Prevalence of herpes simplex virus types 1 and 2 antibodies among individuals screened in a tertiary hospital in the Eastern province of Saudi Arabia.

The epidemiology of herpes simplex virus (HSV) infections varies among populations depending on their demographic characteristics and exposure. This study describes the prevalence of HSV 1/2 IgG and IgM antibodies among individuals over a period of 5 years. A retrospective study was conducted to collect data on cases tested for HSV-1 and HSV-2 IgG and IgM antibodies for different medical conditions over five years between January 2014 and December 2018. 620 samples were tested for HSV 1/2 IgG and IgM during the study period. The total HSV seropositivity in the study population was 68% (422/620). The total seropositivity excluding children below 6 months of age was 65.3% (313/479). HSV-IgG seropositivity was significantly higher in married individuals (p<0.001, 95% CI 1.61-3.69). The HSV IgG seropositivity was significantly higher in children under the age of 6 months (N=109, 77.30%) than in children between 7 and 24 months old (27.6%) (Chi-square for linear trend, p<0.001), and it then tends to increase with age more than 24 months (Chi-square for linear trend, p=0.011). Eleven children showed laboratory evidence of recent HSV infection (6.2%) as indicated by HSV IgM antibodies and had diverse clinical conditions. HSV infection is highly prevalent in the Eastern Province of Saudi Arabia. Infection is most probably acquired during early childhood, and the tendency increases with age. However, a significant number of mothers are at risk of infection and transferring the infection to their fetuses.

Intrapartum cardiotocography trace pattern pre-processing, features extraction and fetal health condition diagnoses based on RCOG guideline.

Context: The computerization of both fetal heart rate (FHR) and intelligent classification modeling of the cardiotocograph (CTG) is one of the approaches that are utilized in assisting obstetricians in conducting initial interpretation based on (CTG) analysis. CTG tracing interpretation is crucial for the monitoring of the fetal status during weeks into the pregnancy and childbirth. Most contemporary studies rely on computer-assisted fetal heart rate (FHR) feature extraction and CTG categorization to determine the best precise diagnosis for tracking fetal health during pregnancy. Furthermore, through the utilization of a computer-assisted fetal monitoring system, the FHR patterns can be precisely detected and categorized. Objective: The goal of this project is to create a reliable feature extraction algorithm for the FHR as well as a systematic and viable classifier for the CTG through the utilization of the MATLAB platform, all the while adhering to the recognized Royal College of Obstetricians and Gynecologists (RCOG) recommendations. Method: The compiled CTG data from spiky artifacts were cleaned by a specifically created application and compensated for missing data using the guidelines provided by RCOG and the MATLAB toolbox after the implemented data has been processed and the FHR fundamental features have been extracted, for example, the baseline, acceleration, deceleration, and baseline variability. This is followed by the classification phase based on the MATLAB environment. Next, using the guideline provided by the RCOG, the signals patterns of CTG were classified into three categories specifically as normal, abnormal (suspicious), or pathological. Furthermore, to ensure the effectiveness of the created computerized procedure and confirm the robustness of the method, the visual interpretation performed by five obstetricians is compared with the results utilizing the computerized version for the 150 CTG signals. Results: The attained CTG signal categorization results revealed that there is variability, particularly a trivial dissimilarity of approximately (+/-4 and 6) beats per minute (b.p.m.). It was demonstrated that obstetricians' observations coincide with algorithms based on deceleration type and number, except for acceleration values that differ by up to (+/-4). Discussion: The results obtained based on CTG interpretation showed that the utilization of the computerized approach employed in infirmaries and home care services for pregnant women is indeed suitable. Conclusions: The classification based on CTG that was used for the interpretation of the FHR attribute as discussed in this study is based on the RCOG guidelines. The system is evaluated and validated by experts based on their expert opinions and was compared with the CTG feature extraction and classification algorithms developed using MATLAB.

Hormonal Contraception Use and Depression Among Women in Saudi Arabia.

