Different treatment modalities for cesarean scar pregnancies: a single-center experience and literature review.

PURPOSE: Cesarean scar pregnancy (CSP) remains a sporadic form of ectopic pregnancy associated with a severe life-threatening condition. There is no consensus on the treatment modality or a generally accepted guideline in CSP. This study aims to evaluate the outcomes of the different treatment modalities used in CSP treatment at a single center, as well as a literature review. METHODS: This is a retrospective case series study that was conducted; all women who diagnosed with CSP between January 2013 and November 2019 at Women's Specialized Hospital, King Fahad Medical City. The clinical characteristics, diagnosis, different treatment modalities, and clinical outcomes were analyzed. RESULTS: Twenty-seven cases of CSP identified during the study period. The median maternal age was 38 years (range 23-47 years). The gestational age at diagnosis ranged between 5 weeks and 5 days to 13 weeks and 6 days. All diagnoses were made by ultrasound. The absence of embryonic cardiac activity was seen in 10 cases (37.03%). The most commonly used method for first-line treatment was medical treatment. A total of 14 patients (51.85%) were treated with systemic methotrexate (MTX), three (11.1%) intra-sac and systemic MTX, and two (7.4%) intra-cardiac potassium chloride (KCl) along with systemic MTX, five (18.51%) cases had expectant management, one case initially treated with Laparotomy Wedge resection, and one case treated with uterine artery embolization (UAE) and systemic MTX. A total of 20 (74.07%) patients were treated successfully with first-line treatment. Seven (25.92%) patients needed additional second-line treatment. Among them, only one case had surgical intervention. None of the women in the medical treatment group experienced any side effects. Based on ANOVA results, there is no considerable relationship between the mean time of resolution of ß-hCG and four treatment modalities for CSP (p = 0.2406). There was no statistical significance when the fetal viability at the time of diagnosis was compared to the need for second-line treatment of CSP (p = 0.58). CONCLUSION: The treatment of CSP should be individualized based on risk factors. Diagnosis and management of CSP need expertise and a multidisciplinary approach to prevent complications. Early diagnosis and management of cesarean scar ectopic pregnancy remains the mainstay for a successful outcome.

Effect of empiric intravenous intralipid therapy on pregnancy outcome in women with unexplained recurrent implantation failure undergoing intracytoplasmic sperm injection-embryo transfer cycle: a randomized controlled trial.

To evaluate the effect of empiric intralipid infusion therapy on pregnancy outcomes for patients with unexplained recurrent implantation failure (RIF) undergoing intracytoplasmic sperm injection (ICSI). A total of 142 patients with a history of unexplained RIF (3 or more cycles) were included in this randomized controlled trial. Patients were randomized into two groups, study group (n = 71) and control group (n = 71). The study group received intralipid 20% infusion on the day of embryo transfer (ET) and a second dose on the day of pregnancy test. The clinical pregnancy rate in the study group was 36.6% (n = 26) compared to 28.2% (n = 20) in the control group (OR 1.47, CI 0.72-2.98, p = .282). The live birth rate in the study group was 18.3% (n = 13) and 14.1% (n = 10) in the control group (OR 1.37, CI 0.55-3.36, p=.49). No side effects of intralipid therapy were reported in the study period. There was improvement in the pregnancy rate among women with unexplained RIF who received empiric intralipid infusion therapy; however, this improvement did not reach statistical significance.

Perrault syndrome with amenorrhea, infertility, Tarlov cyst, and degenerative disc.

Perrault syndrome is a rare autosomal recessive disorder that affects both males and females. The syndrome causes deafness in males, however females display gonadal dysgenesis along with sensorineural hearing loss. Herein, we present a 27-year-old female patient who is deaf and mute along with primary amenorrhea. Hormonal assays revealed hypergonadotropic hypogonadism and the karyotype was 46 XX. Pelvic ultrasound described a hypoplastic uterus and streak ovaries. MRI of the spine showed degenerative discs and Tarlov cysts. Whole exome sequencing identified a LARS2 mutation and the patient was diagnosed with Perrault syndrome type four (PRLTS4).

Chromosomal aberrations in women with primary and secondary amenorrhea: A cross-sectional study.

