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Introduction: Third trimester bleeding is one of the majorobstetric emergencies, which contribute greatly to maternaland fetal morbidity and mortality. It is defined as bleeding from or into the genital tract prior to delivery of thebaby anytime from 20 weeks gestation, in some developedcountries or 24 weeks gestation, in others or 28 weeks incountries with low resource settings thus lacking adequateneonatal support incubators.The aim of this study: The study aimed to elucidate theoutcomes with the associated morbidities, which will help define the magnitude of the problem posed by antepartumhemorrhage in order to better the management measuresavailable to promptly tackle and alleviate this condition.Patients & Methods: This study was prospective observational study conducted in Department of Obstetrics andGynecology, Faculty of Medicine, Fayoum UniversityHospital and El-Sahel Teaching Hospital. All cases of antepartum hemorrhage admitted to emergency unit at maternity hospital after the age of 28 week of gestation during theperiod from (1st of August 2019 to end of November 2020)were included in this study, meeting the inclusion and exclusion criterion.Results: Total number of patients who were admitted toobstetric department with APH during the study period was120 case of them 25 cases were elective and all of themwere placenta previa cases and 95 cases were emergency.67 cases (55.83%) with placenta previa (25 elective and 42emergency) & 44 (36.636%) with accidental hemorrhage(all are emergency or urgent cases), 9 (7.5%) due to othercauses. Maternal outcome in PP include Increased numbersof CS 67 case (100%), Increased number of units of bloodtransfusion (1-18) unit with mean 4.31 ± 3.27, Hysterectomy 21 case (31.3 %), Shock 29 case (43.3 %), Urinary injury either bladder or ureteric injury 5 cases (7.5 %) (4cases bladder injury and 1 case Ureteric injury) all of themwere placenta percreta, ICU admission 14 case (20.9 %),postpartum hemorrhage occurred in 6 cases and maternalmortality one case (1.5%). While maternal out come in accidental hemorrhage patients was numbers of CS delivery was 35 cases and 9 cases delivered vaginally,number of units of blood transfusion (1-18)unit with mean 3.57 ± 3.08, Hysterectomy 3cases (6.8%), Shock 22 case (50%),Conclusion Previous CS was found to be the mostimportant risk factor for Placenta praeviaand accreta Pre-eclampsia& previous abruption were the most important risk factors forabruption. Fetal morbidities associated withboth placenta previa & abruption were prematurity, low birth weight, low Apgar score,admission to NICU.

To evaluate the efficacy and safety of preoperative duloxetine on postoperative pain management after gynecologic laparoscopic surgeries.A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus from inception to September 2021. We selected randomized clinical trials (RCTs) that compared preoperative duloxetine (intervention group) versus placebo (control group) among women undergoing gynecologic laparoscopic surgeries. Our primary outcomes were pain scores evaluated by the Visual Analog Scale (VAS) at 2, 6, 12, and 24 h postoperatively. Our secondary outcomes were the time required for the first analgesic request in minutes, postoperative analgesic consumption in milligrams, length of hospital stay in days, and side effects.Four RCTs with a total number of 244 patients were included in our systematic review and meta-analysis. We found duloxetine was linked to a significant reduction in VAS pain scores at different time intervals. The first analgesic request was significantly earlier in the placebo group than in the duloxetine group (p = 0.03). In addition, duloxetine significantly reduced the postoperative analgesic consumption compared to placebo (MD= -41.97, 95% CI [-53.23, -30.72], p0.001). However, both groups did not differ in the length of hospital stay and side effects.Duloxetine administration prior to gynecological laparoscopic surgeries is safe and effective in improving postoperative pain and analgesia.

