Background: Episiotomy is the procedure that help to promote difficult vaginal deliveries to control and decrease dangerous perineal lacerations during normal labour. The aim of this study was to evaluate the effect of local injection of Autologous Platelet-Rich Plasma (PRP) Solution in healing of episiotomy wounds. Methods: Randomized controlled trial included 200 patients undergoing their first childbirth at Minia Maternity University Hospital and El-Fashn General Hospital between May 2021 and December 2021 randomized into either PRP (study) or control groups. In the study group, PRP solution was injected in subcutaneous tissue of wound while wounds were only cleaned with saline in the control group .Wound healing and pain were assessed using REEDA, VAS and VSS scores. Results: REEDA score was significantly lower in the PRP group compared to the control group at one, two and four weeks (1.5±0.49 vs. 1.85±0.7, 1.19±0.46 Vs. 1.65±0.5 and 1.65±0.5 vs. 1.65±0.5, respectively P=0.0001). Similar results were shown regarding VSS score in favour of PRP (1.13±0.57 vs. 1.62±0.75, 1.1±0.52 vs. 1.48±0.65 and 0.5±0.34 vs. 1.1±0.58, respectively, P =0.0001). Lower pain scores were achieved in the PRP group as compared to the control group; as evidenced by Vas scores (3.22±0.78 vs. 3.09±1.06, 2.18±0.49 vs. 2.45±0.66 and0.73±0.42 vs. 1.5±0.64, respectively, P = 0.001). Conclusion: PRP injection in episiotomy wounds is safe and may have a beneficial effect on wound healing and pain after vaginal delivery.

Background: Cesarean delivery (CD) is one of the most common surgeries performed throughout the world.Many surgical techniques exist to perform CD, but the most optimal technique to limit maternal morbidity is still subject to debate.One aspect of this debate relates to the method of uterine repair following delivery and its potential impact on maternal morbidity.Objective: To compare uterine exteriorization with in situ repair with duration of surgery and blood loss as primary outcome and postoperative or intraoperative complications of cesarean delivery as the secondary outcome. Patients and methods:The current study is a double-blinded randomized clinical trial was conducted at Beni-suef General Hospital between December 2019 and December 2020.This study was planned to be conducted on 200 pregnant females that were undergoing an elective cesarean section at full term.The patients were randomly allocated into two equal groups: Group 1: 100 women with in-situ repair of uterine incision.Group 2: 100 women with exteriorization of the uterus for repair of uterine incision.Results: Hemoglobin levels showed that the mean reduction in hemoglobin level was in the in-situ group more than the exteriorization group.As regard duration of the operation, exteriorization of the uterus had a significant less time than in-situ uterine repair.The occurrence of intra-operative nausea & vomiting increased markedly in the exteriorization group than in the in-situ group.Regarding post-operative pain, it was significantly more in the exteriorization group than in the in-situ group.There was no significant difference between in-situ and exteriorization groups regarding the post-operative febrile illness, wound complications, time of mobilization, time of return of bowel habits, time of oral intake and duration of hospital stay. Conclusion:Exteriorization of the uterus has less time consuming in the operation, decrease blood loss and decrease the post-operative drop in the hemoglobin level.On the other hand, in-situ uterine repair has much less post-operative complications (nausea, vomiting, pain and febrile illness) than the exteriorization group.

Background: We aimed to assess the efficacy of prenatal prophylactic maternal vitamin k administration in decreasing blood loss during and after elective cesarean section (CS) and its effects on neonatal outcomes. Methods: A clinical trial included 200 pregnant women planned for elective CS, were randomized into two equal groups. The study group included 100 women who received vitamin K (10 mg) intramuscularly once daily for three days before elective CS, while the control group included 100 women who did not have vitamin K before CS. Maternal PT, PC, APTT, and hematocrit were evaluated pre-and postoperatively. Maternal blood loss during CS was assessed by counting the soaked gauzes. Vitamin K levels in the umbilical cord, neonatal APGAR score, and the neonatal PT and PC were measured. Results: Postoperative PT and APTT of women in the vitamin K group were shorter than the control group (p<0.001). Also, women's postoperative PC and hematocrit in the vitamin K group were higher than that of the control group (p<0.001). Neonates who received vitamin K had significantly shorter PT, higher PC, and less bleeding than the control group (p<0.001). Cord blood vitamin K levels in the group who received vitamin K were considerably higher than in the controls (p<0.001). Conclusion: Administration of prophylactic vitamin K had a beneficial effect on maternal bleeding tendency but to somewhat added no value in neonates as both PT and PC values were within normal despite of significant differences in both groups.