AIM: Among women of childbearing age, about 2-5% are affected by amenorrhea that is either primary or secondary. However, there are no data regarding the frequency and type of chromosomal abnormalities associated with amenorrhea in Saudi women. The present study aims to establish the frequency and pattern of chromosomal abnormalities in primary amenorrhea (PA) and secondary amenorrhea (SA) cases in a tertiary care center, Riyadh, Saudi Arabia. METHODS: This cross-sectional study was conducted between 2013 and 2016 on women referred to the Reproductive Endocrine and Infertility Medicine Department at a tertiary care center in Riyadh. Women were divided into two groups: PA and SA. After the initial diagnosis of amenorrhea based on medical history, physical examination, hormonal profile and ultrasonography, chromosome karyotype analysis was conducted on metaphase preparations following routine cytogenetics culture and harvest methods. RESULTS: Chromosomal tests were performed for 53 patients (42 with PA and 11 with SA) out of 79 referred patients with amenorrhea. About 19% of the 42 patients with PA and 1 patient (9.1%) diagnosed as SA showed an abnormal karyotype. The most common abnormal karyotypes observed were 46, XY and 45, X. CONCLUSION: The present study indicates that the chromosomal analysis after the exclusion of nongenetic causes should be essentially considered for the precise diagnosis and the development of more successful management for females with amenorrhea. This study also revealed that the prevalence of chromosomal abnormalities in women with PA and SA is similar to that reported in the literature.

Virtual reality-based assessment of basic laparoscopic skills using the Leap Motion controller.

BACKGROUND: The majority of the current surgical simulators employ specialized sensory equipment for instrument tracking. The Leap Motion controller is a new device able to track linear objects with sub-millimeter accuracy. The aim of this study was to investigate the potential of a virtual reality (VR) simulator for assessment of basic laparoscopic skills, based on the low-cost Leap Motion controller. METHODS: A simple interface was constructed to simulate the insertion point of the instruments into the abdominal cavity. The controller provided information about the position and orientation of the instruments. Custom tools were constructed to simulate the laparoscopic setup. Three basic VR tasks were developed: camera navigation (CN), instrument navigation (IN), and bimanual operation (BO). The experiments were carried out in two simulation centers: MPLSC (Athens, Greece) and CRESENT (Riyadh, Kingdom of Saudi Arabia). Two groups of surgeons (28 experts and 21 novices) participated in the study by performing the VR tasks. Skills assessment metrics included time, pathlength, and two task-specific errors. The face validity of the training scenarios was also investigated via a questionnaire completed by the participants. RESULTS: Expert surgeons significantly outperformed novices in all assessment metrics for IN and BO (p < 0.05). For CN, a significant difference was found in one error metric (p < 0.05). The greatest difference between the performances of the two groups occurred for BO. Qualitative analysis of the instrument trajectory revealed that experts performed more delicate movements compared to novices. Subjects' ratings on the feedback questionnaire highlighted the training value of the system. CONCLUSIONS: This study provides evidence regarding the potential use of the Leap Motion controller for assessment of basic laparoscopic skills. The proposed system allowed the evaluation of dexterity of the hand movements. Future work will involve comparison studies with validated simulators and development of advanced training scenarios on current Leap Motion controller.

Vitamin D deficiency among subfertile women: case-control study.

OBJECTIVE: The objective of the study is to compare the dietary vitamin D and calcium intake among subfertile women (cases) versus pregnant women (controls) and to determine the vitamin D levels in the subfertile and pregnant women. The study design was an observational case-control study where a total of 181 (83 previously diagnosed subfertile cases from various causes and 98 pregnant controls) women of reproductive age. A validated questionnaire was used where it focused on key indicators evaluating vitamin D-related factors. Blood was withdrawn for the measurement of serum calcium, albumin and phosphate to exclude secondary causes that might affect vitamin D level. RESULTS: The prevalence of vitamin D deficiency was significantly higher in the subfertile group than controls (59.0% versus 40.4%; p < 0.01). Calcium supplements intake was significantly higher in controls than the subfertile group (64.6% versus 10.0%; p value < 0.001). Total dietary vitamin D intake (> 400 IU/day) was significantly higher in the controls than the subfertile group. CONCLUSION: Vitamin D deficiency is prevalent among subfertile women. Optimization of serum calcium and vitamin D levels is encouraged.

Short and long-term reproductive outcomes after hysteroscopic adhesiolysis for infertile women.

