Comprehensive assessment of fetal wellbeing in intrauterine growth restriction: biophysical profile and doppler cerebroplacental ratio

The current routine prenatal surveillance tests such as the non-stress test and fetal biophysical profile [BPP] may not be sensitive or specific enough to detect fetuses with an early compromise. Studies suggest that the cerebroplacental ratio [CPR] may be a highly sensitive Doppler index for assessment of wellbeing and prediction of outcome in fetuses with intrauterine growth restriction [IUGR]. To evaluate [1] the screening efficiency of Doppler CPR, compared with BPP, for the prediction of IUGR and the associated perinatal complications; and [2] whether the additional use of CPR improves the prediction of such outcomes over BPP alone. A comparative cross-sectional study. Department of Obstetrics and Gynecology, Kasr El-Aini Hospital, Cairo University. Fifty singleton pregnancies at risk for IUGR. Cases were managed with weekly or twice weekly BPP, and Doppler velocimetry of the umbilical artery [UA] and middle cerebral artery [MCA] was performed when delivery is indicated. The CPR, defined as the MCA-RI divided by the UA-RI, was considered abnormal if <1.0. Adverse perinatal outcome was defined as any combination of IUGR and perinatal complications. The perinatal outcomes were correlated to the results of BPP and CPR, and the accuracy of BPP and CPR in the prediction of adverse outcome was calculated. Sixteen cases [32%] had normal outcome and 34 cases [68%] had adverse outcome. The BPP and CPR were significantly lower in cases with adverse outcome [p=0.002 and 0.001, respectively]. Cases with abnormal BPP and CPR had a very high risk of adverse outcome [27/28; 96%]. The CPR was comparable to BPP; and the correlation of BPP and CPR increased the accuracy of prediction of adverse outcome as shown by sensitivity, specificity, +ve predictive value, -ve predictive value, overall accuracy, likelihood ratio +ve, and likelihood ratio-ve of 79%, 75%, 87%, 63%, 78%, 3.16, and 0.28, respectively, for BPP alone; and 82%, 69%, 85%, 65%, 78%, 2.65, and 0.26, respectively, for CPR alone; compared to 79%, 94%, 96%, 68%, 84%, 13.17, and 0.22, respectively, for both BPP and CPR. The main finding was an increase in the perinatal risk when abnormal BPP and CPR are observed. The additional use of CPR appears to improve risk prediction over BPP alone

Leptin and postmenopausal osteoporosis

To investigate plasma leptin concentrations in postmenopausal women to improve the understanding of the role of leptin in determining bone mass. A prospective observational cross-sectional study. Departments of Obstetrics and Gynecology, Rheumatology and Chemical Pathology at Kasr El-Aini Hospital, Cairo University. Thirty postmenopausal women with osteoporosis [ages range 45-73 years and body mass index [BM1] range 23.31-39.37Kg/m[2]], and 30 age- and BMI-matched healthy postmenopausal women. Bone mineral densities were measured by dual energy X-ray absorptiometry [DEXA]. Plasma leptin concentrations were measured using enzyme-linked immunosorbent assay [ELIZA]. The correlation of plasma leptin concentrations and bone mineral density [BMD]. Plasma leptin concentrations were significantly higher in the osteoporotic group than the control group [67.44 +/- 48.60 Vs. 38.10 +/- 19.58, p=0.004]. No correlation was observed between plasma leptin and BMD values in the osteoporotic group [r=0.2462, p=0.198; r=0.3452, p=0.067 and r=0.1898, p=0.324 for T score spine, Rt. hip and Lt. hip, respectively] and the control group [r=0.0050, p=0.980; r=0.2564, p=0.188 and r=-0.0967, p=0.624 for T score spine, Rt. hip and Lt. hip, respectively], but there was a significant positive correlation between plasma leptin and BMI in the osteoporotic group [r=0.4911, p=0.007] and the control group [r=0.8205, p<0.001]. Circulating plasma leptin does not have a significant direct influence on bone mass in postmenopausal women

Placental trophoblastic apoptosis in preeclampsia and intrauterine growth retardation

To determine whether preeclampsia and intrauterine growth retardation [IUGR] are associated with an increase in placental apoptosis. A prospective observational case-control study. Departments of Obstetrics and Gynecology and Pathology, Kasr El-Aini Hospital, Cairo University. Forty pregnant women, between 37 and 40 weeks of gestation. Tissue specimens from 20 normal term placentae and each of 20 term placentae complicated by either preeclampsia [n=10] or IUGR [n=10] were analyzed after delivery. Apoptosis were quantified using light microscopy performed on hematoxylin and eosin stained placental tissue. Apoptotic index in the nuclei of cytotrophoblasts and syncytiotrophoblasts. Apoptosis was apparent in the nuclei of both cytorophoblasts and syncytiotrophoblasts. There was no significant difference in the apoptotic index in cytotrophoblast nuclei among normal term, preeclamptic term, and IUGR term placentae [p>0.05], whereas the apoptotic index of syncytiotrophoblast nuclei was significantly higher in preeclamptic term placentae [p=0.002] and IUGR term placentae [p=0.008] than that in normal term placentae. The apoptotic index of syncytiotrophoblast nuclei in preeclamptic and IUGR term placentae was significantly higher than that in normal term placentae. Further studies to determine factors responsible for regulating apoptosis of trophohlasts are recommended to provide new insight into understanding of the molecular basis of pathophysiology of the placentae complicated by either preeclampsia or IUGR

Maternal serum leptin in pregnancy induced hypertension

To investigate maternal serum leptin levels in pregnancy induced hypertension, subdivided into preeclampsia and gestational hypertension, compared with uncomplicated pregnancies. A prospective observational case-control study. Department of Obstetrics and Gynecology. Kasr El-Aini Hospital, Cairo University. Forty cases in the third trimester of pregnancy with either preeclampsia [n=20] or gestational hypertension [n=20] and 20 normotensive pregnant controls. The control and study groups were matched for maternal age [ +/- two years], pre-pregnancy body mass index [ +/- 10%] and gestational age [ +/- one week]. Fasting blood samples were collected from cases and controls. Glucose was measured using the glucose oxidase method and leptin was measured using enzyme-linked immunosorbent assay [ELISA]. Glucose and leptin levels were compared based on serological data. The demographic and clinical characteristics, which might influence leptin levels, were comparable [p>0.05]. The mean glucose levels were not significantly different in the control and study groups [p>0.05]. However, mean leptin levels were significantly higher in the women with preeclampsia compared with the normotensive group [16.9 +/- 7.0ng/mL vs. 9.8 +/- 4.8ng/mL, p=0.001]. Similarly, mean leptin levels were significantly higher in the women with gestational hypertension compared with their normotensive counterparts [15.1 +/- 5.9ng/mL vs. 9.8 +/- 4.8ng/mL, P=0.003]. Preeclampsia and gestational hypertension ire is associated with elevated maternal serum leptin. Leptin may play a role in the pathogenesis of these disorders. Further longitudinal studies are recommended to investigate the possible value of leptin as a second trimester predictor of pregnancy induced hypertension