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Gluck O, Barber E, Friedman M, Feldstein O, Tal O, Grinstein E, Kerner R, Menasherof M, Saidian M, Weiner E, Sagiv R. Medical treatment for early pregnancy loss following in vitro fertilization compared to spontaneous pregnancies. Arch Gynecol Obstet 2024; 309:2137-2141. [PMID: 38478159 DOI: 10.1007/s00404-024-07423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Misoprostol is a well-studied medical treatment for early pregnancy loss (EPL), with success rates ranging between 70 and 90%. However, treatment failure is associated with major patient discomfort, including the need for surgical intervention to evacuate the uterus. It was previously reported that medical treatment was especially successful among women who conceived after in vitro fertilization (IVF). We aimed to study if there is a difference in rates of medical treatment failures for EPL between pregnancies conceived by IVF and spontaneous pregnancies. METHODS In this retrospective cohort study, we included all women who underwent medical treatment for EPL at our institute between 07/2015 and 12/2020. Treatment outcome was compared between IVF and spontaneous pregnancies. Treatment failure was defined as a need for surgical intervention, namely, dilation & curettage (D&C) and/or hysteroscopy, due to retained products of conception, which was defined as a gestational sac or endometrial thickness greater than 15 mm in a TVS scan. RESULTS Overall, 775 patients were included, of which 195 (169/775 = 25.1%) ultimately required surgical intervention. There was no difference between the study groups in the rate of treatment failure. However, among IVF pregnancies, the rate of emergency D&C was lower (3.6% vs. 9.8%, p = 0.001), compared to spontaneous group. CONCLUSION In cases of medical treatment for EPL, IVF pregnancies had no differences in rates of treatment failure compared to spontaneous pregnancies. That being said, IVF pregnancies have lower chances to undergo emergency D&C, compared to spontaneous pregnancies.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matan Friedman
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.
- School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ohad Feldstein
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Tal
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grinstein
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mai Menasherof
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Saidian
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gluck O, David M, Kovo M, Mor L, Kleiner I, Weiner E, Ginath S. The clinical significance of cervical tears' anatomical location - A retrospective study. Eur J Obstet Gynecol Reprod Biol 2024; 295:215-218. [PMID: 38382129 DOI: 10.1016/j.ejogrb.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/27/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Up to 4.8% of all vaginal deliveries are complicated by significant cervical tears related to maternal compromise, yet the location of the cervical tear and its impact on the attributed risk have not been studied to date. This study aimed to determine the associations between the location and characteristics of cervical tears with short-term maternal complications and outcomes. METHODS This is a retrospective cohort study. Included were all patients that delivered vaginally at our institute between the years 2009-2020 and were diagnosed with a cervical tear. Maternal complications were compared between cases with posterior cervical tears and cases with anterior or lateral cervical tears. Exclusion criteria included patients who delivered by cesarean delivery and preterm labor below 37.0 weeks of gestation. RESULTS Overall, 96 patients were diagnosed with posterior cervical tears, while 117 patients were diagnosed with anterior or lateral tears. Maternal demographics and pregnancy characteristics were similar between the groups. There were also no differences in delivery outcomes between the groups. Patients with posterior cervical tears had a higher rate of disseminated intravascular coagulation (DIC) (6.25 % vs. 0.9 %, p = 0.04) and prolonged hospitalization (35.4 % vs. 23.1 %, p = 0.05), as compared to patients with anterior or lateral tears. There were no differences in other maternal complications. CONCLUSIONS Cases of posterior cervical tears are at higher risk for maternal adverse outcomes (DIC and prolonged hospitalization), as compared to cases of anterior or lateral tears.
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Affiliation(s)
- Ohad Gluck
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maayan David
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Mor
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilia Kleiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mor L, Tamayev L, Laxer B, Toledano E, Schreiber L, Ganor Paz Y, Barda G, Levy M, Weiner E. Improved neonatal outcomes in pregnancies with coexisting gestational diabetes and preeclampsia in normal birthweight neonates- insights from a retrospective cohort study. Placenta 2024; 149:1-6. [PMID: 38430682 DOI: 10.1016/j.placenta.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION We aimed to assess neonatal and maternal outcomes in appropriate-for-gestational-weight (AGA) neonates of mothers with both gestational diabetes mellitus (GDM) and preeclampsia (PET). METHODS Medical records of women diagnosed with GDM or PET were reviewed. Women with AGA neonates were divided into three groups- GDM, PET, and GDM + PET and maternal neonatal and placental outcomes were compared. The primary outcome was a composite of adverse neonatal outcomes, including intensive care unit admission (NICU), neurological morbidity, hypoglycemia, ventilation, respiratory distress syndrome (RDS), phototherapy, sepsis, blood transfusion, and neonatal death. Post-hoc analysis was performed to determine between-group significance. RESULTS Composite adverse neonatal outcomes are significantly lower in women with multiple morbidities compared to women with confined PET (p = 0.015), and a similar trend is observed when comparing neonatal outcomes between women with GDM to those with GDM + PET, yet these results are underpowered (18.9 % vs. 12.8 % respectively, p = 0.243). Placentas of women with GDM + PET were larger, with a lower rate of placentas below the 10th percentile as compared to placentas of women with isolated PET (p < 0.001), but with similar rates of MVM lesions. DISCUSSION While maternal and placental outcomes in patients of the GDM + PET group resemble the characteristics of the PET group, surprisingly, the neonatal outcomes in this group are significantly better compared to isolated morbidities. The paradoxical benefit attributed to the coexistence of GDM + PET may be explained by a balance of the opposing trends characterizing these morbidities-the reduced blood and nutrient supply characterizing PET vs. chronic overflow and abundance typical of GDM. CLINICAL TRIAL REGISTRATION approval of local ethics committee WOMC-19-0152.
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Affiliation(s)
- Liat Mor
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel.
| | - Liliya Tamayev
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel
| | - Barak Laxer
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel
| | - Ella Toledano
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel
| | - Yael Ganor Paz
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel
| | - Giulia Barda
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel
| | - Michal Levy
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel
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Mor L, Toledano E, Ben-Shoshan N, Weiner E, Paz YG, Barda G, Levy M. Does the combination of four OGTT values enhance the prediction of adverse pregnancy outcomes? Insights from a retrospective cohort study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07455-9. [PMID: 38488897 DOI: 10.1007/s00404-024-07455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
AIM To explore the correlation between a singular value of additive OGTT scores and adverse maternal and neonatal outcomes. We postulated that a higher additive OGTT score would predict poorer maternal and neonatal outcomes. METHODS In this retrospective cohort study, data were collected from all women with a documented complete OGTT result and subsequent diagnosis of GDM. The additive OGTT score was calculated by adding each individual hourly glucose measurement. Maternal demographics, pregnancy and labor characteristics, and neonatal outcomes were compared between the lower-sum and higher-sum OGTT groups. A multivariate regression analysis was performed to identify confounders associated with adverse outcomes. RESULTS In this study, a total of 1497 patients were assessed. The group with higher-sum OGTT scores was characterized by increased rates of GDMA2 (p = 0.008), higher insulin doses (p = 0.009), and higher rates of composite maternal and neonatal adverse outcomes (p = 0.021 and p = 0.030, respectively) compared to the lower-sum OGTT group. CONCLUSION The additive OGTT score may aid in predicting the need for insulin treatment, labor course, and neonatal outcomes in GDM patients.
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Affiliation(s)
- Liat Mor
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ella Toledano
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Ben-Shoshan
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Ganor Paz
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon, 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gonen N, Cohen I, Gluck O, Jhucha D, Shmueli A, Barda G, Weiner E, Barber E. Umbilical cord blood gases sampling in low-risk vaginal deliveries as a predictor of adverse neonatal outcome. Arch Gynecol Obstet 2024; 309:523-531. [PMID: 36801967 DOI: 10.1007/s00404-023-06965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION There is no clear correlation between abnormal umbilical cord blood gas studies (UCGS) and adverse neonatal outcome in low-risk deliveries. We investigated the need for its routine use in low-risk deliveries. METHODS We retrospectively compared maternal, neonatal, and obstetrical characteristics among low-risk deliveries (2014-2022) between "normal" and "abnormal" pH groups: A:normal pH ≥ 7.15; abnormal pH < 7.15; B: normal pH ≥ 7.15 and base excess (BE) > - 12 mmol/L; abnormal pH < 7.15 and BE ≤ We retrospectively compared 12 mmol/L; C: normal pH ≥ 7.1; abnormal pH < 7.1; D: normal pH > 7.1 and BE > - 12 mmol/L; abnormal pH < 7.1 and BE ≤ - 12 mmol/L. RESULTS Of 14,338 deliveries, the rates of UCGS were: A-0.3% (n = 43); B-0.07% (n = 10); C-0.11% (n = 17); D-0.03% (n = 4). The primary outcome, composite adverse neonatal outcome (CANO) occurred in 178 neonates with normal UCGS (1.2%) and in only one case with UCGS (2.6%). The sensitivity and specificity of UCGS as a predictor of CANO were high (99.7-99.9%) and low (0.56-0.59%), respectively. CONCLUSION UCGS were an uncommon finding in low-risk deliveries and its association with CANO was not clinically relevant. Consequently, its routine use should be considered.
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Affiliation(s)
- Noa Gonen
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Ido Cohen
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Dan Jhucha
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Anat Shmueli
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel.
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel.
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Kleiner I, Mor L, Friedman M, Abeid AA, Shoshan NB, Toledano E, Bar J, Weiner E, Barda G. The use of virtual reality during extra-amniotic balloon insertion for pain and anxiety relief-a randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101222. [PMID: 37951577 DOI: 10.1016/j.ajogmf.2023.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Induction of labor with an extra-amniotic balloon catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. OBJECTIVE We aimed to investigate the distractive effect of virtual reality technology on pain and anxiety among pregnant patients who underwent induction of labor with an extra-amniotic balloon catheter. STUDY DESIGN In this randomized controlled trial, pregnant patients who were undergoing planned induction of labor using an extra-amniotic balloon catheter at term for various obstetrical indications were recruited and randomized in a 1:1 ratio into 2 groups. Patients in the virtual reality group were exposed to a virtual reality technology clip (using SootheVR All-In-One virtual reality care system for pain and anxiety) during the entire extra-amniotic balloon catheter insertion, whereas patients in the control group received the institutional standard care for extra-amniotic balloon catheter insertion. Pain scores, expressed as visual analog scale scores, and maternal hemodynamic parameters were obtained before, during, and after extra-amniotic balloon catheter insertion. Anxiety was evaluated using the validated State-Trait Anxiety Inventory Scale before and after the procedure. Maternal satisfaction with the virtual reality technology was also recorded. The primary outcome was the change in visual analog scale score before and during extra-amniotic balloon catheter insertion. Among the secondary outcomes was the change in anxiety levels before and after extra-amniotic balloon catheter insertion. The study was powered to detect a 25% decrease in the primary outcome. RESULTS A total of 132 pregnant patients were recruited (66 in each group). There were no differences between groups in terms of age, body mass index, gestational age at enrollment, indication for induction of labor, and preprocedural visual analog scale score and anxiety levels. The change in visual analog scale score (maximal visual analog scale score during the procedure minus the initial visual analog scale score before the procedure, ie, the primary outcome) was significantly lower in the virtual reality group than in the control group (2.78±3.0 vs 4.09±2.99; P=.01). In addition, the virtual reality group experienced a higher rate of anxiety relief, expressed as the difference between the preprocedure and postprocedure State-Trait Anxiety Inventory Scale scores (-6.46±9.6 vs -2.01±9.11; P=.007). Patients in the virtual reality group reported a very high overall (94%) satisfaction score. CONCLUSION In this randomized controlled trial, we demonstrated that the use of virtual reality technology among patients who underwent induction of labor using an extra-amniotic balloon catheter was associated with lower visual analog scale scores during the procedure and a significant reduction in anxiety than patients who received standard care. There was also a very high satisfaction rate with the use of virtual reality technology.
