Abortion and Ensoulment

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Torsion of a normal ovary in the third trimester of pregnancy: a case report

INTRODUCTION: Adnexal torsion in advanced pregnancy is an uncommon emergency. Torsion usually occurs in ovaries with functional cysts or tumors. It is uncommon for a normal-sized ovary to undergo torsion in advanced gestation. We report torsion of a normal-sized ovary in the third trimester of pregnancy, most probably the first case report of its kind in the English-language literature. CASE PRESENTATION: A 32-year-old Omani woman at 32-weeks gestation (gravida 2 para 1) was admitted with right iliac fossa pain, nausea and vomiting of 2 days duration, as well as a history of a similar episode one month earlier. On examination, a provisional diagnosis of appendicitis was made. Laparotomy revealed, however, that the right ovary was gangrenous and had undergone torsion. CONCLUSION: Adnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation. Although in our patient, the affected ovary could not be saved, an early diagnosis using imaging like Doppler of the adnexae will enable early intervention to save the ovaries of the patient, especially in young women

Woman-Centered Care in Pregnancy and Childbirth

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Obstetrics and Gynaecology as a Future Career for Medical Graduates in Oman: Factors that attract and discourage graduates

Objectives: Obstetrics and gynaecology (OBGYN) is a major speciality in the medical field that is often demanding yet rewarding; however, OBGYN receives the least number of applicants in Oman. This study aimed to determine the factors that influence graduates in choosing OBGYN as their speciality. Methods: This cross-sectional questionnaire-based study was conducted from February to March 2017 at Sultan Qaboos University Hospital, Royal Hospital, Khoula Hospital and Al Nahdha Hospital, Muscat, Oman. The questionnaire was distributed to 150 Omani medical graduates (interns and post-intern doctors). Results: A total of 145 Omani graduates took part in the study (response rate: 96.7%) and the participants’ average age was 26 years. Family medicine ranked as the first choice followed by paediatrics and emergency medicine. OBGYN was the first choice for eight female graduates. The top factors attracting male graduates to the OBGYN speciality were its surgical opportunities (80.6%), intellectual content (77.4%), faculty interactions and the opportunity to care for a healthy population (54.8% each); however, the top factors attracting females were the intellectual content (88.6%), patients’ desire for female physicians (85.1%), the opportunity to care for a healthy population (76.3%) and cultural expectations (69.5%). The most discouraging factors for male graduates were cultural expectations (100%), the patients’ desire for a female physician (93.5%) and the level of stress (71%), while the discouraging factors for female graduates were the level of stress (82.5%), time demands (78.1%), night duties and the length of the residency (71.9% each). Conclusion: Most of the factors that discourage female graduates from choosing OBGYN are to some extent modifiable. These changes should be considered to encourage the selection of OBGYN as a career by medical students.Keywords: Career Choice; Obstetrics and Gynecology Department, Hospital; Internship and Residency; Medical Student; Oman

Prevalence of gestational choriocarcinoma in a parous population in ten years

Background: Choriocarcinoma is a rare disease with varying incidence in different parts of the world. Asian, American Indian and Africans are quoted to be at a higher risk. There are no epidemiological data from Middle East and hence authors studied the prevalence of choriocarcinoma in Oman, a Middle East nation with a high parity.Methods: This is a retrospective, descriptive, observational study done at tertiary care hospital; Royal Hospital from Jan 2010 to Dec 2019. Since all women are referred to a single center from all over the country, authors believe all cases are included over ten years.Results: There were 22 patients and the prevalence were 1 in 36966 live births. The main presenting symptom was abnormal uterine bleeding and all were gestational type of choriocarcinoma. Median gravidity was 6 and median parity was 5. Almost 80 % received chemo as their risk scoring was more than 7 and one woman died.Conclusions: The prevalence of choriocarcinoma was much similar to Europe and USA though the median gravidity and parity was high. Clinical features were comparable to the literature and management protocols were as per international recommendations

Ruptured Rudimentary Horn Pregnancy Diagnosed by Preoperative Magnetic Resonance Imaging Resulting in Fetal Salvage

Pregnancy in a rudimentary horn is very rare. The rupture of the horn during pregnancy is an obstetric emergency which can be life-threatening for both the mother and fetus. Preoperative diagnosis of such pregnancies can be challenging and they are usually diagnosed intraoperatively. We report a unique case of a 31-year-old multiparous woman who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in January 2013 at 32 gestational weeks with abdominal pain. Ultrasonography was inconclusive. A rudimentary horn pregnancy was subsequently diagnosed via magnetic resonance imaging (MRI). An emergency laparotomy revealed haemoperitoneum and a ruptured rudimentary horn pregnancy. A live baby with an Apgar score of 2 at one minute and 7 at five minutes was delivered. The rudimentary horn with the placenta in situ was excised and a left salpingooophorectomy was performed. The postoperative period was uneventful. The authors recommend MRI as an excellent diagnostic modality to confirm rudimentary horn pregnancies and to expedite appropriate management

Submyomatous Cornual Pregnancy : Managed surgically after failed medical management

