Correlation between uterine artery Doppler indices and menstrual irregularities among levonorgestrel releasing intrauterine system and depot medroxyprogesterone acetate users: a prospective observational study

Objective: To ascertain whether menstrual irregularities among users of levonorgestrel releasing intrauterine system (LNG-IUS) and depot medroxyprogesterone acetate (DMPA), were associated with changes in uterine artery Doppler indices or not.

Methods: This three-year prospective observational study included 102 women using LNG-IUS and 104 women using DMPA for contraception. Participants were followed at regular intervals over three years with performance of transvaginal ultrasound to measure uterine artery pulsatility index (PI) and resistance index (RI) before starting the method and at six months, 12 months, two and three years thereafter. Data was collected and tabulated.

Results: Significant changes in uterine artery PI and RI were detected. PI indices were reduced after six months of use in both groups and elevated significantly at 12 months in both groups compared to initial values (p?p?p?Conclusions: LNG-IUS and DMPA induce hemodynamic changes in the uterine arteries denoting positive correlation with menstrual irregularities. Larger multicentre studies are warranted to potentiate our findings.     

Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section*

Objectives: To assess the effects of previous cesarean delivery (CD) and placental location on second trimester uterine artery Doppler indices in subsequent pregnancy and to assess the predictive values of abnormal Doppler findings for adverse pregnancy outcomes in women with previous CD.

Study design: This prospective cohort study evaluated 400 gravida two pregnant women (200 with previous none medically indicated CD and 200 with previous normal vaginal deliveries (NVD)) who were referred for second trimester fetal anatomic survey. Uterine artery Doppler studies were performed in all participants who were then followed until delivery.

Results: Compared with women having prior NVD, women with prior CD had significantly higher rates of abnormal uterine artery pulsatility index (PI) (p?p?=?.01). Among women with previous CD, all the measured adverse pregnancy outcomes occurred significantly more often in women with abnormal uterine artery Doppler indices (p?Conclusions: CD seems to be associated with increased risks of impaired placental function and circulation and adverse pregnancy outcomes in the subsequent pregnancy, particularly in women with anteriorly located placenta near the previous uterine scar.     

Evaluation of third trimester uterine artery flow velocity indices in relationship to perinatal complications

Objective.?Uterine artery Doppler is becoming a routine part of pregnancy surveillance in high-risk pregnancies. Which blood flow velocity waveform index to measure is debated and the ‘notch’ in early diastole is not widely accepted, as it is a subjective measure. The aim of the present study was to evaluate the different indices in the prediction of adverse outcome of pregnancies suspected for intrauterine fetal growth restriction (IUGR).

Methods.?Uterine artery blood flow was recorded in 217 pregnancies admitted for Doppler ultrasound surveillance due to suspected IUGR. The median gestational age at examination was 38 weeks (range 25–42 weeks). Only cases having bilateral uterine artery notching were included in the evaluation. The uterine artery Doppler spectrum was analyzed for different indices, including evaluation of notch and end-diastolic velocities. Umbilical artery Doppler velocimetry was also performed. The outcome variables chosen were: a small-for-gestational-age (SGA) newborn, preterm birth, and abdominal delivery. ROC-curve calculations were used to compare the different indices.

Results.?The uterine artery blood velocity pulsatility index (PI) and resistance indices (RI) were the best predictors of adverse outcome of pregnancy. Apart from premature birth, the systolic/end-diastolic ratio was less predictive of adverse outcome. The indices including only diastolic blood velocities were the least predictive of adverse outcome. The group with notch velocity above end-diastolic velocity was compared with those having notch velocity below the end-diastolic velocity. No difference in outcome was seen between the two groups.

Conclusions.?RI and PI as measures of third trimester utero-placental vascular impedance are the best predictors of adverse outcome of IUGR-suspected pregnancies.     

Assessment of left ventricular function using the Myocardial Performance Index in term fetuses that develop intrapartum compromise

Objective: To investigate the relationship between the prelabour left ventricular Myocardial Performance Index (LVMPI) and intrapartum fetal compromise (IFC) in low-risk term pregnancies.

Methods: A blinded, prospective observational cohort study at the Mater Mother’s Hospital, Brisbane, Australia. A cohort of 284 women with uncomplicated singleton pregnancies underwent fortnightly ultrasound from 36 weeks until delivery. The LVMPI was assessed by conventional Doppler ultrasound and correlated with intrapartum outcomes. The LVMPI was also correlated with other Doppler indices of fetal wellbeing.

