Effect of esomeprazole on maternal serum soluble fms-like tyrosine kinase-1 and endoglin in patients with early-onset preeclampsia

Objective: This study evaluates the effect of esomeprazole on the maternal serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) in patients with early-onset preeclampsia.Methods: A randomized, double-blind, placebo-controlled trial was carried out in a tertiary University hospital between March 2018, and September 2019 (Clinical Trials.Gov: NCT03213639). The study included women between 28 and 31+6 weeks gestational age who had been diagnosed as preeclampsia without severe features. They were randomly assigned in a 1:1 ratio into an esomeprazole group, which received esomeprazole 40 mg orally once a day, and a placebo group, which received one placebo tablet daily. Blood samples were obtained to assess levels of serum sFlt-1and sEng using ELISA testing. The primary outcome was the difference between the mean serum level of sFlt-1 and sEng at the start of treatment and at the termination of pregnancy in both groups.Results: Eighty-eight patients were randomly assigned into both groups (44 in each). No statistically significant difference was found in the levels of sFlt-1 between both groups at admission and termination of pregnancy. The number of days of treatment for the esomeprazole group was slightly longer than the placebo group (11.4±9.4 vs. 10.3±6.3 days, P=0.515). No statistically significant difference in the rate of maternal and fetal complications occurred between the two groups. No side effects from the study medications were reported.Conclusions: Esomeprazole, at the dosage used in this study did not effectively lower the serum levels of sFlt-1 and sEng in patients with early-onset preeclampsia. Furthermore, it did not prolong the duration of pregnancy, nor did it decrease maternal or fetal complications

Knowledge, attitude and practice of long acting reversible hormonal contraception (LARHC) among women in urban upper Egypt

Background: The current study aims to assess the knowledge, attitude and practice of long acting reversible hormonal contraception (LARHC) among women in urban upper Egypt.Methods: A cross sectional study which included 902 married women, in the reproductive age, attending the outpatient clinics (Gynecology and family planning) of: 1-Assiut University Maternity Hospital, 2- Sohag University Hospital, and 3-Gehina General Hospital (MOH hospital) with current or previous use of any method of LARHC methods. A Questionnaire file was designed to assay knowledge attitude and practice of clients towards contraceptive methods. All data collected from clients reviewed separately to assess knowledge, attitude and practice of women towards contraceptive methods.Results: The most popular contraceptive method is COCs followed by IUD then DMPA. 99% of studied sample heard with good description about different types of LARHC. 54.9% of studied sample most popular/famous LARHC DMPA, most sources of information on LARHC were, Hospital, Relative/friends and health workers. 94.24% of the studied sample were in favor to use of LARHC, 94.2% of them agree to take a space between births, about 55.4% of them were health child and 61% comfortable lifestyle benefit from birth spacing, 33% of studied sample were maternal health, 68% of them were think/prefer to use implants, 64.5% of them didn’t pregnant while breastfeeding. 11% of sample women never used any contraception before and most reasons for not using contraception are fear of side effects, desire for more children, irregular sexual relationship, and husband opposition. Only 16.6 % of studied sample used LARHC before and most of them used DMPA, however 3 women who used DMPA get pregnant while using it.Conclusions: There is a good level of knowledge between upper Egypt women about LARHC methods

Vasodilator factors in the systemic and local adaptations to pregnancy

We postulate that an orchestrated network composed of various vasodilatory systems participates in the systemic and local hemodynamic adaptations in pregnancy. The temporal patterns of increase in the circulating and urinary levels of five vasodilator factors/systems, prostacyclin, nitric oxide, kallikrein, angiotensin-(1–7) and VEGF, in normal pregnant women and animals, as well as the changes observed in preeclamptic pregnancies support their functional role in maintaining normotension by opposing the vasoconstrictor systems. In addition, the expression of these vasodilators in the different trophoblastic subtypes in various species supports their role in the transformation of the uterine arteries. Moreover, their expression in the fetal endothelium and in the syncytiotrophoblast in humans, rats and guinea-pigs, favour their participation in maintaining the uteroplacental circulation. The findings that sustain the functional associations of the various vasodilators, and their participation by endocrine, paracrine and autocrine regulation of the systemic and local vasoactive changes of pregnancy are abundant and compelling. However, further elucidation of the role of the various players is hampered by methodological problems. Among these difficulties is the complexity of the interactions between the different factors, the likelihood that experimental alterations induced in one system may be compensated by the other players of the network, and the possibility that data obtained by manipulating single factors in vitro or in animal studies may be difficult to translate to the human. In addition, the impossibility of sampling the uteroplacental interface along normal pregnancy precludes obtaining longitudinal profiles of the various players. Nevertheless, the possibility of improving maternal blood pressure regulation, trophoblast invasion and uteroplacental flow by enhancing vasodilation (e.g. L-arginine, NO donors, VEGF transfection) deserves unravelling the intricate association of vasoactive factors and the systemic and local adaptations to pregnancy

