Assem Elbiaa | Ain Shams University (original) (raw)

Papers by Assem Elbiaa

Research paper thumbnail of A Simple Proline Stitch is Safe and Easy to Use for Sacrospinous Fixation: a Prospective Cohort Study

Obstetrics & Gynecology International Journal, Dec 3, 2014

A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure... more A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure for pelvic organ prolapse.

Research paper thumbnail of Impact of antenatal oxytocin infusion on neonatal respiratory morbidity associated with elective cesarean section

Archives of Medical Science, 2017

Introduction: This study was designed to estimate respiratory morbidity associated with elective ... more Introduction: This study was designed to estimate respiratory morbidity associated with elective cesarean section (ECS) and to determine the effect of antenatal oxytocin exposure on this morbidity. Material and methods: Nine hundred and sixty-five neonates ≥ 37 weeks' gestation delivered by cesarean section during 1 year were included in this retrospective study and classified into two groups according to oxytocin exposure before cesarean deliveries. Respiratory morbidity for each group was recorded and statistically analyzed. Results: Transient tachypnea of newborn (TTN) was significantly more frequent in group II (ECS group) than in group I (cesarean section after oxytocin exposure) (8.19% vs. 2.92%; respectively, p = 0.0006). Mechanical ventilation, continuous positive airway pressure (CPAP) and oxygen therapy were significantly more frequent in group II than in group I (1.78%, 2.14% and 4.28% versus 0.44%, 0.58% and 1.46%, respectively; p = 0.039, and p = 0.033 and p = 0.009, respectively). The number of newborns admitted to the neonatal unit and neonatal intensive care unit (NICU) was significantly higher in group II than in group I (6.41% and 2.14% vs. 2.05% and 0.58%, respectively; p = 0.001 and p = 0.033, respectively). Surfactant, fluid therapies and parenteral nutrition were significantly more frequent in group II than in group I (2.14%, 4.28% and 2.49% vs. 0.15%, 1.46% and 0.73%, respectively; p = 0.001, p = 0.009 and p = 0.02, respectively). Conclusions: Neonatal respiratory morbidity associated with ECS significantly decreased after antenatal oxytocin exposure. A significant reduction of neonatal respiratory morbidity would be achieved if ECS were performed after 39 weeks' gestation.

Research paper thumbnail of Beneficial Effects of Tibolone on Sexual Dys-function in Women with Premature Ovarian Failure (POF)

Health, 2016

Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of... more Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the association between Premature Ovarian Failure and sexual dysfunctions and outcome of management with tibolone. Patients and Methods: Thirty-one women with Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital were enrolled into the study with 31 healthy women as control group. The instrument of data collection included two types of questionnaires to assess the effect of Premature Ovarian Failure on sexuality. All the women with POF had oral tibolone 2.5 mg for at least one year and the second questionnaire and the profiles were repeated. Results: Of the 31 women with POF that presented with sexual dysfunction (SD), 27 (87.1%) complained of one or more SD domains such as reduced frequency of coitus, dyspareunia, vaginal dryness, reduced libido and general sexual satisfaction (P < 0.01), amenorrhea (P < 0.01) and hot flashes compared to 5 (16.1%) control women (P < 0.01). Administration of tibolone was associated with significant increase in frequency of coitus, reduced dyspareunia and vaginal dryness, increase libido and general satisfaction and happiness. Reduction of sexual dysfunction was predicated on the estrogenic, progestogenic and androgenic metabolite of tibolone through the reduction of serum level of FSH and LH and increased levels of estrogen and testosterone (P < 0.01). Tibolone had no adverse effect on serum lipid profile. Conclusion: Premature Ovarian Failure is associated with sexual dysfunction. Tibolone provides an effective means of treating sexual dysfunction caused by Premature Ovarian Failure.

Research paper thumbnail of Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse

Przeglad Menopauzalny, 2015

Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions i... more Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods: Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results: Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions: Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

Research paper thumbnail of Effect of Adding Sildenafil to Clomiphene Citrate versus Clomiphene Citrate alone on Endometrium in Unexplained Infertility: Cross-Sectional, Non-Randomized Study

Obstetrics & Gynecology International Journal, 2017

Aim of the study: To evaluate the endometrial thickness, pattern, and endometrial flow, in patien... more Aim of the study: To evaluate the endometrial thickness, pattern, and endometrial flow, in patients taking clomiphene citrate plus sildenafil tablets introduced vaginally as compared to patients who had no pregnancy on clomiphene citrate alone in unexplained infertility.

Research paper thumbnail of Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy: A double-blind randomised study

