Can three-dimensional ultrasound measurement of fetal adrenal gland enlargement predict preterm birth?

PURPOSE: To assess the diagnostic accuracy of three-dimensional (3D) ultrasound measurements of fetal adrenal gland volume (AGV) and fetal zone enlargement (FZE) as predictors of PTB compared to measurements of cervical length (CL) and cervicovaginal fetal fibronectin (CVFF). METHOD: This prospective study included women presenting at 28-36 weeks of gestation with threatened preterm labor (TPL). Fetal AGV and FZE were measured using 3D ultrasound. Two-dimensional (2D) ultrasound was used to measure the CL. The AGV was corrected for the ultrasound-estimated fetal weight (cAGV). Qualitative CVFF detection was also performed. The diagnostic accuracy of cAGV, FZE, CL, and CVFF was compared considering preterm birth (PTB) within 7 days of recruitment as the main outcome measure. RESULTS: Seventy-five pregnant women were included in the final statistical analysis. Twenty-seven women (36 %) delivered within 7 days. cAGV and FZE had the highest sensitivities and specificities to predict PTB within 7 days when compared with CL and CVFF. Multivariate analysis, including cAGV, FZE, CL, and CVFF, revealed that cAGV and FZE were independent predictors of PTB within 7 days in the study participants. CONCLUSION: In women who presented at 28-36 weeks of gestation with TPL, cAGV and FZE can be used as independent predictors of PTB.

The role of adding metformin in insulin-resistant diabetic pregnant women: a randomized controlled trial.

PURPOSE: The aim of the present study is to assess the impact of adding oral metformin to insulin therapy in pregnant women with insulin-resistant diabetes mellitus. METHODS: The current non-inferiority randomized controlled trial was conducted at Ain Shams University Maternity Hospital. The study included pregnant women with gestational or pre-existing diabetes mellitus at gestations between 20 and 34 weeks, who showed insulin resistance (defined as poor glycemic control at a daily dose of ≥1.12 units/kg). Recruited women were randomized into one of two groups: group I, including women who received oral metformin without increasing the insulin dose; and group II, including women who had their insulin dose increased. The primary outcome was maternal glycemic control. Secondary outcomes included maternal bouts of hypoglycemia, need for another hospital admission for uncontrolled diabetes during pregnancy, gestational age at delivery, mode of delivery, birth weight, birth trauma, congenital anomalies, 1- and 5-min Apgar score, neonatal hypoglycemia, need for neonatal intensive care unit (NICU) admission and adverse neonatal outcomes. RESULTS: A total number of 154 women with diabetes mellitus with pregnancy were approached; of them 90 women were eligible and were randomly allocated and included in the final analysis. The recruited 90 women were randomized into one of two groups: group I (metformin group) (n = 46), including women who received oral metformin in addition to the same initial insulin dose; and group II (control group) (n = 44), including women who had their insulin dose increased according to the standard protocol. The mean age of included women was 29.84 ± 5.37 years (range 20-42 years). The mean gestational age at recruitment was 28.7 ± 3.71 weeks (range 21-34 weeks). Among the 46 women of group I, 17 (36.9 %) women reached proper glycemic control at a daily metformin dose of 1,500 mg, 18 (39.2 %) at a daily dose of 2,000 mg, while 11 (23.9 %) received metformin at a daily dose of 2,000 mg without reaching proper glycemic control and needed raising the dose of insulin dose. CONCLUSION: Adding metformin to insulin therapy in women with insulin-resistant diabetes mellitus with pregnancy seems to be effective in proper glycemic control in a considerable proportion of women, along with benefits of reduced hospital stay, reduced frequency of maternal hypoglycemia as well as reduced frequency of neonatal hypoglycemia, NICU admission and neonatal respiratory distress syndrome.

First trimester assessment of pentraxin-3 levels in women with primary unexplained recurrent pregnancy loss.

OBJECTIVE: To evaluate the potential role of measuring first-trimester maternal Pentraxin-3 levels in patients with primary unexplained recurrent pregnancy loss. STUDY DESIGN: A case control study was conducted in Ain Shams University Maternity Hospital. Cases included 45 women with primary unexplained recurrent pregnancy loss and early pregnancy failure admitted for medical or surgical termination of pregnancy. Controls (45 women) included a matched group of apparently healthy pregnant women who had at least one previous uneventful pregnancy with no previous obstetric history of adverse pregnancy outcomes. Maternal venous blood samples were collected for assay of Pentraxin-3 using enzyme-linked immunosorbent assay. The main outcome measure was the pregnancy outcome in women with elevated Pentraxin-3 levels. RESULTS: 90 participants were statistically analyzed. In the patient group, the mean Pentraxin-3 level was 12.00 ± 4.07 ng/ml, while in the control group it was 1.69 ± 0.91 ng/ml. The difference was statistically significant (p<0.001). In the patient group, Pentraxin-3 showed a significant positive correlation with the number of previous miscarriages (p=0.038). CONCLUSION: Abnormally elevated Pentraxin-3 levels indicate the presence of an abnormally exaggerated intrauterine inflammatory or innate immune response that may cause pregnancy failure in women with primary unexplained recurrent pregnancy loss.