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Affiliation(s)
- Ilia Kleiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel.
| | - Liat Mor
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Matan Friedman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Amir Abu Abeid
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Noa Ben Shoshan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Ella Toledano
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Giulia Barda
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
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Nachum Z, Perlitz Y, Shavit LY, Magril G, Vitner D, Zipori Y, Weiner E, Alon AS, Ganor-Paz Y, Nezer M, Harel N, Soltsman S, Yefet E. The effect of oral probiotics on glycemic control of women with gestational diabetes mellitus-a multicenter, randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol MFM 2024; 6:101224. [PMID: 37956906 DOI: 10.1016/j.ajogmf.2023.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Gestational diabetes mellitus should be treated adequately to avoid maternal hyperglycemia-related complications. Previously, probiotic supplements were suggested to improve fasting blood glucose in women with gestational diabetes mellitus. However, a major limitation of previous studies was that preprandial and especially postprandial glucose values, which are important predictors of pregnancy outcomes, were not studied. OBJECTIVE This study aimed to examine the effect of a mixture of probiotic strains on maternal glycemic parameters, particularly preprandial and postprandial glucose values and pregnancy outcomes among women with gestational diabetes mellitus. STUDY DESIGN A multicenter prospective randomized, double-blind, placebo-controlled trial was conducted. Women newly diagnosed with gestational diabetes mellitus were randomly allocated into a research group, receiving 2 capsules of oral probiotic formula containing Bifidobacterium bifidum, B lactis, Lactobacillus acidophilus, L paracasei, L rhamnosus, and Streptococcus thermophilus (>6 × 109/capsule), and a control group, receiving a placebo (2 capsules/day) until delivery. Glycemic control was evaluated by daily glucose charts. After 2 weeks, pharmacotherapy was started in case of poor glycemic control. The primary outcomes were the rate of women requiring medications for glycemic control and mean daily glucose charts after 2 weeks of treatment with the study products. RESULTS Forty-one and 44 women were analyzed in the treatment and placebo cohorts, respectively. Mean daily glucose during the first 2 weeks in the probiotics and placebo groups was 99.7±7.9 and 98.0±9.3 mg/dL, respectively (P=.35). The rate of women needing pharmacotherapy because of poor glycemic control after 2 weeks of treatment in the probiotics and placebo groups was 24 (59%) and 18 (41%), respectively (P=.10). Mean preprandial and postprandial glucose levels throughout the study period were similar between the groups (P>.05). There were no differences in maternal and neonatal outcomes, including birthweight and adverse effect profile between the groups. CONCLUSION The oral probiotic product tested in this study did not affect glycemic control of women with gestational diabetes mellitus.
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Affiliation(s)
- Zohar Nachum
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum); Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Nachum, Vitner, and Zipori)
| | - Yuri Perlitz
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel (Drs Perlitz, Harel, Soltsman, and Yefet); Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Drs Perlitz and Yefet)
| | - Lilach Yacov Shavit
- Diabetes in Pregnancy Clinic, Tzafon Medical Center, Poriya, Israel (Ms Shavit)
| | - Galit Magril
- Nutrition Division, Tzafon Medical Center Poriya, Israel (Ms Magril)
| | - Dana Vitner
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Nachum, Vitner, and Zipori); Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Vitner and Zipori)
| | - Yaniv Zipori
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Nachum, Vitner, and Zipori); Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Vitner and Zipori)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Drs Weiner, Alon, and Ganor-Paz); Sackler Faculty of Medicine, Tel Aviv university, Tel Aviv, Israel (Drs Weiner, Alon, and Ganor-Paz)
| | - Ayala Shevach Alon
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Drs Weiner, Alon, and Ganor-Paz); Sackler Faculty of Medicine, Tel Aviv university, Tel Aviv, Israel (Drs Weiner, Alon, and Ganor-Paz)
| | - Yael Ganor-Paz
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Drs Weiner, Alon, and Ganor-Paz); Sackler Faculty of Medicine, Tel Aviv university, Tel Aviv, Israel (Drs Weiner, Alon, and Ganor-Paz)
| | - Meirav Nezer
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel (Dr Nezer)
| | - Noa Harel
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel (Drs Perlitz, Harel, Soltsman, and Yefet)
| | - Sofia Soltsman
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel (Drs Perlitz, Harel, Soltsman, and Yefet)
| | - Enav Yefet
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel (Drs Perlitz, Harel, Soltsman, and Yefet); Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Drs Perlitz and Yefet); Women's Health Center, Clalit Health Services, Afula, Israel (Dr Yefet).
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Marom O, Weiner E, Gindes L, Mor L, Gury M, Toledano E, Alon AS, Miremberg H, Shalev J, Levy M. The effect of watching an informational video prior amniocentesis on maternal anxiety: a randomized controlled trail. Arch Gynecol Obstet 2023:10.1007/s00404-023-07288-y. [PMID: 38060016 DOI: 10.1007/s00404-023-07288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/22/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE This randomized controlled trial aimed to ascertain the effect of a pre-procedure informational video on anxiety, pain perception, and satisfaction levels in patients undergoing amniocentesis. METHODS Patients were randomized into two groups: a video group who watched an informational video prior to the procedure, and a control group who received standard care. Anxiety was gauged both pre- and post-procedure via the State-Trait Anxiety Inventory (STAI) score. Post-procedure, patients' perceived pain, anxiety, and satisfaction levels were evaluated using the Visual Analog Scale questionnaire (VAS). RESULTS Of 110 randomized patients, 100 completed the study and were included in the final analysis. No significant difference was noted in overall anxiety levels between the study and control groups. However, in-procedure anxiety was significantly lower in the video group compared to the control group (p = 0.04). Among patients undergoing amniocentesis for the first time, the subgroup analysis revealed reduced levels of anxiety during the procedure and diminished pain 10 min after the procedure in the video group compared to the control group. (p = 0.041 and p = 0.025, respectively). CONCLUSION A pre-procedural informational video could help in alleviating anxiety and mitigating pain during amniocentesis. CLINICAL TRIAL REGISTRATION The study was registered at 27.3.2022 in clinical-trials.gov (identifier NCT05463549).
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Affiliation(s)
- Or Marom
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Eran Weiner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Liat Gindes
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Liat Mor
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - May Gury
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ella Toledano
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ayala Shevach Alon
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hadas Miremberg
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Josef Shalev
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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9
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Barber E, Ganer Herman H, Kovo M, Tairy D, Schreiber L, Horowitz E, Weissman A, Weiner E, Raziel A. Placenta previa in in vitro fertilization and unassisted pregnancies-is there a difference in perinatal outcomes and placental histology? J Matern Fetal Neonatal Med 2023; 36:2221763. [PMID: 37286205 DOI: 10.1080/14767058.2023.2221763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION In-vitro-fertilization (IVF) is an independent risk factor for placenta previa (PP). Our aim was to study this link by comparing the clinical characteristics and placental histology of pregnancies complicated by PP in IVF versus unassisted pregnancies. METHODS A retrospective-cohort study of deliveries with PP between 2008 and 2021. Placental histology, obstetric and neonatal outcomes were compared between IVF and unassisted pregnancies. Included, were singleton deliveries complicated by PP at gestational weeks (GA) >24. RESULTS A total of 182 pregnancies were included - 23 IVF pregnancies (IVF group) and 159 unassisted pregnancies (Control group). The control group was characterized by higher gravidity (p = .007) and parity (p < .001) and a trend of more past cesarean deliveries, whereas the IVF group- by a higher rate of nulliparity (p < .001) and diabetes mellitus (p = .04). The control group was characterized by a higher rate of placental weight below the 10th percentile (47.8 versus 13.9%, p = .001) and by a trend of a lower overall placental weight. No differences were noted in maternal and fetal vascular lesions. DISCUSSION While PP in non-assisted pregnancies is probably associated with previous CDs, in IVF it is more "sporadic," and may complicate any index pregnancy. A lower placental weight was more prevalent in the control group, supporting the concept that pregnancies complicated by PP following IVF can be attributed to initial abnormal location of placentation, rather than an underlying pathological uterine segment of implantation. Nevertheless, IVF and unassisted pregnancies entail similar perinatal outcomes in cases of PP.
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Affiliation(s)
- Elad Barber
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tairy
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Horowitz
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Weissman
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Bachar G, Siegler Y, Kabakov E, Lauterbach R, Justman N, Ben-Ezry E, Weiner E, Ganor-Paz Y, Yefet E, Khamaisi T, Nachum Z, Massalha M, Shamali K, Khatib N, Zipori Y, Weiner Z, Vitner D. Intermittent vs continuous catheterization for postpartum urinary retention: A multicenter randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:101084. [PMID: 37423430 DOI: 10.1016/j.ajogmf.2023.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Postpartum urinary retention is a common complication in the immediate postpartum period. However, there is no consensus regarding optimal management. OBJECTIVE This study aimed to compare 2 catheterization strategies for the treatment of postpartum urinary retention. STUDY DESIGN A multicenter prospective randomized controlled trial was conducted at 4 university-affiliated medical centers between January 2020 and June 2022. Individuals with postpartum urinary retention (bladder volume of >150 mL) up to 6 hours after vaginal or cesarean delivery were randomly allocated to 1 of 2 protocols: intermittent catheterization every 6 hours, up to 4 times, or continuous catheterization with an indwelling urinary catheter for 24 hours. If postpartum urinary retention was not resolved after 24 hours, an indwelling catheter was inserted for an additional 24 hours in both groups. The primary endpoint was the mean time to postpartum urinary retention resolution. The secondary endpoints included postcatheter urinary tract infection rate and length of hospital stay. The satisfaction rate was estimated using the 30-Item Birth Satisfaction Scale questionnaire. RESULTS After randomization, 73 individuals were allocated to the intermittent catheterization group, and 74 individuals were allocated to the continuous catheterization group. The mean time to postpartum urinary retention resolution was significantly shorter in the intermittent catheterization group than in the continuous catheterization group (10.2±11.8 vs 26.5±9.0 hours; P<.001), with 75% and 93% resolution rates after 1 and 2 catheterizations, respectively. The number of individuals who achieved resolution at 24 hours was 72 (99%) in the intermittent catheterization group and 67 (91%) in the continuous catheterization group (P=.043). The satisfaction rate was higher in all categories in the intermittent catheterization group than in the continuous catheterization group (P<.001). No intercohort difference was found in the urinary tract infection rates (P=.89) or hospital stay length (P=.58). CONCLUSION Compared with indwelling catheterization, intermittent catheterization for urinary retention after delivery was associated with quicker postpartum urinary retention resolution and a higher satisfaction rate without increasing the complication rates.
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Affiliation(s)
- Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner).
