected ovarian cancer. A pelvic mass found in 62 of these women and this was the main indication of referral. The number of women referred with suspected cervical cancer was 117 (10.59%) and the main indication for referral was postcoital bleeding. Forty-four women (3.98%) referred with suspected vulvo-vaginal cancer and the main presentation was vulval lesion. The positive predictive value of referrals for diagnosing endometrial, ovarian, cervical and vulvo-vaginal malignancy was 8.1%, 9.5%, 5.98% and 13.64% and the overall predictive value for diagnosing gynaecological malignancy was 8.33%. The predictive values of the 2WW referrals for diagnosing different types of gynaecological cancers in premenopausal women are low compared to postmenopausal women (1.86% and 9.89% respectively, p < 0.001). The number of cancers diagnosed through non-urgent system was higher than the number diagnosed through urgent system (95 vs. 92). Presence of diabetes mellitus, increased endometrial thickness, prolonged bleeding and advancing age represent the best model for predicting endometrial cancer. Conclusion: The overall predictive value of the 2WW system for suspected gynaecological malignancies is low particularly in premenopausal women. The current referral criteria need to be modified with a view to incorporating risk factors to prioritise urgent appointments and refine subsequent management plans.

Minia Journal of Medical Research

Introduction: Premature membrane rupture (PROM) is generally characterized as membrane rupture at... more Introduction: Premature membrane rupture (PROM) is generally characterized as membrane rupture at any point prior to the initiation of uterine contractions. PROM, which occurs before 37 weeks of gestation, is referred to as preterm premature membrane rupture (PPROM), while PROM, which occurs after 37 weeks of gestation, is referred to as the term premature membrane rupture. The latent phase is known as the duration of the rupture of the membranes until the onset of true labor. (1) Aim of the Work: This study was conducted to evaluate the maternal and perinatal outcome of PPROM (between 24 and 37 weeks) among pregnant women attending Minia University Maternity Hospital [MUMH]. Patients and Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Minia University Maternity Hospital (MUMH) during the period from march 2021 to august 2021 and after being approved by the local department ethical committee of MUMH. All patients diagnosed by PPROM during this study period were recruited into this study. Results: This prospective observational study was conducted in MUMH during the period from march to December 2021. 110 pregnant females presented with PPROM between 24 and 37weeks' gestation were recruited in this study

Minia Journal of Medical Research, 2021

Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occ... more Gestational trophoblastic neoplasia (GTN) represents a rare complication of pregnancy. It may occur after a full-term delivery and a spontaneous miscarriage however, the risk of occurrence is more common after molar pregnancy. in this study we try to evaluate the management strategies and outcome of cases of molar pregnancies at maternity hospital Minia university over one year from July 2019 up to July 2020. Our study include 94 patients having picture of molar pregnancy. The post molar rising B-hcg titter occur more commonly with patients more than 35 years old and with patients with high parity Para five or more. while spontaneous resolution common with young, low parity patients. In our study we try to find the prediction model for the patients at high risk for developing persistent GTD. Thus we find that persistent GTD is more common in women aged 35 years old or more and women having high parity. Based on the results of the present study we concluded that molar pregnancy in patients with old age , high parity at high risk to develop persistent GTD. The early prediction and recognition of persistent GTD allow early and better treatment for patients with high risk. which lead to the better prognosis for this patients.

The Egyptian Journal of Hospital Medicine

Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in ... more Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in obstetrics. The major complication associated with PAS disorders is massive hemorrhage, which ultimately may lead to maternal death. Objectives: This study aimed to detect the optimum time and mode of interventions to remove the morbidly adherent placenta after leaving it in situ for conservative management. Patients and Methods: This was a cohort study carried out at the Obstetrics and Gynecology Department, Minia Maternity and Children University Hospital through the period from March 2018 to December 2020. The total number of patients with a placenta that was left in place was 20 patients out of 29 patients who were eligible for the study. Results: This approach of leaving the placenta in place then interval placental delivery was successful in 16 cases (80%). Four cases needed hysterectomy. Placental removal was through spontaneous placental resorption in one case (5%), a spontaneous expulsion of the placenta in one case (5%), in addition to a successful interval placental delivery through D & C in 2 cases (10%) as well as removal by mini-laparotomy in 12 cases (60%). The mean time between the cesarean section and the 2 nd set of interventions to remove the placenta was 48.2 ± 6.7 days. Conclusion: Conservative treatment by leaving the placenta in place followed by interval placental delivery seemed to be an appropriate management choice in selected patients desiring preservation of the uterus, but complications such as sepsis and secondary postpartum hemorrhage should be carefully diagnosed and appropriately managed.

