Small cell carcinoma of the ovary hypercalcemic type (SCCOHT): A rare case after in vitro fertilization (IVF).

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a very rare and lethal tumor, mostly affecting young women, with aggressive clinical course. It has a worse prognosis in younger women and most of them died within two years of diagnosis. We are reporting a unique case of SCCOHT in a 35 years old, nulliparous lady with primary infertility in which symptomatic hypercalcemia was a presenting feature of her cancer. She was completely healthy before third cycle of IVF. Within two months of her third IVF cycle, she developed SCCOHT with a very rapid and aggressive course of disease and fatal outcome. Patient died within one month of her first symptom presentation (3 months after IVF cycle).

Metformin-clomiphene citrate vs. clomiphene citrate alone: Polycystic ovarian syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy in women that is associated with reproductive and metabolic disorders. OBJECTIVES: We compared the ovulation and conception rates after the treatment with clomiphene citrate (CC) alone and in combination with metformin in infertile patients presented with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: This randomized controlled trial of independent cases and controls was conducted at the Department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia from February 01 to December 31, 2008. The 42 subjects diagnosed as PCOS were divided into group A and B (21 subjects in each) for management with CC + metformin and CC alone, respectively. Group A received 500 mg three times a day of metformin continuously from the first cycle for 6 months or till pregnancy was confirmed. In both groups CC was started at a dose of 50 mg from day-2 till day-6 of the menstrual cycle. The dose of CC was increased to 100 mg in second and 150 mg in third cycle, and then remained 150 mg for the remaining three cycles. With ovulation the dose of CC was unaltered in both groups. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 16. RESULTS: More than 50% females in both groups were had body mass index > 25. Group A achieved high rate of regular cycles, ovulation success, and conception than group B (71.4% vs. 38.1%; P = 0.03), (76.2% vs. 38.1%; P = 0.021), and (66.6% vs. 28.6%; P = 0.01), respectively. CONCLUSION: Management with metformin + CC increased the ovulation and conception rates.

Clinical course of ectopic pregnancy: A single-center experience.

OBJECTIVES: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP) in a general hospital. MATERIALS AND METHODS: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007). RESULTS: Out of total 7564 pregnancies, 44 (0.58%) patients were diagnosed as EP. Out of 44, 22 (50%) patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%), and 21 (48%) had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%), abdominal pain (39, 88.6%), and tenderness (38, 86%). Previous pelvic surgery (13, 29.5%), infertility treatment (11, 25%), and pelvic inflammatory disease (10, 22.7%) were the common predisposing factors. Twenty-five (57%) presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%). No mortality was observed. CONCLUSION: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

Risk of adverse maternal and peri-natal outcome in subjects with placenta previa with previous cesarean section.

The aim of this study was to compare maternal and perinatal adverse outcomes between groups of placenta previa (PP) with and without previous cesarean section (CS). A prospective study was carried out from March 2008 to August 2009 at the department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia. Diagnosed cases of PP with singleton pregnancy presenting with ante-partum hemorrhage (APH) in the 3rd trimester undergoing either emergency or elective CS were included. Subjects were divided into two groups, 30 with previous CS (group A) and 27 without previous CS (group B), and the risks of adverse maternal and perinatal outcomes were compared. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA).One mother in group A died due to disseminated intravascular coagulation. The risk of post partum hemorrhage (PPH), blood transfusion and coagulopathy was higher in group A, (OR 4.8, 95% CI 1.5-15; p=0.008; OR 4.8, 95% CI 1.5-15; p=0.008; OR 9.5, 95% CI 1.2-81.6; p=0.03, respectively). Mean length of hospital stay (days±SD) in group A was significantly longer than that in group B (5.3±3.2 vs. 3.2±1.5, 95% CI 0.8-3.2; p=0.002). A higher risk of perinatal adverse outcome was found in group A, but the difference was not significant.Risk of maternal morbidity was higher than that of perinatal morbidity in Group A.

The role of doppler ultrasound in high risk pregnancy: A comparative study.

BACKGROUND: The objective was to determine the effectiveness of Doppler velocimetry results in the management of high-risk pregnancy. MATERIALS AND METHODS: This cohort study was conducted from January 2005 to December 2006 in Obstetrics and Gynecology Department of Alnoor Specialist Hospital, Makkah, Saudi Arabia. A total of 200 high-risk pregnant women with gestational age >28 weeks were selected for the study and divided into group A (100) subjected to Doppler velocimetry and group B (100) without Doppler velocimetry. Standard management protocols were followed in all cases. The primary outcome measures were mode of delivery and gestational age at the time of delivery. The secondary outcome measures were prenatal and neonatal complications. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). RESULTS: Preterm deliveries, preterm as well as full-term neonatal admissions were more frequent in group A than those in group B, i.e., (39% vs. 26%), (56% vs. 88%) (OR 0.2, 95% CI 0.04-0.7), and (30% vs. 57%) (OR 0.3, 95% CI 0.2-0.7), respectively. Similarly preterm and full-term neonatal deaths were rare in group A than those in group B, i.e., (9% vs. 78%) (OR 0.1, 95% CI 0.02-0.7), and (6% vs. 29%) (OR 0.2, 95% CI 0.03-1.8), respectively. Emergency caesarean section rate was rare in the subjects with normal Doppler than those with abnormal Doppler (48% vs. 100%) (OR 0.1, 95% CI 0.03-0.4) as well as in group B (48% vs. 82%) (OR 0.2, 95% CI 0.1-0.4). CONCLUSION: Doppler studies in high-risk pregnancies are more beneficial in the management of perinatal as well as neonatal management.

