Saad Ghazal-Aswad

Outcome of twin pregnancies after assisted reproductive techniques—a comparative study

OBJECTIVE To compare obstetrical and perinatal outcome of twin pregnancies after assisted reproductive techniques (ART) with that of twins conceived spontaneously. STUDY DESIGN Hospital based retrospective study. RESULTS There were 132 twin deliveries of which 36 were conceived after ART. Patients of the ART group were mostly nulliparous and slightly older. There was no statistically significant difference in the frequency of preterm delivery or mean gestational age at delivery. Elective Caesarean delivery was more frequent in twin pregnancies conceived after ART, and there were no other differences in maternal complications. There was also no difference in the mean birth weight or frequency of neonatal complication between the two groups. CONCLUSION In this comparative study, the obstetric and neonatal outcomes between spontaneous twins and those conceived after ART are similar except for higher operative deliveries in the latter group of twins.

Prevalence of Chlamydia trachomatis infection among women in a Middle Eastern community.

BackgroundCommon vaginal infections that manifest in women are usually easily diagnosed. However, Chlamydia infection is often asymptomatic, leading to infertility before it is detected. If it occurs in pregnancy, it could lead to significant neonatal morbidity. It may also play a role with other viral infections for e.g. Human Papilloma Virus in the development of cervical cancer. The objective of this study was to determine the prevalence of Chlamydia infection in women undergoing screening for cervical abnormalities as a part of a research project in primary and secondary care institutions in the United Arab Emirates.MethodsIn this cross sectional study married women attending primary and secondary care participating in a large nationwide cervical abnormalities screening survey were offered Chlamydia testing using a commercially available test kit. This kit uses a rapid immunoassay for the direct detection of Chlamydia trachomatis antigen in endocervical swab specimens. As this study was performed in a traditional Islamic country, unmarried women were excluded from testing, as the management of any positive cases would create legal and social problems. All married women consenting to take part in the study were included irrespective of age.ResultsOf 1039 women approached over a period of eight months 919 (88.5%) agreed to participate. The number of women in the 16 to 19 years was small (0.01%) and 30% were aged over 40 years. The prevalence of Chlamydia infection in this study was 2.6% (95% confidence interval 1.2–3.3%), which was marginally higher in women screened in secondary care (p = 0.05).ConclusionThis is one of the few reports on the prevalence of Chlamydia infection in women from the Middle East. Due to cultural and social constraints this study excluded a large proportion of women aged less than 19 years of age. Hence no direct comparisons on prevalence could be made with studies from the West, which all included younger women at high risk of Chlamydia. However this study emphasizes the importance of cultural factors while interpreting results of studies from different cultures and communities.

A STUDY OF KNOWLEDGE, ATTITUDE, AND PRACTICE OF CERVICAL SCREENING AMONG FEMALE PRIMARY CARE PHYSICIANS IN THE UNITED ARAB EMIRATES

Cancer is the third leading cause of death In the United Arab Emirates (UAE), which is situated in the Arabian Gulf. A national programme for cervical cancer screening is likely to be implemented in the future. In this study, we assessed the knowledge, attitude, and practice of UAE female primary care physicians of cervical screening through a self-administered questionnaire. Of the 98 physicians who participated in the study only 40% reported ever having performed a Pap smear. In the study, we identified various training needs, and a training programme on cervical screening currently is being developed based on the results of this study.

Cervical smear abnormalities in the United Arab Emirates : A pilot study in the arabian gulf

OBJECTIVE To gather epidemiologic data on cervical abnormalities and make recommendations pertaining to a national cervical screening policy in the United Arab Emirates (UAE). STUDY DESIGN A cross-sectional survey of patients and physicians in the UAE with regard to cervical cytology was carried out. Knowledge, attitudes and practices (KAP) of a group of female primary care physicians on cervical cytology were assessed by a self-administered questionnaire. Pap smears and Chlamydia testing were offered to women attending selected primary care centers and secondary health care facilities. RESULTS Results of Chlamydia prevalence and KAP were published elsewhere; this report addresses the cytologic aspects of this study. There were 2,013 smears collected from primary health centers and 2,042 from secondary care. The overall rate of cervical screening among women in this survey was 85.5% in primary care and 77% in secondary care. The proportion of unsatisfactory smears was < 5%. The prevalence of cervical abnormalities according to the Bethesda System 2001 was 3.6%. There were 9 (primary care) and 21 (secondary care) cases of low grade squamous intraepithelial lesion (LSILs), for a prevalence of 0.77%. There were 4 primary care and 17 secondary care cases of high grade squamous intraepithelial lesion (HSIL), for a prevalence of 0.54%. The combined prevalence for LSIL and HSIL is 1.32%. There were 3 cases of glandular abnormalities. The atypical squamous cells of undetermined significance/SIL ratio was 1.71. No cases of squamous cell carcinoma were detected. No tissue follow-up information is available. The prevalence of cervical abnormalities is low in the UAE. We first recommend the institution of a more organized approach to opportunistic screening in the UAE with appropriate clinical follow-up rather than the immediate launch of a cervical mass screening program.

