Objective: To evaluate Plavix impact on the perfusion of the uterine artery compared to low dose aspirin in women with unexplained recurrent miscarriage Patients and Methods: It was a prospective case control study that was carried out at Ain Shams University Maternity Hospital and included women who were presented to the outpatient clinic hospital department due to unexplained recurrent miscarriage. This study was performed over a 2-year period, between January 2014 and January 2016. 105 patients were recruited and divided into two arms. Group I (plavix group) included 50 women who had a history of recurrent miscarriage and received plavix (75 mg) for 3 successive months, while group II (low dose aspirin group) included 55 women who had previously early pregnancy loss and received low dose aspirin (75 mg) for 3 successive months. After ultrasound examination had done, endometrial pattern and thickness, uterine artery resistance and pulsatility indices were measured.

Objective: To assess the response and evolution of vaginal intraepithelial neoplasia (VAIN) after CO2 laser treatment. Material and Methods: A retrospective study was conducted from a database of 139 women who had VAIN and were referred for treatment with CO2 laser. The lesions were detected following a hysterectomy. Human papillomavirus (HPV) typification was performed in all cases. The diagnosis of the lesions was performed by liquid based cytology and the location was by colposcopic study. Treatment with CO2 laser was performed in continuous mode. In the statistical study were assessed: age, diagnosis before hysterectomy, diagnosis before the laser treatment, the characteristics of the lesions and HPV genomic.

Objective: This study was done to evaluate the maternal morbidities and perinatal outcomes of delivery in women with preterm pre-labor rupture of the membranes who delivered before and after 34 week along a period of five years in Al-Arish General Hospital. Methods:This retrospective study involved pregnant women with a singleton pregnancy who suffered from preterm pre-labor rupture of the membranes. Maternal morbidities included chorioamnionitis and febrile reaction, umbilical cord prolapse, and puerperal pyrexia, while, neonatal outcomes comprised neonatal intensive care unit (NICU) admission as in case of neonatal sepsis or respiratory distress syndrome, neonatal jaundice, or eventual mortality. Results: A total of 443 eligible women were involved. The mean age of included women was 23.11 ± 3.8 years (range: 18 – 38 years). The mean gestational age at delivery was 23.17 ± .2 weeks (range: 21 – 36 weeks). The included women were divided into 2 groups: group I n=232) including women who delivered at < 34 weeks of gestation; and group II (n=211) including women who delivered at = 34 weeks of gestation. The rate of chorioamnionitis was significantly higher in women of group II [21 (9.95%) vs. 11 (4.74%), respectively, p=0.023].The rate of NICU admission for neonatal sepsis was significantly higher in women of group II [32 (15.2%) vs. 19 (8.2%)), respectively, p=0.018].

Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown. Hyper insulinemia ascribed to PCOS and insulin resistance (IR) seem to be a contributing factor to RPL. The aim of this study was to assess the relationship between serum homocysteine level and insulin resistance in PCOS women with a history of send trimester recurrent pregnancy loss. The present study was carried out on 100 non-pregnant women in the reproductive period; their age ranged from 20 to 35 years. They were classified under two groups: Group 1: women having a history of second trimester recurrent pregnancy loss with PCOs (60 women). Group 2: women having a history of second trimester recurrent pregnancy loss and non-PCOs (40 women). We assessed plasma insulin and homocysteine (Hcy) levels in all cases. In addition, insulin resistance was determined using homeostasis model assessment (HOMA2-IR). The results: We found that homocysteine and insulin resistance are higher in PCOS women with recurrent pregnancy loss than non PCOS women. Conclusion: We conclude that that women with PCOS having a history of recurrent pregnancy loss had a higher serum level of homocysteine and a higher score of HOMA2-IR women without PCOS.

Rudimentary horn pregnancy (RHP) as a rare incidence has been estimated at 1:76,000- 1:150,000 pregnancies. It has been also reported that 80-90% of RHP lead to uterine rupture in second trimester. Early diagnosis with the use of 3-dimentional ultrasonography (3-DUS) that is followed by laparoscopic resection of RH and ipsilateral fallopian tube is likely to be considered as the best management strategy that prevents maternal morbidity and mortality. We present a case of 9-week pregnancy in a non-communicating rudimentary horn with positive fetal heart rate (FHR) that was diagnosed by 3-DUS and successfully treated with laparoscopic resection.

Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of supraphysiologic ovarian stimulation but infrequently has been described in spontaneous pregnancy. Aim: To present a case of a woman in spontaneous pregnancy complicated by OHSS. Results: A 32-year-old gravida 1, para 1 with spontaneous conception, was diagnosed with moderate OHSS at the 11th week of gestation and was managed conservatively. The woman delivered vaginally at term a health female infant. Conclusion: Although the ovarian hyper stimulation syndrome is characteristic for patients undergoing ovarian stimulation or assisted reproductive technologies it may also occur in spontaneous pregnancy. Multidisciplinary approach has to be taken in managing of those patients.

Objective: To explore the role of estimating endometrial volume by Virtual Organ Computer-aided Analysis (VOCAL) and it’s correlation with endometrial thickness, on the day of hCG, in prediction of IVF/ICSI success. Patients and Methods: It was a prospective study that was carried out at Al-Amin Maternity Hospital, Saudi Arabia. Endometrial thickness and volume were measured in women undergoing an IVF/ICSI cycle, on the day of HCG, using the 3D trans vaginal ultrasound probe. Women were divided as regards to endometrial volume calculated into 3 subgroups; < 3 ml, 3-5 ml, and >5 ml, also according to endometrial thickness into 3 groups; <7 mm, 7-12 mm and >12 mm. Success rate of IVF/ICSI was compared between all groups.

Objectives: To assess the accuracy of 5D automated measurement of long bones, three dimensional VOCAL measurement of fetal thigh volume in prediction of fetal weight in comparison to the conventional two dimensional Hadlock formulas. Methods: This prospective study was conducted at Ain shams university maternity hospital. Forty four pregnant women with singleton pregnancy at 37 to 41 weeks of gestation admitted for planned delivery within 48 hours were enrolled. All patients were examined by 2D, 3D VOCAL and 5D long bones for the purpose of estimating the fetal weight. Each technique was performed by the same examiner for all the patients who were blinded to the results of the two other techniques. Results were compared to actual birth weights using a unified weight scale. The accuracy, precision and agreement between the three types of ultrasound were calculated as well the time needed to perform each technique.

Objective: To explore the validity of hysteroscopy in detection of uterine cavity abnormalities in women with recurrent pregnancy loss. Patients and Methods: This was a prospective study performed at Ain Shams University Maternity Hospital, over a 3-year period, between Jan 2013 and Jan 2016, and included 200 women who were presented for evaluation of the cause of repeated early pregnancy loss and scheduled for hysteroscopy for assessment of any uterine cavity abnormality. Participant ages ranged from 18 to 35 years. A written informed consent was obtained from all women before participation. Results: the mean age was 29.5 ± 3.5, the mean number of previous abortion 4.1 ± 1.1, the mean number of 1st trimesteric abortion was 2 with range and the mean number of 2nd trimesteric abortion was 2. In this study, 81 % of patients were nullipara. It was also found that hysteroscopic findings were found in 41.5%. Uterine anomalies was present in 14%, including septate uterus and intrauterine adhesion (IUAs) were present in 11 %. Endometrial polyps were present in 3.5%, bicornute uterus in 3.5%, unicornuate uterus in 3.5% while submucous myomas were present in 6.5%. It was found that 17% need hysterscopic intervention including 7.5% need septectomy 4.5% need adhesiolysis, 2.5% need myomectomy while 2.5% need polypectomy.

Introduction: Tubal dysfunction is diagnosed as an underlying cause of infertility in more than one third of cases. Laparoscopy dye is the gold standard procedure to detect tubal patency, but hysterosalpingography (HSG) and hystero-contrast-sonography (HyCoSy) is also used. Office hysteroscopy guided selective chromopertubation (OHSC-SPT) is a less invasive and reproducible method, which can be performed in an outpatient setting without anesthesia, therefore it can be carried out as an outpatient procedure. Method: For the examination an office hysteroscope is used. A 1.7 mm diameter flexible plastic catheter is inserted through an inbuilt channel of the sheath. Normal saline is used for distention. The hysteroscope is introduced without grasping or dilatation of the cervix. First, diagnostic hysteroscopy is performed, then the catheter is inserted through the working channel and the tip of it is placed into the tubal orifice, through which methylene blue dye is injected slowly. If the tube is patent the blue dye does not appear in the uterine cavity and the normal color of the endometrium is seen. In case of tubal occlusion the distention media of the uterine cavity turns blue, due to the back-flow of the methylene blue.

