Egyptian Maternal and Fetal Medicine Foundation

19/05/2026

Pulmonary artery sling(PAS) . Prenatal sonographic diagnosis and clinical implications .
By professor:
Mohamed Ali Abdelkader
Prof. of Ob/Gyn, Cairo university.

Case presentation :
This case has been sent to me by Dr. Sayed Hamdoon from Uganda to target the fetal heart .
She is about 34 weeks gestation and her fetus showed the following sonographic features :
-Severe IUGR
-Cardiac examination showed disproportionately large right ventricle in the 4 chamber view (figure 1),normal criss crossing of aorta and pulmonary arteries in the 5 chamber view . The outstanding changes were detected in the 3 vessel and tracheal view where the pulmonary artery was detected encircling the trachea (figure 2) .Color Doppler confirmed the previous findings.(figure3)
A provisional diagnosis of pulmonary artery sling was reported
An illustrative video clip shows the whole case (seen after the figures).
Discussion :
-A pulmonary artery sling (PAS) ,also known as Aberrant left pulmonary artery, is a rare congenital vascular anomaly where the left pulmonary artery (LPA) originates from the the right pulmonary artery (RPA) instead of the main pulmonary artery. (1)
-In this case you will find that the trachea lies between the branches of the pulmonary artery with the aorta and superior vena cava lying in their normal anatomical positions
-The tiny branch encircling the trachea and forming the sling is the aberrant left pulmonary artery originating from the right pulmonary artery.
Clinical implications:
Pulmonary artery sling if causing complete tracheal ring might compress the trachea causing severe neonatal respiratory distress necessitating emergency corrective surgery ,so confirming the diagnosis neonatally together with a preparing a corrective surgical team is mandatory (2)

Mohamed Ali Abdelkader, MD.

References :
1)Backer CL, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: vascular rings, tracheal stenosis, pectus excavatum. Ann Thorac Surg. 2000 Apr;69(4 Suppl):S308-18.
2) Ore AC, Brown JW, Weber TR, Turrentine MW. Surgical treatment of pulmonary artery sling and tracheal stenosis. Ann Thorac Surg. 2005 Jan;79(1):38-46; discussion 38-46.

16/04/2026

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06/04/2026

Congenital adrenal hyperplasia (CAH).Prenatal sonographic diagnosis and case presentation :
By professors:
Mohamed Ali Abdelkader MD, Egypt.
Durr Sabih MD, Pakistan.
Case presentation :
A pregnant woman about 23 weeks gestation came for routine second trimester ultrasound . Her fetus showed the following sonographic features :
⁃ Remarkably enlarged highly vascular adrenal glands with dimensions equal to or even exceeding renal dimensions .They are detected as bilateral hypo echoic masses above the more echogenic kidneys .(clip 1)
⁃ Ambiguous genitalia , detected as echogenic swelling between the fetal thighs without a phallus or labial formation (clip 2)
A provisional diagnosis of congenital adrenal hyperplasia was set .

Discussion :
Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorderscharacterized by impaired cortisol synthesis. (1)
It results from the deficiency of enzymes required for the synthesis of cortisol in the adrenal cortex. Impaired cortisol synthesis, prompts a compensatory increase in adrenocorticotropic hormone, which leads to adrenal cortex hyperplasia ,hence the name "CAH."
The most common form, 21-hydroxylase (21-OH) deficiency, accounts for approximately 95% of cases. (2)
Prenatal sonographic diagnosis is achieved by finding remarkably enlarged highly vascular adrenals together with the presence of ambiguous genitalia (3) .
Prognosis :
Depending on the enzymatic defect , there are 2 major problems resulting from imbalance of s*x steroids and mineralocorticoids in this disease:
First :Ambiguous genitalia and virilization in genotypic females resulting from excessive androgens
Second : Potentially life-threatening adrenal insufficiency from deficiency of mineralocorticoids .
Management :
Once CAH is suspected by prenatal ultrasound and confirmed by neonatal examination , it is essential to perform neonatal karyotyping to prevent genotypic females with ambiguous genitalia to be reared as males
Neonatal diagnosis can also prevent the life threatening acute adrenal insufficiency .
Neonatal screening for 21 hydroxylase deficiency between 2-4 days after birth is essential and currently performed routinely in more than 40 countries .
Once diagnosis is made , the best treatment is cortisol (hydrocortisone ) replacement therapy (4).

