Study of intrahepatic cholestasis of pregnancy before and after treatment with ursodeoxycholic acid

To investigate bile acids patterns in patients with intrahepatic cholestasis of pregnancy [ICP] and to test the efficacy of ursodeoxycholic acid [UDCA] treatment. The study included a reference group comprised ten healthy pregnant women and 21 patients with ICP, who were randomly divided into 2 groups, one received UDCA for 21 days and followed until delivery [11 cases] and the other received vitamin B as a placebo and followed in time same manner [10 cases]. Bile acids were analyzed by gas chromatography-mass spectrometry in maternal serum at the start, 21 days later and after delivery. They were also analyzed in amniotic fluid and neonatal meconium after delivery. UDCA treatment improved bile acid levels after 21 days and markedly after delivery. Amniotic fluid levels of bile acids were lower in UDGA treated cases than placebo treated cases. Neonatal meconium bile acids were higher in placebo treated ICP cases than reference cases. After delivery, serum TBA and cholic acid in UDC'A treated cases were correlated with those in amniotic fluid [r = 0.91, r = 0.6], with positive correlations with neonatal meconium TBA [r= 0.39]. The obstetric and neonatal outcomes were better in UDCA treated cases tf compared to placebo cases. Ursodeoxycholic acid is effective and safe in patients with intrahepatic cholestasis of pregnancy. It attenuates pruritus, corrects bile acid abnormalities in the mothers and improves fetal and neonatal outcomes

effect of metformin on the endocrine variables in clomiphene resistant polycystic ovarian disease

To investigate the effect of metformin on the endocrine variables in clomiphene resistant polycystic ovarian disease [PCOD]. Departments of Obstetrics and Gynaecology, Internal Medicine and Clinical Pathology, Faculty of Medicine, Tanta University, Egypt. Thirty-three infertile women due to PCOD were enrolled and divided into 23 cases received oral metformin 850 ma/ twice daily for 8 weeks and 10 cases received placebo for the same period. Basic hormonal parameters, serum glucose and insulin were tested before and after treatment. Metformin led to 65% improvement in acne score, 57% menstrual improvement and significant reduction of serum LH androstenedione, DHEAS, free testosterone, glucose and insulin. Highly significant elevation of SHBG was observed. The mean fasting insulin dropped from 28 uU/ml before to 16 uU/ml after therapy and this drop was significantly correlated to changes in testosterone, free testosterone, SHBG and glucose. Metformin may be suggested as a therapy for women with colomiphene resistant polycystic ovarian disease. It can ameliorate hyperinsulinemia, hyperadrogenemia with their impacton the restoration of regular menses and ovulation; and hence improving the pregnancy capability

Automatic fetal movement detection [fectal actogram] in cases of high risk pregnancy

This study was designed to compare automatic fetal movement detection [Fetal Actogram] with daily fetal movement count [DFMC] versus the st and ard real time ultrasound [RT/US]. 48 high risk pregnant women. admitted in Obstetrics and Gynecology Department of Tanta University Hospitals, from April 1997 to December 1997 were enrolled. Fetal movements [FMs] were evaluated by daily fetal movement count [DFMC], by automatic fetal movement detection [Fetal Actogram] and by RT/US Acceptable FMs were detected clinically, by actogram and by RT/US in 60.4%, 72.7% and in 81.25% of cases. The sensitivity, specificity and accuracy of Actogram for detection of acceptable FMs, they were 89.7%, 100%% and 91.7% respectively. Those for alarming FMs were 100%, 97.8% and 97.9% respectively. Fetal actogram identified 548 total FMs out of total 641 FMs by RT/US [85.4%]. It identifies 88.8% of complex FMs. 94.2% of isolated trunk movements and 93.7% of limb movements fetal Actogram evaluates FMs without extra testing if done with NST It gives good results in quantitative and qualitative evaluation of FMs