Effect of topical oxytocin gel on vaginal mucosa in postmenopausal Egyptian women: a clinical randomized trial.

BACKGROUND: Vaginal atrophy is common after menopause and is often linked to sexual dysfunction, particularly dyspareunia. AIM: The study aimed to investigate the effect of intravaginally applied oxytocin on expressions of vaginal atrophy. METHODS: Fifty postmenopausal women aged 47 to 66 years with vaginal atrophy participated in this double-blinded placebo-controlled study. The women were randomized to intravaginal treatment with either gel with 600 IU/mL of oxytocin (oxytocin group) or gel alone (control group) once daily for 2 weeks. The gel consisted of hypromellose, pH 3.8 (Vagovital). OUTCOMES: The color of the vaginal mucosa, the vaginal pH, and the cytology of vaginal epithelial cells were investigated before and after treatment. RESULTS: The color of the vaginal mucosa shifted from pale to red in all 25 patients treated with oxytocin but only in 4 patients in the control group (P < .001). There was a significant decrease in intravaginal pH in the oxytocin group and the control group, with the delta value being significantly greater in the oxytocin group than in the control group (P < .001). The vaginal maturation index increased significantly (P < .001) in the oxytocin group but not in the control group. CLINICAL IMPLICATIONS: Topical oxytocin gel offers an effective solution to the sexual dysfunction that is related to vaginal atrophy after menopause. STRENGTHS AND LIMITATIONS: Strengths include studying different outcomes of applying the oxytocin gel for vaginal atrophy. Limitations include the small-scale population with a relatively short duration of treatment (2 weeks). CONCLUSION: Intravaginal treatment with a gel containing 600 IU/mL of oxytocin effectively counteracts physical expressions of vaginal atrophy. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05275270; https://clinicaltrials.gov/ct2/show/NCT05275270).

Letrozole vs. Placebo Pretreatment in the Medical Management of First Trimester Missed Miscarriage: a Randomized Controlled Trial.

INTRODUCTION: Misoprostol is used for the medical management of miscarriage as it is more effective in the early stages of pregnancy. Letrozole has an anti-estrogen effect and is used for the pretreatment of miscarriage with misoprostol. AIM: The aim of this study was compare the efficacy and safety of letrozole with placebo pretreatment in the medical management of first trimester missed miscarriage. DESIGN: This was a prospective randomized case-control study. PATIENTS AND METHODS: Four hundred and thirty-eight women were randomly divided into two groups of 219; the placebo group received placebo tablets twice daily for 3 days, followed by 800 micrograms of misoprostol vaginally on the fourth day of enrolment, while the letrozole group received letrozole 10 mg twice daily for three days followed by 800 micrograms misoprostol administered vaginally. Symptoms and side effects were recorded, and the women advised to return to hospital if they experienced severe pain or bleeding or intolerable side effects and to report to hospital for a check-up one week after misoprostol administration. Ultrasound was done seven days after misoprostol administration to monitor outcomes. Surgical evacuation was carried out if medical management failed. RESULTS: There were significant differences between the two groups, with better outcomes found for the letrozole group in terms of rates of complete miscarriage, onset of vaginal bleeding, and interval between induction and onset of expulsion (p < 0.001). A higher rate of nausea and vomiting was reported for the letrozole group (p = 0.002). Differences between groups with regard to pre- and post-termination hemoglobin levels, fever, severe pain and severe bleeding needing evacuation were not statistically significant. CONCLUSION: Adding letrozole to misoprostol improves the success rate and decreases the interval between induction and expulsion in cases of first trimester miscarriage; however, nausea and vomiting is higher with letrozole.

Correction: Letrozole vs. Placebo Pretreatment in the Medical Management of First Trimester Missed Miscarriage: a Randomized Controlled Trial.

[This corrects the article DOI: 10.1055/s-0043-122499.].

Lidocaine gel vs lidocaine spray in reducing pain during insertion of the intrauterine contraceptive device.

OBJECTIVES: The aim of this study was to compare the pain-relieving effect of intracervical lidocaine gel with that of lidocaine spray or no local anaesthesia in decreasing pain during insertion of the intrauterine contraceptive device (IUCD). METHODS: In a prospective multicentre non-randomised comparative study design, 420 women were divided into three groups of 140 and fitted with the same type of IUCD. Group 1 received cervical lidocaine gel, group 2 received cervical lidocaine spray and group 3 received no topical anaesthesia. A visual analogue scale was used to measure the degree of pain experienced. RESULTS: There were no significant differences between the three groups with regard to baseline characteristics such as age and number of deliveries. Significantly less pain was felt during cervical traction in women using a local anaesthetic. However, there were no significant differences in pain due to IUCD insertion. CONCLUSIONS: Application of a local anaesthetic decreased the pain resulting from cervical traction but not that resulting from IUCD insertion.

Three-dimensional ultrasound first trimester fetal volume measurement and its relation to pregnancy outcome.

AIM OF WORK: To determine whether fetal volume (FV) measured by three-dimensional (3D) ultrasound was able to detect fetuses at risk of low birth weight (primary outcome) and/or preterm labor (secondary outcome). METHODS: One hundred pregnant women carrying a singleton living pregnancy who were sure of dates, and had a dating scan, with gestational age between 11 weeks and 13 weeks+6 days coming for routine first trimester nuchal translucency (NT) were examined by both two-dimensional (2D) and 3D ultrasound (Vocal System) for crown-rump length (CRL) and FV then followed up regularly every 4 weeks until 28 weeks then biweekly until 36 weeks then weekly until delivery both clinically and by ultrasound biometry. FINDINGS: Eighty-seven cases had a normal outcome, while the remaining 13 cases had either preterm labor (four cases) or low-birth weight (nine cases). FV positively correlated with CRL (P=0.026), gestational age in weeks (P=0.002), neonatal body weight in grams (P=0.018) and neonatal body length at birth (P=0.04). A mean FV of 8.3 mm3 was association with neonatal complications (P=0.045). A cut-off point of 9 mm3 for FV was associated with 100% sensitivity for detection of the date of birth, while a cut-off point of 9.15 mm3 for FV was associated 100% sensitivity for detection of neonatal birth weight. CONCLUSION: 3D assessment of FV in the first trimester provides an accurate method for predicting pregnancy outcome namely low birth weight and neonatal complications, however, it is a better positive predictor than a negative one.