Badreldeen Ahmed

New scoring system for fetal neurobehavior assessed by three- and four-dimensional sonography

Abstract Aim: To produce a new scoring system for fetal neurobehavior based on prenatal assessment by 3D/4D sonography. We identified severely brain damaged infants and those with optimal neurological findings and compared fetal with neonatal findings. Results: The new scoring system was retrospectively applied in a group of 100 low-risk pregnancies. After delivery, postnatal neurological assessment was performed, and all neonates assessed as normal reached a score between 14 and 20, which we assumed to be a score of optimal neurological development. Subsequently, the same scoring system was applied in the group of 120 high-risk pregnancies in which, based on postnatal neurological findings, three subgroups of newborns were found: normal, mildly or moderately abnormal, and abnormal. Normal neonates had a prenatal score between 14 and 20, mildly or moderately abnormal neonates had a prenatal score of 5–13, whereas those infants who were assigned as neurologically abnormal had a prenatal score from 0–5. Conclusion: A new scoring system for the assessment of neurological status for antenatal application is proposed, similar to the neonatal optimality test of Amiel-Tison. This preliminary work may help in detecting fetal brain and neurodevelopmental alterations due to in utero brain impairment.

The potential of 4D sonography in the assessment of fetal neurobehavior - multicentric study in high-risk pregnancies

Abstract Objective: An evolving challenge for obstetrician is to better define normal and abnormal fetal neurological function in utero in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Patients and methods: Prenatal neurological assessment in high-risk fetuses using four-dimensional ultrasound applying the recently developed Kurjak antenatal neurodevelopmental test (KANET). Postnatal neurological assessment was performed using Amiel Tisons neurological assessment at term (ATNAT) for all live-borns and general movement (GM) assessment for those with borderline and abnormal ATNAT. Results: Inclusion criteria were met by 288 pregnant women in four centers of whom 266 gave birth to a live-born baby. It was revealed that 234 fetuses were neurologically normal, 7 abnormal and 25 borderline. Out of 7 abnormal fetuses ATNAT was borderline in 5 and abnormal in 2, whereas GM assessment was abnormal in 5 and definitely abnormal in 2. Out of 25 KANET borderline fetuses, ATNAT was normal in 7, borderline in 17 and abnormal in 1, whereas the GM assessment was as follows: normal optimal in 4, normal suboptimal in 20, and abnormal in 1. In summary, out of 32 borderline and abnormal fetuses ATNAT was normal in 7, borderline in 22 and abnormal in 3; GM assessment was normal optimal in 4, normal suboptimal in 20, abnormal in 6 and definitely abnormal in 2. Conclusion: The sonographic test requires further studies before being recommended for wider clinical practice.

The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies

Objective. To assess differences of fetal behavior in normal and high-risk pregnancies. Methods. In the 1-year period (1 January 2007–31 December 2007), four-dimensional ultrasound has been used to assess Kurjak antenatal neurodevelopmental test (KANET) in low- and high-risk pregnancies after randomization in prospective longitudinal cohort study. Based on the KANET scores, the fetuses were considered as normal (≥14 points), borderline (6–13), or abnormal (0–5). Results. Comparison of KANET scores in low- and high-risk pregnancies were expectedly statistically significant. The largest incidence of fetuses with abnormal KANET was in the group of fetuses who had siblings with cerebral palsy. The largest incidence of the borderline KANET has been found in the group of fetuses whose mothers had fever during pregnancy. The following parameters of KANET test significantly differed between the fetuses from low- and high-risk pregnancies: overlapping cranial sutures, head circumference, isolated eye blinking, facial expressions, mouth movements, isolated hand movements, isolated leg movements, hand to face movement, finger movements, and general movements. Conclusion. KANET test has the potential to detect and discriminate normal from borderline and abnormal fetal behavior in normal and in high-risk pregnancies.

Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study

Abstract Aim: To determine the effect of routine intraoperative cervical dilatation during elective cesarean section on maternal morbidity. Subjects and methods: Patients with even numbers in the operative elective cesarean section list were included in the study. Of these, every second patient underwent intraoperative cervical dilatation. All participants in the two groups had otherwise similar preoperative care, operative procedures and subsequent clinical care. Blood loss was estimated and maternal infection status was assessed postoperatively by any rise of temperature or wound infection. Results: Of the 131 patients included in the study, 67 underwent cervical dilation and 64 served as controls. There was no significant difference in postoperative hemoglobin, incidence of fever, or wound infection between the two groups. Only two of the cervical dilation group and one control patient developed postoperative fever. A hemoglobin drop of more than 0.5 g/dL was noted in 27 and 26 patients in the cervical dilation and the no dilation groups, respectively (NS). None of the study patients had signs of wound infection. Conclusion: Intraoperative cervical dilatation during elective cesarean section did not reduce the risk of postoperative maternal fever, wound infection or change in hemoglobin concentration.

Fetal behavioral and structural abnormalities in high risk fetuses assessed by 4D sonography

We have realized that the way we are looking at the motoric activity influenced the way we assessed the motoric activity. Throughout the years of these investigations, it has been influenced by those who thought that all motility was caused by generation of CNS or matured CNS. However, there remains an incomplete view of the neurological development of fetuses over the course of the life span, with methods of assessment remaining grounded in newborn models of the CNS. It is through this review hat we attempt to develop a continuous line of understanding of fetal behavior assessment in abnormal fetuses after ascertaining the normal standard behavioral pattern parameters.

