Severe early-onset preeclampsia:Prognostic role of uterine artery doppler examination

Preeclampsia is essentially an endothelial disease. Early –onset preeclampsia appears to be linked mainly to a failed placental vascular remodeling, uterine artery Doppler is a validated noninvasive surrogate of trophoblastic invasion and placental perfusion. Objective: To evaluate the predictive capacity of uterine artery Doppler investigation for maternal and neonatal complications in women with severe early – onset preeclampsia. Methods: This prospective comparative study was carried out on sixty-five Iraqi pregnant women with severe early-onset preeclampsia. Their gestational age ranged from 28-34 weeks of gestation, a uterine artery Doppler examination was performed on admission to the participants. According to the result of Doppler ultrasound, they were arranged into two main groups: group one comprising thirty-six patients with abnormal uterine artery. Doppler results. The maternal and neonatal outcome of women with abnormal uterine Doppler results was compared to those with normal Doppler results, and then results were analyzed accordingly. Results: Sixty-five patients were enrolled in this study, in 53% of them; uterine artery Doppler results were abnormal. This group showed statistically significant lower birth weight [p=0.003], higher caesarean section rate [p=0.014], abnormal umbilical artery Doppler examinations [p.0.0001] and higher neonatal complications rate [p=0.006]. Regarding the maternal complications [HELLP Syndrome, neurological manifestations, acute renal failure and pulmonary oedema], occurred at higher rate in the group with abnormal uterine artery Doppler compared with those having normal Doppler results [58.3% versus 37.9%], but only acute renal failure reached the statistical level of significance [p=0.017] Conclusion: Women with severe early-onset preeclampsia are at higher risk of maternal and neonatal complications if abnormal uterine blood flow is present

Serum CA-125 in ectopic pregnancy

CA-125 is a glycoprotein, its origin is uncertain during pregnancy. It rises during the first trimester and returns to a non-pregnancy range in late pregnancy. To compare CA-125 levels between tubal ectopic and normal intrauterine pregnancy, and to find it's usefulness in differentiating intact from ruptured tubal ectopic pregnancy. This prospective case-control study was carried out on sixty healthy women with single normal intrauterine pregnancy [NIUP] of 6-10 weeks gestation and sixty women with tubal ectopic pregnancy of same gestational age which were further subdivided into twenty-five women with ruptured tubal ectopic pregnancy [REP] and thirty-five women with unruptured tubal ectopic pregnancy [UREP]. The levels of CA-125 were compared between these groups. The mean level of CA-125 in ruptured ectopic pregnancy group was 49.04 +/- 33.63 IU/ml and in unruptured ectopic pregnancy group was 24.3 +/- 16.89 IU/ml. The mean level of CA-125 in normal pregnant women [control group] was 53.95 +/- 31.2 IU/ml. There was a statistically significant difference between mean serum CA-125 levels of ruptured ectopic pregnancy and unruptured ectopic pregnancy group [p< 0.05], also there was a statistically significant difference between mean of CA-125 level of unruptured ectopic pregnancy group and control group [p <0.05], while there was no statistically significant difference between ruptured ectopic pregnancy group and control group [p > 0.05]. CA-125 level is significantly elevated in ruptured tubal ectopic pregnancy than the intact tubal ectopic pregnancy, this increase in CA-125 levels can be used as additional test to identify tubal rupture.

Study of lipid profile in patients with uterine fibroid

Leiomyomas are the most common gynaecological neoplasms. Despite the major public health impact of leiomyomas, little is known about their cause. As fibroids are hormone-dependent tumours and their development can be promoted by estrogens, an inverse association between hypercholesterolemia and fibroids should be observed as well as direct association between high-density lipoprotein cholesterol [HDL-C] levels and the presence of fibroids. To investigate the lipid profile in patients with uterine fibroids and to compare it with the lipid profile of women without fibroids. A case-control study was conducted in the Department of Obstetrics and Gynaecology at Al-Yarmouk Teaching Hospital during the period from May 2008 to May 2009. Participants were one-hundred twenty pre-menopausal women aged between 18 and 45 years who were recruited during their visit to the gynaecological outpatient clinic and were not taking hormonal therapy. Cases consisted of 60 women with uterine fibroids, and controls were 60 women visiting the same gynaecological outpatient clinic for routine reasons. Thorough history and examination was done for each participant. Body Mass Index [BMI] was measured in kg/m[2]. All patients underwent a baseline ultrasound examination and classified into two groups according to the presence or absence of uterine fibroids. All women where scheduled to undergo blood test at the beginning [2[nd] -5[th] day] of their next menstrual cycle. Fasting venous blood glucose and lipid profile were determined in blood samples taken for each patient. Atherogenic index was also calculated. Women with uterine fibroids were found to have significantly higher levels of serum HDL-C compared to the controls [P=0.0001]. A significantly lower levels of total serum cholesterol, low-density lipoprotein cholesterol [LDL-C] were also found in women with uterine fibroids compared to the controls [P=0.0001]. Atherogenic index was significantly lower in fibroid group compared with controls [P=0.0001]. There was a significant positive correlation between largest fibroid volume and HDL-C level [P<0.0001]. Women with uterine fibroid have lower atherogenic index compared to women without uterine fibroid. Larger volume of fibroid is associated with higher level of HDL-C

