Mohamed Ellaithy | Ain Shams University (original) (raw)

Papers by Mohamed Ellaithy

Research paper thumbnail of The Advantages in the Selection and Use of Bipolar Vessel Sealing Devices in Vaginal Hysterectomy, Dependent on the Different Degrees of Operative Difficulty

Uterine enlargement, previous pelvic surgery, absence of uterine descent, a narrow pubic arch, li... more Uterine enlargement, previous pelvic surgery, absence of uterine descent, a narrow pubic arch, limited vaginal and pelvic spaces, nulliparity, obesity, and the need for concomitant oophorectomy should no longer be considered as contraindications to vaginal hysterectomy (VH). The introduction of Electrobipolar vessel sealing (EBVS) systems, in VH, has facilitated the achievement of proper hemostasis in situations of difficult access into the pelvis, allowing vessels sealing with great ease and safety. Hereby, the advantages of using EBVS in performing VH as well as some surgical considerations are thoroughly discussed.

Research paper thumbnail of Mechanical induction of labor and ecbolic-less vaginal birth after cesarean section: A cohort study

Taiwanese Journal of Obstetrics and Gynecology

Research paper thumbnail of Use of an antiemetic to shorten the length of labor in nulliparous women, exploring a potential role of an old drug: A randomized controlled trial

International Journal of Gynecology & Obstetrics

To assess whether metoclopramide is effective in shortening the duration of the first stage of la... more To assess whether metoclopramide is effective in shortening the duration of the first stage of labor in primiparous women.

Research paper thumbnail of Cervical length should be measured for women with placenta previa: cohort study

The Journal of Maternal-Fetal & Neonatal Medicine

Abstract Objectives To study the relevance between cervical length (CL) and different maternal/ne... more Abstract Objectives To study the relevance between cervical length (CL) and different maternal/neonatal outcomes in pregnancies complicated with placenta previa/accreta. Methods Three hundred twenty-eight women, who had medically free singleton live pregnancies with the diagnosis of placenta previa and/or accreta, were included and divided regarding their CL into two groups. Threatened preterm labor, maternal tocolysis, multiple gestations, polyhydramnios, ruptured fetal membranes, fetal complications, history of cervical conization, and the presence of cervical cerclage were the exclusion criteria. Demographic data, obstetric history, as well as, the courses of the complicated pregnancies were collected and statistically analyzed. Results The short CL group had significantly less distance between the placenta and the internal cervical os (p-value < .001) Also, they showed more ultrasound parameters of complete placenta previa with anterior location (p-value < .001 and .003 respectively) and placental adherence (21.8 versus 41.1%). Women with short cervix had significantly higher rates of preterm birth, antepartum hemorrhage, emergency cesarean sections, intraoperative estimated blood loss, massive bleeding, prevalence of placental adherence and cesarean hysterectomy (p-value < .001 for the entire outcomes). Multivariable binary logistic regression showed that CL (<30 mm) was a significant independent risk factor in prediction of severe hemorrhage, PTB, emergency CS, placental adherence, cesarean hysterectomy (p-value < .001 for adverse maternal outcomes) and low cord Ph (p-value = .016). Conclusions Assessment of the cervical length could be a crucial step in the work-up and decision making for pregnancies complicated with abnormally situated and/or adherent placenta as it is strongly associated with a wide range of maternal and neonatal morbidities.

Research paper thumbnail of Knot positioning during McDonald cervical cerclage, does it make a difference? A cohort study

The Journal of Maternal-Fetal & Neonatal Medicine

Abstract Objective: To study the effect of McDonald cerclage knot position on the different mater... more Abstract Objective: To study the effect of McDonald cerclage knot position on the different maternal and neonatal outcomes. Methods: This historical cohort study included women with singleton pregnancy who had a prophylactic McDonald cervical cerclage between 1 May 2010 and 31 September 2017. Maternal and neonatal outcome parameters were compared between the anterior and posterior knot cerclage procedures. The primary outcome measure was the rate of term birth. Results: 550 Women had a prophylactic McDonald cervical cerclage, 306 with anterior knot (Group A) and 244 with posterior knot (Group B). There were no statistically significant differences regarding gestational age (GA) at delivery (36.3 ± 4.2 versus 35.8 ± 5.3 for groups A and B respectively), term birth rate, post-cerclage cervical length, symptomatic vaginitis, urinary tract infection, difficult cerclage removal and cervical lacerations. Similarly, there were no statistically significant differences as regards the studied neonatal outcomes including take home babies, neonatal intensive care admission, respiratory distress syndrome and neonatal sepsis. Survival analysis on GA at delivery demonstrated no statistically significant difference as regards the proportion of term deliveries in the anterior and posterior knot cerclage groups (log-rank test p-value = .478). Conclusions: Knot positioning during McDonald cervical cerclage, anteriorly or posteriorly, didn’t significantly impact the studied maternal and neonatal outcomes.

Research paper thumbnail of Prediction of spontaneous preterm birth: salivary progesterone assay and transvaginal cervical length assessment after 24 weeks of gestation, another critical window of opportunity

The Journal of Maternal-Fetal & Neonatal Medicine

Abstract Objectives: Measurement of salivary progesterone (SP4) levels and cervical length (CL) a... more Abstract Objectives: Measurement of salivary progesterone (SP4) levels and cervical length (CL) after 24 weeks to assess their potential predictive value among asymptomatic women at high risk of spontaneous preterm birth (PTB). Methods: This prospective observational (noninterventional) study consecutively recruited asymptomatic women at high risk of spontaneous PTB. SP4 and CL were measured at recruitment (24–28 weeks of gestation) then repeated after 3–4 weeks. All recruited women were followed up regularly till delivery. The primary outcome measure was the occurrence of spontaneous PTB. Results: One hundred and thirty four women completed the study, 22 (16.4%) and 32 (23.9%) women had early (<34 weeks) and late (≥34 weeks) PTB, respectively. Initially, the mean CL was 3.2 ± 0.6 cm and the mean SP4 was 4062.8 ± 814.6 pg/ml; with follow up, the mean CL became 3.0 ± 0.6 cm and the mean SP4 became 3871.6 ± 1136.9. Women with early PTB had significantly lower initial and follow up CL and SP4 measures when compared to women with late PTB and those who had birth at term. The rate of drop in SP4 and CL measurements between the two visits was also significantly higher among women with early PTB than those with late PTB and term birth. Receiver-operating characteristic (ROC) curves showed that, CL was a good predictor but SP4 was a better predictor of PTB as the area under the curve (AUC) for CL was less than that for SP4 at both visits (i.e. 0.858 and 0.868 versus 0.986 and 0.990 at the initial and follow up visits, respectively). There was a statistically significant correlation between CL and SP4 measurements. Multivariable binary logistic regression analysis revealed that follow up SP4 measurement was the only independent predictor of spontaneous PTB, and neither BMI, maternal age, SP4 nor CL were independent predictors of early spontaneous PTB. Conclusions: After 24 gestational weeks, SP4 assessment is a simple and reliable promising tool to predict spontaneous PTB among asymptomatic high-risk women, with a little superior performance than CL measurement.

