61 results on '"Shlomi Sagi"'
Search Results
2. Comparison between the modified French AmbUlatory Cesarean Section and standard cesarean technique—a randomized double-blind controlled trial
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Shlomi Sagi, Inna Bleicher, Rabia Bakhous, Amir Pelts, Samira Talhamy, Orna Caspin, Rami Sammour, and Lena Sagi-Dain
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Obstetrics and Gynecology ,General Medicine - Published
- 2023
3. Early exploration of COVID-19 vaccination safety and effectiveness during pregnancy: interim descriptive data from a prospective observational study
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Shlomi Sagi, Einav kadour-Peero, Lena Sagi-Dain, and Inna Bleicher
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medicine.medical_specialty ,COVID-19 Vaccines ,Population ,Article ,Pregnancy vaccination ,Pregnancy ,Humans ,Medicine ,Vaginal bleeding ,Prospective Studies ,Child ,Prospective cohort study ,education ,BNT162 Vaccine ,Covid-19 vaccine ,education.field_of_study ,General Veterinary ,General Immunology and Microbiology ,SARS-CoV-2 ,business.industry ,Obstetrics ,Vaccination ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,COVID-19 ,Gestational age ,medicine.disease ,Gestational diabetes ,mRNA vaccine ,Infectious Diseases ,Premature birth ,Premature Birth ,Molecular Medicine ,Female ,medicine.symptom ,business ,Cohort study - Abstract
Objective During December 2020, a massive vaccination program was introduced in our country. The Pfizer-BioNTech, BNT162b2 vaccine was first offered exclusively to high-risk population, such as medical personnel (including pregnant women). In this study we compare short term outcomes in vaccinated vs. non-vaccinated pregnant women. Methods In this prospective observational cohort study, vaccinated and non-vaccinated pregnant women were recruited using an online Google forms questionnaire targeting medical groups on Facebook and WhatsApp. A second questionnaire was sent one month after the first one for interim analysis. Our primary outcome was composite complications in vaccinated and non-vaccinated groups, considered any of the following: vaginal bleeding, pregnancy loss, hypertension, gestational diabetes, and preterm birth. Secondary outcomes included: vaccine side effects, diagnosis of COVID-19 since the last questionnaire, prevalence of vaccinated participants, and reasons for refusal to be vaccinated. Results Overall, 432 women answered the first questionnaire, of which 326 responses were received to the second questionnaire. Vaccination rate increased from 25.5% to 62% within a month. Maternal age, gestational age at enrollment, nulliparity and number of children were similar in both groups. The rate of composite pregnancy complications was similar between vaccinated and non-vaccinated group (15.8% vs 20.1%, p = 0.37), respectively. The risk for COVID-19 infection was significantly lower in the vaccinated group (1.5% vs 6.5%, p = 0.024, Odds Ratio: 4.5, 95% confidence interval 1.19-17.6). Conclusions mRNA vaccine during pregnancy does not seem to increase the rate of pregnancy complications and is effective in prevention of COVID-19 infection.
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- 2021
4. Double balloon device for labor induction in women with and without previous cesarean delivery
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Inna Bleicher, Marianna DASHKOVSKY-FELDGORN, Shlomi SAGI, Ola GUTZEIT, Lihi BLUMEN, Naama Farrago, Nizar KHATIB, Yaniv ZIPORI, and Dana VITNER
- Abstract
Purpose Induction of labor (IOL) after cesarean delivery is reasonable option and should be discussed. While IOL has been shown to be superior to expectant management in low-risk nulliparous women, the literature in women after cesarean delivery (CD) is sparse. The aim of our study was to compare IOL between in nulliparous women to women who had IOL after cesarean (TOLAC) Methods This was a retrospective cohort study, from two medical centers, that compared between TOLAC and nulliparous women who had IOL with a double balloon device. Inclusion criteria were: singleton pregnancy > 37 + 0 weeks and no contraindication for vaginal delivery. We excluded women who withdrew their consent for TOLAC. Primary outcome was the mode of delivery. Results: We compared 161 TOLAC to 1577 nulliparous women. Vaginal delivery rate was 70% in both groups, and CD rate remained similar even after adjusting for confounders (29.8% vs. 28.9%, OR 1.1, 95% CI = 0.76–1.58, p = 0.59). CD due to non-reassuring fetal heart rate (NRFHR) was more common in the TOLAC group (75% vs. 56%, p = 0.014) and CD due to non-progressive labor (NPL) was more likely in the Nulliparous group (45.4% vs. 25%, p = 0.014). Other secondary maternal and neonatal outcomes remained similar between groups. Conclusion: Induction of labor, with double balloon device in women with a previous cesarean delivery, results in a similar vaginal delivery rate when compared to nulliparous women, with no additional adverse maternal or neonatal outcome. Labor progression might be different in these women attempting TOLAC, and if managed accordingly, VBAC can be achieved in a higher rate when given a genuine trial of labor, regardless of a previous vaginal delivery.
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- 2022
5. Are we preventing the primary cesarean delivery at the second stage of labor following ACOG-SMFM new guidelines? Retrospective cohort study
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Inna Bleicher, Janan Awad, Dana Vitner, Shlomi Sagi, Einav Kadour-Peero, and Ron Gonen
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medicine.medical_specialty ,Cesarean Section ,Obstetrics ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,Delivery, Obstetric ,Perinatology ,Obstetric care ,Maternal-fetal medicine ,Pregnancy ,Labor Stage, Second ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Female ,Cesarean delivery ,Stage (cooking) ,business ,Retrospective Studies - Abstract
In 2014, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) published an Obstetric Care Consensus for safe prevention of primary cesarean delivery. We aimed to assess whether these guidelines decreased the primary CD rate during the second stage of labor, in our department.A retrospective cohort study of all women reaching the second stage of labor, at term, in a single university-affiliated medical center between2010 and 2017.We compared maternal and neonatal outcomes over three year's periods:-pre-guidelines (2010-2013) vs. 2nd period - post-guidelines (2014-2017).CD rate at 2ndstage of labor.The study included 11,464 women. The CD rate in the 2nd stage of labor has increased significantly from 4% to 5.9% in the post-guidelines period (OR 1.48, 95% CI 1.16-1.89,The implementation of the new ACOG and SMFM guidelines was not associated with a change in the CD rate performed at the 2nd stage of labor in the whole study population. However, there was a rise in the CD rate performed at the 2nd stage in nulliparous women. Furthermore, there was an increase in operative deliveries in the whole study population, especially in multiparous women, without an apparent increase in other immediate adverse neonatal or maternal outcomes.
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- 2021
6. COVID-19 vaccination during pregnancy – short- and long-term outcomes of a prospective cohort study
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Inna Bleicher, Dafna Ben Yehuda, Fyrooz Yossef, Shlomi Sagi, Lena Sagi-Dain, and Lisa Kaly
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Obstetrics and Gynecology - Published
- 2023
7. The Maternal Age Cut-Off for an Increase in Composite Adverse Outcomes
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Janan Awad, Dana Vitner, Shlomi Sagi, and Einav Kadour-Peero
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Adult ,medicine.medical_specialty ,Adverse outcomes ,Birth weight ,Youden's J statistic ,Logistic regression ,Pregnancy ,medicine ,Humans ,Cesarean delivery ,Retrospective Studies ,Receiver operating characteristic ,Obstetrics ,business.industry ,Cesarean Section ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Retrospective cohort study ,Hypertension, Pregnancy-Induced ,medicine.disease ,Gestational diabetes ,Diabetes, Gestational ,Female ,business ,Maternal Age - Abstract
To investigate whether there is a specific maternal age cut-off at which there is an increase in maternal and neonatal adverse outcomes.A retrospective study comparing maternal and neonatal outcomes between nulliparous women of different ages. The receiver operating characteristic model with the Youden index was used to find the best age cut-off using cesarean delivery (CD) and composite adverse outcomes. A multivariable logistic regression analysis was calculated after adjusting for smoking, induction of labour, epidural use, hypertensive disorders, gestational diabetes, and birth weight.The study included 11 343 nulliparous women. Age 28 years was found to be the cut-off age at which we found a significant increase in adverse outcomes. Women older than age 28 years had a higher risk of CD than women younger than 28 years (35.7% vs. 21.3%, P0.0001). They were also more likely to deliver prematurely (11.9% vs. 7.9%; P0.0001) and had higher rates hypertensive disorders (2.3% vs. 1.1%; P0.0001) and gestational diabetes mellitus (0.4% vs. 0.1%; P = 0.001). Furthermore, their babies were more likely to be growth restricted (1.1% vs. 0.3%; P0.0001). There were no differences in the rates of induction of labour or macrosomia. After adjusting for confounders, we found that women older than 28 years had higher risks of CD and adverse outcomes than younger women (aOR 1.9 [95% CI 1.744-2.1] and aOR 1.6 [95% CI 1.6-1.77], respectively).Increasing maternal age is independently associated with adverse maternal and neonatal outcomes with an age cut-off of 28 years. Women older than age 28 years are at higher risk for composite adverse outcomes than younger women.
