Ghadeer K. Al-Shaikh

Pre-existing diabetes mellitus and adverse pregnancy outcomes

BackgroundPregnancies complicated by pre-existing diabetes mellitus (PDM) are associated with a high rate of adverse outcomes, including an increased miscarriage rate, preterm delivery, preeclampsia, perinatal mortality and congenital malformations; compared to the background population. The objectives of this study are to determine the prevalence of PDM and to investigate the maternal and the neonatal outcomes of women with PDM.MethodsThis is a retrospective cohort study for women who delivered in King Khalid University Hospital (KKUH) during the period of January 1st to the 31st of December 2008. The pregnancy outcomes of the women with PDM were compared to the outcomes of all non-diabetic women who delivered during the same study period.ResultsA total of 3157 deliveries met the inclusion criteria. Out of the study population 116 (3.7%) women had PDM. There were 66 (57%) women with type 1 diabetes mellitus (T1DM) and 50 (43%) women with type 2 diabetes mellitus (T2DM). Compared to non-diabetic women those with PDM were significantly older, of higher parity, and they had more previous miscarriages. Women with PDM were more likely to be delivered by emergency cesarean section (C/S), OR 2.67, 95% confidence intervals (CI) (1.63-4.32), P < 0.001, or elective C/S, OR 6.73, 95% CI (3.99-11.31), P < 0.001. The neonates of the mothers with PDM were significantly heavier, P < 0.001; and more frequently macrosomic; OR 3.97, 95% CI (2.03-7.65), P = 0.002. They more frequently have APGAR scores <7 in 5 minutes, OR 2.61, 95% CI (0.89-7.05), P 0.057 and more likely to be delivered at <37 gestation weeks, OR 2.24, 95% CI (1.37- 3.67), P 0.003. The stillbirth rate was 2.6 times more among the women with PDM; however the difference did not reach statistical significance, P 0.084.ConclusionPDM is associated with increased risk for C/S delivery, macrosomia, stillbirth, preterm delivery and low APGAR scores at 5 min.

Effects of secondhand smoke on the birth weight of term infants and the demographic profile of Saudi exposed women.

BackgroundMaternal exposure to tobacco smoke during pregnancy is associated with detrimental effects on the mother and the fetus including; impaired fetal growth, low birth weight and preterm delivery. In utero exposure to tobacco is implicated in the etiology of many adults’ diseases including obesity, diabetes and hypertension.The objectives of this study were to evaluate the effects of Secondhand Tobacco Smoke (SHS) exposure on newborns’ anthropometric measurements and to compare the demographic profile of the women exposed to SHS to those who were not.MethodThis is a retrospective cohort study investigating the effects of SHS during pregnancy on newborns’ anthropometry. Women who self-reported SHS exposure were compared with those not exposed. The primary outcomes were birth weight, newborn length and head circumference. Univariate analysis and multivariate regression analysis were performed. Adjusted differences with 95% confidence intervals were calculated.ResultsMothers exposed to SHS constituted 31% of the cohort. The mean birth weight of infants of exposed mothers was significantly lower by 35 g, 95% CI: 2–68 g, (P = 0.037) and the mean length was shorter by 0.261 cm, 95% CI 0.058-0.464 cm, (P = 0.012) compared to the infants of unexposed mothers. Women exposed to SHS, were younger, of lower parity and more likely to be illiterate than those who were not exposed in addition, exposed women were less likely to be primiparous.ConclusionThe prevalence of exposure of Saudi pregnant women to SHS is high at 31% and it is associated with reduced birth weight, and shorter length of the newborn.

