Search

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.

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.

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.