Effect of parity on bone mineral density among postmenopausal Saudi Arabian women

Osteoporosis and osteopenia among postmenopausal Saudi Arabian women are common to the extent of over 60%. Pregnancy, multiparity and prolonged lactation are suggested as factors modifying negatively in the development of osteoporosis. Earlier reports from the institution indicated a beneficial role of multiparity in postmenopausal osteoporosis [PMO]. We conducted this study to measure the effect of parity on bone mineral density [BMD] measurement of lumbar spine and the upper femur. We conducted this prospective study at King Fahd Hospital of the University, College of Medicine, King Faisal University, Dammam, Saudi Arabia, between January 2002 and June 2003. This study analyzed 256 patients who attended orthopedic clinics. The data gathered was age, duration of menopause, number of children borne, height and weight for body mass index [BMI] calculation. We excluded women with secondary osteoporosis from the study. We entered the patients orthopedic complaints in the database. We carried out the BMD measurements using Hologic total body DEXA machine. We analyzed the data using SPSS package with significance at p<0.05 and confidence interval of 95%. For final analysis, we took into consideration an average of results of the lumbar spine and hip region. We analyzed the available data of 256 patients. We divided the patients into 2 groups; group A with >6 children and group B with women of <5 children. In group A, there were 116 women and 140 in group B. The mean age of patients in group A was 56.81 [50-65] years SD +/- 5.19 and in group B the mean age was 58.86 years [48-76] SD +/- 7.68. The average BMI in group A was 31.95 kg/m2 and in group B it was 29.14 kg/m2. The BMD of the lumbar spine of group A was 0.850g/cm2 [SD +/- 0.112] compared to group B of 0.699g/cm2 [SD +/- 0.141], p<0.005. The BMD of the hip region of group A was 0.836g/cm2 and that of group B patients was 0.716g/cm2 [p<0.01]. In women with <5 children, 25.5 had normal BMD as compared to 47 in women with >6 children, 25.4% were osteoporotic in group A and in group B 48%. As per the World Health Organization classification 56% in group A had an increased risk of fracture as compared to 77.5% in group B women. Our results indicate that women who had borne >6 children were less osteoporotic and of low fracture risk as compared to those women who had <5 children. The BMD of the women with >6 children was statistically higher than their counterparts, and they sustain this after prolonged lactation. We believe that increased parity protects women from osteoporosis and the severity of the disease, and it is our suggestion that women with <5 children and those nulliparous, who are at increased risk of developing osteoporosis should be investigated and treated accordingly

Birth associated trauma

To assess the incidence of birth-injuries seen at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia [KSA]. A retrospective analysis was carried out in 31028 consecutive deliveries between January 1986 and December 1996 at the King Fahd Hospital of the University, Al-Khobar, KSA. The study group was compared with a matched control group. There were 203 newborns with 208 injuries with an incidence of 6.70 per 1000 live births. The majority [55%] of the injuries was sustained during normal vaginal deliveries and the least were during cesarean section [5.2%]. The average gestational age was 39 weeks [25-44 weeks] in the study group and in the control group was 38.84 [21-44 weeks]. The birth weight in the study group was 3323 gms [780-6190] and the control group was 3015 gms [790-6015] p<0.01. The Apgar score in the study group was 7 and 9 at one and 5 minutes and in the control group was 8 and 9. There were 104 scalp injuries, 50 nerve injuries, 20 fractures [11 clavicle and 9 long bones] and 21 newborns had intracranial hemorrhage. This study demonstrates a variety of birth related trauma at the teaching institution with a lower overall incidence as compared to reports from the literature. The only significant factor was that birth weight was higher in the study group as compared to the control group [p <0.01]. It is recommended that every effort be required to further decrease the incidence of birth injuries

Epidemiology and antenatal complicaitons of twin gestation: an 8-year review

To determine the incidence, epidemiology and antenatal complications of twin gestation. Setting: Department of Obstetrics and Gynecology, King Fahad University hospital, Al- Khobar, Saudi Arabia. Subject and Design: Two-hundred and twenty-seven [227] patients with twin gestation that delivered over an 8 year period were studied. The control group comprised of two singleton deliveries that followed immediately after the twins. Patients were divided into three groups according to gestational age of the first, prenatal care and the total number of antenatal visits to the hospital. Main outcome and result: The incidence of twin deliveries after 24 weeks gestation was ten per thousand. The majority of cases occurred in patients aged 20-30 years of parity 4 and above. There was a higher incidence of iron deficiency, anemia, pre-term labor, intrauterine growth retardation, pregnancy induced hypertension and intrauterine fetal death in the study group compared to the control. Frequent prenatal visits, earlier diagnosis and management of several maternal complications would lower the incidence of perinatal morbidity and mortality. Early determination of zygosity is useful in establishing the prognostic categories of twin gestation. Further studies are needed to address the specific aspect of twin gestation in order to outline those areas for improvement of care in this challenging area of obstetrics