Fetal malformations complicate approximately 3 % of all pregnancies. Many of these are minor or can be corrected after birth, but there are certain malformations that are lethal and others that are severe and others, that, even if... more
Fetal malformations complicate approximately 3 % of all pregnancies. Many of these are minor or can be corrected after birth, but there are certain malformations that are lethal and others that are severe and others, that, even if corrected lead to per-manent disability. Advances in prenatal diagnosis made possible the diagnosis of many fetal malforma-tions. This led to the concept of the fetus a patient, independent of the pregnant woman, even though the moral status of the fetus is in dispute. Many of the lethal malformations are untreatable. However, for some, innovative in utero treatments, both med-ical and surgical, became possible. These interven-tions should be evaluated for the relative benefit and
19 women ages 25-43 who developed hypertension after prolonged use of oral contraceptives (3-8 years) were studied at Ain Shams University (Cairo) between 1966 and 1969. All patients complained of paresthesia and burning pain in the hands... more
19 women ages 25-43 who developed hypertension after prolonged use of oral contraceptives (3-8 years) were studied at Ain Shams University (Cairo) between 1966 and 1969. All patients complained of paresthesia and burning pain in the hands of a median nerve distribution. 17 patients became mormotensive when the pill was discontinued. All patients displayed symptoms of carpal tunnel syndrome and many showed evidence of salt and fluid retention. Salt retention was felt to be of prime importance and causally related to the estrogen component of oral contraceptives.
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A case of unilateral renal dysplasia was diagnosed in utero using realtime scanning. The diagnosis was confirmed neonatally and the affected kidney was surgically removed. Pathologic findings were consistent with the features of this... more
A case of unilateral renal dysplasia was diagnosed in utero using realtime scanning. The diagnosis was confirmed neonatally and the affected kidney was surgically removed. Pathologic findings were consistent with the features of this malformation. The echographic characteristics of renal dysplasia and the differential diagnosis are described. The potential uses of ultrasonography in the diagnosis and follow-up of pregnancies associated with or at risk of renal malformations are discussed.
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The cardiovascular effects of ritodrine tocolytic therapy were assessed by noninvasive simultaneous recordings of indirect carotid pulse, electrocardiogram (ECG), phonocardiogram, and M-mode echocardiogram in 12 patients in preterm labor.... more
The cardiovascular effects of ritodrine tocolytic therapy were assessed by noninvasive simultaneous recordings of indirect carotid pulse, electrocardiogram (ECG), phonocardiogram, and M-mode echocardiogram in 12 patients in preterm labor. The study was performed before and during infusion, and afterward when the patient was on oral drug therapy. Ritodrine therapy increased heart rate, left ventricular fractional shortening, pre-ejection period/left ventricular ejection time ratio, and cardiac index. A progressive rise in pulmonary capillary pressure was observed in all patients, exceeding 18 mmHg (the threshold for the development of pulmonary congestion) in six patients. Systolic arterial pressure, left ventricular end-diastolic dimension, and plasma protein oncotic pressure remained unchanged during therapy. Ritodrine therapy resulted in a significant drop in diastolic blood pressure and peripheral vascular resistance. This noninvasive means of measuring cardiovascular parameters, including pulmonary capillary pressure, may be useful in monitoring patients who develop significant cardiovascular side effects during tocolytic therapy.
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62 patients using oral contraceptives of various types (average of 45.2 cycles) were diagnosed as suffering from the carpal tunnel syndrome (numbness and tingling of the hands along the median nerve) without any other apparent... more
62 patients using oral contraceptives of various types (average of 45.2 cycles) were diagnosed as suffering from the carpal tunnel syndrome (numbness and tingling of the hands along the median nerve) without any other apparent physiological aberation to account for the condition. After ceasing use of the contraceptives all patients improved except that the thenar muscle atrophy found in 16 of the patients continued. 15 patients who re-commenced use of oral contraceptives against medical advice showed signs of renewed exacerbation of the syndrome. Estrogens effect on fluid retention appears to be the cause for this development. It is concluded that patients showing fluid retention tendencies after prolonged oral contraceptive use will be very susceptible to the carpal tunnel syndrome and lower-dose progesterone contraceptive formulas should therefore be sought.
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Defects in the central nervous system (CNS) are the most devastating of the various fetal malformations that can be sonographically diagnosed. The sonographer often initiates a decision-making process that presents the patient with... more
Defects in the central nervous system (CNS) are the most devastating of the various fetal malformations that can be sonographically diagnosed. The sonographer often initiates a decision-making process that presents the patient with difficult options. An accurate and reliable sonographic diagnosis becomes an essential part of this evolving aspect of obstetric care. In this paper, some of the major defects of the CNS that have been diagnosed sonographically are presented with a brief outline of the pathologic features, diagnostic features, the prognosis, as well as management options. Most of these malformations are serious enough so that termination of pregnancy is usually offered if the diagnosis is made prior to the age of viability and, for some malformations (ie, hydranencephaly, alobar holoprosencephaly), even later. Intrauterine treatment, principally ventriculoamniotic shunting, remains an investigational procedure. A diagnosis of a serious or lethal malformation allows the ob...