OBJECTIVE: To evaluate reproductive outcomes after hysteroscopic adhesiolysis for patients with Asherman syndrome (AS) who presented with infertility and/or subfertility. METHODS: A retrospective study was conducted in the Women's Specialized Hospital, King Fahad Medical City, from December 2010 to December 2018. The medical records were reviewed for all infertile women who had hysteroscopic adhesiolysis. The specific study's main reproductive outcomes included: [1] the overall rate of conception, [2] the overall rate of conception according to the severity degree of intrauterine adhesions (IUAs), [3] the reproductive methods for achieving conception, and [4] pregnancy outcomes. Reproductive methods for conception included spontaneous conception, ovulation induction (OI), intrauterine insemination (IUI), and in-vitro fertilization (IVF) with/without intracytoplasmic sperm injection (ICSI). Outcomes of pregnancy included ectopic pregnancy, miscarriage, and live birth events. RESULTS: Forty-one patients (n=41) were analyzed. Their mean age was 32.2±4.6 years. The most common menstrual pattern amongst these patients was hypomenorrhea 46.4%. All patients resumed regular menstrual cycles after the adhesiolysis procedure. The overall conception rate during the 24 months follow up was 53.6%, and the overall live birth rate was 34.2%. Of the 22 patients who conceived, 12 patients (29.2%) conceived spontaneously, 2 (4.9%) with IUI, and 8 (19.5%) with IVF-ICSI. The patients with minimal IUAs had a significantly higher pregnancy rate (71.4%) when compared to those with moderate (47%) and severe (40%) IUA (two-tailed log-rank test, p=0.041). CONCLUSIONS: The spontaneous cumulative conception rate following hysteroscopic adhesiolysis was higher in patients with minimal IUAs than those with moderate and severe IUAs.

Experiences of patients undergoing IVF treatment during the COVID-19 pandemic.

OBJECTIVE: To assess the willingness of patients with infertility to continue with their in vitro fertilization (IVF) treatment during the COVID-19 pandemic. METHODS: This cross-sectional survey was conducted in the reproductive, endocrine, and infertility medicine department (REIMD) at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Patients that were planned to undergo IVF treatment at REIMD were contacted and asked about whether they would like to start IVF treatment during the COVID-19 pandemic from August 2020 to August 2021. Data was analyzed using the SPSS version 24. Statistics obtained as means and standard deviations from continuous variables correlated with the Chi-square test and results were considered significant at p≤0.05. RESULTS: Of the 400 participants, 245 (61.25%) were between the ages of 30-39 years. About 42.75% (n=171) of the patients had 6-10 years of infertility, and 18% (n=72) had at least one pregnancy but no living children. While 64.7% (n=259) of the participants responded on the first call, 83% (n=332) agreed to continue their treatment. Of those, 13% (n=43) preferred to book appointments as soon as possible; 29.8% (n=99) preferred booking within three months; while 57.2% (n=190) chose to book after three months. From our sample, 86.8% (n=59) were afraid to contract the virus and the choice to delay the IVF treatment correlated with the patient's age (p<0.001) and duration of infertility (p=0.007). CONCLUSIONS: The COVID-19 pandemic affected IVF treatment courses, and many patients were afraid to be infected during this pandemic.

Adding Weekly Intramuscular Progesterone to a Twice Daily Vaginal Progesterone Capsule for Luteal Phase Support in IVF/ICSI Cycles Results in Similar Live Birth Rates.

OBJECTIVE: To compare pregnancy outcomes in patients undergoing artificial reproductive treatment (ART) and fresh embryo transfer (ET) who received twice-daily vaginal progesterone capsule (Cyclogest) alone verses twice daily vaginal progesterone capsule (Cyclogest) plus weekly intramuscular Hydroxyprogesterone Capronate (Proluton depot) for luteal phase support. METHODS: A retrospective cohort study that included 1162 patients who completed fresh ART/ET cycle from January 2015 to April 2018. Vaginal Cyclogest 400 mg twice daily was given to 985 patients following oocytes retrieval; whereas 177 patients received weekly intramuscular Proluton depot 250 mg in addition to twice-daily Cyclogest. The primary outcome was live birth rate. The secondary outcomes included biochemical pregnancy rate, clinical pregnancy, biochemical, and early and late pregnancy loss. RESULTS: There was no difference between the twice-daily vaginal progesterone and the addition of weekly intramuscular progesterone injections to the twice-daily vaginal progesterone regarding a positive pregnancy test (40.5% and 46.9%, respectively, p=0.112). There was no statistical difference in live birth rates between the groups (24% for group one, 26% for group two, p=0.582). CONCLUSIONS: The administration of weekly intramuscular progesterone in addition to twice-daily vaginal progesterone capsule for luteal phase support post ART cycle does not result in higher live birth rate.

Baseline Assessment of Health Research Systems in Saudi Arabia: Harnessing Efforts and Mobilizing Actions.

