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Korytnikova E, Elnir Katz M, Gabizon I, Eshkoli T. Normal Term Deliveries in a Patient with Phosphoglucomutase 1 Deficiency. Isr Med Assoc J 2024; 26:311-314. [PMID: 38736348] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Elena Korytnikova
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Maayan Elnir Katz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Itzhak Gabizon
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Saadi R, Saban A, Weintraub AY, Yardeni D, Eshkoli T. The association between aspartate aminotransferase (AST) to platelets (PLT) ratio (APRI) and the development of intrahepatic cholestasis in pregnancy and other related complications. Arch Gynecol Obstet 2024:10.1007/s00404-024-07383-8. [PMID: 38355761 DOI: 10.1007/s00404-024-07383-8] [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: 12/08/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To assess the association between aspartate aminotransferase (AST) to platelet count ratio index (APRI score), during the first and third trimesters of pregnancy and the development of intrahepatic cholestasis in pregnancy (ICP). METHODS Case-control study was conducted. The study included patients diagnosed with ICP by elevated bile acids (n = 118) and a control group of women with symptoms such as elevated liver enzymes or pruritus with normal level of bile acids (n = 127) who attended a large tertiary teaching medical center between the years 2014 and 2021. The groups were compared in terms of obstetrical characteristics, perinatal outcomes, first- and third-trimester laboratory tests, and APRI scores during the first and third trimester. A receiver operating characteristic (ROC) analysis was performed to determine the APRI score cutoff value that could predict ICP. RESULTS The third-trimester APRI scores of patients with ICP were significantly higher than those of the control group (P < 0.001). The ROC analysis revealed that the cutoff value for the APRI score was 0.42 with 65.3% sensitivity and 73.2% specificity. CONCLUSION Our results suggest that the third-trimester APRI score is positively associated with ICP.
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Affiliation(s)
- Razan Saadi
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Alla Saban
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Yardeni
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Saban A, Shoham-Vardi I, Stein L, Eshkoli T, Weintraub AY. Can we predict peritoneal adhesions formation after cesarean delivery? Int J Gynaecol Obstet 2024; 164:650-655. [PMID: 37503788 DOI: 10.1002/ijgo.15013] [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: 06/15/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To examine demographic and obstetrical factors that are associated with adhesion formation following cesarean delivery. METHODS We conducted a population-based study that included all women over 18 years og age who underwent two cesarean deliveries between the years 1988 and 2016 in a large tertiary medical center. We excluded women with adhesions already diagnosed during the first cesarean delivery, history of other abdominal or pelvic surgery, history of pelvic infection or pelvic inflammatory disease, history of endometriosis and history of uterine Müllerian anomalies. In addition, women with a classical or T-shaped uterine incision, non-singleton pregnancies, and fetal chromosomal or structural abnormalities were excluded. RESULTS During the study period, 32.6% (n = 2283) of women were diagnosed with peritoneal adhesions during the second cesarean delivery. Factors found to be significantly associated with peritoneal adhesions were maternal age 35 years or older at the first cesarean delivery, Bedouin Arab ethnicity, composite of intrapartum and postpartum infectious morbidity, and cesarean deliveries that were performed after the onset of labor. In contrast, having a previous vaginal birth was found to be protective. CONCLUSIONS Our results suggest that a woman's characteristics at her first cesarean delivery and her obstetrical history may be predictive of the likelihood of adhesion formation.
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Affiliation(s)
- Alla Saban
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilana Shoham-Vardi
- Faculty of Health Sciences, Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Liane Stein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Weiss E, Eshkoli T, Baumfeld Y, Rotem R, Kaur G, Weintraub AY. Maternal and fetal outcomes among women with GDMA1 before and post-date. Eur J Obstet Gynecol Reprod Biol 2024; 293:44-49. [PMID: 38104393 DOI: 10.1016/j.ejogrb.2023.12.013] [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: 09/05/2023] [Revised: 11/13/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To investigate adverse pregnancy outcomes in patients complicated with GDMA1 who delivered at term before or after 40 weeks of gestation. STUDY DESIGN A population-based cohort study including all women with GDMA1 during pregnancy was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. RESULTS During the study period, 11,765 women with GDMA1 met the inclusion criteria. Of these, 1303 (11 %) delivered after 40 weeks (post-date, study group), while 10,462 (89 %) delivered at term before 40 weeks of gestation (before date, control group). Those who delivered after 40 weeks of gestation (the study group) had a significantly lower percent of cesarean deliveries (CD), higher rates of spontaneous vaginal deliveries and induction of labor in comparison to those who delivered before 40 weeks of gestation (the control group). The control group had significantly higher rates of preeclampsia and intrauterine growth restriction than the study group. Using a multivariable logistic regression model, delivery after 40 weeks was noted as an independent protective factor for CD (adjusted OR = 0.78, 95 %CI 0.66-0.92, p value = 0.001). Delivery after 41 + 0 weeks had a significantly higher rate of CD and LGA. CONCLUSION No significant increase in adverse pregnancy outcomes at term post-date pregnancies complicated with GDMA1 was demonstrated. Furthermore, there was no increase in the rate of CD with the increase in gestational age until 41 weeks of gestation.
