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Naeh A, Maor-Sagie E, Hallak M, Toledano Y, Gabbay-Benziv R. Greater risk of type 2 diabetes progression in multifetal gestations with gestational diabetes: the impact of obesity. Am J Obstet Gynecol 2023:S0002-9378(23)02060-4. [PMID: 38360449 DOI: 10.1016/j.ajog.2023.11.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND The relationship between gestational diabetes mellitus and adverse outcomes in multifetal pregnancies is complex and controversial. Moreover, limited research has focused on the risk of gestational diabetes mellitus progression to type 2 diabetes mellitus specifically in multifetal pregnancies, resulting in conflicting results from existing studies. OBJECTIVE This study aimed to assess the risk of gestational diabetes mellitus progression to type 2 diabetes mellitus between singleton and multifetal pregnancies in a large cohort of parturients with a 5-year follow-up. STUDY DESIGN A retrospective study was conducted on a prospective cohort of pregnant individuals with pregnancies between January 1, 2017, and December 31, 2020, followed up to 5 years after delivery. Glucose levels during pregnancy were obtained from the Meuhedet Health Maintenance Organization laboratory system and cross-linked with the Israeli National Diabetes Registry. The cohort was divided into 4 groups: singleton pregnancy without gestational diabetes mellitus, singleton pregnancy with gestational diabetes mellitus, multifetal pregnancy without gestational diabetes mellitus, and multifetal pregnancy with gestational diabetes mellitus. Gestational diabetes mellitus was defined according to the American Diabetes Association criteria using the 2-step strategy. Univariate analyses, followed by survival analysis that included Kaplan-Meier hazard curves and Cox proportional-hazards models, were used to assess differences between groups and calculate the adjusted hazard ratios with 95% confidence intervals for progression to type 2 diabetes mellitus. RESULTS Among 88,611 parturients, 61,891 cases met the inclusion criteria. The prevalence of type 2 diabetes mellitus was 6.5% in the singleton pregnancy with gestational diabetes mellitus group and 9.4% in the multifetal pregnancy with gestational diabetes mellitus group. Parturients with gestational diabetes mellitus, regardless of plurality, were older and had higher fasting plasma glucose levels in the first trimester of pregnancy. The rates of increased body mass index, hypertension, and earlier gestational age at delivery were significantly higher in the gestational diabetes mellitus group among patients with singleton pregnancies but not among patients with multifetal pregnancies. Survival analysis demonstrated that gestational diabetes mellitus was associated with adjusted hazard ratios of type 2 diabetes mellitus of 4.62 (95% confidence interval, 3.69-5.78) in singleton pregnancies and 9.26 (95% confidence interval, 2.67-32.01) in multifetal pregnancies (P<.001 for both). Stratified analysis based on obesity status revealed that, in parturients without obesity, gestational diabetes mellitus in singleton pregnancies increased the risk of type 2 diabetes mellitus by 10.24 (95% confidence interval, 6.79-15.44; P<.001) compared with a nonsignificant risk in multifetal pregnancies (adjusted hazard ratio, 9.15; 95% confidence interval, 0.92-90.22; P=.059). Among parturients with obesity, gestational diabetes mellitus was associated with an increased risk of type 2 diabetes mellitus for both singleton and multifetal pregnancies (adjusted hazard ratio, 3.66; [95% confidence interval, 2.81-4.67; P<.001] and 9.31 [95% confidence interval, 2.12-40.76; P=.003], respectively). CONCLUSION Compared with gestational diabetes mellitus in singleton pregnancies, gestational diabetes mellitus in multifetal pregnancies doubles the risk of progression to type 2 diabetes mellitus. This effect is primarily observed in patients with obesity. Our findings underscore the importance of providing special attention and postpartum follow-up for patients with multifetal pregnancies and gestational diabetes mellitus, especially those with obesity, to enable early diagnosis and intervention for type 2 diabetes mellitus.
