Buphenine and threatened abortion.

One hundred and seventy patients with threatened abortion have been studied in two groups. Group 1 of eighty-five patients were treated with the uterine muscle relaxant, buphenine hydrochloride. The second group of eighty-five patients were given placebo. Pregnancy continuation was 90.6% in group 1 and 62.3% in group 2. Only three of 22 patients with history of recurrent abortion using buphenine aborted.

Congenital skin defects and zinc deficiency - a possible relationship.

Two infants with congenital skin defects were born to mothers who had uneventful pregnancies; drugs were not ingested, nor was any infection noted. Maternal plasma zinc and copper were measured postnatally and were found to be abnormal. We suggest that these skin abnormalities were related to maternal zinc deficiency.

Pregnancy following rupture of the pregnant uterus.

OBJECTIVE: To review the cases of ruptured uterus at King Khalid University Hospital (KKUH) over the 11 years of the hospital's existence (1984-1994), to analyze the causative factors of uterine rupture with a view to its prevention, and to highlight the management approach in relation to maintaining the patients' future fertility. METHODS: Case notes were reviewed for all patients with ruptured uterus at KKUH over a period of 11 years from January 1984 to December 1994. Relevant data relating to the clinical features, characteristics of labor, operative procedures, and maternal and perinatal outcome were assessed. RESULTS: There were 11 cases of ruptured uterus, six of which occurred in patients with previous cesarean scars. Two patients were primigravidas, one of whom ruptured her uterus following a road traffic accident. In one patient with six previous preterm labors, rupture resulted from non-removal of cervical cerclage during labor. The rupture occurred in the fundus in one case, and in the lower segment in the remaining 10. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in three cases, two of which were total and the third subtotal. The remaining eight patients had suture repair, all of whom became pregnant later and were delivered by cesarean section. CONCLUSION: Even though rupture of the uterus was a rare complication of pregnancy at KKUH, it occurrence should be suspected when there are sudden fetal heart abnormalities during labor, or unexplained postpartum shock. Suture repair should be considered whenever possible in order to preserve the patients' reproductive potential.

Obstetric outcome in uncomplicated prolonged pregnancy.

OBJECTIVE: To study and compare the obstetric outcome in term pregnancies and uncomplicated prolonged pregnancies. METHODS: The study was a retrospective review of 596 cases. The case notes of 286 patients with uncomplicated prolonged pregnancies (> or = 42 weeks) and 310 patients with normal term pregnancies (37 to < 42 weeks) were analyzed. The Gold Stat package was used for statistical coding and analysis. RESULTS: There was no fetal morbidity or mortality among the two groups. However, the number of previous abortions were significantly higher in prolonged pregnancies compared with term pregnancies. Similarly, fetal and placental weights, labor induction and operative delivery rates were significantly higher in prolonged pregnancies. However, there were no significant differences between the patients who were induced and those who had spontaneous labor among the prolonged pregnancies. CONCLUSIONS: There is no doubt that prolonged pregnancy may be associated with certain risks factors. However, there is no outcome variable to justify whether or not to induce those pregnancies which are prolonged.

Sequelae of repeat cesarean sections.

OBJECTIVES: To study and analyze the factors related to repeat cesarean section and to highlight the problems that may be associated with it. METHODS: The study was carried out in the Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh, Saudi Arabia, and involved 395 patients who had had two or more previous cesarean sections prior to the current pregnancy. Various factors which may be associated with repeat cesarean sections, as well as the outcome of the operations, were assessed and analyzed. The chi2-test and other analyses were used to examine the association between the number of cesarean sections and the various variables. RESULTS: Four or more previous cesarean sections was significantly associated with dense adhesions. On the other hand, height, parity, antenatal clinic attendance, postoperative complications, fetal weight and fetal outcome had no significant effect on, nor influenced, the multiplicity of cesarean sections. CONCLUSION: No specific risk is associated with repeat cesarean sections that is not normally associated with single cesarean sections.

Values of certain clinical and biochemical tests for prediction of pre-eclampsia.

