The objective of this study is to compare the safety and efficacy of laparoscopic ovarian drilling (LOD) utilizing monopolar versus bipolar needle in clomiphene-resistant polycystic ovaries (PCO) in infertile women. This study is a prospective randomized comparative diagnostic trial. The procedures were performed in an endoscopic unit of a tertiary care referral facility and university hospital. Eighty clomiphene-resistant PCO patients were randomly assigned by using a computerized random table into group A and group B for monopolar and bipolar LOD of 40 patients in each group, respectively. The intervention was LOD using monopolar or bipolar needle in groups A and B, respectively. The main outcome measures are resumption of regular menstruation, spontaneous ovulation, and pregnancy. Both groups showed a significant postoperative improvement of menstrual patterns and hormonal profiles if compared to preoperative levels without significant difference between both groups. Spontaneous ovulation resumed in 13 (32.5 %) and 25 (62 %), p = 0.007, while spontaneous pregnancy within 1 year after LOD occurred in 9 (22.5 %) and 18 (45 %) cases (p = 0.033) in both groups, respectively. Both monopolar and bipolar needles are effective tools for LOD in clomiphene citrate (CC)-resistant PCO infertile patients as a second-line therapy. Utilizing bipolar LOD is superior to monopolar LOD due to a significantly higher postoperative incidence of resumption of spontaneous ovulation and spontaneous pregnancy. Theoretical less adhesion formation following bipolar LOD requires a second-look laparoscopy study. In the meantime, spread of bipolar LOD should be encouraged.

Study objective: to evaluate the impact of adolescent first and second pregnancy on fetal and maternal outcomes and to assess the prevalence of obstetric complications among this age group. Design: This is a retrospective hospital-based study, women who attended our hospital for antenatal care between January 2014 and January 2015 were considered for eligibility. Adolescents 20 years old who were presented by their first or second pregnancy were included as a study group and were controlled by women between 20 and 35 years old. Statistical analysis was conducted using SPSS software version 22. Setting: Al-Sabeen hospital in Sanaa city (capital of Yemen). Participants: One thousand and two hundred mothers aged less than 20 years (study group) and 2400 control mother whom age ranged between 20 to 35 years (control group). Interventions and Main Outcome Measures: included women were evaluated for the pregnancy, mode of delivery, obstetric adequacy of antenatal care, complications of complications and fetal outcomes. Results: Among the study group, the prevalence of adequate antenatal care visits was higher than the control group (55% vs. 42.5%, P=0.001). Pre-eclampsia was reported in 10% of adolescents versus 5.8% in control group (p=0.001). No gestational diabetes was diagnosed among adolescents. Antepartum hemorrhage was less prevalent among study group (5%) in comparison to the control group (10.8%). Normal vaginal delivery was less while instrumental delivery and Cesarean section rates were more in adolescent group (35% vs. 60%, 45% vs. 25%, 20% vs. 15%, respectively, p=0.05). The rates of intrauterine fetal death (IUFD) and stillbirth were comparable. Women in the control group tended to deliver newborns weighing > 3.5 kg (15% vs. 7.5%, p=0.001). Conclusion: Adolescent pregnancy is a risk factor for pre-eclampsia, anemia, instrumental vaginal delivery and cesarean section. More frequent antenatal care visits may be warranted in these women.

Study objective: to evaluate the impact of adolescent first and second pregnancy on fetal and maternal outcomes and to assess the prevalence of obstetric complications among this age group. Design: This is a retrospective hospital-based study, women who attended our hospital for antenatal care between January 2014 and January 2015 were considered for eligibility. Adolescents 20 years old who were presented by their first or second pregnancy were included as a study group and were controlled by women between 20 and 35 years old. Statistical analysis was conducted using SPSS software version 22. Setting: Al-Sabeen hospital in Sanaa city (capital of Yemen). Participants: One thousand and two hundred mothers aged less than 20 years (study group) and 2400 control mother whom age ranged between 20 to 35 years (control group). Interventions and Main Outcome Measures: included women were evaluated for the pregnancy, mode of delivery, obstetric adequacy of antenatal care, complications of complications and fetal outcomes. Results: Among the study group, the prevalence of adequate antenatal care visits was higher than the control group (55% vs. 42.5%, P=0.001). Pre-eclampsia was reported in 10% of adolescents versus 5.8% in control group (p=0.001). No gestational diabetes was diagnosed among adolescents. Antepartum hemorrhage was less prevalent among study group (5%) in comparison to the control group (10.8%). Normal vaginal delivery was less while instrumental delivery and Cesarean section rates were more in adolescent group (35% vs. 60%, 45% vs. 25%, 20% vs. 15%, respectively, p=0.05). The rates of intrauterine fetal death (IUFD) and stillbirth were comparable. Women in the control group tended to deliver newborns weighing > 3.5 kg (15% vs. 7.5%, p=0.001). Conclusion: Adolescent pregnancy is a risk factor for pre-eclampsia, anemia, instrumental vaginal delivery and cesarean section. More frequent antenatal care visits may be warranted in these women.

