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ABSTRACT: Introduction:Macrolide antibiotics are largely used in pregnancy for different bacterial infections. Their fetal safety has been studied by several groups, yielding opposing results. In particular, there have been studies claiming association between macrolides and cardiovascular malformations. Exposure in early infancy has been associated with pyloric stenosis and intussusception. This has led to avoidance of macrolides in several Scandinavian countries. The Objectives of the present study was to investigate the fetal safety of this class of drug by linking large administrative database of drug dispensing and pregnancy outcome in Southern Israel.Methods:A computerized database of medications dispensed from 1999 to 2009 to all women registered in the "Clalit" health maintenance organization in Southern Israel, was linked with two computerized databases containing maternal and infant hospitalization records. Also, medical pregnancy terminations data were analyzed. The following confounders were controlled for: maternal age, ethnicity, maternal pre gestational diabetes, parity and year of birth or medical pregnancy termination. First and third trimester exposures to macrolide antibiotics as a group, and to individual drugs was analyzed.Results:During the study period there were 105,492 pregnancies among Clalit women that met the inclusion criteria. 104,380 of them ended up in live or dead fetus and 1,112 by abortion due to medical reasons. In the first trimester of pregnancy 1,033 women were exposed to macrolides. There was no association between macrolides and either major malformations [OR 1.08 (95% CI 0.84-1.38)], or specific malformations, after accounting for maternal age, parity, ethnicity, pre pregnancy diabetes and year of exposure. During the third trimester of pregnancy 959 women were exposed to macrolides. There was no association between such exposure and perinatal mortality, low birth weight, low Apgar score or preterm delivery. Similarly, no associations were demonstrated with pyloric stenosis or intussusception.Conclusions:Use of macrolides in the first trimester of pregnancy is not associated with an increased risk of major malformations. Exposure in the third trimester is not likely to increase neonatal risks for pyloric stenosis or intussusception in a clinically meaningful manner.
Antimicrobial Agents and Chemotherapy 05/2013; · 4.84 Impact Factor
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ABSTRACT: Objectives. Diabetes mellitus (DM) and hypothyroidism are each associated with increased rate of pregnancy complications. However, their combined morbidity during gestation is poorly studied. Therefore, the aims of this study were to determine the prevalence of the combined morbidity of DM & hypothyroidism and whether it is associated with adverse maternal and neonatal outcome. Study design. This population based retrospective cohort study included 87,213 women who had 232,293 deliveries. All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy, who served as a control group (n = 217, 296). Results. The prevalence of DM & hypothyroidism in our population was 0.17%. In comparisons to the other study groups, women with DM & hypothyroidism had higher rates of infertility (p < 0.001), preeclampsia (p < 0.001), chronic hypertension (p < 0.001), preterm birth (p < 0.001), and cesarean deliveries (p < 0.001). In Generalized Estimating Equations (GEE) model, hypothyroidism & DM was an independent risk factor for cesarean section (OR 3.46; 95% CI 2.53-4.75) and for preeclampsia (OR 1.82; 95%CI 1.16-2.84). Conclusion. The combination of DM & hypothyroidism is rare, yet it is associated with higher rate of infertility, cesarean sections, preterm deliveries, and hypertensive disorders of pregnancy than the rest of the population. This dual endocrinological combination is an independent risk factor for preeclampsia and cesarean section. These findings suggest that these patients are at risk for perinatal complications and should be followed and delivered as high risk pregnancies.
PeerJ. 01/2013; 1:e52.
