Papers by Refaat Alsheemy
Abstract: Background: Few histopathologic studies of lower uterine segment and Cesarean section s... more Abstract: Background: Few histopathologic studies of lower uterine segment and Cesarean section scar have been
published compared with that in other tissues. Our objective was to describe the incidence of various
histopathological findings at the site of cesarean section scar defect (niche) and to determine its relation to
gynecological symptoms in women with history of previous CS to acquire a better understanding of possible
aberrations in uterine wound healing. Methods: The study included 44 non-pregnant women with abnormal
gynecological symptoms, history of at least 1 cesarean delivery and their transvaginal ultrasound revealed a cesarean
section scar defect (niche) at the uterus. Cases were divided into 2 groups, group A (24 cases) had no other
associated pathology and group B (20 cases) with a cesarean section scar defect and associated pathology such as
uterine fibroid considered as control group. The parity, number of previous cesarean deliveries, time elapsed
between last cesarean delivery and first consultation, the width and depth of the defect and its shape and distance
from the internal os by transvaginal ultrasound were recorded for each case, biopsy was taken from the defect after
hysterectomy of all cases. A histopathological study for all specimens was done. The pathological findings were
correlated to the clinical and ultrasonographic findings in both groups. Results: Women with a previous CS could
have a gynecological symptoms related to the CS scar defect as abnormal uterine bleeding, dysmenorrhea and
chronic pelvic pain and the most frequent clinical symptom related to the scar defect is postmenstrual spotting.
Large defect size is a risk factor for more clinical symptoms especially postmenstrual bleeding. Also larger defects
are associated with more histopathological changes such as congested endometrial fold, distortion of lower uterine
segment and disorganized muscle fibers. High scars are associated with more clinical symptoms and
histopathological changes. Multiple cesarean sections is a risk factor for larger cesarean scar defects, increased
clinical symptoms and associated with increased histopathological changes at the defect site. Conclusion: The
present study shed light on the role of histopathological study in detection of macroscopic and microscopic changes
related to the cesarean scar defects and the possible relation between these changes and clinical presentations of
those patients. Histopathological changes of such as congested endometrial fold, distortion of lower uterine segment
and disorganized muscle fibers at the niche site are risk factors for abnormal gynecological symptoms. There is no
doubt that further studies should be carried out in order to gain better understanding of the nature of niche and to
have a better management of it.
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Abstract: Background: Excessive menstrual loss, or menorrhagia, is a significant health care pr... more Abstract: Background: Excessive menstrual loss, or menorrhagia, is a significant health care problem in the
developed world. Surgical management had been the standard of treatment in menorrhagia due to organic causes (eg,
fibroids) or when medical therapy fails to alleviate symptoms. A number of minimally invasive treatment options
are now available, but the final consensus on the best treatment modality is still to be determined. The novel
operation of bilateral uterine artery ligation (BUAL operation) as an alternative to hysterectomy seems to be a
promising treatment of both menorrhagia and most of the associated uterine pathology. Our objective: was to
determine the feasibility of transvaginal bilateral uterine artery ligation as a conservative minimally invasive
treatment for refractory menorrhagia. Methods: The study included 50 women of gynecology outpatient department
of Damietta university hospital (Al-Azhar University) attendants with refractory menorrhagia; where other types of
therapy as medical and hormonal had failed to control the bleeding. For all cases; pre and post-procedural clinical
assessment and ultrasound Doppler study were done to evaluate the changes. Results: At 12 months postoperative,
there was a statistically significant decrease in the following measured outcomes: menstrual blood loss (84%);
dysmenorrhea (85.7%); dyspareunia (33.3%); uterine volume (30.1%). Conclusion: Transvaginal bilateral uterine
artery ligation(VBUAL) was found to be a safe, efficacious, feasible, cost-effective procedure with good patient
satisfaction rates with a conservative approach for treating refractory menorrhagia.
