Publications by authors named "Ihab Usta"

78 Publications

Practice patterns of obstetric care in twin gestations: the value of MFM consultation.

J Matern Fetal Neonatal Med 2020 Sep 20:1-7. Epub 2020 Sep 20.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Objectives: To evaluate the practice patterns among Lebanese obstetricians regarding obstetric care of twins and to compare selected practice patterns between general obstetricians and maternal fetal medicine physicians.

Methods: Questionnaires distributed during the annual meeting of the Lebanese Society of Obstetrics and Gynecology.

Results: Questionnaires were returned by 69.2% of the 296 physicians approached. Ten percent had fellowship training in Maternal Fetal Medicine (MFM). Thirty-nine percent perform cervical length measurement at 20-24 weeks of gestation and 34% recommend vaginal progesterone in case of a short cervix. When comparing selected practice patterns between MFM & general obstetricians, MFM specialists were less likely to perform cervical cerclage in the first trimester (5.9% versus 49%,  = .001), more likely to offer prenatal screening for aneuploidy (66.6% vs 46.4%,  = .03), less likely to use vaginal progesterone in the second trimester in the case of a short cervix (42.1% vs 61.8%,  = .04), less likely to perform serial ultrasound exam in the third trimester to assess fetal growth (50% vs 78%,  = .005) and more likely to deliver monoamniotic twins at 32-34 weeks of gestation (55% vs 37%,  = .05).

Conclusion: Because of the different background of the Lebanese physicians, MFM specialists are more likely to follow obstetric care guidelines in twin gestation.
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http://dx.doi.org/10.1080/14767058.2020.1821640DOI Listing
September 2020

Practice and attitudes towards immunization among Lebanese obstetricians and gynecologists.

Hum Vaccin Immunother 2018 06 11;14(6):1501-1508. Epub 2018 Apr 11.

a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut-Lebanon.

We designed our study to evaluate the knowledge and immunization practices among Lebanese obstetricians and gynecologists (OBGYN) for women of different age groups. Anonymous questionnaires were used to assess the knowledge and immunization practices among OBGYN. The survey was conducted at the annual meeting of the Lebanese Society of Obstetrics and Gynecology on November 13-15, 2014. Data collected included demographics, type of practice, academic background and familiarity with vaccine guidelines. Descriptive statistical methods were used to evaluate the responses. The response rate was 54.8% (114/208). Only 62.3% (71/114) recommend vaccination(s) to pregnant women with only 25.9% of those who recommend the Tdap vaccine for pregnant women giving it during the recommended third trimester. In addition, 52.6% are unaware of the CDC/ACIP immunization schedule for women in general. However, 83.0% (93/112) of respondents are willing to integrate vaccination in their practice. Our study highlights several gaps in the knowledge of Lebanese OBGYN regarding vaccination in addition to practices that are not in full accordance with common guidelines. Measures should be taken to spread proper awareness of the proper guidelines among Lebanese practitioners.
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http://dx.doi.org/10.1080/21645515.2018.1440163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037476PMC
June 2018

Intravenous Oxytocin Use to Decrease Blood Loss during Scheduled Cesarean Delivery: A Randomized Double-Blinded Controlled Trial (OXYTRIAL).

Am J Perinatol 2017 03 2;34(4):379-387. Epub 2016 Sep 2.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

 The objective of this study was to determine the optimal dose of intravenous oxytocin administered during cesarean delivery (CD) to decrease the amount of blood loss.  Out of a total of 226 women presenting for CD, 189 patients were randomized into three groups by a computer-generated random number sequence table. Low-risk women with singleton term pregnancies undergoing scheduled CD were assigned to receive 20, 30, or 40 units (U) of oxytocin diluted in 500 mL of lactated Ringer solution intraoperatively. The primary outcome was the change in hemoglobin from pre-CD to post-CD.  Overall, 63 women were assigned to each group. The primary outcome which was the drop in hemoglobin (1.4 ± 1.1 g/dL, 1.1 ± 0.8 g/dL, 1.0 ± 1.1 g/dL;  = 0.097) and the total calculated blood loss (798.6 ± 298.3 mL, 794.4 ± 313.5 mL, 820.2 ± 316.2 mL;  = 0.893) were not significantly different among the study groups. The incidence of intraoperative hypotension, postoperative systolic, and diastolic blood pressure changes was similar across the groups.  The amount of blood loss during CD was not significantly different among the three groups, thus the lowest dose of oxytocin infusion (20 U in 500 mL of lactated Ringer solution) seems to be an appropriate regimen.
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http://dx.doi.org/10.1055/s-0036-1592130DOI Listing
March 2017

Echogenic intracardiac focus on second trimester ultrasound: prevalence and significance in a Middle Eastern population.

