Placental Histopathological Lesions and Adverse Neonatal Outcomes in Patients with Inflammatory Bowel Diseases- A retrospective Cohort Study.

Inflammatory bowel diseases (IBD) are significantly associated with adverse pregnancy and neonatal outcomes, though the pathomechanism is yet unknown. To investigate the relationship between IBD and adverse pregnancy outcomes by comparing neonatal outcomes and placental histopathology in two matched groups of patients with and without IBD. In this retrospective study, data of all patients who gave birth between 2008-2021 and were diagnosed with IBD were reviewed and compared to a control group matching two control cases for every IBD case. Neonatal outcomes and placental pathology were compared between the groups. Compared to the control group (n=76), the placentas of patients with IBD (n=36) were characterized by significantly lower placental weight (p < 0.001), and higher rates of maternal vascular malperfusion lesions (MVM, p < 0.001) and maternal and fetal inflammatory response lesions (p < 0.001). Neonates of patients with IBD were more frequently small for gestational age (SGA) (p=0.01), with increased rates of need for phototherapy (p = 0.03), respiratory morbidity and NICU admission (p < 0.001 for both outcomes). Multivariate logistic regression analyses adjusting for possible confounders (including maternal age, gestational age, chronic hypertension, smoking, and thrombophilia) confirmed the independent association between IBD and composite MVM lesions (aOR 4.31, p < 0.001), maternal inflammatory responses (aOR 40.22, p < 0.001) and SGA infants (aOR 4.31, p = 0.013). IBD is associated with increased rates of placental histopathological lesions and adverse pregnancy outcomes, including SGA infants. These novel findings imply the role of placental malperfusion and inflammatory processes in pregnancy complications of IBD patients, which should be followed accordingly. Approval of local ethics committee # WOMC-0219-20.

Improved neonatal outcomes in pregnancies with coexisting gestational diabetes and preeclampsia in normal birthweight neonates- insights from a retrospective cohort study.

INTRODUCTION: We aimed to assess neonatal and maternal outcomes in appropriate-for-gestational-weight (AGA) neonates of mothers with both gestational diabetes mellitus (GDM) and preeclampsia (PET). METHODS: Medical records of women diagnosed with GDM or PET were reviewed. Women with AGA neonates were divided into three groups- GDM, PET, and GDM + PET and maternal neonatal and placental outcomes were compared. The primary outcome was a composite of adverse neonatal outcomes, including intensive care unit admission (NICU), neurological morbidity, hypoglycemia, ventilation, respiratory distress syndrome (RDS), phototherapy, sepsis, blood transfusion, and neonatal death. Post-hoc analysis was performed to determine between-group significance. RESULTS: Composite adverse neonatal outcomes are significantly lower in women with multiple morbidities compared to women with confined PET (p = 0.015), and a similar trend is observed when comparing neonatal outcomes between women with GDM to those with GDM + PET, yet these results are underpowered (18.9 % vs. 12.8 % respectively, p = 0.243). Placentas of women with GDM + PET were larger, with a lower rate of placentas below the 10th percentile as compared to placentas of women with isolated PET (p < 0.001), but with similar rates of MVM lesions. DISCUSSION: While maternal and placental outcomes in patients of the GDM + PET group resemble the characteristics of the PET group, surprisingly, the neonatal outcomes in this group are significantly better compared to isolated morbidities. The paradoxical benefit attributed to the coexistence of GDM + PET may be explained by a balance of the opposing trends characterizing these morbidities-the reduced blood and nutrient supply characterizing PET vs. chronic overflow and abundance typical of GDM. CLINICAL TRIAL REGISTRATION: approval of local ethics committee WOMC-19-0152.

Does the combination of four OGTT values enhance the prediction of adverse pregnancy outcomes? Insights from a retrospective cohort study.

AIM: To explore the correlation between a singular value of additive OGTT scores and adverse maternal and neonatal outcomes. We postulated that a higher additive OGTT score would predict poorer maternal and neonatal outcomes. METHODS: In this retrospective cohort study, data were collected from all women with a documented complete OGTT result and subsequent diagnosis of GDM. The additive OGTT score was calculated by adding each individual hourly glucose measurement. Maternal demographics, pregnancy and labor characteristics, and neonatal outcomes were compared between the lower-sum and higher-sum OGTT groups. A multivariate regression analysis was performed to identify confounders associated with adverse outcomes. RESULTS: In this study, a total of 1497 patients were assessed. The group with higher-sum OGTT scores was characterized by increased rates of GDMA2 (p = 0.008), higher insulin doses (p = 0.009), and higher rates of composite maternal and neonatal adverse outcomes (p = 0.021 and p = 0.030, respectively) compared to the lower-sum OGTT group. CONCLUSION: The additive OGTT score may aid in predicting the need for insulin treatment, labor course, and neonatal outcomes in GDM patients.

