Abstracts of the International Conference on Women and Fetal Health

Abstract

Objectives: The International Conference on Women and Fetal Health, held 14–15 November 2025 at the Grand Hyatt Muscat, aimed to advance women’s health and fetal medicine through scientific exchange, skill development, and regional collaboration. Organized by the Oman Society of Ultrasound in Obstetrics and Gynecology (OSUOG), the Oman Society of Obstetrics and Gynecology (OSOG), and the Egyptian Fetal Medicine Foundation (EFMF), the conference sought to foster inclusivity by engaging physicians, residents, nurses, interns, and students, while promoting excellence in research and clinical practice. Awards for the top three abstracts and the launch of the Dr. Istiqlal Al Ghaithi Memorial Award for Young Researchers underscored its commitment to nurturing future leaders. Theme: The conference embraced a theme of innovation, ethics, and collaboration in obstetrics and gynecology. By combining clinical expertise with emerging technologies, the program highlighted the growing challenges facing clinicians in the field of women health. The sessions emphasized both scientific research and ethical responsibility, reflecting recent updates in the field of obstetrics and gynecology. Highlight of the Scientific Program: The program featured keynote lectures and panel discussions on high-risk pregnancy, maternal medicine, fetal growth restriction, recurrent miscarriage, genetic testing, endometrial cancer, menopausal health, peri-operative complications, pelvic organ prolapse, and chronic pelvic pain. Specialized workshops provided hands-on training in postpartum hemorrhage management, electronic fetal monitoring, fetal echocardiography, and transperineal ultrasound, led by international faculty. The agenda also featured artificial intelligence, emerging technologies, and medico-legal issues in clinical practice. With speakers from Oman, the Gulf, Africa, Europe, and Asia, the conference fostered an environment for networking and knowledge exchange, setting a new link for regional collaboration.

1. Conference Abstracts 2025

1.1. A001: Case Report: IVIG in the Recurrent Unexplained Miscarriages

• Rahma Al Ghabshi ¹ and Asma Ali Salim Al Farsi ²

¹ 

Department of Obstetrics and Gynecology, Khoula hospital, Ministry of Health, P.O. Box 90, Postal Code 116, Muscat, Oman

² 

Obstetrics and Gynecology Residency program, Oman Medical Specialty Board, P.O Box 1422, Postal Code 130, Muscat, Oman

• Introduction and Aim: Recurrent miscarriage (RM), defined as the loss of three or more pregnancies before 20 weeks, affects approximately 1–2% of women and has a variety of potential etiologies, including genetic, anatomical, endocrine, immune, and infectious factors. Despite extensive investigation, nearly half of the cases remain unexplained, with increasing evidence suggesting that immune abnormalities may play a significant role. Autoimmune causes, such as antiphospholipid syndrome (APS), and alloimmune factors, involving the maternal immune system’s response to paternal antigens on trophoblast cells, have been implicated. Additionally, cellular immune dysfunction, including an altered balance of T-helper (Th)1/Th2 cells and elevated natural killer (NK) cell activity, is commonly observed in these patients. One emerging treatment modality for unexplained RM is intravenous immunoglobulin (IVIG), an immunomodulatory therapy that has shown mixed results in clinical studies. Methods: This case report discusses the treatment of a 37-year-old woman with a history of recurrent pregnancy loss, infertility due to male hypogonadotropic hypogonadism, and unexplained recurrent miscarriage. After multiple losses, including intrauterine fetal demise (IUFD) at 33 weeks, the patient underwent IVIG therapy as part of her management plan during her subsequent pregnancy. Despite early signs of intrauterine growth restriction (IUGR) and other complications, she achieved a successful live birth at 31 weeks with good neonatal outcomes, highlighting the potential of IVIG in cases of unexplained RM. Conclusion: The use of IVIG in RM remains controversial due to inconsistent results across studies, but this case suggests that it may offer benefits in selected patients, particularly those with underlying immune dysfunction. Further research, including large-scale, randomized controlled trials, is needed to better define the role of IVIG in recurrent miscarriage management and identify patient populations that may benefit most.
• Keywords: recurrent miscarriage; IVIG; IUFD

1.2. A002: A Case Report: Necrotizing Fasciitis After Cesarean Section

• Atika Al Hadhrami ¹ and Asma Ali Salim Al Farsi ²

¹ 

Department of Obstetrics and Gynecology Khoula hospital, Ministry of Health, P.O Box 90, Postal Code 116, Muscat, Oman

² 

Obstetrics and Gynecology Residency program, Oman Medical Specialty Board, P.O Box 1422, Postal Code 130, Muscat, Oman

• Introduction and Objective: Necrotizing fasciitis (NF) following cesarean section (CS) is a rare but life-threatening complication characterized by rapid progression and high morbidity and mortality if not diagnosed and treated promptly. This condition is more likely in patients with risk factors such as obesity, diabetes, and immunocompromised states. Typically presenting within the first few days postpartum, symptoms include increasing pain, erythema, and swelling at the surgical site. Early diagnosis is crucial, with imaging techniques like ultrasound and MRI playing a supportive role, though clinical evaluation remains essential. Prompt surgical debridement of necrotic tissue, combined with broad-spectrum intravenous antibiotics, is the mainstay of treatment. The prognosis depends heavily on the timeliness of intervention, with delays increasing the risk of sepsis and multi-organ failure. Case and Discussion: This case report describes a 35-year-old woman who developed NF following an emergency CS, presenting with fever, abdominal distention, and elevated CRP levels. Diagnosis was confirmed via CT, leading to urgent surgical intervention and antibiotic therapy. The patient responded well to treatment, with successful recovery and discharge. The discussion emphasizes the importance of early recognition and swift management, including interdisciplinary collaboration, to improve outcomes in such critical cases. Conclusion: Although rare, understanding NF pathophysiology, risk factors, and management strategies is vital to reducing the risks associated with this severe condition.
• Keywords: cesarean section; necrotizing fasciitis

1.3. A003: Case Report: A Pregnant Women with Double Inlet Left Ventricle (DILV)

• Alya Al Madhani ¹ and Asma Ali Salim Al Farsi ²

¹ 

Department of Obstetrics and Gynecology, Royal Hospital, Ministry of Health, P.O. Box 1331, Postal Code 111 Muscat, Oman

² 

Oman Medical Specialty Board, Obstetrics and Gynecology Residency program, P.O Box 1422, Postal Code 130, Muscat, Oman

• Introduction and Objective: Double Inlet Left Ventricle (DILV) is a rare form of univentricular congenital heart disease (CHD), accounting for less than 2% of all CHD cases, with an incidence of 0.05 to 0.1 per 1000 live births. In DILV, a single morphologic left ventricle functions as the primary ventricle, and venous return from both the systemic and pulmonary circulations enters this ventricle, leading to reduced systemic oxygen saturation. The clinical presentation often includes tachycardia, tachypnea, heart failure, arrhythmias, and, in severe cases, shock. Surgical management typically involves a series of staged procedures, including the Blalock-Taussig shunt, Glenn shunt, and Fontan procedure, which aim to optimize blood flow and separation of circulations. Despite improvements in surgical outcomes, DILV patients remain at risk for significant complications, including arrhythmias and thromboembolic events. Case and Discussion: This case report describes the successful pregnancy outcome of a 28-year-old woman with DILV who underwent multiple cardiac surgeries, including pulmonary artery banding, bidirectional Glenn, and Fontan procedures. Following comprehensive preconception counseling and careful monitoring throughout her pregnancy, including anticoagulation therapy with low molecular weight heparin (LMWH), she delivered a healthy 2.2 kg baby via elective cesarean section at 35 weeks. Both mother and child had an uneventful postpartum course, and the patient continued to be closely monitored for cardiac and anticoagulation management. Conclusion: Managing pregnancy in DILV patients is highly complex and requires a multidisciplinary approach, including cardiology, obstetrics, and anesthesiology, to address the increased physiological demands of pregnancy. Careful monitoring of cardiac function, anticoagulation therapy, fetal growth, and potential complications such as intrauterine growth restriction (IUGR) and preterm labor is critical. Elective cesarean section is often preferred to minimize cardiac stress during delivery. The positive outcome in this case emphasizes the importance of tailored care and collaborative decision-making in improving pregnancy outcomes for women with DILV.

