Publications by authors named "Dina M R Dakhly"

10 Publications

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Post-placental intrauterine device insertion vs puerperal insertion in women undergoing caesarean delivery in Egypt: a 1 year randomised controlled trial.

Eur J Contracept Reprod Health Care 2020 Dec 2;25(6):439-444. Epub 2020 Oct 2.

Department of Obstetrics and Gynaecology, Cairo University, Cairo, Egypt.

Objective: The aim of the study was to compare 6 month expulsion rates of the copper-bearing intrauterine device (IUD) inserted after delivery of the placenta or at the 6 week postpartum visit in women undergoing caesarean section.

Methods: A parallel-group randomised trial was conducted in an Egyptian university hospital between February 2016 and December 2018. Participants were randomised to either post-placental IUD insertion or IUD insertion at the 6 week postpartum visit. Participants were followed for 12 months. Primary outcomes were IUD expulsion and the proportion of women using an IUD at 6 months. A secondary outcome was the cumulative pregnancy rate at 12 months.

Results: Five hundred participants were enrolled in each group. At 6 months the total expulsions were 58/416 (13.9%) in the post-placental group and 4/214 (1.9%) in the puerperal group; IUD use at 6 months was 416/478 (87.0%) in the post-placental group and 214/232 (92.2%) in the puerperal group. Data collected by phone at 12 months showed a higher cumulative pregnancy rate in the puerperal group (84/500, 16.8%) vs the post-placental group (22/500, 4.4%). IUD continuation at 12 months was higher in the post-placental group.

Conclusion: Participants in the post-placental group had a higher expulsion rate at 6 months, but more IUDs were placed in this group and fewer pregnancies had occurred at 12 months compared with the puerperal group.

Trial Registration: Clinicaltrials.gov NCT02679820.
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http://dx.doi.org/10.1080/13625187.2020.1823366DOI Listing
December 2020

Diagnostic value of the International Ovarian Tumor Analysis (IOTA) simple rules versus pattern recognition to differentiate between malignant and benign ovarian masses.

Int J Gynaecol Obstet 2019 Dec 26;147(3):344-349. Epub 2019 Sep 26.

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

Objective: To compare the efficacy of the International Ovarian Tumor Analysis (IOTA) simple rules versus pattern recognition to differentiate between benign and malignant ovarian masses.

Methods: A prospective cross-sectional study conducted at Kasr El Aini Hospital, Cairo, between April 2016 and October 2018 of 396 women with ovarian masses measuring more than 5 cm who were candidates for surgery. All patients underwent two-dimensional transvaginal sonography: level 2 with IOTA simple rules followed by level 3 with pattern recognition. Patients subsequently underwent ovarian cystectomy or oophorectomy and the specimens were examined histopathologically. Accuracy was measured by comparing sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Results: IOTA simple rules specified 44/50 cases as malignant and 220/242 as benign (sensitivity and specificity of 88.0% and 90.9%, respectively). Pattern recognition identified 83/94 cases as malignant and 281/302 as benign (sensitivity and specificity of 88.3% and 92.7%, respectively). No statistically significant difference in accuracy was found between the two methods.

Conclusion: IOTA simple rules are an effective tool for detecting ovarian malignancy when performed by nonexpert sonographers. When results are inconclusive, pattern recognition should be performed additionally by an expert sonographer.

Clinical Trials Registration: NCT02800031.
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http://dx.doi.org/10.1002/ijgo.12970DOI Listing
December 2019

Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt.

Arch Gynecol Obstet 2019 03 4;299(3):695-702. Epub 2019 Jan 4.

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

Purpose: To evaluate the effect of a modified type II radical hysterectomy on maternal morbidities and mortality in cases with abnormally invasive placenta (AIP).

Methods: 63 cases with AIP were managed at one of the largest referral centers in Egypt in a prospective study design. This technique entails devascularization of the uterus laterally on both sides and to clamp the uterus at the lowest possible point just below the level of the placenta while sparing the ureters.

Results: The difference between pre- and post-operative hemoglobin was only about 1 gm/dl, and the mean blood loss was 1673 ± 958 ml. There was a significant drop in the post-operative need for blood and blood product replacement, packed red blood cells (p = 0.013), fresh red blood cells (p < 0.001), and plasma units (p = 0.012). Operative time (skin to skin) averaged 190 ± 58.2 min as the technique is slow and utilizes meticulous hemostatic steps. ICU admission was 4.8% with a mean total hospital stay of 8.6 ± 3.6 days. Histopathological examination revealed 58 cases of placenta increta and five percreta cases. We also had 16 bladder injuries (25.4%) and two ureteric injuries, and no maternal mortalities.

Conclusion: This technique reduces maternal morbidity and mortality while performing cesarean hysterectomy for cases with AIP.
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http://dx.doi.org/10.1007/s00404-018-5027-7DOI Listing
March 2019

Current contraceptive trends among married Egyptian women: a cross-sectional survey.

Eur J Contracept Reprod Health Care 2018 Oct 29;23(5):351-356. Epub 2018 Oct 29.

b Department of Public Health and Community Medicine , Cairo University , Cairo , Egypt.