- Published
- 2021
8. Does prenatal identification of fetal macrosomia change management and outcome?
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Dana Vitner, Hayley Lipworth, Shlomi Sagi, Einav Kadour-Peero, Ron Gonen, and Inna Bleicher
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Adult ,Episiotomy ,medicine.medical_specialty ,endocrine system diseases ,medicine.medical_treatment ,Fetal Macrosomia ,Cohort Studies ,03 medical and health sciences ,Shoulder dystocia ,0302 clinical medicine ,Pregnancy ,Heart rate ,Fetal macrosomia ,medicine ,Humans ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Infant, Newborn ,Obstetrics and Gynecology ,Prenatal Care ,Retrospective cohort study ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,Birth injury ,Pregnancy Complications ,Increased risk ,Neonatal outcomes ,030220 oncology & carcinogenesis ,Female ,business - Abstract
To assess whether there is an association between predicted fetal macrosomia and adverse outcomes in macrosomic newborns (> 4000 g), based on a sonographic evaluation up to 2 weeks prior to delivery. A retrospective cohort study of 3098 mothers of macrosomic babies who were delivered at our institution (2000–2015). We compared the management and outcomes of women with predicted fetal macrosomia with that of women with unknown fetal macrosomia. The primary outcomes were cesarean section (CS) rate and postpartum hemorrhage. Secondary outcomes were composite maternal and neonatal outcomes and birth injuries. In 601 (19.4%) women fetal macrosomia was predicted, and in 2497 (80.6%) women, fetal macrosomia was unknown. CS rate was more than 3.5 times higher in the group of predicted macrosomia (47.2% vs. 12.7%, P
- Published
- 2018
9. Induction of labor versus expectant management among women with macrosomic neonates: a retrospective study
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Shlomi Sagi, Einav Kadour-Peero, Liron Borenstein-Levin, Amir Kugelman, Inna Bleicher, Dana Vitner, and Ron Gonen
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Adult ,Male ,medicine.medical_specialty ,Fetal Macrosomia ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Macrosomic fetus ,030225 pediatrics ,medicine ,Humans ,Labor, Induced ,Watchful Waiting ,reproductive and urinary physiology ,Expectant management ,Retrospective Studies ,Fetus ,030219 obstetrics & reproductive medicine ,Cesarean Section ,Obstetrics ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,Induction of labor ,medicine.disease ,Birth injury ,Treatment Outcome ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Background: The macrosomic fetus predisposes a variety of adverse maternal and perinatal outcomes. Although older studies have shown no benefit in inducing women of suspected macrosomic fetuses, mo...
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- 2018
10. In women with spontaneous vaginal delivery, repair of perineal tears might be easier compared to episiotomy
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Rabia Bahous, Shlomi Sagi, Chen Shkolnik, Lena Sagi-Dain, and Inna Kreinin-Bleicher
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Episiotomy ,Spontaneous vaginal delivery ,medicine.medical_specialty ,Urology ,Subjective rating ,medicine.medical_treatment ,030232 urology & nephrology ,Spontaneous vaginal ,Perineum ,Lacerations ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Suture (anatomy) ,Randomized controlled trial ,law ,Pregnancy ,Medicine ,Humans ,030219 obstetrics & reproductive medicine ,Sutures ,business.industry ,Vaginal delivery ,Obstetrics and Gynecology ,Delivery, Obstetric ,Surgery ,Obstetric Labor Complications ,Tears ,Female ,business - Abstract
To examine a common assumption that suturing of episiotomy, a straight performer-controlled incision, might be easier compared to repair of unpredictable spontaneous perineal tears. Data for this study were collected prospectively, as part of a randomized controlled trial examining the outcomes of episiotomy avoidance. Suturing characteristics were compared between vaginal deliveries with episiotomy vs. spontaneous perineal tears. Primary outcomes included the duration of the repair, number of suture packs used for the repair, and subjective rating of suturing difficulty (rated from 1 to 5 by practitioner performing the suturing). Of 525 vaginal deliveries, episiotomy was performed in 165 (31.4%) of the cases, 59 of which (35.8%) were accompanied by additional vaginal tears. Spontaneous vaginal tears without episiotomy were noted in 272 deliveries (51.8%). Compared to spontaneous perineal tears, episiotomy performance was associated with an adverse effect on all three suturing characteristics in the overall cohort and in subgroup of non-operative deliveries. When comparing episiotomy only to second-degree tear suturing, in the subgroup of non-operative vaginal deliveries a higher rate of suturing duration < 10 min was noted in favor of spontaneous tears. However, in sub-analysis of vacuum-assisted deliveries, a benefit was noted in favor of the episiotomy-only group in terms of fewer suture packs and lower subjective difficulty. In women with non-operative vaginal delivery, suturing of spontaneous perineal tears was easier and shorter compared to episiotomy repair. This might be related to the unpredictable nature of perineal tears, which might be shorter and shallower compared to the standard episiotomy incision.
- Published
- 2020
11. In reply: Letter to the editor: Is it time to abandon episiotomy use? A randomized controlled trial (epitrial)
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Shlomi Sagi, Rabia Bahous, Lena Sagi-Dain, and Inna Kreinin-Bleicher
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Episiotomy ,medicine.medical_specialty ,Letter to the editor ,business.industry ,Urology ,General surgery ,medicine.medical_treatment ,MEDLINE ,Obstetrics and Gynecology ,Perineum ,law.invention ,Randomized controlled trial ,law ,Pregnancy ,medicine ,Humans ,Female ,business - Published
- 2020
12. Double-Balloon Device for 6 Compared With 12 Hours for Cervical Ripening: A Randomized Controlled Trial
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Rami N. Sammour, Aya Eshel, Shlomi Sagi, Inna Bleicher, Dana Vitner, Ron Gonen, Liraz Nussam, Elena Dikopoltsev, and Einav Kadour-Ferro
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Adult ,medicine.medical_specialty ,Time Factors ,Fever ,Bishop score ,Cervix Uteri ,Balloon ,law.invention ,Catheterization ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Pregnancy ,Oxytocics ,medicine ,Humans ,030212 general & internal medicine ,Labor, Induced ,Prospective Studies ,Cervix ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Cesarean Section ,Obstetrics and Gynecology ,Ripening ,Odds ratio ,Delivery, Obstetric ,Clinical trial ,Pregnancy Complications ,Parity ,medicine.anatomical_structure ,Cohort ,Female ,business ,Cervical Ripening - Abstract
OBJECTIVE To evaluate whether removal of a double-balloon device for cervical ripening for 6 compared with 12 hours in women with an unfavorable cervix will result in a shorter time to delivery, similar cervical ripening, and without affecting cesarean delivery rate. METHODS In a prospective randomized trial, cervical ripening was performed using a double-balloon device. Women were randomized to removal of the device after 6 compared with 12 hours. Primary outcome was time to delivery. Secondary outcomes included mode of delivery, Bishop score, and maternal and neonatal adverse outcomes. A sample size of 100 nulliparous and 100 parous women was required assuming a 95% CI, power of 80%, and mean decrease of 6 hours to delivery between the groups. RESULTS From March 2017 through February 2019, 688 women were screened, 243 were found eligible, and 197 were randomized as follows: nulliparous cohort (n=101): removal after 6 hours (n=48) compared with removal after 12 hours (n=53); parous cohort (n=96): removal after 6 hours (n=49) compared with removal after 12 hours (n=47). Insertion-to-delivery interval was significantly shorter in the 6-hour group for both nulliparous (25.6±12.8 hours vs 31.4±15.2 hours, P
- Published
- 2020
13. The effect of late pregnancy date fruit consumption on delivery progress - A meta-analysis
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Shlomi Sagi and Lena Sagi-Dain
