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8. Time of Birth and the Risk of Adverse Maternal and Neonatal Outcomes—A Retrospective Cohort Study.

Author

Schwartz, Anat, Shinar, Shiri, Iton-Schwartz, Amit, Marom, Ronella, Mandel, Dror, Dangot, Ayelet, and Many, Ariel

Subjects
CESAREAN section, COHORT analysis, NEONATOLOGY, ANUS, INFANT health, BREECH delivery, BLOOD platelet transfusion
Abstract

Objectives: To determine whether in a labor floor housed continuously by senior physicians the risk of adverse maternal and neonatal outcome is affected by time of delivery. Methods: This retrospective cohort study, conducted at a tertiary medical center, assessed singleton term deliveries from 1 January 2011 to 30 January 2020. Participants were categorized based on delivery timing, correlating with nursing shifts, to evaluate perinatal outcomes. The primary endpoint included adverse maternal outcomes such as emergency Cesarean section, anal sphincter injuries, blood product transfusions, and postpartum surgeries (laparotomy/laparoscopy). Secondary outcomes focused on neonatal health indicators, including low Apgar scores, ICU admissions, respiratory issues, extended hospital stays, and neurological complications. Results: 87,863 deliveries were available for analysis with equal distribution during the day. The risk of adverse composite maternal outcome was highest during the evening (aOR 1.25, 95% CI 1.18–1.32) and lowest during the night (aOR 0.94, 95% CI 0.88–0.99) compared to daytime deliveries. This difference was primarily driven by the highest rate of emergency CD in the evening. Neonatal outcomes were comparable, except for length of stay > 5 days, which was more frequent among newborns delivered during the evening and night shifts compared to the morning shift (aOR 1.19, 95% CI 1.07–1.33 and aOR 1.17, 95% CI 1.05–1.31, respectively). Conclusions: In term pregnancies, the evening shift is associated with the highest risk of adverse maternal and neonatal outcomes despite physician seniority. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine

Author

Beharier, Ofer, Mayo, Romina Plitman, Raz, Tal, Sacks, Kira Nahum, Schreiber, Letizia, Suissa-Cohen, Yael, Chen, Rony, Gomez-Tolub, Rachel, Hadar, Eran, Gabbay- Benziv, Rinat, Moshkovich, Yuval Jaffe, Biron-Shental, Tal, Shechter-Maor, Gil, Farladansky-Gershnabel, Sivan, Sela, Hen Yitzhak, Benyamini-Raischer, Hedi, Sela, Nitzan D., Goldman-Wohl, Debra, Shulman, Ziv, Many, Ariel, Barr, Haim, Yagel, Simcha, Neeman, Michal, and Kovo, Michal

Subjects
Antigen-antibody reactions -- Health aspects, Maternal-fetal exchange -- Health aspects, Immune response -- Health aspects, Pregnant women -- Drug therapy, Infants (Newborn) -- Health aspects, Health care industry
Abstract

BACKGROUND. The significant risks posed to mothers and fetuses by COVID-19 in pregnancy have sparked a worldwide debate surrounding the pros and cons of antenatal SARS-CoV-2 inoculation, as we lack sufficient evidence regarding vaccine effectiveness in pregnant women and their offspring. We aimed to provide substantial evidence for the effect of the BNT162b2 mRNA vaccine versus native infection on maternal humoral, as well as transplacentally acquired fetal immune response, potentially providing newborn protection. METHODS. A multicenter study where parturients presenting for delivery were recruited at 8 medical centers across Israel and assigned to 3 study groups: vaccinated (n = 86); PCR-confirmed SARS-CoV-2 infected during pregnancy (n = 65), and unvaccinated noninfected controls (n = 62). Maternal and fetal blood samples were collected from parturients prior to delivery and from the umbilical cord following delivery, respectively. Sera IgG and IgM titers were measured using the Milliplex MAP SARS-CoV-2 Antigen Panel (for S1, S2, RBD, and N). RESULTS. The BNT162b2 mRNA vaccine elicits strong maternal humoral IgG response (anti-S and RBD) that crosses the placenta barrier and approaches maternal titers in the fetus within 15 days following the first dose. Maternal to neonatal antiCOVID-19 antibodies ratio did not differ when comparing sensitization (vaccine vs. infection). IgG transfer ratio at birth was significantly lower for third-trimester as compared with second trimester infection. Lastly, fetal IgM response was detected in 5 neonates, all in the infected group. CONCLUSION. Antenatal BNT162b2 mRNA vaccination induces a robust maternal humoral response that effectively transfers to the fetus, supporting the role of vaccination during pregnancy. FUNDING. Israel Science Foundation and the Weizmann Institute Fondazione Henry Krenter., Introduction The worldwide pandemic of COVID-19 continues to spread, with substantial morbidity and mortality. To date, more than 80,000 pregnant women have been infected in the U.S. alone, and the [...]

Published
2021
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28. Induction of Labor in Twins—Double Trouble?

Author

Lopian, Miriam, primary, Kashani-Ligumsky, Lior, additional, Cohen, Ronnie, additional, Wiener, Izaak, additional, Amir, Bat-Chen, additional, Gold Zamir, Yael, additional, Many, Ariel, additional, and Rosen, Hadar, additional

Published
2023
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36. TOLAC after 2 previous cesarean deliveries (TOLAC2). Why not?

Author

Lopian, Miriam, primary, Perlman, Sharon, additional, Cohen, Ronnie, additional, Gershi, Hagai, additional, Lasry, Ariel, additional, Ayalon, Tal, additional, Olteanu, Ioana, additional, Rosen, Hadar, additional, Many, Ariel, additional, and Ligumsky, Lior Kashani, additional

Published
2023
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