Objective: To assess the effect of high level of circulating antimullerian hormone on the outcome of gonadotrophin ovulation induction in women with polycystic ovarian syndrome. Patients and Methods: This was a prospective study performed at Ain Shams University Maternity Hospital, over a 3-year period, between Jan 2013 and Jan 2016, and included 300 women who were presented at the infertility clinic and scheduled for having gonadotrophin ovulation induction. Participant ages ranged from 18 to 35 years, the patients were divided into two equal groups; group I (N=150) included women with PCOS having antimullerian hormone < 7.7 mg/dl and group II (N=150) which included women with PCOS with antimullerian hormone = 7.7 mg/dl. The two groups underwent gonadotrophin stimulation of the ovary, serum AMH concentrations were measured on cycle day 3 before the commencement of gonadotrophins ovarian induction. Ovarian response and the biochemical and clinical pregnancy rates were analyzed in both groups.

A 72 year old lady attended for elective administration of intravesical Botulinum A toxin (Botox 200iu) injections, as a daycase procedure, for the treatment of detrusor over activity. The procedure was undertaking without any complications. A few hours after the operation the patient developed severe constant generalized abdominal pain and distension. There were no other associated features. She underwent a computerized tomography (CT) scan of her abdomen and pelvis which was normal, followed by a Cystogram which was also normal. The only abnormal finding was that of an elevated CRP (380 mg/L). She was treated empirically with intravenous Cefuroxime and Metronidazole for twenty-four hours. Her symptoms slowly resolved and she was discharged home on the 3rd post-operative day with oral antibiotics. She experienced no further complications. Although the exact cause of her symptoms was not found, the timing of this complication means it is highly probable to be due to the intravesical Botox injection. Given the above findings, the most likely diagnosis is that chemical peritonitis. This has not previously been reported in the literature as a side effect of intravesical Botox.

Objective: To explore the level of apolipoprotein A1 expression in human endometrial tissues in women with polycystic ovary syndrome compared to fertile women. Patients and Methods: This was a cross sectional study performed at Ain Shams University Maternity Hospital, over a 2-year period, between Jan 2014 and Jan 2016, and included 80 women divided into two groups. Group I (n=40) with polycystic ovary syndrome who were presented at the infertility clinic and group II (n=40) fertile women who were presented due to any cause other than infertility as a control group. All women were scheduled for endometrial sampling by Endosampler. Participant ages ranged from 20 to 35 years. A written informed consent was obtained from all women before participation. Endometrial apolipoprotein A1 was investigated using ELIZA. Samples were obtained from all patients in the proliferative phase (just before ovulation when the dominant follicle is 20 mm) and secretory phase (5 days after the 1st sample).

Introduction: Tuberculosis affects about a third of world population. Genitourinary tuberculosis is one of the most common manifestations of extra pulmonary tuberculosis. Postmenopausal tubercular endometritis is an uncommon condition that usually occurs with abnormal vaginal bleeding. Aim: The aim of the paper is to report a rare case of asymptomatic postmenopausal tubercular endometritis. Case report: Trans-abdominal and trans-vaginal ultrasound performed in a 59 years-old Romanian asymptomatic woman showed a huge hypo-echoic area centrally located in the uterine shape and a severe endometrial hypo-echoic thickness ( > 2 cm). Color Doppler did not detect any vascularity into this area. Magnetic Resonance Imaging (MRI) of the lower abdomen confirmed the severe endometrial thickness. The histopathological diagnosis obtained by biopsy during hysteroscopy documented tubercular endometritis. The patient started a medical treatment for tuberculosis. Forty days later a control ultrasound showed the fluidization of the caseous material in the uterine cavity. Discussion: The main localizations of genitourinary tuberculosis are primarily the fallopian tubes, then it spreads towards endometrium, cervix, vagina and ovaries. In post-menopausal age patients with tubercular endometritis usually present with a story of vaginal bleeding; however, patients may be asymptomatic or they may present aspecific symptoms. This usually leads to a delay in diagnosis and therapeutical interventions. Conclusions: Tubercular endometritis is a severe disease that may affect both pre- and postmenopausal woman. Symptoms could be absent or aspecific. Diagnosis is not simple and it often needs laparoscopy, laparotomy or hysteroscopy. Histology is needful for the correct diagnosis. A standard medical anti-tubercular therapy of 6 months is often sufficient to obtain a complete therapeutical response. In some selected cases surgery may be necessary. In our paper, an asymptomatic woman in post-menopausal age, affected by endometrial tuberculosis showed clinical response after a standard antitubercular medical therapy.