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Eli Kabakov
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Emilie Ben-Ezry
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Dr Ben-Ezry, Dr Weiner, and Dr Ganor-Paz)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Dr Ben-Ezry, Dr Weiner, and Dr Ganor-Paz)
| | - Yael Ganor-Paz
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Dr Ben-Ezry, Dr Weiner, and Dr Ganor-Paz)
| | - Enav Yefet
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel (Dr Yefet); Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Yefet and Dr Khamaisi)
| | - Thana Khamaisi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Yefet and Dr Khamaisi)
| | - Zohar Nachum
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner); Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali)
| | - Manal Massalha
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner); Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali)
| | - Khadeje Shamali
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali)
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner); Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner)
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11
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Dekalo A, Kogan Z, Herman HG, Marelly C, Yaka C, Schreiber L, Weiner E, Miremberg H. Fetal growth restriction, neonatal morbidity and placental pathology in dichorionic twins-a comparison of twin-specific versus singleton growth charts. Placenta 2023; 140:6-10. [PMID: 37506499 DOI: 10.1016/j.placenta.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Fetal growth restriction (FGR) in dichorionic diamniotic (DCDA) twin gestations is a known complication associated with adverse neonatal outcomes. The international guidelines have no consensus on whether to use singleton or twin-specific growth charts. Thus, we aimed to compare growth charts in correlation with pregnancy outcomes and placental histopathology. METHODS The medical files of all DCDA twin deliveries between 2010 and 2020 were reviewed. Birthweight percentile for gestational age (GA) for each individual neonate was assigned using the updated local singleton and twin-specific growth chart. We then divided the study population into two groups, neonates that were FGR based on the local singleton charts (FGR-singleton group) versus FGR on both twin-specific and singleton charts (FGR-twin group). Placental lesions were classified as lesions related to maternal or fetal malperfusion lesions (MVM, FVM), vascular and villous changes, and inflammatory lesions. RESULTS Overall, 185 neonates met the inclusion criteria. The FGR-twin group (59/185) had a higher rate of PE, lower GA at delivery, lower birthweight, and a higher rate of neonatal composite adverse outcomes compared to the FGR-singleton group. Moreover, placental pathology of the FGR-twin group demonstrated a higher rate of MVM lesions (p = 0.035). DISCUSSION In our cohort, neonates considered FGR based on twin-specific charts had worse neonatal outcomes with underlying placental insufficiency demonstrated by a higher rate of placental malperfusion vascular lesions. Our findings support using a twin-specific chart to diagnose FGR that is more clinically relevant.
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Affiliation(s)
- Ann Dekalo
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Zviya Kogan
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Hadas Ganer Herman
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Cindy Marelly
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Chen Yaka
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Letizia Schreiber
- Departments of Pathology, The Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Hadas Miremberg
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
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12
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Barber E, Ram M, Mor L, Ganor Paz Y, Shmueli A, Bornstein S, Barda G, Schreiber L, Weiner E, Levy M. Pregnancy and placental outcomes according to maternal BMI in women with preeclampsia: a retrospective cohort study. Arch Gynecol Obstet 2023:10.1007/s00404-023-07148-9. [PMID: 37466689 DOI: 10.1007/s00404-023-07148-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Obesity and preeclampsia share similar patho-mechanisms and can both affect placental pathology. We aimed to investigate pregnancy outcomes in correlation with placental pathology among pregnancies complicated by preeclampsia in three different maternal body mass index (BMI, kg/m2) groups. METHODS In this retrospective cohort study, medical and pathological records of patients with preeclampsia and a singleton pregnancy delivered between 2008 and 2021 at a single tertiary medical center were reviewed. Study population was divided into three BMI groups: BMI < 22.6 kg/m2 (low BMI group), 22.7 ≤ BMI ≤ 28.0 kg/m2 (middle-range BMI group), and BMI > 28.0 kg/m2 (high BMI group). Data regarding maternal characteristics, neonatal outcomes, and placental histopathological lesions were compared. RESULTS The study groups included a total of 295 patients diagnosed with preeclampsia-98, 99, and 98 in the low, middle-range, and high BMI groups respectively. Neonatal birth weight was significantly decreased in the low maternal BMI group compared to both middle and high BMI groups (p = 0.04) with a similar trend seen in placental weight (p = 0.03). Villous changes related to maternal malperfusion were more prevalent in the low and high BMI groups compared to middle-range BMI group (p < 0.01) and composite maternal vascular malperfusion lesions were also more prevalent in the groups of BMI extremities compared to the middle-range BMI group (p < 0.01). CONCLUSION Maternal BMI might influence neonatal outcomes and placental pathology in pregnancies complicated by preeclampsia. Both extremes of BMI were associated with higher rates of placental maternal vascular malperfusion. Balanced BMI in women at risk for preeclampsia may reduce the incidence of placental lesions.
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Affiliation(s)
- Elad Barber
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Ram
- Clalit Health Organization, Jerusalem, Israel
| | - Liat Mor
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel.
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yael Ganor Paz
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sandy Bornstein
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Shmueli A, Mor L, Blickstein O, Sela R, Weiner E, Gonen N, Schreiber L, Levy M. Placental pathology in pregnancies with late fetal growth restriction and abnormal cerebroplacental ratio. Placenta 2023; 138:83-87. [PMID: 37224646 DOI: 10.1016/j.placenta.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/25/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Late fetal growth restriction (FGR) is associated with mild growth restriction and normal or mild abnormal doppler flows. The cerebroplacental ratio (CPR) has been demonstrated as more sensitive to hypoxia than its individual components in these fetuses. We hypothesized that abnormal CPR in late FGR is reflected in specific placental vascular malperfusion lesions. METHODS Retrospective cohort study of late FGR newborns between 2012 and 2022 in a tertiary hospital. Overall, 361 cases were included: 104 with pathological CPR (study group), and 257 with normal doppler flows (control group). The primary outcome was a composite of maternal vascular malperfusion lesions (MVM) and fetal vascular malperfusion lesions (FVM). Secondary outcomes were macroscopic placental characteristics and various obstetrical and neonatal outcomes. RESULTS The study group had lower birthweight compared with the normal CPR group (2063.5 ± 470.5 vs. 2351.6 ± 387.4 g. P < 0.0001), higher rates of composite adverse neonatal outcomes (34.2% vs. 22.5%, p < 0.0001), lower mean placental weight (318 ± 71.6 vs. 356.6 ± 76.5 g, p < 0.0001), as well as a higher prevalence of Vascular lesions of MVM (15.3% vs. 5.0%, p = 0.002), villous lesions of FVM (37.5% vs. 24.9%, p = 0.02), and composite FVM lesions (36.5% vs. 25.6%, p = 0.04). On multivariate regression analysis for MVM lesions and composite FVM lesions, abnormal CPR was found as an independent risk factor (aOR 2.17, 95% CI 1.63-4.19, and aOR 1.31, 95% CI 1.09-3.97, respectively). DISCUSSIONS Abnormal CPR in late FGR is reflected in placental histopathologic vascular malperfusion lesions, and the incidence of these lesions is higher than in FGR placentas with normal CPR.
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Affiliation(s)
- Anat Shmueli
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Liat Mor
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ophir Blickstein
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Rinat Sela
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Noa Gonen
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Letizia Schreiber
- Department of Pathology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michal Levy
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
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14
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Ben Zvi M, Arad Cohen M, Friedman M, Ganer Herman H, Weiner E, Ginath S. Urinary Incontinence in Parous Women Practicing Non-Extreme Competitive Sports Compared to the General Population. J Clin Med 2023; 12:jcm12082803. [PMID: 37109140 PMCID: PMC10141981 DOI: 10.3390/jcm12082803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/11/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE This cross-sectional study aimed to compare the prevalence of urinary symptoms in physically active females to the general population represented by medical staff. MATERIALS AND METHODS We conducted a survey utilizing the UDI-6 questionnaire on women playing catchball for at least one year and training twice a week or more in an official Israeli competitive league. The control group consisted of women practicing medicine (physicians and nurses). RESULTS The study group consisted of 317 catchball players and the control group consisted of 105 medical staff practitioners. Both groups were similar in most of the demographic characteristics. Urinary symptoms represented by UDI-6 scores were higher in women in the catchball group. Frequency and urgency symptoms were common in women playing catchball. Stress urinary incontinence (SUI) was insignificant between the groups (43.8% in the catchball group and 35.2% in the medical staff group, p = 0.114). However, severe symptoms of SUI were more common in catchball players. CONCLUSIONS The rates of all urinary symptoms were higher in in catchball players. SUI symptoms were common in both groups. However, severe symptoms of SUI were more common in catchball players.
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Affiliation(s)
- Masha Ben Zvi
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Maya Arad Cohen
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Matan Friedman
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Hadas Ganer Herman
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Eran Weiner
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Shimon Ginath
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
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Gluck O, Barber E, Tal O, Kerner R, Weiner E, Sagiv R. Surgical intervention after medical treatment for early pregnancy loss according to gestational size. Int J Gynaecol Obstet 2023; 160:933-938. [PMID: 35899733 PMCID: PMC10087292 DOI: 10.1002/ijgo.14371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the rate of surgical intervention for unsuccessful medical treatment in early pregnancy loss (EPL), according to gestational size by ultrasound (GS-US). METHODS This was a retrospective cohort study. All women who were treated with misoprostol for EPL between July 2015 and December 2020 were included. The cohort was divided according to GS-US: group 1: gestational sac without an embryonic pole; group 2: an embryonic pole with crown-rump length (CRL) compatible with <7 weeks; group 3: CRL compatible with 7+0 -7+6 weeks; group 4: CRL compatible with 8+0 -8+6 weeks; group 5: CRL compatible with ≥9 weeks. We compared the rate of any surgical intervention due to treatment failure. RESULTS Overall, 783 patients were included: group 1, 236 (30.1%); group 2, 319 (40.7%); group 3, 115 (14.7%); group 4, 78 (10.0%); and group 5, 35 (5.0%) patients. The rate of any surgical intervention was significantly lower in groups 1-4 (54, 22.9%; 85, 26.6%; 28, 24.3%; and 22, 28.2%, respectively) compared with group 5 (17, 48.6%; P = 0.030). On multivariant analysis, GS-US greater than 9 weeks was independently associated with the need for surgical intervention (adjusted odds ratio 1.23, 95% confidence interval 1.01-1.51; P = 0.040). CONCLUSION When treating EPL medically, GS-US greater than 9 weeks increases the risk of undergoing additional surgical intervention compared with younger weeks.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Tal
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gluck O, Matani D, Rosen A, Barber E, Weiner E, Ginath S. Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection. J Clin Med 2023; 12:jcm12020678. [PMID: 36675607 PMCID: PMC9866699 DOI: 10.3390/jcm12020678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Background: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the rectocele is larger than 3 cm and/or symptomatic, surgery should be considered. The surgical approach can be either transvaginal, transanal or transperineal. Two of the most common procedures in treating rectocele are posterior colporrhaphy (PC) and stapled trans anal rectal resection (STARR). The purpose of this study was to compare surgical outcomes of both procedures. Methods: This is a retrospective cohort study. Included were patients of the age of 18−85 years that underwent either STARR (n = 49 patients) or PC (n = 24 patients) procedures after a full clinical (defecography and physical exam before and after the surgery) and physiologic (a detailed questionnaire before and after the surgery) surveys. Symptoms of ODS before and after surgery were evaluated by questioners. Results: Preoperatively, the patients in the STARR group had significantly higher rates of ODS: straining (90.9% vs. 65.2%), incomplete evacuation (100% vs. 69.6%), hard stool (57.8% vs. 43.5%), sense of obstruction (76.1% vs. 56.5%), and use of digitation (64.4% vs. 47.8%), or laxatives (70% vs. 47.8%), p < 0.001. Anatomically, the mean rectocele size was smaller for the STARR group, compared to the PC group (3.8 ± 1.4 vs. 5.3 ± 2.2 cm, respectively, p < 0.001). Postoperatively, in the STARR group, higher rates of patients complained about straining (36.4% vs. 21.7%, p < 0.001) and use of digitation (64.4% vs. 26.1%, p < 0.001), whereas lower rates of patients complained about incomplete evacuation (41.2% vs. 56.5%, p = 0.05) and sense of obstruction (17.6%, vs. 34.8%, p = 0.03), compared to the PC group. Among patients who underwent the STARR procedure, a decrease in rates of all symptoms was noted (straining 54.5%, incomplete evacuation 58.8%, hard stool 29.2%, sense of obstruction 58.5%, use of digitation 0.1%, and use of laxatives 31.5%). Both procedures are effective in reducing rectocele size (STARR- 1.9 ± 1 cm, PC- 3.1 ± 1). Conclusions: Both STARR and PC are effective in treating rectocele. It seems that the STARR procedure is superior to the PC procedure in treating symptoms of ODS.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +972-35028329; Fax: +972-35028503
| | - Doraid Matani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ada Rosen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Proctology and Pelvic Floor Unit, Division of General Surgery, Wolfson Medical Center, Holon 58100, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Marom O, Weiner E, Gindes L, Mor L, Toledano E, Alon AS, Miremberg H, Gury M, Josef shalev, Essaev S, Levy M. The effect of exposure to an informative video about amniocentesis on maternal anxiety. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gonen N, Herman HG, Barda G, Kleiner I, Tairy D, Torem M, Shmueli A, Weiner E. Effect of mobility during induction of labor on time to delivery: a randomized controlled trial. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gluck O, Amram S, Feldstein O, Barber E, Tamayev L, Weiner E, Oren B, Ginath S. The Effect of Preemptive Local Infiltration on Postoperative Pain After Vaginal Hysterectomy: a Retrospective Study. J Minim Invasive Gynecol 2022; 30:308-311. [PMID: 36543269 DOI: 10.1016/j.jmig.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/18/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To investigate the effect of preemptive infiltration on postoperative pain and the use of analgesics after vaginal hysterectomy (VH). DESIGN A retrospective study. SETTING An urogynecology unit in a tertiary medical center. PATIENTS A total of 120 patients who had undergone VH. INTERVENTIONS The study group contained 60 patients who participated in a former randomized control study, in which preemptive local infiltration of bupivacaine (n = 30) or sodium chloride 0.9% (n = 30) was performed. The control group included 60 consecutive patients who underwent a VH, for whom no local infiltration was performed. MEASUREMENTS AND MAIN RESULTS Postoperative pain at rest was assessed using the 10 cm visual analog scale at 3, 8, and 24 hours after surgery. The levels of pain, as well as the use of analgesics, postoperatively, were compared between the groups. The mean surgery length in the infiltration group was shorter (86.4±29 vs 118.6±30, p <.001) and the rate of posterior colporrhaphy was lower (73.1% vs 91.3%, p = .010) than the control group. There were no differences in levels of pain at all points of time. However, the infiltration group required a lower morphine dose in the recovery unit (3.7 ± 2.3 mg vs 5.3 ± 2.4 mg, p <.001) and less use of analgesia (all kinds) 24 hours after surgery (54.2% vs 79.6%, p <.001) compared with the control group. On multivariant analysis, preemptive infiltration was found to be independently inversely associated with the dose of morphine used in recovery, as well as analgesics used 24 hours after surgery. CONCLUSION Preemptive local infiltration of either bupivacaine or sodium chloride 0.9% reduced the use of morphine in the recovery unit, as well as the use of analgesics 24 hours after VH, compared with no infiltration at all.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel.
