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Purpose: To determine whether meconium-stained amniotic fluid (MSAF) encountered in pregnancies complicated by preterm premature rupture of membranes (PPROM) is associated with adverse maternal and perinatal outcome., Methods: A retrospective cohort study of all singleton pregnancies with PPROM and MSAF who delivered in a tertiary hospital at 24 + 0-36 + 6 weeks of gestation between 2007 and 2017. Women with PPROM-MSAF (study group) were compared to women with PPROM and clear amniotic fluid (control group). Controls were matched to cases according to age, gravidity, parity and gestational age at delivery in a 3:1 ratio. Primary outcome was defined as neonatal intensive care unit admission. Secondary outcomes were neonatal adverse outcomes, chorioamnionitis and placental abruption diagnosed clinically or by placental cultures and histology., Results: Seventy-five women comprised the study group and were matched to 225 women representing the control group. A significantly higher rate of neonatal intensive care unit admissions was noted in the study group compared to controls (61.3% vs. 45.7%, p = 0.03). Multivariate analysis demonstrated that MSAF is an independent risk factor for neonatal intensive care unit admission (adjusted OR = 2.82, 95% CI 1.39-5.75, p = 0.004). MSAF was found to be associated to higher rates of cesarean and operative vaginal deliveries (30.7% vs. 24.4% and 5.3% vs. 2.7%, p = 0.057, respectively) as well as to chorioamnionitis and placental abruption (33.3% vs. 19.3%, p = 0.034 and 16.0% vs. 7.7%, p = 0.021, respectively)., Conclusion: MSAF is associated with higher frequencies of adverse perinatal outcome when compared to clear amniotic fluid in pregnancies complicated by PPROM.

Objective: Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with pelvic pain and subfertility, affecting 0.6-10% of the general female population. The association between endometriosis and obstetrical outcomes is not well established. We aimed to evaluate whether endometriosis is associated with a higher incidence of obstetrical and neonatal complications., Study Design: A retrospective cohort study of all deliveries in a university-affiliated tertiary hospital (2007-2014). Eligibility was limited to women with previously diagnosed endometriosis and singleton pregnancies. Fetuses or neonates diagnosed with structural or chromosomal anomalies were excluded. We compared labor and delivery outcomes and immediate neonatal outcomes among women with endometriosis compared with women without endometriosis., Results: Overall, 61,535 deliveries were eligible for analysis, of which 135 (0.002%) had endometriosis. Women with in the endometriosis group were characterized by higher maternal age, lower parity and higher nulliparity rate, and an earlier gestational age at delivery. Women with endometriosis had higher rate of failure of induction of labor (aOR 5.2, 95%CI 1.8-14.9), cesarean delivery (aOR 5.0, 95%CI 3.3-7.4), postpartum hemorrhage (aOR 3.7, 95%CI 1.6-8.5), placenta accreta (aOR 6.24, 95%CI 2.20-17.67), postpartum hemoglobin <10 mg/dL (aOR 2.03, 95%CI 1.31-3.14), and packed cell transfusion (aOR 3.66, 95%CI 1.94-6.91). No significant differences in neonatal outcomes were observed., Conclusions: Endometriosis is associated with higher risk of cesarean delivery and postpartum hemorrhage. Our findings suggest appropriate preparations for delivery, such as uterotonic agents and blood products, should be considered in these women.

Background: Several studies have shown inconsistent associations between anxiety during pregnancy and adverse pregnancy outcome. This inconsistency may be due to lack of controlling for the timing and type of maternal anxiety. We aimed to isolate a specific type of anxiety - maternal anxiety propensity, which is not directly related to pregnancy, and evaluate its association with adverse pregnancy outcome., Methods: We conducted a prospective observational study of 512 pregnant women, followed to delivery. The trait anxiety scale of the State-Trait Anxiety Inventories was used in order to detect a propensity towards anxiety. The association between anxiety propensity (defined as trait-anxiety subscale score above 38) and adverse pregnancy outcome was evaluated. Primary outcome was a composite outcome including preterm birth prior to 37 gestational weeks, hypertensive disorders in pregnancy, small for gestational age newborn and gestational diabetes mellitus. Secondary outcomes were each one of the above mentioned gestational complications., Results: There were no significant between-group differences in adverse pregnancy outcomes, including the rate of preterm birth, hypertensive disorders, small for gestational age, gestational diabetes or a composite outcome of them all., Conclusion: Anxiety propensity is not associated with adverse pregnancy outcome.

Purpose: Maternal thyroid gland dysfunction may adversely affect pregnancy outcome. We aimed to examine the association between subclinical thyroid dysfunction, both hypothyroidism and hyperthyroidism, to adverse pregnancy outcome., Materials and Methods: Retrospective cohort study of all women with an available first trimester thyroid function testing and known pregnancy outcome, categorized to subclinical hypothyroidism, or hyperthyroidism and evaluated for complication during gestation and delivery., Results: Four thousand five hundred and four women were included in the final analysis - 3231 were euthyroid, 73 (1.6%) were categorized as subclinical hyperthyroidism and 1200 (26.6%) had subclinical hypothyroidism. Low thyroid-stimulating hormone (TSH) levels, i.e. subclinical hyperthyroidism, correlates with higher rates of placental abruption and extremely low birth weight, below 1500 g. Also, the risk for preterm delivery prior to 34 gestational weeks is higher among women with subclinical hypothyroidism, with greater risk among those with a higher TSH level. (OR 1.81, 95% CI 1.0-3.28 for TSH 2.5-4.0 mIU/L and OR 2.33, 95% CI 1.11-4.42 for those with TSH > 4 4.0 mIU/L)., Conclusions: Subclinical hypothyroidism is associated with an increased risk for preterm delivery prior to 34 gestational weeks. Additionally, subclinical hyperthyroidism may also have a role in adverse pregnancy outcome - low birth weight and placental abruption - although this needs to be further explored.

Objective: To investigate the association between subclinical hypothyroidism and preterm contractions., Methods: Prospective observational study among women at 23 + 0/7 and 34 + 6/7 weeks of gestation, with no known thyroid function abnormality, and preterm uterine contractions (PTC). All patients underwent laboratory evaluation of Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4). Patients with and without PTC were compared., Results: No association was found between PTC and subclinical hypothyroidism. Rate of spontaneous preterm delivery (PTD) was comparable between women with abnormal and normal thyroid function tests. Excluding indicated PTD, patients in the study group had a higher rate of spontaneous PTD (24.7% versus 9.6%, p = 0.03). Patients with past PTD and preterm contractions had higher rates of hypothyroxinemia compared with patients without past PTD (54.6% versus 19.0% and 31.2%, p = 0.001), and patients with past PTD (regardless of the presence or absence of PTC) had higher rate of subclinical hypothyroidism compared with patients with PTC and without PTD (59.1% and 66.7% versus 31.6%, p = 0.017)., Conclusions: No association was found between PTC and subclinical hypothyroidism in the entire cohort, except for patients with preterm contractions and a history of past PTD. This specific group of patients might benefit from thyroid function evaluation.

Objective: To compare perioperative and pregnancy outcome between women undergoing laparoscopic appendectomy and those undergoing open appendectomy during pregnancy for presumed acute appendicitis., Methods: A retrospective cohort study of all women undergoing appendectomy during pregnancy in a tertiary referral medical center from 2000 to 2009. Outcome was compared between those undergoing laparoscopic appendectomy and those undergoing open appendectomy., Results: Overall, 83,510 deliveries occurred during the study period, 85 (0.10%) were eligible for the study group. Of these, 26 (31%) had a laparoscopic appendectomy and 59 (69%) had an open appendectomy. No significant difference was found in the general, delivery and neonatal outcome characteristics between the two groups. There was a significant difference in the mean gestational age at surgery between laparoscopic appendectomy and the open appendectomy groups (14.6 versus 19.3 weeks respectively, p = 0.009). Post-operative complications (fever >38.0 °C or the presence of uterine contractions) rate was higher in the open appendectomy compared to the laparoscopic appendectomy group (25.5% versus 3.8%, respectively, p = 0.009)., Conclusion: Laparoscopic appendectomy appears to be a safe procedure for presumed acute appendicitis during pregnancy with less post-operative complications as compared to open appendectomy.

