Stillbirths in Qatar: a review of 83 cases.

To evaluate the aetiology, diagnostic procedures and current management of stillbirths in Qatar, 83 stillbirths with a birth weight of more than 500 g were studied. The validity of the cause of death was classified as certain, probable and unexplained. Frequency and descriptive statistics were used. The stillbirth rate was 8.15 per 1000. The cause of death was certain in 29%, probable in 62% and remained entirely unexplained in 9% of the cases. The major factors that might be the causes of fetal death were intrauterine growth retardation (23%), abruptio placentae (16.3%), congenital anomalies (13.3%), gestational diabetes (9.6%) and hydrops fetalis (7.2%). The cause of death was found unavoidable in 24 cases (29%). The autopsy rate was terribly low (1/80) and far away from the recommended rate of 75%. The introduction of a stillbirth programme, that includes post-mortem autopsy, in any maternity hospital, is considered crucial to reach a specific diagnosis for almost all stillbirths and to prevent fetal death in future pregnancies. However, if the patient or her family refused autopsy, a combination of patience and learned communication can pave the way to their understanding and acceptance of the procedure. Postmortem magnetic resonance imaging may be used as alternative to autopsy if it is refused.

Case series of uterine rupture and subsequent pregnancy outcome.

OBJECTIVE: TO review the incidence of ruptured uterus at Women's Hospital, Hamad Medical Corporation (HMC), highlight the management approach of suture repair in relation to maintaining the patient's future fertility, and study subsequent pregnancy outcome and the risk of recurrent uterine rupture. METHODS: Case notes were reviewed for every patient with a ruptured uterus at the Women's Hospital in Doha for a period of 15 years, from 1 January 1983 to 31 December 1997. RESULTS: There were 17 cases of ruptured uterus. The incidence of ruptured uterus was calculated to be 0.012%; eight (47%) of these occurred in patients with previous cesarean scars, while nine cases (52.9%) were grand multiparas (5 or more). In nine cases (52.9%), uterine rupture was associated with oxytocin use, and four patients (23.5%) were associated with prostaglandin E2 (PGE2) use. The ruptures occurred in the posterior uterine wall in one patient, the scar of a classical cesarean section in another, and in the lower segment in the remainder. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in eight cases (47%). The remaining nine patients had suture repair, two with sterilization, and the other seven without sterilization. Six of these subsequently became pregnant, for a total of ten babies, all delivered by cesarean section. CONCLUSION: Even though rupture of the uterus was rare in our study, its occurrence should be suspected when there are sudden fetal heart abnormalities during labor or unexpected antepartum or postpartum hemorrhage. Suture repair should be considered whenever possible to maintain the patient's future fertility.

Gynaecological malignancies in Qatar.

Gynaecological malignancies constitute 6.88% (144 of 2092) of all malignant lesions in Qatar over a 15 year period (1979-1993). Cancer of the cervix was the most common with 54.86% followed by ovarian cancer 22.91%, endometrium 15.97%, vulva and vagina 2.75% and 2.08% respectively. Malignancies of the corpus uteri were rare. No tumours of the Fallopian tubes were registered during the study period. Early marriage, frequent coitus started early in life and increasing number of pregnancies were predisposing factors for the genesis of cancer of the cervix. As in some other developing countries, cervical and ovarian neoplasms tend to occur in the younger age group. Germ cell and gonadal stromal tumours were rare in Qatar and this may suggest rarity of these tumours in women of Arab and Indian subcontinent descent. Increasing number of pregnancies seems to protect against ovarian cancer. Abortions and age at menarche do not influence the incidence of gynaecological malignancies. Our findings provide an adequate data base for planning of gynaecological cancer education, screening programmes and resource allocation in Qatar.