Kirkuk Journal of Medical Sciences

Background: Pre-eclampsia (PE) is an idiopathic specific syndrome that affects every organ system during pregnancy.It is a leading cause of both fetal and maternal morbidity and mortality worldwide. Setting: Antenatal and Obstetric Department in Azadi Teaching Hospital. Study design: Case-Control study (prospective). Duration: From April - December 2017.
Patients and methods: The study included 90 pregnant women, who were divided into three groups. 30 normotensive women (control), 30 women with mild pre-eclampsia and last 30 were with severe pre-eclampsia.
Results: Plasma level of Copeptin were 6.87 pmol/l in normotensive pregnant group, 51.70 pmol/l in mild pre-eclamptic group and 54.17 pmol/l in severe pre-eclamptic group (p-value<0.05). Copeptin was significantly elevated in pre-eclamptic subjects compared with controls and in severe pre-eclamptic group compared with mild ones. Assessing the diagnostic property of Copeptin for PE, (2) still births were recorded in severe PE, while no still births in mild PE and controls. Copeptin levels in pre-eclamptic patients with adverse neonatal outcomes as low birth weight, admission to NICU were significantly higher than the normotensive group.
Conclusion: This research suggest that increased maternal levels of Copeptin may be involved in the pathogenesis of pre-eclampsia and it may be useful in the assessment of the severity of the disease in the third trimester and this associated with adverse perinatal outcomes

Background: Threatened abortion is presumed when there is a bloody vaginal discharge or bleeding through a closed cervical os. cancer antigen 125 (CA-125), B-Human chorionic gonadotropin (B-hCG), and Soluble vascular endothelial growth factor receptor (sVEGFR-1 or sFlt-1R) are biochemical markers that have been studied to establish if they can predict the outcome of threatened miscarriage. Methods: A prospective observational study that was conducted at the Department of Obstetrics and Gynecology at Azadi Teaching Hospital/ Kirkuk-Iraq, over a period of eight months from first of April 2019 till first of December 2019. It included 96 pregnant women at 7 – 13 weeks of gestation with singleton pregnancy, viable fetus, and closed cervical os they presented with signs and symptoms of first trimester threatened miscarriage. After the first visit, follow up was done until they passed into the second trimester of pregnancy, and patients from the study group were divided into group 1: Included 19 patients who ended with miscarriage and group 2: Included 69 women who continued their pregnancy into the second trimester. We compared the level of the Cancer antigen 125 (CA-125), B-Human chorionic gonadotropin (B-hCG), and Soluble vascular endothelial growth factor receptor (sVEGFR-1 or sFlt-1R) between the two study groups to assess their utility for prediction of the outcome of first-trimester threatened miscarriage. Results: Mean of CA 125 marker was significantly higher in participants who ended with miscarriage than that in participants who continued to second trimester. Means of B-hCG and sFlt-1markers were significantly lower in participants who ended with miscarriage than that in participants who continued to second trimester Serum CA-125 marker > 38.8 IU/ml, Serum β-hCG marker < 20211.3 mIU/ml, and serum sFlt-1 marker < 1731.7 pg/ml are predictors for risk of miscarriage. Conclusion: Serum CA 125, B-hCG, and sFlt-1 biomarkers represent non-invasive, early, fast and excellent predictors of pregnancy outcome in women with threatened miscarriage. Taking into account the feasibility and cost, using serum β-hCG instead of the more accurate one (i.e. serum sFlt-1) would be more logical decision. Further studies are needed in this field.

Background: Anemia is defined as hemoglobin levels of ≤ 11 g/dl , is one of the world's leading causes of disability , and thus one of the most serious global public health problems .More than (50%) of the pregnant women in the world are anemic. Knowledge about the anemia is very important in our community. This knowledge will encourage those who work in primary health care (PHCS) provider for pregnant women to detect the problem earlier and treat the problem properly.
Aims: Is to determine the effective factors related to anemia in pregnant women in Kirkuk governorate. Patient & Method: A total of 250 pregnant women were asked while attending antenatal unit in Azadi Teaching Hospital and several Primary Health Centers in Kirkuk City out patients clinic from 25.10. 2014 to1.3.2015. Data were taken involve: age, residency, educational level, history of last menstrual period, onset of anemia and level of hemoglobin (Hb). These data were organized in special questionnaire prepared for this purpose.
Results: From the total (250) pregnant women (61.6%) of them have low Hemoglobin (Hb) level mild, moderate or severe anemia the majority of them (75.33%) with mild anemia. according to severity the rate was (3.2%).
Conclusions and Recommendations: The prevalence of anemia among women in Kirkuk city during pregnancy is high (61.6%) in compare to (52%) in the world wide in developing countries.