Indian Journal of Anaesthesia

Background and Aims: Myomectomy is associated with perioperative bleeding. The aim of the study i... more Background and Aims: Myomectomy is associated with perioperative bleeding. The aim of the study is to evaluate the effect of intramyometrial vasopressin on blood loss and the associated cardiovascular complications during myomectomy. Methods: The study included 194 patients classified into two groups- 1) Vasopressin group: the vasopressin was diluted as 0.1 unit/ml and 15 ml was injected by the surgeon in the plane between the myometrium and the myoma. 2) Control group: The patients received an equal amount of normal saline. The monitored parameters included the amount of blood loss, required blood transfusion, heart rate, mean arterial blood pressure, the incidence of hypertension, hypotension, bradycardia, tachycardia, electrocardiogram (ECG) changes and the blood troponin I level. Results: The heart rate decreased significantly in both groups, but the decrease was lower with vasopressin than the control group through the time points T3 to T5 (P < 0.05) The mean arterial blood pressure increased significantly in both groups, but the increase was higher with vasopressin than the control group through T3 to T5 (P < 0.05). The amount of blood loss decreased significantly with vasopressin than the control groups (P = 0.001). The number of transfused packed red blood cells was lower with vasopressin than the control group (P = 0.001). The incidence of hypertension, bradycardia and atrial extrasystole was higher with vasopressin than the control group (P = 0.005, P = 0.012, P = 0.033, respectively). Conclusion: Intramyometrial vasopressin decreases blood loss and blood transfusion, but it is associated with cardiovascular complications that may be serious as reported in other studies. Therefore, anaesthesiologists and gynaecologists must follow the precautions to avoid and minimise the incidence of complications with intramyometrial vasopressin.

Research paper thumbnail of Early Clomiphene Citrate for Ovulation Induction in Polycystic Ovary Syndrome

Research paper thumbnail of Heme iron to correct Iron deficiency anemia with pregnancy

Objectives: This study designed to evaluate the efficacy and tolerability of heme iron polypeptid... more Objectives: This study designed to evaluate the efficacy and tolerability of heme iron polypeptide (HIP) in treatment of iron deficiency anemia during pregnancy. Methods: 150 pregnant women with hemoglobin <10 gm/dl due to iron deficiency included in this study and treated with HIP for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing the pre-treatment values of hemoglobin, serum ferritin, reticulocytes, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) by the 3-months` post-treatment values. Results: The mean pre-treatment hemoglobin significantly increased from 8.8 ± 3.7 to 11.4 ± 3.04 gm/dl and the mean pretreatment ferritin level significantly increased from 15.6 ± 6.3 to 118.4 ± 4.6 ug/l 3-months` after Proferrin treatment. In addition; the mean pre-treatment RBCs MCV significantly increased from 72.6 ± 5.2 to 92.1 ± 3.8 FL, and the mean -treatment RBCs MCH significantly increased from 24.5 ± 8.1 to 25.8 ± 6.6 pg...

Research paper thumbnail of Heme iron polypeptide (proferrin®-ES) versus iron saccharate complex (ferrosac) for treatment of iron deficiency anemia during pregnancy

Acta Medica International, 2017

Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and m... more Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and mortality. This study designed to compare the efficacy and safety of Heme iron polypeptide (Proferrin ®-ES) versus iron saccharate complex (Ferrosac) in treatment of iron deficiency anemia during pregnancy. Methods: Two hundred and sixty (260) pregnant women with hemoglobin level below 10 gm/dl due to iron deficiency anemia were included in this study and randomized to receive either; intravenous Iron Saccharate (IV group) or oral Proferrin ®-ES (PO group) for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing pre-treatment values of hemoglobin, serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and reticulocytes count by the 3-months` post-treatment values. Results: The 3-months` post-treatment hemoglobin level increased compared to the pre-treatment level without any significant difference between the two studied groups (from 8.5 ± 3.5 to 11.3 ± 1.3 gm/dl in PO group and from 8.7 ± 2.5 to 11.7 ± 0.9 gm/dl in IV group). In addition; the 3-months` post-treatment ferritin level, increased compared to the pre-treatment level without any significant difference between the two studied groups (from 19.4 ± 4.9 to 118.8 ± 7.1 ug/l in PO group and from 15.3 ± 5.6 to 122.3 ± 6.4 ug/l in IV group). 1.6% (2/124) of the studied women developed gastrointestinal intolerance and upset with oral Proferrin ®-ES (insignificant difference and excluded from the study) and no other side effects recorded with oral Proferrin ®-ES. Conclusion: HIP (Proferrin ®-ES) is an effective, safe, well tolerable oral iron preparation as well as intravenous iron saccharate complex for treatment of iron deficiency during pregnancy; it increases the hemoglobin and replaces the depleted iron store.

Research paper thumbnail of Effect of progesterone therapy versus diet modification on constipation during pregnancy

Journal of Basic and Clinical Reproductive Sciences, 2016

Background: Pregnant women may experience constipation for the first time or their existing const... more Background: Pregnant women may experience constipation for the first time or their existing constipation symptoms increase in severity during pregnancy. Aim: To compare the effect of progesterone versus diet modification in the treatment of constipation during pregnancy. Subjects and Methods: Women aged ≥18 years with functional constipation according to the Rome III criteria from obstetrics outpatients' clinic and midwife practices included in this study. Participants divided into two groups; control group managed with diet modifications and study group pregnant women with threatened miscarriage and advised to take vaginal progesterone ≥1 week. Participants completed a nonvalidated questionnaire created by the authors during the whole week before intake of progesterone or diet modifications and after treatment phase. Independent Student's t-test and Chi-square ( 2) test were used for statistical analysis to compare between two studied groups. Primary outcome measures; change in defecation frequency. Results: Sensation of anorectal obstruction and sensation of incomplete evacuation were significantly less in Group B (progesterone therapy) compared to Group A (diet modification) (54% [154/281] and 62.98% [177/281] vs. 89.76% [614/684] and 91.08% [623/684], respectively) (P = 0.04 and 0.03, respectively). Straining during defecation and manual maneuvers to facilitate evacuation were significantly less in Group B compared to Group A (63.7% [179/281] and 19.9% [56/281] vs. 94.59% [647/684] and 86.54% [592/684], respectively) (P < 0.01 and 0.02, respectively). Episodes of abdominal pain and presence of reflux episodes were also significantly less in Group B compared to Group A (18.5% [52/281] and 17.43% [49/281] vs. 84.11% [589/684] and 75% [513/684], respectively) (P = 0.01 and 0.03, respectively). Conclusions: Estrogen, rather than progesterone, may be a detrimental factor of constipation during pregnancy via decreased bowel movement. Progesterone therapy seems to be effective in the treatment of functional constipation during pregnancy. A randomized placebo controlled trial is required to confirm the data of this study.

