Decision-to-Delivery Time Intervals in Emergency Caesarean Section Cases: Repeated cross-sectional study from Oman.

OBJECTIVES: In cases of fetal intolerance to labour, meeting the standard decision-to-delivery time interval (DDI) of ≤30 minutes is challenging. This study aimed to assess DDIs in emergency Caesarean section (CS) cases to identify factors causing DDI delays and the impact of a delayed DDI on perinatal outcomes. METHODS: This repeated cross-sectional study included all emergency CS procedures performed due to acute fetal distress, antepartum haemorrhage or umbilical cord prolapse at the Nizwa Hospital, Nizwa, Oman. Three audit cycles of three months each were conducted between April 2011 and June 2013, including an initial retrospective cycle and two prospective cycles following the implementation of improvement strategies to address factors causing DDI delays. Poor perinatal outcomes were defined as Apgar scores of <7 at five minutes, admission to the Special Care Baby Unit (SCBU) or a stillbirth. RESULTS: In the initial cycle, a DDI of ≤30 minutes was achieved in 23.8% of 84 cases in comparison to 44.6% of 83 cases in the second cycle. In the third cycle, 60.8% of 79 women had a DDI of ≤30 minutes (P <0.001). No significant differences in perinatal outcomes for cases with a DDI of ≤30 minutes versus 31-60 minutes were observed; however, a DDI of >60 minutes was significantly associated with poor neonatal outcomes in terms of increased SCBU admissions and low Apgar scores (P <0.001 each). Factors causing DDI delays included obtaining consent for the CS procedure, a lack of operating theatre availability and moving patients to the operating theatre. CONCLUSION: The identification of factors causing DDI delays may provide opportunities to improve perinatal outcomes.

Primary amenorrhea. Varied etiology.

Investigation of primary amenorrhea is usually initiated by the age of 14 years if there is delayed puberty absent secondary sexual characteristics and absent menses, or no menstruation within 4 years of the onset of adrenarche and thelarche. We established diagnosis in our 3 cases on the basis of chromosomal analysis, hormonal analysis, diagnostic laparoscopy, and histopathological examination of the samples biopsied. We identified 3 varied etiologies.

Twin intrauterine and cornual gestation in a case of triplet pregnancy.

Ectopic implantation with in-vitro fertilization-embryo transfer may occur in the cornu or tubal stump, which is otherwise rare. Our patient with previous left salpingostomy and right salpingo-oophorectomy had 4 embryos transferred through in vitro fertilization out of which 3 were successfully implanted with twin intrauterine gestation and cornual pregnancy. The cornual pregnancy ruptured at 12 weeks of gestation and the twin intrauterine pregnancy had a successful outcome.

Placenta previa in a referral hospital in Oman.

OBJECTIVE: To determine the incidence of placenta previa associated pregnancies, to find out the strength of association of identified risk factors with the major placenta previa associated pregnancies and to identify predictors for preterm outcome. METHODS: Records of women with placenta previa, who delivered at Nizwa Hospital, Al-Dakhliya region, Sultanate of Oman between October 1998 and September 2002, were analyzed retrospectively utilizing a case control approach. RESULTS: An incidence of 0.6% for placenta previa was noted in our study. Nearly two thirds (64.8%) of the pregnancies resulted in antepartum bleeding. Pregnancies with major placenta previa constituted 72% of all the subjects. Higher parity (>/=5), maternal age (>/=30) and history of previous abortion had high odds of association with major placenta previa of 2.1, 2.4 and 2.5. Antepartum hemorrhage was not significantly associated with pregnancies presenting with major placenta previa (odds ratio [OR] 1.3; p>0.05). The proportion of preterm deliveries was 55.5% in the study. There was a significant association between preterm outcome and presence of antepartum hemorrhage (OR 10.8; p<0.001). CONCLUSION: In spite of higher maternal age, parity and previous abortions having high odds of presenting in pregnancies with major placenta previa, no significant statistical association could be proven. Also, no significant difference among pregnancies presenting with major or minor placenta previa as regards the preterm outcome, could be established. Antepartum hemorrhage, irrespective of severity, was a strong predictor of preterm outcome.

Mayer-Rokitansky-Küster-Hauser syndrome of Müllerian agenesis [corrected].

Müllerian agenesis, a congenital malformation of the genital tract is the second most common cause of primary amenorrhoea. Its etiology is poorly understood. It may be associated with renal, skeletal or other abnormalities. The diagnosis is often made radiologically or laparoscopically. Three-dimensional ultrasound is a useful diagnostic tool. The hormonal profile and karyotype in these patients are normal. The management varies, but the treatment of choice is non surgical aimed at creating a neovagina. These patients require psychological support due to the implications for reproduction. Here, we present the case of a 24-year-old married woman with primary amenorrhoea with this malformation.

Pregnancy outcome in women with sickle cell trait.

OBJECTIVE: The aim of the study is to assess the pregnancy outcome among Omani women with sickle cell trait (SCT), and to compare it with a control group of Omani women with normal hemoglobin. METHODS: Relevant data of both groups was obtained from labor room records, patient files and computerized records at the Nizwa Hospital, Dakhliya Region, Nizwa, Oman from January 1999 to July 2000. Available data was analyzed. RESULTS: Three thousand, five hundred and one pregnant Omani women were included in this study, 319 had SCT (9.1%), the average age was 27 years in both groups, and 51% were primigravida. There was an increase in the incidence of anemia in the SCT women. The incidence of abortion and neonatal death in previous pregnancies was significantly increased among SCT women. CONCLUSION: Pregnant women with SCT need special care and attention during pregnancy, labor, puerperium and surgery. They should be identified early to prevent complications such as anemia, infection and fetal wastage.