Hassan Mostafa Gaafar

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.

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.

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.

Periconceptional risk factors of spina bifida among Egyptian population: a case-control study.

Abstract Objective: To study the preconceptual & early conceptional risk factors predisposing to the development of spina bifida (SB) among Egyptian population. Study design: The study involved 197 pregnant women undergoing fetal anatomy scan; 97 women proved to have fetal SB and 100 women with normal fetuses as a control group. The control group was recruited randomly in the same period from patients undergoing anatomical scan. Risk factors that might lead to SB were investigated including maternal age, gravidity, parity, residence, history of diabetes mellitus or drug intake, smoking, infections, exposure to X-ray, history of congenital anomalies in other offspring, parental consanguinity, positive family history, and folate supplementations. Results: SB affected the lumbo-sacral region in the majority of cases (89.7%). It was associated with hydrocephalus in 66 cases (68%), polyhydramnios in 12 cases (12.4%). The SB group showed significantly higher parity (p = 0.005), more frequent history of drug intake (p < 0.001), higher frequency of infection with CMV (p = 0.004), and HSV (p = 0.013) and less proportion of folate supplementation (p < 0.001). Conclusion: The rate of SB in the tested group was five per 1000. Risk factors were lack of folate supplementation and history of antiepileptic drugs intake.

The role of three-dimensional ultrasonography fetal lung volume measurement in the prediction of neonatal respiratory function outcome

Abstract Background: Respiratory distress is commonly encountered among premature babies immediately after birth resulting in significant neonatal morbidity or mortality. Objectives: To evaluate the possible correlation between three dimensional fetal lung volumes (FLVs) and neonatal respiratory outcomes. Study design: A cohort study included 100 pregnant women who participated in the study and were divided into two groups; group A (n: 50 – women pregnant ±34–37 weeks) and group B (n: 50 – women pregnant ±37+1 to 40 weeks). A three dimensional measurement of the right fetal lung was made using virtual organ computer-aided analysis (VOCAL) software then correlated to neonatal respiratory functions namely Apgar score at birth and the occurrence of respiratory distress syndrome (RDS). Results: In group A, FLV was negatively correlated with Apgar score and the occurrence of RDS. In group B, FLV showed no statistical correlation with Apgar score and the occurrence of RDS. Conclusions: Three dimensional fetal lung volumes might be an accurate noninvasive predictor for the development of RDS among preterm fetuses.

The effect of addition of dexamethasone to levobupivacaine in parturients receiving combined spinal-epidural for analgesia for vaginal delivery

Background and Aims: Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia. Methods: A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement. Forty females were included randomly in either Group L (received intrathecal levobupivacaine 0.25% in 2 mL) or Group LD (received intrathecal levobupivacaine 0.25% combined with dexamethasone 4 mg in 2 mL). The primary outcome was the duration of spinal analgesia. Secondary outcomes included the total dose of epidural local anaesthetic given, time to delivery, neonatal outcome and adverse effects. Results: The duration of spinal analgesia was significantly longer in the LD group compared with L group (80.5 ± 12.4 min vs. 57.1 ± 11.5 min, respectively; P< 0.001). In Group LD compared with Group L, time from spinal analgesia to delivery was significantly lower (317.4 ± 98.9 min vs. 372.4 ± 118.8 min, respectively; P = 0.027), and total epidural levobupivacaine consumption was significantly lower (102.4 ± 34.8 mg vs. 120.1 ± 41.9 mg, respectively; P = 0.027). The two groups were comparable with respect to characteristics of sensory and motor block, haemodynamic parameters, pain scores, neonatal outcome and frequency of adverse effects. Conclusion: Intrathecal dexamethasone plus levobupivacaine prolongs the duration of spinal analgesia during combined spinal-epidural CSE for labour analgesia.

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.

Pattern of fetal congenital anomalies among consanguineous marriages in Cairo University Hospitals

Background Congenital anomalies – that is, any malformation that occurs in the developing fetus – is one of the major childhood health problems. Objective The aim of the study was to examine the pattern of fetal congenital anomalies in consanguineous marriages. Participants and methods This cross-sectional study included 150 pregnant women from consanguineous marriages with fetal congenital anomalies. They were recruited from the Fetal Medicine Unit at Cairo University Hospital. A structured interview was conducted to collect data on sociodemographic characteristics, medical history, and past obstetric history. An ultrasonographic examination was performed for anatomical scanning of the fetus to screen for the presence of congenital anomalies, in addition to fetal biometry. Results The central nervous system was the most commonly affected system (44%), followed by the musculoskeletal system (23%). Multiple anomalies were detected in 52.7% of the fetuses; they were significantly more common in first-degree consanguineous marriages (P=0.001). The most common types of congenital anomalies among fetuses from consanguineous marriages were cleft palate, bilateral cleft lip, hydronephrosis, and unilateral cleft lip. Conclusion Multiple-system malformations were significantly associated with first-degree consanguineous marriages.

Maternal prepregnancy BMI and gestational weight gain: which correlates more with neonatal birth weight?

Objective The objective of this study was to evaluate whether neonatal birth weight was affected more by prepregnancy BMI or by gestational weight gain. Design This study was a prospective observational cohort study. Setting The study was carried out at University Teaching Hospital, Kasr Al Aini, Cairo, Egypt. Patients and methods Two hundred and seventy-nine pregnant women fulfilled the inclusion criteria. The study population was divided according to the WHO classification of BMI into four groups: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), and obese (≥30). They were also divided according to the Institute of Medicine guidelines of gestational weight gain into three categories: inadequate, adequate, and excessive weight gain. Neonatal birth weight was measured, and the correlation between neonatal birth weight and both prepregnancy BMI and gestational weight gain was assessed to determine the stronger correlation. Results Only 1.1% of patients (three) were underweight, whereas 34% were of normal weight, 33% were overweight, and 31.9% were obese. A high percentage of the study population (46.6%) gained excess weight as compared with adequate (26.5%) and inadequate (26.9%) weight gain. The majority of women who were obese before pregnancy (85.7%) gained excess weight during pregnancy. There was a positive correlation between both maternal prepregnancy BMI and gestational weight gain with the neonatal birth weight, but the former showed a stronger correlation (adjusted r2=0.882 for BMI and 0.303 for gestational weight gain). Conclusion Prepregnancy BMI correlates more with neonatal birth weight than with gestational weight gain.