Egyptian Maternal and Fetal Medicine Foundation

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

30/10/2025

Persistent attacks of opisthotonus before birth might be more serious than you think:

Prof. Mohamed Ali Abdelkader MD.,
Dr. Durr Sabih MD ,Pakistan.

Case presentation:
A full term fetus had repeated attacks of opisthotonus before birth . The attacks occurred on three ultrasounds 12 hours apart . Each attack lasted more than 30 seconds.The patient delivered normally . The baby died shortly after birth .

Definition and prenatal sonographic detection of opisthotonus:
Opisthotonus is defined as a dramatic abnormal posture(hyper extension of the neck ,trunk and lower limbs) due to spastic contraction of the extensor muscles of the neck, trunk, and lower extremities .
This produces a severe backward arching from neck to heel. It is usually sudden in onset and can be sustained or repetitive. (1)
This typical picture has been detected clearly by prenatal ultrasound. Notice the remarkable extension of fetal the neck and trunk. Opisthotonus was not detected in the neonate after birth (See attached clip and figure).

Etiology:
Opisthotonos occurs in a wide variety of disorders.
1)Infections :Meningitis,encephalitis,tetanus.
2)Poisoning: Strychnine,phenothiazines, lignocaine.
3) Developmental and Metabolic
Cerebral palsy, hyperbilirubinemia, kernicterus, Gaucher disease.
4)Cerebral: lnreased intracranual pressure as intracranial hemorrhage, subarachnoid hemorrhage, hydrocephalus, or a space-occupying lesion.
5)Anoxic injury: cardiac arrest,suffocation,or birth asphyxia (2)

Impact of prenatal detection on postnatal management:
Once the prenatal condition is confirmed postnatally,tests to confirm the underlying cause and for monitoring the disease activity are performed.
They include complete blood counts, metabolic profile, renal and hepatic functions. Brain MRI or CT is performed to confirm the presence of lesions causing raised intracranial pressure. A lumbar puncture can be performed .The fluid obtained undergoes relevant tests like glucose, protein, cell count to rule out infections.
Supportive measures include maintenance of fluid and electrolyte balance,ventilatory support, nutritional support, either parenteral or enteral. Avoidance of triggers like noise and light in a dark, soundproof room is preferred. Oral administration of medication such as benzodiazepines and baclofen to improve the spasms. Intrathecal baclofen can reduce spasticity/dystonia.
Analgesics are given to reduce the pain.
The prognosis is dismal with a high rate of neonatal mortality.(3)

Conclusion:
In this article , I meant to throw the light on a severe and life threatening situation that both the sonographer and clinician might be exposed to prenatally, in order not to be surprised by it after birth. It is important to educate both sonographer and clinician about opisthotonus and its consequences. Prenatal identification is important for counseling parents about the severity and bad prognosis of this life threatening condition.

Mohamed Ali Abdelkader .MD

References:

1)Tapajós R. Trismus, opisthotonus and risus sardonicus: who remembers this disease? Rev Bras Ter Intensiva. 2011 Dec;23(4):383-7.

2)Shahade A, De Jesus O. Opisthotonus. 2023 Aug 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32644596.

3)Ceulemans B, van Rhijn J, Kenis S, Krols R, Laridon A, Van Havenbergh T. Opisthotonus and intrathecal treatment with baclofen (ITB) in children. Eur J Pediatr. 2008 Jun;167(6):641-5. [PubMed]

16/10/2025

A warm invitation to attend the scientific session held at 1.30 PM on Friday 17th of October on the second day of the 39th annual conference of OB/GYN department. Alexandria university at Radisson Blu Hotel . Alexandria.

14/10/2025

Master the technique of 3D/4D transvaginal ultrasound in this course under supervision of prof. Mohamed Ali Abdelkader.
Advanced lectures, live demo, and hands on sessions are all available. For further information call the numbers at the bottom of this brochure

15/09/2025

Tuberous Sclerosis . Prenatal sonographic diagnosis:
By Prof. Mohamed Ali Abdelkader MD

