Metformin Improves the Depression Symptoms of Women with Polycystic Ovary Syndrome in a Lifestyle Modification Program.

BACKGROUND: Metformin is commonly prescribed to manage polycystic ovary syndrome (PCOS), which is one of the most common endocrine disorders among women of childbearing age and is associated with high prevalence rates of depression and anxiety. OBJECTIVE: This study's objective was to determine the impact of prescribed metformin on depression and anxiety levels of patients with PCOS. METHODS: This prospective, multi-center, cohort study examined the impact of prescribed metformin on the depression and anxiety of women with PCOS in four gynecology clinics in Saudi Arabia and Jordan. The women had recently been prescribed metformin along with lifestyle modifications, such as diet and exercise, and were compared to another group of women with PCOS who were prescribed lifestyle modifications only. Depression and anxiety were assessed at baseline and three months later using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) scale, respectively. Health-related quality of life was measured using the Short Form Health Survey (SF-36). Multiple logistic regression analyses were conducted to examine the impact of metformin on depression and anxiety. RESULTS: Eighty-six women participated in the study: 53 were prescribed metformin with lifestyle modifications, and 33 were prescribed lifestyle modifications only. The women on metformin had 70% lower odds of having major depression (PHQ-9≥10) (OR=0.302, P=0.045); however, no significant effect of metformin on anxiety (GAD-7≥10) was found. CONCLUSION: Metformin may have a role in the management of depression symptoms among patients with PCOS; however, its potential antidepressant effect should be further examined in randomized double-blind placebo-controlled clinical trials.

Urinary phthalate metabolites among children in Saudi Arabia: Occurrences, risks, and their association with oxidative stress markers.

Phthalates have been used as plasticizers in numerous consumer applications and therefore, their metabolites have been detected in human urine worldwide. Despite concerns regarding their potential adverse health effects, few exposure assessments have been conducted among young populations in Middle Eastern countries. In this study, children (n = 109, aged 3-9 years) were recruited from four elementary schools in Riyadh, Saudi Arabia, in 2017, and major phthalate metabolites were measured in their urine. Their parents were asked to complete a questionnaire on their behalf to assess potential exposure sources of phthalates. In addition to 18 phthalate metabolites, malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured in urine samples by LC/MS/MS. Among the children of Saudi Arabia, urinary levels of monoisobutyl phthalate (MiBP) and monobutyl phthalate (MnBP) were higher than those reported previously in children worldwide. Monoethyl phthalate (MEP) was also detected at high levels. Several phthalate metabolites showed significant associations with the levels of MDA or 8-OHdG. Hazard quotients (HQs) derived for certain phthalates were greater than one. In particular, the HQs for di(2-ethylhexyl) phthalate (DEHP) were greater than one in 34% of the participating children. Levels of monocyclohexyl phthalate (MCHP), monoisodecyl phthalate (MiDP), mono(2-ethylhexyl) phthalate (MEHP), and mono[2-(carboxymethyl)hexyl] phthalate (MCMHP) in the urine samples were positively associated with the consumption frequency of certain foods. Very high levels of exposure to phthalates, along with positive associations with oxidative stress markers, outline the importance of follow-up investigations for identification of phthalate exposure sources and potential health implications among the young population of Saudi Arabia.

Purification and MIC analysis of antimicrobial proteins from Cucumis sativus L. seeds.

BACKGROUND: Cucumis sativus L. (cucumber), from the family Cucurbitaceae, is a therapeutic plant with various pharmacological benefits, broadly utilized as a part of complementary medicine (e.g., Unani, Ayurveda, Siddha, and Traditional Chinese). In light of past research discoveries, this plant had been chosen to consider its potential antibacterial action. METHODS: Extracts were purified by dialysis and ion exchange chromatography strategy and then assayed for antibacterial activity against four standard pathogenic bacterial strains known to cause foodborne infections and spoilage of food and herbal drugs. Antimicrobial peptides were extracted from seeds using a sodium phosphate citrate (pH 7.2) - CTAB cradle (pH 6.0). RESULTS: The highest protein concentration was seen with elute fractions 1 and 3 (370 mg/mL) compared with elute fractions 2 and 4 (340 mg/mL). Among the bacteria utilized, E. coli was clearly the most sensitive out of selected four strains. CONCLUSION: Our results suggest that Cucumis sativus L seeds extracts have significant potentials as new antimicrobial agents.