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Affiliation(s)
- Amir Naeh
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Esther Maor-Sagie
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Meuhedet Health Maintenance Organization, Haifa, Israel
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Meuhedet Health Maintenance Organization, Haifa, Israel
| | - Yoel Toledano
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Meuhedet Health Maintenance Organization, Haifa, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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Wilkof-Segev R, Naeh A, Barda S, Hallak M, Gabbay-Benziv R. Unintended uterine extension at the time of cesarean delivery - risk factors and associated adverse maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2023; 36:2204997. [PMID: 37127602 DOI: 10.1080/14767058.2023.2204997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To identify risk factors, maternal and neonatal adverse outcomes related to unintended lower segment uterine extension during cesarean delivery (CD). METHODS A retrospective cohort analysis in a single, university-affiliated medical center between 1 January 2018 and 31 December 2019. All singleton pregnancies delivered by CD were included. Univariate and multivariate analyses were performed to identify maternal and obstetrical predictors for uterine extension during CD. For secondary outcomes, we assessed the correlation between uterine extension and any adverse maternal or neonatal outcome. Risk factors were analyzed using ROC statistics to measure their prediction performance for a uterine extension. RESULTS Overall, 1746 (19.3%) CDs were performed during the study period. Of them, 121 (6.9%) CDs were complicated by unintended uterine extension. There was no difference in maternal demographics and clinical data stratified by uterine extension at CD. Uterine extensions were significantly more common following induction of labor, intrapartum fever, premature rupture of membranes, a trial of labor after cesarean, advanced gestational age, emergent CD, and in particular CD during the second stage of labor (37.2% vs. 6.5%) and after failed vacuum extraction (6.6% vs. 1.1%), p < .05 for all. The incidence of postpartum hemorrhage and re-laparotomy did not differ between the groups. Most of the extensions were caudal-directed (40.4%), and were closed by a two-layer closure (92%). Mean extension size was 4.5 ± 1.7 cm. Using multivariable analysis, the only factor that remained significant was CD at the second stage of labor (adjusted odds ratio (aOR) 54.2, 95% CI 4.5-648.9, p = .002), with an area under the ROC curve 0.653 (95% CI 0.595-0.712, p < .001). Emergent CD, body mass index, birth weight, failed vacuum attempt, and trial of labor after cesarean were not significant. For secondary outcomes, an unintended uterine extension was associated with longer operation time, higher estimated blood loss, greater pre- to post-CD hemoglobin difference, increased blood products transfusion, puerperal fever, and longer hospital stay. No clinically significant neonatal adverse outcomes were observed. CONCLUSIONS In our cohort, second-stage CD was the strongest predictor for an unintended uterine extension. Following uterine extension, women had increased infectious and blood-loss morbidity.
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Affiliation(s)
- Renana Wilkof-Segev
- Hillel Yaffe Medical Center, Hadera, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amir Naeh
- Hillel Yaffe Medical Center, Hadera, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sivan Barda
- Hillel Yaffe Medical Center, Hadera, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mordechai Hallak
- Hillel Yaffe Medical Center, Hadera, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Rinat Gabbay-Benziv
- Hillel Yaffe Medical Center, Hadera, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Barda S, Yoeli Y, Stav N, Naeh A, Maor-Sagie E, Hallak M, Gabbay-Benziv R. Factors Associated with Progression to Preeclampsia with Severe Features in Pregnancies Complicated by Mild Hypertensive Disorders. J Clin Med 2023; 12:7022. [PMID: 38002636 PMCID: PMC10672209 DOI: 10.3390/jcm12227022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
In this retrospective cohort study, we aimed to investigate the variables associated with progression to preeclampsia with severe features in parturients already diagnosed with mild hypertensive disorders of pregnancy. The study was conducted in a single university-affiliated medical center between 2018 and 2020. All women admitted due to hypertensive disorders were included. Data collected was compared between parturients who progressed and did not progress to preeclampsia with severe features. Among 359 women presenting without severe features, 18 (5%) developed severe features, delivered smaller babies at lower gestational age, and with higher rates of cesarean delivery (p < 0.001 for all). Chronic hypertension, maternal diabetes, any previous gestational hypertensive disorder, gestational diabetes, number of hospitalizations, earlier gestational age at initial presentation, and superimposed preeclampsia as the preliminary diagnosis were all associated with preeclampsia progression to severe features. Previous delivery within 2-5 years was a protective variable from preeclampsia progression. Following regression analysis and adjustment to confounders, only gestational age at initial presentation and superimposed preeclampsia remained significant variables associated with progression to severe features (aOR 0.74 (0.55-0.96) and 34.44 (1.07-1111.85), aOR (95% CI), respectively, p < 0.05 for both) with combined ROC-AUC prediction performance of 0.89, 95% CI 0.83-0.95, p < 0.001. In conclusion, according to our study results, early gestational age at presentation and superimposed preeclampsia as the preliminary diagnosis are the only independent factors that are associated with progression to severe features in women already diagnosed with mild hypertensive disorders during pregnancy.