Objective: To determine whether an abnormal 50-g glucose-challenge test (GCT) is independently associated with adverse pregnancy outcome., Methods: A retrospective study of women with abnormal GCT (>140 mg/dL) but normal subsequent 100-g oral glucose-tolerance test (OGTT). Pregnancy outcome was compared with that of women with normal GCT (<140 mg/dL)., Results: Of the 79,153 women delivered during the study period, the results of the GCT were available for 14,268. Of these, 809 (5.7%) had an abnormal GCT and normal OGTT and were eligible for the study group. An abnormal GCT was independently associated with an increased risk for macrosomia (odds ratio [OR] = 2.0, 95% CI: 1.5-2.7), large for gestational age (OR = 1.6, 95% CI: 1.3-2.0), cesarean section (OR = 1.3, 95% CI: 1.1-1.6), respiratory morbidity (OR = 1.6, 95% CI: 1.1-2.7) and neonatal hypoglycemia (OR = 1.8, 95% CI: 1.1-3.2). In contrast, an abnormal GCT was associated with decreased risk for preterm delivery at less than 37 weeks (OR = 0.7, 95% CI: 0.5-0.9) and 34 weeks (OR = 0.3, 95% CI: 0.1-0.6). The association between abnormal GCT and adverse pregnancy outcome was unrelated to the degree of GCT abnormality except for cases in which the GCT was extremely high (≥180 mg/dL)., Conclusion: Women with abnormal-GCT result are at increased risk for adverse pregnancy outcome even in the presence of a normal subsequent OGTT.

Objective: To identify risk factors for adverse pregnancy outcome in women with inflammatory bowel disease (IBD) and to assess the effect of maternal pre-pregnancy weight and weight gain during pregnancy on pregnancy outcome., Methods: A retrospective, matched control study of all gravid women with IBD treated in a single tertiary center. Data were compared with healthy controls matched to by age, parity and pre-pregnancy BMI in a 3:1 ratio., Results: Overall, 300 women were enrolled, 75 women in the study group (28 with ulcerative colitis and 47 with Crohn's disease) and 225 in the control group. The rates of preterm delivery and small for gestational age were higher in the study group (13.3 vs. 5.3% p = 0.02 and 6.7 vs. 0.9%, p = 0.004). The rate of cesarean section (36 vs. 19.1%; p = 0.002), NICU admission (10.7 vs. 4.0%, p = 0.03) and low 5-Min Apgar (4.0 vs. 0.4%, p = 0.02) were increased in the study group. Disease activity within 3 months of conception [OR 8.4 (1.3-16.3)] and maternal weight gain of less than 12 kg. [OR 3.6 (1.1-12.2)] were associated with adverse pregnancy outcome., Conclusion: Active disease at conception and inappropriate weight gain during pregnancy are associated with increased adverse pregnancy outcome in patients with IBD.

Objective: To investigate short- and long-term outcome following blunt trauma in pregnancy, and to identify risk factors for adverse pregnancy outcome in these cases., Methods: A retrospective cohort study of all pregnant women who were admitted following blunt trauma (N=411). Women who experienced immediate complications (N=13) were compared with those who did not (N=398). Pregnancy outcome of women who experienced trauma during pregnancy and did not deliver during the trauma admission (N=303) were compared with a control group of women matched to by maternal age and parity in a 3:1 ratio (N=909)., Results: The overall rate of immediate complications was 3.2%, with the most common complications being preterm labor (2.0%) and placental abruption (1.7%). Independent risk factors for immediate complications were higher severity of trauma, multiple gestation, vaginal bleeding and uterine contractions at admission. Patients who experienced trauma were at increased risk for long-term adverse outcome including preterm labor, placental abruption, and perinatal morbidity. Increased trauma severity (ISS ≥ 5) and the need for laparotomy during the trauma hospitalization were independently associated with long-term adverse pregnancy outcome., Conclusion: Trauma during pregnancy is associated with both immediate and long-term adverse pregnancy outcome. Women who experience trauma should be followed more closely throughout pregnancy.

The aim of this study was to explore whether scoliosis is a risk factor for adverse obstetric outcomes and specifically for cesarean delivery (CD) and labor dystocia. Association between scoliosis and pregnancy outcome was studied before. Confounding conclusions prevent proper counseling of patients. Appropriate statistical analysis of a suitable cohort is helpful in resolving this issue. A retrospective population-based study comparing all singleton pregnancies of women with and without documented scoliosis was conducted. Deliveries occurred between the years 1988 and 2009. Multiple logistic regression models were used to control for confounders. Out of 229,116 patients which were included in our cohort, 0.043% (n = 98) had a documented scoliosis. These patients had higher rates of fertility treatments (7.1% vs. 1.6%; p < 0.001). Scoliosis was found to be significantly associated with labor induction (36.7% vs. 26.3 %; p = 0.02) and cesarean deliveries (21.4% vs. 13.1%; p = 0.014). Using multiple logistic regression models, with CD as the outcome variable, controlling for confounders such as nulliparity, labor induction and maternal age, scoliosis was not found to be an independent risk factor for CD (OR = 1.56, 95% CI 1.9-2.7; p = 0.121). Scoliosis is not a risk factor for adverse pregnancy outcome, and specifically for labor dystocia.

Objective: To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis., Study Design: A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders., Results: Out of 219,612 singleton deliveries in 1988-2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, p<0.001), younger maternal age (26.3 ± 6.0 vs. 28.6 ± 5.8 years, p<0.001), intrauterine growth restriction (IUGR) (6.7% vs. 2.1%, p<0.001), placental abruption (3.6% vs. 0.7%, p<0.001), low 1 min Apgar scores (10.3% vs. 6.0%, p<0.05), urinary tract infection (UTI) (4.2% vs. 0.4%, p<0.001) and preterm delivery (less than 37 weeks gestation; 20.0% vs. 7.8%; p<0.001). Using a multivariable analysis, independent risk factors for acute antepartum pyelonephritis were nulliparity (OR 2.0; 95% C.I 1.4-2.9; p<0.001), UTI (OR 10.3; 95% C.I 4.8-22.1; p<0.001) and younger maternal age (OR 0.96; 95% C.I 0.93-0.99; p=0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7-3.9; p<0.001)., Conclusion: Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine the time trends and risk factors for intrapartum fetal death (IPFD)., Study Design: A case-control study comparing pregnancies with and without IPFD between the years 1988 and 2008 was conducted. A multiple logistic regression model was used to determine the risk factors for IPFD., Results: During the study period, 204,102 singleton births were analyzed; of these, 110 IPFD cases occurred. The following independent risk factors were identified: Bedouin ethnicity (OR = 1.85, 95% CI 1.22-2.8), malpresentations (OR = 2.76, 95% CI 1.71-4.47), gestational age (OR = 0.72, 95% CI 0.69-0.76), polyhydramnios (OR = 3.49, 95% CI 1.94-6.26), meconium-stained amniotic fluid (OR = 3.18, 95% CI 2.01-5.05), umbilical cord prolapse (OR = 6.64, 95% CI 2.79-15.78), placental abruption (OR = 3.24, 95% CI 1.73-6.04), uterine rupture (OR = 38.59, 95% CI 10.58-140.71) and congenital malformations (OR = 2.41, 95% CI 1.47-3.97). A gradual decline over the years in the rate of IPFD was noted in the Bedouin population. No significant association was noted in the prevalence of IPFD during the weekends as compared to the week days (OR = 0.85; 95% CI 0.54-1.32; P = 0.475)., Conclusion: Independent risk factors for IPFD are preterm birth, malpresentation, polyhydramnios, meconium-stained amniotic fluid, umbilical cord prolapse, placental abruption, uterine rupture, congenital malformations and Bedouin ethnicity. Weekends do not pose additional risk for the occurrence of IPFD.

Background: We wished to investigate whether women with a history of eating disorders have an increased risk for adverse obstetric and perinatal outcomes., Study Design: A retrospective study was conducted comparing pregnancy complications in patients with and without eating disorders. Deliveries occurred during the years 1988-2009 in a tertiary medical center. Women lacking prenatal care and with multiple gestations were excluded from the study. Stratified analyses were performed using multivariable logistic regression models. Odds ratios (OR) and their 95% confidence interval (CI) were computed. A p value<0.05 was considered statistically significant., Results: During the study period, of 117,875 singleton deliveries, 122 (0.1%) occurred in patients with eating disorders. Eating disorders were significantly associated with fertility treatments (5.7% vs. 2.8%, p=0.047), intrauterine growth restriction (7.4% vs. 2.3%, p<0.001), term low birth weight (<2500 g) (7.4% vs. 2.8%, p=0.002), preterm delivery (15.6% vs. 7.5%, p=0.002), and cesarean delivery (25.4% vs. 15.0%, p=0.001). Using multivariable analyses, low birth weight (OR 2.5, 95% CI 1.3-5.0), preterm delivery (OR 2.2, 95% CI 1.4-3.6), and cesarean section (OR 1.9, 95% CI 1.3-2.9) were significantly associated with eating disorders., Conclusions: Eating disorders are associated with increased risk of adverse pregnancy outcomes. Accordingly, careful surveillance is needed for early detection of possible complications.

