Chromosomal study in newborn infants with congenital anomalies in Assiut University hospital: cross-sectional study

In 40-60% of congenital malformations, the cause is unknown. Genetic factors account for approximately 15%; environmental factors produce approximately 10%; a combination of genetic and environmental influences produces 20-25%. The study aims to document prevalence and patterns of congenital malformations detected at birth in Assiut University hospital and clarify underlying chromosomal abnormalities of such malformations. Also possible predisposing factors will be studied. Newborns with apparent congenital anomalies were selected from 5000 newborn infants delivered consecutively at the department of Obstetrics and Gynecology within 7 months. Full maternal history, family history, perinatal history, pedigree construction as well as clinical examinations and investigations including karyotype were done. Congenital anomalies were found in 103 cases with a prevalence of 2.06% with male to female ratio of 1.7:1. Skeletal system anomalies had the highest frequency [37.9%], followed in descending order by chromosomal abnormalities [27.2%], circulatory system anomalies [22.3%], central nervous system [CNS] anomalies [19.4%], genital organs anomalies [16.5%], gastrointestinal tract [GIT] anomalies [14.6%], eye and ear anomalies [8.7%], and lastly urinary system and others anomalies in 3.9% each. Breech presentation, perinatal asphyxia, incubator admission and the need for resuscitation were significantly associated with the presence of congenital anomalies. Higher prevalence of congenital anomalies was observed in neonates of grand multiparous women, diabetic mothers delivery by CS, cases with oligohydramnios and with positive consanguinity. Chromosomal abnormalities were found in 28 cases [27.18% of malformed cases] [5.6/1000]. Numerical abnormalities were found in 22 cases [21.35%] [4.4/1000], Down syndrome in 16 cases, Edward syndrome in two cases, Patau syndrome in one case and Turner syndrome [monosomy] in three cases. Structural abnormalities were present in six cases [5.83%] [1.2/1000], Down syndrome in two cases, Turner syndrome in two cases, balanced translocation [[12;13][q15;q34]] with dysmorphic features and undescended testis in one case and deletion 9[q11;q31] with disorder of sex development in one case. To conclude karyotype should not be done routinely for all malformed cases as many of them are due to genetic syndromes. So, it is more useful to consult expert dysmorphologists for proper syndrome identification and for the decision to use more recent molecular techniques for diagnosis

study of T-helper 2 / T-Helper 1 imbalance in respiratory syncytial virus bronchiolitis in relation to severity and outcome

The present study was carried out on 80 infants with acute bronchiolitis. Their ages ranged from 2-22 mo. They were 60 males and 20 females. 30 apparently healthy infants of matchable age and sex were enrolled in the study as controls. Besides taking history, thorough clinical examination and routine laboratorial investigations, arterial oxygen saturation, RSV tissue culture of nasopharyngecil lavage, direct immunoflourescence for serum RSV Ig-M, serum IL-4 and INF-gamma were done. Results showed that viral bronchiolitis is predominant in males around 6 mo of age and in winter months. RSV infection was found, in 72.5% of cases. Serum IL-4 was not different between RSV negative patients and controls but it was significantly higher in RSV positive patients than either RSV-ve cases or controls [P< 0.001 for each]. Furthermore in RSV + ve patients it was significantly higher in severe and fatal cases than in milder and surviving ones [P<0.001 for each]. Serum INF-gamma showed no significant difference between RSV + ve and RSV -ve patients hut it was significantly higher in both groups than controls [P< 0.001 for each]. In RSV+ve cases it was significantly lower in more severe and fatal cases than milder and living ones [P<0.05 respect]. The ratio I-L-4/ INF-gamma was significantly higher in RSV + ve group than RSV-ve and than controls [P<0.001 and P< 0. 05 respectively]. ARC and SaO[2]% showed significantly lower values in RSV + ve patients than RSV-ve ones [P<0.001], but the latter showed significantly higher AEC than controls [P < 0.05]. In RSV + ve group, both parameters were significantly lower in severer and fatal cases than milder and living ones [P < 0.001 for each]. In RSV positive group, significant positive correlations were found between disease severity and either serum IL-4 or IL-4 /INF-gamma ratio [r=0.789 and r=0.823, P < 0.001 respectively] but disease severity was inversely correlated with either AEC or SaO2% [r = - 0.962 and r = - 0.828, P < 0.001 respectively]. RSV is the major etiologic virus of bronchiolitis in young infants. Viral tissue cultures and direct immunoflourescene are of equally diagnostic value but both may be needed. Most of the severe and fatal cases are in RSV + ve group. Th2 / Th-l imbalance reflected on IL-4 /INF gamma ratio is more deranged in RSV bronchiolitis with Th-2 predominance especially in more severe and fatal cases. These conclusions may be a rationale for addition of antiviral in severe cases of bronchiolitis but further studies of antiviral drugs and their effect on cytokines may be needed to address this recommendation