| | - Stav Amram
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; The Adelson School of Medicine, Ariel University (Amram), Ariel, Israel
| | - Ohad Feldstein
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Ben Oren
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University (Oren), Safed, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
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20
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Leytes S, Kovo M, Weiner E, Ganer Herman H. Isolated oligohydramnios in previous pregnancy is a risk factor for a placental related disorder in subsequent delivery. BMC Pregnancy Childbirth 2022; 22:912. [PMID: 36474207 PMCID: PMC9727971 DOI: 10.1186/s12884-022-05230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed to assess the association between isolated oligohydramnios in previous pregnancy and the incidence of placental related complications in subsequent pregnancy. METHODS This was a retrospective cohort study of live singleton births from a single university affiliated medical center during an eleven-year period of women with two subsequent deliveries at our center. An analysis of outcomes was performed for all second deliveries, comparing women for whom their first delivery was complicated by isolated oligohydramnios (previous oligohydramnios group), and women without isolated oligohydramnios in their first delivery (control group). Patients for whom their first delivery was complicated by small for gestational age, pregnancy induced hypertension and preterm birth were excluded. The study groups were compared for obstetric and early neonatal outcomes, recurrence of oligohydramnios and a composite of placental related pregnancy complications. RESULTS A total of 213 in the previous oligohydramnios group and 5348 in the control group were compared. No differences were found between the groups in maternal age, body mass index, smoking and comorbidities. Gestational age at delivery was, 39.6 ± 1.3 vs. 39.3 ± 1.4 weeks, p = 0.006, in the previous oligohydramnios and controls respectively, although preterm birth rate was similar between the groups. The previous oligohydramnios group had a significantly higher incidence of oligohydramnios in second delivery, aOR 3.37, 95%CI 1.89-6.00, small for gestational age neonates, aOR 1.94, 95% CI 1.16-3.25, and overall placental related disorders of pregnancy, aOR 2.13, 95%CI 1.35-3.35. CONCLUSION Pregnancies complicated by isolated oligohydramnios are associated with an increased risk of placental related disorders in subsequent pregnancy. Isolated oligohydramnios may be the first sign of placental insufficiency and an independent manifestation of the placental related complications spectrum.
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Affiliation(s)
- Sophia Leytes
- grid.414317.40000 0004 0621 3939Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Michal Kovo
- grid.415250.70000 0001 0325 0791Department of Obstetrics & Gynecology, the Meir Medical Center, Kfar Saba, Israel
| | - Eran Weiner
- grid.414317.40000 0004 0621 3939Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Hadas Ganer Herman
- grid.414317.40000 0004 0621 3939Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
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Barber E, Ganer Herman H, Kovo M, Tairy D, Schreiber L, Horowitz E, Weissman A, Weiner E, Raziel A. P-353 Placenta previa in In Vitro Fertilization and unassisted pregnancies – is there a difference in perinatal outcomes and placental histology? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Why is In-vitro-fertilization (IVF) an independent risk factor for placenta previa (PP).
Summary answer
While PP in non-assisted pregnancies is probably associated with previous cesarean deliveries (CD), in IVF it is more “sporadic”, and may complicate any index pregnancy.
What is known already
PP is more prevalent following IVF pregnancies as compared with unassisted pregnancies, with an increased risk of three to six-fold according to some authors. The etiology for this increased risk in IVF pregnancies in unclear, and may be related to reproductive procedures performed or to subfertility characteristics which have led to IVF.
Study design, size, duration
A retrospective-cohort study of deliveries with PP between 2008 and 2021. A total of 182 pregnancies were included.
Participants/materials, setting, methods
Placental histopathology, obstetric and neonatal outcomes were compared between IVF and unassisted pregnancies. Included, were singleton deliveries complicated by PP at gestational weeks (GA)> 24. Placental pathology was obtained utilizing the well-accepted Amsterdam criteria.
Main results and the role of chance
Out of 182 pregnancies which were included - 23 IVF pregnancies (IVF group) and 159 in the unassisted pregnancies (Control group). The control group was characterized by higher gravidity (p = 0.007) and parity (p < 0.001), whereas the IVF group- by a higher rate of nulliparity (p < 0.001) and diabetes mellitus (p = 0.04). A higher rate of patients with past CDs was noted in unassisted pregnancies, although not statistically significance (38.9% versus 21.7%, p = 0.10). There was a trend for a lower placental weight in the control group, and a higher incidence of placental weight below the 10thpercentile in this group (47.8% versus 13.9%, p = 0.001). No differences were noted in maternal and fetal vascular lesions. Nevertheless, IVF and unassisted pregnancies entail similar perinatal outcomes in cases of PP.
Limitations, reasons for caution
A major limitation was our small sample size in the IVF group. Despite a power calculation, larger study groups would have possibly allowed for the demonstration of additional differences in outcomes, including previous cesarean deliveries and placenta accreta. Moreover, this limitation prevented us from matching against possible cofounders.
Wider implications of the findings
While a growing proportion of pregnancies worldwide are conceived by IVF, possible iatrogenic side effects should be studied. As PP is of clinical importance, it is essential to diagnose it on time, as well as study the mechanisms and risk factors behind it, which could possibly help with its prevention.
Trial registration number
0282-20-WOMC
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Affiliation(s)
- E Barber
- Tel Aviv university, OBGYN , 5834468, Israel
| | - H Ganer Herman
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - M Kovo
- Tel Aviv university, Obstetrics and gynecology , Tel Aviv, Israel
| | - D Tairy
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - L Schreiber
- Wolfson medical center , Pathology, Holon, Israel
| | - E Horowitz
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - A Weissman
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - E Weiner
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - A Raziel
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
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Miremberg H, Yirmiya K, Vinter D, Lauterbach R, Yefet E, Nassra R, Paz YG, Hagege R, Weiner E. An informative video before planned cesarean delivery and maternal anxiety-a multicenter randomized controlled trial. Am J Obstet Gynecol MFM 2022; 4:100604. [PMID: 35240345 DOI: 10.1016/j.ajogmf.2022.100604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cesarean delivery is one of the most common procedures performed in obstetrics, and although cesarean delivery is a blissful occasion, it is commonly associated with fear and anxiety for the new mother. OBJECTIVE We aimed to study the impact of watching a detailed, informative video on maternal anxiety levels, childbirth experience, and patient satisfaction in patients undergoing a primary cesarean delivery. STUDY DESIGN We performed a multicenter randomized control trial. Women scheduled to undergo a primary nonemergent cesarean delivery were recruited. All participants in the intervention group watched an informative video on recruitment. This 4-minute video described in detail the expected cesarean delivery process: preparations before entering the operation room, regional anesthesia administration, sterile covering, the surgical procedure itself, and recovery (including mobilization and lactation). Situation-specific anxiety was measured at recruitment, before exposure to the video (S1), at the day of the operation (S2), and at postpartum day 1 (S3) using the State-Trait Anxiety Inventory score. In addition, participants answered a 10-item Childbirth Experience Questionnaire. A sample size of 63 per group was planned to achieve 80% power to detect a difference of 5 points in the primary outcome (State-Trait Anxiety Inventory score on the day of the operation). RESULTS Overall, 154 participants from 4 medical centers were randomized, and 132 participants were analyzed after completing all questionnaires, 64 participants in the video group and 68 participants in the control group. The groups did not differ in demographics and delivery characteristics and had similar baseline anxiety levels (S1). On operation day (S2, the primary outcome), significantly lower anxiety levels were reported in the video group than in the control group (State-Trait Anxiety Inventory scores, 41.3±9.5 vs 49.3±10.3; P<.001). Moreover, anxiety levels in postpartum day 1 (S3) remained significantly lower in the video group (P<.001). No difference between the groups in childbirth experience score or patient satisfaction was demonstrated. CONCLUSION A detailed informative video shown to patients before primary cesarean delivery decreased maternal anxiety levels before and after the procedure.
