Retrospective analysis of torsion in adolescence, a university hospital experience

Objective: to highlight and suggest a strategy in the management of adnexal torsion in pre- and post- menarcheal adolescent girls

Material and Methods: a retrospective 1 O year chart review was carried out between the period January 2002 and December 2011 at King Khal id University Teaching Hospital [KKUH], Riyadh, a tertiary care center

Results: a total of 71 girls were admitted with post-operative diagnosis of ovarian cyst. Of them, 10 girls had adnexal torsion and underwent oophorectomy; the mean age of the 10 girls was 14.1 [range 8-19] years. The commonest clinical symptom was lower abdominal pain in 9 out of 10 girls. Only 7 out of 10 patients had adnexal tor ion. Other 3 had suspected acute appendicitis. The clinical presentation in general was not specific. The mean time lags between the onset of symptoms and diagnosis was 2.6 +/- 1.3 days [range 1-5 days]. The mean time from diagnosis to surgery was 22.9 +/- 13.6 hours [range 6 -48 hours]. Two girls had normal appearing adnexa while two had benign neoplasm

Conclusion: the evidence from the literature supports conservative laparoscopic management of adnexal torsion with a view of conserving the ovary. Unfortunately, all cases in our study were managed with removal of the adnexa and more than half via laparotomy

Caesarean section on demand? should we do it?

This article gives food for thought regarding the implications of the rising rate of caesarean section on demand. The obstetricians concerned should curtail the rising trend. Of this practice by a balanced decision making, keeping the women informed of all the implications instead of giving in to the demands of the patient

Women with breech presentation in previous cesarean section the controversy continues

Objective: The study was undertaken to evaluate the outcome of offering a trial of vaginal delivery to women with breech presentation in women with a previous cesarean section [CS]

Material and Methods: All women who attended the obstetric unit at the King Khalid University Hospital [KKUH] Riyadh, with a history of one CS and breech presentation in the current pregnancy were enrolled in this prospective study. Trial of vaginal delivery was allowed as per the selection protocol including mother's request. Outcome of pregnancies were compared among those who ended in vaginal delivery and emergency CS or elective CS

Results: Of the 172 women with a history of one previous CS and a breech presentation in the current pregnancy, 115 [66.9%] were allowed a trail of vaginal delivery and the remaining 57[33.1%] underwent elective repeat CS. In the trial group, vaginal delivery was achieved in 44 [25.6 %] and 71 [41.3%] ended in emergency CS. The success rate for vaginal delivery was 25.6%. Maternal morbidity was significantly higher in elective CS group [77.2%] compared with vaginal delivery [2.3 %] and emergency CS groups [56.3 %]. The Apgar score of < 7 at 1 and 5 minutes respectively did not differ significantly between the babies born by vaginal route and those born by CS. Corrected neonatal morbidity also did not differ significantly among the three groups. There was no maternal or neonatal mortality

Conclusion: The favorable outcome of vaginal delivery in women with a previous CS and a current breech in this study suggests that a trial of vaginal delivery can be safely offered to women who meet the protocol criteria. However, the sample size will have to be expanded in future studies for firm conclusion to be drawn

"Serotyping and antibiotic susceptibility of Group B streptococcal isolates from obstetric patients"

A total of 156 recent distinct isolates of Group B streptococcus [GBS] were recovered from clinical specimens of female patients at Madinah Maternity and Children Hospital and King Khalid University Hospital, Saudi Arabia. Serotyping results revealed that 96 percent of the strains were serotypable and the most frequent serotypes were III, II, and Ia which accounted for 35.26, and 15 percent strains respectively. Whereas serotypes Ib, IV, and V constituted 9, 7, and 4 percent respectively. The minimum inhibitory concentrations [MIC] of antibiotics against GBS isolates were determined by an agar dilution method. All GBS strains were susceptible to 0.125 mg/L of either penicillin, ampicillin, erythromycin, or clindamycin. Whereas at 0.06 mg/L the inhibitory effect of these antibiotics were 80, 69, 45, and 86 percent respectively. Cefoxtin, gentamicin, and tetracycline, however, showed remarkable variation in their activities. The majority of GBS strains showed intermediate susceptibility towards cefoxitin, whereas 35 and 77 percent of the isolates were resistant to gentamicin [GM] and tetracycline [Tc] respectively. The genetic basis of Tc-resistance was investigated was investigated. No plasmids were detected among the randomly selected different GBS sterotypes resistant to Tc. However, in all cases EcoRI- digested chromosomal DNA from resistant strains hybridized with the used tet-gene probe [ATCC 37234] of Kpnl/Hpal 0.39 [Kb] fragment. No differences were detected between GBS strains of various origin. No resistance to penicillin or ampicillin was found, nor was penicillinase production demonstrated. Yet tolerace to penicillin was found among GBS strains as tested by penicillinase-disk diffusion, penicillin-gradient replica plating and quantitative killing curves methods. Data of the latter method showed that 21 strains [14 percent] were tolerant to penicillin. Results suggest that penicillin tolerance is not rare among strains of GBS isolated in our hospitals and its routine testing may be warranted

Out come in elective and emergency cesarean sections: a comparative study

To study the obstetric outcome of cesarean sections [CS] in relation to the elective or emergency nature of this procedure, a comparative study was conducted on 1426 females whose deliveries were by CS in King Khalid University Hospital [KKUH]. Of the various factors analyzed in relation to the two types of CS, statistically significant associations were found between emergency CS and younger patients, low parity, irregular attendance at antenatal clinics, complications in labor, postoperative morbidity and low Apgar score [<6]. It was concluded that every effort should be directed to effect-planned CS, as determined during the antenatal period, if possible, so as to reduce the various problems associated with emergency CS. The chances are that this approach is unlikely to influence the overall CS rate in either way

Subchorionic hematoma in threatend abortion: sonographic evaluation and significance

In a study of 92 women with subchorionic hematoma evaluated with sonographic scan in King Khalid University Hospital, it was found that the mean ages and live births of patients who carried their pregnancies to viability -were higher when compared with the patients who aborted. There was a statistically significant association between the gestational age at diagnosis of subchorionic hematoma and the size of the hematoma. There was, however, no statistically significant association found between the gestational age at diagnosis, size and site of the hematoma and the outcome of pregnancy. It was concluded that subchorionic hematoma which appear either in the second trimester, or are larger, or located in the lower uterine segment, may be associated with higher rates of abortion or preterm deliveries. Nevertheless, there is no statistically significant impact of these on the outcome of pregnancy