Mohamed Ali Abdelkader , MD.

References:
1)El-Maouche D, Arlt W, Merke DP (November 2017). "Congenital adrenal hyperplasia" (PDF). Lancet. 390 (10108): 2194–2210.

2) Gurpinar Tosun B, Guran T. Rare forms of congenital adrenal hyperplasia. Clin Endocrinol (Oxf). 2024 Oct;101(4):371-385.

3)Chen S, Wu L, Ma X, Guo L, et al. Current status and prospects of congenital adrenal hyperplasia: A bibliometric and visualization study. Medicine (Baltimore). 2024 Nov 08;103(45):e40297. [PMC free article] [PubMed]

4)Yanase T, Tajima T, Katabami T, et al.Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocr J. 2016 Sep 30;63(9):765-784. [PubMed]

06/03/2026

Edward syndrome(trisomy 18), prenatal sonographic soft markers and case presentation:
By professors:
Mohamed Ali Abdelkader MD, Egypt
Durr Sabih MD, Pakistan

Case presentation:
A third trimesteric pregnant women about 34 weeks gestation presented with the following soft markers:
Micrognathia ,Sloping forehead, clenched hands with overlapping fingers,characteristic CNS features including wide cavum septum pellucidum (10 mm) ,cerebellar hypoplasia, megacisterna magna (15 mm) and poorly formed Sylvian fissure.

Dicussion
Soft markers are sonographic findings with little or no pathological significance, and they are not usually associated with any handicaps . However, the presence of more than one soft marker with or without
major anomalies should make the sonologist suspect an aneuploidy.(1)
In the event of multiple soft markers, ACOG recommends a detailed fetal anatomic ultrasound examination, additional screening, diagnostic testing, and genetic counseling.(2)
The trisomy 18 syndrome, also known as Edwards syndrome, is a common autosomal chromosomal disorder due to the presence of an extra chromosome 18. The first reported infants were described in 1960 by Edwards et al.(3)
The prevalence of trisomy 18 rises with the increasing maternal age. The recurrence risk for a family with a child with full trisomy 18 is about 1%.
Typical soft markers include characteristic craniofacial features, clenched fist with overlapping fingers, together with CNS , cardiac and renal anomalies.
In this case , who was pregnant at 34 weeks ,some typical soft markers of trisomy 18 were detected and I am going to discuss them in details .
1)Craniofacial features :
-Sloping forehead,micrognathia (figure 1)
-Prefrontal thickening (figure 2)
2)CNS features :
-Wide cavum septum pellucidum >10 mm
(figure 3)
-Poorly formed Sylvian fissure (figure 4)
-Mega cisterna magna (15 mm)- (figure 5)
3)Clenched hands with overlapping index finger ((figure 6).

Mohamed Ali Abdelkader , MD

References:
1) Hu, T.; Tian, T.; Zhang, Z.; Wang, J.; Hu, R.; Xiao, L.; Zhu, H.; Lai, Y.; Wang, H.; Liu, S. Prenatal chromosomal microarray analysis in 2466 fetuses with ultrasonographic soft markers: A prospective cohort study. Am. J. Obstet. Gynecol. 2021, 224, 516.e1–516.e16.
2) American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics; Committee on Genetics; Society for Maternal-Fetal Medicine. Screening for Fetal Chromosomal Abnormalities: ACOG Practice Bulletin, Number 226. Obstet. Gynecol. 2020, 136, e48–e69.
3) Edwards JH, Harnden DG, Cameron AH, Crosse VM, Wolff OH. A new trisomic syndrome. Lancet. 1960;1:787–789.

23/01/2026

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20/01/2026

Maternal corticosteroids to enhance fetal lung maturity . My concerns for the clinicians about potential hazards .

By professor Salah sand .Prof. of Ob/Gyn . Cairo university .

