Hassan S. Abduljabbar

The use of intrapartum defibulation in women with female genital mutilation

Objective To assess the use of intrapartum defibulation for women who have had female genital mutilation.

Urinary tract infection in pregnancy.

During the period January 1987 until January 1988, midstream urine specimens were collected during the first antenatal visit of 2,642 pregnant patients. The specimens were obtained for the purpose of microbiological study. Significant bacteriuria was found in 15.8% (N = 419); 188 of the patients were asymptomatic and 231 were symptomatic, yielding an incidence of 7.1% and 8.7%, respectively. Two hundred females with negative urine cultures were selected as a control group, and matched by age, gravidity, and gestational age. The frequency of occurrence of premature birth was found to be higher only in the symptomatic group (P<0.05), while the frequency of anemia, hypertension, and diabetes was found to be higher in both symptomatic and asymptomatic patients, compared with the control group (P<0.04).

Type I female genital mutilation: a cause of completely closed vagina.

INTRODUCTION Female genital mutilation (FGM) ranges in severity from a nick of the clitoris to partial or total removal of the external genitalia. Sexual complications after FGM include sexual dysfunction, difficult intercourse, and dyspareunia. AIM We report a case of Type I FGM presenting as complete vaginal closure and urinary retention. METHODS A 16-year-old adolescent was referred for obliterated vagina and urinary retention. She had recurrent urinary tract infections, difficulty in voiding, and cyclic hematuria. At the age of 1 year she had been taken by her mother to a pediatric surgeon to have a Type I FGM procedure. On examination, the urethral meatus and vaginal orifices were completely closed by the FGM scar. She underwent uneventful surgical opening of the vagina. RESULTS A normal vaginal orifice was created and normal flow of urine and menses occurred. CONCLUSION Type I FGM can present as complete vaginal closure and urinary retention. Proper diagnosis and treatment are of paramount importance.

Analysis of chromosomal and genetic disorders in patients with recurrent miscarriages in Saudi Arabia

BackgroundRecurrent spontaneous abortion has been reported tooccur in 15-20% of all clinically recognizable pregnancies.Numerous studies have reported a clear relationshipbetween the chromosomal abnormalities in parents andrecurrent miscarriages and infertility [1-3], however lim-ited data is available from Arabian Peninsula. The maingoal of this study was to determine the prevalence ofchromosomal abnormalities and correlate them with clini-cal characteristics of couples with recurrent spontaneousabortions (RSA) in Saudi Arabia.Materials and methodsCytogenetic analysis of 171 consent patients with sponta-neous recurrent abortions was performed by the standardmethod of 72-hour lymphocyte culture and GTG banding.

Retraction technique for urinary catheterization of women with female genital mutilation

OBJECTIVE To evaluate the retraction technique for urinary catheterization of women with Type III female genital mutilation (FGM). STUDY DESIGN The hospital records of all women from Sudan, Somalia, Ethiopia, Egypt, Eritrea, and Chad who were admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia from January 1, 2011 to January 1, 2012 were reviewed. Women with Type III FGM who had urinary catheterization were identified and their records were examined. RESULTS During the study period, 162 women with Type III FGM had urinary catheterization by residents in our hospital. One hundred and twelve (69.1%) women had urinary catheterization by the standard procedure and 50 (30.9%) by the retraction technique because of failure of the standard procedure. No attempts to use the technique were unsuccessful; that is, no procedures were converted to emergency defibulation. No complications occurred during insertion or while the catheter was in place (37.5±5.6h). CONCLUSIONS The retraction technique provides a safe and effective option for urinary catheterization of women with Type III FGM.

Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a cultural practice that involves several types of removal or other injury to the external female genitalia for nonmedical reasons. Although much international research has focused on the health consequences of the practice, little is known about sexual functioning among women with various types of FGM/C. OBJECTIVE: To assess the impact of FGM/C on the sexual functioning of Sudanese women. STUDY DESIGN: This is a cross‐sectional study conducted at Doctor Erfan and Bagedo Hospital, Jeddah, Saudi Arabia. Eligible women completed a survey and a clinical examination, which documented and verified womens type of FGM/C. The main outcome measure was female sexual function, as assessed by the Arabic Female Sexual Function Index. RESULTS: A total of 107 eligible women completed the survey and the gynecological examination, which revealed that 39% of the women had FGM/C Type I, 25% had Type II, and 36% had Type III. Reliability of self‐report of the type of FGM/C was low, with underreporting of the extent of the procedure. The results showed that 92.5% of the women scored lower than the Arabic Female Sexual Function Index cut‐off point for sexual dysfunction. The multivariable regression analyses showed that sexual dysfunction was significantly greater with more extensive type of FGM/C, across all sexual function domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and overall. CONCLUSION: The study documents that a substantial proportion of women subjected to FGM/C experience sexual dysfunction. It shows that the anatomical extent of FGM/C is related to the severity of sexual dysfunction.

