Publications by authors named "Omar M Shaaban"

37 Publications

Rectal misoprostol versus intravenous oxytocin for prevention of postpartum hemorrhage.

Int J Gynaecol Obstet 2009 Jun 26;105(3):244-7. Epub 2009 Feb 26.

Department of Obstetrics and Gynecology, Women's Health Center, Assiut University, Assiut, Egypt.

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%, P<0.001).

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.
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June 2009

Breastfeeding and contraception use among women with unplanned pregnancies less than 2 years after delivery.

Int J Gynaecol Obstet 2009 May 20;105(2):127-30. Epub 2009 Feb 20.

Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.

Objective: To examine breastfeeding and contraceptive use after the lactational amenorrhea method (LAM) criteria were no longer met.

Methods: Two hundred and thirty-three parous Egyptian women with unplanned pregnancies less than 2 years after delivery completed a questionnaire examining breastfeeding practice and contraceptive use.

Results: The majority of women (81.5%) with unplanned pregnancies within 2 years of delivery were breastfeeding at conception. Of these women, 36.3% had used a method of contraception other than LAM compared with 60.5% of women who had weaned (P<0.05). Among the breastfeeding women, 61.2% failed to use contraception because they believed breastfeeding would prevent pregnancy.

Conclusion: Breastfeeding women with unplanned pregnancies were less likely to have used contraception than women who had weaned, suggesting that prolonged breastfeeding contributes to unmet contraceptive need.
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May 2009

N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss.

Reprod Biomed Online 2008 Nov;17(5):722-6

Department of Obstetrics and Gynaecology, Women's Health Centre, Faculty of Medicine, Assiut University, Assiut, Egypt.

Pregnancy could be associated with a state of oxidative stress that could initiate and propagate a cascade of changes that may lead to pregnancy wastage. This process of oxidative stress may be suppressed by the antioxidant effect of N-acetyl cysteine (NAC). The current study aimed to evaluate the effect of NAC therapy in patients diagnosed with unexplained recurrent pregnancy loss (RPL). The study was a prospective controlled study performed in the Women's Health Centre, Assiut University, Egypt. A group of 80 patients with history of recurrent unexplained pregnancy loss were treated with NAC 0.6 g + folic acid 500 microg/day and compared with an aged-matched group of 86 patients treated with folic acid 500 microg/day alone. NAC + folic acid compared with folic acid alone caused a significantly increased rate of continuation of a living pregnancy up to and beyond 20 weeks [P < 0.002, relative risk (RR) 2.9, 95% confidence interval (CI) 1.5-5.6]. NAC + folic acid was associated with a significant increase in the take-home baby rate as compared with folic acid alone (P < 0.047, RR 1.98, 95% CI 1.3-4.0). In conclusion, NAC is a well-tolerated drug that could be a potentially effective treatment in patients with unexplained RPL.
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November 2008

Reproductive implications of endoscopic third ventriculostomy for the treatment of hydrocephalus.

Eur J Obstet Gynecol Reprod Biol 2008 Sep 7;140(1):55-60. Epub 2008 May 7.

Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.

Objective: The objective of this study was to compare reproductive function after two neurosurgical procedures for treating non-neoplastic hydrocephalus; endoscopic third ventriculostomy (ETV) and ventriculo-peritoneal shunt (VP).

Study Design: A cohort of 96 women who underwent neurosurgical procedures to treat non-neoplastic hydrocephalus at the Cleveland Clinic between January 1995 and January 2004 was identified. A follow up mailed survey was sent to all identified women between 15 and 45 years of age. In addition, phone interviews were performed to complete the required data. Clinical, laboratory and operative details were collected from 69 participants.

Results: There was a two-fold significant increase in the menstrual irregularities after the procedure in the ETV group [5/52(10%)-10/52(19%), P=0.03] while those treated with VP shunt maintained the same menstrual pattern postoperatively. The rate of pregnancy was higher in the VP group compared to the ETV group, but did not reach statistical significance [8/17(47%) vs. 17/52(33%), P=0.462]. Similarly, the rate of term pregnancies was higher in the VP group compared to ETV group [8/8(100%) vs. 13/17(76%), P=0.269], which reflected a higher spontaneous miscarriage rate in ETV compared to VP group [4/17(33%) vs. 0/8(0%), P=0.269].

Conclusion: ETV appears to alter reproductive function postoperatively. In patients who establish a pregnancy, abortion rates seem to be higher in the ETV group; however, a prospective study will be required to validate these observations.
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September 2008

Pregnancy during breastfeeding in rural Egypt.

Contraception 2008 May 18;77(5):350-4. Epub 2008 Mar 18.

Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.

Background: Breastfeeding does not reliably protect against pregnancy except during the first 6 months postpartum and only then if accompanied by amenorrhea. Reluctance to use other methods of contraception during lactation may result in unplanned pregnancy. The aims of this study were to describe, among women in rural Egypt attending for antenatal care the prevalence of pregnancy during breastfeeding, contraceptive practice and unintended pregnancy. Finally, the study assessed women's impressions of the effect of conception during breastfeeding on breast milk and on the health of the breastfed infant.

