The morbid adherent placenta is still a challenge, which faces us as obstetricians, due to high morbidity and mortality. A multidisciplinary team is mandatory to avoid complications.

No abstract

It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Objective: The aim of this trial was to determine whether endometrial scratch-suction caused by insertion tube of (IUCD) with suction improved the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome by removing small polyps and any hazardous materials. Design: Observational prospective cohort experimental study. Setting: Zagazig University Hospital, Obstetrics and Gynecology department. From period between September 2011 till September 2012. Population: 30 patients with previous failed IVF despite transfer of goodquality embryos were allocated to endometrial scratch-suction in the same the cycle of embryo transfer. Methods: From day 5 to day 7 of same ICSI cycle, the patients in study underwent endometrial scratch-suction technique. After preparation of insertion tube of (IUCD) and infant feeding tube 8 F, moving the insertion tube of IUCD from below upwards with scratching anterior uterine wall, then posterior, then left lateral uterine wall, then right lateral uterine wall, then fundus, all these steps are associated with suction by attaching proximal end of infant feeding tube 8 F to suction apparatus. Main Outcome Measures: Implantation and clinical pregnancy rates. Results: The implantation occurred in 24/30 (80%). The clinical pregnancy occurred in 20/30 patients (66.66%). 12/30 patients (40%) during scratch-suction technique had small fleshy masses obstructing suction tube which were small endometrial polyps. Conclusions: Endometrial scratch-suction improves clinical pregnancy and implantation rates in the same IVF-ET cycle in patients with previous unsuccessful IVF cycles.

Objective: The aim of this work is to compare between intraoperative frozen section and scrape smear cytology in the diagnosis of ovarian neoplasm. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The area was scraped with a sharp scalpel or the end of a glass slide, depending upon the type of tissue. A semifluid drop thus obtained was spread over a glass slide. One to four slides per case were taken from different representative areas. The slides were labelled and immediately put into 95% ethyl alcohol and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of benign ovarian masses were 100%, 95.2%, 96.7%, 100% and 98% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of border line ovarian masses were 100%, 93.4%, 25%, 100% and 94% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of malignant ovarian masses were 80%, 100%, 100%, 88.2% and 92% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of benign ovarian masses were 100%, 100%, 100%, 100% and 100% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of borderline * Corresponding author. A. M. Abdelghany et al. 29ovarian masses were 100%, 95.9%, 33.3%, 100% and 96% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of malignant ovarian masses were 90%, 100%, 100%, 93.8% and 96% respectively. Conclusion: Frozen section is more accurate than smear preparations in the intraoperative assessment of ovarian tumors in this study. However, the cytology preparations were helpful in supporting the histological diagnoses, and in some cases, provided additional useful information. Thus, cytology has a complementary role to frozen section in the intraoperative assessment of ovarian lesions. At the centers where the facilities of frozen section are not available, intraoperative scrape cytology is a useful tool for intraoperative diagnosis of tumor.