Michael Diejomaoh - Academia.edu (original) (raw)
Papers by Michael Diejomaoh
International Journal of Women's Health, Dec 1, 2013
To evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregna... more 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. The study and control patients were monitored through labor/puerperium, and the outcome was documented. Results: Gestational diabetes mellitus was diagnosed in 71.9% of the study patients, a past history of diabetes mellitus was recorded in 81.34% of the study patients, and 49.2% of the patients were admitted at 8-12 weeks of gestation for diabetic control. The mean weight gained in pregnancy was significantly higher for control patients (11.52±5.643 versus [vs] 9.90±5.757 kg/m 2 ; P,0.009), and the body mass index of study patients was higher (32.00±6.160 vs 28.20±5.885 kg/m 2 ; P,0.0001). Of the study population, 64.3% of the patients were managed with diet and increased physical activity and 35.7% with insulin, diet, and increased physical activity. The incidences of maternal morbidity in both study and control groups were comparable, and the incidence of preeclampsia was low, at 2.3%. The gestational age at delivery was higher in the control group (39.02±1.834 weeks vs 38.62±1.773 weeks; P,0.0001), and the percentage of cesarean deliveries was higher in the study population (44.4% vs 33.3%; P=0.046). The Apgar scores of the both groups were comparable and in the normal range, and the incidences of fetal anomaly (1.17%), shoulder dystocia (1.8%), and Erb's palsy (1.8%) were low. Conclusion: Gestational diabetes mellitus was diagnosed in 71.9% of the diabetic patients studied, and dietary control and increased physical activity were the main modalities of management. There was an increased rate of cesarean section in the study population, the incidences of maternal and perinatal morbidity were low, and the perinatal outcomes were satisfactory.
Archives of Gynecology and Obstetrics, Nov 26, 2005
The major objective of this study is to analyze the histological findings in emergency obstetric ... more 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. Fifty-eight patients had peripartum hysterectomies (incidence of 0.07% of all deliveries) out of which 65% were aged between 30 and 40 years. The number of hysterectomy increased with parity up to five and then declined. The number of blocks examined varied from 2 to 53. Satisfactory pathology was found in 40 and absent in 18 cases. There were 33 adherent placentas. Amniotic fluid embolism (AFE) was found in seven patients. Adequate tissue blocks (>or=10) were significantly associated with positive pathological findings. P value <0.05.
Clinical medicine insights. Case reports, 2013
Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response t... more 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. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP. Conclusion: Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.
Journal of Obstetrics and Gynaecology, 2001
Recurrent pregnancy loss (RPL) is often associated with elevated levels of serum antiphospholipid... more 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. Non-pregnant Kuwaiti women with a history of RPL were subdivided into two cohorts based on presence or absence of elevated plasma antibodies to cardiolipin. Whole blood from these individuals was analysed by flow cytometry for selected lymphocyte subsets and compared with a non-RPL control population. When compared with controls and low AC titre subjects, women with a high AC titre exhibited significantly elevated percentages of pathogenic CD5+ B cells; two categories of activated T cells including CD4+CD25+ and CD8+CD25; NK cells and CD3+NK cells; naive (CD4+CD45RA+) cells; and transitional (CD45RO+CD45RA+) cells. In conclusion, women with elevated levels of AC antibodies possess substantially higher levels of activated T cells and pathogenic B cells, suggesting a fundamental predisposition to immune-mediated rejection of the fetus by these patients. Further characterisation of this phenomenon may allow development of novel intervention methods for management of RPL.