Introduction: Premature membrane rupture (PROM) is generally characterized as membrane rupture at any point prior to the initiation of uterine contractions. PROM, which occurs before 37 weeks of gestation, is referred to as preterm premature membrane rupture (PPROM), while PROM, which occurs after 37 weeks of gestation, is referred to as the term premature membrane rupture. The latent phase is known as the duration of the rupture of the membranes until the onset of true labor. (1) Aim of the Work: This study was conducted to evaluate the maternal and perinatal outcome of PPROM (between 24 and 37 weeks) among pregnant women attending Minia University Maternity Hospital [MUMH]. Patients and Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Minia University Maternity Hospital (MUMH) during the period from march 2021 to august 2021 and after being approved by the local department ethical committee of MUMH. All patients diagnosed by PPROM during this study period were recruited into this study. Results: This prospective observational study was conducted in MUMH during the period from march to December 2021. 110 pregnant females presented with PPROM between 24 and 37weeks’ gestation were recruited in this study

The intrauterine device (IUD), being a reversible and effective contraception method, is the most widely used worldwide. This study aims to demonstrate the efficacy of IUD insertion during elective lower segment cesarean section (LSCS) versus its insertion six weeks postpartum. A cohort study was conducted on 200 women planned for elective cesarean delivery and desired IUD as a contraceptive method. They were allocated into two groups; group I, in which IUD was inserted during LSCS, and group II, in which IUD was inserted six weeks or more after LSCS. Both groups were compared regarding failed insertion, post-insertion pain, and uterine perforation. They were followed for one year for the incidence of menorrhagia, vaginal infection, IUD displacement/expulsion, missed threads, or unintended pregnancy. Women in the second group showed a significantly higher incidence of failed insertion and uterine perforation than women in the first group. On the contrary, women in the first group showed a significantly higher incidence of missed threads than women in the second group. Regarding other consequences, there were no significant differences between both groups concerning menorrhagia, vaginal infection, IUD displacement/expulsion, or unintended pregnancy. IUD insertion during elective LSCS showed a significantly lower incidence of failed insertion and uterine perforation than its insertion six weeks postoperative.

Abstract Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%. Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

To assess the efficacy of first‐trimester three‐dimensional (3D) placental volume as well as 3D power Doppler of placental vascular indices for early prediction of pre‐eclampsia.

BACKGROUND:This study aims to detect the effects of increased BMI on labor outcomes in primigravida pregnant women.METHODS:A cross-sectional study involved 600 full-term singleton primigravida pregnant women who presented in the active phase of labor to the labor ward. They were divided according to BMI into three equals groups; women with normal BMI (group I), overweight women (group II), and women with class I obesity (group III).RESULTS:We found that high BMI was associated with a significantly increased risk of Caesarean section (C.S.) (13% in group I, 18% in group II and 40% in group III). Women with higher BMI and delivered vaginally had a significantly prolonged first and second stage of labor, consequently increased the need for oxytocin augmentation as well as the oxytocin dose. Regarding the maternal and fetal outcomes, there are significantly increased risks of postpartum sepsis, perineal tears, wound infection, as well as significantly increased birth weight and longer neonatal stay in the neonatal unit (NNU).CONCLUSION:Obese primigravida pregnant women were at higher risk of suboptimal outcomes. Besides, prolonged first and second stages of labor and the incidence of C.S. have also been increased.

