Nine Months by SSS Cairo

Students’ Scientific Society - Kasr El-Ainy Issue 3, 1st edition Spring 2012

SSS is an independent, non profit association; run by volunteered medical students & aiming at producing active contributing physicians of a global society

Gaining weight during pregnancy Prof. Hesham Badawi

Obstetric Ultrasound Prof. Khaled Rashid

Mother and Child... The Bond In-Between Prof. Tharwat el Ahwany

Nine Months What to expect when you’re expecting Breastfeeding: One More Challenge Prof. Azza Abul-Fadl When You’re About to Eat for Two The editorial team

Genome Wide Associated Studies in the Field of Gynecology. Prof. Mahmoud E. Salem Having a baby is more than just being pregnant: Strange Stories about Pregnancy Worldwide

Oh my God! I’m having a baby! The editorial team

The Fair Share The editorial team

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Issue 3 - 1 Edition

SSS Publications Support Division Director & Editor In-Chief: Ismail El-Kharbotly Special Thanks to the SSS Vice-President for External Affairs: Noha El-Zaydy . Special Thanks to the SSS Board of Officials and to everyone who helped create this copy come true.. 2

Editorials of SSS Medical—Issue 3: Sammar Moharram Ayman Sabae Yehia Hashish Nihal Abdelazim Ahmed Atef Belal Yomna Zaghloul Mohammed Salah Raghda Ayman Raghda Gasser Amal Soliman Yasmine Hefnawy

Students’ Scientific Society— Kasr Al Ainy

Nine Months Prof. Mohamed Elsada, SSS Supervisor

ear ―SSS Medical‖ readers. It is my pleasure that I have been involved with the activities of the SSS since October 2004. I admit that I did not know much about the society, nor the participants, although member of the faculty staff. I was surprised to encounter a group of motivated, highly active students, working together in a harmonized fashion, forming a superb team. The activities of the society are diverse covering more than one scope, among which is the ―SSS Medical‖ journal. The first issue, which was about Breast Cancer Awareness was the perfect example of what medical students are capable of achieving. They proved that such a scientific work can be presented in an all new different way: the SSS way.

The second issue as well so very well received that a second issue was to see the light of day. And here we are, the third issue.. I’m sure this edition won’t fail to accomplish the same goal as the first and the second in the most unique way. The journal ―SSS medical‖, is by far an accomplishment for SSS. Every page, every word of the journal you’re holding in your hands is yet another proof that SSS members aren’t only medical students, they are practically anything they want to be. The achievement of this important project shall be reflected on the medical community, final year students and young graduates. I sincerely hope that members of the society proceed more and more in their activities and hope that I can help them whenever they need it.

Samar Moharram Head of the 3rd Issue Team

ave you ever noticed that a quiet nap in the arms of a mother is the safest feeling on earth? Nothing beats those moments when the mother looks into her newborns' eyes and falls utterly in love, or when she tells her partner, mom, dad, sister, brother or even her cat the good news and watches their faces light up, or when she looks at her growing bump in the mirror and realizes there's a person in there! For a moment like this, some people wait a lifetime. That's why we chose this topic to be discussed in the 3 rd issue of the SSS medical; this unconditional love, this close unbreakable bond which will sustain them throughout the years- in a more or less scientific basis.

Putting together a journal like the SSS medical is a major collaborative undertaking. I've been blessed by a team who knew that a successful journal like the SSS medical will take time, dedication and perseverance to make it a blast at the end. So, I would like to thank each and everyone who made my job almost complete, I really do appreciate the effort, hard work and solidarity you carried out here. Special thanks to the marvelous Yahia Hashish for his great guidance, assistance and support.

Issue 3 - 1 st Edition

Oh my God, I’m Having a Baby! What to Expect When You Are Expecting

By the Editorial Team

regnancy is a time when one gets to hear a number of myths; however a lot of the things the new pregnant woman hears might not have a scientific basis. Early pregnancy symptoms can often be very confusing. The woman may see signs that lead her to believe she's pregnant when she's not, or she may easily miss signs that would indicate that she is, in fact, pregnant. Since the earliest days of pregnancy are so crucial for the baby's development, it is very important that she understands and knows how to recognize the early pregnancy symptoms correctly. There are quite a few things the pregnant woman can do during her pregnancy to help

improve her health and the baby's health as well. She can also avoid risks that can complicate or terminate a pregnancy. For example, she probably knows that getting enough Folic Acid is important. But does she know it is just as important to avoid cats? As soon as the woman discovers she's pregnant, she must start on changing some of her daily habits such as her diet. The pregnant woman should take special care of her health and diet during pregnancy. Caffeine, fish, junk food, uncooked meat should be avoided during these nine months.