Research paper thumbnail of Prediction of recurrent ectopic pregnancy: A five-year follow-up cohort study

European journal of obstetrics, gynecology, and reproductive biology, 2018

To evaluate the value of different clinical risk factors in the prediction of recurrent ectopic p... more To evaluate the value of different clinical risk factors in the prediction of recurrent ectopic pregnancies (REP). This cohort study was carried out at a tertiary-care maternity hospital in Saudi Arabia, between January 2010 and June 2017. All women with a primary ectopic pregnancy (EP) were consecutively recruited, thoroughly assessed and followed up for a minimum duration of five-years (5.6 ± 0.61 years) to diagnose the nature and location of the subsequent pregnancies. The primary outcome measure was the occurrence of REP, while the secondary outcomes included intrauterine pregnancy, the pregnancy of unknown location and infertility rates. A total of 272 women with a primary ectopic pregnancy (EP) were initially recruited, 217 women were included in the final analysis, among them 41 (18.9%) women had REP. Univariate analysis showed that women who subsequently developed REP had more prevalent prior miscarriages, evacuation of retained products of conception (ERPC), pelvic inflamma...

Research paper thumbnail of How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

The journal of obstetrics and gynaecology research, Jan 3, 2018

Of the different described methods of placental delivery during cesarean section (CS), manual rem... more Of the different described methods of placental delivery during cesarean section (CS), manual removal and cord traction are the most commonly used techniques. The ideal method of placental delivery during CS is still a conflicting issue as the data derived from the previous studies are widely heterogeneous and inconsistent. This study has investigated the effect of two different methods of placental delivery, controlled cord traction and manual removal, on perioperative blood loss. This randomized controlled trial recruited 345 pregnant women scheduled for elective cesarean delivery at term. Eligible participants were randomly assigned to have their placentae delivered either by manual removal or cord traction. Perioperative blood loss was the study primary outcome measure. A total of 300 women were included in the final analysis. The longer placental delivery time in the cord traction group (n = 150) (60 s. [45-61.25] versus 45 s. [35-60] in the manual placental delivery group, P &...

Research paper thumbnail of The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 29, 2018

To endorse the impact of chewing gum on the intestinal functions' restoration, hospital stay ... more To endorse the impact of chewing gum on the intestinal functions' restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD). Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 h after recovery at least for half an hour and at 2-h interval during daytime. The second group received oral fluids 6 h postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the tim...

Research paper thumbnail of Pre-induction cervical ripening using two different dinoprostone vaginal preparations: A randomized clinical trial of tablets and slow release retrievable insert

Taiwanese journal of obstetrics & gynecology, 2018

The current study compared the safety and efficacy of two different dinoprostone preparations (di... more The current study compared the safety and efficacy of two different dinoprostone preparations (dinoprostone vaginal tablets & dinoprostone slow release retrievable vaginal insert) to ripen the cervix at term. Women admitted for pre-induction cervical ripening were included in a randomized controlled trial. Eligible women were randomly assigned to receive Dinoprostone either in the form of vaginal tablets or slow release retrievable vaginal insert. Study outcomes included time to vaginal delivery and time to onset of labor intervals and vaginal delivery rate. No statistically significant difference was found between the two groups regarding the main outcome measures, however, the probability of successful vaginal delivery was independently related to the type of dinoprostone preparation used to ripen the cervix (proportional hazard, 1.366; 95% CI, 1.010-1.847; P, 0.043) and the parity (proportional hazard, 1.412; 95% CI, 1.041-1.915; P, 0.026). Both dinoprostone preparations were eff...

Research paper thumbnail of Maternal serum amyloid A level as a novel marker of primary unexplained recurrent early pregnancy loss

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2017

To assess maternal serum amyloid A (SAA) levels among women with primary unexplained recurrent ea... more To assess maternal serum amyloid A (SAA) levels among women with primary unexplained recurrent early pregnancy loss (REPL). A prospective study was conducted among women with missed spontaneous abortion in the first trimester at Ain Shams University Maternity Hospital, Cairo, Egypt, between January 21 and December 25, 2014. Women with at least two consecutive primary unexplained REPLs and no previous live births were enrolled. A control group was formed of women with no history of REPL who had at least one previous uneventful pregnancy with no adverse outcomes. Serum samples were collected to measure SAA levels. The main outcome was the association between SAA and primary unexplained REPL. Each group contained 96 participants. Median SAA level was significantly higher among women with REPL (50.0 μg/mL, interquartile range 26.0-69.0) than among women in the control group (11.6 μg/mL, interquartile range 6.2-15.5; P<0.001). The SAA level was an independent indicator of primary unex...

Research paper thumbnail of Blind vaginal fetal fibronectin swab for prediction of preterm birth

Journal of Obstetrics and Gynaecology Research, 2015

To assess the accuracy of blind vaginal swab in diagnosis of preterm labor (PTL) and prediction o... more To assess the accuracy of blind vaginal swab in diagnosis of preterm labor (PTL) and prediction of subsequent occurrence of preterm birth (PTB). Eligible women who presented at 24-34 weeks of gestation with threatened PTL had their cervicovaginal secretions sequentially sampled for fetal fibronectin (fFN) using two types of swabbing techniques. The first swab was a blind vaginal swab collected without the aid of speculum, while the second one was a routine cervicovaginal swab. All participants were followed up until delivery. fFN in both swabs was significantly higher in women who delivered before term compared with women who delivered at term. On regression analysis, r(2) = 0.735 and 0.785 for blind vaginal and cervicovaginal swabs respectively, while on receiver operating characteristic analysis the area under curve was 0.965 and 0.977, respectively, without a statistically significant difference. Using an fFN cut-off of ≥0.05 μg/dL, the sensitivity, specificity, positive predictive value and negative predictive value of blind vaginal swab to predict PTB were 53.9%, 91.9%, 70.0% and 85.0%, respectively; while those for cervicovaginal swab were 58.3%, 94.7%, 77.8% and 87.8%, respectively. In women presenting at 24-34 weeks of gestation with threatened PTL, blind vaginal fFN swab is as effective as cervicovaginal swab to predict PTB, but it is easier to perform and does not require doctor supervision.

