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