Objective: One of the major causes of carcinogenesis is loss of genome stability. The double strand break DNA repair pathway, including X-ray repair cross complementing group 2 (XRCC2) gene, is implicated in maintenance integrity of genome and therefore could affect endometrial cancer (EC) risk. The purpose of this study was to evaluate the clinical significance of the XRCC2 4234G/C (rs3218384) gene single nucleotide polymorphism (SNP) in endometrial cancer patients.

Background: primary ectopic pregnancy (EP), with 0.001-0.013% incidence rate, is a very scarce obstetrical condition. Among EPs Ovarian EP is more rarely seen? Case: We present a case of ovarian EP following In vitro fertilization in a patient with history of endometriosis and curettage. With a primary diagnosis of tubal EP, the patient underwent laparoscopy, during which ovarian pregnancy was revealed. This was later confirmed with pathological review of the specimen. Conclusion: Ovarian EP constitutes 3% of all EPs. Diagnosis of this condition is extremely hard before surgery; therefore, laparoscopy is considered a reliable means of diagnosis. Moreover, women conceiving with IVF-embryo transfer have a higher risk of EP.

Background: Pseudo membranous colitis is a rarely reported condition in obstetrics. The clinical presentation varies from a self-limiting diarrhea to a severe pseudo membranous colitis with toxic megacolon and subsequent death. The process of this disease is mainly associated with prior antibiotic intake. Case presentation: A 32 year-old, G4L4RIV woman was admitted 3 days after her delivery with severe diffuse abdominal pain and distention. The patient had intravenously cefazolin after cord clamping. The colonoscopy showed pseudo membranous colitis. She was managed conservatively and after 12 days of medical treatment the patients was discharged in a good condition. Conclusion: In the patients with low grade fever, abdominal distention and diarrhea after delivery, pseudo membranous colitis should be considered a possible diagnosis in order initiate the treatment as soon as possible.

Introduction: Fetomaternal haemorrhage (FMH) refers to the passage of fetal erythrocytes to the maternal circulation. In most pregnancies, small amounts of fetal erythrocytes can cross over to the maternal circulation without causing problems for the fetus. In rare occasions, the FMH can result in fetal anaemia or in fetal death. Case report: Here, we present a case where a 30-year-old, II gravida, I para, in gestational week 35 reported decreased fetal movements, leading to the diagnosis of severe FMH. The fetal haemorrhage calculated by Kleihauer-Betke test was estimated to 287 mL, causing a mixed-field in the mother’s ABO typing, as the mother and the baby had different blood types. Fetal anaemia was suspected and diagnosed by Doppler ultrasound, and emergency caesarean section was performed, saving the baby’s life. Discussion: Severe FMH is very rare, and may present as decreased fetal movements, together with sinusoidal fetal heart rate pattern. This condition requires rapid intervention such as intrauterine transfusions or emergency caesarean section. Assessment of fetal anaemia by Doppler ultrasound should be considered in mothers reporting decreased fetal movements.

Objective: The aim of this study was to evaluate the potential predictive value of day-3 serum estradiol for follicle growth, ovulation, and pregnancy rate in women with premature ovarian insufficiency. Patients and Methods: This was a retrospective study which was carried out in International Fertility Centre Kingdom Saudi Arabia. The study included 80 consented women with desired fertility who were treated and monitored between the years of 2013-2016 into this study. The clinical, endocrinologic, chromosomal, and immunologic characters of these women were gathered. The main outcome values were follicle growth, ovulation, and pregnancy rate. Results: In the current study, it was found that women with follicle growth, ovulation, and pregnancy rates were not significantly different as a function of parity, iatrogenic history, age of disease onset, follicle stimulating hormone (FSH) level at the time of diagnosis. The serum E2 levels on days 3 of withdrawal bleeding (Day 3 E2) were significantly higher in the cycles with successful follicle growth and ovulation than unsuccessful cycles (P < 0.05). Receiver-operator characteristic curve (ROC) analysis revealed the cutoff value of the Day 3 E2 to be 25 pg/mL for follicular growth, ovulation and spontaneous pregnancy. Conclusion: In this study we found that those cycles with a Day 1-5 E2 = 25 pg/mL have a higher rate of follicle growth and ovulation in patients with POI.

