Saudi Journal of Obstetrics and Gynecology

Laparoscopic management of benign adnexal masses: Two years’ experience

2022-01-23T21:05:35+00:00

Abstract

Objective:Our objective is to evaluate the safety and reliability of laparoscopy in the

management of benign adnexal masses in patients with diversity of presentations through a

retrospective study.

Methods:We analyzed data from 41 patients who were admitted to King Abdulaziz Hospital,

Obstetrics and Gynecology Department through outpatient clinic, emergency department and

referred from other hospitals. All patients were diagnosed as benign adnexal mass and

underwent laparoscopy for both diagnostic confirmation and management. Laparoscopy was

performed after fulfillment of the diagnostic work up of benign adnexal masses.

Results: All the study cases were operated successfully by operative laparoscopy. High BMI ,

pregnancy, and large adenexal masses were not limitations for the procedure. Fertility

potentials were preserved in most of cases Long operative time was noticed. Operative and post

operative parameters were comparable to former studies.

Conclusion: Laparoscopic approach can be considered the gold standard surgical approach

for the management of benign adnexal masses. It can be offered for patients who want to

preserve their fertility potential. It can be successfully performed on patients with benign

adnexal masses regardless of the size of the mass and with low risk in patients with

intraperitoneal adhesions when done by skilled team.

Keywords:Laparoscopy, benign, adnexal masses, management

Vulvar lipoma: a Case Report

2022-01-25T06:56:15+00:00

Case Report and literature review
We reported a case of 29 years old para two patient who was presented with painful left
labial mass for 3 years , a physical examination revealed freely mobile left labial tender
cystic mass .
A differential diagnosis of vulvar lipoma , smooth muscle neoplasm , inclusion cyst ,
Bartholin cyst and epidermal cyst had been made .The patient underwent surgical
excision; The mass was easily separated from the surrounding tissue, and was removed
completely from its capsule. The histopathological examination revealed
Single firm discoid shape mass measure 5x4x2 cm delicate capsule brown color
homogenous yellow cut section , outer surface is coated black by indian ink , partialy
submitted 4 cassettes diagnosis was fibrolipoma

Intrauterine Device Knowledge and Practices among Obstetrics and Gynaecology Residents in Western Region of Saudi Arabia

2022-01-25T04:34:18+00:00

Abstract Background: There observed underuse of intrauterine device among Saudi women. This partly related to the information that women receive from their healthcare providers. Therefore, this survey aimed to evaluate the knowledge and counselling practices of obstetrics and gynaecology residents in the Western region of Saudi Arabia. Methods:This cross-sectional study conducted in several Saudi hospitals in western region throughout four months. Obstetrics and gynaecology residents across all five years of residency randomly selected to fill out a web-based questionnaire. Results: Among 206 residents, 101 of them completed the questionnaire. Overall, respondents were least likely (4%) to correctly answer the question ‘‘Mechanism of action of IUD’. Only 29.7% correctly responded with ‘’10 years’’ as the answer for the question ‘‘Maximum years of use for copper IUD’’, and “Paragard (Copper T380A) IUD” as the answer for the question “Emergency contraception.” Only 2.0% of respondents knew the prophylactic use of levonorgestrel IUD against endometrial hyperplasia and malignancy. Knowledge of the respondents about the routine use of IUD in patients that reported a history of deep vein thrombosis or pulmonary embolism was deficient (25.7%). Forty-two percentages of participants reported their usual recommendation of IUD to patients younger than 20 years old, immediately after delivery of the placenta, and to patients who have never been pregnant. Conclusion: These findings explored a substantial lack of IUD knowledge and counselling practices among the participating residents. Also emphasises the need to develop our residency syllabuses. Additionally, provision of Ryan programs in the Saudi Obstetrics & Gynecology residency programs recommended.. Keywords:Obstetrics &gynaecology residents, intrauterine device, knowledge, counselling practices, survey, Saudi Arabia

Measure Incidence of 3rdand 4th degree perineal tear among pregnant ladies in King Abdulaziz Medical City, Jeddah - delivering vaginally and assisted vaginal deliveries