Background Endometriosis affects the responsiveness to ovarian stimulation. This study aimed to assess the role of Dienogest pretreatment for endometriosis suppression as compared to Gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis pursuing IVF treatment. Methods In this randomized controlled trial, 134 women with endometriosis-related infertility were randomly allocated to group A ( n = 67) who had monthly depot GnRHa for 3 months before ovarian stimulation in IVF treatment (Ultra-long protocol), and Group B ( n = 67) who had daily oral Dienogest 2 mg/d for 3 months before starting standard long protocol for IVF. The primary outcome measure was the number of oocytes retrieved. The secondary outcome measures included the number of mature oocytes, fertilization rate, quality of life assessed by FertiQoL scores, cost of treatment, and pregnancy outcomes. Results Although there was no statistically significant difference between both groups regarding ovarian stimulation, response parameters, and pregnancy outcomes, the Dienogest group had a lower cost of treatment (2773 vs. 3664 EGP, P < 0.001), lower side effects (29.9% vs. 59.7%, P < 0.001), higher FertiQoL treatment scores (33.2 vs. 25.1, P < 0.001) and higher tolerability scores (14.1 vs. 9.4, P < 0.001 < 0.001). Conclusion Our study indicates that Dienogest is a suitable and safe substitute for GnRHa pretreatment in endometriosis patients. Trial registration NCT04500743 “Retrospectively registered on August 5, 2020”.

BackgroundReducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services' coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR.This study aims to examine the contribution of the three delays in relation to maternal deaths.MethodsDuring a 10 year period (2008-2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model.ResultsFrom 2008 to 2017 MMR in this hospital was 186/100.000 live births. Most frequent causes of maternal mortality were postpartum hemorrhage, hypertensive disorders of pregnancy and sepsis.Third phase delay occurred in 184 deaths (88.9%), second phase delay was observed in 104 deaths (50%), always together with other phases of delay. First phase delay alone was observed in 13 deaths (6.3%) and in 82 deaths (40%) with other phases of delay. One fifth of the women had experienced all three phases of delay together. Major causes of third phase delay were delayed referral from district hospitals, non-availability of skilled staff, lack of blood transfusion facilities and shortage of drugs.ConclusionsThere is a paradigm shift from first and second phases of delay to the third phase of delay as a major contributor to maternal mortality. Reduction of maternal mortality can be achieved through improving logistics, infrastructure and health care providers' training.Trial registrationThis study is a retrospective study registered locally and approved by the ethical committee of the Department of Obstetrics and Gynaecology, Minia University Hospital on 1/4/2016 (Registration number: MUEOB0002).

The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15–16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69–10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS >  1 h (AOR 3.42; 95% CI =2.45–5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14–4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04–3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78–3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26–2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11–2.39; p = 0.021). The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.

Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n = 38) underwent cesarean hysterectomy, group (B), (n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place. The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling. Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

Controlling massive haemorrhage from morbidly adherent placenta (MAP) at caesarean section is a major surgical challenge to obstetricians. This study compares different intra-operative interventions to control haemorrhage from morbidly adherent placenta and its impact on maternal morbidity. Retrospective analysis was done for baseline characteristics, intra-operative and postoperative complications of 125 patients with morbidly adherent placenta who had elective CS at 35–38 weeks gestation in the period from 01/2012 to 01/2017. The included patients were categorized into three groups according to intra-operative interventions they had for controlling bleeding; Group A (n = 42) had only balloon tamponade, Group B (n = 40) had balloon tamponade and bilateral uterine artery ligation, in Group C (n = 43) all cases were managed by bilateral uterine artery ligation and inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment using the cervix as a natural tamponade. There were no differences of baseline characteristics of patients in all groups. Group C had significantly better outcomes as compared with groups A and B; less total blood loss (Group C 2869.5 ml vs Group B 4580 ml, Group A 4812 ml, P <  0.001), less requirement of blood transfusion more than 4 units (Group C 4/43, Group B 10/40,Group A 12/42, P <  0.02), significant reduction in prolonged hospital stay over 10 days (Group C 2/43, Group B 9/40,Group A 14/42, P < 0.001) and lower risk of coagulopathy (Group C 4/43, B 8/40, A 9/42), visceral injuries (Group C 4/43 vs B 8/40, A 10/42,P < 0.01) and need for hysterectomy (Group C 4/43 vs B 11/40, A 13/42,P < 0.001). A combination bilateral uterine artery ligation and using the cervix as a natural tamponade are very effective and simple methods in controlling bleeding resulting from separated placenta accreta. The findings are part of the research project registered in ClinicalTrials.gov NCT02590484 . Registered 28 October 2015.

