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This study was designed to evaluate the outcome of the implemented post-cesarean section (CS) surgical site infection (SSI) prevention protocol in Ahmadi Hospital, Kuwait. A total of 229 women who delivered by elective repeat cesarean section (ERCS) were included in this comparative study: 112 women who delivered by ERCS after the implemented protocol (study group) compared to 117 controls (who delivered by ERCS before the implemented protocol). The outcome include the incidence of post-CS SSI after and before the implemented protocol and the risk factors which may predispose to post-CS SSI. The incidence of post-CS SSI was significantly high in the controls (who delivered by ERCS before the implemented protocol) compared to the study group (who delivered by ERCS after the implemented protocol) (12.8% (15/117) versus 3.6% (4/112), respectively) (P = 0.01). The relative risk (RR) analysis showed that obesity and pregestational diabetes were significant risks for post-CS SSI (RR 0.35 (95%CI; 0.13–0.99) P = 0.04 and RR 0.24 (95%CI; 0.063–0.93) P = 0.03, respectively). In addition, the prolonged rupture of membranes (ROM) before the ERCS, duration of ERCS (more than 1 h), and surgical difficulties/adhesions during the ERCS were significant risks for post-CS SSI (RR 6.0 (95%CI; 1.003–35.9) P = 0.04, RR 6.0 (95%CI; 1.003–35.9) P = 0.04, and RR 6.0 (95%CI; 1.003–35.9) P = 0.04, respectively). The incidence of post-CS SSI after ERCS significantly reduced following the post-CS SSI prevention protocol. Obesity, pregestational diabetes, prolonged ROM, duration of ERCS (more than 1 h), and surgical difficulties/adhesions during the ERCS were definite risks for post-CS SSI.

OBJECTIVES: This study designed to compare the efficacy, and tolerability of heme-iron OptiFer® to ferrous fumarate in the treatment of iron deficiency anemia during pregnancy. STUDY DESIGN: Two hundred and thirty-four (234) women with iron deficiency anemia during pregnancy were included in this study; 121 women in the heme-iron OptiFer® group, and 113 women in the ferrous fumarate group. Women in the heme-iron OptiFer® group received OptiFer® tablets twice daily for ≥3 months then once daily as a maintenance dose. Women in the ferrous fumarate group received 350 mg oral ferrous fumarate once daily for ≥3 months. The pre-treatment ferritin, hemoglobin, red blood cells-mean corpuscular volume, and red blood cells-mean corpuscular hemoglobin were compared by the post-treatment values in the two studies. RESULTS: The post-treatment hemoglobin and ferritin were significantly high in the heme-iron OptiFer® group (11.2±7.1 gm/dL and 112.8±54.8 ug/l, respectively) compared to the ferrous fumarate group (10.9 ±5.1 and 89.9±43.3, respectively; p=0.0002 and p=0.006; respectively). The post-treatment red blood cells-mean corpuscular volume and red blood cells-mean corpuscular hemoglobin were significantly high in the heme-iron OptiFer® group (92.0±4.1 fl and 31.9±6.2 pg, respectively) compared to the ferrous fumarate group (87.7±2.9 and 28.5±4.7, respectively; p=0.0001 and p=0.001, respectively). The rates of poor compliance and gastrointestinal intolerance were significantly high in the ferrous fumarate group compared to the heme-iron OptiFer® group (12.4% and 19.5%, respectively versus 3.3% and 2.5%, respectively), (p=0.01 and p=0.0001, respectively). CONCLUSION: Heme-iron OptiFer® is an effective therapeutic option for the treatment of iron deficiency anemia during pregnancy with low side effects. heme-iron OptiFer® can be used in women who have low compliance, and/or gastrointestinal intolerance to conventional iron salts.

The novel coronavirus disease-19 (COVID-19) considered a global health problem. Pregnant women are considered a COVID-19 high-risk group. A 26-years old woman, G2 P1+0, previous cesarean section, 31 weeks`+4 days, admitted with preterm labor, without fever, cough, and/or respiratory symptoms on admission. She presented to the emergency department with fever, and cough, 27 days before the current admission, she was referred to the Ministry of Health, and her COVID-19 PCR swab at Ministry of Health was positive. She delivered by cesarean section, and the PCR swab of the studied woman taken on admission came positive for COVID-19. The delivered girl was admitted to the neonatal intensive care unit for 16 days. The PCR swab of the delivered girl came negative for COVID-19. This report highlights that the COVID-19 infection during pregnancy may increase the rates of preterm labor and cesarean section. There is no strong evidence of vertical COVID-19 transmission when the infection manifests during the 3rd trimester of pregnancy.

