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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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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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Gluck O, Feldstein O, Barber E, Tamayev L, Condrea A, Grinstein E, Sagiv R, Wolfson I, Bar J, Ginath S. The effect of preemptive local anesthesia on postoperative pain following vaginal hysterectomy: A randomized controlled trial – Letter to the editor. Eur J Obstet Gynecol Reprod Biol 2022; 276:246. [DOI: 10.1016/j.ejogrb.2022.07.031] [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] [Received: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/04/2022]
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Gluck O, Feldstein O, Barber E, Tamayev L, Condrea A, Grinstein E, Sagiv R, Wolfson I, Bar J, Ginath S. The effect of preemptive local anesthesia on postoperative pain following vaginal hysterectomy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2021; 267:269-273. [PMID: 34839248 DOI: 10.1016/j.ejogrb.2021.11.421] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We aimed to study the effect of preemptive local anesthetic without adrenaline on postoperative pain following vaginal hysterectomy and concomitant trans obturator tape (TOT). STUDY DESIGN This was a double-blinded, randomized, controlled trial. Women who undergone elective vaginal hysterectomy were included. Solutions of either Bupivacaine-Hydrochloride 0.5%, or Sodium-Chloride 0.9% as a placebo, were prepared prior to surgery, according to randomization. The chosen solution was injected before incision, in a circumferential manner, to the cervix. The amount of fluid administered was 10 ml. When colporrhaphy was also performed, an additional 5 ml of solution were injected in the midline of the vaginal wall prior to each incision line. We conformed to the CONSORT recommendations. By utilizing the 10 cm Visual-analogue-scale (VAS) we assessed post-operative pain at rest at 3, 8, and 24 h, and during ambulation at 8 and 24 h. We estimated that the intervention would cause a 25% reduction in the primary outcome. The required total sample size was calculated to be 30 patients women for each group. We used ANOVA for continuous variables and the Chi-square or Fisher exact tests for categorical variables. RESULTS A total of 30 women were included in each group. The level of postoperative pain, as assessed by VAS, was not significantly different between the groups, in all points of time. In addition, there was no difference between the groups in opioid based analgesics during recovery, nor in postoperative analgesic use. CONCLUSION Preemptive local anesthesia was not shown to be efficient in reducing postoperative pain after vaginal hysterectomy and TOT.
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Affiliation(s)
- Ohad Gluck
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel.
| | - Ohad Feldstein
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Elad Barber
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Liliya Tamayev
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Alexander Condrea
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Grinstein
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ron Sagiv
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Inna Wolfson
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Shimon Ginath
- Departments of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Israel
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Miremberg H, Barber E, Tamayev L, Ganer Herman H, Bar J, Kovo M. When is the right time to remove staples after an elective cesarean delivery?: a randomized control trial. J Matern Fetal Neonatal Med 2020; 33:4004-4009. [PMID: 30897986 DOI: 10.1080/14767058.2019.1594189] [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] [Indexed: 10/27/2022]
Abstract
Objective: To determine if there are differences in scar healing and cosmetic outcome between early and late metal staples removal after cesarean delivery.Study design: Randomized controlled trial, in which patients undergoing a scheduled nonemergent cesarean delivery were randomly assigned to early staples removal versus late staples removal. Outcome assessors were blinded to group allocation. Scars were evaluated 8 weeks after cesarean delivery. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) scores. Secondary outcome measures included surgical site infection, wound disruption, hematoma, or seroma.Results: During the study period, 104 patients were randomized. There were no between-group differences in maternal demographics. Both groups had similar indications for cesarean delivery and similar rate of previous one or more cesarean delivery. Patient and Observer Scar Assessment Scale were similar for patients (p = .932) and for physician observer (p = .529). No significant differences were demonstrated between the groups in the rate of surgical site infection or wound disruption.Conclusions: Removal of stainless steel staples on postoperative 4 versus postoperative 8 after cesarean delivery showed similar outcome without significant effect on incision healing. Therefore, timing of removal staples after cesarean delivery could be performed based on patients and surgeon preference.
