Manchester repair. An alternative to hysterectomy

Local data regarding Manchester repair are not available in the current literature. We report a retrospective case series of 7 women who presented with uterine prolapse, and underwent Manchester repair from January 1997 to May 2008 at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. All of these women were multiparous [para 3 +/- 1] and wanted to avoid hysterectomy, and become pregnant. The duration of the procedure was 119 +/- 16 minutes. No operative complications were observed. The mean duration of follow up was 5 +/- 2 years. All of the women were satisfied with the procedure. Two [28.6%] patients subsequently became pregnant and had a successful vaginal delivery. Manchester repair is a valid alternative to hysterectomy for women with a second degree uterine prolapse who want to preserve their fertility

Intracytoplasmic sperm injection after total conventional in-vitro fertilization failure

This study assessed the value of delayed intracytoplasmic sperm injection after failure of initial in-vitro fertilization in patients with normal seminology. A case series analysis was conducted on 82 couples who underwent delayed intracytoplasmic sperm injection after failure of initial in-vitro fertilization at Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia between January 1995 and January 2001. Seventy-eight couples had 616 unfertilized metaphase II mature oocytes after initial in-vitro fertilization. Second day "rescue" reinsemination by intracytoplasmic sperm injection [ICSI] resulted in 174 embryos that were suitable for transfer. This resulted in 4 clinical pregnancies [5.1% per started rescue ICSI cycle]. The limited success rate in this study provides confirmatory data that rescue ICSI is not an efficient adjuvant laboratory procedure

Uterine rupture incidence, risk factors, and outcome

To determine the incidence of uterine rupture and to analyze risk factors and outcome in a local hospital in Makkah, Kingdom of Saudi Arabia, [KSA]. The hospital records of the Maternity and Children's Hospital [MCH], in Makkah, KSA from April 1999 to December 2000 were retrospectively reviewed to identify women with ruptured uterus. The relevant data relating to the clinical features, risk factors, operative procedures, and maternal and fetal outcomes were assessed. During the study period, there were 23245 deliveries and 23 women were diagnosed to have uterine rupture giving an incidence of one in 1011 deliveries. Fifteen [65.2%] occurred in women with previous cesarean scar and 8 [34.8%] women had no previous uterine surgery. In the 15 women with uterine rupture and previous cesarean section there was no maternal death. They were treated by repair of the uterus. Two women sustained bladder injury, and one subsequently developed vesico-vaginal fistula. In contrast, in the 8 women with no previous uterine surgery, one woman died, one woman developed renal failure, and there were 3 fetal losses. Four women needed total abdominal hysterectomy, and 4 women needed repair. Two women needed internal iliac ligation in addition to the hysterectomy. In our circumstances, uterine rupture is not rare and consequences can be life threatening. The outcome is worse in women with unscarred uterus

Repeat intracytoplasmic sperm injection. clinical Perspective

To report the results of repeat intracytoplasmic sperm injection [ICSI] after complete failure of fertilization with initial ICSI. The medical records of the couples undergoing repeat ICSI at the Human Reproductive Biology Unit, Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia, after complete failure of fertilization by initial ICSI between December 1994 and December 2000 were retrospectively examined. Seven hundred and eighty two oocytes from 146 women failed to fertilize by initial ICSI. The main indications for the procedure were severe oligoasthenoteratozoospermia or azoospermia. Fresh sperms were used in 136 cases, of which 98 [72%] were ejaculated, 33 [24.3%] were obtained by testicular sperm extraction, and 5 [3.7%] by testicular sperm aspiration. Of the remaining 10: 3 were from cryopreserved semen samples and 7 were from cryopreserved testicular biopsies. The age of the women [mean +/- standard deviation] was 31 +/- 16.2 years. The duration of infertility was 10.5 +/- 9.4 years. A total of 151 [19.3%] oocytes were fertilized after repeat ICSI. The number of cleaved embryos was 125 [15.9%]; of which 2 [1.6%] were grade 5, 47 [37.6%] were grade 4, 65 [52%] were grade 3, and 11 [8.8%] were grade 2. A total of 122 embryos were transferred to 71 women. This resulted in one pregnancy and the birth of a healthy full term baby. In cases of complete failure of fertilization with initial ICSI, fertilization and pregnancy can follow repeat ICSI. Further clinical and cytogenetic studies in this area are necessary

Abdominal myomectomy versus abdominal hysterectomy for symptomatic and big uterine fibroids

To compare abdominal myomectomy with abdominal hysterectomy in women with big and symptomatic uterine fibroids. The hospital records at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia were reviewed to identify women who underwent abdominal myomectomy or abdominal hysterectomy between 1989 and 1999. Inclusion criteria were the presence of symptoms and size of the uterus equaling that of 12 weeks gestation or more. Women who underwent myomectomy as a treatment of infertility were excluded. During the study period, 111 women met the inclusion criteria. Thirty-eight women underwent abdominal myomectomy and 73 women underwent abdominal hysterectomy. Forty women were excluded because of myomectomy for infertility. Abdominal myomectomy was successfully performed in all women for whom it was scheduled. Hysterectomy, internal iliac ligation, or other procedures were not necessary to control the bleeding. The primary indication for myomectomy was abnormal vaginal bleeding in 23 women and pelviabdominal mass in 15 women compared to 6 women and 67 women in the hysterectomy group. There were statistically significant differences in the mean age and parity [p value 0.01 and <0.001] between women who underwent abdominal myomectomy and abdominal hysterectomy. The uterine size clinically [mean +/- standard deviation], size of largest myoma by ultrasonography, and from histopathology reports were 15.4 +/- 3.8, 11.8 +/- 2.8, and 13.6 +/- 3.2 compared to 17.9 +/- 4.4, 16.9 +/- 4.2, and 13.8 +/- 3.7 [p values not statistically significant]. Similarly, there were no statistically significant differences in the pre- and postoperative hemoglobin, estimated blood loss, rate of blood transfusion, operative time, and numbers of days in hospital. Abdominal myomectomy for big and symptomatic uterine fibroids carries similar risks to abdominal hysterectomy