Ultrasonographically observed grade III placenta at 36 weeks' gestation: maternal and fetal outcomes

Current ultrasound assessment of placental calcification relies on Grannum grading. The ultrasonographic appearance of grade III placental maturation, if it occurs before 37 weeks, may signify placental dysfunction and is found to be associated with development of pre-eclampsia and low birth weight. To look at the prevalence of a grade III placenta at 36 weeks' gestation in a low-risk obstetric population, and to explore the association between premature aging observed ultrasonographically and pregnancy outcome. Scans were performed at 36 weeks' gestation in 591 low-risk pregnant women to determine placental maturity. The prevalence of grade III placenta at 36 weeks' gestation was determined. Follow-up was performed for the group of women demonstrating a grade III placenta in comparison to those not demonstrating a grade III placenta for determining pregnancy outcome. The prevalence of grade III placenta at 36 weeks' gestation was 3.9%. A grade III placenta at 36 weeks' gestation was significantly associated with young maternal age P = 0.01. The Grannum grade III of the placenta at 36 weeks' gestation was statistically associated with increased risk for development of proteinuric pregnancy-induced hypertension [PITT] later in pregnancy [PR 4.94; 95% CI 1.15-21.26], P =0.021. Women demonstrating a grade III placenta at 36 weeks' gestation had a significant high risk of induction of labour for suspected fetal compromise [RH 4.7; 95% CI 1.76-12.59], P = 0.001. The risk for delivering a baby with a weight <10[th] centile at birth was significantly higher in women with grade III placentas in comparison to those with grades 0-Il [RR 3.19; 95% CII .23-8.27], P = 0.017. In a low-risk obstetric population, ultrasound detection of Grannum grade III placenta at 36 weeks' gestation helps to identify at risk pregnancy. It appears to predict subsequent development of proteinuric PIII and may help in identifying the growth-restricted baby

value of transvaginal sonography performed before diagnostic hysteroscopy for the evaluation of uterine cavity in infertile women

Hysteroscopy have gained general acceptance as a method for the investigation of infertility. The main advantage of hysteroscopy is the capability of inspecting the uterine cavity. Transvaginal sonography [TVS] is a noninvasive modality that provide excellent imaging of the uterus and of endometrial abnormalities. The present study was designed to evaluate the use of TVS as the initial diagnostic procedure before hysteroscopy for detecting intrauterine disorders. Seventy-eight infertile women were examined by TVS and diagnostic hysteroscopy in the late follicular phase of the menstrual cycle and the results were compared. The uterine cavity abnormalities were present in 19.2% of the infertile females involved in the study. The Transvaginal scnography had 87.5% sensitivity, 100% specificity for detecting endometrial polyps while it had 100% sensitivity and 100% specificity for detecting other intrauterine cavity abnormalities including intrautcrine adhesions, uterine septae and submucosal myomas. Examination of the uterine cavity is an integral part of any thorough evaluation of an infertile woman. Tranavaginal sonography, when performed during the follicular phase, can detect most uterine cavity abnormalities. It was an accurate tool in the identification of intrauterine adhesions, uterine septae and submucosal fibroids

Diagnostic efficacy of transvaginal colour doppler sonography in ectopic pregnancy

Ectopic pregnancy continues to be a major cause of maternal morbidity and mortality. A dramatic increase in incidence over time has been reported in several countries. The advent and wide application of ultrasound has greately improved the possibility of non- surgical diagnosis of ectopic pregnancy . Images obtained by the higher frequency and better resolution transvaginal ultrasound scan [TVS] probes facilitates the earlier diagnosis of ectopic pregnancy. The addition of Doppler ultrasound have revolutionised the non-invasive diagnosis of ectopic pregnancy. Patients presenting to AI-Yarmouk Teaching Hospital with clinical suspicion of ectopic pregnancy were evaluated using TVUS. Colour flow imaging was performed and resistance indices [PIs] of the artery blood flow were calculated. The pulsatility indices [PIs] of both uterine arteries were also measured and serum beta-hCG was quantitated. The Doppler flow results were correlated with surgical findings at laparoscopy or explorative laparotomy. Forty-seven women were enrolled .Six patients with intrauterine gestation were excluded. Tubal pregnancy was diagnosed by TVUS in 28 of 32 patients with ectopic pregnancy, while 30 of 32 patients were diagnosed by colour Doppler sonography. Colour flow in the trophoblastic tissue was detected in 59.3% of the tubal pregnancies, and the mean [ +/- SD] RI of the trophoblastic flow was [0.49 +/- 0.1]. The PIs tended to decrease at higher beta- hCG levels. The average PI of the uterine arteries was [2.29 +/- 0.3]. The PIs of the ipsilateral uterine arteries were significantly lower than the contralateral ones. The sensitivity of colour Doppler in the diagnosis of ectopic pregnancy was [93 .8%] with accuracy of [85 .4%] Colour imaging is a good supplementary diagnostic tool in modern management of ectopic pregnancy. The addition of colour Doppler flow imaging to transvaginal sonography allows increased sensitivity in the detection of ectopic pregnancy