To evaluate different predictive tests for pre-eclampsia, either individually or in combination, we prospectively studied 100 primigravid females. Eighty-eight of the subjects continued the follow-up until delivery and 17 developed pre-eclampsia. Venous blood samples were take for determination of plasma fibronectin, and urine samples were taken for determination of microalbuminaria and calcium-creatinine ratio. Isometric handgrip exercise tests were also performed. Evaluation of predictive tests, as well as t and chi-squared statistical tests, were used for analysis of data. Pre-eclampsia developed in 19.3% of the patients studied. Pre-eclamptic and normotensive females showed significant differences in calcium-creatinine ratio and plasma fibronectin levels in both ( 14-24 weeks and 28-32 weeks) gestation periods (P <.0001). Plasma fibronectin had the best sensitivity, positive, and negative values in gestation period 14-24 weeks, whereas isometric handgrip exercise tests had the best specificity. These values improved for all the tests in the 28-32-week gestation period; even so, plasma fibronectin proved best of all. A combination of tests failed to improve the predictive ability of fibronectin alone. We conclude that plasma fibronectin is the best predictive test for pre-eclampsia.

Outcome in elective and emergency cesarean sections: A comparative study.

To study the obstetrics outcome of cesarean sections (CS) in relation to the elective or emergency nature of this procedure, a comparative study was conducted on 1426 females whose deliveries were by CS in King Khalid University Hospital (KKUH). Of the various factors analyzed in relation to the two types of CS, statistically significant associations were found between emergency CS and younger patients, low parity, irregular attendance at antenatal clinics, complications in labor, postoperative morbidity and low Apgar score(>6). It was concluded that every effort should be directed to effect-planned CS, as determined during the antenatal period, if possible, so as to reduce the various problems associated with emergency CS. The chances are that this approach is unlikely to influence the overall CS rate in either way.

Primary cesarean section in King Khalid University Hospital: Indications and obstetric outcome.

This study was conducted to estimate the rate and indications for primary cesarean section in King Khalid University Hospital, Riyadh, over a period of five years. The overall cesarean section rate of 10.3% was found to be lower than in the Western world. The primary cesarean section rate of 6.1% was equally lower than in most other studies. Breech presentation, failure to progress and fetal distress were the main indications for primary cesarean section in the study. Maternal age, parity and fetal weight were found to be significantly associated with the primary cesarean section rate.

Different Doses of Sublingual Misoprostol versus Methylergometrine for the Prevention of Atonic Postpartum Haemorrhage.

OBJECTIVE: In the poor underdeveloped countries, anaemia is very common in pregnant women. Maternal mortality is four times higher in severely anaemic women than non-anaemic ones and postpartum haemorrhage (PPH) is the most common cause of death. Its main cause is uterine atony, which accounts for more than 70%. The objective of this study is to evaluate the use of sublingual misoprostol in different doses of 600, 800 and1000µg in management of the third stage of labor, with regards to blood loss and incidence of atonic postpartum haemorrhag (APPH). STUDY DESIGN: Double blind randomized controlled study METHODS: One thousand and two hundred parturient were studied in a control and three study groups, each composed of 300 women. Methylergometrine 0.2 mg IM injection and sublingual misoprostol 600, 800 and 1000 µg tablets were given to women in control and the three study groups respectively, immediately after delivery. OUTCOME MEASURES: Duration of the third stage of labour, Blood loss in the third stage of labour, Outcomes in anaemic compared to non-anaemic women, Incidance of atonic postpartum haemorrhage in different groups, Haemoglobin deficit after 24 hrs of delivery, Changes in the women's blood pressure during the study, Side effects of the drug, and, Women's acceptability of sublingual misoprostol administration. RESULTS: Only significant reduction in blood loss and haemoglobin deficits were seen in the third stage of labour and after delivery in women used misoprostol doses of 800 µg and 1000 µg. The incidences of PPH in studied women and controls were almost similar, ranging between 2 and 3%. Similar results were seen in anaemic and non-anaemic women with a higher incidence of APPH in the non-misoprostol user anaemic women. Side effects of the drug were dose related. CONCLUSION: Misoprostol in high dose may be used for managing third stage of labour to reduce maternal morbidity and mortality due to APPH particularly, in the poor underdeveloped countries where, facilities to deliver in health centers, purchase and store the oxytocic ampoules or medically trained persons are not readily available in all places. Benefits of large dose misoprostol outweigh its side effects.