Grand multiparity and the possible risk of adverse maternal and neonatal outcomes: a dilemma to be deciphered.

BACKGROUND: The relation between grand multiparity (GMP) and the possible adverse pregnancy outcomes is not well identified. GMP (parity ≥5 births) frequently occurs in the Arab nations; therefore, this study aimed to identify the correlation between GMP and the different adverse maternal and neonatal outcomes in the Saudi population. METHOD: This cohort study was conducted on a total of 3327 women from the labour ward in King Khaled University Hospital, Riyadh, Saudi Arabia. Primiparous, multiparous and grand multiparous females were included. Socio-demographic data and pregnancy complications like gestational diabetes or hypertension, preeclampsia and intrauterine growth restriction were retrieved from the participants' files. In addition, the labour ward records were used to extract information about delivery events (e.g. spontaneous preterm delivery, caesarean section [CS]) and neonatal outcomes including anthropometric measurements, APGAR score and neonatal admission to the intensive care. RESULTS: Primiparas responses were more frequent in comparison to multiparas and GMP (56.8% and 33%, and 10.2% respectively). In general, history of miscarriage was elevated (27.2%), and was significantly higher in GMP (58.3%, p < 0.01). Caesarean delivery was also elevated (19.5%) and was significantly high in the GMP subgroup (p < 0.01). However, after adjustment for age, GMP were less likely to deliver by CS (odds ratio: 0.6, 95% CI: 0.4-0.8; p < 0.01). The two most frequent pregnancy-associated complications were gestational diabetes and spontaneous preterm delivery (12.6% and 9.1%, respectively). The former was significantly more frequent in the GMP (p < 0.01). The main neonatal complication was low birth weight (10.7%); nevertheless, neonatal admission to ICU was significantly higher in GMP (p = 0.04), and low birth weight was more common in primiparas (p < 0.01). Furthermore, logistic regression analysis revealed an insignificant increase in the maternal or neonatal risks in GMP compared to multiparas after adjustment for age. CONCLUSION: Grand multiparous Saudi females have similar risks of maternal and neonatal complications compared to the other parity groups. Advanced age might play a major role on pregnancy outcomes in GMP. Nevertheless, grand multiparty might not be discouraged as long as women are provided with good perinatal care.

The effect of metformin use on pregnancy rates among polycystic ovary syndrome patients undergoing in vitro fertilization: A retrospective-cohort study.

BACKGROUND: Metformin is widely used with gonadotropins by women with polycystic ovary syndrome (PCOS) during in vitro fertilization (IVF) to increase their chances of pregnancy. The aim of this study was to evaluate the efficacy of metformin in improving the rates of clinical pregnancy among women with PCOS undergoing IVF. METHODS: This was a retrospective cohort study of women with PCOS, aged 18-40 years, undergoing IVF during 2006-2012 at a University Hospital in Riyadh, Saudi Arabia. Baseline patient data including menstrual frequency, biochemical parameters such as fasting serum insulin (FSI) concentration, comorbidities, and the rates of ovulation and pregnancy were collected. Pregnancy rates were compared between the metformin and non-metformin groups. RESULTS: A total of 210 women with PCOS met the inclusion criteria and were included in the study. Of the 210 women with PCOS, 109 of them received metformin in addition to gonadotropins. Patients who received metformin were 16% less likely to be pregnant in comparison with those who did not receive metformin (OR = 0.840; 95% CI = 0.710-0.993; P = 0.0415), when controlled for baseline prolactin level, testosterone level, lipid panel, FSI concentration, fasting plasma glucose (FPG) concentration, comorbidities, duration of infertility, daily metformin dosage, and the previous use of clomiphene and/or leuprolide. CONCLUSIONS: Metformin co-treatment during IVF may negatively affect pregnancy rates. Further well-designed, randomized, double-blind placebo-control clinical trials are needed to confirm the findings of this study.

Ovulation induction by metformin among obese versus non-obese women with polycystic ovary syndrome.