2022-01-25T05:26:11+00:00

Abstract Objective: The aim of the present study is to assess the incidence of 3rd and 4th perineal tear among patient who deliver vaginally or with assisted vaginal delivery in King Abdulaziz Medical City (KAMC) Jeddah. Methods: Settings: A population based retrospective cohort study conducted all deliveries with 3rd and 4 th vaginal tear analyzed from January 2016- January 2019 in King Abdulaziz Medical City, Jeddah. The hospital has around 3400 deliveries per year. Subjects: There was a total of 10,517 deliveries from January 2016 until January 2019. A total of 3,357 (31.9% ) Cesarean sections delivery were excluded from the study. Results: Parity: It has a great impact of having a 3rd and 4thperineal tear in about 113 cases were nulliparous. Total of 78.2% of women had sever perineal tear were nulliparous. Instrumental delivery: In our study ventouse delivery account for 40% of all delivery with 3rd and 4th degree perineal tear. Whereas forceps delivery account for 2.1 %. Episiotomy: After reviewing the data, total number of patients who had episiotomy from january 2016 until January 2019 were 1059 cases about 45 cases had sever perineal tears (4.2 %). Position: In our study about 52.77 % are undetermined position ,36.8% are occipitoanterior position and 9% are occipitoposterior, as observed undetermined vertex position is high. Anesthesia and suturing: Patients who had local anesthesia were 51.7 %, epidural 35.2 %, spinal 6.9 %. About 86.9 % of cases were suture in labor and delivery room. 12.4 % of cases were suture in operating room Conclusion: Result from our study showed that instrumental delivery and nulliparity are major risk factors for having sever perineal tears.

patients who had episiotomy from january 2016 until January 2019 were 1059 cases about 45 cases had sever perineal tears (4.2 %). Position: In our study about 52.77 % are undetermined position ,36.8% are occipitoanterior position and 9% are occipitoposterior, as observed undetermined vertex position is high. Anesthesia and suturing: Patients who had local anesthesia were 51.7 %, epidural 35.2 %, spinal 6.9 %. About 86.9 % of cases were suture in labor and delivery room. 12.4 % of cases were suture in operating room Conclusion: Result from our study showed that instrumental delivery and nulliparity are major risk factors for having sever perineal tears.

Attitudes and Behavior of Pregnant Omani Women towards Gestational Weight Gain and Exercise during Pregnancy: A survey study.

2022-01-25T05:46:45+00:00

Abstract
Objective:The purpose of this study was to evaluate the attitude of pregnant Omani women
toward their current weight, healthy weight gain and exercise during pregnancy. And to
investigate their views on what they might consider as helpful resources to prevent excessive
gestational weight gain.
Methods:A cross sectional study was conducted in Sultan Qaboos University Hospital (SQUH)
between October and December 2016. One hundred and eighty pregnant Omani women
between 19 to 45 years of age were recruited. A questionnaire was used to collect the data.
Statistical analysis using Pearson’s chi-square test was conducted to evaluate the association
between the study variables and Body Mass Index (BMI) group.
Results: The prevalence of obesity among the study sample was 37%. Out of the obese group,
58% felt uncomfortable about their weight (P value <0.05). Most pregnant Omani women
stopped exercising when they got pregnant. Only 34% of women in this sample exercised during
pregnancy. Significant associations were found between the concern about potential weight
gain and BMI group (P value =0.05). Fourteen percent of the women gained excessive weight
but did not lose it after delivering previous babies and majority of them were classified as obese
(p value <0.05). Feeling tired and lack of time were the main reasons reported for not exercising
during pregnancy.

Conclusion: The results suggest that attitude of pregnant Omani women is reasonable toward
weight gain and exercise during pregnancy. However, only few of them exercised during
pregnancy, which highlights the fact that practicing physical activities were inadequate.
Keywords: Omani women, Pregnancy, Attitude, Exercise, Excessive gestational weight gain,
weight, BMI, body mass index.

Knowledge, attitudes, and practices of family planning and contraceptive methods among woman of reproductive age in Jeddah, Saudi Arabia - 2020 - a cross-sectional study

2022-01-25T05:57:08+00:00

Background:

Family planning is a regulation of pregnancy spacing by using contraceptive methods. It plays

an enormous role in enhancing women's and children's health as well as controlling the

population's growth. What is not yet clear is the degree of understanding and usage of family

planning methods among females. Therefore, this study aims to assess the level of knowledge,

attitudes, and practices of family planning and contraceptive methods among the females of

reproductive age in Jeddah, Saudi Arabia.

