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Biomedical subjects

M Ezimokhai

Publications and source records attributed to M Ezimokhai.

At least 19 recordsLinked to original sources
PubMed2006

Audit of pregnancies complicated by diabetes from one center five years apart with selective versus universal screening.

The article compares the effect of selective and universal screening on detection rate and outcomes of pregnancies complicated by diabetes mellitus (DM) in a multiethnic population. The method used was to review the pregnancy and delivery of two 18-month periods, 5 years apart. In the year 1996-1997 when selective screening was used 315 (5.7%) of 5506 delivered women had diabetes during pregnancy. The rates of diabetes in the different ethnic groups were: UAE (4.4%), Peninsula Arabs (4.0%), Chami Arabs (4.5%), North African Arabs (6.7%), Indian subcontinent (7.5%), and Somalis and Sudanese (9.7%). The rate of diabetes among the different ethnic groups for the year 2001-2002 when screening was universal but diagnosis made by the same criteria were 590 (9.7%) of 6232 delivered women, UAE (9.2%), Peninsula Arabs (8.4%), Chami Arabs (8.2%), North African Arabs (9.6%), Indian Subcontinent (11.0%), Somalis and Sudanese (11.3%). The outcome indicators and their rates in the years 1996-1997 and 2001-2002 were respectively: gestational diabetes, 86.3%, 89.0%; requirement of insulin treatment, 74.3% 82.5%; vaginal delivery, 68.2%, 75.3%; cesarean section, 30.3%, 19.8%; macrosomia, 22.2%, 6.7%; intrauterine fetal death, 2.9%, 1.1%; and preterm delivery, 22.5%, 17.5%. This article confirms the influence of ethnic background on the prevalence of gestational diabetes in a multiethnic and multicultural society. Over a period of 5 years, there was a 66.7% increase in the incidence of gestational diabetes, which was probably due to a combination of increased detection by change in screening policy and an increase in the incidence of gestational diabetes. The indicators of disease severity and control, such as insulin requirement, rates of abdominal delivery, macrosomia, and structural congenital malformations, were significantly better in a cohort identified by universal screening compared with that identified by selective screening. Universal screening seems to be a more appropriate strategy for screening in this environment.

Diabetes Complications↗
PubMed2005

Planned vaginal delivery of term breech remains an option--result of eight years experience at a single centre.

In order to compare the short term outcome of vaginal and abdominal delivery of babies with breech presentation at term at a single centre, a retrospective study of 299 women presenting with singleton normal breech fetuses at term between 1st January 1996 and 31st December 2003, at a tertiary referral centre, was conducted. The rates of perinatal mortality, neonatal mortality, serious neonatal morbidity and low Apgar scores of neonates delivered after either planned vaginal or planned abdominal delivery were compared. Among 299 women with singleton normal breech at term, 32.1% delivered vaginally and 67.9% had C/S. Successful planned vaginal delivery rate was 97.9%. There was no perinatal or neonatal death in either group and no significant difference in the rates of serious perinatal morbidity between the two groups. We concluded that planned vaginal delivery is associated with no significant adverse perinatal outcome and remains an option for selected term breech presentation.

Birth Injuries↗
PubMed2004

Pregnancy-related admissions to the intensive care unit.

We conducted a retrospective review of obstetric patients admitted to the intensive care unit at Al-Ain hospital during period January 1(st) 1997 to December 31(st) 2002, in order to identify the indications for admission and the outcome. A total of 60 patients were admitted during the six years. The frequency of admission was 2.6 per 1000 deliveries and obstetric patients represented 2.4% of all ICU admissions. Admission was planned in 11 patients (18%) and unplanned in 49 (82%). The mean (+/-SD) duration of stay in ICU was 1.6+/-1.5 days. The leading indications for admission were haemorrhage (28.4%) and preeclampsia/eclampsia (25%). Of the 60 admissions, 47 (78.4%) followed surgery. The mean APACHE II score was 5.0+/-3.0. Twenty-two patients (37%) had blood transfusions, and only two (3.3%) required ventilation. Of the 60 patients only 28 (46.7%) were deemed to have severe illness necessitating intensive care; the remaining 32 patients were suitable for high dependency care. The mean APACHE II score and duration of stay were significantly higher in these patients. There were two deaths, representing 3.3% of obstetric intensive care unit admissions. Our findings highlight the need for establishing a high dependency unit to avoid unnecessary admission to the intensive care unit and to ensure proper management.

