Serum Iron Parameters among Pre-Eclamptic and Normotensive Pregnant Patients in The Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

Objective-To compare the serum iron parameters in parturients with and without preeclampsia Study design- Acase-control study Materials and Methods-Thirty-nine pre-eclamptic patients who presented in labour or about to be delivered by Caesarean section were selected as cases while fifty-eight normotensives admitted within the same period served as the controls. Blood samples were taken from informed participants before delivery and sent to the laboratory for analysis. Relevant bio-data was obtained from case records of the participants while the results of serum iron, ferritin, binding capacity and percentage saturation were recorded. Results-There were no statistically significant differences between the two groups regarding maternal age, parity, birth weight and gestational age at delivery, p>0.05.There were no differences also between the two groups with regard to the mode of delivery and fetal outcome, p>0.05. Even though total iron binding capacity was lower in preeclamptic patients, it didn't reach statistical significance. However, statistically significant differences were found between the two groups regarding serum iron and ferritin, p<0.05. Conclusion -Serum iron and ferritin were increased in patients with preeclampsia which may promote oxidative stress and therefore preeclampsia. More studies with larger sample sizes are advocated to validate the reliability of these findings.

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.

Induction of labor with prostaglandin E2 vaginal tablets in parous and grandmultiparous patients with previous cesarean section.

OBJECTIVES: To compare the outcome of induction of labor with prostaglandin E2 vaginal tablets between lower parity (parity 1-5) and grandmultiparous (parity >5) patients with a history of one previous lower segment cesarean section. METHODS: A prospective study of 113 patients conducted at King Faisal Military Hospital, Khamis Mushayt, Saudi Arabia during a 5-year period spanning January 1995 to December 1999. RESULTS: There were no statistically significant differences in the two groups regarding mean maternal age, dose of prostaglandin used, gestation at delivery, mean birth weight, P>0.05. Syntocinon augmentation was used in 16 (21.9%) of the lower parity patients compared with 8 (20.0%) in the grandmultiparas but this was not statistically significant, (P=0.677). However, there was a statistically significant difference in the cesarean section rate between the two groups, P=0.019. Although no cases of uterine hyperstimulation were recorded, there was one rupture of the uterus in each of the two groups of patients; 1.36% and 2.5%, respectively, but this was not statistically significant, P=1.000. CONCLUSIONS: The complications of induction of labor with prostaglandin E2 vaginal tablets in grandmultiparous patients with previous cesarean section were similar to those with lower parity but the cesarean section rate was significantly higher. However, larger studies are needed for validation.

Pregnancy outcome in asthmatic patients from high altitudes.

OBJECTIVE: To compare pregnancy outcome in asthmatic and non-asthmatic patients from high altitudes. METHOD: A prospective case-control study over a 4-year period. The setting was: Abha Maternity Hospital, south-west region of Saudi Arabia. Eighty-eight asthmatic pregnant patients were followed up on during their pregnancies and deliveries (cases). The control subjects were 106 non-asthmatic patients who delivered during the same period. RESULTS: There were no statistically significant differences in the mean age, parity and gestation at delivery between the cases and control subjects (P>0.05), while there were statistically significant differences in the mean birth weight, placental weight and number of abortions between the two groups (P<0.05). Antenatal complications occurred in 12.5% of the asthmatic patients and 1.9% of the control subjects. Pre-eclampsia was diagnosed in 7.9% of the asthmatic group but in none of the control subjects. Induction of labor, cesarean section rate, perinatal mortality, congenital malformations and Apgar score <7 at 5 min were significantly higher in the asthmatic patients. CONCLUSION: Asthma occurring in pregnancy was associated with increased antenatal complications, increased perinatal loss and congenital malformations in our study population.

Factors influencing reproductive performance following previous ectopic pregnancy.

