Ma’asoumah Makhseed

Cytokine patterns in maternal blood after premature rupture of membranes

OBJECTIVE To compare two types of cytokines, type 1, which activate cell‐mediated reactions and are important in cytotoxic and delayed‐type hypersensitivity reactions, and type 2, which encourage vigorous antibody production and are commonly found in association with humoral immune responses, in blood of women with premature rupture of membranes (PROM). METHODS Forty‐four women with histories of at least three successful pregnancies and who currently delivered normally served as controls. The PROM group consisted of 30 women with spontaneous rupture of fetal membranes at term. Peripheral blood mononuclear cells were stimulated separately with a mitogen, placental cells, and a trophoblast antigen extract, and the supernatants examined for type 1 and type 2 cytokines. RESULTS Mitogen‐stimulated blood cells produced significantly higher levels of type 1 cytokines in PROM women than in normal controls. Higher levels of the type 1 cytokine interferon‐γ were produced by PROM samples stimulated with autologous placental cells and with trophoblast antigens. Ratios of type 1 to type 2 cytokines were higher in PROM compared with normal pregnancy, and in some cases as much as 25‐fold higher. CONCLUSION Women in the PROM group had a stronger type 1 reactivity whereas normal women were more predisposed to type 2 immunity; thus, PROM appears to be associated with a maternal type 1 bias.

Effect of insulin on transport kinetics of alpha-aminoisobutyric acid in the perfused human placental lobule in vitro.

Abstract Background : The limited data available on the role of insulin on maternal‐fetal transport of amino acids prompted us to undertake this study.

Kinetics of palmitic acid transport in insulin‐dependent diabetic pregnancies: In vitro study

Abstract Backgound: The paucity of data relating to transport kinetics of free fatty acids (FFA) in pregnant diabetic women prompted the undertaking of the present study.

Rupture of the Gravid Uterus: Experience of the Maternity Hospital, Kuwait

Objective: To review the cases of ruptured uteri at the Maternity Hospital, Kuwait, over a period of 11 years, and to analyze the predisposing factors, maternal and fetal outcome and modes of management. Method: This is a retrospective study of 91 cases of uterine rupture out of 168,486 deliveries at the Maternity Hospital, Kuwait, between January 1981 and December 1993. Result: The incidence of uterine rupture was 1 in 1,851. A previous uterine scar was present in 51 (56%) cases. The percentage of cases with instrumental delivery, malpresentation, history of previous cesarean section, use of oxytocics, higher age of the mother and parity of 5 or more was significantly higher in mothers with uterine rupture than mothers without uterine rupture. The percentage of cases with parity of 5 or more and those using oxytocics was significantly higher in the unscarred uterus group than scarred uterus group. Anterior lower segment was the most common site of rupture. The percentage of cases with simple repair of the uterus was higher in patients with the unscarred uterus than scarred uterus. Total hysterectomy was more common in patients with previously unscarred uterus. The perinatal and maternal mortality was 25.5 and 3.3%, respectively. Conclusion: The incidence of uterine rupture in this study is comparable to that in developed countries. Previous uterine scar, use of oxytocics, grand multiparity, instrumental delivery and malpresentation are associated with the rupture of the gravid uterus.

Effect of antihypertensive therapy in preeclampsia on levels of serum interleukin-4

We investigated the effects of antihypertensive therapy on serum levels of interleukin-4 using InterTest-4 ELISA in 25 preeclamptic women; 14 were placed on treatment, while 11 were not. Comparison was made with 14 non-preeclamptic pregnant controls. Interleukin-4 levels were significantly lower in the controls than in the treated preeclamptic women (p < 0.001): 68.6 +/- 10.9 versus 106.1 +/- 13.2, 64.7 +/- 9.6 versus 119.8 +/- 11.4, 90.2 +/- 9.1 versus 124.3 +/- 15.7, and 65.6 +/- 3.6 versus 109.7 +/- 11.4 pg/ml, during antepartum, early intrapartum, late intrapartum and postpartum periods, respectively. No significant differences were detected between the therapy and no therapy subgroups (p > 0.05). This shows that antihypertensive therapy has no effect on interleukin-4 levels.

