Majda Al-Yatama

Hormone profile of Kuwaiti women with hyperemesis gravidarum

Abstract Objective: To evaluate the incidence of hyperemesis gravidarum among pregnant women in Kuwait and the status of HCG, TSH, Total T4 and Free T4 in the serum of patients with hyperemesis gravidarum compared with a control group of women. Methodology: During a 6-month period all patients admitted to Maternity Hospital with features of hyperemesis gravidarum (excessive vomiting and ketonuria) were enlisted into the study. In fifty of these patients and their fifty normal controls, the status of serum total βhCG, TSH, total T4 and freeT4 were evaluated with AXSYM micro particle enzyme immunoassay. Results: The incidence of hyperemesis in the maternity population was 45 per 1000 deliveries. Total βhCG and Total T4 and FreeT4 were significantly higher in the hyperemesis patients than in the normal controls (p<0.0001, p=0.004 and p=0.01 respectively). TSH levels were significantly lower in hyperemesis patients than in their normal controls (p<0.0001). There was a strong positive correlation between the total βhCG and the gestational age (r=0.8). Conclusion: There is a high incidence of hyperemesis gravidarum in the Kuwaiti population. Total βhCG, Total T4 and Free T4 titers were significantly higher in patients with hyperemesis gravidarum, but none of the patients showed signs of hyperthyroidism.

Alteration of sonographic texture of the endometrium in post-menopausal bleeding a guide to further management

BACKGROUND The purpose of this study was to assess the utility of transvaginal ultrasonography in the evaluation of endometrial morphology in addition to the standard criterion of endometrial thickness for selecting patients for endometrial sampling. METHODS Two hundred and seven consecutive cases of postmenopausal bleeding were evaluated by transvaginal ultrasound. Endometrial thickness was measured as the maximum anteroposterior thickness of the endometrium including both the anterior and posterior layers, in the sagittal long axis view. The morphology of the endometrium was studied and categorized as homogeneous, focally increased echogenecity, diffusely increased echogenecity or diffusely inhomogeneous. Patients were followed up for clinical course and endometrial histopathology. RESULTS Textural inhomogeneity was observed in all the three cases of endometrial cancers with endometrial thickness of less than 6 mm, and, in ten out of 11 cases of a more than 6 mm thick endometrium. On the other hand the endometrial texture was homogeneous in all cases of endometrial atrophy/tissue inadequate for diagnosis, with thickness of less than 6 mm. CONCLUSION This study adds the dimension of abnormal echogenecity of the endometrium to the currently followed criterion of endometrial thickness with a view to enhance accuracy, both for a better prediction of atrophy and a higher prediction for endometrial cancer. Expectant management can be offered to patients with a homogeneous endometrium which is 6 mm thick or less. Aggressive evaluation for a malignancy must be made if there is a focal increased echogenecity or a diffuse increased echogenecity even in a thin endometrium.

Connection between human leucocyte antigens D region and T helper cytokines in preeclampsia

Abstract. Preeclampsia is a common and major cause of maternal and perinatal morbidity and mortality. Human leucocyte antigen (HLA) susceptibility and impaired adaptation of the T lymphocyte sub-population and a bi-directional effect of T helper cytokines on the outcome of pregnancy have been reported in patients with preeclampsia. The association between maternal HLA class II and T helper cytokines in women with preeclampsia was investigated in seventy-six preeclamptic women and normotensive controls using Terasaki microlymphocytotoxicity test. T helper cytokines interleukin (IL)-8, IL-6, IL-4, tumour necrosis factor (TNF)-α and interferon (IFN)-γ were estimated in the maternal blood and placenta by enzyme-linked immunosorbent assay (ELISA). Histopathological evaluation of the placenta was also carried out. HLA class II DR2, DR4, DR5, DRw8, DRw10, DRw11, DRw18, and DQw2 had significant relative risk ratios for preeclampsia, while DQw3 was more common in the controls. DR4-DRw11-DQw2 haplotype was more common in preeclamptic women with intrauterine growth restriction, low birth weight and placental weight, increased expression of T helper cytokines IL-8, TNF-α and IFN-γ and abnormal uteroplacental vasculature. These findings suggest that HLA class II DR4-DRw11 -DQw2 haplotypes may be associated with preeclampsia with intrauterine growth restriction through low placental weight from impaired placental development, as a result of increased expression of T helper 1 cytokines IL-8, TNF-α and IFN-γ.

