Comparison of the prognostic values of inhibin and CA-125 as tumour markers for ovarian masses diagnosed by ultrasonography

To evaluate the performance of screening for ovarian malignancy by serum assay of inhibin and cancer antigen [CA-125] in patients with ultrasonographically diagnosed ovarian masses. Their predictive efficacy as tumour markers will also be assessed. Two-year observational, cross-section study of screening performance. Al-Azhar University Hospitals in Damietta and Cairo. 60-women with ovarian masses larger than 10cm were enrolled in this study. All patients were subjected to a complete medical history, clinical and ultrasonographic examinations. Laboratory assay of serum inhibin and CA-125 were performed before surgical procedure and repeated at 3-week and 6-month postoperative visits. All ovarian specimens were examined histopathologically. Mean concentrations of serum inhibin and CA-125. The mean concentrations of serum inhibin and CA-125 declined significantly in patients with benign ovarian masses at 3-week and 6-month follow-up visits in comparison with baseline concentrations [8.01 +/- 3.91 and 7.07 +/- 3.22 vs 14.30 +/- 5.42pg/mL; 24.60 +/- 5.19 and 24.30 +/- 10.72 vs 32.10 +/- 10.41U/mL, respectively]. [p+<0.05]. It was evident that the mean concentrations of serum inhibin and CA-125 were significantly higher in patients with malignant ovarian masses than in those with benign ovarian masses [p*<0.001]. In malignant ovarian mass group, there was a significant reduction of serum inhibin and CA-125 at 3-week and 6-month follow up visits in comparison with the baseline concentrations [21.60 +/- 2.35 and 21.60 +/- 3.07 vs 58.10 +/- 20.62pg/mL; 34.31 +/- 11.56 and 33.32 +/- 12.50 vs 69.81 +/- 27.72U/mL, respectively] [p+<0.05] The serum levels of inhibin and CA-125 were significantly higher in patients with endometrioid cysts than that in patients with other benign ovarian tumours [p<0.05]. In addition, the mean concentrations of serum inhibin and CA-125 were significantly higher in patients with dysgerminoma [82.70 +/- 21.20pg/mL and 63.52 +/- 15.90U/mL, respectively] compared with other pathological types of malignant ovarian tumours [p<0.05]. Considering the predictive efficacy of the studied tumour markers, elevated serum levels of inhibin and CA-125 could predict ovarian malignancy with a sensitivity of [82% vs 85%], specificity of [85% vs 78%], positive predictive value of [87% vs 82%], and negative predictive value of [79% vs 81%], respectively [p>0.05]. Screening modality of plasma inhibin assay has been proven to be efficacious as a tumour marker for ovarian malignancy. It has a predictive efficacy comparable to that of CA-125. Their use together could potentially improve sensitivity and specificity in screening for ovarian cancer

First trimester ultrasonographic detection of fetal aneuploidies and fetal structural abnormalities in an unselected population

To determine the value of early pregnancy ultrasonography in detecting fetal structural and chromosomal abnormalities in an unselected obstetric population. Prospective, observational, cross-sectional, screening study. Al-Azhar University Hospitals in Damietta and Cairo. 1500 sequential unselected women [mean maternal age 28.3 years, range 18-42; mean gestational age 12 +4 weeks, range 11-14], carrying 1468 live fetuses participated in this study. All women initially underwent transabdominal ultrasonograpy and when the anatomical survey was considered to be incomplete, transvaginal ultrasonography was also performed [20.1%]. Nuchal translucency was measured and karyotyping was performed as appropriate. Detection rate of fetal anomalies and measurements of nuchal translucency thickness. Pregnancy outcome was obtained through karyotyping, outcome questionnaires and examination of the newborn infants. The incidence of anomalous fetuses was 1.4% [21/1468] including 9 chromosomal abnormalities. The detection rate for structural abnormalities was 62.5% [10/16] and the specificity was 99.9% in early pregnancy. When the first and second trimester scans were combined, the detection for structural abnormalities was 81% [13/16]. Hundred percent [9/9] of chromosomal abnormalities were diagnosed at 11-14 weeks, either because of a nuchal translucency greater than or equal to the 99 th centile for gestational age [66.6%; 6/9] or due to the presence of structural abnormalities [44%; 3/9]. Hundred percent [6/6] of cases of trisomy 21 were also diagnosed either because of having a nuchal translucency >/= 99 th centile [67%; 4/6] or due to the presence of a structural abnormality [33%; 2/6]. It was found that a cut-off point >/= 3 for fetal nuchal translucency could predict trisomies 21 and 18 with a sensitivity 67 and 50%, specificity 96.6 and 96.6%, positive predictive value 7.5 and 2% and negative predictive value 99.8 and 99.9%, respectively. A significant proportion of fetal structural and chromosomal abnormalities can be detected by ultrasonographic screening at 11-14 weeks, but the second trimester scan should not be abandoned. The sensitivity of detection can be improved by combining measurement of nuchal translucency with detailed examination of fetal anatomy

