Effects of assisted hatching method and age on implantation rates of IVF and ICSI.

The objective of this study was to investigate whether a change in assisted hatching (AH) technique from total to partial penetration of the zona pellucida improved the outcome of IVF and intracytoplasmic sperm injection cycles where AH was indicated. This was an observational study conducted from the beginning of January 2000 to the end of April 2005. Total AH was performed in 312 cycles, while partial AH was performed in 592 cycles. In women of all ages, implantation, clinical pregnancy and live birth rates were higher in the partial AH group than in the total AH group (12.6 versus 7.2%, P = 0.0001; 22.3 versus 15.7%, P = 0.02; 18.2 versus 12.5%, P = 0.03 respectively). The benefit of partial AH was most marked in women under 38 years old (i.e. the recurrent implantation failure group). The authors conclude that partial AH is associated with higher implantation and pregnancy rates than total AH, especially in women under 38 years old who suffer from recurrent implantation failure.

Scalp and cranial bone metastasis of endometrial carcinoma: a case report and literature review.

OBJECTIVE: The aim of this study is to report a rare case of scalp and cranial bone metastasis of endometrial carcinoma and review the literature. METHOD: We report a 45-year-old multiparous woman with FIGO Stage 1A Grade II endometrial adenocarcinoma who presented 3 years following total abdominal hysterectomy and bilateral salpingo-oophorectomy with scalp and cranial bone metastasis. Similar cases in the literature are reviewed. RESULTS: The patient metastatic workup revealed local, distant, scalp, and cranial bone metastasis. She died within 6 months. The poor prognosis is similar to that of six other cases reviewed. CONCLUSION: Scalp and cranial bone metastasis following endometrial carcinoma is extremely rare. It is a reflection of a widely disseminated disease and poor prognosis. However, single bone metastasis has a better postmetastatic survival with the help of local radiotherapy than scalp and multiple bone metastasis.

Cytogenetic study in cases with recurrent abortion in Saudi Arabia.

BACKGROUND: A proportion of cases with repeated abortion are caused by chromosomal abnormality in one of the parents. Several studies have been done to determine the role of chromosomal abnormalities in couples with repeated fetal loss in various countries. None of these studies was done in the Arab Peninsula. MATERIAL AND METHODS: Cytogenetic study was done for 193 consecutive Saudi couples who presented with repeated abortion at the King Khalid University Hospital in Riyadh, Saudi Arabia. RESULTS: We found that the frequency of chromosomal abnormalities was not significantly different from that reported worldwide. The nature of those abnormalities and their relation to the obstetric history of cases were discussed. CONCLUSION: This study should help physicians working in the region to realize the contribution of chromosomal abnormalities to cases of repeated fetal loss. It should also help in setting priorities of cytogenetic screening in individual cases.

Undiagnosed term breech: management and outcome.

OBJECTIVE: To assess the antenatal and intra-partum risk factors associated with undiagnosed breech at term and to compare their outcome with those diagnosed before the onset of labor, as well as identifying the determinants for cesarean section in breech presentation. METHODS: Case control study of 183 undiagnosed breech deliveries at term with those diagnosed before labor. RESULTS: There was no significant difference between diagnosed term breech and undiagnosed breech deliveries with regards to maternal, neonatal outcome and incidence of cesarean section. Footling breech presentation, hypertension and failure to attend antenatal visits were independent risk factor for cesarean section in all case of breech. CONCLUSION: Undiagnosed breech at term are not at increased risk for cesarean section and there is no additional maternal or fetal morbidity.

Socio-demographic characteristics of the "unbooked mother".

In a study to investigate the characteristics of the "Unbooked mother", the medical records of 467 patients who presented for delivery with no prenatal care at the obstetric unit of the King Khalid University Hospital (KKUH), Riyadh, during the period 1991 to 1995 were evaluated. For controls, the records of 415 mothers who had pre-natal care in the Unit over the same period were also evaluated. Data pertaining to their socio-demographic characteristics, previous obstetric history, prevalence of pregnancy-related and familial diseases, gestation age at delivery and weights of the babies, were extracted and analysed using odds ratios and 95% confidence intervals (C.I.). The unbooked mother tended to be young (< or = 24 years), unskilled worker, or student. On the other hand, the booked ones tended to be primigravid, with pregnancy-related (PET) and familial diseases (hypertension and diabetes). However, the level of parity, gestation age and birth weights did not appear to significantly influence the tendency to be booked or unbooked. These findings highlight the group of women who should be targeted for health education counselling regarding the value of prenatal care. This way, one can avoid some of the catastrophes often said to be associated with deliveries in the unbooked mother.

