Eran Ashwal

Rabin Medical Center · Helen Schneider Hospital for Women

(Abstracted from Lancet 2024;403(10426):545–553 Up to 3% of term pregnancies result in adverse perinatal outcomes, often caused by placental insufficiency. Detecting placental insufficiency can facilitate the prevention of adverse perinatal outcomes.

Objective To determine the impact of prior gestational diabetes mellitus (GDM) on perinatal outcomes in a subsequent GDM pregnancy. Methods This retrospective cohort study included 544 multiparous patients with two consecutive pregnancies between 2012‐2019, where the second (index) pregnancy was affected by GDM. The primary exposure was prior GDM...

Introduction: To determine lung hypoplasia in cases with fetal skeletal dysplasia based on the total lung weight at autopsy as the most accountable surrogate marker for pulmonary hypoplasia. Methods: This retrospective cohort study included all pregnancies with antenatal diagnosis of skeletal dysplasia (2012-2018). We included only cases in whic...

Objective: To evaluate the short- and long-term outcome of fetuses with evidence of extension of the choroid plexus into the frontal horns. Methods: This is a retrospective cohort study of fetuses diagnosed with isolated choroid plexi extending into the frontal horns. Fetuses with major central nervous system anomalies were excluded. Ultrasound...

Objective: To evaluate the role of mid-trimester placental growth factor (PlGF) in patients with abnormal circulating levels of first-trimester biomarkers. Methods: Retrospective cohort study including singleton pregnancies complicated by abnormal first-trimester biomarkers (2017-2020). Pregnancies complicated with chromosomal/structural anomali...

Background: Second-trimester uterine artery Doppler is a well-established tool for the prediction of preeclampsia and fetal growth restriction. At delivery, placentas from affected pregnancies may have gross pathologic findings. Some of these features are detectable by ultrasound, but the relative importance of placental morphologic assessment and...

Objective Oxytocin uterotonic agents are routinely administered during the third stage of labor, however, the administration route is varying, intravenously or intramuscularly. We aimed to compare the effect of different regimens of postpartum oxytocin administration on hemoglobin (Hb) and hematocrit (Hct) decline. Methods A randomized, 3-arm stud...

Introduction A rise in the rate of cesarean delivery (CD) has been found to be associated with a higher length of hospital stay, making it a public health concern. We aimed to evaluate risk factors for prolonged hospitalization following CD. Methods A retrospective cohort study, in a single tertiary medical center, was conducted (2011-2019). Cesar...

Background Placental pathology assessment following delivery in pregnancies complicated by preeclampsia, fetal growth restriction, abruption and stillbirth reveal a range of underlying diseases. The most common pathology is maternal vascular malperfusion (MVM), characterized by high resistance uterine artery Doppler (UtAD) waveforms and abnormal ex...

Objective We aimed to investigate the association of mild thrombocytopenia with postpartum hemorrhage (PPH) and blood transfusion among women with twin gestations. Methods A retrospective cohort study (Jan 2015 to May 2019) was performed. Women with twin pregnancies and pre‐delivery mild thrombocytopenia were compared to those with normal platelet...

Objectives: We aimed to investigate whether surgery for adnexal detorsion within 6 hours from admission to the hospital is associated with less adnexal ischemia. Design: Retrospective cohort study Participants/Materials, Setting, Methods: This retrospective study was conducted at two university-affiliated medical centers, assessed women aged 18...

Introduction Fetoplacental Doppler is considered to be a key tool for the diagnosis of placenta-mediated fetal growth restriction(FGR). We aimed to determine the diagnostic accuracy of fetoplacental Doppler for specific placental diseases. Methods A retrospective cohort study of all women with a singleton pregnancy and an antenatal diagnosis of SG...

Objective To evaluate the correlation of maternal and cord blood levels of SARS‐CoV‐2 antibodies in pregnant women immunized against COVID‐19. Methods A prospective cohort study was performed of pregnant women who delivered at a single university affiliated tertiary medical center. Women who received the COVID‐19 vaccine (BNT162b2 Pfizer©) were ap...

Purpose To compare pregnancy outcomes in grand-multiparous (GMP) women with and without one previous cesarean delivery (CD), and to evaluate the number of previous successful vaginal deliveries after a CD needed to reduce the complication rate of trials of labor after a previous CD. Methods This is a retrospective cohort study of women with single...

Objective To determine maternal and neonatal complications associated with an intrapartum cesarean delivery (CD) with and without a history of a previous CD. Methods A retrospective cohort study of all women who underwent an unplanned intrapartum CD following a trial of labor in a university‐affiliated tertiary hospital, between 2009 and 2016. Per...

