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Background: The increasing prevalence of obesity worldwide has prompted the World Health Organization (WHO) to designate obesity as one of the most important global health threats. The epidemic is especially pronounced in women of reproductive age. Prepregnancy obesity is an independent risk factor for maternal and neonatal morbidity and mortality. The origin of this epidemic is unhealthy lifestyle – high energy and high-fat diet and physical inactivity. During periconceptual period and pregnancy, the composition of a woman’s diet is of particular importance, as it may influence the pregnancy, the delivery and the health of the mother and the infant later on, so an excessive gestational weight gain (GWG) is not recommended. The aim of our study is to clarify the complications related to excess prepregnancy body weight on maternal and fetal health. Methods: Hundred obese pregnant women with BMI (30-40 Kg/m2) measured at first trimester were prospectively enrolled into this study. Routine blood pressures, random blood sugar measuring and ultrasonographic follow up are required during pregnancy for early detection of any complications related to maternal obesity and excessive gestational weight gain (GWG). Results: cases statistically evaluated in these study were 100 pregnant females with mean age 27.34 years + 5 years SD and mean BMI 32.97 Kg/m2 + 2.92 Kg/m2 SD. Denoting in our study, the effect of maternal obesity om maternal and fetal health. Conclusion: A causal relationship between the prepregnancy BMI and obstetric complications is proven. Weight management is important for every women of reproductive age. Thus, medical Practice must consider these complications by providing early detection and management to improve both maternal and neonatal outcome.

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in the reproductive period. It is one of the leading causes of infertility. The manifestations of PCOS include irregular or no menstrual periods, excess body weight and facial hair, acne, heavy periods and pelvic pain. The aim of this study is to determine the efficacy of stair step protocol compared to traditional protocol in ovulation induction of polycystic ovarian syndrome (PCOS) patients in terms of increasing rate of ovulation and pregnancy. Methods: This study is non-blinded, multicenter, randomized controlled study and was carried out on infertile women attending the Fertility Clinic of Tanta University Hospital and Hurghada General Hospital. Two Hundred infertile patients with PCOS criteria and no other causes of infertility were enrolled according to inclusion and exclusion criteria. Results: Student t test was used for the continuous variables (FSH, LH, Prolactin, AMH, TSH, Free testosterone). Student t test was used for the continuous variables (Endometrial thickness, Time to ovulate (d)). Chi-square analysis was used for the categorical variables (Ovulation rate, Pregnancy rate). Chi-square analysis was used for the categorical variables (Ovulation rate per cycle). There was no significant difference between two groups as regards mild and severe side effects. Conclusions: This study concluded that stair step regimen improves the ovulation rate and pregnancy rate without any detrimental side effects compared to traditional regimen. It helps to know the sensitivity and resistance of an individual to clomiphene citrate much earlier and helps to plan ahead with alternative treatment for desired outcome. The advantage of shorter treatment period with similar side effects makes the stair step protocol suitable for use in routine clinical practice.

To compare the efficacy and safety of two uterine sparing techniques in conservative management of placenta accreta spectrum (PAS).This multicenter randomized controlled study was conducted from January 1, 2017 to December 31, 2020 at two university hospitals. Patients were randomly allocated into two groups; Group 1 was managed by Assar's technique and Group 2 was managed by Shehata's technique. Operative time, blood loss, operative complications (organ or vessel injury), and postoperative complications (early and late) were reported. Success of the technique, units of blood transfusion, and intensive care unit admissions were recorded.Demographic data in both groups were not significantly different. The mean gestational age at the delivery time was 36 weeks in both groups. Operative time was 120 (100-140) minutes and 75 (60-100) minutes in Assar's and Shehata's techniques, respectively (P 0.001). Blood loss was higher in Shehata's technique than in Assar's (P 0.001). Intensive care unit admissions were minimal in both groups. Operative complications were comparable in both groups. The success of Assar's and Shehata's techniques in uterine preservation was 85% and 95%, respectively.Both techniques were safe and successful in uterine sparing. Therefore, we recommend these techniques for conservative management of PAS.The trial was registered on UMIN-CTR and had the unique ID: UMIN000025315 on the following link: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029120.