Major transformations are taking place in the Kingdom of Saudi Arabia (KSA) to achieve the 2030 vision for the health sector. A key component in strengthening the health system is a strong research governance strategy that can support the decision-making process by providing timely and accurate evidence that reflects local context and needs. This paper sought to better understand governance structures and policies for health research systems and support clusters so that they function effectively. This paper outlines the findings of an in-depth baseline assessment of existing health research efforts, activities, and plans of eight research clusters in the KSA and identifies key gaps and strengths in health research governance and capabilities. A cross-sectional design was used to survey research clusters in KSA. A six-part survey was developed to better understand the research clusters' health research governance and capacities. The survey was sent to all KSA clusters and was completed in a group setting during meetings. Findings clearly show strong efforts to support research governance initiatives in health clusters in KSA. While some clusters are more advanced than others, there are plenty of opportunities to share knowledge and combine efforts to help achieve the goals set out for KSA health transformation. This baseline assessment also reflects the first attempt of its kind to understand the KSA experience and provide much-needed lessons on country-wide efforts to support the health system given the trickling effect of this sector on all others, enhancing and advancing national growth.

Economic perspective of evaluating fertility treatment in obese and overweight infertile women.

OBJECTIVES: To evaluate direct cost of in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle and reproductive outcomes among infertile women with different body mass index (BMI). METHODS: A retrospective study of 826 subfertility patients who had IVF or IVF-ICSI in 2017 to 2018 were reviewed. The patients were divided into 4 groups bestowing to BMI to normal weight (18.5-24.9 kg/m2), underweight (<18.5 kg/m2), overweight(25-29.9 kg/m2), and obese(≥30 kg/m2). Data on treatment costs of IVF/ICSI and reproductive outcomes were collected and analyzed. A total of 338 patients (40.9%) were overweight, and 300 (36.3%) patients were obese. A bottom-up methodology was used to measure the resource utilization. The capital inputs needed for individual procedures were defined and calculated by consulting with appropriate clinicians and priced using market prices for 2017-2018. RESULTS: There was no statistical significant difference for live birth rate (LBR) among the BMI groups, with the occurrence of LBR in 23 women with normal BMI (13.1%), in 48 (14.2%) women who were overweight, in 48 (16%) in women who were obese (p=0.7). The median cost for IVF/ICSI treatment cycle did not differ across BMI groups; the cost was 10,380 SAR for women of normal weight, 10,440 SAR for women who are overweight and obese (p=0.6). CONCLUSION: Our results suggest that costs of IVF/IVF-ICSI is not significantly affected in women who are overweight or obese.

The status of rubella IgG antibody titer between antenatal and postnatal among pregnant non-immune to rubella.

Background: The infection of rubella in pregnancy is worrisome due to the fact that it causes miscarriages, congenital defects, and Congenital Rubella Syndrome (CRS). The purpose of this study was to determine the status of Rubella IgG antibody levels both during the antenatal and postnatal periods among pregnant women nonimmune to rubella and the incidence of exposure to rubella in pregnancy. Methods: This was a prospective cohort study that included 4770 pregnant, who attended the obstetric clinics and delivered in Women's Specialized Hospital, King Fahad Medical City, between January and December 2015. The study utilized the following measures for rubella screening tests (IgG and IgM) during the antenatal and postnatal period. Pregnant women with recent rubella infection (IgM antibody positive), history of rubella infection, or had immunity against rubella (IgG antibody concentration ≥10 IU/ml) were excluded from the study. Results: The prevalence of pregnant women nonimmune to rubella was 6.3% (n = 301). The majority (93.7%) were immune (IgG antibody concentration ≥10 IU/ml). No patients tested positive for rubella (IgM +ve). Overall, The Median (IQR) Rubella (IgG) in the antenatal period (6.3 (8.30-5.00) IU/m) was significantly less in comparison to the postnatal period (5.0 (6.40-5.00) IU/m). The difference was statistically significant, p <.001. Conclusion: There is a significant decrease in the Rubella (IgG) titer between antenatal and postpartum periods, and we report a very low incidence of rubella infection and CRS among pregnant women nonimmune to rubella.

Risk of Infertility Index in Women with Polycystic Ovarian Syndrome.

