A Multicenter Retrospective Cohort Study Assessing the Incidence of Anemia in Patients Associated With Uterine Fibroids.

OBJECTIVES: Uterine fibroids are benign tumors that develop from the smooth muscle tissue of the uterus, typically during a woman's reproductive years. A substantial proportion of women with uterine fibroids exhibit symptoms, including menorrhagia that considerably compromise their quality of life. This study aims to characterize the fibroid subtype most commonly associated with the incidence of anemia. METHODS: This retrospective multi-center cohort study investigated the incidence of anemia in premenopausal women who were diagnosed with uterine fibroids between January 2016 and December 2022. Fibroid position, size, location, and number were assessed by trans-abdominal/vaginal ultrasound and hysteroscopy and correlated to the pre-treatment hemoglobin level. RESULTS: Three-quarters of patients (n=6) with submucosal fibroid presented with any form of anemia followed by 59.3% (n=115) of patients with intramural fibroid and only 36.8% (n=25) of patients with sub serousal fibroid. Interestingly, there was no difference between the groups with regard to the severity of anemia at presentation. Most red blood cells (RBCs) and hemoglobin (Hb) indices were comparable between the groups, except for mean corpuscle volume (MCV) as it was significantly lower in patients with intramural fibroids. Moreover, our investigations showed that the submucosal fibroids tend to present in a higher number as well as the biggest in size. The multivariable logistic regression showed that subserosal fibroids are associated with the lowest risk of developing anemia. CONCLUSION: In conclusion, our results suggest that the occurrence of anemia should always be considered in women with submucosal fibroids. However, after adjusting for other contributing factors such as menorrhagia, submucosal fibroid did not show an increase in the risk of anemia.

The effect of COVID-19 pandemic on antibiotic usage during pregnancy.

OBJECTIVES: To investigated the usage of antibiotic during pregnancy before and during COVID-19 pandemic in Kingdom of Bahrain. METHODS: This was a retrospective study of antibiotic usage in 2 groups of patients. The first group was 280 patients who attended the in active labor room pre-COVID pandemic. The second group was 193 patients who attended the labor room after the COVID-19 pandemic. Most of the data discussed below explores the impact of COVID-19 infection before the development of full vaccinations against COVID-19 in Bahrain. RESULTS: The analysis confirmed higher usage of antibiotics during pregnancy post-COVID-19 outbreak (27.9% vs [versus] 5%), and the most notable difference was observed during the third trimester (17.1% vs 3.2%) followed by the second trimester (7.3% vs 1.1%). Likewise, there were more patients treated for urinary tract infection (16.1% vs 3.6%) and bacterial vaginosis (10.4% vs 0.7%) during the post-COVID period. There was no difference in the percentage of patients treated for upper respiratory tract infection among the groups. CONCLUSION: The analysis confirmed higher usage of antibiotic during pregnancy post COVID19.

Preeclampsia and Its Maternal and Perinatal Outcomes in Pregnant Women Managed in Bahrain's Tertiary Care Hospital.

OBJECTIVE: Hypertensive disorders during pregnancy being the leading causes of maternal and fetal morbidity and mortality remains a serious health issue worldwide due to the high rate of adverse maternal outcomes and close association with neonatal morbidity and mortality. The purpose of our study was to ascertain the perinatal outcomes of preeclampsia (PE) in a tertiary care hospital in Bahrain. METHODS: A retrospective cohort study was conducted from January 2018 to December 2019 in the department of Gynecology and Obstetrics in Bahrain Defense Hospital. The process of data collection included a baseline review of all women who had delivered during the study period in order to identify those with PE. Additionally, the postdelivery records of the mothers and newborns were reviewed to identify relevant maternal and neonatal outcomes. RESULTS: During the research period, records revealed 142 patients with PE with a rate of 1.95%. The mean gestational age at diagnosis was 35.61 (± 3.69) weeks, ranging between 20 and 42 weeks. The mean birth weight was 2.64 ± 0.79 kg, ranging from 0.5-4.5 kg. Furthermore, most babies had an Apgar score of 9 at 5 minutes. The preterm delivery rate was (16.3%) and intrauterine growth restriction (IUGR) was seen in 19 patients (13.5%) and it was significantly higher in patients who presented between 30 and 34 gestational weeks P < 0.001. Twenty-one infants were admitted to the NICU primarily for prematurity and low birth weight. There was only one early neonatal death of a hydrops baby. One infant was stillborn with extreme prematurity at 24 weeks+4 days. Maternal complications included five abruption placentae (3.5%) cases, five HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) cases (3.5%), four eclampsia (2.8%) cases, and four patients had ICU admission. Other maternal complications included acute renal failure (ARF) in two patients (1.4%), pulmonary edema in one patient, and peripartum cardiomyopathy in one patient. Data showed that adverse pregnancy outcomes were significantly more common in those with PE as compared to other pregnant populations. CONCLUSION: Preeclampsia causes a remarkable increase in adverse maternal and perinatal outcomes as compared to the normotensive pregnant population. A regular goal-oriented clinical audit into perinatal morbidity and mortality associated with this condition and an active multidisciplinary approach to the management of pre-eclampsia patients in the hospital might improve the clinical outcomes.