Abdomino-pelvic packing to control severe haemorrhage following caesarean hysterectomy.

Surgically uncontrollable peri-operative obstetric haemorrhage associated with coagulopathy, developed in five women who were managed by emergency caesarean hysterectomy. All women had a morbidly adherent anterior placenta praevia and a previous lower segment caesarean section scar. Conventional medical and surgical therapy to control bleeding from pelvic and abdominal raw surfaces were unsuccessful. Abdomino-pelvic packing was performed with 10-12 dry laparotomy pads applied firmly over bleeding sites. The abdomen was closed after observation of the cessation of bleeding for 5-10 minutes. Following correction of coagulation and haemodynamic disorders relaparotomy for pack removal was performed 34-48 hours later. One patient developed small bowel obstruction on the 5th post-operative day, however, there was no long term gynaecological morbidity in any of the cases. Abdomino-pelvic packing achieved complete haemostasis in all of the five women which we believe may have been impossible using alternative measures.

Hysterectomy - A female Gynecologists perspective.

Full text is available as a scanned copy of the original print version.

Demographic and fertility variables as determinants of spontaneous abortions in women with previous abortions.

The objective of the study was to examine the demographic and fertility factors that may predispose to spontaneous abortion in women with prior abortion. The study was conducted in King Khalid University Hospital, Riyadh, Saudi Arabia. It included a series of women who aborted their pregnancies over a period of months (January 1; 1992-December 31, 1992). Chi-square and Fisher's exact test were used to analyze the statistical relationship between abortion and various demographic and fertility, related to abortion. There was a direct statistically significant relationship between maternal age, level of education, parity and a history of previous abortion. In a multivariate logistic regression analysis, parity and history of previous abortion were found to be significant as determinants of recurrent abortion. Even though many of these risk factors are not preventable, counseling of the women about the value of education, early reproduction in the child-bearing age, and control of fertility would go a long way in reducing the incidence of fetal wastage in these women.

Correlation of smoking and coffee drinking with sperm progressive motility in infertile males.

The objective of the study was to assess the effect of some social characteristics on the forward progressive motion of sperms in males of infertile couples. The study was conducted in the Department of Obstetrics and Gynecology, King Kahlid University Hospital (KKUH), Riyadh, from September 1, 1994 to February 28, 1995. Semen specimens were obtained from 68 Saudi males of infertile couples, and 29 fertile males. Using computer-assisted semen analysis (CASA), sperm forward progressive motion was determined and graded on a scale of 1-4. The actuarial life table survival analysis method was used to investigate the sperm motility potentials across intervals 0-1, 1-2, 2-3, and 3-4 and the effect of smoking and coffee drinking was also determined on the sperm motility. Smoking was found to significantly improve sperm motility among the infertile group. Similarly, frequent coffee drinking was shown to enhance sperm motility. There is a need for further studies on the influence of smoking and coffee drinking, as well as the plethora of other influence of the daily life that may compound the detection of the subtle changes in semen quality.

Pregnancy trends after abortion.

A series of women who aborted their pregnancies at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, over a period of 12 months (1 January 1992 to 3 December 1992), were followed up for 6-48 months afterwards to examine their pregnancy trends. Descriptive statistics for data presentation with Kaplan-Meier survivorship function estimates time from abortion to the next pregnancy and Cox proportional hazard regression analysis were used to identify prognostic factors. Eighty-one per cent of the women achieved pregnancy over a 4-year follow-up. The median time to pregnancy was 7.6 months, with a 95% confidence interval of 6.4-10.0 months. Age and nationality were found to be significant prognostic factors related to time to achieve a pregnancy. Furthermore, the outcome of the subsequent pregnancy was found to be statistically related to the number of previous abortions. There is a high chance of fertility after an abortion, with 75.2% of these occurring within the first 12 months of the post-abortion follow-up period and dwindling to only 4.1% by the end of 36 months. Using multivariate regression analysis, only age seemed to be an important determinant factor.

Sickle cell and G-6-PD deficiency gene in cord blood samples: experience at King Khalid University Hospital, Riyadh.

