Experience of assisted reproductive technology at King Abdulaziz University Hospital.

AIM: To present the authors' experience with assisted reproductive technology (ART) at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. MATERIALS AND METHODS: Retrospective analysis of data collected from the charts of 264 women who were undergoing their first cycle of ART between September 2013 and March 2014. All the women were treated with gonadotropin-releasing hormone (GnRH) antagonist protocol. For all patients, the documented data included age, infertility type, cause, and hormone profile. Number of follicles > 10 mm, endometrial thickness, number of oocytes retrieved, number of fertilized ova, and number of embryos produced, as well as the number transferred, day of transfer, cancellation rate, and treatment administered for luteal phase support (oral and vaginal progesterone) treatment type, and outcome were recorded. The data was analyzed using the Statistical Package for the Social Sciences. RESULTS: The authors included women aged 21 to 39 years (mean ± standard deviation, 32.28 ± 5.51). Patients suffered from primary infertility in 69.7% of the cases; approximately 30% of the women had secondary infertility. Eighty of the 264 patients (30.3%) conceived; however, only 56 women (21.2%) had a live birth. The overall cancellation rate in the patients was 12.1%. The following reasons were documented for cases of failure: no oocytes, 16 (6.1%); no sperm, eight (3.0%); and no embryo, eight (3.0%). CONCLUSION: The success rate of ART at the present institution falls within the range reported in the medical literature. However, further studies should be conducted to investigate the course and outcome of ART in patients who undergo treatment in this institution.

Screening of sexual dysfunction in Saudi women before and after the age of 40 years.

OBJECTIVE: The aim was to assess sexual performance by screening Saudi women before and after the age of 40 years. MATERIALS AND METHODS: A cross-sectional study (March-May 2013), conducted at King Abdulaziz University Hospital (KAUH), with two groups of women under 40 years of age and aged 40 or more years, were randomly selected from OPD. Ethical committee approved the study. After verbal consent, one-paper self-administered questionnaire was distributed, and filled in anonymously and privately. Questionnaire included demographic data, the six-item version of female sexual function index (FSFI) to assess desire, lubricants, orgasm, satisfaction, and pain. If score was 19 or less, it meant that women needed further investigations (full assessment using FSFI- 19). RESULTS: Out of 194, 49.5% (96) were over 40 years of age and 50.5% (98) were under 40 years of age. Answering the six questions regarding sexual dysfunction in- dicated that women > 40 years had sexual dysfunction more than women <40 (statistically significant). A scored of less than 19 was found to be statistically significant in women > 40 years. Post-menopausal women, diabetics, women with urogynecological symptoms and/or psychological disorder required further evaluation. DISCUSSION: Using the six-item version of FSFI and calculating a score less than 19 for screening, women aged more than 40 years, reduction in estrogen, diabetes, urogynecological symptoms, and psychological disorder were all found to be important factors affecting female sexual dysfunction.

Comparison of the classic TVT and TVT-Secur.

BACKGROUND AND AIMS: Tension-free vaginal tape (TVT) is a well-established surgical procedure for the treatment of female stress urinary incontinence (SUI) and TVT-Secur was designed to reduce the undesired complications and to minimize the operative procedure as much as possible. AIM: To present the authors' experience in using the classic TVT and TVT-Secur and to evaluate and compare complications and short- and long-term results. MATERIALS AND METHODS: A retrospective study and analysis of 230 patients presented with SUI at King Abdulaziz University Hospital (KAUH) and United Doctor Hospital (UDH) from March 1, 2007 until July 3, 2010. Classical TVT and TVT-Secur with or without associated operation were performed. All patients were controlled at six months and complications, as well as objective results, have been reported. The study was approved by ethical committee of KAUH. RESULTS: All patients with SUI admitted to KAUH and UDH for sub-urethral tape were analyzed (230 patients); 149 had classical TVT and 81 had TVT-Secur. Their age ranged from 30 years to 73 years with a mean of 49.8 years and std of 9.4. Their parity ranged from two to 15 with a mean of 6.2 and std of 2.4. One hundred eighty patients had SUI and 50 patients had mixed incontinence. The type of anesthesia used was general anesthesia in 69.6% (160) of cases and regional anesthesia in form of epidural or spine in 30.4% (70) of cases. Operative complications revealed a bladder perforation in 3.5% (eight) of cases and 2.2% had bleeding of more than 200 ml, and 53 patients which contribute to 23% had retention and required a catheter for 48 hours or more. After three months, it was observed that erosion of the mesh occurred in three cases. Fourteen cases (7%) continue to have SUI failure rate. CONCLUSION: The classical TVT and TVT-Secur were found to be very effective, easy, and safe procedures and with excellent results.