There are no established data about lymphadenectomy during treatment of endometrial cancers (ECs) and to what extent lymphadenectomy should be performed. In addition, retroperitoneal lymphadenectomy increases the intraoperative and postoperative complications. Sentinel lymph node (SLN) mapping has the lowest costs and highest quality-adjusted survival. SLN is the most cost-effective strategy in the management of low-risk ECs. Women staged with SLN mapping were more likely to receive adjuvant treatment compared with women staged with systemic lymphadenectomy. This review article designed to evaluate the diagnostic accuracy and the methods of SLN detection in ECs.

Intra-leiomyoma hemorrhage in postmenopausal woman is a very rare complication. This case report represents a case report of spontaneous hemorrhage inside the uterine leiomyoma in postmenopausal woman who presented with acute abdomen. A 55-year-old woman, multipara, postmenopausal for 7 years, known case of multiple fibroid uteruses, was presented to the emergency department of Ahmadi Hospital, Kuwait Oil Company, with acute abdominal pain and vomiting, without any reported trauma and/or associated vaginal bleeding. The studied woman was generally stable regarding her vital signs, her hemoglobin dropped from 12 to 10.2 g/dl. Abdominal examination revealed; palpable pelvi-abdominal mass firms in consistency with tenderness and guarding which provisionally support the diagnosis of degenerated fibroids or intra-leiomyoma hemorrhage. The diagnosis was confirmed by basic pelvi-abdominal ultrasound, followed by correction of the patient's general condition and total abdominal hysterectomy with bilateral salpingo-oophrectomy (TAHBSO). Bisected largest cystic fibroid showed brownish serous fluid inside with organized clotted hematoma which confirmed the diagnosis of intra-leiomyoma hemorrhage. Postoperatively, the studied woman received an unit of packed red blood cells for correction of the postoperative anemia and discharged from the hospital in good general condition for postoperative follow-up in the outpatients’ department on iron tablets. This case report represents a rare complication of intra-leiomyoma hemorrhage in postmenopausal, diagnosed by the basic clinical and ultrasound findings. The case was managed by TAHBSO after correction of the general condition because of the increased risk of the sarcomatous changes of the uterine fibroid in postmenopausal women.

Background: Preterm labor (PTL) remains a major source of neonatal morbidity, and mortality. Currently the trans-vaginal cervical length (TVCL), and/or cervico-vaginal fetal fibronectin (fFN) are the common diagnostic tools used for prediction of PTL. Consequently, many women and their fetuses are exposed unnecessarily tocolysis and hospital admission. Objectives: This study was designed to compare the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days. Patients and Methods: Two-hundred and twenty women (220) were included in this comparative prospective study and classified into two groups: 110 women with threatened preterm labor (TPTL) in the study group, and 110 controls (no TPTL). Women included in the study were subjected to: through history, collection of the cervico-vaginal fluid (CVF) samples for assessment by PremaQuick and Actim Partus tests, followed by trans-vaginal cervical length (TVCL) assessment. Studied women managed according to the hospitals protocol, with follow-up weekly in the obstetrics outpatients’ clinic after discharge from the hospital until delivery. The main outcome measures the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days of admission. Results: PremaQuick test was significantly more specific with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (95.5% and 89.6%; respectively) compared to CL < 25 mm (56.3% and 54.6%; respectively), (P = 0.02 and 0.03; respectively). In addition, PremaQuick test was significantly more sensitive with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (39.8% and 89.6%; respectively) compared to Actim Partus (13.9% and 55.5%; respectively), (P = 0.001 and 0.01; respectively). The Odds ratio and the relative risk for prediction of PTL in symptomatic women within 14 days were significantly high for PremaQuick compared to the CL < 25 mm, and Actim Partus. Conclusion: PremaQuick test seems to be the best complementary test to the CL < 25 in prediction of PTL in symptomatic women within 14 days. PremaQuick test compensates the low specificity and low PPV of the CL < 25 mm in prediction of PTL.

