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Chibber R.,Kuwait University | Al-Harmi J.,Kuwait University | Fouda M.,Al Adan Tertiary Hospital | El-Saleh E.,Kuwait University
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2015

Objectives: (1) To evaluate maternal and fetal outcome after motor-vehicle injury during pregnancy. (2) To determine if there was prenatal care provider counseling for seat belt use. Methods: Retrospective chart analysis of materno-fetal outcome following motor vehicle injury in 728 pregnant women between 2009 and 2012. Women attending antenatal clinics over these years were asked if they were counseled regarding correct seat belt use by prenatal health care providers during their antenatal visits. Results: In these pregnant women, 80 (11%) sustained minor injuries/sprains. 648 women (89%) had severe adverse materno-fetal pregnancy outcomes. Important causes being: (1) placental abruption 58.8%; (2) preterm labor (40%); and (3) uterine rupture (1.6%). There were 100 (13.7%) maternal and 78 (10.7%) fetal deaths. 91 (12.5%) perimortem cesarean deliveries were performed and 74 (81%) fetus survived, as did 31 women. Prenatal care provider counseling for seat belt use occurred in 44.8% of prenatal visit. Only 125 (21%) were using seat belt during the accident. Conclusion: Important causes of adverse pregnancy outcome were: abruptio placenta, preterm labor and uterine rupture. There were 100 maternal and 78 fetal deaths with 97 preterm births. Counseling occurred in 44.8% of women. Those using seat belts during the accidents sustained minor injuries. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.


Al-Harmi J.,Kuwait University | Chibber R.,Kuwait University | Fouda M.,Al Adan Tertiary Hospital | Mohammed K Z.,Al Adan Tertiary Hospital | And 2 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2015

Objective: To determine whether cervical membrane sweeping during labor induction is beneficial.Methods: Outcomes of labor after induction in pregnant women at term were compared in a randomized trial. Women were assigned to having their membranes "swept" or "not swept" at the initiation of labor induction.Results: We recruited a total of 870 women of which 70 were excluded. There were 400 nullipara (Group A) [198 "swept", 202 "not swept"] and 400 multiparas (Group B) (201 "swept" and 199 "not swept"]. Among group A who received intravaginal prostaglandin (PG) E2, those who had simultaneous sweeping had significantly shorter mean induction-labor interval (12.9 ± 1.3 versus 16.2 ± 1.1 hours, p = 0.046), lower mean dose of oxytocin (6.6 ± 0.6 versus 10.11 ± 1.4 mU/minute, p = 0.01), and increased normal delivery rates (vaginal delivery 82.8% versus 58.6%, p = 0.01). Sweeping also had a favorable effect on nulliparas who had ARM and received oxytocin alone (mean induction-labor interval 5.9 ± 2.9 versus 10.9 ± 2.6 hours p = 0.04, mean maximum dose of oxytocin 9.8 ± 1.1 versus 15.2 ± 1.1 mU/min, p = 0.01). These results were restricted to women with unfavorable cervix in Group A those who had membrane sweeping.Conclusion: Membrane sweeping, has beneficial effects on labor and delivery, which is limited to nulliparas with unfavorable cervix requiring PGE2 or Oxytocin alone. © 2014 Informa UK Ltd.


Chibber R.,Kuwait University | Al-Harmi J.,Kuwait University | Foda M.,Al Adan Tertiary Hospital | Mohammed K Z.,Al Adan Tertiary Hospital | And 2 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2015

Objective: To compare the outcome of induced and spontaneous labor in grand multiparous women with one previous lower segment cesarean section (CS), so that the safety of labor induction could be assessed. Methods: In 102 women (study group), labor was induced and the outcome was compared with 280 women (control group) who went into spontaneous labor. All 382 women were grand multiparous and had one previous CS. Results: There were no significant difference in oxytocin augmentation, CS, scar dehiscence, fetal birth weight or apgar scores between groups. There was one neonatal death, two still births, one early neonatal death and one congenital malformation in the study group and this was not significant. There was no significant difference in vaginal birth in the study (80.9%) and the control group (83.8%). Conclusion: In this moderate-sized study, induction of labor may be a safe option in grand multiparous women, if there is no absolute induction for repeating CS. © 2014 Informa UK Ltd.


Chibber R.,Kuwait University | Fouda M.,Al Adan Tertiary Hospital | Al-Hijji J.,Al Adan Tertiary Hospital | Al-Dossary M.,Al Adan Tertiary Hospital | And 4 more authors.
Journal of Obstetrics and Gynaecology | Year: 2014

The objective of this retrospective analysis was to evaluate maternal, fetal and neonatal outcomes in primi-adolescent pregnancies in Kuwait. Case records of primigravidae under 29 years of age, attending the antenatal clinic at our tertiary hospital, between January 2002 and December 2010, were analysed. The study group (up to 19 years of age at first pregnancy) consisted of 3,863 women and the control group (20-29 years of age at first pregnancy) comprised of 4,416 women. Maternal obstetric, fetal and neonatal complications were compared between the groups. Rates of ectopic pregnancy, pre-eclampsia, eclampsia, preterm labour, premature rupture of membrane and caesarean section were significantly higher among adolescents < 15 years of age; the risk then decreased steadily with age and became comparable with the control group after 16 years of age. © 2014 Informa UK, Ltd.


Chibber R.,Kuwait University | Fouda M.,Al Adan Tertiary Hospital | Shishtawy W.,Al Adan Tertiary Hospital | Al-Dossary M.,Al Adan Tertiary Hospital | And 3 more authors.
Archives of Gynecology and Obstetrics | Year: 2013

Objectives: To review the maternal and fetal outcome of triplet, quadruplet and quintuplet gestations following ART, which were managed at a hospital over 11 years. Study design: Retrospective chart review of 150 triplet, 27 quadruplet, and 6 quintuplet pregnancies between January 2001 and December 2011. 25 women aged 50-56 years with triplet pregnancies, were excluded due to lack of data. No prophylactic interventions were used. Results: 300 triplets, 108 quadruplets, and 30 quintuplets were born. The mean maternal age was 30.2 years (SD 4.2 years). Mean gestational age delivery was 32.2 weeks (SD 4.2 weeks). Maternal complications included preterm labor 114 (86 %), prematurity 115 (87 %), anemia 44 (33 %) gestational diabetes 35 (27 %), preeclampsia 33 (25 %), post partum hemorrhage 13 (10 %). Preterm labor was diagnosed in 84 (84 %) triplets, 32 (97 %) of quadru- and quintuplet pregnancies (P > 0.05). Prematurity and preterm labor were major determinants. Of the 438 fetuses born there were 57 (13 %) still births, 77 (18 %) neonatal deaths. 32 (7 %) were early neonatal deaths, 45 (10 %) late neonatal deaths. The majority died due to extreme low birth weight. 75 (17 %) neonates had low apgar score of <7 at 5 min. 22 (5 %) infants had congenital anomalies. Severe respiratory distress syndrome, perinatal asphyxia, very early preterm delivery and perinatal mortality were higher in quadru- and quintuplets (P < 0.05). Conclusion: Preterm labor and preterm prematurity were the commonest complications. Neonatal mortality and morbidity was significantly increased in quadru- and quintuplets. Prophylactic interventions were not used in an attempt to prevent preterm labor. © 2013 Springer-Verlag Berlin Heidelberg.

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