A total of 54 166 mothers delivered at the Riyadh Armed Forces Hospital between 1990 and 1997, including 6119 (11.3%) caesarean sections. Emergency peripartum hysterectomy for obstetric haemorrhage was carried out in 16 cases (0.3/1000 deliveries). The operation followed major degrees of placenta praevia in 12 (75%) cases and atonic postpartum haemorrhage in four (25%). All patients required blood transfusion. There was one neonatal death and no maternal deaths. Although the operation was straightforward, bladder injury occurred in five (31%) cases which was repaired with no residual damage. Placenta accreta was confirmed histologically in 12 (75%) patients. In conclusion, all obstetricians should be aware of the strong association between a scarred uterus, placenta praevia and placenta accreta which can be very adherent and difficult to remove causing bleeding and necessitating hysterectomy. The operation should be performed by an experienced obstetrician before the patient's condition is extreme.

One hundred and I'orty cases of cord prolapse and 2.5 cases of cord presentation were reported aiiiong 39 420 deliveries which occurred at the Riyadh Military Hospital between 19x3 and 1990 ( I in 3-39 deliveries). The incidence was higher with malpresentation (breech 8.5 per cent, and transverse lie or compound presentation S.5 per cent) low birth weight, < IS00 g ( I2 per cent), mncrosoniia, > 4000 g. mothers over 3.5 years of age and highly parous women. para 4. One hundred and forty-five (87.8 per cent) caesarean sections were performed. Seven patients were delivered by forceps or ventouse and eight had normal vaginal deliveries. After 26 weeks of pregnancy, pronipt ciiesiirean section is the treatment of choice, when cord prolapse is diagnosed, when the fetus i\ still alive and when delivery is not imminent.

No abstract

No abstract

Between 1994 and 1999, of the 44 357 mothers delivered at the Riyadh Armed Forces Hospital (RAFH), 255 patients had four or more previous caesarean sections (CS). This comprised 0.5% of the obstetric population. One hundred and eighty-nine (74%) had four, 52 (20%) five, 12 (5%) six and two (0.4%) patients had seven CSs. Adhesions were severe in 128 (50%), moderate in 18 (7%), mild in 81 (32%) and no adhesions in 28 (11%) cases. The incidence of placenta praevia was five times that of the overall obstetric population (2.4% vs. 0.5%). One case of uterine rupture occurred, an incidence of 4/1000 cases. The incidence of placenta praevia rises with rising CS rate. Patients with multiple CS and placenta praevia should be counselled regarding the possibility of caesarean hysterectomy. Repeat CS is safe and tubal ligation should be advised, but not forced as it is not an absolute indication for sterilisation.