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Cesarean delivery is a commonly practiced obstetrical surgical intervention. 1 Its rate has risen worldwide, 1 reaching 52% in 2018 in Egypt. 2 This leads to increased repeat cesarean deliveries and related morbidity. 3 Intraperitoneal adhesions result from abdominal or pelvic surgeries. They have serious consequences such as intestinal obstruction, chronic pelvic pain, ectopic pregnancy, infertility, visceral

Aim To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. Methods A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy. Revman software was utilized for performing our meta‐analysis. Our primary outcomes were pain scores evaluated by the visual analog scale (VAS) during and after the procedure. Our secondary outcome was the patient satisfaction between both groups. Results Five RCTs met our inclusion criteria with a total number of 441 patients. We found warm saline was linked to a significant reduction in the VAS pain score during the procedure compared to the control group (mean difference [MD] = −1.12, 95% confidence interval [CI] [−1.80, −0.45], p = 0.001). Moreover, the VAS pain score after the procedure was significantly declined among the warm saline group (MD = −0.62, 95% CI [−0.97, −0.27], p = 0.005). Interestingly, more patients were significantly satisfied with warm saline distension medium application compared to room temperature group (odds ratio [OR] = 3.71, 95% CI [2.01, 6.86], p < 0.001). Conclusions Warm saline application in office hysteroscopy is effective in reducing pain during and after the procedure as well as improvement in patient satisfaction.

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Background: Missed abortion (MA) is a pregnancy with an embryo without cardiac pulsation or gestational sac without embryo without attempt for expulsion of the product of conception outside the uterus. Objective: to detect the efficacy of serum Angiopoietin-1(Ang-1) as a biomarker of missed abortion at 6 to 8 weeks of pregnancy Methodology: This case-control study comprised eighty pregnant women aged 20-40 years; they were divided into; A) control group which composed of 40 women with normal viable pregnancy at the 6-8 weeks of pregnancy , B) study group that included 40 women with missed abortion diagnosed by TVUS at same gestational age. Results: This study revealed that, there was highly statistically significant decrease in serum levels of Ang-1 in missed abortion .The mean ±SD of serum Ang-1 were 926.16 ± 211.48 ( 700 -1620.3) pg/ml in normal pregnant women, and 700.04 ± 87.87 (435.9-797.8) pg/ml in women with missed abortion. The cutoff point was ≤ 780.99 pg/ml with high sensitivity and specificity (87.5.% and 90.00% respectively). There was no correlation between the Ang-1 levels and (age, parity, and body mass index). Conclusion: Serum levels of Ang-1 were highly significantly decreased in a status of missed abortion as early as 6 to 8 weeks of conception when compared with Ang-1 levels in normal viable pregnancies of similar gestational age which indicate its role in pathogenesis of missed abortion. Angiopoietin 1 is not a reliable biomarker for instant diagnosis of missed abortion as some patients need further transvaginal ultrasound (TVUS) and regular follow up.