Search

Ectopic pregnancy (EP) occurs in approximately 2% of all pregnancies. A common method of treatment is methotrexate therapy, considered in haemodynamically stable patients. Endometrial thickness has been investigated as a tool for diagnosing EP. The objective of this study was to evaluate the association between endometrial thickness and the criteria for MTX treatment, in an attempt to facilitate outcome prediction. We retrospectively collected data from records of patients diagnosed with EP between 2012 and 2014 including information regarding the mode of treatment and outcome. The endometrial thickness was compared between cases that met the criteria for MTX treatment and those who did not. Of 267 cases of EP that were reviewed, 108 patients were treated with MTX. The MTX treatment success rate was 88%. Endometrial thickness was found to be significantly and inversely associated with criteria for MTX treatment. In conclusion, an association was found between the endometrial thickness and the criteria for selection of MTX treatment for EP. This may be a useful tool in treatment selection for EP.Impact Statement What is already known on this subject? Transvaginal sonography along with β-human chorionic gonadotrophin (β-hCG) monitoring is the standard for evaluation of suspected ectopic pregnancy (EP). The most specific sonographic finding for EP is the presence of a live extra uterine pregnancy. In research conducted with the purpose of finding intrauterine sonographic findings associated with EP, this condition has been shown to be correlated with a thinner endometrial lining, compared with that of an intrauterine pregnancy. What the results of this study add? The results of this study add information on the subject of methotrexate treatment success rates in correlation with the endometrial thickness. What the implications are of these findings for clinical practice and/or further research? The findings of this study contribute to the process of treatment selection for ectopic pregnancy by emphasising the association between a thick endometrium and the lower success rates of MTX treatment.

Objective: The data regarding microbiological and clinical characteristics of Bartholin gland abscesses during pregnancy is limited. Given the hormonal and physiological changes during pregnancy we aimed to examine whether a difference exists in the clinical and microbiological features of Bartholin's gland abscess during pregnancy and the puerperium as compared with nonpregnant patients. In addition, we aim to evaluate whether a Bartholin's gland abscess during pregnancy is associated with adverse pregnancy outcomes., Study Design: A retrospective cohort study was conducted, including all women with Bartholin's gland abscess who were treated surgically between the years 2009-2016 in the Soroka University Medical Center. Various demographic, clinical and microbiological characteristics were retrieved and a comparison was made between patients with a Bartholin's gland abscess during pregnancy and the puerperium (study group) as compared with nonpregnant patients (controls). In addition, obstetrical characteristics of patients in the study group were retrieved., Results: Of the 363 women who were treated surgically, 38 (10.5%) were in the study group. Women in the study group were significantly younger (26.8 versus 32.8 p  < .001). No differences were found between the groups with regard to the clinical presentation (affected side, fever, leukocytosis and need for antimicrobial treatment) or the selected mode of drainage. In addition, no difference was found in the percentage of positive culture results, nor in the distribution of the pathogens between the groups, in both groups the most common pathogen was Escherichia coli . Yet, among the study group, recurrence of the abscess was more common (13.5 versus 2.15% p  = -.067) as evident by significantly higher recurrent referrals to the emergency department and recurrent hospitalizations (28.9 versus 14.8%, p  < .05, and 26.3 versus 8.0% p  < .001, respectively). Of note, fever after the procedures, pain, discharge and bleeding did not differ significantly between groups. No cases of premature rupture of membranes or chorioamnionitis were noted following treatment., Conclusions: In our cohort, no differences were found between the study groups in the clinical presentation and microbiological features. A significantly higher recurrence rate was noted in the study group. Among pregnant patients no adverse perinatal outcomes were noted.

Objective: To evaluate whether neutrophil-to-lymphocyte ratio (NLR), a well-established inflammatory marker, can be used as an early predictor for small-for-gestational-age (SGA) neonates and other adverse pregnancy outcomes., Methods: A case-control study compared first-trimester hematological biomarkers in pregnancies of patients with and without SGA (n=149, n=151, respectively). Demographic, clinical, and obstetrical characteristics and first-trimester complete blood count were retrieved. Woman with singleton pregnancies who delivered at Soroka University Medical Center between January 2015 and December 2016 were included. Patients with known maternal infections, relevant medications, hematological conditions, and chronic diseases that may alter the blood count, those with multiple pregnancies, and those with congenital or chromosomal abnormalities were excluded. After univariate analysis, a linear regression model was constructed to assess the association between hematological indices and SGA. Receiver operating curves were constructed to evaluate the sensitivity and specificity of NLR., Results: First-trimester NLR values of the SGA group were significantly higher compared to controls (3.03 ± 1.68 vs 2.63 ± 1.2, P=0.016). Significantly higher levels of NLR were noted among the severely (<3%) SGA neonates (3.12 ± 1.62 vs 2.62 ± 1.2; P=0.034)., Conclusion: NLR may be an early, clinically useful marker in the prediction of SGA. As blood samples are routinely collected, correct implication of this result may serve as a valuable non-invasive, low-cost, readily available predicting tool., (© 2020 International Federation of Gynecology and Obstetrics.)

