Obstetrics & Gynecology

SECTION OF GYNECOLOGY ONCOLOGY

We are also proud of our status as a premier treatment institution in our field and the quality of care provided by KFSHRC-Riyadh to cover all referral cases of suspected or diagnosed gynecological malignancies.

Our staff of Gynecologic Oncologists is all board-certified women’s cancer specialists who are qualified and experienced in advanced medical and surgical training in the treatment of gynecological malignancies. They provide unified, comprehensive medical and surgical care to women with reproductive-tract cancers from diagnosis to completion of treatment in liaison with other specialties in multidisciplinary approach e.g. medical oncologists, radiation oncologists, and other supportive care.

Our role in patient care

Women who have recently been diagnosed with gynecologic cancer, including cervical, endometrial, ovarian, uterine, vaginal, and vulvar cancer, or Gynecological cancer during pregnancy, all receive treatment at our division. We also provide treatment for uterine sarcoma, molar pregnancy, and all types of gestational trophoblastic disease.

Our approach to comprehensive management of our patients is of multidisciplinary effort, thru weekly tumor board meetings with our colleagues, medical and radiation oncologist, histopathologist and radiologist, advanced practice nursing, state of art diagnostic imaging medical oncology, social workers, and nutrition.

SECTION OF MATERNAL FETAL MEDICINE

The Section creates an environment of service combining information and technology with genuine care for families at fetal or maternal risks which makes them full partners in their healthcare. We provide comprehensive perinatal care for pregnant women who are at high risk for adverse outcomes themselves or their fetuses. We facilitate high standards excellent obstetrical care in the community and embrace contemporary and innovative knowledge and technology in an ethical manner. Our aim is to set the standard for perinatal care and genetic counseling in the community. Our focus is to facilitate research and professional growth, and maintain fiscal responsibility with ongoing analysis to maximize benefit for cost.

Our role in patient care

Members of the division provide services for maternal and fetal complications of pregnancy. Medical complications include chronic hypertension, diabetes, cardiac disease, venous thromboembolic disorders, hematological disorders, pulmonary diseases, gastrointestinal disorders, renal disease, collagen vascular disease and neoplastic disease. The team manages these problems in active collaboration with other specialties and programs such as internal medicine, endocrinology, gastroenterology, immunology, microbiology, thromboembolic and hematology.

Pregnancy complications such as preterm labor, preterm rupture of the membranes, pregnancy induced hypertension, eclampsia, chorioamnionitis, placental abruption, and other obstetrical complications are managed by expert staff.

Fetal complications such as Rh isoimmunization, intrauterine growth restriction, macrosomia, polyhydramnios, oligohydramnios, multiple-pregnancy, evidenced of fetal compromise, fetal malformations and other fetal/placental disorders are referred to our section from all over the kingdom. Prenatal diagnosis, genetics and fetal dysmorphology services are available for the prenatal detection, evaluation and counseling of patients and/or pregnancies at risk of or complicated by fetal malformations, chromosomal and genetic disorders. Procedures offered include invasive prenatal diagnostic procedures: chorionic villous sampling, amniocentesis, fetal blood sampling and fetal tissue sampling. Non-invasive prenatal screening with nuchal translucency and detailed advanced ultrasound evaluation using state of art ultrasound equipment with 3D/4D scans. When fetal anomalies are identified, we provide a team approach for the care of the fetus and the mother during the course of pregnancy and the postnatal period. The team is unique to each case but often includes neonatology, medical genetics and dysmorphology, pediatric nephrology, pediatric neurosurgery, pediatric cardiology and/or pediatric surgery.

The fetal therapy program was developed for the in-utero management of complicated fetal problems such as Twin-Twin Transfusion Syndrome, fetal diaphragmatic hernia and other conditions which if left untreated will lead to increased perinatal mortality.

OB ULTRASOUND UNIT

KFSHRC –Riyadh is a tertiary care center considered as a referral center for the country. We work to identify potential obstetrical or fetal problems as early as possible and provide clinically relevant diagnoses of fetal anomalies.

Our staff includes highly trained experienced Sonographers in level III obstetrics scans. The unit is run and supervised by Maternal Fetal Medicine subspecialist consultants who provide patients’ counseling, plan further management and care for high-risk pregnancies especially if fetal abnormalities are diagnosed.