Knowledge, attitudes, beliefs, and barriers associated with the uptake of influenza vaccine among pregnant women

Objective: The purpose of the study was to assess the knowledge, attitudes, beliefs, and factors associated with the uptake of the influenza (flu) vaccination in women within Saudi Arabia during their pregnancy period. Methods: A cross-sectional prospective survey was conducted on 1085 pregnant women at the antenatal clinic over a period of 6 weeks with the provision of influenza vaccination. The questionnaire collected demographic and other data; it included 12 questions on their general knowledge and assessed their attitude toward influenza vaccination, and their awareness of vaccine risk and the potential benefits during pregnancy. The knowledge score obtained was then calculated and compared. Results: A total of 998 patients took part in the questionnaire with a response rate of 92%. There was poor awareness that the flu vaccine is safe to administer during pregnancy (130, 13.1%) and that all pregnant women should receive the flu vaccine (190, 19.1%). Pregnant women with flu vaccine knowledge score of ⩽5 (range 0–12) were significantly less likely to take the vaccine (OR 3.78, 95% CI 2.68–5.26, p < 0.001). There was a low uptake of the vaccine (178, 18.1%) and only 29 (3.0%) had previously been offered the flu vaccine by any doctor during their pregnancy. In addition, 255 (25.8%) were against taking the flu vaccine during pregnancy. Conclusion: The knowledge and uptake of the influenza vaccine among Saudi pregnant women are low. One quarter was against the vaccine during pregnancy. Very few believed the flu vaccine to be safe during pregnancy. Rarely, physicians advise their clients to take flu vaccine.

Knowledge of Saudi female university students regarding cervical cancer and acceptance of the human papilloma virus vaccine

We read the recent publication on the “Knowledge of Saudi female university students regarding cervical cancer and acceptance of the human papilloma virus vaccine (HPV)” by Al Sheikh et al.1 Cervical cancer is the third most common female cancer worldwide with an estimated incidence of 530,000, with 270,000 related deaths in 2012. Attributable fraction due to HPV infection was estimated to be 100%.2 Cervical cancer is one of the most common cancers among women in Saudi Arabia. Oncologist Dr. Najla Al-Mari said a study carried out in the year 2011 in 3 general hospitals showed that 55 women die annually from cervical cancer and more than 150 cases were recorded.3 The good thing on this type of cancer is that it takes years to develop. The body may contract the virus, but it remains dormant for a number of years. It is also very easy to detect because its symptoms appear before the contraction of the actual disease. This allows recognizing it and removing it in its first stages. This type of cancer can be detected in its early stages through vaginal scanning to monitor mutations of the cervical tissues. Every married woman should have a vaginal scan biennially after 3 years into her marriage. The factors that increase the risk of human papillomavirus are marriage at a young age, and marrying someone who has had multiple sexual partners. Konno et al4 reported that the highest incidence rates are in sub Saharan Africa, central, and South America. In contrast, the incidence rate is lowest in the Middle East particularly among Muslims and Jews as compared with other religious groups.4 Association of oncogenic HPV infection and the development of cervical cancer provides an opportunity for primary prevention through prophylactic vaccination. The vaccination is highly effective and safe.5 In our daily practice in the pediatric clinic, parents often enquire on available vaccines after their child finishes the recommended immunization schedule for persons aged 0 through 6 years. Recommendations from the American Academy of Pediatrics (AAP), the American Academy of Family Practice (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) all recommend the bivalent or quadrivalent HPV vaccines for female children aged 11-12 years of age for the prevention of cervical, vaginal, and vulvar cancer and the related precursor lesions caused by the HPV types targeted by these vaccines.6 Two vaccines have been developed against HPV infection; one is a quadrivalent vaccine (Gardasil), and the other is a bivalent (Cervarix) vaccine. Excellent antibody responses have been reported following immunization with both quadrivalent and bivalent vaccines.7 In view of the magnitude of this problem; cervical cancer vaccine should be included in the present immunization schedule. This vaccine is available in private hospitals at a cost, and the public would like the Ministry of Health to make this vaccine freely available. We agree with the authors that there is a need to utilize all means of communication to raise awareness among the public regarding this disease.

Awareness of an obstetric population about environmental tobacco smoking.

