Major placenta previa among patients with and without previous cesarean section: Maternal characteristics, outcomes and risk factors.

OBJECTIVES: To compare maternal characteristics and outcomes among patients having major placenta previa (PP) with and without previous cesarean section (CS). And to determine if previous CS alone is a risk factor for associated adverse maternal outcomes in these patients. MATERIALS AND METHODS: This is a retrospective analysis including two groups of major PP patients, with previous CS (n = 184) and without CS (n = 115); who were admitted to Abha Maternity and Children's Hospital over the last ten-years (January 2012-December 2021), Aseer region, Saudi Arabia. RESULTS: Compared to those without previous CS, major PP patients with previous CS had significantly advanced ages with higher mean numbers of gravidity and parity, but significantly less rates of previous uterine surgery and IVF pregnancies. Moreover, they were more likely to acquire higher rates of adverse maternal outcomes. In the same way, these patients had an increased Odds Ratios of cesarean hysterectomy (OR of 20.462), urinary tract injuries (OR of 12.361), associated PAS (OR of 4.375), moderate/ heavy intra-operative bleeding (OR of 2.153) and the need for transfusion of 3+ units of packed RBCs (OR of 1.849). CONCLUSION: (1) Patients with combined existence of major PP and previous CS had significantly higher rates of adverse maternal outcomes (2) Alone, prior CS in major PP patients increased the Odds Ratios of cesarean hysterectomy, urinary tract injuries, diagnosis of PAS, excessive intra-operative bleeding and repeated packed RBCs transfusions. (3) Among our PP patients with previous CS, the increased rate and OR of PAS diagnosis could in-part explain the adverse maternal outcomes.

Microfluidic-based nanoemulsion of Ocimum basilicum extract: Constituents, stability, characterization, and potential biomedical applications for improved antimicrobial and anticancer properties.

This paper reports on the findings from a study that aimed to identify and characterize the constituents of Ocimum basilicum extract using gas chromatography-mass spectrometry (GC-MS) analysis, as well as assess the physicochemical properties and stability of nanoemulsions formulated with O. basilicum extract. The GC-MS analysis revealed that the O. basilicum extract contained 22 components, with Caryophyllene and Naringenin identified as the primary active constituents. The nanoemulsion formulation demonstrated excellent potential for use in the biomedical field, with a small and uniform particle size distribution, a negative zeta potential, and high encapsulation efficiency for the O. basilicum extract. The nanoemulsions exhibited spherical morphology and remained physically stable for up to 6 months. In vitro release studies indicated sustained release of the extract from the nanoemulsion formulation compared to the free extract solution. Furthermore, the developed nanoformulation exhibited enhanced anticancer properties against K562 cells while demonstrating low toxicity in normal cells (HEK293). The O. basilicum extract demonstrated antimicrobial activity against Pseudomonas aeruginosa, Candida albicans, and Staphylococcus epidermidis, with a potential synergistic effect observed when combined with the nanoemulsion. These findings contribute to the understanding of the constituents and potential applications of O. basilicum extract and its nanoemulsion formulation in various fields, including healthcare and pharmaceutical industries. Further optimization and research are necessary to maximize the efficacy and antimicrobial activity of the extract and its nanoformulation. RESEARCH HIGHLIGHTS: This study characterized the constituents of O. basilicum extract and assessed the physicochemical properties and stability of its nanoemulsion formulation. The O. basilicum extract contained 22 components, with Caryophyllene and Naringenin identified as the primary active constituents. The nanoemulsion formulation demonstrated excellent potential for biomedical applications, with sustained release of the extract, low toxicity, and enhanced anticancer and antimicrobial properties. The findings contribute to the understanding of the potential applications of O. basilicum extract and its nanoemulsion formulation in healthcare and pharmaceutical industries, highlighting the need for further optimization and research.

Incidence, risk factors, and maternal outcomes of major degree placenta previa: A 10-year retrospective analysis.