Abdominal myomectomy versus abdominal hysterectomy for symptomatic and big uterine fibroids.

OBJECTIVE: To compare abdominal myomectomy with abdominal hysterectomy in women with big and symptomatic uterine fibroids. METHODS: The hospital records at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia were reviewed to identify women who underwent abdominal myomectomy or abdominal hysterectomy between 1989 and 1999. Inclusion criteria were the presence of symptoms and size of the uterus equaling that of 12 weeks gestation or more. Women who underwent myomectomy as a treatment of infertility were excluded. RESULTS: During the study period, 111 women met the inclusion criteria. Thirty-eight women underwent abdominal myomectomy and 73 women underwent abdominal hysterectomy. Forty women were excluded because of myomectomy for infertility. Abdominal myomectomy was successfully performed in all women for whom it was scheduled. Hysterectomy, internal iliac ligation, or other procedures were not necessary to control the bleeding. The primary indication for myomectomy was abnormal vaginal bleeding in 23 women and pelviabdominal mass in 15 women compared to 6 women and 67 women in the hysterectomy group. There were statistically significant differences in the mean age and parity (p value 0.01 and <0.001) between women who underwent abdominal myomectomy and abdominal hysterectomy. The uterine size clinically (mean +/- standard deviation), size of largest myoma by ultrasonography, and from histopathology reports were 15.4 +/- 3.8, 11.8 +/- 2.8, and 13.6 +/- 3.2 compared to 17.9 +/- 4.4, 16.9 +/- 4.2, and 13.8 +/- 3.7 (p values not statistically significant). Similarly, there were no statistically significant differences in the pre- and postoperative hemoglobin, estimated blood loss, rate of blood transfusion, operative time, and numbers of days in hospital. CONCLUSION: Abdominal myomectomy for big and symptomatic uterine fibroids carries similar risks to abdominal hysterectomy.

The use of intrapartum defibulation in women with female genital mutilation.

OBJECTIVE: To assess the use of intrapartum defibulation for women who have had female genital mutilation. DESIGN: A retrospective case analysis. SETTING: King Abdulaziz University Hospital, a teaching hospital in Jeddah, Saudi Arabia. SAMPLE: Two hundred and thirty-three Sudanese and 92 Somali women who were delivered at the hospital between January 1996 and December 1999. METHODS: The outcome of labour of women with female genital mutilation who needed intrapartum defibulation were compared with the outcome of labour of women without female genital mutilation who did not need intrapartum defibulation. RESULTS: One hundred and fifty-eight (48.6%) women had infibulation and needed intrapartum defibulation to deliver vaginally, 116 women (35.7%) did not have infibulation and gave birth vaginally without defibulation, and 51 (15.7%) women were delivered by caesarean section. There were no statistically significant differences, between women who underwent intrapartum defibulation and those who did not, in the duration of labour, rates of episiotomy and vaginal laceration, APGAR scores, blood loss and maternal stay in hospital. The surgical technique of intrapartum defibulation was easy and no intraoperative complications occurred. CONCLUSIONS: Intrapartum defibulation is simple and safe, but sensitivity to the cultural issues involved is essential. In the longer term, continuing efforts should be directed towards abandoning female genital mutilation altogether.

Use of the computer for interpretation of fetal heart tracings.

