Slack as a virtual undergraduate dermatology community: a pilot study.

BACKGROUND: Dermatology is under-represented in UK undergraduate curricula, and with a diagnostic and educational toolkit that is heavily centred on face-to-face (F2F) clinical examination, dermatology education has been disproportionately affected by the COVID-19 pandemic. Online channel-based messaging apps such as Slack offer an opportunity to engage students in remote, multimodal collaborative learning by reproducing a classroom environment in the virtual space. AIM: To determine the feasibility, acceptability and proof of concept for an online Slack community in undergraduate dermatology education. METHODS: Undergraduate medical students participated in an online classroom for a 6-week programme encompassing case-based discussions, seminars and journal clubs. The platform was facilitated by junior doctors (n = 10) and patient educators (n = 6). Students and faculty completed a post-course evaluation. Students additionally completed a pre- and post-intervention dermatology quiz. Mixed methods analyses included quantitative analyses to explore data trends and qualitative phenomenographic analyses to assimilate key underlying themes. RESULTS: Students (n = 65) were enrolled to join the platform. The evaluation was completed by students (n = 52) from UK universities (n = 27). The majority of students (n = 27) interacted with the platform as passive observers (≤ 5 active interactions with the channel), with a small group (n = 4) of 'super-users' (≥ 100 active interactions). The overall quality of the course was described as 'excellent' by 96% of participants and 100% of faculty. CONCLUSION: A community-based online classroom can act as an enjoyable, acceptable and collaborative means of delivering dermatology education to undergraduate medical students. Its ease of use and supportive nature may also facilitate patient involvement. Such advances may provide vital safeguards against the reduction in F2F learning that has accompanied the COVID-19 pandemic.

To What Extent do Social Determinants of Health Modulate Presentation, ITU Admission and Outcomes among Patients with SARS-COV-2 Infection? An Exploration of Household Overcrowding, Air Pollution, Housing Quality, Ethnicity, Comorbidities and Frailty.

Background: Internationally, researchers have called for evidence to support tackling health inequalities during the severe acute respiratory syndrome coronavirus 2 (COVID19) pandemic. Despite the 2020 Marmot review highlighting growing health gaps between wealthy and deprived areas, studies have not explored social determinants of health (ethnicity, frailty, comorbidities, household overcrowding, housing quality, air pollution) as modulators of presentation, intensive care unit (ITU) admissions and outcomes among COVID19 patients. There is an urgent need for studies examining social determinants of health including socioenvironmental risk factors in urban areas to inform the national and international landscape. Methods: An in-depth retrospective cohort study of 408 hospitalized COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including a two-step cluster analysis were applied to explore the role of social determinants of health as modulators of presentation, ITU admission and outcomes. Results: Patients admitted from highest Living Environment deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services (BHS) deprivation Indies were at increased risk of ITU admission. Black, Asian and Minority Ethnic (BAME) patients were more likely, than Caucasians, to be admitted from regions of highest Living Environment and BHS deprivation, present with multi-lobar pneumonia and require ITU admission. Conclusion: Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. BAME patients are demographically at increased risk of exposure to household overcrowding, air pollution and housing quality deprivation, are more likely to present with multi-lobar pneumonia and require ITU admission. Irrespective of deprivation, consideration of the Charlson Comorbidity Score and the Clinical Frailty Score supports clinicians in stratifying high risk patients.

Screening for depression in a sample of Egyptian secondary school female students.

BACKGROUND: Depression is common in female adolescents. Data on prevalence rates, socio-demographic correlates, and putative risk factors in Egyptian population are needed along with better screening tools to inform future research and service development. We aimed to estimate the point prevalence of depression in a representative sample of Egyptian female students; to detect the sensitivity and specificity of CDI as a screening tool, and to highlight some putative risk factors associated with depression. METHOD: Multistage random selection of 602 female students from public and private secondary schools in Eastern Cairo. All participants were subjected to screening using the Children Depression Inventory (CDI) and the Non-patient version of the Structured Clinical Interview for DSM-IV axis-I disorders. RESULTS: Depression was estimated to be 15.3% by CDI in comparison to 13.3% by SCID-I/NP. The sensitivity and specificity of CDI were 74.8% and 97.6% respectively. Regression Analysis pointed to a number of predictive factors as; academic underachievement, quarrelsome family atmosphere, socioeconomic status, negative life events and family history of psychiatric disorders. LIMITATIONS: The cross-sectional design, the lack of collateral information and access to records precluded inference of casualty. The lack of the rural comparator and samples from other governorates limits the generalisation of results. CONCLUSION: Depression was prevalent in a sample of Egyptian female secondary school students. It correlated with some psychosocial factors and can be effectively screened using CDI. Hence, there is a need for better screening, Psychoeducational programmes, and services for better identification, early intervention and targeting for those at risk.

