Outcome of pregnancies with preterm premature rupture of membranes.

OBJECTIVE: To study the outcomes of pregnancies complicated with preterm premature rupture of the membranes (PPROM) between 26-36 week gestation. METHODS: A retrospective study of 36670 pregnancies registered and managed in the Department of Obstetrics and Gynecology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia (KSA) from March 1993 to February 2003. RESULTS: Two hundred and twenty cases of PPROM (0.6%) were registered and treated expectantly out of 36670 total pregnancies registered during the study period. The majority of the cases (38.6%) were delivered within 72 hours of premature rupture of the membranes (PROM). Only 2.3% of the cases were prolonged to a latency period of more than one month. Maternal morbidity included chorioamnionitis (20.9%), postpartum endometritis (6.8%), abruptio placentae (4%) and septicemia (0.5%). The prenatal survival rate was 94.5% whereas neonatal outcomes included neonatal mortality (5.5%), respiratory distress (15.9%), sepsis (7.7%), and necrotizing enterocolitis (3.1%). Our study showed a positive correlation between increasing maternal age and cesarean section; increased maternal and neonatal infection rates with prolonged latency; and increased risk of neonatal infection among mothers having chorioamnionitis. CONCLUSION: The incidence of PPROM in KSA is low. Ultimate goal of therapy must be safety of the mother first. Expectant management should be the rationale if fetal immaturity exists. Induction of labor in PPROM patient > or = 34-week-gestation is a logical approach to minimize maternal infectious morbidity.

Higher order multiple repeat cesarean sections: maternal and fetal outcome.

BACKGROUND: Multiple repeat cesarean delivery is common in many parts of Saudi Arabia. We conducted a retrospective analysis of patient records to determine the major and minor complications as well as the neonatal outcome associated with multiple repeat cesarean sections. METHODS: We analyzed relationships between the number of cesarean sections and various demographic and clinical variables in 150 patients undergoing 4 to 8 cesarean sections (mean 6.0) compared with a control group of 140 patients undergoing 2 to 3 cesarean sections (mean 2.5) during the period from 1996 to 2000 at the Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: Both the gestation age of the mother and birth weight of the baby were lower in the study group compared with the control group (mean gestation age 36 weeks in the study group compared with 37 weeks in the control group (P=0.001), and mean birth weight 2.9 kg for infants in the study group compared with 3.1 kg in the control group (P=0.01). The total duration of the operation was longer in the study group (63 minutes on average) compared with the control (45 minutes on average) (P=0.001). There were 80 cases of severe adhesion encountered during surgery in the study group compared with 40 cases in the control group (P=0.001). There was no difference in the Apgar score of the baby and the neonatal admission rate in the two groups. The incidence of cesarean hysterectomy, uterine scar dehiscence, placenta placenta previa, placenta accreta and bladder injury was similar in two groups. The incidence of post partum pyrexia, wound infection, urinary tract infection, and blood transfusion was also comparable in the two groups. CONCLUSION: No specific additional risk is associated with higher order (four to eight) repeat cesarean sections that is not normally encountered with lower order (two to three) repeat cesarean sections.

Prevalence of gestational trophoblastic disease. A single institution experience.

OBJECTIVE: To study the incidence and time trends of gestational trophoblastic disease in the Kingdom of Saudi Arabia (KSA). METHODS: A retrospective study of medical records of 64,762 pregnancies registered and treated at Security Forces Hospital, Riyadh, KSA, from January 1988 through to December 1998. RESULTS: Fifty-nine cases of hydatidiform mole (36 complete hydatidiform mole (CHM) and 23 partial hydatidiform mole (PHM) and 2 cases of choriocarcinoma were observed, out of 64,762 pregnancies registered at Security Forces Hospital, Riyadh, KSA, during an 11 year period. The temporal trends exhibited significant reduction in the incidence of GTD during the study period. CONCLUSION: The incidence of GTD has declined with the rapid socio-medical development of the KSA, and is now comparable to that of Europe. The optimal management of this disease depends on prompt diagnosis, correct stratification of the risk category and appropriate treatment using various modalities such as chemotherapy and surgery.

Uterine didelphus with obstructed hemivagina.

Complex congenital anomalies of the mullerian ducts can occur in isolation or in association with other developmental disorders. They result from non-development or non-fusion of the mullerian ducts or the failure of reabsorption of the uterine septum. Early diagnosis is necessary to relieve symptoms, optimize preservation of the genital organs and prevent the development of endometriosis. We present a case report to highlight this phenomenon.

Current trends in hormone replacement therapy.

As life span increases, more and more women live longer after the menopause, and see its long-term consequences. The menopause and climacteric have major consequences for the well being of most women, resulting in a variety of symptoms including vasomotor, psychological, sexual symptoms and increased risk of osteoporosis and atherosclerosis. Prevention of osteoporosis and reduction in cardiovascular risks are the long-term goals of post-menopausal hormone replacement therapy. Post-menopausal women who receive hormone replacement therapy have approximately half of the rate of coronary artery disease compared to those who do not take it. Similarly, estrogen replacement alone for 5 years results in 50% reduction in the risk of overall fracture and is a major factor in the prevention and management of osteoporosis. A wide range of estrogen preparations is available for administration by various routes. The choice depends on indications, side effects and convenience. Oral estrogen is the most commonly used preparation followed by transdermal preparation. Controversy still exists over the efficacy and safety of hormone replacement therapy among both the medical and lay authorities. There is overwhelming evidence that hormone replacement therapy improves the quality of life and reduces the morbidity and mortality by reversing the metabolic and pathological changes induced by the menopause. The benefits of hormone replacement therapy out weigh any increased risk of venous thromboembolism or breast, ovarian and endometrial cancers.