[Show abstract][Hide abstract] ABSTRACT: Pregnancy associated with ovarian tumors was reviewed over a 20-year period to determine the maternal and fetal outcome in patients undergoing surgery during pregnancy.
A retrospective study of 94 cases of ovarian tumors treated surgically during pregnancy was investigated for incidence, clinico-pathological features and outcome in a teaching hospital between June 1987 and May 2007.
The overall incidence of ovarian tumor in pregnant women was 1 in 505 (0.2%) deliveries. Diagnosis of 69.2% tumors resulted in the first and second trimesters of pregnancy. Twenty-two (23.4%) patients presented as an emergency at different periods of gestation and 16 (17.1%) tumors were incidentally discovered at cesarean section which underlines the significance of examining the ovaries routinely at cesarean section. Benign teratoma (39.4%) and serous cystadenoma (24.5%) were the most common types of ovarian tumors found in the study. The incidence of malignant tumors was 5.3%. Tumors with low malignant potential comprised 40% of malignancy. The miscarriage rate after surgery was 44.4% in the first trimester compared with 16.6% in the second trimester. The preterm birth rate was 4.3% in the series.
The value of clinical and ultrasound examinations in early pregnancy as a diagnostic aid is highlighted. Whenever an ovarian tumor is detected in pregnancy, malignancy should always be suspected. Treatment of an ovarian tumor in pregnancy should be tailored according to the age, parity, clinical presentation, gestational age and histopathology of the tumor. Removal of persisting or enlarging ovarian masses as soon as possible is important to obtain a final histologic diagnosis and rule out malignancy. Early diagnosis and appropriate treatment of malignant tumors offers the best prognosis for the patient.
Archives of Gynecology 11/2010; 282(5):529-33. DOI:10.1007/s00404-009-1346-z · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study evaluated the maternal and fetal outcome in 64 pregnancies complicated by HELLP syndrome.
A retrospective analysis of the medical records was performed of patients with HELLP syndrome managed at this tertiary Obstetric unit between January 1996 and December 2005, who were admitted for preeclamsia/eclampsia and had documented evidence of hemolysis, elevated liver enzymes and low platelet count. Maternal and neonatal complications were recorded and analyzed.
The incidence of HELLP syndrome in the study was 8.3%. Mean gestational age at delivery was 32.4 +/- 4.2 weeks and mean birth weight was 1851 +/- 810 g. Forty-two percent of the patients had deliveries <32 weeks and 28% IUGR. Respiratory distress syndrome was the main indication for NICU admissions (33.9%). The PNM rate was 20%. Maternal morbidity rate was 34%. The most common maternal complications were abruptio placentae (36.4%) and DIC (31.8%). There was no maternal death.
Once the diagnosis of HELLP syndrome is confirmed, the management depends on several obstetric and maternal variables like gestational age, severity of laboratory abnormalities and fetal status. As soon as the maternal condition is stabilized and fetal assessment is obtained, prompt delivery of the fetus is indicated. It is not yet established whether expectant management in preterm pregnancies with HELLP syndrome would improve perinatal outcome.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 12/2009; 22(12):1140-3. DOI:10.3109/14767050903019627 · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the past 40 to 50 years, a steady increase in the incidence of cesarean section (CS) worldwide has stimulated interest in complications associated with CS. One such complication, bladder injury, occurs infrequently with a reported incidence of less than 1%. This retrospective study investigated the incidence of bladder injury during CS, and identified risk factors associated with injuries, as well as discussing potential means of prevention, suggested management, and ultimate outcome. Review of medical records of 67,618 deliveries between 1983 and 2007 at a hospital in Saudi Arabia identified 7708 patients (11.4%) delivered by CS. Demographic and clinical data assessed included number of prior cesarean deliveries and previous pelvic surgery, elective or emergency procedure, presence of adhesions, location and size of the bladder injury, diagnosis, management, and outcome. Among the 7708 CS deliveries, 34 cases of bladder injury were identified (overall incidence: 0.44%). More bladder injuries were found among women with repeat CS (58.6%) than those with primary CS (41.4%) with an incidence of 0.81% and 0.27%, respectively (P < 0.0014). During surgery, there was a significant association between occurrence of bladder injury and separation of the bladder flap over the lower uterine segment (P < 0.024) and previous CS, other pelvic surgery and presence of adhesions (P < 0.0006). Surgeons recognized all bladder injuries intraoperatively and made immediate repairs resulting in an overall satisfactory outcome. Bladder injury occurred more frequently with emergency CS (64.3%) than elective CS (35.7%) (P < 0.024). These data show that optimal outcomes for bladder injuries occurring during CS are associated with early recognition of the injury and adequate repair. Patients with a history of multiple CS are at significant risk for bladder injury.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the maternal and fetal outcome in pregnant women with sickle cell disease and to highlight the complications encountered during pregnancy and delivery at a university hospital in the Eastern Saudi Arabia.
A retrospective study of 255 pregnancies in 145 patients with sickle cell disease (SCD) over an 8-year-period analyzed the perinatal complications and maternal and fetal outcomes compared with a control group of 500 Saudi females with the normal hemoglobin phenotype selected randomly that matched for age, parity and delivered during the study period.
