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OBJECTIVES: Term oligohydramnios is linked to pregnancy complications. We previously presented the outcome of the low-risk population (no pregnancy complications) with term oligohydramnios. This study aims to address the high-risk group (Any maternal complication during pregnancy, such as gestational diabetes, pre-gestational diabetes, chronic hypertension, preeclampsia, anemia, asthma, obesity, and multi parity.). METHODS: This retrospective cohort study of 1,114 singleton term (≥37), oligohydramnios (AFI <50â¯mm) pregnancies from Shamir Medical Center between 2017 and 2021. Compering the low-risk to high-risk groups with subdivision by severity of oligohydramnios. RESULTS: A total of 211 subjects (19â¯%) were high-risk cases and 903 (81â¯%) low-risk cases. Comparing these two groups, subjects of the high-risk group were older (31.34 ± 5.85 vs. 29.51 vs. 4.96), had earlier gestational age at delivery 39.53 ± 1.18 vs. 40, had higher mean AFI (35 ± 12.7 vs. 33 ± 14.5), were subject to more labor inductions (81 vs. 69.7â¯%), and CS rate (19.9 vs. 12.4â¯%). Logistic regression revealed a need for more cesarean sections in the high-risk group. Additionally, more labor inductions and a higher risk of negative fetal outcomes. CONCLUSIONS: This study highlights the importance of considering pregnancy risk factors when we are approaching oligohydramnios in high-risk pregnancies.
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INTRODUCTION: OpenAI's GPT-4 (artificial intelligence [AI]) is being studied for its use as a medical decision support tool. This research examines its accuracy in refining referrals for fetal echocardiography (FE) to improve early detection and outcomes related to congenital heart defects (CHDs). METHODS: Past FE data referred to our institution were evaluated separately by pediatric cardiologist, gynecologist (human experts [experts]), and AI, according to established guidelines. We compared experts and AI's agreement on referral necessity, with experts addressing discrepancies. RESULTS: Total of 59 FE cases were addressed retrospectively. Cardiologist, gynecologist, and AI recommended performing FE in 47.5%, 49.2%, and 59.0% of cases, respectively. Comparing AI recommendations to experts indicated agreement of around 80.0% with both experts (p < 0.001). Notably, AI suggested more echocardiographies for minor CHD (64.7%) compared to experts (47.1%), and for major CHD, experts recommended performing FE in all cases (100%) while AI recommended in majority of cases (90.9%). Discrepancies between AI and experts are detailed and reviewed. CONCLUSIONS: The evaluation found moderate agreement between AI and experts. Contextual misunderstandings and lack of specialized medical knowledge limit AI, necessitating clinical guideline guidance. Despite shortcomings, AI's referrals comprised 65% of minor CHD cases versus experts 47%, suggesting its potential as a cautious decision aid for clinicians.
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INTRODUCTION: Antibiotic resistance is a worldwide concern. No study has ever examined the correlation between ethnicity and antibiotic resistance. We examined those parameters among hospitalized pregnant patients diagnosed with pyelonephritis. AIMS: Should ethnic origin play a role in optimizing antibiotic therapy? To better comprehend, we have chosen a cohort of hospitalized pregnant patients with a pyelonephritis diagnosis. METHODS: A total of 105 cases of patients hospitalized in the Shamir Medical Center between the years 2017-2020 were analysed. Feto-maternal outcomes and antibiotic resistance in relation to ethnicity were plotted statistically using chi-square tests (Arab, 40%; North Africa, 13%; Europe-Ashkenaz,10%; Ethiopia/Iran/Kavkaz/Iraq/other, 3%; Turkey/Uzbekistan/Yemen 2%). RESULTS: Ethnic groups included Arab (40%), others referred as "None-Arab". The antibiotic resistance panel revealed differences comparing the two largest groups (Arab% VS non-Arab%), whereas there was no correlation between any ethnic group and obstetrics parameter. Arab women were more resistant to ciprofloxacin (33% vs 7%, P= 0.026) and less sensitive to imipenem (60% vs 90.9%, P= 0.03); less sensitive to ceftriaxone and cefuroxime. CONCLUSIONS: There was a correlation between ethnic origin of pregnant patients diagnosed with pyelonephritis and antibiotic resistance. We hope ethnicity, might, in some cases, assist physicians choosing the optimal therapy.
