Abstract OBJECTIVE: To assess the effectiveness of 800 microg of rectal misoprostol compared with an intravenous infusion of 5 IU of oxytocin as prophylaxis against postpartum hemorrhage (PPH). METHODS: A total of 514 women in labor were randomized into two groups (257 women in each). Within 1 minute of delivery of the anterior shoulder participants in group 1 received 800 microg of rectal misoprostol and 1 ampoule of normal saline in 5 mL lactated Ringer solution intravenously; group 2 received a rectal placebo tablet and 5 IU of oxytocin in 5 mL lactated Ringer solution intravenously. RESULTS: Both groups were comparable regarding the need for uterotonics, blood transfusion, and hematocrit drop of 10% or greater, 24 hours post partum (P=0.54, P=0.25, and P=0.85, respectively). Fever was significantly higher among misoprostol patients (18.7% vs 0.8%, P0.001). CONCLUSIONS: Routine use of 800 microg of rectal misoprostol was effective in reducing blood loss after delivery. We recommend the regimen for low-resource, busy obstetric settings.

Abstract OBJECTIVE: To compare the efficacy of hysterosalpingo-contrast sonography (HyCoSy) using a saline solution with that of radiographic hysterosalpingography (HSG) in the assessment of tubal patency. METHOD: We compared the findings obtained by the 2 methods with those obtained by standard diagnostic laparoscopy with the chromopertubation test in a study with 88 infertile women younger than 40 years. RESULTS: The sensitivity, specificity, and diagnostic accuracy of HyCoSy and HSG were similar, and 65 (74%) of the women reported the pain associated with HyCoSy as mild to moderate. CONCLUSION: The HyCoSy procedure is well tolerated and can be used as a primary tool for the evaluation of tubal patency in infertile women.

Abstract OBJECTIVE: To compare the efficacy of hysterosalpingo-contrast sonography (HyCoSy) using a saline solution with that of radiographic hysterosalpingography (HSG) in the assessment of tubal patency. METHOD: We compared the findings obtained by the 2 methods with those obtained by standard diagnostic laparoscopy with the chromopertubation test in a study with 88 infertile women younger than 40 years. RESULTS: The sensitivity, specificity, and diagnostic accuracy of HyCoSy and HSG were similar, and 65 (74%) of the women reported the pain associated with HyCoSy as mild to moderate. CONCLUSION: The HyCoSy procedure is well tolerated and can be used as a primary tool for the evaluation of tubal patency in infertile women.

Abstract OBJECTIVE: To compare the efficacy of hysterosalpingo-contrast sonography (HyCoSy) using a saline solution with that of radiographic hysterosalpingography (HSG) in the assessment of tubal patency. METHOD: We compared the findings obtained by the 2 methods with those obtained by standard diagnostic laparoscopy with the chromopertubation test in a study with 88 infertile women younger than 40 years. RESULTS: The sensitivity, specificity, and diagnostic accuracy of HyCoSy and HSG were similar, and 65 (74%) of the women reported the pain associated with HyCoSy as mild to moderate. CONCLUSION: The HyCoSy procedure is well tolerated and can be used as a primary tool for the evaluation of tubal patency in infertile women.

Abstract OBJECTIVE: To determine if resectoscopic sectioning of complete uterocervicovaginal septum is as effective as cold knife excision of the vaginal part followed by resectoscopic cutting of the cervicouterine part in symptomatic patients. DESIGN: Randomized controlled clinical trial. SETTING: University hospital. PATIENT(S): Thirty-two women with a diagnosis of complete uterocervicovaginal septum who had a history of pregnancy wastage or infertility. They were randomized into two groups: Group A underwent resectoscopic excision of the complete septum starting from the vaginal interoitus; group B underwent cold knife excision of the vaginal part followed by resectoscopic excision of the cervical and uterine parts. INTERVENTION(S): Hysteroscopic metroplasty alone or preceded by cold knife excision of the vaginal part. MAIN OUTCOME MEASURE(S): Operating time, perioperative bleeding, complications, reproductive outcome, and patient and husband satisfaction. RESULT(S): Patients in group A showed significantly less operative time and scar-related dyspareunia. There were no significant differences in the reproductive outcome in the two groups. CONCLUSION(S): Resection of the vaginal part of symptomatizing complete vaginocervicouterine septum using resectoscopic metroplasty makes the procedure faster with less possibility of scar-related dyspareunia than cold knife excision.

Abstract OBJECTIVE: To determine if resectoscopic sectioning of complete uterocervicovaginal septum is as effective as cold knife excision of the vaginal part followed by resectoscopic cutting of the cervicouterine part in symptomatic patients. DESIGN: Randomized controlled clinical trial. SETTING: University hospital. PATIENT(S): Thirty-two women with a diagnosis of complete uterocervicovaginal septum who had a history of pregnancy wastage or infertility. They were randomized into two groups: Group A underwent resectoscopic excision of the complete septum starting from the vaginal interoitus; group B underwent cold knife excision of the vaginal part followed by resectoscopic excision of the cervical and uterine parts. INTERVENTION(S): Hysteroscopic metroplasty alone or preceded by cold knife excision of the vaginal part. MAIN OUTCOME MEASURE(S): Operating time, perioperative bleeding, complications, reproductive outcome, and patient and husband satisfaction. RESULT(S): Patients in group A showed significantly less operative time and scar-related dyspareunia. There were no significant differences in the reproductive outcome in the two groups. CONCLUSION(S): Resection of the vaginal part of symptomatizing complete vaginocervicouterine septum using resectoscopic metroplasty makes the procedure faster with less possibility of scar-related dyspareunia than cold knife excision.

