Isolated left descended inguinal ovary with ipsilateral ectopic pelvic kidney: a case report and review of literature.

Isolatd descended inguinal ovary is a rarity, but it should be considered as a differential diagnosis of an inguinal mass at any age; in particular during female infancy and up to adulthood. Herein the authors report a case of asymptomatic isolated left descended inguinal ovary, with ipsilateral left ectopic pelvic kidney that was accidentally discovered a few years after menarche.

Cervical cerclage for prevention of preterm birth in women with twin pregnancy.

OBJECTIVE: To compare the effect of elective cervical cerclage in women with twin pregnancy on gestational age at time of delivery. METHOD: In a pragmatic fashion women in Abha Maternity Hospital, Saudi Arabia with twin gestations were allocated to receive either an elective cerclage (group I) or no cerclage (group II). Elective cerclage was performed at 12 to 14 weeks of gestation after sonographic examination of the fetus to confirm gestational age and exclude major congenital anomalies. In all cases, follow up of the pregnancy was continued until delivery. RESULTS: Of the 176 twin pregnancies included, cerclage was performed in 76 women, and no cerclage in 100 women. In Group I: 12 pregnancies ended in spontaneous miscarriage, 37 in preterm labor, and 27 women reached full term. There were a total of 106 live births in 62 women. In Group II: 8 women aborted, 44 women ended in preterm labor and 48 women reached full term. There were a total of 160 live births in 89 women. The gestational age at delivery ranged from 20 to 41 weeks. Multiple regression analysis did not show association between cerclage and time of delivery, although a trend was observed (P=0.056). CONCLUSION: Elective cerclage contributes little in prolongation of gestational age at the time of delivery in women with twin pregnancy, especially in women of high parity. Those with a previous history of preterm labor may be a subgroup that could benefit from elective cerclage.

Staphylococcus lugdunensis endometritis: a case report.

BACKGROUND: Staphylococcus lugdunensis has been reported to cause several localized and blood stream infections, but not endometritis. OBJECTIVE: To desribe a case of Staphylococcus lugdunensis endometritis associated with premature rupture of membranes. CASE REPORT.A 39-year old woman presented with premature rupture of membrane (PROM) and underwent an emergency caesarean section at 40 weeks of gestation. Her endometritis was characterized by a foul odour and was so extensive that the baby was adherent to the endometrium and had to be separated by a gentle pull. In spite of these, neither the mother nor her baby suffered any adverse effect. The organism exhibited several unusual characteristics that are atypical ofstaphylococci. The baby did not develop any sepsis. The mother responded well to antibiotics and both were discharged home on the 4th postoperative day. CONCLUSION: To the best of our knowledge, this is the first report of this organism causing endometritis.

Complications of pregnancy and foetal outcomes in pregnant diabetic patients managed in a tertiary hospital in Saudi Arabia.

OBJECTIVE: To compare the pregnancy complications and fetal outcomes in pregnancies complicated by diabetes mellitus. DESIGN: A retrospective cohort study. Setting- Abha Maternity Hospital, Abha, Saudi Arabia. MATERIALS AND METHODS: One hundred and eighty five diabetic pregnant patients who delivered at the Abha Maternity Hospital during the 3-year-period from April 2000-March 2003 formed the subjects of this study. There were 27(14.6%) (type 1) - insulin dependent diabetics, group 1, 19 (10.2%)(type 2), non insulin dependent diabetic patients who constituted group 2 and 139(75.2%) gestational diabetic patients who made up group 3. Data extracted from the case files included maternal age, gravidity, parity, number of abortions, gestational age at booking, time of diagnosis of diabetes mellitus, complications during pregnancy, birth weight, placental weight. RESULTS: There were no statistically significant differences in the three groups regarding the mean gravidity, parity, birth weight and placental weight (p > 0.05). However, statistically significant differences were found with respect to the mean maternal age, gestation at booking, fasting blood sugar, and gestation at delivery (p < 0.05). Out of 139 gestational diabetics, 23(16.5%) were diagnosed by the 141 week of pregnancy while 24(17.2%) were diagnosed between the 15- 27 weeks of gestation. The control of blood sugar was adjudged to be poor in 32% of gestational diabetics, 50% of type 2 diabetics and 69% of type l diabetics, with statistically significant difference between the groups, (p < 0.05). Although there was statistically significant difference between the groups regarding one of the pregnancy complications (polyhydramnios) (p < 0.05), none were found in other complications (p > 0.05). The overall caesarean section rate was 48%. The overall perinatal mortality was 5.7%, all the deaths occurred in babies born to patients with gestational diabetes. CONCLUSION: Gestational diabetes accounted for all the fetal losses in this study, while polyhydramnios was the most common antenatal complication which was significantly higher in type 1 diabetics.

