Bone mass measurement using quantitative ultrasound in healthy Saudi women. A cross-sectional screening.

OBJECTIVE: To study the prevalence of osteopenia and osteoporosis in healthy Saudi women, a community-based screening was carried out. METHODS: Three thousand and two hundred sixty-nine women in the young women in peak bone mass (PBM) age group and 3131 in the postmenopausal age (PMA) group were screened using Achilles Insight (GE, USA). Subjects included in the study were healthy and residents of eastern province. The screening was conducted between January 2006 and December 2007. The study took place in King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia. RESULTS: In the PBM age group, 2090 (63.9%) were normal, 791 (24.2%) were osteopenic and 388 (11.9%) were osteoporotic. Osteopenia was more common in single urban women compared to those who were married and living in rural areas (p<0.01 and p<0.001). Women with college education had significantly normal bone mass than women with less than high school education (p<0.01). In the PMA, 948 (30.3%) were osteopenic and 720 (23%) were osteoporotic. Osteopenic was more common in women in urban areas as compared to industrial and the rural areas (p<0.01). Those women whose education was less than primary had significantly more osteoporosis when compared to women with college education (p<0.001). CONCLUSION: In the PBM, 11.9% were osteoporotic and in PMA group 23% were osteoporotic. Factors that influenced the risk for osteopenia and osteoporosis included level of education, number of children, and place of living.

Effect of parity on bone mineral density among postmenopausal Saudi Arabian women.

OBJECTIVE: Osteoporosis and osteopenia among postmenopausal Saudi Arabian women are common to the extent of over 60%. Pregnancy, multiparity and prolonged lactation are suggested as factors modifying negatively in the development of osteoporosis. Earlier reports from the institution indicated a beneficial role of multiparity in postmenopausal osteoporosis (PMO). We conducted this study to measure the effect of parity on bone mineral density (BMD) measurement of lumbar spine and the upper femur. METHODS: We conducted this prospective study at King Fahd Hospital of the University, College of Medicine, King Faisal University, Dammam, Saudi Arabia, between January 2002 and June 2003. This study analyzed 256 patients who attended orthopedic clinics. The data gathered was age, duration of menopause, number of children borne, height and weight for body mass index (BMI) calculation. We excluded women with secondary osteoporosis from the study. We entered the patients orthopedic complaints in the database. We carried out the BMD measurements using Hologic total body DEXA machine. We analyzed the data using SPSS package with significance at p<0.05 and confidence interval of 95%. For final analysis, we took into consideration an average of results of the lumbar spine and hip region. RESULTS: We analyzed the available data of 256 patients. We divided the patients into 2 groups; group A with >6 children and group B with women of <5 children. In group A, there were 116 women and 140 in group B. The mean age of patients in group A was 56.81 (50-65) years SD +/- 5.19 and in group B the mean age was 58.86 years (48-76) SD +/- 7.68. The average BMI in group A was 31.95 kg/m2 and in group B it was 29.14 kg/m2. The BMD of the lumbar spine of group A was 0.850 g/cm2 (SD+/-0.112) compared to group B of 0.699 g/cm2 (SD+/-0.141), p<0.005. The BMD of the hip region of group A was 0.836 g/cm2 and that of group B patients was 0.716g/cm2 (p<0.01). In women with <5 children, 25.5 had normal BMD as compared to 47 in women with >6 children, 25.4% were osteoporotic in group A and in group B 48%. As per the World Health Organization classification 56% in group A had an increased risk of fracture as compared to 77.5% in group B women. CONCLUSION: Our results indicate that women who had borne >6 children were less osteoporotic and of low fracture risk as compared to those women who had <5 children. The BMD of the women with >6 children was statistically higher than their counterparts, and they sustain this after prolonged lactation. We believe that increased parity protects women from osteoporosis and the severity of the disease, and it is our suggestion that women with <5 children and those nulliparous, who are at increased risk of developing osteoporosis should be investigated and treated accordingly.

Pre-eclampsia: maternal risk factors and perinatal outcome.