Knowledge and practice of contraception in United Arab Emirates women

Objective To determine the knowledge and practice of contraception among United Arab Emirates (UAE) women. Method Four hundred and fifty UAE women at risk of pregnancy were randomly selected from the community and primary health care centres and interviewed about knowledge and practice of contraception using a structured questionnaire. Results Four hundred women (89%) gave consent to participate in the study. One hundred and sixty-six participants (41.5%) were using contraception. All used natural methods backed with other methods. There were significant associations between using contraception and each of age, high level of education and low family income (p < 0.0001 for the three variables). Religious beliefs and low expectation of success of birth control were the reasons given for non-use. Eighty-five percent of subjects did not accept sterilisation without medical indications, nor using contraception before the first pregnancy. Of the women, 42.5% believed that contraceptive methods should not be used after the age of 40, and 78% were unaware that they could be used for treatment of gynaecological diseases. Disturbed bleeding patterns occurred in 48.7% of users, and these were most bothered by the inability to pray (100%) and to have sexual intercourse (97.5%). Conclusion Contraception is not commonly used by UAE women because of sociocultural traditions, religious beliefs and poor knowledge.

Confidential enquiries into maternal mortality in the United Arab Emirates: A feasibility study

Aim:  Routine confidential enquiry into maternal deaths is not yet part of the United Arab Emirates health care system. A confidential enquiry into maternal deaths was undertaken to test the feasibility of this approach and to identify the causes and preventability of maternal deaths.

Is there a correlation between vaginal chlamydia infection and cervical smear abnormalities? A community‐based study in the Al‐Ain district, United Arab Emirates

Aim:  The purpose of this study was to determine the correlation between vaginal chlamydia infection and cervical abnormalities. The data on the prevalence of chlamydia infection and cervical abnormalities have been presented elsewhere and in this article we provide the results of a correlation analysis.

Colposcopy services in the United Arab Emirates.

Background. United Arab Emirates (UAE) is a young country with a population of 3 million, an abundant oil wealth, and a high standard of living. There is no organized cervical screening program, but the authorities are planning to introduce one soon. Objective. To study the availability and quality of colposcopy services. Methods. A questionnaire survey of all gynecologists in the major government and private hospitals in the country. Results. Twenty government hospitals offer obstetrics and gynecology services, 11 governments and 4 private hospitals have colposcopy services. Of the 52 specialists performing colposcopy, 8 had adequate training, 3 had formal recognition, and 3 had long-term experience. The number of cases seen per doctor varies from 10 to 100 a year, with a mean and median of 28 and 15, respectively. Three units had the required basic colposcopy equipment for diagnosis and treatment. Only 1 unit performs audit. Conclusions. Colposcopy service is widely available in many hospitals in the United Arab Emirates, but substantial variation exists in clinical standards and needs more organization and standardization.

Expression of insulin-like growth factor-1 receptors, Wilm’s tumor-1 protein, c-kit and p16 in primary fallopian tube carcinoma in diabetic patients

BackgroundPrimary fallopian tube carcinoma (PFTC) represents less than 1% of all gynecological malignancies and its association with diabetes mellitus is seldom reported.CasesWe report three cases of PFTC presented primarily as advanced ovarian cancer while the primary site totally silent. Two of them were diabetics and showed expression of insulin-like growth factor receptors, Wilm’s tumor protein-1, c-kit and P16. In all these cases there was neither clinical nor perioperative suspicion of PFTC and the first clinical diagnosis was ovarian carcinoma which was supported by positive cytology for ascitic fluid and raised serum level of CA125. The diagnosis was only established after histopathologic examination of serial sections of the whole fallopian tube since we were able to demonstrate the continuity between the invasive and the in situ components of PFTC in the lining epithelial layer of the fallopian tube.ConclusionThe presence of malignant cells in the female pelvic organs without a mass should raise the possibility of primary fallopian tube carcinoma. Pre-operative diagnosis of PFTC is seldom made and most of the time the diagnosis is made after histopathological examination as in our cases. Diabetes mellitus can be a risk factor in the development of PFTC.