Elective hysterectomy: a clinicopathological review from Abha catchment area of Saudi Arabia.

OBJECTIVE: To review the major indications, types and clinicopathological features of elective hysterectomy managed in our locality. MATERIAL AND METHODS: A retrospective study of 317 consecutive patients who had elective hysterectomy performed for various indications during the study period from January 1994-December 2001,(96 months) was conducted. The patients were divided into 3 groups: Group 1, total abdominal hysterectomy(TAH) 165 (52%); Group 2: subtotal abdominal hysterectomy(STAH) 59(18.6%) and Group 3: vaginal hysterectomy (VH),93 (28.4%). Data extracted from the case files included age, parity, presenting symptoms and indication for hysterectomy. Others included relevant investigation results, type of hysterectomy, and histopathological diagnosis of the specimens SETTING: Abha Maternity Hospital, Abha, Saudi Arabia. RESULTS: No statistically significant trend was found in the annual number of hysterectomies performed during the study period (p > 0.05). There was statistically significant difference in the mean age in the 3 groups of patients (p < 0.05), but none in the parity (p > 0.05). Menorrhagia and abnormal vaginal bleeding was the indication for hysterectomy in 123(38.8%) patients, followed by uterine prolapse in 91(28.7%), abdominopelvic mass, 48 (15.1%) and pelvic mass in 46 (14.8%). Histopathology of hysterectomy specimens and appendages were reported as abnormal in 179 (56.4%), with uterine fibroids the most common pathology in 82 specimens (25.8%) followed by adenomyosis in 72 specimens(22.7%). CONCLUSION: Uterine fibroids and adenomyosis were the most common benign conditions in hysterectomy specimens in our community with peak incidence at 41-50 years, while endometrial and ovarian cancers peaked at the same age group. At the same time, vaginal hysterectomy was performed exclusively for utero-vaginal prolapse.

The effect of high altitude on endothelial and vascular dysfunction markers in preeclamptic patients.

Placental hypoxia, a major component of the pathophysiology of preeclampsia, is associated with various maternal vascular and endothelial dysfunctions. The higher incidence of preeclampsia at high altitude remains incompletely explained. The aim of the present study was to investigate the effect of high altitude on some endothelial and vascular dysfunction markers in normal and preeclamptic pregnancies. Eighty pregnant women (Paras 2-4) were enrolled in this study, which included four groups (each n = 20): normal pregnancies at low altitude (NL), normal pregnancies at high altitude (NH), preeclamptic pregnancies at low altitude (PL), and preeclamptic pregnancies at high altitude (PH). In normal pregnancies at high altitude serum ET-1, plasma TXA2, and serum TNF-α levels increased significantly with a significant reduction in plasma PGI2 (66.81 ± 7.36, 122.86 ± 13.37, 102.23 ± 13.31, 191.57 ± 19.68, respectively) compared with the NL group (48.92 ± 4.58, 89.03 ± 10.67, 69.86 ± 7.97, 238.01 ± 24.55, respectively). In preeclampsia at low altitude serum ET-1, plasma TXA2, and serum TNF-α levels increased significantly with a significant reduction in plasma PGI2 (88.39 ± 9.54, 162.73 ± 15.92, 142.39 ± 15.37, 149.155 ± 15.66, respectively) compared with both NL and NH groups. High altitude significantly augmented these changes in preeclamptic patients (117.75 ± 12.96, 211.01 ± 22.69, 196.86 ± 17.64, 111.92 ± 10.74) compared with PL, NH and NL groups. In conclusion hypoxia at high altitude aggravated the disturbances in the levels of ET-1, TXA2, PGI2 and TNF-α associated with preeclampsia. This may contribute to the higher risk of preeclampsia at high altitude.

Pityriasis lichenoides et varioliformis acuta in pregnancy.

Pityriasis lichenoides et varioliformis acuta is an uncommon disease, especially during pregnancy. In review of the obstetric literature, there was no report of pityriasis lichenoides et varioliformis acuta during pregnancy. A 25-year-old female was seen at 24 weeks of gestation for consultation about a cutaneous disease. She was admitted at 30 weeks of gestation because of threatened premature labor, and some active cutaneous papules presented themselves at that time. After the treatment, cutaneous papules remitted. But at 35 weeks of gestation, she had spontaneous labor. Both the mother and infant were doing well at 5 months postpartum. If pityriasis lichenoides et varioliformis acuta exists in the vagina or cervical bone of the uterus, it is due to infections from lymphatic vasculitis and necrosis. It may cause threatened premature labor and premature rupture of the membrane.

