Adel T. Abu-Heija

To study maternal and neonatal outcome of triplets, quadruplets and quintuplets gestations. This retrospective review of 21 triplet, 3 quadruplet and 3 quintuplet deliveries between 1(st) January 1990 and 31(st) of August 2001. Preterm labor was the most common maternal complication (96%). The 27 high order gestation resulted in 88 live births and two stillbirths. The early neonatal mortality rate for the entire group was 91, late neonatal deaths 45 and infant deaths 57. Of the 88 live born infants, 71(81%) survived to discharge. The incidence of respiratory distress syndrome was 69.3%, and mechanical ventilation was necessary also in 70% of the newborns, patent ductus arteriosus was diagnosed in 8% of cases. Intraventricular hemorrhage was diagnosed in 14% of cases. Nercotizing enterocolitis occurred in 8 cases. Neonatal sepsis was diagnosed in 24 cases (27%). Early diagnosis, meticulous antenatal care, early hospitalization, frequent evaluation of fetal well being, delivery by cesarean section and on site availability of trained neonatologists and a highly functional intensive care unit are essential for better outcome.

To study the prevalence of antenatal, intrapartum and postnatal complications and their perinatal outcome in women who are delivering for the 6th time and have also had one cesarean section. The records of all women para > or = 5 with one previous cesarean section (n = 238) delivered at King Fahd Hospital of the University between the January 1 1994 and December 31 2000 were reviewed and compared with women who delivered at the hospital in the year 2000 (n = 2470). This data was analyzed for the peripartum and perinatal outcome. The incidence of malpresentation was higher in the study group. The incidence of uterine rupture and uterine scar dehiscence was significantly higher in the study group, but there was no perinatal or maternal death associated with this and in all cases the uterus was preserved. More women managed to deliver vaginally after the cesarean section in the grandmultiparous women compared with the women in the control group (81.5% vs 63.0%) P < 0.00006, where the cesarean section rate was significantly higher (P < 0.02). There were no significant differences in the incidences of preterm labor, lethal malformations, stillbirths and neonatal deaths in the two groups of women. There was one case of cesarean hysterectomy in each group due to placenta accreta and atonic postpartum hemorrhage, and one maternal death in the control group. Grandmultiparous women with one previous cesarean section have an increased risk of operative delivery, scar dehiscence, but there is no increase in perinatal or maternal mortality.

Objective: To study obstetrics and perinatal outcome in nulliparous teenage singleton pregnancies at a referral teaching hospital in the eastern province of Saudi Arabia. Method: All singleton births during 1996–2000 of nulliparous mothers aged ≤17 years at King Fahd University Hospital were reviewed (n = 102) and compared with births of a control group of nulliparous mothers aged 20–24 years who delivered during the same period (n = 102). Results: The incidence of nulliparous teenage pregnancies was 0.8%. As compared with women aged 20–24 years, women of 17 years or less were at higher risk of very preterm birth (p < 0.05). The 5-min Apgar scores were not different between the two groups. Babies born to younger mothers had a significantly lower birth weight than those born to older mothers (p < 0.001); the incidence of a low birth weight (Conclusion: The increase in the very preterm births and the subsequently lower birth weight observed in nulliparous teenage women suggest that the maternal age may be a risk factor for very preterm births and associated long-term hazards.

Objective: To compare the outcome of induced and spontaneous labor in grand multiparous women with one previous lower segment cesarean section, so that the safety of labor induction could be assessed. Method: In 56 women labor was induced and their outcomes were compared with those of 177 women with spontaneous labor. All women were multiparous and had had one previous cesarean section. Results: There were no significant differences in the incidences of 1- and 5-min Apgar scores, congenital malformation, cesarean section rates and uterine scar dehiscence or uterine rupture. There were 4 cases of intrauterine fetal death in the induction group, but no case of intrapartum or early neonatal death in the 2 groups. In the study group, 80.4% of the women delivered vaginally compared with 84.3% in the control group. Conclusion: In this moderate-sized study, we may conclude that when there is no absolute indication for repeating cesarean section, induction of labor may be a safe option in these high-risk women.

We set out to describe the maternal and perinatal outcome of pregnancies in women 45 years old at the time of delivery. A retrospective review of hospital deliveries after 28 weeks of pregnancy was performed at the Princess Badeea Teaching Hospital (PBTH) in North Jordan for patients delivered between 1 April 1994 and 31 December 1997. During the study period, there were 114 women aged 45 years atdelivery at the PBTH. The incidence was 3.3 per 1000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45-46 years old. Maternal ages were 45 (n =64), 46 (n =29), 47 (n =9), 48 (n =8), 49 (n =2) and 50 (n =2) years. Median gravidity was 10, median parity was seven. Fortyfour (38.6%) patients had obstetric complications. The most frequent complication was diabetes mellitus (9.6%), followed by hypertension (4.4%). Caesarean section was performed in 32.5%. There were nine stillbirths and four early neonatal deaths, the perinatal mortality rate was 114/1000births. We conclude that women 45 years old at delivery have high perinatal mortality rate and we also noted a higher incidence of placental abruption, placenta praevia and caesarean delivery, compared with a younger group of women.