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Affiliation(s)
- Sivan Barda
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel (A.N.); (E.M.-S.); (M.H.)
| | | | | | | | | | | | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel (A.N.); (E.M.-S.); (M.H.)
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Anabusi S, Aviram A, Melamed N, Asztalos E, Naeh A, Zaltz A, Barrett J, Mei-Dan E. Mild neonatal morbidity in twins by planned mode of delivery: a secondary analysis of the Twin Birth Study. Am J Obstet Gynecol MFM 2023; 5:100973. [PMID: 37061042 DOI: 10.1016/j.ajogmf.2023.100973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The Twin Birth Study showed no differences in major severe adverse neonatal outcomes between those with planned vaginal delivery and those with planned cesarean delivery. OBJECTIVE This was a secondary analysis of the Twin Birth Study in which mild neonatal morbidities, not previously reported, were compared between parturients with planned cesarean deliveries and those with planned vaginal delivery in twin births. STUDY DESIGN This was a secondary analysis of the Twin Birth Study. In this study, women with a twin pregnancy at 32+0/7 to 38+6/7 weeks of gestation with the first twin in cephalic presentation and with an estimated weight between 1500 and 4000 g were randomized to either planned cesarean delivery or planned vaginal delivery. The primary outcome of this study was a composite mild neonatal outcome of respiratory and neurologic morbidities and neonatal intensive care unit admission that were not reported in the original Twin Birth Study at 34+0/7 to 38+6/7 weeks of gestation. A multivariable logistic regression analysis was used to identify factors associated with the composite adverse neonatal outcomes. Neonatal outcomes were further stratified by gestational age at delivery and by actual mode of delivery. RESULTS A total of 1304 women and 1326 women were randomly assigned to planned cesarean delivery and planned vaginal delivery, respectively. Demographic and obstetrical characteristics were similar between the study groups. The rate of cesarean delivery was 90.1% in the planned cesarean delivery group and 40.1% in the planned vaginal delivery group. There was no significant difference in the primary composite outcome between the groups (10.6% vs 11.3%; P=.45) neither by planned mode of delivery nor by actual mode of delivery. Stratification by gestational age found a lower rate of the primary outcomes at ≥38+0/7 weeks of gestation in the planned cesarean delivery group when compared with the planned vaginal delivery group (4.8% vs 10.8%, respectively; P=.02). Furthermore, a lower risk for some individual outcomes was reported in the planned cesarean delivery group when compared with the planned vaginal delivery group, including intraventricular hemorrhage stage 1 to 2 (0.2% vs 0.6%; P<.05), low Apgar scores (0.8% vs 2.3%; P<.05), pH <7.0 (0.3 vs 1%; P<.05), and assisted ventilation needed at delivery (0.4% vs 0.9%; P<.05). CONCLUSION In twin deliveries, with the first twin in the cephalic presentation, composite mild neonatal morbidity was not affected by the planned mode of delivery. These findings reinforce the original results of the Twin Birth Study. Nevertheless, an increased composite outcome after 38 weeks' gestation and a higher risk for some individual morbidities in the planned vaginal delivery group might be viewed as a concerning signal for the safety of vaginal delivery in twin deliveries and requires further research.