OBJECTIVE: To construct the risk of infertility index for women with polycystic ovarian syndrome, that can be used to assess the prognostic factors for conception; and categorise them in mild, moderate and high-risk groups. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: King Fahad Medical City, Riyadh, Saudi Arabia from March 2017 to  February 2018.   Methodology: Fifty women who were diagnosed as polycystic ovarian syndrome were selected by simple randomisation. After initial scrutiny, 39 women with all clinical, biochemical and sonographic features of Rotterdam criteria were included. Patients with congenital adrenal hyperplasia (CAH) and premature ovarian insufficiency (POI) were excluded. Risk of infertility (RII) scale was used to assess the score in women with polycystic ovarian syndrome (PCOS) and classify them into different risk categories like mild (score ≤7), moderate  (score 8-10) and severe  (score >10). RESULTS: There were 5.1% cases with a mild score, 61.5% with a moderate score, and 33.3% with a severe score. For cases in the high-risk group, 89.8% of women had no pregnancy. RII with the cut-off point of 12.5 had a sensitivity of 100%, and specificity of 88.2%, for the defined outcome. Area under the curve was 0.553 and 95% CI was 48.3% (lower bound) and 62.3% (upper bound). CONCLUSION: PCOS patients can be categorised in mild, moderate and high-risk depending on the score on RII scale. The patients with higher score of RII had fewer chances of pregnancy with assisted reproductive technologies (ART). Once the intensity of the risk of PCOS is identified, focused management can be implied thereby reducing the duration of infertility and cost of the treatment. Key Words: Risk, Female infertility, Index, Polycystic ovarian syndrome, Assisted reproductive technology.

47, XXX syndrome with infertility, premature ovarian insufficiency, and streak ovaries.

We report a patient with primary infertility and clinical manifestation of premature ovarian insufficiency (POI) who upon investigation was found to have streak ovaries, and genetic testing revealed Trisomy X (47, XXX). Therefore, we suggest for genetic testing in women with POI to detect common aneuploidies for better counseling and treatment.

Mayer-Rokitansky-Kuster-Hauser syndrome with hyperprolactinemia.

Mayer-Rokitansky-Kuster-Hauser Syndrome in association with hyperprolactinemia is very rare. An 18-year-old, Saudi, single, virgin female was accompanied by her mother seeking medical advice regarding absent menses. She had normal breasts, normal axillary and pubic hair, normal vulva, urethra, and labial folds, however, the vagina was blind, approximately 2 cm length. Pelvic magnetic resonance imaging showed normal appearing ovaries, a small uterus and small cervix and vagina. Investigations showed initial high serum prolactin of 1,517 mIU/L. Cranial MRI was normal. The patient was diagnosed as mullerian hypoplasia class I American Fertility Society. After an extensive literature search, we present a unique case of concomitant occurrence of MRKH, in the form of mullerian hypoplasia, and hyperprolactinemia.

The association between menstrual cycle pattern and hysteroscopic march classification with endometrial thickness among infertile women with Asherman syndrome.

Women with Asherman syndrome (AS) have intrauterine adhesions obliterating the uterine cavity. Hysteroscopic March classification describes the adhesions which graded in terms of severity. This study has been designed to assess the prevalence and association between of clinical presentations, potential causes, and hysteroscopic March classification of AS among infertile women with endometrial thickness.A retrospective descriptive study was carried out that included 41 women diagnosed with AS. All of the patients underwent evaluation and detailed history. All cases classified according to March classification of AS were recorded. Patients were divided into 2 groups based on measurement of endometrial thickness. Group A consisted of 26 patients with endometrial thickness ≤5 mm, and group B included 15 patients with endometrial thickness >5 mm.The prevalence of AS was 4.6%. Hypomenorrhea was identified in about 46.3%, and secondary infertility 70.7%. History of induced abortion, curettage, and postpartum hemorrhage were reported among 56.1%, 51.2%, and 31.7%, respectively. AS cases were classified as minimal in 34.1%, moderate 41.5%, and severe among 24.4% as per March classification. Amenorrhea was reported by 23.1% of women in group A, compared to 0% in group B (P = .002). Ten of 26 patients (38.5%) from group A had a severe form of March classification, compared with 0 of 15 patients (0%) in group B. This was statistically significant (P < .001).The thin endometrium associated with amenorrhea and severe form of March classification among patients with AS.

Neonate female to male ratio after assisted reproduction following antagonist and agonist protocols.

