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Lessans N, Gilan A, Dick A, Bibar N, Saar TD, Porat S, Dior UP. Ovarian reserve markers of women with superficial endometriosis. Int J Gynaecol Obstet 2024; 165:696-702. [PMID: 38124348 DOI: 10.1002/ijgo.15310] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Endometriosis affects up to 10% of reproductive age women and is associated with pelvic pain and subfertility. While previous studies have shown an association between deep and ovarian endometriosis to reduced ovarian reserve, there is no data on the effect of superficial endometriosis on ovarian reserve markers. Hence, we aimed to compare ovarian reserve markers of women with superficial endometriosis to that of women without endometriosis. METHODS This was a case control study in a tertiary medical center. The study group included women aged 18-40 with surgically and histopathology-proven superficial endometriosis with no deep lesions or ovarian involvement. The control group included women with no known or suspected endometriosis and was matched to the study group by age, BMI and parity. We excluded women with other known risk factors for ovarian failure and with other gynecological disorders. Participants completed a questionnaire with demographic, medical and gynecological data. Each patient underwent anti-Mullerian hormone (AMH) testing and an ultrasound to assess their antral follicular count (AFC). AMH and AFC were then compared between groups. RESULTS A total of 124 women participated in the study. Of these, 50% (n = 62) had surgically proven superficial endometriosis and 50% (n = 62) were without known or suspected endometriosis. Mean AMH levels of women with and without superficial endometriosis was 3.0 ± 2.8 ng/mL and 2.8 ± 1.9 ng/mL, respectively (P = 0.71). AFC also did not differ between groups (women with superficial endometriosis: 12.0 ± 6.6; women without endometriosis: 10.2 ± 5.0, P = 0.15). CONCLUSIONS In our cohort, superficial endometriosis was not associated with diminished ovarian reserve. While further studies are needed, to date, it does not appear to be justified to assess ovarian reserve for patients with superficial endometriosis.
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Affiliation(s)
- Naama Lessans
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Gilan
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aharon Dick
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Natalie Bibar
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal D Saar
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shay Porat
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri P Dior
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Cohen A, Alter R, Lessans N, Meyer R, Brezinov Y, Levin G. Performance of ChatGPT in Israeli Hebrew OBGYN national residency examinations. Arch Gynecol Obstet 2023; 308:1797-1802. [PMID: 37668790 DOI: 10.1007/s00404-023-07185-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Previous studies of ChatGPT performance in the field of medical examinations have reached contradictory results. Moreover, the performance of ChatGPT in other languages other than English is yet to be explored. We aim to study the performance of ChatGPT in Hebrew OBGYN-'Shlav-Alef' (Phase 1) examination. METHODS A performance study was conducted using a consecutive sample of text-based multiple choice questions, originated from authentic Hebrew OBGYN-'Shlav-Alef' examinations in 2021-2022. We constructed 150 multiple choice questions from consecutive text-based-only original questions. We compared the performance of ChatGPT performance to the real-life actual performance of OBGYN residents who completed the tests in 2021-2022. We also compared ChatGTP Hebrew performance vs. previously published English medical tests. RESULTS In 2021-2022, 27.8% of OBGYN residents failed the 'Shlav-Alef' examination and the mean score of the residents was 68.4. Overall, 150 authentic questions were evaluated (one examination). ChatGPT correctly answered 58 questions (38.7%) and reached a failed score. The performance of Hebrew ChatGPT was lower when compared to actual performance of residents: 38.7% vs. 68.4%, p < .001. In a comparison to ChatGPT performance in 9,091 English language questions in the field of medicine, the performance of Hebrew ChatGPT was lower (38.7% in Hebrew vs. 60.7% in English, p < .001). CONCLUSIONS ChatGPT answered correctly on less than 40% of Hebrew OBGYN resident examination questions. Residents cannot rely on ChatGPT for the preparation of this examination. Efforts should be made to improve ChatGPT performance in other languages besides English.