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ABSTRACT: OBJECTIVES: Despite high rates of hypertension in pregnancy, the effects of hypertension have not been appropriately separated from those of the medications used. We evaluated the safety of exposure to antihypertensive medications during pregnancy, while accounting for disease effects. STUDY DESIGN: A population- based retrospective cohort study was performed, comparing all pregnancies of women with hypertension, either exposed or unexposed to antihypertensive medications. A computerized database of medications dispensed to pregnant women from 1998 to 2008 was linked with computerized databases containing maternal and infant hospitalization records from the district hospital during the same period. RESULTS: During the study period 100,029 deliveries occurred; of those, 1964 pregnant women suffered from chronic hypertension and 620 neonates (0.6%) were exposed to at least one antihypertensive medication (methyldopa or atenolol) during pregnancy. A higher rate of intrauterine growth restriction (IUGR 7.2% vs. 2.1%) (Adjusted OR 4.37; 95% CI 3.00-6.36; p<0.001), small for gestational age (SGA 3% vs. 1.7%, adjusted OR=2.23 95% CI: 1.27-3.92, P=0.005) and preterm deliveries (PTD<37 weeks, 22.9% vs. 8.0%) (Adjusted OR 3.69; 95% CI 2.90-4.69; p<0.001) were noted among pregnancies of women who were exposed to antihypertensive medications during the third trimester. Importantly, a similar association was detected when comparing untreated woman with chronic hypertension during pregnancy (n=1074) to woman without chronic hypertension and unexposed to antihypertensive medications (n=97,820). CONCLUSIONS: Chronic hypertension with or without treatment during pregnancy is an independent and significant risk factor for adverse perinatal outcomes such as IUGR, SGA and PTD.
American journal of obstetrics and gynecology 11/2012; · 3.28 Impact Factor
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ABSTRACT: Objective: To examine whether plasma levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) during the first 20 weeks of pregnancy can predict preeclampsia in the second half of pregnancy. Methods: The study population included 150,10 registered births. Receiver operating characteristic (ROC) curve analysis was used to describe the relationship between different values of AST and ALT during the first 20 weeks of pregnancy in the prediction of preeclampsia. Results: Using ROC curve analyses, elevated ALT levels were significantly associated with both mild preeclampsia (p < 0.001) and severe preeclampsia (p = 0.032). However, an ALT level of 50 IU/L had a sensitivity of only 3.3% (despite a specificity of 97%) in the prediction of severe preeclampsia. While no significant association was noted between AST levels and mild preeclampsia (p = 0.669), elevated levels of AST during this period were significantly associated with severe preeclampsia (p = 0.027). However, AST of 50I U/L had a sensitivity of only 2.0% (despite a specificity of 98%) in the prediction of severe preeclampsia. Conclusions: Higher levels of the liver enzymes AST and ALT during the first 20 weeks of pregnancy are associated with higher risk for the development of severe preeclampsia in the second half of the pregnancy. Nevertheless, there is no clinical cutoff value that can be practically used for the prediction of preeclampsia.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2012; · 1.36 Impact Factor
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ABSTRACT: OBJECTIVE: Nonsteroidal antiinflammatory drugs (NSAID) are among the most common medicines used by pregnant women. Published data are controversial regarding fetal safety following intrauterine exposure to NSAID. We investigated exposure to NSAID in the first trimester in a large cohort of infants and fetuses. METHODS: A computerized database of medications dispensed from 1998 to 2009 to all women registered in the "Clalit" health maintenance organization in Southern Israel was linked with 2 computerized databases containing maternal and infant hospitalization records. Pregnancy terminations for medical reasons were analyzed. The following confounders were controlled for: parity, maternal age, ethnicity, maternal pregestational diabetes, maternal inflammatory disease, and year of birth or pregnancy termination. First trimester exposure to nonselective cyclooxygenase (COX) inhibitors and to selective COX-2 inhibitors as groups and to individual drugs was analyzed. RESULTS: There were 110,783 pregnancies during the study period: 109,544 singleton births and 1239 pregnancy terminations for medical reasons. In total, 5267 mothers were exposed to NSAID during the first trimester of pregnancy: 5153 to nonselective COX inhibitors and 114 to COX-2 selective inhibitors. Exposure to NSAID in the first trimester, as groups (nonselective COX and selective COX-2 inhibitors) and as individual drugs, was not associated with an increased risk of major congenital malformations in general (adjusted OR 1.07, 95% CI 0.96-1.21 for nonselective; and adjusted OR 1.40, 95% CI 0.70-2.78, for selective COX-2 inhibitors), although an increased risk for musculoskeletal malformations was found following exposure to COX-2 selective inhibitors (adjusted OR 3.39, 95% CI 1.37-8.34). CONCLUSION: Intrauterine exposure to NSAID was not associated with increased risk for major congenital malformations. Further studies are needed to assess the risk for malformations after exposure to COX-2 selective inhibitors.
