Cumulative incidence of venous thromboembolism during pregnancy and puerperium: a hospital-based study.

Pregnancy is associated with an increased risk of venous thromboembolism. The rate of occurrence of this complication has not been reported from this area previously. The aim of this study was to establish the incidence of venous thromboembolism in pregnancy and puerperium by using objective diagnostic methods. From January 1986 to December 1998, 39,757 deliveries were registered at King Fahad Hospital, Al Baha, and 59 of these were referred to hematology services with a clinical suspicion of venous thromboembolism. The majority (86%) of these underwent objective diagnostic methods such as ascending venogram (AV) and color Doppler imaging (CDI) of the venous system for the diagnosis of deep venous thrombosis (DVT). Pulmonary scintigraphy was performed when available and echocardiography was included towards the end of the study. Fifty-nine patients with suspicion of pregnancy-associated venous thromboembolism (PAVTE) were studied. The diagnosis was confirmed in 50 patients, who received anticoagulation therapy. DVT was diagnosed in 35 (70%) cases and pulmonary embolism in 27 (54%) cases. The cumulative incidence of PAVTE was 1.25 cases per 1,000 deliveries (95% confidence interval = 0.89-1.16). One patient died during the study period (0.025 case per 1,000 deliveries). There was a predominance of venous thromboembolism during the postpartum period (66%), and DVT occurred more frequently in the left leg (77%). The risk of pregnancy-associated venous thromboembolism is low and a resulting death rare. Proximal or whole-limb DVT occurs more frequently and there is a predilection for the left leg. The majority of events occur in the postpartum period. A hypercoagulable state probably exists and needs further evaluation.

Spider bite envenomation in Al Baha Region, Saudi Arabia.

BACKGROUND: The purpose of this study was to highlight the clinical features of spider bite envenomation, a subject which has not, to our knowledge, been previously published in Saudi Arabia. PATIENTS AND METHODS: Ten patients (8 males and 2 females) aged between 13 and 75 years (mean 36.8) were hospitalized at King Fahad Hospital, Al Baha, with the diagnosis of spider bites during the 9-year period from June 1988 to May 1997. RESULTS: One of the patients was bitten on the right hand by a brown spider, causing severe cellulitis and tissue necrosis, and requiring surgical debridement and pedicle skin flap graft. The nine other patients (90%) had bites from black spiders identified as black widow spiders. Two of the nine (22.2%) suffered only local reactions in the form of pain, erythema and swelling at the site of bite. The remaining seven (77.8%), had varying symptoms of systemic envenomation, including pulmonary edema, myocardial dysfunction with elevated creatinine kinase, electrocardiographic and echocardiographic abnormalities, progressive paresthesia, generalized body ache, etc. Therapy included analgesics, muscle relaxants, intravenous infusion of calcium gluconate and oxygen where indicated. Specific antivenin therapy was available for only four of the nine patients (44%) with black widow spider bite. Antivenin therapy still produced dramatic relief of the symptoms in the patient with pulmonary edema, even after a delay of 30 hours. CONCLUSION: Spider bite envenomation should be considered in the differential diagnosis of acute surgical abdomen and myocardial infarction.

Venous thrombo-embolism at high altitude.

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