1.4. A004: Immediate Neonatal Outcomes for Patients Who Had Emergency CS for Abnormal Fetal Heart Rate Tracing

• Dr Tamima Al Dughashi ¹ and Asma Alli Salim Al Farsi ²

¹ 

Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

² 

Oman Medical Specialty Board, Obstetrics and Gynecology Residency program, P.O Box 1422, Postal Code 130, Muscat, Oman

• Background: Cardiotocography (CTG) is a standard tool for intrapartum fetal monitoring, widely employed to assess fetal well-being during labor. Although abnormal CTG tracings often trigger clinical concern, their interpretation is not always straightforward, and such abnormalities may not necessarily indicate adverse neonatal outcomes. Overinterpretation can lead to unnecessary interventions, particularly emergency caesarean sections (CS), which carry maternal and neonatal risks. Accurate and contextual interpretation of CTG findings remains critical for balancing fetal safety with appropriate obstetric management. Objective: This study aimed to assess the relationship between abnormal fetal heart rate tracings and immediate neonatal outcomes among women undergoing emergency CS. In addition, it sought to identify maternal and fetal factors that may influence this association, thereby clarifying the clinical value of CTG interpretation in urgent obstetric decision-making. Method: A prospective observational cohort design was employed at Sultan Qaboos University Hospital (SQUH) over a one-year period, from 1 August 2023, to 31 July 2024. Eligible participants included all women who underwent emergency CS due to suspected fetal compromise based on abnormal CTG findings. Data collected encompassed maternal demographics, intrapartum clinical characteristics, fetal heart rate features, and neonatal outcomes. The primary endpoints were cord blood pH values and the need for neonatal intensive care unit (NICU) admission. Statistical analysis was performed using SPSS version 20. Results: Preliminary findings indicated that abnormal CTG tracings did not show a statistically significant association with immediate adverse neonatal outcomes, including low cord blood pH or NICU admission (p > 0.05). Conclusion: The results highlight that abnormal CTG patterns should not be interpreted in isolation, as they are not always predictive of neonatal compromise. A broader clinical assessment that integrates maternal status, labor progression, and fetal physiology is essential for guiding decisions regarding emergency CS and ensuring evidence-based, individualized care.

1.5. A005: Diagnostic Accuracy and Cost-Effectiveness of the IOTA Simple Rules for Evaluation of Adnexal Masses in Oman

• Bashair Al Siyabi ¹, Dr Sharifa Al Farsi ², Dr Abdul Rahman Al farsi ³, Dr Nada Al Hasani ³, Dr Huda Al Ghaithi ³, Dr Michelle L. Desierto ³, Dr Mona Eleheimer ², Dr Buthina Al Matrooshi ² and Dr Abir Al Al Aufi ²

¹ 

MD, Resident, Obstetrics and gynecology, Oman Medical Specialty Board, P.O Box 1422, Postal Code 130, Muscat, Oman

² 

Department of Obstetrics and Gynecology, Medical for Military and Security services, P.O. Box: 393, Postal Code 100, Muscat, Oman

³ 

Department of Obstetrics and Gynecology, Royal Hospital, Ministry of Health, P.O. Box 1331, Postal Code 111 Muscat, Oman

• Objective: To evaluate the diagnostic accuracy and cost-effectiveness of the IOTA Simple Rules in the assessment of adnexal/ovarian masses at two tertiary hospitals in Oman, and to compare its performance with computed tomography (CT), magnetic resonance imaging (MRI), and the Risk of Malignancy Index (RMI). Method: In this prospective study, 248 women with adnexal masses underwent ultrasound assessment using IOTA Simple Rules. Final diagnoses were validated by histopathology in surgically managed cases (n = 86). Additional imaging and tumor marker investigations were recorded for cost analysis. Diagnostic performance was compared with RMI. Results: The IOTA Simple Rules achieved a sensitivity of 72.7% and specificity of 96.8%. The positive predictive value was 80.0%, and the negative predictive value was 95.3%. Compared to RMI, IOTA demonstrated superior accuracy in malignancy risk stratification. Cost analysis showed significantly lower diagnostic expenses for masses classified as benign by IOTA compared to malignant or inconclusive cases. Conclusion: The IOTA Simple Rules offer a reliable, cost-effective approach for the preoperative evaluation of adnexal masses, with high specificity and acceptable sensitivity. Their integration into national diagnostic protocols may reduce unnecessary imaging and improve clinical decision-making. Further validation of complementary models, such as ADNEX, is recommended.

1.6. A006: Diuretics Use in the Treatment of Oedema Associated with Preeclampsia a Case Report

• Dr. Buthaina AlMatrooshi ¹, Anita Banrjee Anita ² and DrLujian Alkalifaa ²

¹ 

Department of Obstetrics and Gynecology, Medical City for Military and Security services, P.O. Box: 393, Postal Code 100, Muscat, Oman

² 

St Thomas hospital, SE1 7EH, London, United Kingdom

• Objective: Diuretics are commonly used to treat hypertension in non-pregnant individuals. They were also formerly used in pregnancy to treat high blood pressure, and delay or prevent the onset of pre-eclampsia. Method: Case report: a 47-year-old pregnant woman with a previous history of preeclampsia complicated by flash pulmonary edema at 34 weeks of gestation. She was admitted at 28 weeks of pregnancy for observation and prediction of preeclampsia (PET) due to low placental growth factor (PlGF). The patient received multiple doses of furosemide for edema and steroids for fetal lung maturity. Delivery occurred after 4 weeks at 32 weeks due to rising BNP levels and recurrent peripheral edema. Results: The use of diuretics have become conterversial with the evadance of reducation of plasam volume in preeclamsia, which is theoretically thought to worsen hypovolemia and lead to adverse effect on the mother and the fetus.however there is no firm clinical evidance of that. Doppler studies showed mildly elevated resistance, which improved after steroid administration. Which furosmide is thought to be the calibare in doing so. Conclusion: Diuretics sever as a corner stoon of treatment for oedema and hypertension, the known effects so far are meternal and fetal with no specifcity, it can be though that the doppler increase resistance observed in our patient one of the effects.

1.7. A007: Is PLGF a Good Indicator for Predicting Preeclampsia and Timing of Delivery? A Case Report

• Buthaina Darwish AlMatrooshi ¹ and Dr Anita Banrjee ²

¹ 

Department of Obstetrics and Gynecology, Medical City for Military and Security services, P.O. Box: 393, Postal Code 100, Muscat, Oman

² 

St Thomas hospital, SE1 7EH, London, United Kingdom

• Objective: This paper emphasizes the global need to support the use of PlGF testing as a reliable screening tool for preeclampsia. Results: PlGF serves as a critical marker for evaluating placental health and can be instrumental in determining the optimal timing of delivery, particularly in complicated pregnancies like those with preeclampsia and IUGR. Conclusion: Monitoring PlGF levels provides valuable insights that can guide clinicians in making informed decisions to optimize maternal and fetal outcomes. However, further diagnostic testing is essential to assess the need for early delivery and ensure the best possible outcomes for both mother and baby.

1.8. A008: Angular Pregnancy—A Case Report

• Dr Jayasree Santhosh
• Royal Hospital, Ministry of Health, P.O. Box 1331, Postal Code 111 Muscat, Oman
• Objective: Angular Pregnancy is a defined as implantation of the embryo, just medial to the utero-tubal junction, in the lateral angle of the uterine cavity near the proximal ostium of the fallopian tube. This can result in miscarriage, rupture uterus, placenta accreta, postpartum haemorrhage and hysterectomy. Live birth rate of 25% is reported. This is a rare entity, often misdiagnosed as interstitial ectopic pregnancy or cornual pregnancy and associated with management pitfalls. We describe a case of angular pregnancy, managed conservatively and had a term vaginal delivery without any complications. Method: A 41-year-old, gravida 5, para 2 was referred to our fetal medicine clinic at 6 weeks of gestation as suspected interstitial pregnancy. Ultrasound scan showed a regular gestational sac at the right angular region of the uterus, communicating with the endometrial cavity. Myometrial thickness was 5 mm. Crown rump length (CRL) corresponded to 6 weeks. After 10 days, CRL increased to 7 weeks, and the gestational sac was seen growing towards the uterine cavity. At 10 weeks, the patient started complaining of lower abdominal pain. She was admitted and had Magnetic Resonance Imaging of the pelvis, which confirmed the scan findings of an angular pregnancy. There was no history of vaginal bleeding. The cervix was 3.8 cm long, and the internal os was closed. Her further follow-ups were at her local hospital. She remained asymptomatic. Growth scans were normal. Results: She had induction of labour due to pregnancy induced hypertension at 38 weeks and delivered without any complications. Conclusion: The ultrasonographic differentiation between interstitial pregnancy, angular pregnancy and cornual pregnancy is the initial step in successful management. There is a therapeutic dilemma whether to continue or terminate an angular pregnancy given the high risk of complications. Close follow-up by ultrasound scan in the first trimester can guide the clinical management of individual cases.