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Etnicidad , Pielonefritis , Femenino , Humanos , Embarazo , Mujeres Embarazadas , Perinatología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Pielonefritis/diagnóstico , Pielonefritis/tratamiento farmacológico , Pielonefritis/microbiologíaRESUMEN
OBJECTIVE: Azathioprine, a prodrug of 6-mercaptopurine (6-MP), is used in the treatment of inflammatory bowel disease and may be continued during pregnancy. Acute cholestatic liver injury has been reported to occur with azathioprine. We aimed to examine azathioprine related cholestasis effect on pregnancy complications and outcome. CASE REPORT: We present a unique case of 6-MP-induced severe intrahepatic cholestasis of pregnancy (ICP) that required meticulous combined therapy including plasma exchange. The symptoms resolved following 6-MP withdrawal. A literature review revealed 11 pregnancies complicated by early-induced severe ICP among women treated with azathioprine or 6-MP. CONCLUSION: We recommend weekly bile acid level tests for pregnant women treated with azathioprine or 6-MP, beginning early in the second trimester of pregnancy, and the prompt discontinuation of treatment upon establishment of an ICP diagnosis.
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Colestasis Intrahepática , Complicaciones del Embarazo , Embarazo , Femenino , Humanos , Azatioprina/efectos adversos , Mercaptopurina/efectos adversos , Colestasis Intrahepática/inducido químicamente , Complicaciones del Embarazo/tratamiento farmacológicoRESUMEN
PURPOSE: The clinical implications of gestational diabetes mellitus (GDM) diagnosed in the third trimester are not well established and controversy continues regarding the performance of diagnostic tests beyond 28-week gestation. This study aimed to evaluate the incidence of abnormal third trimester oral glucose tolerance test (OGTT) results in women at high risk and to compare the obstetric and neonatal outcomes with those of women with normal OGTT results. METHODS: The study included 372 women who completed late (>29 weeks) 100-g OGTT due to suspected fetal macrosomia, polyhydramnios or a personal risk factor for GDM, diagnosed according to the Carpenter & Coustan criteria. Women with only one abnormal OGTT value were diagnosed with GDM by abnormal glucose follow-up and analyzed separately. Obstetric and neonatal outcomes were compared between the GDM and the non-GDM groups. RESULTS: GDM was diagnosed in 85/372 (22%) women, including 35 (59.3%) women with one abnormal OGTT value who were later diagnosed with GDM. Of 200 women who had a normal 1-h 50-g glucose challenge test at 24-28 weeks, late GDM was diagnosed in 33 (16.5%). Seventy-six (89.5%) of those with GDM were treated by dietary therapy and 9 (10.5%) by pharmacological therapy. Among women with GDM, large-for-gestational-age fetuses, labor induction and elective cesarean section were more prevalent than for those without GDM. Significant differences were not found between the groups in macrosomia and neonatal outcomes. CONCLUSIONS: The performance of OGTT in women with risk factors during the third trimester should be considered following further prospective trials.
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Cesárea , Diabetes Gestacional , Recién Nacido , Embarazo , Femenino , Humanos , Masculino , Prueba de Tolerancia a la Glucosa , Tercer Trimestre del Embarazo , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Glucosa , GlucemiaRESUMEN
AIM: We investigated associations of maternal obesity with late gestational diabetes mellitus (GDM) diagnosis (>34 weeks) in women with previous normal glucose screening, and associations of late GDM with obstetrical outcomes. METHODS: This retrospective cohort study assessed obstetrical and neonatal outcomes of 238 women with normal (24-28 week) glucose screening results, who underwent late repeat oral glucose tolerance tests (OGTT) (>34 weeks) due to a suspected LGA fetus (54.6%) or polyhydramnios (45.4%). A sub-analysis was performed of outcomes of women with late versus mid-trimester GDM. RESULTS: The GDM rate in repeat OGTT screening was 22.2% for the total sample, and 33% among women with morbid obesity. Among women with late GDM versus without late GDM, rates were higher for macrosomia, large-for-gestational-age fetus induction of labor, neonatal hypoglycemia, jaundice, and the need for phototherapy. Among women with late GDM, a higher pregestational BMI was associated with adverse maternal and perinatal outcomes. Higher risks for macrosomia and CS due to macrosomia were demonstrated in women with late vs. mid-trimester GDM. CONCLUSION: Late screening in pregnancy may reveal GDM among women with previous normal glucose screening, particularly among those with late third trimester BMI ≥ 35 kg/m2 , GDM in a previous pregnancy or fasting glucose >95 mg/dl. Women diagnosed with GDM at >34 weeks following normal glucose screening at 24-28 weeks are at higher risk for adverse perinatal outcomes. For women with morbid obesity, or suspected macrosomia or polyhydramnios in the late third trimester, and normal glucose screening in the second trimester, retesting should be considered.