Medical Principles and Practice, 1999
Objective: The main purpose of this study was to investigate the role of bacterial vaginosis (BV)... more Objective: The main purpose of this study was to investigate the role of bacterial vaginosis (BV) in prematurity, premature rupture of membranes (PROM) and other disorders of pregnancy. Methods: High vaginal and cervical swabs were taken from pregnant women in the second and third trimesters of pregnancy and from 30 non-pregnant women. Informed consent was obtained from all potential subjects. The specimens were smeared, gram-stained and cultured on a variety of selective and non-selective media which were then incubated at the appropriate atmospheres. Vaginal pH, character of the discharge, and outcome of the amine test were noted. Ultrasound was performed to Correlation between Bacterial Vaginosis and Adverse Pregnancy Outcome
Gynecologic and Obstetric Investigation, 2004
Intravenously administered polyspecific IgG is being increasingly used as an immunomodulating the... more 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 placebotreated group given multivitamins (8 patients). Control groups comprised either normal pregnant women without APS (10 patients) or non-pregnant women. The T-cell markers were characterized using a monoclonal antibody panel including CD3, CD4, CD8, CD25, CD29, CD38, CD45RA, CD45RO, CD54 and HLA-DR. Analysis was performed with a two-color fluorescent-activated flow cytometer. In the first trimester, the percentage of CD4+CD25+, CD4+CD45RO+, CD8+HLA-DR+, and CD8+CD38+ populations were reduced in the multivitamin group compared to normal pregnant women (p ! 0.05) while in the RPL-IVIg group only CD4+CD25+ cells were reduced (p ! 0.05). By the second trimester, CD3+CD16+CD56+ was significantly higher in multivitamin-than in IVIg-treated women (p ! 0.05). The percentage of CD4+HLA-DR+ was significantly higher in the two RPL groups compared to normal pregnant women (p ! 0.05). IVIg therapy in women with RPL was associated with a significant reduction in CD3+CD16+CD56+ and CD4+CD25+. This may contribute to the suppression of immune-mediated processes contributing to premature abortion.
Human Reproduction, Jun 1, 1999
Of 682 women who had undergone in-vitro fertilization (IVF) or intracytoplasmic sperm injection (... more Of 682 women who had undergone in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with embryo transfer, 84 were successful on two occasions, with 16 of these resulting in miscarriage before 20 completed weeks. Antiphospholipid antibodies (APA) were estimated by enzyme-linked immunosorbent assay in these women (group 1) and compared to two control groups: 42 fertile women with three or more miscarriages (group 2) and 60 women with primary infertility undergoing IVF or ICSI (group 3). An apparently higher prevalence of seropositivity was seen in group 1 women (25%) compared to the group 3 women (6.6%) and it was similar to that seen in group 2 women (21.4%). Therefore the recommendation that women with two consecutive miscarriages after IVF or ICSI should have APA estimations performed routinely may be justified.
Archives of Gynecology and Obstetrics, Oct 1, 2002
Objective: To evaluate the incidence of hyperemesis gravidarum among pregnant women in Kuwait and... more 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 βhCG, TSH, total T4 and freeT4 were evaluated with AXSYM micro particle enzyme immunoassay. Results: The incidence of hyperemesis in the maternity population was 45 per 1000 deliveries. Total βhCG and Total T4 and FreeT4 were significantly higher in the hyperemesis patients than in the normal controls (p<0.0001, p=0.004 and p=0.01 respectively). TSH levels were significantly lower in hyperemesis patients than in their normal controls (p<0.0001). There was a strong positive correlation between the total βhCG and the gestational age (r=0.8). Conclusion: There is a high incidence of hyperemesis gravidarum in the Kuwaiti population. Total βhCG, Total T4 and Free T4 titers were significantly higher in patients with hyperemesis gravidarum, but none of the patients showed signs of hyperthyroidism.
![Research paper thumbnail of The Significance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates [13]](https://attachments.academia-assets.com/107861228/thumbnails/1.jpg)
](Obstetrics & Gynecology, May 1, 2015
Medical Principles and Practice, 2018
Significance of the Study • In this study, a high primary cesarean delivery rate was reported, wh... more Significance of the Study • In this study, a high primary cesarean delivery rate was reported, which could lead to future cesarean deliveries; the high incidence of repeat cesarean delivery commences with the second cesarean, further elevating institutional rates. This study highlights recommendations for the reduction of the second cesarean and ultimately, overall institutional cesarean delivery rates.
