Does cutaneous lupus erythematosus have more favorable pregnancy outcomes than systemic disease? A two-center study.

OBJECTIVE: To compare pregnancy outcomes in cutaneous lupus erythematosus (CLE) with systemic lupus erythematosus (SLE) and healthy pregnant women. DESIGN: Cohort comparative study. SETTING: Two university maternity centers in Saudi Arabia and Egypt. POPULATION: Pregnant women with CLE and SLE and healthy pregnant women. METHODS: Over a three-year period, 201 participants were allocated to three groups: group 1 (n = 67) contained women with CLE, group 2 (n = 67) women with SLE, and group 3 healthy controls (n = 67). Diagnosis of lupus erythematosus was based on American College of Rheumatology criteria. All participants were followed until delivery. Lupus exacerbation was evaluated by Lupus Activity Index score. ANOVA and chi-squared tests were used to compare obstetrical and neonatal outcomes, and regression analysis was used to define independent factors of adverse pregnancy outcomes. MAIN OUTCOME MEASURES: Pregnancy losses, preterm labor, intrauterine growth restriction, preeclampsia, neonatal intensive care unit admissions, cesarean sections and lupus exacerbations. RESULTS: There was no significant difference between groups 1 and 3 in rates of pregnancy loss, preterm labor, preeclampsia, intrauterine growth restriction and neonatal intensive care admission. Group 1 had lower pregnancy loss (p = 0.005), growth restriction (p = 0.001), preeclampsia (p = 0.05), neonatal intensive care admissions (p = 0.001), cesarean section (p = 0.03), lupus exacerbations (p = 0.05) and anti-phospholipid antibodies (p = 0.02) compared with group 2. In groups 1 and 2, lupus exacerbation and anti-phospholipid antibodies were significant independent factors for adverse outcomes. CONCLUSIONS: Cutaneous lupus erythematosus means comparable pregnancy outcomes to those of the healthy population. Lower rates of disease exacerbation and anti-phospholipid antibodies are potential factors for better pregnancy outcome in CLE compared with SLE.

Addition of procyanidine to semen preserves progressive sperm motility up to three hours of incubation.

Several studies on semen physiology and sperm fertilizing capacity have shown a beneficial effect of antioxidants. Procyanidine is a natural antioxidant, more efficient compared with vitamin C and E, with many applications in the food, agriculture, pharmaceutical and cosmetic industry. Thus, we tested whether the addition of procyanidine to the semen of infertile men has a beneficial effect on spermatozoa during their in vitro incubation and during the cryopreservation process. Semen samples of 25 infertile men were divided in to two aliquots, in which procyanidine was added or not. Semen analysis, measurement of sperm DNA fragmentation index (DFI) and measurement of reactive oxygen species (ROS) were performed 3 h after incubation at 37 °C and after sperm cryopreservation and thawing. In-vitro addition of procyanidine to semen of infertile men resulted in a lesser decrease in progressive motility [-4 (-31:+6) vs. -6 (-31:+5), p < 0.001] and total motility [-5 (-29:+3) vs. -9 (-32:+2), p < 0.001] after 3 h of incubation compared with no addition of procyanidine. Sperm morphology was decreased only in the control group after 3 h of incubation [2 (0:+6) vs. 1 (0:+4), p = 0.009]. Furthermore, a larger increase in sperm DFI was observed in the control compared with the procyanidine group [9 (-7:+27) vs. 3 (-3:+18), p = 0.005] after thawing of cryopreserved semen samples. In conclusion, in-vitro addition of procyanidine to the semen of infertile men exerts a protective effect on progressive motility during handling and after 3 h of incubation as well as on sperm DFI during the process of cryopreservation.

Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy.