Research paper thumbnail of Impact of antenatal oxytocin infusion on neonatal respiratory morbidity associated with elective cesarean section

Archives of medical science : AMS, 2017

This study was designed to estimate respiratory morbidity associated with elective cesarean secti... more This study was designed to estimate respiratory morbidity associated with elective cesarean section (ECS) and to determine the effect of antenatal oxytocin exposure on this morbidity. Nine hundred and sixty-five neonates ≥ 37 weeks' gestation delivered by cesarean section during 1 year were included in this retrospective study and classified into two groups according to oxytocin exposure before cesarean deliveries. Respiratory morbidity for each group was recorded and statistically analyzed. Transient tachypnea of newborn (TTN) was significantly more frequent in group II (ECS group) than in group I (cesarean section after oxytocin exposure) (8.19% vs. 2.92%; respectively, p = 0.0006). Mechanical ventilation, continuous positive airway pressure (CPAP) and oxygen therapy were significantly more frequent in group II than in group I (1.78%, 2.14% and 4.28% versus 0.44%, 0.58% and 1.46%, respectively; p = 0.039, and p = 0.033 and p = 0.009, respectively). The number of newborns admit...

Research paper thumbnail of Beneficial Effects of Tibolone on Sexual Dys-function in Women with Premature Ovarian Failure (POF)

Health, 2016

Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of... more Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the association between Premature Ovarian Failure and sexual dysfunctions and outcome of management with tibolone. Patients and Methods: Thirty-one women with Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital were enrolled into the study with 31 healthy women as control group. The instrument of data collection included two types of questionnaires to assess the effect of Premature Ovarian Failure on sexuality. All the women with POF had oral tibolone 2.5 mg for at least one year and the second questionnaire and the profiles were repeated. Results: Of the 31 women with POF that presented with sexual dysfunction (SD), 27 (87.1%) complained of one or more SD domains such as reduced frequency of coitus, dyspareunia, vaginal dryness, reduced libido and general sexual satisfaction (P < 0.01), amenorrhea (P < 0.01) and hot flashes compared to 5 (16.1%) control women (P < 0.01). Administration of tibolone was associated with significant increase in frequency of coitus, reduced dyspareunia and vaginal dryness, increase libido and general satisfaction and happiness. Reduction of sexual dysfunction was predicated on the estrogenic, progestogenic and androgenic metabolite of tibolone through the reduction of serum level of FSH and LH and increased levels of estrogen and testosterone (P < 0.01). Tibolone had no adverse effect on serum lipid profile. Conclusion: Premature Ovarian Failure is associated with sexual dysfunction. Tibolone provides an effective means of treating sexual dysfunction caused by Premature Ovarian Failure.

Research paper thumbnail of Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse

Menopausal Review, 2015

Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions i... more Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods: Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results: Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions: Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

Research paper thumbnail of Minimal Invasive Laser Treatment for Female Stress Urinary Incontinence

Obstetrics & Gynecology International Journal, 2015

Objectives: Stress urinary incontinence (SUI) is common health problem and affects quality of lif... more Objectives: Stress urinary incontinence (SUI) is common health problem and affects quality of life. This study was designed to evaluate minimal invasive laser as treatment option for female SUI. Patients and methods: Fifty (50) women with SUI were included in this study which was conducted over one year. A specially designed laser speculum was introduced into women's vagina to serve as a guide for insertion of hand piece for irradiation of anterior vaginal wall. Second phase of the IncontiLaseTM procedure was performed on the vestibule and introitus. Preoperative and 6 months post-operative urodynamic studies were done for all studied women. Results: Average flow rate was significantly improved from 3ml/second before treatment to 11ml/second after laser treatment and voiding time was also significantly improved from 9 seconds before treatment to 24 seconds after treatment. Residual urine volume was significantly increased from 17ml before treatment to 38ml after treatment, and first sensation was also significantly increased from 54ml before treatment to 122ml after treatment. First desire was desire was significantly increased from 75ml before treatment to 180 ml after treatment and strong desire was also significantly increased from 150ml before treatment to 250 ml after treatment. Maximal uretheral closure pressure was significantly increased from 16cm H 2 O before treatment to 34cm H 2 O after treatment. Conclusion: Minimal invasive laser is outpatient procedure, has the advantage of improving of SUI symptoms without any possible complications as bladder perforation or hematoma. Also, it improves vaginal mucosa tone, regenerates collagen and collagen regains its power to contract with subsequent stabilization of bladder neck.

Research paper thumbnail of A Simple Proline Stitch is Safe and Easy to Use for Sacrospinous Fixation: a Prospective Cohort Study

A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure... more A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure for pelvic organ prolapse. the most common inpatient procedure performed in women older than 70 years between1979 and 2006 .

