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Background Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. Methods This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A) , ( n  = 38) underwent cesarean hysterectomy, group (B) , ( n  = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C) , ( n  = 16): the placenta was left in place. Results The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. Conclusions The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling. Trial registration Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

Ovarian Hyper-stimulation Syndrome (OHSS) is the main iatrogenic problem linked to ovarian stimulation with reproductive medications. Increased vascular permeability is considered the cause of OHSS. It leads to excess fluid flowing from blood vessels into surrounding tissue. Serious consequences include imbalances in electrolytes and impairment of the heart, liver, and kidneys. This study aims to the comparison of the efficacy of calcium gluconate and diosmin combination, cabergoline alone, and a combination of cabergoline and diosmin in preventing OHSS in high-risk individuals undergoing intracytoplasmic sperm injection (ICSI) procedures. A prospective, randomized, single-blind, interventional study was carried out on 180 high-risk females for OHSS. They were divided into three groups, each with 60 women: Group A received IV infusion of calcium gluconate and diosmin. Group B received cabergoline alone. Group C received cabergoline and diosmin. Patients were regularly evaluated using clinical examinations and ultrasound to check for signs of OHSS. The main outcome was the frequency of moderate to severe OHSS. Secondary outcomes were the rates of clinical pregnancy, miscarriage, and live birth. The research demonstrated that there was no significant difference in the prevalence of mild OHSS among the three groups (p-value = 0.91for each). Nevertheless, the three groups showed a notable difference in the occurrence of moderate OHSS (p = 0.044) respectively. Notably, severe ovarian hyper-stimulation syndrome wasn't observed in Group C. However, 13.3% of patients in Group B and 6.6% in Group A were affected with a highly significant difference (p = 0.007). The chemical and clinical pregnancy rates across the three groups did not demonstrate any statistically significant differences (p-value of 0.53), (p-value of 0.17) correspondingly). Our study found that using cabergoline and diosmin together in high-risk females undergoing ICSI procedures was significantly more successful in preventing OHSS compared to using calcium gluconate and diosmin or cabergoline alone. This combination did not impact miscarriage, pregnancy rate, or the likelihood of multiple pregnancy. identifier NCT06333691.