Biomedical subjects

S M Ziadeh

Publications and source records attributed to S M Ziadeh.

14 recordsLinked to original sources

PubMed2001

Has consanguinity any impact on occurrence of pre-eclampsia and eclampsia?

In this study we tested the hypothesis of an association between consanguinity and pre-eclampsia/eclampsia. This is a case-control study conducted at Princess Badea Teaching Hospital, Irbid-Jordan during the period May 1997-April 1998. The study population were Jordanian women delivered at Princess Badea Teaching Hospital with or without hypertensive disorders of pregnancy. The total number was 208 pre-eclamptic/eclamptic women (76 primiparous and 132 multiparous) and 618 randomly selected non-hypertensive women. In primiparous as well as multiparous women, it was evident that neither consanguinity nor the degree of the relationship to the husband in consanguineous marriages had an impact on the incidence of preeclampsia/eclampsia. However, comparing the incidence of consanguinity between pre-eclamptic/eclamptic and non-hypertensive, multiparous women married to a relative other than first cousin, the P value was 0.0248, which we explained as chance incidence. When we compared the incidence of consanguineous marriages as a whole between pre-eclamptic/eclamptic and non-hypertensive, multiparous women, there was no evidence of any impact of consanguinity on the incidence of pre-eclampsia/eclampsia.

Journal Article↗

PubMed2001

Obstetrical outcomes amongst preterm singleton births.

OBJECTIVE: The purpose of this study was to review the outcome of preterm singleton neonatal morality based on birthweight and gestational age at delivery. METHODS: A retrospective review of hospital case notes of maternity data and neonatal mortality data was carried out on all singleton preterm deliveries from 26 to < 37 completed weeks between 1996 and 1999 to investigate neonatal death. RESULTS: There were 20,758 live-born singleton deliveries over the study period, of which 638 were preterm (3%). The overall neonatal mortality in the preterm group was 42/1000. The neonatal mortality rate fell with advancing gestational age from 174/1000 live births at 28 weeks to 37/1000 live births at < 37 completed weeks of gestation. The neonatal mortality rate also fell with increasing birth-weight from 285/1000 live births of 1000g to 14/1000 live births at 2500g. There was a significant increase in the proportion of babies delivered spontaneously. CONCLUSION: This study has demonstrated neonatal mortality using gestational age and birth weight. The results will be of use in obstetric management when elective preterm delivery is considered, and for providing prognostic guidance following preterm delivery.

Adult↗

PubMed2000

Obstetric and perinatal outcome of pregnancies with term labour and meconium-stained amniotic fluid.

The purpose of this study was to evaluate the meconium staining of amniotic fluid (AF) in term of fetal distress, meconium aspiration syndrome, and perinatal morbidity and mortality. In a prospective study at Princess Badeea Teaching Hospital from April to November 1999, women with a singleton cephalic pregnancy of completed 37-42 weeks and with no pre-defined risk factor were recruited into the study. Study patients comprised 390 (10%) patients with meconium and 400 patients as controls but with clear amniotic fluid. Virtually meconium staining of the amniotic fluid was significantly associated with poor neonatal outcome in all outcomes measures assessed. Perinatal mortality increased from 2 per 1000 births with clear AF to 10 per 1000 with meconium (P<0.001). Other adverse outcomes also increased; e. g., severe fetal acidemia, Apgar score < or = 3 at 1 min and 5 min, and meconium aspiration syndrome. Delivery by cesarean section also increased with meconium from 7-14% (P<0.001). We concluded that meconium in the amniotic fluids associated with an obstetric hazard and significantly increase risks of adverse neonatal outcomes. Women with thin meconium in the presence of normal fetal heart rate can be safely managed at the clinical level. Mod-thick meconium alone should alert the obstetrician to a high risk fetal condition. Continuous fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most significant factors in the reduction of meconium aspiration syndrome.

Adult↗

PubMed2000

Effect of mode of delivery on neonatal outcome of twins with birthweight under 1500 g.