Objective: To report a case of cervical ectopic managed by intra-cardiac injection of potassium chloride to terminate pregnancy. Design: Case Report . Patient: A 24-year-old G2P1+0, presented with vaginal bleeding. Cervical pregnancy (7 weeks+4 days) was diagnosed by transvaginal ultrasound. Intervention: Intra-cardiac injection of (KCL) was done plus intra-amniotic injection of methotrexate under ultrasound guidance. Outcomes: Safe pregnancy termination and uterine preservation. Results: Pregnancy was terminated successfully, without complications or side effects. Conclusion: Intra-cardiac injection of KCL appears to be an effective and safe method in termination of cervical ectopic pregnancy less than 10 weeks. Keywords: Cervical ectopic, Intra-cardiac feticide, Potassium Chloride, Methotrexate.

A lot of debate is present about Cesarean myomectomy (CM) in women with uterine myoma whether to consider it a feasible and safe procedure or an absolute contraindication.To assess the safety and feasibility of myomectomy during cesarean section in women with uterine myoma.Electronic search was made on MEDLINE, EMBASE, Cochrane Library, ISI web of knowledge and Scopus from January 1, 2008 to December 31, 2019 using terms "Caesarean section", "Myomectomy", "Fibroid", "Caesarean myomectomy".All full length studies either prospective or retrospective that address caesarean myomectomy were included.The outcomes studied were haemorrhage, mean change in haemoglobin, operative time, need for blood transfusion, febrile morbidity and duration of hospital stay.Total 249 studies were assessed for eligibility and 17 studies included in analysis with 6545 women. There were 4702 (71.85 %) women in caesarean myomectomy (CM) group and 1843 (28.15 %) women in cesarean section (CS) group. There was statistically significant but clinically insignificant decrease in hemoglobin [MD = 0.27, 95 %CI = 0.08-0.45, p = 0.005; very low quality], significant higher need for blood transfusion [RR = 1.45, 95 %CI = 1.05-1.99, p = 0.02; high quality] in CM group versus CS alone. The mean operative time (minutes) [MD = 14.77, 95 %CI = 6.91-22.64, p = 0.0002; moderate quality] and mean hospital stay (days) [MD = 0.36, 95 %CI = 0.19-0.53, p 0.00001; high quality] was significantly less in CM group, though of not any clinical significance. No difference in incidence of haemorrhage [RR = 1.16, 95 %CI = 0.86-1.56, p = 0.32; moderate quality evidence] and fever [RR = 1.17, 95 %CI = 0.83-1.65), p = 0.36; moderate quality] in two groups.The meta-analysis suggests CM is associated with clinical insignificant increase in operative time, blood loss and hospital stay, especially with multiple and large size myomas. CM should be preferred over CS alone especially by experienced surgeons with appropriate haemostatic techniques and tertiary care centres.

Objectives: The aim of this study is to evaluate the applicability and feasibility of Colpotomizer-assisted total abdominal hysterectomy (CATAH), a new technique for uterine removal in benign uterine pathologies. Materials and Methods: This study is a prospective cohort study conducted at a tertiary University hospital in Egypt. Eligible patients (n = 88) for total abdominal hysterectomy (TAH) were divided into two groups; the study group who underwent TAH by the CATAH technique and the control group who underwent TAH by the conventional technique. Demographic data, operative time, blood loss, and operative complications were recorded. Results: The mean operative time was significantly reduced (64.47 ± 3.60 min) in the study group than in the control group (86.42 ± 5.54 min, P < 0.001). The mean time for cervical removal was significantly less (8.60 ± 1.39 min) in the study group than (17.77 ± 2.62 min) in the control group (P < 0.001). The mean volume of blood loss was less (197.38 ± 39.42 ml) in the study group than in the control group (462.69 ± 167.96 ml). Complications were fewer in the study group than in the control group. Conclusion: The CATAH technique was feasible, quicker with less intraoperative and postoperative complications than the conventional technique for TAH in benign uterine pathologies.

Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. Background: IUD could be applied to the female after delivery of placenta during cesarean section, it had many advantages as the female is under anesthesia so no extra manipulation needed, decrease pain, and also the female at the period of delivery had high motive for family planning. Post placental IUD insertion also had many disengages like bleeding and displacement. Material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to May 31 2019. Two groups of patients were selected; each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion during cesarean section and group II was subjected to interval IUD insertion (3 months after cesarean delivery). The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 12 months was 13.72% in study group compared to 16.66% in the control group. The satisfaction rates in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 1.96% in study group and 4.17% in control group with p value = 0.949. Conclusion: Post-placental IUD insertion is found to be safe, easily applied during cesarean section with slight prolongation of cesarean section duration. Post-placental IUD insertion is also effective, with few complications compared to interval IUD insertion. This modality of insertion was accepted by the great majority of patients being painless and at the same time of surgery with no added cost or maneuver and utilizing the enthusiasm of patients for immediate contraception. The continuation rates are good in the study follow up duration.

Background: although cesarean delivery is a relatively simple procedure, it is associated with some long-term sequelae such as peritoneal adhesions that may result in infertility, chronic pelvic pain, or bowel obstruction. Objective: it was to evaluate the efficacy of laproscopic adhesiolysis for post caesarean adhesions evidenced by the pregnancy rates. Patients and Methods: this study was a single armed clinical trial study, which was done at Obstetrics and Gynecology Department of Tanta University Hospital in the period from October 2017 to March 2018. Fifty patients with secondary infertility after previous caesarean delivery were included. Three patients dropped off follow up. Results: pregnancy rate in studied patients, 22 (47%) patients got pregnant, while 25 (53%) patients had no pregnancy Conclusions: there is high incidence of pelvic adhesions in patients with an unexplained secondary infertility following a caesarean delivery, which is mainly periadenxial type. There is a significant increase in pregnancy rate after laproscopic adhesiolysis.

Objective To evaluate the benefits and risks of three-step technique as a conservative treatment for women with placenta accreta and desiring future fertility. Study design This study is a retrospective study where the files of 91 cases of placenta accreta managed by three-step technique were reviewed. This study was conducted at Tanta University Hospitals in the period from June 1, 2015 to May 31, 2017. All demographic and operative data were extracted and recorded. Results The mean age was 32.44 ± 2.72 years; the mean operative time was 81.65 ± 15.68 min. The mean gestational age at operation was 35.67 ± 1.19 weeks. The technique succeeded to preserve the uterus in 86 cases and failed in 5 cases. There was no cases required ICU admission with mean hospital stay of 3.065 ± 1.04 days. The postoperative morbidities were mild and in the form of fever (n = 9) and wound sepsis (n = 4), pyometra (n = 1) and secondary hemorrhage (n = 1). Conclusion The three-step procedure is effective as a uterine sparing technique in management of placenta accreta with success rate of 94.5%. The operative and postoperative complications were minimal and expected in such case.

Ayman Shehata Dawood,1 Adel Elgergawy,1 Ahmed Elhalwagy,1 Walid M Ataallah,1 Shereen B Elbohoty,1 Shereef L Elshwaikh,1 Amal A Elsokary,1 Ahmed M Elkhyat,1 Amr T Elbadry,2 Ahmed M Abbas3 1Department of Obstetrics & Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt; 3Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Objective: The current study aimed to evaluate the impact of mechanical cervical dilatation during elective cesarean section (CS) on postpartum scar integrity at 6 months post operation. Methods: A randomized double-blind clinical trial (UMIN000027946) was conducted at a tertiary university hospital in the period between July 1, 2017 and April 30, 2018. The study included pregnant women with a singleton fetus at term ≥37 weeks of gestation scheduled for elective CS. Eligible participants were allocated either to the study group (women with intraoperative cervical dilatation) or the control group (women with no intraoperative cervical dilatation). The patients were followed up at 6 months after CS by 3D ultrasonography to check for the scar integrity and quality. The primary outcome was the difference in sonographic parameters of the scar integrity between the two groups. Results: Four hundred twenty two women were approached to participate in the study. There was no statistically significant difference regarding the baseline characteristics of both the groups. Scar width and depth were significantly higher in the cervical dilatation group (P=0.002 and 0.001, respectively). Fewer cases with scar defects (niche) were found in the cervical dilatation group than in the control group (5.03% vs 11.04%, respectively, P=0.048). There was no significant difference regarding the rate of wound infection or endometritis in both the groups (P=0.717 and 0.227, respectively). The incidence of febrile morbidity was higher in the no cervical dilatation group (10.5%) compared to (5.0%) the cervical dilatation group (P=0.045). Conclusion: Cervical dilatation during elective CS is associated with thick scars with low incidence of scar defects. Keywords: cesarean section, cervical dilatation, cesarean scar defect, scar integrity