Primary caesarean section in nulliparous and grandmultiparous Saudi women from the Abha region: indications and outcomes.

OBJECTIVE: To assess the indications for and outcomes of primary caesarean section (PCS) perfomed in nulliparous and grandmultiparous women in the Abha region of Saudi Arabia. METHODS: A retrospective cohort study. MATERIALS: 393 nulliparous women (para 0) (NPG) and 432 grandmultiparous women (parity>5) (GMPG) who had PCS at the Abha Maternity Hospital (AMH) over a 3-year period, (1997-1999) formed the basis of the study. RESULTS: The PCS rates in NPG and GMPG were 19.4% and 18.3% respectively with no statistically significant difference. (p>0.05). There were statistically significant differences between the two groups regarding the mean age, blood loss during surgery, post operative haemoglobin, and birth weight were compared, p<0.05. There was no statistically significant differences in the mean gestation at delivery, p>0.05. The most common indication for surgery in the two groups of patients was fetal distress (NPG=28%, GMPG=25%: p=NS), followed by failure of progress in labour. (NPG=22.7%, GMPG =21.6%, p=NS). Antepartum haemorrhage (APH) was the indication for PCS in 6.8% of the NPG and 13.9% of the GMPG, (p<0.05). Multivariate linear regression analysis indicated that maternal age and booking status significantly affected birth weight (p=0.004,p=0.022 respectively). However, neither birth weight nor low Apgar score was affected by the indications for CS or parity. While there were no perinatal deaths in the series, no statistically significant difference was found between the two groups with regards to low Apgar score (<7 at 5 mins), p>0.05. CONCLUSION: The major indications for PCS were the same in the NPG and GMPG in our study while the CS rates were similar in both groups. However, APH and its inherent complications occured more commonly in the GMPG. Neonatal morbidity was similar in both groups of women, but the mean birth weight was significantly higher in the GMPG. However, in order to reduce the high CS rate in these groups of patients, and in our obstetric population in general, it is suggested that CTG be used appropriately in high risk women and that intermittent auscultation is recognized as a valid form of management for most low risk cases.

BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis.

BACKGROUND The global obesity epidemic has paralleled a decrease in semen quality. Yet, the association between obesity and sperm parameters remains controversial. The purpose of this report was to update the evidence on the association between BMI and sperm count through a systematic review with meta-analysis. METHODS A systematic review of available literature (with no language restriction) was performed to investigate the impact of BMI on sperm count. Relevant studies published until June 2012 were identified from a Pubmed and EMBASE search. We also included unpublished data (n = 717 men) obtained from the Infertility Center of Bondy, France. Abstracts of relevant articles were examined and studies that could be included in this review were retrieved. Authors of relevant studies for the meta-analysis were contacted by email and asked to provide standardized data. RESULTS A total of 21 studies were included in the meta-analysis, resulting in a sample of 13 077 men from the general population and attending fertility clinics. Data were stratified according to the total sperm count as normozoospermia, oligozoospermia and azoospermia. Standardized weighted mean differences in sperm concentration did not differ significantly across BMI categories. There was a J-shaped relationship between BMI categories and risk of oligozoospermia or azoospermia. Compared with men of normal weight, the odds ratio (95% confidence interval) for oligozoospermia or azoospermia was 1.15 (0.93-1.43) for underweight, 1.11 (1.01-1.21) for overweight, 1.28 (1.06-1.55) for obese and 2.04 (1.59-2.62) for morbidly obese men. CONCLUSIONS Overweight and obesity were associated with an increased prevalence of azoospermia or oligozoospermia. The main limitation of this report is that studied populations varied, with men recruited from both the general population and infertile couples. Whether weight normalization could improve sperm parameters should be evaluated further.

Severe pre-eclampsia and eclampsia in Abha, the south west region of Saudi Arabia.

A retrospective study was conducted over a 10-year period on 32,000 maternities at Abha General Hospital, Abha, Saudi Arabia, to estimate the contribution of eclampsia and severe pre-eclampsia to maternal mortality and morbidity and also fetal wastage. It included 18 cases of eclampsia and 297 cases of severe pre-eclampsia. Multiple regression analysis revealed that only the presence of prodromal symptoms significantly affected the occurrence of eclampsia, p < 0.05, while nulliparous patients were a high risk group for eclampsia. Maternal complications including eight cases of massive ascites occurred exclusively in severe pre-eclamptics. Although no maternal deaths were reported, the perinatal mortality rate was 16.6% and 14.1% among the eclamptics and severe pre-eclamptic patients, mainly from prematurity. Regarding the eclamptic patients, 17(94.4%) had the first fit before arrival at the hospital, 13(72.2%) before labour, while 3(16.6%) had fits before and during labour and 1(5.6%) had the fits after delivery. Suggestions are proffered to reducing maternal morbidity and perinatal mortality and morbidity.

