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

Etiological profile of Omani women with recurrent pregnancy loss

To define the different causes of recurrent pregnancy loss [RPL] among Omani women. This retrospective study included all women with RPL seen between June 2006 and March 2012 in the RPL outpatient clinic in Sultan Qaboos University hospital, Muscat, Oman. The data were collected from the Hospital Information System by screening the electronic records of these patients. The sample size gathered during the study period was 290 women. One hundred and forty [48%] of the examined patients had an identifiable cause for RPL, while in 150 [52%], no cause was identified. The most common causes were immunological factors [35.4%] and the least common were environmental factors [1.7%]. Other causes implicated included: chromosomal abnormalities [8%], anatomical factors [9.4%], endocrine disorders [29.8%], infectious causes [3%], and thrombotic causes [12.7%]. Recurrent pregnancy loss is prevalent among Omani women. The etiological profile of RPL in Omani women is consistent with that reported elsewhere according to previously published studies, with minor variations

Clinical and histological profile of surgically managed benign adnexal masses

To study the clinical and histological nature of benign adnexal masses managed surgically. A retrospective descriptive study in a teaching hospital in Oman of all the women who had surgical management of benign adnexal masses from January 2008 to May 2012. Data pertaining to age, parity, presenting symptoms, imaging and tumor markers performed and the surgical intervention done on those women with benign adnexal masses was collected from the electronic health records of the patients. There were 198 women during this period operated for benign adnexal masses. The most common benign neoplasm was mature teratoma of the ovary followed by endometriosis. Conservative surgery in the form of ovarian cystectomy was necessary in three fourths of women and in about just less than 50% of women, the procedure was completed laparoscopically. The most common benign tumor was teratoma but laparoscopic approach, which is the standard of care in these women, was possible only in just about 50% of the women

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

Effects of pre-pregnancy body mass index and gestational weight gain on low birth weight in Omani infants: a case-control study

This study aimed to investigate the association between pre-pregnancy maternal body mass index [BMI], gestational weight gain and low birth weight [LBW] in babies born to a sample population of Omani women. A case-control study was carried out among deliveries registered between 1[st] May 2010 and 30[th] April 2011 at Sultan Qaboos University Hospital, Muscat, Oman. A case was defined as a woman who delivered a low birth weight baby [<2,500 g]; a control was a woman delivering a baby weighing between 2,500 and 4,000 g. A random selection of 150 cases and 300 controls was carried out using the hospital information system. Maternal, pre-natal, and delivery data were extracted from the mothers' follow-up cards. Bivariate and multivariate logistic regression analyses were executed to examine the association between pre-pregnancy maternal BMI and LBW. The percentage of underweight mothers [BMI <18.5] was higher among the cases compared to the controls [17.3% versus 6%; P <0.001]. The proportion of mothers with less-than-recommended weight gain was also higher among the cases compared to the controls [57.7% versus 33%; P <0.001]. After adjustment for potential confounders, infants of underweight mothers had more than twice the risk of LBW compared to those of mothers with normal weight [odds ratio = 2.27; 95% confidence interval 1.09-4.71]. Underweight Omani women as well as women with less-than-recommended gestational weight gain were at higher risk of delivering LBW babies. Maternal health promotion programmes should be directed towards improving mothers' nutrition before and during pregnancies

Prevalence of tubal obstruction in the hysterosalpingogram of women with primary and secondary infertility

The purpose of this study was to evaluate the fallopian tube of women with infertility and to observe whether there are any significant differences in the Hysterosalpingogram findings with regard to prevalence of tubal block in women with primary and secondary infertility. A retrospective study of unilateral and bilateral tubal obstruction in Hysterosalpingogram of women with primary and secondary infertility was carried out. The frequencies of tubal obstruction were about 19% in women with primary infertility and 29% in secondary infertility. Chlamydia antigen positivity rate was similar in both groups. Ectopic pregnancy [p<0.01] and previous pelvic surgery [p<0.001] were higher in women with secondary infertility. Tubal obstruction is a cause of female infertility according to this study. Bilateral tubal obstruction was similar in primary and secondary infertility groups and previous pelvic surgery may be the cause of tubal obstruction in the secondary infertility group

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

Obstetric and non-obstetric risk factors for cesarean section in Oman

This study aims to explore the risk factors, profiles and neonatal outcomes of Cesarean sections among selected women in Oman. In this hospital-based case-control study, a total of 500 participants [250 cases who had cesarean section and 250 controls who had spontaneous vaginal delivery], were randomly selected from four hospitals. Cases and controls were matched according to timing and place of delivery. The following predictors were found to be significantly associated with increased risk of cesarean section: a] advancing age [above the age of 25 years, OR=1.42; p=0.03], b] prior cesarean section [previous cesarean section=1, OR=22.71; p=0.001], c] increased body mass index [obesity, OR=2.11; p=0.07], d] extremes of neonatal birth weight [neonates birth weight <2.5 kg, OR=5.2; neonates birth weight >4.0 kg, OR=7.3; p<0.001], and e] prepregnancy diabetes [OR=9.3; p=0.04]. On the contrary, increased parity and history of the use of birth spacing methods [OR=0.38; p=0.03] were associated with decreased risk of cesarean section. The study calls for increasing awareness about clinical and public health majors that would lead to prevention of risk factors associated with increased risk of cesarean section such as maintaining normal BMI and prevention of gestational and type 2 diabetes mellitus