Research paper thumbnail of Ovarian function and ovarian blood supply following premenopausal abdominal hysterectomy

Przegla̜d menopauzalny = Menopause review, 2015

The issue of conserving the ovaries at hysterectomy in premenopausal women with benign gynecologi... more The issue of conserving the ovaries at hysterectomy in premenopausal women with benign gynecologic disease has been the subject of considerable controversy. Some clinicians prefer prophylactic oophorectomy in premenopausal women during hysterectomy to prevent future development of malignant changes in conserved ovaries. Other clinicians prefer to conserve apparently normal ovaries, because bilateral oophorectomy in premenopausal women results in an abrupt imbalance, sudden onset of menopausal symptoms, decreased libido, increased cardiovascular risk and osteoporosis. Two hundred and twenty multipara women (who had completed their families), with benign uterine pathology were included in this prospective study for abdominal hysterectomy with bilateral ovarian preservation. Pre-operative vaginal ultrasound, Doppler studies, diagnostic hysteroscopy and endometrial biopsy were done followed by laboratory studies including Anti-mullerian hormone (AMH), follicle stimulating hormone (FSH) ...

Research paper thumbnail of Accuracy of endometrial sampling compared to conventional dilatation and curettage in women with abnormal uterine bleeding. Archives of Gynaecology and Obstetrics 2014. 291(5); 1:121-126

To compare the diagnostic accuracy of brush endometrial sampling with conventional dilatation and... more To compare the diagnostic accuracy of brush endometrial sampling with conventional dilatation and curettage in women with abnormal uterine bleeding. Two hundred and twenty (220) women with abnormal uterine bleeding were included in this comparative study; endometrial sampling was done before cervical dilatation using Tao Bruch followed by conventional dilatation and curettage (D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C). The histopathology report of the Tao Bruch samples was compared with that of the D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C samples and the D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C results were considered as the gold standard. 100 % of samples obtained by conventional D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C, while 98.2 % of the samples obtained by Tao Brush were adequate for histopathology examination. In this study; Tao Brush had 100 % sensitivity, 100 % specificity, 100 % predictive values and accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium, also, it had 86.7 % sensitivity, 100 % specificity, 100 % positive predictive value (PPV) and 99 % negative predictive value (NPV) and accuracy for diagnosing endometritis (no significant difference compared to conventional D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C), while, it had 77.8 % sensitivity, 100 % specificity, 100 % PPV and 99 % NPV and accuracy for diagnosing endometrial polyps (no significant difference compared to conventional D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C) CONCLUSION: Endometrial sampling using endometrial brush cytology (EBC) is safe, accurate, cost-effective outpatient procedure, avoids general anesthesia with high sensitivity and specificity for detection of endometrial hyperplasia and endometrial carcinoma. EBC could be used as complementary diagnostic tool when hysteroscopic biopsies or other blinded procedures for endometrial sampling are unwanted or not available.

Research paper thumbnail of Acceptability and Efficacy of Levonorgestrel Intrauterine Device for Treatment of Menorrhagia

Background: Menorrhagia or cyclic heavy menstrual bleeding (HMB) over several consecutive cycles ... more Background: Menorrhagia or cyclic heavy menstrual bleeding (HMB) over several consecutive cycles during reproductive years is the most frequent form of dysfunctional uterine bleeding (DUB). Hysterectomy is often used to treat women with menorrhagia or HMB with high satisfaction rate and medical treatment can be considered a successful alternative therapy to hysterectomy. Levonorgestrel Intrauterine system (LNG-IUS) is a highly effective, long acting, reversible method of contraception, which offers additional health benefits and strong suppressive effect on the endometrium. Objectives: This study was designed to evaluate the acceptability and efficacy of Levonorgestrel Intrauterine system as a method for treatment of menorrhagia. Study Design: Prospective, observational, multicenter study, conducted in Ahmadi Hospital, Kuwait Oil Company (KOC), Kuwait and King Hussain Royal Medical Services (KH-RMS), Jordon, over two years. Patients and Methods: One hundred and twenty (120) premenop...

Research paper thumbnail of A Prospective Randomized Study Comparing Abdominal Sacrocolpopexy and Vaginal Sacrospinous Fixation for the Management of Vault Prolapse Assem AM Elbiaa

Introduction Pelvic organ prolapse is a common health problem, affecting up to 40% of parous wome... more Introduction Pelvic organ prolapse is a common health problem, affecting up to 40% of parous women over 50 years old, with significant negative influence on quality of life [1]. Some degree of prolapse is common in most parous women, but treatment is required only for the symptomatic patients [2]. Surgery for prolapse is one of the most common operations Performed in gynecology. In women, the lifetime risk of needing surgery for prolapse by the age of 80 is around 11%. It is interesting to note that 25% of these operations are performed for recurrent prolapse, suggesting that success rates for initial operations are poor [3]. The ideal procedure for vaginal apical support has yet to be determined. The past decade has seen several innovations in the treatment of prolapse due to greater understanding of pelvic anatomy and pathophysiology [2]. Abdominal sacral colpopexy is the gold standard abdominal procedure used for apical prolapse. Success rates range from 78% to 100%. This is prob...