Pregnancy Symptoms & Signs

When it Occurs

Other Possible Causes

Delay in menstruation

During entire pregnancy

Excessive weight gain or loss, fatigue, hormonal problems, stress, change of birth control

Nausea and vomiting

2-8 weeks after conception

Food poisoning, stress, other stomach disorders

Sensitivity to taste and smell

2-8 weeks after conception

Food poisoning, stress, other stomach disorders

Darkening of areola

1-14 weeks after conception, first signs, then throughout pregnancy

Hormonal imbalance

Dizziness

6-8 weeks after conception

Low blood pressure, middle ear infection

Frequent urination

6-8 weeks after conception

Diabetes, urinary infection, excessive intake of diuretics

Students’ Scientific Society— Kasr Al Ainy

Nine Months The woman should also be aware of the medications she takes before and after being pregnancy. Drugs that are safe to be taken while not being pregnant can cause devastating effects to a fetus when you are pregnant, such as Aspirin. It's recommended not to take any drugs during the first 8 weeks of pregnancy when the heart, lung, and brain of the baby are being formed, unless told to do so by the doctor. It's also to be known, that one of the common discomforts of pregnancy is that the pregnant woman feels continuously tired. It would be surprising if she wasn't tired. In some ways, her "pregnant" body is working harder even when she's resting than a non-pregnant body is when mountain-climbing; she just can't see its efforts. For one thing, it's manufacturing her baby's life-support system, the placenta, which won't be completed until the end of the first trimester. For another, it's adjusting to the many other physical and emotional demands of pregnancy, which are considerable. Once her body has adjusted and the placenta is complete (around the fourth month), she should have more energy. There are other common discomforts of pregnancy such as skin changes, backaches, breast changes, constipations, nausea, vomiting, difficulty sleeping, mood changes, heartburn and intestinal gas; however, this is not experienced by all pregnant women. Although each pregnancy is unique, certain changes are common to all normal pregnancies due to unusual amounts of hormones manufactured by the female body, like for example: In the first trimester of pregnancy extreme fatigue or morning sickness can color the mother’s daily life. Moodiness is normal. Happiness and anxiety about a new pregnancy, or upset about an unplanned pregnancy, are also common. Frequently a woman will become tearful with little cause. When asked why she is crying, she may find it difficult or impossible to give a reason. The pregnant woman needs increased love and affection; she may perceive her husband as unloving and non-supportive because he is sometimes unable to handle her tears. In the second trimester: Fatigue, morning sickness, and moodiness usually improve or go away. Perception of fetal movement often leads to dramatic changes in a woman. She now perceives the baby as a real person and becomes excited about the pregnancy even if she was not prior to this time. Women sometimes have more energy and feel better during the second trimester, commonly known as the "glow of pregnancy". Most women begin wearing maternity clothes during this time. The third trimester combines a sense of pride with anxiety about what is to come in order for the baby to be born. Forgetfulness may continue. As the labor is getting near, it is common to feel more anxious about the childbirth and how a new baby will change the mother’s life. In this period, the woman feels unattractive and undesired by her husband; some warm sensual feelings like cuddling or holding hands can be very uplifting for her… At the end, it’s important to say that pregnancy (especially the first one) is a very unique experience for each and every woman. The feelings and fears experienced during pregnancy are intense and varied. These feelings and concerns are a normal part of pregnancy. Each woman comes to terms with the changes in her own way, with the support of her husband & family...

Issue 3 - 1 st Edition

Understanding Obstetric Ultrasound By Prof. Khaled Rashid

ook Daddy, the baby is smiling and waving at you on TV!", the pregnant woman said joyously to her husband, while they were watching their unborn baby on a large television screen as it flails his tiny arms and legs, while twisting its little head back and forth. This is not a once-in-a-while story.. This is something that happens every single day somewhere on the planet. Ultrasound imaging, also known as sonography, uses inaudible sound waves to produce images of the different structures in the body. During an ultrasound examination, a small, hand-held device called a transducer is pressed against the skin. It generates highfrequency sound waves that pass through the body, sending back echoes as they bounce off organs, vessel walls and tissues. Special computer equipment then converts these echoes into an image. Because ultrasound uses sound waves instead of radiation, it is a safe way to image a pregnant woman and her unborn child. Obstetrical ultrasound is used to assess the baby's well-being and position, diagnose multiple gestations (twins, triplets, etc.) and estimate a delivery date. If the baby is old enough and positioned correctly, its sex also can be determined.

At present, most well established centers will offer every pregnant woman at least two or three ultrasound scans throughout her antenatal care. The timing and reasons for such scans are discussed in more details below.

Fetal Viability scan (6-10 weeks) This is an ultrasound examination that can be carried out either vaginally or abdominally. It aims to confirm an intrauterine pregnancy, determine the number of fetuses present and whether the pregnancy is progressing normally inside the uterus. This scan is useful for women who are experiencing pain or bleeding in the pregnancy and those who have had previous miscarriages or ectopic pregnancies. It may also help in accurate dating of pregnancy and calculation of the expected delivery date. Nuchal Translucency Scan (11-13 weeks) The vast majority of babies are normal. However all women, whatever their age, have a small risk of delivering a baby with a physical and/or mental handicap. In some cases the handicap is due to chromo som al abnormality such as Downs Syndrome. The only way to know for sure whether or not the fetus has a chromosomal abnormality is by having Ultrasound picture of an invasive test such as a 12-weeks fetus chorion villus sampling showing the normal (CVS) or amniocentesis. nuchal translucency However these tests carry and nasal bone a risk of miscarriage of about 1%. As a guideline, an invasive test is usually offered if the risk of Downs Syndrome is 1 in 300 or above.