Falling in serum β human chorionic gonadotropin levels between days 1 and 7 as a new protocol to predict successful single-dose of methotrexate therapy for ectopic pregnancy

Objective: To study the patterns of serum βhCG levels on days 1–4 and days 1–7 after single-dose methotrexate injection (MTX) for ectopic pregnancy (EP) and to determine the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the best cut-off points for the “percentage of fall” in serum βhCG levels for predicting a successful outcome. Patients and methods: This is a retrospective cohort study including forty-nine consecutive patients treated with single-dose MTX (50 mg/m2). We analyzed patterns of falling in βhCG levels on D1, D4 and D7 of follow up. Our main outcome measures included the overall success rate, the “percentage of fall” variable of serum βhCG levels on D4 and D7 and the best cut-off point for the “percentage of fall” that predicts a successful outcome. Results: The success rate of single-dose MTX treatment in EP was 77.5%. A cut-off “percentage of fall” in βhCG serum levels on D1–D7 of ⩾33% has the best sensitivity (96%) and PPV (85%) for predicting a successful outcome. This is out performing any cut-off on days 1–4 and comparable to the standard D4–D7 protocol. Conclusions: After single-dose MTX injection for EP, the use of D1 to D7 follow up protocol outperforms that of D1 to D4; with possible elimination of D4 routine βhCG blood draw. A cut-off “percentage of fall” in βhCG serum levels on D1–D7 of ⩾33% has the best sensitivity and PPV

Intramuscular 17α-hydroxyprogesterone caproate to decrease preterm delivery in women with placenta praevia: a randomised controlled trial

We tested the hypothesis that 17α-hydroxyprogesterone caproate (17α-OHP-C) may decrease preterm delivery (PTD) in women with placenta praevia. This was a randomised controlled trial included 114 women with placenta praevia (between 24 and 28 weeks). They were randomly assigned to group I (17α-OHP-C) who received weekly injection of 17α-OHP-C (250 mg/IM) till completing 37 weeks’ gestation or group II (Non 17α-OHP-C). The percentage of placenta praevia patients went into PTD in the 17α-OHP-C group was significantly less in comparison to the PTD in the Non 17α-OHP-C group (∼37% vs. 63.5%, p = .004). Furthermore, the mean gestational age was significantly longer (36.7 ± 0.7 vs. 34.9 ± 1.2 weeks, p < .000), the mean number of bleeding attacks was significantly less and the mean birth weight was significantly higher (2841 ± 159 vs. 2561 ± 168 g, p < .000). In conclusion, maintenance tocolysis with intramuscular 17α-OHP-C in placenta praevia women appears beneficial in decreasing the number of bleeding attacks, the percentage of PTD and the neonatal ICU admission.IMPACT STATEMENT What is already known on this subject? Over the last two decades, a large number of studies indicated that placenta praevia is a major risk factor for preterm labour and prematurity with its neonatal complications. Increasing caesarean section rates had proportionally increased the incidence of placenta praevia. What do the results of this study add? Up to now, the effective and safe tocolytic agent among these patients is not established. The results of this study (prospective, randomised and controlled with calculated sample size) added a considerable support for hydroxyprogesterone caproate as an effective, safe and cheap tocolytic agent with excellent patient compliance. What are the implications of these findings for clinical practice and/or further research? Our findings may prompt researchers to conduct a large multicentre study to evaluate the prophylactic use of hydroxyprogesterone caproate to decrease preterm labour due to placenta praevia

Abortion hysterectomy at 11 weeks’ gestation due to undiagnosed placenta accreta (PA): A case report and a mini review of literatures

First trimester placenta accreta (PA) is a rare event; there are few reported cases worldwide. Herein we report a case of abortion hysterectomy at 11 weeks’ gestation due to undiagnosed first trimester placenta accreta. Also, we reviewed medical literatures over the past 20 years for case reports of first trimester PA diagnosed after the occurrence of severe bleeding during abortive curettage or in the post abortive period

Effect of uniplant on liver function in Egyptian women with Asymptomatic Hepatitis B virus infection

