Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?

OBJECTIVE: To describe the feasibility of hysteroscopy-assisted suction curettage for early pregnancy loss and to investigate whether it reduces the rates of retained products of conception (RPOC) and intrauterine adhesions (IUA). DESIGN: Prospective single-arm cohort study. SETTING: University-affiliated Department of Obstetrics and Gynecology. PATIENTS: Women admitted for surgical evacuation of early pregnancy loss were invited to participate in the study. INTERVENTION: Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, a diagnostic hysteroscopy was performed to identify the pregnancy's implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and then diagnostic hysteroscopy to verify complete uterine cavity emptying. Postoperative IUA were evaluated by follow-up office hysteroscopy. MAIN OUTCOME MEASURE: Identification of the pregnancy's implantation wall on hysteroscopy, and intra-, and postoperative complications associated with the procedure. The evaluation of postoperative IUA was limited due to the COVID-19 pandemic-related restrictions on elective procedures. RESULTS: Forty patients were included in the study group. Their mean age was 34.0 ± 6.6 years, and their mean gestational age was 8.9 ± 1.6 weeks. The implantation wall was clearly visualized on hysteroscopy in 33 out of 40 cases (82.5%). The mean operative time was 17.2 ± 8.8 min, and no intraoperative complications occurred. Suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed in 4 cases, and the histologic examination confirmed the presence of RPOC in three of them. Follow-up office hysteroscopy was performed in nine women: mild IUA was diagnosed in one case and a normal cavity was confirmed in eight cases. A new pregnancy was reported at the time of follow-up in 15 cases, while 12 women declined to attend the follow-up hysteroscopy and four were lost to follow-up. CONCLUSIONS: Hysteroscopy-assisted suction curettage for early pregnancy loss is a safe, short, and inexpensive procedure, which allows the identification of the pregnancy's wall in most cases and may reduce the rates of RPOC.

Abnormal Uterine Bleeding Among COVID-19 Vaccinated and Recovered Women: a National Survey.

The objective of this research was to characterize menstrual changes including amount, duration, and frequency among COVID-19 vaccinated and infected women. We conducted an online nationwide questionnaire survey on premenopausal, non-pregnant women over 18 years of age in Israel, querying about any changes in their menstrual patterns after COVID-19 vaccination or infection. In total, 10,319 women responded, of which 7904 met the inclusion criteria. Changes in menstrual patterns following COVID-19 vaccination or infection were reported in 3689/7476 (49.3%) women compared with 202/428 (47.2%) women, respectively, (P = .387). The most commonly described menstrual disturbance was excessive bleeding (heavy, prolonged, or intermenstrual) in both the vaccinated and infected groups, (80.6% versus 81.4%, respectively, P = .720). Among women who experienced abnormal uterine bleeding (AUB), in most cases (61.1%), it occurred between the vaccination and the ensuing menstrual period. Menstrual disturbances were similar in type among the vaccinated and infected women. In conclusion, AUB emerged as a side effect of the BNT162b2 vaccine and a symptom of the COVID-19 infection and was characterized mainly by excessive bleeding. Although the precise incidence could not be determined in this study, the type of bleeding disorder as well as the characterization of risk factors including increasing age and a baseline menstrual pattern of prolonged, frequent, and heavy menses are well defined. The incidence and the long-term consequences of the BNT162b2 vaccine on uterine bleeding warrant further investigation.

Ruptured ectopic pregnancies following methotrexate treatment: clinical course and predictors for improving patient counseling.

To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. We performed a retrospective cohort analysis in a tertiary university-affiliated medical center. Medical records of 401 women who were diagnosed with ectopic pregnancy and were treated with MTX between January 2001 and June 2017 were reviewed. Forty-one women were diagnosed with ruptured ectopic pregnancy (study group) and 360 women with non-ruptured ectopic pregnancy (control group). Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment were reviewed. Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6 days (1-25). ß-hCG percentage change in the 48 h preceding MTX treatment and ß-hCG level at day 0 were independent predictors for tubal rupture (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04-1.12, p < 0.001 for every percent change in ß-hCG; OR = 1.001, 95% CI = 1.0003-1.002 for every unit change in ß-hCG, respectively). In a decision tree analysis model, in women with ß-hCG percentage increment >69% in the 48 h preceding methotrexate the probability for tubal rupture was 85%. Risk assessment for tubal rupture should be made before methotrexate treatment according to ß-hCG dynamics and level. The absolute risk for tubal rupture in women with ß-hCG increment<20% is low.