study of some oxidant products and antioxidants in children with acute respiratory distress

The present study included sixty pediatric patients with acute respiratory distress, their age ranged from 2 months to 13 years. They were 42 males and 18 females, in addition to twenty apparently healthy children of matchable age, sex and socioeconomic status as control group. All patients were selected from the Intensive care and emergency unit of pediatric department, Assiut University Hospitals. Patients with sepsis or suspected metabolic disease were excluded. Thorough clinical history, examination and chest x-ray were conducted. Laboratory assessments included a peripheral hemogram, serum electrolytes, urea, creatinine, arterial blood gases and estimation of some products of oxidant stress and antioxidants including nitric oxide [s. nitrite], lipid peroxides [LPER], total thiols [glutathione], ceruloplasmin and vitamin E. Out of the 60 patients, 5 cases had viral croup [8.33%], 11 cases had acute viral bronchiolitis [18.33%], 14 children had bronchial asthma [23.33%], 26 cases were diagnosed as bronchopneumonia [43.33%] and 4 cases had lobar pneumonia [6.67%]. No significant difference in arterial blood gases was found between the 5 groups except for PaO[2] which was significantly lower in asthmatic children than in those with bronchopneumonia [P<0.01]. Hemoglobin value was significantly lower and total WBC count was significantly higher in all patients with respiratory distress than controls [P<0.001 for each]. Regarding serum electrolytes, only serum calcium was significantly lower in patients with respiratory distress than controls [P<0.001]. The levels of serum nitrite, lipid peroxides and ceruloplasmin were significantly higher in patients than in controls [P<0.001 for each]. However, serum SOD, total thiols and vitamin E were significantly lower in patients than in controls [P<0.001 for each]. Patients with bronchial asthma showed significantly higher serum nitrite, lipid peroxides and ceruloplasmin and significantly lower total thiols and vitamin E than those with viral croup. Significant positive correlations were noticed between arterial oxygen pressure [PaO[2]] and serum nitrite level and between lipid peroxides and respiratory distress score [P<0.001 for each]. Significant negative correlations were observed between SOD levels fraction of inspired oxygen, between total thiols and either respiratory distress score or Fio2 and between serum vitamin E levels and either respiratory distress score or Fio2 [P<0.001 for each]. Imbalance between endogenous antioxidant systems and oxidant stress with shifting toward oxidant stress may be an underlying pathophysiologic mechanism leading to or aggravating the severity of respiratory distress in airway diseases. Further studies are recommended to delineate the effect of exogenous therapeutic augmentation of antioxidant defenses

study of the occurrence of obesity and some risk factors among primary school children in Assiut governorate

