The Attitude of Physicians Towards Female Genital Cosmetic Surgery

Introduction

Female genital cosmetic surgery (FGCS) is a trending topic in the field of gynecology practice. It is defined as any genital procedure that is not medically indicated but is designed to improve the appearance of the genitals. With the increasing demand for FGCS, little is known about the attitudes of physicians, especially gynecologists, toward FGCS. The study objective is to assess physicians' attitudes towards female genital cosmetic surgeries in Jeddah, Saudi Arabia.

Methods

A cross-sectional survey was done among physicians in Jeddah, Saudi Arabia. Four-sectioned questionnaires were distributed to physicians. All board-certified consultants and registrars of obstetrics and gynecology, plastic, and reconstructive surgery in private/public hospitals were included in the study. Data management was done using the SPSS program version 19 (IBM Corp., Armonk, NY, USA).

Results

Out of 165 physicians, 40 were practicing physicians (female genital cosmetic surgery) (24.2%) while 125 were non-practicing physicians (75.8%). The age of practicing and non-practicing respondents ranges from 26 to 60 with a mean and standard deviation (42.6±8.6) and 24 to 60 (40.1±8.9) years old. Our study showed that there were females under 18 years old requesting FGCS from all physicians. Results of attitude towards FGCS showed that the majority of non-practicing physicians were more comfortable in providing advice about FGCS (N=53) and very confident about female anatomy (N=65). Non-practicing physicians also knew a lot more about the long and short-term risks of FGCS and discussed them all the time with their patients. In terms of giving advice on labiaplasty, clitoral hood reduction, perineoplasty, hymenoplasty, and G-spot augmentation procedures, practicing physicians were more confident compared to non-practicing physicians. Statistical analysis showed a significant difference between practicing and non-practicing physicians in terms of gender (p=0.001), career level (p=0.005) and type of work (p=0.006), giving advice on labiaplasty (p=0.001), clitoral hood reduction (p=0.001), perineoplasty (p=0.016) and G-spot augmentation (p=0.001), the number of patients per month, patients seeking advice about FGCS, knowledge about short-term and long-term risks and possible risks of FGCS, vaginal examination, offering referral/counseling and confidence in assessing female anatomy (all, p=0.001). 

Conclusion

Physicians in Jeddah, Saudi Arabia showed an overall positive attitude towards FGCS. The study suggests that with enough training and knowledge about FGCS, physicians could exhibit a more positive attitude towards FGCS.

Obesity Among Pregnant Women in Saudi Arabia: A Retrospective Single-Center Medical Record Review

Background Obesity in Saudi Arabia is on the rise, especially among females who are more likely to suffer from obesity in the reproductive age group than males in the adult age group. Biologically, pregnancy can increase women's weight and put them at greater risk for adverse obstetric outcomes. Objectives To find the prevalence of obesity among pregnant women and their obstetric outcomes. Methods This retrospective study was conducted on pregnant women who delivered between January 2013 and May 2018 at the obstetrics clinic of King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. A datasheet was formed to collect data from the medical records of these pregnant women. The analysis was done using the Statistical Package for Social Sciences (SPSS), version 26 (IBM SPSS Statistics, Armonk, NY). A p-value of < 0.05 was used to calculate statistical significance. Results A total of 9,095 pregnant women delivered during that period. Of those women, a total of 2,235 were found to be obese, and 1,842 were included in the study. A total of 1,130 women were categorized under Class I obesity, 458 were categorized under Class II obesity, and 254 were categorized under Class III obesity. The majority of the sample were Saudis (72.3%) and young adults (90.8%) with 1,672 cases. The average age was 31.7 (standard deviation (SD): 5.9). Twenty percent of the sample had preterm newborns, while the majority (62.4%) ended up with cesarean delivery. Advanced age, multipara, and cesarean delivery were statistically significant with adverse pregnancy outcomes (p < 0.05). Conclusion As demonstrated in this study, obesity among females in Saudi Arabia has increased over the past decade. Hence, this puts them at higher risk of developing adverse pregnancy outcomes, as pregnancy physiologically results in additional weight gain. Proper antenatal counseling, health education, and a comprehensive plan prior to conception are highly recommended.

