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Human papillomaviruses (HPVs) are small, non-enveloped, double-stranded DNA viruses that consist of more than 200 genotypes. Low-risk genotypes are associated with warts or benign lesions, whereas high-risk genotypes are usually associated with malignancies and cancers including cervical cancer. However, the real prevalence and incidence of HPV in Saudi Arabia may be understated due to a lack of comprehensive data reporting. Determine the positivity rate of HPV in men and women in Jeddah, Saudi Arabia. Cross-sectional. Tertiary care center in Jeddah. Self-collected vaginal swab samples were obtained from females attending the gynecological clinic in the period between October 2017 and April 2018 at a tertiary care center, Jeddah, Saudi Arabia. PCR-positive HPV samples were sequenced to determine genotype. Additionally, serum samples were collected from healthy male and female blood donors and screened for HPV IgG antibodies by ELISA. Molecular and serological positivity for HPV. 119 self-collected vaginal swabs from females at a gynecology clinic and 966 serum samples from healthy blood donors. Of the 119 tested vaginal swabs, 7 samples (5.9%) were positive for HPV DNA. Several genotypes were identified. Most of the positive samples were from Saudi females in the age range of 31-50 years seeking care for infertility. Of the 966 serum samples, only 16 samples (1.7%) were positive for HPV IgG antibodies. While the prevalence of HPV in men and women in our sample from the western region of Saudi Arabia was low, our data clearly show that it is not uncommon among high-risk groups and people are still exposed to the risk of HPV infection. Most importantly, these data provide valuable information that could aid in enhancing national awareness about HPV and in introducing an HPV vaccination program. Single hospital and a convenience sample CONFLICT OF INTEREST: None.

BackgroundEndometrial thickness has been identified as a prognostic factor for improving the pregnancy rate for patients with female infertility.Study questionDoes platelet-rich plasma (PRP) treatment affect the endometrial thickness and pregnancy rate after an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle?AimThis study aims to evaluate the effects of autologous PRP treatment on IVF/ICSI, endometrium, and clinical pregnancy rate.Materials, setting, and methodsThis is a prospective, non-blind, randomized controlled study. The ethical committee of the Jeddah IVF Center approved the study, and informed written consent was obtained from all patients. We recruited patients who consulted at the Jeddah IVF Center from September 2020 to May 2021.ResultsA total of 70 patients undergoing IVF/ICSI and embryo transfer (ET) were randomly divided by simple randomization into two groups: those who received PRP treatment after oocyte pickup (OPU) (group A) and those who did not receive PRP treatment (control, group B). The endometrial thickness was measured after OPU and before ET. The mean ages of patients in groups A and B were 35.91 ± 4.09 (range: 24-43) and 34.63 ± 4.26 (range: 25-43), respectively, which were not statistically significant (P < 0.223). In the PRP cases, the types of infertility were primary in 16 (45.7%) and secondary in 19 (54.3%), and the causes of infertility were male factors in 24 (68.6%), unexplained in five (14.3%), ovulatory factor in two (5.6%), endometriosis in two (5.6%), tubal factor in one (2.9%), and preimplantation genetic diagnosis (PGD) in one (2.9%). In the control group, the types of infertility were primary in 14 (40%) and secondary in 21 (60%), and the causes of infertility were male factors in 21 (60%), unexplained in three (8.6%), ovulatory factor in eight (22.9%), endometriosis in one (2.8), and PGD in two (5.6%). In our study, we found that the mean endometrial thicknesses after OPU were 0.594 ± 0.089 (range: 0.4-0.7) and 0.589 ± 0.090 (range: 0.6-0.9) in the treatment and control groups, respectively (odds ratio (OR): 0.005; 95% confidence interval (CI): 0.376-0.047; P < 0.791). Before ET, the mean endometrial thicknesses were 0.86 ± 0.090 (range: 0.7-0.9) and 0.7464 ± 0.06 (range: 0.7-1) in groups A and B, respectively, (OR: 0.114; 95% CI: 0.763-0.151; P < 0.001). Of the 35 patients in each group, 12 (34.3%) and five (14.3%) had confirmed pregnancies in groups A and B, respectively (OR: 0.319; 95% CI: 0.099-1.036; P < 0.05), which is statistically significant.ConclusionAutologous PRP treatment in IVF/ICSI improves the endometrial thickness and clinical pregnancy rate.