Effect of dietary chromium supplementation on productive and reproductive performance of early lactating dairy cows under heat stress.

One hundred and twenty early lactating Holstein dairy cows were assigned to investigate the effect of dietary chromium (Cr) supplementation (0 or 6 mg Cr/head/day from organic preparation) on the productive and reproductive performance as well as on some blood serum parameters under heat stress (35-40 degrees C). Cows received treatment from 3 weeks pre-partum through 12 weeks post-partum. Chromium supplemented diet had lower body weight loss and improved dry matter intake with consequent reduction in the energy balance deficits during the first period after calving when compared with the control group. Chromium supplementation increased (p < 0.05) milk yield by 6.7%, 12.3% and 16.5% at 4, 8 and 12 weeks post-partum, respectively, whereas milk composition and milk to feed ratio were unaffected (p > 0.05) when compared with the control. Moreover, dietary Cr supplementation had no effect (p > 0.05) on blood serum glucose, calcium and phosphorus concentrations. A reduction (p < 0.05) of non-esterified fatty acids at 1 week pre-partum, 2 and 4 weeks post-partum was also observed. Serum insulin concentration increased whereas cortisol concentration decreased, when compared with the control group, throughout the whole experimental period. Also Cr supplementation showed a trend towards improving reproductive performance as indicated by increased percentage of pregnant cows in the first 28 days of breeding. It could be concluded that dietary Cr supplementation at level of 6 mg/head/day may offer a potential protective management practice to lessen the effect of heat stress in dairy cattle.

Different Doses of Sublingual Misoprostol versus Methylergometrine for the Prevention of Atonic Postpartum Haemorrhage.

OBJECTIVE: In the poor underdeveloped countries, anaemia is very common in pregnant women. Maternal mortality is four times higher in severely anaemic women than non-anaemic ones and postpartum haemorrhage (PPH) is the most common cause of death. Its main cause is uterine atony, which accounts for more than 70%. The objective of this study is to evaluate the use of sublingual misoprostol in different doses of 600, 800 and1000µg in management of the third stage of labor, with regards to blood loss and incidence of atonic postpartum haemorrhag (APPH). STUDY DESIGN: Double blind randomized controlled study METHODS: One thousand and two hundred parturient were studied in a control and three study groups, each composed of 300 women. Methylergometrine 0.2 mg IM injection and sublingual misoprostol 600, 800 and 1000 µg tablets were given to women in control and the three study groups respectively, immediately after delivery. OUTCOME MEASURES: Duration of the third stage of labour, Blood loss in the third stage of labour, Outcomes in anaemic compared to non-anaemic women, Incidance of atonic postpartum haemorrhage in different groups, Haemoglobin deficit after 24 hrs of delivery, Changes in the women's blood pressure during the study, Side effects of the drug, and, Women's acceptability of sublingual misoprostol administration. RESULTS: Only significant reduction in blood loss and haemoglobin deficits were seen in the third stage of labour and after delivery in women used misoprostol doses of 800 µg and 1000 µg. The incidences of PPH in studied women and controls were almost similar, ranging between 2 and 3%. Similar results were seen in anaemic and non-anaemic women with a higher incidence of APPH in the non-misoprostol user anaemic women. Side effects of the drug were dose related. CONCLUSION: Misoprostol in high dose may be used for managing third stage of labour to reduce maternal morbidity and mortality due to APPH particularly, in the poor underdeveloped countries where, facilities to deliver in health centers, purchase and store the oxytocic ampoules or medically trained persons are not readily available in all places. Benefits of large dose misoprostol outweigh its side effects.

El-menia air inflated balloon in controlling atonic post partum hemorrhage.

