The aim of this study was to evaluate the sequelae of menopause and how this can be managed in a ... more The aim of this study was to evaluate the sequelae of menopause and how this can be managed in a primary health care setting. Between June 1992 and June 1994, 261 postmenopausal females who attended the menopause clinic at the Kuwait Maternity Hospital were evaluated clinically and with laboratory investigations; mammography, bone density assessment with quantitative computed tomography (QCT) scan and colposcopy were done for some patients. Ninety percent of the patients attended the clinic because of distressing vasomotor symptoms of hot flushes, night sweats and palpitations, and others because of psychological and/or psychiatric problems and secondary amenorrhea and infertility. About 21.5% of the patients were hypertensive, while 13.8% were diabetic. Nonspecific inflammatory bacterial vaginal infection occurred in 18.4% of the patients. High total cholesterol was found in 26%, high LDL in 20% and low HDL in 17% of the patients. Thirty-one percent of females who had bone density ...
The contribution of multiple pregnancy to overall perinatal mortality in the 3 major hospitals in... more The contribution of multiple pregnancy to overall perinatal mortality in the 3 major hospitals in Benin City has been reviewed. Although the incidence is 2.6% of all deliveries, it accounts for 14.3% of the overall perinatal mortality. The factors of importance in relation to perinatal loss included preterm delivery, low birthweight, birth order, malpresentation, mode of delivery, and failure to diagnose multiple pregnancy before labor. Bedrest is advocated. Health education is important in encouraging parturients to avail themselves of available antenatal facilities. A high index of suspicion for multiple pregnancy and referral of such patients to major units equipped to manage such high risk pregnancies will reduce fetal wastage.
Twenty-six pregnancies in 20 parturients were studied. There was a high frequency of antenatal co... more Twenty-six pregnancies in 20 parturients were studied. There was a high frequency of antenatal complications, especially bone pain crisis (61%), haemolytic crisis (31%), urinary tract infection (42%), pneumonia (23%) and malaria (23%). Ninety-six percent of the patients were anaemic at first clinic attendance. There was a high operative delivery rate (29%), mainly by forceps or vacuum extraction. The perinatal mortality rate was 250 per 1000. There was one maternal death.
Circulating antisperm antibodies have been shown to have an adverse effect on a couple&am... more Circulating antisperm antibodies have been shown to have an adverse effect on a couple's ability to achieve fertilization. This study investigated the HLA class II pattern in couples with infertility associated with antisperm antibodies. Forty-nine couples with significant circulating antisperm antibodies confirmed with immunofluorescence technique and 15 control couples had HLA class II-DR, DQ typing. The Terasaki lymphotoxicity test was used. In women with antisperm antibodies, HLA class II haplotypes DR4, DR6, and DQW3 were more common than in the control group. For the men, DR6 and DQ7 were more common in those with antisperm antibodies, than in controls. With sharing of the haplotypes by the couples, DR4, DR6, and DQ7 were more common in couples with antisperm antibodies, but deficient in DQW3. HLA class II-DR4, DR6, and DR7 sharing in couples and deficiency of DQW3 may be associated with circulating antisperm antibody production.
Journal of Obstetrics and Gynaecology Research, 1997
During the postmenopausal period, sexual interest and activity seem to decline, as part of the me... more During the postmenopausal period, sexual interest and activity seem to decline, as part of the menopausal effect of oestrogen deficiency. The aim of this study was to evaluate other factors that could contribute to sexual dysfunction and the effect of hormone replacement therapy among postmenopausal women in Kuwait. Between June 1992, and June 1994, details of sexual history were compiled from 261 postmenopausal women that attended the Menopause Clinic at the Maternity Hospital, Kuwait. The effect of hormone replacement was analysed from the sexual history and the bacteriology of the lower genital tract. About 71% of the 261 postmenopausal women were still sexually active. Among those not sexually active, 38% had loss of interest, 22% because of divorce or death of husband, 20% from loss of interest by husband, and in 13% because the husbands had impotence from medical problems. Of the sexually active women, 41.1% had reduced libido. Contributing factors included vaginal symptoms like dyspareunia and vaginal dryness, vaginal infection, disturbances in the premenopausal menstrual pattern and disharmony with husbands. About 23 to 45% of the postmenopausal women with oestrogen replacement therapy, had significant relief of their symptoms of sexual dysfunction. Vasomotor symptoms had better response compared to sexual dysfunction (p < 0.01). Natural oestrogen gave slightly better relief of symptoms of sexual dysfunction than other forms of oestrogen therapy. Livial gave complete relief of dyspareunia and vaginal dryness in 9.1% and 3.9% respectively, but none of those with libido and vaginal discharge had any relief. There is a decline in sexual response and activity in postmenopausal women in Kuwait. This is however, multifactorial in origin. Although oestrogen replacement therapy gives significant relief in symptoms of sexual dysfunction, other contributory factors should always be evaluated.