IntroductionFemale genital cosmetic surgery (FGCS) is a trending topic in the field of gynecology practice. It is defined as any genital procedure that is not medically indicated but is designed to improve the appearance of the genitals. With the increasing demand for FGCS, little is known about the attitudes of physicians, especially gynecologists, toward FGCS. The study objective is to assess physicians' attitudes towards female genital cosmetic surgeries in Jeddah, Saudi Arabia.MethodsA cross-sectional survey was done among physicians in Jeddah, Saudi Arabia. Four-sectioned questionnaires were distributed to physicians. All board-certified consultants and registrars of obstetrics and gynecology, plastic, and reconstructive surgery in private/public hospitals were included in the study. Data management was done using the SPSS program version 19 (IBM Corp., Armonk, NY, USA).ResultsOut of 165 physicians, 40 were practicing physicians (female genital cosmetic surgery) (24.2%) while 125 were non-practicing physicians (75.8%). The age of practicing and non-practicing respondents ranges from 26 to 60 with a mean and standard deviation (42.6±8.6) and 24 to 60 (40.1±8.9) years old. Our study showed that there were females under 18 years old requesting FGCS from all physicians. Results of attitude towards FGCS showed that the majority of non-practicing physicians were more comfortable in providing advice about FGCS (N=53) and very confident about female anatomy (N=65). Non-practicing physicians also knew a lot more about the long and short-term risks of FGCS and discussed them all the time with their patients. In terms of giving advice on labiaplasty, clitoral hood reduction, perineoplasty, hymenoplasty, and G-spot augmentation procedures, practicing physicians were more confident compared to non-practicing physicians. Statistical analysis showed a significant difference between practicing and non-practicing physicians in terms of gender (p=0.001), career level (p=0.005) and type of work (p=0.006), giving advice on labiaplasty (p=0.001), clitoral hood reduction (p=0.001), perineoplasty (p=0.016) and G-spot augmentation (p=0.001), the number of patients per month, patients seeking advice about FGCS, knowledge about short-term and long-term risks and possible risks of FGCS, vaginal examination, offering referral/counseling and confidence in assessing female anatomy (all, p=0.001). ConclusionPhysicians in Jeddah, Saudi Arabia showed an overall positive attitude towards FGCS. The study suggests that with enough training and knowledge about FGCS, physicians could exhibit a more positive attitude towards FGCS.

To determine the attitudes of obstetric and gynecological patients towards medical students' participation in clinical care. Patients in an obstetric and gynecological practice in Kingdom of Saudi Arabia, completed a structured self-administered online questionnaire to assess demographic, reproductive and lifestyle variables that affected their attitude towards the acceptance of medical students' participation in outpatient clinical care. Out of the 595 women surveyed, 64.7% received perinatal care, while 35.3% received gynecologic care. Women mostly held positive attitudes towards medical students' participation. Women expressed more comfort with medical students' involvement during limited clinical care roles such as obtaining patient's history and physical examinations without a pelvic examination. Women reported higher comfort levels in the presence of female medical students, especially during pelvic examinations. The presence of male medical students caused a significant reduction in patient's comfort. Our results suggest that women seeking obstetrics and gynecology medical services are accepting students' involvement during the healthcare encounter. Most patients are more comfortable if direct contact with students is minimized and students' participation in medical care is restricted to more limited roles. In addition, the student's gender is a significant determinant of patient's acceptance and comfort during the clinical encounter.