OBJECTIVE: To design and test an in-expensive air-inflated balloon that is easy to sterilize and use for the control of atonic post partum hemorrhage (APPH). PRIMARY OUTCOME MEASURE: Maternal Mortality (MM). SECONDARY OUTCOME MEASURES: Surgical maternal morbidities, amount and doses of drugs, blood transfusion units used for resuscitation, general condition of women on admission and outcome on discharge, the resuscitation time and time for regaining normal uterine tone; hospital stay and ICU admission. TECHNICAL OUTCOMES: Incidence of Balloon rupture, allergic manifestations, and pyrexia. METHODS: Randomized clinical trail / cross over study Two hundred and forty women with diagnosis of atonic PPH complicating vaginal deliveries were randomly assigned to be managed either by ecbolics and uterine massage as recommended by the WHO; or by WHO protocol plus El-Menia air inflated balloon. RESULTS: No maternal mortality in either group. The maternal morbidities in the form of surgical intervention (uterine and ovarian artery ligation, uterine compression suture, internal iliac artery ligation and abdominal hysterectomy) were observed in five women in controls and none in the studied women. Blood transfusion units, ecobolic drugs, resuscitation time, regaining uterine tone time, hospital stay and ICU admission were significantly less in studied women than controls. Out of the 19 failures to arrest APPH in the controls; 14 cases responded to secondary application of El-Menia balloon, and only five cases required surgical intervention. CONCLUSION: El-Menia balloon is an inexpensive, easy to apply, effective in controlling APPH with minimal side effects. It is targeted for use on a large scale in developing countries to reduce the maternal mortality and morbidity caused by APPH.

Animal hair as biological indicator for heavy metal pollution in urban and rural areas.

Animal hair is a good biomonitoring tool for heavy metals assessment and reflects the content of heavy metals in the forage and soil. Heavy metals Fe, Mn, Co and Ni as well as toxic metals Cd and Pb were determined in goat, sheep and camel hair, forage and soil collected from four different environmental urban and rural regions. These regions are Aswan city farms, Allaqi desert pasture, Kalabsha farms and Halaiub desert pasture at far south of Egypt. The results reveal that sheep hair contains the highest levels of Fe and Mn (879 and 55 microg/g, respectively), camel hair contains the highest Pb, whereas for goat Cd and Ni were the highest. Heavy metal concentrations in the studied hair reflect the presence of these metals in the surrounding forage and soil and vary from one area to another, and give knowledge of pollution in the area. Correlation statistics analysis and cluster analysis show a good and significant value between metals in hair and plants.

Experimental approaches and analytical technique for determining heavy metals in fallen dust at ferrosilicon production factory in Edfu, Aswan, Egypt.

In this study aimed to evaluate the pollution extent of metals and nonmetals inside and outside the ferrosilicon production factory in Edfu, Aswan, Egypt, raw materials (quartz, cokes, iron oxides), ferrosilicon alloy, silica fume, dust and suspended dust (at different sites) samples were collected from the factory, and fallen dust samples were collected from outside the factory, horizontally (at different sites and different distance and directions) and vertically (at different floors in the selected buildings). Gravimetric methods, X-ray fluorescence (XRF), flame photometer, wide range carbon determinator and atomic absorption spectroscopy tools were used for elements determination. The results indicating that the fallen dust and its element contents on southern factory walls being higher than those on eastern factory walls may be due to the nature of the dusts and effects of wind force and wind direction. Fallen dust levels in different regions outside the factory were found to be affected by the distance, direction and floors. The nature of dust samples was affected by gravity and the suspended dust in different factory units depended on the work capacity and method of handling materials by personnel in different production units. Silica fume was a complicated problem, had dangerous effect against the workers' health, and was characterized by high concentrations of SiO(2) (90.6%approximately 93.6%) and heavy metals (Mn, 420.6 x 10(-6) approximately 520.3 x 10(-6); Fe, 2354 x 10(-6)approximately 2685 x 10(-6); Co, 80.7 x 10(-6) approximately 101.6 x 10(-6) and Ni, 5.3 x 10(-6) approximately 6.05 x 10(-6)). The TSP (Total Suspended Particulate) levels in all factory units were higher than the recommended air quality value (70 microg/m(3)) under Egyptian law. The effect of ferrosilicon factory fallen dust on the surrounding regions decreased with increasing distance between the factory and these regions. The suspended dust samples in the factory units and their components greatly exceeded national and international standards, so health and environmental criteria must be enforced on these units.