Studentsâ&#x20AC;&#x2122; Scientific Societyâ&#x20AC;&#x201D; Kasr Al Ainy

Nine Months During the scan, the amount of fluid at the back of the baby’s neck (Nuchal Translucency) will be measured. Using this measurement, along with the mother's age, the age of the baby and the presence or absence of the baby's nasal bone, a risk is calculated to determine the likelihood of the baby having a chromosomal abnormality. Fetal Anomaly Scan (20-24 weeks) This is a detailed scan during which each part of the fetal body is examined. Special attention is paid to the brain, face, spine, heart, stomach, bowel, kidneys and limbs. If any abnormalities are detected the significance of the findings will be discussed and the couple will be given the opportunity to have further counseling. Fetal Cardiac Scan (20 weeks) A detailed examination of the fetal heart and connecting vessels is carried out usually at 20 weeks by a consultant cardiologist. It is especially recommended for women with a family history of heart abnormalities, or where increased nuchal translucency had been found at the 12 week scan. It is also an important scan in assessing the risk for Downs Syndrome because many of these babies have heart abnormalities.

This scan aims to determine the growth and health of the fetus by: • Measurement of the size of the fetal head, abdomen and thigh bone and calculation of an estimate of fetal weight • Examination of the movements Colour Doppler pictures of of the fetus the fetal brain • Evaluation of the placental position and appearance • Measurement of the amount of amniotic fluid • Assessment of blood flow to the placenta and fetus by colour Doppler ultrasound From the pattern of blood flow in these vessels we can assess if the placenta is working well and the fetus receives a normal amount of oxygen. It is evident from the previous data presented that ultrasound has become the most important tool in refined obstetric practice. The availability, safety, simplicity, and cost effectiveness of the techniques and their unmatched feedback on maternal and fetal outcome makes learning its skill a pivotal part in any modern obstetric practice.

Ultrasound picture of a normal 20-weeks fetus showing the four chambers of the heart

Fetal Wellbeing Scan (24-42 weeks) Some obstetricians advise that an ultrasound scan to assess fetal growth and wellbeing is offered to all women at about 30-32 weeks of pregnancy. Others reserve such scans for those women who have had previous complications of pregnancy such as preeclampsia, growth restriction, diabetes, still birth, and for those women who develop a problem during the course of their current pregnancy.

Hearing the baby's heartbeat for the first time is one of the most exciting moments of pregnancy, but nothing beats actually seeing the fluttering of his tiny heart on an ultrasound. Ultrasound pictures are not only a valuable diagnostic tool used to spot birth defects and other potential problems, but also a window into the baby's world that would have been unimaginable a generation ago.

Issue 3 - 1 st Edition

When Youâ&#x20AC;&#x2122;re About to Eat for Two By the Editorial Team

hat the pregnant woman eats during pregnancy can affect the health of the growing child. Even before the woman starts trying to get pregnant, she should take special care of her health by loading up on the food that is rich in vitamins and minerals and balancing her meals; once she becomes pregnant, she must make good nutrition a priority, as she'll be needing additional nutrients to keep her and the baby healthy. Water plays a key role in the diet during pregnancy. It carries the nutrients from the food the mother eats to her baby. Drinking enough water, especially in the last trimester, prevents her from becoming dehydrated. Not getting enough water can lead to premature or early labor. The amino acids that make up protein are one of the building blocks of the body's cells. So the pregnant woman should make sure she's getting enough protein throughout her pregnancy, especially during the second and third trimesters, when her baby is growing the fastest and her breasts and other organs are getting bigger to accommodate the needs of the growing baby. Dairy products provide the calcium the pregnant woman and her baby need for strong bones and teeth. Dairy products are also great sources of vitamins A and D, proteins, and B vitamins. Folic acid is essential for a healthy baby and helps in the development of the fetal brain and spine. Some excellent sources of folic acid include dried beans, tofu, peanuts as well as fortified cereals. Iron is needed in larger doses, especially in the later

stages of pregnancy, and cannot be met by diet alone. More iron is needed because the mother's blood volume may be increased by much as 30 percent. Without enough iron, the fetus will draw its supply from the mother, often leaving her anemic and exhausted. An iron supplement can alleviate this condition. However some food are considered harmful to the pregnant woman and her baby, therefore they should be avoided: Fish facts: Fish and shellfish are a great source of protein and heart-healthy omega-3 fatty acids. But almost all fish and shellfish contain mercury. Only high levels of this metal seem to be harmful to developing babies. So the risk of mercury in fish and shellfish depends on the amount and type eaten. Caffeine: Large quantities of caffeine can cause irritability, nervousness and insomnia as well as low birth-weight babies. Caffeine is also a diuretic and can deprive the body of valuable water. Finally, the pregnant woman should keep in mind that more is not always better. Some vitamins, such as vitamin A, are harmful in high dosages. It is important to be aware of the food and nutrients she introduces to her body. Maintaining a healthy lifestyle before, during, and after pregnancy benefits both mother and child.

Studentsâ&#x20AC;&#x2122; Scientific Societyâ&#x20AC;&#x201D; Kasr Al Ainy

Nine Months

The Fair Share

s it true, that the role of the father during pregnancy is limited to driving his screaming wife to the hospital and to pace nervously around the waiting room? Of course not! Being heavily involved during the nine months of pregnancy is probably the best way, not only to assist the pregnant mother through the traumas of it all, but also to let the father feel a sense of participation himself. During the nine months, the mother undergoes many psychological changes that may extend till after birth. The father should provide the best support for his wife making her the strongest & enabling her to face all these changes. Many things can be changed in a couples' daily life: For example, if the mother quits smoking, the father should try & quit too. As the pregnancy progresses she may feel unattractive at times. The father should understand & tell her that she's beautiful even if she's not. The discussions between the parents are extremely important, like discussions about the baby's name, decorations of the new baby's room, the hospital/clinic to go toâ&#x20AC;&#x201C; the list is just endless.. As a father-to-be, the man may also undergo psychological changes. It differs from one man to another, but there are some common concerns like "Will I be a good father?", "What's it like to be a dad?", "How can I help if I don't understand "women's" problems" & "Will she love the baby more than me?". Other more drastic fears include the financial situation of the family during pregnancy & after birth, making the pressure for the man to get a better job quite intense. The best way to look at all these emotions & fears is to remember that for the first child, both parents are learning how this works, so they should do as much as possible together and share the load and the laugh about it.

