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Mohamed Ibrahem Eid,1 Mohamed Sayed Abdelhafez,1 Waleed El-refaie,2 Ahmed A El-Zayadi,1 Khaled Samir,1 Mahmoud Mohamed Abdelrazik,1 Mahmoud Thabet,1 Alaa Wageh,1 Emad Ahmed Fyala,1 Yasser Abdeldayem,1 Ahmed Badawy1 1Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt; 2Department of Obstetrics and Gynecology, Port Said University, Port Said, Egypt Objective: We aimed to evaluate the effect of different timing of initiation of low-molecular- weight heparin (LMWH) administration on the pregnancy outcomes in women with antiphospholipid syndrome (APS). Materials and methods: A randomized controlled study was conducted on women with obstetrical APS. All participants were randomly divided at documentation of positive pregnancy test into two groups; early initiation group in which LMWH therapy was started once positive pregnancy test was established (in the fifth week of gestation), and later initiation group in which LMWH therapy was started after sonographic confirmation of fetal cardiac pulsation (in the seventh week of gestation). In both groups, LMWH (enoxaparin) was given at a dose of 40 mg/day subcutaneously and the therapy continued until end of pregnancy. The primary outcome measure was ongoing pregnancy rate and the secondary outcome measures were fetal loss, live birth rate, preterm labor before 34 weeks of gestation, intrauterine growth restriction (IUGR), and congenital fetal malformations. Results: Ninety-four women (48 in the early initiation group and 46 in the later initiation group) were subjected to final analysis. The ongoing pregnancy rate was significantly higher in the early initiation group than in the later initiation group (81.2% vs 60.9%; P=0.040). However, both groups were similar in the incidences of fetal loss, preterm labor before 34 weeks of gestation, and IUGR, and live birth rate. No recorded congenital fetal malformations in both groups. Conclusion: Early administration of LMWH for pregnant women with obstetrical APS reduces early pregnancy loss, but does not affect the incidence of late obstetrical complications. Keywords: APS, LMWH, fetal loss

Objective: To evaluate the value of myomectomy during delivery by cesarean section (CS) in pregnant women with uterine fibroids., Methods: Retrospective cohort study of pregnant women diagnosed to have uterine fibroids during index pregnancy. Women who underwent myomectomy during CS (study group; n = 91) were compared with women in whom myomectomy was not performed during CS (control group; n = 87)., Results: No significant difference between both groups in the amount of blood transfusion and postoperative hemoglobin level. The operative time was significantly higher in the myomectomy group than in the control group (80.22 ± 13.06 vs 56.67 ± 8.85 min; P <  0.001). Also, the postoperative hospital stay period was significantly higher in the myomectomy group (P <  0.001)., Conclusion: Myomectomy during CS can be performed safely without increase in the peripartum maternal morbidities. It only may prolong the operative time and postoperative hospital stay period but it may have many benefits including avoiding another operation to remove fibroids., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the value of vaginal progesterone therapy for reduction of preterm labor in asymptomatic women with twin pregnancies and sonographic short cervix., Methods: This randomized controlled study was conducted in Mansoura University Hospital and private practice settings in Mansoura, Egypt. Of 322 women with dichorionic twin pregnancy, 250 asymptomatic women with cervical length of 20-25 mm at 20-24 weeks of gestation were included in the study. All women were randomly divided into two groups; the study group (n = 125) received vaginal progesterone suppositories in a dose of 400 mg daily starting at 20-24 weeks of gestation while the control group (n = 125) received no treatment. The primary outcome measure was preterm labor before 34 weeks of gestation and the secondary outcome measures were neonatal respiratory distress syndrome (RDS) and early neonatal death (END)., Results: 224 women (116 in the study group and 108 in the control group) were subjected to final analysis. The duration of pregnancy was significantly longer in the study group and the incidence of preterm labor before 34 and 32 weeks of gestation was significantly lower in the study group. The neonatal morbidities and mortality were significantly lower in the study group as shown by lower incidence of very low (<1500 gm) birth weight, neonatal RDS, the need for mechanical ventilation and END., Conclusions: Vaginal progesterone administration in asymptomatic twin pregnancies with sonographic short cervix (20-25 mm) at 20-24 weeks of gestation is effective and safe treatment for reducing the incidence of preterm labor with subsequent reduction in the neonatal morbidities and mortality associated with preterm birth.