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Affiliation(s)
- Hadas Miremberg
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Drs Miremberg, Ganor Paz, and Weiner); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Miremberg and Weiner).
| | - Karen Yirmiya
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel (Dr Yirmiya); Interdisciplinary Center, Herzliya, Israel (Dr Yirmiya)
| | - Dana Vinter
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Vinter and Lauterbach); The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Vinter and Lauterbach)
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Vinter and Lauterbach); The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Vinter and Lauterbach)
| | - Enav Yefet
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Tiberias, Israel (Drs Yefet and Nassra); Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Yefet)
| | - Rima Nassra
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Tiberias, Israel (Drs Yefet and Nassra)
| | - Yael Ganor Paz
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Drs Miremberg, Ganor Paz, and Weiner); Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel (Drs Ganor Paz and Hagege); Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel (Dr Ganor Paz)
| | - Rina Hagege
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel (Drs Ganor Paz and Hagege)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Drs Miremberg, Ganor Paz, and Weiner); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Miremberg and Weiner)
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Yefet E, Perlitz Y, Yaakov LS, Magril G, Vitner D, Zipori Y, Weiner E, Alon AS, Paz YG, Nezer M, Soltsman S, Nachum Z. The effect of probiotics on glycemic control of women with gestational diabetes mellitus-multicenter, randomized, double blind, placebo controlled-trial. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Miremberg H, Yirmiya K, Vinter D, Lauterbach R, Yefet E, Nassra R, Paz YG, Hagege R, Kovo M, Weiner E. Exposure to an informative video before planned Cesarean-delivery and maternal anxiety-a multicenter randomized controlled trial. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Miremberg H, Yirmiya K, Rona S, Gonen N, Marom O, Pohol A, Kovo M, Bar J, Weiner E. Smartphone-based counseling and support platform and the effect on postpartum lactation: a randomized controlled trial. Am J Obstet Gynecol MFM 2021; 4:100543. [PMID: 34871782 DOI: 10.1016/j.ajogmf.2021.100543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Human milk lactation provides health benefits for both the mother and infant. Patients commonly report stopping breastfeeding sooner than they planned. Interventions with proper accessible counseling and support to the mother can potentially increase lactation rates and duration. OBJECTIVE This study aimed to investigate the impact of introducing a smartphone-based daily feedback and counseling platform between women after delivery and a multidisciplinary lactation support team on lactation rates and various maternal and neonatal outcomes. Counseling was provided via a specifically developed application from a multidisciplinary team (obstetricians, nurses, lactation counselors, and psychologist) in an attempt to assist and counsel to maintain lactation. STUDY DESIGN This was a prospective, single-center, randomized controlled trial. Women planning to lactate were recruited at postpartum day 1 and were randomized to (1) routine lactation counseling and support (control group) or (2) additional daily detailed counseling and feedback on lactation from the team via the application (App group). The primary outcome was partial or full lactation at 3 months after delivery. The secondary outcomes included lactation at additional time points up to 6 months after delivery. The study was adequately powered to detect a 15% difference in the primary outcome. RESULTS A total of 197 patients were recruited, 97 in the App group and 100 in the control group. The 2 groups did not differ in any background or delivery characteristics. The App group showed higher rates of lactation 6 weeks after delivery (96.9% vs 82.0%; P<.001) and 3 months after delivery (81.4% vs 69.0%; P=.049) than the control group. Patients in the App group reported excellent satisfaction from the use of the application and their overall postnatal care. CONCLUSION Our study has provided further information on the growing efficacy of technology platforms in obstetrical care. The introduction of a smartphone-based daily feedback and counseling platform between postpartum patients and a multidisciplinary lactation support team increased the lactation rates after delivery with excellent patient satisfaction.
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Affiliation(s)
- Hadas Miremberg
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Karen Yirmiya
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel; Interdisciplinary Center, Herzliya, Israel
| | - Shiran Rona
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel
| | - Noa Gonen
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Or Marom
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Alona Pohol
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Miremberg H, Ganer Herman H, Bustan M, Weiner E, Schreiber L, Bar J, Kovo M. Placental vascular lesions differ between male and female fetuses in early-onset preeclampsia. Arch Gynecol Obstet 2021; 306:717-722. [DOI: 10.1007/s00404-021-06328-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 11/05/2021] [Indexed: 01/04/2023]
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Bar J, Weiner E, Levy M, Gilboa Y. The thrifty phenotype hypothesis: The association between ultrasound and Doppler studies in fetal growth restriction and the development of adult disease. Am J Obstet Gynecol MFM 2021; 3:100473. [PMID: 34481995 DOI: 10.1016/j.ajogmf.2021.100473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022]
Abstract
Barker pioneered the idea that the epidemic of coronary heart disease in Western countries in the 20th century, which paradoxically coincided with improved standards of living and nutrition, has its origin in fetal life. Indeed, there is substantial evidence associating low birthweight because of fetal growth restriction with an increased risk of vascular disease in later adult life. These conclusions led to the second part of the Barker hypothesis, the thrifty phenotype, in which adaptation to undernutrition in fetal life leads to permanent metabolic and endocrine changes. Such changes are beneficial if the undernutrition persists after birth but may predispose the individual to obesity and impaired glucose tolerance if conditions improve. The hypothesis assumes that a poor nutrient supply during a critical period of in utero life may "program" a permanent structural or functional change in the fetus, thereby altering the distribution of cell types, gene expression, or both. The fetus, in response to placental undernutrition and to maintain sufficient vascular supply to the brain, decreases resistance to blood flow in the middle cerebral artery. Simultaneously, because of the limited blood supply to the fetus, the arterial redistribution process is accompanied by increased resistance to flow to other fetal vital organs, such as the heart, kidneys, liver, and pancreas. It may explain why individuals exposed to ischemic changes in utero develop dyslipidemia, lower nephron number, and impaired glucose tolerance, all factors contributing to metabolic syndrome later in life. Nevertheless, support for the hypotheses comes mainly from studies in rodents and retrospective epidemiologic studies. This review focused on ultrasound and Doppler studies of human fetal growth restriction in several fetal organs: the placenta, fetal circulation, brain, heart, kidneys, adrenal glands, liver, and pancreas. Support for the hypothesis was provided by animal studies involving conditions that create fetuses with growth restriction with effects on various fetal organs and by human studies that correlate impaired fetal circulation with the in utero development and function of fetal organs.
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Affiliation(s)
- Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa).
| | - Michal Levy
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy)
| | - Yinon Gilboa
- Ultrasound Unit, Helen Schneider Comprehensive Women's Health Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel (Dr. Gilboa); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
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Warshafsky C, Ronzoni S, Quaglietta P, Weiner E, Zaltz A, Barrett J, Melamed N, Aviram A. Comparison of sonographic fetal weight estimation formulas in patients with preterm premature rupture of membranes. BMC Pregnancy Childbirth 2021; 21:149. [PMID: 33607956 PMCID: PMC7893917 DOI: 10.1186/s12884-021-03631-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Estimation of fetal weight (EFW) by ultrasound is useful in clinical decision-making. Numerous formulas for EFW have been published but have not been validated in pregnancies complicated by preterm premature rupture of membranes (PPROM). The purpose of this study is to compare the accuracy of EFW formulas in patients with PPROM, and to further evaluate the performance of the most commonly used formula - Hadlock IV. METHODS A retrospective cohort study of women with singleton gestations and PPROM, admitted to a single tertiary center between 2005 and 2017 from 220/7-330/7 (n = 565). All women had an EFW within 14 days of delivery by standard biometry (biparietal diameter, head circumference, abdominal circumference and femur length). The accuracy of previously published 21 estimated EFW formulas was assessed by comparing the Pearson correlation with actual birth weight, and calculating the random error, systematic error, proportion of estimates within 10% of birth weight, and Euclidean distance. RESULTS The mean gestational was 26.8 ± 2.4 weeks at admission, and 28.2 ± 2.6 weeks at delivery. Most formulas were strongly correlated with actual birth weight (r > 0.9 for 19/21 formulas). Mean systematic error was - 4.30% and mean random error was 14.5%. The highest performing formula, by the highest proportion of estimates and lowest Euclidean distance was Ott (1986), which uses abdominal and head circumferences, and femur length. However, there were minimal difference with all of the first 10 ranking formulas. The Pearson correlation coefficient for the Hadlock IV formula was strong at r = 0.935 (p < 0.001), with 319 (56.5%) of measurements falling within 10%, 408 (72.2%) within 15% and 455 (80.5%) within 20% of actual birth weight. This correlation was unaffected by gender (r = 0.936 for males, r = 0.932 for females, p < 0.001 for both) or by amniotic fluid level (r = 0.935 for mean vertical pocket < 2 cm, r = 0.943 for mean vertical pocket ≥2 cm, p < 0.001 for both). CONCLUSIONS In women with singleton gestation and PPROM, the Ott (1986) formula for EFW was the most accurate, yet all of the top ten ranking formulas performed quite well. The commonly used Hadlock IV performed quite similarly to Ott's formula, and is acceptable to use in this specific setting.
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Affiliation(s)
- Chelsie Warshafsky
- Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Stefania Ronzoni
- Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Paula Quaglietta
- Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Eran Weiner
- Edith Wolfson Medical Center, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Holon, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arthur Zaltz
- Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Jon Barrett
- Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Nir Melamed
- Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Amir Aviram
- Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
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kogan Z, Ganer-Herman H, Bustan-Nahumson M, Weiner E, Bar J, Kovo M. 462 Postpartum antihypertensive treatment in preeclamptic patients – correlation to clinical and placental findings. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Levy M, Kovo M, Schreiber L, Bustan-Nahumson M, Bornstein S, Macov M, Barda G, Bar J, Weiner E. 470 Pregnancy outcomes and placental-histopathology in pregnancies complicated by preeclampsia in different maternal BMI groups. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levy M, Kovo M, Feldstein O, Dekalo A, Schreiber L, Levanon O, Bar J, Weiner E. The effect of concomitant histologic chorioamnionitis in pregnancies complicated by fetal growth restriction. Placenta 2020; 104:51-56. [PMID: 33276235 DOI: 10.1016/j.placenta.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to investigate the effect of placental histologic chorioamnionitis (HC) on neonatal outcomes in pregnancies complicated by fetal growth restriction (FGR). METHODS - The computerized medical files of all pregnancies diagnosed with FGR (birthweight <10th percentile) at 24-42 weeks of gestation between 2008 and 2019 were reviewed. Maternal and neonatal outcomes were compared between FGR with and without evidence of placental HC. Placental lesions were classified according to "Amsterdam" criteria. Composite adverse neonatal outcome-included any of the following complications: neurological morbidity, neonatal respiratory assistance, RDS, NEC, sepsis, blood transfusion, phototherapy, hypoglycemia, or neonatal death. Composite severe adverse neonatal outcome included any of the following complications - neurological morbidity, blood transfusion, NEC, sepsis, RDS, neonatal death. RESULTS - Compared to FGR without HC (n = 446), FGR with HC (n = 57) was characterized by more advanced gestational age at delivery 39.2 (38.3-39.9) vs. 38.2 (36.9-39.2), weeks respectively, p < 0.001), higher rate of nulliparity (73.7% vs. 45.1%, p < 0.001), less vascular lesions of MVM (1.8% vs.11.2%, p = 0.02), higher rate of Apgar scores at 5 min <7 (10.5% vs. 2%, p = 0.004), increased neonatal death (7.0% vs. 0.9%, p = 0.007), higher rates of both composite adverse neonatal outcome (31.1% vs. 17.3% p = 0.02), and composite severe adverse neonatal outcome (16.3% vs. 8.2% p = 0.04). By multivariate regression analysis HC was found to be independently associated with composite adverse neonatal outcome (aOR = 1.21, 95% CI 1.08-2.38) and with severe composite adverse neonatal outcome (aOR = 1.39, 95% CI 1.16-3.76). CONCLUSIONS Pregnancies complicated by FGR with concomitant HC were associated with higher rates of adverse neonatal outcomes.