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Affiliation(s)
- Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel.
| | - Roie Alter
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Naama Lessans
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Cedar-Sinai Medical Center, Los Angeles, USA
| | - Yoav Brezinov
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Canada
- The Department of Gynecoloic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Stern S, Khalaileh A, Shveiky D, Lessans N. Laparoscopic Resection of a Giant Liver Tumor in Pregnancy. J Minim Invasive Gynecol 2023; 30:683-684. [PMID: 37196885 DOI: 10.1016/j.jmig.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Shira Stern
- Department of Obstetrics and Gynecology (Drs. Stern, Shveiky, and Lessans), Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Abed Khalaileh
- Department of Surgery (Dr. Khalaileh), Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology (Drs. Stern, Shveiky, and Lessans), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naama Lessans
- Department of Obstetrics and Gynecology (Drs. Stern, Shveiky, and Lessans), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Dick A, Lessans N, Ginzburg G, Gutman-Ido E, Karavani G, Hochler H, Suissa-Cohen Y, Rosenbloom JI. Induction of labor in twin pregnancy in patients with a previous cesarean delivery. BMC Pregnancy Childbirth 2023; 23:538. [PMID: 37495974 PMCID: PMC10373413 DOI: 10.1186/s12884-023-05868-z] [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: 04/18/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Trial of labor after cesarean delivery (TOLAC) in twin gestations has been associated with decreased rates of successful vaginal delivery compared to singleton pregnancies, with mixed results regarding maternal and neonatal morbidity. However, induction of labor (IOL) in this unique population has not yet been fully evaluated. OBJECTIVE To assess success rates and maternal and neonatal outcomes in women with a twin gestation and a previous cesarean delivery undergoing IOL. METHODS A retrospective cohort study including women with a twin gestation and one previous cesarean delivery undergoing a trial of labor between the years 2009-2020. Patients requiring IOL were compared to those with a spontaneous onset of labor. RESULTS There were 53 patients who met the inclusion criteria: 31 had a spontaneous onset of labor (58%) and 22 required an IOL. Baseline characteristics were comparable between the groups apart from a history of labor arrest which was more common in the IOL group (40.9% vs. 9.6%, P = 0.006). A successful vaginal delivery occurred in all (100%) women with a spontaneous labor compared to 81% in the IOL group (p = 0.02). Secondary outcomes were comparable. A history of no previous vaginal delivery, maternal obesity, and IOL were associated with TOLAC failure. CONCLUSIONS IOL after cesarean delivery in twin gestation is associated with an increased risk of TOLAC failure compared to spontaneous onset of labor. However, no adverse neonatal or maternal outcomes were found. IOL in this high-risk population is feasible but patients should be counseled about the lower rate of success.
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Affiliation(s)
- Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Naama Lessans
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Einat Gutman-Ido
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Suissa-Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gilan A, Laster-Haim S, Rottenstreich A, Porat S, Lessans N, Saar TD, Dior UP. The effect of SARS-CoV-2 BNT162b2 vaccine on the symptoms of women with endometriosis. Arch Gynecol Obstet 2023; 307:121-127. [PMID: 36098831 PMCID: PMC9468530 DOI: 10.1007/s00404-022-06765-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE As the use of the messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) Coronavirus disease 2019 vaccine has grown, reports on menstrual changes have arisen. We aimed to examine menstrual bleeding patterns and endometriosis-associated symptoms after receiving the mRNA BNT162b2 SARS-CoV-2 vaccine in women with endometriosis, as compared to the control group. METHODS This is a questionnaire-based cross-sectional study including a total of 174 women. The study group included 86 women with a confirmed diagnosis of endometriosis and the control group included 88 women with no diagnosis or suspected diagnosis of endometriosis. Each woman completed a questionnaire on menstrual bleeding patterns and endometriosis-associated symptoms before and after receiving two doses of the BNT162b2 vaccine. Primary outcomes were changes in amount or length of menstrual bleeding, rates of intermenstrual bleeding and worsening in dysmenorrhea in the endometriosis patient group, as compared to the control group. Secondary outcomes included changes in all endometriosis-associated symptoms. RESULTS In our cohort, women with endometriosis were more likely to experience changes in bleeding patterns (women with endometriosis: 39.5%, control group: 31.0%, p = 0.02), and a significant worsening in endometriosis-associated symptoms with an almost 4.3-fold worsening in dysmenorrhea [95% CI 1.9-9.9, p < 0.01] and 5.5-fold odds for any worsening in symptoms in endometriosis patients, as compared to the control group [95% CI 2.7-11.1, p < 0.01]. CONCLUSION In our cohort, endometriosis was shown to be a significant risk factor for worsening of menstrual symptoms, after receiving the SARS-CoV-2 BNT162b2 mRNA vaccine. Further research is needed to confirm these findings.
