Uterine artery flow velocity waveform (FVW) type and subednometrial vascularity in recurrent pregnancy loss.

Purpose: To assess the subendometrial and uterine artery blood flow and pattern of the waveform of the uterine artery in cases of recurrent pregnancy loss compared with normal controls.Subjects and methods: Fifty women with a history of two or more successive pregnancy losses were investigated by Doppler transvaginal ultrasound to assess the subendometrial blood flow resistance index (RI), type of Doppler waveform of the uterine artery, and uterine artery pulsatility index (PI) in the mid-luteal phase. Fifty normal women acted as controls.Results: Subendometrial blood flow RI and uterine artery PI were higher in cases than controls. The majority of cases of recurrent pregnancy loss had a waveform pattern of A, or loss of diastolic flow, whereas the controls were mainly C wave.Conclusions: Some sort of endometrial and subendometrial ischemia can be suggested in cases of recurrent pregnancy loss, waveform pattern of uterine artery changes may be used to monitor changes in vascularity of endometrium if vascular enhancers are given in such cases.

Combined measurement of fetal lung volume and pulmonary artery resistance index is more accurate for prediction of neonatal respiratory distress syndrome in preterm fetuses: a pilot study.

OBJECTIVE: The objective of this study is to estimate optimal cut-off values for mean fetal lung volume (FLV) and pulmonary artery resistance index (PA-RI) as non-invasive measures to predict neonatal respiratory distress syndrome (RDS) in preterm fetuses. METHODS: A prospective study conducted at Ain Shams University Maternity Hospital, Egypt from May 2015 to July 2017: 80 eligible women diagnosed with preterm labor were recruited at 32-36 weeks' gestation. Before delivery, three-dimensional ultrasound was used to estimate FLV using virtual organ computer-aided analysis (VOCAL), while PA-RI was measured by Doppler ultrasonography. RESULTS: A total of 80 women were examined. Thirty-seven (46%) of the newborns developed neonatal RDS. FLV was significantly lower in neonates who developed RDS (p = .04), whereas PARI was significantly higher in those who did not (p = .02). Cut-off values of FLV ≤27.2 cm3 and PARI ≥0.77 predicted the subsequent development of RDS. Combining both cut-offs generated a more sensitive and specific methodical approach for the prediction of RDS (sensitivity 100%, specificity 88.5%). CONCLUSION: Measurement of FLV or PA-RI can predict RDS in preterm fetuses. Combined use of both measures bolstered their predictive significance.

Prediction of Fetal Hypertrophic Cardiomyopathy in Diabetic Pregnancies Compared with Postnatal Outcome.

OBJECTIVE: The aim of this study was to estimate the accuracy of prenatal assessment of interventricular septum (IVS) thickness, right myocardial wall thickness (RMWT), and left myocardial wall thickness (LMWT) by two-dimensional (2D) ultrasound for the prediction of perinatal mortality and postnatal diagnosis of hypertrophic cardiomyopathy (HCM) among diabetic pregnant women. SUBJECTS AND METHODS: A total of 120 diabetic pregnant women at 35 weeks or more were enrolled in this study from January 1, 2012, to June 30, 2014, at Ain Shams Maternity Hospital, Cairo, Egypt. The 2D ultrasound was done once for all the participants at the time of recruitment; IVS thickness, RMWT, and LMWT were measured. The glycosylated hemoglobin (HbA1c) levels of the participants were recorded. Neonatal assessment including postnatal echocardiography was done after 48 hours. Postnatal results were compared with the prenatal predictive results. RESULTS: Higher thickness values for IVS, RMW, and LMW were obtained in the uncontrolled diabetic cases (HbA1c > 6.5%) than in the controlled diabetic cases (HbA1c < 6.5%; P < 0.01). Of the included 120 neonates, 10 (8.3%) were stillborn, 99 (82.5%) had a five-minute Apgar score ≥7, and 4 (3.3%) had a five-minute Apgar score ≤3. The four neonates with severe neonatal distress died after admission to neonatal intensive care unit within one week after delivery. Out of 110 live-born neonates, 4 (3.6%) neonates had a low ejection fraction (EF) (<50%) due to HCM; of them 2 (1.8%) died within one week after delivery, while 2 (1.8%) survived. Another two (1.8%) neonates died from severe respiratory distress syndrome. A cutoff value of ≥4.5 mm for prenatal IVS thickness was predictive of neonatal distress due to HCM with a sensitivity of 82%, specificity of 68%, and diagnostic accuracy of 72%. A cutoff value of <1.18 for the ratio of IVS thickness to LMWT had a sensitivity of 82%, specificity of 72%, and diagnostic accuracy of 74% for the prediction of neonatal distress due to HCM. In this study, 8 of the 10 fetuses with intrauterine demise and the 2 neonates who died within one week after delivery due to heart failure had a prenatal IVS thickness of ≥4.5 mm, while 7 of the 10 fetuses with intrauterine demise and the 2 neonates who died postnatal from heart failure had a prenatal IVS thickness to LMWT ratio of ≤1.18. CONCLUSION: A prenatal IVS thickness of ≥4.5 mm or an IVS/LMWT ratio of ≤1.18 seems to be predictive of HCM and is associated with almost twofold higher risk of intrauterine fetal death and almost threefold higher risk of possibly relevant perinatal mortality.