We retrospectively compared neonatal sex after antagonist- versus long-stimulation protocols followed by fresh in vitro fertilization (IVF) or fresh intracytoplasmic sperm injection (ICSI) with either protocol. We reviewed data for 762 IVF/ICSI cycles in 2015, including 23 IVF procedures. We summarized sex outcomes in the entire cohort, and for the additional subgroups: embryo transfer day and number of embryos transferred, and number of oocytes recovered and maternal age. Among 169 live births for all protocols combined, 50.9% of babies were male, and we saw no difference between the antagonist versus long-stimulation groups (52.3% vs 48.3% male babies, respectively; P = .740). Our results also showed no significant difference in sex proportion when comparing IVF versus ICSI, although a higher proportion of babies were male with the antagonist-ICSI protocol. Differences between the additional subgroups were also neither clinically nor statistically significant.

Successful management of a spontaneous viable monochorionic diamniotic twin pregnancy on cesarean scar with systemic methotrexate: A case report.

RATIONALE: Cesarean scar twin pregnancy is exceedingly rare and it remains to be a life-threatening condition even in the early weeks of gestation. Because of its rare occurrence, there is no consensus on the treatment modality of cesarean ectopic pregnancy. PATIENT CONCERNS: A 41-year-old, woman, gravida 7, para 6, with a history of low transverse cesarean section 2 years back presented with an estimated 6 weeks gestational age and viable spontaneous twin, monochorionic diamniotic gestation. The patient presented to the Emergency Department with complaints of vaginal bleeding and mild lower abdominal pain for 5 days. DIAGNOSES: An ultrasound examination was performed demonstrating a single intrauterine gestational sac with 2 viable embryos (monochorionic diamniotic) implanted in the lower uterine segment at the level of the prior cesarean section scar. A diagnosis of viable cesarean scar twin pregnancy was made. INTERVENTIONS: A 2 doses of 50 mg/m methotrexate (MTX) was given intramuscularly. The response to the treatment was monitored by serial beta-human chorionic gonadotropin (ß-hCG) and ultrasound. OUTCOMES: Patient was followed up with ß-hCG weekly levels which became 0 after 68 days of treatment. During the follow-up, the patient was asymptomatic, no side effects of MTX were noticed. LESSONS: We reported a rare case of viable monochorionic diamniotic twin pregnancy on a cesarean scar that was successfully treated with systemic MTX without any additional therapy. Additionally, the decline of ß-hCG in twin ectopic cesarean scar pregnancy appears to be similar to a singleton ectopic pregnancy.

Hydrosalpinx with acute abdominal pain during the third trimester of pregnancy: A case report.

BACKGROUND: Acute abdomen in pregnancy is a unique clinical challenge. We report a rare case of hydrosalpinx presenting as acute abdomen in the third trimester of pregnancy in the absence of infection and hormonal treatment. CASE: A 38-year-old Caucasian woman (gravida 4, para 3), at an estimated 29 weeks of a spontaneous singleton pregnancy, presented to the emergency department with severe abdominal pain in the right lower quadrant, which had been present for three days. Magnetic resonance imaging (MRI) demonstrated a right-sided hydrosalpinx. It was successfully treated with conservative treatment and the patient delivered vaginally at term without complication. CONCLUSION: Hydrosalpinx should be considered as one of the differential diagnoses for acute abdomen during pregnancy. A multidisciplinary approach is recommended, with a careful work-up, due to the risks to both fetus and mother.

The birth weight in pregnant women with Asherman syndrome compared to normal intrauterine cavity: A case-control study.

Women with Asherman syndrome (AS) have damaged endometrium and reduced blood flow to the uterus and placenta which may lead to low birth weight and several obstetric complications.The objective is to determine the association between low birth weight and obstetrical complications in women with AS compared to women with normal intrauterine cavity.A retrospective case-control study was conducted in Women's Specialized Hospital, King Fahad Medical City, from December 2008 to December 2015. Pregnant women with AS undergoing hysteroscopic adhesiolysis who presented to our clinic were matched for age, parity, body mass index, methods of conception, and gestational age to pregnant women without AS based on a 1:3 ratio. The main outcome measure included birth weight and obstetrical complications.The study included 56 women with 14 cases and 42 controls. Pregnant women with AS had significantly lower birth weight (2.23 ±â€Š0.28 kg) compared with pregnant women without AS (3.13 ±â€Š0.383 kg) (P < .001 odds ratio [OR] 0.029, 95% confidence interval [CI] 0.006-0.148, P = .001). Complications of delivery including retained placenta, placenta previa, and fetal death were significantly higher in patients with AS compared with controls 28.6% 7.1%, and 7.1% compared to 4.8%, 0%, and 0%, respectively. This was statistically significant (P < .001).Pregnant women with AS delivered low birth weight newborns and had more obstetrical complications as compared with pregnant women with normal cavity.