Association between intrauterine fetal growth restriction and ABO blood groups at King Abdulaziz University Hospital, Saudi Arabia: Retrospective study.

OBJECTIVES: To investigate the potential association between ABO blood groups and intrauterine fetal growth restriction (IUGR) among pregnant women who delivered at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. METHODS: This is a retrospective cohort study analyzed the medical records of pregnant women who delivered at KAUH and had postnatal follow-up visits. Missing data were completed by conducting phone interviews with patients. RESULTS: A total of 436 patients with a mean age of 31.2±5.5 years were included in the study. 50.7% of the women had blood type O, 28.4% had blood type A, 16.5% had blood type B, and 4.4% had blood type AB. The majority (94.7%) tested positive for the Rhesus antigen. Although statistically significant, women with blood groups AB and B exhibited higher rates of IUGR (31.6%, and 27.8%, respectively) compared to those with blood groups A and O, who had lower rates of IUGR (26.6%, and 24%, respectively). CONCLUSION: Our study results showed that women with blood groups AB and B had slightly higher rates of IUGR than those with A and O, who had lower rates of IUGR. A larger study comparing blood group O to other groups may provide more insight into the relationship between ABO blood groups and IUGR.

Practice of Placenta Submission for Histopathological Examination, Experience of a Teaching/Tertiary Care Hospital in Saudi Arabia.

Objectives The aim of this study is to determine the appropriateness of histopathologic examination of the placenta at King Abdulaziz University Hospital (KAUH), Jeddah, based on the guidelines of the College of American Pathologists (CAP). Methods It is a retrospective review of obstetric and pathologic records for all deliveries at KAUH, between January 1, 2017, and April 30, 2019. The placentae were assessed for eligibility to undergo pathologic examination. Furthermore, examined and non-examined placentae meeting the CAP criteria were compared based on their actual indications. Results There were 8,929 deliveries, of which 1,444 (16.2%) placentae met the CAP guidelines. A total of 583/1,444 placentae (40.4%; 95% confidence interval [CI] = 37.8-43) were sent for pathologic examination. Of the 7,485 placentae that did not require submission for pathological examination, as determined by the pathologist, 7,456 (99.6%; 95% CI = 99.4-99.7) were not submitted appropriately. The labor and delivery staff were more likely to submit placentae with fetal/neonatal indications rather than those with maternal indications for examination, which was statistically significant (odds ratio = 6.5; 95% CI = 5.08-8.30). Conclusion While most of the examined placentae at KAUH met the CAP guidelines, there was a substantial under-submission of eligible placentae. Further studies are advised to reveal the reasons behind this underestimation so that correctional measures may be adopted, as placenta examination is a valuable tool to understand the risk factors and pathogenesis of deleterious maternal, neonatal, and fetal events.

Saudi Society of Maternal-Fetal Medicine guidance on pregnancy and coronavirus disease 2019.

[No Abstract Available]    Saudi Med J 2020; Vol. 41 (8): 779-790doi: 10.15537/smj.2020.8.25222 How to cite this article:Yaser A. Faden, Nadia A. Alghilan,  Samiha H. Alawami, Eman S. Alsulmi, Hythem A. Alsum, Yasir A. Katib, Yasser S. Sabr, Fadwah H. Tahir, Nabeel S. Bondagji. Saudi Society of Maternal-Fetal Medicine guidance on pregnancy and coronavirus disease 2019. Saudi Med J 2020; Vol. 41 (8): 779-790. doi: 10.15537/smj.2020.8.25222.

Recently reported familial hypercholesterolemia-related mutations from cases in the Middle East and North Africa region.