OBJECTIVES: There is some evidence that the efficacy of metformin as an ovulation stimulation agent depends on the body mass index (BMI) of the treated anovulatory women with polycystic ovary syndrome (PCOS). The aim of this study was to examine the likelihood of successful ovulation among obese (BMI ⩾30 kg/m2) versus non-obese (BMI <30 kg/m2) women with PCOS. METHODS: A total of 243 medical charts of women with PCOS who visited King Khaled University Hospital (KKUH) in Riyadh, Saudi Arabia, between 2006 and 2012 were reviewed. Patients' sociodemographic, laboratory, and medical data were collected. Descriptive statistics and multiple logistic regression analyses were performed to compare the patients' baseline data and successful ovulation among the obese and non-obese anovulatory women with PCOS, respectively. RESULTS: One hundred and nine women with PCOS who were prescribed metformin for ⩾3 months were included in the study. Almost 60% of the women who were included in the study were obese. The likelihood of ovulation among obese women with PCOS was 77.9% (odds ratio = 0.221, 95% CI 0.052-0.947, P = 0.042) less than that in their non-obese counterparts. CONCLUSION: The findings of this study suggest that metformin is more effective as an ovulation stimulation agent when administered to non-obese women with PCOS. Lifestyle modifications such as diet and exercise should be emphasized upon as an integral part of any treatment plan for PCOS.

Effectiveness and outcomes of thermablate endometrial ablation system in women with heavy menstrual bleeding.

Heavy menstrual bleeding (HMB) is a common problem in women of reproductive age group with major impact on their quality of life (QoL). The aim was to study the short-term effectiveness of Thermablate Endometrial Ablation System (EAS) and its impact on QoL in women with HMB. This was a prospective cohort study conducted on consecutive 72 women suffering from HMB. The success rate was estimated and patients' QoL was compared before and after the procedure using the Aberdeen menorrhagia severity scale. The mean follow-up period was 18 months (6-24 months). The mean age and body mass index were 48 (±5.2) years 33.2 (±7.4) kg/m2 respectively. Among treated participants, 58 (80.6%) reported the absence of bleeding. A significant decrease was observed in the rate of missed social activity and increase in the leisure time activities. The overall patient satisfaction was 95.7%. Thermablate EAS is an effective minimally invasive treatment with marked improvement in QoL in women with HMB. Impact statement Heavy menstrual bleeding (HMB) is a common problem that affects 11-13% of reproductive age women with major impact on their quality of life (QoL). A variety of methods for endometrial ablation has been used for the destruction of the endometrial lining to treat HMB. The short-term results of this study shows amenorrhoea rate of (80.6%) after the procedure and a significant decrease in the rate of missed social activity and increase in the leisure time activities with marked improvement in QoL. The overall patient satisfaction was 95.7%. Thermablate Endometrial Ablation System is an effective minimally invasive treatment for HMB with advantages of shorter operating time, shorter hospital stay and high-level patient satisfaction. However, further clinical research with large-scale studies and possible comparison with other treatment options are recommended.

Knowledge, attitudes, beliefs, and barriers associated with the uptake of influenza vaccine among pregnant women.

Objective: The purpose of the study was to assess the knowledge, attitudes, beliefs, and factors associated with the uptake of the influenza (flu) vaccination in women within Saudi Arabia during their pregnancy period. Methods: A cross-sectional prospective survey was conducted on 1085 pregnant women at the antenatal clinic over a period of 6 weeks with the provision of influenza vaccination. The questionnaire collected demographic and other data; it included 12 questions on their general knowledge and assessed their attitude toward influenza vaccination, and their awareness of vaccine risk and the potential benefits during pregnancy. The knowledge score obtained was then calculated and compared. Results: A total of 998 patients took part in the questionnaire with a response rate of 92%. There was poor awareness that the flu vaccine is safe to administer during pregnancy (130, 13.1%) and that all pregnant women should receive the flu vaccine (190, 19.1%). Pregnant women with flu vaccine knowledge score of ⩽5 (range 0-12) were significantly less likely to take the vaccine (OR 3.78, 95% CI 2.68-5.26, p < 0.001). There was a low uptake of the vaccine (178, 18.1%) and only 29 (3.0%) had previously been offered the flu vaccine by any doctor during their pregnancy. In addition, 255 (25.8%) were against taking the flu vaccine during pregnancy. Conclusion: The knowledge and uptake of the influenza vaccine among Saudi pregnant women are low. One quarter was against the vaccine during pregnancy. Very few believed the flu vaccine to be safe during pregnancy. Rarely, physicians advise their clients to take flu vaccine.

Validation of the International Urogynecology Association's Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire in Arabic.