Abstract OBJECTIVE: The aim of the trial was to assess the safety and efficacy of tricholoroacetic acid for the treatment of dysfunctional uterine bleeding using topical versus intrauterine instillation. STUDY DESIGN: In a pilot prospective randomized clinical trial, seventy women were randomly allocated to one of two groups. In Group I, the patients were subjected to intrauterine instillation of 95% tricholoroacetic acid. Group II underwent dilatation and curettage before topical application of 95% tricholoroacetic acid. RESULTS: The groups were similar regarding baseline clinical characteristics. There was a satisfactory clinical reduction of menstrual flow (amenorrhea, hypomenorrhea and eumenorrhea) at a rate of 97.1% (Group I) and 85.7% (Group II) at 6 months. A significant increase was observed in the mean haemoglobin value at 3 and 6 months in both treatment groups (P0.05). Group I showed a significant increase in haemoglobin level compared to Group II (P0.05) and a significant reduction of the endometrial thickness compared to Group II (2.21 ± 0.41 versus 3.03 ± 3.37). CONCLUSION: Trichloroacetic acid use for treating dysfunctional uterine bleeding seems to be efficient and safe, especially in women who do not require conception. Trichloroacetic acid intrauterine instillation is associated with longer duration of reduced menstrual bleeding than topical application. Copyright © 2012. Published by Elsevier Ireland Ltd.

Abstract OBJECTIVE: The aim of the trial was to assess the safety and efficacy of tricholoroacetic acid for the treatment of dysfunctional uterine bleeding using topical versus intrauterine instillation. STUDY DESIGN: In a pilot prospective randomized clinical trial, seventy women were randomly allocated to one of two groups. In Group I, the patients were subjected to intrauterine instillation of 95% tricholoroacetic acid. Group II underwent dilatation and curettage before topical application of 95% tricholoroacetic acid. RESULTS: The groups were similar regarding baseline clinical characteristics. There was a satisfactory clinical reduction of menstrual flow (amenorrhea, hypomenorrhea and eumenorrhea) at a rate of 97.1% (Group I) and 85.7% (Group II) at 6 months. A significant increase was observed in the mean haemoglobin value at 3 and 6 months in both treatment groups (P0.05). Group I showed a significant increase in haemoglobin level compared to Group II (P0.05) and a significant reduction of the endometrial thickness compared to Group II (2.21 ± 0.41 versus 3.03 ± 3.37). CONCLUSION: Trichloroacetic acid use for treating dysfunctional uterine bleeding seems to be efficient and safe, especially in women who do not require conception. Trichloroacetic acid intrauterine instillation is associated with longer duration of reduced menstrual bleeding than topical application. Copyright © 2012. Published by Elsevier Ireland Ltd.

Abstract OBJECTIVE: To evaluate modified anterior abdominal wall cervicopexy (AWC) as a less invasive (via 3-cm minilaparotomy) and more augmented (via securing posterior vaginal wall to uterosacral ligaments) technique. METHODS: Case series of 30 women with Stages III and IV apical uterine prolapse assessed by the pelvic organ prolapse quantification system. RESULTS: The modified AWC procedure was performed successfully for 17 cases with Stage III uterovaginal prolapse and 13 cases with Stage IV uterovaginal prolapse. The procedure was conducted safely with no operative or postoperative complications, apart from two cases with postoperative urinary retention. Operative time ranged from 45 to 70min. Follow-up was available for 1-3 years. Overall, 27 cases were satisfied with the procedure, and three cases developed recurrence after caesarean section due to cutting the supporting sutures. CONCLUSIONS: The modified AWC procedure is less invasive, simple and effective for Stages III and IV uterine prolapse. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Abstract OBJECTIVE: To evaluate modified anterior abdominal wall cervicopexy (AWC) as a less invasive (via 3-cm minilaparotomy) and more augmented (via securing posterior vaginal wall to uterosacral ligaments) technique. METHODS: Case series of 30 women with Stages III and IV apical uterine prolapse assessed by the pelvic organ prolapse quantification system. RESULTS: The modified AWC procedure was performed successfully for 17 cases with Stage III uterovaginal prolapse and 13 cases with Stage IV uterovaginal prolapse. The procedure was conducted safely with no operative or postoperative complications, apart from two cases with postoperative urinary retention. Operative time ranged from 45 to 70min. Follow-up was available for 1-3 years. Overall, 27 cases were satisfied with the procedure, and three cases developed recurrence after caesarean section due to cutting the supporting sutures. CONCLUSIONS: The modified AWC procedure is less invasive, simple and effective for Stages III and IV uterine prolapse. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.