Mohammad Abrar Ahmed

Middle cerebral artery to umbilical artery resistance index ratio in the prediction of neonatal outcome

Objective: The objectives of this study were to evaluate the usefulness of the middle cerebral artery to umbilical artery resistance index ratio (C/U ratio) as a predictor of adverse perinatal outcome, and to show that the absence of fetal umbilical artery end‐diastolic velocity (AEDV) in SGA fetuses is associated with high morbidity and mortality. Method: In this prospective study, color Doppler flow imaging was used for the estimation of the C/U ratio in fetuses that were small for their gestational age, in 70 singleton pregnancies between 29 and 42 weeks of gestation. The subjects were categorized into two groups, with Group A consisting of 35 small for gestational age (SGA) fetuses with a normal C/U ratio (1.05 or higher), and Group B comprising 35 SGA fetuses with an abnormal C/U ratio (below 1.05). Result: The mean C/U ratio values for birth weight and gestational age were higher in group A than in group B. Fetuses born to mothers in group B stayed longer in the neonatal special care unit (NSCU), whereas the period from ultrasound examination to delivery was higher in the cases in group A. A higher percentage of mothers with an abnormal C/U ratio underwent cesarean section. Fetuses with an absent end‐diastolic velocity of the umbilical artery had a higher morbidity. Three stillbirths occurred in fetuses with an absent end‐diastolic velocity of the umbilical artery. Conclusion: Our results suggest that the C/U ratio is a good predictor of neonatal outcome, and could be used to identify fetuses at risk of morbidity and mortality. Fetal umbilical artery AEDV with intrauterine growth restriction is associated with high perinatal morbidity and mortality.

Influence of Seasonal Variation on Pregnancy‐induced Hypertension and/or Preeclampsia

Seasonal variation of temperature and humidity are said to influence the incidence of hypertensive disorders of pregnancy. The aim of this study was to determine if temperature and humidity exert any influence on the incidence of pregnancy‐induced hypertension and preeclampsia in Kuwait. This is a retrospective study performed in the Maternity Hospital, Kuwait (MHK) in the years 1992–1994. Monthly distribution of all deliveries and those in which the patients had pregnancy‐induced hypertension and preeclampsia were recorded. There are some studies including ours which do not show any significant correlation between meteorological factors and hypertensive disorders of pregnancy. We found that the incidence of pregnancy‐induced hypertension per 1,000 deliveries was high in June when the temperature was very high and the humidity at its lowest. The reverse was true for the incidence of preeclampsia per 1,000 deliveries, which was high in November when the temperature was low and the humidity high.

Association of fetal gender with pregnancy-induced hypertension and pre-eclampsia

Hypertensive disorders of pregnancy complicate approx. 10% of all pregnancies. Studies have shown that fetal gender plays an important role in the development of this disease, however, their results are contradictory. Genetic studies have shown that daughters of women with a history of eclampsia are more susceptible to pre-eclampsia w x than women in the general population 1 . Studies with a high malerfemale ratio suggest that toxw x emia of pregnancy has an immunological basis 2 . Histo-incompatibility of the fetus and the mother due to an antigen dependent on the Y chromosome may play a role in the pathogenesis of pregnancy toxemia. Studies on hormonal factors have shown that hCG levels are higher in pregnant women carrying female fetuses than those with male fetuses. Higher hCG levels are also observed in women with severe pre-eclampsia. Hsu et al. observed a predominance of female

Placental pathology in relation to the White’s classification of diabetes mellitus

Abstract The objective of this study was to investigate various macroscopic and microscopic features of the placenta in pregnancies complicated by diabetes according to White’s classification. A total of 148 placentas were studied. Sixty-five were from control patients and 83 from diabetic mothers. The diabetic mothers were further divided into three groups according to White’s classification. There were 40 cases in White’s group A and 36 cases in White’s group B. There were 7 cases in White’s groups C and D combined. Advanced maternal age and grandmultiparity were significantly higher in White A, White B and White C&D compared to the normal group. Mean weight of the mother was higher in White group A and group B compared to the control group and group C&D. The placental weight and neonatal weight were increased provided the diabetes was not complicated by vascular disease. With accompanying vascular disease the placental weight and neonatal weight were reduced compared to the controls. As a result of increased perinatal jeopardy the rate of operative delivery was higher in diabetic mothers. No major difference was observed in microscopic changes of placentas in different groups according to White’s classification and the normal group.

The prevalence of antibody to human parvovirus B19 in pregnant women in Kuwait.

Infection with parvovirus B19 during pregnancy is known to be associated with various fetal damage, such as aplastic anemia and hydrops fetalis. Our objective was to study the seroprevalence of parvovirus B19 in the obstetric population in Kuwait and to compare this with that in the adult population in other regions. Blood samples from 1047 pregnant women were used in this prospective study. Information regarding patients age, parity, nationality and symptoms was obtained at the time of collection of the sample. Blood was tested for IgG and IgM antibodies specific for parvovirus B19 using the ELISA technique. The overall prevalence for IgG and IgM was 53.3 and 2.2%, respectively. IgG seropositivity was higher in non-Kuwaiti women, while IgM antibodies was more frequent in Kuwaiti women. A total of 17.4% of the acutely infected patients were symptomatic. Prevalence of parvovirus B19 infection in Kuwait is comparable with that in the other countries.

The status of rubella immunity among pregnant women in Kuwait: screening in childbearing age should be reintroduced.

The objective of this study was to investigate the immunity against rubella in the obstetric population in Kuwait by testing 600 pregnant women at a prenatal clinic, using the haemagglutination inhibition technique. In addition, a comparison was made between this study and one done in 1978 at the same clinic; its relation to the vaccination programme is also discussed. 7.7% of the population under study were non-immune. Statistically significant effect was demonstrated for maternal age but not for parity and nationality. Though it has been almost 20 years since an intense rubella vaccination programme was implemented, the percentage of non-immune pregnant women has not decreased. In Kuwait, termination of pregnancy for congenital rubella syndrome is prohibited. As a result, it is recommended that women be screened and vaccinated at the time of marriage.

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.

Pattern of Parvovirus B19 Infection During Different Trimesters of Pregnancy in Kuwait

OBJECTIVE: Aims of this study were to determine the IgG and IgM seropositivity to parvovirus B19 during the three trimesters of pregnancy. METHODS: Initially, a total of 1,047 pregnant women were included in a prospective study. Blood samples were obtained from 343, 406 and 298 cases in the first, second and third trimesters, respectively. To study the incidence of seroconversion, a second sample of blood was obtained 2-4 weeks later from the first 100 cases, who were IgG and IgM negative in the first trimester. RESULTS: The seroprevalence of parvovirus B19 IgG and IgM was 53.3% and 2.2%, respectively. The incidence of seroconversion was 16.5%. The rate of fetal loss was 15.4% in patients with acute infection, all of which occurred in the first two trimesters. CONCLUSIONS: The percentage of IgG positive cases is significantly higher in first and second trimesters compared to the third trimester. The seroconversion rate was 16.5%.

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.