Cornual pregnancy constitutes an emergency while its diagnosis and management remain a challenge. Anatomical abnormalities in the uterus, such as fibroids in the cornual region, make the management even more difficult. A nulliparous patient presented with an ectopic pregnancy at the right cornua under a huge fibroid. Despite multiple doses of methotrexate for a cornual ectopic gestation, the serum beta human chorionic gonadotropin (β-hcG) levels doubled on the fifth day and a viable fetus was demonstrated on imaging. Thus surgical intervention in the form of laparoscopy followed by laparotomy, myomectomy of a large cornual fibroid and cornuostomy was performed. The serum beta human chorionic gonadotropin result was negative three weeks later. Surgical intervention in the form of myomectomy and cornuostomy was necessary to preserve fertility in this unusual presentation of cornual ectopic pregnancy.

Effects of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Low Birth Weight in Omani Infants : A case-control study

Objectives: This study aimed to investigate the association between pre-pregnancy maternal body mass index (BMI), gestational weight gain and low birth weight (LBW) in babies born to a sample population of Omani women. Methods: A case-control study was carried out among deliveries registered between 1st May 2010 and 30th April 2011 at Sultan Qaboos University Hospital, Muscat, Oman. A case was defined as a woman who delivered a low birth weight baby (<2,500 g); a control was a woman delivering a baby weighing between 2,500 and 4,000 g. A random selection of 150 cases and 300 controls was carried out using the hospital information system. Maternal, pre-natal, and delivery data were extracted from the mothers’ follow-up cards. Bivariate and multivariate logistic regression analyses were executed to examine the association between pre-pregnancy maternal BMI and LBW. Results: The percentage of underweight mothers (BMI <18.5) was higher among the cases compared to the controls (17.3% versus 6%; P <0.001). The proportion of mothers with less-than-recommended weight gain was also higher among the cases compared to the controls (57.7% versus 33%; P <0.001). After adjustment for potential confounders, infants of underweight mothers had more than twice the risk of LBW compared to those of mothers with normal weight (odds ratio = 2.27; 95% confidence interval 1.09–4.71). Conclusion: Underweight Omani women as well as women with less-than-recommended gestational weight gain were at higher risk of delivering LBW babies. Maternal health promotion programmes should be directed towards improving mothers’ nutrition before and during pregnancies

Effectiveness of misoprostol for induction of first and early second trimester spontaneous miscarriages in parous women

Background: Medical termination of missed miscarriage and incomplete miscarriage with misoprostol, are an alternative to surgical evacuation (dilatation and curettage). This study aimed to evaluate the effectiveness of misoprostol in highly parous woman for incomplete and missed miscarriage.Methods: This was a retrospective study was conducted in two different time lines (2010 and 2014). All patients admitted to the Sultan Qaboos University hospital, Muscat, Oman, for the management of first-trimester miscarriages (missed and incomplete types) during the study period were included. Some women were moved to dilation and curettage even after misoprostol. The effect of gravidity and parity on those women in whom misoprostol was not effective was studied.Results: The overall success rate of misoprostol for the management was 62.14% in 2010 and 53.8% 2014. In nulliparous woman the success rate of misoprostol was slightly higher than parous women. There was no apparent effect of gravidity and parity of ≥ 5 or ≥ 5 on the success of misoprostol.Conclusions: Misoprostol reduced the rate of surgical evacuation among the study subjects. In highly parous and multigravid women (≥ para 5 and gravida ≥5) the success was not significantly different compared to less parous women

Knowledge and Practice of Umbilical Cord Clamping among Maternity Care Providers

Background & aim: Based on the current scientific evidence, delayed cord clamping (DCC) elevates early hemoglobin concentrations and iron stores in the neonate. However, the persistent practice of early cord clamping (ECC) is still a routine care. The aim of the present study was to investigate the umbilical cord clamping practices of maternity care providers in Oman. Methods: This cross-sectional study was conducted on 175 maternity care providers who were registered members of the Oman Society of Obstetricians and Gynecologists and participated voluntarily in the study. The data were collected using a modified version of an online survey in form of a questionnaire developed by Stoll and Hutton (2012). The data were analyzed using descriptive statistics. Results: According to the results, 61% and 31% of the participants were obstetricians and midwifes, respectively, with more than 10 years of experience. The findings indicated that the timing of cord clamping varied among the participants. 87.4-89.6% of the care providers considered ECC timing to be within 1 min of birth, and 70-72.6% of them clamped umbilical cord within 1 min for both normal term and preterm newborns. The most frequently listed benefits of DCC were the physiologic transitioning of the newborn, enhancement of neonatal iron stores, reduced risk of neonatal anemia, and decreased need for transfusions. 45.7% of the participants considered polycythemia and jaundice as the highest associated risks of DCC. Only 11% of the participants reported that they use hospital policy as a reference guide on decision making regarding the timing of cord clamping. Conclusion: Although the majority of the maternity care providers are aware of the new guidelines regarding the timing of cord clamping, they still follow ECC practice. The high prevalence of ECC highlighted the demand for the implementation of a nation- and hospital-wide policy