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Affiliation(s)
- Hadas Miremberg
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, 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, Holon, 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, Holon, Tel Aviv, Israel
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Herman HG, Tamayev L, Feldstein O, Bustan M, Rachmiel Z, Schreiber L, Raziel A, Bar J, Kovo M. Placental-related disorders of pregnancy and IVF: does placental histological examination explain the excess risk? Reprod Biomed Online 2020; 41:81-87. [PMID: 32451302 DOI: 10.1016/j.rbmo.2020.04.001] [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] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 01/04/2023]
Abstract
RESEARCH QUESTION What are the clinical characteristics of pregnancies complicated by fetal growth restriction (FGR) and preeclampsia in patients who have undergone IVF, and what is the correlation between these complications and histopathological placental findings in such pregnancies. DESIGN A retrospective cohort of patients who had delivered their babies at our institution who had been diagnosed with preeclampsia, whose babies had been diagnosed with FGR, or both. Deliveries in which the placenta was sent for histopathological examination were included. Computerized files and pathological reports were reviewed, and maternal, obstetric, neonatal outcomes and placental histopathological reports were compared between pregnancies conceived by IVF and controls. Placental lesions were classified according to the Amsterdam criteria. RESULTS Between December 2008 and December 2018, the placentas of 1114 singleton babies who had received a diagnosis of FGR, whose mothers had received a diagnosis of preeclampisa, or both, were examined. A total of 105 patients conceived with IVF and 1009 were conceived spontaneously. The IVF group was older, of lower parity and had a higher rate of diabetes and chronic hypertension. Deliveries occurred at an earlier gestational age, although birth weight was not significantly different between the groups. The rate of neonatal adverse composite outcome among IVF deliveries was significantly lower (59.0% versus 76.7%; P < 0.001). On placental examination, placental weight, maternal and fetal vascular malperfusion lesions were similar between the groups, whereas villitis of unknown etiology was significantly more common among the IVF group (16.2% versus 8.3%; P = 0.007). CONCLUSION Neonatal outcome is relatively favourable in IVF patients with placental-related diseases. Placental chronic villitis is more common in IVF patients, pointing to an additive immunological cause.
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Affiliation(s)
- Hadas Ganer Herman
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel.
| | - Liliya Tamayev
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Ohad Feldstein
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Mor Bustan
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Zehavit Rachmiel
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Letizia Schreiber
- Pathology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62 Holon, Tel Aviv, Israel
| | - Arieh Raziel
- In Vitro Fertilization Unit, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62 Holon, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
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Tamayev L, Schreiber L, Marciano A, Bar J, Kovo M. Are there gender-specific differences in pregnancy outcome and placental abnormalities of pregnancies complicated with small for gestational age? Arch Gynecol Obstet 2020; 301:1147-1151. [PMID: 32239281 DOI: 10.1007/s00404-020-05514-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Adaptations to pathological intrauterine environment might differ in relation to fetal gender. We aimed to study sex-specific differences in placental pathology of pregnancies complicated by small for gestational age (SGA). METHODS The medical records and placental histology reports of all neonates with a birth-weight ≤ 10th percentile, born between 24 and 42 weeks of gestation, during 2010-2018, were reviewed. Composite neonatal outcome was defined as one or more of early following complications: neonatal sepsis, blood transfusion, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis, or death. Results were compared between the male and female groups of neonates. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions, maternal and fetal inflammatory responses (MIR and FIR), and villitis of unknown etiology (VUE). RESULTS The male SGA group (n = 380) and the female SGA group (n = 363) did not differ in regard to maternal age, BMI, smoking, associated pregnancy complications, gestational age, and mode of delivery. Neonates in the SGA male group had increased birth-weight and increased respiratory morbidity as compared to the female SGA group (p = 0.007, p = 0.005, respectively). There was no between-group differences in the rate of placental lesions. By multivariate logistic regression analysis, male gender (aOR 1.55, 95% CI 1.05-2.30, p = 0.025), FIR (aOR 4.83, 95% CI 1.07-13.66, p = 0.003), and VUE (aOR 1.89, 95% CI 1.03-3.47, p = 0.04), were found to be independently associated with adverse composite neonatal outcome. DISCUSSION Male gender as well as placental FIR and VUE are independently associated with adverse neonatal outcome in SGA neonates.