Purpose: To evaluate obstetric complications and birth outcome in pregnant women with nephrolithiasis., Methods: A retrospective population-based study comparing all pregnancies of women with and without nephrolithiasis between 1989 and 2010 was conducted. Clinical characteristics were compared, and the obstetric risk factors and labor complication were analyzed. Multivariable logistic regression models were constructed in order to identify independent risk factors for nephrolithiasis., Results: During the study period, there were 219,656 deliveries, of which 195 women with nephrolithiasis were identified. Nephrolithiasis in pregnant women was significantly associated with recurrent abortions, mild preeclampsia, chronic hypertension, gestational diabetes mellitus, and cesarean deliveries. Nephrolithiasis was also significantly associated with urinary tract infections, pyelonephritis, hydronephrosis, and hydroureter. Nevertheless, no higher rates of premature rupture of membranes, preterm deliveries, or adverse perinatal outcomes (birth weight, Apgar scores or perinatal mortality) were noted in patients with nephrolithisais. Using a multiple logistic regression model, obesity (odds ratio 4.4, 95% confidence interval 2.1-9.0) and hypertensive disorders (odds ratio 2.8, 95% confidence interval 1.9-4.1) were independently associated with nephrolithiasis., Conclusion: Maternal kidney stones are significantly associated with several pregnancy complications, including recurrent abortions, hypertensive disorders, gestational diabetes, and cesarean deliveries. Nevertheless, it is not associated with adverse perinatal outcomes. These findings raise the question regarding the proper management of small asymptomatic kidney stone in a pregnant woman.

Objective: To investigate pregnancy outcome of patients with fibromyalgia syndrome (FMS)., Methods: A retrospective cohort study comparing pregnancies of women with and without FMS was conducted. Multivariable logistic regression models was performed to control for confounders, Results: Deliveries of 112 women with FMS were compared with a control group of 487 deliveries of women without FMS. Parturients with FMS had higher rates of intrauterine growth restriction (IUGR; 7.1% vs. 1.0%, p = 0.001), recurrent abortions (9.8% vs. 1.8%, p < 0.001), gestational diabetes mellitus (14.3% vs. 7%, p = 0.012), and polyhydramnios (12.5% vs. 1.6%, p < 0.001). These patients had lower rates of preterm deliveries (PTD; 6.3% vs. 16.7%, p = 0.018). No significant differences were noted between the groups regarding the rates of cesarean deliveries (CD) (15.2% vs. 21.2%, p = 0.149) and perinatal outcomes such as low Apgar scores (<7) at 1 and 5 min (4.5% vs. 6.7%, p = 0.292 and 1.2% vs. 0.6%, p = 0.372; respectively). Using two multiple logistic regression models, the positive association between FMS and IUGR (adjusted OR = 4.1, 95% CI 1.2-13.2; p = 0.02) and the negative association with PTD (OR = 0.3, 95% CI 0.2-0.6; p = 0.001) remained significant., Conclusion: FMS is an independent risk factor for intrauterine growth restriction. Nevertheless, it is associated with lower rates of preterm deliveries.

Background: Vitiligo, characterized by destruction of melanocytes, causes a patchy depigmentation of the skin. It has been hypothesized to have an autoimmune pathogenesis. Autoimmune disorders are more common among women and may be associated with adverse pregnancy outcomes, such as recurrent abortions, intrauterine growth restriction (IUGR), and pre-eclampsia., Objective: The purpose of this study was to investigate whether patients with vitiligo have increased rates of gestational complications., Methods: A retrospective comparative study was undertaken comparing pregnancy complications of patients with and without vitiligo. The population was composed of all singleton deliveries that occurred at the Soroka University Medical Center in Israel during the years 1988-2006. Women lacking prenatal care and multiple gestations were excluded from the study. A multivariable logistic regression model was constructed to control for confounders., Results: Of 186,222 singleton deliveries, 79 (0.04%) were patients with vitiligo. Vitiligo was not found to be associated with adverse pregnancy outcomes, including obstetric risk factors, labor characteristics and complications, and birth outcome. Using multivariable analysis, only grand multiparity (above five deliveries) was independently associated with vitiligo (OR = 2.01; 95% CI 1.2-3.2; P = 0.007)., Limitations: Retrospective analysis was a limitation., Conclusion: Vitiligo is not associated with adverse pregnancy outcomes. Accordingly, patients with vitiligo should not be managed differently from the general obstetric population., (© 2011 The International Society of Dermatology.)

Objective: To determine whether an association exists between Bell's palsy during pregnancy and adverse perinatal outcomes., Methods: A retrospective study comparing all singleton pregnancies of patients with and without Bell's palsy was conducted. Multiple logistic regression model was performed to control for confounders., Results: Out of 242,216 deliveries, 0.017% (n = 42) were diagnosed with Bell's palsy during pregnancy. Risk factors for Bell's palsy were chronic hypertension (9.5% vs. 1.5%, P < .001) and maternal obesity (7.1% vs. 0.8%, P < .001). Patients with Bell's palsy during pregnancy had higher rates of severe preeclampsia (9.5% vs. 1.1%, P < .001) and Cesarean deliveries (31.0% vs. 13.3%, P = .001) compared to the comparison group. In contrast, no significant association was documented between Bell's palsy and adverse perinatal outcomes such as low Apgar scores (<7) at 5 minutes (4.8% vs. 3.1%; P = .524) and perinatal mortality (2.4% vs. 1.4%; P = .57). Using multivariable analysis, controlling for confounders such as maternal age, fertility treatments, and ethnicity, Bell's palsy during pregnancy was significantly associated with obesity (odds ratio [OR] = 9.08 95% confidence interval [CI] 2.8-29.46; P < .001), chronic hypertension (OR = 6.69 95% CI 2.38-18.76; P < .001), and severe preeclampsia (OR = 9.46 95% CI 3.37-26.53; P < .001)., Conclusions: Chronic hypertension and obesity are independent risk factors for Bell's palsy. Bell's palsy during pregnancy is significantly associated with severe preeclampsia. Nevertheless, no significant association exists between Bell's palsy and adverse perinatal outcomes., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Objective: To investigate pregnancy outcome in patients post-total thyroidectomy., Methods: A retrospective study comparing pregnancy outcome of women post-total thyroidectomy (n = 50), patients with hypothyroidism due to other reasons (n = 1015) and pregnancies without hypothyroidism (n = 200,000) was performed., Results: A significant linear association was documented between the three groups and adverse outcomes such as placental abruption (6.1% in the total thyroidectomy group, 1.0% in hypothyroidism and 0.8% in the no-hypothyroidism group; p = 0.002), and caesarean delivery (33.3% in the total thyroidectomy, 30.4 in hypothyroidism and 14.4% in the no-hypothyroidism group; p < 0.001). Total thyroidectomy was independently associated with placental abruption and fertility treatment in a multivariable model controlling for maternal age. No significant differences were noted between the groups in terms of perinatal outcomes such as low Apgar score (<7) at 1 min (6.1% vs. 4.5% and 4.3%; p = 0.846) and 5 min (3.0% vs. 0.6% and 3.0%; p = 0.198); perinatal mortality (0.0% vs. 0.9% and 0.01%; p = 0.293)., Conclusions: Women post-total thyroidectomy and women with hypothyroidism due to other reasons are at increased risk for adverse obstetric outcomes, while the risk is higher for pregnancies with total thyroidectomy as compared to hypothyroidism due to other reasons.

Objective: To investigate pregnancy outcome of patients with dermoid and other benign ovarian cysts., Methods: A population-based study comparing all pregnancies of women with and without benign ovarian cysts was conducted. Deliveries occurred during the years 1988-2007 at Soroka University Medical Center. A multivariate logistic regression model, with backward elimination, was constructed to find independent risk factors associated with benign ovarian cysts., Results: During the study period there were 212,114 deliveries, of which 93 occurred in patients with benign ovarian cysts. Most of the lesions were benign cyatadenoma (41.9%), 36.7% were dermoid cyst, and 11.8% were adenofibroma, mostly diagnosed during cesarean delivery (76.3%). Others (12.9%) were diagnosed during pregnancy by ultrasonography and the remaining 10.8% were diagnosed before pregnancy. The mean diameter at diagnosis was 9.05+/-7.6 cm for cystadenoma, 6.09+/-3.0 cm for dermoid cyst and 4.55+/-4.1 cm for adenofibroma. Only 3 cases of ovarian torsion were noted (3.2%), and 15 cases of hospitalization due to abdominal pain (16.2%). The following conditions were significantly associated with benign ovarian cysts: hypertensive disorder [odds ratio (OR) 3.05; 95% confidence interval (CI) 1.87-4.97], and maternal age (OR 1.04; 95% CI 1.01-1.07). Ovarian dermoid cyst was significantly associated with fertility treatments (8.6 vs. 2.4% OR=3.75; 95% CI 1.1-12.2; P=0.019). In addition, after controlling for maternal age using a multivariate analysis, fertility treatments remained significantly associated with ovarian dermoid. No significant differences were noted between the groups regarding perinatal outcomes such as birth weight, low birth weight, congenital malformations, low Apgar scores, or perinatal mortality., Conclusion: The course of pregnancy of patients with dermoid and other benign ovarian cysts, including perinatal outcomes, is favorable. The cysts should be managed conservatively if possible with routine ultrasound follow up during the pregnancy since complications are extremely rare.

