Ghada Abdel Fattah Abdel Moety

Vitamin D deficiency in Egyptian mothers and their neonates and possible related factors

Abstract Objective: To correlate vitamin D level in Egyptian mothers with that of their newborns, and examine risk factors related to maternal vitamin D deficiency. Methods: A cross-sectional study was carried out at the university teaching hospital in Cairo, Egypt. Serum 25(OH) D levels were measured by enzyme-linked immunosorbent assay in 135 pregnant women at ≥37 weeks’ gestation immediately before delivery and in cord blood of their newborns. Results: The levels of serum 25(OH) D were 32.6 ± 21.4 ng/ml in mothers and 16.7 ± 10 ng/ml in their newborns. Maternal vitamin D level was strongly correlated with that of the newborns (r = 0.7, p < 0.0001). Maternal vitamin D deficiency/insufficiency and neonatal vitamin D deficiency/insufficiency were encountered in (40%, 28.9% and 60%, 32.6% respectively). Maternal vitamin D levels showed significant correlations with maternal body mass index (BMI; r = −0.201, p = 0.021), gestational age at delivery (r = 0.315, p ≤ 0.0001), fish consumption (r = 0.185, p = 0.032), educational level (r = 0.29, p = 0.001), and skin exposure (r = 0.247, p = 0.004). Conclusion: Maternal vitamin D levels strongly correlate with neonatal levels. Maternal vitamin D deficiency is a real problem in Egypt; this is generally related to high BMI, low fish consumption, low educational level, and limited skin exposure.

Could first-trimester assessment of placental functions predict preeclampsia and intrauterine growth restriction? A prospective cohort study.

Abstract Objective: To examine the role of first-trimester uterine artery Doppler, serum β-hCG and pregnancy-associated placental protein-A (PAPP-A) in prediction of preeclampsia and IUGR. Methods: A total of 100 pregnant women in the 11–14 weeks’ gestation were examined using uterine artery Doppler, serum β-hCG and PAPP-A. All women were followed-up for development of preeclampsia or IUGR. Results: A total of 94 women completed the study of which 7 (7.4%) developed complications. Uterine artery PI and RI were significantly higher whereas serum β-hCG and PAPP-A levels were significantly reduced in patients who developed complications when compared with those who did not. Uterine artery PI had the highest sensitivity (100%) but a low specificity (56% and 45%) in prediction of preeclampsia and IUGR, respectively. Adding PAPP-A to uterine artery PI elevated the specificity into 94.44% and 95.51%, respectively. Combined PI and β-hCG elevated the specificity into 88.89% and 89.89%, respectively. Conclusion: Our study suggests that first-trimester uterine artery impedance, as measured by Doppler ultrasound as well as low serum biomarkers (β-hCG and PAPP-A) can be used for prediction of preeclampsia and IUGR. The most sensitive is uterine artery PI. Adding β-hCG to PI improves specificity in prediction of both preeclampsia and IUGR. Uterine artery PI plus PAPP-A is the best combination for prediction of both preeclampsia and IUGR

Accuracy of Hysteroscopic Endomyometrial Biopsy in Diagnosis of Adenomyosis

OBJECTIVES To investigate the diagnostic accuracy of endomyometrial biopsy obtained via office hysteroscopy for the diagnosis of adenomyosis. STUDY DESIGN Cross-sectional study. SETTING Cairo University Teaching Hospital, Cairo, Egypt. PATIENTS A total of 404 premenopausal women with symptoms clinically suggestive of having adenomyosis. INTERVENTIONS All patients were subjected to 2-dimensional transvaginal sonography (TVS) in-office hysteroscopy examination with endomyometrial biopsy. Patients who subsequently underwent hysterectomy were included in the final analysis. MAIN MEASUREMENTS AND RESULTS Accuracy of diagnostic modalities was represented using the terms sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. A total of 292 patients were eligible for final analysis. Of these, 162 (55.47%) were diagnosed with adenomyosis based on hysterectomy specimens. TVS had a high sensitivity (83.95%) and a moderate specificity (60%). In contrast, endomyometrial biopsy was more specific (78.46%) than sensitive (54.32%). Hysteroscopic appearance of the endometrial cavity had low sensitivity (40.74%) and specificity (44.62%). Adding endomyometrial biopsy to TVS improved specificity (89.23%). CONCLUSION Endomyometrial biopsy obtained via office hysteroscopy can diagnose adenomyosis with a high specificity and is recommended after TVS.