Background: Hysterectomy is the most common major gynaecolog- ical surgery often performed for benign lesions.Many studies have reported adverse psychosocial outcomes post-hysterectomy. This study is to evaluate psychological wellbeing, and quality of life in patients undergoing hysterectomy for non-malignant conditions, in comparison with patientsundergoing surgery other than hysterecto- my. Methods: A comparativestudy was conducted on 90con- secutive out-patients who underwent hysterectomy for non-malignant indications at least 6 months ago. The comparison group comprised of 45 consecutive out-patients whounderwent gy- naecological surgery other than hysterectomy at least 6 months ago formed the comparison group. Thestudy participants were evaluated on , Psychological General Wellbeing Index (PGWBI), and Wom- en’s Quality of Life Questionnaire (WOMQOL). Results: No statistically significant different on socio-demographic characteristics such as patient age, marital status, social and education levels .There were no significant differences in the study groups on scores of PGWBI, and WOMQOL . Both the study groups had good marital adjustment andmajority reported no depression and anxiety. Conclusion: There is no major psychiatric morbidity, decline in mar- ital adjustment and quality of life afterhysterectomy for benign condi- tions among women at Aswan university hospital in upper Egypt.

Introduction: Hysterectomy is the removal of uterus and it is the commonest major surgical procedure performed in gynecology. It is the 2nd most common operative procedure performed on women in world after lower segment caesarean section(LSCS). Its incidence varies between 6.1 to 8.6 per 1000 women of all ages.Like all other major surgical procedures it is not free of complica- tions. There may be intra or post-operative complications. Rates of various complications vary from 0.05% to 43%.Methods: This study involved all women who underwent hysterec- tomy at Department of Obstetrics and GynaecologyAswan Univer- sity, Aswan, EgyptThis was a retrospective study and included all cases of hysterectomy from 1st Jan 2017 to 31st Dec 2017. Records from register and case sheets of patients were collected.Results: A total of hysterectomies 53 were performed in the study period. Out of these 7(13.2%) were obstetrical and 46(86.79%)were gynaecological. Out of 46 gynaecological hysterectomies were 5(10.86%) were vaginal hysterectomy and 41(89.13%) were abdomi- nal hysterectomy. Rupture uterus was most common cause represents 5 cases (71.42%) followed by abnormal placentation 2 cases (28.57%)indications for abdominal hysterectomy were 27 cases (65.85%) un- derwent hysterectomy as a consequence of abnormal uterine bleeding(AUB), and among them the most common was leiomyoma (fibroid uterus) 18 (66.6%) . and postmenopausal bleeding represents 14 cases(34.14%).Conclusion: Hysterectomy is a major surgery and it may be associ- ated with complications during and after surgery. Therefore, the indi- cation for hysterectomy should be carefully evaluated. Hence report- ing of all hysterectomies should be made mandatory so that the audit results can be used for improvement in the quality of health services.

Atonic post-partum haemorrhage (PPH) is one of the most challenging complications of normal delivery process. There are many maneuvers applied to the atonic uterus for controlling the blood loss and conserving the uterus from hysterectomy process. There are pharmacological and surgical methods to control the bleeding. In this study, we introduce the Mostafa Maged technique to prevent and control post-partum bleeding during vaginal delivery. It is so simple and not-costly method.

Background: Cesarean section (CS) is a life-saving surgery when certain complications occur during pregnancy and childbirth. The method of placental removing is one such procedure that can affect outcomes of cesarean delivery, such as the amount of bleeding during intraoperative and postoperative, the time of operation, the occurrence of postoperative endometritis, and may contribute to an increase or decrease in the incidence of CS. The objective of the study was to compare the manual removal of the placenta and spontaneous placental delivery at caesarean section.Methods: One hundred twenty sex consented to participate and divided randomly into two groups: Group A: included 63 pregnant women underwent elective caesarean section, the placental left in situ and the uterus massaged waiting spontaneous placental separation and Group B: included 63 pregnant women underwent elective caesarean section in which placenta was removed manually.Results: We found that women who had manual removal of the placenta lost significantly more blood than those who had spontaneous separation. A significant drop in hemoglobin was observed in manual separation group compared to spontaneous separation group. The median duration of placental delivery was shorter in manual separated group than spontaneously separated group. There was a statistically significant difference between both groups was found as regard the need for blood transfusion. There was a statistically significantly longer hospital stay with manual delivery of the placenta.Conclusions: Spontaneous separation of the placenta during cesarean section is more beneficial than manual separation.