Little data exist on the safety of H(2)-blockers during pregnancy. A computerized database of medications dispensed from 1998 to 2007 to all women registered in the "Clalit" health maintenance organization, in the Southern District of Israel, was linked with computerized databases containing maternal and infant hospitalization records from the district hospital. The following confounders were controlled for: parity, maternal age, ethnic group, maternal diabetes, smoking, and peripartum fever. Also, therapeutic pregnancy termination data were analyzed. A total of 117 960 infants were born during the study period, 84 823 of them (72%) to women registered at Clalit; 1148 of the latter were exposed to H(2)-blockers during the first trimester of pregnancy. Exposure to H(2)-blockers was not associated with an increased risk for congenital malformations (adjusted odds ratio [OR] = 1.03, 95% confidence interval [CI]: 0.80-1.32); also, no such association was found when therapeutic pregnancy terminations were included in the analysis (adjusted OR = 1.17, 95% CI: 0.93-1.46). Exposure to H(2)-blockers was not associated with perinatal mortality, premature delivery, low birth weight, or low Apgar scores.

Objective: Evaluating the correlation between the nuchal translucency (NT) measurement throughout its range of values independent of gestational age, and adverse pregnancy outcome: in euploid structurally normal fetuses., Methods: A prospective observational study was conducted in which NT measurements were made in consecutive singleton euploid fetuses derived from an unselected pregnant population. Pregnancies terminated before the 22nd gestational week, and those with major malformations (diagnosed before or after delivery) were excluded from the analysis. We evaluated the linear association between NT thickness and selected obstetric outcomes., Results: A total of 2205 euploid singleton fetuses were evaluated during the study period. Significant linear-by-linear association was documented between the NT measurement and perinatal mortality (p < 0.001). Thicker NT was significantly associated with diabetes (either gestational or pre-gestational) (p = 0.013)., Conclusions: A linear association exists between NT thickness in chromosomally and structurally normal fetuses, and the risk for gestational diabetes and perinatal mortality.

Objective: To investigate pregnancy outcome of patients with a history of deep vein thrombosis (DVT)., Methods: A population-based study comparing all pregnancies of patients with and without a history of DVT was conducted. Deliveries occurred during the years 1988-2007 at a tertiary Medical Center. Stratified analyses were performed using multivariable logistic regression models and the Mantel-Haenszel technique., Results: During the study there were 212,086 deliveries, of which 122 (0.06%) occurred in patients with a history of DVT. Using a multivariate analysis, with backward elimination, the following conditions were significantly associated with DVT: advanced maternal age (OR, 1.1; 95% CI, 1.02-1.1; p = 0.004), chronic hypertension (OR, 2.9; 95% CI, 1.4-6.0; p = 0.005) and previous caesarean delivery (OR, 2.8; 95% CI, 1.9-4.1; p < 0.001). Patients with a history of DVT were more likely to have caesarean deliveries (OR, 2.6; 95% CI, 1.8-3.8; p < 0.001) than non-DVT patients. After controlling for possible confounders, such as maternal age, hypertensive disorders, pregestational diabetes and multiple gestations, by using another multivariate analysis with preterm delivery (<37 weeks' gestation) as the outcome variable, DVT was found to be an independent risk factor for preterm birth (OR, 1.8; 95% CI, 1.1-2.9; p = 0.033). This association remained significant after controlling for labor induction, using the Mantel-Haenszel technique (OR, 1.8; 95% CI, 1.1-3.0; p = 0.011). No significant differences were noted between the groups regarding perinatal outcomes such as low Apgar scores, congenital malformations or perinatal mortality., Conclusions: A history of DVT is an independent risk factor for spontaneous preterm delivery. Nevertheless, in our population it is not associated with adverse perinatal outcome.

Objective: To investigate pregnancy outcome of patients with Familial Mediterranean fever (FMF)., Study Design: A population-based study comparing all pregnancies of women with and without FMF between the years 1988 and 2006 was conducted. Stratified analyses, using the Mantel-Haenszel procedure and multiple logistic regression models, were performed to control for confounders., Results: During the study period there were 175,572 deliveries, of which 239 occurred in patients with FMF. Using a multivariable analysis, the following conditions were significantly associated with FMF: preterm delivery (PTD, <37 weeks) (odds ratio (OR)=1.5; 95% confidence interval (CI) 1.1-2.2), fertility treatments (OR=2.5; 95% CI 1.4-4.4), recurrent abortions (OR=2.2; 95% CI 1.5-3.2), labor induction (OR=1.9; 95% CI 1.5-2.5) and malpresentations (OR=1.8; 95% CI 1.2-2.8). Patients with FMF were more likely to deliver by cesarean delivery (CD) as compared to the comparison group (18.0% vs. 12.8%; P=0.017). However, while controlling for possible confounders such as malpresentations, labor dystocia and failed induction, using multivariable analysis with CD as the outcome variable, FMF was not found as an independent risk factor for CD (adjusted OR=1.2; 95% CI 0.8-1.8, P=0.388). No significant differences were noted between the groups regarding perinatal outcomes such as low Apgar scores (<7) at 1 and 5 min (2.4% vs. 4.3%, P=0.153 and 0.4% vs. 0.6%, P=0.692; respectively), congenital malformations (5.2% vs. 4.9%, P=0.838), or perinatal mortality (0.8% vs. 1.4%, P=0.445). Stratified analysis, using the Mantel-Haenszel technique, was used to assess the association between FMF and PTD while controlling for possible confounders such as iatrogenic labor induction, fertility treatments, recurrent abortions and placental abruption. None of those variables explained the higher incidence of PTD in the group of patients with FMF., Conclusion: Familial Mediterranean fever is an independent risk factor for preterm delivery. Nevertheless, perinatal outcome is comparable to the general population.

Objective: To compare the perinatal outcomes of women who delivered before with women who delivered after bariatric surgery., Methods: A retrospective study was undertaken to compare perinatal outcomes of women who delivered before with women who delivered after bariatric surgery in a tertiary medical center between 1988 and 2006. A multivariate logistic regression model was constructed to control for confounders., Results: During the study period, 301 deliveries preceded bariatric surgery and 507 followed surgery. A significant reduction in rates of diabetes mellitus (17.3% vs 11.0; P=0.009), hypertensive disorders (23.6% vs 11.2%; P<0.001), and fetal macrosomia (7.6% vs 3.2%; P=0.004) were noted after bariatric surgery. Bariatric surgery was found to be independently associated with a reduction in diabetes mellitus (OR 0.42, 95% CI 0.26-0.67; P<0.001), hypertensive disorders (OR 0.38, 95% CI 0.25-0.59; P<0.001), and fetal macrosomia (OR 0.45, 95% CI 0.21-0.94; P=0.033)., Conclusion: A decrease in maternal complications, such as diabetes mellitus and hypertensive disorders, as well as a decrease in the rate of fetal macrosomia is achieved following bariatric surgery.

We investigated pregnancy outcome among obese women using a prospective cohort study comparing consecutive deliveries of obese and nonobese patients. Stratified analysis, using the Mantel-Haenszel technique, was done to assess the association between obesity and the risk for cesarean delivery (CD) while controlling for confounding variables. Complete data were abstracted for 376 women, of whom 21% ( N = 79) were obese. CD rate was significantly higher among obese women (32.9% versus 18.9%; P = 0.006). Maternal obesity was associated with multiparity (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.27 to 6.97; P = 0.012), fertility treatments (OR 11.3, 95% CI 2.84 to 44.89; P = 0.001), insulin-treated gestational diabetes (OR 24.55, 95% CI 2.28 to 264.08; P = 0.008), and hydramnios (OR 20.46, 95% CI 2.17 to 192.89; P = 0.008). When controlling for possible confounders, the association between maternal obesity and CD remained significant (weighted OR 2.2, 95% CI 1.2 to 4.1; P = 0.018). No significant differences were noted between the groups regarding neonatal complications. Both first and second stages of labor were longer in obese women. Obesity is a risk factor for developing gestational hypertension, insulin-treated gestational diabetes, and hydramnios. Moreover, maternal obesity is an independent risk factor for CD. Additional independent risk factors for CD were fertility treatments, insulin-treated gestational diabetes, and hydramnios. However, neonatal outcome of obese women is comparable to women with normal prepregnancy body mass index.