OBJECTIVE: To compare efficacy between double-dose methotrexate and single-dose methotrexate for treatment of tubal ectopic pregnancy (EP). METHODS: Between March 2008 and February 2011,157 patients who had tubal EP diagnosed by a non-laparoscopic approach and were hemodynamically stable were enrolled in a prospective study in Qassim, Saudi Arabia. The participants were randomized to receive either double-dose (50mg/m(2) intramuscularly on days 0 and 4; group 1) or single-dose (50mg/m(2) intramuscularly on day 0; group 2) methotrexate. Serum human chorionic gonadotropin (ß-hCG) levels were followed until negative. RESULTS: The overall success rate was comparable between groups 1 and 2 (88.6% versus 82.0%, P=0.1). The duration of follow up until negative ß-hCG was shorter in group 1 (P=0.001). Receiver operative characteristics showed that higher cut-off levels of ß-hCG and gestational mass diameter were associated with successful outcome in group 1. Among participants with initial ß-hCG of 3600-5500 mIU/mL, the success rate was higher in group 1 (P=0.03). There was no significant difference between groups in adverse effects. CONCLUSION: For treatment of EP, double-dose methotrexate had efficacy and safety comparable to that of single-dose methotrexate; it had better success among patients with moderately high ß-hCG and led to a shorter follow up.

Prepregnancy obesity and pregnancy outcome.

BACKGROUND: Maternal obesity has long been correlated with an increased risk of chronic hypertension and diabetes prior to pregnancy and adverse pregnancy outcomes including preeclampsia, gestational diabetes, fetal macrosomia, Cesarean deliveries, postpartum endometritis and a prolonged hospital stay OBJECTIVE: To determine the effect of maternal pre-pregnancy obesity on pregnancy outcomes Methods: One hundred and twenty two women were recruited in the study. The patients were allocated into two groups, group 1 obese patients (68) BMI 30 or more and group 2 non obese patients (54) BMI between 19.8-24.9. OUTCOMES: About two - third of the study group were having mild obesity, moderate obesity comprised about 28% and about 4% only was morbidly obese. Hypertensive disorders were nine folds more among obese women (R.R 4.74). Obese pregnant women were significantly more prone to have gestational diabetes (R.R 6.35). Even anemia was significantly more amongst Obese women when compared to non obese ones (29/68, R.R 3.84). Ante partum hemorrhage had significantly more in obese women (R.R 3.14). There was no increased risk for PROM (R.R 0.71). Moreover The macrosomic babies were extremely commoner among obese (R.R 9.1). CONCLUSION: Pre-pregnancy obesity is a risk factor for gestational diabetes, preeclampsia, labor induction, cesarean section for fetal distress, and wound infection. They should be considered as high risk and counseled accordingly.

The effect of advanced maternal age on pregnancy outcome in women with cervical insufficiency treated with cerclage.

Background: As a woman’s age increases, infertility also increases. Women with cervical insufficiency seek pregnancy at advanced age. Objectives: This study quantifies pregnancy outcome in women with cervical incompetence according to maternal age. Methods: A register-based study conducted between May 1, 2010 to April 30, 2011 at MCH, Qassim, KSA. During this period, 8723 deliveries and 52 cases with cervical insufficiency were identified. Patients were divided according to maternal age into group 1 less than 35 years of age or group 2 at or greater than 35 years of age. Results: Out of these 52, 38(73.1%) comprised Group1 and 14 (26.9%) comprised group 2. Patients in group 2, were older, (40 vs. 27 years, P=0.00), of high gravidity (17 vs. 4, P=0.00), had less previous history of ERCP (14.3% vs.31.6% P=0.002), were likely delivered by caesarean section (0.002) and were less likely developed PROM (P=0.047). However, both groups (G1 and G2) were similar in gestational age at delivery (36.6 vs. 36.6 weeks, P=0.95), the abortion rate, [8(21.1%) vs. 2(14.3%), P=0.58], and the rate of preterm delivery, 3(10.3%) vs. 2(16.7%) respectively (P=0.57). Conclusion: pregnancy outcome in women with cervical incompetence and advanced maternal age is not influenced by maternal age.