Umbilical cord blood gases sampling in low-risk vaginal deliveries as a predictor of adverse neonatal outcome.

INTRODUCTION: There is no clear correlation between abnormal umbilical cord blood gas studies (UCGS) and adverse neonatal outcome in low-risk deliveries. We investigated the need for its routine use in low-risk deliveries. METHODS: We retrospectively compared maternal, neonatal, and obstetrical characteristics among low-risk deliveries (2014-2022) between "normal" and "abnormal" pH groups: A:normal pH ≥ 7.15; abnormal pH < 7.15; B: normal pH ≥ 7.15 and base excess (BE) > - 12 mmol/L; abnormal pH < 7.15 and BE ≤ We retrospectively compared 12 mmol/L; C: normal pH ≥ 7.1; abnormal pH < 7.1; D: normal pH > 7.1 and BE > - 12 mmol/L; abnormal pH < 7.1 and BE ≤ - 12 mmol/L. RESULTS: Of 14,338 deliveries, the rates of UCGS were: A-0.3% (n = 43); B-0.07% (n = 10); C-0.11% (n = 17); D-0.03% (n = 4). The primary outcome, composite adverse neonatal outcome (CANO) occurred in 178 neonates with normal UCGS (1.2%) and in only one case with UCGS (2.6%). The sensitivity and specificity of UCGS as a predictor of CANO were high (99.7-99.9%) and low (0.56-0.59%), respectively. CONCLUSION: UCGS were an uncommon finding in low-risk deliveries and its association with CANO was not clinically relevant. Consequently, its routine use should be considered.

The use of virtual reality during extra-amniotic balloon insertion for pain and anxiety relief-a randomized controlled trial.

BACKGROUND: Induction of labor with an extra-amniotic balloon catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. OBJECTIVE: We aimed to investigate the distractive effect of virtual reality technology on pain and anxiety among pregnant patients who underwent induction of labor with an extra-amniotic balloon catheter. STUDY DESIGN: In this randomized controlled trial, pregnant patients who were undergoing planned induction of labor using an extra-amniotic balloon catheter at term for various obstetrical indications were recruited and randomized in a 1:1 ratio into 2 groups. Patients in the virtual reality group were exposed to a virtual reality technology clip (using SootheVR All-In-One virtual reality care system for pain and anxiety) during the entire extra-amniotic balloon catheter insertion, whereas patients in the control group received the institutional standard care for extra-amniotic balloon catheter insertion. Pain scores, expressed as visual analog scale scores, and maternal hemodynamic parameters were obtained before, during, and after extra-amniotic balloon catheter insertion. Anxiety was evaluated using the validated State-Trait Anxiety Inventory Scale before and after the procedure. Maternal satisfaction with the virtual reality technology was also recorded. The primary outcome was the change in visual analog scale score before and during extra-amniotic balloon catheter insertion. Among the secondary outcomes was the change in anxiety levels before and after extra-amniotic balloon catheter insertion. The study was powered to detect a 25% decrease in the primary outcome. RESULTS: A total of 132 pregnant patients were recruited (66 in each group). There were no differences between groups in terms of age, body mass index, gestational age at enrollment, indication for induction of labor, and preprocedural visual analog scale score and anxiety levels. The change in visual analog scale score (maximal visual analog scale score during the procedure minus the initial visual analog scale score before the procedure, ie, the primary outcome) was significantly lower in the virtual reality group than in the control group (2.78±3.0 vs 4.09±2.99; P=.01). In addition, the virtual reality group experienced a higher rate of anxiety relief, expressed as the difference between the preprocedure and postprocedure State-Trait Anxiety Inventory Scale scores (-6.46±9.6 vs -2.01±9.11; P=.007). Patients in the virtual reality group reported a very high overall (94%) satisfaction score. CONCLUSION: In this randomized controlled trial, we demonstrated that the use of virtual reality technology among patients who underwent induction of labor using an extra-amniotic balloon catheter was associated with lower visual analog scale scores during the procedure and a significant reduction in anxiety than patients who received standard care. There was also a very high satisfaction rate with the use of virtual reality technology.

