Background: Iron deficiency anemia (IDA) is considered one of the leading problems in pregnancy.Objective: To compare the impact of doubling the standard dose of oral iron ferrous fumarate versus I.V iron sucrose to improve Hb, and S.ferritin levels in pregnancy for those women suffering from IDA between fourteen and thirty four week of gestation. Patients and Methods:This was a controlled randomized clinical trial done over five hundred women with gestational age between fourteen and thirty four weeks in the department of Obstetrics and Gynecology at Al-Sayd Galal Hospital, from June 2019 to October 2020. All pregnant women included were counselled with an informed consent obtained before beginning of this study. Pregnant women were randomly divided into 2 equal groups: Group A for ferrous fumarate oral iron therapy while Group B for parenteral iron sucrose therapy. Pregnant women precipitating in this study were asked for medical history in details. Also they had undergone clinical examination and laboratory investigations including CBC and S. ferritin pretreatment and post treatment. Results:The parenteral iron sucrose had more significant results than doubling the dose of ferrous fumarate oral iron treating IDA women during pregnancy. Few side effects were detected, and thus, it considered as a useful and alternative formulation in treatment of IDA. So, i.v iron sucrose infusion was more favorable for doubling the standard dose of ferrous fumarate as anaphylaxis risk was minimal. On the contrary, noncompliance to ferrous fumarate oral iron increased with doubling the dose. Parental iron showed a faster and more significant response than that for oral iron because of increased amount of iron available for Hb synthesis in the bone marrow when treating women using I.V iron therapy. Conclusion:Parenteral iron sucrose has better results than that when using double the standard dose oral iron ferrous fumarate treating IDA in women during pregnancy as I.V iron improves the concentration of Hb and S.ferritin more significant than oral iron therapy.

Background: Recurrent pregnancy loss is still a challenging obstetric condition. It linked to impaired uterine blood, and vasodilators seem to prevent recurrent pregnancy loss. The aim of the work:The current study aimed to compare between investigate the Doppler uterine artery indices in females with recurrent pregnancy loss [unexplained]. It also aimed to study the effect of intravaginal isosorbide mononitrate, on the pattern of uterine blood flow. Materials and Methods: This observational, nested case control study had been completed at Al-Azhar University Hospitals. Two groups of females [each 50 females] were studied. The control group [females with no previous pregnancy loss and have a viable child or more]. The study group [females with history of unexplained recurrent pregnancy loss]. Vaginal color Doppler ultrasound was done to assess pulsation and resistance indices of uterine arteries in the mid-luteal phase of the cycle. Then, 20 mg of isosorbide mononitrate was applied vaginally and measurement of the vascular indices were registered after two hours again. Both groups were compared and the effect of isosorbide mononitrate on the uterine artery vascular indices the study group was documented.Results: Higher uterine artery resistance and pulsation indices are noticed in females with recurrent pregnancy. A significant reduction in these indices was found after vaginal application of Isosorbide mononitrate. Both groups were comparable regarding patient demographics. Doppler indices were significantly lower in control than study group. The endometrial thickness was negatively correlated with right RI and left PI (r = -0.328, -0.342, p = 0.039 and 0.031, respectively). Conclusion:Poor uterine perfusion is associated with spontaneous abortion. The vaginal application of isosorbide mononitrate, nitric oxide donor could be an effective treatment for the correction of uterine vasculature in patients with recurrent pregnancy loss.