The school age period is one of the apparent feeding problems.Over weight and obesity may soon cause as much preventable disease. The obesity rates have been accelerated dramatically in the past 20 years, in conjunction with a nation trend toward sedentary lifestyles. Estimating the prevalence of overweight and obesity is a preliminary step to build up the prevention and control strategies of obesity. The aims of this study is to assess the occurrence of obesity among primary school children in Assiut, and determine some of it is risk factors. The study was conducted in 11 primary school in Assiut Governorate [both urban and rural areas]. Cross sectional study was used. The total sample included 1000 pupil from primary schools. They were divided into two groups; first group [562 pupil from urban areas] and second group [438 pupil from rural areas]. They were 717 pupil from governmental schools and 283 pupil from private schools. The pupil's age ranged from 6 to 12 years. They were 571 males and 429 females. Data were collected through interviewing pupils individually using a developed questionnaire sheet. Measurements of weight and height were done for each child individually at school using a scale, and non-stretchable tape and body mass index was calculated. The results revealed that the occurrence of obesity and overweight were [6.4% and 16.3% respectively] and more than half of them [53.6%] had family history of obesity, also all parameters are significant predisposing factors except for sex and scholastic level and also there were significant relations between obesity and taking dinner, eating in front of T. V, and increase eating during stress [P < 0.000, 0.013 and 0.038 repectively]. Further more overweight and obesity were significantly more frequent in urban than in rural localities and in private than in governmental schools. Also they were more frequent in children of illiterate than literate parents. From this work it is to recommend increasing physical activity and practical nutritional knowledge through education programs in the school curriculum, encouragement of physical activity during school days and periodic follow up for overweight and obese children by the school physicians and school nurses to avoid future pathological insults and handicaps

Delayed gastric emptying in children with type I diabetes mellitus

Diabetes mellitus is considered a cause of gastroparesis in 30-50% of children and it Is presented with various gastrointestinal symptoms. Erythromycin has a variable effect in treating gastroparesis and the increase in blood sugar can affect its effect. The aim of the work is to assess gastroparesis in diabetic children and to evaluate its relation to gastrointestinal symptoms and also to study the role of erythromycin in the treatment of gastroparesis. The study included 67 children suffered type I diabetes mellitus of moro than 5 years duration. Their ages ranged from 7-11 years. Ten children of matchable age and sex were taken as controls. Clinical history and examination were done with the measurement of glycosylated hemoglobin% and gastric emptying time by scintigraphy. Glycosylated hemoglobin% [HbA1c%] was significantly high in the diabetic patients in comparison to that of the controls [8.02 +/- 1.77 and 4.92 +/- 1.64 respectively]. Out of the 67 patients 31[46.26%] showed delayed gastric emptying time and 18 of them were with gastrointestinal symptoms. HbA1c% was significantly high in those patients with delayed gastric emptying time in comparison to those with normal gastric emptying time [8.48 +/- 1.92 and 7.06 +/- 0.81 respectively]. Also it is higher in those with symptoms than those without symptoms [9.64 +/- 1.75 and 6.89 +/- 0.39 respectively]. As regards the other possible complications that are found in diabetes, patients with neurological type showed significant higher HbA1c%and more delayed gastric emptying time than those without neurological complications [8.31 +/- 2.13 and 6.92 +/- 1.39 and 236.21 +/- 79.12 and 102.1 +/- 43.21 respectively]. By giving erythromycin to the symptomatized patients in a dose of 250, mg 3 times daily for 3 months, 8 out of 18 showed improvement. A positive correlation was found between HbA1c% and GET. In conclusion, gastroparesis could be found in diabetic patients even without symptoms. The presence of other complications especially the neurological type and the uncontrolled blood sugar augment gastroparesis. Therefore, the variable response to erythromycin in gastroparesis is multifactorial

A study of some viral pathogens in infants and children with lowe respiratory tract infection and attending the intensive care unit

