Correlates of age at menopause and osteoporosis in Saudi women.

OBJECTIVE: To evaluate the age of menopause among Saudi Arabian women and to predict the local trend in the prevalence of osteoporosis. MATERIAL & METHOD: All menopausal women who had bone mineral density studies at King Khaled University Hospital, Riyadh, Saudi Arabia, between 1999 to 2003. Correspondence and logistic regression analysis were conducted to identify variables that were positively associated with age of menopause. RESULTS: 935 postmenopausal females were included. The mean age of menopause was 48.1 +/- 5.9 years. Early and late onset of menopause were associated with osteoporosis, while normal onset of menopause was associated with osteopenia or remained normal. There was no association between age of menopause and parity or body mass index. CONCLUSION: The age of menopause among Saudi women is lower than in Western countries but similar to other Arabic countries. In addition to cultural differences genetics play a role in determining the age of menopause and the development of osteoporosis.

Recurrent congenital hydrocephalus: two case reports and counseling highlights.

Familial hydrocephalus presents a very considerable morphological and etiological heterogenecity. It can be a manifestation of several autosomal dominant or recessive syndromes. The non-syndromal forms include autosomal X-linked or recessive types and these tend to be recurrent. We report for the first time in the literature on two families with recurrent congenital hydrocephalus each for the fourth time. The first showed evidence of X-linked recessive form, while the second was an autosomal recessive form. The objective of these reports is to highlight the need for proper counseling of such families.

Fetal sex and leptin concentrations in pregnant females.

BACKGROUND: Adult females have significantly more leptin than males. We investigated the effect of fetal sex on levels of leptin and other pregnancy hormones (progesterone, estradiol, FSH, LH and beta hCG) in pregnant females during different stages of pregnancy. PATIENTS AND METHODS: Serum leptin levels in pregnant females followed at King Khaled University Hospital, Riyadh, Saudi Arabia in the year 2001 were estimated at the first, second, and third trimester of pregnancy as well as after delivery. Progesterone, estradiol, FSH, LH and beta hCG levels were also measured. RESULTS: Leptin levels were significantly higher during all three trimesters in the pregnant females carrying female fetuses compared with those with male fetuses, while other hormones did not differ between the two groups. After delivery, the leptin levels decreased in both groups, and were still higher in the females who delivered baby girls, but the results were not statistically significant. CONCLUSION: These finding suggests that leptin might play a role in sex regulation during embryonic development.

Serum cystatin C in pregnant women: reference values, reliable and superior diagnostic accuracy.

BACKGROUND: A simple, endogenous, accurate and minimally invasive marker of glomerular filtration rate (GFR) is much desired in clinical nephrology. Cystatin C fulfills all criteria to be a marker for GFR. For early detection of renal impairment in pregnant women, it is necessary to determine serum cystatin C reference values and the correlation with GFR. The present study was therefore undertaken. METHOD: Healthy pregnant women were followed during pregnancy and the postnatal period. Patient demographics included age, height, weight, BMI, parity, total blood count, LFT, urea, creatinine, Na, K, and blood sugar. Serum cystatin C was estimated using particle enhanced nephlo-immunoassay method. All the parameters were recorded at the start of pregnancy and then in each trimester and the postnatal period. Regression analysis correlation coefficient, ANOVA and the Student's t-test were used for analysis using the SPSS statistical package. RESULTS: A total of 197 pregnant women were included. Mean serum cystatin C for all the women was 0.82 +/- 0.184 mg/l. Serum cystatin C levels were high -0.89 +/- 0.12 mg/l in the first trimester, decreased significantly to 0.651 +/- 0.14 mg/l during the second trimester (p = 0.0000 compared to first trimester), and increased again to 0.82 +/- 0.191 mg/l in the third trimester. After delivery the level rose to 0.94 +/- 0.12 mg/l. A strong correlation was found between serum cystatin C and serum creatinine. A strong negative correlation was found between GFR and cystatin C values in the women (r = -0.546, p = 0.000). A linear relationship was found between GFR and cystatin C levels. A significant increase in the GFR was noted with the progression of pregnancy from 128.06 +/- 29.7 ml/min in the first trimester to 155.2 +/- 29.59 ml/min during second trimester (p = 0.006). A decline in the level of cystatin C exactly parallel to the increase in the GFR was noted with the progression of pregnancy. Interestingly cystatin C was found to have a strong negative correlation with gestational age (r = -0.663, p = 0.000). CONCLUSION: Our results indicate that the mean serum cystatin C levels reflect changes in the GFR during the entire pregnancy and also in the postnatal period. Moreover, serum cystatin C levels are independent of age, height, weight, or blood sugar level. Cystatin C can be used for close supervision and early diagnosis of renal impairment in pregnant patients. Cystatin C is a reliable, useful and promising marker of GFR in pregnant women.

