George Saade

University of Texas Medical Branch at Galveston, Galveston, Texas, United States

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Publications (614)1523.63 Total impact

  • Luis D Pacheco, George R Saade, Gary D V Hankins
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    ABSTRACT: Myocardial infarction complicating pregnancy is an important cause of maternal morbidity and mortality. The coexistence of obesity, diabetes, chronic hypertension, and delayed age at pregnancy is expected to increase the prevalence of myocardial infarction during pregnancy. Timely treatment in the form of percutaneous coronary intervention has dramatically improved outcomes. Early medical treatment with antiplatelet and antithrombotic agents is important, and maternal fetal medicine specialists must be familiar with it. In this article we will describe the basic initial medical management of patients with an acute coronary syndrome.
    Clinical obstetrics and gynecology. 10/2014;
  • Luis D Pacheco, George R Saade, Gary Dv Hankins
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    ABSTRACT: Severe sepsis is a major cause of mortality among critically ill patients. Early recognition accompanied by early initiation of broad-spectrum antibiotics with source control and fluid resuscitation improves outcomes. Hemodynamic resuscitation starts with fluid therapy followed by vasopressors if necessary. Cases refractory to first-line vasopressors (norepinephrine) will require second-line vasopressors (epinephrine or vasopressin) and low-dose steroid therapy. Resuscitation goals should include optimization of central venous oxygenation and serum lactate.
    Clinical obstetrics and gynecology. 10/2014;
  • Article: In Reply.
    Obstetrics and gynecology. 10/2014; 124(4):836-837.
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    ABSTRACT: Objective To compare population versus customized fetal growth norms in identifying neonates at risk for adverse perinatal and neonatal outcomes (AOs) associated with small for gestational age (SGA) in high-risk women. Design Secondary analysis to a multicenter treatment trial of pregnant women at high risk for preeclampsia using low-dose aspirin versus placebo. The associations between SGA by population (SGApop) and customized (SGAcust) norms and AOs were evaluated. Results A total of 2,289 mother/infant pairs were included in the analysis. The rates of SGA in the aspirin and placebo groups were similar by the customized (22.8% vs 23.9%; p = 0.55) or population (8.7% vs 7.5%; p = 0.54) norms; however, they were lower using population norms compared with customized norms (p < 0.001). SGAcust, but not SGApop, was associated with spontaneous preterm birth (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.15-1.81; p < 0.001), preterm premature rupture of membranes (OR 1.42 95% CI 1.05-1.92; p = 0.02), and cesarean delivery (OR: 1.35, 95% CI: 1.11-1.64; p = 0.002). Both SGAcust and SGApop were associated with the composite neonatal outcome, indicated preterm delivery before 32, 35, and 37 weeks, oligohydramnios, fetal distress, as well as decreased risk of oxygen requirement. Neither was associated with preeclampsia. Conclusion Customized approach for assessment of fetal growth was associated with higher SGA rates and better identification of SGA neonates at risk for AOs.
    American Journal of Perinatology 09/2014; · 1.57 Impact Factor
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    ABSTRACT: Pregnant women occasionally require mechanical ventilation. Ventilated patients commonly need some form of analgesia and/or sedation with or without paralytics. The use of these agents is common in the intensive care unit setting, but most maternal-fetal medicine specialists are unfamiliar with their use. In the vast majority of cases, guidelines and recommendations regarding the use of these agents should be followed as recommended for nonpregnant individuals. This article discusses the most relevant issues of sedatives, analgesics, and neuromuscular blockers used in modern critical care practice.