Objective. The aim of the current study was to laparoscopically investigate the effects of peritoneal nonclosure on the sites, types, and degrees of adhesions developed after primary caesarean section (CS) in women complaining of secondary infertility after first CS delivery. Study Design. This was a cross-sectional study, where 250 women suffering from secondary infertility after their first CS had been recruited. They had been classified into group I (n = 89), where both the visceral and parietal peritoneum had been left opened; group II (n = 75), where only the parietal peritoneum had been closed; and group III (n = 86), where both peritoneal layers had been closed. Laparoscopy had been used to classify those adhesions according to the location, severity, and their adverse impact on the reproductive capacity. Results. Both adnexal and nonadnexal adhesions had been found significantly higher in group I, while adnexal types of adhesions were significantly higher after nonclosure of the visceral peritoneum in group II. Laparoscopic tubal surgery performed included tubo-ovariolysis, fimbrioplasty, and neosalpingostomy. Pregnancy rate was found correlating with the adnexal adhesion location and score. Conclusion. Nonclosure of the peritoneum in CS is associated with more adhesion formation, which might adversely affect the future women reproduction.

Background:To compare the effect of prophylactic trans-vaginal cervical Cerclage versus the conservative treatment in management of triplet pregnancies and also the effect of parity on gestational age and birth weight in triplet pregnancies.Patients and Methods: 40 women with triplet pregnancies were divided into 2 groups.Group 1 (20) received prophylactic cerclage.Group 2 (20) with no Cerclage [conservative management].Each group subdivided into two half ; half of the women were primi-para and the other half were multi-para (including unipara &multi-para), women with possibility of cervical insufficiency were excluded and pregnancy was followed in all women until delivery.Results: There was no significant difference between the both groups regarding the gestational age at time of delivery (31.45±4.68 in Cerclage group versus 32.65±4.01 in non Cerclage), the miscarriage rate (20% in Cerclage versus 15% in conservative management group) and time of delivery (35% delivered before 34 w, 35% between 34w and 36w, and 10% after 36w in cerclage group versus 35%, 40%, 10% in conservative management group respectively).There was no significant difference between both groups regarding the neonatal birth weight (1390±467.24 in cerclage group versus 1405±475.7 in conservation group) & NICU admission (90% in both groups).parity has effect on gestational age of delivery (75% of prime para delivered before 34 wks.20 % between 34-36 weeks and 5% after 36weeks while in multi para (35%,40%, and 10%) respectively.Conclusion: Prophylactic trans-vaginal cervical cerclage in triplet pregnancies regarding pregnancy prolongation and neonatal outcomes is similar to conservation.Parity has effect on pregnancy prolongation & consequently the neo-natal outcomes.

Background: Eclampsia is a major cause of maternal and neonatal morbidity and mortality in low and middle income countries. The aim of this study was to assess the risk factors and maternal and perinatal outcome in patients with eclampsia in order to get reliable data that helps in reducing the incidence and improving the outcome in an area with high incidence of eclampsia. Methods: Retrospective study including 250 patients diagnosed with eclampsia at Minia Maternity University Hopsital, Minia, Egypt in the period between January 2013 and December 2014. We analyzed the data obtained from medical records of these patients including patient characteristics, medical, obstetric, current pregnancy history, data on hospital admission, treatment given at hospital and maternal and perinatal outcome. Statistical analysis was done using SPSS version 21. Results: During the study period, 21690 women gave birth in the hospital; of which 250 cases of eclampsia were diagnosed (1.2%). Four women died (case fatality rate 1.6%). The main risk factors identified were young age, nulliparity, low level of education, poor ante-natal attendance and pre-existing medical problems. The most common complication was HELLP syndrome (15.6%). Magnesium sulphate therapy was given to all patients but there was lack of parenteral anti-hypertensive therapy. Forty six cases delivered vaginally (18.4%). Assisted delivery was performed in 22 (8.8%) cases and caesarean section in 177 (70.8%) cases; 151(60.4%) primary caesarean sections and 26 (10.4%) intra-partum. Perinatal deaths occurred in 11.9% on cases. Prematurity and poor neonatal services were the main cause. Conclusion: Morbidity and mortality from eclampsia are high in our setting. Improving ante-natal and emergency obstetric and neonatal care is mandatory to improve the outcome.