Manometric and ultrasonographic assessment of anal sphincter function following forceps or vacuum assisted vaginal delivery

To compare differences in anal sphincter function following vacuum or forceps assisted vaginal delivery. Prospective, r and omized controlled trial. Al-Azhar University Hospitals in Damietta and Cairo.One hundred and thirty primiparous women were recruited antenatally and if an instrumental delivery was indicated, were r and omized to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow-up consisted of a symptom questionnaire, anal manometry, and endoanal ultrasonography. Faecal continence scores, anal manometry and endoanal ultrasonography. Sixty-one women delivered with forceps assistance [42 for failure to progress in the second stage] and 69 with vacuum assistance [50 for failure to progress]; 16/69 vacuum deliveries proceeded to a forceps assisted delivery [23%]. There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 7 [11%] forceps and 3 [4%] vacuum deliveries. Based on intention-to-treat analysis, 32 [52%] women complained of altered faecal continence after forceps delivery compared with 21 [30%] following vacuum delivery three months postpartum. Endoanal ultrasonography was reported as abnormal following 34 [56%] forceps deliveries and 34 [49%] vacuum deliveries. After exclusion of 'failed vacuum', median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone [p<0.001]. There were no significant differences in degree of ultrasound abnormality between the two groups. Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery

Evaluating the effectiveness of high-dose misoprostol in the prevention of postpartum haemorrhage

To investigate the effectiveness of high dose rectal msoprostolpreventing postpartum haemorrhage. Study design: 270 women were randomly allocated to receive 600 micro g misoprostol per rectum after norrnal vaginal delivery or to receive no medication in their third stage of labour. Any excessive bleeding in either group was actively managed with conventional oxytocic agents. Blood loss was measured directly. Setting: Damietta and Ali-Hussein University Hospitals. The inclusion criteria were similar. Blood loss of >/= 1000 ml occurred in 2.3% [3/1 30] of the misoprostol group and 6.4% [9/140] of the "no drug' group. Additional oxytocic therapy was required by 1.5% [2/130] and 4.2% [6/140] respectively. Side effects attributable to prostaglandins, particularly-shivering and pyrexia, occurred more frequently in the misoprostol group. The use of 600 micro g misoprostol per rectum in the management of the third stage of labour was well tolerated and associated with statistically significant less postpartum haemorrhage

Relation between maternal haemoglobin and birth weight in Damietta

To assess the relation between the lowest haemoglobin [Hb] level in pregnancy with birth weight [B. Wt.] and the rates of low birth weight [LBW] and preterm delivery. 100 indwelling low-risk pregnant women clients of the outpatient antenatal clinic at Al-Azhar University Hospital, Damietta. A prospective study was conducted on the year 2002 between January and July. The haemoglobin measurement was the lowest one recorded during pregnancy. Birth weights were recorded and the rates of LBW [<2500 g] and the preterm delivery rate [<37 completed weeks] were the main outcome measures. The maximum mean B. Wt. was achieved with a lowest Hb concentration [Hb%] in pregnancy of 85-95 g/1; the lowest incidence of LBW and preterm labour occurred with a lowest Hb of 96-105 g/1. The magnitude of the fall in Hb% in pregnancy, physiological haemodilution, is related to B. Wt.; failure of the haemoglobin concentration to fall below 106 g/1 indicates an increased risk of LBW and preterm delivery

Vaginal fetal fibronectin and maternal dehydroepiandrosterone sulphate levels as selection criteria for induction of labour: a correlation study with bishop score

This study aimed to evaluate the predictive efficacy of two biochemical markers, the vaginal fetal fibronectin and maternal dehydroepiandrosterone sulfate for the fate of labor induction attempt. The reliability as well as the efficacy of their use together with Bishop score as selection criteria for induction of labor were also assessed. One hundred women with singleton pregnancies above 37 weeks gestation and with various indications for induction of labor with no signs of maternal of fetal compromise were enrolled in this study. After clinical assessment and fulfillment of selection criteria, patients were randomly allocated in two equal groups to have either vaginal fetal fibronectin [FFN] [GI=50] or maternal serum dehydroepiandrosterone sulfate [DHEAS] [GII=50] as a biochemical marker. Prior to induction of labor, all women were subjected to a detailed medical history, clinical examination including the cervical Bishop scoring, ultrasonographic assessment and estimation of the offered biochemical marker in each group. Induction-active phase interval was measured for all participants. The main outcome measures were mean concentrations of vaginal [FFN] and maternal [DHEAS], bishop score and induction-active phase interval. From this study, it was concluded that both fetal fibronectin and maternal dehydroepiandrosterone sulfate are effective predictors of the induction-active phase interval