Research paper thumbnail of Can three-dimensional ultrasound measurement of fetal adrenal gland enlargement predict preterm birth?

Archives of Gynecology and Obstetrics, 2015

To assess the diagnostic accuracy of three-dimensional (3D) ultrasound measurements of fetal adre... more To assess the diagnostic accuracy of three-dimensional (3D) ultrasound measurements of fetal adrenal gland volume (AGV) and fetal zone enlargement (FZE) as predictors of PTB compared to measurements of cervical length (CL) and cervicovaginal fetal fibronectin (CVFF). This prospective study included women presenting at 28-36 weeks of gestation with threatened preterm labor (TPL). Fetal AGV and FZE were measured using 3D ultrasound. Two-dimensional (2D) ultrasound was used to measure the CL. The AGV was corrected for the ultrasound-estimated fetal weight (cAGV). Qualitative CVFF detection was also performed. The diagnostic accuracy of cAGV, FZE, CL, and CVFF was compared considering preterm birth (PTB) within 7 days of recruitment as the main outcome measure. Seventy-five pregnant women were included in the final statistical analysis. Twenty-seven women (36 %) delivered within 7 days. cAGV and FZE had the highest sensitivities and specificities to predict PTB within 7 days when compared with CL and CVFF. Multivariate analysis, including cAGV, FZE, CL, and CVFF, revealed that cAGV and FZE were independent predictors of PTB within 7 days in the study participants. In women who presented at 28-36 weeks of gestation with TPL, cAGV and FZE can be used as independent predictors of PTB.

Research paper thumbnail of Can Porphyromonas gingivalis be a novel aetiology for recurrent miscarriage?

The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, Jan 20, 2014

Objective To study the association between Porphyromonas gingivalis (P. gingivalis) infection and... more Objective To study the association between Porphyromonas gingivalis (P. gingivalis) infection and recurrent miscarriage. Methods This case control study included women with early pregnancy failure admitted for surgical evacuation of retained products of conception. Cases (group 1) included 50 women with unexplained recurrent early miscarriage whereas the control group (group 2) consisted of 50 women with no such history. The evacuated products of conception, subgingival plaques, cervicovaginal secretions and saliva of all participants were examined to detect P. gingivalis deoxyribonucleic acid (DNA) using a polymerase chain reaction. Results The prevalence of P. gingivalis DNA in the chorionic villous tissue samples of group 1 was significantly higher than in group 2 (8 [16%] vs. 1 [2%], respectively; p = 0.036, odds ratio [OR]: 9.3, 95% confidence interval [CI]: 1.1-76.9). The prevalence of P. gingivalis DNA was significantly higher in cervicovaginal secretions of group 1 than in g...

Research paper thumbnail of The use of cell salvage in women undergoing cesarean hysterectomy for abnormal placentation

Although transfusion of autologous blood obtained from cell salvage has increased, its role in ob... more Although transfusion of autologous blood obtained from cell salvage has increased, its role in obstetric practice remains controversial. This case series reports the use of cell salvage in an attempt to avoid allogeneic transfusion in women undergoing cesarean hysterectomy for placenta accreta. This prospective observational study, conducted in a large public maternity hospital, included 41 women with an antenatal diagnosis of placenta accreta, of whom 20 underwent cesarean hysterectomy and 15 received autologous blood after cell salvage. Intraoperative cell salvage was used for autologous blood transfusion, and salvaged blood was monitored for prewash and postfiltration squamous cells, fetal hemoglobin, and potassium concentration. Pre- and postoperative hemoglobin, platelet count and coagulation profile were compared. Twenty women underwent caesarean hysterectomy. Cell-salvaged blood was collected in 18 women and re infused in 15 women (83.3%). The mean volume of reinfused salvaged blood was 1476 ± 247 mL. Mean potassium concentrations (1.4 ± 1.2 versus 3.7 ± 0.42 mEq/L) and median squamous cell counts (0 [0-1] versus 8 [3-12]/high power field) were significantly lower postfiltration compared to prewash values. There were no instances of intraoperative or postoperative amniotic fluid embolism, hypotension, sepsis or coagulopathy. Of the 15 women who received autologous blood, 13 (86.7%) did not require allogeneic red blood cell transfusion. Autologous transfusion of salvaged blood can be used to minimize allogeneic transfusion in women undergoing cesarean hysterectomy for placenta accreta.

Research paper thumbnail of Fetal mid-thigh soft-tissue thickness: a novel method for fetal weight estimation

Archives of Gynecology and Obstetrics, 2014

To derive a novel formula for fetal weight estimation utilizing the linear measurement of mid-thi... more To derive a novel formula for fetal weight estimation utilizing the linear measurement of mid-thigh soft-tissue thickness (STT). 300 women, with singleton uncomplicated pregnancy, were included in a prospective cross-sectional study. The study included four consecutive phases: phase (1) validated the original Scioscia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s formula, phase (2) derived a novel modified formula for fetal weight estimation, phase (3) validated the novel modified formula, and phase (4) evaluated the agreement between the modified and original formulae. A statistically significant correlation was found between actual fetal weight (AFW) and various sonographic biometric measurements including mid-thigh STT (r (2) = 0.656, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), femur length (FL) (r (2) = 0.573, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), bi-parietal diameter (BPD) (r (2) = 0.250, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), abdominal circumference (AC) (r (2) = 0.310, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and estimated fetal weight (EFW) using the original Scioscia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s formula (r (2) = 0.644, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The modified formula showed a better signed % difference (median = -0.41 %, IQR -1.88 to 2.03) than the original formula (median = -0.51 %, IQR -2.33 to 2.00). It was noted that, using the original formula, 88.7 % of the sample had absolute error below 5 and 98.3 % of the sample had absolute error below 10 %. On the other hand, using the modified formula, 87.3 % of the sample had absolute error below 5 %, while 97.3 % had absolute error below 10 %. The agreement between the two formulae was moderate as 134 patients out of 150 had similar ranking (κ = 0.57). Fetal mid-thigh SST is a simple, useful, and easily applicable parameter for fetal weight estimation.