Results: Two hundred and seventy-three women were included in the final analysis, the median LVMPI was higher in fetuses that required any emergency operative delivery for IFC (0.56, 0.52–0.60 versus 0.54, 0.50–0.58, p?=?.007). The left ventricular cardiac output (LVCO) and cerebroplacental ratio (CPR) were lower in fetuses that required any emergency operative delivery for IFC compared to those that did not (164?±?19?ml/min/kg versus 181?±?30?ml/min/kg, p?p?r?=??0.20, p?r?=??0.29, p?r?=??0.22, p?Conclusions: Higher global LVMPI is associated with a higher risk for IFC and poorer condition of the newborn.     

Association between first trimester vaginal bleeding and uterine artery Doppler measured at second and third trimesters of pregnancy

Abstract

Objective: To evaluate the prevalence of first trimester vaginal bleeding among patients with abnormal second and third trimester uterine artery Doppler.

Methods: A prospective study of patients with a uterine artery Doppler measurement between 27 and 42 weeks’ gestation was undertaken. A comparison was made between two groups: patients with and without first trimester vaginal bleeding. Abnormal uterine artery Doppler was defined as PI >95th% or the presence of a diastolic notch.

Results: Of the 277 patients that were included in the study, 65 (23%) had first trimester vaginal bleeding. No differences were noted in uterine artery Doppler waveforms among patients with and without first trimester vaginal bleeding.

Among patients with first trimester vaginal bleeding, 9 (14%) had a bilateral uterine artery notch and 56 (86%) did not, compared with 51 (24%) and 161 (76%), in the control group, respectively. Patients with first trimester vaginal bleeding, and a bilateral uterine artery notch had significantly higher rates of small for gestational age neonates, low-Apgar scores (<7) at one minute and cesarean deliveries compared to patients with first trimester vaginal bleeding who did not have bilateral uterine artery notch.

Conclusion: First trimester vaginal bleeding was not associated with a higher incidence of abnormal uterine artery waveforms or with placental related conditions. However, adverse perinatal outcomes were found when first trimester vaginal bleeding was associated with second and third trimester bilateral uterine artery notchs.     

Could 3D placental volume and perfusion indices measured at 11–14 weeks predict occurrence of preeclampsia in high-risk pregnant women?

Objective: Preeclampsia (PE) is a known cause of maternal, fetal and neonatal morbidity and mortality. Thus, evaluation of the predicting value of combining the 3D assessment of placental volume with the assessment of placental perfusion indices through 3D power Doppler (3DPD) at 11–14 weeks in pregnant women at high risk to develop PE could be a suitable screening method.

Methods: 3D assessment of placental volume and 3DPD assessment of placental vascularization indices at 11–13 weeks and uterine artery Doppler scan (RI and PI) at 21–22 weeks were conducted in this prospective case–control study. Their predictive ability for PE was assessed.

Results: One-hundred pregnant women divided into two groups were enrolled in our study. High-risk group (n?=?50) and control group (n?=?50). Thirty-eight (76%) patients in the high-risk group and 6.0 (12%) patients in the control group developed PE, respectively. The mean values of placental volume (<0.001), vascularization index (<0.001), vascularization flow index (<0.002) were significantly lower in the high-risk group. Meanwhile, uterine artery RI (0.011) and PI (<0.001) was significantly higher in the study group. Uterine artery PI is negatively correlated with placental volume and vascularization indices (?0.36).

Conclusion: Our findings suggest that 3D placental volume measurement and 3DPD assessment of placental vascular indices in the first trimester has the potential to detect women at risk for subsequent development of PE.     

Alteration of vascularization in preeclamptic placentas measured by three-dimensional power Doppler ultrasound

Abstract

Objective: To evaluate the alteration of vascularization in preeclamptic placentas measured by three-dimensional (3D) power Doppler ultrasound.

Methods: We performed a prospective study of placental vascularization and placental volume in 27 singleton pregnancies complicated by preeclampsia and 41 normal pregnancies from 27 to 39 weeks of gestation. The placental volume was analyzed using the VOCAL imaging analysis program and 3D power histogram was used to calculate the placental vascular indices including vascularization index (VI), flow index (FI) and vascularization flow index (VFI).

