First pages:

مستوى مصل الدم للهرمون مضاد مولر AMH كاداة تشخيصية للاستجابة لتحريض الاباضة في مرضى متلازمة المبيض المتعدد الكيسات PCOS == Serum Level Of AMH As A Prognostic Tool For Response To Ovulation Induction In Pcos Patients

Author name: فرح حسام الدين سعران

Supervisor name: صالحة علي حسين | بتول عبد الواحد

General topic: Medicine

Specific topic: Obstetrics and Gynecology

Degree: Higher Diploma

University: University of Kufa - Faculty Of Medicine - Department Of Obstetrics And Gynecology

Language: English

University location: Najaf

First pages:

Abstract: متلازمة المبيض المتعدد الكيسات (PCOS) هواضطراب شائع جدا التي تحدث في 4? الى 7? من النساء في سن الانجاب. من المعروف انPCOSغالبا ما يترافق مع الاصابة بالامراض التناسلية وزيادة خطرالاصابة بسرطان بطانة الرحم،والتشخيص له اهمية خاصة لانه يعتقد الان بانPCOS له ا | From the observation that some PCOS patients were known to have high serum level AMH and it has been shown to be useful in its diagnosis, however; the clinical significance of high serum AMH level in prediction of ovarian response to medical therapy was under studied we are doing this study aiming to test the value of serum AMH level as a marker of sever disease and may be subsequent resistance to medical therapy. (AMH) has glycoprotein dimmer structure.AMH is produced by the granulose cells. AMH level in the plasma of PCOS patient are two or three times higher than average and begin to decline five years later than healthy womenObjectivesThe main objective of the study is to estimate the AMH level as a prognostic factor in PCOS infertile women on ovulation induction, also to describe some risk factors of infertility and their association with the AMH level.MethodologyA cross sectional study has been carried out in the outpatient clinic at Al Sadr infertility center under supervision of specialist gynecologist on 60 patients. The data has been collected by a questionnaire which contains demographic characteristics, gynecological history, physical examination and some laboratory investigations. The data collected by simple random to select the case from the outpatient clinics in the fact of 4 - 5 infertile women one day/week, then a period of time required for following up them after the ovulation induction The data have been collected during the period from the 1st of February till the 30 of September 2015.ResultsThere was a high statistically significant difference (P 0.000) in mean AMH among the cases with negative PT from those with positive PT, also the higher level of AMH strongly linked (P 0.023) with the presence of acne as a symptom of PCOS. There was no correlation of AMH with the age, LH, FSH, prolactin, TSH, size of dominant follicle and infertility duration. While it was positively correlated (P 0.000) with the age of menarche, BMI (P 0.000), Serum testosterone (P 0.002) andendometrial thickness (P 0.000).Conclusions & RecommendationsAMH is a useful test to study folliculogenesis and ovarian potential in various situations of infertility and for identification of PCOS. High levels of AMH are commonly associated with pregnancy failure.So, a recommendation of AMH level measuring for all PCOS patients should be done in order to know the prognosis during the ovulation induction.

العلاقة بين البروتين التفاعلي عالي الدقة في حالات سمدمية الحمل مع او بدون تخلف نمو الجنين == Associationbetween Highly Sensitive C - Reactive Protein Level In Cases Of Preeclampsia With Or Without Intrauterine - Growth Restriction

Author name: روسم جاسم محمد

Supervisor name: الاء محمد صادق

General topic: Medicine

Specific topic: Obstetrics and Gynecology

Degree: Higher Diploma

University: University of Kufa - Faculty Of Medicine - Department Of Obstetrics And Gynecology

Language: English

University location: Najaf

First pages:

Abstract: سمدم?ةالحملھوخلل?ص?بتقر?با 4% منالنساءاثناءالحملوتترتبعل?ھمخاطركث?رةبالنسبةل?موالطفل. نعرفتسممالحملعللىانھا?صابةالحد?ثةغ?رالمسبوقةبارتفاعضغطالدماثناءالحملبعدا?سبوع 20 منالحملوالمصحوبةبوجودبروت?نفيالبول.البروت?نالتفاعليعاليالدقةھومؤشرك?م?ائيبامكانناق?اسھف | Preeclampsia is a hypertensive disorder that affects 4% of pregnant women , in which the exact cause cannot identified it is one of the major causes of maternal and fetal morbidity and mortality as it causes death of more than 6300 women annually , also it puts a burden on perinatal outcome as prematurity and Intrauterine growth restriction.Continuous search for predictive markers of severe PE is important and can be used to target high risk women for effective preventive treatment.Aim of study : to evaluate that Highly Sensitive C - Reactive Protein can be used as maker for severity of PE and whether it can be used to predict development of Intrauterine growth restrictionPatients and methods : this is convenient a cross - sectional study includes 80 pregnant women with their age 18 - 35 years , their gestational age 32 - 40 weeks , admitted to AL - Zahraa teaching hospital , whose diagnosed as PE based on BP and proteinurea. Full history and clinical examination were performed, venous blood aspirated for each women for biochemical analysis, Liver functions tests, Renal function tests Highly Sensitive C - Reactive Protein, and Doppler ultrasound.Results : The patients divided into those with mild PE and severe PE, with or without IUGR. No significant difference between the level of hsCRP and the severity of PE as p value was(0.779), but there is significant difference between the presence of IUGR and the level of hsCRP when it is 2mg/L as the p value was(0.020).Conclusion : We conclude that s.hsCRP is not sign