Purpose: To estimate the prevalence of depression amongst hormonal and non-hormonal contraception users, and the risk factors associated with depression in the sample. Patients and Methods: This is a community-based cross-sectional study conducted in the Kingdom of Saudi Arabia from October to November 2021, covering all regions of Saudi Arabia. All participants were women, living in Saudi Arabia, ≥21 years old and ≤45 years old, using a contraceptive method, and with no established history of depression. Results: A total of 4853 out of 18,596 met our criteria and were included in this study. Among all sample groups, 29% had moderate to severe depression. Rates of depression and association studies' results in women using hormonal were higher than those who use non-hormonal birth control methods. Psychiatric disorders, medical illnesses, substance use and depressogenic medication use were all associated with depression in both hormonal and non-hormonal contraception users. Conclusion: The current study shows high prevalence of depression amongst hormonal contraceptive users compared to non-hormonal contraceptive users.

Susceptibility to Rubella Infection and Incidence of Congenital Rubella Infection: 6 Years Retrospective Study.

Introduction: Rubella is considered one of the most serious and most common congenital infections. Despite global efforts for elimination, rubella cases are still being reported in many parts of the world. The purpose of this study is to determine the level of immunity to rubella in the community and most importantly among women at childbearing age in the eastern province of Saudi Arabia and compare it with the target set by the World Health Organization (WHO) along with the incidence of acute rubella infection and the associated congenital rubella infection and congenital rubella syndrome. Methods: This is a retrospective cross-sectional study over the six years period (Jan 2014-Jun 2020) on all individuals tested for rubella IgM and IgG in a university teaching hospital. Results: Nighty one percent (15,894/17,469) of the population tested showed evidence of rubella immunity with 8.8% (1546/17,469) being susceptible. Among women at childbearing age, susceptibility to rubella was higher with 9.2% (1220/13,278) of women showing no evidence of immunity. In addition, acute rubella infection was reported for 0.17% (29/17,469) of the population tested and 0.15% (20/13,278) in women at childbearing age. No cases of congenital rubella infection were reported in the study period. Discussion: The level of Rubella immunity in the population is 91% and is less than the WHO target for rubella control therefore, risk of resurge of cases is present, indicating the need for continued national surveillance and more efforts to improve vaccination coverage in the kingdom.

Celomic Fluid: Laboratory Workflow for Prenatal Diagnosis of Monogenic Diseases.

BACKGROUND: Celomic fluid can be considered as an ultra-filtrate of maternal serum, containing a high protein concentration, urea, and many other molecules. It is an important transfer interface and a reservoir of nutrients for the embryo. Celomic fluid contains fetal cells that can be used for prenatal diagnosis of monogenic diseases in an earlier gestational period than villocentesis and amniocentesis. OBJECTIVE: The purpose of this study was to evaluate the characteristics of celomic fluid and to establish a workflow laboratory procedure for very early prenatal diagnosis of monogenic diseases. METHODS: Three hundred and eighty-five celomatic fluids were collected between the seventh and tenth week of gestation. We sampled 1 mL of celomic fluid in all cases. The embryo-fetal erythroid precursor cells were selected by the anti-CD71 microbead method or by a direct micromanipulator pick-up on the basis of their morphology. We amplified the extracted DNA using a nested polymerase chain reaction. Primers for short tandem repeat amplification were used to perform a quantitative fluorescent polymerase chain reaction evaluation to control maternal contamination. RESULTS: We observed maternal contamination in 95% of celomic fluids with a range between 5 and 100%. No fetal cells were observed in 0.78% of celomic fluids. The number of fetal cells ranged from a few units to several hundred. Isolation of embryo-fetal erythroblasts selected by the micromanipulator made diagnosis feasible in all cases. CONCLUSIONS: The selection of fetal cells by a micromanipulator and nested polymerase chain reaction analysis made celomatic fluid suitable for early prenatal diagnosis of monogenic disorders even in the presence of high maternal contamination and few fetal cells. The procedure reported in this study provides the opportunity for the use of celomic fluid sampled by celocentesis as an alternative to chorionic villi sampling and amniocentesis, to allow invasive prenatal diagnosis at a very early stage of pregnancy.

Fetal Nucleated Red Blood Cells Preferable Than Cell-Free Fetal DNA for Early Determination of Gender Among Invasive and Non-Invasive Source Using Novel Four Genes Multiplex PCR.

