Lulu Al-Nuaim

Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy

OBJECTIVE To evaluate the safety and efficacy of intravenous iron sucrose complex (ISC) as compared with oral ferrous sulfate in the treatment of iron deficiency anemia during pregnancy. STUDY DESIGN prospective, open, controlled study in which pregnant women with iron deficiency anemia were sequentially selected from the antenatal clinic and assigned either to ISC (study group) or to ferrous sulfate (control group). METHODS Each study patient was given the total calculated amount of ICS (Hb deficit (g/l) x body weight (kg) x 0.3) in divided doses (200 mg (elemental iron) in 100 ml normal saline intravenously over 1 h daily) followed by 10 mg/kg to replenish iron stores. Each patient of the control group was given ferrous sulfate 300 mg (60 mg elemental iron) orally three times a day. All patients were monitored for adverse effects, clinical and laboratory response. RESULTS There were 52 patients and 59 controls. ISC group achieved a significantly higher Hb level (128.5 +/- 6.6 g/l vs. 111.4 +/- 12.4 g/l in the control group P < or = 0.001) in a shorter period (6.9 +/- 1.8 weeks vs. 14.9 +/- 3.1 weeks in the control group, P < or = 0.001). ISC complex group showed no major side effects while 4 (6%) of the control group could not tolerate ferrous sulfate, 18 (30%) complained of disturbing gastrointestinal symptoms and 18 (30%) had poor compliance. CONCLUSION We conclude that ISC is safe and effective in the treatment of iron deficiency anemia during pregnancy.

Accuracy of hysterosalpingography and laparoscopic hydrotubation in diagnosis of tubal patency

OBJECTIVE To compare the diagnostic accuracy of two methods of assessment of tubal patency, viz, hysterosalpingography (HSG) and laparoscopic hydrotubation. DESIGN One hundred four infertile women who were investigated with both HSG and laparoscopy in King Khalid University Hospital were selected for the study. Complete history of factors that may predispose to tubal occlusion was obtained. Patients with problems of ovulatory failure or poor semen analysis that may contribute to their infertility were excluded. RESULTS The overall agreement between the two methods was 62.5%. However, the diagnostic accuracy of the two methods differed significantly. CONCLUSION It would appear that laparoscopic hydrotubation, despite its invasive nature, had an edge in diagnostic accuracy when compared with HSG. It would be advantageous to subject patients in whom HSG has shown tubal blockage to laparoscopy or any of the newer techniques of hysteroscopy or sonographic hydrotubation.

Basement membrane thickening in the placentae from diabetic women

A light microscopy study was carried out on 48 placentae. Seventeen placentae were obtained from non‐diabetic mothers while the other 31 placentae were from both women with controlled diabetes and women who had an abnormality of the glucose tolerance test. All the women delivered at 38–40 weeks of gestation. Placentae from diabetic patients showed immaturity of the villi, hypertrophy of the capillaries and thickening of the basement membrane of the tropho‐blastJc vllll (3.2 ± 0.35 μm) and the amniotlc membrane (1.8 ±0.3 μm). Focal fibrinold necrosis, an increase in the number of Hofbauer cells and dilatation of villi capillaries were also commonly observed in placentae from diabetic mothers, and the normal cuboidal cells lining the amniotic membrane tended to become tall columnar (17.6 ± 6.3 μm) with distaily located nuciel. Similar findings were observed in patients who had a potentially abnormal glucose toierance test, which suggests the possibility of primary lesion in origin. Therefore, control of hyperglycemia may only partially prevent the development of placental abnormalities.

