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OBJECTIVE: This study aims to determine the characteristics and outcome of prenatally diagnosed cardiac rhabdomyomas. STUDY DESIGN: This retrospective descriptive study includes cases referred to our university hospital. We studied sonographic characteristics of rhabdomyoma along with the neonatal outcome. RESULTS: Eight cases were included, with a mean gestational age at diagnosis at 31 weeks of gestation and five patients diagnosed after 32 weeks. We noted a male gender in 75%, multiple rhabdomyoma in 50%, mostly situated in the interventricular septum (41%) and valvular regurgitation in 25%. Most patients delivered at term, including five cesareans (62.5%). Six babies survived (75%); three of them were later diagnosed with tuberous sclerosis (50%). CONCLUSION: Cardiac rhabdomyoma have variable ultrasound features. The usual favorable outcome can however be complicated by neonatal death (12%), valvular regurgitation and cerebral tuber.

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Low-income countries do not have well-established simulation centers; introduction of simulation-based learning in obstetrics faces many cost-associated difficulties. Simulation-based learning yield many benefits that are reported in many studies such as improved maternal and neonatal outcomes, social stature of medical teachers, and better management of difficult situations. Though low-income countries do not have established surgical simulations, centralization, and cooperation amongst the educational institutions and local and regional hospitals for maintenance of medical educational practices and financial supplementation through both established and newly created entities will provide the potential for improved patient outcomes and maintenance of quality of education, that is, comparable to the medical education found in higher income countries.

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The authors report a patient admitted at 12 weeks of pregnancy with an acute infectious syndrome, leading to abortion, sepsis, and multiple organ failure. Admission to intensive care unit (ICU) was needed after curettage for incomplete abortion complicated by uterine atony, hemorrhage, and septic shock. The patient had multiple organ failure and required non-invasive ventilation. Hemoculture showed streptococcus G bacteremia. She had no evidence of concurrent infection, mainly genital or urinary, except amygdalitis few days before. Hematogenous spread to the gestational sac could have possibly been the cause of her sepsis. Streptococcus G infection during pregnancy can lead to severe consequences.

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OBJECTIVE: To assess the awareness and knowledge of pregnant Lebanese women about the risks of drinking during pregnancy and the factors that influence their drinking patterns. MATERIALS AND METHODS: A prospective study was conducted on a sample of 107 women consulting the gynecology outpatient department of Hôtel-Dieu de France in Beirut, Lebanon, who completed the T-ACE screening test included in a 21 multiple choice questionnaire which examine knowledge and beliefs about alcohol use during pregnancy, drinking patterns and awareness of fetal alcohol exposure. RESULTS: The 107 women of our sample were all married, between 20 and 41 years old and had mostly a high educational level (86%). Most of the women (47%) were at their first pregnancy. Of the 20 women who self-reported drinking during pregnancy, 60% obtained a positive score on the T-ACE questionnaire, which indicates that more than 11% of the women engaged with potentially high risk drinking for the baby. There is not a significant difference between the different age categories or educational levels. This proportion is lower than that found in international publications. However, the rate of excessive drinking (4 drinks or more on any one occasion in females) was higher and one woman in five reported excessive drinking in the previous year. There is a high level of knowledge that alcohol use during pregnancy is harmful to the child, and the more consumption the more harmful and likely the effects, but there is confusion about the safety of small amounts of alcohol. Women (37%) think that there is a safe level of drinking during pregnancy; 29% tolerate up to one drink a month, 9% tolerate up to one drink a week and one woman thinks having one drink a day is safe. Women who actually drink during pregnancy are more likely to think that alcohol consumption to a certain level is safe. Women (31%) think that beer and/or wine are safe alcohols to a certain level during pregnancy. When asked about the source of this belief, 22% mention a gynecologist but the majority (61%) says it is a personal belief. Women (65%) in our sample are aware that alcohol use during pregnancy can lead to life-long disabilities in a child, such as delayed development (36%), birth defects/deformities (35%) and mental retardation (32%). However, up to 33% of the respondents report having no information about the effects of alcohol on the fetus and two women believe alcohol is not harmful at all. Women with lower levels of education are somewhat less knowledgeable about the risks of alcohol use during pregnancy than those with higher levels of education. There is no association between the drinking patterns of the women with their age, their professional habits and the alcohol consumption of their husbands. The women in our sample seem to be more aware of the necessity to stop smoking rather than stop drinking during pregnancy. CONCLUSION: Lebanese women are not fully aware of the recommendations and risks related to drinking during pregnancy. This is the reason why action must be taken to ensure better diffusion of these recommendations and better assessment of alcohol intake during prenatal visits.