The Journal of Rheumatology 09/2012; · 3.69 Impact Factor
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ABSTRACT: Objective: The present study was aimed to evaluate long-term morbidity of patients with hypertensive disorders of pregnancy. Study design: A retrospective cohort study was conducted, including women who gave birth between the years of 1988 to 1998, and had a follow-up until December 2009. Data were extracted by linking a computerized database of hospitalizations with computerized database containing maternal records from the same regional medical center. The exposed group comprised 2072 patients with mild or severe preeclampsia in one or more of their pregnancies and the comparison group included 20742 patients without preeclampsia. Excluded from the study were patients with chronic hypertension and pre-gestational diabetes before the index pregnancy. Data included subsequent hospitalizations in internal medicine, oncology, nephrology, neurology, cardiac intensive care unit, and hematology, as well as a diagnosis of chronic hypertension during the follow-up period. Results: Patients with preeclampsia had significantly higher rates of chronic hypertension diagnosed after the index pregnancy as compared with patients without preeclampsia (12.5% vs. 0.9%; OR = 15.8, 95% CI 12.9-19.3; p < 0.001). Likewise, patients with preeclampsia were more likely to be hospitalized at least once (13.7% vs. 11.4%; OR = 1.2, 95% CI 1.1-1.4; p = 0.002) as compared with patients without preeclampsia. Exposed women had 582 hospitalizations (0.28 hospitalization/patient), while the non-exposed patients had a total of 4687 hospitalizations (0.23 hospitalization/patient; p < 0.001). Conclusion: Preeclampsia is a significant risk factor for long-term morbidity such as chronic hypertension and hospitalizations later in life.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 08/2012; · 1.36 Impact Factor
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ABSTRACT: OBJECTIVE: To investigate whether episiotomy prevents 3rd or 4th degree perineal tears in critical conditions such as shoulder dystocia, instrumental deliveries (vacuum or forceps), persistent occiput-posterior position, fetal macrosomia (>4,000 g), and non-reassuring fetal heart rate (NRFHR) patterns. METHODS: A retrospective study comparing 3rd and 4th degree perineal tears during vaginal deliveries with or without episiotomy, in selected critical conditions was performed. Multiple gestations, preterm deliveries (<37 weeks' gestation) and cesarean deliveries were excluded from the analysis. Stratified analysis (using the Mantel-Haenszel technique) was used to obtain the weighted odds ratio (OR), while controlling for these variables. RESULTS: During the study period, there were 168,077 singleton vaginal deliveries. Of those, 188 (0.1 %) had 3rd or 4th degree perineal tears. Vaginal deliveries with episiotomy had statistically significant higher rates of 3rd or 4th degree perineal tears than those without episiotomy (0.2 vs. 0.1 %; P < 0.001). The association between episiotomy and severe perineal tears remained significant even in the critical conditions. Stratified analysis revealed that the adjusted ORs for 3rd or 4th degree perineal tears in these critical conditions (Macrosomia OR = 2.3; instrumental deliveries OR = 1.8; NRFHR patterns OR = 2.1; occipito-posterior position OR = 2.3; and shoulder dystocia OR = 2.3) were similar to the crude OR (OR = 2.3). CONCLUSIONS: Mediolateral episiotomy is an independent risk factor for 3rd or 4th degree perineal tears, even in critical conditions such as shoulder dystocia, instrumental deliveries, occiput-posterior position, fetal macrosomia, and NRFHR. Prophylactic use of episiotomy in these conditions does not seem beneficial if performed to prevent 3rd or 4th degree perineal tears.
