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Article
Study of Lipid Profile in Patients with Uterine Fibroid

Author: Lilyan W. Sersam
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 2 Pages: 274-279
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Leiomyomas are the most common gynaecological neoplasms. Despite the major public health impact of leiomyomas, little is known about their cause. As fibroids are hormone-dependent tumours and their development can be promoted by estrogens, an inverse association between hypercholesterolemia and fibroids should be observed as well as direct association between high-density lipoprotein cholesterol (HDL-C) levels and the presence of fibroids.OBJECTIVE:To investigate the lipid profile in patients with uterine fibroids and to compare it with the lipid profile of women without fibroids.METHODS:A case-control study was conducted in the Department of Obstetrics and Gynaecology at Al-Yarmouk Teaching Hospital during the period from May 2008 to May 2009. Participants were one-hundred twenty pre-menopausal women aged between 18 and 45 years who were recruited during their visit to the gynaecological outpatient clinic and were not taking hormonal therapy. Cases consisted of 60 women with uterine fibroids, and controls were 60 women visiting the same gynaecological outpatient clinic for routine reasons. Thorough history and examination was done for each participant. Body Mass Index (BMI) was measured in kg/m2. All patients underwent a baseline ultrasound examination and classified into two groups according to the presence or absence of uterine fibroids. All women where scheduled to undergo blood test at the beginning (2nd -5th day) of their next menstrual cycle. Fasting venous blood glucose and lipid profile were determined in blood samples taken for each patient. Atherogenic index was also calculated.RESULTS:Women with uterine fibroids were found to have significantly higher levels of serum HDL-C compared to the controls (P=0.0001). A significantly lower levels of total serum cholesterol, low-density lipoprotein cholesterol (LDL-C) were also found in women with uterine fibroids compared to the controls (P=0.0001). Atherogenic index was significantly lower in fibroid group compared with controls (P=0.0001). There was a significant positive correlation between largest fibroid volume and HDL-C level (P<0.0001).CONCLUSION:Women with uterine fibroid have lower atherogenic index compared to women without uterine fibroid. Larger volume of fibroid is associated with higher level of HDL-C.


Article
Diagnostic Efficacy of Transvaginal Colour Doppler Sonography in Ectopic Pregnancy

Author: Lilyan W. Sersam
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 63-70
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Ectopic pregnancy continues to be a major cause of maternal morbidity and mortality . A dramatic increase in incidence over time has been reported in several countries. The advent and wide application of ultrasound has greately improved the possibility of non- surgical diagnosis of ectopic pregnancy . Images obtained by the higher frequency and better resolution transvaginal ultrasound scan (TVS) probes facilitates the earlier diagnosis of ectopic pregnancy. The addition of Doppler ultrasound have revolutionised the non-invasive diagnosis of ectopic pregnancy.METHODS:Patients presenting to Al-Yarmouk Teaching Hospital with clinical suspicion of ectopic pregnancy were evaluated using TVUS. Colour flow imaging was performed and resistance indices (RIs) of the artery blood flow were calculated . The pulsatility indices (PIs) of both uterine arteries were also measured and serum β-hCG was quantitated . The Doppler flow results were correlated with surgical findings at laparoscopy or explorative laparotomy .RESULTS:Forty-seven women were enrolled .Six patients with intrauterine gestation were excluded . Tubal pregnancy was diagnosed by TVUS in 28 of 32 patients with ectopic pregnancy, while 30 of 32 patients were diagnosed by colour Doppler sonography. Colour flow in the trophoblastic tissue was detected in 59.3% of the tubal pregnancies, and the mean (±SD) RI of the trophoblastic flow was (0.49 ±0.1) . The RIs tended to decrease at higher β- hCG levels. The average PI of the uterine arteries was (2.29 ± 0.3) . The PIs of the ipsilateral uterine arteries were significantly lower than the contralateral ones. The sensitivity of colour Doppler in the diagnosis of ectopic pregnancy was (93.8%) with accuracy of (85.4%)CONCLUSION:Colour imaging is a good supplementary diagnostic tool in modern management of ectopic pregnancy . The addition of colour Doppler flow imaging to transvaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.


