Out of a total of 45,836 deliveries over a five-year period (1986)(1987)(1988)(1989)(1990), 128 cases of ectopic pregnancy (0.28% incidence) managed during this period was compared with other previously published data in terms of presentation and management. There were no maternal deaths among the cases treated. The age distribution was 16-44 years with higher incidence 46 (36%) occurring in the range of 25-30. One hundred thirty (93%) were multipara. The presenting complaints included pain (100%), vaginal bleeding (78.4%) and amenorrhea (39.8%). The most consistent clinical finding was cervical excitation tenderness (88%). Ultrasonography (88%) and laparoscopy (50%) were adjunctive only to history and physical examination which was found to be most important in the diagnosis. Detection of an adnexal mass separate from the ovaries with or without hemoperitoneum was diagnostic of ectopic pregnancy. One hundred two (79.6%) diagnosed as rupture, 17 (13%) as aborted and five (3.9%) as intact. With the changing picture of ectopic pregnancy, one case each was initially diagnosed as appendicitis, urinary tract infection and anemia and admitted in the medical ward before further review confirmed the diagnosis of ectopic pregnancy. The sites of implantation included 123 in ampulla (96%), one each in ovary, cornual and cervix with two diagnosed as having abdominal pregnancy. The predisposing factors include pelvic inflammatory disease (22.6%), previous ectopic (10.2%) and recent IUCD (9%), but none insitu at the time of ectopic. Our treatment of choice is salpingectomy but 12% had salpingo-oophorectomy for various reasons, while total abdominal hysterectomy was performed for the cervical pregnancy for uncontrollable hemorrhage. BN Ogbonna, A Al-Nemr, M Moghanam, Ectopic Pregnancy in King Fahad Hofuf Hospital: A Five Year Experience. 1992; 12(6): 544-547 A total of 128 cases of ectopic pregnancy were treated over a five year period in King Fahad Hofuf Hospital. The total number of deliveries during this period was 45,836 and the incidence of ectopic pregnancy in the area was 0.28% (2.8/1000 births). No maternal deaths occurred among the cases diagnosed and treated in the hospital during the five years. King Fahad Hospital is the only tertiary center in Al-Hassa and therefore serves a population of approximately 600,000. The aim of this study was to analyze the clinical features, and diagnosis and treatment of all cases encountered in Al-Hassa and comparison, where necessary, of our results with previously published data. Patients and ResultsThe hospital charts of all the patients who were admitted with or diagnosed to have ectopic pregnancy between 15 September 1986 and 22 July 1990G (1 Muharram 1406 and 30 Dhu Al-Hijjah 1410H) were retrieved and reviewed. The relevant information collected from the charts included nationality, parity, age, clinical presentation, treatment, and subsequent follow-up. The anatomical description of the site of implantation was also obtained from During 15 September 1986 and 22 July 1990, ...
This article reviews the outcomes of 450 women in a high-risk obstetric population that were induced with Dinoprostone (Pharmacia and Upjohn, Kalamazoo, MI) intracervical gel containing 0.5 mg of dinoprostone in 2 g gel. The risk factors include advancing maternal age, multiparity, and the social demand on women to avoid cesarean section by any means to avoid compromising their ability for repeated pregnancies.Fifty three women (11.7%) were para 10 and above, 46 (10.2%) were in the over-40 years of age group. The clinical dilemma one is frequently confronted with is an elderly grandmultiparous woman with one previous cesarean section requiring induction at term.Four hundred and ten (91%) of the women had normal vaginal delivery and forty (8.9%) delivered by cesarean section. The cesarean sections were KEYWORDS Cervical ripening; Induction of labor; Dinoprostone evenly distributed among the various age and parity groups. The cesarean section rate is the same as in women presenting in spontaneous labor. Of the 72 women with a history of one previous section that had cervical ripening with dinoprostone gel, 56 (77.7%) had normal vaginal delivery and 16 (22.3%) had repeat section. Main indications for repeat section were failure to progress, failed induction, and non-reassuring fetal heart trace. In our practice, a history of one previous cesarean section is not a contraindication for cervical ripening with dinoprostone intracervical gel [1]. The high vaginal delivery rate for these women is cost-effective. Chung et al.[2] estimated a baseline cost of a successful trial of labor to be $4950 versus $7244 for elective repeat section.Regarding the number of prepidil applications needed to ripen the cervix, 234 women (52%) had one insertion, 138 (30.6%) had two, 49 (10.8%) had three, and the rest had more than three. Cumulatively, 94% of the patients were treated with three or less prepidil insertions (odds ratio, 1.753: 95% confidence interval, 1.658--1.848) ( Table 1). Compared with Misoprostol (Cytotec), the cost differential may not be as high as previously thought.Augmentation of labor with oxytocin occurred in 122 women (27%), and the average inductiondelivery interval was 12 h (range 8 to 18 h) compared with 4 to 8 h for women that presented in spontaneous labor.
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