Effectiveness of Lifestyle Modification on Health-Related Quality of Life among Women with Polycystic Ovary Syndrome.

Background: Polycystic Ovary Syndrome (PCOS) is the most common reproductive endocrine disorder, which affects approximately one in every five women at the age of reproduction. The first line of PCOS management is recommended to be lifestyle modification. This study aimed to evaluate the effectiveness of lifestyle modification on Health-Related Quality of Life (HRQoL) among women with PCOS. Materials and Methods: This quasi-experimental study was conducted on 124 women with PCOS recruited from the outpatient clinic at El-Takhassosy Obstetrics Hospital, Port-Said, Egypt, in 2021 and allocated to two groups; an educational group (n = 62) and a control group (n = 62). For data gathering, two tools were used; an interviewing questionnaire for assessing the demographic characteristics and a standardized HRQoL questionnaire. Healthy lifestyle modification educational sessions included nutritional guidelines for PCOS, physical exercise (walking for 30 min five times weekly), and instructions to relieve stress. Results: The mean (SD) of HRQoL score was 97.52 (8.75) in the educational group higher than the control group 87.32 (18.68) at 3 months postintervention and at 6 months postintervention; it reached 106.74 (11.53) in the educational group and 89.47 (22.14) in the control group. They were statistically significant after intervention (3 and 6 months) between studied groups (after 3 months was t86,563 = 3.891, p < 0.001 and after 6 months was t91,826. Conclusions: Women with PCOS should receive structured education about lifestyle modification next to treatment to ensure improvement, particularly in patient-centered care.

Knowledge, attitude, and practice of obstetricians towards vaginal birth after caesarean in Egypt.

This was a cross sectional study surveying a total of 451 physicians. A questionnaire was constructed and distributed electronically to the participants. The main outcome measure was evaluation of physicians' knowledge, attitude, and practice towards VBAC in Egypt. Although 76.3% of the physicians agreed to present VBAC as an option, 38.1% disagreed with encouraging it. Also, a large proportion of them advised against the induction of labour and refused it if post-term (69.4% and 76.1%, respectively). The physicians' attitude towards VBAC was to allow vaginal birth if the patient went into spontaneous labour (72.3%) and perform repeat CS if not in labour (86.7%). Fear of complications (78.71%) was the most common cause of not conducting VBAC. The consensus of practice was to present VBAC as an option for women with a single Caesarean scar; however, one-third of them did not encourage VBAC. They strongly refused the induction of labour. Impact StatementWhat is already known on this subject? This is the first study to evaluate physicians' knowledge, attitude, and practice towards VBAC in Egypt and the Arab world.What do the results of this study add? From the current survey of the practice of the obstetricians in Egypt, the consensus of practice was to present VBAC as an option for women with a single Caesarean scar; however, one-third of them did not encourage VBAC. They strongly refused the induction of labour. The presence of labour pain is the strongest determinant to allow VBAC, while the vast majority of obstetricians were willing to conduct ERCS in the absence of labour pain. This contributed significantly to the rising rates of CS in Egypt.What are the implications of these findings for clinical practice and/or further research? Physicians' attitude towards VBAC should be evaluated in countries with higher rates of CS deliveries. Women's perspectives and attitude towards VBAC should be evaluated.

Violence and depression among pregnant women in Egypt.

BACKGROUND: Depression is a serious mental health disorder that might affect women in the childbearing period. Incidences increase during pregnancy as well as after delivery. Its association with intimate partner violence (defined as physical, sexual, or psychological harm by a current or former partner) has been reported in many countries. Data about this sensitive issue are lacking in Egypt. The aim of the study was to determine the relation between intimate partner violence and depression during pregnancy. METHODS: This was a case control study conducted at the outpatient clinics in Suez Canal University hospital, from January 2019 to March 2020. The study included two groups, the study group included women exposed to violence during the current pregnancy and a control one included women with no history of violence. Both groups were recruited according to the predetermined inclusion criteria (women aged 18-45 years, continuous marital relationship, no history of depression in current or previous pregnancies, and singleton pregnancy). Women were asked to complete the Arabic validated NorVold Domestic Abuse Questionnaire (measuring four types of abuse: emotional, physical, sexual, and violence in the health care system, the last one being excluded). Depression was evaluated using the Arabic validated form of the Edinburgh Postnatal Depression Scale (comprises 10 questions that represent patients' feelings in the last 7 days). The main outcome measure was to assess the association between intimate partner violence and depression. RESULTS: We recruited 158 women in each group. Both groups were matched in their demographic characters. Although emotional violence was reported prominently among women exposed to IPV 87.9% (139/158), it was not significantly reported in depressed women (P value 0.084). Physical and sexual violence were significantly reported among depressed women (P value 0.022 and 0.001, respectively). There was a significant difference between women exposed to violence and those who were not exposed to violence in the total depression scores (13.63 ± 5.47 and 10.65 ± 5.44, respectively with a p value < 0.001). Emotional (p value < 0.001) and sexual violence (mild and severe with p value of 0.026 and 0.002 respectively) had significant roles as risk factors for depression during pregnancy in single regression and after control of other confounders. CONCLUSION: There was a strong association between intimate partner violence and depression during pregnancy.

Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections.

BACKGROUND: The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions. METHODS: This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey's scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair's scoring system was used to evaluate intraperitoneal adhesions. RESULTS: The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey's and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001). CONCLUSION: Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.

Violence and sexual dysfunction among infertile Egyptian women.

