correlation between anthropometric measurements, insulin and reproductive hormones in Saudi females with and without polycystic ovary syndrome

The recent theories of the pathogenesis of polycystic ovary syndrome [PCOS] have focused on the role of insulin resistance and hyperinsulinemia. The insights into the role of hyperinsulinemia in the development of PCOS brought into focus the role of obesity, which magnifies hyperinsulinemia observed in PCOS patients. [1] To study the variations in the levels of insulin and reproductive hormones in lean, overweight, and obese females with and without PCOS. [2] To evaluate the relationship between anthropometric measurements, insulin, and reproductive hormones. A comparative cross-sectional study at King Faisal Specialist Hospital and Research Center [KFSH and RC], and the Department of Obstetrics and Gynecology, Umm Al-Qura University. 212 Saudi female volunteers aged 19-36 years. Cases were 90 women with PCOS. Controls were 122 volunteers representing cross section of Saudi society. The cases and controls were subdivided into six groups according to their body mass index [BMI]; lean [BMI 18.5-24], overweight [BMI 25-29], and obese [BMI >30]. Anthropometric measurements included body weight, height, BMI, and waist: Hip ratio. Hormone and metabolic assessment was made for fasting insulin, glucose, FSH, LH, oestradiol, progesterone, testosterone, androstendione, and SHBG. Main Outcome Measures: The correlation between anthropometric measurements, insulin, and reproductive hormones in females with and without PCOS. Significant positive correlation between BMI and insulin was seen in overweight and obese control women. Fasting insulin levels were significantly higher among obese control women and PCOS patients. The presence of PCOS was not associated with any differences in FSH levels, but LH levels were increased significantly. Progesterone levels were significantly lower and E[2] levels were significantly higher among the PCOS patients than their control females. Testosterone and androstenedione levels were significantly higher and SHBG significantly lower in both obese control and PCOS patients. The main finding was a significant positive correlation between BMI and insulin in overweight and obese control women. In addition, insulin levels were significantly high in obese group, which confirmed that obesity in Saudi women is associated with hyperinsulinaemia and insulin resistance. Longitudinal follow-up studies of these women are, therefore, recommended to evaluate the effects on future fertility and reproductive health

randomized double-blind trial comparing vaginal misoprostol versus prostaglandin E2 for labour induction at term

To determine the efficacy and safety of vaginal misoprostol [50mcg] compared to vaginal prostaglandin E2 [PGE2] for induction of labour. A randomized double-blind clinical trial. Obstetric Unit, King Faisal Armed Forces Hospital, Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia. Two hundred and twenty pregnant women at term requiring induction. The women were randomized to receive vaginal misoprostol 50mcg or Prostaglandin E2 3mg. The dose was repeated 6, 24 and 30 hours after the first dose if an adequate uterine response was not achieved. The primary outcome was vaginal delivery within 24 hours. Secondary outcomes were the time from induction to delivery, the need for oxytocin augmentation, the mode of delivery, the frequency of side effects, and the maternal and neonatal outcomes. There were no significant differences in maternal characteristics or indications for induction. The percentage of women who achieved vaginal delivery within 24 hours was higher in the misoprostol group compared with the PGE2 group [67% Vs. 53%, p<0.05] and fewer patients in this group needed more than 2 doses [11% Vs. 28%, p<0.05]. The time to vaginal delivery was shorter in the misoprostol group when compared with the PGE2 group [15.2 hours Vs. 20.2 hours, p<0.05]. Fewer patients in the misoprostol group required oxytocin augmentation [24% Vs. 50%, p<0.0001]. There were no significant differences between the two groups with respect to rates of caesarean section, fetal heart rate anomalies, lachysystole, hyperstimulation, meconium passage and neonatal outcome. Induction of labour with vaginal misoprostol is more effective than vaginal PGE2 with no apparent adverse effect on the mother or the fetus

Influence of parity and operative vaginal delivery on the prevalence of stress, urge and mixed urinary incontinence, and overactive bladder in Saudi Arabia

To evaluate the contribution of number and mode of vaginal deliveries to the occurrence of stress, urge and mixed urinary incontinence and overactive bladder. A prospective observational case-control study. Outpatient gynecology clinics of Umm Al-Qura University associated hospitals. The study involved 600 women satisfying the selection criteria seen for counseling and/or treatment of urinary incontinence or overactive bladder, or observed for routine gynecological examination or minor gynecological complaints without any symptoms related to these disorders. Cases were 450 women classified into 3 groups; Group I [one or two vaginal deliveries], Group II [three or more vaginal deliveries] and Group III [one or more instrumental vaginal deliveries]. Controls were 150 nulliparous women observed during the study period in the same gynecology clinic. Urogenital symptoms were measured using a questionnaire with questions from the Urogenital Distress Inventory. Parity and operative vaginal delivery as obstetric determinants of stress, urge, and mixed urinary incontinence and overactive bladder. In comparison with nulliparae [Controls], a history of one or two vaginal deliveries [Group I] was associated with the risk of stress, mixed and overall urinary incontinence [0.7 vs. 6.7, 1.3 vs. 9.3 and 5.3 vs. 23.3 respectively; P < 0.05]. Likewise, in comparison with nulliparae [Controls], a history of three or more vaginal deliveries [Group II] was associated with the risk of stress, mixed and overall urinary incontinence and overactive bladder [0.7 vs. 14.7, 1.3 vs. 12.0, 5.3 vs. 38.0 and 2.7 vs. 11.3 respectively; P < 0.05]. However, in comparison with women with one or two vaginal deliveries [Group I], a history of three or more vaginal deliveries [Group II] was associated with the risk of overactive bladder [3.3 vs. 11.3; P < 0.05]. When compared with nulliparae [Controls], a history of one or more operative vaginal deliveries [Group III] was associated with the risk of stress, mixed and overall urinary incontinence [0.7 vs. 6.7, 1.3 vs. 6.0 and 5.3 vs. 18.0 respectively; P < 0.05]. The number of vaginal births was associated with the risk of stress and mixed urinary incontinence and overactive bladde. A history operative vaginal delivery was directly associated with the risk of stress and mixed urinary incontinence. Further studies are recommended to investigate other factors in obstetric practice related to the risk of urinary incontinence

Progress of active phase of labor for multiparous Saudi Women: an observational study

To demonstrate the presence or the absence of similarity between the normograme for normal Saudi women in labor and the standard stencil normograme and to define the characteristics of active phase of labor in different multigravidal groups. Observational Study. Maternity Unit at Al-Noor Hospital, in Makkah 318 women who had uncomplicated pregnancy at term in active phase of spontaneous labor. Women in the study were included into one of 4 groups according to gravidity, have their cervical dilatation recorded every two hours during the active phase of labor from 4 to10 cm and compeared to a normograme curve drawn from the labor stencil [Studd and Duignan. The main outcome was the rate of cervical dilatation and the type of cervimetric pattern during the active phase of labor in normal Saudi at different group under the study. The aberrant cervicometric patterns for Saudi primiparous labor were similar to the monogram of the labor stencil from 4 cm to full dilatation. The progress of labor in multipara and grandmultipara from 4 to 8 cm was not significantly faster than in corresponding primipara. The grandgrandmultipara with 8 or more deliveries exhibited a non-linear trends with a periods of non progress during dilatation from 7 to 8cm for two hour followed by normal linear trends corresponding to primipara until full cervical dilatation. The cervical normogram of expected labor progress using labor stencil from 4 cm to fall dilatation can be applied for Saudi primipara and multipara until eight delivery. That will suggested the useful of using graphic analysis and labor stencil to identifying women at risk in Saudi population