Interstitial pregnancy is a rare variety of ectopic pregnancy, it can have disturbed 8-16 weeks of amenorrhea (later than the distal tubal ectopic pregnancy), due to the dispensability of the myometrium covering the interstitial segment of the fallopian tube, with subsequent massive internal hemorrhage.A 29-years-old female, Gravida 3, Para 2, presented with severe abdominal pain, vomiting, and syncope 3 days after her missing period, and positive pregnancy test. Trans-vaginal ultrasound showed empty uterine cavity, free pelvic fluid with severe cervical motion tenderness. She was diagnosed with ruptured ectopic pregnancy. Ruptured ectopic pregnancy in the proximal segment of right fallopian tube was confirmed with laparotomy.The ruptured pregnancy was managed by right salpingectomy, and hemostatic stitches at the right uterine corn. Her hemoglobin was 8 gr on admission, and she received 3 units of packed RBCs (one intra-operative, and two post-operative). Her post-operative hemoglobin was 10.5 gr, and she was discharged from the hospital on the 3rd post-operative day in good general condition for follow up in the outpatients` department. This case report represents a rare variety of ectopic pregnancy, which is the interstitial pregnancy, because it can rupture few days or weeks after the missed period with subsequent massive internal hemorrhage. Interstitial pregnancy is a rare form of ectopic pregnancy, the obstetricians should be aware of rare forms of ectopic pregnancies, it can have disturbed few days or weeks after the missed period leading to subsequent significant morbidity.

Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and mortality. This study designed to compare the efficacy and safety of Heme iron polypeptide (Proferrin®-ES) versus iron saccharate complex (Ferrosac) in treatment of iron deficiency anemia during pregnancy. Methods: Two hundred and sixty (260) pregnant women with hemoglobin level below 10 gm/dl due to iron deficiency anemia were included in this study and randomized to receive either; intravenous Iron Saccharate (IV group) or oral Proferrin®-ES (PO group) for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing pre-treatment values of hemoglobin, serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and reticulocytes count by the 3-months` post-treatment values. Results: The 3-months` post-treatment hemoglobin level increased compared to the pre-treatment level without any significant difference between the two studied groups (from 8.5 ± 3.5 to 11.3 ± 1.3 gm/dl in PO group and from 8.7 ± 2.5 to 11.7 ± 0.9 gm/dl in IV group). In addition; the 3-months` post-treatment ferritin level, increased compared to the pre-treatment level without any significant difference between the two studied groups (from 19.4 ± 4.9 to 118.8 ± 7.1 ug/l in PO group and from 15.3 ± 5.6 to 122.3 ± 6.4 ug/l in IV group). 1.6% (2/124) of the studied women developed gastrointestinal intolerance and upset with oral Proferrin®-ES (insignificant difference and excluded from the study) and no other side effects recorded with oral Proferrin®-ES. Conclusion: HIP (Proferrin®-ES) is an effective, safe, well tolerable oral iron preparation as well as intravenous iron saccharate complex for treatment of iron deficiency during pregnancy; it increases the hemoglobin and replaces the depleted iron store.

Background: The iron requirements increase during the second and third trimesters of pregnancy. Maternal anemia is a leading cause of adverse perinatal outcome. Objectives: This study was designed to evaluate the efficacy of the heme-bound iron in treatment of pregnancy-associated iron deficiency anemia (IDA). Materials and Methods: In all, 122 women with IDA during pregnancy and hemoglobin ≤10 g/dL were studied. The studied women were treated with heme-bound iron tablets for ≥3 months. Pretreatment hemoglobin, ferritin, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) were compared with the posttreatment values to detect the efficacy of heme-bound iron (Optifer®) in treatment of IDA during pregnancy. Results: The mean pretreatment hemoglobin significantly increased from 8.4 ± 2.7 to 11.2 ± 2.1 g/dL and the mean pretreatment ferritin level significantly increased from 22.6 ± 5.6 to 112.8 ± 4.8 μg/L (P < 0.003 and 0.04; respectively) 3 months after heme-bound iron treatment. In addition, the mean pretreatment red blood cells’ MCV and MCH significantly increased from 74.2 ± 4.8 fL and 24.2 ± 7.8 pg, respectively, to 92.0 ± 4.1 fL and 32.6 ± 6.2 pg) (P = 0.04 and 0.007, respectively) 3 months after heme-bound iron treatment. Conclusion: Heme-bound iron (Optifer®) is an effective oral iron preparation to treat IDA during pregnancy and to replace the depleted iron store.

