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12- THE NUMBER OF FOLLICLES AND OVARIAN VOLUME IN THE ASSESSMENT OF RESPONSE TO CLOMIPHENE CITRATE TREATMENT IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME

Author: Haifa Al-Shaheen
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 1 Pages: 78
Publisher: Basrah University جامعة البصرة

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Abstract

Haifa Al-ShaheenCABOG, Consultant Obstetrician & Gynecologist, Basrah Maternity & Childhood HospitalE-mail: hayfa_alshaheen@yahoo.comAbstractThis prospected follow–up study was carried out over 12 months period (from 1stSeptember 2008 till 30th August 2009) in infertility clinic in Basrah maternity and childhospital to evaluate whether certain criteria assessed during initial screening (number offollicles and ovarian volume) could predict the response to ovulation induction withclomiphene citrate (CC) medication.Clinical, ultrasonographic and endocrine data were collected and analyzed on 58 womenwith oligomenorrhoea or secondary amenorrhoea with PCOS and infertility beforeinitiation of CC medication. The ovarian morphology were determined by transvaginalU/S which showed all women had altered ovarian morphology ( both ovaries had >10multiple small cyst of 2-9 mm, mean total follicular number (11.0±2.5) and enlargedovaries, mean ovarian volume (13.2±4.01). Thirty eight patients (65%) ovulate, theremaining 20 (35%) did not. Age, body mass index (BMI), ovarian volume, number ofsmall follicles, serum LH, testosterone and LH/FSH ratio in CC non responders were allsignificantly higher than in CC responders (P< 0.05).Data suggest that patients whose ovarian are less likely to respond to stimulation by CCtreatment, can be predicted on the basis of initial screening characteristics, such as:BMI, history (oligomenorrhoea, or secondary amenorrhoea) and number of follicles andmean ovarian volume.These ultrasonographic features & laboratory assays could be clinically useful fordistinguishing better the CC no responders from responders.These observations may add to ongoing discussion regarding etiological factorsinvolved in ovarian dysfunction in these patients and classification of anovulatoryinfertile women.

Keywords

FOLLICLES --- CLOMIPHENE --- POLYCYSTIC --- OVARIAN


Article
CORRELATION OF OVARIAN VOLUME IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) WITH CLINICAL AND HORMONAL FINDINGS

Author: Haifa Al-Shaheen
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2006 Volume: 12 Issue: 2 Pages: 71-82
Publisher: Basrah University جامعة البصرة

