Mortality outcomes between pregnant women booked for antenatal care and unbooked pregnant women.

BACKGROUND: Perinatal fetal mortality and maternal mortality remains relatively high in Saudi Arabia. Antenatal care aims to improve outcomes; however, evidence to demonstrate its impact on outcomes in Saudi Arabia is lacking. OBJECTIVES: Investigate whether booking status for antenatal care impacted outcomes for pregnant women and identify outcomes that predicted booking status. DESIGN: Retrospective observational cohort study. SETTINGS: Tertiary care center. PATIENTS AND METHODS: All Saudi women admitted to the labor or delivery units between January 2011 and December 2019 were included. Outcomes were compared between booked and unbooked women, and logistic regression was used to identify outcomes that predicted booking status, adjusted for age. MAIN OUTCOME MEASURES: Booked/unbooked status and perinatal mortality of Saudi women. SAMPLE SIZE: 10 781 women; 9546 (88.5%) booked, (11.1%) 1192 unbooked. RESULTS: Unbooked mothers had higher incidences of meconium-stained liquor (P=.040), ruptured uterus (P=.017), and blood loss >1000 mL during cesarean deliveries (P=.003), but a lower episiotomy rate (P<.001). Perinatal fetal mortality and maternal mortality were equivalent between the two groups. Episiotomy, higher birth weight, higher mother age, perinatal death, delivery mode, onset of labor, and use of analgesics were all independent predictors of the mother being booked when adjusted for all outcomes and age. CONCLUSIONS: The rate of perinatal and maternal mortality in this cohort was relatively low and equivalent between booked and un-booked mothers, contrary to our expectations. More analysis of the socioeconomic data may explain this striking result. LIMITATIONS: Retrospective chart-review with incomplete data retrieval that affected the completeness of data retrieved. The results of the multivariate analysis cannot be used to infer causality because the study is observational.

Molecular differential analysis of uterine leiomyomas and leiomyosarcomas through weighted gene network and pathway tracing approaches.

Uterine smooth muscular neoplastic growths like benign leiomyomas (UL) and metastatic leiomyosarcomas (ULMS) share similar clinical symptoms, radiological and histological appearances making their clinical distinction a difficult task. Therefore, the objective of this study is to identify key genes and pathways involved in transformation of UL to ULMS through molecular differential analysis. Global gene expression profiles of 25 ULMS, 25 UL, and 29 myometrium (Myo) tissues generated on Affymetrix U133A 2.0 human genome microarrays were analyzed by deploying robust statistical, molecular interaction network, and pathway enrichment methods. The comparison of expression signals across Myo vs UL, Myo vs ULMS, and UL vs ULMS groups identified 249, 1037, and 716 significantly expressed genes, respectively (p ≤ 0.05). The analysis of 249 DEGs from Myo vs UL confirms multistage dysregulation of various key pathways in extracellular matrix, collagen, cell contact inhibition, and cytokine receptors transform normal myometrial cells to benign leiomyomas (p value ≤ 0.01). The 716 DEGs between UL vs ULMS were found to affect cell cycle, cell division related Rho GTPases and PI3K signaling pathways triggering uncontrolled growth and metastasis of tumor cells (p value ≤ 0.01). Integration of gene networking data, with additional parameters like estimation of mutation burden of tumors and cancer driver gene identification, has led to the finding of 4 hubs (JUN, VCAN, TOP2A, and COL1A1) and 8 bottleneck genes (PIK3R1, MYH11, KDR, ESR1, WT1, CCND1, EZH2, and CDKN2A), which showed a clear distinction in their distribution pattern among leiomyomas and leiomyosarcomas. This study provides vital clues for molecular distinction of UL and ULMS which could further assist in identification of specific diagnostic markers and therapeutic targets.Abbreviations UL: Uterine Leiomyomas; ULMS: Uterine Leiomyosarcoma; Myo: Myometrium; DEGs: Differential Expressed Genes; RMA: Robust Multiarray Average; DC: Degree of Centrality; BC: Betweenness of Centrality; CGC: Cancer Gene Census; FDR: False Discovery Rate; TCGA: Cancer Genome Atlas; BP: Biological Process; CC: Cellular Components; MF: Molecular Function; PPI: Protein-Protein Interaction.

Labour outcomes with defibulation at delivery in immigrant Somali and Sudanese women with type III female genital mutilation/cutting.