Clinical Presentation of Paraovarian Cysts.

BACKGROUND: A paraovarian cyst (POC) is located between the ovary and the fallopian tube. In many cases POCs are diagnosed and managed as ovarian cysts. But since POC are a distinct entity in their clinical presentation and surgical intervention, they should be better defined. OBJECTIVES: To describe the clinical perioperative and operative characteristics of patients with POCs in order to improve pre-operative diagnosis and management. METHODS: A retrospective cohort study of patients with an operative diagnosis of POC between 2007 and 2019 in a single university-affiliated tertiary care medical center was included. Demographic characteristics as well as symptoms, sonographic appearance, surgery findings, and histology results were retrieved from electronic medical records. RESULTS: During the study period 114 patients were surgically diagnosed with POC, 57.9% were in their reproductive years and 24.6% were adolescents. Most presented with abdominal pain (77.2%). Preoperative sonographic exams accurately diagnosed POC in only 44.7% of cases, and 50.9% underwent surgery due to suspected torsion, which was surgically confirmed in 70.7% of cases. Among women with confirmed torsion, 28.9% involved the fallopian tube without involvement of the ipsilateral ovary. Histology results showed benign cysts in all cases, except two, with a pathological diagnosis of serous borderline tumor. CONCLUSIONS: POC should always be part of the differential diagnosis of women presenting with lower abdominal pain and sonographic evidence of adnexal cysts. If POC is suspected there should be a high level of suspicion for adnexal torsion and low threshold for surgical intervention, especially in adolescent, population who are prone to torsion.

Torsion of Functional Adnexal Cysts in Pregnancy: Aspiration and Drainage are Important in Preventing Recurrence.

BACKGROUND: Adnexal torsion in pregnancy is often associated with functional adnexal cysts, especially in pregnancies conceived by ovulation induction (OI) or in-vitro fertilization (IVF). During laparoscopy for adnexal de-torsion, drainage of the functional cysts can be attempted, although this procedure may cause bleeding. OBJECTIVES: To investigate the characteristics of ovarian torsion in pregnancy associated with functional cysts and to compare the rate of torsion recurrence following de-torsion alone versus cyst drainage. METHODS: All cases of surgically diagnosed adnexal torsion occurring during pregnancy between January 2007 and April 2019 in our department were retrospectively analyzed. The cases of torsion associated with presumed functional ovarian cysts were selected. The rate of recurrent torsion during the same pregnancy was compared for de-torsion alone versus de-torsion and cyst aspiration. RESULTS: Of the 113 women who experienced adnexal torsion during pregnancy, 71 (67.0%) of torsion cases were caused by presumed functional ovarian cysts. Among women with torsion of functional ovarian cysts, the rate of torsion recurrence was significantly higher in patients who underwent de-torsion alone (n=28) compared to women who underwent aspiration and drainage of the ovarian cysts (n=43) (14.3% vs. 0, P = 0.021). There were no cases of intra- or post-operative bleeding in the study cohort. CONCLUSIONS: Functional ovarian cysts are the most common adnexal pathology encountered in pregnant women with torsion. Intra-operative cyst aspiration and drainage may reduce the risk of recurrent torsion. Further multi-center studies are required to validate our data prospectively.

Adnexal torsion with paraovarian cysts in pediatric and adolescent populations: A retrospective study.

BACKGROUND: Determination of the clinical characteristics associated with adnexal torsion involving paraovarian cysts in pediatric and adolescent populations. METHODS: Retrospective review of all cases of paraovarian cysts operated on in our department between 2007 and 2019. Demographic characteristics, clinical and sonographic findings were reviewed. RESULTS: The cohort was composed of 39 pediatric and adolescent patients with an operative diagnosis of adnexal masses located in the paraovarian area. The patients were classified into two groups: 19 girls (48.7%) with a confirmed operative diagnosis of adnexal torsion and 20 girls (51.3%) without torsion. The preoperative diagnosis of adnexal torsion was correct in ≈70% of the cases. The mean BMI were similar in both groups. The preoperative sonographic detection rate of paraovarian cysts was also similar (11/19 [57.9%] vs. 14/20 [70.0%]; P = 0.514). The mean cyst diameter did not differ between groups, nor did the classification into cyst size groups (≤50 mm, 51-99 mm and ≥100 mm). CONCLUSION: Adnexal torsion is a common complication diagnosed in girls undergoing surgery for paraovarian cysts, and is not associated with sonographic appearance or cyst diameter. In order to prevent torsion, surgical removal of paraovarian cysts should thus be considered in young girls undergoing surgery for paraovarian cysts. TYPE OF STUDY: Retrospective case series. LEVEL OF EVIDENCE: IV.