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Affiliation(s)
- Michal Levy
- Departments of Obstetrics & Gynecology the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Kovo
- Departments of Obstetrics & Gynecology the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- Departments of Obstetrics & Gynecology the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ann Dekalo
- Departments of Obstetrics & Gynecology the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Levanon
- Departments of Obstetrics & Gynecology the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology the Edith Wolfson Medical Center, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tairy D, Weiner E, Kovo M, Zamir AM, Gandelsman E, Levy M, Herman HG, Volpert E, Schreiber L, Bar J, Barda G. Fetal Growth Restriction in Hypertensive vs. Heavy Smoking Women-Placental Pathology, Ultrasound Findings, and Pregnancy Outcomes. Reprod Sci 2020; 28:819-827. [PMID: 33140325 DOI: 10.1007/s43032-020-00373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
We compared placental pathology, ultrasonographic findings, and obstetric outcomes, in gestations complicated by fetal growth restriction (FGR) with either a background of hypertensive disorder or heavy tobacco cigarette smoking. The medical records and placental pathology reports of pregnancies complicated with FGR (birthweight < 10th percentile) between December 2008 and May 2018 from a single tertiary center were reviewed. Placental pathology, ultrasound findings, and pregnancy outcomes were compared between hypertensive patients (HTN) and heavy smokers (SMO). We included 213 pregnancies: 129 (60.6%) in the SMO group and 84 (39.4%) in the HTN group. The HTN group was characterized by a higher BMI (p = 0.01), higher rates of Cesarean deliveries (p = 0.006), and a lower gestational age at delivery (35.6 ± 3.8 vs. 37.5 ± 2.9 weeks, p < 0.001). The HTN group had higher rates of placental weights < 10th percentile (p = 0.04) and maternal vascular malperfusion lesions (p < 0.001), while the SMO group had higher rates of inflammatory lesions (p = 0.04). On ultrasound, the HTN group had a higher head/abdomen circumference ratio (p < 0.001) and more abnormal Doppler studies (< 0.001). Neonates in the HTN group had lower birthweights (p < 0.001) and higher rates of NICU admissions (p = 0.002) and adverse neonatal outcome (p = 0.006). On multivariable analysis, gestational age at delivery (aOR = 0.65, 95%CI 0.55-0.87), hypertensive disorders (aOR = 1.8, 95%CI = 1.21-4.81), placental MVM lesions (aOR = 1.23, 95%CI = 1.08-5.02), and the combination of HTN+MVM (aOR = 2.63, 95%CI 1.78-7.30) were independently associated with adverse neonatal outcome. Hypertension and smoking may lead to FGR in different pathways as the two groups significantly differed in maternal characteristics, placental pathology, ultrasound findings, and neonatal outcomes. A hypertensive disorder probably represents a more hostile maternal environment than smoking and these pregnancies would probably benefit from closes monitoring.
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Affiliation(s)
- Daniel Tairy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Astar Maloul Zamir
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erika Gandelsman
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldar Volpert
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department Pathology, The Edith Wolfson Medical Center, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiner E, Levy M, Schreiber L, Mizrachi Y, Bar J, Kovo M. [PLACENTAL PATHOLOGY - IS IT JUST THE "BLACK BOX" OF PREGNANCY OR CAN IT SERVE AS A "CRYSTAL BALL" TO PREDICT RECURRENCE OF PREGNANCY COMPLICATIONS?]. Harefuah 2020; 159:829-834. [PMID: 33210856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Analysis of placental histopathology lesions may assist in a better understanding of the underlying mechanisms that lead to different clinical phenotypes in complicated pregnancy. Categorization of placental lesions provide us with a tool to determine the placental reaction and adaptation to abnormal placentation that occurs during pregnancy complications. Placental pathology has traditionally been the "black box" of pregnancy. The associations between placental histopathology and pregnancy complications have been studied comprehensively. After more than a decade of experience in collecting detailed placental pathological reports from various pregnancy complications, we looked for placental characteristics that could serve as predictors in patients with recurrence of pregnancy complications. It was found that in cases of preeclampsia, intrauterine growth restriction and preterm birth, prediction models involving placental pathology performed better than models based only on clinical factors. The placenta histopathology reports should be used not only as records from the "black-box of pregnancy" but more as records from the "crystal ball" for future pregnancies.
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Affiliation(s)
- Eran Weiner
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Deparment of Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levy M, Gonen N, Kovo M, Schreiber L, Marom O, Barda G, Volpert E, Bar J, Weiner E. Does macroscopic estimation of the extent of placental abruption correlate with pregnancy outcomes? Eur J Obstet Gynecol Reprod Biol 2020; 254:188-194. [PMID: 33007579 DOI: 10.1016/j.ejogrb.2020.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We aimed to study the correlation between the extent of placental abruption (PA), as grossly estimated immediately after delivery, and pregnancy outcomes, in correlation with placental histopathology. MATERIALS AND METHODS Pregnancy and placental reports of all pregnancies complicated by PA (clinically diagnosed) between 11/2008-12/2018 were reviewed. We compared maternal background, pregnancy outcomes, and placental histopathology between cases of PA divided into three groups according to the extent of abruption: Group 1-<30 %, Group 2-30-49 %, and Group 3->50 % of placental surface. Placental lesions were classified according to the current "Amsterdam" criteria. The primary outcome was defined as a composite of severe neonatal morbidity and included ≥ 1 of the following complications: seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, periventricular leukomalacia, blood transfusion, necrotizing enterocolitis, intrauterine fetal demise, or neonatal death. RESULTS A total of 260 PA cases were included: 111 (42.7 %) in Group 1, 94 (36.2 %) in Group 2, and 55 (21.1 %) in Group 3. The rate of the primary outcome (7.2 % vs. 11.7 % vs. 27.3 %, p = 0.02) was associated with the degree of PA as well as maternal heavy smoking (p = 0.04), DIC (p = 0.03), umbilical artery Ph <7.1 (p = 0.02), 5-minute Apgar scores <7 (p = 0.03), NICU admissions, placental maternal vascular malperfusion lesions (p = 0.04), and neonatal weights <5th percentile (0.04). In multivariable analysis severe adverse neonatal outcome was independently associated with the percentage of PA (aOR = 1.4, 95 % CI = 1.3-3.9). CONCLUSION The extent of placental abruption, as estimated by the examiner, correlated with DIC and severe neonatal outcomes and may serve as an early alarming sign in deliveries complicated by PA.
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Affiliation(s)
- Michal Levy
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Gonen
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Marom
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldar Volpert
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bustan-Nahumson M, Bornstein S, Feldstein O, Levy M, Schreiber L, Bar J, Kovo M, Weiner E. Preeclampsia in Different Maternal Age Groups-Is There an Association with Pregnancy Outcomes and Placental Pathology? Reprod Sci 2020; 27:1879-1887. [PMID: 32562243 DOI: 10.1007/s43032-020-00207-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Abstract
We aimed to compare maternal characteristics, pregnancy outcomes, and placental pathology in pregnancies complicated by preeclampsia at three different maternal age groups. Medical records and pathological reports of patients diagnosed with preeclampsia and delivered between 2008 and 2018 in a single tertiary center, were reviewed. Preeclampsia was diagnosed according to the current ACOG guidelines. Study population was divided into 3 groups of maternal age: group 1-< 27 years; group 2-27-35 years; and group 3-> 35 years (advanced maternal age = AMA). Data regarding maternal characteristics, neonatal outcomes, and placental histopathological lesions were compared between the groups. Composite adverse neonatal outcome was defined as ≥ 1 early neonatal complication. The AMA group (n = 145) was associated with a higher BMI, and higher rates of diabetes mellitus (DM), chronic hypertension (CHTN), and Cesarean deliveries compared with group 1 (n = 107) and group 2 (n = 255). The AMA group also had lower neonatal birthweights and a higher rate of composite adverse neonatal outcome compared with the other age groups. None of the placental lesions differed between the groups. By multivariable analysis, we found that maternal age (aOR 1.36, 95% CI 1.17-3.93), GA at delivery (aOR 0.80, 95% CI 0.61-0.90), DM (aOR 1.19, 95% CI 1.07-3.05), and CHTN (aOR 1.23, 95% CI 1.08-2.01) were independently associated with composite adverse neonatal outcome. Pregnancies at AMA were associated with higher complication rates, but without any differences in placental pathology, suggesting that the worse outcomes associated with AMA in preeclampsia are attributed to maternal chronic morbidities and not to differences observed in placental pathology.
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Affiliation(s)
- Mor Bustan-Nahumson
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sandy Bornstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Aviram A, Quaglietta P, Warshafsky C, Zaltz A, Weiner E, Melamed N, Ng E, Barrett J, Ronzoni S. Utility of ultrasound assessment in management of pregnancies with preterm prelabor rupture of membranes. Ultrasound Obstet Gynecol 2020; 55:806-814. [PMID: 31332850 DOI: 10.1002/uog.20403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the utility of ultrasound markers in the management of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) between 23 + 0 and 33 + 6 weeks' gestation, and to assess the ability of ultrasound markers to predict adverse neonatal outcomes. METHODS This was a retrospective cohort study of all patients with PPROM between 23 + 0 and 33 + 6 weeks' gestation and latency period (PPROM to delivery) > 48 h, who delivered before 34 weeks' gestation at a tertiary referral center between 2005 and 2017. All patients underwent a non-stress test daily and an ultrasound scan twice a week for assessment of amniotic fluid volume, biophysical profile (BPP) and umbilical artery (UA) pulsatility index (PI). In patients with suspected fetal growth restriction, fetal middle cerebral artery (MCA)-PI was also assessed and the cerebroplacental ratio (CPR) calculated. The last ultrasound examination performed prior to delivery was analyzed. We compared the characteristics and outcomes between women who were delivered owing to clinical suspicion of chorioamnionitis and those who were not delivered for this indication. The primary objective was to evaluate the utility of ultrasound in the management of patients with PPROM. The secondary objective was to assess the diagnostic performance of ultrasound markers (BPP score < 6, oligohydramnios, UA-PI > 95th percentile, MCA-PI < 5th percentile, CPR < 5th percentile) for the prediction of composite adverse neonatal outcome, which was defined as the presence of one or more of: perinatal death, respiratory distress syndrome, periventricular leukomalacia, intraventricular hemorrhage Grade 3 or 4, necrotizing enterocolitis, hypoxic ischemic encephalopathy, neonatal sepsis or neonatal seizures. RESULTS A total of 504 women were included in the study, comprising 120 with suspected chorioamnionitis and 384 without. Women with suspected chorioamnionitis, compared with those without, were less likely to be nulliparous (34.2% vs 45.3%; P = 0.03) and more likely to have fever (50.8% vs 2.6%; P < 0.001) and be delivered by Cesarean section (69.2% vs 42.4%; P < 0.001), mainly owing to a history of previous Cesarean section (18.3% vs 9.1%; P = 0.005) and to having non-reassuring fetal heart rate tracings (32.5% vs 14.6%; P < 0.001). No significant differences were found between the two groups with regard to the median amniotic fluid volume, overall BPP score, BPP score < 6, MCA-PI or CPR. Median UA-PI was slightly higher in the suspected-chorioamnionitis group, yet the incidence of UA-PI > 95th percentile was similar between the two groups. There was a higher incidence of composite adverse neonatal outcome in the group with suspected chorioamnionitis than in the group without (78.3% vs 64.3%, respectively; P = 0.004). However, on logistic regression analysis, none of the ultrasound markers evaluated was found to be associated with chorioamnionitis or composite adverse neonatal outcome, and they all had a poor diagnostic performance for the prediction of chorioamnionitis and composite adverse neonatal outcome. CONCLUSIONS Commonly used ultrasound markers in pregnancies complicated by PPROM were similar between women delivered for suspected chorioamnionitis and those delivered for other indications, and performed poorly in predicting composite adverse neonatal outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - P Quaglietta
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - C Warshafsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Zaltz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Weiner
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Ng
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, affiliated with the Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - S Ronzoni
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Miremerg H, Frig O, Rona S, Ganer Herman H, Mizrachi Y, Schreiber L, Bar J, Kovo M, Weiner E. Is advanced maternal age associated with placental vascular malperfusion? A prospective study from a single tertiary center. Arch Gynecol Obstet 2020; 301:1441-1447. [PMID: 32363549 DOI: 10.1007/s00404-020-05562-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Pregnancy at advanced maternal age (AMA) has become more common. There has been concern regarding the adverse effect deferring pregnancy might have on pregnancy outcomes. We aimed to prospectively study the effect of AMA on placental pathology. METHODS A prospective case-control study was performed in a single university center. Placental histopathology, maternal demographics, labor characteristics, and neonatal outcomes of pregnancies with AMA were collected and compared to matched controls. We defined AMA as maternal age > 35 years at delivery. In attempt to isolate the effect of maternal age, we excluded cases complicated by preterm birth, hypertensive disorders, diabetes mellitus, small for gestational age, and congenital/genetic anomalies. RESULTS The study group included 110 AMA patients that were matched with controls. The groups did not differ in maternal demographics, but the AMA group had a higher rate of assisted reproductive technologies (ART) as compared to the control group (p < 0.001). Placentas in the AMA group were characterized by a higher rate of maternal vascular lesions (MVM) (39.1% vs. 24.5%, p = 0.003), but not fetal vascular malperfusion lesions (p = 0.576). In multivariable analysis maternal age was associated with placental MVM lesions independent of all other maternal demographics (aOR 1.18 95% CI 1.06-3.17). Neonatal outcomes did not significantly differ between the groups. CONCLUSIONS After excluding all background morbidities-AMA was associated with a higher rate of placental MVM lesions vs. controls. These findings suggest an independent effect of AMA on placental function. Large prospective trials are needed to study the clinical importance of these findings.
