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

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

prevalence and significance of ultrasonically diagnosed polycystic ovaries in ovulatory women with unexplained infertility

The implications of polycystic ovary syndrome on reproductive and general health are well known, but the functional significance of polycystic ovaries [PCO] appearance, on ultrasonography, in ovulatory women remains to be clarified. 1- To define the prevalence of ultrasonically diagnosed PCO in ovulatory women with unexplained infertility; and 2- To compare the endocrine profiles in women with and without PCO within unexplained infertility group and with control subjects with and without PCO. A prospective observational case-control study. Department of Obstetrics and Gynecology, Kasr El-Aini Hospital, Cairo University. Thirty cases complaining of unexplained infertility without symptoms of polycystic ovary syndrome [menstrual disturbance, obesity, acne or hirsutism], and 30 fertile parous women as controls. Ultrasound scan was performed to assess ovarian morphology, and confirm ovulation. Mid-follicular phase serum luteinizing hormone [LH], follicle-stimulating hormone [FSH] and testosterone concentrations were measured in cases and controls. 1- The prevalence of PCO in women with unexplained infertility; and 2- The endocrine profiles in women with and without PCO within both groups. 1- The prevalence of PCO was higher in the unexplained infertility group [23%] versus the control group [10%], but the difference was not statistically significant [p=0.299]; 2- In the unexplained infertility group, LH and testosterone were significantly higher in the PCO women [p=0.002 and <0.001 respectively]; 3- In the control group, LH was also significantly higher in the PCO women [p=0.017]; and 4- PCO women with unexplained infertility had significantly higher testosterone than PCO controls [p=0.038]. The prevalence of PCO among ovulatory women with unexplained infertility is higher than that in the normal population, suggesting that PCO may, perhaps by virtue of an effect of hyperandrogenaemia, contribute to the causes of subfertility

comparison of supracervical foley catheter, prostaglandin E2 tablet and combination of foley catheter and prostaglandin E2 tablet for cervical ripening and labor induction

The purpose of this study is to compare the efficacy and safety of supra-cervical Foley Catheter and vaginal prostaglandin E[2] [PGE[2]] tablet and combination of supracervical Foley Catheter and PGE[2] tablet for cervical ripening and labor induction. 90 patients admitted for induction of labor with a Bishop score

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

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

Insulin resistance in pregnancy induced hypertension

Pregnancy induced hypertension continues to be a major of pregnancy associated morbidity and mortality. Yet, its exact pathophy sinology remains obscure. There is a growing body of evidence linking insulin resistance and pregnancy induced hypertension. To investigate the association between insulin resistance and pregnancy induced hypertension, subdivided into preeclampsia and gestational hypertension, compared with uncomplicated pregnancies. A prospective observational case-control study. Setting: Obstetric Unit of Cairo University Hospital [Kasr EL-Aini]. Participants: Forty cases in the third trimester of pregnancy with either preeclampsia [n=20] or gestational hypertension [n=20], and 20 normotensive pregnant control. 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 using the glucose oxidase method and insulin was measured using radioimmunoassay. Main Outcome Measure: Fasting glucose and insulin levels were compared based on serological data and fasting insulin levels were used as a marker of insulin resistance. The demographic and clinical characteristics, which might influence insulin resistance, were comparable [p>0.05]. The mean fasting glucose levels were not significantly different in the control and study groups [p>0.05]. However, mean fasting insulin levels were significantly lower in the women with preeclampsia compared with the normotensive group [p<0.001]. Conversely, mean fasting insulin levels were significantly higher in the women with gestational hypertension compared with their normotensive counterparts [p<0.001]. As with other forms of secondary hypertension, preeclampsia is not associated with insulin resistance, and like essenential hypertension, gestational hypertension is associated with insulin resistance. Insulin resistance may play a role in the pathogenesis of gestational hypertension, but not preeclampsia

Comparative study of spontaneous vaginal delivery and elective caesarean section as obstetric risk factors for urinary and anal incontinence

The aim of this study was to evaluate the contribution of the mode of delivery to the occurrence of stress, urge and mixed urinary incontinence, overactive bladder, anal incontinence and combined incontinence. The study involved 900 women satisfying the selection criteria seen for counseling and/or treatment of urinary and/or anal incontinence or observed for routine gynecological examination or minor gynecological complaints without any symptoms related to these disorders. Six hundred women with previous 1-3 deliveries were included in this study and classified into 2 groups [each comprising 300 women]. Group I included women with only spontaneous vaginal deliveries and group II included women with only elective caesarean section deliveries. In addition, 300 nulliparous women observed during the study period in the same gynecology clinic. Urinary and anal incontinence symptoms were measured using questions from the urogenital distress inventory and Manchester health questionnaire. The main outcome measures included spontaneous vaginal delivery and elective caesarean section delivery as obstetric determinants of stress, urge and mixed urinary incontinence, overactive bladder, anal incontinence and combined incontinence. The results showed that in comparison with women reporting 1-3 elective caesarean section deliveries [group II], a history of 1-3 spontaneous vaginal deliveries [group I] was associated with the risk of stress, mixed and overall urinary incontinence and increased the risk of urge urinary incontinence, overactive bladder, anal incontinence and combined urinary and anal incontinence

randomised controlled trial of orally and rectally administered prostaglandin E1 analogue misoprostol and standard management of the third stage of labour in the prevention of postpartum haemorrhage

Misoprostol may have the potential to prevent atonic postpartum haemorrhage, when administered orally or rectally, and may be an alternative to conventional standard oxytocic regimens for the active management of third stage of labour. To examine the efficacy and side effects of oral versus rectal misoprostol compared to standard oxytocics for the prevention of postpartum haemorrhage. A prospective randomised controlled trial. Obstetric Unit of Cairo University Hospital [Kasr El-Aini]. Five hundred low risk women with anticipated vaginal delivery. In the third stage of labour, the women were randomised to 600 micro g misoprostol given orally [Group I; n=150] rectally [Group II; n= 150] after clamping and division of the cord, or to standard oxytocic regimens of syntometrine or syntocinon [Group III; n=200] after the delivery of the anterior shoulder. The main primary outcomes were changes in haemoglobin concentration and haematocrit from before delivery to 12 hours postpartum. Secondary outcomes were the side effects of drug regimens, including, nausea, vomiting, diarrhoea, shivering and elevated temperature. The baseline demographic characteristics and labour variables were similar. There were no statistically significant differences [P>0.05] between the groups in the changes of haemoglobin concentrations and haematocrit [the main primary outcomes], the estimated blood loss, the incidence of postpartum haemorrhage, the incidence of severe postpartum haemorrhage, the proportions of women requiring blood transfusion, the length of the third stage, the incidence of prolonged third stage, the need for manual removal of the placenta, the percentage of women requiring additional oxytocic administration and the incidence of delayed haemorrhage in post natal ward. The main side effects were shivering and a rise in temperature, which occurred more frequently in the oral misoprostol group [P-overall <0.001 and 0.012 respectively]. Other side effects were mild with no differences between the groups. Oral and rectal misoprostol were comparable to standard oxytocics for the prevention of postpartum haemorrhage. Shivering and pyrexia were the main side effects of oral misoprostol. Of importance is the apparent lack of these side effects with the rectal route. Further randomised controlled trials are required to identify the best drug combinations, route, and dose for the prevention of postpartum hemorrhage