Leptin concentration during different stages of pregnancy.

OBJECTIVES: To determine the levels of leptin in pregnant females during different stages of pregnancy and to correlate these levels to maternal weight, body mass index (BMI), neonate weight and neonate BMI. MATERIAL & METHODS: A case control study was carried out in which 60 pregnant females were enrolled, but only 36 completed the study and 30 non-pregnant females were used as controls. Blood samples were collected at the 1st trimester, 2nd trimester and 3rd trimester, and after delivery. Serum was used for the estimation of leptin (by radioimmunoassay). RESULTS: The results showed that the levels of leptin were significantly higher in pregnant females compared to non-pregnant females, but significantly decreased after delivery. In pregnant females with gestational diabetes the leptin level was insignificantly higher. CONCLUSION: The increase of leptin levels may be due to the stimulatory effect of insulin on leptin secretion from adipose tissue.

Age at menarche and risk of abortion: further evidence.

OBJECTIVES: To study the relationship between the age of menarche and risk of abortion. METHODS: Correspondence analysis and application of life table survival analysis were used to study the association between the age at menarche and the outcome of pregnancy on data collected from 329 women. RESULTS: Both analyses showed increased risk of abortion with increasing age of menarche. Risk of abortion associated with early age at menarche (9-11 years) was 1.2% and it increased to 66.7% when the menarche age was 15 years or above. CONCLUSION: Early age at menarche is associated with lower risk of abortion.

Attitudes of a high-risk group of pregnant Saudi Arabian women to prenatal screening for chromosomal anomalies.

The attitude of 550 pregnant Saudi Arabian women aged > 35 years to prenatal screening for chromosomal anomalies was investigated. A total of 336 women (61.1%) accepted the general idea of prenatal screening while 160 (29.1%) did not; 54 women (9.8%) were undecided. There was a high acceptance of non-invasive methods such as ultrasound (61.3%) and biochemical screening (53.0%) but a low acceptance of invasive methods (34.2%). The main reason for refusal of screening was the unacceptability of termination of pregnancy as a treatment option. There were statistically significant differences between those who accepted the idea of screening and those who did not with regard to their awareness of the availability of prenatal screening, their rejection of pregnancy termination, their doubt of the accuracy of the tests and in their belief that chromosomal abnormalities need no be screened for.

Attitudes of a high-risk group of pregnant Saudi Arabian women to prenatal screening for chromosomal anomalies

The attitude of 550 pregnant Saudi Arabian women aged > 35 years to prenatal screening for chromosomal anomalies was investigated. A total of 336 women [61.1%] accepted the general idea of prenatal screening while 160 [29.1%] did not; 54 women [9.8%] were undecided. There was a high acceptance of non-invasive methods such as ultrasound [61.3%] and biochemical screening [53.0%] but a low acceptance of invasive methods [34.2%].The main reason for refusal of screening was the unacceptability of termination of pregnancy as a treatment option. There were statistically significant differences between those who accepted the idea of screening and those who did not with regard to their awareness of the availability of prenatal screening, their rejection of pregnancy termination, their doubt of the accuracy of the tests and in their belief that chromosomal abnormalities need not be screened for

Undiagnosed term breech: management and outcome.

OBJECTIVE: To assess the antenatal and intra-partum risk factors associated with undiagnosed breech at term and to compare their outcome with those diagnosed before the onset of labor, as well as identifying the determinants for cesarean section in breech presentation. METHODS: Case control study of 183 undiagnosed breech deliveries at term with those diagnosed before labor. RESULTS: There was no significant difference between diagnosed term breech and undiagnosed breech deliveries with regards to maternal, neonatal outcome and incidence of cesarean section. Footling breech presentation, hypertension and failure to attend antenatal visits were independent risk factor for cesarean section in all case of breech. CONCLUSION: Undiagnosed breech at term are not at increased risk for cesarean section and there is no additional maternal or fetal morbidity.