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Affiliation(s)
- Eyal Weiss
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Gurkamaljot Kaur
- Medical School for International Health, Ben-Gurion University of the Negev, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Eshkoli T, Baumfeld Y, Yohay Z, Binyamin Y, Speigel E, Dym L, Weintraub AY. Is epidural analgesia an independent risk factor for OASIS? A population-based cohort study. Arch Gynecol Obstet 2023:10.1007/s00404-023-07150-1. [PMID: 37454350 DOI: 10.1007/s00404-023-07150-1] [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: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION To evaluate whether epidural analgesia is an independent risk factor for OASIS. METHODS A population-based cohort study including all women who delivered by spontaneous vaginal delivery or by instrumental delivery beyond 24 weeks gestation was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. Women with multiple gestations and those lacking prenatal care were excluded from the analysis. RESULTS During the study period, 252,542 women delivered at the Soroka University Medical Center and met the inclusion criteria. Of these, 583 (0.23%) were diagnosed with OASIS. Women with OASIS were more likely to be younger, nulliparous, with suspected fetal macrosomia, had higher rates of labor induction and vacuum extraction delivery, higher rates of conceiving after infertility treatments, more advanced gestational age at delivery, higher mean birth weight, higher rates of post-partum hemorrhage and need for blood transfusions. Use of epidural analgesia during pregnancy was significantly high among the OASIS group. Rates of episiotomy were not significantly different between the groups. Using a multimodal logistic regression model, after controlling for vacuum delivery, large for gestational age, nulliparity, gestational age, ethnicity, maternal age, induction of labor, fertility treatments, non-reassuring fetal heart rate and non-progressive second stage of labor, epidural analgesia was found to be significantly associated with OASIS. CONCLUSION Epidural analgesia was found to be an independent risk factor for OASIS in our population.
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Affiliation(s)
- Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel.
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Zehava Yohay
- Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Efrat Speigel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Lianne Dym
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
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Yohay NZ, Cohen R, Hasan M, Daya K, Weiss A, Abukaf H, Yohay Z, Weintraub AY, Eshkoli T. Condition-specific validation of the Arabic version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) among parturient. Int Urogynecol J 2023; 34:1529-1539. [PMID: 36592172 DOI: 10.1007/s00192-022-05417-w] [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: 09/24/2022] [Accepted: 11/17/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy and mode of delivery have a major effect on pelvic floor disorders (PFD). Assessing knowledge regarding PFD is essential not only for making more informed decisions regarding mode of delivery, but also for seeking help when PFD appear. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a validated tool that assesses women's knowledge regarding urinary incontinence (UI) and pelvic organ prolapse (POP). Validation of the Arabic version of the PIKQ had never been carried out. The purpose of this study was to conduct a condition specific validation among parturients of the PIKQ in the Arabic language. METHODS Translation of the PIKQ to the Arabic language was carried out according to international recommended guidelines. A cross-sectional study of pregnant women was conducted from June to September 2020 at the Soroka University Medical Center, Israel. The recommended 10:1 ratio between the number of subjects and the number of items in the questionnaire (n=24) was maintained. A total of 244 third trimester pregnant women have completed the Arabic version of the PIKQ. In addition to the validation of the psychometric characteristics, construct validity, criterion validity, and reliability were tested as well. RESULTS Initially, exploratory factor analysis (EFA) was conducted, resulting in two 12-item scales representing UI and POP. Then, to validate the scale construct we conducted confirmatory factor analysis (CFA). Results of the CFA demonstrated that the PIKQ displayed construct validity, with standardized factor loadings ranging from 0.30 to 0.62. Finally, Cronbach's alpha indicated a good internal reliability for the two factors UI and POP. Criterion validity further supported the validity of the scale. CONCLUSIONS The Arabic version of the PIKQ is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding UI and POP in Arabic speaking pregnant women. This instrument may be used to assess women's knowledge about PFD and to direct the need for educational interventions that may empower women to make informed decisions regarding perinatal care.