BJOG: An International Journal of Obstetrics & Gynaecology, 2012

Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of ... more Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. Objective To evaluate factors affecting uptake of risk-reducing salpingo-oophorectomy(RRSO) over time in women at high-risk of familial ovarian cancer. Design Prospective observational cohort Setting Tertiary high-risk familial gynaecological cancer clinic Population/Sample New clinic attendees between March-2004 and November-2009, fulfilling high-risk criteria for the UK Familial Ovarian Cancer Screening Study. Methods Risk management options discussed included RRSO and ovarian surveillance. Outcomes data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function(CIF) of RRSO over time, and Sub-Hazard ratio(SHR) to assess the strength of association of variables of interest with RRSO. Gray's test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis to model the cumulative probabilities of co-variates on the CIF. Results Of 1133 eligible women 265(21.4%) opted for RRSO and 868(69.9%) for screening. Women undergoing RRSO were older (49years,IQR-12.2) than those preferring 3 screening (43.4years,IQR-11.9)(p<0.0005). The cumulative probability(CIF) for RRSO at 5years was 0.55(CI0.45,0.64) for BRCA1/2 carriers and 0.22(CI0.19,0.26) for women of unknown mutation status(p<0.0001); 0.42(95%CI0.36,0.47) for postmenopausal women(p<0.0001); 0.29(95%CI0.25,0.33) for parity ≥1(p=0.009) and 0.47(95%CI 0.39,0.55) for a personal history of breast cancer(p<0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation(SHR 2.31(CI 1.7, 3.14)), postmenopausal status(SHR2.16(CI 1.62,2.87)) and a personal history of breast cancer(SHR1.5(CI 1.09,2.06)). Conclusions Decision making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.

Background: Pain relief modalities during labour are an essential part of the labour process. Aim... more Background: Pain relief modalities during labour are an essential part of the labour process. Aim: This study aimed to determine the most common barriers encountered among obstetric health professionals regarding utilization of labour pain relief methods. Study Design: Hospital-based, cross- sectional study design was utilized. Sample: Purposive sampling technique was used to enroll 234 health professional personnel. Setting: This study conducted in maternity units in Minya Governorate including Minya Maternity and Children University Hospital. Methods: Data were collected by using a structured, self-administrated questionnaire which was designed for this research. Results: most of the participants (98.7%) thought that hospital-related barriers were the main barrier encountered among participants regarding utilization of both pharmacological and no pharmacological methods of pain relief. Followed by mixed barriers fluctuating between hospital, patient and clinician related barriers ...

Cervical Inversion_placenta accreta. This is a movie file showing detailed steps of the technique... more Cervical Inversion_placenta accreta. This is a movie file showing detailed steps of the technique of cervical inversion. (XML 7 kb)

Indian Journal of Anaesthesia, 2020

Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (S... more Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH. Methods: This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25. Results: Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively (P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group (P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group. Conclusion: Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

BMC Pregnancy and Childbirth, 2019

Background: The incidence of post cesarean intra-abdominal infection (IAI) and the independent ri... more Background: The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. Methods: The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. Results: During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15-16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69-10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS > 1 h (AOR 3.42; 95% CI =2.45-5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14-4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04-3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78-3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26-2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11-2.39; p = 0.021). Conclusions: The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.

