Can Fetal Heart Lie? Intrapartum CTG Changes in COVID-19 Mothers.

Background: COVID-19 infection has raised multiple concerns in pregnant mothers; many questioned the risk of vertical transmission and the implication on the feto-maternal outcome. Cardiotocogrm (CTG) is the principal method to observe intrapartum fetal well-being. This paper aims to verify intrapartum CTG changes seen in seropositive COVID-19 mothers versus healthy controls and looks into their relation to subsequent delivery mode and neonatal outcome. Methods: A case-control study recruited 90 pregnant women at the labor word of AL Yarmouk Teaching Hospital. All were term pregnancy admitted for delivery. They were grouped into 2: seropositive COVID-19 confirmed by real-time RT-PCR test (30/90) and healthy controls (60/90). We recorded their demographic criteria, laboratory results, CTG changes, delivery mode, and indication. Results: COVID-19 cases showed significantly higher pulse rate, temperature, and leukocyte counts. Cesarian deliveries (CS) were higher in cases versus healthy controls (70 % vs. 53.3 %) and P = 0.45. Analysis of the CS indications showed that abnormal fetal heart tracing accounts for 33.3 % versus 15.6 % (P-value = 0.015) for cases versus healthy controls. 60 % of COVID-19 cases exhibited abnormal CTG changes versus 19.4 % in healthy controls. These changes were primarily fetal tachycardia and reduced variabilities. Conclusions: The higher incidence of abnormal CTG in COVID-19 cases, alongside infection signs and symptoms, underlies the exaggerated inflammatory reactions inside the pregnant mother. These inflammatory reactions are the main causes of CTG changes and higher CS rates. Therefore, obstetricians are advised to optimize the maternal condition to rectify reactive CTG changes rather than proceeding into urgent CS. Supplementary Information: The online version contains supplementary material available at 10.1007/s13224-022-01663-6.

The role of PCSK9 in blood lipids recycling in women with acute toxoplasmosis.

Toxoplasma gondii is intracellular parasite; it is considered one of the most important causes of miscarriage and can inhibit the development of the fetus, especially at the beginning of pregnancy. Host lipids have an important role in the pathogenesis of T. gondii infection. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a liver secreted protein that has the unusual ability to interfere and block the natural recycling of lipid receptors, resulting in impaired lipid clearance from the plasma. This study designed to investigate the role of PCSK9 in recycling blood lipid levels in women with acute toxoplasmosis and to evaluate the relationship between them. Forty serum blood samples were collected from aborted women, who were having acute toxoplasmosis (IgM and IgA positive result) for the period October 2020 to March 2021. In addition, 25 samples were collected from apparently-healthy women (negative control group) and 25 samples collected from other aborted women (positive control group). Both groups gave negative result for the presence of IgM, IgA and IgG-Toxoplasma antibodies. Finally, PCSK9 and blood lipids levels were measured for all groups. Positive relations were found between lipid profile values and T. gondii infected women. There were an increased in triglycerides (149.65 mg/dl), HDL (38.5 mg/dl), VLDL (140.53 mg/dl) values, while there was a decreased in LDL values (41.7 mg/dl). The PCSK9 was a highly significant increase in PCSK9 in T. gondii infected women (3.23) compared with aborted and healthy control groups (1.57, 1.15 respectively). The measurement of PCSK9 can be used as a biomarker and may be useful in screening for acute toxoplasmosis. In spite of a highly significant increase in PCSK9 and blood lipids in acute toxoplasmosis, there was a decrease in BMI. This may be due to toxoplasmosis infection.

Serum Leptin as a Marker for Severity of Endometriosis.

