MRI diagnostic value in pregnant patients with acute abdominal and pelvic pain

The use of ultrasonography during pregnancy provides a tremendous amount of valuable information about fetal and maternal well-being. However, in some cases the image quality may be poor. Excellent soft-tissue contrast resolution and multiplanar imaging capability, in combination with lack of ionizing radiation, make magnetic resonance imaging a promising modality for use in pregnant women. The purpose of this study was to show the usefulness of magnetic resonance imaging in the evalluation of pregnant women with acute abdominal or pelvic pain. in Alyamamah Maternity Hospital and Hammadi General Hospital. prospective observational study. 25 pregnant patients were referred for magnetic resonance imaging examination because of acute abdominal or pelvic pain with insufficient ultrasonographic findings between September 2003 and August 2005. Multiplanar multisequence magnetic resonance imaging of the abdomen and pelvis were obtained in each patient. The magnetic resonance imaging interpretations were compared with follow-up medical, surgical and obstetric final diagnosis to determine the correctness of the interpretation. Correlation of magnetic resonance imaging interpretations with final diagnosis showed correct identification of disease entities in all but one patient with acute appendicitis, falsely diagnosed by magnetic resonance imaging as normal findings. Magnetic resonance imaging showed an accuracy rate of 96% in diagnosing acute abdominal and/or pelvic pain in pregnant women with unclear ultrasound diagnosis. The Specificity and positive predictive value were 100% but sensitivity was 94.7% and negative predictive value was 85.7 Abdominal and pelvic diseases in pregnant patients can be well evaluated by magnetic resonance imaging, when it is an available modality. It can provide important information that may influence a patient's treatment options, which range from operating emergently to delaying treatment until after delivery. Magnetic resonance imaging should be reserved for cases in which results of ultrasonography are inconclusive and patient care depends on further imaging.

Clinical, sonographic and doppler flow effects of levonorgestrel releasing intrauterine system in menorrhagic women

Menorrhgia is one of the commonest gynecological problems, yet medical treatment has been disappointing. Levonorgestrel released from an intrauterine system suppresses endometrial growth and causes marked reduction of menstrual loss menorrhagic women. To study the mechanism by which Levonorgestrel releasing intrauterine system, [Mirena, Schering], can control menorrthagia by evaluating its effect on blood flow in the uterine and subendometrial region, and endometrial thickness using color Doppler. Setting: in Alyamamah Maternity Hospital and Hammadi specialized Hospital. Design: prospective observational study. Patients and thirty two patients were included in this study complaining of menorrhagia. Levonorgesttrel releasing intrauterine system, [Mirena, Schering], was inserted. Menstrual blood loss was measured using the pictorial blood loss assessment chart, pulsatility index of uterine artery, subendometrial blood flow and endometrial thickness were measured before and six months after insertion. Levonorgestrel releasing intrauterine system reduced menstrual blood loss. There was no significant difference in pulsatility index of uterine artery before and after insertion, but, there was highly significant reduction in the blood flow in the subendomentrial region. Also, there was highly significant reduction in the endometrial thickness. Through its local effect on endometrium, Levonorgestrel releasing intrauterine device a good option for treatment of menorrhagia so, it is advisable before resorting to any invasive surgical maneuver

Antiphospholipid autoantibodies in women with unexplained infertility and recurrent first trimester abortion

To assess the presence of antiphospholipid auto-antibodies [aPLA] in women who are suffering from unexplained infertility or recurrent first trimester abortion to evaluate their pathogenic role in these disorders. King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. Between January 2004 and June 2005, a prospective study was carried out on 20 women with unexplained infertility [group A], 20 women with recurrent first trimester abortion [group B], compared to 20 healthy women as control [group C]. IgA, IgM, and IgG against phospholipids were detected in the sera of all cases. It was found that IgA, IgM, and IgG levels were significantly higher in groups A, B when compared to group C. Venereal Disease Research Laboratory [VDRL] test was positive in 2 [10%] cases in group A and in 3 [15%] cases in group B but it was negative in group C. Lupus anticoagulant [LA], tested by the activated partial thromboplastin time [APTT], was prolonged in 4 [20%] group A and 3 [15%] cases in group B. From the results of this study it can be concluded that reproductive performance may be affected by the abnormal presence of antiphospholipid auto-antibodies