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Affiliation(s)
- Saja Anabusi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Zaltz, Barrett, and Mei-Dan); Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan).
| | - Amir Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Zaltz, Barrett, and Mei-Dan); Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan)
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Zaltz, Barrett, and Mei-Dan); Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan)
| | - Elizabeth Asztalos
- Unit of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada (Drs Anabusi and Mei-Dan); Department of Newborn & Developmental Pediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (Dr Asztalos); Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan)
| | - Amir Naeh
- Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan)
| | - Arthur Zaltz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Zaltz, Barrett, and Mei-Dan); Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan)
| | - Jon Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Zaltz, Barrett, and Mei-Dan); Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan)
| | - Elad Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Zaltz, Barrett, and Mei-Dan); Unit of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada (Drs Anabusi and Mei-Dan); Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada (Drs Anabusi, Aviram, Melamed, Asztalos, Naeh, Zaltz, Barrett, and Mei-Dan)
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Weinberger H, Nekave S, Hallak M, Naeh A, Gabbay-Benziv R. Single Sporadic Deceleration during Reactive Nonstress Test-Clinical Significance and Risk for Cesarean Delivery. J Clin Med 2023; 12:jcm12103387. [PMID: 37240493 DOI: 10.3390/jcm12103387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in reactive non-stress test (NST) is scarce, and optimal management has yet to be established. We aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for fetal heart rate decelerations during labor and the need for intervention. METHODS This was a retrospective, case-control study of singleton term pregnancies at one university-affiliated medical center in 2018. The study group consisted of all pregnancies with an SSD in an otherwise reactive NST. For each case, two consecutive pregnancies without SSD were matched in a 1:2 ratio. The primary outcome was the rate of cesarean delivery (CD) due to non-reassuring fetal heart rate monitoring (NRFHRM). RESULTS 84 women with an SSD were compared to 168 controls. SSD during antenatal fetal surveillance did not increase the rate of CD overall or for NRFHRM (17.9% vs. 13.7% and 10.7% vs. 7.7%, respectively, p > 0.05). Rates of assisted deliveries and maternal and neonatal complications were similar between the groups. CONCLUSIONS SSD during a reactive NST in term pregnancies is not associated with an increased risk for adverse perinatal outcomes. SSD should not necessarily require induction of labor, and expectant management is a reasonable alternative.
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Affiliation(s)
- Hila Weinberger
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Shlomit Nekave
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Mordechai Hallak
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Amir Naeh
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Rinat Gabbay-Benziv
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
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Naeh A, McLaughlin K, Snelgrove J, Ashwal E, Agrawal S, Kingdom JC. PlGF (Placental Growth Factor) testing in clinical practice – identifying the optimal threshold. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Naeh A, Ray JG. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health - Reply: letter to the editor. Pregnancy Hypertens 2022; 30:96. [DOI: 10.1016/j.preghy.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
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Berezowsky A, Naeh A, Chandrasekaran N. Prenatal diagnosis of aorto-pulmonary window. Arch Gynecol Obstet 2022; 306:1409-1410. [PMID: 35849170 DOI: 10.1007/s00404-022-06696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandra Berezowsky
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Saint Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - Amir Naeh
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Saint Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Nirmala Chandrasekaran
