Oxytocin gel is useful in the restoration of the vaginal epithelium in cases of postmenopausal atrophic vaginitis. Further studies with a longer follow-up period are required to test the long-term effects of oxytocin as a treatment for vaginal atrophy.
Introduction
Misoprostol is used for the medical management of miscarriage as it is more effective in the early stages of pregnancy. Letrozole has an anti-estrogen effect and is used for the pretreatment of miscarriage with misoprostol.
Aim
The aim of this study was compare the efficacy and safety of letrozole with placebo pretreatment in the medical management of first trimester missed miscarriage.
Design
This was a prospective randomized case-control study.
Patients and Methods
Four hundred and thirty-eight women were randomly divided into two groups of 219; the placebo group received placebo tablets twice daily for 3 days, followed by 800 micrograms of misoprostol vaginally on the fourth day of enrolment, while the letrozole group received letrozole 10 mg twice daily for three days followed by 800 micrograms misoprostol administered vaginally. Symptoms and side effects were recorded, and the women advised to return to hospital if they experienced severe pain or bleeding or intolerable side effects and to report to hospital for a check-up one week after misoprostol administration. Ultrasound was done seven days after misoprostol administration to monitor outcomes. Surgical evacuation was carried out if medical management failed.
Results
There were significant differences between the two groups, with better outcomes found for the letrozole group in terms of rates of complete miscarriage, onset of vaginal bleeding, and interval between induction and onset of expulsion (p < 0.001). A higher rate of nausea and vomiting was reported for the letrozole group (p = 0.002). Differences between groups with regard to pre- and post-termination hemoglobin levels, fever, severe pain and severe bleeding needing evacuation were not statistically significant.
Conclusion
Adding letrozole to misoprostol improves the success rate and decreases the interval between induction and expulsion in cases of first trimester miscarriage; however, nausea and vomiting is higher with letrozole.
3D assessment of FV in the first trimester provides an accurate method for predicting pregnancy outcome namely low birth weight and neonatal complications, however, it is a better positive predictor than a negative one.
Aim of work: To assess the efficiency of vaginal polypropylene mesh as a cheaper alternative to Obtape.
Patients and methods:Forty qualified patients were subjected to history, examination and investigations including urodynamic studies and the patients were divided into two groups each containing twenty patients. Group 1 underwent the procedure using OB TAPE LG (Mentor Corporation-USA) and Group 2 did the procedure using a polypropylene mesh (Ethicon). Follow-up was done atone and six months post-operatively by clinical exam and by urodynamics (after 6 months only).Results: Age, parity, duration of disease, mode of delivery, menopausal status, associated anterior vaginal wall repair and pre-operative urodynamics were similar in both groups. Success rate was 95% in the mesh group and 90% in the OBTAPE LG (Mentor Corporation-USA) and mean operative time was 18.5 minutes for the mesh and 17.5 minutes for the OBTAPE LG (Mentor Corporation-USA). After 6 months follow-up complications did not differ greatly between the two groups except for mesh erosion which was three cases with Obtape and none with the mesh. Post-operative urodynamics showed significant improvement in cystometric capacity in mesh (P<0.001) and ob Tape (P=0.05), maximum urethral closure pressure in mesh (P=0.01) and obtape (P=0.03), maximum urethral closure pressure at stress in mesh (P=0.04) and obtape (P=0.007) and pressure transmission in mesh (P=0.01) and obtape (P=0.05).
Conclusion:Transobturator approach is a safe minimally invasive surgical technique. The use of vaginal mesh for this operation can provide a cheaper alternative for poorly resourced hospital settings. Further studies are needed to properly assess the efficiency of vaginal mesh for this surgical technique.
Aim: To assess the incidence of undiagnosed intrauterine pathology based on saline sonohysterography in women with normal transvaginal ultrasound and their impact on the success rate of Intracytoplasmic sperm injection in Egyptian community.Patients and methods: Two hundred qualified patients scheduled for first time Intracytoplasmic sperm injection treatment were divided into 2 groups each containing 100 patients. Group 1 did saline sonohysterography and cases with intrauterine lesions were treated by hysteroscopy prior to undergoing Intracytoplasmic sperm injection, while group 2 did Intracytoplasmic sperm injection without prior saline sonohysterography. The main outcome measures were undiagnosed intrauterine abnormalities as uterine anomalies and polyps, in addition to, pregnancy, miscarriage and on-going pregnancy rates.Results: Uterine lesions were found in 35% of cases undergoing sonohysterography, and 27 out of the 35 cases were treated by hysteroscopy. A significant difference in pregnancy rate and on-going pregnancy rate in favour of the sonohysterography group (P=0.04) and (P=0.031) respectively.
Conclusion:Saline sonohysterography is a non-invasive method for the diagnosis of uterine abnormalities improving the outcome of IVF/ICSI cycles.
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