Measurement of maternal serum amyloid A as a novel marker of preterm birth.

OBJECTIVE: To study the association between maternal serum amyloid A (mSAA) levels and preterm birth (PTB). METHODS: This prospective observational nested case control study was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between May 2017 and December 2017. The study recruited pregnant women at 26-34 weeks presented with threatened preterm labor (PTL). Women with PTB were included in cases group while control group included women who continued pregnancy and delivered at term. Serum samples were collected to measure mSAA levels. The main outcome of the study was the association between mSAA levels and PTB. Secondary outcomes included neonatal intensive care unit admissions and neonatal mortality. RESULTS: Fifty-eight women were included in the final analysis (29 in each group). Women with PTB had a statistically significant higher mSAA levels [5.1 (4.5-7.7) vs. 1.2 (0.0-2.5) mg/l, for cases and controls respectively, p < .001]. Higher mSAA levels were also observed among women whose babies were admitted to NICU, but there was no significant relation between mSAA level and neonatal death. A statistically significant negative correlation was found between mSAA and gestational age at delivery and neonatal birth weight. mSAA had an excellent value to predict PTB (AUC = 0.972 [95% CI, 0.891-0.998], p < .0001), fair value to predict admission to NICU and a poor value to predict neonatal death. CONCLUSIONS: mSAA level was found to be elevated among women with threatened PTL who end with PTB; mSAA is a potentially useful predictive marker of PTB that warrant further study. CLINICALTRIALS.GOV: NCT01639027.

Influence of Aquatain™, a monomolecular surface film on surface tension for controlling the filarial vector Culex pipiens (Diptera: Culicidae).

Surface tension is a phenomenon in the liquid media and plays an important part in the development and survival of aquatic animals. Influence of Aquatain™ monomolecular film on surface tension was determined against mosquito larvae and pupae at different temperatures (10, 15, 20, 25, 30 and 35 °C) and Aquatain™ doses (0.5, 1.0 and 2.0 ml/m2). In the laboratory, Aquatain™ showed larvicidal and pupicidal effects against the filarial vector Culex pipiens. Higher mortality was observed in late and more weighted instars/stages than young ones as well as in the pupal stage. The pupal mortality reached 76.2%, 86% and 93.3% after 12 h post-treatment at 0.5, 1.0 and 2.0 ml/m2, respectively, and it was completely eliminated (100%) within 24 h compared to 15.1%, 26.9% and 38.2% for 1st larval instar, respectively. Also, results showed at 0.5 ml/m2 with temperature range: 10, 15, 20, 25, 30 and 35 °C, the mortality reached 4.0, 6.7, 10.8, 17.3, 22.7, 29.3% and 32, 44, 54, 72, 84, 97.3% for 1st and 4th larval instar, respectively, where the surface tension (γ) was 65.6, 62.4, 58.0, 57.0, 54.2 and, 49.6 dyn/cm, while the Aquatain™ was more effective on mosquito larvae and pupae at high doses with the temperature range. On the other hand, without Aquatain™ dose, the mortality value ranged between 0.0 - 1.2%, and the surface tension (γ) was 74.5 dyne/cm, which is considered as an accidental death. Aquatain™ was effective against all aquatic phases of mosquitoes, especially against the last and weighted ones. Not only was the efficacy of Aquatain™ increased by increasing the dose, but it also increased with the increased temperature of the environment. This efficiency of Aquatain™ is due to its ability to reduce the surface tension of the water medium, preventing different stages of mosquitoes from reaching the surface for breathing thereby leading to suffocation and death. Therefore, we recommended Aquatain™ in programmes for mosquito control and other aquatic insects as a safe, cost-effective control agent.

Maternal serum amyloid A level as a novel marker of primary unexplained recurrent early pregnancy loss.