1.9. A009: Fertility Trends and Determinants in GCC Countries: A Systematic Review (2005–2025)

• Hamideh Barangar
• Ahvaz Jundishapur University of Medical Sciences, P.O. Box 17, Ahvaz, Iran
• Introduction: Fertility is a core demographic indicator that reflects social, economic, and cultural dynamics within a population. In the Gulf Cooperation Council (GCC) fertility trends have undergone significant changes over the past two decades. Traditionally characterized by high fertility rates rooted in cultural and religious norms. This review aims to systematically examine the fertility patterns in GCC countries from 2005 to 2025 and identify the key factors influencing reproductive behavior. Method: This review follows a systematic methodology based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria includes, studies published between 2005 and 2025, English-language peer-reviewed articles and empirical, quantitative, or qualitative data on fertility trends and influencing factors in GCC countries Exclusion criteria: Non-GCC countries and Editorials, opinion pieces, or non-peer-reviewed articles. Results: All GCC countries experienced a decline in total fertility rates (TFR) during the review period. Countries such as the UAE and Qatar recorded the most substantial reductions, while Oman and Saudi Arabia showed more moderate decreases. Average TFR across the region dropped from around 3.5 in 2005 to approximately 2.1–2.5 by 2025. Determinants of Fertility include: Education, Age at Marriage, Economic Factors, Employment, Contraceptive Use, Policy Interventions. Conclusion: The observed fertility decline in GCC countries mirrors global trends associated with modernization and economic development. This review underscores the multidimensional nature of fertility change, shaped by both structural (education, economy, policy) and cultural (norms, values) factors Policymakers should focus on: Supporting work-life balance, Affordable childcare and housing, Reforming gender and family policies and Promoting reproductive health education. Fertility in GCC countries has declined significantly over the past two decades due to a complex interplay of social, economic, and policy-related factors.

1.10. A010: Incidence, Risk Factors, and Neonatal Outcomes Associated with Early Preterm Birth Compared to Late Preterm Birth in a Tertiary Hospital: Sultan Qaboos University Hospital

• Hanan Salim Humaid AlMabsali ¹, Dr. Tamima ALDughaishi ² and Dr. Yusra Abid Shah ¹

¹ 

Oman Medical Specialty Board, Obstetrics and Gynecology Residency program, P.O Box 1422, Postal Code 130, Muscat, Oman

² 

Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

• Objective: The World Health Organization defines preterm birth as any birth that takes place before 37 completed weeks of gestation. It is a global epidemic and a major contributor to neonatal morbidity and mortality. This study assesses the incidence, risk factors, and neonatal outcomes associated with early preterm births compared to late preterm births among Omani females. Method: This study was conducted at Sultan Qaboos University Hospital in Oman from January to December 2022. Data were gathered from the Trak Care system and delivery registry books. We included 311 women who delivered preterm. The study compared early preterm births (24 to 33 6/7 weeks) and late preterm births (34 to 36 6/7 weeks) based on various demographic and obstetric risk factors. Additionally, data on neonatal outcomes were collected. The analysis was conducted using the SPSS version 29, and statistical significance was assessed using Chi-square tests and t-tests, with p < 0.05 considered significant. Results: In our study group, the incidence of early preterm births was 2.7%. We identified various risk factors for early preterm birth, including extremes of body mass index (p = 0.001), placenta abruption (10.7% vs. 2.2% for control; p = 0.003), short cervical length (17.9% vs. 4.8% for control; p = 0.001), oligohydramnios (17.9% vs. 4.8% for control; p = 0.001), severe preeclampsia (15.7% vs. 6.2% for control = 0.012), and maternal infection (38.1% vs. 24.7%; p = 0.023). Moreover, we found that early preterm birth was associated with neonatal mortality and morbidity with p < 0.001. Conclusion: The current study indicated that various socio-demographic, nutritional, and obstetric risk factors are linked to early preterm birth. Modifying these risk factors and implementing timely interventions could help reduce preterm births rates and related morbidity and mortality.

1.11. A011: Advanced Age Pregnancy and Its Outcome in Pregnant Patients Coming for Antenatal Visits in Musannah Polyclinic

• Dr Hina Toufique ¹, Dr Saira Bano ¹, Dr Afsheen Shahid ² and Dr Abdullah Mohammad Al Mubeihsi ²

¹ 

Al Musanna Extended Health Centre, Postal Code 333, Musana, Oman.

² 

Rustaq General Hospital, P.O. Box 2, Postal Code 329, Rustaq, Oman

• Objective: Advanced maternal age (AMA) has become increasingly prevalent as women postpone childbearing due to social, cultural, and economic reasons. Previous studies have linked AMA to a higher risk of adverse maternal and fetal outcomes, but regional data from Oman remain limited. This study aimed to evaluate the association between advanced maternal age and pregnancy outcomes in women attending antenatal visits at Musanna Polyclinic. Method: This observational comparative cohort study was conducted at Musanna Polyclinic, Sultanate of Oman, over 12 months beginning in July 2024. A total of 646 pregnant women were enrolled, comprising 323 women aged ≥40 years (AMA group) and 323 women <35 years (control group). Participants were recruited using non-probability convenient sampling. Data collection included demographic variables, maternal comorbidities, pregnancy complications, and fetal outcomes. Laboratory and imaging assessments were performed according to Ministry of Health protocols. Statistical analysis was conducted using SPSS version 26, with t-tests and chi-square tests applied for group comparisons, and logistic regression performed to identify independent predictors of adverse outcomes. Results: The mean age of AMA women was 42.8 ± 2.1 years compared to 28.6 ± 3.5 years in controls (p < 0.001). AMA women had significantly lower rates of spontaneous vaginal delivery (16.1% vs. 46.1%, p < 0.001) and higher rates of preterm delivery (4.3% vs. 1.5%, p = 0.03). Gestational diabetes (48.3% vs. 14.6%, p < 0.001), hypertensive disorders (11.8% vs. 2.8%, p < 0.001), and thyroid disorders (11.8% vs. 3.4%, p < 0.001) were markedly higher in the AMA group. Fetal outcomes were also poorer, with significantly more miscarriages (5.3% vs. 1.2%, p = 0.004) and NICU admissions (3.4% vs. 0.9%, p = 0.04). Logistic regression confirmed AMA as an independent predictor of GDM, hypertensive disorders, cesarean delivery, miscarriage, NICU admission, and thyroid disorders. Conclusion: In conclusion, advanced maternal age is strongly associated with adverse maternal and fetal outcomes, underscoring the need for targeted antenatal monitoring, early screening, and specialised counseling in this high-risk group.

1.12. A012: Exploring the Association Between Ectopic Pregnancy and Uterine Fibroids: A Cross-Sectional Study at Sultan Qaboos University Hospital (2017–2022)

• Khadija Mahfoodh Al Balushi ¹ and Rawan Al Alawi ²

¹ 

College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, P.C. 123, Muscat, Oman

² 

Department of Obstetrics & Gynecology, Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

• Objective: This study aimed to determine the prevalence of ectopic pregnancy at Sultan Qaboos University Hospital (SQUH), assess the frequency of fibroids among affected women, and examine whether fibroids or other risk factors are associated with ectopic pregnancy in uncommon locations. Method: A retrospective cross-sectional study was conducted at SQUH, Oman, including 347 women diagnosed with ectopic pregnancy between January 2017 and December 2022. Data were extracted from medical records on sociodemographic and clinical characteristics, including age, history of ectopic pregnancy, infertility treatments, uterine surgeries, and presence of fibroids. The prevalence of ectopic pregnancy was calculated relative to total recorded pregnancies during the study period. Patients were categorized according to fibroid presence and ectopic pregnancy location (common vs. uncommon). Statistical analyses included Chi-square tests and multivariate logistic regression to identify independent risk factors. Results: The prevalence of ectopic pregnancy was 1.7% of all pregnancies. Among women with ectopic pregnancy, 9.8% had uterine fibroids. Most ectopic pregnancies occurred in common locations, irrespective of fibroid status. Chi-square testing showed no significant association between fibroid presence and ectopic pregnancy location (p = 0.397). Multivariate logistic regression confirmed this finding (p = 0.267). In contrast, previous uterine surgery was significantly associated with ectopic pregnancy in uncommon locations (p = 0.003 in bivariate analysis; p = 0.002 in multivariate analysis). Conclusion: This study found no evidence that uterine fibroids increase the risk of ectopic pregnancy in uncommon locations. Prior uterine surgery emerged as the only independent risk factor. These findings highlight the importance of considering surgical history in risk assessment and clinical management of women presenting with ectopic pregnancy. Larger studies are recommended to validate these results and explore underlying mechanisms.