INTRODUCTION AND HYPOTHESIS: A valid and reliable Arabic version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-revised (PISQ-IR) is needed. METHODS: Of 238 Saudi Arabian women who fulfilled the inclusion criteria, 227 were recruited. A detailed history was obtained and pelvic examination was performed in all participants. An Arabic version of the PISQ-IR was administered with three quality of life measures. Reliability was assessed by factor analysis, and internal consistency was measured with Cronbach's α. Face validity was established with translation, back-translation, and cognitive reviews. Criterion validity was determined by analysing the correlations between the responses and the clinical examinations and by comparing the responses with those to other validated measures of incontinence and prolapse. RESULTS: Overall, 67 % of the women were categorized as sexually active and 33 % as sexually inactive. The overall frequency of urinary incontinence was highest (85.5 %), followed by prolapse (59 %) and fecal incontinence (53.3 %). The average score in the factor analysis for dimensions of sexual inactivity was 2.7 and Cronbach's α was 0.61; an item-by-item assessment of the majority of the scales showed an α value of >0.75, suggesting a moderate-to-high internal consistency. Regarding external validity, strong negative correlations were found with the Pelvic Organ Prolapse Distress Inventory, the Colorectal-Anal Distress Inventory (CRADI), and the Pelvic Floor Impact Questionnaire (PFIQ) in the sexually active group, and positive correlations were found with the CRADI and PFIQ in the sexually inactive group. CONCLUSIONS: The Arabic version of the PISQ-IR is reliable and valid for assessing sexual function in Arabic-speaking women with pelvic floor disorders.

Clinical Practice Guidelines on the Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention in Saudi Arabia.

BACKGROUND: Cervical cancer is the third most common gynecological malignancy in Saudi women with an estimated incidence rate of 1.9 cases per 100 000 women-years. More than 40% of cervical cancer cases are diagnosed at advanced stages due to lack of a routine screening program in Saudi Arabia. Thus, national guidelines for routine screening and treatment of precancerous cervical lesions are needed. METHODS: The Saudi Centre for Evidence-Based Healthcare invited a panel of local experts and partnered them with a team from McMaster University in Canada for methodological support, to develop national clinical practice guidelines on the screening and treatment of precancerous lesions for cervical cancer. After the panel identified key clinical questions, the McMaster University working group updated existing systematic reviews that had been used for the 2013 WHO Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Recommendations were based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Those recommendations took into account the available evidence, patient values and preferences, and resource use in the Saudi context. The panel provided recommendations on two major issues: screening for precancerous lesions (cervical intraepithelial neoplasia 2 & 3) and treatment of those lesions to prevent cervical cancer in women who tested positive after screening. CONCLUSIONS: The Saudi expert panel recommends using the HPV DNA test followed by colposcopy or cytology (Pap test) followed by colposcopy to screen for CIN2+ in women at risk of cervical cancer. The panel recommends cryotherapy or loop excision electrosurgery procedure (LEEP) over cold knife cone biopsy to treat women at risk of cervical cancer that tests positive for CIN2+. Universal screening for precancerous cervical dysplasia in women in Saudi Arabia is recommended using HPV testing and or cytology. Either cryotherapy or LEEP are preferred for treatment. LIMITATIONS: National studies on cervical cancer screening modalities and treatment of precancerous cervical lesions, including HPV prevalence and its association with cervical cancer, are scarce.

Attitudes of Patients in Developing Countries Toward Participating in Clinical Trials: A Survey of Saudi Patients Attending Primary Health Care Services.

OBJECTIVES: Clinical trials are experimental projects that include patients as subjects. A number of benefits are directly associated with clinical trials. Healthcare processes and outcomes can be improved with the help of clinical trials. This study aimed to assess the attitudes and beliefs of patients about their contribution to and enrolment in clinical trials. METHODS: A cross-sectional study design was used for data collection and analysis. A questionnaire was developed with six categories to derive effective outcomes. RESULTS: Of the 2000 participants approached to take part in the study, 1081 agreed. The majority of the study population was female, well educated, and unaware of clinical trials. Only 324 subjects (30.0%) had previously agreed to participate in a clinical trial. The majority (87.1%) were motivated to participate in clinical trials due to religious aspects. However, fear of any risk was the principal reason (79.8%) that reduced their motivation to participate. CONCLUSIONS: The results of this study revealed that patients in Saudi Arabia have a low awareness and are less willing to participate in clinical trials. Different motivational factors and awareness programs can be used to increase patient participation in the future.

Recurrent pelvic organ prolapse: International Urogynecological Association Research and Development Committee opinion.

