Publications by authors named "Mohamed Momtaz"

9 Publications

  • Page 1 of 1

The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders.

Arch Gynecol Obstet 2020 11 1;302(5):1143-1150. Epub 2020 Aug 1.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

Purpose: To assess the value of various grey-scale ultrasound, 2D color Doppler, and 3D power Doppler sonographic markers in predicting major intraoperative blood loss during planned cesarean hysterectomy for cases diagnosed with placenta accreta spectrum (PAS) disorders.

Methods: 50 women diagnosed with PAS were scanned the day before planned delivery and hysterectomy for various sonographic markers indicative of placental invasion. These women were then later divided according to blood loss in two groups: group A (minor hemorrhage, < 2500 ml), and group B (major hemorrhage, > 2500 ml), and the data were analyzed.

Results: The odds ratio (OR) for major hemorrhage was as follows for the following sonographic markers: 'number of lacunae > 4' OR 3.8 95% CI (1.0-13.8) (p = 0.047); 'subplacental hypervascularity' OR 10.8 95% CI (1.2-98.0) (p = 0.035); 'tortuous vascularity with 'chaotic branching' OR 10.8 95%CI (1.2-98.0) (p = 0.035); 'numerous coherent vessels involving the serosa-bladder interface OR 14.6 95% CI (2.7-80.5) (p = 0.002); and 'presence of bridging vessels OR 2.9 95% CI (1.4-6.9) (p = 0.005). Only the presence of numerous coherent vessels involving the bladder-serosal interface (p = 0.002) was proven to be independent predictor of major hemorrhage during hysterectomy.

Conclusion: The use of 2D color Doppler and 3D power Doppler can help predict massive hemorrhage in cases of PAS disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-020-05707-yDOI Listing
November 2020

Diagnostic value of the International Ovarian Tumor Analysis (IOTA) simple rules versus pattern recognition to differentiate between malignant and benign ovarian masses.

Int J Gynaecol Obstet 2019 Dec 26;147(3):344-349. Epub 2019 Sep 26.

Department of Obstetrics and Gynecology, Cairo University, Giza, Egypt.

Objective: To compare the efficacy of the International Ovarian Tumor Analysis (IOTA) simple rules versus pattern recognition to differentiate between benign and malignant ovarian masses.

Methods: A prospective cross-sectional study conducted at Kasr El Aini Hospital, Cairo, between April 2016 and October 2018 of 396 women with ovarian masses measuring more than 5 cm who were candidates for surgery. All patients underwent two-dimensional transvaginal sonography: level 2 with IOTA simple rules followed by level 3 with pattern recognition. Patients subsequently underwent ovarian cystectomy or oophorectomy and the specimens were examined histopathologically. Accuracy was measured by comparing sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Results: IOTA simple rules specified 44/50 cases as malignant and 220/242 as benign (sensitivity and specificity of 88.0% and 90.9%, respectively). Pattern recognition identified 83/94 cases as malignant and 281/302 as benign (sensitivity and specificity of 88.3% and 92.7%, respectively). No statistically significant difference in accuracy was found between the two methods.

Conclusion: IOTA simple rules are an effective tool for detecting ovarian malignancy when performed by nonexpert sonographers. When results are inconclusive, pattern recognition should be performed additionally by an expert sonographer.

Clinical Trials Registration: NCT02800031.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.12970DOI Listing
December 2019

Fetal heart examination at the time of 13 weeks scan: a 5 years' prospective study.

J Perinat Med 2019 Oct;47(8):871-878

Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt.

Objective To evaluate our ability in classifying the fetal heart as normal or abnormal during the 1st trimester scan through fetal cardiac examination and determining the best time for this examination. Methods This was a prospective study performed on 3240 pregnant women to examine the fetal heart. Four chambers view and ventricular outflow tracts were mainly examined during the scan. We used grayscale and color mapping in the diagnosis. Color Doppler was used if additional information was needed, and all patients were rescanned during the 2nd trimester to confirm or negate our diagnosis. Results The cardiac findings were normal at both scans in 3108 pregnancies. The same cardiac abnormality was detected at both scans in 79 cases. In 36 cases there was false-positive diagnosis at the early scan; in 20 of these cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 17 fetuses, there was discordance between the early and later diagnosis due to missed or incorrect diagnoses. The best time to do fetal heart examination during 1st trimester is between 13 and 13 + 6 weeks. Conclusion A high degree of accuracy in the identification of congenital heart disease (CHD) can be achieved by a 1st trimester fetal echocardiography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2019-0222DOI Listing
October 2019

Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt.