Objective: To investigate pregnancy outcome in women with hypothyroidism., Study Design: A population-based study was performed comparing all singleton pregnancies of patients with and without hypothyroidism. Hypothyroidism was diagnosed and treated before pregnancy. Patients lacking prenatal care were excluded from the analysis. Deliveries occurred between the years 1998 and 2002 in a tertiary medical center. Stratified analysis using a multiple logistic regression model was performed to control for confounders., Results: During the study period 139,168 singleton deliveries occurred at our medical center. Of those, 0.8% (n = 1,102) were in patients with hypothyroidism. Using multivariate analysis with back-step elimination, the following risk factors were significantly associated with hypothyroidism: fertility treatments, recurrent abortions, diabetes mellitus, previous cesarean section and advanced maternal age. No significant differences regarding pregnancy complications, such as placental abruption, preterm deliveries or postpartum hemorrhage, were noted between the groups. However, patients with hypothyroidism had higher rates of cesarean deliveries (20.1% vs. 11.5%, p < 0.001). This association remained significant even after controlling for confounders, such as diabetes mellitus, previous cesarean section, fertility treatments, recurrent abortions and advanced maternal age using a multivariate analysis. Perinatal outcomes, including birth weight < 2,500 g (10.4% in the hypothyroidism group vs. 9.5% in the comparison group, p = 0.159), Apgar score < 7 at 5 minutes (0.8% vs. 0.6%, p = 0.312) and perinatal mortality (1.4% vs. 1.3%, p = 0.950) did not differ between the groups. Nevertheless, patients with treated hypothyroidism and adverse perinatal outcomes had well-controlled disease, using thyroxine doses of 50-100 microg daily, with mean thyroid stimulating hormone levels of 3.035 +/- 2.4 mU/L., Conclusion: Treated maternal hypothyroidism is not associated with adverse perinatal outcome. However, hypothyroidism is an independent risk factor for cesarean section.

Objective: To investigate the pregnancy outcome of patients with epilepsy., Study Design: A population-based study comparing all singleton pregnancies of patients with and without epilepsy was performed. Patients lacking prenatal care were excluded from the analysis. Deliveries occurred between the years 1988 and 2002 in a tertiary medical center. Stratified analysis, using a multiple logistic regression model, was performed to control for confounders., Results: During the study period 139 168 singleton deliveries occurred in our medical center. Of these, 220 (0.2%) were of patients with epilepsy. With the exception of gestational diabetes mellitus (GDM), no other significant differences regarding maternal outcomes were noted between the groups. However, a higher rate of congenital malformations was noted among the epileptic population (7.7% vs. 3.8%; p < 0.001). Also, a higher rate of cesarean deliveries (CD) was found among epileptic women (17.3% vs. 11.55%, p = 0.008). This association was persistent after controlling for possible confounders, using a multivariable analysis (OR = 1.5, 95% CI 1.1-2.3; p = 0.05)., Conclusion: The course of pregnancy of patients with epilepsy is favorable, except for higher rates of cesarean deliveries, GDM, and congenital malformations.

Objective: To investigate pregnancy outcome of asthmatic patients., Methods: A retrospective population-based study comparing all singleton pregnancies in women with and without asthma was conducted. Patients lacking prenatal care (less than three visits in prenatal care facilities) were excluded from the study. Deliveries occurred during the years 1988-2002. Stratified analysis, using a multiple logistic regression model was performed to control for confounders., Results: During the study period 139 168 singleton deliveries occurred, of which 1.4% in asthmatic patients (n = 963). Using a multivariate analysis, with backward elimination, the following complications were significantly associated with maternal asthma: diabetes mellitus (OR = 1.8, 95%CI 1.5-2.0, p < 0.001), fertility treatments (OR = 1.6, 95%CI 1.3-2.1, p < 0.001), intrauterine growth restriction (IUGR) (OR = 1.5, 95%CI 1.1-1.9, p = 0.004), hypertensive disorders (OR = 1.5, 95%CI 1.2-1.7, p < 0.001) and premature rupture of membranes (OR = 1.2, 95%CI 1.1-1.5, p = 0.013). Higher rates of cesarean deliveries were found among asthmatic patients as compared to the controls (17.1% vs. 11.4%, p < 0.001). This association persisted even after controlling for possible confounders such as failure to progress in labor, mal-presentations, IUGR, etc. No significant differences regarding low Apgar scores (less than 7) at 1 and 5 minutes were noted between the groups (3.9% vs. 4.4%, p = 0.268 and 0.4% vs. 0.6%, p = 0.187, respectively). Likewise, the perinatal mortality rate was similar among patients with and without asthma (1.3% vs. 1.3%, p = 0.798)., Conclusion: Pregnant women with asthma are at an increased risk for adverse maternal outcome. This association persists after controlling for variables considered to co-exist with maternal asthma. However, perinatal outcome is favorable. Careful surveillance is required in pregnancies of asthmatic patients, for early detection of possible complications.

The treatment of women in childbearing age with a mechanical heart valve is a challenge for the medical staff. Warfarin (Coumadin) is considered to be a safe and effective anticoagulant for patients with prosthetic heart valves. However, treatment during pregnancy poses many difficulties, especially during the first trimester, due to its ability to cross the placenta and its associated fetotoxicity. Treatment with heparin during the first trimester decreases the rate of embryopathy, but increases maternal morbidity and mortality. Warfarin therapy throughout pregnancy, which is common mainly in Europe, carries low rates of maternal complications and roughly six percent of embryopathy. Several studies compared warfarin treatment throughout pregnancy versus treatment with heparin during the first trimester. The relationship between daily warfarin doses and the rate of embryopathy was recently investigated. We report two cases of pregnant women with mechanical heart valves who were treated with heparin during the first trimester. Both underwent an emergency replacement of the prosthetic valve during the eighth week of pregnancy. In this article, we review the literature regarding anticoagulation therapy in pregnant women with prosthetic heart valves; the comparison between treatment with warfarin throughout pregnancy and heparin in the first trimester; and the relation of daily warfarin doses with the rate of embryopathy. The two case reports demonstrate the common approach for therapy and the danger within it. In the discussion we present a new approach for treating pregnant women with prosthetic valve and guidelines for the medical staff.

To compare maternal and neonatal outcomes following cesarean delivery during second stage of labor, according to the fetal extraction method. A retrospective cohort study of all women who underwent term cesarean delivery during the second stage of labor at a university-affiliated tertiary medical center (2012–2016). The cohort was divided according to three extraction methods: standard vertex extraction, the push method in which the head extraction is accompanied by pushing through the vagina, and the reverse breech extraction method. Primary outcomes were intraoperative maternal complications, and secondary outcomes were neonatal adverse events. Three hundred and fifty women were included, of whom 206 (59%) underwent standard vertex fetal extraction, 116 (33%) the push method extraction, and 28 (8%) reverse breech extraction. Operation time was significantly shorter in the standard vertex extraction method compared to push and reverse breech extraction methods (33.5 vs. 40.5 and 39.0 min, respectively, p =.013). Uterine laceration and incision extension frequencies were lower in the vertex extraction method as well (24.76 vs. 45.69–46.40% in others, p <.001). Delivery related neonatal injury was significantly more frequent in the reverse breech extraction method (39.29 vs. 12–15% in others, p <.001). In a multivariate analysis reverse breech extraction was associated with higher rates of uterine laceration and incision extension (OR = 2.739 95% confidence interval 1.44–6.56, p =.0237) and delivery related neonatal injury (OR = 2.837, 95% CI: 1.081–7.448, p =.0342). Standard vertex extraction method during second stage of labor cesarean delivery is safer both to the mother and neonate when compared to alternative extraction methods. NRFHR: non-reassuring fetal heart rate; NICU: neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Pregnancies conceived by in vitro fertilization (IVF) are associated with a higher prevalence of perinatal complications than pregnancies conceived spontaneously, even after correction of confounding factors. Little is known about the prevalence of complications of the third stage of labor in IVF pregnancies. To compare the prevalence and types of complications of the third stage of labor following vaginal delivery of singleton infants born to matched groups of women who conceived through IVF or spontaneously. A retrospective case-control study design was used. The electronic delivery files of a tertiary medical center were reviewed for all women with a singleton IVF pregnancy who gave birth by vaginal delivery from August 2011 to March 2014. The women were matched 1:2 for age, gravidity, parity, and week of delivery to women with a singleton spontaneously conceived pregnancy who gave birth by vaginal delivery during the same period at the same hospital. The impact of mode of conception on the length and complications of the third stage of labor was evaluated. The study group consisted of 242 women with IVF pregnancies (cases), and 484 matched controls with spontaneously conceived pregnancies (controls). The length of the third stage was similar in the cases and controls (14.23 ± 8.89 and 13.69 ± 9.19 min, respectively). IVF pregnancy was associated with a significantly higher rate of postpartum hemorrhage (PPH) (5.79 versus 1.45%, p =.001), manual removal of retained placenta (11.98 versus 7.02%, p =.025), and blood transfusion (2.07 versus 0.41%, p =.032). On multivariate analysis, pregnancy conceived by IVF was an independent risk factor for an adverse outcome of the third stage of labor (OR 2.86, 95% CI 1.53–5.33). After correction for confounders, IVF conception proved to be a significant independent risk factor for PPH, manual removal of the placenta, and blood transfusion in the third stage of labor. Therefore, the management of women who give birth vaginally following IVF pregnancy should be designed to anticipate complications in the third stage even in the absence of other risk factors. [ABSTRACT FROM AUTHOR]