Research paper thumbnail of Sacrospinous colpopexy using Masson luethy needle holder

European journal of obstetrics, gynecology, and reproductive biology, 2014

Sacrospinous colpopexy (SSC) is a well-known surgical technique to correct apical support defect,... more Sacrospinous colpopexy (SSC) is a well-known surgical technique to correct apical support defect, however its approach is still challenging. The current study describes an alternative and economic approach for suture placement in the sacrospinous ligament during SSC using Masson luethy needle holder. A prospective study was conducted in a tertiary care center. The study recruited women with uterovaginal prolapse or post hysterectomy vaginal vault prolapse scheduled for SSC as a constructive surgery for vaginal superior segment defect. Eligible women were assigned to have SSC using Masson luethy needle holder (Group I) for suture placement in the sacrospinous ligament. The control group (Group II) consisted of a group of patients who had SSC using Deschamps ligature carrier. By the end of the study, 104 women underwent SSC. (Group I) included 55 women while (Group II) included 49 women. The mean SSC operative time was significantly shorter in (Group I) [109±33min versus 206±67min in ...

Research paper thumbnail of The association between pentraxin 3 in maternal circulation and pathological intrauterine fetal growth restriction

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2015

To assess the diagnostic accuracy of maternal serum pentraxin 3 (PTX3) in identifying pathologica... more To assess the diagnostic accuracy of maternal serum pentraxin 3 (PTX3) in identifying pathological intrauterine fetal growth restriction (IUFGR) among women presented in the third trimester of pregnancy with a small for gestational age (SGA) fetus. This case control study was conducted in Ain-Shams University Maternity Hospital, Abbasiya Square, Cairo, Egypt and included women diagnosed at the third trimester of pregnancy as having a SGA fetus. Cases included pregnant women with pathological IUFGR, while women with physiologically SGA fetus were included in the control group. Diagnosis of antenatal SGA fetus was based on the presence of abdominal circumference &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10th percentile. Pathological IUFGR was provisionally diagnosed antenatally by the presence of falling percentiles on serial ultrasound scans and then the definitive diagnosis was established postnatally after comprehensive neonatal evaluation. Maternal venous blood samples were collected from the eligible participants, once at the time of enrollment, to assess serum PTX3 levels using enzyme-linked immunosorbent assay (ELISA). Both groups were then followed up till delivery to confirm the diagnosis. Among the 68 pregnant included in the study, PTX3 was found to be significantly elevated in women with SGA fetus due to pathological IUFGR (n=34) than those with physiologically SGA fetus (n=34) [6.5ng/ml (2.5-11.0) versus 1.2ng/ml (0.8-2.5) respectively], with a best cutoff value of ≥1.3ng/ml [sensitivity of 85.3% (95% confidence interval (CI), 68.9-95.0) and a specificity of 73.5% (95% CI, 55.6-87.1)]. Using multivariable binary logistic regression model, amniotic fluid index (AFI) (P=0.010), estimated fetal weight (EFW) (P=0.016), PTX3 level (P=0.041), and umbilical artery pulsatility index (UA-PI) (P=0.027) were all found to be independent diagnostic markers for pathological IUFGR. PTX3 is a promising marker that deserves further evaluation as it may differentiate normal and abnormal fetal growth among women presenting at third trimester of pregnancy with a SGA fetus.

Research paper thumbnail of Measurement of serum estradiol/progesterone ratio on the day of embryo transfer to predict clinical pregnancies in intracytoplasmic sperm injection (ICSI) cycles. Is this of real clinical value?

Middle East Fertility Society Journal, 2013

ABSTRACT Study objective: To assess the value of measuring serum estradiol/progesterone (E 2 /P) ... more ABSTRACT Study objective: To assess the value of measuring serum estradiol/progesterone (E 2 /P) ratio on the day of embryo transfer (ET) in intracytoplasmic sperm injection (ICSI) cycles to predict clinical pregnancies. Design: A prospective study. Setting: The assisted reproduction unit of a large University Maternity Hospital. Materials and methods: Fifty seven women consecutively treated by ICSI for male factor infertility were included in the study. Early luteal serum E 2 and P were measured on the day of ET and serum E 2 /P ratios were calculated for clinical pregnancies and non-clinical pregnancy cycles. Main outcome measure: Clinical pregnancy rate. Results: Thirty four women failed to have clinical pregnancy (Non-clinical pregnancy group) while 23 women had clinical pregnancies (Clinical pregnancy group). There were no statistically significant differences between the two outcome groups regarding the median values for E 2 levels, P levels and E 2 /P ratios (655 pmol/l, 172.5 nmol/l and 2.8 for non-clinical pregnancy cycles versus 814 pmol/l, 180 nmol/l and 2.9 for clinical pregnancy cycles, respectively). Receiver-operating characteristic (ROC) curve for E 2 /P ratio was constructed to predict clinical pregnancies, the area under the curve (AUC) was 0.513 (95% confidence interval, 0.377–0.648; P, 0.865) and the best cut-off value was an E 2 /P ratio of 2.5 (sensitivity of 69.57%, specificity of 44.12%, positive predictive value of 45.7% and negative predictive value of 68.2%).

Research paper thumbnail of Skin test reactivity to female sex hormones in women with primary unexplained recurrent pregnancy loss

Journal of Reproductive Immunology, 2013

The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss mig... more The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss might be associated with an inappropriate immunologically mediated response to progesterone and/or estrogen. This prospective study included 47 women with two or more documented consecutive early pregnancy losses of unknown etiology, and no previous history of deliveries. Intradermal skin testing was performed in the luteal phase of the cycle (days 16-20) using estradiol benzoate, progesterone, and a placebo of refined sesame oil. Immediate (20 min) and late (24 h and 1 week) skin test readings for all cases were compared with those of 12 parous women of comparable age with no history of spontaneous miscarriages, premenstrual disorders, pregnancy, or sex hormone-related allergic or autoimmune diseases. Main outcome measure was skin test reactivity to estradiol and/or progesterone. Immediate skin test reactivity to both hormones was observed among half of the cases at 20 min. A papule after 24 h, which persisted for up to 1 week, was observed among 32 (68.1%) and 34 (72.3%) cases at the sites of estrogen and progesterone injection, respectively. 55.3% of cases had combined skin test reactivity to both estradiol and progesterone at 1 week. All women in the control group showed absence of skin test reactivity for both estradiol and progesterone at 20 min, 24 h, and 1 week. None of the subjects in either group showed skin test reactivity to placebo. There is an association between primary unexplained recurrent pregnancy loss and skin test reactivity to female sex hormones.