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Affiliation(s)
- Liliya Tamayev
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel.
| | - Letizia Schreiber
- Departments of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Adi Marciano
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
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Mizrachi Y, Tamayev L, Shemer O, Kleiner I, Bar J, Sagiv R. Early versus delayed follow-up after misoprostol treatment for early pregnancy loss. Reprod Biomed Online 2019; 39:155-160. [DOI: 10.1016/j.rbmo.2019.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/15/2019] [Accepted: 02/25/2019] [Indexed: 12/27/2022]
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Ganer Herman H, Tamayev L, Houli R, Miremberg H, Bar J, Kovo M. Risk factors for nonreassuring fetal heart rate tracings after artificial rupture of membranes in spontaneous labor. Birth 2018; 45:393-398. [PMID: 29687488 DOI: 10.1111/birt.12350] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to characterize factors associated with nonreassuring fetal heart (FHR) tracings after artificial rupture of membranes (AROM), during the active phase of labor. METHODS Delivery charts of patients who presented in spontaneous labor, at term, between 2015 and 2016 were reviewed. We identified cases in which AROM was performed during the active stage of labor. We compared deliveries with a normal FHR and those who developed nonreassuring FHR. Nonreassuring FHR was defined as fetal tracing that necessitated intrauterine resuscitation, which included: oxytocin withheld, amnioinfusion, or immediate instrumental or cesarean birth. RESULTS Of 664 deliveries, nonreassuring FHR occurred in 141 (21.2%) and normal FHR in 523 (78.7%). Both groups were notable for similar maternal characteristics and a similar gestational age. Epidural block was significantly more common in the nonreassuring FHR group (P < .001), as was meconium during delivery (P = .01). Deliveries in the nonreassuring FHR group were characterized by significantly lower Bishop scores at AROM. Mean birthweight was significantly lower in the nonreassuring FHR group (3201 ± 418 vs 3342 ± 376 g, P < .001), yet, neonatal outcome did not differ between the groups. In a multivariate logistic regression model, nulliparity, AROM at a station lower than -2, and increased birthweight were all significantly associated with a decreased rate of nonreassuring FHR, while prolonged duration from AROM to delivery and oxytocin augmentation significantly increased the risk for nonreassuring FHR. DISCUSSION Nonreassuring FHR after AROM during delivery is associated with parity, fetal station at AROM, birthweight, and oxytocin augmentation.
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Affiliation(s)
- Hadas Ganer Herman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Rotem Houli
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Hadas Miremberg
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
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Gluck O, Tamayev L, Torem M, Bar J, Raziel A, Sagiv R. The Impact of Salpingectomy on Anti-Mullerian Hormone Levels and Ovarian Response of In Vitro Fertilization Patients. Isr Med Assoc J 2018; 20:509-512. [PMID: 30084578] [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: 06/08/2023]
Abstract
BACKGROUND Laparoscopic salpingectomy is strongly related to successful in vitro fertilization (IVF) treatments. OBJECTIVES To compare the ovarian reserve, including anti-mullerian hormone (AMH) levels, in patients who underwent salpingectomy before IVF to IVF patients who had not been salpingectomized. METHODS In this retrospective study, medical records of women who were treated by the IVF unit at our institute were reviewed. We retrieved demographic data, surgical details, and data regarding the ovarian reserve. Details of 35 patients who were treated by IVF after salpingectomy were compared to 70 IVF patients with no history of salpingectomy treatment. Nine women underwent IVF treatment before and after having salpingectomy, and their details were included in both groups. RESULTS The levels of AMH, follicular stimulating hormone (FSH), estradiol, and progesterone were not significantly different in the groups. The antral follicular count (AFC), number of oocytes retrieved, amount of gonadotropin administered for ovarian stimulation, and number of embryos transferred (ET) were also not significantly different. CONCLUSIONS Salpingectomy does not seem to affect ovarian reserve in IVF patients.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Torem