Pregnancy and placental outcomes according to maternal BMI in women with preeclampsia: a retrospective cohort study.

PURPOSE: Obesity and preeclampsia share similar patho-mechanisms and can both affect placental pathology. We aimed to investigate pregnancy outcomes in correlation with placental pathology among pregnancies complicated by preeclampsia in three different maternal body mass index (BMI, kg/m2) groups. METHODS: In this retrospective cohort study, medical and pathological records of patients with preeclampsia and a singleton pregnancy delivered between 2008 and 2021 at a single tertiary medical center were reviewed. Study population was divided into three BMI groups: BMI < 22.6 kg/m2 (low BMI group), 22.7 ≤ BMI ≤ 28.0 kg/m2 (middle-range BMI group), and BMI > 28.0 kg/m2 (high BMI group). Data regarding maternal characteristics, neonatal outcomes, and placental histopathological lesions were compared. RESULTS: The study groups included a total of 295 patients diagnosed with preeclampsia-98, 99, and 98 in the low, middle-range, and high BMI groups respectively. Neonatal birth weight was significantly decreased in the low maternal BMI group compared to both middle and high BMI groups (p = 0.04) with a similar trend seen in placental weight (p = 0.03). Villous changes related to maternal malperfusion were more prevalent in the low and high BMI groups compared to middle-range BMI group (p < 0.01) and composite maternal vascular malperfusion lesions were also more prevalent in the groups of BMI extremities compared to the middle-range BMI group (p < 0.01). CONCLUSION: Maternal BMI might influence neonatal outcomes and placental pathology in pregnancies complicated by preeclampsia. Both extremes of BMI were associated with higher rates of placental maternal vascular malperfusion. Balanced BMI in women at risk for preeclampsia may reduce the incidence of placental lesions.

The association of placental histopathological lesions and adverse obstetric outcomes in patients with Müllerian anomalies.

INTRODUCTION: An increased risk of an unfavorable obstetric outcome has been reported in relation with Müllerian anomalies (MA). We evaluated whether placental lesions are more frequent among patients with MA and correlates with adverse pregnancy outcomes. METHODS: The medical records and placental histopathologyy of consecutive patients with MA between 2007 and 2020 were reviewed. A control group matched for maternal age and pregnancy complications was selected in a 1:1 ratio. Characteristics were then compared between the MA and control groups. RESULTS: The study group included 110 patients with MA. Patients in the MA group gave birth at earlier gestational age as (35.8 ± 3.3 vs 39.1 ± 1.3 weeks, respectively, P < 0.001). Placental weight <10th percentile was significantly more frequent in the MA cohort compared with controls (31% vs. 6%, respectively, p < 0.001). Higher rates of vascular and villous lesions of maternal vascular malperfusion (MVM) were also detected in the MA group (P = 0.04, P = 0.01, respectively). On multivariable analysis the presence of MA was an independent predictor of composite placental MVM lesions (OR 3.9, 95% CI 2.2, 6, p = 0.04). Using multivariate logistic regression models, the presence of MA was also found to be an independent predictor of small for gestational age (SGA), (OR 4.2, 95% CI 2.7, 11.7, p = 0.01). DISCUSSION: MA are associated with placental MVM lesions and SGA independent of background confounders including gestational age - suggesting a placental involvement in the association between MA and adverse pregnancy outcomes. Prospective studies among larger cohorts are needed to corroborate our results.

Management of pregnancies with suspected preeclampsia based on 6-hour vs 24-hour urine protein collection-a randomized double-blind controlled pilot trial.