European Journal of Obstetrics & Gynecology and Reproductive Biology, May 1, 2006
Objective: Adverse pregnancy outcome and increased operative deliveries have been reported in wom... more 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. One-hundred and sixty-eight women formed the study group while 160 women aged 25-30 years served as the control group. The antenatal records, the intrapartum and postpartum events, and the perinatal outcome were extracted and analysed. Statistical analysis was done by Chi-square test, Fisher exact two-tailed test and the Welch t-test. Results: The mean age of the study and control groups were 41.46 AE 1.38 (range 40-47) and 27.40 AE 1.67 (range 25-30) years, respectively. The mean parity of the study group, 4.24 AE 2.35 was statistically higher than for the control group, 1.69 AE 1.39, P < 0.0001. The past history of previous preterm delivery (10.1% versus 4.4%) and previous caesarean section (24.4% versus 11.9%) were more significant in the study group, P = 0.0562 and 0.0053, respectively. Women of 40 years and over presented significantly more medical complications. The incidence of caesarean section in the study group was significantly higher (31.0% versus 16.3%), P = 0.0027, OR 2.310, CI 1.356-3.935. The overall maternal and perinatal outcomes in both groups were comparable and satisfactory. Conclusion: Advanced maternal age of 40 years and over was not associated with adverse maternal and perinatal outcome, although the incidence of caesarean section was significantly increased in these women.
International journal of gynaecology and obstetrics, Nov 1, 1975
The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with hig... more The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with high HCG doses of 10000 units twice weekly for 10 weeks, 24 of whom were treated with moderate HCG dose of 5000 units twice weekly for 10 weeks and 22 of whom received combination therapy of HCG 5 000 units and PMS 750 unita twice weekly for 10 weeks is here presented. In the first group, seven pati ents (14 %) had improvement in seminal quality with a single subsequent pregnancy whereas in the latter two groups, II patients (23.9 %) had improvement in seminal quality with six subsequent pregnancies. The overall pregnancy rate in the series was 23.95 %; the overall pregnancy rates for the two groups of patients were virtually equal, although mo t of the pregnancies in the high HCG dosage schedule occurred in the absence of seminal improvement. Varicocelectomy did not improve the pregnancy rate in this series. Female fertility problems did not hinder the occurrence of pregnancy in this seri es as such female fertility problems were usually corrected. No correlation was found between testicular pathology and improvement in semen quality .
Medical Principles and Practice, 2010
The main presenting symptoms at admission were vaginal bleeding: 31 (57.4%), abdominal pain: 17 (... more The main presenting symptoms at admission were vaginal bleeding: 31 (57.4%), abdominal pain: 17 (31.5%), abdominal mass: 10 (18.5%), and vomiting: 10 (18.5%). Ultrasonography revealed that dermoid cysts were the most frequently encountered ovarian cysts. Patients were hospitalized for 1-7 days. Conclusion: Disorders of pregnancy and ovarian cysts were the most frequently encountered pediatric/adolescent gynecological disorders. It is recommended that there should be a dedicated specialized clinic to guarantee privacy and centralized discreet care for these patients.
Scandinavian Journal of Clinical & Laboratory Investigation, Oct 20, 2010
Obesity plays pathogenetic roles in nonalcoholic fatty liver disease (NAFLD) and hyperandrogenic ... more 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. 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. Beta cell function (%B), insulin sensitivity (%S) and insulin resistance were calculated using the homeostasis model assessment (HOMA-IR). Ninety-two women had PCOS (Rotterdam criteria); 64 had idiopathic hyperandrogenism; 44 were normal controls. ALT showed significant positive correlations with waist circumference (WC), systolic blood pressure, glucose, leptin, FLI, triglycerides, HOMA-IR and androgens and significant inverse correlations with leptin receptor, HDL-C, %S and SHBG. Correcting for WC and fat% showed that the associations between ALT and glucose, HOMA-IR, testosterone and free androgen index are independent of obesity. Binary logistic regression analyses showed significant association of ALT with PCOS and hyperandrogenemia. ALT ≥ 18 IU/L showed significant association with PCOS with Odds Ratio = 2.28 (95% Confidence Interval = 1.03-5.08), p = 0.043. In women of reproductive age, normal levels of ALT are associated with metabolic and androgenic phenotypes. We suggest a paradigm shift and extension of the routine use of ALT beyond the diagnosis of liver disease.