Placenta previa. A 13 years experience at a tertiary care center in Western Saudi Arabia

Objectives: To review cases of placenta previa in the last 13 years in a tertiary teaching hospital to identify risk factors for maternal morbidity. Methods: A retrospective analysis of all cases of placenta previa managed at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia from January 2001 to December 2013. Results: The total number of deliveries was 55,862 deliveries, and 11,412 (20.3%) delivered by cesarean section (C/S). The charts of 230 cases diagnosed with placenta previa was reviewed, and different variables were collected and analyzed. Diagnoses were achieved in 94% of them using ultrasound. The prevalence rate of placenta previa was 4.1 per 1000 births. Cesarean section was carried out as an emergency procedure in 130 (56.5%) women and as elective in 100 (43.5%) women. Of them, 26 patients were admitted to the intensive care unit (ICU) (11.3%), all of which received blood transfusion >6 units and 22 patients had a hysterectomy for uncontrollable bleeding. Conclusion: Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital must have a protocol, or algorithm for the management of placenta previa. Risk factors for maternal morbidity included complete previa, history of previous C/S, emergency C/S at a gestational age of <36 weeks, and estimated blood loss >2000 ml.

Women’s perception and attitude to medical students’ participation in obstetrics and gynecology care

Objectives: To determine the attitudes of obstetric and gynecological patients towards medical students’ participation in clinical care. Methods: Patients in an obstetric and gynecological practice in Kingdom of Saudi Arabia, completed a structured self-administered online questionnaire to assess demographic, reproductive and lifestyle variables that affected their attitude towards the acceptance of medical students’ participation in outpatient clinical care. Results: Out of the 595 women surveyed, 64.7% received perinatal care, while 35.3% received gynecologic care. Women mostly held positive attitudes towards medical students’ participation. Women expressed more comfort with medical students’ involvement during limited clinical care roles such as obtaining patient’s history and physical examinations without a pelvic examination. Women reported higher comfort levels in the presence of female medical students, especially during pelvic examinations. The presence of male medical students caused a significant reduction in patient’s comfort. Conclusion: Our results suggest that women seeking obstetrics and gynecology medical services are accepting students’ involvement during the healthcare encounter. Most patients are more comfortable if direct contact with students is minimized and students’ participation in medical care is restricted to more limited roles. In addition, the student’s gender is a significant determinant of patient’s acceptance and comfort during the clinical encounter.

Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Western Saudi Arabia

Objectives We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia as well as the risk factors of HDP, and maternal and fetal outcomes. Methods We retrospectively evaluated the medical records of 9493 women who delivered at King Abdulaziz University Hospital, a tertiary care center, between January 2015 and June 2017. All cases of HDP were included. Results We identified 224 pregnant women with HDP in our patient cohort, giving a prevalence of 2.4%. Their mean age was 31.3±6.7 years, with an average gravidity of 4.0 and average parity of 3.0. The most prevalent subtype of HDP was preeclampsia (54.9%) while 29.5% of the women had gestational hypertension, and 8.0% had eclampsia. The prevalence of subtypes of HDP differed significantly with gravidity, and mean age differed significantly with HDP subtype. Personal and family histories of preeclampsia and the presence of diabetes were more prevalent in women with preeclampsia and gestational hypertension; however, only the difference in diabetes prevalence was significant. The overall prevalence of maternal complications was 9.4% and the prevalence of maternal mortality was 1.3%. Multigravid women and women with chronic hypertension were at increased risk of prematurity compared to other pregnant women, but not significantly. Conclusions The prevalence of HDP was relatively low in our cohort. However, to prevent harmful impacts on both the mother and fetus, screening for this disorder is recommended early in pregnancy.

The Awareness Regarding the Episiotomy Procedure Among Women in Saudi Arabia

Introduction: Episiotomy is an intended incision made through the perineal body to enlarge the vaginal orifice during the second stage of labor to ease the parturition. A cross sectional study in Jeddah, Saudi Arabia, showed that 35% of the females in 2012 had an episiotomy, this slightly increased in 2015 to (36.4%). Given the increase rates of episiotomy and the significance of patients’ awareness, there were very limited data on the awareness of episiotomy among women. Aim: Aim of this study is to estimate the extent of the awareness regarding the episiotomy procedure among women in Saudi Arabia. Material and methods: Participants aged 15 and above filled a questionnaire distributed online to different regions of Saudi Arabia. Descriptive statistics were used. Results: a total of 626 women participated in this study with a mean age 34.7 years. The majority (63.6%) of women reported being informed about the procedure. Still, only (40%) of them were able to describe the procedure correctly. Only age, parity and history of previous episiotomy were predictors for episiotomy awareness. Women aged 35 or less were more aware of episiotomy than those aged more than 35 with a p-value (<0.001). However, the multigravida were more aware of episiotomy than primigravida with a p-value (< 0.001). Conclusion: The awareness of episiotomy is still not accomplish in Saudi Arabia, which poses the need for further modalities to educate women and increase their awareness regarding selective episiotomy rather than the old method of routine episiotomy.