Effects of Vitamin E pretreatment on subacute toxicity of mixture of Co, Pb, and Hg nitrate-induced nephrotoxicity in rats.

The aim of the study was to prove that Vitamin E has some beneficial effects on the kidneys of rats by protecting them from the toxicity of certain heavy metals. The protective effect of Vitamin E on Co, Pb, or Hg nitrate and a mixture of them induced nephrotoxicity was tested in a 3-months-old Norway strain (inberd) rat (Raltus norvigus) weighing 100-120g. A study was carried out, which comprised one control group and five experimental groups. In this experiment, nitrate salts of Co, Pb, or Hg were administered subcutaneously (s.c.) either alone (0.5mg/100g body weight) for 4 weeks or as a mixture (0.25mg/100g body weight); Vitamin E internal control (250IU/100g body weight) was administered by oral gavage for 4 weeks, Vitamin E pretreatment for 7 days was followed by concomitant administration of Co, Pb, and Hg, respectively and Vitamin E pretreatment for 7 days, followed by concomitant administration of mixture of three heavy metals for 4 weeks. Blood and kidney tissue samples were taken from the control and all the experimental groups for biochemical and histological study. Nephrotoxicity was characterized by histopathological as well as renal function data. The main pathological changes in the kidney after Co administration were shrunken and degeneration of renal tubule cells, disturbance in their position, size, shape, and staining affinity. Treatment with Hg caused desquamation, necrosis, atrophy, and loss of renal tubule cells and glomeruli. Lead intoxication had a profound effect on the structure and consequently on the function of the rat kidney. Most renal tubule cells were very dense, dehydrated with obscure cytoplasmic details. Most nuclei were shrunken and pyknotic. Also, most glomeruli revealed shrinkage and widening of capsular space. On the other hand, subacute exposure with the mixture of the three heavy metals showed marked destruction and distortion of the renal tubule cells. Marked fibrosis between the damaged tubules was also seen. On the other hand in the recovery groups, i.e., in groups II and III, the previously observed histopathological changes were still present with regression of their intensity. Four-week oral administration with Vitamin E (250IU/100g body weight) revealed no abnormal histological findings as compared with the normal kidney of the control animal, except for some Malpighian corpuscles which demonstrated wide capsular space, and spherical masses were seen within the glomeruli. After pretreatment with Vitamin E for 7 days, followed by treatment with (0.5mg/100g body weight ) Co, Pb, or Hg nitrate alone or with their mixture (0.25mg/100g body weight) for 4 weeks, an improvement in the histological changes were observed compared to those previously seen in groups II and III. The glomeruli showed minimal degenerated changes, the tubular arrangement and cytoplasmic basophilia more or less similar to the normal control. It was also found that the heavy metals were investigated both alone and in combination; the serum creatinine and blood urea level were significantly increased, and this elevation was diminished by Vitamin E pretreatment. According to the present results, it is concluded that combined exposure to a mixture of Vitamin E and examined heavy metals can minimize the histological alteration and diminish the serum creatinine and blood urea level. Also, it was found that the rank order of metal cytotoxicities was Hg > Co > Pb.

Environmental chemical study on the marsh of Fatimid cemetery at Aswan City, Egypt.

Environmental chemical study were carried out on the Fatimid cemetery marsh at Aswan City(24 degrees 1'N and 32 degrees 9'E), Egypt, Marsh contents(warter, soil, sediment, metal and nonmetal-bearing salts, and emergent weed) were analysed to known the source of marsh water, speciation of the different elements between the marsh contents, and the toleration of emergent weed(Phargmites australies) for different metals and their bioaccumulation coefficients. Thus, metals(Ca, Mg, Na, K, Ni, Fe, Mn, Cu, Zn, Cd and Pb) and nonmetals(CO(3)2-, HCO3-, Cl-, SO(4)2-, PO(4)3-, NO3-, SiO2, organic matter and pH value) were determined in the samples. According to the chemical analysis, and applying the base exchange equation(water type) and calculate the hydrochemical parameters for marsh water samples, we can indicate that the marsh water is ground water with Na-SO4 type and deep meteoric genesis. Topsoil of marsh dry land characterized by CaCl as dominant salt, while NaCl is a dominant salt in subsoil. The elevated pH values of marsh contents minimized the metal solubilities in different samples. Phragmites australies showed a strong ability to accumulate Mn and Fe in the aerial part in opposite to Co, Ni and Cd.

