Effect of maternal BMI on labor outcomes in primigravida pregnant women.

BACKGROUND: This study aims to detect the effects of increased BMI on labor outcomes in primigravida pregnant women. METHODS: A cross-sectional study involved 600 full-term singleton primigravida pregnant women who presented in the active phase of labor to the labor ward. They were divided according to BMI into three equals groups; women with normal BMI (group I), overweight women (group II), and women with class I obesity (group III). RESULTS: We found that high BMI was associated with a significantly increased risk of Caesarean section (C.S.) (13% in group I, 18% in group II and 40% in group III). Women with higher BMI and delivered vaginally had a significantly prolonged first and second stage of labor, consequently increased the need for oxytocin augmentation as well as the oxytocin dose. Regarding the maternal and fetal outcomes, there are significantly increased risks of postpartum sepsis, perineal tears, wound infection, as well as significantly increased birth weight and longer neonatal stay in the neonatal unit (NNU). CONCLUSION: Obese primigravida pregnant women were at higher risk of suboptimal outcomes. Besides, prolonged first and second stages of labor and the incidence of C.S. have also been increased.

Assessment of fetal growth and anomalies in the era of COVID-19 pandemic: an Egyptian pilot study.

BACKGROUND: Many issues need to be studied regarding pregnant women during the SARS-CoV-2 (COVID-19) infection pandemic. The aim of this study was to assess fetal growth, fetal well-being, and any observed gross anomalies that may follow SARS-CoV-2 infection in Egyptian pregnant women. During fetal anomaly scan at 22 weeks, we compared 30 pregnant women with a history of SARS-CoV-2 infection at 6­12 weeks of gestation (group A) with 60 pregnant women (group B) who had no history of SARS-CoV-2. Then, we followed them on 28 and 34 weeks of gestation with fetal biometry and Doppler study. RESULTS: Our results revealed no significant difference between both groups regarding fetal biometry, estimated fetal weight, amniotic fluid index, Doppler scan, and gross anomaly scan throughout all visits. CONCLUSION: According to the results of our pilot study, SARS-CoV-2 infection in pregnancy was not found to increase the risk of fetal growth restriction or possible fetal gross anomalies. Nevertheless, larger-scale studies are needed to confirm those findings. Perhaps, post-SARS-CoV-2 infection pregnancies may run an uncomplicated course regarding fetal parameters.

FSH versus AMH: age-related relevance to ICSI results.

BACKGROUND: Women's fecundity is known to decrease with the increase in chronologic age. Several biomarkers of the ovarian reserve, including follicle stimulating hormone (FSH), anti Müllerian hormone (AMH), have been proposed as possible predictors for the response to controlled ovarian stimulation (COS). Although there are assumptions indicating that the relationship between age and ovarian reserve is highly variable and the potential different validity of ovarian reserve markers in women in different age groups remains to be demonstrated. The purpose of our study was evaluating FSH and AMH as potential predictors of response to controlled ovarian stimulation and prediction of intracytoplasmic sperm injection (ICSI) outcome according to age. This prospective study has been carried out on 218 women having ICSI cycles. Cases were divided into two groups, group 1 (n 148), their age < 35 years, and group 2 (n 70), their age ≥ 35 years. All women received antagonist protocol during their ICSI cycles. Basal FSH and AMH were measured and correlated to the number of follicles on the day of trigger, the number of oocytes retrieved, chemical, and clinical pregnancies. RESULTS: The fertilization rate in group 1 was 68.15%, while in group 2 was 77.82% (p = 0.003) while the implantation rate (number of gestational sacs observed at 6 weeks of pregnancy divided by the number of transferred embryos) was 18.95 and 11.98% in group 1 and group 2, respectively (p = 0.041). The clinical pregnancy rate among both groups was 38.51% in group 1, while 24.29% in group 2 (p = 0.038). Women who got pregnant among those aged < 35 years had significantly lower basal FSH (p < 0.001), while women who got pregnant among those aged ≥ 35 years had significantly higher AMH levels (p value < 0.001) and higher E2 levels on the day of trigger (p = 0.007). CONCLUSION: We found that below the age of 35 years, the chances of pregnancy are more correlated to FSH levels, while above the age of 35 years, AMH was a more relevant test.

Alalfy modified cervical inversion technique as a tamponade in controlling PPH in placenta previa, a multicentric double blind randomized controlled trial.