El-menia air inflated balloon in controlling atonic post partum hemorrhage.

OBJECTIVE: To design and test an in-expensive air-inflated balloon that is easy to sterilize and use for the control of atonic post partum hemorrhage (APPH). PRIMARY OUTCOME MEASURE: Maternal Mortality (MM). SECONDARY OUTCOME MEASURES: Surgical maternal morbidities, amount and doses of drugs, blood transfusion units used for resuscitation, general condition of women on admission and outcome on discharge, the resuscitation time and time for regaining normal uterine tone; hospital stay and ICU admission. TECHNICAL OUTCOMES: Incidence of Balloon rupture, allergic manifestations, and pyrexia. METHODS: Randomized clinical trail / cross over study Two hundred and forty women with diagnosis of atonic PPH complicating vaginal deliveries were randomly assigned to be managed either by ecbolics and uterine massage as recommended by the WHO; or by WHO protocol plus El-Menia air inflated balloon. RESULTS: No maternal mortality in either group. The maternal morbidities in the form of surgical intervention (uterine and ovarian artery ligation, uterine compression suture, internal iliac artery ligation and abdominal hysterectomy) were observed in five women in controls and none in the studied women. Blood transfusion units, ecobolic drugs, resuscitation time, regaining uterine tone time, hospital stay and ICU admission were significantly less in studied women than controls. Out of the 19 failures to arrest APPH in the controls; 14 cases responded to secondary application of El-Menia balloon, and only five cases required surgical intervention. CONCLUSION: El-Menia balloon is an inexpensive, easy to apply, effective in controlling APPH with minimal side effects. It is targeted for use on a large scale in developing countries to reduce the maternal mortality and morbidity caused by APPH.

Dermatofibrosarcoma protuberans of the vulva. Case report.

A woman aged 83 had a vulval swelling measuring 8 cm x 3.5 cm excised. Histological examination showed the features of dermatofibrosarcoma protuberans. This tumour, which is usually only locally invasive, has not previously been described in the vulva.

Retained placenta and associated risk factors.

In a retrospective study, the factors that might influence the retention of placenta such as age, parity, antenatal abnormalities, labour onset and duration, history of uterine surgery and previous retained placenta, were studied in 146 patients with retained placenta. Three hundred women who were delivered vaginally without retained placenta were similarly evaluated under the same conditions. The results showed (in descending order of significance), history of retained placenta, previous uterine surgery, preterm delivery, age above 35 years, placental weight less than 601 g, pethidine use in labour, labour induction and parity of more than five to be associated with retained placenta. The existence of some or all these risk factors in a pregnant woman should alert the obstetrician about the possibility of retained placenta in labour.

Plasma prolactin and puerperal blood pressure.

Plasma prolactin concentration was measured on days 1, 3, 6 and 21 of the puerperium in women who had been normotensive or hypertensive during pregnancy. Elevated plasma prolactin concentration due to breast feeding or reduced plasma prolactin concentration due to treatment with bromocriptine was found not to be related to blood pressure changes in the puerperium in women with essential hypertension, pregnancy induced hypertension or in normotensive patients.

Outcome in patients with post-pill amenorrhoea.

Ninety-six patients who developed amenorrhoea following the use of oral contraceptives were studied in two groups; one with a history of regular periods and the other with irregular periods prior to the use of oral contraceptives. Pregnancy rates were similar in patients with and without a previous history of menstrual dysfunction. Thirty-nine of 47 patients who desired pregnancy and in whom there was no definable factor inhibiting pregnancy, succeeded in conceiving.