Use or overuse of antenatal corticosteroids for suspected preterm birth

Abstract Objectives: To determine the ratio of women who received antenatal steroid for suspected preterm birth (PTB) to those who actually deliver before 34 weeks of gestation at a tertiary care center. Methods: This is a retrospective study. Data was collected from November 2008 to February 2009 on women who presented with suspected PTB had received corticosteroids (between 26 weeks and 33 weeks-6 days of gestation). Result: More than two-thirds of the women who received antenatal corticosteroids for suspected PTB actually delivered after 34 weeks. Conclusion: The ratio of women who received complete dose of steroids for suspected PTB compared to the number of patients who actually deliver prematurely is high raising doubts about the methods employed to diagnose PTB.

The role of antepartum transabdominal amnioinfusion in the management of oligohydramnios in pregnancy.

Objective. The purpose of this study was to evaluate the role of transabdominal amnioinfusion in the management of oligohydramnios with the view to improving pregnancy outcome. Methods. The study consisted of a retrospective analysis of 17 pregnant women presenting with oligohydramnios who were treated with amnioinfusion during pregnancy in a period from 2003 to 2006. Results. The mean gestational age at first treatment was 24 weeks. The mean pre-procedure deepest pool of amniotic fluid was 1.8 cm and post-procedure was 3.8 cm. The mean number of infusions was 1.05. The mean first infusion to delivery interval was 31 days. Perinatal mortality was 88% and neonatal mortality was 35%, with only one baby surviving the neonatal period. There were three cases of chorioamnionitis, with one of these cases presenting with premature rupture of the membranes at the time of amnioinfusion. Conclusions. Transabdominal amnioinfusion is a useful procedure to reduce complications that result from oligohydramnios. Although the results show a high perinatal mortality, it must be borne in mind that most of these pregnancies had multiple fetal abnormalities with an already predicted poor outcome. Importantly, as this procedure increases the latency period, it may be useful in preterm pregnancies where prolonging the duration of the pregnancy may result in better perinatal outcome by improving important factors that influence survival including increased birthweight.

Non-immune hydrops: Qatar experience

Objective: To describe the presenting signs, diagnostic findings, and outcomes of 64 cases of non-immune hydrops fetalis (NIHF) cases seen in Women’s Hospital, Qatar during the years 2003–2011. Method: A retrospective chart review of patients with signs suggesting of NIHF was done. A detailed scan was performed and karyotyping and detailed investigations were offered. Results: Average maternal age at diagnosis was 31 years. Fifty-six percent of the patients were diagnosed during the 2nd trimester. Most common presenting signs were: ascites, pleural effusion, scalp edema, skin edema, pericardial effusion, generalize edema and cystic hygroma. Two patients were positive for PV B19 infection. Fetal karyotyping performed in 78% of the patients showed abnormal chromosomes in 9 cases. Three patients showed fetal anemia with abnormal peak systolic velocity of the medial cerebral artery (MCA-PSV). Seventeen (27%) fetuses survived the perinatal period with live births occurring between gestational ages 30–41 weeks. Ten (59%) of the 17 babies survived post delivery (6 months post survival data). Major identifiable abnormalities that might have caused symptoms of hydrops were cardiac (23.43%), and chromosomal (14%). Conclusion: Non-immune hydrops fetalis is a complex problem. Establishment of a clear procedure for the follow up of such patients is extremely important.

Increased rates of cesarean sections and large families: a potentially dangerous combination.

Abstract Rates of cesarean sections have been on the rise over the past three decades all over the world, despite the ideal rate of 10–15% that had been set by the World Health Organization (WHO) in 1985, in Fortaleza, Brazil. This epidemic increase in the rate of cesarean delivery is due to many factors which include, cesarean delivery on request, advanced maternal age at first pregnancy, decrease in number of patients who are willing to try vaginal birth after cesarean delivery, virtual disappearance of vaginal breech delivery, perceived increase in the weight of the fetus and increase in the number of women with chronic medical conditions such as Diabetes Mellitus and congenital heart disease in the reproductive age. There is no doubt that cesarean delivery is a safe procedure and it is getting safer and safer for many reasons. However, like all other surgical procedures it is not without risks both to the mother and the new born. There is a substantial increase in the incidence of morbidly adherent placenta and the risk of scar pregnancy. In the Middle East and many African and Asian countries women tend to have large families. The number of previous cesarean section deliveries is directly proportional to the risk of developing morbidly adherent placenta. Morbidly adherent placenta is the most common cause of emergency postpartum hysterectomy, which is often associated with multiple surgical complications, severe maternal morbidity and mortality. The increased rates of cesarean sections lead to increased rates of scar pregnancies, which can have lethal consequences. Cesarean delivery has a negative impact on the infant immune system. This effect on the infant led to the introduction of a new concept called “Vaginal seeding”. This refers to the practice of transferring some maternal vaginal fluid to the infant born via cesarean section in an effort to enhance its immune system.

Study of peripheral circulation in non‐pregnant, pregnant and pre‐eclamptic women using applied potential tomography

Background:  Profound changes are known to occur in the cardiovascular system during pregnancy, involving an increase in cardiac output and a fall in peripheral resistance. In some women these adaptations may be inappropriate and this may result in pregnancy‐induced hypertension and pre‐eclampsia.