Archives of Gynecology 07/2012; · 0.91 Impact Factor
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ABSTRACT: Objective: α-1 antitrypsin (AAT) is an anti-protease, anti-inflammatory and tissue-protective molecule. Normal circulating levels are <3.5 mg/dl and rise during pregnancy. Although AAT deficiency is associated with several pregnancy and placental disorders, little is known regarding AAT levels and preeclampsia. Since unopposed inflammation might contribute to preeclampsia, we studied whether preeclampsia is associated with lower than normal levels and activity of AAT. Methods: In a prospective case-control study, we compared maternal serum AAT activity and levels between patients with severe preeclampsia (n = 23) and without preeclampsia (n = 18). Results: AAT levels were 1.91 ± 0.08-fold lower in the preeclampsia group compared to healthy group (3.854 ± 0.26 vs. 7.397 ± 0.34 mg/ml; p < 0.001), and correlated with protease inhibitory capacity (46.56 ± 2.08% vs. 67.08 ± 1.74%; p < 0.001). Conclusions: Our findings show association between lower AAT levels and severe preeclampsia during pregnancy. Further studies are required to identify the mechanism behind the association, and the possibility of safe AAT augmentation for individuals with insufficient circulating AAT.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 06/2012; · 1.36 Impact Factor
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ABSTRACT: Objective: To investigate pregnancy outcomes of patients with and without group-B streptococcus (GBS) bacteriuria. Methods: A retrospective study comparing pregnancy outcomes of women with GBS bacteriuria during pregnancy, those with positive GBS vaginal cultures and those without GBS colonization during pregnancy was conducted. Results: A significant linear association was found with regard to intrapartum fever (U-GBS 0.5%, V-GBS 0.3%, no GBS 0.1%, p = 0.001) and chorioamnionitis (U-GBS 3.3%, V-GBS 1%, no GBS 0.7%, p = 0.001). In addition preterm delivery (15.3% vs. 7.9%, p = 0.001) and premature rupture of membranes (10.7% vs. 7.9, p = 0.001) were significantly higher in the U-GBS group compared to no GBS. Woman with U-GBS had higher rates of diabetes mellitus, hypertensive disorders, and habitual abortions as well as a higher risk for intrauterine growth restriction (IUGR). In addition patients with U-GBS underwent induction of labor and cesarean delivery more frequently. Conclusions: Our study showed a significant association between U-GBS and adverse obstetrical outcomes. In addition a linear association was found between GBS culture location and obstetric complications. However, GBS was not associated with adverse perinatal outcome in our population.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 04/2012; 25(10):1983-6. · 1.36 Impact Factor
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ABSTRACT: To investigate factors associated with latent syphilis and pregnancy outcome among women with latent syphilis.
A retrospective population-based study was conducted to compare all pregnancies among women with and without latent syphilis at Soroka University Medical Center, Be'er-Sheva, Israel, between 1988 and 2010. Stratified analysis using a multiple logistic regression model was performed to control for confounders.
Of the 219656 deliveries during the study period, 159 (0.1%) involved women with latent syphilis. Multivariate analysis with backward elimination revealed the following conditions to be significantly associated with latent syphilis: fetal growth restriction (odds ratio [OR] 2.20; 95% confidence interval [CI], 1.07-4.49; P=0.03); drug abuse (OR 9.95; 95% CI, 1.31-75.46; P=0.02); tobacco use (OR 3.35; 95% CI, 1.74-6.45; P<0.05); and Jewish (vs Bedouin) ethnicity (OR 4.05; 95% CI, 2.65-6.20; P<0.05).
Women with latent syphilis are at risk for adverse maternal and perinatal outcomes, including fetal growth restriction. Careful surveillance of these high-risk pregnancies should be considered.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2012; 118(1):15-7. · 1.41 Impact Factor
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ABSTRACT: To compare postoperative pain perception and analgesia requirements in patients undergoing cesarean section (CS) using general versus spinal anesthesia.
A prospective, observational study of patients undergoing elective CS during 2009 under either general or spinal anesthesia. Postoperative pain intensity and analgesia requirements were evaluated for up to 48 h after surgery.
A total of 153 women were enrolled; 77 received general and 76 received regional anesthesia. Postoperative meperidine requirements in the first 24 h were significantly higher in the general anesthesia group. Pain scores were mostly comparable between the groups. Nevertheless, lower pain scores were graded after 8 h in the general versus the spinal anesthesia and this reversed at 48 h.
Spinal anesthesia is comparable to general anesthesia in terms of post-operative pain control. In choosing the type of anesthesia in CS, other factors such as the urgency and potential maternal and fetal hazards should be taken into account.
Archives of Gynecology 03/2012; 286(1):75-9. · 0.91 Impact Factor
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ABSTRACT: To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis.
A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders.