Research paper thumbnail of Maternal and obstetrical factors associated with a successful trial of vaginal birth after cesarean section

Journal of the Turkish German Gynecological Association, 2014

Research paper thumbnail of A Simple Proline Stitch is Safe and Easy to Use for Sacrospinous Fixation: a Prospective Cohort Study

Obstetrics & Gynecology International Journal, Dec 3, 2014

A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure... more A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure for pelvic organ prolapse.

Research paper thumbnail of Impact of antenatal oxytocin infusion on neonatal respiratory morbidity associated with elective cesarean section

Archives of Medical Science, 2017

Introduction: This study was designed to estimate respiratory morbidity associated with elective ... more Introduction: This study was designed to estimate respiratory morbidity associated with elective cesarean section (ECS) and to determine the effect of antenatal oxytocin exposure on this morbidity. Material and methods: Nine hundred and sixty-five neonates ≥ 37 weeks' gestation delivered by cesarean section during 1 year were included in this retrospective study and classified into two groups according to oxytocin exposure before cesarean deliveries. Respiratory morbidity for each group was recorded and statistically analyzed. Results: Transient tachypnea of newborn (TTN) was significantly more frequent in group II (ECS group) than in group I (cesarean section after oxytocin exposure) (8.19% vs. 2.92%; respectively, p = 0.0006). Mechanical ventilation, continuous positive airway pressure (CPAP) and oxygen therapy were significantly more frequent in group II than in group I (1.78%, 2.14% and 4.28% versus 0.44%, 0.58% and 1.46%, respectively; p = 0.039, and p = 0.033 and p = 0.009, respectively). The number of newborns admitted to the neonatal unit and neonatal intensive care unit (NICU) was significantly higher in group II than in group I (6.41% and 2.14% vs. 2.05% and 0.58%, respectively; p = 0.001 and p = 0.033, respectively). Surfactant, fluid therapies and parenteral nutrition were significantly more frequent in group II than in group I (2.14%, 4.28% and 2.49% vs. 0.15%, 1.46% and 0.73%, respectively; p = 0.001, p = 0.009 and p = 0.02, respectively). Conclusions: Neonatal respiratory morbidity associated with ECS significantly decreased after antenatal oxytocin exposure. A significant reduction of neonatal respiratory morbidity would be achieved if ECS were performed after 39 weeks' gestation.

Research paper thumbnail of Beneficial Effects of Tibolone on Sexual Dys-function in Women with Premature Ovarian Failure (POF)

Health, 2016

Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of... more Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the association between Premature Ovarian Failure and sexual dysfunctions and outcome of management with tibolone. Patients and Methods: Thirty-one women with Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital were enrolled into the study with 31 healthy women as control group. The instrument of data collection included two types of questionnaires to assess the effect of Premature Ovarian Failure on sexuality. All the women with POF had oral tibolone 2.5 mg for at least one year and the second questionnaire and the profiles were repeated. Results: Of the 31 women with POF that presented with sexual dysfunction (SD), 27 (87.1%) complained of one or more SD domains such as reduced frequency of coitus, dyspareunia, vaginal dryness, reduced libido and general sexual satisfaction (P < 0.01), amenorrhea (P < 0.01) and hot flashes compared to 5 (16.1%) control women (P < 0.01). Administration of tibolone was associated with significant increase in frequency of coitus, reduced dyspareunia and vaginal dryness, increase libido and general satisfaction and happiness. Reduction of sexual dysfunction was predicated on the estrogenic, progestogenic and androgenic metabolite of tibolone through the reduction of serum level of FSH and LH and increased levels of estrogen and testosterone (P < 0.01). Tibolone had no adverse effect on serum lipid profile. Conclusion: Premature Ovarian Failure is associated with sexual dysfunction. Tibolone provides an effective means of treating sexual dysfunction caused by Premature Ovarian Failure.

Research paper thumbnail of Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse

Przeglad Menopauzalny, 2015

Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions i... more Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods: Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results: Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions: Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

Research paper thumbnail of Effect of Adding Sildenafil to Clomiphene Citrate versus Clomiphene Citrate alone on Endometrium in Unexplained Infertility: Cross-Sectional, Non-Randomized Study

Obstetrics & Gynecology International Journal, 2017

Aim of the study: To evaluate the endometrial thickness, pattern, and endometrial flow, in patien... more Aim of the study: To evaluate the endometrial thickness, pattern, and endometrial flow, in patients taking clomiphene citrate plus sildenafil tablets introduced vaginally as compared to patients who had no pregnancy on clomiphene citrate alone in unexplained infertility.

Research paper thumbnail of Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy: A double-blind randomised study

Indian Journal of Anaesthesia

Background and Aims: Myomectomy is associated with perioperative bleeding. The aim of the study i... more Background and Aims: Myomectomy is associated with perioperative bleeding. The aim of the study is to evaluate the effect of intramyometrial vasopressin on blood loss and the associated cardiovascular complications during myomectomy. Methods: The study included 194 patients classified into two groups- 1) Vasopressin group: the vasopressin was diluted as 0.1 unit/ml and 15 ml was injected by the surgeon in the plane between the myometrium and the myoma. 2) Control group: The patients received an equal amount of normal saline. The monitored parameters included the amount of blood loss, required blood transfusion, heart rate, mean arterial blood pressure, the incidence of hypertension, hypotension, bradycardia, tachycardia, electrocardiogram (ECG) changes and the blood troponin I level. Results: The heart rate decreased significantly in both groups, but the decrease was lower with vasopressin than the control group through the time points T3 to T5 (P < 0.05) The mean arterial blood pressure increased significantly in both groups, but the increase was higher with vasopressin than the control group through T3 to T5 (P < 0.05). The amount of blood loss decreased significantly with vasopressin than the control groups (P = 0.001). The number of transfused packed red blood cells was lower with vasopressin than the control group (P = 0.001). The incidence of hypertension, bradycardia and atrial extrasystole was higher with vasopressin than the control group (P = 0.005, P = 0.012, P = 0.033, respectively). Conclusion: Intramyometrial vasopressin decreases blood loss and blood transfusion, but it is associated with cardiovascular complications that may be serious as reported in other studies. Therefore, anaesthesiologists and gynaecologists must follow the precautions to avoid and minimise the incidence of complications with intramyometrial vasopressin.