Conception rates after medical versus surgical evacuation of early miscarriage.

OBJECTIVE: To compare short-term fertility rates after medical and surgical management of early miscarriage. DESIGN: Observational cohort study. SETTING: Academic tertiary-care medical center. PATIENT(S): A total of 203 patients were enrolled between June 2017 and May 2018, comprising 106 surgical evacuations and 97 medical evacuations. INTERVENTION(S): Either surgical or medical evacuation of the uterine cavity. MAIN OUTCOME MEASURE(S): Conception rates 6 months after miscarriage. RESULT(S): Conception rates 6 months after miscarriage among women who had attempted to become pregnant were similar between the medically and surgically evacuated groups (68.0% vs. 65.1%). There were no significant differences in background characteristics between the groups, apart from younger age and earlier gestational age among the medically treated group. There was no difference in the proportion of women using assisted reproductive technologies between the medically and surgically managed groups (15.5% vs. 12.6%, respectively). The median time-to-conception was 4 ± 2 months in both groups. Cumulative pregnancy rate 12 months after pregnancy loss, live birth rate, and repeat miscarriage rate also were similar between groups. CONCLUSION(S): Modality of uterine evacuation after early miscarriage does not affect short-term fertility outcomes.

Obstetrical outcomes following laparoscopy during pregnancy: a retrospective case-control study.

PURPOSE: To evaluate pregnancy outcome of patients who undergo laparoscopy during pregnancy. METHODS: A retrospective case-control study, conducted in a single university-affiliated tertiary care medical center, comparing pregnancy outcomes of women who underwent laparoscopy during pregnancy to women without operations during pregnancy. The study group (n = 232) included all pregnant women who underwent a single laparoscopic surgery during pregnancy (4-28 weeks of gestation) which culminated in delivery between 2006 and 2017; this study group was matched to a control group (n = 463) without surgical intervention during pregnancy, in a 2:1 ratio by maternal age, parity, and multiple gestation. RESULTS: The main pregnancy outcomes included preterm birth, cesarean section, small for gestational age (≤ 10 percentile), and Apgar score of less than 7 in 5 min. Laparoscopy during pregnancy was associated with an increased risk for cesarean section (32.3% vs. 24.6%, adjusted OR = 1.9, CI 1.2-3.1, p = 0.011). We found no difference between the groups with regard to other outcomes, including rates of preterm birth (12.1% vs. 10.4%, adjusted OR = 1.3, CI 0.64-2.72, p = 0.451). In a subgroup analysis of the study group, various perioperative parameters such as operation duration, hospitalization length, and others, did not correlate with adverse pregnancy outcome. CONCLUSIONS: Laparoscopy during pregnancy may be associated with an increased rate of cesarean section. We did not find an increase in any other pregnancy or neonatal complication. Different perioperative parameters did not appear to predict adverse pregnancy outcome.

Is Hysteroscopy the Best Surgical Approach for Removal of Retained Products of Conception Following Surgical Termination of Pregnancy?

OBJECTIVE: To investigate the rates of intrauterine adhesion following hysteroscopy for removal of RPOC associated with surgical termination of pregnancy. METHODS: We conducted a retrospective cohort study of all cases of removal by hysteroscopy of RPOC associated with surgical termination of pregnancy carried out at the Yitzhak Shamir (Assaf Harofe) Medical Center from January 2013 to December 2018. The rates of postoperative intrauterine adhesion were assessed by follow-up hysteroscopy. RESULTS: Our study involved 85 cases of removal by hysteroscopy of RPOC associated with surgical termination of pregnancy. The mean size of the RPOC was 1.9 ± 0.9 cm, and the mean time from termination of pregnancy to hysteroscopy was 1.5 ± 0.9 months. Two patients (2.4%) were readmitted for postoperative complications (fever). Postoperative follow-up information was available for 49 cases (57.6%). A total of 47 of these women had a normal uterine cavity (95.9%) while 2 women (4.1%) were diagnosed with mild intrauterine adhesions. CONCLUSIONS: Hysteroscopy for removal of RPOC following surgical termination of pregnancy is associated with low rates of postoperative intrauterine adhesions. Additional studies may determine whether this is the procedure of choice in these cases.

