Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse.

BACKGROUND: Rapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial. OBJECTIVE: The aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome. STUDY DESIGN: The database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman's rank correlation coefficient. RESULTS: Of the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0-15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24-7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman's Ρ = - 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman's Ρ = .425; Ρ = .079, Ρ = - .205; Ρ = .336, Ρ = - .324; Ρ = .122 for groups 1-3, respectively). CONCLUSION: Intrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH.

Long-term risk of adnexal operation after vaginal hysterectomy for pelvic organs prolapse repair.

OBJECTIVE: To determine if women who undergo vaginal hysterectomy for pelvic floor prolapse repair without concomitant opportunistic bilateral salpingo-oophorectomy are at increased risk of further complications related to the remaining adnexa later in life. STUDY DESIGN: The database of a tertiary university medical center was searched for all women who underwent vaginal hysterectomy as part of the treatment for pelvic organ prolapse, without opportunistic adnexectomy, from 2006 to 2015 to provide adequate time for long-term evaluation. Demographic and clinical data including surgeries performed during the long-term follow-up were collected from all medical insurer electronic medical records. RESULTS: The cohort included 427 women of mean age 63 ± 9.3 years; 90.9 % were postmenopausal. Mean duration of follow-up was 10.7 ± 2.6 years. During the follow-up period, only 3 patients (0.7 %) were re-operated for left adnexal pathology, non-malignant in all cases. CONCLUSION: In women undergoing vaginal hysterectomy for pelvic organ prolapse without opportunistic adnexectomy, preservation of the adnexa poses only a very low risk for adnexal pathology or need for reoperation later in life.

Abnormal Pathology Following Vaginal Hysterectomy for Pelvic Organ Prolapse Repair.

Objective: Uterine-sparing surgery for pelvic organ prolapse (POP) repair has shown good results, but the potential negative implications of leaving the uterus in place are yet to be fully defined. We aimed to assess the risk of unanticipated abnormal gynecological pathology at the time of reconstructive pelvic surgery. Methods: A retrospective consecutive case series including women who underwent vaginal hysterectomy for POP repair at a tertiary medical center in 2006-2020. All patients were offered a free Pap smear test at the age of 65 years as part of a national screening program. Transvaginal ultrasound was routinely performed preoperatively. Standard 3 pedicle hysterectomy was performed with/without bilateral salpingo-oophorectomy (BSO). Results: The study comprised 462 women of mean age 63 ± 9.3 years without previous known malignant or premalignant pathology. Benign pathology was observed in 286 patients (61.9%). Endometrial malignancy was found in three patients (0.7%) and significant premalignant pathology in 15 patients (3.2%), including cervical intraepithelial neoplasia stage 2-3 in seven patients (1.5%) and complex hyperplasia with atypia in eight patients (1.7%). All these pathologies were found in postmenopausal women. None had preoperative clinical symptoms or endometrial thickness of ≥5 mm on preoperative ultrasound. In the 35 patients after BSO, adnexal findings were normal (77.2%) or benign (22.8%). Conclusions: Premenopausal women with uterovaginal prolapse and normal preoperative evaluation have a minimal risk of significant abnormal uterine pathology. In postmenopausal women, the risk of unanticipated malignant uterine pathology is 0.7% and 3.2% for significant premalignancy.

Uncertain prelabor rupture of membranes at term and associated delivery outcomes.

OBJECTIVE: To determine whether equivocal prelabor rupture of membranes (PROM) cases are associated with adverse outcomes. METHODS: A retrospective study was conducted in a tertiary medical center between July 2012 and March 2022. The cohort comprised all women diagnosed with term PROM (≥37 gestational weeks), divided into two groups. (1) Certain PROM-suggestive history of a watery vaginal discharge confirmed by visualization of fluid leaking from the cervix or pooling in the vagina on speculum examination. (2) Uncertain PROM-suggestive history of a watery vaginal discharge not supported by speculum examination. All patients were hospitalized and gave birth spontaneously or following either expectant management for up to 24 h from PROM or induction. The primary outcome measure was cesarean delivery (CD) rate. Secondary outcome measures were adverse maternal/neonatal events. RESULTS: Of the 2012 women included in the study, 1750 had certain PROM and 262 uncertain PROM. CD rate was 5.8% in the certain PROM group and 8.8% in the uncertain PROM group; the difference was not statistically significant (P = 0.074). There was a significant between-group difference in the rate of CD due to failed induction on univariate analysis (0.69% vs 2.67%, respectively, P = 0.007), but it was not maintained on multivariate logistic regression (odds ratio 0.37, 95% confidence interval: 0.12-1.17). Other maternal and neonatal outcomes were similar in the two groups. CONCLUSION: Our findings indicate that following the same management guidelines for equivocal cases of ruptured membranes as for confirmed cases of term PROM did not compromise maternal or fetal outcomes.