Pregnancy Outcomes among Obese Pregnant Women with Hypothyroidism: Medical Record Review of a Single Tertiary Center in Saudi Arabia

Background Thyroid disorder is common among pregnant women. Hashimoto thyroiditis is the most common etiology of hypothyroidism among pregnant women. Many studies showed that hypothyroidism during pregnancy has been associated with negative outcomes for the mother and for child as well including miscarriage, intrauterine growth retardation, preterm delivery and cognitive impairment in the offspring. Objectives To assess the adverse maternal and neonatal outcome among hypothyroidism obese pregnant women. Methods This is a retrospective study conducted among obese pregnant women diagnosed with hypothyroidism attending King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia between January 1, 2013, and December 31, 2018. For analysis, we used (1) descriptive statistics, (2) Chi-square test, Pearson correlation, independent t-test, and one-way ANOVA to test the difference in thyroid stimulating hormone (TSH) levels and adverse pregnancy outcomes. A p-value of <0.05 is used to calculate statistical significance. Results A total of 9095 pregnant women had delivered in the last five years, 65 of these pregnant women had been diagnosed with hypothyroidism and 57 were enrolled in our study. Out of 65, 44 (77.2%) were Saudi, and 13 (22.8%) non-Saudis. Mean age at the time of delivery was 32.9 ± 5.6 years, while BMI means were 35.7 ± 4.6. A total of 35 (61.4%) were from class 1, 14 (26.2%) were from class 2 and eight (12.3%) were from class 3. Out of 57, 16 (28.1%) developed undesired antepartum outcomes, while 14 (21.5%) had postpartum outcomes. Preterm labor, gestational diabetes mellitus, and urinary tract infections were significantly associated with abnormal TSH levels (P < 0.05). Conclusion As demonstrated earlier, hypothyroidism during pregnancy leads to unfavorable outcomes. Therefore, screening for thyroid function tests in prenatal and antenatal periods is vital to avoid potential adverse outcomes.

Impact of Mothers' Age on Telomere Length and Human Telomerase Reverse Transcriptase Expression in Human Fetal Membrane-Derived Mesenchymal Stem Cells

Age-related cellular changes and limited replicative capacity of adult mesenchymal stem cells (MSCs) are few of the challenges confronting stem cell research. MSCs from human fetal membranes (hFM-MSCs), including placental, umbilical cord, and amniotic membrane, are considered an alternative to adult MSCs. However, the effect of mothers' age on hFM-MSC cellular properties is still not clearly established. This study aimed to evaluate the effect of mothers' age on hFM-MSC telomere length, telomerase activity, and proliferation ability in three different age groups: GI (20-29 years), GII (30-39 years), and GIII (≥40 years). hFM samples were collected from pregnant women ≤37 weeks after obtaining consent. hFM-MSCs were isolated and cultured to characterize them by flow cytometry and assess proliferation by MTT assay and doubling time. Telomere length and expression levels of human telomerase reverse transcriptase were assessed by quantitative real-time polymerase chain reaction (qRT-RCR). hFM-MSCs in the three age groups were spindle-shaped, plastic-adherent, and exhibited high proliferation rates and strong expression of hMSC markers. GI showed the longest telomere length in hMSCs in various FM regions, whereas GIII showed the highest level of telomerase expression. There was no difference in telomere length between GII and GIII, and both groups showed the same hMSC characteristics. In conclusion, although the hFM-MSCs derived from different fetal membranes maintained the MSC characteristics in all study groups, the hFM-MSCs of older mothers had shorter telomeres and higher telomerase activity and proliferation rate than did those derived from younger mothers. Thus, the hFM-MSCs of older mothers could be unsuitable for expansion in vitro or stem cell therapy. Determination of telomere length and telomerase expression level of hFM might help characterizing and understanding the biological differences of hFM-MSCs in different age groups.

Pregnancy Outcomes among Obese Pregnant Women with Varying Levels of Vitamin D in King Abdulaziz University Hospital: A Single-center Retrospective Study

Background

Vitamin D deficiency among pregnant women is a global issue. Despite its high prevalence, the optimal level of vitamin D among pregnant women is not well established. On the other hand, multiple adverse pregnancy outcomes have been strongly associated with vitamin D deficiency.