The incidence of SCD was 1.3% of all deliveries with one maternal death (0.4%) and a perinatal mortality rate of 78.2/1,000 deliveries in the series. The major maternal complications in the 255 pregnancies were anemia 84.3%, sickle cell crisis 44.3% (26.6% painful and 17.7% hemolytic crises), infection 45.9%, fetal growth restriction 20.1%, preterm delivery 12.6%, and pregnancy-induced hypertension 10.6%. Blood transfusion was necessary in 34% pregnancies. Stillbirths accounted for 63% of the perinatal mortality.
Saudi women with SCD are at a greater risk of morbidity and mortality in pregnancy than previously reported, with a high perinatal mortality rate. Early booking, meticulous antenatal care and supervised hospital delivery will improve the maternal and fetal outcomes in these patients.
Archives of Gynecology 04/2009; 280(5):793-7. DOI:10.1007/s00404-009-1002-7 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective was to determine the prevalence of bladder injury during cesarean section (CS) and identify the risk factors causing these injuries, their management and the outcome.
We retrospectively reviewed the medical records of all the patients who had bladder injury during CS over a period of 25 years (1983-2007) at the King Fahad Hospital, Al-Khobar, Saudi Arabia. Demographic data, obstetric, surgical details, mechanism of injury, anatomic location, diagnosis, management and outcome were assessed.
Thirty-four cases of bladder injury were identified among 7,708 cesarean deliveries performed during this period with an overall incidence of 0.44%. Primary CS was found in 41.2% of the patients and 58.8% had repeat CS giving an incidence of 0.27 and 0.81%, respectively. Bladder injury occurred when surgical difficulties were encountered during opening of the peritoneal cavity and while developing the bladder flap over the lower uterine segment, mainly due to adhesions and scar tissue resulting from previous abdominal surgery. All the bladder injuries were recognized intraoperatively and repaired with an overall satisfactory outcome. Repeat CS and presence of adhesions were found to be statistically significant risk factors in the study, while operator experience and emergency nature of the CS were considered risk factors in a few cases of bladder injury.
Data presented in this study indicates that bladder injury when adequately repaired is rarely associated with any complications. Multiple cesarean deliveries is a significant risk factor for bladder injury at the time of repeat CS and patients should be counseled regarding this risk before surgery.
Archives of Gynecology 03/2009; 279(3):349-52. DOI:10.1007/s00404-008-0733-1 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: EDITORIAL COMMENT: This study confirms the well known fact that shoulder dystocia is more common with macrosomia, but also shows that the large baby of a diabetic is significantly more at risk than an equally large baby of a nondiabetic. There is much attention in the literature to the need to recognize the small for dates infant because of increased risk of perinatal mortality and morbidity. There is less emphasis on the need to recognize the large for dates baby although this can be equally important, especially in diabetics. Most authors have concluded that shoulder dystocia is usually unpredictable - i.e. without clear indication for elective Caesarean section to avoid the risk; nobody would recommend elective section for all macrosomic babies since most are delivered uneventfully. However, past history of shoulder dystocia can justifv elective Caesarean section when the fetus appears large on clinical evidence. Delay in the second stage of labour and slow descent of the head in an obese multipara should warn the clinician that Caesarean section rather than mid-forceps delivery is the best decision, especially when the fetus seems large. Unfortunately clinical judgement in these cases is often not helped by ultrasonographic evidence of birth-weight, in this editor's experience. The obese multipara labouring ineffectively should always be taken as a warning that the baby may be larger than expected, and that Caesarean section, not enhancement of labour with oxytocin, is the proper management. Since there is often no time to summon aid, all accouchers should have a plan of how to manage shoulder dystocia - the authors provide most details and it shoulder be noted that all their patients were delivered in the lithotomy position - the dorsal position does not allow downwards traction to release the anterior shoulder, and time is short when the complication has occurred. (See previous comment on Shoulder Dystocia, Aust NZ J Obstet Gynaecol 1988; 28: 107)Summary: A retrospective analysis of 17,127 singleton vaginal deliveries revealed 56 cases of shoulder dystocia giving an incidence of 0.3%. Although an increasing incidence of shoulder dystocia was noted as the infant birth-weight increased, 41% of shoulder dystocia occurred in infants of average birth-weight (2,500–3,999g). Diabetes mellitus, postmaturity, maternal weight above 90 kg were each factors associated with a large sized infant which should signal the possible occurrence of shoulder dystocia. In the present series shoulder dystocia occurred in 2.7% of all infants weighing 4,000 g or more. Diabetic women experienced shoulder dystocia more often than non-diabetics. In the diabetics 15.7% of neonates of birth-weight 4,000 g and above sustained shoulder dystocia compared to 1.6% in the nondiabetic patients. Immediate neonatal injury was apparent in 43% of infants with shoulder dystocia, Erb palsy being the commonest injury. The perinatal mortality rate in the series was 54/1,000 deliveries. There was no maternal death. To avoid the potentially lethal and dangerous complications of shoulder dystocia, all clinical and technological methods available should be utilized to detect the excessive sized infants so that abdominal delivery may be performed before it is too late.
Australian and New Zealand Journal of Obstetrics and Gynaecology 04/1989; 29(2):129 - 132. DOI:10.1111/j.1479-828X.1989.tb01701.x · 1.62 Impact Factor