Out of 219,612 singleton deliveries in 1988-2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, p<0.001), younger maternal age (26.3 ± 6.0 vs. 28.6 ± 5.8 years, p<0.001), intrauterine growth restriction (IUGR) (6.7% vs. 2.1%, p<0.001), placental abruption (3.6% vs. 0.7%, p<0.001), low 1 min Apgar scores (10.3% vs. 6.0%, p<0.05), urinary tract infection (UTI) (4.2% vs. 0.4%, p<0.001) and preterm delivery (less than 37 weeks gestation; 20.0% vs. 7.8%; p<0.001). Using a multivariable analysis, independent risk factors for acute antepartum pyelonephritis were nulliparity (OR 2.0; 95% C.I 1.4-2.9; p<0.001), UTI (OR 10.3; 95% C.I 4.8-22.1; p<0.001) and younger maternal age (OR 0.96; 95% C.I 0.93-0.99; p=0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7-3.9; p<0.001).
Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery.
European journal of obstetrics, gynecology, and reproductive biology 02/2012; 162(1):24-7. · 1.97 Impact Factor
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ABSTRACT: Objective. Trace elements are minerals required in minute quantities to maintain proper physical functioning. The role of trace elements in the process of parturition is poorly understood. This study was aimed to determine levels of trace elements’ concentration in maternal plasma and umbilical venous and arterial plasma at term during active labor vs elective cesarean delivery (CD). Study design. A prospective case–control study was conducted. Forty healthy parturients in active labor at term with their newborns were compared to 40 healthy parturients matched for maternal age, parity, and gestational age, who delivered by elective CD (before commencement of labor). Samples of maternal venous blood and umbilical cord arterial and venous blood were drawn immediately following delivery. Trace elements’ concentrations were measured using the inductively coupled plasma mass spectrometer (ICP-MS). Results. Significant higher levels of manganese (Mn) and selenium were found in maternal venous plasma during active labor vs elective CD. Magnesium (Mg) levels were significantly higher in maternal venous blood during elective CD compared to active labor. Umbilical cord artery levels of Mg, Mn, and zinc (Zn) were significantly higher in active term labor vs elective CD. Also, significant higher levels of copper and Zn were found in umbilical cord vein between active labor and elective CD. Conclusion. Trace elements’ concentrations differ significantly in fetal blood during active labor vs elective CD. Hence, trace elements may play a crucial role in the process of human parturition.
02/2012; 25(3):286-289.
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ABSTRACT: To describe the prevalence of lack of prenatal care (LOPC) over the years and to examine the association between LOPC and perinatal complications among Bedouin parturients.
A retrospective study comparing all singleton births of Bedouin women with and without prenatal care, between the years 1988 and 2009, was conducted. Multiple logistic regression models were used to control for confounders.
Out of 123,506 singleton deliveries, 16.5% (n = 20,402) were of women lacking prenatal care. A gradual increase in the rate of LOPC was noted between the years 2006 and 2009. Using multivariable analyses, controlling for parity, LOPC was found to be significantly associated with preterm delivery (PTD) < 37 weeks (odds ratio (OR) 1.13, 95% CI 1.07-1.19), PTD < 34 weeks (OR 1.53, 95% CI 1.40-1.67), low birth weight < 2,500 g (LBW; OR 1.39, 95% CI 1.32-1.46), very LBW < 1,500 g (OR 1.67, 95% CI 1.49-1.86), and perinatal mortality (OR 1.63, 95% CI 1.47-1.80).
Lack of prenatal care in a traditional community is associated with adverse obstetric outcomes and specifically is an independent risk factor for preterm delivery, low birth weight, and perinatal mortality.
Archives of Gynecology 11/2011; 285(5):1237-42. · 0.91 Impact Factor
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ABSTRACT: To determine whether intrauterine fetal death (IUFD) of one twin of diamnionic twins after 22 weeks of gestation is associated with adverse perinatal outcome to the co-twin.
A retrospective case-control study (n = 4070), including all twin births delivered between the years 1988 and 2010, was conducted. Perinatal outcome of the co-twin in diamnionic pregnancies complicated by IUFD were compared with the first twin from a pair of live-born diamnionic twins. A multiple logistic regression model was constructed to determine the association between IUFD of one twin and postpartum death (PPD) of the co-twin while controlling for confounders such as gestational age.