BACKGROUND: Deoxyribonucleic acid from invasive, non-invasive and 9th week embryo can be a resource for the determination of fetal sex using highly sensitive and specific multiplex PCR. METHODS: A total of 402 DNA samples were used to test the newly developed novel multiplex PCR including male specific (3 genes: SRY, DAZ2 and TSPY1) Y-biomarkers and internal control, ACTB. The study isolated cffDNA (Cell-free fetal DNA; n = 73) from mother's plasma, serum and urine, fetal DNA from 9th week embryo and cord blood, and fetal DNA from CD71+ve nucleated red blood cells (fNRBC; n = 73). Paternal and maternal DNA from buccal cells (n = 20) and blood (n = 232) used for male and female confirmation. RESULTS: The study observed that SRY alone cannot be a suitable Y-biomarker. Confirmation from any two Y-biomarkers is mandatory for male fetus identification. Direct sequencing of the gel eluted multiplex and single amplicons confirmed the specific sequences. Presence of two out of 3 Y-biomarkers OR single Y-biomarker with >1,000,000 intensity is considered positive for male. The multiplex PCR is suitable for determining sex from all source of fetal DNA including highly degraded cffDNA and can detect the sex using 0.5ng DNA. Individual marker-based real-time qPCR followed by combined melt curve analysis showed distinguished melt curve peaks for the markers. CONCLUSION: The multiplex PCR achieved 100% accuracy on fetal DNA from fNRBC for early determinations (<13 weeks) of gender. The developed novel and simple multiplex PCR and individual qPCR can be adopted in all types of laboratories for determining human fetal gender using fetal DNA from fNRBC. Early identification of gender can support to prepare for possible X-linked analysis, reduce anxiety in mother, strengthen a bond between mother and fetus, and effective decision making. Non-invasive source of fetal DNA from fNRBC preferred for identifying gender to reduce the risk of invasive procedures in early (8-13 weeks) pregnancy.

Whole-Genome Sequencing Reveals Exonic Variation of ASIC5 Gene Results in Recurrent Pregnancy Loss.

Family trio next-generation sequencing-based variant analysis was done to identify the genomic reason on unexplained recurrent pregnancy loss (RPL). A family (dead fetus and parents) from Saudi Arabia with an earlier history of three unexplained RPLs at the ninth week of pregnancy was included in the study. Whole-genome sequencing (WGS) of a dead fetus and the parents was done to identify the pathogenic variation and confirmed through Sanger sequencing. WGS of dead fetus identifies a novel homozygous exonic variation (NM_017419.3:c.680G>T) in ASIC5 (acid-sensing ion channel subunit family member 5) gene; the parents are heterozygous. Newly designed ARMS PCR followed by direct sequencing confirms the presence of heterozygous in one subject and absence of homozygous novel mutation among randomly selected healthy Saudis. The second family with heterozygous was confirmed with three unexplained RPLs. Pathogenicity analysis of R227I amino acid substitution in ASIC5 protein through molecular docking and interaction analysis revealed that the mutations are highly pathogenic, decrease the stability of the protein, and prevent binding of amiloride, which is an activator to open the acid-sensing ion channel of ASIC5. The identified rare and novel autosomal recessive mutation, c.680G>T:p.R227I (ASIC5Saudi), in two families confirm the ASIC5 gene association with RPL and can be fatal to the fetus.

The Effect of Dietary Intake of Vitamin D on Gestational Diabetes Mellitus.

Diabetes mellitus (DM) is a growing health issue that has been reaching epidemic proportions in the recent years. Low intake of some nutrients like vitamin D may increase the risk of gestational diabetes mellitus (GDM). This study was to investigate the association between the dietary intake of Vitamin D and GDM among women in the Eastern Region of Saudi Arabia. A case-control study was conducted in a sample of 121 women, among those 72 were with GDM and 49 were controls. Vitamin D was estimated using food frequency questionnaire. Also, the 24-h's dietary recall was carried out for 3 days to determine the nutrient intake as well as biochemical analysis for blood glucose level. In this study, GDM subjects were consuming significantly more eggs (P = .040). Vitamin D and vitamin C intakes in GDM and control pregnant women were lower than recommended dietary allowances (RDA). It was also found that low-fat milk, full-fat milk, fortified yogurt, and fortified orange juice were significantly associated with GDM (P < 0.05). Saudi women with GDM need a well-organized dietary counseling before, during pregnancy, and after delivery especially for vitamin D sources.