دراسة علاقة طول عنق الرحم المقاس بالسونار الداخلي مزامنة مع كمية السائل الامنيوسي في توقع وقت حدوث الولادة المبكرة خلال سبعة ايام من تمزق غشاء السائل الامنيوسي المبكر == Transvaginal Cervical Length & Amniotic Fluid Index : Can They Predict Delivery Latency Following Preterm Premature Rupture Of Membrane

Author name: وسن غائب حسون غائب

Supervisor name: امال منير مبارك

General topic: Medicine

Specific topic: Obstetrics and Gynecology

Degree: Higher Diploma

University: University of Kufa - Faculty Of Medicine - Department Of Obstetrics And Gynecology

Language: English

University location: Najaf

First pages:

Abstract: توقع حدوث الولادة عند الحوامل المصابات بتمزق غشاء السائل الامنيوسي المبكريساعد الحامل على تهيئه نفسها لدخول المستشفى لاجراء اللازم لها واعطاءالجرعةالمنشطةلرئة الطفل وادخاله الى وحده العناية المركزة لحديثي الولادة.هدف الدراسة : تهدف الدراسة الى قياس طول عن | Patients with PPROM are often hospitalized for a prolonged period of time and deliver premature infants who frequently require neonatal intensive care. These women and their infants contribute significantly to obstetric &neonatal health care costs. The prediction of delivery latency could help direct the need for specific interventions such as hospitalization, intensive monitoring, timing of antenatal steroids.Objective : To determine whether transvaginal CL, AFI,or a combination of both can predict delivery latency within 7 days in women presenting with PPROM.Methods and Study Design : This was a prospective observational study of TVCL measurements in 80 singleton pregnancies with PPROM between 24 - 34 weeks. Transvaginal ultrasonography was performed with TOSHIBA SSA - 340A(Tokyo - Japan) apparatus 7.5MHz transvaginal probe, to measure the CL&AFI. Delivery latency was defined as the period from the initial TVCL after PPROM to delivery of the baby with our primary outcome being delivery within 7 days of TVCL. The independent predictability of significant characteristics for delivery within 7 days was determined using multiple logistic regression.Sensitivity, specificity, and predictive values were used to determin, whether the presence of a short TVCL, AFI or a combination of both affected the risk of delivery within 7 days.Result : Our study in women with PPROM show the validity of CL in predicting labor when the cut off value2cm the sensitivity=52.6%, specificity=69%, PPV=60.6%, NPV =61.7% and Accuracy=61.25%.The validity of AFI when the cut off value 5cm the sensitivity=71.1%, specificity=50%, PPV=56.3%, NPV=65.6% and Accuracy=60%.With combination of CL&AFI in predicting time of labor after PPROM the sensitivity=50%, specificity=92.8%, PPV=86.4%, NPV=67.2% and Accuracy 72.5%.In women with PPROM the rate of gestational age ? 30 weeks that labored within 7 days 44.7% and those labored more than 7 days 55.3%.Also the rate of gestational age >30 weeks that delivered within and after 7 days are 50%.According to the parity we found the mean value of those delivered within 7 days are 1.24 and those after 7 days are 1.28.Conclusion : Our study shows there is increase in positive predictive value when combination of AFI and CL in prediction of time of labour so women with AFI?5 and CL?2 had 86.4% risk of delivery within 7 days after PPROM. Also the study found there was no significant association between gestational age, or parity with the prediction time of labor.

Author name: رياض وحيد العيساوي

Supervisor name: عقيل عبد المنعم حسن زوين

General topic: Medicine

Specific topic: Physiology

Degree: Doctorate

University: University of Kufa - Faculty Of Medicine - Department Of Physiology And Medical Physics

Language: English

University location: Najaf

First pages:

Abstract: يعتبر داء السكري المصاحب للحمل هو احد مضاعفات الحمل الاكثر شيوعا والتي ترتبط بمعدلات هامة من الاعتلال والوفاة ما حول الولادة , ان العلاج الفعال لداء السكري ما قبل الحمل ولداء السكر المصاحب للحمل قد تبين تحسين النتائج والحد من وفيات ما حول الولادة بالمقارن | Diabetes mellitus complicating pregnancy is one of the most common antenatal complications that are associated with significant perinatal mortality and morbidity(Magee et al., 1993, Schmidt et al., 2001and Platt et al., 2002). Effective treatment of pre - existing as well as gestational diabetes mellitus was shown to improve outcome and reduce perinatal mortality, as compared to untreated patients (Lao TT, et al., 2001and Langer , et al., 2005). Doppler studies have conventionally been utilized for fetal surveillance. The use maternal uterine artery Doppler as a screening tool to predict subsequent development of pre - eclampsia and fetal growth restriction in later gestation have gained acceptance in recent years. Umbilical artery Doppler, middle cerebral artery Doppler have been widely used for the assessment of growth restricted fetuses. The role of Doppler study in diabetic pregnancies has not been unequivocally evaluated. An atherogenic factor, that promotes vascular endothelial growth, insulin - like growth factor - 1 has been implicated with micro vascular complication during pregnancy (Kathryn 2000). Presently, short - term beneficial metabolic effects of recombinant human insulin - like growth nfactor - 1 (rhIGF) - 1 therapy have been demonstrated in numerous diabetic conditions, including type 1 diabetes mellitus, type 2 diabetes mellitus. Until recently, insulin - like growth factor - 1, based upon its endothelial growth promotion, was considered a mediator of vascular disease( Bayes - genis et al., 2001a; 2001b). Conversely, increasing evidence indicate the protective mechanism of insulin - like growth factor - 1 against vascular derangements, relating to its ability of nitric oxide production (Okura et al., 2001). We sought to investigate the impact of insulin - like growth factor - 1 levels on maternal/fetal blood flow in diabetic non - hypertensive pregnant women; an avenue of research that has yet to be fully explored. Taken together, this information will materialize the intervention needed to prevent or at least ameliorate diabetes maternal and fetal outcomes. OBJECTIVES1 - To evaluate effect of diabetes mellitus on utero - and cerebro - placental Doppler velocimetry in pregnant women, such as resistive index (RI), pulsatility index (PI), Systolic/diastolic ratio (S/D)2 - To find whether a meaningful correlation exists between the above mentioned parameters and the levels of HBA1c and maternal IGF - 1.3 - To predict the most sensitive parameter detecting complications of diabetes mellitus on fetal outcomes. MATERIAL AND METHOD In this prospective cohort study a total of 190 pregnant women with single viable fetus, cephalic presentation, were enrolled after having their verbal and written consent and approval of the ethical committee at Faculty of Medicine. They were divided into two Groups : group (Ia) women with gestational diabetes mellitus (n=70), group ( Ib ) women with pre - gestational diabetes mellitus (n=64) and the remaining (n=56) participants (group II) were free from diabetes and hypertension and served as a control group. The study performed at Al Ameer Diagnostic Center in Al Najaf, between March, 2013 and August, 2014.Examination of the participants done twice, in the second and third trimesters. In each time, history and clinical examinations performed with Doppler ultrasonography of the pregnant women including interrogations of bilateral maternal uterine arteries, fetal umbilical and middle cerebral arteries in addition to measurement of IGF - 1 and HbA1c concentrations. RESULTS AND CONCLUSIONS 1 - IGF - 1 mean± SD in second trimester was 582.61± 183.7 ng/ml in group Ia, 429.5± 231.3 ng/ml in group 1b and 278.6 ± 60.8 ng/ml in the group II with significant difference among the groups (P=0.0001) In the third trimester the mean± SD was 653.69 ±197.6 ng/ml in group Ia, 487.5± 242.4 ng/ml in group Ib and 316.6 ± 60.9 ng/ml in group II with significant difference among the groups (P=0.0001).2 - HbA1c mean± SD in second trimester was 6.59± 0.89 % in group Ia, 6.42 ± 0.9% in group Ib and 5.35 ± 0.56 % in group II with significant difference between group Ia and group II, as well as between Ib and group II, but no significant difference between Ia and Ib groups.Third trimester HbA1c mean value was 6.29 ± 0.78 % in group Ia , in group Ib 6.27 ± 0.87 % and 5.08 ± 0.57% in group II.There was no significant difference between group Ia and Ib (P=0.843) , while there was a significant difference between group Ia and group II as well as between group Ib and group II(P=0.0001).3 - Uterine artery Doppler velocimetry was considered more sensitive predictor than other arteries in evaluation of fetal outcomes and its sensitivity in the total studied population (190) was 44.3%, in gestational diabetic pregnancy group was 58.3%, in pregestational diabetic pregnancy 34.3% and in control was 29.4%.4 - Multiple maternal and fetal arterial Doppler studies at same time yield high predictive values in evaluation of fetal outcomes with general sensitivity in the total studied population was 63.6%, specificity 79.4%79, PPV 72.2% and NPV 71.7%. In gestational diabetic pregnancy the sensitivity was 94.4%, specificity was 61.8%, PPV was 72.3%, NPV was 91.3%. In pregestational diabetic pregnancy sensitivity was 88.6%, specificity was 86.2 %, PPV was 88.6 %, NPV was 86.2%. In control healthy pregnancies the sensitivity was 70.6 %, specificity was 71.8%, PPV was 52.2%, NPV was 84.8 %.