Article
The Value of Transvaginal Sonography Performed before Diagnostic Hysteroscopy for the Evaluation of Uterine Cavity in Infertile Women

Author: Lilyan W. Sersam
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 4 Pages: 276-285
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Hysteroscopy have gained general acceptance as a method for the investigation of infertility. The main advantage of hysteroscopy is the capability of inspecting the uterine cavity. Transvaginal sonography (TVS) is a noninvasive modality that provide excellent imaging of the uterus and of endometrial abnormalities. The present study was designed to evaluate the use of TVS as the initial diagnostic procedure before hysteroscopy for detecting intrauterine disorders.METHODS:Seventy-eight infertile women were examined by TVS and diagnostic hysteroscopy in the late follicular phase of the menstrual cycle and the results were compared.RESULTS:The uterine cavity abnormalities were present in 19.2% of the infertile females involved in the study. The Transvaginal sonography had 87.5% sensitivity, 100% specificity for detecting endometrial polyps while it had 100% sensitivity and 100% specificity for detecting other intrauterine cavity abnormalities including intrauterine adhesions, uterine septae and submucosal myomas.CONCLUSION:Examination of the uterine cavity is an integral part of any thorough evaluation of an infertile woman. Transvaginal sonography, when performed during the follicular phase, can detect most uterine cavity abnormalities. It was an accurate tool in the identification of intrauterine adhesions, uterine septae and submucosal fibroids.


Article
Ultrasonographically Observed Grade III Placenta at 36 Weeks’ Gestation: Maternal and Fetal Outcomes

Author: Lilyan W. Sersam
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 1 Pages: 67-72
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Current ultrasound assessment of placental calcification relies on Grannum grading. The ultrasonographic appearance of grade III placental maturation, if it occurs before 37 weeks, may signify placental dysfunction and is found to be associated with development of pre-eclampsia and low birth weight.OBJECTIVE:To look at the prevalence of a grade III placenta at 36 weeks’ gestation in a low-risk obstetric population, and to explore the association between premature aging observed ultrasonographically and pregnancy outcome.METHODS:Scans were performed at 36 weeks’ gestation in 591 low-risk pregnant women to determine placental maturity. The prevalence of grade III placenta at 36 weeks’ gestation was determined. Follow-up was performed for the group of women demonstrating a grade III placenta in comparison to those not demonstrating a grade III placenta for determining pregnancy outcome.RESULTS:The prevalence of grade III placenta at 36 weeks’ gestation was 3.9%. A grade III placenta at 36 weeks’ gestation was significantly associated with young maternal age P = 0.01. The Grannum grade III of the placenta at 36 weeks’ gestation was statistically associated with increased risk for development of proteinuric pregnancy-induced hypertention (PIH) later in pregnancy (RR 4.94; 95% CI 1.15-21.26), P = 0.021. Women demonstrating a grade III placenta at 36 weeks’ gestation had a significant high risk of induction of labour for suspected fetal compromise (RR 4.7; 95% CI 1.76-12.59), P = 0.001. The risk for delivering a baby with a weight <10th centile at birth was significantly higher in women with grade III placentas in comparison to those with grades 0-II (RR 3.19; 95% CI 1.23-8.27), P = 0.017.CONCLUSION:In a low-risk obstetric population, ultrasound detection of Grannum grade III placenta at 36 weeks’ gestation helps to identify at risk pregnancy. It appears to predict subsequent development of proteinuric PIH and may help in identifying the growth-restricted baby

Keywords

ultrasound --- grade III --- placenta --- outcomes


Article
Extended Clomiphene Citrate (CC) and Prednisone for the Treatment of Clomiphene-Resistant Anovulatory Women with the Polycystic Ovary Syndrome (PCOS)
الاستخدام المطوّل للكلومفين ستريت والبردنيسون في علاج عدم الاباضة المقاوم لاستخدام الكلومفين وحده في المريضات المصابات بمتلازمة تكيس المبيض المتعدد