Successful term pregnancies after laparoscopic excision of poorly differentiated Sertoli-Leydig cell tumor of the ovary / 부인종양

Ovarian Sertoli-Leydig cell tumors are rare sex cord-stromal tumors, accounting for less than 1% of ovarian tumors. Majority of these tumors are benign and unilateral, only 3-5% are bilateral. These patients present with clinical features of virilization due to excessive secretion of testosterone from the tumor, however 50% may have no endocrine symptoms. We report a case of poorly differentiated Sertoli-Leydig cell tumour in a woman diagnosed during routine investigation of infertility. She had two spontaneous successful pregnancies after tumor excision laparoscopically.

Submyomatous cornual pregnancy managed surgically after failed medical management

Cornual pregnancy constitutes an emergency while its diagnosis and management remain a challenge. Anatomical abnormalities in the uterus, such as fibroids in the cornual region, make the management even more difficult. A nulliparous patient presented with an ectopic pregnancy at the right cornua under a huge fibroid. Despite multiple doses of methotrexate for a cornual ectopic gestation, the serum beta human chorionic gonadotropin [beta-hcG] levels doubled on the fifth day and a viable fetus was demonstrated on imaging. Thus surgical intervention in the form of laparoscopy followed by laparotomy, myomectomy of a large cornual fibroid and cornuostomy was performed. The serum beta human chorionic gonadotropin result was negative three weeks later. Surgical intervention in the form of myomectomy and cornuostomy was necessary to preserve fertility in this unusual presentation of cornual ectopic pregnancy

Comparison of the demographics, semen parameters and hormone profiles in men with primary and secondary infertility

The objectives of this study were to compare the demographics, semen parameters and hormone profiles in men with primary and secondary infertility. The study was designed as a retrospective analysis of data collected from men attending a combined infertility clinic [seen together by urologist and gynaecologist] from January 2005 to December 2008 at Sultan Qaboos University Hospital, a tertiary care hospital in Oman. Ninety-eight consecutive male patients with one or more abnormalities in semen analysis were referred to the combined infertility clinic. A complete physical examination was carried out by a urologist followed by hormone evaluation of follicle stimulating hormone [FSH], luteinizing hormone [LH], testosterone [T] and prolactin [PRL]. The semen parameters and the sex hormone evaluation were not significantly different between the men with primary and secondary infertility. The men with primary infertility were younger than the men with secondary infertility. A total of 24% of the men in the primary group and 16% in the secondary group were azoospermic with normal gonadotropin values in 9 men and 1 man in the primary and secondary group respectively. Azoospermia was more common in the primary infertile group and, based on gonadotropin levels, obstructive causes seemed more prevalent in the primary group compared to secondary group

Magnetic resonance pelvimetry for trial of labour after a previous caesarean section

To stratify the magnetic resonance [MR] pelvimetric diameters according to mode of delivery and establish possible reference values for pelvic diameters and outlet index for trial of labor after a previous caesarean section. This is a retrospective study of 125 patients at Sultan Qaboos University Hospital who underwent MR pelvimetry prior to a trial of vaginal delivery after a previous caesarean section between May 2001 and October 2003. Sagittal inlet, Transverse inlet, interspinous diameter, sagittal outlet and transverse outlet diameters were measured in all patients. The mean diameters were stratified according to delivery modality [vaginal delivery or caesarean section]. The outlet index [sum of interspinous, sagittal outlet and intertuberous diameters], biparietal diameter of the foetus and head circumference were compared in women who delivered by caesarean section or vaginally. All the diameters except sagittal inlet, were significantly larger [P < 0.05] in women who delivered normally as compared with those who had a caesarean section for any indication. The mean outlet index in the spontaneous delivery group with vertex presentation 31.89 +/- 2.05, was significantly larger than that of the elective and emergency caesarean section, which were 29.69 +/- 1.85 and 30.62 +/- 1.80 respectively. The mean head circumference was also found to be significantly larger in the caesarean section deliveries. An outlet index of 31.89 +/- 2.05 and the pelvic diameters, transverse inlet 12.56 +/- 0.80cm, sagittal outlet 10.54 +/- 1.00 cm, interspinous diameter10.46 +/- 0.89cm, and intertuberous diameter [transverse outlet] 10.89 +/- 1.02cm are useful cut-off points for vaginal delivery in our population

Ultrasound location of misplaced levonorgestrel releasing intrauterine system [LNG-IUS] - is it easy?

The Levonorgestrel intrauterine device [LNG-IUD] is a hormone-containing device licensed for treatment of menorrhagia and contraception. Though complications such as perforation have been reported similar to other non-hormonal intrauterine devices, the diagnosis of such complications is difficult with this device because the LNG-IUD has a different ultrasound appearance compared to copper devices and these case reports are intended to emphasize this point