Background Obesity in Saudi Arabia is on the rise, especially among females who are more likely to suffer from obesity in the reproductive age group than males in the adult age group. Biologically, pregnancy can increase women's weight and put them at greater risk for adverse obstetric outcomes. Objectives To find the prevalence of obesity among pregnant women and their obstetric outcomes. Methods This retrospective study was conducted on pregnant women who delivered between January 2013 and May 2018 at the obstetrics clinic of King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. A datasheet was formed to collect data from the medical records of these pregnant women. The analysis was done using the Statistical Package for Social Sciences (SPSS), version 26 (IBM SPSS Statistics, Armonk, NY). A p-value of < 0.05 was used to calculate statistical significance. Results A total of 9,095 pregnant women delivered during that period. Of those women, a total of 2,235 were found to be obese, and 1,842 were included in the study. A total of 1,130 women were categorized under Class I obesity, 458 were categorized under Class II obesity, and 254 were categorized under Class III obesity. The majority of the sample were Saudis (72.3%) and young adults (90.8%) with 1,672 cases. The average age was 31.7 (standard deviation (SD): 5.9). Twenty percent of the sample had preterm newborns, while the majority (62.4%) ended up with cesarean delivery. Advanced age, multipara, and cesarean delivery were statistically significant with adverse pregnancy outcomes (p < 0.05). Conclusion As demonstrated in this study, obesity among females in Saudi Arabia has increased over the past decade. Hence, this puts them at higher risk of developing adverse pregnancy outcomes, as pregnancy physiologically results in additional weight gain. Proper antenatal counseling, health education, and a comprehensive plan prior to conception are highly recommended.

Fecal incontinence (FI) and urinary incontinence (UI) are major problems faced by women worldwide, with pregnancy and delivery representing two major risk factors for these conditions. The prevalence of FI and UI varies across studies. In our region, only a few publications have addressed this topic. The aim of this study was to determine the prevalence of FI and UI in Saudi pregnant women, their characteristics, and a specific clinical pattern that could identify patients that are at a risk for incontinence. This was a questionnaire-based crosssectional study conducted over a 3 months period in 2017, among pregnant women attending King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Our study included 393 pregnant women. FI was reported by 24 patients (6.1%), and fecal urgency was reported by 30.5%. UI was reported by 84 patients (21.4 %). When patients with no UI were compared with patients with UI, the only statistically significant factor was BMI (p = 0.043). There were no statistically significant differences when comparing patients with FI versus no-FI, and fecal urgency versus no-fecal urgency. However, laceration (OR: 1.696, p = 0.036), episiotomy (OR: 1.413, p = 0.029), constipation (OR: 1.944, p < 0.001), hypertension (OR: 1.993, p = 0.022), and Bristol stool scale score (p = 0.002) were statistically significant factors for determining fecal control. FI and UI are frequently associated with pregnancy and delivery, but their prevalence is underestimated. The role of the practitioner is crucial in preventing and treating these conditions, and in impeding their harmful effects on the postpregnancy quality of life of Saudi women.

Background Thyroid disorder is common among pregnant women. Hashimoto thyroiditis is the most common etiology of hypothyroidism among pregnant women. Many studies showed that hypothyroidism during pregnancy has been associated with negative outcomes for the mother and for child as well including miscarriage, intrauterine growth retardation, preterm delivery and cognitive impairment in the offspring. Objectives To assess the adverse maternal and neonatal outcome among hypothyroidism obese pregnant women. Methods This is a retrospective study conducted among obese pregnant women diagnosed with hypothyroidism attending King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia between January 1, 2013, and December 31, 2018. For analysis, we used (1) descriptive statistics, (2) Chi-square test, Pearson correlation, independent t-test, and one-way ANOVA to test the difference in thyroid stimulating hormone (TSH) levels and adverse pregnancy outcomes. A p-value of <0.05 is used to calculate statistical significance. Results A total of 9095 pregnant women had delivered in the last five years, 65 of these pregnant women had been diagnosed with hypothyroidism and 57 were enrolled in our study. Out of 65, 44 (77.2%) were Saudi, and 13 (22.8%) non-Saudis. Mean age at the time of delivery was 32.9 ± 5.6 years, while BMI means were 35.7 ± 4.6. A total of 35 (61.4%) were from class 1, 14 (26.2%) were from class 2 and eight (12.3%) were from class 3. Out of 57, 16 (28.1%) developed undesired antepartum outcomes, while 14 (21.5%) had postpartum outcomes. Preterm labor, gestational diabetes mellitus, and urinary tract infections were significantly associated with abnormal TSH levels (P < 0.05). Conclusion As demonstrated earlier, hypothyroidism during pregnancy leads to unfavorable outcomes. Therefore, screening for thyroid function tests in prenatal and antenatal periods is vital to avoid potential adverse outcomes.