Assisted hatching in assisted reproduction

Assisted reproductive techniques including in vitro fertilisation and embryo transfer (IVF-ET) have become the principal method to resolve long term infertility. Despite major advances such as the introduction of intracytoplasmic sperm injection (ICSI) for severe male infertility, the proportion of embryos leading to live offspring has increased only marginally since the inception of assisted reproductive techniques . A successful outcome is dependent on many factors including the ability of the embryo to hatch from its zona pellucida – . Prolonged exposure of human embryos to in vitro culture could lead to loss of zona elasticity and hardening thus impairing their ability to hatch. Since Cohen et al. reported the first pregnancy after assisted hatching in 1988, several techniques to assist embryos to hatch from the zona have been developed with the aim of improving pregnancy rates. This review will consider zona pellucida physiology, zona hardening, different techniques of assisted hatching, who may benefit from assisted hatching and potential hazards. This article benefited from the publications identified in the protocol for the ongoing Cochrane systematic review in this area. These references were supplemented with a search of the Medline database and a hand search of appropriate journals and abstracts from relevant international meetings. However, this review did not seek to statistically combine the data from the diverse studies on assisted hatching, because, as will be shown below, the available techniques differ radically, potentially influencing both benefits and risks.

Abdomino-pelvic packing to control severe haemorrhage following caesarean hysterectomy

Surgically uncontrollable peri-operative obstetric haemorrhage associated with coagulopathy, developed in five women who were managed by emergency caesarean hysterectomy. All women had a morbidly adherent anterior placenta praevia and a previous lower segment caesarean section scar. Conventional medical and surgical therapy to control bleeding from pelvic and abdominal raw surfaces were unsuccessful. Abdomino-pelvic packing was performed with 10-12 dry laparotomy pads applied firmly over bleeding sites. The abdomen was closed after observation of the cessation of bleeding for 5-10 minutes. Following correction of coagulation and haemodynamic disorders relaparotomy for pack removal was performed 34-48 hours later. One patient developed small bowel obstruction on the 5th post-operative day, however, there was no long term gynaecological morbidity in any of the cases. Abdomino-pelvic packing achieved complete haemostasis in all of the five women which we believe may have been impossible using alternative measures.

Reproductive potential after an ectopic pregnancy.

OBJECTIVE To measure statistically how soon pregnancy can occur after an ectopic pregnancy (EP) so as to determine the cumulative pregnancy rate and the risk factors involved in nonpregnancy. DESIGN The risk of not getting pregnant after an EP (survivorship) was estimated for 120 patients followed up for up to 60 months using the actuarial life-table technique. The risk factors involved in nonpregnancy, abortions, or live births were analyzed, using Cox regression models. SETTING King Khalid University Hospital, Riyadh, Saudi Arabia. RESULTS There were 68 pregnancies over the study period, with a conception rate of 56.7%. Using the actuarial life table, the cumulative probability of not achieving pregnancy in a patient decreased sharply during the first 12 months, followed by a gradual decrease up to 48 months. The Cox regression analysis showed a correlation between pregnancy and two variables, namely, age and history of prior EP. The chances of a pregnancy resulting in abortion or live birth also correlated with the presence of prior infertility, pelvic inflammatory disease (PID), or postoperative complications. CONCLUSION Age and prior EP are important determinants in pregnancy rates after an EP. Similarly, history of PID, infertility, and postoperative complications are important risk factors in whether the pregnancy goes to term or ends in abortion.

Effects of assisted hatching method and age on implantation rates of IVF and ICSI.

The objective of this study was to investigate whether a change in assisted hatching (AH) technique from total to partial penetration of the zona pellucida improved the outcome of IVF and intracytoplasmic sperm injection cycles where AH was indicated. This was an observational study conducted from the beginning of January 2000 to the end of April 2005. Total AH was performed in 312 cycles, while partial AH was performed in 592 cycles. In women of all ages, implantation, clinical pregnancy and live birth rates were higher in the partial AH group than in the total AH group (12.6 versus 7.2%, P = 0.0001; 22.3 versus 15.7%, P = 0.02; 18.2 versus 12.5%, P = 0.03 respectively). The benefit of partial AH was most marked in women under 38 years old (i.e. the recurrent implantation failure group). The authors conclude that partial AH is associated with higher implantation and pregnancy rates than total AH, especially in women under 38 years old who suffer from recurrent implantation failure.