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OBJECTIVES: To study the prevalence of depression during pregnancy and its associated risk factors in Lebanese women. MATERIALS AND METHODS: A prospective randomized study was conducted on a sample of 79 women consulting the gynecology outpatient department of Hotel-Dieu de France in Beirut, Lebanon who completed the Beck depression inventory as well as a 45 multiple choice questionnaire covering known risk factors implicated in depression during pregnancy. RESULTS: The 79 women of our sample were mostly over 20 years old, had a high educational level, and were almost all in the second or third trimesters of pregnancy. The prevalence of depression was 13.9%, without a significant difference between the different trimesters. Risk factors implicated were: personal or familial history of depression (OR = 8.1 and 4.9 respectively), a history of anti-depressive medication (OR = 12.4) and oral contraceptives (OR = 4.9), mood disorders associated with menstruation (OR = 8), major financial problems (OR = 10.5), medical complications associated with pregnancy (OR = 6.9), unwanted pregnancy (OR = 6.4), lack of support from the husband (OR=10.4), and poor quality of sexual relationship (OR = 13.3). CONCLUSION: Our results were comparable to those in the literature. Depression during pregnancy is a common problem in Lebanon, which should be treated and diagnosed early.

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The Authors report a case where cocaine abuse during pregnancy assessed by drug analysis at various site was associated with foetal microcephaly. Foetal pathologic findings revealed anomalies in neuronal migration and in the vascular architecture in the brain. Such anomalies might be the result of prolonged exposure to cocaine in utero, aggravated by the high concentration of cocaine metabolites in the amniotic fluid over a prolonged period.

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OBJECTIVE: To assess the effectiveness of a protocol of pulsatile gonadotropin releasing-hormone (GnRH) in treating infertility in women with primary hypothalamic amenorrhea. STUDY DESIGN: Retrospective analysis of 44 cycles treated at an infertility center. Twenty-four patients with primary hypothalamic amenorrhea were treated intravenously with pulsatile GnRH using 5 micrograms per bolus every 90 minutes. Ultrasound monitoring and cervical assessment by Insler's scoring system allowed timed injection of human chorionic gonadotropin (hCG) and intrauterine insemination if needed. Luteal support was provided with hCG. RESULTS: The ovulation rate was 95% with the 5-microgram dose. A single follicle was produced in 91% of cycles. The overall pregnancy rate per ovulatory cycle was 45%, and the pregnancy rate per patient was 83%. In patients treated previously with exogenous gonadotropins, poor results were observed. Only one case of mild overstimulation was reported. CONCLUSION: Pulsatile GnRH is an effective and safe method of treating infertility in women with primary hypothalamic amenorrhea, thus simulating normal ovulation; however, more-interventional management, including the qualitative estrogenic response, may lead to optimal results and increase the pregnancy rate.

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In a review of the literature the authors describe the complications encountered during gynecological laparoscopy, insisting on the preparation phase, the conversion to laparotomy and the death cases. Vascular, digestive and urinary lesions, as well as anesthetic difficulties are discussed, aiming at a better prevention. Early recognition of the problem is an important prognostic factor for these patients.

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Prenatal diagnosis of neuroblastoma is a rare event. Two cases diagnosed at 32 and 34 weeks are reported together with a description of the various ultrasound appearances of this tumor. Both cases had a favorable outcome and surgery was necessary in only one case. The management options are discussed in the light of the current literature. The role of ultrasound in the detection and follow-up of this tumor in the third trimester of pregnancy is discussed.

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The association between pregnancy and Cushing syndrome is extremely rare. The diagnosis of Cushing syndrome during pregnancy is rendered difficult by hyperoestrogenic state that alters many of the classical tests. An early and precise diagnosis with adequate management will allow us to reduce maternal and fetal risks.

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