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Affiliation(s)
- Adi Gilan
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
| | - Sarit Laster-Haim
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Amihai Rottenstreich
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Shay Porat
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Naama Lessans
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Tal D Saar
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Uri P Dior
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
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Stern S, Lessans N, Shveiky D, Saar TD, Tevet A, Dior UP. Repair of Uterine Rupture Following Vaginal Delivery: A Comparison between Minimally invasive and Open Repair. Int J Gynaecol Obstet 2022; 161:942-948. [PMID: 36433868 DOI: 10.1002/ijgo.14590] [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] [Received: 07/29/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare operative data and patient satisfaction between open and laparoscopic surgery for postpartum-diagnosed uterine rupture. METHODS In this questionnaire-based cohort study, the authors collected all cases of postpartum-diagnosed uterine rupture after vaginal delivery between 2016 and 2020 in a single academic tertiary center. The cohort was divided according to surgical method of repair, and demographic, clinical, operative and postoperative data were collected and compared between groups. A phone questionnaire on various satisfaction domains was conducted and satisfaction rates were compared between groups. RESULTS Eight cases of uterine rupture following vaginal delivery were treated by laparoscopy and eight were treated by laparotomy. The median operative time was 103 min (interquartile range [IQR], 86.3-129.0 min) for the laparoscopy group and 61 min (IQR, 59.0-75.0 min) for the laparotomy group (P = 0.04). Blood transfusion was required in 25% of women who underwent laparoscopy, as compared with 88% of women who underwent laparotomy (P = 0.01 < 0.05). Median hospitalization time was 3 days (IQR, 3-4 days) in the laparoscopy group and 4 days (IQR, 4-4 days) in the laparotomy group (P = 0.2). Overall satisfaction, satisfaction from recovery, satisfaction from scars, satisfaction from ability to care for the neonate, and postoperative pain and mood were all improved in the laparoscopy group, as compared with the laparotomy group. CONCLUSION Minimally invasive surgery is a viable surgical option for patients with uterine rupture diagnosed after vaginal delivery and may result in better patient recovery and satisfaction.
