IRAQI JOURNAL OF MEDICAL SCIENCES

Since its invention, electron microscope (EM) has been a valuable tool in the development of scientific theory and it contributed greatly to biology, medicine and material sciences. This wide spread use of EMs is based on the fact that they permit the observation and characterization of materials on a nanometer (nm) to micrometer (µm) scale. In this review article, the transmission electron microscope (TEM) and the scanning electron microscope (SEM) were defined and reviewed. The EMs functions and types were discussed, in addition to clarifying the parts and components of TEM, SEM and optical microscopes for neophyte, starting from the sample’s preparation through imaging of the samples. Also, this review will point out the limitations and advantages of each type and issues to be considered during experimental design. Advanced EM techniques are listed as well.in this review, Diagrammatically, identify the various parts of a microscopes, what is the differences between TEM, SEM and optical microscopes and finally the methods of samples preparation have been mentioned.
Keywords: Electron microscopy, SEM, TEM, sectioning, staining
Citation: Hamid MK. The electron microscopes: Concise history and review. Iraqi JMS. 2022; 20(2): 154-167. doi: 10.22578/IJMS.20.2.1

Background: The use of labor induction to shorten the duration of a pregnancy has increased steadily during the last few decades. Paraoxonase 1 levels were observed to be higher in the oxytocin-induced group than in the spontaneous labor group.
Objective: To compare the influence of induced labor on fetal Apgar score and birthweight, and to measure the level of oxidative stress (paraoxonase 1) experienced during labor by the neonates of pregnant women undergoing induced or spontaneous birth.
Methods: A case control study that was conducted in the Department of Obstetrics and Gynecology, Azadi Teaching Hospital, Kirkuk during a period of nine months from 10th of February till 10th of November 2019. It included 60 healthy pregnant women with singleton pregnancy and viable fetus attending the labor room of the hospital. They were divided into two groups: Case group included 30 pregnant women who underwent oxytocin-induced labor and control group included 30 pregnant women underwent spontaneous vaginal delivery in latent phase of first stage labor without oxytocin induction. A five ml of blood was drawn from the umbilical artery to measure Paraoxonase 1 level. Pregnancy outcome was also monitored.
Results: The mean of Paraoxonase 1 enzyme was significantly higher in women who underwent oxytocin-induced labor than that in women who underwent vaginal delivery without oxytocin induction. No significant differences between study groups regarding birthweight, Apgar score 1 min, Apgar score 5 min, packed cell volume, and hemoglobin F.
Conclusion: Serum Paraoxonase 1 as a marker was elevated in neonates of pregnant women who underwent oxytocin induced labor without a significant effect on Apgar score of neonates or its birthweight.
Keywords: Paraoxonase 1, labor induction, oxidative stress, pregnancy outcome
Citation: Ahmed SN, Ghalib AK. Evaluation of paraoxonase 1 oxidative stress enzyme in cord blood of newborn to patients delivered with oxytocin induced labor. Iraqi JMS. 2022; 20(2): 168-174. doi: 10.22578/IJMS.20.2.2

Background: The pathogenesis of migraine is thought to include activation of the trigeminovascular system. The blink reflex (BR) test is a well-known method of studying the trigeminal system.
Objective: To look into the differences in BR response in migraine patients using the standard approach and to compare the results with matched control subjects, looking for a possible difference in BR ictally and interictally, and clarify whether migraineurs with aura differ from those without aura.
Methods: A case-control study of 80 subjects; 40 patients were diagnosed with migraine, with or without aura, and 40 matched healthy volunteers. Disease duration ranges from 2 to 82 months. Both groups were submitted to medical history, clinical neurological examination, and binocular BR study of both eyes.
Results: BR data were not different between male and female patients. Right cR2 latency and left iR2 were prolonged in the migraineurs group patients. Right iR2 and cR2 latencies recorded interictally were longer than those obtained ictally. No difference was observed between those with and without aura. The pain location side is not associated with the stimulation side.
Conclusion: Patients suffering from episodic migraine may have altered interneuronal brainstem circuits. BR data would not change whether migraine was with or without aura. Interictal changes in BR suggest trigeminovascular dysfunction in migraineurs patients is not a transient phenomenon.
Keywords: Migraine, Blink Reflex
Citation: Esmael ZF, Hamdan FB. Blink reflex study in patients with migraine. Iraqi JMS. 2022; 20(2): 175-182. doi: 10.22578/IJMS.20.2.3