Amino acid chelated iron versus an iron salt in the treatment of iron deficiency anemia with pregnancy: A randomized controlled study

OBJECTIVE The aim of this study was to compare the efficacy and tolerability of iron amino acid chelate (IAAC) and ferrous fumarate (FF) in treatment of iron deficiency anemia (IDA) with pregnancy. STUDY DESIGN A total of 150 pregnant women having iron deficiency anemia (IDA) were randomized to receive either IAAC or FF for 12 weeks. Hemoglobin, red cell indices, serum iron, and serum ferritin were measured at baseline and then 4, 8, and 12 weeks after treatment. Adverse effects were questioned in both groups. RESULTS The mean values of hemoglobin, red cell indices, serum iron, and serum ferritin were not significantly different between both groups after 12 weeks of treatment. However, the rise in hemoglobin level after 4, 8, and 12 weeks of treatment was significantly faster in the IAAC group (p=<0.001). Constipation and abdominal colicky pain were significantly more common in the FF group (p=0.022 and 0.031 respectively). CONCLUSION IAAC and FF are comparable in curing IDA with pregnancy; however, IAAC has the advantage of providing a faster rate of improvement of hemoglobin level and is better tolerated by the patients.

Role of ultrasonographic markers of ovarian reserve in prediction of IVF and ICSI outcome.

Abstract The aim of the study was to assess correlation of ultrasonographic markers of ovarian reserve and IVF/ICSI outcome. Two-hundred twelve IVF/ICSI patients were included. Upon pituitary suppression confirmation, antral follicle count (AFC), ovarian volume (OV), and ovarian stromal indices [vascularization index (VI), flow index (FI), and vascularization flow index (VFI)] were assessed by three-dimensional (3D) and power Doppler (PD) ultrasound and correlated with the number of mature oocytes retrieved. The number of mature oocytes retrieved correlated strongly with AFC (r = 0.832, p ≤ 0.001) and OV (r = 0.835, p ≤ 0.001), but weakly with VI (r = 0.166, p = 0.016), FI (r = 0.151, p = 0.028), and VFI (r = 0.14, p = 0.041). AFC and OV correlate strongly with the number of mature oocytes retrieved in IVF/ICSI cycles, whereas 3D PD indices of the ovarian stromal vascularity have a weak correlation.

Histological Structure and Vascularity of Hysteroscopically Removed Uterine Septa in Patients With Primary Infertility and Patients With Recurrent Pregnancy Loss

OBJECTIVE To examine the histological structure and vascularity of uterine septa in patients with unexplained primary infertility and patients with recurrent pregnancy loss (RPL). DESIGN Case-control study (Canadian Task Force classification II-2). SETTING Kasr Al Aini Hospital, Cairo University, Egypt. PATIENTS AND INTERVENTIONS A total of 41 patients with uterine septa presenting with either unexplained primary infertility or RPL underwent 3-dimensional (3D) and power Doppler (PD) ultrasound to calculate the septum volume, septal vascularization index (VI), and myometrial VI. Hysteroscopically removed septa were examined histologically for myometrial and fibrous tissue content. MEASUREMENTS AND MAIN RESULTS Septal characteristics differed between the primary infertility group (24 patients) and the RPL group (17 patients). Mean septal VI was significantly higher in the RPL group compared with the infertility group (18.39% ± 7.57% vs 11.67% ± 4.56%; p = .003), as was septal myometrial area (20.74% ± 5.97% vs 13.57% ± 5.55%; p < .001). In both groups, septal VI was strongly correlated with myometrial VI and myometrial content, but not with fibrous tissue content. CONCLUSION Uterine septa of patients with RPL are more vascularized and contain more muscular tissue compared with those of patients with primary unexplained infertility.