By the Editorial team The pregnant woman may find some difficulties dealing not only with the father, but also with her other children if this is not her first pregnancy. Some children want to have a sibling, so experience mostly happiness, while others like being the only "babies" in the family & hence experience jealousy, fright and even rage. Most of the children though experience a rollercoaster of feelings, with ups and downs according to their moods and the way the parents deal with this issue. The arrival of a new baby usually occupies the parents, leaving their other children in an awful feeling of loneliness. All children crave love & attention of the parents. When it is lacking, the child's feelings of security & uniqueness are endangered leaving only fears of being abandoned or left behind. These feelings may be projected directly to the new baby, creating hatred & a condition known as sibling rivalry once the baby is born. That is why the parents must discuss this issue with their children & take the time to make them feel important, loved & unaffected negatively by the baby. The parents should also try to convince the children of the importance of being a big brother/sister, & how lucky they are now that they are no longer babies, but have a bigger role in the family. The children will respond mostly by assuming responsibility, turning one of the toughest situations a child could face into the greatest gift the child could receive. Pregnancy is not an event concerning only the mother as many might feel, but it needs the involvement of all family members making them experience the happiest times in their lives each with a fair share that should not be neglected.

Issue 3 - 1 st Edition

Mother and Fetus: The Bond In-Between By Prof. Tharwat el Ahawany and the Editorial Team

he mother-child relationship is probably the strongest, most long lasting relationship in the history of any life form. Mankind is no exception. Let’s reflect a little bit on that, shall we? Can’t we say that this relationship is what guarantees the continuity of anything that can be described as “alive”? No wonder a relationship as old as time, such as this One, begins since the very first day of child conception, even before his actual birth. Not only does the mother perceive the messages sent to her by her unborn child, but also, the fetus, in return does capture and react to the stimuli sent to him by the flesh surrounding him he’ll later learn to call “mum”. A 24/7 hotline between the mother and the life inside of her is what we’re here to present. A mutual love story that combines instincts and emotions as big as life itself.

From Mother to Fetus.. A World to Explore While it is often believed that the human fetus is an immature emotionless piece of meat, lacking true sensations, emotional affects, or even the ability to feel pain, pregnant women through the ages have intuitively known what scientists have only recently discovered: That a mother's unborn child hears her voice and senses her love. As strange as it might sound, the unborn child has significant sensory capabilities. He can see, hear, and feel.

For example, by the fourth month after conception, the unborn child has a welldeveloped sense of touch and taste. He can perceive a bright light shining on the mother's abdomen; if the light is particularly bright, he will lift his hands to protect his eyes. At five months, he will react to a loud sound by raising his hands and covering his ears. The unborn has the capacity to perceive and remember sounds of speech, to recognize a story heard repeatedly, and to recognize his own mother's voice. He has formed the brain structures necessary for learning, and even awareness, sometime between the 28th and 32nd weeks of development. In his highly acclaimed study, Dr. Michael Lieberman showed that an unborn child grows emotionally agitated (as measured by the quickening of his heartbeat) each time his mother thinks of having a cigarette. She doesn’t even have to put it to her lips or light a match; just the idea of having a cigarette is enough to upset him. Naturally, the fetus has no way of knowing his mother is smoking – or thinking about it – but he is intellectually sophisticated enough to associate the experience of her smoking with the unpleasant sensation it produced in him. This is caused by the drop in his oxygen supply (smoking lowers the oxygen content of the maternal blood crossing the placenta), which is physiologically harmful to him, but possibly even more harmful are the psychological effects of maternal smoking.

Students’ Scientific Society— Kasr Al Ainy

Nine Months We know also that most of what a mother eats, drinks or inhales, is passed through her bloodstream into the body of her baby; maternal emotions are transmitted physiologically as well. Stress hormones travel through the mother's bloodstream to the fetus, inducing the same stressful state in the unborn child. Babies respond not only to a surge of adrenaline, but also to mother's behavior. When she pats her stomach, talks, sings, or dances, the unborn child knows that the mother is actively there. of maternal smoking. Dr. Thomas Verny, in his book “The Secret Life of the Unborn Child”, gives numerous examples of how, by creating a warm, emotionally enriching environment in-utero, a woman can make a decisive difference in everything her child feels, hopes, dreams, thinks, and accomplishes throughout life. Communication also occurs on the psychological plane, with baby responding to mother's deepest thoughts and feelings. This does not mean that every fleeting worry, doubt, or anxiety a woman has rebounds on her child. What matters are deep persistent patterns of feeling, such as chronic anxiety or a continuous doubt about motherhood as a whole. On the other hand, thoughts infusing the baby with a sense of happiness or calmness set the stage for a balanced, happy, and serene disposition throughout life.