APACHE↗
PubMed2004

The effect of intermittent maternal fasting on human fetal breathing movements.

In order to determine the effect of maternal fasting on human fetal breathing movements (FBM), 63 healthy pregnant women with singleton uncomplicated pregnancies of 30 weeks' gestation or more, and who were fasting during Ramadan, were recruited. Maternal blood glucose level and fetal movements were recorded during and after fasting. Statistical comparison of samples before and after a meal was made using Wilcoxon's signed-ranks test. Maternal glucose level during fasting (5.1 +/- 0.5 mmol/l) was significantly (P = 0.01) lower than after breakfast (5.3 +/- 1.0 mmol/l). There was a significant association between maternal glucose levels and numbers of days faster (P = 0.01). The time needed to detect breathing movements was significantly longer (P = 0.005) during fasting than postprandial. The continuous variety of fetal breathing movement was significantly (P = 0.02) less during fasting compared to postprandial. It is concluded that intermittent maternal fasting is associated with a significant alteration in the frequency and pattern of human FBM.

Adult↗
PubMed2003

The effect of maternal fasting on the fetal biophysical profile.

OBJECTIVES: To determine fetal biophysical profile changes in women observing Ramadan with uncomplicated singleton pregnancy. METHODS: In this cross-sectional observational study healthy women who were observing Ramadan at 30 weeks or more of gestation were recruited as well as a non-fasting control group matched for age, parity, and gestational age. Ultrasound examination included assessment of amniotic fluid volume, fetal bladder volume, fetal biophysical profile, and umbilical artery Doppler flow. RESULTS: A total of 162 pregnant women were observed. Mean umbilical artery pulsatility index, vertical amniotic pool depth, and fetal bladder volume were similar in the study and control groups. However, there was a significant difference in biophysical scores between the two groups. In the fasting group, 30 of 81 fetuses (37%) had a score of 6/8 compared with 11 of 81 fetuses (13.6%) in the control group (P=0.001). All fetuses in both groups with a biophysical score of 6/8 showed no breathing movements. CONCLUSIONS: Fetal breathing movements are reduced during maternal fasting.

Adult↗
PubMed2001

Obstetric outcome in grand multipara in the United Arab Emirates. A case control study.

OBJECTIVE: To compare the obstetric outcome in grand multiparous and low parous United Arab Emirates women. METHOD: The records of 418 grand multiparous women (study group), defined as having had given birth at least 5 times after completed 22 weeks gestational age, and 418 women of parity 2-4 (control group) were reviewed. RESULTS: Mean parity in the study group was 7.9 +/- 2.4. The number of subjects who attended for antenatal care and the number of visits were equal in both groups. Diabetes mellitus (both overt and gestational) was significantly more common in the study group (p < 0.0001) but there was no significant increase in the incidence of other obstetric complications nor in perinatal mortality rate. Babies of grand multiparous mothers required significantly more admissions to special care unit because of maternal diabetes mellitus (p < 0.0002). CONCLUSION: Diabetes mellitus was more common in grand multiparous United Arab Emirates women but the incidence of other obstetric complications was similar to lower parity women.

Case-Control Studies↗
PubMed2001

Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins.

In populations with a high incidence of gestational diabetes (GDM), any form of oral glucose testing for screening or diagnosis excessively strains the health care system. We investigated the value of glycated proteins as potential screening tests in 430 pregnant women, i.e. protein corrected fructosamine (cFRUC) and hemoglobin A1c (HbA(1c)) both alone and in combination for a GDM diagnosis confirmed by the 'gold standard' 100-g oral glucose tolerance test (OGTT). Two cut-off values were used for each test, the upper to rule in and the lower to rule out GDM. At the lower cut-off values for cFRUC of 210 micromol/l and HbA(1c) of 5%, the sensitivities achieved were 92.2 and 92.1% while the negative predictive values were 88.9 and 86.9%, respectively. The upper cut-off values did not achieve acceptable positive predictive values to be useful for ruling in GDM. Screening of our multiethnic, high-risk pregnant population with a combination of cFRUC and HbA(1c) on a single fasting sample would have avoided the cumbersome OGTT (by ruling out GDM) in 37.9% women with only a 3.9% misclassification rate. This potentially simpler approach, though not universally applicable, would be clinically useful and more acceptable to patients in selected high-risk populations.

