Letrozole, an aromatase inhibitor, has recently been introduced as a favorable medical treatment for ectopic pregnancy. We aimed at evaluating the effects of different doses of letrozole for termination of ectopic pregnancy and study their effects on villous trophoblastic tissue. Sixty patients with undisturbed ectopic pregnancy were classified into three equal groups. Group I: the control group that contained women who underwent laparoscopic salpingectomy, Group II: patients who received letrozole (5 mg day−1) for 10 days, and Group III: patients who received letrozole (10 mg day−1) for 10 days. Subsequently, the β-hCG levels were determined on the first day and after 11 days of treatment. Group IV consisted of patients of GII and GIII; their β-hCG did not drop below 100 mIU/ml within 11 days, and underwent salpingectomy. Placental tissues from patients undergoing salpingectomy either from the control group or GIV were processed for the evaluation of estrogen (ER) and progesterone (PR) receptors, vascular endothelial growth factor (VEGF), and cleaved caspase 3 (CC-3) expression. Cases exposed to high dose letrozole 10 mg day−1 resulted in a higher ectopic pregnancy resolution rate of 85% (17/20), while the resolution rate of the low dose letrozole-treated group (5 mg day−1) was 65% (13/20), and also showed a significant reduction in β-hCG levels on the 11th day, 25.63 ± 4.29 compared to the low dose letrozole group 37.91 ± 7.18 (P < 0.001), Meanwhile, the letrozole-treated group GIV showed markedly reduced expression of ER, PR, and VEGF and a significant increase in the apoptotic index cleaved caspase-3 compared to the control group (P < 0.001). The utilization of letrozole at a dose of 10 mg day−1 for medical treatment of ectopic pregnancy results in a high-successful rate without any severe side effects. Letrozole depriving the placenta of estrogen that had vascular supporting signals resulted in destroying the vascular network with marked apoptosis. Graphical abstract

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Background: Overactive bladder (OAB), a clinical condition with chronic, complex symptoms that negatively affect quality of life (QoL) and affects a large section of the population. Beta-3 adrenergic agonists that provides a different mode of action and are still in the early stages of development, are being used more frequently than antimuscarinics to treat OAB.Aim: To compare between antimuscarinics and a beta-adrenergic agonist (mirabegron) regarding efficacy and side effects in treatment of adult female with overactive bladder. Patients and methods: This prospective trial was carried out in the Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University on 82 female patients with OAB. Patient groups were divided into two groups (mirabegron 50 mg n = 41 and tolterodine 4 mg n = 41). Results: There was a significant difference between each group's baseline and final assessment in terms of post-void residual urine, number of micturitions, urgency episodes, incontinence episodes, and urgency incontinence episodes/24 h, volume voided/micturition, number of nocturia episodes, and number of incontinences. The only significant difference between the two groups was a lower number of nocturia episodes in mirabegron than tolterodine. Conclusion:In the Egyptian population, with a low incidence of side effects, mirabegron 50 mg and tolterodine 4 mg are efficient therapies for OAB symptoms.

Background: cesarean scar niche is one of the novels mentioned complications of cesarean section due to the rising numbers of cesarean sections and improved imaging modalities. The causes of cesarean scar niche are still being investigated, one of them is the uterine closure method that should be studied to pick up the best one to decrease the incidence of niche after cesarean delivery. Objective: The aim of this work was to find the best way of uterine closure decreasing the incidence of cesarean section niche. Material and methods: A prospective randomized controlled study that was conducted between May 2021 and April 2022 at the department of Obstetrics and Gynecology, Zagazig University. Full term ninety-eight primigravida undergoing first elective cesarean section were equally randomized to either purse string or double-layer unlocked suture. Six months after cesarean section, Sonohysterography was done for assessment of cesarean scar integrity. Markers of cesarean scar healing included residual myometrial thickness "RMT", niche depth "D", hypoechoic triangular niche width "W" and healing ratio "D/RMT". All these markers were calculated by experienced sonographers who were not aware of the uterine closure technique. Results: In terms of estimated blood loss, there was no significant differences between both groups. However, frequency of appearance of niche in purse-string group was 25% compared to 56.8% in the double layer group (P=0.002). The mean thickness of the residual myometrium covering the defect was significantly higher 7.8 ± 1.1 mm after purse-string than 5.9 ± 0.6 mm after a double-layer closure (P = 0.001). The mean healing ratio in purse-string group was 0.449 versus 0.600 in the double-layer closure (p<0.001). Conclusion: Purse-string uterine closure was associated with better uterine scar healing, higher residual myometrial thickness and lower rate of cesarean scar defect than double layer closure.

background: inguinal hernia in females is rare. At the time of pregnancy, a rare condition can evolve, round ligament varicosities, which is difficult to differentiate for the inguinal hernia on clinical bases. Ultrasonography with Doppler study differentiates the two conditions. Round ligament varicosities disappear spontaneously after delivery, while inguinal hernia needs surgical repair. This study aimed to highlight a cause of groin swelling in females during pregnancy, round ligament varicosities, and the feasibility of inguinal hernia repair during the elective cesarean section. Patients and methods: A prospective study of 17 pregnant patients presented with inguinal swelling. Ultrasonography was the cornerstone investigation for these patients that revealed round ligament varicosities in most patients and only four inguinal hernia cases. Patients with round ligament varicosities managed conservatively. Patients with hernia offered to repair the hernia during the cesarean section. Results: 17 pregnant patients presented with reducible inguinal swelling with impulse on cough. Most patients 14/17 presented with inguinal swelling without pain, while 3/17 patients had inguinal swelling and pain. The total patients with inguinal hernias were 4 patients; two of them were diagnosed before the occurrence of the pregnancy, and two patients during pregnancy. Thirteen patients with inguinal swelling had round ligament varicosities by ultrasound examination. Conclusion: The diagnosis of an inguinal hernia depending on the clinical picture only during pregnancy may be misleading in most cases. Concomitant preperitoneal inguinal hernioplasty with cesarean section is feasible.