J Matern Fetal Neonatal Med 2016 15;29(14):2293-6. Epub 2015 Sep 15.

a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut , Lebanon .

Objective: The association between echogenic intracardiac focus (EIF) and trisomy 21 is well established, with a recognized ethnic variation. Our study aimed to determine the prevalence of EIF in a Middle Eastern population and to examine its association with trisomy 21 and other adverse pregnancy outcomes.

Methods: Retrospective case-control study of second-trimester obstetric sonograms (16-28 weeks) performed at a tertiary care center over a 5-year period. Cases with EIF were retrieved, and a matched control group with no EIF was identified. The incidence of trisomy 21 and other adverse pregnancy outcomes was compared.

Results: A total of 9270 obstetric sonograms were examined, with an EIF prevalence of 2.5% (95% CI: 2.2-2.8%). Of patients with available outcome data, EIF was not associated with trisomy 21 (0/163 versus 1/163; p value = 1.00). Additionally, EIF was not associated with trisomy 18, trisomy 13, small for gestational age, preterm birth, fetal demise, cesarean delivery, operative vaginal delivery, or admission to the neonatal intensive care unit.

Conclusion: In a contemporary Middle Eastern population, EIF is a rare occurrence. As an isolated finding, it is not associated with aneuploidy or other adverse pregnancy outcomes. EIF appears to be incidental with no impact on clinical practice.
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http://dx.doi.org/10.3109/14767058.2015.1083549DOI Listing
January 2017

Use of antenatal corticosteroids in the management of preterm delivery.

Am J Perinatol 2015 Apr 23;32(5):417-26. Epub 2014 Dec 23.

Department of Obstetrics & Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Objective: This narrative review of the literature explores the current evidence and recommendations in favor of antenatal corticosteroids use during impending preterm deliveries as well as related issues and concerns.

Study Design: Synthesis of findings from published medical literature on antenatal corticosteroids and prematurity, retrieved from searches of computerized databases and authoritative texts.

Results: It is now recognized that an intramuscular course of betamethasone or dexamethasone given to a woman expected to deliver preterm not only accelerates pulmonary epithelial development but also matures other organ systems, significantly decreasing the chances of neonatal morbidities and increasing chances of survival.

Conclusion: There remain uncertainties over the efficacy of the established protocol in populations such as the very early preterm, the late preterm, and multiple gestations. Alternative regimens remain controversial because of fear of adverse effects and doubts regarding whether benefits outweigh risks.
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http://dx.doi.org/10.1055/s-0034-1395476DOI Listing
April 2015

Attitudes of Lebanese university students towards surgical hymen reconstruction.

Arch Sex Behav 2013 Nov 24;42(8):1627-35. Epub 2013 Aug 24.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, POB 113-6044, Beirut, Lebanon.