Cord blood samples (1039) collected at King Khalid University Hospital were analysed for abnormal haemoglobins using electrophoresis at alkaline and acid pH, for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency using spectrophotometric method and for G-6-PD phenotypes using electrophoresis and specific staining. Only two samples showed the presence of Hb AS and no case of sickle cell anaemia was identified. The Hb S gene frequency was 0.00096. This was the lowest frequency identified so far in different regions of Saudi Arabia. The frequency of G-6-PD deficiency was calculated separately in the males and females, and was found to be 3.605 per cent in the males and 0.195 per cent in the females. Phenotyping showed the presence of G-6-PD-B+ as the normal enzyme at a frequency of 0.943 in both males and females and G-6-PD-A+ at a frequency of 0.0208 in males and 0.0059 in females. The deficient variant was mainly G-6-PD Mediterranean which occurred at a frequency of 0.0341 and 0.0019 in males and females, respectively. Only one case of G-6-PD-A- was identified in the males giving a frequency of 0.0019. This is the first report of Hb S and G-6-PD deficiency genes in cord blood samples in Riyadh. Comparison of the results in Riyadh with values reported elsewhere showed that Riyadh had the lowest frequency of both Hb S and G-6-PD deficiency gene.

An appraisal of the appropriateness of the indications for hysterectomy.

Over a five-year period, 197 hysterectomies were performed at King Khalid University Hospital (KKUH). Indications for the procedures vary from menstrual disorders and symptomatic fibroids to ovarian malignancy. The most common indication was found to be menorrhagia. Among multiple pre-operative indications, only the first listed major indication for hysterectomy was chosen. There were 145 abdominal and 52 vaginal hysterectomies and all were elective gynaecological procedures, majority of which were performed on women in their fourth and fifth decades of life. Verification of pre-operative diagnosis, when correlated with pathological findings, showed that some of the indications for the procedure deserve a more critical reappraisal. Since hysterectomy carries substantial economic and medical consequences, indications for undertaking the procedure deserve more careful scrutiny given the surgical and nonsurgical options that are currently available. There may be a need, therefore, to assess the appropriateness or otherwise of the use of hysterectomy in many of the patients in future.

Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy.

OBJECTIVE: To evaluate the safety and efficacy of intravenous iron sucrose complex (ISC) as compared with oral ferrous sulfate in the treatment of iron deficiency anemia during pregnancy. STUDY DESIGN: prospective, open, controlled study in which pregnant women with iron deficiency anemia were sequentially selected from the antenatal clinic and assigned either to ISC (study group) or to ferrous sulfate (control group). METHODS: Each study patient was given the total calculated amount of ICS (Hb deficit (g/l) x body weight (kg) x 0.3) in divided doses (200 mg (elemental iron) in 100 ml normal saline intravenously over 1 h daily) followed by 10 mg/kg to replenish iron stores. Each patient of the control group was given ferrous sulfate 300 mg (60 mg elemental iron) orally three times a day. All patients were monitored for adverse effects, clinical and laboratory response. RESULTS: There were 52 patients and 59 controls. ISC group achieved a significantly higher Hb level (128.5 +/- 6.6 g/l vs. 111.4 +/- 12.4 g/l in the control group P < or = 0.001) in a shorter period (6.9 +/- 1.8 weeks vs. 14.9 +/- 3.1 weeks in the control group, P < or = 0.001). ISC complex group showed no major side effects while 4 (6%) of the control group could not tolerate ferrous sulfate, 18 (30%) complained of disturbing gastrointestinal symptoms and 18 (30%) had poor compliance. CONCLUSION: We conclude that ISC is safe and effective in the treatment of iron deficiency anemia during pregnancy.

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.

Subchorionic hematoma in threatened abortion: Sonographic evaluation and significance.

In a study of 92 women with subchorionic hematoma evaluated with sonographic scan in King Khalid University Hospital, it was found that the mean ages and live births of patients who carried their pregnancies to viability were higher when compared with the patients who aborted. There was a statistically significant association between the gestational age at diagnosis of subchorionic hematoma and the size of the hematoma. There was, however, no statistically significant association found between the gestational age at diagnosis, size and site of the hematoma and the outcome of pregnancy. It was concluded that subchorionic hematoma which appear either in the second trimester, or are larger, or located in the lower uterine segment, may be associated with higher rates of abortion or preterm deliveries. Nevertheless, there is no statistically significant impact of these on the outcome of pregnancy.

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.