Assessment of plasma carnitine and acylcarnitine levels in preeclampsia

Objective: carnitine plays a crucial role in fatty acids oxidation. The aim of the study is to assess plasma carnitine and acylcarnitines levels in preeclamptic womedas a measure of abnormal fatty acid oxidation

Methods: the study included 40 women with preeclampsia and 30 normotensive control women in the third trimester of pregnancy. Women with multiple pregnancy, chronic hypertension, diabetes mellitus and renal diseases were excluded. Plasma levels of free carnitine and acylcarnitines were measured with high performance liquid chromatography [HPLC]

results: total and free carnitines and acylcamitines were significantly increased in preeclamptic cases in comparison to the control group. A positive correlation was found between acylcarnitines and diastolic blood pressure [r=0.382, p= 0.018]

Conclusion: the significantly high plasma carnitine concentrations found in this study supports the hypothesis of abnormal fatty acid metabolism in the pathophysiology of preeclampsia. This may contribute to the endothelial cell dysfunction of preeclarnpsia

Single versus double fallopian tube sperm perfusion in the treatment of unexplained infertility: a prospective randomized study

Objective: to evaluate the efficacy of double fallopian tube sperm perfusion [FSP] in comparison with single FSP in patients with unexplained infertility undergoing controlled ovarian stimulation

Study design: sixty six patients with unexplained infertility undergoing a standard ovarian stimulation regimen were randomized to receive either single FSP [group I, n=33] or double FSP [group II, n=33]. The same insemination method was performed in subsequent cycles if the patient does not become pregnant in the first one. A maximum of three cycles was performed. Fallopian tube sperm perfusion was carried out with pediatric Foley's catheter, which prevents reflux of sperm suspension. Semen was prepared by a classical swim-up technique

Results: a total of 133 cycles were completed; 68 single FSP cycles and 65 double FSP cycles. There were no differences in demographic data, ovarian stimulation and insemination characteristics between the two study groups. In the single FSP group, there were 10 clinical pregnancies [14.7% per cycle] of which 8 were ongoing [11.7% per cycle]. In the double FSP group, 19 clinical pregnancies [29.2% per cycle] of which 16 ongoing pregnancies [24.6% per cycle] were obtained. These differences were statistically significant. The prevalence of multiple pregnancies, abortions, and ectopic pregnancies was similar in the two groups

Conclusion: the results of this study indicate that there is significant improvement of pregnancy rates in patients with unexplained infertility when treated with double FSP after controlled ovarian stimulation in comparison with single FSP. Double FSP method is simple, easy to perform, inexpensive and convenient for the patients. Trials of this method in patients with unexplained infertility may be useful before the adoption of the expensive assisted reproductive techniques

Objective assessment of the severity of stress urinary incontinence by urodynamic tests and introital ultrasound

To determine whether objective differences exist in the results of urodynamic tests and introital ultrasonography between patients with grade 1 and 2 stress urinary incontinence. The study included fifty premenopausal women with the diagnosis of stress urinary incontinence as proved by urodynamic findings [cystometric exclusion of detrusor hyperactivity]. Patients were classified into grade 1 and 2 according to the degree of physical activity required to produce urinary leakage. Twenty five patients had grade 1 and 25 had grade 2 stress urinary incontinence. Parameters of uroflowmetry filling crystometry, urethral pressure profile and introital ultrasound were compared between grade 1 and 2 stress urinary incontinence. Urodynamic measurements showed that in uroflowmetry, there were no significant differences in maximum flow rate or residual urine between grade 1 and 2. In Filling crystometry, there were no significant differences in the first desire to void or maximum cystometric capacity between the two groups. There were also no significant differences in any of the urethral pressure profile parameters. Intorital ultrasound revealed no significant differences in posterior urethrovesical angle, bladder neck descent or urethral funneling between grade 1 and 2. There are no differences in objective related parameters between patients with grade 1 and 2 stress urinary incontinence, as documented by both urodynamic and ultrasound studies. The development of more objective tests as 3D ultrasound, ultrasound with contrast media, color Doppler and MRI is required to accurately classify stress urinary incontinence