PIP: This study reports on the resumption of menstruation and of pregnancy in women with postpill amenorrhea. 96 patients, aged 18-36, who had been on different types of oral contraception (OC) for periods varying from 3 to 108 months, were investigated. Before OC treatment 45 had regular cycles (group 1), and 51 had suffered from menstrual irregularities (group 2). Ovulation induction therapy was employed when necessary. 26 patients in group 1 resumed spontaneous ovulation and 6 achieved pregnancy; 19 patients in group 2 resumed spontaneous ovulation and 7 conceived. 18 patients in group 1, and 18 patients in group 2 underwent ovulation induction therapy mostly with gonadotropins; 12 achieved pregnancy in group 1 and 14 in group 2. Of the 96 patients 31 did not wish to conceive, 7 were lost to follow-up, 7 had primary gonadal failure, 2 had undergone tubal occlusion, and the husbands of the remaining 2 had oligospermia. Of the remaining 47 patients 39 conceived, or a pregnancy rate of 82%; more specifically, a pregnancy rate of 81% in group 1, and of 84% in group 2. These results show that treatment for patients with previous irregular cycles resulted in pregnancy rates comparable to those of patients without menstruation disorders prior to OC treatment.

Hydrops fetalis due to congenital cardiac rhabdomyoma. Case report.

A case is presented of hydrops fetalis, polyhydramnios and intrauterine death diagnosed antenatally by ultrasound in which congenital cardiac rhabdomyoma was found at postmortem. Conditions associated with rhabdomyoma are briefly discussed.

Plasma copper and zinc concentrations and infertility.

Plasma copper concentration was significantly lower in 48 infertile women than in 35 control subjects and somewhat lower in women with secondary rather than primary infertility. Plasma zinc concentration was not appreciably different in infertile and fertile women. Low plasma copper concentration may influence normal human female fertility.

Maternal and fetal plasma zinc concentration and fetal abnormality.

Plasma zinc concentration was significantly lower in the maternal blood of 54 women giving birth to congenitally abnormal babies either within 24 h or 24 months previously when compared with control mothers. Cord blood zinc concentrations in 20 congenitally abnormal babies were also lower than in the control babies. We conclude that low plasma zinc may be an associated factor in the aetiology of fetal abnormality.

Risk of retained placenta: multivariate approach.

BACKGROUND: To identify important covariates related to retained placenta using logistic regression analysis. METHODS: The study was carried out in the King Khalid University Hospital, Saudi Arabia, and involved 114 women who had retained placenta, and 116 women with normal deliveries. Chi-square test and logistic regression analysis were used for analysis of data. Adequacy of predictor variables was examined using indices of sensitivity and specificity and plots of probability histograms for prediction of retained placenta among patients and controls. RESULTS: Logistic regression analysis highlighted multiparity, induced labor, small placenta, and large amount of blood loss to be significantly associated with retained placenta. In addition, high pregnancy number, previous injury to uterus, and pre-term labor related significantly to retained placenta. Predictor variables had sensitivity of 65.5% and 87.9% specificity and achieved 77% overall correct classification. CONCLUSIONS: These findings could be used to develop a predictive procedure for identifying high-risk cases of retained placenta.

Association of fetal growth with elevated maternal plasma zinc concentration in human pregnancy.

This report consists of two separate studies. Study I was a prospective one in which 23 pregnant women ultrasonically diagnosed as having small fetuses were compared with 22 women with large fetuses. Maternal plasma zinc concentrations pre- and post-35 weeks gestation were significantly higher in mothers of small than in mothers of large infants. Twelve women with normal pregnancies participated in study II. Biochemical data obtained in maternal plasma during the third trimester of pregnancy, including total, albumin-bound and alpha 2-macroglobulin-bound plasma zinc concentrations and plasma copper concentration were compared with infant anthropometric data at birth. The results indicated significant negative correlations between maternal plasma zinc and albumin-bound zinc concentrations and plasma copper concentration in the third trimester of pregnancy and mid-arm circumference and ponderal index. The results of these studies, in the light of other data reported for primates and humans, suggest the need for a more extensive investigation of the relationship between maternal circulating zinc and copper concentrations and fetal growth.