Endometrial thermal balloon ablation with the ThermaChoice system: effect of intrauterine pressure and duration of treatment.

STUDY OBJECTIVE: To determine the safety and efficacy of thermal balloon therapy under variable intrauterine pressures and durations of treatment. DESIGN: Retrospective cohort study. (Canadian Task Force classification II-1). SETTING: University-affiliated teaching hospital. Patients. Sixty-six women with menorrhagia. INTERVENTION: Eighteen patients were treated with the ThermaChoice thermal balloon system for 8 minutes at 80 to 150 mm Hg pressure, 15 were treated for 8 minutes at 151 to 180 mm Hg, and 33 were treated for 12 to 16 minutes at 151 to 180 mm Hg. MEASUREMENTS AND MAIN RESULTS: No intraoperative complications occurred and postoperative morbidity was minimal. At 12 to 24 months follow-up, persistent menorrhagia was reported in 56% of women treated at 80 to 150 mm Hg compared with 20% treated at 151 to 180 mm Hg for 8 minutes (p = 0.01), and in 24% treated for 12 to 16 minutes at 151 to 180 mm Hg (p = 0.1). CONCLUSION: Thermal balloon endometrial ablation is a safe and effective treatment for menorrhagia. Balloon pressure greater than 150 mm Hg increased the effectiveness of treatment. Success was not affected or influenced by increasing the duration of treatment from 8 to 12 minutes or more.

Thermal balloon endometrial ablation to treat menorrhagia in high-risk surgical candidates.

OBJECTIVE: To evaluate the safety and efficacy of thermal balloon therapy in a subset of women with menorrhagia considered to be high-risk surgical candidates for hysteroscopic endometrial ablation or hysterectomy. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: University-affiliated teaching hospital. PATIENTS: Women with menorrhagia, at high risk because of bleeding disorders (12), morbid obesity (6), heart-lung transplantation (2), cardiac pacemaker (2), postmenopausal bleeding (8), bowel disease with extensive adhesions and ileostomies (3), cervical stenosis (3), and other medical disorders (9). INTERVENTION: Treatment consisted of controlled heating to 87 degrees C of 5% dextrose in water within an intrauterine latex balloon pressurized to 170 mm Hg for 8 minutes. General anesthesia was used in 28 patients (60%) and local anesthesia with or without intravenous sedation in 18 (40%). MEASUREMENTS AND MAIN RESULTS: No intraoperative complication occurred and postoperative morbidity was minimal. Follow-up of 43 women ranged between 6 and 30 months. Overall success of the procedure was 79% (34 patients), with 33% reporting amenorrhea, 19% hypomenorrhea, 28% eumenorrhea, and 21% menorrhagia. CONCLUSION: Thermal balloon endometrial ablation is safe and effective in treating menorrhagia when other therapies are contraindicated or difficult to perform.

Hysteroscopic endometrial ablation is an effective alternative to hysterectomy in women with menorrhagia and large uteri.

STUDY OBJECTIVES: To examine the feasibility, safety, and outcome of hysteroscopic endometrial ablation, and to determine the volume of fluid absorbed during resection versus rollerball coagulation in women with menorrhagia and large uteri. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University-affiliated teaching hospital. PATIENTS: Forty-two consecutive patients (mean +/- SD age 45.6 +/- 6 yrs) with uterine size greater than 12 weeks (cavity >12 cm). Intervention. Endometrial ablation; 26 (62%) women were pretreated to thin the endometrium. MEASUREMENTS AND MAIN RESULTS: Resection was performed in 27 patients (65%) and rollerball coagulation in 15 (35%). Ablation was successfully performed in all patients in a day surgery setting. Multiple regression analysis examined the relationship of uterine size, pretreatment, procedure, and duration of surgery to amount of glycine absorbed. Glycine absorption was higher with resection than with coagulation (p = 0.04). Fluid absorption correlated with type of procedure (r = 0.32, p = 0.04) but not with duration of the procedure, uterine size, or pretreatment. One patient with uterine fibroids and one with endometrial adenocarcinoma had hysterectomy. With follow-up of 39 (95%) of 41 women (excluding the one with adenocarcinoma) for 14 +/- 2 months, 38 (93%) were very satisfied. Thirty (73%) had amenorrhea, six (15%) had hypomenorrhea (<3 pads/day), and three (7%) had eumenorrhea (<10 pads/day). CONCLUSION: Hysteroscopic endometrial ablation may be a feasible, safe, and effective alternative to hysterectomy in women with menorrhagia and large uteri.