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Abstract:Background: Adverse perinatal outcomes in patients with polyhydramnios have been associa... more Abstract:Background: Adverse perinatal outcomes in patients with polyhydramnios have been associated with
congenital fetal anomalies in numerous studies. Perinatal morbidity and mortality rates also significantly
increase.The etiologic factors of polyhydramnios are varied and may include maternal and fetal conditions such as
congenital anomalies, diabetes mellitus, isoimmunization, multiple gestations, and placental abnormalities. But the
cause of polyhydramnios remains idiopathic in most cases (60%). Ratios of the fetal Doppler parameters provide the
clearest evidence of deterioration in the fetal condition, there is a controversy regarding the value of middle cerebral
artery Doppler ultrasound as a single parameter in assessing the fetal wellbeing. However a combination of multiple
fetal vessels Doppler study as umbilical, aorta, renal and middle cerebral artery may be more accurate. Methods:
Group1 (Control): This group consisted of 50 pregnant women with no polyhydramnios. Group 2 (study): This
group consisted of 50 pregnant women complicated by idiopathic polyhydramnios (amniotic fluid index ≥ 24cm).
We were done Doppler US study of fetal vessels including umbilical, descending thoracic aorta, renal artery (RA)
and MCA. Peak systolic volume of the MCA and renal arteryand RA/MCA pulsatile index were done. Results:
There was significant increase in the mean PI of both umbilical artery and fetal descending aorta (0.76-0.98) and
(1.55-2.34) respectively in the cases of polyhydraminos if compared with the controls.The mean PSV of both the
UA and fetal descending aorta was reduced below accepted reference values for gestation (40.13--68.47) and
(69.03—144.2) respectively in the cases of polyhydramnios denoting brain sparing in case of hypoxia when
compared with the controls. Conclusions: Middle cerebral artery pulsatility index Doppler velocimetry is
considered more valid for prediction of the fetal outcome compared with the renal artery. Middle cerebral artery has
the highest negative predictive value (87.9%) than the renal artery (80%). Therefore middle cerebral artery Doppler
indices may be useful in identifying those fetuses not likely to have a major perinatal outcome. Our preliminary
results suggest that RA/MCA ratio may be a predictor of fetal outcome.
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Papers by Refaat Alsheemy
published compared with that in other tissues. Our objective was to describe the incidence of various
histopathological findings at the site of cesarean section scar defect (niche) and to determine its relation to
gynecological symptoms in women with history of previous CS to acquire a better understanding of possible
aberrations in uterine wound healing. Methods: The study included 44 non-pregnant women with abnormal
gynecological symptoms, history of at least 1 cesarean delivery and their transvaginal ultrasound revealed a cesarean
section scar defect (niche) at the uterus. Cases were divided into 2 groups, group A (24 cases) had no other
associated pathology and group B (20 cases) with a cesarean section scar defect and associated pathology such as
uterine fibroid considered as control group. The parity, number of previous cesarean deliveries, time elapsed
between last cesarean delivery and first consultation, the width and depth of the defect and its shape and distance
from the internal os by transvaginal ultrasound were recorded for each case, biopsy was taken from the defect after
hysterectomy of all cases. A histopathological study for all specimens was done. The pathological findings were
correlated to the clinical and ultrasonographic findings in both groups. Results: Women with a previous CS could
have a gynecological symptoms related to the CS scar defect as abnormal uterine bleeding, dysmenorrhea and
chronic pelvic pain and the most frequent clinical symptom related to the scar defect is postmenstrual spotting.
Large defect size is a risk factor for more clinical symptoms especially postmenstrual bleeding. Also larger defects
are associated with more histopathological changes such as congested endometrial fold, distortion of lower uterine
segment and disorganized muscle fibers. High scars are associated with more clinical symptoms and
histopathological changes. Multiple cesarean sections is a risk factor for larger cesarean scar defects, increased
clinical symptoms and associated with increased histopathological changes at the defect site. Conclusion: The
present study shed light on the role of histopathological study in detection of macroscopic and microscopic changes
related to the cesarean scar defects and the possible relation between these changes and clinical presentations of
those patients. Histopathological changes of such as congested endometrial fold, distortion of lower uterine segment
and disorganized muscle fibers at the niche site are risk factors for abnormal gynecological symptoms. There is no
doubt that further studies should be carried out in order to gain better understanding of the nature of niche and to
have a better management of it.