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Affiliation(s)
- Hadas Miremerg
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Omry Frig
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shiran Rona
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Departments of Pathology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Warshafsky C, Ronzoni S, Quaglietta P, Weiner E, Melamed N, Zaltz A, Barrett J, Aviram A. Accuracy of Hadlock IV and fetal weight estimation in preterm premature rupture of membranes. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Warshafsky C, Ronzoni S, Quaglietta P, Weiner E, Zaltz A, Barrett J, Aviram A. Comparison of sonographic fetal weight estimation formulas in patients with preterm premature rupture of membranes. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gluck O, Ganer Herman H, Tal O, Grinstein E, Bar J, Kovo M, Ginath S, Weiner E. The association between the number of vaginal examinations during labor and perineal trauma: a retrospective cohort study. Arch Gynecol Obstet 2020; 301:1405-1410. [PMID: 32328711 DOI: 10.1007/s00404-020-05552-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the association between the number of vaginal examinations (VEs) performed during labor and subsequent severe perineal trauma. METHODS This is a retrospective cohort study. We included all women admitted to the delivery ward between 2008 and 2017, in active labor. Exclusion criteria included preterm deliveries (< 37 weeks), Cesarean deliveries and episiotomy during delivery. The primary outcome, severe perineal trauma, was defined as perineal tears grades 3-4. The cohort was divided into 4 groups, based on the number of VEs performed during labor: Group 1-up to two VEs (n = 4588), Group 2-three to four VEs (n = 5815), Group 3-five to six VEs (n = 4687), and Group 4-seven or more VEs (n = 7297). RESULTS Overall, 22,387 women were included in the study. The rate of severe perineal trauma in groups 1, 2, 3 and 4 was 0.4%, 0.1%, 0.8%, and 0.4%, respectively (p < 0.001). Performing five or more VEs during labor was associated with a higher risk of severe perineal trauma (0.26% vs. 0.53%, p < 0.01), as compared to four VEs or less. Using a logistic regression model, we found that performing five or more VEs during labor (aOR = 1.72 CI 95% (1.21-2.47), p < 0.001) or performing an instrumental delivery (aOR = 2.65 CI 95% (1.72-4.07), p < 0.001) were directly associated with the risk for severe perineal trauma. Applying epidural anesthesia showed an inverse association with severe perineal trauma (aOR = 0.54 CI 95% (0.38-0.77), p < 0.001). CONCLUSION Performing five or more VEs during active labor is associated with an increased risk for severe perineal trauma.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel.
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Ori Tal
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Ehud Grinstein
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
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Gluck O, Mizrachi Y, Ganer Herman H, Bar J, Kovo M, Weiner E. The correlation between the number of vaginal examinations during active labor and febrile morbidity, a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:246. [PMID: 32334543 PMCID: PMC7183634 DOI: 10.1186/s12884-020-02925-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background The association between the number of vaginal examinations (VEs) performed during labor and the risk of infection is unclear. The literature regarding this issue is not consensual, and the available studies are relatively small. Therefore, we aimed to study the association between the number of VEs during labor, and maternal febrile morbidity, in a very large cohort. Methods This is a retrospective cohort study. All women who delivered vaginally ≥37 weeks, at our institute, between 2008 and 2017 were included. Patients who underwent cesarean delivery or who were treated with prophylactic antibiotics, or had a fever ≥38.0 °C prior to the first VE were excluded. Cases of intrauterine fetal death, known malformations, or missing data were excluded as well. The cohort was divided according to the number of VEs performed: up to 4 VEs (n = 9716), 5–6 VEs (n = 4624), 7–8 VEs (n = 2999), and 9 or more VEs (n = 4844). The rates of intrapartum febrile morbidity (intrapartum fever and chorioamnionitis), postpartum febrile morbidity (postpartum fever and endometritis), and peripartum febrile morbidity (any of the mentioned complications) were compared. Results Overall, 22,183 women were included in the study. On multivariate analysis, we found that performing 5 VEs or more during labor was independently associated with intrapartum febrile morbidity (5–6 VEs: aOR = 1.83, 95% CI (1.29–2.61), 7–8 VEs: aOR = 2.65 95% CI (1.87–3.76), 9 or more VEs aOR = 3.47 95% CI (2.44–4.92)), postpartum febrile morbidity (5–6 VEs: aOR = 1.29, 95% CI (1.09–1.86), 7–8 VEs: aOR = 1.94 95% CI (1.33–2.83), 9 or more VEs aOR = 1.91 95% CI (1.28–2.82)), and peripartum morbidity (5–6 VEs: aOR = 1.48, 95% CI (1.15–1.91), 7–8 VEs: aOR = 2.15 95% CI (1.66–2.78), 9 or more VEs: aOR = 2.57 95% CI (1.97–3.34)). Conclusion The number of VEs performed during labor is directly correlated with febrile morbidity. Performing five or more VEs during labor is independently associated with febrile morbidity; For intrapartum and peripartum febrile morbidity the risk rises as more VEs are performed.
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Affiliation(s)
- Ohad Gluck
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel.
| | - Yossi Mizrachi
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Hadas Ganer Herman
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Eran Weiner
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
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Levy M, Alberti D, Kovo M, Schreiber L, Volpert E, Koren L, Bar J, Weiner E. Placental pathology in pregnancies complicated by fetal growth restriction: recurrence vs. new onset. Arch Gynecol Obstet 2020; 301:1397-1404. [PMID: 32333099 DOI: 10.1007/s00404-020-05546-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In an attempt to shed new light on the pathogenesis of fetal growth restriction (FGR), we aimed to study pregnancy characteristics, neonatal outcomes, and placental histopathological lesions of FGR pregnancies in two different subgroups: when developed after appropriate for gestational age (AGA) pregnancy and when developed after previous pregnancy with FGR. STUDY DESIGN Pregnancy and placental reports of all singleton pregnancies complicated by FGR (defined as actual birthweight below the 10th percentile according to local birthweight nomograms) between 2008 and 2018 were reviewed. Included were only cases with previous delivery. Maternal background, neonatal outcomes, and placental histopathology were compared between FGR that occurred after FGR (recurrent FGR group) and FGR that occurred after an AGA pregnancy (FGR after AGA group). Placental lesions were classified according to the current "Amsterdam" criteria. Continuous variables were compared using the Student's t test or the Mann-Whitney test as appropriate. Categorical variables were compared using Chi-square or Fisher's exact test as appropriate. RESULTS A total of 334 FGR cases with a previous delivery were included in the study. Of them, 111 cases constituted the recurrent FGR group and 223 constituted the FGR after AGA group. The recurrent FGR group was characterized by higher rates of maternal diabetes during pregnancy and hypertensive diseases (9% versus 2.7%, p = 0.01 and 19.8% versus 11.6%, p = 0.04). The FGR after AGA group was characterized by a higher rate of fetal vascular malperfusion (FVM) lesions (29.6% versus 18.0%, p = 0.02), and by lower mean birthweight (1842 ± 424.9 versus 1977.4 ± 412.2, p = 0.005), as compared to the recurrent FGR group. CONCLUSION Recurrent FGR was associated with maternal background morbidities during pregnancy which represents a chronic repeated insult, while "new" FGR cases (those followed an AGA pregnancy) were characterized by a higher rate of FVM lesions and lower birthweight which probably represent an "accident" in placentation. These findings may suggest that different mechanisms of placental dysfunction exist in the two subgroups of FGR.
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Affiliation(s)
- Michal Levy
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel.
| | | | - Michal Kovo
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Letizia Schreiber
- Department of Pathology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University The Edith Wolfson Medical Center, Holon, Israel
| | - Eldar Volpert
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Liron Koren
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Eran Weiner
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
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Kleiner I, Ram S, Kovo M, Schreiber L, Barber E, Levy M, Fainstein N, Bar J, Weiner E. Pregnancy outcomes in association with placental histopathology in pregnancies complicated by macrosomia in diabetic vs. non-diabetic women. Eur J Obstet Gynecol Reprod Biol 2020; 248:24-29. [PMID: 32172022 DOI: 10.1016/j.ejogrb.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to compare pregnancy outcomes in association with placental pathology in pregnancies complicated by macrosomia in diabetic vs. non-diabetic women. STUDY DESIGN Pregnancies complicated by macrosomia (≥4000gr) were included. Pregnancy and delivery characteristics, neonatal outcomes and placental histopathology reports were compared between macrosomia in diabetic [pre-gestational or Gestational Diabetes Mellitus (GDM)] women (diabetic-macrosomia group) vs. non-diabetic women (non-diabetic macrosomia group). Adverse neonatal outcome was defined as ≥1 neonatal complications. Multivariate analysis was used to identify independent associations with adverse neonatal outcome. RESULTS The diabetic macrosomia group (n = 160) was characterized by higher maternal age (p = 0.002), Body Mass Index (BMI) (p < 0.001), and smoking (p = 0.03), and lower gestational age at delivery (p = 0.001). The diabetic-macrosomia group had higher rates of scheduled Cesarean deliveries (CDs) (58.9 % vs23.7 %,p < 0.001) while the non-diabetic macrosomia group (n = 214) had higher rates of emergent CDs (76.3 % vs.40.7 %,p < 0.001), perineal tears (p = 0.027) and Post Partum Hemorrhage (PPH) (p = 0.006). Placentas from the non-diabetic macrosomia group were characterized by higher rates of maternal and fetal inflammatory response lesions (p < 0.001). Except for higher jaundice rate in the diabetic macrosomia group (p < 0.001), none of the other neonatal outcomes including shoulder dystocia differed between the groups. In multivariate analysis GA < 37 weeks (aOR = 1.4,95 %,CI-1.2-3.9), and emergent CDs (aOR = 1.7,95 %,CI-1.4-4.1) but not diabetes (aOR = 1.1,95 %,CI-0.7-3.9) were associated with adverse neonatal outcome. CONCLUSIONS Despite major differences in maternal demographics, mode of delivery, maternal morbidity, and placental characteristics- adverse neonatal outcome did not differ between macrosomia in diabetic vs. non-diabetic women and was high in both groups. Clinicians should be aware of the high rate of adverse neonatal outcome in macrosomic fetuses, even in the absence of diabetes mellitus.