BACKGROUND: Traditionally, the diagnosis of preeclampsia requires elevated blood pressure measurements and proteinuria demonstrated in a 24-hour urine collection. This prolonged urine collection is associated with patient discomfort, a delay in diagnosis, and in some cases, hospitalization for further management of outcomes. OBJECTIVE: We aimed to assess the feasibility, reliability, and association between maternal and neonatal outcomes of pregnancies managed according to a 6-hour vs 24-hour urine protein collection for suspected preeclampsia. STUDY DESIGN: This was a randomized controlled trial conducted at a tertiary university hospital between January 2019 and January 2021 (ClinicalTrials.gov Identifier: NCT03724786). Patients who were hospitalized for preeclampsia workup were asked to participate and randomized at a 1:1 ratio to 6- and 24-hour urine protein collection groups. Both groups collected urine for 24 hours, during which the collection was also tested after 6-hours. After 24 hours, both results were reviewed by one of the research staff, and either the 6- or 24-hour collection result was reported to the patient's managing physician and was documented in the patient's medical record. Both patient and the managing physician were blinded to group allocation. Unblinding was undertaken in cases of a discrepancy between the results (1 of 2 results of >300 mg protein), and the results were analyzed by intention to treat. The primary study outcome was defined as a composite of adverse maternal outcomes. The sample size was set empirically as per proof on concept design. RESULTS: During the study period, 115 patients participated in the trial, 101 of whom completed the follow-up and were analyzed-51 in the 6-hour group and 50 in the 24-hour group. Patient demographics were similar between the study groups. Unblinding occurred in 7 cases in the 6-hour group, in which the initial 6-hour result ranged from 168 to 475 mg. The rates of composite adverse maternal outcomes were 15.6% and 12.0% in the 6- and 24-hour groups, respectively (P=.59). No significant difference was demonstrated in the rate of adverse neonatal outcomes, cesarean delivery, induction of labor, gestational age at delivery, betamethasone treatment, or neonatal birthweight. CONCLUSION: Managing pregnancies suspected of preeclampsia with a 6-hour urine protein collection is feasible and associated with similar maternal and neonatal outcomes. In cases where the 6-hour result is in the 168 to 475 mg range, we propose completing a 24-hour collection.

The effect of pregnancy on maternal cognition.

To determine whether there are differences in measures of cognitive function between second and third trimester pregnant women compared to non-pregnant controls. This prospective study comprised 40 pregnant and 40 non-pregnant women, 20-40 years old, native-Hebrew speakers who were recruited from the outpatient clinics during a period of nearly 2 years. The patients underwent cognitive and affective evaluation. The performance on the three following tests: difficult and total items of Verbal Paired Associates, the Digit Span-forward and the Naming Objects and Fingers test scores were significantly better among non- pregnant women. All the other test results were similar between the two groups, including the depression scores. On multivariate linear regression analysis, after adjusting for age and years of education , Verbal Paired Associates total score (p = 0.04), and Naming Objects and Fingers (p = 0.01) remained significantly associated with pregnancy, but not Digit Span (p = 0.09). Our study demonstrates an impairment in memory among pregnant women. Furthermore language skills, particularly naming, were also impaired, a finding which has not been previously described.

Should the interval between doses of antenatal corticosteroids be shortened in certain cases? Factors predicting preterm delivery < 48 h from presentation.

PURPOSE: Treatment with antenatal corticosteroids (ACS) to women at risk for preterm birth (PTB) is associated with a reduction in adverse neonatal outcomes. Obstetricians occasionally shorten the interval between the doses of steroids if delivery is predicted to occur before ACS are fully administered. In this study, we aimed to investigate predicting factors to identify patients that will deliver prematurely, less than 48 h from presentation. METHODS: The computerized medical files of all PTBs (< 34 weeks) were reviewed. Maternal demographics, pregnancy and delivery characteristics were compared between PTB that occurred < 48 h vs. > 48 h from triage presentation. RESULTS: In total, 494 PTB cases were included: 302 women in the study group (PTB < 48 h) and 192 women in the control group (PTB > 48 h). No significant differences were found in demographic characteristics between the groups. At presentation, the study group had higher rates of uterine contractions (p < 0.001) and cervical length < 25 mm (p < 0.001) as well as a higher rate of non-reassuring fetal (NRFHR) monitor (p < 0.001). In contrast, the control group presented with higher rates of preeclampsia (p = 0.003) and preterm premature rupture of membranes (p = 0.038). In multivariable analysis, all of the above factors remained significant after controlling for background confounders. CONCLUSIONS: Various factors at presentation can predict delivery < 48 h. These factors can be used to predict patients to whom the ACS interval should be shortened. Future prospective studies should investigate the effect of this shortening on neonatal outcomes.

The impact of mode of delivery on neonatal outcome in preterm births.