Creative Education, 2016
Introduction: The Department of Obstetrics and Gynaecology first implemented the Objective Struct... more Introduction: The Department of Obstetrics and Gynaecology first implemented the Objective Structured Clinical Examination (OSCE) in the final examinations in 2003 academic year to replace the long case and oral examination on short cases and to evaluate the attitude of staff and medical students towards OSCE as a method of clinical assessment. Methods: Three main groups were evaluated: 1) 96 medical students at their final examination in Obstetrics and Gynaecology and were assessed with OSCE; 2) 30 Kuwait trained doctors who were assessed with OSCE during their undergraduate training; 3) academic staff made up internal faculty staff (12) and external examiners. Results: Perception of examination was highly positive among the students: Quality of instruction and organization (96%), transparency of the process (96%), method of assessing clinical skills (90%), patients' care (89%), assessment of knowledge (84%) and communication skills (84%). Significantly, more of the trainee doctors that had OSCE during their training (92%) had positive perception of OSCE than those trainees (65%) that did not (P < 0.05). Both the internal and external examiners had an equally high perception of OSCE (83% versus 92%; P = 0.85), citing less examiner fatigue and more enjoyable for examiners and students. Conclusion: OSCE may be a more appropriate choice for graduation examinations of compared to the conventional clinical examination. It is expensive in terms of manpower requirement. There should be continuing research to reduce stress to students and examiners.
International Journal of Gynecology & Obstetrics, 1975
The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with hig... more The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with high HCG doses of 10000 units twice weekly for 10 weeks, 24 of whom were treated with moderate HCG dose of 5000 units twice weekly for 10 weeks and 22 of whom received combination therapy of HCG 5 000 units and PMS 750 unita twice weekly for 10 weeks is here presented. In the first group, seven pati ents (14 %) had improvement in seminal quality with a single subsequent pregnancy whereas in the latter two groups, II patients (23.9 %) had improvement in seminal quality with six subsequent pregnancies. The overall pregnancy rate in the series was 23.95 %; the overall pregnancy rates for the two groups of patients were virtually equal, although mo t of the pregnancies in the high HCG dosage schedule occurred in the absence of seminal improvement. Varicocelectomy did not improve the pregnancy rate in this series. Female fertility problems did not hinder the occurrence of pregnancy in this seri es as such female fertility problems were usually corrected. No correlation was found between testicular pathology and improvement in semen quality .
Archives of Gynecology and Obstetrics, 2005
The major objective of this study is to analyze the histological findings in emergency obstetric ... more 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. Fifty-eight patients had peripartum hysterectomies (incidence of 0.07% of all deliveries) out of which 65% were aged between 30 and 40 years. The number of hysterectomy increased with parity up to five and then declined. The number of blocks examined varied from 2 to 53. Satisfactory pathology was found in 40 and absent in 18 cases. There were 33 adherent placentas. Amniotic fluid embolism (AFE) was found in seven patients. Adequate tissue blocks (>or=10) were significantly associated with positive pathological findings. P value <0.05.
![Research paper thumbnail of The Significance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates [13]](https://attachments.academia-assets.com/94052398/thumbnails/1.jpg)
](Obstetrics & Gynecology, 2015
Nigerian medical journal : journal of the Nigeria Medical Association
Tropical and geographical medicine, 1981
Twelve cases of adhesion of the labia minora complicating circumcision in the neonatal period of ... more Twelve cases of adhesion of the labia minora complicating circumcision in the neonatal period of a Nigerian Community are presented. 9 of the cases were under one year in age. 10 of the cases were erroneously diagnosed by general practitioners as cases of imperforate vagina or hymen. The commonest presenting symptom was a poor urinary stream. Treatment was by separation of the adhesion and local application of dienoestrol cream, the success rate of this mode of therapy was 91.7%. The aetiology and treatment of labial adhesions are discussed. If labial adhesions are untreated other complications could arise in later life, hence female circumcision in the neonatal period should be discouraged.