Objective: To compare maternal and neonatal outcomes of immediate versus delayed cord clamping in women with placenta accreta spectrum (PAS). Study Design: PAS-ID is an international retrospective multicenter database originating from 11 centers (9 countries), which included women with confirmed PAS between January 1st, 2010 and December 31st, 2019. Women were considered eligible to this study if diagnosis of PAS was confirmed, women were adequately followed ante- and postpartum. Women with intrauterine fetal death were excluded. Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Secondary outcomes include 1-minute, 5-minute APGAR scores, and admission to neonatal intensive care unit (NICU). Multivariable logistic regression was used for analysis and results were presented as adjusted odds ratios (aOR) and 95% confidence interval (CI). Results: Out of 797 women, 716 met our inclusion criteria. Of these women, 120 underwent delayed cord clamping (16.76%). After adjustment for potential confounders, delayed cord clamping was associated with lower risk of massive blood loss (aOR 0.26, 95% CI 0.11 – 0.63) and admission to NICU (aOR 0.45, 95% CI 0.29 - 0.87). It was not associated with lower risk of 1 minute APGAR < 7 (aOR 1.88, 95% CI 0.92 - 3.85) or 5-minute APGAR < 7 (aOR 0.67, 95% CI 0.21 - 2.10). Conclusion: Delayed cord clamping does not seem to increase risk of PAS-associated massive blood loss. However, maternal, and neonatal stability should be considered before a decision can be made. Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors have no conflicts of interest. Ethics Approval Statement: Ethical approval was obtained in each contributing center from their receptive institutional review board before the study was conducted. This includes Aswan University, Egypt (Ethics Committee on Feb 11th, 2020, reference N; Aswu/439/2/20), Inonu University (reference number: 2020/476, dated 3/3/2020), Yuzuncu yil University (reference number: 55163642-100-E.36909, dated 09/06/2020), and Ege University (reference number: 20-4.1 T/3, dated 14/4/2020) in Turkey, Fatima memorial hospital/College of Medicine, and Dentistry, Pakistan (reference number: FMH-03-2020-IRB747-M, dated 5/12/2020), Kazan State University, Russia (reference number: 1765, dated 30/6/2020), Centro Hospitalar Sao Joao, Portugal (reference number: 76/2020, dated 21/5/2020), National Taiwan University College of Medicine, Taiwan (reference number: 202003007RINC, dated 30/3/2020), Faculty of Medicine of University of Yaounde I, Cameroon (reference numbers: 1019/CIERSH/DM/2020, dated 25/2/2020). Both Peking University Shenzhen Hospital and Universitas Padjadjaran Bandung were waived for the minimal risk per their local hospital policies. All data were anonymized and authorized for use before submission for analysis.

