Clinical response to therapeutic plasmapheresis and intravenous immunoglobulin in pregnancies complicated by alloimmunization despite persistently high titers: Report of two cases.

Key Clinical Message: Plasmapheresis and IVIG use in cases of alloimmunization during pregnancy are effective strategies when severe early fetal anemia is anticipated. Despite no change in antibody titer levels before and after plasmapheresis, clinical response was observed in both fetuses, and both had an excellent obstetrical outcome. Abstract: Hemolytic disease of the fetus and newborn is a potentially lethal complication of alloimmunization, and intrauterine fetal blood transfusion (IUBT) is the standard treatment and care plan for severe fetal anemia. However, IUBT is technically unattainable before 20 weeks of gestation. Plasmapheresis and intravenous immunoglobulin (IVIG) are the two treatment modalities described in the literature that postpone the need for transfusion until after 20 weeks. Here, we present two cases of alloimmunization (one with anti-Kell and the other with anti-D). Both had poor outcomes in previous pregnancies because of the early development of severe fetal anemia and hydrops before 24 weeks of gestation. Both patients underwent three sessions of plasmapheresis before 18 weeks, followed by weekly IVIG infusion, which continued until 23-27 weeks of pregnancy. Antibody titers were measured before and after plasmapheresis. In addition, weekly MCA Doppler was performed to monitor the development of severe fetal anemia requiring blood transfusion, which was diagnosed when the peak systolic velocity (PSV) was 1.5 multiples of the median or more. The first patient underwent IUBT at 24 weeks and the second at 28 weeks, as indicated by the MCA Doppler. Both patients were delivered by cesarean section, the first at 34 weeks and the second at 36 weeks, for different obstetrical indications. Both pregnancies resulted in a live birth. We conclude that the use of plasmapheresis and IVIG in alloimmunization during pregnancy is an effective treatment strategy when severe early fetal anemia is anticipated before 20 weeks of gestation. Despite no change in antibody titer levels before and after plasmapheresis, a clinical response was observed in both fetuses, and both had excellent obstetrical outcomes.

Association between intrauterine fetal growth restriction and ABO blood groups at King Abdulaziz University Hospital, Saudi Arabia: Retrospective study.

OBJECTIVES: To investigate the potential association between ABO blood groups and intrauterine fetal growth restriction (IUGR) among pregnant women who delivered at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. METHODS: This is a retrospective cohort study analyzed the medical records of pregnant women who delivered at KAUH and had postnatal follow-up visits. Missing data were completed by conducting phone interviews with patients. RESULTS: A total of 436 patients with a mean age of 31.2±5.5 years were included in the study. 50.7% of the women had blood type O, 28.4% had blood type A, 16.5% had blood type B, and 4.4% had blood type AB. The majority (94.7%) tested positive for the Rhesus antigen. Although statistically significant, women with blood groups AB and B exhibited higher rates of IUGR (31.6%, and 27.8%, respectively) compared to those with blood groups A and O, who had lower rates of IUGR (26.6%, and 24%, respectively). CONCLUSION: Our study results showed that women with blood groups AB and B had slightly higher rates of IUGR than those with A and O, who had lower rates of IUGR. A larger study comparing blood group O to other groups may provide more insight into the relationship between ABO blood groups and IUGR.

Association between the use of epidural analgesia during labour and incidence of postpartum depression.

INTRODUCTION: Postpartum depression is a significant episode of depression beginning after giving birth. The prevalence of postpartum depression is approximately 20% in Jeddah, Saudi Arabia. Epidural analgesia is the gold standard for labour pain management. Conflicting results exist regarding the association between postpartum depression and epidural analgesia use during labour. Accordingly, this study assessed the association between epidural analgesia use and postpartum depression incidence. METHODS: A prospective observational study of 170 mothers was conducted, with surveys administered after labour and at six weeks postpartum. Surveys included the following: mothers' demographics, obstetric history, postpartum depression (Edinburgh Postnatal Depression Scale), and pain severity (Visual Analogue Scale). RESULTS: In the final analysis, 91 patients were enrolled. Epidural analgesia was administered to 48.4% of mothers during labour. Nearly two-thirds of mothers learned about EA via sources including family members and social media. However, more than half reported worries regarding epidural analgesia. Edinburgh Postnatal Depression Scale scores showed that 38 mothers (41.8%) likely had depressive symptoms within two days following delivery. Further, 35 (38.5%) met criteria for postpartum depression at six weeks postpartum. For both groups regardless use of analgesia, the mean Visual Analogue Scale score at two days postpartum was 4.16 ± 2.13. Data revealed no correlation between epidural analgesia use and Edinburgh Postnatal Depression Scale within two days and at six weeks postpartum. Multiple regression analysis showed Edinburgh Postnatal Depression Scale scores correlated with Visual Analogue Scale scores but not epidural analgesia use at 1-2 days postpartum. CONCLUSION: This study showed that depressive symptoms resolved in three percent of participants. This suggests that institutions should increase postpartum depression awareness during the antenatal period and implement effective post-delivery screening systems for postpartum depression.

The Effect of Delivery Mode, ABO Blood Type, and Passive Smoking on Postpartum Depression: A Cross-Sectional Study in Saudi Arabia.

