Red cell alloimmunization to rhesus antigen among pregnant women attending a tertiary care hospital in Oman

Objectives: The detection of maternal alloimmunization against red cell antigens is vital in the management of hemolytic disease of the fetus and newborn. We sought to measure the presence of allosensitization to Rhesus D [RhD] antibodies in antenatal women attending a tertiary care hospital and assess the fetal outcome in sensitized women

Methods: We conducted a retrospective review of pregnant Omani women who registered at the Sultan Qaboos University Hospital between June 2011 and June 2013. Pregnant women were tested for ABO blood type and were screened for RhD antigen and antibodies at their first antenatal clinic visit. In women who tested positive for the RhD antibodies, an antibody titer was performed to evaluate the severity of their case

Results: Data was available on 1,251 pregnant women who were managed and delivered at Sultan Qaboos University Hospital. The prevalence of RhD negative pregnant women was 7.3%. Blood group O was the most common followed by A, B, and AB. The rate of RhD negative alloimmunization was 10%, and anti-D was the most common antibody detected. There were no stillbirths or neonatal deaths. Postnatal transfusion was necessary for only one baby

Conclusions: The prevalence of RhD negativity was comparable to other Asian countries. Previous RhD alloimmunization and history of miscarriages were the most common maternal medical history

Use of intracervical foley catheter for induction of labour in cases of previous caesarean section experience of a single tertiary centre in Oman

Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman

Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records

Results: Most women were 25-35 years old [76.5%] and 20 women had had one previous vaginal delivery [29.4%]. The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios [27.9%]. Most women delivered after 40 gestational weeks [48.5%] and there were no neonatal admissions or complications. The majority experienced no complications during the induction period [85.3%], although a few had vaginal bleeding [5.9%], intrapartum fever [4.4%], rupture of the membranes [2.9%] and cord prolapse shortly after insertion of the Foley catheter [1.5%]. However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section [30.9%]

Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications

Pregnancy outcomes in women with homozygous beta thalassaemia: a single-centre experience from Oman

Pregnancy in women with homozygous beta thalassaemia [HBT] carries a high risk to both the mother and fetus. The aim of this study was to investigate pregnancy outcomes among this group at a single tertiary centre. This retrospective descriptive study was conducted between January 2006 and December 2012 on all women with HBT who received prenatal care and subsequently delivered at Sultan Qaboos University Hospital, Muscat, Oman. Women who delivered elsewhere and women with the beta thalassaemia trait were excluded. Ten women with HBT were studied with a total of 15 pregnancies and 14 live births. The mean maternal age +/- standard deviation [SD] was 27.9 +/- 3.7 years, with a range of 24-35 years. There were 14 spontaneous pregnancies and one pregnancy following hormone treatment. Eight women had been on chelation therapy before pregnancy, one of whom needed chelation during late pregnancy. Of the pregnancies, 93% had a successful outcome with a mean +/- SD gestational age at delivery of 38.6 +/- 0.9 weeks, with a range of 37-40 weeks. Eight babies [57%] were delivered by Caesarean section. The mean +/- SD birth weight was 2.6 +/- 0.2 kg, with a range of 1.9-3.0 kg. Three babies [21%] were born with low birth weights. Pregnancy is safe and usually has a favourable outcome in patients with HBT, provided that a multidisciplinary team is available. This is the first study of Omani patients with HBT whose pregnancies have resulted in a successful outcome

Peer review and audit of morbidity after three or more caesarean sections

A retrospective cohort study was conducted of caesarean sections for women who had previously undergone two or more caesarean section performed by six obstetrician registrars in Sultan Qaboos University Hospital, a tertiary referral hospital in Oman. Retrospective data were collected from electronic health records of 120 Omani women between January 2010 and December 2011 [20 per registrar]. Haemorrhage of more than 1000 ml was recorded in 10% of patients, one patient was found to have a bladder injury intraoperatively, and postoperative wound infection occurred in 5% of patients. Difficulty in opening the abdomen was found in one patient, and one case of deep vein thrombosis occurred despite prophylactic heparinisation. One infant was preterm, and four had intrauterine growth restriction. Intraoperative complications, such as blood loss, visceral injury and long mean operating time and postoperative complications, such as deep vein thrombosis, wound infection and febrile morbidity, were comparable among the registrars. The standard of the registrars was comparable, and similar to international standards