Prevalence and risk factors for urinary tract infection up to one year following midurethral sling incontinence surgery.

OBJECTIVE: To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel. METHODS: A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed. RESULTS: During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively). CONCLUSIONS: Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI.

Pregnancy outcomes in women with endometriosis.

BACKGROUND: The aim of this study was to investigate whether patients with endometriosis who achieved pregnancy have a higher risk for pregnancy complications and adverse perinatal outcomes as compared to patients without endometriosis. METHODS: The study compared obstetrical and perinatal outcomes of women with and without endometriosis who delivered between 1988-2013 at the Soroka University Medical Center. The study population included 504 deliveries divided into the following groups: 1) women with endometriosis (N.=35); and 2) without endometriosis (N.=467). Endometriosis was diagnosed by laparoscopy or laparotomy. Multiple logistic regression models were used to control for confounders. RESULTS: No significant increase in obstetrical complications was noted in the endometriosis group, but significantly higher rates of cesarean sections. Perinatal outcomes were comparable between the groups. CONCLUSIONS: In our population, endometriosis was not found as a risk factor for obstetrical complications or adverse perinatal outcomes. Larger population based cohort studies are needed to clarify the relationship between endometriosis and adverse pregnancy outcomes.

Current strategies in the diagnosis of endometrial cancer.

PURPOSE: Endometrial cancer is the most common gynecological malignancy in developed countries. There are no uniform recommendations for endometrial cancer screening in the general population. Therefore, it is of paramount importance that the primary physician profoundly understands, and is familiar with the methods for prevention and early detection of endometrial cancer. The aim of this review is to provide the primary physician with a toolbox to reach these goals. METHODS: We performed a systemic review to summarize the current strategies to diagnose and prevent endometrial cancer. Many published articles from the last years were identified and included. RESULTS: A systematic review that summarizes the important subjects in the diagnosis and prevention of endometrial cancer. CONCLUSION: Maintaining a high index of suspicion and obtaining endometrial biopsies from all suspected patients is the key for achieving a timely diagnosis.

Calcium level during the first trimester of pregnancy as a predictor of preeclampsia.

OBJECTIVE: To examine the association between calcium levels during the first trimester of pregnancy and preeclampsia. METHODS: The study population included registered births (n = 5233) in a tertiary medical center between 2001 and 2011. A comparison was performed between women with and without hypocalcemia during the first trimester of pregnancy. A second analysis was performed after correcting calcium levels for albumin. Multiple logistic regression models were used to control for confounders. Receiver operating characteristic curve analysis graphs were used to describe the relationship between the true-positive rate (sensitivity) and the false-positive rate for different values of calcium during the first half of pregnancy in the prediction of preeclampsia. RESULTS: Of 5233 deliveries, 841 (16%) had hypocalcemia and 4392 (84%) had a normal calcium level. No significant difference were found between the groups regarding mild preeclampsia [odds ratio (OR) = 1.216; 95% confidence interval (CI) 0.831-1.779; p = 0.312], severe preeclampsia (OR = 1.618; 95% CI 0.919-2.849; p = 0.092) and any hypertensive disorders (OR = 1.324; 95% CI 0.963-1.821; p = 0.083). CONCLUSIONS: Hypocalcemia during the first trimester of pregnancy is not a risk factor for preeclampsia.

Saturated fatty acid composition of human milk in Israel: a comparison between Jewish and Bedouin women.

