No abstract

Uterine fibroids are benign tumors of the myometrium with a diverse range of manifestations. Fibroids can dramatically increase in size during pregnancy due to the increase in estrogen levels. After delivery, the fibroids usually shrink back to their pre-pregnancy size. Uterine myomas may have many complications, including abnormal uterine bleeding, infertility, pressure on nearby organs, degeneration, and malignant transformation. No previous reports have indicated that a fistula may develop between a uterine fibroid and the bowel loops, although previous studies have documented the occurrence of fistulas from the uterus to the bowel following myomectomy or uterine artery embolization performed to treat a myoma. In our case report, we document the rare complication of a fistula occurring between a degenerated myoma in the posterior wall and the ileum 1 week postoperatively in a patient who underwent a Caesarean section but did not have a history of uterine artery embolization.

Background: Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.Methods: All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.Results: Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.Conclusions: Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.

Background: First-trimester pregnancy loss is the most common complication of human reproduction with an incidence ranging between 50 and 70% of all conceptions. The uterine cervix has to be firm enough to retain the conceptus through the pregnancy. Cervical ripening and maturation is very important prerequisite for the successful termination of pregnancy. Misoprostol softens the cervix and cause uterine contractions used for ripening of the cervix before surgical or for medical abortion. Isosorbide mononitrate promote cervical smooth muscle relaxation has been applied clinically as cervical ripening agents. First trimester abortion is terminated by surgical evacuation of the uterus.Conclusion: Cervical preparation is beneficial prior to surgical abortion and should be routine if gestation more than 10 weeks using one of cervical ripening agents Misoprostol or IMN. Aim of Study:To compare efficacy and safety of Isosorbide Mononitrate (IMN) and misoprostol for cervical ripening prior to surgical termination of missed abortion aged between 8 and 12 weeks. Patients and Methods:Eighty patients aged between 20 & 35 years presenting with missed abortion in early weeks of gestation and requiring medical or surgical evacuation of the retained products of conception were included in this prospective clinical study. Number of doses required to achieve cervical ripening, Induction-Ripening interval (I/R) was recorded. Amount of operative blood loss and other safety indices were assessed.Results: Number of doses to achieve cervical ripening using (Misoprostol) was significantly less than number of the (IMN) doses and with further analytical statistics about 66% of cases have successful ripening using (Misoprostol) compared to only 31% using (IMN). The mean (I/R interval) was as follows; 18.5 hours for (Misoprostol) and 22.5 hours for (IMN); with much less operative blood loss for the Misoprostol group than the IMN group.

Background: Newborn respiratory complication is one of the most prevalent and life-threatening disorders. The clinical indications of early newborn respiratory distress with consistent radiologic features. The Doppler examination of the primary pulmonary artery in the foetus has been proven to be beneficial. The foetal pulmonary artery At/Et ratio is linked to foetal gestational age and amniotic fluid foetal lung maturity (FLM) tests. The aim of the study was to assess the accuracy of foetal main pulmonary artery (MPA) Doppler indices in prediction of the development of neonatal respiratory distress syndrome (RDS) in diabetic mothers.Methods: This was a prospective observational study carried out on 100 cases of diabetic mothers in obstetrics and gynecology department, Tanta University during one year from the approval of the university counsel. The physician evaluated the foetal heart in a methodical manner after a regular ultrasound assessment that included foetal biometry, anomaly scan, measured foetal weight, and amniotic fluid index. Classic chest radiological features include reticulogranular patterns, air bronchogram and ground glass look, as well as the need for surfactant.Results: PI and RI were significantly higher in newborns with RDS than those without RDS (p=0.025 and 0.036 respectively) PSV and At/Et ratio were significantly reduced in neonates with RDS compared with RDS free ones (p=0.004 and <0.001 respectively). RI was significantly higher in neonates with RDS than those without RDS (P = 0.048) PSV and At/Et ratio were significantly reduced in newborns with RDS compared to RDS free ones (p=0.008 and <0.001 respectively). The ROC curve displayed that the cut off value of ≤0.25 for At/Et ratio was associated with a sensitivity of 76.92%, a specificity of 100.0%, a PPV of 100.0% and a NPV of 96.7% for prediction of neonatal RDS with AUC of 0.925 and p≤0.001.Conclusions: development of neonatal RDS in foetus of diabetic mothers with a cut off value of ≤0.25, a sensitivity of 76.92%, a specificity of 100.0%, a PPV of 100.0%, a NPV of 96.7% and AUC of 0.925 The usage of corticosteroids improved the Doppler indices of main pulmonary artery and is accompanied by less morbimortality related to RDS.