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Consumption (economics) ,medicine.medical_specialty ,Labor, Obstetric ,Obstetrics ,business.industry ,medicine.medical_treatment ,Latent phase ,Phoeniceae ,Late pregnancy ,Confidence interval ,Complementary and alternative medicine ,Pregnancy ,Meta-analysis ,Relative risk ,Labor induction ,medicine ,Humans ,Female ,Chiropractics ,business ,General Nursing ,Analysis ,Date Fruit - Abstract
Objective To summarize the available evidence exploring the influence of date fruit consumption on delivery outcomes. Methods A search was conducted for relevant articles in three databases for manuscripts in English, with no time restrictions. Results Four articles were eligible for inclusion. Women consuming date fruit were admitted with higher cervical dilatation (mean difference (MD) 1.1 cm [95% confidence interval (CI) 0.2-1.99 cm) and yielded a lower need for labor induction/augmentation (relative risk (RR) 0.6, 95% CI 0.43-0.83). Date fruit consumption was associated with shorter latent phase (MD -4.6 hours, 95% CI -7.77 to -1.4) and second stage duration (MD -7.7 minutes, 95% CI -12.0 to -3.4). Conclusions Although the overall quality of the included studies was weak due to high risk of bias, the results of our meta-analysis point to beneficial effects of date fruit consumption on labor process. fruit
- Published
- 2020
14. Clinical Use and Optimal Cutoff Value of Ca15-3 in Evaluation of Adnexal Mass
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Ofer Lavie, Shlomi Sagi, Lena Sagi-Dain, and Ron Auslander
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Adult ,CA15-3 ,Cancer Research ,medicine.medical_specialty ,Adolescent ,Malignancy ,Adnexal mass ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Biomarkers, Tumor ,Humans ,Medicine ,Cutoff ,Young adult ,Aged ,Retrospective Studies ,Aged, 80 and over ,Ovarian Neoplasms ,Gynecology ,030219 obstetrics & reproductive medicine ,Receiver operating characteristic ,business.industry ,Mucin-1 ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,ROC Curve ,Oncology ,Adnexal Diseases ,030220 oncology & carcinogenesis ,Female ,Radiology ,business ,Follow-Up Studies - Abstract
Objective: To estimate the diagnostic performance and reference values of serum cancer antigen (Ca)15-3 levels in the triage of adnexal masses. Materials and Methods: This retrospective cohort study was carried out in 481 patients referred to the Gynecology Department at Carmel Medical Center due to adnexal mass between years 2005 and 2012. All patients underwent surgery with histopathologically confirmed diagnosis and routine preoperative measurements of serum Ca125 and Ca15-3. Results: Combination of Ca125 with Ca15-3 elevated the sensitivity of Ca125 alone (from 86.9% to 93.2%; P=0.029), along with reduction of its specificity (from 80.5% to 69.5%; P=0.005) in differentiation between malignant and benign cases. According to receiver operating characteristic curve, Ca15-3 level of 21 U/mL was shown to be the optimal reference value for malignancy detection. All cases with Ca15-3 levels above 44.5 U/mL were malignant, mostly of primary ovarian source. Conclusions: As Ca15-3 assessment allowed detection of significantly more malignancy cases, we believe that measurement of this marker in combination with Ca125 is worthwhile in patients presenting with adnexal masses. The cutoff of 21 U/mL seems to be the optimal value in this specific population. High Ca15-3 levels (above 44.5 U/mL) strongly direct to a diagnosis of malignancy, mostly of primary ovarian tumors rather than breast malignancy.
- Published
- 2018
15. [ISOLATED OLIGOHYDRAMNIOS - THE DILEMMA OF PROPER MANAGEMENT]
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Marina, Marks Kazatsker, Rami, Sammour, and Shlomi, Sagi
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Meconium Aspiration Syndrome ,Pregnancy ,Infant, Newborn ,Pregnancy Outcome ,Humans ,Female ,Labor, Induced ,Amniotic Fluid ,Oligohydramnios - Abstract
There are two methods to diagnose oligohydramnios: maximal vertical pocket (MVP) and amniotic fluid index (AFI). Following a recent large Cochrane review and other studies, MVP is being recommended as the method of choice by professional societies, after it was shown to result in fewer inductions of labor and C-sections (CS), without compromising neonatal outcome. There is controversy regarding the management of isolated oligohydramnios (IO). It is unclear whether this finding reflects an underlying pathological process, and therefore management protocols differ between different institutions. Studies have shown a higher rate of CS (RR of2) in IO. Whether this is a true complication of IO or is a result of different confounders like labor inductions and primigravidity is unclear. The effects on neonatal outcomes are also unclear; whereas some authors did not show any adverse effects, others have shown higher rates of neonatal intensive care unit (NICU) admissions, lower Apgar scores and higher rate of Meconium aspiration syndrome. Some studies have shown a higher rate of undiagnosed small for gestational age (SGA) in IO pregnancies. There is no consensus regarding the optimal management and time of delivery. Until now, common practice was to induce labor at term, and some advocate induction in late preterm. Recently, the growing awareness to early term morbidity has led practitioners to question the benefit of early induction. There are several studies that have shown maternal hydration to improve AFI, but there is insufficient data to show the effect on outcomes. In conclusion, many questions regarding IO are still unanswered, and further research, specifically RCT studies, is needed.
- Published
- 2019
16. Primary Papillary Serous Carcinoma of the Fallopian Tube Presenting as a Vaginal Mass: A Case Report and Review of the Literature
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Shlomi Sagi, Lena Sagi-Dain, Einav Kadour-Peero, Jacob Bejar, Gil Cohen, Roman Korobochka, and Abed Agbarya
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Adult ,030213 general clinical medicine ,medicine.medical_specialty ,Vaginal Neoplasms ,Serous carcinoma ,Genital Neoplasms, Female ,medicine.medical_treatment ,Uterus ,Vaginal neoplasm ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cystadenocarcinoma ,Fallopian Tubes ,Ovarian Neoplasms ,business.industry ,Vaginectomy ,General Medicine ,Articles ,medicine.disease ,female genital diseases and pregnancy complications ,Cystadenocarcinoma, Serous ,Serous fluid ,Adenocarcinoma, Papillary ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Right Fallopian Tube ,Cystadenocarcinoma, Papillary ,Female ,Radiology ,Uterine Hemorrhage ,business ,Fallopian tube - Abstract
Patient: Female, 41 Final Diagnosis: Serous papillary carcinoma Symptoms: Vaginal discharge • weakness Medication: — Clinical Procedure: Total abdominal hysterectomy Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: There is now evidence to support that some cases of high-grade serous papillary carcinoma arise from the fallopian tubes rather than the ovaries. Common symptoms at presentation include abdominal pain and swelling, vomiting, altered bowel habit and urinary symptoms. To our knowledge, this is the first case of serous papillary carcinoma presenting as a vaginal mass lesion. Case Report: A 41-year-old woman was referred to the Bnai-Zion Medical Center with the main complaint of irregular vaginal bleeding, vaginal mucous discharge, and suspected pelvic mass. Physical examination showed a soft, painless mass, measuring about 10 cm in diameter located mainly in the recto-vaginal septum, but not involving the uterus. Ultrasound examination showed no abnormal ovarian or uterine findings. Transvaginal biopsies of the mass showed a poorly differentiated serous papillary carcinoma of ovarian, tubal, or peritoneal origin. The physical examination and imaging findings strongly indicated an inoperable tumor, and the patient was treated with neoadjuvant (pre-surgical) chemotherapy. Pre-operative computed tomography (CT) imaging showed the partial involvement of the colon, and so surgical treatment included total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, partial vaginectomy, anterior rectal resection, and lymph node dissection. Histopathology of the surgical specimens showed a poorly differentiated serous carcinoma originating from the fimbria of the right fallopian tube. Conclusions: To the best of our knowledge, this is the first report to describe primary fallopian tube papillary serous carcinoma presenting as a vaginal mass. Therefore, physicians should be aware of this possible diagnosis.
