Ariel Many

• Head of Department at Tel Aviv Sourasky Medical Center

Objective The rising rates of cesarean delivery (CD), which are a leading cause of intra‐abdominal adhesions, represent a major concern for maternal health. We aimed to describe early maternal complications following CD in women with severe intra‐abdominal adhesions. Methods A prospective observational study was conducted at a university‐affiliate...

Objective: The increasing rate of cesarean sections (CSs) raises concerns over severe intra-abdominal adhesions, which are associated with numerous complications. We aimed to identify risk factors and predictive tools for severe adhesions. Design: A prospective study was conducted. Participants/Materials: Women with at least one prior CS were ev...

Purpose To assess the prevalence, microbial profile, and clinical risk factors of maternal bacteremia associated with intrapartum fever (IPF). Methods A retrospective cohort study, in a single tertiary university-affiliated medical center between 2012 and 2018. Demographic and labor characteristics of women, who delivered at term (37+0/7–41+6/7) a...

Objectives: To determine whether in a labor floor housed continuously by senior physicians the risk of adverse maternal and neonatal outcome is affected by time of delivery. Methods: This retrospective cohort study, conducted at a tertiary medical center, assessed singleton term deliveries from 1 January 2011 to 30 January 2020. Participants were c...

The relation between grand multiparity and poor pregnancy outcome, especially postpartum hemorrhage and blood transfusion, has displayed inconsistent findings. Some studies have identified an increased maternal and neonatal morbidity, but the more recent literature is less clear about the risks. The objective of the study is to determine the associ...

Background The relation between grand multiparity and poor pregnancy outcome, especially post-partum hemorrhage and blood transfusion has not been consistent. Some studies found an association between maternal and neonatal mortality more recent literature is less clear about the risks. Objectives We aimed to determine the association of grand multi...

Objective Postpartum hemorrhage is a major cause of maternal morbidity and mortality, so early identification of patients at risk is crucial. In this study, we aim to assess the risk factors for major transfusion in parturients. Methods A case–control study was conducted between 2011 and 2019. The cases included women who were treated with postpar...

Objective To determine pregnancy outcomes in women with subjective sensation of increased fetal movements (IFM). Methods A prospective cohort study of women after 20 weeks of gestation who were referred with subjective sensation of IFM (April 2018–April 2019) for assessment. Pregnancy outcome was compared to pregnancies with a normal sensation of...

Background: Intraabdominal adhesions may develop following cesarean delivery and are considered a major concern. Objective: This study aimed to determine the effect of surgeon seniority in evaluating intraabdominal adhesions at cesarean delivery. Study design: A prospective study to estimate interrater reliability between surgeons was conducte...

Intrahepatic cholestasis of pregnancy (ICP) is characterized by elevated total bile acids (TBA). Although elevated maternal TBA is a major risk factors for fetal morbidity and mortality, it is unclear why some fetuses are more prone to the hazardous effect of bile acids (BA) over the others. It is unclear whether fetuses are protected by placental...

Pregnant women and their partners often ask healthcare professionals whether sex is safe during pregnancy, and what consequences may result from sexual activity. Many clinicians can also be unsure of the answers to these type of questions, leading to both patient and clinician resorting to the internet for advice, which can be inaccurate and anxiet...

Objective We aimed to assess the efficacy of three different labor induction methods for non-viable third-trimester fetuses. Methods This retrospective cohort study included women who had an intra-uterine fetal death or termination of pregnancy at or after 28 weeks of gestation and underwent labor induction by either transcervical foley catheter a...

Introduction Lower uterine segment scarring after cesarean section can decrease intraoperative bleeding during subsequent surgery. We examined whether first elective cesarean section is associated with greater average blood loss compared to repeated surgery. Methods Decrease in maternal hemoglobin and hematocrit after surgery was retrospectively c...

Background: Exploratory laparotomy is considered the gold standard treatment for women with suspected uterine rupture. We aimed to investigate the feasibility and safety of laparoscopy as an alternative for laparotomy for the management of hemodynamically stable women with suspected postpartum uterine rupture. Study design: We conducted a case s...

Objective To investigate trial of labor after cesarean (TOLAC) success rates in twin gestations with no prior vaginal delivery. Methods A retrospective study of women with twin gestations who underwent a TOLAC and had no prior vaginal delivery during 2011–2020. TOLAC success and failure groups were compared. Results Of 675 twin gestations with a...