Many cultural and religious beliefs place virginity at a high level of social significance, in that women who lose their virginity before marriage may face humiliation, ostracism, divorce, and extreme violence. This led to an increase in the demand for virginity restoration through surgical hymen reconstruction among these cultures. However, data regarding the acceptance of hymenoplasty in societies that consider sexuality a taboo are scarce. In this cross-sectional study, we investigated the effects of gender and religion on sexual attitudes towards hymenoplasty, premarital sex, and virginity in a sample of 600 Lebanese university students. Our findings showed that approval of hymenoplasty was low among participants regardless of gender (25.7 % men vs. 19.1 % women) and religious affiliations (22.5 % Muslims vs. 22.3 % Christians). Arguments for rejection were rooted in moral ethics and personal convictions: "form of deceiving and cheating" (80.7 %) and "betrayal of honesty in the relationship" (80.4 %). Reasons for acceptance included: personal belief in "women's rights, autonomy, and freedom" (72.2 %) and "physical harm and death" (63.5 %).Male participants were more likely to approve premarital coital sex than females (61.0 vs. 27.3 %). Muslims were also more likely to reject marrying a non-virgin than Christians (39.9 vs. 18.0 %). Female participants expressed more tolerance towards marrying a non-virgin male partner (78.3 vs. 57.3 %). Low acceptance of hymenoplasty among Lebanese university students was found to be related to moral ethics and personal convictions independently from gender and religious affiliation. Differences in sexual attitudes towards premarital coital sex and virginity, however, were more significantly influenced by culture and religion.
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http://dx.doi.org/10.1007/s10508-013-0161-6DOI Listing
November 2013

A clinical approach to intrahepatic cholestasis of pregnancy.

Am J Perinatol 2014 Jan 28;31(1):1-8. Epub 2013 Jan 28.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Intrahepatic cholestasis of pregnancy (ICP) has a varying prevalence worldwide. The etiology behind this disease remains not fully understood with multiple factors influencing its development including genetic variations, dietary factors, hormonal changes, and environmental influences. Presenting mainly during the third trimester with generalized itching and resolving spontaneously postpartum, this condition is still associated with fetal morbidity and mortality. The diagnosis is based on clinical presentation in association with biochemical abnormalities. Elevation in total bile acid levels is the most frequent laboratory abnormality and seems to be the most important for gauging further management of the disease. The most appropriate gestational age for the delivery of women with ICP is yet to be determined. In this review we discuss the epidemiology, clinical features, diagnosis, etiology, and management of ICP, trying to shed light on some controversial aspects of the disease.
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http://dx.doi.org/10.1055/s-0033-1333673DOI Listing
January 2014

Effects of sildenafil in Nω-nitro-L-arginine methyl ester-induced intrauterine growth restriction in a rat model.

Am J Perinatol 2012 Jun 7;29(6):429-34. Epub 2012 Mar 7.

Department of Obstetrics and Gynecology, American University of Beirut-Medical Center, Beirut, Lebanon.

Objective: To assess the effect of sildenafil citrate in a rat model of Nω-nitro-l-arginine methyl ester (L-NAME)-induced intrauterine growth restriction (IUGR).

Study Design: An in vivo experimental study was conducted where 40 pregnant Sprague-Dawley rats were randomly assigned to receive either: (1) control, (2) L-NAME 50 mg/kg/d by gavage (days 14 to 19), (3) L-NAME and sildenafil 15 mg/kg/d by gavage, or (4) sildenafil (days 14 to 21). On day 21, a hysterotomy was performed and all fetuses (live and dead) were counted, examined, and weighed. The primary outcome measure was the difference in pup birth weight.

Results: The median number of live pups per dam was 11.5 (range: 1 to 15), 13.5 (2 to 17), 13.5 (7 to 16), and 11.5 (4 to 17) in controls, L-NAME, sildenafil, and combined drug groups, respectively (p = 0.02). Rats treated with L-NAME had a significantly higher number of stillbirths compared with control (p = 0.013) and sildenafil (p = 0.008) groups. L-NAME reduced pup birth weight compared with controls (4.53 ± 1.49 versus 5.65 ± 1.63 g, p < 0.001); this effect was more pronounced in the L-NAME and sildenafil groups (3.37 ± 1.25 g, p < 0.001).

Conclusion: Our data indicate that sildenafil citrate does not ameliorate L-NAME-induced IUGR, and in the doses utilized in this study might even have a synergistic negative effect on pup birth weight.
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http://dx.doi.org/10.1055/s-0032-1304823DOI Listing
June 2012

Indomethacin in pregnancy: applications and safety.

Am J Perinatol 2012 Mar 22;29(3):175-86. Epub 2011 Jul 22.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Hamra, Lebanon.