Background: The two most commonly used nomograms for amniotic fluid index (AFI) were developed by Moore and Cayle and Magann et al. However, there are several inconsistencies between the two methods.Objective: The aim of the study was to determine whether these differences carry clinical significance.Methods: A retrospective cohort of women with singleton pregnancies evaluated for AFI during pregnancy at a tertiary medical center in 2007-2014 were divided into five groups: group A, definite oligohydramnios-AFI below the fifth percentile according to the nomograms of both Moore and Cayle and Magann et al.; group B, intermediate oligohydramnios-AFI below the fifth percentile according to only one nomogram (Moore and Cayle); group C, euhydramnios-normal AFI according to both nomograms; group D, intermediate polyhydramnios-AFI above the 95th percentile according to one nomogram (Magann et al.); group E, definite polyhydramnios-above the 95th percentile according to both nomograms. The association of group by maternal and perinatal outcomes was analyzed.Results: A total of 6987 women were included: group A, 996 (14%); group B, 1344 (19%); group C, 2561 (37%); group D, 1051 (15%); group E, 1034 (15%). Group B (intermediate oligohydramnios) was characterized by significantly lower rates of adverse perinatal outcomes than group A (definite oligohydramnios): small for gestational age neonate (12.3 versus 15.2%, p = .05), neonatal intensive care unit admission (11.1 versus 21.5%; p < .001), composite respiratory outcome (4.8 versus 9.8%; p < .001), and neonatal sepsis (6.4 versus 10.8%; p < .001). No such differences were found between groups B and C. Group D (intermediate polyhydramnios) differed from group E (definite polyhydramnios) by lower rates of 5 minutes Apgar score <7 (1.3 versus 3.2%; p = .003), neonatal intensive care unit admission (10.9 versus 14.4%; p = .02), and major congenital anomalies (1.7 versus 5.6%; p = .02). There was no difference in these parameters between groups D and C.Conclusion: This study suggests that intermediate oligohydramnios and intermediate polyhydramnios are not associated with adverse perinatal outcomes. Outcome in these pregnancies is similar to pregnancies with euhydramnios. Commonly used AFI nomograms should be updated. [ABSTRACT FROM AUTHOR]

Objective: To compare pregnancy outcomes following induction of labor with prostaglandins versus extra-amniotic balloon catheter indicated for term isolated oligohydramnios.Study Design: Retrospective cohort study of all women who underwent induction of labor due to term isolated oligohydramnios at a university affiliated medical center (2007-2016). The cohort was divided into two subgroups, according to induction method: vaginal prostaglandins E2 versus extra-amniotic balloon catheter. Primary outcomes were successful cervical ripening, defined as a Bishop score ≥ 8, and vaginal delivery rate. Secondary outcomes were neonatal adverse events.Results: Five hundred and ten women were included, of whom 454 (89%) underwent induction by prostaglandins and 56 (11%) by extra-amniotic balloon. Cervical ripening success rate was significantly higher in the prostaglandins group (89.4 vs. 76.79%, p = 0.006), as was the rate of vaginal delivery (77.53 vs. 48.21%, p < 0.0001). Induction with prostaglandins remained superior to extra-amniotic balloon in vaginal delivery rate following adjustment to potential confounders (aOR 3.470, 95% CI 1.296-9.296, p < 0.0001). Neonates delivered following induction with extra-amniotic balloon catheter were more often admitted to the neonatal intensive care unit (14.55 vs. 3.39%, p = 0.002).Conclusion: Both prostaglandins and extra-amniotic balloon catheter are reasonable interventions for isolated term oligohydramnios. Prostaglandins were superior to extra-amniotic balloon both in cervical ripening success and in vaginal delivery rates. [ABSTRACT FROM AUTHOR]

Objectives: To report the preoperative ultrasound (US) signs of isolated fallopian tube torsion in surgically verified cases and to estimate whether preoperative US detection of this condition can be improved. Methods: The charts of 27 women with a surgical diagnosis of isolated fallopian tube torsion at a tertiary medical center from 2005 to 2016 were retrospectively reviewed. Data were collected from the electronic database of the US unit and compared with the surgical findings. Results: Isolated fallopian tube torsion was correctly diagnosed by US before surgery in 8 of the 27 women (29.6%). In the remainder, the US signs were attributed to torsion of the ovary or the entire adnexa (n = 13), or no torsion was suspected (n = 6). Fallopian tube edema was listed as a US finding in 7 patients, of whom 5 had a correct diagnosis of isolated fallopian tube torsion. The presence of a paraovarian cyst concomitant with normal‐appearing ovaries was assumed by US in 5 of the 8 cases that were accurately diagnosed as isolated fallopian tube torsion. The most misinterpreted US finding was an ovarian cyst (suspected in 10 patients and verified at surgery in 2). Absence of blood flow was described in 12 women, of whom 5 had an accurate diagnosis of isolated fallopian tube torsion. Six of the patients with a correct US diagnosis were adults (37.5% of total adults), and 2 were adolescents (18.2% of total adolescents). Conclusions: The US diagnosis of isolated fallopian tube torsion is challenging. A high index of suspicion is necessary to improve its detection, especially when there are possible US signs of torsion in the presence of a normal‐appearing ovary. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether cesarean delivery (CD) indication, labor status, and other primary CD characteristics affect the risk for uterine rupture in subsequent deliveries.Methods: A case-control study of women attempting trial of labor after cesarean (TOLAC) in a single, tertiary, university-affiliated medical center (2007-2016). Deliveries complicated by uterine rupture were matched to successful vaginal birth after cesarean (VBAC) deliveries in a 1:3 ratio. Indication, labor status and post-partum complications (postpartum hemorrhage and postpartum infection) at primary CD were compared between study and control group.Results: During study period, there were 75,682 deliveries, of them, 3937 (5.2%) were TOLAC. Study group included 53 cases of uterine rupture at TOLAC and 159 women with successful VBAC. Women in study group had significantly lower rates of previous VBAC (15.1 vs. 28.9%, p = 0.047). Rate of postpartum complications at primary CD was significantly higher in women with TOLAC complicated by uterine rupture (7.5 vs. 1.9%, respectively, p = 0.042). Utilizing the multivariate logistic regression analysis, postpartum complications remained an independent risk factor for uterine rupture in the following TOLAC (aOR 4.07, 95% CI 1.14-14.58, p = 0.031).Conclusion: Postpartum hemorrhage and infection, in primary CD, seem to be associated with increased risk for uterine rupture during subsequent TOLAC. [ABSTRACT FROM AUTHOR]