INTRODUCTION: To evaluate the impact of mode of delivery on the outcome of neonates born before 34 weeks of gestation. MATERIAL AND METHODS: This is a retrospective cohort study of all singleton live neonates born between 24.1 and 34.0 weeks of gestation at our institute between January 2009 and July 2017. Maternal and pregnancy characteristics, as well as the neonatal outcome, were compared between vaginal delivery (VD) and cesarean delivery (CD). RESULTS: Of 475 preterm births, 223 (46.9%) were delivered vaginally and 252 (53.1%) were delivered by CD. Women who delivered vaginally were younger, (29.6 ± 6 versus 31.2 ± 6 years, p = .003), had lower rate of hypertensive disorders (9.9 versus 36.1%, p < .001), and diabetes mellitus (0.4 versus 4.4%, p = .006), and had higher rate of drug abuse (4.9 versus 1.6%, p = .006), as compared to those who delivered by CD. Neonates who were born by VD had higher birth weight (1716 ± 595 versus 1443 ± 507, p < .001) and a lower rate of Small for gestational age (7.2 versus 19.4%, p < .001) than those who were born by CD. Although VD neonates had higher Apgar score, as compared with CD, the neonatal composite outcome was similar between the two modes of deliveries. These findings were consistent in subgroups analysis according to gestational age (GA). By logistic regression analysis, only the administration of betamethasone up to 1 week prior to delivery (aOR = 0.59, 95% CI 0.38-0.92, p = .001) and GA at delivery (aOR = 0.74 95% CI 0.64-0.84, p = .004) were found to be independently protective against composite neonatal outcome. CONCLUSIONS: It seems that neonatal outcome is not affected by the mode of delivery.

Fetal Growth Restriction in Hypertensive vs. Heavy Smoking Women-Placental Pathology, Ultrasound Findings, and Pregnancy Outcomes.

We compared placental pathology, ultrasonographic findings, and obstetric outcomes, in gestations complicated by fetal growth restriction (FGR) with either a background of hypertensive disorder or heavy tobacco cigarette smoking. The medical records and placental pathology reports of pregnancies complicated with FGR (birthweight < 10th percentile) between December 2008 and May 2018 from a single tertiary center were reviewed. Placental pathology, ultrasound findings, and pregnancy outcomes were compared between hypertensive patients (HTN) and heavy smokers (SMO). We included 213 pregnancies: 129 (60.6%) in the SMO group and 84 (39.4%) in the HTN group. The HTN group was characterized by a higher BMI (p = 0.01), higher rates of Cesarean deliveries (p = 0.006), and a lower gestational age at delivery (35.6 ± 3.8 vs. 37.5 ± 2.9 weeks, p < 0.001). The HTN group had higher rates of placental weights < 10th percentile (p = 0.04) and maternal vascular malperfusion lesions (p < 0.001), while the SMO group had higher rates of inflammatory lesions (p = 0.04). On ultrasound, the HTN group had a higher head/abdomen circumference ratio (p < 0.001) and more abnormal Doppler studies (< 0.001). Neonates in the HTN group had lower birthweights (p < 0.001) and higher rates of NICU admissions (p = 0.002) and adverse neonatal outcome (p = 0.006). On multivariable analysis, gestational age at delivery (aOR = 0.65, 95%CI 0.55-0.87), hypertensive disorders (aOR = 1.8, 95%CI = 1.21-4.81), placental MVM lesions (aOR = 1.23, 95%CI = 1.08-5.02), and the combination of HTN+MVM (aOR = 2.63, 95%CI 1.78-7.30) were independently associated with adverse neonatal outcome. Hypertension and smoking may lead to FGR in different pathways as the two groups significantly differed in maternal characteristics, placental pathology, ultrasound findings, and neonatal outcomes. A hypertensive disorder probably represents a more hostile maternal environment than smoking and these pregnancies would probably benefit from closes monitoring.

[THE EDITH WOLFSON CENTER FOR VICTIMS OF SEXUAL ASSAULT - LESSONS FROM 17 YEARS OF EXPERIENCE].