Preterm labor (PTL) is a major cause of neonatal morbidity and mortality worldwide. Among the available tocolytics, indomethacin, a prostaglandin synthetase inhibitor, has been in use since the 1970s. Recent studies have suggested that prostaglandin synthetase inhibitors are superior to other tocolytics in delaying delivery for 48 hours and 7 days. However, increased neonatal complications including oligohydramnios, renal failure, necrotizing enterocolitis, intraventricular hemorrhage, and closure of the patent ductus arteriosus have been reported with the use of indomethacin. Indomethacin has been also used in women with short cervices as well as in those with idiopathic polyhydramnios. This article describes the mechanism of action of indomethacin and its clinical applications as a tocolytic agent in women with PTL and cerclage and its use in the context of polyhydramnios. The fetal and neonatal side effects of this drug are also summarized and guidelines for its use are proposed.
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http://dx.doi.org/10.1055/s-0031-1284227DOI Listing
March 2012

Effect of parity on maternal and neonatal outcomes in twin gestations.

Acta Obstet Gynecol Scand 2012 Jan 16;91(1):117-21. Epub 2011 Jun 16.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Objective: To compare maternal and neonatal outcomes of twin gestations in nulliparous and multiparous women.

Design: Retrospective analysis of maternal and neonatal records.

Setting: American University of Beirut Medical Center, a referral university-affiliated hospital.

Population: Pregnant women who delivered twin gestations beyond 24 weeks from 1990 to 2004.

Methods: The data collected were analyzed using Student's paired t-test or χ(2) test. Logistic regression analysis was used to study the effect of multiple variables on preterm delivery.

Main Outcome Measure: Preterm birth rate.

Results: Nulliparas (n=333) were more likely to be younger (28.1±5.4 vs. 30.0±5.2 years; p<0.001) and the pregnancy a product of assisted reproductive technology (23.1 vs. 4.5%; p<0.001) compared with multiparas (n=508). They were at significantly increased risk of preterm delivery (54.4 vs. 45.1%; p=0.009) at lower gestational age (35.6±3.2 vs. 36.2±3.0 weeks; p=0.004). They had longer first and second stages of labor and a higher cesarean delivery rate (61.3 vs. 44.9%; p<0.001). Except for a higher intensive care nursery admission rate and longer nursery stay for twins of nulliparas, all neonatal morbidities were comparable. On multiple logistic regression analysis, multiparity (relative risk 0.70, 95% confidence interval 0.51-0.97) and growth restriction (relative risk 0.16, 95% confidence interval 0.12-0.22) were protective, while discordance (relative risk 2.24, 95% confidence interval 1.40-3.60) was a predictor of preterm delivery.

Conclusions: Nulliparous women with twin gestations are at significantly higher risk for preterm delivery and cesarean delivery compared with multiparous women. Although this was not translated into higher perinatal mortality, these women should be monitored closely and counseled regarding these risks and their attendant morbidity.
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http://dx.doi.org/10.1111/j.1600-0412.2011.01192.xDOI Listing
January 2012

First trimester sonographic diagnosis of ectopia cordis: a case report and review of the literature.

J Matern Fetal Neonatal Med 2011 Jun;24(6):867-9

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

A case of ectopia cordis (EC) with gastroschisis in a 27-year-old primigravida was diagnosed at 10(3/7) weeks of gestation. The pregnancy was terminated by suction dilatation and curettage. With the increasing use of first trimester ultrasonography, early detection of fetal abnormalities is becoming more frequent. We review other published cases of EC detected in the first trimester and discuss the possible advantages of early diagnosis including options of termination at earlier gestational ages which might decrease the physical and psychological trauma on some patients.
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http://dx.doi.org/10.3109/14767058.2010.531306DOI Listing
June 2011

Oxytocin antagonists for the management of preterm birth: a review.

Am J Perinatol 2011 Jun 17;28(6):449-60. Epub 2010 Dec 17.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Preterm birth, the leading cause of neonatal morbidity and mortality, is estimated at incidence of 12.7% of all births, which has not decreased over the last four decades despite intensive antenatal care programs aimed at high-risk groups, the widespread use of tocolytics, and a series of other preventive and therapeutic interventions. Oxytocin antagonists, namely atosiban, represent an appealing choice that seems to be effective with apparently fewer side effects than the traditional tocolytics. This article reviews the available literature on the pharmacokinetics, mode of administration, and clinical utility of oxytocin antagonists for acute and maintenance tocolysis with special emphasis on its safety profile.
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http://dx.doi.org/10.1055/s-0030-1270111DOI Listing
June 2011

Rheumatoid granuloma of the cervix and vagina: a challenging diagnosis and treatment.