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Saint Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Naeh A, Berezowsky A, Yaniv SS, Berger H, Agrawal S, Ray JG. Persistence of abnormal uterine artery flow postpartum: case-control study. Pregnancy Hypertens 2022; 29:21-22. [DOI: 10.1016/j.preghy.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
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Weinberger H, Shlomit nekave, Hallak M, Gabbay-Benziv R, Naeh A. Single sporadic deceleration during reactive nonstress test – clinical significance and risk for cesarean delivery. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gelman M, Galperin T, Maor-Sagie E, Yoeli Y, Hallak M, Gabbay-Benziv R, Naeh A. Pregnancy outcomes in women with poorly-controlled pregestational diabetes mellitus. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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12
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Raviv S, Wilkof-Segev R, Maor-Sagie E, Naeh A, Yoeli Y, Hallak M, Gabbay-Benziv R. Hypoglycemia during the oral glucose tolerance test in pregnancy-maternal characteristics and neonatal outcomes. Int J Gynaecol Obstet 2021; 158:585-591. [PMID: 34796491 DOI: 10.1002/ijgo.14037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate maternal and neonatal outcomes in pregnancies complicated by hypoglycemia on 100-g oral glucose tolerance test (OGTT). METHODS A retrospective cohort analysis of all live-born deliveries in a single medical center during 2018 and 2019 with available OGTT results and birth outcomes. Preterm deliveries (<34 weeks), multiple pregnancies and major anomalies were excluded. Hypoglycemia during OGTT was defined as at least one glucose value below 60 mg/dl. Maternal characteristics and perinatal outcomes were compared between three groups: Hypoglycemia on OGTT, Normal OGTT and Abnormal OGTT. Univariate followed by multivariate analyses were used to control for confounders. RESULTS Overall, 2079 women were entered into the analysis. Of these, 216 (10.4%) had at least one hypoglycemic value, 1072 (51.6%) had normal OGTTs and 791 (38%) abnormal OGTTs. Hypoglycemia in OGTT was more prevalent in multiparous women and was associated with fetal male gender. Absolute birth weight, low birth weight and small for gestational age differed between groups; however, there was no difference between groups in overall birth weight centiles (60.1 ± 26.8 versus 63 ± 26 versus 60.9 ± 27; P > 0.05). Following adjustment of confounders, hypoglycemia was not associated with rates of low birth weight or small for gestational age (P < 0.05). There were no other differences in perinatal outcomes between groups. CONCLUSION Hypoglycemia in OGTT is not associated with maternal or neonatal adverse outcomes.
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Affiliation(s)
- Shira Raviv
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Renana Wilkof-Segev
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Esther Maor-Sagie
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amir Naeh
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yochai Yoeli
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mordechai Hallak
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Rinat Gabbay-Benziv
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Naeh A, Berezowsky A, Yudin MH, Dhalla IA, Berger H. Preeclampsia-Like Syndrome in a Pregnant Patient With Coronavirus Disease 2019 (COVID-19). J Obstet Gynaecol Can 2021; 44:193-195. [PMID: 34648956 PMCID: PMC8505022 DOI: 10.1016/j.jogc.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hypertension, proteinuria, and hepatic dysfunction have been described as manifestations of coronavirus disease 2019 (COVID-19) and are generally accepted as poor prognostic factors. However, these same findings can also occur in pregnant women with preeclampsia, thus creating a diagnostic challenge. CASE We report a case of COVID-19 infection in an otherwise healthy pregnant patient with secondary hypertension, proteinuria, and significant hepatic dysfunction. Maternal placental growth factor (PlGF) testing was used to rule out preeclampsia. The patient received supportive care and improved significantly. She went on to have a spontaneous vaginal term delivery of a healthy male baby. CONCLUSION COVID-19 infection in pregnancy may present as preeclampsia-like syndrome. PlGF testing can be used to differentiate preeclampsia from COVID-19 and facilitate appropriate management.
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Affiliation(s)
- Amir Naeh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON.