    Clinical obstetrics and gynecology. 09/2014;
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    ABSTRACT: Objective To determine if passive leg raising (PLR) significantly increases cardiac output in a cohort of healthy pregnant women during the third trimester. Study Design Using a noninvasive monitor, baseline hemodynamic measurements for arterial blood pressure, systolic and diastolic blood pressure, heart rate, cardiac output, cardiac index, stroke volume, and systemic vascular resistances were obtained with patients in the semirecumbent position. Measurements were repeated after a 3-minute PLR maneuver in supine, right lateral decubitus, and left lateral decubitus positions. Results After 10 minutes of bed rest, the cohort's mean baseline heart rate was 80 ± 12 beats/minute. Baseline stroke volume was 98 ± 14 mL, mean cardiac output was 7.8 ± 1.2 L/min, and mean cardiac index was 4.32 ± 0.63 L/min. The baseline systemic vascular resistance value was 893 ± 160 dynes/sec/cm(5). Baseline mean arterial blood pressure was 84 ± 11 mm Hg. Following a PLR maneuver in the supine position, heart rate decreased significantly. No difference was noted in other measurements. Findings were similar with PLR in the left lateral decubitus. PLR in the right lateral decubitus resulted in significantly decreased heart rate, cardiac output, and cardiac index. Conclusions PLR did not result in cardiac output recruitment in a cohort of healthy pregnant women during the third trimester.
    American Journal of Perinatology 09/2014; · 1.57 Impact Factor
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    ABSTRACT: To review and update available evidence regarding outcomes after cesarean delivery (CD) using blunt versus sharp expansion of the uterine incision.
    American journal of obstetrics and gynecology. 06/2014;
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    ABSTRACT: Alcohol exposure during pregnancy results in an array of structural and functional abnormalities called fetal alcohol spectrum disorders (FASD). Alcohol dysregulates the exquisite coordination and regulation of gestational adaptations at the level of the uterine vasculature. We herein hypothesized that chronic binge-like alcohol results in uterine vascular dysfunction and impairs maternal uterine artery reactivity to vasoconstrictors and dilators.
    Alcoholism Clinical and Experimental Research 06/2014; · 3.42 Impact Factor
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    ABSTRACT: Lactation is associated with reduction in maternal metabolic disease and hypertension later in life; however, findings in humans may be confounded by socioeconomic factors. We sought to determine the independent contribution of lactation on cardiovascular parameters and adiposity in a murine model.
    American journal of obstetrics and gynecology. 06/2014;
  • American journal of obstetrics and gynecology. 05/2014;
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    ABSTRACT: Elevated testosterone levels increase maternal blood pressure and decrease uterine blood flow in pregnancy, resulting in abnormal perinatal outcomes. We tested whether elevated testosterone alters uterine artery adaptations during pregnancy, and whether these alterations depend on endothelium-derived factors such as nitric oxide, endothelium-derived hyperpolarizing factor, and prostacyclin, or endothelium-independent mechanisms such as angiotensin II (Ang-II). Pregnant Sprague-Dawley rats were injected with vehicle (n=20) or testosterone propionate (0.5 mg/kg per day from gestation day 15 to 19; n=20). Plasma testosterone levels increased 2-fold in testosterone-injected rats compared with controls. Elevated testosterone significantly decreased placental and pup weights compared with controls. In endothelium-intact uterine arteries, contractile responses to thromboxane, phenylephrine, and Ang-II were greater in testosterone-treated rats compared with controls. In endothelium-denuded arteries, contractile responses to Ang-II (pD2=9.1±0.04 versus 8.7±0.04 in controls; P<0.05), but not thromboxane and phenylephrine, were greater in testosterone-treated rats. Ang-II type 1b receptor expression was increased, whereas Ang-II type 2 receptor was decreased in testosterone-exposed arteries. In endothelium-denuded arteries, relaxations to sodium nitroprusside were unaffected. Endothelium-dependent relaxation to acetylcholine was significantly lower in arteries from testosterone-treated dams (Emax=51.80±6.9% versus 91.98±1.4% in controls; P<0.05). The assessment of endothelial factors showed that nitric oxide-, endothelium-derived hyperpolarizing factor-, and prostacyclin-mediated relaxations were blunted in testosterone-treated dams. Endothelial nitric oxide synthase, small conductance calcium-activated potassium channel-3, and prostacyclin receptor expressions were significantly decreased in arteries from testosterone-treated dams. Hypoxia-inducible factor-1α, Ankrd37, and Egln were significantly increased in testosterone-exposed placentas. These results suggest that elevated maternal testosterone impairs uterine vascular function, which may lead to an increased vascular resistance and a decrease in uterine blood flow.