1.13. A013: Clinical Audit of Vacuum-Attempted at IPRA Hospital from May 2024 to April 2025: Outcomes and Performance Indicators

• Dr. Makarim Mohammed Zain ¹ and Dr. Nawal Al Mamari
• Ibra Hospital
• Objective: To evaluate the success rate, indications, maternal and neonatal outcomes, and complications associated with vacuum assessed vaginal delivery (VAVD) at IPRA Hospital over a 12-month period, and to assess adherence to clinical protocols and areas for improvement. Method: A prospective audit of 124 VAVD cases was conducted. Data was collected in ready format for each case and filled by the doctors who conduct the delivery, it included indications, application-to-delivery time, whether prerequisites fulfilled or not, complications and delivery outcomes. Statistical analysis was performed using chi-square tests to assess associations between variables and complications. Cases were evaluated against institutional guidelines and RCOG standards. Results: Of the 124 cases, 110 (88.7%) resulted in successful vacuum deliveries, while 14 (11.3%) required emergency cesarean section. Fetal distress (74.2%) was the most common indication. Prerequisites were met in all cases. Longer application-to-delivery times (15–20 min) correlated with higher CS rates (29.4%) (p ≈ 0.0036). A statistically significant association was found between the number of vacuum attempts and complication rates (p ≈ 0.005). Single-attempt deliveries had the lowest complication rate (13.6%). Maternal complications occurred in 37% of cases, with vaginal lacerations and hematomas being most common. Neonatal outcomes were generally favorable, with Apgar scores ≥8 in 91% of cases. However, 8 neonates required NICU admission mostly due to respiratory distress. Conclusion: VAVD demonstrates high success rates when prerequisites are met, and application-to-delivery time is minimized. Increased attempts and prolonged procedures significantly elevate maternal and neonatal risks, underscoring the importance of timely and skilled intervention. Improved documentation, adherence to best practices and regular audits are recommended to optimize outcomes and maintain high standards of obstetric care.

1.14. A014: Association of Polycystic Ovarian Syndrome Candidate Genes with Metabolic Profile in Omani Women

• Malak Saif Mohammed Al Fahdi and Maha Al-Khaduri
• College of Medicine, Sultan Qaboos University, P.O. Box 35, P.C. 123, Muscat, Oman
• Objective: This study aimed to investigate the relationship between selected PCOS candidate genes and the risk of CVD, addressing the gap in research that examines both factors concurrently. Understanding these genetic associations could help identify women with PCOS who are at elevated risk of cardiovascular complications. Method: A hospital-based, retrospective case-control study was conducted on Omani women attending Sultan Qaboos University Hospital’s Gynecology and Infertility Clinic. The study included 49 women diagnosed with PCOS (based on Rotterdam 2003 criteria) and 50 control women without PCOS, all aged 15–49 years. Genetic, biochemical, and clinical data were collected using the TrackCare^® system. Three single-nucleotide polymorphisms (SNPs) in the LEPR, FSHR, and YAP1 genes were analyzed for associations with CVD. Results: Although no statistically significant association was found between the selected SNPs and overall CVD risk, the LEPR (rs200779194) and YAP1 (rs112417656) variants were notably linked to hypertension in PCOS patients, especially in individuals with metabolic syndrome. Women with both PCOS and metabolic syndrome were 3.84 times more likely to develop hypertension. Conclusion: LEPR and YAP1 gene variants may serve as potential genetic markers for increased cardiovascular risk in women with PCOS, particularly those with coexisting metabolic syndrome.

1.15. A015: Laparoscopic Ovarian Cystectomy and Detorsion for Large Ovarian Cyst at 22 Weeks Gestation in a Primigravida: A Case Report

• Dr. Noha Salah Omer Ibrahim and Dr. Rahma Salim Hamood AL Ghabshi
• Department of obstetrics and gynecology, Khoula hospital. Ministry of Health, P.O Box 90, Postal Code 116, Muscat, Oman
• Objective: To describe the safe and effective use of laparoscopy for the management of large ovarian cyst with adnexal torsion in the second trimester of pregnancy, emphasizing That ultrasonography with preserved vascularity in Doppler cannot exclude torsion, highlighting specific intraoperative adaptations made to accommodate gravid anatomy. Method: A 26-year-old primigravida at 22 weeks and 4 days gestation presented with acute left lower abdominal pain and vomiting. Ultrasonography showed a large left adnexal cyst measuring 10 × 9.3 × 7.5 cm with preserved vascularity. Emergency laparoscopic surgery was performed under general anesthesia. Surgical modifications included Lee-Huang point (midpoint between umbilicus and xiphoid) trocar placement this port, used for the camera and modified palmar point along with Trendelenburg positioning with left tilt. The cyst was decompressed and ovary exteriorized for cystectomy following successful detorsion. Results: Laparoscopy has advantage of quick recovery and reduces intrabdominal Adhesions This patient experienced symptoms relief, had an uneventful postoperative course and discharged on second postoperative day. and the pregnancy continued normally till term. Histopathology confirmed a benign serous cystadenoma. Conclusion: Laparoscopic management of adnexal torsion during the second trimester is both feasible and safe even with large ovarian cyst when appropriate modifications are made for the gravid uterus. This report underscores the importance of prompt diagnosis and intervention to preserve ovarian function without disturbing the pregnancy. Techniques such as supraumbilical access, uterine displacement, and extracorporeal cystectomy can optimize outcomes and minimize risks to both mother and fetus.

1.16. A016: Urinary Tract Infection in Pregnant Omani Women: Etiology, Risk Factors, Maternal and Neonatal Outcomes

• Miriam Fenn ¹, Nihal Al Riyami ¹, Ruai Amer Al Abri ² and Noor Anwer Al Saadi ²

¹ 

Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

² 

Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, P.C. 123, Muscat, Oman

• Objective: Urinary tract infection (UTI) during pregnancy is a common condition that may predispose to adverse perinatal outcomes. This study aimed to investigate the association between UTI during pregnancy and specific maternal risk factors. It also aimed to evaluate selected maternal outcomes, including sepsis and pyelonephritis and selected neonatal outcomes including preterm labor, NICU admission, low birth weight (LBW), and neonatal sepsis. These associations and outcomes were compared between pregnant women with and without UTI. Method: A retrospective comparative analysis was conducted on 600 pregnant women, categorized by UTI status, who delivered at SQUH from January 2019 to December 2021. Maternal and neonatal outcomes were assessed in both groups using frequency tables, cross-tabulation, and chi-square tests. Results: Out of 300 confirmed UTI cases, Candida albicans was the leading pathogen (n = 106), followed by Escherichia coli (n = 56) and Group B Streptococcus (n = 47). Amoxicillin was the most frequently prescribed antibiotic. Gestational diabetes was the most prominent risk factor (45.7%). Preterm premature rupture of membranes (4.6%), pyelonephritis (1.8%), and sepsis (0.3%) were reported in women with UTI compared to those without UTI. The incidence of preterm labour was higher in the UTI group (29.2%) than in the non-UTI group (15.9%) (p < 0.001). Mothers with UTI had higher rates of NICU admission (59.1% vs. 12.6%; p < 0.001) and low birth weight (22.9% vs. 3.3%) (p = 0.002). Neonatal sepsis was also more common in the UTI group (10.3% vs. 5.8%), but the difference was not statistically significant (p = 0.055). Conclusion: Gestational diabetes was the main risk factor associated with maternal UTI. Preterm birth, NICU admission, and low birth weight were more frequent in neonates.