- Published
- 2018
17. When should repeat cesarean delivery be scheduled, after two or more previous cesarean deliveries?
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Inna Bleicher, Ron Gonen, Eyal Levy, Ronen Sloma, Shlomi Sagi, Rabea Bahous, Einav Kadour-Peero, and Dana Vitner
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Adult ,medicine.medical_specialty ,Birth weight ,Gestational Age ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,030225 pediatrics ,medicine ,Birth Weight ,Humans ,Cesarean Section, Repeat ,Cesarean delivery ,reproductive and urinary physiology ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Previous cesarean ,Obstetrics ,business.industry ,Guideline adherence ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,Neonatal morbidity ,Logistic Models ,surgical procedures, operative ,Pediatrics, Perinatology and Child Health ,Female ,Guideline Adherence ,business - Abstract
The optimal gestational age for a planned high-order cesarean delivery (CD) reflects the balance between the risk of neonatal morbidity and the risk of unscheduled cesarean delivery prior to the scheduled date.A retrospective cohort study of 656 women with ≥2 previous CDs were divided in two groups of women based on the gestational age at which the CD was scheduled: "38 group" and "39 group". Medical records were reviewed for demographic, medical and obstetrical history, and for adverse maternal and neonatal outcomes.The rate of unscheduled CDs was significantly higher among the 39 group (23.2% vs. 12.7%). There were no significant differences in the rate of maternal or neonatal composite adverse outcome between the two groups. The rate of neonatal respiratory morbidity, however, was higher among the 38 group (5.8% vs. 2.1%).Compared with planned CD, unscheduled CD was associated with a similar rate of maternal composite adverse outcome, but with increased rate of neonatal composite adverse outcome (23.3% vs. 8%, respectively). In a multivariable logistic regression analysis we found that this latter association was due to the earlier actual gestational age at delivery in cases of unscheduled versus planned CD.Planned CD at 39 weeks, rather than at 38 weeks, is associated with more unscheduled CDs, a similar rate of maternal and neonatal composite morbidity, but a decreased rate of neonatal respiratory morbidity.
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- 2017
18. 760: Is there an obstetrical risk in adolescence pregnancy?
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Shlomi Sagi, Dana Vitner, Inbal Willner, Einav Kadour-Peero, Janan Awad, and inna Blaicher
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medicine.medical_specialty ,Adolescence pregnancy ,Obstetrics ,Obstetrical risk ,business.industry ,medicine ,Obstetrics and Gynecology ,business - Published
- 2020
19. 1201: Effect of antepartum perineal massage on perineal tears during first vaginal delivery
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Rabia Bahous, Inna Bleicher, Lena Sagi-Dain, and Shlomi Sagi
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Perineal massage ,medicine.medical_specialty ,business.industry ,Vaginal delivery ,Obstetrics ,Obstetrics and Gynecology ,Medicine ,Tears ,business - Published
- 2020
20. Pregnancy outcomes in oocyte recipients with fibroids not impinging uterine cavity
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Shlomi Sagi, David Bider, Viktor Zinchenko, Martha Dirnfeld, Sharon Walster, Lena Sagi-Dain, Jacob Levron, and K. Ojha
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Adult ,0301 basic medicine ,medicine.medical_specialty ,Uterine fibroids ,Fertilization in Vitro ,Endometrium ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Uterine Myomectomy ,medicine ,Humans ,Risk factor ,Adverse effect ,Pregnancy outcomes ,Retrospective Studies ,Gynecology ,030219 obstetrics & reproductive medicine ,Leiomyoma ,Oocyte Donation ,business.industry ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,General Medicine ,Oocyte ,medicine.disease ,Abortion, Spontaneous ,030104 developmental biology ,medicine.anatomical_structure ,Uterine Neoplasms ,Female ,Uterine cavity ,Live birth ,business ,Live Birth ,Pregnancy Complications, Neoplastic - Abstract
To examine the effects of fibroid uterus on pregnancy outcomes and endometrial features in ovum donation recipients. Retrospective analysis of 744 ovum donation cycles was conducted in two private IVF centers between 2005 and 2012. All the recipients underwent transvaginal ultrasound examination, including endometrial thickness and grade measurements. Clinical pregnancy, spontaneous miscarriage, and live birth rates were regarded as the primary outcomes. Leimyomas not distorting the uterine cavity were diagnosed in 264 (35.5%) of the cycles. This group exhibited lower endometrial thickness (8.33 ± 1.8 vs. 8.73 ± 2.03 mm, p = 0.009), lower rates of Grade A (16.1 vs. 30.1%, p
- Published
- 2016
21. The effectiveness of foot reflexology in reducing anxiety and duration of labor in primiparas: An open-label randomized controlled trial
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Ilana Levy, Tamar Stern Lavee, Shlomi Sagi, Samuel Attias, Shosh Balachsan, Elad Schiff, Ofri Avneri, and Gil Cohen
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Adult ,medicine.medical_specialty ,medicine.drug_class ,Anxiety ,Affect (psychology) ,Anxiolytic ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Reducing anxiety ,Randomized controlled trial ,law ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Massage ,Reflexology ,Labor, Obstetric ,business.industry ,Foot ,Musculoskeletal Manipulations ,Parity ,Complementary and alternative medicine ,Physical therapy ,Female ,medicine.symptom ,Open label ,business ,030217 neurology & neurosurgery ,Foot (unit) - Abstract
Background and purpose Reflexology alleviates anxiety and may shorten the duration of labor. We evaluated the effect of reflexology on anxiety level and duration of labor in primiparas with moderate-to-severe anxiety. Materials and methods In this open-label randomized-controlled trial, primiparas with moderate-to-severe anxiety were randomized into one of two groups: addition of reflexology to usual care, or usual care only. The primary outcome was a change in the level of anxiety during reflexology treatment. Results Ninety-nine women were assigned to reflexology treatment while ninety received usual care only. A larger alleviation of anxiety was observed immediately after reflexology treatment as compared to the control group during the 30 min following group assignment. Reflexology did not affect the length of delivery. Conclusion Foot reflexology had a positive short-term anxiolytic effect during labor in primiparas with moderate-to-severe anxiety but did not affect the duration of labor.
- Published
- 2019
22. Cervical Cancer with Intermediate Risk Factors: Is there a Role for Adjuvant Radiotherapy? A Systematic Review and a Meta-Analysis
- Author
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Shlomi Sagi, Yakir Segev, Alon Ben Arie, Lena Sagi-Dain, Ofer Lavie, and Sereen Abol-Fol
- Subjects
Oncology ,medicine.medical_specialty ,Gastrointestinal Diseases ,medicine.medical_treatment ,Uterine Cervical Neoplasms ,Hysterectomy ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Statistical significance ,Internal medicine ,Odds Ratio ,Medicine ,Humans ,In patient ,Risk factor ,Neoplasm Staging ,Cervical cancer ,Adjuvant radiotherapy ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Radiation therapy ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Meta-analysis ,Female ,Radiotherapy, Adjuvant ,Neoplasm Recurrence, Local ,Intermediate risk ,business - Abstract
Background: The yield of adjuvant radiotherapy in cervical cancer patients with intermediate risk factors is controversial. The objective of our meta-analysis was to shed light on this important issue. Material and Methods: Search was conducted in several databases. By independent screening of titles and abstracts, 2 investigators selected original researches examining the effect of adjuvant radiation treatment on overall survival and progression-free survival in cervical cancer patients with intermediate risk factors. Results: Of the 5 articles included, a total of 591 patients with intermediate risk factors were encompassed. Statistical significance was noted in favor of radiation therapy in a subgroup of patients with 2 or more intermediate factors in terms of recurrence (OR 0.46 [95% CI 0.28–0.74, p = 0.001]) and overall survival (OR 1.86 [95% CI 1.03–3.36, p = 0.04]). After adding patients with one risk factor, radiation exerted a non-significant effect on recurrence rate, overall survival, disease-free survival, and 5-year cancer-specific survival, while increasing the rate of gastrointestinal side effects (2.4 vs. 0%, p = 0.0156). Conclusions: Adjuvant radiation therapy decreases the risk for recurrence and increases the overall survival in patients with 2 intermediate risk factors. These benefits were not shown after adding patients with one risk factor.
- Published
- 2019
23. [LABOR INDUCTION BY ORAL MISOPROSTOL - EFFECTIVE, SAFE, EASY TO ADMINISTRATE AND INEXPENSIVE]
- Author
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Lena, Sagi-Dain, Moti, Bardicef, Reuven, Kedar, Ron, Gonen, Ofer, Lavie, and Shlomi, Sagi
- Subjects
Administration, Intravaginal ,Pregnancy ,Oxytocics ,Humans ,Female ,Labor, Induced ,Misoprostol - Published
- 2018
24. Indications for episiotomy performance – a cross-sectional survey and review of the literature
- Author
-
Shlomi Sagi and Lena Sagi-Dain
- Subjects
Episiotomy ,medicine.medical_specialty ,Cross-sectional study ,medicine.medical_treatment ,education ,03 medical and health sciences ,Shoulder dystocia ,0302 clinical medicine ,Pregnancy ,Perineal tear ,medicine ,Fetal macrosomia ,Humans ,030212 general & internal medicine ,Professional literature ,Gynecology ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Cross-Sectional Studies ,Vacuum delivery ,Family medicine ,Female ,Guideline Adherence ,business - Abstract
Our objective was to assess the reported reasons for episiotomy performance in Israel and to review the relevant professional literature. Using anonymous questionnaires, a survey was conducted among obstetricians and midwives in four northern Israel hospitals, and the accoucheurs were asked to score their agreement with 13 proposed indications for episiotomy. Overall, 84 doctors and 32 midwives completed the questionnaires. 86.1% of the responders reported performing episiotomy in all or most cases of shoulder dystocia, and more than half reported performing it in most cases of vacuum deliveries, fetal macrosomia and advanced perineal tear in previous delivery. Subjective assessment of perineal characteristics constituted a justified reason for episiotomy for 15.8-43.9% of the accoucheurs. In conclusion, there is a wide variation in reported reasons for episiotomy between the obstetricians, and many of these indications are not congruent with international practice guidelines. Uniform protocols and educational programmes are needed to guide episiotomy practice.