Many clinicians are fan of giving maternal corticosteroids to enhance fetal lung maturity in premature infants . This preventive treatment has been proven effective if delivery occurs within a week of administering the injection. But do they have any long-term harms? Studies indicate that the most important potential complications for the fetus (especially with treatment use in the ninth month, or with repeated doses) are:
1. Increased rates of behavioral disorders and cognitive skill problems.(1)
2. Impaired stress response to life stressors, due to disruption in the secretion of the cortisol hormone when needed , which normally reduces reaction time, increases mental focus, provides energy, and boosts immunity during physical injuries.(2)
The mechanism behind these potential negative effects can be understood by presenting the following points:
Firstly: Cortisol works to mature cells, but if its level rises above its normal physiological rate, it contributes to their atrophy.
(Maturational but antiproliferative effect, which if increased becomes pro-apoptotic)
Therefore:
a) In the ninth month, the fetus needs its cells to mature in preparation for birth, so its cortisol level rises. Consequently, the negative effect of the lung injection appears if used at that time due to the cumulative increase in cortisol level.
b) The brain regulates cortisol secretion from the adrenal gland. If the cortisol level in the fetus's blood rises, it may lead to atrophy of some cells in this part of the brain (Hippocampus), as animal experiments have shown, thus causing a long-term disruption in cortisol secretion.
(Hippocampus mediates hypothalamic-pituitary-adrenal axis. It is specifically rich in glucocorticoid receptors, therefore it's a primary target for the cortisol negative feedback action)(3)
Secondly: Corticosteroids have a profound effect on nerve cells, and this effect on the brain increases during its rapid growth in the ninth month.
Thirdly: The primary action of cortisol occurs through its effect on the cell nucleus, which explains its ability to cause an "epigenetic" change and to program the fetus's cells for life.
Comparing benefit to potential harm:
1. In premature birth: The fetus's cortisol level is low, so the potential for harm from the cortisone injection is minimal, and the benefit far outweighs the potential risk.
2. In the ninth month: The occurrence of complications is more likely, due to the cumulative cortisone level exceeding its physiological increase, in addition to the accelerated brain growth which makes it vulnerable to damage and to epigenetic changes.(4)
Finally, it should be noted that administering cortisone without anticipating a premature birth contradicts all scientific recommendations, as its benefit is almost negligible.

Salah Sanad.MD

References:
1)Ninan, Kiran et al. “Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids: A Systematic Review and Meta-analysis.” JAMA pediatrics vol. 176,6 (2022): e220483.
2) Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocrine Reviews. 2000;21(1):55–89.
3)Matthews SG. Early programming of the hypothalamic-pituitary-adrenal axis. Trends in Endocrinology & Metabolism. 2002;13:373–380.
4) Chung, Hao-Wei et al. “Antenatal corticosteroid exposure and neonatal outcomes in term infants.” Early human development vol. 208 (2025): 106325.

04/01/2026

The Mindray Nuewa club scientific meeting was held in Tolip Galala Majestic in Ain-Sokhna on December 26th . The event was attended by fetal medicine professors and specialists from different Egyptian universities. The EMFMF was represented by prof. Mohamed Ali Abdelkader professor of fetal medicine - Cairo university & president of the foundation and prof. Hesham El-Gammal head of FM unit Alexandrea university. The meeting started by a welcome speech from Eng. Attia Said President of Cairo Medical Mindray Egypt. This was followed by an elegant scientific program by professors from different Egyptian universities. The EMFMF would like to thank all organizers and attendees of this event for this greatly successful scientific celebration.

30/12/2025

Female Superiority Over Males in Many Bodily Aspects:
By professor Salah Sanad.
Prof. Of Ob/Gyn . Cairo university.

If God Almighty has favored males with muscular strength, by His wisdom, He has endowed females with some physical advantages, making them more capable of resisting oxidative stress. This is a state of imbalance within cells between molecules that arise as waste products of metabolic processes, called free radicals, and the body's defense mechanisms, or antioxidants. These molecules increase with exposure to pollution, psychological stress, smoking, and chronic diseases, leading to premature aging, cancer, weakened immunity, heart diseases, and diabetes.

