Pregnancy outcomes at advanced maternal age in a tertiary Hospital, Jeddah, Saudi Arabia.

OBJECTIVES: To evaluate obstetrical and fetal outcomes among advanced maternal age (AMA) women. METHODS: Retrospective cohort study carried out at a teaching hospital, Jeddah, Saudi Arabia, during 18 years period (from January 2003 until December 2020). A total of 79095 women gave birth, and randomized block was used to include 4318 singleton pregnancy women (>28 gestational weeks), of them 2162 age ≥40 years. Associations between AMA and obstetrical and fetal parameters were assessed. RESULTS: Advanced maternal age independently associated with non-Saudi national, mother's weights 80-99 kg, diabetes mellitus, and hypertension. Advanced maternal age mothers were more liable to premature rupture of membranes (PROM), caesarean (CS) deliveries, and postpartum hemorrhage. Newborn of AMA women were at high risk of birth weight <2500 g, birth weight 3600-4500 g, decline Apgar score at 5 minutes, and neonatal intensive care unit (NICU) admissions. CONCLUSION: Advanced maternal age is an independent risk factor for adverse obstetric hazards as CS, antepartum haemorrhage, diabetes mellitus, hypertension, PROM, postpartum hemmorage, and fetal complications as low birth weight, macrosomia, NICU admission, congenital anomalies, and low Apgar score. These results must be carefully considered by maternal care providers to effectively improve clinical surveillance.

Practices and complications of pubic hair removal among Saudi women.

BACKGROUND: Pubic hair grooming, including the complete removal of pubic hair, has become an increasingly common practice, particularly among young women. Although widespread, there is limited data regarding the methods, products, reasons, and complications of pubic hair removal, particularly among Saudi women. The objective was to examine pubic hair removal practices and the prevalence of its complications among Saudi women living in Jeddah, Saudi Arabia. METHODS: In this cross-sectional study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, Saudi women between 16 and 60 years of age who had the ability to read and speak Arabic, were eligible to complete an anonymous and self-administered survey on pubic hair removal practices and its complications. RESULTS: Between December 2015 and September 2016, 400 Saudi women completed the survey. The age was 26.3 ± 6.9, 16-58 (mean ± SD, range) years. About three quarters (77.0%) self-removed their pubic hair, while the remainder made use of professional personnel in medical clinics (15.5%), beauty salons (5.3%), and professional services at home (2.2%). Many women (41.8%) used a combination of hair removal methods, with non-electric razor as the most common single method used (33.5%), followed by laser (8.7%), sugaring (6.0%), waxing (4.5%), trimming (2.0%), electric razor (2.0%), and cream (1.5%). Three-quarters of women (75.5%) reported complications, and although they were mostly minor injuries, treatment had to be sought for 17.9% of complications. Multivariable analyses showed that no variables remained correlated with the occurrence of complications (age of starting hair removal, income, BMI, level of education, mode of removal, advice on removal). CONCLUSIONS: Saudi women initiate pubic hair removal in early adolescence. While most complications are minor, close to one in five women experience complications.

Randomized clinical trial between hourly titrated and 2 hourly static oral misoprostol solution for induction of labor.

BACKGROUND: Misoprostol is an effective agent for the induction of labor. Existing guidelines recommend oral misoprostol solution 25 µg every 2 hours. However, more research is required to optimize the use of oral misoprostol solution for the induction of labor. OBJECTIVE: The purpose of this study was to compare efficacy and safety of hourly titrated-dose oral misoprostol solution with static-dose oral misoprostol solution every 2 hours for labor induction. STUDY DESIGN: In this randomized controlled study, oral misoprostol solution was administered as (1) 20 µg hourly (≤4 doses) that was increased in the absence of regular uterine contractions to 40 µg hourly (≤4 doses) and then to 60 µg hourly (≤16 doses) or (2) 25 µg every 2 hours until active labor began (≤12 doses). A sample size of 146 women was planned with the use of a projected 95% rate for the primary endpoint (vaginal delivery within 24 hours) for hourly titrated-dose misoprostol and 80% rate for static-dose misoprostol every 2 hours. Safety outcomes included maternal morbidity and adverse neonatal outcomes. RESULTS: From December 2013 to July 2015, 146 women were assigned randomly to treatment. Demographic and clinical factors were similar between groups, except for age. Vaginal delivery was achieved within 24 hours in 47 women (64.4%) who received hourly titrated-doses of misoprostol solution and 48 women (65.8%) who received 2-hourly static-dose misoprostol solution (P=1.00). Rates of vaginal delivery within 24 hours did not differ significantly between treatment groups for women who were nulliparous (P=1.00) or who had postterm pregnancies (P=.66), a Bishop score of ≤3 (P=.84), or oxytocin augmentation (P=.83). Cesarean deliveries were performed within 24 hours in 9 women who received hourly titrated-dose misoprostol solution and 2 women who received 2-hourly static-dose misoprostol solution (P=.056). Pyrexia and meconium-stained liquor occurred more frequently with the hourly titrated-dose regimen. CONCLUSION: The static-dose oral misoprostol solution every 2 hours has similar efficacy as hourly titrated-dose misoprostol solution but with fewer side-effects and lower complication rates.

Randomized clinical trial between hourly titrated oral misoprostol and vaginal dinoprostone for induction of labor.

OBJECTIVE: The objective of the study was to compare the efficacy and safety of hourly titrated oral misoprostol with vaginal dinoprostone insert. STUDY DESIGN: Subjects were randomized into hourly titrated oral misoprostol or dinoprostone 10 mg vaginal insert. Misoprostol was given as 20 µg hourly for 2 doses. In the absence of regular uterine contractions, the dose was increased to 30 µg hourly for 3 doses and then 40 µg for 1 dose, 50 µg for 1 dose, and 60 µg hourly for 4 doses. Before the 40 and 50 µg doses, 1 more hour of observation was given. The primary outcome variable was vaginal delivery within 24 hours. Safety assessments included the incidence of maternal morbidity and adverse neonatal outcomes. RESULTS: A total of 160 women was enrolled in the study. The groups were similar for demographic and clinical factors. Vaginal delivery was achieved within 24 hours in 100 women (62.5%): 44 in the dinoprostone group (55.0%) and 56 in the misoprostol group (70.0%) (P = .05). The proportion of women who achieved vaginal delivery within 24 hours was significantly greater for nulliparous women in the misoprostol group (24 of 51, 58.5%) compared with the dinoprostone group (12 of 36, 33.3%; P = .0270). Significantly more women with baseline Bishop score of 3 or less in the misoprostol group had successful induction (43 of 59, 72.9%) compared with the dinoprostone group (27 of 60, 45.0%; P = .002). Frequencies of maternal adverse events were similar between groups. CONCLUSION: Hourly titrated oral misoprostol can provide an efficacious and safe substitute for the expensive dinoprostone vaginal insert.