Background: Intestinal loop evisceration complicates 35-67% of vaginal cuff dehiscence, constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Complications associated with the use of a pessary are rare. They are usually due to loss of patient follow-up or negligent use of the device. Clinical presentation: We present the case of a 94-year-old patient who debuted with vaginal evisceration after vaginal cuff dehiscence, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: EV requires vaginal, abdominal, or mixed repair, generally deferring definitive prolapse treatment to a second stage and we recommend being very careful with the closure of the vaginal vault after any type of hysterectomy

Post-reproductive health is challenging, and menopausal hormone therapy (THM) is surrounded by many controversies. It has witnessed a rise and fall lasting several years. We understand that comorbidity increases its incidence beyond menopause and we need to prevent them. When THM was used universally, the risk-benefit ratio became unfavorable, its use fell dramatically; although more recent studies have introduced the concept of window of opportunity, where THM has no ill effects and will in fact prevent comorbidities associated with menopause.

Background: Gestational diabetes mellitus (GDM) is a major global public health issue, with prevalence increasing in recent years due to the epidemic of obesity and type 2 diabetes. Aim of the Work: to compare different neonatal outcomes according to the different treatment modalities used in the management of GDM. Our hypothesis was that Metformin is as effective and safe as insulin in patients with gestational diabetes. Patients and Methods: The current non inferiority-Randomized controlled trial was conducted at Ain Shams Maternity hospital between June 2020 to February 2021. The study included 140 outpatient cases or admitted patients for antenatal care: Group A: women were given Metformin (Total 70) and Group B: Women were given insulin. (Total 70). Results: there was no significant difference between Metformin and Insulin groups regarding age, enrollment BMI, parity and family history of DM. There was no significant difference between Metformin and Insulin groups regarding gestational age at enrollment and delivery as well as pregnancy duration after intervention. BMI at delivery, BMI increase as well as BMI increase rate were significantly lower in Metformin group. There were no significant differences between Metformin and Insulin groups regarding fasting, two-hour postprandial and HbA1c blood glucose at enrollment and throughout treatment as well as their reduction after intervention. Maternal complications as hypoglycemia, hyperglycemia and preeclampsia were non-significantly less frequent among Metformin group than among Insulin group. Compliance to treatment was significantly more frequent among Metformin group than among Insulin group. Cesarean delivery was non­significantly less frequent among Metformin group than among Insulin group. There was no significant difference between Metformin and Insulin regarding birth weight APGAR-1, but APGAR-5 was significantly higher in Metformin group. Neonatal complications as IUFD, IUGR, macrosomia, congenital anomalies, neonatal hypoglycemia, respiratory distress and NICU admission were non-significantly less frequent among Metformin group. Conclusions: From the results of current study we can conclude that: Oral metformin was effective as insulin injection in control and management of GDM. BMI was controlled with oral metformin better than insulin injection. Maternal and neonatal complications specially birth weight were the same with both types of treatment. Women had better compliance to metformin treatment. Type of delivery wasn’t affected by type of treatment.

Background: Polycystic ovary syndrome (PCOS) is a common metabolic and endocrine disease among women of reproductive-age, which cause prone to psychological symptoms. Aim: The aim of the study is to assess the relationship between PCOS and psychological symptoms. Method: This case control study was conducted in the Gynecology Clinic of a Private University Hospital, Ankara, Turkey in 2016. The study conducted on patients with PCOS who received therapy in Gynecologic Oncology Center of a Private University Hospital in Ankara, Turkey. A total of 80 women with PCOS were administered The Survey Form, Beck Anxiety Index, and Beck Depression Index. Results: The PCOS group showed significantly higher scores of anxiety and depression symptoms compared to controls (p<,05). Age, education, marital status and income level were significantly associated with anxiety and depression scores of women with PCOS (p<,05). Conclusion: Women with PCOS are at risk for anxiety and depression. These results emerged the need of emotional support into clinical process with appropriate interventions as an additional therapy to improve life quality for women with PCOS. Further studies are need to broader understanding of this area.

Background: Thrombocytopenia is correlated to hemorrhagic complications in patients with low molecular weight heparin (LMWH) thromboprophylaxis. Aims: The aims of our study were to investigate an experimentally induced in vitro thrombocytopenia and then adding 2 types of LMWHs in vitro. Our hypothesis was that a platelet depleted whole blood sample could reflect a stronger synergistic anticoagulative effect of in vitro added LMWH than in the non-manipulated blood. Method: Two venous citrated blood samples were consecutively drawn from 8 patient’s gynaecologic cancer and normal routine coagulation laboratory analyses immediately preopewratively. One of the two samples had its buffy coat pipetted away into a separate tube. Half of the buffy coat was returned to the same sample (treated sample). 3x500 µl of blood from the non-treated sample was added to 3 separate microtubes and corresponding for the treated sample. Thromboprophylactic doses corresponding to an in vivo peak effect 0.5 anti-Xa international units/ml of tinzaparin and enoxaparin were added both to untreated and treated samples – 2 microtubes were unheparinized (treated/untreatedsample). All samples were analysed with rotational thromboelastometry (ROTEM). Results: Wilcoxon matched-pairs signed rank tests of the in-group differences between non-non-treated and treated samples showed no significant differences (p=0.05) for any of the parameters analysed with the ROTEM-INTEM reagent regardless of heparinization or not. Calculation of non-parametric spearman correlation for clotting time (CT) vs. platelet count (PLC) were not significant for any group. Tinzaparin was clearly observed to prolong CT in the buffy-coat lowered blood from two patients. Conclusions: Our results corroborate previous research that ROTEM cannot detect anticoagulative effects of low dose LMWH in patients with normal PLC. In two patients there was a clear prolongation of clot initiation after tinzaparin that warrants further studies on a more developed in vitro induced thrombocytopenia model.