The Other Side of the Story Taking a look through the mother’s eyes makes things get a bit clearer and less hypothetical. Hence, science managed to use the mother’s side of this relationship to be able to reduce perinatal mortality and morbidity aiming at the outcome of a healthy mum and

baby. The science of assessment of fetal wellbeing by the mother is the outcome. Prof. Dr. Tharwat El Ahawany extrapolates on this issue by stressing on the importance of understanding the normal fetal behavior in-utero to assess its wellbeing, based on the facts, that fetal breathing movements occur 30% of the time and gross body movements 10% of the time during the last 10 weeks of pregnancy. He elaborates: ―Cycles between activity and calmness occurs over a time span of approximately 60 minutes in fetal heart rate at term and that fetal heart rate accelerates with fetal body movements. A compromised fetus will demonstrate the following, a reduction reactivity and absence of breathing movements. In more severe cases fetal body movements and tone are decreased. The blood going to the kidneys is reduced thus leading to reduced liquor volume and the fetal growth is also reduced‖. His vital assessment is an indispensable part of the proper antenatal care. A right, which every unborn child should have from the start. No reason to gamble with the well-being of the baby forming inside yourself when science is offering numerous ways to ensure the unborn child's well-being and the mother’s own. Dr. El Ahawany kindly presents us with some of these tests that should be all incorporated, to reach dependable results that should clearly identify the compromised fetus at a stage at which intervention will improve the outcome: 1- Fetal movement Count by the Mother: It is well recognized that reduction in maternal perception of movements maybe the harbinger of a sick fetus. However this may occur too late, with her fetus being already dead. Or the fetus may demonstrate normal activity, which she failed to perceive. It is recommended that women who report a reduction or alteration in the movements of their fetus should be offered another form of fetal assessment.

Issue 3 - 1 Edition

Pregnancy worldwide

Nine Months

Issue 3 - 1 st Edition 2- Non-Stress Test (NST) or “Recording Fetal Heart via Cardiotocography (CTG)”: Although it is quick and simple, interpretation can be difficult. A normal test will show accelerations linked to fetal movements and reduction in heart rate variability in a compromised fetus. Despite its importance, the predictive value for an abnormal NST for perinatal morbidity and mortality is less than 40%. 3- Biophysical Profile (BPP): Assessing the biophysical activity, to predict fetal compromise has first been described by Manning in the 1980s. It depends upon ultrasonic assessment over 30 minutes liquor, fetal tone, body and breathing movements and finally the NST. Many adjustments had occurred since then, including the addition of the placental grading. The most powerful tools in which would be the liquor volume and the NST and thus may well be used alone. 4- Ultrasonography and Doppler Analysis of the Umbilical Artery Waveforms: This can be done by assessing the fetal weight with serial ultrasound examinations. To add to the practicality of this test, Doppler analysis of the umbilical artery waveform is done.

Speaking of Ultrasonography She was once only a street corner away from getting an abortion. "I was scared and I didn’t really know what to do. I thought that abortion was my only option." On her way to the clinic, she finds an ad for an Ultrasonography center, decided to check it out. Seeing these tiny black -and-white images of little hands and feet, ―…and I could hear the heartbeat. It sounded like horses galloping". You can guess the rest of the story, seeing her unborn child made the difference in this child’s life.

This story is not only typical, but it happens every day ev er yw h er e on the planet. Utrasonography has proved to give a m a j o r boost to the already abundant flow of emotions between a mother and the fetus, and, in fact, between the father and the fetus as well. Not only that, but a very serious study conducted by the Department of Radiology, CHA University in Seoul, Korea, showed that mothers who had 3D Ultrasonographies showed their ultrasound images to a greater number of people compared to mothers who had 2D Ultrasonographies alone and this may represent mother's social support system, concluding that 3D Ultrasonographies may have a greater impact on the maternal-fetal bonding process than 2D Ultrasonographies. Before ultrasound was used, a woman had less reason to feel attached to her baby during the first 16 to 18 weeks of pregnancy. The in-utero child was still too small to be felt, yet only seen. The maternal bonding phenomenon seemed to begin at about 16 to 18 weeks into the pregnancy, when the mother could feel the baby kick in the womb. Ultrasound has changed all this. Even during the first trimester, a woman who saw a sonogram image of her unborn fetus now felt attached to her baby. That is, she wanted to know and protect her child. The image on the screen isn’t just an image of any tiny human; a generic photo of fetal development could show her that. It is hers, a human life she has helped create, a moving baby with a beating heart. Hearing your baby's heartbeat for the first time is an amazing experience, seeing your baby on a monitor while having an ultrasound is even more amazing. This is all a part of prenatal care and while you will have to be responsible and make many visits to the obstetrician, the payoff will be well worth it.

