Salah Roshdy Ahmed

Fetal and maternal outcomes in pregnancies complicated with fetal macrosomia

Background: Fetal macrosomia remains a considerable challenge in current obstetrics due to the fetal and maternal complications associated with this condition. Aim: This study was designed to determine the prevalence of fetal macrosomia and associated fetal and maternal morbidity and mortality in the Al Qassim Region of Saudi Arabia. Materials and Methods: This register-based study was conducted from January 1, 2011 through December 30, 2011 at the Maternity and Child Hospital, Qassim, Saudi Arabia. Macrosomia was defined as birth weight of 4 kg or greater. Malformed babies and those born dead were excluded. Results: The total number of babies delivered was 9241; of these, 418 were macrosomic. Thus, the prevalence of fetal macrosomia was 4.5%. The most common maternal complications were postpartum hemorrhage (5 cases, 1.2%), perineal tear (7 cases, 1.7%), cervical lacerations (3 cases, 0.7%), and shoulder dystocia (40 cases, 9.6%) that resulted in 4 cases of Erbs palsy (0.96%), and 6 cases of bone fractures (1.4%). The rate of cesarean section among women delivering macrosomic babies was 47.6% (199), while 52.4% (219) delivered vaginally. Conclusion: Despite extensive efforts to reduce fetal and maternal complications associated with macrosomia, considerable fetal and maternal morbidity remain associated with this condition.

Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy

To compare efficacy between double‐dose methotrexate and single‐dose methotrexate for treatment of tubal ectopic pregnancy (EP).

Does cutaneous lupus erythematosus have more favorable pregnancy outcomes than systemic disease? A two-center study.

To compare pregnancy outcomes in cutaneous lupus erythematosus (CLE) with systemic lupus erythematosus (SLE) and healthy pregnant women.

Co‐infection with Toxoplasma gondii and Clostridium perfringens in a postpartum woman with uterine gas gangrene: A case report

Toxoplasmosis is a protozoan infection caused by Toxoplasma gondii. We report a case of Toxoplasma gondii and Clostridium perfringens co‐infection complicating uterine gas gangrene following a term pregnancy. The histological examination of the necrotic uterine tissues and uterine swab cultures obtained at laparotomy revealed T. gondii and C. perfringens, respectively. Treatment was administered with bactericidal activity against both pathogens and the patient had an uneventful post‐operative recovery. Although there have been some cases that have documented an association between toxoplasmosis and non‐uterine C. perfringens infection, such a relationship has not been established. It is of interest to determine if the presence of both organisms can explain the severe myonecrosis that occurs in some cases of uterine gas gangrene.

Risks and indications for cesarean sections in primiparous women: A case-control study

Objective: The objective of the following study is to determine the indications and risks for cesarean section (CS) among primiparous women. Materials and Methods: This register-based study was conducted from January to December 2011, at the Maternity and Childrens Hospital, Buraidah, Saudi Arabia. The total number of primiparous women who delivered during the study period was 1146. Of the 367 who delivered by CS, 13 multiple pregnancies were excluded from the study. The remaining 354 women that comprised the study group were compared with 354 primiparous women who had delivered vaginally during the same period (control group). Logistic regression analysis was used to compare selected variables for the risk of CS. Results: Of the total 1146 primiparous women who had delivered during the study period, 32% (n = 367) underwent CS, with most (71.7%, n = 263) undergoing an emergency CS. Common indications for CS were fetal distress (30%, n = 110), breech presentation (19.3%, n = 71), failure of labor progression (18.8%, n = 69), and failure to induce labor (11.7%, n = 43). Logistic regression analysis showed that the rate of CS increased significantly in association with lower maternal age (odds ratio [OR] = 1.868, 95% confidence interval [CI] = 1383-2.523, P < 0.0001) and a fetal weight of ≥4 kg (OR = 3.491, 95% CI = 2.082-5.854, P < 0.0001). No fetal or maternal mortality was reported. Conclusion: This study shows that the cesarean section rate (CSR) is increasing. Common indications for CS were fetal distress, breech presentation in labor, failed induction of labor, and failure to progress. This increase in the CSR was significantly associated with younger maternal age (≤22 years) and a fetal birth weight ≥4 kg.

Grandmultiparity: risk factors and outcome in a tertiary hospital: a comparative study.

Aims: The aim of the current study was to determine the prevalence of grandmultiparity and the associated risks factors. Methods: Four hundred thirty grandmutliparas (parity 5 or more) were compared with multiparous population (parity 2-4) with regard to maternal age, gestational age, mode of delivery, fetal and maternal outcomes and inter-current medical and obstetrical problems. Results: There were significant association between grandmultiparity and adverse pregnancy outcomes such as cesarean delivery (OR=2.699, CI=2.072-3.515, p<0.001), fetal macrosomia (OR=1.675; 95% CI=1.004- 2.796, p=.048), Diabetes mellitus (OR=1.634, 95%CI=1.076-2.481, p=0.021), and pregnancy induced hypertension (OR=1.838, 95% CI=1.054-3.204, p=.032). No significant associations were seen in placenta abruption, placenta previa, preterm labor, postpartum hemorrhage and the frequency of admission to neonatal intensive care unit. No prenatal or maternal mortality was reported in this study. Conclusion: Grandmultiparty remains a major obstetrics problem. It is associated with many medical and obstetrical complications. In communities where large family is desirable it is important to address the value of family planning and conduction of meticulous antenatal care.