Evaluation of infertile couple indicated because of failure of conception for one year of unprotected intercourse, and indicated for the infertile couple because of failure of conception for 6 months of unprotected intercourse if the female partner is above 35 years. Initial male partner evaluation includes: 1) thorough reproductive history, and at least one semen analysis. If the initial male partner evaluation showed any abnormality, complete assessment needed. Initial assessment of the infertile male include; thorough reproductive history, and at least one semen examination. Endocrine assessment indicated for males with abnormal semen analysis. Post-ejaculatory urine analysis performed in males having

Ovarian fibroma usually misdiagnosed preoperatively as uterine leiomyoma. A 36-year-old woman, presented with abdominal pain and vomiting, provisionally diagnosed as complicated ovarian cyst. The transvaginal ultrasound and Doppler showed left solid adnexal mass with preserved ovarian blood flow. Magnetic resonance imaging showed a well-defined solid mass in the left side of the pelvis, measuring 8 cm × 10 cm most probably subserous uterine leiomyoma. At laparotomy, the solid ovarian mass was originating from the left ovary, and the microscopic examination confirmed the diagnosis of the ovarian fibroma. This report represents the preoperative misdiagnosis of the ovarian fibromas and the conservative ovarian surgery for the ovarian fibromas and the importance of the follow-up for future fertility and/or recurrence of the fibromas in young women.

Fetuses with single umbilical artery (SUA) at great risk of intrauterine growth retardation (IUGR), intrauterine fetal death (IUFD) and prematurity. A 24-years-old woman, 28 weeks' gestation, presented to the Ahmadi hospital, Kuwait, with history of preterm premature rupture of fetal membranes (PPROM). After exclusion of the PPROM, the ultrasound scan of the studied woman showed; asymmetrical IUGR with SUA. The diagnosis of SUA confirmed by the color flow Doppler. She delivered spontaneously at 36 weeks+2, and a cut section in the umbilical cord done to confirm the diagnosis of SUA. The congenital and chromosomal abnormalities of the studied neonate excluded after normal pelvi-abdominal, brain ultrasound and normal karyotyping (46, xx); respectively. The prenatal diagnosed SUA in the studied cases associated with IUGR, preterm labor (PTL) and small for gestational age (SGA). SUA can be considered a marker of diagnosable congenital fetal malformation (CFM) and aneuploidy.

Background and objectives Exposure to environmental hazards will destroy a number of ovarian primordial follicles, reduce ovarian reserve and subsequent reproductive ability. This study designed to evaluate ovarian parameters and ovarian blood flow of women living in the area of environmental crisis Shalkar city (Kazakhstan) compared to women living in Aktobe city (Kazakhstan). Patients and methods 220 women in their reproductive age studied and classified into two groups; study (Shalkar) group and control (Aktobe) group. Blood sample taken from studied women during follicular phase (day 3) for hormonal level evaluation including; follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH). Studied women evaluated using trans-vaginal ultrasound (TVS) to detect antral follicle count (AFC) during follicular scan and ovarian volume (OV), ovarian blood flow (OBF) using pulsatility index (PI) during follicular scan and luteal scan. Results Both ovaries AFC was significantly less in study (Shalkar) group compared to and control (Aktobe) group ( p = 0.0001). Mean ovarian volume was significantly less in Shalkar group in both follicular phase and luteal phase (5.86 ± 0.23 and 6.19 ± 0.22 Cm 3 ; respectively) compared to Aktobe group (6.85 ± 0.19 and 6.92 ± 0.18 Cm 3 ; respectively). In addition, mean ovarian pulsatility index was significantly high with subsequent decrease in ovarian blood flow in Shalkar group in both follicular phase and luteal phase (3.36 ± 0.20 and 3.45 ± 0.19 Cm/s; respectively) compared to Aktobe group (2.96 ± 0.16 and 2.92 ± 0.15 Cm/s; respectively). Conclusion This study suggests definite environmental effect on ovarian parameters as indicated by decreased AFC, decreased both follicular and luteal OV and OBF in women living in environmental crisis Shalkar group compared to Aktobe group.