Background: Endometriosis is the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. Some women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. The aim of this study was to detect the incidence of endometriosis among symptomatic and asymptomatic cases of primary infertility in Tanta University Hospital over one year. Methods: This prospective observational study was conducted on 50 females aged between 20 and 35 years old, with unexplained infertility, symptoms of endometriosis and infertility for 1 or more years. Patients were divided into two equal groups: group (1):  cases with unexplained infertility for 1 year or more and group (2):  cases with symptoms of primary infertility and endometriosis for 1 year or more. Patients were subjected to the following: meticulous history taking (personal, obstetric and menstrual history, history of present illness, past history 'medical and surgical'), thorough clinical examination, routine laboratory investigations, imaging techniques (ultrasound and HSG) and laparoscopy for diagnosis of possible presence of endometriosis. Results: Endometrioma size was significantly higher in group 2 compared to group 1 (P value = 0.020). Stage 1 of endometriosis was significantly lower in group 2 compared to group 1 and Stage 2, 3 and 4 of endometriosis were significantly higher in group 2 compared to group 1 (P value = 0.04). Dysmenorrhea of endometriosis after treatment were significantly higher in group 2 compared to group 1(P value <0.001). Chronic pelvic pain was significantly higher in group 1 compared to group 2 (P value <0.001). Conclusions: The presence of dysmenorrhea, dyspareunia, pelvic pain, infertility, and clinical signs of cul-de-sac tenderness raise the suspicion of endometriosis in infertility patients.

Background: Obstetric ultrasound is the first imaging modality used to assess the foetus and track its development. When the last menstrual period (LMP) is unknown, foetal ultrasonography can help with dates. According to studies, over 30% of pregnant women forget their LMP date. When the gestational age (GA) is uncertain, the pregnancy's outcome may be undesirable. To assess the ultrasonographic fetal kidney length as a measure of gestational age in third trimester. Methods: All participant women were in the third trimester whose gestational age was calculated by reliable LMP which was confirmed by recorded ultrasonic measurement of BPD, AC& FL). Participant women were divided into 2 equal groups: Group 1: normal pregnancy & average. Group 2: patients with growth restriction fetuses. Results: The mean length and width of the left kidney were similar in both groups, as the mean length of the left kidney in the IUGR group was (38.40 ± 4.000) while it was in the control group (38.17 ± 3.637). The average width of the left kidney in the intrauterine growth restriction group was (23.09 ± 2.339) while it was in the control group (23.16 ± 2.341), there were significant positive correlations between the different study variables. A positive association was found between gestational age, fetal weight, bipolar diameter, femur length and abdominal circumference with the length of the right kidney, and they also found a positive association with the length of the left kidney. Conclusions: In absence of renal anomalies/ abnormalities, kidney measurements; length, weight, volume can be used to determine gestational age accurately. No difference between measuring Rt or Lt kidney on determining GA. Also, no difference between measurements in female or male fetuses. Kidney measurement is not affected in cases of IUGR and can be used as a reliable indicator for actual gestational age of the fetus in these cases.