Objectives

To identify the potential effect varying levels of vitamin D have on maternal and neonatal outcomes.

Methods

This is a non-intervention retrospective record review conducted on pregnant women who delivered in King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 1, 2013, and December 31, 2018. Data were collected from their hospital electronic files and analyzed by Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY) version 24. A p-value of <0.05 is used to calculate statistical significance.

Results

A total of 9095 pregnant women had delivered in the last five years, 137 of these pregnant women had vitamin D measurement during their pregnancy. Out of 137, 99 were deficient, 20 optimal, 11 therapeutic, and two excess. A total of 97 (70.8%) were Saudis and 40 (29.2%) were non-Saudis. The majority of pregnant women in obese class 1 and 2 were deficient with 99 cases, while obese class 3 was mostly those with optimal levels. Regarding pregnancy outcomes, those with vitamin D deficiency had the majority of undesired antepartum, neonatal, and postpartum outcomes. Placenta previa, endometritis, poor APGAR scores, birth defects, intrauterine fetal demise, low birthweight, and macrosomia were significantly associated with abnormal vitamin D levels (P < 0.05).

Conclusion

Although vitamin D optimum level during pregnancy is not known, pregnant women with deficient levels appeared to have more serious risks to develop adverse pregnancy outcomes. Therefore, early screening during prenatal visit or antenatal for vitamin D level with vitamin D supplementations is important to reduce these negative pregnancy outcomes for pregnant women with deficient levels.

Prevalence of human papillomavirus in Jeddah, Saudi Arabia

BACKGROUND

Human papillomaviruses (HPVs) are small, non-enveloped, double-stranded DNA viruses that consist of more than 200 genotypes. Low-risk genotypes are associated with warts or benign lesions, whereas high-risk genotypes are usually associated with malignancies and cancers including cervical cancer. However, the real prevalence and incidence of HPV in Saudi Arabia may be understated due to a lack of comprehensive data reporting.

OBJECTIVES

Determine the positivity rate of HPV in men and women in Jeddah, Saudi Arabia.

DESIGN

Cross-sectional.

SETTING

Tertiary care center in Jeddah.

SUBJECTS AND METHODS

Self-collected vaginal swab samples were obtained from females attending the gynecological clinic in the period between October 2017 and April 2018 at a tertiary care center, Jeddah, Saudi Arabia. PCR-positive HPV samples were sequenced to determine genotype. Additionally, serum samples were collected from healthy male and female blood donors and screened for HPV IgG antibodies by ELISA.

MAIN OUTCOME MEASURES

Molecular and serological positivity for HPV.

SAMPLE SIZE

119 self-collected vaginal swabs from females at a gynecology clinic and 966 serum samples from healthy blood donors.

RESULTS

Of the 119 tested vaginal swabs, 7 samples (5.9%) were positive for HPV DNA. Several genotypes were identified. Most of the positive samples were from Saudi females in the age range of 31-50 years seeking care for infertility. Of the 966 serum samples, only 16 samples (1.7%) were positive for HPV IgG antibodies.

CONCLUSION

While the prevalence of HPV in men and women in our sample from the western region of Saudi Arabia was low, our data clearly show that it is not uncommon among high-risk groups and people are still exposed to the risk of HPV infection. Most importantly, these data provide valuable information that could aid in enhancing national awareness about HPV and in introducing an HPV vaccination program.

LIMITATIONS

Single hospital and a convenience sample CONFLICT OF INTEREST: None.

Fecal and Urinary Incontinence Associated with Pregnancy and Childbirth

Introduction:

Fecal incontinence (FI) and urinary incontinence (UI) are major problems faced by women worldwide, with pregnancy and delivery representing two major risk factors for these conditions. The prevalence of FI and UI varies across studies. In our region, only a few publications have addressed this topic.

Aim:

The aim of this study was to determine the prevalence of FI and UI in Saudi pregnant women, their characteristics, and a specific clinical pattern that could identify patients that are at a risk for incontinence.