Students’ Scientific Society— Kasr Al Ainy

Nine Months

Bad News in the Scanning Room! By the Editorial Team

woman seeing her own baby die before even being born is definitely a scene that's too heart-breaking to even picture. A woman receiving the news of her baby being a boy, together with the news of him having a cardiac anomaly that won't allow him to exert any physical effort (he won't be on the football team at school!) is truly a grief-evoking situation. This kind of situations happens in the scanning rooms, but thank God, it doesn't happen that often. As a matter of fact anomalies in the developing fetus affect only 1-3% of newborns in the general population with different variations from minor disorders that have little or no impact to the body physiology to major disorders that may need intervention. Why Would Those Unexpected Anomalies Happen?! This occurs mainly due to aberrations in the chromosomes; a defect in the constituent genes can be translated in abnormal development of organs or deficiency in certain metabolic pathways. This may be due to behavioural factors especially for young mothers who are relatively ignorant to the risk factors like exposure to various medications in pregnancy particularly anti-epileptic drugs, maternal diabetes, ionizing radiation, or it may result from relatives' marriage. Luckily, a good proportion of chromosome disorders goes into miscarriage in the first trimester of pregnancy and is by far the commonest cause of miscarriage in the first trimester. Parents: Don't Worry! In good hands, doctors can exclude most of defects in the fetus at 20 weeks of pregnancy including even performing a full echocardiography assessment of the fetal heart similar to what we do in adult life. Some of the disorders in the developing fetus can be treated intrauterine.

Draining pleural effusions, transfusing blood to an anaemic fetus, relieving urine obstructions by insertion of shunts in the urinary bladder or kidneys, are all examples of intrauterine treatable conditions. In all of the previous techniques, physicians use ultrasound to guide them to the right spot. Being in a Dilemma Prenatal screening has created a dilemma for women as it requires them to quickly decide whether to continue a pregnancy or terminate it. This can be psychologically traumatic for women to choose between their connection to an unborn child with all its possible imperfections, and a desire to prevent its suffering as a disabled child in later life. Women who terminate a pregnancy following prenatal screening may experience an acute grief reaction or be plagued by guilt and fear that can precipitate marital breakdown. Because parents form a bond with their child long before birth, it is normal for parents to experience intense loss when their unborn baby dies. A woman and her partner may cope with their grief in different ways, sometimes creating tension between them when they need each other most. Parents should seek emotional support from friends, family & even their physician. It takes more than a married couple's support to one another, to safely pass one of the hardest times of their lives, to get over their precious loss, & to recover from such damage to their psyche.

Issue 3 - 1 st Edition

Gaining Weight during Pregnancy By Prof. Hesham Badawi

hether the woman likes it or not, weight gain is inevitable during pregnancy. The baby's growth and development depends on it. For the 1st half of the 20th century, it was recommended that weight gain during pregnancy to be limited to less than 9.1 kg to prevent hypertensive disorders and fetal macrosomia resulting in operative deliveries. By the 1970s, however, women were encouraged to gain at least 11.4 kg to prevent preterm births and fetal growth restriction. After 1990, it is recommended a weight gain of 11.5-16 kg for women with normal pre-pregnancy body mass index (BMI).

C a u t i o n should be Fetus undertaken Placenta in women Liquor who have Uterus weight platBreasts eaus or lose Blood weight at or Extracellular fl. near term, it Fat may indiTotal cate an alarm bell that the pregnancy is not progressing normal.

3.4 kg 0.64 kg 0.8 kg 1 kg 0.40 kg 1.25 kg 1.2 kg 3.8 kg 12.5 kg

Many women get concerned about how Underweight (BMI < 19.8) 12.5-18 kg they're going to lose all this extra weight Normal weight (BMI 19.8-26) 11.5-16 kg afterwards. Following a healthy diet Overweight (BMI > 26-29) 7-11.5 kg and exercising while pregnant makes it easier to Obese (BMI > 29) < 7 kg lose this extra weight. However, not all the weight put on during pregnancy is lost during and immediThe ideal weight gain during pregnancy is ately after delivery. The normal lady who gains about 1 kg in the 1st trimester, 5 kg in the 2nd 12.5 kg in pregnancy is about 4.4 kg above her rd trimester and another 5 kg in the 3 trimester. pre-pregnant weight when she goes home post -partum. Although excess weight carries risks - such as gestational diabetes - pregnancy isn't the time In the end, gaining the to lose weight. Even women who are overright amount of weight during weight should gain some weight during pregpregnancy is a balancing act. nancy. The mother needs to Pre-pregnancy BMI

Recommended total weight gain

The model value weekly weight gain from 20 weeks gestation is 0.4/kg. Higher rates of weight gain (> 0.5 kg / week) are associated with an increased risk of hypertension and operative deliveries, whereas low rates of weight gain (<0.3 kg/ week) are associated with an increased risk of low birth weight and perinatal loss.

eat extra calories, but not too many. And she'll have to stay active, but not so active that she ends up burning all of those extra calories. This is one time when a woman's weight really matters to somebody else.

Studentsâ&#x20AC;&#x2122; Scientific Societyâ&#x20AC;&#x201D; Kasr Al Ainy

Nine Months

Breastfeeding: A Challenge By Prof. Azza Abul Fadl

nly a mother knows how it feels like to be a mother, only a mother knows how to be a mother, & only a mother knows how hard it is to be a good mother. A mother knows that her role in her baby's life, since his very early days, is probably the most important thing she'll ever do. So she does it, & she does it well. She seeks perfection in everything & continuously offers her baby the best. When it comes to nutrition, the best is breast milk. It Could be Life Saving! More than five million babies can be saved every year if they were breastfed. Deaths from diarrheal diseases are 16 times more common among non-breastfed, and death from respiratory infections is four times more among the non-breastfed. Among the 11 million babies who die every year from malnutrition and disease, at least half of them can be saved if they were exclusively breastfed from birth to six months and had continued to breastfeed with adequate complementary foods for two years or more. It's Not about Just Doing It; it's about Doing It Right. Research has shown that such benefits are influenced by the manner in which this mother breastfeeds her baby i.e. 'breastfeeding practices'. It has been shown that many of the so called "disadvantages of breastfeeding" were related to poor practices that place successful breastfeeding at risk and harm the baby and mother. They include early mother infant separation, delaying breastfeeding, placing restrictions on the durations and frequency of the breastfeeds, giving unnecessary supplements other than breast milk or bottles that interfere with breast milk production, and finally enslaving the baby to suck at a rubber dummy so called 'nipple' to make it forget about the mother and sever the relationship even more.