Genetic disorder prenatal diagnosis and pregnancy termination practices among high consanguinity population, Saudi Arabia.

The prevalence of consanguineous marriage and genetic disorders are high in Saudi Arabia. There were records on the practices of Saudis toward prenatal diagnosis (PND) and termination of pregnancy (TOP), however the sample sizes are small. This study has targeted the Saudi Arabian community and family history of genetic disorders to determine the practices toward PND and TOP. The cross-sectional survey was conducted among Saudis (n = 2761) to determine their practices toward reproductive-decision making. Regression analysis was conducted to identify the association of the limiting factors, relative merits and family history on the outcomes. Total of 2507 participants returned completed questionnaire. The practice towards PND (68%) were more favorable than TOP (33%). PND was found to be a good opportunity for early diagnosis and gives parent's choice. Education, history with affected baby, prior knowledge and religious belief were significant deciding factors of PND and TOP. Down syndrome (n = 161) and sickle cell anemia (n = 152) were commonly available genetic disorder among participant's family. Respondents with autistic cases in their family have higher acceptance rate for TOP. Non-consanguineous are more willing to consider TOP than consanguineous. Participants with abnormal fetus, aged of > 36 years, married and educated Saudis were more likely consider TOP. Though, religion is the most influencing factor for not accepting TOP, comparatively willingness to PND and TOP have increased recently. Awareness campaigns about PND and TOP may increase the chances of accepting prenatal genetic diagnosis.

Outcome of Pregnancy in Saudi Women with Sickle Cell Disease Attending the Tertiary Care University Hospital in Eastern Province of Saudi Arabia.

Sickle cell disease (SCD) is a chronic genetic hematological disorder with multiorgan involvement and is associated with complications during the pregnancy. This is a well-known disorder in Saudi Arabia, but no study has reported its outcomes in pregnant Saudi females of the Eastern region. This study was carried out to compare the fetomaternal outcome in patients with SCD with those without SCD. This was a retrospective cohort study done in the Eastern Province of Saudi Arabia in a tertiary care, teaching hospital, by retrieving the data through the code ICD-9 for SCD, the control group was also selected with comparable characteristics. A total of 302 SCD pregnant patients were included for comparison with 600 pregnant women without SCD as control, during the period of Jan 1, 2008 to December 31, 2018. After the data retrieval, percentages of complications were calculated between the study and control groups. Fischer's exact test and t-test were used for statistical analysis by using SPSS version 22. The results showed higher complication rates in pregnancies of patients with SCD. Hypertensive disorders (13.3%), abruptio placenta (1.6%), intrauterine growth restriction (19.2%), thromboembolism (6.6%) and stroke (2.6%) were all higher in SCD as compared to the control group .The complications of SCD itself including anemia (89.4%), acute chest syndrome (13.2%) and sickle cell crisis (39.2%) were also increased during the pregnancy. Both still birth (3.3%) and neonatal intensive care unit admission (1.6%) were also higher in SCD. SCD during the pregnancy is a high-risk situation and can lead to many fetomaternal complications; however, preconceptional counselling, early booking, a careful monitoring during pregnancy and multidisciplinary management approach can prevent potential adverse outcome in this regard.

The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding. More conservative therapeutic approaches.