developed world. Surgical management had been the standard of treatment in menorrhagia due to organic causes (eg,
fibroids) or when medical therapy fails to alleviate symptoms. A number of minimally invasive treatment options
are now available, but the final consensus on the best treatment modality is still to be determined. The novel
operation of bilateral uterine artery ligation (BUAL operation) as an alternative to hysterectomy seems to be a
promising treatment of both menorrhagia and most of the associated uterine pathology. Our objective: was to
determine the feasibility of transvaginal bilateral uterine artery ligation as a conservative minimally invasive
treatment for refractory menorrhagia. Methods: The study included 50 women of gynecology outpatient department
of Damietta university hospital (Al-Azhar University) attendants with refractory menorrhagia; where other types of
therapy as medical and hormonal had failed to control the bleeding. For all cases; pre and post-procedural clinical
assessment and ultrasound Doppler study were done to evaluate the changes. Results: At 12 months postoperative,
there was a statistically significant decrease in the following measured outcomes: menstrual blood loss (84%);
dysmenorrhea (85.7%); dyspareunia (33.3%); uterine volume (30.1%). Conclusion: Transvaginal bilateral uterine
artery ligation(VBUAL) was found to be a safe, efficacious, feasible, cost-effective procedure with good patient
satisfaction rates with a conservative approach for treating refractory menorrhagia.
congenital fetal anomalies in numerous studies. Perinatal morbidity and mortality rates also significantly
increase.The etiologic factors of polyhydramnios are varied and may include maternal and fetal conditions such as
congenital anomalies, diabetes mellitus, isoimmunization, multiple gestations, and placental abnormalities. But the
cause of polyhydramnios remains idiopathic in most cases (60%). Ratios of the fetal Doppler parameters provide the
clearest evidence of deterioration in the fetal condition, there is a controversy regarding the value of middle cerebral
artery Doppler ultrasound as a single parameter in assessing the fetal wellbeing. However a combination of multiple
fetal vessels Doppler study as umbilical, aorta, renal and middle cerebral artery may be more accurate. Methods:
Group1 (Control): This group consisted of 50 pregnant women with no polyhydramnios. Group 2 (study): This
group consisted of 50 pregnant women complicated by idiopathic polyhydramnios (amniotic fluid index ≥ 24cm).
We were done Doppler US study of fetal vessels including umbilical, descending thoracic aorta, renal artery (RA)
and MCA. Peak systolic volume of the MCA and renal arteryand RA/MCA pulsatile index were done. Results:
There was significant increase in the mean PI of both umbilical artery and fetal descending aorta (0.76-0.98) and
(1.55-2.34) respectively in the cases of polyhydraminos if compared with the controls.The mean PSV of both the
UA and fetal descending aorta was reduced below accepted reference values for gestation (40.13--68.47) and
(69.03—144.2) respectively in the cases of polyhydramnios denoting brain sparing in case of hypoxia when
compared with the controls. Conclusions: Middle cerebral artery pulsatility index Doppler velocimetry is
considered more valid for prediction of the fetal outcome compared with the renal artery. Middle cerebral artery has
the highest negative predictive value (87.9%) than the renal artery (80%). Therefore middle cerebral artery Doppler
indices may be useful in identifying those fetuses not likely to have a major perinatal outcome. Our preliminary
results suggest that RA/MCA ratio may be a predictor of fetal outcome.
published compared with that in other tissues. Our objective was to describe the incidence of various
histopathological findings at the site of cesarean section scar defect (niche) and to determine its relation to
gynecological symptoms in women with history of previous CS to acquire a better understanding of possible
aberrations in uterine wound healing. Methods: The study included 44 non-pregnant women with abnormal
gynecological symptoms, history of at least 1 cesarean delivery and their transvaginal ultrasound revealed a cesarean
section scar defect (niche) at the uterus. Cases were divided into 2 groups, group A (24 cases) had no other
associated pathology and group B (20 cases) with a cesarean section scar defect and associated pathology such as
uterine fibroid considered as control group. The parity, number of previous cesarean deliveries, time elapsed
between last cesarean delivery and first consultation, the width and depth of the defect and its shape and distance
from the internal os by transvaginal ultrasound were recorded for each case, biopsy was taken from the defect after
hysterectomy of all cases. A histopathological study for all specimens was done. The pathological findings were
correlated to the clinical and ultrasonographic findings in both groups. Results: Women with a previous CS could
have a gynecological symptoms related to the CS scar defect as abnormal uterine bleeding, dysmenorrhea and
chronic pelvic pain and the most frequent clinical symptom related to the scar defect is postmenstrual spotting.