Objective: Cesarean section rates are increasing with associated increase in placenta previa and accreta. Placenta accreta is a major cause of maternal morbidity and mortality. Our objective was to evaluate of a new method of combined surgical steps in management of morbidly adherent placenta (MAP) to face its burden, psychological and marital disintegration if managed by hysterectomy in our low facilities. Materials and Methods: In this case series, we evaluated the use of sequential surgical steps for conservative management of 20 cases of MAP as regard the intra-operative and post-operative outcomes in Assiut Women Health Hospital, Egypt from June to December 2014. The sequential steps started by perfect dissection of urinary bladder, then delivery of the fetus followed by exteriorization of the uterus and application of 4 ring forceps on both uterine and ovarian vessels. Trial of placenta removal followed by application of two towels in the uterine cavity to achieve hemostasis. Ligation of uterine artery bilaterally at double low level. Finally, plication of the friable lower uterine segment from anterior wall after removal of towels. Results: The mean age of the included women was 29.95±4.8 years. All cases had previous uterine scar and placenta previa. Ten cases (50%) had placenta accreta, 8 cases (40%) had placenta increta and 2 cases had placenta percreta. Our procedure was succesfulin all 18 cases of placenta accreta and increta but 2 cases of placenta percreta required hysterectomy. No postpartum hemorrhage in all cases. There were no maternal deaths. Discussion: This new method was favorable in the management of MAP and decreased the incidence of hysterectomy in cases of placenta accreta and increta.

Objective: Cesarean section rates are increasing with associated increase in placenta previa and accreta. Placenta accreta is a major cause of maternal morbidity and mortality. Our objective was to evaluate of a new method of combined surgical steps in management of morbidly adherent placenta (MAP) to face its burden, psychological and marital disintegration if managed by hysterectomy in our low facilities. Materials and Methods: In this case series, we evaluated the use of sequential surgical steps for conservative management of 20 cases of MAP as regard the intra-operative and post-operative outcomes in Assiut Women Health Hospital, Egypt from June to December 2014. The sequential steps started by perfect dissection of urinary bladder, then delivery of the fetus followed by exteriorization of the uterus and application of 4 ring forceps on both uterine and ovarian vessels. Trial of placenta removal followed by application of two towels in the uterine cavity to achieve hemostasis. Ligation of uterine artery bilaterally at double low level. Finally, plication of the friable lower uterine segment from anterior wall after removal of towels. Results: The mean age of the included women was 29.95±4.8 years. All cases had previous uterine scar and placenta previa. Ten cases (50%) had placenta accreta, 8 cases (40%) had placenta increta and 2 cases had placenta percreta. Our procedure was succesfulin all 18 cases of placenta accreta and increta but 2 cases of placenta percreta required hysterectomy. No postpartum hemorrhage in all cases. There were no maternal deaths. Discussion: This new method was favorable in the management of MAP and decreased the incidence of hysterectomy in cases of placenta accreta and increta.

Background: In the management of first trimester miscarriage, the use of oral misoprostol is beneficial for patients as it offers a more discrete and less invasive route for those women who find vaginal administration unacceptable. In spite of high incidence of side-effects from use of oral misoprostol women still found oral route satisfactory. Methods: This study was a prospective cohort study done at El-Mukala maternal and child hospital and Hadhramout maternal and child university hospital in the period between 1st October 2014 and 30th September 2015. All pregnant women (less than 14 weeks) who were diagnosed as an embryonic pregnancy or missed miscarriage were included in the study. Every patient received single dose of oral misoprostol 600 μg in half full stomach at home. The primary outcome measure was complete miscarriage rate. Results: One-hundred women were included in the study. The mean age of study participants was 26.25±4.08 years, the mean BMI was 27.35±3.6 while the mean parity was 2.6±1.5.Ten cases needed emergency surgical evacuation within the period of first 48 hours. Complete miscarriage had occurred in 75 cases, 65 of them in the first 48 hours. Fifteen cases presented by incomplete miscarriage after waiting for one week. They needed surgical evacuation at the end of 7 days due to still considerable intrauterine contents. Conclusions: In our closed community in El-Mukala, Yemen, the use of oral misoprostol in single dose of 600 μg at home as a method for termination of first-trimester miscarriage was effective (75%, success rate), tolerable regarding side effects, has the advantage of high confidentiality and privacy resulting in good satisfaction.

