Effect of umbilical vein blood flow on perinatal outcome of fetuses with lean and/or hypo-coiled umbilical cord.

OBJECTIVE: To evaluate the effect of umbilical vein (UV) blood flow measured by color-directed pulsed-wave Doppler on perinatal outcome of fetuses with lean and/or hypocoiled umbilical cord after 24 weeks of gestation. METHODS: Two hundred and forty-four women with singleton fetus after 24 weeks of gestation were studied. Umbilical cord area, umbilical vessel cross-sectional area and antenatal umbilical coiling index (UCI) were calculated and compared with Doppler parameters including UV blood flow volume in ml/min/kg, UV peak systolic velocity in cm/s, and umbilical artery pulsatility index. RESULTS: Thirty-eight (15.5%) fetuses had lean umbilical cord (area < 10th percentile). A significant difference between fetuses with and those without lean cord was found in terms of: UCI (0.17 ± 0.06 vs. 0.35 ± 0.08, P < 0.001), cord cross-sectional area (89.6 ± 11.7 vs. 198.7 ± 33.7 mm(2), P < 0.001), Wharton's jelly amount (36.5 ± 11.2 vs. 125.2 ± 34.1 mm(2), P < 0.001), UV blood flow (83.4 ± 15.8 vs. 131.0 ± 19.8 ml/min/kg, P < 0.001), and UV blood flow mean velocity (8.6 ± 3.7 vs. 12.1 ± 2.8 cm/s, P < 0.05). A significant positive correlation was found between antenatal UCI and UV blood flow (r = 0.73, P < 0.001). CONCLUSION: Fetuses with lean and/or hypo-coiled umbilical cord showed a noticeable decrease in UV blood flow of sufficient magnitude that could affect fetal growth, and this could explain the higher prevalence of fetal intrapartum complications in growth-restricted fetuses.

Effect of laparoscopic ovarian drilling on vascular endothelial growth factor and ovarian stromal blood flow using 3-dimensional power Doppler.

OBJECTIVE: To determine, by using 3-dimensional power Doppler ultrasonography, the effect of laparoscopic ovarian drilling (LOD) on the serum level of vascular endothelial growth factor (VEGF) and ovarian stromal blood flow changes in polycystic ovary syndrome (PCOS). METHODS: A prospective controlled clinical study was conducted on 26 clomiphene-resistant women with PCOS who were scheduled for LOD and a control group of 22 fertile regularly menstruating women. VEGF and 3 ovarian Doppler indices-vascularization index, flow index, and vascularization flow index-were measured and compared between the 2 groups, and before and after LOD in the PCOS group. RESULTS: Serum VEGF and the Doppler indices of ovarian stromal blood flow were significantly higher in the PCOS group than in the control group. Serum VEGF and the ovarian stromal blood flow Doppler indices were significantly reduced in the PCOS group after LOD. CONCLUSION: Increased vascularity in PCOS demonstrated by Doppler blood flow measurements might be explained by the high level of VEGF. LOD reduced ovarian vascularization and serum VEGF.

Laparoscopic supracervical hysterectomy compared with total abdominal hysterectomy.

OBJECTIVE: To assess if laparoscopic supracervical hysterectomy (LSH) had any advantage over traditional total abdominal hysterectomy (TAH) carried out for benign conditions. METHODS: This prospective case control study was carried out between June 2005 and October 2006 in the Obstetrics and Gynecology Department of Zagazig University Hospitals, Zagazig, Egypt. Twenty-eight women operated upon by LSH were compared to 56 women who had undergone TAH. Variables compared were patient's age, weight, preoperative diagnosis, number of previous laparotomies, operative time, intra/post-operative complications, blood loss, uterine weight, hospital stay, need for analgesia, and resumption of normal activity. RESULTS: Patient's demographics were similar in both groups. The operative time was longer in the LSH group (93.7+/-5.7 versus 69.0+/-6.8 min, p=0.001). Other operative and post-operative parameters were similar except that LSH patients showed shorter hospital stay (1.7+/-0.5 versus 4.0+/-0.7 days), time to resume normal activity (20.8+/-2.6 versus 50.0+/-7.9 days) and lower dose of post-operative analgesia (141.7+/-62.4 versus 282.0+/-87.4mg diclofenac), (p=0.001). CONCLUSION: Laparoscopic supra cervical hysterectomy is a safe procedure and should be considered, if hysterectomy will be carried out for a benign condition with healthy cervix. A further larger study is needed to confirm these findings.

Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry.

OBJECTIVE: To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). METHOD: Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. RESULTS: Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR (P<0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. CONCLUSION: Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.

Uterine ruptures in Yemen.

OBJECTIVE: To study the incidence, risk factors, clinical presentation, maternal morbidity and mortality, and perinatal mortality in cases with ruptured gravid uterus. METHODS: All cases with diagnosis of uterine rupture at Saudi Hospital at Hajjah, Yemen during 5-years period from April 1999 to March 2004 were studied. Detailed informations were obtained by reviewing hospital records. RESULTS: Out of the total number of deliveries during the period (N=5547), 60 cases had uterine rupture giving a hospital incidence of one in 92 deliveries (1.1%). Forty-three cases (71.7%) with unscarred uterus and 17(28.3%) had a previous cesarean scar. Poor antenatal and intra-natal care were the main contributing factor (93.3% had no prenatal visit, 95% presented to the hospital late after long period of obstructed labor at home). Grand-multiparty was encountered in 69.8% of cases with unscarred uterus and 41.2% of cases with a previous scar (p<0.05). Associated factors in unscarred uterus cases included: cephalopelvic disproportion (39.5%), shoulder presentation (25.6%), oxytocin (14%), breech delivery (7%), hydrocephalus (7%), brow (2.3%), misoprostol induction of labor (2.3%), and previous surgical evacuation (2.3%). In previous cesarean scar cases, cephalopelvic disproportion affected 58.8%, and shoulder presentation 5.9%. The complete rupture was reported in 48 cases (80%), hysterectomy was carried out for 33 cases (55%), repair for 23 cases (38%), and repair plus bilateral tubal ligation for 4 cases (7%). Five cases (8.3%) needed additional surgical intervention in the form of repair of ruptured bladder (3 cases), and repair of bladder injury (2 cases). Vesico-vaginal fistula developed in 2 cases (3.3%). Fifty-three cases required blood transfusion (88%). Hospital stay ranged between 1-17 days (mean 6.2, SD 3.6). There was one maternal death (1.7%) and 49 (81.7%) perinatal deaths. CONCLUSION: This study confirms high incidence of such serious preventable obstetrical problem. Poor antenatal and intranatal care, poor provision of health service and low socio-economic standard are the main factors contributing to uterine rupture.