The Baby Friendly Hospital Initiative With the building up of research showing how important breastfeeding practices were to make breastfeeding more effective in saving lives and improving maternal and child health and well being, UNICEF and WHO developed the "Ten Steps to Successful Breastfeeding" and called the health facility that abides by these Ten Steps a "Baby Friendly Hospital".

10 steps to successful breastfeeding 1) Have a written breastfeeding policy 2) Train all heath care in skills necessary to implement all this policy 3) Inform all pregnant women about the benefits and management of breastfeeding 4) Help mother initiate breastfeeding within a half hour of birth 5) Show mothers how to breastfeed and maintain lactation even if they should be separated from their infants 6) Give newborn infants no drink or food other than breast milk, unless medically indicated 7) Practice rooming-in by allowing mothers and infants to remain together 24 hours a day 8) Encourage breastfeeding on demand 9) Give no artificial teats or pacifiers (also known as dummies) to breastfeeding infants 10) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic

So the question now isn't why mothers should breastfeed their babies. "Why not" is the better question. Every mother has the choice whether to try, succeed and make it a wonderful experience or to take the easy way out, use bottle milk & miss tasting the joys of nursing her own child from her own body.

Genome Wide Associated Studies in the Field of Gynecology By Prof. Mahmoud E. Salem

he study of genetics is a rapidly expanding field in all areas of medicine, including fertility, particularly in the fields of ovarian function, polycystic ovary syndrome (PCOS) and endometriosis. In addition, the number of genes known to be expressed reproductive function has increased dramatically in recent to have a role in complex reproductive diseases, such as candidate gene families that may be differentially regulated identified.

in the ovary and involved in years. Genetics also appear endometriosis. A number of in endometriosis have been

Increasing our understanding of the genes involved in normal and abnormal ovarian function may lead to improved clinical diagnosis and early detection, along with the development of new agents or technologies for use in fertility treatment. The new vision of ―personalized medicine‖ as touted today by academia, industry, and others could probably be better thought of as ― genomically personalized medicine‖. In many ways, this vision truly represents a revolution in healthcare. A central axiom of the movement is the concept of ’The right drug at the right dose for the right person at the right time’. Although the search for candidate genes is bound to continue, it seems increasingly likely that Genome Wide Associated Studies (GWAS) is the approach that is most likely to uncover the genes contributing to such significant fertility issues with genetic background. Although this would require substantial resources and very large case– control populations, the limitations of earlier studies may be overcome and new studies promise to be more informative. What is a GWAS? • A genome wide association study is an approach that involves rapidly scanning markers across genome ( ≈ 0.5M or 1M) of many people ( ≈2K) to find genetic variations associated with a particular disease. • A large number of subjects are needed because (1) Associations between SNPs (Single Nucleotide Polymorphisms) and causal variants are expected to show low odds ratios , typically below 1.5 (2)In order to obtain a reliable signal, given the very large number of tests that are required, associations must show a high level of significance to survive the multiple

Students’ Scientific Society— Kasr Al Ainy

Genome Wide Studies What have GWAS found? • In 2005, it was learned through GWAS that age-related macular degeneration is associated with variation in the gene for complement factor H, which produces a protein that regulates inflammation (Kleinetal. (2005) Science, 308, 385– 389) carried out GWAS for the diseases coronary heart disease, type 1 diabetes, type 2 diabetes, rheumatoid arthritis, Crohn's disease, bipolar disorder and hypertension. This study was successful in uncovering many new disease genes underl ying these diseases. Examples

GWAS:

• Association scan of 14,500 nonsynonymous SNPs in four diseases identifies autoimmunity variants. Nat Genet. 2007 • Genomewide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Wellcome Trust Case Control Consortium Nature. 2007;447;661 - 78  Genomewide association analysis of coronary artery disease. Samaniet al. N Engl J Med. 2007;357;443 -53 • Sequence variants in the autophagy gene IRGM and multiple other replicating loci contribute to Crohn's disease susceptibility. Parkesetal. Nat Genet. 2007;39;830- 2  Robust associations of four new chromosome regions from genome‐ wide analyses of type 1 diabetes. Todd et al. Nat Genet. 2007;39;857- 64 • A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Frayling et al. Science. 2007;316;88994 • Replication of genomewide association signals in UK samples reveals risk loci for type 2 diabetes. Zeggini et al. Science. 2007;316;1336- 41 • Scott et al. (2007) A genome-wide association study of type 2 diabetes in Finns detects multiple susceptibility variants. Science, 316, 1341–1345. GWAS on Endometriosis Endometriosis, a major contributor to pelvic pain and subfertility, is characterized by endometrial like tissue outside the uterus (Giudice, 2010). Estimates suggest endometriosis affects 20–50% of women with infertility (Gao et al., 2006) and up to 82% of women with pelvic pain ( D’Hooghe e t al., 2003). Endometriosis is commonly regarded as a complex trait, caused by the interplay between genetic and environmental factors. There is a rapidly increasing interest in identifying genes and genetic polymorphisms that predispose women to increased risk of developing endometriosis (Kennedy, 2003). A genome wide association study involving 1,907 Japanese individuals with endometriosis (cases) and 5,292 controls has identified genetic variants in the CDKN2BAS locus associated with endometriosis (2010). Another genome wide association study in 3,194 surgically confirmed endometriosis cases and 7,060 controls from Australia and the UK has identified a locus at 7p15.2 to be associated with endometriosis (2011)