Cervical incompetence causes repeated mid-trimester miscarriage and preterm delivery with high fe... more Cervical incompetence causes repeated mid-trimester miscarriage and preterm delivery with high fetal wastage. Since the introduction of cervical cerclage in 1951, it has undergone many changes with regard to the techniques, indications and postoperative care. The objective of this study is to review the changing trends in the current indications of cervical cerclage and subsequent perinatal outcome at the maternity hospital from January 1992 to December 1999. All the files of women who had had cervical cerclage were evaluated in terms of characteristics of the women, indications and obstetric outcome after cervical cerclage. Of 65539 who delivered in the hospital, 1021 women had had cervical cerclage, giving an incidence of 1.21%. There was a significant increase in the incidence of cervical cerclage, from 1.13% in 1992 to 1.40% in 1999 (P < 0.01). More women with multiple pregnancy in 1996 - 99 had cerclage than in 1992 - 94 period [22.7 vs. 8.5% (P < 0.01)]. It is clear that more cervical sutures are being performed in multiple pregnancies arising from assisted reproductive technology as well as after ultrasonographic evidence of cervical dilatation. A multicentre randomised clinical trial is therefore advocated to evaluate its effectiveness in these cases.
International Journal of Gynecology & Obstetrics, 1991
Sera from pregnant and nonpregnant women were analyzed for thiocyanate. Serum thiocyanate concent... more Sera from pregnant and nonpregnant women were analyzed for thiocyanate. Serum thiocyanate concentration was higher in Nigerians compared with Caucasians and was significantly higher also in pregnancy. Hypoalbuminemia and dietary consumption of cyanogenic substances in pregnancy probably contributed to the higher thiocyanate levels. This may have a possible significant bearing on the fetal well-being, particularly fetal birthweight.
International Journal of Gynecology & Obstetrics, 1996
To investigate the association between menopause and lipoproteins and the effect of hormone repla... more To investigate the association between menopause and lipoproteins and the effect of hormone replacement therapy (HRT). Total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were estimated in 50 postmenopausal women and 25 ovulating women who served as controls. The lipoprotein estimations were repeated after 1 year of therapy with natural estrogen-norgestrel combination. More postmenopausal women than younger women had lipoprotein values in the high-risk status (P <0.001). There were no significant changes in lipoprotein levels (P >0.05) after HRT. Women with a body mass index below 26 kg/m2 had a significant reduction in their lipoprotein risk status (P <0.01). There was no demonstrably clear effect of the estrogen-progestin combination on lipoprotein levels, probably because of other compounding variables such as obesity, lack of exercise and the type of progestin used.
... Delivery after Prior Cesarean Section in Kuwait Address correspondence to: Dr. Alexander E. O... more ... Delivery after Prior Cesarean Section in Kuwait Address correspondence to: Dr. Alexander E. Omu, Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait. ... Huda Abdul Azeem2, Hanan N Al-Salem2 ...
Preeclampsia remains a disease of theories as the real aetiology has remained elusive. Altered ni... more Preeclampsia remains a disease of theories as the real aetiology has remained elusive. Altered nitric oxide production has been associated with preeclampsia although conflicting results showing elevation, decrease or no change in nitric oxide levels have emerged from previous studies. The aim of the study was to measure the serum levels of nitrate and nitrite in normal pregnancies and pregnancies complicated by pre-eclampsia. Venous blood was extracted from 39 normal pregnant women (control) and 34 women with preeclampsia (study group). Serum concentrations of nitrate and nitrite were determined using the HPLC method. Other special investigations including renal function tests were performed. The patients were managed according to protocol and the outcome of the pregnancies evaluated. There was no significant difference in the mean maternal age and gestational age at delivery between the groups. However the mean systolic and diastolic blood pressure of the study group (150.5 mmHg and 98.8 mmHg) were significantly higher than the levels in the control group, (110.86 and 85.5), p<0.0001. There was no significant difference in the mean serum nitrate levels (19.157+/-13.407 vs. 19.189+/-16.805) p=0.993. The fetal and maternal outcomes were comparable. Our study has demonstrated that there was no alteration in nitric oxide production in preeclampsia, thus contributing to the existing unresolved role of nitric oxide in the pathogenesis of preeclampsia. Further research is called for.
Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions i... more Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.
Preeclampsia is a multisystemic disorder of unknown etiology. Recently, endothelial damage has be... more Preeclampsia is a multisystemic disorder of unknown etiology. Recently, endothelial damage has been implicated in its cause. The objective of this study was to determine the role of interleukins in the etiology of preeclampsia. Thirty-two primigravidas with preeclampsia but without any clinical evidence of infection and 32 age-matched primigravidas with uncomplicated normal pregnancies were investigated. Phlebotomy was performed at 32 weeks of gestation and blood collected for immunoassays of interleukin-2 (IL2), interleukin-2 receptor (IL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10 (IL-10), using commercially available immunoassay kits. Although the maternal plasma concentrations of IL-2 and IL-2R were slightly higher in normal pregnant women (76.3+/-13.7 pg/mL and 526.3+/-47.1 pg/mL, respectively) than in women with preeclampsia (57.8+/-10.8 pg/mL and 476.9+/-33.9 pg/mL, respectively), the differences were not statistically significant (P>0.05). However, ...
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 1999
The lactate-pyruvate (L/P) ratio was used for assessment of anaerobic metabolism, hypoxia or oxyg... more The lactate-pyruvate (L/P) ratio was used for assessment of anaerobic metabolism, hypoxia or oxygen debt in uterine contractile muscle during labour and immediately after parturition. The mean blood lactate level was significantly higher in mothers with twin pregnancies (P<0.001) than in singleton pregnancies at term. L/P ratios were markedly elevated in established labour both in mothers of singleton as well as in mothers of twin pregnancies and were also higher in cord blood of the twins than those of singleton babies (P<0.001). The twins delivered second had higher L/P ratios (P<0.05) than the leading twins.
The aim of this study was to evaluate the sequelae of menopause and how this can be managed in a ... more The aim of this study was to evaluate the sequelae of menopause and how this can be managed in a primary health care setting. Between June 1992 and June 1994, 261 postmenopausal females who attended the menopause clinic at the Kuwait Maternity Hospital were evaluated clinically and with laboratory investigations; mammography, bone density assessment with quantitative computed tomography (QCT) scan and colposcopy were done for some patients. Ninety percent of the patients attended the clinic because of distressing vasomotor symptoms of hot flushes, night sweats and palpitations, and others because of psychological and/or psychiatric problems and secondary amenorrhea and infertility. About 21.5% of the patients were hypertensive, while 13.8% were diabetic. Nonspecific inflammatory bacterial vaginal infection occurred in 18.4% of the patients. High total cholesterol was found in 26%, high LDL in 20% and low HDL in 17% of the patients. Thirty-one percent of females who had bone density ...
The contribution of multiple pregnancy to overall perinatal mortality in the 3 major hospitals in... more The contribution of multiple pregnancy to overall perinatal mortality in the 3 major hospitals in Benin City has been reviewed. Although the incidence is 2.6% of all deliveries, it accounts for 14.3% of the overall perinatal mortality. The factors of importance in relation to perinatal loss included preterm delivery, low birthweight, birth order, malpresentation, mode of delivery, and failure to diagnose multiple pregnancy before labor. Bedrest is advocated. Health education is important in encouraging parturients to avail themselves of available antenatal facilities. A high index of suspicion for multiple pregnancy and referral of such patients to major units equipped to manage such high risk pregnancies will reduce fetal wastage.
Twenty-six pregnancies in 20 parturients were studied. There was a high frequency of antenatal co... more Twenty-six pregnancies in 20 parturients were studied. There was a high frequency of antenatal complications, especially bone pain crisis (61%), haemolytic crisis (31%), urinary tract infection (42%), pneumonia (23%) and malaria (23%). Ninety-six percent of the patients were anaemic at first clinic attendance. There was a high operative delivery rate (29%), mainly by forceps or vacuum extraction. The perinatal mortality rate was 250 per 1000. There was one maternal death.