Objective: The aim of this work was to investigate the level of the serum level of tumor necrosis factor alpha (TNF-alpha) as an inflammatory biomarker in lean and obese women with polycystic ovary disease (PCOD), who are resistant to clomiphene citrate (CCR-PCOD). Patients and design: It is a case controlled study, where one hundred and fifty (n = 150) PCOD women (study group), who are resistant to clomiphene citrate (CCR-PCOD) had been recruited, in addition to one hundred (n = 100) women with PCOD, who are not resistant to clomiphene citrate (NCCR-PCOD) as the first control group, and another one hundred women (n = 100) fertile women with normal reproductive health, as the second control group. All the recruited subjects had been divided into subgroups according to the BMI: One obese group with BMI >= 27, and the second lean group with BMI < 27. TNF-alpha had been measured in all women groups recruited, in addition to the other essential, basic and PCOD relevant biochemical and hormonal tests. Results: TNF-alpha level was found to be higher in all PCOD women, either the study or control PCOD groups, than the fertile control group (49.93 +/- 3.39 vs. 35.83 +/- 2.47 pg/ml, P < 0.001). The level of TNF-alpha has come highest in the obese clomiphene citrate resistant PCOD women (obese CCR-PCOD), while the lowest has come in the lean PCOD women, who are not resistant to clomiphene citrate (NCCR-PCOD). Free Androgen Index (FAI) and androgenic obesity with higher W/H ratio were clearly going with TNF-alpha pattern, and have come higher in all PCOD compared to the fertile control group. Insulin Resistance (IR) shows a positive correlation with BMI regardless off PCOD status and androgen level as well. The level of other basic and PCOD relevant hormones like FSH, TSH, and prolactin have never shown statistically significant differences between all the study and control groups, except LH serum level which has shown a non significant higher level in all PCOD women included either resistant to CC or not. Conclusion: TNF-alpha serum level has come significantly higher in all women with PCOD, especially in those resistant to CC. Androgenic obesity with higher W/H ratio has shown a positive correlation with TNF-alpha level, which could consider it a good severity index of PCOD status, and an informative predictor of CCR before its use. (C) 2017 Middle East Fertility Society. Production and hosting by Elsevier B.V.

Objective: The aim of the current work was to investigate the effects of prolonged use of Statins on the clinical and biochemical abnormalities and ovulation dysfunction in young single women with polycystic ovary syndrome (PCOS).Patients and methods: It was a randomized, double-blind, placebo-controlled study. Where 200 single young women with PCOS were randomized into either 100 (n=100) women using Simvastatin 20mg daily considered as group A (study group), or 100 (n=100) women using placebo and considered as group B (control group), for six months treatment period. The main outcome measures were the changes in serum androgen levels (testosterone, androstendione and dehydro-epiandrostenion sulfate-DHEAS), LH, FSH, LH/FSH ratio and insulin resistance (IR), in addition to menstrual regularity, hirsutism, BMI and W/H ratio. Follow-up of spontaneous ovulation, confirmed with both trans-abdominal sonography (TAS) and luteal serum progesterone had been performed as well.Result(s): After 6 months' treatment, in group A serum testosterone showed decreased level by 28%, with significant decrease of LH (40%) and a decline of the LH/FSH ratio (43%). There was also a clear decrease of total cholesterol (26%), low-density lipoprotein (LDL; 39%) and triglycerides (23%). IR did not show a significant difference in the two groups. High-density lipoprotein (HDL) increased by 17%. Improved menstrual regularity and decreased hirsutism, acne, ovarian volume, BMI had been clearly noticed in the study group. Spontaneous ovulation had been confirmed songoraphically (TAS), and biochemically (progesterone >10ng) in 10 women (10%) in the study group compared to none in the control group.Conclusions: Long-term Statins' treatment was associated with clear improvement of all PCOS clinical and biochemical abnormalities, in addition to ovarian dysfunction as well.

Placenta previa and placenta accreta carry significant maternal and fetal morbidity and mortality. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections. The objective of this study was to evaluate the efficacy and safety of the use of the cervix as a natural tamponade in controlling postpartum hemorrhage caused by placenta previa and placenta previa accreta.