Maternal obesity and its adverse impact on labor outcome

To study the impact of maternal obesity on the outcome of labour. Al Zahraa University hospital prospective randomized control study. A total of [80] pregnant women were included in this study from April 2009 to March 2010. According to the BMI the patients were classified into two groups. Group [I]: [Control Group]: Included [30] patients with [body mass index] [BMI] ranging from 20 to 25 kg/m[2].Group [II]: [Obese Group]: Included [50] patients with [BMI] ranging from 25 to 30kg/m[2]. Each patient were subjected to full clinical examination [General] Abdominal and pelvic] U/S pelviabdominal examination that is to confirm the inclusion and exclusion criteria of the study. A significant differences was noticed between 2 groups as regard the BMI. The current study showed significant difference in cases subjected to induction of labour with p-value < 0.001. Also significant difference between control group and obese group regarding failed induction, failure to progress 1[st] stage, 2[nd] stage, shoulder dystocia with p-value < 0.01.Case of C.S showed the highest significant diff. with P-value < 0.0001 .In the present study no sig. diff. between cases of both groups as regard 3rd stage complication, 4th stage [PPH] and blood transfusion with P-value 0.658, 0.684 and 0.658 respectively. A high significant diff. between the two groups as regard case of macrosomia, Apgar score < 7 1[st] minute, and birth injury with p-value < 0.01. A significant diff. were showed between the cases of both groups as regard the incubation with p-value > 0.05.No significant diff. were noticed between the 2 groups as regard the cases with Apgar score < 7 at 5 minutes with p-value 0.06. A positive correlation coefficient between the BMI [25-29], [29-33] kg/m[2] with the case of induction of labour, failure to progress 1[st] stage, shoulder dystoca, cesarean section and fetal low Apgar score. While a negative correlation was recorded between the BMI of the control group and all the adverse outcomes. Obesity of the gravid women is a sensitive predictor of the adverse outcome during pregnancy, labour, and post partum. Researches are needed into effective, applicable and acceptable community -based program for obese women planning a pregnancy

predictive value of studying the uterine and umbilical artery resistance indices in cases of pre term labour

To assess the value of uterine artery and umbilical artery resistance indices changes in predicting cases of PTD. The study was carried on gravid women attending Al zahraa University Hospital between February 2009 to September 2010. A prospective study on gravid women picked up at 24 week gestation during ANC. They were subjected to Doppler velocimetry study of the Umbalical and Uterine artery blood flow to measure the resistive indices changes on going GA. Participants were 24 weeks pregnant with a singleton pregnancy, Participants were seen at three study visits: at recruitment, at, 28 weeks gestation; and finally at 34 weeks gestation. Patients who later developed PTL formed the study group n=28. The control group were the women who completed 40 weeks gestation at the time of delivery. For each patient seen at the three visits Doppler velocimetry ultrasound study of the umbilical and uterine were performed to assess the RI indices changes. The current study revealed a high significant difference in the RI value of the umblical artery starting from 28 weeks visit to be [0.74], [0.61] in the study group and control group respectively with p-value [0.001] also a highly significant diff. were noticed at the 34 weeks visit to be [0.65],[0.49] in the study group and control group respectively with p-value [0.0001]. As regard the uterine artery RI the study group showed a highly significant difference at 28 weeks visit when compared to the value of the control group with p-value [0.001] in the same manner the RI value at 34 weeks visit showed a highly significant difference between both groups with p-value [0.0001].In the current study the mean RI for both uterine and umbilical arteries decreased steadily across all study visits from 24 weeks to 34 weeks gestation. In linear regression models, the relationships of both uterine and umbilical artery RI with gestational age were significantly different between study group and control group. The mean umbilical artery RI and uterine artery RI indices decreased significantly more slowly across gestation for study group than for control group. In univariate analyses, a 2.9 fold increase in risk for PTD was associated with a 0.1 unit increase in uterine artery RI across gestation; while a 3.4 fold increase in risk for PTD was associated with a 0.1 unit increase in umbilical artery RI across gestation. The RI indices values in the umblical artery and uterine artery showed a significant slowly decrease along gestational age among gravid patients developed preterm labour so that they could be predictive for PTL

Role of maternal serum procalcitonin, interleukin-6 and hs-c reactive protein in prediciton of subclinical [intrauterine] infection in preterm premature rupture of membranes

To evaluate the role of procalcitonin [PCT], high senstive C-reactive protein [hs-CRP] and Interleukin-6 [IL-6] for prediction of subclinical intrauterine infection in pregnant women with preterm premature rupture of membranes. Twenty patients with preterm premature rupture of membranes PPROM [study group] and twenty apparently healthy pregnant women [control] group between 26-34 weeks of pregnancy were enrolled in this study. In all cases analysis of serum procalcitonin by high performance liquid chromatography, Il-6 by ELISA method and hs-CRP by nephelometry were done. Culture of vaginal bacteria was done for study group only. Procalcitonin levels in the PRROM group were significantly higher than in healthy pregnant women [median 1.95 versus 0.39-Interquartile range 1.375 versus 0.213 - P0.001]. A significant correlation was observed between PCT and hs-CRP [r=0.510; P0.031] and leucocytosis [r=0.544- P 0.013]. Also IL-6 levels were significantly higher in cases of PPROM compared with control group [median 40.01 versus 5.55 - Interquartile range, 45.88 versus 4.22 P 0.001]. No significant correlation was present between PCT and IL-6. Determination of PCT, hs-CRP and IL-6 in mother's blood sample can be useful for diagnostics of PPROM cases suspected of intrauterine infection. However PCT more valuable and specific