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Diabetes Gestacional , Obesidad Mórbida , Polihidramnios , Recién Nacido , Embarazo , Femenino , Humanos , Diabetes Gestacional/diagnóstico , Tercer Trimestre del Embarazo , Macrosomía Fetal , Estudios Retrospectivos , Aumento de Peso , Glucosa , Glucemia/análisis , Resultado del EmbarazoRESUMEN
INTRODUCTION: Preeclampsia (PE) is a major pregnancy complication, posing considerable morbidity and mortality. The maternal serum angiogenic factors - PlGF and sFlt-1, and their ratio appear to be promising markers to predict PE. Aims: To assess whether the evaluation of PlGF and sFlt-1 adds to the clinical workup of women with suspected PE, and to estimate the cost/benefit. METHODS: We prospectively enrolled pregnant women with suspected PE who were admitted to the Maternal-Fetal Medicine Unit (MFM) at Shamir Medical Center. Pregnancy and delivery records were collected from their computerized electronic medical records. PlGF<150pg/ml and sFlt-1/PlGF>38 measured prospectively were used to predict PE. RESULTS: Of 105 women included, 28 were in the control group with unrelated complications and none developed PE. Among 66 women with suspected PE, 27(41%) developed the syndrome, with a positive predictive value (PPV) of 90.3% for PlGF<150 pg/ml and 88.9% for sFlt-1/PlGFabove 38. Out of 11 women with suspected intrauterine growth restriction (IUGR), six developed the syndrome, and among them, the negative predictive value (NPV) was ~ 90%. CONCLUSIONS: Angiogenic factors are reliable in predicting PE near delivery. Of 8355 annual deliveries, 584 were admitted for suspected PE. The annual test cost was NIS 66,576 (NIS 140 per single test). Cost-saving was NIS 2.18 million, the ratio of cost saved vs. test cost was 32.7. DISCUSSION: The angiogenic factors are efficient and cost-saving in PE prediction near delivery. A larger study is necessary to determine the inclusion of angiogenic factors in the workup for suspected PE.
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Preeclampsia , Complicaciones del Embarazo , Embarazo , Femenino , Humanos , Preeclampsia/diagnóstico , Biomarcadores , Análisis Costo-Beneficio , Valor Predictivo de las PruebasRESUMEN
INTRODUCTION: Preterm labor involves about 7.4% of live births in Israel and constitutes over 85% of morbidity and mortality in newborns. Risk factors for preterm labor include a history of preterm delivery shortening of the uterine cervix, cervical procedures, uterine malformations, polyhydramnios, intrauterine growth restriction, preeclampsia, multiple gestations, and more. Progesterone is an essential hormone in the process of fertilization and is involved in the menstrual cycle, implantation and preservation of pregnancy. Due to its various functions in the prevention of preterm labor, the use of progesterone as a preventive treatment has been extensively studied since the second half of the last century and tested in various forms of administration, mainly intramuscular injection and vaginal root. For years, women with a history of preterm labor were treated with intramuscular progesterone once a week between 16 to 36 weeks' gestation or until birth. Recently, vaginal progesterone treatment was initiated in women with cervical length > 25 mm measured by ultrasound between 18-24 weeks gestation. Studies have shown that progesterone treatment reduces the incidence of preterm labor given in the proper indication. This update overview examines progesterone treatment for the prevention of preterm labor.