PURPOSE OF REVIEW: Familial hypercholesterolemia is an inherited disorder where cases have a significantly higher risk of having premature myocardial infarction than noncases. The prevalence of this genetic disease is currently unknown in countries of the Middle East and North Africa region. Given that a high percentage of marriages are consanguineous in this region, the prevalence may be much higher than assumed. We systematically reviewed the literature to identify case-related mutations reported within the last 4 years and since our first report in 2014. RECENT FINDINGS: Mutations were reported in familial hypercholesterolemia cases from the Saudi, Iranian, Lebanese, and Syrian populations. Some of the mutations were novel and a variety of familial hypercholesterolemia genotypes were identified, such as compound heterozygotes and double heterozygotes. SUMMARY: In recent years, work has been done to identify familial hypercholesterolemia cases in various countries of the Middle East and North Africa region. With regards to the prospective familial hypercholesterolemia registry for the Middle East and North Africa region, an important goal for the near future would be to have physician specialists collaborate with primary care clinicians for the identification and optimal care of familial hypercholesterolemia cases.

In Silico Approach to Investigate the Structural and Functional Attributes of Familial Hypercholesterolemia Variants Reported in the Saudi Population.

Familial hypercholesterolemia (FH) is a metabolic disorder that leads primarily to premature cardiovascular diseases, the main cause of mortality in Saudi Arabia (SA). FH is underreported and underdiagnosed in SA with statistical evidence of high expected prevalence in such a consanguineous community. Lacking knowledge of which and how these alterations are actually impacting lipid metabolism is one of the main reasons why FH is insufficiently diagnosed in the region. The aim of this study was to develop a fast prediction approach using an integrated bioinformatics method for future screening of the potential causative variants from national registries. A total of 21 variants were detected with majority rate in LDLR (81%). Variants were classified based on the type of mutation. Missense variants resulting in amino acid changes, c.1429G>A (p.D477N), c.1474G>A (p.D492N), c.1731G>T (p.W577C), and c.1783C>T (p.R595W) in LDLR gene, in addition to c.9835A>G (p.S3279G) in APOB, were shown to be deleterious by concordant analysis. Furthermore, functional interaction deformities showed a significant loss and gain of energies in the mutated proteins. These findings will help in distinguishing the most harmful mutations needed to be screened for clinically diagnosed FH patients in SA. Such computational research is necessary to avoid time consumption and the usage of expensive biological experiments. This can be a fast track to facilitate the future filtering and screening of causative mutations from national registries.

Health rights knowledge among medical school students at King Abdulaziz University, Jeddah, Saudi Arabia.

BACKGROUND: Health care is a basic human right, and Saudi Arabia affirms these rights for all its citizens. OBJECTIVES: To assess the knowledge of medical students regarding health rights in Saudi Arabia. METHODS: This cross-sectional study was conducted at King Abdulaziz University (KAU) from September 2015 through November 2015. A questionnaire written in English collected demographic data and included questions about reproductive health care and health rights of women and patients with cancer, senility, or special needs. RESULTS: Of the 267 participants, 184 (68.9%) were female, and 252 (94.4%) were Saudi. Regarding consent, 87 (32.6%) and 113 (42.3%) participants believed a female patient required the consent of a male guardian to receive medical treatment or surgery, respectively, in Saudi Arabia, and only 106 (39.7%) knew that a female patient could provide consent for a caesarean section. Sixty-six (24.7%) believed that abortion is never allowed in Islam. Only 93 (34.8%) were aware that acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) patients had health rights, about half (144, 53.9%) knew that cancer patients have a right to full information, and most (181, 67.8%) believed that a patient had the right to withhold health information from his/her family. Approximately half were aware that cancer patients have the right to free medical treatment (138, 51.7%) or that health rights applied to special needs patients (137, 51.3%) and senile patients (122, 45.7%). CONCLUSIONS: The knowledge of KAU medical students regarding health rights of certain patient populations highlights the importance of health rights education in medical school.

Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia.