Purpose To evaluate the correlation between urine protein/creatinine ratio (UPCR) and proteinuria in a 24-h urine collection and to calculate the predicative accuracy of different cutoffs of UPCR for the diagnosis of proteinuria. Methods A retrospective cohort study including women who admitted for the evaluation for suspected preeclampsia (PET) b...

Objective We aimed to investigate the association of advanced maternal age with intrapartum cesarean delivery and to assess its risk factors and perinatal outcomes. Study Design A retrospective cohort study of all women with singleton pregnancies who attempted a trial of labor (≥24 + 0 weeks of gestation) in a single center (2011–2017). The study...

Background We assessed the association of early term at first birth (ETB) with the risk of preterm birth (PTB) and ETB in women with 3 consecutive deliveries. Methods We conducted a retrospective cohort study of all women with 3 consecutive singleton births at a single institute from 1994 to 2013. The risk of PTB (<37 weeks), spontaneous PTB and E...

Background Gestational diabetes (GDM) is associated with accelerated fetal growth in singleton pregnancies, but may impact twin pregnancies differently due to the slower growth of twin fetuses during the third trimester and their greater predisposition to fetal growth restriction. Objective To evaluate the association of GDM with longitudinal feta...

Objective: The aim of the current study was to identify the optimal cutoff that should define discordance in dichorionic twin gestations through correlation with abnormal placental pathology as a specific measure of fetal growth restriction of the smaller twin. Methods: We performed a retrospective cohort study of all women with dichorionic twin...

Objective To identify risk factors for postpartum hemorrhage (PPH) following cesarean delivery (CD). Methods A retrospective study of all women who underwent CD in a university-affiliated tertiary hospital (2014–15). PPH was defined as any of the following: clinical PPH (≥1000 ml estimated blood loss), hemoglobin (Hb) drop ≥3 g/dl (the difference...

Background: We aimed to explore the association of the number, order, gestational age and type of prior PTB and the risk of preterm birth (PTB) in the third delivery in women who had three consecutive singleton deliveries. Methods: A retrospective cohort study of all women who had three consecutive singleton births at a single medical center over a...

Purpose: To evaluate pregnancy outcome of patients who undergo laparoscopy during pregnancy. Methods: A retrospective case-control study, conducted in a single university-affiliated tertiary care medical center, comparing pregnancy outcomes of women who underwent laparoscopy during pregnancy to women without operations during pregnancy. The stud...

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...

Background: Controversy surrounds the impact of the fetal head station on labor duration and mode of delivery. Whereas an extensive body of evidence has been published evaluating fetal head station in early labor, there is a paucity of data on the impact of fetal head descent during the second stage. Objective: To explore the association between...

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 The aim of this study was to investigate the effect of short or long interpregnancy interval (IPI) with placental mediated pregnancy complications after already complicated first delivery. Methods We performed a retrospective cohort analysis of all women with singleton pregnancies who delivered their first three consecutive deliveries in...

Background: Pregnancies conceived by in vitro fertilization (IVF) are associated with a higher prevalence of perinatal complications than pregnancies conceived spontaneously, even after correction of confounding factors. Little is known about the prevalence of complications of the third stage of labor in IVF pregnancies. Objective: To compare the p...

Background: Controversy surrounds the defining normal and abnormal labor. Objective: In this study, we used contemporary labor charts to explore labor patterns in large obstetric population (2011-2016). Study design: Detailed information from electronic medical records of live singleton deliveries at term (≥37 weeks) was extracted. Cases of el...

Purpose To evaluate whether induction of labor (IOL), as compared with expectant management, in gestational diabetes mellitus (GDM) mothers at term (between 370/7 and 406/7), decreases caesarean section (CS) rate and the rate of adverse composite neonatal outcomes. Methods A retrospective cohort study, of all women with GDM and a singleton gestati...

Objective: To determine predictors for cesarean delivery (CD) in pregnancies complicated by preterm premature rupture of membranes (PPROM) with an intention for vaginal delivery. Materials and methods: A retrospective cohort analysis of all singleton, preterm deliveries (24 + 0 to 36 + 6 weeks) following PPROM (2007-2014). Exclusion criteria includ...

Purpose To evaluate the best performing formula for macrosomia prediction in pregnancies complicated by diabetes. Methods A retrospective analysis was performed of 1060 sonographic fetal biometrical measurements performed within 7 days of delivery in term pregnancies (37–42 gestational weeks) complicated by diabetes. Sonographic prediction of macr...