OBJECTIVE: The purpose of this retrospective study was to evaluate. The mode of delivery on neonatal outcome of twins weighing <1500 g. METHODS: We reviewed the effect of birth order, presentation, and method of delivery on neonatal outcome in twin gestation under 1500 g at Princess Badeea' Teaching Hospital in North Jordan over the 6-years from 1994 to 1999. RESULTS: During the study period, there were 51475 deliveries of which 695 were twin gestations. One hundred and eight (108) sets of twins weighing <1500 g were included in the study (15.5%), of which 41 were in vertex-vertex presentation, 40 in vertex-nonvertex, and 27 with first twin in nonvertex presentation. The second twin pregnancies characterized by a higher incidence of respiratory distress syndrome (82 vs. 70%; p=0.02) more neonatal mortality (23 vs. 17.6%), and lower Apgar score at 1 and 5 min. Cesarean delivery for vertex-vertex presentation did not improve the neonatal outcome. Rather, the incidence of RDS was significantly greater in this group delivered by cesarean section (65.6 vs. 42%, p=0.012). For nonvertex presentation, those delivered by cesarean section had a lower incidence of neonatal mortality. CONCLUSION: We concluded there was no advantage for cesarean delivery that could be demonstrated after multivariate analysis to correct the differences in birthweight between the groups. Therefore, the differences in the neonatal outcome of non vertex twins presentation accounted for the differences in birthweight, rather than in mode of delivery.

Cesarean Section↗

PubMed2000

Perinatal outcome in 41 sets of triplets in Jordan.

BACKGROUND: Triplet births, which have increased greatly throughout the world in recent years, have a much greater risk of poor birth outcome than singleton births. The purpose of this study was to determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. METHODS: We conducted a retrospective study of 41 sets of triplets born between January 1, 1994, and June 30, 1999, at the Princess Badee'a Teaching Hospital in Amman, Jordan. The primary outcome measures were perinatal mortality and early neonatal complications. RESULTS: Of these sets, 21 triplets were delivered vaginally and 20 triplets were delivered by cesarean section. The perinatal mortality rate was 260 per 1000 live births in this series, primarily due to respiratory distress syndrome. The perinatal deaths occurred to infants whose birthweights were primarily 500 to 1500 g (90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5% vs 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0% vs 22.2%). CONCLUSIONS: These results suggested that cesarean delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal mortality rate was significantly higher than that in other recent series due to limited resources in Jordan.

Adult↗

PubMed2000

The effect of mode of delivery on neonatal outcome of twins with birthweight under 1500 grams.

The purpose of this retrospective study was to evaluate the mode of delivery on neonatal outcome of twins weighing <1500 grams. We reviewed the effect of birth order, presentation, and method of delivery on neonatal outcome in twin gestation under 1500 grams at Princess Badeea' Teaching Hospital in North Jordan over the 6 years from 1994 to 1999. During the study period, there were 51 475 deliveries of which 695 were twin. One hundred and eight (108) sets of twins weighing <1500 grams were included in the study (15.5%), of which 41 were in vertex-vertex presentation, 40 in vertex-nonvertex, and 27 with first twin in nonvertex presentation. The second twin was characterised by a higher incidence of respiratory distress syndrome (82% vs. 70%; P = 0.02), more neonatal mortality (23% vs. 17.6%), and lower Apgar scores at 1 and 5 minutes. Cesarean delivery for vertex-vertex presentation did not improve the neonatal outcome. Rather, the incidence of RDS was significantly greater in this group delivered by caesarean section (65.6% vs. 42%; P = 0.012). For nonvertex presentation, those delivered by caesarean section had a lower incidence of neonatal mortality. We conclude that there was no advantage in caesarean delivery after multivariate analysis to correct for differences in birthweight between the groups. The differences in the neonatal outcome of nonvertex twin presentation was accounted for by the differences in birthweight, rather than in mode of delivery.

Journal Article↗

PubMed2000

The outcome of triplet versus twin pregnancies.

