Effect of metformin treatment on endometrial vascular indices in anovulatory obese/overweight women with polycystic ovarian syndrome using three-dimensional power doppler ultrasonography.

PURPOSE: Metformin has been shown to be an effective treatment for anovulatory polycystic ovary syndrome (PCOS) patients in terms of menstrual cyclicity, ovulation, and pregnancy, as well as reduction of early miscarriage rate. The aim of the study is to assess the effect of metformin on the endometrial vascular indices in anovulatory obese PCOS women using three-dimensional power Doppler sonography (3DPDUS). METHODS: A prospective study was set to determine the beneficial effects of metformin on PCOS patients. Fifty anovulatory obese PCOS patients were compared with another 50 healthy volunteers who were age- and body mass index-matched (control group). PCOS patients were treated with metformin (Glucophage; MerckSerono) 850 mg 3 times a day for 6 months. Assessment of the endometrial thickness and volume, uterine Doppler indices, and Doppler vascular indices of the endometrium and subendometrium in the periovulatory and midluteal phases were performed with 3DPDUS. RESULTS: There was a significant increase in the endometrial thickness, endometrial volume, and endometrial and subendometrial vascularity indices (vascularization index, flow index, vascularization flow index) after 6 months of metformin treatment in PCOS women, whereas there was no change in the resistance index and the pulsatility index of the uterine artery in both periovulatory and midluteal phases. CONCLUSIONS: Metformin, owing to its metabolic, endocrine, vascular, and anti-inflammatory effects, improves markers of endometrial receptivity.

Effect of obesity on parameters of ovarian reserve in premenopausal women.

OBJECTIVE: To study the relationship between obesity and serum and ultrasound markers of ovarian reserve in premenopausal women. METHODS: We performed a cross-sectional comparative study of two age-matched groups of premenopausal participants (early transition phase): 50 participants ("non-obese") had a BMI < 30 kg/m2, and the other 50 participants ("obese") had a BMI of 30 to 35 kg/m2. The obese women had a mean age of 46.2 years and the non-obese women had a mean age of 46.1 years. Blood samples were collected from all participants, anthropometric measurements were calculated, and transvaginal ultrasonography was performed to measure the antral follicle count (AFC) and ovarian volume during the early follicular phase. The blood samples were assayed for antimüllerian hormone (AMH), follicle-stimulating hormone (FSH), fasting blood glucose (FBG) and two-hour postprandial blood glucose (2h PP). RESULTS: There was no significant difference between the two groups in mean age, levels of serum AMH, serum FSH, FBG, 2 hr PP, or AFC. Ovarian volume was significantly lower in obese women (3.7 +/- 0.8 mL) than in non-obese women (6.6 +/- 0.4 mL) (P = 0.03). There was no significant correlation between BMI and serum AMH, serum FSH, FBS, or 2 hr PP. CONCLUSION: Obesity has no association with levels of serum FSH, AMH, blood glucose, or AFC indicating that obesity is unlikely to affect ovarian reserve in the perimenopausal age group.

Correlation of Serum CA-125 and Progesterone Levels with Ultrasound Markers in The Prediction of Pregnancy Outcome in Threatened Miscarriage.

BACKGROUND: The aim of this study was to evaluate the relationship between ultrasonographic findings and serum progesterone and cancer antigen-125 (CA-125) levels in threatened miscarriage and to predict pregnancy outcome. MATERIALS AND METHODS: In a prospective comparative case-control study, serum CA-125 and progesterone levels were measured for 100 pregnant women with threatened miscarriage who attended the outpatient clinic or the causality department of Obstetrics and Gynecology at Kasr El-Aini Hospital, Giza, Egypt, during the period from March 2013 to October 2013. Ultrasound was performed for fetal viability, crown-rump length (CRL), gestational sac diameter (GSD) and fetal heart rate (FHR). The patients were followed up and divided into two groups based on the outcome: 20 women who miscarried (group 1), and 80 women who continued pregnancy (group 2). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were tested for CA-125 and progesterone levels in prediction of the pregnancy outcome. Correlation of these chemical markers with the ultrasound markers was also examined. RESULTS: In the group that miscarried, CA-125 level was significantly higher (P<0.001) and serum progesterone level was significantly lower (P<0.001). For prediction of the outcome of pregnancy, the cut-off limit of 31.2 IU/ml for CA-125 level yielded sensitivity, specificity and an overall accuracy of 96.2, 100 and 99.4% respectively. The cut-off limit of 11.5 ng/ml for progesterone level yielded sensitivity, specificity and an overall accuracy of 97.5, 100 and 99.8% respectively. CA-125 level had a negative correlation with progesterone level and FHR levels (r=-0.716, P<0.001) and (r=-0.414, P<0.001) respectively. Serum progesterone level correlated with GSD (r=0.521, P<0.001) and with CRL (r=0.407, P<0.001) and FHR (r=0.363, P<0.001). CA-125 level was significantly higher in the group that showed hematoma as compared with the group without hematoma (P<0.001). Also, serum progesterone level was significantly lower in the group that showed hematoma as compared with the group without hematoma (P=0.017). CONCLUSION: Serum CA-125 and progesterone levels are valid early predictors of the outcome of pregnancy in women with threatened miscarriage. They are correlated with some ultrasonographic markers (GSD, CRL, and FHR).

