sildenafil citrate treatment may present a new hope towards better perinatal outcomes for pregnancies complicated by IUGR and impaired placental circulation that may help to decrease neonatal admission to the newborn nursery.

ObjectiveWe aimed to evaluate the effect of different timing of initiation of low-molecular-weight heparin (LMWH) administration on the pregnancy outcomes in women with antiphospholipid syndrome (APS).Materials and methodsA randomized controlled study was conducted on women with obstetrical APS. All participants were randomly divided at documentation of positive pregnancy test into two groups; early initiation group in which LMWH therapy was started once positive pregnancy test was established (in the fifth week of gestation), and later initiation group in which LMWH therapy was started after sonographic confirmation of fetal cardiac pulsation (in the seventh week of gestation). In both groups, LMWH (enoxaparin) was given at a dose of 40 mg/day subcutaneously and the therapy continued until end of pregnancy. The primary outcome measure was ongoing pregnancy rate and the secondary outcome measures were fetal loss, live birth rate, preterm labor before 34 weeks of gestation, intrauterine growth restriction (IUGR), and congenital fetal malformations.ResultsNinety-four women (48 in the early initiation group and 46 in the later initiation group) were subjected to final analysis. The ongoing pregnancy rate was significantly higher in the early initiation group than in the later initiation group (81.2% vs 60.9%; P=0.040). However, both groups were similar in the incidences of fetal loss, preterm labor before 34 weeks of gestation, and IUGR, and live birth rate. No recorded congenital fetal malformations in both groups.ConclusionEarly administration of LMWH for pregnant women with obstetrical APS reduces early pregnancy loss, but does not affect the incidence of late obstetrical complications.

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Background: Preeclampsia (PE) is one of the most common pregnancy complications affecting approximately 5-7% of pregnant women worldwide. Pathogenesis of PE is still mysterious. Literature studies reported differences between early and late onset PE. Also, whether placenta of late-onset PE without fetal growth restriction (FGR) is different from normal one needs further declaration. Objective: This study aims at evaluating the placental microvessel density (MVD), apoptosis and endoglin (CD105) expression in late-onset PE without FGR. Patients and Methods: Placentae of 15 PE and 15 matched control ones were evaluated grossly, microscopically and by immunohistochemistry for caspase-3, CD 34 and CD105. Results: Placentas in PE group showed a statistically significant difference as regard size, syncytial knots, perivillous fibrin deposition, villous infarction increased apoptosis, and endoglin (CD105) expression. However, the percentage of terminal villi and microvessel density (MVD) were comparable in both groups. Conclusion: Placenta from late onset PE without FGR is still different from the normal placenta whatever time onset of PE pathogenesis may be similar. Absence of changes in MVD may explain good fetal outcome.

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