Author: Lilyan W. Sersam د. ليليان وديع سرسم
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2005 Volume: 18 Issue: 2 Pages: 173-176
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractObjective: To evaluate the effectiveness of a regimen of extended clomiphene Citrate (CC) and prednisone for the treatment of clomiphene-resistant polycystic ovary syndrome (PCOS) patients who had failed to ovulate on CC alone.Design: Prospective interventional study.Setting: Department of Obstetrics and Gynaecology/ Al-Yarmouk Teaching Hospital during the period September 2001 through February 2002.Patients & Methods: Twenty-one anovulatory (PCOS) patients who failed to ovulate after clomiphene citrate (CC) treatment administered for 5 days. Treatment consisted of CC, 100 mg, given on cycle days 3 through 9 (extended). Additionally, patients were given prednisone 5 mg orally each night throughout the cycle. Ovulation was confirmed by midluteal serum progesterone levels. Pregnancy was confirmed by serum hCG Levels and 7-week gestation ultrasound.Results: A total of 21 patients completed 53 cycles of treatment with extended CC and prednisone (mean, 2.5 cycles; range 1-6 cycles). Sixteen (76%) of 21 patients became ovulatory and 40 (75%) of treatment cycles resulted in ovulation. Eleven of 21 patients, (52%) conceived with this therapy. In the conception group, one ended in spontaneous abortion.Conclusion: The treatment with extended CC and prednisone is an economic, safe and effective alternative treatment for PCOS patients in whom the classical treatment with CC has failed.Keywords: Clomiphene Citrate, Prednisone, Polycystic Ovary Syndrome (PCOS)

ملخــصهدفت الدراسة الى تقييم فعالية الاستخدام المطوّل لدواء الكلومفين ستريت والبردنيسون لعلاج عدم الاباضة المقاوم لاستخدام الكلومفين وحده في المريضات المصابات بمتلازمة تكيس المبيض المتعدد. أجريت هذه الدراسة في فرع النسائية والتوليد/ كلية الطب/ الجامعة المستنصرية/ بغداد – العراق في الفترة الواقعة بين أيلول 2001 وحتى نهاية شباط 2002.شملت هذه الدراسة المستقبلية على احدى وعشرين مريضة انطبقت عليهن الصفات التشخيصية لمتلازمة تكيس المبيض المتعدد واللواتي فشلن سابقا في حدوث الاباضة بعد استعمال دواء الكلومفين وحده.تم اعطاء دواء الكلومفين ستريت (100 ملغم) يومياً ابتداءً من اليوم الثالث وحتى التاسع للدورة الشهرية، مضافاً اليه اعطيت كل مريضة دواء البردنيسون (5 ملغم) كل ليلة وخلال فترة الدورة الشهرية بأكملها.تم قياس مستوى هرمون البروجسترون في مصل الدم لكل مريضة في منتصف النصف الثاني من الدورة الشهرية كمؤشر لحدوث الاباضة كما تم اثبات حصول الحمل بقياس مستوى هرمون الحمل (أج، سي، جي) في مصل الدم لكل مريضة اضافة الى الفحص بالامواج فوق الصوتية.اظهرت النتائج حدوث الاباضة في 76% من المريضات وفي 75% من الدورات العلاجية وان احدى عشرة مريضة من مجموع 21 مشاركة بالدراسة (52%) أصبحن حوامل باستخدام العلاج المذكور.يستنتج من هذه الدراسة الى ان الاستخدام المطوّل لدواء الكلومفين ستريت والبردنيسون هو علاج اقتصادي، آمن ومن البدائل الفعالة في علاج المريضات المصابات بمتلازمة تكيس المبيض المتعدد واللواتي لم يستجبن للعلاج التقليدي بالكلومفين ستريت وحده


Article
Serum CA-125 in Ectopic Pregnancy

Authors: Lilyan W. Sersam --- Rasha Shakir Mahmood
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 3 Pages: 343-350
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: CA-125 is a glycoprotein, its origin is uncertain during pregnancy. It rises during the first trimester andreturns to a non-pregnancy range in late pregnancy. OBJECTIVE: To compare CA-125 levels between tubal ectopic and normal intrauterine pregnancy, and to find it’susefulness in differentiating intact from ruptured tubal ectopic pregnancy. METHODS: This prospective case-control study was carried out on sixty healthy women with single normalintrauterine pregnancy (NIUP) of 6-10 weeks gestation and sixty women with tubal ectopic pregnancyof same gestational age which were further subdivided into twenty-five women with ruptured tubalectopic pregnancy (REP) and thirty-five women with unruptured tubal ectopic pregnancy (UREP). Thelevels of CA-125 were compared between these groups. RESULTS: The mean level of CA-125 in ruptured ectopic pregnancy group was 49.04±33.63 IU/ml and in unruptured ectopic pregnancy group was 24.3±16.89 IU/ml. The mean level of CA-125 in normalpregnant women (control group) was 53.95±31.2 IU/ml. There was a statistically significant differencebetween mean serum CA-125 levels of ruptured ectopic pregnancy and unruptured ectopic pregnancygroup (p< 0.05), also there was a statistically significant difference between mean of CA-125 level ofunruptured ectopic pregnancy group and control group (p <0.05), while there was no statisticallysignificant difference between ruptured ectopic pregnancy group and control group (p > 0.05).CONCLUSION: CA-125 level is significantly elevated in ruptured tubal ectopic pregnancy than the intact tubal ectopicpregnancy, this increase in CA-125 levels can be used as additional test to identify tubal rupture


