Objectives: To assess the safety and feasibility of a novel technique, External Pop-out (EPO), for supporting the lower uterine segment during fetal head extraction in cesarean section (CS). Study design: Prospective cohort study. Patients and Methods: The current research is a registered (NCT02755168) study compassing the new technique, EPO, for head extraction during CS. The technique was performed on single, living, cephalic, elective cesarean deliveries at Women's Health Hospital, Assiut University, Egypt. The primary study outcomes were; the feasibility and the rate of incision extensions with the External Pop-out technique. The secondary outcomes included the easiness score and the learning curve of this technique on five senior obstetricians’ trainee. Results: The EPO technique was successful in 845/877 cases (96.3%) but impossible in the remaining 32 case because of extensive pelvic adhesions. The rate of occurrence of minor extensions associated with EPO was 8/845 (0.95%) with no major extensions in succeeded cases. There was a statistically significant difference between the mean of easiness score in the early 5 cases and the next 5 cases in 4 out of 5 trainees. The remaining trainee reported a higher easiness score earlier from his 4th case. The mean of total scores in the late cases was also significantly higher than the early cases (p=0.0001). Conclusions: External Pop-out technique is feasible with low rates of uterine incisions extensions. Moreover; this technique is easily learned and performed by obstetricians. Key Words: Cesarean Section; Fetal Head Extraction; Maternal Morbidity; Uterine Extension.

Objectives: To assess the safety and feasibility of a novel technique, External Pop-out (EPO), for supporting the lower uterine segment during fetal head extraction in cesarean section (CS). Study design: Prospective cohort study. Patients and Methods: The current research is a registered (NCT02755168) study compassing the new technique, EPO, for head extraction during CS. The technique was performed on single, living, cephalic, elective cesarean deliveries at Women's Health Hospital, Assiut University, Egypt. The primary study outcomes were; the feasibility and the rate of incision extensions with the External Pop-out technique. The secondary outcomes included the easiness score and the learning curve of this technique on five senior obstetricians’ trainee. Results: The EPO technique was successful in 845/877 cases (96.3%) but impossible in the remaining 32 case because of extensive pelvic adhesions. The rate of occurrence of minor extensions associated with EPO was 8/845 (0.95%) with no major extensions in succeeded cases. There was a statistically significant difference between the mean of easiness score in the early 5 cases and the next 5 cases in 4 out of 5 trainees. The remaining trainee reported a higher easiness score earlier from his 4th case. The mean of total scores in the late cases was also significantly higher than the early cases (p=0.0001). Conclusions: External Pop-out technique is feasible with low rates of uterine incisions extensions. Moreover; this technique is easily learned and performed by obstetricians. Key Words: Cesarean Section; Fetal Head Extraction; Maternal Morbidity; Uterine Extension.

Objectives: To assess the safety and feasibility of a novel technique, External Pop-out (EPO), for supporting the lower uterine segment during fetal head extraction in cesarean section (CS). Study design: Prospective cohort study. Patients and Methods: The current research is a registered (NCT02755168) study compassing the new technique, EPO, for head extraction during CS. The technique was performed on single, living, cephalic, elective cesarean deliveries at Women's Health Hospital, Assiut University, Egypt. The primary study outcomes were; the feasibility and the rate of incision extensions with the External Pop-out technique. The secondary outcomes included the easiness score and the learning curve of this technique on five senior obstetricians’ trainee. Results: The EPO technique was successful in 845/877 cases (96.3%) but impossible in the remaining 32 case because of extensive pelvic adhesions. The rate of occurrence of minor extensions associated with EPO was 8/845 (0.95%) with no major extensions in succeeded cases. There was a statistically significant difference between the mean of easiness score in the early 5 cases and the next 5 cases in 4 out of 5 trainees. The remaining trainee reported a higher easiness score earlier from his 4th case. The mean of total scores in the late cases was also significantly higher than the early cases (p=0.0001). Conclusions: External Pop-out technique is feasible with low rates of uterine incisions extensions. Moreover; this technique is easily learned and performed by obstetricians. Key Words: Cesarean Section; Fetal Head Extraction; Maternal Morbidity; Uterine Extension.