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Affiliation(s)
- Neriya Zion Yohay
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Medical Corps, Israel Defense Forces, Hebrew University of Jerusalem, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Rinat Cohen
- School of Education, Achva Academic College, Arugot, Israel
| | - Mahmod Hasan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kochav Daya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Ari Weiss
- Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hanaa Abukaf
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Eshkoli T, Baumfeld Y, Yohay Z, Binyamin Y, Hershkovitz R, Gliklis S, Sade S, Weintraub AY. The impact of epidural analgesia on third stage of labor disorders. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.697] [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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Spiegel E, Adler Y, Saban A, Eshkoli T, Hershkovitz R, Weintraub AY. Does a sonographic estimation of macrosomia effect perinatal outcomes? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.525] [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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Yohay NZ, Weiss A, Weintraub AY, Daya K, Katz ME, Elharar D, Yohay Z, Madar RT, Eshkoli T. Knowledge of women during the third trimester of pregnancy regarding pelvic floor disorders. Int Urogynecol J 2022; 33:3407-3414. [PMID: 35588318 DOI: 10.1007/s00192-022-05098-5] [Citation(s) in RCA: 2] [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: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to examine knowledge regarding pelvic floor disorders (PFDs) among women during the third trimester of pregnancy. METHODS A cross-sectional study was conducted at a large teaching medical center in Israel between June and September 2020. Women in their third trimester (N = 649) were asked to complete the validated Hebrew and Arabic versions of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). The PIKQ instrument examines the knowledge of two major PFDs: urinary incontinence (UI) and pelvic organ prolapse (POP). The study population included women over 18 years of age, in the third trimester, who speak and read Hebrew or Arabic fluently. Two separate scores were calculated, one for each section of the PIKQ. The association of questionnaire scores with the different independent variables was examined using Student's t test or one-way ANOVA. Correlations were examined using Pearson's or Spearman's correlation coefficient. RESULTS The Hebrew version was filled out by 405 women, and 244 women completed the Arabic version. The average questionnaire scores were 7.65 ± 2.8 and 5.32 ± 2 for the UI and POP sections respectively. Significantly higher average scores in both the UI and the POP sections were noted among health care workers (UI: 10.19 ± 2.3 vs 7.34 ± 2.6, p < 0.001; POP: 8.27 ± 2.7 vs 4.97 ± 2.6, p < 0.001), women with higher education (p < 0.001 in both parts) and those with higher incomes (p < 0.001 for both parts). CONCLUSIONS Knowledge of PFD among women in the third trimester of pregnancy in Israel was found to be low. Founding educational programs for targeted groups may improve both the knowledge of PFD and the quality of life for these women.
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Affiliation(s)
- Neriya Zion Yohay
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem and Medical Corps, Israel Defense Forces, Jerusalem, Israel. .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ari Weiss
- Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kochav Daya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Maayan Elnir Katz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | | | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Lichtman Y, Horev A, Matyashov T, Rotem R, Katz ME, Eshkoli T, Weintraub AY. Association between striae gravidarum and pelvic floor dysfunction symptoms during pregnancy. Int Urogynecol J 2022; 33:3441-3447. [PMID: 35666288 DOI: 10.1007/s00192-022-05249-8] [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: 04/08/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Striae gravidarum are linear atrophic scars appearing on the abdomen of pregnant women reported to be related to pregnancy-induced changes in the connective tissue. Pelvic floor distress symptoms are also known to be linked to connective tissue weakness. Given that common pathophysiological pathways may play a role in both striae gravidarum and pelvic floor dysfunction symptoms, we sought to examine whether there is a correlation between them during pregnancy. METHODS A prospective observational study among third-trimester pregnant women who visited a tertiary medical center for routine pregnancy follow-up was conducted by using the Pelvic Floor Distress Inventory (PFDI-20) questionnaire to evaluate pelvic floor distress symptoms and the Davey method for evaluating striae gravidarum severity. Obstetrical characteristics as well as pelvic floor distress symptoms were compared between two groups according to the severity of striae gravidarum. Univariate analysis was carried out using appropriate tests; PFDI scores were compared between the groups using the Mann-Whitney test. RESULTS Women with striae gravidarum were significantly older (31.06 vs. 28.83 years, p < 0.01), had a lower body mass index (27.5 vs. 30.98, p < 0.01), and gave birth to smaller neonates (3155 vs. 3389 g, p < 0.01). In addition, the overall and median PFDI-20 scores differed between the groups (with severe SG having the highest median score of 20 and those with milder SG having a score of 16 compared to 14 in those without SG). A distinct association between the PFDI-20 score and SG severity was not demonstrated (p = 0.63). CONCLUSIONS In our population, an association was demonstrated between pelvic floor distress symptoms and the presence of striae gravidarum. However, following a linear regression model, no statistically significant association between SG severity and total PFD-20 score was seen. Our findings strengthen the hypothesis of common connective tissue involvement in the pathophysiology of both conditions.