Circulating antisperm antibodies have been shown to have an adverse effect on a couple&amp;am... more Circulating antisperm antibodies have been shown to have an adverse effect on a couple&amp;amp;amp;amp;#39;s ability to achieve fertilization. This study investigated the HLA class II pattern in couples with infertility associated with antisperm antibodies. Forty-nine couples with significant circulating antisperm antibodies confirmed with immunofluorescence technique and 15 control couples had HLA class II-DR, DQ typing. The Terasaki lymphotoxicity test was used. In women with antisperm antibodies, HLA class II haplotypes DR4, DR6, and DQW3 were more common than in the control group. For the men, DR6 and DQ7 were more common in those with antisperm antibodies, than in controls. With sharing of the haplotypes by the couples, DR4, DR6, and DQ7 were more common in couples with antisperm antibodies, but deficient in DQW3. HLA class II-DR4, DR6, and DR7 sharing in couples and deficiency of DQW3 may be associated with circulating antisperm antibody production.
Journal of Obstetrics and Gynaecology Research, 1997
During the postmenopausal period, sexual interest and activity seem to decline, as part of the me... more During the postmenopausal period, sexual interest and activity seem to decline, as part of the menopausal effect of oestrogen deficiency. The aim of this study was to evaluate other factors that could contribute to sexual dysfunction and the effect of hormone replacement therapy among postmenopausal women in Kuwait. Between June 1992, and June 1994, details of sexual history were compiled from 261 postmenopausal women that attended the Menopause Clinic at the Maternity Hospital, Kuwait. The effect of hormone replacement was analysed from the sexual history and the bacteriology of the lower genital tract. About 71% of the 261 postmenopausal women were still sexually active. Among those not sexually active, 38% had loss of interest, 22% because of divorce or death of husband, 20% from loss of interest by husband, and in 13% because the husbands had impotence from medical problems. Of the sexually active women, 41.1% had reduced libido. Contributing factors included vaginal symptoms like dyspareunia and vaginal dryness, vaginal infection, disturbances in the premenopausal menstrual pattern and disharmony with husbands. About 23 to 45% of the postmenopausal women with oestrogen replacement therapy, had significant relief of their symptoms of sexual dysfunction. Vasomotor symptoms had better response compared to sexual dysfunction (p &lt; 0.01). Natural oestrogen gave slightly better relief of symptoms of sexual dysfunction than other forms of oestrogen therapy. Livial gave complete relief of dyspareunia and vaginal dryness in 9.1% and 3.9% respectively, but none of those with libido and vaginal discharge had any relief. There is a decline in sexual response and activity in postmenopausal women in Kuwait. This is however, multifactorial in origin. Although oestrogen replacement therapy gives significant relief in symptoms of sexual dysfunction, other contributory factors should always be evaluated.
Cervical incompetence causes repeated mid-trimester miscarriage and preterm delivery with high fe... more Cervical incompetence causes repeated mid-trimester miscarriage and preterm delivery with high fetal wastage. Since the introduction of cervical cerclage in 1951, it has undergone many changes with regard to the techniques, indications and postoperative care. The objective of this study is to review the changing trends in the current indications of cervical cerclage and subsequent perinatal outcome at the maternity hospital from January 1992 to December 1999. All the files of women who had had cervical cerclage were evaluated in terms of characteristics of the women, indications and obstetric outcome after cervical cerclage. Of 65539 who delivered in the hospital, 1021 women had had cervical cerclage, giving an incidence of 1.21%. There was a significant increase in the incidence of cervical cerclage, from 1.13% in 1992 to 1.40% in 1999 (P &lt; 0.01). More women with multiple pregnancy in 1996 - 99 had cerclage than in 1992 - 94 period [22.7 vs. 8.5% (P &lt; 0.01)]. It is clear that more cervical sutures are being performed in multiple pregnancies arising from assisted reproductive technology as well as after ultrasonographic evidence of cervical dilatation. A multicentre randomised clinical trial is therefore advocated to evaluate its effectiveness in these cases.
International Journal of Gynecology & Obstetrics, 1991
Sera from pregnant and nonpregnant women were analyzed for thiocyanate. Serum thiocyanate concent... more Sera from pregnant and nonpregnant women were analyzed for thiocyanate. Serum thiocyanate concentration was higher in Nigerians compared with Caucasians and was significantly higher also in pregnancy. Hypoalbuminemia and dietary consumption of cyanogenic substances in pregnancy probably contributed to the higher thiocyanate levels. This may have a possible significant bearing on the fetal well-being, particularly fetal birthweight.