Background Postpartum depression (PPD) is a form of depression that can occur after childbirth and is characterized by feelings of sadness. It is a common psychological problem that affects women and children. This study aimed to assess the association between PPD and risk factors, such as delivery mode, ABO blood group, and passive smoking in Saudi Arabia. Methods PPD was assessed in this cross-sectional using an Arabic version of the Edinburgh postnatal depression scale through an online questionnaire distributed to women in Saudi Arabia between January and March 2022. The data were analyzed using SPSS version 26 (IBM Corp., Armonk, NY). Results A total of 354 postpartum women completed the questionnaire within six weeks of giving birth. Their mean age and BMI were 30.1±6.78 years and 25.98±5.84 kg/m2, respectively. PPD occurred in 56.2% of the participants. Elective cesarean section and operative vaginal delivery were associated with the presence of PPD symptoms in 17.6% and 7% of the women, respectively. The majority of those with third and fourth degrees and those who had instrumental assisted delivery had postpartum depression and this was statistically significant (p=0.017). About 26.6% of the participants were exposed to passive smoking, and 21.9% of them developed PPD. However, it was not statistically significant. Moreover, women with PPD were more likely to have blood type O+, followed by A+. Demographic factors did not show a significant correlation with developing PPD except for age (p=0.01), those who developed PPD were much younger on average than those who did not develop PPD (29.28±6.61 years vs. 31.15±6.86 years). Conclusion A significant association was found between PPD and the type of delivery. The association between PPD and passive smoking, ABO blood groups was insignificant. However, women who developed PPD were younger on average than those who did not develop PPD.

Association Between ABO Blood Group and Gestational Diabetes Mellitus in Pregnant Women at King Abdulaziz University Hospital: A Retrospective Study.

Objective Gestational diabetes mellitus (GDM) can occur during pregnancy. One of the leading causes of it is a hormone produced by the placenta that interferes with glucose absorption and causes glucose buildup in the bloodstream. Genetic variations between ethnicities are believed to be associated with GDM, and there has been some research on the association of ABO blood group with GDM in different populations. However, the results so far are inconsistent, and there is no conclusive evidence on how ABO blood group affects the occurrence of GDM. This study aims to examine the link between ABO blood group and GDM in pregnant women at King Abdulaziz University Hospital. Methodology A retrospective cohort study was conducted on a group of GDM patients between 2019 and 2022 using data collected from the patients' medical records at King Abdulaziz University Hospital. Results The overall prevalence of GDM was high at 74.7%, and the percentage of patients with A, O, B, and AB blood group who had GDM was 42.9%, 41.41%, 12.1%, and 3.59%, respectively. However, there was no significant difference in Rh status or any other clinical characteristic between the participants who had GDM and those who did not have GDM. Conclusion The present findings indicate that blood group is not associated with the development of GDM in this cohort from Saudi Arabia. However, more studies are required in the future to corroborate these findings.

Effect of Premarital Education on the Quality of Life of Female Partners: A Cross-Sectional Study.

Background A happy and satisfied marriage is the result of two happy spouses. Getting premarital education is one of the most significant reasons for marital and sexual satisfaction. This study aimed to assess the effect of premarital education on the quality of life of Saudi women. Methodology A cross-sectional study was conducted on 596 Saudi women married for ≤15 years selected from the general population. Data on participants' demographics were collected, and the quality of life was assessed using the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Results Only 37.2% of the participants had premarital counseling and education, even though 86.4% thought it was crucial before marriage. When this study was conducted, most participants with shorter mean marriage durations had received premarital education or counseling. The mean WHOQOL-BREF score, which measures the quality of life, was considerably higher for participants who indicated that premarital education significantly impacted the quality of their marriage and those who received premarital counseling or attended any form of premarital education. Conclusions Even though premarital education was viewed favorably, only 37.2% of couples obtained it. There is a need to increase public awareness of premarital education's significance and incorporate it into the education curriculum due to the positive associations between receiving it and a higher quality of life.

Correction: Effect of Premarital Education on the Quality of Life of Female Partners: A Cross-Sectional Study.

[This corrects the article DOI: 10.7759/cureus.32186.].

Placenta previa. A 13 years experience at a tertiary care center in Western Saudi Arabia.

OBJECTIVES: To review cases of placenta previa in the last 13 years in a tertiary teaching hospital to identify risk factors for maternal morbidity.  METHODS: A retrospective analysis of all cases of placenta previa managed at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia from January 2001 to December 2013.    RESULTS: The total number of deliveries was 55,862 deliveries, and 11,412 (20.3%) delivered by cesarean section (C/S). The charts of 230 cases diagnosed with placenta previa was reviewed, and different variables were collected and analyzed. Diagnoses were achieved in 94% of them using ultrasound. The prevalence rate of placenta previa was 4.1 per 1000 births. Cesarean section was carried out as an emergency procedure in 130 (56.5%) women and as elective in 100 (43.5%) women. Of them, 26 patients were admitted to the intensive care unit (ICU) (11.3%), all of which received blood transfusion >6 units and 22 patients had a hysterectomy for uncontrollable bleeding.   CONCLUSION: Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital must have a protocol, or algorithm for the management of placenta previa. Risk factors for maternal morbidity included complete previa, history of previous C/S, emergency C/S at a gestational age of less than 36 weeks, and estimated blood loss more than 2000 ml.

Retraction technique for urinary catheterization of women with female genital mutilation.

OBJECTIVE: To evaluate the retraction technique for urinary catheterization of women with Type III female genital mutilation (FGM). STUDY DESIGN: The hospital records of all women from Sudan, Somalia, Ethiopia, Egypt, Eritrea, and Chad who were admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia from January 1, 2011 to January 1, 2012 were reviewed. Women with Type III FGM who had urinary catheterization were identified and their records were examined. RESULTS: During the study period, 162 women with Type III FGM had urinary catheterization by residents in our hospital. One hundred and twelve (69.1%) women had urinary catheterization by the standard procedure and 50 (30.9%) by the retraction technique because of failure of the standard procedure. No attempts to use the technique were unsuccessful; that is, no procedures were converted to emergency defibulation. No complications occurred during insertion or while the catheter was in place (37.5±5.6h). CONCLUSIONS: The retraction technique provides a safe and effective option for urinary catheterization of women with Type III FGM.