Study Design: A descriptive study using an interviewer-administered structured questionnaire for 2617 parous women attending a hospital in Egypt for antenatal care.

Results: More than 95% of women breastfed the child before their current pregnancy; 25.3% conceived while breastfeeding. Conception occurred during the first 6 months postpartum in 4.4%, before resumption of menstruation in 15.1% and while exclusively or almost exclusively breastfeeding in 28.1%. Only 10 pregnancies (1.5%) occurred when all the prerequisites of the lactational amenorrhea method of contraception (LAM) were present. Twenty-nine percent of pregnancies conceived during breastfeeding were unintended, 10% of women had considered terminating their pregnancy while 4.4% of them reported trying to do so.

Conclusions: Pregnancy during breastfeeding is common in Egypt and is often unintended. There is great potential for using LAM, but it must be properly taught, and women should be encouraged to start using effective contraception as soon as any of the prerequisites of LAM expires.
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May 2008

Tamoxifen treatment of bleeding irregularities associated with Norplant use.

Contraception 2005 Dec 9;72(6):432-7. Epub 2005 Aug 9.

Department of Obstetrics and Gynecology, Assiut University Hospital, Assiut 71511, Egypt.

Objectives: To evaluate the possible role of tamoxifen (selective estrogen receptor modulators, SERM) in treating bleeding irregularities associated with Norplant contraceptive use.

Material And Methods: Randomized clinical trial including 100 Norplant users complaining of vaginal bleeding irregularities. The trial was conducted in the Family Planning Clinic of Assiut University Hospital. Women were assigned at random to receive tamoxifen tablets (10 mg) twice daily for 10 days or similar placebo. Women were followed-up for 3 months. The end points were percentage of women who stopped bleeding during treatment, bleeding/spotting days during the period of follow-up, effect of treatment on their lifestyle, and side effects and discontinuation of contraception.

Results: There was good compliance with treatment. At the end of treatment, a significantly higher percentage of tamoxifen users stopped bleeding in comparison to the control group (88% vs. 68%, respectively; p=.016). Women who used tamoxifen had significantly less bleeding and/or spotting days than women who used placebo, during the first and second months. During the third month, there were no significant differences between the two groups. Women who used tamoxifen reported improvement in performing household activities, religious duties and in sexual life, during the first 2 months. In the third month, there were no differences between the two groups. There were no significant differences between tamoxifen and placebo groups in reporting side effects. In the group who used tamoxifen, two women discontinued Norplant use because of bleeding vs. nine women in the placebo group.

Conclusion: Tamoxifen use at a dose of 10 mg twice daily orally, for 10 days, has a beneficial effect on vaginal bleeding associated with Norplant use. In addition, the bleeding pattern was better in women who used tamoxifen for the following 2 months after treatment. However, these results have to be confirmed in a larger trial before advocating this line of treatment.
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December 2005

Acceptability for the use of postpartum intrauterine contraceptive devices: Assiut experience.

Med Princ Pract 2003 Jul-Sep;12(3):170-5

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

Objectives: To evaluate the acceptance of postpartum intrauterine contraceptive devices (PPIUCD) among the inhabitants of Assiut governorate, Egypt and to study the factors that influence this acceptance.

Subjects And Methods: Contraceptive counseling was given to 3,541 clients: 1,880 and 1,661 during the antenatal visits and postpartum hospitalization, respectively. Acceptors during antenatal counseling were to receive IUCDs via postplacental insertion in the case of vaginal delivery or transcesarean insertion in case of abdominal delivery. The clients who refused PPIUCD and chose interval IUCD insertion were referred to the Family Planning Clinic after the end of puerperium. Among postpartum counselees, PPIUCD acceptors received predischarge insertion within 48 h of delivery and the interval IUCD were referred to have IUCD inserted after the end of puerperium. The acceptance rate of both PPIUCD and interval IUCD and the percentage of actual insertions were recorded. The causes of both acceptance and refusal were also recorded.

Results: Of the 3,541 clients, 1,024 (28.9%) accepted the use of IUCD after delivery. Acceptance was approximately the same during antenal and postpartum counseling: 26.4 and 31.8%, respectively. Verbal acceptance was higher among women with formal education than among illiterate women. Planning another pregnancy in the near future, preference for another contraceptive method, namely lactational infertility, and complications from previous use of IUCD were the most common reasons for refusing the use of IUCD. Of the 1,024 verbal acceptors, only 243 (23.7%) had the actual insertion of IUCD.

Conclusion: Both the acceptance and actual insertion of IUCD were low probably because the use of IUCD is a new concept in the community. For these women, the only opportunity to receive information about contraceptives is during childbirth when they are in contact with medical personnel. Hence, it is suggested that family planning should be integrated with maternal and child-care services in order to effectively promote the use of contraceptive devices in these women who otherwise would not seek the use of such a device.
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August 2003