International Journal of Women's Health, Dec 1, 2013
To evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregna... more 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. The study and control patients were monitored through labor/puerperium, and the outcome was documented. Results: Gestational diabetes mellitus was diagnosed in 71.9% of the study patients, a past history of diabetes mellitus was recorded in 81.34% of the study patients, and 49.2% of the patients were admitted at 8-12 weeks of gestation for diabetic control. The mean weight gained in pregnancy was significantly higher for control patients (11.52±5.643 versus [vs] 9.90±5.757 kg/m 2 ; P,0.009), and the body mass index of study patients was higher (32.00±6.160 vs 28.20±5.885 kg/m 2 ; P,0.0001). Of the study population, 64.3% of the patients were managed with diet and increased physical activity and 35.7% with insulin, diet, and increased physical activity. The incidences of maternal morbidity in both study and control groups were comparable, and the incidence of preeclampsia was low, at 2.3%. The gestational age at delivery was higher in the control group (39.02±1.834 weeks vs 38.62±1.773 weeks; P,0.0001), and the percentage of cesarean deliveries was higher in the study population (44.4% vs 33.3%; P=0.046). The Apgar scores of the both groups were comparable and in the normal range, and the incidences of fetal anomaly (1.17%), shoulder dystocia (1.8%), and Erb's palsy (1.8%) were low. Conclusion: Gestational diabetes mellitus was diagnosed in 71.9% of the diabetic patients studied, and dietary control and increased physical activity were the main modalities of management. There was an increased rate of cesarean section in the study population, the incidences of maternal and perinatal morbidity were low, and the perinatal outcomes were satisfactory.
Archives of Gynecology and Obstetrics, Nov 26, 2005
The major objective of this study is to analyze the histological findings in emergency obstetric ... more 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. Fifty-eight patients had peripartum hysterectomies (incidence of 0.07% of all deliveries) out of which 65% were aged between 30 and 40 years. The number of hysterectomy increased with parity up to five and then declined. The number of blocks examined varied from 2 to 53. Satisfactory pathology was found in 40 and absent in 18 cases. There were 33 adherent placentas. Amniotic fluid embolism (AFE) was found in seven patients. Adequate tissue blocks (>or=10) were significantly associated with positive pathological findings. P value <0.05.
Clinical medicine insights. Case reports, 2013
Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response t... more 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. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP. Conclusion: Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.
Journal of Obstetrics and Gynaecology, 2001
Recurrent pregnancy loss (RPL) is often associated with elevated levels of serum antiphospholipid... more 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. Non-pregnant Kuwaiti women with a history of RPL were subdivided into two cohorts based on presence or absence of elevated plasma antibodies to cardiolipin. Whole blood from these individuals was analysed by flow cytometry for selected lymphocyte subsets and compared with a non-RPL control population. When compared with controls and low AC titre subjects, women with a high AC titre exhibited significantly elevated percentages of pathogenic CD5+ B cells; two categories of activated T cells including CD4+CD25+ and CD8+CD25; NK cells and CD3+NK cells; naive (CD4+CD45RA+) cells; and transitional (CD45RO+CD45RA+) cells. In conclusion, women with elevated levels of AC antibodies possess substantially higher levels of activated T cells and pathogenic B cells, suggesting a fundamental predisposition to immune-mediated rejection of the fetus by these patients. Further characterisation of this phenomenon may allow development of novel intervention methods for management of RPL.