OBJECTIVES: Abnormal uterine bleeding (AUB) is a leading cause of hysterectomies, the cause of which is usually diagnosed with preoperative endometrial sampling. We planned this study to assess the accuracy of diagnosing the histologic patterns of endometrium in the preoperative sample in reference to the final histologic diagnosis in hysterectomy. METHODS: We retrospectively reviewed medical charts between January 2011 and December 2015 at a tertiary hospital in Saudi Arabia and identified 43 cases of AUB with complete documentation. The histologic diagnoses were classified into normal and benign pathology group (N/B), or carcinoma and hyperplasia category (Ca/H). Measures of validity were used to compare endometrial sampling histological diagnoses to diagnoses following hysterectomy and Cohen's kappa to assess for agreement between the 2 modalities. Results: The median age of all patients was 49 years. Preoperative histologic examination showed 53.8% sensitivity, 90% specificity, 70% positive predictive values and 81.8% negative predictive values, 30.1%  false positive rates and 18.2% false negative rates. The agreement between preoperative and postoperative histologic diagnoses was moderate (79.1%, k=0.469). Conclusion: The accuracy of preoperative histologic examination was moderate. Our findings recommend cautious clinical decision making and limiting hysterectomy to women who do not respond to other therapeutic measures.

Outcome of pregnancy in Saudi women with sickle cell disease attending the tertiary care university hospital in eastern province of Saudi Arabia

Sickle cell disease (SCD) is a chronic genetic hematological disorder with multiorgan involvement and is associated with complications during the pregnancy. This is a well-known disorder in Saudi Arabia, but no study has reported its outcomes in pregnant Saudi females of the Eastern region. This study was carried out to compare the fetomaternal outcome in patients with SCD with those without SCD. This was a retrospective cohort study done in the Eastern Province of Saudi Arabia in a tertiary care, teaching hospital, by retrieving the data through the code ICD-9 for SCD, the control group was also selected with comparable characteristics. A total of 302 SCD pregnant patients were included for comparison with 600 pregnant women without SCD as control, during the period of Jan 1, 2008 to December 31, 2018. After the data retrieval, percentages of complications were calculated between the study and control groups. Fischer's exact test and t-test were used for statistical analysis by using SPSS version 22. The results showed higher complication rates in pregnancies of patients with SCD. Hypertensive disorders (13.3%), abruptio placenta (1.6%), intrauterine growth restriction (19.2%), thromboembolism (6.6%) and stroke (2.6%) were all higher in SCD as compared to the control group .The complications of SCD itself including anemia (89.4%), acute chest syndrome (13.2%) and sickle cell crisis (39.2%) were also increased during the pregnancy. Both still birth (3.3%) and neonatal intensive care unit admission (1.6%) were also higher in SCD. SCD during the pregnancy is a high-risk situation and can lead to many fetomaternal complications; however, preconceptional counselling, early booking, a careful monitoring during pregnancy and multidisciplinary management approach can prevent potential adverse outcome in this regard

Outcome of vaginal birth after cesarean section: A retrospective comparative analysis of spontaneous versus induced labor in women with one previous cesarean section.

Objective: The purpose of this study is to compare the success rate of vaginal birth after cesarean (VBAC) in spontaneous and induced labor. Design: This is an 8-year retrospective comparative study. Setting: University hospital. Population: Five hundred and ninety-four women who had one previous lower segment cesarean delivery. Materials and Methods: This is a retrospective study of all women, who had lower segment cesarean section, admitted for trial of labor between April 2010 and November 2016. Five hundred and sixty-seven women who elected to have trial of labor after one previous cesarean were included in the study, of these 477 (84.13%) had spontaneous onset of labor (control group) and 90 (15.87%) had induction of labor (IOL) (study group). Two hundred and seventy-seven women had no previous vaginal delivery, and 297 had one previous vaginal delivery. Results: We compared the success rates of VBAC in women who had IOL with those who came with spontaneous labor. The rate of vaginal delivery after CS (VBAC) was 50.0% and 66.6% in the study and control groups, respectively. There was a significant increase in the rate of cesarean delivery due to fetal distress in the study group (P = 0.016). There were no cases of uterine rupture in the control group and one case in the study group. Patients who had spontaneous labor and at least one previous vaginal delivery have higher success rate of vaginal delivery. Conclusion: Women with one previous CS, who undergo IOL, have lower success rates of vaginal delivery compared with those who presented in spontaneous labor. They also have higher risk of CS delivery due to fetal distress. Previous normal vaginal delivery increases the success rate of VBAC.

Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors.