Results: Of the 27 preeclamptic pregnancies, 9 were complicated by intrauterine growth restriction and 15 were severe preeclampsia. Furthermore, nine of the preeclamptic pregnancies had abnormal end diastolic flow in the umbilical artery. No significant correlation was noted between the placental vascular indices and gestational age in normal pregnancies. The placental vascular indices including VI, FI and VFI were significantly lower in preeclamptic placentas compared with controls (VI, p?<?0.001; FI, p?=?0.022; VFI, p?<?0.001). Preeclamptic placental volume was also decreased compared with that of the controls (p?=?0.002). After adjustment for confounding factors, significant differences were observed in VI and placental volume. However, no correlation was found between 3D power Doppler vascular indices and umbilical artery flow velocities, and neither intrauterine growth restriction nor the severity of preeclampsia could be predicted by the vascular indices.

Conclusion: VI and placental volume are reduced in preeclamptic placenta. Placental vascular indices using 3D power Doppler ultrasound provide insights of placental vascularization in preeclampsia.     

P-wave and QT dispersion in hypertensive disorders of pregnancy

Abstract

Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.

Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n?=?43), chronic hypertension (n?=?51), and gestational hypertension (n?=?46). P-wave and QT dispersion values were compared between groups.

Results: Hypertensive pregnants had higher P-wave (41.74?±?5.51 vs. 37.73?±?5.62, p?<?.001) and QTc dispersion (45.44?±?7.62 vs. 39.77?±?8.34, p?<?.001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r?=?0.409, p?<?.001 and r?=?0.306, p?<?.001) and diastolic blood pressure (r?=?0.390, p?<?.001 and r?=?0.287, p?<?.001) which are main clinical determinants of hypertensive disorders.

Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases.     

Superior mesenteric artery Doppler is poor at predicting feed intolerance and NEC in preterm small for gestational age neonates

Abstract

Objective: To study SMA Doppler for predicting feed intolerance and necrotizing enterocolitis (NEC) in preterm SGA neonates with umbilical artery absent/reversed end diastolic flow (A/REDF).

Study design: Prospective study.

Patients: SGA neonates <36 weeks born with antenatally diagnosed A/REDF formed cases. Those with normal Doppler formed controls. Primary outcomes were feed intolerance and NEC. Peak systolic velocity, end diastolic velocity (EDV), time-averaged mean velocity, pulsatility index and resistive index (RI) were measured in SMA Doppler done postnatally on days 1 and 5.

Results: Fifty neonates were enrolled in each group. Gestation, birth weight, gender and Apgar scores were comparable. Feed intolerance rate was similar (A/REDF: 26% versus controls: 20%, p 0.48), NEC was commoner in A/REDF group (32% versus 4%, p?<?0.001). Baseline SMA Doppler indices were similar; RI on day 1 was higher in babies with A/REDF [5.4 (IQR 3.3, 7.3)] who developed NEC compared to controls [3.3 (IQR 1.7, 3.9)], (p 0.049). RI of 3.63 on day 1 had only a sensitivity of 61% and a specificity of 57% in predicting NEC in A/REDF group (area under curve (AUC) 0.61, 95% CI: 0.43–0.79, p?=?0.25). Similarly, EDV of 8.7?cm/s had only a sensitivity of 61% and a specificity of 60% for the prediction of NEC (AUC of 0.64, 95% CI: 0.47–0.81, p?=?0.16).

Conclusions: Postnatal SMA Doppler indices do not predict feed intolerance and NEC in preterm SGA babies with A/REDF.     

Inducible nitric oxide inhibitor aminoguanidine,ameliorated oxidative stress,interleukin-6 concentration and improved brain-derived neurotrophic factor in the brain tissues of neonates born from titanium dioxide nanoparticles exposed rats

Abstract

Introduction: An interaction between oxidative stress, neuroinflammation, and nitric oxide (NO) has been suggested to have a role neurotoxicity. The aim of current research was to investigate the effect of aminoguanidine (AG) as an inducible NO synthase (iNOS) inhibitor, on brain-derived neurotrophic factor (BDNF), oxidative stress, and interleukin-6 (IL-6) concentrations in the brain tissues of neonates born from the rats exposed to titanium dioxide nanoparticles (TiO2 NPs) during gestation.

Methods: The pregnant rats were grouped into three and received: (1) saline, (2) TiO2 (200?mg/kg, gavage), and (3) TiO2-AG [200?mg/kg intraperitoneal (IP)]. The treatment was started since the second gestation day up to the delivery time. The neonates born from the rats were deeply anesthetized, sacrificed, and the brains were collected for biochemical evaluations.