Background: Despite adequate treatment, about 50% of patients with type 1 diabetes mellitus (T1DM) usually develop a serious complication during their lifetime. The level of hemoglobin A1c (HbA1c) reflects glycemic control, the screening of which is particularly helpful in community-based care settings where tests requiring fasting are not that practical.
Objective: To describe the difference in HbA1c level among a sample of children with T1DM and to identify the most common type of compilations and its association with HbA1c and different sociodemographic factors.
Methods: A cross sectional study, included 96 children with T1DM, their age ranged between 8-18 years, that attended Medical City Complex in Baghdad in the Pediatrics outpatients Clinic and Endocrine Outpatient Clinic during period from 1st of July 2021 to 30th of October 2021.
Results: Males formed 47.9%, 45.8% of them were in school age group, the mean HbA1c level was (10.74±2.974) mg/dl. Employed fathers formed 52.1%. Family history of T1DM was among 13.5% and that of T2DM was among 34.4%. Complication appeared among 71.9% of children, mainly neuropathy found among 50% of them. Children with retinopathy, positive family history have significantly poor controlled DM (last reading HbA1c ≥7 mg/dl).
Conclusion: HbA1c level in children with T1DM is found to be associated with family history, parents' education and employment, in addition a significant association with development of retinopathy in those children was also found in this study.
Keywords: Type 1 DM, HbA1c, retinopathy
Citation: Qasim MF, Tawfeeq ZA. Significance of HbA1c test and different sociodemographic factors in the development of complications in type 1 diabetes in children. Iraqi JMS. 2022; 20(2): 183-190. doi: 10.22578/IJMS.20.2.4

Background: Approximately 20% of ischemic strokes affect the posterior circulation of brain structures. Mortality and risk of recurrent stroke are high with the possibility of misdiagnosis. As a result, an effective mode of examination is required for early diagnosis.
Objective: To investigate the clinical diagnostic utility of brainstem auditory evoked potentials (BAEPs) in patients with posterior circulation ischemic stroke (PCIS).
Methods: Twenty patients with PCIS aged 40 to 70 years were studied, along with 20 age-matched healthy controls. Medical history was taken, as well as a clinical neurological examination and BAEPs.
Results: Waves IV and V latencies, and III-V inter-peak latencies were significantly prolonged and wave V amplitude was significantly reduced in patients with PCIS. Fifteen patients with PCIS show retrocochlear (central) dysfunction abnormality. Wave V latency and amplitude showed the highest estimated specificity and sensitivity with 80 % and 90%, respectively. Wave V latency negatively correlated with a duration from onset of stroke to neurophysiological examination.
Conclusion: BAEPs are a useful tool as a biomarker for the clinical evaluation of PCIS. Wave V latency and amplitude is the most specific and sensitive among BAEPs parameter in the diagnosis of PCIS. Topographic distribution of the lost BAEP waves (according to diffusion-weighted MRI findings) may be closely linked to lost generators of individual waves, which suggests regional diagnostic validity of BAEPs. Finally, an early post-stroke BAEPs examination is better in detecting the abnormality and can provide reference values for further evaluation.
Keywords: Posterior circulation ischemic stroke, brainstem auditory evoked potentials
Citation: Tuaimeh MS, Hamdan FB, Al-Hamdani HA. Brainstem auditory evoked potential in patients with posterior circulation ischemic stroke. Iraqi JMS. 2022; 20(2): 191-200. doi: 10.22578/IJMS.20.2.5

