Changing Trends in the Clinical Presentation and Incidence of Molar Pregnancy in Saudi Arabia: A 30-Year Retrospective Analysis.

Background Molar pregnancy (MP) incidence and clinical presentation vary significantly worldwide. Recent trends show changes in its clinical representation and incidence, particularly with the adoption of early diagnosis using first-trimester ultrasonography, which has reduced the prevalence of classical second-trimester presentations. This study aimed to analyze the changes in clinical presentation and incidence of MP among the Saudi population over the past 30 years. Methods In this retrospective study at King Fahad University Hospital, 121 complete mole (CM) pregnancy cases diagnosed and pathologically confirmed were reviewed. This included 87 cases from 2007 to 2022 (recent group) and 34 cases from 1992 to 2006 (older group). Cases of CM diagnosed before January 1992 and other diagnoses such as PM, invasive mole, or choriocarcinoma were excluded; thus, this study is focused on CM in particular. We compared patient age, gravidity, parity, abortion history, gestational age at diagnosis, hyperemesis gravidarum symptoms, anemia symptoms, and hemoglobin levels. Classical symptoms and signs related to CM were also reviewed. Data were analyzed using Microsoft Excel 2021 (Microsoft Corporation, Redmond, Washington, United States) and presented as mean, frequency, and percentage, with chi-squared tests for categorical variables; p<0.05 was considered statistically significant. Results The incidence of CM declined from 2.1 per 1,000 deliveries to 0.9 per 1,000 deliveries. Vaginal bleeding was the most common presentation in both the older (91.9%) and recent (67.6%) groups. Hyperemesis gravidarum prevalence was similar in both groups. Theca-lutein cysts were more frequent in the older group (27.5%) than the recent group (8.8%). A significant difference was observed in the occurrence of a large-for-date uterus between the older (63.20%) and recent (23.5%) groups. Notably, 14.7% of patients in the recent group were asymptomatic at diagnosis. Anemia was present in 46 cases (52.8%) of the older group but absent in the recent group, and preeclampsia occurred in 10 cases (11.4%) of the older group but not in the recent group. Conclusions Advancements in ultrasound technology, including transvaginal probes with Doppler capabilities, have enabled earlier pregnancy diagnosis, as early as five to six weeks of gestation. Many MP are now diagnosed in the first trimester without the classic clinical symptoms or "snow-storm" ultrasound appearance. The availability of sensitive beta-human chorionic gonadotropin assays has led to the early termination of these pregnancies, marking a significant shift in the management of MP.

The Rule of Ultrasonography in the Management of Retained Placenta.

Retained placenta is clinically diagnosed when the placenta has failed to deliver within 18 to 60 minutes after birth. The retained placenta is a risk factor for postpartum fever. In this paper, we report a patient with a delivery complicated by a retained placenta and postpartum fever. This patient, a 34-year-old pregnant female, was admitted at 32 weeks of gestation for a case of preterm labor with preterm premature rupture of membranes and bacterial vaginosis. A 2.5 kg infant was delivered by normal vaginal delivery, which was followed by active management of the third stage of labor. The retained placenta was removed manually under general anesthesia. Two days later, the patient developed a fever and elevated inflammatory markers. Ultrasound-guided evacuation and curettage were done, and two endometrial cavities were noted. Both cavities were evacuated of products of conception. Two days later, the patient started to have spikes of fever. Imaging revealed an intra-cavity soft tissue mass measuring 6.5 cm. Hysteroscopy with dilation and curettage was performed and showed fibrous bands covering a soft mass of products of conception, which was then evacuated.

The use of progesterone during pregnancy to prevent preterm birth.

One of the most significant problems facing maternal and children health worldwide is preterm birth (PTB). Although strategies to increase the survival of premature infants have significantly improved in the past few decades, they have yet to be successful. Nine years ago, the use of progesterone in pregnancy was approved by the United States Food and Drug Administration (FDA) for PTB prevention. This paper reviews the recent evidence supporting the use of progesterone in pregnancy for PTB prevention and provides guidelines for its use in daily clinical practice. The guidelines address multiple current controversial areas regarding the prevention of PTB to aid physicians with their clinical decision-making practice, including the use in multifetal gestation, different formulations, safety in pregnancy, dose and route of administration.Saudi Med J 2020; Vol. 41 (4): 333-340doi: 10.15537/smj.2020.4.25036How to cite this article:Alsulmi ES, Alfaraj M, Faden Y, Al Qahtani N. The use of progesterone during pregnancy to prevent preterm birth. Saudi Med J 2020; Vol. 41: 333-340. doi: 10.15537/smj.2020.4.25036.

Foetal response to music and voice.

OBJECTIVE: To examine whether prenatal exposure to music and voice alters foetal behaviour and whether foetal response to music differs from human voice. SUBJECTS AND METHODS: A prospective observational study was conducted in 20 normal term pregnant mothers. Ten foetuses were exposed to music and voice for 15 s at different sound pressure levels to find out the optimal setting for the auditory stimulation. Music, voice and sham were played to another 10 foetuses via a headphone on the maternal abdomen. The sound pressure level was 105 db and 94 db for music and voice, respectively. Computerised assessment of foetal heart rate and activity were recorded. 90 actocardiograms were obtained for the whole group. One way anova followed by posthoc (Student-Newman-Keuls method) analysis was used to find if there is significant difference in foetal response to music and voice versus sham. RESULTS: Foetuses responded with heart rate acceleration and motor response to both music and voice. This was statistically significant compared to sham. There was no significant difference between the foetal heart rate acceleration to music and voice. CONCLUSION: Prenatal exposure to music and voice alters the foetal behaviour. No difference was detected in foetal response to music and voice.