Characterisation, classification, and evaluation of some ground water samples in upper Egypt.

Study of the ground water quality at upper Egypt is an essential ingredient for a healthy population, irrigation, and industrial purposes at this developed region. Thus, the measurements of water quality parameters (pH, conductivity, HCO3-, Cl-, NO3-, PO4(3-), SO4(2-), Ca, Mg, TH, Co, Cr, Cu, Fe, K, Mn, Na, Ni, Pb, Zn, and DS) were carried out on ground water samples at different localities in Aswan governorate, Egypt. Differentation of ground water samples according to Cl-, SO4(2-), HCO3- + CO3(2-)' base exchange, and hydrochemical parameters were calculated. Evaluation of the samples for different uses (drinking and domestic uses, irrigation and industrial purposes) were obtained according to WHO standards, sodium adsorption ratio (SAR), and saturation index. Results of this study show that the most ground water samples characterize by good quality for different uses. Statistical analysis of data exhibits positive, good, and interesting correlation values lead to interpretation the results of analyses and suggestion the forms of ions in the water samples.

Risk of retained placenta: multivariate approach.

BACKGROUND: To identify important covariates related to retained placenta using logistic regression analysis. METHODS: The study was carried out in the King Khalid University Hospital, Saudi Arabia, and involved 114 women who had retained placenta, and 116 women with normal deliveries. Chi-square test and logistic regression analysis were used for analysis of data. Adequacy of predictor variables was examined using indices of sensitivity and specificity and plots of probability histograms for prediction of retained placenta among patients and controls. RESULTS: Logistic regression analysis highlighted multiparity, induced labor, small placenta, and large amount of blood loss to be significantly associated with retained placenta. In addition, high pregnancy number, previous injury to uterus, and pre-term labor related significantly to retained placenta. Predictor variables had sensitivity of 65.5% and 87.9% specificity and achieved 77% overall correct classification. CONCLUSIONS: These findings could be used to develop a predictive procedure for identifying high-risk cases of retained placenta.

Retained placenta and associated risk factors.

In a retrospective study, the factors that might influence the retention of placenta such as age, parity, antenatal abnormalities, labour onset and duration, history of uterine surgery and previous retained placenta, were studied in 146 patients with retained placenta. Three hundred women who were delivered vaginally without retained placenta were similarly evaluated under the same conditions. The results showed (in descending order of significance), history of retained placenta, previous uterine surgery, preterm delivery, age above 35 years, placental weight less than 601 g, pethidine use in labour, labour induction and parity of more than five to be associated with retained placenta. The existence of some or all these risk factors in a pregnant woman should alert the obstetrician about the possibility of retained placenta in labour.

Obstetric outcome in uncomplicated prolonged pregnancy.

OBJECTIVE: To study and compare the obstetric outcome in term pregnancies and uncomplicated prolonged pregnancies. METHODS: The study was a retrospective review of 596 cases. The case notes of 286 patients with uncomplicated prolonged pregnancies (> or = 42 weeks) and 310 patients with normal term pregnancies (37 to < 42 weeks) were analyzed. The Gold Stat package was used for statistical coding and analysis. RESULTS: There was no fetal morbidity or mortality among the two groups. However, the number of previous abortions were significantly higher in prolonged pregnancies compared with term pregnancies. Similarly, fetal and placental weights, labor induction and operative delivery rates were significantly higher in prolonged pregnancies. However, there were no significant differences between the patients who were induced and those who had spontaneous labor among the prolonged pregnancies. CONCLUSIONS: There is no doubt that prolonged pregnancy may be associated with certain risks factors. However, there is no outcome variable to justify whether or not to induce those pregnancies which are prolonged.

Outcome in elective and emergency cesarean sections: A comparative study.