Research paper thumbnail of Early Clomiphene Citrate for Ovulation Induction in Polycystic Ovary Syndrome

Research paper thumbnail of Heme iron to correct Iron deficiency anemia with pregnancy

Objectives: This study designed to evaluate the efficacy and tolerability of heme iron polypeptid... more Objectives: This study designed to evaluate the efficacy and tolerability of heme iron polypeptide (HIP) in treatment of iron deficiency anemia during pregnancy. Methods: 150 pregnant women with hemoglobin <10 gm/dl due to iron deficiency included in this study and treated with HIP for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing the pre-treatment values of hemoglobin, serum ferritin, reticulocytes, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) by the 3-months` post-treatment values. Results: The mean pre-treatment hemoglobin significantly increased from 8.8 ± 3.7 to 11.4 ± 3.04 gm/dl and the mean pretreatment ferritin level significantly increased from 15.6 ± 6.3 to 118.4 ± 4.6 ug/l 3-months` after Proferrin treatment. In addition; the mean pre-treatment RBCs MCV significantly increased from 72.6 ± 5.2 to 92.1 ± 3.8 FL, and the mean -treatment RBCs MCH significantly increased from 24.5 ± 8.1 to 25.8 ± 6.6 pg...

Research paper thumbnail of Heme iron polypeptide (proferrin®-ES) versus iron saccharate complex (ferrosac) for treatment of iron deficiency anemia during pregnancy

Acta Medica International, 2017

Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and m... more Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and mortality. This study designed to compare the efficacy and safety of Heme iron polypeptide (Proferrin ®-ES) versus iron saccharate complex (Ferrosac) in treatment of iron deficiency anemia during pregnancy. Methods: Two hundred and sixty (260) pregnant women with hemoglobin level below 10 gm/dl due to iron deficiency anemia were included in this study and randomized to receive either; intravenous Iron Saccharate (IV group) or oral Proferrin ®-ES (PO group) for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing pre-treatment values of hemoglobin, serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and reticulocytes count by the 3-months` post-treatment values. Results: The 3-months` post-treatment hemoglobin level increased compared to the pre-treatment level without any significant difference between the two studied groups (from 8.5 ± 3.5 to 11.3 ± 1.3 gm/dl in PO group and from 8.7 ± 2.5 to 11.7 ± 0.9 gm/dl in IV group). In addition; the 3-months` post-treatment ferritin level, increased compared to the pre-treatment level without any significant difference between the two studied groups (from 19.4 ± 4.9 to 118.8 ± 7.1 ug/l in PO group and from 15.3 ± 5.6 to 122.3 ± 6.4 ug/l in IV group). 1.6% (2/124) of the studied women developed gastrointestinal intolerance and upset with oral Proferrin ®-ES (insignificant difference and excluded from the study) and no other side effects recorded with oral Proferrin ®-ES. Conclusion: HIP (Proferrin ®-ES) is an effective, safe, well tolerable oral iron preparation as well as intravenous iron saccharate complex for treatment of iron deficiency during pregnancy; it increases the hemoglobin and replaces the depleted iron store.

Research paper thumbnail of Effect of progesterone therapy versus diet modification on constipation during pregnancy

Journal of Basic and Clinical Reproductive Sciences, 2016

Background: Pregnant women may experience constipation for the first time or their existing const... more Background: Pregnant women may experience constipation for the first time or their existing constipation symptoms increase in severity during pregnancy. Aim: To compare the effect of progesterone versus diet modification in the treatment of constipation during pregnancy. Subjects and Methods: Women aged ≥18 years with functional constipation according to the Rome III criteria from obstetrics outpatients' clinic and midwife practices included in this study. Participants divided into two groups; control group managed with diet modifications and study group pregnant women with threatened miscarriage and advised to take vaginal progesterone ≥1 week. Participants completed a nonvalidated questionnaire created by the authors during the whole week before intake of progesterone or diet modifications and after treatment phase. Independent Student's t-test and Chi-square ( 2) test were used for statistical analysis to compare between two studied groups. Primary outcome measures; change in defecation frequency. Results: Sensation of anorectal obstruction and sensation of incomplete evacuation were significantly less in Group B (progesterone therapy) compared to Group A (diet modification) (54% [154/281] and 62.98% [177/281] vs. 89.76% [614/684] and 91.08% [623/684], respectively) (P = 0.04 and 0.03, respectively). Straining during defecation and manual maneuvers to facilitate evacuation were significantly less in Group B compared to Group A (63.7% [179/281] and 19.9% [56/281] vs. 94.59% [647/684] and 86.54% [592/684], respectively) (P < 0.01 and 0.02, respectively). Episodes of abdominal pain and presence of reflux episodes were also significantly less in Group B compared to Group A (18.5% [52/281] and 17.43% [49/281] vs. 84.11% [589/684] and 75% [513/684], respectively) (P = 0.01 and 0.03, respectively). Conclusions: Estrogen, rather than progesterone, may be a detrimental factor of constipation during pregnancy via decreased bowel movement. Progesterone therapy seems to be effective in the treatment of functional constipation during pregnancy. A randomized placebo controlled trial is required to confirm the data of this study.

