Antenatal diagnosis and management of fetal mid-gut volvulus

Fetal volvulus is an uncommon cause of bowel obstruction, which is rarely detected by an antenatal ultrasound scan. We report a case which presented with fetal stomach and small bowels dilatation at 33 weeks of gestation detected by ultrasonography. She was referred to our unit for safe delivery at 34th week of gestation following a spontaneous rupture of membranes and signs of fetal distress. Delivery was accomplished by Cesarean section. Postnatally, the infant was surgically explored with resection of ileum and end to end anastomosis because of bowel gangrene and volvulus. Ultrasound diagnosis during pregnancy with fetal bowels dilatation is an important tool and may lead to early diagnosis and optimal management of intestinal obstruction

Human papillomavirus infection among women attending health facilities in the Kingdom of Bahrain

To investigate the occurrence of human papillomavirus [HPV] infection and the associated risk factors in Bahrain's female population. This study was carried out between March to December 2004, which includes cervical scrapings for Pap smear and HPV-DNA testing using polymerase chain reaction[PCR] and restriction fragment length polymorphism [RFLP] analysis, obtained from 100 women attending the Gynecology Clinic at Salmaniya Medical Center and Sheikh Sabah Health Center in the Kingdom of Bahrain. We distributed questionnaires that include the sociodemographic data as well as information on risk factors such as smoking, parity, and the contraceptive used. Eleven women [11%] with normal cytology were HPV-positive. The RFLP analysis detected HPV-types 16, 18, 45, 62 and 53. Positive women were significantly older [43.3 +/- 10.1 years] than negatives [36.5 +/- 9.9 years; P=0.04], however, there was no difference in age of first sexual contact [positive: 18.1 +/- 5.7 years versus negative: 20.6 +/- 4.4 years]. Polygamy, smoking and hormonal contraception was not identified as risk factors, but positive women showed higher parity. In this study on HPV infection in Bahrain, the 11% positivity with high risk HPV types, in the presence of normal cytology suggests that in addition to the cervical cancer screening program, offer of HPV testing deserves consideration

case report and review of the literature: Pelvic congestion syndrome

Pelvic congestion syndrome [PCS] is a well described, but frequently overlooked cause of chronic pelvic pain. It is manifested by pelvic pain of variable intensity that is aggravated by prolonged standing, fatigue, menstruation or intercourse.Although the condition has been described since the middle of the nineteenth century, the exact cause of the condition is not fully understood. Recent advances in imaging and laparoscopy have helped in achieving an accurate diagnosis. Surgical procedures are not always helpful in managing cases of pelvic varices. The most recent breakthrough has been the management of gonadal varicosities by an embolization technique. This case was first suspected following a pelvic ultrasound study. The diagnosis was confirmed by venography and embolization was performed in the Radiology Depar tment. This treatment modality is the first ever in the Kingdom of Bahrain. It shows specialized skills can satisfactorily cure a hither to difficult disease with simple minimally invasive techniques

Invasive malignant thymoma in early pregnancy

Thymomas are an uncommon tumor of the mediastinum. When they are malignant it is even rarer for a young or pregnant woman to be affected. The condition has a bad prognosis unless surgery is followed by radiation therapy and chemotherapy, which must be instituted. The urgency of treatment makes medical termination of pregnancy an important procedure, particularly if the tumor is discovered in early pregnancy. We present here the first case reported in Bahrain of an invasive malignant thymoma in early pregnancy. The epidemiology, pathology and management of such cases are discussed

Cryptogenic fibrosing alveolitis necessitating therapeutic termination of a first trimester pregnancy

Twenty-seven years old Bahraini lady, known to be suffering with fibrosing alveolitis for some eight years, presented to the accident and emergency department of Salmaniya Medical Complex. Recently her respiratory function had deteriorated and she had become house-bound on home oxygen therapy and nebulizers. She was taking Prednisolone tablets and Immuran. She was admitted to the Intensive Care Unit [ICU] in extreme respiratory distress for the past two days. While she was in the hospital, she complained of breast tenderness and supra pubic pain, her period being twenty days overdue. BIICG pregnancy test proved to be positive. Management and outcome of her case is herewith discussed