A randomized controlled trial of clomifene citrate, metformin, and pioglitazone versus letrozole, metformin, and pioglitazone for clomifene-citrate-resistant polycystic ovary syndrome.

To examine the efficacy of clomifene citrate, metformin, and pioglitazone versus letrozole, metformin, and pioglitazone among women with polycystic ovary syndrome (PCOS) resistant to clomifene citrate.

Can fetal pulmonary artery Doppler indices predict neonatal respiratory distress syndrome

Objective:To study whether fetal main pulmonary artery (MPA) Doppler indices can predict the development of neonatal respiratory distress syndrome (RDS).Study Design:This prospective cross-sectional study included pregnant women between 34 and 38+6 weeks gestation. The diagnostic accuracy of MPA Doppler measurements (systolic/diastolic (S/D) ratio, peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI) and acceleration time/ejection time (At/Et)) for diagnosis of neonatal RDS was tested.Result:Of the 698 eligible fetuses, 55 (7.87%) developed neonatal RDS. PSV, PI, RI and At/Et were positively correlated with gestational age. The strongest correlation was found with At/Et (r=0.602, P<0.001). PI and RI were significantly higher, whereas At/Et and PSV were significantly lower in fetuses that developed RDS. A cutoff value of 0.305 for At/Et predicted the development of RDS (sensitivity: 76.4%; specificity: 91.6%).Conclusion:Development of neonatal RDS can be predicted using the MPA At/Et with high sensitivity and specificity.

Vaginal misoprostol tablets versus misoprostol gel for induction of labor in post-term primigravidas

Objective To compare the efficacy of 50 µg of misoprostol tablet with the same dose of misoprostol prepared gel in induction of labor in post-term primigravidas. Design Prospective randomized clinical trial. Setting University teaching hospital, Kasr El Aini, Cairo, Egypt. Population A total of 100 primigravidas admitted at 40–42 weeks of gestation for induction of labor. Patients and methods Women were randomized to receive either 50 µg of misoprostol vaginal tablet or 50 µg of misoprostol prepared gel, both administered every 6 h for a maximum of 24 h. Main outcome measure Successful vaginal delivery within 24 h. Results Thirty-six women (72%) in the tablet group and 32 women (64%) in the gel group delivered vaginally within 24 h (P=0.179). The mean interval in hours from drug administration to the start of contractions was lower in the gel group (5.8±1.94 vs. 6.27±1.93, P=0.235). However, the induction to delivery interval was significantly lower in the tablet group (15.31±3.48 vs. 17.11±3.32 h, P=0.009). The need for oxytocin was less in the tablet group (52 vs. 56%, P=0.574). The incidence of tachysystole (12 vs. 8%), hypertonus (10 vs. 4%), hyperstimulation (16 vs. 8%), and fetal distress (22 vs. 20%) was nonsignificantly higher in the tablet group. Neonatal outcomes were similar in both groups. Conclusion A total of 50 µg of misoprostol tablet or gel form every 6 h is similarly effective in inducing labor in post-term primigravidas. However, the gel form is slower in inducing delivery and the tablet form is more easy to use.

Brain Volume and Doppler Velocimetry in Growth-Restricted, Small-for-Gestational-Age, and Appropriate-for-Gestational-Age Fetuses.

Objective This study aims to detect possible differences in fetal brain volumes between growth‐restricted fetuses (FGR), small‐for‐gestational‐age (SGA) fetuses with normal Doppler indices, and appropriate‐for‐gestational‐age fetuses (AGA). Study Design Three‐dimensional measurements of fetal brain volume and umbilical artery and middle cerebral artery (MCA) pulsatility index (PI) and resistance index (RI) were made in 80 AGA fetuses, 68 SGA fetuses with normal Doppler indices, and 68 FGR with brain‐sparing effect between 32 and 36 weeks of gestation. Results MCA‐PI and MCA‐RI were significantly lower in FGR group compared with the other two groups (p < 0.001). Brain volume was significantly lower in SGA and FGR groups compared with AGA group (p < 0.001). Conclusion Brain volume is significantly lower in SGA and FGR groups compared with AGA group.