The Effect of Endometrial Scratch on Pregnancy Rate in Women with Previous Intrauterine Insemination Failure: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

The objective of this study was to evaluate the impact of endometrial scratch on the pregnancy rate among women with previous failed intrauterine insemination (IUI). A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to November 2021. We selected randomized clinical trials (RCTs) that compared endometrial scratch in the intervention group versus placebo or no intervention in the control group among infertile women with previous failure of IUI regarding different pregnancy outcomes. Revman software was utilized for performing our meta-analysis. Our main outcomes were biochemical pregnancy, clinical pregnancy, and live birth rates. Five RCTs met our inclusion criteria with a total number of 989 patients. We found endometrial scratch significantly improved the biochemical and clinical pregnancy rates in comparison with the control group among women with previous IUI failure (p < 0.001). Moreover, the live birth rate was significantly increased among the endometrial scratch group (RR = 2.00, 95% CI [1.20, 3.34], p = 0.008). In conclusion, endometrial scratch is effective in improving pregnancy outcomes among women with previous IUI failure. More trials are required to confirm our findings.

Titrated oral misoprostol versus static regimen of oral misoprostol for induction of labour: a systematic review and meta-analysis.

We aimed to conduct a systematic review and meta-analysis to compare the efficacy and safety of titrated oral misoprostol versus static oral misoprostol for labour induction. We searched for the available randomised clinical trials (RCTs) in the Cochrane Library, PubMed, ISI web of science, Scopus, and ClinicalTrials.gov. We included RCTs compared titrated oral misoprostol versus static regimen of oral misoprostol during labour induction. Our main outcomes were vaginal and caesarean delivery rates, uterine tachysystole, misoprostol side effects, and neonatal adverse events. Three RCTs met our inclusion criteria with a total number of 360 patients. The vaginal delivery rate did not significantly differ between both groups (p = 0.49). Titrated oral misoprostol was associated with significant increase in the caesarean delivery rate compared to static oral misoprostol (p = 0.04). Moreover, titrated oral misoprostol led to significant increase in the uterine tachysystole and misoprostol side effects (p = 0.01 & p = 0.003, respectively). There were no differences among both groups regarding different neonatal adverse events. In conclusion, titrated oral misoprostol increases the incidence of caesarean delivery, uterine tachysystole, and misoprostol side effects with a similar vaginal delivery rate compared to static dose misoprostol. Thus, static oral misoprostol should be used instead of titrated oral misoprostol during labour induction. Impact StatementWhat is already known on this subject? Different studies have evaluated titrated oral misoprostol administration for induction of labour and proved their efficacy in comparison with other induction methods. However, there is controversy among the published studies between titrated oral misoprostol and static oral misoprostol during induction of labour. A recent study concluded that hourly titrated misoprostol and static oral misoprostol are equally safe and effective when utilised for induction of labour with no fear of any adverse events. However, another study recommended static oral misoprostol administration for labour induction as it was linked to a lower caesarean section incidence, fewer drug side effects, and decline in complication rates in comparison with titrated oral misoprostol.What the results of this study add? Titrated oral misoprostol increases the incidence of caesarean delivery, uterine tachysystole, and misoprostol side effects with a similar vaginal delivery rate compared to static dose misoprostol.What the implications are of these findings for clinical practice and/or further research? Static oral misoprostol should be used instead of titrated oral misoprostol during labour induction. More future trials are required to confirm our findings.

Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta-analysis of randomized controlled trials.

AIM: To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. METHODS: A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy. Revman software was utilized for performing our meta-analysis. Our primary outcomes were pain scores evaluated by the visual analog scale (VAS) during and after the procedure. Our secondary outcome was the patient satisfaction between both groups. RESULTS: Five RCTs met our inclusion criteria with a total number of 441 patients. We found warm saline was linked to a significant reduction in the VAS pain score during the procedure compared to the control group (mean difference [MD] = -1.12, 95% confidence interval [CI] [-1.80, -0.45], p = 0.001). Moreover, the VAS pain score after the procedure was significantly declined among the warm saline group (MD = -0.62, 95% CI [-0.97, -0.27], p = 0.005). Interestingly, more patients were significantly satisfied with warm saline distension medium application compared to room temperature group (odds ratio [OR] = 3.71, 95% CI [2.01, 6.86], p < 0.001). CONCLUSIONS: Warm saline application in office hysteroscopy is effective in reducing pain during and after the procedure as well as improvement in patient satisfaction.

The Effect of Low Molecular Weight Heparin in Recurrent Pregnancy Loss: Changes in Radial Uterine Artery Blood Flow and Peripheral Blood NK Cell Fraction.

Immunological alteration has been suggested as a cause of unexplained early recurrent pregnancy loss (RPL). Natural killers (NKs) have been reported to play a role in vascular remodeling of decidual vessels. We aimed to find out if there is a relationship between peripheral blood NKs (pbNKs) and uterine radial artery (uRA) blood flow, and if low molecular weight heparin (LMWH) is effective in improving uRA blood flow in RPL cases and pregnancy outcome. The study was conducted on 30 pregnant women (5-7 weeks gestation) with ≥ 2 RPL and control group including 30 healthy pregnant women. The frequency of pbNKs (CD3 negative/CD56+CD16 positive) was measured using flow cytometry. Uterine color-pulsed doppler ultrasound was performed to evaluate uterine radial artery resistance index (uRA-RI). LMWH was administered daily in RPL cases with elevated uRA-RI (≥0.5) and uRA-RI was reassessed one week later. Comparison between cases and controls revealed that uRA-RI was significantly higher in RPL cases than controls (P =0.023), while pbNK frequency showed no significant difference between both groups. Post LMWH treatment, uRA-RI was significantly decreased when compared to pretreatment uRA-RI with mean±SD= (0.48+0.08) and (0.68±0.09) respectively (P=0.007). There was significant correlation of uRA-RI with number of abortions. There was no significant correlation of pbNK% with URa-RI (r=0.125 P=0.509) in RPL group. We concluded that LMWH treatment carries potentiality of improving pregnancy outcome in cases of RPLs with elevated uRA-RI. No significant correlation of NK% with uRA-RI, which denies the association of pbNK and RPL and raises questions about impact of pbNK cell testing in RPL.