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Affiliation(s)
- Yael Lichtman
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Amir Horev
- Pediatric Dermatology Services, Soroka Medical Center, Beer-Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Matyashov
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, 12 Bayit Street, 91031, Jerusalem, Israel
| | - Maayan Elnir Katz
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Eshkoli T, Fraenkel M, Zaid D, Cohen D, Yoel U, Tsvetov G, Gorshtein A, Goldbart A, Greenman Y, Shimon I. Resistant prolactinomas: a case series of 26 patients. Endocrine 2022; 77:349-356. [PMID: 35604631 DOI: 10.1007/s12020-022-03080-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Prolactin (PRL)-secreting tumors are the most common functional pituitary adenomas. They usually respond to dopamine agonist (DA) treatment, with PRL normalization and adenoma shrinkage. Our aim was to characterize patients with prolactinoma resistant to DA treatment. METHODS This retrospective case series included patients diagnosed with DA-resistant prolactinomas between 1993-2017 in three medical centers. Resistance was defined as PRL levels above three times the upper limit of normal (ULN) despite a weekly dose of ≥2 mg cabergoline (CAB). Clinical and biochemical information, and response to treatment, were retrieved from medical records. RESULTS Twenty-six patients were identified; 20 males. Of 25 macroadenomas, three were giant tumors (>40 mm) and 15 (57.7%) were invasive. The mean age at diagnosis was 31.8 ± 14.9 years (range: 13-62). The median maximal CAB dose was 3.5 mg/week (IQR, 2.5-5). Half the patients received only CAB in escalating doses, nine received CAB and underwent transsphenoidal surgery, and four underwent surgery and radiotherapy in addition to CAB treatment. PRL levels at baseline between patients treated only with CAB and those operated were (91.6 [51.1-296.7] vs. 73.1 [22.6-170.9] XULN p = 0.355), and under maximal CAB dose PRL levels between patients treated only with CAB and those operated were similar (5.77 [1.27-11.27] vs 5.27 (2.9-26) XULN p = 0.317). At the last visit patients who received combined therapy achieved lower PRL levels than those treated with DA only (5.22 [1.7-21.6] vs 1.1 [0.44-3.99] XULN p = 0.017) PRL normalization was attained in seven patients and levels below 3 × ULN in fourteen patients; the overall response was 56%. CONCLUSIONS Resistant prolactinomas usually require a multi-modal treatment strategy. We were able to control 14/25 (56%) of resistant tumors.
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Affiliation(s)
- Tamar Eshkoli
- Endocrine Unit, Soroka Medical Center, Beer-Sheva, Israel.
- Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Merav Fraenkel
- Endocrine Unit, Soroka Medical Center, Beer-Sheva, Israel
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Zaid
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - Dayana Cohen
- Endocrine Unit, Soroka Medical Center, Beer-Sheva, Israel
| | - Uri Yoel
- Endocrine Unit, Soroka Medical Center, Beer-Sheva, Israel
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gloria Tsvetov
- Endocrine Institute, Rabin-Beilinson Medical Center, Petah-Tiqva, Israel
| | - Alexander Gorshtein
- Endocrine Institute, Rabin-Beilinson Medical Center, Petah-Tiqva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Goldbart
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yona Greenman
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Shimon
- Endocrine Institute, Rabin-Beilinson Medical Center, Petah-Tiqva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Weiss A, Yohay NZ, Daya K, Elnir Katz M, Yohay Z, Hasan M, Baumfeld Y, Elharar D, Weintraub AY, Eshkoli T. Validation of the hebrew version of the prolapse and incontinence knowledge questionnaire (PIKQ) during pregnancy. Int Urogynecol J 2022; 33:3123-3128. [PMID: 35088091 DOI: 10.1007/s00192-021-05038-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy and delivery have a major effect on pelvic floor disorders. Assessing knowledge regarding pelvic floor disorders in childbearing age women and appropriate interventions will enable women to seek appropriate medical advice once pelvic floor disorders have developed. The purpose of this study was to validate the prolapse and incontinence knowledge questionnaire in the Hebrew language. METHODS Translation of the prolapse and incontinence knowledge questionnaire to the Hebrew language according to international recommended guidelines. A study was conducted to validate the questionnaire. The study took place between June to September 2020 in a tertiary medical center in Israel. A total of 240 third trimester pregnant women completed the Hebrew version of the prolapse and incontinence knowledge questionnaire. Construct validity, criterion validity and reliability tests were performed. RESULTS Factor analysis of the Hebrew version of the prolapse and incontinence knowledge questionnaire demonstrated 12 strong positive factor loadings to one principal factor in the prolapse and incontinence knowledge questionnaire-pelvic organ prolapse domain (FL > 0.3) and 10/12 in the prolapse and incontinence knowledge questionnaire-urinary incontinence domain. The Hebrew prolapse and incontinence knowledge questionnaire was found to have internal consistency, with Cronbach alpha coefficient of 0.745 for the urinary incontinence domain and 0.796 for the pelvic organ prolapse domain. CONCLUSIONS The Hebrew version of the prolapse and incontinence knowledge questionnaire is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding pelvic floor disorders in Hebrew-speaking pregnant women.
