Factors affecting the accuracy of ultrasound fetal weight assessment among diabetic patients

Background: Antenatal ultrasound [US] Estimated Fetal Weight [EFW] is an important component of antenatal care

Objective: To evaluate the accuracy and consequences of US EFW within one-week interval prior to delivery in diabetic Bahraini population

Design: A Retrospective Cohort Study. Setting: Bahrain Defence Force Hospital, Bahrain

Method: Two hundred eighty-four diabetic women deliveries were reviewed. EFW, actual birth weight, gestational diabetes and mode of delivery were documented and analyzed via stats Direct. P-value of less than 0.05 was considered significant

Result: The study population was divided into two groups. Twenty-eight [10%] yield an accurate EFW. Accurate fetal weight estimation was affected by GA, EFW and actual birth weight. Fetal gender, parity, diabetic status, maternal BMI, maternal age, mode of delivery and induction of labor was not altered by the inaccurate estimation

Conclusion: Ultrasound EFW in diabetic patient is more accurate at early gestation and for smaller fetuses

Thrombocytopenia among Pregnant Women

Background: Pregnant women with thrombocytopenia have a higher risk of bleeding during or after childbirth; the severity of thrombocytopenia can affect the obstetric outcome

Objective: To evaluate the prevalence of thrombocytopenia among pregnant women and to evaluate the obstetric outcome

Setting: Bahrain Defence Force Hospital, Bahrain. Design: A Retrospective Study

Method: Platelet count was analyzed in 4233 pregnant women who gave birth from 1 January 2016 to 31 December 2016. Two hundred eighty-seven pregnant women with thrombocytopenia were reviewed. Platelet level, maternal age, gestational age, parity, BMI, mode of delivery, pre-delivery coagulation profile, hemoglobin level, blood transfusion, postpartum hemorrhage [PPH] or preeclampsia were documented

Result: Two hundred eighty-seven pregnant women with low platelet levels were included in the study. A positive relation between low platelet levels and gestational age and previous deliveries was found. A negative relation between low platelet and previous deliveries was found. No relation was found between platelet levels, Hb levels and coagulation profile. No difference was found in the mode of delivery or preeclampsia between the study groups

PPH needing blood transfusion was found in women with platelet counts above 100xl09/L; however, it did not reach statistical significance

Conclusion: A low platelet rate in our population was found in 287 [6.8%] women. The majority of the women had platelet count above 100*109/L, 251 [87.45%] and gestational thrombocytopenia was the most common cause of thrombocytopenia, 275 [95.8%]. Our study revealed lower gestational age and higher parity as risk factors for severe thrombocytopenia and the majority of the cases had good outcome

TESA/ICSI outcome among obstructive and non-obstructive azoospermia

Objective: To evaluate the Intracytoplasmic Sperm Injection [ICSI] cycle outcome for azoospermic in non-obstructive azoospermia [NOA] compared to obstructive azoospermia [OA] patients undergoing TESA procedures

Setting: IVF Unit, Prince Sultan Military Medical City, Riyadh, KSA

Design: A retrospective study

Method: The data of couples that underwent ICSI with fresh sperm retrieval using TESA and reached the stage of embryo transfer were documented from November 2012 to March 2015. A total of 85 patients were included in this study, Personal characteristics, laboratory data, TESA data, stimulation parameter and pregnancy outcome were documented

Result: Fifty-six males had OA and 29 had NOA. Female characteristics including age, FSH, BMI and the parity were similar. Male characteristics including age, smoking, and TESA motility and count were similar. Cycle characteristics including cycle number, protocol type, stimulation drug and duration, and estradiol and progesterone on the day of human chorionic gonadotropin [hCG] trigger were similar. Stimulation outcome including the number of collected, mature, and fertilized oocytes, embryo transferred, the day of embryo transfer and number of grade 1 embryo were similar. There was significantly better quality oocytes and higher number of frozen embryos in NOA group, P-value=0.03 and 0.04, respectively. Pregnancy, implantation, and miscarriage rate were also similar with no significant difference between both groups

Conclusion: ICSI cycle outcome for azoospermic patients in NOA compared to OA undergoing TESA procedure was similar in both groups and no factors were affected the final cycle outcome