Materials and Methods:

This was a questionnaire-based crosssectional study conducted over a 3 months period in 2017, among pregnant women attending King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Results:

Our study included 393 pregnant women. FI was reported by 24 patients (6.1%), and fecal urgency was reported by 30.5%. UI was reported by 84 patients (21.4 %). When patients with no UI were compared with patients with UI, the only statistically significant factor was BMI (p = 0.043). There were no statistically significant differences when comparing patients with FI versus no-FI, and fecal urgency versus no-fecal urgency. However, laceration (OR: 1.696, p = 0.036), episiotomy (OR: 1.413, p = 0.029), constipation (OR: 1.944, p < 0.001), hypertension (OR: 1.993, p = 0.022), and Bristol stool scale score (p = 0.002) were statistically significant factors for determining fecal control.

Conclusion:

FI and UI are frequently associated with pregnancy and delivery, but their prevalence is underestimated. The role of the practitioner is crucial in preventing and treating these conditions, and in impeding their harmful effects on the postpregnancy quality of life of Saudi women.

Women's perception and attitude to medical students' participation in obstetrics and gynecology care

Objectives:

To determine the attitudes of obstetric and gynecological patients towards medical students’ participation in clinical care.

Methods:

Patients in an obstetric and gynecological practice in Kingdom of Saudi Arabia, completed a structured self-administered online questionnaire to assess demographic, reproductive and lifestyle variables that affected their attitude towards the acceptance of medical students’ participation in outpatient clinical care.

Results:

Out of the 595 women surveyed, 64.7% received perinatal care, while 35.3% received gynecologic care. Women mostly held positive attitudes towards medical students’ participation. Women expressed more comfort with medical students’ involvement during limited clinical care roles such as obtaining patient’s history and physical examinations without a pelvic examination. Women reported higher comfort levels in the presence of female medical students, especially during pelvic examinations. The presence of male medical students caused a significant reduction in patient’s comfort.

Conclusion:

Our results suggest that women seeking obstetrics and gynecology medical services are accepting students’ involvement during the healthcare encounter. Most patients are more comfortable if direct contact with students is minimized and students’ participation in medical care is restricted to more limited roles. In addition, the student’s gender is a significant determinant of patient’s acceptance and comfort during the clinical encounter.

Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Western Saudi Arabia

Objectives

We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia as well as the risk factors of HDP, and maternal and fetal outcomes.

Methods

We retrospectively evaluated the medical records of 9493 women who delivered at King Abdulaziz University Hospital, a tertiary care center, between January 2015 and June 2017. All cases of HDP were included.

Results

We identified 224 pregnant women with HDP in our patient cohort, giving a prevalence of 2.4%. Their mean age was 31.3±6.7 years, with an average gravidity of 4.0 and average parity of 3.0. The most prevalent subtype of HDP was preeclampsia (54.9%) while 29.5% of the women had gestational hypertension, and 8.0% had eclampsia. The prevalence of subtypes of HDP differed significantly with gravidity, and mean age differed significantly with HDP subtype. Personal and family histories of preeclampsia and the presence of diabetes were more prevalent in women with preeclampsia and gestational hypertension; however, only the difference in diabetes prevalence was significant. The overall prevalence of maternal complications was 9.4% and the prevalence of maternal mortality was 1.3%. Multigravid women and women with chronic hypertension were at increased risk of prematurity compared to other pregnant women, but not significantly.

Conclusions

The prevalence of HDP was relatively low in our cohort. However, to prevent harmful impacts on both the mother and fetus, screening for this disorder is recommended early in pregnancy.

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 <36 weeks, and estimated blood loss >2000 ml.

Review of 244 cases of ovarian cysts

OBJECTIVES

To review cases of ovarian cysts managed at a University Hospital, and to identify the factors necessitating the use of laparotomy over laparoscopy.

METHODS

We carried out a retrospective chart review of all cases of ovarian cysts diagnosed and managed at the Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2010 and August 2014. All data collected from medical record charts, patents details, clinical presentations, ovarian cysts description, and pathology type were recorded, and management by laparoscopy or laparotomy was identified. Ethical approval was obtained from ethical hospital committee.