Correlation between Bacterial Vaginosis and Adverse Pregnancy Outcome

Objective: The main purpose of this study was to investigate the role of bacterial vaginosis (BV) in prematurity, premature rupture of membranes (PROM) and other disorders of pregnancy. Methods: High vaginal and cervical swabs were taken from pregnant women in the second and third trimesters of pregnancy and from 30 non-pregnant women. Informed consent was obtained from all potential subjects. The specimens were smeared, gram-stained and cultured on a variety of selective and non-selective media which were then incubated at the appropriate atmospheres. Vaginal pH, character of the discharge, and outcome of the amine test were noted. Ultrasound was performed to confirm gestational age and all pregnant women followed up until postpartum. Results: A total of 123 pregnant women were evaluated at the end of the study. BV was diagnosed clinically and bacteriologically in 34 women, giving a prevalence rate of 28%. BV was diagnosed in none of the 30 non-pregnant control patients. Fifty-four percent and 46% of the study population were Kuwaitis and non-Kuwaitis, respectively. The mean parity recorded was 2.24 ± 2.06. There was a positive correlation between BV and preterm labour (9/34, 27%; CI, p < 0.05), PROM (7/34, 21%: CI; p < 0.05) and preterm delivery (7/34, 21%; CI, p < 0.05). Three (9%) of the women with BV had babies with intra-uterine growth retardation compared with 1 (1%) in the 89 non-BV group (p < 0.05). Conclusion: The prevalence rate of BV among pregnant women in Kuwait is high and is significantly associated with prematurity and other disorders of pregnancy.

Polymerase-Chain-Reaction-Based Detection of Fetal Rhesus D and Y-Chromosome-Specific DNA in the Whole Blood of Pregnant Women during Different Trimesters of Pregnancy

Objective: The aim of this study was to determine whether or not a noninvasive procedure utilizing maternal peripheral blood as the source of DNA and polymerase chain reaction (PCR) could be used to detect fetal rhesus D (RhD) status as well as fetal gender during different gestational stages of pregnancy. Materials and Methods: Maternal blood samples were obtained from 54 RhD-negative pregnant women during the first trimester (6–13 weeks, n = 14), second trimester (14–26 weeks, n = 26) and third trimester (27–40 weeks, n = 14). Genomic DNA was extracted from the whole blood and analyzed by seminested and nested PCR for detection of DNA sequences corresponding to RhD (n = 54) and Y chromosome (n = 48) using RhD and Y-chromosome-specific oligonucleotide primers, respectively. The seminested/nested PCR results were compared with the RhD status and gender of the babies after delivery. Results: The sensitivity and specificity of seminested PCR for detection of fetal RhD positivity in whole blood of pregnant women were 81 and 100%, respectively, while the sensitivity and specificity of nested PCR for detection of male fetuses, using Y-chromosome-specific DNA as a marker, were 96 and 91%, respectively. There were no significant differences in the PCR results with samples obtained from women at different gestational stages of pregnancy. Conclusion: Seminested and nested PCRs for detection of fetal RhD and gender status, respectively, by using the blood of pregnant women during different gestational stages of pregnancy, are reliable noninvasive procedures with high sensitivity and specificity.

Alteration of sonographic texture of the endometrium in post‐menopausal bleeding

Background. The purpose of this study was to assess the utility of transvaginal ultrasonography in the evaluation of endometrial morphology in addition to the standard criterion of endometrial thickness for selecting patients for endometrial sampling.

