BACKGROUND AND OBJECTIVESDespite the known benefits of support during chilbirth, most hospitals in Saudi Arabia do not allow a companion during labor. This can be due to cultural beliefs among pregnant Saudi women. The aims of this study are to describe Saudi women’s preferences towards supportive companions during labor and to explore their attitudes and knowledge about the importance of support during childbirth.DESIGN AND SETTINGProspective cohort study conducted in three governmental tertiary hospitals within Riyadh.SUBJECTS AND METHODSWomen who consented were interviewed during their postpartum hospital stay using a validated standardized Arabic questionnaire. Participants were asked about their preferences and attitudes towards companions during childbirth, as well as about their knowledge on the importance of such support.RESULTSOf 402 women who participated in the study, 182 women (45.3%) preferred the presence of a companion during childbirth and only 57 of all interviewed women (14.2%) had ever had a supportive companion during any of their previous childbirths. The mother (58%) or husband (51%) was the most preferred person as a childbirth companion. Age, level of educational, or antenatal, intrapartum or postpartum status had no impact on their decision. However, women who had some sort of antenatal educational classes and/or read educational material about childbirth were more likely to prefer support during labor. More than one-third of participants (35.9%) thought that having a companion as support during labor would not help, but the most common reason for not preferring to have a companion was their fear of being exposed most of the time to their companion (64.1%).CONCLUSIONSA significant percentage of surveyed Saudi women preferred not to have a supportive companion during childbirth. The reason might be a lack of understanding of the positive role of a companion during childbirth or because of cultural beliefs. Education of women during their antenatal care about the importance and the implementation of such a practice are warranted.

Objective: To evaluate cochlear implantation in Vogt-Koyanagi-Harada syndrome with regard to surgical difficulties and hearing outcomes. Patients: Single case report. Intervention(s): Therapeutic complete electrode insertion during surgery despite evident intra-cochlear fibrosis. Main Outcome Measure(s): Postoperative speech audiometry, categories of auditory performance, and speech intelligibility rating. Results: Vogt-Koyanagi-Harada syndrome is a multisystem autoimmune disease that affects tissues containing melanin. It is characterized by bilateral uveitis with auditory, vestibular, and dermatologic manifestations. Standard treatment comprises aggressive administration of systemic corticosteroids. This report describes the use of bilateral cochlear implants in a 30-year-old Saudi woman who presented with uveitis and was diagnosed with Vogt-Koyanagi-Harada syndrome. She had progressive hearing loss in both ears and experienced minimal improvement with hearing aids. The patient underwent sequential cochlear implantation, which was challenging because it was difficult to insert the electrode in the right ear due to intra-cochlear fibrosis. After more than 5 years of follow-up, she has good hearing in both ears, despite the advancement of ocular disease and recurring visual complaints. Conclusion: This study suggests that patients with Vogt-Koyanagi-Harada syndrome could develop intra-cochlear fibrosis during cochlear implantation due to the autoimmune nature of disease. Moreover, cochlear implantation becomes more difficult with disease advancement. Therefore, it is essential that healthcare professionals consider early detection and prompt treatment of hearing loss in patients with this syndrome.

ObjectiveCochlear implants (CIs) are typically activated four weeks after the implantation surgery. This delay between device implantation and activation lengthens the implant process and consequently induces personal and financial burdens for some patients who travel from remote regions to receive the surgery. However, fitting the speech processor and eliminating the waiting period could decrease the indirect cost associated with cochlear implantation. The objective of this study was to assess the impact of an early CI fitting on the overall cost paid by patients and their families aiming to improve future care strategies for patients receiving CIs.MethodsThis retrospective study was conducted in a tertiary referral center. All patients who received any kind of CI with early fitting of the speech processor were included. The total financial benefit for the patients and their families over the standard activation visit was investigated by assessing the cost of the non-medical expense for one hospital visit.ResultsOur results showed that the non-medical cost for each hospital visit associated with cochlear implantation was higher for those who traveled from remote areas: 81 USD for each patient within 200 km of the implantation center and 748.56 USD for each patient farther than 200 km from the implantation center.ConclusionsUsing the early fitting approach, some of the financial burden associated with implantation could be alleviated.

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