Eye diseases during pregnancy can be classified according to the cause of disease as the disease can be pregnancy-induced or due to presence of pre-existing eye disorder or due to normal physiological changes with pregnancy. Here, we have a case of valsalva retinopathy which demonstrates a condition resulting from increase in the intra-abdominal and intra-thoracic pressures owing to multiple bearing-downs in normal labour due to bad management of the process of normal labour. Ophthalmologists plus obstetricians play great role in prevention and diagnosing valsalva retinopathy. Prevention could be managed through curbing the patient from straining and by proper management of normal labour so pregnancy is a risk factor for valsalva retinopathy.

Endometriosis is a common, chronic inflammatory disease defined by the presence of extrauterine endometrial tissue. The aetiology of endometriosis is complex and multifactorial, where several not fully confirmed theories describe its pathogenesis.The current literature suggests that stem cells, dysfunctional immune response, genetic predisposition, and aberrant peritoneal environment may all be involved in the establishment and propagation of endometriotic lesions. An orchestrated scientific and clinical effort is needed to consider all factors involved in the pathogenesis of this multifaceted disease and to propose novel therapeutic targets to reach effective treatments for this distressing condition.

Background: Uterine rupture (UR)is one of the most serious obstetrical emergencies necessitating prompt diagnosis and management, as it en-dangers the maternal and fetal life. Uterine rupture (scarred/ unscarred) may occur at any stage of pregnancy. In developed countries, with good antenatal care and good supervision during labour, (UR) has become rare except by dehiscence of a caesarean scar. The objective of present study was to find out risk factors, management, related complications and associated maternal and fetal outcomes with rupture uterus.Methods: A retrospective study, data files and the case notes was retrieved from the medical records department at Aswan university hospital from January 1 2013 to December 31 2013 in the form of data relating to the age, parity, gestational age, method of termination, perinatal outcomes, and related maternal complications.Results: There were 4284 deliveries during the period under review among them 5 cases of uterine rupture. Thus, the incidence of uterine rupture was 1.1/1000 deliveries.3 cases (60%) of them had no antenatal care at any hospital or primary care center. The risk factors in these cases are in majority 4 (80%) of cases uterine rupture occurred in women with previous scar, 1case (20%) of cases uterine rupture occurred in women with none scarred uterus. As regard surgical management 3 cases (60%) managed by hysterectomy and 2cases (40%) managed by repair. As regard maternal and fetal outcome all women required blood transfusion. Associated bladder rupture was repaired in two cases (40%). After excluding fetal wastage before the age of viability, perinatal mortality was 100% (5/5).Conclusions: Present retrospective analytical study has concluded that rupture uterus is a life-threatening complication. Proper antenatal and intrapartum care, identification of high risk factors, promotion of skilled attendance at birth and institutional delivery are key factors in reduction and early diagnosis.

Endometriosis is defined as the presence of endometrial-like tissue (glands and stroma) outside the uterus, which induces a chronic inflammatory reaction, scar tissue, and adhesions that may distort a woman’s pelvic anatomy. Endometriosis is primarily found in young women, but its occurrence is not related to ethnic or social group distinctions. Patients with endometriosis mainly complain of pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is a very common debilitating disease that occurs in 6 to 10% of the general female population; in women with pain, infertility, or both, the frequency is 35-50%. This is an evidence based narrative review conducted by searching Medline up to (2017) and other online articles from Pubmed, Google scholar by using terms like Endometriosis, management, evidence based, updated treatment, pharmacoceutical hormon treatment and non-hormonal treatment. Articles were selected based on their currency and relevance to the discussion. Numerous cofactors can play a role in the progression and maintenance of endometriosis, which is thus a complex multifactorial disease. Hormonal therapy represents the treatment of choice in patients with endometriosis; with this in mind, we could consider CAM a supplementary option to be added to hormonal treatment, or as a valuable opportunity for those women in whom medical therapy is contraindicated.