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Objectives: The aim of this study is to assess the effectiveness and acceptability of using vaginal misoprostol for management of first trimester spontaneous incomplete abortion as an alternative to direct vaginal surgical evacuation in our setting. Methods: This is a prospective comparative study performed on 147 patients with first trimester incomplete abortion between 8 and 12 weeks requesting medical management. They were divided into two groups according to patients’ choice; group (I) received misoprostol tablet 400 mcg (Cytotec, Serono) every 4 h for a maximum of three doses while group (II) underwent surgical vaginal evacuation directly under general anesthesia. Only 54 patients in group I and 51 patients in group II completed their follow up and included in the analysis. Results: Although vaginal surgical evacuation was successful in solving the problem in 100% of cases, misoprostol was successful in 79.6% (p= 0.0006). The overall satisfaction was slightly higher in the surgical group but almost equal percentage of both groups mentioned that they will recommend the method to a friend. No serious side effects or complications were reported in the misoprostol group. The incidence of excessive post-abortive bleeding was more in the misoprostol group than in the surgical evacuation group (p =0.0336). Also endometrium using transvaginal ultrasonography was significantly thicker in the misoprostol group than in group II (p= 0.0071) but with no clinical importance as it was not associated with severe vaginal bleeding necessitating medical or surgical interventions. Conclusion Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to undergo surgical management.

Objectives: The aim of this study is to assess the effectiveness and acceptability of using vaginal misoprostol for management of first trimester spontaneous incomplete abortion as an alternative to direct vaginal surgical evacuation in our setting. Methods: This is a prospective comparative study performed on 147 patients with first trimester incomplete abortion between 8 and 12 weeks requesting medical management. They were divided into two groups according to patients’ choice; group (I) received misoprostol tablet 400 mcg (Cytotec, Serono) every 4 h for a maximum of three doses while group (II) underwent surgical vaginal evacuation directly under general anesthesia. Only 54 patients in group I and 51 patients in group II completed their follow up and included in the analysis. Results: Although vaginal surgical evacuation was successful in solving the problem in 100% of cases, misoprostol was successful in 79.6% (p= 0.0006). The overall satisfaction was slightly higher in the surgical group but almost equal percentage of both groups mentioned that they will recommend the method to a friend. No serious side effects or complications were reported in the misoprostol group. The incidence of excessive post-abortive bleeding was more in the misoprostol group than in the surgical evacuation group (p =0.0336). Also endometrium using transvaginal ultrasonography was significantly thicker in the misoprostol group than in group II (p= 0.0071) but with no clinical importance as it was not associated with severe vaginal bleeding necessitating medical or surgical interventions. Conclusion Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to undergo surgical management.

Objectives: The aim of this study is to assess the effectiveness and acceptability of using vaginal misoprostol for management of first trimester spontaneous incomplete abortion as an alternative to direct vaginal surgical evacuation in our setting. Methods: This is a prospective comparative study performed on 147 patients with first trimester incomplete abortion between 8 and 12 weeks requesting medical management. They were divided into two groups according to patients’ choice; group (I) received misoprostol tablet 400 mcg (Cytotec, Serono) every 4 h for a maximum of three doses while group (II) underwent surgical vaginal evacuation directly under general anesthesia. Only 54 patients in group I and 51 patients in group II completed their follow up and included in the analysis. Results: Although vaginal surgical evacuation was successful in solving the problem in 100% of cases, misoprostol was successful in 79.6% (p= 0.0006). The overall satisfaction was slightly higher in the surgical group but almost equal percentage of both groups mentioned that they will recommend the method to a friend. No serious side effects or complications were reported in the misoprostol group. The incidence of excessive post-abortive bleeding was more in the misoprostol group than in the surgical evacuation group (p =0.0336). Also endometrium using transvaginal ultrasonography was significantly thicker in the misoprostol group than in group II (p= 0.0071) but with no clinical importance as it was not associated with severe vaginal bleeding necessitating medical or surgical interventions. Conclusion Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to undergo surgical management.