Definition:
Tuberous sclerosis (TS) , sometimes referred to as tuberous sclerosis complex (TSC) is a rare multi system genetic disease that causes benign tumors(tubers) to grow in the brain, heart and kidneys . It sometimes involves the skin .The name is composed of the latin tuber (swelling) and greek skleros(hard) referring to the finding of thick firm lesions called tubers in the affected parts .(1)
Ultrasound diagnosis:
Prenatal diagnosis is confined to detection of the multiple echogenic nodules in the heart and brain. The echogenic cardiac lesions (rabdomyomas)are usually detected at > 20 weeks’ gestation . When there are multiple rabdomyomas the risk of tuberous sclerosis is >90%. The echogenic brain lesions (cortical tubers and subependymal nodules) are usually detected at >30 weeks’ gestation.(2)
Inheritance and prognosis:
TS is inherited as autosomal dominant trait. Cases with de novo mutations also have been reported.(3)
Prognosis depends on the number, size and location of the tumors.The disease has a wide spectrum prognosis ranging from normal life expectancy with mild symptoms to arrhythmias, hydrops,stillbirth,severe neurodevelopmental delay, epilepsy, and renal or pulmonary failure.(4)
Case presentation:
The attached video shows a 32 weeks gestation patient with tuberous scletosis affecting both the fetal brain and heart .The first part of the clip shows the cerebral lesions in the form of subependymal echogenic nodules in the fetal brain (There is also associated severe ventriculomegaly) . I have freezed the clip to show you the nodules marked by the white lines . The second part shows the rhabdomyomas of the heart appearing as echogenic nodules .

Prof. Mohamed Ali Abdelkader .

References:

1) Sharma N, Sharma S, Thiek J L, Ahanthem S S, Kalita A, Lynser D. Maternal and fetal tuberous sclerosis: do we know enough as an obstetrician? J Reprod Infertil. 2017;18(02):257–260.

2) Wang C C, Wang C Y, Lai Y J, Chang T Y, Su H Y. Prenatal diagnosis of tuberous sclerosis complex using fetal ultrasonography and magnetic resonance imaging and genetic testing. Taiwan J Obstet Gynecol. 2018;57(01):163–165.

3) Curatolo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet 2008;372(9639):657-668.

4) M. Bekiesinska-Figatowska, P. Sobieraj, M. Pasieczna and J.Szymkiewicz-Dangel .Early Diagnosis of Tuberous Sclerosis Complex: Prenatal Diagnosis.AJNR Am J Neuroradiol 2023, 44 (9) 1070-1076

18/08/2025

Fetal cardiac rhabdomyomas. Could it be vascular?
By Prof. Mohamed Ali Abdelkader. MD
Case of Dr. Durr Sabih . MD

In a previous article , I have presented a case of fetal cardiac rhabdomyomas .Fetal cardiac rhabdomyomas, the most common fetal heart tumors, are typically described as non-vascular, homogenous, and hyperechoic masses on ultrasound, meaning they appear bright and solid on imaging and do not show blood flow within them.
However , I recently received a case from my friend ,Dr Sabih from Pakistan showing massive vascularity .
The video clip below shows a case of a solitary huge rhabdomyoma of the interventricular septum that presented during third trimester. Color Doppler showed that the rhabdomyoma has massive internal vascularity .The rhabdomyoma is apparently arising from the interventricular septum and protruding into the left ventricle . In the same time you can see hypoplastic right ventricle, meaning that it also encroaches upon the cavity of the right ventricle and the annulus of tricuspid valve . The important question is what might cause the originally non vascular cardiac rhabdomyomas to show this massive vascularity ?
I searched in the literature and found the following possible explanations :
1)One important explanation is increased flow in the circumflex artery, a major branch of the left coronary artery which may nourish the tumor mass.(1)
2)Another explanation is that the mass is originally cardiac rhabdomyosarcoma ,a rare highly vascular malignant neoplasm of the heart occurring in all age groups and genders.(2)
3) Rhabdomyomas, particularly fetal rhabdomyomas, can exhibit myxoid changes, meaning they contain a prominent myxoid matrix. This myxoid matrix contain cells that resemble immature skeletal muscle fibers (myoblasts). The myxoid variant of fetal rhabdomyoma usually shows high vascularity.(3)

Mohamed Ali Abdelkader.MD.

References:
1) Niewiadomska-Jarosik K, Stańczyk J, Janiak K, Jarosik P, Moll JJ, Zamojska J, et al. Prenatal diagnosis and follow-up of 23 cases of cardiac tumors. Prenat Diagn. 2010;30(9):882–887

2) Frank Adusei Poku,Bernice Biney, Samuel Mensah, Sandra Oppong-Twum, Chukwuemeka Aghasili, Joshua Oppong Ampadu, Shawyon B. Rhabdomyosarcoma: An Updated Review of the English Literature From 1980 Through 2023. CirculationVolume 150, Number Suppl_1.2024; https://doi.org/10.1161/circ.150.suppl_1.4138622

3) Mocellin, S. (2021). Fetal Rhabdomyoma. In: Soft Tissue Tumors . Springer, Cham. https://doi.org/10.1007/978-3-030-58710-9_96