Acute lower respiratory tract infections are the most common illness in pediatrics. A great variety of viruses especially RSV can cause bronchopneumonia and bronchiolitis in infants and children. This work aimed to evaluate some viral pathogens in pneumonia and bronchiolitis in infants and children admitted to the ICU. This study included 142 patients, 70 suffered bronchopneumonia and 72 suffered bronchiolitis admitted to the ICU in Assiut Pediatric University Hospital, Egypt. The study was done from November 2002 to February 2003 and from the period of November 2003 to February 2004. Clinical evaluation, chest x-ray, complete blood count and arterial blood gases as well as endotracheal suction for collection of the samples for viral study and bacterial cultures were done. Regarding viral tissue culture 66 patients were positive to the studied viruses [26 with bronchopneumonia and 40 with bronchiolitis] with male predominance [43 males with 65.1%]. Out of the 66, 48 were below age of 12 months, 12 were below age of 24 months and 6 were below 36 months. Respiratory Synsytial virus [RSV] was found in 32 cases [484%], influenza A was in 12 [18.1%], Parainfluenza 3 in 18[27.2%], Parainfluenza I in 4 [6%] and adenovirus in 4 [6%]. It was noticed that there were positive bacterial cultures in 27 cases and also mixed viral types. Malnutrition especially the severe type was concomitant with viral infection specially RSV, As regards the blood gases and respiratory rate it was found that cases with bronchiolitis showed significant differences than those of bronchopneumonia where bronchiolitis was more severe than bronchopneumonia. There were 76 cases negative to the studied viruses 44 were bronchopneumonia and 32 were bronchiolitis. Bacterial cultures were positive in 25 patients. Analysis of the blood count showed leucocytosis in the cases as a whole with significant higher levels in the cases with positive bacterial cultures than those with viral infection only. Lymphocytes were significantly higher in the cases with positive viral cultures than those negative to these cultures and eosinophils were significantly higher in the cases negative to the studied viruses and also showed negative bacterial cultures that the cause could be due to allergic conditions. As regards the outcome of the cases that were positive to the studied viruses 29 died [43.9%], 20 of them were due to RSV infection. It is concluded that RSV is the commonest cause of viral lower respiratory tract infection in infants and children. Mixed viral and bacterial infection is not uncommon which is strongly concomitant with the immunocompromised patients' especially malnourished cases. So the use of immunostimulants in addition to antimicrobial and antiviral drugs may be beneficial in such cases

Evaluation of some organochlorine pesticides in human breast milk and infants' dietary intake in middle and Upper Egypt

A total of fifty-four human breast milk samples were collected from Pediatric Department of Assiut University Hospital from lactating mothers during January-August, 2001. The samples were analyzed for organochlorine pesticide residues by using gas chromatography-electron capture detector [GC-ECD]. The results revealed that all detected organochlorine residue levels were markedly lower in comparison with the previously documented levels although they still had the same frequency percentages as recorded previously. The study indicated also that p,p'-DDE and beta-HCH were found to be the main contaminants and were detected in all analyzed samples [100%] followed by HCB [88.9%], p,p'-DDT [83.3%] and oxychlordane [33.3%]. The mean total DDTs level in breast milk samples was 16.166 +/- 14.82 microg/I formed mainly of p,p'-DDE [95%]. The levels ranged from 3.353 to 67.159 microg/I, with levels exceeding the Extraneous Residue Limits [ERLs] issued by FAO/WHO, in 1994 and1996 [50 microg/I] in only 3 samples [5.6%]. The total HCH isomers average was 1.599 +/- 1.595 microg/I milk formed mainly of beta-HCH. HCB and oxychlordane were detected at lower average levels of 0.389 +/- 0.156 and 0.285 +/- 0.175 microg/I milk, respectively. Within the detection limits no sample was found to contain aldrin, dieldrin, heptachlor, heptachlor epoxide, endrin, gamma- and alpha chlordane residues. The estimated daily intakes [EDIs] for total DDTs, gamma-HCH and total HCH residues never exceeded the recommended FAO/WHO acceptable daily intake [ADIs]. The possible health impact of these pollutants was reviewed

study of serum magnesium, zinc, copper and glycohemoglobin in children with type 1 diabetes mellitus