The umbilical cord represents a unique lifeline between the fetus and mother and contains two arteries and one vein wrapped up in Wharton’s jelly with moderate twists. Umbilical coiling abnormalities can result in fetal growth restriction, fetal distress, or intrauterine fetal death. Hypocoiled umbilical cords are associated with intrauterine fetal death (IUFD), fetal growth restriction, fetal distress, low Apgar scores, fetal congenital anomalies, and abnormal insertion of the umbilical cord. Hypercoiled umbilical cords are associated with IUFD, fetal distress, asphyxia, fetal congenital anomalies, and the presence of a single umbilical artery. The aim of this work is to determine if the umbilical Cord coiling index measurement during second trimester ultrasound scan can predict perinatal outcome. Seventy eight healthy uncomplicated pregnant women who regularly attended the antenatal care clinic for antenatal care and to do anomaly ultrasound scan on her baby in 2nd trimester. All participants were informed about the aims and the procedures of the study and signed an informed consent form prior to beginning. Regular antenatal cThe umbilical cord represents a unique lifeline between the fetus andmother and contains two arteries and one vein wrapped up in Wharton’s jelly with moderate twists. Umbilical coiling abnormalities canresult in fetal growth restriction, fetal distress, or intrauterine fetal death. Hypocoiled umbilical cords are associated with intrauterine fetal death (IUFD), fetal growth restriction, fetal distress, low Apgar scores, fetal congenital anomalies, and abnormal insertion of the umbilical cord. Hypercoiled umbilical cords are associated with IUFD, fetal distress, asphyxia, fetal congenital anomalies, and the presence of a single umbilical artery. The aim of this work is to determine if the umbilical Cord coiling index measurement during second trimester ultrasound scan can predict perinatal outcome. Seventy eight healthy uncomplicated pregnant women who regularly attended the antenatal care clinic for antenatal care and to do anomaly ultrasound scan on her baby in 2nd trimester. All participants were informed about the aims and the procedures of the study and signed an informed consent form prior to beginning. Regular antenatal care visit was done every two weeks till delivery with assessment of perinatal outcomes regarding: gestational age at delivery, fetal monitoring by CTG, method of delivery, meconium staining amniotic fluid or not, examination by apgar score at 1stand 5th minute, birth weight, admission to NICU or not and perinatal death. According to umbilical cord index, of total 78 pregnant women who completed the study 62 (79.2%) were having normal UC coiling, 10 of cases (12.8%) were having hypocoiling and 6 (7.7%) were having hypercoiling. Our results showed that hypo- and hyper-coiling were associated with increased incidence of preterm labor (32-36 weeks) “22.2%and 40% respectively” while normo-coiling was associated with lesser incidence “2%”. Both hypocoiling “10%” and hypercoiling “16.7%”groups showed higher incidence of IUGR when compared with the normocoiling group “1.6%”. APGAR score at minute one was significantly lower in the both hypocoiling and hypercoiling groups than the normocoiling group with p- value: 0.005. While at minute five, there was no significant difference between the three groups of the study. Conclusion: The abnormal umbilical coiling index “< 10th percentile or > 90th percentile” is associated with adverse perinatal outcomes. Therefore, early evaluation on Umbilical cord Index in the 2nd trimester can identify fetuses who are at risk and thus help in further management.are visit was done every two weeks till delivery with assessment of perinatal outcomes regarding: gestational age at delivery, fetal monitoring by CTG, method of delivery, meconium staining amniotic fluid or not, examination by apgar score at 1stand 5th minute, birth weight, admission to NICU or not and perinatal death. According to umbilical cord index, of total 78 pregnant women who completed the study 62 (79.2%) were having normal UC coiling, 10 of cases (12.8%) were having hypocoiling and 6 (7.7%) were having hypercoiling. Our results showed that hypo- and hyper-coiling were associated with increased incidence of preterm labor (32-36 weeks) “22.2%and 40% respectively” while normo-coiling was associated with lesser incidence “2%”. Both hypocoiling “10%” and hypercoiling “16.7%”groups showed higher incidence of IUGR when compared with the normocoiling group “1.6%”. APGAR score at minute one was significantly lower in the both hypocoiling and hypercoiling groups than the normocoiling group with p- value: 0.005. While at minute five, there was no significant difference between the three groups of the study. Conclusion: The abnormal umbilical coiling index “< 10th percentile or > 90th percentile” is associated with adverse perinatal outcomes. Therefore, early evaluation on Umbilical cord Index in the 2nd trimester can identify fetuses who are at risk and thus help in further management.