Background: In the management of first trimester miscarriage, the use of oral misoprostol is beneficial for patients as it offers a more discrete and less invasive route for those women who find vaginal administration unacceptable. In spite of high incidence of side-effects from use of oral misoprostol women still found oral route satisfactory. Methods: This study was a prospective cohort study done at El-Mukala maternal and child hospital and Hadhramout maternal and child university hospital in the period between 1st October 2014 and 30th September 2015. All pregnant women (less than 14 weeks) who were diagnosed as an embryonic pregnancy or missed miscarriage were included in the study. Every patient received single dose of oral misoprostol 600 μg in half full stomach at home. The primary outcome measure was complete miscarriage rate. Results: One-hundred women were included in the study. The mean age of study participants was 26.25±4.08 years, the mean BMI was 27.35±3.6 while the mean parity was 2.6±1.5.Ten cases needed emergency surgical evacuation within the period of first 48 hours. Complete miscarriage had occurred in 75 cases, 65 of them in the first 48 hours. Fifteen cases presented by incomplete miscarriage after waiting for one week. They needed surgical evacuation at the end of 7 days due to still considerable intrauterine contents. Conclusions: In our closed community in El-Mukala, Yemen, the use of oral misoprostol in single dose of 600 μg at home as a method for termination of first-trimester miscarriage was effective (75%, success rate), tolerable regarding side effects, has the advantage of high confidentiality and privacy resulting in good satisfaction.

Introduction: Adhesions developed after cesarean sections (CS) vary according to the number of repeat section. Delivery times were reported to be increase with increased number of CS. Material and Methods: This is a prospective cohort study done in Assiut Women Health Hospital from August 2012 to August 2015 to evaluate the implications of doing adhesiolysis at CS either before delivery of the fetus or after that on maternal morbidity during current CS and recurrence rate in next sections. Adhesiolysis during CS avoid the use of anti-adhesion substances which is costly and not available in our low income society. Results: Fifty patients were included in the study. The dominant type of adhesion was omental, bladder and uterine adhesions forming bands with anterior abdominal wall. The uterovesical adhesion was present in all cases. No maternal morbidity occurred during adhesiolysis. Follow up of those patients were cone for 3 years. The percentage of adhesions in the next CS after this adhesiolysis was only 2 cases (4%) and both cases were omental adhesions. Conclusions: The use of adhesiolysis in repeat CS adhesions with ascending curve of experience is essential in our low socioeconomic countries and associated with no maternal or neonatal complications.

Introduction: Adhesions developed after cesarean sections (CS) vary according to the number of repeat section. Delivery times were reported to be increase with increased number of CS. Material and Methods: This is a prospective cohort study done in Assiut Women Health Hospital from August 2012 to August 2015 to evaluate the implications of doing adhesiolysis at CS either before delivery of the fetus or after that on maternal morbidity during current CS and recurrence rate in next sections. Adhesiolysis during CS avoid the use of anti-adhesion substances which is costly and not available in our low income society. Results: Fifty patients were included in the study. The dominant type of adhesion was omental, bladder and uterine adhesions forming bands with anterior abdominal wall. The uterovesical adhesion was present in all cases. No maternal morbidity occurred during adhesiolysis. Follow up of those patients were cone for 3 years. The percentage of adhesions in the next CS after this adhesiolysis was only 2 cases (4%) and both cases were omental adhesions. Conclusions: The use of adhesiolysis in repeat CS adhesions with ascending curve of experience is essential in our low socioeconomic countries and associated with no maternal or neonatal complications.

Objective: The purpose of this study was to determine the efficacy and safety of intrauterine extra-amniotic misoprostol solution for termination of second trimester missed abortion. Methods: A clinical pilot descriptive study that was done in Women Health Hospital, Assiut University, Egypt between March 2015 and June 2015. Fifty patients having missed abortion of gestational age between 13 to 24 weeks were included in the study. Insertion of an intrauterine Foley's catheter followed by infusion of sterile misoprostol solution through sterile infusion set at a constant drip rate. The primary outcome was successful expulsion of the fetus in 12 hours after starting misoprostol infusion. Results: The mean age of the study group was 27.25±4.08, the mean BMI was 26.35±3.6, the mean gestational age was 22.85±3.4 and the mean parity was 2.5±1.5. The mean induction expulsion interval was 5.27±2.66 hours. Six cases (12%) needed an analgesic. The need for surgical evacuation of retained contents was needed in 3 cases (6 %). Side effects in the form of rigors, fever and diarrhea were recorded in 4 cases (8%). No serious maternal events were recorded. Conclusion: The present results showed that intrauterine extra-amniotic misoprostol solution instillation appear to be an effective and safe method for termination of second trimester missed abortions.