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Trabajo de Parto Prematuro , Nacimiento Prematuro , Administración Intravaginal , Cuello del Útero , Femenino , Humanos , Recién Nacido , Trabajo de Parto Prematuro/tratamiento farmacológico , Trabajo de Parto Prematuro/prevención & control , Embarazo , Nacimiento Prematuro/prevención & control , ProgesteronaRESUMEN
BACKGROUND AND OBJECTIVE: In nonpregnant patients high insulin requirements are associated with hypoglycemia and weight gain but not with improvement in glucose control. The effect of insulin requirement on maternal and neonatal outcomes in gestational diabetes mellitus (GDM) is yet unknown. METHODS: We conducted a retrospective cohort study of maternal and neonatal outcomes of pregnancy according to insulin requirements in women with GDM who were followed and delivered at the Yitzhak Shamir Medical Center between 2006 and 2016. The daily insulin dose in units per body weight was divided into quartiles and analyses were performed to compare the lowest, highest, and two middle quartiles. The primary outcome was a composite of any of the following: cesarean-section (CS), preeclampsia, macrosomia and large for gestational age (LGA) birth weight, neonatal intensive care unit admission, need for phototherapy, and neonatal hypoglycemia. RESULTS: Women were divided according to their insulin requirements as follows: 79 (24.8%) women who needed <0.13 IU/kg/day of insulin (insulin-sensitive group), 160 (50%) women who needed 0.14-0.42 IU/kg/day of insulin (comparison-group), and the rest who needed >0.43 IU/kg/day of insulin (insulin resistant group). There were no differences in the composite outcome between the groups (64.6, 61.3, and 69.6% for the insulin sensitive-, comparison- and resistant- groups, respectively, p = .44). Women in the insulin-resistant group had higher fasting glucose levels in the first trimester (91, 98 and 102 mg/dL for women in the insulin sensitive-, comparison- and insulin-resistant groups, respectively; p = .01). Women in the insulin-sensitive group had significantly better glycemic control (fasting glucose levels ≤90 mg/dL and 1-hour and 2-hour postprandial glucose levels ≤140 mg/dL and ≤120 mg/dL for more than 80% of measurements) than those in the insulin-resistant group (70.3 versus 29.9%; p < .001). The rate of CS was significantly higher in the insulin-resistant group (42.3 versus 24.1%; p = .03), but the rate of LGA birth weight was surprisingly higher in the insulin-sensitive group (29.5 versus 16.7%, p = .04). After controlling for confounders, women in the insulin-sensitive group had a decreased risk for CS in relation to the comparison group (OR = 0.46, 95%CI 0.23-0.9, p = .025). CONCLUSION: We found no association between insulin requirements and adverse composite outcome in women with GDM. However, those with higher insulin requirements have poorer glucose control and higher rates of CS than those with lower insulin requirements. Larger studies are needed to inquire short- and long-term outcomes of insulin requirements on fetal and maternal outcomes.
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Diabetes Gestacional , Glucemia , Diabetes Gestacional/tratamiento farmacológico , Femenino , Macrosomía Fetal/epidemiología , Macrosomía Fetal/etiología , Prueba de Tolerancia a la Glucosa , Humanos , Recién Nacido , Insulina , Embarazo , Resultado del Embarazo/epidemiología , Estudios RetrospectivosRESUMEN
AIM: To explore the effects of pregestational body mass index (BMI) and gestational weight gain (GWG) on maternal and neonatal outcomes of women with gestational diabetes mellitus (GDM). METHODS: We conducted retrospective cohort analyses of outcomes among women with GDM who delivered at Shamir Medical Center, Israel (2017-2018). RESULTS: We included 673 women with GDM in our analysis, 217 (32.24%) with appropriate GWG (aGWG), 247 (36.7%) with excessive GWG (eGWG), and 209 (31%) with insufficient GWG (iGWG). Cesarean section (CS) was less prevalent among women with iGWG (19.6%), compared with women with eGWG (31.2%) and aGWG (31.1%) (p = .008). Small for gestational weight (SGA) newborns were more prevalent in women with iGWG 9.1%, compared with 2% and 0.9% for women with eGWG and aGWG, respectively (p<.001). Large for gestational age (LGA) newborns were significantly more prevalent in women with eGWG 17.4% compared with 4.8% and 9.7% in patients with iGWG and aGWG women, respectively (p<.001). SGA and LGA newborns were more prevalent in women with iGWG and e-GWG across all pre-gestational BMI groups >18.5 kg/m2. CONCLUSIONS: A complex interplay exists between pregestational weight, GWG, and GDM and pregnancy outcomes, specifically SGA and LGA newborns. A strict follow-up considering the pregestational BMI, GWG, blood glucose levels, treatment modality, and fetal abdominal circumference could assist in managing the complex interplay of patients with GDM for better neonatal outcomes.