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IN AN ERA of organ transplantation, the conceptus is looked upon as Nature's successful allogenic graft. Implantation of the growing ovum with establishment of an adequate blood supply appears to be the most difficult stage in the... more
IN AN ERA of organ transplantation, the conceptus is looked upon as Nature's successful allogenic graft. Implantation of the growing ovum with establishment of an adequate blood supply appears to be the most difficult stage in the retention of the fetal homograft. Abortion in the early weeks of gestation perhaps reflects, in the majority of cases, an immunologic rejection system. Similarly, delivery could be regarded as a timed rejection reaction. Serum complement is known to show specific changes during organ transplantation. It has been shown that, in man, the rejection of a renal transplant is monitored by a drop of the serum complement level. We thought that a study directed to the determination of complement values during the various stages of normal pregnancy may throw some light on the immunologic problems of pregnancy.
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The effect of oral contraception on blood pressure was studied in women attneding a family clinic in Cairo UAR. The blood pressure was recorded serially in 110 women on 3 types of contraceptive pills during a period of 6 months. 50 women... more
The effect of oral contraception on blood pressure was studied in women attneding a family clinic in Cairo UAR. The blood pressure was recorded serially in 110 women on 3 types of contraceptive pills during a period of 6 months. 50 women were using SH 840 (ethinyl nortestosterone acetate 1 mg + ethinyl estradiol .05 mg) 33 women were using Lyndiol 1 (lynestrenol 1 mg. + mestranol .1 mg) and 27 were using Eugynon (norgestrel .5 mg + ethinyl estradiol .05 mg). For control there were 100 women fitted with IUDs. The mean blood pressure at the end of 6 months was slightly lower than the pretreatment levels in women on oral contraceptives. However many patients disclosed a tendency to develop hypertension by isolated elevated blood pressure readings. Most of the elevations occurred in the first 3 months. Sodium and fluid retention is thought to play an important role in the pathogenesis of this oral contraception-related hypertension. It is concluded that hypertension should be considered a contraindication to the use or continued use of the pill.
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Seven suprarenal biopsies were obtained accidentally from both pre-eclamptic and eclamptic patients. The essential lesions found were focal hemorrhages and necrosis. Similar lesions had. been previously described in the suprarenals in... more
Seven suprarenal biopsies were obtained accidentally from both pre-eclamptic and eclamptic patients. The essential lesions found were focal hemorrhages and necrosis. Similar lesions had. been previously described in the suprarenals in eclampsia in postmortem material, but not in pre-eclampsia. This proves the similar pathogenetic mechanism. It has also been shown that these lesions are reversible in those patients who recover after delivery. The possible pathogenesis of these lesions is discussed.
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Guillimeau was the first to use the term cesarean section (CS) in 1598, but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be... more
Guillimeau was the first to use the term cesarean section (CS) in 1598, but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be performed in all cultures dating to ancient times. In the past, it was mainly done to deliver a live baby from a dead mother, hence the name postmortem CS (PMCS). Many heroes are reported to have been delivered this way. Old Jewish sacred books have made references to abdominal delivery. It was especially encouraged and often mandated in Catholicism. There is evidence that the operation was done in Muslim countries in the middle ages. Islamic rulings support the performance of PMCS. Now that most maternal deaths occur in the hospital, perimortem CS (PRMCS) is recommended for the delivery of a fetus after 24 weeks from a pregnant woman with cardiac arrest. It is believed that emergent delivery within four minutes of initiation of cardiopulmonary resuscitatio...
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Fetal malformations complicate approximately 3% of all pregnancies. Many of these are minor or can be corrected after birth, but there are certain malformations that are lethal and others that are severe and others, that, even if... more
Fetal malformations complicate approximately 3% of all pregnancies. Many of these are minor or can be corrected after birth, but there are certain malformations that are lethal and others that are severe and others, that, even if corrected lead to permanent disability. Advances in prenatal diagnosis made possible the diagnosis of many fetal malformations. This led to the concept of the fetus a patient, independent of the pregnant woman, even though the moral status of the fetus is in dispute. Many of the lethal malformations are untreatable. However, for some, innovative in utero treatments, both medical and surgical, became possible. These interventions should be evaluated for the relative benefit and risk for both the fetus and the mother, because any such treatment has to involve the integrity of her body. This raises the ethical question of beneficence (to the fetus) versus the autonomy of the pregnant woman. The process of resolving this issue will be discussed, especially how ...