INTRODUCTION AND HYPOTHESIS: This committee opinion paper summarizes available evidence about recurrent pelvic organ prolapse (POP) to provide guidance on management. METHOD: A working subcommittee from the International Urogynecological Association (IUGA) Research and Development Committee was formed. The literature regarding recurrent POP was reviewed and summarized by individual members of the subcommittee. Recommendations were graded according to the 2009 Oxford Levels of Evidence. The summary was reviewed by the Committee. RESULTS: There is no agreed definition for recurrent POP and evidence in relation to its evaluation and management is limited. CONCLUSION: The assessment of recurrent POP should entail looking for possible reason(s) for failure, including persistent and/or new risk factors, detection of all pelvic floor defects and checking for complications of previous surgery. The management requires individual evaluation of the risks and benefits of different options and appropriate patient counseling. There is an urgent need for an agreed definition and further research into all aspects of recurrent POP.

Impact of vitamin D deficiency on maternal and birth outcomes in the Saudi population: a cross-sectional study.

BACKGROUND: Low serum vitamin D [25(OH)D] has been associated with different health problems worldwide. However, its causal role in several diseases remains unclear. We aimed to correlate vitamin D status with maternal and neonatal outcomes in pregnant females. METHOD: One thousand pregnant women were recruited during early labour from the labour ward of King Khaled University Hospital, Riyadh, Saudi Arabia. Detailed medical data of all participants were collected from their records. Delivery events and birth outcomes were also documented. Serum 25(OH)D levels were measured using an enzyme-linked immunosorbent assay. A receiver operating characteristic (ROC) curve was constructed to evaluate the ability of vitamin D levels to predict complicated pregnancies. Regression analysis was used to test the correlation between serum 25(OH)D levels and different variables. RESULTS: Most of the participants were Saudis (89.9 %) and housewives (85.1 %) and 86.4 % of them had vitamin D deficiency (mean: 30.46 ± 19.6 nmol/L). Gestational diabetes mellitus (GDM) was the commonest complication detected (11.1 %) while the history of miscarriage was elevated (24.5 %). There was no association between GDM and low 25(OH)D. Yet, there was a significant negative correlation between serum 25(OH)D levels and fasting blood glucose among females older than 35 years (r = -0.2, p = 0.03). Hypertensive disorders of pregnancy and pre-existing hypertension were less than 1.5 % of frequency. Nevertheless, they were only recorded in women with insufficient and deficient vitamin D. ROC curve revealed that 25(OH)D levels were not able to discriminate between normal and adverse pregnancy outcomes (AUROC curve: 0.51; 95 % confidence interval (CI): 0.44-0.58; p = 0.8). CONCLUSION: Hypovitaminosis D, a highly prevalent health problem among pregnant females in Riyadh, has no relation to adverse pregnancy outcomes except for a higher prevalence of miscarriage in women with low 25(OH)D.

Prevalence of vitamin D deficiency in Saudi newborns at a tertiary care center.

OBJECTIVE: To evaluate vitamin D levels in Saudi newborns utilizing umbilical cord samples, and to benchmark the results with international figures. METHODS: This cross-sectional study was carried out at King Khalid University Hospital, Riyadh, Saudi Arabia between November 2013 and March 2013. Vitamin D levels were assessed in the umbilical cord of healthy term neonates born above 2.5 kg from healthy pregnant mothers. Gestational age (GA), birth weight, gender, levels of sun exposure, and consumption of vitamin D rich food data were collected. Our primary outcome was the percentage of newborns with vitamin D deficiency (vitamin D level below 25 nmol/l). Association of vitamin D deficiency with sun exposure and consumption of vitamin D rich food was tested using a Chi-squared test. RESULTS: Umbilical samples of 200 newborns were obtained. The average birth weight was 3.2 kg. Deficient vitamin D levels were detected in 59% of the sample. Almost 90% of included newborns had vitamin D levels below 50 nmol/l. We found no association of vitamin D deficiency status to level of sun exposure or to consumption of vitamin D rich food. CONCLUSION: Vitamin D deficiency is very common in Saudi newborns at hospital, and is consistent with regional data. Efforts to assess and treat vitamin D deficiency during pregnancy and provide adequate supplementation to newborns are necessary to rectify such a public health concern.

Incidence of Early Postpartum Voiding Dysfunction in Primiparae: Comparison Between Vaginal Delivery and Cesarean Section.