Research paper thumbnail of The Advantages in the Selection and Use of Bipolar Vessel Sealing Devices in Vaginal Hysterectomy, Dependent on the Different Degrees of Operative Difficulty

Uterine enlargement, previous pelvic surgery, absence of uterine descent, a narrow pubic arch, li... more Uterine enlargement, previous pelvic surgery, absence of uterine descent, a narrow pubic arch, limited vaginal and pelvic spaces, nulliparity, obesity, and the need for concomitant oophorectomy should no longer be considered as contraindications to vaginal hysterectomy (VH). The introduction of Electrobipolar vessel sealing (EBVS) systems, in VH, has facilitated the achievement of proper hemostasis in situations of difficult access into the pelvis, allowing vessels sealing with great ease and safety. Hereby, the advantages of using EBVS in performing VH as well as some surgical considerations are thoroughly discussed.

Research paper thumbnail of Mechanical induction of labor and ecbolic-less vaginal birth after cesarean section: A cohort study

Taiwanese Journal of Obstetrics and Gynecology

Research paper thumbnail of Use of an antiemetic to shorten the length of labor in nulliparous women, exploring a potential role of an old drug: A randomized controlled trial

International Journal of Gynecology & Obstetrics

To assess whether metoclopramide is effective in shortening the duration of the first stage of la... more To assess whether metoclopramide is effective in shortening the duration of the first stage of labor in primiparous women.

Research paper thumbnail of Cervical length should be measured for women with placenta previa: cohort study

The Journal of Maternal-Fetal & Neonatal Medicine

Abstract Objectives To study the relevance between cervical length (CL) and different maternal/ne... more Abstract Objectives To study the relevance between cervical length (CL) and different maternal/neonatal outcomes in pregnancies complicated with placenta previa/accreta. Methods Three hundred twenty-eight women, who had medically free singleton live pregnancies with the diagnosis of placenta previa and/or accreta, were included and divided regarding their CL into two groups. Threatened preterm labor, maternal tocolysis, multiple gestations, polyhydramnios, ruptured fetal membranes, fetal complications, history of cervical conization, and the presence of cervical cerclage were the exclusion criteria. Demographic data, obstetric history, as well as, the courses of the complicated pregnancies were collected and statistically analyzed. Results The short CL group had significantly less distance between the placenta and the internal cervical os (p-value < .001) Also, they showed more ultrasound parameters of complete placenta previa with anterior location (p-value < .001 and .003 respectively) and placental adherence (21.8 versus 41.1%). Women with short cervix had significantly higher rates of preterm birth, antepartum hemorrhage, emergency cesarean sections, intraoperative estimated blood loss, massive bleeding, prevalence of placental adherence and cesarean hysterectomy (p-value < .001 for the entire outcomes). Multivariable binary logistic regression showed that CL (<30 mm) was a significant independent risk factor in prediction of severe hemorrhage, PTB, emergency CS, placental adherence, cesarean hysterectomy (p-value < .001 for adverse maternal outcomes) and low cord Ph (p-value = .016). Conclusions Assessment of the cervical length could be a crucial step in the work-up and decision making for pregnancies complicated with abnormally situated and/or adherent placenta as it is strongly associated with a wide range of maternal and neonatal morbidities.

Research paper thumbnail of Knot positioning during McDonald cervical cerclage, does it make a difference? A cohort study

The Journal of Maternal-Fetal & Neonatal Medicine

Abstract Objective: To study the effect of McDonald cerclage knot position on the different mater... more Abstract Objective: To study the effect of McDonald cerclage knot position on the different maternal and neonatal outcomes. Methods: This historical cohort study included women with singleton pregnancy who had a prophylactic McDonald cervical cerclage between 1 May 2010 and 31 September 2017. Maternal and neonatal outcome parameters were compared between the anterior and posterior knot cerclage procedures. The primary outcome measure was the rate of term birth. Results: 550 Women had a prophylactic McDonald cervical cerclage, 306 with anterior knot (Group A) and 244 with posterior knot (Group B). There were no statistically significant differences regarding gestational age (GA) at delivery (36.3 ± 4.2 versus 35.8 ± 5.3 for groups A and B respectively), term birth rate, post-cerclage cervical length, symptomatic vaginitis, urinary tract infection, difficult cerclage removal and cervical lacerations. Similarly, there were no statistically significant differences as regards the studied neonatal outcomes including take home babies, neonatal intensive care admission, respiratory distress syndrome and neonatal sepsis. Survival analysis on GA at delivery demonstrated no statistically significant difference as regards the proportion of term deliveries in the anterior and posterior knot cerclage groups (log-rank test p-value = .478). Conclusions: Knot positioning during McDonald cervical cerclage, anteriorly or posteriorly, didn’t significantly impact the studied maternal and neonatal outcomes.

Research paper thumbnail of Prediction of spontaneous preterm birth: salivary progesterone assay and transvaginal cervical length assessment after 24 weeks of gestation, another critical window of opportunity

The Journal of Maternal-Fetal & Neonatal Medicine

Abstract Objectives: Measurement of salivary progesterone (SP4) levels and cervical length (CL) a... more Abstract Objectives: Measurement of salivary progesterone (SP4) levels and cervical length (CL) after 24 weeks to assess their potential predictive value among asymptomatic women at high risk of spontaneous preterm birth (PTB). Methods: This prospective observational (noninterventional) study consecutively recruited asymptomatic women at high risk of spontaneous PTB. SP4 and CL were measured at recruitment (24–28 weeks of gestation) then repeated after 3–4 weeks. All recruited women were followed up regularly till delivery. The primary outcome measure was the occurrence of spontaneous PTB. Results: One hundred and thirty four women completed the study, 22 (16.4%) and 32 (23.9%) women had early (<34 weeks) and late (≥34 weeks) PTB, respectively. Initially, the mean CL was 3.2 ± 0.6 cm and the mean SP4 was 4062.8 ± 814.6 pg/ml; with follow up, the mean CL became 3.0 ± 0.6 cm and the mean SP4 became 3871.6 ± 1136.9. Women with early PTB had significantly lower initial and follow up CL and SP4 measures when compared to women with late PTB and those who had birth at term. The rate of drop in SP4 and CL measurements between the two visits was also significantly higher among women with early PTB than those with late PTB and term birth. Receiver-operating characteristic (ROC) curves showed that, CL was a good predictor but SP4 was a better predictor of PTB as the area under the curve (AUC) for CL was less than that for SP4 at both visits (i.e. 0.858 and 0.868 versus 0.986 and 0.990 at the initial and follow up visits, respectively). There was a statistically significant correlation between CL and SP4 measurements. Multivariable binary logistic regression analysis revealed that follow up SP4 measurement was the only independent predictor of spontaneous PTB, and neither BMI, maternal age, SP4 nor CL were independent predictors of early spontaneous PTB. Conclusions: After 24 gestational weeks, SP4 assessment is a simple and reliable promising tool to predict spontaneous PTB among asymptomatic high-risk women, with a little superior performance than CL measurement.