    Hypertension 05/2014; · 6.87 Impact Factor
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    ABSTRACT: Preterm prelabor rupture of the membranes (pPROM) may lead to preterm births (PTBs). We investigated premature senescence of fetal membranes in women with pPROM and spontaneous PTB with intact membranes (<34 weeks) and the inducibility fetal membrane senescence phenotype by oxidative stress in vitro. IHC was performed for p53, p21, and phospho (p)-p38 mitogen-activated protein kinase (MAPK) as markers of senescence phenotype in pPROM, PTBs, and term births. Term fetal membranes were exposed to cigarette smoke extract to induce oxidative stress. Western blots documented p-p53 and p-p38 MAPK. Transmission electron microscopy assessed cellular morphologic features in clinical and cigarette smoke extract-treated membranes. A total of 80% of pPROM cells and >60% of term cells were positive for all three senescence phenotype markers, and concentrations were higher than in PTBs (P < 0.05). p53 staining was comparable in membranes from PTB and term birth pregnancies, whereas only <30% and <45% of cells were positive for p21 and p38 MAPK, respectively. In vitro cigarette smoke extract exposure increased p-p38 MAPK without any detectable change in p-p53 MAPK. Enlargement of organelles consistent with senescence phenotype was evident in pPROM and term membranes in vivo and after cigarette smoke extract treatment in vitro but was less apparent in PTBs. Histologic and biochemical resemblance of pPROM and term membranes suggests premature senescence of the membranes is a mechanistic feature in pPROM, and this can be phenocopied in an in vitro model.
    American Journal Of Pathology 05/2014; · 4.60 Impact Factor
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    ABSTRACT: Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
    Obstetrics and Gynecology 05/2014; 123(5):1070-1082. · 4.80 Impact Factor
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    ABSTRACT: Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2014; 33(5):745-57. · 1.40 Impact Factor
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    ABSTRACT: Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and magnetic resonance imaging in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost-effectiveness and to identify research opportunities. This article is the executive summary of the workshop.
    American journal of obstetrics and gynecology 05/2014; 210(5):387-397. · 3.28 Impact Factor
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    ABSTRACT: To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.Supplemental Digital Content is Available in the Text. This was a secondary analysis of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (more than three units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity; these were used to develop a prediction model for severe maternal morbidity. Among 115,502 women who delivered during the study period, 332 (2.9/1,000 births, 95% confidence interval 2.6-3.2) experienced severe maternal morbidity. Postpartum hemorrhage was responsible for approximately half of severe maternal morbidity. Multiple patient factors were found to be independently associated with severe maternal morbidity and were used to develop a predictive model with an area under the receiver operating characteristic curve of 0.80. Severe maternal morbidity occurs in approximately 2.9 per 1,000 births, is most commonly the result of postpartum hemorrhage, and occurs more commonly in association with several identifiable patient characteristics. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 04/2014; 123(4):804-810. · 4.80 Impact Factor
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    ABSTRACT: Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. We conducted a population-based case-control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US. Fetal growth abnormalities were categorized as small for gestational age (SGA) (<10th percentile) or large for gestational age (LGA) (>90th percentile) at death (stillbirth) or delivery (live birth) using population, ultrasound, and individualized norms. Gestational age at death was determined using an algorithm that considered the time-of-death interval, postmortem examination, and reliability of the gestational age estimate. Data were weighted to account for the sampling design and differential participation rates in various subgroups. Among 527 singleton stillbirths and 1,821 singleton live births studied, stillbirth was associated with SGA based on population, ultrasound, and individualized norms (odds ratio [OR] [95% CI]: 3.0 [2.2 to 4.0]; 4.7 [3.7 to 5.9]; 4.6 [3.6 to 5.9], respectively). LGA was also associated with increased risk of stillbirth using ultrasound and individualized norms (OR [95% CI]: 3.5 [2.4 to 5.0]; 2.3 [1.7 to 3.1], respectively), but not population norms (OR [95% CI]: 0.6 [0.4 to 1.0]). The associations were stronger with more severe SGA and LGA (<5th and >95th percentile). Analyses adjusted for stillbirth risk factors, subset analyses excluding potential confounders, and analyses in preterm and term pregnancies showed similar patterns of association. In this study 70% of cases and 63% of controls agreed to participate. Analysis weights accounted for differences between consenting and non-consenting women. Some of the characteristics used for individualized fetal growth estimates were missing and were replaced with reference values. However, a sensitivity analysis using individualized norms based on the subset of stillbirths and live births with non-missing variables showed similar findings. Stillbirth is associated with both growth restriction and excessive fetal growth. These findings suggest that, contrary to current practices and recommendations, stillbirth prevention strategies should focus on both severe SGA and severe LGA pregnancies. Please see later in the article for the Editors' Summary.