Pregnancies complicated with IUFD of a co-twin (n = 116) had higher rates of adverse perinatal outcomes such as PPD (9.5% vs. 2.3%, p < 0.001), low Apgar scores (<7) at 1 and 5 min (30.2% vs. 10.6%, p < 0.001 and 6.9% vs. 1.8%, p < 0.001, respectively), lower birth weight (1953 ± 746 g vs. 2299 ± 559 g), and higher rates of preterm birth before 34 weeks of gestation (38.8% vs. 16.4%, p < 0.001). Using a multivariate analysis with PPD as the outcome variable, mortality was attributed to gestational age (adjusted OR = 0.58; 95% CI 0.5-0.6, p < 0.001) and not to the IUFD per se (adjusted OR = 1.3, 95% CI 0.5-3.3, p = 0.552).
Intrauterine fetal death of one twin (of diamnionic twins) is associated with adverse perinatal outcome of the co-twin mainly due to prematurity.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 11/2011; 25(8):1453-5. · 1.36 Impact Factor
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ABSTRACT: The study was aimed to define trends, risk factors and perinatal outcome associated with shoulder dystocia (SD).
A population-based study comparing all singleton deliveries with and without SD was conducted. Statistical analysis was performed using multiple logistic regression analysis.
Shoulder dystocia complicated 0.2% (n = 451) of all deliveries included in the study (n = 240,189). The rate of SD declined from 0.4% in 1988 to 0.13% in 2009. Independent risk factors for SD in a multivariable analysis were fetal macrosomia (birth-weight ≥ 4 kg; OR = 16.1; 95% CI 13.2-19.6, P < 0.001), failure of labor to progress during the second stage (OR = 2.4; 95% CI 1.5-3.7, P < 0.001), diabetes mellitus (OR = 1.8; 95% CI 1.4-2.3, P < 0.001) and advanced maternal age (years, OR = 1.02; 95% CI 1.001-1.03, P = 0.029). Perinatal mortality was significantly higher after SD as compared to the comparison group (6.2 vs. 1.4%, P <0.001). Another multivariable analysis, with perinatal mortality as the outcome variable, controlling for confounders such as maternal age, gestational age, diabetes mellitus, etc. was constructed; SD was noted as an independent risk factor for perinatal mortality (adjusted OR = 11.1; 95% CI 7.2-17.1, P < 0.001).
Shoulder dystocia, associated with macrosomia, labor dystocia, diabetes mellitus, and advanced maternal age, is an independent risk factor for perinatal mortality. In an era of increased rate of cesarean deliveries, and perhaps increased accuracy of birth weight estimation, the rate of shoulder dystocia gradually declines.
Archives of Gynecology 11/2011; 285(5):1225-9. · 0.91 Impact Factor
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ABSTRACT: The aim of this study was to explore whether scoliosis is a risk factor for adverse obstetric outcomes and specifically for cesarean delivery (CD) and labor dystocia. Association between scoliosis and pregnancy outcome was studied before. Confounding conclusions prevent proper counseling of patients. Appropriate statistical analysis of a suitable cohort is helpful in resolving this issue. A retrospective population-based study comparing all singleton pregnancies of women with and without documented scoliosis was conducted. Deliveries occurred between the years 1988 and 2009. Multiple logistic regression models were used to control for confounders. Out of 229,116 patients which were included in our cohort, 0.043% (n = 98) had a documented scoliosis. These patients had higher rates of fertility treatments (7.1% vs. 1.6%; p < 0.001). Scoliosis was found to be significantly associated with labor induction (36.7% vs. 26.3 %; p = 0.02) and cesarean deliveries (21.4% vs. 13.1%; p = 0.014). Using multiple logistic regression models, with CD as the outcome variable, controlling for confounders such as nulliparity, labor induction and maternal age, scoliosis was not found to be an independent risk factor for CD (OR = 1.56, 95% CI 1.9-2.7; p = 0.121). Scoliosis is not a risk factor for adverse pregnancy outcome, and specifically for labor dystocia.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 11/2011; 25(6):639-41. · 1.36 Impact Factor
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ABSTRACT: We wished to investigate whether women with a history of eating disorders have an increased risk for adverse obstetric and perinatal outcomes.
