The scope of pediatric and adolescent gynecological problems in Kuwait.

OBJECTIVE: To establish an insight into pediatric and adolescent gynecological disorders encountered in a tertiary care center in Kuwait. SUBJECTS AND METHODS: A retrospective case cohort review of 89 case records of patients under the age of 19 years who were admitted to the Maternity Hospital, Kuwait, from October 2002 through September 2003 was undertaken. For a variety of reasons, 35 patients were excluded and the remaining 54 patients constituted the study population. The patients were divided into 5 groups (A-E): group A = ovarian cysts, group B = disorders of pregnancy, group C = menstrual disorders, group D = gynecological infections and group E = miscellaneous. The clinical presentation and management of patients were analyzed. RESULTS: The following spectrum of gynecological disorders was obtained: 13 ovarian cysts (24.1%), 28 disorders of pregnancy (51.8%), 4 menstrual disorders (7.4%), 2 infections (3.7%) and 7 miscellaneous cases (13.9%). Of the 54 patients, 36 (66.7%) were Kuwaitis and the remaining 18 (33.3%) were non-Kuwaitis. The mean age of the study population was 15.16 years, the median was 15.5 years, and the range was 8-19 years. The mean age of the patients with disorders of pregnancy was 17.52 +/- 1.16 years, which is significantly higher than that of groups A, C and E (p = 0.007, 0.0001 and 0.05). The main presenting symptoms at admission were vaginal bleeding: 31 (57.4%), abdominal pain: 17 (31.5%), abdominal mass: 10 (18.5%), and vomiting: 10 (18.5%). Ultrasonography revealed that dermoid cysts were the most frequently encountered ovarian cysts. Patients were hospitalized for 1-7 days. CONCLUSION: Disorders of pregnancy and ovarian cysts were the most frequently encountered pediatric/adolescent gynecological disorders. It is recommended that there should be a dedicated specialized clinic to guarantee privacy and centralized discreet care for these patients.

Intrapartum performance of patients presenting with diabetes mellitus in pregnancy.

OBJECTIVE: To investigate the intrapartum performance of pregnancies complicated by diabetes mellitus (DM). SUBJECTS AND METHODS: A pilot study (April-June 2005) of medical records of patients with DM admitted into the labour wards of the Maternity Hospital, Kuwait, was undertaken. Consecutive patients, matched for age and parity with the study group and with no medical complications, admitted for induction of labour during the study period served as the control. The ethnicity, obstetric/medical history and antenatal course of the index pregnancy were extracted. The intrapartum, postpartum and the neonatal outcome were documented. Statistical analysis was performed using chi(2) and alternative Welch t tests. RESULTS: During the study period, 3,005 patients were delivered at the hospital, and 177 of these (the study population) presented with DM, an incidence of 5.9%. Another 177 patients admitted for induction of labour served as the control. Of the 177 study patients, 86 (48.6%) were Kuwaitis, and the remaining 91 (51.4%) were non-Kuwaitis, of whom 41 were Arabs (23.2%), 34 Indians (19.2%), and 16 Asians (9%). Of the controls, 65 (36.7%) and 112 (63.3%) were Kuwaitis and non-Kuwaitis, respectively. Of the 177 study patients, 128 (72.3%) presented with gestational DM. The significant complications were pregnancy-induced hypertension (13, 7.3%) and premature rupture of membranes (14, 7.9%). The incidence of caesarean section in the study population (58, 32.8%) was significantly higher than that of the controls (35, 19.8%; p = 0.008). Although the mean gestational ages at delivery in both groups were comparable (p = 0.669), the mean birth weight in the study group was significantly higher, 3.315 +/- 0.605 vs. 3.160 +/- 0.594 kg (p = 0.012). The neonatal complications in the diabetic patients were shoulder dystocia (4, 2.3%) and Erb's palsy (12, 1.1%); there were more perinatal deaths (3) in the control group. CONCLUSION: The incidence of DM was high, and the rate of caesarean section significant. The maternal and neonatal morbidity were high. A prospective study is recommended for enhanced management guidelines.

The reproductive performance of women at 40 years and over.

OBJECTIVE: Adverse pregnancy outcome and increased operative deliveries have been reported in women of advanced maternal age. The objective of our study was to evaluate the reproductive performance of our women 40 years and over, and assess if they were at increased risk for adverse pregnancy outcome compared to younger women. STUDY DESIGN: A retrospective study of all women 40 years and over who delivered singleton pregnancies at Maternity Hospital, Kuwait, from 1 January 2000 through 30 June 2002, was undertaken. One-hundred and sixty-eight women formed the study group while 160 women aged 25-30 years served as the control group. The antenatal records, the intrapartum and postpartum events, and the perinatal outcome were extracted and analysed. Statistical analysis was done by Chi-square test, Fisher exact two-tailed test and the Welch t-test. RESULTS: The mean age of the study and control groups were 41.46+/-1.38 (range 40-47) and 27.40+/-1.67 (range 25-30) years, respectively. The mean parity of the study group, 4.24+/-2.35 was statistically higher than for the control group, 1.69+/-1.39, P < 0.0001. The past history of previous preterm delivery (10.1% versus 4.4%) and previous caesarean section (24.4% versus 11.9%) were more significant in the study group, P = 0.0562 and 0.0053, respectively. Women of 40 years and over presented significantly more medical complications. The incidence of caesarean section in the study group was significantly higher (31.0% versus 16.3%), P = 0.0027, OR 2.310, CI 1.356-3.935. The overall maternal and perinatal outcomes in both groups were comparable and satisfactory. CONCLUSION: Advanced maternal age of 40 years and over was not associated with adverse maternal and perinatal outcome, although the incidence of caesarean section was significantly increased in these women.