Emergency cerclage. A successful challenge despite advanced second trimester cervical dilatation

A 22-year-old, primigravida +/- 20 weeks of gestation presented with abdominal pain. She was diagnosed as a case of advanced cervical incompetence. We carried out an emergency cerclage after 24 hours from her admission, while the cervix was fully dilated with bulging of the membranes and prolapse of both lower limbs in the middle of the vagina. She delivered normally at 38 weeks of gestation with favorable outcomes. We believe that even if miscarriage is inevitable, the so called emergency cerclage might be considered

Safety and efficacy of systemic methotrexate in the treatment of unruptured tubal pregnancy

To evaluate the safety and efficacy of single dose intramuscular methotrexate [MXT] as a treatment option for early unruptured ectopic pregnancies, and to compare the results with those of previously published studies. We performed a prospective study on 30 patients with small unruptured ectopic pregnancies treated with a single dose of MXT therapy in the Department of Obstetrics and Gynecology, Maternity and Children Hospital, Buraidah, Qassim, Kingdom of Saudi Arabia from January 2002 to June 2004. The mean pretreatment level of beta-human chorionic gonadotropin [beta-hCG] was 2209 +/- 1381 mIU/ml. Only 22 women [73.3%] were successfully treated with a single dose of MXT. Five women required a second injection, and one woman required a third dose. The combined success rate for medical management of ectopic pregnancy with 1-3 doses of MXT was 86.7% [26 women]. Pretreatment beta-hCG levels were significantly lower in women who responded to single dose therapy than in those who required either multiple doses or who had failure of medical management [p<0.001]. The mean time to resolution of beta-hCG was 32.5 +/- 17 days. Higher pretreatment levels correlated with longer resolution time [p<0.001]. Four women [13.3%] had a failure of medical management and required surgery. In our series, MXT was successful in 26 women [86.7%]. Women with a pretreatment beta-hCG level of 3000-4000 mIU/ml had a greater probability of requiring either surgical intervention or multiple doses of MXT. The potential for emergency surgery remains an important risk

Evaluation of the role of plasma levels of thrombomodulin and endothelin-1 in hypertensive pregnant women

The objective of this study was to determine the maternal serum levels of thrombomodulin and endothelin-1 [Et-1] in pregnancy complicated by preeclampsia or gestational hypertension and in normal pregnancy. This clinical study included 40 pregnant women, 20 preeclamptic patients, 10 with gestational hypertension and 10 healthy pregnant women [the control group]. Plasma thrombomodulin and endothelin-1 [Et-1] levels were measure using an enzyme linked immunosorbent assay [ELISA] technique. There was a highly significant elevation of both thrombomodulin and endothelin-1 levels in preeclamptic group than in either gestational hypertensive and control groups [P <0.001]. There was a significant increase in the level of endothelin-1 and no change in thrombomodulin level in gestational hypertensive group when compared to the control group [P < 0.001 and P > 0.05 respectively]. There was a significant difference in endothelin-1 between cases with mild and severe gestational hypertension and also those with mild and severe preeclampsia, [P<0.001] such findings were not true for thrombomodulin. The study demonstrated that the plasma endothelin -1 level could be used as a molecular marker that reflects the vascular endothelial injury in cases of preeclampsia and gestational hypertension particularly those with severe cases. So, it is a good indicator of progression of the disease. On the other hand plasma thrombomodulin elevation comes late in the disease process. The increased level of plasma thrombomodulin in preeclampsia but not in gestational hypertension may suggest different underlying changes or disease enitities among those two pregnancy related hypertensive disorders