A retrospective study was conducted comparing pregnancy complications in patients with and without eating disorders. Deliveries occurred during the years 1988-2009 in a tertiary medical center. Women lacking prenatal care and with multiple gestations were excluded from the study. Stratified analyses were performed using multivariable logistic regression models. Odds ratios (OR) and their 95% confidence interval (CI) were computed. A p value<0.05 was considered statistically significant.
During the study period, of 117,875 singleton deliveries, 122 (0.1%) occurred in patients with eating disorders. Eating disorders were significantly associated with fertility treatments (5.7% vs. 2.8%, p=0.047), intrauterine growth restriction (7.4% vs. 2.3%, p<0.001), term low birth weight (<2500 g) (7.4% vs. 2.8%, p=0.002), preterm delivery (15.6% vs. 7.5%, p=0.002), and cesarean delivery (25.4% vs. 15.0%, p=0.001). Using multivariable analyses, low birth weight (OR 2.5, 95% CI 1.3-5.0), preterm delivery (OR 2.2, 95% CI 1.4-3.6), and cesarean section (OR 1.9, 95% CI 1.3-2.9) were significantly associated with eating disorders.
Eating disorders are associated with increased risk of adverse pregnancy outcomes. Accordingly, careful surveillance is needed for early detection of possible complications.
Journal of Women s Health 11/2011; 21(1):61-5. · 1.57 Impact Factor
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ABSTRACT: The study was aimed to compare trace elements concentrations in women with and without severe pre-eclampsia (PE).
A prospective case-control study was conducted comparing 43 parturients with severe PE (who received magnesium sulfate [MgSO4]) and 80 healthy parturients and their newborns, matched for gestational age and mode of delivery. Inductively coupled plasma mass spectrometry (ICPMS) was used for the determination of zinc (Zn), copper (Cu), selenium (Se) and magnesium (Mg) levels in maternal as well as arterial and venous umbilical cord serum.
Zn levels (µg/L) were significantly higher in fetal arterial and venous blood of the PE group (947.3 ± 42.5 vs. 543.1 ± 226, 911.1 ± 220.2 vs. 422.4 ± 145, p < 0.001; respectively). Se levels (µg/L) were significantly lower in maternal and fetal arterial and venous cord blood of the PE group (98.6 ± 24.2, 110.7 ± 19.4, 82 ± 17.8 vs. 111.6 ± 17.6, 82.1 ± 17.4 vs. 107.1 ± 25.7, p < 0.001; respectively). Cu levels (µg/L) were significantly lower in fetal arterial and venous cord blood (581.6 ± 367.4 vs. 949 ± 788.8, p = 0.022, 608.3 ± 418.1 vs. 866.9 ± 812.6, p = 0.001 respectively) but higher in maternal blood (2264.6 ± 751.7 vs. 1048 ± 851.1, p < 0.001). These differences remained significant while controlling for the mode of delivery. Mg levels were significantly higher in the PE group as compared with the control group.
Severe PE is associated with abnormal concentrations of Zn, Cu and Se. Therefore, trace elements may have a crucial role in the pathogenesis of severe PE.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2011; 25(7):1127-30. · 1.36 Impact Factor
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ABSTRACT: To evaluate the impact of local lidocaine incision-site injection in patients undergoing cesarean deliveries (CD), on post operative pain and analgesic requirements.
In this prospective, double-blinded, placebo-controlled study, patients undergoing elective CD were randomly assigned to receive 1% lidocaine solution or placebo to the incision site, prior to the performance of a Pfannenstiel incision. Pain intensity was evaluated for up to 48 hours after surgery and analgesic requirements of the patients were recorded.
During the study period, 153 patients were enrolled; 77 received pre-emptive analgesia with lidocaine and 76 received a placebo. No significant differences were noted between the groups in respect to parity, previous CD, maternal age and gestational age. Pain scores or requirements of analgesia did not differ between the groups.
Pre-emptive analgesia with local incision-site injection with lidocaine does not seem beneficial in reducing post cesarean pain scores and analgesic requirements.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2011; 25(7):1131-4. · 1.36 Impact Factor