Large defect size is a risk factor for more clinical symptoms especially postmenstrual bleeding. Also larger defects
are associated with more histopathological changes such as congested endometrial fold, distortion of lower uterine
segment and disorganized muscle fibers. High scars are associated with more clinical symptoms and
histopathological changes. Multiple cesarean sections is a risk factor for larger cesarean scar defects, increased
clinical symptoms and associated with increased histopathological changes at the defect site. Conclusion: The
present study shed light on the role of histopathological study in detection of macroscopic and microscopic changes
related to the cesarean scar defects and the possible relation between these changes and clinical presentations of
those patients. Histopathological changes of such as congested endometrial fold, distortion of lower uterine segment
and disorganized muscle fibers at the niche site are risk factors for abnormal gynecological symptoms. There is no
doubt that further studies should be carried out in order to gain better understanding of the nature of niche and to
have a better management of it.
developed world. Surgical management had been the standard of treatment in menorrhagia due to organic causes (eg,
fibroids) or when medical therapy fails to alleviate symptoms. A number of minimally invasive treatment options
are now available, but the final consensus on the best treatment modality is still to be determined. The novel
operation of bilateral uterine artery ligation (BUAL operation) as an alternative to hysterectomy seems to be a
promising treatment of both menorrhagia and most of the associated uterine pathology. Our objective: was to
determine the feasibility of transvaginal bilateral uterine artery ligation as a conservative minimally invasive
treatment for refractory menorrhagia. Methods: The study included 50 women of gynecology outpatient department
of Damietta university hospital (Al-Azhar University) attendants with refractory menorrhagia; where other types of
therapy as medical and hormonal had failed to control the bleeding. For all cases; pre and post-procedural clinical
assessment and ultrasound Doppler study were done to evaluate the changes. Results: At 12 months postoperative,
there was a statistically significant decrease in the following measured outcomes: menstrual blood loss (84%);
dysmenorrhea (85.7%); dyspareunia (33.3%); uterine volume (30.1%). Conclusion: Transvaginal bilateral uterine
artery ligation(VBUAL) was found to be a safe, efficacious, feasible, cost-effective procedure with good patient
satisfaction rates with a conservative approach for treating refractory menorrhagia.
congenital fetal anomalies in numerous studies. Perinatal morbidity and mortality rates also significantly
increase.The etiologic factors of polyhydramnios are varied and may include maternal and fetal conditions such as
congenital anomalies, diabetes mellitus, isoimmunization, multiple gestations, and placental abnormalities. But the
cause of polyhydramnios remains idiopathic in most cases (60%). Ratios of the fetal Doppler parameters provide the
clearest evidence of deterioration in the fetal condition, there is a controversy regarding the value of middle cerebral
artery Doppler ultrasound as a single parameter in assessing the fetal wellbeing. However a combination of multiple
fetal vessels Doppler study as umbilical, aorta, renal and middle cerebral artery may be more accurate. Methods:
Group1 (Control): This group consisted of 50 pregnant women with no polyhydramnios. Group 2 (study): This
group consisted of 50 pregnant women complicated by idiopathic polyhydramnios (amniotic fluid index ≥ 24cm).
We were done Doppler US study of fetal vessels including umbilical, descending thoracic aorta, renal artery (RA)
and MCA. Peak systolic volume of the MCA and renal arteryand RA/MCA pulsatile index were done. Results:
There was significant increase in the mean PI of both umbilical artery and fetal descending aorta (0.76-0.98) and
(1.55-2.34) respectively in the cases of polyhydraminos if compared with the controls.The mean PSV of both the
UA and fetal descending aorta was reduced below accepted reference values for gestation (40.13--68.47) and
(69.03—144.2) respectively in the cases of polyhydramnios denoting brain sparing in case of hypoxia when
compared with the controls. Conclusions: Middle cerebral artery pulsatility index Doppler velocimetry is
considered more valid for prediction of the fetal outcome compared with the renal artery. Middle cerebral artery has
the highest negative predictive value (87.9%) than the renal artery (80%). Therefore middle cerebral artery Doppler
indices may be useful in identifying those fetuses not likely to have a major perinatal outcome. Our preliminary
results suggest that RA/MCA ratio may be a predictor of fetal outcome.