OBJECTIVE: To assess the factors that influence the reproductive performance in patients who had previous salpingectomy by laparotomy for ectopic pregnancy in the South-west Region of Saudi Arabia. METHODS: Fifty four patients who had pregnancies following salpingectomy for previous ectopic pregnancy were studied retrospectively at Abha Maternity Hospital in the Southern Region of Saudi Arabia. RESULTS: There were 130 ectopic pregnancies during the study period out of which 54 patients became pregnant subsequently. Of the subsequent pregnancies, there were 41 (80%) intrauterine pregnancies and 13 (20%) extrauterine recorded pregnancies. Out of the intrauterine pregnancies, 36 (88%) resulted in full term live births while abortion occurred in 5 (12%) of the cases. The risk of a 2nd ectopic pregnancy seemed to be positively related to the age of the patient and also the interval between the previous ectopic and new pregnancy, while it was negatively related to the parity of the patient. The mean age of the patients was 27.89 years and the mean parity 2.74. Of the 13 patients who had extrauterine pregnancies, 4 (30%) were nulliparous while 9 (70%) had had between 1-5 children. In those patients who had a repeat ectopic pregnancy, the mean gestation of the ectopic pregnancy was 6.78 weeks while the interval between admission to hospital and surgery ranged between 1 to 48 hours with a mean of 21.85 hours. At the time of surgery, the fallopian tube was ruptured in 6 (46%) of the cases and these included patients who were nulliparous. They all had repeat salpingectomy. Conservative surgery was performed only in 2 (28%) of those whose fallopian tubes were not ruptured at the time of surgery. CONCLUSION: It seemed as if the probability of repeat ectopic pregnancy increased as the age of the patient increased and the interval between the previous ectopic gestation and new pregnancy is prolonged. At the same time the probability of another ectopic pregnancy decreased as the parity increased. The obstetric outlook following laparotomy for ectopic pregnancy seemed not to be very encouraging as the fertility rate was about 48% and therefore, efforts should be geared at managing patients with ectopic pregnancy laparoscopically. A larger multicenter study is needed to validate these findings.

Heterotopic pregnancy following spontaneous conception: Successful pregnancy outcome.

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Ectopic pregnancy in Abha, Saudi Arabia. A continuing conundrum.

OBJECTIVE: To determine the incidence of ectopic pregnancy in Abha, in the south-western region of Saudi Arabia and to evaluate the relevance of the known risk factors. METHODS: Eighty-two women with histologically confirmed ectopic pregnancies, managed in Abha Maternity Hospital over a three-and-a-half year period, were retrospectively studied. RESULTS: The incidence of ectopic pregnancy was 0.74 per 100 live births. Most (56%) of our patients were within the 21-30 age group. Parous women constituted 56% and nulliparous patients constituted 21% of the study group. No previous history of abortion was found in 60% of the patients. Fourteen (17%) had used the intra uterine contraceptive device and 5% had a history of previous ectopic pregnancy. There were 3 cases of heterotopic pregnancies in the series. The right and left fallopian tubes were equally affected. Salpingectomy (90%) was the most frequent definitive surgical procedure performed, and 15% of the patients required blood transfusion. There was no obvious seasonal variation and no maternal death was reported. CONCLUSION: The incidence of ectopic pregnancy appears to be comparatively low in our community and the risk factors do not seem to be clearly defined. A nation-wide multicenter survey to determine the effect of climatic factors and to check, as routine, Chlamydia trachomatis serology in suspected cases of ectopic pregnancy, may be desirable. Without these determinations, ectopic pregnancy and possible preventive measures may continue to remain a conundrum.

Ruptured tubal pregnancy co-existing with acute appendicitis: A rare occurence.

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Ruptured tubal pregnancy co-existing with acute appendicitis. A rare occurrence.

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Splenic artery aneurysm rupture during pregnancy.

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Diabetes and perinatal loss. A continuing problem.

OBJECTIVE: To determine the fetal outcome in diabetic pregnant patients managed exclusively by the obstetrician at King Faisal Military Hospital in the south-west region of Saudi Arabia, and to compare this with the non-diabetic control group in the same hospital. METHODS: Case-control study of 83 diabetic and non-diabetic pregnant patients who delivered at King Faisal Military Hospital over a 2 year period. RESULTS: The perinatal mortality rate in diabetic patients was 6.02% while that in the non-diabetic control group was 1.2%. However, the difference was not statistically significant, p>0.05. There was a difference in the mean birth weight between the cases and controls; p = 0.001 and the cesarean section rate was 5 times higher in the cases than in controls [corrected]. This was statistically significant; OR=5.22 (1.90-16.48). CONCLUSION: Diabetes in pregnancy is still a major cause of perinatal loss in our community. The increase in cesarean section in diabetic pregnant patients also indicates a drain in the financial resources. It is recommended that emphasis should be placed on health education in order to reduce the cost of child birth as this condition may be prevented.

Efficacy and acceptability of depo-medroxyprogesterone acetate injection. As a method of contraception in Saudi Arabia.