Background: A corona virus (COVID-19) pandemic in Iraq has extended all over the country, including Fallujah city in western of Iraq. Being aware of the epidemiological features of this novel disease can greatly assist in making the suitable decisions regarding the management and thus control of this epidemic.
Objective: To study the epidemiological characteristics of COVID-19 patients in Fallujah city, Iraq.
Methods: In this retrospective study, information in regard to the epidemiological features of COVID-19 suspected cases who underwent polymerase chain reaction (PCR) testing at Fallujah Teaching Hospital in Fallujah, Al-Anbar, Iraq, from September 12th, 2020 to January 5th, 2021. Inclusive, have been collected, analyzed and then reported. General features including age, sex, occupation and quarantine site were investigated. Whole data were retrieved from patients' official records.
Results: A total 3604 samples from COVID-19 suspected cases were collected, 575 cases of them were tested positive for COVID-19. Among the COVID-19 patients, 402 of them were males (69.9%) and 173 were females (30.1%). The age range of the patients was (15-86) years and the mean age ±SD was 40.98±14.3 years. Forty-one COVID-19 patients were healthcare workers (7.1%) and the rest 534 patients had non-healthcare related occupations (92.9%). Only 40 COVID-19 positive cases were admitted to the hospital (7%), and 535 patients were in home quarantine (93%). In case of the total 143 hospital admitted patients, the PCR test results were negative in 103 patients (72%) and positive in only 40 patients (28%).
Conclusion: This study found that COVID-19 was more prevalent among the young male individuals, whom represent the community active group. This study can serve in documenting the features of the patients with COVID-19 in Fallujah, Iraq, and also in helping the healthcare workers in detecting and managing the patients.
Keywords: COVID-19, Coronavirus, epidemiology, SARS-CoV-2, Iraq
Citation: Taher NM, Abady NH, Jamal QW. A retrospective study regarding coronavirus disease epidemiological features among people in Fallujah City, Iraq. Iraqi JMS. 2022; 20(2): 201-206. doi: 10.22578/IJMS.20.2.6

Background: Osteoarthritis (OA) is a complex degenerative articular disease that has an ambiguous pathogeny because variant risk factors participate in the process of cartilage deterioration. Genetic factors may have a role in the onset and progression of OA.
Objective: To investigate potential association between severity of knee OA (KOA) and Double von Willebrand factor A domains DVWA rs11718863 gene polymorphism.
Methods: One hundred and twenty Iraqi patients diagnosed with KOA, aged (45 years and above) and sixty healthy people (control) at the same age range, with no family history of OA were evaluated at Al-Imamein Al-Kadhimein Medical City (Rheumatology Department). The degree of severity of KOA was assessed by clinical and radiographic assessment. DVWA rs11718863 genotyping was performed using DNA sequencing (Sanger’s method).
Results: Two different genotypes wild homozygote (TT) genotype and heterozygote (AT) appeared by genotyping of DVWArs:11718863. Highly significant difference (p<0.001) was found in distribution of the two genotypes in the three study groupsl the genotype (TT) was more frequent in control group (95.0%). Also, high significant difference (p<0.001) was noted in the two alleles (A, T) frequencies between control group and KOA patients group giving odd ratio 6.437 with 95% confidence intervals of (1.93-21.42).
Conclusion: Iraqi subjects carrying AT genotype of DVWA rs11718863 gene are mostly susceptible for developing of KOA and the allele A of Tyr169Asn polymorphism are more frequent in those patients indicating that allele A may be a risk factor of onset of this disease. Age and body mass index are considered risk factors of onset and progression of KOA.
Keywords: Double von Willebrand factor A domains (DVWA), single nucleotide polymorphism (SNP), body mass index, Knee osteoarthritis, KOA
Citation: Hasan NN, Alwasiti EA, Ahmed MH. Association of DVWA rs11718863 gene polymorphism with knee osteoarthritis in Iraqi patients. Iraqi JMS. 2022; 20(2): 207-216. doi: 10.22578/IJMS.20.2.7