Sickle cell and G-6-PD deficiency gene in cord blood samples: experience at King Khalid University Hospital, Riyadh.

Cord blood samples (1039) collected at King Khalid University Hospital were analysed for abnormal haemoglobins using electrophoresis at alkaline and acid pH, for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency using spectrophotometric method and for G-6-PD phenotypes using electrophoresis and specific staining. Only two samples showed the presence of Hb AS and no case of sickle cell anaemia was identified. The Hb S gene frequency was 0.00096. This was the lowest frequency identified so far in different regions of Saudi Arabia. The frequency of G-6-PD deficiency was calculated separately in the males and females, and was found to be 3.605 per cent in the males and 0.195 per cent in the females. Phenotyping showed the presence of G-6-PD-B+ as the normal enzyme at a frequency of 0.943 in both males and females and G-6-PD-A+ at a frequency of 0.0208 in males and 0.0059 in females. The deficient variant was mainly G-6-PD Mediterranean which occurred at a frequency of 0.0341 and 0.0019 in males and females, respectively. Only one case of G-6-PD-A- was identified in the males giving a frequency of 0.0019. This is the first report of Hb S and G-6-PD deficiency genes in cord blood samples in Riyadh. Comparison of the results in Riyadh with values reported elsewhere showed that Riyadh had the lowest frequency of both Hb S and G-6-PD deficiency gene.

Pregnancy trends after abortion

A series of women who aborted their pregnancies at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, over a period of 12 months (1 January 1992 to 3 December 1992), were followed up for 6-48 months afterwards to examine their pregnancy trends. Descriptive statistics for data presentation with Kaplan-Meier survivorship function estimates time from abortion to the next pregnancy and Cox proportional hazard regression analysis were used to identify prognostic factors. Eighty-one per cent of the women achieved pregnancy over a 4-year follow-up. The median time to pregnancy was 7.6 months, with a 95% confidence interval of 6.4-10.0 months. Age and nationality were found to be significant prognostic factors related to time to achieve a pregnancy. Furthermore, the outcome of the subsequent pregnancy was found to be statistically related to the number of previous abortions. There is a high chance of fertility after an abortion, with 75.2% of these occurring within the first 12 months of the post-abortion follow-up period and dwindling to only 4.1% by the end of 36 months. Using multivariate regression analysis, only age seemed to be an important determinant factor.

Pregnancy outcome in women with antiphospholipid antibodies

SummaryThe association of antiphospholipid antibodies (APA) or lupus anticoagulant (LA) and recurrent fetal loss (RFL) is well established; however, the spectrum of pregnancy outcome in relation to various therapeutic approaches versus placebo is unknown. We studied 49 women with RFL, 14 with immune thrombocytopenia (ITP) 13 of whom without a history of RFL, and 32 controls (all in the first trimester of pregnancy) for the presence of APA. Tests for APA were positive in 15/49 women with RFL (30%), 6/14 ITP (43%) and 2/32 controls (6%). Treatment in the APA positive patients consisted of: no treatment for the 8 patients who had no history of RFL (Group A; all 34 previous pregnancies successful), aspirin alone (Group B, 5 patients; all 30 previous pregnancies unsuccessful), aspirin with prednisolone (Group C, 9 patients; 69/80 previous pregnancies unsuccessful), or aspirin, prednisolone and immunoglobulin G for resistant cases (Group D, 4 patients, previously in Group C). 10/11 (90.9%), 3/7 (43%), 7/13 (53.8%) and 4/7 (57.1%) pregnancies were successful in Group A, B, C and D, respectively. There was a total of 19/45 (42%) failures including 3 pregnancies in one patient who failed to respond to all forms of therapy.This open study with small subgroups of patients draws attention to a wide range of pregnancy outcome in women with APA and to the fact that APA may serve only as a marker for a wide range of pathological conditions with variable degrees of disease severity. More studies are, however, needed to explore the real mechanism of RFL in women with APA and RFL, especially those who are resistant to therapy.