Article
Leptin Levels in Women with Uterine Leiomyomas

Authors: Lilyan W. Sersam --- Dalia Riad Abd- Almajeed**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 302-308
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Uterine leiomyomas are important, common pathological conditions that impose a major healthcare burden. Leptin, a product of the obese (Ob) gene, is produced predominantly in adipose tissue and expressed in several tissues and organs and in myomas and the surrounding myometrium. OBJECTIVE: To assess serum leptin levels in women with and without uterine leiomyomas.METHODS:This prospective case- control study was carried out on ninety women in their reproductive age. They were divided into two groups; the study group consisted of 45 women with uterine leiomyomas proved by histopathology after operation, and a control group consisting of 45 healthy women without uterine leiomyomas proved by ultrasound examination. Body mass index (BMI) was calculated in all women. Blood samples were collected from all women in both groups in the proliferative phase of their menstrual cycle. Hemoglobin, blood urea nitrogen, serum creatinine, fasting blood sugar and serum leptin levels were examined. Serum leptin levels were determined by Radioimmunoassay and compared in myomatic and normal women.RESULTS: The mean serum leptin levels were significantly lower (p=0.0001) in the myomatic women (7.57± 2.88 ng/mL) than in the normal women (9.56± 1.77 ng/mL). The mean ratios of serum leptin levels / body mass index in the myomatic women (0.267± 0.09) were significantly lower (p=0.0001) than in the normal women (0.34±0.05). In addition, a significant correlation was found between serum leptin levels and body mass index in both the myomatic women (r=0.587, p=0.0001) and the normal women (r=0.608, p=0.0001). CONCLUSION: In myomatic women compared to normal women, the lower serum leptin levels observed were independent of body mass index with no significant up-regulation of leptin production in response to increased adiposity.K


Article
Serum Vitamin D3 Levels in Women with and without Uterine Fibroids

Author: Lilyan W. Sersam*, Shahla Fekri Najeeb **
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 3 Pages: 239-248
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Uterine leiomyomas are the most common benign tumours of the female genital tract. They are a major source of morbidity for women and a frequent indication of gynecological surgery. Understanding the etiology of uterine fibroids remains incomplete. Vitamin D may be an unrecognized risk factor for their development.OBJECTIVE: To assess serum vitamin D3 levels in women with and without uterine fibroids and to identify whether serum vitamin D3 levels correlate with the severity of uterine fibroids disease. METHODS: This prospective case- control study involved 150 women in their premenopausal state who presented at the outpatient gynecology clinic at AL-Yarmook Teaching Hospital, Baghdad-Iraq. They were arranged into two groups; the control group consisted of 75 healthy women without uterine fibroids confirmed by ultrasound examination. The remaining 75 women, had at least one fibroid lesion of 2cm3 in volume or larger confirmed by transvaginal/ transabdominal ultrasound examination, represented the study group. All women enrolled in the study had similar demographic background. For each case woman, total uterine volume, and total volume of all existing fibroids were measured. Serum vitamin D3 levels were measured for all participants by ELISA method. Statistical analysis was performed to compare serum vitamin D3 levels across groups of women with and without uterine fibroids and to assess the correlation of serum vitamin D3 levels with uterine fibroids burden.RESULTS: Serum vitamin D3 levels were significantly (p=0.0001) lower among women with uterine fibroids compared to the control group with a mean value (15.81±8.64) ng/ml in women with uterine fibroid and (34.25±8.07) ng/ml in the control group. A significant negative correlation was found between serum vitamin D3 levels and the increase in number of uterine fibroids (r=-0.623, p=0.0001) and the increase in total uterine fibroids volume (r=-0.742, p=0.0001). CONCLUSION: According to the present study, lower serum vitamin D3 levels are significantly associated with the occurrence of uterine fibroids and serum vitamin D3 levels inversely correlate with both uterine fibroids number and total uterine fibroids volume.


