Rupture of the pregnant uterus: an analysis of risk factors

The purpose of our study was to evaluate the risk factors associated with uterine rupture or dehiscence after caesarean section. We also reviewed the clinical presentation, complications and management of the problem. During the study period there were 28494 deliveries. Among those deliveries there were 24 cases of ruptured and dehiscence of uterine scar. In four cases [16.6%], uterine rupture occurred in an intact uterus. The remaining 20 patients had one or more previous caesarean section delivery. Eight of those patient [33.4%] had uterine rupture, two of them following classical scar and the remaining six patients had two or more transverse caesarean scars. The remaining twelve patients [50%] had dehiscence of the caesarean scars. The remaining twelve patients [50%] had dehiscence of the caesarean section scar. Eighteen patients [75%] of all women who had uterine ruptured were admitted in labour,having had no previous antenatal care. Sixteen patients [66.6%] were grandmultipara. Hysterectomy was performed in 10 [41.6%] patients, while the remaining 14 patients were treated conservatively. In conclusion, we found that the risk of uterine rupture was increased in grandmultipara, in those patients who had no antenatal care, in patients who had classical scare, and in those who gave history of two or more cesarean deliveries

Diagnosis of gestational diabetes mellitus a study of 315 pregnant women at King Fahd hospital of the university, Al-Khobar, Saudi Arabia

The purpose of the study was to determine the best method for the diagnosis of gestational diabetes. A prospective study was conducted over a period of seven years in 315 pregnant women seen at the antenatal clinic at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, between January 1987 and December 1993. Each one of those patients has one or more risk factors of developing gestational diabetes. All the patients were tested by both 100 gm oral glucose tolerance test and sugar profile. After analysing the results we got three different groups of patients. In one group which consists of 123 patients, all patients, have abnormal glucose tolerance test and abnormal sugar profile. This group was labelled as Group 1. In the second group which consists of 77 patients, all patients have abnormal glucose tolerance test, but normal sugar profile. This groups was labelled as Group 2. The third group which consists of 115 patients, all patients have normal glucose tolerance test and normal sugar profile. This groups was labelled as Group 3 and used as control group. The positive results were more common following 100 gm oral glucose tolerance test [33.3%] compared with the sugar profile tests [6.6%] with a highly significant differences. P-value < 0.001 which indicate a high false positive result when oral glucose tolerance test is used. The outcome of this study indicates that oral glucose tolerance test is a stress test, it is non- physiological with a high false positive result, it has a number of unpleasant side effects and lacks reproducibility. Sugar profile on the other hand is a non-stress, simple test and more convenient for the patient and far more representative of the patient's usual meal intake and dietary habits. It is highly acceptable by the patients and can be repeated many times throughout the pregnancy

Idiopathic hyperprolactinaemia: aclimical study of 140 patients

Report the findings and experience in the management of 140 patient with idiopathic hyperprolactinaemia treated at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, and the effect of the treatment with bromocriptine on the restoration of normal menstrual pattern and fertility. Method: The study was conducted over a period of five years in 140 patients with idiopathic hyperprolactinaemia who were investigated and treated at the Endocrinological, Infertility and Gynaecological Clinics at the King Fahd Hospital of the University, Al-Khobar between January 1988 and December 1992. The initial serum prolactin levels ranged from 28.5 to 224 ng/ml, with a mean of 62 ng/ml. Among the 140 patients with idiopathic hyperprolactinaemia, 102 patients were complaining of infertility. All the patients in the study were treated with bromocriptine to normalise serum prolactin or to achieve pregnancy. Result: Out of the 102 infertile patients, 82 [80.3%] achieved pregnancy with bromocriptine therapy alone, and the remaining 20 patients received additional treatment with clomiphene and Human Chorionic Gonadotrophine for induction of ovulation. A total of 88 [86.2%] patients achieved pregnancy, 76 had full term pregnancy and 12 ended with abortion. There was no significant difference in the pregnancy rate, between the patients with initial low serum prolactin levels and those with high levels. Similarly, the presence of galactorrhea did not influence the pregnancy rate. No lethal congenital foetal abnormalities were observed in the patients. Bromocriptine therapy in the treatment of hyperprolactinaemia is safe and effective resulting in high pregnancy rate and resumption of normal menstrual pattern

