Publications by authors named "Ahmed Elhalwagy"

8 Publications

  • Page 1 of 1

Outcome of Laparoscopic Adhesiolysis in Infertile Patients with Pelvic Adhesions Following Cesarean Delivery: A Randomized Clinical Trial.

J Gynecol Obstet Hum Reprod 2021 May 2;50(5):101969. Epub 2020 Nov 2.

Faculty of Medicine, Tanta University, Egypt.

Objectives: To evaluate results of laparoscopic adhesiolysis in patients with post cesarean infertility regards restoration of the fertility and achievement of pregnancy. To identify a group of patients who should primarily be offered laparoscopic adhesiolysis and those who should be treated by IVF.

Design: Randomized prospective clinical trial MATERIALS AND METHODS: 184 patients with secondary infertility diagnosed to have periadnexal and pelvic adhesions, were randomly allocated into two groups: group I (92 cases) treated by laparoscopic adhesiolysis and group II (92 cases) who treated for a year by controlled ovarian stimulation and IUI up to 3 trials. Diagnostic work-up of infertility was carried out denoting normal semen, patent both tubes at HSG, and ovulatory at ovulation testing with normal hormonal profile. The outcomes, cumulative pregnancy rates calculated for each group after one year.

Results: According to the adhesions, the patients classified into 4 groups: 8 cases inoperable, 43 cases with mild type adhesions, 26 cases with moderate type adhesions, and 5 cases with severe type adhesions. The patients followed up postoperatively for year. Overall pregnancy rate 54.35 %. For patients with mild adhesions 76.7%, for patients with moderate adhesions 61.5%, and for patients with severe adhesions 20%. Complications present in (1.57%), cost is (125.7-180.9 $). Over all pregnancy rate was 11.96% in group (II) CONCLUSIONS: laparoscopic adhesiolysis is the method of choice for dealing with mild to moderate periadnexal adhesions after C.S. The pregnancy outcome after lysis of severe periadnexal adhesions is poor. So, such patients are best treated by IVF.
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http://dx.doi.org/10.1016/j.jogoh.2020.101969DOI Listing
May 2021

Circulating Levels of Vitamin D and Leptin in Lean Infertile Women with Polycystic Ovary Syndrome.

J Hum Reprod Sci 2018 Oct-Dec;11(4):343-347

Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt.

Objective: The objective of this study is to measure levels of Vitamin D and leptin and assess their relation of each to the pathogenesis of polycystic ovary syndrome (PCOS).

Design: This was a cohort observational study.

Settings: This study was conducted at the Department of Obstetrics and Gynecology, Tanta University.

Materials And Methods: Ninety lean women were enrolled in this study and were allocated into two groups with 45 patients in each group: the first group (study group) who are lean women with PCOS and the second group (control group) who are the lean infertile patients without PCOS. Blood samples were collected and tested for study parameters.

Results: There were no significant differences regarding demographic characteristics between both groups. The differences were in ovarian volume and hormonal profiles. Serum leptin was found to be significantly increased in lean PCOS than in control groups. Vitamin D levels were found to be lower in the lean PCOS group than in control group.

Conclusion: Lean PCOS women are a unique group with specific hormonal profiles different from the typical PCOS profiles. Leptin and Vitamin D may have a role in the pathogenesis of lean PCOS, but large studies are still required regarding this unique group.
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http://dx.doi.org/10.4103/jhrs.JHRS_40_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333029PMC
February 2019

The impact of mechanical cervical dilatation during elective cesarean section on postpartum scar integrity: a randomized double-blind clinical trial.

Int J Womens Health 2019 10;11:23-29. Epub 2019 Jan 10.

Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt,

Objective: The current study aimed to evaluate the impact of mechanical cervical dilatation during elective cesarean section (CS) on postpartum scar integrity at 6 months post operation.

Methods: A randomized double-blind clinical trial (UMIN000027946) was conducted at a tertiary university hospital in the period between July 1, 2017 and April 30, 2018. The study included pregnant women with a singleton fetus at term ≥37 weeks of gestation scheduled for elective CS. Eligible participants were allocated either to the study group (women with intraoperative cervical dilatation) or the control group (women with no intraoperative cervical dilatation). The patients were followed up at 6 months after CS by 3D ultrasonography to check for the scar integrity and quality. The primary outcome was the difference in sonographic parameters of the scar integrity between the two groups.