Clostridial species and group D streptococcal septicemia in a pregnant woman: Case report and Literature review.

Full text is available as a scanned copy of the original print version.

A case of varix dilatation of the umbilical vein and review of the literature.

Umbilical cord cysts diagnosed antenatally present a challenge to the clinician as they may be associated with adverse perinatal outcomes including abnormal karyotypes and stillbirths. We present a case of an umbilical cord cyst diagnosed by routine ultrasound at 30 weeks of gestation. Findings on sonography included unidirectional movement of echogenic particles suggesting a large varix of the umbilical vein. The patient delivered vaginally at 39 weeks and histopathology confirmed the diagnosis.

Risk factors for spontaneous abortion among Saudi women.

The objective of this study was to identify important risk factors for spontaneous abortion (SA) among Saudi women. It was a case-control study conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. The cases were 226 consecutive women hospitalized for SA between October 1992 and January 1993. The controls were 226 consecutive women who had normal delivery in the same hospital during the same period. Bivariate analysis using chi-square tests and estimates of relative risks indicated a positive association of age at menarche with risk of SA (P < 0.01). Also, there was a significant higher risk of SA when a women was married to a blood related husband than if married to a non relative (RR = 2.1). The number of previous abortions was also positively related to the risk of SA in the current pregnancy (P < 0.01). Compared to primigravidas, the risk of SA was 3.2 times greater than if the outcome of the most recent pregnancy was also an SA. Other factors that had significant bivariate association with SA were a family history of SA, abdominal trauma, and infection during pregnancy. When multiple logistic regression was used to adjust for the effects of confounding variables, all the factors that showed significant bivariate association with SA (except outcome of the last pregnancy) remained significant. Early menarche may be protective, but further study is needed to confirm this. Greater attention should be given to pregnant women who had personal or family history of SA and those who had trauma and/or infection during pregnancy. Premarital counselling concerning consanguineous marriages is recommended.

Multiple pregnancy management: The King Khalid University Hospital experience.

This review analyzes the multiple pregnancies in King Khalid University Hospital (KKUH) from January 1985 to December 1989. Over this period, the incidence of multiple pregnancy was found to be 10.25/1000. The study confirms a higher incidence of complications among multiple pregnancy cases. For example, the cesarean section rate was 32.2% as compared with 3.6% for the single pregnancies, and the neonatal deaths occurred in a higher number (3.3%) as compared to 1.0% in the controls. However, even though the overall prematurity rate (

Risk factors for spontaneous abortion: a preliminary study on Saudi women.

A preliminary case-control study was conducted on Saudi women to detect possible risk factors for spontaneous abortion (SA). Two hundred and twenty six consecutive women hospitalised for SA and 226 women admitted for normal delivery and used as controls, were studied. Women with SA were significantly older at menarche (Relative Risk (RR) = 3.2), more frequently married to blood-related husbands (RR = 2.1) and husbands older than 50 years (RR = 2.4). Number of previous abortions related linearly to the risk of aborting spontaneously in the next pregnancy. Compared to primigravidas, the RR was 3.2 if the outcome of the most recent pregnancy was SA, and 0.8 if it was a livebirth. A family history of SA was more common among cases (RR = 4.6). Spontaneous abortion was also associated with daily consumption of more than 150 mg of caffeine, abdominal trauma, infection and fever during pregnancy. No significant association, however, emerged with maternal age, social class, education, exposure to video display terminals, parity, use of contraception, diabetes or obesity. The application of these data in clinical practice and future research needs are discussed.

The role of Chlamydia trachomatis infection in female infertility.

The incidence of positive Chlamydia cultures in females undergoing laparoscopy for tubal patency is high. We advocate routine screening for Chlamydia infection in females with infertility. Of seventy-five patients undergoing laparoscopy for infertility, 49 grew Chlamydia on tissue culture of material from the cervix, an incidence of 65.3%. of these 49 cases, 33 (67.3%) had tubal blockage. In asymptomatic patients, 22 out of 50 had positive cultures from the cervix, an incidence of 44%. Peritoneal fluid culture was negative in all infertile patients. When compared to populations studied elsewhere, the incidence of Chlamydia appears to be high in our population and significantly higher in the infertile patients. In the management of infertility, pelvic inflammatory disease, and neonatal conjunctivitis, Chlamydia should be routinely investigated and treated.