Maternal and fetal outcomes of triplet gestation in a tertiary hospital in Oman

The aim of this study was to describe the fetal and maternal outcomes of triplet gestation and to report on the maternal characteristics of those pregnancies in a tertiary care centre in Oman. A retrospective study was undertaken of all triplet pregnancies delivered at Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2011. Over the three-year study period, there were 9,140 deliveries. Of these, there were 18 triplet pregnancies, giving a frequency of 0.2%. The mean gestational age at delivery was 31.0 +/- 3.0 weeks, and the mean birth weight was 1.594 +/- 460 g. The most common maternal complications were preterm labour in 13 pregnancies [72.2%], gestational diabetes in 7 [39%] and gestational hypertension in 5 [28%]. Of the total deliveries, there were 54 neonates. Neonatal complications among these included hyaline membrane disease in 25 neonates [46%], hyperbilirubinaemia in 24 [43%], sepsis in 18 [33%] and anaemia in 8 [15%]. The perinatal mortality rate was 55 per 1.000 births. The maternal and neonatal outcomes of triplet pregnancies were similar to those reported in other studies

Extreme preterm premature rupture of membranes: risk factors and feto maternal outcomes

Preterm premature rupture of membranes [PPROM] is defined as a rupture of the amniotic membranes occurring before 37 weeks of gestation and before the onset of labor. Extreme PPROM occurs prior to 26 weeks gestation and contributes to an increased risk of prematurity, leading to maternal and fetal complications. This study aims to estimate the risk factors associated with various maternal complications and to determine the worst outcomes in Omani females with extreme PPROM. A retrospective cohort study was conducted on 44 women with extreme PPROM, who delivered at Sultan Qaboos University Hospital [SQUH] from January 2006 to December 2011. Women with incomplete information, multiple gestations, or a preterm delivery resulting from medical intervention, as well as women who delivered elsewhere were excluded from the study. Forty-four women with extreme PPROM were included in our study. The results revealed the most important risk factor to be history of infection, which was noted in 24 study participants. The mean maternal age was 30 years. The mean gestational age at PPROM and at delivery were 20.7 +/- 3.2 [range: 16-26 weeks] and 29.7 +/- 7.6 weeks [range: 17-40 weeks], respectively. The maternal complications observed in this study included; infection which was seen in 20 [45%] patients, antepartum hemorrhage in 11 [25%] patients, and cesarean section which was required in 12 [27%] patients. There was no significant association between risk factors such as gestational age at delivery, parity, maternal age at PPROM, or maternal Body Mass Index [BMI] and cesarean section rate. Infection played a major role, both as a risk factor and in causing extreme PPROM, which in turn increased in 12 patients [27%]. In the multivariable model for predicting the need for cesarean section [gestational age at delivery, parity, maternal age at PPROM in years and maternal BMI], none of the factors were statistically significant. Overall, concurrent infection rate was high among patients presenting with extreme PPROM. None of the baseline maternal factors predicted the need for cesarean section. This is likely due to the small sample size; hence, larger prospective studies are needed to confirm these findings

