[show abstract][hide abstract] 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.
[show abstract][hide abstract] 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
[show abstract][hide abstract] 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
[show abstract][hide abstract] 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
[show abstract][hide abstract] ABSTRACT: To investigate whether colonization with GBS in a previous pregnancy is associated subsequently with adverse obstetric and perinatal outcomes.
A retrospective study was undertaken comparing pregnancy complications of patients with and without colonization with GBS in a previous pregnancy from 1988 to 2006. Women with a positive GBS culture in the current pregnancy, women lacking prenatal care and multiple gestations were excluded from the analysis.
Adverse obstetric and perinatal outcomes including premature rupture of membranes, intrapartum fever, chorioamnionitis and perinatal mortality.
Out of 184,266 singleton deliveries, 230 (0.12%) were of patients with a positive GBS culture in their previous pregnancy. Previous GBS colonization was not found to be associated with adverse pregnancy outcomes such as PROM (9.1 vs. 6.8%; P = 0.16), intrapartum fever (1.3 vs. 2.2%; P = 0.72) and chorioamnionitis (1.3 vs. 0.8%; P = 0.29).
GBS colonization in a previous pregnancy is not associated with adverse pregnancy outcomes in the current pregnancy.
Archives of Gynecology 10/2010; 284(4):787-91. · 0.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine the necessity of routine cervical dilatation during elective cesarean delivery (ECD).
A retrospective cohort study including all ECD during 2005 was performed, comparing post operative complications between patients with and without cervical dilatation.
Out of 666 ECD, 348 underwent routine cervical dilatation. No significant differences were found between the cervical dilatation and the comparison group regarding postpartum febrile morbidity (5.1 and 3.1%, respectively; p = 0.071), hospitalisation duration (4.1 +/- 1.4 and 4.1 +/- 2.0 days; p = 0.95), wound infection (0.9% and 1.25%, p = 0.451) or anemia rate (9.50 +/- 0.73 and 9.54 +/- 0.65, p = 0.91). Nevertheless, among patients following a previous vaginal delivery, cervical dilatation was significantly associated with post-operative fever (OR = 5.8; 95%CI 1.2-38.0; p = 0.021).
Routine cervical dilatation during ECD does not reduce post operative morbidity. Moreover, among patients with a previous vaginal delivery cervical dilatation is a risk factor for febrile morbidity.
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 05/2009; 22(7):608-11. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: To characterize neonatal morbidity and mortality rates in extreme preterm deliveries (between 23 and 27 weeks' gestation) with and without PPROM, and to evaluate the association between PPROM and chorioamnionitis.
A retrospective population-based study was conducted on preterm singleton pregnancies delivered between 23 and 27 weeks' gestation from 1988 to 2007. Immediate neonatal morbidity and mortality rates in pregnancies complicated by PPROM were compared to pregnancies with intact membranes. A multivariate analysis was conducted in order to determine the independent association between PPROM and chorioamnionitis.
Out of 1,437 preterm deliveries, 236 (16.4%) were complicated with PPROM. There were more neonates with low 1 min (61.0 vs. 42.5%; P = 0.001) and low 5 min (30.1 vs. 23.8%; P = 0.042) Apgar scores (of less than 7) in pregnancies complicated by PPROM than in the comparison group. There were more cases of chorioamnionitis in the PPROM group born at 23-24 weeks' gestation (33.8 vs. 17.0%; P < 0.001), and in the PPROM group born at 25-27 weeks (42.0 vs. 15.5%; P < 0.001). In the group born at 23-24 weeks' gestation, there were more postpartum deaths (PPD) in the PPROM group (70.0 vs. 54.8%; P = 0.013); however, there was no significant difference in PPD in the groups born at 25-27 weeks. In the group born at 23-24 weeks, as well as at 25-27 weeks, there were fewer antepartum deaths (APD) in the PPROM group as compared to the control group (16.3 vs. 32.6%; P = 0.002, and 5.3 vs. 36.3%; P < 0.001; respectively). After adjusting for gestational age and gender, using a multivariate analysis, the association between PPROM and chorioamnionitis remained significant (OR = 3.32; 95% CI 2.43-4.51, P < 0.001).
PPROM is associated with adverse perinatal outcome in deliveries between 23 and 27 weeks' gestation. Moreover, PPROM is an independent risk factor for chorioamnionitis.
Archives of Gynecology 12/2008; 280(1):7-11. · 0.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to determine whether women who experienced perinatal mortality in their first delivery had, in their subsequent birth, a higher risk for adverse perinatal outcome.