INTRODUCTION: Postpartum hemorrhage that occurs frequently with placenta previa is one of the causes of maternal mortality in 14% in developing countries. OBJECTIVE: To assess efficacy of cervical inversion as a tamponade in controlling bed of placenta in cases of placenta previa. PATIENTS AND METHOD: A prospective randomized controlled study was conducted among a total of 240 pregnant women with placenta previa (120 subjected to Alalfy modified cervical inversion technique plus hemostatic sutures and 120 was not subjected cervical inversion and only was subjected to hemostatic sutures in Obstetrics and Gynecology Department at Suez Canal University hospital, Helwan University and Algezeerah hospital for a planned cesarean section). RESULTS: The mean intraoperative blood loss, the intraoperative time, and the postoperative hemoglobin show a statistically significant difference between cases with placenta previa who were exposed to cervical inversion in comparison to cases that had no cervical inversion with a p-value <.001. CONCLUSION: Modified cervical inversion (Alalfy technique) as a tamponade when added to hemostatic sutures to the placental bed is an easy, rapid, and efficient procedure that can decrease the amount of blood loss, time needed to stop bleeding per bed, total operative time, also it can decrease the need for blood transfusion.

Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women.

BACKGROUND: Many expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula. OBJECTIVE: To compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment. PATIENTS AND METHODS: This was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt. RESULTS: The present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche. CONCLUSION: Scar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence). TRIAL REGISTRATION: Clinical Trials.gov Id NCT04076904.

The pattern of risk-factor profile in Egyptian patients with acute coronary syndrome: phase II of the Egyptian cross-sectional CardioRisk project.

BACKGROUND: Egypt is the most populous country in the Middle East and North Africa and has more than 15% of the cardiovascular deaths in the region, but little is known about the prevalence of traditional risk factors and treatment strategies in acute coronary syndrome (ACS) patients across Egypt. METHODS: From November 2015 to August 2017, data were collected from 1 681 patients with ACS in 30 coronary care centres, covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta and Upper Egypt, with a focus on risk factors and management strategies. RESULTS: Women constituted 25% of the patients. Premature ACS was common, with 43% of men aged less than 55 years, and 67% of women under 65 years. Most men had ST-elevation myocardial infarction (STEMI) (49%), while a larger percentage of women had unstable angina and non-ST-elevation myocardial infarction (NSTEMI) (32% each; p < 0.001). Central obesity was present in 80% of men and 89% of women, with 32% of men and women having atherogenic dyslipidaemia. Current smoking was reported by 62% of men and by 72% of men under 55 years. A larger proportion of women had type 2 diabetes (53 vs 34% of men), hypertension (69 vs 49%), dyslipidaemia, and obesity (71 vs 41%) (p < 0.001 for all). There were no gender differences in most diagnostic and therapeutic procedures, but among STEMI patients, 51% of men underwent primary percutaneous coronary intervention compared to 46% of women (p = 0.064). CONCLUSIONS: Central obesity and smoking are extremely prevalent in Egypt, contributing to an increased burden of premature ACS, which warrants tailored prevention strategies. The recognised tendency worldwide to treat men more aggressively was less pronounced than expected.

Electrocardiogram screening of deaf children for long QT syndrome: An Egyptian experience.

BACKGROUND: Jervell and Lange-Nielsen syndrome is an autosomal recessive form of long QT syndrome (LQTS), clinically manifested by long QT interval and bilateral sensorineural hearing loss (SNHL) with the highest prevalence in Norway and Sweden. No data are available about the prevalence of such syndrome in Egypt. OBJECTIVES: This study aimed to assess by electrocardiogram (ECG) the prevalence of LQTS among Egyptian children with SNHL. METHODS: One thousand and twelve patients, aged ≤ 10 years (mean age 5.8 ± 2.6), were included in this study, 578 male patients (57%) and 434 female patients (43%). A 12-lead ECG was recorded for all patients and the corrected QT interval (QTc) was calculated by Bazett's formula. The probability of LQTS was evaluated by Schwartz criteria and laboratory investigations were done on all patients with long QT interval. RESULTS: In the current study, the mean QTc interval was 411.7 ± 25.3 ms (range 343-675 ms). Twenty-one patients (2.1 %) had probable LQTS; of these, 11 patients had intermediate probability (Schwartz score 1.5-3 points) and 10 patients had high probability (Schwartz score ≥ 3.5 points). CONCLUSION: This study shows that 2.1% of Egyptian children with SNHL in a tertiary care setting have LQTS.

Variants of CDKAL1 rs7754840 (G/C) and CDKN2A/2B rs10811661 (C/T) with gestational diabetes: insignificant association.