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Affiliation(s)
- Ari Weiss
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Neriya Zion Yohay
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Corps, Israel Defense Forces, Tel Aviv, Israel
| | - Kochav Daya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Maayan Elnir Katz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Mahmod Hasan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Reicher Y, Weintraub AY, Dym L, Baumfeld Y, Steiner N, Talmon T, Karen BA, Eshkoli T. Perinatal outcomes in pregnancies complicated with GDMA1 following fertility treatments. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.955] [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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Reicher Y, Weintraub AY, Baumfeld Y, Dym L, Amit K, Eshkoli T. Diabetes Mellitus in pregnancy-a risk factor for perineal injuries, independent of neonatal macrosomia. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.223] [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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15
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Eshkoli T, Reicher Y, Hay-Azogui H, Yohay N, Cohen R, zehava Yohay, Elharar D, Weiss A, Assor A, Weintraub AY. The Implementation of the Self-Determination Theory (SDT) in the Prediction of Successful TOLAC. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.227] [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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16
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Dym L, Baumfeld Y, Hershkovitz R, Reicher Y, Saban A, Weintraub AY, Eshkoli T. Gestational characteristics and perinatal outcomes in women complicated with placental abruption. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.205] [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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17
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Dym L, Baumfeld Y, Hershkovitz R, Reicher Y, Weintraub AY, Eshkoli T. Pregnancy and perinatal outcomes in women complicated with placental abruption with and without uterine malformations. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.204] [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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18
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Weiss E, Eshkoli T, Baumfeld Y, Rotem R, Weintraub AY. Maternal and fetal outcomes among women at term with GDMA1 before and post-date. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.642] [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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Dym L, Baumfeld Y, Hershkovitz R, Reicher Y, Weintraub AY, Eshkoli T. Adverse perinatal outcomes in pregnancies complicated with placental abruption accompanied by hypertensive disorders of pregnancy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.203] [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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Eshkoli T, Barski L, Faingelernt Y, Jotkowitz A, Finkel-Oron A, Schwarzfuchs D. Diabetic ketoacidosis in pregnancy - Case series, pathophysiology, and review of the literature. Eur J Obstet Gynecol Reprod Biol 2021; 269:41-46. [PMID: 34968873 DOI: 10.1016/j.ejogrb.2021.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/28/2021] [Revised: 11/22/2021] [Accepted: 12/11/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) during pregnancy is a life-threatening emergency for both the mother and the fetus. The pathophysiology of DKA in pregnancy has its own characteristics due to multiple factors, such as insulin resistance, accelerated starvation and respiratory alkalosis, thus creating ketosis-prone state, with DKA occurring at milder degrees of hyperglycemia, even in normoglycemic levels, which can result in delayed diagnosis and treatment with potential for adverse metabolic consequences. STUDY DESIGN In this article, we presented 8 clinical cases of DKA during pregnancy. We discuss the spectrum of the clinical picture, the entity of euglycemic DKA vs hyperglycemic DKA, the period of pregnancy in appearance of episode of DKA and triggers of DKA. CONCLUSION The treatment of DKA in pregnant women must be started immediately and must be accentuated on intravenous fluids, insulin and electrolyte replacement. DKA in pregnancy may be euglycemic. Prevention, early recognition, immediate hospitalization, and aggressive management remain the cornerstones in DKA management in pregnancy.
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Affiliation(s)
- Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel; Endocrinology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Leonid Barski
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Yaniv Faingelernt
- Department of Pediatric Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alan Jotkowitz
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alona Finkel-Oron
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel
| | - Dan Schwarzfuchs
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
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21
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Madar R, Adini B, Greenberg D, Waisman Y, Eshkoli T, Newman N, Goldberg A. Physician and nurses' perception of paediatric trauma care in Israeli emergency departments. Nurs Crit Care 2021; 27:55-65. [PMID: 33913224 DOI: 10.1111/nicc.12635] [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: 05/31/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment of paediatric trauma requires specialized infrastructure, medical equipment, medical staff and ancillary support personnel that have been specifically trained for such tasks. AIMS AND OBJECTIVES To examine the perceptions and attitudes of physicians and nurses in general and paediatric emergency departments (PEDs) on training, confidence, and management of paediatric trauma in order to facilitate the establishment of an optimal model for admitting and treating paediatric trauma patients. DESIGN Drawing on published literature and a previously conducted qualitative study that explored the provision of medical care to paediatric trauma patients, we conducted an attitude survey. METHODS A 26-item paper-based questionnaire was distributed by nurse managers to all staff working within general EDs and PEDs of 22 medical centres across Israel. RESULTS Of 843 physicians and nurses who completed the survey, 61.1% considered PEDs the most appropriate facility for treating both minor and severe paediatric trauma, 88.5% believed that minor paediatric trauma should be treated in designated paediatric trauma centres, and 53.6% deemed that paediatric emergency medicine specialists are the most suitable primary decision makers in paediatric trauma. PED teams expressed greater professional confidence for treating paediatric trauma and multiple casualty incident patients. Greater professional confidence was positively correlated with paediatric trauma training, greater exposure to paediatric trauma cases, and working in larger medical centres. CONCLUSIONS The results of the current study suggest that PEDs are perceived to be more appropriate for dealing with paediatric trauma. Also, treatment of severe trauma may be more appropriate in centres that admit large numbers of paediatric trauma cases. RELEVANCE TO CLINICAL PRACTICE Emergency medicine teams should undergo training for dealing with paediatric trauma. Such training would develop their skills, increase their confidence, and enhance their emotional abilities to cope with paediatric trauma.
