Print ISSN: 0027-1446

Online ISSN: 2309-6217

Keywords : Pregnancy

Assessment of cardiac hemodynamic changes during pregnancy in normal and hypertensive women

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 9-17
DOI: 10.33899/mmed.2018.160007

Background: The hypertensive disorders of pregnancy (HDP) are the most common complication of pregnancy and are major cause of maternal and perinatal morbidity and mortality. Hypertension in pregnancy complicates about 10 % of all pregnancies worldwide.
Objective: This study aims to compare the hemodynamics of healthy pregnant women with hemodynamics of pregnant women with gestational hypertension (GH) or preeclampsia (PE).
Methods: A total of (120) women were included in this study; their ages range from (17 to 42) years; classified as follows: (60) normotensive pregnant women and (60) pregnant women with GH or PE. 2nd group is subdivided into: (30) hypertensive pregnant women who take antihypertensive treatment (methyldopa) and (30) those without antihypertensive medications. All women subjected to echocardiographic examination by experience specialist.
Results: Compared with healthy pregnant women, untreated pregnant women with GH or PE were associated with increase mean arterial pressure (MAP) (82.81±9.083 mm Hg vs. 113.66±7.327 mm Hg, p ˂ 0.001), increase total peripheral vascular resistance (TPR) (1379.01±425.65 vs. 1733.99 ± 396.97, p˂0.001), increased cardiac output (CO) (5.01 ± 1.100 L / min vs. 5.55 ±1.42 L/min, p = 0.04), increased ejection fraction (EF) (64.9 ± 4.9 % vs. 67.4± 6.561%, p=0.04) and fractional shortening (FS) (34.76±3.492% vs. 37.34±4.21%, p = 0.003), increased left ventricular mass (LVM) (136.41±29.22 gm vs. 174.16±41.04 gm, p˂0.001) and decreased ratio of peak velocity of early transmitral flow to late transmitral flow (E/A ratio) (1.39±0.166 vs. 1.30±0.19, p=0.02).
The hypertensive pregnant patients treated with methyldopa; compared to non-treated group; showed a significant decreased in MAP (99.91±13.874 mm Hg vs. 113.66±7.325 mm Hg, p˂ 0.001, decreased TPR (1534.58 ± 349.47 vs. 1733.99 ± 396.97, p= 0.04), decreased EF (63.7±4.621% vs. 67.4±6.561%, p=0.014), decreased LVM (153.087±33.778 gm vs. 174.16±41.04 gm, p=0.03) and significant increase in E/A ratio (1.444±0.262 vs. 1.306±0.190, p=0.02).
Conclusion: Pregnant women with PE or GH have evidence of hemodynamic changes that justify routine echocardiographic assessment even in the absence of cardiac symptoms.


Histopathological changes of decidua and decidualvessels of early pregnancy

Noel S. Al-Sakkal; Rana A. Azooz

Annals of the College of Medicine, Mosul, Volume 35, Issue 1, Pages 37-41
DOI: 10.33899/mmed.2009.8896

ABSTRACTObjective: The histological examination of the decidua can provide a clue in the diagnosis of intrauterine pregnancy. The purpose of this study is to describe the morphologic features observed in the decidual blood vessels of early pregnancy loss cases prior to 20 weeks gestation, and to compare these findings with Arias-Stella reaction and with changes found in endometrial biopsies of non-pregnant women as a control group.Material and method: A prospective case control study done at the Department of Pathology of Mosul Medical College, Histopathological Laboratories of Al-Khansa and Al-Zahrawi Teaching Hospitals and the gynecological units of Al-Khansa and Al- Batool Teaching Hospitals in Mosul. The study was conducted on 161 reproductive aged women with different clinical types of abortion admitted for uterine evacuation. The histopathological features in the decidua and decidual vessels of curettage specimens were described, graded and compared with that observed in endometrial biopsies of non pregnant women as a control group. Results: Out of a total 161 abortion specimens examined,10.6% of cases showed severe degree of obliterative endarteritis involving one or more decidual vessels. This finding was higher than the frequency of Arias-Stella reaction in the same specimens and none of these features were described in the control group . Conclusion: Obliterative endarteritis of decidual vessels can be used together with other morphological features for the possibility of occurrence of a pregnancy in the absence of chorionic villi, trophoblast and other emberyonic elements.

Popular health beliefs: Old wives tales about pregnancy and its outcome in Mosul city.

Asma A. AL-Jawadi; Nuha Hachim; Dhafer B. AL-Youzbaki

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 42-50
DOI: 10.33899/mmed.2007.8836

Background: Searching of popular health beliefs carries many benefits to the whole health process and any physician wants to function effectively in his community must be aware, socially, about these important popular beliefs about health and illness that may manipulate any treatment or preventive health plan. This work was conducted to evaluate the most important popular health beliefs related to pregnancy and its outcome. Methods: A cross sectional design was used in this work. From the sociological point of view, it is a qualitative research, using a consecutive sample of women attendants at a primary health care centers for the period from. 1st. October 2006 to 1st. February 2007.Assessment of the popular health beliefs about pregnancy regarding nutrition, hygiene, physical activity, dressing, utilization of medical services during pregnancy, deliveries, breast feeding, and sexual activities throughout the pregnancy was carried out by the use of especially designed questionnaire. All the information were gathered from women more than 40 years old, who have children and living in Mosul city since 30 years. Results: Most of the participants in this study agreed about the importance of organ and red meats, milk, vegetables and fruits during pregnancy (99%, 97%, 95%, and 94% respectively). A lower proportion agreed about the usefulness of vitamins (63%), iron tablets (61%) and white meats (61%). Sufficient numbers (71%) regarded bathing as a healthy practice during pregnancy as well as tooth brushing (68%) and hand washing (92%). Only 36% went with walking for the pregnant women, 96% were against aerobics and also against running. More than two thirds (77%) supported vaccination, all refused exposure to X-ray and 90% also refused non-prescribed medication. The majority (91%) agreed about the importance of hospital deliveries and three quarters (75%) disagreed about untrained dia as a birth attendant. Fortunately, 83% were agreed about giving the colostrums to the new born directly after delivery. A dangerous proportion (18%) of mothers was assured about the benefits of application ash of dung or dung on the umbilical stump. Breast feeding got support from 84% while, 60% agreed about 3 weeks and more as a rest period after delivery. Conclusion: Many popular health beliefs regarding pregnancy in Mosul city go in agreement with the scientific health facts and theories that should be reinforced and supported. Moreover, the very hazardous popular health belief that ash of dung or dung may be applied to the umbilical stumps of the newly born babies, still needs an intensive intervention health educational program.