Services provided:

We have our own mission, vision, and values and coping with hospitals and departments' mission, vision, and value we are trying to build one of the best teams of KFSH.
We offer non-invasive screening for various genetic/metabolic/cardiac and aneuploidy using Nuchal translucency scans at 11-14 weeks gestation, detailed early anatomy scan offered from 16-18weeks for those at very high risk for recurrence of severe fetal anomalies, routine level III anatomical evaluation is done routinely at 20-22 weeks scan was uterine artery Doppler as screening for placental insufficiency is carried out in high-risk patients,  serial growth scans with fetal well-being tests including fetal arterial and venous Doppler and Biophysical profile is done for high-risk patients. Placental anomalies, abnormal placentation, hematomas and fibroids, and evaluation of uterine cervix all were evaluated thoroughly. All the above is offered also for multi-fetal pregnancy.

Annually we are performing over 10000 ultrasound examinations.

SECTION OF REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY

The combination of academic, scientific, and technical expertise found in our division has created one of the most respected fertility programs and clinical divisions in the country. Our reproductive endocrinologists and physician-scientists are actively engaged in research, both clinical and basic, as well as training residents and fellows in this specialized field. Our clinical work includes some of the world's finest technicians and physicians who have pioneered new innovations and been honored for their outstanding contributions to the field of reproductive medicine. We accept referral cases for diagnosis, and treatment of endocrine and reproductive disorders including abnormal menses, amenorrhea, infertility, recurrent early pregnancy loss, ovulatory problems, uterine or tubal abnormalities. As for Men Fertility Services, we provide Semen analysis, Sperm preparation for intra-uterine insemination, andrology testing, and Urology referrals.

Therapies may include hormonal and/or surgical treatment or advanced technologies such as In-Vitro Fertilization (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI).

We recently added the service of fertility preservation for female patients with different types of cancer, in whom chemotherapy and/or radiation therapy is likely to affect their future fertility potentials. Through different patient-customized procedures, we can preserve their fertility potentials which could be used after their recovery from their disease.

Our role in patient care

Controlled Ovarian-stimulation, IVF, ICSI, cryopreservation, and pre-implantation genetic diagnosis PGD a well-organized program.

The REI Laboratory

Our andrology laboratory uses CASA (Computer Assisted Semen Analyzer)—another example of cutting-edge technology in the laboratory, headed by leading medical technologists.

DEPARTMENT INNOVATIVE PRACTICES:

Section of Gynecology Oncology:
1. Robotic Surgery

Gynecology is one of the fastest-growing fields of robotic surgery. Robot-assisted surgery was developed to overcome the limitations of minimally invasive surgery; it can be used to treat fibroids, endometriosis, ovarian tumors, pelvic prolapse, and female cancers. Using the robotic system, our gynecologists performed hysterectomies, myomectomies, and lymph node biopsies. The need for large abdominal incisions is virtually eliminated.

2. Laparoscopic Oophoropexy for Ovarian Function Reservation in Cancer Patients with New Techniques Such Single Port Laparoscopy

Minimally invasive technique for ovarian transposition (oophoropexy) can offered to any age premenopausal women with Hodgkins disease, brain tumors, cervical, vaginal, and others who is undergoing total Lymph Node Irradiation (TNI) deliver as a dose of 200-400 Centigray (CGY) It is safe and effective procedure for ovarian function preservation.

3. Intra-Operative Radiation Therapy (IORT)

In patients with recurrent gynecologic cancers in the pelvic sidewalls, para-aortic or pelvic lymph nodes, the use of aggressive surgery and IORT appeals beneficial. Our colleagues with surgical oncology and radiation oncology helped in establish this new approach in gynecology oncology section.

4.Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

It became to be an important and potential curative treatment for intra-abdominal metastases for both advanced primary and recurrent ovarian and peritoneal cancers.
Our Section with the collaboration of surgical oncology team succeeded in achieving a combined program with very promising results.

Section of Maternal Fetal Medicine-Fetal Therapy Program:

Established end of 2007 and the first case of Fetoscopic laser coagulation for stage III Twin to twin transfusion syndrome was performed early 2008.  The program is active in accepting patients from all over the kingdom and from the neighbouring Gulf region for evaluation of fetal pathology, and intervention when indicated.

As the program has expanded, a clinical coordinator joined the team, and specialized clinics was opened to receive all the new referrals.  Cases will be evaluated through the Fetal Therapy team which consists of the Maternal Fetal Medicine subspecialists, pediatric surgeons, neurosurgeons, pediatric cardiologists, neonatologist, and clinical coordinators.  All newly referred patients will be seen and evaluated by the appropriate team members and the plan of care will be explained and documented.  Patients requiring further testing or therapy will be scheduled for the procedures if indicated, another counselling session will be conducted with the family, the findings explained, the plan of care explained, the complete reports provided, and the patients could be referred back to their referring hospital for further pregnancy and delivery care.