Research paper thumbnail of Prediction of recurrent ectopic pregnancy: A five-year follow-up cohort study

European journal of obstetrics, gynecology, and reproductive biology, 2018

To evaluate the value of different clinical risk factors in the prediction of recurrent ectopic p... more To evaluate the value of different clinical risk factors in the prediction of recurrent ectopic pregnancies (REP). This cohort study was carried out at a tertiary-care maternity hospital in Saudi Arabia, between January 2010 and June 2017. All women with a primary ectopic pregnancy (EP) were consecutively recruited, thoroughly assessed and followed up for a minimum duration of five-years (5.6 ± 0.61 years) to diagnose the nature and location of the subsequent pregnancies. The primary outcome measure was the occurrence of REP, while the secondary outcomes included intrauterine pregnancy, the pregnancy of unknown location and infertility rates. A total of 272 women with a primary ectopic pregnancy (EP) were initially recruited, 217 women were included in the final analysis, among them 41 (18.9%) women had REP. Univariate analysis showed that women who subsequently developed REP had more prevalent prior miscarriages, evacuation of retained products of conception (ERPC), pelvic inflamma...

Research paper thumbnail of How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

The journal of obstetrics and gynaecology research, Jan 3, 2018

Of the different described methods of placental delivery during cesarean section (CS), manual rem... more Of the different described methods of placental delivery during cesarean section (CS), manual removal and cord traction are the most commonly used techniques. The ideal method of placental delivery during CS is still a conflicting issue as the data derived from the previous studies are widely heterogeneous and inconsistent. This study has investigated the effect of two different methods of placental delivery, controlled cord traction and manual removal, on perioperative blood loss. This randomized controlled trial recruited 345 pregnant women scheduled for elective cesarean delivery at term. Eligible participants were randomly assigned to have their placentae delivered either by manual removal or cord traction. Perioperative blood loss was the study primary outcome measure. A total of 300 women were included in the final analysis. The longer placental delivery time in the cord traction group (n = 150) (60 s. [45-61.25] versus 45 s. [35-60] in the manual placental delivery group, P &...

Research paper thumbnail of The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 29, 2018

To endorse the impact of chewing gum on the intestinal functions' restoration, hospital stay ... more To endorse the impact of chewing gum on the intestinal functions' restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD). Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 h after recovery at least for half an hour and at 2-h interval during daytime. The second group received oral fluids 6 h postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the tim...

Research paper thumbnail of Pre-induction cervical ripening using two different dinoprostone vaginal preparations: A randomized clinical trial of tablets and slow release retrievable insert

Taiwanese journal of obstetrics & gynecology, 2018

The current study compared the safety and efficacy of two different dinoprostone preparations (di... more The current study compared the safety and efficacy of two different dinoprostone preparations (dinoprostone vaginal tablets & dinoprostone slow release retrievable vaginal insert) to ripen the cervix at term. Women admitted for pre-induction cervical ripening were included in a randomized controlled trial. Eligible women were randomly assigned to receive Dinoprostone either in the form of vaginal tablets or slow release retrievable vaginal insert. Study outcomes included time to vaginal delivery and time to onset of labor intervals and vaginal delivery rate. No statistically significant difference was found between the two groups regarding the main outcome measures, however, the probability of successful vaginal delivery was independently related to the type of dinoprostone preparation used to ripen the cervix (proportional hazard, 1.366; 95% CI, 1.010-1.847; P, 0.043) and the parity (proportional hazard, 1.412; 95% CI, 1.041-1.915; P, 0.026). Both dinoprostone preparations were eff...

Research paper thumbnail of Maternal serum amyloid A level as a novel marker of primary unexplained recurrent early pregnancy loss

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2017

To assess maternal serum amyloid A (SAA) levels among women with primary unexplained recurrent ea... more To assess maternal serum amyloid A (SAA) levels among women with primary unexplained recurrent early pregnancy loss (REPL). A prospective study was conducted among women with missed spontaneous abortion in the first trimester at Ain Shams University Maternity Hospital, Cairo, Egypt, between January 21 and December 25, 2014. Women with at least two consecutive primary unexplained REPLs and no previous live births were enrolled. A control group was formed of women with no history of REPL who had at least one previous uneventful pregnancy with no adverse outcomes. Serum samples were collected to measure SAA levels. The main outcome was the association between SAA and primary unexplained REPL. Each group contained 96 participants. Median SAA level was significantly higher among women with REPL (50.0 μg/mL, interquartile range 26.0-69.0) than among women in the control group (11.6 μg/mL, interquartile range 6.2-15.5; P<0.001). The SAA level was an independent indicator of primary unex...

Research paper thumbnail of Blind vaginal fetal fibronectin swab for prediction of preterm birth

Journal of Obstetrics and Gynaecology Research, 2015

To assess the accuracy of blind vaginal swab in diagnosis of preterm labor (PTL) and prediction o... more To assess the accuracy of blind vaginal swab in diagnosis of preterm labor (PTL) and prediction of subsequent occurrence of preterm birth (PTB). Eligible women who presented at 24-34 weeks of gestation with threatened PTL had their cervicovaginal secretions sequentially sampled for fetal fibronectin (fFN) using two types of swabbing techniques. The first swab was a blind vaginal swab collected without the aid of speculum, while the second one was a routine cervicovaginal swab. All participants were followed up until delivery. fFN in both swabs was significantly higher in women who delivered before term compared with women who delivered at term. On regression analysis, r(2) = 0.735 and 0.785 for blind vaginal and cervicovaginal swabs respectively, while on receiver operating characteristic analysis the area under curve was 0.965 and 0.977, respectively, without a statistically significant difference. Using an fFN cut-off of ≥0.05 μg/dL, the sensitivity, specificity, positive predictive value and negative predictive value of blind vaginal swab to predict PTB were 53.9%, 91.9%, 70.0% and 85.0%, respectively; while those for cervicovaginal swab were 58.3%, 94.7%, 77.8% and 87.8%, respectively. In women presenting at 24-34 weeks of gestation with threatened PTL, blind vaginal fFN swab is as effective as cervicovaginal swab to predict PTB, but it is easier to perform and does not require doctor supervision.