Objective: The primary goal of this study was to compare the ovulation and pregnancy rates in women with unexplained infertility undergoing intrauterine insemination utilizing an antagonist (cetrolix) protocol versus the commonly used clomiphene citrate regimen. Patients and Methods: This was a randomized controlled study performed at Assisted Reproductive Techniques Center of Ain Shams University Maternity Hospital, over a 2-year period, between Jan 2014 and Jan 2016, and included 80 women,with unexplained infertility undergoing intrauterine insemination (IUI), were randomised into two groups. Group I (n=40) received the antagonist protocol: human menopausal gonadotropins were given from Day 2 to reach a dominant follicle of 18-22 mm, intramuscularly. Then, cetrolix ( 0.25 mg) was subcutaneously started from Day 6 or Day 7 until the day of human chorionic gonadotropins (hCG; that was given in the dose of 10,000 IU, intramuscularly) when follicles reached 18-22 mm. Group II (n=40) receivd the clomiphene citrate protocol: clomiphene citrate given 100 mg/d from Day 2 to Day 6 and then human menopausal gonadotropin (hMG) to reach a dominant follicle of 18-22 mm, intramuscularly. Follow up until day of hCG, afterward, the IUI of 0.5mL was done from 34 hours to 36 hours using IUI catheter without guidance of ultrasonography and with an empty urinary bladder. The primary outcome was clinical pregnancy rate defined as the presence of intrauterine gestational sac detected by ultrasound at 5-weeks’ gestation . The number of dominant follicles, level of serum estradiol, and luteinizing hormone at the day of hCG injection and the incidence of twin or triplet pregnancies in both groups were secondary outcome measures.

vv Journal of Gynecological Research and Obstetrics CC By 078 Citation: Ozay OE, Ozay AC, Acar B, Koyuncuoglu M, Comlekci A (2016) Follicular Variant of Papillary Thyroid Carcinoma Arising in a Matu re Cystic Teratoma of the Ovary. J Gynecol Res Obstet 2(1): 078-080. DOI: http://dx.doi.org/10.17352/jgro.000026 Clinical Group http://dx.doi.org/10.17352/jgro.000026 DOI Abstract Mature cystic teratomas form approximately 20% of all ovarian tumours. Of these, approximately 15% include benign thyroid tissue. When thyroid tissue comprises more than 50% of the ovarian teratoma, it is termed ‘‘struma ovarii’’. The exact incidence of malignancy in struma ovarii is hard to evaluate, because of its uncommon nature. The aim of this study is to report a rare case of follicular variant of papillary thyroid carcinoma arising in mature cystic teratoma of the right ovary. A 43-year-old premenopausal female, gravida 3, para 2 was admitted to Dokuz Eylul University Hospital with an incidental ultrasonographic fi nding of a complex solid echogenic right ovarian mass during her annual gynecological examination. The preoperative diagnosis was dermoid cyst. The patient underwent laparoscopic surgery. At exploration, the left ovary, the left fallopian tube, and the uterus were normal. The right ovary was enlarged, white and smooth ovarian semisolid mass was noted. Histopathologic evalutation revealed a tumor of follicular variant of papillary thyroid carcinoma arising in a mature cystic teratoma. The case was discussed at the multidisciplinary oncology meeting. Postoperatively, the thyroid function tests, thyroid gland sonogram were requested. The results were normal. A total body scanning with I 131 was done. The test revealed no residual intrabdominal/pelvic carcinoma. Total abdominal hysterectomy, bilateral salpingo- oophorectomy, peritoneal washings, bilateral pelvic-paraaortic lymphadenectomy, partial omentectomy and peritoneal biopsies were performed. In conclusion, the treatment modalities for malignancy in struma ovarii or mature cystic teratoma depend on the stage of the disease and fertility desire.