The Relevance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates.

Objective: The cesarean delivery rate has increased worldwide. The aim of our study was to assess the events associated with the second cesarean deliveries in our institution.

Subjects And Methods: All cesarean deliveries at the Maternity Hospital, Kuwait, from January 1 to December 31, 2013, were identified.

Fusion of lower limbs with severe urogenital malformation in a newborn, a rare congenital clinical syndrome: case report.

Background: Fused lower limbs combined with severe urogenital malformation, also known as sirenomelia, is a rare congenital clinical syndrome. The etiology is unknown, and the outcome for the affected fetus is rather uncertain.

Case Report: Mrs RB, a Kuwaiti woman primigravida, married to a non-consanguineous husband, had uneventful antenatal care in a private health service, until she was admitted to the Maternity Hospital, Kuwait, at 31 weeks of gestation with a 3-hour history of ruptured membranes.

Consecutive successful pregnancies subsequent to intravenous immunoglobulin therapy in a patient with recurrent spontaneous miscarriage.

Background: Recurrent spontaneous miscarriage (RSM) has a multifactorial etiology, mainly due to karyotype abnormalities including balanced translocation, anatomical uterine disorders, and immunological factors, although in 50%-60% the etiology is unexplained. The treatment of RSM remains challenging, and the role of intravenous immunoglobulin (IVIG) in RSM is controversial.

Case Report: Mrs HM, 37 years old, obstetric summary: P0+1+13+1, a known case of hypothyroidism/polycystic ovary syndrome, married to an unrelated 47-year-old man, presented to our RSM clinic in early January 2014 for investigation and treatment.

Recurrent spontaneous miscarriage is still a challenging diagnostic and therapeutic quagmire.

Recurrent spontaneous miscarriage (RSM), affecting 1-2% of women of reproductive age seeking pregnancy, has been a clinical quagmire and a formidable challenge for the treating physician. There are many areas of controversy in the definition, aetiology, investigations and treatment of RSM. This review will address the many factors involved in the aetiology of RSM which is multifactorial in many patients, with antiphospholipid syndrome (APS) being the most recognized aetiological factor.

Clinical presentation and management of diabetes mellitus in pregnancy.

Objective: To evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregnancy.

Methods: One hundred seventy-one patients with diabetes mellitus admitted between September 1, 2006, and June 30, 2008, to the labor room at Maternity Hospital in Kuwait for induction of labor made up the study population; while an equivalent number of patients without medical complications who also were admitted for induction of labor made up the control group. The patients were assessed at admission, and their medical data were extracted.

Vernix caseosa peritonitis after vaginal delivery.

Introduction: Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section.

Case Presentation: We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery.

Computational methods are significant determinants of the associations and definitions of insulin resistance using the homeostasis model assessment in women of reproductive age.

Background: Insulin resistance (IR) plays an important role in the pathogenesis of polycystic ovary syndrome (PCOS), but identification of insulin-resistant individuals is difficult. The homeostasis model assessment (HOMA), a surrogate marker of IR, is available in 2 computational models: HOMA1-IR (formula) and HOMA2-IR (computer program), which differ in incorporated physiological assumptions. This study evaluates the associations of the 2 models as markers of IR, the metabolic syndrome (MS), and PCOS.

Variations in alanine aminotransferase levels within the normal range predict metabolic and androgenic phenotypes in women of reproductive age.

Background And Aims: Obesity plays pathogenetic roles in nonalcoholic fatty liver disease (NAFLD) and hyperandrogenic states like polycystic ovary syndrome (PCOS). We tested the hypothesis that alanine aminotransferase (ALT), a marker of NAFLD, is associated with endocrine and metabolic abnormalities in women with normal ALT.

Methods And Results: Fasting glucose, insulin, total testosterone, DHEA-S, 17-hydroxyprogesterone, prolactin, leptin, soluble leptin receptor, free leptin index (FLI), lipid profile, ALT, gonadotropins, and sex hormone binding globulin (SHBG) were measured in 200 women aged 18-48 years.

The scope of pediatric and adolescent gynecological problems in Kuwait.

Objective: To establish an insight into pediatric and adolescent gynecological disorders encountered in a tertiary care center in Kuwait.