Obstet Gynecol 2010 Aug;116 Suppl 2:501-503

From the Departments of Obstetrics and Gynecology, Internal Medicine, and Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Background: Granulomas of the female genital tract are rare and usually occur after operative procedures.

Case: A patient with rheumatoid arthritis presented with vaginal discharge and bleeding with ulcerative, red, friable lesions of the cervix, which extended to the bladder floor and the right upper vaginal wall. Cervical biopsy was highly suggestive of rheumatoid nodules. This prompted revision of the diagnosis of tuberculosis, which was suspected several months earlier when pulmonary and renal lesions were noted. The cervico-vaginal lesions did not respond to local steroid treatment and improved when the systemic steroid dose was increased; however, they recurred on tapering the dose.

Conclusion: Rheumatoid nodules can occur in the genital tract, which poses diagnostic and treatment challenges.
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http://dx.doi.org/10.1097/AOG.0b013e3181d992d0DOI Listing
August 2010

Calcium channel blockers for the management of preterm birth: a review.

Am J Perinatol 2011 Jan 16;28(1):57-66. Epub 2010 Jul 16.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Preterm birth continues to be the leading cause of perinatal morbidity and mortality. A wide range of tocolytics have been utilized for the management of preterm labor. Calcium channel blockers, namely nifedipine, gained popularity as tocolytics due to the oral route of administration, availability of immediate- and slow-release preparations, the low incidence of maternal adverse effects associated with their use, and the fact that they are inexpensive. This article reviews the available literature on the clinical utility of calcium channel blockers for acute and maintenance tocolysis with special emphasis on potential adverse effects, the most appropriate dose/regimen, and contemporary practice patterns among obstetricians. There are no randomized, placebo-controlled studies demonstrating the benefit of nifedipine in preterm labor. A suggested tocolytic protocol would be to start with the lowest dose of oral immediate-release nifedipine. For the first 48 hours thereafter, all attempts should be made not to exceed 60-mg daily doses.
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http://dx.doi.org/10.1055/s-0030-1262512DOI Listing
January 2011

Effect of female nargile smoking on in vitro fertilization outcome.

Eur J Obstet Gynecol Reprod Biol 2010 Jun 11;150(2):171-4. Epub 2010 Mar 11.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Objective: Smoking is a significant health hazard that has been associated with poor reproductive outcome and reduced fertility in reproductive age women. The aim of this study was to assess the effect of nargile smoking on intra-cytoplasmic sperm injection (ICSI) outcome.

Study Design: A prospective analysis of the outcomes of 297 women who underwent ICSI treatment at the ART Unit at the American University of Beirut Medical Center between January 1, and December 31, 2006 was done. The patients were divided into 3 groups based on their smoking status: cigarette smokers (n=42), nargile smokers (n=51) and non-smokers (n=204).

Results: The mean age of nargile smokers was significantly lower than the other groups; however, the 3 groups were similar with respect to the cause of infertility, total dose of follicular stimulating hormone (FSH), number of oocytes and embryos obtained, and number and quality of embryos transferred. There was no significant difference in the clinical pregnancy rate between nargile smokers and non-smokers (51.0% vs 43.6%). However, cigarette smokers had a significantly lower clinical pregnancy rate compared to non-smokers (23.8% vs 43.6%, p=0.0238). On multiple logistic regression analysis, factors that decreased the clinical pregnancy rates were cigarette smoking and maternal age.

Conclusion: Although this study did not find a deleterious effect of nargile smoking on ICSI outcome, the results need to be confirmed in prospective studies that would include larger number of women with more objective measures of nargile smoke exposure.
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http://dx.doi.org/10.1016/j.ejogrb.2010.02.036DOI Listing
June 2010

Effect of religion on the attitude of primiparous women toward genetic testing.