Transport Kinetics of Alpha-Aminoisobutyric Acid in the Perfused Human Placental Lobule in vitro

Objective: The transports kinetics of α-aminoisobutyric acid (AIB) has been investigated in the human placenta in vitro using perfusion of isolated placental lobules. Methods: NCTC 135 tissue culture medium diluted with Earle’s salt solution was used as the perfusate, and tritiated water was used as the reference marker. Results: The transport fraction of AIB averaged 13.2% of that of tritiated water in 5 single-bolus injection experiments. The differential transport rates for 10, 25, 50, 75 and 90% cumulative efflux in the fetal vein of the study and the reference substances differed significantly as well. The transport kinetic parameters as area under the curve, clearance, elimination constant, time for maximum response, absorption rate and elimination rate of the amino acid averaged 0.12, 19.8, 0.78, 1.28, 0.10 and 0.06 times, respectively. Plotting of relative AIB transport ratios as a function of perfusion time demonstrated the active nature of amino acid transport in our perfusion conditions. Conclusions: The transport and kinetic parameters employed in the study may be useful in assessing dynamic placental membrane function of A type amino acids and other substances in varying experimental conditions as well as in disease states.

Percutaneous Testicular Sperm Aspiration and Intracytoplasmic Sperm Injection in Obstructive and Non-Obstructive Azoospermia: An Easy Alternative to TESE and MESA

Objective: To evaluate the recovery rate of sperm from the testis using percutaneous testicular aspiration with a 22-gauge hypodermic needle followed by evaluation of the fertilization rate and pregnancy rate after intracytoplasmic sperm injection. Materials and Methods: This is a prospective observational study performed in a private in vitro fertilization setting in Kuwait. Fifteen patients with obstructive and non-obstructive azoospermia were included in the study. Thirteen of them had previous microepididymal sperm aspiration, percutaneous epididymal sperm aspiration or testicular sperm extraction. The sperm were retrieved using percutaneous testicular aspiration under local analgesia. This was followed by intracytoplasmic sperm injection. A total of 146 eggs were collected and 112 were injected. Results: Normal fertilization occurred in 91 oocytes (87.5%) and the total number of embryos cleaved was 83 (91%). Embryo transfer was performed in 13 with pregnancy rate of 33.3 per treatment cycle and 38.5 per embryo transfer. Failure to retrieve sperm was encountered in 2 cases both in the hypospermatogenesis group. Conclusions: Percutaneous testicular sperm aspiration using hypodermic needles under local analgesic is an easy and cheap method with high patient acceptability, minimal complications and no need of special training. In this small group, it seems to have an acceptable success rate in terms of sperm retrieval and pregnancy in the obstructive type as well as hypospermatogenesis, but to lesser extent.

Survey of Drug Use in Labour in a Kuwaiti Hospital: A Pilot Study

Objective: To study the trends of drugs used in labour in Kuwait. Methods: A drug survey of a total of 326 mothers was conducted in the labour room of the Maternity Hospital, Kuwait. Data were collected from the prescription sheets and patient files by four doctors from the labour room based on a 4-day duty rotation schedule. Results: Percentages of the prescribed drugs were: analgesics 59.5, tranquilizers 25.5, uterotonics 7.4, antibiotics 5.5, anticonvulsants 0.9, antihypertensives 1.5, and H2 receptor blockers 38.96. Conclusion: Our survey has shown that analgesics, H2 receptor blockers and tranquilizers constitute the most commonly used drugs in labour.

Fetal Fibronectin Membrane Immunoassay in the Detection of Premature Rupture of Membranes and Prediction of Preterm Labour

The objective of this study was to evaluate the sensitivity of fetal fibronectin membrane immunoassay in the detection of premature rupture of membranes and prediction of preterm labour. Seventy-two w

Trends and Determinants of Cesarean Section in Kuwait Maternity Hospital

The rise in cesarean section (CS) rates seen throughout the world has been a source of concern in many countries. The aim of this study was to investigate both the main determinants of CSs and the trend in CS rates at the Kuwait Maternity Hospital from 1973 to 1989. The records of all deliveries at the Kuwait Maternity Hospital during the 17-year study period were scrutinized to determine the main indications for the CS and to calculate the annual rate of CS. For comparison, the study was divided into two periods, 1973-1980 and 1981–1989. The results showed that the CS rate increased from 3.9% in 1973 to 12.6% in 1989 (p