Pregnancy outcome of sickle cell disease women

Objective: To evaluate the maternal and fetal outcome in pregnant women with sickle cell disease [SCD] compared with healthy women

Setting: Department of Gynecology and Obstetrics, Salmaniya Medical Complex, Bahrain

Design: Retrospective Case-Control Study

Method: Patients with SCD who delivered from 1 January 2011 to 31 December 2012 were reviewed. The matched controls had neither SCD nor sickle cell trait

Result: Patients with sickle cell disease required significantly more admissions during their pregnancy, 135 [78.4%] compared to the control, 74 [37.4%]. One hundred thirteen [65.6%] SCD patients were admitted with vaso-occlusive crises and 18 [10.4%] with hemolytic crises. SCD patients had a significant decrease in parity, gestational age and birth weight compared with the control group. SCD patients had a significant rise in the incidence of urinary tract infection, but there was no difference between both groups in the incidence of hypertensive disorders, mode of delivery and perinatal outcome. Four [2.3%] patients with SCD died; two [1.2%] patients died due to pulmonary embolism, one [0.6%] due to acute chest syndrome and one due sepsis and disseminated intravascular coagulopathy

Conclusion: Sickle cell disease is hazardous both to the mother and the fetus and is associated with high maternal morbidity and mortality

Management of primitive neuro-ectodermal tumor of the vagina in a sickle cell disease patient

A twenty-five years old female, a known case of sickle cell disease, presented with frequent and heavy periods of six months duration. Pelvic ultrasound and MRI showed a vaginal mass pushing the bladder anteriorly; the diagnosis of cervical fibroid was considered. Histopatholgical examination of the mass revealed a very rare entity of primitive neuro-ectodermal tumor of the vagina. This is the first recorded patient of sickle cell disease with primitive neuro-ectodermal tumor of the vagina. The management was challenging in dealing with her disease and preserving her fertility

Effect of Hyoscine-N-Butyl bromide [buscopan] in accelerating first stage of labor

To determine the effect of Hyoscine-N-Butyl Bromide [Busocpan] in accelerating first stage of labor and its relationship to the presence or absence of fetal membrane. The study was carried out between 1st May, 2007 and 3rd October, 2007 at Jidhafs Maternity Hospital in the Kingdomof Bahrain. A quasi-experimental prospective randomized control study was conducted on 92 primigravidas with single cephalic pregnancies who underwent spontaneous labor and who were not subjected for augmentation with any drug in active phase of labor. Sixty four patients were subjected to 40 mg intra-muscular injection of Busocpan and 28 acted as control. The rate of cervical dilatation was compared in both groups. The duration of fist stage of labor was 3.6 +/- 3.0 hours [mean +/- Standard deviation] for the Busocpan group and 4.7 +/- 2.9 hours [mean +/- SD.] for the control group. On comparing the mean of the duration of first stage of labor amongst different subgroups, it was found that the difference was only statistically significant in Buscopan group with absent membranes as compared to Busocpan group with intact membranes. Hyoscine-N-Butylbromide [Buscopan] was not effective in shortening the first stage of labor for primigravidas in comparison to control. However, Busocpan proved to be highly effective in shortening first stage of labor among patients with absent fetal membranes as compared to those who received Busocpan when their fetal membranes were present

comparative analysis of uterine rupture in 2 decades

To compare the changing trends of uterine rupture in 2 decades along with the maternal and fetal outcome in scarred and unscarred uterus. The risk factors of the uterine ruptures, which occurred in the Ministry of Health Hospitals in Bahrain in 2 decades, were analyzed. The maternal and the fetal outcome was compared between the 2 decades [1981-2000] and between the scarred and unscarred uterus. The rise of uterine rupture in the 2nd decade [50] as compared with the first decade [25] was parallel to the increasing rate of cesarean section [CS]. Instrumental deliveries and augmentation of labor were the main significant risk factors in the first decade while induction of labor was in the later decade. There was a significant decrease of maternal morbidity in the 2nd decade inspite of the increasing rate of uterine rupture. There was no maternal death; however, there were 11 perinatal deaths in the first group compared to 14 in the 2nd group. The maternal morbidity and perinatal mortality was significantly higher in the uterine ruptures of the intact uterus as compared to those with scarred uterus. Inspite of the high incidence rate of the uterine rupture in the later decade, the morbidity of the mother and the fetus show no increase. The increase in the incidence of the uterine rupture is connected to the increasing rate of CS. The rupture of the intact uterus is more catastrophic as compared to the scarred uterus

Abnormal uterine bleeding: Diagnostic value of hysteroscopy

To determine the specificity, sensitivity and predictive value of hysteroscopic impression versus histological diagnosis of endometrial curettings in evaluating patients with abnormal uterine bleeding. In addition, to determine whether office hysteroscopy can eliminate hospital diagnostic dilatation and curettage for patients with abnormal uterine bleeding. A retrospective study of 556 patients who underwent hysteroscopy and dilatation and curettage for abnormal uterine bleeding between January 1995 and December 1998 at the Salmaniya Medical Complex in Bahrain. A comparison was made between hysteroscopic impression and histological examination. Out of 556 patients who were included in the study, 53 were diagnosed to have endometrial polyps hysteroscopically, however only 13 patients [24.5%] were confirmed to have polyps histologically. Hysteroscopy had revealed submucous leiomyoma in 33 women but none of these were diagnosed histologically. Hysteroscopy was highly specific for diagnosis of both endometrial hyperplasia and endometrial carcinoma [specificity was 85% for endometrial hyperplasia and 99.5% for endometrial carcinoma], however the sensitivity of hysteroscopy for diagnosing endometrial cancer was 40% and 30% for endometrial hyperplasia. Hysteroscopy was more sensitive than curettage in detecting endometrial polyps and submucous fibroids, but less sensitive than curettage in detecting endometrial hyperplasia and endometrial carcinoma. Hysteroscopy should be carried out in conjunction with curettage for evaluating women with abnormal uterine bleeding. Office hysteroscopy with directed biopsies could be carried out, to reduce hospital diagnostic dilatation and curettage