Background Advanced magnetic resonance imaging (MRI) methods are increasingly being used to assess the human placenta. Yet, the structure–function interplay in normal placentas and their associations with pregnancy risks are not fully understood. Purpose To characterize the normal human placental structure (volume and umbilical cord centricity ind...

Background Visual and acoustic virtual reality (VR) has been increasingly explored as a non-pharmacological tool for pain relief in clinical settings. Objective We aimed to evaluate the effectiveness of VR as a distraction technique in the management of acute pain during operative hysteroscopy in the outpatient setting. Methods A prospective, ope...

Importance The SARS CoV2 alpha variant posed increased risk for COVID19 complications in pregnant women. However, its impact on the maternal humoral response and placental IgG transport remains unclear. Objective To characterize the maternal humoral waning and neonate immunity acquired during the third COVID19 wave in Israel, dominated by the Alpha...

The importance of breastmilk in postnatal life lies in the strong association between breastfeeding and the reduction in the risk of infection and infection-related infant mortality. However, data regarding the induction and dynamics of breastmilk antibodies following administration of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine is scarce, a...

Background: Pregnancy and parturition reflect the complex interaction between physiologic conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We aimed to investigate the characteristics of the mother-infant dyad of term infants detected as having congenital hypo...

Purpose Pregnancies conceived by in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are associated with an increased incidence of obstetrical and neonatal complications. With the growing rate of male factor infertility, which is unique by not involving the maternal milieu, we aimed to assess whether obstetrical outcomes differed b...

Objective: To identify the clinical characteristics of pregnancy associated group A streptococcus (GAS) infection and predictors for intensive care unit (ICU) admission. Design: A retrospective cohort study of culture-proven pregnancy-related GAS infections. Setting and population: a tertiary university-affiliated hospital between 1/2008-7/2020. Me...

Objective We aimed to assess the role of lactate and hemoglobin levels as predictors for the need for blood transfusion in post-partum hemorrhage (PPH). Methods A retrospective cohort study of women with PPH in a single university-affiliated tertiary medical center between August 2018 and June 2020. PPH was defined as an estimated excessive blood...

Background: The significant risks posed to mothers and fetuses by COVID-19 in pregnancy have sparked a worldwide debate surrounding the pros and cons of antenatal SARS-CoV-2 inoculation, as we lack sufficient evidence regarding vaccine effectiveness in pregnant women and their offspring. We aimed to provide substantial evidence for the effect of B...

Objective To evaluate the impact of prolonged exposure to meconium-stained amniotic fluid (MSAF), in women with term pre-labor spontaneous rupture of membranes (PROM), on pregnancy outcome. Methods A retrospective cohort study of women who gave birth in a single university-affiliated tertiary medical center (2011–2019). Eligibility was limited to...

Objective: Cefazolin is a widely used antimicrobial prophylactic agent, however the appropriate dosage, timing, pharmacology and microbial coverage have not been well-established for gynecologic procedures. We aimed to describe serum concentrations and pharmacokinetics of Intravenous cefazolin given to women prior to scheduled minimally invasive g...

Pregnancy and parturition reflect the complex interaction between physiologic conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We investigated the characteristics of the mother-infant dyad of term infants detected by the National Newborn Screening Program as h...

Objective: To evaluate the length of the second stage of labor in twin deliveries and to compare the length of the second stage in twin and singleton gestations. Methods: This is a retrospective cohort study from three large hospitals in Israel. Clinical data were collected from the electronic medical record. The primary outcome was the length o...

We describe the dynamics of the vaccine-specific antibody response in the breastmilk and serum in a prospective cohort of ten lactating women who received two doses of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. The antibody response was rapid and highly synchronized between breastmilk and serum, reaching stabilization 14 days after the sec...

Aim Enterovirus is a common pathogen. Although mostly asymptomatic, this infection has the potential to be life‐threatening in neonates. This article aims to describe the early neonatal outcomes in peripartum infection. Methods We performed a retrospective cohort study in a tertiary hospital between 1/2014 and 5/2019. The enterovirus infection was...

