Nora Sahly

Cisplatinum and docetaxel for ovarian cancer in pregnancy

BackgroundThere is limited data on chemotherapy for advanced ovarian cancer during pregnancy. Most women received cisplatin-based chemotherapy. There are no published reports on the use of docetaxel for ovarian cancer in pregnancy.CaseA 32-year-old pregnant lady underwent laparatomy at 18-week gestation for ruptured ovarian cyst. The pregnancy was the result of in vitro fertilization with intracytoplasmic sperm injection. Left salpingo-oophorectomy and omental biopsy were done. A diagnosis of stage IIIC, poorly differentiated papillary serous adenocarcinoma of the ovary was made. She was given four cycles of cisplatinum and docetaxel followed by cesarean hysterectomy, right salpingo-oophorectomy, and cytoreductive surgery. The mother is well and has completed six cycle of chemotherapy.ConclusionThis is the first report on the use of docetaxel during pregnancy for ovarian cancer.

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.

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.

The prevalence of sexual dysfunction in the female health care providers in Jeddah, Saudi Arabia

The objective of this study was to determine the prevalence of sexual dysfunction in Saudi and non-Saudi female health care providers in Jeddah, Saudi Arabia. One -hundred twenty (60 Saudi and 60 non-Saudi) sexually active female health care professionals in Jeddah, Saudi Arabia, were anonymously surveyed using the English version of the female sexual function index questionnaire. The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score for the Saudi and non-Saudi women were calculated and compared. The two groups were comparable in demographic characteristics. No statistically significant differences were found between Saudi and non-Saudi women in desire (P = .22) and arousal scores (P = .47). However, non-Saudi women had significantly higher lubrication (P < .001), orgasm (P = .015), satisfaction (P = .004), and pain scores (P = .015). The overall scores in Saudi and non-Saudi women were low (23.40 ± 4.50 compared with 26.18 ± 5.97), but non-Saudi women had a significantly higher overall score (P = .005). Taken together, sexual dysfunction is prevalent among Saudi and non-Saudi female health care providers, with Saudi women demonstrating lower scores in four sexual function domains and the overall score.

Efficacy of intra-cervical misoprostol in the management of early pregnancy failure

The aim of this prospective study was to assess the efficacy of intra-cervical misoprostol in the management of early pregnancy failure. Twenty women with early pregnancy failure received intra-cervical misoprostol via an endometrial sampling cannula. The first dose was 50 μg of misoprostol dissolved in 5 ml of normal saline. The administration was repeated after 12 h if there was no vaginal bleeding or pain. Nine (45%) women received 1 dose and 11 (55%) women received 2 doses of intra-cervical misoprostol. Abortion within 24 h occurred in 16 (80%) women, and complete abortion was achieved in 14 (70%) cases. Two women with incomplete abortion were managed with 600 μg of misoprostol orally (1 case) and surgical intervention (1 case). The mean time interval between the first dose and the abortion was 10.6 ± 6.3 h. Two women did not respond within 24 h of treatment initiation, 1 woman withdrew consent after the first treatment, and 1 woman developed heavy vaginal bleeding after the first dose and underwent surgical management. Intra-cervical misoprostol is a promising method of medical treatment of early pregnancy failure. Further randomized clinical trials are needed to validate its safety and efficacy.

HYSTEROSCOPY FOR SEVERE ASHERMAN SYNDROME

In 1948 Joseph G. Asherman described the syndrome of amenorrhea secondary to cervical stenosis and intrauterine adhesions\ It may result in menstrual abnormalities, infertility, recurrent pregnancy loss, premature labor, and placenta previa or accreta. Hysteroscopy is the best method to diagnose and treat Asherman syndrome . There are few reports in the literature which evaluate the efficacy of hysteroscopic treatment of severe Asherman syndrome. The objective of this study is to provide the menstrual and fertility outcome after hysteroscopic treatment of severe Asherman syndrome.