RESULTS

There were 244 cases of ovarian cysts during the study period. The age ranged from 3 months to 77 years of age. The parity from 0-6. The height range from 37-180 cm. The weight range from 3-161 kg, and calculated body mass index ranged from 12-47. Out of 244 patients diagnosed, 165 were married (67.4%). Of those, only 16 patients were pregnant (6.6%). The most common presentation was abdominal pain in 142 patients (58.2%). Only 79.9% were ovarian cysts, and 17.5% were either para-ovarian or retroperitoneal. The right ovaries were affected in 63.1%, and only 18.9% were bilateral. The types of ovarian cysts included functional cysts 33.2%, benign cyst-adenoma 19.3%, and dermoid cysts 12.3%.

CONCLUSION

Factors associated with laparotomy management rather than laparoscopy included older age more than 35, single, pregnant, or patients presenting with abdominal pain, and more than one cyst.

Neglected intra-cervical bizarre foreign object

Foreign objects in the female genital tract neglected for a long period of time may lead to many clinical problems including recurrent vaginal discharge and infertility. We present a case of 3-year long infertility, and 11-year long recurrent vaginal discharge in a 24-year-old female. She was treated empirically with several courses of antibiotics, which did not resolve her symptoms. Before her marriage, the family declined initial attempts to perform a physical examination due to fear of tearing the hymen, which has many social implications in the Kingdom of Saudi Arabia. After her marriage, she suffered from infertility and continued to have the vaginal discharge. On vaginal examination, she was found to have a foreign body in the uterine cervix. It was inserted 13 years ago, and lead to chronic vaginal discharge and infertility.

Men's knowledge and attitude towards breast cancer in Saudi Arabia. A cross-sectional study

OBJECTIVE

To identify men's knowledge and attitude towards early detection of breast cancer.

METHODS

This cross-sectional study was conducted at the outpatient clinics of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Five hundred and fifty participants were selected by systemic randomization. The distributed questionnaire included: demographics, knowledge and its source on breast cancer, beliefs and practice regarding breast self-examination (BSE), mammography, and difficulties that may prevent women from seeking medical help. The questionnaire was filled anonymously and in private.

RESULTS

The response rate was 90.9%, and most were employees (63.2%). Physicians represented 43.4% of the source of knowledge, followed by the internet (40.4%), and last, the media (30.4%). Breast mass was the most common symptom (36.6%), followed by change of breast size (26%) and pain (20.2%), while 24% did not know the symptoms of breast cancer. Approximately 13% believed that all cases of breast cancer ended with mastectomy. Only 57.6% were aware of the importance of BSE in early detection of breast cancer, and approximately 90% did not know the importance of mammography.

CONCLUSION

Awareness campaigns aimed at husbands and men in general are to be strongly considered. They should encourage their wives and families to enroll in awareness and screening campaigns.

Health care provider's role in facing the future burden of breast cancer in Saudi

OBJECTIVE

To investigate the knowledge, attitude, and practice of health care professionals on the early detection of breast cancer.

METHODS

A cross-sectional study was conducted in Jeddah and Abha regions of Saudi Arabia from May to November 2009. A detailed questionnaire was distributed to 500 doctors from different hospitals. The questionnaire contained items on the practice of clinical breast examination and mammogram examination, and the doctor's perception of their roles in education.

RESULTS

The results of 337 questionnaires analyzed indicated that most health care professionals do not practice clinical breast examination and mammography, and the perception of their roles in education is not as expected.

CONCLUSION

Health care providers are one of the main barriers in improving early detection of breast cancer in Saudi Arabia. There is a need to increase awareness among health care providers of their role in the fight against breast cancer through focused education and training programs.

The knowledge of breast cancer among young Saudi females

OBJECTIVE

To assess the breast cancer knowledge level of Saudi female school students.

METHODS

A detailed questionnaire on cancer breast was designed with all the needed information. Using a map of the Jeddah area of Saudi Arabia, schools were identified in each area and permission was sought from the Ministry of Education to distribute the questionnaire to the students. A team of volunteers was instructed on how to distribute and collect the questionnaires. The collected questionnaires were then statistically analyzed. This Pilot study of 500 students was performed in King Abdul-Aziz University Hospital using high schools from the city of Jeddah between April and June 2009. The results were used to build up a base for designing a community educational program.