Methods:

This study is a descriptive, cross-sectional study using pre-designated questionnaire among

women of reproductive age who live in Jeddah, Saudi Arabia, from July to September 2020. The

sample was randomly selected, and those who met the inclusion criteria asked to fill a

questionnaire survey. The data was collected then analyzed with SPSS.

Results:

The total responses 689, The mean age of our sample was 34.8 (± 9.04), and most of them were

in the age group 21-25 (21%). Furthermore, 67.6% had a moderate level of knowledge about

contraceptive methods. A good majority of the participants (69.6%) had agreed that

contraceptives protected the family and the community's health.

Conclusion:

This study found a strong relationship that demonstrates the impact of awareness and

knowledge on attitude, practice of family planning, and contraceptive methods for limiting the

offspring's number and spacing pregnancies. Also, it highlights the need for woman's education

programs. The results of the study will help physicians promote family planning services in

Jeddah.

Keywords:

Family planning, Contraception, Reproductive age, Saudi Arabia.

Vasa Previa with short uterine cervix : A case report

2022-01-25T06:20:57+00:00

Abstract Background Diagnosis of Vasa Previa and short cervix is a rare gynecological condition, and it can occur even without any placental malposition. Ultrasonography is one of the most useful and accessible devices for detecting this condition and to confirm such diagnosis. Case Presentation A 31years old G3P0 woman presented with short cervical length at 20th week of gestation. Vasa previa measuring 14 cm was diagnosed at 22nd week of gestation. At the 30th week, she delivered a baby girl weighing 1440grams.Both mother and child are well and healthy. Conclusion: Timely detection of vasa previa decreases the chances of neonatal mortality. There is need for setting up proper guidelines at the national level for raising awareness about the complications and prompt diagnosis of vasa previa specially of associated with other obstetrical complications. Keywords: Vasa previa, Fetal distress, cervical length, risk factors, complications, systematic review

Primary adrenal insufficiency in pregnancy: A review article

2022-01-25T06:32:28+00:00

Background:
Primary adrenal insufficiency is a rare disease in the general population with an estimated
incidence of approximately 144 cases per million.1,3 Congenital adrenal hyperplasia (CAH)
and autoimmune adrenalitis (AA) are the two most common causes for primary adrenal
insufficiency in general.1
Primary adrenal insufficiency can be congenital or acquired.2 Congenital types include
congenital adrenal hyperplasia (CAH), familial glucocorticoid deficiency (FGD) and
congenital adrenal hypoplasia.2Autoimmune adrenalitis and tuberculosis account for the
majority of acquired primary adrenal insufficiency.2 In AA, there is autoimmune mediated
destruction of the adrenal cortex resulting in cortisol, mineralocorticoid and androgen
deficiency.1Polyendocrine syndrome (APS) is when this autoimmune process extend to involve
the pancreas causing type 1 diabetes and the thyroid gland causing autoimmune thyroid
disease.1
Addison disease is the term used to describe acquired primary adrenal insufficiency2
a disease that is more prevalent in women than men with a peak incidence in third and fourth
decades of life3
. This makes good understanding of this disease during pregnancy crucial. The
estimated prevalence of adrenal insufficiency during pregnancy is 10 per 100 000.3 This
includes all cases of adrenal insufficiency, primary or secondary congenital or acquired.
As mentioned, Adrenal disorders in pregnancy are not common, the autoimmune nature
of the disease leading to chronic anovulation and impaired infertility is one of the reasons 13
.
timely diagnosis is imperative because these disorders can lead to significant maternal and
fetal morbidity. Making the diagnosis poses a challenge to the clinician because the fetalplacental unit alters the maternal endocrine metabolism and hormonal feedback mechanisms.
Pregnancy and its hypermetabolic state may alter the manifestation of disease, making the
diagnosis difficult.

