Oxytocin gel is useful in the restoration of the vaginal epithelium in cases of postmenopausal atrophic vaginitis. Further studies with a longer follow-up period are required to test the long-term effects of oxytocin as a treatment for vaginal atrophy.

Introduction Misoprostol is used for the medical management of miscarriage as it is more effective in the early stages of pregnancy. Letrozole has an anti-estrogen effect and is used for the pretreatment of miscarriage with misoprostol. Aim The aim of this study was compare the efficacy and safety of letrozole with placebo pretreatment in the medical management of first trimester missed miscarriage. Design This was a prospective randomized case-control study. Patients and Methods Four hundred and thirty-eight women were randomly divided into two groups of 219; the placebo group received placebo tablets twice daily for 3 days, followed by 800 micrograms of misoprostol vaginally on the fourth day of enrolment, while the letrozole group received letrozole 10 mg twice daily for three days followed by 800 micrograms misoprostol administered vaginally. Symptoms and side effects were recorded, and the women advised to return to hospital if they experienced severe pain or bleeding or intolerable side effects and to report to hospital for a check-up one week after misoprostol administration. Ultrasound was done seven days after misoprostol administration to monitor outcomes. Surgical evacuation was carried out if medical management failed. Results There were significant differences between the two groups, with better outcomes found for the letrozole group in terms of rates of complete miscarriage, onset of vaginal bleeding, and interval between induction and onset of expulsion (p < 0.001). A higher rate of nausea and vomiting was reported for the letrozole group (p = 0.002). Differences between groups with regard to pre- and post-termination hemoglobin levels, fever, severe pain and severe bleeding needing evacuation were not statistically significant. Conclusion Adding letrozole to misoprostol improves the success rate and decreases the interval between induction and expulsion in cases of first trimester miscarriage; however, nausea and vomiting is higher with letrozole.

Objective: To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). Design: Systematic review and network meta-analysis of randomized controlled trials. Setting: Not applicable. Patient(s): Pre-or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. Intervention(s): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Main Outcome Measure(s): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. Result(s): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score ¼ 0.83) and immediately after OEB (P-score ¼ 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score ¼ 1.00), followed by misoprostol plus lidocaine (P-score ¼ 0.87). Conclusion(s):Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA. (Fertil Steril Ò 2019;112:140-8. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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Background: Delivery by ceasarean section is one of the most common surgical procedures nowadays. However, Choosing of anesthesia is a matter of controversy among obstetrician. Objective:To study the effect of two types of anesthesia on maternal hemoglobin and hematocrit level after elective cesarean section. Patients and methods:This was a randomized controlled study done at Sayed Galal University hospital and private centers (Tbarak Private Hospital Group) including 100 pregnant women underwent elective first time ceasarean section for variables causes. Changes in maternal hemoglobin and hematocrit indices were measured.Result: There was statistically significant difference between both groups after 48th hour post ceasarean section. Mean 48 hours postoperative hemoglobin and hematocrit parameter differences were significantly lower in the group with spinal anesthesia. Conclusion:Spinal anesthesia was better and has a greater advantage for maternal condition than general anesthesia as regard post-operative blood indices changes. So, whenever it is not contraindicated, spinal anesthesia should be recommended for elective ceasarean section.