RESULTS

Analysis of the data from 337 questionnaires from high school and college students showed that the level of knowledge of young females on breast cancer is limited. However, it also indicated that the students are very enthusiastic to learn about cancer breast, and its prevention.

CONCLUSION

The limited knowledge level of breast cancer in the younger generation might be an obstacle to screening programs and early diagnosis. Awareness programs should be developed including lectures, seminars workshops, and on hands training.

Manchester repair. An alternative to hysterectomy

Local data regarding Manchester repair are not available in the current literature. We report a retrospective case series of 7 women who presented with uterine prolapse, and underwent Manchester repair from January 1997 to May 2008 at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. All of these women were multiparous (para 31) and wanted to avoid hysterectomy, and become pregnant. The duration of the procedure was 119 16 minutes. No operative complications were observed. The mean duration of follow up was 52 years. All of the women were satisfied with the procedure. Two (28.6%) patients subsequently became pregnant and had a successful vaginal delivery. Manchester repair is a valid alternative to hysterectomy for women with a second degree uterine prolapse who want to preserve their fertility.

Assisted reproductive technology in Saudi Arabia

This paper aims at presenting details of the application of assisted reproductive technology and the impact of the Islamic law (Sharia) on its practice in the Kingdom of Saudi Arabia (KSA). Analysis of the data sourced from manual searches of bibliographies from key articles showed that this technology in KSA is practiced in a strictly religious manner and certain aspects of the technology are completely forbidden. It further showed that lack of an official government in-vitro fertilization (IVF) registry to gather information on the activities of IVF clinics has limited the data available for international comparisons. Sharing information internationally could allow religiously concerned infertile couples to have access to the reproductive services in the Kingdom. It would further improve the quality of care, enhance certain techniques like in-vitro maturation and experimentation on embryos, by providing resources that are currently unavailable, keeping in view the religious beliefs and avoiding conflicts.

Abdominal myomectomy versus abdominal hysterectomy for symptomatic and big uterine fibroids

OBJECTIVE

To compare abdominal myomectomy with abdominal hysterectomy in women with big and symptomatic uterine fibroids.

METHODS

The hospital records at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia were reviewed to identify women who underwent abdominal myomectomy or abdominal hysterectomy between 1989 and 1999. Inclusion criteria were the presence of symptoms and size of the uterus equaling that of 12 weeks gestation or more. Women who underwent myomectomy as a treatment of infertility were excluded.

RESULTS

During the study period, 111 women met the inclusion criteria. Thirty-eight women underwent abdominal myomectomy and 73 women underwent abdominal hysterectomy. Forty women were excluded because of myomectomy for infertility. Abdominal myomectomy was successfully performed in all women for whom it was scheduled. Hysterectomy, internal iliac ligation, or other procedures were not necessary to control the bleeding. The primary indication for myomectomy was abnormal vaginal bleeding in 23 women and pelviabdominal mass in 15 women compared to 6 women and 67 women in the hysterectomy group. There were statistically significant differences in the mean age and parity (p value 0.01 and <0.001) between women who underwent abdominal myomectomy and abdominal hysterectomy. The uterine size clinically (mean +/- standard deviation), size of largest myoma by ultrasonography, and from histopathology reports were 15.4 +/- 3.8, 11.8 +/- 2.8, and 13.6 +/- 3.2 compared to 17.9 +/- 4.4, 16.9 +/- 4.2, and 13.8 +/- 3.7 (p values not statistically significant). Similarly, there were no statistically significant differences in the pre- and postoperative hemoglobin, estimated blood loss, rate of blood transfusion, operative time, and numbers of days in hospital.

CONCLUSION

Abdominal myomectomy for big and symptomatic uterine fibroids carries similar risks to abdominal hysterectomy.

The use of intrapartum defibulation in women with female genital mutilation

OBJECTIVE

To assess the use of intrapartum defibulation for women who have had female genital mutilation.

DESIGN

A retrospective case analysis.

SETTING

King Abdulaziz University Hospital, a teaching hospital in Jeddah, Saudi Arabia.

SAMPLE

Two hundred and thirty-three Sudanese and 92 Somali women who were delivered at the hospital between January 1996 and December 1999.