Three-dimensional power Doppler indices of preeclamptic placentas correlated to umbilical artery Doppler and albuminuria.

UNLABELLED: Abstract Purpose: To obtain three-dimensional power Doppler (3DPD) indices of placenta in pregnancies complicated with preeclampsia compared to normal pregnancies and correlated to umbilical artery Doppler and albuminuria. METHODS: A case-control study was conducted at Ain Shams University Maternity Hospital. Evaluation of placental vascular indices, vascularization index (VI), flow index (FI) and vascularization flow index (VFI), was done using 3DPD in 80 preeclampsia pregnancies compared to 80 normal controls. RESULTS: 3DPD indices (VI, FI and VFI) of preeclampsia cases revealed lower values than controls (p<0.001). There was a statistical inverse correlation between albuminuria versus VI (p<0.05) and a statistical inverse correlation was found between VI, FI and VFI versus umbilical artery RI. CONCLUSION: 3DPD indices of placental vasculature revealed lower values in preeclamptic pregnancies than normal pregnancies. Further studies are needed to discuss the possible role of 3DPD in predicting preeclampsia.

Feasibility of prediction of cesarean section scar dehiscence in the third trimester by three-dimensional ultrasound.

PURPOSE: To assess the role of three-dimensional (3D) ultrasound mutiplanar view in prediction of cesarean section (CS) scars dehiscence. SUBJECTS AND METHODS: One hundred pregnant women with previous CS scars were investigated by ultrasound to measure the scar thickness by 2D ultrasound and to depict the uterine wall by 3D coronal plane, using 3D multiplanar view. Straight line cut section by 3D multiplanar view was used and prediction of dehiscence was by detecting fenestration of the wall. RESULTS: Operative findings revealed that 95 cases (95%) of the studied group had intact uterine scar, while dehiscence was detected among five ladies (5%). Validity of 3D U/S versus operative findings revealed a sensitivity of 83.3%, specificity 100%, positive predictive value 100%, negative predictive value 99% and accuracy 99%. C technique was superior to straight line technique in multiplanar view for assessment of the scars. CONCLUSION: Three-dimensional ultrasound is useful in prediction of dehiscent scars during pregnancy with perfect sensitivity. Machines with the availability of C dissection in the multiplanar view are more useful in this field.

Prediction of neonatal respiratory distress syndrome in term pregnancies by assessment of fetal lung volume and pulmonary artery resistance index.

OBJECTIVE: To develop reference cutoff values for mean fetal lung volume (FLV) and pulmonary artery resistance index (PA-RI) for prediction of neonatal respiratory distress syndrome (RDS) in low-risk term pregnancies. METHODS: As part of a cross-sectional study, women aged 20-35 years were enrolled and admitted to a tertiary hospital in Cairo, Egypt, for elective repeat cesarean at 37-40 weeks of pregnancy between January 1, 2012, and July 31, 2013. FLV was calculated by virtual organ computer-aided analysis, and PA-RI was measured by Doppler ultrasonography before delivery. RESULTS: A total of 80 women were enrolled. Neonatal RDS developed in 11 (13.8%) of the 80 newborns. Compared with neonates with RDS, healthy neonates had significantly higher FLVs (P<0.001) and lower PA-RIs (P<0.001). Neonatal RDS is less likely with FLV of at least 32 cm(3) or PA-RI less than or equal to 0.74. Combining these two measures improved the accuracy of prediction. CONCLUSION: The use of either FLV or PA-RI predicted neonatal RDS. The predictive value increased when these two measures were combined.

Helicobacter pylori and anemia with pregnancy.

