INTRODUCTION: skin pigmentation. This for the most part happens

INTRODUCTION:

The
general clinical appearance of skin is identified with pigmentation, glands,
vasculature, and connective tissue. Cutaneous changes amid pregnancy can be
best comprehended by looking at each of these diverse parts of skin structure
1.

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Pigmentation
— almost every single pregnant woman builds up some level of expanded skin
pigmentation. This for the most part happens in discrete, restricted areas and
might be because of provincial contrasts in melanocyte thickness inside the
epidermis 1. Occasionally, generalized hyperpigmentation occurs 2.

It
has been shown that the pigmentary changes occur early in pregnancy and before
the elevation in alpha-melancyte stimulating hormone (MSH) plasma levels, which
occur in late gestation 3.

The
most regular cutaneous pigmentary change is darkening of the linea alba, which
turns into the linea nigra 4. The expanded pigmentation may traverse from the
pubic symphysis to the xiphoid process, yet for the most part returns to its
typical hypopigmented state after delivery 5.

Striae
distensae are a common form of dermal scarring that appear on the skin as
erythematous, violaceous, or hypopigmented linear striations. Synonyms include
the terms striae, stretch marks, and striae atrophicans. Striae gravidarum are
striae dispense occurring secondary to pregnancy 6.

There
are two principle types of striae distensae, striae rubra and striae alba.
Striae rubra are the most punctual introduction of striae distensae and are
portrayed by an erythematous to violaceous shading 7. After some time, striae
rubra advance into striae alba, which seem hypopigmented, atrophic, and
scar-like. Basic areas for striae distensae are the abdomen, breasts, medial
upper arms, hips, lower back, buttocks, and thighs 8.

 Although typically asymptomatic, striae
distensae may be disfiguring causing psychological stress to patients 9. Different
topical and procedural modalities have been introduced for the treatment of
striae distensae 10.

Stretch
marks are thin and disorganized all over the body, fibrils are
trophoelastin-rich, which is likely due to uncoordinated synthesis 11.

Under
light microscopy, there is flattening of the epidermis with atrophy and loss of
rete ridges and increased glycosaminoglycans 12.

 The severity and progression of affected areas
varies from patient to another, which indicates a variable genetic
predisposition 13. Striae gravidarum is a sign for decreased skin elasticity which
in turn makes it more vulnerable to vaginal and perineal lacerations 14.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PATIENTS
& METHODS:

This
cross-sectional multicentre observational study was carried out in Egypt over a
period of 5 months, on 534 pregnant females, who gave birth in Cairo, Ain Shams
Universities’ hospitals, in addition to a private hospital. Out of 534 women,
466 women who fulfilled the inclusion criteria reached the final analysis. The
ethical committee, National Research Centre endorsed its approval before
starting the study. Written consents have been signed by the patients before
enrolment in the study. Women who refused to participate
were excluded from the study.

Our inclusion criterion was; primiparous vaginal
delivery of a single, vertex, term fetus (completed 37 weeks of gestation to
the end of 41 weeks) with expected fetal weight 2- 4 Kg.

Women who had any of the following criteria were
excluded from the study; multiparous, need for instrumental delivery,
non-vertex presentation, EFW 4 kg, preterm delivery