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Introduction: The levonorgestrel intrauterine system (LNG-IUS) is a long-acting hormone-releasing uterine device that has many non-contraceptive benefits. The study aims to assess the safety and efficacy of LNG-IUS in the management of adenomyosis. Material and methods:We searched the following bibliographic databases: MEDLINE via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Google Scholar for the relevant studies which used LNG-IUS in management of patients with clinically or ultrasonographic diagnosed adenomyosis.The main outcome measures are pain score at the end of follow-up, bleeding, symptomatic relief, uterine volume (mL), endometrial thickness (mm) and/or hemoglobin level.Results: Ten prospective studies (patients n = 551) were included. The overall effect estimates showed that the LNG-IUS led to significant reductions in pain score after 12 months (standardized mean difference [SMD[ −3.87, 95% confidence interval [CI] −5.51 to −2.23, P < .001), 24 months (SMD −5.56, 95% CI −9.80 to −1.32, P = .01) and 36 months of insertion (SMD −3.81, 95% CI −4.27 to −3.36, P < .001). Similarly, the Pictorial Blood Assessment Chart (PBAC) showed significant reduction up to 36 months after LNG-IUS insertion (SMD −2.32, 95% CI −2.91 to −1.73, P < .001).The LNG-IUS led to significant reductions in the uterine volume 12 months (SMD −.60, 95% CI −0.88 to −.31, P < .001) and 36 months after insertion (SMD −0.42, 95% CI −0.69 to −0.14, P = .003). Conclusions:LNG-IUS is a promising and effective option for the management of adenomyosis. Its use effectively reduced the severity of symptoms, uterine volume and endometrial thickness, and improved laboratory outcomes. K E Y W O R D Sadenomyosis, hormonal intrauterine device, levonorgestrel intrauterine system, pain relief

Background: Antenatal cervical length measurement has paramount importance in the prediction of labor. It was compared to the Bishop Score and incorporated in the modified Bishop score due to its relevance and convenience. It is a more accurate tool that imposes no harm or distress to the patients. The study aimed to evaluate the role of antenatal cervical length measurement in the prediction of a successful vaginal birth and its relation to the duration of labor. Methods: This was a prospective cohort study, conducted at the emergency ward of obstetrics and gynecology department. We recruited 162 women over 1 year from January 2018 to January 2019. Women eligible for the study had a transvaginal ultrasound for the examination of the cervical length before the onset of labor. The success of vaginal delivery was evaluated. Results: The mean cervical length (mm) was 43.3 ± 8.0. The majority of the patients labored spontaneously [102 (63.0%)] while the remaining ones required induction of labor due to different causes. One hundred and eight patients (66.7%) had a successful vaginal delivery. The cervical length was significantly shorter among patients who delivered vaginally than those delivered by CS (P-value < 0.001). Multiple factors had a significant role in the prediction of the mode of delivery (cervical length, BMI, the onset of labor, parity). Maternal body mass index and labor induction were associated with a prolonged duration of the active phase of labor. Conclusion: Antenatal cervical length measurement predicted the mode of delivery as well as the gestational age at which delivery ensued. It can be used in patients' counseling regarding the mode of delivery.

Background The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions. Methods This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey’s scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair’s scoring system was used to evaluate intraperitoneal adhesions. Results The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey’s and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001). Conclusion Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.

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Objective: Intracorporeal suturing is an effective hemostatic technique after laparoscopic ovarian cystectomy, but evidence of suturing superiority over electrocoagulation is lacking. This study compared the effects of bipolar electrocoagulation versus hemostatic suturing on ovarian reserve, as assessed by antral follicle count (AFC), anti-Müllerian hormone (AMH), and follicle-stimulating hormone (FSH) after laparoscopic benign ovarian cystectomy. Materials and Methods: This prospective cohort study, conducted in a tertiary-care university hospital, enrolled 50 patients with benign ovarian cysts. The patients were divided into 2 groups: (1) intracorporeal suturing and (2) bipolar electrocoagulation. Serial ultrasounds and blood samples for AMH and FSH were assessed preoperatively; then at 3-and 6-month follow-ups. Results: There was a statistically significant reduction in AMH (p < 0.001) at the 6-month follow up from baseline (preoperative) in patients managed with bipolar electrocoagulation (-0.49-0.28 ng/mL), compared to those who had hemostatic sutures (-0.25-0.36 ng/mL). The difference in FSH was also significantly higher in the bipolar-electrocoagulation group than in the hemostatic-sutures group (0.68-0.49 mIU/mL versus 0.39-0.81 mIU/mL; p < 0.001). However, there was a statistically significant increase in AFC in the hemostaticsutures group, compared to the bipolar-electrocoagulation group (2.64-1.52 versus 1.8-2.27; p = 0.03). Conclusions: Intracorporeal hemostatic suturing is better than electrocauterization for patients undergoing laparoscopic benign ovarian cystectomy, with fewer deleterious effects on ovarian reserve markers.

Background Digital transvaginal examination of fetal head progression is subjective evaluation with many limitations. Using ultrasound (US) in the assessment of labor progression in prolonged labor is the current trend to predict the mode of delivery. The study intends to evaluate the women’s acceptance to the transperineal ultrasound (TPUS) compared with digital transvaginal examination, and its ability to predict the mode of delivery in prolonged labor. We included 28 pregnant ladies in a prolonged active phase of first or second stages of labor and followed them till delivery. TPUS was used to measure the fetal head–perineum distance (FHPD) and the angle of fetal head descent. Results Of the 28 participants, 53.5% of them delivered vaginally and 46.5% by Cesarean section (CS). All pregnant ladies described the TPUS as more convenient and less painful than digital vaginal examination. Cervical dilatation was negatively correlated with FHPD, and positively correlated with angle of fetal head descent. Both FHPD and angle of fetal head descent had a strong significant negative correlation. Using a cutoff value of 115° for the angle of fetal head descent, the positive predictive value (PPV) of vaginal delivery was 87%; using a cutoff value of 4.2 cm for FHPD, the PPV for vaginal delivery was 85%. Conclusion TPUS is more convenient, more accepted, and less painful than digital vaginal examination. Angle of head descent and FHPD are reliable predictors of the mode of delivery in prolonged labor.