role of interleukin-6 promoter polymorphism -174G/C in Saudi women with hypertensive disorders of pregnancy

To study the relationship between -174 GC interleukin-6 single nucleotide polymorphism and hypertensive disorders of pregnancy [HDP] in Saudi women. In this case-control study, 109 HDP patients and 100 women with normal pregnancy as a control group were studied. The HDP study group constituted of 60 women with gestational hypertension [GH] and 49 women with preeclampsia [PE]. All women were randomly selected from the antenatal clinic and the prenatal and postnatal wards at the Antenatal Clinic and the Obstetric Ward of King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from April 2010 to December 2011. The -174 GC of IL-6 SNP was determined using real time polymerase chain reaction, allele discrimination technique. Distribution of -174 GC of IL-6 genotype in HDP patients was GG [58.5%], GC [31.1%], and CC [10.4%], while in the control group was GG [67%], GC [30.9%], and CC [2.1%]. The CC homozygosity was significantly associated with HDP [odds ratio [OR] = 5.76; 95% confidence interval [CI] 1.23 - 27.06, p=0.03]. This association only manifested with GH [OR = 7.65; 95% CI = 1.54-38.03, p=0.01]. However, no significant association was found with PE [OR = 3.48; 95% CI = 0.55-21.99, p=0.19]. The results indicate a positive association between -174 GC of IL-6 genotype and the risk of HDP. Genotypes CC and GC are associated with increased risk of GH but not with PE, suggesting that they are of differing genetic predisposition/pathophysiology

Ruptured spontaneous heterotopic pregnancy

The coexistence of intrauterine and ectopic pregnancy [heterotopic pregnancy] occurs in 1/30,000 of spontaneous pregnancies, 1/900 in Clomiphene citrate induced pregnancies and rises to 1% in assisted reproduction. It is a life-threatening condition with diagnostic and therapeutic complexities. There is strong association between infertility and ectopic pregnancy. Risk factors for ectopic pregnancy are past history, assisted reproduction, and adhesions due to pelvic infection or surgery. Our patient was diagnosed initially as having an intrauterine singleton pregnancy, with urinary tract infection. At presentation pain out of proportion to primary diagnosis led to urgent ultrasonographic review that diagnosed heterotopic pregnancy. It was followed by laparoscopic salpingectomy. Human chorionic gonadotrophin [HCG] after laparoscopy in the subsequent days along with a sonographic evaluation revealed a viable intrauterine pregnancy. This ended in missed miscarriage and medical expulsion at 16 weeks of gestation. Issues discussed here are rarity, delayed, or misdiagnosis with its sequel

Pattern of drug prescribing during pregnancy in saudi women: a retrospective study

The drugs hat were prescribed during pregnancy were assessed retrospectively in 727 Saudi pregnant women living in Riyadh region who attended the prenatal clinic of King Khalid University hospital from November 2004 until December 2005. Only drugs prescribed in an outpatient setting during pregnancy were included in the study. Drug exposures were presented in terms of three 90-day trimesters of pregnancy; first, second, and third trimester. In order to evaluate whether drugs with known risk have been prescribed, all medications taken during pregnancy were categorized into five groups: A,B,C,D and X according to Briggs etal.,1978. The study showed that during pregnancy; nearly 31% of pregnant women took no prescription drugs at any stage, whereas 69% were found to have been prescribed at least one drug with a mean of 2.87 medications per woman. The most commonly prescribed drugs were folic acid, iron preparations, anti-infectives, especially systemic antibiotics and drugs for endocrine disorders. The study, also, showed that the rate of prescribed drugs was highest during the third trimester [58%], with a diminishing trend in the second [26%] and first [16%] trimesters, respectively. The observed patterns in the prescribing of drugs for the three trimesters are consistent with other previous studies. Further, the study showed a well considered and cautious drug prescription during pregnancy by the obstetricians in our hospital. Since the potential risks for drugs used during pregnancy on the foetus have been established for only few drugs, the present study emphasizes the need for clear guidelines for the physicians on the use of drugs during pregnancy

prevalence of lupus anticoagulant in normal pregnancy and in women with recurrent fetal loss-recommendations for laboratory testing for lupus anticoagulant

There is wide disagreement in the literature on the rate of detection of lupus anticoagulant [LA] in women with recurrent fetal loss [RFL]. The aim of this study was to determine the prevalence of LA using four phospholipid-dependant coagulation tests in a large population of Saudi women. We determined the prevalence of LA in women with RFL [n=925], normal pregnancy [n=663], and in healthy blood donors [n=204], at the King Khalid University Hospital, Riyadh. The following coagulation tests were employed: the activated partial thromboplastin time [APTT], platelet neutralization procedure [PNP], kaolin clotting time [KCT] and the dilute Russel's viper venom test [dRVVT]. In RFL patients, positive APTT was 10.2%, APTT+PNP 3.6%, KCT 10.5%, and dRVVT 10.9%. In normal pregnancy, the corresponding figures were 12.8%, 3.1%, 10.8%, and 5.6%. Three positive tests occurred in 2.3% of RFL patients, including APTT+KCT 3.5%, APTT+dRVVT 3.9%, and KCT+dRVVT 4.1%. The corresponding figures for normal pregnancy were 1.6% for three positive tests, and 3.0%, 1.8%, 2.4%, respectively. The dRVVT was the only test that showed a rate of positive results almost double that seen in normal pregnancy. If only one or even two screening tests were performed, a significant number of LA positive cases would have been missed. This could make a difference to treating physicians as to the possible etiology and management of RFL. It is therefore advisable to routinely use the three tests [APTT, KCT and dRRVT] when screening for LA