Results: Four hundred twenty two women were approached to participate in the study. There was no statistically significant difference regarding the baseline characteristics of both the groups. Scar width and depth were significantly higher in the cervical dilatation group (=0.002 and 0.001, respectively). Fewer cases with scar defects (niche) were found in the cervical dilatation group than in the control group (5.03% vs 11.04%, respectively, =0.048). There was no significant difference regarding the rate of wound infection or endometritis in both the groups (=0.717 and 0.227, respectively). The incidence of febrile morbidity was higher in the no cervical dilatation group (10.5%) compared to (5.0%) the cervical dilatation group (=0.045).

Conclusion: Cervical dilatation during elective CS is associated with thick scars with low incidence of scar defects.
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http://dx.doi.org/10.2147/IJWH.S188628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330971PMC
January 2019

Evaluation of three-step procedure (Shehata's technique) as a conservative management for placenta accreta at a tertiary care hospital in Egypt.

J Gynecol Obstet Hum Reprod 2019 Mar 11;48(3):201-205. Epub 2018 Oct 11.

Tanta University, Tanta, Egypt.

Objective: To evaluate the benefits and risks of three-step technique as a conservative treatment for women with placenta accreta and desiring future fertility.

Study Design: This study is a retrospective study where the files of 91 cases of placenta accreta managed by three-step technique were reviewed. This study was conducted at Tanta University Hospitals in the period from June 1, 2015 to May 31, 2017. All demographic and operative data were extracted and recorded.

Results: The mean age was 32.44±2.72 years; the mean operative time was 81.65±15.68min. The mean gestational age at operation was 35.67±1.19 weeks. The technique succeeded to preserve the uterus in 86 cases and failed in 5 cases. There was no cases required ICU admission with mean hospital stay of 3.065±1.04 days. The postoperative morbidities were mild and in the form of fever (n=9) and wound sepsis (n=4), pyometra (n=1) and secondary hemorrhage (n=1).

Conclusion: The three-step procedure is effective as a uterine sparing technique in management of placenta accreta with success rate of 94.5%. The operative and postoperative complications were minimal and expected in such case.
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http://dx.doi.org/10.1016/j.jogoh.2018.10.007DOI Listing
March 2019

Subcuticular interrupted versus continuous skin suturing in elective cesarean section in obese women: a randomized controlled trial.

J Matern Fetal Neonatal Med 2019 Dec 27;32(24):4114-4119. Epub 2018 Jun 27.

Department of Obstetrics and Gynecology, Cairo University, Giza, Egypt.

To compare the interrupted subcuticular skin closure with continuous one in obese women undergoing cesarean delivery. A randomized controlled study conducted on 169 obese women with term uncomplicated singleton pregnancy who underwent elective cesarean delivery. They were randomized to either skin closure through continuous subcuticular sutures using vicryl 3/0 or interrupted subcuticular suturing using vicryl 3/0. The primary outcome parameter was occurrence of wound infection. Secondary outcomes included other skin complications, postoperative pain, operative duration and hospital stay There was a statistically higher number of cases with wound hematoma (20 vs. 10,  = .04), infection (30 vs. 15,  = .008) and those who needed reclosure of wound (8 vs. 0,  = .004) in the continuous when compared to women in the interrupted subcuticular group, respectively. Healing with secondary intension was significantly higher in women in the continuous subcuticular group (52 vs. 26, respectively,  < .001). The number of cases with wound seroma and keloid formation was not statistically different between the two groups (25 vs. 19,  = .272 and 12 vs. 5,  = .069 in the continuous vs. interrupted groups, respectively). The duration of CS was longer in those who underwent interrupted closure when compared to continuous ones. However, that was statistically insignificant (40.95 + 6.376 vs. 37.05 + 6.455,  = 0.14). Most surgical wound complications were reduced if skin closure with continuous subcuticular sutures is replaced with interrupted one.
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http://dx.doi.org/10.1080/14767058.2018.1481950DOI Listing
December 2019

Reduction of the cetrorelix dose in a multiple-dose antagonist protocol and its impact on pregnancy rate and affordability: A randomized controlled multicenter study.

Clin Exp Reprod Med 2017 Dec 31;44(4):232-238. Epub 2017 Dec 31.

Department of Obstetrics and Gynaecology, Faculty of Medicine, Tanta University, Tanta, Egypt.

Objective: To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology.

Methods: This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group).