Background: Genomic studies of hepatitis B virus (HBV) diversity are becoming increasingly significant to understand how HBV mutations interact with a wide spectrum of clinical and pathological disorders.
Objective: This study focused on identifying HBV genotypes and determining the status of pre-core (PC) and core promoter (CP) mutants.
Methods: Nested polymerase chain reaction was used to identify the viral genotypes of 100 patients with chronic HBV infection. Only 30 samples out of 100 were selected to determine the prevalence of mutations in the PC and CP by Sanger sequencing.
Results: Over 95% of the samples had only D genotype and mixed genotypes 5% (B+C+D) in chronic hepatitis B (CHB) patients. G1898A, G1901A, G1910A and G1915A mutations in PC gene were found in total 15 out of 30 (50%) samples, which were distributed in the following proportions: 12 out of 25 (48%) in patients with hepatitis B e antigen (HBeAg) -ve, 8 samples with mutants at G1898A, G1901A, G1910A and G1915A (four mutations), 4 samples with mutants at G1898A, G 1901A and G1910A (three mutations). In addition, 3 out of 5 (60%) in patients with HBeAg +ve, while no type of any mutation was detected in the core gene in patients with chronic hepatitis type B.
Conclusion: The genotype D was predominantly prevalent among HBV in CHB patients with 95% and with 5% in mixed genotypes (B+C+D), while genotype B and C were relatively less prevalent among CHB patients than genotype D. The mutations were found in the PC gene at nucleotides G1898A, G1901A, G1910A and G1915A, while no type of mutation was detected in the core gene.
Keywords: Genotypes, pre-core mutation, core mutation, HBV
Citation: Hussain HT, Al-Shuwaikh AM, Ahmed AM. Hepatitis B virus genotypes and pre-core and core genes mutations in a sample of Iraqi patients with chronic hepatitis B Infection. Iraqi JMS. 2022; 20(2): 217-225. doi: 10.22578/IJMS.20.2.8

Background: Nephrotic syndrome (NS) is the most common glomerular disease seen in the pediatric age group.
Objective: To study demographic, socioeconomic, disease related characteristics and the physical examination including height, weight and blood pressure correlation with frequency of relapses in children with steroid sensitive NS (SSNS).
Methods: This is a cross sectional study that was conducted at Nephrology Consultation Clinic, in Al-Imamein Al-kadhimein (peace on them) Medical City, Baghdad, Iraq starting from 1st of January, 2020 to 31 July, 2021.
Results: Total number of patients was 60 children with SSNS, 24 (40%) patients were frequent relapsers and 36 patients (60%) were infrequent relapsers. Most of the children at onset of the disease were less than 5 yr (76.7%) and males were more than females (78.3%). Fifty-three patients were responder to steroid in less than 2 weeks (88.3%). Ten patients with low body weight (16.7%) and 6 patients with low body height (10%), 25 patients presented with elevated blood pressure (41.7%). A significant correlation was found between future relapses and following characteristics; response to steroid in less than 2 weeks, urinary tract infection (UTI) and gross hematuria, low body weight, short stature and elevated blood pressure.
Conclusion: Comparing frequent with infrequent relapsers, the following factors found to be statically significant: response to steroid less than 2 weeks, UTI, gross hematuria, low body weight, short stature and elevated blood pressure.
Keywords: Relapse, steroid, nephrotic syndrome, frequency
Citation: Ali SH, Ali HA, Neamah AM. Risk factors for relapses in children with steroid sensitive nephrotic syndrome. Iraqi JMS. 2022; 20(2): 226-232. doi: 10.22578/IJMS.20.2.9

Background: Elastography is an imaging technique which has been used in the last decades and its role in breast masses characterization is well established. However, its value for predicting breast cancer grading is yet to be studied.
Objective: To determine the role of strain elastography in the prediction of the grade of mammary ductal carcinoma.
Methods: A cross sectional study enrolled 44 female patients with Breast Imaging Reporting and Data System (BI-RADS) Category 5 breast mass. Complete B-mode and elastographic ultrasound examination of the breast was performed with evaluation of the elastoscore and strain ratio. Correlation with the detailed histopathological report was done for cases that were proved to be ductal type breast carcinoma.
Results: Significant correlation was found between the speculated outline of the tumor and grade III tumor (p=0.03). Breast tumors with higher Elastography/B mode size ratio (>1) and with high elasticity score (score 5) were significantly associated with grade III (p=0.02). The mean strain ratio of masses was significantly higher among grade III breast tumors (p<0.001).
Conclusion: Elastography is a helpful non-invasive tool that has the potential for predicting breast ductal carcinoma grade and by such predicting the prognosis.
Keywords: Breast ductal carcinoma, strain elastography, ductal carcinoma grades
Citation: Said TTM, Sheet AT, Nuaman BN. The role of elastography in predicting the grade of mammary ductal carcinoma. Iraqi JMS. 2022; 20(2): 233-238. doi: 10.22578/IJMS.20.2.10