OBJECTIVE: The purpose of this study was to examine and to determine whether triplet pregnancies are associated with a significantly greater risk of adverse outcome than are twin pregnancies. METHODS: Maternal and perinatal outcomes were evaluated retrospectively in 41 sets of triplets and twin pregnancies that were matched for maternal age, parity, mode of delivery, preterm delivery, mode of conception, and antepartum complications. MAIN OUTCOME MEASURES: Perinatal outcome in triplet versus twin gestation. RESULTS: Triplets had a significantly lower mean average birth weight than in twin gestation (1,596 vs. 2,317 g, p<0.018) and gestational age at delivery (32.9 vs. 35.9 weeks; p< 0.03). Preterm labour occurred significantly more often in triplet than in twin gestation (80.5 vs. 41.5%) as did preterm delivery (87.8 vs. 46.2%). Triplets required a longer hospital stay than did twins (25 vs. 9 days; p<0.04). There were no significant differences between the groups in number of administrations to the Special Care Baby Unit (32.5 vs. 30.5%). Apgar score <7 at 5 min was significantly more in triplet as compared with twin gestation (17 vs. 6%; p<0.0015). Neonatal deaths occurred significantly more in triplets than in twins (26 vs. 8.5%; p< 0.0001). There were no significant differences between the groups in maternal antepartum or neonatal complications such as anaemia, pregnancy-induced hypertension, placental abruption, respiratory distress syndrome or intraventricular haemorrhage. Preterm labour was the only complication that occurred significantly more often in the triplet than in the twin gestation. CONCLUSIONS: We concluded that this information could be useful in counseling patients with respect to the anticipated perinatal outcome of triplet pregnancies.

Adult↗

PubMed2000

Perinatal outcome in 41 sets of triplets.

OBJECTIVE: To determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. METHODS: Retrospective analysis of maternal and neonatal medical records of 41 triplets. 21 were delivered vaginally and 20 were delivered by cesarean section. MAIN OUTCOME: To measure perinatal mortality and early neonatal complications. RESULTS: Between January 1, 1994, and June 30, 1999, there were 41 triplets delivered at our institution. Of these 21 triplets were delivered vaginally and 20 triplets were delivered abdominally. The perinatal mortality rate was 32/123 (26.0%), primarily due to the respiratory distress syndrome. The perinatal deaths are mainly at a birth weight of 500-1,500 g (29/32; 90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5 vs. 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0 vs. 22. 2%). CONCLUSIONS: Abdominal delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal deaths are increased with low birth weight (500-1,500 g) and with breech presentation. The main cause of neonatal mortality is the respiratory distress syndrome.

Cesarean Section↗

PubMed1999

Placental praevia and accreta: an analysis of two-years' experience.

This retrospective review of the case records was designed to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. All women delivered with the diagnosis of placenta praevia at Princess Badeea Teaching Hospital from 1 January 1995 to 31 December 1996 were analysed. There were 18 651 deliveries in the study period. Sixty-five had placenta praevia, 21 of whom had a history of previous caesarean. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%) (P<0.0001). The risk increased as the number of previous caesarean sections increased. We also conclude that there is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections.

Journal Article↗

PubMed1999

Obstetric uterine rupture: a four-year clinical analysis.

OBJECTIVE: The purpose of our study was to identify the risk factors of uterine rupture during labour, to report maternal and neonatal outcome, and to propose preventive measures. STUDY DESIGN: A retrospective study with review of patients' files and monitor strips was performed. RESULTS: Between January 1, 1994 and November 30, 1998, there were 21 cases of uterine rupture at our institution. Of these, 6 patients had complete rupture, and 15 had incomplete rupture. The risk of uterine rupture was increased in patients who had a history of one or more Caesarean sections, obstructed labour, dysfunctional labour, and those who had injudicious use of uterine stimulants. There was no maternal death and fetal loss was 7 (33.3%). CONCLUSIONS: The high incidence of uterine rupture is attributed to lack of prenatal care, labour in high-risk patients outside hospital because of declining economy, and more patients with two or more previously scarred uterus. The maternal and neonatal complications have remained very high in the developing countries. We recommend that all patients with a history of Caesarean delivery should be delivered in hospital and observed closely for progression of labour, recognition of an active phase arrest requires operative delivery.

