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Introduction: Treatment of refractory thin endometrium during IVF is a relatively challenging problem, considering that optimal endometrium thickness is one of the critical factors for successful implantation and pregnancy. Autologous intrauterine platelet-rich plasma (PRP) infusion is an adjuvant therapeutic alternative for enhancing the endometrial thickness (EMT) and echo pattern. It was shown that PRP could expand EMT and improve pregnancy outcomes with its high content of growth factors and cytokines, and its role in the regulation of the immunological interaction between the embryo and the endometrium. The aim of the study is to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF. Material and methods: A prospective study in Ain Shams University Hospital including 66 infertile women with a refractory thin endometrium below 7 mm by ultrasound on the day of human chorionic gonadotropin injection in fresh embryo transfer (ET) cycle, who did not respond to standard medical therapies after more than 2 cycles of previous medical therapy, and who were candidates for IVF cycle were given intrauterine PRP. Results: A significant increase in EMT was noted and enhancement of endometrial pattern after intrauterine PRP infusion in the days of ovum pick-up and ET. There was also a significant increase in ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, while the miscarriage rate decreased after PRP infusion. Conclusions: Intrauterine PRP infusion improved ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, in addition to EMT and pattern on the days of ovum pick-up and ET, while the miscarriage rate significantly decreased.

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AIM: To evaluate the role of uterine natural killer (uNK) CD56dim and CD16+ cells in patients with refractory antiphospholipid, antibody-mediated, recurrent, pregnancy loss. SETTINGS AND DESIGN: A case-control study was conducted between 2012 and 2015 at a university hospital. PATIENTS AND METHODS: A group of 118 women with a history of antiphospholipid antibody syndrome experiencing fetal loss in spite of low dose aspirin (LDA) and low molecular weight heparin (LMWH) treatment in the current pregnancy were included in this study. A group of 32 patients undergoing an elective termination of viable pregnancies before 20 weeks were taken as controls. Suction evacuation was performed to collect abortus specimens, and uterine wall curettage was performed to collect decidua specimens, which were then stained using monoclonal antibodies specific to CD56 and CD16. STATISTICS: Statistical analyses were performed using the Statistical Package for the Social Sciences version 18 software. Chi-square and Fisher exact tests were used for making comparison between the groups. RESULTS: Abnormal fetal karyotype was found in nine (9/97) cases of the study group, which means that abnormal karyotype accounts for only 9.3% of the causes of failure of treatment. Abnormal karyotype was found in four cases of the control group. Only cases with normal karyotyping were subjected to decidual uNK cells analysis. We found that CD56dim and CD16+ were found in the decidua of 79 cases (79/97), which means that aberrant natural killer cells expression might account for 81.4% of the cases of refractory antiphospholipid antibody (APA)-mediated recurrent pregnancy loss. CONCLUSION: CD56dim and CD16+ uNK cells might be correlated with refractory APA-mediated recurrent pregnancy loss.

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AIM: The aim of this study was to evaluate the volume of blood loss, wound incision time and wound complication according to use of scalpel or electrosurgery during the creation of transverse abdominal incisions during repeated cesarean section (CS). MATERIAL AND METHODS: A randomized controlled trial was carried out at Ain Shams University Maternity Hospital. We recruited 130 women with a history of one previous CS at the time of their planned lower-segment CS. Participants were randomized to anterior abdominal wall opening from subcutaneous tissue till the peritoneum by either the use of scalpel with disposable blade (No. 22) or diathermy using the standard diathermy pen electrode. The main outcome measures were the volume of blood loss from skin incision to the end of the peritoneal incision, the operative time and wound complication. RESULTS: We observed a highly significant difference between the two groups in blood loss (median [interquartile range], 11 [8-15.25] g for the diathermy group vs 20 [18-23] g for the scalpel group, P < 0.001) and skin-to-peritoneum incision time (median [interquartile range], 7 [5-7.25] min for the diathermy group vs 10 [7-11] min for the scalpel group, P < 0.001). The postoperative pain was less in the diathermy group but wound complications showed no statistical difference. CONCLUSION: The use of diathermy in the opening of anterior abdominal wall during CS decreases blood loss and operative time but has no impact on postoperative pain or wound complications.

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PURPOSE: To evaluate the efficacy of the use of oral Prednisolone and heparin versus the use of heparin alone in treatment of patients with unexplained recurrent miscarriage. METHODOLOGY: The study was a double-blind placebo randomized control trial conducted on 160 patients with unexplained recurrent miscarriage. Patients recruited were randomized into two groups. The first group received oral Prednisolone in addition to low dose aspirin and heparin, while the other group received a placebo in addition to low dose aspirin and heparin. A peripheral venous blood sample was taken from all included patients before starting treatment and collected in heparinized tubes. Natural Killer (NK) cells were checked in each sample and then re-checked in another sample at 20 weeks of gestation. RESULTS: We found that in the prednisolone group, 70.3 % of women had successful outcome (defined as an ongoing pregnancy beyond 20 weeks gestation), while 29.7 % miscarried before this gestation. On the contrary, among women in the placebo group, 9.2 % had successful outcome while 90.8 % miscarried before 20 weeks, which was statistically significant. On the other hand, we found that there were no significant paired differences between initial serum levels of the NK cells markers CD16 and CD56 and their levels at 20 weeks gestation in both groups. CONCLUSION: The addition of prednisolone to heparin and low dose aspirin might be beneficial in patients with unexplained recurrent miscarriage, and this effect might be due to a suppressive effect of steroids on the peripheral CD16 NK cells concentration.

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