Results: The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating hormone units required was 2,350.43±150.76 IU in group I and 2,366.25±140.34 IU in group II, which was not a significant difference (=0.548). The duration of stimulation, number of retrieved oocytes, and number of developed embryos were not significantly different between the groups. The clinical and ongoing pregnancy rates likewise did not significantly differ. The cost of intracytoplasmic sperm injection per cycle was significantly lower in group I than in group II (US $494.66±4.079 vs. US $649.677±43.637).

Conclusion: Reduction of the cetrorelix dose in the antagonist protocol was not associated with any significant difference either in the number of oocytes retrieved or in the pregnancy rate. Moreover, it was more economically feasible for patients in a low-resource country.
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http://dx.doi.org/10.5653/cerm.2017.44.4.232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783921PMC
December 2017

Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis.

Fertil Steril 2018 02 6;109(2):289-301. Epub 2018 Jan 6.

Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.

Objective: To evaluate the effectiveness of low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens in terms of ongoing pregnancy per fresh IVF attempt in women with poor ovarian reserve undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment.

Design: A systematic review and meta-analysis of randomized controlled studies that evaluate the effectiveness of low dosing of gonadotropins alone or combined with oral compounds compared with high doses of gonadotropins in women with poor ovarian reserve undergoing IVF/ICSI treatment.

Setting: Not applicable.

Patient(s): Subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment.

Intervention(s): We searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and the Clinical Trials Registry using medical subject headings and free text terms up to June 2016, without language or year restrictions. We included randomized controlled studies (RCTs) enrolling subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment and comparing low doses of gonadotropins and gonadotropins combined with oral compounds versus high doses of gonadotropins. We assessed the risk of bias using the criteria recommended by the Cochrane Collaboration. We pooled the results by meta-analysis using the fixed and random effects model.

Main Outcomes Measure(s): The primary outcome was ongoing pregnancy rate (PR) per woman randomized.

Result(s): We retrieved 787 records. Fourteen RCTs (N = 2,104 women) were included in the analysis. Five studies (N = 717 women) compared low doses of gonadotropins versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (2 RCTs: risk rate 0.98, 95% confidence interval 0.62-1.57, I = 0). Nine studies (N = 1,387 women) compared ovarian stimulation using gonadotropins combined with the oral compounds letrozole (n = 6) or clomiphene citrate (CC) (n = 3) versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (3 RCTs: risk rate 0.90, 95% confidence interval 0.63-1.27, I = 0).

Conclusion(s): We found no evidence of a difference in pregnancy outcomes between low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens. Whether low doses of gonadotropins or gonadotropins combined with oral compounds is to be preferred is unknown, as they have never been compared head to head. A health economic analysis to test the hypothesis that an ovarian stimulation with low dosing is more cost-effective than high doses of gonadotropins is needed.

Prospero Registration Number: CRD42016041301.
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http://dx.doi.org/10.1016/j.fertnstert.2017.10.033DOI Listing
February 2018

Salivary progesterone and cervical length measurement as predictors of spontaneous preterm birth.

J Matern Fetal Neonatal Med 2015 Jul 14;28(10):1147-51. Epub 2014 Aug 14.

a Obstetrics and Gynecology Department , Kasr AlAini Hospital, Cairo University , Cairo , Egypt and.

Objective: To evaluate the efficacy of salivary progesterone, cervical length measurement in predicting preterm birth (PTB).

Methods: Prospective observational study included 240 pregnant women with gestational age (GA) 26-34 weeks classified into two equal groups; group one are high risk for PTB (those with symptoms of uterine contractions or history of one or more spontaneous preterm delivery or second trimester abortion) and group 2 are controls.

Results: There was a highly significant difference between the two study groups regarding GA at delivery (31.3 ± 3.75 in high risk versus 38.5 ± 1.3 in control), cervical length measured by transvaginal ultrasound (24.7 ± 8.6 in high risk versus 40.1 ± 4.67 in control) and salivary progesterone level (728.9 ± 222.3 in high risk versus 1099.9 ± 189.4 in control; p < 0.001). There was a statistically significant difference between levels of salivary progesterone at different GA among the high risk group (p value 0.035) but not in low risk group (p value 0.492). CL measurement showed a sensitivity of 71.5% with 100% specificity, 100% PPV, 69.97% NPV and accuracy of 83%, while salivary progesterone showed a sensitivity of 84% with 90% specificity, 89.8% PPV, 85.9% NPV and accuracy of 92.2%.

Conclusion: The measurement of both salivary progesterone and cervical length are good predictors for development of PTB.
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http://dx.doi.org/10.3109/14767058.2014.947474DOI Listing
July 2015