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Diabetes Gestacional , Recién Nacido , Humanos , Femenino , Embarazo , Diabetes Gestacional/epidemiología , Índice de Masa Corporal , Estudios Retrospectivos , Cesárea , Edad Gestacional , Aumento de Peso , Resultado del Embarazo/epidemiologíaRESUMEN
OBJECTIVE: In 2011, the Israeli Ministry of Health (MOH) published standard guidelines for the follow-up of pregnant women infected by CMV, recommending that amniocentesis be performed in cases of maternal serum viral seroconversion or abnormal sonographic findings suggestive of CMV, in order to prove fetal infection before electing for pregnancy termination. METHODS: A retrospective cohort study was performed, describing 448 pregnant women from 2006 to 2017. We collected data from all women that elected to continue their pregnancies after seroconversion and also of those who chose to undergo pregnancy termination. Subsequently, a telephone survey was then conducted to record outcomes of the newborns of women with CMV seroconversion during pregnancy. RESULTS: 325 (73%) women chose to continue their pregnancy, while 123 (27%) opted for termination of pregnancy. We found that pregnancy termination due to CMV infection was reduced by 7%, from 72 cases (32%) to 51 cases (25%) after the implementation of the MOH guidelines in 2011. In addition, 182/305 (60%) of women responded to our telephone questionnaire regarding newborn outcomes. Of these women, 45/305 (14%) reported complications, and no correlation was found between the prenatal findings and postnatal outcome among those who have responded to our survey. CONCLUSION: Implementation of the new MOH guidelines has reduced the rate of pregnancy termination, without increasing the rate of neonatal complications in Israel with a similar outcome of complication rate as reported in the literature.
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Infecciones por Citomegalovirus , Complicaciones Infecciosas del Embarazo , Citomegalovirus , Infecciones por Citomegalovirus/epidemiología , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes. STUDY DESIGN: This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019. RESULTS: During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p < 0.0001, respectively). A significantly (p = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups. CONCLUSION: The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel. KEY POINTS: · Less obstetrical ER attendance is observed during the pandemic.. · There is a parallel increase in stillbirth rate.. · Stillbirth cases tested negative for COVID-19.. · Lockdown and pandemic panic are possible causes..
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COVID-19 , Control de Enfermedades Transmisibles , Parto Obstétrico , Obstetricia , Complicaciones del Embarazo , Mortinato/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/psicología , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Diagnóstico Tardío/psicología , Diagnóstico Tardío/estadística & datos numéricos , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Israel/epidemiología , Obstetricia/métodos , Obstetricia/organización & administración , Obstetricia/tendencias , Mortalidad Perinatal , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/epidemiología , Atención Prenatal/métodos , Atención Prenatal/estadística & datos numéricos , Estudios Retrospectivos , SARS-CoV-2RESUMEN
INTRODUCTION: Preeclampsia (PE) is a major obstetric complication affecting 3-5% of pregnancies and a major contributor to fetal and maternal morbidity and mortality. The level of placental growth factor (PLGF) >150pg/ml in the third trimester was reported to predict PE occurrence within the next 14 days. AIMS: We have conducted a preliminary study among pregnant Israeli women in order to evaluate whether maternal serum PLGF test at admission with suspected PE could rule-out the risk for developing PE. METHODS: We prospectively enrolled pregnant women who were admitted to the high-risk pregnancy department at Shamir Medical Center with suspected PE. The women signed an informed consent form and blood samples were drawn, separated into serum, and taken for PLGF immuno-diagnostic test. All women with suspected PE were managed according to local protocol. The medical staff was blinded regarding PLGF results. All patients' computerized medical records, including developing of PE within 14 days and patients' computerized medical records were collected and a telephone interview was held to verify whether post charging events occurred. RESULTS: Of the 29 women who were enrolled in the study, the group with PLGF<150 pg/ml included 19 women, who had mean PLGF=44.7pg/ml [(95%CI: 6.5-95.3], of which 14 developed PE (positive predictive value 73.7%). There were ten women in the PLGF>150pg/ml group, with mean PLGF=528.7 pg/ml [(95% CI:168-1300, P<0.001)] of which one developed PE (negative predictive value 90%). The sensitivity for ruling out PE by PLGF>150pg/ml was 93%, and the specificity=64.3. CONCLUSIONS: Incorporating blood testing of PLGF into the evaluation triage of pregnant women in Israel who admitted to the delivery clinic with suspected development of PE has generated high efficacy and negative predictive value (NPV) as was previously published Our findings are in accordance with results reported elsewhere but need validation in Israel with larger studies. DISCUSSION: Assuming that at least 7% of ~184,450 (2018) live births in Israel are admitted to the high risk departments for evaluating suspected PE, implementing a PLGF test has a cost-benefit ratio of ~1/8.28 with a cost of NIS 2.52M for test performance of all women attending the delivery clinic with suspected PE over saving NIS 21.37M on unnecessary hospital days.