OBJECTIVE: To assess maternal serum amyloid A (SAA) levels among women with primary unexplained recurrent early pregnancy loss (REPL). METHODS: A prospective study was conducted among women with missed spontaneous abortion in the first trimester at Ain Shams University Maternity Hospital, Cairo, Egypt, between January 21 and December 25, 2014. Women with at least two consecutive primary unexplained REPLs and no previous live births were enrolled. A control group was formed of women with no history of REPL who had at least one previous uneventful pregnancy with no adverse outcomes. Serum samples were collected to measure SAA levels. The main outcome was the association between SAA and primary unexplained REPL. RESULTS: Each group contained 96 participants. Median SAA level was significantly higher among women with REPL (50.0 µg/mL, interquartile range 26.0-69.0) than among women in the control group (11.6 µg/mL, interquartile range 6.2-15.5; P<0.001). The SAA level was an independent indicator of primary unexplained REPL, after adjusting for maternal age and gestational age (odds ratio 1.12, 95% confidence interval 1.06-1.19; P<0.001). CONCLUSION: Elevated SAA levels found among women with primary unexplained REPL could represent a novel biomarker for this complication of pregnancy.

Can Porphyromonas gingivalis be a novel aetiology for recurrent miscarriage?

OBJECTIVE: To study the association between Porphyromonas gingivalis (P. gingivalis) infection and recurrent miscarriage. METHODS: This case control study included women with early pregnancy failure admitted for surgical evacuation of retained products of conception. Cases (group 1) included 50 women with unexplained recurrent early miscarriage whereas the control group (group 2) consisted of 50 women with no such history. The evacuated products of conception, subgingival plaques, cervicovaginal secretions and saliva of all participants were examined to detect P. gingivalis deoxyribonucleic acid (DNA) using a polymerase chain reaction. RESULTS: The prevalence of P. gingivalis DNA in the chorionic villous tissue samples of group 1 was significantly higher than in group 2 (8 [16%] vs. 1 [2%], respectively; p = 0.036, odds ratio [OR]: 9.3, 95% confidence interval [CI]: 1.1-76.9). The prevalence of P. gingivalis DNA was significantly higher in cervicovaginal secretions of group 1 than in group 2 (9 [18%] vs. 1 [2%], respectively; p = 0.02, OR: 10.8, 95% CI: 1.3-88.5). On the contrary, P. gingivalis DNA could not be detected in subgingival plaques and saliva samples of either group. CONCLUSION: The current study found an association between P. gingivalis infection of the female genital tract and the occurrence of recurrent miscarriage.

The association between pentraxin 3 in maternal circulation and pathological intrauterine fetal growth restriction.

OBJECTIVE: To assess the diagnostic accuracy of maternal serum pentraxin 3 (PTX3) in identifying pathological intrauterine fetal growth restriction (IUFGR) among women presented in the third trimester of pregnancy with a small for gestational age (SGA) fetus. STUDY DESIGN: This case control study was conducted in Ain-Shams University Maternity Hospital, Abbasiya Square, Cairo, Egypt and included women diagnosed at the third trimester of pregnancy as having a SGA fetus. Cases included pregnant women with pathological IUFGR, while women with physiologically SGA fetus were included in the control group. Diagnosis of antenatal SGA fetus was based on the presence of abdominal circumference <10th percentile. Pathological IUFGR was provisionally diagnosed antenatally by the presence of falling percentiles on serial ultrasound scans and then the definitive diagnosis was established postnatally after comprehensive neonatal evaluation. Maternal venous blood samples were collected from the eligible participants, once at the time of enrollment, to assess serum PTX3 levels using enzyme-linked immunosorbent assay (ELISA). Both groups were then followed up till delivery to confirm the diagnosis. RESULTS: Among the 68 pregnant included in the study, PTX3 was found to be significantly elevated in women with SGA fetus due to pathological IUFGR (n=34) than those with physiologically SGA fetus (n=34) [6.5 ng/ml (2.5-11.0) versus 1.2 ng/ml (0.8-2.5) respectively], with a best cutoff value of ≥1.3 ng/ml [sensitivity of 85.3% (95% confidence interval (CI), 68.9-95.0) and a specificity of 73.5% (95% CI, 55.6-87.1)]. Using multivariable binary logistic regression model, amniotic fluid index (AFI) (P=0.010), estimated fetal weight (EFW) (P=0.016), PTX3 level (P=0.041), and umbilical artery pulsatility index (UA-PI) (P=0.027) were all found to be independent diagnostic markers for pathological IUFGR. CONCLUSION: PTX3 is a promising marker that deserves further evaluation as it may differentiate normal and abnormal fetal growth among women presenting at third trimester of pregnancy with a SGA fetus.

Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing.

PURPOSE: To compare the superficial incisional surgical site infection (SSI) rate after cesarean section (CS) in obese women using subcuticular versus interrupted skin suturing. METHODS: The current randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital. Obese non-diabetic women who underwent elective CS were randomized into two groups: group I included women who had their skin closed with interrupted mattress suture using non-absorbable polypropylene, and group II included women who had their skin closed with subcuticular suture using the same suture material. Primary outcome measure was superficial incisional SSI and secondary outcome measures were skin closure time, postoperative pain assessed by ten-point visual analog scale (VAS) and short-term cosmetic wound outcome according to the Stony Brook Scar Evaluation Scale (SBSES). RESULTS: A total of 130 obese women were finally analyzed. Group II (n = 67) was associated with higher incidence of superficial incisional SSI. There were nine cases (13.4 %) compared to three cases (4.8 %) in group I (n = 63); however, this difference was statistically not significant (P = 0.088). Skin closure time was significantly prolonged in group I (8.6 ± 2.3 min versus 5.7 ± 2.2 min, respectively, P < 0.001). Postoperative pain was significantly lower in group I and the mean VAS in group I was 4.7 ± 2 versus 5.5 ± 1.8 in group II (P = 0.017). Using SBSES, group II had mean score 4.5 ± 0.7, while group I had mean score 2.7 ± 1.1. This was statistically significant (P < 0.001), which means a better cosmetic outcome in group II. CONCLUSION: Subcuticular skin closure during CS for non-diabetic obese women was significantly associated with better short-term cosmetic outcome, less skin closure time, yet, with slightly higher risk of superficial incisional SSI and significantly more postoperative pain.

Drotaverine to improve progression of labor among nulliparous women.

OBJECTIVE: To reevaluate the role of the antispasmodic drug drotaverine in shortening the length of the active first stage of labor among nulliparous women. METHODS: In a randomized, double-blind, placebo-controlled trial, 422 young nulliparous women admitted to Ain-shams University Maternity Hospital, Cairo, Egypt, in spontaneous labor were initially enrolled between May and December 2012. Drotaverine hydrochloride (40mg) or placebo was given at the start of the active phase of labor and then repeated every 2hours (maximum 3 doses). All participants were consistently managed in accordance with the local institutional intrapartum protocol. The primary outcome was the rate of cervical dilation. RESULTS: After excluding women who delivered by cesarean, data were analyzed from 320 women. There was a significant difference in post-treatment labor pain scores, duration of the active phase of labor, and rate of cervical dilatation between the 2 groups (P<0.001 for all). There was no difference in maternal adverse effects. Kaplan-Meier survival analysis showed a greater probability of faster delivery among patients treated by drotaverine hydrochloride (log rank test; P<0.001). CONCLUSION: Drotaverine hydrochloride was used effectively and safely to shorten the duration of the first stage of labor among nulliparous women with active spontaneous labor. ClinicalTrials.gov: NCT01639027.

Diagnostic validity of cervicovaginal human chorionic gonadotrophin at 26-36 weeks of gestation as a biochemical predictor of preterm birth.