Medical Principles and Practice, 1999
Objective: The main purpose of this study was to investigate the role of bacterial vaginosis (BV)... more Objective: The main purpose of this study was to investigate the role of bacterial vaginosis (BV) in prematurity, premature rupture of membranes (PROM) and other disorders of pregnancy. Methods: High vaginal and cervical swabs were taken from pregnant women in the second and third trimesters of pregnancy and from 30 non-pregnant women. Informed consent was obtained from all potential subjects. The specimens were smeared, gram-stained and cultured on a variety of selective and non-selective media which were then incubated at the appropriate atmospheres. Vaginal pH, character of the discharge, and outcome of the amine test were noted. Ultrasound was performed to Correlation between Bacterial Vaginosis and Adverse Pregnancy Outcome
Gynecologic and Obstetric Investigation, 2004
Intravenously administered polyspecific IgG is being increasingly used as an immunomodulating the... more 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 placebotreated group given multivitamins (8 patients). Control groups comprised either normal pregnant women without APS (10 patients) or non-pregnant women. The T-cell markers were characterized using a monoclonal antibody panel including CD3, CD4, CD8, CD25, CD29, CD38, CD45RA, CD45RO, CD54 and HLA-DR. Analysis was performed with a two-color fluorescent-activated flow cytometer. In the first trimester, the percentage of CD4+CD25+, CD4+CD45RO+, CD8+HLA-DR+, and CD8+CD38+ populations were reduced in the multivitamin group compared to normal pregnant women (p ! 0.05) while in the RPL-IVIg group only CD4+CD25+ cells were reduced (p ! 0.05). By the second trimester, CD3+CD16+CD56+ was significantly higher in multivitamin-than in IVIg-treated women (p ! 0.05). The percentage of CD4+HLA-DR+ was significantly higher in the two RPL groups compared to normal pregnant women (p ! 0.05). IVIg therapy in women with RPL was associated with a significant reduction in CD3+CD16+CD56+ and CD4+CD25+. This may contribute to the suppression of immune-mediated processes contributing to premature abortion.
Human Reproduction, Jun 1, 1999
Of 682 women who had undergone in-vitro fertilization (IVF) or intracytoplasmic sperm injection (... more Of 682 women who had undergone in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with embryo transfer, 84 were successful on two occasions, with 16 of these resulting in miscarriage before 20 completed weeks. Antiphospholipid antibodies (APA) were estimated by enzyme-linked immunosorbent assay in these women (group 1) and compared to two control groups: 42 fertile women with three or more miscarriages (group 2) and 60 women with primary infertility undergoing IVF or ICSI (group 3). An apparently higher prevalence of seropositivity was seen in group 1 women (25%) compared to the group 3 women (6.6%) and it was similar to that seen in group 2 women (21.4%). Therefore the recommendation that women with two consecutive miscarriages after IVF or ICSI should have APA estimations performed routinely may be justified.
Archives of Gynecology and Obstetrics, Oct 1, 2002
Objective: To evaluate the incidence of hyperemesis gravidarum among pregnant women in Kuwait and... more 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 βhCG, TSH, total T4 and freeT4 were evaluated with AXSYM micro particle enzyme immunoassay. Results: The incidence of hyperemesis in the maternity population was 45 per 1000 deliveries. Total βhCG and Total T4 and FreeT4 were significantly higher in the hyperemesis patients than in the normal controls (p<0.0001, p=0.004 and p=0.01 respectively). TSH levels were significantly lower in hyperemesis patients than in their normal controls (p<0.0001). There was a strong positive correlation between the total βhCG and the gestational age (r=0.8). Conclusion: There is a high incidence of hyperemesis gravidarum in the Kuwaiti population. Total βhCG, Total T4 and Free T4 titers were significantly higher in patients with hyperemesis gravidarum, but none of the patients showed signs of hyperthyroidism.
Obstetrics & Gynecology, May 1, 2015
Medical Principles and Practice, 2018
Significance of the Study • In this study, a high primary cesarean delivery rate was reported, wh... more Significance of the Study • In this study, a high primary cesarean delivery rate was reported, which could lead to future cesarean deliveries; the high incidence of repeat cesarean delivery commences with the second cesarean, further elevating institutional rates. This study highlights recommendations for the reduction of the second cesarean and ultimately, overall institutional cesarean delivery rates.