    PLoS Medicine 04/2014; 11(4):e1001633. · 15.25 Impact Factor
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    ABSTRACT: The most common DNA lesion generated by oxidative stress (OS) is 7, 8-dihydro-8-oxoguanine (8-oxoG) whose excision repair is performed by 8-oxoguanine glycosylase (OGG1). We investigated OGG1 expression changes in fetal membranes from spontaneous preterm birth (PTB) and preterm premature rupture of the membranes (pPROM) and its changes in vitro in normal fetal membranes exposed to OS inducer water-soluble cigarette smoke extract (CSE). DNA damage was determined in amnion cells treated with CSE by comet and FLARE assays. OGG1 mRNA expression and localization in fetal membranes from clinical specimens and in normal term membranes exposed to CSE were examined by QRT-PCR and by immunohistochemistry. DNA strand and base damage was seen in amnion cells exposed to CSE. OGG1 expression was 2.5-fold higher in PTB samples compared with pPROM (P = 0.045). No significant difference was seen between term and pPROM or PTB and term. CSE treatment showed a nonsignificant decrease in OGG1. OGG1 was localized to both amnion and chorion with less intense staining in pPROM and CSE-treated membranes. Increased OS-induced DNA damage predominated by 8-oxoG is likely to persist in fetal cells due to reduced availability of base excision repair enzyme OGG1. This can likely lead to fetal cell senescence associated with some adverse pregnancy outcome.
    American Journal Of Reproductive Immunology 03/2014; · 3.32 Impact Factor
  • George R Saade, Baha M Sibai, Robert Silver
    JAMA pediatrics. 02/2014; 168(2):190-1.
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    ABSTRACT: Develop classification models of demographic/clinical factors and biomarker data from spontaneous preterm birth (PTB) in African Americans and Caucasians. Secondary analysis of biomarker data using multivariate adaptive regression splines (MARS), a supervised machine learning algorithm method. Thirty-six biomarker data analysis from 191 women were reduced by MARS to develop predictive models for preterm birth in African Americans and Caucasians. Maternal plasma, cord plasma collected at admission for preterm or term labor and amniotic fluid at delivery. Data were partitioned into training and testing sets. Variable importance, a relative indicator (0-100%) and area under the receiver operating characteristic curve (AUC) characterized results. MARS generated models for combined and racially stratified biomarker data. Clinical and demographic data did not contribute to the model. Racial stratification of data produced distinct models in all three compartments. In African Americans maternal plasma samples IL1RA, TNFα, angiopoietin2, TNFRI, IL5, MIP1α, IL1β, and TGFα modeled preterm birth (AUC train: 0.98, AUC test: 0.86). In Caucasians TNFR1, ICAM1, and IL1RA contributed to the model (AUC train: 0.84, AUC test: 0.68). African Americans cord plasma samples produced IL12P70, IL8 (AUC train: 0.82, AUC test: 0.66). Cord plasma in Caucasians modeled IGFII, PDGFBB, TGFβ1, IL12P70, and TIMP1 (AUC train: 0.99, AUC test: 0.82). Amniotic fluid in African Americans modeled Fas ligand, TNFRII, RANTES, KGF, IGFI (AUC train: 0.95, AUC test: 0.89) and in Caucasians, TNFα, MCP3, TGFβ3, TNFR1, and angiopoietin2 (AUC train: 0.94 AUC test: 0.79). MARS models multiple biomarkers associated with preterm birth and demonstrated racial disparity. This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 01/2014; · 1.85 Impact Factor

Publication Stats

5k Citations
1,523.63 Total Impact Points

Institutions

  • 1997–2014
    • University of Texas Medical Branch at Galveston
      • • Maternal Fetal Medicine Division
      • • Department of Obstetrics and Gynecology
      • • Department of Radiology
      Galveston, Texas, United States
  • 1992–2014
    • Baylor College of Medicine
      • Department of Obstetrics and Gynecology
      Houston, Texas, United States
  • 2013
    • Emory University
      Atlanta, Georgia, United States