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Abstract

CORRELATION OF OVARIAN VOLUME IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) WITH CLINICAL AND HORMONAL FINDINGSHayfa Al- ShaheenMB,ChB, DGO, CABGO, Department of Obstetrics & Gynecology, Basrah Maternity and Child HospitalAbstractThe aim of this study is to evaluate the ovarian morphological findings in infertile women given the diagnosis of polycystic ovarian syndrome (PCOS) based on chronic anovulation (menstrual disorders) and evidence of hyperandrogenism (hirsutism & acne), and whether clinical and selected hormonal findings correlate with ovarian volume.Over 12 months period (from 1st of Jan 2005 till the 1st of Jan 2006), the ovarian morphology were determined by transabdominal ultrasound in107 patients included in this prospective study in infertility clinic in Basrah Maternity and Child Hospital. Clinical and endocrinological state was evaluated by history, physical examination and measurements of serum testosterone, Luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactine and progesterone levels. Their ages ranged (18-40 years), mean (27.28 ± 4.4) and their mean body mass index (BMI) was (29.77± 4.0 kg/m2). Ultrasound studies showed all women studied (100%) had altered ovarian morphology (both ovaries had multiple small cyst of (2-9mm), mean total follicular number (12.3±1.7) & thick capsule. Bilaterally enlarged ovaries were found in 84 (78.5%), mean (15.6± 2.04 cm3) and normal ovarian size were found in 23(21.5%) mean (6.6± 1.1 cm3). All patients who had enlarged ovaries were compared with those who had normal ovarian size regarding clinical and hormonal findings in order to determine a possible association between these findings and ovarian volume. Hirsutism was present in (78.5%), acne in (68.2%), Obesity (BMI>25 kg/m2) in (87.8%), menstrual disorders in (100%), manifested as oligomenorrhoea in (77.6%) and secondary amenorrhea in (22.4%). Comparing these clinical findings between patient who had enlarged ovaries and those who had normal ovarian size, this study has confirmed that hirsutism, acne and obesity were significantly higher in women who had enlarged ovaries the values were: (84.5% versus 56.5%), (73.8 %versus 47.8%) and( 92.9% versus 69.6%) respectively, whereas oligomenorrhoea occurred more frequently in women with normal ovarian size (82.6% vs. 76.2%), the difference was statistically non significant p.value>0.05. No significant relationship was found between ovarian volume and amenorrhea. Analysis of biochemical data showed that women with PCOS were found to have elevated Serum testosterone levels (1.3±0.74ng/ml ), elevated LH (11.80 ± 4.2 miu/ml ) and elevated LH/FSH ratio (1.90 ± 1.03) whereas all women were found to have normal prolactin levels (10.8 ± 4.0ng/ml). Comparing these hormonal levels between women who had enlarged ovaries and those who had normal- sized ovaries we found that serum testosterone, LH & LH/FSH ratio were significantly higher in women who had enlarged ovaries. Subtle differences existed between ovarian volume in hypretestosteonemic & hyperluteinizenemic subgroups of polycystic ovarian syndrome compared to normotestosteronemic & normoluteinizenemic ones. With significant relationship was found between the ovarian size and testosterone & LH levels p. value< 0.05. A significant differences also existed between ovarian volume in elevated LH/FSH ratio subgroup of polycystic ovarian syndrome compared to normal LH/FSH ratio ones. P. value 0.001. Whereas no statistical significant difference was found between ovarian volume and FSH levels. Hirsutism, acne and obesity correlated positively with total ovarian volume (r=0.282, p- value 0.002), (r=0.229, p- value 0.009) (r=0.372, p. value 0.0001) respectively. While Oligomenorrhoea and amenorrhea showed negative correlations with total ovarian volume. Total ovarian volume correlated positively with Serum testosterone levels, LH and LH/FSH>2, (r=0.518, p- value 0.0001), (r=0.563, p- value 0.0001), (r=0.266, p- value 0.01) respectively. It can be concluded from the present study that ultrasound scanning provide a non- invasive and accurate procedure for the assessment of ovarian morphology (specifically ovarian volume).Correlation of ovarian volume in women with polycystic ovary Hayfa Al- ShaheenBas J Surg, September, 12, 2006And when clinical diagnosis of PCOS was made, virtually all women were found to have characteristic ovarian morphology that extending from apparently normal to markedly enlarged cystic ovaries. Hirsutism acne, obesity, serum testosterone levels, LH and LH/FSH ratio correlated sssstrongly with increased ovarian size. These results allow us to suggest that ovarian size > 10 cm3 in women with PCOS with hyperandrogenism & menstrual disorders might be predictive of endocrine profiles, and emphasized the importance of careful assessment of ovarian volume by Ultrasound.

Keywords

OVARIAN --- POLYCYSTIC --- PCOS --- HORMONAL


Article
9-EMERGENCY PERIPARTUM HYSTERECTOMY: EXPERIENCE AT BASRAH MATERNITY AND CHILDREN HOSPITAL

Author: Haifa Al-Shaheen
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 2 Pages: 56-63
Publisher: Basrah University جامعة البصرة

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Abstract

To estimate the incidence, indications, risk factors and complications associated with emergency peripartumhysterectomy, we analyzed retrospectively all cases of emergency peripartum hysterectomy performedat Basrah Maternity and Children from 1st of January 2005 to 31st of December 2007. Emergencyperipartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatmentless than 24 hours after delivery. There were 20 emergency peripartum hysterectomy among 51,121deliveries for a rate of 0.3/1000. Fifteen women (75%) were delivered by caesarean delivery. Eighteenwomen were multiparous and 2 were primiparous. Most frequent indications were placenta accrete (60%),9 with praevia and 3 with out praevia), followed by uterine atony in (20%), uterine rupture in (10%),extended cervical tear in (5%), and retroperitoneal haematoma in 5%.Placenta accreta was the most common indication in multiparous women (66.6%, 12 of 18) while uterineatony was the most common in primiparous.Eleven out of 12 (91.7%) women with placenta accrete had a previous caesarean delivery. Three (25%)had a previous one caesarean section and 8 (66.6%) women had .2 previous caesarean section. Fourteen(70%) of hysterectomies were subtotal. Intraopeartive complications were (15%) and Postoperativefebrile morbidity was (60%).We concluded that placenta accreta has become the most common indicationfor emergency peripartum hysterectomy. The number of caesarean deliveries increased the risk ofplacenta accreta proportionally.

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