SUBJECTS AND METHODS: Study was conducted in Ain Shams University hospitals on 100 pregnant women with iron-deficiency anemia (IDA), including 50 cases infected with Helicobacter pylori (H. pylori) and 50 cases negative for H. pylori infection. Cases with symptomatic gastritis or hyperemesis gravidarum were not included in the study, obstetric history, sociodemographic and dietary variables were also assessed. Hemoglobin level, serum iron, serum ferritin, total iron binding capacity (TIBC), H. pylori serum antibody, stool analysis to exclude parasitic infection causing IDA, occult blood in stool and ultrasound for the fetus to ensure its cardiac pulsations and to exclude any associated abnormality were all done for all patients. Iron therapy in a fixed dose was given to all patients for 1 month. Response was estimated and statistical comparison was done between both groups. Eradication of H. pylori was done in positive cases by triple therapy in the second trimester and iron therapy was given after treatment in the same dose for another month. Their response to treatment after eradication was compared to their response to iron therapy prior to H. pylori eradication. RESULTS: Hb levels, serum iron, serum ferritin were lower and TIBC was higher in H. pylori-infected cases than negative ones. The average rise of Hb in cases negative to H. pylori was higher than those positive to H. pylori. After comparing response of cases infected with H. pylori to iron therapy before and after eradication of H. pylori, it was found that rise of Hb was higher after treatment than before eradication of H. pylori. CONCLUSION: Response to iron therapy in cases of iron deficiency anemia in patients without H. pylori infection was better than those infected with H. pylori. H. pylori eradication in the infected cases increased their response to iron therapy.

Endometrial/uterine corporeal volume ratio (EV/UCV) as predictor of malignancy in women with postmenopausal bleeding.

OBJECTIVE: To evaluate the role of endometrial/uterine corporeal volume ratio for the prediction of endometrial malignancy in cases of postmenopausal bleeding. METHODS: Endometrial volumes and uterine body volumes excluding cervices measured by VOCAL (virtual organ computer-aided analysis) were estimated in 160 women with postmenopausal bleeding. Endometrial/uterine corporeal volume ratios were calculated for all. Endometrial biopsies and histopathological results were obtained for all. One hundred normal postmenopausal women were included as controls. RESULTS: Histopathological results of the 160 women with postmenopausal bleeding revealed 53 atypia, 27 endometrial cancer and 80 benign conditions. An endometrial/uterine volume (EV/UCV) ratio of a cutoff value >0.017 was predictive of malignancy. Endometrial/uterine volume ratio was more sensitive than endometrial volume and endometrial thickness for prediction of endometrial cancer. CONCLUSION: An endometrial/uterine volume ratio (EV/UCV) >0.017 is predictive of malignancy. (EV/UCV) was more accurate in the prediction of malignancy than endometrial thickness and endometrial volume.

Role of Helicobacter pylori in the pathogenesis of hyperemesis gravidarum.

PURPOSE: To evaluate the role of Helicobacter pylori (H. pylori) in the pathogenesis of hyperemesis gravidarum (HG) and the value of adding a non teratogenic regimen for its treatment in intractable cases. METHODS: Eighty hyperemesis gravidarum cases were recruited from Ain Shams University out patient clinics. A complete history was taken including history of medical disorders and chronic medications intake as non steroidal anti-inflammatory drugs. After general and local examination, ultrasound was done for all cases to exclude obstetric causes of hyperemesis. Eighty normal pregnant women acted as control. Serum test for H. pylori IgG antibody titre was done for all patients and controls. RESULTS: Seventy-one cases among the 80 HG cases and twenty-four out of the 80 controls were H. pylori positive. Eight HG cases developed severe intractable vomiting. Three of them developed attacks of hematemesis. Gastroscopy done for the eight cases revealed antral gastritis and duodenitis. Gastric and duodenal erosions were found in two cases. The eight patients received a non teratogenic regimen for treatment. Attacks of vomiting decreased and pregnancy continued till delivery of healthy newborns. CONCLUSION: Screening for H. pylori should be added to the investigations of hyperemesis gravidarum cases. Non teratogenic treatment can be considered in intractable cases.

Adnexal mass vascularity assessed by 3-dimensional power Doppler: does it add to the risk of malignancy index in prediction of ovarian malignancy?: four hundred-case study.

The Risk of Malignancy Index (RMI) is used for the prediction of ovarian malignancy. It includes menopausal status, carbohydrate antigen 125 serum levels, and ultrasound criteria. Three-dimensional power Doppler (3-DPD) is a reproducible investigation for assessment of tumor vascularity, classifying vascularity to avascular, parallel, and chaotic patterns. In this study; 3-DPD was added to RMI for prediction of malignancy in 400 cases of ovarian masses. Sensitivity of RMI for prediction of malignancy was 88%, with a cutoff value of 202.5 at 95% confidence interval. Sensitivity of 3-DPD for prediction of malignancy was 75%, adding 3-DPD to RMI increased its sensitivity to 99%. Considering the pilot nature of the study, further studies are needed to corroborate such findings.