Arch Gynecol Obstet 2019 03 4;299(3):695-702. Epub 2019 Jan 4.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

Purpose: To evaluate the effect of a modified type II radical hysterectomy on maternal morbidities and mortality in cases with abnormally invasive placenta (AIP).

Methods: 63 cases with AIP were managed at one of the largest referral centers in Egypt in a prospective study design. This technique entails devascularization of the uterus laterally on both sides and to clamp the uterus at the lowest possible point just below the level of the placenta while sparing the ureters.

Results: The difference between pre- and post-operative hemoglobin was only about 1 gm/dl, and the mean blood loss was 1673 ± 958 ml. There was a significant drop in the post-operative need for blood and blood product replacement, packed red blood cells (p = 0.013), fresh red blood cells (p < 0.001), and plasma units (p = 0.012). Operative time (skin to skin) averaged 190 ± 58.2 min as the technique is slow and utilizes meticulous hemostatic steps. ICU admission was 4.8% with a mean total hospital stay of 8.6 ± 3.6 days. Histopathological examination revealed 58 cases of placenta increta and five percreta cases. We also had 16 bladder injuries (25.4%) and two ureteric injuries, and no maternal mortalities.

Conclusion: This technique reduces maternal morbidity and mortality while performing cesarean hysterectomy for cases with AIP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-018-5027-7DOI Listing
March 2019

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor.

Am J Obstet Gynecol 2019 02 12;220(2):189.e1-189.e8. Epub 2018 Oct 12.

Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy. Electronic address:

Background: The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed.

Objective: The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor.

Study Design: Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary-level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed.

Results: In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r = -0.230, P = .021) and active second stage (r = -0.338, P = .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 ± 56 vs 28 ± 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158-3.752; P = .014). There was no significant difference between women who underwent operative delivery (n = 46) when compared with the spontaneous vaginal delivery group (n = 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P = .49).

Conclusion: Levator ani coactivation is associated with a longer active second stage of labor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2018.10.013DOI Listing
February 2019

Therapeutic Plasma Exchange Outcomes in Cairo University Hospitals: 6 Years Experience.

Ther Apher Dial 2018 Dec 15;22(6):666-673. Epub 2018 Jul 15.

Department of Internal Medicine, Nephrology Unit, Cairo University Hospital, Cairo, Egypt.

Therapeutic plasma exchange is used in treating different immunological and non-immunological diseases. We analyzed the outcome of 308 patients treated by 1783 membrane plasma exchange sessions from January 2011 until January 2017 at Cairo University Hospital. Thrombotic microangiopathies were the commonest indication [73 (23.7%) patients] with response in 63/73 patients (86.3%), followed by systemic vasculitis with pulmonary-renal involvement [40(13%) patients] with recovery in 32/40 patients (80.0%), Guillain-Barré syndrome [39(12.7%) patients] with recovery in 30/39 patients (76.9%), myasthenia gravis [31(10.1%) patients] with response in 26/31 patients (83.9%), and catastrophic antiphospholipid syndrome [28(9.1%) patients] with recovery in only 6/28 patients (21.4%). Complications included hypotension [276/1783 (15.5%) sessions], hypocalcemia [26/308 (8.5%) patients], and 37/308 (12%) patients died. Sepsis caused mortality in 29/37 (78.4%) of patients. In conclusion, our therapeutic plasma exchange experience shows a favorable outcome for thrombotic microangiopathies, systemic vasculitis, myasthenia gravis, and Guillain-Barré syndrome. Sepsis was the leading mortality cause.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1744-9987.12710DOI Listing
December 2018

The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial.

J Matern Fetal Neonatal Med 2019 Oct 25;32(20):3386-3392. Epub 2018 Apr 25.

a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt.