Objectives: To assess the safety and feasibility of a novel technique, External Pop-out (EPO), for supporting the lower uterine segment during fetal head extraction in cesarean section (CS). Study design: Prospective cohort study. Patients and Methods: The current research is a registered (NCT02755168) study compassing the new technique, EPO, for head extraction during CS. The technique was performed on single, living, cephalic, elective cesarean deliveries at Women's Health Hospital, Assiut University, Egypt. The primary study outcomes were; the feasibility and the rate of incision extensions with the External Pop-out technique. The secondary outcomes included the easiness score and the learning curve of this technique on five senior obstetricians’ trainee. Results: The EPO technique was successful in 845/877 cases (96.3%) but impossible in the remaining 32 case because of extensive pelvic adhesions. The rate of occurrence of minor extensions associated with EPO was 8/845 (0.95%) with no major extensions in succeeded cases. There was a statistically significant difference between the mean of easiness score in the early 5 cases and the next 5 cases in 4 out of 5 trainees. The remaining trainee reported a higher easiness score earlier from his 4th case. The mean of total scores in the late cases was also significantly higher than the early cases (p=0.0001). Conclusions: External Pop-out technique is feasible with low rates of uterine incisions extensions. Moreover; this technique is easily learned and performed by obstetricians. Key Words: Cesarean Section; Fetal Head Extraction; Maternal Morbidity; Uterine Extension.

Objective: To evaluate the safety and efficacy of laparoscopic anterior abdominal wall cervicopexy (LAWC), a novel minimally invasive procedure for management of stages III and IV uterine prolapse. Subjects and methods: The procedure was performed on 39 cases with symptomatic uterine prolapse during the period from June 2012 to January 2015. The procedure was started with obliteration of the pouch of Douglas through the approximation of the uterosacral ligaments with non-absorbable suture. Then, the procedure completed through anchoring the supravaginal cervix to the anterior abdominal wall by two non-absorbable sutures taken in good bites in the dense stroma of the supravaginal cervix. Results: Uterine prolapse was diagnosed as stage III in 36 (92.3%) women and stage IV in three cases. The procedure was conducted safely without any intraoperative complications. At 3 month follow-up, there was a statistically significant reduction in the extent of prolapse at all pelvic organ prolapse quantification (POP-Q) points as compared with preoperative assessment (p = 0.000). Only five cases (12.8%) were found to have stage I uterine prolapse on evaluation by the POP-Q system after one year. Conclusion: LAWC is a minimally invasive, simple, and highly effective procedure to treat marked uterine prolapse and seems not to compromise fertility. Keywords: Anterior abdominal wall cervicopexy, uterine prolapse, laparoscopy, uterine descent

Objective: To evaluate the safety and efficacy of laparoscopic anterior abdominal wall cervicopexy (LAWC), a novel minimally invasive procedure for management of stages III and IV uterine prolapse. Subjects and methods: The procedure was performed on 39 cases with symptomatic uterine prolapse during the period from June 2012 to January 2015. The procedure was started with obliteration of the pouch of Douglas through the approximation of the uterosacral ligaments with non-absorbable suture. Then, the procedure completed through anchoring the supravaginal cervix to the anterior abdominal wall by two non-absorbable sutures taken in good bites in the dense stroma of the supravaginal cervix. Results: Uterine prolapse was diagnosed as stage III in 36 (92.3%) women and stage IV in three cases. The procedure was conducted safely without any intraoperative complications. At 3 month follow-up, there was a statistically significant reduction in the extent of prolapse at all pelvic organ prolapse quantification (POP-Q) points as compared with preoperative assessment (p = 0.000). Only five cases (12.8%) were found to have stage I uterine prolapse on evaluation by the POP-Q system after one year. Conclusion: LAWC is a minimally invasive, simple, and highly effective procedure to treat marked uterine prolapse and seems not to compromise fertility. Keywords: Anterior abdominal wall cervicopexy, uterine prolapse, laparoscopy, uterine descent