1.17. A017: Epidemiology of Preterm Birth: Two Years of Data from Armed Forces Hospital, Oman

• Rowena A. Zaplan ¹ and Dr. Michelle L. Desierto ¹

¹ 

Medical City for Military and Security services, P.O. Box: 393, Postal Code 100, Muscat, Oman

• Objective: This study aimed to evaluate maternal and perinatal outcomes associated with preterm deliveries in a tertiary care hospital, with a focus on indications for cesarean delivery and neonatal outcomes. The goal was to generate data to guide clinical decision-making, optimize care strategies, and inform policy to reduce adverse outcomes. Method: A descriptive cross-sectional study was conducted at Armed Forces Hospital, Muscat, Oman, analyzing 395 preterm deliveries between 23 and 36 weeks of gestation from January 2020 to January 2022. Data were collected from the delivery suite census and electronic patient records. Variables included maternal risk factors, gestational age at delivery, labor onset, mode of delivery, and neonatal outcomes—such as estimated fetal weight (EFW), Apgar scores, Special Care Baby Unit (SCBU) admission, and discharge status. Results: The majority of preterm deliveries occurred between 35–36 weeks (59.7%). Spontaneous labor was observed in 50.6% of cases, while 39.2% had no labor prior to delivery, often due to indicated interventions. Cesarean section was performed in 64.8% of cases, with the most common indications being prior cesarean section (13.9%), abnormal cardiotocography or Doppler findings (9.1%), and placenta previa or abruption (4.1%). Neonatal data showed that 61.3% had an EFW between 2001–3000 g. Favorable Apgar scores (8–9) were seen in 83.3% at both 1 and 5 min. Nearly half (47.6%) of neonates required SCBU admission. Despite this, 96.5% were discharged in good condition; 3.5% experienced neonatal death or were transferred for advanced care. Conclusion: Preterm cesarean deliveries were largely driven by obstetric and fetal indications. While nearly half of neonates required SCBU admission, overall perinatal outcomes were favorable. Continued efforts to enhance antenatal risk identification, standardize delivery protocols, and strengthen neonatal services are essential to further improve preterm birth outcomes in Oman.

1.18. A018: Maternal Autonomy and Clinical Decision in Severe Chronic Hypertension and Early-Onset Fetal Growth Restriction Leading to Viable Delivery: A Case Report

• Michelle Desierto and Rowena Zaplan
• Medical City for Military and Security Services, P.O. Box: 393, Postal Code 100, Muscat, Oman
• Objective: To present a rare case of early-onset fetal growth restriction (FGR) in a pregnancy complicated by severe chronic hypertension and maternal refusal of pregnancy termination, during non-viable gestation, emphasizing the importance of maternal autonomy and multidisciplinary management in achieving viable neonatal outcomes. Method: We report the case of A.M., a 34-year-old G2P1L0 at 26 + 3 weeks’ gestation, with a history of secondary infertility and a prior intrauterine fetal death due to severe preeclampsia. The current pregnancy was complicated by chronic hypertension and diet-controlled gestational diabetes mellitus (GDM). At 15 + 2 weeks, the patient was admitted to the ICU for hypertensive urgency and managed with intravenous glyceryl trinitrate, fentanyl, labetalol, methyldopa, hydralazine, and nifedipine. Despite counselling regarding maternal risks, the patient declined pregnancy termination; her decision was respected per ACOG guidelines. Results: Following stabilization, inpatient monitoring was continued. At 21 + 6 weeks, fetal ultrasound revealed early-onset FGR with an estimated fetal weight of 278 g (3rd percentile), absent umbilical artery end-diastolic flow, and normal ductus venosus flow. At 24 weeks, antenatal corticosteroids were given. At 25 + 5 weeks, fetal Doppler studies worsened, showing a cerebroplacental ratio of 0.3, middle cerebral artery PI of 1.3, umbilical artery PI of 2.1–2.4 with absent to reversed end-diastolic flow, and absent a-wave in the ductus venosus. Delivery was performed via hysterotomy after a second course of corticosteroids and magnesium sulfate. A 350 g extremely preterm infant with symmetric IUGR and moderate respiratory distress was delivered and managed with early surfactant. At 2 years and 6 months, the child demonstrates appropriate developmental milestones. Maternal blood pressure improved postpartum, requiring fewer antihypertensives. Conclusion: This case highlights the critical role of maternal autonomy and multidisciplinary care in high-risk pregnancies. Individualized clinical decisions and close surveillance can support favorable maternal and neonatal outcomes despite severe complications.

1.19. A019: Bilateral Uterine Artery Embolization for Pseudoaneurysm During Puerperium

• Sally Damra Elnour Mohammed
• Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman
• Objective: Diagnosis and Management of Bilateral Uterine Arteries Pseudo aneurysm during Puerperium: a rare case report. The aim was to help in diagnosis and management of such life-threatening cause of secondary post-partum hemorrhage. Method: Rare case report. Results: Pt was successfully treated by selective embolization of the bilateral uterine arteries to resolve the lesion without complication (Left uterine artery embolization followed by right uterine artery embolization 24 days later due to another attack of massive hemorrhage). Conclusion: Rupture of aneurysm of the uterine artery can be a life-threatening condition. Diagnosis can achieve by angiography. Clinical suspicion is essential for a prompt diagnosis and treatment and embolization therapy can effectively stop the bleeding.

1.20. A020: Fetus Diagnosed with Cervical Teratoma Delivered by EXIT Procedure (Ex-Utero Intrapartum Treatment)

• Sally Damra Elnour Mohammed
• Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman
• Objective: Fetus Diagnosed with Cervical Teratoma Delivered by EXIT Procedure (Extra Uterine Intrapartum Treatment). Method: Rare case report. Results: The delivery was planned at 37 weeks’ gestation. The team was assembled for EXIT procedure, which was performed at Al Amal National Hospital after liaison with the anesthetist, neonatologist and the pediatric surgeon. A female fetus weighing 3.8 kg was delivered and intubated immediately. Unfortunately, the newborn died at 48 h of age. Conclusion: Prenatally diagnosed head and neck teratomas can result in early neonatal death if the delivery was not planned correctly with right multidisciplinary team. In this case EXIT is the procedure of choice.

1.21. A021: Age of Menarche & Contributory Factors Among College of Medicine and Health Sciences, National University (COMHS/NU) Omani Girls Cross Section Study 2025

• Wisal Omer Mohamed Nabag, Eqbal Jaber Said Al Julandani, Jawaher Abdullah Humaid, Alfeteisi, Maryam Abdullrhman Darwish Albalushi, Maryam Ali Ahmed Albalushi and Sara Mohammed Hassan Albalushi
• College of Medicine and Health Sciences, National University P.O. Box 391, Postal Code 321, Sohar, Oman
• Objective: To calculate the average age of menarche among Omani girls and to Identify biological, environmental & psychological, and lifestyle factors that contribute to variations in the age of menarche. Method: This cross-sectional descriptive prospective study targeting 427 out of 917 total students, Omani girls’ medical students and medical laboratory science students from the (COMHS/NU) located in Sohar/ Sultanate of Oman. Data was collected through an online survey utilizing the standardized questionnaire, assessing variables such as age of menarche and comparing with mother and older sister age of menarche, BMI, lifestyle, stress level, medical history, and socioeconomic status. The survey aimed to explore the factors affecting age of menarche. The results are presented in form of tables & figures. Normality was assessed using the Shapiro-Wilk test while categorical variables were compared via the Chi-square test (p > 0.05 is significant). Results: The study involved 342 with 80% response rate. It showed that the mean age of menarche among participants was 12.77 years while the mean age of their older sisters was 13.13, & the mean age of menarche of their mothers was 13.49 so the average menarcheal age declined; the median age of menarche among all three groups is 13 years. There was a significant positive correlation between the participant’s age of menarche and that of their mother and older sister (p > 0.001 & > 0.001 respectively). The study also identified a statistically significant negative correlation between age of menarche with the participant’s weight (p = 0.023), height (p = 0.19) and BMI (p = 0.002). Conclusion: Understanding the determinants of menarcheal age is crucial for addressing the health implications associated with early onset. The study aims to provide insights into the unique socio-cultural context of Oman, emphasizing the need for targeted educational interventions and health strategies to support young girls during this critical developmental stage.
• Keywords: Menarche, Age, COMHS, Oman

