Obstetric outcomes of teenage pregnancy versus adult pregnancy in Egypt

The aim of this study was to compare the obstetric outcome of the teenage pregnancy with that of adult pregnancy. 3260 women with first pregnancy attending Assiut hospital for delivery participated in the study. According to mother age the women were assigned into one of two groups; the 1[st] group included 847 women; the teenage group [primigravida with age of nineteen or less] and the 2[rd] group included 2413 women, the elderly group [primigravida with age more than nineteen]. A structural questionnaire was conducted including background information that covers details of socioeconomic status, obstetric history and complication, delivery and its complications andietal and neonatal outcomes. Complete medical and obstetric examination was performed for every woman in the study as well as their born baby. Only 847 [26.0%] teenagers were

pituitary ovarian axis in the late phase of breast-feeding

This study was performed to evaluate the changes in the pituitary ovarian axis during the stage of escape from the inhibitory effect when breast feeding is prolonged. Also, to investigate the probability of occurrence of subclinical abortion during this stage. Volunteers from the attendee of the postpartum and well-baby clinic of Assiut University Hospital, were studied. Women who had been breast feeding for more than 6 months were frequently examined during one complete menstrual cycle or one month if still amenorrheic. They were having regular marital sexual relation. Examinations included sonographic scanning of the ovary and measurement of FSH, LH, prolactin, estradiol, progesterone and hCG. 7 patients out of the 8 who were amenorrheic showed either quiescent ovaries or partial follicular activity. 8 patients got pregnant during the period of observation. Out of 21 menstrual cycles studied 14 were ovulatory. Ovulation occurred in spite of persistence of hyperprolactinemia in most of them. These ovulatory cycles showed relatively high FSH values in the early and mid-follicular phases but the mid-cycle peak of FSH was occasionally absent. The mid-cycle peaks of E and LH, were lower than normal. The preovulatory rise in P was absent in most of the cycles. P and E production during luteal phase tended to be subnormal [LPD]. Prolongation of breast feeding is associated with resumption of folliculogenesis in spite of hyperprolactinemia. But it seems that the negative feed-back effect of E is exaggerated while the positive feed-back is subnormal. These findings may contribute to LPD which is common during this phase of breast feeding

Folliculogenesis and ovulation during prolonged breast-feeding

This work aimed to determine the probability of ovulation and luteal phase adequacy during prolonged breast feeding. Frequent ultrasonographic ovarian scanning by the vaginal probe of a sector scanner to diagnose ovulation and measurement of serum progesterone seven days after the day of ovulation to assess adequacy of luteal phase. About 42% of the amenorrheic women showed ovarian quiescence, the rest had sonographic evidences of various types of ovarian activity. Ovulation followed by adequate luteal phase occurred in 8% of amenorrheic women [one of them resulted in pregnancy]. This incidence rose to 15 and 18% after resumption of menstruation. However, 73% of these ovulations were followed by evidence of luteal phase deficiency [LPD]. The women who showed ovulation followed by normal luteal phase gave less breast-feeds and more solid supplements than those who had quiescent ovaries. The differences in the infant feeding pattern was less marked between women showing other types of ovarian activity. Active breast feeding gave some protection from pregnancy after the sixth postpartum month with much less reliability than that found before that time. LPD is an important cause of infertility during prolonged breast feeding

Morphological and hormonal changes during menstrual cycle

ovarian morphological changes were monitored by the use of the vaginal probe of a sector ultrasound in thirty five normally menstruating volunteers during 38 cycles. The results were correlated with changes in serum concentrations of oestradiol-17 [E2], progesterone [Prog.], FSH, LH and prolactin [Prl.]. Thirty one out of the 38 cycles studied [81.58%] were considered to fulfill the criteria of a normal ovulatory cycle. These cycles served to document the base-line for the population Assiut, Egypt. In these cycles, the mean-/+ SD follicular diameter increased form 11.17-/+0.68 mm on day [-4] to a maximum of 23.52-/+3.37 mm [range 18 to 23 mm] before ovulation, and subsequent luteal function was judged to be normal by normal progesterone production. Over the five days preceding ovulation and during the days [-1,0, and +1], follicular diameter was most closely correlated with serum E2 levels. The ultrasonographic evidence of ovulation never preceded the LH peak and the time of interval between the LH peak and ovulation which was within 24 hours in 93% [29/31] of the studied cycles. A significant rise in serum progesterone levels prior to or in the day of the LH peak, was demonstrated in ovulatory cycles indicating that luteinization of the dominant graafian follicle occurs prior to ovulation. Of the remaining seven cycles, three [8%] were conceptional cycles with ultrasonic and biochemical confirmation. The morphologic and hormone profile of these cycles did not differ from those of nonconceptional cycle. A chemical message indicating pregnancy was obtained as early as six days after ovulation by a rise of the serum concentration of either-hCG or Sp1. Two out of the seven cycles [5%] gave an ultrasonographic picture suggesting LUF syndrome. In these two cycles, no progesterone rise was observed over the period [-2 to +2]. Inadequate luteal phase was observed in one cycle [3%] which showed normal follicular growth but low progesterone level in the luteal phase. It can be concluded that ultrasonography and hormonal levels should be concurrently used in the detection of ovulation and characterization of the menstrual cycle in any programs of assisted conception

Value of C.T. scan in the evaluation of facial trauma

The introduction of high resolution C.T. scanner as a new diagnostic modality has provided marked improvement in the diagnosis of facial trauma. Both the bony and soft tissue injuries could be well evaluated. The basic technique involves no hazard or discomfort for the patient. It supplies a wealth of information concerning the effect of trauma on the bones and soft tissues. Multiple facial fractures, especially those associated with craniocerebral or spinal injuries, are better and more safely assessed by C.T. Degrees of comminution, previously grossly underestimated by conventional radiography, are more accurately assessed by C.T. High resolution C.T. has become the definite method for studying complex facial fractures. In this study, thirty eight patients with facial trauma were studied by C.T. scan. Axial and coronal thin slices were used. The accuracy of the results were confirmed in patients who have undergone surgical management. The role of C.T. was evaluated and its accuracy was found to be high in demonstrating fractures involving maxillary bone and sinus, zygoma, as well as orbital walls. Le Fort II and Le Fort III fractures were well identified and easily recognized Fractures-involving the nasal bones and nasal septum either alone or associated with other fractures could be well visualized and evaluated. Fractures involving the zygomatic area and mandible were also assessed by C.T. scan with proper determination of the degree of comminution or displacement. Both axial and coronal slices were performed and the two methods complemented each other and increased the diagnostic efficiency of the C.T. technique