INTRODUCTION: There is a scarcity of studies on labour outcomes with defibulation. This study assessed the outcomes of labour with defibulation at delivery in women with type III female genital mutilation/cutting (FGM/C) compared to labour without defibulation. METHODS: We identified and reviewed the records of all Somali and Sudanese women who delivered at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2012 and December 2016. Labour outcomes of women with type III FGM/C who delivered vaginally with defibulation at delivery were compared to the outcomes of women without type III FGM/C who delivered vaginally without defibulation. Data extracted from the records included demographics, registration status, and labour outcomes. RESULTS: During the study period, 1086 Somali and Sudanese women delivered at our institution, with 42% delivering by caesarean section. Among the 631 women with vaginal delivery, 27% had type III FGM/C and delivered with defibulation while 73% did not have type III FGM/C and delivered without defibulation. Demographic and clinical factors were similar between the two groups who delivered vaginally. The outcomes of labour with defibulation at delivery in women with type III FGM/C were not different from women without defibulation, except in regards to instrumental delivery and maternal blood loss. There were also no statistically significant differences between the two groups in neonatal outcomes. CONCLUSIONS: Defibulation at delivery is an effective minor surgical procedure that should be in the armamentarium of the healthcare providers managing women with type III FGM/C.    .

Expanded Somatic Mutation Spectrum of MED12 Gene in Uterine Leiomyomas of Saudi Arabian Women.

MED12, a subunit of mediator complex genes is known to harbor genetic mutations, (mostly in exon 2), causal to the genesis of uterine leiomyomas among Caucasian, African American, and Asian women. However, the precise relationship between genetic mutations vs. protein or disease phenotype is not well-explained. Therefore, we sought to replicate the MED12 mutation frequency in leiomyomas of Saudi Arabian women, who represents ethnically and culturally distinct population. We performed molecular screening of MED12 gene (in 308 chromosomes belonging to 154 uterine biopsies), analyzed the genotype-disease phenotype correlations and determined the biophysical characteristics of mutated protein through diverse computational approaches. We discovered that >44% (34/77) leiomyomas of Arab women carry a spectrum of MED12 mutations (30 missense, 1 splice site, and 3 indels). In addition to known codon 44, we observed novel somatic mutations in codons 36, 38, and 55. Most genetically mutated tumors (27/30; 90%) demonstrated only one type of genetic change, highlighting that even single allele change in MED12 can have profound impact in transforming the normal uterine myometrium to leiomyomas. An interesting inverse correlation between tumor size and LH is observed when tumor is positive to MED12 mutation (p < 0.05). Our computational investigations suggest that amino acid substitution mutations in exon-2 region of MED12 might contribute to potential alterations in phenotype as well as the stability of MED12 protein. Our study, being the first one from Arab world, confirms the previous findings that somatic MED12 mutations are critical to development and progression of uterine leiomyomas irrespective of the ethnic background. We recommend that mutation screening, particularly codon 44 of MED12 can assist in molecular diagnostics of uterine leiomyomas in majority of the patients.

Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a cultural practice that involves several types of removal or other injury to the external female genitalia for nonmedical reasons. Although much international research has focused on the health consequences of the practice, little is known about sexual functioning among women with various types of FGM/C. OBJECTIVE: To assess the impact of FGM/C on the sexual functioning of Sudanese women. STUDY DESIGN: This is a cross-sectional study conducted at Doctor Erfan and Bagedo Hospital, Jeddah, Saudi Arabia. Eligible women completed a survey and a clinical examination, which documented and verified women's type of FGM/C. The main outcome measure was female sexual function, as assessed by the Arabic Female Sexual Function Index. RESULTS: A total of 107 eligible women completed the survey and the gynecological examination, which revealed that 39% of the women had FGM/C Type I, 25% had Type II, and 36% had Type III. Reliability of self-report of the type of FGM/C was low, with underreporting of the extent of the procedure. The results showed that 92.5% of the women scored lower than the Arabic Female Sexual Function Index cut-off point for sexual dysfunction. The multivariable regression analyses showed that sexual dysfunction was significantly greater with more extensive type of FGM/C, across all sexual function domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and overall. CONCLUSION: The study documents that a substantial proportion of women subjected to FGM/C experience sexual dysfunction. It shows that the anatomical extent of FGM/C is related to the severity of sexual dysfunction.

The prevalence of sexual dysfunction in the female health care providers in Jeddah, Saudi Arabia.

The objective of this study was to determine the prevalence of sexual dysfunction in Saudi and non-Saudi female health care providers in Jeddah, Saudi Arabia. One -hundred twenty (60 Saudi and 60 non-Saudi) sexually active female health care professionals in Jeddah, Saudi Arabia, were anonymously surveyed using the English version of the female sexual function index questionnaire. The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score for the Saudi and non-Saudi women were calculated and compared. The two groups were comparable in demographic characteristics. No statistically significant differences were found between Saudi and non-Saudi women in desire (P = .22) and arousal scores (P = .47). However, non-Saudi women had significantly higher lubrication (P < .001), orgasm (P = .015), satisfaction (P = .004), and pain scores (P = .015). The overall scores in Saudi and non-Saudi women were low (23.40 ± 4.50 compared with 26.18 ± 5.97), but non-Saudi women had a significantly higher overall score (P = .005). Taken together, sexual dysfunction is prevalent among Saudi and non-Saudi female health care providers, with Saudi women demonstrating lower scores in four sexual function domains and the overall score.