Objective: To evaluate the safety and efficacy of laparoscopic anterior abdominal wall cervicopexy (LAWC), a novel minimally invasive procedure for management of stages III and IV uterine prolapse. Subjects and methods: The procedure was performed on 39 cases with symptomatic uterine prolapse during the period from June 2012 to January 2015. The procedure was started with obliteration of the pouch of Douglas through the approximation of the uterosacral ligaments with non-absorbable suture. Then, the procedure completed through anchoring the supravaginal cervix to the anterior abdominal wall by two non-absorbable sutures taken in good bites in the dense stroma of the supravaginal cervix. Results: Uterine prolapse was diagnosed as stage III in 36 (92.3%) women and stage IV in three cases. The procedure was conducted safely without any intraoperative complications. At 3 month follow-up, there was a statistically significant reduction in the extent of prolapse at all pelvic organ prolapse quantification (POP-Q) points as compared with preoperative assessment (p = 0.000). Only five cases (12.8%) were found to have stage I uterine prolapse on evaluation by the POP-Q system after one year. Conclusion: LAWC is a minimally invasive, simple, and highly effective procedure to treat marked uterine prolapse and seems not to compromise fertility. Keywords: Anterior abdominal wall cervicopexy, uterine prolapse, laparoscopy, uterine descent

Objective: To evaluate the safety and efficacy of laparoscopic anterior abdominal wall cervicopexy (LAWC), a novel minimally invasive procedure for management of stages III and IV uterine prolapse. Subjects and methods: The procedure was performed on 39 cases with symptomatic uterine prolapse during the period from June 2012 to January 2015. The procedure was started with obliteration of the pouch of Douglas through the approximation of the uterosacral ligaments with non-absorbable suture. Then, the procedure completed through anchoring the supravaginal cervix to the anterior abdominal wall by two non-absorbable sutures taken in good bites in the dense stroma of the supravaginal cervix. Results: Uterine prolapse was diagnosed as stage III in 36 (92.3%) women and stage IV in three cases. The procedure was conducted safely without any intraoperative complications. At 3 month follow-up, there was a statistically significant reduction in the extent of prolapse at all pelvic organ prolapse quantification (POP-Q) points as compared with preoperative assessment (p = 0.000). Only five cases (12.8%) were found to have stage I uterine prolapse on evaluation by the POP-Q system after one year. Conclusion: LAWC is a minimally invasive, simple, and highly effective procedure to treat marked uterine prolapse and seems not to compromise fertility. Keywords: Anterior abdominal wall cervicopexy, uterine prolapse, laparoscopy, uterine descent

Objective: To evaluate the safety and efficacy of laparoscopic anterior abdominal wall cervicopexy (LAWC), a novel minimally invasive procedure for management of stages III and IV uterine prolapse. Subjects and methods: The procedure was performed on 39 cases with symptomatic uterine prolapse during the period from June 2012 to January 2015. The procedure was started with obliteration of the pouch of Douglas through the approximation of the uterosacral ligaments with non-absorbable suture. Then, the procedure completed through anchoring the supravaginal cervix to the anterior abdominal wall by two non-absorbable sutures taken in good bites in the dense stroma of the supravaginal cervix. Results: Uterine prolapse was diagnosed as stage III in 36 (92.3%) women and stage IV in three cases. The procedure was conducted safely without any intraoperative complications. At 3 month follow-up, there was a statistically significant reduction in the extent of prolapse at all pelvic organ prolapse quantification (POP-Q) points as compared with preoperative assessment (p = 0.000). Only five cases (12.8%) were found to have stage I uterine prolapse on evaluation by the POP-Q system after one year. Conclusion: LAWC is a minimally invasive, simple, and highly effective procedure to treat marked uterine prolapse and seems not to compromise fertility. Keywords: Anterior abdominal wall cervicopexy, uterine prolapse, laparoscopy, uterine descent

Objective: To investigate the effect of aspirin on fetal weight in fetuses with idiopathic asymmetrical intrauterine growth restriction (IUGR) complicated by abnormal umbilical artery Doppler indices. Materials and methods: The study was a randomized controlled trial conducted at Woman’s Health Hospital, Assiut, Egypt, between June 2016 and the January 2017 included 60 pregnant women (28_30 weeks) with idiopathic asymmetrical IUGR associated with abnormal umbilical artery Doppler indices. Women were randomly assigned to group I (aspirin 75 mg) daily for four weeks or group II (no intervention). The primary outcome was the fetal weight after four weeks. Secondary outcomes included Doppler blood flow changes in the umbilical artery plus delivery and neonatal outcomes. Results: The estimated fetal weight and umbilical artery blood flow increased significantly in aspirin group (p¼.00) when compared with no intervention group. As regard neonatal outcomes; aspirin group showed better results and encouraging outcomes (p.05). Conclusions: Aspirin improves fetal weight and umbilical artery blood flow in idiopathic asymmetrical IUGR fetuses complicated by abnormal umbilical artery Doppler blood flow.