Color doppler ultrasonography evaluation of nuchal cord before induction of labor in postterm pregnancies

To asses the ability of color Doppler ultrasonography to detect the presence of nuchal cord [NC] before induction of labor in uncomplicated postterm pregnancies, and to investigate whether fetal umbilical artery vascular resistance, mode of delivery, and neonatal outcome are affected by its presence in such cases. In a prospective study, a transabdominal grayscale and color Doppler ultrasound imaging was performed prior to induction of labor in 250 women with uncomplicated postterm pregnancies at 41 weeks to detect the presence of nuchal cord and to measure the umbilical artery [UA] systolic/diastolic ratio [S/D] and resistance index [RI]. The outcomes of labor, delivery and neonates were obtained. Outcome parameters evaluated included presence of nuchal cords at delivery, mode of delivery, non-reassuring fetal heart rate patterns [NRFHR], meconium-stained amniotic fluid, birth weight, 1 and 5 minutes Apgar scores, and admission to neonatal intensive care unit. A total of 250 women were included in this study, of which 71 had sonographic evidence of NC [group I] and 179 without sonographic evidence of NC [group II]. A nuchal cord was present at 26.8% of deliveries. The sensitivity of color Doppler sonography in diagnosing NC was 94%, with specificity, positive and negative predictive values of 95.6%, 88.7%, and 97.7%, respectively. No abnormal UA waveform patterns were detected in either group, and no statistically significant differences in UA S/D or RI values were found between the two study groups. There were also no significant differences between group I and group II with respect to mode of delivery, NRFHR, meconium-stained amniotic fluid, birth weight, 1 and 5 minutes Apgar scores, and neonatal intensive care unit admissions. Color Doppler ultrasonography is highly sensitive and specific method of diagnosing nuchal cord prior to induction of labor in uncomplicated postterm pregnancies. However, fetal umbilical artery vascular resistance, mode of delivery, and neonatal outcome are not affected by cord encirclement in such cases. Therefore, ultrasonographic nuchal cord assessment is neither a necessary nor a useful procedure before labor induction in uncomplicated postterm pregnancies, and intrapartum intervention based on the antenatal diagnosis may not be appropriate

Study on modification of the Misgav Ladach method for cesarean section versus the Pfannenstiel technique

To evaluate the operative and postoperative outcomes of two different methods of cesarean section, and to determine whether the modified Misgav Ladach Technique can offer benefits when compared with the conventional Pfannenstiel cesarean section. In this prospective randomized controlled study, 80 women undergoing a first elective or emergency cesarean section were randomly allocated to two groups. One group [n=40] was operated on by the modified Misgav Ladach method for cesarean section and the other group [n=40] by the Pfannenstiel method. The modified points in the Misgav Ladach method included: transversely incising the subcutaneous tissue and rectus sheath 2 to 3 cm then dividing them bluntly, two layers suturing of low transverse uterine incision; closing the skin by staples. Outcome measures studied were operating time, time to newborn delivery, amount of intraoperative blood loss, analgesics required in the first postoperative day, bowel restitution by the second postoperative day, febrile morbidity, postpartum endometritis, wound infection and hospitalization period. Operating time was significantly different between the two methods, with an average of 26.4 minutes with the modified Misgav Ladach method and 39.8 minutes with the Pfannenstiel method [p<0.05]. Time to newborn delivery was with average 1.2 minutes with the modified Misgav Ladach method and 3.9 minutes with the Pfannenstiel method [p<0.05]. The amount of intraoperative blood loss differed significantly, with 388 ml and 555 ml respectively [p<0.05]. Significantly less analgesic doses were needed after the modified Misgav Ladach method. Proportion of cases who had bowel restitution by the second postoperative day was significantly higher in the modified Misagav Ladach group. There was no significant difference between the two groups regarding febrile morbidity, endometritis, wound infection and period of hospitalization. The modified Misgav Ladach method of cesarean section has advantages over the Pfannenstiel technique by being significantly quicker to perform, faster in delivering the newborn, with more reduction of intraoperative blood loss, lesser need for analgesia and earlier bowel restitution. In this study no negative effects of the modified Misgav Ladach method were found