OBJECTIVE: Prenatally compromised fetal head growth leading to smaller brain volumes (BV) is a risk factor for neurodevelopmental delay in children with CHD. Little is known about the dynamics of fetal head growth in different types of CHD. Aim of this study was to characterize fetal brain growth in relation to the type of CDH and associated cardiovascular dynamics. STUDY DESIGN: 89 chromosomally normal fetuses with isolated CHD had head circumference (HC), calculated BV (HC3/6_2), fetal cephalization index (CI_HC/EFW), growth potential (GP), middle cerebral artery Pulsatility index(MCAPI) and central hemodynamic measurements. Z-scores for these parameters were compared between cases and 1535 normal singleton controls. CHD was grouped as follows: group 1: transposition of the great arteries (TGA, n_7), group 2: Hypoplastic left heart and critical aortic stenosis with retrograde aortic flow (n_55), group 3: (right sided lesions) pulmonary stenosis, Tetralogy of Fallot, Tricuspid atresia (n_ 14), group 4: Left ventricular outflow obstructions with net antegrade isthmic flow (n_13). RESULTS: HC, BV and GP were lower in groups 1 and 2 (all p_0.001). BVs were smaller in group 1 (_1.98 vs_0.72, p_0.001). The MCAPI z-score was significantly decreased in groups 2 and 4 (p_0.001 compared to controls) with the lowest median values in the latter (_0.65 vs. _1.51, p_0.04). MCA PI z-score was not correlated with head growth in group 2 but was inversely correlated to BV in group 4 (p_0.04). CONCLUSION: Transposition of the great arteries and left sided CDH leading to isthmic blood flow reversal are associated with significantly smaller head size. TGA is not associated with MCA brain sparing and delayed brain growth probably results from central switching of nutrient streams. Left sided lesions are associated with MCA brain sparing but head growth is only spared when net antegrade flow in the aortic isthmus can be maintained. Prenatal evaluation of central hemodynamics in CDH may become essential for predicting neurodevelopmental risks and potentially critical to direct prenatal interventions

Aim: To estimate the prevalence of low bone mineral density (BMD) among rural women of reproductive age in Upper Egypt and to evaluate the association of selected anthropometric, reproductive, lifestyle and socioeconomic class factors on BMD. Methods: A cross-sectional study was conducted among contraceptive users in rural Sohag Governorate, Upper Egypt. A structured questionnaire was administered for 362 eligible participants. Anthropometric measurements were made, and BMD was measured by ultrasonographic bone densitometry. Results: Of the participants, aged 20–50 years, 61% were of low socioeconomic level and 47.8% were illiterate. The prevalence of low BMD was 31.8%. Age, low socioeconomic level, BMI, illiteracy, family history, the total duration of breastfeeding and reproduction, total number of pregnancies and decreased intake of food rich in calcium were significant factors according to bivariate analysis. Low BMD was significantly associated with an increase in the duration of depomedroxy progesterone acetate (DMPA) use, low dietary calcium intake, low BMI and an increase in the duration of reproduction according to multivariate regression analysis. Conclusion: Focusing on improving the bone health of reproductive age females of low socioeconomic levels will improve the outcomes of programs to prevent pre- and postmenopausal osteoporosis.

Aim: To estimate the prevalence of low bone mineral density (BMD) among rural women of reproductive age in Upper Egypt and to evaluate the association of selected anthropometric, reproductive, lifestyle and socioeconomic class factors on BMD. Methods: A cross-sectional study was conducted among contraceptive users in rural Sohag Governorate, Upper Egypt. A structured questionnaire was administered for 362 eligible participants. Anthropometric measurements were made, and BMD was measured by ultrasonographic bone densitometry. Results: Of the participants, aged 20–50 years, 61% were of low socioeconomic level and 47.8% were illiterate. The prevalence of low BMD was 31.8%. Age, low socioeconomic level, BMI, illiteracy, family history, the total duration of breastfeeding and reproduction, total number of pregnancies and decreased intake of food rich in calcium were significant factors according to bivariate analysis. Low BMD was significantly associated with an increase in the duration of depomedroxy progesterone acetate (DMPA) use, low dietary calcium intake, low BMI and an increase in the duration of reproduction according to multivariate regression analysis. Conclusion: Focusing on improving the bone health of reproductive age females of low socioeconomic levels will improve the outcomes of programs to prevent pre- and postmenopausal osteoporosis.

Aim: To estimate the prevalence of low bone mineral density (BMD) among rural women of reproductive age in Upper Egypt and to evaluate the association of selected anthropometric, reproductive, lifestyle and socioeconomic class factors on BMD. Methods: A cross-sectional study was conducted among contraceptive users in rural Sohag Governorate, Upper Egypt. A structured questionnaire was administered for 362 eligible participants. Anthropometric measurements were made, and BMD was measured by ultrasonographic bone densitometry. Results: Of the participants, aged 20–50 years, 61% were of low socioeconomic level and 47.8% were illiterate. The prevalence of low BMD was 31.8%. Age, low socioeconomic level, BMI, illiteracy, family history, the total duration of breastfeeding and reproduction, total number of pregnancies and decreased intake of food rich in calcium were significant factors according to bivariate analysis. Low BMD was significantly associated with an increase in the duration of depomedroxy progesterone acetate (DMPA) use, low dietary calcium intake, low BMI and an increase in the duration of reproduction according to multivariate regression analysis. Conclusion: Focusing on improving the bone health of reproductive age females of low socioeconomic levels will improve the outcomes of programs to prevent pre- and postmenopausal osteoporosis.