Adolescent↗
PubMed2001

Abnormal vascular coiling of the umbilical cord in gestational diabetes mellitus.

The objective of this study was to identify abnormal vascular coiling of the umbilical cord in neonates of mothers with gestational diabetes mellitus. The umbilical cords of 57 neonates of gestational diabetic mothers were examined and the coiling index determined by dividing the total number of complete vascular coils by the length of the cord in centimeters. Obstetric history, delivery data and neonatal outcome were also evaluated. These variables were compared with those obtained for 389 normal pregnancies. The frequency distribution of umbilical coiling index in the control population and gestational diabetic mothers were normal (10th and 90th percentiles = 0.17 and 0.37; mean +/- SD = 0.26 +/- 0.09 and 0.24 +/- 0.12 coils/cm, respectively). Non-coiling and hyper-coiling were significantly more frequent with diabetic than with normal pregnancy (p = 0.004; p = 0.008, respectively). Both abnormalities of umbilical vascular coiling were also significantly associated with adverse perinatal outcome (p = 0.04) and emergency cesarean delivery (p < 0.0001) in the diabetic and control (p = 0.03; p < 0.0001, respectively) groups. Neonates of gestational diabetic mothers are therefore more likely to have hyper-coiled or non-coiled umbilical blood vessels. Perinatal morbidity and emergency cesarean delivery are increased in this subgroup.

Adult↗
PubMed2001

Women's perceptions and experiences of childbirth in United Arab Emirates.

AIMS: To determine women's perceptions and experiences of childbirth in United Arab Emirates [UAE]. METHODS: A consecutive sample of 715 women who delivered during a 3 month period wer interviewed on the third postnatal day about their experience and satisfaction with maternity care using a structured questionnaire. RESULTS: 95 (13.2%) women had negative feelings including fear, anger, sorrow and regret, guilt, jealousy, sense of failure and disappointment while the rest felt that childbirth was enjoyable and that they had been well-informed, especially by nurses, about their perinatal care. Subjects delivered by cesarean (N = 104, 14.5%) were significantly less satisfied with the information provided by their caregivers and their involvement in decision-making before the operation than the vaginal group (p = 0.001). Irrespective of mode of delivery, most participants strongly agreed that cesarean is worse than vaginal delivery whatever the reason and should be performed only for medical reasons. Adverse maternal experiences were significantly more frequent with cesarean delivery (p = 0.00001), older age (p = 0.04), primiparity (p = 0.03), higher education (p = 0.03), lack of antenatal care (p = 0.03) and prolonged labor (p = 0.04). CONCLUSIONS: Childbirth experience and the prevalence and correlates of postnatal psychosocial morbidity in UAE are not different from those observed elsewhere.

Adult↗
PubMed2000

Human chorionic gonadotrophin is an endothelium-independent inhibitor of rat aortic smooth muscle contractility.

The study tested the hypothesis that human chorionic gonadotrophin (hCG) attenuates isolated vascular smooth muscle contractility and investigated the role of the vascular endothelium in hCG-induced altered responses of vascular smooth muscle. The contractile responses of isolated aortic rings from normal, hCG-treated, and estrogen-treated female virgin Wistar rats to phenylephrine, angiotensin II, KCl, and CaCl2 were compared. The effect of pretreatment with N-monomethyl-L-arginine (L-NMMA), methylene blue, indomethacin, calcium-free medium, and de-endothelialization on responses to phenylephrine of aortic rings from control and hCG-treated rats were also examined. Intraperitoneal administration of hCG caused attenuation of contractile responses of isolated aortic rings to all agents. The attenuated responses to phenylephrine were not reversed by de-endothelialization, or pretreatment of the rings with L-NMMA, methylene blue, or indomethacin. It was concluded that hCG attenuates vascular smooth muscle contractility. The effect is independent of the vascular endothelium, not agonist-specific, and appears to involve alterations of calcium availability.

