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Objective: To synthesize the evidence on the most effective medications for the relief of intrauterine device (IUD) insertion-related pain. Design: Systematic review and network meta-analysis of randomized controlled trials (RCTs). Setting: Not applicable. Patient(s): Patients undergoing IUD insertion who received different medications for pain relief versus those who received placebo. Intervention(s): Electronic search in the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect. Main Outcome Measure(s): Visual analog scale (VAS) pain score during tenaculum placement, IUD insertion, and 5 to 20 minutes after insertion, the score of easiness of insertion and the need for additional analgesics. Result(s): The present review included 38 RCTs (n ¼ 6,314 patients). The network meta-analysis showed that lidocaine-prilocaine cream (genital mucosal application) statistically significantly reduced pain at tenaculum placement compared with placebo (mean difference À2.38; 95% confidence interval, À4.07 to À0.68). In the ranking probability order, lidocaine-prilocaine cream ranked the highest in reducing the pain at tenaculum placement, followed by lidocaine (paracervical). Similarly, lidocaine-prilocaine cream ranked as the highest treatment in pain reduction during IUD insertion, followed by lidocaine (paracervical). Conclusion(s): Lidocaine-prilocaine cream is the most effective medication that can be used for IUD insertion-related pain. Other medications are not effective. (Fertil Steril Ò 2019;111:553-61. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Background: Cesarean section (CS) rates have almost doubled globally from 2000 to 2015, with Egypt having one of the highest rates worldwide. This survey was carried out to highlight the role of poor knowledge in increasing unindicated cesarean deliveries (CDs). Aim and objective: To assess the awareness of Egyptian women about the indication of their first CD, their knowledge about different modes of delivery, and their attitude toward CD. Materials and methods: A cross-sectional survey of 2,379 multiparous ladies, with history of at least one CS, was conducted at a tertiary university hospital, from April 2018 to August 2018. A semistructured questionnaire was used which covered sociodemographic aspects, information about previous deliveries, and 13 closed-ended questions assessing awareness, knowledge, and attitude toward CD. Results: We found that 72.8% of the women had their CS in their first delivery. The private sector is responsible for 48.5% of the primary CD. Nineteen percent of the participants did not know or were not told of their indication for CD, and nine percent had a CS upon demand. Answers showed that 54.6% of women saw CS is safer for the mother, and 63.7% that it is safer for the baby. Participants thought that CS compared to vaginal delivery is less painful (63.4%), associated with less bleeding (69.8%); does not affect emotional bonding (54.1%); protects against prolapse, urinary, and sexual problems (48.7%); and does not affect future fertility (75.8%). In addition, 44% did not know that vaginal birth is possible after a CS, 28% would opt for a CS to avoid the lithotomy position, and 72.5% did not regret delivering by CS. Conclusion: Egyptian women's awareness about their indication for CD is defective, and their knowledge regarding pros and cons of different modes of delivery is inadequate and incorrect.

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Aim:To evaluate the accuracy of Pap smear and colposcopy as predictors of cervical histopathology in patients undergoing total hysterectomy for benign indications, and to determine the incidence of unexpected cervical pathology in these patients. Study Design: Prospective observational study Patients and Methods: One hundred women scheduled for total hysterectomy for benign indications were subjected to preoperative Pap smear and colposcopy, at Kasr Al-Ainy Hospital, Cairo University, Egypt, during the period from September 2017 to March 2018. Findings were compared with the histopathological results of the cervices of the hysterectomy specimens. Results: Out of 100 patients included in our study, 13 had an abnormal Pap smear and 44 had abnormal findings on colposcopy. Abnormal cervical pathology was found in 30 hysterectomy specimens. Pap smear had a sensitivity and specificity of 33.3% and 95.7%, respectively, while colposcopy had a sensitivity and specificity of 96.7% and 78.6%, respectively. The incidence of unexpected cervical pathology was 66.7% depending on the Pap alone, and 3.3% when depending on colposcopy. Conclusion: Pap smear has a good specificity, but a low sensitivity in predicting cervical histopathology. Meanwhile, colposcopy has a high sensitivity and a reasonable specificity in predicting the histopathology. Colposcopy has a higher sensitivity and specificity as a pathology predictor, when compared to Pap smear.