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Objectives: As the COVID-19 pandemic wanes, understanding maternal–fetal antibody transfer remains crucial for optimizing vaccination strategies. This study evaluates anti-SARS-CoV-2 antibody levels in amniotic fluid following maternal BNT162b2 mRNA vaccination and/or COVID-19 infection during early pregnancy, focusing on the first and second trimesters. Methods: A retrospective cohort study was conducted at a tertiary university-affiliated hospital, involving 149 pregnant women who underwent amniocentesis. Anti-SARS-CoV-2 spike IgG levels were measured in amniotic fluid samples. Participants were categorized based on vaccination and infection status: vaccine-only, infection-only, vaccine + infection, and no vaccine/infection. Correlations between antibody levels and the time since vaccination or infection were analyzed. Results: The vaccine + infection group had a higher proportion of positive antibody levels compared to the vaccine-only group (63.6% vs. 35.9%, p = 0.029). Median SARS-CoV-2 IgG levels were significantly higher in the vaccine + infection group (283.0 AU/mL) than in the vaccine-only group (64.1 AU/mL, p = 0.006). Women who received three vaccine doses had higher antibody levels and more positive antibody rates compared to those with one or two doses. A significant negative correlation was found between antibody levels and the interval since the last vaccine dose or infection. Conclusions: Our results indicate the presence of anti-SARS-CoV-2 antibodies in the amniotic fluid, reflecting antibody transfer during early pregnancy. However, a noticeable decrease in immunity was observed, as indicated by declining amniotic fluid antibody levels over time. Further studies are needed to determine the optimal timing and number of boosters required to protect against new variants of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Objective Our objective was to examine the association between sonographic estimated fetal weight (EFW) and obstetrical and neonatal outcomes in women with neonatal macrosomia. Study Design This study, conducted at a tertiary university-affiliated hospital from 2017 to 2021, compared obstetrical and neonatal outcomes between two groups of women who delivered macrosomic newborns (actual birth weight ≥ 4,000 g): (1) those with EFW ≥ 3,800 g (suspected impending macrosomia) and (2) those with EFW < 3,800 g (unsuspected impending macrosomia). Results During the study period, 854 women with neonatal macrosomia attempted vaginal delivery. Only 9.2% had a sonographic EFW ≥ 4,000 g. Among women with EFW ≥3,800 g (n = 317) compared with EFW < 3,800 g (n = 537), the cesarean delivery (CD) rate was higher (17.0 vs. 10.5%, p = 0.004) and the operative delivery rate was lower (3.2 vs. 0.6%, p = 0.015). Among primiparous women, the CD rate was higher among those with EFW ≥ 3,800 versus <3,800 g (37.3 vs. 23.2%, p = 0.033). EFW ≥3,800 g was associated with CD, regardless of predelivery body mass index, parity, diabetes mellitus, maximal fetal weight at previous deliveries, actual birth weight, and labor induction (p = 0.014). EFW ≥3,800 g and diabetes mellitus were independent predictors of CD. Among women with EFW ≥3,800 g and diabetes mellitus, the risk of CD was double that of those without diabetes and with EFW ≥ 3,800 g (31.4% vs. 15.2%, p = 0.02), although their actual birth weights were similar. Obstetrical and neonatal outcomes were similar between those with sonographic EFW ≥3,800 and < 3,800 g. Conclusion Larger EFW increased CD risk among pregnancies with actual neonatal macrosomia. Antenatally suspected macrosomia might alter labor management due to concerns for potential complications, especially when associated with primiparity, diabetes mellitus, or maternal obesity. The increase in the CD rate did not show an association with improved maternal and neonatal outcomes. Key Points Antenatally suspected macrosomia might alter labor management due to concerns about complications. Larger EFW increased cesarean delivery risk among pregnancies with actual neonatal macrosomia. The increase in the cesarean delivery rate was not associated with improved outcomes. [ABSTRACT FROM AUTHOR]