European Journal of Obstetrics & Gynecology and Reproductive Biology, May 1, 2006
Objective: Adverse pregnancy outcome and increased operative deliveries have been reported in wom... more 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. One-hundred and sixty-eight women formed the study group while 160 women aged 25-30 years served as the control group. The antenatal records, the intrapartum and postpartum events, and the perinatal outcome were extracted and analysed. Statistical analysis was done by Chi-square test, Fisher exact two-tailed test and the Welch t-test. Results: The mean age of the study and control groups were 41.46 AE 1.38 (range 40-47) and 27.40 AE 1.67 (range 25-30) years, respectively. The mean parity of the study group, 4.24 AE 2.35 was statistically higher than for the control group, 1.69 AE 1.39, P < 0.0001. The past history of previous preterm delivery (10.1% versus 4.4%) and previous caesarean section (24.4% versus 11.9%) were more significant in the study group, P = 0.0562 and 0.0053, respectively. Women of 40 years and over presented significantly more medical complications. The incidence of caesarean section in the study group was significantly higher (31.0% versus 16.3%), P = 0.0027, OR 2.310, CI 1.356-3.935. The overall maternal and perinatal outcomes in both groups were comparable and satisfactory. Conclusion: Advanced maternal age of 40 years and over was not associated with adverse maternal and perinatal outcome, although the incidence of caesarean section was significantly increased in these women.
International journal of gynaecology and obstetrics, Nov 1, 1975
The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with hig... more The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with high HCG doses of 10000 units twice weekly for 10 weeks, 24 of whom were treated with moderate HCG dose of 5000 units twice weekly for 10 weeks and 22 of whom received combination therapy of HCG 5 000 units and PMS 750 unita twice weekly for 10 weeks is here presented. In the first group, seven pati ents (14 %) had improvement in seminal quality with a single subsequent pregnancy whereas in the latter two groups, II patients (23.9 %) had improvement in seminal quality with six subsequent pregnancies. The overall pregnancy rate in the series was 23.95 %; the overall pregnancy rates for the two groups of patients were virtually equal, although mo t of the pregnancies in the high HCG dosage schedule occurred in the absence of seminal improvement. Varicocelectomy did not improve the pregnancy rate in this series. Female fertility problems did not hinder the occurrence of pregnancy in this seri es as such female fertility problems were usually corrected. No correlation was found between testicular pathology and improvement in semen quality .
Medical Principles and Practice, 2010
The main presenting symptoms at admission were vaginal bleeding: 31 (57.4%), abdominal pain: 17 (... more The main presenting symptoms at admission were vaginal bleeding: 31 (57.4%), abdominal pain: 17 (31.5%), abdominal mass: 10 (18.5%), and vomiting: 10 (18.5%). Ultrasonography revealed that dermoid cysts were the most frequently encountered ovarian cysts. Patients were hospitalized for 1-7 days. Conclusion: Disorders of pregnancy and ovarian cysts were the most frequently encountered pediatric/adolescent gynecological disorders. It is recommended that there should be a dedicated specialized clinic to guarantee privacy and centralized discreet care for these patients.
Scandinavian Journal of Clinical & Laboratory Investigation, Oct 20, 2010
Obesity plays pathogenetic roles in nonalcoholic fatty liver disease (NAFLD) and hyperandrogenic ... more 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. 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. Beta cell function (%B), insulin sensitivity (%S) and insulin resistance were calculated using the homeostasis model assessment (HOMA-IR). Ninety-two women had PCOS (Rotterdam criteria); 64 had idiopathic hyperandrogenism; 44 were normal controls. ALT showed significant positive correlations with waist circumference (WC), systolic blood pressure, glucose, leptin, FLI, triglycerides, HOMA-IR and androgens and significant inverse correlations with leptin receptor, HDL-C, %S and SHBG. Correcting for WC and fat% showed that the associations between ALT and glucose, HOMA-IR, testosterone and free androgen index are independent of obesity. Binary logistic regression analyses showed significant association of ALT with PCOS and hyperandrogenemia. ALT ≥ 18 IU/L showed significant association with PCOS with Odds Ratio = 2.28 (95% Confidence Interval = 1.03-5.08), p = 0.043. In women of reproductive age, normal levels of ALT are associated with metabolic and androgenic phenotypes. We suggest a paradigm shift and extension of the routine use of ALT beyond the diagnosis of liver disease.