BACKGROUND: Breast milk is well established as the ideal source of nutrition for infants. Mature human breast milk generally contains 3.5-4.5% lipids comprising mostly triacylglycerols. In general, the fat composition of maternal human milk in developing countries shows higher levels of saturated fats, reflecting diets rich in carbohydrates. OBJECTIVES: To determine the profile of unsaturated fatty acids in the breast milk of two populations in southern Israel--urban Jewish and rural tent-dwelling Bedouin women. METHODS: This study involved 48 lactating Israeli mothers, 29 Jewish and 19 Bedouin (16-20 weeks postpartum), whose full-term infants were fed exclusively with breast milk. Total milk lipid extracts were transmethylated and analyzed by using an improved gas chromatographic method. RESULTS: The breast milk of the Bedouin women contained significantly higher levels of total major saturated fatty acids, lauric acid and palmitic acid (45.2 +/- 4.7% vs. 41.0 +/- 5.6%, P = 0.005; 5.2 +/- 2.1 vs. 6.8 +/- 2.0%, P = 0.03; and 22.7 +/- 2.4 vs. 20.6 +/- 3.8%, P = 0.02) respectively. No difference was found in the myristic acid level between the groups. The level of stearic acid was significantly higher in the Jewish group compared to the Bedouin group (5.7 +/- 1.1 vs. 5.1 +/- 1.1%, P = 0.04). There was a linear correlation between the levels of C14:0 and C12:0 in the Bedouin and lewish groups respectively (R = 0.87, R = 0.82, P < 0.001). CONCLUSIONS: Higher levels of saturated fatty acids were measured in the breast milk of Bedouin women, an economically weaker population. The results emphasize the importance of diet among lactating women and its influence on milk quality.

Is there an association between platelet count during the first trimester and preeclampsia or other obstetric complications later in pregnancy?

OBJECTIVE: To examine whether an association exists between platelet (PLT) count in the first trimester of pregnancy and the risk for hypertensive disorders or other obstetric complications. METHODS: The study population included all registered births with available PLT count from the first trimester of pregnancy during 2000-2010. Thrombocytopenia was defined as PLT count below 100,000/µL. A comparison was performed between women with and without thrombocytopenia. Multiple logistic regression models were used to control for confounders. RESULTS: The study population included 33,890 deliveries; of these, 119 (0.35%) were with thrombocytopenia. Women with thrombocytopenia had significantly higher rates of preterm delivery (16.0% vs. 9.4%; p = 0.015). There was no significant difference between the groups regarding hypertensive disorders. CONCLUSIONS: Hypertensive disorders cannot be predicted based on PLT count during the first trimester of pregnancy. Nevertheless, thrombocytopenia during the first trimester is a risk factor for preterm delivery.

Can leukocyte count during the first trimester of pregnancy predict later gestational complications?

PURPOSE: To examine whether an association exists between maternal leukocyte count in the first trimester of pregnancy and the risk for development of obstetric complications. METHODS: The study population included all the registered births (n = 33,866) with available white blood cell count (WBC) from the first trimester of pregnancy, during 2000-2010 in a tertiary medical center. The leukocyte count was sorted by the following groups: WBC < 3.5 10 × 9/l, WBC = 3.5 10 × 9/l-13.8 10 × 9/l, and WBC > 13.8 10 × 9/l. These groups were compared regarding obstetrical characteristics and perinatal outcomes. Multiple logistic regression models were used to control for confounders. RESULTS: The study population included 33,866 deliveries, of these 0.94 % had leukocytosis WBC > 13.8 10 × 9/l. Women with leukocytosis delivered significantly earlier, were more likely to be Jewish, and in their first pregnancy. There were significantly higher rates of preterm delivery before 37 weeks, fertility treatments, hypertensive disorders, gestational diabetes mellitus, and cesarean section among these patients. There was no significant difference between the groups regarding preterm premature rupture of membranes (PPROM) and chorioamnionitis. Women with leukocytosis during the first trimester had significantly higher rates of fetuses who were small for gestational age and with birth weight <2,500 g. Multivariable analysis showed a significant association between preterm delivery before 37 weeks and leukocytosis during the first trimester of pregnancy (p = 0.003). CONCLUSIONS: Leukocytosis during the first trimester is significantly associated with an increased risk for obstetrical complications, in particular preterm delivery. Nevertheless, further studies should focus on women with leukocytosis during the first trimester in order to verify our results.

Can anemia in the first trimester predict obstetrical complications later in pregnancy?

OBJECTIVE: The present study examines whether there is an association between anemia during the first trimester and the risk to develop preterm delivery (PTD), intrauterine growth restriction, and other obstetrical complications. METHODS: The study population included all registered births between 2000 and 2010. Anemia was defined as hemoglobin <10 g/dl. A comparison of obstetrical characteristics and perinatal outcomes was performed between women with and without anemia. Multiple logistic regression models were used to control for confounders. RESULTS: The study population included 33,888 deliveries, of these 5.1% (1718) were with anemia during the first trimester. Women with anemia were significantly older, delivered earlier, and were more likely to be grand multiparous. There were significantly higher rates of PTD and low birth weight (LBW; <2500 g) among patients with anemia (12.3% vs. 9.3%; p < 0.001 and 11.7% vs. 9.0%; p < 0.001, respectively). On the contrary, no significant differences between the groups were noted regarding the rate of intrauterine growth restriction. Using a multivariable analysis, the significant association between anemia and PTD persisted (OR = 1.35; 95% CI 1.2-1.6, p < 0.01). CONCLUSIONS: Anemia during the first trimester is significantly and independently associated with an increased risk for subsequent PTD.