Induction of labor: a comparative study of intravaginal misoprostol and dinoprostone.

OBJECTIVE: To compare the efficacy and safety of intravaginal misoprostol and dinoprostone for elective induction of labor in nulliparous women with an unfavorable cervix. MATERIALS AND METHODS: A quasi-experimental study was conducted in Bahawal Victoria Hospital, Bahawalpur, Pakistan, from July 1, 2005 to August 31, 2006. A total of 120 primigravid women with gestational ages of > 40 weeks to < 42 weeks were divided into two groups. Group A (n = 60) was given 50 microg of misoprostol and Group B (n = 60) was given 3 mg of dinoprostone every 6 hours, for a maximum of three doses. RESULTS: The induction to onset of significant uterine contractions and delivery intervals were lower in Group A than in Group B (6.1 vs. 7.2 hours; p = 0.16; and 8.2 vs. 11.0 hours; p = 0.007, respectively). Group A had a lower cesarean section rate than Group B (7% vs. 30%; p = 0.003), but a higher rate of uterine hyperstimulation (10% vs. 3%; p = 0.16), tachysystole (17% vs. 3%; p = 0.02), and neonatal admissions to the intensive care unit within 24 hours of delivery (4 vs. 3; p = 0.71) and after 24 hours (2 vs. 1; p = 0.56) than Group B. CONCLUSION: Vaginal misoprostol is more effective than dinoprostone for the elective induction of labor beyond 40 weeks of gestation, but is associated with more uterine hyperstimulation, tachysystole, and neonatal intensive care unit admissions.

Labour induction with randomized comparison of oral and intravaginal misoprostol in post date multigravida women.

The efficacy and safety of oral versus vaginal misoprostol for elective induction of labor in post date multigravida with an unfavourable cervix was compared over a period of one year in the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Eightyeight multigravida post date women were divided into two groups and given 50 mg misoprostol orally and 50 mg intravaginally, respectively. The induction to onset of significant uterine contractions and delivery intervals were lower in the first group (7.8 h vs. 8.9 h) when compared to (10.4 h vs. 12 h). The first group had a higher rate of Caesarean section (7% vs. 4%; p>0.05), uterine hyperstimulation (9% vs. 5%; p>0.05), uterine tachysystole (23% vs. 14%; p>0.05) and neonatal admissions to intensive care unit (12% vs. 4%; p>0.05) when compared to second group. Fifty mg oral misoprostol has the potential to induce labor as safely and effectively as the intravaginal route.

Pre-labor rupture of membranes at term in patients with an unfavorable cervix: active versus conservative management.

OBJECTIVE: To compare the safety and efficacy of conservative management of pre-labor rupture of membranes (PROM) at term in patients with an unfavorable cervix, with active treatment using oral misoprostol. MATERIALS AND METHODS: This quasi-experimental study was conducted between June 1, 2004 and November 30, 2004 at Bahawal Victoria Hospital, Bahawalpur, Pakistan. Eighty-four multigravid women (parity, < 5) at > or = 37 weeks' gestation and with unfavorable cervices were divided equally between group S (study) and group C (conservative). Group S was given 50 micrograms of oral misoprostol every 4 hours for a maximum of four doses, while group C was managed conservatively. The intervals between PROM and significant uterine contractions and delivery, the mode of delivery, and maternal and fetal/neonatal complications were the main outcome measures. RESULTS: The intervals between PROM and the onset of uterine contractions and delivery were lower in group S than group C (9.6 vs. 14.8 hours; p < 0.001) and (11.6 vs. 17 hours; p < 0.001), respectively. Fewer women delivered abdominally within 24 hours of PROM in group S than in group C (5% vs. 24%; p < 0.05). Induction failure in group S was less than conservative management failure in group C (10% vs. 60%; p < 0.001). The maternal complication rate was less in group S than in group C (7% vs. 14%; p > 0.05), but the fetal/neonatal complication rate was similar in both groups (5%). CONCLUSION: Oral misoprostol (50 micrograms) is safe and effective for cervical ripening and labor induction in patients with PROM and an unfavorable cervix.