Egyptian Maternal and Fetal Medicine Foundation

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

11/08/2025

Fetal cardiac rhabdomyomas:
By prof. Mohamed Ali Abdelkader(MD)

Definition:
Rhabdomyomas are rare, benign tumors composed of abnormal heart muscle cells (myocytes) that grow within the heart muscle (myocardium). They are the most common cardiac tumor and accounts for about 60% of all cardiac tumors.(1)Cardiac rhabdomyomas are frequently found in individuals with tuberus sclerosis(TS),a genetic disorder that can cause tumors to grow in various organs, including the heart, brain, skin, and kidneys (1)
Diagnosis:
Rhabdomyomas are typically diagnosed during prenatal ultrasound scans between 20 and 30 weeks of gestation.Fetal echocardiography is the primary method for detecting cardiac rhabdomyomas. The tumors often appear as well-defined, rounded echogenic masses within the heart muscle. The lesions are usually multiple and arise from ventricular walls , atrial walls and interventricular septum . They are mostly avascular by color Doppler mapping . (2)
Symptoms and complications:
Most fetal cardiac rhabdomyomas are asymptomatic and regress spontaneously after birth.However, large tumors or those located in certain areas of the heart can cause: • Arrhythmias (irregular heartbeats)
• Heart failure • Obstruction of blood flow out of the heart (outflow tract obstruction) • Hydrops fetalis (swelling of the fetus due to fluid buildup) • Fetal demise in severe cases (3)
Treatment:
Many cases require no specific treatment as the tumors regress on their own. In cases of severe symptoms or complications, treatment options may include: • Medications to manage arrhythmias or heart failure • Surgical removal of the tumor • In some cases, prenatal treatment with medications like rapalogs (e.g., sirolimus) may be considered to reduce tumor size and improve fetal heart function. (4)
Prognosis:
The prognosis for fetal cardiac rhabdomyomas is generally good, with most tumors resolving spontaneously. However, the presence of TS or severe cardiac complications can affect the overall outcome.Regular monitoring of the fetus and newborn is crucial to assess tumor growth and address any potential complications.
Case presentation :
I am presenting here a case of cardiac rhabdomyoma diagnosed at 32 weeks gestation . The echogenic lesions involve the right and left ventricular walls together with a small lesion in the lower part of the interventricular septum (figure1)

Mohamed Ali Abdelkader (MD)

References

1) Harding C.O., Pagon R.A. Incidence of tuberous sclerosis in patients with cardiac rhabdomyoma. Am. J. Med. Genet. 1990;37:443–446
2) Zhou Q.C., Fan P., Peng Q.H., Zhang M., Fu Z., Wang C.H. Prenatal echocardiographic differential diagnosis of fetal cardiac tumors. Ultrasound Obstet. Gynecol. 2004;23(2):165–171.
3) F. Okmen, H. Ekici, I. Hortu, et al., “Outcomes of Antenatally Diagnosed Fetal Cardiac Tumors: A 10-Year Experience at a Single Tertiary Referral Center,” Journal of Maternal-Fetal and Neonatal Medicine 35, no. 18 (2022): 3489–3494.
4) Will JC, Siedentopf N, Schmid O, Gruber TM, Henrich W, Hertzberg C, Weschke B. Successful Prenatal Treatment of Cardiac Rhabdomyoma in a Fetus with Tuberous Sclerosis. Pediatr Rep. 2023 Mar 22;15(1):245-253.

28/07/2025

Lower doses of enoxaparin(clexane) is more effective in lowering pregnancy loss rates in women with recurrent spontaneous abortion than higher doses .A recent study says:

Recurrent spontaneous abortion (RSA) is a severe concern for women's reproductive health, with an incidence of 1% to 5%.(1)
Low molecular weight heparin (LMWH)is widely recognized as an effective treatment for RSA caused by antiphospholipid syndrome (APS), post-thrombotic syndrome (PTS), autoimmune diseases, and other conditions.(2)
Recent studies have shown that LMWH, aside from its anticoagulant effects, offers immunomodulatory and other benefits. These benefits include inhibiting the immune response triggered by antiphospholipid antibodies , promoting trophoblast proliferation , invasion and differentiation, preventing trophoblast apoptosis, protecting vascular endothelium, and enhancing placental formation.(3,4)
There has been an increasing trend among clinicians that increasing the doses of clexane might be more effective in improving live birth rates and lowering prenancy loss rate (LBR). However, the current evidence antagonizes that belief.
A recent systematic review and meta-analysis (level I evidence & level A recommendation) , published by American Journal of Of Obstetrics & Gynecology in February 2025 concluded that both the 20mg and 40mg doses of enoxaparin were effective in increasing live birth rates and lowering pregnancy loss risk, among women with recurrent pregnancy loss . The study emphasized that the 20mg dose has shown superior efficacy over the 40mg dose. (5)
The research added that enoxaparin beside significantly improving live birth rates , also reduces the risks of pre-eclampsia, preterm delivery, and pregnancy loss.
The research data were collected from 22 randomized controlled trials, encompassing 4,773 participants.
It seems that increasing the doses of clexane during pregnancy as a trial to improve live birth rates and reducing pregnancy loss risk might only add more economic suffering together with higher risks of maternal side effects from the drug.