OBJECTIVES: Pathophysiological similarity exists between gestational diabetes mellitus (GDM) and type 2 diabetes mellitus with common genetic origin. Genetic liability for GDM in our population is still not researched. The goal was to reveal the genotypic and allele frequency differences of 2 single nucleotide polymorphisms (SNPs) namely, CDKAL1 (rs7754840) and CDKN2A/2B (rs10811661) between GDM pregnancies and normal pregnancies. We assessed them by real time polymerase chain reaction using Taqman® allelic discrimination assays. We included 47 GDM pregnant subjects and 51 normal glucose tolerance (NGT) pregnant women as controls. RESULTS: The genotype frequencies in the GDM group and the NGT group of rs7754840-GG/GC/CC were 6.4/15.7% (3/8), 55.3/45.1% (26/23) and 38.3/39.2% (18/20) respectively. Also, those of rs10811661-CC/CT/TT were 74.5/14.9/4.3% (38/7/2) and 80.9/19.6/5.9% (38/10/3) respectively. The allele frequencies in the GDM group and the NGT group of C/G and T/C were 66/34% (62/32), 61.8/38.2% (63/39) and 11.7/88.3% (11/83), 15.7/84.3% (16/86) respectively. There were no statistical differences between the two groups in allele frequencies and genotype frequencies (all P > 0.05). Non-significant association was seen in the two SNPs of CDKAL1 and CDKN2A/B genes with GDM. Further studies are essential to validate data.

Effect of laser-assisted zona thinning, during assisted reproduction, on pregnancy outcome in women with endometriosis: randomized controlled trial.

OBJECTIVE: To compare the ICSI-ET outcomes in patients with endometriosis with or without laser-assisted zona pellucida thinning. DESIGN: Randomized controlled trial. SETTING: The study was conducted in the Obstetrics & Gynecology Department, Cairo University hospital, and two private IVF centers in Cairo & Beni-Suif from July 2015 to January 2017 upon infertile and known endometriosis patients who planned to do ICSI-ET. INTERVENTIONS: Before randomization, all patients received the same ovarian stimulation preparation, oocyte retrieval procedures, and the same intracytoplasmic sperm injection procedures. After randomization, laser-assisted hatching was performed only for embryos of 158 patients, while the other group (n = 150) no laser-assisted hatching was made. The verification of pregnancy was achieved by the serum hCG concentration 14 days after the embryo transfer, and the clinical pregnancy was confirmed 2 weeks later by the presence of gestational sac with pulsating fetal pole on vaginal ultrasonography. MEASUREMENTS: The main outcome measures were the clinical pregnancy rate and the clinical implantation rate. MAIN RESULTS: Both groups were comparable with regard their baseline characteristics, baseline hormonal profile, the ovarian stimulation characteristics, and the ovulation characteristics. The mean number of embryos developed per patient and the mean transferred number of embryos per patient were comparable between groups (p value > 0.05). The implantation rate was significantly higher (p value 0.002) in the study group than the control group with an odds ratio of 1.86 (CI 95% 1.24-2.80) and NNT 13.81 (CI 95% 8.35-39.94). The clinical pregnancy rate, was significantly (p value 0.022) higher in the study group than in the control group with an odds ratio of 1.79 (CI 95% 1.05-3.06) and NNT 9.57 (CI 95% 5.03-98.99). CONCLUSION: That laser-assisted hatching by thinning of the zona pellucida may be a suitable method to improve the ICSI-ET outcomes, in term of the implantation and the pregnancy rates, in cases of endometriosis. CLINICAL TRIAL REGISTRATION: Pan African Clinical Trials Registry (PACTR), http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201502001022393 , PACTR201602001467322.

Studies on West Nile virus infection in Egypt.

We conducted a prospective cohort study to determine prevalence and incidence of West Nile virus (WNV) in Egypt. Cohorts were established in Upper (UE), Middle (ME), and Lower (LE) Egypt. Additionally, a cross-sectional serosurvey was performed in the North (NS) and South (SS) Sinai. Cohorts were bled initially and 1 year later. Sera were tested for WNV-IgG by ELISA and positive sera were confirmed by plaque reduction neutralization test (PRNT). Sentinel chicken flocks placed in the above sites were bled monthly for virus isolation and serology. Mosquitoes were collected monthly from the above sites and tested for WNV. Human seroprevalence rates were 35%, 27%, 14%, 1% and 7% in UE, ME, LE, NS and SS, respectively. Seroconversion rates were 18%, 17% and 7% in UE, ME and LE, respectively; 49% of the seroconverters reported undiagnosed febrile illness. Sentinel chickens showed seroconversion in all study sites. WNV was isolated from both sentinel chickens and mosquitoes in cohort sites. This study demonstrates that WNV was actively circulating during the study period in different areas in Egypt and causing febrile illness in a considerable proportion of individuals in the study sites.