METHODS

The outcome of labour of women with female genital mutilation who needed intrapartum defibulation were compared with the outcome of labour of women without female genital mutilation who did not need intrapartum defibulation.

RESULTS

One hundred and fifty-eight (48.6%) women had infibulation and needed intrapartum defibulation to deliver vaginally, 116 women (35.7%) did not have infibulation and gave birth vaginally without defibulation, and 51 (15.7%) women were delivered by caesarean section. There were no statistically significant differences, between women who underwent intrapartum defibulation and those who did not, in the duration of labour, rates of episiotomy and vaginal laceration, APGAR scores, blood loss and maternal stay in hospital. The surgical technique of intrapartum defibulation was easy and no intraoperative complications occurred.

CONCLUSIONS

Intrapartum defibulation is simple and safe, but sensitivity to the cultural issues involved is essential. In the longer term, continuing efforts should be directed towards abandoning female genital mutilation altogether.

Use of the computer for interpretation of fetal heart tracings

OBJECTIVE

To compare the interpretations of antepartum fetal heart tracing by computer and by three experts.

METHOD

One hundred and forty-eight patients with high risk pregnancies were included. Their fetal heart tracing was interpreted by each of the three experts and the computer. The interpretation of whether it was reactive or nonreactive, by each of the experts with that of the computer controlling for the outcome, were cross-tabulated using the chi 2-test with a control variable. To define the abnormal outcome the odds ratio and 95% confidence interval were used.

RESULTS

The computer defined 14 tracings as nonreactive and the experts, respectively, 19, 18 and 17. The gestation age ranged from 34 to 42 weeks with a mean of 38.26 and standard deviation of 2.31. The common reasons for monitoring were diabetes (20.9%), hypertension (20.3%) and post-date (11.9%). Out of 148, 16 had an abnormal fetal outcome. There were no statistically significant differences between any of the experts and the computer in determining the normal outcome. However, to determine the abnormal outcome, there was a statistically significant difference between two of the experts and the computer with P < 0.025. It was found that the computer was superior to any of the experts in defining the abnormal outcome with an odds ratio of 55.9 and experts odds ratio and 95% computer interpretation were 1.6 (0.4-6.5), 1.0 (0.2-4.9) and 1.1 (0.2-5.3), respectively.

CONCLUSION

There was no difference between the experts and the computer in defining the normal outcome, but it appears that the computer was better in defining the abnormal outcome.

Retention of urine in females: causes and management

Retention of urine in the female results from various medical, surgical and gynaecological causes, but is often thought to be due to psychological disturbances. In order to find out the causes of urinary retention in females in our own population and the results of its management, we conducted a retrospective study on 30 female patients with retention of urine, seen at King Abdulaziz University Hospital, Jeddah, over a five year period. Only six (20%) patients were found to have psychological disturbances. Out of the 30 patients, 27 were available for follow-up. In those patients followed up, a success rate of over 85% was achieved through using clean intermittent catheterization with or without pharmacological treatment, either in regaining complete bladder function or in overcoming this clinical problem.

Pericardial effusion in normal pregnant women

Fifty-two normally pregnant women underwent echocardiography to examine their pericardium in the first, second and third trimester. Pericardial effusion was noted in 15.3% of the women (n = 8) in the first trimester, 19.2% (n = 10) in the second trimester and 44.2% (n = 23) in the third trimester of pregnancy. Pericardial effusion during pregnancy was found to be completely resolved in all patients who underwent an echocardiogram 6 weeks post delivery (n = 11). There was no statistically significant difference in age, hemoglobin, total protein, albumin/globulin ratio or mean blood pressure during pregnancy between those who developed pericardial effusion and those who did not. The frequency of occurrence of pericardial effusion in primigravidas at 69.2% (9/13) was higher than that in multigravidas, with a ratio of 35.9% (14/39), the difference being statistically significant (p less than 0.025). The frequency of occurrence of pericardial effusion in patients who gained more than 12 kg during pregnancy at 67.7% (11/17) was higher than in patients who gained less than 12 kg, with a ratio of 34.3% (12/35), the difference being statistically significant (p less than 0.025).