Subjects And Methods: A retrospective case cohort review of 89 case records of patients under the age of 19 years who were admitted to the Maternity Hospital, Kuwait, from October 2002 through September 2003 was undertaken. For a variety of reasons, 35 patients were excluded and the remaining 54 patients constituted the study population.

Excision of high vaginal septum.

Introduction: Transverse vaginal septum occurs because there is a defect in vertical fusion during embryological development of the vagina. It is quite rare and is infrequently encountered by most obstetricians and gynecologists in their practice.

Case Report: A 14-year-old unmarried student, Miss AUX, presented to a private gynecologist complaining of absent menses.

Intrapartum performance of patients presenting with diabetes mellitus in pregnancy.

Objective: To investigate the intrapartum performance of pregnancies complicated by diabetes mellitus (DM).

Subjects And Methods: A pilot study (April-June 2005) of medical records of patients with DM admitted into the labour wards of the Maternity Hospital, Kuwait, was undertaken. Consecutive patients, matched for age and parity with the study group and with no medical complications, admitted for induction of labour during the study period served as the control.

Butyrylcholinesterase activity and lymphocyte subpopulations in peripheral blood of Kuwaiti women experiencing recurrent spontaneous abortion.

This study has evaluated the hypothesis that activity of the detoxifying enzyme butyrylcholinesterase (BuChE) correlates with levels of serum anti-cardiolipin antibodies (ACA) and T lymphocytes in peripheral blood of women experiencing recurrent spontaneous abortion (RSA). Peripheral venous blood from 16 non-pregnant, RSA-afflicted women and 8 healthy non-pregnant women was analyzed for frequency of T lymphocyte subpopulations by two-color flow cytometry and for serum BuChE using butyrylthiocholine iodide/spectrophotometry. RSA-afflicted women with high serum ACA, but not those with normal ACA levels, exhibited significantly increased percentages of CD4+CD25+ cells (p<0.

Interleukins in preeclampsia.

Background: Preeclampsia is a multisystemic disorder of unknown etiology. Recently, endothelial damage has been implicated in its cause. The objective of this study was to determine the role of interleukins in the etiology of preeclampsia.

Insulin resistance in women with recurrent spontaneous miscarriage of unknown aetiology.

Objective: The objective of this study was to explore the role of insulin resistance in women with recurrent spontaneous miscarriage (RSM). Patients with > or =3 consecutive spontaneous miscarriages were classified as having RSM.

Subjects And Methods: Thirty-five non-pregnant women presenting with RSM in our specialized RSM clinic constituted the study population, while 30 non-pregnant, parous, fertile women without RSM served as controls.

Emergency obstetric hysterectomy in Kuwait: a clinico pathological analysis.

The major objective of this study is to analyze the histological findings in emergency obstetric hysterectomy specimens and correlate them with the clinical diagnosis, epidemiological factors and number of tissue blocks examined. The records of all peripartum hysterectomy specimens examined between 1995 and 2001 in the Department of Pathology, Al-Sabah Hospital Kuwait were analyzed. A minimum of ten blocks from the cervix or lower uterine segment was arbitrarily regarded as adequate.

The reproductive performance of women at 40 years and over.

Objective: Adverse pregnancy outcome and increased operative deliveries have been reported in women of advanced maternal age. The objective of our study was to evaluate the reproductive performance of our women 40 years and over, and assess if they were at increased risk for adverse pregnancy outcome compared to younger women.

Study Design: A retrospective study of all women 40 years and over who delivered singleton pregnancies at Maternity Hospital, Kuwait, from 1 January 2000 through 30 June 2002, was undertaken.

Effect of IgG therapy on lymphocyte subpopulations in the peripheral blood of Kuwaiti women experiencing recurrent pregnancy loss.

Intravenously administered polyspecific IgG is being increasingly used as an immunomodulating therapy with controversial beneficial outcome. The aim of this study was to evaluate the effects of IgG infusion on peripheral T-cell subpopulations in women with recurrent pregnancy loss (RPL). Fifteen women with a history of three previous RPL between 6 and 22 weeks of gestation and positivity for the antiphospholipid antibody syndrome (APS) were randomized to one of two treatment groups: (a) an intravenous immunoglobulin therapy group (RPL-IVIg; 7 patients), 500 mg IVIg/kg/month and (b) a placebo-treated group given multivitamins (8 patients).