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Affiliation(s)
- Raya Madar
- Nursing Administration, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Bruria Adini
- Department of Disaster Management and Injury Prevention, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Pediatrics Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yehezkel Waisman
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,School of Continuing Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Nitza Newman
- Pediatric Surgery Department, Soroka University Medical Center, Beer Sheva, Israel
| | - Avishay Goldberg
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer Sheva, Israel
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22
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Weiss A, Yohay NZ, daya K, Katz ME, yohay D, yohay Z, Baumfeld Y, Elharar D, Weintraub AY, Eshkoli T. 478 Validation of the hebrew version of the prolapse and incontinence knowledge questionnaire (PIKQ) during pregnancy. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.499] [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: 10/22/2022]
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23
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Eshkoli T, Wainstock T, Sheiner E. 379: Maternal gestational diabetes mellitus and risk of long term pediatric infectious diseases of the offspring. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.395] [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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24
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Abstract
Euglycemic DKA (eu-DKA) is a life-threatening emergency. It may occur in patients with both type 1 and type 2 DM, and characterized by milder degrees of hyperglycemia with blood glucose level < 200 mg/dl, which can result in delayed diagnosis and treatment with potential for adverse metabolic consequences. Following the wide introduction of the sodium glucose transporter 2 inhibitors (SGLT2i) in therapeutic practice for DM type 2 treatment the amount of eu-DKA increased and therefore, interest to this entity rose. Other causes associated with eu-DKA include pregnancy, decreased caloric intake, heavy alcohol use, insulin use prior to hospital admission, cocaine abuse, pancreatitis, sepsis, chronic liver disease and liver cirrhosis. Patients with eu-DKA as well as with DKA need immediate referral for emergency evaluation and treatment. The treatment includes rapid correction of dehydration, correction electrolyte abnormalities, and use of insulin drip until the anion gap, and bicarbonate levels normalize. Increased glucose administration using higher percentages of dextrose (10 or 20%) are required to facilitate the concomitant administration of the relatively large amounts of insulin that are needed to correct the severe acidosis in these patients.
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Affiliation(s)
- Leonid Barski
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel.
| | - Tamar Eshkoli
- Endocrinology Unit, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Evgenia Brandstaetter
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Alan Jotkowitz
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
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25
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Eshkoli T, Yohai D, Laron E, Weintraub AY. [EPIDEMIOLOGY OF OVER-ACTIVE BLADDER (OAB) SYNDROME]. Harefuah 2016; 155:682-685. [PMID: 28530071] [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: 06/07/2023]
Abstract
An over-active bladder is a common disorder which influences women's health and quality of life. There is difficulty defining the exact prevalence of the disorder since there are various definitions in the literature. The ICS definition from 2002 on the over-active bladder (OAB) syndrome enables more uniformity, by declaring that OAB syndrome is a symptomatic syndrome defined as presence of urgency with or without urinary incontinence, mostly accompanied by frequency and nocturia. In this article we reviewed the current medical literature on the prevalence of the OAB syndrome by focusing on relevant crosssectional and longitudinal studies, the trend changes during life, co-morbidities, the influence of quality of life and the economic burden following the disorder and its treatment. The authors' hope is that elevating awareness of the OAB syndrome will help improve its diagnosis and treatment.
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Affiliation(s)
- Tamar Eshkoli
- Obstetrics and Gynecology Department, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Yohai
- Obstetrics and Gynecology Department, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elad Laron
- Obstetrics and Gynecology Department, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Y Weintraub
- Obstetrics and Gynecology Department, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
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26
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Eshkoli T, Weintraub AY, Baron J, Sheiner E. The significance of a uterine rupture in subsequent births. Arch Gynecol Obstet 2015; 292:799-803. [DOI: 10.1007/s00404-015-3715-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
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27
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Quaranta M, Erez O, Mastrolia SA, Koifman A, Leron E, Eshkoli T, Mazor M, Holcberg G. The physiologic and therapeutic role of heparin in implantation and placentation. PeerJ 2015; 3:e691. [PMID: 25653897 PMCID: PMC4304855 DOI: 10.7717/peerj.691] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 09/03/2014] [Accepted: 11/19/2014] [Indexed: 01/19/2023] Open
Abstract
Implantation, trophoblast development and placentation are crucial processes in the establishment and development of normal pregnancy. Abnormalities of these processes can lead to pregnancy complications known as the great obstetrical syndromes: preeclampsia, intrauterine growth restriction, fetal demise, premature prelabor rupture of membranes, preterm labor, and recurrent pregnancy loss. There is mounting evidence regarding the physiological and therapeutic role of heparins in the establishment of normal gestation and as a modality for treatment and prevention of pregnancy complications. In this review, we will summarize the properties and the physiological contributions of heparins to the success of implantation, placentation and normal pregnancy.