This study describes a retrospective analysis of all women admitted for induction of labour (IoL), carrying a viable singleton foetus, after 34 + 0 weeks of gestation. We aimed to evaluate if foetal sex has an impact on the rate of caesarean delivery following labour induction. Our results demonstrate that among the 1062 women who met the inclusion criteria, 49% (521/1062) were carrying a male foetus. Other than a lower rate of Oxytocin use for the female sex pregnancies, there were no significant differences in pre-labour and labour characteristics between male or female sex pregnancies. There was no difference in caesarean delivery rate between groups (14.4% vs. 14.2%, male vs. female, respectively, p = .505). We concluded conclude that foetal sex does not impact the caesarean delivery rate among women undergoing IoL, regardless of the indication for induction and the indication for the caesarean delivery. Impact statement Male sex foetuses are at increased risk for adverse perinatal outcomes including, among others, an increased risk for caesarean delivery. The possible contribution of male sex to caesarean delivery after labour induction has not been specifically explored. Following induction of labour, there is no difference in failed induction or caesarean delivery rate between male and female sex pregnancies. Induction of labour may be safely employed for both male and female foetuses. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between subclinical hypothyroidism and preterm contractions.Methods: Prospective observational study among women at 23 + 0/7 and 34 + 6/7 weeks of gestation, with no known thyroid function abnormality, and preterm uterine contractions (PTC). All patients underwent laboratory evaluation of Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4). Patients with and without PTC were compared.Results: No association was found between PTC and subclinical hypothyroidism. Rate of spontaneous preterm delivery (PTD) was comparable between women with abnormal and normal thyroid function tests. Excluding indicated PTD, patients in the study group had a higher rate of spontaneous PTD (24.7% versus 9.6%, p = 0.03). Patients with past PTD and preterm contractions had higher rates of hypothyroxinemia compared with patients without past PTD (54.6% versus 19.0% and 31.2%, p = 0.001), and patients with past PTD (regardless of the presence or absence of PTC) had higher rate of subclinical hypothyroidism compared with patients with PTC and without PTD (59.1% and 66.7% versus 31.6%, p = 0.017).Conclusions: No association was found between PTC and subclinical hypothyroidism in the entire cohort, except for patients with preterm contractions and a history of past PTD. This specific group of patients might benefit from thyroid function evaluation. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between single previous abortion and pregnancy outcome in nulliparous women.Methods: A retrospective cohort study of all nulliparous women who delivered in a university-affiliated tertiary hospital (2009-2014). Pregnancy outcome of women with single previous first trimester abortion (study group) was compared to those of primigravida (control group).Results: Of the 44 371 deliveries during the study period, 14 498 (32.6%) were of nulliparous women, of them 1501 (10.3%) had single previous abortion (<13 weeks). Except for a higher rate of diabetes mellitus in the study group (6.1 versus 4.4%, p = 0.003), no differences were found between the groups regarding pregnancy complications. In multivariate analysis, previous single abortion was independently associated with induction of labor (OR = 1.31, 95%C.I 1.04-1.63, p = 0.01), cesarean section (OR = 1.38, 95%C.I 1.18-1.60, p < 0.001) and retained placenta (OR = 1.29, 95%C.I 1.03-1.61, p = 0.02). Among nulliparous women with previous single abortion no difference in pregnancy outcome was observed between those with previous induced termination of pregnancy and spontaneous abortion, except for increased risk for retained placenta in those with previous spontaneous abortion.Conclusion: Single early previous abortion in nulliparous women was associated with higher rate of induction of labor, cesarean section and retained placenta compared to primigravida women. [ABSTRACT FROM AUTHOR]

Objective This study aims to determine the impact of meconium-stained amniotic fluid (MSAF) in low-risk pregnancies at term on pregnancy outcome. Study Design A retrospective cohort study of women with MSAF during labor who delivered in a tertiary hospital at 37 to 41+6 weeks of gestation (2007-2013). Exclusion criteria included: multiple gestations, noncephalic presentation, fetal structural/chromosomal anomalies, hypertensive disorders, diabetes, oligohydramnios, or small for gestational age. Pregnancy outcome of women with MSAF (N = 4,893) was compared with a control group of women without MSAF (N = 39,651). Neonatal respiratory morbidity was defined as the presence of any of the following: respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, or need for ventilatory support. Results Overall, 10.9% of low-risk pregnancies at term were diagnosed with MSAF. Compared with the controls, women with MSAF had higher rates of nulliparity, gestational age at delivery ≥ 41 weeks, induction of labor, nonreassuring fetal heart rate, and operative deliveries. In multivariate analysis MSAF was associated with operative delivery (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.63-2.09; p < 0.001), cesarean section (OR, 1.48; 95% CI, 1.31-1.69; p < 0.001), respiratory morbidity (OR, 4.74; 95% CI, 3.87-5.82; p < 0.001), and increased risk for short-term neonatal morbidity. Conclusions MSAF is associated with a higher rate of adverse perinatal outcome even in low-risk pregnancies at term. [ABSTRACT FROM AUTHOR]

Objective: To estimate the association of fetal head position prior to vacuum extraction (VE) and pregnancy outcome.Study Design: A retrospective cohort study of singleton pregnancies who underwent VE. Pregnancy outcome of occipito-anterior (OA) position of the fetal head was compared to those with occipito-posterior (OP) position.Results: Amongst overall 12,063 women undergoing trial of labor, there were 1118 (9.2%) VE deliveries. Of them, 871 (77.9%) had OA and 247 (22.1%) had OP position of the fetal head. Except for a higher rate of nulliparity in the OA group, no significant differences between the groups regarding pregnancy complications and birthweight were noted. In the OP group, there were higher rates of prolonged 2nd-stage of labor as an indication for VE (49.8 vs. 36.5%, p < 0.001) and single detachment of vacuum cup (11.3 vs. 6.7%, p = 0.02) without any increased risk of failed extraction. Higher risks for sub-galeal hematoma (aOR = 4.36, p = 0.03) and low 5-min Apgar score (aOR = 4.63, p = 0.02) were observed in the OP group with otherwise similar rates of adverse maternal and neonatal outcomes.Conclusion: Among women undergoing VE, OP position is associated with higher rate of vacuum cup detachment, low 5-min Apgar score and increased risk for sub-galeal hematoma with otherwise similar rates of adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate whether midtrimester isolated short femur length is associated with pregnancy complications.Study Design: Retrospective analysis of pregnancies with a midtrimester femur length <5th percentile for gestational age compared to controls with a femur length ≥5th percentile. Outcome measures included hypertensive disorders, being small for gestational age, oligohydramnios and preterm delivery.Results: 2,105 women were eligible for this study, 85 (3.45%) of whom were in the study group and 2,020 were controls. Birth weight <10th percentile for gestational age (OR 4.4, 95% CI 2.5-7.8), birth weight <3rd percentile for gestational age (OR 31.0, 95% CI 13.3-72.3) and severe preeclampsia (OR 6.3, 95% CI 1.4-28.6) were significantly associated with midtrimester isolated short femur length.Conclusions: Midtrimester isolated short femur length is associated with higher rates of being small for gestational age and preeclampsia. [ABSTRACT FROM AUTHOR]

Purpose: As conflicting data exist concerning the implications of isolated oligohydramnios on pregnancy outcome at term, we aimed to assess this association in low-risk pregnancies. Methods: A retrospective cohort study of term pregnancies with sonographic finding of isolated oligohydramnios (amniotic fluid index (AFI) <5 cm) between 2007 and 2012. Outcome was compared to a control group of pregnancies with normal AFI (5-25 cm). Pregnancies complicated by thrombophilia, hypertension, diabetes, deviant fetal growth or chromosomal/structural abnormalities were excluded. Composite adverse outcome included CS/operative delivery due to non-reassuring heart rate (NRFHR), low Apgar score, umbilical artery pH < 7.10, neonatal intensive care admission, meconium aspiration syndrome, intubation or hypoxic-ischemic encephalopathy. Results: Overall, 987 pregnancies complicated by isolated oligohydramnios were compared to 22,280 low-risk pregnancies with normal AFI. Isolated oligohydramnios was associated with a higher rate of induction of labor (27.7 vs. 3.7 %, p < 0.001), CS due to NRFHR (2.3 vs. 1.1 %, p < 0.01) and composite adverse outcome (9.7 vs. 7.1 %, p < 0.01). However, after adjusting for potential confounders as induction of labor and nulliparity using multivariable logistic regression analysis, isolated oligohydramnios was not found to be independently associated with increased risk for composite adverse outcome (OR 1.01, 95 % CI 0.80-1.27, p = 0.93). Conclusion: Isolated oligohydramnios at term by itself is not associated with increased obstetrical morbidity. [ABSTRACT FROM AUTHOR]

Objective: To examine if, as in obesity, pregnancies complicated by gestational diabetes mellitus (GDM) exhibit increased macrophage in filtration and activated MAP-kinases in omental adipose tissue. Methods: Paired omental (OM) and abdominal subcutaneous (SC) fat samples were collected from 11 GDM and 20 normal pregnancies during cesarean delivery. Tissues were stained to detect macrophages, and analyzed to assess MAP-kinases. Results: OM had higher macrophage counts than SC in GDM (6.10 ± 2.20 versus 2.53± 1.45, p = 0.04), but not in normal pregnancies (p = 0.346). GDM pregnancies had more macrophages than normal pregnancies in OM (6.10± 2.20 versus 1.29± 0.55, p = 0.01), while only a trend was observed in SC fat (p = 0.08). Significant correlation (R = 0.619, p = 0.005) was observed between OM-macrophage in filtration and insulin resistance. Using multivariate analysis, only obesity independently associated with GDM. Expression of total p38MAP-kinase was higher in OM versus SC in both normal and GDM pregnancies, without significant differences between these groups. However, expression of activated p-p38MAP-kinase, and its upstream kinase MKK4, was comparable between fat depots. Conclusion: GDM pregnancies demonstrate increased macrophage in filtration to OM fat, correlating with higher insulin resistance. As in non-pregnant-patients obesity and OM macrophage in filtration may be on the same causal pathway, leading to GDM. Yet, this occurs without activation of p38MAP-kinase signaling. [ABSTRACT FROM AUTHOR]