Measurement of inhibin A and inhibin pro-alphaC in early human pregnancy and their role in the prediction of pregnancy outcome in patients with recurrent pregnancy loss.

Objective: To examine the temporal relationship among inhibin A, beta-hCG, and pro-alphaC in early pregnancy and to determine whether the measurement of these hormones has any role in prediction of pregnancy outcome in patients with recurrent spontaneous miscarriage.

Design: Prospective descriptive study.

Setting: A tertiary referral center for recurrent miscarriage.

Streptococcus agalactiae (Group B Streptococci) carriage in late pregnancy in Kuwait.

Objectives: This study investigated the vaginal colonization rate of Streptococcus agalactiae (group B streptococci, GBS) in an antenatal population in a maternity hospital.

Subjects And Methods: Anal, vaginal and combined anal and vaginal specimens were obtained from 110 pregnant women (mean age 30.7 +/- 5.

Nitric oxide metabolites in preterm and induced labor.

Background: Nitric oxide has potent relaxant effects on the pregnant uterus and has been associated with a quiescent uterus in animal and human studies. Nitric oxide donors have been used to arrest preterm labor and a reduction in nitric oxide production has been reported before the onset of labor.

Objective: The aim of the study was to estimate the serum levels of nitrate and nitrite in women undergoing spontaneous preterm labor and induced labor.

A comparison of the uterine and intraovarian arterial flows in nonpregnant women having a history of recurrent spontaneous miscarriage associated with antiphospholipid syndrome.

Objective: The objective was to study the relationship between values of Doppler indices characterizing the uterine and intraovarian arterial flows and presence or absence of antiphospholipid syndrome in women with history of recurrent spontaneous miscarriage in the midluteal phase of unstimulated menstrual cycle.

Methods: Sixty two non pregnant women attending our recurrent spontaneous miscarriage clinic were recruited for this prospective study and subsequently divided to group A ( n=35) involving recurrent spontaneous miscarriage women with normal anticardiolipin antibodies values and group B ( n=27) for those with abnormal anticardiolipin antibodies values. Anticardiolipin antibodies were measured in the blood using the standardized enzyme linked immunosorbent assay.

The relationship of recurrent spontaneous miscarriage with reproductive failure.

Objective: To investigate the reproductive performance of non-pregnant women with recurrent spontaneous miscarriage (RSM) and the association between RSM and polycystic ovary syndrome (PCOS) in reproductive failure.

Subjects And Methods: Fifty non-pregnant women with 3 or more consecutive RSM attending our RSM clinic were evaluated prospectively. Detailed history and physical examination were completed.

Lymphocyte subpopulation frequency and presence of anti-cardiolipin and anti-nuclear antibodies in peripheral blood of Kuwaiti women experiencing recurrent pregnancy loss.

Recurrent pregnancy loss (RPL) is often associated with elevated levels of serum antiphospholipid antibodies, which contribute to the pathology of the disorder by promoting formation of thromboses, leading to placental infarction and fetal loss. Patients with recurrent pregnancy loss also exhibit pathological alterations in composition and activity of peripheral blood lymphocytes, which may be indicative of an autoimmune processes. This investigation examines the correlation between levels of anticardiolipin antibody (AC) and specific subsets of the lymphocyte repertoire in RPL patients, with the objective of further characterising the immunological basis for RPL.

The aetiology and pattern of recurrent pregnancy loss.

The aims of this study were to determine the aetiological factors and the pattern of recurrent pregnancy loss in Kuwait. Ninety consecutive patients attending the special recurrent miscarriage clinic were studied prospectively. A comprehensive history of all previous miscarriages and pregnancies, past medical and gynaecological events were established.

Hormone profile of Kuwaiti women with hyperemesis gravidarum.

Objective: To evaluate the incidence of hyperemesis gravidarum among pregnant women in Kuwait and the status of HCG, TSH, Total T4 and Free T4 in the serum of patients with hyperemesis gravidarum compared with a control group of women.

Methodology: During a 6-month period all patients admitted to Maternity Hospital with features of hyperemesis gravidarum (excessive vomiting and ketonuria) were enlisted into the study. In fifty of these patients and their fifty normal controls, the status of serum total (beta)hCG, TSH, total T4 and freeT4 were evaluated with AXSYM micro particle enzyme immunoassay.