To study the obstetrics outcome of cesarean sections (CS) in relation to the elective or emergency nature of this procedure, a comparative study was conducted on 1426 females whose deliveries were by CS in King Khalid University Hospital (KKUH). Of the various factors analyzed in relation to the two types of CS, statistically significant associations were found between emergency CS and younger patients, low parity, irregular attendance at antenatal clinics, complications in labor, postoperative morbidity and low Apgar score(>6). It was concluded that every effort should be directed to effect-planned CS, as determined during the antenatal period, if possible, so as to reduce the various problems associated with emergency CS. The chances are that this approach is unlikely to influence the overall CS rate in either way.

Values of certain clinical and biochemical tests for prediction of pre-eclampsia.

To evaluate different predictive tests for pre-eclampsia, either individually or in combination, we prospectively studied 100 primigravid females. Eighty-eight of the subjects continued the follow-up until delivery and 17 developed pre-eclampsia. Venous blood samples were take for determination of plasma fibronectin, and urine samples were taken for determination of microalbuminaria and calcium-creatinine ratio. Isometric handgrip exercise tests were also performed. Evaluation of predictive tests, as well as t and chi-squared statistical tests, were used for analysis of data. Pre-eclampsia developed in 19.3% of the patients studied. Pre-eclamptic and normotensive females showed significant differences in calcium-creatinine ratio and plasma fibronectin levels in both ( 14-24 weeks and 28-32 weeks) gestation periods (P <.0001). Plasma fibronectin had the best sensitivity, positive, and negative values in gestation period 14-24 weeks, whereas isometric handgrip exercise tests had the best specificity. These values improved for all the tests in the 28-32-week gestation period; even so, plasma fibronectin proved best of all. A combination of tests failed to improve the predictive ability of fibronectin alone. We conclude that plasma fibronectin is the best predictive test for pre-eclampsia.

Sequelae of repeat cesarean sections.

OBJECTIVES: To study and analyze the factors related to repeat cesarean section and to highlight the problems that may be associated with it. METHODS: The study was carried out in the Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh, Saudi Arabia, and involved 395 patients who had had two or more previous cesarean sections prior to the current pregnancy. Various factors which may be associated with repeat cesarean sections, as well as the outcome of the operations, were assessed and analyzed. The chi2-test and other analyses were used to examine the association between the number of cesarean sections and the various variables. RESULTS: Four or more previous cesarean sections was significantly associated with dense adhesions. On the other hand, height, parity, antenatal clinic attendance, postoperative complications, fetal weight and fetal outcome had no significant effect on, nor influenced, the multiplicity of cesarean sections. CONCLUSION: No specific risk is associated with repeat cesarean sections that is not normally associated with single cesarean sections.

Pregnancy following rupture of the pregnant uterus.

OBJECTIVE: To review the cases of ruptured uterus at King Khalid University Hospital (KKUH) over the 11 years of the hospital's existence (1984-1994), to analyze the causative factors of uterine rupture with a view to its prevention, and to highlight the management approach in relation to maintaining the patients' future fertility. METHODS: Case notes were reviewed for all patients with ruptured uterus at KKUH over a period of 11 years from January 1984 to December 1994. Relevant data relating to the clinical features, characteristics of labor, operative procedures, and maternal and perinatal outcome were assessed. RESULTS: There were 11 cases of ruptured uterus, six of which occurred in patients with previous cesarean scars. Two patients were primigravidas, one of whom ruptured her uterus following a road traffic accident. In one patient with six previous preterm labors, rupture resulted from non-removal of cervical cerclage during labor. The rupture occurred in the fundus in one case, and in the lower segment in the remaining 10. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in three cases, two of which were total and the third subtotal. The remaining eight patients had suture repair, all of whom became pregnant later and were delivered by cesarean section. CONCLUSION: Even though rupture of the uterus was a rare complication of pregnancy at KKUH, it occurrence should be suspected when there are sudden fetal heart abnormalities during labor, or unexplained postpartum shock. Suture repair should be considered whenever possible in order to preserve the patients' reproductive potential.

Primary cesarean section in King Khalid University Hospital: Indications and obstetric outcome.

This study was conducted to estimate the rate and indications for primary cesarean section in King Khalid University Hospital, Riyadh, over a period of five years. The overall cesarean section rate of 10.3% was found to be lower than in the Western world. The primary cesarean section rate of 6.1% was equally lower than in most other studies. Breech presentation, failure to progress and fetal distress were the main indications for primary cesarean section in the study. Maternal age, parity and fetal weight were found to be significantly associated with the primary cesarean section rate.