| | - Alexandra Berezowsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON
| | - Mark H Yudin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON
| | - Irfan A Dhalla
- Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, Toronto, ON
| | - Howard Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON
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Naeh A, Sigal E, Barda S, Hallak M, Gabbay-Benziv R. The association between congenital uterine anomalies and perinatal outcomes - does type of defect matters? J Matern Fetal Neonatal Med 2021; 35:7406-7411. [PMID: 34238096 DOI: 10.1080/14767058.2021.1949446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the association between congenital uterine anomalies (CUA) and adverse perinatal outcomes stratified by type of anomaly. METHODS A retrospective cohort study of all women delivered in one university-affiliated medical center between 2010 and 2017 with CUA. Multiple pregnancies and pregnancies complicated by fetal anomalies were excluded. Maternal and short-term neonatal outcomes were evaluated and compared between women with unification defects (unicornuate, bicornuate, or uterus didelphys), and canalization defects represented by septate uterus. Univariate analysis was utilized followed by multivariate analysis to adjust for confounders. p < .05 was considered significant. RESULTS Among 167 pregnancies with CUA, 92 (55.1%) had bicornuate uterus, 32 (19.1%) septate uterus, 26 (15.6%) didelphys uterus, and 17 (10.1%) unicornuate uterus. Maternal demographics and obstetric characteristics were similar between women with unification and canalization defects. The entire cohort had high rates of preterm delivery (PTD), malpresentation, and cesarean delivery (CD) (25.7%, 42.5%, and 63.5%, respectively). In comparison to unification defects, pregnancies in women with canalization defects (septate uterus), had increased risk for PTD <32 weeks (12.5% vs. 2.9%, p = .02), and placental abruption (12.5% vs. 3%, p = .02), however, a lower overall rate of CD (46.9% vs. 67.4%, p = .03). Following adjustment to confounders (age, BMI, nulliparity, chronic hypertension, and smoking) none of the results remained statistically significant. There were no differences in neonatal outcomes between the groups. CONCLUSIONS Overall, women with CUA have a high prevalence of adverse pregnancy outcomes. However, outcome does not differ by type of anomaly.
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Affiliation(s)
- Amir Naeh
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Affiliated to the Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel
| | - Emiliya Sigal
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Affiliated to the Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel
| | - Sivan Barda
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Affiliated to the Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Affiliated to the Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Affiliated to the Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel
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15
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Naeh A, Wilkof-Segev R, Jaffe A, Maor-Sagie E, Hallak M, Gabbay-Benziv R. Flat Oral Glucose Tolerance Test During Pregnancy: Maternal Characteristics and Risk for Adverse Outcomes. Clin Diabetes 2021; 39:313-319. [PMID: 34421208 PMCID: PMC8329013 DOI: 10.2337/cd20-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Flat oral glucose tolerance test (OGTT) curve is characterized by low glucose levels, seemingly nonresponsive to glucose load. Few studies have explored flat OGTT during pregnancy and have yielded conflicting results, some suggesting risk for fetal growth restriction. This study evaluated the characteristics and perinatal outcomes of women with a flat OGTT during pregnancy. We found that a flat OGTT curve occurs in younger, leaner pregnant women. Also, flat OGTT curve was significantly associated with a male fetus and higher levels of pregnancy-associated plasma protein A at the first-trimester screening. Although flat OGTT can possibly reflect some degree of hyperinsulinemia, it is generally not associated with adverse maternal or neonatal outcomes.
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Affiliation(s)
- Amir Naeh
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Renana Wilkof-Segev
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Anat Jaffe
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Esther Maor-Sagie
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Naeh A, Hantisteanu S, Meisel-Sharon S, Boyango I, Hallak M, Gabbay-Benziv R. The expression of heparanase in term and preterm human placentas. J Matern Fetal Neonatal Med 2021; 35:5840-5845. [PMID: 33691578 DOI: 10.1080/14767058.2021.1895743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Heparanase is an endo-β-glucuronidase that cleaves side chains of heparan-sulfate proteoglycans, an integral constituent of the extra cellular matrix. The abundance of heparanase in placental trophoblast cells implies its role in the processes of placentation and trophoblast invasion. This study aims to explore the involvement of heparanase in parturition and preterm deliveries (PTD). METHODS Sixteen human placentas were collected following singleton spontaneous onset term vaginal deliveries (n = 6), spontaneous onset preterm vaginal deliveries (n = 7) and term elective cesarean sections (n = 3). Placentas were excluded in case of any maternal chronic illness, pregnancy or delivery complications apart from PTD. Placental tissue samples were dissected, homogenized and proteins were extracted. Additionally, cryosections were prepared from the placental tissues. Heparanase expression was evaluated utilizing western blot analysis and immunofluorescence staining using heparanase specific antibodies. Heparanase expression was compared between the study groups qualitatively and quantitatively. RESULTS Western blot analysis results demonstrated higher expression of both pro-heparanase and heparanase in PTD placentas compared to term vaginal placentas. Accordingly, immunofluorescence staining shows elevated heparanase expression in PTD placentas compared to term vaginal placentas (5.1 ± 0.92 vs. 1.2 ± 0.18, p < .005). Expression level of heparanase was higher in term cesarean section placentas as compared to term vaginal deliveries placentas, but did not reach statistical significance (1.8 ± 0.39 vs. 1.2 ± 0.18, p = .06). CONCLUSION This study demonstrates for the first time that preterm vaginal deliveries are associated with higher expression of heparanase in placental tissue. This may imply a direct effect of heparanase on preterm labor. Further studies should evaluate the functional role by which heparanase influence preterm delivery.
