Maternal obesity and its effect in late pregnancy and labour

Background: In recent years, obesity has become a major public health problem and its prevalence is increasing at an alarming pace. Moreover, this problem has affected children and adolescents in marked fashion with a higher prevalence in females than in males

Objective: To evaluate the effect of maternal obesity on length of gestation and mode of delivery and subsequent intrapartum and neonatal complications

Methods: This prospective cohort study involved a total no. of 600 women with singleton pregnancies delivered in the period between December 2011 and July 2012 and were categorized into three groups according to their BMI; normal weight [18.5-24.9 kg/m2], overweight [25-29.9 kg/m2] and obese [>/=30 kg/m2]. The main outcome measures were length of gestation, mode of delivery, risk of delivery and neonatal complications in overweight and obese women versus normal weight women

Results: Obese women had a significantly increased risk of post-term pregnancy and higher rate of induction ending in caesarean section compared with women of normal weight. Again, there was a significantly longer median length of first stage, increased incidence of second-degree tear and significantly increased risk of low Apgar score. However, the incidence of postpartum haemorrhage and third-degree tear were similar in all body mass index categories. As regard shoulder dystocia, there was a trend towards increased incidence with increasing BMI for primiparous women but just failed to reach significance [P=0.05]. There was a trend towards increased incidence of macrosomia with increasing BMI category [P=0.074] this trend was significantly true for primiparous women [P=0.047], but no trend was observed for analysis restricted to multiparous women

Conclusion: Increasing BMI is associated with increased incidence of post-term pregnancy, failed progress of labour, labour induction, CS delivery, low Apgar score and macrosomic babies

Establishing ultrasound based transient elastography cutoffs for different stages of hepatic fibrosis and cirrhosis in Egyptian chronic hepatitis C patients

Background and study aim: transient elastography is widely used to assess fibrosis stage in chronic hepatitis C [CHC]. We aimed to establish and validate different transient elastography cut-off values for significant fibrosis and cirrhosis in CHC genotype 4 patients

Patients and Methods: the data of 100 treatment-naive CHC patients [training set] and 652 patients [validation set] were analysed. The patients were subjected to routine pretreatment laboratory investigations, liver biopsy and histopathological staging of hepatic fibrosis according to the METAVIR scoring system. Transient elastography was performed before and in the same week as liver biopsy using FibroScan [Echosens, Paris, France]. Transient elastography results were correlated to different stages of hepatic fibrosis in both the training and validation sets

Results: ROC curves were constructed. In the training set, the best transient elastography cut-off values for significant hepatic fibrosis [>/=F2 METAVIR], advanced hepatic fibrosis [>/=F3 METAVIR] and cirrhosis [F4 METAVIR] were 7.1, 9 and 12.2 kPa, with sensitivities of 87%, 87.5% and 90.9% and specificities of 100%, 99.9% and 99.9%, respectively. The application of these cut-offs in the validation set showed sensitivities of 85.5%, 82.8% and 92% and specificities of 86%, 89.4% and 99.01% for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, respectively

Conclusion: transient elastography performs well for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, with validated cut-offs of 7.1, 9 and 12.2 kPa, respectively, in genotype 4 CHC patients