International Journal of Reproductive BioMedicine, 2017

Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despit... more Background: More than 3 decades after the introduction of in vitro fertilization (IVF) and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands. Objective: To evaluate the role of laparoscopy±hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice. Materials and Methods: This case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014. Results: The causes of infertility as identified by laparoscopy±hysteroscopy were polycystic ovary syndrome (25.1%), tubal factor (30%), uterine cause (4%), and endometriosis (2.7%). No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases (15.3%). Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases (62%). Sixty cases (10%) had intrauterine insemination and sixty four cases (10.7%) underwent in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy (30%). The most favorable outcome was recorded in women with unexplained infertility (36.7% of cases got pregnant) followed by women with polycystic ovary syndrome (27.8%). Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis. Conclusion: Laparoscopy still has an important role in the diagnosis and treatment of infertility.

International Journal of Gynecological Cancer, 2012

Diathermy induced injury may affect detection of occult tubal lesions at risk reducing salpingo-o... more Diathermy induced injury may affect detection of occult tubal lesions at risk reducing salpingo-oophorectomy (RRSO). Background Electro-surgery induced tubal thermal injury obscures cellular detail and hampers histo-morphological assessment for occult pathology. Objective To report on diathermy related thermal injuries to the fallopian tube observed at RRSO and explore its potential impact on the detection of occult tubal epithelial lesions. Design High-risk women from breast and/or ovarian cancer families attending a tertiary highrisk familial gynaecological cancer clinic. Retrospective case control analysis of high-risk women who underwent RRSO. Cases: All women detected to have occult lesions (tubal atypia/carcinoma in situ/cancer) between January-2005 and December-2010. Controls: All women with normal tubal/ovarian histology between August-2006 and December-2007 Methods Two pathologists performed histopathological assessment for grade of thermal injury. Tubal diathermy injury rates were compared between cases and controls. Statistical analysis was undertaken using SPSS-18. The Mann-Whitney test compared age distributions, Chi-Square / Fisher's tests the difference between proportions and Gamma test the difference in ordinal variables between the groups. Results 3 A novel tubal thermal index to describe the severity of injury is reported. Lack of fimbrial thermal injury is twice as likely (odds ratio 2.04, 95%CI 1.06,3.92) to be associated with detection of occult tubal pathology, whereas isthmic injury does not affect detection rate (p=0.744). The groups were comparable with respect to age at RRSO (p=0.531) and the presence of BRCA mutations (p=0.192). Conclusions This report highlights the potential impact of electrosurgical thermal injury on detection of occult tubal pathology following RRSO. It is important for surgeons to avoid thermal injury to the distal end of the tube.

Archives of Gynecology and Obstetrics, 2012

Middle East Fertility Society Journal, 2015

Abstract Objective & Aim: The objective of this study was to analyze the usefulness of office... more Abstract Objective & Aim: The objective of this study was to analyze the usefulness of office microlaparoscopy in the re-assessment of ovarian morphological picture, relevant clinical types and future fertility prognosis of primary ovarian insufficiency (POI). Methods: Forty-five patients with POI diagnosed in a private fertility care center between October 2009 and December 2014, who gave informed consent and underwent office microlaparoscopy were studied. Pelvic ultrasound had failed to visualize and morphologically assess both ovaries in the women included. The cases were divided into four groups based on the microlaparoscopic ovarian morphology: Group N (near to normal), Group G (Gyrus shaped), Group A (atrophied), and Group S (streak shaped). These groups were analyzed with respect to patient background, blood hormone levels, the level of antinuclear antibodies measured, and their individual fertility prognosis. Result: No significant differences in patient background and serum hormone levels were observed between groups. There was complete absence of both ovaries in 5 patients included. Groups N and G had shown some improvement, such as regular spontaneous menstruation, and forthcoming pregnancy, which happened once in Group N. Many other internal genital anomalies could be diagnosed during the same office procedure. Conclusion: Office microlaparoscopy under augmented local anesthesia is a useful procedure in the definite demarcation, and the differentiation between the types of POI, regarding their menstrual regularity and future fertility prognosis.

BJOG: An International Journal of Obstetrics & Gynaecology, 2011

BMC Pregnancy and Childbirth

Background: Placenta accreta spectrum (PAS) disorders have become a significant life-threatening ... more Background: Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. Methods: This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n = 38) underwent cesarean hysterectomy, group (B), (n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place. Results: The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. Conclusions: The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling.

BMC Pregnancy and Childbirth

Background Surgical site infection (SSI) is one of the commonest complications following cesarean... more Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean se...