Section of Reproductive Endocrinology Infertility-Pre-implantation Genetic Diagnosis (PGD)

Preventing disease is a standard goal of medicine. PGD provides an early genetic diagnosis for an embryo before it is implanted into the uterus. It is an effective method to prevent the transmission of hereditary diseases to the next generations in the families with single gene disorders or chromosomal abnormalities. PGD requires combined expertise in the field of reproductive medicine together with molecular genetics and/or cytogenetic. It involves two stages: Firstly; IVF for ovarian stimulation, monitoring and timing of oocyte retrieval, fertilization and embryo biopsy. Secondly; a genetic diagnosis that is reliable and efficient is necessary to report the result in early enough time for embryo transfer to take place in the same cycle. 

Couples referred for PGD are at risk of having a pregnancy affected with a known genetic disease, the majority of them at least have one affected child of their own or in the close family. The available reproductive option for them was prenatal diagnosis, which remains an unsatisfactory solution for some couples at high genetic risk, e.g. couples who had undergone repeated termination of affected pregnancies often ask for diagnosis prior to pregnancy. Furthermore, certain high-risk mothers would need to avoid risks associated with abnormal pregnancy. Our take home baby following IVF/ PGD cycle is 30-40%, which more or equal to traditional IVF cycle.

There is also a group of patients who are sub-fertile, or with previous pregnancy with chromosomal abnormality, or had repeated miscarriages, recurrent implantation failure following IVF cycles, or for those mothers with advanced maternal age, PGD and Preimplantation Genetic Screening (PGS) allows the screening for chromosomal abnormalities.

Fluorescent in situ hybridization (FISH) is a technique used most often for preimplantation genetic screening (PGS) and for chromosomal rearrangements, while Polymerase chain reaction (PCR) is used for single gene disorders. The most up-to-date techniques Array Comparative Genome Hybridization (CGH-Array) and single nucleotide polymorphism (SNP) array “karyomapping” has been implemented.

Another group of patients suffers from cancer predisposition such as hereditary breast and/or ovarian cancer, or had inherited some genes that develop cancers such as the Familial adenomatous polyposis A gene (colon cancer). Most of cancer patients receive radiotherapy/chemotherapy as part of their treatments which may permanently affect their fertility.  Therefore, IVF/ PGD cycles help them to diagnose the embryos and those healthy embryos which do not have the cancer-causing mutations can be transferred to the mother in order to initiate diseased-free pregnancy.

Patients who underwent radiotherapy/chemotherapy for different cancers can undergo IVF treatment to freeze embryos, which can be replaced later one once the disease is cured.

DEPARTMENT GOALS

1.       To continuously provide high quality tertiary health care services in an efficient manner and safe environment as well as providing an ever expanding and up-to-date diagnostic and therapeutic modalities for pregnant women with complicated medical or surgical diseases, fetal assessment and therapy and high risk pregnancies, complex gynecological problems and various gynecological malignancies and urogynecologic problems, and state-of-the-art treatment for patients with infertility and expanding services to cover patients with known genetic diseases.
2.       To continue introducing cutting edge technology in the field of Robotics minimally invasive surgery program in gynecology and new surgical approach for advanced ovarian cancer Hyperthermic Intraperitoneal Chemotherapy (HIPEC), to continue expanding the component of the Fetal Diagnosis and Therapy Program, the service for prenatal invasive diagnostic methods/procedures to reduce genetic and other medical diseases of the newborn which prevent the delivery of abnormal babies, and the Preimplantation Genetic Diagnosis (PGD) program in IVF.
3.      To ensure quality education and training in medical and technical areas by improving the passing rate for residents in national exams and encourage and support active involvement of medical staff in national and international meetings. To expand basic and applied research by closely monitoring the progress and completion of research projects and enforcing the requirement for each fellow to complete a research project before graduation.

DUTIES & RESPONSIBILITIES

• Deliver state-of-the-art clinical care in the field of obstetrics and gynecology including Prenatal diagnosis and therapy; full antepartum, intrapartum and postpartum management of pregnancies complicated by obstetrics, maternal or fetal morbidities; Workup and management of various gynecologic neoplasms; performance of complex gynecologic surgeries; pre-implantation diagnosis and counseling, and management of infertility and hormonal dysfunction.
  • Maintain a didactic and practical training for residents and fellows in Obstetrics and Gynecology.
  • Update regularly existing clinical protocols as dictated by changes in the standard of care.
  • Ensure adequate staffing coverage for each division, namely, Maternal Fetal Medicine; Reproductive, Endocrinology and Infertility Medicine; and Gynecology Oncology.
  • Ensure continuous improvement in the documentation of medical records by all team members.
  • Support administration to maintain Joint Commission International Accreditation (JCIA) accreditation.