Tubo-Ovarian abscess in a female virgin with partially imperforated hymen

A tubo-ovarian abscess is a serious complication of pelvic inflammatory disease; it is very rare among sexually inactive females. We report a case of tubo-ovarian abscess in a twelve-year-old sexually inactive female. The first menarche was two months prior to her presentation with acute abdominal pain and fever and no evidence of acute appendicitis. The patient had a partially imperforated hymen. Laparoscopy revealed large bilateral tubo-ovarian abscess. Unilateral salpingo-oophorectomy and appendectomy were performed. Postoperatively the patient received an antibiotic course. Early diagnosis and intervention are essential to prevent further complications, such as infertility and ectopic pregnancy

Primary postpartum hemorrhage and maternal outcome

Background: Primary postpartum hemorrhage [PPH] is a significant cause of maternal morbidity and mortality. The value of reviewing the care of women with severe PPH is to improve the obstetric practice

Objective: To evaluate maternal outcome after postpartum hemorrhage

Design: A Retrospective Data Analysis

Setting: Bahrain Defence Force Hospital, Bahrain

Method: Data analysis of PPH from 1 January 2015 to 31 December 2016 was performed. Data were obtained from all patients who delivered during this period including born before arrival [BBA], home deliveries and stillborns. All relevant maternal complications, including postpartum events, morbidities correlation of maternal outcomes with Hb drop, blood transfusion, length of hospital stay, ICU admission, coagulopathy, organ failure, hysterectomy and management were recorded. The data were analyzed using StatDirect. A P-value of less than 0.05 was considered statistically significant

Result: During the study period, 8,449 women had given birth. Seventy-two [0.85%] cases of PPH were identified. A significant correlation between estimated blood loss [EBL] and the need for blood transfusion and length of hospital stay was discovered, P-value<0.0001 and P-value<0.0001, respectively. However, no correlation was discovered between EBL and hemoglobin drop, P-value= 0.12. Receiver Operating Characteristic [ROC] curve analysis of morbidities associated with PPH pointed to the bleeding cutoff point of 2L for morbidity to occur

Conclusion: PPH is significantly related to maternal need for transfusion and hospital stay. Morbidity occurs once EBL reach 2000 ml

Cervical ectopic pregnancy managed with methotrexate

Cervical pregnancy is a rare, life-threatening form of ectopic pregnancy. We report a case of cervical pregnancy successfully managed with a single dose of systemic Methotrexate, 50 mg/m[2], intramuscularly. A repeat BHCG revealed a reduced level to 259 mlu/ ml. The patient started to have intermittent painless vaginal bleeding. The patient had 2 units of RBCS and passed the products of conception spontaneously. The patient was discharged with an HB of 11 gm/dl. Two weeks later, BHCG was 0.5 and transvaginal scan revealed an empty uterus with thin endometrium

Factors influencing the need for evacuation of retained products of conception in missed miscarriage

Background: Surgical evacuation of the uterus is one of the treatment options for a missed miscarriage. Usually, the decision to perform surgery is mostly based on clinical grounds

Objective: To evaluate the patient's clinical presentation on Evacuation of Retained Products of Conception [ERPC]. Design: A Retrospective Study. Setting: Gynecology and Obstetrics Department, Bahrain Defense Force Hospital, Bahrain

Method: All missed miscarriage cases from 1 December 2013 to 21 December 2014 were included in the study. The management of missed miscarriage was divided into group A and group B, based on the need for ERPC. Factors such as history of previous miscarriage ERPC, pain/bleeding, and cervical opening were evaluated. Data were analyzed using Stats Direct. P-value of < 0.05 was considered statistically significant

Result: One thousand five hundred patients with confirmed miscarriage were included in the study; 91 [6%] were missed miscarriage and 49 [54%] of those required ERPC. The study groups had similar personal characteristics. Patients who had a previous history of miscarriage were less likely to have ERPC. Having a history of ERPC did not increase the risk of repeat procedure. Patients who presented with abdominal pain and bleeding were significantly more likely to have ERPC. Cervical assessment on admission had no role in the decision to perform surgery

Conclusion: ERPC accounted for more than 50% of our management of missed miscarriages. We found a higher rate of surgical management in patients who presented with pain and bleeding

Factors influencing successful vaginal birth after cesarean delivery

Background: Cesarean delivery is one of the most common procedures performed worldwide; women giving birth by cesarean delivery are increasing over the past several decades. The demand to decrease the rate of repeat cesarean is an international drive. This goal needs to be achieved through safe approach

Objective: To evaluate the factors of successful Vaginal Birth after Cesarean [VBAC] Delivery