Prevalence of human papilloma virus (HPV) and its genotypes in cervical specimens of Egyptian women by linear array HPV genotyping test.

BACKGROUND: The association of human papillomavirus (HPV) with cervical cancer is well established. AIM: To investigate HPV genotype distribution and co-infection occurrence in cervical specimens from a group of Egyptian women. METHODS: A group of 152 women with and without cervical lesions were studied. All women had cervical cytology and HPV testing. They were classified according to cytology into those with normal cytology, with squamous intraepithelial lesions (SIL) and invasive squamous cell carcinoma (SCC). Cervical samples were analyzed to identify the presence of HPV by PCR, and all positive HPV-DNA samples underwent viral genotype analysis by means of LINEAR ARRAY HPV Genotyping assay. RESULTS: A total of 26 HPV types with a prevalence of 40.8 % were detected. This prevalence was distributed as follows: 17.7 % among cytologically normal females, 56.5, 3.2, and 22.6 % among those with LSIL, HSIL and invasive SCC respectively. Low-risk HPV types were detected in 81.8 % of the cytologically-normal women, in 5.7 % of those in LSIL women, and in 14.3 % of infections with invasive SCC, while no low-risk types were detected in HSIL. High-risk HPV types were detected in 18.2 % of infections in the cytologically normal women, 14.3 % of infections in LSIL, and in 21.4 % of invasive lesions. The probable and possible carcinogenic HPV were not detected as single infections. Mixed infection was present in 80 % of women with LSIL, in 100 % of those with HSIL, and in 64.3 % of those with invasive SCC. This difference was statistically significant. HPV 16, 18 and 31 were the most prevalent HR HPV types, constituting 41.9, 29.03 and 12.9 % respectively, and HPV 6, 62 and CP6108 were the most prevalent LR HPV types constituting 11.3, 9.7 and 9.7 % respectively. CONCLUSION: These data expand the knowledge concerning HPV prevalence and type distribution in Egypt which may help to create a national HPV prevention program. HPV testing using the LINEAR ARRAY HPV Genotyping assay is a useful tool when combined with cytology in the diagnosis of mixed and non-conventional HPV viral types.

Osseous metaplasia of the cervix: A rare transformation.

Although numerous cases of endometrial osseous metaplasia appear in the literature, only 6 cases of osseous metaplasia of the cervix have been reported since 1982. A 30 years old nulligravida women was referred to our colposcopy clinic with cervical mass. General, gynecologic and colposcopic assessments were done. The patient had an excision biopsy. Diagnosis of cervical osseous metaplasia was confirmed on histologic examination. The cervical epithelium has the potency to differentiate to multiple types of epithelium including osseous epithelium.

A comparative study of folate and vitamin B12 serum levels in preeclamptic versus normotensive pregnant women in correlation with uterine and umbilical artery Doppler findings and pregnancy outcome.

OBJECTIVE: To detect the serum levels of folate and B12 in both preclamptic and normotensive pregnant women and to determine whether there is any relation between these levels with the uterine and umbilical artery Doppler indices as well as the pregnancy outcome. MATERIAL AND METHODS: This case controlled study comprised 79 pregnant patients with preeclampsia and 113 healthy, normotensive pregnant women with singleton pregnancies at gestational ages ranging from 34-40 weeks. Patients were not obese (BMI<30) and did not suffer from chronic hypertension, chronic renal or liver disease nor diabetes mellitus. Serum folate and B12 were detected in all cases. They were also subjected to a Doppler study of both the uterine and umbilical arteries. Serum folate and B12 blood levels as well as the Doppler study indices (RI and PI) were compared in both groups. RESULTS: The serum folate level was significantly lower in preeclamptic patients than normal pregnant women (p<0.001). It was significantly correlated to uterine artery Doppler indices (RI and PI) and negatively correlated to umbilical artery Doppler indices (RI and PI). Low serum folate was significantly correlated to poor maternal outcome. Low serum folate was also significantly correlated to poor perinatal outcome. Serum B12 level was not significantly different in preeclamptic patients from the control group (P value=0.14). CONCLUSION: Serum folate was significantly lower in preeclamptic pregnant women with a significant correlation to increased uterine and umbilical RI, PI and poor maternal and neonatal outcome.