Prenat Diagn 2010 Mar;30(3):241-6

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Background: Factors that influence a pregnant woman's decision to accept or decline genetic tests are largely undefined. The objective of this study was to determine the acceptance rate of prenatal diagnostic testing in Lebanon according to religion.

Methods: Prenatal charts were reviewed to obtain information about prenatal genetic testing. Women were divided according to their religion and were compared regarding the acceptance of triple screen test (TST) or amniocentesis (AMN) and reasons for declining such tests. Differences between groups were examined using the student's t-test, chi(2)-test and multivariate analysis (age >or= 35 years, religion, education and class).

Results: The religious distribution was 73.8% Moslems, 14.0% Christians and 11.2% Druze. Utilization of TST, AMN, and either (TST/AMN) was 61.2%, 7.6% and 67.0%, respectively. Uptake of TST/AMN was highest in Christians and lowest in Moslems and that of AMN higher in Christians >or= 35 years compared with Moslems. On multivariate analysis, none of the factors studied significantly affected the utilization of TST or TST/AMN except for age >or= 35 years which was associated with a borderline decrease in the utilization of TST Odds Ratio (OR) 0.485 (95% CI 0.21-1.12). The utilization of AMN significantly increased with age >or= 35 years OR 7.19 (95% CI 2.65-19.56) and lower education.

Conclusion: Religion does not seem to affect utilization of prenatal diagnostic tests in Lebanon.
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http://dx.doi.org/10.1002/pd.2447DOI Listing
March 2010

A short cervical length in pregnancy: management options.

Am J Perinatol 2009 Nov 6;26(10):761-70. Epub 2009 Oct 6.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut-Lebanon.

Measuring cervical length using transvaginal ultrasonography is a useful tool to predict the risk of preterm birth in low- and high-risk pregnancies. Management of a short cervix poses a significant dilemma for clinicians. Different management plans have been proposed and studied, with mixed results in different clinical settings. This article reviews the various management options in the different patient subpopulations and proposes a scheme for management once a short cervix is identified.
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http://dx.doi.org/10.1055/s-0029-1239495DOI Listing
November 2009

Ectopic pregnancy in a uterine perforation site.

Am J Obstet Gynecol 2009 Jul;201(1):e15-6

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Uterine perforation can occur following first-trimester abortion or more commonly postpartum after evacuation of retained placental tissues. We report a case of a pregnancy at the site of a recent uterine perforation. Possible mechanisms of this rare condition and different therapeutic options are mentioned.
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http://dx.doi.org/10.1016/j.ajog.2009.04.032DOI Listing
July 2009

Two dose regimens of nifedipine for management of preterm labor: a randomized controlled trial.

Am J Perinatol 2009 Sep 27;26(8):575-81. Epub 2009 Apr 27.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

We compared two dose regimens of tocolytic oral nifedipine. Women with singleton pregnancies admitted in preterm labor (24 to 34 weeks) were randomized to high-dose (HD) nifedipine ( N = 49; 20 mg loading dose, repeated in 30 minutes, daily 120 to 160 mg slow-release nifedipine for 48 hours followed by 80 to 120 mg daily until 36 weeks) or low-dose (LD) nifedipine ( N = 53; 10 mg, up to four doses every 15 minutes, daily 60 to 80 mg slow-release nifedipine for 48 hours followed by 60 mg daily until 36 weeks). Uterine quiescence at 48 hours (primary outcome); delivery at 48 hours, 34 and 37 weeks; and recurrent preterm labor were similar. Gestational age at delivery was higher in HD (36.0 +/- 2.8 versus 34.7 +/- 3.7 weeks, P = 0.049). Rescue treatment was needed more in LD (24.5 versus 50.9%, odds ratio = 0.3; 95% confidence interval 0.1 to 0.7). Maternal adverse effects, birth weight, intensive care nursery admission, and composite neonatal morbidity were similar. However, neonatal mechanical ventilation was needed less and nursery stay was shorter in HD. HD nifedipine does not seem to have an advantage over LD in achieving uterine quiescence at 48 hours. Further studies should address the optimal dose and formulation of tocolytic nifedipine.
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http://dx.doi.org/10.1055/s-0029-1220780DOI Listing
September 2009

Prescribing practices among Lebanese obstetricians for prenatal corticosteroids to enhance fetal lung maturity.