Adult↗

PubMed1997

Pregnancy rates using CC/hMG or hMG alone.

OBJECTIVE: The purpose of our study was to determine which of the two drug regimens is more successful in achieving conception in the infertile couple. SUBJECTS: One hundred and sixty women with primary infertility were included in this study. Group A, consisted of 102 patients were treated with clomiphene citrate (CC) and human menopausal gonadotrophin (hMG). Group B, consisted of 58 patients were treated with hMG alone. METHODS: This retrospective study was performed between April 1993 and March 1996, to compare the pregnancy rates in women using two drug regimens with ultrasound scan and serum E2 to monitor ovulation induction. RESULTS: The pregnancy rate per patient in Group A was significantly higher than in Group B (46% vs 25.9%) as was the pregnancy rate per treatment cycle (31.3% vs 15.8%) pregnancy loss was lower in Group A than in Group B (17% vs 33.3%). The incidence of multiple pregnancy was 8.5% in Group A, and 13.3% in Group B. While the incidence of ovarian hyperstimulation syndrome was 3% in Group A, and 6.9% in Group B. CONCLUSIONS: We concluded that the use of CC + hMG in an assisted conception programme gives a better pregnancy rate 46% than in the hMG alone 25.9%. These data with the use of U/S scan and serum E2 clearly showed that the use of CC + hMG is a successful and safe method for the treatment of infertile patients.

Adult↗

PubMed1996

Obstetric uterine rupture in north Jordan.

OBJECTIVE: The purpose of our study was to determine the aetiological factors of uterine rupture during labour, and propose preventive measures. METHODS: This retrospective study was performed between February 1989 and July 1994, to analyze the cases of rupture uterus in relation to causes, age, parity, maternal and fetal mortality and morbidity. RESULTS: There were 37 cases of uterine rupture at our institutions. Obstructed labour by malpresentation and disproportion was the main cause. The presence of previous caesarean section scar, dysfunctional labour, injudicious use of uterine stimulant, were the other causes. There was no maternal death and the fetal loss was 17 (46%). CONCLUSIONS: The high incidence of uterine rupture is attributed to lack of prenatal care, labour in high risk patients outside the hospital because of declining economy, and more patients with 2 or more previously scarred uterus with many of them labouring more than 14 hours. Maternal and neonatal complications have remained very high in the developing countries.

Adult↗

PubMed1995

Decreased cesarean birth rates and improved perinatal outcome: a seven-year study.

This study examined the decrease in cesarean section rates in relation to perinatal mortality between 1987 and 1993 at the primary referral hospital in north Jordan. Most of the population is at high risk and of low socioeconomic status. The cesarean section rate decreased from 15.5 percent in 1987 to 8.7 percent in 1993, and has remained at this low rate. During the same period the perinatal mortality dropped from 52 to 20.9 deaths per 1000 live births. These results do not include perinatal morbidity. The successful reduction of the cesarean section rate is attributed to active management of labor, trial of labor for women with a previous cesarean birth, and vaginal breech delivery in selected women. We conclude that the rate of cesarean delivery can be safely reduced in a developing country without adverse effects on birth outcomes.

Cesarean Section↗

PubMed1994

Duration of labor in patients delivered vaginally after one previous lower segment cesarean section.

OBJECTIVES: To determine the presence or significance of labor patterns in women attempting vaginal birth after a previous cesarean. METHODS: This prospective study was performed for patients who have only had one prior birth by cesarean section. Eighty-four women who had a cesarean section for failure to progress in labor had a trial of labor. RESULTS: Fifty-eight were delivered vaginally. This has been matched to nulliparous and multiparous controls. The duration of the first and second stages of labor were similar in the study group and controls. There was no significant difference in oxytocin requirements among the three groups. CONCLUSIONS: Patients who have had a previous cesarean section for failure to progress, have a duration of labor similar to primiparous patients.

Cesarean Section↗