Magnesium and some trace elements known to act as antioxidants or to be related directly to glucose metabolism may be altered in diabetes mellitus. The aim of the present work is to study the state of these elements in relation to disease duration, control and complications. The study included 25 children with type 1 diabetes and 13 apparently healthy controls studied for serum magnesium, zinc, copper and blood HbA1c. Serum magnesium, zinc and copper were significantly lower in diabetic children than in controls. Serum magnesium was significantly lower in cases with longer duration of disease [>/= 5 years]. Serum magnesium level negatively correlated with the duration of diabetes. Serum zinc was significantly lower in uncontrolled than in controlled and in complicated than in uncomplicated cases. Serum zinc level correlated negatively with the degree of disease control [HbA1c]. It is to be concluded that serum magnesium, zinc and copper are deficient in diabetic children. This deficiency may be related to disease control and/or complications. Supplementation of diabetic children with these nutrients may help in control of the disease and its complications

study of some factors triggering febrile seizures in children

Febrile seizures [FS] represent a common pediatric problem. The pathogenesis of FS is not yet clear. This study was designed to evaluate the role of some clinical and laboratory data as possible triggering factors for FS. The study included 117 patients and 100 age and sex-matched controls [febrile children without seizures]. Both groups were subjected to full history and clinical examination as well as evaluation of some laboratory data as serum iron, sodium, potassium, calcium, lead, zinc, and histamine. EEG was also performed for patients with FS. The results of the present study revealed that patients had significantly higher temperature levels at the time of admission [38.85 +/- 0.60 °C] than controls [38.16 +/- 0.45 °C] [p < 0.002]. Laboratory investigations revealed the presence of significantly lower serum levels of iron, sodium, calcium, zinc and histamine in patients than among controls. Patients with recurrent FS rather than those with single FS had significantly younger age of onset of 1[st] FS [13.80 +/- 6.37 and 19.53 +/- 10.88 months respectively, p < 0.05], and higher percentage of positive family history of FS [44.83% and 25% respectively, p < 0.02] as well as lower serum sodium levels [133.26 +/- 2.76 and 136.81 +/- 3.2 mmol/L respectively, p < 0.001]. We concluded that higher temperature levels, low serum iron, sodium, calcium, zinc and histamine could play an important role as triggering factors for FS. Younger ages at onset of 1[st] FS, positive family history and hyponatremia are possible important factors in pathogenesis of recurrent rather than single FS

effect of clomiphene citrate on coagulability state, HDL and LDL in correlation to serum estradiol levels, ovarian and uterine blood flow

This study was carried out on 25 patients suffering only from anovulatory infertility. The patients received clomiphene citrate tablets in a dose of 100 mg/day for 5 days starting from day 3. Blood cloting time, plasma clot lysis time, plasma fibrinogen level, HDL, LDL, serum estradiol levels, vaginal ultrasonography for assessment of follicular development and vaginal Doppler to measure PI of the ovarian and uterine arteries were done for each patient in early, mid and late follicular phases. This study showed that there was a no significant in the whole blood clotting time, significant prologation of clot lysis time [p< 0.05 at LF] and a significant increase of the plasma fibrinogen at MF and LF [p < 0.05 < 0.005]. There was also a significant increase in the level of HDL at MF and LF [p< 0.05 < 0.005 respectively] and a significant lowering of LDL at MF and LF [p< 0.01 <0.0005]. This study found also a significant increase of the plasma estradiol level [p< 0.005] after clomiphene citrate therapy. It was found also that the pulsatility index [PI] of ovarian and uterine arteries decreased throughout the follicular phase [p< 0.05] and that PI correlated with the number of follicles > 15 mm during EF [r=0.66, P< 0.001], MF [r=0.73, p< 0.001] and LF [r=0.83, p< 0.001]. Serum estradiol levels demonstrated a negative linear correlation with the PI of ovarian artery [r=0.62, p< 0.001] and uterine artery [r=0.52, p< 0.001]. In conclusion, this study linked the changes in coagulation, HDL and LDL levels to changes in serum estradiol levels induced by colmiphene citrate therapy which was reflected by changes in follicular development, uterine and ovarian artery blood flow. However, these changes are within the normal range, so using clomiphene cirate is not risky to induce cogalution disorders exceptin high risk patients