Objective: The aim of our study was to assess the knowledge and attitudes of married Egyptian women towards the different methods of contraception, examining the role of employment and education in modulating contraceptive behaviour.

Methods: A cross-sectional survey was conducted among 2360 Egyptian women between 15 and 45 years of age who were attending outpatient clinics at a university hospital in Cairo between August 2017 and January 2018. The survey collected sociodemographic data as well as information on education, employment, knowledge about contraceptive methods, current and previous use of contraception, source of family planning advice and side effects from previous contraceptive use.

Results: The response rate was 90.2%. Current use of a contraceptive method was 38.3%. The intrauterine device (IUD) was the leading contraceptive method (50.7%), followed by oral contraceptives (OCs) (23.6%). Contraceptive prevalence was significantly higher among working women (p < .001), whose primary choice was OCs, while IUD use was significantly higher among non-working women (p < .001). Contraceptive prevalence was highest among women with secondary school education or higher (41.6%).

Conclusion: Both employment status and educational level of the surveyed women played a significant role in their contraceptive behaviour.
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http://dx.doi.org/10.1080/13625187.2018.1532074DOI Listing
October 2018

The addition of growth hormone adjuvant therapy to the long down regulation protocol in poor responders undergoing in vitro fertilization: Randomized control trial.

Eur J Obstet Gynecol Reprod Biol 2018 Sep 22;228:161-165. Epub 2018 Jun 22.

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

Objective: to detect the impact of growth hormone (GH) co-treatment to the long down regulation protocol, on the outcomes of IVF/ICSI cycles in poor responders.

Study Design: this parallel open label randomized control trial was conducted in a university hospital. It included 240 females satisfying the bologna criteria for poor responders. The enrolled females were randomized into 2 groups: A (long/GH) receiving GH adjuvant therapy to the long protocol and group B (control) receiving the long protocol alone. The main outcome measure was the live birth rate (fresh, frozen and cumulative).

Results: GH supplementation improved the number of collected oocytes (5.4 ± 1.7 vs. 4.3 ± 2.1), MII oocytes (4.1 ± 2.1 vs. 2.1 ± 1.4), fertilized oocytes (4.0 ± 2.2 vs. 2.0 ± 1.2), transferred embryos (2.4 ± 0.9 vs. 1.6 ± 1.1) and cryopreserved (0.5 ± 0.7 vs. 0.2 ± 0.5). There was no significant difference in the live birth rate whether fresh (17.5% vs. 14.1%) or cumulative (18.3% vs. 14.7%).

Conclusions: Further studies are needed to know the true impact of adding GH to the induction protocols in poor responders, as there was no difference in the live birth rates between the study groups, indicating a lack of trend toward benefit from GH supplementation in poor responders.

Clinical Trial Registration: NCT02338206.
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http://dx.doi.org/10.1016/j.ejogrb.2018.06.035DOI Listing
September 2018

Randomized trial of combined cabergoline and coasting in preventing ovarian hyperstimulation syndrome during in vitro fertilization/intracytoplasmic sperm injection cycles.

Int J Gynaecol Obstet 2018 Feb 9;140(2):217-222. Epub 2017 Nov 9.

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

Objective: To assess the efficacy of coasting alone, cabergoline alone, or combining both interventions for preventing ovarian hyperstimulation syndrome (OHSS) among high-risk patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles.

Methods: The present randomized controlled trial was conducted at the IVF unit of a university hospital in Cairo between October 28, 2013, and July 31, 2015. Patients undergoing IVF/ICSI considered at risk of OHSS were randomly allocated to coasting, cabergoline, or combined coasting and cabergoline. The primary outcome was the rate and degree of symptomatically assessed OHSS. Data were analyzed on a per-protocol basis.

Results: There were 100 patients recruited to each group. The occurrence of early OHSS was lowest in the combination group compared with the other groups (P=0.002).

Conclusion: Combining coasting and cabergoline was associated with a lower OHSS rate compared with either therapy alone. CLINICALTRIALS.GOV: NCT01984320.
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http://dx.doi.org/10.1002/ijgo.12360DOI Listing
February 2018

Intralipid supplementation in women with recurrent spontaneous abortion and elevated levels of natural killer cells.

Int J Gynaecol Obstet 2016 Dec 30;135(3):324-327. Epub 2016 Aug 30.

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

Objective: To investigate the efficacy of intralipid supplementation in women with recurrent spontaneous abortion (RSA) and elevated natural killer cell activity undergoing in vitro fertilization/intracytoplasmic sperm injection.

Methods: Between February 10, 2013, and April 30, 2015, a double-blind randomized controlled study was conducted at a center in Egypt. Women with unexplained secondary infertility, RSA, and elevated levels of natural killer cells (>12%) were enrolled and randomly assigned to receive intralipid (2mL diluted at 20% in 250mL saline) or saline (250mL) infusion on the day of oocyte retrieval using random numbers and sealed envelopes. Patients and attending physicians were masked to group assignment. The infusions were repeated within 1week of a positive pregnancy test and then every 2weeks until the end of the first trimester. The primary outcome was chemical pregnancy 14days after embryo transfer. Analyses were by intention-to-treat.