Results: The neonates born from the rats exposed to TiO₂ showed a lower BDNF (p?<?.001) but a higher IL-6 (p?<?.01) concentrations in their hippocampal tissue. TiO₂ exposure also increased malondialdehyde (MDA) (p?<?.001) and NO metabolites (p?<?.001), while diminished thiol (p?<?.001), superoxide (SOD) (p?<?.001), and catalase (CAT) (p?<?.001) in all hippocampal, cortical, and cerebellar tissues. Administration of AG improved BDNF (p?<?.01) but attenuated IL-6 (p?<?.01) concentrations in the hippocampal tissue. AG also decreased MDA (p?<?.001) and NO metabolites (p?<?.01–p?<?.001), while increased thiol (p?<?.01–p?<?.001), SOD (p?<?.001), and CAT (p?<?.05–p?<?.001) in all cerebellar, hippocampal, cortical, and tissues.

Conclusion: The results of the current research revealed that iNOS inhibitor AG, ameliorated oxidative stress, IL-6 concentration, and improved BDNF in the brain tissues of neonates born from TiO₂ NPs exposed rats.     

The clinical value of maternal and fetal Doppler parameters in low-risk postdates pregnancies – a prospective study

Objective: The objective of this study is to determine the clinical significance of maternal and fetal ultrasound Doppler flow indices in postdates pregnancies.

Methods: This prospective study comprised 120 low-risk pregnant women beyond 40 weeks of gestation. All participants underwent Doppler assessment including of fetal middle cerebral artery (MCA), umbilical, and uterine arteries. Perinatal outcomes were recorded and evaluated for possible associations with Doppler flow values. Adverse perinatal outcomes were defined as umbilical cord arterial pH <7.1, Apgar score <7 at 5?min, neonatal admission to a neonatal intensive care unit, and emergency cesarean section due to abnormal intrapartum cardiotocogram

Results: Adverse perinatal outcome rate was 17.5% (n?=?21). Doppler indices of umbilical artery, MCA, uterine artery and the cerebroplacental ratio (CPR) did not differ significantly between pregnant women with and without adverse perinatal outcomes. Neonatal birth weight was found to correlate negatively with umbilical artery Doppler indices, including the peak systolic to end diastolic ratio (p?=?.04), the resistance index (p?=?.02), and the pulsatility index (p?=?.01). Doppler values of the uterine artery, MCA and CPR did not correlate with neonatal birth weight.

Conclusions: The contribution of maternal and fetal ultrasound Doppler to the prediction of adverse perinatal outcomes in low-risk postdates pregnancies is low. Hence, performing routine Doppler examination as part of postdates pregnancy assessments is unlikely to yield significant clinical benefit.     

Predicting small for gestational age in the first trimester of pregnancy using maternal ophthalmic artery Doppler indices

Objective: To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestational age (SGA) newborns in the first trimester of pregnancy.

Methods: We performed a prospective observational cohort study involving 499 singleton pregnancies during the first trimester scan (11–14 weeks). The following maternal ophthalmic Doppler indices were assessed: pulsatility index (PI), first diastolic peak velocity (PD1) and peak ratio (PR)?=?PD1/peak systolic velocity. We considered SGA all newborns with weight below 10th percentile. We used chi-square test (χ²) to compare the groups. We used area under receiver operating characteristics (ROC) curves with 95% confidence intervals (CI) and detection rate of 5% of false positive of each maternal ophthalmic Doppler index and the mean uterine artery PI for prediction SGA.

Results: 27 (5.4%) patients delivered SGA newborns, 12 (2.4%) patients developed preeclampsia (PE) and delivered SGA newborns, and 460 had uneventful pregnancies (controls). We observed significant difference of PI and PR between SGA (SGA and SGA+PE) and control groups, p?=?0.043 and p?=?0.014, respectively. To 5% of false positive, the detection rate of SGA (SGA and SGA+PE groups) using PI, PD1 and PR were 14.8, 3.7, 14.8, 16.7, 16.7 and 16.7%, respectively. Mean uterine PI was significantly higher in the SGA+PE group (p?=?0.003).

Conclusion: The isolated use of maternal ophthalmic Doppler indices or in combination with uterine artery Doppler, in the first trimester of pregnancy, was not efficient to predict SGA newborns.     

Outcome of small-for-gestational-age fetuses according to umbilical artery Doppler: Is there any yield from additional middle cerebral artery Doppler?

Abstract

Objective.?To investigate the outcome of small-for-gestational-age (SGA) fetuses in relation to the features of umbilical artery (UA) Doppler and to explore the prognosticator of middle cerebral artery (MCA) Doppler in SGA fetuses with normal UA impedance.