Research paper thumbnail of Can three-dimensional ultrasound measurement of fetal adrenal gland enlargement predict preterm birth?

Archives of Gynecology and Obstetrics, 2015

To assess the diagnostic accuracy of three-dimensional (3D) ultrasound measurements of fetal adre... more To assess the diagnostic accuracy of three-dimensional (3D) ultrasound measurements of fetal adrenal gland volume (AGV) and fetal zone enlargement (FZE) as predictors of PTB compared to measurements of cervical length (CL) and cervicovaginal fetal fibronectin (CVFF). This prospective study included women presenting at 28-36 weeks of gestation with threatened preterm labor (TPL). Fetal AGV and FZE were measured using 3D ultrasound. Two-dimensional (2D) ultrasound was used to measure the CL. The AGV was corrected for the ultrasound-estimated fetal weight (cAGV). Qualitative CVFF detection was also performed. The diagnostic accuracy of cAGV, FZE, CL, and CVFF was compared considering preterm birth (PTB) within 7 days of recruitment as the main outcome measure. Seventy-five pregnant women were included in the final statistical analysis. Twenty-seven women (36 %) delivered within 7 days. cAGV and FZE had the highest sensitivities and specificities to predict PTB within 7 days when compared with CL and CVFF. Multivariate analysis, including cAGV, FZE, CL, and CVFF, revealed that cAGV and FZE were independent predictors of PTB within 7 days in the study participants. In women who presented at 28-36 weeks of gestation with TPL, cAGV and FZE can be used as independent predictors of PTB.

Research paper thumbnail of Can Porphyromonas gingivalis be a novel aetiology for recurrent miscarriage?

The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, Jan 20, 2014

Objective To study the association between Porphyromonas gingivalis (P. gingivalis) infection and... more Objective To study the association between Porphyromonas gingivalis (P. gingivalis) infection and recurrent miscarriage. Methods This case control study included women with early pregnancy failure admitted for surgical evacuation of retained products of conception. Cases (group 1) included 50 women with unexplained recurrent early miscarriage whereas the control group (group 2) consisted of 50 women with no such history. The evacuated products of conception, subgingival plaques, cervicovaginal secretions and saliva of all participants were examined to detect P. gingivalis deoxyribonucleic acid (DNA) using a polymerase chain reaction. Results The prevalence of P. gingivalis DNA in the chorionic villous tissue samples of group 1 was significantly higher than in group 2 (8 [16%] vs. 1 [2%], respectively; p = 0.036, odds ratio [OR]: 9.3, 95% confidence interval [CI]: 1.1-76.9). The prevalence of P. gingivalis DNA was significantly higher in cervicovaginal secretions of group 1 than in g...

Research paper thumbnail of The use of cell salvage in women undergoing cesarean hysterectomy for abnormal placentation

Although transfusion of autologous blood obtained from cell salvage has increased, its role in ob... more Although transfusion of autologous blood obtained from cell salvage has increased, its role in obstetric practice remains controversial. This case series reports the use of cell salvage in an attempt to avoid allogeneic transfusion in women undergoing cesarean hysterectomy for placenta accreta. This prospective observational study, conducted in a large public maternity hospital, included 41 women with an antenatal diagnosis of placenta accreta, of whom 20 underwent cesarean hysterectomy and 15 received autologous blood after cell salvage. Intraoperative cell salvage was used for autologous blood transfusion, and salvaged blood was monitored for prewash and postfiltration squamous cells, fetal hemoglobin, and potassium concentration. Pre- and postoperative hemoglobin, platelet count and coagulation profile were compared. Twenty women underwent caesarean hysterectomy. Cell-salvaged blood was collected in 18 women and re infused in 15 women (83.3%). The mean volume of reinfused salvaged blood was 1476 ± 247 mL. Mean potassium concentrations (1.4 ± 1.2 versus 3.7 ± 0.42 mEq/L) and median squamous cell counts (0 [0-1] versus 8 [3-12]/high power field) were significantly lower postfiltration compared to prewash values. There were no instances of intraoperative or postoperative amniotic fluid embolism, hypotension, sepsis or coagulopathy. Of the 15 women who received autologous blood, 13 (86.7%) did not require allogeneic red blood cell transfusion. Autologous transfusion of salvaged blood can be used to minimize allogeneic transfusion in women undergoing cesarean hysterectomy for placenta accreta.

Research paper thumbnail of Fetal mid-thigh soft-tissue thickness: a novel method for fetal weight estimation

Archives of Gynecology and Obstetrics, 2014

To derive a novel formula for fetal weight estimation utilizing the linear measurement of mid-thi... more To derive a novel formula for fetal weight estimation utilizing the linear measurement of mid-thigh soft-tissue thickness (STT). 300 women, with singleton uncomplicated pregnancy, were included in a prospective cross-sectional study. The study included four consecutive phases: phase (1) validated the original Scioscia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s formula, phase (2) derived a novel modified formula for fetal weight estimation, phase (3) validated the novel modified formula, and phase (4) evaluated the agreement between the modified and original formulae. A statistically significant correlation was found between actual fetal weight (AFW) and various sonographic biometric measurements including mid-thigh STT (r (2) = 0.656, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), femur length (FL) (r (2) = 0.573, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), bi-parietal diameter (BPD) (r (2) = 0.250, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), abdominal circumference (AC) (r (2) = 0.310, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and estimated fetal weight (EFW) using the original Scioscia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s formula (r (2) = 0.644, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The modified formula showed a better signed % difference (median = -0.41 %, IQR -1.88 to 2.03) than the original formula (median = -0.51 %, IQR -2.33 to 2.00). It was noted that, using the original formula, 88.7 % of the sample had absolute error below 5 and 98.3 % of the sample had absolute error below 10 %. On the other hand, using the modified formula, 87.3 % of the sample had absolute error below 5 %, while 97.3 % had absolute error below 10 %. The agreement between the two formulae was moderate as 134 patients out of 150 had similar ranking (κ = 0.57). Fetal mid-thigh SST is a simple, useful, and easily applicable parameter for fetal weight estimation.