Etiology of maternal deaths in a tertiary care hospital in Oman, over 27 years (1991-2017)

2022-01-25T06:38:24+00:00

Background:Maternal mortality was specifically targeted by the WHO Millennium
Development Goal 5 (MDG-5) which required reducing the maternal mortality ratio (MMR)
by three quarters between 1990 and 2015. Although maternal MMR has changed in the
Eastern Mediterranean Region, the trend of maternal deaths in the countries of the region is
important.
Methods:This was a retrospective chart review for 27 years. Data was collected from the
delivery ward register and Hospital Information System.
Results: There were 18 maternal deaths out of 62849 live births making the MMR 28.6 per
100,000. The direct causes were embolism and hemorrhage 3 for each, sepsis 2 and abortion
2. The indirect causes were sickle cell disease (n=2), cardiac lesions (n=2), retroviral infection
(n=1), and metastatic adenocarcinoma (n=1), Road traffic accident (n=1) and one with
unknown cause brought dead (n=1).
Conclusion: Indirect causes contributed to maternal death over 27 years, especially in second
half of the study period.
Keywords: Maternal mortality, Causes of death, Risk factors, Oman.

Cesarean section scar ectopic pregnancy -a management dilemma: a case report

2022-01-25T06:47:34+00:00

Background: Cesarean section scar ectopic pregnancy is a rare complication of pregnancy
that has increased following the increasing number of cesarean sections. It is important to have
a high clinical suspicion in any patient who presents with first trimester bleeding and multiple
previous cesarean deliveries. This is important because a delay in diagnosis can lead to
increased maternal morbidity and mortality. Fortunately, the use of first-trimester ultrasound
imaging has led to a significant number of these pregnancies being diagnosed. Early diagnosis
leads to prompt management and improves the outcome by avoiding significant morbidity and
allowing preservation of future fertility.
Case Presentation: We report a case of a 34year-old patient who had a history of two previous
cesarean sections. She presented with twin viable cesarean section scar ectopic pregnancy that
was diagnosed on the basis of transvaginal ultrasound imaging, and managed successfully by
systemic and local (intrasac) Methotrexate. Due to timely diagnosis and management we were
able to avoid complications and were able to preserve her fertility.
Conclusion: It is important for clinicians and radiologists managing women with risk factors
for a scar ectopic pregnancy to maintain a high index of suspicion Failure to diagnose and
initiate prompt management may lead to uterine rupture, massive hemorrhage, and maternal
death.
Keywords:Cesarean scar ectopic pregnancy, Diagnostic challenge, Management

Comparison of pelvic organ prolapse recurrence between abdominal sacrocolpopexy and vaginal uterosacral ligament suspension/sacrospinous fixation

2022-01-25T07:05:29+00:00

Introduction and Hypothesis: Pelvic organ prolapse usually involves the descent of one or
more of the vaginal walls and/or the uterus. Pregnancy and age are the most common causes.
Although it is often asymptomatic, it has a high prevalence. Several approaches are used to fix
pelvic organ prolapse, but the best procedure remains undetermined. In this study, we
evaluated the primary surgical outcomes to compare the efficacy between abdominal
sacrocolpopexy and vaginal uterosacral ligament suspension/sacrospinous fixation in fixing
and preventing recurrence of utero-vaginal or vault prolapse.
Methods: This retrospective cohort study included 110 patients who underwent either
sacrocolpopexy, uterosacral ligament suspension, or sacrospinous fixation between 2016 and
2019 at King Abdulaziz Medical City and who were followed up for >1 year using pelvic
organ prolapse quantification (POP-Q). Primary outcome was Recurrence rate, and
secondary outcome sexual and overall satisfaction using Likert scale. All patients who met the
inclusion and exclusion criteria were included. The required data were collected from medical
charts, then analyzed using the chi-square test and t-test. Results were reported as frequency,
percentage, mean, and standard deviation.
Results: The most affected women were those aged 40-49 years with 7-9 previous deliveries;
4
th degree prolapse was the most common. The most frequent procedure was sacrocolpopexy,
and the most common postoperative complication was dyspareunia.
Conclusions: There were no differences in recurrence rates among the approaches.
Uterosacral ligament suspension or sacrospinous fixation is more suitable for multiparous
women with 2nd
-degree prolapse as they resulted in fewer postsurgical complications
(especially dyspareunia). Sacrocolpopexy may be preferred for patients with advanced pelvic
organ prolapse, especially those aged 50-59 years.
Key words: dyspareunia, pelvic organ prolapse, postoperative complications, uterine
prolapse, vaginal prolapse