Angiotensin II↗
PubMed2000

Fasting plasma glucose as a screening test for gestational diabetes in a multi-ethnic, high-risk population.

AIMS: Screening every pregnant woman for gestational diabetes mellitus (GDM), as widely recommended for high-incidence populations, strains the healthcare system excessively. This study investigated the value of fasting plasma glucose (FPG) as an alternative to the more cumbersome oral glucose tolerance test (OGTT). METHODS: One thousand six hundred and forty-four pregnant women in a multi-ethnic, high-risk population were evaluated by the FPG as a screening test among two principal subgroups, i.e. women (n = 1276) at risk for GDM on clinical grounds and those women (n = 368) with a positive post 50-g, 1-h plasma glucose challenge test (GCT). Two threshold values for FPG 'ruled in or ruled out' a GDM diagnosis, which was confirmed by the 3-h, 100-g OGTT, using Carpenter's modified criteria as the 'gold standard'. RESULTS: In the women with a positive clinical history, at an optimal cut-off value of FPG < 4.4 mmol/l to rule out GDM; a sensitivity of 94.7% was achieved, 21 (1.6%) women being false negatives. Using a FPG > or = 5.3 mmol/l to rule in GDM; the specificity was 94.0% with 53 (4.2%) women being classified as false positives. FPG would have eliminated need for the OGTT in 50.9% pregnant women (misclassification rate 5.8%). In the positive GCT group, using similar cut-offs for FPG, a sensitivity of 96.6% and specificity of 90.8% was achieved with a potential to avoid 51.6% OGTTs (misclassification rate 7.3%). The positive predictive value of the GCT was 31.8% compared to 80.2% for FPG at 5.3 mmol/l. CONCLUSIONS: While previously neglected as a screening test for GDM, in selected high-risk populations the FPG offers a potentially simple, practical algorithm to screen for GDM by being cost-effective and patient friendly. A wider application should be explored.

Adolescent↗
PubMed2000

Maternal risk factors for abnormal vascular coiling of the umbilical cord.

The objective of this paper is to identify maternal risk factors for abnormal vascular coiling of the umbilical cord. The umbilical cords of 657 neonates were examined and the coiling index determined by dividing the total number of complete vascular coils by the length of the cord in cm. Obstetrical history, delivery data, and neonatal outcome were also evaluated. The frequency distribution of umbilical coiling index was normal (10 th and 90th percentile and mean +/- SD = 0.17, 0.37, and 0.26 +/- 0.09 coils/cm, respectively). Maternal risk factors for abnormal vascular coiling were extremes of age for hyper-coiling, obesity, gestational diabetes mellitus, and preeclampsia for non-coiling. Hyper-coiled and non-coiled cords were significantly associated with adverse perinatal outcome (p < 0.001) and cesarean delivery (p < 0.0001). Neonates whose mothers are old or young, obese, diabetic, or have preeclampsia are likely to have hyper-coiled or non-coiled umbilical blood vessels.

Adult↗
PubMed1999

Renal handling of endogenous human chorionic gonadotrophin in preeclampsia.

OBJECTIVE: To test the hypothesis that the elevated maternal serum concentration of human chorionic gonadotrophin (hCG) in preeclampsia is due to altered renal handling of the hormone. SETTING: Department of Obstetrics and Gynecology, Al Ain Hospital, United Arab Emirates, a tertiary center affiliated with the Faculty of Medicine and Health Sciences, UAE University. METHODS: The renal clearances and handling of endogenous creatinine and human chorionic gonadotrophin were compared in 14 normotensive volunteer and 14 preeclamptic mothers who received oral hydration at 34-37 weeks' gestation. The hCG content in the placentas was estimated immunohistochemically after delivery. RESULTS: Maternal serum concentration of hCG (p = 0.0057), the placental hCG immunopositive cell (p < 0.0001), and syncytial knot counts (p < 0.0001) were significantly higher in preeclamptic mothers. The renal clearances of endogenous creatinine and hCG and fractional hCG clearance were not significantly different in both groups. Significantly increased amounts of hCG were filtered (p = 0.007) and excreted (p = 0.007) by preeclamptic mothers. Only a small but fixed proportion of the filtered load of hCG is excreted in both groups and there was a positive correlation (r = 0.5, p = 0.005) between filtered and excreted loads of hCG. CONCLUSION: The results indicate increased placental content of hCG in preeclampsia. The resultant increased maternal serum concentration is probably sustained by the mechanism of renal handling of the hormone.