Background and Objectives: The reported rate of womens smoking is typically low. However, many pregnant women are exposed to environmental tobacco smoke (ETS), which could affect their own health and the health of their growing fetus. The aim of this study was to estimate the magnitude of the problem of exposure to ETS and assess the awareness of postpartum women to ETS and its possible effects. Designs and Settings: This was a cross-sectional study conducted on 1182 postpartum women at a university hospital in Riyadh, Saudi Arabia, between 1st January and 30th June, 2012. Materials and Methods: A structured questionnaire was used for data collection. Factors associated with the level of understanding of the possible effects of ETS exposure were analyzed. Results: The majority of the participating women knew that exposure to ETS had adverse effects on maternal and fetal health (>80%), but their knowledge of the specific effects on fetal health was limited. The level of mothers’ education was found to be associated with better knowledge of effects on mother and fetal health (P < 0.01). Conclusion: This study revealed that pregnant women in our sample had limited knowledge of the specific effects of ETS on fetal health. This shortcoming in knowledge needs to be addressed by improving health.

Evaluation of Sacrospinous Hysteropexy vs. Uterosacral Suspension for the Treatment of Uterine Prolapse: A Retrospective Assessment

This single‐center retrospective study aimed to compare the outcomes of vaginal hysterectomy with utero‐sacral suspension (VH/USS) versus sacro‐spinous hysteropexy (SSHP) in the management of uterine prolapse at a tertiary care center specializing in Urogynecology.

Use of cross-institutional progress test as a predictor of performance in a new medical college

Background The progress test was initiated by Qassim University in 2000 as a tool to evaluate the educational process among Saudi medical colleges. Princess Nourah Bint Abdul Rahman University (PNU) College of Medicine is a new medical college established in 2012 that implemented the same innovative reformed curriculum of King Saud University College of Medicine. Objectives The objective of this study was to use the progress test to evaluate the rate of knowledge acquisition among a new medical school compared to other long-established medical schools in Saudi Arabia. Materials and methods As part of an ongoing strategy, the progress test was administered before the end of the academic year. Students in PNU were enrolled for 2 years in the progress test. We compared the mean progress test scores for PNU students compared to students at comparable stages in other medical schools in Saudi Arabia. Results The results showed that the rate of knowledge acquisition was similar in students at PNU to students in other well-established medical schools in Saudi Arabia. Conclusion The present study showed that the interinstitutional progress test demonstrated that the level of acquisition of knowledge and performance of students in a new medical school was similar to other medical colleges in Saudi Arabia.

Vesicovaginal fistula formation after oocyte retrieval.

Development of a vesicovaginal fistula (VVF) is a devastating condition that has profound effects on both the physical and psychological health of a patient [1]. VVF is uncommon in the developed world. In modern urological practice, around 90% of cases are caused by inadvertent injury to the bladder during surgery [2]. The reported incidence after pelvic surgery is 0e52% [3]. Other less common causes include pelvic malignancy, pelvic irradiation, obstetric trauma, and infection including tuberculosis [4]. Transvaginal ultrasound-guided oocyte retrieval has been performed since 1985 [5]. It is a safe and well-tolerated procedure. In this technique, oocytes are collected by passing a 16e18 gauge needle attached to a transducer through the vaginal wall in the lateral superior fornices under ultrasound (US) guidance into the stimulated ovarian follicles. The main reported complications are minor vaginal bleeding and pelvic infection. Injuries to the surrounding organs, such as the bowel and bladder or large vessels, are rare. In the literature, a few case reports of ureterovaginal fistula have been found, but to our knowledge, VVF formation after oocyte pickup has not been reported [6]. Recent advances have improved the success ofVVF repairda challenge that can test even the most experienced gynecologic surgeon. For example, it is now apparent that small, uncomplicated fistulae respond well to conservative treatment [7]. Here, we present a rare case of VVF after US-guided oocyte retrieval and its conservative management in the form of continuous urinary catheter drainage for 3 weeks’ duration. The patient was a 28-year-old woman P0 þ 1 referred from the Assisted Conception Unit to the urogynecology clinic at a university hospital after embryo transfer with a history of passing watery vaginal discharge requiring a pad. The couple had infertility due to a male factor and was on the second cycle of in vitro fertilization (IVF). Oocyte retrieval was performed by a junior consultant at a private center using a single-lumen 16gauge needle. Day 3 after oocyte retrieval, three embryos