INTRODUCTION: The Center for Victims of Sexual Assault at Wolfson's Medical Center is the first of its kind in Israel. It was launched in 2000 by the Department of Obstetrics and Gynecology, and has since served over 4000 victims. The center provides care by a multidisciplinary team of gynecologists, social workers, forensic physicians, and police investigators, in a single place and with a supporting atmosphere. AIMS: To review the characteristics of female victims who were treated in the Center for Victims of Sexual Assault at Wolfson's Medical Center between 2000 and 2017. METHODS: This is a retrospective observational study. The data of all female victims who were treated in our center were retrieved from the medical files. The study was approved by the Institutional Review Board. RESULTS: During the study period, 3598 (90.5%) women and 376 (9.5%) men were treated in our center. The mean age of the female victims was 23.0 years, of whom 27.1% were minors. Most victims (69.8%) arrived at the center within 24 hours from the assault. The victim knew the perpetrator before the assault in half of the cases. About half of the assaults occurred on weekends. The victims reported a high rate of alcohol and drug use before the assault (36.2% and 8.1%, respectively), and this rate has increased over the years. Most victims (70.4%) filed a police report, though this rate has decreased over the years. DISCUSSION: The Center for Victims of Sexual Assault at Wolfson's Medical Center treats many victims each year. The challenges that we will face in the future are education against irresponsible use of alcohol and drugs, and efforts to increase the proportion of victims willing to report to the police.

Does macroscopic estimation of the extent of placental abruption correlate with pregnancy outcomes?

INTRODUCTION: We aimed to study the correlation between the extent of placental abruption (PA), as grossly estimated immediately after delivery, and pregnancy outcomes, in correlation with placental histopathology. MATERIALS AND METHODS: Pregnancy and placental reports of all pregnancies complicated by PA (clinically diagnosed) between 11/2008-12/2018 were reviewed. We compared maternal background, pregnancy outcomes, and placental histopathology between cases of PA divided into three groups according to the extent of abruption: Group 1-<30 %, Group 2-30-49 %, and Group 3->50 % of placental surface. Placental lesions were classified according to the current "Amsterdam" criteria. The primary outcome was defined as a composite of severe neonatal morbidity and included ≥ 1 of the following complications: seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, periventricular leukomalacia, blood transfusion, necrotizing enterocolitis, intrauterine fetal demise, or neonatal death. RESULTS: A total of 260 PA cases were included: 111 (42.7 %) in Group 1, 94 (36.2 %) in Group 2, and 55 (21.1 %) in Group 3. The rate of the primary outcome (7.2 % vs. 11.7 % vs. 27.3 %, p = 0.02) was associated with the degree of PA as well as maternal heavy smoking (p = 0.04), DIC (p = 0.03), umbilical artery Ph <7.1 (p = 0.02), 5-minute Apgar scores <7 (p = 0.03), NICU admissions, placental maternal vascular malperfusion lesions (p = 0.04), and neonatal weights <5th percentile (0.04). In multivariable analysis severe adverse neonatal outcome was independently associated with the percentage of PA (aOR = 1.4, 95 % CI = 1.3-3.9). CONCLUSION: The extent of placental abruption, as estimated by the examiner, correlated with DIC and severe neonatal outcomes and may serve as an early alarming sign in deliveries complicated by PA.

Reduced fetal movements at term, low-risk pregnancies: is it associated with adverse pregnancy outcomes? Ten years of experience from a single tertiary center.

OBJECTIVE: We aimed to assess the outcomes of low-risk pregnancies complicated by isolated reduced fetal movements (RFM) at term. STUDY DESIGN: The study population were patients at term, with singleton, low-risk, pregnancies who presented to our obstetric-triage and delivered during the subsequent 2 weeks. The study group included patients with an isolated complaint of RFM (RFM group). The control group included patients without history of RFM (control group). The pregnancy, delivery, and neonatal outcomes were compared between the groups. Severe and mild composites of adverse neonatal outcomes were defined. Multivariate regression analyses were performed to identify independent association with adverse neonatal outcomes. RESULTS: Among the 13,338 pregnant women, 2762 (20.7%) were included in the RFM group and 10,576 (79.3%) in the control group. The RFM group had higher rates of nulliparity (p < 0.001), and smoking (p < 0.001). At admission, the RFM group had higher rates of IUFD (p < 0.001). The RFM group had higher rates of Cesarean delivery due to non-reassuring fetal monitor (p < 0.001), and mild adverse neonatal outcomes (p = 0.001). RFM was associated with mild adverse outcome independent of background confounders (aOR = 1.4, 95% CI 1.2-2.6, p < 0.001). CONCLUSION: Patients presented with isolated RFM at term had higher rates of IUFD at presentation and significant adverse outcomes at delivery.

Reduced fetal movements is twin pregnancies and the association with adverse neonatal outcomes.