Obscure chronic pelvic pain: role of transvaginal doppler ultrasonography

65 patients with chronic pelvi pain of obscure origin, and 20 normally menstruating women as control; were studied. A compined transvaginal real imaging and pulsed Doppler system were used to study the pelvic anatomy and velocimetry in the uterine and ovarian arteries in these women. Pelvic varicosities were found in 47 patients [72.3%]. These were bilateral in 53%, left sided in 34%, and right sided in 13%. Additionally intramural myomas were found in 10.5%, hydrosalpinx in 4.6%, cystic ovaries in 15.4%, and no findings in 6.2%. The severity of the presenting symptoms was directly correlated to the degree and extent of vascular abnormalities. The includence of varicosities was found to carry a direct relation with the duration of pain. The resistance index [RI] of the uterine and ovarian arteries was increased in patient group [0.81 +/- 0.06 and 0.76 +/- 0.04] when compared to control group [0.69 +/- 0.04 and 0.66 +/- 0.05] respectively. A significant correlation was noticed between RI, the bulk of varicosities and the severity of pelvic pain. We conclude that transvaginal Duplerx Doppler ultrasonography is of value in the study of cases of obscure pelvic pain

Lumbar epidural analgesia and utero-placental blood flow in pregnancies complicated by hypertension

Eighteen parturient patients [15 with severe pre-eclampsia and 2 patients with chronic essential hypertension] were studied before and after lumbar epidural analgesia during first stage of labour using 10ml of 0.25% of bupivacaine. The utero-placental perfusion was evaluated by determining the systolic/diastolic [A/B] ratio in the uterine and umbilical arteries using Doppler velocimetry waveform analysis. The uterine artery systolic/diastolic [A/B ratio] decreased significantly from 1.95 + 0.45 before analgesia to 1.36 + 0.20 after it [p < 0.01]. The umbilical artery systolic/diastolic [A/B ratio] also decreased from 2.85 + 0.45 before analgesia to 2.22 + 0.53 after it [p < 0.01]. These results suggest improved utero-placental perfusion and improved intervillous blood flow after epidural analgesia which mades it the the obstetric analgesia method of choice in cases of sever pre-eclampsia

Utero-placental perfusions after epidural analgesia for cesarean section

The blood flow resistance in the maternal utero-placental and fetal umbilical artery circulation were studied in 20 pregnant patients with uneventful pregnancy undergoing elective lower segment Caesarean section. The systolic/diastolic [A/B] ration for utero-placental and fetal umbilical circulation were determined by Doppler velocimetry waveform analysis and were used as an index blood flow resistance. Each patients received 1 liter intravenous crystalloid infusion before an epidural bupivacaine infection. Epidural anaesthesia resulted in significant decease in the maternal utero-placental systolic/diastolic [A/B] ration associated with a decrease in fetal umbilical artery [A/B] ratio. This study suggests a beneficial fetal effect from the improved maternal uterine perfusion after epidural anaesthesia

Antepartum fetal surveillance in postmaturity: Role of vibroacoustic stimulation test, amniotic fluid index, doppler velocitymetry and biophysical profile