1.22. A022: Staphylococcus aureus and MRSA in Post-Caesarean Surgical Site Infections: A Preliminary Review of Prevalence, Risk Factors and Antibiotic Prophylaxis

• Diksha Joshi ¹, Dr Shalaka P Kant ², Dima Zeineddine², Sana Zulfikar ³ and Dr Shahila Sheik ²

¹ 

Goa Medical College and Hospital, NH17, 403202, Goa, India

² 

Kims Health Hospital, P.O. Box: 1522, Postal Code. 114, Muscat, Oman

³ 

University of Buckingham Medical School, MK18 1EG, Buckingham, United Kingdom

• Objective: Staphylococcus aureus is one of the most common organisms implicated in Surgical site infections (SSIs) following Caesarean sections, yet it has not been adequately studied. Method: The review assesses the prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) in surgical site infections following Caesarean sections over a period of 10 years (2014–2024). It also examines common risk factors and the antibiotic prophylaxis administered in these cases. The review included 16 studies and assessed 35,237 patients who underwent Caesarean section, of whom 2757 developed SSIs. Results: The overall SSI rate following Caesarean sections was 7.82% (range 0.79–28%). 7 studies mentioned Staphylococcus aureus as the causative organism with the rate of 40.2%. MRSA was mentioned by 3 studies only giving a rate of 19.36% (55/284). The prominent risk factors for developing SSIs were anemia (29.1%), vertical skin incision (34.5%) and multiple vaginal examinations (32.3%). High BMI was seen in > 80% of cases in two studies and emergency Caesarean section was the risk factor in 100% in one study and 55% in another. No uniformity was noted in the antibiotic prophylaxis given before Caesarean sections. No antibiotic emerged as the preferred choice, and timing of antibiotic administration in relation to the skin incision did not affect the incidence of SSIs. Most of the infected wounds were superficial (92.17%) and only two involved organ space (0.44%) if we exclude one study which has reported the highest incidence of SSI after Caesarean section (28%) with 82.5% of the wounds requiring re-suturing and 7 cases of burst abdomen (0.56%). Conclusion: More robust studies are required focused on SSIs following Caesarean sections, with particular attention to the common organisms involved and the appropriate and safe prophylactic and therapeutic options for lactating mothers.

1.23. A023: Success Rate of Vaginal Birth After Cesarean Section (VBAC): A Retrospective Systematic Review of Factors with Successful Maternal and Fetal Outcome

• Shadya Mohammed Salim Al Saeghi, Shiren Redha, Hansa Dhar, Qamariya Ambusaidi
• Nizwa Hospital, P.O. Box 1222, Postal Code 611 Nizwa, Oman
• Objective: To review the success rate of vaginal birth after caesarian section (VBAC) in women with a previous caesarean section in Nizwa Hospital, Oman and study the factors that predict successful maternal and neonatal outcome. Method: Systematic retrospective cohort review conducted at Nizwa Hospital for one year. Results: A Total of 461 patient were included in this study, 42% (197/461) had successful VBAC while 57% (264/461) had repeated LSCS. Majority of patient who had repeated LSCS were with less parity < 3 compare to patient who had VBAC and they were at younger age group 20–30 years old. Various Indications for repeat noted in this Study, but more repeated LSCS due abnormal CTG (29.5%) than due to maternal request (27.2%). ALL patient who had VBAC had no complication, while those who had repeat LSCS majority were un eventful (98.5%), but one case had major PPH and hysterectomy with ICU admission, two patients had re-laparotomy and evacuation of hematoma, one case had uterine rupture. Conclusion: This study showed the influence of cultural factors, age, parity in VBAC decision-making and outcomes, highlighting the need for culturally tailored counseling and care. It also confirms the safety and efficacy of VBAC in appropriately selected cases, advocating for more research into counseling practices and long-term outcomes of VBAC.

1.24. A024: A Rare Complication of Cesarean Section, Seroma Formation Draining Through Cesarean Incision to the Vagina

• Nawal al Mamari and Reena Raju
• Ibra hospital, P.O. Box 3, Postal Code 400, Ibra, Oman
• Objective: How to manage rare post op complications. Method: In this case; we report on the expectant management of a intrapeitoneal collection where the cesarean wound was opened to drain through the vagina. It avoided unnecessary major surgical intervention. Conclusion: Good history and clinical examination remains the gold standard of patient care in all aspects.

1.25. A025: Towards Precision Medicine: Association of Polycystic Ovarian Syndrome (PCOS) Candidate Genes with Pregnancy Complications

• Maha Al-Khaduri, Ebtihal Al Shereiqi and Amjaad Al Kindi
• College of Medicine, Sultan Qaboos University, P.O. Box 35, P.C. 123, Muscat, Oman
• Objective: To determine whether certain PCOS candidate genes are associated with increased risk of pregnancy complications. Method: We conducted a prospective study on 50 PCOS cases and 50 control Omani females from the Gynecology clinic at a tertiary care hospital in Oman. Cases fulfilled Rotterdam criteria for PCOS. Women with congenital adrenal hyperplasia, androgen secreting tumors, Cushing syndrome and hyperprolactinemia were excluded. Data included pregnancy outcomes, and genotyping results for six single nucleotide polymorphisms (SNPs) in LEPR, FSHR, and VDR genes. Statistical analysis was performed using SPSS to compare pregnancy complications and neonatal outcomes as well as their correlation with PCOS phenotypes. Results: 37 (74%) PCOS cases and 38 (76%) controls achieved pregnancy. Cases exhibited significantly higher pregnancy complications, including intrauterine growth restriction (IUGR) (18.9% vs. 2.6%; OR = 8.6, p = 0.02) and gestational diabetes (OR = 2.0, p = 0.4). Obesity showed an association with IUGR (OR = 4.3, p = 1.00). HOMA-IR, hypertension, and metabolic syndrome, showed no clear associations with IUGR. There was no difference in preterm deliveries among cases and controls. Congenital anomalies were observed only in phenotype A cases (n = 3, 6%). Neonatal mortality was higher in Phenotype A cases (n = 2, 5.4%) compared to controls (n = 1, 2.6%). Among pregnant cases 28 (75%) were Phenotype A, 2 (5%) C and 6 (16%) D. There were more IUGR (n = 4, 10%) and GDM cases in phenotype A. Although no single gene variant was significantly associated with pregnancy complications, FSHR rs6165 showed the highest odds ratio (OR 3.4), suggesting an increased IUGR risk, LEPR 1,137,101 exhibited a potential protective trend (OR 0.2), however p-value was non-significant highlight the limited power due to small sample size. Conclusion: IUGR and GDM were higher in PCOS cases (mainly phenotype A) than controls. These findings suggest the need for studies on phenotype specific and metabolic targeted interventions in managing pregnancies in PCOS patients.

1.26. A026: Body Mass Index (BMI), Gestational Weight Gain and Pregnancy Outcomes: A Retrospective Cohort Study in a Tertiary Hospital in Oman (January 2023–December 2023)

• Dr. Ahlam Al-Hinai, Manar Ibrahim Hashim Alhashemi, Hajar Mohammed Salim Alharthi and Asil Abdullah Hamed AL-Busaidi
• Sultan Qaboos University Hospital P.O. Box 38, Postal Code 123, Muscat, Oman
• Objective: As maternal obesity continues to rise worldwide, it is important to examine the impact of pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG) on maternal and fetal outcomes. This study aim to investigate the association between BMI, GWG, and pregnancy outcomes among Omani women. Method: This retrospective cohort study was conducted at Sultan Qaboos University Hospital (SQUH), Oman, and included 630 women who delivered between January and December 2023. After applying exclusion criteria (multiple pregnancies, chronic conditions, missing BMI records), 482 women were analyzed. BMI was classified according to the World Health Organization (WHO) into underweight, normal weight, overweight, and obese, based on measurements at the first antenatal visit. GWG was assessed using the Institute of Medicine (IOM) guidelines. Statistical analyses included descriptive statistics, chi-square, and Fisher’s Exact tests using SPSS v26. Results: Nearly 60% of women were overweight (31%) or obese (29.4%), while only (3.6%) were underweight. Excessive GWG occurred in (15.5%) of participants, being most frequent among overweight (18.2%) and obese (25.2%) women. None of the underweight women exceeded recommended weight gain. Obese women had significantly higher rates of gestational diabetes mellitus (53.7%) and pregnancy-induced hypertension (6.8%). In contrast, anemia (20.0%) and preterm labor (15.0%) were more common among normal-weight women. For fetal outcomes, intrauterine growth restriction (IUGR) was inversely associated with BMI, with the lowest rates in obese women. IUGR rate was 18.3%, 11.6% and 6.1% among ladies with normal weight, overweight and obese. No significant association was found between BMI and other neonatal complications. Conclusion: This study concludes that higher maternal BMI is strongly linked to excessive gestational weight gain and increased risks of GDM and hypertension. Findings emphasize early risk assessment, tailored prenatal care, and obesity prevention strategies to optimize maternal and neonatal outcomes.

