Anwar H. Nassar

Obstetric outcome of teenage pregnancies compared with adult pregnancies

Background. To compare the obstetric outcome of teenage pregnancies with that of older women. Methods. Retrospective chart review of singleton births ≥24 weeks’ gestational age at the American University of Beirut from 1994 to 2003. Adolescents (<20 years) were compared to subsequently delivered women aged 25–30 years (controls), n = 486 each. Results. Only 131 (27.0%) adolescents were <18 years. More adolescents were nulliparous (79.8 versus 17.9%; p<0.0001). Preterm delivery <37 but not <34 weeks occurred more frequently in cases (11.1 versus 5.8%, p = 0.004). Pre‐eclampsia was more commonly encountered (2.9 versus 0.6%; p = 0.012) and mean predelivery haematocrit was lower in cases (30.6±3.3 versus 33.8±4.3%, p<0.001), but the incidence of gestational diabetes, placenta previa, abruptio placentae, breech presentation, or meconium‐stained amniotic fluid were similar. Caesarean delivery was performed less frequently in cases (9.2 versus 14.0%; p = 0.028), but primary caesarean and operative vaginal delivery rates were similar though vacuum was used more frequently in multiparous controls (0.2 versus 2.7%, p = 0.011). Nulliparous cases had shorter first and second stages of labour (384±304 versus 524±339 min, p<0.0001 and 47±36 versus 63±50 min, p = 0.002), respectively. Mean birth weight was higher in controls (3177±567 versus 3284±511 g, p<0.001), but intrauterine growth restriction, birth weight <2500 g, low Apgar scores, intrauterine fetal death, and stillbirths were similar in both groups. Conclusions. Adolescents are more likely to deliver preterm than older women, and are more likely to suffer from anaemia and pre‐eclampsia. Nulliparous adolescents have a quicker progress of labour while multiparous adolescents require vacuum less frequently compared to their older counterparts. In most other respects, they have comparable maternal and perinatal morbidity.

A randomised comparison of patient satisfaction with vaginal and sublingual misoprostol for induction of labour at term

Objectiveu2002 To compare patient satisfaction with two routes of misoprostol for term labour induction.

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.

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

Incidence and correlates of cesarean section in a capital city of a middle-income country.

Abstract Objective: To determine the prevalence and correlates of cesarean deliveries (CS) in Beirut. Methods: A cross-sectional study conducted on 18,837 consecutive infants born at nine hospitals from the National Collaborative Perinatal Neonatal Network (NCPNN). Stepwise Logistic Regression was performed to determine CS correlates. Results: The rate of CS was 26.4% and correlated with socio-demographic, obstetrical and provider-related variables. Regression analysis identified age, paternal occupation, mode of payment, parity, birth weight, gestational age, multiple pregnancies, adequate prenatal care, complications during pregnancy, body mass index at delivery, hospital teaching status, day of the week and year of delivery to be significant correlates of CS. Conclusion: This study shows an increased CS rate in a middle-income country, and identifies the correlates of women delivering by the abdominal route. These correlates may be used for effective reduction policies in the future.