This cross-sectional study was designed to evaluate the incidences and sites of pelvic adhesions in women with post-caesarean unexplained infertility. This study was conducted at the Tanta University Hospitals in the period from August 1 2015 to July 31 2016. The enrolled patients were assessed by a diagnostic laparoscopy for the presence and sites of abdominal and pelvic adhesions. Pelvic adhesions were found in 98 cases (73.13%) and the remaining 36 cases (26.87%) were free of adhesions. Adhesions were tubal in 55.10%, ovarian in 20.40%, combined tubo-ovarian and omental adhesions in 11.22%, uterine adhesions in 6.12% and a frozen pelvis was found in 7.14%. There was no correlation between the severity of the adhesions and the number of previous caesarean sections (CS). The data of this study led us to conclude that pelvic adhesions are common in patients with unexplained infertility following a caesarean delivery. Tubal and ovarian adhesions to the lateral pelvic wall represent a pathognomonic feature in post-caesarean infertility. Impact Statement What is already known on this subject? Adhesions following a caesarean delivery have been assessed by many studies at the time of the next caesarean delivery. These adhesions have not been studied well in the patients with unexplained infertility. What the results of this study add? The results of this study specify the incidences and the sites of the adhesions which are considered to be pathognomonic for caesarean section. What the implications are of these findings for clinical practice and/or further research? These findings should be applied when the cases of post-caesarean infertility are evaluated in order to shorten the duration and burdens of infertility.

The purpose of this paper is to review the current clinical uses of platelet-rich plasma (PRP) in the field of gynecology. All relevant articles published from January 2000 to December 2017 were reviewed and analyzed. The articles on PRP in the field of gynecology were mainly case series, pilot studies, or case reports. PRP is currently considered a new therapeutic modality for some disorders that are refractory to conventional drugs.

Objective: The objective of this study is to measure levels of Vitamin D3 and leptin and assess their relation of each to the pathogenesis of polycystic ovary syndrome (PCOS). Design: This was a cohort observational study. Settings: This study was conducted at the Department of Obstetrics and Gynecology, Tanta University. Materials and Methods: Ninety lean women were enrolled in this study and were allocated into two groups with 45 patients in each group: the first group (study group) who are lean women with PCOS and the second group (control group) who are the lean infertile patients without PCOS. Blood samples were collected and tested for study parameters. Results: There were no significant differences regarding demographic characteristics between both groups. The differences were in ovarian volume and hormonal profiles. Serum leptin was found to be significantly increased in lean PCOS than in control groups. Vitamin D3 levels were found to be lower in the lean PCOS group than in control group. Conclusion: Lean PCOS women are a unique group with specific hormonal profiles different from the typical PCOS profiles. Leptin and Vitamin D3 may have a role in the pathogenesis of lean PCOS, but large studies are still required regarding this unique group.

Objectives To evaluate results of laparoscopic adhesiolysis in patients with post cesarean infertility regards restoration of the fertility and achievement of pregnancy. To identify a group of patients who should primarily be offered laparoscopic adhesiolysis and those who should be treated by IVF. Design Randomized prospective clinical trial Materials and Methods 184 patients with secondary infertility diagnosed to have periadnexal and pelvic adhesions, were randomly allocated into two groups: group I (92 cases) treated by laparoscopic adhesiolysis and group II (92 cases) who treated for a year by controlled ovarian stimulation and IUI up to 3 trials. Diagnostic work-up of infertility was carried out denoting normal semen, patent both tubes at HSG, and ovulatory at ovulation testing with normal hormonal profile. The outcomes, cumulative pregnancy rates calculated for each group after one year. Results According to the adhesions, the patients classified into 4 groups: 8 cases inoperable, 43 cases with mild type adhesions, 26 cases with moderate type adhesions, and 5 cases with severe type adhesions. The patients followed up postoperatively for year. Overall pregnancy rate 54.35 %. For patients with mild adhesions 76.7%, for patients with moderate adhesions 61.5%, and for patients with severe adhesions 20%. Complications present in (1.57%), cost is (125.7-180.9 $). Over all pregnancy rate was 11.96% in group (II) Conclusions laparoscopic adhesiolysis is the method of choice for dealing with mild to moderate periadnexal adhesions after C.S. The pregnancy outcome after lysis of severe periadnexal adhesions is poor. So, such patients are best treated by IVF.