- Published
- 2015
25. Is There a Survival Advantage in Diagnosing Endometrial Cancer in Asymptomatic Patients? A Systemic Review and Meta-analysis
- Author
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Ofer Lavie, Lena Dain-Sagi, Yakir Segev, Ofer Gemer, and Shlomi Sagi
- Subjects
medicine.medical_specialty ,Disease ,Original research ,Asymptomatic ,Disease-Free Survival ,Endometrium ,03 medical and health sciences ,Polyps ,0302 clinical medicine ,Statistical significance ,Internal medicine ,Humans ,Medicine ,Survival advantage ,030212 general & internal medicine ,Early Detection of Cancer ,Ultrasonography ,030219 obstetrics & reproductive medicine ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,medicine.disease ,Survival Analysis ,Endometrial Neoplasms ,Meta-analysis ,Relative risk ,Asymptomatic Diseases ,Female ,Uterine Hemorrhage ,medicine.symptom ,business - Abstract
Data supporting a survival advantage of endometrial cancer diagnosed before the onset of postmenopausal bleeding are lacking. This study sought to compare overall survival and disease recurrence between women who were asymptomatic at diagnosis and women who were symptomatic at diagnosis. A systemic search was conducted in databases using the terms: "asymptomatic," "ultrasound," "screening," and "endometrial cancer." Only original research studies that compared characteristics of tumour advancement and survival measures were included. The six articles included in the meta-analysis comprised 2961 patients. Data were collected on study design and period, number and characteristics of participants, and outcomes in terms of tumour histology and survival measures. Higher rates of stage I tumours were shown among asymptomatic patients (relative risk 1.19). The proportion of high-grade histology did not differ between the two groups (relative risk 0.92). The crude pooled estimate for overall survival did not yield statistical significance, nor did recurrence-free survival (which was reported by three studies). In conclusion, endometrial cancer diagnosed in asymptomatic women is not associated with higher survival than in symptomatic women. Invasive procedures in asymptomatic women with incidental ultrasonographic findings should be carefully weighed because no survival advantage is expected.
- Published
- 2020
26. 1081: Suturing of episiotomy incision is not easier than repair of spontaneous perineal tears
- Author
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Shlomi Sagi and Lena Sagi-Dain
- Subjects
Episiotomy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine ,Obstetrics and Gynecology ,Tears ,business ,Surgery - Published
- 2020
27. 920: The relationship between perinea length and obstetric anal sphincter injuries
- Author
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Shlomi Sagi, Rabia Bahous, Inna Bleicher, and Lena Sagi-Dain
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics and Gynecology ,Medicine ,business ,Anal sphincter ,Surgery - Published
- 2020
28. 903: A randomized double blind controlled trial- Modified French Ambulatory Cesarean Section vs. standard cesarean section
- Author
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Rami Samour, Luka Velemir, Shlomi Sagi, Orna Caspin, Israel Hendler, Lena Sagi-Dain, Benedicte Simon, and Sivan Navot
- Subjects
Double blind ,medicine.medical_specialty ,Randomized controlled trial ,law ,business.industry ,Section (typography) ,Ambulatory ,medicine ,Obstetrics and Gynecology ,business ,Surgery ,law.invention - Published
- 2020
29. Prophylactic antibiotics after operative vaginal delivery
- Author
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Shlomi Sagi, Mordechai Bardicef, Eli Gutterman, Lena Sagi-Dain, and Reuven Kedar
- Subjects
Pregnancy ,medicine.medical_specialty ,Vaginal delivery ,business.industry ,Obstetrics ,medicine.drug_class ,Antibiotics ,medicine ,MEDLINE ,General Medicine ,Antibiotic prophylaxis ,medicine.disease ,business - Published
- 2020
30. Who may accompany the parturient to the delivery room?
- Author
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Inna Bleicher, Shlomi Sagi, Suraia Said, Einav Kadour-Peero, Eyal Levy, Dana Vitner, Netanella Miller, Mariana Dashkovsky, and Ron Gonen
- Subjects
Adult ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Medicine ,Humans ,Cesarean delivery ,Prospective cohort study ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Labor, Obstetric ,business.industry ,Vaginal delivery ,Obstetrics ,Cesarean Section ,Medical record ,Delivery Rooms ,Delivery room ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,General Medicine ,Delivery, Obstetric ,Mode of delivery ,Increased risk ,030220 oncology & carcinogenesis ,Female ,business - Abstract
To assess the association of the attendant of the parturient (husband or mother or both), on labor duration, mode of delivery, maternal and neonatal complications. A retrospective cohort study, over a 4-year period, of women admitted to the delivery room accompanied by their husband, their mother or both. Medical records were reviewed for demographic, medical and obstetrical history. Overall, 3029 patients were included, 2192 were accompanied by their husband; 127 were accompanied by their mother and 710 were accompanied by both. Women accompanied by their husbands were significantly older and more likely to be multiparous than women accompanied by their mother (30.2 years vs. 27.8 years, P
- Published
- 2018
31. Vaginal delivery within 24 hours of labor induction as a primary outcome: what's the rush?
- Author
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Shlomi Sagi and Lena Sagi-Dain
- Subjects
medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Vaginal delivery ,business.industry ,Obstetrics ,medicine.medical_treatment ,Obstetrics and Gynecology ,Delivery, Obstetric ,Oxytocin ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Pregnancy ,Labor induction ,Oxytocics ,Medicine ,Humans ,Female ,030212 general & internal medicine ,Labor, Induced ,business ,Cervical Ripening - Published
- 2018
32. Differences in outcomes between cesarean section in the second versus the first stages of labor
- Author
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Dana Vitner, Yossi Bart, Inna Bleicher, Ronen Sloma, Eyal Levy, Ron Gonen, Amir Aviram, Shlomi Sagi, and Einav Kadour-Peero
- Subjects
Adult ,medicine.medical_specialty ,Maternal morbidity ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Primary outcome ,Postoperative Complications ,Blood loss ,Labor Stage, Second ,Pregnancy ,Medicine ,Humans ,030212 general & internal medicine ,Intraoperative Complications ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Singleton ,Obstetrics ,Cesarean Section ,Cephalic presentation ,Obstetrics and Gynecology ,Retrospective cohort study ,Pediatrics, Perinatology and Child Health ,Female ,business ,Labor Stage, First - Abstract
We aimed to compare maternal morbidity and mortality of cesarean sections (CS) in the second versus first stage of labor.Retrospective study of all CS at a single, university-affiliated medical center, between January 2010 and December 2014. Eligibility was limited to term, singleton pregnancies with cephalic presentation. Maternal outcomes of second-stage CS were compared to those of first-stage CS. The primary outcome was defined as estimated blood loss1000 ml.Overall, 1004 women met the inclusion criteria, of which 290 (29%) had a second-stage CS and 714 (71%) had a first-stage CS. Women in the second-stage CS group had a higher nulliparity and hypertensive disorders rates and a lower rate of previous CS. Second-stage CS was associated with more than double the rate of estimated blood loss1000 ml (9.7% versus 3.8%, p.001), and more prone to unintentional uterine incision extension, uterine atony, hemoglobin decrease2 g/l and antibiotic treatment for suspected endometritis. In a multivariable logistic regression model, second-stage CS was found to be independently associated with unintentional uterine incision extension (OR 6.8, 95% CI 4.1-11.2), uterine atony (OR 3.3, 95% CI 1.4-8.0) and antibiotic treatment for suspected endometritis (OR 2.6, 95% CI 1.4-5.1), but not with excessive blood loss (OR 1.5, 95% CI 0.8-2.8). Additionally, failed assisted vaginal delivery prior to second-stage CS was not associated with a higher rate of complications.Second-stage CS is associated with higher rates of adverse maternal outcomes, mainly unintentional uterine incision extension, uterine atony, and suspected endometritis.