Steps Toward Decreasing Maternal Alcohol Consumption in Israel: Nationwide Trends During a Decade.

OBJECTIVES: Prenatal alcohol exposure poses a substantial risk to fetal development. Efforts were made in 2011-2020 to increase public awareness of and prevent alcohol consumption during pregnancy. We conducted a cross-sectional survey in Israel of pregnant women's alcohol consumption from January 2021 through June 2023 and compared our results with the results of a survey conducted during 2009-2010 to assess changes over time. METHODS: We conducted cross-sectional surveys at 3 public hospitals in central and northern Israel. Surveyors visited hospitals twice weekly and used a questionnaire consistent with one used in 2009-2010 that focused on alcohol consumption 3 months before pregnancy and during pregnancy. We conducted a stratified analysis of the prevalence of alcohol consumption during pregnancy by demographic characteristics. We also used a multivariable logistic regression model to examine variables associated with receiving guidance on alcohol consumption during pregnancy. RESULTS: Of 1915 women in the 2021-2023 survey (mean [SD] age, 30.8 [5.6] y), 1204 (62.9%) reported never consuming alcohol before pregnancy and 1708 (89.2%) reported no alcohol consumption during pregnancy. During pregnancy, 157 (8.2%) women reported consuming alcohol weekly or less, 12 (0.6%) more frequently, and 52 (2.7%) binge drinking. We found a significant decrease in alcohol consumption during pregnancy in 2021-2023 as compared with 2009-2010 (odds ratio, 0.68; 95% CI, 0.52-0.88; P = .03). Predictors of alcohol consumption during pregnancy included alcohol consumption before pregnancy, parity, and smoking. Significantly more women in the 2021-2023 sample (n = 569; 29.7%) than in the 2009-2010 sample received guidance on alcohol consumption during pregnancy (P < .001). CONCLUSIONS: Educational efforts should continue to increase awareness of the risks of prenatal alcohol exposure in the general population and among health professionals.

Cleavage stage at compaction-a good predictor for IVF outcome.

OBJECTIVE: To analyze whether cleavage stage at compaction, and not only kinetics, can serve as a reliable predictor for clinical outcome. METHODS: A retrospective cohort study including 1194 embryos, classified by compaction initiation stage (Group 1: compaction at fewer than eight cells, Group 2: compaction at eight cells, Group 3: compaction at more than eight cells). Of these, 815 embryos were evaluated for morphokinetic preimplantation parameters, and 379 embryos were analyzed for clinical implantation following thawing and transfer of single blastocysts during the same period. RESULTS: In total, 1194 embryos were analyzed. Embryos that underwent compaction from more than eight cells (Group 3) exhibited more synchronous cleavage compared with Groups 1 and 2 (at both S2 and S3; P < 0.001), and displayed a significantly lower fragmentation rate. The likelihood of obtaining top-quality blastocysts decreased by 73% and 44% when comparing Group 3 embryos with those of Groups 1 and 2, respectively, (P < 0.03). Clinical validation of the results shows that while compaction from fewer than eight cells barely produced blastocysts for transfer, compaction at eight or more cells is crucial for implantation and birth (birth rates 11.1% and 18.5% for Groups 2 and 3, respectively). CONCLUSION: Cleavage stage at compaction has a direct effect on blastocyst quality and subsequent pregnancy, so can be included in newly developed deep learning models for embryo selection.