Int J Gynaecol Obstet 2009 Feb 28;104(2):144-5. Epub 2008 Nov 28.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

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http://dx.doi.org/10.1016/j.ijgo.2008.09.008DOI Listing
February 2009

Advanced maternal age. Part II: long-term consequences.

Am J Perinatol 2009 Feb 19;26(2):107-12. Epub 2008 Nov 19.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

In addition to the possible association between pregnancy in women with advanced maternal age and increased rates of obstetric and perinatal complications, those women and their children might suffer from long-term sequelae. In this review, the long-term consequences of delayed motherhood on the offspring and the possible association between advanced maternal age and the development of certain cancers are discussed.
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http://dx.doi.org/10.1055/s-0028-1090593DOI Listing
February 2009

Effect of 1-month war in Lebanon on sex ratio.

Fertil Steril 2009 Apr 18;91(4 Suppl):1571-3. Epub 2008 Nov 18.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Our study showed no effect of 33-day war in Lebanon on sex ratio. More research is needed to explore other modifying factors for a better understanding of the complex effect of wars on sex ratio changes.
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http://dx.doi.org/10.1016/j.fertnstert.2008.09.079DOI Listing
April 2009

Shoulder dystocia: what is the risk of recurrence?

Acta Obstet Gynecol Scand 2008 ;87(10):992-7

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Objective: To study the recurrence risk of shoulder dystocia in women who have previously experienced at least once shoulder dystocia.

Design: A retrospective study of vaginal deliveries complicated by shoulder dystocia. Setting. American University of Beirut Medical Center - Lebanon.

Sample: Vaginal deliveries complicated by shoulder dystocia over a 15-year period who had subsequent vaginal delivery. Methods. Charts of index and subsequent deliveries beyond 24 weeks' gestation were reviewed for demographics and intrapartum events. Women were divided into those with recurrent shoulder dystocia (group I) and those with uncomplicated subsequent delivery (group II) and compared.

Main Outcome Measures: Recurrent shoulder dystocia and characteristics of women with recurrence.

Results: The incidence of shoulder dystocia was 0.9% of all vaginal deliveries. Of 193 shoulder dystocia cases, 48 women had a subsequent delivery. After excluding cesarean deliveries (n=4), 44 women were analyzed. Eleven had recurrent shoulder dystocia (25.0%). Mean birthweight was larger (4,019+/-430 vs. 3,599+/-398 g, p=0.005) with a higher rate of macrosomia > or =4,000 g (63.6 vs. 15.2%, p=0.004) and the birthweight in the subsequent pregnancy was larger than the index pregnancy in a significantly larger proportion of women in group I compared with group II (72.7% vs. 33.3%, p=0.035). Otherwise, maternal age, gestational age at delivery, parity, duration of labor, gender, history of macrosomia, and interval between pregnancies were similar.

Conclusions: The risk of recurrence of shoulder dystocia is around 25%. When counseling women about recurrence risk, the absence of macrosomia and a smaller birthweight than the previous pregnancy could be reassuring.
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http://dx.doi.org/10.1080/00016340802415614DOI Listing
November 2008

Advanced maternal age. Part I: obstetric complications.

Am J Perinatol 2008 Sep 4;25(8):521-34. Epub 2008 Sep 4.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

More women are postponing pregnancy into the fourth and fifth decades of life for a variety of reasons. Advanced maternal age, traditionally defined as age more than 35 years, has been associated with increased obstetric morbidity and interventions. In addition, perinatal complications are reported to be higher in this patient population, although recent data point to a more favorable outcome. This article reviews the available literature with special emphasis on antepartum, intrapartum, and postpartum complications and perinatal outcome.
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http://dx.doi.org/10.1055/s-0028-1085620DOI Listing
September 2008

Attitude of women with IVF and spontaneous pregnancies towards prenatal screening.

Hum Reprod 2008 Nov 29;23(11):2438-43. Epub 2008 Jul 29.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Background: Factors influencing a pregnant woman's decision to accept prenatal testing are largely undefined. Our study aimed to compare the acceptance rate of prenatal diagnosis in women who conceived through IVF or ICSI (cases) with that of women who conceived spontaneously (controls).