OBJECTIVES: To determine the incidence, risk factors, and maternal outcomes of "major degree" placenta previa (PP)/placenta accreta spectrum (PAS) in Abha Maternity and Children's Hospital, Abha, Saudi Arabia. Secondly, to compare our findings to those of previous studies on PP/PAS in Saudi Arabia. METHODS: This is a retrospective study that included 299 patients diagnosed with major degree PP/PAS and admitted to Abha Maternity and Children's Hospital, Abha, Saudi Arabia, within 10 years (January 2012-December 2021). Also, we compared our results to the outcomes of PP/PAS patients in 6 previous Saudi studies. RESULTS: The total number of deliveries was 54,341; PP minor and major degrees were diagnosed in 376 (0.69%) patients. Of them, 299 patients had PP major degree (79.5%). The pattern of main risk factors for major PP/PAS included: elder age, high parity, and previous cesarean deliveries. Nearly 30.5% had evidence of PAS on antenatal MRI (n=91). Approximately 68.5% (n=205) of patients were delivered <37 weeks. Of 299 patients, 29 (9.7%)patients had emergency cesarean hysterectomy. The maternal mortality rate was 0.3% (n=1). Generally, in many aspects, our results are comparable to similar Saudi studies on PP/PAS. CONCLUSION: Major degree of PP/PAS is associated with high maternal morbidity but rare mortality. Over 30 years, our patients' obstetric characteristics did not change, including both elder age and high parity. A substantial increase in the rate of cesarean deliveries is a leading cause of major PP/PAS.

Placenta accreta spectrum in major placenta previa diagnosed only by MRI: incidence, risk factors, and maternal morbidity.

BACKGROUND: Antenatal assessment of maternal risk factors and imaging evaluation can help in diagnosis and treatment of placenta accreta spectrum (PAS) in major placenta previa (PP). Recent evidence suggests that magnetic resonance imaging (MRI) could complement ultrasonography (US) in the PAS diagnosis. OBJECTIVES: Evaluate the incidence, risk factors, and maternal morbidity related to the MRI diagnosis of PAS in major PP. DESIGN: A 10-year retrospective cohort study. SETTING: Tertiary care hospital. PATIENTS AND METHODS: We report on patients with major PP who had cesarean delivery in Abha Maternity and Children's Hospital (AMCH) over a 10-year period (2012-2021). They were evaluated with ultrasonography (US) and color Doppler for evidence of PAS. Antenatal MRI was ordered either to confirm the diagnosis (if equivocal US) or to assess the depth of invasion/extra-uterine extension (if definitive US). MAIN OUTCOME MEASURES: Risk factors for PAS in major PP and maternal complications. SAMPLE SIZE: 299 patients RESULTS: Among 299 patients, MRI confirmed the PAS diagnosis in 91/299 (30.5%) patients. The independent risk factors for MRI diagnosis of PAS in major PP included only repeated cesarean sections and advanced maternal age. The commonest maternal morbidity in major PP with PAS was significantly excessive intraoperative bleeding. CONCLUSION: MRI may be a valuable adjunct in the evaluation of PAS in major PP; as a complement, but not substitute US. MRI may be suitable in major PP/PAS patients who are older and have repeated cesarean deliveries with equivocal results or deep/extra-uterine extension on US. LIMITATION: Single center, small sample size, lack of complete histopathological diagnosis. CONFLICT OF INTEREST: None.

Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women in south western, Saudi Arabia.

This study aimed to determine the seroprevalence of Toxoplasma gondii in pregnant women in the south western region of Saudi Arabia and to find out the possible risk factors that may lead to infection. This cross sectional hospital based study was carried out at three hospitals in the south western region of Saudi Arabia from January 2008 to August 2010. Blood samples from 487 pregnant women were collected and used to detect anti-T. gondii antibodies IgM and IgG by enzyme linked immunosorbent assay (ELISA). A questionnaire interview was carried out to ask about some risk factors of infection. Among the 487 studied pregnant women, 38.8 % were seropositive for anti T. gondii IgG while 6.2 % were positive for anti T. gondii IgM and 3.3 % were positive for both anti T. gondii IgG & IgM. The only risk factor associated with seropositive anti T. gondii IgM was the history of the intake of immunosuppressive drugs. Regarding anti T. gondii IgG seropositivity, it was found to increase significantly with increased age, number of gravida and parities, and previous history of toxoplasmosis. The seroprevalence of T. gondii IgG & IgM by ELISA among pregnant women in the south western region of Saudi Arabia is considerable with few identifiable significant risk factors reported.

Concentration of free vascular endothelial growth factor and its soluble receptor, sFlt-1 in the maternal and fetal circulations of normal term pregnancies at high and low altitudes.

