Emergency obstetric hysterectomy in a university hospital: A 25-year review.

Over the past 25 years, 43 peripartum hysterectomies were performed at the authors' institution, an incidence of 0.64/1,000 deliveries; 31 procedures followed caesarean section and 12 were performed for haemorrhage following vaginal delivery. The common indications for hysterectomy were abnormal placentation (39.5%), uterine atony (23.3%), uterine rupture (23.3%), and haemorrhage during caesarean section (11.6%). The risk factors for hysterectomy included advancing maternal age and parity, previous caesarean section scars and abnormal placentation. Subtotal hysterectomy was performed in 72.1% cases which appeared a quicker and safer procedure than total hysterectomy in desperately ill patients. Five (11.6%) maternal deaths occurred in the series. Mortality was associated with massive haemorrhage. With rising caesarean section rates worldwide, MRI and colour Doppler sonography is useful to diagnose antepartum placenta accreta/bladder involvement in order to plan elective surgery that is associated with reduced maternal morbidity and mortality. Early decision to perform an emergency hysterectomy is essential before the patient's condition deteriorates, besides availability of an experienced obstetrician to undertake a technically demanding operation.

Obstetric complications and perinatal outcome in triplet pregnancies.

The incidence of multiple pregnancies with more than two fetuses has significantly increased since the introduction of ovulation agents and assisted reproductive technologies. Over a 15-year period there were 35 triplet pregnancies beyond 24 weeks that delivered at the King Fahad Hospital, an incidence of 1 in 1,099 deliveries. Early diagnosis is important for improving the rate of fetal salvage in triplet pregnancy. These pregnancies were managed on an outpatient basis. Prophylactic interventions were not utilised. A total of 91% of the pregnancies had at least one antenatal complication, pre-term labour being the most common (80%) followed by anaemia (43%). The average gestational age at delivery was 31.7 weeks (SD 4.2 weeks). A total of 94.3% of the patients were delivered by lower segment caesarean section. The mean birth weight of the neonates was 1,552 g (SD 510 g) and mean 5-min Apgar score was 7.6 (SD 0.8). The corrected perinatal mortality rate in the study was 152/1,000. Pregnancy outcome did not vary with birth order or mode of conception. Higher rate of pre-term births among triplet pregnancies make considerable demands on the neonatal intensive care unit. All methods of assisted reproduction should aim at prevention of multifetal pregnancies.

Maternal mortality: a twenty-year survey at the King Faisal University Hospital, Al-Khobar, Eastern Saudi Arabia.

This was an institutional study of all maternal deaths that occurred among 56422 total births at the King Faisal University Hospital, Al-Khobar, Saudi Arabia, between 1983 and 2002. The underlying cause of each maternal death and potentially avoidable factors were analysed. There were 16 maternal deaths in the hospital during the study period, giving a maternal mortality rate of 28.4/100,000 births. The leading cause of death was haemorrhage in seven (43.75%) patients, followed by pulmonary embolism in four (25%) and general anaesthesia in two (12.5%) mothers. The risk factors noted were maternal age 35 years and parity 5 coupled with iron deficiency anaemia. The main avoidable factors were failure of the patients to seek timely medical care and to follow medical advice. More than half the number of direct obstetrical causes of death was thought to be preventable. A rapidly changing attitude of women towards childbirth is occurring through progressively increasing female education and community health programmes in the region. Further reduction of maternal mortality rates in the community is envisaged through greater patient acceptance of medical advice, family spacing and proficient obstetric services.

Congenital malformations in newborns in a teaching hospital in eastern Saudi Arabia.

A review of 14762 singleton live-born babies during a period of 6 years at the King Fahad Hospital, Al-Khobar, Saudi Arabia is made with a view to study the clinical pattern of easily identifiable congenital malformations among neonates. The incidence of congenital malformations in the study was 17.0/1000 live births. Major abnormalities were present in 74.4% and minor ones in 25.6% of cases. The anatomical organs most commonly affected were the central nervous system (CNS), musculoskeletal and renal defects followed by gastrointestinal and chromosomal defects. CNS anomalies accounted for 48.8% of the total defects, hydrocephaly, anencephaly and meningocele being the predominant lesions. The incidence of malformed babies in diabetic mothers was 7.8%. Multiple anomalies were present in 16.7% infants. Of the total 251 malformed infants, 38 died within the first week of life with a mortality rate of 15.1%, compared with the overall perinatal mortality rate of 12.2/1000 live births in the hospital during the period of study.

Pregnancy complicated by maternal cardiac disease: a review of 274 patients.

The outcome of 274 viable pregnancies in 229 patients with cardiac disease that delivered at the King Fahad Hospital, Al-Khobar, Saudi Arabia, between 1982 and 1998 was reviewed. The incidence was 0.6% of deliveries. Rheumatic heart disease complicated 208 (75.9%) pregnancies, congenital heart lesion in 49 (17.9%) and the remaining 17 (6.2%) pregnancies were a miscellaneous group that included supraventricular tachycardia, ectopic beats, ischaemic heart disease and cardiomyopathies. The NYHA grading was between 1-2 in 243 (88.7%) pregnancies antenatally. Thirty-one patients developed heart failure, most commonly in the antenatal period, 29 of whom were of Grade 1-2. One mother in the series died from heart failure following a cesarean section. She had had a mitral valvotomy before pregnancy and was categorised as Grade 2, antenatally. The perinatal mortality rate was 14.6/1000 deliveries in the study group. Prophylactic antibiotics were given to all the patients an hour before delivery. There were two instances of bacterial endocarditis in the series.

Outcome of pregnancy in women with idiopathic thrombocytopenic purpura.

The obstetric management and haematological problems in 28 pregnancies of 23 mothers with idiopathic thrombocytopenic purpura (ITP) are analyzed. There was no maternal death and only 1 stillbirth occurred in the series. Ten infants were born by Caesarean section and 18 were delivered vaginally. Neonatal cord bloodplatelet counts showed thrombocytopenia in 12 infants, but in only 4 (14.3%) was the cord blood platelet count <50 x 10(9)/L. None of the 27 liveborn infants died, although 4 required supportive treatment with corticosteroids and IgG. No maternal characteristics could be used to predict the neonatal platelet count. These results are comparable with other studies reported in the literature. The rarity of poor neonatal outcome in mothers with ITP does not justify obstetric intervention solely on the basis of their platelet counts. The management of patients should be individualized and carefully planned.

Prolonged intrauterine transabdominal ventricular external drainage. A method to decompress dilated fetal ventricles.

Advances in diagnostic procedures to detect intrauterine hydrocephalus have compelled neurosurgeons to intervene in order to preserve precious neural tissue. We present the first case (to the best of our knowledge) of a successful decrease in intracranial pressure and head circumference by repeated transabdominal intrauterine external drainage. The mother tolerated the procedure well. No complication occurred from the procedure. This method may temporarily decrease the intracranial pressure and head circumference in utero, preserve neural tissue and facilitate normal vaginal delivery. The literature of intrauterine intervention in hydrocephalic fetuses is reviewed.