1.27. A027: Maternal and Perinatal Outcome Among Pregnant Women with Thrombocytopenia Attending Ibrahim Malik Hospital Sudan 2022–2023

• Siddig Omer Mohammed Handadi and Omima Ibrahim Idris
• Garden city University, PO Box 12865, Khartoum, Sudan
• Objective: TTo determine the etiologies of maternal thrombocytopenia and determine maternal & perinatal outcomes compared with normal pregnancy. Method: It was prospective observational and analytic case control study carried out at Ibrahim Malik Hospital, Khartoum State, Sudan during the period from September 2022 to February 2023, 756 pregnant women who attended the Antenatal clinic regularly were selected. All women were screened for thrombocytopenia in second trimester (after 20 weeks), women with normal platelet (n = 677) were taken in control group and those with low counts less than 150 x109/L (n = 79) were included in study group, maternal & perinatal outcomes were assesed. Results: The incidence of maternal thrombocytopenia in our study was 10.4%. Fifty two (65.8%) of the women had mild thrombocytopenia while 22 (27.8%) and 5 (6.4%) of women were moderate and severe thrombocytopenic respectively. Out of total 79 cases 49 (62.0%) had gestational thrombocytopenia which the most commonest cause, followed by severe preeclampsia 17 (21.5%), Idiopathic thrombocytopenic Purpura (ITP) 5 (6.3%), (HELLP) syndrome 4 (5.1%) and medical cause like malarial, human immunodeficiency virus (HIV) and hepatic disorders were 4 (5.1%). Maternal complications were massive haemorrhage due to atonic postpartum hemorrhage were higher in the study group. Fetal complications and Perinatal mortality was 31.75% were significantly higher in study group. Conclusion: The common causes of thrombocytopenia in pregnancy are gestational thrombocytopenia, preeclampsia, (ITP), HELLP syndrome and malaria. Gestational thrombocytopenia is associated with better maternal and perinatal outcome as compared to pre eclampsia, HELLP syndrome, ITP which expose them to life threatening complications as placental abruption, post partum hemorrhage, birth asphyxia and stillbirth.
• Keywords: Thrombocytopenia, pregnancy, maternal outcome, fetal outcome

1.28. A028: Association of Maternal Age with Adverse Maternal and Fetal Outcomes in Omani Nulliparous Women with Singleton Pregnancies in Sultan Qaboos University Hospital

• Dr. Hetal Sameer Raniga ¹, Safa Ali Said Al-Julandani ¹, Safa Ali Said Al-Julandani (student) ², Safa Obaid Alharthi (student) ², Shuhd Saleem Alsubaihi (student) ² and Maryam Abdullah Alhatmi (student) ²

¹ 

Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

² 

College of Medicine, Sultan Qaboos University, P.O. Box 35, P.C. 123, Muscat, Oman

• Objective: Childbearing demographics have seen significant changes worldwide over the past few decades, including a notable increase in the mean maternal age at first childbirth. This increase has also been observed recently in Oman. Our study aims to evaluate various adverse pregnancy and fetal outcomes to identify the optimal age group for Omani mothers with the least complications when planning pregnancy. Method: A retrospective descriptive cross-sectional study was conducted on 799 nulliparous singleton pregnancies delivered at Sultan Qaboos University Hospital between May 2022 and December 2023. Women were divided into four age groups: <25, 25–30, 31–35, and ≥36 years. Maternal outcomes assessed included BMI at booking, gestational diabetes mellitus (GDM), preeclampsia, anemia, induction of labor, labor duration, mode of delivery, episiotomy, vaginal tears, postpartum hemorrhage (PPH), need for blood transfusion, hospital stay, and readmission. Neonatal outcomes included intrauterine growth restriction (IUGR), birth weight, gestational age, 5-min Apgar score, and NICU admission. Data were analyzed with cross-tabulation and chi-square tests using SPSS. Results: Mothers ≥36 years had the highest prevalence of GDM (48.8%), preeclampsia (19.5%), and preterm births (29.3%). Cesarean section rates rose significantly with maternal age, peaking at 53.7% in this group. Subfertility, fibroids, and miscarriages also showed an upward trend with age. Older mothers experienced higher readmission rates and prolonged hospital stays. Conversely, anemia at booking, episiotomy, and vaginal tears were more common in younger mothers. PPH increased up to age 35, then declined slightly, likely due to smaller sample sizes in older women. Conclusion: Advanced maternal age is associated with higher maternal, obstetric, and neonatal complications, necessitating more interventions and prolonged care. These findings highlight the need for tailored prenatal strategies and policy measures to support women in planning pregnancies and optimizing outcomes across age groups.

1.29. A029: Kleefstra Syndrome in Prenatal and Pediatric Practice: Implications for Genetic Counseling and Women’s Health in Consanguineous Populations

• Syeda Heyam
• College of Medicine and Health Sciences, National University of Science and Technology, P.O. Box 391, Postal Code 321, Sohar, Oman.
• Objective: This narrative review aims to explore the clinical presentation, diagnostic challenges, and prenatal implications of Kleefstra Syndrome (KS), a rare neurodevelopmental disorder caused by EHMT1 gene mutations or 9q34.3 deletions. The analysis is contextualized with the first genetically confirmed KS case reported in Oman, underscoring the need for improved genetic counseling services and diagnostic infrastructure in consanguineous populations. Method: A structured literature search was conducted using PubMed, Scopus, and Google Scholar to identify studies published between 2005 and 2025. Keywords included: Kleefstra Syndrome, EHMT1, prenatal diagnosis, consanguinity, and genetic counseling. Relevant case reports, review articles, and clinical guidelines were included. The review also includes a local case: a 2-year-old Omani girl presenting with global developmental delay, hypotonia, and dysmorphic features, who was diagnosed with KS via microarray analysis at Royal Hospital, Muscat. Results: KS is typically diagnosed postnatally due to subtle or variable prenatal findings. Common features include intellectual disability, facial dysmorphism, muscular hypotonia, and congenital anomalies. In the reviewed Omani case, prenatal indicators were missed, and diagnosis was delayed until after the onset of developmental delays. Literature suggests that while prenatal detection is possible with microarray or whole exome sequencing, such testing is not routinely performed in many low-resource or high-consanguinity settings. Challenges include limited access to prenatal genetic services, lack of awareness among obstetricians, and cultural considerations impacting counseling. Conclusion: Kleefstra Syndrome, though rare, represents an important case for expanding genomic literacy and prenatal screening frameworks in Oman and the broader Gulf region. Integrating early genetic counseling and diagnostic services into obstetric care, especially in consanguineous populations, can facilitate timely diagnosis, reduce parental anxiety, and improve long-term care outcomes. Future directions should include national rare disease registries, clinician training, and culturally adapted prenatal counseling models.