OBJECTIVE: Vascular endothelial growth factor (VEGF) is regulated by hypoxia that is essential for placental development. It is antagonized by a soluble form of its receptor (sFlt-1). The purpose of this study was to measure these factors in the maternal and the cord bloods, at low and high altitude. METHODS: Samples were collected from full term births normal pregnant women. Free (unbound) VEGF and sFlt-1 levels were measured in plasma samples from cord and maternal blood for each subject by enzyme-linked immunosorbent assay (ELISA) using commercially available kits from R&D systems, UK (Cat # DVE00 and Cat # SVR100B, respectively). RESULTS: At high altitude, the average maternal free VEGF in pg/ml was significantly (p < 0.001) lower than that of the cord level (71.30 ± 282.14 and 431.35 ± 424.31, respectively). On the other hand, the average maternal sFlt-1 was significantly (p < 0.001) higher than that of the cord level (8205.41 ± 6244.72 and 1811.74 + 3469.30, respectively). At low altitude, the average maternal free VEGF was significantly lower than that of the cord level (0.47 ± 0.89 and 483.44 ± 457.31, respectively, p < 0.001). On the other hand, the average maternal sFlt-1 was significantly higher than that of the cord level (9267.82 ± 6345.68 and 958.66 ± 1359.92, respectively, p < 0.001). There were no significant differences by altitude. CONCLUSION: Secretion of sFlt-1 appears to be polarized, in that concentrations are higher in the maternal compartment than on the fetal side at both high and low altitudes. This may be a normal physiological phenomenon to permit angiogenesis in the placenta and fetus while protecting the mother. Chronic exposure to hypobaric hypoxia at high altitude does not affect these distributions.

Impact of male obesity on semen quality and serum sex hormones.

Introduction. To investigate the association of high Body Mass Index (BMI) with semen parameters and reproductive hormones in men of reproductive age. Setting. The Saudi Center for Assisted Reproduction. Method. This study was conducted during the period from February 2009 to February 2011. Subjects were exposed through medical history evaluation as well as physical examination. BMI was calculated. Two semen samples about 1 week apart were taken from each participant by masturbation after 2-5 days of abstinence. The samples were assessed according to the WHO Criteria. Blood samples (5 ml) were withdrawn; centrifuged and the resulting sera were preserved at -4 degrees Centigrade. Serum FSH, LH, PRL, and Testosterone levels were estimated by the ELISA method. Results. There was no significant correlation between BMI and any of semen and hormonal parameters. There was significant negative correlation between age and total motility. Only the advanced paternal age has shown significant association with low motility (P = 0.007). Conclusion. Our study showed a significant effect of aging on sperm motility and concentration.

Early Maternal Serum ß-human Chorionic Gonadotropin Measurements After ICSI in the Prediction of Long-term Pregnancy Outcomes: A Retrospective Cohort Analysis.

BACKGROUND: Initial low maternal serum ß-human chorionic gonadotropin (ß-hCG) is a good predictor of early pregnancy demise. Our objective was to determine its predictive value in determining the long-term outcome in ICSI pregnancies. METHODS: A retrospective cohort study was designed at the Saudi Center for Assisted Reproduction. Two hundred and sixty-one women with ICSI pregnancies were followed up from initial ß-hCG level determination till the end of pregnancy. Accuracy of early ß-hCG in predicting the occurrence of a live-birth, ongoing pregnancy, late miscarriage, ectopic pregnancy and early miscarriage following ICSI was measured. RESULTS: ß-hCG levels were significantly different in pregnancies that reached the stage of an ongoing pregnancy and live-birth as compared to early pregnancy loss. The ROC curves demonstrated a high sensitivity for identifying patients with ectopic pregnancies and early miscarriage (100% and 93.33% respectively). The remaining results ranged from a sensitivity of 69% to 79% and specificity of 62% to 75%. CONCLUSIONS: In ICSI pregnancies, a single early ß-hCG may help to identify pregnancies that will reach full-term and delivery. KEYWORDS: ICSI; Human chorionic gonadotropin; Outcome; Pregnancy.