OBJECTIVE: To evaluate domestic violence and sexual dysfunction in infertile women. MATERIALS AND METHODS: We recruited women complaining of infertility (primary or secondary infertility). A control group of fertile women attending the outpatient clinic for any concern was recruited. Domestic violence was evaluated using the Arabic validated NorVold Domestic Abuse Questionnaire (NORAQ). Female sexual function was evaluated using the Arabic validated female sexual function index. RESULTS: There was no significant difference between both groups in rates of exposure to violence (p-value 0.830). Primary infertility was a significant contributing factor in infertile women's exposure to violence (p-value 0.001). All the studied population had female sexual dysfunction, with more dysfunction was reported by the infertile women (total score 18.87 ± 5.92, 19.51 ± 5.42, p-value 0.072). They differed significantly in arousal (2.83 ± 1.33, 3.13 ± 1.29, p-value 0.001) and satisfaction (3.98 ± 1.27, 4.28 ± 1.28, p-value 0.003) which were impaired in infertile women. CONCLUSIONS: The recruited infertile women were exposed to violence. Emotional abuse was the most common reported type of violence. Sexual dysfunction was reported in the entire studied population with no significant difference relating to fertility.

Knowledge, attitude and practice towards abortion and post abortion care among Egyptian private obstetricians and gynaecologists.

OBJECTIVE: To assess the knowledge, attitude, and practice of private obstetricians and gynaecologists towards abortion, post-abortion care, and post-abortion family planning. PATIENTS AND METHODS: A cross-sectional study, from June 2017 to May 2018, using a self-administered questionnaire of 150 obstetricians/gynaecologists at private clinics, centres, hospitals in Ismailia, Egypt. The questionnaire was composed of four broad sections: section one was about the socio-demographic characteristics of the participants; section two was about physicians' knowledge, attitude and practices regarding abortion; section three was about their attitudes and practices regarding post-abortion family planning and screening for sexually transmitted diseases (STDs) in patients presenting for induced abortion; and section four was about the socio-demographic characteristics of women seeking induced abortion taken from the physicians' views. RESULTS: Only 15.2% of participants had performed an abortion for unwanted pregnancies at ≤12 weeks vs. 3.8% for unwanted pregnancies >12 weeks' gestation. The most common reason for not performing an abortion was religious prohibition (80.35% vs. 86.6% for unwanted pregnancy ≤12 and > 12 weeks, respectively). Social causes were the most common reason for seeking an induced abortion. None of the physicians used manual vacuum aspiration (MVA) for abortion or had received training in MVA. Post-abortion family planning counselling was offered by 20.5% of physicians, while 13.6% screened for STDs. CONCLUSIONS: The majority of private obstetricians/gynaecologists in Ismailia, Egypt, do not perform abortions for unwanted pregnancies because of their religious beliefs. Post-abortion screening for STDs and family planning services are not sufficiently integrated into post-abortion care.

The role of levonorgestrel intra-uterine system in the management of adenomyosis: A systematic review and meta-analysis of prospective studies.

INTRODUCTION: The levonorgestrel intrauterine system (LNG-IUS) is a long-acting hormone-releasing uterine device that has many non-contraceptive benefits. The study aims to assess the safety and efficacy of LNG-IUS in the management of adenomyosis. MATERIAL AND METHODS: We searched the following bibliographic databases: MEDLINE via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Google Scholar for the relevant studies which used LNG-IUS in management of patients with clinically or ultrasonographic diagnosed adenomyosis.The main outcome measures are pain score at the end of follow-up, bleeding, symptomatic relief, uterine volume (mL), endometrial thickness (mm) and/or hemoglobin level. RESULTS: Ten prospective studies (patients n = 551) were included. The overall effect estimates showed that the LNG-IUS led to significant reductions in pain score after 12 months (standardized mean difference [SMD[ -3.87, 95% confidence interval [CI] -5.51 to -2.23, P < .001), 24 months (SMD -5.56, 95% CI -9.80 to -1.32, P = .01) and 36 months of insertion (SMD -3.81, 95% CI -4.27 to -3.36, P < .001). Similarly, the Pictorial Blood Assessment Chart (PBAC) showed significant reduction up to 36 months after LNG-IUS insertion (SMD -2.32, 95% CI -2.91 to -1.73, P < .001). The LNG-IUS led to significant reductions in the uterine volume 12 months (SMD -.60, 95% CI -0.88 to -.31, P < .001) and 36 months after insertion (SMD -0.42, 95% CI -0.69 to -0.14, P = .003). CONCLUSIONS: LNG-IUS is a promising and effective option for the management of adenomyosis. Its use effectively reduced the severity of symptoms, uterine volume and endometrial thickness, and improved laboratory outcomes.

Prevalence and risk factors for domestic violence among infertile Egyptian women: a cross-sectional study.

Objective: Domestic violence (DV) is an important social and public health problem affecting women globally. This study aims to assess the prevalence and risk factors of DV among infertile Egyptian women. Patients and methods: A cross-sectional hospital-based study included infertile women attending the outpatient gynaecological clinic in a tertiary University hospital was carried out between September 2017 and October 2018. After obtaining ethical approval, 304 infertile women were enrolled in the study and investigated using an interview questionnaire of Infertile Women's Exposure to Violence Determination Scale (IWEVDS). The questionnaire was examined for accuracy after translation into the Arabic language. Results: The infertile women's reported DV resulted in an average total score on the IWEVDS of 73 ± 17. The top three domains with the highest scales were DV, punishment and exposure to traditional practices domains with scale 20.84 ± 7.67, 18.25 ± 4.15 and 14.63 ± 3.18 points, respectively. Using Multivariable linear regression analysis, we found that the best-fitting predictors for this scale were the wife's age (p = .001), residency (p = .033), previous intracytoplasmic sperm injection (ICSI) (p = .016), divorce threatens (p = .022) and fear from husband (p = .026). Conclusions: Infertile Egyptian women are at an increased risk of DV. The most common forms of DV are psychological violence and verbal abuse.