Antoine Abu Musa

Fetal Macrosomia (≥4500 g): Perinatal Outcome of 231 Cases According to the Mode of Delivery

OBJECTIVE: To determine perinatal complications in infants ≥4500 g according to delivery mode.STUDY DESIGN: Records of 231 mothers and live cephalic infants weighing ≥4500 g over a 13-year period were retrospectively reviewed. Maternal and perinatal complications were compared in relation to delivery mode.RESULTS: Vaginal delivery (NVD) was achievable in 168/189 (88.9%) of women allowed to labor, of which 36.9% were operative. The cesarean delivery (CS) rate was 27.3%. The NVD group had a lower incidence of diabetes; however, hypoglycemia and transient tachypnea were more common in the CS group. The frequency of low Apgar scores at 1 and 5 minutes was similar in both groups. A total of 13 (7.7%) major fetal injuries were documented in the NVD group (arm weakness 3, hematoma 3, clavicular fracture 2, and brachial plexus injury 5). Shoulder dystocia was documented in only 7/13 (53.8%).CONCLUSION: Vaginal delivery is achievable in 88.9% of pregnancies with infants ≥4500 g allowed to labor, at the expense of a 7.7% risk of perinatal trauma.

Pregnancy outcome in patients with previous uterine rupture

Background. To review the outcome of subsequent pregnancies in conservatively managed cases of uterine rupture. Methods. Charts of patients with full thickness uterine rupture in the past 25 years were reviewed and information on subsequent pregnancies was extracted from maternal and neonatal charts. Results. Thirty‐seven patients with uterine rupture were identified; the uterus was scarred in 62.2%. Ruptures were repaired in 26 (70.3%). Twelve patients subsequently conceived (24 pregnancies), with recurrence in 8/24 (33.3%) pregnancies or 5/12 (41.7%) patients. Patients with recurrence had a shorter median interval from previous rupture (2 versus 5 years), a higher incidence of previous longitudinal ruptures (60.0% versus 0.0%), and the median gestational age at the preceding rupture was lower without reaching statistical significance (34 versus 38 weeks; p = 0.209). Conclusions. Longitudinal ruptures and short intervals between rupture and subsequent pregnancy predispose to recurrence of uterine rupture.

Addition of sphingosine-1-phosphate to human oocyte culture medium decreases embryo fragmentation.

Apoptosis is implicated in the fragmentation of preimplantation mammalian embryos, yet the extent of this association remains controversial. The aim of this study was to assess the ability of sphingosine-1-phosphate (S1P), a known anti-apoptotic substance, to reduce the fragmentation rate of human preimplantation embryos when added to their culture microenvironment. Mature human oocytes were inseminated using intracytoplasmic sperm injection, incubated for 3 days and evaluated for embryo quality and fragmentation by the same embryologist. Oocytes in the study group were manipulated and cultured in culture medium supplemented with S1P to a 20 micromol/l concentration. A total of 46 patients donated 177 mature oocytes for the study group and 546 oocytes for the control group. The fertilization rate was significantly lower in the S1P-supplemented group (52.4% versus 67.3%; P=0.002) and the proportion of grade I embryos with less than 15% fragmentation was significantly higher in the same group (79.5% versus 53.9%; P<0.0001). Sphingosine-1-phosphate added to the culture medium of human preimplantation embryos is associated with a significantly lower fragmentation rate and hence better quality embryos. The clinical significance of these findings on reproductive outcome remains highly speculative awaiting further studies to translate this improvement in embryo quality into better pregnancy rates.

Effect of war on the menstrual cycle.

OBJECTIVE: To study the effect of a short period of war on the menstrual cycles of exposed women. METHODS: Six months after a 16-day war, women in exposed villages aged 15–45 years were asked to complete a questionnaire relating to their menstrual history at the beginning, 3 months after, and 6 months after the war. A control group, not exposed to war, was also interviewed. The data collected were analyzed to estimate the effect of war on three groups of women: those who stayed in the war zone for 3–16 days (Group A), those who were displaced within 2 days to safer areas (Group B), and women not exposed to war or displacement (Group C-control). RESULTS: More than 35% of women in Group A and 10.5% in Group B had menstrual aberrations 3 months after the cessation of the war. These percentages were significantly different from each other and from that in Group C (2.6%). Six months after the war most women regained their regular menstrual cycles with the exception of 18.6% in Group A. CONCLUSION: We found a short period of war, acting like an acute stressful condition, resulted in menstrual abnormalities in 10–35% of women and is probably related to the duration of exposure to war. This might last beyond the war time and for more than one or two cycles. In most women the irregular cycles reversed without any medical intervention. LEVEL OF EVIDENCE: II

Effect of female nargile smoking on in vitro fertilization outcome.

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.

Undiagnosed term breech: impact on mode of delivery and neonatal outcome.

Background.  The purpose of this study was to compare delivery mode and neonatal outcome in breech pregnancies diagnosed antepartum (Dx group) with those diagnosed on admission for delivery or intrapartum (No‐Dx group).

Effect of powdered gloves, worn at the time of embryo transfer, on the pregnancy outcome of IVF cycles

PurposeTo assess the effect of wearing powdered gloves during embryo transfer as compared to un-powdered gloves on the pregnancy outcome of IVF cycles.MethodsPatients, undergoing embryo transfer procedures, were prospectively randomized into two groups: In the first (group A, n=356) group embryo transfer was performed while wearing powdered gloves; in the second (group B, n=356) group embryo transfer was performed while wearing un-powdered gloves. The primary end point of the study was the clinical pregnancy rate.ResultsThe two groups were comparable with respect to the mean age, mean number of grade one embryos obtained, and the mean number of embryos transferred. The clinical pregnancy rates of the two groups were not different.ConclusionsPowdered gloves, worn during embryo transfer, have no adverse effect on the pregnancy outcome of IVF cycles.