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1.
Saudi Med J ; 39(4): 373-378, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29619489

ABSTRACT

OBJECTIVES: To reviewe the etiology and management of urogenital fistulas at a tertiary care referral center. METHODS: We retrospectively identified all patients with urogenital fistula referred to the King Fahad Medical City, Riyadh, Saudi Arabia, between January 2005 and July 2016 from electronic records. We collected data on age, parity, etiology and type of fistula, radiologic findings, management, and outcome. Results: Of the 32 patients with urogenital fistula identified, 17 (53.1%) had vesicovaginal fistula. The mean parity was 5.9 (0-15). Obstetric surgery was the most common etiology, accounting for 22 fistulas (68.8%). Twenty of these (90.9%) were complications of cesarean delivery, of which 16 (80%) were repeat cesarean delivery. Forty surgical repair procedures were performed: 20 (50%) via an abdominal approach, 11 (27.5%) via a vaginal approach, 7 (17.5) via a robotic approach, and 2 (5%) using cystoscopic fulguration. The primary surgical repair was successful in 23 patients (74%), the second repair in 5 (16.1%), and the third repair in one (3.1%). One fistula was cured after bladder catheterization, and 2 patients are awaiting their third repair. Conclusion: Unlike the etiology of urogenital fistulas in other countries, most fistulas referred to our unit followed repeat cesarean delivery: none were caused by obstructed labor, and only a few occurred after hysterectomy. Most patients were cured after the primary surgical repair.


Subject(s)
Cesarean Section, Repeat/adverse effects , Vesicovaginal Fistula/etiology , Vesicovaginal Fistula/surgery , Adolescent , Adult , Female , Humans , Hysterectomy/adverse effects , Middle Aged , Parity , Postoperative Complications/etiology , Retrospective Studies , Young Adult
2.
Int Urogynecol J ; 26(7): 1077-8, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25752468

ABSTRACT

Peri-urethral bulking agents are used as a management option for selected patients with stress urinary incontinence (SUI). We present a case of urinary retention and a large firm para-urethral vaginal mass as a complication of peri-urethral collagen injections 3 years before presentation. The patient was managed successfully with complete surgical resection of the mass. Subsequent recurrent SUI was managed using a rectus fascial sling.


Subject(s)
Collagen/adverse effects , Granuloma, Foreign-Body/complications , Urinary Retention/etiology , Collagen/administration & dosage , Female , Granuloma, Foreign-Body/surgery , Humans , Middle Aged , Urinary Incontinence, Stress/therapy
3.
J Pediatr Adolesc Gynecol ; 25(3): 190-4, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22578479

ABSTRACT

OBJECTIVES: Dystocia, the presence of abnormal labor, is the most common indication for cesarean delivery. Risk factors for dystocia include abnormalities of expulsatile forces during labor, fetal factors, and maternal pelvic size abnormalities. The objective of our study was to evaluate the effect of pelvic size on the risk of cesarean delivery rates using adolescent maternal age as an unbiased determinant of pelvic size. METHODS: We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all births in the US between 1995 and 2004 for women aged 12 to 20. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations or chromosomal abnormalities. Maternal age and mode of delivery information was obtained from the birth records. RESULTS: There were 6,188,704 births in our cohort of which 1,863 were to women aged 12; 12,903 to women aged 13; 68,890 to women aged 14, and the remainder to women aged 15 and above. Cesarean delivery rates were highest amongst women aged 12 at 19.59 % and declined to 13.92% amongst 15 year-olds, and 14.84 % amongst 20 year olds. This effect was more pronounced when the analysis was restricted to macrosomic fetuses (P<0.005). CONCLUSION: Cesarean delivery rates increase the younger the maternal age is suggesting that pelvic factors can play an important role in dystocia.


Subject(s)
Cesarean Section/statistics & numerical data , Maternal Age , Pelvis/anatomy & histology , Adolescent , Cephalopelvic Disproportion , Child , Cohort Studies , Dystocia/etiology , Female , Humans , Models, Biological , Pregnancy , Retrospective Studies , Risk , United States , Young Adult
4.
J Pediatr Adolesc Gynecol ; 25(2): 98-102, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22088316

ABSTRACT

OBJECTIVES: Pregnancy in young adolescents is often understudied. The objective of our study was to evaluate the effect of young maternal age on adverse obstetrical and neonatal outcomes. METHODS: We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all births in the US between 1995 and 2004. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations or chromosomal abnormalities. Maternal age was obtained from the birth certificate and relative risks estimating its effect on obstetrical and neonatal outcomes were computed using unconditional logistic regression analysis. RESULTS: 37,504,230 births met study criteria of which 300,627 were in women aged <15 years with decreasing rates from 11/1,000 to 6/1,000 over a 10-year period. As compared to women 15 years and older, women <15 were more likely to be black and Hispanic, less likely to have adequate prenatal care, and more likely to not have had any prenatal care. In adjusted analysis, births to women <15 were more likely to be IUGR, born under 28, 32, and 37 weeks' gestation and to result in stillbirths and infant deaths. Prenatal care was protective against infant deaths in women < 15 years of age. CONCLUSION: Although public health initiatives have been successful in decreasing rates of young adolescent pregnancies, these remain high risk pregnancies that may benefit from centers capable of ensuring adequate prenatal care.


Subject(s)
Birth Weight , Maternal Age , Pregnancy in Adolescence/statistics & numerical data , Adolescent , Adult , Black or African American/statistics & numerical data , Cohort Studies , Female , Fetal Growth Retardation/epidemiology , Hispanic or Latino/statistics & numerical data , Humans , Infant , Infant Mortality , Infant, Newborn , Logistic Models , Middle Aged , Pregnancy , Pregnancy in Adolescence/ethnology , Premature Birth/epidemiology , Prenatal Care/statistics & numerical data , Stillbirth/epidemiology , United States/epidemiology , Young Adult
5.
J Perinat Med ; 39(5): 495-8, 2011 09.
Article in English | MEDLINE | ID: mdl-21714767

ABSTRACT

OBJECTIVE: To identify risk factors for postpartum hemorrhage (PPH) in low risk patients. METHODS: All deliveries between 2001 and 2007 were retrieved. Women with well-established preexisting risk factors for PPH were excluded. Among the remaining women (n=15,198) considered at low risk, various factors were assessed to evaluate their role in PPH. RESULTS: Rates of PPH increased from 1.03 in 2001 to 2.45% in 2007. Gestational age at delivery, induction of labor with oxytocin, cesarean section and regional analgesia were not associated with PPH. Logistic regression analysis demonstrated that the following factors were significantly associated with PPH: increased birth weight (P<0.001), female gender (P=0.006), duration of membrane rupture (P=0.002), duration of second stage (P<0.001), chorioamnionitis (P=0.02), and use of prostaglandins (P=0.041). CONCLUSION: Early recognition of the specific factors presented as associated with PPH should prompt early intervention to reduce the PPH and maternal morbidity.


Subject(s)
Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/etiology , Adult , Birth Weight , Chorioamnionitis/epidemiology , Cohort Studies , Databases, Factual , Female , Fetal Membranes, Premature Rupture/epidemiology , Gestational Age , Humans , Labor Stage, Second , Logistic Models , Male , Pregnancy , Prostaglandins, Synthetic/adverse effects , Quebec/epidemiology , Retrospective Studies , Risk Factors , Sex Factors , Time Factors
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