Background: Insulin resistance is a major risk factor in the development of cardiovascular diseases and type 2 diabetes mellitus. Some studies concluded that serum lipoproteins levels and hence lipoprotein ratios were altered in patients with insulin resistance.
Objective: To identify the possibility of using lipoprotein ratios as markers for insulin resistance.
Methods: A cross sectional study conducted in Baghdad (Medical City) and in Maysan (Al Shaheed Al Sadir Teaching Hospital) from February to December 2020. Eighty-three male and 51 female in Coronary Care Unit and Internal Medicine Wards patients were selected in the study group.
Results: Lipoprotein ratios were significantly higher in individuals with homeostatic model assessment for insulin resistance (HOMA-IR) ≥2.5 as compared to subjects with HOMA-IR <2.5. There was a statistically significant association between lipoprotein ratios and insulin resistance when HOMA-IR ≥2.5 (P less than 0.05). Fasting insulin correlated significantly with lipoprotein ratios.
Conclusion: Serum lipoprotein ratios and the best one is triglyceride/high density lipoprotein cholesterol could be used as markers for insulin resistance.
Keywords: Lipoprotein ratios, insulin resistance, diabetes
Citation: Issa EF, Rasheed MK. Serum lipoprotein ratios as markers for insulin resistance among non-diabetic acute coronary syndrome patients with impaired fasting glucose. Iraqi JMS. 2022; 20(2): 239-244. doi: 10.22578/IJMS.20.2.11

Background: Nanomedicine has emerged as a powerful platform for applying nanotechnology in the prevention and treating many diseases.
Objective: To investigate the toxicity of designated anti-cancer drugs composed of gold nanoparticles (GNPs), tumor necrosis factor-alpha (TNF-α), and cysteine-Alanine-Leucine-Asparagine-Asparagine (CALNN) peptide on kidney and liver parameters, using animals’ model.
Methods: A Combination of TNF-α and CALNN peptide on the surface of GNPs were achieved depending on formation of dative covalent bond between molecules and pH of solutions, which leads to react with active groups of different molecules of nanoparticles, which characterized using ultraviolet visible spectroscopy. Moreover, their effects on kidney and liver blood variables had been examined. These blood values included measurement of the glutamic oxaloacetic transaminase, glutamic pyruvic transaminase and alkaline phosphatase, creatinine, and urea levels after intraperitoneal injection of an anti-cancer drug in female albino mice.
Results: Overall, the results indicated that there was no significant change in the concentration of different biochemical values between treated and control groups.
Conclusion: The results suggest that GNPs-TNF-α-CALNN combination have no harmful impact on kidney and liver organs of tested mice.
Keywords: Nanomedicine, GNPs, TNF-α, CALNN peptide, drug delivery, cytotoxicity
Citation: Abood NA, Kadhim HS, Jabir MS. Effect of TNF-gold nanoparticles combination on kidney and liver parameters of female mice. Iraqi JMS. 2022; 20(2): 245-251. doi: 10.22578/IJMS.20.2.12