- Published
- 2018
33. Complementary medicine for laboring women: a qualitative study of the effects of reflexology
- Author
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Shlomi Sagi, Shoshana Balachsan, Elad Schiff, Zahi Arnon, Hadar Bazak, Asnat Dor, and Samuel Attias
- Subjects
Adult ,medicine.medical_specialty ,media_common.quotation_subject ,Anxiety ,Pregnancy ,medicine ,Childbirth ,Humans ,Pain Management ,Empowerment ,media_common ,Pain Measurement ,Labor Pain ,Massage ,Reflexology ,Labor, Obstetric ,business.industry ,Foot ,Labor pain ,Treatment Outcome ,Complementary and alternative medicine ,Evaluation Studies as Topic ,Family medicine ,Female ,Integrative medicine ,Pregnant Women ,medicine.symptom ,Patient Participation ,Complementary medicine ,business ,Qualitative research - Abstract
Background Despite pharmacological interventions, labor pain and anxiety still remain a challenge, and can carry long-term psychological complications. The goal of this study was to assess the effect of reflexology on these symptoms and to explore the physical and psychological components of women’s experience associated with this treatment. Methods This qualitative study was conducted in an Israeli university hospital that offers integrative medicine services. Reflexology was offered to laboring women in the hospital, by the medical staff. In-depth, open interviews were conducted with 36 women, still in hospital, who consented to be interviewed, within 48 h after delivery. Questions referred to their labor experience with reflexology treatment. Results Of the 36 participants, 34 (94%) described a positive and empowering experience. They reported reduced pain and anxiety, and an increased sense of self-efficacy brought about by the ability to become active and manage labor. Conclusions Using reflexology as one of the complementary medicine treatment available can contribute greatly to the entire labor experience as it empowers women and increases self-confidence and ability to self-manage labor and delivery.
- Published
- 2018
34. 153: What is the maternal age cut-off showing an increase in adverse outcomes?
- Author
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Einav Kadour-Peero, Dana Vitner, Ron Gonen, Inbal Vilner, and Shlomi Sagi
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics ,Adverse outcomes ,Obstetrics and Gynecology ,Medicine ,business - Published
- 2019
35. 151: The impact of nurses and doctors shifts change on obstetrical outcomes
- Author
-
Netanella Miller, Einav Kadour-Peero, Aula Asali, Dana Vitner, Ron Gonen, Suraia Said, and Shlomi Sagi
- Subjects
medicine.medical_specialty ,business.industry ,Family medicine ,medicine ,Obstetrics and Gynecology ,business - Published
- 2019
36. 329: The effect of decreased episiotomy use on obstetric outcomes – a randomized controlled trial (EPITRIAL)
- Author
-
Shlomi Sagi, Aya Eshel, Tamar Shema, Inna Kreinin, Noga Gur Arye, Rabia Bahous, Lena Sagi-Dain, and Orna Caspin
- Subjects
Episiotomy ,medicine.medical_specialty ,Randomized controlled trial ,business.industry ,law ,Obstetrics ,medicine.medical_treatment ,Obstetrics and Gynecology ,Medicine ,business ,law.invention - Published
- 2019
37. 152: Impact of recommended changes in management of prolonged second-stage for prevention of the primary cesarean-delivery
- Author
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Kadour-Peero, Einav, primary, Shlomi, Sagi, additional, Gonen, Ron, additional, and Vetnir, Dana, additional
- Published
- 2019
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38. First-Trimester Crown-Rump Length and Risk of Chromosomal Aberrations-A Systematic Review and Meta-analysis
- Author
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Lena Sagi-Dain, Shlomi Sagi, and Amir Peleg
- Subjects
medicine.medical_specialty ,Down syndrome ,Gestational Age ,Risk Assessment ,Crown-Rump Length ,Ultrasonography, Prenatal ,Fetal Development ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Odds Ratio ,Humans ,030212 general & internal medicine ,Prospective Studies ,Retrospective Studies ,Crown-rump length ,Chromosome Aberrations ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,fungi ,Case-control study ,food and beverages ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Odds ratio ,medicine.disease ,Confidence interval ,Pregnancy Trimester, First ,Meta-analysis ,Case-Control Studies ,Female ,Down Syndrome ,business ,Trisomy ,Trisomy 18 Syndrome - Abstract
Importance Lower than expected first-trimester crown-rump length (CRL) is a common sonographic finding, usually leading to reassessment of gestational age. Objective The aim of this study was to perform a meta-analysis defining the risk of chromosomal aberrations in pregnancies with decreased first-trimester CRL. Evidence acquisition A search was conducted by a research librarian in 5 databases, with no time or language restrictions. Original researches examining the risk of chromosomal aberrations in pregnancies with low CRL were selected. The effect estimates were presented as odds ratios with 95% confidence intervals). Results Following screening of 3894 references, 12 articles were selected. Only 2 articles directly fulfilled the review goals, comparing the rates of chromosomal aberrations in small-CRL versus normal-CRL fetuses. Combined analysis of these 2 studies, encompassing a total of 403 fetuses with small CRL and 4047 control pregnancies, yielded an odds ratio of 5.54 (95% confidence interval, 1.2-26.1) for abnormal karyotype in small-CRL fetuses. Ten studies compared CRL in fetuses with specific chromosomal aberrations to pregnancies with normal karyotype, yielding a significant growth delay in fetuses with trisomy 18 (6 of 7 articles) and triploidy, but not in fetuses with trisomy 21. Overall quality of evidence was rated as "very low" using Grading of Recommendations Assessment, Development and Evaluation criteria. Conclusions and relevance Our review results indicate that low first-trimester CRL might be associated with a significantly increased risk of chromosomal anomalies. Thus, invasive prenatal testing or cell-free DNA screening might be offered in such pregnancies, particularly if dating is certain.
- Published
- 2017
39. The Role of Episiotomy in Prevention and Management of Shoulder Dystocia
- Author
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Lena Sagi-Dain and Shlomi Sagi
- Subjects
Episiotomy ,Shoulder ,medicine.medical_specialty ,Pregnancy ,business.industry ,Obstetric emergency ,medicine.medical_treatment ,Infant, Newborn ,MEDLINE ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Dystocia ,female genital diseases and pregnancy complications ,body regions ,Shoulder dystocia ,Systematic review ,medicine ,Humans ,Female ,Intensive care medicine ,business ,reproductive and urinary physiology - Abstract
Shoulder dystocia is an obstetric emergency with potential catastrophic outcomes.To perform a systematic literature review examining the effectiveness of episiotomy in the prevention and management of shoulder dystocia during vaginal birth.Search was conducted by a research librarian in MEDLINE, Web of Science, Cochrane Library, and SCOPUS databases using the terms "episiotomy" and "shoulder dystocia," with no language or time restrictions. Two investigators independently selected original researches examining the effects of episiotomy on shoulder dystocia and its neonatal andmaternal outcomes. Relevant articles were accessed in full text, including manual search of the references. We contacted authors of studies with insufficient or unclear data. Because of clinical and methodological diversity of the studies, meta-analysis was not performed.Fourteen articles met the inclusion criteria, encompassing a total of 9769 shoulder dystocia cases. Only 1 study effectively evaluated the role of episiotomy in shoulder dystocia prevention, yielding a nonsignificant result. Three articles assessed neonatal consequences of shoulder dystocia, one of them linking episiotomy to higher risk of neonatal injury. Two of the 3 studies evaluating maternal outcomes showed that episiotomy is related to increased risk of advanced perineal tears. Overall quality of evidence was rated as very low.Our systematic review found no evidence supporting the use of episiotomy in the prevention and management of shoulder dystocia. This observation carries major clinical and legal implications for the obstetricians. Higher-quality studies are needed to evaluate this important issue.