AIM: The aim of this study was to assess the diagnostic accuracy of qualitative and quantitative assay of human chorionic gonadotrophin (hCG) in cervicovaginal secretion as a biochemical predictor of preterm birth. MATERIAL AND METHODS: A prospective study was conducted at Ain-Shams University Maternity Hospital, Cairo, Egypt. A total of 390 pregnant women were included in the statistical analysis: 90 women who presented with threatened preterm labor and 300 asymptomatic pregnant women with matched age, gestational age, bodyweight, parity and obstetric history. Qualitative and quantitative measurements of cervicovaginal fluid hCG at 26-36 weeks of gestation were performed to assess the risk for preterm birth. RESULTS: In women with threatened preterm labor (group 1) and asymptomatic pregnant women (group 2), preterm birth occurred in 35.6% and 9.3%, respectively. We analyzed predictive performances of qualitative and quantitative assay of hCG in cervicovaginal secretion, while combining group 1 and group 2. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of qualitative test, by the cut-off level of 25 mIU/mL, to predict preterm birth were 68.3%, 96.1%, 76.9%, 94.3% and 91.8%, respectively; those of quantitative test, by the cut-off level of 34.5 mIU/mL, were 100%, 98.5%, 92.3%, 100% and 98.7%, respectively. CONCLUSIONS: Both the qualitative and quantitative assessment of cervicovaginal fluid hCG at 26-36 weeks of gestation were valuable in the prediction of occurrence of preterm birth in the women who presented with threatened preterm labor as well as in the asymptomatic pregnant population.

Risk of postpartum uterine synechiae following uterine compression suturing during postpartum haemorrhage.

BACKGROUND: Uterine compression suturing is considered a successful, safe, inexpensive and simple method for the conservative treatment of atonic postpartum haemorrhage (PPH). However, insufficient data are available about the potential risk of subsequent intrauterine synechiae (IUS). AIM: To determine the risk of postpartum uterine synechiae in women who received isolated uterine compression suturing for the management of major uncontrolled PPH. MATERIALS & METHODS: All women with major PPH from May 2005 to June 2011 were reviewed retrospectively. Diagnostic hysteroscopy was performed to assess the uterine cavity in the 27 women who successfully underwent isolated uterine compression suturing for major atonic PPH and fulfilled the study inclusion and exclusion criteria. RESULTS: Among the 27 women who underwent isolated uterine compression suturing, 5 (18.5%) were found to have IUS on hysteroscopic examination. The mode of delivery for all women who developed IUS was caesarean section. Among these five women, three had mild IUS, one had moderate IUS and one had severe IUS. All adhesions were later successfully resected by hysteroscopy, except for one case with dense IUS. CONCLUSIONS: Uterine compression suturing was found to be associated with a risk of postpartum uterine synechiae formation, which may subsequently affect future fertility.

Letrozole versus clomiphene citrate for superovulation in Egyptian women with unexplained infertility: a randomized controlled trial.

OBJECTIVES: To compare the efficacy of letrozole with clomiphene citrate (CC) in Egyptian women with unexplained infertility. STUDY DESIGN: This randomized controlled trial was conducted at Ain Shams University Hospital and Dar Al Hekma hospital between February 2010 and May 2011. PATIENTS AND METHODS: Two hundreds and seventy women with unexplained infertility were randomized into two groups using computer-generated randomization plan, and were given letrozole 2.5 mg/day from cycle day 3 to 7 (Letrozole group, n=136) or CC 100 mg/day from cycle day 3 to 7 (CC group, n=134). On day 9, the participants underwent a transvaginal sonography (TVS) every other day to monitor their ovulation and measure both endometrial thickness and Doppler flow indices of uterine and subendometrial vessels. Single injection of 10,000 IU of human chorionic gonadotropin (hCG) was given when the mean diameter of at least one ovarian follicle was ≥18 mm, quantitative ßhCG was done 2 weeks after hCG injection to diagnose chemical pregnancy. Clinical pregnancy was confirmed by observing a gestational sac with fetal echoes and pulsation 4 weeks after positive pregnancy test by TVS. RESULTS: Both groups were comparable with regard to the day of hCG administration (letrozole 13.4±5 vs CC 12.1±4.9, respectively, p=0.06). The mean number of mature follicles was significantly higher in CC group (2±0.9 vs 1±0.0, P=0.02). Serum estradiol was significantly greater in CC group (817±299 vs 364±149 pg/ml, P<0.001). The clinical pregnancy rate was significantly higher in letrozole group (23.07 vs 10.68%, P<0.001). There was statistically significant increase in endometrial receptivity in letrozole group as assessed by endometrial thickness and Doppler flow indices of uterine and subendometrial vessels. No serious side effects were reported in either group. CONCLUSION: Letrozole has beneficial effect on endometrium, an action that may improve the implantation and pregnancy rates in women with unexplained infertility.