Research paper thumbnail of Impact of antenatal oxytocin infusion on neonatal respiratory morbidity associated with elective cesarean section

Archives of medical science : AMS, 2017

This study was designed to estimate respiratory morbidity associated with elective cesarean secti... more This study was designed to estimate respiratory morbidity associated with elective cesarean section (ECS) and to determine the effect of antenatal oxytocin exposure on this morbidity. Nine hundred and sixty-five neonates ≥ 37 weeks' gestation delivered by cesarean section during 1 year were included in this retrospective study and classified into two groups according to oxytocin exposure before cesarean deliveries. Respiratory morbidity for each group was recorded and statistically analyzed. Transient tachypnea of newborn (TTN) was significantly more frequent in group II (ECS group) than in group I (cesarean section after oxytocin exposure) (8.19% vs. 2.92%; respectively, p = 0.0006). Mechanical ventilation, continuous positive airway pressure (CPAP) and oxygen therapy were significantly more frequent in group II than in group I (1.78%, 2.14% and 4.28% versus 0.44%, 0.58% and 1.46%, respectively; p = 0.039, and p = 0.033 and p = 0.009, respectively). The number of newborns admit...

Research paper thumbnail of Beneficial Effects of Tibolone on Sexual Dys-function in Women with Premature Ovarian Failure (POF)

Health, 2016

Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of... more Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the association between Premature Ovarian Failure and sexual dysfunctions and outcome of management with tibolone. Patients and Methods: Thirty-one women with Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital were enrolled into the study with 31 healthy women as control group. The instrument of data collection included two types of questionnaires to assess the effect of Premature Ovarian Failure on sexuality. All the women with POF had oral tibolone 2.5 mg for at least one year and the second questionnaire and the profiles were repeated. Results: Of the 31 women with POF that presented with sexual dysfunction (SD), 27 (87.1%) complained of one or more SD domains such as reduced frequency of coitus, dyspareunia, vaginal dryness, reduced libido and general sexual satisfaction (P < 0.01), amenorrhea (P < 0.01) and hot flashes compared to 5 (16.1%) control women (P < 0.01). Administration of tibolone was associated with significant increase in frequency of coitus, reduced dyspareunia and vaginal dryness, increase libido and general satisfaction and happiness. Reduction of sexual dysfunction was predicated on the estrogenic, progestogenic and androgenic metabolite of tibolone through the reduction of serum level of FSH and LH and increased levels of estrogen and testosterone (P < 0.01). Tibolone had no adverse effect on serum lipid profile. Conclusion: Premature Ovarian Failure is associated with sexual dysfunction. Tibolone provides an effective means of treating sexual dysfunction caused by Premature Ovarian Failure.

Research paper thumbnail of Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse

Menopausal Review, 2015

Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions i... more Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods: Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results: Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions: Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

Research paper thumbnail of Minimal Invasive Laser Treatment for Female Stress Urinary Incontinence

Obstetrics & Gynecology International Journal, 2015

Objectives: Stress urinary incontinence (SUI) is common health problem and affects quality of lif... more Objectives: Stress urinary incontinence (SUI) is common health problem and affects quality of life. This study was designed to evaluate minimal invasive laser as treatment option for female SUI. Patients and methods: Fifty (50) women with SUI were included in this study which was conducted over one year. A specially designed laser speculum was introduced into women's vagina to serve as a guide for insertion of hand piece for irradiation of anterior vaginal wall. Second phase of the IncontiLaseTM procedure was performed on the vestibule and introitus. Preoperative and 6 months post-operative urodynamic studies were done for all studied women. Results: Average flow rate was significantly improved from 3ml/second before treatment to 11ml/second after laser treatment and voiding time was also significantly improved from 9 seconds before treatment to 24 seconds after treatment. Residual urine volume was significantly increased from 17ml before treatment to 38ml after treatment, and first sensation was also significantly increased from 54ml before treatment to 122ml after treatment. First desire was desire was significantly increased from 75ml before treatment to 180 ml after treatment and strong desire was also significantly increased from 150ml before treatment to 250 ml after treatment. Maximal uretheral closure pressure was significantly increased from 16cm H 2 O before treatment to 34cm H 2 O after treatment. Conclusion: Minimal invasive laser is outpatient procedure, has the advantage of improving of SUI symptoms without any possible complications as bladder perforation or hematoma. Also, it improves vaginal mucosa tone, regenerates collagen and collagen regains its power to contract with subsequent stabilization of bladder neck.

Research paper thumbnail of A Simple Proline Stitch is Safe and Easy to Use for Sacrospinous Fixation: a Prospective Cohort Study

A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure... more A study evaluating clinical outcomes from the use of a simple and inexpensive operative procedure for pelvic organ prolapse. the most common inpatient procedure performed in women older than 70 years between1979 and 2006 .

