Undiagnosed term breech: management and outcome.

OBJECTIVE: To assess the antenatal and intra-partum risk factors associated with undiagnosed breech at term and to compare their outcome with those diagnosed before the onset of labor, as well as identifying the determinants for cesarean section in breech presentation. METHODS: Case control study of 183 undiagnosed breech deliveries at term with those diagnosed before labor. RESULTS: There was no significant difference between diagnosed term breech and undiagnosed breech deliveries with regards to maternal, neonatal outcome and incidence of cesarean section. Footling breech presentation, hypertension and failure to attend antenatal visits were independent risk factor for cesarean section in all case of breech. CONCLUSION: Undiagnosed breech at term are not at increased risk for cesarean section and there is no additional maternal or fetal morbidity.

Socio-demographic characteristics of the "unbooked mother".

In a study to investigate the characteristics of the "Unbooked mother", the medical records of 467 patients who presented for delivery with no prenatal care at the obstetric unit of the King Khalid University Hospital (KKUH), Riyadh, during the period 1991 to 1995 were evaluated. For controls, the records of 415 mothers who had pre-natal care in the Unit over the same period were also evaluated. Data pertaining to their socio-demographic characteristics, previous obstetric history, prevalence of pregnancy-related and familial diseases, gestation age at delivery and weights of the babies, were extracted and analysed using odds ratios and 95% confidence intervals (C.I.). The unbooked mother tended to be young (< or = 24 years), unskilled worker, or student. On the other hand, the booked ones tended to be primigravid, with pregnancy-related (PET) and familial diseases (hypertension and diabetes). However, the level of parity, gestation age and birth weights did not appear to significantly influence the tendency to be booked or unbooked. These findings highlight the group of women who should be targeted for health education counselling regarding the value of prenatal care. This way, one can avoid some of the catastrophes often said to be associated with deliveries in the unbooked mother.

Hysterectomy - A female Gynecologists perspective.

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Correlation of smoking and coffee drinking with sperm progressive motility in infertile males.

The objective of the study was to assess the effect of some social characteristics on the forward progressive motion of sperms in males of infertile couples. The study was conducted in the Department of Obstetrics and Gynecology, King Kahlid University Hospital (KKUH), Riyadh, from September 1, 1994 to February 28, 1995. Semen specimens were obtained from 68 Saudi males of infertile couples, and 29 fertile males. Using computer-assisted semen analysis (CASA), sperm forward progressive motion was determined and graded on a scale of 1-4. The actuarial life table survival analysis method was used to investigate the sperm motility potentials across intervals 0-1, 1-2, 2-3, and 3-4 and the effect of smoking and coffee drinking was also determined on the sperm motility. Smoking was found to significantly improve sperm motility among the infertile group. Similarly, frequent coffee drinking was shown to enhance sperm motility. There is a need for further studies on the influence of smoking and coffee drinking, as well as the plethora of other influence of the daily life that may compound the detection of the subtle changes in semen quality.

An appraisal of the appropriateness of the indications for hysterectomy.

Over a five-year period, 197 hysterectomies were performed at King Khalid University Hospital (KKUH). Indications for the procedures vary from menstrual disorders and symptomatic fibroids to ovarian malignancy. The most common indication was found to be menorrhagia. Among multiple pre-operative indications, only the first listed major indication for hysterectomy was chosen. There were 145 abdominal and 52 vaginal hysterectomies and all were elective gynaecological procedures, majority of which were performed on women in their fourth and fifth decades of life. Verification of pre-operative diagnosis, when correlated with pathological findings, showed that some of the indications for the procedure deserve a more critical reappraisal. Since hysterectomy carries substantial economic and medical consequences, indications for undertaking the procedure deserve more careful scrutiny given the surgical and nonsurgical options that are currently available. There may be a need, therefore, to assess the appropriateness or otherwise of the use of hysterectomy in many of the patients in future.

High prevalence of clinical obesity among Saudi females: a prospective, cross-sectional study in the Riyadh region.

A cross-sectional study of 1385 Saudi females attending 15 health centres in urban and rural areas in the Riyadh region was conducted during September and October 1992 to determine the prevalence of obesity and its associated factors. The mean age was 32.2 +/- 11.7 years and body mass index (BMI) 29.2 +/- 7.0 kg m-2. Only 26.1% of subjects were their ideal weight (BMI < 25 kg m-2), while 26.8% were overweight (BMI 25-29.9 kg m-2), 41.9% were moderately obese (BMI 30-40 kg m-2) and 5.1% were morbidly obese (BMI > 40 kg m-2). High-risk groups for obesity were mostly middle aged, multiparous housewives. Patients living in rural areas had greater BMIs than those living in urban areas (P < 0.01). Thirty per cent of overweight participants did not think they were overweight. The study emphasizes the need for community based programmes for preventing and reducing obesity since weight control is effective in ameliorating most of the disorders associated with obesity such as Type 2 non-insulin dependent diabetes mellitus, hypertension, stroke, heart disease, sleep apnoea syndrome and osteoarthritis of the knees. The focus of efforts should be directed towards young mothers who are at risk of developing obesity and who play a central role in perpetuating it in their offspring.