Uniplant is a single 35mm contraceptive implant releasing nomegestrol acetate with an effective life span of one year. This study was undertaken to evaluate the possible effects of three-year use of uniplant on some liver enzymes (SGPT, SGOT and GGT) in Egyptian women and to evaluate whether the past asymptomatic hepatitis B virus infection would predispose to any changes in these enzymes. This is an uncontrolled prospective study including 187 women of reproductive age who desired contraception for three years (three segments each year). They were apparently healthy on clinical assessment with no history of jaundice or liver diseases. They also had normal levels of liver function enzymes (SGPT, SGOT & GGT). Fasting blood samples were drawn at admission for assessing the levels of these liver enzymes and to detect anti-HBS antibodies as a marker of past asymptomatic hepatitis B virus infection (HBV) and HBS antigen to diagnose the chronic carrier state. The liver enzymes were measured at 6th, 12th, 18th, 24th, 30th and 36th month of use, and 3–6 months after implant removal. Out of 187 subjects enrolled 159, 83 and 33 women completed one, two and three years of Uniplant use respectively. The mean levels of SGPT, SGOT and GGT showed slight but significant elevations at the end of the first and second years of use compared to the pre-insertion levels. By the end of the third year, the elevated mean values of all enzymes gradually decreased to approach the pre-insertion levels without any significant differences. The percentage of anti-HBS antibodies positive titre due to past asymptomatic infection was 23.3% (n = 41) while HBsAg positive antigenaemia (i.e., carrier state) was 3.4% (n = 6). In both groups of women – anti-HBS antibodies positive (n = 41) without antigenaemia and anti-HBS antibodies negative (n = 129) – the changes in the mean levels of all enzymes during uniplant use were closely similar without any statistical significance. These results demonstrated that: (1) uniplant induced slight but significant elevations in the mean levels of SGPT, SGOT and GGT; these elevations were within the normal ranges, completely reversible and of doubtful clinical significance. (2) The non-carrier women who had been exposed to past asymptomatic HBV infection showed no significant effects on the studied liver enzymes compared to the normal women during long-term use of Uniplant RÉSUMÉ L'Uniplant est un seul implant contraceptif de 35mm qui libère l'acétate nomegestrol ayant une durée de vie d'une année. Cette étude a été menée pour évaluer les effets possibles d'une utilisation de trios années de l'Uniplant sur certains enzymes du foie (TGPS, TGOS et TGG) chez les femmes égyptiennes et pour vérifier si une hépattite virale B asymptomatique ultérieur pourrait disposer à des changements dans ces enzymes. Il s'agit d'une étude prospective sans contrôle qui comprend cent quatre-vingt-sept femmes en âge de reproduction qui avaient de la contraception pour trios ans (trois segments chaque année). Elles étaient apparamment en bonne santé selon une évaluation clinique sans aucune histoire de la jaunisse ou de la maladie du foie. Elles avaient les niveaux normaux des enzymes du fonctionnement du foie (TGPS, TGOS et TGG). Les échantillons de sang à jeun ont été collectés le moment de l'admission pour détecter les anticorps anti-HBS comme marqueur de l'hépatite virale B (HVB) ultérieure et l'antigène HBS pour diagnostiquer l'état de porteur chronique. Les enzymes du foie ont été mesurés après le 6ème, 18ème 24ème, 30ème et 36ème mois d'utilisation et entre trois et six mois de l'enlèvement de l'implant. Sur les 187 sujets inscrits, 159, 83 et 33 ont terminé un, deux et trois ans de l'utilisation de l'Uniplant respectivement. Les niveaux moyens des TGPS, TGOS et TGG ont révélé de petites hausses significatives au bout de la première et deuxième année d'utilisation par rapport aux niveaux de pré-insertion. Au bout de la troisième année, les valeurs moyennes élevées de tous les enzymes ont baissé petit à petit et s'approchaient des niveaux de pre-insertion sans aucune différence significative. Le pourcentage des titres positifs des anti-corps anti-HBS causés par une infection asymptomatique ultérieure était de 23,3% (n = 41) alors que l'antigenéanémie positive HBS (ie état de porteur) était de 3,4% (n = 6). Dans les deux groupes des femmes les anti-corps positifs anti-HBS (n = 41) sans l'antigenéanémie et les anti-corps négatifs anti-HBS (n = 129) — les changements dans les niveaux moyens de tous les enzymes pendant l'utilisation de l'Uniplant étaient très similaires sans aucune signification statistique. Les résultats ont montré que (1) L'Uniplant a provoqué quelques petites hausses à l'égard des niveaux moyens des TGPS, TGOS et TGG. Ces hausses étaient dans les limites normales, complètement réversibles et d'une signification clinique douteuse. (2) Les femmes non-porteuses qui ont été exposées à l'infection HVB asympomatique ultérieure n'ont pas eu d'effets importants sur les enzymes du foie étudiés par rapport aux femmes normales pendant l'utilisation à long terme de l'Uniplant. Afr J Reprod Health Vol.9 (1) 2005: 24–3