Objective: To evaluate the effect of attending a prenatal childbirth preparation course (CPC) on labor duration and outcomes., Methods: A cross sectional study of 53 primiparous women who attended and 54 women who did not attend a CPC was conducted. The state-trait anxiety inventory (STAI) score was used to diagnose anxiety. Clinical and obstetrical data were collected from the perinatal database of our center. Through post-partum interviews, coping strategies were assessed, patients graded their childbirth experience and breastfeeding was evaluated. Data were analyzed using description analyses and a P-value <0.05 was considered statistically significant., Results: The STAI score was significantly lower in the study group compared with controls (P=0.025). The first stage and the entire duration of labor were significantly shorter (P=0.036 and P=0.026, respectively) in women who attended the CPC. No significant differences were found with regard to the mode of delivery, rate of episiotomy, use of analgesics and neonatal outcomes between the groups. Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls., Conclusions: The knowledge acquired in the CPC has positive effects on the course of labor and delivery outcomes as well as higher rates of breastfeeding.

Introduction and Hypothesis: The urogenital distress inventory (UDI-6) is a simple questionnaire assessing quality of life (QoL) among patients with urinary incontinence. Despite widespread use in Israel, linguistic validation of this tool has not yet included examination of the psychometric characteristics of this instrument in the Hebrew language. The purpose of this study was to validate the psychometric characteristics of the UDI-6 in the Hebrew language., Methods: A cross-sectional study was conducted from April to June 2016 using the recommended ratio of 10:1 between the number of subjects and the number of items in the questionnaire. A Hebrew version of the UDI-6 was given to a sample of 60 women with urinary incontinence. Internal consistency, validity, and test-retest reliability were evaluated., Results: UDI-6 showed internal consistency with Cronbach's alpha coefficient of 0.637. The kappa coefficient for test-retest reliability of the UDI-6 ranged from 0.845 to 0.606., Conclusions: The Hebrew version of UDI-6 showed adequate reliability, consistency and validity for measuring symptoms and QoL in women with urinary incontinence.

Introduction: The purpose of our study was to explore maternal and fetal outcomes in the second and third trimester in women with bicornuate uterus., Methods: A total of 280,106 pregnancies met the inclusion criteria and were divided in two study groups: (1) pregnancies in women with bicornuate uterus (n = 444); and (2) controls (n = 279,662). The diagnosis of bicornuate uterus was performed in all patients during the workup for infertility or recurrent pregnancy loss, during pregnancy, or at the time of cesarean delivery. Multivariate logistic regression models were performed in order to assess the risk factors for cervical insufficiency in women with bicornuate uterus., Results: The rate of women with a bicornuate uterus in our population was 0.15%. Women with bicornuate uterus had lower parity (2.93 ± 1.90 vs. 3.42 ± 2.51, p < 0.001) and a higher rate of previous cesarean deliveries (54.1% vs. 12.3%, p < 0.001). In addition, these patients were more prone to conceive with assisted reproductive techniques (5.6% vs. 1.9%, p < 0.001) and had a significantly higher rate of recurrent abortions (12.4% vs. 5.1%, p < 0.001) compared to controls., Conclusions: Bicornuate uterus is an independent risk factor for cervical os insufficiency. This is an important finding due to the burden of the risk for midtrimester periviable birth associated with cervical incompetence.

