Objective: To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). Design: Systematic review and network meta-analysis of randomized controlled trials. Setting: Not applicable. Patient(s): Pre-or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. Intervention(s): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Main Outcome Measure(s): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. Result(s): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score ¼ 0.83) and immediately after OEB (P-score ¼ 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score ¼ 1.00), followed by misoprostol plus lidocaine (P-score ¼ 0.87). Conclusion(s):Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA. (Fertil Steril Ò 2019;112:140-8. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients.

Background: Postpartum hemorrhage is the ugly ghost that most obstetricians believe because many cases unpredicted and may be associated with rapid patient deterioration that may lead mortality or developing serious long-term morbidities. The objective of this study is to assess the efficacy of slowly intravenous administration of tranexamic acid in prevention and decline the severity of postpartum hemorrhage immediately prior to elective caesarean section.Methods: A double blinded, randomized, case control trial carried out at Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt from May 2017 to April 2018. This study was conducted on 500 full term pregnant women underwent elective caesarean section. The patients were divided randomly into: Group A (study group) included 250 patients received tranexamic acid 1gm slowly iv over 2 minutes at least 10 minutes before operation started and Group B (control group) included 250 patients that received placebo (normal saline NaCl 0.9%).Results: Incidence of PPH in group A and group B were (4.4% and 6.8) respectively, 1.2% in group A and 2.8% in group B had severe degree of PPH. Amount of blood loss immediately after placental delivery up to first 6 hours postoperative was statistically significant increase in placebo group than tranexamic acid group with p value <0.001.Conclusions: Tranexamic acid administration few minutes prior to elective cesarean section was effective in reducing the incidence and severity of PPH and decreased the use of additional uterotonic drugs and additional surgical interventions.

OBJECTIVE: To assess the effect of vitamin D supplementation on enhancement of embryos implantation rates in intracytoplasmic sperm injection procedures. STUDY DESIGN: A randomized double-blinded controlled trial.

BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasound (TVUS) on intracytoplasmic sperm injection (ICSI) outcomes in patients with unexplained recurrent implantation failure (RIF). SETTING: . STUDY DESIGN: A prospective observational study. METHDS: Fifty couples with history of unexplained RIF in previous ICSI cycles and prepared for another ICSI cycle (group I) and fifty couples with unexplained infertility prepared for ICSI for the first time (group II) had been included in this study. At time of ovum pick up, 3-DTVUS was done for all cases in both groups for assessment of sub endometrial junction zone thickness and correlated with ICSI outcome. RESULTS: There were statistically significant differences between group I and group II in JZ thickness in the 3 uterine regions (fundus, anterior and posterior walls) with p < 0.001, but there were mildly statistically significant differences between both groups in chemical and clinical pregnancy rates with p < 0.01. CONCLUSIONS: The thickness of JZ in patients with history of unexplained RIF was higher than those with unexplained infertility scheduled for ICSI. The JZ thickness was inversely correlated with increased embryo implantation rates in ICSI procedures, the thinner the JZ thickness was associated with higher pregnancy rates (both chemical and clinical pregnancy rates).