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Affiliation(s)
- Ilia Kleiner
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1).
| | - Shai Ram
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1)
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1)
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel
| | - Elad Barber
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1)
| | - Michal Levy
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1)
| | - Nataly Fainstein
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1)
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1)
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1)
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Gluck O, Kovo M, Tairy D, Herman HG, Bar J, Weiner E. The effect of meconium thickness level on neonatal outcome. Early Hum Dev 2020; 142:104953. [PMID: 31935610 DOI: 10.1016/j.earlhumdev.2020.104953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite its prevalence and potential maternal and neonatal implications, the literature on the thickness levels of meconium stained amniotic fluid (MSAF) and its impact on neonatal outcomes is relatively outdated and relies on relatively small sample sizes. AIMS To study if different thickness levels of MSAF correlate with adverse neonatal outcome. STUDY DESIGN A retrospective cohort study. SUBJECTS The medical records and neonatal charts of all women with a singleton pregnancy, who underwent a trial of labor, at 37 + 0/7 weeks or beyond, between 10/2008 and 7/2018 were reviewed. OUTCOME MEASURES The cohort was divided according to the level of meconium reported during labor into four groups: Clear (C group), Light meconium (LM group), Intermediate meconium (IM group), and Heavy meconium (HM group). Composite neonatal outcome included at least one of the following: umbilical artery pH ≤ 7.1, sepsis, need for blood transfusion, need for phototherapy, respiratory distress syndrome, meconium aspiration syndrome, need for mechanical ventilation support, necrotizing enterocolitis, intraventricular hemorrhage, hypoxic ischemic encephalopathy, periventricular leukomalacia, seizures, hypoglycemia, hypothermia, and death. Continuous parameters were compared with Anova's test or Kruskal Wallis, and categorical variables by chi-square test or Fisher exact test, as appropriate. Multivariant logistic regression was performed in order to eliminate possible cofounders. RESULTS Overall, 24,445 deliveries were reviewed (C-20,185, LM-1074, IM-2736, HM-450). Composite adverse neonatal outcome was more common with increasing thickness of MSAF. On multivariable analysis, IM and HM were independently associated with composite adverse neonatal outcome. CONCLUSION The degree of meconium thickness independently correlates with composite adverse neonatal outcome.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Kovo
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tairy
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levy M, Kovo M, Izaik Y, Luwisch Cohen I, Schreiber L, Ganer Herman H, Barda G, Bar J, Weiner E. Reduced fetal movements at term in singleton low risk pregnancies-Is there an association with placental histopathological findings? Acta Obstet Gynecol Scand 2020; 99:884-890. [PMID: 31960411 DOI: 10.1111/aogs.13810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 01/12/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Maternal perception of fetal movements has long been considered an indicator of fetal well-being. A sudden decrease in the number of fetal movements is suggestive of fetal compromise. We aimed to determine whether the maternal perception of reduced fetal movements (RFM) is associated with placental pathological lesions in a low-risk term population. MATERIAL AND METHODS Our study was a case-control study that was performed in a single university center. Placental histopathology, maternal demographics, labor characteristics, and neonatal outcomes of term, singleton pregnancies with maternal perception of RFM during the 2 weeks prior to delivery were collected. To isolate the effect of RFM on placental pathology, we excluded cases complicated by preterm birth, hypertensive disorders, diabetes mellitus, small-for-gestational-age and congenital/genetic anomalies. We compared pregnancy outcomes and placental pathology between the RFM group and a control group matched for gestational age and mode of delivery. Placental lesions were classified according to the "Amsterdam" criteria. Composite adverse neonatal outcome was defined as one or more of the following: sepsis, transfusion, hypoglycemia, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis and fetal/neonatal death. Multivariable regression analysis was performed to identify independent associations with adverse neonatal outcome. RESULTS We included patients who gave birth from January 2008 until May 2019. The study group included 203 term pregnancies with RFM during the 2 weeks prior to delivery, which was matched with 203 controls. The RFM group was characterized by a higher rate of placental weight <10th percentile (22.6% vs. 3.9%, P < .001), a higher rate of maternal vascular malperfusion lesions (30.5% vs. 18.7%, P = .007) and lesions of maternal inflammatory response (43.3% vs. 29.5%, P = .005). At delivery, the RFM group had higher rates of cesarean delivery due to non-reassuring fetal heart rate monitoring (P = .01), 5-minute Apgar score ≤7 (P = .03), neonatal intensive care unit admissions (P < .001) and composite adverse neonatal outcomes (P = .007). Using multivariable analysis, RFM (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.1-4.8), and placental maternal vascular malperfusion lesions (aOR 1.2, 95% CI 1.0-2.9) were independently associated with adverse neonatal outcome. CONCLUSIONS After excluding important placental-related morbidities, RFM was associated with a higher rate of placental weight <10th percentile and placental maternal vascular malperfusion lesions vs. controls. This study suggests a placental involvement in the association between RFM at term and adverse pregnancy outcomes.
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Affiliation(s)
- Michal Levy
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yakira Izaik
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Isca Luwisch Cohen
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Edith Wolfson Medical Center, Holon, Israel
| | - Hadas Ganer Herman
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levy M, Kovo M, Izaik Y, Ben-Ezry E, Gonen N, Barda G, Bar J, Weiner E. Reduced fetal movements is twin pregnancies and the association with adverse neonatal outcomes. Eur J Obstet Gynecol Reprod Biol 2020; 246:165-168. [PMID: 32032929 DOI: 10.1016/j.ejogrb.2020.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Reduced fetal movements (RFM) is an obstetric complaint known to be associated with adverse neonatal outcomes and should serve as an alarming sign in obstetric triage. Whether this assumption holds for twin pregnancies, is still an obstetric enigma, and this complaint is sometimes overlooked in twins. We, therefore, aimed to study neonatal outcomes in twin pregnancies complicated by RFM. We hypothesised that in twin pregnancy, maternal ability to perceive RFM will be limited, and therefore, will not be associated with adverse neonatal outcome. STUDY DESIGN Included were all dichorionic twin pregnancies between 2009-2019 who presented to our obstetric triage at a gestational age >34 weeks with an isolated complaint of RFM and delivered during the subsequent two weeks (RFM group). The control group included patients with twin pregnancies (matched for gestational age and maternal age) who presented for routine assessment and reported regular fetal movements throughout pregnancy (no RFM group). Data regarding pregnancy, delivery, and neonatal outcomes were compared between the groups. The primary outcome was a composite of adverse neonatal outcomes, which included one or more of the following: neonatal hypoglycemia, respiratory morbidity, cerebral morbidity, phototherapy, neonatal sepsis, blood transfusions, necrotizing enterocolitis, or neonatal death. Multivariable regression analysis was used to identify independent associations with adverse neonatal outcomes. RESULTS Maternal demographics and gestational age at delivery did not differ between the RFM group (n = 83 pregnancies and 166 neonates) and the no RFM group (n = 83 pregnancies and 166 neonates). Neonatal birthweights, as well as the rate of birthweights <10th centile, did not differ between the groups. There were 2 cases of fetal demise diagnosed at triage in the RFM group. The rate of the primary outcome, as well as NICU admissions, were significantly higher in the RFM group compared to the no RFM group (29.5 % vs. 19.2 %, p = 0.01 and 32.5 % vs. 19.2 %, p = 0.001). In multivariable analysis RFM (aOR = 1.18, 95 % CI = 1.06-2.73), and GA at delivery (aOR = 0.88, 95 % CI = 0.67-0.97) were associated with adverse neonatal outcome-independent from background confounders. CONCLUSION Patients presented to obstetric triage with twin pregnancies and isolated RFM had higher rates of adverse neonatal outcomes and NICU admissions compared to twin pregnancies without RFM.
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Affiliation(s)
- Michal Levy
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1).
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1)
| | - Yakira Izaik
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1)
| | - Emilie Ben-Ezry
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1)
| | - Noa Gonen
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1)
| | - Giulia Barda
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1)
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1)
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel(1)
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Weiner E, Feldstein O, Schreiber L, Grinstein E, Barber E, Dekalo A, Mizrachi Y, Bar J, Kovo M. None, One, or Both Placentas Involved with Malperfusion Lesions in Twin Pregnancies Complicated by Preeclampsia-Does It Matter? Reprod Sci 2020; 27:845-852. [PMID: 32046401 DOI: 10.1007/s43032-019-00087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
Abstract
We aimed to study the association between the number of placentas with vascular malperfusion lesions in dichorionic twin pregnancies complicated by preeclampsia and the severity of the disease and pregnancy outcomes. Dichorionic twin pregnancies with preeclampsia (n = 125), from January 2007-June 2018, were reviewed. Affected placenta was defined as the presence of maternal/fetal vascular malperfusion lesions. Maternal demographics, pregnancy characteristics, and neonatal outcomes were compared between three groups: no pathological placentas, one pathological placenta, and two pathological placentas. Composite adverse neonatal outcome was defined as ≥ 1 early neonatal complication. Regression analysis models were used to recognize independent associations with the number of involved placentas. The two pathological placenta group (n = 57 pregnancies), the one pathological placenta group (n = 40 pregnancies), and the no pathological placenta group (n = 28 pregnancies) differed in terms of gestational age (GA) at delivery (p < 0.001, p = 0.008) and the rates of severe features (p = 0.028, p = 0.047). Neonates born to the two pathological placenta group (n = 114), the one pathological placenta group (n = 80), and the no pathological placenta group (n = 56) were characterized by lower birth weights (p < 0.001, p = 0.031), higher rates of small for gestational age (SGA) (p = 0.017, p = 0.748), neonatal intensive care unit admission (p = 0.004, p = 0.013), and composite adverse neonatal outcome (p < 0.001, p = 0.025). By regression analyses, the presence of two pathological placentas was found to be independently associated with severe features (aOR = 5.1), GA at delivery < 32 weeks (aOR = 2.0), SGA (aOR = 2.5), and composite adverse neonatal outcome (aOR = 2.7). In dichorionic twin pregnancies, there is an association between the presences of placental vascular malperfusion lesions in none, one, or both placentas and the development of early and severe preeclampsia, as well as with SGA and adverse neonatal outcome.
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Affiliation(s)
- Eran Weiner
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel.
| | - Ohad Feldstein
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Ehud Grinstein
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Ann Dekalo
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Yossi Mizrachi
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
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Levy M, Kovo M, Izaik Y, Cohen IL, Herman HG, Barda G, Bar J, Weiner E. 204: Is there an association between reduced fetal movements at term and placental histopathological findings? Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gonen N, Schreiber L, Levy M, Bar J, Kovo M, Weiner E. 471: Predictors of Cesarean delivery due to non-reassuring fetal heart rate in cases of placental abruption. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Levy M, Kovo M, Barda G, Anchel N, Herman HG, Bar J, Schreiber L, Weiner E. 332: Maternal use of SSRIs during pregnancy - neonatal outcomes in correlation with placental histopathology. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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