Congenital anomalies and other perinatal outcomes in ICSI vs. naturally conceived pregnancies: a comparative study.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) procedures have become accepted worldwide and their effect on society is well-known. However, the full extent of the possible complications of these procedures on maternal and neonatal outcome is still unclear. MATERIALS AND METHODS: This is a retrospective case controlled study from January 2003 to December 2007 which compared 253 women that had conceived using assisted reproduction (ICSI) and delivered 327 children at our center (study group) with a matched group of 349 women who naturally conceived and delivered 354 children at Abha General Hospital (control group) during the same period. The obstetrical and neonatal characteristics of the women and their children were assessed to determine any significant differences between the groups. RESULTS: The number of gestations per pregnancy (1.34 +/- 0.57 vs. 1.01 +/- 0.12) and number of children born per woman (1.28 +/- 0.49 vs. 1.01 +/- 0.12) was significantly higher in the ICSI group (p < 0.001). In addition, the gestational age at delivery (37.23 +/- 2.68 vs. 38.56 +/- 1.89) was significantly shorter in the ICSI group (p < 0.001) and this led to an increased number of obstetrical interventions, as well as the incidence of cesarean deliveries. Examination of the new-born children revealed similar incidence of congenital anomalies in both groups. CONCLUSION: ICSI conceived pregnancies were characterized by an increased number of gestations and live-born, and there was no increase in congenital malformations compared to naturally conceived pregnancies.

Risk factors and pregnancy outcome in different types of placenta previa.

OBJECTIVE: To compare risk factors and pregnancy outcome between different types of placenta previa (PP). MATERIALS AND METHODS: We conducted a retrospective study of 306 women presenting with PP over a 10-year period from January 1996 to December 2005. Differences between women with major and minor PP regarding age, parity, history of Caesarean section, antepartum hemorrhage, preterm deliveries, placenta accreta, Caesarean hysterectomy, operative complications, and neonatal outcome were identified using Mann-Whitney U test, chi-square test, and multivariate logistic regression. RESULTS: The overall incidence of PP was 0.73%. Major PP (complete or partial PP) occurred in 173 women (56.5%) and minor PP (marginal PP or low-lying placenta) in 133 women (43.5%). There were no differences between women with major and minor PP regarding age, parity, and previous miscarriages. After controlling for confounding factors, women with major PP showed a significantly higher incidence of antepartum hemorrhage (OR 3.18; 95% CI 1.58-6.4, P = 0.001), placenta accreta (OR 3.2; 95% CI 1.22-8.33, P = 0.017), and hysterectomy (OR 5.1; 95% CI 1.31-19.86, P = 0.019). Antepartum hemorrhage in women with PP was associated with premature delivery (OR 14.9; 95% CI 4.9-45.1, P < 0.001), more commonly in women with major PP. The only significant difference between women with major and minor PP regarding neonatal outcome was that major PP was associated with a higher incidence of admission to the neonatal intensive care unit (P = 0.014). CONCLUSION: Complete or partial placenta previa is associated with higher morbidity than marginal placenta previa or low-lying placenta.

Ultrasound guidance during embryo transfer: a prospective, single-operator, randomized, controlled trial.

OBJECTIVE: To determine whether the implementation of ultrasound (US) guidance will improve the clinical outcomes of ET compared with the standard clinical touch method of embryo catheter placement. DESIGN: Prospective, single-operator, randomized, controlled trial. SETTING: Saudi Center for Assisted Reproduction. PATIENT(S): Three hundred seventy-three women. INTERVENTION(S): Transcervical, intrauterine ET with or without US guidance. MAIN OUTCOME MEASURE(S): Primary outcomes were the live-birth/ongoing pregnancy and clinical pregnancy rates per randomized woman. Secondary outcomes were the incidences of difficult transfers, blood and/or mucus on the catheter tip, spontaneous miscarriages, and ectopic pregnancies. RESULT(S): Demographics and cycle characteristics were not different between the two groups. The live-birth/ongoing pregnancy rate was significantly higher in the US ET group (68 of 183, 40.98%) than in the clinical touch ET group (50 of 190, 28.42%) (odds ratio = 1.66, 95% confidence interval 1.07-2.57). In addition, there was a significantly higher number of clinical pregnancies in the US ET group (75 of 183, 40.98%) than in the clinical touch ET group (54 of 190, 28.42%) (odds ratio = 1.75, 95% confidence interval 1.14-2.69). Secondary outcomes were not significantly different between the two groups. CONCLUSION(S): Ultrasound-guided ET significantly increases ongoing pregnancy/live-birth and clinical pregnancy rates compared with the clinical touch method.

