Genetic polymorphisms of plasminogen activator inhibitor-1, vascular endothelial growth factor and angiotensin converting enzyme among pre-eclamptic women

Pre-eclampsia is one of the leading causes of maternal as well perinatal morbidity and mortality. The exact pathogenesis of pre-eclampsia is most likely multifactorial. Polymorphisms of plasminogen-activator inhibitor-1 [PAI-1], vascular endothelial growth factor [VEGF] and angiotensin converting enzyme [ACE] may contribute to the pathogenesis of pre-eclampsia. This study was conducted to evaluate the PAI-1, VEGF and ACE genetic polymorphisms in pregnant women with and without pre-eclampsia. A total of 42 pre-eclamptic women and 20 women with normotensive pregnancy, aged between 20-43 years were enrolled in this study. Genomic DNA was isolated from peripheral blood leucocytes. The 4G/5G polymorphism of the PAI-1 gene and insertion-deletion polymorphism of the ACE gene were detected in DNA samples with the use of the polymerase chain reaction [PCR] and the 936 C/T polymorphism of the VEGF gene was determined by polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP]. Chi-squared and student t-tests were used for statistical analysis. In pre-eclampsia [n=42 women], the frequencies of 4G4G and 4G5G genotypes of PAI-1 gene were significantly higher [14.3% and 57.1% respectively] than in the normotensive pregnant controls [0% and 15%, respectively], P<0.001. The 4G allele frequency was significantly higher in pre-eclampsia [42.9%] than pregnant controls [7.5%]; P<0.001. Besides, no difference was detected in the ACE [I/D] and VEGF [936C/T] genotypes distribution of pre-eclampsia and normal pregnancy. The 4G allele of the 4G/5G polymorphism in the promoter region of the PAI-1 gene is suggested to be a genetic risk factor for pre-eclampsia

Serum AMH, estradiol and progesterone: is there a role in predicting the outcome in IVE?

To evaluate the role of antimullerian hormone and serum Estradiol in predicting the outcome in IVF, Prospective controlled trial. Egyptian Fertility center. 89 patients who suffer from infertility and are candidate for IVF are recruited for the study after consenting. Serum estradiol and progesterone are measured on day 1 of the cycle and on the day of HCG administration; we measure serum antimullerian hormone, estradiol and progesterone. The results are compared with the number of retrieved oocytes, number of tansferred embryos, pregnancy rat and incidence of twin pregnancy. The results are statistically analyzed. The age of the patients ranged from 22-45 years with a mean of 30.68 years. 4 patients of the 89 patients of the study got pregnant. There was significant difference between AMH and number of retrieved oocytes, the number of embryos as well as pregnancy rate. There is no significant correlation between AMH and twining. There is no significant correlation between serum estradiol at day 1 with either number of retrieved ooeytes, the number of embryos, pregnancy rate or twining. When we measure estradiol level at the date of HCG administration, there was a significant correlation with the number of retrieved oocytes and the number of embryos but with no significant correlation with pregnancy rate or twining. As regard to the progesterone level, there was no significant correlation with the number of retrieved oocytes, the number of embryos, pregnancy rate or twining at either progesterone levels at day 1 of the cycle or the day of HCG administration. When the estradiol level is below 50 pg/ml the AMH shows the most significant correlation with the number of retrieved oocytes, the number of embryos and pregnancy rate. The cut-off point or AMH is 0.3028 ng/ml below which we face poor ovarian response whereas that for estradiol at day 1 is 47.32 pg/ml. Both AMH and estradiol level at the day of HCG administration have a role in predicting the outcome of IVF in regard to the number of retrieved oocytes, the number of embryos and pregnancy rates in opposition which shows no actual relation to the IVF outcome parameters. In view of these laboratory investigations mainly AMH, our results do not recommend it as a routine procedure for women undergoing IVF. We can use them in patients whom we anticipate poor response in IVF program

Maternal mortality in Kasr EL Aini Hospital: Eleven years experience

To estimate the maternal mortality rate in Kasr AL Aini hospital, Cairo University, Egypt over eleven years duration to suggest different strategies to maternal mortality. Materials and Retrospective analysis of the mortality the period between 1992 to 2003. WE divide the duration of study into three periods as prophylactic were started in the second period and continued during the third period. The number of maternal deaths in the 1st period [1992-1995] was 61 with maternal mortality ratio [MMR] of 207 per 100,000 live births, while in the 2nd period [1997-2000] the number of maternal deaths was 43 with MMR of 118. Finally in the 3rd period [2001-2003] the number of maternal deaths was 37 with MMR of 97.1. Comparison between maternal mortality in 1st period and 3rd period was statistically significant. Relative risk was 2.39 [95% CI 1.56-3.71] [p = 0.000015]. The main causes of maternal mortality were postpartum hemorrhage, complications of sever hypertensive disorders, anesthetic complications and rheumatic heart diseases. Maternal deaths occurred in most of cases in late pregnancy and labor mostly due to postpartum hemorrhage and sever hypertensive disorders during pregnancy. Maternal mortality involves complex mixture clinical, infrastructural and social causes and requires a multifaceted approach, however it can effectively avoided and prevented through improving antenatal care, emergency obstetric services and reform of internship training program.

Evaluating the value of sonographic criteria for polycystic ovary compared to endocrine profile

To evaluate the reliability of using transvaginal sonography criteria and Doppler examination for diagnosis of polycystic ovarian disease compared to hormonal profile of these cases. prospective controlled trial. Kasr El-Aini Hospital. Participants and Seventy eight women were enrolled in the present study. Forty eight of them were infertile women shown to have elevated LH/FSH ratio [Group I]. Group II included 30 apparently normal parous women nonhirsute, non obese, with normal menstrual rhythm. Detailed assessment of the ovary for all cases was done using transvaginal ultrasonogmphy and Doppler examination and the following was recorded: ovarian volume, stromal width, number of follicles, and peak stromal blood flow velocity. The mean ovarian volume in the study group [13.4] was significantly higher than mean ovarian ' volume in the control group [7.8] [P <0.05]. The mean number of follicles in the study group [11.2] was significantly higher than that of the control group [4.3] [P <0.05]. The mean stromal width in the study group [16.3mm] was also significantly higher than that of the control group [8.8mm] [P <0.05]. Peak stromnl blood flow velocity also showed significant difference between both groups [9.6 vs 6,6 [cm/s]]. Increased stromal width showed the highest sensitivity amongst all the ultrasonographic morphological criteria. Transvaginal ultrasonography is a valuable tool for diagnosis of FCO. Stromal width as a single test appears to be the most favorable screening test to predict endocrine abnormalities characteristic for PCOS