International Journal of Gynecology & Obstetrics, 1996
To investigate the association between menopause and lipoproteins and the effect of hormone repla... more To investigate the association between menopause and lipoproteins and the effect of hormone replacement therapy (HRT). Total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were estimated in 50 postmenopausal women and 25 ovulating women who served as controls. The lipoprotein estimations were repeated after 1 year of therapy with natural estrogen-norgestrel combination. More postmenopausal women than younger women had lipoprotein values in the high-risk status (P &lt;0.001). There were no significant changes in lipoprotein levels (P &gt;0.05) after HRT. Women with a body mass index below 26 kg/m2 had a significant reduction in their lipoprotein risk status (P &lt;0.01). There was no demonstrably clear effect of the estrogen-progestin combination on lipoprotein levels, probably because of other compounding variables such as obesity, lack of exercise and the type of progestin used.
... Delivery after Prior Cesarean Section in Kuwait Address correspondence to: Dr. Alexander E. O... more ... Delivery after Prior Cesarean Section in Kuwait Address correspondence to: Dr. Alexander E. Omu, Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait. ... Huda Abdul Azeem2, Hanan N Al-Salem2 ...
Preeclampsia remains a disease of theories as the real aetiology has remained elusive. Altered ni... more Preeclampsia remains a disease of theories as the real aetiology has remained elusive. Altered nitric oxide production has been associated with preeclampsia although conflicting results showing elevation, decrease or no change in nitric oxide levels have emerged from previous studies. The aim of the study was to measure the serum levels of nitrate and nitrite in normal pregnancies and pregnancies complicated by pre-eclampsia. Venous blood was extracted from 39 normal pregnant women (control) and 34 women with preeclampsia (study group). Serum concentrations of nitrate and nitrite were determined using the HPLC method. Other special investigations including renal function tests were performed. The patients were managed according to protocol and the outcome of the pregnancies evaluated. There was no significant difference in the mean maternal age and gestational age at delivery between the groups. However the mean systolic and diastolic blood pressure of the study group (150.5 mmHg and 98.8 mmHg) were significantly higher than the levels in the control group, (110.86 and 85.5), p&lt;0.0001. There was no significant difference in the mean serum nitrate levels (19.157+/-13.407 vs. 19.189+/-16.805) p=0.993. The fetal and maternal outcomes were comparable. Our study has demonstrated that there was no alteration in nitric oxide production in preeclampsia, thus contributing to the existing unresolved role of nitric oxide in the pathogenesis of preeclampsia. Further research is called for.
Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions i... more Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.
Preeclampsia is a multisystemic disorder of unknown etiology. Recently, endothelial damage has be... more Preeclampsia is a multisystemic disorder of unknown etiology. Recently, endothelial damage has been implicated in its cause. The objective of this study was to determine the role of interleukins in the etiology of preeclampsia. Thirty-two primigravidas with preeclampsia but without any clinical evidence of infection and 32 age-matched primigravidas with uncomplicated normal pregnancies were investigated. Phlebotomy was performed at 32 weeks of gestation and blood collected for immunoassays of interleukin-2 (IL2), interleukin-2 receptor (IL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10 (IL-10), using commercially available immunoassay kits. Although the maternal plasma concentrations of IL-2 and IL-2R were slightly higher in normal pregnant women (76.3+/-13.7 pg/mL and 526.3+/-47.1 pg/mL, respectively) than in women with preeclampsia (57.8+/-10.8 pg/mL and 476.9+/-33.9 pg/mL, respectively), the differences were not statistically significant (P>0.05). However, ...
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 1999
The lactate-pyruvate (L/P) ratio was used for assessment of anaerobic metabolism, hypoxia or oxyg... more The lactate-pyruvate (L/P) ratio was used for assessment of anaerobic metabolism, hypoxia or oxygen debt in uterine contractile muscle during labour and immediately after parturition. The mean blood lactate level was significantly higher in mothers with twin pregnancies (P<0.001) than in singleton pregnancies at term. L/P ratios were markedly elevated in established labour both in mothers of singleton as well as in mothers of twin pregnancies and were also higher in cord blood of the twins than those of singleton babies (P<0.001). The twins delivered second had higher L/P ratios (P<0.05) than the leading twins.
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