Objective: To assess pregnancy outcome among women with hyperemesis gravidarum (HEG) with and without total parenteral nutrition (TPN) support. Study design: A retrospective study of all pregnant women with singleton pregnancies who were hospitalized due to HEG between 1997 and 2011. Pregnancy outcome was compared with a control group without HEG matched by maternal age and parity in a 3:1 ratio. Results: Overall 599 women were admitted during the study period with the diagnosis of HEG and subsequently delivered in our center. Of those, 122 (20.4%) received TPN support. Women in the HEG group were characterized by a higher rate of severe preeclampsia (1.3% versus 0.5%, p = 0.04), and a higher rate of preterm delivery at less than 37 and 34 weeks (10.9% versus 6.9%, p < 0.001 and 4.7% versus 1.6%, p < 0.001, respectively). Neonates in the HEG group were characterized by a lower birth weight (3074 ± 456 g versus 3248 ± 543 g, p < 0.001), higher rate of birth weight < 10th percentile (12.7% versus 6.8%, p < 0.001), and a higher rate of neonatal morbidity (8.7% versus 3.8%, p < 0.001). These associations persisted after adjustment for potential confounders, and were of most notable among women with HEG who did not receive TPN support. Conclusion: HEG is an independent risk factor for adverse pregnancy outcome. TPN support during early pregnancy is associated with a decreased risk for perinatal morbidity. [ABSTRACT FROM AUTHOR]

Objective: To assess the risk of recurrence of third- and fourth-degree perineal tears (34DPT) and to determine whether previous 34DPT is an independent risk factor for 34DPT in subsequent deliveries. Method: The study group included all women who had a vaginal delivery complicated by 34DPT (2000-2012, N = 356) and subsequently delivered again in the same medical center ( N = 204). The rate of recurrence of 34DPT was compared with a control group of women who had a previous vaginal delivery not complicated by 34DPT ( N = 58 581) and had a subsequent delivery in the same time period ( N = 23 045). Results: Women in the past-34DPT group had a higher rate of CS (18.6% versus 10.1%, p < 0.001), fetal head in occiput-posterior position (POP; 2.5% versus 0.7%, p = 0.004) and mediolateral episiotomy (25.5% versus 19.4%, p = 0.03). Women in the past-34DPT group had a higher rate of 34DPT in the subsequent delivery (2.0% versus 0.3%, p < 0.001). The rate of recurrence of 34DPT was considerably higher among women with past fourth-degree tear versus women with past third-degree tear (22.2% versus 1.0%, p < 0.001). 34DPT in previous pregnancy is independently associated with increased risk of 34DPT in subsequent delivery (OR = 4.6, 95%-CI 1.3-15.3). Conclusion: Women who experienced 34DPT in their previous pregnancy have an increased risk for recurrence of 34DPT in subsequent pregnancy, especially in cases of past fourth-degree tears. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the incidence, severity and effects of hyperemesis gravidarum (HEG) are related to fetal gender. Method: A retrospective study of all pregnant women who were admitted with the diagnosis of HEG between 1994 and 2008 ( N = 545). The association between fetal gender and pregnancy outcome in pregnancies complicated by HEG was compared to that of a control group of women with singleton pregnancies matched by maternal age and parity in a 3:1 ratio ( N = 1635). Results: Women with HEG with a female fetus were younger (28.2 ± 4.8y versus 29.5 ± 5.5y, p = 0.003), were admitted earlier in pregnancy for HEG (admission < 10w: 62.3% versus 53.4%, p = 0.04), and were more likely to require TPN support (35.6% versus 26.9%, p = 0.03) compared to women with HEG having a male fetus. Compared to controls, women with HEG were more likely to have a female rather than a male fetus (odds ratio (OR) = 1.20) although this difference reached statistical significance only for the subgroup of women with HEG who were admitted prior to 10 weeks of gestation (OR = 1.40, 95%-confidence interval (CI) 1.03-1.70) or who required TPN support (OR = 1.593, 95% CI 1.15-2.0263). The presence of a male fetus in pregnancies complicated by HEG was associated with an increased risk for preterm delivery (OR = 0.49, 95% CI 0.27-0.87), and composite neonatal morbidity (OR = 0.38, 95% CI 0.20-0.74). Conclusion: Although HEG appears to be more common and more severe in the presence of a female fetus, male fetuses appear to be more susceptible to the adverse effects of HEG on pregnancy outcome. [ABSTRACT FROM AUTHOR]

Objective: To examine whether plasma levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) during the first 20 weeks of pregnancy can predict preeclampsia in the second half of pregnancy. Methods: The study population included 150,10 registered births. Receiver operating characteristic (ROC) curve analysis was used to describe the relationship between different values of AST and ALT during the first 20 weeks of pregnancy in the prediction of preeclampsia. Results: Using ROC curve analyses, elevated ALT levels were significantly associated with both mild preeclampsia ( p < 0.001) and severe preeclampsia ( p = 0.032). However, an ALT level of 50 IU/L had a sensitivity of only 3.3% (despite a specificity of 97%) in the prediction of severe preeclampsia. While no significant association was noted between AST levels and mild preeclampsia ( p = 0.669), elevated levels of AST during this period were significantly associated with severe preeclampsia ( p = 0.027). However, AST of 50I U/L had a sensitivity of only 2.0% (despite a specificity of 98%) in the prediction of severe preeclampsia. Conclusions: Higher levels of the liver enzymes AST and ALT during the first 20 weeks of pregnancy are associated with higher risk for the development of severe preeclampsia in the second half of the pregnancy. Nevertheless, there is no clinical cutoff value that can be practically used for the prediction of preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: To assess subsequent pregnancy outcome and to identify risk factors for recurrence of preeclampsia (PET) in women with PET in their first pregnancy. Methods: A retrospective cohort study of all nulliparous women diagnosed with PET during the years 1996-2008 (PET group, N = 600). Outcome of subsequent pregnancy was compared with a control group of nulliparous women without PET matched by maternal age in a 3:1 ratio ( N = 1800). Results: Subsequent pregnancies in the PET group were characterized by a higher rate of preterm delivery at less than 37 and 34 weeks (15.2% vs. 5.7%, p < 0.001 and 3.8% vs. 0.8%, p < 0.001, respectively), placental abruption (1.7% vs. 0.2%, p = 0.004), IUGR (2.8% vs. 0.9%, p = 0.016), and PET (5.9% vs. 0.8%, p < 0.001). Risk factors for PET and adverse outcome in the subsequent pregnancy included: PET complicated by placental abruption in the index pregnancy (OR = 10.8, 95%-CI = 1.8-34.6), PET requiring delivery prior to 34 weeks in the index pregnancy (OR = 6.5, 95%-CI = 1.6-22.5), chronic hypertension (OR = 5.3, 95%-CI = 1.9-12.7), and maternal age > 35 (OR = 4.3, 95%-CI = 1.2-20.5). Conclusion: PET in the first pregnancy is independently associated with an increased risk for adverse pregnancy outcome and recurrence of PET in the subsequent pregnancy in a manner that is related to the severity of PET in the first pregnancy. [ABSTRACT FROM AUTHOR]

Objective: α1-Antitrypsin (AAT) is protective of tissue damage induced by enzymes of inflammatory cell source. Inflammatory cells are involved in preterm labor, preterm premature rupture of membrane (PPROM) and term premature rupture of membrane (PROM). The purpose of this research was to examine whether plasma concentration and activity of AAT differ between these manifestations. Methods: In a prospective case control study, blood samples were assayed for AAT concentration and activity in 71 individuals. AAT concentration and activity were measured by standard methods. Results: No significant differences were found between AAT levels ( p = 0.497) and activity ( p = 0.879) in preterm and term labor. AAT levels and activity in PPROM and PROM were not significantly different as well ( p = 0.748 and p = 0.880, respectively). While 69 out of 71 patients displayed normal circulating levels of AAT, 2 PPROM patients out of 15 had abnormally low, previously undiagnosed,AAT concentrations, and had subsequently developed complications that were absent in the other groups. Conclusions: No statistically significant differences were demonstrated in the levels of AAT between patients with preterm and term labor, nor between preterm and term PROM. Yet, unexpectedly, patients that had marked AAT deficiency belonged exclusively to the PPROM group. [ABSTRACT FROM AUTHOR]