Does the addition of a gonadotropin-releasing hormone agonist improve the pregnancy rate in intrauterine insemination? A prospective controlled trial.

OBJECTIVE: The purpose of the present study was to determine if the use of a gonadotropin-releasing hormone (GnRH) agonist can improve pregnancy and live-birth rates during superovulation and intrauterine insemination (IUI). SUBJECTS AND METHODS: In this prospective study, which started in January 2004 and finished in October 2006, women aged 18-39 years underwent 500 cycles of superovulation/IUI with (n = 254) and without (n = 246) GnRH agonist. SETTING: Saudi Center for Assisted Reproduction, Abha, Saudi Arabia. RESULTS: There were no significant differences with regard to patient demographics between the studied groups. In addition, there was no statistically significant difference in the live-birth, ongoing and clinical pregnancy rates per cycle for patients who received GnRH agonist and patients who did not receive GnRH agonist. CONCLUSION: Superovulation/IUI cycles using GnRH agonist produce similar pregnancy rates to superovulation/IUI cycles without using GnRH agonist.

Breech delivery before and after the term breech trial recommendation.

OBJECTIVE: To compare the outcome of breech delivery at term in women before and after the term breech trial (TBT) recommendation. METHODS: A retrospective study carried out at Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia comprising 796 women with breech presentation at term who delivered at our hospital between May 1997 and February 2005 divided into 2 groups. Group 1 consisted of 394 patients who were delivered 4 years before the recommendation of the TBT, and group 2 comprised 402 patients delivered 4 years after the recommendation. RESULTS: There were no statistically significant differences between the 2 groups with regards to the mean maternal age and birth weight, p>0.05, however, parity, gestational age at delivery, booking status, and cesarean section (CS) rate reached statistically significant levels, p<0.05. Assisted vaginal delivery was conducted in 106 (26.9%) of patients in group 1 and 69 (17.1%) in group 2, this also was statistically significant. No statistically significant differences were found between the 2 groups regarding the perinatal mortality, low Apgar score, <7 at 5 minutes and complications during delivery, p>0.05. CONCLUSION: There was a dramatic increase in the rate of CS without a corresponding improvement in the neonatal outcome in the years following the TBT recommendation in our hospital. We suggest that the policy is formulated to reduce the number of unbooked patients with breech presentation at term in our community to reduce the CS rate in these groups of patients.

Regional clinical practice patterns in reproductive endocrinology: a collaborative transnational pilot survey of in vitro fertilization programs in the Middle East.

BACKGROUND: This research describes current clinical and demographic features sampled from reproductive endocrinology programs currently offering in vitro fertilization (IVF) in the Middle East. METHODS: Clinic leadership provided data via questionnaire on patient demographics, demand for IVF services, annual cycle volume, indications for IVF, number of embryos transferred, twinning frequency, local regulations governing range of available adjunct therapies, time interval between initial enrollment and beginning IVF as well as information about other aspects of IVF at each center. RESULTS: Data were received from representative IVF clinics (n = 13) in Cyprus, Egypt, Iran, Israel, Jordan, Lebanon, Qatar, Saudi Arabia and Turkey. Mean (+/- SD) age of respondents was 47.8 +/- 8 yrs, with average tenure at their facility of 11.2 +/- 6 yrs. Estimated total number of IVF programs in each nation responding ranged from 1 to 91. All respondents reported individual participation in accredited CME activity within 24 months. 76.9% performed embryo transfers personally; blastocyst transfer was available at 84.6% of centers. PGD was offered at all sites. In this population, male factor infertility accounted for most IVF consultations and the majority (59.1%) of female IVF patients were < 35 yrs of age. Prevalence of smoking among female IVF patients was 7.2%. Average number of embryos transferred was 2.4 (+/- 0.4) for patients at age < 35 yrs, and 2.9 (+/- 0.8) at age > 41 yrs. For these age categories, twinning (any type) was observed in 22.6 (+/- 10.8)% and 13.7 (+/- 10.4)%, respectively. In 2005, the average number of IVF cycles completed at study sites was 1194 (range 363-3500) and 1266 (range 263-4000) in 2006. Frozen embryo transfers accounted for 17.2% of cycles at these centers in 2005. Average interval between initial enrollment and IVF cycle start was 8 weeks (range 0.3-3.5 months). CONCLUSION: This sampling of diverse IVF clinics in the Middle East, believed to be the first of its kind, identified several common factors. Government registry or oversight of clinical IVF practice was limited or nonexistent in most countries, yet number of embryos transferred was nevertheless fairly uniform. Sophisticated reproductive health services in this region are associated with minimal delay (often < 8 weeks) from initial presentation to IVF cycle start. Most Middle East nations do not maintain a comprehensive IVF database, and there is no independent agency to collect transnational data on IVF clinics. Our pilot study demonstrates that IVF programs in the Middle East could contribute voluntarily to collaborative network efforts to share clinical data, improve quality of care, and increase patient access to reproductive services in the region.

