Severe acute maternal morbidity in a high-income developing multiethnic country.

With declining maternal mortality, the study of severe acute maternal morbidity (SAMM) provides an opportunity to measure the quality of maternal care and to identify ways to improve it. The objective was to study the epidemiology of severe acute maternal morbidity in a high income, rapidly developing, multiethnic country in the Middle East, and to determine the role of ethnicity in maternal morbidity. We included all births occurring in maternal units with more than 500 births a year over a 6 year period in Abu Dhabi emirate, the largest province of the United Arab Emirates. Data on SAMM was collected retrospectively for the first 3 years and prospectively for the later 3 years. A clinical criteria based approach was used to define SAMM. Over the 6 year period there were 122,705 deliveries, and a total of 926 cases of SAMM were identified. The SAMM to births ratio was 7.5/1,000 deliveries. The leading cause of maternal morbidity was hypertensive disorders (59.5 %) followed by hemorrhage (39.6 %). There were clear ethnic differences. Preeclampsia was significantly higher in women from the Indian sub-continent and hemorrhage was more prevalent in UAE women. We have shown that it is possible to use a clinical criteria based approach to study the epidemiology of SAMM. The leading contributors to SAMM were hypertensive disorders and hemorrhage with clear ethnic links supporting earlier reports of a complex interaction between ethnicity, socioeconomic status and maternal health.

Ovarian salvage in bilaterally complicated severe ovarian hyperstimulation syndrome.

OBJECTIVE: To report the management of 2 cases of severe ovarian hyperstimulation syndrome (OHSS) bilaterally complicated by rupture and late subsequent torsion. DESIGN: Two case reports. SETTING: Obstetrics and Gynecology department of a hospital. PATIENT(S): Case 1: Severe OHSS complicated by massive intraperitoneal hemorrhage and bilateral extensive ovarian rents and rupture at multiple sites. Case 2: Twin IVF pregnancy and late severe OHSS complicated further by subsequent bilateral torsion. INTERVENTION(S): Case 1: Diagnosed by clinical, hematologic, and ultrasound findings. Resuscitation, laparotomy, and meticulous ovarian repair with suture, glue, and hemostat affected bilateral ovarian conservation. Case 2: Diagnosed clinically and confirmed by color Doppler. Left salpingoopherectomy was performed because of a devitalized left ovary; 3 days later laparoscopic right ovarian detorsion and aspiration was possible as early Doppler diagnosis was made. MAIN OUTCOME MEASURE(S): Case 1: ovarian conservation. Case 2: ovarian conservation and continuation of pregnancy. RESULT(S): Case 1: Recovery and normal serum FSH and E(2) 2 months postsurgery. Case 2: Continuation of pregnancy and the remaining ovary was healthy at abdominal delivery. CONCLUSION(S): Two cases of bilaterally complicated severe OHSS in which the patients' safety and bilateral ovarian integrity were at jeopardy. The cases are presented to define the importance of awareness, early diagnosis, and intervention, as well as the use of various methods and techniques to affect preservation of ovarian integrity and reserve.

Confidential enquiries into maternal mortality in the United Arab Emirates: a feasibility study.

AIM: Routine confidential enquiry into maternal deaths is not yet part of the United Arab Emirates health care system. A confidential enquiry into maternal deaths was undertaken to test the feasibility of this approach and to identify the causes and preventability of maternal deaths. MATERIAL & METHODS: Data on all maternal deaths over a six year period from 1998 to 2003 were abstracted and reviewed by a panel of experts to assign the cause if in doubt, and to determine whether the deaths were preventable. RESULTS: Over the six year period, 26 deaths were identified with 122,075 births and the maternal mortality ratio was 21.2/100,000 live births. The mean maternal age at death was 32.3 years and two-thirds of the deaths occurred during the postpartum period. The leading causes of death were thromboembolic events, hemorrhage and infection. After reviewing the clinical data the expert panel concluded that one third of the deaths were avoidable. CONCLUSION: This first ever confidential enquiry has shown that it is feasible to adopt this approach in the United Arab Emirates and the causes identified would be of help in prioritizing clinical guidelines development and training programs aimed at professionals, which will ultimately lead to safer motherhood for women.

Colposcopy services in the United Arab Emirates.