Article
Severe Early– Onset Preeclampsia: Prognostic Role of Uterine Artery Doppler Examination

Authors: Eftekhar Shmkhee Abood --- Shamam Y. Mohammed --- Lilyan W. Sersam
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 1 Pages: 37-43
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Preeclampsia is essentially an endothelial disease. Early- onset preeclampsia appears to be linked mainly to a failed placental vascular remodeling. Uterine artery Doppler is a validated noninvasive surrogate of trophoblastic invasion and placental perfusion.OBJECTIVE: To evaluate the predictive capacity of uterine artery Doppler investigation for maternal and neonatal complications in women with severe early- onset preeclampsia.METHODS: This prospective comparative study was carried out on sixty-five Iraqi pregnant women with severe early-onset preeclampsia. Their gestational age ranged from 28-34 weeks of gestation. A uterine artery Doppler examination was performed on admission to the participants. According to the result of Doppler ultrasound, they were arranged into two main groups: group one comprising twenty-nine patients with normal uterine artery Doppler results, and group two comprising thirty-six patients with abnormal uterine artery Doppler results. The maternal and neonatal outcome of women with abnormal uterine Doppler results was compared to those with normal Doppler results, and then results were analyzed accordingly. RESULTS: Sixty-five patients were enrolled in this study. In 53% of them, uterine artery Doppler results were abnormal. This group showed statistically significant lower birth weight (p = 0.003), higher caesarean section rate (p= 0.014), abnormal umbilical artery Doppler examinations (p=0.0001) and higher neonatal complications rate (P= 0.006). Regarding the maternal complications (HELLP syndrome, neurological manifestations, acute renal failure and pulmonary oedema), occurred at higher rate in the group with abnormal uterine artery Doppler compared with those having normal Doppler results (58.3% versus 37.9%), but only acute renal failure reached the statistical level of significance (P=0.017). CONCLUSION: Women with severe early-onset preeclampsia are at higher risk of maternal and neonatal complications if abnormal uterine blood flow is present. .


Article
Second and Third Trimester Placental Thickness: Correlation with Placental and Birth Weights

Author: Lilyan W. Sersam*, Zena Z. Abdul-Razzak **, Shamam Y. Mohammed ***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 185-193
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:The placenta is a materno-fetal organ; it is closely related to the fetus and the mother, it acts like a mirror, reflecting the statuses of both the mother and the fetus. Placental evaluation by ultrasound has been used to characterize placental morphologic changes as the placenta matures. Using different parameters such as placental thickness, weight, and volume have exhibited significant and positive relationship with gestation and birth weight.OBJECTIVE: To investigate the relationship between placental thickness during the second and third trimesters and placental and birth weight. METHODS: This Prospective Longitudinal study involved pregnant women who presented at Al-Yarmouk Teaching Hospital antenatal clinic. All recruited women were assessed at their 1st trimester visit for baseline demographic and obstetrical data. At the second and third trimesters, maternal weight, weight gain, body mass index, body mass index gain, placental thickness measured by ultrasound, and thickness change were recorded. Statistical analysis was performed to establish the degree of relationship between placental thickness and placental and birth weights. RESULTS: Of 150 recruited participants, 100 women were able to complete the study. The mean maternal age was 32.1±4.2 years. Ultrasonographic measures of placental thickness in the second and third trimesters and thickness changes between them were 2.44±0.57, 3.58±0.59 and 1.14±0.38 cm respectively. Values of mean birth and placental weights were 3433± 350.99, and 457.95±46.82 grams respectively. A significant positive correlation was found between placental thickness and birth weight in the second and third trimesters (r=0.0237, p=0.018, r=0.399, p<0.001) respectively.CONCLUSION: According to the present study, birth weight has a positive correlation with both second and third trimester placental thickness; however, placental thickness change could not predict low or high birth weights.

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