The Use of Beta-Human Chorionic Gonadotropin (ß-hCG) Levels as a Predictor of Successful Medical Management of Ectopic Pregnancy.

Objectives The early diagnosis of ectopic pregnancy is essential in determining the appropriate therapeutic approach. This study demonstrates the important factors considered in the prediction of a successful medical treatment, which will, in turn, improve the quality of patient counseling and guidance prior to the initiation of the treatment. Methods This was a retrospective cohort study of 58 ectopic pregnancies that were treated medically with methotrexate in Bahrain Defense Force (BDF) Hospital from January 2016 to January 2021. All patients that were offered medical treatment of ectopic pregnancy and completed the follow-up were included in the study. StatsDirect software was used to analyze the baseline characteristics of the successful and failed medical treatment of ectopic groups. Simple linear regression was used to correlate initial beta-human chorionic gonadotropin (ß-hCG) levels and the drop of ß-hCG levels after one week of medical treatment. Results Patients were divided into two outcomes: the primary outcome represented in the successful treatment group, 68.9% (40/58), and the secondary outcome represented in the unsuccessful treatment group 31% (18/58). The mean ß-hCG level in the successful group was significantly lower than that of the unsuccessful treatment group (1403.6±1421 IU/L versus 2845.1±1705 IU/L, p=0.001). There were no differences between the two groups with regards to the size of the adnexal mass, presence of gestational sac, or size of the gestational sac. The cut-off value of the initial ß-hCG level for successful medical treatment was 2,141 IU/L, with 72% sensitivity, 75% specificity, and receiver operator curve (ROC) of 0.76 [95% confidence interval (CI) = 0.63 to 0.89)]. The cut-off value of ß-hCG fell between day four and day seven and was 37.2%, with 78% sensitivity, 68% specificity, and a ROC curve of 0.72 (95% CI = 0.55 to 0.89). Conclusion This study found that low initial ß-hCG levels can be used to predict successful methotrexate treatment of ectopic pregnancy. In this cohort of patients, the cut-off level of initial ß-hCG for successful treatment was 2141 IU/L.

Maternal Obesity: An Obstetric Risk.

OBJECTIVE: To analyze the obstetric risks and to evaluate the effects of maternal obesity during pregnancy and postpartum period. METHOD: This is a retrospective study of pregnant women with a BMI of more the 30 conducted at Bahrain Defence Force Hospital, West Riffa, Bahrain, from September 2019 to August 2020. Data includes demographic characteristics, and course of pregnancy from gestational age 24 weeks, through intrapartum to the postpartum period. Adverse maternal effects and delivery complications were the primary study outcomes. The BMI was calculated at the time of the booking visit. Comparative analysis was done to calculate the odds of each outcome taking a non-obese group (BMI less than 30) as a reference.  Results: The total number of pregnant women studied was 2972, out of which 1657 had BMI ≥30. In our study, women with high BMI were older (p<0.0001). High BMI was associated with high parity and higher miscarriage history. High BMI increased the risk of developing hypertension (OR 2.5; 95%CI 1.1-5.3). This analysis also found that high BMI was associated with increased risk of antepartum hemorrhage (OR 2.4; 95%CI 1-5.4), postpartum complications (OR1.6; 95%CI 1.1-2.2), and a hospital stay of more than five days (OR 1.6; 95%CI 1.3-2). High BMI patients were less likely to have Intrauterine growth restriction (OR 0.6; 95%CI 0.3-0.9). High BMI patients did not have an increased risk of gestational diabetes mellitus, induction of labor, or caesarean birth. CONCLUSION: Higher BMI pregnant women are associated with higher incidences of hypertension. The high BMI group also had a significant relationship with antepartum hemorrhage and postpartum length of stay.

Follicular aspiration versus coasting for ovarian hyper-stimulation syndrome prevention.