60 pregnant post-date pregnancies were studied. For each patient, vibroacoustic stimulation [VAS] was done using artificial electronic larynx. The S/D ratio of the umbilical arteries was determined. Additionally, 4 quadrant assessment of amniotic fluid volume and fetal biophysical profile were done for each case. The results of these tests were correlated with the outcome of delivery. 47 fetuses were reactive during VAS [78.3%], whereas 13 were nonreactive [21.7%]. Amniotic fluid index was very low in 2 cases [3.3%], low in 10 cases [16.33%], normal in 4 cases [66.6%], and above 18 cm in 8 cases [13.3%]. The S/D ratio was >3 in 10 cases [16.6%] and <3 in 50 cases [83.4%]. The biophysical score was normal in 51 cases [85%] and abnormal in 9 cases [15%]. The VAS test proved to be of high predictive ability when correlated with Apgar score, meconium staining of amniotic fluid, fetal distress during labor, prolonged incubation and the perinatal mortality. Its ability to shorten the testing time and to reduce the incidence of nonreactive NSTs suggests its routine use in post-date pregnancies. Similarly, amniotic fluid index yielded significant correlation with the fetal outcome, whereas the Doppler velocitymetry proved to be of little predictive ability of the fetal wellbeing in postterm pregnancies

Foetal foot length and heel ossification centers as predictors of gestational age in infants of normal and high risk pregnancies

Ultrasonographic measurement of fetal foot length, heel ossification centers, biparietal diameter and femur length and postpartum measurement of foot length was carried out on 200 cases of normal pregnancy, 20 diabetic and 30 pregnancy induced hypertensive mothers of gestational age between 16-40 weeks. Mathematical evaluation of the relationship between Fetal foot length and gestational age was performed with use of the linear regression model and curvilinear regression models. Our study demonstrated marked accuracy of fetal foot length in estimation of gestational age between 16 and 40 weeks not only in normal pregnancies, but also in infants of diabetic and pregnancy-induced hypertensive mothers, where the measurement in the last group did not differ from those of normal pregnancies. A curvilinear association between fetal foot length and gestational age - based on regression analysis - was detected. The fetal foot length correlated in a linear manner to biparietal diameter [r = 0.952 and P < 0.0001], and in a curvilinar relationship to femur length [r = 0.944 and P < 0.0001]. It was found that the presence or absence of calcaneus and talus descriminated between gestations < 18 weeks and > 18 weeks and between gestations < 22 weeks and > 22 weeks respectively. It was concluded that the measurement of fetal foot length and identification of fetal heel ossification centers should be undertaken as adjuncts for estimation of gestational age especially when other parameters such as biparietal diameter and femur length does not accurately reflect fetal age such as in cases of intrauterine growth retardation

Amniotic fluid zinc in pregnancies with intrauterine growth retardation

Amniotic fluid samples were obtained from twenty pregnant women with intrauterine growth retardation [IUGR] and fifteen normal controls at 36 to 38 weeks of gestation. Amniotic fluid zinc content was assayed by atomic absorption spectrophotometry. A highly significant reduction of amniotic fluid zinc was found in the group of women with intrauterine growth retardation compared to the control group [P< 0.001]. This finding suggests that amniotic fluid zinc measurement may be used as a parameter for assessment of fetal growth rate

Maternal zinc status and fetal wellbeing in pre-eclampsia

Maternal zinc contents in plasma, polymorphnuclear [PMN] and mono-nuclear [MN] white cells were determined in forty pregnant women with preeclampsia and in fifteen normal pregnant women as controls. The gestational age varied between 34 and 38 weeks. Fetal wellbeing was assessed using non stress test [NST], contraction stress test [CST] and ultrasonography. Significant reduction of maternal zinc contents of plasma and leucocytes were detected in cases of severe preeclampsia, non reactive stress test, positive contraction stress test and in women with evidence of intrauterine growth retardation. Whether this reflects nutritional deficiency or fetal jeopardy is not known. The possibility of determination of maternal zinc content for detecting increased fetal risk is discussed

effect of nifedipine [ADALAT] therapy on maternal and fetal hemodynamics in pregnancy-induced hypertension [clinical and Doppler studies]

