Pregnancy outcomes after laparoscopic ovarian drilling in women with polycystic ovarian syndrome

To study whether there is an increased risk of glucose intolerance and hypertensive complications during pregnancy in women with polycystic ovarian syndrome [PCOS] who conceived after laparoscopic ovarian drilling and to investigate if there is an adverse pregnancy outcome. This prospective study took place at Salmaniya Medical Complex in Bahrain, between June 1996 and June 2003. We compared the pregnancy and neonatal outcomes of 134 patients with PCOS who were treated with laparoscopic ovarian drilling with 479 pregnant women without PCOS [controls]. We used the multiple logistic regression analysis to assess the risk of PCOS on impaired glucose tolerance [IGT], gestational diabetes mellitus [GDM], hypertensive disorders in pregnancy [HDP] and premature delivery. Subjects with PCOS had a significantly greater prepregnancy body mass index, prevalence of obesity and nulliparity as compared with controls. The incidence of IGT [p=0.007], GDM [p=0.01] and HDP [p=0.001] were significantly higher in pregnant PCOS compared with the control group. There were no significant differences in the neonatal outcomes and prevalence of premature delivery between the 2 study groups. When non-obese PCOS patients were compared with non-obese controls, the incidence of GDM [p=0.04] and HDP [p=0.004] were still significantly higher in the former. The prevalence of pregnancy complications were not significantly different when obese PCOS were compared with obese control patients. The PCOS was demonstrated as a risk factor for IGT [p=0.05], GDM [p=0.03] and HDP [p=0.03], but not for premature delivery. Women with PCOS who conceived after the drilling were at higher risk of IGT, GDM and HDP, and this risk seemed to be independent of maternal obesity

Successful Intrauterine aspiration of a large Fetal ovarian cyst

A 32-year-old Bahraini lady with a large fetal intra-abdominal cyst detected antenatally on ultrasound examination at 16 weeks of gestation. The cyst was simple anechoic, increasing in size and causing progressive displacement of the fetal thoracic organs. A successful intrauterine needle aspiration was carried out under ultrasound guidance at 30 weeks gestation without maternal or fetal morbidity. Cytology of the cyst fluid showed luteinized granulosa cells and biochemistry demonstrated high concentrations of estradiol, progesterone, and testosterone that confirmed the etiology of the cyst as ovarian. There was no evidence of recurrence following aspiration and no further need for postnatal surgery

Placenta percreta with urinary bladder involvement

A 37-year-old Pakistani lady, who had previously undergone one cesarean delivery and one uterine curettage, was admitted to the labor ward at 29 weeks of gestation with history of a sudden severe painless vaginal bleeding from a sonographically diagnosed placenta previa. An immediate cesarean section was performed and a live male infant was delivered. The placenta was morbidly adherent to the lower uterine segment and attempts at removal caused torrential bleeding, necessitating cesarean hysterectomy. In addition, attempts to dissect the bladder from the lower uterine segment were unsuccessful and, hence, the diagnosis of placenta percreta with involvement of the urinary bladder was made. A modified posterior approach to the hysterectomy was carried out, with subsequent good recovery

Endocrine changes after laparoscopic ovarian drilling in clomiphene citrate - resistant women with polycystic ovarian syndrome

To study the effects of laparoscopic ovarian drilling on the serum hormone levels in clomiphene citrate resistant women with polycystic ovarian syndrome [PCOS] and to determine the criteria which influenced their clinical response. A prospective study that was carried out at Salmaniya Medical Complex in Bahrain. One hundred and eighty-one women with clomiphene citrate-resistant PCOS were treated with laparoscopic ovarian drilling, all procedures were performed over a 4-year period between June 1996 and June 2000. Fasting blood samples for determination of the serum levels of luteinizing hormone [LH], follicle stimulating hormone [FSH], LH-FSH ratio, testosterone and prolactin were taken during the follicular phase before and one month after laparoscopic ovarian drilling. Responders who ovulated spontaneously after the drilling were obese and had higher preoperative LH levels and the LH-FSH ratio. Both responders and non-responders showed a significant decline in LH, LH-FSH ratio and testosterone with a significant increase in FSH but no significant change in prolactin mean values compared with pretreatment levels. The magnitude of change was significantly higher for LH and the LH-FSH ratio [p<0.05] in responders, while there were no significant differences in the corresponding values of the other hormones between the 2 groups. Moreover, the decrease in LH [p<0.01] and the LH-FSH ratio [p<0.05] was significantly greater in obese than non-obese women and this was only observed in the responders group. Laparoscopic ovarian drilling is an effective procedure in women with clomiphene citrate resistant PCOS. It produces significant endocrine changes with better results in obese patients with higher preoperative LH values and LH-FSH ratio. The magnitude of these changes was the highest in obese responders