Mohamed Ali Abdelkader(MD)

References:
1) Genovese HG, McQueen DB. The prevalence of sporadic and recurrent pregnancy loss. Fertil Steril. 2023 Nov;120(5):934-936

2) Berker B, Taşkın S, Kahraman K.
The role of low-molecular-weight heparin in recurrent implantation failure: a prospective, quasi-randomized, controlled study.Fertility and Sterility, Volume 95, Issue 7, June 2011, Pages e29

3) Brenner B. Enoxaparin use in pregnancy: state of the art. Womens Health (Lond). 2007 Jan;3(1):9-14.

4) Pasquier E, de Saint Martin L, Bohec C, Chauleur C, Bretelle F, Marhic G, Le Gal G, Debarge V, Lecomte F, Denoual-Ziad C, Enoxaparin for prevention of unexplained recurrent miscarriage: a multicenter randomized double-blind placebo-controlled trial. Blood. 2015 Apr 2;125(14):2200-5.

5)Huang W, Yu Y, Chen L, Tang X, Fang X, Ou X, Du X. Comparative effectiveness of low molecular weight heparin on live birth for recurrent spontaneous abortion: systematic review and network meta-analysis. Am J Obstet Gynecol MFM. 2025 Feb;7(2):101572.

11/07/2025

Fetal Aortic Stenosis with Left Ventricular Hypoplasia and Endocardial Fibroelastosis.
By
Durr-e-Sabih.Multan-Pakistan

Fetal aortic stenosis refers to narrowing of the aorta, this is most commonly due to valvular stenosis but can very rarely be subvalvular or supravalvular. Isolated aortic stenosis is found in about 1:1000 live births[1]. Bicuspid aortic valves are the most common cause of valvular aortic stenosis, but a diagnosis of fetal bicuspid valves tends to be difficult [2]. Focused ultrasound of the aortic valve is still not part of the ISUOG guidelines.
Aortic stenosis can occur as an isolated finding or be combined with other anomalies, it can be mild, severe or critical. Ultrasound has a low sensitivity (~15%) for diagnosing isolated mild aortic stenosis [3]. This improves (~85%) when secondary signs of aortic stenosis like left ventricular hypoplasia or fibroelastosis occur [4].
Aortic stenosis is often a progressive disease and might not be apparent at the time of the routine anomaly scan in mid-second trimester.As the aortic stenosis becomes more severe it can progress to critical aortic stenosis with left ventricular dysfunction.Eventually leading to left ventricular hypoplasia and endocardial fibroelastosis in about 75% of cases of severe/critical aortic stenosis.
In this talk , I will present 2 cases of fetal aortic stenosis with left ventricular hypoplasia and endocardial fibroelastosis .

Case 1. 32 year old woman in a non-consanguinous marriage Para-4, G-3, all alive, had Gestational diabetes. She was unsure of dates. She had had a previous scan (done elsewhere) at 22 wks that was reported as normal. On a routine visit to her obstetrician, she noted cardiomegaly and sent for a repeat scan. Scan findings: ( Clip 1) Right ventricle is enlarged, and extends below the left ventricle to form the apex. The left ventricle is smaller and has a globular shape, it contracts poorly. The left ventricular walls are echogenic. The tricuspid valve shows good excursion but the mitral valve is restricted. The flap of the foramen ovale was in the right atrium andthere was left to right blood flow through the foramen ovale.

Case 2 G-2- P1, previous baby healthy, no consanguineous, non- diabetic, unsure of dates 26 weeks of pregnancy breech at the time of examination.Scan findings (clip 2). Scan showed a very small left ventricle with markedly reduced contraction and echogenic walls. Right ventricle is enlarged and forms the apex. The left ventricle is globular, contracts poorly and has echogenic walls (endocardial fibroelastosis). The aortic root and isthmus are narrow and there is reversed flow in the isthmus.
Durr-e-Sabih.Multan-Pakistan

References

1. Abnormalities seen in the great arteries view (Aortic Valve Stenosis). Available from: https://courses.fetalmedicine.com/fmf/show/809?locale=en.
2. Zheng, M., et al., Diagnostic value of selected fetal echocardiographic parameters in the prenatally suspected bicuspid aortic valve. Echo Research & Practice, 2025. 12(1): p. 1.
3. Freud, L.R., et al., Low rate of prenatal diagnosis among neonates with critical aortic stenosis: insight into the natural history in utero. Ultrasound Obstet Gynecol, 2015. 45(3): p. 326-32.
4. Respondek-Liberska, M., et al., Fetal hypoplastic left heart syndrome and neonatal follow-up in Polish Mother's Memorial Hospital Research Institute report from January 2023 to January 2024: an improvement of survival rate. Ginekol Pol, 2025.
5.Simpson, J., Z. V, and M. O, Fetal Cardiology: A Practical Approach to Diagnosis and Management 2018.

03/07/2025

03/07/2025

Master the technique of fetal cardiac examination on the machine supervised by Prof. Mohamed Ali Abdelkader.
For any Information about the workshop call:
(+2) 01223409160
(+2) 01092515830