OBJECTIVE: To study the prevalence, pattern of distribution, and the outcome of different types of kidney and urinary tract anomalies (CAKUT) diagnosed during the antenatal period. The second objective is to test the accuracy of antenatal diagnosis of CAKUT. MATERIALS AND METHODS: In a cross-sectional hospital-based study, all cases diagnosed antenatally with urinary tract anomalies at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia, were studied. The prevalence, pattern of distribution, and immediate postnatal outcomes, in addition to the accuracy of antenatal diagnosis, of those cases are reported. RESULTS: One hundred and forty-one cases of urinary tract anomalies were antenatally diagnosed; postnatal diagnosis was confirmed in 128 cases (90.1%). The prevalence of CAKUT in our population is 3.26 per 1000 births. The most common abnormalities detected were hydronephrosis, polycystic kidney disease, multicystic dysplastic kidney, and renal agenesis, in descending order of frequency. The perinatal mortality rate among fetuses with CAKUT is 310 per 1000, the majority of these cases (90%) occurred in cases with renal parenchyma involvement. CONCLUSIONS: The prevalence of different types of CAKUT is higher than that reported in developed countries. Urinary tract anomalies can be accurately diagnosed and classified in the antenatal period using ultrasonography imaging. Antenatal diagnosis is a helpful tool in planning immediate postnatal care and deciding the place for delivery. This might prevent or slow renal function deterioration and help in early identification of patients who need early surgical intervention.

Congenital heart defects in Down syndrome patients from western Saudi Arabia.

OBJECTIVE: To characterize congenital heart defects in individuals with Down syndrome (DS) in the Western Region of Saudi Arabia, and compare with studies from other regions of Saudi Arabia and with international figures. METHODS: We conducted a prospective study including all patients attending the DS clinic at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between October 2007 and October 2011. All patients underwent full history and physical evaluations, dysmorphologic assessment, chromosomal studies, and echocardiography. RESULTS: A total of 130 individuals (59% males and 41% females) with ages ranging between 0-33 years (mean=5+/-4.9) were included. Most individuals (90.9%) had trisomy 21 due to non-disjunction, 5.05% due to Robertsonian translocation, and 4% had mosaicism. Congenital heart defects were found in 86.8% of patients. The majority 71/92 (77%) showed combined cardiac defects, while 21/92 (23%) of DS patients had isolated congenital heart defects (CHD). The most frequent CHDs detected in this study were: patent ductus arteriosis in 44/92 (47.8%), atrial septal defect in 38/92 (41.3%), trivial tricuspid regurge in 31/92 (33.7%), ventricular septal defect in 27/92 (29.3%), and patent foramen oval in 26/92 (28.3%). CONCLUSION: We found a higher incidence of CHDs among DS individuals from the Western Region, compared to national and international figures. We detected more combined CHD and a different pattern of distribution.

The corrected perinatal mortality rate. A hospital-based study in Saudi Arabia.

OBJECTIVE: To determine the corrected perinatal mortality rate (PMR) in a single tertiary care center, and to test the effect of unbooked pregnancies on the PMR, and amalgamate the 2 to develop a new terminology known as the extended corrected PMR. METHODS: We conducted a retrospective cohort study of all women who delivered at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January 2000 and December 2010. We recorded all cases of perinatal death and calculated the PMR per annum. The PMR was corrected for extreme prematurity and congenital anomalies. The unbooked cases were reported, and the PMR was further corrected for booking status. For statistical analyses, the Statistical Package for Social Sciences was used for descriptive analysis and tests of significance. RESULTS: The total number of births was 46,677. Seven hundred and seventy-one perinatal deaths were reported, giving a PMR of 16.5 per 1000 per year. The corrected perinatal mortality was 11.0 per 1000. The PMR decreased significantly to 6.4 per 1000 (odds ratio 2.6, 95% confidence interval 1.2-2.4, p=0.001) after correction for booking status. CONCLUSION: The PMR in our study population is higher than those in developed countries, and when corrected for congenital anomalies and extreme prematurity, it is marginally higher. It was then considerably reduced after correction for booking status.

Histopathological pattern of ovarian neoplasms and their age distribution in the western region of Saudi Arabia.