OBJECTIVES: To compare the incidence of early postpartum voiding dysfunction (PPVD) in primiparae women delivered vaginally (VD) to those delivered by elective Caesarean section (CS). METHODS: A prospective study of primiparae in early postpartum period, were grouped into: VD group and CS group. Following the first 24 h from delivery, patients had uroflowmetry and post-void residual urine (PVR) volume measurement. RESULTS: Two hundred and fifty six primiparae women recruited; 204 (81%) had VD and 48 (19%) had primary elective CS. Forty-two women in the VD group (20.2%) diagnosed with PPVD compared to only four (8.3%) in the CS group (P = 0.05). Within VD group, women who had vaginal tear (86.4% vs. 44%, P < 0.001) or epidural analgesia (33.3% vs. 18.1%, P < 0.05) experienced higher incidence of PPVD. CONCLUSION: Women who had normal VD are at higher risk of transient PPVD than those delivered by CS during their early postpartum period.

Reliability of Arabic ICIQ-UI short form in Saudi Arabia.

CONTEXT: The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) provides a brief measure of symptoms and impact of urinary incontinence on quality of life. It is suitable for use in clinical practice and research. An Arabic version of the ICIQ-UI SF was translated and validated in Egypt and Syria. AIMS: The objective was to assess the reliability of the Arabic version of the ICIQ-UI SF in women from Saudi Arabia. SETTINGS AND DESIGN: A study at the Urogynecology Clinic was conducted from November 2010 until August 2011. MATERIALS AND METHODS: Thirty-seven consecutive Saudi women attending urogynecologic clinic were recruited. Questionnaires were distributed for self-completion and then redistributed to the same set of respondents two to four weeks later as part of a test-retest analysis for assessing questionnaire's stability. STATISTICAL ANALYSIS USED: Agreement between two measurements was determined by weighted Kappa. Internal consistency was assessed using Cronbach's alpha coefficient. RESULTS: Participants had a mean (SD) age of 39 (9.9), median parity of 4, and mean BMI (SD) of 30.9 kg/m(2) (4.6). There were no differences in the frequency and amount of urine leaks or the impact of UI on quality of life observed between the two visits. Assessment of internal consistency was excellent with the Cronbach's alpha coefficient of 0.97 (95% CI: 0.88-0.98). Participants agreed that the questionnaire was clear, appropriate, and easy to understand. CONCLUSIONS: The Arabic ICIQ-UI SF is a stable and clear questionnaire that can be used for UI assessment in clinical practice and research among Saudi women.

Saudi womens acceptance and attitudes towards companion support during labor: should we implement an antenatal awareness program?

BACKGROUND AND OBJECTIVES: Despite the known benefits of support during chilbirth, most hospitals in Saudi Arabia do not allow a companion during labor. This can be due to cultural beliefs among pregnant Saudi women. The aims of this study are to describe Saudi women's preferences towards supportive companions during labor and to explore their attitudes and knowledge about the importance of support during childbirth. DESIGN AND SETTING: Prospective cohort study conducted in three governmental tertiary hospitals within Riyadh. SUBJECTS AND METHODS: Women who consented were interviewed during their postpartum hospital stay using a validated standardized Arabic questionnaire. Participants were asked about their preferences and attitudes towards companions during childbirth, as well as about their knowledge on the importance of such support. RESULTS: Of 402 women who participated in the study, 182 women (45.3%) preferred the presence of a companion during childbirth and only 57 of all interviewed women (14.2%) had ever had a supportive companion during any of their previous childbirths. The mother (58%) or husband (51%) was the most preferred person as a childbirth companion. Age, level of educational, or antenatal, intrapartum or postpartum status had no impact on their decision. However, women who had some sort of antenatal educational classes and/or read educational material about childbirth were more likely to prefer support during labor. More than one-third of participants (35.9%) thought that having a companion as support during labor would not help, but the most common reason for not preferring to have a companion was their fear of being exposed most of the time to their companion (64.1%). CONCLUSIONS: A significant percentage of surveyed Saudi women preferred not to have a supportive companion during childbirth. The reason might be a lack of understanding of the positive role of a companion during childbirth or because of cultural beliefs. Education of women during their antenatal care about the importance and the implementation of such a practice are warranted.

De novo stress urinary incontinence after vaginal repair for pelvic organ prolapse: one-year follow-up.