A population-based study was undertaken to compare all second deliveries of women with previous perinatal mortality in their first delivery to those with no such history. Deliveries occurred from 1988 to 2004 in a tertiary medical center. Patients lacking prenatal care, multiple gestations, and congenital malformations were excluded from the analysis. A multivariable logistic regression model and the Mantel-Haenszel procedure were carried out to control for confounders.
During the study period, out of 25,876 singleton second deliveries, 230 (0.9%) cases were of patients with previous perinatal mortality. Multivariable analysis with backward elimination showed a significant association between previous perinatal mortality and the following conditions: hypertensive disorders (OR=2.6, 95% CI 1.7-3.9, P<0.001), diabetes mellitus (OR=2.4, 95% CI 1.5-3.7, P<0.001), fertility treatment (OR=2.7, 95% CI 1.6-4.7, P=0.001), and younger maternal age (OR=0.9, 95% CI 0.92-0.98, P<0.001). Controlling for preterm delivery, using the Mantel-Haenszel procedure, the association between previous and subsequent perinatal mortality remained significant (weighted OR=2.2, 95% CI 1.2-3.9, P=0.010).
Previous perinatal loss poses an independent risk for subsequent perinatal mortality. Prospective studies are warranted in order to establish the appropriate means of surveillance and/or interventions needed to decrease future adverse perinatal outcomes.
Archives of Gynecology 06/2008; 279(3):299-303. · 0.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: Women who work commercially in sex work (female sex workers [FSW]) are considered a high-risk group for sexually transmissible infections (STI), yet the level of reported pathogens varies in studies around the world. This study reviewed STI rates reported in 42 studies of FSW around the world published between 1995 and 2006 and analysed the trends and types of populations surveyed, emphasising difficult to access FSW populations.
Studies were retrieved by PUBMED and other search engines and were included if two or more pathogens were studied and valid laboratory methods were reported.
The five most commonly assessed pathogens were Neisseria gonorrhea (prevalence 0.5-41.3), Chlamydia trachomatis (0.61-46.2), Treponema pallidum (syphilis; 1.5-60.5), HIV (0-76.6), and Trichomonas vaginalis (trichomoniasis; 0.11-51.0). Neisseria gonorrhea and C. trachomatis were the most commonly tested pathogens and high prevalence levels were found in diverse areas of the world. HIV was highly prevalent mostly in African countries. Although human papillomavirus infection was surveyed in few studies, prevalence rates were very high and its aetiological role in cervical cancer warrant its inclusion in future FSW monitoring. Hard-to-access FSW groups tended to have higher rates of STI.
The five most commonly detected pathogens correspond to those that are highly prevalent in the general population, however there is an urgent need to develop rapid testing diagnostics for all five pathogens to increase prevention and treatment, especially in outreach programs to the most vulnerable groups among FSW.
Sexual Health 04/2008; 5(1):9-16. · 1.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: Due to the mobile and clandestine nature of those who enter a country illegally, female sex workers (FSWs) who are working without papers or work permits often have no access to sexual health care. This study reports on the sexually transmissible infection (STI) prevalence among a sample of 43 sex workers working illegally. Brothel workers from republics of the Former Soviet Union (FSU), working in two locales in Israel were tested for the presence of eight pathogens and the presence of pathology by Pap smear. Of these brothel workers, 48.8% had at least one positive STI result, 14% had two STIs and one woman had three STIs. There were no cases of HIV, gonorrhoea or malignancy detected; high rates of ureaplasma (26.8%) and chlamydia were found (16.7%). Four cases of hepatitis C (9%) and three cases of hepatitis B (7%) and mycoplasma (7%) were detected. There was no relationship between reported symptoms and the detection of STIs. The level of STIs is high among this population of FSWs and it is imperative to develop more accessible health services for these women.
Sexual Health 01/2007; 3(4):301-3. · 1.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: Hodgkin's disease occurs frequently in women of reproductive age. Anthracyclines in general and doxorubicin in particular are integral parts of therapy.
A 24-year-old primigravida had dilated cardiomyopathy diagnosed at 34 weeks'gestation. Three years earlier she had been treated with chest radiation and combination chemotherapy, including doxorubicin, for Hodgkin's disease.
The clinician should be aware of this manifestation. Multidisciplinary supervision throughout pregnancy as well as planned timing and mode of delivery are mandatory.
The Journal of reproductive medicine 06/2004; 49(5):401-3. · 0.75 Impact Factor