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiner E, Feldstein O, Tamayev L, Grinstein E, Barber E, Bar J, Schreiber L, Kovo M. Placental histopathological lesions in correlation with neonatal outcome in preeclampsia with and without severe features. Pregnancy Hypertens 2018; 12:6-10. [PMID: 29674201 DOI: 10.1016/j.preghy.2018.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 12/09/2022]
Abstract
OBJECTIVE We aimed to compare pregnancy outcome and placental histopathology in women with preeclampsia (PE) with and without severe features. METHODS The medical records and placental pathology reports of all pregnancies complicated by PE during 2008-2016, were reviewed. Results were compared between those with and without severe features (severe PE vs. mild PE groups), according to current ACOG guidelines. Placental lesions were classified to maternal/fetal vascular supply lesions, and maternal/fetal inflammatory responses. Small for gestational age (SGA) was defined as neonatal birth-weight ≤10th%. Composite adverse neonatal outcome was defined as one or more of the following: sepsis, transfusion, phototherapy, respiratory morbidity, cerebral morbidity, NEC, or death. RESULTS The severe PE group (n = 284) was characterized by lower gestational age at delivery (p < 0.001), and higher rates of antenatal corticosteroid use (p = 0.003), and cesarean deliveries (p < 0.001) as compared to the mild PE group (n = 151). More placentas <10th% and more composite maternal vascular malperfusion (MVM) lesions were observed in the severe PE group as compared to the mild PE group (p < 0.001 for both). In multivariate analysis, composite placental MVM lesions were independently associated with severe PE (aOR = 1.75, 95%CI 1.4-4.9). Higher rates of SGA (p = 0.016), and composite adverse neonatal outcome (p = 0.002) characterized the severe PE group. In multivariate analysis, adverse neonatal outcome was independently associated with gestational age (aOR = 0.54, 95%CI 0.49-0.68), SGA (aOR = 1.75, 95%CI = 1.15-3.59), severe PE (aOR = 1.8, 95%CI = 1.13-3.54) and placental MVM lesions (aOR = 2.13, 95%CI = 1.05-4.39). CONCLUSION More pronounced placental pathology and higher rate of adverse neonatal outcome characterize preeclampsia with severe features as compared with the milder form of the disease.
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Affiliation(s)
- 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.
| | - 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
| | - Liliya Tamayev
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grinstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics & 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 & 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
| | - 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
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Durrant AR, Tamayev L, Anglister L. Serum cholinesterases are differentially regulated in normal and dystrophin-deficient mutant mice. Front Mol Neurosci 2012; 5:73. [PMID: 22723768 PMCID: PMC3378013 DOI: 10.3389/fnmol.2012.00073] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/24/2012] [Indexed: 01/28/2023] Open
Abstract
The cholinesterases, acetylcholinesterase (AChE), and butyrylcholinesterase (BChE) (pseudocholinesterase), are abundant in the nervous system and in other tissues. The role of AChE in terminating transmitter action in the peripheral and central nervous system is well understood. However, both knowledge of the function(s) of the cholinesterases in serum, and of their metabolic and endocrine regulation under normal and pathological conditions, is limited. This study investigates AChE and BChE in sera of dystrophin-deficient mdx mutant mice, an animal model for the human Duchenne muscular dystrophy (DMD) and in control healthy mice. The data show systematic and differential variations in the concentrations of both enzymes in the sera, and specific changes dictated by alteration of hormonal balance in both healthy and dystrophic mice. While AChE in mdx-sera is elevated, BChE is markedly diminished, resulting in an overall cholinesterase decrease compared to sera of healthy controls. The androgen testosterone (T) is a negative modulator of BChE, but not of AChE, in male mouse sera. T-removal elevated both BChE activity and the BChE/AChE ratio in mdx male sera to values resembling those in healthy control male mice. Mechanisms of regulation of the circulating cholinesterases and their impairment in the dystrophic mice are suggested, and clinical implications for diagnosis and treatment are considered.
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Affiliation(s)
- Andrea R Durrant
- Department of Medical Neurobiology, Institute for Medical Research - Israel-Canada, IMRIC, Faculty of Medicine, Hebrew University Medical School Jerusalem, Israel
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