    • Mayo Clinic - Rochester
      Rochester, Minnesota, United States
    • Eastern Virginia Medical School
      Norfolk, Virginia, United States
    • Case Western Reserve University School of Medicine
      Cleveland, Ohio, United States
  • 2010–2013
    • University of Texas Health Science Center at San Antonio
      San Antonio, Texas, United States
    • University of Pittsburgh
      • Division of General Obstetrics and Gynecology
      Pittsburgh, PA, United States
  • 2012
    • Northwestern University
      • Department of Obstetrics and Gynecology
      Evanston, IL, United States
    • Università degli Studi di Modena e Reggio Emilia
      • Department of Biomedical, Metabolical and Neurosciences
      Modène, Emilia-Romagna, Italy
    • University of Cincinnati
      • Department of Obstetrics and Gynecology
      Cincinnati, OH, United States
    • Winthrop University Hospital
      Mineola, New York, United States
  • 2009–2012
    • University of Texas Health Science Center at Houston
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Houston, Texas, United States
    • University Hospitals Coventry and Warwickshire NHS Trust
      Coventry, England, United Kingdom
  • 2007–2012
    • Society for Maternal-Fetal Medicine
      Detroit, Michigan, United States
    • Royal College of Surgeons in Ireland
      • Department of Obstetrics & Gynaecology
      Dublin, Leinster, Ireland
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
    • University of California, San Francisco
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      San Francisco, CA, United States
  • 2006–2012
    • Yale University
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      New Haven, CT, United States
    • New York Downtown Hospital
      New York City, New York, United States
    • Women & Infants Hospital
      Providence, Rhode Island, United States
    • Icahn School of Medicine at Mount Sinai
      Manhattan, New York, United States
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 2000–2012
    • University of North Carolina at Chapel Hill
      • Department of Obstetrics and Gynecology
      Chapel Hill, NC, United States
  • 2011
    • American University of Beirut
      • Department of Obstetrics and Gynecology
      Beirut, Mohafazat Beyrouth, Lebanon
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Maryland, United States
    • Albert Einstein Medical Center
      Philadelphia, Pennsylvania, United States
  • 2010–2011
    • University of Alabama at Birmingham
      • Department of Obstetrics and Gynecology
      Birmingham, AL, United States
  • 2009–2011
    • University of Texas Medical School
      • Department of Obstetrics, Gynecology & Reproductive Sciences
      Houston, Texas, United States
    • The Ohio State University
      • Department of Obstetrics and Gynecology
      Columbus, OH, United States
  • 1999–2011
    • University of Utah
      • Department of Obstetrics and Gynecology
      Salt Lake City, UT, United States
  • 2008
    • University of Colorado
      • Department of Obstetrics and Gynecology
      Denver, CO, United States
    • University of Chicago
      • Department of Radiology
      Chicago, IL, United States
    • Maxima Medical Center
      • Department of Obstetrics & Gynaecology
      Veldhoven, North Brabant, Netherlands
  • 2006–2008
    • Columbia University
      • Department of Obstetrics and Gynecology
      New York City, NY, United States
  • 2001–2007
    • Fukushima Medical University
      • • Department of Obstetrics and Gynecology
      • • Department of Obstetrics
      Hukusima, Fukushima, Japan
  • 1998–2007
    • Texas A&M University - Galveston
      Galveston, Texas, United States
  • 2005
    • Imperial College London
      Londinium, England, United Kingdom
    • CUNY Graduate Center
      New York City, New York, United States
  • 2004
    • Mid-Columbia Medical Center
      The Dalles, Oregon, United States
  • 1995
    • Marshfield Clinic
      • Division of Cardiology
      Marshfield, WI, United States