A study of ghrelin and leptin levels and their relationship to metabolic profiles in obese and lean Saudi women with polycystic ovary syndrome (PCOS)

BACKGROUND: Polycystic ovary syndrome (PCOS) is considered as one of the most frequently encountered hormonal pathologies in women during their reproductive years. Leptin and ghrelin, peptide hormones with adipostatic and orexigenic effect, respectively, seem to be involved in the metabolic changes that occur in PCOS. The aim of this study was to determine serum ghrelin and leptin levels in obese and lean Saudi women with PCOS and to investigate their relationship to the metabolic profiles in these women. METHODS: This study was conducted as a prospective, observational, cross-sectional, case-control study, at the Department of Obstetrics and Gynecology, Al-Noor Hospital, Makkah, Kingdom of Saudi Arabia. The study population included 252 women [130 women with PCOS (diagnosed according to the Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus, 2003) and 122 normo-ovulatory women as matched controls] attending the outpatient Gynecology Clinic. Demographic details were recorded, blood was extracted following overnight fast and serum was used for the determination of serum ghrelin and leptin levels and other hormonal and biochemical parameters including total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, glucose, and insulin. Insulin resistance and sensitivity were calculated as HOMA-IR and HOMA-S. RESULTS: No significant differences in ghrelin (P\u2009=\u20090.1830) and leptin (P\u2009=\u20090.8329) levels were detected between the PCOS and control groups. However, ghrelin levels were significantly lower; and leptin levels were significantly higher in obese PCOS patients in comparison with lean patients (P\u2009=\u20090.0001 for both). In the PCOS group, there were significant correlations between ghrelin and leptin levels with Body Mass Index (BMI), waist-hip ratio, total cholesterol, triglycerides, HDL, LDL and insulin levels. Multiple regression analysis demonstrated that insulin was the main determinant for ghrelin (R2\u2009=\u20090.316) and leptin (R2\u2009=\u20090.352) levels (P\u2009=\u20090.0001 for both). CONCLUSIONS: Although serum ghrelin and leptin levels were found to be normal in women with PCOS; yet, there is a relationship, possibly linked to obesity, hyperinsulinemia and insulin resistance between these levels and metabolic profile of Saudi PCOS

Diagnostic correlation between sonohysterography and hysteroscopy in the assessment of uterine cavity after cesarean section

Background: The evolution of sonohysterography (SHG) over the past years has contributed significantly to the assessment of uterine cavity. Objectives: To compare SHG versus the “gold standard” diagnostic hysteroscopy (DH) for the assessment of the uterine cavity in women with previous cesarean section (CS). Design: Comparative observational cross-sectional study. Setting: Department of Obstetrics and Gynecology, Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University. Subjects: Seventy-five women with previous CS(s), complaining of infertility, menstrual disorders or recurrent pregnancy loss. The inclusion criteria were: age between 20 and 35years; previous 1–3 CS(s); and the duration from the last CS ranging from 1 to 5years. Methods: Transvaginal SHG with saline infusion as contrast medium for assessment of the thickness of the scar, filling defect in the scar (niche) and intrauterine adhesions. DH was performed to confirm different findings. Main outcome measures: The findings at SHG were compared to DH; and the accuracy of SHG was calculated. Results: The scar thickness at SHG was significantly lower in cases with scar defect at DH (P=0.016). SHG was comparable to DH as shown by sensitivity, specificity, +ve predictive value, −ve predictive value and overall accuracy of 87%, 100%, 100%, 95% and 96%, respectively, in the diagnosis of scar defect; and 76%, 100%, 100%, 87% and 91%, respectively, in the diagnosis of intrauterine adhesions. Conclusion: SHG is reliable and feasible, and may be recommended as an alternative to DH for the assessment of the uterine cavity and uterine scar in women with previous CS

Anti-Müllerian hormone in polycystic ovary syndrome and normo-ovulatory women: Correlation with clinical, hormonal and ultrasonographic parameters

Background: Although the ultimate pathogenesis of polycystic ovary syndrome (PCOS) remains obscure, the distinctive feature is failure of follicular maturation resulting in anovulation and accumulation of preantral and small antral follicles which contribute significantly to the production of anti-Müllerian hormone (AMH). Objectives: To compare serum AMH levels between PCOS and normo-ovulatory women; and to investigate whether AMH correlates to clinical, hormonal and ultrasonographic parameters in both groups. Design: Comparative observational cross-sectional study. Setting: Department of Obstetrics and Gynecology, Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University. Subjects: Thirty-five women with PCOS according to the Rotterdam consensus; and 35 normo-ovulatory-matched controls with male, tubal or unexplained infertility. Methods: Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, androstenedione, estradiol, fasting insulin and AMH were measured in the early follicular phase (day 3–4) of natural cycle or progestin-induced withdrawal bleeding (in PCOS); together with transvaginal sonography for detection of the number of small follicles (<10mm) and calculation of ovarian volume. Main outcome measures: Correlation between AMH and clinical, hormonal and ultrasonographic parameters in both groups. Results: AMH was significantly higher in the PCOS group. In the whole group of patients and in each group separately, AMH was positively correlated to LH, LH/FSH, number of follicles <10mm and ovarian volume; and negatively correlated to FSH. No correlation was found between AMH and age, BMI, estradiol or fasting insulin. Testosterone and androstenedione were positively correlated to AMH in the PCOS group exclusively (r=0.557; P=0.001 and r=0.451; P=0.007, respectively). Multiple regression analysis demonstrated that testosterone was the only determinant for AMH level (r=0.485; P<0.001). Conclusions: Hyperandrogenism is associated with increased AMH secretion in PCOS patients, possibly due to increased number of small antral follicles. Assessment of AMH levels before and after the treatment of hyperandrogenism should be recommended in the plan of management of PCOS