Aim: We investigated associations of maternal obesity with late gestational diabetes mellitus (GDM) diagnosis (>34 weeks) in women with previous normal glucose screening, and associations of late GDM with obstetrical outcomes. Methods: This retrospective cohort study assessed obstetrical and neonatal outcomes of 238 women with normal (24–28 week) glucose screening results, who underwent late repeat oral glucose tolerance tests (OGTT) (>34 weeks) due to a suspected LGA fetus (54.6%) or polyhydramnios (45.4%). A sub‐analysis was performed of outcomes of women with late versus mid‐trimester GDM. Results: The GDM rate in repeat OGTT screening was 22.2% for the total sample, and 33% among women with morbid obesity. Among women with late GDM versus without late GDM, rates were higher for macrosomia, large‐for‐gestational‐age fetus induction of labor, neonatal hypoglycemia, jaundice, and the need for phototherapy. Among women with late GDM, a higher pregestational BMI was associated with adverse maternal and perinatal outcomes. Higher risks for macrosomia and CS due to macrosomia were demonstrated in women with late vs. mid‐trimester GDM. Conclusion: Late screening in pregnancy may reveal GDM among women with previous normal glucose screening, particularly among those with late third trimester BMI ≥ 35 kg/m2, GDM in a previous pregnancy or fasting glucose >95 mg/dl. Women diagnosed with GDM at >34 weeks following normal glucose screening at 24–28 weeks are at higher risk for adverse perinatal outcomes. For women with morbid obesity, or suspected macrosomia or polyhydramnios in the late third trimester, and normal glucose screening in the second trimester, retesting should be considered. [ABSTRACT FROM AUTHOR]

Objective Administering prophylactic antibiotics before cesarean section (CS) decreases postpartum infections significantly. They should be administered within 60 min prior to CS. In 2014 the Israeli Ministry of Health introduced the administration of pre-operative antibiotic prophylaxis for CS as a quality criterion. This was immediately adopted by the Galilee Medical Center (GMC). This study aimed to examine the compliance to this quality standard in the GMC under 3 criteria: the type of antibiotics, timing of administration, and use of one dose only. Study design Data of women who underwent CS from the day of introducing the new quality standard on January 1, 2014, to July 31, 2015, were retrospectively analyzed. Results The study included 1790 women who delivered by elective (24.4%) or emergency CS. In general, the medical staff’s compliance to this quality standard was 90.9; 95.6% of the patients received the correct antibiotic, 94.6% had it within 65 min before surgery to 5 min after it, and 100% received it in less than 24 h. There was an increase in the overall compliance rate with time (logistic regression, p = .001). During the day shift, 60.4% of CS were emergency surgeries while during the on-call shift (evening and night) almost all (99%) of the CS were emergencies (p < .001, 2-sided). In morning shift’s emergency CS, only 4.1% of the cases were not given prophylactic antibiotics as against 7.8% in the on-call shift (p = .005). Conclusion Over a period of 18 months, the compliance to the new quality standard of administering prophylactic antibiotics before CS was 90.9%. It was particularly high in the subgroup of elective CS during the morning shift. This high compliance rate may be attributed to the introduction of clear guidelines and assignment of a specific team member, the anesthesiologist, to administer the medication. Key points Compliance rate to the guideline was 90.9%. Compliance was better in the morning shift. Compliance was better for elective cesarean section. Compliance was not affected by time. [ABSTRACT FROM AUTHOR]

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution. Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity. Material and methods: Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (= 10 µmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity. Results: The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007). A higher rate of preeclampsia was found in the severe (BA = 40 µmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018). Conclusions: The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients. [ABSTRACT FROM AUTHOR]

Objectives: To compare expectant management with early planned labor induction in pregnancies complicated by late preterm pre-labor rupture of membranes (PPROM). Material and methods: A retrospective file review was conducted in a single tertiary center from January 2015 to September 2019. Singleton pregnancies complicated by late PPROM at 34-36 completed weeks of gestation were enrolled. We compared maternal and neonatal complications between expectant management and early planned labor induction. Results: We retrospectively assigned 41 women to the expectant management group and 39 to the early planned labor induction group. No difference was found in the mode of delivery between the groups. Women in the expectant management group had a longer antepartum hospital stay compared with the induction group (median of three versus one day, p < 0.01). Neonates were delivered at a more advanced gestational age in the expectant management group compared with that in the induction group (35 5/7 versus 35 2/7 weeks, p < 0.01). In the induction group, 74.4% of the neonates were admitted to the intensive care unit (ICU), and 66.7% received antibiotics compared with 51.2% of neonates admitted to ICU and 29.3% receiving antibiotics in the expectant management group (p = 0.04 and p < 0.01, respectively). Conclusions: In pregnancies complicated by late PPROM, early labor induction was associated with a shorter antepartum maternal hospital stay but a higher neonatal ICU admission rate and more frequent antibiotic administration than expectant management. We consider expectant management to be an acceptable alternative to early labor induction in PPROM. [ABSTRACT FROM AUTHOR]