Removal of cervical mucus prior to embryo transfer improves pregnancy rates in women undergoing assisted reproduction.

The removal of cervical mucus during embryo transfer has been postulated to increase the pregnancy and implantation rates by not interfering with embryo implantation. Even so, this is a time-consuming procedure that may increase the incidence of difficult transfers by removing the naturally lubricant mucus. In addition, any cervical manipulations at the time of embryo transfer may cause unwarranted uterine contractions. In this prospective, controlled study, 286 women undergoing embryo transfer between January and May 2006 were divided into two groups according to whether the cervical mucus was scheduled to be aspirated (group A) or not (group B). The two groups were similar with regards to the demographics, cause of infertility, characteristics of ovarian stimulation and embryos transferred. Even so, the clinical pregnancy rate was significantly higher in group (A) than group (B) (OR = 2.18, 95% CI = 1.32-3.58), although there were easier transfers in group (B) than group (A) (OR = 3.00, 95% CI = 1.05-8.55). This demonstrates that even though embryo transfers were easier to perform when the cervical mucus was left in place, aspiration resulted in an increased chance of clinical pregnancy.

Multiple repeat caesarean sections: complications and outcomes.

OBJECTIVE: To compare the complications and outcomes of Caesarean section (CS) in women who have had three or more previous lower segment Caesarean sections with those in women with one previous CS. METHODS: We performed a retrospective study of 371 patients undergoing repeat CS. Of these, 115 (31%) had previously had three or more Caesarean sections (group 1) and 256 (69%) had previously had one CS (group 2). All 371 patients had the repeat CS performed at Abha Maternity Hospital, Saudi Arabia between June 2002 and May 2004. Demographic data, complications, and outcomes were compared using the Student t and chi-square tests. RESULTS: There were statistically significant differences between the two groups with respect to mean maternal age, parity, gestation at delivery, and experience of the surgeon (P < 0.05). CS was performed as an emergency in 38 (32.9%) and 186 (72.6%) of patients in groups 1 and 2 respectively (P < 0.05). The consultant was involved in the decision to perform CS in 215 (84.6%) of patients with one previous CS. There were significant differences between the two groups in the type of skin incision, the presence of dense adhesions during surgery, and bladder injury (P < 0.05). There were no statistically significant differences in birth weight, stillbirth rate, low Apgar score, blood loss during surgery, duration of surgery, or the duration of postoperative hospital stay. CONCLUSION: The prevalence of dense intra-abdominal adhesions and of bladder injury during CS was higher in women with a history of three or more previous CS than in women with one previous CS. Placenta previa and Caesarean hysterectomy occurred with equal frequency in each group, and wound dehiscence and uterine rupture were rare.

Emergency cervical cerclage. Does the gestational age make a difference?

OBJECTIVE: To investigate the effectiveness of emergency cervical cerclage in prolongation of pregnancy and its effect on pregnancy outcome in patients with cervical incompetence. METHODS: A retrospective review of patients who had an emergency cervical cerclage performed for cervical incompetence during the period from July 1995 to June 2002 was carried out in Abha General Hospital, Abha, Kingdom of Saudi Arabia. Twenty patients between 16 and 26 weeks of gestation with 1) cervical effacement, 2) cervical dilatation of < or =3 cm, 3) herniation of intact fetal membranes through the cervical os, 4) absence of established labor, and 5) absence of clinical evidence of infection were studied. The duration of cerclage in situ, gestation at delivery and birth weight were analyzed. RESULTS: The mean duration of cerclage in situ was 68.5 days. The mean gestation at delivery was 30.5 weeks and the mean birth weight was 1844 grams. The duration of cerclage in situ was significantly longer when the procedure was performed at or before 22 weeks of gestation with a p value of <0.02 (Mann-Whitney U test), but the difference in the gestation at delivery and birth weight was not significant. There was also a significant negative correlation between the gestation at cerclage and the duration of cerclage in situ (Spearman's correlation coefficient rs = -0.56, p<0.05). CONCLUSION: Emergency cervical cerclage in early second trimester effectively prolonged pregnancy compared to emergency cerclage performed in late second trimester.