[Birth and pregnancy outcomes of drug addicted women].

INTRODUCTION: Illegal drug abuse causes significant health problems with consequences to the mother and the neonate, and an economic burden to the health system. OBJECTIVES: The present study aimed to investigate pregnancy and perinatal outcome in women using illegal drugs prior to and during pregnancy. METHODS: A retrospective cohort study comparing pregnancy and neonatal outcomes of drug addicted women to the outcomes of other Jewish women. The study population includes all women who gave birth between the years 1989-2008 at the Soroka University Medical Center. RESULTS: From a total of 106,000 deliveries, 119 women were known to be drug addicted. No significant differences were found between the groups regarding maternal age and origin, but more women in the addicted group smoked, and tacked prenatal care. More women in the addicted group had obstetrics complications such as: recurrent abortions, placenta previa, pLacental abruption and preterm labor. Illegal drug abuse was significantly associated with adverse perinatal outcomes such as low birth weight, congenital anomalies, peripartum death and prolonged hospitalizations. CONCLUSIONS: Illegal drug abuse is an independent risk factor for adverse obstetric and perinatal outcomes. DISCUSSION: This study investigated a significant problem that may be underestimated in our population. The higher incidence of pLacental abruption, placenta previa, preterm tabor and low birth weight could be a sign for placentaL insult. SUMMARY: Illegal drug abuse is an independent risk factor for adverse perinatal outcomes and causes an economic burden. Further national studies are needed to characterize the problem, and to develop appropriate intervention programs.

[Pregnancy after bariatric surgery].

BACKGROUND: Recent research has put the spotlight on two different aspects of pregnancy after bariatric surgery: safety of the mother and fetus, and the procedure's effectiveness in preventing the complications surrounding reproduction and pregnancy often seen in the obese woman. OBJECTIVE: To evaluate the pregnancy outcome foLlowing bariatric surgery. RESULTS: Although there are severaL reports documenting poor perinatal outcomes and late surgical complications during pregnancies subsequent to bariatric surgery, systematic studies have generaLLy not proven such an association. CONCLUSIONS: Pregnancy after bariatric surgery appears to be safe, and in general perinatal outcome is better when compared to pregnancies of obese women. Providers should be familiar with potential complications related to postoperative pregnancies and be prepared to provide appropriate interventions such as nutritional supplementation and band adjustment when necessary.

"At fingers' ends": risk factors and perinatal outcome of pregnancies complicated by digital malformations.

OBJECTIVE: To identify the incidence, risk factors, and perinatal outcome of newborns with congenital finger or toe (digital) anomalies. METHOD: A retrospective study including all neonates born at a tertiary medical center during 2001-2006 with congenital digital anomalies was conducted. The comparison group consisted of newborns without such anomalies born during the same period. RESULTS: Of 115,876 newborns delivered during the study period, 360 (31 per 10,000) were diagnosed with digital anomalies. Polydactyly was the most common diagnosis (n = 263; 73% of digital anomalies). Associated anomalies in these patients were congenital heart malformations (n = 93; 25.8% of the newborns with congenital digital anomalies), central nervous system anomalies (n = 17; 4.7%), and musculoskeletal anomalies (n = 13; 3.6%). Newborns with congenital digital anomalies were more likely to be males (62.2 vs. 37.8%; P < 0.001), and of a Bedouin Arab descent compared to Jewish ethnicity (61.4 vs. 38.6%; P = 0.004). Significantly higher rates of severe pre-eclampsia, recurrent abortions, transverse lie, and low birth-weight (<2,500 g) infants were found among newborns with digital anomalies. CONCLUSIONS: The incidence of digital anomalies can vary according to the population characteristics. It may be associated with other skeletal and non-skeletal malformations as well as with certain adverse obstetrical and perinatal outcomes. If a fetal digit anomaly is suspected, a detailed assessment of fetal anatomy is mandatory to exclude other malformations.