Objective: To investigate fetal gender and its influences on neonatal outcomes, taking into consideration the available tools for the assessment of fetal well-being., Methods: We conducted a retrospective study comparing maternal, fetal and neonatal outcomes according to fetal gender, in women carrying a singleton gestation. A multivariate analysis was performed for the prediction of adverse neonatal outcomes according to fetal gender, after adjustment for gestational age, maternal age and fetal weight., Results: A total of 682 pregnancies were included in the study, of them 56% (n = 383) were carrying a male fetus and 44% (n = 299) a females fetus. Male gender was associated with a significant higher rate of abnormal fetal heart tracing patterns during the first (67.7% versus 55.1, p = 0.001) and the second stage (77.6 versus 67.7, p = 0.01) of labor. Male gender was also significantly associated with lower Apgar scores at 1' (19.1% versus 10.7%, p < 0.01), as well as lower pH values (7.18 ± 0.15 versus 7.23 ± 0.18, p < 0.001), and significant differences in cord blood components (PCO 2 , PO 2 ) compared with female fetuses. In the multivariate analysis, male gender was found to be significantly associated with first (OR 1.76, 95% CI 1.28-2.43, p = 0.001) and second stage (OR 1.73, 95% CI 1.20-2.50, p < 0.01) pathological fetal heart tracing patterns, pH < 7.1, and for Apgar scores at 1'< 7., Conclusions: The present study confirms the general trend of a lower clinical performance of male neonates compared with females. In addition, the relation between fetal heart rate patterns during all stages of labor and fetal gender showed an independent association between male fetal gender and abnormal fetal heart monitoring during labor.

Introduction: The aim of our study was to compare maternal and neonatal outcomes in women with placenta previa complicated with severe bleeding leading to hospitalization until delivery versus those without severe bleeding episodes., Methods: This is a population-based retrospective cohort study including all pregnant women with placenta previa who delivered at our medical center in the study period, divided into the following groups: 1) women with severe bleeding leading to hospitalization resulting with delivery (n = 32); 2) patients with placenta previa without severe bleeding episodes (n = 1217)., Results: Out of all women with placenta previa who delivered at our medical center, 2.6% (32/1249) had an episode of severe bleeding leading to hospitalization and resulting with delivery. The rate of anemia was lower (43.8% versus 63.7%, p = 0.02) while the need for blood transfusion higher (37.5% versus 21.1%, p = 0.03) in the study group. The rate of cesarean sections was significantly different between the groups, and a logistic regression model was constructed in order to find independent risk factors for cesarean section in our patients., Conclusion: To the best of our knowledge, this is the first study to evaluate the impact of severe bleeding on the outcome of pregnancies complicated with placenta previa. Our study demonstrates that, in women with placenta previa, severe bleeding does not lead to increased adverse maternal or neonatal outcomes.

Introduction: An over-active bladder is a common disorder which influences women's health and quality of life. There is difficulty defining the exact prevalence of the disorder since there are various definitions in the literature. The ICS definition from 2002 on the over-active bladder (OAB) syndrome enables more uniformity, by declaring that OAB syndrome is a symptomatic syndrome defined as presence of urgency with or without urinary incontinence, mostly accompanied by frequency and nocturia. In this article we reviewed the current medical literature on the prevalence of the OAB syndrome by focusing on relevant crosssectional and longitudinal studies, the trend changes during life, co-morbidities, the influence of quality of life and the economic burden following the disorder and its treatment. The authors' hope is that elevating awareness of the OAB syndrome will help improve its diagnosis and treatment.

Women with thrombophilia and a history of recurrent pregnancy loss have poor pregnancy outcomes. Prophylaxis with enoxaparin 40 mg/day or 80 mg/day resulted in favorable gestational and neonatal outcomes.

Idiopathic generalized epilepsy (IGE) is a common, complex disease with an almost exclusively genetic etiology but with variable phenotypes. Clinically, IGE can be divided into different syndromes. Varying lines of evidence point to the involvement of several interacting genes in the etiology of IGE. We performed a genome scan in 91 families ascertained through a proband with adolescent-onset IGE. The IGEs included juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and epilepsy with generalized tonic clonic seizures (EGTCS). Our linkage results support an oligogenic model for IGE, with strong evidence for a locus common to most IGEs on chromosome 18 (lod score 4.4/5.2 multipoint/two-point) and other loci that may influence specific seizure phenotypes for different IGEs: a previously identified locus on chromosome 6 for JME (lod score 2.5/4.2), a locus on chromosome 8 influencing non-JME forms of IGE (lod score 3.8/2.5), and, more tentatively, two newly discovered loci for absence seizures on chromosome 5 (lod scores 3.8/2.8 and 3.4/1.9). Our data also suggest that the genetic classification of different forms of IGE is likely to cut across the clinical classification of these subforms of IGE. We hypothesize that interactions of different combinations of these loci produce the related heterogeneous phenotypes seen in IGE families.

