Maternal serum biochemical markers as a predictor for adverse pregnancy outcome

To establish reference values of assaying some maternal serum biochemical markers, namely; MSAFP. MSHCG, uE3 and PAPP-A: at 10-20 weeks gestation; among healthy pregnant women and observe the relationship of such markers to predict adverse pregnancy outcome. This is a prospective randomized controlled study conducted in the Obstetrics and Gynecology Departments at AL-Azhar and Cairo University Hospitals during a period of two and half years starting January 2003. Three hundreds healthy pregnant women from those attending the antenatal clinics were participated in this study. Their age ranged between 20-38 years. They all had a spontaneous pregnancy in singleton with gestational age of 10-20 weeks gestation at the time of study. This was confirmed by ultrasonic scanning. Pregnancy outcomes were obtained for all women. The incidence of adverse pregnancy outcome namely: miscarnage, preterm delivery, intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD]. pregnancy induced hypertension [PIH] and congenital malformation were evaluated. Blood samples were withdrawn and sera were separated for estimation of levels of maternal serum alpha fetoprotein [MSAFP], unconjugated estriol [uE3], free 3-human chorionic gonadotropin [beta-hCG] and pregnancy associated plasma protein-A [PAPP-A]; using time resolved flouroi mmunoassay technique. Our study showed, unexplained significant elevations of MSAFP and serum 3hCG levels with adverse pregnancy outcome [miscarriage, preterm delivery, IUGR, IUFD]. Low unconjugated estriol levels, was associated with adverse pregnancy outcome except for preterm delivery. Maternal serum levels of PAPP-A were found to be significantly decreased in all adverse pregnancy outcome except in PIH. Combinations of maternal serum markers for prediction of adverse pregnancy outcome were compared. Increased maternal serum AFP and 3hCG were significant only for miscarriage and preterm delivery, whereas increased MSAFP and decreased uE, was significant for all adverse pregnancy outcome except for preterm delivery. Increased levels of MSAFP and decreased levels of PAPP-A was only significant with PIH. Whereas increased levels of beta hCG with decreased uE3 levels was significant for all adverse pregnancy outcome except for preterm delivery and PIH. The combination of increased beta hCG levels and PAPP-A were not significant correlated to adverse pregnancy outcomes. combined maternal serum four markers can be used not only for the detection of fetal structural and chromosomal anomalies but also for early prediction and detection of high risk pregnancies

Bone turnover markers in infertile women and patients with endometriosis under gonadotropin releasing hormone agonist [GnRH-a] and with add-back therapy

Gonadotropin releasing hormone agonist [GnRH-a] induces an acute reversible inhibition of ovarian function with an increase in bone turnover and significant bone loss. This study was conducted to evaluate the bone turnover in women under single and multiple injections of GnRH-a and also to determine the role of add-back therapy on bone turnover. Patients and The present study was designed to include 80 female patients under single injection [40 cases] and multiple injections [40 cases] of long acting GnRH-a with and without add back therapy [add back therapy was nasal salmon calcitonin 200 I.U daily supplement of 1gm calcium daily]. Biochemical bone turnover markers [serum calcium, phosphorus, alkaline phosphatase, osteocalcin and urinary deoxypyridinoline] were estimated. Determination of serum calcium and phosphorus showed no significant differences after two weeks, three months and six months of GnRH-a therapy. Serum alkaline phosphatase level was of no significant difference after two weeks and also after three and six months in the groups with add-back therapy. But after three and six months in the groups without using add-back therapy, it was significantly elevated. Serum osteocalcin and urinary deoxypyridinoline showed no significant changes after two weeks, three and six months of GnRH-a therapy with add-back therapy. But these markers were significantly increased after three and six months in group under GnRH-a therapy without use add-back therapy. A routine survey for females under GnRH-a therapy is recommended to identify subjects of. accelerated bone loss. Such survey should include serum osteocalcin and urinary deoxypyridinoline as these methods are reliable markers of bone turnover. Add-back therapy proved to be an effective measure against the induced bone loss during GnRH-a therapy

Chronic anovulation: its phases and the associated hormonal perturbation

A total of 230 cases of infertility due to anovulation was selected for this study. Amenorrhea, PCOs, galactorrhea and hirsutism were clinically associated with these cases. FSH, LH, PRL, E2, free testosterone and DHEA-S04 were assayed in all cases by IRMA and RIA methods. One- and two-gravida was found in 102 cases and nulligravidae in the rest. Anovulation was proved in all cases by endometrial biopsy. All cases were assessed clinically for the progress of the disease and to exclude other causes of infertility. It was concluded that chronic anovulation must be considered a single clinico endocrinal entity with variable phases. Accordingly, hormonal assay is essential to confirm the diagnosis and to determine the state of chronicity or its phase