The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s The short text of the guidelines is available on the CNGOF website at http://www.cngof.asso. fr/D_TELE/RPC%20GEMELLAIRE_2009.pdf (in French) and http://www.cngof.asso.fr/D_TELE/RPC_ Gemel_en.pdf (in english). The full guidelines have been published in the December 2009 issue of the “Journal de Gynécologie Obstétrique et Biologie de la Reproduction”. Because many areas of practice have not been well studied, the level of evidence and strength of the recommendations are low. Indeed, many of the recommendations are made on best opinion of the experts group but not on best evidence. However, we hope that these guidelines will improve twin gestation management and prognosis. In addition, these guidelines highlighted several questions that will lead to conduct further multicenter clinical studies. DELAYED INTERVAL DELIVERY: OUR CASE SERIES AT MGH Mohamad Khaled Ramadan MD It has been a frequent encounter to receive pregnant ladies in the emergency room presenting with full cervical dilatation or premature rupture of membranes rendering these unsalvageable in most cases of previability or severe prematurity in spite of efforts to rescue such pregnancies that are sometimes very precious and difficult to attain. This disparate situation has increased several folds owing to the surge in the number of multiple pregnancies in recent two decades. However, though the risk of preterm labor and preterm premature rupture of membranes is increased in multiple pregnancies, yet having more than one fetus especially with independent sacs and placentas provide a second or more chances of rescuing this pregnancy. A concept named delayed interval-delivery. We describe the outcome of six attempts at (Delayed Interval-Delivery) at our service with varying degrees of success. Four twins, one triplet and one quadruplet gestations were managed with this intention during the past thirteen years. Five of these six pregnancies presented with advanced cervical dilation due to PTL with the leading member of multiple gestation within its bulging membranes while one was due to PPROM. Four were previable and two were at the limits of viability. Two cases developed chorioamnionitis/septicemia and were delivered of the remaining members within 8 days after initial presentation. In all cases delivery of the latter sibling/s could be delayed and the range was 6-141 days. In all cases, except one twin gestation, the first member died immediately after delivery due to severe prematurity, while in 2 twin pregnancies the latter survived. In one case (25 weeks +1 day) the delivery of the second twin could be delayed 9 days with a 200g weight gain and 30 days less stay in the NICU together with better growth and neurodevelopment during the first year of life. The only case with impressive outcome was a delay of 141 days of the second twin following delivery of the first member at 19 weeks gestation. The salvage rate was 16% (1/6). There is no consensus as to the optimal management protocol of delayed interval-delivery and many components are still the grounds of debate. In spite of the complications inherent in such management plan, and in the absence of any specific well-detailed action plan for such hopeless cases, we recommend a minimally invasive management plan to postpone delivery of the second/more member of multiple gestation, and cannot but agree to the principle that multiple gestations might represent multiple chances for survival in pregnancies doomed to perish if it were a single gestation. 102
A SONOGRAPHIC SHORT CERVIX: CLINICAL SIGNIFICANCE AND TREATMENT PRETERM BIRTH EXAMINATION OF THE UTERINE CERVIX: DIAGNOSIS AND PITFALLS PRETERM BIRTH PREVENTION: WHAT IS PROGESTERONE AND HOE DOWS IT WORK? Sonia S. Hassan, MD Preterm birth is the leading cause of perinatal morbidity and mortality, accounting for 85% of neonatal deaths; one in eight babies was born preterm in 2005. This accounts for 530,000 newborns per year in the United States alone. Moreover, the complications of preterm birth can be devastating, as prematurity is the leading identifiable cause of neurologic handicap. The uterine cervix plays a central role in the maintenance of normal pregnancy and in parturition. Thus, cervical disorders have been implicated in common obstetrical complications, such as “cervical insufficiency”, preterm labor, and abnormal term parturition. Yet, there is an incomplete understanding of the physiology and pathology of untimely cervical effacement and dilatation during pregnancy. Midtrimester cervical dilation is a major diagnostic and therapeutic challenge and a subject of intense debate among clinicians and researchers. It is well established that a sonographic short cervix is the most powerful predictor of spontaneous preterm birth. Cervical sonography has been used most widely to assess the risk for spontaneous preterm birth in three circumstances: 1) asymptomatic patients; 2) patients at high risk for preterm delivery and/or mid-trimester loss; and 3) patients presenting with preterm labor. The cause of a sonographic short cervix is unknown; but it is proposed to be syndromic in nature. Sonographic imaging of the cervix is a less invasive, more precise and objective method of assessing the cervical status when compared to digital examination. Effacement (or cervical shortening), changes in the anatomy of the internal os (funneling), endocervical canal dilatation, and spontaneous modifications, or induced (transfundal pressure) can be determined by ultrasound examination. Therefore, several potential pitfalls should be avoided. These will be discussed at length and include: 1) excessive probe pressure (falsely long) 2) failure to observe cervical shortening for enough time (falsely long); 3) failure to recognize a poorly developed lower uterine segment; 4) unequal size and density of the anterior and posterior lips; 5) full bladder; 6) endocervical canal not visualized; and 7) lack of amniotic fluid sludge recognition. Sonographic cervical length has also been utilized to identify the patients who may benefit from cerclage placement or progesterone treatment. Yet, despite numerous trials conducted to determine a treatment for a sonographic short cervix, no standard, effective intervention is available. We will discuss past and ongoing clinical trials of the use of progesterone for the prevention of preterm birth. 103
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The IX th Makassed Medical Congress
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CONGRESS PRESIDENT Said Sayegh, MD,
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GENERAL INFORMATION
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• Target Audience: Physicians, Pr
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Durriya Sinno, MD Pediatrics Americ
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Moderators
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PEDIATRICS Bassem Abou Merhi, MD Pe
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Maroun Sokhn, MD Pediatrics Saint G
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Scientific Program
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Session 3: Intensive Care Neonatolo
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Session 1: Pediatric Intensive Care
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8:00 - 8:05 08:05 - 08:10 Welcome r
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Cardiology Session III: Interventio
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Cardiology Session VI: Intervention
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Cardiology Symposia (NON-CME) Frida
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T h e I X t h M a k a s e d M e d i
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The IX t h Makassed Medical Congress - American University of Beirut

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