Noori Chowdhury

Risk of retained placenta: Multivariate approach

Background. To identify important covariates related to retained placenta using logistic regression analysis.

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.

Sequelae of repeat cesarean sections

Objectives: To study and analyze the factors related to repeat cesarean section and to highlight the problems that may be associated with it. Methods: The study was carried out in the Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh, Saudi Arabia, and involved 395 patients who had had two or more previous cesarean sections prior to the current pregnancy. Various factors which may be associated with repeat cesarean sections, as well as the outcome of the operations, were assessed and analyzed. The χ2‐test and other analyses were used to examine the association between the number of cesarean sections and the various variables. Results: Four or more previous cesarean sections was significantly associated with dense adhesions. On the other hand, height, parity, antenatal clinic attendance, postoperative complications, fetal weight and fetal outcome had no significant effect on, nor influenced, the multiplicity of cesarean sections. Conclusion: No specific risk is associated with repeat cesarean sections that is not normally associated with single cesarean sections.

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.

Ectopic pregnancy in a defined Saudi population.

Casesof ectopic pregnancies clinically had histopathologically confirmed and managed in the King Khalid University Hospital (KKUH) over a five year period are presented. With a prevalence rate of 6.9 per 1000 deliveries, ectopic pregnancy was depicted as not so common in this region of the world, although there has been a rising trend of the condition over the years. Of the risk factors, infertility treatment (19.7%), use of IUCD (10.9%), PID (8.7%) and chlamydia infections (2.9%) were found to be associated. However, there may be a need for nationally based as well as case controlled studies to evaluate the risk factors in this major gynecological catastrophy which is often associated with a high maternal morbidity and mortality, pregnancy wastage and impairment of fertility.

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.

Fertility following ectopic pregnancy.

In addition to the acute adverse consequences of ectopic pregnancy, the subsequent reproductive potential of the affected women has continued to attract the attention of medical scientists in recent times. In a study to evaluate the fertility potentials in 138 patients treated for ectopic pregnancy in the King Khalid University Hospital (KKUH) Riyadh, 105 (76.1%) of the patients had follow-up management for periods varying from 12 to 60 months. Since all these patients desired pregnancies, they were classified as “at risk” for evaluation of their reproductive potentials. Of these, 51 (48.6%) eventually became pregnant and produced 63 viable pregnancies, 18 abortions and one repeat ectopic pregnancy. Many of those who failed to become pregnant over the follow-up period probably had tubal damage due to the antecedent pelvic inflammatory disease (PID), perhaps compounded by the effects of the ectopic pregnancy and the management, among other factors.

Obstetric outcome in uncomplicated prolonged pregnancy

Objective: To study and compare the obstetric outcome in term pregnancies and uncomplicated prolonged pregnancies. Methods: The study was a retrospective review of 596 cases. The case notes of 286 patients with uncomplicated prolonged pregnancies (≥ 42 weeks) and 310 patients with normal term pregnancies (37 to < 42 weeks) were analyzed. The Gold Stat package was used for statistical coding and analysis. Results: There was no fetal morbidity or mortality among the two groups. However, the number of previous abortions were significantly higher in prolonged pregnancies compared with term pregnancies. Similarly, fetal and placental weights, labor induction and operative delivery rates were significantly higher in prolonged pregnancies. However, there were no significant differences between the patients who were induced and those who had spontaneous labor among the prolonged pregnancies. Conclusions: There is no doubt that prolonged pregnancy may be associated with certain risks factors. However, there is no outcome variable to justify whether or not to induce those pregnancies which are prolonged.

An appraisal of the appropriateness of the indications for hysterectomy

Over a five-year period, 197 hysterectomies were performed at King Khalid University Hospital (KKUH). Indications for the procedures vary from menstrual disorders and symptomatic fibroids to ovarian malignancy. The most common indication was found to be menorrhagia. Among multiple pre-operative indications, only the first listed major indication for hysterectomy was chosen. There were 145 abdominal and 52 vaginal hysterectomies and all were elective gynaecological procedures, majority of which were performed on women in their fourth and fifth decades of life. Verification of pre-operative diagnosis, when correlated with pathological findings, showed that some of the indications for the procedure deserve a more critical reappraisal. Since hysterectomy carries substantial economic and medical consequences, indications for undertaking the procedure deserve more careful scrutiny given the surgical and nonsurgical options that are currently available. There may be a need, therefore, to assess the appropriateness or otherwise of the use of hysterectomy in many of the patients in future.

Subchorionic hematoma in threatened abortion: Sonographic evaluation and significance.

In a study of 92 women with subchorionic hematoma evaluated with sonographic scan in King Khalid University Hospital, it was found that the mean ages and live births of patients who carried their pregnancies to viability were higher when compared with the patients who aborted. There was a statistically significant association between the gestational age at diagnosis of subchorionic hematoma and the size of the hematoma. There was, however, no statistically significant association found between the gestational age at diagnosis, size and site of the hematoma and the outcome of pregnancy. It was concluded that subchorionic hematoma which appear either in the second trimester, or are larger, or located in the lower uterine segment, may be associated with higher rates of abortion or preterm deliveries. Nevertheless, there is no statistically significant impact of these on the outcome of pregnancy.