Post-war changes in the outcome of pregnancy in Maternity Hospital, Kuwait.

To analyse the pre- and post-Gulf War changes in the outcome of pregnancy and to explore the possible causes that could have affected these changes, a retrospective analysis of medical records of patients delivering in Maternity Hospital Kuwait (MHK) was carried out for the period 1987-89 (pre-Gulf-War) and 1992 (post-Gulf War). The records of 1991 were used when adequate information was available. The normal z test was used to assess the significance between two proportions. There is a significant rise in abortion, low birth weight babies, triplet pregnancies, and major congenital anomalies in the post-war period. The still-birth rate, early neonatal mortality rate and perinatal mortality rate significantly increased in the immediate post-war period in 1991, but decreased to levels below the pre-war period in 1992. It should be investigated whether these changes are secondary to the changes in the population structure; the effects of war in terms of deterioration of health care services; environmental pollution caused by oil well fires, oil spills; or the psychological trauma, anxiety and stress caused by the Iraqi invasion of Kuwait.

Maternal sexuality during pregnancy and after childbirth in Muslim Kuwaiti women.

The sexuality of Kuwaiti Muslim women before pregnancy, during pregnancy, and 6 months after childbirth was studied. A group of 220 women attending the prenatal clinic of the Maternity Hospital Kuwait were randomly selected; 40 (18.2%) declined at the outset, 10 (4.6%) withdrew due to miscarriage and 10 (4.6%) due to failure to attend interviews. The semistructured interview was conducted by a female obstetrician at 4-week intervals starting from 12 weeks pregnancy to 6 months after childbirth. The study led to the following observations: (i) All the women were religious and abided by the Islamic rules and way of life. (ii) The diagnosis of pregnancy led to a decline in sexuality that continued throughout the pregnancy, with a second and early third trimester increase in sexuality but still below the prepregnancy baseline. (iii) Each woman had a consistent pattern of sexuality during pregnancy reflecting her prepregnancy level of sexuality. (iv) Younger age group, multiparity, low-level of education, lesser duration of marriage, and intention of breast-feeding characterized the sexuality pattern positively, as did attitudes towards sexuality during pregnancy and after childbirth. Breast-feeding mothers exceeded their prepregnancy level of sexuality earlier than bottle-feeding mothers.

A retrospective analysis of pathological placental implantation--site and penetration.

OBJECTIVES: To determine the incidence of pathologically implanted placenta, i.e. placenta previa and accreta, at the Maternity Hospital of Kuwait. In addition the study aimed to identify the risk factors for such conditions, and test the hypothesis that previous cesarean section increases the likelihood of abnormal placentation. METHODS: Analysis of all deliveries in the Maternity Hospital of Kuwait with identification of cases of placenta previa, placenta accreta, previous cesarean section and manual removal of placenta. Information was obtained from the medical records of the hospital between 1981 and 1992 except for the period 1990-1991 due to incomplete information as a consequence of the Iraqi invasion. The incidences of these conditions were calculated followed by identification of risk factors for placenta accreta and previa. RESULTS: The incidence of placenta previa was 0.5% and that of placenta accreta 9.5 per 100,000 deliveries. Placenta previa and previous cesarean section were found to be significant predisposing factors for placenta accreta. The increased risk for placenta accreta in the presence of these factors was much less than that reported in the international literature. Abnormal placentation was responsible for 34% of peripartum hysterectomies. CONCLUSIONS: Placenta accreta and previa are major causes of massive obstetric hemorrhage. They are interrelated with a common predisposing factor, cesarean section. Even though the rate of cesarean section and placenta previa is increasing, the incidence of placenta accreta remains stable in Kuwait.

Maternal sexuality during pregnancy and after childbirth in kuwait.

Although pregnancy had an adverse effect on sexuality, many women improved at the mid-trimester and early postpartum period. Sociocultural attitudes and pre-pregnancy sexuality level are important determinants. A study of sexual adjustment of 160 pregnant Muslim women of Kuwait revealed that pregnant women showed a decline in sexual activity soon after the diagnosis of pregnancy that continued throughout the whole pregnancy with a second trimester and early third trimester increase in sexuality, but continued to be below the pre-pregnancy base line. Resumption of sexual activities was not problematic for many of our patients at eight or twelve weeks postpartum, except for those with marital disharmony. For some women, pregnancy and labor improved their sexuality in general. But the majority of our subjects had a consistent pattern of sexuality during pregnancy that reflects their pre-pregnancy level of sexuality. This study shows clearly the important influence of the father-to-be on the sexuality of his wife. Sociocultural taboos influence sexual adjustment during pregnancy, as this highly important topic is always ignored during discussion between patients and doctors at ante- and post-natal clinics. It is recommended for obstetricians to counsel patients about sexual activity, keeping in mind the prevailing sociocultural attitudes.