Background: Coronavirus disease 2019 (COVID-19) is an epidemic disease produced via the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) beta coronavirus, which affects the lower respiratory tract. Secondary bacterial infection (SBI) is a serious and public problem in patients hospitalized with COVID-19 and caused 50% of deaths. Type A and O blood groups are more susceptible to infection with SBIs.
Objective: To examine the relationship between SBI and ABO blood group with COVID-19 hospitalized patients in Baghdad and Diyala province.
Methods: Three hundred and forty-two patients with COVID-19 were collected from several sources (nasal swab, pharyngeal swab, sputum, blood, and urine) of patients of different ages for the period between September to November 2021. Real-time reverse-transcription polymerase chain reaction technique was used to diagnose COVID-19 in the patients as well as selective and differential media, biochemical tests BACT/ALERT system, and VITEK 2 compact system were used to diagnose the isolates of SBIs. The disk diffusion technique was used to assess the susceptibility test of all isolates. ABO group analysis was done for totally patients with COVID-19 under the study.
Results: Antimicrobial sensitivity test showed all SBIs were highly strong resistant to antibiotics. Fifty-seven isolates of bacteria were diagnosed including Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Group A and O showed a higher rate of acquired SBIs. Duration of infection with COVID-19 showed 61% for 10 days and 30% for one month while 9% in the patients infected with SBI for more than one month. The result appeared that SBIs infection at were very high rate in COVID-19 patients who had untreated antibiotics compared with the patient treated with antibiotics through the duration of infection.
Conclusion: The study revealed that many COVID-19 patients were more susceptible to infection with SBIs, especially in the early days of infection as well as there was a correlation between ABO blood groups and SBIs of COVID-19 patients.
Keywords: COVID-19; SBIs, AST, ABO blood group
Citation: Albadri AF, Alzubaidy ZM. Investigation of the prevalence of secondary bacterial infection associated with COVID-19 in Baghdad and Diyala province. Iraqi JMS. 2022; 20(2): 252-261. doi: 10.22578/IJMS.20.2.13

Background: Laparoscopic cholecystectomy (LC) is the most common elective surgery performed by a general surgeon. Although being a routine procedure, classical pitfalls as misperception of intraoperative anatomy is one of the leading causes of bile duct injuries (BDI). The critical view of safety (CVS) in LC can be a new safe technique for identification of anatomy to reduce such a risk.
Objective: To assess the efficacy of CVS in LC compared with the traditional infundibular technique.
Methods: This comparative study included 344 patients who suffered from symptomatic gall stones. Patients have been grouped into two groups: group A (172 patients) operated utilizing the traditional infundibular technique and group B (172 patients) by CVS technique. Preoperative patient assessment, operating time and intraoperative and postoperative events including hospital stay, were recorded. Those patients who were unfit and or with bleeding disorders were excluded from the study. Postoperatively, patients were assessed using clinical examination for the possible complications.
Results: The main perioperative complications bleeding and bile leak were significantly reported in infundibular group 6.98% and 9.88% respectively compared to 0.58% and 1.74% in CVS group respectively. Postoperatively, both intra-abdominal collection and bile leak were significantly lower in CVS group (1.16% and 1.74%, respectively) than in infundibular group (7.58% and 6.98%, respectively). Furthermore, hospital stay was significantly less in CVS group (1.8±2.7 days) compared to infundibular group (3.14±2.8 days).
Conclusion: Using the CVS is associated with shorter operative time, less frequent peri- and postoperative complications and shorter hospital stay compared with infundibular technique.
Keywords: Laparoscopic cholecystectomy, critical view of safety (CVS)
Citation: Abdulhassan BA, Noman ZK, Hamdawi MA. Adoption of critical view of safety versus infundibular technique in laparoscopic cholecystectomy: A comparative study. Iraqi JMS. 2022; 20(2): 262-268. doi: 10.22578/IJMS.20.2.14

Background: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. There is evidence to support a connection between COPD and Diabetes mellitus type 2 (T2DM). T2DM affects 2-37% of COPD patients, with results being highly variable between studies.
Objective: To determine the prevalence of T2DM in patients with severe and very severe stages of COPD and to assess the risk factors affecting the prevalence of T2DM among COPD patients.
Methods: A cross sectional study was conducted on 140 patients with COPD attending Outpatient and Inpatient of Respiratory Unit at Baghdad Teaching Hospital. The data were collected between the 10th of October 2016 to the 10th of August 2017. These data included demographic parameters such as: age, sex, smoking habit, and respiratory parameters from history and clinical examination. Spirometry was used to assess the severity of COPD patients. Random blood sugar testing was used for identification of COPD patients having T2DM when they are not clear or not known as a case of T2DM previously.
Results: The prevalence of T2DM among COPD patients was 19.38%; the prevalence of T2DM in those with severe stage was 10.9%, while in very severe stage was 35.4%. In comparison to women, men were more likely to have T2DM.The prevalence of T2DM increased in the elderly COPD patients (>61 years), with high body mass index, and also increased more among current smokers followed by former smokers and never smokers. Lung function tests decline more in COPD patients with presence of T2DM.
Conclusion: T2DM is more common among COPD patients, and its prevalence rose as the severity of the COPD patients' condition worsened. Additionally, T2DM patients are more likely to experience a decline in pulmonary function.
Keywords: Diabetes mellitus type 2, chronic obstructive pulmonary disease, prevalence, random blood sugar
Citation: Al-Ani NAH, Al-Obaidy MW. The prevalence of diabetes mellitus type 2 in severe and very severe chronic obstructive pulmonary disease patients. Iraqi JMS. 2022; 20(2): 269-277. doi: 10.22578/IJMS.20.2.15

