Peritoneal inclusion cysts in an adolescent female: A case report and review of the literature.

Several studies have shown that most peritoneal inclusion cysts (PIC) cases occur almost exclusively in women of childbearing age and patients who have had abdominal or pelvic surgery. We report a case of PIC diagnosed in a 19 years old single adolescent female with chronic pelvic pain and secondary amenorrhea with no prior history of abdominal surgery. A multilocular abnormality in the pelvis and a septated pelvic fluid encompassing the ovaries and extending to the right iliac fossa was revealed by ultrasound images and Magnetic Resonance Imaging (MRI), respectively. She was treated with broad-spectrum antibiotics, and after symptoms persisted, a laparoscopic exploration that resolved all symptoms was performed. After histological analysis, she was diagnosed with peritoneal inclusion cysts. PICs are a rare non-ovarian cause of cystic pelvic lesions and should be considered in its differential diagnosis. Furthermore, diagnostic laparoscopy can be performed when no precise radiological diagnosis is obtained. Surgical excision of all visible cyst walls remains the best-recommended treatment.

Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome.

OBJECTIVE: To determine maternal/neonatal complications and outcome in patients with multiple repeat cesarean sections (CSs). STUDY DESIGN: A retrospective case-control study of 144 pregnant women with > or = 4 cesarean sections was compared with a control group of 288 women having 2-3 cesarean sections for maternal, operative and neonatal complications. RESULTS: The study patients had longer operating times (p = 0.0001) due to severe adhesions (p = 0.0005), with increased blood loss and blood transfusion (p = 0.0001). Rupture of the uterus (p = 0.0015), placenta previa (p = 0.0372), gestational age at delivery (p < 0.0002), preterm birth (p = 0.0497) and Apgar scores < 7 at 5 minutes (p = 0.0140) were significant in the study group. There was no significant difference of placenta accreta, bladder and bowel injury, cesarean hysterectomy, wound infection and postoperative pyrexia between the 2 groups. Among the neonates of the 2 groups, NICU admissions, small-for-gestational-age birth weights, large-for-gestational-age birth weights and perinatal mortality were similar. No mother died in the series. The incidence of a single major complication was higher in women with > or = 4 cesarean deliveries (p = 0.0011). CONCLUSION: Repeated CS increases the risk of uterine rupture and intraoperative complications, making these patients a high-risk group. No absolute upper limit for the number of repeat cesarean deliveries can be given. Patients must be informed of the risks of multiple CSs and encouraged to have tubal ligation.

Massive Hematometra due to Congenital Cervicovaginal Agenesis in an Adolescent Girl Treated by Hysterectomy: A Case Report.

A case of massive hematometra with a bicornuate uterus in a 14-year-old mentally handicapped girl complicated by vaginal agenesis and absent cervix is presented. She was managed by abdominal hysterectomy and right salpingo-oophorectomy that included the ovarian cystadenoma. The left ovary was conserved. This treatment was considered appropriate for this patient.

Gestational diabetes mellitus: maternal and perinatal outcomes in 220 saudi women.

OBJECTIVES: To assess the maternal and fetal complications of pregnancy in mothers with gestational diabetes mellitus (GDM) compared with non-diabetic patients who delivered in the hospital during the study period. METHODS: The outcome of pregnancy in 220 Saudi patients with GDM identified from the delivery register/hospital database and matched for age, parity and body mass index with 220 non-diabetic controls were studied retrospectively from their case files. Patients with multiple pregnancies and abnormal presentation of the fetus were excluded from the study. RESULTS: The GDM patients were treated with either diet alone or with additional insulin in some patients who required better control of their blood sugar levels. Patients with GDM had a significantly higher incidence of pre-eclampsia (p<0.0001); preterm delivery (p=0.0226); induction of labor (p<0.0001); cesarean section (p=0.0019); higher mean birth weight (p<0.0001) of babies; large for gestational age infants (p=0.0011); macrosomia (p=0.0186); and admission to the neonatal intensive care unit (p=0.0003), compared with the control group. However, the rates of Apgar score <7 at 5 minutes, respiratory distress syndrome, neonatal hypoglycemia, hyperbilirubinemia and the need for phototherapy were similar in both groups of patients. Congenital anomalies and perinatal mortality rates were not significantly different in the two groups. CONCLUSION: GDM is recognized to be associated with increased rates of adverse maternal and neonatal outcomes, which are supported by the findings of this study. Even the mild form of GDM seems to have significant consequences for women and their offspring and is recommended to be aggressively treated. Evidence suggests that early diagnosis and strict control of blood sugar levels throughout the pregnancy can significantly reduce maternal and fetal complications. A multicenter, randomized controlled trial, based on universally accepted criteria for GDM screening test, standardized diagnostic OGTT and management of all patients with GDM versus the standard obstetric management of the control is warranted.

Immune thrombocytopenic purpura in pregnancy: a reappraisal of obstetric management and outcome.