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Affiliation(s)
- Amir Naeh
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynecology, The Hillel Yaffe Medical Center, Hadera, Israel, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shay Hantisteanu
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynecology, The Hillel Yaffe Medical Center, Hadera, Israel, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shilhav Meisel-Sharon
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynecology, The Hillel Yaffe Medical Center, Hadera, Israel, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ilanit Boyango
- Cancer and Vascular Biology Research Center, The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mordechai Hallak
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynecology, The Hillel Yaffe Medical Center, Hadera, Israel, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Rinat Gabbay-Benziv
- Laboratory for Reproductive Immunology, Department of Obstetrics and Gynecology, The Hillel Yaffe Medical Center, Hadera, Israel, The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Naeh A, Hallak M, Gabbay-Benziv R. 378 Age, parity and interval from previous delivery – influence on perinatal outcome. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Naeh A, Sigal E, Barda S, Hallak M, Gabbay-Benziv R. 379 The association between congenital uterine anomalies and perinatal outcomes – canalization vs. unification defects. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wilkof-Segev R, Naeh A, Hallak M, Gabbay-Benziv R. 368 Predictors and adverse outcome of uterine extension at the time of cesarean delivery. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Naeh A, Bruchim I, Hallak M, Gabbay-Benziv R. Endometriosis-related Hemoperitoneum in Late Pregnancy. Isr Med Assoc J 2019; 21:557-559. [PMID: 31474021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Amir Naeh
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ilan Bruchim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Shrem G, Egozi T, Naeh A, Hallak M, Walfisch A. Pre-cesarean Staphylococcus aureus nasal screening and decolonization: a prospective randomized controlled trial. J Matern Fetal Neonatal Med 2016; 29:3906-11. [PMID: 26857727 DOI: 10.3109/14767058.2016.1152243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Staphylococcus aureus (S. aureus) is a common pathogen in surgical site infections (SSIs). Mupirocin ointment is an effective treatment for nasal carriers. We aimed to investigate whether screening for nasal colonization of S. aureus and treating carriers prior to a cesarean section (CS) decreases the likelihood of SSI. METHODS This is a randomized controlled trial. All participants underwent nasal culture prior to the CS. Nasal carriers of S. aureus were treated with Mupirocin ointment according to a standardized protocol. In the control group, nasal cultures were obtained immediately prior to surgery and carriers were not treated. RESULTS We recruited 568 patients. Demographic characteristics were comparable between the groups. S. aureus nasal colonization rates were 20.1% and 14.9% in the intervention and control groups, respectively (p = 0.12). S. aureus eradication rate with Mupirocin treatment was 88%. SSI rates were similar in the intervention and control groups (13.1% versus 12.1%, respectively, p = 0.78) and in treated carriers, untreated carriers, and non-carriers (7.4% versus 13.0% versus 13.1%, respectively, p = 0.69). Previous CS was the only factor found to independently predict SSI (OR 2.5, CI 1.09-5.65 p = 0.029). CONCLUSION Pre-cesarean screening for nasal S. aureus carriage and decolonization does not appear to be an effective intervention in reducing SSI rates.
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Affiliation(s)
- Guy Shrem
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and
| | - Tomer Egozi
- b The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Amir Naeh
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and
| | - Mordechai Hallak
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and.,b The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Asnat Walfisch
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and.,b The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
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Egozi T, Shrem G, Naeh A, Hallak M, Walfisch A. 398: Nasal carriage of Staphylococcus aureus in patients undergoing cesarean section and surgical site infection: a prospective randomized trial. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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