OBJECTIVE: A few studies have reported a wide range (2-43%) in incidence of de novo stress urinary incontinence (SUI) following surgical repair of pelvic organ prolapse (POP) in previously continent women. The aim of this study was to re-examine this incidence up to one year following vaginal repair of prolapse. STUDY DESIGN: Retrospective review of a cohort of women who underwent reconstructive vaginal repair of POP without a concomitant anti-incontinence procedure between 2003 and 2007 at two tertiary referral centers. Women were considered eligible if they were stress continent by symptoms and objective assessment (including urodynamics testing) prior to surgical repair. All women who had had any anti-incontinence procedure previously were excluded. The endpoint was subjective SUI that prompted the patient to undergo any treatment within one year from their prolapse surgery. RESULTS: 64 women, with a mean age of 61 (±11) years, were eligible for the study: 26 (41%) had preoperative symptoms of overactive bladder. Fifty-four patients were available for analysis at the one-year visit. Seven women (13.5%) had symptoms of SUI but only one (2%) was found to have SUI objectively. Another patient underwent anti-incontinence surgery following her prolapse surgery. CONCLUSION: The incidence of de novo SUI requiring treatment in previously continent women who underwent vaginal repairs for POP without concomitant anti-incontinence surgery is low (4%). A large-scale prospective study is necessary to further evaluate this finding.

The outcomes of trial of labour after cesarean section following induction of labour compared to spontaneous labour.

PURPOSE: To determine the success rate of vaginal birth after cesarean birth (VBAC) and its outcome when labour was induced compared to spontaneous labour. METHODS: Prospective cohort study of all women who had lower segment caesarian section (LSCS) in any previous delivery and were admitted for a trial of labour after cesarean between April 2010 and March 2011 at a University Hospital. We compared the success rates of VBAC in women who had induction of labour (IOL) to those who came with spontaneous labour. RESULTS: During the study period, 320 women who elected to have trial of labour after cesarean and were included in the study, 268 (83.8 %) had spontaneous labour and 52 (16.3 %) had IOL. The most common indications for IOL were post term pregnancy 30 %, diabetes during pregnancy 19 % and prelabour spontaneous rupture of membranes 17 %. There was no difference between both groups in age, previous vaginal delivery and gestational age. In terms of the method of induction, the most commonly used method was transcervical Foley catheter in 21 cases (40.4 %) and then Oxytocin in 19 cases (36.5 %), nine women had combined methods of induction (17.3 %). Prostaglandin E2 was used in three women (5.8 %). The incidence of successful VBAC in spontaneous labour was 72 %, however, when induced, the incidence of successful VBAC was 63.5 %. Compared to the spontaneous labour group, induced women had significantly higher rate of CS (36.5 vs. 28 %; P = 0.026). CONCLUSION: Women with one previous CS who undergo IOL have lower success rates of vaginal delivery compared to those presented in spontaneous labour. These findings might help clinicians and patients in the decision making for the method of delivery when it comes to pregnancy with a previous scar.

Effects of intentional delivery on maternal and neonatal outcomes in pregnancies with preterm prelabour rupture of membranes between 28 and 34 weeks of gestation: a systematic review and meta-analysis.

OBJECTIVE: To assess the effects of intentional delivery (ID) over expectant management (EM) in pregnancies complicated by preterm prelabour rupture of membranes (PPROM) between 28 and 34 weeks of gestation on maternal and neonatal outcomes. METHODS: We searched Ovid MEDLINE, EMBASE, CINAHL, CENTRAL and Science Citation Index; contacted experts and checked reference lists of relevant studies. Studies were included if they were randomized controlled trials in all languages. RESULTS: Five randomized trials were included and 488 subjects were analyzed. Overall, the results showed significant heterogeneity. Maternal infection as well as respiratory distress syndrome (RDS) & neonatal sepsis (NS) were not different between the two groups. Neonatal death, however, was significantly higher (risk ratio: 5.81; 95% CI: 1.35-25.08; p = 0.03) in the ID group after excluding studies that gave antenatal steroids. Incidence of cesarean section was significantly higher in the intentional delivery group, as well (risk ratio: 1.35; 95% CI: 1.02-1.80; p = 0.03). CONCLUSION: Based on the available evidence, ID in pregnancies complicated with PPROM between 28 and 34 weeks carries some maternal and neonatal risks with no added benefits. Thus, this treatment should not be considered as an option for women with PPROM before 34 weeks of gestation in the absence of other indications for early delivery.