Our work intended to study the effects of sublingual administration of Nifedipine [Adalat] on fetal and maternal hemodynamics in 33 pregnant patients suffering of severe pregnancy induced hypertension. It was found that Nifedipine has a rapid onset of action and caused fall of systolic, diastolic and mean arterial blood pressure after 30 minutes of therapy that reached maximum after 2 hours. In long term follow up, these three parameters dropped but showed fluctuations that never reached the initial level before Adalat intake. The mean heart rate was increased 30 minutes after Adalat intake and remained high in the first 6 hours following therapy, after which it started to fluctuate in the long term follow up. The reported material side effects of Adalat therapy were mild and insignificant. Doppler studies showed a non-significant drop of uterine and umbilical arteries blood flow, 2 days after start of Adalat intake. We concluded that Nifedipine can be used safely for acute hypertensive crisis, but not for long term therapy. It does not produce significant fall of uterine and umbilical blood flow

conservative management of placenta previa: role of Doppler velocimetry of umbilical arteries

In order to evaluate the role of doppler velocimetry in predicting pregnancies at risk of fetal compromise in cases of placenta previa [P.P]+ADs- we studied 65 cases during the peroid of 32 to 40 weeks gestational age. The umbilical artery velocity waveforms were analyzed one week after the last bleeding episode for estimation of the peak systolic/ end diastolic ratio [S/D]. At the same time multiple measurements of fetal growth were determined by ultrasonography [Head circumference, Abdominal circumference and femur length]. The fetal outcome was also determined in a [S/D] ratio of three or more, whereas only five out of 49 cases with normal measurements [10+ACU-] had a high S/D ratio. The high S/D ratio was more prevalent among cases with two or more bleeding episodes. The high S/D ratio was highly correlated with low birth weight [below tenth percentile] at delivery, low Apgar scoring, difficult neonatal resuscitation, admission to NICU development of respiratory distress, prolonged neonatal hospital stay and higher perinatal mortality. We conclude that doppler velocimetry of umbilical arteries proved to be a valuable tool in predicting fetal jeopardy, and in elucidating fetoplacental hemodynamics in cases of P.P

Correlation of ultrasonic epiphyseal centers and fetal lung maturity

One hundred thirty three pregnant women with uneventful pregnancies were studied. Gestational age was accurately determined by clinical and multiple ultrasonographic parameters [The BPD, head circumference, and femur length]. The fetal knees and shoulders were examined for the presence and size of the distal femoral epiphysis [DFE], the proximal tibial epiphysis [PTE] and the proximal humeral epiphysis [PHE]. Amniocentesis was done to all cases for determination of fetal pulmonary maturity through L/S ratio and phosphatidyl glycerol. Our results showed that prior to 37 weeks, the distal femoral epiphysis was detected in 30 patients [100%] with diameters of 1-2 mm in 15 patients [56%], 3-4 mm in 11 patients [36%] and 5-7 mm in 4 patients [14%]. After 37 weeks the DFE measured 1-2 mm in 8 patients [8%], 3-4 mm in 34 patients [33%] and 5-7 mm in 61 patients [59%]. The PTE was detected in 30 patients with a diameter of 1-2 mm, 3-4 mm, 5-7 mm in 28, 2 and none of the patients respectively. After the 37 weeks these measurements were attained in 48, 34, and 21 patients consecutively. On the other hand, the PHE was not detected at all prior to 37 weeks. After the 37 weeks it was detected in 26 patients measuring 0.2 mm in 32 patients [22%] and 3-4 mm in 3 patients [3%]. The pulmonary maturity profile proved to be mature in 99% of these cases. We concluded that the demonstration of PHE is a strong suggestive non-invasive evidence that the fetus has passed 37 weeks and that mostly a mature pulmonary profile was attained