Intraventricular hemorrhage in ICSI twin pregnant woman with thrombasthenia: A rare case report.

Intraventricular hemorrhage is bleeding into the fluid-filled areas (ventricles) inside the brain. The condition occurs most often in babies that are born premature, growth restricted and twins pregnancies. Abnormal platelets number or functions are responsible greatly for this condition. We presented here a pregnant woman had thrombasthenia at 28 weeks of gestation with ultrasound findings of intraventricular haemorrhage in her both ICSI twin's fetuses.

Evaluation of the effectiveness of low-dose aspirin and omega 3 in treatment of asymmetrically intrauterine growth restriction: A randomized clinical trial.

OBJECTIVE: To test the effect of aspirin and omega 3 on fetal weight as well as feto-maternal blood flow in asymmetrical intrauterine growth restriction (IUGR). STUDY DESIGN: This study is a clinically registered (NCT02696577), open, parallel, randomized controlled trial, conducted at Assiut Woman's Health Hospital, Egypt including 80 pregnant women (28-30 weeks) with IUGR. They were randomized either to group I: aspirin or group II: aspirin plus omega 3. The primary outcome was the fetal weight after 6 weeks of treatment. Secondary outcomes included Doppler blood flow changes in both uterine and umbilical arteries, birth weight, time and method of delivery and admission to NICU. The outcome variables were analyzed using paired and unpaired t-test. RESULTS: The estimated fetal weight increased significant in group II more than group I (p=0.00). The uterine and umbilical arteries blood flow increased significantly in group II (p<0.05). The birth weight in group II was higher than that observed in group I (p<0.05). CONCLUSION: The using of aspirin with omega 3 is more effective than using aspirin only in increasing fetal weight and improving utero-placental blood flow in IUGR.

Levonorgestrel-releasing intrauterine system versus a low-dose combined oral contraceptive for treatment of adenomyotic uteri: a randomized clinical trial.

INTRODUCTION: This study compares the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a low-dose combined oral contraceptive (COC) in reducing adenomyosis-related pain and bleeding. MATERIALS AND METHODS: A randomized clinical trial included 62 participants complaining of pain and bleeding that was associated with adenomyosis. Participants were randomly assigned to either LNG-IUS or COC treatment. The outcomes included the improvement of pain using a visual analogue scale, menstrual blood loss using a menstrual diary and estimated uterine volume by ultrasound for 6 months of treatment. We also compared uterine arteries and intramyometrial Doppler indices before and 6 months after treatment with both LNG-IUS and COCs. RESULTS: Both treatments significantly reduced pain after 6 months of use; however, the reduction was greater in the LNG-IUS group (from 6.23±0.67 to 1.68±1.25) compared with the COCs group (from 6.55±0.68 to 3.90±0.54). Both treatment arms significantly decreased the number of bleeding days, uterine volume and Doppler blood flow in the uterus from before to after treatment. These effects were more significant in the LNG-IUS arm compared with the COC arm. CONCLUSION: Both LNG-IUS and COCs decreased the pain and menstrual bleeding that is associated with adenomyosis. However, LNG-IUS is more effective than the COCs in reducing pain and menstrual blood loss. This effect may be secondary to the decrease in uterine volume and the increase in blood flow resistance.

Bilateral uterine artery ligation plus B-Lynch procedure for atonic postpartum hemorrhage with placenta accreta.

OBJECTIVE: To assess the effectiveness of bilateral uterine artery ligation followed by B-Lynch compression suturing in women with atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta. METHOD: This protocol was followed in 26 women undergoing cesarean delivery for placenta accreta. RESULTS: Two women died from disseminated intravascular coagulopathy. In the remaining 24 women, placental remnants completely disappeared within 8 months and ovulation resumed after a mean+/-SD of 51.6+/-3.2 days. Moreover, 18 women (75%) became pregnant within 12 months. CONCLUSION: Atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta can be safely controlled by bilateral uterine artery ligation followed by B-Lynch compression suturing in women who desire to remain fertile.

Effect of short-term maternal fasting in the third trimester on uterine, umbilical, and fetal middle cerebral artery Doppler indices.

OBJECTIVE: To assess the effect of short-term maternal fasting on uterine, umbilical, and middle cerebral artery Doppler indices, and on maternal serum glucose levels and fetal behavior. METHODS: Maternal serum glucose levels, fetal biophysical profiles, and uterine, umbilical, and middle cerebral artery Doppler indices were assessed in 110 healthy women in the third trimester of pregnancy after fasting for 10-12 hours and 2 hours after a balanced meal. RESULTS: Maternal serum glucose levels, nonstress test results, fetal breathing movements, and biophysical profile improved after a meal compared with after fasting for 10-12 hours. Uterine, umbilical, and middle cerebral artery Doppler indices were not significantly different after fasting and after a meal. CONCLUSION: Short-term maternal fasting during the third trimester of pregnancy has no effect on uterine, umbilical, or fetal cerebral artery Doppler indices, and has a transient but significant effect on maternal serum glucose levels and fetal behavior.

Vascular endothelial growth factor and insulin-like growth factor-1 in polycystic ovary syndrome and their relation to ovarian blood flow.