Background Vitamin D deficiency among pregnant women is a global issue. Despite its high prevalence, the optimal level of vitamin D among pregnant women is not well established. On the other hand, multiple adverse pregnancy outcomes have been strongly associated with vitamin D deficiency. Objectives To identify the potential effect varying levels of vitamin D have on maternal and neonatal outcomes. Methods This is a non-intervention retrospective record review conducted on pregnant women who delivered in King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 1, 2013, and December 31, 2018. Data were collected from their hospital electronic files and analyzed by Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY) version 24. A p-value of <0.05 is used to calculate statistical significance. Results A total of 9095 pregnant women had delivered in the last five years, 137 of these pregnant women had vitamin D measurement during their pregnancy. Out of 137, 99 were deficient, 20 optimal, 11 therapeutic, and two excess. A total of 97 (70.8%) were Saudis and 40 (29.2%) were non-Saudis. The majority of pregnant women in obese class 1 and 2 were deficient with 99 cases, while obese class 3 was mostly those with optimal levels. Regarding pregnancy outcomes, those with vitamin D deficiency had the majority of undesired antepartum, neonatal, and postpartum outcomes. Placenta previa, endometritis, poor APGAR scores, birth defects, intrauterine fetal demise, low birthweight, and macrosomia were significantly associated with abnormal vitamin D levels (P < 0.05). Conclusion Although vitamin D optimum level during pregnancy is not known, pregnant women with deficient levels appeared to have more serious risks to develop adverse pregnancy outcomes. Therefore, early screening during prenatal visit or antenatal for vitamin D level with vitamin D supplementations is important to reduce these negative pregnancy outcomes for pregnant women with deficient levels.

Background: Recurrent spontaneous abortion has been reported to occur in 15-20% of all clinically recognizable pregnancies. Numerous studies have reported a clear relationship between the chromosomal abnormalities in parents and recurrent miscarriages and infertility [1-3], however limited data is available from Arabian Peninsula. The main goal of this study was to determine the prevalence of chromosomal abnormalities and correlate them with clinical characteristics of couples with recurrent spontaneous abortions (RSA) in Saudi Arabia. Materials and methods: Cytogenetic analysis of 171 consent patients with spontaneous recurrent abortions was performed by the standard method of 72-hour lymphocyte culture and GTG banding. Further validation by conventional PCR and gel electrophoresis was done whenever required. Results: Our results showed that 6.43% of patients are carrier of a chromosomal abnormality. The prevalence of mosaicism, balanced translocations, duplications, Robertson translocation, triple X syndrome, and allelic polymorphism were 2.34%, 1.17%, 1.17%, 0.58%, 0.58% and 1.17% respectively. Interestingly, our data showed that women exhibited a higher prevalence to these chromosomal and genetic aberrations than men with female to male ratio of 2.7:1. A significant correlation (P<0.05; Table 1) was found between consanguineous marrying families and chromosomal abnormalities in subjects with recurrent abortions, confirming previous findings [4,5]. Surprisingly, 78.6% of young women ( less than or equal to 35 years) with chromosomal aberrations had recurrent miscarriages and therefore infertility problems. Conclusions: The current study reported a strong association between the higher rates of chromosomal abnormalities and recurrent spontaneous abortions. Given the high rate of consanguineous marriages in the Saudi population, these results underline the importance of systematic cytogenetic investigation and genetic counseling preferably at the premarital stage or at least during early pregnancy phase (Preimplantation genetic diagnosis) as recommended elsewhere [6].