Perinatal outcome of monochorionic in comparison to dichorionic twin pregnancies

The aim of this study is to compare the neonatal outcomes of monochorionic and dichorionic twin pregnancies. A retrospective cohort study involving 51 twin pregnancies followed and delivered at Sultan Qaboos University Hospital was conducted between January 2006 and December 2011. Thirty six [71%] pregnancies were dichorionic diamniotic [DCDA], 14 [27%] were monochorionic diamniotic [MCDA], and one [2%] was monochorionic monoamniotic [MCMA]. The antepartum complications noted in the 15 monochorionic twins were discordant fetal growth in 2 [14%] cases, low birth weight in 11 [73%] babies, pre-eclampsia in three mothers [21%] and twin to twin transfusion syndrome in four [29%] cases. Fetal respiratory distress affected eight [57%] of the pregnancies. Six [40%] twin sets were delivered before 30 weeks, 4 [27%] sets at 31 to 32 weeks, 2 [13%] sets at 34-35 weeks, 2 [13%] sets at 36-37 weeks, and 1 [7%] at 37-38 weeks. Fifteen mothers delivered 16 live infants, 9 [30%] stillbirths and 5 [17%] died after birth. Most neonatal deaths were due to neonatal sepsis and pulmonary hypoplasia. Dichorioinic twins, [DC] morbidity was seen in 11% and 40% for monochoroinic twins [MC]. Mortality rate was 17% for DC and 47% for MC twins. Perinatal morbidity and mortality remain high among monochorionic twins. This is likely due to frequent twin-to-twin transfusion syndrome, prematurity, fetal growth restriction and intrauterine fetal death. Improved fetal and neonatal management may result in improved outcomes

Perinatal outcome in pregnancies with extreme preterm premature rupture of membranes [Mid-Trimester PROM]

Preterm premature rupture of membranes [PPROM] is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks' gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM. A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks' gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks' gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study. Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 [55%] survived, 7 [16%] died within 24 hours of birth, 9 [20%] were miscarried, and 4 [9%] were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 [46%], respiratory distress syndrome in 19 [79%], sepsis in 12 [50%], and low birth weight in 11 [46%]. The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes. Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counseling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals

Spontaneous resolution of fetal and neonatal ascites after birth

Fetal ascites is an uncommon abnormality usually reported in relation to non- immunological causes. The prospect for fetal and neonatal mortality is high, particularly when the ascites develops before 24 weeks of gestation. The diminution of severe fetal ascites without intrauterine management, especially with an uncomplicated neonatal outcome, is unusual. We report a case of isolated fetal ascites detected at 20 weeks' gestation. All investigations carried out were normal. Consecutive ultrasound examination showed ascites at 20 weeks' gestation. A follow-up ultrasound examination at 6 months of age revealed complete recovery from the ascites. Spontaneous resolution of fetal ascites, with a good prognosis, can occur in cases with an idiopathic aetiology

Caesarean myomectomy feasibility and safety

Caesarean myomectomy has traditionally been discouraged due to fears of intractable haemorrhage and increased postoperative morbidity. However, a number of authors have recently shown that myomectomy during Caesarean section does not increase the risk of haemorrhage or postoperative morbidity. We present a series of 8 cases from Sultan Qaboos University Hospital, Oman, where myomectomy was performed during Caesarean section for large lower segment fibroids. Seven were anterior lower segment fibroids, while one was a posterior lower uterine fibroid which interfered with closure of the uterine incision. The antenatal course, perioperative management, and postoperative morbidity are discussed. The average age of the women was 28.7 years and mean gestational age at delivery was 36.75 weeks. Regarding intra-operative blood loss, 1 patient lost 900 ml, 5 patients lost 1-1.5 litres, 2 lost 1.5-2 L, and 1 patient with a 10 x 12 cm fibroid lost 3.2 L. Despite the majority being large myomas [7 of the 8 patients had myomas >5 cm in size] and 50% being intramural, no hysterectomy was required. Stepwise devascularisation was necessary in one case and preoperative placement of uterine balloon catheters was necessary in another. The size of the fibroids was confirmed by histopathology. Myomectomy added 15 minutes to the operating time and 1 day to the hospital stay, but there was no significant postoperative morbidity. Neonatal outcome was good in all patients. In selected patients, myomectomy during Caesarean section is a safe and effective procedure at tertiary centres with experienced surgeons

Fetal amelia: a case report

Congenital limb defects are rare fetal anomalies with a birth prevalence of 0.55 per 1,000. Amelia is an extremely rare birth defect marked by the complete absence of one or more limbs. We report a case of fetal amelia, ultrasound findings, manifestations and the fetal outcome