Objective To investigate the association of maternal peripartum bacteremia and meconium stained amniotic fluid in early preterm deliveries. Methods We conducted a single center retrospective study, in a tertiary university affiliated medical center. The study cohort included women with culture proven maternal bacteremia who had a preterm delivery...

Objective Our objective was to evaluate the effects of time and temperature on umbilical-cord blood analysis. Methods This prospective study included the term spontaneous vaginal deliveries. One venous and seven arterial samples were drawn from each umbilical cord within 5 min from delivery. Three samples were immediately refrigerated (3 °C), whil...

Objective To compare the pregnancy outcome of women who underwent cesarean section in the second stage of labor, with or without a vacuum extraction attempt Methods A retrospective cohort study of women who underwent a cesarean section during the second stage of labor in a single tertiary university-affiliated medical center (2012–2019). Pregnancy...

Objective: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vaginal secretions of both reproductive-aged and postmenopausal women during acute SARS-CoV-2 infection. Design: Prospective study. Setting: A single tertiary, university-affiliated medical centre in Israel. Time period, 1 June 2020 t...

Introduction Understanding regarding the whole placental vascular network structure is limited. Our aim was to quantitatively characterize the human placental vascular tree ex-vivo using high-resolution MRI. Methods 34 normal placentas were rinsed and injected with a solution of gelatin and contrast agent through the umbilical vessels. A sample of...

Background and Objectives Surgical site infection and other postoperative complications are relatively common in obstetrical procedures, and they are associated with morbidity, prolonged hospital stay, and readmissions. Appropriate levels of antimicrobial agents given directly before skin incision can prevent the establishment of surgical-related i...

Objective: We aimed to compare features of preeclampsia between twin and singleton pregnancies. Methods: In this retrospective case-control study, women with twin pregnancies who were diagnosed with preeclampsia were matched to singleton pregnancies controls. Results: Ninety-four women with twin gestation diagnosed with preeclampsia were compared t...

Objective To report the first successful oocyte cryopreservation in a prepubertal girl. Design Case report and review of the literature. Setting Tertiary medical center. Patient(s) A 7-year-old prepubertal girl with Turner syndrome mosaicism (45,X[37]/47,XXX[15]) who underwent a novel fertility preservation procedure after fertility preservation...

Introduction Understanding regarding the whole placental vascular network structure is limited. Our aim was to quantitatively characterize the human placental vascular tree ex-vivo using high-resolution MRI. Methods 34 normal placentas were rinsed and injected with a solution of gelatin and contrast agent through the umbilical vessels. A sample of...

To study the effect of very advanced maternal age on perinatal outcomes. A retrospective cohort study of women aged 45 years and above, who delivered ≥22 weeks of gestation in a single tertiary center between 1/ 2011 and 12/ 2018. Maternal and neonatal outcomes were compared between women ≥50 years and women of 45–49 years at delivery. Of 83,661 pa...

Objective This study was aimed to assess the utility of diagnostic tests of maternal and fetal infection in the evaluation of stillbirth. Study Design A single-center retrospective study from January 2011 to December 2016 of all women presenting to the hospital with intrauterine fetal death at or after 20 weeks of gestation. Standard evaluation inc...

Objective: To determine fetal gender on umbilical cord parameters. Methods: Umbilical cords were prospectively collected from uncomplicated, singleton, term pregnancies, which ended either by elective cesarean section or spontaneous vaginal delivery. Data regarding obstetrical history and pregnancy outcome were collected. Various cord parameters we...

Purpose To determine the impact of pelvic inflammation caused by tubo-ovarian abscess (TOA) on ovarian response to stimulation. Methods This retrospective longitudinal cohort analysis that was carried out in a tertiary university-affiliated medical center included 15 women with TOA during in vitro fertilization (IVF) cycles. The ovarian response t...

Introduction: Infected abortion is a life-threatening condition that requires immediate surgical and medical interventions. We aimed to assess the common pathogens associated with infected abortion and to test the microbial coverage of various empiric antimicrobial regimens based on the bacteriological susceptibility results in women with infected...

Introduction and hypothesis Our aim was to examine the effect of the number of catheterizations during labor on the development of overt postpartum urinary retention (PUR) in women who had a vaginal delivery with epidural anesthesia. Methods A single-center retrospective matched case–control study between 1 January 2015 and 31 December 2016. Women...