OBJECTIVE: To evaluate the complications of pregnancy and perinatal outcome in women with idiopathic thrombocytopenic purpura (ITP). STUDY DESIGN: A retrospective analysis of 38 singleton pregnancies, their course, obstetric management and perinatal outcome of 32 patients with known ITP was undertaken. RESULTS: No major antenatal complications were noted among the patients. There were no maternal deaths, and only 1 stillbirth occurred in the series. Fourteen infants were delivered by cesarean section and 24 by vaginal delivery. Neonatal cord blood platelet count was performed in each of the live-born infants and revealed thrombocytopenia in 16 infants, but in only 6 (16.2%) of them was the cord blood platelet count < 50 x 10(9)/L. There was no neonatal death in the study, although 6 infants required supportive treatment with corticosteroids and intravenous immunoglobulin G. No maternal features could be used to predict the neonatal platelet count at birth. These results are comparable with other studies in the recent literature. CONCLUSION: Due to the low incidence of poor neonatal outcome in mothers with ITP, obstetric intervention based solely on their platelet count is not justified. Every patient with ITP should be managed individually, and the routine use of cesarean section should be abandoned.

Ovarian tumors in children and adolescents--a clinical study of 52 patients in a university hospital.

STUDY OBJECTIVE: To review the clinical presentation of ovarian tumors in children and adolescents treated at the University of Dammam and King Fahad University Hospital. DESIGN: Data of the patients was noted retrospectively from the hospital medical records regarding age, presentation, diagnosis, treatment, and outcome. SETTING: The study was carried out in the Ob/Gyn department at King Fahad Hospital of Dammam University, Saudi Arabia between January 1985 and December 2009. PARTICIPANTS: There were 52 patients between 6 and 20 years of age who presented with an ovarian tumor during the study period. INTERVENTION: Preoperative diagnostic approach included history, physical examination, ultrasonography, radiological examination, tumor markers, operative treatment, and histopathological examination of the tumor. Chemotherapy was given to patients where indicated. RESULTS: The main presenting symptom was abdominal pain in 30 (58%) patients. Of the neoplastic tumors, 87% were germ cell tumors, of which 73% were benign while 13% were malignant. Operative procedures included 48 (92%) exploratory laparotomies and 4 (8%) laparoscopic resections. Ovarian cystectomy was done in 23 (44%) patients and salpingoophorectomy in 28 (54%) patients. Of the 7 (13%) patients with malignant tumors, five received postoperative chemotherapy. Three patients with malignancy died in the series. CONCLUSION: Early diagnosis of ovarian masses in young girls is important. Since most of these masses are benign, operation should be designed to optimize future fertility, while the treatment of malignant tumors would involve complete staging, resection of the tumor, postoperative chemotherapy when indicated, to give the patient a chance for future childbearing.

Ovarian tumors associated with pregnancy: a 20-year experience in a teaching hospital.

OBJECTIVE: Pregnancy associated with ovarian tumors was reviewed over a 20-year period to determine the maternal and fetal outcome in patients undergoing surgery during pregnancy. METHOD: A retrospective study of 94 cases of ovarian tumors treated surgically during pregnancy was investigated for incidence, clinico-pathological features and outcome in a teaching hospital between June 1987 and May 2007. RESULTS: The overall incidence of ovarian tumor in pregnant women was 1 in 505 (0.2%) deliveries. Diagnosis of 69.2% tumors resulted in the first and second trimesters of pregnancy. Twenty-two (23.4%) patients presented as an emergency at different periods of gestation and 16 (17.1%) tumors were incidentally discovered at cesarean section which underlines the significance of examining the ovaries routinely at cesarean section. Benign teratoma (39.4%) and serous cystadenoma (24.5%) were the most common types of ovarian tumors found in the study. The incidence of malignant tumors was 5.3%. Tumors with low malignant potential comprised 40% of malignancy. The miscarriage rate after surgery was 44.4% in the first trimester compared with 16.6% in the second trimester. The preterm birth rate was 4.3% in the series. CONCLUSION: The value of clinical and ultrasound examinations in early pregnancy as a diagnostic aid is highlighted. Whenever an ovarian tumor is detected in pregnancy, malignancy should always be suspected. Treatment of an ovarian tumor in pregnancy should be tailored according to the age, parity, clinical presentation, gestational age and histopathology of the tumor. Removal of persisting or enlarging ovarian masses as soon as possible is important to obtain a final histologic diagnosis and rule out malignancy. Early diagnosis and appropriate treatment of malignant tumors offers the best prognosis for the patient.

Preterm singleton breech delivery in a teaching hospital of saudi arabia: vaginal versus cesarean delivery.

OBJECTIVES: The aim of this study was to determine the incidence of singleton preterm breech babies born in a teaching hospital, and to study the influence of the mode of delivery on perinatal outcome in preterm births with breech presentation. METHODS: A retrospective analysis from the medical records of patients who had preterm singleton breech delivery (24 - 36 weeks gestation) was undertaken in a tertiary care hospital in the Eastern province of Saudi Arabia between January 1992 and December 2001. All the patients with intrauterine fetal death, multiple pregnancies and lethal congenital fetal malformations were excluded from the study. Intrapartum and neonatal morbidity and mortality in vaginal versus cesarean delivery groups were the main outcomes measured. RESULTS: Of 24,708 deliveries that occurred in the hospital during the period of study, there were 195 preterm singleton breech deliveries, giving an incidence of 0.08%. One hundred and forty-eight (75.9%) patients delivered vaginally and did not have any medical or obstetric complications. Forty-seven (24.1%) patients underwent caesarean section. While the neonatal morbidity was similar in the two groups, the neonatal mortality was significantly higher for vaginal delivery than cesarean section (p<0.00069). CONCLUSION: In view of the significantly higher neonatal mortality found in vaginal delivery, the present study favors abdominal delivery for a singleton preterm breech fetus.