Methods.?Two hundred ninety-seven patients were classified into Group 1 with normal UA and MCA pulsatility index (PI), Group 2 with normal UA but abnormal MCA PI and Group 3 with abnormal UA PI/absent or reversed end diastolic flow. Neonatal outcomes were compared between each group.

Results.?Neonatal intensive care unit (NICU) admission, duration of hospital stay and perinatal mortality were higher in Group 3 as compared to the others. Group 2 had a lower birth weight and more fetuses with 5-min Apgar score <7 than Group 1; NICU admission and need for ventilators were also significantly higher than Group 1.

Conclusions.?SGA fetuses with abnormal UA Doppler suffered more morbidity and mortality compared to those with normal UA Doppler. SGA fetuses with normal UA PI but abnormal MCA PI had worse outcomes compared to those with normal UA and MCA PI.     

Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia?

Objective: Preeclampsia (PE) is a severe pregnancy complication with significant maternal and neonatal morbi–mortality resulting in high health care costs. Prevention, mainly based on the administration of acetylsalicylic acid, is only possible if timely identification of high-risk patients can be realized in an easy, nonexpensive, and widely available method. This paper explores the clinical usability of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) in discriminating between women that will and those that will not develop PE.

Study design: Demographic data and laboratory results were retrospectively collected and compared in 2050 pregnant women (164 PE and 1886 controls) between 1 January 2014 and 31 January 2016.

Results: In the PE group, gravidity, parity, gestational age, and birth weight were significantly lower compared to the control group. Before the 20th pregnancy week, MPV was significantly elevated in the PE group compared to the controls (p?=?.006), hence analysis revealed an optimal cut-off point of 8.15 (sensitivity 66.7%, specificity 56.3%) for predicting PE. At the end of pregnancy, NLR and MPV appeared to be higher and PLR lower in the PE group compared to the controls, which strengthens the current knowledge on the pathogenesis of PE.

Conclusions: MPV is significantly elevated in the first half of pregnancy in women who later develop PE and might therefore be implemented in combination with other parameters in a PE prediction model.     

Is platelet mass a more significant indicator than platelet count of closure of patent ductus arteriosus?

Background: The purpose of this study was to evaluate whether or not platelet mass contributes to closure of patent ductus arteriosus (PDA) in premature newborns.

Study design and subjects: This retrospective study included 115 preterm newborns with hemodynamically significant PDA (hPDA) and 120 newborns without PDA. The newborns’ platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) were noted from their files and the platelet mass (platelet count plus MPV/10³) was calculated. Patients with congenital abnormality, persistent pulmonary hypertension or sepsis were not included in the study.

Results: Platelet count and PDW were found to not be risk factors for closure of hPDA (p?>?0.05), but both high platelet mass (OR 1.25; 95% CI 1.12–1.41) and MPV (OR 1.87; 95% CI 2.52–3.85) were determined to be independent risk factors for hPDA.

Conclusions: Platelet mass may be a more significant indicator than platelet count of closure of hPDA in preterm newborns.     

Fetal cerebral and cardiac hemodynamics in postdate pregnancy

Objective: We aimed to determine the fetal cerebro-placental Doppler indices and modified myocardial performance index (Mod-myocardial performance index (MPI)) in this homogenous group of postdated pregnancies.

Methods: A total of 92 singleton pregnant women were included in this prospective study. The study involved three groups; full term control (Group 1, n?=?42, 39 0/7 to 40 6/7 week’ gestation), late term (Group 2, n?=?34, 41 0/7 to 41 6/7 week’ gestation) and post term (Group 3, n?=?16, ≥ 42 0/7 weeks’ gestation). Each participant underwent a Doppler assessment of the fetal umbilical artery (UA), middle cerebral artery (MCA), Mod-MPI. We determined the correlation of the Doppler indices and mod-MPI in patients with unfavorable outcome.

Results: MCA pulcatility indices (PI), cerebroplacental ratio (CPR) values were significantly higher in the control group than those in the late-term and post-term groups (Group 1: 1.63?±?0.3, Group 2: 1.27?±?0.51, Group 3: 1.13?±?0.22, respectively, p?p?Conclusions: Fetal Mod-MPI does not differ in postdate pregnancies with favorable and unfavorable outcome. The monitorization of fetal well-being with CPR may help to clinicians to select patient for expectant management in postdate pregnancies.     

Prevalence and diagnostic accuracy of Doppler ultrasound of placenta accreta in Egypt

Objective: The objective of this study is to assess the prevalence of placenta accrete (PA) among those with placenta implanted over cesarean section (CS) scar and to evaluate the accuracy of Doppler ultrasound in diagnosis.