Objectives: To evaluate the efficacy, compliance, safety and economic cost for Fosfomycin trometamol and Nitofurantoin in uncomplicated lower urinary tract infections during pregnancy. Background: Nitofurantoin and Fosfomycin trometamol are recommended as the first-line agents for treatment of urinary tract infections (UTIs) in the latest guidelines endorsed by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). Fosfomycin is bactericidal and inhibits bacterial cell wall biogenesis and reduces bacterial adherence to uroepithelial cells. Fosfomycin has broad antibacterial activity against both Gram-positive and Gram-negative pathogens, as Escherichia coli, Escherichia faecalis, and various Gram-negatives like Citrobacter and Proteus. Both Nitofurantoin and Fosfomycin are category B in pregnancy. Patients and Methods: This study was conducted at Tanta University Hospitals in the period from June, 1, 2015 to January, 1, 2017. Patients were recruited from outpatient clinics of Obstetrics and Gynecology and Urology Departments presenting with asymptomatic bacteruria or cystitis. Patients were allocated randomly into 2 groups: group I (n = 50 cases) received Fosfomycin therapy and group II (n = 50 cases) received Nitofurantoin therapy (n = 50 cases). After treatment, evaluation of patient symptoms, organism count, patient compliance and cost of treatment were done. Results: The enrolled patients were suffering from lower urinary tract infections; asymptomatic bacteruria (17 cases) or cystitis (83 cases). Ten patients were excluded. The demographic data of included patients were not significant for both groups. Complete relief (100%) of symptoms 5 days after start of treatment was noticed in Fosfomycin group while improvement of symptoms after 5 day-treatment was noticed in 86.49% in Nitofurantoin group (p-value = 0.030). The side effects were recorded in 7 cases (18.42%) in Fosfomycin group compared to (35.14%) with significant difference in the reported side effects, (p-value = 0.003). Compliance was 38/38 (100%) in Fosfomycin group compared to 34/37 (91.89%) in Nitrofuantoin group (p-value = 0.001). Resistance was very minimal in Fosfomycin group where 1/38 case (2.63%) reported resistance for treatment compared to 8/37 cases (21.62%) in Nitofurantoin group (p-value = 0.001). Conclusion: Fosfomycin trometamine proved to be safe, effective, and has limited resistance. Moreover higher patient compliance and fewer side effects were recommending Fosfomycin to be a first choice drug for uncomplicated lower urinary tract infections during pregnancy at Tanta University.

Aim: To evaluate and compare the efficacy of methotrexate injection in management of persistent simple ovarian cyst versus the use of transvaginal ultrasound aspiration alone. Patients and Methods: This randomized controlled study was conducted at Tanta University Hospitals in the period from April 1, 2016 to October 31, 2016. Patients were randomly allocated into two groups; each group has 25 patients with benign persistent simple ovarian cyst. Group I: Patients were subjected to transvaginal aspiration of the cyst. Group II: patients were subjected to methotrexate injection inside the cyst. Patients in both group were followed up at 1, 3, 6 months after procedure for the recurrence and occurrence spontaneous pregnancy. Results: The mean age in group I was 28.8 years, and the mean age in group II was 26.52 years with non-significant difference. Also there was non-significant difference between both groups regarding size of the cyst. No case recorded to have a cyst recurrence in group II and four cases in group I within six months with significant difference (P value 0.037), and there was non-significant differences as regard the pregnancy rate and complications. Conclusion: Transvaginal intra-cystic methotrexate injection is a safe and effective choice for management of persistent simple benign ovarian cyst.

Objective: To evaluate the effect of nontense vaginal hydrocele in male partner with oligoasthenospermia on the success rates of the intracytoplasmic sperm injection (ICSI). Patients and Methods: Enrolled patients (n = 60) were divided into two groups: Group I who have oligoasthenospermia with nontense vaginal hydrocele (study group) and Group II who have oligoasthenospermia with no hydrocele group (control group). The primary outcomes included the fertilization and pregnancy rates whereas the secondary outcomes included any complications occurred. Results: There were no differences in demographic characteristics between both groups. Semen parameters were poorer in the hydrocele group than in the nonhydrocele group regarding count and motility (P < 0.001). The volume of testis was reduced significantly in the hydrocele group (P < 0.001). The results of ICSI regarding fertilization rate, number and quality of developed embryos, and pregnancy rates are not statistically different between both groups. Conclusion: Hydrocele affects both sperm count and motility, but it has no effects on ICSI outcomes. Clinical pregnancy rate was comparable in patients with or without hydrocele. Hence, the surgical management of hydrocele before ICSI is not recommended.