- Published
- 2015
40. The correct episiotomy: does it exist? A cross-sectional survey of four public Israeli hospitals and review of the literature
- Author
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Shlomi Sagi and Lena Sagi-Dain
- Subjects
Episiotomy ,medicine.medical_specialty ,Health professionals ,Obstetrics ,Cross-sectional study ,business.industry ,Urology ,medicine.medical_treatment ,Obstetrics and Gynecology ,Family medicine ,medicine ,Professional literature ,Initiation point ,business ,Mediolateral episiotomy - Abstract
Our objective was to assess episiotomy technique used in Israeli hospitals, to determine factors influencing incision parameters, and to review relevant up-to-date professional literature. Using anonymous questionnaires, a survey was conducted among obstetricians and midwives in the four public hospitals in northern Israel over a 1-year period commencing in October 2013. In addition to demographic and professional data, the accoucheurs were asked to describe the technique they usually use to perform an episiotomy (length, angle, and distance of initiation point from midperineum). Overall, 84 obstetricians and 32 midwives participated in the survey. Only 37.6 % reported performing a mediolateral episiotomy, while the rest described the lateral type, placing the initiation point at an average distance of 2.45 ± 0.88 cm from the fourchette. Compared with midwives, obstetricians reported performing a significantly longer episiotomy (3.53 ± 1.01 vs. 2.73 ± 0.81 cm, p = 0.0002). According to our study and relevant literature review, the technique of episiotomy varies significantly between health professionals and is not uniformly congruent with international practice guidelines. In part, this is derived from unclear literature evidence and lack of consensus definition for proper technique of this procedure by the national guidelines. Thus, further higher-quality research, uniform protocols, and educational programs are needed to guide episiotomy practice.
- Published
- 2015
41. No episiotomy versus selective lateral/mediolateral episiotomy (EPITRIAL): an interim analysis
- Author
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Shlomi Sagi, Rabia Bahous, Orna Caspin, Lena Sagi-Dain, Inna Kreinin-Bleicher, and Ron Gonen
- Subjects
Episiotomy ,Adult ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Anal Canal ,Perineum ,Lacerations ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Labor Stage, Second ,Pregnancy ,Clinical endpoint ,medicine ,Odds Ratio ,Humans ,030212 general & internal medicine ,030219 obstetrics & reproductive medicine ,Intention-to-treat analysis ,Obstetrics ,business.industry ,Postpartum Hemorrhage ,Obstetrics and Gynecology ,Odds ratio ,medicine.disease ,Interim analysis ,Obstetric labor complication ,Surgery ,Intention to Treat Analysis ,Obstetric Labor Complications ,medicine.anatomical_structure ,Tears ,Female ,business - Abstract
The objective of this trial was to evaluate whether avoiding episiotomy can decrease the risk of advanced perineal tears. In this randomized (1:1) parallel-group superiority trial, primiparous women underwent randomization into standard care (155 cases) vs. no episiotomy (154 cases) groups. The primary endpoint was the incidence of advanced (3rd- and 4th-degree) perineal tears. Secondary outcomes included perineal integrity, suturing characteristics, second-stage duration, incidence of postpartum hemorrhage, neonatal variables, and various postpartum symptoms 2 days and 2 months after delivery. At prespecified 1-year interim analysis, the groups did not differ in terms of baseline demographic and obstetric characteristics. Six advanced perineal tears (3.9%) were diagnosed in the standard care group vs. two in no episiotomy group (1.3%), yielding a calculated odds ratio (OR) of 0.33 [95% confidence interval (CI) 0.06–1.65). Unexpectedly, rates of episiotomy performance also did not significantly vary between groups: 26.5% (41 cases) vs. 21.4% (33 cases), respectively, p = 0.35. No significant differences were noted in any secondary outcomes. No difference in the rates of advanced perineal tears was found between groups; however, the main limitation of our study was unexpectedly high rates of episiotomy in the nonepisiotomy group. Thus, the main conclusion is that investigator monitoring and education should be continuously practiced throughout the trial duration, stressing the importance of adherence to the protocol.
- Published
- 2017
42. Statins, aspirin and risk of thromboembolic events in ovarian cancer patients
- Author
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Hedy S. Rennert, Ayelet Shai, Gad Rennert, Ofer Lavie, Shlomi Sagi, and Michelle Leviov
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Population ,Carcinoma, Ovarian Epithelial ,Cohort Studies ,Young Adult ,Risk Factors ,Thromboembolism ,Internal medicine ,medicine ,Humans ,Neoplasms, Glandular and Epithelial ,cardiovascular diseases ,education ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Ovarian Neoplasms ,education.field_of_study ,Aspirin ,business.industry ,Incidence (epidemiology) ,Warfarin ,Anticoagulants ,Obstetrics and Gynecology ,Cancer ,Retrospective cohort study ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,Middle Aged ,medicine.disease ,Surgery ,Oncology ,Multivariate Analysis ,Platelet aggregation inhibitor ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Pulmonary Embolism ,business ,Platelet Aggregation Inhibitors ,medicine.drug ,Cohort study - Abstract
Objectives Studies suggest that statins and low dose aspirin reduce risk of VTEs in the general population. We aimed to study the effect of these drugs on the incidence of VTEs in patients with ovarian cancer. Methods Patients diagnosed with ovarian cancer between 2000 and 2011 were identified through the Clalit Health Services (CHS) chronic disease registry. Data were extracted from CHS database and from computerized pharmacy records. Use of medications was analyzed as a time dependent covariate in a Cox regression model. Results Of 1746 patients 175 (10%) had a VTE during a median follow up of 3.13years. 83 patients (5.6%) had a VTE within 2years of diagnosis of ovarian cancer. Use of chemotherapy and stage 3 and 4 at presentation were associated with an increased risk for VTEs. Statins were used by 43.5% of the patients, and 32.3% used aspirin. Aspirin use was associated with a marginally significant reduction in incidence of VTEs within 2years of diagnosis, HR 0.423 (95% CI 0.182–1.012, p -value 0.053). Statin use was not associated with risk of VTEs. Conclusion This is the first study looking at the effect of statins and aspirin on the incidence of VTEs in ovarian cancer patients. In our cohort, statins did not decrease the risk for a VTE and aspirin use was associated with a reduced risk which was marginally significant. Our results might be explained by use of low potency statins and by alternate mechanisms for VTE formation in cancer patients.
- Published
- 2014
43. Risk for chromosomal aberrations in apparently isolated intrauterine growth restriction: A systematic review
- Author
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Lena Sagi-Dain, Amir Peleg, and Shlomi Sagi
- Subjects
Gynecology ,Chromosome Aberrations ,medicine.medical_specialty ,Fetus ,030219 obstetrics & reproductive medicine ,Fetal Growth Retardation ,Obstetrics and Gynecology ,Aneuploidy ,Intrauterine growth restriction ,Karyotype ,Biology ,medicine.disease ,Quality of evidence ,03 medical and health sciences ,0302 clinical medicine ,Growth restriction ,medicine ,Humans ,Clinical significance ,030212 general & internal medicine ,Genetics (clinical) ,Cohort study - Abstract
Objective To perform a systematic review examining the risk of chromosomal aberrations in apparently isolated intra-uterine growth restriction (IUGR). Methods Search was conducted by research librarian in five databases. By independent screening of 2894 references, two investigators selected original studies examining the risk of chromosomal aberrations in apparently isolated IUGR diagnosed at the second and third trimesters using ultrasound. We excluded studies describing IUGR combined with additional fetal anomalies detected by ultrasound and those where fetuses with structural anomalies or aneuploidy were not reported. Results Fourteen observational cohort studies were found, encompassing 874 apparently isolated IUGR cases. Mean rate of chromosomal aberrations was 6.4%, ranging between 0% (in three studies) to 26.3%. Only two articles examined apparently isolated IUGR diagnosed in third trimester, encompassing a total of 32 pregnancies. Invasive testing of these cases yielded normal karyotypes. A single article analyzed 137 second trimester IUGR pregnancies, reporting two abnormal karyotypes of minimal clinical significance. Overall quality of existing evidence was defined as "very low". Conclusions Due to a limited number of cases and insufficient quality of evidence, high-quality well standardized case-controlled trials should be conducted, further exploring the risk for chromosomal aberrations in pregnancies with isolated IUGR.
- Published
- 2016
44. 966: Cesarean delivery skin closure technique: comparison between staples and antibacterial knotless suture
- Author
-
Inna Bleicher, Einav Kadour, Shlomi Sagi, and Dana Vitner
- Subjects
medicine.medical_specialty ,Suture (anatomy) ,business.industry ,medicine ,Closure (topology) ,Obstetrics and Gynecology ,Cesarean delivery ,business ,Surgery - Published
- 2019
45. The Effect of Paternal Age on Oocyte Donation Outcomes
- Author
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Shlomi Sagi, Lena Sagi-Dain, and Martha Dirnfeld
- Subjects
0301 basic medicine ,Adult ,Male ,Pregnancy Rate ,media_common.quotation_subject ,MEDLINE ,Fertility ,Reproductive Behavior ,Paternal Age ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,media_common ,Aged ,030219 obstetrics & reproductive medicine ,Oocyte Donation ,business.industry ,Reproduction ,Confounding ,Pregnancy Outcome ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,medicine.disease ,Pregnancy rate ,030104 developmental biology ,Ageing ,Sperm Motility ,Female ,business ,Neurocognitive ,Developed country ,Demography - Abstract
Importance In recent decades, a trend toward delayed childbearing is noted in developed countries. Whereas the effects of maternal age on fertility, pregnancy complications, and postnatal outcomes have been thoroughly explored, consequences of advanced paternal age are less well known. Oocyte donation cycles can be used as an optimal model to analyze the association between male ageing and reproductive outcomes with minimal confounding. Objective The purpose of this work was to summarize the updated and relevant literature dealing with the effect of paternal age on oocyte donation outcomes. Results According to the available evidence from oocyte donation cycles, it seems that no significant association exists between advanced paternal age and fertility. However, this evidence is based on few studies, many of which are of low quality, yielding conflicting results. In addition, the emerging evidence clearly indicates an increased risk of adverse postnatal manifestations of pregnancies conceived by older fathers, including de novo autosomal dominant disorders, impaired neurocognitive development, and increased risk of malignancy. Conclusions and relevance This review may be of aid to medical practitioners in counseling couples on the risks of delayed childbearing.