Analysis of Variance↗
PubMed1998

The age and symptomatology of natural menopause among United Arab Emirates women.

OBJECTIVES: To determine the median age of natural menopause in United Arab Emirates women, the factors affecting that age and the prevalence of climacteric symptoms amongst those women. METHODS: A population-based survey was conducted on a community sample of United Arab Emirates women who had had natural menopause defined as cessation of menstruation for at least 6 months at the end of reproductive years. A total of 742 women aged 40 years and above were recruited from both urban and rural areas of the country using the multi-stage stratified cluster sampling technique. Data were collected using a structured questionnaire and face to face interviews and included a number of familial, reproductive and life-style variables. RESULTS: The median age of the menopause in the United Arab Emirates is 48 years (mean = 47.3 +/- 3.29, range 40-59). This is significantly lower than the median age reported from the West (50.3 years). The subject median age of the menopause was significantly related to that of the mother (P < 0.001), older sister (P < 0.001), parity (P < 0.0001) and the previous use of oral contraceptive pills for more than 1 year (P < 0.001). Hot flushes were the commonest feature of the menopause occurring in 45% of women. CONCLUSION: The age of natural menopause in United Arab Emirates women, as in other developing countries, is less than in Western women and may be influenced by genetic factors, parity and previous use of oral contraceptives. Climacteric symptomatology, however, is similar in the different patient groups.

Adult↗
PubMed1998

Persistent müllerian duct syndrome.

We report an 18-month old male presenting with a right-sided inguinal hernia and undescended testes. At herniotomy, a uterus and two fallopian tubes were found in the pelvic peritoneum adjacent to the two gonads which received their blood supply partly along the müllerian duct remnants. The gonads were testes by histological examination. Bilateral orchiopexy was performed without removal of the müllerian structures for fear of jeopardizing the testicular blood supply. The diagnosis of persistent müllerian duct syndrome was confirmed postoperatively by genetic and hormonal investigations.

Anti-Mullerian Hormone↗
PubMed1998

The effect of sodium based hypo-osmolality on arterial smooth muscle reactivity in vitro.

The study tested the hypothesis that the reduced [Na+]e and hypo-osmolality of normal pregnancy are causally linked to the attenuation of vascular smooth muscle reactivity in vitro. Aortic rings from nonpregnant female rats were incubated in physiological medium containing 114 mM NaCl/l and the contractile responses to phenylephrine, KCl and CaCl2 as well as the relaxations to acetylcholine and KCl were compared with those of rings incubated in normal medium containing 119 mM NaCl/l. There was no solute substituted for the lowered [Na+]. Experiments with phenylephrine were repeated using de-endothelialized rings and intact rings pretreated with indomethacin. Contractile responses of intact rings (n = 11) in hypo-osmolar solution to phenylephrine were significantly (P < 0.001) lower than of those in normal medium (n = 11). Responses were partially restored by endothelial denudation but not in the presence of indomethacin. Relaxations to acetylcholine (n = 7 for hypo-osmolar; n = 6 for normal solution) and KCl (n = 7 for each of hypo- and normal osmolar) were significantly enhanced (P < 0.05) in rings incubated in hypo-osmolar solution. There was no significant difference between the responses of the rings to KCl, and CaCl2 in either solution. These effects are similar to some of those previously described for vascular smooth muscle in normal pregnancy suggesting that the reduced [Na+]e and hypo-osmolarity of normal pregnancy may be contributing to the diminished vascular reactivity.

Acetylcholine↗