relationship between body mass index [BMI] and pregnancy complications including mode of delivery

To study the impact of prepregnancy BMI on the mode of delivery. We wish to test the hypothesis that a raised BMI in the first trimester predicts a higher rate of medical complications and operative deliveries. This is a prospective observational study of women delivering at the Women's Hospital during January and February 2005. Of 340 primigravidas who delivered during that period we included sixty in the study using exclusion criteria such as booking after the first trimester and multiple pregnancies. The authors collected data; a sheet was used and then entered in the computer. The obstetric outcomes looked into by means of SPSS statistical package. Both overweight and obese patients showed a higher pregnancy complication rate as compared to those of normal prepregnancy BMI. Glucose intolerance [25% in the obese Vs 15%in the normal BMI group]. Hypertension was 8.3% in the obese vs. 0% in the normal BM1 group. Obstetric interventions were also significantly higher in the High BMI group. Induction of labour was 31% in the obese group compared to 15% in the normal BMI group, prolonged second stage was 56% in the obese versus 37% in the normal BMI group, Caesarean section [CS] was 46% in the overweight women and 33% in the obese vs. 20% in the normal BMI group. Fetal macrosomia was 12.5% in the obese compared to a zero percent in the normal BMI group. The rate of prematurity was significantly reduced in the obese] 0% vs. 15% [n=3] in the normal BMI group with 26.7% [n=4] in the overweight.] A high BMI may be an indicator of risk for the pregnancy and delivery

Non-invasive diagnosis of fetal anemia due to maternal red- cell alloimmunization

To determine the value of measurement of velocity of the middle cerebral artery [MCA] in the prediction of fetal anemia in alloimmunized pregnancies without ultrasound evidence of hydrops and to see if this could replace the invasive techniques in the diagnosis and management of this condition. In a prospective cohort study, 65 non-hydropic fetuses with red blood cell alloimmunization were evaluated with ultrasound and Doppler imaging. This study was carried out at Feto Maternal Medicine Unit at Women's Hospital, Hamad Medical Corporation, Doha, Qatar from January 2003 to December 2003. Middle cerebral artery-peak systolic velocity [PSV] was measured. We interfered only if there is a sign of fetal anemia as indicated by changes in blood velocity in MCA using the table designed by Giancarlo Mari or the fetus developed signs of hydrops fetalis. Immediately after delivery, the blood was taken from umbilical cord for full blood count, blood group, bilirubin and antibodies level. Results before first fetal blood sampling [FBS] or delivery were analyzed. Sixty-five patients met the inclusion criteria for the study and were managed. Sixty-three women were alloimmunized with rhesus [Rh]-D antibodies and 2 with anti-C. With the conventional management, all 65 patients undergone amniocentesis to determine bilirubin levels. However, with non-invasive management, 60 women were safely prevented from undergoing invasive testing or invasive procedures. Amniocentesis was performed for only one [1.54%] patient, despite having a normal MCV-PSV which was carried out solely due to the care provider was insisting on this procedure and the result was normal. Planning delivery based on MCA-PSV allowed us to deliver 97% [63/65] of these babies without any signs of severe anemia between 28-38 weeks. Two [3%] of the fetuses were diagnosed as severely anemic with MCA-PSV. In both cases, anemia was confirmed by FBS and intra uterine transfusion was carried out immediately to the test. Only 2 babies were diagnosed anemic after birth and underwent blood transfusion. Doppler evaluation of MCA-PSV is effective in the prediction of fetal anemia in red blood cell alloimmunization. Using this technique will reduce the number of invasive procedures needed with the added risks of these procedures with good fetal outcome

Female genital mutilation and child birth

The practice of female genital mutilation sadly remains to this day, part of the life of many women worldwide. In the Middle East and Africa, it is hard to practice obstetrics and gynecology without some knowledge of the condition. This review is an attempt to discuss the salient points as regards to management of these women during pregnancy and labor

Cesarean section on request

Obstetricians are facing a tide of non-medically indicated requests for cesarean section. Risks and benefits of accepting cesarean section on request are discussed