Background In situations of a morbidly adherent placenta, studies have shown that maternal serum alfa feto protein (AFP) is clinically high.
Objective To examine the association of morbidly adherent placenta (MAP) in pregnant women with placenta previa (PP) and their serum AFP biomarker.
Methods A prospective observational study that was conducted in the Department of Obstetrics and Gynecology at Azadi Teaching Hospital, Kirkuk, Iraq during the period from Feb. till Nov. 2019. It included 82 pregnant women those between 14-20 weeks of gestation with singleton pregnancy, viable fetus, and diagnosed with low lying placenta, with and without vaginal bleeding. A blood sample from all women was taken to investigate for serum AFP level after confirming the diagnosis of low-lying placenta by early abdominal ultrasound (U/S) scan. All the enrolled pregnant women were followed by Doppler U/S at gestational age 28-32 weeks, underwent targeted screening for MAP and were divided into two groups according to the status of placenta: MAP group included 11 pregnant women and PP group alone included 71 pregnant women.
Results In this study, MAP was diagnosed in 13.4% of cases. Mean of serum AFP biomarker in women with MAP was significantly higher than that in women with PP. Serum AFP biomarker in early pregnancy >200 ng/ml is predictive for diagnosis of MAP in late pregnancy.
Conclusion Maternal serum AFP biomarker may play an important role at early pregnancy in prediction of placental adherence at late pregnancy in cases of early low-lying placenta.
Keywords Morbidly adherent placenta, alpha feto protein, previa, pregnancy, Iraq
Citation Hassan SS, Ghalib AK. Maternal serum alpha feto protein level may predict morbidly adherent placenta in women with placenta previa. Iraqi JMS. 2022; 20(2): 278-285. doi: 10.22578/IJMS.20.2.16
Background: In situations of a morbidly adherent placenta, studies have shown that maternal serum alfa feto protein (AFP) is clinically high.
Objective: To examine the association of morbidly adherent placenta (MAP) in pregnant women with placenta previa (PP) and their serum AFP biomarker.
Methods: A prospective observational study that was conducted in the Department of Obstetrics and Gynecology at Azadi Teaching Hospital, Kirkuk, Iraq during the period from Feb. till Nov. 2019. It included 82 pregnant women those between 14-20 weeks of gestation with singleton pregnancy, viable fetus, and diagnosed with low lying placenta, with and without vaginal bleeding. A blood sample from all women was taken to investigate for serum AFP level after confirming the diagnosis of low-lying placenta by early abdominal ultrasound (U/S) scan. All the enrolled pregnant women were followed by Doppler U/S at gestational age 28-32 weeks, underwent targeted screening for MAP and were divided into two groups according to the status of placenta: MAP group included 11 pregnant women and PP group alone included 71 pregnant women.
Results: In this study, MAP was diagnosed in 13.4% of cases. Mean of serum AFP biomarker in women with MAP was significantly higher than that in women with PP. Serum AFP biomarker in early pregnancy >200 ng/ml is predictive for diagnosis of MAP in late pregnancy.
Conclusion: Maternal serum AFP biomarker may play an important role at early pregnancy in prediction of placental adherence at late pregnancy in cases of early low-lying placenta.
Keywords Morbidly adherent placenta, alpha feto protein, previa, pregnancy, Iraq
Citation: Hassan SS, Ghalib AK. Maternal serum alpha feto protein level may predict morbidly adherent placenta in women with placenta previa. Iraqi JMS. 2022; 20(2): 278-285. doi: 10.22578/IJMS.20.2.16