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Affiliation(s)
- Michela Quaranta
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, Università degli Studi di Verona , Verona , Italy
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Azienda Ospedaliera-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | - Arie Koifman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Moshe Mazor
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Gershon Holcberg
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
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Feinshtein V, Erez O, Ben-Zvi Z, Erez N, Eshkoli T, Sheizaf B, Sheiner E, Huleihel M, Holcberg G. Cannabidiol changes P-gp and BCRP expression in trophoblast cell lines. PeerJ 2013; 1:e153. [PMID: 24058883 PMCID: PMC3775628 DOI: 10.7717/peerj.153] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 05/27/2013] [Accepted: 08/15/2013] [Indexed: 12/13/2022] Open
Abstract
Objectives. Marijuana is the most commonly used illicit drug during pregnancy. Due to high lipophilicity, cannabinoids can easily penetrate physiological barriers like the human placenta and jeopardize the developing fetus. We evaluated the impact of cannabidiol (CBD), a major non-psychoactive cannabinoid, on P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) expression, and P-gp function in a placental model, BeWo and Jar choriocarcinoma cell lines (using P-gp induced MCF7 cells (MCF7/P-gp) for comparison). Study design. Following the establishment of the basal expression of these transporters in the membrane fraction of all three cell lines, P-gp and BCRP protein and mRNA levels were determined following chronic (24-72 h) exposure to CBD, by Western Blot and qPCR. CBD impact on P-gp efflux function was examined by uptake of specific P-gp fluorescent substrates (calcein-AM, DiOC2(3) and rhodamine123(rh123)). Cyclosporine A (CsA) served as a positive control. Results. Chronic exposure to CBD resulted in significant changes in the protein and mRNA levels of both transporters. While P-gp was down-regulated, BCRP levels were up-regulated in the choriocarcinoma cell lines. CBD had a remarkably different influence on P-gp and BCRP expression in MCF7/P-gp cells, demonstrating that these are cell type specific effects. P-gp dependent efflux (of calcein, DiOC2(3) and rh123) was inhibited upon short-term exposure to CBD. Conclusions. Our study shows that CBD might alter P-gp and BCRP expression in the human placenta, and inhibit P-gp efflux function. We conclude that marijuana use during pregnancy may reduce placental protective functions and change its morphological and physiological characteristics.
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Affiliation(s)
- Valeria Feinshtein
- Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev , Israel
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Weintraub AY, Amash A, Eshkoli T, Piltcher Haber E, Bronfenmacher B, Sheiner E, Holcberg G, Huleihel M. The effects of magnesium sulfate on placental vascular endothelial growth factor expression in preeclampsia. Hypertens Pregnancy 2013; 32:178-88. [DOI: 10.3109/10641955.2013.784787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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30
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Harlev A, Pariente G, Kessous R, Aricha-Tamir B, Weintraub AY, Eshkoli T, Dukler D, Ayun SB, Sheiner E. Can we find the perfect oil to protect the perineum? A randomized-controlled double-blind trial. J Matern Fetal Neonatal Med 2013; 26:1328-31. [PMID: 23570446 DOI: 10.3109/14767058.2013.784261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether perineal massage during the second stage of labor using oil enriched with vitamins, increases the chances of delivering with an intact perineum as compared to perineal massage using pure liquid wax. METHOD A prospective, randomized, double-blind study was conducted. Women were assigned to liquid wax (jojoba oil) versus purified formula of almond and olive oil, enriched with vitamin B1, B2, B6, E and fatty acids. The caregivers used the oils during the second stage of labor. RESULTS A total of 164 women undergoing vaginal delivery were recruited. No significant differences regarding perineal lacerations, number of sutures and length of suturing were noted between the two groups. Likewise, while analyzing separately nulliparous and multiparous women, no significant differences were noted. Controlling for birth weight >4000 g, using the Mantel-Haenszel technique, no association was noted between perineal lacerations and the type of oil used (weighted OR = 0.9, 95% CI 0.3-2.4; p = 0.818). CONCLUSION The type of the oil used during the second stage of labor for prevention of perineal tears has no effect on the integrity of the perineum. Accordingly, it seems that there is no perfect oil.