Research paper thumbnail of Ovarian function and ovarian blood supply following premenopausal abdominal hysterectomy

Przegla̜d menopauzalny = Menopause review, 2015

The issue of conserving the ovaries at hysterectomy in premenopausal women with benign gynecologi... more The issue of conserving the ovaries at hysterectomy in premenopausal women with benign gynecologic disease has been the subject of considerable controversy. Some clinicians prefer prophylactic oophorectomy in premenopausal women during hysterectomy to prevent future development of malignant changes in conserved ovaries. Other clinicians prefer to conserve apparently normal ovaries, because bilateral oophorectomy in premenopausal women results in an abrupt imbalance, sudden onset of menopausal symptoms, decreased libido, increased cardiovascular risk and osteoporosis. Two hundred and twenty multipara women (who had completed their families), with benign uterine pathology were included in this prospective study for abdominal hysterectomy with bilateral ovarian preservation. Pre-operative vaginal ultrasound, Doppler studies, diagnostic hysteroscopy and endometrial biopsy were done followed by laboratory studies including Anti-mullerian hormone (AMH), follicle stimulating hormone (FSH) ...

Research paper thumbnail of Accuracy of endometrial sampling compared to conventional dilatation and curettage in women with abnormal uterine bleeding. Archives of Gynaecology and Obstetrics 2014. 291(5); 1:121-126

To compare the diagnostic accuracy of brush endometrial sampling with conventional dilatation and... more To compare the diagnostic accuracy of brush endometrial sampling with conventional dilatation and curettage in women with abnormal uterine bleeding. Two hundred and twenty (220) women with abnormal uterine bleeding were included in this comparative study; endometrial sampling was done before cervical dilatation using Tao Bruch followed by conventional dilatation and curettage (D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C). The histopathology report of the Tao Bruch samples was compared with that of the D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C samples and the D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C results were considered as the gold standard. 100 % of samples obtained by conventional D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C, while 98.2 % of the samples obtained by Tao Brush were adequate for histopathology examination. In this study; Tao Brush had 100 % sensitivity, 100 % specificity, 100 % predictive values and accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium, also, it had 86.7 % sensitivity, 100 % specificity, 100 % positive predictive value (PPV) and 99 % negative predictive value (NPV) and accuracy for diagnosing endometritis (no significant difference compared to conventional D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C), while, it had 77.8 % sensitivity, 100 % specificity, 100 % PPV and 99 % NPV and accuracy for diagnosing endometrial polyps (no significant difference compared to conventional D&amp;amp;amp;amp;amp;amp;amp;amp;amp;C) CONCLUSION: Endometrial sampling using endometrial brush cytology (EBC) is safe, accurate, cost-effective outpatient procedure, avoids general anesthesia with high sensitivity and specificity for detection of endometrial hyperplasia and endometrial carcinoma. EBC could be used as complementary diagnostic tool when hysteroscopic biopsies or other blinded procedures for endometrial sampling are unwanted or not available.

Research paper thumbnail of Acceptability and Efficacy of Levonorgestrel Intrauterine Device for Treatment of Menorrhagia

Background: Menorrhagia or cyclic heavy menstrual bleeding (HMB) over several consecutive cycles ... more Background: Menorrhagia or cyclic heavy menstrual bleeding (HMB) over several consecutive cycles during reproductive years is the most frequent form of dysfunctional uterine bleeding (DUB). Hysterectomy is often used to treat women with menorrhagia or HMB with high satisfaction rate and medical treatment can be considered a successful alternative therapy to hysterectomy. Levonorgestrel Intrauterine system (LNG-IUS) is a highly effective, long acting, reversible method of contraception, which offers additional health benefits and strong suppressive effect on the endometrium. Objectives: This study was designed to evaluate the acceptability and efficacy of Levonorgestrel Intrauterine system as a method for treatment of menorrhagia. Study Design: Prospective, observational, multicenter study, conducted in Ahmadi Hospital, Kuwait Oil Company (KOC), Kuwait and King Hussain Royal Medical Services (KH-RMS), Jordon, over two years. Patients and Methods: One hundred and twenty (120) premenop...

Research paper thumbnail of A Prospective Randomized Study Comparing Abdominal Sacrocolpopexy and Vaginal Sacrospinous Fixation for the Management of Vault Prolapse Assem AM Elbiaa

Introduction Pelvic organ prolapse is a common health problem, affecting up to 40% of parous wome... more Introduction Pelvic organ prolapse is a common health problem, affecting up to 40% of parous women over 50 years old, with significant negative influence on quality of life [1]. Some degree of prolapse is common in most parous women, but treatment is required only for the symptomatic patients [2]. Surgery for prolapse is one of the most common operations Performed in gynecology. In women, the lifetime risk of needing surgery for prolapse by the age of 80 is around 11%. It is interesting to note that 25% of these operations are performed for recurrent prolapse, suggesting that success rates for initial operations are poor [3]. The ideal procedure for vaginal apical support has yet to be determined. The past decade has seen several innovations in the treatment of prolapse due to greater understanding of pelvic anatomy and pathophysiology [2]. Abdominal sacral colpopexy is the gold standard abdominal procedure used for apical prolapse. Success rates range from 78% to 100%. This is prob...

Research paper thumbnail of Maternal and obstetrical factors associated with a successful trial of vaginal birth after cesarean section

Journal of the Turkish German Gynecological Association, 2014