1.30. A030: Comparison of Gender-Based Delay in the Diagnosis and Management of Adnexal Torsion: A Retrospective Cohort Study at Sultan Qaboos University Hospital, Oman

• Maisa Khalifa Al Falahi ¹, Maryam Al Shukri ², Khurram Siddiqui ² and Vaidyanathan Gowri ³

¹ 

Oman Medical Specialty board, Obstetrics and Gynecology Residency Program, P.O Box 1422, Postal Code 130, Muscat, Oman

² 

Sultan Qaboos University hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

³ 

College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, P.C. 123, Muscat, Oman

• Background: Adnexal torsion is an emergency in both genders. Torsion of with testis or ovary leads to vascular compromise. Delayed diagnosis can result in ischemia, infarction, and loss of gonadal function. Though adnexal torsion predominantly affects females and males of reproductive age, there is limited research comparing diagnostic delays and management outcomes based on gender. This study aims to analyze gender-based disparities in the diagnosis and management of adnexal torsion and to identify factors contributing to delays in treatment. Methods: A retrospective cohort study was conducted at Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Medical records of 146 patients diagnosed with adnexal torsion were reviewed, including 55 females (37.7%) and 91 males (62.3%). Data collected included demographic information, clinical presentation, time intervals to diagnosis and treatment, and surgical outcomes. Statistical analysis was performed to assess differences in time from the presentation to radiology, specialty consultation, and operative intervention across genders. Results: Among the study population, the median time to radiological assessment was significantly longer in females (1.5 h; IQR: 0.75–3.00) compared to males (1.03 h; IQR: 0.45–2.00; p = 0.013). Similarly, the median time to specialty consultation was prolonged in females (3 h) compared to males (1.61 h; p = 0.027). The most pronounced delay was observed in the time to surgical intervention, with females experiencing a median duration of 7 h, significantly longer than the 3.53-h median observed in males (p < 0.001). Despite the prolonged time to surgery in females, the proportion of salvageable ovarian tissue was notably higher at 81.1%, compared to 48.9% in males with testicular torsion. These findings highlight significant sex-based disparities in the timely diagnosis and management of adnexal torsion. Conclusion: Gender-based disparities exist in the diagnosis and management of adnexal torsion, with female patients experiencing longer delays in obtaining specialty consultation and surgical intervention. Despite this, salvageable outcomes were higher in females compared to males. Addressing these delays through improved clinical protocols and awareness can help enhance timely diagnosis and preserve ovarian function. Further research is needed to explore underlying causes for these gender differences and their implications on long-term reproductive health.
• Keywords: Adnexal torsion, ovarian torsion, gender disparities, surgical intervention, Oman

1.31. A032: Evaluation of Autophagy Activity in Term Placentas of COVID-19 Positive Women

• Dr. Younis Al-Mufargi ¹, Vaidyanathan Gowri ², Marwa Al-riyami ¹, Deepthy Geetha ¹, Shadya Al-Sinawi ¹, Khalfan Al Jabri ¹, Nadia Al-Abri ¹, Adham Al-Rahbi ¹ and Srinivasa Rao Sirasanagandla ¹

¹ 

Medical City Hospital for Military and Security Services, P.O. Box: 393, Postal Code 100, Muscat, Oman

² 

College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, P.C. 123, Muscat, Oman

• Objective: Autophagy is a conserved intracellular degradation pathway essential for maintaining cellular homeostasis by recycling damaged organelles and proteins. Dysregulation of autophagy has been implicated in pregnancy-related complications such as preeclampsia and fetal growth restriction, underscoring its importance in maternal and fetal health. However, the autophagy status in the placental tissue of CoV-infected pregnant women remains unknown. Our aim is to investigate autophagy activity in term placentas of SARS-CoV-2-infected pregnant women compared to healthy pregnant controls. Method: In this observational study, 15 SARS-CoV-2-positive and 15 SARS-CoV-2-negative term pregnant women who delivered at Sultan Qaboos University Hospital between January 2020 and December 2022 were included. Placental tissue samples were collected post-delivery and assessed for autophagy activity using immunohistochemistry (IHC) for LC3 and p62 markers, histopathology, and transmission electron microscopy (TEM). The proportion and intensity of LC3 and p62 staining were quantified. Statistical analysis was performed using the Mann-Whitney U test. Results: Significant differences were observed in autophagy markers between the Covid-infected and control groups. The proportion of p62-LCK (U = 21.000, p = 0.000) and LC3B-MAP1 (U = 46.000, p = 0.003) were significantly altered in infected placentas, suggesting dysregulated autophagy. Similarly, intensity levels of both markers showed significant differences (p < 0.05), supporting the evidence of altered autophagic flux. Histopathology findings in the covid placenta showed the presence of coagulative necrosis, chorionitis, fibrin deposition and infarction along with the ultrastructural changes in the cytotrophoblasts and syncytiotrophoblasts. Conclusion: This study demonstrates significant dysregulation of autophagy in the placental tissues of term pregnant women with SARS-CoV-2 infection. These findings highlight the potential impact of CoV infection on placental function and fetal development, and underscore the need for further investigation into autophagy-modulating strategies in maternal-fetal health.

1.32. A033: Psychological Distress Among Pregnant Omani Women After Detection of Congenital Fetal Anomalies: A Multicenter Cohort Study

• Raiya Ali Al Amri ¹ and Amal Al Fahdi ²

¹ 

Oman Medical Specialty board, P.O Box 1422, Postal Code 130, Muscat, Oman

² 

Sultan Qaboos University hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

• Objective: To compare the level of psychological distress in pregnant women with a fetal anomaly diagnosis with distress level in pregnant women with normal ultrasound findings. To examine the association between maternal psychological distress level and the different variables. Method: This prospective cohort study included 127 Omani pregnant women aged ≥18 years attended for an ultrasound appointment. With fetal anomalies (n = 41) and with normal fetuses (n = 86). Alpha at 5% level and power at 80%. • Maternal distress was detected using Depression, Anxiety and Stress Scale-21 (DASS-21) at two different time points: T1 (immediately or within a few days post-scan) &amp;T2 (4–6 weeks after T1). Results: Women in study group had significantly higher risk of depression (Relative risk [RR] = 2.4) and anxiety (RR = 2.6) and higher risk of stress (RR = 1.9) but was not significant. AtT2, there was an increase in depression and stress means and a decrease in anxiety mean. This change was not statistically significant (p = 0.595, p = 0.475 and p = 0.616). Gravidity status explained the variance in depression score. Grand multigravida women (&gt; = 6th time) were significantly more distressed than multigravida (2nd–5th time) (p = 0.006). AtT1, cumulative incidence of depression, anxiety and stress were higher in study group. Conclusion: Women with abnormal fetuses were found to have significantly higher risk of depression and anxiety. Distress levels remined relatively stable 4–6 weeks after results reveal. Among the investigated maternal variables, psychological distress was predicted by gravidity status. Our findings suggest the need to incorporate a psychometric screening tool in the prenatal care settings.

1.33. A034: Clinical Pregnancies in Women Above the Age of 45 Years Resulting from Assisted Reproductive Technology Treatment with Autologous Oocytes: Report of Two Cases

• Maha Al Khaduri ¹, Muhanad Abusharo ¹, Manal Al Busaidi ² and Al Bayan Al Hinai ³

¹ 

New Hope Medical Center, Oman

² 

Sultan Qaboos University Hospital, P.O. Box 38, Postal Code 123, Muscat, Oman

³ 

University of Galway, H91 TK33, Galway, Ireland

• Objective: Advanced maternal age and decreased ovarian reserve are challenges for assisted reproductive technology (ART). Few cases of pregnancies from ART, using autologous oocytes, in women over 45-years-old, have been reported. We report two cases of women over the age of 46 yr who achieved clinical pregnancies with ART. Method: Two patients underwent ART treatment in private fertility centers. The first was a 46 yr old Para 2 woman with secondary infertility and anti-Müllerian hormone 0.9 ng/mL, FSH 2.3 ng/mL, who underwent ICSI PGTA using autologous oocytes. A frozen thawed embryo transfer with a single euploid blastocyst in an artificial cycle was performed. The second case is a 47 yr old Para 0 Aborta 1 woman with anti-Müllerian hormone 0.05 ng/mL and FSH ng/mL, who underwent ICSI without PGTA and a fresh day 3 single embryo transfer. Both patients had undergone an antagonist protocol for ovarian stimulation with letrozole 5 mg, FSH-r plus hMG and ganirelix 0.25 mg, for ovarian stimulation and inhibition of the LH surge, respectively. Oocyte maturation was triggered with hCG alfa 500 mcg + a GhRh agonist 0.2 mg. The couples were counseled about the scientific evidence on IVF treatment with autologous oocytes that results in pregnancy in 46-year-old women is extremely rare and that these pregnancies are associated with an increased risk of aneuploidies. Results: Both cases were pregnant with confirmed quantitative beta-hCG values and clinical pregnancy confirmation in the first trimester with viable fetuses on ultrasound examination till 12 weeks gestation. Conclusion: This is a rare case report of two successful clinical pregnancies at ages 46 and 47 yrs after ART. Pregnancy with women’s own oocytes using ART after the age of 45 yrs is possible and should be considered in specific cases taking into consideration cultural and legal constraints for oocyte donation in the Middle East.