OBJECTIVE: The aim of this study was to throw light on the incidence of pre-eclampsia (PE) in women attending for care and delivery at a hospital in Saudi Arabia, and analyze the maternal risk factors and outcome of mothers and neonates in pregnancies complicated by PE. METHODS: This retrospective study involved almost all women (n = 27,787) who delivered at King Fahad Hospital of the University in a 10-year period (1992-2001). The maternal records were reviewed for age, parity, gestational age, mode of delivery, antenatal care, onset of PE, severity of proteinuria, and the frequency of antenatal and intrapartum complications. The neonatal records were reviewed for perinatal outcome including birth weight, frequency of stillbirths, and neonatal deaths. RESULTS: Among the study cohort of pregnancies, 685 women, i.e. 2.47%, were diagnosed as having PE among whom a high proportion (42.0%) were nulliparous women. Similarly, PE was encountered at a high percentage (40.0%) in women at the extreme of their reproductive age (< 20 and >40 years), and more women with PE delivered prematurely (30.2%) as compared to healthy controls (13.5%). Spontaneous vaginal deliveries were less frequent in women with PE (69.2%) as compared with healthy controls (86.2%). Instrumental deliveries, with spontaneous labor, amounted to 15.9% in women with PE, but they comprised only 2.9% in healthy women. The deliveries were more likely to be induced (22.8%) or be performed by cesarean section (14.9%) in women with PE than in healthy controls (6.8% and 9.6%). Placental abruption was the most common maternal complication (12.6%) in women with PE, followed by oligouria (7.9%), coagulopathy (6.0%), and renal failure (4.1%). The perinatal outcome of pregnancies with PE shows that stillbirths (2.34%) and early neonatal deaths (1.02%) comprised an overall mortality rate of 33.6 per 1,000. More stillbirths and neonatal deaths showed a tendency to be associated with the severe form of PE (diastolic BP > or =120), as compared with the mild form (diastolic BP 90-110). Stillbirths and neonatal deaths appear to be associated with women who had no or irregular antenatal care and whose proteinuria amounted to or exceeded 3 g per 24 h, when delivery occurred at 28th gestational week or less, and when the birth-weight of the neonates was between 500 and 1,000 g. CONCLUSION: We document a hospital-based incidence rate of PE of 2.47%, with a high proportion of PE cases occurring among nulliparous women and those at the extreme ends of the reproductive age. More maternal and neonatal complications were encountered in women with PE when the PE was severe, when the pregnancy had to be terminated early, when there was no regular antenatal care, the birth-weight was low, or the proteinuria was severe.

Ovarian carcinoma associated with pregnancy. A review of 9 cases.

BACKGROUND: The purpose of this study was to review patients with ovarian cancer in pregnancy, the effectiveness of the available methods of treatment and their prognosis. METHODS: A retrospective review of all women diagnosed to have cancer of the ovary associated with pregnancy who delivered at the authors' hospitals between January 1976 and December 2000. The demography, clinical presentation, time and mode of diagnosis, treatment, pregnancy outcome and maternal survival were noted. RESULTS: The incidence of ovarian carcinoma in pregnancy in the series was 0.08/1000 deliveries. Of the 9 patients, 7 had epithelial cancers; 4 serous cystadenocarcinoma, 2 mucinous cystadenocarcinomas and one undifferentiated cancer. One patient each had dysgerminoma and granulosa cell tumor. Six patients were in FIGO stage Ia, one Ic, one IIa. One patient was in stage III. Five patients were treated by unilateral salpingo-oophorectomy during pregnancy. Three patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy followed by chemotherapy. Debulking of the tumor was done in a patient in stage III with subsequent chemotherapy. This patient died 13 months from the time of diagnosis of the tumor. The overall 5-year survival rate in the series was 78% and 100% for stage Ia. CONCLUSIONS: Association of ovarian cancer with pregnancy is a rare occurrence. Early diagnosis and appropriate treatment offers the best prognosis for the patient. The higher survival rates in the series was attributed to a larger number of patients in stage I of the disease and 2 patients with a germ cell tumor and dysgerminoma which have the best prognosis. Aggressive postoperative chemotherapy also contributed to the better outcome.

Course and outcome of pregnancy in 54 persistently HIV-1-seronegative sex workers and their infants.

OBJECTIVE: To determine the course and outcome of pregnancy in 54 persistently HIV-1-seronegative pregnant commercial sex workers (prostitutes). STUDY DESIGN: Five hundred twenty-three initially HIV-1-seronegative prostitutes in Manipur, India, were studied between 1990 and 1999. Two hundred forty (46%) women seroconverted to HIV-1 during the study period. HIV-1 polymerase chain reaction with env, nef and vif gene primers was done on 98 persistently seronegative sex workers, who remained seronegative after three years of follow-up. Fifty-four of these women became pregnant (study group). The course and outcome of pregnancy were studied prospectively in 54 persistently HIV-1-seronegative women and compared with those in matched HIV-1-seronegative women from the general population coming for routine antenatal checkups. RESULTS: In the 54 seronegative women (study group) who became pregnant, there were 52 singleton, term vaginal deliveries and two emergency cesarean sections for fetal distress. All 54 infants had negative viral cultures for HIV-1 at birth. The women remained seronegative throughout pregnancy, as did the control group. All 54 infants were breast-fed and remained well. CONCLUSION: A small proportion of highly exposed individuals may have natural protective immunity to HIV, may be resistant to HIV-1 and may have successful outcomes of pregnancy.