Background and Objective: Liver plays an important role in regulating glucose levels in the body. The liver enzyme gamma-glutamyl transferase (GGT), is a common marker of liver function and has also been associated with insulin resistance, which can be a precursor to gestational diabetes and type 2 diabetes. The aim of this study was to evaluate serum GGT in gestational diabetics. Materials and Methods: The cross sectional study was conducted between department of biochemistry and gynecology during Junes to November, 2016 in Erbil city. Blood specimens were collected in the diabetic center in Maternally Teaching Hospital after diagnostic by gynecologist. A total 50 cases were considered as Group I (GDM) and 50 were Group II controls (normal healthy pregnant women). Patient group also subdivided into three subgroups; subgroup 1 GDM first time, subgroup 2 GDM second time and subgroup 3 regard as diabetic patient type2. Results: There were statistically significant differences at the level (p value <0.001) elevations in serum GGT in GDM compared with control group, also uric acid, and calcium were increased in GDM. Conclusions: Our finding showed that increase serum GGT level is an independent risk factor for GDM and identified as high risk factor for GDM.

Background: Anemia is defined as a state of decreased blood concentration of hemoglobin which can by too few red blood cells, too little hemoglobin in red blood cells or both. Worldwide, anemia is considered as one of the major nutritional deficiency disorders. In developing countries, almost two thirds of pregnant ladies are anemic. Most of the studies suggest that there is a significant rise in perinatal mortality rate when hemoglobin of pregnant woman becomes pregnant below 11.0 g/dl. The aim of study is to estimate prevalence of anemia during pregnancy in Kirkuk province. Subjects and methods: This study was conducted at the beginning of May to the end of September 2017. 100 females, whose ages were between 18-35 years, were collected randomly in Kirkuk province (50 pregnant females and 50 nonpregnant females at childbearing age as control). The mean and standard deviation of our sample ages were 27.72+5.38 years (23.39+4.1 years for nonpregnant females and 31.9+2.3 years for pregnant females). Among pregnant females, the mean and standard deviation of ages were 28.17+1.2 for 1st trimester, 32.2+2 for 2nd trimester and 32.9+1.4 for 3rd trimester. 68 of our sample were from urban areas and 32 from rural areas. 3 ml of blood drawn from the cubital vein by using disposable needles and syringes. CBC (complete blood count) was estimated by using same automated analyser in same laboratory. 5 parameters (Hemoglobin (Hb), hematocrit (Hct), Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC)) have collected for each woman in this study. Results: In this study, it has been seen that the changes in all parameters during pregnancy becomes more obvious in last two trimesters of pregnancy. Conclusions: Regarding results of present study, prevalence of anemia during pregnancy in Kirkuk province is high and type of anemia is mild anemia

Background and objective: Pregnancy is characterized by profound changes in almost every organ system to accommodate the demands of the fetoplacental unit. Hematologic system is one of these systems and should adapt in a number of ways. This study, attempted to assess the effect of pregnancy on the hematological indices and compare these indices at different stages of pregnancy with non- pregnant women. Methods: A cross sectional study was conducted in different medical health centers in Erbil, Iraq from 1 st April 2016 to 31st January 2017. (139) apparently healthy pregnant women aged from (16-46) years, were recruited into the study as a case group, and (104) healthy non pregnant aged from (19-46) years as a control group. Venous blood was collected from each subject. Complete blood count was estimated by automated hematological analyzer. Results: Study group showed statistical difference in RBC count, hematocrit, MCH, WBC count, monocyte %, granulocyte % and platelet count at (p< 0.0.5) between pregnant and non pregnant women. Significant differences were observed in some of the hematological parameters among the three TMs. Conclusion: Normal pregnancy can alter hematological indices and also affected by different pregnancy stages.

Background and objectives: Diabetes mellitus is a major public health concern with adverse pregnancy outcome. The objective of this study was to assess the validity of HbA1c as a screening tool in pregnant ladies not known to have diabetes before pregnancy. Patients and methods: Three hundred pregnant women with gestational age between 24 - 28(25.3±2.1) weeks were evaluated for diabetes mellitus using HbA1c, fasting and postprandial plasma glucose for the period of October 2010 - October 2012, using McNamara's test which is expressed as percentages and 95% confidence intervals of the percentages. Results: Of pregnant ladies with non-diabetic fasting plasma glucose values: 79% had HbA1c level of <6.1%, 17% had an HbA1c level of > 6.1% and 5% showed diabetic 2-h plasma glucose values (17% CI 51–71 vs. 5% CI 35–55, respectively; P = 0.007). Of pregnant ladies with diabetic fasting plasma glucose:72% had an HbA1c level of ≥6.1%, 28% had HbA1c level of ≤ 6.0 % and 11% subjects in this group showed nondiabetic 2-h plasma glucose values (28% CI 66 – 86 vs. 11% CI 32–52, respectively; P = 0.003).Of pregnant ladies with postprandial blood glucose >200mg/dL; 42% had normal, 18% had impaired, 39% had high fasting plasma glucose while 71% had HbA1c ≥ 6.1% (71 % CI 51–71 vs. 39% CI 35–55, respectively; P = 0.003). Conclusion: HbA1c is an important alternative screening tool to identify pregnant ladies with undiagnosed diabetes.