OBJECTIVE: To compare the interpretations of antepartum fetal heart tracing by computer and by three experts. METHOD: One hundred and forty-eight patients with high risk pregnancies were included. Their fetal heart tracing was interpreted by each of the three experts and the computer. The interpretation of whether it was reactive or nonreactive, by each of the experts with that of the computer controlling for the outcome, were cross-tabulated using the chi 2-test with a control variable. To define the abnormal outcome the odds ratio and 95% confidence interval were used. RESULTS: The computer defined 14 tracings as nonreactive and the experts, respectively, 19, 18 and 17. The gestation age ranged from 34 to 42 weeks with a mean of 38.26 and standard deviation of 2.31. The common reasons for monitoring were diabetes (20.9%), hypertension (20.3%) and post-date (11.9%). Out of 148, 16 had an abnormal fetal outcome. There were no statistically significant differences between any of the experts and the computer in determining the normal outcome. However, to determine the abnormal outcome, there was a statistically significant difference between two of the experts and the computer with P < 0.025. It was found that the computer was superior to any of the experts in defining the abnormal outcome with an odds ratio of 55.9 and experts odds ratio and 95% computer interpretation were 1.6 (0.4-6.5), 1.0 (0.2-4.9) and 1.1 (0.2-5.3), respectively. CONCLUSION: There was no difference between the experts and the computer in defining the normal outcome, but it appears that the computer was better in defining the abnormal outcome.

Retention of urine in females: causes and management.

Retention of urine in the female results from various medical, surgical and gynaecological causes, but is often thought to be due to psychological disturbances. In order to find out the causes of urinary retention in females in our own population and the results of its management, we conducted a retrospective study on 30 female patients with retention of urine, seen at King Abdulaziz University Hospital, Jeddah, over a five year period. Only six (20%) patients were found to have psychological disturbances. Out of the 30 patients, 27 were available for follow-up. In those patients followed up, a success rate of over 85% was achieved through using clean intermittent catheterization with or without pharmacological treatment, either in regaining complete bladder function or in overcoming this clinical problem.

Current practice patterns and training status of selected graduates at the King Abdulaziz University College of Medicine, Saudi Arabia.

Graduate doctors are the primary output of medical education programmes. It is important for institutions to identify systematically the types of medical activities in which their former students are involved in order to determine the effectiveness of the curriculum, assessing academic standards and reviewing admissions policies. Information was obtained from a survey of men and women graduates from three of the early graduation classes of King Abdulaziz University College of Medicine in Saudi Arabia about postgraduate medical training, certification, practice patterns, and other curriculum issues. Information collected from 151 graduates (90%) indicated that 96% were practising medicine in a variety of medical specialties and subspecialties. Six were not practising at the time of the study. Significant differences were found in the specialties being practised when men and women were compared. Men tended to practise in medicine, surgery, dermatology, urology, ENT, ophthalmology and orthopaedics, while women concentrated in obstetrics and gynaecology and paediatrics. Certification beyond medical school was earned by 49% with no significant difference being found comparing men to women. Men earned the majority of their postgraduate certifications outside Saudi Arabia while most women earned theirs in Saudi Arabia. Graduates indicated that departments in the basic sciences were least helpful in preparing them as doctors, while selected clinical departments were most helpful. It was concluded from the study that the curriculum goals of the College of Medicine, namely a curriculum of international standards producing graduates to take leadership roles in both teaching and medical practice, were realized in part by the graduates surveyed.

Pericardial effusion in normal pregnant women.

Fifty-two normally pregnant women underwent echocardiography to examine their pericardium in the first, second and third trimester. Pericardial effusion was noted in 15.3% of the women (n = 8) in the first trimester, 19.2% (n = 10) in the second trimester and 44.2% (n = 23) in the third trimester of pregnancy. Pericardial effusion during pregnancy was found to be completely resolved in all patients who underwent an echocardiogram 6 weeks post delivery (n = 11). There was no statistically significant difference in age, hemoglobin, total protein, albumin/globulin ratio or mean blood pressure during pregnancy between those who developed pericardial effusion and those who did not. The frequency of occurrence of pericardial effusion in primigravidas at 69.2% (9/13) was higher than that in multigravidas, with a ratio of 35.9% (14/39), the difference being statistically significant (p less than 0.025). The frequency of occurrence of pericardial effusion in patients who gained more than 12 kg during pregnancy at 67.7% (11/17) was higher than in patients who gained less than 12 kg, with a ratio of 34.3% (12/35), the difference being statistically significant (p less than 0.025).