use and misuse of ultrasound in obstetrics and gynecology

The goal of the present study was to analyze the results of 8,800 ultrasound scan examinations performed on a wide range of obstetrical and gynaecological patients over two years period at the King Fahd Hospital of the University, AI-Khobar, and the cost effectiveness of ultrasonic examination during the two years study period over 78% of the gynaecological and 80% of the obstetrical ultrasound scans performed were normal and only 22% of the gynaecological and 20% of the obstetrical ultrasonic examination showed some abnormality respectively

Unruptured tubal twin pregnancy

We report a tubal twin pregnancy which occurred after a spontaneous pregnancy presented with abdominal pain at ten week gestation. Two gestational sacs with two fetal echoes were found by ultrasonic examination. Emergency laparoscopy followed by laparotomy confirmed the diagnosis, and salpingectomy was performed. To the best of our knowledge this is the first case of tubal twin pregnancy to be reported

Mayer-Rokitansky-Kuster-Hauser syndrome: a study of fifteen cases

Although Mayer Rokitansky Kuster Hauser [MRKH] syndrome is a rare entity, it is a fairly common cause of primary amenorrhoea. The purpose of the study is to establish guidelines for the investigation of a patient suspected to have a MRKH and to look for some congenital defects which may be associated with this syndrome. We reviewed fifteen cases of MRKH seen at the King Fahd Hospital of the University, Al-Khobar, and Al-Madina Maternity and Childrens Hospital, Al-Madina, Saudi Arabia. The age of the patients ranged between 14 to 24 years old [mean 17.3 years old]. Eight of the patients complained of delayed menstruation, five of whom were unable to conceive, and two complained of dyspareunia. All patients were investigated by cytogenetic studies, hormonal profile, intravenous pyelography, pelvic ultrasound and a diagnostic laparoscopy. Cystogenetic studies revealed that all fifteen patients were normal females of 46XX karyotype. Hormonal studies in nine patients were within normal range, but in the other six the hormonal values correlated well with polycystic ovary syndrome and this was confirmed by pelvic ultrasound

Hyperprolactinaemia, diagnosis and treatment: a study of 150 cases

We reviewed the management of 150 patients with hyperprolactinaemia, who presented with infertility, amenorrhoea, menstrual irregularities and/or galactorrhoea during a 4 year period to evaluate the efficacy of treatment of the condition with bromocriptine. Radiographic evidence of pituitary microadenoma was seen in 23 patients and 7 had macroadenoma. The majority of our patients [53%] had no obvious cause for elevated prolactin levels. Seven patients were taking antidepressants, five had antihypertensive drugs and twelve had taken oral contraceptives for a period of six months or more. Patients with pituitary adenoma had a significantly higher baseline serum prolactin level than those with no adenoma. All patients in the study were treated with bromocriptine to normalise serum prolactin or to achieve pregnancy. The patients without an adenoma required a significantly smaller dose of bromocriptine than those with an adenoma. There was no significant difference in the pregnancy rate between the patients with and those without pituitary adenoma. Similarly, presence of galactorrhoea or a high level of prolactin did not influence the pregnancy rate. No lethal congenital foetal abnormalities were observed. The results obtained from this study indicate the efficacy and safety of bromocriptine therapy in the treatment of hyperprolactinaemia with and without pituitary adenoma

Gonadal biopsy for assessment of gonadal function in secondary amenorrhea

Gonadal biopsy provides an opportunity for the investigation of ovarian function and for diagnosing of ovarian dysfunction I. This procedure is particularly relevant in cases of primary amenorrhea, secondary amenorrhea, the polycystic ovary syndrome, resistant ovary syndrome and infertility2. Data thus collected assist the planning of logical management, the provision of accurate prognosis, and the assessment of response to treatment. The operation per se may have a therapeutic effect. We present here the results of investigations on 6 patients with secondary amenorrhea and discuss the value of gonadal biopsy