Ultras ono graphic and Doppler Evaluation of the Lower Uterine Segment in Pregnant Women with Previous Cesarean Section: Correlation with Intraoperative Findings

Abstract Background: The safety of vaginal birth after cesarean (VBAC) has been confirmed in various clinical trials; however, the possibility of uterine rupture exists. With the availability of ultrasonography, assessment of the integrity of the uterine scar has become possible even in a gravid uterus

Comparison between placental 3D power Doppler and uterine artery pulsatility index in early prediction of pre-eclampsia

Aim of the work: To compare between placental 3D Power Doppler vascular indices and uterine artery pulsatility index in early prediction of preeclampsia. Methods: The prospective comparative observational cohort study included 200 women in their first trimester at 11–14 weeks of pregnancy divided into 2 groups. 100 women with no risk factor to develop preeclampsia (control group), 100 women with any risk factor to develop preeclampsia (case group). All women were examined by 3D abdominal ultrasound, Blood flow in placenta was examined using 3D power Doppler technique for the placental vascular indices. Uterine artery pulsatility index was also assessed. All Patients were followed up to the end of their pregnancies and their medical files reviewed to obtain whether patients developed preeclampsia and other hypertensive disorders. Results: Overall, 17 women developed pre-eclampsia while 183 women remained normotensive (7 out of 100 women in the control group and 10 out of 100 women in the case group). In both groups the women with pre-eclampsia had significantly lower placental vascular indices (vascularization-index, flow index, and vascularization flow index) compared with the normotensive women. In contrast, women with pre-eclampsia in both groups had significantly high mean uterine pulsatility index compared with the normotensive women

Estradiol and luteinizing hormone concentrations in the follicular aspirate during ovum pickup as predictors of in vitro fertilization (IVF) outcome

Background: A relationship between ‘oocyte quality’ and follicular fluid hormones is expected, since its formation coincides with the ‘oocyte maturation’ phase. The aim of this study was to find a possible relation between oocyte quality with follicular luteinizing hormone (LH) and estradiol (E2) as hormonal parameters of oocyte quality during ovum pickup for intra-cytoplasmic sperm injection (ICSI). Methods: Concentrations of LH and E2 in individual follicular fluid samples obtained during assisted reproduction treatment were related to oocyte nuclear maturation, fertilization and embryo grading. E2 and LH differences between individual groups of oocytes and embryos were calculated using the paired Student’s t test and ANOVA test. Results: Follicular E2 levels showed a significant positive correlation with oocyte nuclear maturation, fertilization and embryo grading being higher in follicles whose oocytes had matured nucleus (475 ± 142.9 ng/ml vs. 332 ± 76.4 ng/ml, P value <0.001), normally fertilized (502.5 ± 131.3 ng/ml vs. 339.8 ± 78.3 ng/ml, P value <0.001) and developed into good quality embryos (596.9 ± 72.4 ng/ml grade A vs. 511.7 ± 73 ng/ml grade B vs. 310.9 ± 57 ng/ml grade C, P value <0.001). However Follicular LH was only positively correlated with oocyte nuclear maturation. Conclusions: The local follicular environment may play a key role in the observed differences in oocyte quality. Our results suggest that the use follicular E2 may be of value in the assessment of oocyte quality. If there is a marker for oocyte quality, it would be possible to select oocytes rather than embryos, which may improve selection criteria of the best embryo to transfer, therefore increases success rate of ICSI

Comparison Between Placental 3D Power Doppler and Uterine Artery Pulsatility Index in Early Prediction of Pre-eclampsia

Aim of the work: To compare between placental 3D Power Doppler vascular indices and uterine artery pulsatility index in early prediction of preeclampsia. Methods: The prospective comparative observational cohort study included 200 women in their first trimester at 11–14 weeks of pregnancy divided into 2 groups. 100 women with no risk factor to develop preeclampsia (control group), 100 women with any risk factor to develop preeclampsia (case group). All women were examined by 3D abdominal ultrasound, Blood flow in placenta was examined using 3D power Doppler technique for the placental vascular indices. Uterine artery pulsatility index was also assessed. All Patients were followed up to the end of their pregnancies and their medical files reviewed to obtain whether patients developed preeclampsia and other hypertensive disorders. Results: Overall, 17 women developed pre-eclampsia while 183 women remained normotensive (7 out of 100 women in the control group and 10 out of 100 women in the case group). In both groups the women with pre-eclampsia had significantly lower placental vascular indices (vascularization-index, flow index, and vascularization flow index) compared with the normotensive women. In contrast, women with pre-eclampsia in both groups had significantly high mean uterine pulsatility index compared with the normotensive women

Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis

Abstract Objective To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). Data sources Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis. Study eligibility criteria All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them. Study appraisal and synthesis methods Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity. Results The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively. Conclusions The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. Trial registration Number CRD42021267501