OBJECTIVE: To determine the efficacy and acceptability of Depo-Medroxyprogesterone acetate (depo-provera) among the women using that method of contraception at King Faisal Military Hospital in the south-west region of Saudi Arabia. METHODS: A preliminary retrospective and questionnaire analysis of 165 Saudi women who had depo-provera as a method of contraception at the contraception clinic of King Faisal Military Hospital over a period of 2 months. RESULTS: The mean age of the women was 31.21 years and the mean parity 6.77. There was no pregnancy reported during the period of use of the contraceptive method which ranged from 3 months to 7.25 years. The side effects were mainly irregular spotting (69%), continuous bleeding per vaginam (7%), amenorrhoea (8%) and menorrhagia (1%). The rest reported normal menstrual pattern. Irregular spotting was common in women who had used the method for less than 2 years while amenorrhoea was the most common menstrual abnormality after 3 years of use. The other complaints included weight gain, loss of hair, abdominal pain and backache. The side effects were not acceptable to 4% of the women and they tried other methods of contraception. Thirteen percent of the women became pregnant after stopping the injections within intervals varying between 6 months to 2 years. Seventeen percent were using the method for the 2nd time. CONCLUSION: Depo-provera is a very effective form of contraception in our community. While a few of the patients (4%) in our series would try other methods if not happy with the side effects, the majority were prepared to cope with the side effects as long as the desired prevention of pregnancy was guaranteed. Further studies are needed to validate these findings.

Abha septuplets and total infant survival.

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The changing pattern of malignant neoplasms among females in Asir region of Saudi Arabia.

OBJECTIVE: The study was undertaken to compare the frequencies of the various types of malignant neoplasms affecting females in the Asir Region of Saudi Arabia during the years 1996-1998, to the experience of a previous report (1987 to 1989) in the same population with rapid advancing health care services. METHODS: A retrospective descriptive approach was adopted. Histopathological records of Asir Central Hospital were reviewed to extract data on female malignant neoplasms seen in the years January 1996-December 1998. The cancer from various sites were ranked based on their percentage (crude relative) frequencies, and compared with the previous report (1987-1989). RESULTS: Of the 274 cases of histologically confirmed female malignant diseases, the breast (22%), skin (9%) and thyroid (7%) were the leading sites. This ranking contrasts with the previous finding (1987-1989) which involved the skin, breast and non-Hodgkin's lymphoma, in descending order of frequencies. The frequency of gynecological malignancies was relatively higher than in the previous report. CONCLUSION: There may be a need to review the pattern of malignancies in the female population in this region from time to time in order to concurrently update planning on preventive and treatment measures.

Pregnancy outcome in singleton term breeches from a referral hospital in Saudi Arabia.

OBJECTIVE: To compare the pregnancy outcome in women with singleton breech presentation at term delivered by caesarean section (CS) and vaginal breech delivery. DESIGN: A retrospective study. SETTING: Abha Maternity hospital, Saudi Arabia. MATERIAL AND METHODS: 573 women with singleton breech presentation at term who delivered between January 1994 and December 2000 formed the basis of this study. There were 166 patients (28.9%) who had assisted vaginal breech delivery (AVBD) and 407 patients (71.1%) who were delivered by CS. RESULTS: There were no statistically significant differences in the mean age and number of abortions between the two groups, (p>0.05) but statistically significant differences were found regarding the birth weight and parity respectively (p<0.05). One hundred and fourteen (19.7%) of patients had a previous CS, and of these 2 (1.75%) delivered vaginally. Caesarean section was carried out electively in 161 (39.5%) of the 407 who had caesarean delivery. There were no statistically significant differences in the perinatal mortality rates, congenital malformation rates and Apgar score of less than 7 at 5 minutes in babies born by AVBD and CS, (p>0.05). There was statistically significant difference in birth trauma (p<0.00001). CONCLUSION: Vaginal breech delivery is strongly associated with birth trauma in our community. It is recommended that attention should be given to trainee obstetrician in selective external cephalic version at term and also the procedure of AVBD so as to reduce the caesarean section rate and also neonatal morbidity in term breeches in our community.

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.

Induced labour with prostaglandin E2 in different parity groups after premature rupture of membranes.

The study compared the outcome of induction of labour with prostaglandin E2 vaginal tablets in patients with premature rupture of membranes (PROM) at term in different parity groups. A retrospective review was made of the hospital records of 169 women attending the maternity unit of King Faisal Military Hospital, Saudi Arabia. There were no statistically significant differences between the 3 groups (parity 0, parity 1-4 and parity 5+) in rates of labour augmentation, caesarean sections, neonatal intensive care admissions or low Apgar scores. There were no serious complications of induction of labour such as infection or uterine hyperstimulation or rupture. Prostaglandin E2 may be used with care for labour induction in women with PROM at term, even grand multiparas, unless there is history of previous caesarean delivery.