Efficacy of intra-cervical misoprostol in the management of early pregnancy failure.

The aim of this prospective study was to assess the efficacy of intra-cervical misoprostol in the management of early pregnancy failure. Twenty women with early pregnancy failure received intra-cervical misoprostol via an endometrial sampling cannula. The first dose was 50 µg of misoprostol dissolved in 5 ml of normal saline. The administration was repeated after 12 h if there was no vaginal bleeding or pain. Nine (45%) women received 1 dose and 11 (55%) women received 2 doses of intra-cervical misoprostol. Abortion within 24 h occurred in 16 (80%) women, and complete abortion was achieved in 14 (70%) cases. Two women with incomplete abortion were managed with 600 µg of misoprostol orally (1 case) and surgical intervention (1 case). The mean time interval between the first dose and the abortion was 10.6 ± 6.3 h. Two women did not respond within 24 h of treatment initiation, 1 woman withdrew consent after the first treatment, and 1 woman developed heavy vaginal bleeding after the first dose and underwent surgical management. Intra-cervical misoprostol is a promising method of medical treatment of early pregnancy failure. Further randomized clinical trials are needed to validate its safety and efficacy.

Type I female genital mutilation: a cause of completely closed vagina.

INTRODUCTION: Female genital mutilation (FGM) ranges in severity from a nick of the clitoris to partial or total removal of the external genitalia. Sexual complications after FGM include sexual dysfunction, difficult intercourse, and dyspareunia. AIM: We report a case of Type I FGM presenting as complete vaginal closure and urinary retention. METHODS: A 16-year-old adolescent was referred for obliterated vagina and urinary retention. She had recurrent urinary tract infections, difficulty in voiding, and cyclic hematuria. At the age of 1 year she had been taken by her mother to a pediatric surgeon to have a Type I FGM procedure. On examination, the urethral meatus and vaginal orifices were completely closed by the FGM scar. She underwent uneventful surgical opening of the vagina. RESULTS: A normal vaginal orifice was created and normal flow of urine and menses occurred. CONCLUSION: Type I FGM can present as complete vaginal closure and urinary retention. Proper diagnosis and treatment are of paramount importance.

Retraction technique for urinary catheterization of women with female genital mutilation.

OBJECTIVE: To evaluate the retraction technique for urinary catheterization of women with Type III female genital mutilation (FGM). STUDY DESIGN: The hospital records of all women from Sudan, Somalia, Ethiopia, Egypt, Eritrea, and Chad who were admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia from January 1, 2011 to January 1, 2012 were reviewed. Women with Type III FGM who had urinary catheterization were identified and their records were examined. RESULTS: During the study period, 162 women with Type III FGM had urinary catheterization by residents in our hospital. One hundred and twelve (69.1%) women had urinary catheterization by the standard procedure and 50 (30.9%) by the retraction technique because of failure of the standard procedure. No attempts to use the technique were unsuccessful; that is, no procedures were converted to emergency defibulation. No complications occurred during insertion or while the catheter was in place (37.5±5.6h). CONCLUSIONS: The retraction technique provides a safe and effective option for urinary catheterization of women with Type III FGM.

Manchester repair. An alternative to hysterectomy.

Local data regarding Manchester repair are not available in the current literature. We report a retrospective case series of 7 women who presented with uterine prolapse, and underwent Manchester repair from January 1997 to May 2008 at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. All of these women were multiparous (para 31) and wanted to avoid hysterectomy, and become pregnant. The duration of the procedure was 119 16 minutes. No operative complications were observed. The mean duration of follow up was 52 years. All of the women were satisfied with the procedure. Two (28.6%) patients subsequently became pregnant and had a successful vaginal delivery. Manchester repair is a valid alternative to hysterectomy for women with a second degree uterine prolapse who want to preserve their fertility.

Cisplatinum and docetaxel for ovarian cancer in pregnancy.

BACKGROUND: There is limited data on chemotherapy for advanced ovarian cancer during pregnancy. Most women received cisplatin-based chemotherapy. There are no published reports on the use of docetaxel for ovarian cancer in pregnancy. CASE: A 32-year-old pregnant lady underwent laparatomy at 18-week gestation for ruptured ovarian cyst. The pregnancy was the result of in vitro fertilization with intracytoplasmic sperm injection. Left salpingo-oophorectomy and omental biopsy were done. A diagnosis of stage IIIC, poorly differentiated papillary serous adenocarcinoma of the ovary was made. She was given four cycles of cisplatinum and docetaxel followed by cesarean hysterectomy, right salpingo-oophorectomy, and cytoreductive surgery. The mother is well and has completed six cycle of chemotherapy. CONCLUSION: This is the first report on the use of docetaxel during pregnancy for ovarian cancer.