Genome Wide Studies GWAS on PCOS Polycystic ovary syndrome (PCOS); the most common endocrine disorder in women, is responsible for a large percentage of infertility cases through the associated anovulation. As the most common cause of anovulatory infertility, PCOS affects 6%–8% of childbearing aged women2,3. PCOS is also associated with endocrine‐ metabolic derangements leading to a broad range of adverse sequel that include dyslipidemia, atherosclerosis, insulin resistance and type 2 diabetes (T2D). The pathogenesis of PCOS is not fully understood. Heritable tendencies have long been recognized, but complex interactions exist between genetic and environmental factors. Association studies have been conducted on at least 70 candidate genes principally related to reproductive hormones, insulin resistance and chronic inflammation—for example, follicle stimulating hormone receptor (FSHR), insulin receptor (INSR) and Interleukin 6 (IL6)10–13. However, few genes influencing susceptibility to PCOS have been determined. Array‐ based genome‐ wide SNP association analyses should provide a more comprehensive, unbiased approach to detect susceptibility genes for diseases like PCOS14. Results have been published recently of a GWAS in Han Chinese women with PCOS. The discovery set included 744 PCOS cases and 895 controls; subsequent replications involved two independent cohorts (2,840 PCOS cases and 5,012 controls from northern Han Chinese; 498 cases and 780 controls from southern and central Han Chinese). The researchers identified strong evidence of associations between PCOS and three loci: 2p16.3; 2p21; and 9q33.3. These findings provide new insight into the pathogenesis. A number of loci of interest were identified, including one close to the gene encoding the LH receptor ( Chen et al ., 2011 ).

Useful

links:

http://www.gwascentral.org/studies?pag e_size=10&page=2&format=&q=&m=All&t=ZE RO&o=Identifier%20(descending)

Students’ Scientific Society— Kasr Al Ainy

Nine Months

We are As our constitution reads - the Students' Scientific Society is an independent, non-profit association, run by volunteered Kasr El Ainy medical students and represents the local level of the International Federation of Medical Students' Association "IFMSA". The SSS opens for future physicians a gateway to understanding global health issues; becoming culture-sensitive medical students capable of constructively appreciating, criticizing, and improving the community . Our approach varies greatly from common traditional tools of the learning process. Projects and activities are developed and periodically reviewed to guarantee a place for every taste! Professional and Research Exchange:

We are those who chose to take responsibility for life, for community, for our medical colleagues and for ourselves. We are those who want to be worthy of demanding a brighter tomorrow that we can be proud to share with future generations… We are the SSS members… The fuel? The members. We do EVERYTHING ourselves, from human resources to public relations, from management to finances, from fundraising to publications. Our members learn everything by doing everything, proving once more that medical students can do everything they put their minds into doing. Please take the time to navigate through our committees and to become acquainted with what we offer.

The SSS is already highly recognized for its exchange program. On an annual basis, dozens of Egyptian Medical Students are given the chance to experience a different medical atmosphere abroad. We also receive Standing Committee on Public Health foreign students of different Standing Committee on A real major concern in all over the world & backgrounds - who come for a Medical Education particularly in Egypt is Public health. Health winter or summer school. education, direct supportive projects and Medical Education - like medicampaigns associated with projects as cine itself - evolves from day to Standing Committee on Hepatitis Awareness, TB Advocacy, and day. Amid this revolution to Reproductive Health provide the best line of medical Diabetic Complications Awareness are part of the committee's trials to ensure education there's an increasing Even we, medical students, face knowledge of the disease & treatment to demand at our faculty for a some problems at appreciating & both the medical & the non-medical sensible, feasible change in the developing awareness towards an

near future & a major shift in important issue such as reStanding Committee on Child Health & the long term. At the SSS we productive health. This committee Humanitarian projects totally appreciate that change has been specially developed to demands the administration & The very first, the very new, the one & only tackle the problem. Awareness the students working hand in committee to pay particular attention to chilcampaign, peer-education prodren. Believing that a doctor must be a grams & workshops are conducted hand. Via research methodolohuman doctor, we decided to place a child's gy courses, participation in on an annual basis, usually in faculty's accreditation proto- interests as the priority of this committee, to relation to internationally recogunderstand a child's feelings, struggles & col, competitions and more to nized days, such as the needs. This is where your inner child comes come we believe we are well World Aids Day, into action! on the correct path.. since we work on local, Last but not least…Our Publications national and international This issue of SSS Medical is the latest in a number of topic-oriented publications; with each issue, levels. there's a topic of medical interest to be tackled. Our previous publications include The Buzz and Impulse - social magazines - plus our own wall magazine . The Publications Support Division aims to not only provide both informative enrichment and entertainment to Medical Students, through its magazines, but also to SSS members, through exclusive projects, a newsletter, an online podcast ―SSS Radio‖ and an in-office library.

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Students’ Scientific Society— Kasr Al Ainy