OBJECTIVES: (1) To determine the serum levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) in women with polycystic ovary syndrome (PCOS). (2) To study Doppler blood flow changes within the ovarian stroma of women with PCOS. (3) To evaluate the relationship between VEGF and IGF-1 and Doppler indices as well as hormonal profile. SETTING: Department of Obstetrics and Gynecology, and Department of Biochemistry, Faculty of Medicine, Assiut University, Egypt. DESIGN: Cross-sectional study. PATIENTS AND METHODS: Fifty infertile women with PCOS diagnosed by ultrasound examination and a history of oligomenorrhea, hirsutism and obesity were studied. Serum levels of vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1) and hormonal profile were measured. Doppler blood flow velocity waveforms analysis in both right and left intraovarian arteries was done. Twenty healthy and fertile women with regular menstrual cycles served as a comparison group were similarly studied at the third day of the cycle. RESULTS: The serum levels of VEGF, IGF-1 (4.79 +/- 0.91, 253.15 +/- 70.07 versus 2.39 +/- 0.42, 186.65 +/- 42.7) were significantly elevated (P <0.001 and P <0.01, respectively) in women with PCOS compared with control. Doppler indices, PI (2.01 +/- 0.77, 2.66 +/- 1.00 versus 2.98 +/- 0.77, 3.75 +/- 0.98) and RI (0.77 +/- 0.12, 0.82 +/- 0.09 versus 0.87 +/- 0.09, 0.89 +/- 0.09) in both right and left intraovarian vessels were significantly lower in the patients than controls. The VEGF and IGF-1 levels were negatively correlated with RI and PI in the uterine and intraovarian arteries. VEGF level was positively correlated with IGF-1 (r=0.41, P <0.05) in women with PCOS. CONCLUSIONS: Higher serum levels of VEGF and IGF-1 in PCOS women may be related to the increased vascularity that underlies the increased blood flow demonstrated by Doppler blood flow measurements in these women.

Uterine artery Doppler blood flow in cases of hydatidiform mole and its correlation with beta-hCG.

OBJECTIVES: To study the correlation between Doppler blood flow and beta-human chorionic gonadotropin (hCG), to assess the course of the disease and the follow up evaluation. SETTING: This study was conducted in Assiut University Hospital, Department of Obstetrics and Gynecology. DESIGN: Longitudinal study. SUBJECTS AND METHODS: Fifteen cases of vesicular mole were recruited and followed up. The patients were evaluated the day before evacuation of the uterus. This included clinical assessment, Doppler uterine artery blood flow velocity waveforms using the Doppler indices and assessment of the serum level of beta-hCG. These cases were followed up every 2 weeks in the first 2 months, and every month thereafter until the 6 month. RESULTS: Twelve patients showed continuous decrease in beta-hCG level from 1192+/-697 to 6+/-11 IU/ml by the end of the second month. Systolic-diastolic (S/D) increased from (2.57+/-1.13) to (15.9+/-2.07) (P<0.0001), RI increased from 0.55+/-0.15 to 1.0+/-0.26(P<0.0001) and PI increased from 1.02+/-0.47 to 6.12+/-2.34 (P<0.0001). One patient showed a fluctuating level of beta-hCG around the same level, and two showed a slowed decrease. Doppler indices showed similar results. There is a strong correlation between beta-hCG and all Doppler indices throughout the course of follow up: beta-hCG and S/D r<0.01, beta-hCG and RI r<0.01 and beta-hCG and PI r<0.01. CONCLUSION: Doppler ultrasound can be used as an adjuvant tool in the follow up of cases of vesicular mole and can predict the progress in the course of the disease.

Evaluation of the impact of laparoscopic ovarian drilling on Doppler indices of ovarian stromal blood flow, serum vascular endothelial growth factor, and insulin-like growth factor-1 in women with polycystic ovary syndrome.

OBJECTIVE: To study the serum levels and correlation of vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), hormonal profile, and Doppler blood flow changes within the ovarian stroma before and after laparoscopic ovarian drilling (LOD) in women with clomiphene-resistant polycystic ovary syndrome (PCOS). DESIGN: Prospective controlled study. SETTING: University teaching hospital. PATIENT(S): Twenty-five women with clomiphene-resistant PCOS (group 1) and 20 women with regular menstrual cycles as a comparison group (group 2). INTERVENTION(S): Laparoscopic ovarian drilling. MAIN OUTCOME MEASURE(S): Serum levels of VEGF, IGF-1, and Doppler indices of ovarian stromal blood flow. RESULT(S): The serum levels of VEGF, IGF-1, T, and LH were significantly higher in group 1 before LOD than in group 2. The Doppler indices (pulsatility index and resistance index) of ovarian stromal blood flow were also significantly lower in group 1 before LOD than in group 2. The serum levels of VEGF, T, and LH were significantly reduced in group 1 after LOD compared with in group 1 before LOD. Doppler indices (pulsatility index and resistance index) of ovarian stromal blood flow were significantly increased after LOD. The VEGF levels before LOD were positively correlated with IGF-1, LH, and T. After LOD, the VEGF levels were positively correlated with LH and T. CONCLUSION(S): Higher serum levels of VEGF and IGF-1 may explain the increased vascularity that was demonstrated by Doppler blood flow measurements in PCOS. Laparoscopic ovarian drilling reduced serum VEGF, IGF-1, T, and LH and reduced ovarian blood flow velocities, which may explain the reduction of ovarian hyperstimulation syndrome in women with PCOS after LOD.