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Affiliation(s)
- Shira Stern
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Naama Lessans
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Tal D. Saar
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Aharon Tevet
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Uri P. Dior
- Department of Obstetrics and Gynecology, Hadassah‐Hebrew University Medical Center Jerusalem Israel
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Lessans N, Rottenstreich A, Stern S, Gilan A, Saar TD, Porat S, Dior UP. The effect of BNT162b2 SARS-CoV-2 mRNA vaccine on menstrual cycle symptoms in healthy women. Int J Gynaecol Obstet 2022; 160:313-318. [PMID: 35856178 PMCID: PMC9349849 DOI: 10.1002/ijgo.14356] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA BNT162b2 vaccine on women's menstrual cycle. METHODS In this questionnaire-based cross-sectional study, we assessed menstrual pattern and changes in women who completed the SARS-CoV-2 mRNA BNT162b2 vaccine 3 months before and after receiving the vaccine. Included were women aged 18-50 years without known gynecologic comorbidities who regularly monitor their menstruation through electronic calendars. All participants competed a detailed questionnaire on their menstrual symptoms including information on any irregular bleeding. To minimize bias, each woman served as a self-control before and after vaccination. Primary outcome was rate of irregular bleeding following vaccination and secondary outcome was presence of any menstrual change, including irregular bleeding, mood changes, or dysmenorrhea following the vaccine. RESULTS A total of 219 women met the inclusion critieria. Of them, 51 (23.3%) experienced irregular bleeding following the vaccine. Almost 40% (n = 83) of study participants reported any menstrual change following vaccination. Parity was positively asssociated with irregular bleeding with 26 (50%) of those suffering from irregular bleeding being multiparous compared with only 53 (31.5%) of women with no irregular bleeding (nulliparous 46% vs 60%, multiparous 50% vs 31%, rest 4% vs 8%, P = 0.049). The presence of medical comorbidities was also significantly higher among patients who experienced irregular bleeding (20.0% vs 6.0%, P = 0.003). CONCLUSION Our study shows relatively high rates of irregular bleeding and menstrual changes after receiving the SARS-CoV-2 mRNA BNT162b2 vaccine. Further research is needed to confirm our findings and to better characterize the magnitude of change and any possible long-term implications.
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Affiliation(s)
- Naama Lessans
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Amihai Rottenstreich
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Shira Stern
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Adi Gilan
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Tal D. Saar
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Shay Porat
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Uri P. Dior
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
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Lessans N, Martonovits S, Rottenstreich M, Yagel S, Kleinstern G, Sela HY, Porat S, Levin G, Rosenbloom JI, Ezra Y, Rottenstreich A. Trial of labor after cesarean in primiparous women with fetal macrosomia. Arch Gynecol Obstet 2021; 306:389-396. [PMID: 34709449 DOI: 10.1007/s00404-021-06312-3] [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: 02/12/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
KEY MESSAGE Spontaneous labor onset, epidural anesthesia and prior cesarean for non-arrest disorders are strong predictors of successful vaginal birth after cesarean in women delivering a macrosomic fetus. PURPOSE Lower rates of successful vaginal birth after cesarean in association with increasing birthweight were previously reported. We aimed to determine the factors associated with successful trial of labor after cesarean (TOLAC) among primiparous women with fetal macrosomia. METHODS A retrospective cohort study conducted during 2005-2019 at two university hospitals, including all primiparous women delivering a singleton fetus weighing ≥ 4000 g, after cesarean delivery at their first delivery. A multivariate analysis was performed to evaluate the characteristics associated with TOLAC success (primary outcome). RESULTS Of 551 primiparous women who met the inclusion criteria, 50.1% (n = 276) attempted a TOLAC and 174 (63.0%) successfully delivered vaginally. In a multivariate analysis, spontaneous onset of labor (aOR [95% CI] 3.68 (2.05, 6.61), P < 0.001), epidural anesthesia (aOR [95% CI] 2.38 (1.35, 4.20), P = 0.003) and history of cesarean delivery due to non-arrest disorder (aOR [95% CI] 2.25 (1.32, 3.85), P = 0.003) were the only independent factors associated with TOLAC success. Successful TOLAC was achieved in 82.0% (82/100) in the presence of all three favorable factors, 61.3% (65/106) in the presence of two factors and 38.6% (27/70) in the presence of one or less of these three factors (P < 0.001). CONCLUSION Spontaneous onset of labor, epidural anesthesia and prior cesarean delivery due to non-arrest disorders were independently associated with higher vaginal birth after cesarean rate among women with fetal macrosomia, with an overall favorable success rate in the presence of these factors. These findings should be implemented in patient counseling in those contemplating a vaginal birth in this setting.
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Affiliation(s)
- Naama Lessans
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Stav Martonovits
- Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Geffen Kleinstern
- Department Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Yosef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
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