BACKGROUND: United Arab Emirates (UAE) is a young country with a population of 3 million, an abundant oil wealth, and a high standard of living. There is no organized cervical screening program, but the authorities are planning to introduce one soon. OBJECTIVE: To study the availability and quality of colposcopy services. METHODS: A questionnaire survey of all gynecologists in the major government and private hospitals in the country. RESULTS: Twenty government hospitals offer obstetrics and gynecology services, 11 governments and 4 private hospitals have colposcopy services. Of the 52 specialists performing colposcopy, 8 had adequate training, 3 had formal recognition, and 3 had long-term experience. The number of cases seen per doctor varies from 10 to 100 a year, with a mean and median of 28 and 15, respectively. Three units had the required basic colposcopy equipment for diagnosis and treatment. Only 1 unit performs audit. CONCLUSIONS: Colposcopy service is widely available in many hospitals in the United Arab Emirates, but substantial variation exists in clinical standards and needs more organization and standardization.

Cervical smear abnormalities in the United Arab Emirates: a pilot study in the Arabian Gulf.

OBJECTIVE: To gather epidemiologic data on cervical abnormalities and make recommendations pertaining to a national cervical screening policy in the United Arab Emirates (UAE). STUDY DESIGN: A cross-sectional survey of patients and physicians in the UAE with regard to cervical cytology was carried out. Knowledge, attitudes and practices (KAP) of a group of female primary care physicians on cervical cytology were assessed by a self-administered questionnaire. Pap smears and Chlamydia testing were offered to women attending selected primary care centers and secondary health care facilities. RESULTS: Results of Chlamydia prevalence and KAP were published elsewhere; this report addresses the cytologic aspects of this study. There were 2,013 smears collected from primary health centers and 2,042 from secondary care. The overall rate of cervical screening among women in this survey was 85.5% in primary care and 77% in secondary care. The proportion of unsatisfactory smears was < 5%. The prevalence of cervical abnormalities according to the Bethesda System 2001 was 3.6%. There were 9 (primary care) and 21 (secondary care) cases of low grade squamous intraepithelial lesion (LSILs), for a prevalence of 0.77%. There were 4 primary care and 17 secondary care cases of high grade squamous intraepithelial lesion (HSIL), for a prevalence of 0.54%. The combined prevalence for LSIL and HSIL is 1.32%. There were 3 cases of glandular abnormalities. The atypical squamous cells of undetermined significance/SIL ratio was 1.71. No cases of squamous cell carcinoma were detected. No tissue follow-up information is available. The prevalence of cervical abnormalities is low in the UAE. We first recommend the institution of a more organized approach to opportunistic screening in the UAE with appropriate clinical follow-up rather than the immediate launch of a cervical mass screening program.

Prevalence of Chlamydia trachomatis infection among women in a Middle Eastern community.

BACKGROUND: Common vaginal infections that manifest in women are usually easily diagnosed. However, Chlamydia infection is often asymptomatic, leading to infertility before it is detected. If it occurs in pregnancy, it could lead to significant neonatal morbidity. It may also play a role with other viral infections for e.g. Human Papilloma Virus in the development of cervical cancer. The objective of this study was to determine the prevalence of Chlamydia infection in women undergoing screening for cervical abnormalities as a part of a research project in primary and secondary care institutions in the United Arab Emirates. METHODS: In this cross sectional study married women attending primary and secondary care participating in a large nationwide cervical abnormalities screening survey were offered Chlamydia testing using a commercially available test kit. This kit uses a rapid immunoassay for the direct detection of Chlamydia trachomatis antigen in endocervical swab specimens. As this study was performed in a traditional Islamic country, unmarried women were excluded from testing, as the management of any positive cases would create legal and social problems. All married women consenting to take part in the study were included irrespective of age. RESULTS: Of 1039 women approached over a period of eight months 919 (88.5%) agreed to participate. The number of women in the 16 to 19 years was small (0.01%) and 30% were aged over 40 years. The prevalence of Chlamydia infection in this study was 2.6% (95% confidence interval 1.2-3.3%), which was marginally higher in women screened in secondary care (p = 0.05). CONCLUSION: This is one of the few reports on the prevalence of Chlamydia infection in women from the Middle East. Due to cultural and social constraints this study excluded a large proportion of women aged less than 19 years of age. Hence no direct comparisons on prevalence could be made with studies from the West, which all included younger women at high risk of Chlamydia. However this study emphasizes the importance of cultural factors while interpreting results of studies from different cultures and communities.