Transport Kinetics of Alpha-Aminoisobutyric Acid and Water in Pre-Eclamptic Pregnancies: An in vitro Study

Objective: To investigate the transport kinetics of a model amino acid, alpha-aminoisobutyric acid (AIB), in the maternal-fetal direction in placentae from pre-eclamptic pregnancies. Methods: Transport kinetics of the amino acid was assessed in vitro using perfusion of human placental lobules. Control placental lobules were perfused for comparison. National Culture and Tissue Collection-135 medium diluted with Earle’s buffered salt solution was used as the perfusate, and tritiated water served as the internal reference marker. AIB along with reference marker was injected as a single bolus into the maternal arterial perfusate, and serial perfusate samples were collected from maternal and fetal venous circuits for a study period of 5 min. Results: The differential transport rate of the amino acid for various efflux fractions differed significantly between control and experimental groups when compared to that of the reference marker. The transport rate (corresponding to 50% of efflux into the fetal vein), transport fraction, absorption and elimination rates of the amino acid differed significantly compared to the reference marker values in study and control groups. Conclusion: The results indicate that amino acid transport function is compromised in placentae of pre-eclamptic pregnancies.

Establishment and Evaluation of Polymerase Chain Reaction for Detection of Y-Chromosome-Specific Fetal DNA in Maternal Blood Circulation during Pregnancy and after Delivery

Objective: To establish and evaluate nested polymerase chain reaction (PCR) for detection of Y-chromosome-specific fetal DNA in maternal blood circulation during pregnancy and its clearance several days after delivery. Materials and Methods: Genomic DNA was isolated from a male donor to amplify Y-chromosome-specific DNA sequences by using four pairs of oligonucleotide primers targeting single or multiple copy genes in standard and nested PCR. The nested PCR was evaluated for detection of Y-chromosome-specific sequences in the maternal blood circulation of pregnant women bearing a male fetus during pregnancy and at 2 and 24 h and 7 days after delivery. Results: Although both standard and nested PCR assays were established by using genomic DNA from a male donor to detect Y-chromosome-specific DNA sequences, the nested PCR was 10 times more sensitive than standard PCR. Further experiments showed that nested PCR was able to detect Y-chromosome-specific DNA in the peripheral blood cells as well as in the plasma and serum of pregnant women carrying a male fetus. When tested with plasma samples from women carrying male fetuses during pregnancy, nested PCR was positive with 53/55 (96%), 22/22 (100%), 16/22 (73%) and 0/30 (0%) specimens obtained before and at 2 and 24 h and 7 days after delivery, respectively. These results showed that fetus-specific Y-chromosome DNA was cleared from maternal circulation within 7 days of delivery. Conclusion: Our results suggest that nested PCR is useful in fetal sex determination and that prenatal diagnosis can be done without interference from previous pregnancy.

Factors Associated with Significant Emotional Distress in Women Attending Obstetric Clinics in Kuwait

&NA; The objective of this study was to examine the incidence of and factors associated with significant emotional distress in a sample of women attending prenatal clinics in Kuwait. Two hundred and forty‐eight pregnant women attending prenatal clinics at the Maternity Hospital and Maternity unit of Farwaniya Hospital in Kuwait from September 1997 to April 1998 participated in the study. Consenting women were assessed for symptoms of depression and anxiety using the Hopkins Symptom Checklist. We found that 6.5% of all women in the study reported psychiatrically significant levels of depression and 6.9% reported significant levels of anxiety. Together, 13.4 % of all subjects reported clinically significant levels of emotional distress, specifically anxiety, depression or both anxiety and depression symptoms. Women in their second trimester of pregnancy were less likely to report significant emotional distress than those in their first or third trimesters. Women reporting marital conflicts and those reporting higher levels of family stress other than that related to their marriage were more likely to report significant emotional distress than those not reporting such conflicts or other family stress. In conclusion, we found that emotional distress was noteworthy in a subgroup of pregnant women in Kuwait and that this distress was more strongly associated with psychosocial factors (such as marital relationship and family stress) than with obstetric or other health‐related factors. It is important that prenatal health care providers diagnose such cases using appropriate screening measures and provide appropriate referrals early.