Methods: A cross-sectional study included 100 patients with placenta previa (PP) anterior with at least one previous CS. Ultrasound and color Doppler were done to all participants and correlated with operative findings.

Results: There was a significant difference between accrete and non-accrete group regarding maternal age (32.6?±?5.01 versus 29.14?±?4.89), and a highly significant difference regarding the postoperative hemoglobin (6.71?±?1.156 versus 8.41?±?1.257) and the number of previous CSs (p?<.001). The abnormal Doppler findings showed a highly significant difference between the two groups as loss of retroplacental clear zone (87.3% versus 10.8%), intraplacental lacunae (93.7% versus 37.8%), hypervascularity in uterine bladder interface (47.6% versus 5.4%), and blood vessels invading myometrium (82.5% versus 18.9%) (p?p?Conclusion: The use of ultrasound together with the color Doppler allowed for better prediction of placental invasion of the myometrium prior to obstetrical intervention to improve the maternal and the fetal outcome.     

The effect of low-dose aspirin on fetal weight of idiopathic asymmetrically intrauterine growth restricted fetuses with abnormal umbilical artery Doppler indices: a randomized clinical trial

Objective: To investigate the effect of aspirin on fetal weight in fetuses with idiopathic asymmetrical intrauterine growth restriction (IUGR) complicated by abnormal umbilical artery Doppler indices.

Materials and methods: The study was a randomized controlled trial conducted at Woman’s Health Hospital, Assiut, Egypt, between June 2016 and the January 2017 included 60 pregnant women (28?30 weeks) with idiopathic asymmetrical IUGR associated with abnormal umbilical artery Doppler indices. Women were randomly assigned to group I (aspirin 75?mg) daily for four weeks or group II (no intervention). The primary outcome was the fetal weight after four weeks. Secondary outcomes included Doppler blood flow changes in the umbilical artery plus delivery and neonatal outcomes.

Results: The estimated fetal weight and umbilical artery blood flow increased significantly in aspirin group (p?=?.00) when compared with no intervention group. As regard neonatal outcomes; aspirin group showed better results and encouraging outcomes (p?Conclusions: Aspirin improves fetal weight and umbilical artery blood flow in idiopathic asymmetrical IUGR fetuses complicated by abnormal umbilical artery Doppler blood flow.     

The effect of myoinositol on ovarian blood flows in women with polycystic ovary syndrome

To evaluate whether 4 gram myoinositol and 400?mcg folic acid(MYO) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at 3?months follow-up period in polycystic ovary syndrome (PCOS). One-hundred eighty patients were designed into six groups; Group 1: PCOS patients that received OCP containing 30?mcg ethinyl estradiol (EE) plus 3?mg drospirenone (DRP); Group 2: PCOS patients that received MYO; Group 3: PCOS patients that received no medication. Group 4: Healthy patients that received OCP; Group 5: Healthy patients that received MYO; Group 6: Healthy patients that received no medication. Resistance index (RI) and pulsatility index (PI) of both ovaries were assessed. There was a significant increase in RI and PI of both ovarian stromal blood flow women with PCOS who received OCP (Group 1, p?<?.001) and MYO (Group 2, p?<?.001). The rate of increment in both RI and PI values were similar for OCP users (Group 1) and MYO users(Group2) in PCOS patients. MYO therapy reduced ovarian vascularization in both PCOS and healthy users after 3?months and this decrease is especially noticeable in women with PCOS compared to healthy women. OCP therapy also reduced ovarian vascularization just like MYO therapy.     

Improved pregnancy outcome following earlier splenectomy in women with immune thrombocytopenia: a 5-year observational study

Objective: To assess prospectively the maternal and fetal outcome in women with immune thrombocytopenic purpura (ITP) who undergone earlier splenectomy compared to women on medical therapy.

Methods: A 5-year observational study included pregnant women in the first trimester previously diagnosed with primary ITP with 74 patients underwent splenectomy before pregnancy and 86 patients on medical therapy. Patients were followed throughout pregnancy and labour to record their obstetric outcome. Data were collected and tabulated.

Results: There was a higher platelet count in the splenectomy group at enrollment (p?p?p?p?p?p?p?p?p?Conclusion: Earlier splenectomy in patients with ITP may have a beneficial impact on obstetric outcome and should be explained to patients wishing to get pregnant. Further larger multicenter studies are warranted to confirm or refute our findings.