Methods: Retrospective chart review in Lebanon of all primiparas carrying singletons who were offered prenatal testing (triple screen/amniocentesis) from 2004-2007. The influence of IVF/ICSI on the acceptance of prenatal screening was evaluated.

Results: 336 pregnant women were offered prenatal testing (120 cases and 216 controls). Cases were less likely to perform prenatal testing compared with controls (52.5 versus 72.7%; P < 0.001). The rate of utilization of prenatal testing was independent of the infertility cause. Multiple logistic regression analysis revealed that women who conceived through IVF/ICSI [odds ratio (OR) 0.427, 95% confidence interval (CI) 0.252-0.724], those >or=35 years old (OR 0.184, 95% CI 0.102-0.329) and lower socioeconomic class (OR 0.339, 95% CI 0.197-0.584) were less likely to perform triple screen test, and women who conceived through IVF/ICSI (OR 0.354, 95% CI 0.131-0.958) and those of lower socioeconomic class (OR 0.113, 95% CI 0.033-0.403) were less likely to perform amniocentesis.

Conclusions: There was a significant difference in acceptance rate of prenatal diagnostic testing between women who conceived through IVF/ICSI and those who conceived spontaneously. Women who conceived through IVF/ICSI were less likely to opt for prenatal diagnosis even after controlling for confounding variables.
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http://dx.doi.org/10.1093/humrep/den291DOI Listing
November 2008

Acceptance of preimplantation genetic diagnosis for beta-thalassemia in Lebanese women with previously affected children.

Prenat Diagn 2008 Sep;28(9):828-32

Genetics Laboratories, Chronic Care Center, Hazmieh, Lebanon.

Objective: The aim of the study was to assess the rate of acceptance of preimplantation genetic diagnosis (PGD) as an alternative to prenatal diagnosis in Lebanese women with previously affected children with homozygous beta-thalassemia.

Methods: Women with a previously affected child attending a non governmentally funded thalassemia care center between 1 June 2005 and 31 May 2007 were offered a genetic counseling session. This was followed by administering a questionnaire through direct interview.

Results: All 97 women approached accepted to participate in the study (100% response rate). Sixty eight per cent of women considered PGD a better alternative to prenatal diagnosis. The most important perceived advantage of PGD was the avoidance of termination of an affected pregnancy.

Conclusions: PGD is an acceptable alternative to conventional prenatal diagnosis in women at risk of conceiving a child affected with beta-thalassemia. This is particularly true in countries of the Middle-East where therapeutic abortions for fetal indications are prohibited by the law and religion.
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http://dx.doi.org/10.1002/pd.2067DOI Listing
September 2008

Effect of the Lebanese civil war on sex ratio.

Reprod Biomed Online 2008 ;17 Suppl 1:21-4

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.

Sex ratio is a subject of scientific interest but little is known about the factors that affect the sex ratio of humans. The aim of this study was to assess the effect of the Lebanese civil war on sex ratio. Data on all live births delivered at a large university hospital for the years 1977-2005 were used in this study. Study periods were defined as wartime (1977-1992) and post-war (1993-2005). The sex ratio in the study time period was calculated as the male proportion, i.e. males/males + females in live-born infants. Sex ratio during the war was compared with that of the post-war period. The sex ratio was similar in the war and post-war period (0.515 versus 0.513; OR = 1.007; 95% CI 0.98-1.04). The annual variation in the sex ratio during the study period did not show any significant change in any of the years. In conclusion, the Lebanese civil war did not cause a detectable change in sex ratio at birth. Factors that might have affected the sex ratio include the nature of the study population (civilians), the variable intensity of war in different periods, and the effect of stress and environmental toxins.
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http://dx.doi.org/10.1016/s1472-6483(10)60186-1DOI Listing
August 2008

Peripartum hysterectomy: 1999 to 2006.

Obstet Gynecol 2008 Jun;111(6):1446; author reply 1446-7

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http://dx.doi.org/10.1097/AOG.0b013e31817aff21DOI Listing
June 2008