OBJECTIVE: To compare follicular reduction prior to human chorionic gonadotropin (HCG) trigger and coasting in terms of ovarian hyper-stimulation syndrome (OHSS) reduction, pregnancy, and cancellation rates in in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles. METHODS:  This study was designed as a prospective study. The setting was the IVF unit at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. A total of 39 patients undergoing IVF/ICSI cycles, who were at risk of OHSS, 20 were put into a coasting group and 19 had follicular reduction instead. This occurred between October 2010 and January 2011. Our main outcome was OHSS reduction. RESULTS: Six (30%) women developed OHSS in the coasting group and 2 (10.5%) women developed OHSS in the follicular group (p-value=0.235). The pregnancy rates in the cycles were similar for both groups: 4/20 (20%) in the coasting group and 3/19 (15.8%) in the follicular group (p-value=1.000). The cancellation rate of the cycles was similar for both groups, 6/20 (30%) in the coasting group and 1/19 (5.3%) in the follicular group (p-value=0.09). The median number of punctured follicles was significantly lower in the follicular group (16 follicles, interquartile range (IQR)=21-12) compared to the coasting group (29 follicles, IQR=37.8-19.8, p-value=0.001). The retrieved, fertilized, and cleaved oocytes, as well as the number of embryos transferred, were similar amongst both groups. CONCLUSION: There was no difference between follicular reduction prior to HCG and coasting, in terms of OHSS reduction, pregnancy, and cancellation rates in both the IVF and ICSI cycles.

Pregnancy outcomes in relation to different types of diabetes mellitus and modes of delivery in macrosomic foetuses in Bahrain.

OBJECTIVES: The mode of delivery in diabetic patients is debatable. This study was designed to assess the pattern of delivery of macrosomic babies with a high prevalence of diabetes mellitus in Bahrain. METHODS: This retrospective analysis was conducted on mothers who delivered babies weighing ≥4.0 Kgs from 2001 to 2011 at Bahrain Defence Force Hospital. Data regarding patients' age, weight, mode of delivery, diabetic status, gestational age and parity were recorded. The main outcome was the effect of diabetes mellitus on the decision to allow vaginal delivery for macrocosmic babies. Other outcomes were failed trial of labour, parity, maternal age and foetal weight on the trial of labour and neonatal morbidity associated with vaginal births. RESULTS: The incidence of macrosomic babies was 2.2% of total births. Pre-existing diabetes mellitus was 3.9% of the study cohort. The rate of elective Caesarean section increased from 12.5% in non-diabetic mothers to 50% in patients with pre-existing diabetes. In cases of allowing a trial of labour, approximately 70% of patients with pre-existing diabetes had successful vaginal delivery. Patients with a previous delivery were less likely to undergo emergency procedures, but had the same probability for elective Caesarean compared with primigravida. Patient's age and foetal weight had no influence on successful trial of vaginal birth. CONCLUSIONS: There was a trend to offer more elective Caesarean sections in patients with macrosomic babies in the presence of pre-existing diabetes. The majority of patients who were offered a trial of labour achieved vaginal delivery with minimal morbidity.

Successful IVF pregnancy after radical trachelectomy using transabdominal cervico isthmic cerclage.

A 34-year-old woman was referred to the in vitro fertilisation (IVF) clinic following failure to conceive after ovulation induction with antioestrogens and intrauterine insemination. She had a long history of hypothalamic amenorrhoea secondary to weight loss and stress and received hormone replacement to maintain her bone density. She also underwent radical trachelectomy and bilateral laparoscopic pelvic node dissection as fertility sparing surgery for cancer of the cervix stage 1B. She remained under our care for 4 years during which she had two successful IVF pregnancies with elective single embryo transfers on both occasions. She delivered preterm by caesarean section at 31 weeks and 35 weeks, respectively, for premature rupture of membranes with good outcomes. There was no evidence of local or distant recurrence of her early cervical cancer at 10-year follow-up at the combined gynaecology oncology clinic and she was discharged to primary care for follow-up.

Schistosomiasis-induced male infertility.

Azoospermia is a rare, irreversible complication in the UK resulting from heavy infection of schistosomiasis of the male genital tract. Adequate anti-bilharzial treatment and close follow-up with urological assessments should reduce the risk of chronic ill health. This patient contracted schistosomiasis following swimming in lakes in Uganda, Africa, which resulted in azoospermia and reversible loss of libido. The couple underwent treatment at our assisted conception programme with testicular sperm extraction and intracytoplasmic sperm injection (ICSI). The female partner conceived in her second stimulated ICSI cycle and had a spontaneous vaginal delivery at term.

A clinico-pathological study of postcoital bleeding.

METHODS: To undertake a clinical study of postcoital bleeding (PCB) in a district general hospital we retrospectively reviewed the records of 248 patients referred to the gynaecology department over a 5-year period. RESULTS: 63% were in the 21-40-year age group and 80% were multiparous. Seventy per cent were referred to the gynaecology out patients' clinic and 28% to the colposcopy clinic. Associated symptoms included menstrual abnormalities (39%) and dyspareunia (13%). Twenty per cent had benign polyps, including endometrial polyps and 25% had cervical ectropion. Cervical intraepithelial neoplasia was detected in 6.8% of cases. There was no case of invasive cancer of the lower genital tract. CONCLUSIONS: This is the first report of associated endometrial polyps contributing to PCB. We conclude that CIN may not always be asymptomatic and the incidence of cervical or endometrial cancer is low in women with PCB.