Excision of high vaginal septum.

INTRODUCTION: Transverse vaginal septum occurs because there is a defect in vertical fusion during embryological development of the vagina. It is quite rare and is infrequently encountered by most obstetricians and gynecologists in their practice. CASE REPORT: A 14-year-old unmarried student, Miss AUX, presented to a private gynecologist complaining of absent menses. Initial examination and investigation revealed intact hymen, normal uterus but no hematometra/hematocolpos. She was commenced on combined oral contraceptives [Yasmin] by the gynecologist. On December 14, 2007, she presented to Maternity hospital with a 6-months history of monthly cyclical abdominal pain with no menses. Physical examination and ultrasonography revealed a high transverse vaginal septum with hemotometra but no hematocolpos. Excision of the septum was performed under ultrasound guidance. The post operative period was uneventful. Normal menses were reported by the patient during outpatient follow-up. CONCLUSION: The excision of a high transverse vaginal septum in a 14-year-old unmarried student, presented with cyclical abdominal pain and absent menses and confirmed to have hematometra, was followed by a return of regular menstruation.

The reproductive performance of women at 40 years and over.

OBJECTIVE: Adverse pregnancy outcome and increased operative deliveries have been reported in women of advanced maternal age. The objective of our study was to evaluate the reproductive performance of our women 40 years and over, and assess if they were at increased risk for adverse pregnancy outcome compared to younger women. STUDY DESIGN: A retrospective study of all women 40 years and over who delivered singleton pregnancies at Maternity Hospital, Kuwait, from 1 January 2000 through 30 June 2002, was undertaken. One-hundred and sixty-eight women formed the study group while 160 women aged 25-30 years served as the control group. The antenatal records, the intrapartum and postpartum events, and the perinatal outcome were extracted and analysed. Statistical analysis was done by Chi-square test, Fisher exact two-tailed test and the Welch t-test. RESULTS: The mean age of the study and control groups were 41.46+/-1.38 (range 40-47) and 27.40+/-1.67 (range 25-30) years, respectively. The mean parity of the study group, 4.24+/-2.35 was statistically higher than for the control group, 1.69+/-1.39, P < 0.0001. The past history of previous preterm delivery (10.1% versus 4.4%) and previous caesarean section (24.4% versus 11.9%) were more significant in the study group, P = 0.0562 and 0.0053, respectively. Women of 40 years and over presented significantly more medical complications. The incidence of caesarean section in the study group was significantly higher (31.0% versus 16.3%), P = 0.0027, OR 2.310, CI 1.356-3.935. The overall maternal and perinatal outcomes in both groups were comparable and satisfactory. CONCLUSION: Advanced maternal age of 40 years and over was not associated with adverse maternal and perinatal outcome, although the incidence of caesarean section was significantly increased in these women.