Creative Education, 2016
Introduction: The Department of Obstetrics and Gynaecology first implemented the Objective Struct... more Introduction: The Department of Obstetrics and Gynaecology first implemented the Objective Structured Clinical Examination (OSCE) in the final examinations in 2003 academic year to replace the long case and oral examination on short cases and to evaluate the attitude of staff and medical students towards OSCE as a method of clinical assessment. Methods: Three main groups were evaluated: 1) 96 medical students at their final examination in Obstetrics and Gynaecology and were assessed with OSCE; 2) 30 Kuwait trained doctors who were assessed with OSCE during their undergraduate training; 3) academic staff made up internal faculty staff (12) and external examiners. Results: Perception of examination was highly positive among the students: Quality of instruction and organization (96%), transparency of the process (96%), method of assessing clinical skills (90%), patients' care (89%), assessment of knowledge (84%) and communication skills (84%). Significantly, more of the trainee doctors that had OSCE during their training (92%) had positive perception of OSCE than those trainees (65%) that did not (P < 0.05). Both the internal and external examiners had an equally high perception of OSCE (83% versus 92%; P = 0.85), citing less examiner fatigue and more enjoyable for examiners and students. Conclusion: OSCE may be a more appropriate choice for graduation examinations of compared to the conventional clinical examination. It is expensive in terms of manpower requirement. There should be continuing research to reduce stress to students and examiners.
International Journal of Gynecology & Obstetrics, 1975
The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with hig... more The report of 96 normogonadotropic oligospermic infertile males, 50 of whom were treated with high HCG doses of 10000 units twice weekly for 10 weeks, 24 of whom were treated with moderate HCG dose of 5000 units twice weekly for 10 weeks and 22 of whom received combination therapy of HCG 5 000 units and PMS 750 unita twice weekly for 10 weeks is here presented. In the first group, seven pati ents (14 %) had improvement in seminal quality with a single subsequent pregnancy whereas in the latter two groups, II patients (23.9 %) had improvement in seminal quality with six subsequent pregnancies. The overall pregnancy rate in the series was 23.95 %; the overall pregnancy rates for the two groups of patients were virtually equal, although mo t of the pregnancies in the high HCG dosage schedule occurred in the absence of seminal improvement. Varicocelectomy did not improve the pregnancy rate in this series. Female fertility problems did not hinder the occurrence of pregnancy in this seri es as such female fertility problems were usually corrected. No correlation was found between testicular pathology and improvement in semen quality .
Archives of Gynecology and Obstetrics, 2005
The major objective of this study is to analyze the histological findings in emergency obstetric ... more 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. Fifty-eight patients had peripartum hysterectomies (incidence of 0.07% of all deliveries) out of which 65% were aged between 30 and 40 years. The number of hysterectomy increased with parity up to five and then declined. The number of blocks examined varied from 2 to 53. Satisfactory pathology was found in 40 and absent in 18 cases. There were 33 adherent placentas. Amniotic fluid embolism (AFE) was found in seven patients. Adequate tissue blocks (>or=10) were significantly associated with positive pathological findings. P value <0.05.
Obstetrics & Gynecology, 2015
Nigerian medical journal : journal of the Nigeria Medical Association
Tropical and geographical medicine, 1981
Twelve cases of adhesion of the labia minora complicating circumcision in the neonatal period of ... more Twelve cases of adhesion of the labia minora complicating circumcision in the neonatal period of a Nigerian Community are presented. 9 of the cases were under one year in age. 10 of the cases were erroneously diagnosed by general practitioners as cases of imperforate vagina or hymen. The commonest presenting symptom was a poor urinary stream. Treatment was by separation of the adhesion and local application of dienoestrol cream, the success rate of this mode of therapy was 91.7%. The aetiology and treatment of labial adhesions are discussed. If labial adhesions are untreated other complications could arise in later life, hence female circumcision in the neonatal period should be discouraged.