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Factor de Crecimiento Placentario/sangre , Preeclampsia/sangre , Biomarcadores , Femenino , Humanos , Israel , Valor Predictivo de las Pruebas , EmbarazoRESUMEN
OBJECTIVE: In this study we report our experience in the management of Splenic Artery Aneurysm (SAA), diagnosed during pregnancy. STUDY DESIGN: The current manuscript describes three different events, treated in out our department, involving SAAs diagnosed during pregnancy. Each case presents an unusual course and a unique clinical challenge. RESULTS: The first case is of a 25 week's gestation twin pregnancy with ruptured SAA ending in maternal and fetal death. Another case of SAA rupture presented at 27 week's gestation with consequent emergency cesarean section and splenectomy. In the last case, two SAAs were incidentally diagnosed at 25 weeks' singleton gestation. The patient was managed conservatively and delivered by an elective cesarean section at 34 weeks followed by postpartum angiographic embolization of the aneurysms. CONCLUSIONS: Health care providers and especially obstetricians should be aware of the diagnosis of ruptured SAA in a pregnant woman with abdominal discomfort and hemodynamic deterioration. In addition, once an asymptomatic pregnant patient is diagnosed with a SAA, conservative surveillance may be allowed.
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Aneurisma/terapia , Embolización Terapéutica , Complicaciones Cardiovasculares del Embarazo/terapia , Esplenectomía , Arteria Esplénica/cirugía , Aneurisma/cirugía , Resultado Fatal , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/cirugíaRESUMEN
OBJECTIVE: To compare the prevalence of postpartum retained products of conception (RPOC) among parturients with a history of third stage of labor placental complications and parturients without those complications. STUDY DESIGN: All women operated for postpartum RPOC following vaginal delivery by hysteroscopy or suction curettage between January 2013 and December 2017 were included in the study. Their medical records were reviewed for the occurrence of third stage of labor placental complications (including early postpartum hemorrhage treated with uterotonics, manual separation of the placenta, and revision of the uterine cavity for removal of cotyledons). RESULTS: The study cohort included 172 women operated for postpartum RPOC following vaginal delivery by operative hysteroscopy (143 cases, 83.1%) or by suction curettage (29 cases, 16.9%). Third stage of labor placental complications were reported in 65 (37.8%) cases, while 107 (62.2%) women had an uncomplicated third stage of labor. When considering all vaginal deliveries in our institution during the study period, the risk for RPOC was significantly higher among parturients with third stage of labor placental complications compared to those with an uneventful third stage of labor (3.7% versus 0.3%, p < 0.001, Odds ratio = 12.5, 95% confidence interval 9.0-17.3). CONCLUSION: Postpartum RPOC following vaginal delivery were more common in parturients with third stage of labor placental complications. However, the majority of postpartum RPOC cases were diagnosed in women reported to have an uncomplicated third stage of labor. Thus, focused postpartum ultrasound follow-up of women considered at risk for RPOC will not identify all cases.
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Parto Obstétrico/estadística & datos numéricos , Tercer Periodo del Trabajo de Parto , Complicaciones del Trabajo de Parto/patología , Retención de la Placenta/etiología , Adulto , Parto Obstétrico/métodos , Femenino , Humanos , Histeroscopía/estadística & datos numéricos , Complicaciones del Trabajo de Parto/etiología , Retención de la Placenta/epidemiología , Retención de la Placenta/cirugía , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Legrado por Aspiración/estadística & datos numéricos , Adulto JovenRESUMEN
This is a retrospective cohort study of women with GDM treated with glucose-lowering agents that were followed and gave birth between 2005 and 2015 in the Assaf Harofeh medical center, Israel. Classification and regression tree method identified four groups according to adverse outcomes, consisted of 74 women with pre-gestational BMI below 25, 98 women with BMI 25-31, 90 women 31-39 and 18 women above 39. Respectively, median GWG was 12 kg (8-16), 11 kg (8-15), 7.5 kg (3.75-11) and 5 kg (-1.5 to 11.5) (p < .001). The risk for composite adverse outcomes was higher in the groups of BMI 25-31 (73.5%) and 31-39 (83.3%) in comparison to BMI <25 (51.4%) and 39 < (55.6%), p < .001. In women with pre-gestational BMI of <25, GWG of more than the median resulted in odds ratio of 2.75 (1.07-7.08, p = .036) for adverse pregnancy outcomes compared with participants who gained less than the median. Maternal obesity is related to adverse pregnancy outcomes. Women with GDM with normal pre-gestational BMI who gained weight according to IOM recommendations still experienced adverse outcomes.