Purpose To determine neonatal birthweight (BW) thresholds for adverse maternal and neonatal outcome following vaginal delivery. Methods A retrospective cohort study of all women with singleton pregnancies who underwent vaginal delivery in a university-affiliated tertiary hospital (1996–2015). The association between BW and adverse outcome in neona...

Objective: to describe our two dimensional (2D) ultrasound approach to visualize the fetal secondary palate, and plot its growth curve, and to describe demonstrate its clinical implementation. Methods: this is a two parts retrospective study. First, we measured the antero-posterior length of the bony secondary palate, from the soft to hard palat...

Objective Increased birthweight is a risk factor for early neonatal complications, as well as cardiovascular and metabolic disease later in adulthood. We aimed to assess birthweight trends and the rate of large for gestational age newborns in women in their third delivery according to birthweight in the first and second deliveries. Study designA re...

Purpose To evaluate labor and perinatal outcomes of transient isolated polyhydramnios. Materials and Methods A retrospective cohort study (2008 – 2013) at a university-affiliated, tertiary medical center. Eligibility was limited to patients with singleton gestations, no maternal diabetes or known structural/chromosomal anomalies, and no rupture of...

Purpose: Uterine activity plays a crucial role in labor, especially when utero-tonic materials are administered. We aimed to determine the electrical responsiveness of the uterine musculature to labor augmentation with oxytocin using electrical uterine myography (EUM) technology, and to assess whether the kinetics of the EUM device may serve as a...

Introduction: Spinal anesthesia is considered the gold standard anesthetic technique for cesarean deliveries (CD) but is associated with a high rate of hypotension. The recent international consensus recommends continuous prophylactic phenylephrine infusion (PPI) administered throughout CD to prevent hypotension. However little information is avail...

Objective: To evaluate the outcomes of vacuum-assisted vaginal deliveries (VAD) among neonates of mothers with gestational diabetes mellitus (GDM). Study design: Retrospective cohort study of women with singleton gestation ≥37 + 0 weeks of gestation who underwent VAD at a single, tertiary, medical center (2007–2014). Women with GDM and their neonat...

Introduction: Spinal anesthesia for cesarean delivery is associated with high incidence of hypotension and is most often prevented by a prophylactic phenylephrine infusion (PPI). In this study, we aimed to identify maternal hemodynamic changes both intraoperatively and postoperatively with the use of the NICaS noninvasive cardiac output monitor in...

Purpose: To stratify maternal and neonatal outcomes of trials of labor after previous cesarean delivery (TOLAC) by gestational age. Methods: Retrospective cohort study of all singleton pregnancies with one previous cesarean delivery in TOLAC at term between 2007 and 2014. We compared outcomes of delivery at an index gestational week, with outcom...

PurposeTo evaluate the impact of vacuum extraction on birth injuries among low birth weight neonate (2000–2499 g). Methods Retrospective cohort study of women with singleton pregnancies > 34 weeks, birth weight of 2000–3500 g, undergoing vacuum extraction, between 2007 and 2014. Outcomes were compared between neonates who weighed 2000–2499 g and 25...

Objective: To evaluate separate and combined contributions of gestational diabetes mellitus (GDM) and large-for-gestational age (LGA) on delivery outcomes. Methods: In a retrospective cohort study of term singleton deliveries between 2007 and 2014 in Tel Aviv, Israel, outcomes were compared between non-GDM/AGA pregnancies (reference) and three s...

Background: Intrapartum fetal heart rate (FHR) monitoring is well recommended during labor to assess fetal wellbeing. Though commonly used, the external Doppler and fetal scalp electrode monitor have significant shortcomings. Lately, non-invasive technologies were developed as possible alternatives. Objective: The objective of this study is to comp...

Objective: We aimed to evaluate perinatal outcomes of advanced maternal age (AMA) primiparous women seeking scheduled cesarean delivery (CD) versus a trial of labor (TOL). Materials and methods: This was a retrospective cohort study of primiparous women ≥ 40 years of age carrying a single fetus, who delivered at a tertiary, university-affiliated me...

Objective: Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with pelvic pain and subfertility, affecting 0.6–10% of the general female population. The association between endometriosis and obstetrical outcomes is not well established. We aimed to evaluate whether endometriosis is associated with a h...

Objective: The sonographic prediction of fetal macrosomia affects obstetrical decision regarding the timing and mode of delivery. We aimed to compare the accuracy of various formulas for prediction of macrosomia at different thresholds. Study design: This was a retrospective cohort study of singleton gestations at term, with fetal biometrical me...

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,...