Research paper thumbnail of Sacrospinous colpopexy using Masson luethy needle holder

European journal of obstetrics, gynecology, and reproductive biology, 2014

Sacrospinous colpopexy (SSC) is a well-known surgical technique to correct apical support defect,... more Sacrospinous colpopexy (SSC) is a well-known surgical technique to correct apical support defect, however its approach is still challenging. The current study describes an alternative and economic approach for suture placement in the sacrospinous ligament during SSC using Masson luethy needle holder. A prospective study was conducted in a tertiary care center. The study recruited women with uterovaginal prolapse or post hysterectomy vaginal vault prolapse scheduled for SSC as a constructive surgery for vaginal superior segment defect. Eligible women were assigned to have SSC using Masson luethy needle holder (Group I) for suture placement in the sacrospinous ligament. The control group (Group II) consisted of a group of patients who had SSC using Deschamps ligature carrier. By the end of the study, 104 women underwent SSC. (Group I) included 55 women while (Group II) included 49 women. The mean SSC operative time was significantly shorter in (Group I) [109±33min versus 206±67min in ...

Research paper thumbnail of The association between pentraxin 3 in maternal circulation and pathological intrauterine fetal growth restriction

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2015

To assess the diagnostic accuracy of maternal serum pentraxin 3 (PTX3) in identifying pathologica... more To assess the diagnostic accuracy of maternal serum pentraxin 3 (PTX3) in identifying pathological intrauterine fetal growth restriction (IUFGR) among women presented in the third trimester of pregnancy with a small for gestational age (SGA) fetus. This case control study was conducted in Ain-Shams University Maternity Hospital, Abbasiya Square, Cairo, Egypt and included women diagnosed at the third trimester of pregnancy as having a SGA fetus. Cases included pregnant women with pathological IUFGR, while women with physiologically SGA fetus were included in the control group. Diagnosis of antenatal SGA fetus was based on the presence of abdominal circumference &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10th percentile. Pathological IUFGR was provisionally diagnosed antenatally by the presence of falling percentiles on serial ultrasound scans and then the definitive diagnosis was established postnatally after comprehensive neonatal evaluation. Maternal venous blood samples were collected from the eligible participants, once at the time of enrollment, to assess serum PTX3 levels using enzyme-linked immunosorbent assay (ELISA). Both groups were then followed up till delivery to confirm the diagnosis. Among the 68 pregnant included in the study, PTX3 was found to be significantly elevated in women with SGA fetus due to pathological IUFGR (n=34) than those with physiologically SGA fetus (n=34) [6.5ng/ml (2.5-11.0) versus 1.2ng/ml (0.8-2.5) respectively], with a best cutoff value of ≥1.3ng/ml [sensitivity of 85.3% (95% confidence interval (CI), 68.9-95.0) and a specificity of 73.5% (95% CI, 55.6-87.1)]. Using multivariable binary logistic regression model, amniotic fluid index (AFI) (P=0.010), estimated fetal weight (EFW) (P=0.016), PTX3 level (P=0.041), and umbilical artery pulsatility index (UA-PI) (P=0.027) were all found to be independent diagnostic markers for pathological IUFGR. PTX3 is a promising marker that deserves further evaluation as it may differentiate normal and abnormal fetal growth among women presenting at third trimester of pregnancy with a SGA fetus.

Research paper thumbnail of Measurement of serum estradiol/progesterone ratio on the day of embryo transfer to predict clinical pregnancies in intracytoplasmic sperm injection (ICSI) cycles. Is this of real clinical value?

Middle East Fertility Society Journal, 2013

ABSTRACT Study objective: To assess the value of measuring serum estradiol/progesterone (E 2 /P) ... more ABSTRACT Study objective: To assess the value of measuring serum estradiol/progesterone (E 2 /P) ratio on the day of embryo transfer (ET) in intracytoplasmic sperm injection (ICSI) cycles to predict clinical pregnancies. Design: A prospective study. Setting: The assisted reproduction unit of a large University Maternity Hospital. Materials and methods: Fifty seven women consecutively treated by ICSI for male factor infertility were included in the study. Early luteal serum E 2 and P were measured on the day of ET and serum E 2 /P ratios were calculated for clinical pregnancies and non-clinical pregnancy cycles. Main outcome measure: Clinical pregnancy rate. Results: Thirty four women failed to have clinical pregnancy (Non-clinical pregnancy group) while 23 women had clinical pregnancies (Clinical pregnancy group). There were no statistically significant differences between the two outcome groups regarding the median values for E 2 levels, P levels and E 2 /P ratios (655 pmol/l, 172.5 nmol/l and 2.8 for non-clinical pregnancy cycles versus 814 pmol/l, 180 nmol/l and 2.9 for clinical pregnancy cycles, respectively). Receiver-operating characteristic (ROC) curve for E 2 /P ratio was constructed to predict clinical pregnancies, the area under the curve (AUC) was 0.513 (95% confidence interval, 0.377–0.648; P, 0.865) and the best cut-off value was an E 2 /P ratio of 2.5 (sensitivity of 69.57%, specificity of 44.12%, positive predictive value of 45.7% and negative predictive value of 68.2%).

Research paper thumbnail of Skin test reactivity to female sex hormones in women with primary unexplained recurrent pregnancy loss

Journal of Reproductive Immunology, 2013

The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss mig... more The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss might be associated with an inappropriate immunologically mediated response to progesterone and/or estrogen. This prospective study included 47 women with two or more documented consecutive early pregnancy losses of unknown etiology, and no previous history of deliveries. Intradermal skin testing was performed in the luteal phase of the cycle (days 16-20) using estradiol benzoate, progesterone, and a placebo of refined sesame oil. Immediate (20 min) and late (24 h and 1 week) skin test readings for all cases were compared with those of 12 parous women of comparable age with no history of spontaneous miscarriages, premenstrual disorders, pregnancy, or sex hormone-related allergic or autoimmune diseases. Main outcome measure was skin test reactivity to estradiol and/or progesterone. Immediate skin test reactivity to both hormones was observed among half of the cases at 20 min. A papule after 24 h, which persisted for up to 1 week, was observed among 32 (68.1%) and 34 (72.3%) cases at the sites of estrogen and progesterone injection, respectively. 55.3% of cases had combined skin test reactivity to both estradiol and progesterone at 1 week. All women in the control group showed absence of skin test reactivity for both estradiol and progesterone at 20 min, 24 h, and 1 week. None of the subjects in either group showed skin test reactivity to placebo. There is an association between primary unexplained recurrent pregnancy loss and skin test reactivity to female sex hormones.