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Diabetes Gestacional/fisiopatología , Ganancia de Peso Gestacional , Resultado del Embarazo , Adulto , Peso Corporal , Femenino , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
[This corrects the article DOI: 10.1371/journal.pone.0197196.].
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BACKGROUND: Current knowledge regarding chronic use of psychotropic medications during breastfeeding is limited. The objective of this study was to evaluate the long-term effects of psychotropic monotherapy use during lactation on the breastfed infant. MATERIALS AND METHODS: In this prospective study, we followed 280 infants whose mothers contacted the Drug Consultation Center (DCC) at Assaf Harofeh Medical Center between January 2011 and December 2015, seeking information regarding the chronic use of psychotropic medications during lactation. This group was compared with a group of 152 callers, who inquired evidence regarding the use of antibiotics compatible with breastfeeding. Information on adverse effects, physical measures and gross motor developmental milestone achievements of the breastfed infants was obtained during a follow-up telephone interview. At follow up, the median age of the infants in the Psychotropic-drug group was 20 (11-33) months versus 36 (20-48) months in the Antibiotic group (p < 0.001). The outcomes were compared between the groups followed by a propensity score matching to control for difference in baseline characteristics. RESULTS: At follow-up, no significant differences between infants in the two groups were observed with regard to height, weight, head circumference and weight-length ratio percentile (p = 0.339, p = 0.223, p = 0.738, p = 0.926, respectively). Children in both groups were, according to their parents, within the normal developmental range for all milestones, according to the Denver Developmental Scale. Use of psychotropic medications during breastfeeding was not significantly associated with adverse reactions. After propensity score matching (n = 120 pairs) to control for differences in baseline characteristics and the length of lactation, only one significant difference was reported, sleepiness in infants in the study group (7/120) and none in the comparison group (p = 0.008). CONCLUSIONS: Chronic use of psychotropic monotherapy during lactation is associated with normal growth and gross motor developmental as by milestone achievements reported by parents. Sleepiness was reported, it seemed self-limited with no developmental effect.
Asunto(s)
Antidepresivos/efectos adversos , Desarrollo Infantil/efectos de los fármacos , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Adulto , Antidepresivos/uso terapéutico , Lactancia Materna , Depresión/tratamiento farmacológico , Femenino , Humanos , Lactante , Lactancia/efectos de los fármacos , Análisis Multivariante , Estudios Prospectivos , Medición de Riesgo , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéuticoRESUMEN
OBJECTIVES: To study the current practices in the management of subclinical hypothyroidism (SCH) and thyroid nodules during pregnancy of obstetricians/gynecologists (OB/GYNs) and endocrinologists in Israel. METHODS: An electronic questionnaire was sent by email to all members of the Israeli Endocrine Society and the Israel Society of Obstetrics and Gynecology. Questionnaires included demographic data and clinical scenarios with questions regarding the screening and management of pregnant women with SCH, hypothyroxinemia, and a palpable thyroid nodule. The questionnaire for OB/GYNs was slightly modified. RESULTS: We received 90 responses from endocrinologists and 42 responses from OB/GYNs. Among endocrinologists, 39% would repeat a thyroid-stimulating hormone (TSH) test of 2.9 mU/L with normal free thyroxine and treat with thyroxine if the second result was above 2.5 mU/L. Among OB/GYNs, 73% would manage a woman with SCH at the beginning of her pregnancy by themselves and only 22% would start thyroxine after a first TSH result above 2.5 mU/L. Concerning screening, 57% endocrinologists and 71% OB/GYNs recommended screening for thyroid dysfunction in every woman at the beginning of her pregnancy. Among endocrinologists, 54% would order an ultrasound for a palpable thyroid nodule and perform a fine needle aspiration only for suspicious lesions. CONCLUSIONS: The medical approach to thyroid disease in pregnant women remains a matter of controversy. Our results support the need for larger and prospective clinical studies.