OBJECTIVE: Reduced fetal movements (RFM) is an obstetric complaint known to be associated with adverse neonatal outcomes and should serve as an alarming sign in obstetric triage. Whether this assumption holds for twin pregnancies, is still an obstetric enigma, and this complaint is sometimes overlooked in twins. We, therefore, aimed to study neonatal outcomes in twin pregnancies complicated by RFM. We hypothesised that in twin pregnancy, maternal ability to perceive RFM will be limited, and therefore, will not be associated with adverse neonatal outcome. STUDY DESIGN: Included were all dichorionic twin pregnancies between 2009-2019 who presented to our obstetric triage at a gestational age >34 weeks with an isolated complaint of RFM and delivered during the subsequent two weeks (RFM group). The control group included patients with twin pregnancies (matched for gestational age and maternal age) who presented for routine assessment and reported regular fetal movements throughout pregnancy (no RFM group). Data regarding pregnancy, delivery, and neonatal outcomes were compared between the groups. The primary outcome was a composite of adverse neonatal outcomes, which included one or more of the following: neonatal hypoglycemia, respiratory morbidity, cerebral morbidity, phototherapy, neonatal sepsis, blood transfusions, necrotizing enterocolitis, or neonatal death. Multivariable regression analysis was used to identify independent associations with adverse neonatal outcomes. RESULTS: Maternal demographics and gestational age at delivery did not differ between the RFM group (n = 83 pregnancies and 166 neonates) and the no RFM group (n = 83 pregnancies and 166 neonates). Neonatal birthweights, as well as the rate of birthweights <10th centile, did not differ between the groups. There were 2 cases of fetal demise diagnosed at triage in the RFM group. The rate of the primary outcome, as well as NICU admissions, were significantly higher in the RFM group compared to the no RFM group (29.5 % vs. 19.2 %, p = 0.01 and 32.5 % vs. 19.2 %, p = 0.001). In multivariable analysis RFM (aOR = 1.18, 95 % CI = 1.06-2.73), and GA at delivery (aOR = 0.88, 95 % CI = 0.67-0.97) were associated with adverse neonatal outcome-independent from background confounders. CONCLUSION: Patients presented to obstetric triage with twin pregnancies and isolated RFM had higher rates of adverse neonatal outcomes and NICU admissions compared to twin pregnancies without RFM.

Reduced fetal movements at term in singleton low risk pregnancies-Is there an association with placental histopathological findings?

INTRODUCTION: Maternal perception of fetal movements has long been considered an indicator of fetal well-being. A sudden decrease in the number of fetal movements is suggestive of fetal compromise. We aimed to determine whether the maternal perception of reduced fetal movements (RFM) is associated with placental pathological lesions in a low-risk term population. MATERIAL AND METHODS: Our study was a case-control study that was performed in a single university center. Placental histopathology, maternal demographics, labor characteristics, and neonatal outcomes of term, singleton pregnancies with maternal perception of RFM during the 2 weeks prior to delivery were collected. To isolate the effect of RFM on placental pathology, we excluded cases complicated by preterm birth, hypertensive disorders, diabetes mellitus, small-for-gestational-age and congenital/genetic anomalies. We compared pregnancy outcomes and placental pathology between the RFM group and a control group matched for gestational age and mode of delivery. Placental lesions were classified according to the "Amsterdam" criteria. Composite adverse neonatal outcome was defined as one or more of the following: sepsis, transfusion, hypoglycemia, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis and fetal/neonatal death. Multivariable regression analysis was performed to identify independent associations with adverse neonatal outcome. RESULTS: We included patients who gave birth from January 2008 until May 2019. The study group included 203 term pregnancies with RFM during the 2 weeks prior to delivery, which was matched with 203 controls. The RFM group was characterized by a higher rate of placental weight <10th percentile (22.6% vs. 3.9%, P < .001), a higher rate of maternal vascular malperfusion lesions (30.5% vs. 18.7%, P = .007) and lesions of maternal inflammatory response (43.3% vs. 29.5%, P = .005). At delivery, the RFM group had higher rates of cesarean delivery due to non-reassuring fetal heart rate monitoring (P = .01), 5-minute Apgar score ≤7 (P = .03), neonatal intensive care unit admissions (P < .001) and composite adverse neonatal outcomes (P = .007). Using multivariable analysis, RFM (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.1-4.8), and placental maternal vascular malperfusion lesions (aOR 1.2, 95% CI 1.0-2.9) were independently associated with adverse neonatal outcome. CONCLUSIONS: After excluding important placental-related morbidities, RFM was associated with a higher rate of placental weight <10th percentile and placental maternal vascular malperfusion lesions vs. controls. This study suggests a placental involvement in the association between RFM at term and adverse pregnancy outcomes.