Background: Caesarean delivery (CD) rates in developing countries are rising beyond the recommended rates of World health organization. Objective of this study was to evaluate whether Dexamethasone injections reduce neonatal incubation admissions when given before scheduled caesarean delivery (CD) at term or not.Methods: A double blinded, two armed, randomized clinical trial was conducted at Tanta University hospitals in the period from October 2017 to March 2019. Four hundred pregnant women admitted for scheduled CD with gestational age ≥37 weeks were included. Patients were randomized into study group and control group. The study group was given 3 dexamethasone doses, 8 mg each while control group was given saline injections simultaneously as a placebo drug. The primary outcome was the neonatal incubatory admissions.Results: Demographic data in both groups were comparable. Transient tachypnea of newborn (TTN) was 15.47% in study group versus 20.33% in control group with p=0.227. The respiratory distress (RDS) in study group was 6.63% versus 9.89% in control group with p=0.260. The incubation admissions were nasal oxygen 12.71% versus 15.38%, continuous positive airway pressure ventilation (CPAP) 5.52% versus 8.24% and mechanical ventilation was 3.87% versus 6.59% in the study and control groups respectively.Conclusions: Although Dexamethasone administration before scheduled CD at term reduced both respiratory morbidity and incubation admissions, the differences between study and control groups were not significant.

Objective To describe the feasibility and effectiveness of a novel technique for Hysteroscopic sterilization using the distal ends of a copper-T intrauterine device (Ostialoc). Patient and methods A pilot study included 11 cases selected and informed about the technique at a tertiary University hospital. Through hysteroscopy, the knobs with the distal 1 cm of Copper-T intrauterine devices (Ostialoc) were inserted into the interstitial part of both fallopian tubes for the tubal block. Patients were evaluated two weeks later by plain X-ray and ultrasound to ensure nonexpulsion of the Ostialoc, then every month for three successive months. The patients were scheduled for HSG at 3 months and one year after the Ostialoc placement to evaluate tubal occlusion. Results The mean age of cases was 39.20 ± 4.09 years, mean parity was 4.48 ± 1.00, and the mean BMI was 28.92 ± 4.31 Kg/m2. The mean operative time was 22.24 ± 5.63 minutes. The technique was feasible in all cases. The postoperative complications were present in one case suffered from pelvic pain. HSG demonstrated complete block of both fallopian tubes after three months and at one year in 100% of the cases. Conclusion Hysteroscopic sterilization using Ostialoc technique seems to be a feasible and effective technique in low resources countries.

Objectives: To evaluate the efficacy of live bee stings at fertility points and acupuncture in treating symptoms and managing infertility in premature ovarian failure (POF) of autoimmune etiology. Patients and methods: Patients with primary POF were allocated randomly into two groups: group I: subjected to acupuncture at specific fertility points and group II: subjected to live bee stings at sites of fertility points. Results: A total of 24 cases show significant reduction of Follicle stimulating hormone (FSH) level to normal range with gradual decline over the study duration: 13 cases in group I and 11 cases in group II. Eight cases got pregnant while the other 13 cases regained normal menses but still infertile. Conclusions: Both bee sting therapy and acupuncture were effective in reduction of FSH levels with restoration of regular menstrual patterns and restoration of fertility. The bee sting therapy was superior in the pregnancy rate, while acupuncture was superior in alleviation of symptoms.

Objective To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology. Methods This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group). Results The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating hormone units required was 2,350.43±150.76 IU in group I and 2,366.25±140.34 IU in group II, which was not a significant difference (p=0.548). The duration of stimulation, number of retrieved oocytes, and number of developed embryos were not significantly different between the groups. The clinical and ongoing pregnancy rates likewise did not significantly differ. The cost of intracytoplasmic sperm injection per cycle was significantly lower in group I than in group II (US $494.66±4.079 vs. US $649.677±43.637). Conclusion Reduction of the cetrorelix dose in the antagonist protocol was not associated with any significant difference either in the number of oocytes retrieved or in the pregnancy rate. Moreover, it was more economically feasible for patients in a low-resource country.

