Background: Vaginal delivery is a physiological process that holds multiple complications. Perineal trauma and vaginal laceration is considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg, persistent occipital posterior position, nulliparity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature but data are conflicting, such as Prolonged second stage of labor, episiotomy and obesity Objectives: This study aimed to evaluate third and fourth degree tears rates and the impact of related risk factors on perineal tears in a single Saudi center. Study Design: A retrospective observational cohort study. Methods: This retrospective cohort study analyzed all vaginal deliveries from January 2011 to December 2015 in Security Forces Hospital, Riyadh, Saudi Arabia. The Hospital has around 6000 deliveries per year. Data were extracted from dedicated database software for antenatal care through Hospital System (Medical Record Viewer-MRV) and from Midwife Head Nurse daily record system. Results: During the period of interest 28325 records were identified. Caesarean section was performed in 7322 of them (25.8%). Of the remaining 21003 records, 20300 were included in the study according to the inclusion criteria mentioned above. 56 patients (0.28%) had a severe perineal tear because of delivery and were included in group A (Study Group). Group B (Control Group) consisted of remaining 20244 patients. Univariate analysis indicated the following as risk factors for severe perineal tears: gestational age >40 weeks, nulliparity, moderate/ severe obesity, instrumental delivery, shoulder dystocia, pushing stage >90 min, birth weight >4 kg, head circumference at birth >34 cm and length at birth >50 cm. Risk factors still significant in the final multivariate model were moderate/severe obesity (OR=2.8, CI=1.3-6.1), instrumental delivery (OR=2.6, CI=1.2-5.6) and birth weight (OR=1.1/hg, CI=1.1-1.2). Conclusions: Moderate/severe obesity, vacuum delivery and fetal weight resulted as independent risk factors for severe obstetrical tears.
To find out the period prevalence of congenital malformation diagnosed in security forces hospital -Riyadh -kingdom of Saudi Arabia, during the study period from Jan 2012 till Dec 2014 and the possible associated risk factors. Method: This is a retrospective chart review of all pregnant ladies who were following at security forces hospital -Riyadhin the period between Jan 2012 till Dec 2014 in whom congenital abnormalities were diagnosed by ultrasound. Results: Out of 18748 scans done for 9374 patient during the study period, 283 cases of congenital abnormalities were diagnosed, which gives a period prevalence of 3.02%. The majority -around 70% of these anomalies-involved one body system; out of them 31% were renal anomalies. Conclusion:The period prevalence of congenital abnormalities in our study group is similar to that seen in other population worldwide. Strikingly enough, consanguinity in our population appears to play a major associated risk factor.
Heterotopic pregnancy is defined as multiple gestation in which one gestational sac is intrauterine while the other is extra uterine-most commonly tubal ectopic pregnancy. An interstitial ectopic pregnancy is one of the most lifethreatening types of ectopic gestations, with a mortality rate that can reach 6-7 times higher than that of the ectopic pregnancies in general. In our case report, heterotopic pregnancy occurs after a spontaneous conception cycle. A 34-year-old Gravid 3 Para 1 + Abortion 1 woman with a gestational age of 8 weeks + 3 days by LMP. She was diagnosed and managed laparoscopicaly by right salpingectomy with preservation of intrauterine pregnancy. She was discharged on the second postoperative day and followed-up regularly at the obstetrics clinic with uneventful antenatal follow up. This might be the first case to be presented from Middle east with such scenario. Careful evaluation of the adnexa is mandatory not only in women undergoing assisted reproduction, but also with spontaneous pregnancy to avoid delayed diagnosis in such cases.
Abnormal Placentation carries life-threatening consequences to the mother. Placenta percreta is a rare complication of pregnancy. It occurs mostly in the third trimester and presents with severe postpartum hemorrhage and placenta retention. It is rare in the second trimester of pregnancy. Placenta percreta is becoming more common as cesarean section and other uterine surgeries increase. The presence of a uterine scar remains a major risk factor. Clinical presentation is variable with Antepartum hemorrhage is a usual scenario. However, it is usually seen in the third trimester. The presentation here is rare since it occurred in the second trimester rendering clinical suspicion difficult as was evident in the case. We here present a rare presentation of placenta percreta occurring in the second trimester as an acute abdomen secondary to uterine rupture and intraabdominal hemorrhage. She had a life-saving total hysterectomy and good postoperative recovery period. This might be the first case to be presented from Middle east with such scenario. Careful evaluation of a pregnant lady with an acute abdomen must be done with consideration of abnormal placentation as a cause, especially in a patient with risk factors for abnormal placentation.
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