Is recombinant follicle-stimulating hormone more effective in IVF poor responders than human menopausal gonadotrophins?

BACKGROUND: The objective of this study was to determine if the recombinant human follicle-stimulating hormone (rFSH) is more effective than human menopausal gonadotrophin (hMG) in IVF poor responders. MATERIAL/METHODS: A prospective comparative study over a 2-year period. The setting was the Tertiary IVF Center, King Faisal Specialist Hospital and Research Center. A total of 150 patients were selected from 277 patients with poor response in previous hMG-stimulated cycles who were willing to undergo another cycle of treatment. Seventy-five patients stimulated with rFSH were compared with 75 control subjects (matched for age, early follicular phase FSH, and body mass index) stimulated with urinary hMG. The number of follicles, number of oocytes retrieved, cycle cancellations, and pregnancy rates were the main outcome measures. RESULTS: There were no statistical differences in numbers of follicles (6.2 versus 5.7; p=0.97), oocytes recovered (4 versus 3.3; p=0.15), cycle characteristics, or pregnancy rates between hMG- and rFSH-stimulated cycles (p=0.32). CONCLUSIONS: Recombinant follicle-stimulating hormone (rFSH) has no advantage over urinary human menopausal gonadotrophin (hMG) on ovarian performance or the outcome of IVF-ET in poor responders' IVF cycles.

Right lower quadrant pain in females. Is it appendicitis or gynecological?

OBJECTIVE: To determine if a gynecological consultation is needed for patients who are labeled to have acute appendicitis. METHODS: A retrospective study carried out in Assir Central Hospital, Abha, Kingdom of Saudi Arabia. Fifteen female patients who were clinically diagnosed and operated upon for acute appendicitis were discovered intra-operatively to have unrelated gynecological lesions, are presented. RESULTS: Histopathological reports on the removed appendices revealed 80% "normal" and 20% "mildly inflamed". Seven (46.7%) of the patients had right ovarian cysts (one of them, bilateral); 4 (26.7%), corpus luteum cysts, and 4 had bilateral salpingitis, bilateral pyosalpinx, right ovarian cyst with bilateral salpingitis and ruptured right tubal pregnancy each. The majority (60%) of the women were in the 20-30-year-age bracket. CONCLUSION: The need for gynecological review of female patients of childbearing age presenting with lower abdominal pain is stressed. Ultrasonography is an important adjunct in improving diagnostic accuracy in such cases.

Is 24-h sperm motility a useful IVF measure when male infertility is not apparent?

OBJECTIVE: To examine the relationship of 24-h sperm motility between post insemination and fertilization in vitro, in a population with no apparent semen abnormalities. A retrospective study from July 1998 to June 2000. MATERIAL AND METHODS: Four hundred and seventy-one consecutive in-vitro fertilization (IVF) cycles for which the primary diagnosis was not male infertility (total motility count > 40 x 106) were studied. Linear regression was used to examine the general relation between 24-h sperm motility and IVF. The cohort with 0% 24-h motility was compared with all other cycles using the t-test and the chi2-test. Test quality was assessed using the positive likelihood ratio. RESULTS: Overall fertilization was 58 +/- 16%. There were 45/471 cycles (9.5%) with zero fertilization. Linear regression of percent fertilization vs. 24-h motility showed no relationship (r = 0.01). The cohort with 0% 24-h motility had a lower fertilization rate 29 +/- 19% (P = 0.05), and had a higher incidence of no fertilization 7/21 (P = 0.01). The positive likelihood ratio was 4.6. CONCLUSIONS: Zero 24-h motility indicates occult male infertility, and a positive result indicates a fair to good test. Overall there was no relationship between sperm survival at 24 h post insemination and fertilization in vitro. However, 0% 24-h sperm motility was associated with reduced fertilization