BACKGROUND: Endometriosis a disease of theories, and one of the important causes of chronic pelvic pain, dysmenorrhea, dyspareunia, and subfertility. Surgery is the mainstay step for the diagnosis; noninvasive test is the goal in the future. Aim of Study. To test the role of serum leptin in determination of severity of endometriosis. Study Design. A cross-sectional study done in Al-Yarmouk Teaching Hospital from 1st of January 2018 to 1st of January 2019. METHODS: 60 BMI-matched patients were involved in the study. A study group of 30 patients were operated either by laparoscopy or laparotomy for many reasons diagnosed as endometriosis by histopathology, and 30 normal women as a control group underwent elective surgery. Blood sample was taken from all patients in the theater room when laparoscopy finding went with endometriosis, and classifying according to surgical staging of endometriosis, the level of serum leptin was measured by ELISA using Human LEP (Leptin) ELISA Kit. The recording of finding of laparoscopy after conforming of diagnosis by histopathology was compared with the result of serum leptin. RESULT: The result shows no significant difference between the two groups regarding parity and age; however, the level of serum leptin was significantly high in the endometriosis group than in the control group. The P value was less than 0.05. Also, the result shows no significant differences between serum leptin in both groups according to the symptom but there was a significant difference with surgical staging. The mean of the level of serum leptin in stage 1 was 214.8, while it was 340.3 in stage 4. CONCLUSION: Serum leptin can be used as a marker of severity of endometriosis.

Irisin as a Novel Marker for Insulin Resistance in Iraqi Women with Polycystic Ovary Syndrome Before and After Metformin Therapy.

BACKGROUND: Polycystic ovarian syndrome affects 5-10% of women; it represents the most common cause of hyperinsulinemia with anovulation. Many biomarkers are used to assess insulin resistance. Irisin is a newly discovered myokine associated with insulin resistance and other metabolic syndromes. OBJECTIVE: To measure the serum level of irisin in polycystic ovary syndrome patients and assess the effect of metformin treatment on its level. METHOD: This study was a prospective interventional study conducted in a private clinic and Al-Yarmouk Teaching Hospital in Baghdad City from January 1, 2017, till April 1, 2018. A hundred women were enrolled in the study. Fifty of them suffered from PCOS and other fifty were normal. They were randomly selected according to computer-based randomization and assigned as a control group. Hormonal, biochemical and oral glucose tolerance tests were performed on all patients, including Irisin. The results have been compared for both groups. Twenty-nine women of PCOS patients received metformin for a course period of 4 months as the changes in their biochemical results were evaluated. RESULT: Serum irisin level was higher in patients group compared to control group (312 ± 134.3 and 188.4 ± 53.8 µg/l, respectively), and the difference was statistically significant as the p value < 0.001. After 4 months treatment with metformin for twenty-nine polycystic patients, there was a significant reduction in irisin level by (165.8 ± 55.6 µg/l) and the p value was significant. CONCLUSION: Irisin might be used as a simple test for the prediction of insulin resistance in PCOS patients.

Electro-encephalogram as predictor of eclampsia.

OBJECTIVE: To assess the efficacy of using electroencephalographic changes for predicting eclampsia. METHODS: The observational case-control study was conducted in the Obstetrics Department of Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from April 1, 2016, to April 1, 2018, and comprised women with singleton pregnancy who had 24-40 weeks of gestation. They were divided into two groups as preeclamptic cases and normotensive controls. The groups were compared regarding electroencephalographic changes and the development of eclampsia in those with abnormal changes. Data was analysed using EVEIWS 9. RESULTS: Of the 100 subjects, 50(50%) were in each of the two groups. There was no significant difference between the groups in terms of demographic and clinical data (p>0.05) except blood pressure (p<0.05). Among the patients, 31(62%) had electroencephalographic abnormalities, while among the controls 3(6%) showed abnormal waves (p<0.001)..Focal sharp and intermittent slow waves were the commonest abnormal waves detected but the percentages of these waves between the groups were statistically not significant (p>0.05). CONCLUSIONS: Women with preeclampsia were found to have electroencephalographic abnormalities which might predict an eclamptic fit.