To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group ( = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group ( = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, value .83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, value .001) varied significantly between the two groups. Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2018.1463986DOI Listing
October 2019

Would gestational age and presence of brain anomalies affect interobserver reliability of fetal head biometry? Using off-line analysis of 3-D dataset.

Ultrasound Med Biol 2012 Jan 21;38(1):69-74. Epub 2011 Nov 21.

Fetal and Maternal Medicine Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.

The objective was to assess interobserver reliability of fetal head biometry using archived three-dimensional (3-D) volumes and the impact of gestational age and presence of brain anomalies on examiners' performance. Seventy nine 3-D volume datasets of fetal head were examined: 27 were normal and 52 had brain abnormalities. Off-line analysis was done by three fetal medicine experts (E1, E2 and E2), all were blinded to history and patient details. Measurements of the biparietal diameter (BPD), head circumference (HC), lateral ventricle (Vp) and transcerebellar diameter (TCD) were compared between examiners and to two-dimensional (2-D) measurements. Comparisons were made at two gestational age groups (≤22 and >22 weeks) and in presence and absence of brain anomalies. The intraclass coefficient showed a significantly high level of measurement agreement between 3-D examiners and 2-D, with values >0.9 throughout (p < 0.001). Bias was evident between 3-D examiners. E2 produced smaller measurements. The mean percentage difference between this examiner and the other two in BPD, HC, Vp and TCD measurements was significant, of 1.6%, 1%, 4.9% and 1.8%, respectively. E1 measured statistically larger for HC and TCD. E3 measured significantly larger for only BPD. The presence of anomalies was of no influence on the 3-D examiners' performance except for E3 who showed bias in BPD measurements only in cases with brain anomalies. Unlike other examiners, bias of E2 was only seen at gestational age group ≤22 weeks. Limits of agreement in measurements between observers were narrow for all parameters but were widest for the Vp measurements, being ±23% of the mean difference. Despite the above bias, the actual mean difference between examiners was small and unlikely to be of any clinical significance. Off-line measurement of fetal head biometry using 3-D volumes is reliable. In our study, presence of brain anomalies was unlikely to influence the reproducibility of measurements. Gestational age seemed to be of an impact on examiners' bias. Among experts this bias may be of no clinical significance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultrasmedbio.2011.10.016DOI Listing
January 2012

Correlations of urinary biomarkers, TNF-like weak inducer of apoptosis (TWEAK), osteoprotegerin (OPG), monocyte chemoattractant protein-1 (MCP-1), and IL-8 with lupus nephritis.

J Clin Immunol 2011 Oct 21;31(5):848-56. Epub 2011 Jun 21.

Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: This case-controlled study was designed to correlate urinary biomarkers, TNF-like weak inducer of apoptosis (TWEAK), osteoprotegerin (OPG), monocyte chemoattractant protein-1 (MCP-1), and interleukin-8 (IL-8) levels, with renal involvement in a cohort of systemic lupus erythematosus (SLE) patients to examine their diagnostic performance.

Patients And Methods: In 73 SLE patients, and in 23 healthy volunteers, urinary levels of TWEAK, OPG, MCP-1, and IL-8 levels were measured. Disease activity was assessed by total SLE disease activity index, and renal activity by renal activity index (rSLEDAI), and both were correlated with urinary biomarkers. Sensitivity, specificity, and predictive values of individual biomarkers to predict lupus nephritis were also calculated.

Results: Significantly higher levels of urinary biomarkers were observed in SLE patients with lupus nephritis (LN) compared with those without LN (TWEAK, p < 0.001; MCP-1, p < 0.001; OPG, p < 0.001; IL-8, p < 0.032). Other significantly higher levels were observed in SLE patients with LN compared with control subjects (TWEAK, MCP-1, OPG, and IL-8 p < 0.001). Positive correlations were observed between rSLEDAI and TWEAK (r = 0.612 and p < 0.001), MCP-1 (r = 0.635 and p < 0.001), and OPG (r = 0.505 and p < 0.001).

Conclusions: Urinary levels of TWEAK, OPG, and MCP-1 positively correlate with renal involvement as assessed by rSLEDAI with reasonable sensitivity, specificity, and predictive values to detect lupus nephritis while IL-8 was not significantly associated with global or rSLEDAI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10875-011-9555-1DOI Listing
October 2011