Flat maternal glucose response curve and adverse pregnancy outcome.

OBJECTIVE: The significance of a flat oral glucose tolerance test (OGTT) response curve in pregnancy remains unclear. We investigated the association of a flat curve with pregnancy outcomes. STUDY DESIGN: Retrospective cohort study. Flat OGTT curve was defined by an area under the curve below the 10th percentile. Pregnancy outcomes were compared between flat and normal curve. RESULTS: Of the 2673 eligible women, 269 had a flat response curve. Compared with the normal-response group, the flat-curve group had a lower mean birthweight (3363 ± 547 g vs. 3459 ± 519 g, p < 0.005), higher probability of small for gestational age (SGA) (19% vs. 12%, p < 0.005, aOR = 1.75, 95% CI 1.24-2.47), and 5-min Apgar score < 7 (1.12% vs. 0.29%, p < 0.05, aOR = 3.95, 95% CI 1.01-15.5). There were no differences in obstetric or maternal outcomes. CONCLUSIONS: Flat OGTT is associated with lower birthweight, higher rates of SGA, and low Apgar scores. Detecting this previously unrecognized risk group, could potentially reduce these complications.

Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study.

PURPOSE: The aim of the study was to ascertain risk factors and outcomes of elective cesarean deliveries performed urgently prior to their scheduled date. METHODS: Women carrying a viable singleton fetus who were scheduled for elective cesarean delivery at a tertiary medical center between 2012-2020 were identified by retrospective database. Differences in maternal and neonatal parameters between those who ultimately required urgent cesarean delivery and those who underwent the procedure as scheduled were analyzed. RESULTS: Of 4403 women who met the inclusion criteria, 559 underwent urgent cesarean delivery before the scheduled date. On multivariate analysis, factors significantly associated with a risk of transformation to an urgent cesarean delivery were chronic hypertension (aOR 1.92, 95% CI 1.30-2.83 P = 0.001), antenatal corticosteroids administration (aOR 3.26, 95% CI 2.38-4.47, P <0.001), and contraindication for vaginal delivery as the reason for elective cesarean delivery (aOR 1.67, 95% CI 1.32-2.12, P <0.001). Neonates born via urgent cesareans had an increased risk of 1-minute Apgar <7 (6% vs. 1.7%, P <0.001), intensive care unit admission (6.6% vs. 2.5%, P <0.001); their mothers were at risk of postpartum hemorrhage (5.9% vs. 3%, P = 0.001). CONCLUSIONS: The present study sheds light on the risk factors and maternal and fetal morbidities associated with elective cesarean deliveries that become urgent before the originally scheduled date. Physicians should take this information into account when planning an optimal date for elective cesarean delivery.

QT Prolongation as an Isolated Long-Term Cardiac Manifestation of Dichlorvos Organophosphate Poisoning in Rats.

Organophosphates (OP) are used extensively as pesticides and as chemical weapons. Cardiotoxicity is a major concern in survivors of the acute poisoning. To characterize the delayed cardiac effects of OP, rats were poisoned by intraperitoneal administration of dichlorvos. In group I, poisoning (0.25-, 0.75-, 1.4-LD50) was followed by application of atropine and obidoxime. In group II, poisoning (0.35-, 0.5-LD50) was done without antidotes. Cardiac evaluation included electrocardiography and echocardiography 2- and 6-week post-exposure, arrhythmia susceptibility following administration of Isoproterenol (150 mcg/kg), and histological evaluation. All poisoned animals displayed cholinergic symptoms. In group I, all animals exposed to 1.4-LD50 (n = 3) had profound convulsions and died despite antidote treatment. However, in the lower doses, all animals survived and no cardiac abnormalities were noted during follow-up. In group II, six animals had convulsions and died. Surviving animals had mild but significant prolongation of corrected QT at both 2 and 6 weeks, compared to shams. There were no notable echocardiographic, gravimetric, or histological differences between poisoned and sham animals. Our data indicate that dichlorvos poisoning is associated with QT prolongation without anatomical or histopathological abnormalities. This new model can be used to elaborate the molecular mechanism\s of QT prolongation following OP poisoning.