Unintended pregnancy is not only a major health problem, but are also a great social and financial burden on societies and countries. There are about 75 million unwanted pregnancies per year according to WHO statistics. When abortions were included, unintended pregnancies increased to 2.65 million, or 49% of all pregnancies. Counseling prior contraception is a mandatory or a must to prevent these unintended pregnancies and their related risks. Unfortunately counseling is a deficient process in third world countries and usually made by young medical staffs or sometimes by paramedical personnel or not present at all. In this perspective, issues for deficient counseling and how patients select the method of contraception are addressed.

Background: Long Acting Reversible Contraceptives (LARC) had a very high efficacy in lowering unintended pregnancies and their poor health sequalae. Although their reported efficacy, these methods are not widely used among patient’s due to non-awareness and faulty concepts linked to these methods.Methods: This cross-sectional study was conducted to determine the degree of awareness, attitude and preference of LARC by attendants of Tanta University contraceptive clinic in the period from January 1, 2016 to December 31, 2016. All patients were counseled with thorough discussion about LARC methods. The following issues were determined: age, parity, mode of previous delivery, residence, medical diseases, socioeconomic state of family, type of LARC method used, how she know about this method and why she preferred that type.Results: 391 women underwent this study with age range of 21-46 years, and BMI range of 20.46-31.87. LARC were preferred by 72.38% of patients and mainly IUDS (52.94%) while other LARC methods were of very low awareness. Most patients take their knowledge from paramedical staffs (49.87%). Occupation, education, residence and religion were not affecting patients' attitude and preference of one LARC over the other methods. Age was the most effective factor for determining whether to use LARC or not. Counseling revert a lot of faulty concepts and misbelieves about LARC.Conclusions: LARC were not widespread among Tanta University attendants for contraception except for IUDs. Young patients had no motivations towards LARC due to a lot of faulty concepts that need a lot of work to be eradicated.

Hypothesis: bladder pain syndrome (BPS) presents by both urological and gynecological symptoms. The gynecological symptoms include chronic persistent pelvic pain, dyspareunia and decreased libido on the other hand urological symptoms include wide variety of symptoms as bladder discomfort, dysuria, frequency, and urgency. Although, the definition and diagnostic criteria for the condition was established, the pathogenesis, etiology and histologic findings of BPS are still not fully understood and diagnosis is made by exclusion. Review of published data including both gynecological and urological articles focusing on the updates in the diagnostic tests, pathology and the recent therapies. The searched words were bladder pain syndrome, interstitial cystitis and painful bladder. The free full text article found after our search were 454 articles after exclusion of deficient article not covering the whole subject, 91 articles were enough for this work to be completed. From this review, Bladder pain syndrome is still unclear disease lacking curative therapy up till now and patients are still suffering and the mixed complex symptoms put further challenge on both urologists and gynecologists to solve the problem.

This Retrospective observational study was done to determine the actual Caesarean Section rate at Tanta University Hospitals (a tertiary care hospital). Review of all deliveries that have been conducted at Tanta University Hospitals whether Vaginal or Caesarean Section in the period from January 1, 2013 to December 31, 2015 and detection of the most common causes of the Caesarean Section. The total number of deliveries was 3592, 3342, and 3320 in the years 2013, 2014 and 2015 respectively. The Rate of cesarean section was (1049/3592) 41% in 2013, (1004/23342) 45% in 2014, and (1057/3320) 46% in 2015. The CS rate was high at Tanta University Hospital, and there was slight increase in the rate through the period of study. The most common indication for cesarean section was previous cesarean section. The conclusion is that the rate of cesarean section was so high at Tanta University Hospital and much higher than WHO recommendation for developing countries. The rate of cesarean section showed minimal but continuous rise in the past three years.