Setting: Bahrain Defence Force Hospital, Bahrain

Design: A Retrospective Study

Method: Cesarean section patients who had an attempt at vaginal delivery between 1 January 2014 and 31 January 2015 were reviewed. Maternal age, gestation age, maternal weight, birth weight, fetus sex, pervious vaginal delivery, previous VBAC, cervical dilation and other patient's characteristics were documented. Data was analyzed using StatsDirect software and P-value of less than 0.05 was considered statistically significant

Result: Five hundred sixty-eight patients with history of one previous cesarean delivery attempted VBAC. Successful VBAC was documented in 236 [41.5%]. We found significant successful VBAC in patients with previous vaginal birth, high parity, presented with cervical dilatation more than or equal to 4 cm, male fetus and patients with induced labor [P<0.0001]. Other factors negatively affected the success rate, such as recurrent cause for previous cesarean [P<0.0001], short interval [P<0.0001], ethnic background [P=0.0006], and IVF pregnancies [P=0.0106]. Patient and fetus weights did not affect VBAC outcome

Conclusion: Previous vaginal birth, advance cervical dilatation, induction of labor and proper interval after Cesarean increase the success rate of VBAC. Factors which negatively affect the vaginal birth after Cesarean are the history of recurrent indication and maternal diabetes

Intra and postoperative morbidity associated with myomectomy

Background: Abdominal myomectomy is a known treatment modality for uterine fibroid in women who wish to retain their fertility. The procedure is associated with bleeding and eventual hysterectomy

Objective: To evaluate the intraoperative morbidity and postoperative complications of abdominal myomectomy. Design: A Retrospective Data Analysis. Setting: University of Dammam Teaching Hospital, Saudi Arabia

Method: Myomectomy patients between 1 December 2007 to 30 November 2012 were reviewed. The relation of weight and size of myoma to complications, anesthesia type, duration of operating time and estimated blood loss [EBL], Hb drop, blood transfusion, duration of hospital stay and postoperative complications were documented

Results: One hundred thirty-seven procedures were reviewed. The median operating time was 1 hour and 40 minutes. The size of fibroid had a significant effect on the type of abdominal incision. Median estimated blood loss during the procedure was 500 ml with 23% of patients losing >/= 1 liter. There was a significant positive relation between the size of fibroid and estimated blood loss, but this did not affect the Hb drop postoperatively nor blood transfusion rate. The median length of hospital stay was five days. Three cases were converted to hysterectomy. Postoperative complications were seen in 15 [11%] patients, which include hemorrhage, febrile morbidity and paralytic ileus. The weight of the myoma had no relationship to postoperative complications. Midline vertical incision was associated with higher postoperative complications

Conclusion: The larger the fibroid, the more likely the abdominal incision would be midline and more blood loss. Regional anesthesia significantly reduces operating time. Midline incision led to higher postoperative morbidity

effect of uterine leiomyomas size on presenting symptoms and accurate sonography assessment

Uterine leiomyomas are the most common uterine neoplasm; their symptoms could be related to the size and position. They could affect patients' capability to conceive and/or to continue the pregnancy. Ultrasound is the main diagnostic tool. However, accurate assessment might be affected by fibroid characteristics. To evaluate the relationship between fibroid size, presenting symptoms, previous obstetric history and accurate ultrasound fibroid assessment preoperatively in patients who had abdominal myomectomy. A retrospective data analysis. University of Dammam Teaching Hospital. All patients who had abdominal myomectomy between 1 December 2007 and 30 November 2012 were reviewed. Personal characteristics, obstetric history, indication for the myomectomy and myoma preoperative and intraoperative features were reviewed. One hundred thirty-seven procedures were performed during the study period. The mean age of the patients was 36 years, 81 [59.1%] were married and 112 [82%] were Saudi nationals. Menorrhagia was the leading presentation in 66 [48.2%] patients, followed by pain in 26 [19%], mass in 16 [12%], sub-fertility in 14 [10.2%] and pressure symptoms in 9 [7%] patients. However, 6 [4.4%] had combined presentations. The median of the two largest diameter myoma was 7 cm and the weight was 320 gm. However, fibroid size had a significant effect on the presenting symptoms. Previous parity was not affected by the size of the fibroid. The size of the fibroid on ultrasound had no effect on the accuracy of the assessment. There was no relationship between patient's age and presenting symptoms, but fibroid size had a significant effect on presenting complaints. Childlessness with increased fibroid size was noted. However, the size of the fibroid had no effect on previous miscarriage history. Accurate assessment of the fibroid by sonography was not affected by its size