Cervical pregnancy is a rare but serious complication. The most frequent presenting symptom is vaginal bleeding, and is thus common in inevitable abortion. Examination reveals a dilated cervix containing products of conception derived from the emptied uterine cavity. The pathologic criteria are cervical glands opposite the placental site, attachment to and actual invasion of the cervix by the placenta, a portion of the placenta below the posterior reflection, and no fetal parts in the corpus uteri. Treatment ranges from hysterectomy to treatment with chemical agents, mostly methotrexate. We present a case of ectopic, cervical pregnancy with exaggerated placental site in the cervix.

Objective: To evaluate the effect of early amniotomy on mode of delivery and pregnancy outcome in comparison to a group of patients admitted with premature rupture of membranes at term., Study Design: The study population consists of all women (n=338) whose labor was induced by amniotomy, between the years 1988 to 1995. The comparison group were all women (n=1865) who were admitted with premature rupture of membranes during the same period., Results: Cesarean section was significantly higher in the amniotomy group than in the comparison group (162 (47.9%) vs. 348 (18.7%), P<0.001). This significant difference was noted only for those who did not had a previous cesarean section (106 (42.4%) vs. 224 (13.8%), P<0.001). Non progressive labor during the first stage was threefold higher in the amniotomy group than in the control group (30.8% vs. 10.9%, P<0.001). Abnormal fetal heart rate patterns were detected during labor in 52 patients (15.4%) of amniotomy group, as compared to 141 cases (7.6%) in the control group (P<0.001). To assess the independent contribution of early amniotomy to having cesarean section in the present delivery, a multiple logistic model was used. Early amniotomy (odds ratio [OR] 3.07, 95% confidence interval [CI] 2.36-4.01), as well as a previous cesarean section (OR 5.04, 95% CI 3.90-6.52) and high parity (OR 1.07, 95% CI 1.03-1.26) were all found as independent risk factors for cesarean section., Conclusions: Early amniotomy appears to be associated with an increased risk for cesarean section.

Thirty-two infants, aged 1 to 12 months, hospitalized with acute wheezing, were studied. They were randomly divided into four treatment groups of eight patients each. The treatments were intramuscular dexamethasone or placebo (double-blind), and salbutamol (oral and inhaled), or none (open), in all four possible combinations. The study was carried out as a randomized block design with eight blocks of four infants each, matched by age and clinical score. Average daily improvements, as reflected by changes in the clinical score and length of hospital stay, was essentially the same for infants treated with placebo, salbutamol alone, and dexamethasone alone. However, combined salbutamol-dexamethasone treatment resulted in more than twice the rate of improvement of the other treatments. The difference was statistically highly significant (P less than .01). Furthermore, the response of this combined treatment was observed within 24 hours; none of the ten infants in whom there was no significant improvement within 48 hours and neither of the two patients who developed respiratory failure received the combined salbutamol-dexamethasone treatment. A potentiating effect of corticosteroids on the beta-adrenergic responsiveness is a possible explanation for the advantage of this combined treatment in the management of acute wheezing in infancy.

Prostanoid production by rabbit choroid plexus (CP) and iris-ciliary body (ICB), and the effects of adrenergic agonists thereon, were studied in vitro. Immunoreactive prostaglandin (PG) E2 was the major prostanoid released by both tissues; the output from ICB was some two orders of magnitude greater than from CP. Immunoreactive 6-keto PGF1 alpha and thromboxane (TX) B2, the dehydration products of prostacyclin and TXA2, respectively, were detected in smaller quantities. Epinephrine stimulated the outputs of PGE2 and 6-keto PGF1 alpha, but not of TXB2, from both tissues. ICB responded to epinephrine concentrations of 10(-4) and 10(-5), while only 10(-4) was effective in stimulating prostanoid synthesis in the CP. Phenylephrine, an adrenergic agonist, stimulated prostanoid output from the ICB, but not from the CP. It is concluded that adrenergic mechanisms stimulate the biosynthesis of prostanoids in the rabbit CP and ICB. The implications of such interactions to aqueous humor and cerebrospinal fluid dynamics, or to other processes in brain and ocular physiology, are discussed.

A previously healthy 2-year-old girl, who presented with transient neurologic dysfunction manifested mainly by absence and atonic seizures, was treated with large doses of the antihelminthic piperazine hexahydrate. The role of piperazine salts and piperazine-containing compounds in producing neurotoxic side effects is discussed. We suggest that these drugs be considered as a possible cause of transient encephalopathy and nonepileptic seizures in previously healthy individuals.