Objective: Electronic fetal heart monitor chart speeds vary between countries, and it is unclear whether differing chart speeds affect physician tracing interpretation.Methods: Twenty-minute segments of 19 tracings were displayed on both 1 and 3 cm/min strips and interpreted by 14 physicians at the particular speed they were accustomed to reading. Interpretations of tracing characteristics were compared between groups using free margin kappa, a measure of interobserver agreement.Results: Compared to 3 cm/min tracings, 1 cm/min tracings were significantly more often identified as having absent than minimal variability, and minimal than moderate variability. Accelerations were significantly more often identified in 1 versus 3 cm/min strips. There were no significant differences between groups with respect to baseline fetal heart rate, prolonged or repetitive decelerations, or American College of Obstetricians and Gynecologists tracing category. Neither chart speed had substantial interobserver agreement in tracing variables; however, agreement was consistently higher in 3 versus 1 cm/min tracings (all p < 0.05).Conclusions: Tracing interpretation is significantly affected by fetal monitor chart speed with regards to variability, acceleration and deceleration. Further studies are required to determine if differences in chart speed interpretation affect clinical management. [ABSTRACT FROM AUTHOR]

To compare neonatal morbidity in late preterm pregnancies with small-for-gestational-age fetuses, between those exposed and not exposed to antenatal corticosteroids (ACS).A retrospective study which included growth-restricted fetuses delivered at gestational week 34+0 to 36+6 weeks at a tertiary university-affiliated hospital, from March 2016 to March 2022. The primary composite outcome included the need for oxygen therapy or ventilation, respiratory distress syndrome, transient tachypnea of the newborn, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade III/IV and neonatal mortality.The primary composite outcome was comparable between those who did and did not receive ACS (26.1 vs. 20.8 %, p=0.512). Neonatal morbidity rates did not differ significantly between the groups, except for hypoglycemia, which was more common among neonates from ACS-exposed mothers (37.0 vs. 19.5 %, p=0.037). Multivariate analysis, adjusted for gestational diabetes and the mode of delivery showed no significant difference in the composite outcome between the groups (OR=2.03, 95 % CI 0.79–5.20, p=0.142). Cesarean delivery was associated with a higher risk of the primary outcome (OR=2.13, 95 % CI 1.17–3.85, p=0.013). After excluding those who did not receive the initial betamethasone dose within 2–7 days before delivery, the primary composite outcome remained similar between the groups. The primary composite outcome was similar among severely growth-restricted fetuses (<5th percentile) exposed and not exposed to ACS (29.2 vs. 22.0 %, p=0.560).Among preterm pregnancies complicated by small-for-gestational-age fetuses, ACS did not lower the rate of neonatal morbidity. [ABSTRACT FROM AUTHOR]

To compare gestational weight gain (GWG) during pregnancy and obesity-related maternal morbidity between three months of the first year of the COVID-19 pandemic and three months of the previous year.A retrospective comparative study was conducted in a tertiary university-affiliated hospital. GWG, obesity rates and pregnancy complications were compared between the time periods.Among women with class I obesity, GWG was higher during the pandemic (n = 1071) than the previous year (n = 1194): 11.16 vs. 8.69 kg, p = 0.04. Women during the pandemic compared to the previous year were less likely to be diagnosed with gestational diabetes (odds ratio [OR] = 0.66, 95% confidence interval [CI] 0.47–0.91, p = 0.01) or hypertensive disorders of pregnancy (OR = 0.63, 95% CI 0.35–1.0, p = 0.05) after adjustment for parity, mode of conception and advanced maternal age.Gestational weight gain increased during the pandemic, yet rates of obesity-related complications were notably fewer. This is likely attributed to decreased detection consequent to limited antenatal care. [ABSTRACT FROM AUTHOR]