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Affiliation(s)
- Avi Harlev
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva, Israel
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Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013; 208:219.e1-7. [PMID: 23313722 DOI: 10.1016/j.ajog.2012.12.037] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/14/2012] [Accepted: 12/31/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to evaluate risk factors and perinatal outcomes of pregnancies complicated with placenta accreta and to study perinatal outcomes in subsequent pregnancies. STUDY DESIGN A retrospective study comparing all singleton cesarean deliveries (CD) of women with and without placenta accreta was conducted. In addition, a retrospective comparison of all subsequent singleton CD of women with a previous placenta accreta, with CD of women with no such history, was performed during the years 1988 through 2011. Stratified analysis using multiple logistic regression models was performed to control for confounders. RESULTS During the study period, there were 34,869 CD, of which 0.4% (n = 139) were complicated with placenta accreta. Using a multivariable analysis with backward elimination, year of birth (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.03-1.09; P < .001), previous CD (aOR, 5.11; 95% CI, 3.42-7.65; P < .001), and placenta previa (aOR, 50.75; 95% CI, 35.57-72.45; P < .001) were found to be independently associated with placenta accreta. There were 30 subsequent pregnancies of women with placenta accreta. Recurrent accreta occurred in 4 patients (13.3%). Previous placenta accreta was significantly associated with uterine rupture (3.3% vs 0.3%, P < .01) peripartum hysterectomy (3.3% vs 0.2%, P < .001), and the need for blood transfusions (16.7% vs 4%, P < .001). Nevertheless, increased risk for adverse perinatal outcomes such as low Apgar scores at 1 and 5 minutes and perinatal mortality was not found in these patients. CONCLUSION Prior CD and placenta previa are independent risk factors for placenta accreta. A pregnancy following a previous placenta accreta is at increased risk for adverse maternal outcomes such as recurrent accreta, uterine rupture, and peripartum hysterectomy. However, adverse perinatal outcomes were not demonstrated.
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Feinshtein V, Ben-Zvi Z, Erez O, Eshkoli T, Sheiner E, Holcberg G. 558: Cannabidiol enhances placental permeability to xenobiotics throughout direct inhibition of breast cancer resistance protein in the human placental barrier. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.724] [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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Eshkoli T, Sheiner E, Weintraub AY, Holcberg G, Press F. 113: Placenta accreta in a previous pregnancy and its significance on subsequent births. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.278] [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: 10/27/2022]
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Eshkoli T, Holcberg G, Bronfenmacher B, Amash A, Huleihel M, Erez O. Perfusion with magnesium sulfate increases sFlt-1 secretion only in the fetal side of placenta of women with preeclampsia. J Matern Fetal Neonatal Med 2012; 26:116-22. [PMID: 22928533 DOI: 10.3109/14767058.2012.722725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the effect of magnesium sulfate (MgSO(4)) on sFlt (soluble fms-like tyrosine kinase)-1 in the fetal and maternal compartments of normotensive and preeclamptic placentas. METHODS Cotyledons of term normotensive and preeclamptic placentas were dually perfused for six hours, with control medium and MgSO(4) (6-7 mg %) in the maternal reservoir. Perfusate sFlt-1 concentrations were measured. RESULTS Median sFlt-1 concentration was higher in the maternal than in the fetal side in both groups and perfusion media (p < 0.0001). When perfused with control medium, the maternal side median sFlt-1 concentration was higher in the preeclampsia than in the control group (p < 0.0001). After perfusion with MgSO(4), the median maternal and fetal sides perfusate sFlt-1 concentration were higher in the preeclampsia than in the control group (p < 0.0001). In comparison to perfusion with control medium, the median sFlt-1 concentration of normal pregnant women decreased in the fetal and increased in the maternal side. In the preeclampsia group, only median fetal side sFlt-1 concentration increased. CONCLUSION In contrast to normal pregnant women, perfusion with MgSO(4) of preeclamptic placentas did not increase their sFlt-1 concentration. This may indicate that MgSO(4) role may be limited to its anti-eclamptic and does not affect the anti-angiogenic state associated with preeclampsia.
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Affiliation(s)
- Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences Ben-Gurion University of Negev, Beer Sheva, Israel
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Eshkoli T, Weintraub AY, Holcberg G, Bronfenmacher B, Amash A, Huleihel M, Sheiner E. 756: The expression of soluble fms-like tyrosine kinase in the fetal and maternal compartments of normotensive and preeclamptic human placentas. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.774] [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: 12/01/2022]
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Eshkoli T, Sheiner E, Ben-Zvi Z, Feinstein V, Holcberg G. Drug Transport Across the Placenta. Curr Pharm Biotechnol 2011; 12:707-14. [DOI: 10.2174/138920111795470877] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 11/09/2010] [Indexed: 11/22/2022]
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