Study objectives: Obstructive sleep apnea (OSA) during pregnancy has been associated with adverse maternal outcomes. However, the effect of maternal OSA on fetal growth is less clear. The placenta is a critical organ for fetal growth and development and the principal determinant of birthweight. We aimed to investigate the effect of maternal OSA on...

Objectives: The aim of the study is to compare the effect of very advanced maternal age (≥ 45 years) on maternal and neonatal outcomes of twin and singleton pregnancies. Materials and methods: This retrospective cohort study included women ≥ 45 years of age who gave birth to twins. Each was randomly matched to two women ≥ 45 years of age who gave b...

Aim: To compare pregnancy outcome of immigrant women who became pregnant to a same ethnicity partner versus a partner from a different ethnicity. Methods: A retrospective cohort study on all singleton pregnancies of immigrant women who delivered between the years 2011–2015 in a single tertiary University affiliated Hospital. Demographic and obstetr...

Aims: The study aimed to compare the clinical course and disease severity between culture positive and culture negative patients with intra-uterine devices (IUD)-associated pelvic inflammatory disease (PID). Methods: A retrospective study of all IUD-associated PID patients admitted to tertiary medical center between 2010 and 2015. All patients r...

The prevalence of obstructive sleep apnea (OSA) during pregnancy is rising. OSA during pregnancy has been associated with hypertensive disorders of pregnancy and gestational diabetes. The effect of maternal OSA on the fetus, particularly on fetal growth, is less apparent. Most of the currently available human data is based on non-objective assessme...

Abstract Background Preeclampsia is among the most common medical complications of pregnancy. The clinical utility of invasive hemodynamic monitoring in preeclampsia (e.g., Swan-Ganz catheter) is controversial. Thoracic impedance cardiography (TIC) and Doppler echocardiography are noninvasive techniques but they both have important limitations. NIC...

Background: Hyponatremia during labor and delivery may result in severe maternal and neonatal sequelae. Our aim was to describe the direct effect of hyponatremia in labor on pregnancy outcome. Methods: A case series of parturients diagnosed with hyponatremia during labor and their neonates. Clinical presentation, laboratory workup, and maternal and...

PurposeDifferences in hemodynamic changes during a cesarean section (CS) between twin and singleton pregnancies are poorly defined. The Non-Invasive Cardiac System (NICaS) is an impedance device that measures cardiac output (CO) and its derivatives. We compared maternal cardiac parameters using NICaS™ in singleton and twins before and during delive...

Background: Accurate fetal brain volume estimation is of paramount importance in evaluating fetal development. The aim of this study was to develop an automatic method for fetal brain segmentation from magnetic resonance imaging (MRI) data, and to create for the first time a normal volumetric growth chart based on a large cohort. Subjects and met...

Purpose: To assess risk factors and complications of manual placental removal. Materials and methods: An historical prospective study of all parturients undergoing manual placental removal between 2012–2014. Parturients were matched by time of delivery with parturients delivering vaginally with spontaneous placental separation. Multiple gestations,...

Objectives: The objective of this study is to assess the reliability of the cardiac index (CI) in healthy pregnant women at term by investigating the correlation between the cardiac output (CO) and the body surface area (BSA) using a novel non-invasive cardiography technique (NICaS™). Methods: Sixty-one healthy, normotensive women with a singleton...

The generation of rationally-designed polymer therapeutics via the conjugation of low molecular weight anti-cancer drugs to water-soluble polymeric nanocarriers aims to improve the therapeutic index. Here, we focus on applying polymer therapeutics to target two cell compartments simultaneously - tumor cells and angiogenic endothelial cells. Compari...

Objective To investigate coagulation system changes during an in-vitro fertilization (IVF) cycle using Thromboelastogram (TEG) that enables analysis of the elastic properties of whole blood samples and provides a global assessment of the hemostatic function. Study Design A prospective study. TEG indices were evaluated in 23 women who underwent con...

To further investigate the interaction between vitamin D system and estrogen-mimetic compounds in the human vasculature we studied the effect of the “less- calcemic” analog of 1,25(OH)2D3 (1,25D); JK 1624F2-2 (JKF) in the presence of selective estrogen modulator femarelle (F), the phytoestrogen daidzein (D) and estradiol-17b (E2) on 3[H] thymidine...