BACKGROUND: Anxiety and depression during the antenatal period is a growing problem with major effects on the mother, the developing fetus, and the neonate. OBJECTIVES: To assess the prevalence of anxiety and depression during pregnancy in women attending the hospital for antenatal care and assess the associated factors. METHODS: This is a prospective cohort study conducted in the University Hospital of Imam Abdulrahman Bin Faisal University. Anxiety was evaluated using State Trait Anxiety Inventory. Depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Complete data were available for 575 women. The mean EPDS score was 10.5 (SD 5.5). The prevalence of depression was 26.8%. The mean state-anxiety score was 38.4 (SD 11.4) and mean trait-anxiety score was 38.2 (SD 9.5). The prevalence of anxiety using state-anxiety scale was 23.6%, while using the trait scale it was 23.9%. The risk is higher among unemployed women with history of miscarriage and unplanned pregnancy. CONCLUSION: Anxiety and depression are common during pregnancy.

Group B Streptococcus Colonization among Saudi Women During Labor.

BACKGROUND: The presence of group B streptococcus in the genital area during pregnancy and labor is associated with high neonatal morbidity and mortality. However, the exact prevalence of group B streptococcus among Saudi women has not yet been established. OBJECTIVE: The aim of this study was to determine the prevalence of group B streptococcal colonization in Saudi pregnant women as a primary end-point and neonatal complications as a secondary end-point. MATERIALS AND METHODS: A prospective, observational, cross-sectional study was conducted to estimate the prevalence of group B streptococcal colonization among Saudi women admitted in labor to the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. A total of 1371 maternal specimens (vaginal swabs, rectal swabs and midstream urine) were collected from 457 patients between October 2011 and September 2016. Neonatal specimens (urine, blood and cerebrospinal fluid) were collected if clinically indicated. RESULTS: Of the 457 women enrolled in this study, 87 (19%) had positive cultures for group B streptococcus either in the vaginal or rectal swab or both. Group B streptococcus was also found to be the most commonly isolated organism. In total, there were five cases of neonatal sepsis, of which one early-onset neonatal sepsis was caused by group B streptococcus. CONCLUSIONS: This study found that the prevalence of group B streptococcal colonization is 19% among Saudi women admitted in labor to the King Fahd Hospital of the University.

Massive ascites, pelvic mass, elevated CA-125 and weight loss: think outside the 'ovaries'.

A 44-year-old woman presented with 3 months' history of painless progressive abdominal distension and weight loss of more than 15 kg. Clinically a pelviabdominal mass with ascites was detected. CT scan of the pelvis and abdomen showed a subserosal leiomyoma with huge amount of ascites. Cancer Antigen (CA)-125 was 546 kU/L. Exploratory laparotomy with myomectomy was done and this was followed by dramatic improvement postoperatively.

Fertility after complete uterine rupture.

PURPOSE OF REVIEW: This review will address fertility and pregnancy outcome in women with history of uterine rupture. RECENT FINDINGS: Increasing rates of primary Cesarean delivery and vaginal birth after one or more Cesarean sections will lead to higher rates of uterine rupture. Recent advances in reproductive medicine, open fetal surgery and gynecological surgery may also play a role in increasing uterine rupture rate. The implementation of the American College of Obstetricians and Gynecologists and Royal College of Obstetricians and Gynecologists guidelines on birth after Cesarean section will decrease the Cesarean section rate but may transiently increase the rate of uterine rupture. The maternal and perinatal risks of multiple Cesarean birth are much higher than those of uterine rupture. Women with prior uterine rupture are fertile. They have higher risk of recurrent uterine rupture. SUMMARY: Every obstetrician is bound to face the challenge of uterine rupture or women with prior uterine rupture. Those women should have a favorable maternal and perinatal outcome when managed in a tertiary center.

Spontaneous intraperitoneal haemorrhage during pregnancy.

This is a case report of spontaneous haemoperitoneum caused by ruptured utero-ovarian vessels during the third trimester of pregnancy. The patient presented with acute abdominal pain and hypotension twice to the emergency room. The initial diagnosis was placental abruptio and the patient had emergency caesarean section. There was utero-ovarian plexus laceration and suture-ligation was performed. The maternal outcome was good. The infant had birth asphyxia and was extubated on the third day. Both mother and infant were discharged in good condition.