Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women in south western, Saudi Arabia.

This study aimed to determine the seroprevalence of Toxoplasma gondii in pregnant women in the south western region of Saudi Arabia and to find out the possible risk factors that may lead to infection. This cross sectional hospital based study was carried out at three hospitals in the south western region of Saudi Arabia from January 2008 to August 2010. Blood samples from 487 pregnant women were collected and used to detect anti-T. gondii antibodies IgM and IgG by enzyme linked immunosorbent assay (ELISA). A questionnaire interview was carried out to ask about some risk factors of infection. Among the 487 studied pregnant women, 38.8 % were seropositive for anti T. gondii IgG while 6.2 % were positive for anti T. gondii IgM and 3.3 % were positive for both anti T. gondii IgG & IgM. The only risk factor associated with seropositive anti T. gondii IgM was the history of the intake of immunosuppressive drugs. Regarding anti T. gondii IgG seropositivity, it was found to increase significantly with increased age, number of gravida and parities, and previous history of toxoplasmosis. The seroprevalence of T. gondii IgG & IgM by ELISA among pregnant women in the south western region of Saudi Arabia is considerable with few identifiable significant risk factors reported.

Detection of Toxoplasma gondii DNA by PCR in blood samples collected from pregnant Saudi women from the Aseer region, Saudi Arabia.

BACKGROUND AND OBJECTIVES: Toxoplasmosis, caused by Toxoplasma gondii, is diagnosed mainly by serological methods that are hindered by insufficient sensitivity. When it fails, it becomes necessary to rely on either direct detection of the parasite or DNA detection by polymerase chain reaction (PCR). We aimed to establish molecular tools for toxoplasmosis research in the country by using PCR targeting the B1 gene and compare it with ELISA results. DESIGN AND SETTING: Conducted at the College of Science, King Khalid University, Abha, Saudi Arabia between January 2009 and April 2010 on Saudi pregnant women attending three major hospitals in the Aseer region. PATIENTS AND METHODS: Peripheral blood samples (n=137) were collected from patients. DNA was extracted and the B1 T gondii gene was amplified by PCR. The amplicons were visualized and sequenced, and the results were analyzed. For comparison, sera were tested for anti-T gondii IgG and IgM by enzyme-linked immunosorbent assay (ELISA). RESULTS: Of the 137 samples tested, the B1 gene could be amplified in 56 cases (41%) by PCR. DNA sequencing confirmed these results. IgM-ELISA assay detected 9 (6.5%) of these cases. The results of immunoglobulin G detection were positive in 53 (38.6%) of the patients. CONCLUSION: The present study showed the need for PCR as a confirmatory assay in addition to serological assays to detect recent infection. We recommend national implementation of these molecular diagnostic tools.

Ultrasound guidance during embryo transfer: a prospective, single-operator, randomized, controlled trial.

OBJECTIVE: To determine whether the implementation of ultrasound (US) guidance will improve the clinical outcomes of ET compared with the standard clinical touch method of embryo catheter placement. DESIGN: Prospective, single-operator, randomized, controlled trial. SETTING: Saudi Center for Assisted Reproduction. PATIENT(S): Three hundred seventy-three women. INTERVENTION(S): Transcervical, intrauterine ET with or without US guidance. MAIN OUTCOME MEASURE(S): Primary outcomes were the live-birth/ongoing pregnancy and clinical pregnancy rates per randomized woman. Secondary outcomes were the incidences of difficult transfers, blood and/or mucus on the catheter tip, spontaneous miscarriages, and ectopic pregnancies. RESULT(S): Demographics and cycle characteristics were not different between the two groups. The live-birth/ongoing pregnancy rate was significantly higher in the US ET group (68 of 183, 40.98%) than in the clinical touch ET group (50 of 190, 28.42%) (odds ratio = 1.66, 95% confidence interval 1.07-2.57). In addition, there was a significantly higher number of clinical pregnancies in the US ET group (75 of 183, 40.98%) than in the clinical touch ET group (54 of 190, 28.42%) (odds ratio = 1.75, 95% confidence interval 1.14-2.69). Secondary outcomes were not significantly different between the two groups. CONCLUSION(S): Ultrasound-guided ET significantly increases ongoing pregnancy/live-birth and clinical pregnancy rates compared with the clinical touch method.

Breech delivery before and after the term breech trial recommendation.

OBJECTIVE: To compare the outcome of breech delivery at term in women before and after the term breech trial (TBT) recommendation. METHODS: A retrospective study carried out at Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia comprising 796 women with breech presentation at term who delivered at our hospital between May 1997 and February 2005 divided into 2 groups. Group 1 consisted of 394 patients who were delivered 4 years before the recommendation of the TBT, and group 2 comprised 402 patients delivered 4 years after the recommendation. RESULTS: There were no statistically significant differences between the 2 groups with regards to the mean maternal age and birth weight, p>0.05, however, parity, gestational age at delivery, booking status, and cesarean section (CS) rate reached statistically significant levels, p<0.05. Assisted vaginal delivery was conducted in 106 (26.9%) of patients in group 1 and 69 (17.1%) in group 2, this also was statistically significant. No statistically significant differences were found between the 2 groups regarding the perinatal mortality, low Apgar score, <7 at 5 minutes and complications during delivery, p>0.05. CONCLUSION: There was a dramatic increase in the rate of CS without a corresponding improvement in the neonatal outcome in the years following the TBT recommendation in our hospital. We suggest that the policy is formulated to reduce the number of unbooked patients with breech presentation at term in our community to reduce the CS rate in these groups of patients.

Removal of cervical mucus prior to embryo transfer improves pregnancy rates in women undergoing assisted reproduction.

The removal of cervical mucus during embryo transfer has been postulated to increase the pregnancy and implantation rates by not interfering with embryo implantation. Even so, this is a time-consuming procedure that may increase the incidence of difficult transfers by removing the naturally lubricant mucus. In addition, any cervical manipulations at the time of embryo transfer may cause unwarranted uterine contractions. In this prospective, controlled study, 286 women undergoing embryo transfer between January and May 2006 were divided into two groups according to whether the cervical mucus was scheduled to be aspirated (group A) or not (group B). The two groups were similar with regards to the demographics, cause of infertility, characteristics of ovarian stimulation and embryos transferred. Even so, the clinical pregnancy rate was significantly higher in group (A) than group (B) (OR = 2.18, 95% CI = 1.32-3.58), although there were easier transfers in group (B) than group (A) (OR = 3.00, 95% CI = 1.05-8.55). This demonstrates that even though embryo transfers were easier to perform when the cervical mucus was left in place, aspiration resulted in an increased chance of clinical pregnancy.