OBJECTIVE: To identify the different histopathological types of ovarian neoplasms and their age distribution. METHODS: This is a retrospective study were ovarian neoplasms received by the Pathology Department of King Abdulaziz University, Jeddah, Saudi Arabia between January 1995 and December 2010 were reviewed and their frequencies in different age groups were calculated. RESULTS: Out of 618 ovarian specimens studied, 382 (61.8%) were ovarian neoplasms while 38.2% were non-neoplastic functional cysts. Benign neoplasms (n=278; 72.8%) were more common than borderline (n=20; 5.2%) and malignant ones (n=84; 22%) in all age groups. Surface epithelial neoplasms were the most common (61%) followed by germ cell (28%), gender cord stromal (7.6%) and metastatic tumors (3.4%). The most common benign neoplasm was serous cystadenoma (44.6%) and the most common malignant was serous cystadenocarcinoma (33.3%). The most common ovarian neoplasm below the age of 20 years was surface epithelial tumors (n=24) followed by germ cell tumor (16 cases). Benign neoplasms (n=213) were more common than malignant ones (n=42) in the age group from 20-51 years. Malignant ovarian neoplasms (35 out of the 71) were more common than benign (34 cases) in the age above 52. CONCLUSION: Benign ovarian neoplasms are more common than malignant ones. The most common benign ovarian neoplasm is serous cystadenoma and the commonest malignant neoplasm is serous cystadenocarcinoma. The prevalence of malignant ovarian neoplasms increases with increasing age.

Ischaemic heart disease in pregnancy.

Ischaemic heart disease (IHD) in pregnancy, particularly myocardial infarction (MI), is a rare yet potentially fatal condition for the mother and the foetus. With delays in the age of conception, the changes in some social habits among females including cigarette and shisha smoking in addition to an increased prevalence of diabetes mellitus, IHD may represent a real hazard among pregnant women in the near future. The difficulty in the diagnosis emerges from the similarity of the signs and symptoms of ischaemia and infarct to some of the physiological adaptations that occur in a normal pregnancy. The physiological changes that are normal in pregnancy may aggravate pre-existing disease and may unmask some underlying unrecognized coronary vascular changes; therefore, the diagnosis requires a high index of suspicion and careful assessment of the underlying risk factors. The management of IHD always requires a multidisciplinary team approach. The management of each patient should be individualized according to the clinical condition, the risk factors, and the availability of the necessary support. Pregnancy after MI may be an acceptable and reasonably safe option provided the cited criteria are met. A systematic PubMed search was performed to identify all published data including cases reports, small series and systematic reviews in the existing literature. These publications were comprised of both retrospective and cross sectional population studies to maximize the number of cases considered in order to reach conclusions and make recommendations based on the best available evidence considering the rare occurrence of this event. The epidemiology, diagnosis, medical and surgical treatment, and prognosis of IHD in pregnancy are the subjects of the present review.

Rhesus alloimmunization in pregnancy. A tertiary care center experience in the Western region of Saudi Arabia.

OBJECTIVE: To determine the distribution of ABO blood group and rhesus (RH) factor among pregnant women, to estimate the prevalence of Rh alloimmunization, and report the perinatal outcome of all cases of Rh alloimmunization at King Abdul-Aziz University Hospital (KAUH). METHODS: This is a retrospective study of pregnant women attending the antenatal clinics in KAUH, Jeddah, Saudi Arabia between January 2004 and December 2009. Records of patient diagnosed as Rh negative blood group were reviewed for the presence of antibodies, antibodies titer, and progress in the level of antibodies. Maternal and neonatal outcomes were reported. RESULTS: Twenty-four thousand and five pregnant women were included in this study. The most common blood group was O followed by A, B and AB positive. Rhesus negativity blood group was reported in 7.5%. Four hundred and twenty-four cases were reported as Rh antibody positive with a prevalence of alloimmunization of 1.8% in the studied population, and 23.6% among Rh negative women. The perinatal mortality rate was 250 per 1000 in alloimmunized women compared to 17 per 1000 in the study population. CONCLUSION: Blood group O positive is the most prevalent blood group among pregnant women attending our antenatal clinics and the prevalence of Rh negativity was 7.5%. The prevalence of Rh alloimmunization in the present study was 10-folds higher than that reported in the developed countries. Rhesus alloimmunization represent an avoidable direct cause for perinatal morbidity and mortality in our population.