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Objective: The current study investigated the immune response of maternal coronavirus disease 2019 (COVID‐19) vaccination and vertical transmission of anti–severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) spike (S) and nucleocapsid (N) proteins. Study design: This retrospective study included pregnant women in Bahrain Defense Force Hospital from March 2021 to September 2021 who were vaccinated with Sinopharm or Pfizer/BioNTech. Testing of anti‐N and ‐S levels from paired samples of maternal and umbilical cord blood was performed at the time of delivery. The immune response to vaccination, association with maternal and fetal factors, and vertical transmission of antibodies were studied. Results: The current study included 79 pregnant women. The median gestational age for those vaccinated with Sinopharm was 28 weeks and those vaccinated with Pfizer was 31 weeks, with 100% of the vaccinated population generating antibodies and showing vertical transmission. The anti‐N and ‐S titers and interval frequencies varied in both vaccinations. The anti‐N and ‐S and transfer ratio statistically correlated with maternal age, gestational age at delivery, latency period, and birth weight of the neonates differently in both vaccines. In addition, the peak level of antibodies and transfer ratios varied. Conclusion: Although variations are exhibited in both types of vaccination, the vaccinated pregnant population generated a significant level of anti‐N and ‐S and showed vertical transmission. Synopsis: Although variations are exhibited in the type of COVID‐19 vaccination, the vaccinated pregnant population generated a significant level of anti‐N and ‐S and showed vertical transmission. [ABSTRACT FROM AUTHOR]

Multiple pregnancy with a normal live fetus and concurrent gestational trophoblastic disease is associated with obstetric complications and potential adverse outcomes. Diagnosis with appropriate imaging, counselling and a systematic approach are the mainstay of the management of these exceptional cases. 24 years old in her second pregnancy was diagnosed as twin gestation. Early gestational imaging showed twin gestation with one live fetus and the other sac with possible missed miscarriage. Subsequent imaging at 10 weeks showed one live fetus and the other sac with molar changes. Pregnancy was monitored up to 14 weeks but had to be terminated due to thyrotoxicosis, hypertension and vaginal bleeding. At 14 weeks abdominal assessment revealed a uterus of more than 25 gestational weeks. Ultrasound assessment showed the placenta to be covering the cervix with increased vascularity. A multidisciplinary approach was undertaken and in view of thyrotoxicosis associated with molar changes and vaginal bleeding, the pregnancy was terminated by hysterotomy. The postpartum period was complicated with preeclampsia which necessitated admission to the intensive care unit. Post-delivery the client received six cycles of methotrexate as chemotherapy. After 8 months from initiation of chemotherapy, the client attained complete recovery. [ABSTRACT FROM AUTHOR]

Primary Postpartum hemorrhage (PPH) is one of the leading causes of major maternal mortality and morbidity. Severe cases of PPH can be associated with significant surgical intervention, blood transfusion, intensive care admission and death. Identifying risk factors for PPH is difficult as cases can still occur without obvious roots. Preventing Severe cases of PPH can be more challenging. Objective: To explore the risk factors of severe PPH in our hospital. We aimed to address demographic factors, pregnancy related factors and labor characteristics. Method: This is a retrospective case control study of severe PPH in the Obstetrics and Gynecology unit at Bahrain Defense Force Hospital, Teaching and Research Centre. We reviewed medical records of obstetric patients over a 24-month period. Demographic and obstetric risk factors were analyzed into two group of PPH≤ 1500ml and PPH > 1500 ml. The data were analyzed using StatDirect software. A P-value of less than 0.05 was considered statistically significant. Results: We identified 71 cases of PPH with 13 cases in the severe category group. Severe PPH was more than doubled in cases with previous caesarean (54% vs 22%). There was no effect of maternal age, body mass index, previous medical history on severe cases of PPH. The two Polyhydramnios cases in the study ended in a severe PPH. There was no effect from any other pregnancy or labor characteristic on severe PPH rate. Conclusion: Our analysis found previous caesarean birth and polyhydramnios as contributing risk factors for severe PPH. [ABSTRACT FROM AUTHOR]

Chorioangioma is one of the most frequent benign neoplastic diseases of the placenta. Large chorioangioma is a rare primary placental tumor and usually measures greater than 5cm. A twenty-six-year-old Filipina primigravida was seen at 29 weeks of gestation. At 37 weeks of gestation, she was noted to have a large 8×8 cm placental chorioangioma by ultrasound. She underwent elective cesarean section and delivered a live baby girl with good Apgar score. Histopathology of the placenta confirmed the diagnosis of 14×13×4 cm chorioangioma. In this case, a large placental chorioangioma was found with good maternal and fetal outcome. [ABSTRACT FROM AUTHOR]

Background: Primary postpartum hemorrhage (PPH) is a significant cause of maternal morbidity and mortality. The value of reviewing the care of women with severe PPH is to improve the obstetric practice. Objective: To evaluate maternal outcome after postpartum hemorrhage. Design: A Retrospective Data Analysis. Setting: Bahrain Defence Force Hospital, Bahrain. Method: Data analysis of PPH from 1 January 2015 to 31 December 2016 was performed. Data were obtained from all patients who delivered during this period including born before arrival (BBA), home deliveries and stillborns. All relevant maternal complications, including postpartum events, morbidities correlation of maternal outcomes with Hb drop, blood transfusion, length of hospital stay, ICU admission, coagulopathy, organ failure, hysterectomy and management were recorded. The data were analyzed using StatDirect. A P-value of less than 0.05 was considered statistically significant. Result: During the study period, 8,449 women had given birth. Seventy-two (0.85%) cases of PPH were identified. A significant correlation between estimated blood loss (EBL) and the need for blood transfusion and length of hospital stay was discovered, P-value<0.0001 and P-value<0.0001, respectively. However, no correlation was discovered between EBL and hemoglobin drop, P-value= 0.12. Receiver Operating Characteristic (ROC) curve analysis of morbidities associated with PPH pointed to the bleeding cutoff point of 2L for morbidity to occur. Conclusion: PPH is significantly related to maternal need for transfusion and hospital stay. Morbidity occurs once EBL reach 2000 ml. [ABSTRACT FROM AUTHOR]

Uterine fibroids are common in females of reproductive age. Generally, uterine fibroids are a benign condition and acute complications are rare. Reported acute complications include rupture of vessels overlying the fibroid and rupture of uterine fibroids that may lead to life-threatening intraperitoneal hemorrhage. Prompt diagnosis and management are mandatory in emergency gynecological practice. A forty-eight-year-old female presented with sudden onset of abdominal pain of four hours duration. The patient had four uncomplicated vaginal deliveries. Abdominal ultrasound was suggestive of intraperitoneal hemorrhage. An intact uterine fundal fibroid measuring 8x7.2 cm was found. CT scan revealed an enlarged uterus with multiple large fibroids. The patient underwent emergency exploratory laparotomy. Intraoperatively, a spurting vessel over the surface of the fundal subserosal uterine fibroid was found. A total abdominal hysterectomy was performed. The postoperative period was uneventful. She was discharged in a stable condition with a hemoglobin of 10 gm. [ABSTRACT FROM AUTHOR]