Screening for gestational diabetes by measuring fasting plasma glucose levels

To test the sensitivity and specificity of measuring fasting plasma glucose levels [FPG] as a screening test for gestational diabetes mellitus [GDM]. [b] To compare predicting levels of FPG levels with the one-hour, oral 50g non-fasting glucose challenge test [GCT] for predicting GDM. One thousand and six hundred pregnant women from the Health Centres, antenatal clinics and Salmaniya Medical Complex were screened by the GCT after 50g of oral glucose during 26-32 weeks gestation, giving a 13.5% incidence of GDM [using the Third International Workshop cutoff values of 7.8 mmol/l]. All patients also had an FPG estimation followed by the three-hour oral glucose tolerance test [oGTT]. Seventy eight percent of the patients were Bahraini, 19% Asian and 3% other nationalities. Their mean age was 27.2+0.2 years. Receiver-operating curves [ROC] were used to test the ability of the FPG and the oGTT to differentiate patients with GDM and identify the cut off values for predicting a diagnosis of GDM. FPG levels of 5.6 mmol/l and 5.4 mmol/l yielded sensitivities and specificities of 94% and 93% respectively. Measuring FPG as a screening test required a diagnostic oGTT in 32% compared with 13% when the GCT was used. Using FPG levels at a cutoff value of >/= 5.5 mmol/l is an easier, more acceptable test for patients compared to the GCT. Using the FPG levels is also more cost effective and allows nearly 70% of women to avoid the oGTT

HELLP Syndrome [hemolyisis, elevated liver enzymes and low platelets]: a review of the pathophysiology, diagnosis, management and anaesthetic considerations

HELLP syndrome [hemolysis, elevated liver enzymes, low platelets] is associated with poor maternal and fetal outcomes. Maternal mortality has been estimated as high as 24%. These patients are also at greater risks from pulmonary edema, adult respiratory distress syndrome [ARDS], abruption placentae, disseminated intravascular coagulopathy [DIC], ruptured liver hematomas, and acute renal failure [ARF]. Perinatal mortality is equally high ranging from 79 to 367 per 1000 live births, and neonatal complications correlate with the severity of maternal disease. Many clinicians view HELLP syndrome as an entity of preeclampsia, and with the varied symptomatology, the initial diagnosis may be obscured. Prodromal signs include: 1] right upper quadrant and/or epigastric pain, 2] nausea and vomiting, 3] headache, 4] visual changes, 5] increased tendency to bleed from minor trauma, 6] jaundice, 7] diarrhea and 8] shoulder or neck pain. Prior to delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems and timely interruption of the pregnancy in the early phase of accelerated disease progression. Definitive therapy is delivery. Parturients with HELLP syndrome are often critically ill; their infants are frequently premature and compromised. Management criteria should include a multidisciplinary approach in a tertiary care centre. The obstetric anesthesia personnel should petform a thorough preanaesthetic evaluation and have considerable knowledge of the pathophysiology of this syndrome. Unless significant coagulopathy is diagnosed, epidural anesthesia is preferred over general anesthesia, and spinal anesthesia is perhaps contraindicated

Antiphospholipids [Hughes] syndrome pregnancy: a report of three cases and review of the literature

Since the discovery of the antiphospholipids syndrome in the early eighties, many clinical conditions have been described in patients with antiphospholipid antibodies. Complications include infertility, recurrent miscarriage and increased perinatal mortality. A more serious complication, however, are episodes of arterial thrombosis during pregnancy and puerperium. We have had six such cases in the last three years, of which, the three with major complications are reported here. The first patient had a combination of sickle cell disease, J3-thalassaemia and antiphospholipid antibodies during pregnancy. Put on heparin prophylaxis, she was delivered at 38 weeks by Caesarean section, but died postnatally of a massive pulmonary embolism. The second patient reported at eight weeks of gestation with evidence of a cerebro-vascular accident. Her condition improved and her pregnancy was terminated. The third, a young woman with a history of infertility, was treated with assisted reproductive technology and became pregnant but had a mid-trimester abortion. Eventually she had a normal gestation with heparin prophylaxis and delivered a live baby. Antiphospholipids syndrome is not uncommon in Bahraini pregnancies. Considering the impact of this disease on reproduction and the range of complications involved, screening of pregnant women with a bad obstetric history or recurrent miscarriage is essential