Characteristics and trends of sexual assaults in Israel - A large cohort study of 3941 victims.

INTRODUCTION: To improve care for victims of sexual assault, specialized assault centers have been developed globally, providing medical, psychological and legal care in one place. Our assault center serves a large population in the center of Israel. In 2010, we initiated a program aimed to prevent assaults among minors and to encourage early referral of victims to the center. The goal of the current study was to assess the impact of this program by comparing the characteristics of sexual assaults before and after the program's initiation. MATERIAL AND METHODS: We conducted a historic cohort study of all victims of sexual assaults who were treated in our center between October 2000 and November 2017. A comparison was performed between victims treated before and after January 2010 (early vs. late study period), when the prevention program was initiated. The program mainly included lectures in middle and high schools, and workshops for police investigators. RESULTS: Overall, 3941 victims of sexual assault were treated in our center during the study period. Most victims were females (90.5%). Mean age was 23.0 ± 11.0 years. Most victims were single (93.1%), and approximately half knew their perpetrator before the assault. Compared with the early study period, in the late study period we observed a decrease in the rate of minor victims (31.9% vs. 24.7%, respectively, P < .001) and an increase in the rate of victims who arrived to the center within 3 days of the assault (P = .001). However, we observed higher rates of multiple-perpetrator assaults (16.7% vs. 21.9%, respectively, P < .001), alcohol use (29.2% vs. 40.1%, respectively, P < .001), and drug use (7.2% vs. 9.0%, respectively, P = .04). Moreover, in the late study period, fewer victims were willing to press charges (79.5% vs. 64.4%, respectively, P < .001). CONCLUSION: Our prevention program might have contributed to reducing the rate of sexual assaults among minors and shortened the time interval between the assault and victim's arrival to the center. Nonetheless, more efforts should be taken to reduce the involvement of alcohol and drugs in sexual assaults and to encourage victims to press charges.

Pregnancy outcomes in correlation with placental histopathology in subsequent pregnancies complicated by preeclampsia.

OBJECTIVE: In attempt to deepen our understanding of the etiopathogenesis of preeclampsia we aimed to study the placental component and pregnancy outcomes in two consecutive pregnancies complicated by preeclampsia in the same patient. STUDY DESIGN: Pregnancy and placental reports of all pregnancies complicated by preeclampsia between 2008 and 2018 were reviewed. Included were only cases with recurrent preeclampsia in two consecutive pregnancies Neonatal outcomes and placental histopathology were compared between the first preeclampsia delivery (first preeclampsia group) and the subsequent preeclampsia delivery (subsequent preeclampsia group), thus each subject served as her own control in two consecutive pregnancies. Placental lesions were classified according to the current "Amsterdam" criteria. Adverse neonatal outcome was defined as ≥1 early neonatal complication. RESULTS: Included in the study a total of 83 cases with recurrent preeclampsia. The first preeclampsia group delivered at an earlier gestational age (35.7 ±â€¯3.7 vs. 36.8 ±â€¯3.1 weeks, p = 0.03) and had higher rates of severe features (44.6% vs. 25.3%, p = 0.03), placental weight <10th percentile (44.5% vs. 26.5%, p = 0.02), maternal vascular malperfusion (MVM) lesions (84.3% vs. 62.6%, p = 0.002), SGA (44.5% vs. 33.7%, p = 0.03), and adverse neonatal outcome (55.4% vs. 34.9%,p = 0.01), compared to the subsequent preeclampsia group. Using multivariate logistic regression analysis, severe features (aOR = 1.36, 95%CI = 1.12-2.36), MVM lesions (aOR = 1.12, 95%CI = 1.04-1.87) and adverse neonatal outcome (aOR = 1.26 95%CI = 1.14-2.23) were found to be independently associated with the first preeclampsia group. CONCLUSION: The first event of preeclampsia is characterized by an earlier, more severe presentation, as well as a higher rate of MVM lesions, SGA, and adverse neonatal outcome, compared to preeclampsia in a subsequent pregnancy.