Results: Overall, 296 women were enrolled. Chemical pregnancy was recorded for 84 (58.3%) of 144 women in the intralipid group and 76 (50.0%) of 152 in the control group (P=0.129).

Conclusion: Intralipid supplementation did not increase frequency of chemical pregnancy. However, findings related to ongoing pregnancy and live birth should be investigated further. ClinicalTrials.gov:NCT01788540.
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http://dx.doi.org/10.1016/j.ijgo.2016.06.026DOI Listing
December 2016

Accuracy of Hysteroscopic Endomyometrial Biopsy in Diagnosis of Adenomyosis.

J Minim Invasive Gynecol 2016 Mar-Apr;23(3):364-71. Epub 2015 Nov 12.

Department of Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objectives: To investigate the diagnostic accuracy of endomyometrial biopsy obtained via office hysteroscopy for the diagnosis of adenomyosis.

Study Design: Cross-sectional study.

Setting: Cairo University Teaching Hospital, Cairo, Egypt.

Patients: A total of 404 premenopausal women with symptoms clinically suggestive of having adenomyosis.

Interventions: All patients were subjected to 2-dimensional transvaginal sonography (TVS) in-office hysteroscopy examination with endomyometrial biopsy. Patients who subsequently underwent hysterectomy were included in the final analysis.

Main Measurements And Results: Accuracy of diagnostic modalities was represented using the terms sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. A total of 292 patients were eligible for final analysis. Of these, 162 (55.47%) were diagnosed with adenomyosis based on hysterectomy specimens. TVS had a high sensitivity (83.95%) and a moderate specificity (60%). In contrast, endomyometrial biopsy was more specific (78.46%) than sensitive (54.32%). Hysteroscopic appearance of the endometrial cavity had low sensitivity (40.74%) and specificity (44.62%). Adding endomyometrial biopsy to TVS improved specificity (89.23%).

Conclusion: Endomyometrial biopsy obtained via office hysteroscopy can diagnose adenomyosis with a high specificity and is recommended after TVS.
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http://dx.doi.org/10.1016/j.jmig.2015.11.004DOI Listing
September 2016

Which is the best IVF/ICSI protocol to be used in poor responders receiving growth hormone as an adjuvant treatment? A prospective randomized trial.

Gynecol Endocrinol 2016 29;32(2):116-9. Epub 2015 Sep 29.

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

This open label randomized study aims to define the best protocol to be used with growth hormone in poor responders, with comparison performed to delineate which protocol offers the best cycle outcomes. Two-hundred eighty-seven poor responders were included. The patients were randomly allocated into four groups receiving growth hormone (GH) as an adjuvant therapy added to either long or short agonist protocol, miniflare or antagonist protocols. The short/GH gave significantly lower mean number of oocytes when compared with the long/GH, antagonist/GH and miniflare/GH (4 ± 1.69 versus 5.06 ± 1.83, 4.95 + / = 1.90 and4.98 ± 2.51, respectively p = 0.005). Considering the number of fertilized oocytes, the long/GH showed significantly higher levels than short/GH and antagonist/GH (3.73 ± 1.47 versus 3.02 ± 1.52 and 2.89 ± 1.14, respectively). The main drawback is that it required significantly higher HMG dose and longer duration of stimulation. The long/GH was superior when compared with the three protocols regarding the number of oocytes retrieved and fertilized. But, when considering the clinical pregnancy rates, there was a difference in favor of the long/GH but not reaching a statistically significant value (ClinicalTrials.gov Identifier: NCT01897324).
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http://dx.doi.org/10.3109/09513590.2015.1092136DOI Listing
December 2016

Addition of growth hormone to the microflare stimulation protocol among women with poor ovarian response.

Int J Gynaecol Obstet 2015 Dec 23;131(3):305-8. Epub 2015 Aug 23.

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

Objective: To assess the efficacy of adding growth hormone (GH) to the microflare stimulation protocol among women with poor ovarian response.

Methods: A parallel, open-label, randomized controlled trial was conducted among patients with poor ovarian response who attended a center in Cairo, Egypt, between July 10 and December 31, 2014. Participants were randomly assigned using a computer program (random block size of 4-8) to undergo the microflare protocol with or without GH. Primary outcomes were the mean numbers of mature oocytes retrieved and fertilized. Analyses were done per protocol: women with cycle cancellations were excluded.

Results: The analysis included 72 women in the GH group and 73 in the microflare only group. The mean number of oocytes collected was 7.2±1.5 in the GH group versus 4.7±1.2 in the microflare only group (P<0.001). The mean number of metaphase II oocytes was 5.2±1.2 in the GH group and 2.8±1.0 in the microflare only group (P<0.001). The mean number of fertilized oocytes was higher in the GH group (4.2±1.1) than in the microflare only group (2.5±0.7; P<0.001).

Conclusion: Addition of GH to the microflare stimulation protocol provided some potential benefits to women with poor ovarian response. However, further studies are required before it could be recommended for routine clinical use. ClinicalTrials.gov:NCT02185326.
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http://dx.doi.org/10.1016/j.ijgo.2015.05.034DOI Listing
December 2015