Reasons for this female superiority include:
1. The female genetic code has two X-chromosomes, compared to only one in males. This X-chromosome carries most of the genes resistant to oxidation.(1)
2. The female body has a higher level of estrogen, which has anti-oxidant, anti-inflammatory properties.(2)

Consequently, females surpass males in several aspects:

1. Lower overall rate of congenital anomalies (~20% less common). This is also attributed to the ability of a healthy X-chromosome to mask some genetic disorders on the other unhealthy X.(3)
2. Greater ability to resist adverse conditions in fetal life (evidenced by a ~20% higher rate of male mortality in utero) and in newborns, where females have fewer complications from preterm birth, like respiratory distress syndrome & necrotizing enterocolitis. (4)
3. Higher life expectancy in females compared to males by about five years in most societies.(5)
4. Lower incidence of many inflammatory diseases, such as atherosclerosis, chronic kidney diseases, and fibrosis of the liver and lungs.(5)

Finally, it's worth noting that the price of female superiority in immune response and infection resistance has led to an increase in more self attack, ie autoimmune diseases among them.(6)

Salah Sanad.MD
References:
1)Tower, John et al. “Sex differences in the response to oxidative and proteolytic stress.” Redox biology vol. 31 (2020): 101488. doi:10.1016/j.redox.2020.101488
2) Borrás, Consuelo et al. “Direct antioxidant and protective effect of estradiol on isolated mitochondria.” Biochimica et biophysica actavol. 1802,1 (2010): 205-11. doi:10.1016/j.bbadis.2009.09.007
3) Franco B, Ballabio A. X-inactivation and human disease: X-linked dominant male-lethal disorders. Curr Opin Genet Dev. 2006;16:254–259
4) Sutherland, Susanna, and Steven M Brunwasser. “Sex Differences in Vulnerability to Prenatal Stress: a Review of the Recent Literature.” Current psychiatry reports vol. 20,11 102. 18 Sep. 2018
5)https://www.scientificamerican.com/article/why-the-life-expectancy-gap-between-men-and-women-is-growing/
6) Dolgin, Elie. “Why autoimmune disease is more common in women: X chromosome holds clues.” Nature vol. 626,7999 (2024)

13/12/2025

Enhanced myometrial vascularity following curettage for molar pregnancy.An increasingly common clinical situation.
By Mohamed Ali Abdelkader MD

Case presentation :

A primigravida 18 years old had a history of suction evacuation and curettage for molar pregnancy that was diagnosed based on very high levels of B-HCG(280.000 miu/ml) together characteristic ultrasound picture .Bleeding persisted after the curettage for 2 months and she was referred to me by abnormal uterine appearance on ultrasound .
By grey scale ultrasound examination I noticed a mid corporeal circumscribed amorphous heterogeneous lesion measuring 35x36 mm( figure 1).
Color Doppler examination showed extensive color flow signals with aliased flow (figure 2). Spectral Doppler showed turbulent flow(figure 3).
Discussion:

This is the classical picture of enhanced myometrial vascularity . Enhanced myometrial vascularity is a type of acquired arteriovenous malformation that might follow curettage for abortion or molar pregnancy, labor , or surgical uterine procedures. (1)
The characteristic clinical picture is persistent bleeding that might be severe together with persistent or elevated B-HCG in molar pregnancy.
Treatment here is by chemotherapy till B-HCG returns to zero level . Bleeding usually regresses and sonographic picture disappears in 4 to 5 months . If not , uterine artery embolization might be performed with satisfactory results .(2)
This is the 5th case I observe since the last article I posted here about this subject . Please review the article dated 30/1/2024.
I posted this article to increase the awareness of the clinician about the importance of this increasingly common clinical situation.

Mohamed Ali Abdelkader

References:

(1)Moradi B, Banihashemian M, Sadighi N, Shirali E, Saleem SA, Najafi E. Enhanced myometrial vascularity and AVM: A review on diagnosis and management. J Clin Ultrasound. 2023 Jul- Aug;51(6):1051-1058.

(2) O'Rourke-Suchoff, Danielle et al. “Diagnosis and treatment of women with radiologic findings suspicious for uterine arteriovenous malformations.” Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology vol. 41,5 (2021): 769-773.

07/12/2025

The Egyptian maternal and fetal medicine foundation held a scientific event on 5th of December 2025 ‘fetal Doppler workshop’ in the Military production club- Helwan .It was attended by around 75 doctors from different specialities : Obstetricians, fetal medicine specialists and radiologists.Professor Mohamed Ali Abdelkader presented the lectures on fetal Doppler followed by a life demo on the fetal anatomy scan and the techniques of Doppler ultrasound on umbilical , middle cerebral , uterine arteries together with ductus venosus Doppler.
The event was a great success.The EMFMF would like to thank all professors and doctors who attended this event together with Cairo medical - Mindray company who sponsored this event.

03/12/2025