- Published
- 2016
46. When should pregnancies that extended beyond term be induced?
- Author
-
Shlomi Sagi, Adir Iofe, Ron Gonen, Dana Vitner, David Bader, and Inna Bleicher
- Subjects
Adult ,medicine.medical_specialty ,Pediatrics ,Gestational Age ,Statistics, Nonparametric ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Gestational Weeks ,Medicine ,Humans ,Pregnancy, Prolonged ,030212 general & internal medicine ,Labor, Induced ,Cesarean delivery ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Fetal death ,business.industry ,Obstetrics ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,Induction of labor ,medicine.disease ,Neonatal outcomes ,Pediatrics, Perinatology and Child Health ,Practice Guidelines as Topic ,Female ,business - Abstract
Objective: To compare maternal and neonatal outcomes associated with a policy for induction of labor at ≥ 41 versus at ≥42 weeks'. Study design: Retrospective cohort study of a 2 years’ period before and after policy change from induction of labor at ≥ 42 gestational weeks’ versus ≥41 gestational weeks. Results: During the 41-policy period (N = 968), the induction rate was higher, 60% versus 40% (p
- Published
- 2016
47. The effect of ozonated sterile saline irrigation on the endometrium - A preliminary study
- Author
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Shlomi Sagi, Lena Sagi-Dain, Ilan Calderon, Ofir Artzi, Jacob Bejar, and Max Cohen
- Subjects
0301 basic medicine ,Adult ,Ovulation ,medicine.medical_specialty ,Irrigation ,Adolescent ,media_common.quotation_subject ,medicine.medical_treatment ,Therapeutic irrigation ,Sodium Chloride ,Endometrium ,Andrology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Ozone ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Therapeutic Irrigation ,Saline ,Menstrual cycle ,Menstrual Cycle ,media_common ,Gynecology ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Healthy Volunteers ,030104 developmental biology ,medicine.anatomical_structure ,Female ,business - Abstract
The objective of this study was to evaluate the effect of sterile ozonated saline endometrial irrigation on sonographic and histological endometrial parameters. This prospective investigation was performed in 12 healthy, ovulating women over three consecutive menstrual cycles: control cycle (endometrial irrigation with 10 cc of normal saline at day 10), no intervention cycle and study cycle (irrigation with 10 cc of sterile ozonated saline at day 10). Endometrial thickness was measured by transvaginal ultrasound at days 10 and 12 of the control and study cycles, and endometrial samplings were obtained from the participants two days after the irrigations (i.e. on day 12) for histological evaluation. Ozonated saline irrigation, compared to normal saline irrigation, resulted in a statistically significant elevation of the columnar epithelial height (30.30 ± 3.04 vs. 25.82 ± 3.28 μm, p
- Published
- 2016
48. Response to the letter to the editor: the correct episiotomy--does it exist?
- Author
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Shlomi Sagi and Lena Sagi-Dain
- Subjects
Episiotomy ,Male ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Letter to the editor ,postpartum bleeding ,business.industry ,Obstetrics ,External anal sphincter ,Urology ,medicine.medical_treatment ,Obstetrics and Gynecology ,medicine.disease ,Midwifery ,03 medical and health sciences ,Shoulder dystocia ,0302 clinical medicine ,Medicine ,Humans ,Female ,030212 general & internal medicine ,business ,Anal sphincter - Published
- 2015
49. CEA in evaluation of adnexal mass: retrospective cohort analysis and review of the literature
- Author
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Lena Sagi-Dain, Ofer Lavie, Ron Auslander, and Shlomi Sagi
- Subjects
Adult ,Aged, 80 and over ,Ovarian Neoplasms ,Cancer Research ,endocrine system diseases ,Adolescent ,Clinical Biochemistry ,Membrane Proteins ,Middle Aged ,Sensitivity and Specificity ,Pathology and Forensic Medicine ,Carcinoembryonic Antigen ,Young Adult ,Oncology ,Adnexal Diseases ,CA-125 Antigen ,Humans ,Female ,Neoplasms, Cystic, Mucinous, and Serous ,Aged ,Retrospective Studies - Abstract
Background The aim of this study was to estimate the diagnostic accuracy of serum carcinoembryonic antigen (CEA) levels in conjunction with Ca125 in the triage of adnexal masses. Methods This retrospective cohort study was carried out in 495 patients referred to the Gynecology Department at Carmel Medical Center due to adnexal mass, between 2005 and 2012. All patients underwent surgery with histopathologically confirmed diagnosis and preoperative measurements of serum Ca125 and CEA. For each marker, sensitivity, specificity, positive predictive value, negative predictive value and risk ratio were calculated. Results Combination of CEA with Ca125, compared with Ca125 levels alone, yielded a nonsignificant effect on sensitivity (87.4% vs. 88.9%, respectively, p = 0.64) and specificity (79.3% vs. 74.3%, p = 0.18) in differentiating malignant from benign adnexal masses. CEA levels were higher in mucinous histological types, but were not helpful in detection of borderline tumors. Significantly higher CEA (21.4 ± 53.6 vs. 3.2 ± 11.9 ng/mL, p = 0.0002) and lower Ca125 values (103.9 ± 84.9 vs. 796 ± 1,331.5 U/mL, p = 0.0338) were demonstrated in the 17 metastatic cases compared with 181 primary ovarian malignancies. Conclusions The combination of the tumor markers CEA and Ca125 did not contribute significantly to the detection of malignant adnexal masses compared with Ca125 alone. As our results suggest that higher CEA levels could be useful in differentiating metastatic tumors from primary ovarian malignancy and in diagnosis of mucinous histology, this issue should be investigated in large, well-designed, prospective cohort trials.
- Published
- 2015
50. Chromosomal aberrations in idiopathic polyhydramnios: A systematic review and meta-analysis
- Author
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Lena Sagi-Dain and Shlomi Sagi
- Subjects
Genetics ,Chromosome Aberrations ,Polyhydramnios ,Pediatrics ,medicine.medical_specialty ,business.industry ,Aneuploidy ,General Medicine ,medicine.disease ,Amniotic Fluid ,Idiopathic polyhydramnios ,Confidence interval ,Quality of evidence ,Pregnancy ,Risk Factors ,Meta-analysis ,Karyotyping ,medicine ,Humans ,Female ,business ,Genetics (clinical) ,Retrospective Studies - Abstract
The objective of this meta-analysis was to summarize the existing literature examining the risk of chromosomal aberrations in idiopathic polyhydramnios. Search was conducted by a research librarian in five databases. Language and time restrictions were not applied. By independent screening of titles and abstracts, two investigators selected original researches examining the risk of chromosomal aberrations in idiopathic polyhydramnios. Twenty articles were included, encompassing a total of 1729 pregnancies with idiopathic polyhydramnios. The average rate of chromosomal aberrations in these cases was 2.8 ± 3.7%, ranging between 0% and 13.8%. No studies were found examining the relative risk for chromosomal abnormalities in low-risk women with idiopathic polyhydramnios. An analysis of seven case-control trials, including women at high risk for aneuploidy, yielded a relative risk of 3.09 (95% confidence interval 1.92–4.97) for chromosomal aberration. Overall quality of evidence was rated as very low using Grading of Recommendations Assessment, Development and Evaluation criteria. In conclusion, the suboptimal quality of the evidence precludes from drawing any solid recommendations regarding routine karyotype testing in idiopathic polyhydramnios cases, especially in women at low risk for chromosomal aberrations. Future high-quality trials addressing the discussed methodological shortcomings should be conducted to assess this important issue.
- Published
- 2015
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