PurposeSterilization via bilateral total salpingectomy is slowly replacing partial salpingectomy, as it is believed to decrease the incidence of ovarian cancer. Our objective was to compare short-term intra and post-operative complication rates of bilateral total salpingectomy versus partial salpingectomy performed during the course of a cesarean d...

Preimplantation genetic diagnosis (PGD) may pose risks to pregnancy outcome owing to the invasiveness of the biopsy procedure. This study compares outcome of singleton and twin clinical pregnancies conceived after fresh embryo transfers of PGD (n = 89) and matched intracytoplasmic sperm injection (ICSI) pregnancies (n = 166). The study was carried...

Thromboelastography (TEG) provides real-time assessment of hemostasis by measuring the viscoelastic properties, coagulation factor, and platelet activity in whole blood samples. In this prospective case-control study, we wanted to investigate whether blood clot formation assessment, using TEG, can identify a hypercoagulable state in women with seve...

Objective To assess the role of placental cultures in cases of preterm premature rupture of membranes (PPROM) complicated by chorioamnionitis and to determine the effect of positive cultures on short-term neonatal outcomes. Design A retrospective single-center study. The medical records of all women with PPROM between January 1, 2011, and December...

( Birth. 2016;43(1):36–41) Postpartum hemorrhage (PPH) is one of the main risk factors of a prolonged third stage of labor, which is usually 5 to 20 minutes; only 8% of placentae remain undelivered by 20 minutes. The incidence of PPH worldwide is about 6% for >500 mL of blood loss and 1.86% for >1000 mL of blood loss despite active management of th...

Purpose: Meconium-stained amniotic fluid (MSAF) is rarely observed in preterm pregnancies, and its clinical significance is undetermined. We evaluated the correlation between MSAF and obstetrical and perinatal complications prior to 34 weeks’ gestation. Materials and methods: Pregnancies complicated with MSAF between 24 and 34 weeks of gestation we...

Neural cell adhesion molecule (NCAM) expression is known to be associated with an aggressive biological behavior, increased metastatic capacity and expression of stem-cell markers in several tumor types. NCAM was also found to be expressed on tumor endothelial cells while forming new capillary-like tubes, but not on normal endothelial cells. An NCA...

Childbearing age continues to rise and, with the increasing implementation of assisted reproductive technology (ART), the number of multiple pregnancies has also risen. This is a retrospective cohort study on maternal and neonatal outcomes of the twin pregnancies of 57 women aged ≥45 years compared to 114 younger women who gave birth in our institu...

Introduction The aim of our study was to demonstrate the distribution of an uncomplicated third stage and to determine the optimal time for manual intervention. Risk factors for a prolonged third stage were studied. Materials and Methods Computerized data of all vaginal deliveries at our L&D unit from 2010 to 2014 were obtained. Cases of complete a...

The net vascular effect of estrogens on the vasculature is still under debate. Here we tested the effects of estradiol- 17β (E2) as well as estrogen-receptor subtype specific and non-specific agonists and antagonists on the expression and eicosanoid production of lipoxygenase (LO) enzymes expressed in culture human umbilical vascular smooth muscle...

Objective: To describe clinical characteristics in parturients with group A streptococcal infection and suggest preventive strategies. Methods: We performed a retrospective review of all group A streptococci cultures from women presenting with peripartum fever or abdominal tenderness between January 2008 and May 2015 in a university hospital. Re...

Background and objectives: Accidental dural puncture (ADP) during epidural analgesia is a debilitating complication. Symptoms of ADP post-dural puncture headache (PDPH) are headache while rising from supine to upright position, nausea, and neck stiffness. While age, gender and needle characteristics are established risk factors for ADP, little is...

Objective: The aim of our study was to determine the optimal time for manual placental removal in an uncomplicated third stage while taking into consideration the risk for blood transfusion. Risk factors for postpartum blood transfusions were studied. Methods: Computerized data of all vaginal deliveries at our labor and delivery unit from 2010 t...

Objective: This prospective cohort study evaluated the relationship between fertility treatments and the prevalence and outcomes of dichorionic discordant twins. This issue has gained importance due to twin gestations resulting from fertility treatments. Study design: Mothers of dichorionic twin pregnancies achieved in a single fertility clinic...